PURPOSE:To evaluate the effectiveness of test spectacle lens in slowing myopia progression as compared to single vision (SV) spectacle (SPL). DESIGN:Cross-over trial. SUBJECTS:120 children aged 6-12 yrs, cycloplegic spherical equivalent (SE) of -0.75D to -5.00D. INTERVENTION:Enrolled participants were randomly assigned to wear either SV or test SPL (n = 60 each group). The test SPL incorporates a central clear zone and four annular cylindrical rings in the paracentral zone with a mean surface power of + 4.00D. For first six months (stage I), children wore their assigned lenses and then crossed over to wear the other lens for the second six months (stage II). OUTCOMES:Six- monthly changes in SE and AL from baseline presented as mean and 95% confidence intervals (CIs). Differences between groups were assessed using multiple linear regression, adjusting for confounders. To determine potential rebound effect, progression with SV during stage II was compared to progression with SV in stage I. RESULTS:Myopia progression was significantly slower with test SPL during both stages. During stage I, the difference in progression (Δ) between test SPL and SV were 0.32D (0.21, 0.43) and 0.12 mm (0.09，0.16) (P < 0.001). During stage II, myopia progressed slower by 0.25D (0.15, 0.36) and 0.11 mm (0.07, 0.14) (P < 0.001) with test SPL. Progression with SV during stage I and stage II did not differ significantly (SE: -0.42 ± 0.31D vs -0.51 ± 0.30D, p = 0.119; AL: 0.19 ± 0.11 mm vs 0.22 ± 011 mm, P = 0.182). CONCLUSIONS:Test spectacles significantly slow myopia in majority of eyes in 6 months and no statistically significant rebound signal was detected during the observation period.
Purpose To develop and evaluate a multimodal foundation-model-assisted system for differentiating primary open-angle glaucoma (POAG) from non-glaucoma in highly myopic eyes and assessing whether artificial intelligence (AI) assistance changes ophthalmologist diagnostic performance. Design Retrospective diagnostic model-development study with internal validation and paired sequential multi-reader evaluation. Participants Model development used 603 eye-level cases (502 POAG, 101 non-glaucoma); a fixed 150-case set from 149 patients was used for internal test reporting and the paired reader evaluation. Methods A RETFound-based multimodal classifier used color fundus photographs, optical coherence tomography (OCT) images, and 24 structured OCT/retinal nerve fiber layer (RNFL) variables. Six ophthalmologists reviewed each case without and then with AI assistance after a washout interval. Main Outcome Measures Model area under the receiver operating characteristic curve (AUC); reader sensitivity, specificity, accuracy, F1 score, confidence, reading time, diagnostic switching, and inter-reader agreement. Results The final multimodal model achieved an AUC of 0.911 (95% confidence interval [CI], 0.862-0.950) on the fixed 150-case set. In the sequential paired evaluation, unaided versus AI-assisted mean sensitivity was 68.0% versus 75.3%, accuracy was 74.2% versus 79.6%, F1 score was 0.790 versus 0.844, and mean specificity was 91.3% in both phases; Fleiss kappa was 0.583 versus 0.709. Reader-level diagnostic differences were not significant after multiplicity adjustment and were exploratory. Conclusions In this internal retrospective study, the AI-assisted phase showed numerically higher mean sensitivity, accuracy, confidence, and inter-reader agreement than the unaided phase, with unchanged mean specificity. Reader-level diagnostic differences were not statistically significant after multiplicity adjustment and should be considered exploratory. Prospective multicenter validation is required before clinical deployment.
PURPOSE:To evaluate dispensing trends of publicly funded glaucoma medications in New Zealand from 2012 to 2021, and to assess disparities in prescribing across demographic groups. This study provides population-level insights into real-world glaucoma care and treatment equity in a universal healthcare setting. In New Zealand, although limited information exists on prescribing practices, there has been no comprehensive analysis of national dispensing data. This distinction is critical, as dispensing data more accurately reflect medication access, patient uptake, and treatment adherence than prescribing data alone. METHODS:A retrospective observational study was conducted using de-identified national pharmacy dispensing data from the New Zealand Ministry of Health. Dispensing trends for eleven glaucoma medications were analysed by year, medication, sex, and self-identified ethnicity. Age-adjusted per capita dispensing rates were compared using ANOVA with post-hoc analysis. RESULTS:Over 3 million glaucoma prescriptions were dispensed, representing 27.6% of all ocular medications. The number of treated individuals rose from 39,725 in 2012-50,048 in 2021 (a 25.9% increase), outpacing national population growth. The prevalence of pharmacologically treated glaucoma or ocular hypertension increased from 0.90% in 2012-0.98% in 2021. The annual incidence of newly treated glaucoma was estimated at 125 per 100,000 people per year. Latanoprost was the most frequently dispensed glaucoma medication (40%), followed by timolol (13%) and bimatoprost (11%). Disparities in dispensing patterns were evident. Europeans received 87% of glaucoma prescriptions, Māori and Pasifika peoples, who represent 17.8% and 8.9% of the population, received only 1.9% and 1.4% of glaucoma prescriptions, respectively (p < 0.001), even after adjusting for age. CONCLUSION:This nationwide study provides the most comprehensive analysis to date of glaucoma medication dispensing in Aotearoa New Zealand, capturing real-world treatment patterns across a ten-year period. It offers critical insight into the treated prevalence and incidence of pharmacologically treated glaucoma and ocular hypertension at a population level. Latanoprost has clearly emerged as the dominant first-line therapy, consistent with international clinical guidelines, followed by Timolol. However, the findings also expose significant inequities: Māori-the Indigenous people of New Zealand-and Pasifika populations remain markedly under-represented among those receiving glaucoma treatment, even after adjusting for age. Further research is needed to understand the underlying reasons for these disparities and to ensure equitable access to glaucoma care for all New Zealanders.
PURPOSE:To build a visual question answering (VQA) dataset for fine-tuning and evaluating vision-language models (VLMs) in myopic maculopathy (MM). DESIGN:Cross-sectional study. METHODS:Colour fundus photographs (CFPs) from two publicly available datasets were graded using META-PM classification system. GPT-5 was used to generate clinical captions, true/false [TFQ] and open-ended [OEQ] question-answer pairs, all of which were manually verified. InternVL3-8B was fine-tuned on this dataset and evaluated against Gemini 3 Pro, Claude Sonnet 4.5, Qwen3-VL-30B-A3B-Instruct, and pre-trained InternVL3-8B. OEQ responses was evaluated by GPT-5 using a three-level scoring system (0, completely incorrect; 0.5, partially correct; 1, fully correct) and summarized as weighted accuracy. Overall accuracy was defined as the arithmetic mean of the TFQ and OEQ accuracies. RESULTS:MM-VQA comprises 2591 CFPs and 19,648 question-answer pairs. Fine-tuned InternVL3-8B model achieved an overall accuracy of 0.746, surpassing Claude Sonnet 4.5 (0.596), Qwen3-VL-30B-A3B-Instruct (0.566), and pre-trained InternVL3-8B (0.428) (all P < 0.001), while showing no significant difference compared with Gemini 3 Pro (0.724, P = 0.642). For TFQ, the fine-tuned model reached an accuracy of 0.919, outperforming Gemini 3 Pro (0.881), Qwen3-VL-30B-A3B-Instruct (0.834), Claude Sonnet 4.5 (0.796), and the pre-trained model (0.696) (all P < 0.001). On OEQ, it also ranked highest (0.572), outperforming Gemini 3 Pro (0.567, P = 0.044), Claude Sonnet 4.5 (0.395, P < 0.001), Qwen3-VL-30B-A3B-Instruct (0.297, P < 0.001) and the pre-trained model (0.160, P < 0.001). CONCLUSION:This study provides a valuable VQA dataset for MM, supporting the development of disease-specialised VLMs in ophthalmology.
PURPOSE:To investigate the effect of cataracts on a deep learning (DL) model for cardiovascular disease (CVD) risk prediction. METHODS:This retrospective, dual-cohort study analyzed fundus images at baseline, 1, and 6-months post-cataract surgery from a longitudinal cohort (patients who underwent cataract surgery at Hanyang University Guri Hospital [HUGH]) and a cross-sectional replication cohort (Singapore Epidemiology of Eye Diseases [SEED] study). CVD risk scores were generated using an artificial intelligence (AI) software (Dr.Noon CVD). Longitudinal changes were evaluated using a generalized estimating equation (GEE) model. The association between CVD scores and cataract surgery was also assessed in the SEED study using multivariable linear regression. Subgroup analyses were performed based on diabetic retinopathy (DR) status. RESULTS:In the longitudinal cohort, Dr. Noon CVD scores significantly increased from baseline after cataract surgery at 1 month (β = +2.14; 95% CI, 1.28-3.01; P < 0.001) and 6 months (β = +1.69; 95% CI, 0.82-2.56; P < 0.001). A significant interaction with DR was observed, showing substantially larger score increases at 1 month (interaction β = +3.02; 95% CI, 1.20-4.85; P = 0.001) and 6 months (interaction β = +4.78; 95% CI, 2.99-6.56, P < 0.001). These findings were partially replicated in the SEED cohort, where pseudophakia was significantly associated with a higher CVD score compared to phakic eyes (β = +2.60; 95% CI, 1.71-3.49, P < 0.001); however, the interaction between cataract surgery and DR status was not formally significant in SEED (P = 0.451). CONCLUSIONS:Cataract-induced media opacity is associated with significant attenuation of DL-derived CVD risk scores, particularly in eyes with DR. This score shift following improvement in optical clarity highlights the critical need to account for lens status when interpreting fundus-based AI prediction models.
PURPOSE:To evaluate the visual preservation, safety, and surgical outcomes of phacogoniotomy (phacoemulsification combined with or without goniosynechialysis and goniotomy) in patients with end-stage glaucoma. METHODS:This multicenter retrospective study included 134 eyes of 128 patients (92 primary angle-closure glaucoma [PACG] and 42 primary open-angle glaucoma [POAG]) with end-stage glaucoma (defined as inability to perform perimetry or visual acuity ≤ 20/200). Patients underwent phacogoniotomy and were followed ≥ 12 months. Main outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), medication burden, and complications, with specific attention to the "wipe-out" phenomenon. RESULTS:At a mean follow-up of 19.2 ± 8.0 months, no cases of "wipe-out" (sudden, immediate, irreversible central vision loss) occurred. BCVA improved in 63.1% of eyes and remained stable in 30.3%. The mean IOP decreased significantly from 31.4 ± 9.7 mm Hg to 14.1 ± 3.3 mm Hg (P < 0.001) and mean number of medications dropped from 2.2 ± 1.4-0.6 ± 1.0 (P < 0.001). Complete success rate was 67.9% overall, with 76.1% for PACG and 50.0% for POAG (P = 0.005). Qualified success rate was 97.0% overall, with 96.7% for PACG and 97.6% for POAG (P = 0.695). The most common complications were transient hyphema (11.2%) and IOP spike (3.7%). CONCLUSIONS:In end-stage glaucoma, phacogoniotomy is a safe and effective procedure that significantly lowers IOP while preserving or improving vision in > 90% of cases. The procedure may reduce the risk of "wipe-out" associated with traditional filtration surgery and appears particularly effective in eyes with angle-closure mechanisms.
Bietti crystalline corneoretinal dystrophy (BCD), a rare autosomal recessive retinal degenerative disease caused by cytochrome P450 family 4 subfamily V member 2 (CYP4V2) mutations, leads to progressive vision loss and blindness and exhibits a high prevalence in East Asia. Adeno-associated virus (AAV)-mediated gene replacement therapy has emerged as the most promising therapeutic strategy for BCD, considering its success in monogenic retinal diseases and unique advantages for retinal delivery. This review provides valuable insights into the translational journey of BCD gene therapy to accelerate research progress, facilitate the sharing of resources and expertise, and overcome the complex challenges associated with the development of therapies for rare diseases. It also offers a comprehensive overview of the current progress and future prospects of ZVS101e and provides a valuable resource to researchers, clinicians, and patients interested in the development of gene therapy for inherited retinal diseases. Additionally, it highlights the translational potential of AAV-based therapy in addressing unmet medical needs, such as BCD, and emphasizes the crucial role of industry-university-research collaboration in driving innovative therapies from the laboratory to clinical practice. Potential use of suprachoroidal space injection to deliver the gene materials in treating BCD is also discussed.
Geographic atrophy (GA), the advanced stage of dry age-related macular degeneration, has transitioned from an untreatable condition to a field of active therapeutic development. This review outlines the key molecular pathways driving GA progression, including complement system dysregulation, oxidative stress, and chronic inflammation. A marked important therapeutic milestone with the first FDA approvals of complement inhibitors, Pegcetacoplan and Avacincaptad pegol, demonstrated a modest but statistically significant slowing of lesion growth. However, these anatomic benefits have not consistently translated into meaningful functional visual improvement, underscoring the need for additional therapeutic strategies. Beyond complement, the therapeutic landscape is rapidly expanding to include oral agents, topical therapies, implant-based delivery systems, subcutaneous injections, and device-based approaches targeting oxidative stress, neuroprotection, mitochondrial dysfunction, lipid metabolism and proteostasis. Emerging modalities, including gene therapy, stem cell-based repair, and bioelectronic implants, aim to move beyond disease slowing toward durable retinal restoration. Despite progress, significant unmet needs persist. Key challenges include treatment burden associated with frequent intravitreal injections, safety considerations, and the persistent disconnect between anatomic endpoints and functional outcomes. These underscore the necessity for future treatments that not only alter disease anatomy but also effectively preserve patients' vision and improve their quality of life.
PURPOSE:This study aims to investigate retinal structure and vessel density (VD) alterations in the macular and optic nerve head (ONH) regions of patients with dysthyroid optic neuropathy (DON), and to assess their correlation with visual function. METHODS:A total of 133 thyroid eye disease (TED) patients (63 with DON and 70 without DON) and 24 healthy controls were enrolled. Retinal structural and vascular parameters were quantified using optical coherence tomography angiography (OCTA) in the macular (6 × 6 mm) and ONH (4 × 4 mm) regions. Visual function in TED patients was assessed by best corrected visual acuity (BCVA), visual field (VF), and visual evoked potentials. The diagnostic performance of OCTA parameters for identifying DON was evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS:Compared with the non-DON patients, those with DON exhibited significantly decreased retinal VD in both macular and ONH regions, accompanied by thinner macular retina. The most pronounced changes were observed in macular whole retinal layer (WRL) and superficial retinal layer VD (P < 0.001). Both retinal VD and thickness correlated positively with BCVA and VF mean deviation. Furthermore, the macular WRL-VD demonstrated the highest diagnostic performance for DON (AUC = 0.833) and the combination parameters further improved accuracy (AUC = 0.861). CONCLUSIONS:OCTA reveals retinal microvascular and structural alterations in DON and may serve as a simple, precise, and noninvasive tool for early detection and clinical management to prevent irreversible visual loss.
OBJECTIVE:To compare the accuracy of sixteen intraocular lens (IOL) power calculation formulas incorporating targeted adjustments or regression-based modifications of axial length (AL) in eyes longer than 26.00 mm. DESIGN:Retrospective observational study. METHODS:The data of myopic patients with cataract who underwent uneventful phacoemulsification with in-the-bag implantation of a PARTIAL-RoF narrow IOL between January 2020 and June 2025 were reviewed. Preoperative IOL power was calculated using the IOLMaster 700 with six formulas: Barrett Universal II (BU II), Haigis, Hoffer Q, Holladay 1, Holladay 2, and SRK/T. The implanted IOL power was selected from BU II or SRK/T recommendations. Refraction was measured three months postoperatively. Postoperative IOL power predictions were generated using the following formulas or formula variants: K6, PEARL-DGS, Castrop, Eom, VRF CMAL; Holladay 1 with Wang-Koch 2 center optimization (WK2), modified Wang-Koch (MWK), non-linear regression (NLR), and Fam-adjusted method (F2); SRK/T WK2, SRK/T MWK, SRK/T F2; Holladay 2 NLR; Hoffer Q WK2; Haigis WK2; and Barrett True AL. The primary outcome measures were root mean square absolute error (RMSAE) and the percentage of eyes with prediction error (PE) within ± 0.25 D, ± 0.50 D, ± 0.75 D, and ± 1.00 D. RESULTS:One hundred sixty-four eyes with ALs ranging from 26.04 mm to 29.72 mm were included. RMSAE values across the sixteen formulas ranged from 0.393 (Holladay 1 NLR and SRK/T WK2) to 0.803 (Haigis WK2). The percentage of eyes with PE within ±0.50 D ranged from 35.98% (Haigis WK2) to 81.1% (Holladay 1 NLR). Holladay 1 NLR-followed by SRK/T WK2, Holladay 1 MWK, VRF CMAL, PEARL-DGS, and Eom-demonstrated significantly higher accuracy than most other formulas. Haigis WK2 and Hoffer Q WK2 were the least accurate. CONCLUSIONS:Certain modified third-generation formulas (Holladay 1 NLR, SRK/T WK2) achieve accuracy comparable to that of new-generation formulas (PEARL-DGS, K6, VRF CMAL) in IOL power calculations for long eyes. However, some third- and fourth-generation formulas-even after AL-based modification (Hoffer Q WK2, Haigis WK2)-continue to yield suboptimal results in this anatomical range.
Proliferative vitreoretinopathy (PVR) remains a major barrier in vitreoretinal surgery, being the leading cause of recurrent retinal detachment and surgical failure. PVR arises from abnormal wound healing, involving epithelial-mesenchymal transition (EMT) of retinal pigment epithelial cells, hyalocytes trans-differentiation into myofibroblasts, and dysregulated interactions among cytokines, growth factors, and chemokines. These lead to extracellular matrix remodeling and contractile membrane formation. Recent advancements have deepened insight into disease mechanisms and supported preclinical testing of therapies. Despite surgical progress, adjunctive treatments such as corticosteroids, antimetabolites, retinoids, and biologics show limited and inconsistent benefits in clinical trials. Emerging tools like proteomic biomarkers and advanced imaging offer promise for early risk detection and personalized care. However, major challenges remain in understanding disease complexity and improving tailored treatment outcomes. This review emphasizes the urgent need for targeted molecular therapies. Bridging basic science with clinical innovation will be key to advancing PVR management and preserving vision.
Abducens nerve palsy is the most common ocular motor neuropathy, with a population-based annual incidence of approximately 4.7-11.3 per 100,000. It classically manifests as esotropia, horizontal diplopia, abduction deficit and compensatory head turn. Management follows a stepwise approach: immediate evaluation and treatment of underlying causes, followed by nonsurgical interventions, and surgical correction if misalignment persists beyond six months. However, various etiologies make it challenging to accurately diagnose and manage abducens nerve palsy in a cost-effective way. Controversies persist regarding the optimal timing of neuroimaging, the utility of botulinum toxin injection, and the selection of surgical procedures for partial versus complete palsy. To address these controversies and standardize the care, the Asia-Pacific Strabismus and Pediatric Ophthalmology Society (APSPOS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) convened an expert panel of 21 experts from 12 countries/territories to discuss and vote on key consensus statements covering the evaluation and diagnosis, non-surgical management, and surgical management of abducens nerve palsy. 17 consensus statements were discussed, with 16 (94.12%) statements achieved ≥ 75% agreement. These statements can provide a practical, etiology-based algorithm to guide diagnosis and management of abducens nerve palsy.
PURPOSE:To determine predictive factors for fluid-free retina and complete polypoidal choroidal vasculopathy (PCV) regression following 1-year aflibercept monotherapy in PCV. METHODS:Multicenter, retrospective cohort of treatment-naïve PCV eyes receiving 2-mg aflibercept treatments for 1 year from 2015 to 2018 collected demographic data, de-identified fundus photography, optical coherence tomography (OCT), and indocyanine green angiography (ICGA) images at baseline and 1-year of study eyes were graded to identify baseline features and outcomes. RESULTS:Of 100 study eyes, mean age [SD] was 63.8 [8] years; 100% were Thai patients. At 1 year, eighty-five eyes (85%) had fluid-free retina; 48 eyes (48%) had complete polypoidal regression. Multivariate analyses showed baseline OCT and ICGA features associated with 1-year outcomes: sharply-peaked PED with/without double-layer sign on OCT and smaller lesion size on ICGA (<1 disc diameter) were associated with fluid-free retina (OR 6.57; 95%CI 1.27-34.10, and OR 7.86; 95%CI 1.33-46.54, respectively). Multilobulated PED on OCT was associated with poor (20/200 or worse) final VA (OR 4.53; 95%CI 1.33-15.36). Smaller number (1-5) of polypoidal lesions on ICGA was associated with complete polypoidal regression (OR 4.87; 95%CI 1.44-16.43) CONCLUSION: Results suggest baseline OCT and ICGA features could predict fluid-free retina and complete polypoidal regression following aflibercept monotherapy.
Goniotomy (GT) or ab interno trabeculotomy facilitates aqueous humor drainage thereby resulting intraocular pressure (IOP) reduction by incising the trabecular meshwork and the inner wall of Schlemm's canal. It can be performed alone or combined with cataract surgery, a procedure known as phacogoniotomy. As these procedures can be performed with non-device built instruments compared to other minimally invasive glaucoma surgery (MIGS) devices or procedures, they are increasingly adopted in low- and middle-income countries (LMICs) and primary-level hospitals. To summarize the clinical use and future directions of GT and phacogoniotomy, we conducted a comprehensive literature review by searching PubMed. The available evidence suggests that GT and phacogoniotomy are effective and safe procedures, providing a widely adopted surgical option applicable to glaucoma patients of all ages.
PURPOSE:To investigate the effect of switching to faricimab therapy patients with neovascular age-related macular degeneration currently treated with anti-VEGF therapy. DESIGN:Phase IV, prospective, single-arm, open-label, multi-center, investigator-initiated clinical trial. METHODS:Eligible eyes received four initial doses of faricimab 6 mg/0.05 mL every 4-weeks. From week 12, dosing intervals were increased to eight weeks and then modified according to a treat-and-extend based regimen. This interim analysis reports changes in best-corrected visual acuity (BCVA), central subfield thickness (CST), retinal fluid proportions, and the incidence of adverse events from baseline through to week 24. RESULTS:One-hundred-and-two patients of mean age 76.0 years were recruited from 12 sites across Australia and Singapore. Baseline BCVA was 72 Early Treatment Diabetic Retinopathy Study letters and baseline CST was 384 µm. Seventy-two percent of eyes were being treated with aflibercept 2 mg and 28% with ranibizumab. After switching to faricimab, mean BCVA change was + 1.9 letters at week 12 (P < 0.001), and + 1.9 letters at week 24 (P < 0.001). Mean CST change was -83.9 µm at week 12 (P < 0.001), and -82.2 µm at week 24 (P < 0.001). The proportion of eyes with fluid resolution was 54% at week 12, and 59% at week 24. The proportion of eyes assigned to 4-weekly, 8-weekly, and 12-weekly treatment intervals were 16%, 35% and 49% respectively at week 24. Anterior chamber inflammation occurred in one eye with no cases of vasculitis or occlusive retinitis. CONCLUSIONS:In this pre-specified interim analysis of a prospective study, patients switching to faricimab experienced improved anatomic outcomes and maintained visual function, with a large proportion assigned extended dosing intervals under a flexible treatment regimen. TRIAL REGISTRATION NUMBER:ACTRN12623000215628.
