PURPOSE OF REVIEW:Recent advances in large language models (LLMs) have given rise to 'vibe coding', a conversational approach to software development in which users describe desired functionality in natural language and collaborate with an LLM agent to generate functional code. This review examines vibe coding through an ophthalmology-specific lens, identifying where it adds value and how it can be used responsibly. RECENT FINDINGS:Vibe coding platforms now enable nonprogrammers to create fully functional applications, including user authentication and database integration, from natural language prompts alone. In ophthalmology, clinicians may apply this approach to build clinical workflow, research and medical education tools. These applications are most effective when directed at niche, subspecialty-specific problems that are too small or too specialized to attract commercial development. SUMMARY:Vibe coding provides ophthalmologists with a pragmatic pathway to translate unmet needs into executable prototypes. For low-risk applications that do not directly influence clinical decision-making, clinicians may in certain settings be able to deploy vibe-coded tools independently. For higher risk applications, vibe coding does not replace professional software development, but it enables experimentation, clarifies user needs, and makes ideas more tangible. With appropriate guardrails, vibe coding can accelerate clinician-led innovation while preserving safety and accountability.
PURPOSE OF REVIEW:This review surveys recent advances in artificial intelligence-guided small molecule discovery and gene therapy, with a focus on generative and foundation models, and their translational applications to ophthalmic therapeutics. RECENT FINDINGS:A unifying theme across recent work is the shift from artificial intelligence as a screening tool to artificial intelligence as an engine for generative design. In small molecule discovery, reinforcement learning and diffusion-based generative models are producing structurally novel candidates for ophthalmic indications with demonstrated preclinical efficacy, while structure-based approaches leveraging AlphaFold and co-folding models are improving target identification and virtual screening. In gene therapy, artificial intelligence-guided AAV capsid engineering has yielded vectors with improved retinal transduction efficiency in nonhuman primates. Complementing this, deep learning models trained on chromatin accessibility data are enabling de novo design of compact, cell-type-specific regulatory elements, with direct implications for the specificity and payload capacity of ocular gene therapy vectors. Artificial intelligence-guided CRISPR guide RNA optimization is further expanding the precision of gene editing-based approaches. SUMMARY:Artificial intelligence tools may influence the landscape of ophthalmic drug discovery, from nominating small molecule candidates to co-designing next-generation gene therapy vectors. Rigorous experimental validation remains essential; artificial intelligence-nominated candidates and predictions must be tested empirically to confirm their safety, biological relevance, and therapeutic efficacy.
Purpose of review Corticosteroid-sparing immunosuppression is standard for chronic noninfectious uveitis, yet its long-term safety remains a dominant clinical concern. We synthesize the contemporary evidence on long-term safety, common adverse effects that drive treatment discontinuation, and how those effects are managed across various medication classes. Recent findings The largest cohort data show no statistically significant excess in overall or cancer mortality for antimetabolites, calcineurin inhibitors, or antitumor necrosis factor agents, whereas alkylating agents remain the principal malignancy concern. Discontinuation for toxicity is modest across classes and is usually driven by reversible, organ-specific effects: most often gastrointestinal intolerance for antimetabolites, nephrotoxicity for calcineurin inhibitors, and cytopenia for alkylating agents. Long-term data led by a 7-year adalimumab extension showed no new safety signals, with infection and tuberculosis reactivation as the main risks of tumor necrosis factor blockade. Summary Steroid-sparing agents appear to have excellent long-term safety when the agent is matched to disease severity and patients are screened and monitored proactively. The safest agent is the one whose specific toxicity is anticipated and managed.
Purpose of review To evaluate which imaging biomarkers in uveitis have approached clinical utility, which remain incompletely validated, and how consensus frameworks and artificial intelligence are reshaping the path toward standardized, decision-useful assessment. Recent findings Quantitative optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) metrics have gained disease-specific precision. Anterior segment OCT particle-size analysis differentiates inflammatory cells from pigment with high discriminative performance. OCTA vessel density tracks chronic microvascular loss in birdshot chorioretinopathy more reliably than it captures real-time inflammatory activity. Choroidal vascularity index shows promise as a subclinical choroidal marker, though cross-platform standardization remains unresolved. The multimodal uveitis (MUV) international taskforce has established consensus minimal imaging sets for five white dot syndromes, providing the first systematic effort to define which modality is essential for diagnosis, activity monitoring, and complication detection in specific entities. Artificial intelligence applications have demonstrated proof-of-concept performance, but translation is constrained by small datasets and absent prospective validation. Summary Most proposed imaging biomarkers remain disease-specific and incompletely validated. Recent quantitative approaches and international consensus frameworks may narrow the gap between descriptive imaging and actionable, trial-ready biomarkers. The bottleneck has shifted from image acquisition to validation, harmonization, and integration with clinical outcomes.
PURPOSE:Laser in-situ keratomileusis (LASIK Xtra), photorefractive keratectomy (PRK Xtra) and small-incision lenticule extraction (SMILE Xtra) are procedures currently performed worldwide. This review analyses recent literature (2020-2025) on corneal refractive surgery combined with simultaneous corneal crosslinking (CXL) (LASIK Xtra, PRK Xtra and SMILE Xtra) to determine its overall safety and efficacy. METHODS:A comprehensive literature search of various electronic databases (PubMed, PubMed Central and MEDLINE) was performed up to 30 December 2025 and articles in English pertaining to clinical outcomes of LASIK Xtra, PRK Xtra and SMILE Xtra published between 2020 to 2025 were included. Overall results including efficacy and safety were evaluated. Efficacy and safety indices are calculated where possible. RESULTS:Ten relevant studies were found for LASIK Xtra, 3 for PRK Xtra and 8 for SMILE Xtra. Current studies show that refractive surgery and simultaneous CXL produces comparable results in terms of refractive and keratometric stability to refractive surgery alone. Studies that performed LASIK Xtra, PRK Xtra and SMILE Xtra procedures in susceptible eyes showed no cases of postoperative keratectasia. Studies evaluating corneal biomechanical properties showed that LASIK Xtra, PRK Xtra and SMILE Xtra conferred some biomechanical advantages. CONCLUSIONS:Simultaneous accelerated cross-linking and laser vision correction is both safe and effective for the treatment of myopia. No cases of postoperative keratectasia was reported in studies where these procedures were performed in susceptible eyes, indicating a certain biomechanical advantage conferred.
Purpose of review Traumatic macular holes (TMH) represent a distinct subset of macular holes arising from ocular trauma. This review examines controversies in TMH management: whether and when to operate, how to interpret OCT biomarkers as prognostic guides, special considerations in the pediatric population, and the role of emerging surgical and pharmacologic alternatives. Recent findings Minimum hole diameter and the presence of intraretinal cysts appears to reliably stratify eyes by likelihood of spontaneous closure. Pediatric TMH generally demonstrates high spontaneous closure rates. Vitrectomy with ILM peeling achieves high anatomical closure rates; while earlier surgery has been associated with better visual outcomes in observational data, this association is likely confounded by the tendency to observe longer in eyes with more extensive comorbidities and poorer baseline prognosis. Topical treatment is an option, and adjuvant maneuvers and plugging material can be considered during vitrectomy for refractory or TMHs at high risk for nonclosure. Summary The association between earlier surgery and better visual outcomes in the literature requires careful interpretation due to case-mix confounding. A systematic, optical coherence tomography-guided approach integrating hole characteristics, patient age, and associated ocular injuries allows individualized management of TMH. Continued refinement of surgical techniques is promising for large and refractory holes.
Purpose of review Ophthalmology has emerged as the proving ground for medical artificial intelligence (AI) because of its imaging-centric workflows, standardized data acquisition, and well defined clinical endpoints. Recently, the field has started transitioning from narrowly trained, task-specific algorithms toward multimodal models that are trained on large datasets and can be adapted to many tasks. These models may integrate information from images, text, and clinical data and are increasingly trialed in real-world settings. This review examines recent advances and ongoing controversies in the use of AI as a basic science, translational, and clinical research tool in ophthalmology. Recent findings Recent literature highlights the growing role of self-supervised and foundation models for scalable phenotyping, biomarker discovery, and cross-task generalization, particularly in retinal imaging and optical coherence tomography (OCT). In parallel, large-scale clinical deployments, including cloud-based OCT platforms and autonomous diabetic retinopathy screening, demonstrate clinical impact while revealing persistent challenges related to workflow integration and patient generalizability. Regulatory and ethics-focused studies underscore increasing attention to validation rigor, bias, and postdeployment monitoring, exposing heterogeneity in research standards and physician practices. Summary Ophthalmic AI is maturing toward real-world clinical implementation. Future progress will depend less on performance gains alone and more on clinical alignment, rigorous validation, equity-aware evaluation, and postdeployment surveillance, alongside continued investment in basic science to advance disease understanding and inform robust, generalizable model development.
Purpose of review To provide updates on modern refractive procedures including benefits, risks, costs, and clinical considerations. Recent findings Refractive surgery demonstrates excellent safety and efficacy in appropriately selected patients. Recent studies demonstrate differences between cornea- and lens-based procedures in postoperative visual recovery, refractive predictability, ocular surface impact, side effect profiles, enhancement strategies, and cost-efficiency. These distinctions highlight the importance of careful patient selection and screening across the wide range of refractive treatment options to maximize visual function and satisfaction. Summary Modern refractive surgery includes effective treatment options without a one-size-fits-all approach. Understanding the nuances between procedures is critical for clinical decision-making and matching the “best” treatment option to each patient.
Purpose of review This review focuses on the use in patients with keratoconus, of corneal allogeneic intrastromal ring segments (CAIRS) as well as customized and custom shaped CAIRS for corneal reshaping, stabilization and individualized, tissue-based corneal contouring, while delaying or avoiding keratoplasty. Recent findings CAIRS is being widely used in advanced cases of keratoconus, as biological replacement for synthetic intra-corneal ring segments and to prevent the need for keratoplasty. It is also being adopted in early disease in combination with corneal cross-linking. Various techniques and modifications are described as well as its use in different situations. Femtosecond and double bladed trephined CAIRS are discussed, including recent unpublished data demonstrating comparable dimensional accuracy with both. Double bladed trephines may also offer potential for greater segment thickness and customization. Summary CAIRS is evolving into a customizable corneal contouring approach that may complement and potentially reduce reliance on, existing treatment modalities. When combined with corneal cross-linking, it offers both biomechanical stabilization and visual rehabilitation. Future advances are likely to center on data-driven personalization tailored to each patient's corneal phenotype and visual needs, an approach that becomes increasingly important as CAIRS use expands in keratoconus
PURPOSE OF REVIEW:The present review will focus on recent advancements affecting outcomes in keratolimbal allograft (KLAL). RECENT FINDINGS:Recent advancements involve methodologies for donor selection, eye bank preparation of KLAL tissue, risk stratification, and immunosuppression to prevent both early and late immunologic rejection. SUMMARY:Keratolimbal allograft (KLAL) remains an essential technique for addressing severe limbal stem cell deficiency in patients without access to a suitable living donor eye (whether autologous or allogeneic). While outcomes of KLAL have traditionally lagged behind those of living-related limbal allografts, recent advancement in KLAL techniques may reduce this gap.
PURPOSE OF REVIEW:Growing use of sequencing technologies has accelerated investigation of the ocular surface microbiome, yet this environment is characterized by extremely low microbial biomass, complicating data interpretation. This review assesses current evidence linking microbial communities to ocular surface disease, discusses methodological and biological factors influencing interpretation of microbiome-disease associations, and proposes a framework in which microbial roles may be considered as drivers, modifiers, or markers. RECENT FINDINGS:Studies across multiple ocular surface diseases report alterations in microbial composition, including reduced α-diversity and shifts in dominant taxa. Genera such as Staphylococcus , Corynebacterium , and Cutibacterium are frequently reported as resident members of the ocular surface microbiome, although their abundance varies across individuals and sampling sites. Across diseases, microbial patterns often overlap and remain inconsistent between studies. Emerging mechanistic evidence has identified specific microbial products, such as lipoteichoic acid, that promote ocular surface inflammation through defined signaling pathways, providing initial support for a potential driver or modifier role. In low-biomass environments such as the ocular surface, contamination, host DNA predominance, and methodological variability can strongly influence detected microbial signals. SUMMARY:Interpretation of ocular surface microbiome data remains inherently challenging in this low-biomass context. However, the emergence of mechanistic studies suggests a transition from purely associative observations toward functional and translational investigation. Future studies should be designed to better define microbial roles by integrating standardized methodologies with multiomics approaches and detailed clinical phenotyping. Until such evidence emerges, microbiome research is best viewed as advancing biological insight rather than informing clinical decision-making.
Purpose of review To review and summarize the current literature on recent advances in corneal topography and anterior segment tomography, highlighting emerging technological advances and the integration of artificial intelligence, and their clinical applications in screening, planning, and optimizing outcomes of modern refractive surgery. Methods A comprehensive review of the recent literature was conducted using the PubMed, Scopus, and Web of Science databases to identify peer-reviewed articles published within the last 18 months that focus on advancements in corneal imaging technologies, including Placido-based topography, Scheimpflug imaging, and swept-source anterior segment optical coherence tomography (SS-ASOCT). Comparative studies, diagnostic accuracy reports, and new indices and software for ectasia risk assessment were analyzed. Recent findings Recent innovations in corneal topography and tomography have greatly improved the ability to detect subclinical keratoconus, evaluate corneal biomechanics, and develop personalized surgical plans. The integration of 3D corneal mapping, epithelial thickness profiling, and artificial intelligence-based analysis has increased diagnostic accuracy and safety in refractive procedures. These developments enable earlier detection of at-risk corneas and more accurate prediction of postoperative stability. Summary Advances in topography and tomography continue to improve the safety and predictability of refractive surgery. The use of multimodal imaging and AI-based diagnostics is transforming preoperative assessment and postoperative care, leading to more personalized and reliable visual outcomes.
PURPOSE OF REVIEW:Ophthalmologists use anterior segment imaging for diagnosis, measurement, monitoring, and treatment of a variety of conditions. Imaging modalities continue to improve in their precision and reliability, and as such research is needed to discover and demonstrate additional utilities and applications that can further enhance the ophthalmologist's diagnostic toolkit. This review summarizes key research studies over the past 12-18 months and explains how ophthalmologists, ranging from comprehensive to cornea and keratorefractive surgeons, can integrate these imaging techniques into their practice. RECENT FINDINGS:Recent research in anterior segment imaging techniques, particularly optical coherence tomography of the anterior segment, epithelial thickness mapping, and wavefront aberrometry, has demonstrated how these modalities can be integrated to improve diagnostic precision and augment the clinical exam. Increased knowledge about these techniques has allowed ophthalmologists to use imaging to diagnose and monitor conditions of the anterior segment very closely, even in cases with subtle findings that may not be easily seen on slit lamp examination. SUMMARY:Ophthalmologists benefit from advanced imaging technologies that enhance diagnosis and clinical decision-making, and recent research on developments in anterior segment imaging demonstrate how these modalities can be integrated in a wide variety of settings to improve patient care.
Purpose of reviewTo summarize recent technological, procedural and material advances that are reshaping cataract surgery and to appraise their implications for visual outcomes, safety and global accessibility.Recent findingsPhacoemulsification remains the gold-standard technique, yet refinements in fluidics, ultrasound modulation and heads-up 3-D visualization continue to enhance efficiency and surgeon ergonomics. Femtosecond laser assistance yields measurable benefits in dense or unstable lenses but offers comparable long-term vision to modern phaco in routine cases. Presbyopia-correcting optics have diversified: trifocal and extended-depth-of-focus lenses deliver high rates of spectacle independence, light-adjustable lenses permit postoperative power customization, and early fluid-based or dual-optic accommodative models show 2-2.5 D of true accommodation. Intraoperative tool, digital overlays, aberrometry, microscope-integrated optical coherence tomography, and artificial intelligence-driven video analytics increase refractive precision and aid training. Drug-eluting and nanopatterned intraocular lenses, portable low-cost equipment and sustainability initiatives address comorbidity management, access and environmental impact.SummaryCataract surgery is evolving into a comprehensive, personalized ocular-rehabilitation procedure that corrects refractive error, treats coexisting disease and maximizes visual quality. Parallel efforts to expand workforce capacity, reduce costs and minimize waste are essential to ensure these innovations benefit patients worldwide.
PURPOSE OF REVIEW:Trabecular bypass stents and ab interno canaloplasty are popular micro-invasive glaucoma surgery approaches. This review summarizes recent evidence on outcomes, safety, and comparative effectiveness of these procedures. RECENT FINDINGS:Five to 7-year studies of the iStent and Hydrus combined with cataract surgery report sustained efficacy, slower visual field progression, and cost-effectiveness versus cataract surgery alone. However, position-related inflammatory and endothelial concerns have emerged for the Hydrus. Canaloplasty via several modalities can achieve intraocular pressure (IOP) reductions of 30-40% and medication reductions up to 60%, through as long as 6 years of follow-up, with few complications. Regarding standalone delivery, prospective data supports the use of the iStent infinite in refractory glaucoma. Standalone canaloplasty evidence is strongest for the OMNI and iTrack devices, while early STREAMLINE device outcomes are promising. Comparative studies find that the Hydrus may outperform earlier-generation iStents but not the iStent infinite; canaloplasty with the STREAMLINE device demonstrates near-equivalence to iStent inject W; and gonioscopy-assisted transluminal trabeculotomy achieves lower IOP than viscodilation, albeit with more frequent hyphema. SUMMARY:Both trabecular bypass and canaloplasty are effective interventions for open-angle glaucoma. Stents have the largest evidence base, while canaloplasty may offer similar efficacy without implant-related concerns.
PURPOSE OF REVIEW:Inherited retinal diseases (IRDs) are genetically and phenotypically heterogeneous disorders that cause progressive vision loss and lack broadly effective disease-modifying therapies. Increasing evidence implicates metabolic stress, oxidative injury, and photoreceptor-retinal pigment epithelium (RPE) dysfunction in IRD pathophysiology. This review evaluates the evidence and limitations surrounding nutritional and metabolic interventions for retinitis pigmentosa and Stargardt disease.A narrative review of preclinical studies, randomized controlled trials, and contemporary genetic re-analyses was performed. Nutritional interventions reviewed include vitamin A, vitamin E, N-acetylcysteine (NAC), omega-3 fatty acids (docosahexaenoic acid), carotenoids and apocarotenoids, and the deuterated vitamin A analog C20-D3-retinyl acetate (ALK-001). RECENT FINDINGS:Initial studies suggesting a protective effect of vitamin A in retinitis pigmentosa were not confirmed in subsequent trials or genetic re-analyses, which identified baseline differences between groups as a possible contributor to the original findings. In contrast, supplemental vitamin E may accelerate disease progression. NAC demonstrated acceptable tolerability and modest short-term improvements in visual function in early-phase trials, with a phase 3 study ongoing. Omega-3 fatty acids, carotenoids, and apocarotenoids have not shown consistent clinically meaningful benefit in retinitis pigmentosa or Stargardt disease despite strong mechanistic rationale. In Stargardt disease, ALK-001 reduces lipofuscin accumulation in animal models and clinical trials are ongoing to assess efficacy in patients. SUMMARY:Most nutritional supplements studied to date have not demonstrated durable or clinically meaningful benefit in IRDs. Vitamin A supplementation in retinitis pigmentosa is no longer supported by current evidence, while NAC remains a promising metabolic therapy under investigation. High-quality, genotype-informed clinical trials with clinically relevant endpoints are needed before nutritional interventions can be incorporated into IRD management guidelines.
PURPOSE OF REVIEW:This review provides an overview of possible complications of the most commonly performed refractive surgeries: laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and lens-based refractive surgery. While the vast majority of refractive surgeries are safe with successful outcomes, complications can still occur which requires surgeons to have an in-depth understanding of complication prevention and management. RECENT FINDINGS:Although overall rare, corneal laser refractive procedures and lens-based refractive surgeries are associated with a distinct set of potential complications. The most common complications from LASIK, PRK, and SMILE include flap issues, infectious keratitis, haze, dry eye disease, and corneal ectasia. Implantable collamer lenses (ICLs) come with a possible risk of intraocular pressure elevation and cataract formation. Refractive lens exchange (RLE) introduces younger patients to potential complications typically associated with cataract surgery, such as dysphotopsias, uveitis, and retinal detachment. SUMMARY:The elective nature of refractive surgery may raise expectations of patients for successful outcomes. This timely review provides relevant and detailed guidance to refractive surgeons on best practices to mitigate potential complications, and ultimately maximize patient safety and satisfaction.
PURPOSE OF REVIEW:Subretinal hemorrhage (SRH) is most commonly associated with neovascular age-related macular degeneration (nAMD) and can cause profound vision loss in the macula through mechanical, toxic, and inflammatory mechanisms. Submacular hemorrhage (SMH) lacks consensus on management. This review summarizes current treatment options, key comparative studies, and ongoing challenges, with emphasis on SMH management. RECENT FINDINGS:Antivascular endothelial growth factor (anti-VEGF) therapy remains central to SMH management, with outcomes comparable to surgery in small to moderate hemorrhages. Pneumatic displacement (PD) with or without recombinant tissue plasminogen activator (rtPA) shows the greatest comparative benefit in more extensive SMH. Adjunctive rtPA improves hemorrhage displacement rates, and meta-analyses support its efficacy with anti-VEGF therapy. Pars plana vitrectomy (PPV) remains an option for large or refractory hemorrhages but has not consistently shown superior visual outcomes compared to less invasive modalities. SUMMARY:Early intervention is consistently associated with improved outcomes, but there is no universally accepted treatment algorithm. Ongoing randomized trials and advances in multimodal imaging have the potential to refine patient selection and treatment strategies. Future efforts should focus on balancing efficacy, safety, and cost-effectiveness to establish evidence-based guidelines for SMH management.
