BACKGROUND:Knowledge graph (KG) is an artificial intelligence technique that provides a structured representation of medical entities and their relationships, thereby facilitating integration of heterogeneous information, knowledge discovery, and intelligent reasoning. The process of KG construction includes knowledge acquisition, knowledge extraction, knowledge fusion, knowledge inference, KG visualization, and KG evaluation. In ophthalmology, KGs have demonstrated significant potential in advancing disease understanding, supporting clinical decision-making, assisting in ophthalmic image analysis, and facilitating clinical intelligent question-answering. SUMMARY:This paper reviews the methodologies for constructing medical KGs and highlights their applications in ophthalmology, with particular emphasis on the integration of ophthalmic KGs with medical imaging and large language models. Furthermore, it discusses existing challenges - ranging from privacy and regulatory constraints to high construction and maintenance costs, limited fusion of imaging and multimodal data, insufficient coverage of rare eye diseases and insufficient application in education and basic research - aiming to provide insights that promote deeper research and clinical translation of ophthalmology KGs. KEY MESSAGES:The integration of KGs with multimodal technologies represents a research frontier in the transformation of ophthalmic clinical practice, enabling more structured and precise diagnostic reasoning. Future research should focus on the construction of domain-specific KGs for rare ocular diseases and spearhead the development of multimodal knowledge frameworks to fill existing knowledge gaps, thereby ultimately enhancing both patient clinical outcomes and medical education.
Introduction: This study aimed to investigate the relationship between spectral domain optical coherence tomography (SD-OCT) structural findings and visual acuity in patients with retinitis pigmentosa (RP), with and without cystoid macular edema (CME), at baseline and one-year follow-up. Methods: This retrospective chart review included 30 patients with RP treated at the University of Florida (UF) Health Eye Center from 2014 to 2020. Patient records were analyzed for SD-OCT structural features and visual acuity outcomes. Statistical analyses included descriptive statistics, χ² tests, independent t-tests, and Pearson’s correlation tests. Main outcome measures were best corrected visual acuity (BCVA), presence of the ellipsoid zone (EZ) in the fovea and macula, central retinal thickness (CRT), total macular volume (TMV), and presence of an epiretinal membrane (ERM). Results: The study included 30 patients (21 female, 9 male) with an average age of 46.83 ± 18.86 years (range, 10-80 years). The average follow-up period between visits was 11.9 ± 1.6 months (range, 9-15 months). Among the 60 eyes analyzed, 50% had CME. Eyes with CME had a greater CRT at the follow-up visit (p=0.029). No significant differences were found in BCVA or TMV between RP patients with and without CME. Correlation analyses revealed a significant relationship between CRT and BCVA at both visits (p=0.001, p=0.004) in RP patients without CME, but not in RP patients with CME. EZ foveal sparing consistently predicted BCVA outcomes (p<0.001) and CRT (p≤0.001) at both visits in RP patients with and without CME. Greater TMV at both visits (p=0.009, p=0.012) and the presence of an ERM at the follow-up visit (p=0.046) were significantly associated with a decline in BCVA between visits in RP patients without CME. Conclusions: EZ foveal sparing is a significant predictor of visual acuity in RP patients regardless of the presence of CME. While CRT correlates with visual acuity in patients without CME, it does not predict outcomes in those with CME. TMV may serve as a marker for preclinical CME, and both increased TMV and ERM presence may predict visual decline in RP patients with undetectable CME on SD-OCT.
Purpose: Clinical activity score (CAS) is widely used to assess thyroid eye disease (TED) activity, but its predictive value in East Asian patients remains unclear. This study evaluated correlation between CAS and both radiological and serological markers in treatment-naïve ethnic Han Chinese TED patients. Methods: Cross-sectional study of treatment-naïve ethnic Han Chinese TED patients managed at The Chinese University of Hong Kong between January 2014 and May 2022. STIR signal intensity was quantified using signal intensity ratio (SIR), while disease activity was assessed clinically using CAS. Results: A total of 188 patients with a mean onset age of 50±14 years who underwent baseline MRI were included. The mean presenting CAS was 1.4±1.3. A weak positive correlation was observed between CAS and the SIR of the levator palpebral superioris/superior rectus complex (r=0.196, P=0.00709). Nominal positive correlations were observed between CAS and the SIRs of the inferior rectus (r=0.185, P=0.0112), and medial rectus (r=0.167, P=0.0224). In subgroup analysis of patients presenting with CAS ≥3, nominal positive correlations were observed between CAS and the SIRs of the lateral rectus (r=0.374, P=0.0416), medial rectus (r=0.351, P=0.0487), and inferior rectus (r=0.335, P=0.0348). No correlation was identified in patient with CAS <3. No significant correlation was found between CAS and serological markers. Conclusions: The correlation between CAS and STIR signals was generally weak, and no significant correlation was identified between CAS and serological markers. These findings suggest that orbital MRI may provide complementary information beyond clinical assessment in evaluating disease activity in Ethnic Chinese TED patients.
BACKGROUND:Glaucoma is one of the leading causes of irreversible blindness due to the ongoing loss of retinal ganglion cells (RGCs) and degeneration of the axons that form a major part of the retino-cortical pathway. Although there are some therapies available that primarily ameliorate the intraocular pressure, loss of sight often continues, and thus illustrates the need for therapies that address the degeneration of the nervous system. SUMMARY:Stem cell interventions have the unique potential to assist with the preservation and restoration of dysfunctional RGCs via direct cellular replacement, differential neuroprotection, and stimulation of endogenous repair mechanisms. The focus of this review is on the most contemporary innovations which utilize stem cells to preserve and regenerate RGCs, which are vitally important for sight. The review addresses some of the newer cell source and cell prep technologies, particularly those using disorganized retinal microenvironment cell preps. Retinal microenvironment cell preps have resulted in some novel microenvironment cells designed to sequester stem cell grafts, to improve stem cell microenvironment cell preps, and to augment microenvironment cell preps. Some of the major challenges are reconstructing and integrating the lost retino-tectal and retino-collateral synapses in the visual pathway and the axonal outgrowth to and targeting appropriate central visual synaptic areas. KEY MESSAGES:Some major challenges are safety, RGC immunochemistry and cell type diversity, and scalable cell prep technologies. This review encapsulates how stem cell biology, along with other technologies like gene editing and tissue engineering, is forming the basis for developing first-of-its-kind regenerative therapies to restore vision in glaucoma patients, based on recent preclinical studies and ongoing early-phase clinical trials.
INTRODUCTION:The purpose of this study was to make correlations between reading performance patterns - saccades, fixation and reading speed - and functional and structural exams of patients with glaucoma. METHODS:A cross-sectional study collected ophthalmologic information of primary glaucoma patients. All patients had at least 0.5 logMAR best corrected visual acuity on the evaluated eye. Aloud reading of five MNREAD slides displayed on computer screen was recorded using ISCAN Eye-Tracker software. Reading speed, number and amplitude of saccades, and number and duration of fixations were collected. Humphrey 24-2 Standard Automated Perimetry (SAP) and Cirrus Optical Coherence Tomography (OCT) data were collected to make correlations with all reading patterns. RESULTS:In this exploratory analysis, a total of 57 patients with glaucoma were enrolled. Best-corrected visual acuity in the left eye was 0.18 (±0.16) logMAR. Central superior defect in the SAP had the slowest reading speed in all five slides (p < 0.05) and a greater number of saccades (p < 0.05 in three of 5 slides), and thinning of the inferior quadrant in OCT was the most associated with slower reading (p < 0.05 in 2 of five slides) and greater number of fixations (p < 0.05 in one of 5 slides). Peripheral SAP defects had correlation with shorter saccades. CONCLUSION:SAP data had a stronger correlation to reading abnormalities compared to the OCT data. Central superior SAP damage is the most associated with abnormal reading patterns in a computer screen environment. Peripheral SAP injuries correlated with shorter saccades size.
Introduction: In recent years, retinal vascular imaging has attracted growing interest and is experiencing rapid technological advancements in imaging modalities such as swept-source optical coherence tomography angiography (SS OCT-A). OCT-A enables precise, noninvasive, quantitative measurements of retinal vascularization. However, it is also prone to artifacts that are challenging to detect and can significantly limit diagnostic accuracy and biomarker reliability. Methods: We present a dataset of en face retinal SS OCT-A images, labeled by artifact type and severity. Each patient's OCT-A scan consists of 14 images that are graded by multiple experts and assigned corresponding artifact labels with an overall quality grade. We also report results for two deep-learning binary classification models trained on the dataset: one based on image compression via principal component analysis (PCA) and the other using a six-channel tensor. Results: The dataset comprised 281 OCT-A scans from 115 anonymized patients. The PCA-based model achieved a precision of 87% for image quality classification, while the six-channel model achieved 97%. Conclusion: Using a curated dataset of en face SS OCT-A images with detailed artifact annotations, we trained a deep-learning model capable of high-precision image quality classification. These results demonstrate the feasibility of using task-specific artificial intelligence for quality assessment based on artifact detection in retinal imaging.
Introduction: Tear-deficient dry eye disease (DED), including Sjögren’s syndrome and ocular graft-versus-host disease (oGVHD), is often refractory to therapy. We tested whether platelet-derived growth factor (PDGF) isoform imbalance, quantified as a PDGF-AB/BB: PDGF-AA ratio (“PDGF Ratio”), is associated with innate activation and corneal epitheliopathy. Methods: Tear samples from 151 participants were profiled across two independent assay runs: discovery (n = 79) and replication (n = 72). Data were harmonized as within-plate rank percentiles. Plate-adjusted mediation tested whether the PDGF Ratio mediated associations between tear-deficient status and an innate NF-κB composite (IL-18/IL-6/IL-8/TNF-α) and National Eye Institute (NEI) scale graded corneal staining. A parallel model for staining included Schirmer scores to distinguish trophic from aqueous volume deficiency. Results: The PDGF Ratio differed significantly across diagnostic groups (Kruskal-Wallis p < 0.001), driven by concurrent PDGF-AA depletion (median rank 0.69 healthy vs. 0.19 oGVHD) and PDGF-AB/BB enrichment (0.18 vs. 0.62; both p < 0.001). High ratio co-occurred with higher innate cytokine ranks and lower EGF and IFN-γ. In pooled mediation, the ratio accounted for 62.8% of the tear-deficient association with innate inflammation (indirect 0.168; 95% CI 0.118–0.225) and 34.2% of the association with corneal staining (indirect 0.117; 95% CI 0.055–0.190). The staining pathway remained significant after accounting for Schirmer (indirect 0.113; 95% CI 0.050–0.185). Conclusion: Tear-deficient DED exhibits a reproducible PDGF isoform imbalance that statistically accounts for substantial portions of innate activation and corneal staining. These findings support the PDGF Ratio as a coherent candidate biomarker and therapeutic axis for isoform-selective rebalancing.
Introduction: There is a paucity of data on microbial keratitis in the southwestern USA, specifically southern Arizona. Understanding demographic factors and causative organisms will help design future treatments and preventative measures. Methods: A retrospective chart review was conducted on all cases (>17 years old) of microbial keratitis at Banner University Medical Center Tucson, Arizona, from September 1, 2017, to August 31, 2022. Frequencies of social, demographic, ocular factors, and isolated organisms were reported. We used Fisher's exact tests to compare findings with 2023 census data. Results: We identified 272 eyes in 268 patients. Compared with census data, demographic factors overrepresented in microbial keratitis were as follows: unemployment (50.4%) and homelessness (8.2%). Drug use was identified in 22.4% of patients. Associated factors were contact lens wear (33.1%) and preceding ocular trauma (14.7%). Among eyes associated with contact lens use, 49 (54.4%) were worn overnight. Of 203 eyes with culture results, 152 (74.9%) yielded a positive microbial culture; 96.5% were bacterial and 3.4% were fungal. Gram-positive bacteria were found in 54.7%, most commonly Staphylococcus epidermidis (16.7%). The most common gram-negative isolate was Pseudomonas aeruginosa (12.8%). Conclusion: In southern Arizona, microbial keratitis is particularly associated with drug use, unemployment, and homelessness. Contact lens use and overnight wear were common, warranting education on safe practices. Positive fungal cultures were rare. Each factor deserves consideration for societal intervention, to reduce the burden of microbial keratitis in southern Arizona, and should be evaluated as potential risk factors in other communities. Overall culture results may influence choice of initial therapy.
INTRODUCTION:Aims of the study were to determine which donor characteristics, like previous diseases and surgeries, influence the graft preparation difficulty of the Descemet membrane/endothelial lamella in DMEK surgery and to analyze the impact on the 1-year clinical outcome. METHODS:Overall, 1,051 eyes with DMEK surgery between January, 2018, and January, 2021, performed at the University Hospital Cologne, Germany, were included in this single-center and retrospective study. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database that contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively and postoperative clinical follow-up. Three preparation groups (easy, difficult, and very difficult) were correlated to the donors' previous disease and surgeries. Also, outcome parameters, like visual acuity, endothelial cell density, and graft survival, were correlated to the graft preparation group. RESULTS:Donor diabetes was found as significant predictor for central adhesions (p < 0.001). Diabetes patients are 2 times more likely to have central adhesions complicating preparation than non-diabetes patients (OR = 2.2). Previous cataract surgery was significantly associated with difficult stripping and preparation (p < 0.001), with an estimated 1.07-fold increase in stripping difficulty (95% CI: 0.80-1.34) and overall 1.99-fold increase in preparation difficulty (95% CI: 1.71-2.29). Chronic kidney disease (p = 0.012) and previous cataract surgery (p = 0.005) show significant associations to tissue loss. Donor diagnosis such as diabetes mellitus type 2, chronic ischemic heart disease, and respiratory insufficiency has a significant association with the preparation group (p = 0.001; p = 0.004; and p = 0.032, respectively). No interactions were found between preparation difficulties and visual acuity (p = 0.122), rebubbling rate (p = 0.780), or endothelial cell density (p = 0.886) nor graft survival (p value = 0.157) 1 year postoperatively. CONCLUSIONS:Donor diabetes mellitus, heart failure, hypertension, respiratory insufficiency, kidney disease, and previous cataract surgery are associated with difficult DMEK graft preparation, the latter two also with tissue loss. No impact of donor factors on clinical outcome was found.
INTRODUCTION:This study aimed to investigate the relationship between spectral domain optical coherence tomography (SD-OCT) structural findings and visual acuity in patients with retinitis pigmentosa (RP), with and without cystoid macular edema (CME), at baseline and 1-year follow-up. METHODS:This retrospective chart review included 30 patients with RP treated at the University of Florida Health Eye Center from 2014 to 2020. Patient records were analyzed for SD-OCT structural features and visual acuity outcomes. Statistical analyses included descriptive statistics, χ2 tests, independent t tests, and Pearson's correlation tests. Main outcome measures were best corrected visual acuity (BCVA), presence of the ellipsoid zone (EZ) in the fovea and macula, central retinal thickness (CRT), total macular volume (TMV), and presence of an epiretinal membrane (ERM). RESULTS:The study included 30 patients (21 female, 9 male) with an average age of 46.83 ± 18.86 years (range, 10-80 years). The average follow-up period between visits was 11.9 ± 1.6 months (range, 9-15 months). Among the 60 eyes analyzed, 50% had CME. Eyes with CME had a greater CRT at the follow-up visit (p = 0.029). No significant differences were found in BCVA or TMV between RP patients with and without CME. Correlation analyses revealed a significant relationship between CRT and BCVA at both visits (p = 0.001, p = 0.004) in RP patients without CME, but not in RP patients with CME. EZ foveal sparing consistently predicted BCVA outcomes (p < 0.001) and CRT (p ≤ 0.001) at both visits in RP patients with and without CME. Greater TMV at both visits (p = 0.009, p = 0.012) and the presence of an ERM at the follow-up visit (p = 0.046) were significantly associated with a decline in BCVA between visits in RP patients without CME. CONCLUSIONS:EZ foveal sparing is a significant predictor of visual acuity in RP patients regardless of the presence of CME. While CRT correlates with visual acuity in patients without CME, it does not predict outcomes in those with CME. TMV may serve as a marker for preclinical CME, and both increased TMV and ERM presence may predict visual decline in RP patients with undetectable CME on SD-OCT.
INTRODUCTION:The aim of the study was to evaluate functional and anatomical changes at the 44-week follow-up in patients with naïve neovascular age-related macular degeneration (nAMD) treated with faricimab intravitreal injections (IVIs). METHODS:Fifty-four eyes of 54 patients with naïve active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University "G. d'Annunzio," Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI. Each patient underwent complete ophthalmic examination including best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts and optical coherence tomography. All measurements were evaluated at baseline, at week 20 and then according to fixed retreatment interval up to week 44. Fluorescein angiography and indocyanine green angiography were also performed at baseline. Main outcome measures were changes in BCVA, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), intraretinal fluid presence, subfoveal subretinal fluid presence and thickness, the presence of pigment epithelial detachments (PEDs), and its maximum height (PED-MH). RESULTS:BCVA improved and CMT reduced significantly from baseline to week 44 (p = 0.002 and p = 0.020, respectively) in the overall sample with a higher significant improvement from baseline to week 20 (p < 0.001 for both parameters) and no additional significant improvement from week 20 to week 44 in the overall sample (p = 0.348 and p = 0.146, respectively). At week 20, 72.3% of patients were in the Q12/Q16 interval. Patients in the Q8 interval showed significant improvement in BCVA (p < 0.001) and significant reduction of CMT (p = 0.008) from baseline to week 44, respectively. PED-MH as well showed a significant reduction from baseline to week 44 (p < 0.001). Patients in the Q12 interval showed significant improvement in BCVA (p = 0.030) and significant reduction of CMT, SFCT, and PED-MH from baseline to week 36 (p < 0.001). Patients in the Q16 interval showed significant reduction of BCVA during follow-up (p = 0.026). CMT, SFCT, and PED-MH were significantly reduced from baseline to week 44 (p < 0.001). CONCLUSION:Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of many anatomical and functional parameters at 44 weeks, allowing the maintenance of a treatment regimen for most patients equal to or greater than 12 weeks.
Introduction: Diabetes mellitus (DM) is frequently associated with microvascular complications, including diabetic peripheral neuropathy (DPN). The cornea, one of the most densely innervated tissues in the body, has been proposed as a surrogate marker for small fiber neuropathy. Patients with DM often present with ocular surface disease (OSD) and corneal sensitivity impairment, but the relationship between DPN, ocular surface alterations, and inflammatory biomarkers remains unclear. This study aimed to evaluate ocular surface parameters between patients with type 2 DM with and without DPN and to explore the associations among corneal sensitivity, ocular surface inflammation (matrix metalloproteinase-9 [MMP-9]), and dry eye-related parameters. Methods: In this cross-sectional observational study, 158 eyes of 79 patients with type 2 DM were categorized based on the presence or absence of DPN, diagnosed via electromyography. Corneal sensitivity was evaluated using the Brill esthesiometer, and tear MMP-9 levels were assessed with the InflammaDry test. Additional assessments included the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer test, noninvasive tear break-up time, and meibography. Corneal impairment was defined as esthesiometry levels 4–6 or pressure thresholds ≥8 mbar in either eye. Results: Patients with DPN exhibited significantly reduced corneal sensitivity (6.98 ± 2.25 mbar vs. 5.62 ± 2.53 mbar; p = 0.014) and higher OSDI scores (median 26 vs. 10; p < 0.001). MMP-9 positivity was more common in patients with corneal sensory impairment (81.8% vs. 54.3%; p = 0.0215). A significant negative correlation was observed between tear osmolarity and corneal sensitivity (r = −0.182, p = 0.022). Multivariable regression showed that both DPN (β = 1.20) and MMP-9 positivity (β = 1.24) were independently associated with reduced sensitivity. Conclusions: Reduced corneal sensitivity was significantly associated with the presence of DPN and with MMP-9 positivity and showed a negative correlation with tear osmolarity. Corneal sensitivity testing combined with tear MMP-9 assessment may provide complementary information on ocular surface changes in diabetic patients, although current variability and limited reproducibility prevent their use as standalone screening tools for neuropathy.
Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss and requires long-term anti-vascular endothelial growth factor therapy. This study aimed to evaluate the efficacy and safety of faricimab in patients with nAMD. Methods: This systematic review and meta-analysis were performed according to the PRISMA guidelines to identify studies assessing faricimab in nAMD. Primary outcomes included visual acuity, central macular thickness (CMT), and dry macula rate. Secondary outcomes included macular status, central choroidal thickness (CCT), and complications. A random-effects model was used to calculate pooled mean with 95% confidence intervals. Results: Out of the 365 studies identified, 21 studies were included, comprising a total sample size of 1,864 eyes of 1,791 patients. Post-operatively, there was a statistically significant improvement in corrected distance visual acuity (standardized mean difference [SMD]: −0.122, 95% p = 0.039) and CMT (SMD: −3.672, p = 0.010). Similarly, there was a significant improvement in the rate of dry macula at the final follow-up visit (event rate: 0.529; p < 0.05). For the secondary outcomes, there was a statistically significant improvement in CCT (SMD: −0.199, p = 0.026) and in the rate of macular exudates (0.452, p < 0.05), specifically intraretinal fluid (0.140, p < 0.05) and subretinal fluid (0.271, p < 0.05). Complications secondary to faricimab injections included hemorrhagic pigment epithelial detachment with a rate of 0.120 (p < 0.05) and retinal pigment epithelium tear with a rate of 0.025 (p < 0.05). Conclusions: The use of faricimab injection in patients with nAMD is safe and effective, resulting in significant improvements in a myriad of visual measures and OCT parameters.
Introduction: Corneal fluorescein (FL) staining is the most widely used efficacy endpoint in dry eye disease (DED) registrational trials, yet dye diffusion and variable readout timing can blur punctate staining, reducing the precision and consistency of grading. We assessed the performance of FL staining as an efficacy endpoint by analyzing endpoint success across FDA-reviewed DED trials and evaluated whether a standardized, diffusion-resistant dye could provide an alternative quantitative measure of corneal staining. Methods: We conducted a synthesis of FDA-reviewed DED registrational clinical trials through April 2025 to determine the proportion of trials that met the corneal FL staining efficacy endpoint. Clinical relevance was assessed using a minimal clinically important difference (MCID) of ≥3 units on the 0–15 National Eye Institute (NEI) scale. In a clinical cohort of 50 DED patients (97 eyes), total corneal staining was compared after sequential instillation of 5 µL of 2% FL (readout ∼2.5 min) and 1% lissamine green (LG) (readout ≤30 s). Results: Among 20 FDA-reviewed registrational trials that prespecified corneal FL staining as an efficacy endpoint, 10 (50%) failed to meet this endpoint. Of the seven trials in which FL staining served as a primary or co-primary endpoint, only one achieved MCID for corneal staining. Across all trials meeting the endpoint, treatment-vehicle differences were small (mean additional reduction 0.4–1.2 units; Cohen’s d < 0.5), indicating that FL staining yielded uniformly small effect sizes. In the clinical cohort, 1% LG produced corneal staining that was strongly associated with 2% FL for mild (ρ = 0.99), moderate (ρ = 0.93), and severe (ρ = 0.69) disease (p < 0.001). Bland-Altman analysis showed that while the mean bias was negligible, the width of the 95% limits of agreement (−1.26 to 0.85) suggests the two corneal staining dyes are not fully interchangeable at the individual-measurement level. Conclusions: Corneal FL staining demonstrates limited responsiveness as an efficacy endpoint in DED registrational trials. Because 1% LG provides corneal staining strongly associated with 2% FL while preserving discrete punctate detail and allowing standardized, early readouts, it may represent a suitable alternative vital dye for future DED efficacy and safety assessments.
Introduction: Age-related macular degeneration (AMD) is a major cause of irreversible vision loss in middle-aged and older populations worldwide. Understanding its long-term epidemiological trends is essential for anticipating future healthcare needs and guiding preventive strategies. This study characterizes the global, regional, and national burden of AMD in adults aged ≥45 years, with a focus on sex disparities, aging effects, and projected trends. Methods: Using data from the Global Burden of Disease Study 2021, we analyzed the prevalence and disability-adjusted life years (DALYs) of AMD across age, sex, region, country, and Socio-Demographic Index (SDI) groups. We applied an age-period-cohort model to disentangle the effects of aging, temporal changes, and birth cohort on AMD risk. Frontier analysis was conducted to identify best-practice benchmarks in disease burden reduction. The association between SDI and AMD burden was assessed to evaluate health inequities. An autoregressive integrated moving average (ARIMA) model was used to project age-standardized DALY rate (ASDR) and prevalence rate from 2022 to 2036. Results: Between 1990 and 2021, the absolute number of AMD cases and DALYs nearly doubled. In 2021, both prevalence and DALY rates increased exponentially with age, with females exhibiting consistently higher rates across all age groups. The age-period-cohort model indicated a declining trend in AMD risk over successive birth cohorts, suggesting potential improvements in early-life or cumulative risk factors. Notably, the highest age-standardized rates were observed in low-SDI regions, highlighting significant global inequities in disease burden. ARIMA projections suggest a modest but concerning increase in the global ASDR, rising to 6.80 (95% CI: 5.82–7.78) by 2036, with female ASDR reaching 7.46 (95% CI: 6.29–8.63). Conclusion: The burden of AMD remains substantial and is projected to grow, particularly among aging populations and in low-resource settings. The persistent sex disparity, especially the elevated burden in elderly women, calls for targeted screening and intervention programs. These findings emphasize the need for equitable, age- and sex-sensitive public health strategies to mitigate the rising impact of AMD in the coming decades.
Introduction: This study evaluated changes of Schlemm’s canal (SC) and trabecular meshwork (TM) dimensions from digital ocular massage in high myopia. Methods: Healthy participants with either high myopes (≤−6.00 D) or with refractive errors ≥ −3.00D were recruited. Right eyes underwent digital ocular massage. Intraocular pressure (IOP) was monitored using rebound tonometry. Anterior chamber angle was imaged using swept-source optical coherence tomography. IOP, SC, and TM were compared before and immediately after digital ocular massage. Results: Sixteen eyes from 16 high myopes (−6.00 D to −8.125 D) and 18 eyes from 18 control participants (+0.50 D to −2.875 D) were included. There was no difference in age and gender distribution between the two groups. The two groups shared similar IOP, SC area, SC length, TM length, and TM thickness at baseline. Both groups had significant IOP drop from a baseline of around 15 mm Hg to 9 mm Hg after ocular massage. High myopia demonstrated a mild enlargement of the SC area (from 10,655.60 ± 4,362.02 µm2 to 12,632.40 ± 4,393.19 µm2, p = 0.098), not reaching statistical significance. The TM thickness was reduced from 160.21 ± 26.29 µm to 151.77 ± 26.91 µm, p = 0.018). Control eyes showed significant enlargement of SC area (from 8,540.71 ± 3,905.98 µm2 to 11,686.53 ± 4,586.37 µm2, p = 0.001) and SC length (from 240.47 ± 69.96 µm to 280.40 ± 59.37 µm, p = 0.041). Conclusion: Control eyes showed significant enlargement of SC in responding to IOP drop while high myopia did not.
BACKGROUND:Stargardt disease (STGD1) due to biallelic mutations in the ABCA4 gene is the most frequent single-gene retinal disease with a genetic prevalence of about 1 in 7,000. Pathology in STGD1 is due to dysfunction of a retina-specific vitamin A transporter which causes accumulation of cytotoxic vitamin A byproducts known as bisretinoids. Bisretinoids produce a distinct autofluorescent emission within affected cells that is seen to precede atrophy of the retinal pigment epithelium (RPE), photoreceptor cell death, and vision loss. This sequence of pathogenesis, and the fact that formation and accumulation of bisretinoids begin within photoreceptors, suggests early pathology may occur within photoreceptor cells. Here, relevant literature is reviewed to explore the relationship between bisretinoids, fundus autofluorescence, and photoreceptor function/integrity in STGD1 with a focus on early-stage disease and potential biomarkers for clinical investigation. SUMMARY:Currently accepted primary endpoints in STGD1 clinical trials include quantification of areas where the autofluorescence signal is lacking due to the death of RPE and photoreceptor cells. Importantly, many patients with early-stage STGD1 cannot be monitored in this way as they present clinically prior to RPE or photoreceptor loss at a pre-atrophic stage and without significant visual impairment. Imaging analyses of patients with early-stage disease have shown increased fundus autofluorescence and compromised photoreceptor integrity and/or visual function deficits in the absence of atrophic retinal lesions. These findings implicate early accumulation of bisretinoid toxins within the retina as an underlying causative factor and provide an impetus to determine the relevance of these measures as surrogate endpoints or biomarkers for disease progression in STGD1 clinical trials. KEY MESSAGES:Early recognition and treatment of patients with STGD1 who have relatively healthy retinal tissue will likely yield a more favorable visual prognosis. Accordingly, there is a need to identify early disease initiators and progression patterns. The reviewed data support the hypothesis that bisretinoid accumulation within photoreceptors may be responsible for the observed early retinal pathology and vision loss. Clinical evaluation of therapeutics intended to reduce bisretinoid accumulation in early-stage STGD1 patients will likely provide a greater understanding of the role of bisretinoids in disease progression and potential for vision preservation.
Introduction: Age-related macular degeneration (AMD) is a leading cause of vision loss among older adults in the USA. Understanding its prevalence and demographic distribution is critical for developing targeted public health strategies. This study aimed to assess the prevalence of AMD and its clinical stages among US Medicare beneficiaries aged 65 years and older. Methods: We conducted a retrospective cohort study using the Vision and Eye Health Surveillance System (VEHSS) database of Medicare beneficiaries diagnosed with AMD between 2014 and 2021. Crude prevalence rates for overall AMD, early AMD, intermediate AMD, wet AMD, and geographic atrophy (GA) were calculated at national and state levels. Prevalence was stratified by age, sex, and race/ethnicity. Statistical analyses included the Mann-Whitney U test for age and sex comparisons, the Brown-Forsythe one-way ANOVA for racial/ethnic comparisons, and the Dunnett T3 test for post hoc analyses. Results: In 2021, the VEHSS-Medicare dataset included 24,129,807 individuals aged 65 and older, among whom the national prevalence of AMD was 10.40%. Prevalence rates for early AMD, intermediate AMD, wet AMD, and GA were 2.87%, 6.91%, 2.14%, and 0.73%, respectively. The number of AMD cases increased from 2.33 million in 2014 to 2.51 million in 2021. Prevalence was significantly higher in individuals aged ≥85 years compared to those aged 65–84 years, and in females compared to males. Post hoc analyses demonstrated that White individuals had a significantly higher prevalence of AMD compared with all other racial/ethnic groups. Conclusions: The prevalence of AMD among US adults aged 65 years and older was 10.4%, with higher rates observed in the oldest age groups, females, and White individuals. These findings highlight the importance of addressing disparities in AMD prevention and care, particularly in populations at greatest risk.
Introduction: The purpose of this systematic review and meta-analysis was to compare optical coherence tomography (OCT) retinal measurements between patients with autism spectrum disorder (ASD) and the neurotypical controls, exploring the potential of OCT as a noninvasive biomarker for ASD-related neurodevelopmental alterations. METHODS:PubMed, Embase, and Scopus databases were explored to determine eligible articles reporting OCT measurements of the retina and choroid in patients with ASD compared to healthy controls. Statistical analysis of OCT metrics was performed if reported in at least three discrete studies. In the process, fixed- and random-effects models were utilized, depending on the heterogeneity level between studies. Subgroup analysis based on the age group of cases, the method of eye selection, age and sex matching of cases and controls, and the OCT device used was also conducted. RESULTS:Ten studies with 373 ASD cases (with a total of 640 eyes) and 443 controls (with a total of 760 eyes) were included in this study. No significant alteration was observed in the average total macular layer, macular inner nuclear layer (INL), macular inner plexiform layer (IPL), macular ganglion cell layer (GCL), and macular retinal nerve fiber layer (RNFL) thickness. There was also no significant difference in the peripapillary retinal nerve fiber layer (pRNFL) thickness of the eyes of cases with ASD compared to healthy controls, except for the inferonasal portion of the pRNFL, which was significantly thicker in ASD subjects when compared to controls (p = 0.02). CONCLUSION:The findings of the present meta-analysis indicate a localized thickening of the inferonasal pRNFL with no alteration of other portions of pRNFL and macular layers (IPL, INL, GCL, RNFL). Although OCT may reflect subtle neurodevelopmental differences in ASD, current evidence is limited by small sample sizes, methodological heterogeneity, and potential confounders. .
