PURPOSE:This study investigated the change in higher order aberrations (HOAs) and visual acuity with wavefront-guided scleral lenses (WFGSLs) in the management of patients with keratoconus. METHODS:A total of 22 eyes from 13 patients with keratoconus were fit with WFGSLs utilizing a commercially available aberrometer to further reduce residual HOAs uncorrected via traditional scleral lenses (tSLs). The outcomes for total higher order root mean square (HORMS) and individual Zernike terms at various pupil sizes (maximal, 5 mm, 3 mm), best corrected visual acuity (BCVA), tomography, and subjective patient preference at the most recent visit, representing a minimum of 48 weeks of WFGSL adaptation, were compared to the prior traditional SLs. RESULTS:WFGSLs resulted in significant reductions of HORMS and individual Zernike terms (Z7, Z8, Z11, Z17, and Z18) for all pupil sizes (p < 0.05 for all). When analyzing data from a 5 mm pupil, mean HORMS improved 53% (0.59 ± 0.30 μm vs. 0.28 ± 0.14 μm, p < 0.001). BCVA was significantly improved by 2 Snellen lines (0.18 ± 0.16 vs. -0.040 ± 0.090 logMAR, p < 0.001). All patients subjectively preferred WFGSLs over the traditional SLs. No adverse events were observed. CONCLUSIONS:WFGSLs provide effective management for residual HOAs as evidenced by the significant reductions observed in HORMS and individual Zernike terms (Z7, Z8, Z11, Z17, and Z18) for various pupil sizes. Correspondingly, WFGSLs significantly improve BCVA and are preferred over traditional SLs by all patients in this cohort. Therefore, WFGSL provides a valid alternative vision rehabilitation solution to help diminish the need for surgery in keratoconus patients who do not achieve adequate visual outcomes via traditional SLs.
PURPOSE:Dry eye disease is a multifactorial condition in which symptom burden may reflect ocular surface alterations together with broader psychophysiological processes. Previous studies have reported associations between dry eye symptoms and psychological distress, but most relied on cross-sectional designs and could not clarify temporal directionality. This study examined the longitudinal association between perceived stress and dry eye symptoms using a two-wave cross-lagged panel design. METHODS:Seventy-one young adults (60 females; mean age 22 ± 3 years) completed the Perceived Stress Scale-14 (PSS-14) and the Ocular Surface Disease Index (OSDI) at two time points approximately 7.5 months apart. The second assessment took place under conditions of heightened regional threat. Paired-samples t tests, Pearson correlations, bootstrap confidence intervals, and cross-lagged panel modeling were applied. The prespecified directional path from perceived stress at Time 1 to dry eye symptoms at Time 2 was evaluated using a one-tailed test; all other significance tests were two-tailed. RESULTS:Both perceived stress and dry eye symptoms increased significantly over the approximately 7.5-month follow-up period. Perceived stress increased by 4.2 points, t(70) = 6.20, p < 0.001, dz = 0.74, and dry eye symptoms increased by 7.5 points, t(70) = 3.46, p < 0.001, dz = 0.41. Perceived stress and dry eye symptoms were positively associated within each wave and showed substantial rank-order consistency across waves. In the cross-lagged model, the prospective path from perceived stress at Time 1 to dry eye symptoms at Time 2 was small and positive (β = 0.18) but did not reach the conventional two-tailed significance threshold (p = 0.084); it reached statistical significance only under the prespecified directional one-tailed test (p = 0.042). The reverse cross-lagged path was small and not statistically significant (β = 0.09). CONCLUSIONS:These findings provide suggestive, but not confirmatory, evidence of a small prospective association between earlier perceived stress and later dry eye symptom burden in a sample of predominantly young adult women. However, the finding should be interpreted cautiously given the modest sample size, the two-wave design, and its dependence on a directional one-tailed test. Further longitudinal studies are needed.
ABSTRACT Purpose The role of optometrists in glaucoma care is evolving rapidly in many parts of the world. This review aims to describe the current global scope of clinical practice for optometrists with respect to glaucoma, highlighting progress and identifying barriers to care across diverse regions. Methods We reviewed the current landscape of optometric glaucoma practice across Africa, Australia and New Zealand, Canada, Europe, the United Kingdom (UK), and the United States of America (USA). The review of practice in each region was led by authors active in the region using, where possible, publicly available legislation, published guidelines, and peer‐reviewed publications. For Africa and Europe, where the general scope of practice and training level of optometrists varies by country, we used the World Council of Optometry Competency Framework and the European ‘Blue Book’ to benchmark levels of proficiency and standardize comparisons between jurisdictions. A survey was also distributed to optometrists across Europe to collect further information on glaucoma practice patterns, given the lack of published information for many European countries. No countries with optometry in Asia, Mexico, the Greater Caribbean Region, Central, or South America were included in this review. Results The global landscape is characterized by a significant shift from traditional ‘case‐finding’ to comprehensive diagnostic and therapeutic management. In the USA, all 50 states permit independent topical therapy, with an increasing number authorizing laser procedures. In the UK and New Zealand, independent prescribing and expanding roles in laser procedures are also available to optometrists with higher qualifications. Conversely, Europe and Africa exhibit stark variations between countries; while countries, such as Ghana and Nigeria, train to the Doctor of Optometry level with high nominal scope, ‘effective’ scope is often constrained by equipment shortages and high medication costs. A ‘regulatory lag’ persists in some regions, where legislative expansion has not yet translated into broad clinical uptake. Conclusions Optometrists are increasingly essential to patient access and sustainable glaucoma care delivery. Although educational and training standards continue to improve, significant barriers—including regulatory restrictions, inconsistent public funding, and resource limitations—must be addressed to optimize optometry's role in addressing the global burden of glaucoma.
PURPOSE:To assess and compare the time-dependent disinfection efficacy against standard microbial strains and the neutralization kinetics of two commercially available soft contact lens care systems, one based on 0.05% povidone iodine and one based on 3.42% hydrogen peroxide. METHODS:To assess neutralization kinetics of each system, the concentration of the active disinfectants was quantified via iodometric titration (hydrogen peroxide) and high-performance liquid chromatography (povidone iodine) at intervals from 0.5 min to the minimum recommended disinfection time (MRDT). Disinfecting efficacy against the five ISO 14729 microbial strains (Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, Candida albicans, Fusarium solani) was assessed at intervals from 0.5 min to each system's respective MRDT. Microbial log reductions and disinfection rates were calculated using standard plate count methods. Statistical significance between systems was determined using ANOVA and post-hoc comparisons (p < 0.05). RESULTS:The povidone iodine system reached a peak concentration (∼0.05%) within 2 min, maintained this level for 5 min, and was neutralized by 20 min. Despite rapid neutralization, povidone iodine exceeded the standardized criteria for all strains within 1 min and disinfected below the detectable limit within 5 min. Conversely, the hydrogen peroxide system's concentration began declining immediately and fell below 1% within 30 min, before disinfection was complete for three strains. Significant kinetic differences (p < 0.05) favored povidone iodine across four strains, most notably against S. aureus, where hydrogen peroxide lagged by several hours. CONCLUSIONS:This study possesses a conflict of interest, and external validation is encouraged. The povidone iodine system achieved remarkably rapid disinfection across all strains at a 5000-fold lower molar concentration than the hydrogen peroxide system, well below the ocular irritation threshold. Povidone iodine's consistent, rapid disinfection, along with its high safety profile, suggests it may be a more optimal care option than the current gold standard.
PURPOSE:To compare concordance between ganglion cell-inner plexiform layer metrics acquired using widefield optical coherence tomography (OCT) and visual function assessed using Goldmann (G) II, III, and V stimulus sizes, in turn evaluating the role of spatial summation properties in binary classification of visual field (VF) results. METHODS:Eighty three glaucoma and 34 healthy participants underwent widefield OCT scans, segmented to generate ganglion cell-inner plexiform layer measurements, and 24-2 VF assessment using GII, GIII, and GV in full threshold mode. Accuracy was assessed using mean weighted absolute error and 95% prediction interval width from mixed effects models between ganglion cells per stimulus area estimated from ganglion cell-inner plexiform layer thicknesses and VF thresholds compared using mixed effects models and post hoc analyses of estimated marginal means. RESULTS:Across healthy and glaucoma eyes, mean weighted absolute error and 95% prediction interval widths were smallest with GV (p < 0.0001), suggesting the least model variability with GV. With VF locations in glaucoma cohort subclassified into VF nondefective and VF defective, although significant differences in mean weighted absolute error and 95% prediction interval widths were noted within stimulus sizes (p < 0.0001), larger values indicating poorer model accuracy were noted in glaucoma VF defective locations relative to both healthy and VF nondefective models. Larger mean weighted absolute errors and 95% prediction interval widths were observed with increasing disease stage in VF defective locations across all stimulus sizes (p < 0.0001). CONCLUSIONS:Overall, structure-function models in healthy eyes and VF nondefective locations were similar across all stimulus sizes, but larger deviations were observed in VF defective locations and with worsening glaucoma stage. Our findings suggest that GIII sufficiently balances measurement variability and VF defect detection, but that disease stage-specific variations in the structure-function relationship exist and the ability to monitor VF defect progression over time is poor regardless of stimulus size.
PURPOSE:SpotChecks is an accessible contrast sensitivity test with good repeatability in healthy adults. This study compared its intra-visit repeatability with the near Pelli-Robson test in adults with macular disease. METHODS:One eye from 29 adults with macular disease (mean age 71 ± 13 years) underwent high-contrast logMAR acuity and two repeated contrast sensitivity measurements with SpotChecks and Pelli-Robson during one visit. All testing was performed at 40 cm using habitual correction under 110 cd/m2 luminance. SpotChecks was scored as the contrast sensitivity at the highest row with two or more errors. Pelli-Robson was scored as (0.05 × the number of correct letters -0.15). Repeatability was defined as 1.96 2 S $\sqrt{2}S$ w (Sw, within-subject standard deviation), and differences between tests and groups were compared using a bootstrap hypothesis test. Limits of agreement between SpotChecks and Pelli-Robson were assessed with Bland-Altman analysis. Results were compared with previously tested healthy adults. RESULTS:Mean visual acuity was 0.15 ± 0.13 logMAR. Mean contrast sensitivity (logCS) was 1.51 ± 0.18 for SpotChecks, 1.49 ± 0.18 for Pelli-Robson. Repeatability was identical for SpotChecks and Pelli-Robson (0.17 logCS, p = 0.98) and comparable to normal values (SpotChecks: 0.19 logCS, p = 0.53; Pelli-Robson: 0.17 logCS, p = 0.87). Contrast sensitivity correlated with logMAR acuity (SpotChecks: r = -0.60; Pelli-Robson: r = -0.48; both p < 0.001). Limits of agreement between SpotChecks and Pelli-Robson were 0.03 ± 0.21 logCS. Abnormal contrast sensitivity (>2 SD below normal) was detected in 76% of eyes with SpotChecks and 66% with Pelli-Robson, exceeding 34% identified by logMAR acuity (p < 0.001 and p < 0.02, respectively). CONCLUSIONS:In adults with macular disease and good to mildly reduced visual acuity, SpotChecks demonstrated intra-visit repeatability comparable to Pelli-Robson and healthy individuals. Receiver operating characteristic analysis showed comparable discriminative performance for SpotChecks and Pelli-Robson, both outperforming high-contrast logMAR acuity.
PURPOSE:To explore the inherited retinal diseases (IRD) communities' attitudes and perspective toward emerging therapies-specifically gene therapy, cell therapy, and retinal prostheses-following a community education event. METHODS:At an in-person half-day IRD community education event, subject-matter experts presented the scientific foundations and current research developments related to these therapies. Following presentations, we invited attendees with lived experience to participate in an audio-recorded focus group to share their views and reflect on information presented. We conducted a thematic analysis of the focus group transcriptions to identify key themes. Our study was informed by a relativist ontology and constructivist epistemology. RESULTS:We conducted three focus groups, totaling 10 people with IRD and seven caregivers. Our analysis yielded four themes: (1) The drive for therapy, describing the burden of IRD and desire for any therapy; (2) navigating hope and uncertainty, highlighting the emotional complexity of disease progression and need to balance hope with realistic expectations; (3) personalized communication, emphasizing the value of tailored communication from trusted health professionals; and (4) transparency in information sharing, underscoring the importance of ongoing research updates. CONCLUSIONS:Our participants shared a strong desire for effective treatment, regardless of the therapeutic approach. Limited options and anticipated timeline to develop gene-specific therapies led many to view gene-agnostic approaches as more viable within their lifetime. Ongoing research updates were deemed valuable for fostering acceptance of emerging therapies and supporting treatment decision-making.
PURPOSE:To explore methods of evaluating success of optical myopia control interventions, and to apply these methods retrospectively to a clinical population. METHODS:A retrospective cohort study was conducted on pediatric patients attending a United Kingdom myopia clinic and used defocus incorporated multiple segments (DIMS) spectacle lenses, dual-focus (DF), multifocal (MF) or orthokeratology (OrthoK) contact lenses. An intervention was deemed as successful if the progression rate met a threshold value using a variety of methods: (1) spherical equivalent refraction (SER) change; (2) axial length (AL) change (individual-based, population-based, and percentile-based); and (3) AL rate during intervention. Linear regression analyses were conducted to determine which factor(s) had a significant effect on the reduction in AL rate. RESULTS:One hundred twenty-eight eyes of 64 children were analyzed (DIMs: 56, DF: 32, MF: 22, OrthoK: 18). Across the methods to assess success, 33% of eyes had a successful outcome and 32% obtained the mean AL reduction rate from equivalent clinical trials, with a mean (SD) individual-based age-adjusted reduction in AL progression of 0.11 (0.21) mm/year, 95% CI: -0.31 to 0.53 mm/year. Regression models were significant for the individual-based AL change method only, and for this regression, a faster AL rate preintervention was the only significant predictor of a larger AL reduction. CONCLUSIONS:Monitoring the rate of AL progression prior to intervention has advantages such as predicting and measuring success in this UK clinical population. The large variability in treatment response and the 33% overall success rate should help inform balanced discussions about the risks/benefits of optical myopia management interventions.
PURPOSE:To test the hypothesis that a larger, latanoprost-induced intraocular pressure (IOP) reduction is associated with a thicker ciliary muscle. METHODS:Participants (N = 31) were healthy with the following details: mean ± SD age 24.8 ± 3.3 years. The ciliary muscle was imaged with anterior segment optical coherence tomography and Goldmann IOP was measured at baseline and 12-18 h after latanoprost instillation. Linear regression models of baseline IOP and IOP reduction as predicted by baseline ciliary muscle thickness were performed. Partial correlation coefficients were calculated for model predictor variables. RESULTS:The mean ± SD latanoprost-induced IOP reduction was -2.6 ± 2.1 mmHg (t = -7.1, p < 0.0001). A larger reduction in IOP was significantly associated with thicker baseline maximum ciliary muscle thickness (CMTMAX) after controlling for age and baseline IOP (R2 = 0.37; CMTMAX: -0.02, p = 0.01; age: 0.23, p = 0.08; baseline IOP: -0.39, p = 0.003), and was also significantly associated with thicker baseline ciliary muscle thickness 1 mm posterior to the scleral spur (CMT1) after controlling for age and baseline IOP (R2 = 0.44; CMT1: -0.02, p = 0.002; age: 0.22, p = 0.06; baseline IOP: -0.43, p = 0.0008). Partial correlation coefficients between IOP reduction and baseline CMTMAX or CMT1 were -0.47 and -0.56, respectively. CONCLUSIONS:Thicker baseline CMTMAX/CMT1 was associated with larger latanoprost-induced IOP reductions and lower baseline IOP. Future studies should determine the clinical usefulness of ciliary muscle dimensions as a predictor of the response to latanoprost in glaucoma patients.
PURPOSE:Substantial endothelial cell loss (∼80%) occurs after keratoplasty. Corneal rigid and scleral lenses are frequently prescribed to manage irregular astigmatism and high refractive error, but lens wear may contribute to hypoxic stress. The relationship between various lens wear and corneal stress after penetrating keratoplasty remains unclear. This study characterizes cell density distribution in post-keratoplasty corneas and evaluates its influence on swelling during lens wear. METHODS:Participants ≥5 years post-surgery, with or without habitual lens wear, were enrolled. Specular microscopy measured endothelial cell density in central, superior, inferior, superotemporal, and superonasal corneal quadrants (@3 mm). Baseline corneal thickness maps (>2 h after waking without lens wear) were acquired using Scheimpflug imaging (Pentacam). Wearers applied habitual lenses and all participants returned 6-8 h later for imaging. Nonparametric tests assessed cell density variation by quadrant and lens designs. Linear mixed models evaluated associations between endothelial parameters and corneal swelling while accounting for within-subject correlation, repeated measures, lens type, location, and interactions. RESULTS:Twenty-five participants (31 eyes) from three centers were included; 90% had keratoconus preoperatively. Four wore large-diameter scleral lenses (13%), nine wore small-diameter scleral lenses (29%), 12 wore corneal rigid lenses (39%), and six did not wear lenses (19%). Cell density across quadrants averaged 780 ± 240 cells/mm2. Central thickness decreased slightly in non-lens-wearing eyes (-0.3%) but increased in lens-wearing eyes (1.9% ± 3.1%). Central cell density showed a weak negative correlation with swelling (r = -0.39, p = 0.03). Compared with non-lens wearers, corneal rigid (p = 0.02) and large diameter scleral lenses (p = 0.05) generated greater swelling; smaller diameter scleral lenses did not. CONCLUSIONS:Although all eyes fitted with various lens designs were clear, lower central cell density correlated with increased swelling during lens wear, except when smaller diameter scleral lenses were worn. Clinically, however, cell density does not seem to be a robust predictor of corneal swelling induced by lens wear post-keratoplasty.
PURPOSE:To evaluate the visual performance of a new daily wear presbyopia contact lens (Deseyne contact lens for presbyopia with extended depth of focus). METHODS:This was a randomized, crossover, and nondispensing clinical trial. Seventy-eight presbyopic (45-70 years, mean = 53.9 years) habitual soft contact lens wearers were recruited with spherical refractive errors between -6.00 and +4.00 D and less than 1.25 D astigmatism. Subjects were fitted bilaterally with the Deseyne lens and a control monofocal contact lens and randomized as to which of the study lenses would be tested first. Effectiveness measures included monocular lens-induced depth of focus testing-the primary effectiveness measure-and monocular distance, intermediate, and near visual acuity. Contrast sensitivity was also measured at mesopic luminance with and without glare. RESULTS:Mean monocular distance visual acuity was 0.00 ± 0.07 and -0.07 ± 0.07 logMAR with the Deseyne and control lens, respectively. The corresponding mean monocular intermediate visual acuity was +0.02 ± 0.11 and +0.16 ± 0.14 logMAR and monocular near visual acuity was +0.20 ± 0.11 and +0.35 ± 0.17 logMAR. Mean depth of focus was 2.22 ± 0.78 D with the Deseyne lens and 1.44 ± 0.67 D with the monofocal control. The mean extended depth of focus (95% CI) was thus 0.78 (0.63, 0.93) D. Contrast sensitivity was significantly lower with the Deseyne lens at 3, 6, and 12 cycles per degree with and without glare. CONCLUSIONS:The Deseyne contact lens for presbyopia with extended depth of focus extends the depth of focus of the eye and thus improves intermediate and near visual acuity.
PURPOSE:As artificial intelligence (AI) tools become increasingly integrated into optometric practice, higher education providers must adapt to these technological advancements and integrate teaching about AI into the optometry curriculum. Before AI can be taught in the optometry curriculum, educational priorities must be established. Therefore, this research aimed to explore a range of stakeholder views on the integration of AI into optometry education. METHODS:Semi-structured interviews were conducted with a purposive sample of eyecare practitioners, students, educators, regulators, and AI technology experts. Interviews were conducted online, transcribed verbatim, and thematic analysis was conducted. RESULTS:Three themes emerged: (1) Curriculum design and delivery; (2) Facilitators and barriers to teaching; (3) AI as an educational tool. AI topics for inclusion in the optometry curriculum were explored, with "Interpreting outputs of AI tools," "Foundational understanding," "Ethical Considerations" and "Integrating AI into clinical workflows" most commonly identified as important to teach. Barriers to teaching were identified including lack of access to AI devices, funding and time constraints, and rapid developments in AI necessitating frequent curriculum updates. AI tools were already being used by some students as an aid to their studies. However, many participants felt that higher education providers held a negative view of AI and discouraged its use. Participants identified potential risks associated with AI usage within education including plagiarism and reduced critical thinking. CONCLUSIONS:The multidisciplinary participants of this study expressed perspectives on a range of issues relating to the integration of AI into optometry education. This research aimed to aid optometry higher education providers as they explore integrating AI literacy into their curricula. However, further research is required to test the implementation of these recommendations in real-world settings. Additionally, although the potential benefits of AI as an educational tool are vast, the long-term cognitive costs of using these tools are not yet known and require further study.
PURPOSE:The purpose of this study was to examine: (a) the types of questions that neovascular age-related macular degeneration patients had for their ophthalmologists, and (b) whether the patients thought that a pre-visit neovascular age-related macular degeneration question prompt list and video would be a useful intervention to improve health care provider-patient communication. METHODS:Adult neovascular age-related macular degeneration patients attending visits for treatment injections were recruited at two ophthalmology practices and interviewed. They were shown a list of questions and asked to check the ones they had for their eye care provider. They were also asked whether a pre-visit question prompt list and video would be useful to improve provider-patient communication. RESULTS:Fifty neovascular age-related macular degeneration patients participated. Patients had a mean of 11.2 questions (standard deviation = 7.4; range 0-26) for their eye care providers. The most frequently checked questions included "How likely is it that I am going to go blind?" (70%), "What causes macular degeneration?" (64%), "What can I do to prevent vision loss?" (64%), and "What happens if I miss an injection visit?" (56%). Ninety-eight percent of patients felt completing a question prompt list to use during a visit would be helpful and 96% thought having patients watch a video before completing the question prompt list was a good idea. CONCLUSIONS:Neovascular macular degeneration patients have many questions for their eye care providers. Innovative ways to address patient questions should be tested and developed.
PURPOSE:To compare novel multi-periscopic prisms (MPP; 42° field expansion) to commercial Fresnel peripheral prisms (FPP; 30° field expansion) as mobility devices to assist with pedestrian collision hazard detection when walking. METHODS:Participants with hemianopia without neglect or cognitive decline were recruited at 7 sites in a single-masked crossover trial, allocated by minimization to receive either MPP or FPP first. Pedestrian collision detection was evaluated after 4-weeks of home-use of each type of prisms. The test simulated walking through a busy shopping mall with multiple pedestrians; in each trial, one pedestrian could be on a collision course, bearing angle of ±20° or ±40°, or there could be no colliding pedestrian. The main outcome, improvement with prisms (yes/no), was defined as blind-side detection rates that were significantly higher with than without prisms at the same visit. RESULTS:Of 64 participants screened, 38 were eligible and 63% (24/38) showed improvement with at least one type of prism glasses. There were no differences between the proportions of participants showing improvement with MPPs and FPPs for either 40° blind-side pedestrians (MPPs 31%, 12/38 vs. FPPs 26%, 10/38; difference 5%; 95% CI -14% to 24%, p = 0.75) or 20° blind-side pedestrians (MPPs 37%, 14/38 vs. FPPs 42%, 16/38; difference -5%; 95% CI -24% to 14%, p = 0.75). Of the 32 participants who completed both crossover periods, 13 (41%) preferred MPPs whereas 19 (59%) preferred FPPs (p = 0.38). MPPs were preferred for image clarity and extent of field expansion and FPPs for cosmetic appearance. Both MPPs and FPPs reduced (p < 0.01) perceived difficulty when walking in unfamiliar areas, crowded situations, detecting objects and people on the blind side, the most difficult situations without prisms. CONCLUSIONS:Both MPPs and FPPs improved blind-side collision detection at large (40°) as well as smaller (20°) bearing angles. These positive results strengthen the evidence base for FPPs and establish the potential of MPPs as mobility devices for patients with hemianopia. TRIAL REGISTRATION:ClinicalTrials.gov NCT04827147, registered on 04/01/2021.
PURPOSE:To systematically evaluate the quality of eye disease videos on TikTok, WeChat, and rednote, explore links between engagement and quality, and offer evidence-based guidance for ophthalmic health communication. METHODS:The top 100 videos retrieved using the keywords "cataract," "glaucoma," and "high myopia" were screened on TikTok, WeChat, and rednote on 3 October 2025. Two reviewers independently assessed video quality using Journal of the American Medical Association (JAMA), the global quality score (GQS), modified DISCERN, and the Patient Education Materials Assessment Tool (PEMAT). Group differences were analyzed using Kruskal-Wallis and χ2/Fisher exact tests, and adjusted associations were examined using Poisson regression with robust standard errors. RESULTS:A total of 827 eligible videos were analyzed. Most videos were uploaded by physicians and focused on disease knowledge. Across TikTok, WeChat, and rednote, video characteristics, engagement, source, content, presentation form, and quality scores differed significantly. In adjusted analyses, compared with TikTok, WeChat videos had lower likes and comments, whereas rednote videos had lower engagement across all four outcomes. High-myopia videos showed higher engagement across all outcomes, while glaucoma videos showed higher collections and shares. Hospital-uploaded videos were associated with lower engagement, whereas news agency videos were associated with higher engagement. Personal experience videos were associated with higher comments and collections. Higher JAMA scores were consistently associated with lower engagement, whereas modified DISCERN and PEMAT actionability showed inverse associations only for selected outcomes. CONCLUSIONS:This study represents the first large-scale cross-sectional evaluation of science communication on potentially blinding eye diseases across major Chinese short-video platforms. High engagement does not equate to high quality; in fact, engagement metrics were significantly negatively correlated with reliability, scientific accuracy, and understandability. Clinicians should uphold scientific rigor and use accessible and friendly language to improve public eye health literacy.
PURPOSE:To investigate whether early changes in choroidal thickness predict long-term treatment response to peripheral defocus spectacles in premyopic children with insufficient hyperopic reserve. METHODS:Two hundred children aged 6-8 years with cycloplegic spherical equivalent refraction +0.25 to +0.75 diopters (D) and annual hyperopic reserve depletion ≥0.75D were randomized 1:1 to peripheral defocus spectacles with plano central-zone (PDS group, n = 100) or plano-single vision spectacles (SVS group, n = 100). Primary outcome was the subfoveal choroidal thickness (SFCT) change at 12 months measured by swept-source optical coherence tomography. Secondary outcomes included axial length (AL), cycloplegic spherical equivalent refraction, and myopia incidence. The predictive value of 3-month SFCT changes for 12-month AL outcomes within the PDS group was assessed using receiver operating characteristic analysis. RESULTS:At 12 months, mean SFCT increased by 8.34 ± 18.67 μm in the PDS group, whereas it decreased by 16.82 ± 21.43 μm in the SVS group (mean difference: 25.16 μm; 95% CI: 19.84-30.48; p < 0.001). Mean AL elongation was 0.19 ± 0.14 mm (PDS) versus 0.32 ± 0.16 mm (SVS), representing 41% control efficacy (mean difference: -0.13 mm; 95% CI: -0.17 to -0.09; p < 0.001). Myopia incidence (spherical equivalent refraction ≤-0.50D) was 18% (PDS) versus 44% (SVS; p < 0.001). Within the PDS group, SFCT changes at 3 months predicted 12-month treatment response (AL elongation <0.25 mm) with area under curve 0.76 (95% CI: 0.69-0.84; p < 0.001). Children with early SFCT thickening (≥+5 μm at 3 months) showed superior 12-month AL control (0.16 ± 0.11 mm) compared to those with thinning (<-5 μm; 0.28 ± 0.15 mm; p < 0.001). No serious adverse events occurred. CONCLUSIONS:Peripheral defocus spectacles significantly controlled axial elongation and reduced myopia incidence in premyopic children with insufficient hyperopic reserve. Three-month choroidal thickness changes represent a valid early predictive biomarker for treatment response, enabling personalized intervention by 3 months rather than waiting 12 months for conventional outcomes. Early choroidal thickening identifies optimal responders, supporting choroidal perfusion mechanisms in myopia control.
