Purpose:To investigate the interrelationships among choroidal blood supply, photoreceptor structure, and visual function during normal aging using OCT and adaptive optics (AO). Design:A cross-sectional study. Subjects:A total of 68 participants aged 20-70 years were included in this study. Methods:All enrolled participants underwent a complete ophthalmological examination, including best-corrected visual acuity, axial length, OCT, and AO fundus photography. Photoreceptor images captured by AO imaging were used to calculate the cone density. A choroidal thickness map was obtained from OCT images using a custom algorithm. Main Outcome Measures:Detailed analysis was performed for the differences and correlations among cone density, choroidal thickness, and age. Results:Compared with group 1 (G1, aged 20-34 years), the cone densities of group 3 (G3, aged 50-64 years) and group 4 (G4, aged 65-79 years) were significantly lower at 0.5 mm to 1.1 mm eccentricities (all P < 0.05). The mean ± standard deviation cone densities (×1000 cells/mm2) at 0.5, 0.7, 0.9, and 1.1 mm eccentricities were 27.86 ± 2.77, 22.43 ± 2.04, 18.91 ± 1.42, 16.95 ± 1.19 for G1, 25.33 ± 2.44, 21.52 ± 2.02, 18.86 ± 1.89, 17.05 ± 1.29 for G3, and 22.29 ± 2.10, 20.30 ± 2.05, 17.50 ± 1.67, 15.56 ± 1.45 for G4, respectively. The choroidal thicknesses of group2 (G2, aged 35∼49 years), G3, and G4 were significantly thinner (G2: 199.45 ± 15.87 μm, G3: 156.87 ± 13.45 μm,G4: 142.25 ± 20.98 μm, all P < 0.05) than G1 (222.20 ± 40.41 μm). The cone density at all eccentricities was significantly correlated with choroidal thickness (all P < 0.05). Conclusions:The cones showed significant correlation with the choroid and age. Reduced choroidal thickness and older age were associated with lower cone density, highlighting the interdependent aging of vascular and structural parameters in age-related visual impairment. Financial Disclosures:The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

This research aims to describe the design, objective and feasibility of a pioneering community-based eye screening program intended to facilitate the provision of ocular services to the elderly. As a prospective investigation, this project innovatively integrates comprehensive eye examinations into routine annual physical assessments by leveraging cutting-edge automation, digital documentation, and real-time data transmission technologies. Eligible participants included community-dwelling adults aged ≥ 60 years undergoing health check-ups. Four foundational ophthalmic assessments, namely presenting distance visual acuity, autorefraction, intraocular pressure and non-mydriatic fundus photography, were measured to detect prevalent age-related eye diseases. Further, a dual-validation system combining artificial intelligence-driven analysis with on-site expert confirmation was implemented for high-risk case identification. Additionally, a tiered management strategy featuring rapid referral pathways was established to ensure timely tertiary care access. Among 3785 eligible residents, 3459 (91.4% response rate) completed initial screening, with an average examination duration of 4-8 minutes. Following expert validation, 1679 participants (48.5%) required advanced evaluation. Substantial unmet ophthalmic needs were uncovered, with prevalence rates of cataract (43.5%), age-related macular degeneration (37.5%), uncorrected refractive errors (14.6%), glaucoma suspicion (12.4%) and diabetic retinopathy (4.8%). A two-year follow-up analysis demonstrated observed visual improvements, particularly in younger cohorts (60-69 years). In contrast, the relatively older subgroup (70-74 years) exhibited progressive decline. This investigation establishes a model for geriatric vision care that demonstrated feasibility through its synergistic integration of technological innovation and existing primary community health infrastructure, although scalability to other populations and low referral completion require further evaluation.

Corneal fibrosis, a major cause of corneal opacification and vision loss, is characterized by a progressive increase in extracellular matrix (ECM) stiffness. This heightened stiffness accelerates fibrosis, establishing a self-perpetuating vicious cycle. However, the central mechanotransduction mechanisms through which matrix stiffness drives fibrotic progression remain poorly understood. To investigate this, primary human corneal fibroblasts were cultured on hydrogels with varying stiffness. Label-free quantitative proteomics revealed that increased ECM stiffness triggered widespread proteomic reprogramming, with significant enrichment in pathways related to fibrosis, Hippo signaling, cytoskeletal remodeling, and glycolysis. Further experimental validation confirmed that matrix stiffness coordinately activated the Hippo pathway effectors YAP/TAZ (Yes-associated protein 1/Transcriptional coactivator with PDZ-binding motif) and the canonical Wnt component β-catenin. Importantly, in human fibrotic corneal tissues obtained from clinical specimens, YAP and β-catenin were highly expressed and spatially co-localized with the myofibroblast marker alpha-smooth muscle actin (α-SMA). Modulation of the YAP/TAZ-β-catenin axis through genetic silencing (siRNA) and pharmacological approaches, including pathway inhibitors and agonists, significantly altered stiffness-induced fibrotic phenotypes. Mechanistic studies revealed that YAP/TAZ functioned as key mechanotransducers upstream of β-catenin, and that YAP and β-catenin physically interacted. Collectively, this work identifies the YAP/TAZ-β-catenin pathway as one of the key mechanotransduction pathways of stiffness-induced corneal fibrosis. These findings not only deepen our understanding of the biomechanical mechanisms underlying fibrosis but also provide a mechanistic rationale for developing anti-fibrotic biomaterials and therapies that target mechanical sensing. STATEMENT OF SIGNIFICANCE: This study identifies the YAP/TAZ-β-catenin axis as one of the key mechanotransduction pathways in stiffness-driven corneal fibrosis. Label-free quantitative proteomics revealed widespread protein expression alterations in primary human corneal fibroblasts subjected to pathological matrix stiffness. Pharmacological and genetic perturbations confirmed that YAP/TAZ acts upstream of β-catenin to promote myofibroblast differentiation, supported by evidence of direct protein-protein interaction and co-localization of YAP and β-catenin in fibrotic human corneal tissue. These findings highlight the importance of the mechanical microenvironment in corneal fibrosis beyond classical biochemical stimuli and suggest that targeting this pathway may offer a therapeutic strategy for corneal fibrosis.

This study aimed to develop and validate a digital image correlation (DIC) methodology based on swept-source optical coherence tomography (SS-OCT) for quantifying in vivo ciliary muscle (CM) deformation and strain during accommodation. This study was comprised of three phases. First, the measurement performance was examined across two SS-OCT systems (CASIA2 and VG200D) and four scanning modes (R1, R8, R16, and R64) by comparing the DIC-derived displacements with the simulated ground-truth fields. Second, reliability was validated using a “cross-image” strategy, in which artificial deformations were applied to biological images to assess tracking accuracy under realistic speckle noise. Third, 23 subjects were recruited and divided into three groups: control group (CN, n = 7), high myopia group (HM, n = 7), and elderly group (n = 9). Macroscopic morphological parameters (anterior CM length change and maximum CM thickness change) and biomechanical parameters (e.g., equivalent strain) were extracted synchronously. The R8 scanning mode in the CASIA2 device exhibited the most stable acquisition configuration. The robustness of the ncorr‑DIC algorithm was verified through the second-step experiment. Under the accommodative stimulus of − 5.0 D, the effective strain exhibited a highly significant graded attenuation among groups: CN (0.28 ± 0.06) > HM (0.20 ± 0.03) > Elderly (0.16 ± 0.05) (P = 0.002). Morphological changes were consistent with this finding, and CM thickening was significantly greater in the CN group than in the other two groups (P = 0.003). Combined analysis revealed that the mean effective strain was not only significantly positively correlated with macroscopic muscle thickening (r = 0.70, P < 0.001) but was also highly correlated with accommodation amplitude (r = 0.69, P < 0.001). DIC-based OCT analysis is feasible for assessing the biomechanical response of CM. By quantifying mechanical attenuation associated with HM and age-related decline, this method provides a new functional biomarker for investigating the mechanisms of accommodation dysfunction and guiding clinical interventions.

Purpose: To investigate proteomic and clinical changes in active-and quiescent-stage pterygium and identify biomarkers. Methods: This study included 15 and 14 patients with quiescent-and active-stage pterygium, respectively. Clinical parameters (length, area, thickness, vessel density, and hemodynamics) were assessed using slit-lamp, anterior segment-optical coherence tomography angiography, and functional slit-lamp biomicroscopy. Label-free proteomics was performed on excised tissues. Thrombospondin-1 (THBS1) was validated via enzyme-linked immunosorbent assay, immunohistochemistry, and reverse transcription quantitative polymerase chain reaction. Correlation and receiver operating characteristic analyses were also conducted. Results: Compared with the quiescent stage, active pterygium exhibited significantly greater corneal invasion length, area, thickness, and vessel density, along with reduced vessel length. Proteomic analysis revealed 7 upregulated differentially expressed proteins whose pathways were mainly immune related and 15 downregulated differentially expressed proteins. THBS1 was significantly elevated in active tissue, confirmed by enzyme-linked immunosorbent assay, strong immunohistochemical staining, and higher messenger RNA levels. Receiver operating characteristic analysis supported THBS1 as a potential biomarker, yielding an area under the curve of 0.81 for distinguishing active-stage pterygium. Conclusions: Immune dysregulation and neovascularization may play an important role in pterygium progression. THBS1 may serve as a potential biomarker for predicting pterygium development and monitoring its progression. Translational Relevance: This work translates the discovery of elevated thrombospondin-1 into a potential clinical biomarker, bridging proteomic findings to the assessment of pterygium activity.

Bioengineered scaffolds have demonstrated significant potential in enhancing wound healing; while there remains ample room for improvement in mitigating localized hypoxia and preventing infections at wound sites. Here, we introduce a microfluidic in situ 3D bioprinted autotrophic photosynthetic scaffold for promoting the healing of infected wounds. The scaffold incorporates oxygen-producing microalgae (MA) along with its essential nutrients (agarose and sodium bicarbonate). Its exterior is coated with a photothermal material, forming a core-shell structured scaffold capable of autonomously cultivating microalgae while exhibiting excellent oxygen-producing activity and photothermal performance. By employing 3D bioprinting to apply this living autotrophic scaffold to infected wounds, we have achieved effective alleviation of local hypoxia, reduction of oxidative stress, and concurrent inhibition of bacterial infections. These combined effects significantly promoted neoangiogenesis, collagen accumulation, and tissue regeneration in infected wounds. Thus, our autotrophic photosynthetic 3D-bioprinting scaffolds hold substantial potential and value for clinical applications in wound healing.

AIMS:To investigate the changes in choroidal optical coherence tomography (OCT) radiomic features, their correlations with visual acuity and utility in identifying pathological myopia (PM). METHODS:A total of 288 myopic participants aged 18-50 years were included. Choroidal radiomic features were extracted and screened from OCT images via PyRadiomics and machine learning. Selected features were analysed for their associations with axial length, spherical equivalent, age and best corrected visual acuity (BCVA). Classification models were built using these features and their performance to identify PM was evaluated and compared with clinical parameters through five-fold cross-validation using metrics including area under the curve (AUC), accuracy, recall and F1 score. RESULTS:A total of 464 radiomic features were extracted and four choroidal intensity and shape features significantly correlated with axial length (p<0.001) were selected. Smaller maximum diameter, higher coarseness and greater perimeter surface ratio were significantly associated with worse BCVA (p<0.05). Radiomic features showed better performance than clinical features in both the internal test set (AUC=0.970 vs 0.938) and external validation set (AUC=0.858 vs 0.753) in identifying PM. Combining radiomic features with risk factors improved classification performance (AUC=0.990 internally and 0.892 externally). Among the included factors, intensity feature was most predictive for PM. CONCLUSIONS:OCT-based choroidal intensity and shape features were significantly correlated with axial elongation and visual impairment and outperformed clinical parameters in identifying PM. These features could serve as reliable biomarkers for monitoring high myopia progression.

BACKGROUND:This study aimed to investigate the relationship of high-altitude environmental features and ethnic Tibetan background with myopia. METHODS:This cross-sectional study was conducted at highland and lowland sites. The highland sites were located on the Chinese Tibetan Plateau, approximately 4000 m above sea level. A total of 3634 Tibetans and 377 Hans were included in the highland group. The lowland group was from the Yaoxi community, in Wenzhou City, located 10-20 m above sea level, where 176 Han individuals were included. Non-cycloplegic spherical equivalent refraction (SER) and biochemical function tests were measured. RESULTS:Age-specific myopia prevalence was highest in highland Hans, followed by lowland Hans and highland Tibetans. Among participants in the highland group, including Tibetans and Hans, increased risk of moderate and high myopia was associated with gender [OR (95% CI): 0.47 (0.23, 0.97) for females], education level [OR (95% CI): 3.62 (1.76, 7.45) for middle school education and above], and elevated mean haemoglobin per red blood cell (MCH) [OR (95% CI): 8.04 (1.04, 62.34)]. Among Han participants in both groups, only elevated mean corpuscular volume (MCV) [OR (95% CI): 5.91 (1.00, 34.92)] was associated with increased risk of moderate and high myopia. CONCLUSIONS:The higher prevalence of myopia in Hans compared to Tibetans, and in highland Hans compared to lowland Hans, suggests that both ethnicity and high-altitude environment influence myopia development, potentially through gene-environment interactions. Elevated MCV and MCH levels, particularly in highland Hans, may serve as biomarkers for risk, warranting further investigation.

Organ-on-a-chip is highly valuable for tumor drug screening, but further exploration in gastric cancer is needed. Here, we propose an innovative platform to cultivate primary gastric cancer cells using microfluidic encapsulation, enabling three-dimensional (3D) tumor growth and clinical drug assessment. We employ microfluidic electrospray technology to mix human primary gastric cancer cells with carboxymethyl cellulose and encapsulate them within alginate core-shell microcapsules. Tumor cells spontaneously form spheroids and proliferate rapidly. These tumor spheroids display multiple characteristics of natural tumors and exhibit heterogeneity within them. Subsequently, microcapsules containing tumor spheroids are combined with a microfluidic chip that is designed with a gradient generator and a culture chamber. This platform enables dynamic perfusion of various chemotherapy drug solutions and the high-throughput generation of drug concentration gradients to assess tumor spheroid sensitivity to these drugs. The findings reveal variations in drug sensitivity among gastric cancer spheroids from different patients. Notably, the drug sensitivity profiles obtained from the tumor spheroid assays show significant consistency with the actual clinical responses of the corresponding patients. These outcomes underscore the potential of integrating microcapsule-cultured tumor spheroid models with microfluidic technology to create a dependable and precise drug evaluation platform for clinical applications in gastric cancer treatment.

Purpose:To investigate the effects of Lenslet-ARray-Integrated (LARI) spectacle lenses on refractive and corneal astigmatism in myopic children. Design:A secondary analysis of data from a randomized, double-masked trial. Participants:Pertinent data were retrieved from the files of 209 participants from the previous 2-phase LARI study, which reported the efficacy of LARI lenses on myopia control in children aged 6 to 12 years. Methods:Data from participants of the LARI study (phase I: wearing LARI lenses or single-vision (SV) lenses for 12 months; phase II: all wore LARI lenses for another 12 months) were retrieved and analyzed. Participants who wore LARI lenses for 2 years were categorized as the LARI group, whereas those who switched from SV to LARI lenses were categorized as the SV lens switched over to LARI lens in the second year (SV-LARI) group. Data retrieved included cycloplegic spherical equivalent refraction and refractive astigmatism, axial length, and corneal astigmatism at 6-month intervals, and the vector components (J0 and J45) of refractive and corneal astigmatism were calculated for analysis. Main Outcome Measures:Changes in refractive and corneal astigmatism, J0, and J45. Results:No significant differences were found in increased refractive astigmatism, refractive J0 and J45, corneal astigmatism, and corneal J0 and J45 (all P > 0.05) between the LARI and SV groups in phase I. For participants who wore LARI lenses for 2 consecutive years, there were no significant differences in changes in refractive astigmatism and refractive J0 between phases I and II (P = 0.23 and P = 0.41), but change in J45 in phase II increased by -0.03 D (P = 0.003), and a smaller increase in corneal astigmatism was observed in the second year (0.07 ± 0.36 D vs. 0.20 ± 0.34 D, P = 0.02). In the SV-LARI group, a higher change in refractive astigmatism was observed in phase II (-0.12 ± 0.45 D, P = 0.03), but there were no significant differences in changes in refractive J0 and J45, corneal astigmatism, and corneal J0 and J45 between phases I and II (all P > 0.05). Conclusions:Wearing LARI lenses for 2 years did not seem to lead to any clinically significant additional progression in refractive and corneal astigmatism. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Background: Aggregation and pathological phosphorylation of α‑synuclein (α‑syn) are central drivers of Parkinson’s disease (PD) progression. Identifying natural compounds capable of directly targeting α‑syn remains a major challenge in PD drug discovery.Purpose: This study investigated whether bisphenol F (BPF), a naturally occurring polyphenolic compound found in multiple medicinal plants, exerts neuroprotective effects in PD by directly binding to α‑syn and modulating its pathological aggregation.Methods: Network pharmacology and molecular docking were used to predict BPF–target interactions and identify α‑syn as a core hub target. Binding affinity was validated using surface plasmon resonance (SPR) and cellular thermal shift assay (CETSA). Functional assays—including native PAGE, Western blotting, cell viability, climbing assays, and survival analysis—were performed in A53T‑α‑syn–overexpressing SH‑SY5Y cells and a Drosophila PD model.Results: BPF showed favorable drug‑likeness, high predicted oral absorption, and strong BBB penetration potential. Network analysis identified SNCA as a major hub target. SPR confirmed direct BPF–α‑syn binding (KD in the micromolar range), and CETSA demonstrated increased thermal stability of α‑syn upon BPF treatment. BPF significantly inhibited α‑syn oligomerization and S129 phosphorylation in vitro. In vivo, BPF improved climbing ability and extended lifespan in α‑syn transgenic Drosophila without detectable toxicity.Conclusion: BPF directly binds to α‑syn, suppresses its pathological aggregation and phosphorylation, and ameliorates PD‑like motor deficits in vivo. These findings identify BPF as a promising natural α‑syn–targeting candidate for disease‑modifying PD therapy.

PURPOSE:To propose CVS-omics, a radiomics framework using Corvis ST (CVS) (Oculus Optikgeräte GmbH) imaging and machine learning, for precise identification of forme fruste keratoconus (FFKC), a subtle corneal condition often undetected by conventional diagnostics. METHODS:A total of 410 eyes were evaluated, including 265 normal eyes and 145 FFKC eyes. Texture features through radiomics were extracted from CVS images acquired at three key deformation phases: initial state, first applanation, and maximum deformation. These features were used to train three machine learning models (Random Forest [Minitab, Inc], C5.0 [RuleQuest Research], and XGBoost (extreme Gradient Boosting) on 328 eyes, with testing conducted on 82 eyes. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis and compared with conventional biomechanical parameters. RESULTS:The CVS-omics Random Forest model achieved superior diagnostic performance (area under the curve (AUC) = 0.989, sensitivity = 0.931, specificity = 0.962, accuracy = 0.951), significantly outperforming traditional CVS parameters (best AUC = 0.764). Models trained on features from three deformation phases showed higher diagnostic accuracy than those based on a single phase. Other models demonstrated high generalizability of dynamic radiomics features (XGBoost and C5.0 AUC > 0.83). CONCLUSIONS:CVS-omics effectively detects subtle characteristic alterations in FFKC eyes with superior accuracy compared to conventional biomechanical parameters. This texture feature approach shows promise as a non-invasive clinical tool for FFKC detection and timely intervention.

In recent years, some fibroblast growth factors (FGFs) have been reported to be promising therapeutic targets for neovascular age-related macular degeneration (nAMD). Interestingly, we found that the FGFR2b inhibitor bemarituzumab (FPA144) exerts a beneficial effect in a mouse choroidal neovascularization (CNV) model. Our current study aims to uncover the potential molecular mechanism by which FPA144 alleviates CNV. The effect of FPA144 was evaluated in a laser-induced CNV mouse model. Fundus fluorescein angiography (FFA), optical coherence tomography (OCT), and choroidal flat mounts were carried out for the quantitative assessment of CNV. Label-free quantitative proteomics analysis was performed to assess changes in molecular pathways. Primary cultured human umbilical vein endothelial cells (HUVECs) were used for further confirmation of the target pathway in vitro. FFA, OCT, and choroidal flat mounts demonstrate the protective effect of FPA144 in a mouse CNV model. Compared to the control group, the treated group has smaller vascular leakage areas or smaller CNV lesions. Proteomic analyses indicate that the melanoma cell adhesion molecule (MCAM, CD146)-Yes-associated protein 1 (Yap1) pathway may be involved in the effect of FPA144. Immunostaining of choroidal flat mounts and cryosections reveals decreased expression of CD146 and Yap1 in the vascular endothelial cells of the treated animals. Experiments on HUVECs further verify the inhibitory effect of FPA144 on vascular endothelial cells. Our findings demonstrate that FPA144 can efficiently inhibit the development of choroidal neovascularization in mice by downregulating CD146 and Yap1.

Purpose:To develop and validate a dual deep learning model (DLM)-based software (BlinkNet-Q) for near real-time quantification of blink rate and incomplete blinks using standard red-green-blue video. Methods:BlinkNet-Q integrated two DLMs: DLM-1 classified open-eye versus complete-blink frames, and DLM-2 differentiated complete from incomplete blinks. This proof-of-concept technical validation study included separate model development and independent testing cohorts. The development cohort comprised 15 participants (30 eyes), yielding 2953 annotated frames for training and internal validation, with participant-level data splitting. The testing cohort included 39 participants (39 eyes) and was used for final evaluation of the BlinkNet-Q. Frame-wise analysis with computer vision-based eye localization enabled automated blink quantification. Performance was assessed using classification metrics, regression-based metrics, intraclass correlation coefficient (ICC), and Bland-Altman analysis. Results:DLM-1 achieved an area under the curve (AUC) of 0.989 (95% confidence interval [CI], 0.932-0.993), and DLM-2 reached an AUC of 0.884 (95% CI, 0.854-0.963). The BlinkNet-Q showed strong agreement with manual counting for blink rate (ICC = 0.973; R² = 0.948; mean absolute error [MAE] = 1.262 blinks/min) and incomplete-blink ratio (ICC = 0.937; R² = 0.876; MAE = 0.059), with small mean biases under standardized recording conditions. Conclusions:BlinkNet-Q demonstrated the technical feasibility of automated blink rate and incomplete-blink quantification under standardized recording conditions, supporting its potential as a software prototype for blink assessment. Further external validation in diverse clinical populations is needed before clinical implementation. Translational Relevance:BlinkNet-Q may support future development of accessible, camera-based blink assessment tools for ocular surface evaluation.

BACKGROUND:With the increasing prevalence of depression, there is an urgent clinical need for early screening in depression. The retina offers a promising window for early screening in depression due to its rapid, non-invasive, objective, eye-brain correlated characteristics, but previous research has yielded conflicting alterations in retinal microstructure in depression. METHODS:We screened retinal optical coherence tomography and brain magnetic resonance imaging data in the UK Biobank to enroll 23,225 participants for retinal study of depression occurrence, and 1475 participants for the eye-brain association study. We also used genetic data (ID: ebi-a-GCST90014267 and ukb-d-20,448) from the Integrative Epidemiology Unit Open Genome-Wide Association Study for Mendelian randomization analysis. We used Cox regression to assess the association between retinal microstructure and depression risk, Mendelian randomization to infer causality, and mediation analysis to explore retina-brain pathway association. RESULTS:The Cox regression analysis showed that retinal ganglion cell-inner plexiform layer (GCIPL) thickness remained a significant predictor of depression. The Mendelian randomization analysis indicated a positive statistical association between GCIPL thickness and depression. Moreover, there was a significant positive correlation (all p < 0.001) between the volume of specific depression-related brain regions and the GCIPL thickness. Adjusting for age, sex, and head size, the mediation analysis provided preliminary evidence for a potential anatomical pathway linking retinal GCIPL thickness to depression-related brain regions through primary visual cortex and secondary visual cortex volumes. CONCLUSION:Thickened retinal GCIPL is a potential early phenotype of depression and has a potential association pathway with depression-related brain regions using a radiogenomics approach.

Purpose:This study explored large language models (LLMs) as a scalable solution to the global shortage and uneven distribution of ophthalmologists, particularly their actual effectiveness and potential risks in ophthalmic training. Design:This is a prospective study. Subjects:Eleven leading LLMs (ERNIE Bot 4.5 Turbo, Dou Bao, Tongyi Qianwen 3, DeepSeek-R1, ChatGPT-4o, Gemini 2.5 Flash, Tencent Yuanbao T1, HuatuoGPT II, Baichuan4-Turbo, Kimi k1.5, GLM-4) and 10 resident physicians (RPs) from a tertiary ophthalmology hospital in China. Methods:Phase 1: all LLMs were tested on the Chinese and English versions of the Chinese National Health Professional Technical Qualification Examination (Intermediate Level) in Ophthalmology (CNHPTQE-O). Phase 2: the best-performing LLM was used to assist the 10 RPs in 2 tasks: (1) answering the same CNHPTQE-O text questions and (2) classifying 4 types of keratitis images. Resident physicians completed unassisted and assisted phases with a 1-month washout period. Main Outcome Measures:The primary outcomes were accuracy (%) on the CNHPTQE-O for LLMs, and change in accuracy for RPs with versus without LLM assistance (text and image tasks). The secondary outcomes included postassessment survey ratings and confusion matrix analysis. Results:Several Chinese LLMs, especially ERNIE Bot 4.5 Turbo, demonstrated superior performance on the CNHPTQE-O, achieving accuracies of 98.00% (Chinese) and 86.50% (English). ERNIE Bot 4.5 Turbo significantly outperformed all RPs on the Chinese examination (P = 0.001). With LLM assistance, all 10 RPs passed the text examination; the mean accuracy improved from 60.75% to 79.00% (mean difference 18.25%, 95% confidence interval: 10.30%-26.20%, P = 0.001). Questionnaire feedback was positive. However, on the keratitis image task, LLM assistance did not improve RP accuracy (41.25% vs. 40.56%, P = 0.662); questionnaire feedback was markedly less favorable. Conclusions:Large language models possess a solid foundation in ophthalmic knowledge and can effectively enhance trainee performance in text-based assessments, demonstrating clear potential as a training aid. However, their limitations in image-assisted diagnostic tasks and the associated risk of "artificial ignorance" should not be overlooked. Financial Disclosures:The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

BACKGROUND/AIMS:Cost-effective screening models for ocular diseases in large populations remain a critical challenge for blindness prevention. Our preliminary study demonstrated the feasibility of opportunistic glaucoma screening integrated into general health examinations. This study aimed to evaluate the efficacy of this model for fundus disease screening in a multicentre, large-sample Chinese population. METHODS:This study was conducted in five health examination centres from four provinces of China. Chinese participants aged ≥18 years undergoing routine health examinations were invited to complete bilateral presenting visual acuity and non-mydriatic fundus photography. Fundus photography was assessed by two experienced graders. Proportion of fundus diseases/changes were calculated. Costs for the screening were also assessed. RESULTS:A total of 63 935 eligible participants (age 45.4±14.0 years, 51.3% men) were enrolled. The top five diseases/changes were non-macular drusen (8.80%), macular degeneration (6.30%), glaucoma suspect (5.54%), epiretinal membrane (3.92%) and diabetic retinopathy (3.89%). The proportion of low vision and blindness in the total population was 5.85% and 0.15%, respectively. The top five diseases/changes with vision impairment were retinitis pigmentosa (18.18%), myopic retinopathy (16.52%), macular hole (11.76%), non-glaucomatous optic neuropathy (7.25%) and glaucomatous optic neuropathy (6.37%). The unit cost of screening a single case and an ocular disease suspect was US$22.2 (US$15.7 to US$26.7) and US$83.2 (US$58.7 to US$99.9), respectively. CONCLUSIONS:This health examination centre-based screening model is feasible, effective and affordable for detecting multiple fundus diseases in large populations. As the model is promoted and its coverage expands, screening costs may be further reduced.

PURPOSE:To evaluate the diagnostic performance of a radiomics-based machine learning approach applied to corneal optical coherence tomography (OCT) images for detecting forme fruste keratoconus (FFKC). DESIGN:Evaluation of machine learning diagnostic algorithms. METHODS:OCT images from 307 eyes (234 normal, 73 FFKC) were acquired along eight meridians (M1-M8). All images underwent preprocessing before texture-based radiomics feature extraction. Three machine learning classifiers-Random Forest, C5.0, and XGBoost-were trained using a feature subset selected by recursive feature elimination (RFE). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. RESULTS:A total of 3752 features were extracted per eye, of which 41 were selected for model training. All three models demonstrated strong diagnostic performance in the test set (AUCs > 0.92), with no significant differences between models (P > .05). The XGBoost model achieved the highest performance (AUC = 0.93, 95% CI: 0.829-1.0, sensitivity 0.857, specificity = 0.978, accuracy = 0.950). Among the top 10 XGBoost features ranked by importance, a preferred meridional distribution was observed, with most features concentrated along M1 to M3, corresponding to the inferotemporal corneal region. CONCLUSION:Radiomics analysis of corneal OCT images combined with machine learning enables accurate FFKC detection using a single imaging device, providing diagnostic information beyond conventional morphological assessment and suggesting a potential imaging biomarker for early keratoconus screening.

PURPOSE:To measure structural and microvascular alterations of the optic nerve head in high myopia and correlate the measured parameters with the visual field mean sensitivity defect. METHODS:Thirty-two control eyes and 53 eyes with high myopia were analysed to quantify the thickness of the peripapillary retinal nerve fibre layer (pRNFL) and density of radial peripapillary capillary (RPC) perfusion. The pRNFL thickness, RPC perfusion density and other parameters were compared between the two groups and correlations between structural/microvascular alterations and visual field mean deviation (MD) were determined. Receiver operating characteristic curves were used to determine the diagnostic accuracy of RPC perfusion density and pRNFL thickness in high myopia. RESULTS:Global RPC perfusion density and pRNFL thickness were significantly lower in the high myopic group than in the control group (all p < 0.01). The area under the curve (AUC) of global RPC perfusion density for discriminating high myopia from controls was 0.83, which was higher than that for global pRNFL thickness (0.63). The AUC of RPC perfusion density for discriminating visual field defects (MD < -2 dB) was 0.74 (p < 0.001), while global pRNFL thickness did not show a significant AUC (p = 0.20). For high myopia, the correlation coefficient between global RPC perfusion density and MD was numerically higher (r = 0.41, p = 0.003) than that between global pRNFL thickness and MD (r = 0.29, p = 0.04). In contrast, no statistically significant correlations were observed between RPC perfusion density, pRNFL thickness and MD in the control group (all p > 0.05). CONCLUSIONS:Peripapillary structural and microvascular alterations occur in high myopia with a marked decrease in RPC perfusion density, which may be a more sensitive indicator of visual field defects.

Myopia management in China has expanded rapidly, largely driven by government initiatives to address the escalating myopia burden. Despite the availability of multiple interventions, practitioners face challenges in practicing myopia management due to the heterogeneity in practitioner training, practice settings, and geographical locations. A systematic, standardized, evidence-based practice would enhance myopia management practice. This study explored the perceptions of myopia management practices among practitioners in diverse practice settings and geographical locations within China. It compared the perspectives of optometrists and ophthalmologists on myopia management and how the identified barriers can be addressed. Mixed-method research combining qualitative and quantitative approaches was employed in this study. Stage 1 qualitative study involved face-to-face semistructured interviews with 37 practitioners (27 optometrists and 10 ophthalmologists). Stage 2 involved a quantitative survey of 500 practitioners (401 optometrists, 99 ophthalmologists). Logistic regression models were used to explore possible differences between the perceived barriers. The stage 1 analysis identified common barriers, including limited public awareness, treatment costs, poor compliance, and unpredictable clinical outcomes. Stage 2 validated these themes, emphasizing low public awareness, high treatment costs, lack of compliance, unpredictable outcomes, and excessive product availability. Significant geographical and practice-setting differences were evident, particularly in clinical guidance, commercialization, and instrument costs. Myopia control spectacles were most preferred and considered as the most effective treatment option. This study concluded that effective myopia management practice in China necessitates improvements in public education, addressing treatment costs, enhancing patient compliance, managing unpredictable clinical outcomes, promoting a patient-centered approach, and expanding continuing education. Addressing these issues is crucial in delivering effective, accessible, and standardized myopia management care in different geographical locations and practice settings.