PURPOSE:To assess the role of education on myopia prevalence and refractive status in children enrolled in kindergarten and the early grades of primary school. METHODS:In this population-based, cross-sectional study, children from primary schools and kindergartens were recruited prior to the onset of the COVID-19 pandemic in January 2020. Cycloplegic autorefraction and axial length (AL) were measured in all children. Data on parental myopia, family income and children's lifestyle factors were collected via a standard questionnaire. Mediation analyses were used to explore the influence of education on myopia prevalence, spherical equivalent (SE) and AL. RESULTS:In 2525 kindergarten children (413 in grade 2 /(K2) and 2112 in grade 3 (K3)) and 9018 primary school children (4250 in grade 1 (P1) and 4768 in grade 2 (P2)), myopia prevalence increased with academic grade: 7.6% of K2, 8.7% K3, 17.3% P1 and 29.1% P2. AL was longer in K3 than in K2 children (p<0.001) although SE did not differ (p=0.18). Exploratory analyses suggested statistical mediation by education duration in the association between age and myopia-related outcomes. Among kindergarten children, parental myopia was the sole factor associated with myopia prevalence, SE and AL. For primary school children, schooling duration in P1, age, sex, family income and parental myopia were associated with myopia prevalence, SE and AL. CONCLUSION:The prevalence of myopia significantly increased from kindergarten to primary school with education duration being a possible mediator from primary school onward. Notably, significant changes in AL were observed among kindergarten children.

PURPOSE:There have been conflicting findings on the role of leucocyte telomere length (LTL) in the risk of age-related macular degeneration (AMD). In this study, we evaluated the associations between LTL and the risk of incident AMD and explored whether age, sex and/or genetic predisposition to AMD can modify these associations. METHODS:We conducted a longitudinal cohort study involving 332 123 AMD-free participants with complete baseline covariates and LTL data from the UK Biobank. We employed multivariable Cox proportional hazards models to test the association between LTL and AMD incidence, estimating the HRs and 95% CIs. Genetic risk was assessed using polygenic risk score (PRS). RESULTS:During a median follow-up of 13.63 years, 6754 participants (2.03%) developed AMD. Shorter LTL was not associated with incident AMD risk (HR=1.042, 95% CI: 0.992 to 1.094; p=0.10) after adjusting for multiple confounders. Sex showed an interactive effect with LTL (p=0.01 for interaction) on incident AMD risk, while age and PRS did not modify these associations. We identified a significant association between shorter LTL and incident AMD risk in females (HR=1.093, 95% CI: 1.025 to 1.166; p=0.007), but not in males. Moreover, shorter LTL was associated with thinner photoreceptor segments only in females at both baseline and repeated assessments (β=-0.141 µm, 95% CI: -0.267 to -0.016; β=-0.345 µm, 95% CI: -0.649 to -0.041, p<0.05). CONCLUSIONS:Shorter LTL increased the risk of incident AMD in females, suggesting LTL as a potential biomarker for AMD development with sex-specific function.

RATIONALE:Blepharitis is a common ocular condition characterized by inflammation of the eyelid margins, which can cause irritating symptoms and ocular surface damage. Conventional treatment of blepharitis consists of eyelid hygiene and artificial tears. To suppress inflammation, topical corticosteroids, with or without antibiotics, are frequently prescribed. However, long-term use is limited by side effects such as increased intraocular pressure, glaucoma and/or cataract formation. Newer steroid-sparing topical immunosuppressants have emerged as alternative treatments. OBJECTIVES:To assess the benefits and harms of topical immunosuppressants for blepharitis in adults. SEARCH METHODS:We searched CENTRAL, MEDLINE, Embase, and three trial registries from inception to 6 April 2025. We searched the reference lists of included studies for any additional studies not identified by the electronic searches. There were no date or language restrictions on the selection of eligible studies. ELIGIBILITY CRITERIA:We included randomized controlled trials (RCTs) comparing topical immunosuppressants (corticosteroids, cyclosporine, or tacrolimus) of different doses or carrier, with placebo, no treatment, conventional treatment (lid hygiene, artificial tears) or other topical immunosuppressants in adults with blepharitis. We excluded paired-eye studies and highly specific blepharitis subtypes. OUTCOMES:Our outcomes were: (1) change from baseline in composite (or total) symptom score; (2) change from baseline in tear film breakup time; (3) change from baseline in corneal staining scores; (4) proportion of individuals experiencing symptomatic improvement; (5) reduction in number of or eradication of colonies of positive cultures of bacteria; (6) quality of life measures; (7) economic costs of different topical immunosuppressants; and (8) adverse effects. RISK OF BIAS:We used Cochrane's risk of bias (RoB) 2 tool for all outcomes reported in the summary of findings tables. SYNTHESIS METHODS:Two review authors independently selected trials, extracted data, and assessed risk of bias. We used fixed-effect meta-analysis to combine data and forest plots to assess heterogeneity, effect size, and direction. We used GRADE to assess the certainty of evidence for each outcome. When meta-analysis was not possible, we used narrative synthesis. INCLUDED STUDIES:We included 12 RCTs with 2752 participants (2802 eyes) in total. Six of the trials were conducted in the USA. Topical corticosteroid was the most frequently studied immunosuppressant, followed by cyclosporine and tacrolimus. The point of assessment and duration of treatment ranged from two to 12 weeks. No study measured the proportion of individuals experiencing symptomatic improvement. SYNTHESIS OF RESULTS:We report outcomes of interest for three key comparisons below at four to 12 weeks. No study assessed reduction or eradication of colonies of positive cultures of bacteria, quality of life or economic costs. Topical corticosteroids (with or without antibiotics) versus placebo The evidence is very uncertain about the effects of topical corticosteroids on composite symptom scores (corticosteroids with antibiotics: standard mean difference [SMD] 0.19, 95% confidence interval [CI] -0.10 to 0.48; 3 studies, 205 participants; corticosteroids alone: SMD -0.05, 95% CI -0.31 to 0.20; 2 studies, 232 participants; very low-certainty evidence). No study reported tear breakup time. The evidence is very uncertain about the effects of topical corticosteroids on corneal staining scores (corticosteroids with antibiotics: MD 0.70, 95% CI -1.05 to 2.45; 1 study, 27 participants; corticosteroids alone: MD 0.50, 95% CI -1.22 to 2.22; 1 study, 27 participants); both, very low-certainty evidence. The adverse event of irritation of the ocular surface was reported narratively and was similar between the two groups. The adverse event of ocular hypertension was reported narratively and not detected in either group in one study where it was reported. Topical corticosteroids (with or without antibiotics) versus antibiotics The evidence for topical corticosteroids was inconclusive. Two studies found that topical corticosteroid with antibiotic treatment may reduce symptom scores more than antibiotics alone (SMD -0.77, 95% CI -1.04 to -0.51; 2 studies, 294 participants), whereas one study found that it may have little to no effect (MD 0.40, 95% CI -0.11 to 0.91; 1 study, 201 participants); both, low-certainty evidence. Topical corticosteroids plus antibiotics probably result in greater reduction in corneal staining scores compared with antibiotics alone (MD -1.26, 95% CI -1.56 to -0.96; 1 study, 148 participants; moderate-certainty evidence). However, this effect was not observed for tear breakup time when antibiotics alone are likely to perform better (MD -1.10, 95% CI -1.39 to -0.81; 1 study, 148 participants; moderate-certainty evidence). The adverse event of irritation of the ocular surface was reported narratively, and was similar between the two groups. The adverse event of ocular hypertension was reported narratively, and was higher in the corticosteroid (with or without antibiotics) group. Topical cyclosporine versus placebo Topical cyclosporine may have little to no effect on the composite symptom score compared with placebo, but the evidence is very uncertain (SMD 0.15, 95% CI -0.27 to 0.57; 2 studies, 90 participants; very low-certainty evidence). The evidence is very uncertain about the effect of topical cyclosporine on tear breakup time compared with placebo (invasive time: MD 4.70, 95% CI -0.24 to 9.64; 1 study, 26 participants, although for non-invasive time, it may provide a potential benefit: MD 1.59, 95% CI 1.48 to 1.70; 1 study, 64 participants; both very low-certainty evidence). Topical cyclosporine may improve corneal staining compared with placebo, but the evidence is very uncertain (MD 2.60, 95% CI 0.68 to 4.52; 1 study, 26 participants; very low-certainty evidence). No study reported adverse events. AUTHORS' CONCLUSIONS:Topical corticosteroids, with or without antibiotics, including cyclosporine may make little to no difference in reducing signs and symptoms of blepharitis at four to 12 weeks, compared with placebo or antibiotics alone. Topical corticosteroids are generally well tolerated and associated with minimal risk of ocular surface irritation. Topical corticosteroids plus antibiotics probably improve corneal staining compared to antibiotics alone. When managing patients with blepharitis, clinicians should consider the limited quantity and very low certainty of evidence for topical corticosteroids. Conventional lid hygiene and warm compress remain valid therapeutic options. FUNDING:This Cochrane Review was funded (in part) by the National Eye Institute, National Institutes of Health, USA, the National Institute for Health Research, UK, and the Public Health Agency, UK. REGISTRATION:Protocol available via doi.org/10.1002/14651858.CD013550.

TOPIC:This study aimed to assess the long-term effectiveness of toric intraocular lenses (IOLs) in reducing refractive astigmatism (RA) at and beyond 1 year, along with long-term rotational stability and reoperation rates. CLINICAL RELEVANCE:Toric IOLs are widely used to correct corneal astigmatism during cataract surgery. However, most reports are limited to early postoperative outcomes. METHODS:We conducted a systematic review of long-term outcomes after toric IOL implantation. We searched Ovid Embase and PubMed using the terms "(toric IOL)" AND "(toric intraocular lens)" AND "(long term)" AND "(outcome)" up to April 11, 2025. Studies reporting outcomes of at least 1 year after implantation in otherwise healthy eyes were included. Eyes with ocular comorbidities other than cataracts were excluded. The primary outcomes were residual RA, IOL rotation, and reoperation rates. The study protocol was registered at PROSPERO (CRD420251154641). RESULTS:19 studies comprising 15 cohorts, 3 case series, and 1 case report totalling 1180 participants and 1564 eyes were analyzed. The mean follow-up period was 29.9 ± 23.7 (range 12 to 96) months. The mean residual cylinder was -0.65 ± 0.39 D at 1 year ( P < .0001) and -0.80 ± 0.54 D ( P = .01) at 2 years. The mean IOL rotation was 2.27 ± 1.40 and 2.82 ± 1.73 degrees at 1 and 2 years, respectively. 12 IOLs (0.77%) required repositioning. CONCLUSIONS:Toric IOL implantation maintains effective astigmatism reduction for up to 2 years. Longer-term data remained scarce. The majority of toric IOLs exhibited excellent rotational stability, and the reoperation rate was low.

PURPOSE. To investigate the associations of omics-based biological aging with diabetic retinopathy (DR) and life expectancy among individuals with DR. METHODS. We included 68,672 UK Biobank participants with prediabetes or diabetes in the metabolomic cohort and 8716 in the proteomic cohort, from which biological age was estimated using a metabolomic aging score and proteomic age (ProtAgeGap), respectively. Associations with prevalent and incident DR were assessed using logistic regression and Cox proportional hazards models, respectively. Life expectancy was estimated from survival curves. RESULTS. Cross-sectionally, both the higher metabolomic aging score and ProtAgeGap were associated with a higher risk of prevalent DR. Prospectively, during a median follow-up of 13.40 years, 2491 participants (3.7%) developed DR among those free of DR at baseline in the metabolomic cohort and 358 (4.14%) in the proteomic cohort. Higher biological aging was associated with increased DR risk, with hazard ratios of 1.73 (95% confidence interval [CI], 1.59-1.88) for the metabolomic aging score and 1.12 (95% CI, 1.07-1.17) for ProtAgeGap. These associations were independent of and additive to glycated hemoglobin levels and diabetes duration. At age 45 years, individuals with DR had reduced life expectancy compared with those without DR. Among those with DR, the highest quartile of metabolomic aging was associated with a reduced life expectancy compared with the lowest quartile. CONCLUSIONS. Advanced metabolomic and proteomic aging were associated with a higher risk of DR, particularly in individuals with poor glycemic control or longer diabetes duration, while advanced metabolomic aging was associated with reduced life expectancy among those with DR.

This randomized clinical trial examines data from children who received atropine for myopia to evaluate and compare a taper vs stop treatment discontinuation approach. QuestionDoes tapering vs stopping 0.05% atropine for treatment of myopia result in less progression over 3 years?FindingsIn the Low-Concentration Atropine for Myopia Progression (LAMP) randomized clinical trial, children in the taper group had less myopia progression than those in the stop group over 3 years. Older age and less myopia were associated with less myopia progression, while younger children with more myopia benefited more from the taper approach.MeaningThese findings support tapering atropine concentration before treatment discontinuation, particularly for children at a younger age and with more severe myopia. ImportanceSome but not all clinical trials have found 0.05% atropine effective for myopia control; however, discontinuation management remains unclear.ObjectiveTo evaluate a taper vs stop treatment discontinuation approach.Design, Setting, and ParticipantsThis randomized clinical trial involved children aged 4 to 12 years originally from the Low-Concentration Atropine for Myopia Progression (LAMP) study who were followed up for 8 years. All children who completed year 5 follow-up and were receiving atropine treatment were randomized into taper and stop groups at a 1:1 ratio.InterventionsDuring the prediscontinuation period (year 6), participants in the taper group received 0.05% atropine for 6 months and then 0.025% atropine for another 6 months, while the stop group received 0.05% atropine eye drops for a full year. During the discontinuation period (years 7 and 8), all participants stopped the treatment and were monitored for 2 years.Main Outcomes and MeasuresMyopia progression in the taper and stop groups over 3 years; proportion of good response to treatment discontinuation, defined as spherical equivalent (SEP) progression -0.5 diopter (D) or more in both eyes during the discontinuation period; and associated factors with myopia progression over 3 years.ResultsAmong 246 children who completed the year 5 follow-up, 180 children (73.2%) went on to complete 8 years of follow-up. The mean (SD) age was 13.47 (1.63) years; there were 139 male children (56.5%) and 107 female (43.5%). Over 3 years, SEP and axial length (AL) elongation were faster in the stop group than in the taper group: -0.78 D vs -0.54 D, respectively (difference, -0.24 D; 95% CI, -0.46 to -0.03 D; P = .02) and 0.44 mm vs 0.33 mm, respectively (difference, 0.11; 95% CI, 0.03 to 0.19 D; P = .01). The proportion of good response to treatment discontinuation in the taper group was greater than in the stop group (65.1% vs 42.6%, respectively; P = .003). Younger age and more myopic spherical equivalent/longer AL at prediscontinuation were associated with faster SEP and AL elongation over 3 years. Notably, the younger the age and the more myopic the spherical equivalent, the greater the estimated mean differences of SEP/AL elongation between the taper and stop groups.Conclusions and RelevanceThis study found that over 3 years, the participants in the taper group had less myopia progression than the stop group, particularly in children who were younger and had more myopia. However, to our knowledge, the clinical relevance of this approximately 0.25-D difference between treatment groups is not well understood from the current medical literature.

To investigate retinal nerve fibre layer (RNFL) and ganglion cell layer (GCL) thickness in different attention-deficit/hyperactivity disorder (ADHD) subtypes and their association with ADHD symptom severity. This is a cross-sectional study included children aged 6–8 years in Hong Kong. ADHD diagnoses were made by psychiatrists based on ICD-10 criteria. Among 6431 children included in the study, 309 (4.80

Topic: This study systematically evaluates changes in retinal and choroidal microvasculature with increasing Clinical Relevance: Conflicting results in reported studies on the changes in retinal and choroidal microvasculature with increasing myopia severity require comprehensive analysis to guide patient management. Methods: The PubMed, Embase, and Web of Science databases were thoroughly searched for studies published before May 8, 2025 on retinal or choroidal changes across different myopia severities. Included were studies with cross-sectional or prospective case-control and cohort designs that reported outcomes of foveal avascular zone (FAZ) area and vessel densities (VD) in the retina and choroid. The risk of bias was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality tools. Funnel plot with Egger test assessed potential publication bias. Meta-regressions were conducted to identify potential moderators in subgroup meta-analyses with high heterogeneity. The protocol was registered with the International Prospective Register of Systematic Reviews (PROS-PERO): CRD42023402550. Results: A total of 47 studies comprising 7293 eyes were included. Highly myopic eyes demonstrated significantly enlarged FAZ area in both the superficial capillary plexus (SCP) (P = 0.049, standard mean difference [SMD]: 0.37, 95% confidence interval [CI]: [0.00, 0.74], I 2 = 82%) and deep capillary plexus (DCP) (P = 0.001, SMD: 0.61, 95% CI: [0.24, 0.98], I 2 = 83%). Macular VD was significantly reduced in the SCP for moderate and high myopia (HM) subgroups (P = 0.003 and P < 0.001, respectively) and in the DCP for the HM subgroup (P < 0.001). Significant VD reductions were also observed in parafoveal (SCP: P < 0.001, DCP: P = 0.012) and perifoveal (SCP: P = 0.006; DCP: P < 0.001) regions in the HM subgroup in both plexuses. Peripapillary VD showed consistent reductions across mild, moderate, and HM subgroups (all P <= 0.033). No significant differences were observed in choriocapillaris VD or flow area. Conclusions: This meta-analysis revealed significantly enlarged FAZ areas and reduced VD in the macular and peripapillary regions with increasing myopia, especially in HM. These findings enhance the understanding of myopiarelated fundus microvascular changes, guiding the clinical management and screening of patients with HM. Ophthalmology Science 2026;6:100921 (c) 2025 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in the aging population. Although frailty has been recognized as a potential risk factor, previous studies relying on static assessments cannot capture its dynamic nature. This study aims to prospectively evaluate the association between dynamic frailty trajectories and incident AMD. The baseline cohort included 462,573 UK Biobank participants who were free of AMD and had frailty phenotype (FP) data at enrollment. Among them, 53,059 with at least one follow-up FP assessment comprised the trajectory cohort. Participants were categorized as nonfrail, prefrail, or frail based on their FP scores. Annualized frailty progression (ΔFP/year) was estimated via linear regression. Cox models assessed hazard ratios (HRs) and 95

Age-related macular degeneration (AMD) imposes a substantial burden of disability. Metabolic disturbances are associated with increased AMD risk. Here we evaluate the metabolic vulnerability index (MVX), derived from inflammation- and malnutrition-related markers, and MetaboHealth score, developed from metabolomics-based biological aging, as biomarkers for AMD incidence. UK Biobank participants with metabolomic data and no AMD at baseline were included. Cox proportional hazards models were used to estimate the associations of MVX and MetaboHealth with incident AMD, adjusting for demographic, socioeconomic, lifestyle, and comorbidity factors. Interactions between AMD polygenic risk score (PRS, field 26,204) and both scores were evaluated on both multiplicative and additive scales using the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI). Cross-sectional linear models were adopted to assess the associations of both scores with AMD-related retinal traits, including photoreceptor segment (PS) and retinal pigment epithelium–Bruch’s membrane thicknesses. Over a median follow-up of 13.66 years, AMD occurred in 5509 of 265,133 participants for MVX analysis and in 5498 of 264,352 participants for MetaboHealth analysis. Higher quintiles of MVX and the MetaboHealth score demonstrated a dose-dependent association with increased AMD risk (P for trends < 0.001), with hazard ratios (HRs) of 1.17 (95

AIMS:To investigate the interaction and combined effects of cardiovascular health (CVH) and socioeconomic status (SES) on incident cataract risk. METHODS:This prospective cohort study included 236 248 UK Biobank participants free of cataract at baseline and with complete data on SES and CVH. Incident cataract was ascertained through hospital inpatient and self-reported records. SES was derived from household income, employment and education using latent class analysis, while CVH was assessed via the Life's Essential 8 (LE8) score. Cataract risk was evaluated using multivariable Cox regression, with interaction and joint effects analyses performed to assess the interplay between SES and CVH. RESULTS:This analysis involved 236 248 participants with an average age of 55.5 years (range: 38-73); 51.6% were female and 95.6% were of white ethnicity. Over a median follow-up period of 11.7 years, 26 791 participants (11.3%) developed cataract. Compared with the high SES group, participants with low SES had a significantly higher risk of cataract (HR, 1.30; 95% CI 1.25 to 1.35). Significant additive and multiplicative interactions between SES and CVH on cataract risk were observed. Better CVH substantially mitigated the adverse association of low SES with cataract. Notably, individuals with low SES and poor CVH showed the highest cataract risk (HR, 1.74; 95% CI 1.57 to 1.93) in contrast to those with high SES and optimal CVH. CONCLUSIONS:Implementing interventions aimed at enhancing both SES and CVH may prove beneficial in preventing or delaying cataract onset. Adhering to the LE8 guidelines to maintain optimal CVH has the potential to alleviate a significant portion of the excess cataract risk associated with socioeconomic disadvantage.

Abstract Background Understanding how retinal morphological features are associated with the risk of developing depression and anxiety disorders holds significant implications for public health and early detection strategies. This study aims to investigate the association between optical coherence tomography (OCT)-detected retinal features and the incidence of depression and anxiety. Methods This cohort study was conducted using data from UK Biobank participants aged 40–70 years who underwent retinal OCT imaging at recruitment. Baseline retinal morphological features, including the retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL), photoreceptor layer (PRL), retinal pigment epithelium (RPE), and macular thickness, were segmented from macular-centered OCT images. Depression and anxiety disorders were identified using International Classification of Diseases (ICD) codes. Cox proportional hazards regression models were used to assess the association of retinal features with incident depression and anxiety, with the full model adjusting for demographic, lifestyle, and comorbid factors. Results A total of 36,220 participants were included (mean [SD] age, 55.90 [8.22] years, 47.8% male). Over a median follow-up duration of 12.5 years, 1340 new cases of depression and 1373 new cases of anxiety were observed. In fully adjusted Cox hazard regression models, each standard deviation (SD) increase in GCIPL and macular thickness was associated with a lower risk of incident depression (HR [95%CI], 0.92 [0.87, 0.97]; and 0.91 [0.86, 0.96], respectively). The associations of GCIPL and macular thickness with incident depression were more pronounced among females. On the other hand, there was no association between retinal features and incident anxiety disorders in the fully adjusted model. Conclusions Thinner GCIPL and macular thickness were independently associated with increased risk of depression, especially in females. Our findings highlight a potential role of OCT-detected retinal features as additional biomarkers for at-risk stratification of depression.

Objective:To systematically identify plasma proteins associated with cataract development and explore their potential causal relationships. Design: Prospective population-based cohort study with integrated Mendelian randomization (MR) and colocalization analyses. Participants: Forty-nine thousand, five hundred and eighty-one UK Biobank participants free of cataract at baseline. Methods:Cox proportional hazards models were used to assess associations between 2920 plasma proteins and cataract risk, followed by MR to evaluate causal relationships. Colocalization analysis was conducted to examine whether identified protein-cataract associations shared causal genetic variants. Main Outcome Measures: Incident cataract. Results:Of the 2920 plasma proteins analyzed, 58 demonstrated significant associations with cataract risk (P < 1.71×10-5, Bonferroni-corrected threshold). Beta-crystallin B2 (CRYBB2) showed the most robust association (hazard ratio: 1.60; 95% confidence interval: 1.55-1.66, P = 5.28×10-164). Mendelian randomization analysis provided evidence supporting causal relationships for 4 proteins (CRYBB2, V-set and immunoglobulin domain-containing protein 4, mevalonate kinase, and metalloproteinase inhibitor 1) with cataract, with genetically predicted CRYBB2 levels showing a significant association with cataract risk, which is strongly supported by colocalization evidence. Functional enrichment analyses revealed involvement of biological pathways related to immune activation, cell fate decision, and structural remodeling in cataract development. Conclusions:This study identified distinct plasma proteomic signatures associated with incident cataract, offering novel insights into cataract pathogenesis and highlighting potential targets for early detection and therapeutic development. Financial Disclosures:The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To investigate whether secondhand smoke (SHS) exposure alters the ocular surface microbiome (OSM) in children and to explore potential functional consequences. Methods: 432 children aged 3-18 years were enrolled, including 111 SHS-exposed and 321 unexposed controls. Conjunctival swabs were collected and analyzed by 16S rRNA gene sequencing targeting the V3-V4 region. Sequencing data were processed with Qiime2 and DADA2, and taxonomic classification was based on the SILVA 138 database. Alpha diversity and beta diversity were compared using t-tests and PERMANOVA. Differentially abundant taxa were identified using LEfSe, and predicted functional pathways were analyzed using PICRUSt2 with MetaCyc and KEGG annotation. Results: SHS-exposed children showed significantly altered alpha diversity (Chao1, Shannon, Simpson) and distinct beta diversity compared with controls. LEfSe analysis revealed enrichment of several phyla and genera, including Lactobacillus and Rubellimicrobium in controls, with no taxa enriched in SHS-exposed children. Functional prediction showed enrichment of metabolism pathways such as L-methionine salvage, biphenyl, heparin, and toluene degradation and immune-related pathways, including complement activation, T and B cell receptor signaling, MAPK, and TGF-beta pathways. Conclusion: SHS exposure in children is associated with significant alterations in ocular surface microbial diversity, community structure, and predicted functional pathways related to environmental stress and immune signaling. These findings highlight the sensitivity of the pediatric OSM to SHS exposure and underscore the importance of minimizing environmental tobacco smoke to protect children's ocular health.

Objective:To investigate the associations of plasma metabolites with incident rhegmatogenous retinal detachment (RRD). Design:A prospective cohort study. Subjects:A total of 213 173 UK Biobank participants. Methods:Plasma metabolomics were quantified using the Nightingale Health platform based on proton nuclear magnetic resonance spectroscopy, covering 251 metabolites. Associations with incident RRD were assessed using Cox proportional hazard models and restricted cubic splines. Two-sample Mendelian randomization analyses were conducted to assess whether genetically predicted metabolite levels showed patterns consistent with the observational associations. A metabolomic risk score (MRS) was constructed based on significant metabolites to evaluate their combined effects on RRD. Principal component analysis was used to test whether the metabolite profiles improved RRD risk prediction. Main Outcome Measures:Incident RRD, defined as the first recorded diagnosis during follow-up. Results:Over a median follow-up of 11.10 years, 1111 participants developed RRD. Seventeen metabolites were significantly associated with RRD after false discovery rate correction (P FDR < 0.05), including 11 high-density lipoprotein (HDL)-associated metabolites, 4 fatty acids, 1 very low-density lipoprotein (VLDL)-associated metabolite, and creatinine. Among them, omega-3, docosahexaenoic acid (DHA), and 11 HDL-associated metabolites were inversely associated with RRD, whereas monounsaturated fatty acids to total fatty acids, creatinine, and free cholesterol to total lipids in large VLDL showed positive associations. Mendelian randomization analyses provided supportive genetic evidence consistent with the inverse associations for omega-3, DHA, phospholipids in very large HDL, and total lipids in large HDL. Compared with participants in the low MRS group, those with high MRS had a significantly higher risk (hazard ratio = 1.608, 95% confidence interval: 1.187-2.178, P = 0.002). However, the RRD-associated metabolites did not materially improve model discrimination (C-index 0.694-0.697 across models). Conclusions:This study identified 17 plasma metabolites associated with RRD risk, particularly omega-3 and HDL-related lipids. Although metabolomics did not improve risk prediction, these findings provide exploratory evidence of systemic metabolic patterns associated with RRD risk. Financial Disclosures:The authors have no proprietary or commercial interest in any materials discussed in this article.

BACKGROUND:Greater greenspace exposure may be associated with a lower risk of childhood myopia. However, most studies rely on satellite-derived greenness indices that cannot capture ground-level visual exposure or differentiate greenspace components. Whether specific greenspace components are differentially associated with myopia remains unclear. OBJECTIVES:To examine associations between street-view-measured greenspace components and childhood myopia. METHODS:This cross-sectional and prospective cohort study included children aged 6 to 8 years from a population-based study in Hong Kong (2015-2021). Incident myopia was assessed among children without myopia at baseline who completed 3-year follow-up. Applying deep learning segmentation to street-view imagery, we quantified four specific greenspace components (trees, grass, plants, and fields) within 500-m residential and school buffers. A time-weighted "home-school" metric was generated to represent cumulative daily exposure. Myopia was defined as cycloplegic spherical equivalent refraction ≤-80.50 diopters. Associations were estimated using multivariable logistic regression and Cox proportional hazards regression models with school-level cluster-robust standard errors, adjusting for sociodemographic and behavioral covariates. RESULTS:Among 20,422 children, 5,623 (27.5%) had myopia at baseline. Cross-sectionally, higher cumulative exposures to home-school-trees (OR, 0.94; 95% CI, 0.90-0.97), home-school-grass (OR, 0.95; 95% CI, 0.90-0.99), and home-school-plants (OR, 0.93; 95% CI, 0.89-0.97) were associated with lower myopia prevalence, while home-school-fields increased myopia odds (OR, 1.06; 95% CI, 1.01-1.10). In prospective analyses of 2,667 children, only home-school-plants consistently associated with reduced incident myopia (HR, 0.89; 95% CI, 0.83-0.96), whereas home-fields increased incident myopia risk (HR, 1.05; 95% CI, 1.01-1.09). Protective effects of grass and plants were more pronounced among children with higher near-work time and those from lower-income families (both P for interaction < 0.05). CONCLUSION:Specific street-view greenspace components were differentially associated with childhood myopia. These findings suggest the potential importance of considering specific greenspace components in urban planning strategies relevant to childhood myopia prevention.

Abstract This study aims to investigate the associations of multiple single-nucleotide polymorphisms (SNPs) with the risk and magnitude of corneal astigmatism (CA) in children. A total of 14 SNPs were genotyped in 2167 Chinese children aged 4–11 years, recruited from the Hong Kong Children Eye Study. The main outcomes were allelic associations with the risk of significant CA (≥ 1.0D) and magnitude of CA. Allelic associations with the risk of significant CA and magnitude of CA, respectively, were evaluated in additive model through age- and sex-adjusted logistic and linear regression. Subgroup analysis included sex-stratified analysis and linear trend test across age. FMNL2 rs1579050 was associated with the magnitude of CA (β = 0.158D, Pc = 0.045), and with the magnitude of CA (β = 0.301D, Pc = 0.02) in age quartile 4 in the age subgroup analysis. PDGFRA rs17084051 (P = 0.04) and ZC3H11B rs7525202 (P = 0.01) were associated with linear decrease in CA magnitude across age (P < 0.05 considered statistically significant). This study revealed FMNL2, PDGFRA and ZC3H11B as potential genetic factors for corneal astigmatism among Chinese children, with age-specific effects. Further validation of the findings in large cohorts should be warranted.

Background/AimsWe aim to report the risk factors, clinicopathological characteristics, treatment modalities, and outcomes of ocular surface squamous neoplasia (OSSN) and squamous papilloma (SQP) in a Chinese population.MethodsA retrospective cohort study was performed on subjects with histologically proven OSSN and SQP between April 2012 and August 2022 at two hospitals in Hong Kong.ResultsFifty eyes of 48 subjects were analysed, of which 24 were OSSN. The overall ten-year annual incidence rate was 0.34 per 100,000 persons. Men were more commonly affected. Moderate-to-severe dysplastic lesions were more frequently associated with pterygia or pinguecula (p = 0.034), diffuse growth (p = 0.0027), and involvement of the cornea and limbus (p = 0.0037) than benign lesions. Malignant lesions more frequently involved the fornix (p = 0.0086) and involved the inferior quadrant, although the latter did not reach statistical significance. There was no shift in surgical treatment patterns between the periods 2012-2016 and 2017-2022. Recurrence-free survival probabilities were 90% at 6 months and 87.0% at 1, 2 and 3 years, with a median follow-up duration of 24 months (IQR 2-48 months). No tumour-related mortality was recorded.ConclusionThe incidence of OSSN and SQP has remained stable over the last decade in our locality, where the prevalence of the Human Immunodeficiency Virus infection has been low. Male sex and a history of pterygia and/or pinguecula were associated with OSSN in our population. The majority achieved complete resolution following excision with or without adjuvant therapy.

Purpose:This study aimed to characterize the shared genetic architecture and modifiable correlates between myopia and retinal-optic nerve diseases (RONDs). Design:Genetic pleiotropy analysis and population-based cohort study. Participants:A total of 81 491 UK Biobank participants and summary statistics from large-scale genome-wide association studies were included. Methods:We examined associations between myopia and 5 common RONDs using population-based analyses of prevalent and incident outcomes, followed by cross-trait genetic analyses, locus-level annotation, colocalization, and enrichment analyses. Among myopic individuals, modifiable correlates and gene-environment interactions were evaluated, and Mendelian randomization was used as complementary evidence for selected associations. Main Outcome Measures:Myopia and RONDs. Results:The primary findings were that, in baseline prevalent analyses, myopia was associated with higher risks of retinal detachment (RD) and primary open-angle glaucoma (POAG), but a lower risk of primary angle-closure glaucoma (PACG), with evident risk gradients across myopia severity, especially for RD. Diabetic retinopathy (DR) risk estimates were <1.0 across myopia severity categories but were not statistically significant. A U-shaped association was observed between refractive status and age-related macular degeneration, with elevated risk in both high myopia and hyperopia. Incident analyses during follow-up showed broadly consistent patterns. As supportive genetic evidence, cross-trait analyses revealed significant genetic correlations and overlaps between myopia and RONDs, identifying 66 pleiotropic loci and 115 candidate genes, with enrichment in immune-inflammatory, receptor-mediated signaling, and retinal developmental pathways. Among myopic individuals, exploratory analyses further showed that prevalent myopia-ROND comorbidity was associated with various modifiable correlates spanning health status, lifestyle, diet, mental health, sleep patterns, and medication use, and that 7 environmental factors interacted with 5 pleiotropic variants. Mendelian randomization analyses provided complementary and hypothesis-supporting evidence consistent with a positive association of myopia with RD and an inverse association with PACG, whereas findings for DR and POAG required more cautious interpretation because of pleiotropy or heterogeneity. Conclusions:This study reveals a shared genetic architecture and identifies modifiable correlates linking myopia to five common RONDs. These findings provide new insights into shared susceptibility patterns and offer a framework for future mechanistic, validation, and prevention-oriented research in myopic populations. Financial Disclosures:The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.