PURPOSE:Age-related macular degeneration (AMD) is a leading cause of central vision loss worldwide. Emerging evidence suggests that targeting dopaminergic pathways may influence AMD progression. This study evaluates whether levodopa ± carbidopa or dopamine receptor D2 (DRD2) agonists are associated with reduced risk of conversion to neovascular AMD (nAMD). DESIGN:Population-based clinical cohort study. PARTICIPANTS:Adults aged ≥18 years diagnosed with non-nAMD between May 2005 and May 2025, within the TriNetX US Collaborative Network, a federated electronic health record database spanning 69 healthcare organizations. METHODS:This retrospective cohort study emulated four distinct target trials comparing new users of (1) levodopa (± carbidopa) or (2) DRD2 agonists (pramipexole, ropinirole, bromocriptine, rotigotine, or cabergoline) to new users of two comparators (pantoprazole or gabapentin). Patients with prior nAMD or prescriptions of other dopamine-enhancing agents (eg, selegiline, rasagiline, tolcapone) were excluded. Each exposure group was independently matched to comparators using 1:1 propensity score matching for selected demographics, social factors, comorbidities, and AMD stage. MAIN OUTCOME MEASURES:The primary outcome was 3-year risk of conversion from non-nAMD to nAMD. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. An α level of 0.05 was used to determine statistical significance. RESULTS:Patients prescribed levodopa ± carbidopa had a reduced 3-year risk of conversion to nAMD relative to their matched counterparts prescribed pantoprazole (levodopa n = 1312, control n = 1312; HR 0.67; 95% CI, 0.45-0.98) and gabapentin (levodopa n = 1675, control n = 1675; HR 0.69; 95% CI, 0.50-0.95). No significant difference was observed in 3-year risk of conversion to nAMD between DRD2 agonists use relative to pantoprazole (DRD2 n = 1603, control n = 1603; HR 0.81; 95% CI, 0.58-1.13) or gabapentin (DRD2 n = 2779, control n = 2779; HR 0.92; 95% CI, 0.72-1.19). CONCLUSIONS:In this cohort study, levodopa ± carbidopa use was associated with lower 3-year risk of conversion to nAMD in two independent matched comparisons, whereas DRD2 agonists were not associated with significant differences in risk. These findings suggest dopaminergic signaling may influence AMD progression and warrant further prospective investigation.

Purpose: To provide updated survival data for patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) and identify associated prognostic factors. Methods: An aggregated electronic health records research network was used to identify patients with a diagnosis of PDR who underwent PPV between 2009 and 2019 and a control group of patients with PDR without a history of PPV. Groups were propensity score matched for age, sex, race, ethnicity, and HbA1c. Main outcomes included survival rates at 3, 5, and 10 years using the Kaplan-Meier life table method. Additional analyses were performed to assess if survival rates differed in patients with PDR by PPV indication (vitreous hemorrhage [VH] or tractional retinal detachment [TRD]). Results: A total of 8637 patients were included. The 3-, 5-, and 10-year survival rates in patients with PDR after PPV were 89.2%, 80.9%, and 52.8%, respectively. Survival rates in patients with PDR with a history of PPV vs without a history of PPV were lower at 3 (88.7% vs 89.9%; P = .03), 5 (80.2% vs 82.6%; P < .01), and 10 years (51.4% vs 55.8%; P < .01). Survival rates were similar between patients who underwent PPV for VH or TRD at 3 (90.4% vs 88.7%; P = .05), 5 (82.7% vs 81.0%; P = .10), and 10 years (53.0% vs 53.4%; P = .75). Conclusions: Despite major advances in diabetes care, the long-term survival rates in patients with PDR after PPV have remained stable the last 2 decades, emphasizing the need for multidisciplinary evaluation and prompt cardiovascular and renal optimization.

PURPOSE:To evaluate the risk of diabetic retinopathy (DR) progression and associated ophthalmic complications after YAG laser capsulotomy in patients with nonproliferative DR (NPDR) after cataract surgery. SETTING:Multicenter study using deidentified electronic health records from 69 U.S. healthcare organizations across outpatient and academic ophthalmology settings. DESIGN:Retrospective cohort study using propensity score matching to balance baseline characteristics. METHODS:Patients aged 18 years or older with type 1 or 2 diabetes and NPDR who underwent cataract surgery with or without subsequent YAG laser capsulotomy were identified. Patients were followed for 1-year postcataract surgery. Exclusion criteria included less than 6 months of follow-up. Primary outcomes included development of proliferative DR (PDR), vitreous hemorrhage (VH), tractional retinal detachment (TRD), neovascular glaucoma, and need for panretinal photocoagulation (PRP) or pars plana vitrectomy. RESULTS:10 750 patients (10 750 eyes) were included after matching: 5375 YAG-treated and 5375 control eyes. At 1 year, YAG-treated patients had higher risk of PDR (hazard ratio [HR], 1.91; 95% CI, 1.67-2.18), VH (HR, 1.40; 95% CI, 1.15-1.72), TRD (HR, 2.04; 95% CI, 1.32-3.13), and PRP (HR, 1.48; 95% CI, 1.14-1.91). A secondary analysis of patients with ≥5 years of NPDR showed similar elevated risks. CONCLUSIONS:YAG laser capsulotomy in patients with NPDR is associated with increased risk of DR progression and vision-threatening complications. Ophthalmic screening and close follow-up are recommended in this population after YAG treatment.

PURPOSE:To evaluate whether systemic interleukin-6 (IL-6) inhibitor use is associated with reduced risk of incident diabetic retinopathy (DR), DR progression, vision-threatening complications, and retinal interventions in adults with diabetes. DESIGN:Retrospective propensity score-matched cohort study. PARTICIPANTS:Adults with type 1 or type 2 diabetes were identified using the US TriNetX electronic health record network from January 1, 2004, through May 30, 2026. After 1:1 propensity score matching, the primary analysis included 2,605 diabetic patients receiving IL-6 inhibitors and 2,605 matched diabetic controls. The secondary analysis included 1,057 matched patients per group with known nonproliferative diabetic retinopathy (NPDR). METHODS:Cohorts were matched on baseline characteristics, medication exposure, inflammatory disease burden, and ophthalmic history. The primary analysis assessed incident DR among patients without baseline retinopathy. Secondary analyses evaluated progression from NPDR to proliferative diabetic retinopathy (PDR) and compared IL-6 inhibitors with alternative immunosuppressants. Sensitivity analyses compared IL-6 inhibitors with intravitreal steroid injections among patients with severe NPDR or PDR and evaluated outcomes by IL-6 inhibitor occurrence frequency. MAIN OUTCOME MEASURES:Risk ratios for incident NPDR, PDR, vitreous hemorrhage (VH), diabetic macular edema (DME), neovascular glaucoma (NVG), and receipt of anti-vascular endothelial growth factor (anti-VEGF) injections, panretinal photocoagulation (PRP), and pars plana vitrectomy (PPV) at 1, 3, and 5 years. RESULTS:In the primary analysis, IL-6 inhibitor use was associated with significantly lower 5-year risks of NPDR (RR: 0.50; 95% CI: 0.42-0.60), PDR (RR: 0.47; 95% CI: 0.35-0.61), DME (RR: 0.37; 95% CI: 0.27-0.51), and VH (RR: 0.41; 95% CI: 0.28-0.61), with no significant difference in NVG. Anti-VEGF therapy, PRP, and PPV use were also significantly lower at 5 years. Among patients with baseline NPDR, IL-6 inhibitor use was associated with lower 5-year risks of progression to PDR, DME, VH, NVG, and retinal interventions. Findings were consistent in active comparator analyses. CONCLUSIONS:Systemic IL-6 inhibitor use was associated with lower risk of incident DR, DR progression, vision-threatening complications, and retinal interventions over 5 years, with findings persisting in active comparator and sensitivity analyses. Prospective studies are needed to evaluate whether IL-6 pathway modulation may have a therapeutic role in diabetic eye disease.

PURPOSE:To determine whether adjunctive 0.025% povidone-iodine irrigation during pars plana vitrectomy might improve ocular morbidity in infectious endophthalmitis compared to standard irrigation. METHODS:Multicenter, retrospective, comparative cohort study (2019-2024) at four tertiary referral centers. 63 eyes from 63 patients with presumed infectious endophthalmitis requiring vitrectomy were included. Povidone-iodine group (n=32) received 0.025% povidone-iodine in balanced salt solution; control group (n=31) received standard irrigation. Primary outcome was visual acuity at 3 and 6 months. Secondary outcomes included reoperation rates and adverse events. RESULTS:Groups were similar in age, presenting visual acuity (20/2890 vs 20/4000), and culture positivity (13/32 [40.6%] vs 13/31 [41.9%]). Povidone-iodine group was associated with better median visual acuity at 3 months (20/138 [0.84 logMAR] vs 20/3000 [2.21 logMAR], P=.017) and 6 months (20/60 [0.48 logMAR] vs 20/400 [1.34 logMAR], p=.010). Vision improved in 96.7% (29/30) vs 48.3% (14/29) at 6 months (p<0.001). Clinically meaningful improvement of at least 0.3 logMAR occurred in 80.0% of PI-treated eyes (24/30) and 41.4% of control eyes (12/29; p=.003). Reoperation rates were statistically similar, but slightly increased in the povidone-iodine group (28.1% vs 16.1%, p=.365). No ocular toxicity was attributed to povidone-iodine. CONCLUSION:Adjunctive 0.025% povidone-iodine irrigation during vitrectomy was associated with significantly improved visual outcomes without observed ocular toxicity. This simple, cost-effective intervention may benefit endophthalmitis management, though etiologic imbalances between groups limit attribution of this benefit to PI irrigation alone.

Introduction: Retinal vein occlusion (RVO) is a condition in which one of the veins supplying the retina is occluded, causing acute vision changes. This event is often a signal of underlying cardiovascular disease and increases the risk for future adverse cardiovascular events. Aim & method: This mini-review aims to provide an overview of pertinent studies investigating the relationship between RVO and increased risk of cardiovascular events and mortality, as well as treatments proposed to mitigate this risk. Results: Pubmed database was searched for studies on RVO and risk of cardiovascular and mortality. 41 studies met criteria for inclusion. Following RVO, there was found to be a consistently elevated risk for myocardial infarction and cerebrovascular event, highest in the first year. There was also a mildly increased risk post-RVO for deep vein thrombosis and atrial fibrillation, but not for pulmonary embolism. Recent studies have also suggested that there is an increased risk for all-cause mortality after RVO. Central RVO may be more strongly associated with cardiovascular events as compared to branch RVO. To mitigate cardiovascular morbidity and mortality, treatment has been aimed at preventing atherosclerosis. Statin therapy post-RVO was found to significantly decrease cardiovascular risk. Conclusion: While the relationship between RVO and cardiovascular disease has yet to be fully elucidated, evidence indicates that RVO is a strong predictor for future cardiovascular events, particularly acute myocardial infarction and cerebrovascular event. Ophthalmologists should work closely with primary care physicians and cardiologists following RVO to ensure proper risk assessment and treatment. These preventative interventions could reduce mortality and morbidity after RVOs.

PURPOSE:To characterize the prevalence and incidence of mental health disorders in pediatric patients with inherited retinal diseases (IRDs). METHODS:This retrospective cohort study utilized the TriNetX research network to identify, using ICD-10 codes for retinal dystrophies, 74,317 unique IRD patients (16% pediatric) between January 2016 and December 2024 with at least 6 months' follow-up after diagnosis. RESULTS:Anxiety disorders were most prevalent (24.6%). In pediatric patients, anxiety disorders affected 15.3%, and major depression affected 7.7%. Mental health burden increased progressively during adolescence, with anxiety rising from 8.2% in early childhood to 21.4% in late adolescence. Among pediatric patients, Black children demonstrated 2.5-fold higher rates of mental health disorders compared with White children (38.4% vs 15.2%). CONCLUSIONS:This large-scale analysis of mental health in IRDs provides the first population-based characterization of the mental health burden across the IRD spectrum, including in pediatric patients. These findings underscore the need for integrating standardized mental health screening protocols into routine IRD management.

PURPOSE:To evaluate the temporal association between retinal vein occlusion (RVO) and the development of epiretinal membrane (ERM) including subsequent ERM peel. DESIGN:Retrospective cohort study. PARTICIPANTS:After propensity score matching (PSM) and applying inclusion/exclusion criteria, 19,172 patients with branch retinal vein occlusion (BRVO) and 14,974 with central retinal vein occlusion (CRVO) were compared with matched controls. METHODS:Data was extracted using a national clinical database. Patients with BRVO or CRVO were compared with individuals without RVO (control) for the development of main outcomes measures. Secondary analyses examined RVO cohorts with anti-VEGF injections: BRVO-T (anti-VEGF-treated) and CRVO-T versus their respective untreated counterparts. MAIN OUTCOME MEASURES:Relative risk (RR) of incident ERM formation and ERM peel at multiple time points from 3 months to 5 years. RESULTS:During the 5-year study period, BRVO and CRVO cohorts had the highest risk for ERM formation at 3 months compared with their respective controls (BRVO: RR = 4.54; CRVO: RR = 4.90; P < .0001). The risk of ERM peel was greatest at one year for BRVO (RR, 3.83; P < .0001) and 3 years for CRVO (RR, 3.91; P < .0001). In the secondary analysis, anti-VEGF treatment was associated with higher ERM rates at 3 months in BRVO-T (RR, 5.60; P < .0001) and CRVO-T (RR, 6.80; P < .0001) cohorts. The incidence of ERM peel peaked later in treated eyes at 5 years (BRVO-T: RR, 3.30; P = .0004; CRVO-T: RR, 2.60; P = .0075) compared with untreated eyes. CONCLUSIONS:ERM formation typically occurs during the first 3 months following RVO, while surgical intervention peaks later, as early as one year in untreated eyes, and 5 years in eyes treated with anti-VEGF agents. Treated patients also exhibited an elevated risk for ERM development, which could be influenced by differences in baseline disease severity rather than a clear treatment effect.

PURPOSE:To evaluate the association between atopic dermatitis (AD) and risk of retinal detachment (RD), postoperative proliferative vitreoretinopathy (PVR), and complex RD repair after initial RD repair. DESIGN:Retrospective, population-based cohort study. PARTICIPANTS:Adults aged ≥18 years with and without a diagnosis of AD identified from March 2006 to March 2026. METHODS:This retrospective cohort study used data from a federated health research network containing aggregated, deidentified electronic health records from 72 US health care organizations. Patients with AD, identified by International Classification of Diseases, 10th revision codes, were matched 1:1 to controls without documented AD using propensity scores, balancing for demographic characteristics, ocular comorbidities, tobacco use, and systemic corticosteroid exposure. Two analyses were performed: (1) risk of RD diagnosis and RD repair after initial AD diagnosis or outpatient clinic visit; and (2) risk of postoperative PVR and complex RD repair after initial RD repair. MAIN OUTCOME MEASURES:Outcomes for the first analysis included rates of RD repair and RD diagnosis at 1 and 5 years after the index event. Outcomes in the second analysis included rates of PVR (International Classification of Diseases, 10th revision: H35.2) and complex RD repair (Current Procedural Terminology: 67113) within a 180-day period of initial RD repair. RESULTS:A total of 285 408 subjects with a history of AD and 2 856 666 without a history of AD were identified, with 274 547 remaining in each cohort after matching. At 5 years, compared with controls, patients with AD demonstrated increased rates of RD diagnosis (0.7% vs. 0.2%; hazard ratio [HR] 2.74; 95% confidence interval [CI], 2.50-3.00; P < 0.0001) and RD repair (0.2% vs. 0.04%; HR, 4.56; 95% CI, 3.76-5.57; P < 0.0001). In the RD repair cohort (n = 1689 per cohort), AD was associated with increased risk of PVR diagnosis (5.9% vs. 4.0%; HR, 1.45; 95% CI, 1.12-1.87; P = 0.002) and complex RD repair (8.9% vs. 6.6%; HR, 1.36; 95% CI, 1.10-1.62; P = 0.002) at 6 months. CONCLUSIONS:A history of AD is associated with a greater risk of RD and postoperative PVR; however, electronic health record data cannot confirm if PVR occurred in the operative eye. These findings suggest that patients with AD may warrant heightened vigilance for RD symptoms and closer postoperative monitoring after RD repair. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVE:Management of inherited retinal diseases (IRDs) traditionally has been viewed as nonsurgical, but there are known complications of IRDs that may warrant surgical intervention. Patterns of procedural interventions among patients with IRDs remain poorly characterized, given their relatively small representation among individual institutions. The objective of this study is to characterize patterns of surgical diagnoses and procedures in patients with IRD compared with a control cohort. DESIGN:This retrospective cohort study used deidentified aggregated electronic health records from January 1, 2003, through March 30, 2024, from TriNetX, a network with data from more than 119 million patients across 85 health care organizations in 4 countries. METHODS:Patients with IRDs and a control group with other posterior segment pathologies were identified and propensity score matched for age, sex, and ethnicity and race. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis codes for inherited retinal diseases (hereditary retinal dystrophy, hereditary choroidal dystrophy, congenital night blindness, achromatopsia, or other colour blindness) or posterior segment pathologies (disorders of choroid and retina, disorders of vitreous body and globe, glaucoma, visual disturbances and blindness, disorders of optic nerve and visual pathways, other disorders of eye and adnexa) were searched. Rates of surgical diagnoses and subsequent procedures in the IRD group were compared with the control group. RESULTS:Each cohort resulted in 69 235 patients after propensity-score matching. Among patients with IRDs, there was an increased rate of age-related cataracts (risk ratio [RR] 1.39, P < 0.001), other cataracts (RR 1.52, P < 0.001), macular edema (RR 2.98, P < 0.001), epiretinal membrane (RR 1.68, P < 0.001), macular hole/cyst/pseudohole (RR 1.93, P < 0.001), and slightly lower rates of rhegmatogenous retinal detachment (RR 0.87, P = 0.003). There was a greater rate of in-office vitreoretinal procedures, such as intravitreal injections (RR 2.22, P < 0.001), laser (RR 1.32, P < 0.001), and cataract surgery (RR 1.28, P < 0.001). However, there were lower rates of membrane peel (RR 0.74, P = 0.017) and retinal detachment repair (RR 0.60, P < 0.001) and no difference in the rate of macular hole repair (RR 1.09, P = 0.331). CONCLUSIONS:The discordance observed between the prevalence of potential surgical pathologies and the rates of subsequent intervention highlights the complexities in surgical decision-making for patients with IRDs.

Purpose:Lattice poses risks to patients with prior detachments. This study evaluates such patients' likelihood of rhegmatogenous retinal detachments (RRD) and retinal breaks (RB) and assesses the efficacy of prophylactic laser retinopexy and cryopexy.Methods:Retrospective cohort study using the TriNetX registry. Patients either with or without prior contralateral RRD/RB and also with fellow eye lattice were included. Logistic regression calculated the likelihood of RRD/RB in the fellow eye. The number needed to treat (NNT) was calculated for prophylactic laser retinopexy and cryopexy.Results:Patients with prior unilateral RRD/RB had a higher likelihood of fellow eye RRD/RB than those without prior unilateral RRD/RB (OR: 4.47, 99% CI: 3.47-5.76). Myopia increased this likelihood (OR: 5.67, 99% CI: 3.80-8.48). The NNT to prevent one RRD was lower for patients with prior unilateral RRD (NNT: 4.63; 99% CI: 4.07-5.37) than those without (NNT: 43.29; 99% CI: 38.72-49.08). The NNT to prevent one RB was lower for patients with prior unilateral RB (NNT: 3.83; 99% CI: 3.37-4.44) than those without (NNT: 45.70; 99% CI: 39.99-53.30).Conclusion:Prior contralateral RRD/RB increases the likelihood of RRD/RB in fellow eyes with lattice. Prophylactic laser retinopexy and cryopexy reduce the number of fellow eye RRD/RB.

BACKGROUND AND OBJECTIVE:The aim of this study was to characterize longitudinal trends in intraocular lens (IOL) dislocation in patients after cataract surgery. PATIENTS AND METHODS:Using the TriNetX network, a retrospective cohort study was conducted of 866,010 patients who underwent cataract surgery from the years 2000 to 2024. Those patients who had experienced IOL dislocation based on International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and -10) codes were identified. Patients with risk factors for IOL dislocation, such as ocular trauma, prior intravitreal injections, prior pars plana vitrectomy, pseudoexfoliation glaucoma, and Marfan syndrome, based on ICD-9/-10 and Current Procedural Terminology (CPT) codes, were also identified. RESULTS:From 2020 to 2024, 9,929 (1.1%) of the 866,010 patients experienced IOL dislocation. Over the past 2 decades, there was a significant monotonic increase in the incidence rate of IOL dislocation (P < .01), as well as ocular trauma (P < .01), intravitreal injections (P < .01), and pars plana vitrectomy (P < .01). CONCLUSION:IOL dislocation is becoming increasingly common. Practitioners must be prepared to manage these conditions.

Purpose:To report efficacy of intravitreal pegcetacoplan treatment over 36 months in eyes with subfoveal geographic atrophy (GA). Patients and Methods:The GALE (NCT04770545) open-label extension trial adds 12 months of results to the 24-month Phase 3 OAKS (NCT03525613) and DERBY (NCT03525600) trials, representing up to 36 months of continuous pegcetacoplan treatment. They included a heterogeneous population of eyes with subfoveal GA (63%). Pegcetacoplan-treated eyes enrolling in GALE continued at the same interval of pegcetacoplan monthly (PM) or every other month (PEOM). Patients' eyes in sham monthly or every-other-month arms crossed over to receive pegcetacoplan in GALE at the same interval (sham crossover). Consequently, projected sham, calculated from prior 24-month GA growth rate of sham-observed eyes in OAKS and DERBY averaged across four 6-month segments, was the comparator for the first 12 months of GALE (months 24-36). This analysis reports results of eyes with subfoveal GA at baseline. Results:In eyes with subfoveal GA, 84% had best corrected visual acuity (BCVA) ≥20/200 and 38% had BCVA ≥20/63 at OAKS and DERBY baseline. Pegcetacoplan reduced subfoveal GA growth rate by 21% (p<0.0001) with PM and 19% (p=0.0001) with PEOM over 36 months. Increasing efficacy over time was noted between months 24 and 36; 31% reduction in subfoveal GA growth rate with PM and 25% reduction with PEOM (both p<0.0001) compared with projected sham. Microperimetry demonstrated significant reduction in formation of absolute scotomas with PM at 24 months (-2.5 number of scotomas formed; 95% confidence interval [CI]: -4.5, -0.4; p=0.0205) and 36 months (-4.0 number of scotomas formed; 95% CI: -6.8, -1.2; p=0.0050), compared to sham crossover in subfoveal GA. Safety profile in GALE was consistent with OAKS and DERBY. Conclusion:Long-term efficacy of pegcetacoplan in slowing GA progression was demonstrated over 36 months in eyes with subfoveal GA.

Purpose:To assess whether postoperative opioid prescriptions are associated with reduced pain diagnoses or emergency room (ER) visits after ophthalmic surgery. Design:Retrospective cohort study using aggregated electronic health record data (June 2005-June 2025) from the TriNetX collaborative research network. Subjects:Patients who underwent ophthalmic procedures across 11 subspecialty categories in the past 20 years, with or without a postoperative opioid prescription. Methods:Data were analyzed using the TriNetX integrated analytics platform. Patients with chronic pain syndrome or opioid dependence were excluded. Ophthalmic procedures were identified using Current Procedural Terminology codes, and characterized as cataract; major or minor cornea, glaucoma, oculoplastics, trauma; retina; or strabismus. Associations were assessed by calculating absolute risk differences with 95% confidence intervals (CIs) and risk ratios. Main Outcome Measures:Diagnosis of postprocedural pain or ER visits within 2 weeks after surgery. Results:The study included 2 510 984 patients. Absolute rates of postoperative pain diagnoses were low across all subspecialties. Opioid prescriptions were associated with small absolute reductions in postprocedural pain diagnoses in glaucoma major (-1.3%, 95% CI: -1.4% to -1.2%, P < 0.001), oculoplastics major (-0.9%, 95% CI: -1.2% to 0.6%, P < 0.001), cornea major (-0.8%, 95% CI: -0.9% to -0.7%, P < 0.001), cornea minor (-0.8%, 95% CI: -0.8% to -0.7%, P < 0.001), trauma major (-0.8%, 95% CI: -0.9% to -0.6%, P < 0.001), trauma minor (-0.7%, 95% CI: -0.9% to -0.5%, P < 0.001), and oculoplastics minor (-0.1%, 95% CI: -0.2% to < -0.1%, P = 0.008) procedures. Emergency room visit reduction was observed only for glaucoma major procedures (-0.1%, 95% CI: -0.1% to < -0.1%, P < 0.001). In other subspecialties, opioid prescriptions were not associated with reduced ER utilization and were associated with higher ER visit rates in oculoplastics, retina, and trauma major procedures. Conclusions:Postoperative opioid prescriptions were associated with small absolute reductions in pain diagnoses in selected subspecialties, including cornea, glaucoma, oculoplastics, and trauma, but not cataract, retina, or strabismus. Opioid prescriptions offered no consistent benefit in reducing ER visits and were linked to higher ER visit rates in some subspecialties. These findings highlight the limited clinical benefit of routine opioid prescribing after many ophthalmic procedures and underscore the need for subspecialty-specific, evidence-based postoperative pain management strategies in ophthalmology. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

BACKGROUND AND OBJECTIVE:This study aimed to evaluate the association between systemic methotrexate (MTX) use and the incidence of proliferative vitreoretinopathy (PVR) following retinal detachment (RD) repair. PATIENTS AND METHODS:A retrospective cohort study was conducted using the TriNetX Health Research Network. Patients undergoing RD repair were identified by CPT codes and stratified into MTX users (systemic exposure within one year prior to or on the day of RD repair) versus nonusers. Cases of proliferative diabetic retinopathy were excluded. The primary endpoint was development of PVR-related complications within 3, 6, and 12 months postoperatively. Propensity score matching (PSM) was performed to balance baseline demographics and clinical covariates. RESULTS:After 1:1 PSM, 496 patients were identified in both cohorts (mean age: 56.5 (19.0) years). MTX use was associated with significantly higher odds of tractional RD at 3 months (22.38% vs 8.06%; odds ratio [OR] 3.28, 95% CI: 2.23-4.83, P < .0001), 6 months (24.95% vs 8.11%; OR 3.76, 95% CI: 2.57-5.52, P < .0001), and 12 months (20.29% vs 10.63%; OR 2.14, 95% CI: 1.44-3.17, P < .0001). Postoperative ERM development was more frequent in MTX cohort at 3 months (11.49% vs 6.65%, OR 1.82, 95% CI: 1.16-2.85, P = .0080). No significant differences were observed in complex RD repair, repeat PPV, and PPV with ERM removal. CONCLUSION:Systemic MTX use within one year of RD repair was not associated with a reduced risk of PVR. MTX exposure correlated with increased odds of tractional RD and higher rates of ERM development rate. These findings suggest systemic MTX may not offer protective benefit against PVR.

PURPOSE:To evaluate the temporal association between treatment of retinal breaks (RBs) without detachment using laser retinopexy or cryotherapy and the development of epiretinal membrane (ERM), including ERM peel. DESIGN:Retrospective cohort study. PARTICIPANTS:After propensity score matching (PSM) and applying inclusion/exclusion criteria, 20,191 patients undergoing laser retinopexy (treatment cohort) and 730 patients undergoing cryotherapy (treatment cohort) were each compared with matched untreated RB controls. METHODS:Data were extracted from a national clinical database (TriNetX). Patients with RBs without detachment treated with laser retinopexy or cryotherapy were compared with individuals with untreated RBs (control cohort) to examine the incidence of ERM formation and ERM peel from three months to five years. A secondary analysis compared laser retinopexy with cryotherapy cohorts directly. RESULTS:During the five-year study period, both treatment cohorts demonstrated the highest risk for ERM formation early after intervention. In the laser retinopexy cohort, ERM risk was increased at three months (2.88% vs 0.94%; RR, 3.06) and remained elevated at one year (6.27% vs 2.26%; RR, 2.77), with higher ERM peel rates persisting through five years. In the cryotherapy cohort, ERM risk was increased at six months (5.34% vs 1.92%; RR, 2.79) and one year (8.63% vs 2.60%; RR, 3.32). Rates of ERM requiring surgical peeling were low and not estimable at several time points in the cryotherapy cohort due to small event counts. In direct comparison, no significant differences were observed between laser retinopexy and cryotherapy cohorts across all time points. CONCLUSIONS:Treatment of RBs without detachment with either laser retinopexy or cryotherapy is associated with an increased risk of ERM formation compared with untreated RBs, with risk peaking early following treatment and persisting over time. No significant difference in ERM risk was observed between treatment modalities, suggesting that ERM development may occur as a response to vitreoretinal disruption and inflammation regardless of the specific intervention performed.

Purpose: To describe how risk factors such as repair of rhegmatogenous retinal detachment (RRD), cataract extraction, and myopia interrelate to influence the risk of retinal redetachment. Methods: This retrospective cohort study included patients with phakic RRD who had subsequent cataract extraction. The incidence and risk of redetachment were compared using Cox regression and χ2 analyses. Stratified analyses were performed based on time after cataract extraction, age, myopia status, and retinal repair type. Results: Of 1222 patients identified, no significant association was found between myopia and the incidence of redetachment, although the proportion of redetachments increased with the degree of myopia (nonmyopes, 8.5%, myopes, 9.5%, high myopes, 15.6%; P = .36). Myopia and high myopia were not associated with an increased risk of redetachment over time (hazard ratio, 1.01, P = .96; hazard ratio, 1.54, P = .35, respectively). Additionally, the incidence of redetachment was not significantly correlated with the time after cataract extraction (P = .33). A significant difference was observed between the incidence of redetachment and age (P = .003). Patients between 18 and 35 years experienced the highest incidence of redetachment within 1, 3, and 12 months after cataract extraction (5.26%, 7.02%, 7.02%, respectively). Such patients were overrepresented among those who underwent complex surgeries for initial phakic RRD repair (30-39 years, residual: 2.71; 40-49 years, residual: 3.32). Conclusions: Among patients with a phakic RRD, myopia did not significantly increase the risk of redetachment after cataract extraction. However, an upward trend was noted between the proportion of redetachments and the degree of myopia. Younger patients exhibited the highest incidence of redetachment and should be closely monitored after cataract extraction.

Patients with colour vision deficiency (CVD) may not see blood in urine or stool, often the first sign of bladder or colorectal cancer, respectively. Here we sought to identify whether patients with bladder or colorectal cancer and CVD have worse outcomes when compared to matched patients without CVD, using an electronic health records research network (TriNetX). A total of 135 patients with CVD and bladder cancer showed shorter overall survival (χ2 = 4.85, P = 0.028) as compared to 135 matched patients without CVD. There was no significant difference among 187 patients with colorectal cancer and CVD, and controls. This suggests that patients with bladder cancer and CVD may be at risk of reduced survival. This is a hypothesis-generating paper that should raise clinicians’ diagnostic suspicion for bladder cancer in patients with CVD and prompt further investigation into whether screening for bladder cancer should be introduced for high-risk individuals with CVD. In a retrospective case–control study of electronic health records, patients with bladder cancer and colour vision deficiency (CVD) had a 52

BACKGROUND AND OBJECTIVE:This study assessed risk of mental health disorders in patients with age-related macular degeneration (AMD). PATIENTS AND METHODS:Data were obtained from an aggregated electronic health records database. Patients who were diagnosed with AMD with cataract were propensity score-matched with cataract controls. Diagnoses were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Subgroup analyses evaluated relative risk (RR) of new diagnoses of mental health disorders among patients with dry AMD, neovascular AMD (nAMD), vision impairment, and receipt of intravitreal therapy. RESULTS:After matching, 126,799 cases comprising 53.1% female patients with a mean age of 74.6 ± 8.9 years were included. Patients with AMD and cataract had elevated risk of receiving diagnoses of depression (RR = 1.27; 95% CI 1.24-1.29) and anxiety (RR = 1.19; 1.17-1.22). These patients were also at increased risk for self-harm (RR = 1.16), substance use (RR = 1.10), dysthymia (RR = 1.41), and psychosis (RR = 1.22) (all P < .05). The presence of visual impairment amplified these risks, particularly for depression (RR = 1.97) and anxiety (RR = 1.62). Patients with dry AMD had an increased risk of depression and anxiety compared to those with nAMD. Treatment with intravitreal injections in nAMD patients was associated with decreased risk of depression (RR = 0.88) and anxiety (RR = 0.82). CONCLUSIONS:AMD is associated with increased risk of mental health disorders, including anxiety, depression, and self-harm, particularly in the first year following diagnosis. Risk varies by disease subtype, visual function, and treatment status.

Traumatic ocular injuries may lead to short- and long-term psychiatric consequences; however, the risk of developing mental health disorders after such injuries is not well defined. This study aimed to determine the incidence rates of mental health disorders following traumatic ocular or orbital injury compared to matched controls. In this retrospective cohort study, we used electronic health records from a federated database covering 20 years, through December 5, 2025. Patients with ocular or orbital trauma were matched by age, sex, and race to controls who underwent comprehensive ophthalmologic examinations. Patients with preexisting psychiatric diagnoses were excluded. A total of 28,957 patients with traumatic ocular or orbital injury and ≥ 1 year of follow-up were included. The mean (SD) age at injury was 42.80 (25.60) years; 71.13