PURPOSE:To describe baseline characteristics, management patterns, and long-term outcomes in a contemporary cohort of eyes with retinal arterial macroaneurysms (RAM) managed with observation versus treatment. DESIGN:Retrospective cohort study. SUBJECTS:Adult patients (aged ≥18 years) diagnosed with RAM at Bascom Palmer Eye Institute between January 2013 and December 2025. METHODS:Baseline demographics, ocular findings, ancillary optical coherence tomography imaging, treatments, and visual outcomes were recorded. Continuous variables were compared using two-tailed Student t-tests and Wilcoxon signed-rank tests, as appropriate. Categorical variables were compared using chi-square or Fisher exact tests. Statistical significance was defined as P < 0.05. MAIN OUTCOME MEASURES:Resolution of RAM, time to resolution, and changes in best-corrected visual acuity (BCVA) at final follow-up. RESULTS:A total of 161 eyes (156 patients) met inclusion criteria. The mean age was 73.7 years (range 19-97), and 104 (67%) were female. Hypertension was present in 126 (81%) patients. Overall, 110 eyes (68%) were managed with observation, and 51 eyes (32%) were managed with early treatment. The treatment cohort had, on average, worse BCVA compared to the observation cohort (20/160 vs. 20/50, P < 0.0001) and more frequently reported macula-involving hemorrhage (78% vs. 52%; P = 0.0024) at the initial visit. In the observation cohort, 6% of eyes developed symptomatic hemorrhage prompting treatment, which occurred an average of 250 days after the initial diagnosis. In the treatment cohort, 59% of eyes were treated with antivascular endothelial growth factor monotherapy, 22% were treated with focal laser monotherapy, 16% were treated with combination therapy, and 4% were treated with vitrectomy with tissue plasminogen activator. Resolution of RAM, defined as fibrosis of the RAM with resorption of surrounding hemorrhage and/or edema, occurred in 100% of eyes in both cohorts of patients. BCVA at last follow-up was not statistically different between groups (20/50 observation vs. 20/70 treatment, P = 0.0730). However, time to resolution of RAM was more rapid in the treatment cohort (362 vs. 536 days; P = 0.0170). CONCLUSIONS:This descriptive cohort of patients with RAM suggests that most cases will improve spontaneously; however, selective treatment of eyes with more severe initial presentation may be beneficial. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To compare the cumulative incidence of postoperative cystoid macular edema (CME) after secondary intraocular lens (IOL) placement versus routine and complex cataract surgery. METHODS:This retrospective cohort study utilized the TriNetX US Collaborative Network to identify all adult patients who underwent routine cataract surgery, complex cataract surgery, or secondary IOL placement. Propensity score matching was performed, and 90-day CME incidence was compared between groups using relative risks (RRs) with 95% confidence intervals (CIs). Multivariable Cox proportional hazards models were performed to assess the relative hazard of CME, including an analysis of the effect of concurrent pars plana vitrectomy (PPV) in the secondary IOL group. RESULTS:A total of 506,095 routine cataract, 99,337 complex cataract, and 12,644 secondary IOL surgeries met inclusion criteria. The incidence of postoperative CME after secondary IOL placement was 5.1%, significantly higher than routine cataract surgery (1.4%; risk ratio [RR] 3.6; p<0.0001) and complex cataract surgery (2.0%; RR 2.5; p<0.0001). Multivariable Cox proportional hazards models demonstrated an increased risk of CME in patients that had undergone secondary IOL implantation compared to routine cataract surgery (hazard ratio 3.6; p<0.0001). Of the patients that had undergone secondary IOL placement, concurrent PPV was associated with an increased risk of postoperative CME (7.1% vs 5.3%; p<0.0001). Patients who had undergone secondary IOL placement had a lower utilization of prophylactic NSAID eyedrops compared to primary cataract cases (23% vs 32-34%, p<0.0001). CONCLUSIONS:Secondary IOL placement is associated with a higher risk of postoperative CME compared to primary and complex cataract surgery.

Purpose: To summarize current evidence on clinical features, multimodal imaging findings, diagnostic techniques, and management strategies for vitreoretinal lymphoma. Methods: A literature review was performed to provide updated information on available treatment options for vitreoretinal lymphoma. Results: Diagnosis of vitreoretinal lymphoma requires vitreous biopsy, with or without retinal/subretinal tissue, for cytology and immunohistochemistry, along with ancillary tests such as flow cytometry, cytokine profiling (interleukin-10/interleukin-6 ratio >1), immunoglobulin heavy chain gene rearrangement analysis, and detection of the MYD88 L265P mutation. Optical coherence tomography and other multimodal imaging techniques have become increasingly useful in raising suspicion, guiding biopsy, and monitoring treatment response. No standardized treatment protocol exists for isolated vitreoretinal lymphoma. Management options include intravitreal chemotherapy (methotrexate and/or rituximab), radiation therapy, and systemic chemotherapy, often showing a good initial response, but relapse and subsequent central nervous system (CNS) involvement are common, resulting in poor overall prognosis and survival. For vitreoretinal lymphoma with CNS disease, current strategies favor high-dose methotrexate-based systemic chemotherapy, with or without intrathecal chemotherapy; whole-brain radiation is generally reserved as rescue therapy. Emerging directions for earlier diagnosis include metagenomic deep sequencing, and chimeric antigen receptor T-cell (CAR-T) therapy has shown promise for treatment of selected relapsed/refractory cases of primary CNS lymphoma with a potential to prolong survival. Conclusions: Treatment of vitreoretinal lymphoma requires a multidisciplinary, individualized approach that integrates multimodal imaging, cytologic and molecular diagnostics, CNS evaluation, and tailored local or systemic therapy. Prospective multicenter studies are needed to refine diagnostic algorithms and standardize management.

PURPOSE:To evaluate the risk of retinal vein occlusion (RVO) in patients 55 years and younger with a history of migraine compared with a control group without migraine. METHODS:Using the TriNetX platform, a retrospective cohort analysis was conducted comparing patients 55 years and younger with a diagnosis of patients with migraine to nonmigraine undergoing routine health examinations. The study period comprised 20 years from March 2006 through March 2026. 1:1 nearest-neighbor propensity score matching without replacement was used to balance baseline demographics, body mass index, and comorbidities between cohorts. RVO incidence was the primary outcome measure, including central retinal vein occlusion and branch retinal vein occlusion subtypes, defined by International Classification of Disease-10 codes. RESULTS:After propensity score matching, the combined matched sample comprised 3,482,652 individuals (1,741,326 per cohort). RVO (composite): 462 events in the migraine cohort versus 325 events in the control cohort (risk ratio [RR] = 1.422, 95% confidence interval [CI]: 1.234-1.638; P < 0.001; hazard ratio [HR] = 1.331, 95% CI: 1.155-1.534; log-rank χ 2 = 15.655; P < 0.001). Central retinal vein occlusion: 303 versus 206 events (RR = 1.471, 95% CI: 1.232-1.756; P < 0.001; HR = 1.375, 95% CI: 1.152-1.641; log-rank χ 2 = 12.511; P < 0.001). Branch retinal vein occlusion: 221 versus 154 events (RR = 1.435, 95% CI: 1.168-1.763; P = 0.001; HR = 1.340, 95% CI: 1.090-1.646; log-rank χ 2 = 7.798; P = 0.005). CONCLUSION:Patients 55 years and younger with a history of migraine have an increased risk of developing RVO compared with controls without migraines.

PURPOSE:To compare the refractive, visual, and anatomic outcomes following rhegmatogenous retinal detachment (RRD) repair in pseudophakic patients with prior placement of multifocal intraocular lenses (MFIOLs) treated by combined pars plana vitrectomy and scleral buckling (PPV/SB) or PPV alone. DESIGN:Retrospective clinical cohort study. METHODS:A total of 100 patients with MFIOLs who underwent RRD repair at a single tertiary academic center between January 1, 2014 and November 1, 2025 were reviewed. Sixty-two eyes underwent PPV alone and 38 eyes underwent combined PPV/SB. Demographic characteristics, surgical details, pre and postoperative refraction, best-corrected visual acuity (BCVA), and complications were collected. The primary outcome was change in spherical equivalent at least 3 months following RRD repair. Secondary outcomes included visual acuity and single-surgery anatomic reattachment. RESULTS:Postoperative refractions were obtained at an average of 5.4 ± 3.3 months following RRD repair. Eyes treated with PPV alone demonstrated a mean postoperative myopic shift of -0.05 ± 0.53D compared with -1.03 ± 0.78D in eyes that received SB as part of repair (P < .05). Twenty-three of 33 SB-treated eyes (60.5%) demonstrated a postoperative myopic shift of ≤-1.0D and 9 eyes (23.7%) demonstrated a shift of ≤-0.5D. Patients receiving #240 bands demonstrated the smallest mean myopic shift (-0.78 ± 0.62D) compared with #41 bands (-1.14 ± 0.84D) and #42 bands (-2.0 ± 0.71D), although differences were not statistically significant (P = .07). Single-surgery anatomic reattachment was achieved in 53 of 62 eyes (85.5%) treated with PPV alone and 34 of 38 eyes (89.5%) that received SB as part of the repair (P = .56). No significant differences were noted in preoperative or postoperative BCVA between treatment groups. CONCLUSIONS:Compared with eyes treated with PPV alone, the addition of a SB was associated with approximately -1.0D greater postoperative myopic shift while demonstrating similar visual and anatomic outcomes. Refractive outcomes following SB placement in patients with MFIOLs were comparable to prior reports in pseudophakic populations and may not represent a clinically prohibitive refractive change. These findings suggest that the addition of an encircling SB remains a viable option for RRDs in refractive-optimized patients.

Purpose: To evaluate whether vitamin B 12 deficiency with elevated homocysteine is associated with increased risk of retinal vein occlusion (RVO). Methods : A retrospective cohort study was conducted using the TriNetX US Collaborative Network (August 2005—August 2025). Adults (≥18 years) with vitamin B 12 deficiency (International Classification of Diseases, Tenth Revision code D51.0-D51.9) and hyperhomocysteinemia (>15.00 µmol/L) were matched in a 1:1 ratio to controls without B 12 deficiency and with homocysteine status unrestricted, using propensity scores for age, sex, race, ethnicity, body mass index, hypertension, diabetes, ischemic heart disease, and nicotine dependence. Patients with pre-index RVO were excluded. The primary outcome was incident RVO (central or branch) over 10 years, analyzed with risk ratios, odds ratios, hazard ratios, and Kaplan-Meier cumulative incidence curves. Results : After matching and exclusion of patients with prior RVO, 10 161 individuals were included (5070 with B 12 deficiency and hyperhomocysteinemia, 5091 controls). The cohorts were well-balanced across demographics and comorbidities. Incident RVO occurred in 32 patients (0.63%) with B 12 deficiency and hyperhomocysteinemia compared with 15 patients (0.29%) among the control group, corresponding to a statistically significant increased risk (risk ratio, 2.142 [95% CI, 1.162-3.951]; odds ratio, 2.149 [95% CI, 1.163-3.974]; both P = .012). Kaplan-Meier curves demonstrated a higher cumulative incidence of RVO in the B 12 deficiency and hyperhomocysteinemia cohort (log-rank χ² = 7.551, P = .006; hazard ratio, 2.306 [95% CI, 1.249-4.260]). Conclusions : Vitamin B 12 deficiency with hyperhomocysteinemia was associated with an increased RVO risk. These findings highlight a modifiable risk factor, and prospective studies are needed to assess causality and evaluate whether correction of vitamin B 12 deficiency or hyperhomocysteinemia reduces RVO risk.

Introduction:Choroidal melanoma is the most common primary intraocular malignancy in adults. Early detection through ophthalmic screening increases the likelihood of globe-preserving treatment and may reduce metastasis while maximizing survival. Racial and ethnic disparities in access to care may influence outcomes, metastasis, and mortality. Methods:This retrospective cohort study used data from 2004 to 2025 within a federated electronic health record database. Adult patients (≥18 years) with choroidal melanoma were identified. Race/ethnicity was categorized as non-Hispanic white (NHW) or Black/Hispanic. The primary outcomes were primary enucleation, development of liver metastasis, and all-cause mortality within 1, 3, or 5 years from the time of choroidal melanoma diagnosis. Propensity score matching (PSM) was performed to balance cohorts. Multivariate Cox proportional hazards models were used to identify factors associated with enucleation, metastasis, and mortality. Results:A total of 17,436 patients with choroidal melanoma were identified, of whom 659 (6.3%) were Black/Hispanic and 9,883 (93.7%) were NHW. After PSM, primary enucleation within 90 days of diagnosis occurred in 5.2% of Black/Hispanic patients versus 3.8% of NHW patients (risk ratio [RR] 1.36, 95% confidence interval [CI] 0.821-2.253, p = 0.2305). Cumulative rates of liver metastasis in the Black/Hispanic group were significantly higher than NHW at 1 year (RR 2.42, CI: 1.336-4.387), 3 years (RR 1.96, CI: 1.246-3.083), and 5 years (RR 1.77, CI: 1.195-2.611) (p < 0.01 for each). All-cause mortality was higher in the Black/Hispanic cohort at 1 year (RR 1.96, CI: 1.212-3.163), 3 years (RR 1.75, CI: 1.249-2.453), and 5 years (RR 1.48, CI: 1.105-1.976) (p < 0.01 for each). On multivariate Cox analysis, male sex (hazard ratio [HR] 1.49, CI: 1.275-1.736, p < 0.0001) was associated with higher risk of enucleation, while a history of choroidal nevus was protective (HR 0.59, CI: 0.424-0.831, p = 0.0024). For metastatic risk, Black/Hispanic race/ethnicity (HR 1.54, CI: 1.242-1.904) and enucleation (HR 3.27, CI: 1.845-5.780) were associated with an increased risk, whereas prior nevus was protective (HR 0.43, CI: 0.324-0.577). All-cause mortality was elevated with older age (HR 1.03, CI: 1.021-1.031), male sex (HR 1.22, CI: 1.084-1.373), Black/Hispanic race/ethnicity (HR 1.42, CI: 1.135-1.769), metastatic liver disease (HR 7.49, CI: 6.051-9.269), among other comorbidities. Prior nevus history conferred a survival benefit (HR 0.59, CI: 0.458-0.762). Conclusion:In patients with newly diagnosed choroidal melanoma, Black/Hispanic patients had higher rates of metastatic disease and mortality. Previous history of choroidal nevus was associated with a lower risk of primary enucleation, metastatic disease, and mortality.

Purpose: To evaluate the efficacy and safety of adjunctive intravitreal anti-vascular endothelial growth factor (VEGF) therapy combined with standard ablative treatment in Coats disease. Methods: A search of PubMed, Embase, and SCOPUS was conducted to identify studies comparing ablative therapy alone versus ablative therapy with anti-VEGF for Coats disease. Five studies (136 eyes treated with ablation alone and 82 with combination therapy) were included. Data on treatment sessions, quiescence, visual acuity (VA) and tractional retinal detachment (TRD) were extracted. Results: Adjunctive anti-VEGF significantly reduced the treatment sessions required to achieve quiescence (Mean difference [MD] 0.47 sessions, 95% confidence interval [CI] 0.10-0.85, p = 0.01). No significant difference was found in anatomic outcomes with both groups having a similar number of eyes which resulted in phthisis. No significant difference was found in the BCVA at final follow up (MD = 0.20, 95% CI -0.20 to 0.59, p = 0.33) without significant heterogeneity (I 2 =23%, p = 0.28). Eyes with adjunctive anti-VEGF were not found to be associated with a significantly higher risk of TRD (RR 2.64, 95% CI 0.34-20.30, p = 0.35). Due to the retrospective design of the included studies, the overall grade of evidence was deemed low. Conclusions: Adjunctive anti-VEGF therapy may reduce the total treatment burden while achieving similar anatomical and functional outcomes. In addition, there appears to be no significant increase in the risk of TRD. Judicious use of anti-VEGF may be a useful therapy to consider in patients with Coats disease requiring ablative therapy.

Patients with a history of retinal detachment in the fellow eye have a significantly higher short-term risk of retinal detachment after laser retinopexy for retinal tears, without a corresponding increase in repeat laser treatments.

Background: Academic ophthalmology plays a critical role in advancing eye care and training the next generation of ophthalmologists. However, comprehensive data on the U.S. academic ophthalmology workforce remains limited. Existing databases focus on individual subspecialties or specific demographics, without capturing a national, integrated perspective. Purpose: To develop and analyze the U.S. Academic Ophthalmology Faculty Database (US-AOFD), a comprehensive, national resource that characterizes the demographic composition, academic ranks, leadership roles, and research productivity of ophthalmology faculty at Accreditation Council for Graduate Medical Education (ACGME)–accredited programs in the United States. Methods: This cross-sectional descriptive study compiled data for 4,028 faculty members from publicly available institutional websites for 126 ACGME-accredited ophthalmology residency programs. Variables collected included demographics, academic rank, fellowship training, leadership roles (department chair, division director or section chief, fellowship director, program director, and student education director), and research productivity (H-index, publication count, annual publication rate [APR]). Institutional variables included program size, NIH funding, and geographic region. Research metrics were retrieved from Scopus. Descriptive statistics were used, and regional comparisons were conducted using Kruskal-Wallis and χ2 tests. Results: Of the 4,028 faculty included, 37.3% were female, and 96.0% held an MD degree. The median years since residency graduation was 19 (IQR, 11-32). Fellowship training was common (82.5%), with retina (21.6%), cornea (15.8%), and glaucoma (14.0%) being the most frequent. Academic rank distribution showed 43.5% assistant, 24.9% associate, and 31.6% full professors. Full professors had the highest median H-index (27; IQR, 15-43) and publication count (92; IQR, 41-187), compared with assistant professors (H-index, 5; publications, 11). Leadership was common (33.8%), with department chairs having the longest time since graduation (33 years) and highest research productivity. Regional analysis showed the West had the highest research productivity (H-index, 12; APR, 2.4), whereas the Northeast had the lowest. Conclusion: The US-AOFD offers the most comprehensive assessment to date of academic ophthalmology faculty in the United States. It reveals significant differences in research productivity and faculty composition by academic rank, subspecialty, and geography. This database provides a foundational framework for future investigations into workforce development, academic promotion, and equity in academic ophthalmology.

Purpose: To examine the relationship between a composite measure of socioeconomic status, the Social Deprivation Index score, and the severity and treatment of diabetic retinopathy (DR). Methods: A multicenter retrospective cohort study was performed of adults with newly diagnosed DR secondary to type 1 or type 2 diabetes mellitus (DM) and at least 6 months of follow-up. Social Deprivation Index scores were calculated using patients' zip codes. Patient demographics, baseline ocular characteristics, interventions performed, and follow-up duration were extracted from the electronic health records and the Vestrum Health database. The main outcomes were the initial and final visual acuity (VA), presence of proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and diabetic macular edema (DME) at presentation and during follow-up, in addition to the need for procedural intervention. Results: The study included 6781 patients. Social Deprivation Index scores corresponding to greater socioeconomic disadvantage were independently associated with an increased likelihood of the following: presenting with PDR (odds ratio [OR], 1.27, 95% CI, 1.13-1.42; P < .001) or TRD (OR, 1.76, 95% CI, 1.21-2.56; P = .003), VA at presentation ≤20/40 (OR, 1.28, 95% CI, 1.15-1.42; P < .001), ≤20/70 (OR, 1.45, 95% CI, 1.27-1.65; P < .001), and ≤20/200 (OR, 1.33, 95% CI, 1.10-1.60; P = .003), need for procedural or surgical intervention (OR, 1.20, 95% CI, 1.08-1.34; P < .001), and VA ≤20/40 (OR, 1.19, 95% CI, 11.05-1.34; P = .005) and ≤20/70 at last follow-up (OR, 1.33, 95% CI, 1.14-1.55; P < .001). Conclusions: Residing in a lower socioeconomic area is associated with greater DR severity and poorer outcomes, underscoring the need for targeted public health policies and improved outcomes for socioeconomically disadvantaged populations.

Importance:Whether prior pars plana vitrectomy (PPV) independently increases the risk of cystoid macular edema (CME) following cataract surgery remains unknown. Objective:To evaluate associations between prior PPV and incidence of CME after cataract surgery. Design, Setting, and Participants:This retrospective cohort study was conducted using the TriNetX US Network, a multicenter federated electronic health record network from December 2005 to December 2025 including academic and community hospitals in the US. Adults aged 18 years or older who underwent cataract surgery were categorized into those with vs those without a history of PPV (≥6 months prior to cataract surgery), excluding those with preexisting CME or risk factors for CME. Data were analyzed from December 2025 through January 2026. Exposure:History of PPV performed more than 6 months prior to cataract surgery. Main Outcomes and Measures:The primary outcome was the incidence of CME within 30 to 90 days postoperatively, identified by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes. Risk ratios (RR) were used to compare outcomes. Propensity score matching was performed for demographic and clinical covariates (age, sex, race, hypertension, hyperlipidemia, diabetes, myopia, retinal detachment [RD] history). Results:After propensity score matching with 615 983 patients undergoing cataract surgery, 7422 patients had a prior PPV. After propensity score matching, among patients with prior PPV, mean (SD) age was 62.0 (11.6) years, and 3623 patients (49.5%) were female; among the non-PPV group, mean (SD) age was 61.9 (12.2) years, and 3625 patients (49.5%) were female. Among 14 636 patients representing 7318 propensity score-matched pairs, CME occurred in 336 of 7318 patients with prior PPV (4.59%) compared with 90 of 7318 non-PPV controls (1.23%) (difference, 3.36%; 95% CI, 2.82%-3.90%; RR, 3.73; 95% CI, 2.97-4.70; P < .001). Elevated CME risk persisted in subgroup analyses evaluating prior PPV for RD (5.65% vs 1.22%; absolute difference, 4.43%; 95% CI, 3.48%-5.38%; RR, 4.62; 95% CI, 3.20-6.67; P < .001), as well as those for non-RD indications (3.99% vs 1.23%; absolute difference, 2.76%; 95% CI, 2.06%-3.48%; RR, 3.26; 95% CI, 2.36-4.50; P < .001). Furthermore, after excluding patients with intraoperative and postoperative complications of cataract surgery, the prior PPV group was still found to have a higher risk of CME (4.59% vs 1.26%; absolute difference, 3.32%; 95% CI, 2.77%-3.88%; RR, 3.63; 95% CI, 2.88-4.58; P < .001). Conclusions and Relevance:Results of this cohort study suggest that eyes with vs without prior PPV have higher incidences of postoperative CME. However, numerous limitations, including dependence on coding-based diagnoses and lack of visual acuity outcomes, preclude determining the role of prophylaxis or monitoring for CME in vitrectomized eyes undergoing cataract extraction.

PURPOSE:To report a novel technique for biopsying small choroidal tumors for molecular prognostication utilizing a 38-gauge subretinal cannula. METHODS:Through a transvitreal approach, a subretinal cannula enters the eye and penetrates the tumor in an area devoid of blood vessels. Manual aspiration is conducted with the aid of a surgical assistant. The cannula's transparency allows for visualization of biopsy depth and tissue aspiration. The cannula is withdrawn, and the sample is manually injected into the specimen vial. RESULTS:Sixteen patients underwent biopsy using this technique for suspected small choroidal melanoma (1.5 mm average thickness). Sufficient diagnostic yield was appreciated in 88% (14/16) of patients. Six of 16 patients consisted of subfoveal tumors. Of 2 patients without yield, there was a technical processing error and an anteriorly located tumor. No complications were observed. CONCLUSION:The described technique using a subretinal cannula for choroidal tumor biopsy yields sufficient specimen for molecular analysis while potentially minimizing visually threatening side effects. It may hold additional benefit when biopsying small, posterior tumors, which are adjacent to sensitive anatomy.

PURPOSE:Dry eye disease (DED) is a common ocular surface disorder associated with ocular discomfort, visual disturbance, and reduced quality of life. Vitamin D has anti-inflammatory and immunomodulatory properties, and deficiency may predispose individuals to ocular surface disease. This study evaluated the association between vitamin D deficiency and incident DED. DESIGN:Retrospective cohort study. SUBJECTS:Adults aged ≥18 years identified from the TriNetX U.S. Collaborative Network. After 1:1 propensity score matching, 6,047,502 patients with vitamin D deficiency were compared with 6,047,502 matched controls without vitamin D deficiency. METHODS:De-identified electronic health records with up to 20 years of follow-up were analyzed. Vitamin D deficiency was defined using ICD-10 code E55. Controls were patients undergoing routine medical examinations without abnormal findings (ICD-10: Z00.00). Propensity score matching was performed for age, sex, and relevant comorbidities. Time-to-event analyses were conducted using Cox proportional hazards models. Kaplan-Meier curves and log-rank tests compared cumulative incidence between cohorts. Risk ratios (RRs) and odds ratios (ORs) were calculated from end-of-follow-up incidence proportions. MAIN OUTCOME MEASURES:Incident dry eye disease, defined by ICD-10 code H04.12. RESULTS:DED developed in 196,639 patients (3.3%) with vitamin D deficiency and 160,141 patients (2.7%) without deficiency. Vitamin D deficiency was associated with a significantly increased risk of DED (hazard ratio [HR], 1.286; 95% CI, 1.277-1.294; p < .001). Kaplan-Meier curves demonstrated a higher cumulative incidence in the vitamin D-deficient cohort (log-rank χ² = 5590.618; p < .001). The risk ratio was 1.242 (95% CI, 1.234-1.250; p < .001), and the odds ratio was 1.250 (95% CI, 1.242-1.259; p < .001). Limitations include reliance on diagnostic coding and lack of serum vitamin D level data. CONCLUSIONS:Vitamin D deficiency was significantly associated with an increased risk of developing DED, with a 28.6% higher hazard compared with matched controls. These findings suggest that vitamin D deficiency may represent a modifiable risk factor for DED and support further prospective studies to evaluate the role of vitamin D supplementation in prevention and management.

OBJECTIVE:To quantify the long-term risk of incident glaucoma and of undergoing glaucoma surgery associated with intravitreal injection therapy using a large electronic health record network. DESIGN:Retrospective cohort study. SUBJECTS:Patients with no prior glaucoma diagnosis in the TriNetX US Collaboration Network seen between 03/14/2006-03/14/2026 with either exudative age-related macular degeneration (AMD) and intravitreal injection or nonexudative AMD with no history of injection. METHODS:Patients with exudative AMD who received intravitreal injections (Current Procedural Terminology 67028) were compared with patients with nonexudative AMD. Patients with retinal vascular occlusions, proliferative diabetic retinopathy, retinal ischemia, pseudoexfoliation syndrome or pigment dispersion syndrome were excluded. Cohorts were propensity score matched 1:1 for age, sex, race, ethnicity, and systemic comorbidities. Time-to-event analyses were performed, and effect estimates included risk ratios (RR), odds ratios (OR), and hazard ratios (HR). MAIN OUTCOME MEASURES:New glaucoma diagnosis (International Classification of Diseases-10 H40) and glaucoma surgical interventions. RESULTS:After exclusions and matching, each cohort contained 27,967 patients. Incident glaucoma occurred in 15.1% (4,218/27,967) of injection patients versus 12.9% (3,621/27,967) of controls (RR 1.17; OR 1.19; HR 1.08, p<0.001). Any glaucoma surgery occurred in 1.6% (435/27,967) of injection patients compared with 0.8% (236/27,967) of controls (RR 1.84; OR 1.86; HR 1.66, p<0.001). Patients with intravitreal injection were more likely to undergo glaucoma tube implantation (p<0.001), laser trabeculoplasty (p<0.001), cyclodestructive procedures (p=0.001), and trabeculectomy (p=0.03). Incisional angle surgery trended toward significance (p=0.054). CONCLUSIONS:In a large cohort, intravitreal injection therapy for exudative AMD was associated with higher risks of incident glaucoma and glaucoma surgery compared with matched nonexudative AMD controls, corresponding to a number needed to harm of approximately 47 for incident glaucoma.

PURPOSE:To evaluate the association between neighborhood-level disadvantage, measured by the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), and disease severity at presentation, treatment modality, and clinical outcomes in a cohort of Black patients with proliferative sickle cell retinopathy (PSR). METHODS:This retrospective cohort study included Black patients with PSR (Goldberg stages 3-5) seen at a metropolitan academic ophthalmology center from May 1, 2014, to December 31, 2022. Patient demographics, treatment patterns, and clinical outcomes were extracted from electronic medical records. Patient addresses were linked to SVI/ADI at the census tract level. Multiple linear regression analyses were conducted to assess associations between SVI/ADI and disease stage, treatment type (intravitreal injection [IVI], panretinal photocoagulation [PRP], pars plana vitrectomy [PPV]), and outcomes, including change in best-corrected visual acuity and post-treatment complications. RESULTS:The study included 110 eyes from Black patients with PSR. Neither SVI nor ADI was significantly associated with disease stage at presentation, initial treatment modality, or clinical outcomes (p > 0.05 for all models). PPV was the most common initial treatment (42 %), followed by PRP (36 %) and IVI (10 %). Patients undergoing PPV and IVI required significantly more follow-up visits (p = 0.032). CONCLUSION:Neighborhood disadvantage, as measured by SVI/ADI, was not significantly associated with disease severity, treatment selection, or clinical outcomes in this cohort of Black patients with PSR. Patients undergoing PPV or IVI required significantly more follow-up visits (p = 0.032), highlighting the substantial management burden for these patients. While neighborhood disadvantage was not significantly associated with outcomes, larger studies are needed to further assess these relationships. Regardless of measured neighborhood disadvantage, the substantial follow-up burden associated with PSR management underscores the importance of addressing individual-level barriers and support systems in this high-risk population.

Purpose: To evaluate whether disease severity at diagnosis and treatment outcomes in patients with neovascular age-related macular degeneration (nAMD) may be stratified by the Social Deprivation Index (SDI; a measure of socioeconomic status [SES] where higher scores indicate greater socioeconomic deprivation). Methods: We conducted a retrospective cohort study of 643 adults with newly diagnosed unilateral nAMD who were treated with antivascular endothelial growth factor (anti-VEGF) therapy at the Retina Group of Washington. Data collected included best-corrected visual acuity (BCVA) at baseline and 12 months, presence of submacular hemorrhage, and injection frequency in the first year of treatment. Logistic regression was used to assess associations between SDI and BCVA outcomes. Results: A higher SDI score was associated with lower odds of achieving a BCVA of ≥20/40 at 12 months (odds ratio, 0.69, 95% CI, 0.48-0.98; P = .039). Submacular hemorrhage and non-White race were predictive of poorer outcomes, whereas sex at birth was not predictive. The number of anti-VEGF injections received over 12 months was similar between the high SDI quantile group and low SDI quantile group (mean 9.1 vs 8.8; P = .053). Age, baseline BCVA ≥20/40, and race were significant predictors of achieving a BCVA ≥20/40 at 12 months. BCVA at baseline was not significantly different between the SDI quantile groups, suggesting that disparities emerge during treatment rather than at diagnosis. Conclusions: The SDI is a useful metric of social determinants of health in patients with nAMD. Higher SDI was associated with poorer visual outcomes despite similar baseline vision and treatment exposure, suggesting that disparities extend beyond diagnosis to treatment effectiveness. These findings underscore the multifactorial nature of socioeconomic influences, including race, treatment adherence, and access, and the need for targeted strategies to improve equitable care.