AJO International最新文献

{"title":"Association of neutrophil-to-lymphocyte ratio and neutrophil activation with treatment response in neovascular AMD","authors":"Alexander Kai Thomsen ,&nbsp;Maria Abildgaard Steffensen ,&nbsp;Kathrine Gotfredsen ,&nbsp;Henrik Vorum ,&nbsp;Bent Honoré ,&nbsp;Mogens Holst Nissen ,&nbsp;Torben Lykke Sørensen","doi":"10.1016/j.ajoint.2025.100155","DOIUrl":"10.1016/j.ajoint.2025.100155","url":null,"abstract":"<div><h3>Purpose</h3><div>The neutrophil-to-lymphocyte ratio (NLR) and alterations of activation surface markers on circulating neutrophils have been suggested to be involved in the pathogenesis of age-related macular degeneration (AMD). The aim of this study was to investigate the relationship between NLR, activation surface markers on neutrophils, AMD stage, and treatment response in neovascular AMD (nAMD).</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Treatment-naïve nAMD patients, intermediate AMD (iAMD) patients, and healthy controls were consecutively enrolled. Treatment response in nAMD patients was categorized as good, partial and poor based on change of retinal fluid and central retinal thickness. Treatment response was evaluated after the loading phase and after one year of treatment with aflibercept 2 mg. NLR and activation surface markers on circulating neutrophils (CD11a, CD11b, CD31, CD66b, CD162, and CD182) were examined with flow cytometry. NLR and activation surface markers were compared between healthy controls, iAMD, and nAMD patients, as well as between nAMD treatment response groups. Polymorphisms in the CFH and ARMS2 genes were compared to NLR and the surface markers in nAMD patients.</div></div><div><h3>Results</h3><div>NLR was significantly elevated in nAMD patients compared to healthy controls (<em>P</em> &lt; 0.001). nAMD patients with poor 1-year treatment response had a significantly higher NLR compared to good 1-year treatment responders. Expression levels of CD11a, CD11b, CD31, CD66b, CD162, and CD182 on circulating neutrophils were elevated in nAMD patients compared to healthy controls (all <em>P</em> &lt; 0.05), however no significant differences were found between nAMD treatment response groups. No significant associations were found between CFH or ARMS2 genotypes with NLR or neutrophil surface markers in nAMD patients.</div></div><div><h3>Conclusion</h3><div>Elevated NLR was associated with a poor 1-year treatment response. The NLR and expression levels of activation surface markers on circulating neutrophils were significantly elevated in treatment-naïve nAMD patients compared to healthy controls.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of antibiotic additives in irrigation fluid used during cataract surgery: A systematic review","authors":"Brian Edward Yu ,&nbsp;William Herspiegel ,&nbsp;Robert Khatib ,&nbsp;Jeffrey Thevaranjan ,&nbsp;Abbie Lai ,&nbsp;Amit X. Garg ,&nbsp;Cindy M.L. Hutnik ,&nbsp;Monali Malvankar-Mehta","doi":"10.1016/j.ajoint.2025.100134","DOIUrl":"10.1016/j.ajoint.2025.100134","url":null,"abstract":"<div><h3>Purpose</h3><div>To conduct a systematic review investigating the efficacy of antibiotics used in irrigation fluid during cataract surgery on the incidence of post-operative endophthalmitis.</div></div><div><h3>Design</h3><div>Systematic review of literature.</div></div><div><h3>Methods</h3><div>Literature was searched through MEDLINE, EMBASE, CINAHL, ClinicalTrials.gov, and ProQuest Dissertations and Theses until February 17, 2024. Conferences held through the Association for Research in Vision and Ophthalmology and American Academy of Ophthalmology were searched until March 22, 2024. A total of 5341 records were screened leaving 13. One author independently reviewed them for quality and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed. Data on the types of antibiotics used, as well as the incidence of post-operative endophthalmitis and complications, were extracted.</div></div><div><h3>Results</h3><div>A total of 608,064 eyes and 566,760 patients were included in the current study. Surgical procedures included phacoemulsification, manual small-incision, and extracapsular extraction. Results showed antibiotic additives reduced postoperative endophthalmitis and bacterial contamination. Vancomycin showed the lowest infection rates, with one study reporting 0 infections out of 220 patients using a concentration of 20 mg/L. Similarly, gentamicin, tobramycin, and cefuroxime also demonstrated reduced infection rates, with gentamicin achieving rates as low as 0.008 % at higher concentrations. Combination therapy with vancomycin and gentamicin further reduced bacterial contamination, with culture positivity rates as low as 2.73 %. In comparator groups without antibiotics, infection rates were significantly higher, ranging from 0.04 % to 0.07 %. No adverse events or complications were reported in those who received antibiotics in their irrigation fluid.</div></div><div><h3>Conclusions</h3><div>Antibiotic additives in irrigation fluid reduce postoperative endophthalmitis and bacterial contamination in cataract surgery. These findings support their inclusion in surgical practice to improve patient outcomes. Based on the current systematic review, the overall quality of evidence is moderate, as findings are supported by a mix of randomized controlled trials and observational studies with some heterogeneity. Further high-quality RCTs are needed to determine optimal antibiotic concentrations and establish standardized guidelines.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding barriers to spectacle wear compliance among schoolchildren in Calabar Nigeria: A qualitative study","authors":"Anne Effiom Ebri ,&nbsp;Pirindha Govender ,&nbsp;Kovin Naidoo ,&nbsp;Frank Albert ,&nbsp;Kajal Shah ,&nbsp;Ving Fai Chan","doi":"10.1016/j.ajoint.2025.100160","DOIUrl":"10.1016/j.ajoint.2025.100160","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the availability of free spectacles, many schoolchildren in Africa do not wear them regularly. This study explores the factors affecting compliance with spectacle wear among schoolchildren in Nigeria, aiming to inform targeted eye health education strategies and future interventions.</div></div><div><h3>Design</h3><div>A qualitative study using Focus group discussion with 42 participants including 34 schoolchildren.</div></div><div><h3>Methods</h3><div>Participants for the focus group discussions (FGD) were selected from a cluster-randomized controlled trial that assessed spectacle compliance between September 2017 and June 2018. Out of 4241 schoolchildren aged 10 to 18 recruited for the study, 308 received spectacles. In early February 2018, during the third month of the trial, 40 students were purposively identified and invited to participate in the FGD. A total of 34 students were interviewed in four groups across four schools. Additionally, a fifth group of selected adults was interviewed in a hall. The interviews took place in mid-February 2018 and each session lasted between 45 and 85 min<strong>.</strong></div></div><div><h3>Results</h3><div>The findings reveal a mix of sociocultural misconceptions, stigma, environmental factors and self-perception issues influence children's decision to wear spectacles. According to the Health Belief Model, low perceived risk, high barriers to use, and limited cues to action hinder consistent wear. While improved vision and academic performance motivate some children, these benefits are outweighed by peer pressure and a lack of support.</div></div><div><h3>Conclusion</h3><div>Enhancing self-efficacy through child-centred approaches, such as frame choice and improving frame aesthetics, promoting peer acceptance through targeted. School and community-based eye health initiatives should improve compliance.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144779567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-based differences in career paths, parenthood and perspectives on professional barriers among Asian ophthalmologists","authors":"Claire L Peterson ,&nbsp;Brian S.Y. Yeo ,&nbsp;Shelley Yin-Hsi Chang ,&nbsp;Rachel S Chong ,&nbsp;Marcus Ang ,&nbsp;Anna CS Tan ,&nbsp;Tina Wong ,&nbsp;Andrew S.H. Tsai","doi":"10.1016/j.ajoint.2025.100161","DOIUrl":"10.1016/j.ajoint.2025.100161","url":null,"abstract":"<div><h3>Background</h3><div>Gender equality in Asia remains under-researched, especially within medical fields. This study explored gender-related differences among ophthalmologists in Asia.</div></div><div><h3>Design</h3><div>Observational, cross-sectional survey study.</div></div><div><h3>Methods</h3><div>An anonymous online survey was distributed across 21 Asian regions via the Young Ophthalmologist network (June–July 2024), examining career paths, leadership, research, parenthood and gender-related workplace experiences.</div></div><div><h3>Results</h3><div>A total of 242 cisgendered ophthalmologists from 20 regions responded; 163(67%) identified as women. Although most institutions had gender-balanced workforces, gender disparities persisted. Men were more likely than women to pursue surgically-oriented subspecialties such as surgical retina and cornea (M83% VS W52%, p=0.02). Women reported a greater impact on parenthood on subspecialty choice (W54% vs M28%, p&lt;0.001) and career progression (W64% vs M39%, p&lt;0.001). Women were also more likely to work part-time due to family commitments.</div><div>While overall leadership, academic positions and research output were similar, head of department roles in particular were predominantly held by men (62%), with women perceiving they had less opportunities in leadership (W61% vs M90%, p&lt;0.001) and research (W80%, M93%, p=0.01) compared to their male counterparts, and reporting a need to champion women in these areas. Women also experienced more gender discrimination and sexual harassment from their patients, colleagues, and bosses of the opposite sex compared to men(p&lt;0.05).</div></div><div><h3>Conclusion</h3><div>Women contribute significantly to ophthalmology in Asia but gender-related disparities remain for subspecialty choice, perceived leadership and research opportunities, parenthood, discrimination and harassment. Addressing these through mentorship, education, flexible career support, advocacy and institutional reform is essential to achieving gender equity in all areas of ophthalmology.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144861343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding surgical training access: A phacoemulsification course via Orbis Cybersight","authors":"Fatma Shakarchi,&nbsp;Ayorinde Cooley,&nbsp;Curtis R Martin,&nbsp;Traeson Brandenburg,&nbsp;Nicolas Zaunbrecher,&nbsp;Christopher L Shelby,&nbsp;Stephen A LoBue,&nbsp;Wyche T Coleman III","doi":"10.1016/j.ajoint.2025.100151","DOIUrl":"10.1016/j.ajoint.2025.100151","url":null,"abstract":"<div><h3>Purpose</h3><div>To highlight the potential of openly accessible online surgical courses in strengthening global ophthalmic education. We demonstrate a case study focusing on a basic phacoemulsification training course published on Orbis Cybersight, designed to support early surgical learning for ophthalmologists worldwide.</div></div><div><h3>Methods</h3><div>We developed a one-hour, self-paced online course on the basics of phacoemulsification, split into six narrated modules: Incisions, Capsulorhexis, Hydrodissection, Nucleus Removal, Cortex Removal, and IOL Insertion &amp; Wound Closure. We included quizzes for self-testing in every module. We published the course on Orbis Cybersight, a global telemedicine and training platform, and made it freely available on demand. We analyzed engagement patterns and gathered informal feedback from trainees and educators across different regions.</div></div><div><h3>Results</h3><div>The course was accessed by over 5,000 participants based in 162 countries across all seven continents, including Antarctica, working in diverse high-, middle-, and low-income settings. Most participants were ophthalmologists (2,238; 44.4 %), ophthalmology residents (837; 16.6 %), and optometrists (484; 9.6 %), while nearly 20 % (963) represented a variety of other professions, including drivers, teachers, medical students, and security guards. Approximately 1,340 participants (26.6 %) completed the course, while 2,709 (53.6 %) marked it as “in progress.” On average, participants made about five access attempts and spent a mean of 83.63 minutes to complete the course. The optional pre- and post-course quizzes showed a 39.5 % increase in participation and a 35 % relative increase in knowledge acquisition after completing the course.</div></div><div><h3>Conclusions</h3><div>Open-access platforms like Orbis Cybersight can play a key role in delivering foundational surgical education. These platforms help bridge gaps in training and promote equity in surgical education. They are impactful for sharing complex cases and essential foundational learning, without adding a financial burden for trainees globally. Our case study offers a scalable, low-cost way to help global trainees gain exposure to essential surgical steps and concepts.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal crosslinking for keratoconus in children with thin corneas: A multicentre registry study","authors":"Charles J. Proxenos ,&nbsp;Himal Kandel ,&nbsp;Aanchal Gupta ,&nbsp;Jern Yee Chen ,&nbsp;Adam Watson ,&nbsp;Nicholas Downie ,&nbsp;Stephanie L. Watson","doi":"10.1016/j.ajoint.2025.100145","DOIUrl":"10.1016/j.ajoint.2025.100145","url":null,"abstract":"<div><h3>Purpose</h3><div>This study reports the clinical outcomes of corneal crosslinking in children with thin corneas in the real-world setting.</div></div><div><h3>Design</h3><div>Retrospective, longitudinal study</div></div><div><h3>Subjects</h3><div>The subjects were extracted from the Save Sight Keratoconus Registry and 18 children (21 eyes) under the age of 18 with corneas of 400 µm or less were included in the study.</div></div><div><h3>Methods</h3><div>Using the Save Sight Keratoconus Registry data was collected from 10 practices across Australia and New Zealand. Outcomes were assessed at the final follow-up visit. The primary outcome measure was a change in corneal curvature. Secondary outcomes included a change in visual acuity, a change in corneal thickness, and adverse events.</div></div><div><h3>Results</h3><div>Eighteen patients (21 eyes), of which 12 (66.7 %) were male, with a median age of 16 years (IQR 4.0, Range 8 to 18) underwent CXL. Median follow-up was 10 months (IQR 8, range 3 -55). Median values in outcome measures changed from baseline to follow-up: Kmax from 70.5D (IQR 15.5) to 69.3D (IQR 20.7), K2 from 60.5D (IQR 11.3) to 58.6D (IQR 13.5), habitual visual acuity from 47 (IQR 44.0) to 50 (IQR 31.0) LogMAR letters, pinhole visual acuity from 55 (IQR 11.0) to 60 (IQR 11.0) LogMAR letters and minimum corneal thickness from 390 μm (IQR 29.0) to 370.5 μm (IQR 48.5). Three eyes experienced adverse events. Two developed corneal scarring and one developed microbial keratitis requiring corneal graft.</div></div><div><h3>Conclusions</h3><div>This real-world study shows that CXL in children with thin corneas can stabilise corneal parameters and vision. Adverse events occur and include scarring and microbial keratitis. The small sample size and short duration of follow-up are notable limitations, and further larger prospective studies are needed to determine the safety and efficacy of CXL in children.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Danish Ophthalmological Society guidelines for screening of diabetic retinopathy","authors":"Jakob Grauslund ,&nbsp;Nis Andersen ,&nbsp;Jens Andresen ,&nbsp;Toke Bek ,&nbsp;Søren Tang Knudsen ,&nbsp;Yousif Subhi","doi":"10.1016/j.ajoint.2025.100141","DOIUrl":"10.1016/j.ajoint.2025.100141","url":null,"abstract":"<div><div>N/A as this is submitted as a Perspective.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144196435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cornea eye care coverage based on geographic distribution and population demographics in the United States","authors":"Riya H. Patel ,&nbsp;David Mothy ,&nbsp;Hassaam S. Choudhry ,&nbsp;Aliya Grinberg ,&nbsp;Jayant Bhasin ,&nbsp;Mohammad H. Dastjerdi","doi":"10.1016/j.ajoint.2025.100139","DOIUrl":"10.1016/j.ajoint.2025.100139","url":null,"abstract":"<div><h3>Purpose</h3><div>To correlate the geographic distribution of cornea-specializing ophthalmologists with United States population demographics and identify communities with gaps in cornea care access.</div></div><div><h3>Design</h3><div>Cross-sectional analysis</div></div><div><h3>Methods</h3><div>In June 2024, office addresses of cornea ophthalmologists obtained from the Academy of Ophthalmology (AAO) public database and Google searches were geocoded using Esri ArcGIS Pro. Geographic distribution of cornea ophthalmologists within the United States compared to US county-level population demographics, such as county median incomes, educational attainment rates, poverty rates, and health insurance coverage rates. Independent samples <em>t</em>-tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>1665 cornea ophthalmologists’ office addresses were identified. 85.6 % (<em>n</em> = 2688) of US counties had no practicing cornea ophthalmologists whereas 14.3 % (<em>n</em> = 447) of US counties had at least one cornea ophthalmologist. There was an average of 5.02 cornea ophthalmologists per million people throughout the United States. When correlated with population demographics, counties with at least one cornea ophthalmologist had greater median income [$77,444], educational attainment rates [35.5 %], and health insurance coverage rates [98.6 %] compared to the median household annual income [$60,872], educational attainment rates [21.4 %], and health insurance coverage rates [97.5 %] of counties with no cornea ophthalmologists (<em>p</em> &lt; 0.001). Additionally, counties with at least one cornea ophthalmologist had lower poverty rates [12.0 %] compared to counties with no cornea ophthalmologists [14.2 %] (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Geographic disparities in cornea care access are pronounced in low socioeconomic counties. Addressing these issues is crucial for equitable eye care.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100139"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144222899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy and safety of nanoemulsion compared to conventional cyclosporine in dry eye disease: A systematic review and meta-analysis","authors":"Afaf Bachira Gouhiri ,&nbsp;Mohamed A. Aldemerdash ,&nbsp;Naila-Oulfet Zitouni ,&nbsp;Zina Otmani ,&nbsp;Omar F. Abbas ,&nbsp;Weam Aldiban ,&nbsp;Youssef Adel Youssef Ashmawi ,&nbsp;Abdelaziz A Awad ,&nbsp;Hashem Abu Serhan","doi":"10.1016/j.ajoint.2025.100143","DOIUrl":"10.1016/j.ajoint.2025.100143","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the efficacy and safety of nanoemulsion cyclosporine compared to conventional cyclosporine in reducing symptoms of dry eye disease (DED).</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We searched Scopus, Web of Science, PubMed, Embase, and Cochrane for relevant randomized clinical trials (RCTs) and pooled the mean differences (MD) for continuous efficacy outcomes, including the Schirmer test, ocular surface disease index (OSDI), and tear film break-up time (TBUT), and risk ratios (RR) for dichotomous safety outcomes, such as adverse drug reactions or ocular adverse events, with their corresponding 95% confidence intervals (CI) across different time points from baseline. We used R statistical software to run the meta-analysis and I² statistic to assess heterogeneity.</div></div><div><h3>Results</h3><div>Seven RCTs involving 545 patients were included. At 12 weeks, nanoemulsion cyclosporine significantly improved tear production as measured by the Schirmer test (MD = 0.77 mm, 95% CI, 0.22 to 1.31, p &lt; 0.01) and tear film stability assessed by TBUT (MD = 0.51 seconds, 95% CI, 0.32 to 0.70, p &lt; 0.01) compared to conventional cyclosporine. Safety analysis showed no significant difference in overall adverse events between groups (RR = 1.13, 95% CI, 0.81 to 1.56, p = 0.44). However, nanoemulsion cyclosporine was associated with a significantly higher risk of ocular adverse events (RR = 3.53, 95% CI, 1.18 to 10.54, p = 0.02).</div></div><div><h3>Conclusions</h3><div>Our meta-analysis demonstrates that nanoemulsion cyclosporine significantly improves tear production and tear film stability at the longest available follow-up. However, it is also associated with an increased risk of ocular adverse events. These findings highlight the need to balance efficacy and safety when considering nanoemulsion cyclosporine and could help inform clinical guidelines on optimal treatment duration and monitoring.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100143"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144240426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to access diabetic retinopathy treatment in Sri Lanka: A qualitative study","authors":"D. M. Mangala Dharmapriya Bandara Dhanapala ,&nbsp;Mapa Prabath Piyasena ,&nbsp;M. G. L. Mahesh Premarathna ,&nbsp;P. F. Supun Chameera Fonseka ,&nbsp;Sairuban K ,&nbsp;Niruththan K ,&nbsp;Jagjit Gilhotra ,&nbsp;Robert Casson ,&nbsp;Upul Senarath","doi":"10.1016/j.ajoint.2025.100157","DOIUrl":"10.1016/j.ajoint.2025.100157","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore patient and service provider perceptions on diabetic retinopathy (DR), its treatment and barriers faced by patients when accessing care, in order to develop strategies to improve uptake and outcomes of DR treatment care pathway.</div></div><div><h3>Study Design</h3><div>A qualitative study based on 12 focus group discussions (FGDs) and 8 semi-structured interviews (SSIs) was conducted.</div></div><div><h3>Methods</h3><div>Patients were selected from three treatment care pathways: intra-vitreal injections, laser photocoagulation and vitrectomy in a tertiary care public eye hospital. Separate FGDs were conducted for males and females, as well as Sinhalese and Tamil patients, within each treatment method to examine how gender and ethnicity influenced treatment experiences and health seeking behavior. FGDs were conducted in the two main native languages separately by two experienced sociologists. The SSIs were conducted with doctors and nurses in a language preferred by each healthcare worker. A pre-defined topic guide was used in the conduction of FGDs and SSIs. The recordings of these FGDs and SSIs were transcribed and subsequently used to conduct a thematic analysis using the Socio-Ecological Model and the health systems approach as a guide. Recurring concepts were identified by review of the transcripts which informed the development of a thematic code book.</div></div><div><h3>Results</h3><div>A total of 73 patients participated in the FGDs with a majority being male (54.7 %, <em>n</em> = 40) while Sinhala was the language spoken by most (60.2 %, <em>n</em> = 44). A total of four doctors and four nurses were interviewed in the SSIs. The lack of knowledge on diabetes, DR and DR treatment modalities was identified as a key barrier to seeking early care and a significant contributor to patient dissatisfaction. In addition, inadequacy of infrastructure, lack of wayfinding signage systems in the hospital, behavior of healthcare assistants, discrimination, long waiting times, postponement of surgeries and inadequacy of information given by doctors were among many other sub-themes that were identified as barriers. Interviews with healthcare workers revealed lack of public awareness, overcrowding, lack of proper referral systems and inadequacy of opportunities for continuous professional development as major barriers.</div></div><div><h3>Conclusion</h3><div>Multi-dimensional factors at all levels of the Socio-Ecological Model were found to act as barriers to patient care, principal among which was the lack of knowledge among patients on the impact of diabetes on the eye. Tailormade strategies to address these barriers should be implemented in order to improve quality of care. Patient education, staff training and infrastructure development should be the cornerstones among such measures.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}