JAMA ophthalmology最新文献

{"title":"Short-Term Ocular Biometric Changes as Predictors of Long-Term Angle Closure Progression","authors":"Kendra L. Hong, Benjamin Y. Xu, Wei Wang, Austin Cho, Natalie M. Kistler, Paul J. Foster, Yuzhen Jiang, Tin Aung, David S. Friedman, Mingguang He","doi":"10.1001/jamaophthalmol.2025.1007","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1007","url":null,"abstract":"ImportanceBaseline ocular biometrics of the anterior segment forecast progression from primary angle closure suspect (PACS) to primary angle closure (PAC). As ocular biometrics change with aging, it is also important to understand the progression risk associated with these longitudinal anatomical changes.ObjectiveTo assess 18-month ocular biometric changes as risk factors for progression from PACS to PAC between 36 and 72 months.Design, Setting, and ParticipantsThis retrospective cohort study analyzed data from the prospective Zhongshan Angle Closure Prevention (ZAP) Trial, which was a randomized clinical trial conducted from September 2008 to November 2018. Participants were aged 50 to 70 years and had bilateral PACS, defined as inability to visualize pigmented trabecular meshwork in 2 or more quadrants on gonioscopy. Participants were evaluated at baseline, at 2 weeks, and at 6, 18, 36, 54, and 72 months for progression to PAC, defined as development of intraocular pressure greater than 24 mm Hg, peripheral anterior synechiae, or acute angle closure. Untreated eyes without progression at or before 18 months were eligible. Cox regression models assessed risk factors for progression. Data were analyzed from November 2023 to June 2024.Main Outcome and MeasureProgression from PACS to PAC between 36 and 72 months.ResultsA total of 785 untreated eyes (759 without progression, 26 with progression) of 785 participants were analyzed (mean [SD] age, 58.7 [5.0] years; 651 females [82.9%], 134 males [17.1%]). In univariable Cox models, baseline trabecular-iris space area at 500 μm (TISA500) and 18-month change in lens vault (ΔLV) and TISA at 750 μm (ΔTISA750) were associated with progression. In age-adjusted multivariable Cox models, baseline TISA500 (hazard ratio [HR], 1.28 per −0.01 mm<jats:sup>2</jats:sup>; 95% CI, 1.09-1.50; <jats:italic>P</jats:italic> = .006) and ΔLV (HR, 1.22 per 0.1 mm; 95% CI, 1.07-1.41; <jats:italic>P</jats:italic> = .008) (concordance index, 0.73) or baseline TISA500 (HR, 1.31 per −0.01 mm<jats:sup>2</jats:sup>; 95% CI, 1.11-1.54; <jats:italic>P</jats:italic> = .003) and ΔTISA750 (HR, 1.06 per −0.01 mm<jats:sup>2</jats:sup>; 95% CI, 1.02-1.10; <jats:italic>P</jats:italic> = .009) (concordance index, 0.73) were more predictive than baseline TISA500 alone (HR, 1.27 per −0.01 mm<jats:sup>2</jats:sup>; 95% CI, 1.09-1.49; <jats:italic>P</jats:italic> = .007) (concordance index, 0.69). A multivariable model with categorical TISA500 in the lowest quartile (<0.031 mm<jats:sup>2</jats:sup>; HR, 2.65; 95% CI, 1.20-5.86; <jats:italic>P</jats:italic> = .03) and ΔLV in the highest quartile (>0.663 mm; HR, 2.70, 95% CI, 1.23-5.93; <jats:italic>P</jats:italic> = .02) independently conferred greater risk of progression (concordance index, 0.69).Conclusions and RelevanceShort-term (18-month) changes in LV and TISA750 were associated with long-term (36-72 month) angle closure progression in untreated PACS eyes, suggesting th","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"98 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Central Retinal Artery Occlusion After Paclitaxel in Breast Cancer","authors":"Harsh H. Jain, Rabia Naaz, Tanya Sagar, Akshay Kothari, Aditya Kelkar, Sabyasachi Sengupta","doi":"10.1001/jamaophthalmol.2025.1379","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1379","url":null,"abstract":"This case report discusses development of central retinal artery occlusion in a patient undergoing chemotherapy for biopsy-proven stage 3 breast cancer with paclitaxel.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"49 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144165665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemplating the Laser Question for Primary Angle Closure Suspect.","authors":"Steven J Gedde, Vikas Chopra, Kateki Vinod","doi":"10.1001/jamaophthalmol.2025.1494","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1494","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Based Detection of Diabetic Retinopathy-Reply.","authors":"Shreya A Shah,Prithvi Mruthyunjaya,Ravi Parikh","doi":"10.1001/jamaophthalmol.2025.1197","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1197","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"97 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Vision for Site-Neutral Policy.","authors":"Taylor Hall,Brian J Miller,Fasika A Woreta,Catherine L Chen","doi":"10.1001/jamaophthalmol.2025.1278","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1278","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"19 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flying Babies and Swept-Source OCT-An Innovative Technique to Detect Childhood Glaucoma.","authors":"Sylvia L Groth,Rachel W Kuchtey","doi":"10.1001/jamaophthalmol.2025.1375","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1375","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"68 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant Transformation of Choroidal Indeterminate Melanocytic Tumors.","authors":"Arun D Singh,Yehonatan Weinberger,Emily C Zabor","doi":"10.1001/jamaophthalmol.2025.1262","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1262","url":null,"abstract":"ImportanceThe accuracy of the predicted risk of malignant transformation of a large choroidal nevus or indeterminate melanocytic tumor (IMT) is not known.ObjectiveTo estimate the risk of malignant transformation (predicted risk) in a cohort of patients with IMT of known outcomes (observed status; benign [large nevus] or malignant [small melanoma]).Design, Setting, and ParticipantsThis was a cohort study of patients from a single center. Patients diagnosed with IMTs that were benign (large nevus) or malignant (small melanoma) were included in the analysis. Those lesions classified as large nevus (benign; 0% risk) had documented stability over 24 or more months. IMTs classified as small melanoma (malignant; 100% risk) had quantified growth or confirmatory pathology. Data were analyzed from October to December 2024.ExposuresPrediction of malignant transformation of a large choroidal nevus or IMT.Main Outcomes and MeasuresThe primary outcome included the predicted 5-year Kaplan-Meier probability of malignant transformation using combinations of risk factors of predictive models, the Collaborative Ocular Melanoma Study (COMS) and Wills Eye Hospital (WEH) model.ResultsA total of 123 patients (median [IQR] age, 63 [56-67] years; 89 male [72%]), 62 with large nevus and 61 with small malignant melanoma, were included in this study. The mean predicted 5-year Kaplan-Meier probability of melanoma for observed melanoma was 0.39 (95% CI, 0.32-0.46) by the COMS model and 0.44 (95% CI, 0.39-0.49) by the WEH model. The difference of -0.05 (95% CI, -0.14 to 0.04) was not statistically significant. However, the mean predicted 5-year Kaplan-Meier probability of melanoma for observed nevus was 0.18 (95% CI, 0.12-0.23) by the COMS model and 0.31 (95% CI, 0.24-0.38) by the WEH model. The difference of -0.13 (95% CI, -0.22 to -0.05) was statistically significant. There was a significant difference in mean 5-year Kaplan-Meier probability of melanoma between observed melanoma and nevus of 0.21 (95% CI, 0.12-0.31) by the COMS model and 0.13 (95% CI, 0.05-0.21) by the WEH model. Optimal cut points of 0.18 and 0.34 for the COMS model and the WEH model, respectively, were identified using the Youden index. The sensitivity was lower for the COMS model than the WEH model (-15.2% difference; 95% CI, -25.6% to -4.8%), and the specificity was higher for the COMS model than the WEH model (11.7% difference; 95% CI, 2.0%-21.4%).Conclusions and RelevanceFindings of this cohort study suggest that predicted risk for malignant transformation estimated by 2 different models based on combinations of risk factors was suboptimal and may lead to overtreatment in approximately 30% of patients. These findings support pursuing other methods for prediction that should be validated before use in clinical practice.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"136 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Based Detection of Diabetic Retinopathy.","authors":"Flora Lum","doi":"10.1001/jamaophthalmol.2025.1194","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1194","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Swept-Source Anterior-Segment OCT as an In-Office Biomarker for Early Childhood Glaucoma.","authors":"Sushmita Kaushik,Ashok Kumar Singh,Faisal Thattaruthody,Vyshak Suresh,Anchal Gera,Shivangi Yadav,Surinder Singh Pandav","doi":"10.1001/jamaophthalmol.2025.1009","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1009","url":null,"abstract":"ImportanceEarly-onset childhood glaucoma usually is diagnosed based on signs and symptoms (such as a cloudy cornea, buphthalmos, or excessive lacrimation). However, the signs and symptoms can overlap with other congenital conditions, making differentiation important. Swept-source anterior-segment optical coherence tomography (SS-ASOCT) may offer a rapid, noninvasive alternative to assess the trabecular meshwork (TM) structures, providing an additional tool to aid diagnosis.ObjectiveTo evaluate use of SS-ASOCT in diagnosing pediatric patients as having early-onset childhood glaucoma vs not having glaucoma.Design, Setting, and ParticipantsA prospective, comparative study including pediatric patients younger than 2 years of age who were referred to a tertiary care research and referral center in Northern India between June 2023 and July 2024. A diagnosis of early-onset childhood glaucoma was based on the clinical appearance of corneal clarity, intraocular pressure, buphthalmos, and optic disc evaluation.Main Outcomes and MeasuresImaging was performed using SS-ASOCT with the \"flying baby\" technique to analyze the visibility of the TM structures, the angle opening distance (500 mm or 250 mm), and the angle recess area (250 mm2 or 500 mm2). Comparisons were made using analysis of variance. The area under the receiver operating characteristic curve was used to determine the discriminators for the nonglaucomatous angles. The best discriminatory parameters studied were subsequently tested in age-matched infants (controls) with congenital cloudy corneas without glaucoma based on an eye examination using an ophthalmoscope.ResultsThe SS-ASOCT features were compared between 23 pediatric patients without and 30 pediatric patients with early-onset childhood glaucoma; the 30 patients were diagnosed as having glaucoma based on an eye examination using an ophthalmoscope. At the time of SS-ASOCT imaging, the pediatric patients without glaucoma had a mean age of 17.3 (SD, 4.4) months and the pediatric patients with glaucoma had a mean age of 18.6 (SD, 14.2) months. The TM shadow was clearly visible in 23 patients without glaucomatous eyes (100%), whereas the TM shadow was clearly visible in only 8 patients with glaucomatous eyes (26.7%) (sensitivity of 73.3% and specificity of 100%). To diagnose pediatric patients as not having early-onset childhood glaucoma, the highest area under the receiver operating characteristic curve of 0.87 (95% CI, 0.77-0.97; P < .001) was used for a clearly visible TM structure. The pediatric patients with glaucoma had greater anterior chamber angle measurement values than the pediatric patients without glaucoma. The TM structure was visualized in all young children with corneal opacity but who did not have glaucoma, and all 23 patients were correctly diagnosed as not having glaucoma using SS-ASOCT.Conclusions and RelevanceA noninvasive imaging tool, SS-ASOCT can be used to assess the anterior chamber angles in children. The findings sugg","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"31 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Encouraging News for Children With Aphakia.","authors":"William V Good","doi":"10.1001/jamaophthalmol.2025.1243","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.1243","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"55 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}