JAMA ophthalmology最新文献

{"title":"Metformin and the Development of Age-Related Macular Degeneration.","authors":"Darren A Jindal,Jovana Hanna,Jacqueline K Shaia,Jonathan Markle,Aleksandra Rachitskaya,David C Kaelber,Rishi P Singh,Katherine E Talcott","doi":"10.1001/jamaophthalmol.2025.3070","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3070","url":null,"abstract":"ImportanceMetformin has demonstrated protective effects in systemic diseases, including cancer, cardiovascular disease, and retinal diseases, such as diabetic retinopathy and choroidal neovascularization. Literature suggests metformin may reduce the risk of age-related macular degeneration (AMD), but a consensus has not been reached.ObjectiveTo evaluate the association of metformin with the development of any AMD and progression to geographic atrophy and neovascular AMD using a large electronic health record (EHR) platform.Design, Setting, and ParticipantsThis cohort study had 2 exposed cohorts of participants aged 65 years or older who were prescribed metformin: one without AMD to assess development of any AMD and the other with mild or moderate nonexudative AMD to evaluate AMD progression to geographic atrophy or neovascular AMD. Corresponding nonexposed cohorts consisted of participants not prescribed metformin. Participants were required to meet inclusion criteria at least 6 months before the outcome of interest occurred. Those who had outcomes of interest before meeting inclusion criteria were excluded from analysis. This cohort study used a federated health research platform aggregating deidentified EHR data from 70 institutions (TriNetX). Data were collected from January 2013 to June 2025 and analyzed from September 2024 to June 2025.ExposuresParticipants prescribed metformin.Main Outcomes and MeasuresPropensity score matching controlled for confounders, such as age, sex, race, hypertension, diabetes, and other systemic conditions. Risk ratios (RRs) with 95% CIs were calculated to compare outcomes at 5 years, 10 years, and any time after meeting criteria. Any confidence intervals that crossed 0.90 to 1.10 were considered statistically not significant. Comparisons between exposed and unexposed groups were repeated requiring a diagnosis of cataract.ResultsBefore propensity score matching, cohort 1 (no AMD) included 297 008 participants exposed to metformin (mean [SD] age, 74.9 [7.0] years; 157 584 [53.1%] female) and 1 269 644 participants unexposed to metformin (mean [SD] age, 76.8 [7.9] years; 738 640 [58.2%] female). Before propensity score matching in cohort 2 (early or intermediate nonexudative AMD), there were 12 843 participants exposed to metformin (mean [SD] age, 79.5 [7.2] years; 7107 [55.3%] female) and 77 279 participants unexposed to metformin (mean [SD] age, 81.6 [7.2] years; 48 491 [62.7%] female). After propensity score matching, participants prescribed metformin had comparable risk of developing any AMD relative to those not prescribed metformin (RR, 0.90; 95% CI, 0.86-0.94). When stratified by time, the risk remained similar at 5 years (RR, 0.94; 95% CI, 0.90-0.99) and 10 years (RR, 0.91; 95% CI, 0.87-0.94). Similarly, participants prescribed vs not prescribed metformin had a comparable risk of AMD progression over these time spans (RR for geographic atrophy, 0.87; 95% CI, 0.76-1.01; RR for neovascular AMD, 1.03; 95% CI, 0.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"37 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078007","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":"Periocular Leukoderma Associated With Atropine Eye Drops.","authors":"Shilpa Viswanath,Sunil Dogra,Reema Bansal","doi":"10.1001/jamaophthalmol.2025.2656","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2656","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"1 1","pages":"e252656"},"PeriodicalIF":8.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078062","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":"Ultra-Widefield OCT Angiography in Coats Plus Syndrome.","authors":"Meiqian He,Youxin Chen,Xinyu Zhao","doi":"10.1001/jamaophthalmol.2025.2658","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2658","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"18 1","pages":"e252658"},"PeriodicalIF":8.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078129","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":"Assessing the Risk of Acute Angle Closure.","authors":"Rachel S Chong,Tin Aung","doi":"10.1001/jamaophthalmol.2025.3249","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3249","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"48 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078010","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":"Behind the Eyes-Compensation and Complexity in Head Impacts.","authors":"Zachary S Bellini,Keisuke Kawata","doi":"10.1001/jamaophthalmol.2025.3244","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3244","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"71 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145078065","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":"Ocular Risks of Topical Atropine Prescriptions Among Taiwanese Children.","authors":"Yao-Lin Liu,Jin-Yu Tsai,Kai-Yen Chiu,I-Ju Tsai,Ian G Morgan,Tzu-Hsun Tsai,I-Jong Wang","doi":"10.1001/jamaophthalmol.2025.3090","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3090","url":null,"abstract":"ImportanceMyopia is a global health concern, with high myopia elevating the risk of ocular complications. While atropine can affect myopia progression, its long-term safety profile remains uncertain.ObjectiveTo investigate the ocular risks associated with atropine prescription in clinical practice for myopia control in Taiwanese children.Design, Setting, and ParticipantsThis was a retrospective, population-based cohort study using longitudinal data from Taiwan's National Health Insurance Research Database (2000-2021). Children aged 8 to 15 years with newly diagnosed myopia and matched nonmyopic control participants in the period between 2001 and 2015 were included. Data analysis was performed from March 8 to May 30, 2024.ExposureData on atropine prescription were collected, and participants were categorized by cumulative duration and dose.Main Outcomes and MeasuresDiagnoses of cataracts, primary open-angle glaucoma, and maculopathy were recorded during the observation period. The incidence of ocular complications after a minimum 5-year follow-up period was reported. Hazard ratios (HRs) were derived using multivariable Cox regression models to evaluate atropine-related risks.ResultsA total of 1 213 846 Taiwanese children (mean [SD] age at myopia diagnosis, 10.4 [1.9] years; 633 440 [52.2%] female) were included. Among 606 923 children with myopia, 406 383 (67.0%) were prescribed atropine. The incidence of ocular complications (cataracts, glaucoma, and maculopathy) was higher in the myopia group (1.54 per 10 000 person-years) compared with the nonmyopia group (0.96 per 10 000 person-years; adjusted HR [aHR], 1.49; 95% CI, 1.36-1.64). In children with myopia, the incidence of ocular complications was not different between atropine users and nonusers (both 1.54 per 10 000 person-year; aHR, 1.05; 95% CI, 0.93-1.18). An increased risk of ocular complications was observed in children with cumulative duration of atropine prescription exceeding 3 years (aHR, 1.51; 95% CI, 1.17-1.94). However, this trend was not present when conditioned on children with high myopia (aHR, 1.10; 95% CI, 0.56-2.19). No increased risk was found among children with the highest quartile of cumulative atropine dose (aHR, 1.05; 95% CI, 0.89-1.25).Conclusions and RelevanceWhile the incidence of cataracts, glaucoma, or maculopathy was higher in children with myopia, atropine prescription was not associated with these risks. While these findings offer insights for weighing risks and benefits of atropine use in myopia control, they are limited to atropine prescriptions implying atropine use, and they generate hypotheses but cannot imply cause-and-effect relationships.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"16 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032100","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":"Safety of Long-Term Use of Atropine for Myopia in Children.","authors":"S Swaroop Vedula","doi":"10.1001/jamaophthalmol.2025.3212","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3212","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032154","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":"DeepSeek-R1 vs Open-Weight AI in Ophthalmology.","authors":"Zhenzhen Liu,Chen Zhao,Haotian Lin","doi":"10.1001/jamaophthalmol.2025.3153","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3153","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"17 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962666","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":"DeepSeek-R1 vs OpenAI o1 for Ophthalmic Diagnoses and Management Plans.","authors":"David Mikhail,Andrew Farah,Jason Milad,Andrew Mihalache,Daniel Milad,Fares Antaki,Michael Balas,Marko M Popovic,Rajeev H Muni,Pearse A Keane,Renaud Duval","doi":"10.1001/jamaophthalmol.2025.2918","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.2918","url":null,"abstract":"ImportanceLarge language models (LLMs) are increasingly being explored in clinical decision-making, but few studies have evaluated their performance on complex ophthalmology cases from clinical practice settings. Understanding whether open-weight, reasoning-enhanced LLMs can outperform proprietary models has implications for clinical utility and accessibility.ObjectiveTo evaluate the diagnostic accuracy, management decision-making, and cost of DeepSeek-R1 vs OpenAI o1 across diverse ophthalmic subspecialties.Design, Setting, and ParticipantsThis was a cross-sectional evaluation conducted using standardized prompts and model configurations. Clinical cases were sourced from JAMA Ophthalmology's Clinical Challenge articles, containing complex cases from clinical practice settings. Each case included an open-ended diagnostic question and a multiple-choice next-step decision. All cases were included without exclusions, and no human participants were involved. Data were analyzed from March 13 to March 30, 2025.ExposuresDeepSeek-R1and OpenAI o1 were evaluated using the Plan-and-Solve Plus (PS+) prompt engineering method.Main Outcomes and MeasuresPrimary outcomes were diagnostic accuracy and next-step decision-making accuracy, defined as the proportion of correct responses. Token cost analyses were performed to estimate expenses. Intermodel agreement was evaluated using Cohen κ, and McNemar test was used to compare performance.ResultsA total of 422 clinical cases were included, spanning 10 subspecialties. DeepSeek-R1 achieved a higher diagnostic accuracy of 70.4% (297 of 422 cases) compared with 63.0% (266 of 422 cases) for OpenAI o1, a 7.3% difference (95% CI, 1.0%-13.7%; P = .02). For next-step decisions, DeepSeek-R1 was correct in 82.7% of cases (349 of 422 cases) vs OpenAI o1's accuracy of 75.8% (320 of 422 cases), a 6.9% difference (95% CI, 1.4%-12.3%; P = .01). Intermodel agreement was moderate (κ = 0.422; 95% CI, 0.375-0.469; P < .001). DeepSeek-R1 offered lower costs per query than OpenAI o1, with savings exceeding 66-fold (up to 98.5%) during off-peak pricing.Conclusions and RelevanceDeepSeek-R1 outperformed OpenAI o1 in diagnosis and management across subspecialties while lowering operating costs, supporting the potential of open-weight, reinforcement learning-augmented LLMs as scalable and cost-saving tools for clinical decision support. Further investigations should evaluate safety guardrails and assess performance of self-hosted adaptations of DeepSeek-R1 with domain-specific ophthalmic expertise to optimize clinical utility.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"31 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962667","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":"JAMA Ophthalmology.","authors":"","doi":"10.1001/jamaophthalmol.2024.4186","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.4186","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"143 9","pages":"722"},"PeriodicalIF":9.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145080593","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}