Ophthalmology最新文献

{"title":"Access to Intravitreal Anti-VEGF Drugs in Persons with Medicare Advantage Compared with Medicare Fee-For-Service.","authors":"Jennifer Chan, Michael X Repka, George A Williams, Daniel Vail, Flora Lum, Tedi Begaj, Scott Friedman, Ravi Parikh","doi":"10.1016/j.ophtha.2026.06.019","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.06.019","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate intravitreal anti-VEGF drug use among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) beneficiaries.</p><p><strong>Design: </strong>Retrospective, cross-sectional analysis of de-identified healthcare data from the American Academy of Ophthalmology's IRIS® Registry (Intelligent Research in Sight) for patient encounters between January 2017 to December 2022.</p><p><strong>Participants: </strong>Medicare beneficiaries 65 years and older with FFS or MA coverage with continuous insurance enrollment for at least12 months.</p><p><strong>Methods: </strong>Unique FFS and MA beneficiaries receiving intravitreal anti-VEGF were included. Patients were considered to be treated with a particular drug if more than 50% of their injections for at least 12 months were with that drug. For each anti-VEGF drug, we compared proportions of patients treated (more than 50% of their injections) with that drug between FFS and MA and calculated the difference in use between the two Medicare health care programs.</p><p><strong>Main outcome measures: </strong>Differences in anti-VEGF drug utilization between FFS and MA.</p><p><strong>Results: </strong>930,411 beneficiaries underwent 12,942,057 intravitreal injections. In the FFS group, aflibercept 2mg was used most frequently (43.8%; n = 4,271,050), followed by bevacizumab (34.7%; n = 3,382,439), ranibizumab (20.6%; n = 2,008,791), brolucizumab (0.6%; n = 56,728) and faricimab (0.4%; n = 40,729). In the MA group, bevacizumab was used most frequently (45.1%; n = 1,436,151), followed by aflibercept 2mg (37.8%; n = 1,201,311), ranibizumab (6.5%; n = 524,758), brolucizumab (0.4%; n = 13,406), and faricimab (0.2%; n = 6,694). Repackaged bevacizumab (lower cost) was more common in the MA group compared with the FFS group (60.0% vs. 47.0%; difference (diff) = 13.0%, 95% CI:12.8, 13.3%; P<.001). Higher cost drugs were used significantly less often among persons with MA compared with FFS, respectively (aflibercept 2mg (28.9 vs. 36.6%; diff = -7.7%; 95% CI -7.9%, -7.4%; P<.001), ranibizumab (11.9% vs. 16.8%; diff = -4.9%; 95% CI -5.03%, -4.7%; P<.001), faricimab (0.06% vs. 0.24%; diff = -0.18%; 95% CI -0.19%, -0.16%); P<.001, and brolucizumab (0.12% vs. 0.19%; diff = -0.07%; 95% CI -0.09%, -0.05%; P<.001).</p><p><strong>Conclusions: </strong>Beneficiaries enrolled in MA were less likely to receive higher cost, anti-VEGF drugs, raising concerns about reduced beneficiary access to newer more expensive anti-VEGF drugs in MA.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148353009","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":"Re: Dones et al.: Emergency department use of ocular point-of-care ultrasound and its utility in diagnosis at a tertiary academic medical center (Ophthalmology. 2026;133:720-727).","authors":"Emma O'Shaughnessy, Augustin Lecler","doi":"10.1016/j.ophtha.2026.05.019","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.05.019","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302470","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":"Cataract Surgery and the Risk of Conversion from Dry to Neovascular Age-Related Macular Degeneration in the IRIS® Registry (Intelligent Research in Sight).","authors":"Helia Ashourizadeh, Joshua B Gilbert, Connor Ross, William C Kearney, Nicole Grinspan, Tobias Elze, Demetrios G Vavvas, Joan W Miller, Alice C Lorch, Grayson W Armstrong","doi":"10.1016/j.ophtha.2026.06.016","DOIUrl":"10.1016/j.ophtha.2026.06.016","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between cataract surgery (CS) and the risk of conversion from dry age-related macular degeneration (dAMD) to neovascular AMD (nvAMD) and to identify factors associated with conversion.</p><p><strong>Design: </strong>Population-based retrospective time-to-event study.</p><p><strong>Participants: </strong>Eyes of patients 55 years of age or older with early or intermediate dAMD and phakic status at baseline were identified in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) on or after January 1, 2016, through December 31, 2022. Eyes that underwent CS were classified as exposed; those without CS during the study period were classified as nonexposed.</p><p><strong>Methods: </strong>Propensity score matching was used to match eyes 1:1 on age, sex, race and ethnicity, laterality, AMD stage, and smoking status. Cataract surgery was modeled as a time-varying exposure. We used Cox proportional hazards regression to estimate the hazard of conversion to nvAMD.</p><p><strong>Main outcome measures: </strong>Conversion from dAMD to nvAMD, defined by registry-derived diagnosis codes, between exposed and nonexposed cohorts.</p><p><strong>Results: </strong>After matching, 40 053 eyes were included in each exposed and nonexposed cohort (n = 80 106 eyes total). Cataract surgery was associated with a higher risk of nvAMD conversion (hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.16-1.30; P < 0.001). Time-varying analysis demonstrated that this association was strongest early in follow-up (HR, approximately 2.5 in year 1) and declined steadily, reaching nonsignificance (HR, approximately 1.0) by year 4. At year 6, the cumulative incidence of nvAMD was 17.7% in the exposed cohort vs 15.2% in the nonexposed cohort. Baseline AMD stage moderated the effect of CS, with weaker effects of CS for intermediate AMD (interaction HR, 0.82; 95% CI, 0.73-0.92).</p><p><strong>Conclusions: </strong>Cataract surgery was associated with a modestly increased overall rate of conversion from dAMD to nvAMD; however, the time-dependent pattern suggests that the observed association likely reflects increased surveillance or unrecognized preexisting nvAMD, rather than a sustained biological effect of surgery. The absolute risk difference was small (approximately 3.3% over 6 years). These findings support careful perioperative evaluation in patients with dAMD, but do not implicate CS as a long-term driver of neovascular conversion.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148302433","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":"Blunt Ocular Trauma from BB Gun Pellet: Long-Term Corneal Endothelial Changes.","authors":"Paula Basso Dias, Sina Khalili, Kamiar Mireskandari","doi":"10.1016/j.ophtha.2026.05.032","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.05.032","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295805","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":"Medial Posterior Ciliary Artery Occlusion after Facial HA-CaHA Injection.","authors":"Jingxin Zeng, Bo Guo, Fang Lu","doi":"10.1016/j.ophtha.2026.05.027","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.05.027","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295798","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":"Atypical Sebaceous Adenoma of the Caruncle.","authors":"Chao Cheng, Lijuan Tang, Wei Xiao","doi":"10.1016/j.ophtha.2026.05.031","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.05.031","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295828","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":"Glaucoma in the UK Biobank: A Comparison of Diagnostic-Based versus Treatment-Based Definitions.","authors":"William Schierding, Aldric Khoo, Emma Akeroyd, Adam S Butterworth, John Danesh, Helen V Danesh-Meyer","doi":"10.1016/j.ophtha.2026.06.012","DOIUrl":"10.1016/j.ophtha.2026.06.012","url":null,"abstract":"<p><strong>Purpose: </strong>To compare, in the context of a population-scale biobank, associations of established risk factors and severity biomarkers with different glaucoma disease definitions.</p><p><strong>Design: </strong>Observational cohort study.</p><p><strong>Participants: </strong>Five hundred three thousand three hundred twenty-five participants in the UK Biobank.</p><p><strong>Methods: </strong>Odds ratios (ORs) for associations of established risk factors (corneal-compensated intraocular pressure [IOPcc] and polygenic risk score [PRS]) and clinical biomarkers of disease severity (macular retinal nerve fiber layer [mRNFL] and macular ganglion cell layer [mGCL] thickness) with different glaucoma definitions.</p><p><strong>Main outcome measures: </strong>Participants without glaucoma (n = 481 772) were compared with those with: (1) a diagnosis of glaucoma based on self-report or hospital inpatient or primary care records (diagnosis-only group; n = 16 154); or (2) a diagnosis plus evidence of treatment with glaucoma-specific medication or surgery (diagnosis and treatment group; n = 7012), either at baseline or during follow-up.</p><p><strong>Results: </strong>For participants in the highest 5% of IOPcc compared with the remainder, ORs were 23.6 (95% confidence interval [CI], 21.3-26.2) in the diagnosis and treatment group versus 11.4 (95% CI, 10.6-12.3; P < 1 × 10^-10 for difference) in the diagnosis-only group. Corresponding ORs were: 8.0 (95% CI, 6.9-9.2) in the diagnosis and treatment group vs 4.7 (95% CI, 4.2-5.3; P = 2.32 × 10^-7 for difference) in the diagnosis-only group for the thinnest 5% mRNFL; 7.1 (95% CI, 6.1-8.3) in the diagnosis and treatment group vs 4.2 (95% CI, 3.7-4.7; P = 2.53 × 10^-7 for difference) in diagnosis-only group for the thinnest 5% mGCL; and 8.4 (95% CI, 7.9-8.8) in the diagnosis and treatment group versus 5.6 (95% CI, 5.4-5.9; P < 1 × 10^-10 for difference) in the diagnosis-only group for the highest 5% PRS. Similar patterns were found for the other risk factors studied.</p><p><strong>Conclusions: </strong>Definitions of glaucoma that combine both diagnostic and treatment evidence yielded substantially stronger ORs with IOPcc, mRNFL, and mGCL than definitions based on diagnostic evidence alone, suggesting implications for studies of glaucoma in population biobanks.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148272443","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":"Association between Glucagon-like Peptide-1 Receptor Agonist Use and Nonarteritic Anterior Ischemic Optic Neuropathy with Optic Disc Drusen.","authors":"Ibrahim Abboud, Rami Madani, Joseph G Chacko, Paul H Phillips, Abdelrahman M Elhusseiny, Eric D Gaier","doi":"10.1016/j.ophtha.2026.06.014","DOIUrl":"10.1016/j.ophtha.2026.06.014","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265616","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":"The Effects of a Digital Mindfulness Intervention on Mental Health and Vision-Related Quality of Life in Noninfectious Uveitis.","authors":"Jessica G Shantha, Isabel Ray, Anika Kumar, Daisy Yan, Kirsten Da Silva, Charlene Choo, Alison B Coyne, Emily Tang, John A Gonzales, Thuy Doan, Benjamin F Arnold, Thomas Lietman, Nisha R Acharya","doi":"10.1016/j.ophtha.2026.06.011","DOIUrl":"10.1016/j.ophtha.2026.06.011","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of a digital mindfulness-based program (Calm Health) on mental health outcomes in adults with noninfectious uveitis (NIU).</p><p><strong>Design: </strong>Single-center, single-masked, waitlist-controlled, randomized clinical trial.</p><p><strong>Participants: </strong>One hundred adults aged ≥18 years with active or inactive NIU and baseline mild or greater anxiety or depression were randomized 1:1 to immediate access to a mindfulness application (app) (Calm Health) or to a waitlist control group.</p><p><strong>Methods: </strong>Participants in the intervention group were instructed to use the Calm Health mobile app for ≥10 minutes daily for 8 weeks. Controls received no new mindfulness intervention during this period. Outcomes were assessed at baseline and 8 weeks using validated surveys.</p><p><strong>Main outcome measures: </strong>The primary outcome was the mean difference in the anxiety symptom severity score measured by the Generalized Anxiety Disorder-7 (GAD-7) at 8 weeks. Secondary outcomes included changes in depression (Patient Health Questionnaire-9 [PHQ-9]), perceived stress (Perceived Stress Scale-10 [PSS-10]), and vision-related quality of life (National Eye Institute Visual Function Questionnaire-25 [NEI VFQ-25]). Outcomes were analyzed using linear analysis of covariance (ANCOVA) models, adjusting for baseline scores.</p><p><strong>Results: </strong>Of 100 randomized participants (median age 43.5 years; 75% female), 70 completed the primary endpoint assessment. Median [Q1, Q3] total app use among intervention participants was 578.62 [397.79, 923.00] minutes over 8 weeks. After adjustment for baseline scores, the intervention group had a significantly lower GAD-7 score at 8 weeks compared with controls (mean difference -1.7 points; 95% CI, -3.17 to -0.23, P = 0.02). Secondary analyses showed significantly greater reductions in PHQ-9 scores (-1.90 points; 95% CI, -3.04 to -0.76, P = 0.001) and PSS-10 scores (-3.69 points; 95% CI, -6.00 to -1.37, P = 0.002) in the intervention group. Changes in NEI VFQ-25 scores were not statistically significant between groups (mean difference 1.98 points; 95% CI, -0.90 to 4.86, P = 0.18). Sensitivity analyses accounting for missing data and clinical covariates yielded similar results.</p><p><strong>Conclusions: </strong>A digital mindfulness-based intervention (Calm Health) significantly reduced anxiety, depression, and perceived stress in adults with NIU. Digital mindfulness tools may serve as a feasible, scalable adjunct to uveitis care, particularly in settings with limited access to traditional mental health services.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found after the references.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258871","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":"Re: Singer et al.: Fluocinolone acetonide implant as a baseline therapy for diabetic macular edema: results from the randomized phase 4 NEW DAY study (Ophthalmology. 2026;133:837-851).","authors":"Sasikala Jummala, Mohana Kumari C, Soumya Tripathi, Deepti M Sati","doi":"10.1016/j.ophtha.2026.05.025","DOIUrl":"https://doi.org/10.1016/j.ophtha.2026.05.025","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227109","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}