Ophthalmology最新文献

{"title":"Strabismus and Strabismus Surgery Reoperation Rates at 1, 3, and 5 Years: Analyses from the IRIS® Registry (Intelligent Research in Sight).","authors":"Michael X Repka, Flora Lum, Charles Li, Bharanidharan Radha Saseendrakumar","doi":"10.1016/j.ophtha.2025.08.028","DOIUrl":"10.1016/j.ophtha.2025.08.028","url":null,"abstract":"<p><strong>Purpose: </strong>To describe strabismus surgery reoperation rates and risk factors for children and adults in the United States.</p><p><strong>Design: </strong>Retrospective cohort analysis of health care data.</p><p><strong>Participants: </strong>A total of 79 424 597 patients in the IRIS® Registry (Intelligent Research in Sight).</p><p><strong>Methods: </strong>Description of strabismus, strabismus surgery, and reoperations from 2013 to 2022. Multivariable models of factors associated with a reoperation within 1 year were developed.</p><p><strong>Main outcome measure: </strong>Reoperation rates at 1, 3, and 5 years were calculated for strabismus surgeries performed from 2013 to 2017.</p><p><strong>Results: </strong>A total of 1 951 001 patients (2.46%) had strabismus (2.68% among male patients and 2.29% among female patients, difference = 0.39%, 95% confidence interval [CI], 0.38-0.40; P < 0.001). Diagnoses included esotropia (17.8%), exotropia (21.8%), hypertropia (13.5%), and paralytic strabismus (16.1%). At least 1 surgery was performed in 125 984 patients; 79% of reported codes were for horizontal surgery; 58% of cases were performed in patients aged less than 20 years. Reoperation rates were 5.61% (95% CI, 5.43-5.81), 8.53% (8.30-8.76), and 10.13% (9.88-10.38) within 1, 3, and 5 years, respectively. At each time point, reoperation rates were lowest for children 6 to 19 years of age. In multivariable models, the odds ratio (OR) for a strabismus reoperation within 1 year was lower in non-Hispanic Black or African American patients (0.82, 95% CI, 0.73-0.92) compared with non-Hispanic White patients. The risk for reoperation did not differ between White patients and patients of other races and ethnicities. When compared with Medicare Part B, ORs for a reoperation were lower for patients with commercial insurance (0.72, 95% CI, 0.64-0.80) and Medicaid (0.82, 95% CI, 0.72-0.94). The ORs of a reoperation when compared with the Northeastern United States were significantly lower in the Midwest (0.75), South (0.88), and the West (0.73).</p><p><strong>Discussion: </strong>Strabismus is uncommonly reported in clinical practice. The odds of undergoing a reoperation after statistical adjustment differed significantly by race and ethnicity, insurance, and region of the United States. Reasons for these differences deserve future inquiry. Reoperation rates generally increased with duration of follow-up for all age groups, suggesting there is an ongoing need for strabismus care for patients of all ages.</p><p><strong>Conclusions: </strong>These findings may serve as benchmarks for surgical training, measuring physician performance, patient counseling, and development of risk adjustment tools.</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":9.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000993","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":"Characterising Anterior-Segment Dysgenesis in FHONDA with Ultra-High-Speed OCT.","authors":"Rishi Sekhri, Mervyn G Thomas","doi":"10.1016/j.ophtha.2025.07.036","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.07.036","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963697","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":"Instrument-Based Screening for the Detection of Amblyopia and Amblyopia Risk Factors","authors":"Julius T. Oatts MD ,&nbsp;Megan E. Collins MD, MPH ,&nbsp;Kara M. Cavuoto MD ,&nbsp;Sudha Nallasamy MD ,&nbsp;S. Grace Prakalapakorn MD, MPH ,&nbsp;Rupal H. Trivedi MD, MSCR ,&nbsp;Stacy L. Pineles MD ,&nbsp;Melinda Y. Chang MD","doi":"10.1016/j.ophtha.2025.07.007","DOIUrl":"10.1016/j.ophtha.2025.07.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To review the published literature on the diagnostic accuracy of instrument-based screening devices used to detect amblyopia and amblyopia risk factors (ARFs).</div></div><div><h3>Methods</h3><div>A literature search of the PubMed database with no date restrictions and limited to articles published in English was last conducted in January 2025. The search yielded 291 articles; 41 were reviewed in full text, and 33 met the criteria for inclusion in this assessment. The panel methodologist assigned a level of evidence rating to each of the included studies.</div></div><div><h3>Results</h3><div>All 33 articles (which reported results from 28 072 children) were rated level III. Nine screening devices were discussed in the included studies; the most common were the Plusoptix, Spot, and Retinomax. Results from 28 072 children were reported, and most studies focused on children aged 6 years and younger. The most common study setting was ophthalmology clinics, followed by school-based settings and then community-based settings. For detecting ARFs, sensitivity ranged from 32.3% to 100% and specificity ranged from 38.7% to 94% (Plusoptix sensitivity 32.3%–100%, specificity 38.7%–100%; Retinomax sensitivity 70%–95%, specificity 58%–94%; Spot sensitivity 60%–94%, specificity 67%–97%). Examination failure thresholds varied, but most studies after 2013 followed the 2013 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) guidelines. For the 21 studies that reported the referral rate (percentage of children who failed based on the screening result), the rate varied significantly (2.26%–63%). Higher referral rates were seen in studies based in ophthalmology clinics.</div></div><div><h3>Conclusions</h3><div>The best available evidence supports the use of instrument-based screening devices to detect amblyopia and ARFs, although there were high levels of variability in the study design, setting, and target age for screening. Additionally, diagnostic accuracy varied on the basis of the screening device used. Future studies of instrument-based screening devices would benefit from following standardized reporting measures for diagnostic accuracy, which will strengthen the evidence base and provide more complete data on which to base decisions about the most appropriate screening programs and strategies.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found after the references.</div></div>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"132 11","pages":"Pages 1294-1303"},"PeriodicalIF":9.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963678","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":"Utilization Patterns and Costs of Ocular Amniotic Membrane Grafts in the Medicare Population.","authors":"Daniel G Vail, Eric Nudleman, Luay Abdeljaber, Md Enamul Haque, Suzann Pershing","doi":"10.1016/j.ophtha.2025.08.023","DOIUrl":"10.1016/j.ophtha.2025.08.023","url":null,"abstract":"<p><strong>Purpose: </strong>Recent investigations from the Office of the Inspector General and The New York Times have raised concerns about the costs to Medicare of skin substitutes, documenting pervasive fraudulent billing practices outside of ophthalmology. These investigations have not covered the use of tissue in eye care, despite similar reimbursement incentives for the use of sutureless ocular amniotic membrane grafts (AMGs). We examine the volume, cost, and clinical indications associated with sutureless AMGs in eye care.</p><p><strong>Design: </strong>Retrospective cohort study of fee-for-service Medicare patients who received sutureless AMGs and eye care providers who bill for sutureless AMGs.</p><p><strong>Participants: </strong>Nationally representative 20% sample of Medicare Part B claims for sutureless AMGs between 2011 and 2020.</p><p><strong>Methods: </strong>We use longitudinal patient-level and provider-level data to specify regression models for our primary outcomes. We estimate Cox proportional hazards survival models for time-to-event analyses and logistic regression models for binary outcomes.</p><p><strong>Main outcome measures: </strong>Clinical indications for AMG use, time from patients' first encounter with a provider to their first AMG, use of AMGs for dry eye, and costs to Medicare.</p><p><strong>Results: </strong>Dry eye accounted for 44% of all sutureless AMG use in 2020, increased from 7% in 2011. Charges for ocular sutureless AMGs increased from $3.5 million in 2011 to $95.6 million in 2020; charges for AMGs used to treat dry eye increased from $250 000 to $41.4 million over this period. Some 28% of all claims for AMGS were submitted by 1% of providers. Patients are more likely to receive an AMG when seen by an optometrist (hazard ratio, 1.16; P < 0.001). The annual costs to Medicare for a patient with dry eye have increased dramatically among providers who use AMGs.</p><p><strong>Conclusions: </strong>The costs to Medicare for skin substitutes are inflated by reimbursement models that encourage their use even when there is little clinical indication. These concerns may be applicable to eye care as well, where spending on amniotic membrane grafts has increased dramatically, particularly for indications where clinical benefit may be limited. By requiring AMG manufacturers to report accurate sales prices, policymakers could reduce costs without limiting coverage of AMGs for appropriate clinical indications.</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":9.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963723","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":"Intravitreal Aflibercept 8 mg in Neovascular Age-related Macular Degeneration: 96-Week Results from the Randomized Phase 3 PULSAR Trial.","authors":"Jean-François Korobelnik, Paolo Lanzetta, Sergio Leal, Frank G Holz, W Lloyd Clark, David Eichenbaum, Tomohiro Iida, Xiaodong Sun, Alyson J Berliner, Andrea Schulze, Min Zhao, Thomas Schmelter, Ursula Schmidt-Ott, Xin Zhang, Peter Morgan-Warren, Zoran Hasanbasic, Robert Vitti, Karen W Chu, Kimberly Reed, Rafia Bhore, Yenchieh Cheng, Zhanying Bai, Boaz Hirshberg, George D Yancopoulos, Tien Y Wong","doi":"10.1016/j.ophtha.2025.08.022","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.08.022","url":null,"abstract":"<p><strong>Purpose: </strong>To follow up the previously published comparison of aflibercept 8 mg at extended dosing intervals versus aflibercept 2 mg every 8 weeks, in patients with neovascular age-related macular degeneration (nAMD) through 48 weeks, we now report efficacy, durability and safety analyses through 96 weeks.</p><p><strong>Design: </strong>PULSAR (NCT04423718): phase 3, randomized, non-inferiority, 96-week trial.</p><p><strong>Participants: </strong>Treatment-naive adults aged ≥50 years with active, subfoveal choroidal neovascularization secondary to nAMD.</p><p><strong>Methods: </strong>Patients were randomized 1:1:1 to aflibercept 8 mg every 12 weeks (8q12), aflibercept 8 mg every 16 weeks (8q16), or aflibercept 2 mg every 8 weeks (2q8), following three initial monthly doses; dosing intervals in 8-mg groups were modified based on prespecified criteria.</p><p><strong>Main outcome measures: </strong>Change from baseline in best-corrected visual acuity (BCVA) and central retinal thickness (CRT); proportion of patients maintaining or extending their randomized dosing intervals; safety outcomes.</p><p><strong>Results: </strong>Of 1009 patients treated, 869 (8q12: n=291; 8q16: n=292; 2q8: n=286) completed treatment through Week 96. LS mean (95% CI) change from baseline in BCVA at Week 96 was +5.6 (4.1-7.1), +5.5 (4.0-7.0), and +6.6 (5.2-8.0) letters in the 8q12, 8q16, and 2q8 groups, respectively; 8q12 and 8q16 differences versus 2q8 in LS mean BCVA changes at Week 96 met the non-inferiority criteria specified for primary endpoint at Week 48. Mean (SD) change in CRT from baseline was ‒143.9 (123.6), ‒153.4 (140.8), and ‒135.8 (133.1) μm in the 8q12, 8q16 and 2q8 groups, respectively. Patients completing 96 weeks of treatment in the 8q12, 8q16 and 2q8 groups received a mean number of 9.7, 8.2, and 12.8 active injections, respectively. Of these, 87% of patients in the 8q12 group had last assigned dosing intervals of ≥12 weeks, while 78%, 53% and 31% of patients in the 8q16 group qualified for last assigned dosing intervals of ≥16 weeks, ≥20 weeks, and 24 weeks, respectively. Incidence of ocular treatment-emergent adverse events was similar across treatment groups.</p><p><strong>Conclusion: </strong>Aflibercept 8 mg delivered sustained disease control in patients with nAMD, maintaining improvements in visual and anatomic outcomes through Week 96 with extended dosing intervals and similar safety profile to aflibercept 2 mg.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963680","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":"Endophthalmitis after globe perforation from nonanesthetic periocular injections","authors":"Michael Y. Zhao MD, Benjamin R. Lin MD, Jason C. Fan MD, Chrisfouad R. Alabiad MD, Harry W. Flynn Jr. MD","doi":"10.1016/j.ophtha.2025.08.015","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.08.015","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"39 1","pages":""},"PeriodicalIF":13.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924322","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":"Hemophagocytic Syndrome in Aggressive Natural Killer Cell Leukemia with Ocular Presentation.","authors":"Tatsuma Kishimoto, Ken Fukuda, Kenji Yamashiro","doi":"10.1016/j.ophtha.2025.07.020","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.07.020","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963648","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 Call to Action and Roadmap for Improving Emergency Treatment of Ophthalmic Trauma in the United States","authors":"Robert A. Mazzoli MD,&nbsp;Stuart R. Seiff MD,&nbsp;George B. Bartley MD,&nbsp;Stephen D. McLeod MD,&nbsp;Steven E. Feldon MD, MBA,&nbsp;Avery Nathens MD,&nbsp;Tamara R. Fountain MD,&nbsp;Christopher J. Rapuano MD,&nbsp;Boonkit Purt MD","doi":"10.1016/j.ophtha.2025.07.006","DOIUrl":"10.1016/j.ophtha.2025.07.006","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"132 11","pages":"Pages 1197-1201"},"PeriodicalIF":9.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924320","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 Caruncular Dacryops Arising within Lacrimal Glands of Popoff.","authors":"Aruba Zafar, Tatyana Milman, Carol L Shields","doi":"10.1016/j.ophtha.2025.07.028","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.07.028","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963654","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: Shen et al.: Determinants of four-year visual acuity loss in geographic atrophy: An analysis of age-related eye disease study and age-related eye disease study 2 (Ophthalmology. 2025;132:785–798)","authors":"Marc Biarnés PhD","doi":"10.1016/j.ophtha.2025.07.021","DOIUrl":"10.1016/j.ophtha.2025.07.021","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":"132 11","pages":"Page e181"},"PeriodicalIF":9.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924321","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}