Ophthalmology最新文献

{"title":"Factual Evidence on Digital Therapeutics in Pediatric Amblyopia: Insights into Rapid Axial Elongation Risk.","authors":"Ying Yao, Yunsi He, Yun Wen, Lei Feng, Qingqing Ye, Zixuan Xu, Yusong Zhou, Yangfei Pang, Wentong Yu, Yudan Zhong, Qiuying Li, Junpeng Yuan, Jing Liu, Jinrong Li","doi":"10.1016/j.ophtha.2025.01.005","DOIUrl":"10.1016/j.ophtha.2025.01.005","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of daily digital therapeutics (DTx) on the risk of rapid axial elongation (RAE) in children with amblyopia using data from clinical settings.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants: </strong>One thousand three hundred ninety-four children 3-to-12 years of age with amblyopia, 477 of whom received DTx.</p><p><strong>Methods: </strong>Children in the DTx group underwent 30 minutes of daily vision therapy, with axial length (AL) measured at baseline and during follow-up. Cox proportional hazards models were used to assess the risk of RAE, defined as an annual axial elongation exceeding safety thresholds based on age and myopia status.</p><p><strong>Main outcome measures: </strong>The primary outcome was the hazard ratio (HR) for RAE associated with DTx, adjusted for age, sex, best-corrected visual acuity, cycloplegic spherical equivalent refraction, amblyopic eye, type of amblyopia, and baseline AL.</p><p><strong>Results: </strong>Six hundred forty-one children (45.98%) experienced RAE. Use of DTx increased the risk of RAE by 65% (HR, 1.65; 95% confidence interval, 1.40-1.96; P < 0.001), with consistent findings across all subgroups (P > 0.05 for interaction). The increased risk was noted particularly in children with hyperopia, suggesting the potential for DTx to influence axial growth in this population.</p><p><strong>Conclusions: </strong>Digital therapeutics are associated with an increased risk of RAE in children with amblyopia, highlighting the need for careful monitoring of AL during therapy. Although DTx offers visual acuity improvements, its potential impact on ocular growth should be balanced, particularly in children with hyperopia and premyopia.</p><p><strong>Financial disclosure(s): </strong>Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009133","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":"Pigmented Squamous Cell Carcinoma Mimicking Conjunctival Melanoma.","authors":"Thomas A Weppelmann, Curtis E Margo, Edgar M Espana","doi":"10.1016/j.ophtha.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.ophtha.2024.12.010","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966387","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":"Giant Conjunctival Melanoma after Deferred Intervention.","authors":"Radwa Elsharawi, Roma B Pegany, Afshan A Nanji","doi":"10.1016/j.ophtha.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.ophtha.2024.10.029","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966384","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":"Oncocytoma.","authors":"Breanna N Aldred, Eric J Weinlander","doi":"10.1016/j.ophtha.2024.12.011","DOIUrl":"https://doi.org/10.1016/j.ophtha.2024.12.011","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966386","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":"Trombiculid Mite Infestation of the Eyelid.","authors":"Mary Stephen, Nirupama Kasturi, Arun Sahi","doi":"10.1016/j.ophtha.2024.11.025","DOIUrl":"https://doi.org/10.1016/j.ophtha.2024.11.025","url":null,"abstract":"","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966388","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":"Neuroretinal and Retinal Pigment Epithelium Changes and Susceptibility to Age-Related Macular Degeneration: Insights from the Longitudinal ALIENOR Study.","authors":"Petra P Larsen, Marie-Noëlle Delyfer, Cédric Schweitzer, Jean-François Korobelnik, Cécile Delcourt","doi":"10.1016/j.ophtha.2025.01.002","DOIUrl":"10.1016/j.ophtha.2025.01.002","url":null,"abstract":"<p><strong>Purpose: </strong>We assessed the associations of macular layer thicknesses, measured using spectral-domain (SD) OCT, with incident age-related macular degeneration (AMD) and AMD polygenic risk scores (PRSs).</p><p><strong>Design: </strong>Population-based cohort study.</p><p><strong>Participants: </strong>A total of 653 participants from the ALIENOR study, with biennial eye imaging from 2009 through 2024.</p><p><strong>Methods: </strong>Macular layer thicknesses of 8 distinct layers were automatically segmented based on SD-OCT imaging. Total and pathway-specific PRSs were calculated from previous AMD genome-wide association studies summary statistics. Associations of macular layer thicknesses with incident intermediate and advanced AMD were analyzed using time-dependent Cox proportional hazards models. Associations of macular layer thicknesses with PRS were assessed using linear mixed models.</p><p><strong>Main outcome measures: </strong>Incident intermediate and advanced AMD based on fundus color photographs and SD-OCT.</p><p><strong>Results: </strong>Mean age at first OCT examination of the 653 participants was 82.2 ± 4.2 years, 61.3% of which were women. In multivariable adjusted models, incident intermediate AMD was associated with thicker retinal pigment epithelium (RPE)-Bruch membrane (BM) complex in the 1-mm central circle (hazard ratio [HR], 1.13 for 1-μm increase; P = 8.08 × 10^-⁴ with false discovery rate [FDR] correction). Incident advanced AMD was associated with thicker RPE-BM complex in both the central (HR, 1.09; P_FDR = 0.005) and inner circle (1- to 3 mm; HR, 1.28; P_FDR = 1.61 × 10^-⁵). Over the study period, RPE-BM complex thickening in the inner circle was more pronounced in individuals with high total PRS (β = 0.06 μm/year for 1-standard deviation increase; P_FDR = 1.61 × 10^-¹⁰), high complement pathway PRS (β = 0.04 μm/year; P_FDR = 3.23 × 10^-⁵), high lipid pathway PRS (β = 0.03 μm/year; P_FDR = 3.74 × 10^-⁴), and ARMS2 (β = 0.03 μm/year, P_FDR = 0.002). High total PRS and high complement-specific PRS were associated with thinner photoreceptor segment layer (PSL) at baseline and longitudinal thinning of the outer nuclear layer.</p><p><strong>Conclusions: </strong>These findings highlight RPE-BM complex thickening in the pathophysiologic sequence of AMD. Further longitudinal studies are needed, in particular to determine the value of RPE-BM thickening and PSL thinning measured using SD-OCT for the clinical follow-up of patients with AMD.</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":13.1,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966385","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":"Evaluating the Utility of Initial Examinations in Retinopathy of Prematurity: Proposal of FIRST-ROP Algorithm for a Medium-Risk Cohort.","authors":"Francisco Altamirano, Melissa Yuan, Sandra Hoyek, Daniel Hu, Muhammad Abidi, Celine Chaaya, Hanna De Bruyn, Anne Fulton, Iason S Mantagos, Carolyn Wu, Ryan Gise, Efren Gonzalez, Deborah K VanderVeen, Nimesh A Patel","doi":"10.1016/j.ophtha.2025.01.004","DOIUrl":"10.1016/j.ophtha.2025.01.004","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines.</p><p><strong>Design: </strong>Retrospective consecutive study.</p><p><strong>Participants: </strong>Infants screened for ROP between January 2017 and August 2023 at 3 different tertiary-level care neonatal intensive care units.</p><p><strong>Methods: </strong>Analysis of patients who did not meet criteria for microprematurity or nanoprematurity (those born at ≥ 27 weeks and weighing ≥ 800 g).</p><p><strong>Main outcome measures: </strong>The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed.</p><p><strong>Results: </strong>A total of 2004 neonates were screened for ROP, among whom 1125 (56.1%) met the inclusion criteria. Of those, 237 neonates (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (interquartile range [IQR], 33.7-37 weeks; range, 30.3-46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3-41.2 weeks; range, 35.1-44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8-43.3 weeks; range, 35.3-49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1-4 examinations) for traditional screening, 1.0 examination (IQR, 1-3 examinations) after eliminating the first ROP inpatient examination, and 1.0 examination (IQR, 1-2 examinations) after eliminating the first and second ROP examinations (P < 0.001). No patients met type 1 ROP treatment criteria at either the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting examinations at 34 weeks' PMA could save 30.6% of inpatient examinations.</p><p><strong>Conclusions: </strong>In infants not meeting criteria for microprematurity or nanoprematurity, no type 1 ROP was diagnosed at either of the first 2 inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP examinations start at 34 weeks' PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.</p><p><strong>Financial disclosure(s): </strong>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966383","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":"Behavioral Intervention with Eye-Use Monitoring to Delay Myopia Onset and Progression in Children: A Cluster Randomized Trial.","authors":"Yuanyuan Hu, Mingkun Yu, Xiaotong Han, Nathan Congdon, Ziyun Wu, Jianping Liu, Zhaolan Liu, Huanhuan Huo, Jike Song, Mingguang He, Hongsheng Bi","doi":"10.1016/j.ophtha.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.ophtha.2025.01.003","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the efficacy of a behavioral intervention using Eye-Use Monitoring technology to delay the onset and progression of myopia in children.</p><p><strong>Design: </strong>A prospective, cluster-randomized, parallel-groups, examiner-masked, clinical trial (Chinese Clinical Trial Registry, ChiCTR2100052101).</p><p><strong>Participants: </strong>A total of 413 children from grades 2 to 4 in Shandong, China, from October 2021 to December 2023 were randomized by class into three groups: reminder & feedback (6 classes, 156 children), reminder-only (5 classes, 147 children), and control (3 classes, 110 children). Children with prior myopia control interventions, significant eye conditions, or a history of eye diseases were excluded.</p><p><strong>Methods: </strong>The reminder-only group received real-time vibration alerts for prolonged near work, close proximity, head tilt, or inadequate lighting. The reminder & feedback group received these alerts plus behavioral feedback, including praise, rewards, and weekly reports. The control group received no intervention. The intervention lasted 49 weeks, followed by a 49-week observation period without intervention.</p><p><strong>Main outcome measures: </strong>The primary outcome was the mean change in cycloplegic spherical equivalent at 49 weeks. Secondary outcomes included changes in axial length, myopia incidence, rates of rapid myopic shift, participant compliance, and eye-use behaviors.</p><p><strong>Results: </strong>At 49 weeks, changes in spherical equivalent and axial length were least in the reminder & feedback group (spherical equivalent: -0.52±0.35D vs. -0.59±0.43D vs. -0.73±0.48D, axial length: 0.30±0.14mm vs. 0.33±0.16mm vs. 0.40±0.20mm, in reminder & feedback group, reminder only group, and control group, respectively, both P<0.001). Myopia incidence was lowest in the reminder & feedback group (13.3% vs. 21.6% vs. 27.78%, in reminder & feedback group, reminder only group, and control group, respectively, P<0.05). However, differences diminished by the 98-week follow-up.</p><p><strong>Conclusions: </strong>This study demonstrated that the combination of Eye-Use Monitoring reminders and feedback on eye-use behaviors can effectively delay the onset and progression of myopia in children. However, sustained intervention may be necessary to maintain long-term benefits.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142966382","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":"Cost-effectiveness Analysis of Digital Therapeutics for Amblyopia.","authors":"Irene Koc, Saghar Bagheri, Rachel K Chau, Sandra Hoyek, Nour Abou Shousha, Golnoush Mahmoudinezhad, Michelle M Falcone, Isdin Oke, David G Hunter, Nimesh A Patel","doi":"10.1016/j.ophtha.2024.12.037","DOIUrl":"10.1016/j.ophtha.2024.12.037","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the cost-utility of Luminopia (Luminopia, Inc) and CureSight (NovaSight, Ltd) as therapy for amblyopia compared with current common amblyopic treatments such as glasses, atropine drops, and patching.</p><p><strong>Design: </strong>Cost analysis based on data from published randomized control trials (RCTs).</p><p><strong>Subjects: </strong>Data from Luminopia, CureSight, and atropine RCTs.</p><p><strong>Methods: </strong>A cost-utility analysis was performed using patient preference-based time trade-off utility values from previous literature. Costs for eye examinations were calculated using reimbursement data; device costs for duration of treatment were provided by sales representatives of Luminopia and CureSight. All treatments were inclusive of the cost of eyeglasses. Visual acuity (VA) and stereoacuity outcomes were extrapolated from the RCTs for atropine, Luminopia, and CureSight. A quality-adjusted life-year (QALY) was calculated by multiplying utility gain, a value correlated with VA gain, by length of time of benefit.</p><p><strong>Main outcome measures: </strong>Cost, cost per QALY, and cost per stereoacuity gain.</p><p><strong>Results: </strong>The cost to treat amblyopia with glasses alone for 12 weeks was $514. The cost of treating with patching for 12 weeks was $540 and with atropine for 16 weeks was $652, whereas the cost of treating with Luminopia or CureSight for 12 weeks was $1951 and $1564 or $1814, respectively. Treatment with glasses alone or patching for 12 weeks resulted in a cost per QALY gained of $427 and $101, respectively. Atropine treatment for 16 weeks resulted in a cost per QALY gained of $151. The cost per QALY for 12-week Luminopia treatment was $618 versus $368 or $427 for 12-week CureSight treatment and $314 or $354 for 16-week CureSight treatment (P < 0.05). Cost per stereoacuity gain for 12-week treatment duration was $6421/log arcsec (glasses), $1801/log arcsec (patching), and $3007/log arcsec or $3488/log arcsec (CureSight).</p><p><strong>Conclusions: </strong>Treatment of amblyopia with Luminopia or CureSight is cost-effective in comparison with established willingness-to-pay thresholds and can provide a viable treatment option, especially for those who are unable to tolerate patching or atropine penalization. Cost-effectiveness values based on VA gain of Luminopia and CureSight were comparable.</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":13.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932552","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":"High Density Lipoproteins Associate with Age-Related Macular Degeneration in the All of Us Research Program.","authors":"Jimmy S Chen, Jeffrey D Esko, Evan Walker, Philip L S M Gordts, Sally L Baxter, Christopher B Toomey","doi":"10.1016/j.ophtha.2024.12.039","DOIUrl":"10.1016/j.ophtha.2024.12.039","url":null,"abstract":"<p><strong>Objective: </strong>Extracellular lipoprotein aggregation is a critical event in AMD pathogenesis. In this study, we sought to analyze associations between clinical and genetic-based factors related to lipoprotein metabolism and risk for age-related macular degeneration (AMD) in the All of Us research program.</p><p><strong>Design: </strong>Cross-sectional retrospective data analysis.</p><p><strong>Subjects: </strong>5028 healthy and 2328 AMD patients from All of Us.</p><p><strong>Methods: </strong>Participants with and without AMD were age, race, and gender-matched in a 1:2 ratio respectively. Smoking status, history of hyperlipidemia, and statin use were extracted in a binary manner. Statin use was further subcategorized into hepatically vs. non-hepatically metabolized statins. Laboratory values for low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TG) were also extracted, and outliers were excluded from analysis. The PLINK toolkit was used to extract single-nucleotide polymorphisms (SNPs) associated with LDL and HDL dysregulation, as published in prior work. Odds ratio curves were computed to assess the risk between LDL, TG, and HDL versus AMD. All clinical and genetic variables were input into a multivariable logistic regression model, and odds ratios and p-values were generated.</p><p><strong>Main outcome measures: </strong>Statistical significance of risk factors for AMD, thresholded at p ≤ 0.05.</p><p><strong>Results: </strong>On multivariable regression analysis, statin use, and low and high HDL were significantly associated with increased AMD risk (p <0.001, <0.001, 0.004, <0.001 respectively). Additionally, the multivariable regression implicated HDL associated SNPs increased risk for AMD. Lastly, LPA was identified (p =0.007) as a novel SNP associated with increased AMD risk.</p><p><strong>Conclusions: </strong>There exists a U-shaped relationship between HDL and AMD risk, such that high and low HDL are significantly associated with increased AMD risk. Additionally, SNPs associated with HDL metabolism are associated with AMD risk. This analysis further establishes the role of HDL in AMD pathogenesis.</p>","PeriodicalId":19533,"journal":{"name":"Ophthalmology","volume":" ","pages":""},"PeriodicalIF":13.1,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932487","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}