Ophthalmology and Therapy最新文献

{"title":"Impact of an Ophthalmic Cooling Device on Corneal Immune and Sensory Nerve Features in Chronic Ocular Surface Pain: A Prospective, Feasibility Study.","authors":"Jeremy Chung Bo Chiang, Mengliang Wu, Ji-Hyun Lee, Alyssa Curkpatrick, Cristos Ifantides, Thanh Nguyen, Anat Galor, Helen Wu, Richard Lindstrom, Vance Thompson, Laura E Downie","doi":"10.1007/s40123-026-01454-6","DOIUrl":"10.1007/s40123-026-01454-6","url":null,"abstract":"<p><strong>Introduction: </strong>A safe and effective treatment for chronic ocular surface pain (COSP) remains an unmet need. This prospective feasibility study investigated the impact of an ophthalmic cooling device (ETX-4143) on ocular pain, as well as corneal nerve and immune cell features, in individuals with COSP.</p><p><strong>Methods: </strong>For this clinical trial (Clinicaltrials.gov:NCT07059754), the more symptomatic (study) eye was treated with the ETX-4143 device, involving two metallic probes, internally cooled by a -20 °C fluid, applied to the bulbar conjunctiva posterior to the limbus at 3 and 9 o'clock for 4 min, with a fellow (untreated) eye control. Ocular pain, best-corrected visual acuity (BCVA), tear osmolarity, corneal sensitivity, slit lamp biomicroscopy, ocular surface staining, and static and functional in vivo confocal microscopy (Fun-IVCM) were conducted at baseline and 2-, 6-, and 12-weeks posttreatment. Corneal nerve and immune cell parameters were quantified.</p><p><strong>Results: </strong>Five eligible participants were enrolled and completed the study (mean age 66.4 ± 9.9 years, 60% female/40% male). Relative to baseline, ocular pain, measured with the Chronic Ocular Pain Questionnaire (COP-Q) Eye Pain Severity Module, was significantly lower at 2 weeks (mean change -4.4 units, 95% CI -7.4 to -1.4, P = 0.02), 6 weeks (-5.0 units, 95% CI -7.0 to -3.0, P = 0.002), and 12 weeks posttreatment (-5.8 units, 95% CI -7.8 to -3.8, P = 0.001); benefit progressed with time. Clinical ocular surface signs, BCVA, and corneal nerve morphology remained stable. In the study eye, corneal Fun-IVCM showed an increase in putative intraepithelial T-cell motility up to 6 weeks posttreatment (P < 0.001), followed by a reduction at 12 weeks (P = 0.03) that was accompanied by reduced probing of putative dendritic cells (P = 0.049), relative to baseline.</p><p><strong>Conclusions: </strong>The ETX-4143 device showed a favorable safety profile, including preserved corneal nerve morphology, while improving pain outcomes and modulating corneal immune dynamics up to 12 weeks posttreatment, acknowledging these findings are exploratory. Randomized controlled trials are warranted to evaluate treatment efficacy and mechanisms.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT07059754.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2979-2996"},"PeriodicalIF":4.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of OCTA Biomarkers and Cutoff Values Associated with Disease Severity in Dry Age-Related Macular Degeneration.","authors":"Bogdan Dugiełło, Katarzyna Bujała, Bartłomiej Bolek, Adam Wylęgała, Edward Wylęgała","doi":"10.1007/s40123-026-01429-7","DOIUrl":"10.1007/s40123-026-01429-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Optical coherence tomography angiography (OCTA) enables noninvasive assessment of retinal and choroidal microvasculature and may provide quantitative biomarkers of disease severity in dry age-related macular degeneration (AMD). This study aimed to identify OCTA-derived vascular parameters associated with consecutive stages of dry AMD and determine cutoff values for stage differentiation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This cross-sectional study included 182 eyes of 123 participants. Eyes were classified according to the Beckman classification into control, early, intermediate, and late dry AMD groups. OCTA imaging was performed using the ZEISS PLEX Elite 9000 swept-source OCTA system. Quantitative analysis of the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) was conducted using AngioTool software. Vessel density, vessel length, junction-related parameters, endpoints, and lacunarity were analyzed. Group comparisons were performed using analysis of variance (ANOVA) or the Kruskal-Wallis test with post hoc analysis. Receiver operating characteristic (ROC) curves were used to evaluate diagnostic performance and determine optimal cutoff values.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the SCP, vessel density decreased from 43.83 ± 2.08% in controls to 41.27 ± 3.96% in intermediate AMD (p &lt; 0.001), and mean lacunarity increased from 0.05 ± 0.01 to 0.07 ± 0.03 (p &lt; 0.001), while other parameters showed no significant differences. In the DCP, vessel density declined from 51.71 ± 2.38% in controls to 48.73 ± 4.66% and 43.80 ± 4.98% across disease stages (p &lt; 0.001), with total vessel length decreasing from 73.32 ± 2.72 to 61.58 ± 6.69 (p &lt; 0.001), indicating progressive vascular simplification. The most pronounced changes were observed in the choriocapillaris, where vessel density decreased from 63.28 ± 0.94 to 60.31 ± 1.83% and 26.62 ± 22.30% (p &lt; 0.001), and total vessel length from 102.80 ± 2.24 to 35.68 ± 38.42 (p &lt; 0.001). ROC analysis identified SCP mean lacunarity (cutoff 0.0575, AUC 0.76) as a marker of early disease. In the DCP, total number of junctions below 254 and total vessel length below 66.10 were associated with advanced disease. The highest diagnostic performance was observed for choriocapillaris parameters, including vessel density below 57.38 and total vessel length below 91.10, with sensitivity exceeding 94% and specificity above 80%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;OCTA-derived microvascular parameters demonstrate layer-specific alterations in dry AMD. Mean lacunarity in the SCP appeared to be the most sensitive marker of early changes, whereas reductions in junction density and total vessel length in the DCP reflected progressive vascular simplification. The strongest association with disease severity was observed in the choriocapillaris, particularly for vessel density and total vessel length. The identified cutoff values for DCP and CC parameters were ass","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2729-2752"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Modified Peripheral Panretinal Photocoagulation in Proliferative Diabetic Retinopathy.","authors":"Xiang Gao, Shanshan Zhang, Liying Qin, Jingjing Zhang, Jingyi Tian, Xiaolei Sun, Gongqiang Yuan","doi":"10.1007/s40123-026-01430-0","DOIUrl":"10.1007/s40123-026-01430-0","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to compare the outcomes of intraoperative conventional panretinal photocoagulation (CPRP) with the modified peripheral panretinal photocoagulation (PPRP) technique in pars plana vitrectomy (PPV) in patients with proliferative diabetic retinopathy (PDR).</p><p><strong>Methods: </strong>Sixty-three eyes of 56 patients with PDR were retrospectively studied. Patients with very severe proliferation were excluded in this study. Twenty-six patients (30 eyes) received CPRP and 30 patients (33 eyes) received modified PPRP in PPV. Preoperative and postoperative ophthalmologic examinations were performed. Best corrected visual acuity (BCVA) was performed at baseline and 3 months after surgery. Central macular thickness (CMT) was measured at 1 week and 3 months after surgery. Postoperative inflammation was examined at 1 day and 3 months after surgery. Other postoperative complications were also analyzed at 3 months after surgery.</p><p><strong>Results: </strong>Of all the included eyes, 24 eyes (38.1%) were diagnosed with neovascularization elsewhere (NVE) and/or neovascularization of the disc (NVD) and 39 eyes (61.9%) were diagnosed with tractional retinal detachment (TRD) preoperatively. The number of laser spots in the CPRP group ranged from 858 to 2245, with an average of 1232 (1048,1369) spots. The number of laser spots in the PPRP group ranged from 394 to 992, with an average of 673 (579, 798) spots. The mean logMAR BCVA before surgery was 1.71 ± 0.57 in the CPRP group and 1.57 ± 0.64 in the modified PPRP group, with no statistical difference between the two groups (P = 0.476). The mean logMAR BCVA was 1.15 ± 0.74 in the CPRP group and 0.77 ± 0.54 in the PPRP group at 3 months after surgery, showing that the PPRP group had more visual acuity improvement than the CPRP group (P = 0.037). There was a significant correlation between BCVA and the number of laser spots (P = 0.006). The difference of CMT between the two groups was statistically significant at 1 week after surgery (P = 0.02), but not at 3 months after surgery (P = 0.587). The postoperative inflammation in the CPRP group was significantly more severe than that in the PPRP group at the first day after surgery (P = 0.002). The postoperative inflammation in both groups was significantly reduced 3 months after surgery, with no statistical difference (P = 0.593). There was a significant correlation between the degree of inflammation and the number of laser spots at the first day after surgery (P = 0.016). There was no significant difference in the incidence of other complications between the two groups.</p><p><strong>Conclusion: </strong>The modified PPRP technique was used during PPV in patients with PDR in this study, resulting in better BCVA, decreased CMT, and reduced early postoperative inflammation without increasing the incidence of adverse events in PDR.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2753-2761"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topical Insulin for Corneal Persistent Epithelial Defects: A Multicenter Retrospective Study.","authors":"Filippo Lixi, Alessandra Mancini, Costanza Rossi, Claudia Corda, Benedetta Pintus, Andrea Lucisano, Federica Bianca, Maura Mancini, Mario Verdiglione, Giulia Coco, Mara Tomi, Alina Gabriela Gheorghe, Adriano Carnevali, Vincenzo Scorcia, Giuseppe Giannaccare","doi":"10.1007/s40123-026-01446-6","DOIUrl":"10.1007/s40123-026-01446-6","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this study was to evaluate the clinical outcomes of insulin eye drops in a real-world cohort of eyes affected by corneal persistent epithelial defects (PEDs) refractory to conventional therapy.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1 IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA).</p><p><strong>Results: </strong>A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6 years) were included. The most common etiology was chronic ocular surface diseases (62.2%) followed by neurotrophic keratopathy (37.8%). Complete epithelial closure was achieved in 44 of 45 eyes (97.8%), with a median time to closure of 29 days (95%CI 24-38). The cumulative probability of complete reepithelialization was 20.0% at 14 days, 53.3% at 30 days, 90.5% at 60 days, and 95.3% at 90 days. A biphasic healing pattern was observed, with marked early reduction of the defect area progressively slowing over time (p < 0.001). Median BCVA improved from 2.0 to 1.0 logMAR at epithelial closure (p < 0.001). Two eyes (4.4%) experienced PED recurrence: one case regressed after first-line treatment while the other case progressed to corneal melting and ultimately required Gundersen flap surgery. No treatment-related adverse events were recorded.</p><p><strong>Conclusions: </strong>Topical insulin may represent a safe, effective, and accessible therapeutic option for refractory PEDs, achieving high rates of complete reepithelialization with concomitant visual improvement and low short-term recurrence in a heterogeneous real-world cohort.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2763-2773"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacological Characterization of a Novel Complement C3 Inhibitor Antibody Fragment.","authors":"Stephanie Jungmichel, Stefan Kreideweiß, Fabian Scheifele, Anna Sobieraj, Philipp Richle, Pankaj Gupta, Daniel Lenherr-Frey, Remko A Bakker, Leonardo Borras","doi":"10.1007/s40123-026-01397-y","DOIUrl":"10.1007/s40123-026-01397-y","url":null,"abstract":"<p><strong>Introduction: </strong>The complement system is a key driver of geographic atrophy (GA), a disease that leads to progressive, irreversible vision loss. Pharmacological preclinical studies characterizing an antibody fragment, which is a novel complement C3 inhibitor under investigation for GA treatment, are presented.</p><p><strong>Methods: </strong>Kinetic parameters were determined for the antibody fragment binding to C3, C3b, and C3 variants associated with GA. Inhibition of membrane attack complex (MAC) formation after classical (CP), alternative (AP), and lectin (LP) pathway activation was determined. Comparisons with the second-generation compstatin derivative (APL-1) were made because of the expected similarity of binding behavior and in vitro potency with pegcetacoplan (which could not be sourced at the time of the study). Diffusion through Bruch's membrane (BrM) was investigated for the antibody fragment and a pegcetacoplan-similar (PEG-s) molecule using enriched porcine BrM in Ussing chamber devices.</p><p><strong>Results: </strong>The antibody fragment showed high (picomolar) affinity for all tested C3 ligands. APL-1 showed lower (single-digit nanomolar) affinity than the antibody fragment, comparable with published values. The antibody fragment exhibited dose-dependent inhibition of MAC formation via CP (half-maximal inhibitory concentration [IC₅₀] 79 nM), AP (344 nM), and LP (67 nM), with enhanced potency for inhibiting CP- and LP-mediated complement activation vs. APL-1. More efficient permeation of the BrM was observed with the antibody fragment than with the PEG-s molecule.</p><p><strong>Conclusion: </strong>The antibody fragment is a potent and specific C3 inhibitor that displays dose-dependent inhibition of MAC formation across all three complement pathways and effectively crosses the BrM. In line with these results, the antibody fragment is being investigated in patients with GA. Graphical abstract available for this article.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2681-2694"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences and Perspectives on Diabetic Retinopathy Screening and Treatment in Mexico: A Subanalysis of the Diabetic Retinopathy Barometer Study.","authors":"Ingrid Y Pita-Ortiz, Raul Velez-Montoya, Marlon García Roa, Beatriz J Pérez Aragón, Luis F Rosales Rodríguez","doi":"10.1007/s40123-026-01428-8","DOIUrl":"10.1007/s40123-026-01428-8","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss worldwide and represent a growing public health concern in Mexico. Despite the availability of effective treatments, including anti-vascular endothelial growth factor (anti-VEGF) therapies, adherence and persistence remain suboptimal, compromising outcomes. This study, part of the international DR Barometer project, examined the perspectives of patients, healthcare providers, and clinic staff to better understand challenges and opportunities in DR/DME care delivery in Mexico.</p><p><strong>Methods: </strong>A cross-sectional, survey-based study was conducted across five high-volume ophthalmology clinics in Mexico. Standardized, paper-based questionnaires were completed anonymously by patients with DR or DME, healthcare providers, and clinic staff. Data were collected between October and November 2023, scanned, and analyzed descriptively.</p><p><strong>Results: </strong>A total of 1151 participants were included: 558 patients with DME, 265 patients with DR, 122 providers, and 206 clinic staff. Key barriers to adherence included financial burden of treatment (reported by 67.4% of patients with DME; emphasized by 97.5% of providers), logistical difficulties such as travel and long waiting times, and emotional concerns about being a burden to family (71.5% of patients with DME; 61.1% of patients with DR). Nonadherent patients were more likely to prioritize competing health issues and report limited support from care teams. While most patients stated that eye treatment was a priority (87-91%), only 61% of providers believed this to be true. Opportunities highlighted across stakeholders included proactive provider-patient communication, continuity of care with the same clinical team, appointment reminders, and financial assistance. Clinic staff emphasized the need for improved educational materials and better coordination of diabetes and eye care services.</p><p><strong>Conclusions: </strong>This study reveals substantial challenges to adherence in DR/DME management in participating Mexican referral centers, rooted in financial, logistical, and psychosocial factors. Strengthening communication, expanding financial support, and integrating coordinated, patient-centered care strategies could improve long-term treatment engagement and outcomes.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2775-2796"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Polypoidal Choroidal Vasculopathy (PCV) Management: Emerging Evidence for Faricimab and Aflibercept 8 mg.","authors":"Mohamed Zakaria Sherif, Kelvin Y C Teo, Timothy Y Y Lai, Hiok Hong Chan, Beau J Fenner, Won Ki Lee, Chui Ming Gemmy Cheung","doi":"10.1007/s40123-026-01405-1","DOIUrl":"10.1007/s40123-026-01405-1","url":null,"abstract":"<p><strong>Introduction: </strong>Polypoidal choroidal vasculopathy (PCV) is a major subtype of neovascular age-related macular degeneration (nAMD), particularly prevalent in Asian and pigmented populations. While anti-vascular endothelial growth factor (anti-VEGF) therapy has improved outcomes, limitations in durability and incomplete polypoidal lesion regression remain. This review provides an updated synthesis of emerging evidence on newer anti-VEGF agents in PCV management.</p><p><strong>Methods: </strong>This narrative review synthesizes recent evidence in PCV management, integrating data from clinical trials and emerging real-world studies, with a focus on newer anti-VEGF agents including faricimab (Vabysmo, Roche/Genentech)and aflibercept 8 mg (Eylea HD, Regeneron).</p><p><strong>Results: </strong>Faricimab, a bispecific antibody targeting VEGFA and angiopoietin-2 (Ang-2), demonstrated non-inferior efficacy compared with aflibercept 2 mg administered every 8 weeks in the TENAYA/LUCERNE trials, with over 70% of patients achieving dosing intervals of ≥ 12 weeks. The SALWEEN study further evaluated faricimab in 135 patients with PCV, reporting robust visual gains (+ 8.9 letters), 61% polypoidal lesion regression, and over 80% of patients achieving ≥ 12-week dosing intervals at 48 weeks. Aflibercept 8 mg, evaluated in the PULSAR trial, demonstrated comparable safety and efficacy with improved anatomical drying and extended dosing intervals (12-16 weeks) compared with aflibercept 2 mg. In a subgroup analysis of 139 eyes with indocyanine green angiography (ICGA)-confirmed PCV, outcomes were consistent with the overall study population, with similar visual and anatomical improvements but reduced injection burden. More than 80% of eyes achieved dosing intervals of ≥ 12 weeks at 2 years.</p><p><strong>Conclusions: </strong>Faricimab and aflibercept 8 mg represent important advances in PCV management, offering more durable treatment options and reducing treatment burden. However, important gaps remain, including limited real-world data for aflibercept 8 mg, absence of head-to-head PCV-specific trials, and uncertainty regarding long-term recurrence and lesion inactivation. These findings support a shift toward increasingly individualized and durable treatment strategies in PCV.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2563-2586"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Near-Infrared and Red-Light Photobiomodulation for Ocular Aging and Diseases: A Narrative Review.","authors":"Ethan Waisberg, Joshua Ong, Luke Yaldo, Rahul Kumar, Wei Wang, Valerio Calabresi, Giulia Coco, Francisco Gonzalez-Lima, Andrew G Lee, Giuseppe Giannaccare","doi":"10.1007/s40123-026-01427-9","DOIUrl":"10.1007/s40123-026-01427-9","url":null,"abstract":"<p><p>Near-infrared (NIR) and red light photobiomodulation (PBM) has gained increasing interest as a non-invasive therapeutic approach for a variety of medical conditions including ocular diseases. The eye represents a particularly suitable target for light-based therapies owing to its optical accessibility and the high mitochondrial demand of various tissues such as the retina and optic nerve. Ocular aging and several ophthalmic disorders are associated with mitochondrial dysfunction, oxidative stress, and chronic inflammation, providing a biological rationale for the use of PBM as a potential adjunctive approach. This narrative review provides an evidence-weighted, indication-specific synthesis of NIR and red-light PBM in ophthalmology, emphasizing device- and protocol-dependence, differences between multiwavelength PBM and repeated low-level red-light therapy, study-design limitations, safety considerations, and clinical translation gaps. A structured literature search was conducted using major scientific databases to identify relevant experimental studies, clinical trials, and observational reports. The review focuses on proposed mitochondria-centered mechanisms of action, including cytochrome c oxidase-mediated signaling, nitric oxide release, reactive oxygen species-driven hormetic responses, and downstream anti-inflammatory effects. Particular emphasis is reserved to dry age-related macular degeneration, for which literature is more relevant, and to dry eye disease owing to meibomian gland dysfunction and myopia, for which a body of evidence is progressively growing. For other ocular indications, data remain preliminary or exploratory. Overall, available data support biological plausibility and suggest possible functional or anatomical signals in selected ocular diseases, but the clinical evidence remains heterogeneous, with substantial variability in devices, wavelengths, dosimetry, treatment protocols, and study design, and remains insufficient to define PBM as established therapy for most indications. However, the clinical evidence remains heterogeneous, with substantial variability in devices, wavelengths, dosimetry, and treatment protocols. Although available studies generally report favorable short-term tolerability, long-term safety and the role of PBM in routine ophthalmic practice remain insufficiently defined. Well-designed, adequately randomized controlled trials with standardized treatment parameters are required to determine efficacy, optimal protocols, and long-term clinical relevance.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2519-2543"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148295821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Receptor Agonists and the Ocular Surface: A Narrative Review of Restoration, Remodeling, and Clinical Implications.","authors":"Henry Bair, Molly Orlick, Zeba A Syed","doi":"10.1007/s40123-026-01425-x","DOIUrl":"10.1007/s40123-026-01425-x","url":null,"abstract":"<p><p>Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have become a recurring topic in ophthalmology, yet most reviews emphasize posterior segment and neuro-ophthalmic disease while giving comparatively little attention to the ocular surface. In this review, we frame the relevant target not as isolated anterior structures but as a proposed metabolic surface unit composed of the lacrimal gland, tear film, conjunctiva, meibomian glands, corneal epithelium, corneal nerves, and the periocular tissues that support lid-globe function, and we argue that current evidence is best understood as restoration versus remodeling. Preclinical work provides the clearest biologic rationale: liraglutide studies have reported reduced lacrimal gland inflammation and fibrosis, and improved tear secretion, corneal epithelial migration, and nerve regeneration, while a semaglutide study in aged mice suggests lacrimal structural rescue through attenuation of senescence-associated inflammatory, oxidative, and fibrotic programs. Human evidence remains limited and largely observational, with retrospective diabetic cohorts showing lower rates of dry eye disease and superficial keratitis and a small clinical study showing better Schirmer testing and tear breakup time in GLP-1RA users. At the same time, emerging oculoplastic and imaging studies, particularly from obesity and weight loss populations, suggest periocular volume loss, brow descent, and dermatochalasis which may alter lid support, blink mechanics, and tear distribution. For anterior segment clinicians, the practical implication is that GLP-1RA exposure should prompt phenotype-based assessment of both ocular surface status and periocular geometry, although these recommendations remain expert extrapolations rather than guideline-level evidence. Current data are therefore consistent with a dual thesis: GLP-1RAs may be associated with biologic restoration at the lacrimal-corneal-neural axis and with structural remodeling of the periocular scaffold, although direct mechanistic support is presently stronger for the former than for the latter.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2545-2562"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescein Angiography Leakage Patterns in Pachychoroid Neovasculopathy: Neovascularization or Central Serous Chorioretinopathy?","authors":"Soon Il Choi, Chui Ming Gemmy Cheung, Won Ki Lee","doi":"10.1007/s40123-026-01441-x","DOIUrl":"10.1007/s40123-026-01441-x","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this work is to characterize fluorescein angiography (FA) leakage patterns in eyes with pachychoroid neovasculopathy (PNV) and subretinal fluid (SRF), and to evaluate their associations with clinical features and treatment response.</p><p><strong>Methods: </strong>Retrospective observational study of consecutive patients with PNV presenting with SRF on optical coherence tomography and a clearly visible macular neovascular network on optical coherence tomography angiography at a single center. FA findings, multimodal imaging features, and clinical characteristics were analyzed. FA leakage was classified as neovascular (NV)-pattern leakage, characterized by diffuse leakage; central serous chorioretinopathy (CSC)-pattern leakage, characterized by pinpoint leakage; or an undetermined pattern. Main outcome measures were the distribution of FA leakage patterns and their associations with clinical features and treatment response.</p><p><strong>Results: </strong>Seventy-one eyes from 68 patients were included. Baseline FA revealed NV pattern, CSC pattern, and mixed-pattern leakage in 43 (60.56%), 19 (26.76%), and three eyes (4.23%), respectively, while six eyes (8.45%) were indeterminate. Younger age, greater SRF height, and neurosensory retinal sagging were significantly associated with the CSC- pattern group. Among eyes that received anti-vascular endothelial growth factor (VEGF) therapy, complete SRF resolution after three loading injections occurred in 65.85% of the NV pattern group and 27.27% of the CSC pattern group (odds ratio, 5.14; 95% confidence interval, 1.18-22.49; P = 0.037). Of the seven eyes in the CSC pattern group that were observed without anti-VEGF therapy, five (71.43%) showed spontaneous resolution. Ninety-five percent of CSC leakage points (20/21) were located along the NV margin. Leakage pattern changes were observed in 19% of repeated FA examinations during follow-up.</p><p><strong>Conclusions: </strong>In the pachychoroid context, the presence of neovascularization does not necessarily indicate that accumulated fluid originates from the neovascular complex. Combined CSC and nonexudative PNV appears relatively common, with CSC leakage points typically located along the NV margin. Given its frequency, the risk of neovascular activation, and the recurrent nature of CSC, FA remains valuable for identifying the origin of SRF when indicated.</p>","PeriodicalId":19623,"journal":{"name":"Ophthalmology and Therapy","volume":" ","pages":"2669-2679"},"PeriodicalIF":4.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}