Current Opinion in Ophthalmology最新文献

{"title":"Paraneoplastic syndromes and the retina.","authors":"Cindy S Zhao, Prithvi Mruthyunjaya, Ramsudha Narala","doi":"10.1097/ICU.0000000000001205","DOIUrl":"10.1097/ICU.0000000000001205","url":null,"abstract":"<p><strong>Purpose of review: </strong>Paraneoplastic diseases of the retina are rare. Diagnosis can be challenging, and studies on management strategies are limited. The purpose of this review is to summarize our current understanding of the presentation, diagnosis, and management for cancer associated retinopathy, melanoma associated retinopathy, paraneoplastic vitelliform maculopathy, and bilateral diffuse uveal melanocytic proliferation.</p><p><strong>Recent findings: </strong>Multimodal imaging can aid in the diagnosis of paraneoplastic retinopathies since early fundus findings and symptoms can be nonspecific. No standardized treatment protocol exists with therapies having variable efficacy. Generally, systemic immunosuppression is used with possible concomitant local steroid treatment with improved visual outcomes in some cases.</p><p><strong>Summary: </strong>Paraneoplastic syndromes affect the retina as an autoimmune response to tumor antigens or to circulating tumor-derived factors. Diagnosis hinges on maintaining high degree of clinical suspicion, and multimodal imaging can also be helpful. Once diagnosis is made, prompt systemic work-up for malignancy is necessary. Limited literature exists to suggest superiority of a single treatment, but management involves treatment of the underlying malignancy and local or systemic immunosuppression and/or antibody removal.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":"37 3","pages":"149-161"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147522639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic medications and their impact on age-related macular degeneration development and progression: a review of current evidence.","authors":"Melissa Yuan, Amer Alsoudi, Ahmed Alshaikhsalama, Ehsan Rahimy","doi":"10.1097/ICU.0000000000001198","DOIUrl":"10.1097/ICU.0000000000001198","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines commonly prescribed systemic medications and their possible associations with age-related macular degeneration (AMD) development and progression. With the limitations and risks of current intravitreal therapies, there is growing interest in oral pharmacotherapy for AMD management. The following review synthesizes observational studies, meta-analyses, and ongoing clinical trials to evaluate the potential effects of commonly used systemic medications on AMD.</p><p><strong>Recent findings: </strong>Metformin demonstrates conflicting evidence, with several meta-analyses and large cohort study showing reduced AMD odds, while a recent randomized phase II trial found no effect on geographic atrophy progression. For statins, emerging evidence suggests that treatment duration exceeding 2 years and medium-intensity to high-intensity dosing may confer protection against AMD development. Aspirin demonstrates discordant results between different study designs: two large randomized controlled trials showed no benefit for AMD, while a 10-year observational study suggested protective effects.Fenofibrates show promise in preclinical models but require additional clinical investigation. Danicopan also shows modest effects in complement-related disorders and is currently undergoing a phase 2 trial to evaluate efficacy in patients with geographic atrophy. Finally, dopamine agonists appear to improve visual acuity and reduce subretinal fluid and central retinal thickness in newly diagnosed exudative AMD, as shown in an open-label pilot study, but require further investigation.</p><p><strong>Summary: </strong>Multiple systemic medications have highlighted mixed or stage-dependent benefits on AMD development and progression. Some agents such as metformin and aspirin have shown conflicting findings, having been evaluated in randomized trials and large observational studies. Other medications including GLP-1 agonists, dopamine agonists, statins, fenofibrates, and danicopan show early promise in more limited studies, but require further clinical validation.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"251-258"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145892664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Canaloplasty and trabecular bypass glaucoma surgery: indications and outcomes.","authors":"Nicholas E Tan, Cara E Capitena Young, Leonard K Seibold","doi":"10.1097/ICU.0000000000001218","DOIUrl":"10.1097/ICU.0000000000001218","url":null,"abstract":"<p><strong>Purpose of review: </strong>Trabecular bypass stents and ab interno canaloplasty are popular micro-invasive glaucoma surgery approaches. This review summarizes recent evidence on outcomes, safety, and comparative effectiveness of these procedures.</p><p><strong>Recent findings: </strong>Five to 7-year studies of the iStent and Hydrus combined with cataract surgery report sustained efficacy, slower visual field progression, and cost-effectiveness versus cataract surgery alone. However, position-related inflammatory and endothelial concerns have emerged for the Hydrus. Canaloplasty via several modalities can achieve intraocular pressure (IOP) reductions of 30-40% and medication reductions up to 60%, through as long as 6  years of follow-up, with few complications. Regarding standalone delivery, prospective data supports the use of the iStent infinite in refractory glaucoma. Standalone canaloplasty evidence is strongest for the OMNI and iTrack devices, while early STREAMLINE device outcomes are promising. Comparative studies find that the Hydrus may outperform earlier-generation iStents but not the iStent infinite; canaloplasty with the STREAMLINE device demonstrates near-equivalence to iStent inject W; and gonioscopy-assisted transluminal trabeculotomy achieves lower IOP than viscodilation, albeit with more frequent hyphema.</p><p><strong>Summary: </strong>Both trabecular bypass and canaloplasty are effective interventions for open-angle glaucoma. Stents have the largest evidence base, while canaloplasty may offer similar efficacy without implant-related concerns.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"259-264"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147516441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central serous retinopathy: update on disease understanding and treatment.","authors":"Mary-Grace R Reeves, Katherine E Talcott","doi":"10.1097/ICU.0000000000001206","DOIUrl":"10.1097/ICU.0000000000001206","url":null,"abstract":"<p><strong>Purpose of review: </strong>Investigations over the past 2 years involving novel genomics pathways, imaging techniques, risk factors, and therapeutic interventions have sought to better understand and manage central serous retinopathy (CSR). While most cases of acute CSR are self-resolving, chronic CSR remains a challenging condition to manage given response to therapy may be limited and the risk of permanent, severe vision loss. In this work, we present the latest insights on disease pathophysiology and management for acute and chronic cases of CSR, highlighting data from randomized control trials and meta-analyses to compare efficacy of treatment options.</p><p><strong>Recent findings: </strong>There is no difference in best corrected visual acuity (BCVA) or resolution of subretinal fluid (SRF) in cases of chronic CSR that are treated with half-dose/half-fluence photodynamic therapy (PDT) versus full-strength/full-fluence therapy, making half-dose/half-fluence a reasonable option to avoid the atrophic retinal changes that may be more likely with full-strength treatment. Laser therapy could be considered as an alternative to PDT for treating chronic CSR in cases of verteporfin shortage; however, the statistically significant reduction in subretinal fluid seen on optical coherence tomography (OCT) does not translate to a significant improvement in BCVA after intervention. While there may be an early improvement in BCVA and SRF in cases of chronic CSR for which treatment with mineralocorticoid receptor antagonist is initiated, this effect does not appear to persist with extended follow up.</p><p><strong>Summary: </strong>With ongoing extensive research on the disease process of CSR and a more nuanced understanding of the factors that increase risk of disease, observation remains the mainstay of management for acute CSR. For chronic CSR, PDT, laser, or anti-VEGF may be considered, with advances in imaging allowing OCTA to be a less invasive alternative method to dye angiography for detecting neovascularization.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"143-148"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146042120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional supplements: current evidence for retinitis pigmentosa and Stargardt disease.","authors":"Normila Barthelemy, Winston Lee, Ninel Z Gregori, Byron L Lam, Jesse D Sengillo","doi":"10.1097/ICU.0000000000001213","DOIUrl":"10.1097/ICU.0000000000001213","url":null,"abstract":"<p><strong>Purpose of review: </strong>Inherited retinal diseases (IRDs) are genetically and phenotypically heterogeneous disorders that cause progressive vision loss and lack broadly effective disease-modifying therapies. Increasing evidence implicates metabolic stress, oxidative injury, and photoreceptor-retinal pigment epithelium (RPE) dysfunction in IRD pathophysiology. This review evaluates the evidence and limitations surrounding nutritional and metabolic interventions for retinitis pigmentosa and Stargardt disease.A narrative review of preclinical studies, randomized controlled trials, and contemporary genetic re-analyses was performed. Nutritional interventions reviewed include vitamin A, vitamin E, N-acetylcysteine (NAC), omega-3 fatty acids (docosahexaenoic acid), carotenoids and apocarotenoids, and the deuterated vitamin A analog C20-D3-retinyl acetate (ALK-001).</p><p><strong>Recent findings: </strong>Initial studies suggesting a protective effect of vitamin A in retinitis pigmentosa were not confirmed in subsequent trials or genetic re-analyses, which identified baseline differences between groups as a possible contributor to the original findings. In contrast, supplemental vitamin E may accelerate disease progression. NAC demonstrated acceptable tolerability and modest short-term improvements in visual function in early-phase trials, with a phase 3 study ongoing. Omega-3 fatty acids, carotenoids, and apocarotenoids have not shown consistent clinically meaningful benefit in retinitis pigmentosa or Stargardt disease despite strong mechanistic rationale. In Stargardt disease, ALK-001 reduces lipofuscin accumulation in animal models and clinical trials are ongoing to assess efficacy in patients.</p><p><strong>Summary: </strong>Most nutritional supplements studied to date have not demonstrated durable or clinically meaningful benefit in IRDs. Vitamin A supplementation in retinitis pigmentosa is no longer supported by current evidence, while NAC remains a promising metabolic therapy under investigation. High-quality, genotype-informed clinical trials with clinically relevant endpoints are needed before nutritional interventions can be incorporated into IRD management guidelines.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"205-214"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging solutions for neovascular age-related macular degeneration.","authors":"Jovany J Franco, Thomas J Wubben","doi":"10.1097/ICU.0000000000001199","DOIUrl":"10.1097/ICU.0000000000001199","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize emerging therapeutic strategies for neovascular (wet) age-related macular degeneration (nAMD), with emphasis on recent translational and clinical developments.</p><p><strong>Recent findings: </strong>The nAMD treatment landscape is rapidly evolving. Gene therapies (e.g. ABBV-RGX-314, ADVM-022, and 4D-150) have demonstrated sustained intraocular anti-VEGF expression with reduced injection burden in phase 2 and 3 programs, validating the 'biofactory' concept. Tyrosine kinase inhibitors delivered via intravitreal or suprachoroidal implants (e.g. EYP-1901, OTX-TKI, and CLS-AX) show potential for twice-yearly or less frequent dosing. Moreover, emerging therapeutic approaches increasingly target non-VEGF pathogenic pathways, reflecting a shift toward mechanistically diverse vascular stabilization and neuroprotection strategies. These include multitargeted biologics that couple anti-angiogenic and anti-inflammatory effects (e.g. KSI-501, IBI-302, and AG-73305), as well as agents modulating FGF2 signaling, Wnt activation, complement regulation, and cellular metabolism.</p><p><strong>Summary: </strong>Therapeutic innovation in nAMD is transitioning from incremental refinements in intravitreal anti-VEGF delivery to strategies aimed at extending durability or targeting alternative contributory pathways. Long-term safety, efficacy, and durability will determine which of these candidates redefine standard care.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"226-235"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of persistent corneal epithelial defects: role of insulin.","authors":"Barbara Burgos-Blasco, Pilar Perez-Garcia, David Diaz-Valle","doi":"10.1097/ICU.0000000000001208","DOIUrl":"10.1097/ICU.0000000000001208","url":null,"abstract":"<p><strong>Purpose of review: </strong>PED are corneal epithelial defects that fail to heal after 2 weeks and pose a significant therapeutic challenge. In recent years, insulin has emerged as a promising and effective therapy for promoting reepithelialization of the ocular surface, playing a role in the management of PED. The purpose of this article is to provide a summary of the role of topical insulin for persistent corneal epithelial defects (PED) management.</p><p><strong>Recent findings: </strong>Based on current evidence, topical insulin merits an early placement within the therapeutic pathway and may be considered after conventional therapy, before the use of autologous serum. Several studies suggest that insulin eye drops can facilitate faster and more consistent epithelial healing, potentially offering greater efficacy than autologous serum in some cases. Moreover, patients who do not respond to insulin often require escalation to surgical interventions such as amniotic membrane transplantation. Overall, topical insulin appears to represent a well tolerated, cost-effective, and promising option that could serve as an intermediate step between standard medical treatments and surgical management in PED.</p><p><strong>Summary: </strong>The evidence summarized in this review demonstrates that insulin shows considerable promise in managing PED, reinforcing the importance of further investigations to clarify its place in clinical practice. Ongoing clinical trials aim to validate the effectiveness of topical insulin for a range of ocular diseases and to benchmark its performance against other established treatment options.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"215-225"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in supply and demand of vitreoretinal fellowship positions in the United States.","authors":"Anne Strong Caldwell, Arjun Watane, Nikhil Bommakanti","doi":"10.1097/ICU.0000000000001207","DOIUrl":"10.1097/ICU.0000000000001207","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize trends in supply and demand for vitreoretinal fellowship positions in the United States, describe applicant characteristics and match outcomes, and discuss future workforce needs and diversity in the field.</p><p><strong>Recent findings: </strong>Fellowship applications and positions have increased, with medical and surgical retina programs accounting for the largest share of positions. Despite this growth, match rates have declined, and a persistent portion of positions remain unfilled, likely concentrated among less established or non Association of University Professors of Ophthalmology (AUPO) programs. Predictors of matching include completing more interviews and ranking more programs as well as completing residency training in the United States. Women and individuals underrepresented in medicine remain markedly underrepresented in the vitreoretinal pipeline relative to need. Interest in vitreoretinal fellowship is driven by advanced surgical exposure, perceived prestige, financial considerations, and mentorship during residency.</p><p><strong>Summary: </strong>Aligning supply with demand will require expanding high-quality, AUPO-compliant training; improving transparency about medical versus surgical positions; and targeted mentorship/sponsorship to diversify the pipeline. Given projected growth in retinal disease, strategic recruitment and training are essential to ensure equitable access to imaging, injections, laser, and surgery.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"182-186"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical approach to ocular complications of Marfan syndrome.","authors":"Samuel A Cohen, Meghana Kalavar, Jayanth Sridhar","doi":"10.1097/ICU.0000000000001203","DOIUrl":"10.1097/ICU.0000000000001203","url":null,"abstract":"<p><strong>Purpose of review: </strong>Marfan syndrome is a connective tissue disorder with several vision-threatening ocular manifestations. This study synthesizes recent advances in the surgical approach to ocular complication of Marfan syndrome including ectopia lentis, early cataract, glaucoma, and retinal detachment.</p><p><strong>Recent findings: </strong>Recent literature highlights advances in capsular support devices and alternative fixation methods for ectopia lentis, including long-term outcomes with modified capsular tension rings, suture-less scleral fixation, and iris-claw intraocular lenses. Pediatric cohorts underscore elevated risks of retinal detachment following lens removal, particularly when capsular remnants persist, emphasizing the importance of complete removal and vigilant follow-up. In highly myopic Marfan eyes, modern intraocular lens power calculation formulas demonstrate improved refractive predictability, though pediatric patients remain prone to progressive myopic shift. For glaucoma, tailored modifications to trabeculectomy and tube shunt techniques address the challenges of thin sclera and ocular surface fragility. Contemporary retinal detachment series reveal high lifetime risk, with surgical success often requiring multiple procedures, and outcomes closely tied to macular status and presence of proliferative vitreoretinopathy.</p><p><strong>Summary: </strong>Advances across anterior and posterior segment surgery have improved visual outcomes for Marfan patients, but long-term risks remain substantial. Individualized surgical planning, early detection of complications, and long-term surveillance are essential to optimize outcomes in this high-risk population.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"173-181"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of United States federal funding on equity and vision research: lessons from history, justice, and politics, 1968-2025.","authors":"Joana E Andoh, Julia Fu, Kristen H Nwanyanwu","doi":"10.1097/ICU.0000000000001212","DOIUrl":"10.1097/ICU.0000000000001212","url":null,"abstract":"<p><strong>Purpose of review: </strong>Federal policy has long shaped the scope and inclusivity of vision research in the United States. This narrative review and opinion article evaluates the evolution of equity in vision research over time, from the landmark National Institutes of Health Revitalization Act of 1993 to the direct impact of federal policies in today's political landscape.</p><p><strong>Recent findings: </strong>Equity in vision research originated from early epidemiologic studies identifying social and behavioral determinants of health in the 1970s. The post-2020 period accelerated attention to structural disparities in healthcare, catalyzed by the COVID-19 pandemic and a national conversation on race. However, recent executive orders have reversed equity oriented federal policies, restricted terminology and data access, and changed research funding operations. These ongoing developments pose risks to progress in all areas of research.</p><p><strong>Summary: </strong>Equity in vision research in the United States remains vulnerable to federal priorities that serve to support or destabilize. The current political environment underscores the need for the ophthalmologic research community to safeguard data integrity, sustain diverse participation, and continue methodologically rigorous protocols to ensure continued progress toward equitable vision health.</p>","PeriodicalId":50604,"journal":{"name":"Current Opinion in Ophthalmology","volume":" ","pages":"162-167"},"PeriodicalIF":2.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147328058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}