Acta Ophthalmologica最新文献

{"title":"Artificial intelligence-quantified schisis volume as a structural endpoint for gene therapy clinical trials in X-linked retinoschisis.","authors":"Tien-En Tan, Peilun Dai, Jonathan Hensman, Peter Kiraly, Beau J Fenner, Yong Liu, Rick S M Goh, Ian C Han, Daniel S W Ting, Camiel J F Boon, M Dominik Fischer","doi":"10.1111/aos.17485","DOIUrl":"https://doi.org/10.1111/aos.17485","url":null,"abstract":"<p><strong>Purpose: </strong>To use artificial intelligence (AI) for quantifying schisis volume (ASV) in X-linked retinoschisis (XLRS) for use as a structural endpoint in gene therapy clinical trials.</p><p><strong>Methods: </strong>We used data from Singapore, the United Kingdom, the Netherlands, and the United States. The AI model was developed on 250 optical coherence tomography (OCT) slices, with human annotation of schisis cavities (Dataset 1). ASV was quantified on Dataset 2 - 16 OCT scans from 8 eyes with XLRS at two time points, and Dataset 4 - 62 OCT scans from 31 eyes at two time points before and after carbonic anhydrase inhibitor (CAI) treatment. A clinical trial was simulated comparing CAI treatment against control. Changes in ASV, central subfield thickness (CST) and central foveal thickness (CFT) were compared. Effect size (Cohen's d) of the three structural endpoints was determined and used in sample size calculations for a future XLRS gene therapy clinical trial, at a 0.05 significance level and 80% power.</p><p><strong>Results: </strong>In the simulated clinical trial, all structural metrics showed greater reductions with intervention than with control, but only change in ASV reached statistical significance (p = 0.004). Cohen's d for ASV, CST and CFT were 0.972, 0.685 and 0.521, respectively. For the future gene therapy clinical trial, sample sizes required in each arm for ASV, CST and CFT were 18, 35 and 59 participants, respectively.</p><p><strong>Conclusions: </strong>ASV measurements can track changes in schisis volume in response to treatment. As an endpoint, ASV has a greater statistical effect size than CST/CFT, which reduces sample size requirements for future XLRS gene therapy clinical trials.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of artificial tears on corneal parameter measurement using three different devices: Keratometry and Scheimpflug technology, a randomized trial.","authors":"Titus Schug, Thomas Kohnen, Klemens Paul Kaiser, Christoph Lwowski","doi":"10.1111/aos.17487","DOIUrl":"https://doi.org/10.1111/aos.17487","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effect of artificial tear (AT) application on the repeatability of corneal parameters with three different devices.</p><p><strong>Methods: </strong>In this prospective, randomized clinical trial, 145 patients were measured with one of three devices in the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Two baseline measurements and four measurements following AT application after 30 s, 2, 5 and 10 min were performed.</p><p><strong>Results: </strong>Forty-eight eyes were measured with the IOLMaster 700 (Carl Zeiss Meditec AG, Oberkochen, Germany) and Galilei G6 (Ziemer, Port, Switzerland), and 49 with the Pentacam AXL (Oculus, Wetzlar, Germany) (145 total). Repeatability of the mean corneal power (K_m) between baseline measurements was high (0.049 ± 0.008 D for IOLMaster, 0.061 ± 0.011 for the Pentacam AXL and 0.065 ± 0.009 for Galilei G6) but significantly variable after 30 s and 2 min for IOLMaster 700 (0.177 ± 0.021 D, p < 0.001 and 0.079 ± 0.009, p = 0.004) and Galilei G6 (0.163 ± 0.020 D, p < 0.001 and 0.119 ± 0.014 D, p = 0.003). K_m differed significantly from baseline at 30 s, 2 and 5 min with Pentacam AXL (0.215 ± 0.041 D, p < 0.001; 0.157 ± 0.025 D, p < 0.001 and 0.094 ± 0.012 D, p = 0.007). Variability was highest at 30 s and decreased over time.</p><p><strong>Conclusion: </strong>The use of AT leads to high variability of keratometric measurements for each device. This should be considered after use, and at least 5 min should elapse before measurements.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased prevalence of myopia in Swedish conscripts between 1975 and 1995 - associations with education and verbal ability.","authors":"Tomas Bro","doi":"10.1111/aos.17488","DOIUrl":"https://doi.org/10.1111/aos.17488","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study is to examine the trends in the prevalence of myopia in Swedish young men over a 30-year period and identify potential risk factors for myopia development.</p><p><strong>Method: </strong>This retrospective, cross-sectional study analysed testing results from three cohorts of Swedish military conscripts: 1975, 1985 and 1995. Myopia was defined as a spherical equivalent (SE) of ≤ -0.5 D and high myopia as SE ≤ -5 D. Myopia prevalence was analysed in combination with physical measures (height, weight and BMI), social measures (theoretical upper secondary school) and cognitive measures (4 different abilities). The results from the cognitive tests used a STANdard NINE scale (stanine or S9), a method of scaling test scores on a nine-point standard scale, with a mean of five and a standard deviation of two.</p><p><strong>Results: </strong>The study included a total of 13 075 males aged 17 to 19 years. Adequate data on physical measures and vision were available for 95%-98% of participants. The proportion of individuals with myopia increased significantly from 22% to 29% between 1975 and 1995 (p < 0.001). High myopia increased from 1.9% to 3.3% (p < 0.001). Multivariate logistic regression indicated associations between myopia and year of testing (OR = 1.15), presence of theoretical upper secondary school (OR 1.71, compared to the absence of theoretical upper secondary school), verbal ability (OR 1.08 per stanine) and visuospatial perception (OR 1.05 per stanine).</p><p><strong>Conclusion: </strong>Over the 30-year period from 1975 to 1995, the prevalence of myopia among Swedish conscripts increased from 22% to 29%. A higher level of education and higher verbal and visuospatial ability were risk factors for myopia.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Italian glaucoma virtual clinics: Developing a consensus for remote patient management.","authors":"Francesco Matarazzo, Carlo Alberto Cutolo, Alessandro Rabiolo, Michele Figus, Antonio Fea, Stefano Gandolfi, Corrado Gizzi, Gianluca Manni, Giorgio Marchini, Giovanni Montesano, Carlo Nucci, Maria Laura Passaro, Dario Romano, Luca Rossetti, Matteo Sacchi, Lucia Tanga, Carlo Enrico Traverso, Giacinto Triolo, Gianni Virgili, Francesco Oddone, Ciro Costagliola","doi":"10.1111/aos.17484","DOIUrl":"https://doi.org/10.1111/aos.17484","url":null,"abstract":"<p><strong>Purpose: </strong>To establish expert consensus on guidelines for implementing glaucoma virtual clinics in Italy, focusing on patient suitability, essential clinical assessments and staffing requirements.</p><p><strong>Methods: </strong>A modified Delphi method was used to achieve consensus among selected Italian glaucoma specialists. The steering group developed a structured questionnaire with 66 items across key areas: Patient Categories, Clinical Assessments, Roles and Staffing and Guidelines for glaucoma virtual clinic implementation. A panel of experts reviewed and rated each item across multiple rounds to reach consensus.</p><p><strong>Results: </strong>Out of 19 invited glaucoma specialists, 16 and 11 participated in rounds 1 and 2, respectively. Consensus was achieved on 57.6% of the questions, identifying specific patient profiles suitable for glaucoma virtual clinics, essential diagnostic tests and required roles in a virtual setting. Experts agreed on the importance of standardized assessments and the necessity of support staff such as orthoptists and ophthalmic assistants in the glaucoma virtual clinic structure.</p><p><strong>Conclusion: </strong>This Delphi panel provides guidance for implementing glaucoma virtual clinics in Italy, establishing guidelines on patient selection, required assessments and staffing needs. Tailored glaucoma virtual clinics can enhance glaucoma care accessibility, streamline workflows and address the growing demand from healthcare systems.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and associated factors of reduced visual acuity and undercorrected refractive error in Finland: Results from a nationwide survey.","authors":"Petri K M Purola, Seppo V P Koskinen, Hannu Uusitalo","doi":"10.1111/aos.17482","DOIUrl":"https://doi.org/10.1111/aos.17482","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the prevalence and associated factors of reduced distance visual acuity (VA) and undercorrected refractive error in Finland in 2017.</p><p><strong>Methods: </strong>A cross-sectional, nationwide health examination survey representing the Finnish adult population aged ≥18 years in 2017. Bilateral, habitual distance VA was measured in the survey. A pinhole test was performed for all participants with reduced VA, that is binocular distance VA logMAR ≥0.3 based on the initial letter chart test. Participants with an improvement of ≥5 letters using the pinhole were considered to have undercorrected refractive error, including also uncorrected errors. Multiple self-reported and register-based variables related to socio-demographic status, lifestyle, health-care use, health-related quality of life (HRQoL) and mental health were included in the survey, and their association with reduced VA and undercorrected refractive error was analysed using univariable logistic regression adjusted for age and sex as well as multivariable models.</p><p><strong>Results: </strong>VA was measured from a total of 5937 (58%) survey participants, of which 184 had distance VA logMAR ≥0.3 with a population prevalence of 3.1%. Reduced VA was associated with older age, being single, having basic education only, limited/insufficient income, living in an urban setting, lower work ability, smoking, lower physical activity, lower consumption of vegetables and fruits, and worse HRQoL. A total of 110 (60%) participants showed a ≥5-letter improvement using a pinhole with a population prevalence of 1.8%. Among participants with logMAR ≥0.3, undercorrected refractive error was associated with younger age, better work ability, smoking, higher physical activity, a higher number of nurse visits and worse HRQoL.</p><p><strong>Conclusion: </strong>Reduced VA is associated with socio-demographic disadvantage and unfavourable lifestyle. Two out of three persons with reduced VA do not have their spectacles up to date. Inadequately corrected refraction seems to be a complicated phenomenon related to several factors deserving further study.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic impact of a faricimab vial-sharing protocol in age-related macular degeneration and diabetic macular oedema patients.","authors":"J Borrás-Blasco, J Abad, S Cornejo-Uixeda, L Perez Gil, J Zarco Bosquet","doi":"10.1111/aos.17483","DOIUrl":"https://doi.org/10.1111/aos.17483","url":null,"abstract":"","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143602983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of fundus tessellation, myopic diffuse chorioretinal atrophy and choroidal thickness with visual acuity in myopia.","authors":"Jost B Jonas, Songhomitra Panda-Jonas, Jie Xu, Wen Bin Wei, Ya Xing Wang","doi":"10.1111/aos.17480","DOIUrl":"https://doi.org/10.1111/aos.17480","url":null,"abstract":"<p><strong>Purpose: </strong>To explore associations between stages of myopic macular degeneration (MMD) and visual acuity and influencing parameters.</p><p><strong>Methods: </strong>Participants of the population-based study Beijing Eye Study (n = 3468 participants) underwent a detailed ocular and systemic examination.</p><p><strong>Results: </strong>Assessable images were available for 3040 (87.7%) individuals (age: 64.0 ± 9.7 years). In multivariable analysis, worse best-corrected visual acuity (BCVA) (i.e. higher logMAR values) was associated with higher MMD stage (beta: 0.11; B: 0.06; 95% CI: 0.04, 0.08; p < 0.001) and thinner subfoveal choroidal thickness (beta: -0.06; p = 0.002), with adjustments for age, sex, educational level, cognitive function, degree of any cataract and prevalence of glaucoma, diabetic retinopathy and age-related macular degeneration. If only eyes with MMD grade 1 or no MMD were included, worse BCVA was associated (multivariable analysis) with higher prevalence of MMD stage 1 (beta: 0.11; B: 0.07; 95% CI: 0.05, 0.09; p < 0.001) and thinner medium-sized choroidal vessel layer thickness. Correspondingly, BCVA was worse in eyes with MMD stage 1 than in eyes without MMD (0.13 ± 0.27 logMAR vs. 0.04 ± 0.14; p < 0.001). Including only eyes without vision-influencing disorders (except myopia), BCVA was also worse in eyes with MMD stage 1 than in eyes without MMD (0.06 ± 0.13 logMAR vs. -0.01 ± 0.08 logMAR; p < 0.001). In these eyes without vision-influencing ocular disorders, worse BCVA was associated with thinner total subfoveal choroidal thickness (beta: -0.15; R: 0.000; 95% CI: 0.000, 0.000; p < 0.001) and longer axial length (beta: 0.14; R: 0.01; 95% CI: 0.01, 0.02; p < 0.001), or alternatively with higher MMD staging (beta: 0.24; R: 0.09; 95% CI: 0.01, 0.11; p < 0.001).</p><p><strong>Conclusions: </strong>MMD stage 1 (fundus tessellation) is associated with decreased BCVA and may be considered pathological. Independently of longer axial length, thinner choroidal thickness is a factor associated with lower BCVA in myopic eyes, including eyes with MMD stage 1.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of outdoor time on the spherical equivalent and axial length in childhood myopia: A meta-analysis.","authors":"Clara Martinez-Perez, Miguel Angel Sanchez-Tena, José-María Sánchez-González, Cesar Villa-Collar, Cristina Alvarez-Peregrina","doi":"10.1111/aos.17478","DOIUrl":"https://doi.org/10.1111/aos.17478","url":null,"abstract":"<p><p>This meta-analysis investigates the effectiveness of outdoor activities in reducing the onset of myopia in children and adolescents by analysing changes in axial elongation and spherical equivalent refractive error. Following PRISMA guidelines and registered in PROSPERO (CRD42024592971), the study included randomized controlled trials (RCTs) and observational studies. The eligibility criteria targeted children and adolescents aged 6 to 18 years with varying levels of outdoor exposure. Primary outcomes were axial elongation and spherical equivalent change. Studies were assessed for quality using GRADE and AMSTAR-2 tools, and data were analysed using Review Manager 5.4, with random-effects models applied when heterogeneity was significant. Fifteen studies (9 RCTs and 6 observational) were included, with a total of 16 597 participants. Outdoor activities significantly reduced or delayed the onset of myopia, with a mean axial length difference of -0.08 mm per year (95% CI: -0.09 to -0.07) and a spherical equivalent difference of 0.16 diopters per year (95% CI: 0.07 to 0.25). These differences were observed after 1 year of intervention and sustained for up to 3 years, with daily outdoor exposure ranging from 40 to 120 min. Heterogeneity was moderate to high, but sensitivity analyses confirmed the robustness of the results. While higher outdoor exposure appeared more effective in reducing myopia progression, the certainty of this evidence was rated as low due to suspected publication bias, as indicated by the GRADE analysis. Outdoor activities, especially with prolonged exposure to intense light, effectively reduce or delay the onset of myopia in children and adolescents. This study emphasizes the importance of light intensity in maximizing the benefits of outdoor interventions and highlights regional differences in effectiveness, suggesting that environmental factors play a significant role in the outcomes.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual outcome including visual field defects after treatment of paediatric optic pathway glioma: A nationwide cohort study.","authors":"C A M Bennebroek, J van Zwol, M C Montauban van Swijndregt, S E Loudon, A L W Groot, N J C Bauer, J W Pott, I C Notting, A J van Sorge, M M van Genderen, P de Graaf, A Y N Schouten-van Meeteren, P Saeed, G L Porro","doi":"10.1111/aos.17476","DOIUrl":"https://doi.org/10.1111/aos.17476","url":null,"abstract":"<p><strong>Purpose: </strong>To examine long-term visual impairment and visual field examination (VF) after diverse treatments for paediatric optic pathway glioma (OPG), and to determine prognostic factors for long-term severe visual impairment or blindness.</p><p><strong>Methods: </strong>A nationwide retrospective cohort study (1995-2018) was performed on paediatric OPGs that received various (successive) therapies. The analysis of severe VI or blindness was represented by the outcome of both BCVA and VF testing. Prognostic factors for long-term severe VI or blindness were identified.</p><p><strong>Results: </strong>Data on BCVA and VF were available in 117 of 136 children (86.0%) who received treatment. After a median follow-up of 8.3 years (range: 0.1-23.8 years) after the start of treatment, severe VI or blindness (>1.0 LogMAR) was observed in both eyes in 18.8% of 117 patients and in 34.6% of 234 included eyes. This impairment was more common in sporadic OPGs. Monocular VF defects were present in 80.0% of a subgroup of 110 eyes (47.0%), predominantly represented by hemianopia in 69.3% and various scotomas in 28.4%. Independent prognostic factors for severe VI or blindness included starting therapy under the age of 2 years and hypothalamic involvement of the OPG.</p><p><strong>Conclusion: </strong>In this study, long-term binocular severe VI or blindness appeared in almost one in five patients and in one in three eyes after diverse treatment for paediatric OPG. Visual field data were available in only one in two children; VF defects were present in four out of five eyes. Children starting therapy under the age of 2 years were particularly at risk for long-term severe VI or blindness. Future prospective studies need to include VF analysis as an outcome parameter and should analyse treatment effects on both monocular and binocular BCVA.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Semaglutide and non-arteritic anterior ischaemic optic neuropathy: Review and interpretation of reported association.","authors":"Abdullah Amini, Steffen Hamann, Michael Larsen","doi":"10.1111/aos.17473","DOIUrl":"https://doi.org/10.1111/aos.17473","url":null,"abstract":"<p><p>This review covers a seminal study of the relation between exposure to the glucagon-like peptide 1 (GLP-1) agonist semaglutide and incident non-arteritic anterior ischaemic optic neuropathy (NAION) in a neuro-ophthalmology clinic setting, subsequent studies in unselected populations, a meta-analysis of clinical trials and pathophysiology studies of the optic disc and retina that may help elucidate the relation between semaglutide and NAION in patients with diabetes or obesity. In the matched cohort study of neuro-ophthalmology patients, those treated using agents other than semaglutide had NAION rates, orders of magnitude higher than a background population, presumably because referral patterns led to the enrichment of the study populations with patients at high risk of NAION. With semaglutide, the rates of NAION were 4.28 and 7.64 times higher for type 2 diabetes (T2D) and obesity, respectively, and onset of NAION was within 14 months of treatment initiation, whereas non-semaglutide NAION was evenly distributed over the 3 years of follow-up. Of four health care registry studies, each covering more than 100 000 patients, two found relative rates of NAION two to three times higher with semaglutide than without semaglutide, one found a trend towards semaglutide being associated with NAION in patients with type 2 diabetes only, and one found statistically insignificant imbalances between the two alternatives. The meta-analysis of various GLP-1 receptor agonists versus placebo or active comparator found no significant difference in rates of NAION. Prior reports of long-term glycaemia reduction being associated with early worsening of retinopathy and with NAION indicate that semaglutide may promote such events in proportion to its antihyperglycaemic potency. The association of NAION with small, crowded discs, optic disc oedema and peripapillary exudation suggests that semaglutide-related NAION may result from changes in perfusion that lead to venous dilation and, presumably, to venous congestion during relative hypoglycaemia. Given the retrospective nature of the epidemiological studies, causality cannot be inferred, but a cautious approach to the use of semaglutide and other powerful glycaemia-reducing agents seems warranted, particularly in patients with crowded optic discs, a characteristic that can be identified by proactive eye examination for disc-at-risk characteristics by the use of optical coherence tomography.</p>","PeriodicalId":6915,"journal":{"name":"Acta Ophthalmologica","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}