Ophthalmology science最新文献

{"title":"Association of Physical Frailty and Genetic Predisposition with Risk of Irreversible Eye Diseases","authors":"Zhenyi Xu PhD ,&nbsp;Ruilang Lin MMed ,&nbsp;Xiaojun Wang PhD ,&nbsp;Yahang Liu ,&nbsp;Chen Huang PhD ,&nbsp;Ce Wang PhD ,&nbsp;Zhijun Bao PhD","doi":"10.1016/j.xops.2025.100910","DOIUrl":"10.1016/j.xops.2025.100910","url":null,"abstract":"<div><h3>Objective</h3><div>The evidence linking frailty to overall and specific irreversible eye diseases is limited. Moreover, it is unclear whether frailty is associated with similar increased risk across individuals with different genetic risk profiles. The aim of this study was to examine the association between frailty and overall and specific irreversible eye diseases and explore the modification effect of genetic risk of glaucoma, diabetic retinopathy, and age-related macular degeneration (AMD) in such associations.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Participants</h3><div>The study included a total of 409 579 White participants in the UK Biobank study.</div></div><div><h3>Methods</h3><div>Physical frailty was defined by 5 components: weight loss, exhaustion, low physical activity, slow walking speed, and low grip strength. Participants were classified as nonfrail, prefrail, or frail. Polygenic risk score was categorized as low (tertile 1), intermediate (tertile 2), or high (tertile 3). Cox regression was used to assess the association of physical frailty with irreversible eye diseases.</div></div><div><h3>Main Outcomes and Measures</h3><div>Irreversible eye diseases were identified using hospital admission electronic health records and death registries.</div></div><div><h3>Results</h3><div>Among 409 579 individuals (mean age, 56.5 years; 46.5% male) with a median follow-up of 13.1 years, 10 927, 7 095, and 919 were diagnosed with irreversible eye disease in the nonfrail, prefrail, and frail groups, respectively. Prefrail and frail individuals showed increased risks of overall irreversible eye diseases, with a 12% higher risk for prefrail individuals (hazard ratio [HR], 1.12; 95% confidence interval [CI], 1.09–1.16) and a 47% higher risk for frail individuals (HR, 1.47; 95% CI, 1.37–1.58). Increased risks were also observed for specific irreversible eye diseases, including glaucoma (HR, 1.11 [95% CI, 1.06–1.17] for prefrailty; HR, 1.43 [95% CI, 1.28–1.61] for frailty), diabetic retinopathy (HR, 1.12 [95% CI, 1.03–1.21] for prefrailty; HR, 1.53 [95% CI, 1.34–1.73] for frailty), and AMD (HR, 1.13 [95% CI, 1.08–1.19] for prefrailty; HR, 1.35 [95% CI, 1.20–1.52] for frailty). Furthermore, individuals with more severe frailty status and higher genetic risk exhibited higher risks of irreversible eye diseases than those with low genetic risk and nonfrailty.</div></div><div><h3>Conclusions</h3><div>Frailty was associated with an increased risk of irreversible eye diseases, particularly among individuals with higher genetic risk. These findings suggest that targeted strategies to prevent and manage frailty may contribute to reducing the risk of irreversible eye diseases.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100910"},"PeriodicalIF":4.6,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Shared Genetic Architecture of 3 Age-Related Ocular Disorders","authors":"Zhan-Pei Bai ,&nbsp;Yi-Suo Pan BMed ,&nbsp;Yi-Xin Cai MSc ,&nbsp;Chong Chen PhD ,&nbsp;Di Tao BMed ,&nbsp;Xin-Yi Zhao BMed ,&nbsp;Yi-Fan Shen ,&nbsp;Feng Chen MMed ,&nbsp;Jun-Hua Li MD ,&nbsp;Jia Qu MD ,&nbsp;Xiu-Feng Huang PhD","doi":"10.1016/j.xops.2025.100942","DOIUrl":"10.1016/j.xops.2025.100942","url":null,"abstract":"<div><h3>Purpose</h3><div>To explore the shared genetic architecture, causal relationships, and cell type–specific expression patterns of pleiotropic genes in age-related macular degeneration (AMD), cataract, and primary open-angle glaucoma (POAG), uncovering molecular mechanisms and informing targeted therapies.</div></div><div><h3>Design</h3><div>A genetic association study combined with cross-trait meta-analyses, Mendelian randomization analyses, and single-cell RNA sequencing (scRNA-seq) analysis.</div></div><div><h3>Subjects</h3><div>The data related to 3 age-related ocular diseases, including AMD, cataract, and POAG, were obtained from publicly available genome-wide association study (GWAS) databases.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive genetic analysis utilizing GWAS summary statistics to examine genetic correlations among AMD, cataract, and POAG. Cross-trait meta-analyses were performed to identify shared risk loci. Mendelian randomization was employed to investigate potential causal relationships between these conditions. Additionally, we analyzed scRNA-seq data to examine the expression patterns of identified pleiotropic genes across different retinal cell types.</div></div><div><h3>Main Outcome Measures</h3><div>Identification of shared risk single nucleotide polymorphisms (SNPs) and pleiotropic loci. Causal relationships between AMD, cataract, and POAG. Cell type–specific expression patterns of pleiotropic genes in retinal cells.</div></div><div><h3>Results</h3><div>Our analysis revealed significant genetic correlations, with a negative correlation between AMD and POAG and a positive correlation between cataract and POAG. Cross-trait meta-analyses identified shared risk SNPs, with <em>CDKN2B-AS1</em> emerging as a notable pleiotropic locus. Mendelian randomization analyses suggested causal relationships between AMD and cataract, as well as between POAG and AMD. Single-cell expression analysis demonstrated cell type–specific expression patterns of pleiotropic genes including <em>ATXN2</em>, <em>HTRA1</em>, <em>SIX6</em>, and <em>THSD7A</em> across retinal cells.</div></div><div><h3>Conclusions</h3><div>This study provides compelling evidence for shared genetic architecture and causal relationships among AMD, cataract, and POAG. The identification of specific pleiotropic genes and their expression patterns across retinal cell types offers new insights into the molecular mechanisms underlying these age-related ocular diseases, potentially informing the development of targeted therapeutic strategies.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100942"},"PeriodicalIF":4.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Efficacy of Intravitreal Dental Pulp Stem Cells versus Human Umbilical Vein Endothelial Cell–Conditioned Media in Experimental Retinal Ischemia–Reperfusion Injury","authors":"M. Hossein Nowroozzadeh MD,&nbsp;Mehrnoosh Maalhagh MD,&nbsp;Fatemeh Sanie-Jahromi PhD,&nbsp;Navid Fazlinejad MD,&nbsp;Farid Shahrivar MD,&nbsp;Mohsen Farvardin MD","doi":"10.1016/j.xops.2025.100941","DOIUrl":"10.1016/j.xops.2025.100941","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the efficacy of intravitreal dental pulp stem cell–conditioned medium (DPSC-CM) versus human umbilical vein endothelial cell–CM (HUVEC-CM) in preserving retinal function after ischemia–reperfusion injury (IRI) in rabbits.</div></div><div><h3>Design</h3><div>Experimental animal study.</div></div><div><h3>Subjects</h3><div>Eighteen rabbits subjected to retinal IRI and randomized to receive intravitreal injections of DPSC-CM, HUVEC-CM, or balanced salt solution (BSS) (n = 6 per group).</div></div><div><h3>Intervention</h3><div>After induction of retinal IRI, rabbits received intravitreal injections of DPSC-CM, HUVEC-CM, or BSS. Electroretinography (ERG) was performed 7 days postinjection to assess retinal function, measuring both dark-adapted (DA) and light-adapted (LA) responses.</div></div><div><h3>Main Outcome Measures</h3><div>Preservation of a-wave and b-wave amplitudes on ERG as indicators of photoreceptor (PR) and bipolar cell function, respectively.</div></div><div><h3>Results</h3><div>Both DPSC-CM and HUVEC-CM significantly preserved b-wave amplitudes in DA ERG responses compared to BSS (<em>P</em> &lt; 0.05). Dental pulp stem cell–conditioned medium demonstrated superior preservation of a-wave amplitudes, indicating enhanced PR function. Both treatments also maintained LA ERG responses. Transient mucopurulent discharge in 2 DPSC-CM–treated rabbits and a localized posterior subcapsular opacity in one BSS-treated rabbit were observed; all resolved without sequelae.</div></div><div><h3>Conclusions</h3><div>Intravitreal DPSC-CM and HUVEC-CM are effective in preserving retinal function after IRI, with DPSC-CM showing particular advantage in PR protection. These results support further investigation into DPSC-CM and HUVEC-CM as potential therapies for retinal ischemic conditions, such as retinal artery occlusion and anterior ischemic optic neuropathy.</div></div><div><h3>Financial Disclosure(s)</h3><div>The authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100941"},"PeriodicalIF":4.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between Progression of Retinal Pigment Epithelial and Outer Retinal Atrophy and Choroidal Thickness: A 2-Year observation","authors":"Norihiro Nagai MD, PhD ,&nbsp;Hajime Shinoda MD, PhD ,&nbsp;Hisashi Matsubara MD, PhD ,&nbsp;Hiroto Terasaki MD, PhD ,&nbsp;Takao Hirano MD, PhD ,&nbsp;Aki Kato MD, PhD ,&nbsp;Akiko Miki MD, PhD ,&nbsp;Hiromasa Hirai MD, PhD ,&nbsp;Fumiko Murao MD, PhD ,&nbsp;Hiroko Imaizumi MD, PhD ,&nbsp;Fumi Gomi MD, PhD ,&nbsp;Yoshinori Mitamura MD, PhD ,&nbsp;Nahoko Ogata MD, PhD ,&nbsp;Sentaro Kusuhara MD, PhD ,&nbsp;Tsutomu Yasukawa MD, PhD ,&nbsp;Toshinori Murata MD, PhD ,&nbsp;Taiji Sakamoto MD, PhD ,&nbsp;Mineo Kondo MD, PhD ,&nbsp;Yoko Ozawa MD, PhD","doi":"10.1016/j.xops.2025.100939","DOIUrl":"10.1016/j.xops.2025.100939","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical course of retinal pigment epithelial and outer retinal atrophy (RORA) with best-corrected visual acuity (BCVA) and risk factors for rapid progression to explore the pathogenesis.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Subjects</h3><div>Data on eyes with fovea-involved RORA associated with age-related macular degeneration were collected over time from 10 hospitals in Japan.</div></div><div><h3>Methods</h3><div>Data on ophthalmic examination, BCVA, and OCT images were analyzed.</div></div><div><h3>Main Outcome Measures</h3><div>Relationships between changes in BCVA and extents of RORA and outer plexiform layer (OPL) deterioration and their associations with central choroidal thickness (CCT) and pachychoroid characteristics at baseline were evaluated.</div></div><div><h3>Results</h3><div>Of the 53 eyes of 53 patients (mean age; 74.9 ± 1.4 years), 32 eyes (60.4%) belonged to men. The progression in the mean extent of OPL deterioration was evident at year 1, whereas that of RORA, BCVA impairment, thinning of the central retinal thickness, and CCT became apparent at year 2 (<em>P</em> &lt; 0.05). Changes in the extents of RORA and OPL deterioration and BCVA were correlated (<em>P</em> &lt; 0.05). Baseline CCT negatively correlated with baseline RORA and the changes in extent of RORA (<em>P</em> &lt; 0.05). After adjusting for age and sex, a longer extent of RORA at baseline predicted BCVA worsening ≥0.04 per year (odds ratio [OR], 3.444; 95% confidence interval [CI], 1.015–11.691; <em>P</em> = 0.047). Greater horizontal extension of RORA ≥175 μm/y was frequently observed in eyes with thinner CCT &lt;180 μm (OR, 4.684; 95% CI, 1.288–17.036; <em>P</em> = 0.019), subretinal drusenoid deposits (SDDs) (OR, 6.714; 95% CI, 1.555–28.988; <em>P</em> = 0.011), and drusen (OR, 4.392; 95% CI, 1.176–16.410; <em>P</em> = 0.028) and less observed in eyes with pachychoroid characteristics (OR, 0.038; 95% CI, 0.003–0.454, <em>P</em> = 0.010) at baseline after adjusting for age and baseline extent of RORA; similar risks for greater vertical extension of RORA were observed.</div></div><div><h3>Conclusions</h3><div>The change in BCVA paralleled the changes in the extents of RORA and OPL deterioration. Rapid BCVA impairment was observed in eyes with longer RORA at baseline. A thinner choroid, SDD, and drusen were risk factors, and pachychoroid characteristics were protective factors against RORA progression. Further studies are warranted to better understand the progression of RORA and vision loss.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100939"},"PeriodicalIF":4.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproxalap Improves Ocular Redness, Tear Production, and Symptoms in a Pivotal Dry Eye Disease Chamber Trial","authors":"Sumit Garg MD ,&nbsp;Eric Donnenfeld MD ,&nbsp;John Sheppard MD ,&nbsp;Alice Epitropoulos MD ,&nbsp;Todd C. Brady MD, PhD","doi":"10.1016/j.xops.2025.100938","DOIUrl":"10.1016/j.xops.2025.100938","url":null,"abstract":"<div><h3>Purpose</h3><div>The primary objective was to assess the acute efficacy of 0.25% reproxalap ophthalmic solution versus vehicle in patients with dry eye disease.</div></div><div><h3>Design</h3><div>This was a vehicle-controlled, randomized-sequence, double-masked, 2-period crossover trial.</div></div><div><h3>Participants and Controls</h3><div>Sixty-three patients with dry eye disease were treated with reproxalap or vehicle in 2 treatment periods.</div></div><div><h3>Methods</h3><div>For each treatment period, patients were treated 4 times for 1 day, followed the next day by 1 dose before and 1 dose during a 90-minute dry eye chamber. Washout between treatment periods was 7 to 14 days.</div></div><div><h3>Main Outcome Measures</h3><div>The primary endpoints were ocular redness during the chamber and Schirmer test 10 minutes after the fourth dose on the prechamber day. The key secondary endpoint was ≥10 mm unanesthetized Schirmer test responders. Other secondary endpoints included symptoms in the chamber.</div></div><div><h3>Results</h3><div>Relative to vehicle, reproxalap treatment statistically significantly diminished ocular redness and increased Schirmer score and percent ≥10-mm responders. All symptoms assessed in the chamber were statistically significantly lower after treatment with reproxalap versus vehicle. The most common adverse event in patients treated with reproxalap was mild transient instillation site irritation, most commonly lasting ≤1 minute.</div></div><div><h3>Conclusions</h3><div>Within minutes of administration to dry eye disease patients, reproxalap increased tear production, and decreased ocular redness and improved symptoms in a dry eye chamber.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100938"},"PeriodicalIF":4.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Negative Feedback between Age and Baseline Axial Length on Axial Elongation in High Myopia","authors":"Mariko Murata MD,&nbsp;Masahiro Miyake MD, PhD, MPH,&nbsp;Kenji Suda MD, PhD,&nbsp;Yuki Mori MD, PhD,&nbsp;Kazuya Morino MD, PhD,&nbsp;Wakako Okayama MD,&nbsp;Akitaka Tsujikawa MD, PhD","doi":"10.1016/j.xops.2025.100937","DOIUrl":"10.1016/j.xops.2025.100937","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the axial elongation in highly myopic eyes and assess the effects of age, sex, baseline axial length (AL), cataract surgery (CS), pathologic myopia (PM), baseline intraocular pressure (IOP), and genetic risk scores (GRSs).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>This study included 614 eyes from 367 individuals with high myopia.</div></div><div><h3>Methods</h3><div>The study assessed axial elongation rates and their associations with age, sex, baseline AL, CS, PM, and baseline IOP including potential interactions among these factors. Additionally, the study examined whether incorporating GRS improved the predictive model for axial elongation.</div></div><div><h3>Main Outcome Measures</h3><div>Axial elongation rate in highly myopic eyes.</div></div><div><h3>Results</h3><div>The study included 367 participants (217 [59.1%] females, 150 [40.9%] males) with a mean age of 58.9 ± 14.4 years and a mean AL of 28.6 ± 2.0 mm. The mean follow-up duration was 4.7 ± 2.7 years, and the average axial elongation rate was 0.031 ± 0.030 mm/year. Cataract surgery was associated with significantly slower axial elongation (<em>P</em> &lt; 0.001). Multivariate analysis revealed that axial elongation increased with age and baseline AL but decreased with CS and an age–AL interaction. The best-fitting model excluded GRS, thus achieving a lower Akaike information criterion score (–573.4) than models including GRS.</div></div><div><h3>Conclusions</h3><div>Axial elongation persists in highly myopic eyes (0.031 mm/year) but slows over time, owing to baseline AL–age interactions. Genetic risk scores have limited predictive utility in adulthood. This highlights the need for further research on genetic and environmental determinants of myopia progression.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100937"},"PeriodicalIF":4.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Nerve Head Changes over 15 Years—From the Atropine Treatment Long-Term Assessment Study","authors":"Leila Sara Eppenberger MD, MSc ,&nbsp;Ezekiel Ze Ken Cheong MD ,&nbsp;Joey Chung BSc ,&nbsp;Yong Li PhD ,&nbsp;Angeline Toh BA ,&nbsp;Haoran Cheng BSc ,&nbsp;Mark Wong MD ,&nbsp;Audrey Chia MD, PhD ,&nbsp;Damon Wong PhD ,&nbsp;Rachel S. Chong MD, PhD ,&nbsp;Leopold Schmetterer PhD ,&nbsp;Jost B. Jonas MD, PhD ,&nbsp;Marcus Ang MD, PhD","doi":"10.1016/j.xops.2025.100936","DOIUrl":"10.1016/j.xops.2025.100936","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate optic nerve head (ONH) changes over 15 years from childhood to adulthood.</div></div><div><h3>Design</h3><div>A longitudinal study.</div></div><div><h3>Participants</h3><div>The Atropine Treatment Long-Term Assessment Study (ATLAS) included 148 myopic participants from the Atropine for the Treatment of Myopia 2 (ATOM2) trial.</div></div><div><h3>Methods</h3><div>During ATOM2, all participants were treated with daily atropine eye drops in concentrations of 0.01%, 0.1%, or 0.5%. The ATLAS recall visit was conducted in 2021–2022. At 3 study visits—ATOM2 baseline, last ATOM2 (5-year), and ATLAS recall (15-year)—participants underwent cycloplegic autorefractometry, biometry, and fundus photography. At recall, OCT centered on the optic disc was additionally performed. Fundus photographs were morphometrically examined for ONH ovality, torsion, parapapillary atrophy (PPA), disc–fovea distance, position of the central retinal vascular trunk (CRVT), angle kappa, and vertical distance between the arterial arcade. OCT images were analyzed for Bruch membrane opening distance, gamma zone, and Bruch membrane overhang.</div></div><div><h3>Main Outcome Measures</h3><div>Optic nerve head changes from childhood to young adulthood and associated factors.</div></div><div><h3>Results</h3><div>Optic nerve head characteristics were similar across atropine treatment groups. Myopic refractive error increased from –4.54 ± 1.64 diopters (D) at baseline to –6.35 ± 2.02 D at 5 years to –6.88 ± 2.4 D at 15 years (<em>P</em> &lt; 0.0001). Axial length (AL) increased from a mean of 25.08 ± 0.89 mm to 26.31 ± 1.01 mm (<em>P</em> &lt; 0.0001). Significant ONH changes after 15 years included PPA (beta zone/maximal disc diameter) increasing from 0.19 ± 0.11 to 0.31 ± 0.15 (<em>P</em> &lt; 0.0001), and CRVT position ratio increasing from 1.62 ± 0.22 to 2.23 ± 0.5 (<em>P</em> &lt; 0.0001). Multivariable mixed-effect models confirmed the association of age, AL, and spherical equivalent refraction (SER) with optic disc changes (<em>P</em> &lt; 0.0001). Axial length, SER, and PPA were associated with the Bruch membrane opening distance area and the gamma zone (<em>P</em> values &lt;0.0001). Additionally, age (<em>P</em> &lt; 0.0001), PPA ratio (<em>P</em> = 0.002), and disc–fovea distance ratio (<em>P</em> = 0.030) were found to be associated with myopic progression greater than –2D over a 15-years period.</div></div><div><h3>Conclusions</h3><div>This long-term study suggests that myopic subjects showed increased PPA and nasal CRVT shift from childhood into young adulthood.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100936"},"PeriodicalIF":4.6,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autonomous Artificial Intelligence in Diabetic Retinopathy Testing—Lessons Learned on Successful Health System Adoption","authors":"Clare W. Teng MD ,&nbsp;Saawan D. Patel BS ,&nbsp;Andrew J. Barkmeier MD ,&nbsp;T.Y. Alvin Liu MD ,&nbsp;David Myung MD, PhD ,&nbsp;Jeffrey Henderer MD ,&nbsp;James Liu MD ,&nbsp;Eric Hansen MD ,&nbsp;Lama A. Al-Aswad MD, MPH","doi":"10.1016/j.xops.2025.100935","DOIUrl":"10.1016/j.xops.2025.100935","url":null,"abstract":"<div><h3>Purpose</h3><div>Artificial intelligence (AI)–aided diabetic retinopathy (DR) testing systems have been commercialized for 5 years, but adoption is still relatively limited. This article aims to summarize the evidence in clinical settings, describe the current state of adoption, and share themes of successful implementation.</div></div><div><h3>Design</h3><div>Evaluation of diagnostic test or technology.</div></div><div><h3>Participants</h3><div>Ophthalmologists.</div></div><div><h3>Methods</h3><div>We performed literature review and conducted interviews with ophthalmologists leading implementation of AI-aided DR testing programs at several academic health systems. The study focused on the 3 currently US Food and Drug Administration-cleared AI systems: LumineticsCore, EyeArt, and AEYE Diagnostic Screening (AEYE-DS), assessing their performance and strategies utilized by health systems to effectively implement this technology in clinics.</div></div><div><h3>Main Outcome Measures</h3><div>Diagnostic accuracy data, ophthalmologist feedback.</div></div><div><h3>Results</h3><div>The literature review found 6 publications reporting diagnostic accuracy data of autonomous AI DR testing in primary care office settings, including 5 for LumineticsCore and 1 for EyeArt. Additional articles, of which 18 were selected for detailed review, addressed impact on patient adherence, health equity, and carbon footprint, as well as cost-effectiveness and workflow efficiency analyses. There were no studies comparing the systems on the same patients. In aggregate, adopters of the AI systems reported average nonmydriatic gradability of 49% to 75% (n = 5), sensitivity 87% to 100% (n = 3), and specificity 60% to 91% (n = 4). Based on public records at the time of writing, both LumineticsCore and EyeArt have &gt;5 academic adopters in the United States. Limited information is available on AEYE-DS given recency of regulatory clearance. Elements of successful implementation include proper site selection, aligning AI tools with primary care clinic workflows, streamlining patient engagement and referrals, and ongoing training of staff. Health systems utilizing AI reported improved Healthcare Effectiveness Data and Information Set measures, health equity, productivity, and patient adherence to follow-up with ophthalmology.</div></div><div><h3>Conclusions</h3><div>Artificial intelligence–aided diabetic eye examinations present a promising solution to facilitate early detection of DR, promote equitable access, and drive down system-level cost of care. Its successful implementation requires addressing technological, operational, and stakeholder engagement challenges. Our study underscores the potential of AI to revolutionize care delivery provided its adoption is strategically managed.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author has no/the authors have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100935"},"PeriodicalIF":4.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-Context Learning for Data-Efficient Diabetic Retinopathy Detection via Multimodal Foundation Models","authors":"Murat S. Ayhan PhD ,&nbsp;Ariel Y. Ong MD ,&nbsp;Eden Ruffell ,&nbsp;Siegfried K. Wagner MD, PhD ,&nbsp;David A. Merle MD ,&nbsp;Pearse A. Keane MD","doi":"10.1016/j.xops.2025.100934","DOIUrl":"10.1016/j.xops.2025.100934","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to evaluate whether in-context learning (ICL), a prompt-based learning mechanism enabling multimodal foundation models to rapidly adapt to new tasks without retraining or large annotated datasets, can achieve comparable diagnostic performance to domain-specific foundation models. Specifically, we use diabetic retinopathy (DR) detection as an exemplar task to probe if a multimodal foundation model (Google Gemini 1.5 Pro), employing ICL, can match the performance of a domain-specific model (RETFound) fine-tuned explicitly for DR detection from color fundus photographs (CFPs).</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Subjects</h3><div>A retrospective, publicly available dataset (Indian Diabetic Retinopathy Image Dataset) comprising 516 CFPs collected at an eye clinic in India, featuring both healthy individuals and patients with DR.</div></div><div><h3>Methods</h3><div>The images were dichotomized into 2 groups based on the presence or absence of any signs of DR. RETFound was fine-tuned for this binary classification task, while Gemini 1.5 Pro was assessed for it under zero-shot and few-shot prompting scenarios, with the latter incorporating random or k-nearest-neighbors-based sampling of a varying number of example images. For experiments, data were partitioned into training, validation, and test sets in a stratified manner, with the process repeated for 10-fold cross-validation.</div></div><div><h3>Main Outcome Measures</h3><div>Performance was assessed via accuracy, F1 score, and expected calibration error of predictive probabilities. Statistical significance was evaluated using Wilcoxon tests.</div></div><div><h3>Results</h3><div>The best ICL performance with Gemini 1.5 Pro yielded an average accuracy of 0.841 (95% confidence interval [CI]: 0.803–0.879), an F1 score of 0.876 (95% CI: 0.844–0.909), and a calibration error of 0.129 (95% CI: 0.107–0.152). RETFound achieved an average accuracy of 0.849 (95% CI: 0.813–0.885), an F1 score of 0.883 (95% CI: 0.852–0.915), and a calibration error of 0.081 (95% CI: 0.066–0.097). While accuracy and F1 scores were comparable (<em>P</em> &gt; 0.3), RETFound’s calibration was superior (<em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>Gemini 1.5 Pro with ICL demonstrated performance comparable to RETFound for binary DR detection, illustrating how future medical artificial intelligence systems may build upon such frontier models rather than being bespoke solutions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100934"},"PeriodicalIF":4.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Data Duplication and Errors in Large Medical Data Sets: A Case Study in the IRIS® Registry","authors":"Eric A. Goldberg MS,&nbsp;Connor J. Ross BS,&nbsp;Vivian Paraskevi Douglas MD, DVM,&nbsp;Alexander Ivanov MS,&nbsp;Tobias Elze PhD,&nbsp;Joan W. Miller MD,&nbsp;Alice C. Lorch MD, MPH","doi":"10.1016/j.xops.2025.100933","DOIUrl":"10.1016/j.xops.2025.100933","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate entry errors and data duplication within the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) utilizing cataract surgery (CS), neodymium-doped: yttrium aluminum garnet (YAG) capsulotomy, age-related macular degeneration (AMD), and diabetic retinopathy (DR) records.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>Patients in the IRIS Registry.</div></div><div><h3>Methods</h3><div>We collected records of CS and YAG capsulotomy with specified laterality within the IRIS Registry (years 2013–2023), identifying eyes having &gt;1 record and eyes having ≥1 record <em>on a date after the first entry</em> (different date duplication, <em>D</em>_<em>d</em>). Additionally, we identified eyes amongst records of DR and AMD with (1) a diagnosis indicating a more severe stage then reversion to the less severe stage or (2) a transition to a more severe stage before later being diagnosed with the less severe stage, defined as transition errors. We investigated potential predictors of <em>D</em>_<em>d</em> and transition errors among patient and practice characteristics by evaluating the permutation feature importance (PFI) of classification models.</div></div><div><h3>Main Outcome Measures</h3><div>For CS and YAG capsulotomy, we measure the proportion of eyes having &gt;1 procedure record, having &gt;1 record only on the initial procedure date, and having ≥1 procedure record on a date after the first entry. For DR and AMD, we measure the proportion of eyes reverting to an earlier stage after starting at a later stage and the proportion reverting to an earlier stage after transitioning to a later stage.</div></div><div><h3>Results</h3><div>Of the 14 718 896 CS-treated eyes, 30.9% had duplicates, with 5.5% having <em>D</em>_<em>d</em>. For YAG capsulotomy, out of 5 113 679 eyes, 29.1% had duplicates, with 4.1% having <em>D</em>_<em>d</em>. For AMD and DR, 13.6% and 12.7% of eyes, respectively, exhibited transition errors. Models captured a relationship between the eye’s first practice on record and the data errors under study, indicated by F1-loss = 0.230 (<em>D</em>_<em>d</em> model), 0.062 (transition error model) on average by PFI.</div></div><div><h3>Conclusions</h3><div>Data duplication in large medical data sets necessitates caution when analyzing repeated procedures or relapsing conditions. Addressing problematic errors requires transparency and communication amongst stakeholders across organizations. Within the IRIS Registry, the results indicated an association between the first record’s originating practice and data errors, providing an investigative entry point for upstream data stewards.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"6 1","pages":"Article 100933"},"PeriodicalIF":4.6,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}