Ophthalmology science最新文献

{"title":"Loss of Peripheral Retinal Vessels in Retinitis Pigmentosa","authors":"Hossein Ameri MD, PhD ,&nbsp;Alexander T. Hong BS ,&nbsp;Jason Chwa BS","doi":"10.1016/j.xops.2025.100767","DOIUrl":"10.1016/j.xops.2025.100767","url":null,"abstract":"<div><h3>Objective</h3><div>Retinitis pigmentosa (RP) is the most common inherited retinal disease and a major cause of irreversible vision loss. The purpose of this study was to assess peripheral retinal vessels in RP.</div></div><div><h3>Design</h3><div>A cross-sectional study.</div></div><div><h3>Subjects</h3><div>Patients with RP and age-matched controls.</div></div><div><h3>Methods</h3><div>Using ultra-widefield fundus images, the retina was divided into 3 zones: posterior, midperiphery, and far periphery. To evaluate vascularity of the retina, the vessels were counted at the border of posterior and midperipheral zones (Z1/2) and the border of midperipheral and far peripheral zones (Z2/3).</div></div><div><h3>Main Outcome Measures</h3><div>Vessel counts at Z1/2 and Z2/3.</div></div><div><h3>Results</h3><div>One hundred eighty-one eyes of 107 RP patients and 130 eyes of 84 controls were included. In the RP group, the median vessel counts at Z1/2 and Z2/3 were 8 and 3, respectively. These were strikingly lower than the control group with the median vessels of 42 and 43.5 at Z1/2 (<em>P</em> &lt; 0.001) and Z2/3 (<em>P</em> &lt; 0.001), respectively. Twenty-two percent of RP eyes were entirely avascular in the far periphery, and 7% were avascular in the midperiphery and far periphery. Only 5% of RP eyes had &gt;25 vessels at Z2/3. There were significantly fewer vessels in the temporal retina at both Z1/2 (<em>P</em> = 0.01) and Z2/3 (<em>P</em> &lt; 0.001) in RP eyes. Furthermore, eyes with visual acuity of 20/200 or worse had significantly fewer vessels at Z1/2 (<em>P</em> &lt; 0.001) and Z2/3 (<em>P</em> &lt; 0.001). There were no significant differences in the number of vessels at Z1/2 and 2/3 between the right and left eyes of RP patients with both eyes included in the study.</div></div><div><h3>Conclusions</h3><div>This study provides compelling evidence of substantial symmetrical peripheral retinal vascular loss in RP. This finding may aid in clinical diagnosis of the disease and have significant therapeutic implications.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100767"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848530","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":"Loss of OCT Outer Retinal Bands as Potential Clinical Trial Endpoints in Intermediate Age-Related Macular Degeneration","authors":"Zhichao Wu BAppSc(Optom), PhD ,&nbsp;Sandro De Zanet PhD ,&nbsp;Joseph P.M. Blair PhD ,&nbsp;Robyn H. Guymer MBBS, PhD","doi":"10.1016/j.xops.2025.100769","DOIUrl":"10.1016/j.xops.2025.100769","url":null,"abstract":"<div><h3>Purpose</h3><div>To understand the potential utility of evaluating loss of the outer retinal bands on OCT B-scans as outcome measures for early interventional trials in age-related macular degeneration (AMD).</div></div><div><h3>Design</h3><div>An observational study.</div></div><div><h3>Participants</h3><div>Two hundred eighty eyes from 140 participants with bilateral large drusen.</div></div><div><h3>Methods</h3><div>All participants underwent OCT imaging, color fundus photography, and microperimetry testing at 6-monthly intervals up to 36 months. The extent of loss of the external limiting membrane (ELM), ellipsoid zone (EZ), and retinal pigment epithelium (RPE) bands on OCT was derived in the central 5-mm diameter, and within 5 equiareal sectors in the central 3.6-mm diameter where microperimetry testing was performed.</div></div><div><h3>Main Outcome Measures</h3><div>The potential utility of the OCT outer retinal bands was examined based on their performance at capturing longitudinal changes according to the coefficient of variation (CoV; lower values indicating better performance) and their association with visual sensitivity loss.</div></div><div><h3>Results</h3><div>Overall, the extent of loss of all 3 OCT bands increased significantly over time (<em>P</em> &lt; 0.001), with a significant change from baseline first detected at 12 months for ELM and EZ loss and at 24 months for RPE loss (<em>P</em> ≤ 0.005 for all). Changes in the ELM, EZ, and RPE loss were all individually associated with change in mean sensitivity, percentage of locations showing a ≥7 decibels loss from baseline, and change in percentage of deep visual sensitivity defects at each corresponding sector tested on microperimetry (≤10 dB; <em>P</em> &lt; 0.001 for all). The CoV of the rate of ELM and EZ loss was lower than RPE loss (<em>P</em> &lt; 0.001 for both), and lower for EZ compared with ELM loss (<em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The extent of loss of the outer retinal bands on OCT increased significantly over time in a cohort with intermediate AMD that was associated with changes in visual sensitivity, and measurements of EZ loss had the highest performance for capturing longitudinal changes. These findings highlight the potential utility of these parameters for evaluating interventions in the early stages of AMD.</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":"5 4","pages":"Article 100769"},"PeriodicalIF":3.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143858781","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":"Profiles of Choroidal Vortex Vein Drainage System Using Ultra-Widefield OCT Angiography in a Chinese Population","authors":"Zhonghua Luo MD ,&nbsp;Zhenping Li MD ,&nbsp;Yuefeng Yu MD ,&nbsp;Yan Lu MD, PhD ,&nbsp;Yangyang Du MMed ,&nbsp;Xiaolan Xiang MMed ,&nbsp;Caijuan Lin MMed ,&nbsp;Kun Xu MMed ,&nbsp;Yue Xu MD, PhD ,&nbsp;Jingjing Huang MD, PhD ,&nbsp;Shanshan Yu MD ,&nbsp;Yuqing Lan MD, PhD ,&nbsp;Xiaoling Liang MD, PhD","doi":"10.1016/j.xops.2025.100768","DOIUrl":"10.1016/j.xops.2025.100768","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop a normative profile for choroidal vortex vein systems based on ultra-widefield OCT angiography (UWF-OCTA) in a healthy Chinese population.</div></div><div><h3>Design</h3><div>A cross-sectional, multicenter study.</div></div><div><h3>Participants</h3><div>A total of 515 eyes of 515 Chinese adults (515 healthy eyes) aged ≥20 years were recruited from the Choroidal Vortex Vein System Study.</div></div><div><h3>Methods</h3><div>All participants underwent comprehensive ophthalmic examinations. The 2-dimensional and 3-dimensional choroidal parameters of the vortex vein system were measured in each vortex vein drainage quadrant (24 × 20 mm² scan mode; central, superotemporal [ST], superonasal [SN], inferonasal [IN], and inferotemporal [IT] quadrants) using a UWF-OCTA device. The normative profile examined the choroidal parameters' fifth and 95th percentile values. The associations of ocular and systemic factors with choroidal parameters were investigated using multivariable linear regression to account for the correlation.</div></div><div><h3>Main Outcome Measures</h3><div>Choroidal thickness, choroidal vascularity index (CVI), choroidal vascular volume (CVV), and choroidal stromal volume (CSV).</div></div><div><h3>Results</h3><div>The fifth and 95th percentile values of the choroidal parameter dataset for the peripheral choroidal vortex vein system were set. The mean values of the peripheral choroidal vortex vein system parameters (choroidal thickness, CVI, CVV, and CSV) decreased with age, with a significant decline after 50 years. An association was observed between an increased axial length elongation and a thinner choroid layer in the macular region and the ST drainage system (all <em>P</em> &lt; 0.01). The CVI was significantly correlated with gender in the ST vortex vein drainage system (coefficient: −1.02, <em>P</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>We report a normative choroidal parameter dataset for the peripheral choroidal vortex vein system in a large Chinese cohort. Choroidal vessels and stroma in vortex vein drainage systems decrease with age, more remarkably after the age of 50 years.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100768"},"PeriodicalIF":3.2,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143838318","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":"Myopia Control Efficacy of Spectacle Lenses with Dual-Index Aspherical Lenslets: A 1-Year Randomized Clinical Trial","authors":"Yee Ling Wong PhD ,&nbsp;Andrew Tan BBus ,&nbsp;Ee Woon Lim ,&nbsp;Hua Ren Chua ,&nbsp;Liang Shen PhD ,&nbsp;Matthieu Guillot MSc ,&nbsp;Björn Drobe PhD","doi":"10.1016/j.xops.2025.100766","DOIUrl":"10.1016/j.xops.2025.100766","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the myopia control efficacy, in terms of axial elongation, of a new myopia control spectacle lenses with Dual-Index Aspherical Lenslets (DIAL) embedded within the lens, compared with single-vision spectacle lenses (SVLs) over a 1-year period.</div></div><div><h3>Design</h3><div>A prospective, randomized, double-masked clinical trial.</div></div><div><h3>Participants</h3><div>Eighty children aged 8 to 13 years with myopia (spherical equivalent refraction [SER] between −0.75 and −4.75 diopters [D]) were recruited.</div></div><div><h3>Intervention</h3><div>Participants were randomized to either the DIAL or SVL spectacle lenses group (1:1 ratio).</div></div><div><h3>Main Outcome Measures</h3><div>Axial length (AL), noncycloplegic subjective refraction, and best-corrected visual acuity (BCVA) were measured at baseline and 6-month intervals. Questionnaires on adaptation and compliance were administered during all visits.</div></div><div><h3>Results</h3><div>A total of 76 (N = 38 in each group) participants (mean [standard deviation] age, 10.8 [1.6] years) completed the 1-year visit. Mean (± standard error) 1-year AL change in the DIAL and SVL groups was 0.04 ± 0.02 and 0.22 ± 0.04 mm, respectively. A mean difference of −0.18 mm (95% confidence interval [CI], −0.26 to −0.10 mm; <em>P</em> &lt; 0.001) was found. Mean 1-year SER change in the DIAL and SVL groups was −0.13 ± 0.06 and −0.39 ± 0.08 D, respectively, with a mean difference of 0.26 D (95% CI, 0.06–0.46 D; <em>P</em> = 0.01). Compared with SVL, younger children (8 to &lt;11 years) and older children (11–13 years) in the DIAL group had significantly less axial elongation (−0.29 mm less for younger children and −0.09 mm less for older children), with greater myopia control effect of DIAL spectacle lenses among the younger group than among the older group (<em>P</em> = 0.004 for interaction). No significant differences between the lens groups were found for distance BCVA (<em>P</em> = 0.36). All participants adapted within 3 to 4 days regardless of lens group. No significant differences in mean daily wearing time were seen between the DIAL and SVL groups (<em>P</em> = 0.53).</div></div><div><h3>Conclusions</h3><div>Dual-Index Aspherical Lenslets spectacle lenses showed good myopia control efficacy, in terms of axial elongation, compared with SVL, among children aged 8 to 13 years in Singapore.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100766"},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886012","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":"Customized Evaluation of Progressive Visual Sensitivity Loss in Geographic Atrophy to Improve the Power of Clinical Trials","authors":"Abera Saeed MChD ,&nbsp;Robyn H. Guymer MBBS, PhD ,&nbsp;Xavier Hadoux MEng, PhD ,&nbsp;Maxime Jannaud MEng ,&nbsp;Darvy Dang BOrth(Hons) ,&nbsp;Lauren A.B. Hodgson MPH ,&nbsp;Emily K. Glover OD ,&nbsp;Erin E. Gee BAppSc(MedRad) ,&nbsp;Peter van Wijngaarden MBBS(Hons), PhD ,&nbsp;Zhichao Wu BAppSc(Optom), PhD","doi":"10.1016/j.xops.2025.100763","DOIUrl":"10.1016/j.xops.2025.100763","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effectiveness of different approaches for customizing the selection of a subset of test locations on defect-mapping microperimetry (DMP) for improving the detection of progressive visual function decline in geographic atrophy (GA).</div></div><div><h3>Design</h3><div>Prospective longitudinal study.</div></div><div><h3>Participants</h3><div>Sixty eyes from 53 participants with GA secondary to age-related macular degeneration.</div></div><div><h3>Methods</h3><div>Participants underwent 3-monthly DMP testing twice at each visit for up to 24 months, where the extent of deep visual sensitivity losses on each test was determined through single presentations of 10-decibel stimuli at 208 locations within the central 8° radius region. Seven outcome measures were derived, which included evaluating the proportion of locations missed (PLM; showing nonresponse to stimuli) on DMP in a subset of test locations based on their proximity to the GA margin, or to locations neighboring repeatably nonresponding points on 2 baseline tests (i.e., missed both tests at baseline). These outcome measures were compared by their coefficient of variation (CoV; reflecting performance for capturing longitudinal changes) and sample size estimates in a 2-arm trial seeking to detect a ≥30% treatment effect. Changes in GA extent and best-corrected visual acuity (BCVA) were evaluated for comparison.</div></div><div><h3>Main Outcome Measures</h3><div>Coefficient of variation and sample size estimates.</div></div><div><h3>Results</h3><div>Evaluating PLM at points immediately adjacent (&lt;1°) to repeatably nonresponding test locations at baseline (CoV = 47%) was the best performing outcome measure on DMP testing. This measure outperformed BCVA (CoV = 188%; <em>P</em> &lt; 0.001) at detecting longitudinal changes and was comparable to evaluating GA extent (CoV = 58%; <em>P</em> = 0.097). Sample size requirements in a 24-month trial using this outcome measure on DMP testing were lower by 46% and 94% compared with evaluating GA extent and BCVA, respectively.</div></div><div><h3>Conclusions</h3><div>Customized evaluation of DMP functional testing results in regions adjacent to repeatably nonresponding locations at baseline improved the detection of longitudinal changes compared with the evaluation of all test locations. These findings show that it is possible to sensitively capture progressive visual function decline with this approach, supporting its use in future GA treatment trials.</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":"5 4","pages":"Article 100763"},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143815883","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":"CatSkill: Artificial Intelligence-Based Metrics for the Assessment of Surgical Skill Level from Intraoperative Cataract Surgery Video Recordings","authors":"Binh Duong Giap PhD ,&nbsp;Dena Ballouz MD ,&nbsp;Karthik Srinivasan MD, MS ,&nbsp;Jefferson Lustre BS ,&nbsp;Keely Likosky BS ,&nbsp;Ossama Mahmoud MD ,&nbsp;Shahzad I. Mian MD ,&nbsp;Bradford L. Tannen MD, JD ,&nbsp;Nambi Nallasamy MD","doi":"10.1016/j.xops.2025.100764","DOIUrl":"10.1016/j.xops.2025.100764","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and validate a novel artificial intelligence (AI)–powered video analysis system to assess surgeon proficiency in maintaining (1) eye neutrality, (2) eye centration, and (3) adequate focus of the operating microscope in cataract surgery and evaluate differences in these metrics between attending cataract surgeons and ophthalmology residents.</div></div><div><h3>Design</h3><div>A retrospective surgical video analysis.</div></div><div><h3>Subjects</h3><div>Six hundred twenty complete surgical video recordings of 620 cataract surgeries performed by either attending surgeons or ophthalmology residents.</div></div><div><h3>Main Outcome Measures</h3><div>Performance of the proposed AI-powered video analysis system (CatSkill) for cataract surgery was evaluated at multiple stages. Anatomy and surgical landmark segmentation were reported as Dice coefficients. The proposed cataract surgery assessment metrics (CSAMs) were compared between attending and resident surgeons on a phase-wise basis. Surgery-level classification performance (attending vs. resident) of a machine learning (ML) algorithm trained on the CSAMs was assessed using area under the receiver operating characteristic curve (AUC).</div></div><div><h3>Methods</h3><div>An automated system involving video preprocessing, deep learning–based segmentation with limbus obstruction detection and compensation, and CSAM computation was designed to assess surgeon performance based on surgical videos. Three CSAMs were computed to analyze 430 cataract surgeries (254 attendings and 176 residents). An ML algorithm was developed to predict surgeon training level using only CSAMs.</div></div><div><h3>Results</h3><div>The CatSkill system using FPN (VGG16) achieved a Dice coefficient of 94.03% for segmentation of palpebral fissure, limbus, and Purkinje image 1. The phase-wise mean CSAM scores were higher for attendings than residents across all surgical phases. Residents struggled with stability/centration during the Main Wound, Cortical Removal, Lens Insertion, and Wound Closure phases, and had difficulty maintaining adequate microscope focus during later phases of surgery. A random forest model using CSAMs achieved an AUC of 0.865 in predicting the skill level (attending or resident) of the surgeon.</div></div><div><h3>Conclusions</h3><div>The proposed AI-derived CSAMs provide a high level of reliability in assessing the ability of surgeons to maintain eye neutrality, centration, and focus level during cataract surgery. Furthermore, downstream analysis using an ML model for surgical-level classification indicates that the proposed CSAMs provide significant predictive value for assessing the overall training level of the surgeon.</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":"5 4","pages":"Article 100764"},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143886011","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":"Longitudinal Imaging of the Parafoveal Cone Mosaic in Congenital Achromatopsia","authors":"Nickolas Chen MD ,&nbsp;Katie M. Litts PhD ,&nbsp;Danica Nikezic BS ,&nbsp;Christopher S. Langlo MD, PhD ,&nbsp;Brian P. Higgins BS ,&nbsp;Byron L. Lam MD ,&nbsp;Gerald A. Fishman MD ,&nbsp;Frederick T. Collison OD ,&nbsp;Mark E. Pennesi MD, PhD ,&nbsp;Christine N. Kay MD ,&nbsp;Sergey Tarima PhD ,&nbsp;Joseph Carroll PhD","doi":"10.1016/j.xops.2025.100765","DOIUrl":"10.1016/j.xops.2025.100765","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess longitudinal changes in parafoveal cone density in individuals with congenital achromatopsia (ACHM).</div></div><div><h3>Design</h3><div>Retrospective longitudinal study.</div></div><div><h3>Participants</h3><div>Nineteen individuals (7 women and 12 men) with genetically confirmed ACHM. To be eligible, each had adaptive optics scanning light ophthalmoscope (AOSLO) images of the photoreceptor mosaic from ≥2 time points.</div></div><div><h3>Methods</h3><div>For each individual, follow-up AOSLO montages were aligned to their baseline montage. Notably, 100 × 100 μm regions of interest (ROIs) were extracted from the split-detection modality at locations 1°, 5°, and 10° temporal (T) from the peak cone density in each montage. All ROIs from follow-up visits were then manually aligned to their respective baseline ROI for that location. Cones were identified in each ROI by one observer, reviewed by a second observer, and confirmed together in a masked fashion. Cone density was calculated, and a linear mixed model was used to assess changes in density over time. A Wald test was performed to determine if the cone density changes were statistically significant.</div></div><div><h3>Main Outcome Measures</h3><div>Parafoveal cone spacing (at 1°, 5°, and 10° T) as a function of time.</div></div><div><h3>Results</h3><div>The mean (± standard deviation [SD]) age at baseline was 21.6 ± 10.7 years and the mean (±SD) follow-up period was 3.83 ± 2.93 years (range, 0.46–8.66 years). At 1° T, we observed a significant decrease of 352 cones/mm² per year (<em>P</em> = 0.0003). At 5° T, the linear mixed model showed a nonstatistically significant decrease of 58 cones/mm² per year (<em>P</em> = 0.504). At 10° T, we observed a significant decrease of 139 cones/mm² per year (<em>P</em> = 0.0188). For a 100 × 100 μm ROI, these density changes correspond to a reduction of between about 0.5 and 4 cones per year, depending on the location.</div></div><div><h3>Conclusions</h3><div>Parafoveal cone density estimates in ACHM show a small decrease over time. These observed changes are within the previously reported longitudinal repeatability values for normal retinas, suggesting the observed average cone loss may not be clinically meaningful. Further studies with longer follow-up times and more genetically heterogeneous and age-diverse populations are needed to better understand factors contributing to changes in foveal and parafoveal cone structure in ACHM over time.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosures may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100765"},"PeriodicalIF":3.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826112","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":"A Neural Network for the Prediction of the Visual Acuity Gained from Vitrectomy and Peeling for Epiretinal Membrane","authors":"Rupert Kamnig MD,&nbsp;Noah Robatsch,&nbsp;Anna Hillenmayer MD,&nbsp;Denise Vogt MD,&nbsp;Susanna F. König MD,&nbsp;Efstathios Vounotrypidis MD,&nbsp;Armin Wolf MD,&nbsp;Christian M. Wertheimer MD","doi":"10.1016/j.xops.2025.100762","DOIUrl":"10.1016/j.xops.2025.100762","url":null,"abstract":"<div><h3>Purpose</h3><div>A significant proportion of patients with epiretinal membrane (ERM) demonstrate improvement in visual acuity (VA) 3 months after pars plana vitrectomy (PPV) and membrane peeling. The identification of these patients before surgery is clinically relevant.</div></div><div><h3>Design</h3><div>This retrospective study was conducted to establish a neural network to predict improvement using preoperative clinical factors and OCT.</div></div><div><h3>Subjects</h3><div>A total of 427 eyes from 423 patients who underwent a PPV for primary idiopathic ERM combined with or without cataract surgery were included.</div></div><div><h3>Methods</h3><div>The data were automatically labeled according to whether an improvement of at least 2 logarithm of the minimum angle of resolution lines was observed. A multilayer perceptron was trained using a set of 7 clinical factors. The images were processed using a convolutional network. The output of both networks was concatenated and presented to a second multilayer perceptron. The dataset was divided into training, validation, and test datasets.</div></div><div><h3>Main Outcome Measures</h3><div>The accuracy of the neural network on an independent test dataset for the prediction of postoperative VA was analyzed. The impact of individual clinical factors and images on performance was assessed using ablation studies and class activation maps.</div></div><div><h3>Results</h3><div>The clinical factors alone demonstrated the highest accuracy of 0.74, with a sensitivity of 0.82 and a specificity of 0.67. These results were obtained after the exclusion of less significant factors in an ablation study. The inclusion of the factors age, preoperative lens status, preoperative VA, and the distinction between combined phacovitrectomy and vitrectomy yielded the most accurate results. In contrast, the use of ResNet18 as a neural network for image processing alone (0.61) or images combined with clinical factors (0.70) resulted in reduced accuracy. In the class activation map, image regions corresponding to the outer, central, and inner retina appeared to be important for the decision-making process.</div></div><div><h3>Conclusions</h3><div>Our neural network has yielded favorable results in predicting improvement in VA in approximately 3-quarters of patients. This artificial intelligence–based personalized therapeutic strategy has the potential to aid decision-making. Future studies are to assess the clinical potential and generalizability and improve accuracy by including a more extensive dataset.</div></div><div><h3>Financial Disclosure(s)</h3><div>The author(s) have no proprietary or commercial interest in any materials discussed in this article.</div></div>","PeriodicalId":74363,"journal":{"name":"Ophthalmology science","volume":"5 4","pages":"Article 100762"},"PeriodicalIF":3.2,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143828658","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":"Vision-Threatening Diabetic Macular Ischemia Based on Inferred Progression Pathways in OCT Angiography","authors":"Miyo Yoshida MD,&nbsp;Tomoaki Murakami MD, PhD,&nbsp;Keiichi Nishikawa MD,&nbsp;Kenji Ishihara MD, PhD,&nbsp;Yuki Mori MD, PhD,&nbsp;Akitaka Tsujikawa MD, PhD","doi":"10.1016/j.xops.2025.100761","DOIUrl":"10.1016/j.xops.2025.100761","url":null,"abstract":"<div><h3>Purpose</h3><div>To elucidate the progression pathways of diabetic macular ischemia (DMI) using OCT angiography (OCTA) images and to assess changes in visual acuity (VA) associated with each pathway.</div></div><div><h3>Design</h3><div>A single-center, prospective case series study.</div></div><div><h3>Participants</h3><div>One hundred fifty-one eyes from 151 patients with a 3-year follow-up period.</div></div><div><h3>Methods</h3><div>We obtained 3 × 3 mm swept-source OCTA images and conducted analyses of en face images within a central 2.5 mm diameter circle. Nonperfusion squares (NPSs) were defined as 15 × 15-pixel squares without retinal vessels. Each eye at baseline and after 3 years was embedded into a 2-dimensional uniform manifold approximation and projection space and assigned to 1 of 5 severity grades—<em>Initial</em>, <em>Mild</em>, <em>Superficial</em>, <em>Moderate</em>, and <em>Severe</em>—using the k-nearest neighbors method. We assessed major transitions (involving ≥4 cases) during 3 years. Subsequent probabilistic analyses enabled the construction of a graphical model, wherein directed arrows represented inferred pathways of DMI progression. From this cohort, 103 eyes of 103 patients who did not receive any ocular treatments during the follow-up period were subsequently evaluated for VA changes.</div></div><div><h3>Main Outcome Measures</h3><div>Inference of DMI progression pathways.</div></div><div><h3>Results</h3><div>In most cases, NPS counts increased in both the superficial and deep layers. The major transitions between these severity groups at 3 years displayed a unique distribution, and probabilistic analyses suggested a directed graphical model comprising 7 inferred pathways of DMI progression: <em>Initial</em> to <em>Mild</em>, <em>Initial</em> to <em>Superficial</em>, <em>Mild</em> to <em>Superficial</em>, <em>Mild</em> to <em>Moderate</em>, <em>Superficial</em> to <em>Moderate</em>, <em>Superficial</em> to <em>Severe</em>, and <em>Moderate</em> to <em>Severe.</em> Eyes of the <em>Mild</em> and <em>Superfi</em>cial groups had greater increases in superficial NPS within the central sector than those of the <em>Severe</em> group. Additionally, deep NPS counts within the central sector decreased more in the eyes of the <em>Initial</em> group than in those of the <em>Superficial</em> and <em>Moderate</em> groups. Notably, the eyes of the <em>Superficial</em> and <em>Moderate</em> groups exhibited greater VA deterioration at 3 years compared with those in the <em>Initial</em> group.</div></div><div><h3>Conclusions</h3><div>A directed graphical model of DMI progression may serve as a useful tool for inferring progression pathways and predicting VA deterioration.</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":"5 4","pages":"Article 100761"},"PeriodicalIF":3.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sozinibercept (Anti-VEGF-C/-D) Combined with Ranibizumab for Polypoidal Choroidal Vasculopathy: Phase IIb Predefined Subgroup Analysis","authors":"Chui Ming Gemmy Cheung MD, FRCOphth ,&nbsp;Timothy L. Jackson PhD, FRCOphth ,&nbsp;Charles C. Wykoff MD, PhD ,&nbsp;Arshad M. Khanani MD, FASRS ,&nbsp;Ian M. Leitch PhD ,&nbsp;Megan E. Baldwin PhD ,&nbsp;Jason Slakter MD","doi":"10.1016/j.xops.2025.100759","DOIUrl":"10.1016/j.xops.2025.100759","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to assess the efficacy of sozinibercept, a novel “trap” inhibitor of VEGF-C and VEGF-D, when combined with ranibizumab for the treatment of polypoidal choroidal vasculopathy (PCV).</div></div><div><h3>Design</h3><div>Prespecified subgroup analysis of a randomized, double-masked, sham-controlled phase IIb trial.</div></div><div><h3>Participants</h3><div>Adults with treatment-naïve neovascular age-related macular degeneration.</div></div><div><h3>Methods</h3><div>Participants were randomized 1:1:1 to receive a total of 6 intravitreal injections of ranibizumab 0.5 mg given 4-weekly, in combination with either 0.5 mg sozinibercept, 2 mg sozinibercept, or sham injection (control). Active PCV was determined at baseline by masked readers at an independent imaging center based on multimodal imaging, including OCT (notched, sharply peaked, or multilobular pigment epithelial detachments with or without a ring of hyperreflectivity along the inner border), fundus photography (subretinal orange nodules), and fluorescein angiography (typical primarily occult multifocal lesions).</div></div><div><h3>Main Outcome Measures</h3><div>The primary end point was mean change from baseline in best-corrected visual acuity (BCVA) through week 24. Secondary end points included categorical changes in BCVA from baseline, anatomical changes in lesion morphology, and safety.</div></div><div><h3>Results</h3><div>Of 366 participants, PCV was identified in 66 (18%) using predefined criteria. Sozinibercept combination therapy produced a dose response, with a mean BCVA change from baseline to week 24 of +13.54 (2 mg, n = 22) and +10.87 (0.5 mg, n = 24) letters compared with +6.9 letters for ranibizumab (n = 20), respectively. The 2 mg sozinibercept combination group had a superior BCVA gain versus ranibizumab (+6.7 letter difference in least squares mean; <em>P</em> = 0.0253) with more participants gaining ≥10 letters (77.3 vs. 47.4%) and ≥15 letters (40.9 vs. 31.6%) and fewer losing ≥5 letters (4.5 vs. 15.8%). Anatomic responses were consistent with functional outcomes and at week 24, fewer participants in the 2 mg sozinibercept combination group had subretinal fluid (19%) or intraretinal cysts (9.1%) than with ranibizumab monotherapy (42.1% and 25%, respectively). The safety profile of sozinibercept combination therapy was similar to ranibizumab.</div></div><div><h3>Conclusions</h3><div>In this predefined phase IIb subgroup of patients with PCV, sozinibercept combination therapy through inhibition of VEGF-C/-D achieved improved visual and anatomic outcomes compared with ranibizumab monotherapy consistent with the overall population.</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":"5 4","pages":"Article 100759"},"PeriodicalIF":3.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833411","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}