Ophthalmology science最新文献

{"title":"A Novel Bluetooth-Based Automated Flipper for Measuring Accommodative Facility: a Comparison with Conventional Manual Flipper","authors":"Hongxi Wang MD ,&nbsp;Peiting Guo MD ,&nbsp;Riping Zhang MD ,&nbsp;Kunliang Qiu MD, PhD ,&nbsp;Dongfeng Zhao BS ,&nbsp;Liqiong Zhu BS ,&nbsp;Mingzhi Zhang MD","doi":"10.1016/j.xops.2025.100750","DOIUrl":"10.1016/j.xops.2025.100750","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic accuracy of a Bluetooth-based automated flipper for measuring accommodative facility (AF) in children.</div></div><div><h3>Design</h3><div>A cross sectional study with crossover design.</div></div><div><h3>Participants</h3><div>Children aged 8 to 12 years were enrolled and randomly divided into 2 groups (A and B).</div></div><div><h3>Methods</h3><div>Initially, group A participants used the manual flipper to measure monocular (MAF) and binocular (BAF) AF, whereas participants in group B used the automated flipper. Subsequently, the groups underwent a crossover, exchanging the methods to measure AF. The diagnostic accuracy of the automated flipper was evaluated against gold standard, which defined inadequate AF as &lt;7 cycles per minute (cpm) for MAF and &lt;5 cpm for BAF, as measured with the manual flipper.</div></div><div><h3>Main Outcome Measures</h3><div>Accommodative facility measured using automated and manual flipper. Area under the receiver operating characteristic curve for automated flipper; sensitivity and specificity at the optimal cutoff (maximal Youden index).</div></div><div><h3>Results</h3><div>The average age of the 129 participants was 10.50 ± 1.42 years. The MAF and BAF values obtained using automated flipper were significantly correlated with those from the manual flipper (correlation coefficients of 0.819 and 0.813, respectively, both <em>P</em> &lt; 0.001). The mean MAF and BAF measured with the automated flipper were 9.30 ± 2.30 cpm and 9.13 ± 2.34 cpm, respectively, significantly higher than the manual flipper's measurements (8.53 ± 2.16 cpm and 8.33 ± 2.22 cpm, respectively), even after adjusting for the learning effect associated with multiple measurements using analysis of variance for crossover design. The area under the curve for the automated flipper in diagnosing inadequate MAF and BAF was 0.911 (cutoff value = 9 cpm, sensitivity = 71.11%, specificity = 97.44%) and 0.920 (cutoff value = 7 cpm, sensitivity = 85.34%, specificity = 84.62%), respectively.</div></div><div><h3>Conclusions</h3><div>The automated flipper showed a strong correlation with the manual flipper, and demonstrated satisfactory sensitivity and specificity in diagnosing inadequate AF. It is recommended that the Bluetooth-based automated flipper be adopted as a novel tool to enhance the accuracy of AF testing in children.</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 100750"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715337","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":"Comparison of Deep Learning and Clinician Performance for Detecting Referable Glaucoma from Fundus Photographs in a Safety Net Population","authors":"Van Nguyen MD ,&nbsp;Sreenidhi Iyengar ,&nbsp;Haroon Rasheed MD ,&nbsp;Galo Apolo ,&nbsp;Zhiwei Li ,&nbsp;Aniket Kumar ,&nbsp;Hong Nguyen ,&nbsp;Austin Bohner MD ,&nbsp;Kyle Bolo MD ,&nbsp;Rahul Dhodapkar MD ,&nbsp;Jiun Do MD, PhD ,&nbsp;Andrew T. Duong MD ,&nbsp;Jeffrey Gluckstein MD ,&nbsp;Kendra Hong MD ,&nbsp;Lucas L. Humayun ,&nbsp;Alanna James MD ,&nbsp;Junhui Lee MD ,&nbsp;Kent Nguyen OD ,&nbsp;Brandon J. Wong MD ,&nbsp;Jose-Luis Ambite PhD ,&nbsp;Benjamin Y. Xu MD, PhD","doi":"10.1016/j.xops.2025.100751","DOIUrl":"10.1016/j.xops.2025.100751","url":null,"abstract":"<div><h3>Purpose</h3><div>Develop and test a deep learning (DL) algorithm for detecting referable glaucoma.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>A total of 6116 patients from the Los Angeles County (LAC) Department of Health Services (DHS) were included.</div></div><div><h3>Methods</h3><div>Fundus photographs and patient-level labels of referable glaucoma (cup-to-disc ratio ≥0.6) provided by 21 certified optometrists. A DL algorithm based on the Visual Geometry Group-19 architecture was trained using patient-level labels generalized to images from both eyes. Area under the receiver operating curve (AUROC), sensitivity, and specificity were calculated to assess algorithm performance using an independent test set that was also graded by 13 clinicians with 0 to 10 years of experience. Algorithm performance was tested using reference labels provided by either LAC DHS optometrists or an expert panel of 3 glaucoma specialists.</div></div><div><h3>Main Outcome Measures</h3><div>Area under the receiver operating curve, sensitivity, and specificity.</div></div><div><h3>Results</h3><div>The DL algorithm was trained using 12 998 images from 5616 patients (2086 referable glaucoma, 3530 nonglaucoma). In this data set, the mean age was 56.8 ± 10.5 years with 54.8% women, 68.2% Latinos, 8.9% Blacks, 6.0% Asians, and 2.7% Whites. One thousand images from 500 patients (250 referable glaucoma, 250 nonglaucoma) with similar demographics (<em>P</em> ≥ 0.57) were used to test the algorithm. Algorithm performance matched or exceeded that of all independent clinician graders in detecting patient-level referable glaucoma based on LAC DHS optometrist (AUROC = 0.92) or expert panel (AUROC = 0.93) reference labels. Clinician grader sensitivity (range, 0.33–0.99) and specificity (range, 0.68–0.98) ranged widely and did not correlate with years of experience (<em>P</em>≥ 0.49). Algorithm performance (AUROC = 0.93) also matched or exceeded the sensitivity (range, 0.78–1.00) and specificity (range, 0.32–0.87) of 6 certified LAC DHS optometrists in the subsets of the test data set they graded.</div></div><div><h3>Conclusions</h3><div>A DL algorithm for detecting referable glaucoma trained using patient-level data provided by certified LAC DHS optometrists approximates or exceeds performance by ophthalmologists and optometrists, who exhibit variable sensitivity and specificity unrelated to experience level. Implementation of this algorithm in screening workflows could help reallocate resources and provide more reproducible and timely glaucoma care.</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 100751"},"PeriodicalIF":3.2,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143746266","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":"Can OpenAI's New o1 Model Outperform Its Predecessors in Common Eye Care Queries?","authors":"Krithi Pushpanathan MSc ,&nbsp;Minjie Zou MMed ,&nbsp;Sahana Srinivasan BEng ,&nbsp;Wendy Meihua Wong MMed ,&nbsp;Erlangga Ariadarma Mangunkusumo MD ,&nbsp;George Naveen Thomas MMed ,&nbsp;Yien Lai MMed ,&nbsp;Chen-Hsin Sun MD ,&nbsp;Janice Sing Harn Lam MMed ,&nbsp;Marcus Chun Jin Tan MMed ,&nbsp;Hazel Anne Hui'En Lin MMed ,&nbsp;Weizhi Ma PhD ,&nbsp;Victor Teck Chang Koh MMed ,&nbsp;David Ziyou Chen MMed ,&nbsp;Yih-Chung Tham PhD","doi":"10.1016/j.xops.2025.100745","DOIUrl":"10.1016/j.xops.2025.100745","url":null,"abstract":"<div><h3>Objective</h3><div>The newly launched OpenAI o1 is said to offer improved reasoning, potentially providing higher quality responses to eye care queries. However, its performance remains unassessed. We evaluated the performance of o1, ChatGPT-4o, and ChatGPT-4 in addressing ophthalmic-related queries, focusing on correctness, completeness, and readability.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects</h3><div>Sixteen queries, previously identified as suboptimally responded to by ChatGPT-4 from prior studies, were used, covering 3 subtopics: myopia (6 questions), ocular symptoms (4 questions), and retinal conditions (6 questions).</div></div><div><h3>Methods</h3><div>For each subtopic, 3 attending-level ophthalmologists, masked to the model sources, evaluated the responses based on correctness, completeness, and readability (on a 5-point scale for each metric).</div></div><div><h3>Main Outcome Measures</h3><div>Mean summed scores of each model for correctness, completeness, and readability, rated on a 5-point scale (maximum score: 15).</div></div><div><h3>Results</h3><div>O1 scored highest in correctness (12.6) and readability (14.2), outperforming ChatGPT-4, which scored 10.3 (<em>P</em> = 0.010) and 12.4 (<em>P</em> &lt; 0.001), respectively. No significant difference was found between o1 and ChatGPT-4o. When stratified by subtopics, o1 consistently demonstrated superior correctness and readability. In completeness, ChatGPT-4o achieved the highest score of 12.4, followed by o1 (10.8), though the difference was not statistically significant. o1 showed notable limitations in completeness for ocular symptom queries, scoring 5.5 out of 15.</div></div><div><h3>Conclusions</h3><div>While o1 is marketed as offering improved reasoning capabilities, its performance in addressing eye care queries does not significantly differ from its predecessor, ChatGPT-4o. Nevertheless, it surpasses ChatGPT-4, particularly in correctness and readability.</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 100745"},"PeriodicalIF":3.2,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826111","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":"Real-World Evidence for Faricimab in Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema: A Scoping Review","authors":"Varun Chaudhary MD, MSc ,&nbsp;Robyn Guymer MBBS, PhD ,&nbsp;Audrey Artignan MPhil ,&nbsp;Amanda Downey PhD, MBA ,&nbsp;Rishi P. Singh MD","doi":"10.1016/j.xops.2025.100744","DOIUrl":"10.1016/j.xops.2025.100744","url":null,"abstract":"<div><h3>Purpose</h3><div>Since faricimab (Vabysmo) was approved for the treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME), a growing body of real-world data has been reported, forming an important source of evidence for faricimab in a heterogeneous population. Scoping reviews are an effective approach to comprehensively assess the state of evidence on areas yet to be well characterized, allowing for the inclusion of a wide range of study designs and methodologies. This scoping review aimed to assess the current breadth and nature of real-world evidence (RWE) for faricimab and describe its safety and effectiveness in routine clinical practice.</div></div><div><h3>Design</h3><div>Scoping review of published articles and grey literature.</div></div><div><h3>Participants</h3><div>Eligible records included primary research reporting on any real-world data from ≥5 participants treated with faricimab in its licensed indications, published in English since 2022. This review did not involve novel data collection in human participants.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched on February 16, 2024, and the results were reviewed by 2 independent reviewers. Manual searches of proceedings from major relevant conferences, ClinicalTrials.gov, and bibliographies of relevant systematic literature reviews were also conducted. Findings were summarized descriptively.</div></div><div><h3>Main Outcome Measures</h3><div>Data of interest included study design, population characteristics, treatment history, visual function and anatomic outcomes, patient-reported outcomes, safety, and economic outcomes.</div></div><div><h3>Results</h3><div>A total of 63 studies reporting RWE for faricimab in patients with nAMD or DME (n = 6–12 119 eyes) were identified, including a majority of studies in previously treated patients. Studies spanned 10 countries, with a predominance of retrospective observational studies. Results across the majority of studies suggested that faricimab was associated with improved visual acuity, reduced central choroidal/subfield macular thickness, and reduced/resolved retinal fluid and pigment epithelial detachment in both conditions, even over longer study periods (≥6 months). Adverse events reported were similar to the findings within the registration trials.</div></div><div><h3>Conclusions</h3><div>Outcomes of faricimab in routine practice align with reports from clinical trials, supporting the effectiveness and safety of faricimab in heterogeneous populations. Further high-quality studies using prospective, multicenter designs are required to provide a more comprehensive understanding of the long-term outcomes associated with faricimab.</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 100744"},"PeriodicalIF":3.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768991","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":"Reading Performances in Highly Myopic Patients and Correlation with the Topography of Atrophic Maculopathy","authors":"Matteo Mario Carlà MD ,&nbsp;Carlos Mateo MD","doi":"10.1016/j.xops.2025.100743","DOIUrl":"10.1016/j.xops.2025.100743","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate how the topography of atrophic patches influences monocular and binocular reading performances in eyes with pathologic myopia.</div></div><div><h3>Design</h3><div>Prospective single-center observational investigation.</div></div><div><h3>Participants</h3><div>Sixty-two patients (112 eyes) affected by pathologic myopia (axial length [AXL] &gt;26.5 mm). Only college graduates aged &lt;65 years were selected.</div></div><div><h3>Methods</h3><div>All patients underwent monocular and binocular reading evaluation using Colenbrander Reading Charts, taking into account the reading time and missed words/errors. Moreover, eyes underwent fundus photography and autofluorescence: the presence of chorioretinal atrophy within the central, 4 inner, and 4 outer ETDRS grid subfields was reviewed.</div></div><div><h3>Main Outcome Measures</h3><div>Reading acuity (logarithm of the reading acuity determination [logRAD]); reading speed (words per minute [wpm]); percentage of errors/missed word; correlation with ETDRS subfield atrophy localization.</div></div><div><h3>Results</h3><div>Mean AXL was 31.45 ± 2.21 mm. Monocularly, mean reading acuity was 0.37 ± 0.35 logRAD with an 8% ± 11% rate of missed or wrong words, whereas reading speed was 71.5 ± 27.8 wpm (range 25–125 wpm). Binocularly, mean reading acuity was 0.16 ± 0.16 logRAD with 5% ± 7% of missed or wrong words, whereas reading speed was 88.2 ± 18.0 wpm. Reading acuity was significantly associated with the presence of chorioretinal atrophy in the foveal central circle in univariate and multivariate analysis (<em>P</em> = 0.002). Conversely, reading speed negatively correlated with inner right subfield involvement in multivariate analysis (<em>P</em> = 0.008). Binocularly, reading acuity was associated with the presence of bilateral central atrophy (<em>P</em> = 0.001), whereas reading speed was associated with the presence of chorioretinal atrophy in the inner subfields on the horizontal plane in both eyes: bilateral inner right (<em>P</em> = 0.007) or inner left (<em>P</em> = 0.014) subfields; inner left OD (right eye)–inner right OS (left eye) (<em>P</em> = 0.002); inner right OD–inner left OS (<em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>In highly myopic eyes, we reported a significant relationship between the topography of patchy chorioretinal atrophy and reading performance.</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 100743"},"PeriodicalIF":3.2,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681444","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":"Bidirectional Causal Relationships between Corneal Biomechanics and Glaucoma or Intraocular Pressure","authors":"Xiaoyu Zhou MD ,&nbsp;Jiahao Xu MD ,&nbsp;Xuanchu Duan MD","doi":"10.1016/j.xops.2025.100742","DOIUrl":"10.1016/j.xops.2025.100742","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the bidirectional causal relationships between corneal biomechanics (corneal hysteresis [CH] and corneal resistance factor [CRF]) and glaucoma subtypes or intraocular pressure (IOP), and to evaluate the mediating role of IOP in these associations.</div></div><div><h3>Design</h3><div>Bidirectional univariable 2-sample Mendelian randomization (MR), multivariable MR, and mediation MR study using genome-wide association study (GWAS) summary statistics.</div></div><div><h3>Subjects</h3><div>Genetic data from large-scale GWAS cohorts of European ancestry, including individuals with measurements of CH/CRF, glaucoma subtypes (primary open-angle glaucoma [POAG], primary angle-closure glaucoma [PACG], normal-tension glaucoma [NTG], exfoliation glaucoma [XFG], juvenile open-angle glaucoma [JOAG], glaucoma suspect, neovascular glaucoma, secondary glaucoma, and other unspecified glaucoma), and glaucoma endophenotypes (IOP, retinal nerve fiber layer thickness, vertical cup-to-disc ratio).</div></div><div><h3>Methods</h3><div>Bidirectional univariable 2-sample MR analyses were performed to assess the causal effects between CH/CRF and glaucoma subtypes. Multivariable MR and mediation analysis were used to evaluate the role of IOP. Inverse-variance weighted, weighted median, MR-Egger regression, and MR-Pleiotropy RESidual Sum and Outlier were used to evaluate the causal effects, pleiotropy, and heterogeneity.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcomes included causal estimates (odds ratios or β-coefficients) for the associations between CH/CRF and glaucoma subtypes (POAG, PACG, NTG, XFG, JOAG, neovascular glaucoma, etc.) and the mediation effects of IOP. Secondary outcomes included relationships between glaucoma medication or surgery and CH/CRF.</div></div><div><h3>Results</h3><div>Corneal hysteresis and CRF were causally associated with increased risks of total glaucoma and most subtypes, except for the protective effect of CH against neovascular glaucoma. Both CH and CRF elevated IOP. Adjusting for IOP attenuated CH/CRF-glaucoma associations. Glaucoma inversely affected CH but positively influenced CRF. Glaucoma surgery reduced CH and CRF.</div></div><div><h3>Conclusions</h3><div>This study suggests that CH and CRF are risk factors for glaucoma and its subtypes, with IOP playing a mediating role in this relationship. These findings highlight the role of corneal biomechanics in glaucoma pathophysiology and clinical management.</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 100742"},"PeriodicalIF":3.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681874","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":"Potential Efficacy of Metformin for Age-Related Macular Degeneration: A Systematic Review and Meta-Analysis","authors":"Matthew D. Huh BA ,&nbsp;Simon N. Le BA ,&nbsp;Kieran S. O'Brien PhD, MPH ,&nbsp;Jeremy D. Keenan MD, MPH ,&nbsp;Jay M. Stewart MD","doi":"10.1016/j.xops.2025.100741","DOIUrl":"10.1016/j.xops.2025.100741","url":null,"abstract":"<div><h3>Topic</h3><div>Metformin, a widely used diabetes medication, has shown potential for treating age-related macular degeneration (AMD) due to its antioxidative, anti-inflammatory, and antiangiogenic properties. This study aims to systematically review and analyze the efficacy of metformin in reducing AMD prevalence.</div></div><div><h3>Clinical Relevance</h3><div>Metformin's potential to serve as a treatment for AMD could significantly reduce the burden of vision loss, offering a cost-effective and widely accessible solution.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in OVID Embase, OVID MEDLINE, Cochrane Library, and Web of Science databases on May 2, 2024. Both observational and interventional studies were included if they involved oral metformin use before AMD diagnosis. Data were extracted and analyzed using a random-effects model meta-analysis, with subgroup analyses based on study design, AMD subtype, sex, and metformin dosage.</div></div><div><h3>Results</h3><div>Eighteen observational studies were identified, which together included a total of 2 683 234 individuals. Nine studies had a case–control design, 7 were retrospective cohort studies, and 2 were cross-sectional studies. The meta-analysis revealed a significant reduction in the odds of AMD among metformin users (pooled odds ratio [OR] = 0.86, 95% confidence interval = 0.79–0.93, <em>P</em> = 0.0002, I² = 90%). The association was significant in both patients with diabetes (pooled OR = 0.89) and without diabetes (pooled OR = 0.70), although only 2 studies reported nondiabetic ORs. Dose–response analysis revealed significant protective effects at low doses. Sensitivity analysis indicated that the removal of an outlier study did not alter the overall effect. Bias analysis using the Risk of Bias in Nonrandomized Studies of Interventions tool revealed significant risks of bias, particularly due to confounding.</div></div><div><h3>Conclusion</h3><div>Although the current evidence suggests a potential protective role of metformin in AMD, all studies showing an effect of metformin have been observational and thus subject to bias. Randomized clinical trials are needed to determine the effectiveness of metformin for preventing the onset 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 100741"},"PeriodicalIF":3.2,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715338","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":"Diagnostic Performance of a Handheld Electroretinography Test for Glaucoma","authors":"Anika Kumar BA ,&nbsp;Nathan Sanchez MD ,&nbsp;Alan W. Kong MD ,&nbsp;Benjamin F. Arnold PhD, MPH ,&nbsp;Yvonne Ou MD","doi":"10.1016/j.xops.2025.100739","DOIUrl":"10.1016/j.xops.2025.100739","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the diagnostic performance of a sinusoidal flicker stimulus test at various frequencies using a handheld electroretinography (ERG) device in glaucoma versus control participants.</div></div><div><h3>Design</h3><div>A cross-sectional study conducted between June 2019 and October 2022 at the University of California, San Francisco.</div></div><div><h3>Participants</h3><div>Participants with glaucoma were recruited from glaucoma clinics if they had a diagnosis of open-angle glaucoma, as demonstrated by optic nerve damage or reproducible visual field defects. Control participants had normal optic nerves and intraocular pressures of ≤21 mmHg and were recruited from optometry clinics.</div></div><div><h3>Methods</h3><div>The RETeval device (LKC Technologies), a handheld ERG recording system, was used to administer a sinusoidal flicker stimulus modulated at 14 frequencies from 1 to 50 Hz, and the first harmonic frequency response amplitudes were collected. Logistic regression models with glaucoma diagnosis as the outcome were trained using data from 67% of participants; models were then tested on the remaining 33%.</div></div><div><h3>Main Outcome Measures</h3><div>Receiver operating characteristic curves demonstrating model performance on the testing set were generated, and area under the receiver operating characteristic curve (AUC) was calculated. The improved DeLong algorithm was used to compare diagnostic performance of the models and differences in performance in dilated versus nondilated eyes.</div></div><div><h3>Results</h3><div>The study included 117 eyes from 72 participants (18 control, 54 glaucoma; mean age [standard deviation {SD}] = 70.4 [12.2] years; 51.4% female). Among glaucomatous eyes, average (SD) mean deviation was −4.61 (5.55) decibels. In a model assessing the combined effects of amplitude responses across all frequencies, the AUC was 0.57 (95% confidence interval [CI]: 0.37–0.78). However, in a model focusing on frequencies of ≥30 Hz, where the OFF pathway may be more affected, the AUC improved to 0.81 (95% CI: 0.66–0.97). In this higher frequency model, sensitivity was 80% and specificity was 74% at the Youden J cutoff.</div></div><div><h3>Conclusions</h3><div>These findings provide evidence of the potential use of handheld ERG in diagnosing glaucoma by assessing retinal amplitude responses to sinusoidal flicker stimuli at frequencies between 30 and 50 Hz. This supports the hypothesis that the OFF pathway may be more vulnerable in glaucoma.</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 100739"},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681871","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":"OCT-Based Retinal Vasculature Analysis: Age, Sex, and Body Mass Index Associations in the Nagahama Study, a Large Japanese Cohort","authors":"Ran Xiang MD ,&nbsp;Yuki Muraoka MD, PhD ,&nbsp;Takahiro Kogo MD ,&nbsp;Yuki Mori MD, PhD ,&nbsp;Masahiro Miyake MD, PhD ,&nbsp;Yu Hidaka PhD ,&nbsp;Satoshi Morita PhD ,&nbsp;Yasuharu Tabara PhD ,&nbsp;Fumihiko Matsuda PhD ,&nbsp;Akitaka Tsujikawa MD, PhD","doi":"10.1016/j.xops.2025.100740","DOIUrl":"10.1016/j.xops.2025.100740","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate retinal vessel structure using OCT, which enables high-resolution imaging for detailed vascular assessment. We investigated how age, sex, and body mass index (BMI) influence the OCT-measured parameters, including outer and inner diameters (ODs and IDs, respectively), wall thickness, and wall reflectivity—parameters that are challenging to assess using color fundus photography.</div></div><div><h3>Design</h3><div>A cross-sectional retrospective study.</div></div><div><h3>Participants</h3><div>The study included 6981 participants in the Nagahama Study, with 6981 eyes being assessed.</div></div><div><h3>Methods</h3><div>OCT B-scan images centered on the optic disc were obtained. For each participant, mean values of the ODs and IDs, wall thickness, and wall reflectivity of the 4 largest arteries and veins were measured.</div></div><div><h3>Main Outcome Measures</h3><div>Associations of retinal vessel parameters with age, sex, and BMI were evaluated. The reliability of OCT-measured parameters was assessed using intraclass correlation coefficients. Multivariable linear regression adjusted for intraocular pressure and axial length was used to investigate the associations with demographic and anthropometric factors.</div></div><div><h3>Results</h3><div>Intraclass correlation coefficients for retinal vessel parameters demonstrated good-to-excellent reliability (0.767–0.957, <em>P</em> &lt; 0.001). Compared with those of veins, arterial diameters were smaller, and arterial wall thickness and reflectivity were greater. Multivariable analysis revealed a U-shaped association between age and arterial diameter. Participants aged ≥60 years had significantly larger diameters than those aged 30 to 40 years and those in their 50s. Venous diameter decreased linearly with age. The arterial wall thickness and reflectivity increased with age. Women exhibited larger arterial diameters than men. Body mass index was negatively associated with the arterial diameter and positively associated with the venous diameter and arterial wall thickness.</div></div><div><h3>Conclusions</h3><div>OCT enabled detailed evaluation of retinal vessel structure, allowing for the measurement of parameters that are challenging to assess by fundus photography, such as IDs and ODs, wall thickness, and wall reflectivity. This study, conducted in a large Japanese cohort, demonstrated significant associations between these OCT-measured retinal vascular parameters and age, sex, and BMI. These findings support the potential of OCT as a valuable tool for objective, in-depth assessment of retinal vascular health and its relationships with demographic and anthropometric factors.</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 100740"},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681868","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":"Corneal Biomechanics as a Causal Factor in Myopia and Astigmatism: Evidence from Mendelian Randomization","authors":"Pinghui Wei PhD ,&nbsp;Guoge Han PhD ,&nbsp;Qi Su MBBS ,&nbsp;Lanbo Jia MBBS ,&nbsp;Chao Xue PhD ,&nbsp;Yan Wang PhD","doi":"10.1016/j.xops.2025.100738","DOIUrl":"10.1016/j.xops.2025.100738","url":null,"abstract":"<div><h3>Purpose</h3><div>The causal relationship between refractive errors and corneal biomechanical properties remains uncertain. This study aimed to clarify this relationship using Mendelian randomization (MR), offering new insights into the prevention and treatment of refractive errors.</div></div><div><h3>Design</h3><div>A bidirectional, 2-sample MR analysis.</div></div><div><h3>Participants</h3><div>Corneal biomechanical data were obtained from 97 653 European participants in the UK Biobank, whereas refractive error data were sourced from the UK Biobank and FinnGen consortia.</div></div><div><h3>Methods</h3><div>The exposures in this study were identified as corneal biomechanical parameters, specifically corneal hysteresis (CH) and the corneal resistance factor (CRF). The outcomes were defined as refractive errors, including myopia, hyperopia, and astigmatism, along with refractive power, encompassing both spherical and cylindrical power. A meta-analysis was performed to combine the MR estimates from both UK Biobank and FinnGen consortia, with heterogeneity assessed using the Q test and I² statistics. Additionally, a reverse MR analysis was conducted to examine the potential causal effect of the refractive status on corneal biomechanics.</div></div><div><h3>Main Outcome Measures</h3><div>Corneal hysteresis and CRF as causal factors in myopia and astigmatism.</div></div><div><h3>Results</h3><div>Data from UK Biobank revealed that CH and CRF were protective against the development of myopia (CH: odds ratio (OR) = 0.9936, <em>P</em> = 7.79 × 10⁻⁴; CRF: OR = 0.9946, <em>P</em> = 2.41 × 10⁻³) and astigmatism (CH: OR = 0.9975, <em>P</em> = 0.02; CRF: OR = 0.9977, <em>P</em> = 0.017). Conversely, increased corneal-compensated intraocular pressure was a risk factor for myopia development (OR = 1.0091, <em>P</em> = 2.07 × 10⁻²). The meta-analysis, which combined data from both sources, supported a causal relationship between CH and CRF and the development of myopia, although no significant causal link was found for hyperopia. Reverse MR analysis demonstrated a causal effect of spherical power on CH (OR = 1.0664, <em>P</em> = 4.32 × 10⁻⁵).</div></div><div><h3>Conclusions</h3><div>Corneal biomechanical parameters, particularly CH and CRF, may serve as early biomarkers for predicting myopia. This protective role supports their use in clinical screening to enhance early intervention strategies. Corneal-compensated intraocular pressure is a risk factor for myopia and represents a novel therapeutic target. Future research should clarify the underlying mechanisms and assess biomechanical interventions, potentially transforming refractive error management and reducing visual impairment.</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 5","pages":"Article 100738"},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143907486","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}