American Journal of Ophthalmology最新文献

{"title":"Systemic and Metabolic Profile of Sagging Eye Syndrome: A Comparative Analysis","authors":"Veronika Yehezkeli ,&nbsp;Janice J. Kim ,&nbsp;Federico G. Velez ,&nbsp;Joseph L. Demer ,&nbsp;Stacy L. Pineles","doi":"10.1016/j.ajo.2025.11.040","DOIUrl":"10.1016/j.ajo.2025.11.040","url":null,"abstract":"<div><h3>Purpose</h3><div>Sagging eye syndrome (SES) is an acquired strabismus characterized by distance esotropia (ET) and cyclo-vertical deviation, affecting older people. This study identified demographic, systemic, and ocular factors associated with SES and compared them to other forms of ET in older adults.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Methods</h3><div>Demographic data, systemic comorbidities, ocular history, and strabismus were reviewed in esotropic patients at least 55 years old diagnosed with SES between 2013 and 2024 at a single institution, and compared with age-matched controls diagnosed with other forms of ET.</div></div><div><h3>Results</h3><div>A total of 383 patients were studied, of whom 67 had SES, and 316 had ET without SES ET. Male SES patients were significantly older at 81.5 ± 10 years (standard deviation) than esotropic males without SES at 76 ± 10 years (<em>P</em> = .04), and symptom onset was significantly older for SES in both genders (male: 72 ± 10 years vs 68 ± 11 years, <em>P</em> = .02; female: 75 ± 9 years vs 69 ± 9 years, <em>P</em> = .04). Women with SES had significantly lower mean body mass index (BMI) at 23 ± 4 than esotropic women without SES at 25 ± 5 (<em>P</em> = .02). Logistic regression demonstrated that lower BMI was associated with higher odds of SES in women, with the odds of SES increasing by approximately 9.4% for each 1-unit decrease in BMI (odds ratios = 0.91, 95% confidence intervals [CI]: 0.84-0.99). Osteopenia was more prevalent at 77% among esotropic women with SES than women without osteopenia at 51% (<em>P</em> = .003), and remained an independent risk factor for SES after adjusting for age (odds ratios = 1.81, 95% CI: 1.02-3.23, <em>P</em> = .04) and BMI (95% CI, 1.14-6.18; <em>P</em> = .02). There were no significant differential associations with SES for gender, smoking, alcohol use, hypertension, hyperlipidemia, type 2 diabetes, cataract surgery, glaucoma, or use of progressive addition spectacles.</div></div><div><h3>Conclusions</h3><div>SES is associated with advanced age at symptom onset in both genders and with lower BMI and osteopenia in women.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 1-6"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gonioscopy Assisted Transluminal Trabeculotomy (GATT) as a viable intervention for Neovascular Glaucoma","authors":"Avilasha Mohapatra,&nbsp;Vyshak Suresh,&nbsp;Sushmita Kaushik","doi":"10.1016/j.ajo.2025.12.016","DOIUrl":"10.1016/j.ajo.2025.12.016","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages e1-e2"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choroidal Macrovessel Complicated by Choroidal Neovascularisation","authors":"Giuseppe Maria ALBANESE ,&nbsp;Georges CAPUTO ,&nbsp;Youssef ABDELMASSIH","doi":"10.1016/j.ajo.2025.12.033","DOIUrl":"10.1016/j.ajo.2025.12.033","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages e3-e4"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide is Associated With Reduced Risk of Primary Open-Angle Glaucoma and Ocular Hypertension in Patients With Type 2 Diabetes","authors":"Alexander T. Hong ,&nbsp;Forest Lin ,&nbsp;Sally Baxter ,&nbsp;Robert N. Weinreb","doi":"10.1016/j.ajo.2025.12.003","DOIUrl":"10.1016/j.ajo.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has shown superior efficacy in glycemic control, weight loss, and cardiometabolic outcomes compared to GLP-1 RAs alone. While GLP-1 RAs may offer neuroprotective effects relevant to glaucoma, the impact of dual-incretin therapies like tirzepatide on glaucoma remains unknown. This study investigates the association between tirzepatide initiation and the risk of primary open-angle glaucoma (POAG), ocular hypertension (OHTN), and glaucoma treatment initiation in patients with type 2 diabetes mellitus (T2DM), compared to those initiating selective GLP-1 RAs.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study using a nationwide electronic health records network from June 2022 to May 2025.</div></div><div><h3>Subjects</h3><div>Adults with T2DM who initiated tirzepatide or selective GLP-1 RA therapy. Patients with prior exposure to either drug class, recent addition of second-line antihyperglycemic agents, previous glaucoma diagnosis or surgery, or ocular trauma were excluded.</div></div><div><h3>Methods</h3><div>Data from 71 U.S. healthcare organizations were analyzed. Propensity score matching (1:1) was conducted to balance cohorts for demographics, comorbidities, medication use, and ophthalmic encounters. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each outcome.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of POAG, OHTN, and first-line glaucoma treatments (medications or surgery).</div></div><div><h3>Results</h3><div>We identified 41,850 patients who initiated tirzepatide and 147,828 patients who initiated selective GLP-1 RAs. After matching, 41,849 patients remained in each cohort. Tirzepatide use was associated with a significantly lower risk of POAG (RR 0.50, 95% CI 0.34-0.74), OHTN (RR 0.59, 95% CI 0.40-0.88), and need for glaucoma treatment (RR 0.54, 95% CI 0.45-0.64) compared to selective GLP-1 RAs. Risk reductions persisted in subgroups with concomitant metformin or insulin use. Sensitivity analyses limited to patients aged ≥60 years and comparisons with individual GLP-1 RAs (semaglutide and dulaglutide) yielded consistent trends.</div></div><div><h3>Conclusions</h3><div>Tirzepatide use was associated with a significantly reduced risk of developing POAG, OHTN, and need for first-line glaucoma treatment compared to selective GLP-1 RAs in patients with T2DM. These findings suggest a potential additional ocular benefit of tirzepatide and support further investigation into its role in glaucoma management.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 120-128"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract Surgery with IOL Implantation in Children with Chronic Anterior Uveitis Associated with Juvenile Idiopathic Arthritis (JIA) or Antinuclear Antibody (ANA)-Positive Uveitis: Mid-term Results and Predictors for Outcome","authors":"CHARLOTTE WORTMANN ,&nbsp;JOHANNA BACKES ,&nbsp;KAI ROTHAUS ,&nbsp;MAREN KASPER ,&nbsp;THABO LAPP ,&nbsp;CARSTEN HEINZ ,&nbsp;ARND HEILIGENHAUS","doi":"10.1016/j.ajo.2025.11.043","DOIUrl":"10.1016/j.ajo.2025.11.043","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the clinical course and 2-year outcome after cataract surgery with implantation of intraocular lenses (IOL) in children with juvenile idiopathic arthritis (JIA)-associated uveitis or chronic antinuclear antibody (ANA)-positive uveitis.</div></div><div><h3>Design</h3><div>Retrospective interventional clinical study.</div></div><div><h3>Subjects</h3><div>Children with cataract surgery at ≤10 years of age.</div></div><div><h3>Methods</h3><div>Comprehensive uveitis-related data (defined by Standardization of Uveitis Nomenclature standards) were collected before, during and 6 weeks, 1 and 2 years after surgery. Surgical procedures involved small incision phacoemulsification, insertion of foldable acrylic IOLs with a sharp-edge design into the capsular bag, 25 G anterior vitrectomy, posterior capsulectomy, and intravitreal triamcinolone injection. Surgical technique was modified individually according to pre-existing uveitis-related morphological abnormalities.</div></div><div><h3>Main Outcome Measures</h3><div>Best-corrected visual acuity (BCVA) and postoperative complications.</div></div><div><h3>Results</h3><div>All 100 surgeries (81 patients, 100% ANA-positive, 69% female, 90.1% JIA, mean age at JIA diagnosis 4.26 ± 2.35 years) involved insidious-onset anterior uveitis (mean age at uveitis onset 4.6 ± 2.1 years). Surgery was performed at a mean age of 8.2 ± 3.3 years (SD 3.2), and under treatment with conventional synthetic disease-modifying anti-rheumatic drugs (DMARD; 90%), or 45% biologicals. Prior to surgery, uveitis-related complications were present alongside cataract in 99% of patients (eg. lens fibrotic membrane and pupil contraction). BCVA (logMAR) was 1.57 ± 1.24 before surgery, and was 0.32 ± 0.51 and 0.3 ± 0.53 at 1 and 2 years after surgery, respectively (each, <em>P</em> &lt; .001). Fibrin formation was present in 39.6% of cases on the first day after surgery. After 1 and 2 years of surgery, macular edema was present in 4.6% and 9.4%, and glaucomatous optic discs in 17.3% and 18.9%, respectively. Preoperative predictors of poor 2-year visual outcome included poor BCVA, high laser flare (LF) values, unilateral uveitis, and glaucoma medication. Preoperative predictors of 2-year postoperative ocular complications included band keratopathy and a lack of methotrexate or adalimumab use.</div></div><div><h3>Conclusions</h3><div>According to our observations, IOL implantation can be considered for children with JIA-associated or ANA-positive uveitis, on the condition that their uveitis is well controlled with DMARD therapy and the surgical technique is appropriate. The long-term course of the inflammatory disease determines the occurrence of intraocular complications related to inflammation and the visual outcome.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 45-54"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145657303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subretinal Fluid Duration and Clinical Outcomes in Central Serous Chorioretinopathy: An Analysis of Time-to-Photodynamic Therapy","authors":"Ryoh Funatsu,&nbsp;Naohisa Mihara,&nbsp;Shoki Miyake,&nbsp;Koki Okamura,&nbsp;Hiroki Imatsuji,&nbsp;Takato Sakono,&nbsp;Hideki Shiihara,&nbsp;Shozo Sonoda,&nbsp;Taiji Sakamoto,&nbsp;Hiroto Terasaki","doi":"10.1016/j.ajo.2025.11.039","DOIUrl":"10.1016/j.ajo.2025.11.039","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the effect of prolonged serous retinal detachment (SRD) during the waiting period for photodynamic therapy (PDT) on clinical outcomes in patients with central serous chorioretinopathy (CSC).</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Subjects</h3><div>Consecutive patients with CSC who underwent PDT between January 2016 and August 2024. Patients whose SRD resolved spontaneously while awaiting PDT were excluded.</div></div><div><h3>Methods</h3><div>We measured the best-corrected visual acuity (BCVA) and retinal layer thickness at baseline and on the day of PDT. We evaluated (1) the changes in these parameters during the waiting period and (2) the association between the duration of this period and the outcomes.</div></div><div><h3>Main Outcome Measures</h3><div>Associations of the time-to-PDT with 12-month BCVA, SRD remission at 12 months, and changes in retinal layer thickness during the waiting period.</div></div><div><h3>Results</h3><div>Ninety-four patients (94 eyes) with CSC were included, with a mean age of 57.6 ± 12.2 years, a mean BCVA of 0.18 ± 0.24 logMAR (Snellen: 20/30), and a mean waiting period of 50.8 ± 50.2 days. The outer nuclear layer thinned significantly during the waiting period (mean reduction = 1.9 ± 4.4 μm, <em>P</em> = 3.4 × 10⁻⁵), and longer waiting times were associated with greater thinning (crude: <em>β</em> = −0.04, <em>P</em> = 3.5 × 10⁻⁶; adjusted: <em>β</em> = −0.04, <em>P</em> = 1.3 × 10⁻⁶). However, waiting duration was not significantly associated with 12-month treatment outcomes.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that caution is warranted against prolonged subretinal fluid exposure beyond 1 to 2 months, as it may induce outer nuclear layer thinning.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 7-13"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145598807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capsular Tension Ring Use in High Myopic Eyes Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis","authors":"Yu-Min Chang ,&nbsp;Ke-Hung Chien ,&nbsp;Chi-Jung Wu","doi":"10.1016/j.ajo.2025.12.002","DOIUrl":"10.1016/j.ajo.2025.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of capsular tension ring (CTR) implantation on refractive outcomes, intraocular lens (IOL) stability, and postoperative complications in high myopic patients undergoing cataract surgery.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar through March 2025 identified studies comparing cataract surgery with and without CTR implantation in high myopic eyes. The primary outcome was prediction refractive error (PE). Secondary outcomes included absolute refractive error (AE), postoperative corrected distance visual acuity (CDVA), IOL decentration, anterior chamber depth (ACD), posterior capsular opacification (PCO), and Nd:YAG capsulotomy rates. Random-effects meta-analysis, sensitivity analysis, and meta-regression were performed.</div></div><div><h3>Results</h3><div>Nine studies (4 randomized controlled trials and 5 cohort studies; 846 eyes) were included. CTR implantation did not significantly affect PE (mean difference [MD], 0.00; 95% confidence interval [CI], −0.07 to 0.08; <em>P</em> = .93) or postoperative CDVA (MD, 0.00; 95% CI, −0.06 to 0.06; <em>P</em> = 1.00). However, CTR significantly reduced AE (MD, −0.12; 95% CI, −0.20 to −0.05; <em>P</em> = .001) and IOL decentration (MD, −0.04; 95% CI, −0.07 to −0.01; <em>P</em> = .004).No covariates significantly influenced PE in meta-regression.</div></div><div><h3>Conclusions</h3><div>CTR implantation appears to modestly improve refractive predictability and IOL stability in high myopic eyes without compromising postoperative visual acuity. However, given the limited evidence base and small effect sizes, these findings should be interpreted with caution. CTR implantation may be considered in selected myopic cases with suspected zonular weakness or large capsular bags where additional capsular stability is desired.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 109-119"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic Disc Flavoprotein Fluorescence Imaging as a Novel Method to Quantify Disease Burden in Optic Disc Drusen","authors":"Rishita Rama Pujari ,&nbsp;Miaomiao Yu ,&nbsp;Jamie Zhang ,&nbsp;Lorraine Almeda ,&nbsp;Sangeethabalasri Pugazhendhi ,&nbsp;Ping Zhu ,&nbsp;Collin Rich ,&nbsp;Heather E. Moss ,&nbsp;Shannon Beres ,&nbsp;Yaping Joyce Liao","doi":"10.1016/j.ajo.2025.11.018","DOIUrl":"10.1016/j.ajo.2025.11.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the ability of flavoprotein fluorescence (FPF) imaging to quantify disease burden in optic disc drusen (ODD).</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Participants</h3><div>One hundred and fifty-seven ODD eyes (94 participants, ages 7-89 years) and 69 control eyes (53 participants, ages 10-78 years).</div></div><div><h3>Methods</h3><div>Comprehensive examination, visual function testing, and multimodal ophthalmic imaging. Statistical analysis was performed using parametric and nonparametric tests, ANOVA, and Spearman correlation.</div></div><div><h3>Main Outcome Measures</h3><div>LogMAR, static perimetry mean deviation, optic disc and macular FPF, enhanced-depth imaging optical coherence tomography (EDI-OCT), OCT peripapillary retinal nerve fiber layer (pRNFL), and macular ganglion cell complex (mGCC) thickness.</div></div><div><h3>Results</h3><div>Optic disc FPF signal corresponded with superficial and buried drusen visualized on 97 EDI-OCT B-scans. Compared with controls, ODD eyes have significantly elevated disc FPF (<em>P</em> &lt; .0001) but no difference in macular FPF scores. Examination of age-related changes revealed stable disc FPF in controls over the first 7 decades of life. In contrast, ODD eyes exhibited elevated disc FPF within the first 2 decades of age, which increased over time and remained high after age 40. Sectoral analysis showed significantly elevated disc FPF in all quadrants in ODD compared with controls (<em>P</em> &lt; .001). ODD eyes with visual field loss (mean deviation (MD) &lt; –2 dB) had significantly higher disc FPF and lower pRNFL and mGCC thicknesses compared with ODD eyes without visual field loss (MD ≥ –2 dB) (<em>P</em> &lt; .001 for all). We found a nonlinear relationship between disc FPF and MD (RMSE = 4.4271, R² = 0.4504) and a negative correlation between disc FPF and pRNFL (<em>r</em> = –0.78) and mGCC thicknesses (<em>r</em> = –0.62). Disc FPF, pRNFL, and mGCC had high statistical power in segregating ODD eyes with and without visual field loss.</div></div><div><h3>Conclusions</h3><div>Disc FPF is an objective imaging technique to quantify disease burden in ODD, reflecting a combination of drusen autofluorescence signal and metabolic stress from axonopathy. Disc FPF is correlated with structural and functional changes and has high predictive power of visual field loss in ODD, supporting its use as an outcome measure in prospective natural history and treatment studies in ODD.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 14-25"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145553610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT-Assisted Glaucoma Diagnosis: A Health-Equitable Multi-Ancestry Analysis Using Visual Field and Optical Coherence Tomography Data","authors":"ANDY S. HUANG ,&nbsp;ANTHONY FAM ,&nbsp;HETINCE ZHAO ,&nbsp;NICOLE PAULESCU ,&nbsp;ANNA FABCZAK-KUBICKA ,&nbsp;JANEY L. WIGGS ,&nbsp;NAZLEE ZEBARDAST ,&nbsp;DAVID S. FRIEDMAN ,&nbsp;RON DO ,&nbsp;KANZA AZIZ ,&nbsp;JAE HEE KANG ,&nbsp;TOBIAS ELZE ,&nbsp;MENGYU WANG ,&nbsp;ALON HARRIS ,&nbsp;TAK YEE TANIA TAI ,&nbsp;JAMES C. TSAI ,&nbsp;LOUIS R. PASQUALE","doi":"10.1016/j.ajo.2025.11.046","DOIUrl":"10.1016/j.ajo.2025.11.046","url":null,"abstract":"<div><h3>Purpose</h3><div>Early glaucoma detection is challenging due to variable ocular anatomy, non-glaucomatous optic neuropathy impacting optical coherence tomography (OCT) results, and the subjective nature of visual field (VF) tests. Multimodal large language models may overcome these challenges to provide equitable and accurate screening diagnoses across ancestries and glaucoma genetic predispositions. We evaluated ChatGPT o1 Pro’s accuracy in identifying glaucoma using circumpapillary retinal nerve fiber layer (RNFL) OCT and VF data, and its consistency across ancestries and glaucoma polygenic risk scores (PRS).</div></div><div><h3>Design</h3><div>Cross-sectional diagnostic accuracy study.</div></div><div><h3>Settings and Participants</h3><div>We enrolled 204 participants from the Mount Sinai BioMe Biobank for a comprehensive ophthalmic examination from November 2022 to March 2025. This cross-sectional diagnostic accuracy study included 38% European (EUR) and 62% non-European (non-EUR) participants stratified by low/intermediate (<em>n</em> = 107) and high-risk glaucoma PRS (<em>n</em> = 97). Two glaucoma specialists masked to PRS status provided a consensus reference diagnosis. ChatGPT received only de-identified VFs and OCT-RNFL numerical outputs to determine glaucoma status. Performance metrics were compared with the reference diagnosis. Subgroup comparisons by ancestry (EUR versus non-EUR) and PRS (high versus low/intermediate) were conducted. We used logistic regression models to assess the impacts of ancestry, PRS and ocular parameters on classification accuracy.</div></div><div><h3>Main Outcome Measures</h3><div>ChatGPT o1 Pro’s diagnostic performance in detecting glaucoma compared to consensus specialist diagnoses, stratified by ancestry and genetic risk.</div></div><div><h3>Results</h3><div>ChatGPT o1 Pro exhibited 96.0% sensitivity (95% confidence interval (CI): 88.3%-100%), 83.7% specificity (95% CI: 78.3%-89.1%), 85.2% accuracy (95% CI: 80.3%-90.1%), an area under the receiver operator curve (AUC) of 0.899, a positive predictive value (PPV) of 45.3% (95% CI: 31.9%-58.7%), and a negative predictive value (NPV) of 99.3% (95% CI: 98.0%-100%); κ for agreement with the consensus reference was 0.538. No significant differences were observed between EUR and non-EUR subgroups (AUC: 0.894 vs 0.906, <em>P</em> = .79; accuracy: 88.3% vs 83.3%, <em>P</em> = .44) or high and low/intermediate-PRS subgroups (AUC: 0.889 vs 0.922, <em>P</em> = .45; accuracy: 85.4% vs 85.0%, <em>P</em> = .50). Global RNFL was the only determinant of reference disease classification (OR = 1.1 per micron, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>ChatGPT o1 Pro diagnosed glaucoma similarly to specialists using only VF and OCT data. The model performance was similar across ancestral groups and genetic predispositions to glaucoma.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 129-137"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Pigment Epithelium Disruption Lesions on Optical Coherence Tomography in Patients With Vitreoretinal Lymphoma","authors":"Wenwen Chen ,&nbsp;Tingting Jiang ,&nbsp;Junxiang Gu ,&nbsp;Shixue Liu ,&nbsp;Xinyi Zhou ,&nbsp;Qing Chang","doi":"10.1016/j.ajo.2025.11.044","DOIUrl":"10.1016/j.ajo.2025.11.044","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the imaging characteristics and clinical relevance of retinal pigment epithelium (RPE) disruption lesions observed on optical coherence tomography (OCT) of patients with biopsy-proven vitreoretinal lymphoma (VRL).</div></div><div><h3>Design</h3><div>Retrospective interventional case series.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with VRL at the Eye and ENT Hospital of Fudan University between July 2017 and June 2024.</div></div><div><h3>Methods</h3><div>The clinical characteristics, outcomes, and multimodal retinal imaging findings of the eligible VRL patients were collected and studied. RPE disruption lesions were defined as full-thickness RPE discontinuities on OCT and were categorized as major (&gt;300 µm) or minor (&lt;300 µm) based on OCT-measured width.</div></div><div><h3>Main Outcome Measures</h3><div>The associated features of RPE disruption lesions on OCT.</div></div><div><h3>Results</h3><div>Totally 158 eyes of 81 patients were included in the analysis. RPE disruption lesions were detected in 51 of 65 affected eyes of 36 patients. Most of the lesions (47/51 eyes) were detected at initial presentation or disease onset. On OCT scans, 17 eyes had major RPE disruption lesions, and 34 eyes only had minor disruption lesions. The RPE disruption lesions were colocalized with intraretinal or subretinal infiltration. Among the eyes with full-thickness intraretinal infiltration, 14 eyes (14/24) exhibited perivascular infiltration. Major RPE disruption lesions showed a stronger association with subretinal infiltration (<em>P</em> = .041), while minor disruptions demonstrated preferential correlation with intraretinal infiltration (<em>P</em> = .036). On fundus autofluorescence, the RPE disruption lesions sometimes manifest as characteristic hypo-autofluorescent spots accompanied by hyper-autofluorescent rings. Eyes with minor RPE disruption lesions showed a better visual outcome compared to those with major lesions (<em>P</em> = .013), with statistically significant improvement from baseline after treatment (<em>P</em> = .00017). The median recovery time for the RPE disruption lesions was 2.0 months (IQR 1.5-4.0 months). The accompanied retinal infiltration vanished with the recovery of RPE disruption lesions.</div></div><div><h3>Conclusions</h3><div>RPE disruption lesions represent frequently occurring yet underrecognized OCT findings in VRL. Notably, the lesions provide diagnostic clues for VRL identification and may reveal a potential migration pathway for lymphocytic infiltrates between sub-RPE and subretinal/intraretinal spaces.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 100-108"},"PeriodicalIF":4.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}