American Journal of Ophthalmology最新文献

{"title":"Comparative Analysis of Eighteen IOL Power Calculation Formulas Using a Modified Formula Performance Index Across Diverse Biometric Parameters","authors":"Shan Ma ,&nbsp;Cheng Li ,&nbsp;Jing Sun ,&nbsp;Jun Yang ,&nbsp;Kai Wen ,&nbsp;Xiteng Chen ,&nbsp;Fangyu Zhao ,&nbsp;Xuequan Sun ,&nbsp;Fang Tian","doi":"10.1016/j.ajo.2025.02.035","DOIUrl":"10.1016/j.ajo.2025.02.035","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To evaluate the predictive accuracy of 18 intraocular lens (IOL) power calculation formulas across diverse biometric parameters using a modified formula performance index (FPI) and prediction error (PE) variability metrics.</div></div><div><h3>DESIGN</h3><div>Prospective, comparative, accuracy, and reliability analysis of IOL power calculations.</div></div><div><h3>METHODS</h3><div>This study included 213 cataract patients who underwent phacoemulsification with SN60WF IOL implantation. Preoperative biometry was obtained using the IOLMaster 700. Eighteen IOL power calculation formulas, including Barrett TK, Barrett Universal II, Castrop, Cooke K6, EVO 2.0, Haigis, Hoffer Q, Hoffer QST, Holladay 1, Holladay 2, Kane, Karmona, Ladas Super Formula, Nallasamy, PEARL-DGS, RBF 3.0, SRK/T, and T2, were evaluated. Predictive accuracy was assessed using FPI and standard deviation (SD) for overall performance, while root mean square error (RMSE) and subgroup-specific FPI (FPI_sub) were used for biometric subgroup analysis. Additional metrics included mean absolute error, median absolute error, and the percentage of eyes within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D.</div></div><div><h3>RESULTS</h3><div>Cooke K6 achieved the highest FPI (0.724) and lowest SD (0.394), followed by PEARL-DGS (FPI = 0.714, SD = 0.399) and Barrett TK (FPI = 0.710, SD = 0.411). Barrett TK had the highest percentage of eyes within ±0.25 D (54.5%). Subgroup analysis revealed that PEARL-DGS exhibited the highest accuracy in short eyes (axial length ≤22 mm, FPI_sub = 0.838, RMSE = 0.271), while Haigis performed best in long eyes (axial length ≥26 mm, FPI_sub = 0.826, RMSE = 0.336) and steep corneas (<em>K</em> &gt; 46 D, FPI_sub = 0.765, RMSE = 0.350). Barrett TK ranked highest in medium-long eyes (24.5-26 mm, FPI_sub = 0.700, RMSE = 0.400) and flatter corneas (<em>K</em> &lt; 42 D, FPI_sub = 0.639, RMSE = 0.382). Cooke K6 was most accurate in shallow anterior chambers (anterior chamber depth ≤ 3.0 mm, FPI_sub = 0.737, RMSE = 0.383). Traditional formulas, including Hoffer Q, Holladay 1, and SRK/T, exhibited lower accuracy and higher PE variability.</div></div><div><h3>CONCLUSIONS</h3><div>Modern formulas, particularly Cooke K6, PEARL-DGS, and Barrett TK, demonstrated superior accuracy with lower PE variability than traditional formulas. Subgroup analysis highlighted the importance of biometric-driven formula selection to optimize refractive outcomes, providing a clinically reference for personalized IOL power selection.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 221-230"},"PeriodicalIF":4.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faricimab-Associated Intraocular Inflammation With Features of Herpes Simplex Virus","authors":"IMRAN KARIM JANMOHAMED ,&nbsp;MUHAMMED AIZAZ US SALAM ,&nbsp;OMER JAMALL ,&nbsp;MOHAMED ELGHARABLY ,&nbsp;NOHA GHOZ ,&nbsp;AISHWARYA AMARNATH ,&nbsp;KORINA THEODORAKI ,&nbsp;GONCALO ALMEIDA","doi":"10.1016/j.ajo.2025.02.033","DOIUrl":"10.1016/j.ajo.2025.02.033","url":null,"abstract":"<div><h3>Objective</h3><div>Faricimab-associated intraocular inflammation (IOI) is an emerging concern. We aimed to investigate clinical features, management, and outcomes of severe IOI following faricimab therapy, with particular attention to cases displaying features consistent with herpes simplex virus (HSV) involvement.</div></div><div><h3>Design</h3><div>Single-center retrospective interventional case series.</div></div><div><h3>Subjects</h3><div>Five patients (5 eyes) who developed severe IOI following intravitreal faricimab injection for neovascular age-related macular degeneration (nAMD, <em>n</em> = 4) or diabetic macular edema (DME, <em>n</em> = 1) between June 2023 and October 2024. The nAMD patients had received a mean of 17.75 ± 9.18 prior anti-VEGF injections (range 6-26 injections). The DME patient had previously received 7 aflibercept injections and 2 dexamethasone implants. Prior to faricimab, 3 patients were being treated with aflibercept and 2 with ranibizumab biosimilar.</div></div><div><h3>Methods</h3><div>Medical records were reviewed for clinical features, treatment approaches, and outcomes. Cases were identified through systematic review of follow-up appointments and urgent care presentations. When clinically indicated, additional investigations including optical coherence tomography and fluorescein angiography were performed.</div></div><div><h3>Main Outcome Measures</h3><div>Best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber (AC) inflammation, presence of keratic precipitates (KPs), vitreous cells, signs of viral reactivation, and treatment response.</div></div><div><h3>Results</h3><div>The median number of faricimab injections before inflammation was 5 (range 3-13). Mean interval between injection and symptom onset was 16.8 days (range 1-35). All patients presented with AC inflammation and elevated IOP (mean 32.8 ± 4.15 mmHg, range 28-38 mmHg). All patients demonstrated features consistent with HSV keratouveitis, including dendritic ulcers, reduced corneal sensation, and granulomatous KPs. Treatment included topical or systemic steroids in all cases, with 4 patients (80%) receiving concurrent antiviral therapy. Median time to inflammation resolution was 15.5 days. Four patients (80%) did not recover baseline vision.</div></div><div><h3>Conclusions</h3><div>This case series identifies a previously unreported association between faricimab-associated IOI and features of viral reactivation. The temporal relationship including onset patterns suggestive of delayed hypersensitivity, alongside consistent HSV features and favourable antiviral response, suggests a possible mechanism linked to VEGF-A and Ang-2 mediated alterations in ocular immune surveillance. While further investigation is needed to establish causality, clinicians should consider viral mechanisms when evaluating and treating these cases.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 212-220"},"PeriodicalIF":4.1,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522447","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":"Underlying Disease in Atypical Retinopathy of Prematurity","authors":"NATASHA F.S. DA CRUZ ,&nbsp;JULIA L. HUDSON ,&nbsp;JESSE D. SENGILLO ,&nbsp;SERENA M. SHAH ,&nbsp;FRANCISCO LOPEZ-FONT ,&nbsp;CATHERIN I. NEGRON ,&nbsp;MICHEL E. FARAH ,&nbsp;AUDINA M. BERROCAL","doi":"10.1016/j.ajo.2025.02.026","DOIUrl":"10.1016/j.ajo.2025.02.026","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Retinopathy of prematurity (ROP), familial exudative vitreoretinopathy (FEVR), and telomere biology disorders (TBD) are classified as distinct diseases. However, emerging genetic research and evidence on multimodal imaging suggest a spectrum along which ROP may overlap with FEVR or TBD.</div></div><div><h3>Design</h3><div>Retrospective case series.</div></div><div><h3>Methods</h3><div>This was an institutional review board-approved, retrospective study. A literature review was performed, and medical records of all patients with phenotypic ROP evaluated by the pediatric retina service at Bascom Palmer Eye Institute from March 1, 2019 to July 30, 2023 were analyzed.</div></div><div><h3>Results</h3><div>Eighteen patients with phenotypic and genetically confirmed FEVR or TBD were identified. Of these, the initial diagnosis was ROP with preterm gestational age (<em>n</em> = 11, 57.9%) or ROP at moderate to late preterm gestational age (<em>n</em> = 8, 42.1%). Final diagnosis for 15 patients (78.9%) was FEVR, and final diagnosis for 4 patients (21.1%) was TBD. The most common genetic variants in the FEVR group were identified in the genes <em>LRP5</em> (<em>n</em> = 5, 33.3%) and <em>FZD4</em> (<em>n</em> = 3, 20%), and in the TBD group, <em>CTC1</em> (<em>n</em> = 3; 75%). The mean age at diagnosis was 5.7 years old (range 0.3-36.7 years).</div></div><div><h3>Conclusions</h3><div>The authors reinforce the classification of ROPER (ROP and FEVR) and introduce the term, ROPMERE (ROP and TBD), to classify these patients in a way that reflects their clinical presentation and underlying genetic diagnosis. Identification of this subset of patients will allow for sustained surveillance of infants with these diseases.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 67-75"},"PeriodicalIF":4.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514389","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":"Comparative Accuracy Of Five Modern Toric Intraocular Lens Formulas","authors":"SOONWON YANG,&nbsp;HYOJI HAN,&nbsp;HYUN SOO LEE","doi":"10.1016/j.ajo.2025.02.028","DOIUrl":"10.1016/j.ajo.2025.02.028","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the clinical accuracy of 5 modern toric intraocular lens (IOL) calculation formulas—Barrett, EVO, Naeser/Savini combined with Hoffer QST, Kane, and Abulafia-Koch combined with Hill RBF—in predicting postoperative refractive outcomes in cataract patients with astigmatism.</div></div><div><h3>Design</h3><div>Retrospective, comparative analysis of IOL formula accuracy.</div></div><div><h3>Subjects</h3><div>One hundred forty-six eyes from 146 cataract patients with toric IOL implantation.</div></div><div><h3>Methods</h3><div>Biometric measurements were obtained using the Lenstar LS900, with personalized surgically induced astigmatism values applied for each surgeon. Postoperative outcomes, including mean absolute prediction error (MAE), centroid error, and the proportion of eyes within a prediction error of ±0.50 D and ±0.75 D, were evaluated. Subgroup analyses were performed for with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. Statistical significance was assessed using non-parametric and multivariate tests.</div></div><div><h3>Setting</h3><div>Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea.</div></div><div><h3>Results</h3><div>No significant differences in MAE were observed among the formulas in the overall cohort (<em>P</em> &gt; .05). The proportion of eyes with a prediction error ≤ ±0.50 D was highest for EVO (71.92%), followed by Kane and Abulafia-Koch with Hill RBF (70.55%), Naeser/Savini with Hoffer QST (69.18%), and Barrett (67.12%). Among ATR cases, EVO, Abulafia-Koch with Hill RBF, and Naeser/Savini with Hoffer QST demonstrated statistically lower MAEs compared to Barrett (<em>P</em> &lt; .05).</div></div><div><h3>Conclusion</h3><div>All 5 toric IOL calculation formulas demonstrated excellent overall accuracy, with slight variations observed in specific subgroups. The EVO formula showed superior precision in ATR astigmatism. These findings provide real-world insights to enhance refractive outcomes and optimize formula selection in toric IOL surgery.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 1-8"},"PeriodicalIF":4.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514387","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":"Sociodemographic Disparities in Uncorrectable Visual Impairment Among US Adolescents","authors":"Owais Fazal ,&nbsp;Natalie Slopen ,&nbsp;Alison A. Galbraith ,&nbsp;David G. Hunter ,&nbsp;Eric D. Gaier ,&nbsp;Isdin Oke","doi":"10.1016/j.ajo.2025.02.032","DOIUrl":"10.1016/j.ajo.2025.02.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To estimate the prevalence of uncorrectable visual impairment and to identify sociodemographic factors associated with such impairment among US adolescents.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>1999 to 2008 National Health and Nutrition Examination Survey.</div></div><div><h3>Study population</h3><div>Adolescents (age 12-19 years).</div></div><div><h3>Observation</h3><div>Best-corrected visual acuity.</div></div><div><h3>Outcome Measures</h3><div>Prevalence of unilateral uncorrectable visual impairment, defined as best-corrected visual acuity of 20/40 or better in one eye with greater than 2 lines of visual acuity asymmetry, and of bilateral uncorrectable visual impairment, defined as best-corrected visual acuity worse than 20/40 in both eyes. Multivariable logistic regression was used to identify sociodemographic factors (race and ethnicity, caregiver education, household income, food security, citizenship status, health insurance type, and healthcare access) associated with uncorrectable visual impairment, adjusting for age and sex.</div></div><div><h3>Results</h3><div>The survey identified 9949 participants (mean [SD] age, 15.86 [2.27] years; 4914 female participants [49%]). The prevalence estimate of uncorrectable visual impairment was 4.0% (491 participants, 95% confidence intervals [CI] 3.4%-4.7%). After adjusting for age and sex, there were increased odds of uncorrectable visual impairment among those with family income below poverty level (odds ratio [OR], 1.59; 95% CI, 1.14-2.22) compared to poverty level and above, those with Mexican-American ethnicity (OR, 1.64; 95% CI, 1.18-2.29) or non-Hispanic Black race (OR, 1.43; 95% CI, 1.03-1.99) compared to non-Hispanic White race, those with food insecurity (OR, 1.67; 95% CI, 1.21-2.32), those with caregiver education below high school (OR, 1.68; 95% CI, 1.24-2.28), those with public insurance (OR, 1.67; 95% CI, 1.21-2.30), and those with no insurance (OR, 1.71; 95% CI, 1.12-2.59) compared to those with private insurance.</div></div><div><h3>Conclusions</h3><div>Socioeconomic disparities in the prevalence of uncorrectable visual impairment are evident by adolescence. Interventions to treat amblyopia, the most common cause of uncorrectable vision loss, have limited efficacy in late childhood. Efforts are needed to identify and treat amblyopia in socioeconomically disadvantaged populations at an earlier age to prevent permanent vision loss.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 248-254"},"PeriodicalIF":4.1,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514388","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":"Hyperreflective Foci Along the Retinal Pigment Epithelium Predict the Onset of Large Choroidal Hypertransmission Defects in Age-Related Macular Degeneration","authors":"Alessandro Berni ,&nbsp;James D. Kastner ,&nbsp;Mengxi Shen ,&nbsp;Yuxuan Cheng ,&nbsp;Gissel Herrera ,&nbsp;Farhan Hiya ,&nbsp;Jeremy Liu ,&nbsp;Liang Wang ,&nbsp;Jianqing Li ,&nbsp;Omar S. El-Mulki ,&nbsp;Sara Beqiri ,&nbsp;Omer Trivizki ,&nbsp;Nadia K. Waheed ,&nbsp;Robert O'Brien ,&nbsp;Giovanni Gregori ,&nbsp;Ruikang K. Wang ,&nbsp;Philip J. Rosenfeld","doi":"10.1016/j.ajo.2025.02.021","DOIUrl":"10.1016/j.ajo.2025.02.021","url":null,"abstract":"<div><h3>Purpose</h3><div>In eyes with intermediate age-related macular degeneration (iAMD), we separately quantified the hyperreflective foci (HRF) along the retinal pigment epithelium (rpeHRF) and the intraretinal HRF (iHRF) to determine if the location of the HRF predicted the progression from iAMD to the onset of large persistent choroidal hypertransmission defects (hyperTDs).</div></div><div><h3>Design</h3><div>Post hoc subgroup cohort analysis of a prospective study.</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on a prospective natural history database of eyes with AMD imaged using swept-source optical coherence tomography (SS-OCT). En face images derived from choroidal slabs positioned 64 to 400 µm beneath Bruch membrane were used with a semiautomated algorithm to identify and quantify hypotransmission defects (hypoTDs) attributable to either iHRF or rpeHRF within a 5-mm fovea-centered circle. iHRF were identified on corresponding B-scans as hyperreflective lesions within the neurosensory retina, and rpeHRF were identified as areas of retinal pigment epithelium thickening. Multivariable survival analysis was performed to determine if the area measurements of either iHRF or rpeHRF were more likely to predict the onset of the first large persistent hyperTD.</div></div><div><h3>Results</h3><div>Of the 171 eyes with iAMD included in this study, 82 (48%) developed at least 1 large hyperTD during a median follow-up of 59.1 months. Univariable Cox regression analyses showed that rpeHRF area (<em>P</em> &lt; .001), iHRF area (<em>P</em> = .003), and drusen volume (<em>P</em> &lt; .001) were all significantly associated with the onset of the first large persistent hyperTD. However, a multivariable Cox regression model showed that only the rpeHRF area remained a significant predictor of disease progression (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>In iAMD eyes, the area of rpeHRF was more predictive of disease progression than either the drusen volume or iHRF, which suggests that these rpeHRF serve as harbingers of focal atrophy formation and may predict where hyperTDs form.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"274 ","pages":"Pages 76-90"},"PeriodicalIF":4.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482073","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":"Surgical Management of Masquerading Superior Oblique Palsy","authors":"Qingyu Meng ,&nbsp;Veronika Yehezkeli ,&nbsp;Joseph L. Demer","doi":"10.1016/j.ajo.2025.02.015","DOIUrl":"10.1016/j.ajo.2025.02.015","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the surgical outcomes between superior oblique (SO) palsy (SOP) and masquerading SO palsy (mSOP).</div></div><div><h3>Design</h3><div>Comparative interventional case series.</div></div><div><h3>Methods</h3><div>Medical records of patients with SOP and mSOP were reviewed from 1991 to 2024. Palsy cases had maximum SO cross section in the hypertropic eye no more than 80% of that in the fellow eye, whereas mSOP cases had bilaterally symmetric SO muscles on magnetic resonance imaging. Types of surgery and effect on hypertropia were compared between groups.</div></div><div><h3>Result</h3><div>A total of 39 patients aged 38±20 (standard deviation) years had SOP and 18 aged 36±17 years had mSOP. Maximum palsied SO cross section was 10.6±3.8 mm², significantly smaller than 18.9±4.0 mm² of the contralateral fellow (<em>P</em> &lt; .0001), but was bilaterally symmetric in mSOP. Mean preoperative central gaze hypertropia was similar at 14.7±9.8Δ in SOP and 11.0±6.9Δ in mSOP (<em>P</em> = .2). The commonest surgery was ipsilateral inferior oblique (IO) weakening combined with contralateral inferior rectus (IR) recession, followed by ipsilateral IO weakening alone and contralateral IR recession alone. After 41±65 months’ follow-up in SOP and 22±41 months in mSOP, central gaze hypertropia decreased from 14.7±9.8Δ to 1.7±4.1Δ in SOP, and from 11.0±6.9Δ to –2.9±5.4Δ in mSOP (both <em>P</em> &lt; .0001). Surgical effect was similar at 13.2±10.3Δ in SOP and 14.1±10.0Δ in mSOP. Reoperation rate was low and similar in both groups.</div></div><div><h3>Conclusion</h3><div>Clinical characteristics and surgical effect are similar in mSOP and SOP. Conventional surgeries are comparably effective in both. This suggests that mechanism beyond SO muscle function drive head tilt–dependent cylcovertical strabismus.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 240-247"},"PeriodicalIF":4.1,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a Convolutional Neural Network to Predict the Response of Diabetic Macular Edema to Intravitreal Anti-VEGF Treatment: A Pilot Study","authors":"GEORGE MAGRATH ,&nbsp;JOSEPH LUVISI ,&nbsp;DANIEL RUSSAKOFF ,&nbsp;JONATHAN OAKLEY ,&nbsp;EMIL ANTHONY SAY ,&nbsp;JEFFREY BLICE ,&nbsp;ASHWATH JAYAGOPAL ,&nbsp;SALLY TUCKER ,&nbsp;ALEX LOAYZA ,&nbsp;GEORGE HAMILTON BAKER ,&nbsp;JIHAD S. OBEID","doi":"10.1016/j.ajo.2025.02.017","DOIUrl":"10.1016/j.ajo.2025.02.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To utilize a convolutional neural network (CNN) to predict the response of treatment-naïve diabetic macular edema (DME) to a single injection of anti-vascular endothelial growth factor (anti-VEGF) with data from optical coherence tomography (OCT).</div></div><div><h3>Design</h3><div>Retrospective study performed via chart review.</div></div><div><h3>Methods</h3><div>Setting: This was a single-center study performed at the Storm Eye Institute, Medical University of South Carolina.</div><div>Patient Population: Patients with a new diagnosis of DME who underwent intravitreal (IVT) anti-VEGF injections were eligible for inclusion, provided they had a baseline OCT scan at the time of diagnosis and a 1-month follow-up OCT scan after the first anti-VEGF injection. Exclusion criteria included prior treatment with anti-VEGF, lack of required OCT scans, coexistent macular degeneration, and macular edema due to other retinal diseases. Seventy-three (73) eyes from 53 patients were included.</div><div>Intervention: The OCT scan from the baseline visit was compared to the follow-up OCT scan approximately 1 month after the first anti-VEGF injection to determine change in central subfield thickness (delta CST). The delta CST was fed into the CNN as a label to train the system to predict treatment response from only the baseline OCT scan.</div><div>Main Outcome Measure: CNN prediction of treatment response to anti-VEGF. Treatment response was defined as a CST reduction of 10 µm or more.</div></div><div><h3>Results</h3><div>Based on delta CST from 2 OCT scans, 57 eyes were responders and 16 eyes were non-responders to the initial anti-VEGF injection. Analyzing only the baseline OCT scan for each eye, the trained CNN demonstrated an area under the curve (AUC) of 0.81. At the reported operating point, the CNN correctly identified 45 of the 57 responder eyes (i.e., recall of 78.9%) and 11 of the 16 non-responder eyes (i.e., specificity of 68.8%).</div></div><div><h3>Conclusions</h3><div>The results of this study demonstrate the potential of a CNN to predict the response of treatment-naïve DME to a single injection of anti-VEGF therapy.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 176-181"},"PeriodicalIF":4.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of IDX-DR for Detecting Diabetic Retinopathy: A Systematic Review and Meta-Analysis","authors":"ZAID KHAN ,&nbsp;ABHAY M GAIDHANE ,&nbsp;MAHENDRA SINGH ,&nbsp;SUBBULAKSHMI GANESAN ,&nbsp;MANDEEP KAUR ,&nbsp;GIRISH CHANDRA SHARMA ,&nbsp;POOJA RANI ,&nbsp;RSK SHARMA ,&nbsp;SHAILENDRA THAPLIYAL ,&nbsp;MONAM KUSHWAHA ,&nbsp;HARISH KUMAR ,&nbsp;RAJAT KUMAR AGARWAL ,&nbsp;MUHAMMED SHABIL ,&nbsp;LOKESH VERMA ,&nbsp;AMRITPAL SIDHU ,&nbsp;NORHAFIZAH BINTI AB MANAN ,&nbsp;GANESH BUSHI ,&nbsp;RACHANA MEHTA ,&nbsp;SANJIT SAH ,&nbsp;PRAKASINI SATAPATHY ,&nbsp;SHAILESH KUMAR SAMAL","doi":"10.1016/j.ajo.2025.02.022","DOIUrl":"10.1016/j.ajo.2025.02.022","url":null,"abstract":"<div><h3>Purpose</h3><div>Diabetic retinopathy (DR) is a leading cause of vision loss worldwide, making early detection critical to prevent blindness. IDX-DR, an FDA-approved autonomous artificial intelligence (AI) system, has emerged as an innovative solution to improve access to DR screening. This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of IDX-DR in detecting diabetic retinopathy.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted across PubMed, Embase, Scopus and Web of Science, identifying studies published through October 5, 2024. Studies involving adult patients with Type 1 or Type 2 diabetes and reporting diagnostic metrics such as sensitivity and specificity were included. The primary outcomes were pooled sensitivity and specificity of IDX-DR. A bivariate random-effects model was used for meta-analysis, and summary receiver operating characteristic (SROC) curves were generated to assess diagnostic performance. Statistical analyses were performed using MetaDisc software version 2.0.</div></div><div><h3>Results</h3><div>Thirteen studies involving 13,233 participants met the inclusion criteria. IDX-DR's pooled sensitivity was 0.95 (95% CI: 0.82-0.99), and its pooled specificity was 0.91 (95% CI: 0.84-0.95). The SROC curve confirmed IDX-DR's high diagnostic accuracy in detecting diabetic retinopathy across various clinical environments. The AUC value of 0.95 demonstrated high sensitivity and specificity, indicating a robust diagnostic performance for IDX-DR in detecting diabetic retinopathy.</div></div><div><h3>Conclusion</h3><div>IDX-DR is a highly effective diagnostic tool for diabetic retinopathy screening, with robust sensitivity and good specificity. Its integration into clinical practice, especially in resource-limited settings, can potentially improve early detection and reduce vision loss. However, careful implementation is needed to address challenges such as over-diagnosis and ensure the tool complements clinical judgment. Future studies should explore the long-term impacts of AI-based screening and address ethical considerations surrounding its use.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 192-204"},"PeriodicalIF":4.1,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476054","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":"Detection of Ocular Surface Squamous Neoplasia Using Artificial Intelligence With Anterior Segment Optical Coherence Tomography","authors":"Jason A. Greenfield ,&nbsp;Rafael Scherer ,&nbsp;Diego Alba ,&nbsp;Sofia De Arrigunaga ,&nbsp;Osmel Alvarez ,&nbsp;Sotiria Palioura ,&nbsp;Afshan Nanji ,&nbsp;Ghada Al Bayyat ,&nbsp;Douglas Rodrigues da Costa ,&nbsp;William Herskowitz ,&nbsp;Michael Antonietti ,&nbsp;Alessandro Jammal ,&nbsp;Hasenin Al-Khersan ,&nbsp;Winfred Wu ,&nbsp;Mohamed Abou Shousha ,&nbsp;Robert O'Brien ,&nbsp;Anat Galor ,&nbsp;Felipe A. Medeiros ,&nbsp;Carol L. Karp","doi":"10.1016/j.ajo.2025.02.019","DOIUrl":"10.1016/j.ajo.2025.02.019","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop and validate a deep learning (DL) model to differentiate ocular surface squamous neoplasia (OSSN) from pterygium and pinguecula using high-resolution anterior segment optical coherence tomography (AS-OCT).</div></div><div><h3>Design</h3><div>Retrospective Diagnostic Accuracy Study.</div></div><div><h3>Methods</h3><div><em>Setting</em>: Single-center.</div><div><em>Study Population</em>: All eyes with a clinical or biopsy-proven diagnosis of OSSN, pterygium, or pinguecula that received AS-OCT imaging.</div><div><em>Procedures</em>: Imaging data was extracted from Optovue AS-OCT (Fremont, CA) and patients’ clinical or biopsy-proven diagnoses were collected from electronic medical records. A DL classification model was developed using two methodologies: (1) a masked autoencoder was trained with unlabeled data from 105,859 AS-OCT images of 5746 eyes and (2) a Vision Transformer supervised model coupled to the autoencoder used labeled data for fine-tuning a binary classifier (OSSN vs non-OSSN lesions). A sample of 2022 AS-OCT images from 523 eyes (427 patients) were classified by expert graders into “OSSN or suspicious for OSSN” and “pterygium or pinguecula.” The algorithm's diagnostic performance was evaluated in a separate test sample using 566 scans (62 eyes, 48 patients) with biopsy-proven OSSN and compared with expert clinicians who were masked to the diagnosis. Analysis was conducted at the scan-level for both the DL model and expert clinicians, who were not provided with clinical images or supporting clinical data.</div></div><div><h3>Main Outcome</h3><div>Diagnostic performance of expert clinicians and the DL model in identifying OSSN on AS-OCT scans.</div></div><div><h3>Results</h3><div>The DL model had an accuracy of 90.3% (95% confidence intervals [CI]: 87.5%-92.6%), with sensitivity of 86.4% (95% CI: 81.4%-90.4%) and specificity of 93.2% (95% CI: 89.9%-95.7%) compared to the biopsy-proven diagnosis. Expert graders had a lower sensitivity 69.8% (95% CI: 63.6%-75.5%) and slightly higher specificity 98.5% (95% CI: 96.4%-99.5%) than the DL model. The area under the receiver operating characteristic curve for the DL model was 0.945 (95% CI: 0.918-0.972) and significantly greater than expert graders (area under the receiver operating characteristic curve = 0.688, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>A DL model applied to AS-OCT scans demonstrated high accuracy, sensitivity, and specificity in differentiating OSSN from pterygium and pinguecula. Interestingly, the model had comparable diagnostic performance to expert clinicians in this study and shows promise for enhancing clinical decision-making. Further research is warranted to explore the integration of this artificial intelligence-driven approach in routine screening and diagnostic protocols for OSSN.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"273 ","pages":"Pages 182-191"},"PeriodicalIF":4.1,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472182","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}