American Journal of Ophthalmology最新文献

{"title":"Rate of progression among different age groups in glaucoma with high myopia: A 10-year follow-up cohort study.","authors":"Jaekyoung Lee,Young In Shin,Min Gu Huh,Yoon Jeong,Young Kook Kim,Jin Wook Jeoung,Ki Ho Park","doi":"10.1016/j.ajo.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.012","url":null,"abstract":"PURPOSETo investigate the rate of structural and functional progression in different age groups of highly myopic glaucoma patients and identify risk factors associated with rate of change in functional parameters.DESIGNRetrospective clinical cohort study METHODS: This study included open-angle, normal-tension glaucoma (NTG) patients with high myopia who had been followed-up for at least 8 years. Patients were divided into two age groups, \"younger (under age 40)\" and \"older (age 40 or over),\" according to their age at presentation, and progression rates for visual field index (VFI), mean deviation (MD) and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated. Intergroup comparison was performed, and associations between age and progression rates for structural and functional parameters were assessed by scatter plots with linear regression and locally weighted scatterplot smoothing. Cox proportional hazards modeling was performed to identify factors for progression rate of functional parameters.RESULTSA total of 320 eyes of 320 highly myopic NTG patients (mean age at presentation, 38.7 ± 10.4 years) were included in this study with a mean follow-up duration of 13.1 ± 6.2 years. The rate of VFI, MD, and RNFL thickness change showed a positive correlation with the age at presentation (p=0.013, 0.002, 0.003). The mean rate of MD change was -0.36 ± 0.39 dB/year in younger age group and -0.22 ± 0.27 dB/year in older age group (p<0.01). In the locally weighted scatterplot, the rate of change in VFI, MD, and RNFL thickness showed a fast-progressing pattern in those aged 19-29 years and 40-49 years, and a slow-progressing pattern in those aged 30-39 years and 50 years or older. Baseline IOP (β= -0.041; 95% CIs, -0.139-0.413; p=0.047) and baseline VFI (β= 0.364; 95% CIs, 0.247-0.461; p<0.01) was significantly related to the VF MD change rate.CONCLUSIONSThe glaucoma progression rate in highly myopic NTG showed a bimodal pattern based on the age at presentation, younger patients exhibiting faster progression compared to older patients. Baseline IOP and VFI were significantly related to functional progression rate. The findings of this study may assist in deciding the treatment strategy for highly myopic NTG patients.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"28 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853078","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":"Corneal Sensory Changes and Nerve Plexus Abnormalities in Chronic Neuropathic Ocular Pain and Dry Eye Post-Refractive Surgery.","authors":"Amanda Vázquez,Marta Blanco-Vázquez,Elena Martínez-Plaza,Eva M Sobas,María J González-García,Alberto López-Miguel,Enrique Ortega,Amalia Enríquez-de-Salamanca,Margarita Calonge","doi":"10.1016/j.ajo.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.004","url":null,"abstract":"PURPOSEChronic neuropathic ocular pain (NOP) can develop alongside chronic dry eye (DE) post-laser-assisted in-situ keratomileusis (LASIK), yet its specific characteristics remain poorly understood. This study aims to compare the clinical characteristics of patients who developed both DE and NOP after LASIK to those with only DE and to asymptomatic LASIK patients, to facilitate the diagnosis of NOP.METHODSProspective, cross-sectional \"case-control\" comparison study. An 89-subject post-LASIK study comprised three groups: 34 patients developing NOP and DE (NOP-DE group), 25 patients developing only DE (DE group), and 30 asymptomatic subjects (control group). Assessments included clinical history and symptom questionnaires (OSDI, mSIDEQ, NRS, WFPRS), anxiety and depression evaluation (HADS), tear film stability (osmolarity and TBUT) and production (Schirmer), and ocular surface integrity. Corneal mechanical and thermal sensitivity thresholds were measured using Belmonte's non-contact esthesiometer, whereas tactile sensitivity threshold was assessed pre/post-topical anesthesia using the Cochet-Bonnet esthesiometer. In vivo confocal microscopy (IVCM) was used to evaluate the sub-basal nerve plexus characteristics and dendritic cell density in the central cornea. Group comparisons and correlations were conducted.RESULTSCompared with DE group, patients in the NOP-DE group exhibited significantly more DE symptoms with mSIDEQ (p=0.019) higher level of pain with NRS and WFPRS, increased use of ocular lubrication (p=0.003), greater frequency of patients with pathological results on anxiety and depression questionnaires (p<0.001), and a higher prevalence of central sensitization syndromes (p<0.001). Additionally, NOP-DE patients demonstrated higher tactile corneal sensitivity post-topical anesthesia (p=0.002). IVCM revealed lower nerve density (p=0.049) and higher microneuroma density (p=0.008) in the sub-basal nerve plexus of NOP-DE patients compared to DE patients without NOP (p=0.008). Most nerve metrics correlated moderately to strongly with clinical parameters.CONCLUSIONSPersistent high corneal tactile sensitivity post-anesthesia, reduced nerve density and increased microneuroma density in the central cornea may serve as diagnostic indicators for confirming NOP in patients experiencing chronic DE post-LASIK. These findings underscore the potential utility of incorporating these measures into clinical assessments to improve diagnostic accuracy and guide management strategies in this patient population.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"71 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143853076","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":"Validation of the SCREENROP Criteria for Retinopathy of Prematurity Screening: A Canadian Model for Consideration.","authors":"Felicia Tai,Yasmin Jindani,Amit Mukerji,Kourosh Sabri","doi":"10.1016/j.ajo.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.010","url":null,"abstract":"OBJECTIVEReducing unnecessary retinopathy of prematurity (ROP) screenings in neonates is important for minimizing morbidity associated with such examinations including pain for the child, anxiety in parents, and conserving healthcare resources. The Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) guidelines recommend only screening babies with birth weight (BW) <1200g or gestational age (GA) <30 weeks to prevent unnecessary screenings. This study aims to retrospectively test the sensitivity of SCREEN-ROP in a large urban Canadian setting for capturing babies requiring treatment for ROP.DESIGNRetrospective accuracy analysis of revised diagnostic testing criteria.PARTICIPANTSAll babies born at McMaster Children Hospital from July 1, 2016 to May 31, 2024 who: 1) received at least one ROP eye exam, or 2) received ROP treatment, were included.METHODSBirth weight (BW) and gestational age (GA) at birth were collected from Canadian Neonatal Network (CNN) and BORN Ontario, which stores all information on babies admitted to level 3 and level 2 Neonatal Intensive Care Units (NICUs), respectively. SCREEN-ROP criteria were applied to the cohort. Institutional ethics approval was obtained from Hamilton Integrated Research Ethics Board (REB #13216-C) and CNN (REB #04-062).MAIN OUTCOME MEASURESSensitivity and specificity of the model was calculated with 95% confidence intervals. Chi-squared test was used to compare the babies captured with SCREEN-ROP criteria versus prior criteria (GA <31 weeks or birth weight <1251g).RESULTS823 unique babies were screened from July 1, 2016 to May 31, 2024 of which 79 unique babies were treated for ROP. Applying the SCREEN-ROP criteria captured all 79 babies requiring ROP treatment while avoiding another 61 babies (7.41%) from being unnecessarily enrolled into ROP screening. Sensitivity of SCREEN-ROP criteria for capturing babies requiring ROP treatment was 100% (95% CI: 95.44% to 100%), and the specificity was 8.20% (95% CI: 6.33% to 10.41%).CONCLUSIONSBy screening babies with BW <1200g or GA <30 weeks, 7.41% of babies would have been saved from unnecessary ROP screenings, and all babies requiring ROP treatment would have been captured with 100% sensitivity. Further validation in other large centers and countries may allow for broader implementation of SCREEN-ROP guidelines.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851050","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":"Congenital restrictive strabismus associated with anomalous orbital structures: MRI findings and clinical characteristics.","authors":"Dan Wang,Yan-Yan Yang,Qing-Lin Chang,Qian Ma,Yi-Di Wang,Feng-Yuan Man,Yong-Hong Jiao","doi":"10.1016/j.ajo.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.013","url":null,"abstract":"PURPOSETo evaluate and classify the magnetic resonance imaging (MRI) features of anomalous orbital structures (AOS) and correlate these findings with clinical manifestations.DESIGNRetrospective, observational case series.METHODSThe detailed clinical data from 35 patients diagnosed with congenital restrictive strabismus and AOS were retrospectively reviewed between July 2010 and October 2024. All patients underwent brain stem and intraorbital MRI.MAIN OUTCOME MEASURESThe morphological features of AOS, extraocular muscles (EOMs), and ocular motor nerves were examined.RESULTSThis retrospective study included 35 cases (21 males and 14 females). The mean ± SEM age was 6.9 ± 0.8 years (range: 2-22 years). Sixteen patients had right-eye involvement, and 19 had left-eye involvement. AOS were categorized into three types: Type 1, discrete anomalous bands extending from the rectus muscles to the posterior sclera (25.7%), with the inferior rectus (IR) being the most affected; Type 2 refers to anomalous connections observed between the extraocular muscles (EOMs) (65.7%), often occurring in the area between the superior rectus (SR) and medial rectus (MR); Type 3, abnormal connection between the posterior sclera and the surrounding optic nerve sheath and extending to the equatorial region of the globe (8.6%). Varying degrees of restricted eye movements and strabismus were observed in all patients. Most patients also exhibited amblyopia and eyelid malposition in the affected eye.CONCLUSIONSDiscrete anomalous bands most commonly involve the IR, while abnormal EOM connections primarily occur between the SR and MR. Eyelid malposition could suggests the possible presence of AOS.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"139 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851035","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":"Ethnoracial Representation in U.S. Clinical Trials for Retinal Vein Occlusion.","authors":"Selina J Chang,Kabir S Grewal,Amrish Selvam,Jay Chhablani","doi":"10.1016/j.ajo.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.011","url":null,"abstract":"PURPOSERetinal vein occlusion (RVO) is the second most common cause of vision loss from retinal vascular disease. Clinical trials often lack adequate representation of minority groups, limiting the external validity and equity of trial results. We aimed to characterize the evolution of ethnoracial demographic reporting, changes in the racial & ethnic composition of RVO trial participants, and correlations with trial sponsor and collaborator types.DESIGNRetrospective trend study SUBJECTS: Participants, sponsors, and collaborators in RVO clinical trials based in the United States (U.S.) METHODS: We assessed the ethnoracial distribution of patients and sponsors & collaborators in RVO clinical trials. Trial data was sourced from ClinicalTrials.gov and compared with 2022 U.S. Census Bureau data.MAIN OUTCOME MEASURESChange in ethnoracial reporting and representation, and comparison of representation within RVO clinical trials with 2022 U.S. Census demographics.RESULTSRacial data was not documented for all 6 (12.2%) trials completed between 2008 and 2011. There was increased ethnoracial reporting between January 2012 to June 2017 (n = 6/29, 20.7%) vs July 2017 to December 2022 (n = 13/14, 92.9%) (OR 49.8; 95% CI: 5.39-460.47; p<0.0001). The proportion of Asian participants increased from 4.2% to 15.9% (OR 4.37; 95% CI 2.49-8.37; p<0.0001), and Black participants rose from 6.1% to 20.7% (OR 4.03; 95% CI 2.51-6.85; p<0.0001). Conversely, White participants decreased from 73.8% to 56.0% (OR 0.45, 95% CI 0.34-0.59; p<0.0001), and Hispanic/Latino participants decreased from 13.1% to 5.4% (OR 0.38; 95% CI 0.26-0.56; p<0.0001). Compared to the 2022 US Census data, the ethnoracial distribution of the total U.S. population is significantly different than the total enrollment in RVO clinical trials (p<0.0001). Government and academic involvement were correlated with less White and more Black representation respectively (p≤0.01).CONCLUSIONSFrom 2008 to 2022, there has been a notable increase in the documentation of racial and ethnic demographics in RVO clinical trials. Although the recruitment of Asian and Black patients has increased, the Hispanic population remains significantly underrepresented among RVO trial participants, highlighting the need for greater inclusivity in enrollment.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"84 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849359","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":"The effects of Vitamin D on Keratoconus progression.","authors":"Nicolò Bartolomeo,Matteo Pederzolli,Silvia Palombella,Philippe Fonteyne,Giuseppe Suanno,Gianluca Tilaro,Stefano de Pretis,Francesca Borgo,Federico Bertuzzi,Carlotta Senni,Massimo De Micheli,Francesco Bandello,Giulio Ferrari","doi":"10.1016/j.ajo.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.009","url":null,"abstract":"PURPOSEThe aim of this study was to assess whether Vitamin D (Vit D) supplementation affects local disease progression, as well as systemic inflammation, collagen degradation, and oxidative stress in adolescents affected by Keratoconus (KC) and Vit D deficiency.DESIGNProspective, interventional single-center study.SUBJECTSForty patients (age range, 12.2-19.9) presenting with both KC and Vit D insufficiency (<30 ng/mL) were included in the study.METHODSVit D was prescribed for 6 months as per standard of care. Follow-up visits were scheduled for 12 months. Each visit included the measurement of best spectacle-corrected visual acuity (BSCVA) , maximal keratometry (Kmax) , and thinnest corneal thickness (TCT) . Blood samples were collected at month 0 (M0) and month 6 (M6) to measure Vit D levels and systemic biomarkers of inflammation, collagen degradation, and oxidative stress by ELISA or RT-PCR; full RNA sequencing was performed on 20 patients at M0 and M6.MAIN OUTCOME MEASURESThe primary outcome of the study was the percentage of patients with a Kmax progression less than 1 diopter (D) throughout the entire study (i.e.: stable patients) .RESULTS65% of patients remained stable (75% of eyes) after 12 months. Specifically, BSCVA, Kmax, and TCT rates remained stable during the 12-month observational period. ELISA performed on blood plasma showed that Vit D upregulated the expression of VDBP. QPCR performed on peripheral leukocytes showed an increase in the expression of VDR and CD14 with no changes in the principal enzymes involved in Vit D activation/deactivation. ELISA and qPCR showed the modulation of collagen degradation and collagen crosslinking. Subgroup analysis with RNA sequencing showed differential response to Vit D treatment. Responder patients showed downregulation in inflammatory and platelet activation pathways, and upregulation of proteoglycan metabolism/biosynthesis enrichment.CONCLUSIONSOur findings support the hypothesis that Vit D supplementation can affect KC progression in adolescent patients with Vit D insufficiency possibly through the modulation of systemic inflammation, inhibition of collagen degradation and promotion of proteoglycan synthesis. Our results strongly suggest that KC may be the ocular manifestation of a systemic disorder.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"34 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849475","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 Layer Analysis Under Flat Irregular Pigment Epithelial Detachments in Central Serous Chorioretinopathy.","authors":"Pasquale Viggiano,Federico Moscara,Alba Chiara Termite,Giacomo Boscia,Mariapia La Terza,Antonio Salvelli,Maria Grazia Pignataro,Annamaria Porreca,Giovanni Alessio,Francine Behar-Cohen,Francesco Boscia","doi":"10.1016/j.ajo.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.005","url":null,"abstract":"PURPOSETo compare choroidal layer thickness beneath flat irregular pigment epithelial detachments (PEDs) between uncomplicated chronic central serous chorioretinopathy (uCSC) and CSC complicated by type 1 macular neovascularization (cCSC).DESIGNRetrospective cross-sectional study METHODS: This retrospective study included 94 treatment-naïve eyes (45 uCSC, 49 cCSC) with flat irregular PEDs. Using swept-source optical coherence tomography (SS-OCT), we measured choriocapillaris-Sattler layer complex thickness (SLCCT) and Haller's layer thickness (HLT) beneath the PEDs. Measurements were performed in the central segments of three equal divisions under each PED.RESULTSMean SLCCT was significantly lower in cCSC compared to uCSC (47.2 ± 18.6 μm vs 81.4 ± 22.4 μm, p = 0.002). Similarly, HLT was reduced in cCSC (265.3 ± 45.8 μm vs 334.5 ± 43.2 μm, p = 0.008). Other characteristics, including age (56.1 ± 7.9 vs 54.3 ± 8.4 years, p = 0.28), disease duration (11.2 ± 3.1 vs 8.4 ± 2.6 months, p = 0.08), and PED dimensions were comparable between groups.CONCLUSIONScCSC eyes show significant thinning of both the choriocapillaris-Sattler complex and Haller's layer under flat irregular PEDs compared to uCSC eyes. These findings suggest that progressive choroidal thinning may be a key feature of neovascular transformation and could serve as a potential biomarker to identify eyes at risk for neovascular complications.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"27 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846324","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":"Unilateral Conjunctival Parakeratosis: A Rare Case of Mucosal Keratosis with Pathological Findings.","authors":"Hitoshi Hayashi,Shizuka Koh","doi":"10.1016/j.ajo.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.002","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"136 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831608","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":"Understanding Patient Experience with Past Barriers to Eye Care and How Barriers were Addressed in the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program.","authors":"Emily Webber,Ming-Chen Lu,Maria A Woodward,Angela Elam,Amanda Bicket,Sarah Dougherty Wood,Denise John,Leroy Johnson,Martha Kershaw,Michele Heisler,Paula Anne Newman-Casey","doi":"10.1016/j.ajo.2025.04.007","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.007","url":null,"abstract":"PURPOSETo use community engaged research to understand barriers to eye care utilization and explore participant experiences with free glaucoma screenings through the Michigan Screening and Intervention for Glaucoma and eye Health through Telemedicine (MI-SIGHT) program.DESIGNQualitative study Subjects, Participants, and/or Controls: Purposive sampling of 42 participants out of 254 total participants from two community clinics in Flint and Ypsilanti, Michigan enrolled between 10/29/21 and 12/22/21.METHODS, INTERVENTION, OR TESTINGWe conducted semi-structured interviews that explored past barriers to eye care, motivations for attending and overall experience with the MI-SIGHT program. Interviews were transcribed then coded using Grounded Theory; and thematic analysis was completed.MAIN OUTCOME MEASURESThemes were compared between 1) the two clinics; 2) those who did and did not screen positive for glaucoma; and 3) of those who screened positive for glaucoma, comparing between those randomized to standard care and those randomized to personalized coaching and education.RESULTSThe most common past barriers to eye care included cost, insurance status, and transportation. Motivations to attending glaucoma screenings with the MI-SIGHT program included affordability, location of community clinics, and having a trusted referral source endorse the program. Overall, participants most valued the rapport and communication received when interacting with the ophthalmic technicians who also acted as care navigators as part of MI-SIGHT.CONCLUSIONSThe MI-SIGHT program was able to address barriers such as cost and transportation through having free eye screenings located at the community clinic. Developing trust and rapport with the participants and the community clinics was critical to the program's high satisfaction rates.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"25 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831607","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":"Deep Learning Approach Readily Differentiates Papilledema, NAION, and Healthy Eyes.","authors":"David Szanto,Asala Erekat,Brian Woods,Jui-Kai Wang,Mona Garvin,Brett A Johnson,Randy Kardon,Edward Linton,Mark J Kupersmith","doi":"10.1016/j.ajo.2025.04.006","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.006","url":null,"abstract":"OBJECTIVEDeep learning (DL) has been used in differentiating a range of ophthalmic conditions. We describe a model to distinguish among fundus photos of acquired optic disc swelling due to idiopathic intracranial hypertension (IIH), non-arteritic anterior ischemic optic neuropathy (NAION), and healthy eyes.DESIGNDevelopment and validation of a deep-learning diagnostic algorithm.SUBJECTS, PARTICIPANTS, AND/OR CONTROLSOur model was trained and validated on 15,088 fundus photos from 5866 eyes, including eyes with IIH with a Frisén grade ≥ 1 (418), acute NAION (780), and healthy controls (4668). We performed external validation on an additional 1126 photos from 928 eyes across these groups. All images were obtained from randomized and nonrandomized clinical trials, publicly available datasets, and real-world clinical sources.METHODSAfter preprocessing images to standardize optic disc position, we fine-tuned a ResNet-50 model. Performance was evaluated using 5-fold cross-validation, with metrics such as accuracy, AUC-ROC, precision, recall, F1 scores, and confusion matrices calculated. We applied gradient-weighted class activation mapping (Grad-CAM) to generate visual activation maps highlighting the regions of interest in the fundus images. External validation evaluation was performed with majority voting of our cross-validated models.MAIN OUTCOME MEASURESThe primary outcome measures were the model's overall accuracy, class-wide AUC-ROC, precision, recall, F1 scores, and confusion matrices.RESULTSThe model achieved an internal validation accuracy of 96.2%, with a macro-average AUC-ROC of 0.995. F1 scores ranged from 0.90 to 0.97 for all classes. The external validation set had an accuracy of 93.6%, F1 scores from 0.90 to 0.95 and macro-average AUC-ROC of 0.980. Activation maps consistently highlighted the optic disc, with emphasis on the inferior optic disc for IIH, superior optic disc for NAION and the entire optic disc for healthy eyes.CONCLUSIONSOur study demonstrates the potential of fundus-based deep learning models to accurately distinguish among IIH, NAION, and healthy eyes, providing a potentially valuable diagnostic method. With its strong discriminative capabilities, this model can be an important tool for neuro-ophthalmic assessment, particularly when access to specialized neuro-ophthalmologists is limited.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"39 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827098","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}