American Journal of Ophthalmology最新文献

{"title":"Evaluating the role of virtual reality visual fields (VRF) in the diagnosis and management of pediatric neuro-ophthalmic conditions.","authors":"Zara Saleem,Bo Wang,Rizul Naithani,Samuel Alvarez,Sharon F Freedman,Mays El-Dairi","doi":"10.1016/j.ajo.2025.09.028","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.028","url":null,"abstract":"OBJECTIVEVirtual reality field testing (VRF) is feasible and reliable in adults and in children with normal and glaucomatous eyes, but its role in pediatric neuro-ophthalmic conditions remains unexplored.PURPOSEto evaluate the feasibility of using VRF vs. standard automated perimetry (HVF) in children with neuro-ophthalmic conditions.DESIGNProspective reliability and validity comparison of diagnostic approaches.PARTICIPANTSChildren (< 18 years of age) with a known or suspected neuro-ophthalmic condition.METHODSChildren presenting to one pediatric neuro-ophthalmologist at Duke Eye Center between 07/2022-03/2023 were recruited. Participants attempted both HVF and VRF. A neuro-ophthalmologist predicted expected visual field (VF) abnormalities based on history, examination, magnetic resonance imaging, and optical coherence tomography of the retina and optic nerve. A masked ophthalmologist graded HVFs and VRFs with respect to global indices and VF abnormalities.MAIN OUTCOME MEASURESComparison between clinically-predicted and observed visual field defects and visual field global indices between virtual reality fields (VRF) and Humphrey visual fields (HVF).RESULTS129 children (253 eyes) were included, mean age 11.1±3.9 years. Fewer children successfully completed HVF than VRF (191 vs. 240 eyes, p<0.0001). Comparing HVF to VRF, average mean deviation (MD) was similar (-5.0±6.3 vs -5.3±6.2 dB, respectively, p=0.782). When comparing global indices between HVF and VRF, moderate correlation was observed for both MD and pattern standard deviation (PSD). Sensitivity of HVF vs. VRF to detect any clinically-predicted VF defect was 86.5% vs. 88.6%, respectively, p=0.861; specificity was 30.8% vs 33.5%, respectively, p=0.725. HVF vs. VRF concordance for presence/absence of any clinically-predicted VF defect was 52.0% vs 53.0%, respectively (p=0.849).CONCLUSIONHVF and VRF were comparable, with relatively high sensitivity and low specificity for the detection of clinically-predicted VF defects in children with known or suspected neuro-ophthalmic disease. However, more children were able to successfully perform VRF than HVF, suggesting VRF may provide valuable clinical assessment in this challenging population.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"4 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153425","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":"TFOS DEWS III: Executive Summary.","authors":"Victor L Perez, Wei Chen, Jennifer P Craig, Murat Dogru, Lyndon Jones, Fiona Stapleton, James S Wolffsohn, David A Sullivan","doi":"10.1016/j.ajo.2025.09.035","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.035","url":null,"abstract":"<p><p>This article presents an Executive Summary of the conclusions and recommendations of the TFOS DEWS III reports, published in the American Journal of Ophthalmology (AJO) in the Spring of 2025. Downloadable, pdf copies of the three comprehensive TFOS DEWS III reports are available on the AJO website (www.ajo.com).</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145172196","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":"TFOS DEWS III.","authors":"Victor L Perez, Wei Chen, Jennifer P Craig, Murat Dogru, Lyndon Jones, Fiona Stapleton, James S Wolffsohn, David A Sullivan","doi":"10.1016/j.ajo.2025.09.038","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.038","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145147530","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":"Fast Central Visual Field Progression in Patients with Normal-Tension Glaucoma and Nocturnal Blood Pressure Dip.","authors":"Jimin Park,Woo Keun Song,Jooyoung Yoon,Ko Eun Kim,Michael S Kook","doi":"10.1016/j.ajo.2025.09.018","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.018","url":null,"abstract":"PURPOSEThis study aimed to investigate the relationship between nocturnal blood pressure (BP) dip and rapid central visual field (VF) progression in patients with early-to-moderate stage normal-tension glaucoma (NTG).DESIGNProspective cohort study PARTICIPANTS: : In total, 199 untreated NTG patients participated in this study.METHODSIn total, 199 untreated NTG patients underwent 24-h ambulatory BP monitoring (ABPM) in their habitual position, with a minimum 2-year follow-up. Patients were classified as non-dippers, dippers, and over-dippers based on their nocturnal BP dip. The rates of central VF changes over time among these groups were compared using linear mixed model analysis. Fast central VF progression was defined as a decline in the mean total deviation (MTD10) values of 12 central points at a rate of < -0.5 dB/year. Logistic regression analysis identified clinical factors, including nocturnal BP dip, that contribute to accelerated central VF progression.MAIN OUTCOME MEASURESRate of central VF progression and prevalence of fast central VF progression RESULTS: : Over-dippers showed a significantly faster rate of central VF progression than non-dippers and dippers, as indicated by the MTD10 decline over an average follow-up of 4.9 years (non-dippers: -0.23 dB/year; dippers: -0.27 dB/year; over-dippers: -0.53 dB/year; P = 0.007). The prevalence of fast central VF progression was significantly higher in over-dippers (non-dippers: 19.8%; dippers: 23.5%; over-dippers: 60.0%; P < 0.001). A higher percentage of nocturnal mean arterial pressure (MAP) dip was identified as a significant risk factor for fast central VF progression (odds ratio: 1.062, P < 0.05).CONCLUSIONSPatients with NTG classified as over-dippers showed significantly faster central VF progression than non-dippers and dippers, with over 50% of over-dippers experiencing fast progression. Rapid central VF progression was significantly associated with the percentage of nocturnal MAP dip in eyes with early-to-moderate stage NTG. These findings highlight the importance of closely monitoring central VF changes in NTG patients with pronounced nocturnal BP dips to prevent functional impairment caused by rapid central VF loss.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"2 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140257","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":"Leveraging Sight Outcomes Research Collaborative (SOURCE) Data to Predict Initial Presentation with Advanced Open-Angle Glaucoma.","authors":"Rithambara Ramachandran,Aaron T Zhao,Yinxi Yu,Paula Anne Newman-Casey,Joshua D Stein, ","doi":"10.1016/j.ajo.2025.09.032","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.032","url":null,"abstract":"PURPOSETo investigate factors associated with initial presentation at tertiary health systems with advanced primary open-angle glaucoma (OAG) in either eye.DESIGNCross-sectional study.SUBJECTSAdults>40 years old diagnosed with OAG initially presenting at one of eleven SOURCE consortium sites between 2016 and 2023.METHODSOAG severity was dichotomized as \"non-advanced\" (suspect, mild, moderate) or \"advanced,\" based on the most severe stage in either eye within one year of presentation using ICD-10 codes. Logistic regression identified sociodemographic and neighborhood factors linked to \"advanced\" OAG presentation, and ordinal models assessed predictors by stage. Predictors included sociodemographic characteristics, health insurance type, income, education, urbanicity, and neighborhood-level affluence (Distressed Communities Index [DCI]). Associations with intraocular pressure (IOP) and cup-to-disc ratio (CDR) were modeled for all eyes using linear regression with generalized estimating equations.MAIN OUTCOME MEASURESAdjusted odds ratios (aORs) with 95% confidence intervals (CIs) for factors associated with presenting with \"advanced\" OAG.RESULTSAmong 59,409 individuals, 7,560 (12.7%) presented with advanced OAG in at least one eye. Mean age was 65.8(SD 12.7) years; 44.6% male, 56.7% Caucasian. Older age per decade (aOR: 1.74, 95% CI: 1.70-1.78), male sex (aOR: 1.59, CI: 1.51-1.68), Black race (aOR: 1.67, CI: 1.56-1.80), less affluent communities (aOR: 1.04 per 10-unit DCI increase, CI: 1.03-1.05), and non-metropolitan residence (OR range: 1.42-1.99) were associated with advanced presentation. Protective factors included Medicare insurance (aOR: 0.90, CI: 0.90-0.96), higher education (aOR range: 0.74-0.83), and diabetes mellitus (aOR: 0.39, CI: 0.36-0.43). Results were consistent across secondary analyses. Presenting IOP and CDR increased with disease severity and were similarly associated with sociodemographic and neighborhood factors.CONCLUSIONIdentifying sociodemographic predictors of late presentation using large population-based datasets may help inform targeted glaucoma screening efforts, since delayed initial presentation is a major risk factor for vision loss from advanced OAG.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"41 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140270","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":"Longitudinal Evaluation of Microvascular Changes and Imaging Biomarkers Associated with Visual Prognosis in Retinal Artery Occlusion.","authors":"Chong Chen,Kayla Nicole Nodecker,Rajiv M Sastry,Leiyu Wang,Xinyi Ding,Ying Zhu,Francesco Romano,Filippos Vingopoulos,Robbert Roel Struyven,Ioanna Ploumi,Selin S Gumustop,Shivesh Himanshu Shah,Sarah Lillian Wagner,Nimesh A Patel,Leo A Kim,David M Wu,Demetrios Vavvas,Deeba Husain,Joan W Miller,John B Miller","doi":"10.1016/j.ajo.2025.09.031","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.031","url":null,"abstract":"PURPOSETo longitudinally assess changes in macular thickness and microvascular metrics in retinal artery occlusion (RAO) patients, and to identify imaging biomarkers associated with visual prognosis.DESIGNRetrospective cohort study.PARTICIPANTS56 RAO patients (57 eyes) and 27 controls (30 eyes).METHODSComprehensive ophthalmic evaluations were performed, including macular OCT and 6 × 6 mm swept-source OCT angiography (SS-OCTA). Retinal thickness, macular ischemic area, ischemia-fovea distance, vessel skeletonized density (VSD), vessel density (VD), and foveal avascular zone (FAZ) area were quantified. Receiver operating characteristic (ROC) and linear regression analyses assessed imaging biomarkers correlated with visual outcomes.MAIN OUTCOME MEASURESLongitudinal changes in retinal structure and microvasculature, and their associations with final visual acuity (VA).RESULTSAmong 57 RAO eyes (28 BRAO) with a median follow-up of 83.0 (35.5, 172.0) weeks, retinal thickness significantly decreased over time (p < 0.05), while macular ischemic area expanded from 64.97% to 73.58% (p = 0.002). In a subset of 24 RAO eyes with longitudinal SS-OCTA scans, eyes with a baseline ischemic area ≤ 1/3 of the scan area showed increased VSD and VD in both plexuses over time (p < 0.05). FAZ area was significantly larger in CRAO compared to BRAO (p = 0.0001), although no statistically significant change in FAZ area was observed over time (p = 0.341), a numerical increase was noted in CRAO cases. Better baseline VA, greater ischemic distance to fovea, smaller initial ischemic area, higher VSD and VD in SCP, and smaller FAZ area were associated with better final VA (all p < 0.05, AUC: 0.80-0.89). Multivariable linear regression identified baseline ischemic area and FAZ area as independent predictors of final VA (p = 0.003, 0.008).CONCLUSIONSMultimodal quantification demonstrates the progressive ischemia in RAO and potential reperfusion in eyes with limited involvement. Ischemic area and FAZ area are key imaging biomarkers for visual prognosis.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140268","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":"Reply to Comment on \"IOL power calculation project: accuracy of 36 formulas.\": Accuracy of 36 IOL power calculation formulas.","authors":"Oleksiy V Voytsekhivskyy,Kenneth J Hoffer,David L Cooke,Giacomo Savini","doi":"10.1016/j.ajo.2025.09.034","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.034","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"52 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140269","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":"Comment on: 'IOL Power Calculation Project: Accuracy of 36 Formulas'.","authors":"Yi-Ching Chu,Chao-Chun Huang","doi":"10.1016/j.ajo.2025.09.033","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.033","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"18 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133954","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":"Cellular-Level Assessment of Macular Development in Patients with FEVR Using Multimodal Imaging: A Prospective Cohort Study.","authors":"Yarou Hu,Xinyu Zhao,Yaling Liu,Zhen Yu,Kaixuan Cui,Zhenquan Wu,Ziying Zhou,Ruiheng Zhang,Li Dong,Wenbin Wei,Shaochong Zhang,Wei Chi,Jie Zhang,Peiquan Zhao,Guoming Zhang","doi":"10.1016/j.ajo.2025.09.036","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.036","url":null,"abstract":"PURPOSETo investigate the multimodal characteristics of macula in patients with familial exudative vitreoretinopathy (FEVR) at a cellular level.DESIGNProspective cohort study.PARTICIPANTSA total of 46 FEVR-affected and healthy eyes were enrolled from July to October 2024 and underwent multimodal examinations. Participants with conditions such as foveal hypoplasia (FH), a history of ocular surgery or trauma in both the control and FEVR groups were excluded.METHODS AND MAIN OUTCOME MEASURESAll participants were underwent examinations of scanning laser ophthalmoscopy (SLO), ultra-wide-field swept source optical coherence tomography angiography (UWF SS-OCTA), and adaptive optics (AO)-SLO to acquire metrics of multimodal macular characteristics such as macular appearance, layered structure, vasculature and photoreceptor distribution. The baseline information such as best-corrected visual acuity (BCVA), spherical equivalent (SE), and axial length (AL) were also measured.RESULTSComparing to age (9.76 years on average), gender (52% femal), SE (-1.01D on average) and AL (23.66mm on average)-matched healthy eyes, FEVR-affected eyes without FH had increased foveal avascular zone (FAZ) perimeter in deep capillary plexus (DCP), partly thickening inner retina layers and thinning outer nuclear layer, as well as partly lower vessel density of DCP (P<0.05). In cellular-level, eyes with FEVR showed numerically lower cone density and larger cone spacing in fovea, but significantly higher cone density (P=0.03) and smaller cone spacing (P=0.02) in parafovea, as well as higher cone dispersion and lower regularity (P<0.05). Foveal and parafoveal cone density in participants with low BCVA were numerically higher.CONCLUSIONSPatients with FEVR without FH may be characterized by irregular FAZ morphology and cone distribution, exhibiting lower foveal and higher parafoveal cone densities, which was not correlated with their BCVA and may serve as clinical biomarkers for diagnostic assistance in FEVR. Participants with low BCVA but morphologically normal macular structure may harbor underlying cone abnormalities, underscoring the necessity for more thorough assessment, warranting greater caution in diagnosing amblyopia until excluding the influence of cellular-level abnormalities.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"28 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133931","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":"Outcomes of Frontalis Advancement With or Without External Levator Advancement for Congenital Ptosis: A Retrospective Comparative Study.","authors":"Marissa K Shoji,Akshara R Legala,Rolika Bansal,Nahia Dib El Jalbout,Sarah Cheng,Catherine Y Liu,Don O Kikkawa,Bobby S Korn","doi":"10.1016/j.ajo.2025.09.021","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.021","url":null,"abstract":"PURPOSETo compare outcomes of frontalis flap advancement alone versus frontalis flap advancement combined with external levator advancement (ELA) using a bilayer technique for congenital ptosis with poor levator function.DESIGNRetrospective comparative clinical cohort study.SUBJECTSEyelids of patients with severe congenital ptosis with poor levator function who underwent either frontalis advancement flap alone or in combination with ELA were included. Exclusion criteria were non-congenital, neurogenic, traumatic, or aponeurotic ptosis.METHODSThis study evaluated characteristics and postoperative outcomes of the above subjects, with emphasis on comparing outcomes between frontalis advancement alone or combined frontalis advancement with external levator advancement using a bilayer technique. Statistical testing included paired and Students t-testing, chi-squared testing, and multivariate linear regression.MAIN OUTCOME MEASURESThe primary outcome was change in marginal reflex distance-1 (MRD1). Secondary outcomes included change in lagophthalmos, eyelid symmetry, and adverse events.RESULTSNinety-two eyelids from 76 patients (mean age 6.9 ± 9.2 years) were included. Sixty-five eyelids underwent frontalis flap alone and 27 underwent frontalis flap+ELA. Both groups showed significant MRD1 improvement postoperatively (p<0.001 for both) at mean follow-up of 12.0 months. The frontalis flap+ELA group had significantly greater postoperative MRD1 (3.9 ± 0.8 mm vs. 3.2 ± 1.2 mm, p=0.004) and change in MRD1 (3.4 ± 1.2 mm vs. 2.5 ± 1.6 mm, p=0.002). Lagophthalmos remained stable from baseline in both groups and did not significantly differ between groups. No patients in the frontalis flap+ELA group required revision, compared to 7.6% in the frontalis-alone group. All patients achieved visual axis clearance at most recent follow-up.CONCLUSIONSFrontalis advancement flap, particularly when combined with external levator advancement using a bilayer technique, is a safe and effective surgical strategy for congenital ptosis with poor levator function, providing excellent eyelid elevation that optimizes visual axis clearance without the need for synthetic or autologous suspension materials.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145133953","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}