American Journal of Ophthalmology最新文献

{"title":"Updated Guidelines for Imaging the Choriocapillaris in Eyes with Age-Related Macular Degeneration Using Swept-Source OCT Angiography.","authors":"Alessandro Berni, Yuxuan Cheng, Mengxi Shen, Omar S El-Mulki, Gissel Herrera, Sara Beqiri, James D Kastner, Qinqin Zhang, Giovanni Gregori, Ruikang K Wang, Philip J Rosenfeld","doi":"10.1016/j.ajo.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.021","url":null,"abstract":"<p><strong>Purpose: </strong>To update the recommended guidelines when quantifying choriocapillaris (CC) flow deficits (FDs) in eyes with age-related macular degeneration (AMD) using swept-source optical coherence tomography angiography (SS-OCTA).</p><p><strong>Design: </strong>Evidence-based perspective.</p><p><strong>Methods: </strong>Review of literature and experience of authors.</p><p><strong>Results: </strong>A current challenge when quantifying CC FDs using SS-OCTA is the implementation of an objective compensation strategy to adjust for the signal attenuation arising under drusen in eyes with AMD. Our previous compensation strategy was used as a general approach to adjust for the OCTA signal attenuation associated with most drusen. However, the variability of the OCTA signal loss under drusen necessitated a more objective strategy that could be tailored to each case. We propose a compensation strategy using a parameter gamma (γ) that allows for the selection of an appropriate compensation level. The optimal γ value is identified as the one producing the most homogeneous OCT signal across the whole CC structural slab. This approach minimizes the possibility that areas of decreased flow in the compensated CC flow image might reflect drusen-related or compensation-related artifacts rather than true deficits. Additional lesions that present unique challenges when quantifying CC FDs include the presence of choroidal hypotransmission defects (hypoTDs) caused by calcified drusen (CaD) and hyperreflective foci (HRF) as well as choroidal hypertransmission defects (hyperTDs) caused by foci of atrophy. We recommend identifying and outlining these regions on an en face sub-retinal pigment epithelium (subRPE) slab with segmentation boundaries between 64 and 400 µm beneath Bruch's membrane (BM). The hypoTDs should be excluded from CC quantification because of the lack of significant OCTA signal, while the hyperTDs should be excluded from being compensated because doing so can artifactually increase the percentage of CC FDs.</p><p><strong>Conclusions: </strong>The analysis of CC FDs in AMD requires special attention to drusen, hypoTDs, and hyperTDs to avoid introducing artifacts. By properly adjusting the compensation levels under drusen and adjusting the quantification of CC FDs by accounting for hyperTDs and hypoTDs, researchers interested in measuring CC FDs in AMD can have greater confidence in their measurements, particularly when investigating the role of CC flow impairment in AMD progression.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224006","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 Management and Therapy Report.","authors":"Lyndon Jones, Jennifer P Craig, Maria Markoulli, Paul Karpecki, Esen K Akpek, Sayan Basu, Etty Bitton, Wei Chen, Deepinder K Dhaliwal, Murat Dogru, José Alvaro P Gomes, Miranda Koehler, Jodhbir S Mehta, Victor L Perez, Fiona Stapleton, David A Sullivan, Joseph Tauber, Louis Tong, Sònia Travé-Huarte, James S Wolffsohn, Monica Alves, Christophe Baudouin, Laura Downie, Giuseppe Giannaccare, Jutta Horwath-Winter, Zuguo Liu, Shizuka Koh, Messmer Elisabeth, Ernesto Otero, Edoardo Villani, Stephanie Watson, Kyung Chul Yoon","doi":"10.1016/j.ajo.2025.05.039","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.039","url":null,"abstract":"<p><p>This report provides an evidence-based review of current strategies to manage dry eye disease (DED). First-line management focuses on methods to replenish, conserve and stimulate the tear film, with an emphasis on ocular supplements, which remain the cornerstone of DED treatment. Meibomian gland dysfunction, a primary contributor to DED, is typically treated with warm compresses and a wide variety of in-office treatments, including device-driven technologies to warm the eyelids, intense pulsed light therapy, low-level light therapy and other new and emerging technologies. Lid hygiene treatments include lid wipes, anti-Demodex therapies, blepharoexfoliation and topical antibiotics. DED caused by certain etiological drivers can benefit from anti-inflammatory therapies, including corticosteroids, T-cell immunomodulatory topical drugs and a wide variety of pharmacological agents, in addition to biologic tear substitutes such as autologous serum and platelet-rich plasma. Emerging therapies, such as neuromodulation via nasal neurostimulation and novel pharmacological treatments offer potential future options. Advanced options, including amniotic membrane grafts and complex surgical methods, provide options for severe or refractory cases. Lifestyle modifications, including optimized blinking, dietary supplementation and environmental adjustments, play a crucial role in long-term management. Patient education and adherence to treatment regimens remain essential for sustained symptom relief. The TFOS DEWS III prescribing algorithm provides an evidence-based framework to offer guidance to clinicians in selecting relevant interventions based on disease etiology that aim to provide targeted management of the subtype of DED that an individual is experiencing.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224005","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 \"Retinal vascularization rate predicts retinopathy of prematurity and remains unaffected by low-dose bevacizumab treatment\".","authors":"Emer Chang, Amandeep Josan, Ravi Purohit, Sher A Aslam, Caroline Hartley, Chetan K Patel, Kanmin Xue","doi":"10.1016/j.ajo.2025.05.034","DOIUrl":"10.1016/j.ajo.2025.05.034","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214649","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":"Combined Accelerated Crosslinking With Laser In Situ Keratomileusis (LASIK) for Myopic Patients: A Systematic Review and Meta-Analysis","authors":"He Tian ,&nbsp;Le Chang ,&nbsp;Min Yang ,&nbsp;Yan Wang","doi":"10.1016/j.ajo.2025.05.042","DOIUrl":"10.1016/j.ajo.2025.05.042","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare laser in situ keratomileusis (LASIK) and Simultaneous LASIK and accelerated Crosslinking (LASIK Xtra) for myopia correction.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Internet was conducted up to October 1, 2024 to identify studies comparing LASIK and LASIK Xtra for myopia correction. The outcome of visual acuity and refraction, safety, efficiency, predictability, stability, postoperative corneal thickness and endothelial cell count were measure.</div></div><div><h3>Results</h3><div>A total of 1,647 eyes (836 LASIK, 811 LASIK Xtra) from 15 studies were included. LASIK demonstrated superior postoperative uncorrected distance visual acuity (UDVA) compared to LASIK Xtra, with a mean difference (MD) of –0.03 (8 studies, <em>n</em> = 750 eyes; 95% CI: –0.04 to –0.01, <em>P</em> = .007) at 1 month and (7 studies, <em>n</em> = 672 eyes; MD= –0.01 95% CI: –0.02 to 0.00, <em>P</em> = .02) for long-term results (≥6 months). No significant differences were found in corrected distance visual acuity (CDVA; 6 studies, <em>n</em> = 530 eyes; MD = 0.00, 95% CI: –0.01, 0.00, <em>P</em> = .32), spherical equivalent (14 studies, <em>n</em> = 1639 eyes; MD = 0.03, 95% CI: −0.03, 0.08; <em>P</em> = .40), safety (8 studies, <em>n</em> = 779 eyes; odds ratios [OR]= 0.70; 95% CI: 0.39, 1.26; <em>P</em> = .23), efficiency (11 studies, <em>n</em> = 921 eyes; OR = 0.75, 95% CI: 0.54, 1.05, <em>P</em> = .10), predictability (11 studies, <em>n</em> = 971 eyes; OR= 1.03, 95% CI: 0.72, 1.47, <em>P</em> = .86), stability (3 studies, <em>n</em> = 90 eyes; OR = 0.70, 95% CI: 0.21, 2.28, <em>P</em> = .55). Subgroup analysis indicated a higher risk of postoperative CDVA loss in the Ectasia Risk Group undergoing LASIK-Xtra (OR= 0.20, 95% CI: 0.04 to 0.97, <em>P</em> = .05). The 30 mW/cm² for 90 seconds (2.7 J/cm²) irradiation protocol in LASIK Xtra may resulted in worse UDVA compared to LASIK (MD= –0.01, 95% CI: –0.03 to –0.001, <em>P</em> = .05). The certainty of evidence for the outcomes ranged from \"low to very low\".</div></div><div><h3>Conclusions</h3><div>Current evidence suggests that LASIK offers a statistically significant advantage in UDVA compared to LASIK Xtra, especially when LASIK Xtra irradiation protocol of 30 mW/cm² for 90 seconds (2.7 J/cm²) is applied. However, given the low to very low certainty of evidence, these findings require cautious interpretation and further confirmation through long-term studies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 395-412"},"PeriodicalIF":4.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207366","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":"Inadvertent Scleral Perforation During Choroidal Melanoma Surgeries: Incidence, Risk Factors, Management, and Outcomes","authors":"HUNG-DA CHOU ,&nbsp;HEINRICH HEIMANN ,&nbsp;BERTIL E. DAMATO ,&nbsp;RUMANA N. HUSSAIN","doi":"10.1016/j.ajo.2025.05.043","DOIUrl":"10.1016/j.ajo.2025.05.043","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the incidence, risk factors, management, and outcomes of inadvertent scleral perforation during primary choroidal melanoma surgeries.</div></div><div><h3>Design</h3><div>A retrospective interventional case series from a national ocular oncology referral center.</div></div><div><h3>Subjects</h3><div>One thousand and eighty-one consecutive patients with choroidal melanoma who underwent primary ruthenium plaque or tantalum fiducial marker implantation surgery between January 2011 and December 2023 were reviewed from a clinical registry.</div></div><div><h3>Intervention</h3><div>Plaque surgery (n = 697) or marker surgery (n = 684).</div></div><div><h3>Main Outcomes and Measures</h3><div>Incidence and risk factors of inadvertent intraoperative scleral perforation and the related management and clinical outcomes.</div></div><div><h3>Results</h3><div>The incidence of scleral perforation was 6/697 (0.86%) for plaque and 1/684 (0.15%) for fiducial marker surgeries. Five of the 7 eyes with perforation had myopia or thin sclera. All perforations occurred between 16.3-17.6 mm from the fovea, corresponding to the equatorial region. Immediate management included cryotherapy (7/7 eyes), wound suturing (2/7 eyes), and intravitreal gas (2/7 eyes). During plaque removal surgery, the original scleral wound was torn open in 2/7 eyes, and scleral buckling was undertaken for the presence of perforation-associated subretinal fluid in 4/7 eyes. After a mean follow-up of 38 months (range, 9-87 months), no retinal detachment was noted, and the visual acuity remained unchanged in 5/7 eyes. All the tumors regressed, and there were no signs of seeding.</div></div><div><h3>Conclusions</h3><div>The incidence of inadvertent scleral perforation during plaque and fiducial marker implantation was low, and with immediate intervention, the prognosis was favorable. Myopic eyes, eyes with thin sclera, and suturing in the equatorial zone might be the risk factors. During plaque removal, we recommend combined scleral buckling to address perforation-related subretinal fluid and emphasize avoiding traction on the sclera to prevent a second tear. Further prospective studies are needed to understand this complication more comprehensively.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 356-364"},"PeriodicalIF":4.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207367","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":"Association Between Long-Term Ambient Air Pollution and Primary Open-Angle Glaucoma: A Nationwide Cohort Study in Taiwan","authors":"SHU-HAN CHUANG ,&nbsp;CHIEN-LIANG WU ,&nbsp;YEN THI THAO LE ,&nbsp;YU-PIN CHEN ,&nbsp;YI-JIE KUO ,&nbsp;CHENG-HSIEN CHANG","doi":"10.1016/j.ajo.2025.05.031","DOIUrl":"10.1016/j.ajo.2025.05.031","url":null,"abstract":"<div><h3>Objective</h3><div>Glaucoma is a leading cause of irreversible blindness worldwide, with incidence expected to increase with the aging global population. In this study, we aimed to investigate the association between long-term exposure to ambient air pollution and the risk of primary open- angle glaucoma (POAG).</div></div><div><h3>Design</h3><div>Retrospective, nationwide, population-based cohort study.</div></div><div><h3>Participants</h3><div>The study included 590,338 individuals aged 20 years and older who had no prior diagnosis of glaucoma and at least 10 years of air pollution exposure data. Seven air pollutants were examined: sulfur dioxide, carbon monoxide, particles less than 10 micrometers in diameter, particles less than 2.5 micrometers in diameter, nitrogen oxides, nitrogen monoxide, and nitrogen dioxide.</div></div><div><h3>Methods</h3><div>We utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan. Participants were followed from January 1, 2000, to December 31, 2013. To assess the association between air pollutants and POAG risk, air pollution data were linked to patients' residential postal codes recorded in insurance registration records. The cumulative daily average level of each pollutant was calculated for each participant over the 10-year exposure period.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was incident POAG, which was defined as patients who received an ICD-9-CM diagnosis code for POAG confirmed by an ophthalmologist during at least 2 outpatient visits, along with POAG treatment. Hazard ratios (HRs) for exposure at each standard deviation increment over ten years were calculated using Cox regression models adjusted for confounding variables.</div></div><div><h3>Results</h3><div>During the follow-up period, 3158 patients with POAG were identified (0.53% incidence). A 1-standard-deviation increase in the 10-year average pollutant level was associated with a significant increase in POAG risk, ranging from 40% to 108%. This association was consistently observed across pollutants, with the highest risk linked to carbon monoxide exposure; meanwhile sulfur dioxide showed the lowest increase.</div></div><div><h3>Conclusions</h3><div>Long-term exposure to air pollution is significantly associated with an increased risk of POAG. These findings highlight the critical need for further research and public health interventions to mitigate this risk, particularly in regions with high pollution levels.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 441-450"},"PeriodicalIF":4.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207365","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":"Performance of Artificial Intelligence-Based Models for Epiretinal Membrane Diagnosis: A Systematic Review and Meta-Analysis","authors":"David Mikhail ,&nbsp;Angel Gao ,&nbsp;Andrew Farah ,&nbsp;Andrew Mihalache ,&nbsp;Daniel Milad ,&nbsp;Fares Antaki ,&nbsp;Marko M. Popovic ,&nbsp;Reut Shor ,&nbsp;Renaud Duval ,&nbsp;Peter J. Kertes ,&nbsp;Radha P. Kohly ,&nbsp;Rajeev H. Muni","doi":"10.1016/j.ajo.2025.05.041","DOIUrl":"10.1016/j.ajo.2025.05.041","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Topic&lt;/h3&gt;&lt;div&gt;Epiretinal membrane (ERM) can impair central vision by forming a pre-retinal fibrous layer on the inner retina. Artificial intelligence (AI)–based tools may streamline ERM diagnosis, but their overall performance and factors affecting accuracy require evaluation.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Clinical Relevance&lt;/h3&gt;&lt;div&gt;With an aging population, ERM prevalence is expected to rise, placing increased demands on clinical resources. Early detection via AI models could expedite diagnosis, reduce subjective errors, and guide timely surgical intervention. This systematic review and meta-analysis evaluates the pooled diagnostic performance of AI models for detecting ERM and identifies study- and model-level factors influencing their performance.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Systematic review and meta-analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Comprehensive searches were conducted in Medline, Embase, Cochrane Library, Web of Science, and preprint databases from inception to June 2024. Included studies evaluated AI models for ERM diagnosis. Study quality and risk of bias were assessed using the Quality Assessment for Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A random-effects model was applied to pool diagnostic accuracy, sensitivity, specificity, and diagnostic odds ratio. Subgroup analyses explored factors affecting model performance. The study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO - CRD42024563571).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of 379 articles screened, 26 met inclusion criteria, and 19 contributed to the meta-analysis. Study settings were predominantly hospital-based (76.9%), with some studies from academic computer and biomedical science departments (15.4%) and community centers (7.7%). Quality assessments suggested low or unclear risk of bias and applicability concerns in 95% of studies. The pooled sensitivity was 90.1% (95% CI: 85.8-93.2), and the pooled specificity was 95.7% (95% CI: 88.8-95.2). Subgroup analysis showed higher specificity (97.1%, 95% CI: 96.0-97.9) in AI models using color fundus photographs than optical coherence tomography scans, which had a specificity of 92.6% (95% CI: 88.8-95.2). External validation was performed in 26.9% of studies. All included studies used expert human grading as the reference standard, of which 25 (96.2%) were based on the same imaging modality as the AI input. The proportion of ERM cases in development datasets varied across studies, particularly between single-disease and multiclass models.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;AI models demonstrate high diagnostic performance for ERM. However, limited external validation and variability in AI development methodologies limits direct comparison between models and real-world applicability. Future work should standardize model development and reporting practices, improve data interoperability, and develop prediction models to track disease progression and d","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 420-432"},"PeriodicalIF":4.1,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207368","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 Diagnostic Methodology.","authors":"James S Wolffsohn, José Benítez-Del-Castillo, Denise Loya-Garcia, Takenori Inomata, Geetha Iyar, Lingyi Liang, Heiko Pult, Alfonso L Sabater, Christopher E Starr, Jelle Vehof, Michael Tm Wang, Wei Chen, Jennifer P Craig, Murat Dogru, Victor L Perez Quinones, Fiona Stapleton, David A Sullivan, Lyndon Jones","doi":"10.1016/j.ajo.2025.05.033","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.033","url":null,"abstract":"<p><p>A standard approach to the diagnosis of dry eye disease across eye care practitioners is critical to reassuring the patient, providing consistency between practitioners and informing governments as to the true prevalence and resulting healthcare needs. The Tear Film & Ocular Surface Society (TFOS) Dry Eye Workshop (DEWS) III has reviewed the evidence-base since their previous reports published in 2017 and revised the definition to \"Dry eye is a multifactorial, symptomatic disease characterized by a loss of homeostasis of the tear film and/or ocular surface, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities are etiological factors.\" Key features from the definition include that dry eye disease is multifactorial, is a disease and not a syndrome and is always symptomatic. Differential diagnosis and ocular examination guidance is given along with the risk factors that should be discussed with the patient. The recommended screening questionnaire is the OSDI-6 with a cut-off score ≥4. A positive result together with a non-invasive breakup time <10s or alternatively tear film hyperosmolarity (≥308mOsm/L in higher eye or an interocular difference >8mOsm/L) gives a diagnosis of dry eye. In addition, the ocular surface should be stained and positive symptomology together with >5 corneal fluorescein and/or >9 conjunctival lissamine green punctate spots and/or lid margin lissamine green staining of ≥2mm length & ≥25 %width also gives a diagnosis of dry eye. Subclassification was separated into tear film (lipid, aqueous and mucin/glycocalyx) and ocular surface and adnexa (anatomical misalignment, blink/lid closure, lid margin, neural dysfunction, ocular surface cell damage/disruption and primary inflammation/oxidative stress) components, with appropriate clinical tests and cut-offs provided to identify these etiological drivers in an individual, to inform appropriate management and therapy.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207369","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":"Incidence and Predictors of Remission of Childhood Uveitis in a Large Community Cohort","authors":"Ying Qian ,&nbsp;Richie Houhong Xu ,&nbsp;Juleon W. Rabbani ,&nbsp;Lue-Yen Tucker","doi":"10.1016/j.ajo.2025.05.024","DOIUrl":"10.1016/j.ajo.2025.05.024","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To describe a large community cohort of incident cases of childhood uveitis and to determine incidence and predictors of remission.</div></div><div><h3>DESIGN</h3><div>Retrospective clinical cohort study.</div></div><div><h3>METHODS</h3><div>Participants were patients aged 16 years or younger who were newly diagnosed with uveitis at Kaiser Permanente Northern California, a large integrated health care system, between January 1, 2010, and December 31, 2020. Data were extracted electronically from medical records, pharmacy records, and health plan database. Incidence and predictors were determined using Cox regression modeling and survival analysis. The main outcome measure was the incidence of drug-free remission. For the primary analysis, remission was defined as no recurrence of active uveitis for at least 3 months beyond cessation of drug effect. Factors potentially predictive of remission were assessed.</div></div><div><h3>RESULTS</h3><div>Of 1643 patients with incident uveitis, 277 incident cases of noninfectious uveitis were identified, including 145 patients (52.3%) with chronic noninfectious uveitis who were treated for at least 3 months; of these, 75 patients (51.7%) were female and 102 patients (70.3%) had anterior uveitis. Mean age at initial treatment was 9.8 (SD = 4.31) years. Mean follow-up time was 41.3 (SD = 31.8) months. At 5-year follow-up, the cumulative probability of drug-free remission was 50.8% (95% CI = 41.7%-60.6%). Age at start of treatment (adjusted hazard ratio [aHR] = 1.18. 95% CI = 1.1-1.28) and male sex (aHR = 1.85; 95% CI = 1.11-3.08) were associated with higher incidence of remission. Baseline characteristics that did not reach significance included bilateral disease, anterior uveitis, posterior synechiae, cataract, juvenile idiopathic arthritis, visual acuity, tobacco exposure, and socioeconomic status. A dose–response survival effect was seen with increasing age at presentation.</div></div><div><h3>CONCLUSIONS</h3><div>Almost half of the children with newly diagnosed chronic noninfectious uveitis achieved drug-free remission within 5 years of follow-up, with the youngest least likely to achieve remission and the oldest most likely to achieve remission. Female sex and younger age at presentation were independent predictors of lack of remission of childhood uveitis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 221-229"},"PeriodicalIF":4.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191290","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: Retinal vascularization rate predicts retinopathy of prematurity and remains unaffected by low-dose bevacizumab treatment.","authors":"Shujuan Song, Hua Chai","doi":"10.1016/j.ajo.2025.05.037","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.037","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191274","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}