American Journal of Ophthalmology最新文献

{"title":"Subretinal Hyperreflective Material, Atrophy, and Intraretinal Fluid in Pachychoroid Neovasculopathy","authors":"Jiwon Baek ,&nbsp;Ho Ra ,&nbsp;Seung Hoon Lee ,&nbsp;Chui Ming Gemmy Cheung ,&nbsp;Won Ki Lee","doi":"10.1016/j.ajo.2025.08.048","DOIUrl":"10.1016/j.ajo.2025.08.048","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the association between subretinal hyperreflective material (SHRM), atrophy, and intraretinal fluid (IRF) in pachychoroid neovasculopathy (PNV).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Subjects</h3><div>A total of 120 eyes diagnosed with PNV and treated with antivascular endothelial growth factor for more than 1 year.</div></div><div><h3>Methods</h3><div>Central macular thickness (CMT), best-corrected visual acuity (BCVA), and the presence of SHRM, atrophy, fibrosis, subretinal fluid (SRF), and IRF were assessed at baseline, 3 months, and 1 year. SHRM and atrophy areas were also quantitatively measured. Comparisons were made between eyes with SHRM (SHRM [+]) and without SHRM (SHRM [−]) at baseline.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence and area of SHRM, development of atrophy and fibrosis, presence and resolution of IRF and SRF, changes in CMT and BCVA.</div></div><div><h3>Results</h3><div>At baseline, 57 eyes (47.5%) exhibited SHRM, which regressed in 85% after 1 year. Atrophy developed in 40% of eyes at 1 year, with 83.3% occurring in SHRM (+) eyes. Fibrosis was observed in 21.7% of eyes, with 92.3% in SHRM (+). IRF was more prevalent in SHRM (+) (all <em>P</em> ≤ .010) and showed limited resolution compared with SRF (McNemar <em>P</em> = .099 vs <em>P</em> &lt; .001). SHRM (+) eyes had thinner CMT and worse BCVA.</div></div><div><h3>Conclusions</h3><div>SHRM at baseline was associated with the development of atrophy, fibrosis, and IRF in PNV. Although most SHRM regressed after treatment, it frequently resulted in residual atrophy.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 472-480"},"PeriodicalIF":4.2,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924035","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":"Anterior lenticonus in persistent fetal vasculature","authors":"Panisa Singhanetr, Tresa Chambers, Hong-Uyen Hua","doi":"10.1016/j.ajo.2025.08.043","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.043","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899226","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 Long-Term Retinopathy of Prematurity Outcomes with Mandated Screening Interval and Grader Continuity at a High-Volume Quaternary Center","authors":"Cindy S. Zhao, Arthur R. Brant, Sarthak V. Shah, Edward H. Wood, Euna Koo, Rachael E. Antonini, Keithra Ortiz, Michael W. Gaynon, Darius M. Moshfeghi","doi":"10.1016/j.ajo.2025.08.037","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.037","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"57 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899228","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":"Development and Evaluation of an Artificial Intelligence Model to Set Target IOP for Glaucoma","authors":"Alex Pham ,&nbsp;Edgar Robitaille ,&nbsp;Chris Bradley ,&nbsp;Joshua de Souza ,&nbsp;Jithin Yohannan","doi":"10.1016/j.ajo.2025.08.046","DOIUrl":"10.1016/j.ajo.2025.08.046","url":null,"abstract":"<div><h3>Purpose</h3><div>Develop an artificial intelligence (AI) model to predict a personalized target intraocular pressure (IOP) for eyes with glaucoma. Compare the impact of achieving the AI-predicted, clinician-defined, and society guideline-based target IOP on rates of visual field (VF) worsening.</div></div><div><h3>Design</h3><div>Development and evaluation of an AI treatment algorithm</div></div><div><h3>Subjects</h3><div>A dataset of 14,871 eyes with a defined target IOP (set by glaucoma specialists during routine clinical care) and baseline OCT, VF, and clinical measurements. A non-overlapping progression dataset of 10,559 eyes with longitudinal VF testing (≥ 5 reliable tests).</div></div><div><h3>Methods</h3><div>We trained and tested a machine-learning model on the dataset of eyes with baseline structural, functional, and clinical data to predict a target IOP for each eye in the progression dataset. Linear models estimated the effect of mean target difference (measured IOP – target IOP) on the rate of VF worsening, defined by mean deviation (MD) slope. The effect of deviations from AI targets was compared to deviations from clinician-set targets and targets from society-based guidelines by the Canadian Ophthalmological Society (COS). Linear models also estimated the effect of mean absolute IOP on the rate of VF worsening. The effect of mean target difference (AI, clinician, or COS) was compared to the effect of mean absolute IOP.</div></div><div><h3>Main outcome measures</h3><div>Effect of 1 mm Hg increase in mean target difference (AI, clinician, or COS) on the rate of MD worsening (dB/year).</div></div><div><h3>Results</h3><div>The AI model achieved a mean absolute error of 2.28 mm Hg for predicting target IOP. AI and clinician target differences had similar effects on VF outcomes (0.032 dB/year vs 0.026 dB/year faster rate of MD worsening per 1 mm Hg increase, respectively, <em>p</em> = 0.09). AI and clinician target difference had greater effects than COS target difference (0.011 dB/year faster per 1 mm Hg increase, <em>p</em> &lt; 0.001) and mean absolute IOP (0.001 dB/year faster per 1 mm Hg increase, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>AI models can set target IOP with comparable performance to glaucoma specialists and are superior to utilizing mean IOP or society-based guidelines to set targets. Further work is needed to assess the clinical impact of AI-based target IOP guidance for patients managed by non-glaucoma specialists.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 423-435"},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899220","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":"Long-Term Outcomes of Iris-Fixated Phakic Intraocular Lenses in Low Myopia: A Retrospective Analysis With Over a Decade of Follow-up","authors":"Daniel Gómez Plaza,&nbsp;Laura González,&nbsp;José Luis Güell","doi":"10.1016/j.ajo.2025.08.039","DOIUrl":"10.1016/j.ajo.2025.08.039","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical indications and long-term outcomes—specifically efficacy, safety, predictability, and stability—of iris-fixated anterior chamber phakic intraocular lenses (pIOLs) in patients with low myopia spherical equivalent (SE) &lt;–6.00 diopters (D).</div></div><div><h3>Design</h3><div>Retrospective, single-center case series.</div></div><div><h3>Subjects</h3><div>A total of 155 eyes from 96 patients with SE &lt; –6.00 D underwent implantation with either Artisan or Artiflex pIOLs between 2009 and 2019. For long-term analysis, only eyes without prior intraocular surgery that received Artiflex lenses were included (<em>n</em> = 103).</div></div><div><h3>Methods</h3><div>Preoperative and annual postoperative assessments included uncorrected (UDVA) and corrected distance visual acuity (CDVA); efficacy index (postoperative UDVA/preoperative CDVA) and safety index (postoperative CDVA/preoperative CDVA); manifest refraction, SE, endothelial cell density (ECD), and intraocular pressure (IOP). Clinical indications for implantation were recorded. Descriptive statistics were conducted.</div></div><div><h3>Main Outcome Measures</h3><div>Frequency of clinical indications for implantation, visual acuity (UDVA, CDVA), manifest refraction including SE and astigmatism, refractive predictability and long-term stability, ECD, IOP, and incidence of adverse events.</div></div><div><h3>Results</h3><div>The mean preoperative SE was –4.64 ± 0.92 D and cylinder –0.86 ± 0.76 D. The average follow-up was 6.55 ± 4.08 years (range, 1-15 years). Topographic alterations (40.4%), central corneal thickness &lt;500 µm (21.1%), and stable keratoconus (8.5%) were the most common indications. At final follow-up, 71% and 87% of eyes were within ±0.50 D and ±1.00 D of the attempted SE correction, respectively. Postoperative astigmatism was &lt;1.00 D in 93% of eyes. Efficacy and safety indices were 0.90 and 1.02 at 1 year and remained stable over time (<em>P</em> = .140 and <em>P</em> = 1.000, respectively). The mean annual ECD loss was 38.6 cells/mm²/y, corresponding to an annualized percentage loss of 1.11%. IOP remained stable throughout follow-up. Four eyes (2.58%) required IOL explantation.</div></div><div><h3>Conclusions</h3><div>Over more than 10 years of follow-up, long-term results indicate that Artiflex pIOL implantation is effective, predictable, stable, and safe in patients with low myopia &lt;–6 D of SE.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 355-369"},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899224","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":"Early 'Crunch' Effect after Anti-VEGF Therapy for A-ROP: OCT Evidence that Macular Retinoschisis Precedes Tractional Retinal Detachment","authors":"Jiyuan Zhong, Ke Hu, Wentao Dong","doi":"10.1016/j.ajo.2025.08.042","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.042","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"27 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899227","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":"Does Retinal Artery Occlusion Increase the Risk of Following Acute Coronary Syndrome and All-cause Mortality? A Systematic Review and Meta-Analysis","authors":"ERFAN HASHEMI ,&nbsp;FRANCISCO J. BONILLA-ESCOBAR ,&nbsp;HOMA MAZAHERINIA ,&nbsp;MEHDI AZIZMOHAMMAD LOOHA ,&nbsp;DANIEL SÁNCHEZ-CANO ,&nbsp;J. FERNANDO AREVALO","doi":"10.1016/j.ajo.2025.08.041","DOIUrl":"10.1016/j.ajo.2025.08.041","url":null,"abstract":"<div><h3>Topic</h3><div>This meta-analysis examined whether retinal artery occlusion (RAO) increases the risk of acute coronary syndrome (ACS) and all-cause mortality compared to non-RAO individuals. It pooled data from 11 studies (502,291,692 participants; 94,410 with RAO) across Asian, European, and American populations, with 5-10 year follow-ups. It assessed how RAO type (Central/CRAO vs. Branch/BRAO), geography, sex, and comorbidities influenced outcomes.</div></div><div><h3>Clinical Relevance</h3><div>Cardiovascular diseases, including ACS and mortality, are a major global burden. The link between RAO—a potential marker of systemic vascular disease—and these outcomes remains unclear, necessitating this comprehensive evaluation.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines (PROSPERO: CRD42023472877), PubMed, EMBASE, Web of Science, and Scopus were searched through June 2024, and then updated on August 11, 2025. Cohort studies reporting RAO's association with ACS or mortality were included. Study quality was assessed using the Newcastle-Ottawa Scale and the GRADE. Pooled relative risks (RR) were calculated using random-effects models.</div></div><div><h3>Results</h3><div>RAO significantly increased the risk of ACS (RR:1.56, 95%CI = 1.22-1.99) and all-cause mortality (RR: 2.00, 95%CI = 1.22-3.28). Risks were higher for CRAO than BRAO for both ACS (RR: 2.70, 95%CI = 1.57-4.66) and mortality (RR: 1.59, 95%CI = 1.27-1.99). Asian populations faced greater ACS (RR: 1.87, 95%CI = 1.45-2.42) and mortality (RR: 4.63, 95%CI = 1.89-11.31) risks versus non-Asian groups. Among comorbidities, atrial fibrillation posed the highest ACS risk (RR: 2.46, 95%CI = 1.34-4.54), followed by hypertension (RR: 1.99, 95%CI = 1.31- 3.03), hyperlipidemia (RR: 1.86, 95%CI = 1.42-2.44), and diabetes (RR: 1.65, 95%CI = 1.11-2.46).</div></div><div><h3>Conclusion</h3><div>RAO is a potential sentinel event and significant independent marker for cardiovascular risk, underscoring the need for thorough cardiovascular assessment and early intervention in affected patients. Prospective studies should clarify causality and explore targeted prevention strategies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 370-389"},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899225","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":"Intraocular Pressure and Ocular Perfusion Pressure in Central Serous Chorioretinopathy","authors":"Felice Cardillo Piccolino ,&nbsp;Alessandro Arrigo ,&nbsp;Paolo Forte ,&nbsp;Lorenzo Mangoni ,&nbsp;Jennifer Cattaneo ,&nbsp;Daniela Fruttini ,&nbsp;Francesco Bandello ,&nbsp;Massimo Nicolò ,&nbsp;Chiara Maria Eandi ,&nbsp;Marco Lupidi","doi":"10.1016/j.ajo.2025.08.045","DOIUrl":"10.1016/j.ajo.2025.08.045","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether intraocular and ocular perfusion pressure (IOP and OPP, respectively) are significantly associated with central serous chorioretinopathy (CSCR) and compare their degree of disease prediction with that of anterior scleral thickness (AST).</div></div><div><h3>Design</h3><div>Cross-sectional study comparing cases and controls.</div></div><div><h3>Subjects</h3><div>Eighty patients with CSCR and 80 healthy controls.</div></div><div><h3>Methods</h3><div>Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected with an automatic electronic sphygmomanometer, and IOP was determined using Goldman tonometry. Mean OPP was calculated as MOPP = ⅔ [DBP + ⅓ (SBP-DBP)] - IOP. AST was obtained at nasal and temporal gaze positions. Logistic regression models were computed to determine the correlation between risk factors and the presence of the disease. The ROC curve was used to compare the disease probability across different classifier models and determine the best cut-off values ​to distinguish patient subgroups.</div></div><div><h3>Main Outcome Measures</h3><div>IOP, blood pressure measurements, and AST.</div></div><div><h3>Results</h3><div>Patients with CSCR showed greater AST (498 ± 55 vs 455 ± 40 μm, <em>P</em> = .03) and choroidal thickness (435 ± 106 vs 321 ± 76 μm, <em>p</em> &lt; .001), higher blood pressure (SBP: 130.6 ± 13.4 vs 124.8 ± 5.6 mm Hg, <em>P</em> = .001; DBP: 82.8 ± 9.6 vs 77.0 ± 7.1 mm Hg, <em>p</em> &lt; .001), and lower IOP (12.7 ± 1.8 vs 16.1 ± 1.6 mm Hg, <em>P</em> &lt; .001) than the controls, resulting in higher MOPP (57.3 ± 6.6 vs 51.2 ± 3.9 mm Hg, <em>p</em> &lt; .001). ROC curve analysis revealed IOP as the strongest disease predictor (AUC = 0.914), significantly superior to MOPP (AUC = 0.813, <em>P</em> = 0.0096) and AST (AUC = 0.737, <em>P</em> = 0.0001). Using best cut-offs (IOP ≤ 14 mm Hg; AST &gt; 454.5 μm), we identified two distinct CSCR subgroups: 13 eyes with low IOP and 12 with high AST. Both groups displayed similar structural chorioretinal biomarkers and systemic hemodynamic findings.</div></div><div><h3>Conclusions</h3><div>This study demonstrates a significant association of low IOP, high MOPP, and high AST values with CSCR. IOP was a more significant predictor of CSCR than the other two factors, indicating its major role in the pathogenesis of the disease. Low IOP can promote CSCR pathogenesis by increasing the OPP, which favors choroidal overperfusion and exudation, and reducing the interstitial fluid clearance across the sclera.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 414-422"},"PeriodicalIF":4.2,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899223","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":"Clinical Efficacy of Switching to Faricimab in Treatment Resistant Neovascular Age-Related Macular Degeneration: Systematic Review and Meta-analysis","authors":"CHARLES ZHANG ,&nbsp;GEORGES ABOUKASM ,&nbsp;DANIEL A LAI ,&nbsp;NICHOLAS LEUNG ,&nbsp;DANIEL ZHU ,&nbsp;THOMAS A ALBINI ,&nbsp;NICOLAS A YANNUZZI","doi":"10.1016/j.ajo.2025.08.034","DOIUrl":"10.1016/j.ajo.2025.08.034","url":null,"abstract":"<div><h3>Topic</h3><div>Faricimab in the treatment of treatment-resistant neovascular age-related macular degeneration (nAMD).</div></div><div><h3>Clinical Relevance</h3><div>While many studies on faricimab in treatment-resistant eyes have reported improvements in retinal thickness (RT), the impact on visual acuity (VA) remains inconsistent. Additionally, variability in dosing protocols—with some studies utilizing loading interval for the first 3 injections while others continuing at the prior injection interval—introduces further uncertainty regarding the optimal treatment strategy. Understanding these differences is essential for guiding clinical decision-making and maximizing patient outcomes.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420251000088). A systematic search of PubMed, Embase, and Scopus (February 3, 2025) identified studies evaluating the effects of switching to faricimab in treatment-resistant nAMD. Inclusion criteria required patients to have received ≥3 prior anti-VEGF injections and ≥3 faricimab injections, with reported outcomes on RT, VA, fluid status, or injection intervals. Outcomes were measured following completion of loading dose and at last follow up, ranging from 3 months to 1.5 years. Studies were assessed for bias using ROBINS-I and NIH Quality Assessment tool and assessed for certainty of evidence using GRADE. Meta-analyses were conducted using mean differences, odds ratio, and random-effects models.</div></div><div><h3>Results</h3><div>Fourteen studies (926 eyes) met inclusion criteria. Switching to faricimab significantly reduced RT by 46.67 µm (95% CI: 35.91-57.42, I² = 0%, 721 eyes). Eyes that followed a loading interval were found to have greater reduction in RT than those that did not (I² = 74.1%, 640 eyes). The odds of achieving a dry macula increased 4.35-fold (95% CI: 2.95-6.42, I² = 64%, 379 eyes). Eyes with baseline VA &lt;65 ETDRS letters showed a gain of 3.16 letters (95% CI: 0.80-5.52, I² = 0%, 439 eyes). Injection intervals were extended by 1.56 weeks (95% CI: 0.71-2.40, I² = 86%, 591 eyes). Using GRADE, 4 outcomes were graded as either very low (VA, dryness, and treatment interval) or low (RT).</div></div><div><h3>Conclusion</h3><div>Switching to faricimab in treatment-resistant nAMD eyes significantly improved RT with no change in VA. This effect was greater with a loading interval protocol. Overall, there was an extension of injection intervals. Further prospective studies are needed to optimize dosing strategies and assess long-term efficacy.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 248-266"},"PeriodicalIF":4.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899253","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":"Hypertransmission and Vision in Aging and Age-Related Macular Degeneration: Longitudinal Data From ALSTAR2","authors":"Will Johnston ,&nbsp;Sarah S. Kim ,&nbsp;Deepayan Kar ,&nbsp;Liyan Gao ,&nbsp;Mark E. Clark ,&nbsp;Gerald McGwin Jr. ,&nbsp;Kenneth R. Sloan ,&nbsp;Cynthia Owsley ,&nbsp;Christine A. Curcio ,&nbsp;Lukas Goerdt","doi":"10.1016/j.ajo.2025.08.038","DOIUrl":"10.1016/j.ajo.2025.08.038","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the presence of hypertransmission (HT) in normal aging, early (e)AMD, and intermediate (i)AMD, changes over 3 years, and the impact of HTs ≥ 250 µm (LHyperTD) on 7 tests of scotopic, mesopic, and photopic vision.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Subjects</h3><div>Participants of the Alabama Study on Early Age-Related Macular Degeneration 2.</div></div><div><h3>Methods</h3><div>ALSTAR2 participants underwent spectral domain optical coherence tomography angiography (OCTA), color fundus photography, and vision testing at baseline and 3-year follow-up. HT presence and stepped diameters in choroidal en face slabs were assessed with custom review software. Only LHyperTD were analyzed at follow-up. AMD was staged via AREDS 9-step. Vision at baseline and follow-up between eyes with and without LHyperTD was analyzed with linear regression.</div></div><div><h3>Main outcome measures</h3><div>Presence, size, and illustrative examples of HT, association with tests of photopic, mesopic and scotopic vision.</div></div><div><h3>Results</h3><div>Baseline data was available on 460 eyes of 460 patients (mean age 71.5 ± 5.7 years, 277 female; 236 normal, 134 eAMD, 90 iAMD). HT of any size were found in iAMD (86.7%), eAMD (35.1%), and normal (3.8%) eyes, with proportional LHyperTD (13.3% vs 4.2% vs 0.4%, <em>P</em> &lt; .01). For 339 eyes (mean age 71.2 ± 5.8 years, 206 female, 181 normal, 92 eAMD, 66 iAMD), LHyperTD presence significantly increased in normal (<em>P</em> = .01) and iAMD (<em>P</em> &lt; .01) but not in eAMD eyes. At baseline, photopic contrast sensitivity (CS), mesopic CS, and rod intercept time (for rod mediated dark adaptation, RMDA) were worse in eyes with LHyperTD compared to eyes without (all <em>P</em> &lt; .01). At follow-up, the same were worse in LHyperTD (all <em>P</em> &lt; .01), as well as low luminance visual acuity (<em>P</em> &lt; .01) and scotopic light sensitivity (<em>P</em> = .05).</div></div><div><h3>Conclusion</h3><div>LHyperTD are rare in normal and eAMD eyes and associate with mesopic and scotopic visual functions in addition to risk-indicating RMDA. Delayed RMDA reflects other factors other than LHyperTD including differences in disease stage. Our analysis of HT &lt; 250 µm may inform other studies of early disease. LHyperTD are best utilized as imaging biomarkers for later stages of iAMD than ALSTAR2.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 399-413"},"PeriodicalIF":4.2,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899254","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}