American Journal of Ophthalmology最新文献

{"title":"Comment on: Long-Term Retinopathy of Prematurity Outcomes with Mandated Screening Interval and Grader Continuity at a High-Volume Quaternary Center","authors":"Zewu Huang, Feng Chen","doi":"10.1016/j.ajo.2025.08.036","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.036","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899295","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: Tuuminen R, Hecht I, Kanclerz P. Comment on “Is there a safe glycemic threshold for cataract surgery?”","authors":"Zain S. Hussain, Zain M. Chauhan, Ahmed B. Sallam","doi":"10.1016/j.ajo.2025.08.017","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.017","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899300","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":"Optical Coherence Tomography and Optical Coherence Tomography Angiography Features of Optic Disc Melanocytoma: Peripapillary Hyperreflective Ovoid Mass-like Structures, Perfusion Deficits, and Association With Vision Loss","authors":"Ruiheng Zhang,&nbsp;Jiaoyue Dong,&nbsp;Yitong Li,&nbsp;Haotian Wu,&nbsp;Li Dong,&nbsp;Xuhan Shi,&nbsp;Wenda Zhou,&nbsp;Heyan Li,&nbsp;Chuyao Yu,&nbsp;Hanqing Zhao,&nbsp;Yuhang Yang,&nbsp;Shanshan Wang,&nbsp;Yao Huang,&nbsp;Yueming Liu,&nbsp;Wenbin Wei","doi":"10.1016/j.ajo.2025.08.040","DOIUrl":"10.1016/j.ajo.2025.08.040","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the structural and vascular alternations of optic disc melanocytoma (ODM) using optical coherence tomography (OCT) and OCT angiography (OCTA).</div></div><div><h3>Design</h3><div>Retrospective case-series study.</div></div><div><h3>Subjects</h3><div>This study included 34 eyes diagnosed with ODM and 15 eyes with juxtapapillary choroidal melanoma (CM) who referred to Beijing Tongren Hospital from July 2019 to March 2025.</div></div><div><h3>Methods</h3><div>All subjects underwent OCT and OCTA cover the macula and optic nerve head (ONH) region.</div></div><div><h3>Main Outcome Measures</h3><div>The presence of peripapillary hyperreflective ovoid mass-like structures (PHOMS) and ONH vessel density were quantitatively analyzed and correlated with clinical parameters.</div></div><div><h3>Results</h3><div>ODM was characterized as a hyper-reflectivity anterior surface and dense posterior optic shadowing. PHOMS were observed in the 30 cases of ODM (88.2%), significantly more frequent than in fellow eyes (17.1%, <em>P</em> &lt; .001). Epiretinal membrane was present in 20.6% of ODM cases, compared to fellow eyes (2.94%, <em>P</em> = .054). OCTA revealed reduced ONH vessel density in ODM eyes, predominately affecting the radial peripapillary capillary layer on the tumor surface, which resulted in 14 cases of localized radial peripapillary capillary atrophy and patchy nonperfusion areas on En-face images. Eyes with nonperfusion areas demonstrated worse visual acuity (LogMAR: 0.29 ± 0.36 vs 0.93 ± 1.29, <em>P</em> = .06), larger tumor basal diameter (3.9 vs 2.6 mm, <em>P</em> = .05), and tumor thickness (1.6 vs 1.1 mm, <em>P</em> = .03). No intrinsic tumor vasculature was identified within ODM, contrasting with the disorganized vascular network seen in all 15 cases of juxtapapillary CM.</div></div><div><h3>Conclusions</h3><div>ODM is associated with significant structural and vascular alterations, including PHOMS, ONH hypoperfusion, and eventually retinal nerve fiber layer atrophy. These features reflect both mechanical compression and ischemic injury to the optic nerve and can be used to assess visual prognosis. The absence of intrinsic tumor vasculature in ODM underscores its fundamental difference in biological behavior from juxtapapillary CM.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 238-247"},"PeriodicalIF":4.2,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899296","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":"Enhancing Early Keratoconus Detection With Multimodal Machine Learning: Integrating Tomography, Biomechanics, and Clinical Risk Factors","authors":"Kaiyue Du ,&nbsp;Rongmei Peng ,&nbsp;Yueguo Chen ,&nbsp;Bowei Yuan ,&nbsp;Haoran Wu ,&nbsp;Tiehong Chen ,&nbsp;Jianing Zhu ,&nbsp;Xunshan Zu ,&nbsp;Jiaojiao Wang ,&nbsp;Jing Cui ,&nbsp;Liang Han ,&nbsp;Jing Hong","doi":"10.1016/j.ajo.2025.08.035","DOIUrl":"10.1016/j.ajo.2025.08.035","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To develop and validate a machine learning (ML) diagnostic system that integrates Scheimpflug tomography, corneal biomechanics, and clinical risk factors (CRF) to enhance the early detection of keratoconus (KC).</div></div><div><h3>DESIGN</h3><div>Prospective, multicenter, cross-sectional study.</div></div><div><h3>PARTICIPANTS</h3><div>Patients diagnosed with KC and individuals evaluated in preoperative refractive surgery clinics.</div></div><div><h3>METHODS</h3><div>Demographic, lifestyle, and clinical ophthalmic data, including Pentacam and Corvis ST measurements, were collected from patients with KC and refractive surgery candidates across 5 centers between 2020 and 2024. The dataset was divided into training, validation, internal test, and external test sets. Least absolute shrinkage and selection operator regression was used to identify predictive variables. Six ML models were trained using 4 feature sets: CRF, device-derived parameters, combined features, and selected features.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC).</div></div><div><h3>RESULTS</h3><div>The dataset included 1035 eyes from 1035 participants across 5 centers: 590 normal controls, 157 eyes with forme fruste keratoconus (FFKC), 143 with subclinical KC, and 145 with clinical KC. For FFKC detection, the post-feature selection CatBoost model achieved the highest accuracy (AUROC = 0.975), outperforming the combined-feature (AUROC = 0.963), CRF-only (AUROC = 0.856), and device-only models (AUROC = 0.885) in the validation set. This model also outperformed the tomographic and biomechanical index in internal (AUROC = 0.976 vs 0.813; <em>P</em> = .048) and external testing (AUROC = 0.952 vs 0.847; <em>P</em> = .012). For subclinical and clinical KC, external testing yielded near-perfect performance (AUROC = 0.991 and 1.000, respectively).</div></div><div><h3>CONCLUSIONS</h3><div>A multimodal ML system integrating CRF, tomography, and biomechanics improved early KC detection, particularly for FFKC. This approach may enhance clinical decision-making and screening for refractive surgery candidates.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 334-346"},"PeriodicalIF":4.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938899","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":"A Novel Suture-Assisted Technique for the Surgical Removal of Intraocular Foreign Body","authors":"Lijian Fang, Ruiheng Zhang, Mingli Wang","doi":"10.1016/j.ajo.2025.08.044","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.044","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144901841","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 Intracellular Dark Spots on Specular Microscopy and Endothelial Cell Loss After Penetrating Keratoplasty","authors":"TAKAHIRO KANDA ,&nbsp;OSAMA M.A. IBRAHIM ,&nbsp;YURINA MORI-OGIWARA ,&nbsp;YUKARI YAGI-YAGUCHI ,&nbsp;KAZUNARI HIGA ,&nbsp;HIROTSUGU KASAMATSU ,&nbsp;TAIYO SHIJO ,&nbsp;DAISUKE TOMIDA ,&nbsp;HISASHI NOMA ,&nbsp;SHINSUKE SHIBATA ,&nbsp;MURAT DOGRU ,&nbsp;TAKEFUMI YAMAGUCHI","doi":"10.1016/j.ajo.2025.08.022","DOIUrl":"10.1016/j.ajo.2025.08.022","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the incidence and clinical implications of intracellular dark endothelial spots (IDES) following penetrating keratoplasty (PK) and their association with endothelial cell density (ECD) loss and graft failure.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study.</div></div><div><h3>Methods</h3><div>This study included 71 eyes that underwent PK and 33 control eyes that underwent cataract surgery. We evaluated the presence of IDES on specular microscopy, ECD, preoperative aqueous humor (AqH) protein and cytokine levels using Luminex. Follow-up examinations were conducted for 36 months postoperatively. Logistic regression analysis was performed to identify clinical risk factors for IDES development and graft survival.</div></div><div><h3>Results</h3><div>IDES developed in 40 PK eyes (56.3%). IDES was associated with exhibiting significantly lower ECD at all postoperative stages (<em>P &lt; .</em>001) and higher secondary graft failure rates compared to IDES-negative eyes (<em>P = .</em>014). Risk factors for IDES development after PK included the presence of an intraocular lens (<em>P = .</em>028), multiple previous intraocular surgeries (<em>P = .</em>0076), and lower preoperative donor ECD (<em>P = .</em>004). IDES-positive eyes with an ECD decrease of more than 50% within 12 months postoperatively had significantly higher preoperative AqH protein levels compared to those without such a decrease (<em>P = .</em>031). Kaplan-Meier analysis showed a higher rate of graft failure in IDES-positive eyes compared to those without (<em>P = .</em>014).</div></div><div><h3>Conclusions</h3><div>The development of IDES after PK appears to be associated with higher ECD loss and graft failure, suggesting its potential as a biomarker for endothelial cell loss and graft prognosis.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 182-192"},"PeriodicalIF":4.2,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938916","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":"Current Trends in US Ophthalmology Leadership Appointments: Descriptive and Comparative Analysis of Chairs Turnover in the Past Decade","authors":"Amir Sternfeld ,&nbsp;Edward Barayev ,&nbsp;Miriam Ehrenberg ,&nbsp;Gad Dotan","doi":"10.1016/j.ajo.2025.08.020","DOIUrl":"10.1016/j.ajo.2025.08.020","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize, analyze, and compare the profiles of United States (US) academic ophthalmology department chairs appointed in the past decade with those of their predecessors.</div></div><div><h3>Design</h3><div>Trend study.</div></div><div><h3>Subjects</h3><div>Sixty US ophthalmology chairs appointed from 2015 to 2024, and the 60 chairs they replaced.</div></div><div><h3>Methods</h3><div>Online search of publicly available resources conducted December 31, 2024.</div></div><div><h3>Main Outcome Measures</h3><div>Department chairs demographic and academic data.</div></div><div><h3>Results</h3><div>Chairs appointed in the past decade are on average significantly older than those appointed previously (54 years vs 50 years, <em>P</em> = .001). Additionally, they have a longer experience since residency completion (24 years vs 18 years, <em>P</em> = .001). The number of female chairs appointments increased significantly in the last 10 years; however, most new chairs continue to be males. Currently, females constitute 22% (<em>n</em> = 13) of appointed chairs, in contrast to 7% (<em>n</em> = 4) of retiring chairs (<em>P</em> = .033). A higher percentage of appointed chairs (20%, <em>n</em> = 12 vs 8%, <em>n</em> = 5, <em>P</em> = .114) had previously served as chairs of a different department. Additionally, new chairs obtain PhD degrees more frequently (18%, <em>n</em> = 11 vs 10%, <em>n</em> = 6, <em>P</em> = .001), and are almost always fellowship trained (93%, <em>n</em> = 56), specializing in glaucoma (27%, <em>n</em> = 16), vitreoretinal surgery (22%, <em>n</em> = 13), and cornea (22%, <em>n</em> = 13). Notably, in 90% (<em>n</em> = 54) of programs, there was a change in the chair’s subspecialty at the time of leadership exchange. Recently hired chairs published by the time they became department heads a significantly higher mean number of peer-reviewed articles than retiring chairs (67 articles vs 48 articles, <em>P</em> = .001); however, their h-indexes were similar (26 vs 25, <em>P</em> = .723). The academic scholarly output of hired chairs matched that of their predecessors in the department, as evidenced by both the number of articles published (<em>r</em> = 0.381, <em>P</em> = .001) and h-index (<em>r</em> = 0.374, <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Ophthalmology department chairs remain predominantly fellowship trained males specializing in glaucoma, vitreoretinal surgery, and cornea. Although women’s promotions as department heads have increased substantially over the past decade, they remain underrepresented in the ophthalmology chair position. Academic profiles of newly hired chairs closely resemble those of their predecessors, giving a rough estimate of the qualifications required to become chair at a certain institution.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 347-354"},"PeriodicalIF":4.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection Rate of Cataract-Related Gene Variants in Sporadic Childhood Cataract Patients in Southern China","authors":"Zhengfen Luo ,&nbsp;Shengjie Yin ,&nbsp;Chengyao Guo ,&nbsp;Xiaoyuan Yang ,&nbsp;Geng Wang ,&nbsp;Yingjie Cao ,&nbsp;Qingping Liu ,&nbsp;Xiaoqiang Xiao ,&nbsp;Chi Pui Pang ,&nbsp;Tsz Kin Ng ,&nbsp;Mingzhi Zhang","doi":"10.1016/j.ajo.2025.08.032","DOIUrl":"10.1016/j.ajo.2025.08.032","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To screen for disease-associated variants in the cataract-related genes in Chinese sporadic childhood cataract patients by whole exome sequencing analysis.</div></div><div><h3>DESIGN</h3><div>Prospective cohort study.</div></div><div><h3>SUBJECTS</h3><div>Total 145 sporadic childhood cataract patients from southern China were recruited.</div></div><div><h3>METHODS</h3><div>All patients and their parents received complete ophthalmic examinations. Rare variants in 495 reported cataract-related genes were identified by whole exome sequencing analysis and analyzed by multiple bioinformatics programs, including AlphaMissense and the Encyclopedia of Domains. The variants were verified by Sanger sequencing, and the variant protein structures were modeled by AlphaFold2.</div></div><div><h3>MAIN OUTCOMES MEASURES</h3><div>Disease-associated variants identified from 495 reported cataract-related genes.</div></div><div><h3>RESULTS</h3><div>In total, 155 rare variants were identified in 72 cataract-related genes in 127 patients by whole exome sequencing, which were not found in 200 unrelated control subjects. Of these variants, 11 previously reported variants were found in 15 patients, and 26 novel damaging variants were identified in 36 patients. <em>CRYAA</em> variants were detected with highest frequency among 6.21% cataract patients (9/145). In addition, genetic and allelic heterogeneities existed among the childhood cataract patients. The nonsense and frameshift variants had greater effects on the AlphaFold2-modeled protein structures than the missense variants.</div></div><div><h3>CONCLUSIONS</h3><div>This study revealed that 35.17% (51/145) sporadic childhood cataract patients in southern China harbored damaging variants in cataract-related genes, expanding the genetic variation spectrum of childhood cataracts.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 267-282"},"PeriodicalIF":4.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881840","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":"Short-Term Efficacy and Safety of Pilocarpine Ophthalmic Solution for Presbyopia: A Systematic Review and Meta-Analysis","authors":"Gabriel Nery Lima ,&nbsp;Dillan Cunha Amaral ,&nbsp;Yuri Aleksander Ivanov ,&nbsp;Lucas Dias Silva ,&nbsp;Leticia Ribeiro dos Santos ,&nbsp;Carlos Augusto Ferraresi Sampaio ,&nbsp;Leonardo Machado Sampaio ,&nbsp;Denisse J Mora-Paez ,&nbsp;Bruno Machado Fontes ,&nbsp;Edmundo Frota de Almeida Sobrinho ,&nbsp;Jaime Guedes","doi":"10.1016/j.ajo.2025.08.033","DOIUrl":"10.1016/j.ajo.2025.08.033","url":null,"abstract":"<div><h3>Topic</h3><div>This systematic review and meta-analysis (SRMA) addresses the clinical question: In patients with presbyopia, how does pilocarpine compare to a vehicle in improving near-vision acuity over a minimum follow-up of 2 weeks? Randomized clinical trials (RCTs) were included to assess the effectiveness of pilocarpine, an FDA-approved pharmacological alternative to traditional corrective measures.</div></div><div><h3>Clinical Relevance</h3><div>Presbyopia is a progressive age-related condition affecting near vision, impacting approximately 1.8 billion people worldwide. Glasses and contact lenses have limitations and can cause discomfort. In 2021, the FDA approved 1.25% pilocarpine hydrochloride ophthalmic solution (Vuity^Ⓡ) as a pharmacological alternative. Pilocarpine acts on muscarinic receptors to improve accommodation and depth of focus. Its efficacy and safety, however, require further investigation.</div></div><div><h3>Methods</h3><div>This SRMA followed the Cochrane Handbook and PRISMA guidelines. RCTs comparing pilocarpine to a vehicle in presbyopic patients were included. Efficacy outcomes were the gain of ≥3 lines and ≥2 lines in mesopic, high-contrast binocular distance-corrected near visual acuity (DCNVA) at 3 hours postdose after ≥14 days of treatment. Safety analyses focused on the most consistently reported reactions: headache, blurred vision, eye pain, and pupil size variation.</div></div><div><h3>Results</h3><div>Four RCTs with 1531 participants were included. Pooled data showed 33% of pilocarpine users gained ≥3 lines in DCNVA versus 12% in the vehicle group (OR 3.69, 95% CI [2.66-5.14], <em>P</em> &lt; .001) and 63% of pilocarpine users gained ≥2 lines versus 36% (OR 2.94, 95% CI [2.30-3.74], <em>P</em> &lt; .001). Pilocarpine increased the risk of headache (+6.9%; OR 3.02, 95% CI 1.53-5.93), blurred vision (+3.1%; OR 4.93, 95% CI 1.92-12.65), and eye pain (+2.4%; OR 4.26, 95% CI 1.73-10.49), mostly mild and transient. A marked miotic effect was also observed, with a mean pupil size reduction of 1.38 mm versus 0.02 mm in the vehicle group. Sensitivity analysis indicated that removing the VIRGO study reduced heterogeneity, suggesting dosing frequency influence.</div></div><div><h3>Conclusion</h3><div>Pilocarpine demonstrated short-term efficacy in improving near vision in presbyopic patients, with an increased incidence of specific, mostly mild and transient adverse events and a consistent miotic effect. Further large-scale, long-term RCTs are warranted to confirm benefits, optimize dosing, and fully characterize its safety profile.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 298-307"},"PeriodicalIF":4.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144938924","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":"Potency Matters: The Role of Statin Intensity in Modulating Risk for Age-Related Macular Degeneration","authors":"Zain S. Hussain ,&nbsp;Muhammad Z. Chauhan ,&nbsp;Jawad Muayad ,&nbsp;Asad Loya ,&nbsp;Wendy Nembhard ,&nbsp;Ahmed B. Sallam","doi":"10.1016/j.ajo.2025.08.024","DOIUrl":"10.1016/j.ajo.2025.08.024","url":null,"abstract":"<div><h3>Purpose</h3><div>Age-related macular degeneration (AMD) is a leading cause of vision loss. Statins, primarily used for cardiovascular disease prevention, may have pleiotropic effects on AMD, but existing evidence is inconclusive.</div><div>This study investigated the association between statin intensity (high, moderate, low) and the risk of AMD in patients with type 2 diabetes and dyslipidemia.</div></div><div><h3>Design</h3><div>A retrospective clinical cohort study using de-identified electronic health records from the US Collaborative Network.</div></div><div><h3>Methods</h3><div>Adults aged 40 years or older with type 2 diabetes, dyslipidemia, and at least 1 ophthalmologic visit were included from 2014 to 2024 Patients with confounding conditions (liver disease, HIV, etc.) and prior AMD diagnoses were excluded. Propensity score matching was used to balance covariates between statin intensity cohorts and a treatment-naïve control group.</div><div>Intensity groups included: high-intensity statin therapy (rosuvastatin 20-40 mg or atorvastatin 40-80 mg), high-intensity-naïve, medium-intensity statin therapy (rosuvastatin [5 mg, 10 mg], simvastatin [20 mg, 40 mg], fluvastatin [80 mg], pravastatin [40 mg, 80 mg], lovastatin [40 mg], atorvastatin [10 mg, 20 mg], or pitavastatin [1 mg, 2 mg, 4 mg]), and low-intensity statin therapy (simvastatin 5-10 mg, pravastatin 10-20 mg, lovastatin 10-20 mg, or fluvastatin 20-40 mg).</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of combined AMD (nonexudative and exudative), nonexudative AMD, exudative AMD, and all-cause mortality at 6 months, 1 year, 3 years, and 5 years after the index event. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazard regression models.</div></div><div><h3>Results</h3><div>After matching, a total of 20 282 patients were included. High-intensity statin use was associated with a reduced risk of combined AMD at 3 and 5 years (HR: 0.74 (95% CI: 0.57-094) and 0.79 (95% CI: 0.62-0.98), respectively). Medium-intensity statin therapy was associated with a significantly lower risk of combined AMD (HR range: 0.49 [95% CI 0.55-0.91] to 0.77 [95% CI: 0.60-0.98]) and exudative AMD (HR range: 0.19 [0.06-0.054] to 0.62 [95% CI: 0.40-0.96]) at all follow-up points. All statin intensities were associated with reduced all-cause mortality.</div></div><div><h3>Conclusions</h3><div>In this study of patients with type 2 diabetes and dyslipidemia, medium- and high-intensity, but not low-intensity, statin therapies were associated with a reduced risk of AMD. Further research is needed to confirm these findings and elucidate the underlying mechanisms.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 326-333"},"PeriodicalIF":4.2,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881841","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}