American Journal of Ophthalmology最新文献

{"title":"Catering to the Era of Gene Therapy: An Objective Staging Strategy for Bietti Crystalline Dystrophy using Principal Component Regression","authors":"Chenyue Hang ,&nbsp;Ting Zhang ,&nbsp;Zhixuan Chen ,&nbsp;Tianyuan Zhao ,&nbsp;Junran Sun ,&nbsp;Tong Li ,&nbsp;Xiaoling Wan ,&nbsp;Yuanyuan Gong ,&nbsp;Suqin Yu ,&nbsp;Huixun Jia ,&nbsp;Jieqiong Chen ,&nbsp;Xiaodong Sun","doi":"10.1016/j.ajo.2025.05.018","DOIUrl":"10.1016/j.ajo.2025.05.018","url":null,"abstract":"<div><h3>Purpose</h3><div>To devise a novel and objective staging strategy of Bietti crystalline dystrophy (BCD) for gene therapy.</div></div><div><h3>Design</h3><div>Development and validation of severity and staging assessments.</div></div><div><h3>Methods</h3><div>We screened out 127 BCD patients from a cohort of 2146 patients with inherited retinal diseases (IRDs). Our study analyzed 6 critical indicators: age, LogMAR BCVA, absent autofluorescence (AF) area, mottled AF area, and average retinal thickness in ETDRS 1 mm circle and 3 mm ring. Using Principal Component Regression (PCR), we developed a quantitative model termed the Bietti Crystalline Dystrophy Score for Severity Assessment (BCD-SA Score), integrating indicators for disease severity. Additionally, a corresponding staging system (BCD-SA Stage) was derived from this model. We assessed the efficacy of the BCD-SA Stage, comparing it to the traditional staging strategy through a paired-sample t-test and Cohen's Kappa (κ) for agreement evaluation.</div></div><div><h3>Results</h3><div>The patients’ mean age was 47.96 ± 10.1 years. Spearman correlation analysis and univariate linear regression demonstrated a strong correlation between all indicators and the disease stages defined by the traditional method (<em>P</em> &lt; .001). Principal Component Analysis (PCA) addressed the multicollinearity among indicators, extracting 2 linear uncorrelated principal components (PCs, Factor 1 and Factor 2). These PCs were then used in a multiple linear regression model to develop the BCD-SA Score. Subsequently, a novel and objective staging system (BCD-SA Stage) was created, providing a more precise disease delineation.</div></div><div><h3>Conclusions</h3><div>We developed an innovative and objective scoring and staging strategy for BCD by integrating 6 variables and utilizing the PCR approach. This strategy advances BCD assessment and serves as a benchmark for the natural history evaluation and staging of other IRDs.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 269-279"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Anterior Lamellar Keratoplasty With Manual Stromal Dissection for Descemetocele: A Technique for Endothelium Preservation.","authors":"Nilay Kandemir Besek, Sibel Ahmet","doi":"10.1016/j.ajo.2025.05.026","DOIUrl":"10.1016/j.ajo.2025.05.026","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179618","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":"Hormonal Contraception and Retinal Vascular Occlusion Risk","authors":"SIAR NIAZI ,&nbsp;FILIP GNESIN ,&nbsp;BAKER NAWFAL JAWAD ,&nbsp;ZIA NIAZI ,&nbsp;ELLEN LØKKEGAARD ,&nbsp;LINA MØRCH ,&nbsp;CHRISTIAN TORP-PEDERSEN ,&nbsp;YOUSIF SUBHI ,&nbsp;AMANI MEAIDI","doi":"10.1016/j.ajo.2025.05.027","DOIUrl":"10.1016/j.ajo.2025.05.027","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the association between hormonal contraceptive use and the risk of retinal vascular occlusions in women of reproductive age.</div></div><div><h3>Design</h3><div>Register-based, nationwide cohort study.</div></div><div><h3>Participants</h3><div>A total of 2,208,172 women aged 15-49 years were followed from January 1, 1996, to June 30, 2021, excluding those with prior venous or arterial thrombosis, thrombophilia, cancer (except non-melanoma skin cancer), liver disease, chronic kidney disease, hysterectomy, bilateral oophorectomy, hormone therapy, infertility treatment, endometriosis, or polycystic ovary syndrome.</div></div><div><h3>Methods</h3><div>Women were followed until study end, age 50, emigration, death, or occurrence of exclusion criteria. Individual-level, time-updated hormonal contraception use was identified through prescription records; retinal vascular occlusion events were detected through hospital diagnoses. Poisson regression models estimated incidence rate ratios of retinal vascular occlusion by duration, dosage, and type of hormonal contraceptives, adjusting for age, educational level, hypertension, diabetes, hypercholesterolemia, atrial fibrillation/flutter during observation.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted incidence rate ratios (AIRR) and standardized incidence rate differences (SIRD) of retinal vein occlusion and retinal artery occlusion with hormonal contraceptive use compared to non-use.</div></div><div><h3>Results</h3><div>The cohort contributed 23,882,016 person-years with a median follow-up time of 10 years (1st to 3rd quartile: 4 to 17). Compared to non-use, current hormonal contraception use was associated with a 40% increased rate of retinal vein occlusion (AIRR 1.4, 95% Confidence Interval (95% CI): 1.1-1.8), corresponding to SIRD of 4.6 (95% CI: 0.9-8.4) additional cases per 1,000,000 person-years. AIRR of retinal artery occlusion was 1.2 (95% CI: 0.8-1.7) with current hormonal contraception use compared to non-use.</div><div>The increased rate of retinal vein occlusion persisted with use of combined oral contraceptives containing 30-40 µg of estrogen (AIRR 1.6, 95% CI: 1.2-2.3), while no increased rate was observed with the low-dose 20 µg combined contraceptives (AIRR 0.7, 95% CI: 0.3-1.5). No increase observed with use of hormonal intrauterine devices.</div></div><div><h3>Conclusion</h3><div>Combined oral contraceptives containing 30-40 µg estrogen were associated with an increased rate of retinal vein occlusion compared to non-use, although the absolute increase was low. No increased rate was observed for retinal artery occlusions.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 286-294"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180537","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":"RPGR-Related Retinal Dystrophy in Latin America—A Collaborative Study","authors":"Malena Daich Varela ,&nbsp;Rene Moya ,&nbsp;José D. Luna ,&nbsp;Marcela Ciccioli ,&nbsp;M. Eugenia Inga ,&nbsp;Julieta Gras ,&nbsp;Pedro J. Nuova ,&nbsp;Luciana Capalbo ,&nbsp;Alejandra Antacle ,&nbsp;Laura Echandi ,&nbsp;Angelica Moussali ,&nbsp;Alejandro Sanders Villa ,&nbsp;Marcela Pérez Araya ,&nbsp;Tamara Muhlberger ,&nbsp;Rocio A. Villafuerte-de la Cruz ,&nbsp;Adda Villanueva ,&nbsp;Tania Barragán Arévalo ,&nbsp;Olivia Araujo Zin ,&nbsp;Thiago Carvalho Barros de Oliveira ,&nbsp;Fernanda Belga Ottoni Porto ,&nbsp;Juliana Maria Ferraz Sallum","doi":"10.1016/j.ajo.2025.05.025","DOIUrl":"10.1016/j.ajo.2025.05.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide the first genetic and clinical characterization of <em>RPGR</em>-associated inherited retinal diseases (IRDs) in Latin America and assess their genetic, clinical, and socioeconomic landscape.</div></div><div><h3>Design</h3><div>Multicenter, international, retrospective, observational cohort study.</div></div><div><h3>Methods</h3><div>Patients with genetically confirmed <em>RPGR</em>-IRD from Brazil, Argentina, Chile, Mexico, Colombia, and Panama were included in this study. Demographic, clinical, genetic, and socioeconomic data were collected and analyzed to characterize disease prevalence and severity, assess rate of progression, and draw genotype-phenotype correlations. A socioeconomic evaluation analyzed healthcare costs and employment.</div></div><div><h3>Results</h3><div>The study describes the largest cohort to date of patients with <em>RPGR</em>-associated IRD, with 314 individuals from 205 families carrying likely disease-causing variants. Of these, 276 individuals (88%) had retinitis pigmentosa, with a mean age of disease onset at 10.9 ± 7.6 years. Analyzed cross-sectionally at the baseline visit (age 27.3 ± 17.2 years), there was a statistically significant association between age and best-corrected visual acuity (BCVA, <em>P</em> &lt; .0001, R² = 0.3). Kaplan–Meier analysis showed that more than 90% of patients would maintain binocular BCVA better than 1.0 logMAR until age 40 years, decreasing to 50% by age 57 years, and by 58 years of age 50% of patients would have discernible subfoveal ellipsoid zone. The mean age of male patients whose BCVA was 1.0 logMAR or worse in their better-seeing eye was 48.3 ± 9.5 years (median, 49 years). Fourteen previously unreported variants in <em>RPGR</em> are described. Among patients who declared employment status (n = 122), 43% reported being unemployed or in part-time employment due to their visual impairment; among those who reported mental health well-being (n = 133), 45% reported depression or anxiety.</div></div><div><h3>Conclusions</h3><div>This study provides the first genetic and clinical characterization of <em>RPGR</em>-IRD in Latin America, contributing previously unreported variants, natural history details, genotype-phenotype correlations, and an estimated regional prevalence. By providing data on potentially eligible patients, their clinical status, and the socioeconomic impact of <em>RPGR</em>-IRDs, this study lays the foundation for potential access to <em>RPGR</em> future therapies in Latin America.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 313-322"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144179487","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":"Physician Burden and Time Delays in Initiating Immunomodulatory Therapy for Noninfectious Uveitis and Inflammatory Eye Diseases","authors":"Munevver N. Duran ,&nbsp;Karen Beltran ,&nbsp;Jennifer H Cao","doi":"10.1016/j.ajo.2025.05.029","DOIUrl":"10.1016/j.ajo.2025.05.029","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To assess the additional time and effort required and resultant delays imposed by insurance-mandated prior authorization for medications treating uveitis and ocular inflammatory disease.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort study.</div></div><div><h3>PARTICIPANTS</h3><div>Patients with uveitis and ocular inflammatory disease at the University of Texas Southwestern Medical Center requiring approval for new systemic immunomodulatory therapy between February 2023 and January 2024. Infusion-related medications were excluded.</div></div><div><h3>METHODS</h3><div>Electronic medical records were reviewed to assess prior authorization requests, appeals, and related data for initiating therapy.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>Success rate of obtaining requested medications, time to initiation, additional steps required (eg, appeals, peer-to-peer consultations), factors influencing approval (eg, insurance subtype, medication class), and reliance on patient assistance programs.</div></div><div><h3>RESULTS</h3><div>A total of 83 patients had 107 requests for new immunomodulatory therapy. Uveitis subtypes included pemphigoid (38%), anterior uveitis (13%), intermediate uveitis (8%), posterior uveitis (1%), panuveitis (35%), and scleritis (5%). Medications included methotrexate (20.6%), mycophenolate mofetil (12.1%), adalimumab (34.6%), tocilizumab (1.9%), baricitinib (16.8%), and tofacitinib (9.3%), with 75% considered “off-label.” Approval rates were 100% for on-label and 52.3% for off-label medications (<em>P</em> = .033). Off-label requests were twice as likely to be denied, requiring more appeals (1.07 vs 0.50; <em>P</em> = .01). Average time to initiation was 28 days for on-label and 41 days for off-label medications (<em>P</em> = .01). Private insurance had higher approval rates than Medicare for off-label requests (59.5% vs 36.4%; <em>P</em> = .05). Patient assistance programs were required in 63% of cases.</div></div><div><h3>CONCLUSION</h3><div>Prior authorization creates significant administrative burdens and delays, disproportionately affecting off-label therapies and delaying critical vision-preserving treatments.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 280-285"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180588","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":"Screening Corneal Tomography for the Diagnosis of Keratoconus in Pediatric Patients With Trisomy 21","authors":"Casey G. Smith ,&nbsp;Rebecca G. Edwards Mayhew ,&nbsp;Jasleen K. Singh ,&nbsp;Jennifer L. Patnaik ,&nbsp;Brandie D. Wagner ,&nbsp;Ronald E. Wise ,&nbsp;Jennifer L. Jung ,&nbsp;Michael A. Puente ,&nbsp;Francis Hickey ,&nbsp;Cheryl Fonteh ,&nbsp;Emily A. McCourt","doi":"10.1016/j.ajo.2025.05.014","DOIUrl":"10.1016/j.ajo.2025.05.014","url":null,"abstract":"<div><h3>Purpose</h3><div>The goal of this study is to describe the rates of successful corneal tomography in children with Down Syndrome (DS) and to determine whether high levels of astigmatism or myopia are reliable indicators of keratoconus in children with DS.</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional study.</div></div><div><h3>Subjects and controls</h3><div>Patients aged 4 to 18 years old with and without DS who underwent corneal tomography to evaluate for keratoconus at a tertiary pediatric hospital from July 2018-January 2020.</div></div><div><h3>Methods</h3><div>Main observation performed was identifying keratoconus and the success of tomography in patients with down syndrome.</div></div><div><h3>Main Outcome Measures</h3><div>Refractive error at the time of keratoconus diagnosis.</div></div><div><h3>Results</h3><div>358 patients with DS were seen during the study period, and 96 patients without DS were evaluated for keratoconus. Among the patients with DS screened for keratoconus, useful images were obtained in at least 1 eye in 75.9% of patients. We compared patients with and without DS who were diagnosed with keratoconus or keratoconus suspect. At the time of keratoconus diagnosis, children with DS had less astigmatism and myopia than children without DS. Within the group of patients with DS, there was no significant difference in refractive error in the patients who were diagnosed with keratoconus versus those who were not.</div></div><div><h3>Conclusions</h3><div>Children with DS diagnosed with keratoconus often have lower amounts of astigmatism and less myopic spherical equivalents than children with keratoconus without DS at the time of diagnosis; therefore, relying on high astigmatism as a clinical indicator for disease in patients with DS is likely inadequate. Tomographic screening should be employed even when the patient with DS is young or has low amounts of refractive error as earlier detection and treatment is crucial to favorable outcomes in children with DS.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 349-355"},"PeriodicalIF":4.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145911","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":"Practice Patterns, Diagnostic Utility, and Safety of Anterior Chamber Paracentesis","authors":"Charlene H. Choo ,&nbsp;Punyanuch Pisitpayat ,&nbsp;Daisy Yan ,&nbsp;Aaron Chang ,&nbsp;Sarah Lopez ,&nbsp;Shreya Malli ,&nbsp;Gerami D. Seitzman ,&nbsp;John Gonzales ,&nbsp;Nisha Acharya ,&nbsp;Thuy Doan ,&nbsp;Jessica G. Shantha","doi":"10.1016/j.ajo.2025.05.017","DOIUrl":"10.1016/j.ajo.2025.05.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the safety and diagnostic utility of anterior chamber (AC) paracentesis in patients with ocular inflammation at the University of California, San Francisco (UCSF).</div></div><div><h3>Design</h3><div>This was a 2-part study including a cross-sectional survey study to assess practice patterns on AC paracentesis and a retrospective diagnostic and safety study of all outpatient AC paracentesis performed between April 2012 and March 2023 at UCSF.</div></div><div><h3>Participants</h3><div>The participants of the practice patterns survey study were ophthalmologists in the Proctor Foundation listserv. All patients who underwent at least 1 outpatient AC paracentesis at UCSF from 2012 to 2023 were included in the retrospective diagnostic and safety investigation.</div></div><div><h3>Main Outcomes and Measures</h3><div>For the diagnostic and safety study, the main outcomes included the frequency of adverse events and positive results for pathogens on various aqueous fluid testing.</div></div><div><h3>Results</h3><div>In our survey study, most providers had fellowship training in cornea and/or uveitis (68%) and performed AC paracentesis with the patient at the slit lamp (75%).</div><div>Our retrospective diagnostic and safety study included 386 patients (51.3% female, mean age 56.7 years) and 528 AC paracentesis. Complications occurred in 5.7% of AC paracentesis. The overall PCR-positivity was 24.2% (97/401) and highest for cytomegalovirus (56/386; 14.5%). On multivariable analysis, topical corticosteroids increased the odds of PCR-positivity for viral pathogens (<em>P</em> = .01-.02). High AC cell levels were also associated with increased odds of PCR-positivity for HSV/VZV (<em>P</em> = .01).</div></div><div><h3>Conclusions</h3><div>Results of our study demonstrated the safety and diagnostic utility of AC paracentesis. This procedure facilitated the diagnosis of infectious causes of uveitis in almost 25% of cases.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 260-268"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136787","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 of Giant Cell Arteritis Following Herpes Zoster Ophthalmicus: A Multicenter Retrospective Cohort Study","authors":"Itay Nitzan,&nbsp;Nadav Shemesh,&nbsp;Shoham Kubovsky,&nbsp;Tehila Shalmov,&nbsp;Jaime Levy,&nbsp;Radgonde Amer","doi":"10.1016/j.ajo.2025.05.019","DOIUrl":"10.1016/j.ajo.2025.05.019","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the long-term risk of incident giant cell arteritis (GCA) following herpes zoster ophthalmicus (HZO).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants and Controls</h3><div>Adults aged ≥50 years with a diagnosis of HZO (ICD-10 B02.3) between May 2005 and April 2024 were identified from the TriNetX Global Collaborative Network and compared to controls without any history of zoster. All patients had ≥6 months of data before and after the index date. Individuals with prior diagnoses of GCA, polymyalgia rheumatica, HIV, or transplant status were excluded.</div></div><div><h3>Methods</h3><div>Propensity score matching (PSM) was applied in a 1:1 ratio to balance baseline characteristics. Time-to-event analysis was performed using a Cox proportional hazards model and a log-rank test, with cumulative incidence illustrated by a Kaplan–Meier curve. Sensitivity analyses evaluated the impact of antiviral therapy and prior zoster vaccination.</div></div><div><h3>Main Outcome Measures</h3><div>Incident GCA (ICD-10 M31.5 or M31.6), assessed beginning 30 days after index diagnosis. The E-value was calculated to assess robustness against unmeasured confounding.</div></div><div><h3>Results</h3><div>After matching, 18 154 patients were included in each cohort (mean age, 66.6 years; 57.5% female). During 10 years of follow-up, GCA occurred in 42 HZO patients and 14 controls, corresponding to incidence rates of 49.9 vs 16.2 per 100 000 person-years (log-rank <em>P</em> &lt; .001). HZO was associated with a more than threefold increased risk of GCA (HR, 3.09; 95% CI, 1.69–5.65). The E-value was 5.63 for the HR and 2.77 for the lower confidence limit. In sensitivity analyses, antiviral therapy initiated within 7 days of HZO diagnosis was not associated with a reduced risk of GCA (HR, 0.86; 95% CI, 0.43–1.68), and herpes zoster vaccination administered ≥1 month before HZO diagnosis showed no protective association (HR, 1.60; 95% CI, 0.55–4.66).</div></div><div><h3>Conclusions</h3><div>In this large real-world cohort, HZO was associated with an increased risk of incident GCA, although the absolute risk remained low. Further research is needed to clarify pathophysiologic mechanisms and the potential impact of antiviral or vaccine-based interventions.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 213-220"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136803","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":"Macular Microvasculature Asymmetry Analysis for Evaluating Open-Angle Glaucoma in Diabetic Retinopathy Patients Treated With Pan-Retinal Photocoagulation","authors":"Kee-Sup Park,&nbsp;Jung-Tae Kim,&nbsp;Min-Woo Lee","doi":"10.1016/j.ajo.2025.05.016","DOIUrl":"10.1016/j.ajo.2025.05.016","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the usefulness of vertical asymmetry analysis of macular microvasculature for diagnosis of open-angle glaucoma (OAG) in diabetic retinopathy (DR) patients who have undergone pan-retinal photocoagulation (PRP).</div></div><div><h3>Design</h3><div>Retrospective, cross-sectional diagnostic evaluation.</div></div><div><h3>Methods</h3><div>DR patients with PRP were categorized into those without OAG (Group 1) and those with OAG (Group 2). Peripapillary retinal nerve fiber layer (pRNFL) thickness and macular vessel density (VD) were measured, and the vertical difference in pRNFL (vdRNFL) and VD (vdVD) was determined as the absolute difference between the superior and inferior sectors. Diagnostic performance was analyzed by calculating the area under the curve (AUC).</div></div><div><h3>Results</h3><div>Analyses included 128 eyes (Group 1: 68 and Group 2: 60). The mean pRNFL thickness was 93.9 ± 14.8 µm in Group 1 and 85.5 ± 14.4 µm in Group 2 (<em>P</em> = .009). The mean vdRNFL was 13.1 ± 10.9 µm in Group 1 and 14.4 ± 12.6 µm in Group 2 (<em>P</em> = .607). The mean VD was 15.9 ± 3.3 mm⁻¹ in Group 1 and 15.3 ± 2.6 mm⁻¹ in Group 2 (<em>P</em> = .380), whereas the vdVD was 0.6 ± 0.6 mm⁻¹ in Group 1 and 1.6 ± 1.4 mm⁻¹ in Group 2 (<em>P</em> &lt; .001). The AUC for diagnostic accuracy was 0.812 for vdVD, significantly higher than that for other factors (all <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Relying on pRNFL thickness for OAG evaluation in PRP-treated patients is not recommended. Analysis of vertical microvasculature asymmetry can serve as a useful factor for diagnosing OAG.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 242-248"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136804","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":"Income-Related Inequalities in Vision Difficulty Among US Adults, 1999-2018","authors":"YU CHEN ,&nbsp;MINCHUL KIM ,&nbsp;ELIZABETH A. LUNDEEN ,&nbsp;DEBORAH B. ROLKA ,&nbsp;JOSHUA R. EHRLICH ,&nbsp;PAULA ANNE NEWMAN-CASEY ,&nbsp;ANGELA ELAM ,&nbsp;DAVID REIN ,&nbsp;CHRISTOPHER HOLLIDAY ,&nbsp;JINAN SAADDINE","doi":"10.1016/j.ajo.2025.05.015","DOIUrl":"10.1016/j.ajo.2025.05.015","url":null,"abstract":"<div><h3>Purpose</h3><div>Research has shown that the prevalence of vision difficulty is higher among US adults with low income than among those with higher income. We aimed to examine the trends in income-related inequalities in vision difficulty and to identify the contributions of explanatory factors.</div></div><div><h3>Design</h3><div>A cross-sectional and trend study.</div></div><div><h3>Methods</h3><div>Our study estimated income-related inequalities in self-reported vision difficulty among US adults aged 18 years or older using data from the National Health Interview Survey (NHIS) during 1999-2018. The concentration index was used to measure income-related inequality in vision difficulty and was decomposed into contributing factors. We examined temporal changes in income-related vision difficulty inequalities and contributors to those changes from 1999 to 2018.</div></div><div><h3>Results</h3><div>We found that vision difficulty was concentrated among lower income groups and the degree of income-related inequality in vision difficulty widened between 1999 and 2018. Decomposition analysis revealed that poverty-to-income ratio and public health insurance coverage were important contributors to income-related inequalities in vision difficulty, with smaller contributions made by smoking, physical inactivity, and female sex. Among all variables, non-White race/ethnicity, lower physical activity, and poverty-to-income ratio were important factors explaining the change in income-related inequality in vision difficulty.</div></div><div><h3>Conclusion</h3><div>Vision difficulty was more prevalent in low-income populations. Our study enhances the understanding of socioeconomic disparities in vision difficulty, which could inform how to best target the deployment of eye care resources to maximize the visual potential of the US population.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 203-212"},"PeriodicalIF":4.1,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144130710","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}