Asia-Pacific Journal of Ophthalmology最新文献

{"title":"Barriers to artificial intelligence applications in ophthalmology: beyond diagnostic accuracy toward patient outcomes, workflow integration, ethics, and trust.","authors":"Kai Jin, Andrzej Grzybowski","doi":"10.1016/j.apjo.2026.100382","DOIUrl":"10.1016/j.apjo.2026.100382","url":null,"abstract":"<p><p>Artificial intelligence (AI) has become a major area of ophthalmic innovation, with a rapidly expanding literature, yet routine clinical adoption remains limited. Diagnostic accuracy alone is an insufficient marker of clinical value because even technically strong systems may fail to improve referral, follow-up, treatment, clinician workload, or health-system value. This focused narrative review examines the barriers that separate ophthalmic AI performance from real-world implementation. We reviewed ophthalmic AI literature indexed in PubMed, Web of Science, and Google Scholar, with emphasis on studies published from January 2018 to September 2026 and on prospective, randomized, real-world, economic, governance, and patient-centred evidence. We organize translation across four linked domains: algorithmic validity, clinical utility, workflow integration, and health-system value, with ethical governance and trust as cross-cutting requirements. Diabetic retinopathy screening now provides a concrete translational example spanning large-scale retrospective validation, prospective deployment, workflow implementation, and economic evaluation. We also consider how foundation models and large language models alter evidence requirements because outputs can depend on prompts, retrieved context, tools, and model versions. For glaucoma, retinal disease management, retinopathy of prematurity, anterior segment applications, and automated reporting, evidence remains less mature. The central challenge for ophthalmic AI is therefore no longer model development alone, but disciplined clinical translation, including prospective evaluation, operational workflow measurement, equity assessment, lifecycle monitoring, transparent governance, and trustworthy implementation.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100382"},"PeriodicalIF":7.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International consensuses and guidelines on etiology, diagnosis, and treatment of retinal vein occlusion (RVO) by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), Asia-Pacific Vitreo-retina Society (APVRS) and Academia Retina Internationalis (ARI).","authors":"Danny S C Ng, Peter K Kaiser, Nicolas Feltgen, Taraprasad Das, Charles C Wykoff, Mae-Lynn Bastion, Giuseppe Querques, Takeshi Iwase, Usha Chakravarthy, Wei-Chi Wu, Sophie J Bakri, Sanyam Bajimaya, Francesco Bandello, Andrew Chang, San-Ni Chen, Lars-Olof Hattenbach, Min Kim, Adrian H C Koh, Timothy Y Y Lai, Heng Miao, Raja Narayanan, Nishant V Radke, Paisan Ruamviboonsuk, Min Sagong, Dat Dang Tran, Akitaka Tsujikawa, Sebastian Wolf, Se Joon Woo, Lihteh Wu, Yasuo Yanagi, Shaochong Zhang, Mingwei Zhao, Xiaoxin Li, Sobha Sivaprasad, Jost B Jonas, Dennis S C Lam","doi":"10.1016/j.apjo.2026.100381","DOIUrl":"https://doi.org/10.1016/j.apjo.2026.100381","url":null,"abstract":"<p><p>Retinal vein occlusion (RVO) is a prevalent potentially blinding retinal vascular disease, with secondary macular edema, retinal ischemia, and ocular neovascular complications posing substantial threats to visual function. Supported by members of the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), Asia-Pacific Vitreo-retina Society (APVRS) and Academia Retina Internationalis (ARI), a consensus and guideline is provided a comprehensive update on the etiology, diagnosis and management of RVO. An updated consensus was judged necessary following numerous recent results from epidemiology studies, evolution of advanced imaging technologies and novel pharmacotherapeutics from clinical trials, including an expanding portfolio of anti-vascular endothelial growth factor (anti-VEGF) agents, drug delivery systems, and emerging evidence on relevant artificial intelligence. The formulation of these consensus statements were based on the review and discussion of a systematic search for the latest evidence-based data and voting by an International Panel of Experts (IPE) in the following key areas: I) Diagnostic controversies around classification systems and imaging modalities; II) Treatment controversies regarding anti-VEGF therapy, corticosteroid treatments, laser therapy, and surgical interventions; III) Management paradigm between standardized protocols from clinical trials and individualized approaches and IV) Emerging controversies in novel therapeutics. The primary goal was to furnish ophthalmologists with standardized, yet individualized, management protocols to try to optimize treatment safety and efficacy, ensuring alignment with contemporary clinical practices in the Asia-Pacific region.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100381"},"PeriodicalIF":7.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Moderna's mRNA cancer vaccine for cutaneous melanoma be applicable to melanomas of the eye and ocular adnexa?","authors":"Shu Liu, Hiu Ying Enne Leung, Arun D Singh, Martine J Jager, Xianqun Fan, Dennis S C Lam","doi":"10.1016/j.apjo.2026.100380","DOIUrl":"https://doi.org/10.1016/j.apjo.2026.100380","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100380"},"PeriodicalIF":7.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of primary angle-closure glaucoma: An exposome-wide association study in the China Kadoorie Biobank.","authors":"Zilun Shao, Shuo Gong, Charles Li, Canqing Yu, Pei Pei, Ling Yang, Yiping Chen, Enzhong Jin, Ting Shen, Jie Yu, Bin Wang, Zhi Chen, Ruoyan Wei, Jian Wang, Xiaoming Yang, Junshi Chen, Zhengming Chen, Xingtao Zhou, Yongyue Wei, Jun Lv, Liming Li, Huaidong Du, Dianjianyi Sun","doi":"10.1016/j.apjo.2026.100378","DOIUrl":"10.1016/j.apjo.2026.100378","url":null,"abstract":"<p><strong>Purpose: </strong>Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness in Asia. Although traditionally considered an anatomical ocular disorder, the contribution of systemic metabolic, vascular, and lifestyle factors to PACG development remains unclear.</p><p><strong>Methods: </strong>Using data from the China Kadoorie Biobank (CKB), involving 499,102 participants aged 30-79 years at baseline, we explored associations of 117 exposures, including socio-demographics, lifestyle patterns, medical history, and physical measurements, with probable PACG (prob PACG) incidence. Elastic-Net, XGboost, and Cox regression methods were employed.</p><p><strong>Results: </strong>Over a median follow-up of 15.7 years, 3266 incident prob PACG cases were ascertained. After correcting for multiple testing, 26 factors were independently associated with prob PACG. Age, female sex, and postmenopausal status showed the strongest positive associations with pro PACG. Notably, several markers of metabolic and vascular ageing-including diabetes, higher random plasma glucose, larger waist circumference, and elevated pulse pressure-were independently associated with higher risk, whereas BMI was inversely associated (all P < 0.01). In addition, daily intake of dairy products and daily preserved vegetables, and peptic ulcer were associated with a higher risk, while higher physical activity and weekly tea consumption were associated with lower risk. No significant associations were found for hypertension, SBP, or DBP with prob PACG.</p><p><strong>Conclusions: </strong>Our findings suggest that PACG may be influenced not only by anatomical susceptibility but also by broader metabolic, vascular, and lifestyle factors. The clustering of several strong associations around markers of metabolic and vascular ageing provides new insights into PACG aetiology and may help identify priorities for future studies of risk stratification and prevention.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100378"},"PeriodicalIF":7.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multi-label deep learning system for simultaneous detection of nine fundus conditions.","authors":"Jungwoo Ha, Yeon Hee Choi, Danbi Lee, Junseo Choi, Wonyoung Seo, Geunyoung Lee, Dongjin Nam, Sahil Thakur, Tae Keun Yoo, Sunjin Hwang","doi":"10.1016/j.apjo.2026.100379","DOIUrl":"10.1016/j.apjo.2026.100379","url":null,"abstract":"<p><strong>Purpose: </strong>To develop and validate a deep learning model for simultaneous detection of nine fundus conditions from a single color fundus photograph.</p><p><strong>Methods: </strong>A development dataset of 236,242 color fundus images was assembled from 17 heterogeneous sources and partitioned at the patient level into training (70%), tuning (10%), and internal validation (20%) sets; 5-fold cross-validation was applied on the training set. Nine target conditions were labeled using standardized or photographic criteria: diabetic retinopathy (DR), age-related macular degeneration (AMD), myopic macular degeneration (MMD), glaucoma suspect (GS), epiretinal membrane (ERM), retinal vascular occlusion (VO), media opacity, retinal hemorrhages, and any retinal disorder (composite). A multitask ConvNeXt architecture was trained end-to-end, with operating thresholds pre-specified via Youden's index on the tuning set. External validation was performed on an independent cohort of 4055 images from an East Asian health-screening center, excluded from model development.</p><p><strong>Results: </strong>On internal validation (N = 47,229), AUROCs ranged from 0.943 (AMD) to 0.989 (VO), with sensitivity of 88.1%-97.1% and NPV ≥ 98.8% for eight of nine conditions. On independent external validation (N = 4055), AUROCs ranged from 0.894 (retinal disorder) to 0.983 (MMD), with NPV ≥ 95.6% for eight of nine conditions, including 99.3% for DR, 99.9% for VO, and 99.8% for MMD.</p><p><strong>Conclusions: </strong>This study presents a validated, criteria-anchored multi-label fundus triage framework capable of simultaneously screening for nine conditions from a single fundus photograph, with performance maintained on external validation at a source-excluded health-screening site within the same national health-screening system.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100379"},"PeriodicalIF":7.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149057301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incremental diagnostic value and clinical utility of tear MMP-9 for dry eye disease: A multicentre analysis and development of a simplified screening model.","authors":"Wubi Li, Lin Kang, Yang Shen, Lyubang Zhou, Feiyue Xiao, Yuhan Wu, Yayuan Deng, Di Chen, Ying Li, Shihong Zhang, Hongbin Xie, Min Wang, Shaowei Li, Chan Zhao","doi":"10.1016/j.apjo.2026.100377","DOIUrl":"10.1016/j.apjo.2026.100377","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the incremental diagnostic value of tear matrix metalloproteinase-9 (MMP-9) in dry eye disease (DED) and validate a simplified diagnostic model suitable for primary care.</p><p><strong>Methods: </strong>This multicentre study analysed 580 participants (294 DED, 286 controls) from three Centres. Diagnostic performance was evaluated using Generalised Linear Mixed-Effects Models (GLMMs) to adjust for Centre heterogeneity. Three models were compared: (1) Traditional (Ocular Surface Disease Index [OSDI], non-invasive tear breakup time [NIBUT], Schirmer I test, and corneal fluorescein staining [CFS]), (2) Trad + MMP-9, and (3) Simplified (OSDI, Schirmer I test, and MMP-9). Performance was assessed via area under the receiver operating characteristic curve (AUC), Net Reclassification Improvement (NRI), Decision Curve Analysis (DCA), and Leave-One-Centre-Out Cross-Validation (LOCO-CV).</p><p><strong>Results: </strong>The Trad + MMP-9 model achieved the highest discrimination (AUC 0.982) and calibration. Adding MMP-9 yielded significant risk reclassification improvement (Continuous NRI 0.495, p < 0.001) over the Traditional model. A Simplified model (OSDI, Schirmer I test, MMP-9) achieved an AUC of 0.969, statistically comparable to the Traditional model, and demonstrated robust external validity in LOCO-CV. Tear MMP-9 levels correlated strongly with symptom burden (OSDI) independent of clinical signs.</p><p><strong>Conclusion: </strong>Tear MMP-9 provides significant incremental diagnostic value, enabling a simplified, high-accuracy diagnostic strategy that omits slit-lamp examination, potentially expanding DED screening capabilities.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100377"},"PeriodicalIF":7.0,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary intracranial melanoma associated with congenital ocular melanocytosis in the absence of uveal melanoma.","authors":"Antonio Bechara Ghobril, Salaam Botros, Carol L Shields","doi":"10.1016/j.apjo.2026.100375","DOIUrl":"10.1016/j.apjo.2026.100375","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100375"},"PeriodicalIF":7.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D CT reconstruction of silicone encircling band migration into corneal stroma.","authors":"Wenyi Tang, Ting Zhang, Jun Xiang","doi":"10.1016/j.apjo.2026.100376","DOIUrl":"10.1016/j.apjo.2026.100376","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100376"},"PeriodicalIF":7.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal structural changes associated with repeated low-level red-light therapy: Clinical observations and potential mechanisms.","authors":"Yu Yang, Yanxian Chen, Kyoko Ohno-Matsui, Shoji Kishi, Zhuoting Zhu, Xiaoyan Ding, Mingguang He","doi":"10.1016/j.apjo.2026.100374","DOIUrl":"10.1016/j.apjo.2026.100374","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100374"},"PeriodicalIF":7.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving epidemiologic link between myopia and glaucoma: A narrative review on pathophysiology, progression and clinical implications.","authors":"Jong Jin Jung, Ki Ho Park","doi":"10.1016/j.apjo.2026.100371","DOIUrl":"10.1016/j.apjo.2026.100371","url":null,"abstract":"<p><p>As the prevalence of myopia and glaucoma rises worldwide, patients with both conditions are increasing simultaneously. This narrative review summarizes the evidence linking myopia and open-angle glaucoma (OAG). Population-based studies and meta-analyses consistently show that myopia is associated with OAG, and that the risk increases with dose-response as myopia worsens. This may reflect the biomechanical and microvascular vulnerability of the axially elongated optic nerve head. However, the effect of myopia on glaucoma progression has been inconsistent across studies, resulting in an epidemiologic discordance in which the progression signal appears weaker than the association with glaucoma occurrence. This discordance may arise partly because progression is harder to detect reliably in myopic eyes, diverse phenotypes are analyzed as a single unstratified cohort, and the global, rate-based endpoints used in longitudinal studies are insensitive to the topographic effects of axial elongation. We therefore distinguish the rate of progression from its pattern. Young patients with high myopia and normal-tension glaucoma (NTG) show more rapid observed structural and functional deterioration. Whether the degree of myopia accelerates loss independently of NTG and intraocular pressure has not been established: where progression has been modeled against competing risk factors, intraocular pressure and disc hemorrhage have usually dominated. The signal that appears more consistent across cohorts is instead the location of damage, though it too has not yet been attributed to myopia rather than to NTG. We propose this rate-versus-pattern distinction as a conceptual framework for recognizing and monitoring high-risk myopic phenotypes.</p>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":" ","pages":"100371"},"PeriodicalIF":7.0,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148962985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}