BMJ Open Ophthalmology最新文献

{"title":"Sustained proton-pump inhibitor exposure and incident age-related macular degeneration: a new-user, population-based cohort study.","authors":"Maria Anna Bantounou, Maria Emfietzoglou, Konstantinos G Baroutis, Matthew R Starr, Joan W Miller, Demetrios G Vavvas","doi":"10.1136/bmjophth-2026-002935","DOIUrl":"10.1136/bmjophth-2026-002935","url":null,"abstract":"<p><strong>Objective: </strong>Proton-pump inhibitors (PPIs) may disrupt lysosomal acidification, a pathway implicated in age-related macular degeneration (AMD) pathogenesis. We evaluated whether sustained PPI exposure increased the risk of incident AMD in older adults aged ≥60 years.</p><p><strong>Methods and analysis: </strong>This retrospective observational cohort study included adults aged ≥60 years with sustained PPI exposure, matched 1:1 to unexposed controls on demographics, overall health, healthcare utilisation, cardiometabolic factors. Participants were identified from electronic health records. Sustained PPI exposure was defined as ≥2 years of cumulative use within 3 years of the first prescription. Fine-Gray models treating death as a competing event estimated subdistribution hazard ratios (sHRs) for AMD within 10 years; cause-specific Cox models provided complementary HRs. Analyses included histamine H2-receptor antagonists (H2-antagonists) as a negative exposure control and active comparator.</p><p><strong>Results: </strong>Incident AMD occurred in 814/49 796 PPI exposed participants (1.64%) and 668/49 796 controls (1.34%) (overall sHR=1.24, 95% CI 1.12 to 1.38; p<0.001; HR=1.25, 95% CI 1.13 to 1.38, p<0.001). Proportional sHRs were non-constant; sHRs were 1.09 (95% CI 0.91 to 1.29) before 2.5 years and 1.33 (95% CI 1.17 to 1.51) thereafter. For non-exudative AMD, 640 PPI exposed (1.29%) and 510 unexposed (1.02%) participants developed disease (overall sHR=1.28, 95% CI 1.14 to 1.44; p<0.001, HR=1.29, 95% CI 1.14 to 1.44, p<0.001). Among those with non-exudative AMD, 190/2503 PPI-exposed participants (7.59%) and 179/2503 controls (7.15%) progressed to exudative AMD (sHR and HR=1.03, 95% CI 0.84 to 1.26; p=0.802 and p=0.801, respectively). No association was observed between H2-antagonists and AMD (sHR=1.02, 95% CI 0.88 to 1.19; p=0.784; HR=1.03, 95% CI 0.88 to 1.20, p=0.729). Results were consistent in the active-comparator analysis (reciprocal overall sHR=1.24, 95% CI 1.04 to 1.48; p=0.016; HR=1.25, 95% CI 1.05 to 1.49, p=0.012).</p><p><strong>Conclusion: </strong>Sustained PPI exposure was associated with a modestly higher AMD risk, whereas no association was observed with H2-antagonists. The consistency of the active-comparator findings supports the potential specificity of this association and warrants further investigation to determine its clinical implications.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of systemic hypoxia in the progression of diabetic retinopathy: a propensity-matched retrospective cohort study.","authors":"Luqman Munir, Meltem Yashar, Kathlyn Kim, Ayan Vaishnav, Yannis M Paulus","doi":"10.1136/bmjophth-2026-002941","DOIUrl":"10.1136/bmjophth-2026-002941","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the association between systemic hypoxia and progression from non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) and vision-threatening outcomes.</p><p><strong>Methods and analysis: </strong>This retrospective cohort study used the TriNetX Network to identify adults with NPDR with no prior PDR. Systemic hypoxia was defined using International Classification of Diseases 10th revision (ICD-10) codes for anaemia, obstructive sleep apnoea, chronic respiratory failure, chronic obstructive pulmonary disease, pulmonary hypertension or interstitial lung disease. Both cohorts were propensity score-matched. The primary outcome was progression to PDR. Secondary outcomes included vitreous haemorrhage, tractional retinal detachment, legal blindness, diabetic macular oedema and therapeutic interventions. Time-to-event analyses were performed using Cox proportional hazards models, and 5-year cumulative incidence was assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>After matching, 92 454 patients were included in each cohort with well-balanced baseline characteristics (all standardised mean differences <0.1). Systemic hypoxia was associated with increased risk of PDR progression (HR 1.24; 95% CI 1.18 to 1.31; p<0.001). 5-year cumulative PDR incidence was higher in the hypoxia cohort (4.2% vs 2.6%; risk ratio 1.63). Patients with systemic hypoxia also had higher risks of vitreous haemorrhage, tractional retinal detachment, blindness and increased utilisation of panretinal photocoagulation and pars plana vitrectomy. Subgroup analyses identified anaemia as the primary driver of PDR progression, whereas respiratory aetiologies were not independently associated after matching.</p><p><strong>Conclusions: </strong>Systemic hypoxia, a diagnosis-code-based composite in which anaemia-associated phenotypes showed the strongest association, is associated with accelerated PDR progression and near-doubled legal blindness risk. Anaemia screening may offer an opportunity to reduce vision-threatening complications in diabetic patients. These findings are hypothesis-generating and warrant prospective validation before informing screening pathways, given the retrospective design and absence of measured oxygen saturation, haemoglobin and glycaemic data.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual field and driving performance of individuals with inherited retinal disorders: a scoping review.","authors":"Xanthe E Bell, John R Grigg, Clare L Fraser, Elisa E Cornish","doi":"10.1136/bmjophth-2026-002913","DOIUrl":"10.1136/bmjophth-2026-002913","url":null,"abstract":"<p><strong>Objective: </strong>Maintaining a drivers' licence is an important patient-reported outcome. Conditions resulting in peripheral vision loss such as inherited retinal disorders (IRDs) can result in loss of licence due to an inadequate horizontal visual field (VF) extent. There are currently no international visual standards for licensing and current testing protocols outlined in licensing guidelines and conducted in out-patient clinics may not adequately reflect or predict on-road driving performance. The present study undertakes a scoping review of the VF of individuals with an IRD and their driving status and/or performance. It aims to determine the proportion of individuals who either meet the VF licensing requirements or pass a driving test and the impact of VF extent.</p><p><strong>Methods and analysis: </strong>193 publications from online databases and other sources were identified, of which three publications met the inclusion criteria for the review. Publications were from two countries and included studies which measured driving performance based on collision records and driving simulator performance.</p><p><strong>Results: </strong>Only level 4 evidence was available on the topic, including two case-control studies and one cross-sectional study.</p><p><strong>Conclusion: </strong>One study reported 36% of retinitis pigmentosa patients met the VF licencing requirements. There was inconclusive evidence regarding the impact of VF extent on driving performance, with one study finding that VF extent was predictive of driving performance, and other findings did not correlate.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting graft thickness in ultrathin DSAEK using a mechanical microkeratome system.","authors":"Giacomo Visioli, Luca Lucchino, Fabio Scarinci, Valentin Jünger, Giulio Pocobelli, Gemma Lodato, Antonella Falchi, Marco Marenco, Alessandro Lambiase, Augusto Pocobelli, Rossella Anna Maria Colabelli Gisoldi","doi":"10.1136/bmjophth-2026-002721","DOIUrl":"10.1136/bmjophth-2026-002721","url":null,"abstract":"<p><strong>Purpose: </strong>To examine pre-cut factors associated with post-cut graft thickness in ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) prepared with a mechanical microkeratome system and to develop a nomogram to support blade selection.</p><p><strong>Methods: </strong>Donor corneas processed at a single eye bank were included. All tissues were dissected using a standardised mechanical microkeratome protocol with fixed pressure and cutting speed. Pre-cut variables included central pachymetry, microkeratome blade size, endothelial cell density, cause of death and demographic characteristics. Multivariable regression was used to evaluate predictors of post-cut graft thickness. Adjusted predictions across the observed pachymetry range were generated to construct a nomogram estimating expected graft thickness for each blade.</p><p><strong>Results: </strong>A total of 107 donor corneas were analysed. Mean post-cut graft thickness was 92.7±24.3 µm. In the multivariable model, blade size (p<0.001) and pre-cut pachymetry (p<0.001) showed the strongest associations with graft thickness, accounting together for approximately 45.7% of model variance. The cut-to-blade ratio analysis indicated that all blades produced cuts deeper than their nominal thickness, with ratios increasing across blade sizes. The resulting nomogram enables selection of the blade more likely to achieve grafts within the 70-100 µm range based on the donor's initial pachymetry.</p><p><strong>Conclusions: </strong>Blade size and initial pachymetry show measurable associations with post-cut graft thickness in UT-DSAEK prepared under standardised mechanical conditions. The proposed nomogram offers a practical tool to assist in selecting the blade expected to achieve ultrathin grafts with greater reproducibility.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of early treatment response for long-term outcomes after seven years on low-dose atropine.","authors":"Karenna Mehta, Robert Clark","doi":"10.1136/bmjophth-2026-002759","DOIUrl":"10.1136/bmjophth-2026-002759","url":null,"abstract":"<p><strong>Background/aims: </strong>To determine whether first-year response to low-dose atropine predicts long-term myopia control and may guide treatment escalation in myopic children.</p><p><strong>Methods: </strong>A retrospective chart review (2012-2025) identified children treated with atropine 0.01%-0.05% at a single practice with ≥54 months of treatment. Children were excluded with insufficient follow-up (<54 months of treatment), comorbidities that might affect myopia progression or concurrent baseline optical myopia-control therapy. First-year response was modelled as the spherical equivalent refraction (SER) progression rate (diopters (D)/year, continuous, positive values indicating worsening myopia) and by responder status (defined as≤0.25D total progression at 12±3 months). The primary outcome was successful control maintaining≤0.25 D/year over follow-up. Key secondary outcomes were total SER progression and time-to-treatment escalation. Eye-level models accounted for correlation between fellow eyes and adjusted for baseline age and baseline SER.</p><p><strong>Results: </strong>71 children (142 eyes) had a mean follow-up of 6.8±2.0 years. First-year responders included 101/142 eyes (71%) with higher odds of successful control (adjusted OR 2.66, 95% CI 1.11 to 6.35, p=0.028) and less total SER progression (adjusted difference 0.57D, 95% CI 0.28 to 0.86, p<0.001). Each additional 0.25 D/year of year-1 progression was associated with lower odds of successful control (OR 0.73, 95% CI 0.59 to 0.89, p=0.002) and greater total progression (0.22 D more, 95% CI 0.16 to 0.29, p<0.001). Dose escalation occurred earlier in nonresponders; responders had a lower hazard of escalation (HR 0.27, 95% CI 0.14 to 0.52).</p><p><strong>Conclusion: </strong>First-year SER change is strongly predictive of long-term outcomes; despite earlier treatment escalation in nonresponders, responders had a much higher likelihood of sustained long-term control. Early response assessment may help identify high-risk patients for closer monitoring and/or treatment intensification.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Significance of adjuvant external beam radiotherapy of the orbit in managing uveal melanoma with extraocular extension.","authors":"Nathalie Christina Düsberg, Norbert Bornfeld, Anja Merkel-Jens, Philipp Rating, Michael Zeschnigk, Wolfgang A C Sauerwein, Martin Stuschke, Maja Guberina, Nikolaos E Bechrakis, Eva Biewald","doi":"10.1136/bmjophth-2025-002659","DOIUrl":"10.1136/bmjophth-2025-002659","url":null,"abstract":"<p><strong>Objective: </strong>Extraocular extension (EOE) is a known risk factor for metastasis in uveal melanoma. This long-term study investigates neoadjuvant and adjuvant external beam radiotherapy (EBRT) before and after enucleation of eyes with uveal melanoma and EOE with respect to survival, local tumour control, metastatic disease and side effects of radiotherapy.</p><p><strong>Methods and analysis: </strong>Retrospective, consecutive analysis of all patients with enucleation for uveal melanoma and histopathological evidence of EOE from June 1980 to April 2014.</p><p><strong>Results: </strong>The entire cohort comprised 87 patients. 34 of those were lost to follow-up. Of the remaining 43 patients, 26 underwent adjuvant and/or neoadjuvant radiotherapy with a total orbital dose of 50-60 Gy, while the remaining 17 were treated with enucleation only. The mean follow-up time was 65.58±80.44 months (median 37 months) and 184.12±119.760 months (median 132 months) for those being alive at last follow-up. EBRT patients had significantly higher TNM (tumour, node, metastases) stages (p=0.033) and more extensive EOE (p=0.146). There was no significant difference in any relevant parameters between the two groups. The overall survival rate after 5 and 10 years was 32.6% and 16.2%, respectively. There was no evidence of a significantly later (p=0.573) or less frequent (p=0.999) occurrence of metastases in either group. There were no local recurrences in either group. Side effects of the radiotherapy occurred in 61.5%.</p><p><strong>Conclusions: </strong>Adjuvant or neoadjuvant EBRT had no survival benefit in uveal melanoma with EOE. No local recurrence was detected in either group.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between age, pseudophakia, diabetes mellitus and endothelial cell density in corneal donor tissue: a 10-year retrospective study.","authors":"Itay Shavit, Shelly Salminis Linzen, Ariel Shvaiger, Alon Tiosano, Eitan Livny, Assaf Dotan","doi":"10.1136/bmjophth-2025-002618","DOIUrl":"10.1136/bmjophth-2025-002618","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the independent and combined effects of age, diabetes and pseudophakia on endothelial cell density (ECD), assessed both as a continuous measure and as a binary outcome using a commonly used reference threshold of <2000 cells/mm².</p><p><strong>Methods and analysis: </strong>This retrospective, observational, cross-sectional study analysed 681 donor corneas from 350 individuals recorded in the Rabin Medical Center, between 2014 and 2024. Baseline donor variables included age at donation, sex, diabetes status and lens status. ECD was measured centrally using Konan CellChek specular microscopy, which quantifies ECD based on manual marking of central endothelial cell centres. Generalised estimating equations were used to account for within-donor clustering, modelling ECD as both continuous and binary variables. Potential effect modification by pseudophakia was assessed in stratified models.</p><p><strong>Results: </strong>Mean donor age was 62.8 years; 37.1% had diabetes and 22.8% were pseudophakic. Diabetes was associated with lower ECD overall (β = -106 cells/mm²; 95% CI -205 to -7) and with increased odds of ECD <2000 (OR=1.91; 95% CI 1.13 to 3.21). However, this effect was only significant in non-pseudophakic eyes. Pseudophakia (OR=2.88; 95% CI 1.80 to 4.63) and older age (OR per year=1.05; 95% CI 1.03 to 1.07) were consistently associated with lower ECD and a higher likelihood of falling below threshold.</p><p><strong>Conclusion: </strong>Older age and pseudophakia were independently associated with increased risk of low ECD. In subgroup analyses, diabetes was linked to lower ECD only in non-pseudophakic eyes. However, formal statistical testing for interaction between diabetes and lens status was not significant.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual outcome in 5-year-old children operated for non-syndromic craniosynostosis.","authors":"Evangelia Ntoula, Daniel Nowinski, Gerd E Holmstrom, Eva Larsson","doi":"10.1136/bmjophth-2025-002455","DOIUrl":"10.1136/bmjophth-2025-002455","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate visual outcomes in children operated for non-syndromic craniosynostosis at preschool age, in order to elucidate long-term ophthalmological effects and guide treatment and screening strategies.</p><p><strong>Methods: </strong>A cohort of 89 children (63 boys) with various types of non-syndromic craniosynostosis operated at Uppsala Craniofacial Centre between 2012 and 2019 and an age-matched control group of 33 healthy children underwent ophthalmological evaluations at age 5. High-contrast visual acuity (HCVA), crowding ratio, low-contrast visual acuity (LCVA), colour vision and stereo acuity were examined using standardised protocols. Statistical analyses comparing outcomes across craniosynostosis subtypes and between the study group and control group were conducted.</p><p><strong>Results: </strong>Distance HCVA and LCVA were lower in children who underwent operation for unilateral coronal craniosynostosis, mainly due to the higher prevalence of strabismus and refractive error on the side contralateral to the fused suture. Amblyopia and absence of measurable stereoacuity were also more frequent in this subtype. Crowding was common in the craniosynostosis group. Near HCVA was generally lower in all craniosynostosis subtypes compared with controls.</p><p><strong>Conclusion: </strong>Long-term visual outcomes assessed at preschool age varied in children operated for non-syndromic craniosynostosis. Unicoronal craniosynostosis had the greatest risk of visual impairment. Tailored screening is needed in order to address the ophthalmological challenges associated with different craniosynostosis subtypes.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Delphi expert consensus on the optimal intravitreal treatment pathway for centre involving diabetic macular oedema patients within the National Health Service.","authors":"Richard Gale, Clare Bailey, Helen Devonport, Christiana Dinah, Louise Mary Downey, Michael Edward Grinton, Arijit Mitra, Luke Nicholson, Christina Rennie, Maged Habib","doi":"10.1136/bmjophth-2026-002787","DOIUrl":"10.1136/bmjophth-2026-002787","url":null,"abstract":"<p><strong>Aims: </strong>To establish consensus-based guidance on optimising anti-vascular endothelial growth factor (VEGF) and corticosteroid use in centre-involving diabetic macular oedema (CI-DMO).</p><p><strong>Methods: </strong>A two-round modified Delphi study was conducted among medical retina (MR) specialists in the National Health Service in England. In total, 82 statements were developed by a steering group and rated by a wider Delphi panel using a four-point Likert scale. Consensus was predefined as ≥75%.</p><p><strong>Results: </strong>In rounds one and two, 30 and 39 MR specialists responded to the survey, respectively. In total, consensus was achieved for 64/82 statements (78%). Key outcomes were consensus on the value of personalised treatment strategies, consensus of MR specialists to validate a definition of non-response to intravitreal treatment for DMO as a reduction in central retinal thickness (CRT) by ≤10% and a suboptimal response as a reduction in CRT by 10-20% (these thresholds were adapted from those proposed by Downey <i>et al</i>)<i>.</i> Early evaluation of anti-VEGF treatment response should be made at 3-6 months and after trying two different types of anti-VEGF agents. The panel reached moderate consensus that corticosteroid therapy may be considered after 9-12 months in patients with persistent suboptimal response or high treatment burden. The panel also supported consideration of transition to sustained-release corticosteroid therapy in selected patients demonstrating a positive response to short-acting corticosteroids.</p><p><strong>Conclusions: </strong>This Delphi study provides a consensus-based framework to support personalised treatment decisions in CI-DMO, highlighting the importance of timely optimisation of anti-VEGF and corticosteroid therapies in cases of suboptimal response and non-response. However, as these recommendations are derived from expert consensus rather than prospective clinical validation and all panellists were from England, generalisability to other healthcare settings may be limited. Additionally, patient representatives were not included, and the recommendations require validation in clinical practice.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the crystalline lens diameter using swept-source optical coherence tomography.","authors":"Sophia Anna Reifeltshammer, Haidar Khalil, Theresa Höftberger, Peter Laubichler, Leon Pomberger, Klemens Waser, Matthias Bolz, Nino Hirnschall","doi":"10.1136/bmjophth-2026-002819","DOIUrl":"10.1136/bmjophth-2026-002819","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the estimated lens diameter (eLD) of the crystalline lens in a large European cohort.</p><p><strong>Methods and analysis: </strong>Data sets from an Austrian population acquired between 2020 and 2022 were analysed in this study. Measurements included optical biometry (IOLMaster 700, Carl Zeiss Meditec AG, Germany) as well as anterior segment optical coherence tomography (CASIA2, Tomey, Japan). For eLD prediction, three different machine learning approaches were implemented.</p><p><strong>Results: </strong>In total, 2352 eyes of 2352 patients were included in this study. The eLD was normally distributed with a mean value of 10.18±0.56 mm, showing a statistically significant difference (p=0.008) between females and males (10.16±0.54 mm and 10.22±0.57 mm, respectively). There was a low but significant correlation (p<0.01 for all) with age (r=0.246), lens thickness (r=0.265), white-to-white (r=0.122), corneal radii (r=0.090), axial eye length (r=0.092), anterior chamber depth (r=-0.060), decentration (r=-0.087) and tilt (r=-0.159), respectively. Subanalysis of short and long eyes yielded no significant difference in eLD. For eLD prediction, age and lens thickness appeared to be relevant parameters, with all three models demonstrating low predictive accuracy.</p><p><strong>Conclusion: </strong>The crystalline lens diameter followed a normal distribution with no significant differences between short and long eyes. All three models demonstrated low predictive accuracies, suggesting that reliable prediction of eLD is currently not attainable.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}