BMJ Open Ophthalmology最新文献

{"title":"Charles Bonnet Syndrome: associations between psychosocial measures and visual hallucination characteristics in the visually impaired.","authors":"Robin Walker, Lyn Ellett, Daisy Norton, Hana Rouabhi, Hannah Coughlan, Farah Akthar, Katrina DaSilva Morgan, Rhian Tait, Matteo Lisi, Dominic Ffytche","doi":"10.1136/bmjophth-2025-002554","DOIUrl":"10.1136/bmjophth-2025-002554","url":null,"abstract":"<p><strong>Background/aims: </strong>The emotional response to Charles Bonnet Syndrome (CBS) (visual hallucinations in individuals with sight loss) is associated with negative affect, suggesting a link between psychological measures and hallucination characteristics. This study set out to investigate whether the association extends to a broader range of hallucination attributes and psychological measures, taking into account clinical factors likely to influence such associations.</p><p><strong>Methods: </strong>70 participants with self-reported CBS completed an online survey assessing hallucination attributes of frequency, duration, emotional valence, distress, level of control over hallucinations and impact on quality of life (QoL). Anxiety and depression were measured using the Hospital Anxiety and Depression Scale while loneliness was assessed using the University of California Los Angeles (UCLA) Loneliness Scale. All three measures were combined as a mental health factor. Regression models tested relationships between hallucination attributes and mental health, controlling for age, sex assigned at birth, years of sight loss, years experiencing hallucinations, presence of migraine and visual field loss.</p><p><strong>Results: </strong>All visual hallucination attributes except level of control were associated with the mental health factor; higher factor scores were associated with more frequent, longer lasting, more unpleasant and more distressing hallucinations and also with a more negative impact of hallucinations on QoL. These associations were independent of years of sight loss and CBS.</p><p><strong>Conclusion: </strong>Mental health measures are linked to a wider range of CBS attributes than previously recognised, with greater clinical attention required to identify people with CBS who are experiencing psychological difficulties to help provide appropriate treatment and support.</p><p><strong>Limitations: </strong>The study did not include a control group of visually impaired participants without hallucinations and has an uneven representation across age and gender with a small sample size for the sub-group analysis. The study relied on self-reported online data without clinical assessment; details of participants' medication use were not collected.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343610","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":"Is metamorphopsia more important than visual acuity in vitreomacular interface disorders? A scoping review.","authors":"Armin Moroder, Gerard McGowan, David Yorston","doi":"10.1136/bmjophth-2025-002484","DOIUrl":"10.1136/bmjophth-2025-002484","url":null,"abstract":"<p><strong>Background: </strong>Vitreomacular interface disorders are known to reduce vision-related quality of life (VR-QoL). This is due to both reduced visual acuity and metamorphopsia. In clinical practice, visual acuity is measured routinely, but quantitative measurements of metamorphopsia are less frequent. We conducted a scoping literature review to determine whether metamorphopsia or visual acuity has the greatest effect on VR-QoL.</p><p><strong>Methods: </strong>A literature review, of studies published in English, and indexed in Medline or Embase, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 65 studies were identified. 55 were excluded as they did not meet the inclusion criteria.</p><p><strong>Results: </strong>Of the 10 publications, six studied epiretinal membrane, two studied full-thickness macular hole, one studied vitreomacular traction with or without macular hole and one included both macular hole and epiretinal membrane. A variety of different methods were used to measure metamorphopsia and VR-QoL. Of the eight studies reporting the association between preoperative metamorphopsia and VR-QoL, five found a significant correlation. Six studies examined the association between post-operative metamorphopsia and VR-QoL, five of which found a significant correlation. Five studies looked for any link between reduction in metamorphopsia and improvement in VR-QoL. All five found a significant association. In contrast, only two of eight studies found any association between preoperative vision and VR-QoL, and none found any relationship between improvement in visual acuity and improvement in VR-QoL.</p><p><strong>Conclusions: </strong>Although the published evidence is limited, it appears that metamorphopsia may be a better predictor of preoperative and postoperative VR-QoL than visual acuity. Further research is necessary to confirm this, but metamorphopsia should be measured when assessing vitreomacular interface disorders.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302391","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":"Intracameral pressure during capsulorhexis in cataract surgery using cohesive versus dispersive ophthalmic viscosurgical devices: a randomised trial.","authors":"Daniel M Handzel, Walter Sekundo, Chiraz Ben Abdallah, Markus S Ladewig","doi":"10.1136/bmjophth-2025-002573","DOIUrl":"10.1136/bmjophth-2025-002573","url":null,"abstract":"<p><p>ObjectiveTo study the properties of different ophthalmic viscosurgical devices (OVDs) with respect to their ability to create and maintain high intraocular pressure (IOP) during the creation of a continuous curvilinear capsulorhexis (CCC) by comparing the drop in IOP before and after creation of the CCC.</p><p><strong>Methods and analysis: </strong>The study included 174 eyes in four groups using two different OVDs (hyaluronic acid (HA) and hydroxypropylmethylcellulose (HPMC)) and two different instruments (utrata forceps (UF) and 26G cystotome (RN)). IOP was measured using rebound tonometry with sterilised probes immediately before the beginning of the CCC and immediately afterwards during cataract surgery.</p><p><strong>Results: </strong>The drop in IOP during capsulorhexis was measured at 52.1±10.7 mm Hg with the combination HA/RN, 62.4±11.5 mm Hg with HA/UF, 60.5±10.0 mm Hg with HPMC/RN and 68.7±14.1 mm Hg with HPMC/UF. The variance in IOP reduction between HA and HPMC did not reach statistical significance (p=0.100).</p><p><strong>Conclusion: </strong>The lack of a noticeable difference in IOP levels, despite the use of different OVDs with unique properties, indicates that IOP may not be the main factor influencing the notable differences in tactile feedback perceived by surgeons during capsulorhexis procedures conducted with varying OVDs. To elucidate these sensations, additional characteristics such as viscosity, elasticity, pseudoplasticity and cohesion will have to be explored.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275682","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":"Retinal vascular alteration following surgical intraocular pressure reduction in primary angle closure disease.","authors":"Jin Wang, Zijian Liu, Hui Zhang, Yue Wang, Dapeng Mou, Xin Tang, Shi Danli, Mingguang He, Wang Ning-Li, Ye Zhang","doi":"10.1136/bmjophth-2025-002626","DOIUrl":"10.1136/bmjophth-2025-002626","url":null,"abstract":"<p><strong>Aims: </strong>To investigate retinal vascular geometric alterations following intraocular pressure (IOP)-lowering surgery in patients with primary angle closure disease (PACD) and determine associations between IOP reduction magnitude and retinal vascular parameters.</p><p><strong>Methods: </strong>This retrospective, self-controlled study included patients with PACD who underwent IOP-lowering surgery at Beijing Tongren Hospital. Retinal vascular parameters were quantitatively measured from fundus photographs before and after surgery using a validated deep learning-based analysis system. Main outcomes included retinal arteriolar and venular calibre, tortuosity, fractal dimension (FD), segment number (N_seg) and vascular density. Linear mixed-effects models, adjusted for age, follow-up interval and PACD subtype, assessed associations between IOP reduction magnitude and vascular parameter changes.</p><p><strong>Results: </strong>Among 126 eyes (112 patients), surgery decreased IOP from 35.0±9.9 to 16.7±5.7 mm Hg (p<0.001). Venous FD increased from 1.52±0.06 to 1.53±0.05 (p=0.003), N_seg from 123.50 (IQR: 61.75-182.50) to 153.00 (88.50-185.00) (p=0.007), vessel area density (VAD) from 6.13±1.56 to 6.50±1.34 (p=0.006) and vessel skeleton density (VSD) from 1.24±0.35 to 1.35±0.31 (p=0.003). Vessel calibre and tortuosity showed no significant changes. IOP reduction magnitude was independently associated with changes in venous FD (p=0.023), N_seg (p=0.031), VAD (p=0.012) and VSD (p=0.030).</p><p><strong>Conclusions: </strong>Surgical IOP reduction in PACD patients produces selective retinal venous alterations with increased complexity and density. These pressure-responsive changes may provide complementary, non-invasive information regarding vascular response after surgery.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12931541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147275668","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":"Integrating AI, imaging innovations and omics for precision medicine.","authors":"Kai Jin, Danli Shi, Jiong Zhang","doi":"10.1136/bmjophth-2026-002745","DOIUrl":"10.1136/bmjophth-2026-002745","url":null,"abstract":"","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225667","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":"Reduced haemorrhage during external medial orbital wall decompression with nasal packing containing vasoconstrictive agent.","authors":"Anna Helena Christina Wiktorin, Pär Stjärne, Elin Bohman","doi":"10.1136/bmjophth-2025-002460","DOIUrl":"10.1136/bmjophth-2025-002460","url":null,"abstract":"<p><strong>Objective: </strong>In retrocaruncular medial decompression, the incision is small relative to the depth of the surgical space, and haemorrhage may obscure vision. Measures that minimise bleeding are most important to improve visualisation and facilitate the procedure. Despite this, there is no consensus regarding the effect of nasal packing with a vasoconstrictive agent. The aim of this study was to see if haemorrhage during external medial decompression could be reduced by nasal packing.</p><p><strong>Methods and analysis: </strong>A randomised, non-blinded, prospective study in which patients listed for orbital medial wall decompression at St Erik Eye Hospital, Sweden, were recruited. Patients were randomised to receive either nasal packing with a 4%+0.02% Cocaine Hydrochloride-Adrenaline solution or the control group. Intraoperative bleeding was quantified by weighing the suction device before and after the procedure.</p><p><strong>Results: </strong>A total of 46 medial orbital wall decompressions in 37 patients were included in the final analysis. The treatment group, which received nasal packing, demonstrated significantly reduced intraoperative bleeding compared with the control group (median 9.40 g vs 30.10 g, p<0.001). No surgical complications or postoperative infections were reported.</p><p><strong>Conclusions: </strong>This study demonstrated a highly significant reduction in perioperative bleeding during retrocaruncular medial decompression when nasal packing with a vasoconstrictive agent was used (p<0.001). The main limitation of this study is the potential variability between surgeons. However, a post hoc test (p=0.75) and interaction analysis (p=0.63) did not reveal any differences between surgeons. In summary, nasal packing with a potent vasoconstrictor offers a simple, effective means to reduce intraoperative bleeding during external medial wall decompression and can thereby be an easy way to facilitate this surgical procedure and reduce the risk of complications.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12918663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218657","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":"Effects of ascorbic acid on trabecular meshwork gene expression and collagen secretion.","authors":"Paul Holden, Yong-Feng Yang, Ying Ying Sun, Kate Keller","doi":"10.1136/bmjophth-2025-002487","DOIUrl":"10.1136/bmjophth-2025-002487","url":null,"abstract":"<p><strong>Objective: </strong>Aqueous humour (AH) contains relatively high concentrations of vitamin C (ascorbate). AH drains out of the anterior chamber through the trabecular meshwork (TM) and, therefore, TM cells in vivo are routinely bathed in this antioxidant. Yet, most TM cells are cultured in vitro in media without ascorbate. In this study, we investigated molecules expressed by TM cells cultured with and without ascorbate.</p><p><strong>Methods and analysis: </strong>Non-glaucomatous TM cell strains were grown to confluence and placed in serum-free media with or without 0.1 mM ascorbate for 3 days. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and western blotting were used to investigate protein levels, and some bands were analysed by liquid chromatography-mass spectrometry/mass spectrometry (LC-MS/MS) mass spectrometry. RNA was isolated and gene expression was quantified using fluorescent barcode technology. Following data normalisation, bioinformatics software was used to identify differentially expressed genes (DEGs). Quantitative PCR was used to validate results.</p><p><strong>Results: </strong>In ascorbate-treated cells, western immunoblotting showed that several collagen chains were properly modified and secreted and LC-MS/MS identified proteins. Gene expression showed that 76 genes were significantly upregulated, and 20 genes were downregulated. Not surprisingly, antioxidative stress genes (<i>SOD1, PRDX1, TXN2</i>) were upregulated. Several genes involved in collagen synthesis, extracellular matrix assembly and remodelling (<i>HSP47, MMP2, TIMP2, SERPINE1, CDH5, NCAM1, ITGA4</i>) were also upregulated, but <i>ITGB3</i> was downregulated. Genes involved with vascular endothelium growth factor (VEGF) (<i>VEGFA, VEGFB),</i> transforming growth factor β (<i>SMAD2, SMAD4</i>) and Hedgehog (<i>PTCH1, GLI1</i>) signalling pathways were also significantly altered by ascorbate treatment. Interestingly, many DEGs have no currently assigned role in ascorbate response.</p><p><strong>Conclusions: </strong>This study revealed several collagens and 96 genes that are regulated by ascorbate in TM cells. Our results establish the importance of including ascorbate in culture media during the in vitro culture of TM cells. Further analysis of the function of these genes may improve our understanding of the importance of ascorbate for TM cell health.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12911703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200278","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":"Safety and tolerability of avacincaptad pegol in combination with ranibizumab in treatment-naïve patients with neovascular age-related macular degeneration: results from a phase 1 and phase 2a study.","authors":"Sunil S Patel, David S Boyer, Anat Loewenstein, Julie Clark, Liansheng Zhu, Justin Tang, Dhaval Desai","doi":"10.1136/bmjophth-2025-002232","DOIUrl":"10.1136/bmjophth-2025-002232","url":null,"abstract":"<p><strong>Objective: </strong>To assess the safety and tolerability of avacincaptad pegol (ACP), a Food and Drug Administration-approved therapy for geographic atrophy, administered in combination with ranibizumab, an approved therapy for neovascular age-related macular degeneration (nAMD), in patients with nAMD.</p><p><strong>Methods: </strong>The phase 1 study (NCT00709527) was a two-part, ascending-dose and parallel-group, open-label trial that assessed the safety, tolerability and pharmacokinetic profile of monthly intravitreal injections of ACP (0.03, 0.3, 1, 2, 3 mg) in combination with ranibizumab (0.5 mg) on the same day in treatment-naïve patients with nAMD (n=43 patients received a maximum of 6 injections). The phase 2a study (NCT03362190) was an open-label trial assessing the 6-month safety of intravitreal injections of ACP administered in combination with ranibizumab in treatment-naïve patients with nAMD (n=64). Patients received either ACP 2 mg or 4 mg either 14 days or 1 month apart, given on the same day or 2 days after ranibizumab. Primary outcome measures were safety and tolerability.</p><p><strong>Results: </strong>During the phase 1 study, there were no dose-limiting toxicities at any dose level. In both studies, ocular treatment-emergent adverse events were mostly mild or moderate, with the most reported events related to the injection procedure. There were no clinically significant increases in intraocular pressure or cumulative increases with multiple injections over time. There were no safety issues identified through measurement of visual acuity.</p><p><strong>Conclusions: </strong>Coadministration of ACP and ranibizumab in treatment-naïve patients with nAMD was well tolerated across different dosing regimens with no new safety issues based on results from two independent studies.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112366","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":"Research on eye health 2000-2019: a global bibliometric analysis with a focus on equity.","authors":"Jacqueline Ramke, Saad Chugtai, Justas Bezaras, Lisa M Hamm, David Macleod, Jinfeng Zhao, Iris Gordon, Jennifer R Evans, Matthew Burton","doi":"10.1136/bmjophth-2025-002404","DOIUrl":"10.1136/bmjophth-2025-002404","url":null,"abstract":"<p><strong>Objective: </strong>To summarise global peer-reviewed primary research on eye health published from 2000 to 2019.</p><p><strong>Methods and analysis: </strong>We used the 'explode eye disease' function on MEDLINE to obtain all articles reporting primary research studies on eye health published between 1 January 2000 and 31 December 2019. We were intentionally broad and included population, clinical, animal and laboratory studies. We categorised the main eye condition of the paper from Medical Subject Headings (MeSH) terms, and the country of the study from the first country listed in the abstract (or if this was absent, the affiliation of the first author). A validated algorithm was used to assign gender to authors.</p><p><strong>Results: </strong>We included 158 697 publications from 178 countries. Across the period, annual research output increased globally (4.2% per annum, 5057 publications in 2000 to 10 875 in 2019) and in 20 of 21 regions. There was substantial geographical maldistribution, with research output ranging from 1.0 publication/million population in Central Sub-Saharan Africa to 165.8/million in Australasia; 70% of research identified was conducted in high-income countries (n=1 11 417). 42% of publications focused on one of the five leading causes of vision impairment. Of the 789 463 authorships assigned a gender, women held 33% of all (n=261 636/789 463), 36% of first (n=47 729/131 664) and 24% of last authorships (n=31 720/129 800). Women formed 50% of authorship teams when the last author was a woman (IQR 38-71%), compared with 20% of teams when the last author was a man (IQR 0-40%).</p><p><strong>Conclusion: </strong>The annual research output doubled globally over the two decades, with a disproportionate output from high-income countries and slow progress towards gender parity. The main limitations of our study included the use of a single database, which may have led to an underestimation of all outputs, particularly from low- or middle-income countries.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146104129","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":"Metformin and incidence of age-related macular degeneration in people with diabetes: a population-based 5-year case-control study.","authors":"Dewi Fathin Romdhoniyyah, Ayesh Alshukri, David G Parry, Simon Harding, Nicholas A V Beare","doi":"10.1136/bmjophth-2025-002339","DOIUrl":"10.1136/bmjophth-2025-002339","url":null,"abstract":"<p><strong>Objective: </strong>Metformin has been identified as a potential treatment for age-related macular degeneration (AMD). Photographic screening for diabetic retinopathy provides an opportunity to conduct a case-control study with systematic AMD grading. We aimed to investigate associations between metformin use and incidence and progression of AMD at different grades.</p><p><strong>Methods and analysis: </strong>We randomly sampled 2600 participants from 10 336 people aged ≥50 years with diabetes who attended retinopathy screening in 2011 (baseline) and were enrolled to the Individualised Screening for Diabetic Retinopathy study. 2545 of these participants had type 2 diabetes and gradable fundus photographs at baseline, which were graded using modified age related eye disease study grading. We used data including those on metformin prescription from general practitioner records. We used multivariate logistic regression to investigate associations between metformin and incidence or progression of early, intermediate and late AMD.</p><p><strong>Results: </strong>Of 2545 participants, 2089 attended and had gradable fundus images on year 5. Metformin was associated with reduced incidence of intermediate AMD by 5 years after adjusting for confounders (complete record OR 0.63, 95% CI 0.43 to 0.92, p=0.02). In univariate analysis, metformin was associated with reduced incidence of late AMD (OR 0.43, 95% CI 0.21 to 0.88, p=0.02) but this did not remain significant after adjusting for age and sex. The numbers progressing to late AMD were small. There was no association between metformin and the incidence of early AMD.</p><p><strong>Conclusion: </strong>We have found a significant association between metformin use and reduction in incidence of intermediate AMD by 37% in people with diabetes over 5 years. Previous epidemiological studies of metformin and AMD have used secondary data on AMD. In this observational study, there were baseline differences between groups, although significant findings remained after adjusting for important confounders. Given metformin's anti-ageing therapeutic effects, the reduction in risk is plausible and warrants prospective clinical trials.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112380","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}