BMJ Open Ophthalmology最新文献

{"title":"Photopic pupil size, foveal anatomy and emmetropisation: a cross-sectional study in adult eyes.","authors":"Niklas Domdei, Brian Vohnsen, Siegfried Wahl, Wolf Harmening","doi":"10.1136/bmjophth-2026-002836","DOIUrl":"10.1136/bmjophth-2026-002836","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between photopic pupil size, refractive state and foveal anatomy in healthy adults, in the context of emmetropisation and myopia.</p><p><strong>Methods and analysis: </strong>In this cross-sectional study, pupil sizes were recorded in 80 healthy adults (28±8 years/55 women) using a custom-built high-resolution pupil tracker (0.03 mm/pixel). Daylight lamps provided two high-luminance conditions (6.5k and 10k cd/m²). Objective refraction and axial length were measured, and additionally high-resolution optical coherence tomography (OCT) was applied to record retinal volume scans of the fovea. OCT B-scans were automatically segmented for the internal limiting membrane and retinal pigment epithelium layers by the instrument algorithm. Additionally, the ellipsoid and phagosome zones defining the outer segment lengths were determined by a custom-made algorithm. Associations between photopic pupil size, refractive state, axial length and foveal metrics were analysed with correlation and multivariable regression.</p><p><strong>Results: </strong>Photopic pupil sizes at 6.5k cd/m² ranged from 1.77 to 3.38 mm (2.33±0.26 mm). Spherical equivalent of refraction ranged from -9.4 to +4.9 D (-1.24±2.29 D), and axial length ranged from 21.0 to 27.0 mm (23.9±1.2 mm). Photopic pupil size was significantly correlated with axial length and refractive state (all p≤0.01), although the explained variance was modest (R² up to 0.09). Outer segment length and foveal hill distance were significantly associated with refractive state (all p<0.05).</p><p><strong>Conclusion: </strong>The association of photopic pupil size with axial length and refractive state, alongside foveal parameters being linked to refractive state but not to pupil size (exception: nasal hill height), suggests a potential interplay between foveal architecture and emmetropisation. Further investigation via longitudinal studies of children will be required. The main limitation of this study is the under-representation of high-myopes.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13384153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148469286","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":"10-year anniversary of <i>BMJ Open Ophthalmology</i>.","authors":"Stephen B Kaye","doi":"10.1136/bmjophth-2026-002797","DOIUrl":"10.1136/bmjophth-2026-002797","url":null,"abstract":"","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13374467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148444515","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":"Diagnostic delays and sexual health integration in <i>Chlamydia trachomatis</i> conjunctivitis: an 11-year retrospective study at a UK tertiary ophthalmic centre.","authors":"Alice L Milligan, Dalia Abdulhussein, Yan Ning Neo, Chuiki Jasmine La, Nicole Quah, Shara Palanivel, Soonita Oomeer, Siyin Liu, Jeremy Hoffman","doi":"10.1136/bmjophth-2026-002843","DOIUrl":"10.1136/bmjophth-2026-002843","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the epidemiology, clinical features, diagnostic pathways and sexual health integration in patients with <i>Chlamydia trachomatis</i> conjunctivitis (CTC) presenting to a UK tertiary eye hospital over an 11-year period.</p><p><strong>Design: </strong>Retrospective case study.</p><p><strong>Setting: </strong>Tertiary ophthalmic emergency department and corneal and external eye disease service in London, UK.</p><p><strong>Participants: </strong>All patients with laboratory-confirmed <i>CTC</i> from conjunctival nucleic acid amplification tests between 1 January 2013 and 31 December 2023. Of 312 identified cases, 267 with available medical records were included.</p><p><strong>Primary and secondary outcome measures: </strong>Primary outcomes were time to diagnosis, initial misdiagnosis rates and documentation of sexual history. Secondary outcomes were clinical signs, management (including systemic treatment and referral to sexual health services), complications and temporal trends in testing and positivity.</p><p><strong>Results: </strong>Median age was 26 years (range 14-78 years) and 67.8% (181/267) were male. Presentation was unilateral in 88.0% (235/267). Common signs included conjunctival hyperaemia (95.1%) and tarsal follicles (85.4%). Diagnostic samples were obtained at the first visit in 13.1%, with a median time to diagnosis of 14 days (range 1-194 days). An incorrect initial diagnosis was made in 63.6% (170/267), presumed adenoviral conjunctivitis. Sexual history was documented in 24.0% (64/267); among these, 4.5% reported genital symptoms and 7.1% had prior awareness of genital chlamydia. Appropriate systemic antibiotic therapy was documented in 52.4% (140/267). Despite a reduction in number of conjunctival swabs from 1728 in 2013 to 402 in 2023, positivity increased from 1.9% to 3.2%.</p><p><strong>Conclusions: </strong>CTC is frequently misdiagnosed and late diagnosed in ophthalmic practice, with sexual history rarely documented and referral to sexual health services often unclear. These findings highlight opportunities for genital chlamydia detection and support routine sexual health assessment, clear referral pathways and increased clinician awareness. The retrospective, single-centre design and absence of a repeat audit cycle limit the generalisability of these findings.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13347870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410722","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 disability accommodations and ophthalmology.","authors":"Vladimir Mamchik, Joshua R Ehrlich","doi":"10.1136/bmjophth-2026-002838","DOIUrl":"10.1136/bmjophth-2026-002838","url":null,"abstract":"","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366856","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 efficacy of biosimilar aflibercept MYL-1701P in diabetic macular oedema: 20-week extension results following the INSIGHT pivotal trial.","authors":"Rohan Chauhan, Vishali Gupta, Sribhargava Natesh, Rajpal Vohra, Virendra Agarwal, Prasanna C Ganapathi, Debdipta Bose, Subramanian Loganathan","doi":"10.1136/bmjophth-2025-002637","DOIUrl":"10.1136/bmjophth-2025-002637","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety, efficacy and immunogenicity of biosimilar aflibercept (MYL-1701P) in participants with diabetic macular oedema who completed the 52-week global phase III trial and were enrolled in an extension study.</p><p><strong>Methods: </strong>In a 20-week, multicentre, open-label extension study at 15 sites in India, safety and efficacy were assessed in 52 participants who received three doses (2 mg intravitreal) of MYL-1701P either continuing on MYL-1701P (continuation arm) or switching to it from reference aflibercept (switch arm). The primary outcome was safety, assessed by the incidence of treatment-emergent adverse events (TEAEs). The secondary outcome was efficacy and included change in visual acuity (best corrected visual acuity (BCVA) based on Early Treatment Diabetic Retinopathy Study (ETDRS) letters) and central subfield thickness ((CST); by spectral-domain optical coherence tomography).</p><p><strong>Results: </strong>Of the 52 participants enrolled, 46 completed week 76. Participants in both arms had comparable baseline characteristics. Incident TEAEs were noted in 9/29 participants in the continuation arm and 7/23 in the switch arm. No participant reported treatment-induced or boosted antidrug antibodies. The adjusted mean difference in BCVA change between baseline of parent study and week 76 (end of extension study) was -1.20 (2.95) ETDRS letters (90% CI -6.15 to 3.75) and from baseline of extension study to week 20 (week 76-parent study) was 1.59 (1.1) (90% CI -0.26 to 3.43). The adjusted mean difference in CST from baseline of parent study to week 76 was -15.9 (38.07) µm (90% CI -80.47 to 48.62) and from baseline of extension study to its end was 13.53 (16.13) µm (90% CI -13.86 to 40.92).</p><p><strong>Conclusion: </strong>The study had certain limitations, including participation from one geographical area, an open-label design and small number of participants. Despite the limited number of exposures in the switch arm, it still constituted a reasonable exposure, and similar safety, efficacy and immunogenicity profiles were observed between those who continued receiving MYL-1701P and those who switched from reference aflibercept to MYL-1701P in the 20-week extension study of the pivotal trial.</p><p><strong>Trial registration number: </strong>NCT04674800, NCT03610646.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148350799","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":"Clinical efficacy of portable, cost-effective manual thermal pulsation for obstructive meibomian gland dysfunction and factors associated with therapeutic efficacy.","authors":"Xiaoqi Cheng, Hangyu Huang, Zixin Fan, Heyun Wang, Xiaochun Zheng, Lina Dong, Ming Li, Guoming Zhang, Shengli Mi","doi":"10.1136/bmjophth-2026-002769","DOIUrl":"10.1136/bmjophth-2026-002769","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of portable, cost-effective manual thermal pulsation as a single therapy for meibomian gland dysfunction (MGD) and to compare the microbiota and lipid composition in subjects with different therapeutic efficacy.</p><p><strong>Methods and analysis: </strong>In this single-centre, randomised, positive-controlled clinical trial, 84 subjects were randomly assigned (1:1) to receive a single treatment of manual (self-developed device) or automatic (Lipiflow) thermal pulsation and followed up for 4 weeks, 76 of which were finally analysed. Efficacy was evaluated by Δ Meibomian Gland Score (MGS) (Δ variable=parameter at follow-up-parameter at baseline), Δ non-invasive break-up time (NIBUT), Δ standard patient evaluation of eye dryness (SPEED), Δ Meibomian Gland Expressibility Score (MES) and Δ corneal fluorescein staining (CFS), with safety investigated. Subjects who underwent manual thermal pulsation were further divided into two subgroups based on whether ΔMGS ≥-2, meibum microbiome and lipid metabolomics in the subgroups were analysed.</p><p><strong>Results: </strong>ΔMGS, ΔNIBUT, ΔSPEED, ΔMES and ΔCFS were not significantly different between manual and automatic thermal pulsation groups in 4 weeks (both p>0.05), indicating non-inferior efficacy of manual thermal pulsation. No serious ocular or device-related adverse events were reported. A more complex meibum microorganism diversity and 46 differentially expressed lipids (such as triglycerides, diglycerides, ceramides and oxidised species) were identified in those with a relatively weak therapeutic efficacy.</p><p><strong>Conclusions: </strong>Portable, cost-effective manual thermal pulsation demonstrated non-inferiority to automatic thermal pulsation for MGD during the 4-week follow-up period, with therapeutic efficacy associated with meibum micro-organism and lipid components.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13311687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148327081","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":"Long-term axial elongation in myopic children wearing DIMS spectacle lenses: an 8-to-10-year observational study.","authors":"Tsz Wing Leung, Han Yu Zhang, Kin Ho Chan, Paul H Lee, Kenneth Ka King Liu, Yee Mui Kwok, Ka Mei To, Natalia Vlasak, Carly Siu-Yin Lam","doi":"10.1136/bmjophth-2026-002780","DOIUrl":"10.1136/bmjophth-2026-002780","url":null,"abstract":"<p><strong>Background/aim: </strong>To evaluate the long-term effectiveness of Defocus Incorporated Multiple Segments (DIMS) spectacle lenses in a long-term observational follow-up (>8 years) of an original randomised clinical trial cohort transitioning into late adolescence.</p><p><strong>Methods: </strong>This observational post-trial study included 60 young adults (mean age: 19.97±1.64 years) from the original DIMS trial (baseline age: 8-13 years) followed for an average of 9.4±0.3 years. Longitudinal changes in spherical equivalent refraction (SER) and axial length (AL) were analysed using linear mixed-effects models (LMM) to compare rates of change during DIMS versus single vision (SV) wear periods. LMM predictions were benchmarked against an external meta-analysis for untreated Asian children.</p><p><strong>Results: </strong>The LMM revealed a significant treatment effect for DIMS on axial elongation (p=0.003), with a predicted 65% cumulative reduction versus modelled SV wear (0.44±0.11 mm vs 1.27±0.11 mm). Conversely, the LMM found no statistically significant effect on SER progression (p=0.83), despite predicting a large, clinically meaningful cumulative difference (DIMS: -0.57±0.32 D vs SV: -2.17±0.37 D). The LMM-predicted elongation for continuous DIMS wear was 76% lower than the external untreated norm.</p><p><strong>Conclusions: </strong>DIMS spectacle lens provides sustained slowing of axial elongation through late adolescence, yielding substantial benefits compared with modelled SV wear and external norms. However, this significant biological effect did not translate to a statistically significant refractive error effect in the LMM, possibly due to the low signal-to-noise ratio inherent to long-term autorefraction measurements and the lack of a contemporaneous, untreated single-vision control group. Further research should address this paradox between significant AL control and non-significant SER outcomes in long-term studies.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275968","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":"A systematic review of neuroprotective therapies for visual acuity preservation in retinitis pigmentosa.","authors":"Sam Sherratt-Mayhew, Max Bisp, Sanna Waheed, Charles Page, Wing Sze Vangie Koo, Shashwat Deep","doi":"10.1136/bmjophth-2026-002771","DOIUrl":"10.1136/bmjophth-2026-002771","url":null,"abstract":"<p><strong>Objectives: </strong>This systematic review aims to evaluate the efficacy of neuroprotective therapies in improving best-corrected visual acuity (BCVA) in retinitis pigmentosa (RP). Secondary outcomes investigated included electroretinogram measures (ERGs), adverse events and other relevant ophthalmological outcomes.</p><p><strong>Methods and analysis: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered on PROSPERO. MEDLINE, EMBASE, ClinicalTrials.gov and the Cochrane Library were searched without date restrictions. Randomised controlled trials comparing neuroprotective interventions with any relevant comparator in typical RP and reporting BCVA outcomes were included. Risk of bias was assessed using ROB2 and certainty of evidence graded using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Due to heterogeneity in interventions and outcome reporting, narrative synthesis was undertaken.</p><p><strong>Results: </strong>10 trials involving 1364 participants were included. Interventions included antioxidants, gamma-aminobutyric acid (GABA) modulators, mechanical neurostimulation and omega-3 fatty acids. Across studies, no neuroprotective therapy demonstrated a clinically or statistically significant improvement in BCVA compared with control, with the exception of <i>Lycium barbarum</i>, which was associated with modest BCVA improvement in a single phase II trial with a very low GRADE certainty of evidence. Vitamin A, docosahexaenoic acid and lutein were associated with changes on secondary outcomes, such as ERG amplitudes, in phase III trials, though findings were from secondary analyses. Overall certainty of evidence was moderate to very low.</p><p><strong>Conclusions: </strong>Current evidence does not support the use of neuroprotective therapies to preserve visual acuity in RP. While some interventions show promise, including in secondary functional measures, robust conclusions are limited by small sample sizes and methodological heterogeneity. Larger, standardised trials are required to validate the role of neuroprotection in RP.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148257584","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":"Alternative posology for brolucizumab: a 6-week loading regimen is as effective as a 4-week regimen for the treatment of nAMD.","authors":"Zufar Mulyukov, Ufuk Olgac, Jeffrey D Kearns, Chang Liu, Etienne Pigeolet, Georges Weissgerber","doi":"10.1136/bmjophth-2025-002660","DOIUrl":"10.1136/bmjophth-2025-002660","url":null,"abstract":"<p><strong>Background: </strong>Extending the dosing interval with the anti-vascular endothelial growth factor (VEGF) brolucizumab in the loading phase may reduce treatment burden while maintaining functional and anatomical outcomes for patients with neovascular age-related macular degeneration.</p><p><strong>Methods: </strong>We integrated population pharmacokinetic/pharmacodynamic (PK/PD) and quantitative system pharmacology (QSP) modelling approaches to evaluate the effect of brolucizumab 6 mg on central subfield thickness (CSFT) and best-corrected visual acuity (BCVA) using an alternative reduced loading regimen (two or three administrations every 6 weeks (q6w)) followed by individualised every 12 weeks/every 8 weeks (q12w/q8w) maintenance. The simulation results were compared with the CSFT and BCVA outcomes in the phase 3 HAWK and HARRIER studies, in which patients received the approved loading regimen of 3 monthly doses.</p><p><strong>Results: </strong>For both loading regimens, simulations of the QSP model showed almost complete VEGF inhibition during the loading phase and free VEGF recovery commenced 6‒7 weeks following the last loading dose, returning to baseline levels after 12‒13 weeks.The population PK/PD simulations showed that week 48 and week 36-48 mean BCVA and CSFT changes from baseline using the alternative loading regimen and individualised maintenance treatment were similar to HAWK and HARRIER study measures. Simulated disease activity assessments indicate that only 20% of patients needed third q6w loading dose before switching to q12w/q8w maintenance treatment.</p><p><strong>Conclusions: </strong>This integrated modelling approach predicted that reducing the loading regimen of brolucizumab 6 mg treatment to two or three doses every 6 weeks is expected to result in similar efficacy outcomes, resulting in regulatory approval of this alternative dosing regimen in several countries.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223368","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":"Relevance of autoantibodies to carbonic anhydrase 6 (CA6), parotid secretory protein (PSP) and salivary gland protein 1 (SP1) to dry eye disease (DED).","authors":"Shyamal Raolji, Gurnoor Gill, Pragnya R Donthineni, Chloe Shields, Zachary T Campbell, Sara S McCoy, Anat Galor","doi":"10.1136/bmjophth-2026-002776","DOIUrl":"10.1136/bmjophth-2026-002776","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the relevance of autoantibodies to carbonic anhydrase 6 (CA6), parotid secretory protein (PSP) and salivary gland protein 1 (SP1) on dry eye disease (DED) symptoms and signs.</p><p><strong>Methods and analysis: </strong>A retrospective study of 115 individuals diagnosed with DED and tested for CA6, PSP and SP1 antibodies at the Miami Veterans Eye Clinic. Antibody status (positive: ≥1 antibody ≥20 EU/mL vs negative: all antibodies <20 EU/mL) and levels were analysed against DED metrics at baseline and follow-up (67 individuals).</p><p><strong>Results: </strong>Of 115 individuals, 73 were antibody positive, with CA6 IgG most frequently elevated. Antibody-positive individuals had more severe DED symptoms (Ocular Surface Disease Index 56.64±22.56 vs 43.89±20.36, p=0.002) and greater tear film instability (5.38±3.52 vs 6.83±4.01 s, p=0.046). These associations remained significant in forward regression analyses. Quantitative antibody levels also related to ocular signs at baseline: corneal staining to SP1 IgA (r=0.36, p<0.001) and PSP IgM (r=0.19, p=0.04) and Schirmer scores to CA6 IgG (r=-0.19, p=0.04). At follow-up, 43% (n=29) showed an increase in DED symptoms and 82% (n=55) in at least one sign, with PSP IgM being most predictive for worsening DED status.</p><p><strong>Conclusions: </strong>Our study suggests that CA6, PSP and SP1 antibody status and levels are relevant in DED. Antibody positivity correlated with more severe baseline symptoms and signs and individual antibody values predicted progression. Rather than markers of a systemic diagnosis, these autoantibodies may better reflect ocular disease severity and progression.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13264944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210063","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}