BMJ Open Ophthalmology最新文献

{"title":"Multimodal imaging biomarkers for progression from intermediate to advanced age-related macular degeneration (AMD): a 10-year prospective longitudinal cohort study from the University of Colorado AMD registry.","authors":"Ramya Gnanaraj, Andres Lisker-Cervantes, Jennifer Patnaik, Vivian Rajeswaren, Nihaal Mehta, William Gange, Anne M Lynch, Alan Palestine, Marc Mathias, Niranjan Manoharan, Naresh Mandava, Talisa E de Carlo Forest","doi":"10.1136/bmjophth-2024-002112","DOIUrl":"10.1136/bmjophth-2024-002112","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate multimodal imaging (MMI) biomarkers for predicting progression from intermediate to advanced age-related macular degeneration (AMD).</p><p><strong>Methods and analysis: </strong>This prospective longitudinal cohort study included patients with intermediate AMD (iAMD) enrolled in the University of Colorado AMD registry between July 2014 and August 2023, with follow-up through February 2024. At enrolment, patients' medical histories and MMI were collected. Baseline and follow-up imaging were reviewed for progression to geographic atrophy (GA) and neovascular AMD (nAMD). Univariate and multivariable Cox proportional hazard modelling with competing risks to determine HRs for progression.</p><p><strong>Results: </strong>A total of 367 patients (733 eyes) with iAMD were included in the study, with a median follow-up of 27.8 months. During this period, 100 eyes progressed to GA, 58 to nAMD. Adjusted for age, BMI and hypertension, progression to nAMD was significantly associated with soft drusen (HR 5.31, 95% CI 1.95 to 14.4, p=0.001), pigmentary changes (HR 2.74, 95% CI 1.52 to 4.92, p=0.0008) on colour fundus photography (CFP) and subretinal hyper-reflective material (SHRM) (HR 3.36, 95% CI 1.88 to 6.02, p<0.0001) and intraretinal hyper-reflective foci (IHRF) (HR 3.12, 95% CI 1.74 to 5.57, p=0.0001) on optical coherence tomography (OCT). Adjusted for age, progression to GA was predicted by soft drusen (HR 1.90, 95% CI 1.11 to 3.27, p=0.020), drusenoid pigment epithelial detachment (PED) (HR 5.51, 95% CI 2.49 to 12.2, p<0.0001), avascular non-drusenoid PED (HR 6.59, 95% CI 1.54 to 28.1, p=0.011), pigmentary changes (HR 4.44, 95% CI 2.84 to 6.96, p<0.0001) on CFP and nnSRF (HR 6.41, 95% CI 1.39 to 29.6, p=0.017), SHRM (HR 2.55, 95% CI 1.45 to 4.49, p=0.001), drusenoid PED (HR 2.25, 95% CI 1.43 to 3.55, p=0.0005), avascular non-drusenoid PED (HR 4.67, 95% CI 2.45 to 8.92, p<0.0001), IHRF (HR 6.27, 95% CI 3.89 to 10.1, p<0.0001) and incomplete retinal pigment epithelium and outer retinal atrophy (HR 9.42, 95% CI 5.82 to 15.2, p<0.0001) on OCT (table 3).</p><p><strong>Conclusions: </strong>Key imaging biomarkers associated with the progression were identified, which may offer prognostic information for providers. However, the study is limited by its predominantly Caucasian population and single-centre design, which may affect the generalisability of certain biomarkers.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11973788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143787948","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":"Effect of high and low molecular weight sodium hyaluronic acid eye drops on corneal recovery after crosslinking in keratoconus patients.","authors":"Gamze Özkan, Semra Akkaya Turhan, Ebru Toker","doi":"10.1136/bmjophth-2024-001890","DOIUrl":"10.1136/bmjophth-2024-001890","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of eye drops containing high molecular weight hyaluronic acid (HMW-HA) and low molecular weight hyaluronic acid (LMW-HA) on corneal nerve regeneration, dendritic cell (DC) density, corneal sensitivity (CS) and ocular surface parameters in patients with keratoconus following corneal crosslinking (CXL).</p><p><strong>Methods and analysis: </strong>63 eyes of 55 patients with keratoconus were randomised to receive eye drops containing HMW-HA (n: 20) for 12 months, LMW-HA (n: 23) for 12 months and polyvinyl alcohol (n: 20) until closure of the epithelial defect in the control group after CXL. Subbasal nerve plexus (SNP) was imaged with corneal confocal microscopy and quantified with ACCMetrics. DC density was calculated with Image J. Ocular Surface Disease Index (OSDI) questionnaire and non-invasive break-up time (NI-TBUT) were evaluated. All measurements were performed before CXL and 1, 3, 6 and 12 months postsurgery.</p><p><strong>Results: </strong>At 6 months post-CXL, SNP reached to its preoperative. CS was higher in the HMW-HA groups compared with the other two groups in the 3rd and 6th month post-CXL. DC density was higher in the LMW-HA group compared with the HMW-HA group in the postoperative 3rd month. OSDI were higher in the control group compared with both the LMW-HA and HMW-HA groups at postoperative 3rd and 6th months. NI-TBUT was lower in the control group in the 6th and 12th months compared with the other groups.</p><p><strong>Conclusions: </strong>The use of artificial tear drops containing HMW-HA may have a therapeutic effect to promote corneal nerve regrowth and support faster functional recovery after CXL.</p><p><strong>Trial registration number: </strong>NCT06243991.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742515","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":"Quantifying retinal size and shape distortion in different ultra-widefield imaging systems.","authors":"Binwei Huang, Chaoxin Zheng, Siyani Chen, Xulong Liao, Haoyu Chen","doi":"10.1136/bmjophth-2024-001965","DOIUrl":"10.1136/bmjophth-2024-001965","url":null,"abstract":"<p><strong>Objective: </strong>To quantitatively investigate the retinal size and shape distortion in different ultra-widefield (UWF) imaging systems.</p><p><strong>Methods and analysis: </strong>We imaged the posterior segments of model eyes using Daytona, Mirante, CLARUS 500, VG2001, BMizar and TRC-NW8. We measured the scale bars of each grid and the compactness of each ring to quantify the size and shape distortion. The relationship between the relative size with eccentricity and axial length was analysed. The size and shape distortion were compared among different UWF systems.</p><p><strong>Results: </strong>The size is positively associated with eccentricity (β=0.202-0.482; p<0.001) and negatively associated with axial length (β=-0.787 to -0.890; p<0.001) in all UWF systems. There is a significant difference in slopes across devices. The size distortion of Mirante is lower than the other UWF systems (p=0.0083-0.0472) except for TRC-NW8. Multivariate linear regression analysis found the adjusted R²=0.809-0.948, which was improved to more than 0.960 with a quadratic polynomial equation. Only Daytona showed shape distortion, and the compactness of Daytona is smaller than the others (p<0.0001).</p><p><strong>Conclusion: </strong>Quantitative measurements identified different relationships between size distortion with axial length and eccentricity in different UWF systems, which can serve as a reference for correcting size distortion. Shape distortion only occurs in Daytona.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742109","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":"Lymphatic corneal neovascularisation affects graft survival in high-risk corneal transplantation.","authors":"Nadja Franz, Christoph Palme, Alexander Franchi, Victoria Stöckl, Christof Seifarth, Gertrud Haas, Matus Rehak, Bernhard Steger","doi":"10.1136/bmjophth-2024-001961","DOIUrl":"10.1136/bmjophth-2024-001961","url":null,"abstract":"<p><strong>Objectives: </strong>Corneal neovascularisation (CoNV) is a major risk factor for corneal allograft rejection and failure. This study assessed the impact of preoperative lymphatic and haematic vascularisation of the graft bed on graft survival in a clinical setting.</p><p><strong>Methods and analysis: </strong>This retrospective study included patients with histologically confirmed CoNV (positive staining for CD-31) who underwent penetrating keratoplasty (PK) between 2008 and 2023 at the Medical University of Innsbruck, Austria. Cases were divided into two groups depending on the presence or absence of lymphatic CoNV (podoplanin staining). Follow-up was 2 years or until graft failure. Outcome parameters included the risk of graft failure and leakage patterns in a subgroup with preoperative indocyanine green (ICG) angiography.</p><p><strong>Results: </strong>Of 17 included patients, lymphatic CoNV was identified in the excised corneal buttons of 10 cases (group 1). Seven cases stained only for haematic CoNV (group 2). Group 1 had a shorter age of CoNV (0.6±0.4 vs 2.3±0.8 years, p<0.001) and a higher rate of graft failure (6/10 vs 0/7, p=0.005). Lymphatic CoNV was only present in the age of CoNV less than 12 months. ICG leakage was associated with a younger age of CoNV (p=0.0338), corresponding to the presence of lymphatic CoNV at a younger age of CoNV.</p><p><strong>Conclusion: </strong>Lymphatic CoNV in haemvascularised corneal stromal beds increases the risk of graft failure within 2 years. Lymphatic CoNV regression occurs within the first year of an inciting event. This time period or the presence of ICG dye leakage indicates a very high risk for corneal transplantation.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741811","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":"Development of a Sun Protection Factor for contact lenses (CL-SPF).","authors":"James S Wolffsohn, Tom Drew, Andrew Devitt, Sasha Kieran","doi":"10.1136/bmjophth-2024-002005","DOIUrl":"10.1136/bmjophth-2024-002005","url":null,"abstract":"<p><strong>Objective: </strong>Sun Protection Factor (SPF) of sunscreen products is well recognised by consumers. This study explored how SPF could be applied to ultraviolet radiation (UV) protection from contact lenses (CL-SPF).</p><p><strong>Methods and analysis: </strong>UV transmission through 15 commercially available contact lenses and three spectacle lens materials was measured with a deuterium light source and spectrophotometer. CL-SPF values were calculated using the standard in vitro method used to test and label skin products. Ray tracing was applied to two sunglass designs to assess the effect of solar angle and head orientation on light reaching the ocular surface. Cellular damage profile of human corneal and conjunctival cells across the UV range was assessed in vitro to inform an SPF equivalent for CLs.</p><p><strong>Results: </strong>CLs tested fell into three categories: CL-SPF with no UV blocker=1.0-2.0 (equivalent to using no sunscreen); CL-SPF with Class 2 UV blocker=12.3-24.8 (equivalent to SPF15); and CL-SPF with Class 1 UV blocker=59.6-66.2 (equivalent to SPF 50+). Despite the UV-blocking characteristics of sunglasses, ocular surface protection can be substantially reduced at certain solar angle and head orientation combinations; on average, 76%-89% of light was prevented from reaching the ocular surface depending on the intensity of the tint (80%-20% transmission). The data also suggest that cell damage and death of ocular surface cells has a similar profile to that of the skin, but conjunctival cells are more susceptible to UV damage.</p><p><strong>Conclusion: </strong>CL-SPF is a viable metric to communicate the protection from the absorption/transmission of UV radiation that CLs offers wearers. However, a contact lens will only project the area of the ocular surface it covers, which is limited to mainly the cornea and internal eye tissues with soft CLs.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708694","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":"Associations between certification of visual impairment and socioeconomic deprivation: a study using data from the regional Northern Ireland sight impairment certification database.","authors":"Natasha Moore, Laura Cushley, David Wright, Roseleen McCann, Tanya Moutray, Tunde Peto, Augusto Azuara-Blanco, Jonathan Jackson","doi":"10.1136/bmjophth-2024-001868","DOIUrl":"10.1136/bmjophth-2024-001868","url":null,"abstract":"<p><strong>Background/aims: </strong>Within the UK, there are approximately 340 000 people who are registered as sight impaired (SI) or severely Sight Impaired (SSI), mainly due to age-related macular degeneration (AMD), diabetic eye disease (DED) and glaucoma. This study aimed to explore the association between certification of visual impairment (CVI) and socioeconomic deprivation.</p><p><strong>Methods: </strong>Data from all CVI forms across Northern Ireland (NI) between 2018 to 2022 were used for analysis. Data collected included age, sex, visual acuity (logMAR), postcode and certification category. Deprivation measure was obtained using the Northern Ireland Multiple Deprivation Measure 2017 (NIMDM17). Patients were allocated a quintile from 1 (most deprived) to 5 (least deprived).</p><p><strong>Results: </strong>Of the 1863 patients with VI who met the inclusion criteria, 1798 (97%) had postal codes recorded and therefore were allocated an NIMDM17 score. There were 755 patients in total, which were grouped into the most deprived and least deprived areas (357 and 398, respectively). Results showed that patients living in more deprived areas were significantly more likely to be certified as SI/SSI at a younger age than those living in less deprived areas (80.97 vs 85.77, respectively, p<0.001). This was seen in patients with AMD (85.1 vs 87.5, p=0.005) and DED (63.9 vs 69.8, p=0.013) but not in glaucoma (80.9 vs 84.1, p=0.073).</p><p><strong>Conclusion: </strong>This study has shown that patients living in more deprived areas are more likely to be certified as SI or SSI at a significantly younger age compared with patients from less deprived areas across the certification database.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708693","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":"Systematic review of genotype-phenotype associations in <i>CRX</i>-associated retinal dystrophies.","authors":"Malak Banjak, Jinane Noureldine, Zahraa Mousawi, Joseph Nehme, Lama Jaffal, Said El Shamieh","doi":"10.1136/bmjophth-2024-002030","DOIUrl":"10.1136/bmjophth-2024-002030","url":null,"abstract":"<p><strong>Background and objectives: </strong><i>CRX</i>-associated retinal dystrophies (<i>CRX</i>-RDs) exhibit significant genotype-phenotype heterogeneity. This study aimed to elucidate the genotype-phenotype associations of <i>CRX</i> through a systematic analysis of the reported cases.</p><p><strong>Methods: </strong>84 studies, including 373 worldwide participants, were reviewed. These studies were checked for quality using Murad's tool for methodological quality and synthesis of case series and case reports. Clinical data, fundus imaging characteristics and genetic pathogenic variants were analysed.</p><p><strong>Results: </strong>The quality analysis revealed an overall good quality of the dataset, with some exceptions that do not detract from this trend. A predominance of cone-rod dystrophy (CRD) and Leber congenital amaurosis (LCA) among <i>CRX</i>-RDs (43% and 27%, respectively) was noted. Missense pathogenic variants were significantly associated with macular pigmentation, an absence of peripheral atrophy, an absence of peripheral pigmentation and CRD (p<0.05). In contrast, the indels (98% frameshifts) were associated with pale optic discs, attenuated optic vessels, and peripheral bone spicules, and more severe phenotypes, such as LCA (p<0.05). Pathogenic variants in the homeodomain were associated with cone and/or CRD; others in the OTX tail were linked to LCA.</p><p><strong>Conclusion: </strong><i>CRX</i> pathogenic variants are associated with specific phenotypic features.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708622","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":"What do we know about premyopia and should we be giving it greater consideration?","authors":"Neema Ghorbani-Mojarrad, Xiaotong Han, Noora Dbayat, Xiaohu Ding","doi":"10.1136/bmjophth-2024-002059","DOIUrl":"10.1136/bmjophth-2024-002059","url":null,"abstract":"","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691296","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 OCT retinal ganglion cell volume from pattern ERGs and VEPs in children with suspected optic neuropathy in a tertiary referral setting.","authors":"Dorothy A Thompson, Katrina L Prise, Lisa Tucker, Dermot Roche, Richard Bowman, Benjamin E W Evans, Sian Handley, Oliver R Marmoy","doi":"10.1136/bmjophth-2024-001899","DOIUrl":"10.1136/bmjophth-2024-001899","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the relationship between retinal ganglion cell (RGC) structure, measured by optical coherence tomography (OCT), and function measured by electrodiagnostic tests in children with suspected optic neuropathy.</p><p><strong>Methods: </strong>Children presenting consecutively with suspected optic neuropathy were investigated by visual electrophysiology. ISCEV Standard monocular pattern reversal visual evoked potential (PVEP) P100 and pattern electroretinogram (PERG) P50 and N95, amplitudes and peak times were collected, along with the N95 slope 30 ms after the P50 peak. OCT retinal nerve fibre layer (RNFL) thickness from each peripapillary sector and the average macular RGC volume in a 3.45 mm diameter circle were collated. The sensitivity (SENS) and specificity (SPEC) of abnormal visual electrophysiology measures in predicting OCT structural measures were estimated by receiver operating characteristic (ROC) area under the ROC curve (AUC).</p><p><strong>Results: </strong>Monocular PVEPs and PERGs from 30-degree stimulus fields and OCT RNFL and RGC volume were available from 42 children (84 eyes) aged 5.5-16.3 years (median 12.4 years). PVEP AUC was highest for predicting both RGC macular volume and temporal RNFL thinning (SENS 88%, SPEC 88%), followed by the PERG N95 slope (SENS 79%, SPEC 78%). PERG N95:P50 had the lowest SENS of 62% and SPEC of 61%, which were similar for all RNFL sectors.</p><p><strong>Conclusion: </strong>Abnormal PERG N95 slopes and PVEPs predicted severe loss of macular RGC volume and temporal sector RNFL with high diagnostic accuracy. These measures are important additions to the less specific PERG N95:P50, which was broadly sensitive to all RNFL sectors. The N95 slope and PVEPs are valuable objective functional markers of RGC health in children.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691294","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":"Association of plasma metabolites with treatment response after intravitreal anti-vascular endothelial growth factor injections in treatment-naïve neovascular age-related macular degeneration.","authors":"Hae Min Kang, Kevin M Mendez, Inês Laíns, Krupa Sourirajan, Roshni Bhat, Archana Nigalye, Raviv Katz, Georgiy Kozak, Hanna Choi, Augustine Bannerman, Rodrigo A Alvarez, David Wu, Ivana K Kim, Liming Liang, John B Miller, Demetrios G Vavvas, Joan W Miller, Jessica Lasky-Su, Deeba Husain","doi":"10.1136/bmjophth-2025-002149","DOIUrl":"10.1136/bmjophth-2025-002149","url":null,"abstract":"<p><strong>Background/aims: </strong>To investigate the association between plasma metabolomic profiles and treatment response after intravitreal anti-vascular endothelial growth factor (VEGF) injections in treatment-naïve neovascular age-related macular degeneration (nAMD).</p><p><strong>Methods: </strong>This is part of a prospective longitudinal study that included patients with treatment-naïve nAMD who have undergone three loading intravitreal anti-VEGF injections. All patients underwent ophthalmological examinations including spectral domain optical coherence tomography (SD OCT). Fasting blood samples were collected at the time of study enrolment (not to first anti-VEGF injection) and metabolomic profiling was conducted using ultra-performance liquid chromatography-mass spectrometry. Treatment response was defined as no evidence of any subretinal and intraretinal fluid on SD OCT 4-6 weeks after the third injection. Multilevel mixed-effects linear modelling was used to assess associations between plasma metabolites and treatment response. Multiple comparisons were accounted for using the effective number of tests to explain 80% of the variance (ENT80), with a p value threshold of 0.0017.</p><p><strong>Results: </strong>We included 131 eyes of 101 patients, and 69 patients (68.3%) were female. 51 eyes (38.9%) were treatment responders. Taurodeoxycholate (TDCA) was the only plasma metabolite significantly associated with treatment response (β=1.6, ENT80=0.001).</p><p><strong>Conclusion: </strong>In our study, TDCA was the most significant plasma metabolite associated with treatment response after three-loading dose of anti-VEGF therapy in patients with nAMD. Bile acids may have a beneficial impact on treatment response in nAMD through their neuroprotective property. Plasma metabolites may be used as biomarkers to predict responses to initial anti-VEGF therapy in patients with nAMD, providing a more individualised treatment plan.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"10 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639533","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}