BMJ Open Ophthalmology最新文献

{"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":2.7,"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":2.7,"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":2.7,"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":2.7,"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":2.7,"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}

{"title":"First-year real-world outcomes of faricimab in clinically significant diabetic macular oedema: a Swiss retina research network report.","authors":"Amr Saad, Christina Plasencia, Justus Garweg, Isabel Barbara Pfister, Marion R Munk, Chiara Maria Eandi, Sandrine Anne Zweifel, Gabriela Grimaldi, Nicolò Bartolomeo, Richard Stillenmunkes, Christin Schild, Jennifer Cattaneo, Felix Gabathuler, Moreno Menghini, Aude Ambersin, Jacqueline Froehlich, Dmitri Artemiev, Andreas Weinberger, Hamza Mohamed, Gabor Mark Somfai, Katja Hatz","doi":"10.1136/bmjophth-2025-002467","DOIUrl":"10.1136/bmjophth-2025-002467","url":null,"abstract":"<p><strong>Aims: </strong>Evaluate the efficacy and safety of faricimab for treatment-naïve and pre-treated diabetic macular oedema (DME) in a real-world setting.</p><p><strong>Methods: </strong>This multicentre, retrospective cohort study examined consecutive DME patients treated with faricimab for ≥1 year. Data were collected at predefined time points. Primary outcomes were mean changes in corrected visual acuity (VA), centre-point retinal thickness (CRT) and central subfield thickness (CST) and treatment intervals and adverse events (AEs).</p><p><strong>Results: </strong>184 eyes with DME were included: 61 (33.2%) were treatment-naïve, and 123 (66.8%) were pretreated. In treatment-naïve eyes, VA improved from 69.7±15 Early Treatment of Diabetic Retinopathy Study letters at baseline to 73.9±14.1 after 12 months (p=0.014), while it remained stable in pretreated eyes (71.2±14.2 vs 73.0±12.9; p=0.14). CST decreased significantly in both groups (treatment-naïve (366.1±108.3 µm to 316.4±113.5 µm, p<0.001); pretreated (339.1±93.1 µm to 298.3±65.8 µm, p<0.001)). Thirty-one percent of naïve eyes and 21.1% of pretreated eyes were completely dry after 12 months. In treatment-naïve eyes, the mean treatment interval was 12.7±6.4 weeks at 12 months. In pretreated eyes, the interval increased from 6.0±3.0 to 7.8±3.6 weeks (p<0.001). Over 12 months, 8.1±2.1 and 9.4±2.5 injections were administered to naïve and pretreated eyes, respectively (p<0.001). Of the five recorded AEs, two cases of non-infectious intraocular inflammation and one cerebrovascular event were reported.</p><p><strong>Conclusion: </strong>Over 12 months, faricimab demonstrated good efficacy and safety in both treatment-naïve and pretreated eyes with DME. There was a reduction in CST and improved VA in treatment-naïve eyes and stable VA in pretreated eyes. The low number of AEs supports a favourable risk-benefit profile of faricimab in a real-world setting.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092094","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":"Metastatic disease in conjunctival malignant melanoma: a retrospective analysis of 167 cases.","authors":"Melisa Sezgin, Ahmad Rahal, Veronika Nowack, Anke Manthey, Daniela Suesskind, Maja Guberina, Martin Stuschke, Dirk Flühs, Wolfgang A G Sauerwein, Klaus Griewank, Dirk Schadendorf, Joel Herault, Nikolaos E Bechrakis, Henrike Westekemper","doi":"10.1136/bmjophth-2025-002172","DOIUrl":"10.1136/bmjophth-2025-002172","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the data of a cohort of patients with conjunctival melanoma in order to analyse risk and guarding factors and to investigate the impact on metastatic disease with and without adjuvant therapy.</p><p><strong>Methods and analysis: </strong>We have retrospectively analysed the impact of clinical aspects and adjuvant therapies after tumour excision or biopsy in 167 patients cared for at the University Hospital Essen and the University Hospital Tübingen, Germany. Clinical as well as histopathological data and therapeutic approaches were analysed with regard to regional (lymphatic) and/or distant (haematogenous) spread during follow-up. The Kaplan-Meier estimate method was used to analyse survival and the Cox regression hazard model to define the probability of metastases depending on different factors. P value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>167 cases of malignant conjunctival melanoma were retrospectively analysed. The patients received treatment and were followed up for 78.3±67.5 months. Local tumour recurrence occurred in n=79 patients (47.3%) after a mean of 41.5±70.33 months. 30 patients (37.9%) with a recurrence had not received adjuvant therapy. The overall rate of metastasis was 24.5% (n=41). In n=31 cases, regional lymphatic metastases were found after a follow-up of 48.9±63.5 months; in n=24 cases, distant metastases were found, occurring after 55.5±67.4 months. In n=14, the metastatic disease took both pathways. Ruthenium-106 brachytherapy performed in localised melanoma of the bulbar conjunctiva showed a relevant effect of decreasing the risk for haematogenous metastases by 74% (HR=0.256, p<i>=</i>0.003). 4 out of 54 patients developed distant metastases.</p><p><strong>Conclusion: </strong>In conjunctival melanoma, it is important to perform an adjuvant therapy after excision. This reduces not only local recurrences but also significantly the risk for haematopoietic spread.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146092081","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":"Evaluating reasoning large language models with human-like thinking in ophthalmic question answering.","authors":"Zhouqian Wang, Chenjia Xu, Lei Wang, Wei Qiang, Yanzhen Li, Daoyuan Li, Fabao Xu, Yanyan Zhang, Jiewei Jiang, Zhongwen Li","doi":"10.1136/bmjophth-2025-002615","DOIUrl":"10.1136/bmjophth-2025-002615","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the performance of reasoning large language models (LLMs) with human-like thinking in ophthalmic question answering.</p><p><strong>Methods: </strong>We evaluated two state-of-the-art open-source reasoning LLMs (DeepSeek-R1 and QwQ-32B) and one conventional non-reasoning LLM (LLaMA-3.3-70B-Instruct) models on ophthalmology questions, assessing not only answer accuracy (ACC) but also the quality of their reasoning processes. First, we curated MedQA-Eye, a dataset of 967 ophthalmology questions across 10 subspecialties, 3 scenarios, 5 medical entities and 3 languages. Second, we proposed a novel framework considering human thinking patterns essential to medical practice to evaluate the thinking performance of reasoning LLMs on MedQA-Eye.</p><p><strong>Results: </strong>DeepSeek-R1 demonstrated superior overall ACC (90.59%, 95% CI 88.59% to 92.27%) to LLaMA-3.3-70B-Instruct (87.90%, 95% CI 85.69% to 89.81%, p=0.015) and QwQ-32B (84.28%, 95% CI 81.85% to 86.44%, p<0.001) with performance varying across subspecialties. Analysis of reasoning LLMs revealed incorrect logical inference as the primary point of failure, accounting for 93.41%-94.74% of incorrectly answered questions. We further quantified semantic uncertainty in reasoning LLM thinking as a predictor of answer reliability. DeepSeek-R1 exhibited lower semantic uncertainty (1.04±3.63) compared with QwQ-32B (4.31±40.70), p<0.001.</p><p><strong>Conclusion: </strong>Reasoning LLMs demonstrated superior performance in ophthalmology question answering, with DeepSeek-R1 achieving the highest ACC. Our findings demonstrate that reasoning LLM can better simulate human-like thinking processes compared with conventional non-reasoning LLM, suggesting its potential for more trustworthy LLM systems in ophthalmology.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060175","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 biomarkers for early Alzheimer's detection: a systematic review of optical coherence tomography (OCT) findings.","authors":"Maryne Lepoittevin, Jenny Greig, Ozlem Erol, Alaedine Benani, Pierre Bauvin, Claudio Azzolini, Simone Donati, Bruno Dubois, Claude Boscher, Sylvain Bodard","doi":"10.1136/bmjophth-2025-002328","DOIUrl":"10.1136/bmjophth-2025-002328","url":null,"abstract":"<p><strong>Objective: </strong>Retinal biomarkers accessible via non-invasive optical coherence tomography (OCT) could facilitate early detection of Alzheimer's disease (AD), complementing current invasive or costly diagnostic methods. This review evaluates the evidence for spectral-domain OCT (SD-OCT) and OCT angiography (OCT-A) in identifying retinal changes associated with preclinical and early AD.</p><p><strong>Methods and analysis: </strong>We conducted a systematic review registered in PROSPERO and aligned with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. PubMed/MEDLINE was searched up to April 2025, complemented by reference list screening and citation tracking. Eligible studies assessed SD-OCT and/or OCT-A in biomarker-defined preclinical or early AD, mild cognitive impairment or mild AD. Data were synthesised narratively by disease stage, and methodological quality was appraised with the Newcastle-Ottawa Scale.</p><p><strong>Results: </strong>22 studies met inclusion criteria. Reported alterations included thinning of the peripapillary retinal nerve fibre layer and retinal ganglion cell layer, macular and choroidal thickness changes and microvascular alterations on OCT-A. However, findings were heterogeneous: some studies observed early thickening or increased vascular density, possibly reflecting inflammatory or compensatory mechanisms, while others reported thinning and rarefaction more consistent with neurodegeneration. Most studies were of moderate quality, limited by small sample sizes, cross-sectional designs and incomplete control for ocular/systemic confounders.</p><p><strong>Conclusion: </strong>SD-OCT and OCT-A hold promise as candidate biomarkers of early AD, but current evidence remains variable, non-specific and methodologically constrained. Further research is needed to standardise imaging protocols, validate findings in biomarker-confirmed longitudinal cohorts and compare OCT-based measures across dementia subtypes. Integration with other biomarkers (eg, plasma or metabolomics) may improve diagnostic specificity and support translation of OCT/OCT-A into clinical practice.</p><p><strong>Prospero registration number: </strong>CRD42024600456.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12829385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017397","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":"Selecting measures of visual function to classify diabetic retinopathy status: a cross-sectional study.","authors":"David M Wright, Usha Chakravarthy, Radha Das, Katie W Graham, Timos T Naskas, Tunde Peto, Ruth E Hogg","doi":"10.1136/bmjophth-2025-002536","DOIUrl":"10.1136/bmjophth-2025-002536","url":null,"abstract":"<p><strong>Aim: </strong>To identify combinations of up to three visual function tests with the best performance for classifying diabetic retinopathy (DR) severity stage. To describe in detail the measurements from a comprehensive set of visual function tests.</p><p><strong>Methods: </strong>1901 eyes (1032 participants) underwent nine visual function tests. Fundus, ultra-widefield and optical coherence tomography images were graded for DR and diabetic macular oedema (DMO). Three classification tasks were set: (1) distinguishing diabetes mellitus (DM) no DR from healthy with no DM, (2) DR no DMO from DM no DR and (3) DR with DMO from DR no DMO. Ensemble machine learning models for all one-way, two-way and three-way combinations of visual function variables were compared using area under the curve (AUC).</p><p><strong>Results: </strong>The top 30 models for each task achieved high accuracy, with AUC ≥0.94. For task 1, 17/30 top models contained distance visual acuity. Pelli-Robson contrast sensitivity and low luminance visual acuity also featured highly. For task 2, 19/30 models contained mesopic microperimetry. Near visual acuity, matrix microperimetry and reading index featured highly. For task 3, 17/30 models contained distance visual acuity. Smith-Kettlewell low luminance near visual acuity and near visual acuity featured highly. In a subset of eyes where perimetry was not performed, reading index featured in 22, 21 and 22 of the top models for tasks 1, 2 and 3 respectively.</p><p><strong>Conclusions: </strong>These findings will enable researchers and those planning clinical trials to select the best combination of visual function tests for distinguishing stages of diabetic eye disease.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12820872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146009309","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}