Quantifying retinal oxygenation and metabolism by phosphorescence lifetime imaging

The retina is a highly metabolically active tissue, requiring adequate availability of oxygen and other metabolites to generate energy for cellular survival and visual function. Retinal hypoxia has been implicated in several common retinal diseases and associated with the development of vision-threatening pathologies. Since the level of hypoxia determines processes that are activated for either cell survival or death, knowledge of retinal oxygenation is essential. This article reviews depth-resolved quantitative measurements of retinal vascular and tissue oxygen tension in rodents using the technique of phosphorescence lifetime imaging. Furthermore, retinal oxygen metabolic biomarkers were quantitatively derived from oxygen tension measurements and shown to be altered under challenged physiological and pathological conditions. Application of phosphorescence lifetime imaging can be useful for advancing knowledge of retinal ischemia pathophysiology and identifying physiological biomarkers to monitor progression and evaluate therapeutic interventions in animal models of human retinal diseases.

Evidence-Based Experiences of Using Time-Driven Activity-Based Costing in Telemedicine-Based Health Care Delivery Protocols

Background: In the era of value-based health care, maximizing health outcomes and minimizing costs require different value optimization strategies. To maximize value and ensure control of expenditure, time-driven activity-based costing (TDABC) is widely used in health care organizations. In our study, we examined the impact of telehealth technologies on value creation by using the TDABC approach. Methods: We mapped four pairs of (traditional and telemedicine supported) health care delivery processes in terms of time, resource use, and information flow. Data were collected from four sources: approved protocol descriptions, in-depth interviews with senior clinicians, a financial controlling database of unit costs, and additional comments from controlling experts. Results: We found that technological improvements do not necessarily increase the value of protocols. Of the protocols studied, two telemedicine protocols proved to be more cost-effective (80.37% and 45.29% compared with the originals). However, significant cost overruns were detected in two other telemedicine protocols (902.90% and 161.01%, respectively). An increased value could be detected only when the use of telemedicine technology resulted in greater savings in net human capacity compared with the additional expenditure related to telemedicine technology. Conclusions: We concluded that the use of telemedicine technology leads to modifications in protocols at numerous points, which have a significant impact on cost levels. It is not sufficient to examine only the costs of modified steps, as proposed in the TDABC methodology. Our study also suggests that a refined TDABC method is a potential tool for assessing the complex effects of technological change.

A seven-year electroretinography follow-up of a patient with melanoma-associated retinopathy stabilized on pembrolizumab treatment

Purpose

Melanoma-associated retinopathy (MAR) is a rare, auto-immune paraneoplastic syndrome associated with metastatic melanoma. Over the last decade, patient survival has improved dramatically, mainly due to the development of immunotherapy. However, data on long-term MAR patient follow-up and response to modern standard-of-care treatment are lacking. This single-patient case report presents a seven-year, multimodal follow-up of a young MAR patient treated with immune-checkpoint inhibitors.

Observations

A 46-year-old Israeli male with a history of cutaneous malignant melanoma presented with sudden onset of bilateral shimmering, flickering, and nyctalopia a year and a half after diagnosis. Shortly thereafter, new subcarinal metastasis was observed on Positron Emission Tomography-Computed Tomography. Significantly reduced electroretinography (ERG) a- and b-wave responses led to a diagnosis of MAR, later confirmed by high titers of autoantibodies against retinal bipolar cells. Half a year later, macular thinning, particularly within the inner nuclear and inner plexiform layers of the outer macular ring, with no substantial change in the outer retina, was observed on optical coherence tomography (OCT). A treatment regimen combining intravenous immune globulin, azathioprine, and prednisone allowed partial steroid tapering over the following 2.5 years but showed substantial toxicity and a lack of significant improvement on OCT and ERG. Pembrolizumab treatment was initiated following metastatic progression and resulted in stabilization of the patient's primary oncologic disease, as well as an increase in macular thickness and enhanced retinal function with an increase of over 60 % in dark adapted (DA) b-wave response over the following year.

Conclusions and importance

MAR may be the first sign of systemic metastatic melanoma, thus warranting a high degree of clinical suspicion. While OCT and ERG showed mostly concordant results over the patient's follow-up, ERG proved to be a more sensitive tool for the early diagnosis of MAR. Early immunotherapy treatment should be considered in antibody-positive MAR patients.

Prescriber implementation of guideline-directed medical therapy remains poor in the peripheral artery disease population

OBJECTIVE

Peripheral artery disease (PAD) is one of the most prevalent forms of cardiovascular (CV) disease, with many progressing to CV morbidity/death. Adherence to guideline-directed optimal medical therapy (OMT) in PAD is vital. This study evaluated provider adherence to OMT patients with PAD.

METHODS

This is a retrospective cohort study of 3471 patients with PAD who underwent vascular laboratory imaging between 2017 and 2022 at a single large, academic, tertiary referral center. OMT was defined by 2016 American Heart Association guidelines. Adherence to guidelines was denoted by active prescriptions for antiplatelet and statin. The presence of high-intensity OMT (HIOMT) was defined as prescriptions for an antiplatelet and high-intensity statin. Prevalence and incidence (change to OMT/HIOMT within 60 days of index ankle-brachial index [ABI]) were evaluated. Multivariable models were created evaluating predictors of OMT and HIOMT prevalence and incidence.

RESULTS

The OMT prevalence was 45.3%, whereas the HIOMT prevalence was 23.6% at the time of index vascular laboratory. Incident OMT was 24.3%, whereas incident HIOMT was 11.2% within 60 days. Age, minimum/maximum ABI, insurance status, smoking status, and comorbidities were associated with prevalent OMT/HIOMT. Age, gender, minimum/maximum ABI, smoking status, and hemoglobin A1C were associated with incident HIOMT. In multivariable models, incident HIOMT was less common for female patients (odds ratio: 0.7; 95% confidence interval: 0.52-0.91), whereas lower ABIs were predictive of HIOMT (odds ratio: 0.6; 95% confidence interval: 0.51-0.72).

CONCLUSIONS

Despite clear guidelines regarding OMT for patients with atherosclerotic CV disease, in this real-world study of guideline-directed management of PAD, adherence to OMT remains low, especially for HIOMT. Predictors of appropriate HIOMT prescription include lower ABI and non-female sex. Given the high prevalence of PAD, the heterogeneity of caregivers, and the widespread availability of screening, this population should be targeted for better adherence to HIOMT to prevent CV morbidity and death.

Retinal imaging in an era of open science and privacy protection

Artificial intelligence (AI) holds great promise for analyzing complex data to advance patient care and disease research. For example, AI interpretation of retinal imaging may enable the development of noninvasive retinal biomarkers of systemic disease. One potential limitation, however, is government regulation regarding retinal imaging as biometric data, which has been recently under debate in the United States. Although careful regard for patient privacy is key to maintaining trust in the widespread use of AI in healthcare, the designation of retinal imaging as biometric data would greatly restrict retinal biomarker research. There are several reasons why retinal imaging should not be considered biometric data. Unlike images of the iris, high quality images of the retina are more difficult to obtain, requiring specialized training and equipment, and often requiring pupil dilation for optimal quality. In addition, retinal imaging features can vary over time with changes in health status, and retinal images are not currently linked to any large identification databases. While the protection of patient privacy is imperative, there is also a need for large retinal imaging datasets to advance AI research. Given the limitations of retinal imaging as a source of biometric data, the research community should work to advocate for the continued use of retinal imaging in AI research.

Wait times in pediatric ophthalmology clinics: Insights from a tertiary university hospital

PurposeTo analyze wait time (WT) trends at Pediatric Ophthalmology and Strabismus (POS) service clinics.MethodsRetrospective observational study utilizing MDClone and electronic health records (EHRs) on 19,018 patients from POS clinics at a tertiary university-affiliated hospital in Israel, during April 2016-June 2023. Data were collected by the qFlow real-time patient tracking system. Primary outcome measures were WTs trends.ResultsData consisted of 19,018 patients, and the final cohort was 11,320 patients (49.51% female). Median age was 6 (IQR: 7) and median WT was 34.14 (IQR: 16.52-60.35) minutes. WT decreased during the pandemic (p < 0.001). WT across different eye clinics at the POS service differed (p < 0.001). Average WTs differed throughout the day: gradually decreasing from front desk opening until accepting patients, gradually increasing before noon, and followed by a gradual decrease. WTs fluctuated throughout the year with no clear pattern (31 min in May vs. 37 min in July, p < 0.001). There was a significant, weak, negative correlation between patients' lateness and WT, suggesting late arrivals were admitted quicker (p < 0.001). Median WT was not associated with gender (p = 0.93) or religion (p = 0.11) and with age (R = 0.02, p = 0.14).ConclusionWTs remained stable over the years. WTs at the POS service were significantly influenced by the time of day, month, type of clinic, and arrival time relative to the set appointment. WTs were significantly decreased during the COVID-19 epidemic. Personalized clinic schedules and adjusting for the complexity of needing both an orthoptist and ophthalmologist, may shorten WTs and encourage patients to avoid early arrivals.

Comparison of Recurrent and Naïve Keratitis in a Cohort of 1303 Patients

Objectives: Microbial keratitis is a precursor to corneal scarring, the fifth-leading cause of blindness and visual impairment worldwide. Despite its significance, there is a paucity of data quantifying the recurrence rates of keratitis and the subsequent corneal damage. This study aims to address this gap by providing a comprehensive analysis of the frequency and origin of keratitis recurrences and its impact on visual deterioration. Methods: We retrospectively analyzed a cohort of 1303 patients diagnosed with microbial keratitis at the Independent Public University Eye Hospital in Warsaw, Poland, between January 2018 and December 2023. All adult patients with at least one documented episode of infectious keratitis were included in the study. Patients were divided into two cohorts: Group 1: patients with recurrent keratitis (n = 233) and Group 2: patients with the first episode of keratitis (n = 1070). Results: The recurrence rate of keratitis was 17.88% (233 of 1303 patients), regardless of etiology. Visual acuity on admission did not differ significantly between the recurrent and naïve groups. However, among patients with at least three episodes, visual acuity was worse (median logMAR for 1 vs. 2 vs. 3 recurrences were the following: 0.30 (0.08-0.67) vs. 0.60 (0.12-1.30) vs. 0.44 (0.20-0.92), accordingly, p = 0.049). Univariate logistic regression identified contact lens usage as a significant risk factor for recurrence (OR 2.37, 95% CI: 1.84-3.08, p < 0.001), also including its inappropriate use (OR 2.25, 95% CI: 1.42-3.66, p = 0.001). In terms of etiology, bacteria were the most common identified cause of keratitis in both the recurrent and naïve groups, accounting for 38.36% (90 cases) in Group 1 and 47% (503 cases) in Group 2. Viruses were the second most prevalent etiology, representing 31.33% (73 cases) in Group 1 and 19.91% (213 cases) in Group 2. Furthermore, a multivariate logistic regression model indicated that advanced age, delayed treatment, fungal etiology, and post-corneal transplant status were strongly associated with worse visual outcomes. Conclusions: Although each recurrence contributes to cumulative vision loss, the majority of patients with recurrent keratitis present with a useful visual acuity (0.3 to 0.60 logMAR). Our study identified older age, fungal etiology, delayed treatment, and post-keratoplasty keratitis as the most significant risk factors for visual deterioration. These findings underscore the need for targeted interventions in populations at higher risk of adverse visual outcomes.

Pregnancy-induced ocular changes: impacts on intraocular pressure, the cornea, and the anterior chamber

BACKGROUND

This study aims to comprehensively evaluate the trimester-specific effects of pregnancy on intraocular pressure, corneal biomechanics, anterior segment anatomy, and endothelial cell morphology.

METHODS

This prospective cross-sectional study included 90 healthy pregnant women (30 per trimester) and 30 age-matched non-pregnant controls. Comprehensive ophthalmological assessments were performed, including IOP measurement using a non-contact tonometer, corneal structure evaluation with Pentacam Scheimpflug imaging, and endothelial cell analysis using a specular microscope.

RESULTS

A significant decrease in IOP was observed in the third trimester compared to the control group (p = 0.016), although no significant difference was noted in the first and second trimesters (p > 0.05). Corneal endothelial analysis revealed a significant decrease in hexagonal cell percentage (HEX) values during the first trimester (p = 0.007). Correlation analysis demonstrated a strong positive relationship between central corneal thickness (CCT) and corneal volume (r = 0.817, p < 0.001) and a moderate positive correlation between CCT and IOP (r = 0.263, p = 0.004). Axial length was strongly negatively correlated with both flat keratometry (r=-0.562, p < 0.001) and steep keratometry (r=-0.538, p < 0.001), and strongly positively correlated with anterior chamber volume and anterior chamber depth (r = 0.380, p < 0.001 and r = 0.384, p < 0.001, respectively). A moderate positive correlation was also identified between gestational trimester and HEX (r = 0.257, p = 0.005).

CONCLUSIONS

Pregnancy induces temporary but significant ophthalmological changes, particularly a decrease in IOP in the third trimester and a decrease in HEX in the first. These findings highlight the importance of monitoring ocular health during pregnancy to detect potential risks early and ensure timely intervention.

Spectacle coverage for presbyopia correction and its associated factors among employees of an academic centre in Tehran

Near-vision is important for employees to reach better performance. The prevalence of uncorrected presbyopia ranges from less than 10-90% according to various sociodemographic factors including age, sex, educational level, affordability, and awareness. Current study aims to determine the prevalence of spectacle coverage for presbyopia correction and its associated factors among adult employees of a university. A cross-sectional study was conducted on Tehran University of Medical Sciences' staffs aged ≥ 30 years in 2018-2019. All participants were assessed for distance and near visual acuities. Presbyopia was defined as inability to read 20/50 (N8) at 35 cm despite of corrected distance VA of at least 20/50 in the better eye. Total spectacle coverage for presbyopia was calculated as the number of participants with current near vision spectacle ⁄ number of participants with presbyopia. If persons with presbyopia had spectacles that allowed near vision to improve to 20/50 (N8) or better, it was true near spectacle coverage. Included was 4022 participants with mean (standard deviation) age of years 43.61 (7.92) years (range: 30-75 years). The prevalence of presbyopia was found to be 12.6% (507/4022). The total and true spectacle coverage for presbyopia correction were 35.9% (182/507) and 22.7% (115/507), respectively. Female (OR = 4.89, 95%CI = 1.82-13.18, P = 0.002), age ≥ 45 years (OR = 18.69, 95%CI = 1.69-206.18, P = 0.02), hyperopic refractive error (OR = 5.61, 95%CI = 1.75-17.93, P = 0.004), and poor to fair level of general health (OR = 2.94, 95%CI = 1.16-7.69, P = 0.02) were factors significantly associated with the total spectacle coverage. Academic educational level (OR = 2.76, 95%CI = 1.03-7.45, P = 0.04) and poor to fair general health (OR = 3.45, 95%CI = 1.41-8.33, P = 0.007) affected the true spectacle coverage. Nearly one-third of employees with presbyopia used spectacle for near vision, among whom 63% had true near spectacle. Near spectacle use was higher in elderly females with hyperopia and poor to fair general health. People with academic educational level and poor-fair general health wore true near spectacle.

The Effects of Surgical Androgen Deprivation Therapy for Advanced Prostate Cancer on Peripapillary Retinal Nerve Fiber Layer Thickness

Background: Prostate cancer is the most common malignancy in men, and androgen deprivation therapy (ADT) serves as the primary approach for managing advanced cases. Certain research has suggested the impact of androgens on the physiological homeostasis of the optic nerve. Our aim was to investigate the impact of surgical ADT on peripapillary retinal nerve fiber layer (RNFL) thickness in patients with advanced prostate cancer. Methods: The study comprised 30 patients who had undergone bilateral orchiectomy for advanced prostate cancer, with a total of 60 eyes included in the analysis. Each participant received a standard ophthalmological examination. Peripapillary RNFL thickness measurements were performed preoperatively and 12 months postoperatively using optical coherence tomography. Results: The mean age of the patients was 73.77 ± 8.8 years. At the 12th month following surgery, we observed that the mean average thickness of the right and left RNFL, as well as the thickness of the left nasal, left inferior, and right and left temporal quadrants, was significantly thinner compared to presurgical values (P< .05). However, when comparing pre- and postsurgical measurements, the RNFL thickness in the right and left superior quadrants, as well as the right nasal and right inferior quadrants, showed no statistically significant difference. Conclusion: In this study, a significant difference was observed between the preoperative and 12-months postoperative peripapillary RNFL thickness values in patients who underwent surgical ADT for advanced prostate cancer. Additional research using larger sample sizes is required to clinically examine the impact of ADT on optic nerve homeostasis.

A scoping review of digital solutions in diabetes outpatient care: Functionalities and outcomes

BACKGROUND

Digital interventions are increasingly used in outpatient diabetes care to address growing healthcare demands and workforce limitations. This study investigates the functionalities of digital solutions and their impact on Quadruple Aim outcomes: enhancing population health, improving patient experience, supporting clinician well-being, and reducing healthcare costs.

METHODS

We followed Joanna Briggs Institute guidelines, searching PubMed, Embase, Cochrane, Scopus, and Web of Science (January 2019-February 2024). Included studies reported digital diabetes interventions with outcomes directly relevant to the Quadruple Aim. Each intervention was mapped to a digital solution horizon: Horizon 1 involves foundational digital workflows; Horizon 2 leverages real-time data to create analytics; Horizon 3 encompasses transformative uses, such as predictive analytics.

RESULTS

We identified 4,397 articles with 56 meeting the inclusion criteria. Interventions included telehealth (n = 15), mobile health (mHealth) (n = 20), combined telehealth and mHealth (n = 14), robotics (n = 1), electronic medical records (n = 1), and artificial intelligence (n = 5). Most interventions (n = 51) were categorised as Horizon 1, with 10 adopting Horizon 2, 5 using Horizon 3, and 10 spanning multiple horizons. Regarding Quadruple Aim outcomes, 44 studies addressed population health (41 positive), 31 targeted patient experience (29 positive), 4 focused on clinician well-being (3 positive), and 6 on cost reduction (4 positive).

CONCLUSION

Digital solutions have demonstrated measurable benefits, particularly in population health and patient experience. Most interventions remain at Horizon 1. Advancing these digital solutions to Horizon 2 and 3 is essential for system-wide transformation. Future research should include cost efficiency and clinician experience alongside evaluations of population health and patient experience.

Loss to follow-up and risk of incident blindness among patients with glaucoma in the IRIS® Registry (Intelligent Research in Sight)

PURPOSE

To assess the association between loss to follow-up (LTFU) and risk of incident blindness among a national registry cohort of patients with primary open-angle glaucoma (POAG).

DESIGN

Retrospective longitudinal cohort study.

PARTICIPANTS

Patients with a POAG diagnosis who had at least two visual acuity (VA) measures documented in the IRIS Registry (Intelligent Research in Sight) in both 2014 and 2019.

METHODS

LTFU was defined as a calendar year or more without an encounter. Univariable and multivariable robust log-Poisson regression models were used to estimate the relative risk (RR) and 95% confidence interval (CIs) of incident blindness associated with intervals of LTFU as the primary exposure of interest. Effect modification by baseline characteristics on the association between LTFU and incident blindness was also assessed.

MAIN OUTCOME MEASURES

Incident blindness in one or both eyes (VA ≤20/200) in 2019 among patients who were not blind in 2014.

RESULTS

Among 149,172 patients, incident monocular blindness occurred in 6,338 (4.2%) and incident binocular blindness occurred in 691 (0.5%) over the 6-year period. While most patients maintained follow up every year (90%), 8.8% were LTFU for 1-2 years, and 1.1% were LTFU for 3-4 years. Patients with LTFU had greater risk of blindness. In an adjusted model that accounted for age, sex, race and ethnicity, insurance, smoking status, glaucoma severity, baseline intraocular pressure, baseline cup-to-disc ratio, and history of glaucoma surgery, risk of incident monocular blindness was greater among patients with a lapse of 1-2 years (adjusted RR [aRR]=1.19, 95% CI: 1.05-1.35) or a lapse of 3-4 years (aRR=2.17, 95% CI: 1.66-2.78) compared to patients with no lapse in care. Race and ethnicity demonstrated a significant effect modification in the association between the longest lapse between encounters and the risk of blindness (P=0.02). The risk of incident blindness after a lapse of 3-4 years (compared to no lapse) was higher among Black patients (aRR=3.12, 95% CI: 2.06-4.76) than among White patients (aRR=1.93, 95% CI: 1.37-2.73). No effect modifications were identified by other baseline variables.

CONCLUSIONS

LTFU is an independent risk factor for incident blindness among patients with POAG. Lapses in care are particularly consequential for Black patients. Efforts to reduce LTFU may mitigate preventable glaucoma blindness.

Comparing visual outcomes of nAMD treatment during and after the COVID-19 restrictions period

MAIN OBJECTIVE

Compare treatment outcomes of newly diagnosed neovascular age-related macular degeneration (nAMD) during and after the COVID-19 restrictions.

METHODS

This retrospective study at the Retina Group of Washington analyzed nAMD patients treated with anti-VEGF therapy with ≥ 12 months of follow-up. Two groups were identified: 258 subjects diagnosed between March 2020-March 2022 (Group 1) and 376 subjects diagnosed after (Group 2). Primary outcomes were 12-month and final best-corrected visual acuity (BCVA), and number of injections in the first 12 months.

RESULTS

Initial mean BCVA was 20/71 and 20/68 in Group 1 and Group 2, with median BCVA of 20/60 and 20/50, respectively. At 12 months, mean BCVA improved to 20/65 and 20/54 in Group 1 and Group 2, respectively (p = 0.086). Final mean BCVA was 20/76 for Group 1 and 20/58 for Group 2 (p = 0.010). The mean change in LogMAR BCVA from the time of conversion to last follow-up was + 0.03 for Group 1 and -0.08 for Group 2 (p = 0.007). Group 1 had fewer injections in the first year of therapy (8.67 vs. 9.21, p = 0.004). 38.8% of Group 1 reached BCVA ≥20/40 at 12 months, versus 48.9% for Group 2 (p = 0.011).

CONCLUSION

Patients diagnosed during the COVID-19 restrictions period had worse visual outcomes than those diagnosed thereafter. Multiple factors, including, but not limited to reduced treatment frequency, likely contributed to worse visual outcomes.

Microvascular changes in eyes with non-proliferative diabetic retinopathy with or without macular microaneurysms: an OCT-angiography study

PURPOSE

To evaluate different quantitative non-invasive retinal biomarkers of microvascular impairment and neurodegeneration in patients affected by mild and moderate non proliferative diabetic retinopathy (NPDR) with or without macular microaneurysms (MAs).

METHODS

A cross-sectional case-control study. Ninety-seven eyes with NPDR, 49 with no central MAs and 48 with central MAs, underwent color fundus photography and optical coherence tomography (OCT)/OCT-angiography (OCT-A). Thickness of central macula, retinal nerve fiber layer (NFL), ganglion cell layer (GCL+) and NFL + GCL + was evaluated on OCT. FAZ metrics (ImageJ), perfusion and vessel density (PD/VD), and fractal dimension (FD) (MATLAB) were evaluated on 3 × 3 OCT-A slabs of both superficial and deep capillary plexuses (SCP/DCP). All evaluations were performed on the full image and after subdivision in 4 quadrants.

RESULTS

In the MA group, 77 MAs were detected (45.5% in the DCP). The MA group showed: increased FAZ area and perimeter in the SCP (p < 0.01) and DCP (p = 0.02), and reduced circularity index in the SCP (p = 0.03); reduced VD in the SCP (p < 0.01) and reduced PD, VD (p < 0.01) and FD (p = 0.02) in the DCP; decreased VD and FD in the SCP (p = 0.02 and p = 0.05), and in VD and FD in the DCP in the inferior quadrant (p = 0.04 and p = 0.03); a decrease in VD in the SCP in the nasal quadrant (p = 0.05). No differences have been detected in OCT parameters.

CONCLUSIONS

Our results suggest that the presence of central MAs in patients with NPDR may correlate with more pronounced macular microvascular impairment, particularly during the mild and moderate stages of the disease.

Clinical and laboratory risk factors for sickle cell retinopathy and maculopathy: a scoping review of the current evidence

Sickle cell retinopathy (SCR) is a complication of sickle cell disease (SCD) and can drastically impair visual acuity. Screening for SCR is, therefore, recommended, but evidence for optimal screening frequency on an individual level is lacking. This scoping review mapped the current evidence on risk factors for SCR and sickle cell maculopathy (SCM). A literature search (in Medline [Ovid]), Embase [Ovid]), and Scopus) resulted in 67 included articles which covered demographic risk factors, genetic risk factors, systemic therapy, correlations with other forms of SCD-related organ damage, and hematologic risk factors. SCR risk factors include older age, male sex, HbSC genotype, hemolysis, and HbF% <15% (in HbSS) and increased blood viscosity (in HbSC). For SCM, risk factors are older age, HbSS genotype, and higher degree of hemolysis. The pathophysiology of SCR and SCM appears multifactorial, but distinct patterns emerge suggesting that vaso-occlusion and hemolysis cause SCM and NPSCR in HbSS, while hyperviscosity in HbSC leads to peripheral retinopathy. We recommend yearly screening for high-risk patients (older HbSC males) and triennial screening for low-risk patients (young females HbSS with HbF>15%) to ensure comprehensive yet proportionate ophthalmic care. However, future studies are needed on the role of interventions for SCR and the long-term consequences of SCM in order to evaluate and define appropriate screening schedules.

Artificial Intelligence Approaches for Geographic Atrophy Segmentation: A Systematic Review and Meta-Analysis

Geographic atrophy (GA) is a progressive retinal disease associated with late-stage age-related macular degeneration (AMD), a significant cause of visual impairment in senior adults. GA lesion segmentation is important for disease monitoring in clinical trials and routine ophthalmic practice; however, its manual delineation is time-consuming, laborious, and subject to inter-grader variability. The use of artificial intelligence (AI) is rapidly expanding within the medical field and could potentially improve accuracy while reducing the workload by facilitating this task. This systematic review evaluates the performance of AI algorithms for GA segmentation and highlights their key limitations from the literature. Five databases and two registries were searched from inception until 23 March 2024, following the PRISMA methodology. Twenty-four studies met the prespecified eligibility criteria, and fifteen were included in this meta-analysis. The pooled Dice similarity coefficient (DSC) was 0.91 (95% CI 0.88-0.95), signifying a high agreement between the reference standards and model predictions. The risk of bias and reporting quality were assessed using QUADAS-2 and CLAIM tools. This review provides a comprehensive evaluation of AI applications for GA segmentation and identifies areas for improvement. The findings support the potential of AI to enhance clinical workflows and highlight pathways for improved future models that could bridge the gap between research settings and real-world clinical practice.

Willingness to pay for a second pair of near-vision glasses: a cross-sectional study in a rural North Indian population

PURPOSE

There is an enormous unmet need for near vision correction with glasses. The cost and lack of felt need are important barriers. This study, which was conducted among a rural population of northern India, was designed to assess whether the short-term use of a pair of near-vision glasses can increase the desirability for individuals to procure subsequent pairs and to further assess the willingness to pay thresholds.

METHODS

This study followed a quasi-experimental design. Uncorrected presbyopes were given near vision glasses at their doorstep, to carry out their chosen near work task for half- an- hour (this use of glasses was referred to as 'experience' for the purpose of this study). They were then referred to nearby vision centres to procure glasses. This 'experience' given was used as a proxy for having used the first pair. At the vision centre, glasses were offered at no cost, for Indian Rupees 75 (US$0.90) and for Indian Rupees 100 (US$1.20) in the first, second and third phases of the study, respectively. The usual price at which near-vision glasses were otherwise available in the region was Indian Rupees150 (US$1.8). The uptake of glasses after having received the near correction experience was tracked via the Peek Vision platform.

RESULTS

The most preferred chosen near work task by the study participants were stitching, after threading the needle and using a mobile phone. The uptake of near-vision glasses from the vision centre after providing the desired experience was 81.4% (835/1,026), 48.3% (699/1,446) and 29.2% (93/318) when the glasses were provided free of cost, at $0.90 and at $1.20 respectively. The difference between these three phases was statistically significant (p < 0.001). Uptake was found to be increase with need for increasing lens power (p < 0.01) and especially among those who reported the 'experience' as 'very good' or 'excellent'(p < 0.001). Uptake decreased with increasing age (p < 0.01). Differences in uptake between sexes and between those with or without the availability of a mode of transport in their household were not found to be significant.

CONCLUSION

Having experience with the first pair of near-vision glasses can increase desirability of procuring subsequent pairs. Offering the second pair at a reduced price can increase the uptake substantially in this setting, suggesting that active outreach to correct near vision in tandem with accessible and affordable marketplaces for reading glasses could provide a viable solution to scale near vision correction.

Expansion in Teleophthalmology Use for Diabetic Retinopathy Screening During the COVID-19 Pandemic

Introduction: During the COVID-19 pandemic, the University of California, Davis Health (UCDH) system expanded teleophthalmology for diabetic retinopathy (DR) screening through increased sites and personnel, custom workflows, and improved awareness. Here, we report the outcomes of the expansion and investigate disparities during the pandemic lockdown. Methods: We retrospectively reviewed patients who received remote DR screening to compare demographic, socioeconomic, and clinical differences between individuals who underwent screening before, during, and after the COVID-19 lockdown. Results: UCDH increased quarterly teleophthalmology visits from 46.4 ± 13.9 before to 253.8 ± 38.0 visits after the COVID-19 lockdown (p < 0.001), while DR screening rates improved from 51.0 ± 1.5% to 56.9 ± 1.6% over that period (p = 0.03). During the pandemic, we observed greater proportions of unemployed (p < 0.001), higher-income (p < 0.001), geographically nearby (p = 0.001) patients, and fewer individuals with socioeconomic disadvantage as measured by their area deprivation index (p = 0.02). Fewer patients with poorly controlled diabetes (p = 0.014) or hypertension (p = 0.04) also received remote screening during the pandemic, although most of these disparities were no longer detectable after the initial lockdown. Discussion: Teleophthalmology expansion at UCDH during the COVID-19 pandemic led to sustained improvements in DR screening. Although some vulnerable individuals had reduced access to teleophthalmology during the initial lockdown, these disparities were not sustained postpandemic.

Investigation of Sickle Cell Retinopathy in Pediatric and Adolescent Patients Enrolled in a Large Cohort Study

PURPOSE

Sickle cell disease results in vaso-occlusion and hemolysis, leading to ophthalmic and systemic complications. In the eye, these processes initiate retinal ischemia and neovascularization resulting in sickle cell retinopathy (SCR). Hydroxyurea therapy increases fetal hemoglobin (reducing ischemia), and chronic blood transfusions (CTXN) reduce strokes in children with abnormally high intracranial vessel velocities. It is not known if these treatments reduce retinopathy. Our hypothesis is that hydroxyurea and CTXN lower the risk of the development and slow the progression of retinopathy.

DESIGN

Using a large longitudinal cohort study, we determined the prevalence of SCR among pediatric and adolescent patients with sickle cell disease and the effects of disease-modifying therapy on reducing the prevalence and severity of sickle cell retinopathy.

PARTICIPANTS

We included all eye examinations of participants (age 10-18 at time of initial eye exam) at a single site from the Sickle Cell Research and Intervention Program cohort between October 2010 and September 2022. Patients without a dilated eye exam were excluded.

METHODS

At 10 years of age, yearly ophthalmologic assessments began for patients with hemoglobin SC disease and every other year for other sickle cell genotypes. Two ophthalmologists reviewed all 2237 eye examination results.

MAIN OUTCOME MEASURES

We obtained patient age, sex, sickle genotype, treatment received for sickle cell retinopathy, duration of exposure to sickle cell disease-modifying therapy, and hematologic indices (fetal hemoglobin and hemoglobin concentration) and abstracted data regarding SCR, severity grading, and treatment.

RESULTS

We observed that pediatric and adolescent patients with sickle cell disease receiving hydroxyurea therapy were 29% less likely to demonstrate SCR. Of those receiving hydroxyurea, 107 of 351 patients (30%) had SCR as compared with the 118 of 279 patients (42%) not receiving hydroxyurea (P = 0.0028). Patients receiving CTXN were 68% less likely to develop SCR. Of those, 20 of 121 patients (17%) had retinopathy as compared with the 205 of 509 patients (40%) not receiving CTXN (P < 0.001).

CONCLUSIONS

Our data from one of the largest cohorts of pediatric and adolescent patients with sickle cell disease support widespread use of hydroxyurea, CTXN, or both. We found that these therapies are associated with a smaller number of patients demonstrating SCR.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Differential artery-vein analysis in OCTA for predicting the anti-VEGF treatment outcome of diabetic macular edema

This study evaluates the role of differential artery-vein (AV) analysis in optical coherence tomography angiography (OCTA) for treatment outcome prediction of diabetic macular edema (DME). Deep learning AV segmentation in OCTA enabled the robust extraction of quantitative AV features, including perfusion intensity density (PID), blood vessel density (BVD), vessel skeleton density (VSD), vessel area flux (VAF), blood vessel caliber (BVC), blood vessel tortuosity (BVT), and vessel perimeter index (VPI). Support vector machine (SVM) classifiers were employed to predict changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Comparative analysis revealed that differential AV analysis significantly enhanced prediction performance, with BCVA accuracy improved from 70.45% to 86.36% and CRT accuracy enhanced from 68.18% to 79.55% compared to traditional OCTA analysis. These findings underscore the potential of AV analysis as a transformative tool for advancing personalized therapeutic strategies and improving clinical decision-making in managing DME.

Guidelines for the Diagnosis, Management, and Study of Autoimmune Retinopathy from the American Academy of Ophthalmology's Task Force

PURPOSE

The American Academy of Ophthalmology created a Task Force to advance the understanding of autoimmune retinopathy (AIR) and provided guidelines on the diagnosis and management of this complex disorder.

DESIGN

A search on PubMed and Google Scholar of English-language studies was conducted without date restrictions. The Task Force reviewed the current literature and formulated an expert consensus on the management of AIR as well as recommendations for future efforts to improve our understanding of this condition.

RESULTS

Key clinical and imaging features are discussed, and a new diagnostic framework is proposed based on the likelihood of AIR (probable AIR, possible AIR, and unlikely AIR) to provide a more standardized approach for categorizing disease. Patients who possess all the following features can be categorized as having probable AIR: (1) signs of disease progression based on subjective symptoms and objective testing within 6 months; (2) examination with <1+ anterior chamber cells, vitreous cells, or vitreous haze; (3) OCT with outer retinal disruption and loss of the external limiting membrane/outer retinal bands/ellipsoid zone often relatively sparing the fovea; (4) characteristic fundus autofluorescence abnormalities; (5) full-field electroretinogram (ERG) with reduction of both rod and cone responses; and (6) positive antiretinal antibodies. Those with some but not all of these features, or with otherwise atypical presentations, can be classified as possible AIR. Features that would make AIR unlikely and should elicit strong suspicion for alternative diagnoses are as follows: (1) slowly progressive symptoms or changes on testing taking place over the years; (2) retinal examination with bone spicules, retinal vascular sheathing, or retinal hemorrhages; (3) examination with >1+ anterior chamber cells, vitreous cells, or vitreous haze; (4) OCT changes predominantly at the level of the retinal pigment epithelium (RPE) or areas of focal/sharply delineated outer retinal/RPE atrophy; (5) fluorescein angiography with diffuse retinal vasculitis or large areas of nonperfusion; or (6) a normal full-field ERG (even with an abnormal multifocal ERG).

CONCLUSIONS

These criteria will allow for better classification of patients reported in the literature and improve communication between clinicians. Further study is necessary to optimize the approach for managing AIR and will require collaborative multicenter efforts.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Artificial Intelligence Predicts Fitzpatrick Skin Type, Pigmentation, Redness, and Wrinkle Severity From Color Photographs of the Face

BACKGROUND

Due to high patient demand, increasing numbers of non-dermatologists are performing skin assessments and carrying out laser interventions in medical spas, leading to inferior outcomes and higher complications. A machine learning tool that automatically analyzes patient skin has the potential to aid non-dermatologists.

AIMS

To develop a high-performing machine learning model that predicts Fitzpatrick skin type, hyperpigmentation, redness, and wrinkle severity simultaneously.

METHODS

We developed the SkinAnalysis dataset of 3662 images, labeled by a dermatologist across five skin scales. We trained and evaluated machine learning models across 15 different configurations, including three neural network architectures and two loss functions.

RESULTS

The best-performing model was an EfficientNet-V2M architecture with a custom cross entropy loss. This model's mean test set accuracy across all labels was 85.41 ± 9.86 and its mean test set AUROC was 0.8306 ± 0.09599. An interesting trend emerged in which machine learning model performance was higher at the extremes of the scales, suggesting greater clinical ambiguity in the middle of the scales.

CONCLUSIONS

Machine learning models are capable of predicting multiple skin characteristics simultaneously from color photographs of the face. In the future, similar models could assist non-dermatologists in patient skin evaluation to enhance treatment planning.

Metabolic reprogramming and interventions in angiogenesis

BACKGROUND

Endothelial cell (EC) metabolism plays a crucial role in the process of angiogenesis. Intrinsic metabolic events such as glycolysis, fatty acid oxidation, and glutamine metabolism, support secure vascular migration and proliferation, energy and biomass production, as well as redox homeostasis maintenance during vessel formation. Nevertheless, perturbation of EC metabolism instigates vascular dysregulation-associated diseases, especially cancer.

AIM OF REVIEW

In this review, we aim to discuss the metabolic regulation of angiogenesis by EC metabolites and metabolic enzymes, as well as prospect the possible therapeutic opportunities and strategies targeting EC metabolism.

KEY SCIENTIFIC CONCEPTS OF REVIEW

In this work, we discuss various aspects of EC metabolism considering normal and diseased vasculature. Of relevance, we highlight that the implications of EC metabolism-targeted intervention (chiefly by metabolic enzymes or metabolites) could be harnessed in orchestrating a spectrum of pathological angiogenesis-associated diseases.

Impact of a Patient Portal-Based Telehealth Outreach Program on Recall of Patients with Diabetic Retinopathy

Purpose: To evaluate the effectiveness of a patient portal telehealth outreach program to return patients with diabetic retinopathy (DR) lost to follow-up (LTFU) for eye care. Methods: Patients with DR receiving intravitreal injection (IVI) therapy who were >90 days beyond recommended return were deemed LTFU. Outreach messages were sent via a patient portal, when available, or through the U.S. mail. Patients received information on how to schedule a retinal examination and a symptom-screening questionnaire. The adherence rate to scheduled appointments was assessed 90 days postintervention. Labor costs were estimated based on communication time. Results: Among 359 patients with DR receiving IVIs, 22% were LTFU, overdue by a median of 362 days. Receiving fewer IVIs was the factor most strongly associated with becoming LTFU (8.9  ±  9.1 injections vs. 22 ± 20 injections, p < 0.001). The outreach program engaged 39 patients via the patient portal and 28 patients via the U.S. mail. A similar number of patients in each cohort was scheduled (13% vs. 14%, p = 0.862) and completed appointments (10% vs. 14%, p = 0.616). Whereas patient-portal messages took an average of 64 s to send at a labor cost of $0.35/message, each letter sent by mail took approximately 5 min to prepare at a total cost of $2.19. Conclusions: A patient portal-based telehealth outreach program is effective at returning patients with DR to eye care and can be implemented at a lower cost, compared with conventional mailed recall letters. Efforts are needed to increase digital health literacy and access to improve the efficiency of health care delivery.

Age and gender-related changes in choroidal thickness: Insights from deep learning analysis of swept-source OCT images

BACKGROUND

The choroid is a vital vascular layer of the eye, essential for maintaining ocular health. Understanding its structural variations, particularly choroidal thickness (CT), is crucial for the early detection of diseases, such as age-related macular degeneration (AMD), high myopia (HM), and diabetes mellitus (DM). Recent advancements in deep learning have significantly improved the segmentation and measurement of choroidal layers.

OBJECTIVE

This study aims to investigate age- and gender-related changes in CT and its components through deep learning analysis of swept-source optical coherence tomography (SS-OCT) images.

METHODS

A total of 262 participants (136 females and 126 males) were recruited from Peking University International Hospital. Exclusion criteria included ocular pathologies and systemic conditions. SS-OCT was utilized for CT, Sattler layer-choriocapillaris complex thickness (SLCCT), and Haller layer thickness (HLT) measurements. auto-measurement method, based on deep learning algorithms, ensured accuracy. Ethics approval and informed consent were obtained from all participants.

FINDINGS

Significant thinning of CT and SLCCT was observed after the age of 60, with HLT declining after the age of 30. Females exhibited marked thinning between the ages of 40 and 50, while males began to show thinning at age 60.

CONCLUSION AND IMPLICATIONS

This research highlights age-related changes in choroidal thickness, with a particular emphasis on gender differences. The findings suggest that females experience earlier thinning, potentially attributable to hormonal changes. Additionally, the study validates the efficiency of deep learning algorithms in measuring choroidal thickness, thereby enhancing the reliability of clinical practice.

Remote Monitoring of Patients with Retinal Vein Occlusions Treated with Anti-VEGF: A Pilot Study

Purpose: To assess the feasibility and effectiveness of remote monitoring for patients with retinal vein occlusion (RVO) treated with intravitreal anti-VEGF injections. Methods: A retrospective analysis was conducted at the Eye Clinic of the University of Catania. Thirty-four eyes of 34 patients with RVO were included for a 12-month follow-up period. After a comprehensive baseline ophthalmic examination, the patients received a loading treatment consisting of three monthly intravitreal injections of anti-VEGF, followed by monthly or bimonthly remote follow-up visits at peripheral centers. Optical coherence tomography (OCT) images and clinical data were shared online with our eye clinic for remote evaluations. Data on hospital and peripheral center visits, intravitreal injections, and OCT scans were collected and analyzed. Results: The patients had an average of 5.71 ± 1.14 visits to peripheral centers and 2.1 ± 0.8 visits to our center for fluorescein angiography. The mean number of injections was 5.26 ± 1.29 and the mean improvement in best-corrected visual acuity (BCVA) was 11.47 ± 5.56 letters. Remote OCT evaluations accounted for 194 scans, there was a high agreement between two expert in-hospital examinators (Cohen's κ = 0.927) with only 14 cases requiring hospital visits for inconclusive results. Conclusions: Remote monitoring for RVO patients significantly reduced hospital admissions for follow-up visits, reducing the clinical burden on medical staff, patients, and caregivers, while maintaining reliable patient assessments.

Adverse event reporting of faricimab: a disproportionality analysis of FDA adverse event reporting system (FAERS) database

Background

Faricimab is the first and only bispecific antibody approved by the U.S. Food and Drug Administration (FDA) for intravitreal injection. Given its increasingly widespread use in retinal vascular diseases, understanding its adverse events (AEs) in real-world settings is crucial. This study employed the FDA Adverse Event Reporting System (FAERS) database to investigate potential safety concerns, with the aim of providing new insights for clinical practice.

Methods

This study conducted a disproportionality analysis of adverse event data from the FAERS database, in which faricimab was identified as the primary suspect, covering the period from the first quarter of 2022 to the second quarter of 2024. To ensure the accuracy and reliability of the study, we employed four types of disproportionality analyses: the reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), and Bayesian confidence propagation neural network (BCPNN). Additionally, the Weibull distribution was utilized to model the risk of adverse events over time.

Results

A total of 2,735 adverse reaction reports, in which faricimab was identified as the primary suspect, were retrieved from the FAERS database. The analysis showed that faricimab-induced AEs occurred across 25 system organ classes (SOCs), with eye disorders meeting the positive threshold for all four algorithms. Significant AEs were mapped to preferred terms (PT), identifying the adverse reactions listed on the drug label: endophthalmitis, elevated intraocular pressure, cataract, retinal pigment epithelial tear, vitreous floaters, retinal vasculitis, retinal artery occlusion, and retinal vein occlusion. In addition to the AEs listed on the drug label, several previously unreported AEs were identified, including blindness, cerebral infarction, retinal hemorrhage, retinal occlusive vasculitis, glaucoma, dry eye, metamorphopsia, and unilateral blindness.

Conclusion

This study provided valuable evidence on the real-world safety of faricimab, suggesting that clinicians should place greater emphasis on monitoring its adverse effects during use.

Low Vision Services Are Underutilized by Patients with Vision Loss from Corneal Disease

PURPOSE

This study evaluated the rate at which patients with visual impairment primarily from corneal disease were referred for low vision (LV) services and assessed the visual outcomes from completed evaluations.

METHODS

This 1-year retrospective, cross-sectional study included patients with corneal disease limiting best-corrected visual acuity (BCVA) to ≤ 20/40. Outcome measures included the change in BCVA achieved after distance refraction by a LV specialist. Incremental costs per quality-adjusted life years (QALY) gained were calculated upon the better-seeing eye, by using a willingness-to-pay threshold of USD 50,000/QALY.

RESULTS

Of 3230 patients, 143 (4.4%) had visual impairment from corneal disease. The median age of those patients was 80 years (IQR: 66-88 years) and 64.3% were male. Just over half were referred for LV evaluations (53.2%), and most completed appointments (96.1%). Patients more likely to be referred had better vision in their worse-seeing eye (0.961 logMAR vs. 1.451 logMAR, P = 0.002) and were more frequently diagnosed with corneal dystrophies, degenerations, or ectatic disease (51.3% vs. 26.9%, P = 0.003) compared with other corneal conditions, but they were less likely to have immunologic conditions (2.6% vs. 13.4%, P = 0.016). In total, two-thirds of patients achieved improved BCVA for their better-seeing eye, with 32% gaining ≥ 2 lines. This translated into an average gain of 0.04 QALYs/patient at a cost of USD 3128/QALY. The estimated net monetary benefit was USD 1923/LV evaluation completed.

CONCLUSIONS

Referring patients with corneal disease to LV services resulted in significant improvements in visual function at a reasonable cost.

Role of γ-Aminobutyric Acid (GABA) as an Inhibitory Neurotransmitter in Diabetes Management: Mechanisms and Therapeutic Implications

GABA (γ-Aminobutyric Acid), a well-established inhibitory neurotransmitter in the central nervous system, has garnered considerable interest for its potential role in diabetes management, particularly due to its presence in pancreatic islets. This review aims to explore the therapeutic role of GABA in diabetes management and its potential mechanisms for antidiabetic effects. Relevant studies were searched across databases such as PubMed and ScienceDirect, applying strict eligibility criteria focused on GABA administration methods and diabetic models. The collective results showed that the administration of GABA in diabetic models resulted in remarkable enhancements in glucose and insulin homeostasis, favorable modifications in lipid profiles, and amelioration of dysfunctions across neural, hepatic, renal, and cardiac systems. The findings from the literature demonstrated that GABAergic signaling within pancreatic tissues can significantly contribute to the stimulation of β cell proliferation through the facilitation of a sustained trans-differentiation process, wherein glucagon-secreting α cells are converted into insulin-secreting β-like cells. In addition, activated GABAergic signaling can trigger the initiation of the PI3K/AKT signaling pathway within pancreatic tissues, leading to improved insulin signaling and maintained glucose homeostasis. GABAergic signaling can further function within hepatic tissues, promoting inhibitory effects on the expression of genes related to gluconeogenesis and lipogenesis. Moreover, GABA may enhance gut microbiota diversity by attenuating gut inflammation, attributable to its anti-inflammatory and immunomodulatory properties. Furthermore, the neuroprotective effects of GABA play a significant role in ameliorating neural disorders associated with diabetes by facilitating a substantial reduction in neuronal apoptosis. In conclusion, GABA emerges as a promising candidate for an antidiabetic agent; however, further research is highly encouraged to develop a rigorously designed framework that comprehensively identifies and optimizes the appropriate dosages and intervention methods for effectively managing and combating diabetes.

Impact of coronavirus disease 2019 pandemic on the trends of care-seeking behavior for ocular diseases: a systematic review and meta-analysis

We aimed to assess the clinical and epidemiological impacts of the coronavirus disease 2019 pandemic on the number of ophthalmology outpatient department (oOPD) visits. PubMed and EMBASE were searched for literature published between January 1, 2020, and December 5, 2022. The extracted data were pooled using a random-effects model. The primary outcome was the number of oOPD visits. Of the 335 screened articles, 21 and 16 were included in the qualitative and quantitative syntheses, respectively. Among the 16 studies included in the meta-analysis, 7 involving 4,204,209 individuals reported the number of oOPD visits during the pandemic. Compared with the number of pre-pandemic visits, the numbers of oOPD visits declined to 58.1% (95% confidence interval [CI], 0.378-0.784) and 29.8% (95% CI 0.130-0.465) during the pandemic and lockdown, respectively. The proportions of female patient visits decreased from 50.9 to 47.8% and from 48.3 to 42.3% during the pandemic and lockdown, respectively. The proportions of adult visits increased from 86.3 to 89.6% and decreased from 90.6 to 80.1% during the pandemic and lockdown, respectively. The decrease in oOPD visits during the pandemic may have caused delays in diagnosis and treatment, potentially exacerbating the existing ocular diseases.

Comparative insights into the role of sex hormones in glaucoma among women and men

Baseline differences in sex hormone levels between males and females influence tissues including the brain and eye. To investigate the effects of estrogens and androgens on ocular physiology and glaucoma, we review the current literature on the influence of primary sex hormones on ocular function, glaucoma incidence and related parameters like intraocular pressure (IOP) at physiologic levels and related to hormone therapies in men and women. These articles reveal activity of estrogen, testosterone, and progesterone within ocular tissues including the retinal pigment epithelium and ciliary epithelium where they likely influence glaucoma pathophysiology through effects on ocular blood flow and aqueous outflow. A growing body of evidence demonstrates a protective role of estrogen in glaucoma. With fluctuations across a woman's lifetime through menstrual phases, pregnancy, and menopause, the general association seen is a lower risk of glaucoma and lower IOP with higher estrogen. Exogenous hormones in the form of oral contraceptive pills and hormone replacement therapy also appear to affect glaucoma risk, although published findings are inconsistent. Few studies have reported a positive association between IOP and serum testosterone, and men treated with androgen deprivation therapy have shown a reduced risk of glaucoma while masculinizing hormone therapies at supra-physiologic testosterone levels have significantly increased IOP. Sex hormone perturbations affect components of glaucoma pathogenesis including IOP and ocular blood flow and overlap with known risk factors like age and sex. Standardized studies are needed to further elucidate the roles of estrogen and testosterone in glaucoma risk and progression.

Automated Quantitative Assessment of Retinal Vascular Tortuosity in Patients with Sickle Cell Disease

Objective

To quantitatively assess the retinal vascular tortuosity of patients with sickle cell disease (SCD) and retinopathy (SCR) using an automated deep learning (DL)-based pipeline.

Design

Cross-sectional study.

Subjects

Patients diagnosed with SCD and screened for SCR at an academic eye center between January 2015 and November 2022 were identified using electronic health records. Eyes of unaffected matched patients (i.e., no history of SCD, hypertension, diabetes mellitus, or retinal occlusive disorder) served as controls.

Methods

For each patient, demographic data, sickle cell diagnosis, types and total number of sickle cell crises, SCD medications used, ocular and systemic comorbidities, and history of intraocular treatment were extracted. A previously published DL algorithm was used to calculate retinal microvascular tortuosity using ultrawidefield pseudocolor fundus imaging among patients with SCD vs. controls.

Main Outcome Measures

Cumulative tortuosity index (CTI).

Results

Overall, 64 patients (119 eyes) with SCD and 57 age- and race-matched controls (106 eyes) were included. The majority of the patients with SCD were females (65.6%) and of Black or African descent (78.1%), with an average age of 35.1 ± 20.1 years. The mean number of crises per patient was 3.4 ± 5.2, and the patients took 0.7 ± 0.9 medications. The mean CTI for eyes with SCD was higher than controls (1.06 ± vs. 1.03 ± 0.02, P < 0.001). On subgroup analysis, hemoglobin S, hemoglobin C, and HbS/beta-thalassemia variants had significantly higher CTIs compared with controls (1.07 vs. 1.03, P < 0.001), but not with sickle cell trait variant (1.04 vs. 1.03 control, P = .2). Univariable analysis showed a higher CTI in patients diagnosed with proliferative SCR, most significantly among those with sea-fan neovascularization (1.06 ± 0.02 vs. 1.04 ± 0.01, P < 0.001) and those with >3 sickle cell crises (1.07 ± 0.02 vs. 1.05 ± 0.02, P < 0.001).

Conclusions

A DL-based metric of cumulative vascular tortuosity associates with and may be a potential biomarker for SCD and SCR disease severity.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Comparison of intraocular pressure changes in Japanese patients with neovascular age-related macular degeneration treated with aflibercept or faricimab

PURPOSE

To assess the short-term changes in intraocular pressure (IOP) following intravitreal injections of aflibercept or faricimab in Japanese patients with neovascular age-related macular degeneration (nAMD).

STUDY DESIGN

Retrospective observational study.

METHODS

This retrospective observational study included 161 eyes from 160 Japanese patients diagnosed with nAMD. Of these, 127 eyes (127 patients) were treated with 2 mg/0.05 mL aflibercept, and 34 eyes (33 patients) received 6 mg/0.05 mL faricimab. Each group underwent three consecutive monthly injections. The IOP in each treated eye was measured using non-contact tonometry at each visit over a 3-month period following the initial injection.

RESULTS

The mean baseline IOP in the aflibercept group was 14.4 ± 2.8 mmHg, decreasing to 13.2 ± 3.0 mmHg after 3 months (P < 0.001), whereas the mean baseline IOP in the faricimab group was 13.8 ± 2.1 mmHg, with a change to 13.5 ± 1.5 mmHg after 3 months (P = 0.1873).

CONCLUSION

The loading phase treatment with aflibercept resulted in a decrease in IOP. Faricimab showed a similar trend, there was no significant difference between the two treatments.

EyeLiner: A Deep Learning Pipeline for Longitudinal Image Registration Using Fundus Landmarks

Objective

Detecting and measuring changes in longitudinal fundus imaging is key to monitoring disease progression in chronic ophthalmic diseases, such as glaucoma and macular degeneration. Clinicians assess changes in disease status by either independently reviewing or manually juxtaposing longitudinally acquired color fundus photos (CFPs). Distinguishing variations in image acquisition due to camera orientation, zoom, and exposure from true disease-related changes can be challenging. This makes manual image evaluation variable and subjective, potentially impacting clinical decision-making. We introduce our deep learning (DL) pipeline, "EyeLiner," for registering, or aligning, 2-dimensional CFPs. Improved alignment of longitudinal image pairs may compensate for differences that are due to camera orientation while preserving pathological changes.

Design

EyeLiner registers a "moving" image to a "fixed" image using a DL-based keypoint matching algorithm.

Participants

We evaluate EyeLiner on 3 longitudinal data sets: Fundus Image REgistration (FIRE), sequential images for glaucoma forecast (SIGF), and our internal glaucoma data set from the Colorado Ophthalmology Research Information System (CORIS).

Methods

Anatomical keypoints along the retinal blood vessels were detected from the moving and fixed images using a convolutional neural network and subsequently matched using a transformer-based algorithm. Finally, transformation parameters were learned using the corresponding keypoints.

Main Outcome Measures

We computed the mean distance (MD) between manually annotated keypoints from the fixed and the registered moving image. For comparison to existing state-of-the-art retinal registration approaches, we used the mean area under the curve (AUC) metric introduced in the FIRE data set study.

Results

EyeLiner effectively aligns longitudinal image pairs from FIRE, SIGF, and CORIS, as qualitatively evaluated through registration checkerboards and flicker animations. Quantitative results show that the MD decreased for this model after alignment from 321.32 to 3.74 pixels for FIRE, 9.86 to 2.03 pixels for CORIS, and 25.23 to 5.94 pixels for SIGF. We also obtained an AUC of 0.85, 0.94, and 0.84 on FIRE, CORIS, and SIGF, respectively, beating the current state-of-the-art SuperRetina (AUCFIRE = 0.76, AUCCORIS = 0.83, AUCSIGF = 0.74).

Conclusions

Our pipeline demonstrates improved alignment of image pairs in comparison to the current state-of-the-art methods on 3 separate data sets. We envision that this method will enable clinicians to align image pairs and better visualize changes in disease over time.

Financial Disclosures

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Pharmacovigilance in intraocular antiangiogenic therapy

INTRODUCTION/OBJECTIVE

Anti-VEGF (Vascular endothelial growth factor) agents have revolutionized ophthalmotherapy and are vital for various retinal disease treatment in ophthalmic practice. Ophthalmology has witnessed an explosion in the number of intravitreal injections delivered to patients over the past years. The rising popularity of anti-VEGF drugs came along with concerns about its safety in clinical use. The aim of this focused review is to critically analyze currently available findings on systemic safety.

MATERIALS AND METHODS

A literature search was conducted using PubMed, Web of Science, and Google Scholar databases for studies published from January 2012 to February 2025. The reference lists of meta-analyses and selected studies were also reviewed. Eighty four articles of high or medium clinical relevance were selected for review. The exclusion criteria included non-English language publications, articles directly unrelated to the review topic, commentaries, conference abstracts.

RESULTS

Systemic safety concern in intraocular pharmacotherapy by antiangiogenic agents has a strong body of clinical evidence, resulting in plenty of peer reviewed clinical articles. It is certainly becoming recognized that anti-VEGF agents, despite given intraocularly, have the potential to cause systemic adverse events, such as cardiovascular, renal, neurological.

CONCLUSIONS

Accumulating evidence obviate the need to raise medical professionals' awareness about systemic risk profile in patients with eye diseases treated by anti-VEGF, paying a special attention on patients with diabetes and older patients with multimorbidity. Early identification and prompt management of patients with undesirable systemic side effects secondary to intraocular pharmacotherapy by angiogenics can lessen disease severity, and help achieve earlier resolution.

Impact of teleretinal screening program on diabetic retinopathy screening compliance rates in community health centers: a quasi-experimental study

BACKGROUND

Diabetic retinopathy (DR) remains a leading cause of preventable blindness, with inadequate screening rates even in urban areas with high concentrations of medical professionals. While medical guidelines recommend annual diabetic retinopathy screening for patients with diabetes mellitus, adherence to these recommendations remains low. This study evaluates the impact of a novel teleretinal DR screening program on screening compliance across urban community health centers in Boston, Massachusetts.

METHODS

We conducted a quasi-experimental study comparing DR screening compliance between intervention and comparison community health centers before and after implementing a teleretinal screening program. Participants included patients diagnosed with diabetes mellitus with primary care providers at the studied sites. We defined compliance as completion of either teleretinal screening or a documented eye care professional examination within the previous 365 days. Monthly compliance rates were analyzed using two-way fixed effects regression and event study techniques.

RESULTS

The study included 10,247 patients with diabetes mellitus who received care at six participating sites, generating 222 monthly compliance rate estimates. Baseline compliance rates before implementation ranged from 25 to 40% across sites. The two-way fixed effects regression analysis revealed that the screening program significantly increased DR compliance rates by an average of 7.2% points (p < 0.001). Event study analysis showed positive effects across all sites, though the initial improvement tended to diminish over time.

CONCLUSIONS

Implementation of a community-based teleretinal DR screening program significantly improved compliance with annual screening guidelines in urban communities. These findings support the broader adoption of teleretinal screening as an effective strategy for preventing DR-related vision loss in vulnerable populations. Further research is needed to assess long-term clinical outcomes and optimize program sustainability.

Electrodiagnostic Tests as Potential Efficacy Endpoints in Clinical Trials of Novel Pharmacological Therapies for Acquired Retinal Disorders

BACKGROUND

Electrodiagnostic tests (EDTs) provide non-invasive, objective, and measurable indications of retinal and visual pathway function. These hold the promise of evaluating drug efficacy and disease progression over shorter periods than traditional "end-stage" outcome measures (e.g., best-corrected visual acuity) in various ophthalmological pathologies. The International Society for Clinical Electrophysiology of Vision has defined rigorous standards for EDTs, intended to optimize diagnostic power, enabling meaningful inter-laboratory comparisons and facilitating application as outcome measures in increasing numbers of multicentre clinical trials.

SUMMARY

This review outlines the main EDTs, including full-field, pattern, and multifocal electroretinography; the electro-oculogram; and the cortical visual-evoked potential, and highlights the possible role for monitoring disease progression and assessing treatment safety and efficacy. The utility and potential of EDTs are highlighted in studies that have assessed function and tested or monitored treatment safety or efficacy for a range of acquired retinal and optic nerve disorders, including central retinal vein occlusion, diabetic retinopathy, glaucoma, age-related macular degeneration, posterior uveitis, and autoimmune-related retinopathies.

KEY MESSAGES

EDTs are fundamental to the diagnosis and phenotyping of many acquired retinal and visual pathway disorders. They also provide methods for the objective assessment of the efficacy and safety of potential novel treatments across short periods. Conventional psychophysical tests, such as visual acuity, are of limited value in localizing and characterizing dysfunction and are not always suitable for monitoring purposes. This review highlights where EDTs may address the need for better outcome measures to evaluate novel treatments within clinical trials, helping to select early treatment candidates and for the assessment of safety and efficacy.

Ocular neuroinflammatory response secondary to SARS-CoV-2 infection-a review

With the consistent occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the prevalence of various ocular complications has increased over time. SARS-CoV-2 infection has been shown to have neurotropism and therefore to lead to not only peripheral inflammatory responses but also neuroinflammation. Because the receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), can be found in many intraocular tissues, coronavirus disease 2019 (COVID-19) may also contribute to persistent intraocular neuroinflammation, microcirculation dysfunction and ocular symptoms. Increased awareness of neuroinflammation and future research on interventional strategies for SARS-CoV-2 infection are important for improving long-term outcomes, reducing disease burden, and improving quality of life. Therefore, the aim of this review is to focus on SARS-CoV-2 infection and intraocular neuroinflammation and to discuss current evidence and future perspectives, especially possible connections between conditions and potential treatment strategies.

Which Parameter Related to Low-Density Lipoprotein Cholesterol is Superior for Predicting the Recurrence of Myocardial Infarction in Young Patients with Previous Coronary Heart Disease? A Real-World Study

Background

Lowering low-density lipoprotein cholesterol (LDL-C) is a well-established strategy for the secondary prevention of coronary heart disease (CHD). However, the effectiveness of specific LDL-C parameters in predicting myocardial infarction (MI) recurrence in real-world settings remains inadequately explored. This study aims to examine the relationship between MI recurrence and various LDL-C parameters in young CHD patients.

Methods

This retrospective cohort study involved 1013 patients aged 18-44 at the time of initial CHD diagnosis, collected from the cardiology department clinics at Beijing Anzhen Hospital between October 2022 and October 2023. LDL-C levels were assessed at the time of CHD diagnosis and at the final follow-up. The primary outcome was MI events, analyzed using survival analysis and logistic regression models to determine associations with LDL-C parameters.

Results

The study included 1013 patients (mean age: 38.5 ± 3.9 years; 94.7% men), with a median follow-up time of 1.7 years. Initially, 13.6% had LDL-C levels <1.8 mmol/L, which increased to 37.8% by the study's end. During follow-up, 96 patients (9.5%) experienced MI. While LDL-C <1.8 mmol/L at baseline showed a slightly lower cumulative incidence of MI than LDL-C ≥1.8 mmol/L, the difference was not statistically significant (log-rank p = 0.335). Reductions in LDL-C levels of ≥50% and the patterns of change did not correlate with decreased MI risk. However, LDL-C <1.4 mmol/L at the final measurement was associated with a reduced MI risk (adjusted odds ratio [OR]: 0.57, 95% confidence interval [CI]: 0.33-0.98) compared with LDL-C ≥2.6 mmol/L.

Conclusions

This study suggests that the most important parameter related to LDL-C for predicting the recurrence of MI in young patients with a history of CHD is the ideal target LDL-C level. Lowering LDL-C to <1.4 mmol/L could potentially reduce MI risk, regardless of baseline LDL-C levels.

Corneal thickness, contrast sensitivity and binocular vision in menopausal and non-menopausal women

OBJECTIVE

This study aimed to investigate the effects of menopause on ocular health and visual function.

METHOD

Sixty-two women (31 premenopausal and 31 postmenopausal) who visited Rasht Health Center were selected and matched based on their ages and compared in terms of their hormonal status, central corneal thickness (CCT), contrast sensitivity (CS), binocular vision variables and refractive error.

RESULTS

CCT and corneal curvature were significantly thinner in postmenopausal women. However, menopause had no significant impact on CS, binocular vision or refractive error.

CONCLUSION

Age-related hormonal abnormalities play a significant role in corneal thinning, highlighting the intricate relationship between systemic hormonal changes and ocular health. In contrast, binocular vision functions remain unaffected by menopause.

Early-onset atherosclerotic cardiovascular disease

Recent trends indicate a concerning increase in early-onset atherosclerotic cardiovascular disease (ASCVD) among younger individuals (men aged <55 years women aged <65 years). These findings highlight the pathobiology of ASCVD as a disease process that begins early in life and underscores the need for more tailored screening methods and preventive strategies. Increasing attention has been placed on the growing burden of traditional cardiometabolic risk factors in young individuals while also recognizing unique factors that mediate risk of pre-mature atherosclerosis in this demographic such as substance use, socioeconomic disparities, adverse pregnancy outcomes, and chronic inflammatory states that contribute to the increasing incidence of early ASCVD. Additionally, mounting evidence has pointed out significant disparities in the diagnosis and management of early ASCVD and cardiovascular outcomes based on sex and race. Moving towards a more personalized approach, emerging data and technological developments using diverse tools such as polygenic risk scores and coronary artery calcium scans have shown potential in earlier detection of ASCVD risk. Thus, we review current evidence on causal risk factors that drive the increase in early ASCVD and highlight emerging tools to improve ASCVD risk assessment in young individuals.

Physiological and pathological changes to the eye and vision during and after pregnancy

Pregnancy introduces a multitude of changes in the body, including hormonal fluctuations and metabolic changes, which can lead to atypical ocular signs and symptoms. Ocular manifestations range from fluctuations in vision, to microstructural changes in the retina and choroid, to dry eye disease. This narrative review highlights the range of pregnancy-related effects on the eye and vision that are likely to present in the context of routine eyecare. Specifically, physiological ocular changes and pathological ocular changes that manifest for the first time, or are exacerbated, in uncomplicated pregnancy are discussed. The literature has evolved from simply noting differences in the eye between pregnant and non-pregnant groups, to refining knowledge of the proposed underlying pathophysiology with the advent of newer technologies in eyecare. A particular focus of this review is navigating when pregnancy changes in the eye occur or peak during the gestational period, and whether the changes are short-lived or might extend past pregnancy. While many pregnancy-associated changes are temporary and resolve post-partum, it is also recognised that some changes persist after pregnancy, with a notable absence of literature on ocular changes with loss or termination of pregnancy. Currently or previously pregnant women (or those planning to become pregnant), and other health professionals, should be educated about the importance of seeking eyecare before, during and after pregnancy.

Diagnostic Performance of the Offline Medios Artificial Intelligence for Glaucoma Detection in a Rural Tele-Ophthalmology Setting

PURPOSE

This study assesses the diagnostic efficacy of offline Medios Artificial Intelligence (AI) glaucoma software in a primary eye care setting, using nonmydriatic fundus images from Remidio's Fundus-on-Phone (FOP NM-10). Artificial intelligence results were compared with tele-ophthalmologists' diagnoses and with a glaucoma specialist's assessment for those participants referred to a tertiary eye care hospital.

DESIGN

Prospective cross-sectional study PARTICIPANTS: Three hundred three participants from 6 satellite vision centers of a tertiary eye hospital.

METHODS

At the vision center, participants underwent comprehensive eye evaluations, including clinical history, visual acuity measurement, slit lamp examination, intraocular pressure measurement, and fundus photography using the FOP NM-10 camera. Medios AI-Glaucoma software analyzed 42-degree disc-centric fundus images, categorizing them as normal, glaucoma, or suspect. Tele-ophthalmologists who were glaucoma fellows with a minimum of 3 years of ophthalmology and 1 year of glaucoma fellowship training, masked to artificial intelligence (AI) results, remotely diagnosed subjects based on the history and disc appearance. All participants labeled as disc suspects or glaucoma by AI or tele-ophthalmologists underwent further comprehensive glaucoma evaluation at the base hospital, including clinical examination, Humphrey visual field analysis, and OCT. Artificial intelligence and tele-ophthalmologist diagnoses were then compared with a glaucoma specialist's diagnosis.

MAIN OUTCOME MEASURES

Sensitivity and specificity of Medios AI.

RESULTS

Out of 303 participants, 299 with at least one eye of sufficient image quality were included in the study. The remaining 4 participants did not have sufficient image quality in both eyes. Medios AI identified 39 participants (13%) with referable glaucoma. The AI exhibited a sensitivity of 0.91 (95% confidence interval [CI]: 0.71-0.99) and specificity of 0.93 (95% CI: 0.89-0.96) in detecting referable glaucoma (definite perimetric glaucoma) when compared to tele-ophthalmologist. The agreement between AI and the glaucoma specialist was 80.3%, surpassing the 55.3% agreement between the tele-ophthalmologist and the glaucoma specialist amongst those participants who were referred to the base hospital. Both AI and the tele-ophthalmologist relied on fundus photos for diagnoses, whereas the glaucoma specialist's assessments at the base hospital were aided by additional tools such as Humphrey visual field analysis and OCT. Furthermore, AI had fewer false positive referrals (2 out of 10) compared to the tele-ophthalmologist (9 out of 10).

CONCLUSIONS

Medios offline AI exhibited promising sensitivity and specificity in detecting referable glaucoma from remote vision centers in southern India when compared with teleophthalmologists. It also demonstrated better agreement with glaucoma specialist's diagnosis for referable glaucoma participants.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Patient Characteristics Are Associated with Appointment "No-Show" at a Tertiary Academic Glaucoma Service: A Cross-Sectional Study

Introduction

Appointment "no-shows" (NS) are a significant issue for glaucoma patients, potentially leading to loss to follow-up, disease progression, and irreversible vision loss. This study investigates sociodemographic and clinical risk factors associated with NS at a tertiary academic eye center.

Methods

A retrospective review of 100 glaucoma patients at the University of Pittsburgh Medical Center (UPMC) Vision Institute over 1 year was conducted. Patients were categorized as NS if they missed any glaucoma service appointment and as never no-show (NNS) if no appointments were missed. Baseline demographic, medical, and ophthalmic data were collected. Socioeconomic disadvantage was measured using the area deprivation index (ADI) based on residential ZIP codes.

Results

Of 100 patients, 35 were classified as NS and 65 as NNS. NS patients had significantly higher ADI scores (79 vs. 65; p = 0.03) and were more frequently Black (54% [19/35] vs. 26% [17/65]; p = 0.01). Medical comorbidities were more common in NS patients (83% [29/35] vs. 48% [31/65]; p < 0.001), as were mental health diagnoses (34% [12/35] vs. 8% [5/65]; p < 0.001). Insurance type, glaucoma type, intraocular pressure, and visual acuity were not significantly different between groups.

Conclusion

Higher socioeconomic disadvantage, Black race, medical comorbidities, and mental health diagnoses were associated with appointment NS among glaucoma patients. These findings highlight the need for targeted interventions to address these risk factors, improve follow-up adherence, and reduce the risk of disease progression.

Neighborhood Poverty and Clinic Attendance in the Michigan Screening and Intervention for Glaucoma and Eye Health Through Telemedicine Program

PRCIS

Higher neighborhood-level poverty is associated with greater odds of missing a free eye disease screening appointment, underscoring the importance of community-based interventions to address upstream social determinants of health.

PURPOSE

To investigate the association between neighborhood-level characteristics and attendance for a free eye disease screening.

METHODS

The MI-SIGHT program is conducted in 2 community clinics in Southeastern Michigan. Participant-level demographics were extracted from electronic health records. Neighborhood-level characteristics, including Area Deprivation Index (ADI), median household income (HHI), percent of households with >30% rent burden, percent of households without vehicles, percent of households in subsidized housing, and energy burden, were obtained from the Wisconsin Neighborhood Atlas and the United States census. Logistic regression was used to model the probability of clinic visit attendance, which was the main outcome measure.

RESULTS

One thousand four hundred thirty-one participants were scheduled for screening appointments between July 2020 and November 2021, with a no-show rate of 23%. Individuals lived an average of 7.7 miles from each clinic (SD=8.1) and in neighborhoods with a mean ADI of 6.8 (SD=3.2, 1-10 scale, where 10 is the most deprived). After adjusting for age, sex, race, and ethnicity, participants from neighborhoods with higher deprivation were more likely to have missed clinic visits. For example, there was an 8% higher odds of missed clinic visits for every 1-point increase in ADI (odds ratio, OR=1.08, P =0.020) and an 18% higher odds of a missed visit with every 10% increase in households without a vehicle (OR=1.18, P =0.013).

CONCLUSIONS

Higher neighborhood-level poverty was associated with greater odds of missing a free eye disease screening appointment after adjusting for individual characteristics. Increased neighborhood-level resources are likely needed to bolster engagement in preventive eye care.

[Retinal Vein Occlusions]

As retinal vein occlusion is such a complex systemic disease, its underlying risk profile should be narrowed down individually. Ophthalmologists should always rule out glaucoma or ocular hypertension while also screening the patient for systemic vascular diseases or risk factors in particular. Intravitreally applied medication (VEGF inhibitors or steroids) and laser coagulation (focal or panretinal) or a combination thereof can be considered to treat such retinal anomalies.

Narrative review of comprehensive management strategies for diabetic retinopathy: interdisciplinary approaches and future perspectives

This review examines the epidemiological trends, pathophysiologic mechanisms, and current and future therapeutic strategies for diabetic retinopathy (DR), focusing on innovative management countermeasures in the face of this global public health challenge. As the number of patients with diabetes continues to increase, DR, as one of its major complications, poses a significant threat to global visual health. This review not only summarises the latest advances in personalised treatment and emerging therapeutic modalities (such as anti-vascular endothelial growth factor therapy, laser treatment, surgical procedures and cutting-edge gene and stem cell therapies) but also emphasises the revolutionary potential of telemedicine technologies and digital health platforms to improve DR screening and adherence among people with diabetes. We show how these technological innovations, especially in resource-limited settings, can achieve early diagnosis and effective treatment, thereby significantly reducing the public health burden of DR. In addition, this article highlights the critical role of interdisciplinary teamwork in optimising the comprehensive management of DR, involving close collaboration among physicians, researchers, patient education specialists and policy-makers, as well as the importance of implementing these innovative solutions through societal engagement and policy support. By highlighting these innovative strategies and their specific impact on improving public health practices, this review offers new perspectives and strategies for the future management of DR, with the goal of promoting the prevention, diagnosis and treatment of DR worldwide, improving patient prognosis and enhancing quality of life.