Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis

Game-changing breakthroughs to redefine the landscape of the renin-angiotensin-aldosterone system in health and disease

Novel perspectives on the role of the renin-angiotensin-aldosterone system (RAAS) offer a groundbreaking understanding of the system's role in health and illness. Our understanding of the role of the RAAS in several diseases, such as heart failure, hypertension, metabolic disorders, and chronic renal disease, has been broadened by recent studies. Specific variations in RAAS pathways can affect the course of disease and response to treatment, as shown by genetic and molecular research. The dynamic and fast-evolving nature of RAAS research described in this special issue might transform our approach to managing renal, neurological, and cardiovascular health, among other disease conditions, including cancer.

COMPLETE RESOLUTION OF SUBRETINAL FLUID OF THE FELLOW EYE AFTER AFLIBERCEPT INJECTION IN WET AGE-RELATED MACULAR DEGENERATION

PURPOSE

To present a case of a patient with bilateral wet age-related macular degeneration who was unilaterally treated with intravitreal aflibercept injections (IAIs) and the disease status in the fellow eye ameliorated after an IAI.

METHODS

Retrospective case report.

RESULTS

A 72-year-old woman was diagnosed with wet and dry age-related macular degeneration in her right eye and left eye, respectively. In the right eye, treatment strategy comprised three monthly IAIs, followed by reinjections according to need, whereas optical coherence tomography scans were performed before IAIs. One month after the second IAI, subretinal fluid developed in the left eye. One week later, an IAI was applied in the right eye; 2 days later, the disease status in the left eye was assessed by fluorescein angiography and optical coherence tomography. Surprisingly, in the left eye, subretinal fluid completely resolved and fluorescein angiography did not detect leakage, highlighting the absence of an active choroidal neovascularization. The short interval between IAI and the resolution of exudative phenomena in the other eye is suggestive of a beneficial effect in the contralateral eye.

CONCLUSION

In this article, we showed that an IAI had an effect to the fellow untreated eye. Our observation is consistent with active aflibercept in the systemic circulation. To the best of our knowledge, no other report in the literature has demonstrated this effect of aflibercept in wet age-related macular degeneration.

Research progress on antioxidants and protein aggregation inhibitors in cataract prevention and therapy (Review)

Cataracts are primarily caused by aging or gene mutations and are the leading cause of blindness globally. As the older population increases, the number of patients with a cataract is expected to grow rapidly. At present, cataract surgery to replace the lens with an artificial intraocular lens is the principal treatment method. However, surgery has several drawbacks, including economic burdens and complications such as inflammation, xerophthalmia, macular edema and posterior capsular opacification. Thus, developing an effective non‑surgical treatment strategy is beneficial to both patients and public health. Mechanistically, cataract formation may be due to various reasons but is primarily initiated and promoted by oxidative stress and is closely associated with crystallin aggregation. In the present review, the current research progress on anti‑cataract drugs, including antioxidants and protein aggregation inhibitors is examined. It summarizes strategies for preventing and treating cataract through cell apoptosis and protein aggregation inhibition while discussing their limitations and further prospects.

Conjunctival microvascular alteration in patients with coronary artery disease assessed using optical coherence tomographic angiography

BACKGROUND

To quantify conjunctival microvascular characteristics obtained by optical coherence tomographic angiography (OCTA) and investigate their relationship with the presence and severity of coronary artery disease (CAD).

METHODS

This cross-sectional study included 103 consecutive CAD patients confirmed by coronary angiography and 125 non-CAD controls. The temporal conjunctivas along the limbus of each participant were scanned using OCTA. Quantification of conjunctival microvasculature was performed by AngioTool software. The severity of the disease was evaluated using SYNTAX and Gensini scores.

RESULTS

Compared to the controls, the CAD group exhibited significantly lower vessel area density (30.22 ± 3.34 vs. 26.70 ± 4.43 %, p < 0.001), lower vessel length density (6.39 ± 0.77 vs. 5.71 ± 0.89/m, p < 0.001), lower junction density (3.44 ± 0.56 vs. 3.05 ± 0.63/m, p < 0.001), and higher lacunarity (0.11 ± 0.03 vs. 0.14 ± 0.05, p < 0.001). Among all participants, lower vessel area density, lower vessel length density, lower junction density, and higher lacunarity were associated with greater odds of having CAD; the adjusted ORs (95 % confidence intervals) per one SD decrease were 2.71 (1.71, 4.29), 2.51(1.61, 3.90), 2.06 (1.39, 3.05), and 0.36 (0.23, 0.58), respectively. Among CAD patients, junction density was negatively associated with the Gensini score (r = -0.359, p = 0.037) and the Syntax score (r = -0.350, p = 0.042) in women but not in men (p > 0.05).

CONCLUSIONS

Conjunctival microvascular characteristics were significantly associated with the presence of CAD. Junction density significantly associated with the severity of CAD among women patients.

Detection of retinal diseases using an accelerated reused convolutional network

Convolutional neural networks are continually evolving; with some efforts aimed at improving accuracy, others at increasing speed, and some at enhancing accessibility. Improving accessibility broadens the application of neural networks across a wider range of tasks, including the detection of eye diseases. Early diagnosis of eye diseases and consulting an ophthalmologist can prevent many vision disorders. Given the importance of this issue, various datasets have been collected from the cornea to facilitate the process of making neural network models. However, most of the methods introduced in the past are computationally complex. In this study, we tried to increase the accessibility of deep neural network models. We did this at the most fundamental level-specifically, by redesigning and optimizing the convolutional layers. By doing so, we created a new general model that incorporates our novel convolutional layer named ArConv layers. Thanks to the efficient performance of this new layer, the model has suitable complexity for use in mobile phones and perform the task of diagnosing the presence of disease with high accuracy. The final model we present contains only 1.3 million parameters. In comparison to the MobileNetV2 model, which has 2.2 million parameters, our model demonstrated better accuracy when trained and evaluated on the RfMiD dataset under identical conditions, achieving an accuracy of 0.9328 versus 0.9266 on the RfMiD test set.

Lipid-lowering drug and complement factor H genotyping-personalized treatment strategy for age-related macular degeneration

We investigated whether the effect of lipid-lowering drugs (LLDs) on age-related macular degeneration (AMD) differs according to the main complement genetic variants in Singapore Epidemiology of Eye Diseases (SEED) (n = 5,579) and UK Biobank studies (n = 445,727). The effect of LLD was determined for each stratum of 20 complement genetic variants. In SEED, 484 individuals developed AMD and 216 showed progression over 6 years. In the UK Biobank, 913 participants developed AMD over 11 years. rs1061170 variant (complement factor H gene) was the only variant for which we found a protective effect in both populations. This effect was found in individuals carrying at least one C allele in SEED (odds ratio [OR] = 0.41; 95% confidence interval [CI], 0.19-0.87) and in individuals carrying two C alleles in UK Biobank (hazard ratio [HR] = 0.65; 95% CI, 0.45-0.93). These effects corresponded to a 50% and 35% decrease in AMD risk, respectively. Our study highlights the potential for personalized therapy for AMD based on complement genotyping.

Biologically inspired bioactive hydrogels for scarless corneal repair

Corneal injury-induced fibrosis occurs because of corneal epithelial basement membrane (EBM) injury and defective regeneration. Corneal fibrosis inhibition and transparency restoration depend on reestablished EBM, where the collagen network provides structural stability and heparan sulfate binds corneal epithelium-derived cytokines to regulate homeostasis. Inspired by this, bioactive hydrogels (Hep@Gel) composed of collagen-derived gelatins and highly anionic heparin were constructed for scarless corneal repair. Hep@Gel resembled the barrier function of the EBM regarding surface-confined binding, long-time sequestration, and progressive degradation of IL-1, TGF-β, and PDGF-BB, which robustly inhibited the apoptosis and myofibroblast transition of keratocytes. Animal models of rabbits and nonhuman primates confirmed that Hep@Gel effectively limited the influx of inflammatory and fibrotic cytokines from the epithelium into the stroma to down-regulate the wound healing cascade, contributing to better vision quality with 73% reduced fibrosis. Hep@Gel offers a solution for preventing corneal injury-induced scarring and substituting for lamellar keratoplasty to remove scarring.

Causal association between metabolites and age-related macular degeneration: a bidirectional two-sample mendelian randomization study

BACKGROUND

Age-related macular degeneration (AMD) is the leading cause of visual impairment in the elderly population. Accumulating evidence has revealed the possible association between metabolites and AMD. This study aimed to assess the effect of plasma metabolites on AMD and its two subtypes using a bidirectional two-sample Mendelian randomization approach.

METHODS

The causality between plasma metabolites and AMD was assessed by a bidirectional two-sample Mendelian randomization (MR) analysis using the genome-wide association studies (GWAS) summary statistics of 1400 genetically determined metabolites (GDMs) and AMD. For this MR analysis, inverse variance weighted (IVW) was used as the primary method, with weighted median, MR-Egger, weighted mode, and simple mode as supplementary methods to examine the causality. MR-Egger intercept, Cochran's Q, and MR-PRESSO test were employed to evaluate possible pleiotropy and heterogeneity.

RESULTS

The results of IVW showed significant causal associations between 13 GDMs and AMD. 1-stearoyl-GPE (18:0), androstenediol (3β,17β) monosulfate, stearoyl sphingomyelin (d18:1/18:0), xylose, and X-11,850 exhibited a protective effect on AMD, while gulonate and mannonate increased the risk of AMD. 1-stearoyl-GPE (18:0) and X-11,850 exhibited protective effects on dry AMD. DHEAS, 1-stearoyl-GPE (18:0), 5α-androstan-3β,17β-diol disulfate, xylose, androstenediol (3β,17β) monosulfate, and N2-acetyl, N6, N6-dimethyllysine exhibited a protective effect on wet AMD, while succinimide, 16a-hydroxy DHEA 3-sulfate, and X-13,553 increased the risk of wet AMD. Horizontal pleiotropy and heterogeneity did not distort the causal estimates. In the reverse MR analysis, AMD reduced the androstenediol (3β,17β) monosulfate level, and increased the stearoyl sphingomyelin(d18:1/18:0) level.

CONCLUSION

This study supported the effect of plasma metabolites on AMD, providing novel insights for clinical diagnosis and prevention strategy.

Retrospective analysis on the outcomes of contact lens-associated keratitis in a tertiary centre: an evidence-based management protocol to optimise resource allocation

BACKGROUND/AIMS

Contact lens-associated keratitis (CLAK) is a common sight-threatening complication of contact lens use. Current management protocols in the UK are based on historical practice and necessitate a review for every patient within 48 hours regardless of severity, increasing the treatment burden on a resource-limited healthcare service. Our study aims to identify the different risk factors associated with CLAK, categorise CLAK using a novel grading system and recommend modifications to current management protocols based on the outcomes in the individual subgroups.

METHODS

The retrospective cohort study identified 161 eyes from 153 patients with CLAK from the electronic patient records of a tertiary eye centre between 1 July 2021 and 28 February 2022. Patients were categorised based on epithelial defect size (grade 1: <1.0 mm, grade 2: 1.0-2.0 mm, grade 3: >2.0 mm) and their risk factors, clinical features, treatments and outcomes were analysed.

RESULTS

The most significant risk factors for CLAK include extended-wear contact lens, poor hygiene and prolonged duration of wear. Grades 1 and 2 CLAKs have excellent outcomes following an empirical treatment regime with topical moxifloxacin with 96% discharged within 48 hours and 94.1% discharged in 2 weeks, respectively. Grade 3 CLAKs require prolonged average duration of treatment.

CONCLUSION

We recommend typical grade 1 and 2 CLAKs can be discharged with empirical fluoroquinolone treatment. Grade 3 and all CLAKs with atypical features require monitoring for resolution, further diagnostics or treatment. We provide an evidence-based approach to reduce unnecessary patient visits and optimise resource allocation in an urban setting.

Fish Fin-Derived Non-Invasive Flexible Bioinspired Contact Lens for Continuous Ophthalmic Drug Delivery

Efficient drug delivery is crucial for glaucoma patients. Flexible biomedical devices that enable sustained ocular drug delivery and can regulate the drug release rate according to physiological conditions are highly desirable for glaucoma treatments, addressing both low drug bioavailability and poor patient compliance from manual drug administration, and improving treatment outcomes. Inspired by the structure and reciprocating motion of fish dorsal fins, a drug-eluting contact lens based on deformable microstructures for non-invasive ocular surface drug delivery is developed. Liquid drugs are stored within the interstices of the deformable microstructural units, allowing for continuous drug release through diffusion upon contact with the ocular surface. Finite element analysis is utilized to study the intraocular drug transport dynamics of glaucoma and optimize the overall layout of the device. Microstructural units undergo deformation under loading, altering the interstitial spaces and modulating the drug release rate. This device can adaptively adjust its drug release rate based on changes in intraocular pressure (IOP) and can be proactively regulated in response to cyclic eye loads, accommodating elevated IOP caused by varying body postures and activities. As a flexible, non-invasive, highly dynamic, and adaptive drug delivery platform, it holds significant potential for future biomedical applications.

Anti-VEGF drugs compared with laser photocoagulation for the treatment of diabetic retinopathy: a systematic review and meta-analysis

Background

Diabetic retinopathy is a major cause of sight loss in people with diabetes. The most severe form, proliferative diabetic retinopathy, carries a high risk of vision loss, vitreous haemorrhage, macular oedema and other harms. Panretinal photocoagulation is the primary treatment for proliferative diabetic retinopathy. Anti-vascular endothelial growth factor drugs are used to treat various eye conditions and may be beneficial for people with diabetic retinopathy.

Objective

To investigate the efficacy and safety of anti-vascular endothelial growth factor therapy for the treatment of diabetic retinopathy when compared to panretinal photocoagulation.

Methods

A systematic review and network meta-analysis of all published randomised controlled trials comparing anti-vascular endothelial growth factor (alone or in combination with panretinal photocoagulation) to panretinal photocoagulation in people with diabetic retinopathy. The database searches were updated in May 2023. Trials where the primary focus was treatment of macular oedema or vitreous haemorrhage were excluded.

Results

A total of 14 trials were included: 3 of aflibercept, 5 of bevacizumab and 6 of ranibizumab. Two trials were of patients with non-proliferative diabetic retinopathy; all others were in proliferative diabetic retinopathy. Overall, anti-vascular endothelial growth factor was slightly better than panretinal photocoagulation at preventing vision loss, measured as best corrected visual acuity, at up to 2 years follow-up [mean difference in the logarithm of the minimum angle of resolution -0.089 (or 3.6 Early Treatment Diabetic Retinopathy Study letters), 95% confidence interval -0.180 to -0.019]. There was no clear evidence of any difference between the anti-vascular endothelial growth factors, but the potential for bias complicated the comparison. One trial found no benefit of anti-vascular endothelial growth factor over panretinal photocoagulation after 5 years. Anti-vascular endothelial growth factor was superior to panretinal photocoagulation at preventing macular oedema (relative risk 0.29, 95% confidence interval 0.18 to 0.49) and vitreous haemorrhage (relative risk 0.77, 95% confidence interval 0.61 to 0.99). There was no clear evidence that the effectiveness of anti-vascular endothelial growth factor varied over time.

Conclusions

Anti-vascular endothelial growth factor injections reduce vision loss when compared to panretinal photocoagulation, but the benefit is small and unlikely to be clinically meaningful. Anti-vascular endothelial growth factor may have greater benefits for preventing complications such as macular oedema. Observational studies extending follow-up beyond the 1-year duration of most trials are needed to investigate the longer-term effects of repeated anti-vascular endothelial growth factor injections.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132948.

VIIDA and InViDe: computational approaches for generating and evaluating inclusive image paragraphs for the visually impaired

BACKGROUND

Existing image description methods when used as Assistive Technologies often fall short in meeting the needs of blind or low vision (BLV) individuals. They tend to either compress all visual elements into brief captions, create disjointed sentences for each image region, or provide extensive descriptions.

PURPOSE

To address these limitations, we introduce VIIDA, a procedure aimed at the Visually Impaired which implements an Image Description Approach, focusing on webinar scenes. We also propose InViDe, an Inclusive Visual Description metric, a novel approach for evaluating image descriptions targeting BLV people.

METHODS

We reviewed existing methods and developed VIIDA by integrating a multimodal Visual Question Answering model with Natural Language Processing (NLP) filters. A scene graph-based algorithm was then applied to structure final paragraphs. By employing NLP tools, InViDe conducts a multicriteria analysis based on accessibility standards and guidelines.

RESULTS

Experiments statistically demonstrate that VIIDA generates descriptions closely aligned with image content as well as human-written linguistic features, and that suit BLV needs. InViDe offers valuable insights into the behaviour of the compared methods - among them, state-of-the-art methods based on Large Language Models - across diverse criteria.

CONCLUSION

VIIDA and InViDe emerge as efficient Assistive Technologies, combining Artificial Intelligence models and computational/mathematical techniques to generate and evaluate image descriptions for the visually impaired with low computational costs. This work is anticipated to inspire further research and application development in the domain of Assistive Technologies. Our codes are publicly available at: https://github.com/daniellf/VIIDA-and-InViDe.

The FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial: Study Design

PURPOSE

To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial.

DESIGN

Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis (PTT).

METHODS

Up to 2500 eligible persons with trachomatous trichiasis undergoing lid rotation surgery were enrolled in the Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by the surgeon and is simultaneously stratified by the district. Study visits (in addition to programmatic follow-ups) are at the baseline/enrollment, at four-week post-enrollment, and after 6 months and 1 year. The primary outcome is cumulative one-year PTT incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include the number of trichiatic lashes, location (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from the baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and the occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment.

CONCLUSION

The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe.

CLINICAL TRIAL REGISTRATION

https://www.clinicaltrials.gov/study/NCT04149210.

[Techniques for imaging optic disc vasculature in glaucomatous optic neuropathy: A review of the literature]

The anatomy and vasculature of the optic nerve head are complex and subject to numerous variations. The main risk factor for glaucomatous optic neuropathy is elevated intraocular pressure, but many other factors have been identified. A vascular component seems to play an important role in the pathogenesis and/or progression of glaucomatous optic neuropathy, either under the influence of ocular hypertension or as an independent risk factor, particularly as in normal tension glaucoma (NTG). Reduced ocular blood flow has been identified as a risk factor for glaucoma. Numerous instruments have therefore been developed to explore the vasculature of the optic nerve head and to try to better understand the changes in blood flow in the optic nerve in glaucomatous optic neuropathy. In this review, we provide an update on the various means of imaging the vasculature of the optic nerve head, from angiography to the most modern techniques with angiographic OCT and laser Doppler holography. Using the results found in glaucomatous optic neuropathies, we will explore the close link between reduced ocular blood flow and the development or progression of glaucoma. A better understanding of this pathophysiology opens the door to improved management of our glaucoma patients.

Social Risk Factors Associated With Microbial Keratitis

PURPOSE

The objective of this study was to identify social risk factors (SRFs) that affect microbial keratitis (MK) care using the Penchansky-Thomas (P-T) health care access framework.

METHODS

This combined retrospective and prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed.

RESULTS

A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least 1 SRF affecting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, P = 0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared with those not LTFU, had more SRFs (100% vs. 52.4%, P = 0.0001) and reported a greater median number of SRFs (3.0 vs. 1.0, P < 0.0001).

CONCLUSIONS

SRFs affected most patients with MK, most notably accessibility and affordability. Participants with lower income had more SRFs. SRFs are linked to patients being lost to follow-up care.

Omega-3 Fatty Acids as Protective Factors for Age-related Macular Degeneration: Prospective Cohort and Mendelian Randomization Analyses

PURPOSE

Epidemiological studies and clinical trials have reported inconsistent findings regarding the protective role of omega-3 fatty acids in age-related macular degeneration (AMD), we investigated their association in a prospective cohort and examined causality using Mendelian randomization (MR) analyses.

DESIGN

Prospective cohort study and two-sample MR analyses.

PARTICIPANTS

We included individuals of European descent from UK Biobank with plasma omega-3 and docosahexaenoic acid (DHA) measurement. Our MR analyses used genome-wide association study data on plasma level of omega-3 and DHA (UK Biobank, n=115,006) and AMD (dry, wet, and any) (FinnGen, n=208,690 to 209,122).

METHODS

Cox regression models was used to assess the association between plasma omega-3/DHA levels and AMD incidence, adjusting for systemic covariates and AMD polygenetic risk score (PRS). Interaction effects of AMD genetic risk (PRS, CFH/ARMS2 genotypes) and plasma omega-3/DHA levels were tested. For MR analyses, we used random-effect inverse-variance weighted (RE-IVW) model as primary model and five other models for sensitivity. Causality between omega-3/DHA and AMD was considered significant if P-values were <0.05 in the primary model and at least 2 other models.

MAIN OUTCOME MEASURES

The risk of AMD.

RESULTS

Among 258,350 AMD-free individuals, 5,068 (1.9%) developed AMD over 12.9-year follow-up. Higher plasma levels (in mmol/L) of omega-3 (HR, 0.80; 95%CI, 0.72, 0.95; P=0.006) and DHA (HR, 0.65; 95%CI, 0.44, 0.96; P=0.029) were associated with lower risk of being diagnosed with AMD. MR analyses showed causality between genetic predisposition to higher plasma omega-3 levels and lower risk of dry AMD (OR, 0.83; 95% CI, 0.73, 0.96, P=0.010), wet AMD (OR, 0.76; 95%CI, 0.65,0.88; P<0.001), and any AMD (OR, 0.82; 95%CI, 0.74, 0.92; P<0.001). Likewise, genetic predisposition to higher plasma DHA levels were causally associated with a lower risk of wet AMD (OR, 0.79; 95%CI, 0.65, 0.96; P= 0.017) and any AMD (OR, 0.84; 95%CI, 0.72, 0.98; P=0.030). No significant interaction was found between omega-3/DHA levels and AMD genetic risks (all P>0.05).

CONCLUSIONS

Our prospective cohort and MR analyses both suggested a protective effect of omega-3 and DHA on AMD, supporting the need for further clinical trials to test their effectiveness in AMD prevention and treatment.

Evolution of Workload Associated with Anti-VEGF Treatments for AMD, DME, RVO and mCNV in Hospital District of Southwest Finland

Background

The prevalence of vision-threatening diseases, such as age-related macular degeneration (AMD) and diabetic macular edema (DME), is likely to increase in developed countries owing to an aging population, rising life expectancy, and unfavorable lifestyle changes. Increases in the burden of vision-threatening diseases pose a challenge to the healthcare system. After the emergence of intravitreal anti-VEGF inhibitors, treatment options for neovascular AMD (nAMD), DME, retinal vein occlusion (RVO) and myopic choroidal neovascularization (myopic CNV) have increased. As this change in treatment practices has occurred over the last two decades, it is important to demonstrate changes in patient numbers and administered treatments to provide solutions for handling the workload and productivity in ophthalmology departments. In addition, the registry data landscape has evolved in Finland in recent years. Thus, understanding the possibilities and limitations of ophthalmology registries and patient information systems is required.

Methods

This study involved the secondary use of retrospectively registered data from the data warehouse of the Hospital District of Southwest Finland. Our goal was to explore how the workload of ophthalmology departments caused by intravitreal injections has evolved from 2015 to 2022.

Results

The ophthalmology department workload increased significantly during our observation period as the total number of patients receiving intravitreal treatments for nAMD, DME, RVO, and myopic CNV increased 199.6% from 2015 to 2021. In addition, the total number of administered anti-VEGF injections increased during our observation period, but the increase rate began to subside (2019-2020: increase 23.7%, 2020-2021: increase 10.3%, 2021-2022: increase 6.7%).

Conclusion

Supporting the utilization of registry data is essential in evidence-based discussions evolving workload in healthcare. However, it is important to understand the limitations and the quality of the registries. Our study contributes to better understanding the Finnish registry perspective, and it demonstrates the increase in workload in ophthalmology departments caused by intravitreal injections.

OCTA and Microperimetry Changes Preceding the Appearance of Diabetic Retinopathy in Patients with Type 1 Diabetes

PURPOSE

to evaluate changes in retinal microvasculature and sensitivity (RS) preceding the appearance of diabetic retinopathy (DR) among patients with type 1 diabetes (T1D).

METHODS

in this observational cross-sectional cohort study, vascular parameters measured by OCTA and RS evaluated by microperimetry were assessed in patients with T1D without DR (no-DR), T1D with mild DR (m-DR), and healthy controls.

RESULTS

Sixty-two eyes of 31 patients with T1D and 40 eyes of 20 healthy patients were included. OCTA examinations did not yield any significant differences in terms of perfusion density (PD), vascular density (VD), foveal avascular zone (FAZ) area, FAZ perimeter or FAZ circularity between patients with diabetes (no-DR vs. m-DR). However, comparisons between healthy controls and patients with diabetes (both no-DR and m-DR groups) revealed statistically significant differences in PD, VD, and FAZ area. Similarly, no significant differences were observed between no-DR and m-DR groups regarding RS, gaze fixation stability (GFS), or macular integrity (MI). Nevertheless, mean RS and MI were significantly impaired in patients with T1D, both in no-DR and m-DR groups, compared to healthy controls. A statistically significant positive correlation was observed between RS and PD and between FAZ area and RS.

CONCLUSION

although no differences were found between patients with diabetes without DR and those with mild DR, these patients already demonstrated some degree of retinal impairment, both structural and functional, when compared to healthy controls. Our data support the hypothesis that neurodegeneration occurs together with microvascular damage at early stages of diabetes.

Meta-Analysis of Materials and Treatments Used in Ophthalmic Lenses: Implications for Lens Characteristics

PURPOSE

This meta-analysis evaluates the evolution, applications, and recent advancements in the materials and treatments used in ophthalmic lenses, focusing on their effectiveness, comfort, and safety, while also considering sustainability as a key factor.

METHODS

The study was registered with PROSPERO and conducted following the PRISMA and AMSTAR-2 guidelines. A systematic review was performed across databases such as PubMed, Web of Science, and Scopus, without time or language restrictions. Observational studies analyzing optical materials and ophthalmic lens treatments were included, and a random-effects model was applied due to the high heterogeneity observed among the studies.

RESULTS

Nine studies were included that evaluated different materials, such as CR-39®, PMMA with nanoparticles, and high-refractive-index polymers, with variability in refractive index (1.49 to 1.90) and light transmission (84.15% to 99%). Treatments like anti-reflective and abrasion-resistant coatings improved optical quality and durability. However, significant heterogeneity and publication bias were identified, limiting the generalizability of the results.

CONCLUSIONS

The materials and treatments evaluated play a crucial role in the optical quality, durability, and comfort of lenses. Although advancements in sustainable materials show promise for reducing environmental impact, challenges remain in terms of cost and production. It is recommended to establish more stringent standards and promote research to improve the consistency and performance of ophthalmic lenses while ensuring sustainability.

Associations Between Life's Essential 8 and Major Ocular Diseases in the American Middle-Aged and Elderly Population

PURPOSE

To explore the correlation between cardiovascular health (CVH) and ocular diseases, given their shared risk factors and biological mechanisms, this study utilizes the newly updated Life's Essential 8 (LE8) algorithm.

DESIGN

A cross-sectional study.

METHODS

This analysis, conducted from February 15 to April 1, 2024, in Changchun, includes data from 4146 participants aged 40 and above, drawn from the National Health and Nutrition Examination Survey database (2005-2008). It covers information on visual health status, dietary habits through interviews, and professional ophthalmological examinations. Participants' CVH status was assessed using the LE8 algorithm, and relationships with major ocular diseases such as retinopathy, cataracts, diabetic retinopathy, glaucoma, and age-related macular degeneration were explored through weighted logistic regression analysis, restricted cubic splines, stratified analysis, and sensitivity analysis.

RESULTS

After multivariable adjustment, lower LE8 scores showed a significant positive relationship with any ocular disease (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.39-2.96, P = .001), any objectively determined ocular disease (OR: 2.24, 95% CI: 1.48-3.38, P < .001), retinopathy (OR: 2.88, 95% CI: 1.89-4.41, P < .001), diabetic retinopathy (OR: 10.23, 95% CI: 3.11-33.61, P < .001), and glaucoma (OR: 2.76, 95% CI: 1.47-5.21, P = .003), with all trends significant (all P < .01). Additionally, lower scores in the behavioral subdomain were significantly correlated with an elevated risk of cataracts (OR: 1.45, 95% CI: 1.03-2.04). Subgroup analyses revealed more pronounced negative correlations between LE8 and retinopathy among females and those suffering from chronic kidney disease.

CONCLUSIONS

A low CVH score was linked to an increased likelihood of ocular diseases in a US-populated-based study. This correlation supports the potential benefits of enhancing cardiovascular wellness to mitigate the development of ocular conditions.

Artificial intelligence in corneal diseases: A narrative review

Corneal diseases represent a growing public health burden, especially in resource-limited settings lacking access to specialized eye care. Artificial intelligence (AI) offers promising solutions for automating the diagnosis and management of corneal conditions. This narrative review examines the application of AI in corneal diseases, focusing on keratoconus, infectious keratitis, pterygium, dry eye disease, Fuchs endothelial corneal dystrophy, and corneal transplantation. AI models integrating diverse imaging modalities (e.g., corneal topography, slit-lamp, and anterior segment OCT images) and clinical data have demonstrated high diagnostic accuracy, often outperforming human experts. Emerging trends include the incorporation of biomechanical data to enhance keratoconus detection, leveraging in vivo confocal microscopy for diagnosing infectious keratitis, and employing multimodal approaches for comprehensive disease analysis. Additionally, AI has shown potential in predicting disease progression, treatment outcomes, and postoperative complications in corneal transplantation. While challenges remain such as population heterogeneity, limited external validation, and the "black box" nature of some models, ongoing advancement in explainable AI, data augmentation, and improved regulatory frameworks can serve to address these limitations.

Results of Lucia Keratoprosthesis Implantation in Severe Corneal Disease

PURPOSE

Describe complications, functional success, and retention of the Lucia Keratoprosthesis (KPro).

DESIGN

Retrospective interventional case series METHODS: The demographic data, baseline characteristics, complications, functional success, and retention were analyzed for Lucia KPro at the Instituto de Oftalmologia Conde de Valenciana in Mexico City from 2021 to 2023. Multivariate regression analysis and Kaplan-Meier plots were performed to identify associations with functional failure. The main outcome measures were postoperative complications, functional success defined as best-corrected visual acuity (BCVA) ≥20/200 (logMAR 1.0), and device retention rate.

RESULTS

Forty-eight eyes of 48 patients (56.88% male) were studied. The mean age at implantation was 57.29 ± 15.63 years (range 27-91), with a mean follow-up of 20.5 ± 8.83 months (range 3-40). Diagnostic indications for implantation included recurrent graft rejection (54.17%), autoimmune disease (20.83%), chemical injury (12.5%), and other (12.5%). At least 1 postoperative complication occurred in 75% of patients, leading to 65 additional interventions (mean number of subsequent procedures: 1.35 ± 1.3, range 0-5). The preoperative BCVA was 2.40 ± 0.36 logMAR. At the final follow-up, 62.5% had achieved functional success and 22.92% had a BCVA of 20/40 (logMAR 0.3) or better. Glaucoma (adjusted OR 469.74, 95% CI 5.02-43939.14, P = .007) and retinal pathology before KPro (adjusted OR 372.38, 95% CI 4.18-33162.11, P = .009) were associated with functional failure. The device remained in place in 95.83% of recipients over the follow-up period.

CONCLUSIONS

The Lucia KPro offers functional success in severe corneal diseases and excellent retention in the short to intermediate term.

Gelatin nanofibers coated with hyaluronic acid as a mesenchymal stromal cell scaffold for corneal regeneration

Electrospun gelatin nanofibers coated with hyaluronic acid (GelNF-HA) were synthesized as a scaffold for delivering human corneal mesenchymal stromal cells (C-MSCs) directly to deep corneal injuries. Aligned GelNFs were produced by electrospinning, crosslinked using vapor of glutaraldehyde, coated with HA, and crosslinked with EDC/NHS. The GelNF-HA was characterized by SEM, mechanical, and optical properties. It was then investigated as a substrate for C-MSC proliferation and migration in vitro and in a rabbit cornea culture model. The expression of α-smooth muscle actin (α-SMA) was determined in the ex vivo model. SEM showed that the GelNF-HA scaffold was composed of aligned GelNFs with 75 % of the fibers oriented against the same angle. It exhibited a Young's modulus of 1.66 ± 0.59 MPa and approximately 93 % transmittance of visible light. The GelNF-HA membranes supported C-MSC proliferation in vitro. In a scratch migration assay, it facilitated complete wound closure after 48 h in culture. C-MSC-laden GelNF-HA scaffolds supported corneal wound healing in an ex vivo model as well, expressing a lower percentage of stromal α-SMA compared to both the no-treatment keratectomy-only and C-MSC groups (p < 0.05). The C-MSC-supportive GelNF-HA scaffolds hold therapeutic potential for stromal regeneration in the treatment of deep corneal defects.

Interventional Glaucoma: Improving the Patient-Provider Educational Exchange

Glaucoma treatment is beginning to undergo an evolution, moving away from topical medication-based therapies toward more proactive minimally invasive interventions. This shift towards an "interventional glaucoma" treatment paradigm has been shown to benefit patients, providers, and society. A key component of effectively implementing this approach is education about the importance of glaucoma diagnosis and treatment, as well as the various treatment modalities available. Such education is relevant not only for patient but also patients' support networks, ophthalmologists, optometrists, third-party payers, and policy-makers. Education can occur both within and outside the clinical setting. The present article provides an overview of the diverse educational methods available for glaucoma patients, including those based on patient-provider interactions and those based on internet and printed material. Examples of the former could include general and specific verbal instruction, motivational interviewing, or community-based educational workshops, while examples of the latter could include office-based movies or printed materials, virtual reality headset educational videos, artificial intelligence-assisted education, or self-directed internet videos and articles. By empowering patients with knowledge and an up-to-date awareness of treatment options, effective education can be a valuable part of making an interventional glaucoma treatment paradigm possible.

Refractive Outcomes After Cataract Surgery-The Impact of Preoperative Visual Acuity, the Intraocular Lens Model, and the Surgeon's Experience: An Empirical Analysis of Hungarian and Kosovan Patients

Background/Objectives: Phacoemulsification and intraocular lens (IOL) implantation comprise a standard procedure for cataract treatment. However, minimal refractive error remains a determinant of postoperative results. Our study aimed to evaluate the refractive outcomes and the impact of the surgeon's experience and the IOL model on Kosovan and Hungarian patients after cataract surgery. Methods: This study included the preoperative and postoperative data of 1417 patients scheduled to undergo cataract surgery with IOL implantation at two centers: the Ophthalmology Department of Semmelweis University, Budapest, Hungary, and the Ophthalmology Department of the University Clinical Center of Kosovo, Prishtina, Kosovo. STATA and SPSS were used for statistical analysis. Results: The data of 1001 Hungarian and 416 Kosovan patients were included in this study. There was a statistically significant difference between the groups in the 1-month postoperative best-corrected distance visual acuity (BCDVA) (p = 0.001); in the Hungarian patients, the 1-month BCDVA was 85.2%, while in the Kosovan patients, it was 49.6%. Of the 14 different IOLs implanted in the Hungarian patients, the AcrySof IQ toric SN6AT, FineVision HP (POD F GF), and 677MTY IOLs resulted in a statistically significant positive impact on the 1-month postoperative visual acuity (p < 0.05). The AcrySof SA60AT and Akreos ADAPT AO, implanted in the Kosovan patients, had a statistically significant positive impact on the 1-month postoperative visual acuity (p < 0.05). More extensive surgeon experience had a statistically significant positive impact on postoperative outcomes (p < 0.00). Conclusions: Multifocal and toric IOLs showed superiority in terms of postoperative outcomes in our study; therefore, we conclude that greater surgeon experience, the availability of premium IOLs, and appropriate IOL selection have a considerable impact on refractive outcomes after cataract surgery.

Subretinal microglia support donor photoreceptor survival in rd1 mice

PURPOSE

To investigate the potential relationship between subretinal microglia and transplanted donor photoreceptors.

METHODS

Photoreceptor precursors were transplanted into wild-type mice and rd1 mice by trans-scleral injection. Immunohistochemistry was employed to detect microglia and macrophages. PlX5622 feed was used to achieve microglia depletion and microglia repopulation. RNA-seq and qPCR were utilized to evaluate gene expression. Confocal microscopy was used to observe the interaction between microglia and donor photoreceptors.

RESULTS

Donor photoreceptors survived in rd1 mice but not in wild-type mice after trans-scleral injection. The microglial cells closely interacted with donor cells. While donor cells failed to survive in rd1 mice after microglia depletion, they could survive following microglia repopulation. The RNA-seq analysis showed a pro-neurodevelopmental effect of sub-retinal microglia/RPE tissue in rd1 mice.

CONCLUSIONS

Subretinal microglia supported donor photoreceptor survival in rd1 mice.

Predictive role of the peripheral blood inflammation indices neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) for age-related cataract risk

The novel inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) have not yet been used in the study of age-related cataracts. The aim of this study was to investigate the possible relationships between the NLR, PLR, and SII and age-related cataracts. In the 2005-2008 National Health and Nutrition Examination Survey (NHANES) cross-sectional surveys, we collected complete information on blood counts, whether cataract surgery had been performed, and baseline information for adults. We investigated the independent interactions between the inflammatory markers NLR, PLR, and SII and age-related cataracts via weighted multivariate regression analyses and subgroup analyses. Smoothed curve fitting was performed to identify nonlinear associations and saturation effects between inflammation indices and cataract risk. Finally, receiver operating characteristic (ROC) curves were plotted for factors significantly associated with the development of cataracts to identify the optimal diagnostic inflammation index. This study included 8887 participants without cataracts and 935 participants with cataracts. Multivariate logistic regression analyses after adjusting for covariates revealed that a high SII (OR = 1.000, 95% CI = 1.000-1.000; P = 0.017) and high NLR (OR = 1.065, 95% CI = 1.000-1.134; P = 0.048) were independent risk factors for cataracts. Subgroup analyses did not reveal interactions between the SII, NLR, or cataract and covariates. Smoothed curve fits of the relationships between the SII or NLR and cataracts did not show positive significant saturating effect values for any of the variables. The ROC curve revealed some diagnostic value for cataracts for both the SII (AUC = 0.549, P < 0.001) and the NLR (AUC = 0.603, P < 0.001), but both had weak diagnostic value. Our study suggests that the SII and NLR are independent risk factors for cataracts in U.S. adults, but no such associations was identified between the PLR and cataracts.

Cellular component transfer between photoreceptor cells of the retina

Photoreceptor transplantation is a potential therapeutic strategy for degenerative retinal diseases. Studies on mechanisms contributing to retinal regeneration and vision repair identified cellular components transfer (CCT) as playing a role, in addition to somatic augmentation (referred to as "cell replacement" in this paper). In CCT, donor photoreceptors shuttle proteins, RNA, and mitochondria to host photoreceptors through intercellular connections. The discovery of CCT in the transplantation context triggered a re-interpretation of prior transplantation studies that generally did not include specific CCT assays and thereby broadly emphasized the cell replacement model, reflecting the prevailing understanding of retinal transplantation biology at that time. In addition to clarifying our understanding of photoreceptor biology, CCT has raised the possibility of developing treatments to replenish molecular deficiencies in diseased photoreceptor cells. As the CCT field evolves, investigators have used diverse terminology, and implemented different CCT assays following transplantation in animal models. The non-standardized terminology of CCT and absent minimal assay standards for detection can hinder communication between investigators and comparison between studies. In this review, we discuss the current understanding of CCT, provide an overview of transplantation and regeneration studies in small and large animals, and propose terminology and a minimal assay standard for CCT. Further research on CCT may eventually provide new avenues to treat a range of hereditary and acquired retinopathies while illuminating mechanisms of cell-cell interaction in the retina.

Comparison of clinical outcomes, complications and patient satisfaction following deep anterior lamellar keratoplasty and penetrating keratoplasty

BACKGROUND

Keratoplasty is a surgical procedure in which a damaged or diseased cornea is replaced with healthy donor tissue, thereby restoring vision. Recent advancements have led to the replacement of penetrating keratoplasty (PKP) with the more selective deep anterior lamellar keratoplasty (DALK) procedure, especially for treating keratoconus. Although DALK typically has a shorter recovery time, less pain and a lower risk of rejection, PKP is still being performed for more severe corneal diseases. A comparative study of clinical profiles, treatment outcomes and patient-reported satisfaction will provide valuable insights into the cost-effectiveness, impact on quality of life and ability of each procedure to treat different pathologies of the cornea. Here, we aimed to compare the clinical and subjective outcomes of DALK with those of the PKP at a single center in the Kingdom of Saudi Arabia.

METHODS

This retrospective cohort study included eyes that underwent either PKP or DALK from January 2017 to January 2021. The demographic features, indications, best corrected visual acuity (BCVA) and complications of the patients were recorded for both groups, analyzed and compared. A subgroup of eyes with keratoconus was analyzed separately and compared to the larger group. A 6-item survey was conducted via telephone to assess patient satisfaction and expectation, and the results were compared between the two procedures. The chi-square test or Fisher's exact test for categorical variables or the t test or Kruskal‒Wallis test for continuous variables were used as appropriate for all comparisons, and the level of significance was set at α = 0.05.

RESULTS

A total of 97 patients were included. PKP and DALK were performed on 63 and 39 eyes, respectively. Patients who underwent DALK were younger (mean ± standard deviation 31 ± 10.82 years versus 43 ± 26.89 years for patients who underwent PKP). The most frequent indication for PKP was keratoconus (35.5%); however, in 97.4% of the eyes undergoing DALK, the indication was keratoconus. In both groups, visual acuity and refractive error improved, but the postoperative corrected distance visual acuity in the DALK group (0.3 log MAR) was noticeably greater than that in the PKP group (0.6 log MAR). Compared with PKP, DALK may carry a lower risk of early graft edema and rejection. Overall, the reported postoperative patient satisfaction was similar for both procedures.

CONCLUSION

The findings highlight the effectiveness of PKP and DALK in improving visual acuity and emphasize the importance of considering patient-reported outcomes in evaluating success. DALK has been demonstrated to be beneficial for protecting the corneal endothelium and lowering the risk of complications and graft rejection.

The association between age-related macular degeneration and risk of Parkinson disease: A systematic review and meta-analysis

BACKGROUND

Numerous cohort studies have explored the association between age-related macular degeneration (AMD) and Parkinson disease (PD). However, a comprehensive meta-analysis on this topic is currently lacking. This study aims to address this gap by conducting a meta-analysis of existing cohort studies to investigate the relationship between AMD and the risk of developing PD.

METHODS

Relevant studies were systematically identified through thorough searches of the PubMed, Web of Science, Embase, and Cochrane Library databases. Two investigators independently conducted data extraction. Cohort studies meeting the eligibility criteria and providing risk and precision estimates regarding AMD and the risk of PD were included. Pooled hazard ratio (HR) accompanied by 95% confidence interval (CI) were calculated using either a random-effects model or a fixed-effects model. Sensitivity analyses, involving the exclusion of 1 study at a time, were performed to assess the robustness of the findings. Publication bias was evaluated using Egger test.

RESULTS

Five studies were included, encompassing a total of 4,771,416 individuals. Among these, 128,771 individuals had AMD, while 4,642,645 individuals did not. The pooled analysis revealed a significant increase in the risk of developing PD for individuals with age-related macular degeneration (hazard ratio [HR] = 1.44; 95% confidence interval [CI]: 1.22-1.71; I2 = 47.3%). Sensitivity analysis confirmed the robustness of the results. For the exploration of the relationship between nAMD and the risk of developing PD, 2 cohorts were included. The pooled analysis demonstrated a significantly elevated risk of PD for individuals with nAMD (HR = 2.21; 95% CI: 1.55-3.16; I2 = 0%).

CONCLUSION

This meta-analysis suggests a significant association between AMD and an increased risk of PD. These findings offer fresh perspectives on PD's etiology and pathogenesis, but should be interpreted with caution given the limitations in establishing causality.

Prevalence and its associated factors of diabetic retinopathy among type 1 and type 2 diabetic patients at public hospitals in Eastern Ethiopia, 2023: a hospital-based comparative cross-sectional study

Introduction

Diabetic retinopathy (DR) is a highly prevalent microvascular disease among diabetic patients, resulting in irreversible blindness. However, there is a dearth of evidence on diabetic retinopathy (DR) and its associated factors in eastern Ethiopia. The study aimed to determine the prevalence of diabetic retinopathy (DR) and its associated factors among type 1 and type 2 diabetic patients at public hospitals in eastern Ethiopia.

Method

A hospital-based comparative cross-sectional was conducted among 520 diabetic patients. Epidata software was used for data entry, and STATA version 17 was used for statistical analysis. Multivariate binary logistic regression was computed to identify factors associated with DR. The Hosmer and Lemeshow chi-square test assessed goodness of fit.

Results

The overall prevalence of DR was 43.5%. The prevalence of diabetic retinopathy among type 1 DM was 38.5%, and the prevalence of DR among type 2 DM was 48.5%. Age >60 [AOR = 4.64 95% CI (1.60, 13.51)], being male [AOR = 4.05 95% CI (1.51, 10.97)], and having complications [AOR = 0.01 95% CI (0.003, 0.04)] were significantly associated with DR among type 1 diabetes. Having a family history of DM [AOR = 1.57 95% CI (1.76, 3.24)], poor glycemic status [AOR = 1.91 95% CI (1.56, 2.83)], and having complications [AOR = 11.07 95% CI (4.89, 25.13)] were significantly associated with DR among type 2 diabetes.

Conclusions

In the current study, the prevalence of DR was 43.5%. The prevalence was higher among type 2 diabetes compared to type 1 diabetes. Factors such as poor glycemic control, older age, male sex, a family history of diabetes, and complications related to diabetes were significantly associated with DR. To minimize the impact of diabetics, it requires regular screening programs for diabetic patients, especially those with poor glycemic control and other identified risk factors.

Advanced bioengineering strategies broaden the therapeutic landscape for corneal failure

The cornea acts as the eye foremost protective layer and is essential for its focusing power. Corneal blindness may arise from physical trauma or conditions like dystrophies, keratitis, keratoconus, or ulceration. While conventional treatments involve medical therapies and donor allografts-sometimes supplemented with keratoprostheses-these options are not suitable for all corneal defects. Consequently, the development of bioartificial corneal tissue has emerged as a critical research area, aiming to address the global shortage of human cornea donors. Bioengineered corneas hold considerable promise as substitutes, with the potential to replace either specific layers or the entire thickness of damaged corneas. This review first delves into the structural anatomy of the human cornea, identifying key attributes necessary for successful corneal tissue bioengineering. It then examines various corneal pathologies, current treatments, and their limitations. Finally, the review outlines the primary approaches in corneal tissue engineering, exploring cell-free, cell-based, and scaffold-based options as three emerging strategies to address corneal failure.

Global incidence and risk factors for glaucoma: A systematic review and meta-analysis of prospective studies

Background

This study aims to estimate global incidence and assess risk factors for glaucoma subtypes.

Methods

The literature search was performed in three English (PubMed, Embase, MEDLINE) and three Chinese (China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database) databases to identify prospective studies on glaucoma incidence between 1 January 1990 and 29 November 2022. We used a multilevel mixed-effects meta-regression to estimate the age- and sex-specific incidence rate of primary open-angle glaucoma (POAG). The global and regional incidence rate of POAG in 2022 were respectively estimated. The annual cumulative incidence (ACI) of POAG and primary angle-closure glaucoma (PACG), and risk factors for POAG were pooled using a random-effects meta-analysis, respectively. The heterogeneity of the included articles was tested using the Q statistic and measured by I2 index. Publication bias was detected by funnel plots, Egger's regression test, and Begg's rank correlation test.

Results

A total of 9050 articles were identified in literature search, and 50 articles provided incidence data of glaucoma subtypes. In 2022, the global incidence rate of POAG was 23.46 (95% confidence interval (CI) = 15.68-32.91) per 10 000 person-years among 40-79 years. An increase from 5.51 (95% CI = 1.63-11.12) per 10 000 person-years in 40-44 years to 64.36 (95% CI = 49.82-80.70) per 10 000 person-years in 75-79 years was noted between the year 1990 and 2019. Across sociodemographic index (SDI) and World Health Organization (WHO) regions, the incidence rate was the highest in low SDI region and Africa, respectively. The pooled ACI of POAG was 0.21% (95% CI = 0.13%-0.30%). Six risk factors for POAG were identified, including intraocular pressure (IOP) treatment (meta-odds ratio (OR) = 3.69; 95% CI = 2.64-5.15), a family history of glaucoma (meta-OR = 2.49; 95% CI = 1.92-3.24), myopia (meta-OR = 2.08; 95% CI = 1.59-2.70), elevated IOP (meta-OR = 1.13; 95% CI = 1.11-1.15), advanced age (meta-OR = 1.07; 95% CI = 1.05-1.08), male (female: meta-OR = 0.76; 95% CI = 0.66-0.88). The pooled ACI of PACG was 0.05% (95% CI = 0.00%-0.16%).

Conclusions

Significant disparities existed in incidence rates for glaucoma across geographic regions and age groups. Further research is needed to understand which risk factors drive glaucoma incidence in different socioeconomic strata for tailored health policy on preventing glaucoma.

Registration

This study is registered with PROSPERO (number CRD42023434203).

The Development and Validation of a Glaucoma Health Score for Glaucoma Screening Based on Clinical Parameters and Optical Coherence Tomography Metrics

Background/Objectives: This study aims to develop and validate a Glaucoma Health Score (GHS) that incorporates multiple individual glaucoma risk factors to enhance glaucoma detection in screening environments. Methods: The GHS was developed using a retrospective dataset from two clinical sites, including both eyes of glaucoma patients and controls. The model incorporated age, central corneal thickness, intraocular pressure, pattern standard deviation from a visual field threshold 24-2 test, and two parameters from an optical coherence tomography (OCT) test: the average circumpapillary retinal nerve fiber layer thickness and the minimum thickness of the six sectors of the macular ganglion cell plus the inner plexiform layer. The GHS was then validated in two independent datasets: one from primary care sites using Maestro OCT data (test dataset 1) and another from an academic center using DRI OCT Triton (test dataset 2). Results: Both eyes of 51 glaucoma patients and 67 controls were included in the development dataset. Setting the GHS cutoff at 75 points out of 100, test dataset 1, which comprised 41 subjects with glaucoma and 41 healthy controls, achieved an area under the receiver operating characteristic curve (AUROC) of 0.98, with a sensitivity of 71% and specificity of 98%; test dataset 2, which included 53 patients with glaucoma and 53 healthy controls, resulted in an AUROC of 0.95, with a sensitivity of 75% and specificity of 96%. A decision curve analysis across all datasets demonstrated a higher net benefit for the GHS model compared to individual OCT parameters. Conclusions: The GHS offers a feasible, standardized approach for early detection of glaucoma, providing strong specificity and acceptable sensitivity, with clear decision-making benefits in screening settings.

A chimeric anti-vascularization immunomodulator prevents high-risk corneal transplantation rejection via ex vivo gene therapy

Corneal blindness affects more than 5 million individuals, with over 180,000 corneal transplantations (CTs) performed annually. In high-risk CTs, almost all grafts are rejected within 10 years. Here, we investigated adeno-associated virus (AAV) ex vivo gene therapy to establish immune tolerance in the corneal allograft to prevent high-risk CT rejection. Our previous work has demonstrated that HLA-G contributes to ocular immune privilege by inhibiting both immune cells and neovascularization; however, homodimerization is a rate-limiting step for optimal HLA-G function. Therefore, a chimeric protein called single-chain immunomodulator (scIM), was engineered to mimic the native activity of the secreted HLA-G dimer complex and eliminate the need for homodimerization. In a murine corneal burn model, AAV8-scIM significantly reduced corneal vascularization and fibrosis. Next, ex vivo AAV8-scIM gene delivery to corneal allografts was evaluated in a high-risk CT rejection rabbit model. All scIM-treated corneas were well tolerated and transparent after 42 days, while 83% of vehicle-treated corneas were rejected. Histologically, AAV-scIM-treated corneas were devoid of immune cell infiltration and vascularization, with minimal fibrosis at the host-graft interface. The data collectively demonstrate that scIM gene therapy prevents corneal neovascularization, reduces trauma-induced corneal fibrosis, and prevents allogeneic CT rejection in a high-risk large animal model.

Ocular Pharmacokinetics of Faricimab Following Intravitreal Administration in Patients With Retinal Disease

Purpose

To characterize faricimab ocular and systemic pharmacokinetics (PK) in patients with neovascular age-related macular degeneration (nAMD) or diabetic macular edema (DME) and to assess the effect of faricimab ocular exposure on clinical endpoints.

Methods

A population PK (popPK) model was developed using pooled data from phase 1 to 3 studies in patients with nAMD/DME. The dataset included 1095 faricimab aqueous humor (AH) concentrations from 284 patients and 8372 faricimab plasma concentrations from 2246 patients.

Results

Following intravitreal administration, faricimab PK was accurately described by a linear three-compartment model with sequential vitreous humor (VH), AH, and plasma compartments. Faricimab VH elimination to AH is the slowest process, with an estimated half-life (t1/2) of 7.5 days. Due to flip-flop kinetics, plasma, AH, and VH concentrations declined in parallel. Disease had no effect on faricimab PK. Plasma exposure was ∼6000-fold lower than VH exposure. Age, anti-drug antibodies, body weight, and sex statistically significantly influenced PK parameters but had no clinically meaningful effect on ocular and systemic exposure. VH t1/2 alone could not explain faricimab dosing frequency. Exposure-response analyses showed similar gains in best-corrected visual acuity across faricimab exposure ranges and dosing regimens.

Conclusions

Faricimab ocular and systemic pharmacokinetics were quantified and accurately described by the popPK model, developed using a large dataset from patients with nAMD/DME. Exposure-response analyses suggest that faricimab phase 3 dosing algorithms are appropriate to select the most suitable dosing regimen.

Translational Relevance

The popPK analysis suggested that faricimab dosing frequency was influenced by several factors and not by VH t1/2 alone.

Automated Detection of Drusenoid Pigment Epithelial Detachments From Spectral-Domain Optical Coherence Tomography in Patients With AMD

Purpose

This study aimed to develop an algorithm for automated detection of drusenoid pigment epithelial detachments (DPEDs) in optical coherence tomography (OCT) volumes of patients with age-related macular degeneration (AMD) and to compare its performance against traditional reading center grading on color-fundus photographs (CFPs).

Methods

Eyes with a range of AMD severities, excluding neovascular disease, were imaged using spectral-domain OCT (SD-OCT) and paired CFPs and were followed annually for up to 5 years. DPEDs were automatically identified by segmenting the retinal pigment epithelium (RPE) and Bruch's membrane (BM) layers from the SD-OCT volumes and imposing both a minimum RPE BM height (>75 µm) and a two-dimensional length requirement (>433 µm). Comparisons in detection rates and contoured areas were made between the algorithmic SD-OCT detections and manually graded and contoured CFPs.

Results

Of the 1602 visits for the 323 eyes, the automated OCT algorithm identified 139 visits (8.7%) from 50 eyes with DPED, but a reading center review of paired CFPs identified 23 visits (1.4%) from nine eyes as having DPEDs. Eyes identified with DPEDs on OCT received nine-step AMD severity scores ranging from 6 to 10, and those scores had occurrence ratios of 23/160 (14%), 89/226 (39%), 24/99 (24%), 2/63 (3%), and 1/29 (3%), respectively. On a subset of 25 visits that also underwent manual contouring of DPED lesions in CFP, the Pearson correlation coefficient for DPED areas observed by OCT and CFP was 0.85.

Conclusions

Our analysis shows the feasibility of using OCT scans to objectively detect features that historically have been detected qualitatively by expert graders on CFPs.

Translational Relevance

Automated detection and quantitation of high-risk features can facilitate screening patients for clinical-trial enrollment and could serve as an outcome metric [T1 (Translation-to-Humans) and T4 (Translation-to-Population-Health)].

Optical coherence tomography angiography of the retina and choroid in systemic diseases

Optical coherence tomography angiography (OCTA) has transformed ocular vascular imaging, revealing microvascular changes linked to various systemic diseases. This review explores its applications in diabetes, hypertension, cardiovascular diseases, and neurodegenerative diseases. While OCTA provides a valuable window into the body's microvasculature, interpreting the findings can be complex. Additionally, challenges exist due to the relative non-specificity of its findings where changes observed in OCTA might not be unique to a specific disease, variations between OCTA machines, the lack of a standardized normative database for comparison, and potential image artifacts. Despite these limitations, OCTA holds immense potential for the future. The review highlights promising advancements like quantitative analysis of OCTA images, integration of artificial intelligence for faster and more accurate interpretation, and multi-modal imaging combining OCTA with other techniques for a more comprehensive characterization of the ocular vasculature. Furthermore, OCTA's potential future role in personalized medicine, enabling tailored treatment plans based on individual OCTA findings, community screening programs for early disease detection, and longitudinal studies tracking disease progression over time is also discussed. In conclusion, OCTA presents a significant opportunity to improve our understanding and management of systemic diseases. Addressing current limitations and pursuing these exciting future directions can solidify OCTA as an indispensable tool for diagnosis, monitoring disease progression, and potentially guiding treatment decisions across various systemic health conditions.

Long-term efficacy and safety of brolucizumab in neovascular age-related macular degeneration: A multicentre retrospective real-world study

PURPOSE

To investigate the long-term efficacy and safety of intravitreal brolucizumab (BRZ) injections in patients with typical neovascular age-related macular degeneration (typical nAMD) and polypoidal choroidal vasculopathy (PCV).

METHODS

This multicentre retrospective study included 401 eyes of 398 patients with nAMD who received BRZ injection(s), with a follow-up duration of ≥12 months. Changes in best-corrected visual acuity (BCVA), retinal fluid evaluation and central subfield thickness (CST) on optical coherence tomography were assessed. The efficacy of BRZ was compared between typical nAMD and PCV groups.

RESULTS

Analyses were conducted with 280 eyes of 278 patients with typical nAMD and 121 eyes of 120 patients with PCV (mean age, 71.1 ± 8.6 years). 29 eyes (7.2%) were treatment naïve. The mean follow-up period was 15.3 ± 2.8 months; the mean number of BRZ injections within 1 year was 4.5 ± 1.7. BCVA was maintained during the follow-up period, and CST significantly improved from the first injection month and was maintained for 12 months in both the typical nAMD and PCV groups. The dry macula proportion increased from 2.7% at baseline to 56.1% at 1 month and 42.9% at 12 months. Among the 18 eyes that underwent indocyanine green angiography both before and after treatment, 10 (55.6%) showed polyp regression. Overall, the incidence of intraocular inflammation (IOI), retinal vasculitis and occlusive retinal vasculitis was 9.4% (38 eyes), 1.2% (5 eyes) and 0.5% (2 eyes), respectively. IOI occurred from the first to the sixth injections, with an average IOI onset of 28.5 ± 1.4 days. All eyes achieved IOI resolution, although the two eyes with occlusive retinal vasculitis showed a severe visual decline after IOI resolution.

CONCLUSION

Brolucizumab was effective in maintaining BCVA and managing fluid in eyes with nAMD for up to 1 year, exhibiting a high polyp regression rate. However, the not uncommon incidence of IOI and the severe visual decline caused by the rare occlusive retinal vasculitis following BRZ treatment underscore the importance of careful monitoring and timely management.

The role of nicotinamide riboside in the preservation of retinal ganglion cells using an in vitro glutamate-induced excitotoxicity model

Delaying or preventing the loss of retinal ganglion cells (RGCs) in glaucoma is needed for vision preservation. Glutamate-mediated neurotoxicity arises from the excessive stimulation of N-methyl-D-aspartate membrane receptors by glutamate. This overstimulation, occurring specifically in RGCs, triggers a progressive deterioration of the optic nerve that ultimately leads to the vision loss in glaucoma. Our previous investigation demonstrated that nicotinamide riboside (NR) effectively preserved RGCs in multiple mouse models of glaucoma. To investigate the precise role of NR concerning RGCs which remains uncertain, a glutamate-induced excitotoxicity RGCs damage model was established using R28 cells in this study. Results showed that NR treatment could not only prevent the decrease in cell viability but also effectively inhibit the apoptosis of R28 cells induced by glutamate, as proven by flow cytometry and expression of key pro-apoptotic proteins. Additionally, it significantly attenuated oxidative stress induced by glutamate, as evaluated by the production of inflammatory factors, reactive oxygen species (ROS) and mitochondrial ROS (mtROS). Furthermore, NR elevated the intracellular nicotinamide adenine dinucleotide (NAD+) levels in R28 cells. Lastly, we used RNA-seq to reveal the underlying mechanism of NR protection. Combining the results of RNA-seq and Western blot, we found that NR also restored the decreased protein expression of sirtuin 1 (SIRT1) and peroxisome proliferator-activated receptor-gamma coactivator (PGC1α) induced by glutamate. These findings strongly indicated that NR exhibits a protective effect against R28 cell apoptosis in a glutamate-induced excitotoxicity RGCs damage model. This protective effect is likely mediated through the activation of the SIRT1/PGC1α pathway, achieved by increasing intracellular NAD + levels.

Thyroid Function, Diabetes, and Common Age-Related Eye Diseases: A Mendelian Randomization Study

Background: Previous Mendelian randomization (MR) studies showed an association between hypothyroidism and cataract and between high-normal free thyroxine (FT4) and late age-related macular degeneration (AMD), but not between FT4, thyroid stimulating hormone (TSH), or hyperthyroidism and diabetic retinopathy or cataract. These studies included a limited number of genetic variants for thyroid function and did not investigate autoimmune thyroid disease (AITD) or glaucoma, include bidirectional and multivariable MR (MVMR), and examine sex differences or potential mediation effects of diabetes. We aimed to address this knowledge gap. Methods: We examined the causality and directionality of the associations of AITD, and FT4 and TSH within the reference range with common age-related eye diseases (diabetic retinopathy, cataract, early and late AMD, and primary open-angle glaucoma). We conducted a bidirectional two-sample MR study utilizing publicly available genome-wide association study (GWAS) summary statistics from international consortia (ThyroidOmics, International AMD Genetics Consortium, deCODE, UK Biobank, FinnGen, and DIAGRAM). Bidirectional MR tested directionality, whereas MVMR estimated independent causal effects. Furthermore, we investigated type 1 diabetes (T1D) and type 2 diabetes (T2D) as potential mediators. Results: Genetic predisposition to AITD was associated with increased risk of diabetic retinopathy (p = 3 × 10-4), cataract (p = 3 × 10-3), and T1D (p = 1 × 10-3), but less likely T2D (p = 0.01). MVMR showed attenuated estimates for diabetic retinopathy and cataract when adjusting for T1D, but not T2D. We found pairwise bidirectional associations between AITD, T1D, and diabetic retinopathy. Genetic predisposition to both T1D and T2D increased the risk of diabetic retinopathy and cataract (p < 4 × 10-4). Moreover, genetically predicted higher FT4 within the reference range was associated with an increased risk of late AMD (p = 0.01), particularly in women (p = 7 × 10-3). However, we neither found any association between FT4 and early AMD nor between TSH and early and late AMD. No other associations were observed. Conclusions: Genetic predisposition to AITD is associated with risk of diabetic retinopathy and cataract, mostly mediated through increased T1D risk. Reciprocal associations between AITD, diabetic retinopathy, and T1D imply a shared autoimmune origin. The role of FT4 in AMD and potential sex discrepancies needs further investigation.

Keratoplasty to restore vision in trachomatous corneal opacity: A literature review

BACKGROUND

Trachoma is the leading infectious cause of blindness. Patients with trachomatous corneal opacity (TCO) are traditionally considered high-risk cases for graft failure. However, anecdotal evidence suggests that corneal transplantation may restore vision in such individuals. We wanted to review the available evidence for keratoplasty outcomes in TCO.

METHODS

A literature search of PubMed, MEDLINE, and Web of Science was performed using the search terms "trachoma* AND (keratoplasty OR cornea* transplant*)". The search was restricted to studies published between 1 January 1992 and 12 October 2022. All types of prospective and retrospective study designs reporting outcomes of keratoplasty in trachoma were included. The primary outcome assessed was rate of graft survival in patients with TCO who received keratoplasty. Secondary outcomes were postoperative best corrected visual acuity (BCVA) and graft rejection rates.

RESULTS

Seven studies met our inclusion criteria. None were prospective trials; 215/302 grafts (71%) were clear at final follow-up. There was significant variability between studies in the reporting of patient characteristics, follow-up, complications, and outcomes. In data on penetrating keratoplasty (PKP), graft survival at final follow-up was observed in 161/195 eyes (83%). Studies assessing lamellar keratoplasty (LKP) reported graft survival in 18/20 eyes (90%). Rejection episodes were reported in 31/167 (19%) eyes managed with PKP and 0 of 20 eyes managed with LKP. Of 163 eyes, preoperative BCVA was ≤counting fingers in 76% and ≤6/60 in 91%. A postoperative BCVA of >6/60 was achieved in 63% of eyes.

CONCLUSIONS

There is a paucity of evidence supporting keratoplasty in TCO. However, it may hold visual rehabilitation promise for people whose needs have to date been largely ignored. More structured reporting of outcomes from centres which perform keratoplasty in TCO and a well-designed prospective study would be valuable additions to the literature.

Thyroid dysfunction and exudative age-related macular degeneration - A longitudinal nationwide registry-based cohort study

PURPOSE

The association between thyroid dysfunction and exudative age-related macular degeneration (AMD) is unknown.

METHODS

In this Danish longitudinal nationwide registry-based cohort study we included all Danish residents aged 50-100 between 2008 and 2018. Using the Danish national registries, we studied the association between thyroid dysfunction and exudative AMD. Thyroid dysfunction was classified as two consecutive redeemed prescriptions of thyroid hormones (hypothyroidism) or anti-thyroid medication (hyperthyroidism). Exudative AMD was classified as an ICD diagnosis of AMD and a code for anti-VEGF treatment. All patients are treated for exudative AMD in a hospital in Denmark, and we therefore have complete registration of this patient group.

RESULTS

We included 2 087 305 individuals, of which 1 072 567 (51.4%) were women; 59 318 (2.8%) had hypothyroidism, and 33 922 (1.6%) had hyperthyroidism. During a median follow-up of 11 years, 26 998 (1.3%) people developed exudative AMD. Hypothyroidism (adjusted hazard ratio [HR]: 1.17; 95% confidence interval [CI] 1.10-1.25; p < 0.001) and hyperthyroidism (HR: 1.23; 95% CI:1.13-1.34; p < 0.001) were both associated with the development of exudative AMD. The age-stratified analyses yielded similar results to the main analyses, except that the risks were exaggerated in the older part of the population.

CONCLUSION

This is the first longitudinal nationwide study showing that both hypo- and hyperthyroidism are associated with an increased risk of exudative AMD. AMD is a quantitative problem in the population and our findings could have a public health impact. Further studies are needed to study the underlying mechanisms of the association.

Diagnostic performance of deep learning for infectious keratitis: a systematic review and meta-analysis

Background

Infectious keratitis (IK) is the leading cause of corneal blindness globally. Deep learning (DL) is an emerging tool for medical diagnosis, though its value in IK is unclear. We aimed to assess the diagnostic accuracy of DL for IK and its comparative accuracy with ophthalmologists.

Methods

In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, and clinical registries for studies related to DL for IK published between 1974 and July 16, 2024. We performed meta-analyses using bivariate models to estimate summary sensitivities and specificities. This systematic review was registered with PROSPERO (CRD42022348596).

Findings

Of 963 studies identified, 35 studies (136,401 corneal images from >56,011 patients) were included. Most studies had low risk of bias (68.6%) and low applicability concern (91.4%) in all domains of QUADAS-2, except the index test domain. Against the reference standard of expert consensus and/or microbiological results (seven external validation studies; 10,675 images), the summary estimates (95% CI) for sensitivity and specificity of DL for IK were 86.2% (71.6-93.9) and 96.3% (91.5-98.5). From 28 internal validation studies (16,059 images), summary estimates for sensitivity and specificity were 91.6% (86.8-94.8) and 90.7% (84.8-94.5). Based on seven studies (4007 images), DL and ophthalmologists had comparable summary sensitivity [89.2% (82.2-93.6) versus 82.2% (71.5-89.5); P = 0.20] and specificity [(93.2% (85.5-97.0) versus 89.6% (78.8-95.2); P = 0.45].

Interpretation

DL models may have good diagnostic accuracy for IK and comparable performance to ophthalmologists. These findings should be interpreted with caution due to the image-based analysis that did not account for potential correlation within individuals, relatively homogeneous population studies, lack of pre-specification of DL thresholds, and limited external validation. Future studies should improve their reporting, data diversity, external validation, transparency, and explainability to increase the reliability and generalisability of DL models for clinical deployment.

Funding

NIH, Wellcome Trust, MRC, Fight for Sight, BHP, and ESCRS.

The AI revolution in glaucoma: Bridging challenges with opportunities

Recent advancements in artificial intelligence (AI) herald transformative potentials for reshaping glaucoma clinical management, improving screening efficacy, sharpening diagnosis precision, and refining the detection of disease progression. However, incorporating AI into healthcare usages faces significant hurdles in terms of developing algorithms and putting them into practice. When creating algorithms, issues arise due to the intensive effort required to label data, inconsistent diagnostic standards, and a lack of thorough testing, which often limits the algorithms' widespread applicability. Additionally, the "black box" nature of AI algorithms may cause doctors to be wary or skeptical. When it comes to using these tools, challenges include dealing with lower-quality images in real situations and the systems' limited ability to work well with diverse ethnic groups and different diagnostic equipment. Looking ahead, new developments aim to protect data privacy through federated learning paradigms, improving algorithm generalizability by diversifying input data modalities, and augmenting datasets with synthetic imagery. The integration of smartphones appears promising for using AI algorithms in both clinical and non-clinical settings. Furthermore, bringing in large language models (LLMs) to act as interactive tool in medicine may signify a significant change in how healthcare will be delivered in the future. By navigating through these challenges and leveraging on these as opportunities, the field of glaucoma AI will not only have improved algorithmic accuracy and optimized data integration but also a paradigmatic shift towards enhanced clinical acceptance and a transformative improvement in glaucoma care.

Innervation in corneal bioengineering

Given the crucial role nerves play in maintaining corneal function and integrity, the ability of bioengineered cornea to demonstrate functional nerve regeneration directly influences their longevity and stability. Despite advances in biofabrication techniques and an increasing appreciation of the importance of neural innervation, to this day none have completely replicated the complexity and functionality of the cornea with successful innervation. This review evaluates the materials and fabrication techniques used to produce and enhance innervation in bioengineered cornea. Approaches to facilitating innervation are discussed and methods of assessing innervation compared. Finally, current challenges and future directions for innervated bioengineered cornea are presented, providing guidance for future work. STATEMENT OF SIGNIFICANCE: The functional nerve regeneration in bioengineered corneas directly influences their longevity and stability. Despite advancements in biofabrication techniques and growing recognition of the importance of neural innervation for bioengineered cornea, there remains a lack of comprehensive reviews on this topic. This review addresses the critical gap by evaluating the materials and fabrication techniques employed to promote innervation in bioengineered corneas. Additionally, we discuss various approaches to enhancing innervation, compare assessment methods, and examine both in vitro and in vivo responses. By providing a comprehensive overview of the current state of research and highlighting challenges and future directions, this review aims to provide guidance for inducing innervation of bioengineered cornea.

Long-Term Outcome After Canaloplasty and Phacocanaloplasty in Primary Open Angle Glaucoma

PRCIS

Canaloplasty and phacocanaloplasty achieve a statistically significant intraocular pressure (IOP)-reduction for up to 11 years and decrease the long-term need for glaucoma medications. Both procedures have a low long-term complication rate.

PURPOSE

To evaluate the long-term outcome of canaloplasty with and without cataract surgery in primary open angle glaucoma (POAG) patients.

PATIENTS AND METHODS

In all, 48 eyes of 34 patients with POAG who successfully received canaloplasty alone (group A, n=28) or with phacoemulsification (group B, n=20) were retrospectively analyzed. Demographic data, IOP, and IOP-lowering medication were recorded presurgery and postsurgery with a follow-up of up to 14 years.

RESULTS

The mean follow-up time in group A was 91.4±45.0 months. Mean IOP dropped from 22.0±3.8 mm Hg at baseline to 14.0±3.3, 14.3±3.1, 14.4±3.8, and 16.5±1.2 mm Hg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 1.5±1.0 at baseline to 0.1±0.4, 0.3±0.6, 0.6±0.9, and 0.9±1.1 at 1, 4, 7, and 10 years, respectively. The mean follow-up time in group B was 109.1±25.7 months. Mean IOP dropped from 24.5±6.0 at baseline to 13.8±2.9, 14.9±3.6, 15.3±2.9, and 14.8±2.0 mm Hg at 1, 4, 7, and 10 years, respectively. IOP-lowering medication count decreased from 2.2±1.2 before surgery to 0.0, 0.1±0.3, 0.1±0.2, and 0.5±0.9 at 1, 4, 7, and 10 years, respectively.

CONCLUSION

Canaloplasty and phacocanaloplasty achieved a comparable decrease in IOP and glaucoma medication count with a low complication rate. Both procedures showed a high long-term success rate.

Investigating the impact of OCT imaging of the crystalline lens on the accuracy and precision of cataract assessment

PURPOSE

To determine if supplementing standard clinical assessments with Optical Coherence Tomography (OCT) imaging of the crystalline lens improves the accuracy and precision of lens opacity assessment and associated clinical management decisions by optometrists.

METHODS

Fifty optometrists registered in the UK or Éire undertook a clinical vignette study where participants graded lens opacities and made associated clinical management decisions based on the image(s)/information displayed. Three forms of vignettes were presented: (1) Slit-lamp (SL) images of the lens, (2) SL and OCT images and (3) SL, OCT and visual function measures. Vignettes were constructed using anonymised data from 50 patients with varying cataract severity, each vignette being presented twice in a randomised order (total vignette presentations = 300). The accuracy of opacity and management decisions were evaluated using descriptive statistics and non-parametric Bland-Altman analysis where assessments from experienced clinicians were the reference. The precision of assessments was examined for each vignette form using non-parametric Bland-Altman analysis.

RESULTS

All (n = 50) participants completed the study, with 36 working in primary eyecare (primary eyecare) settings and 14 in hospital eyecare services (HES). Agreement was highest where vignettes contained all clinical data (i.e., SL, OCT and visual function data-grading: 51.0%, management: 50.5%), and systematically reduced with decreasing vignette content (p < 0.001). A larger number of vignettes containing imaging and visual function measures exhibited below reference (i.e., less conservative) grading compared with vignettes containing imaging data alone (all p < 0.05). HES-based optometrists were more likely to grade lens opacities lower than clinicians working in primary eyecare (p < 0.001). Good measurement precision was evident for all vignettes, with a mean bias close to zero and limits of agreement below one grading step for all conditions.

CONCLUSIONS

The addition of anterior segment OCT to SL images improved the accuracy of lens opacity grading. Structural assessment alone yielded more conservative decision making, which reversed once visual functional data was available.

[Glaucoma surgeries: Long-term results - A review]

The surgical treatment of glaucoma has been and is still based on filtering surgeries, commonly used for about half a century. The safety and efficacy of these techniques have been well described, as it has also been done for cyclophotocoagulation and valves or tubes, indicated in France mostly for refractory glaucoma. Minimally invasive glaucoma surgeries have emerged in recent decades, increasing the number of therapeutic options, and allowing treatment decisions to be as patient-centered as possible. Most of these techniques have now been studied for more than five years. Since glaucoma is a chronic, progressive optic neuropathy, the sustainability of each surgery's results is essential. The amount of available data concerning long-term efficacy and safety of glaucoma surgeries is increasing, so we have decided to describe it through this review of the literature.