Pub Date : 2026-01-22DOI: 10.1016/j.ajoint.2026.100226
Sheila K. West , Ian J. Saldanha , Fasika Woreta , Christina Ambrosino , Jay Maturi , Fekadu Ayalew , Jordan Kaplan , Annabelle Pan , Winnie Liu , Anna Kim , Emily Joseph , Andreas S. Mueller , Silvio P. Mariotti
Purpose
The World Health Organization (WHO) has specified a global target for “effective cataract surgery coverage” for monitoring progress towards tincreasing eye care quality across populations. The WHO is committed to providing evidence-based guidance for components of cataract surgerythat could lead to better outcomes. The first step is a scoping review of from existing guidelines, including the evidence base and gaps in the evidence for those guidelines.
Design
We developed a conceptual framework for the scoping review that compartmentalized stages of cataract surgery into pre-operative, operative, and postoperative phases and identified potential outcome indicators. A search strategy was developed.
Methods
In 2024, we used a multipronged approach to identify existing guidelines that support cataract surgery programs, reviewed known publicly available cataract surgery quality improvement programs, searched the Trip Medical Database, and reviewed materials sent to us directly from WHO. We noted the evidence-base of the guidelines.
Results
Of the 156 sources, 34 had guidelines. Seven guidelines were cited by multiple sources with good evidence; these include use of pre-operative povidone-iodine, a “time-out” checklist, intracameral antibiotics, and phacoemulsification. Some guidelines were inconsistent and require harmonization, such as the necessity for pre-operative medical visits and laboratory testing, and benchmarks for outcome assessment. Gaps in evidence were also found, such as details on what constitutes “accurate” biometry.
Conclusions
While these results are a reasonable starting point for WHO to begin the development of guidance for effective cataract surgery, there is an urgent need to generate data that will fill identified gaps in evidence and to harmonize inconsistencies going forward.
{"title":"A global scoping review of clinical practice guidelines for cataract surgery","authors":"Sheila K. West , Ian J. Saldanha , Fasika Woreta , Christina Ambrosino , Jay Maturi , Fekadu Ayalew , Jordan Kaplan , Annabelle Pan , Winnie Liu , Anna Kim , Emily Joseph , Andreas S. Mueller , Silvio P. Mariotti","doi":"10.1016/j.ajoint.2026.100226","DOIUrl":"10.1016/j.ajoint.2026.100226","url":null,"abstract":"<div><h3>Purpose</h3><div>The World Health Organization (WHO) has specified a global target for “effective cataract surgery coverage” for monitoring progress towards tincreasing eye care quality across populations. The WHO is committed to providing evidence-based guidance for components of cataract surgerythat could lead to better outcomes. The first step is a scoping review of from existing guidelines, including the evidence base and gaps in the evidence for those guidelines.</div></div><div><h3>Design</h3><div>We developed a conceptual framework for the scoping review that compartmentalized stages of cataract surgery into pre-operative, operative, and postoperative phases and identified potential outcome indicators. A search strategy was developed.</div></div><div><h3>Methods</h3><div>In 2024, we used a multipronged approach to identify existing guidelines that support cataract surgery programs, reviewed known publicly available cataract surgery quality improvement programs, searched the Trip Medical Database, and reviewed materials sent to us directly from WHO. We noted the evidence-base of the guidelines.</div></div><div><h3>Results</h3><div>Of the 156 sources, 34 had guidelines. Seven guidelines were cited by multiple sources with good evidence; these include use of pre-operative povidone-iodine, a “time-out” checklist, intracameral antibiotics, and phacoemulsification. Some guidelines were inconsistent and require harmonization, such as the necessity for pre-operative medical visits and laboratory testing, and benchmarks for outcome assessment. Gaps in evidence were also found, such as details on what constitutes “accurate” biometry.</div></div><div><h3>Conclusions</h3><div>While these results are a reasonable starting point for WHO to begin the development of guidance for effective cataract surgery, there is an urgent need to generate data that will fill identified gaps in evidence and to harmonize inconsistencies going forward.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.ajoint.2026.100228
Karen Matar , Karen C. Liao , Celine Chaaya , Sandra Hoyek , Srujay Pandiri , Francisco Altamirano , Pablo Altschwager Kreft , Efren Gonzalez , Nimesh A. Patel
Topic
Sickle cell retinopathy (SCR)
Relevance
To synthesize evidence on SCR examining genotype-specific features, multimodal imaging findings, systemic correlations, and management approaches, with the goal of informing earlier and more personalized ophthalmic care for children with sickle cell disease (SCD).
Methods
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive PubMed search identified studies published between 1974 and 2025 reporting on SCR in children (≤18 years). Eligible studies included those describing ocular or imaging findings, classification approaches, systemic correlations, or management outcomes in children with SCD.
Results
Thirty-seven studies met inclusion criteria. SCR was recognized as an early, often subclinical manifestation of SCD in children, with retinal changes reported as early as 5–7 years of age. Hemoglobin SC genotype was more often associated with proliferative retinopathy, while hemoglobin SS showed earlier macular thinning and anemia-related changes. Despite structural abnormalities, visual acuity generally remained preserved, underscoring the limitations of symptom-based screening. Optical coherence tomography (OCT), OCT angiography (OCTA), and ultra-widefield imaging reveal macular and peripheral pathology not detected on routine examination. Across studies, classification systems were inconsistently applied; most relied on the Goldberg staging designed for adults, highlighting the lack of pediatric-specific criteria. Retinal findings correlated with hematologic markers, hospitalization burden, and cerebrovascular disease, suggesting potential value as systemic biomarkers. Management remains largely observational, with selective use of laser and systemic therapies in advanced cases.
Conclusions
Pediatric SCR demonstrates early onset, genotype-dependent variation, and systemic associations. Current evidence supports the role of multimodal imaging for early detection and longitudinal monitoring. Standardizing screening practices and refining existing classification frameworks to reflect pediatric disease patterns may enhance early recognition and long-term visual outcomes.
{"title":"Pediatric sickle cell retinopathy: A review of screening, diagnostic imaging and treatment","authors":"Karen Matar , Karen C. Liao , Celine Chaaya , Sandra Hoyek , Srujay Pandiri , Francisco Altamirano , Pablo Altschwager Kreft , Efren Gonzalez , Nimesh A. Patel","doi":"10.1016/j.ajoint.2026.100228","DOIUrl":"10.1016/j.ajoint.2026.100228","url":null,"abstract":"<div><h3>Topic</h3><div>Sickle cell retinopathy (SCR)</div></div><div><h3>Relevance</h3><div>To synthesize evidence on SCR examining genotype-specific features, multimodal imaging findings, systemic correlations, and management approaches, with the goal of informing earlier and more personalized ophthalmic care for children with sickle cell disease (SCD).</div></div><div><h3>Methods</h3><div>This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive PubMed search identified studies published between 1974 and 2025 reporting on SCR in children (≤18 years). Eligible studies included those describing ocular or imaging findings, classification approaches, systemic correlations, or management outcomes in children with SCD.</div></div><div><h3>Results</h3><div>Thirty-seven studies met inclusion criteria. SCR was recognized as an early, often subclinical manifestation of SCD in children, with retinal changes reported as early as 5–7 years of age. Hemoglobin SC genotype was more often associated with proliferative retinopathy, while hemoglobin SS showed earlier macular thinning and anemia-related changes. Despite structural abnormalities, visual acuity generally remained preserved, underscoring the limitations of symptom-based screening. Optical coherence tomography (OCT), OCT angiography (OCTA), and ultra-widefield imaging reveal macular and peripheral pathology not detected on routine examination. Across studies, classification systems were inconsistently applied; most relied on the Goldberg staging designed for adults, highlighting the lack of pediatric-specific criteria. Retinal findings correlated with hematologic markers, hospitalization burden, and cerebrovascular disease, suggesting potential value as systemic biomarkers. Management remains largely observational, with selective use of laser and systemic therapies in advanced cases.</div></div><div><h3>Conclusions</h3><div>Pediatric SCR demonstrates early onset, genotype-dependent variation, and systemic associations. Current evidence supports the role of multimodal imaging for early detection and longitudinal monitoring. Standardizing screening practices and refining existing classification frameworks to reflect pediatric disease patterns may enhance early recognition and long-term visual outcomes.</div></div><div><h3>PROSPERO registration number</h3><div>CRD420251142795.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100228"},"PeriodicalIF":0.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20DOI: 10.1016/j.ajoint.2026.100227
Vibeke Rugaard Christensen , Lars Christian Boberg-Ans , Peter Elmegaard Junior , Lasse Jørgensen Cehofski , Jakob Grauslund , Kamilla Bredsgaard Høeg , Pernille Oversø Hansen , Oliver Niels Klefter , Siar Niazi , Miklos Schneider , Yousif Subhi , Andreas Arnold-Vangsted
Purpose
Randomized controlled trials (RCTs) of anti-vascular endothelial growth factor therapy (anti-VEGF) for retinal vein occlusion (RVO) outline treatment efficacy and aim to guide decisions in clinical practice. However, the strict eligibility criteria applied in registration trials may limit their representativeness and raise concerns about generalizability to real-world populations. This systematic review summarizes the eligibility criteria used in these studies.
Design
Systematic review.
Methods
We systematically searched in 12 scientific literature databases on 22 June 2025. RCTs of intravitreal anti-VEGF therapy for RVO in English were considered eligible for our study. Data on the eligibility criteria for visual function, disease definition and stage, ocular comorbidities, systemic comorbidities, demographics, and other factors not encompassed in other categories were extracted and summarized for a qualitative review. Due to the nature of the systematic review, neither a quantitative meta-analysis nor a formal risk-of-bias assessment was performed.
Results
We identified a total of 23 eligible studies, which in total included 4883 eyes of 4883 patients with RVO. We identified eligibility criteria on areas of visual function (minimum 6–24 ETDRS letters; maximum 70–78 ETDRS letters), disease definition and stage (criteria based on branch or central RVO, retinal features, and minimal central subfield thickness), ocular and systemic comorbidities, specific demographics, as well as a miscellaneous category (e.g., contraception use requirement). The most frequent exclusion criteria across studies were any history of prior intravitreal anti-VEGF (91.3%), ongoing ocular inflammation or infection (82.6%), intraocular surgery (78.3%), diabetic retinopathy (74%), cardiovascular disease (69.6%), laser photocoagulation (69.6%), age-related macular degeneration (56.5%), and glaucoma (52.2%) with percentages reflecting the proportion of the 23 included trials that applied each exclusion criterion. Some studies applied numerous eligibility criteria which, based on post-hoc qualitative comparisons with real-world RVO population, may limit generalizability.
Conclusions
RCTs of anti-VEGF treatments for RVO have used stringent eligibility criteria, which may limit the generalizability of their findings to real-world patients.
{"title":"A systematic review of eligibility criteria in randomized controlled trials of anti-VEGF therapy for retinal vein occlusion","authors":"Vibeke Rugaard Christensen , Lars Christian Boberg-Ans , Peter Elmegaard Junior , Lasse Jørgensen Cehofski , Jakob Grauslund , Kamilla Bredsgaard Høeg , Pernille Oversø Hansen , Oliver Niels Klefter , Siar Niazi , Miklos Schneider , Yousif Subhi , Andreas Arnold-Vangsted","doi":"10.1016/j.ajoint.2026.100227","DOIUrl":"10.1016/j.ajoint.2026.100227","url":null,"abstract":"<div><h3>Purpose</h3><div>Randomized controlled trials (RCTs) of anti-vascular endothelial growth factor therapy (anti-VEGF) for retinal vein occlusion (RVO) outline treatment efficacy and aim to guide decisions in clinical practice. However, the strict eligibility criteria applied in registration trials may limit their representativeness and raise concerns about generalizability to real-world populations. This systematic review summarizes the eligibility criteria used in these studies.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>We systematically searched in 12 scientific literature databases on 22 June 2025. RCTs of intravitreal anti-VEGF therapy for RVO in English were considered eligible for our study. Data on the eligibility criteria for visual function, disease definition and stage, ocular comorbidities, systemic comorbidities, demographics, and other factors not encompassed in other categories were extracted and summarized for a qualitative review. Due to the nature of the systematic review, neither a quantitative meta-analysis nor a formal risk-of-bias assessment was performed.</div></div><div><h3>Results</h3><div>We identified a total of 23 eligible studies, which in total included 4883 eyes of 4883 patients with RVO. We identified eligibility criteria on areas of visual function (minimum 6–24 ETDRS letters; maximum 70–78 ETDRS letters), disease definition and stage (criteria based on branch or central RVO, retinal features, and minimal central subfield thickness), ocular and systemic comorbidities, specific demographics, as well as a miscellaneous category (e.g., contraception use requirement). The most frequent exclusion criteria across studies were any history of prior intravitreal anti-VEGF (91.3%), ongoing ocular inflammation or infection (82.6%), intraocular surgery (78.3%), diabetic retinopathy (74%), cardiovascular disease (69.6%), laser photocoagulation (69.6%), age-related macular degeneration (56.5%), and glaucoma (52.2%) with percentages reflecting the proportion of the 23 included trials that applied each exclusion criterion. Some studies applied numerous eligibility criteria which, based on post-hoc qualitative comparisons with real-world RVO population, may limit generalizability.</div></div><div><h3>Conclusions</h3><div>RCTs of anti-VEGF treatments for RVO have used stringent eligibility criteria, which may limit the generalizability of their findings to real-world patients.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100227"},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.ajoint.2026.100225
Victor T.T. Chan , Noel C.Y. Chan
Purpose
To review the current evidence on artificial intelligence (AI)-based diagnostic systems for ophthalmic emergencies and to evaluate their performance, clinical applicability, and implementation challenges in emergency department settings.
Methods
A narrative review was conducted with a systematic literature search of PubMed/MEDLINE and the Cochrane Library (January 2015–June 2025). Studies were included if they reported AI models for central retinal artery occlusion (CRAO), anterior ischemic optic neuropathy (AION), rhegmatogenous retinal detachment (RRD)/retinal breaks, acute angle closure (AAC), or infectious keratitis using readily available emergency-department imaging modalities (anterior-segment photographs, colour fundus photography, or retinal optical coherence tomography). AI architecture, imaging modality and specific devices, dataset size and source, level of validation, and reported performance metrics were extracted and critically appraised.
Results
Twenty-four studies met inclusion criteria. Deep learning models achieved high diagnostic performance in CRAO (area under curve [AUC] 0.96–0.99 from 2 studies), AION (AUC 0.97 from 1 study), RRD/ retinal break (AUC 0.888–1.00 from 7 studies), AAC (AUC 1.00 from 1 study), and infectious keratitis (AUC 0.65–0.997 from 13 studies). Promising results were also observed for smartphone-based fundus photography and portable OCT devices. However, most studies relied on retrospective, single-centre datasets with limited external or prospective validation.
Conclusions
AI demonstrates considerable potential to support rapid, accurate triage of sight-threatening ophthalmic emergencies, especially in resource-limited settings. Nevertheless, generalisability, data privacy, and integration into clinical pathways remain major barriers to routine adoption. Prospective multicentre trials with adequate external validation and privacy-by-design solutions are needed before widespread clinical implementation.
{"title":"Application of artificial intelligence for ophthalmic emergencies in emergency departments: A narrative review","authors":"Victor T.T. Chan , Noel C.Y. Chan","doi":"10.1016/j.ajoint.2026.100225","DOIUrl":"10.1016/j.ajoint.2026.100225","url":null,"abstract":"<div><h3>Purpose</h3><div>To review the current evidence on artificial intelligence (AI)-based diagnostic systems for ophthalmic emergencies and to evaluate their performance, clinical applicability, and implementation challenges in emergency department settings.</div></div><div><h3>Methods</h3><div>A narrative review was conducted with a systematic literature search of PubMed/MEDLINE and the Cochrane Library (January 2015–June 2025). Studies were included if they reported AI models for central retinal artery occlusion (CRAO), anterior ischemic optic neuropathy (AION), rhegmatogenous retinal detachment (RRD)/retinal breaks, acute angle closure (AAC), or infectious keratitis using readily available emergency-department imaging modalities (anterior-segment photographs, colour fundus photography, or retinal optical coherence tomography). AI architecture, imaging modality and specific devices, dataset size and source, level of validation, and reported performance metrics were extracted and critically appraised.</div></div><div><h3>Results</h3><div>Twenty-four studies met inclusion criteria. Deep learning models achieved high diagnostic performance in CRAO (area under curve [AUC] 0.96–0.99 from 2 studies), AION (AUC 0.97 from 1 study), RRD/ retinal break (AUC 0.888–1.00 from 7 studies), AAC (AUC 1.00 from 1 study), and infectious keratitis (AUC 0.65–0.997 from 13 studies). Promising results were also observed for smartphone-based fundus photography and portable OCT devices. However, most studies relied on retrospective, single-centre datasets with limited external or prospective validation.</div></div><div><h3>Conclusions</h3><div>AI demonstrates considerable potential to support rapid, accurate triage of sight-threatening ophthalmic emergencies, especially in resource-limited settings. Nevertheless, generalisability, data privacy, and integration into clinical pathways remain major barriers to routine adoption. Prospective multicentre trials with adequate external validation and privacy-by-design solutions are needed before widespread clinical implementation.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100225"},"PeriodicalIF":0.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To characterize the online information landscape for ocular malignancies by analyzing patient search queries and evaluating the transparency and readability of linked websites.
Design
Cross-sectional infodemiologic analysis. Searches were conducted on June 12, 2025, using a private, location-masked web browser.
Subjects, Participants, and/or Controls
A total of 300 Google “People Also Ask” (PAA) questions and 205 unique linked websites associated with three search terms: uveal melanoma, retinoblastoma, and ocular surface tumours (100 questions per term).
Methods, Intervention, or Testing
Questions were categorized by type and topic using an adapted Rothwell classification. Websites were classified by source (e.g., commercial, government) and evaluated using the JAMA Benchmark Criteria (transparency) and Flesch-Kincaid Reading Ease (FKRE) and Coleman-Liau Index (readability).
Results
Fact-based queries predominated (71 %). Search topics varied significantly by diagnosis: prognosis was the primary concern for uveal melanoma (17 %) and retinoblastoma (15 %), whereas technical details (24 %) dominated for ocular surface tumours. Commercial websites were the most visible source (44 %). Government sites achieved the highest transparency (mean JAMA Benchmark 3.30) yet were amongst the most difficult to read (FKRE 37.8). Conversely, commercial sites were more readable (FKRE 51.8) but less transparent (JAMA Benchmark 2.67). Academic sources performed surprisingly poorly on transparency (JAMA Benchmark 2.36). Overall, content complexity typically exceeded the recommended 6th- to 8th-grade reading levels for public health information.
Conclusions
Patient information needs are tumor-specific, reflecting distinct clinical anxieties regarding survival versus function. A significant discordance exists in the current online landscape: highly transparent government resources are often too complex, while accessible commercial content lacks transparency. Clinicians must guide patients toward resources that balance accuracy with readability to ensure informed decision-making.
{"title":"What patients ask: Evaluating google search queries and webpage transparency in common ophthalmologic malignancies","authors":"Siddharth Gandhi , Janmejay Buranpuri , Michael Balas , Rachel Curtis","doi":"10.1016/j.ajoint.2026.100224","DOIUrl":"10.1016/j.ajoint.2026.100224","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>To characterize the online information landscape for ocular malignancies by analyzing patient search queries and evaluating the transparency and readability of linked websites.</div></div><div><h3>Design</h3><div>Cross-sectional infodemiologic analysis. Searches were conducted on June 12, 2025, using a private, location-masked web browser.</div></div><div><h3>Subjects, Participants, and/or Controls</h3><div>A total of 300 Google “People Also Ask” (PAA) questions and 205 unique linked websites associated with three search terms: uveal melanoma, retinoblastoma, and ocular surface tumours (100 questions per term).</div></div><div><h3>Methods, Intervention, or Testing</h3><div>Questions were categorized by type and topic using an adapted Rothwell classification. Websites were classified by source (e.g., commercial, government) and evaluated using the JAMA Benchmark Criteria (transparency) and Flesch-Kincaid Reading Ease (FKRE) and Coleman-Liau Index (readability).</div></div><div><h3>Results</h3><div>Fact-based queries predominated (71 %). Search topics varied significantly by diagnosis: prognosis was the primary concern for uveal melanoma (17 %) and retinoblastoma (15 %), whereas technical details (24 %) dominated for ocular surface tumours. Commercial websites were the most visible source (44 %). Government sites achieved the highest transparency (mean JAMA Benchmark 3.30) yet were amongst the most difficult to read (FKRE 37.8). Conversely, commercial sites were more readable (FKRE 51.8) but less transparent (JAMA Benchmark 2.67). Academic sources performed surprisingly poorly on transparency (JAMA Benchmark 2.36). Overall, content complexity typically exceeded the recommended 6th- to 8th-grade reading levels for public health information.</div></div><div><h3>Conclusions</h3><div>Patient information needs are tumor-specific, reflecting distinct clinical anxieties regarding survival versus function. A significant discordance exists in the current online landscape: highly transparent government resources are often too complex, while accessible commercial content lacks transparency. Clinicians must guide patients toward resources that balance accuracy with readability to ensure informed decision-making.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100224"},"PeriodicalIF":0.0,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.ajoint.2025.100223
Siddharth Gandhi , Anne Cao , Michael Balas , Davin Johnson
Objective/Purpose
To analyze the most common patient questions about laser refractive surgery on Google and to evaluate the transparency of the corresponding online information.
Design
Cross-sectional study.
Subjects, Participants, and/or Controls
The first 100 Google “People Also Ask” (PAA) questions were extracted for each of five search terms (“Laser-assisted in situ keratomileusis”, “LASIK”, “Photorefractive Keratectomy”, “PRK”, and “Laser eye surgery”). After deduplication, the study sample comprised 189 unique PAA questions and 284 unique source websites.
Methods, Intervention, or Testing
Data were collected on September 27, 2024, using an automated script. Questions were categorized by topic and type using Rothwell’s classification system. Source websites were assessed for transparency using the Journal of the American Medical Association (JAMA) Benchmark Criteria. A repeat data extraction was performed on November 17, 2025, to assess temporal stability.
Results
Of the 189 unique questions analyzed (88 LASIK, 60 PRK, 41 laser eye surgery), most focused on evaluating the procedures (26 %), recovery timelines (17 %), and indications/management (14 %). Fact-based questions were the most common (43 %). Among the 284 unique websites, medical practice websites were the most frequent (75 %) but had amongst the lowest mean JAMA scores (1.64). Commercial websites had the highest JAMA scores (3.42). LASIK-related searches had the highest mean JAMA score (2.01), followed by laser eye surgery (2.00) and PRK (1.67). The repeat data extraction on November 17, 2025, demonstrated low temporal stability, with only 9 % to 18 % of questions and 18 % to 27 % of websites recurring.
Conclusions
At the primary sampled time point, a transparency deficit characterized the online information most frequently encountered by patients. Although medical practice websites were the most visible sources, they often lacked transparency compared to other site types. These findings suggest that clinicians and academic institutions should prioritize the transparency of their online educational content to better support informed patient decision making.
{"title":"What patients search: Analyzing Google queries on laser refractive surgery and information transparency","authors":"Siddharth Gandhi , Anne Cao , Michael Balas , Davin Johnson","doi":"10.1016/j.ajoint.2025.100223","DOIUrl":"10.1016/j.ajoint.2025.100223","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>To analyze the most common patient questions about laser refractive surgery on Google and to evaluate the transparency of the corresponding online information.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects, Participants, and/or Controls</h3><div>The first 100 Google “People Also Ask” (PAA) questions were extracted for each of five search terms (“Laser-assisted in situ keratomileusis”, “LASIK”, “Photorefractive Keratectomy”, “PRK”, and “Laser eye surgery”). After deduplication, the study sample comprised 189 unique PAA questions and 284 unique source websites.</div></div><div><h3>Methods, Intervention, or Testing</h3><div>Data were collected on September 27, 2024, using an automated script. Questions were categorized by topic and type using Rothwell’s classification system. Source websites were assessed for transparency using the Journal of the American Medical Association (JAMA) Benchmark Criteria. A repeat data extraction was performed on November 17, 2025, to assess temporal stability.</div></div><div><h3>Results</h3><div>Of the 189 unique questions analyzed (88 LASIK, 60 PRK, 41 laser eye surgery), most focused on evaluating the procedures (26 %), recovery timelines (17 %), and indications/management (14 %). Fact-based questions were the most common (43 %). Among the 284 unique websites, medical practice websites were the most frequent (75 %) but had amongst the lowest mean JAMA scores (1.64). Commercial websites had the highest JAMA scores (3.42). LASIK-related searches had the highest mean JAMA score (2.01), followed by laser eye surgery (2.00) and PRK (1.67). The repeat data extraction on November 17, 2025, demonstrated low temporal stability, with only 9 % to 18 % of questions and 18 % to 27 % of websites recurring.</div></div><div><h3>Conclusions</h3><div>At the primary sampled time point, a transparency deficit characterized the online information most frequently encountered by patients. Although medical practice websites were the most visible sources, they often lacked transparency compared to other site types. These findings suggest that clinicians and academic institutions should prioritize the transparency of their online educational content to better support informed patient decision making.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100223"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the safety and preliminary efficacy of platelet-rich fibrin membrane (PRFm) versus conjunctival autograft (CA) for primary pterygium surgery.
Design
Prospective, comparative, non-randomized pilot study.
Subjects, Participants, and/or Controls
This pilot study enrolled 141 patients (76 Group A/CA; 65 Group B/PRFm) undergoing primary pterygium surgery between February 2024 and April 2025. Patients selected their preferred treatment approach.
Methods, Intervention, or Testing
Primary outcome was pterygium recurrence at 12 months (Solomon grading scale). Secondary outcomes included conjunctival inflammation (Efron scale), ocular surface symptoms (Visual Analog Scale and Ocular Surface Disease Index), corneal epithelialization time, visual acuity, surgical time, and graft integration (AS-OCT imaging).
Results
Recurrence occurred in 7 eyes (9.2%; 95% CI 3.8–17.8%) in Group A and 1 eye (1.5%; 95% CI 0.0–8.2%) in Group B. Mean surgical time was substantially shorter with PRFm (18.2 ± 5.2 min versus 38.5 ± 7.1 min; 53% reduction; p < 0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (p < 0.001 at 1 month), with resolution in both groups by 12 months. Within-group improvements in symptom scores were substantially greater with PRFm (VAS frequency 88.6% decrease versus 41.5%; OSDI 44.2% decrease versus 18.6%), with PRFm crossing from moderate to mild symptom category. However, between-group comparisons at individual postoperative timepoints demonstrated no statistically significant differences in symptom outcomes (all p > 0.05). AS-OCT measurements were comparable between groups at all timepoints, with no significant associations between graft morphology and clinical outcomes. Both procedures demonstrated excellent safety profiles with no serious adverse events.
Conclusions
This pilot study suggests PRFm may offer operational advantages and potentially favorable preliminary trends in recurrence and symptom improvement compared with CA for primary pterygium surgery. These exploratory findings warrant investigation in a larger randomized controlled trial with adequate power to determine whether observed trends represent clinically meaningful advantages.
目的比较富血小板纤维蛋白膜（PRFm）与自体结膜移植（CA）在原发性翼状胬肉手术中的安全性和初步疗效。前瞻性、比较性、非随机试验研究。受试者、参与者和/或对照本试点研究纳入了2024年2月至2025年4月期间接受原发性翼状胬肉手术的141例患者（76例A/CA组；65例B/PRFm组）。患者选择自己喜欢的治疗方法。方法、干预或检测主要结果为12个月翼状胬肉复发（所罗门分级量表）。次要结局包括结膜炎症（Efron评分）、眼表症状（视觉模拟评分和眼表疾病指数）、角膜上皮化时间、视力、手术时间和移植物整合（AS-OCT成像）。结果A组复发7只眼（9.2%;95% CI 3.8-17.8%）， b组复发1只眼（1.5%;95% CI 0.0-8.2%）， PRFm的平均手术时间明显缩短（18.2±5.2 min vs 38.5±7.1 min；减少53%；p < 0.001）。B组结膜炎症持续降低3个月（1个月时p <； 0.001），两组结膜炎症在12个月时消退。PRFm组内症状评分的改善明显更大（VAS频率下降88.6%对41.5%；OSDI下降44.2%对18.6%），PRFm从中度症状类别跨越到轻度症状类别。然而，术后各时间点组间比较显示症状结局无统计学差异（均p >； 0.05）。AS-OCT测量在所有时间点组间具有可比性，移植物形态和临床结果之间无显著关联。两种方法均表现出良好的安全性，无严重不良事件。结论与CA相比，PRFm在原发性翼状胬肉手术中可能具有手术优势，并且在复发和症状改善方面具有潜在的有利趋势。这些探索性发现值得在更大的随机对照试验中进行调查，以确定观察到的趋势是否代表临床有意义的优势。
{"title":"Platelet-rich fibrin membrane versus conjunctival autograft in primary pterygium surgery: A comparative 12 months single center study","authors":"Hassan Moutei, Meriem bouzidi, Fouad Chraibi, Meriem Abdellaoui, Idriss Benatiya","doi":"10.1016/j.ajoint.2025.100222","DOIUrl":"10.1016/j.ajoint.2025.100222","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>To compare the safety and preliminary efficacy of platelet-rich fibrin membrane (PRFm) versus conjunctival autograft (CA) for primary pterygium surgery.</div></div><div><h3>Design</h3><div>Prospective, comparative, non-randomized pilot study.</div></div><div><h3>Subjects, Participants, and/or Controls</h3><div>This pilot study enrolled 141 patients (76 Group A/CA; 65 Group B/PRFm) undergoing primary pterygium surgery between February 2024 and April 2025. Patients selected their preferred treatment approach.</div></div><div><h3>Methods, Intervention, or Testing</h3><div>Primary outcome was pterygium recurrence at 12 months (Solomon grading scale). Secondary outcomes included conjunctival inflammation (Efron scale), ocular surface symptoms (Visual Analog Scale and Ocular Surface Disease Index), corneal epithelialization time, visual acuity, surgical time, and graft integration (AS-OCT imaging).</div></div><div><h3>Results</h3><div>Recurrence occurred in 7 eyes (9.2%; 95% CI 3.8–17.8%) in Group A and 1 eye (1.5%; 95% CI 0.0–8.2%) in Group B. Mean surgical time was substantially shorter with PRFm (18.2 ± 5.2 min versus 38.5 ± 7.1 min; 53% reduction; <em>p</em> < 0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (<em>p</em> < 0.001 at 1 month), with resolution in both groups by 12 months. Within-group improvements in symptom scores were substantially greater with PRFm (VAS frequency 88.6% decrease versus 41.5%; OSDI 44.2% decrease versus 18.6%), with PRFm crossing from moderate to mild symptom category. However, between-group comparisons at individual postoperative timepoints demonstrated no statistically significant differences in symptom outcomes (all <em>p</em> > 0.05). AS-OCT measurements were comparable between groups at all timepoints, with no significant associations between graft morphology and clinical outcomes. Both procedures demonstrated excellent safety profiles with no serious adverse events.</div></div><div><h3>Conclusions</h3><div>This pilot study suggests PRFm may offer operational advantages and potentially favorable preliminary trends in recurrence and symptom improvement compared with CA for primary pterygium surgery. These exploratory findings warrant investigation in a larger randomized controlled trial with adequate power to determine whether observed trends represent clinically meaningful advantages.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100222"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145939565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1016/j.ajoint.2025.100220
Alexander T. Hong , Ivan Y. Luu , Tze-Woei Tan , Brian C. Toy
Purpose
Microvascular complications of type 2 diabetes (T2DM), such as diabetic retinopathy, nephropathy (DN), and foot ulcers (DFU), are interrelated outcomes of hyperglycemia-induced vascular injury. Whether comorbid DFU or DN merely indicate diabetic microvascular disease burden or specifically contribute to progression to treatment-warranted diabetic eye disease (TW-DED) remains insufficiently explored. We hypothesized that DFU and DN are independently associated with increased risk of TW-DED.
Design
This retrospective cohort study used electronic health records from a nationwide federated database and followed patients for up to 10 years after index non-proliferative diabetic retinopathy (NPDR) diagnosis.
Setting
Data were aggregated from a multicenter network of 70 U.S.-based healthcare organizations, including both academic and non-academic institutions.
Participants
Patients aged ≥40 years with T2DM and NPDR were included, while those with prior TW-DED were excluded.
Exposures
Baseline DN and/or DFU, with propensity-matched clinical covariates, including demographics, comorbidities, medications, laboratory values, and healthcare utilization.
Main Outcomes
The primary outcome was progression to TW-DED, defined as proliferative DR, macular edema, vitreous hemorrhage, or need for DR-related treatments (intravitreal injection, panretinal photocoagulation, pars plana vitrectomy). Risk of blindness or low vision was also assessed. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).
Results
Among 135,172 patients with NPDR, 21.5% had DN only, 8.5% had DFU only, and 7.0% had both. Compared to those without DN or DFU, patients with DFU (HR 1.27, 95% CI 1.19–1.36), DN (HR 1.17, 95% CI 1.05–1.21), or both DFU and DN (HR 1.49, 95% CI 1.33–1.68) had an associated increased risk of TW-DED. DFU alone was associated with greater risk of TW-DED than DN alone (HR 1.15, 95% CI 1.05–1.28). Patients with DFU or DN had a 2-fold increased risk of PDR and VH, 50% increased risk of blindness/low vision, and 2-fold increased risk of undergoing vitrectomy.
Conclusions
Comorbid DFU and DN are associated with increased risk of diabetic eye disease progression, with DFU showing greater independent risk. Proactively identifying these complications may support risk stratification and guide more intensive ophthalmic monitoring for patients with NPDR.
2型糖尿病（T2DM）的微血管并发症，如糖尿病视网膜病变、肾病（DN）和足部溃疡（DFU），是高血糖诱导的血管损伤的相关结果。是否合并症的DFU或DN仅仅表明糖尿病微血管疾病负担或特别有助于进展到需要治疗的糖尿病眼病（TW-DED）仍未充分探讨。我们假设DFU和DN与TW-DED风险增加独立相关。设计：本回顾性队列研究使用来自全国联邦数据库的电子健康记录，并在诊断为非增殖性糖尿病视网膜病变（NPDR）后对患者进行长达10年的随访。SettingData来自70个美国医疗保健组织的多中心网络，包括学术和非学术机构。年龄≥40岁，伴有T2DM和NPDR的患者被纳入研究，而既往有TW-DED的患者被排除在外。基线DN和/或DFU，具有倾向匹配的临床协变量，包括人口统计学、合并症、药物、实验室值和医疗保健利用。主要结局：主要结局是进展为TW-DED，定义为增殖性DR、黄斑水肿、玻璃体出血，或需要进行DR相关治疗（玻璃体内注射、全视网膜光凝、玻璃体切除）。失明或低视力的风险也被评估。Cox比例风险模型估计了风险比（hr）和95%置信区间（ci）。结果在135172例NPDR患者中，21.5%的患者仅患有DN， 8.5%的患者仅患有DFU， 7.0%的患者两者兼有。与没有DN或DFU的患者相比，DFU（风险比1.27,95% CI 1.19-1.36）、DN（风险比1.17,95% CI 1.05-1.21）或DFU和DN同时存在（风险比1.49,95% CI 1.33-1.68）的患者发生TW-DED的风险增加。单独DFU比单独DN的TW-DED风险更高（HR 1.15, 95% CI 1.05-1.28）。DFU或DN患者PDR和VH的风险增加了2倍，失明/低视力的风险增加了50%，玻璃体切除术的风险增加了2倍。结论DFU和DN合并症与糖尿病眼病进展风险增加相关，其中DFU表现出更大的独立风险。主动识别这些并发症可以支持风险分层，并指导对NPDR患者进行更密切的眼科监测。
{"title":"Impact of diabetic foot ulcers and nephropathy on risk of treatment-warranted diabetic eye disease: A retrospective cohort study","authors":"Alexander T. Hong , Ivan Y. Luu , Tze-Woei Tan , Brian C. Toy","doi":"10.1016/j.ajoint.2025.100220","DOIUrl":"10.1016/j.ajoint.2025.100220","url":null,"abstract":"<div><h3>Purpose</h3><div>Microvascular complications of type 2 diabetes (T2DM), such as diabetic retinopathy, nephropathy (DN), and foot ulcers (DFU), are interrelated outcomes of hyperglycemia-induced vascular injury. Whether comorbid DFU or DN merely indicate diabetic microvascular disease burden or specifically contribute to progression to treatment-warranted diabetic eye disease (TW-DED) remains insufficiently explored. We hypothesized that DFU and DN are independently associated with increased risk of TW-DED.</div></div><div><h3>Design</h3><div>This retrospective cohort study used electronic health records from a nationwide federated database and followed patients for up to 10 years after index non-proliferative diabetic retinopathy (NPDR) diagnosis.</div></div><div><h3>Setting</h3><div>Data were aggregated from a multicenter network of 70 U.S.-based healthcare organizations, including both academic and non-academic institutions.</div></div><div><h3>Participants</h3><div>Patients aged ≥40 years with T2DM and NPDR were included, while those with prior TW-DED were excluded.</div></div><div><h3>Exposures</h3><div>Baseline DN and/or DFU, with propensity-matched clinical covariates, including demographics, comorbidities, medications, laboratory values, and healthcare utilization.</div></div><div><h3>Main Outcomes</h3><div>The primary outcome was progression to TW-DED, defined as proliferative DR, macular edema, vitreous hemorrhage, or need for DR-related treatments (intravitreal injection, panretinal photocoagulation, pars plana vitrectomy). Risk of blindness or low vision was also assessed. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>Among 135,172 patients with NPDR, 21.5% had DN only, 8.5% had DFU only, and 7.0% had both. Compared to those without DN or DFU, patients with DFU (HR 1.27, 95% CI 1.19–1.36), DN (HR 1.17, 95% CI 1.05–1.21), or both DFU and DN (HR 1.49, 95% CI 1.33–1.68) had an associated increased risk of TW-DED. DFU alone was associated with greater risk of TW-DED than DN alone (HR 1.15, 95% CI 1.05–1.28). Patients with DFU or DN had a 2-fold increased risk of PDR and VH, 50% increased risk of blindness/low vision, and 2-fold increased risk of undergoing vitrectomy.</div></div><div><h3>Conclusions</h3><div>Comorbid DFU and DN are associated with increased risk of diabetic eye disease progression, with DFU showing greater independent risk. Proactively identifying these complications may support risk stratification and guide more intensive ophthalmic monitoring for patients with NPDR.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.ajoint.2025.100219
Prashant Ramdas Kokiwar , Amit Singh Pawaiya , Ranjana Roy , Reenoo Jauhari
{"title":"Comment on “Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis”","authors":"Prashant Ramdas Kokiwar , Amit Singh Pawaiya , Ranjana Roy , Reenoo Jauhari","doi":"10.1016/j.ajoint.2025.100219","DOIUrl":"10.1016/j.ajoint.2025.100219","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.ajoint.2025.100221
Neel Edupuganti , Danny Alevy , Tommy Bui , George Liu , Kevin Dobbin , John E. Crews , Atalie C. Thompson
Purpose
To investigate the associations between visual impairment (VI) and diabetic retinopathy (DR) with the prevalence of falls, recurrent falls, and falls reporting injuries (FRIs).
Design
Cross-sectional analyses of associations between VI, DR, or both VI and DR with the prevalence of any fall, recurrent falls, and FRIs using data from 65,046 adults (45+ years) who completed the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Diabetes Module.
Subjects, participants, and/or controls
Participants were categorized into four groups: no VI or DR (reference), DR only, VI only, and both VI and DR.
Methods
Separate multivariable logistic regression models, adjusted for sociodemographics and comorbidities, were used to analyze the association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.
Main Outcome Measures
The association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.
Results
Compared to adults with no VI or DR, those with VI reported 1.72 greater odds of experiencing any fall (adjusted odds ratio (aOR)=1.716, p < 0.001), 1.82 greater odds of an increasing number of falls (aOR=1.824, p < 0.001), and 2.08 greater odds of FRIs (aOR=2.076, p < 0.001). Similarly, those with DR only also had substantially greater odds of experiencing any fall (aOR=1.741, p < 0.001), an increasing number of falls (aOR = 1.735, p < 0.001), and FRIs (aOR=1.658, p = 0.004). The interaction effect between VI and DR was not significant. Subjects with both VI and DR experienced 3.80 greater odds of any fall, 2.73 greater odds of increasing falls, and 2.79 greater odds of FRIs, which was greater than those with VI or DR alone or neither condition. Further, subjects aged 45–64 years had significantly higher odds of FRIs than those aged 65+.
Conclusions
Using data from 17 states and territories implementing the 2018 BRFSS Diabetes Module, we found that adults with both VI and DR experienced a greater likelihood of falls, recurrent falls, and FRIs than those with neither or either condition. However, the inability to infer temporal or causal relationships from this cross-sectional, self-reported analysis should be considered. These findings underscore the importance for practitioners to communicate fall risks among people with DR and VI and support policies promoting tailored interventions for people experiencing these specific conditions.
目的探讨视力损害（VI）和糖尿病视网膜病变（DR）与跌倒、复发性跌倒和跌倒报告损伤（FRIs）发生率之间的关系。横断面分析VI、DR或VI和DR与任何跌倒、复发性跌倒和fri患病率之间的关系，使用来自65,046名完成2018年行为风险因素监测系统（BRFSS）糖尿病模块的45岁以上成年人的数据。受试者、参与者和/或对照组将参与者分为四组：无VI或DR（参考）、仅DR、仅VI和同时有VI和DR。方法采用独立的多变量logistic回归模型，根据社会人口统计学和合并症进行调整，分析VI、DR或VI和DR与经历任何跌倒、复发性跌倒或fri的几率之间的关系。主要结局指标：VI、DR或VI和DR与发生任何跌倒、复发性跌倒或fri的几率之间的关系。结果与没有VI或DR的成年人相比，VI患者发生跌倒的几率高出1.72（调整优势比(aOR)=1.716, p < 0.001），跌倒次数增加的几率高出1.82 (aOR=1.824, p < 0.001)， fri的几率高出2.08 （aOR=2.076, p < 0.001）。同样，那些仅患有DR的人也有更大的几率经历跌倒（aOR=1.741, p < 0.001），跌倒次数增加（aOR= 1.735, p < 0.001）， fri （aOR=1.658, p = 0.004）。VI与DR的交互作用不显著。同时患有VI和DR的受试者跌倒的几率比单独患有VI或DR的受试者高3.80，跌倒次数增加的几率比单独患有VI或DR的受试者高2.73，fri的几率比单独患有VI或DR的受试者高2.79。此外，45-64岁的受试者患fri的几率明显高于65岁以上的受试者。使用实施2018年BRFSS糖尿病模块的17个州和地区的数据，我们发现患有VI和DR的成年人比没有或两种情况的成年人更容易跌倒、复发性跌倒和fri。然而，不能从这种横断面的、自我报告的分析中推断出时间或因果关系，应该加以考虑。这些发现强调了从业人员向DR和VI患者宣传跌倒风险的重要性，并支持促进针对这些特定疾病患者的量身定制干预措施的政策。
{"title":"The association of diabetic retinopathy and visual impairment with falls and falls reporting injuries: Findings from the behavioral risk factor surveillance system","authors":"Neel Edupuganti , Danny Alevy , Tommy Bui , George Liu , Kevin Dobbin , John E. Crews , Atalie C. Thompson","doi":"10.1016/j.ajoint.2025.100221","DOIUrl":"10.1016/j.ajoint.2025.100221","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the associations between visual impairment (VI) and diabetic retinopathy (DR) with the prevalence of falls, recurrent falls, and falls reporting injuries (FRIs).</div></div><div><h3>Design</h3><div>Cross-sectional analyses of associations between VI, DR, or both VI and DR with the prevalence of any fall, recurrent falls, and FRIs using data from 65,046 adults (45+ years) who completed the 2018 Behavioral Risk Factor Surveillance System (BRFSS) Diabetes Module.</div></div><div><h3>Subjects, participants, and/or controls</h3><div>Participants were categorized into four groups: no VI or DR (reference), DR only, VI only, and both VI and DR.</div></div><div><h3>Methods</h3><div>Separate multivariable logistic regression models, adjusted for sociodemographics and comorbidities, were used to analyze the association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.</div></div><div><h3>Main Outcome Measures</h3><div>The association between VI, DR, or VI and DR with the odds of experiencing any fall, recurrent falls, or FRIs.</div></div><div><h3>Results</h3><div>Compared to adults with no VI or DR, those with VI reported 1.72 greater odds of experiencing any fall (adjusted odds ratio (aOR)=1.716, <em>p</em> < 0.001), 1.82 greater odds of an increasing number of falls (aOR=1.824, <em>p</em> < 0.001), and 2.08 greater odds of FRIs (aOR=2.076, <em>p</em> < 0.001). Similarly, those with DR only also had substantially greater odds of experiencing any fall (aOR=1.741, <em>p</em> < 0.001), an increasing number of falls (aOR = 1.735, <em>p</em> < 0.001), and FRIs (aOR=1.658, <em>p</em> = 0.004). The interaction effect between VI and DR was not significant. Subjects with both VI and DR experienced 3.80 greater odds of any fall, 2.73 greater odds of increasing falls, and 2.79 greater odds of FRIs, which was greater than those with VI or DR alone or neither condition. Further, subjects aged 45–64 years had significantly higher odds of FRIs than those aged 65+.</div></div><div><h3>Conclusions</h3><div>Using data from 17 states and territories implementing the 2018 BRFSS Diabetes Module, we found that adults with both VI and DR experienced a greater likelihood of falls, recurrent falls, and FRIs than those with neither or either condition. However, the inability to infer temporal or causal relationships from this cross-sectional, self-reported analysis should be considered. These findings underscore the importance for practitioners to communicate fall risks among people with DR and VI and support policies promoting tailored interventions for people experiencing these specific conditions.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100221"},"PeriodicalIF":0.0,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145884193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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