AJO International最新文献

{"title":"Effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in macular edema secondary to retinal vein occlusion","authors":"Risa Araki ,&nbsp;Yohei Tomita ,&nbsp;Tomonori Yuda ,&nbsp;Xiaoyan Jiang ,&nbsp;Norimitsu Ban ,&nbsp;Hiromitsu Kunimi ,&nbsp;Atsuro Uchida ,&nbsp;Toshihide Kurihara ,&nbsp;Hajime Shinoda ,&nbsp;Kazuno Negishi","doi":"10.1016/j.ajoint.2025.100207","DOIUrl":"10.1016/j.ajoint.2025.100207","url":null,"abstract":"<div><h3>Objective or Purpose</h3><div>To investigate the effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in patients with macular edema secondary to RVO, and to identify how these effects vary based on clinical characteristics such as occlusion location and patient sex.</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Subjects, Participants, and/or Controls</h3><div>Thirty-eight patients (38 eyes) with RVO treated at Keio University Hospital (26 males, 12 females; mean age, 67.7 ± 8.5 years). Seventeen fellow eyes without injection served as internal controls.</div></div><div><h3>Methods, Intervention, or Testing</h3><div>We analyzed 38 eyes with RVO who received intravitreal injections of aflibercept (<em>n</em> = 31) or ranibizumab (<em>n</em> = 7). Wide-field optical coherence tomography (OCT) was performed at baseline (within 7 days before the injection) and at the follow-up visit (30 ± 14 days after the injection). Changes in retinal and choroidal thickness were analyzed across nine predefined regions: a central 5-mm subfield (C0) and eight surrounding peripheral sectors: temporal (L1), superior-temporal (L2), superior (L3), superior-nasal (L4), nasal (L5), inferior-nasal (L6), inferior (L7), and inferior-temporal (L8). Statistical analysis was performed using the Wilcoxon signed-rank test and Bonferroni correction for nine regions.</div></div><div><h3>Main Outcome Measures</h3><div>Changes in regional retinal and choroidal thickness</div></div><div><h3>Results</h3><div>Post-injection, retinal thickness significantly decreased in all regions except L4 and L6 (<em>p</em> &lt; 0.0056). Choroidal thickness showed a significant reduction in L2, L5, and L8 (<em>p</em> &lt; 0.0056). Subgroup analyses revealed no significant changes in choroidal thickness in either the superior RVO group (n = 9) or the inferior RVO group (n = 17). A clear sex-based difference was also observed: male patients (<em>n</em> = 26) exhibited choroidal thinning in L4, L5, L6, and L8 (<em>p</em> &lt; 0.0056), whereas female patients (<em>n</em> = 12) showed no significant changes in any region.</div></div><div><h3>Conclusion</h3><div>Anti-VEGF therapy reduced retinal and choroidal thickness in specific regions in eyes with RVO. No significant differences were observed between eyes with superior and inferior occlusions. In male patients, significant thinning was observed in multiple peripheral regions, whereas no significant changes were noted in female patients. These findings suggest that the choroidal response to anti-VEGF therapy is complex and warrants further investigation.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100207"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747565","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}

{"title":"In memoriam, Nobuhiko Matsuo, 1931-2025","authors":"Toshihiko Matsuo","doi":"10.1016/j.ajoint.2025.100217","DOIUrl":"10.1016/j.ajoint.2025.100217","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840817","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}

{"title":"Assessing demographic variation in large language model outputs for patient education materials in cataract surgery","authors":"Angel Gao ,&nbsp;Abu Bakar Butt ,&nbsp;Fred Min ,&nbsp;Amin Hatamnejad ,&nbsp;Keean Nanji ,&nbsp;Husayn Gulamhusein","doi":"10.1016/j.ajoint.2025.100216","DOIUrl":"10.1016/j.ajoint.2025.100216","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether large language model (LLM)-generated patient education materials for cataract surgery vary in readability, length, and accuracy based on demographic modifiers including race, gender, geography, and insurance status.</div></div><div><h3>Design</h3><div>Cross-sectional study</div></div><div><h3>Methods</h3><div>This study analyzed 7,000 responses from five LLMs (ChatGPT, Claude, Copilot, DeepSeek, and Gemini) between March-May 2025 using 280 standardized prompts that varied by race, gender, province/territory, and insurance coverage. Each prompt was submitted five times. Readability was assessed using the Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), and SMOG index. Accuracy was assessed by dual blinded reviewers against AAO clinical guidelines. ANOVA was performed (α = 0.05).</div></div><div><h3>Results</h3><div>LLM outputs differed significantly across all metrics (<em>p</em> &lt; 0.001). Gemini generated the longest (876 ± 143 words) and among the most complex text (FKGL 11.9 ± 1.2). Race, insurance status, and geography significantly impacted readability. Prompts referencing Indigenous patients were the most complex (FKGL 11.1 ± 1.8, FRE 36.5 ± 7.9). Insured prompts were longer and more complex (11.0 ± 1.7 vs. 10.8 ± 1.7; 429 vs. 399 words; <em>p</em> &lt; 0.001). Prompts from Nunavut and Manitoba were the least readable (FKGL ≥ 11.1), while Quebec and PEI were most readable. Gender had minimal impact. No outputs contained clinically unsafe information, but most lacked sufficient depth. None of the responses met the AMA’s sixth-grade readability recommendation.</div></div><div><h3>Conclusion</h3><div>LLM-generated patient education for cataract surgery varies by patient demographics. These disparities may hinder equitable access to health information and highlight the need for bias-aware development of AI tools in healthcare.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841441","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}

{"title":"Pediatric sickle cell retinopathy: A review of screening, diagnostic imaging and treatment","authors":"Karen Matar ,&nbsp;Karen C. Liao ,&nbsp;Celine Chaaya ,&nbsp;Sandra Hoyek ,&nbsp;Srujay Pandiri ,&nbsp;Francisco Altamirano ,&nbsp;Pablo Altschwager Kreft ,&nbsp;Efren Gonzalez ,&nbsp;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":"2026-04-28","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}

{"title":"A systematic review of eligibility criteria in randomized controlled trials of anti-VEGF therapy for retinal vein occlusion","authors":"Vibeke Rugaard Christensen ,&nbsp;Lars Christian Boberg-Ans ,&nbsp;Peter Elmegaard Junior ,&nbsp;Lasse Jørgensen Cehofski ,&nbsp;Jakob Grauslund ,&nbsp;Kamilla Bredsgaard Høeg ,&nbsp;Pernille Oversø Hansen ,&nbsp;Oliver Niels Klefter ,&nbsp;Siar Niazi ,&nbsp;Miklos Schneider ,&nbsp;Yousif Subhi ,&nbsp;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":"2026-04-28","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}

{"title":"Evaluation of algorithmic bias in large language models for retinal clinical recommendations","authors":"Siddharth Gandhi ,&nbsp;Michael Balas ,&nbsp;Marko M. Popovic ,&nbsp;Peter J. Kertes ,&nbsp;Rajeev H. Muni ,&nbsp;Radha P. Kohly","doi":"10.1016/j.ajoint.2026.100233","DOIUrl":"10.1016/j.ajoint.2026.100233","url":null,"abstract":"<div><h3>Objective/Purpose</h3><div>To assess whether contemporary large language models (LLMs) exhibit demographic or socioeconomic bias when making clinical recommendations for retinal disease and to characterize model-specific equity and reliability profiles.</div></div><div><h3>Design</h3><div>Cross-sectional computational evaluation performed in July 2025.</div></div><div><h3>Subjects, Participants, and/or Controls</h3><div>Ten expert-designed clinical vignettes representing common retinal conditions (e.g., age-related macular degeneration, diabetic macular edema) were combined with 1440 systematically varied patient demographic and socioeconomic profiles (varying race, gender identity, insurance status, housing/clinic proximity, occupation, and age), yielding 14,400 unique simulated patient prompts.</div></div><div><h3>Methods, Intervention, or Testing</h3><div>Each unique prompt was submitted via stateless API calls to four LLMs (ChatGPT-4o, Claude 4 Sonnet, Gemini 2.5 Flash, DeepSeek-V2), generating 57,600 recommendations. The primary outcome was concordance with a predefined expert reference decision. Mixed-effects logistic regression modeled associations between patient factors and concordance, adjusting for vignette as a random effect. Demographic instability scores were calculated to quantify recommendation changes driven solely by non-clinical factors.</div></div><div><h3>Results</h3><div>Overall concordance differed significantly across models (<em>p</em> &lt; 0.001): 56.8% for Claude 4 Sonnet, 53.5% for ChatGPT-4o, 50.5% for DeepSeek-V2, and 45.9% for Gemini 2.5 Flash. In the pooled model, lack of health insurance (OR 0.80; 95% CI 0.76–0.85; <em>p</em> &lt; 0.001), unstable housing far from clinic (OR 0.84; 95% CI 0.79–0.91; <em>p</em> &lt; 0.001), and low-income occupation (OR 0.93; 95% CI 0.87–0.98; <em>p</em> = 0.014) were associated with lower odds of a concordant recommendation. Black patients were associated with higher odds of concordance compared with White patients (OR 1.20; 95% CI 1.11–1.30; <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Major LLMs display moderate concordance with reference retinal management decisions but demonstrate potential for substantial, model-specific, and context-dependent demographic and socioeconomic biases. These findings suggest that equity-focused evaluation beyond traditional accuracy metrics may be warranted before clinical deployment.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100233"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188385","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}

{"title":"Platelet-rich fibrin membrane versus conjunctival autograft in primary pterygium surgery: A comparative 12 months single center study","authors":"Hassan Moutei,&nbsp;Meriem bouzidi,&nbsp;Fouad Chraibi,&nbsp;Meriem Abdellaoui,&nbsp;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> &lt; 0.001). Conjunctival inflammation was consistently lower in Group B through 3 months (<em>p</em> &lt; 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> &gt; 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":"2026-04-28","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}

{"title":"Tele-eye care in Nigeria: interpreting acceptance through an equity and policy lens","authors":"Abha Gahlot ,&nbsp;Sushma Narsing Katkuri ,&nbsp;Janvi Patel ,&nbsp;Jeffrin Reneus Paul","doi":"10.1016/j.ajoint.2025.100206","DOIUrl":"10.1016/j.ajoint.2025.100206","url":null,"abstract":"<div><div>Teleophthalmology is increasingly promoted to expand access to eye care in low- and middle-income countries, yet there is a risk that new digital services primarily benefit already connected urban groups. This correspondence comments on a study of tele–eye care perspectives in Benin City, Nigeria, and argues that the reported high willingness to use mobile applications reflects attitudes among young, educated, digitally enabled clinic attendees rather than the wider population at greatest risk of vision loss. We highlight implications for equity and public health policy, proposing integration of tele–eye care into existing community and outreach-based eye-care programmes.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100206"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145749834","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}

{"title":"Linking multicenter electronic health records with socioeconomic data to examine receipt of standard versus premium intraocular lenses","authors":"Alaa Mohamedali ,&nbsp;Azraa S. Chaudhury ,&nbsp;Adovich S. Rivera ,&nbsp;Xueqing Zhou ,&nbsp;Joshua D. Stein ,&nbsp;Chris A. Andrews ,&nbsp;Yang Li ,&nbsp;Shikha Marwah ,&nbsp;Richa Shah ,&nbsp;Kunal Kanwar ,&nbsp;Charlesnika T. Evans ,&nbsp;Abel N. Kho ,&nbsp;Paul J. Bryar ,&nbsp;Dustin D. French ,&nbsp;Sight Outcomes Research Collaborative (SOURCE) Consortium","doi":"10.1016/j.ajoint.2025.100209","DOIUrl":"10.1016/j.ajoint.2025.100209","url":null,"abstract":"<div><h3>Purpose</h3><div>Premium intraocular lenses (IOLs) can improve visual outcomes and reduce dependence on glasses but often require out-of-pocket payment. The socioeconomic factors influencing their selection remain poorly understood. Leveraging a multi-institutional electronic health record dataset, we examined demographic and socioeconomic factors associated with receiving a premium versus standard IOL and the likelihood of switching IOL type (premium to standard or vice versa) between first and second cataract surgeries.</div></div><div><h3>Design</h3><div>Retrospective cohort study across 10 medical centers.</div></div><div><h3>Participants</h3><div>46,349 patients who underwent cataract surgery with IOL implantation from 2010 to 2023.</div></div><div><h3>Results</h3><div>9.7 % of patients received at least one premium intraocular lens (IOL). Toric lenses comprised 79 % of premium implants. Premium IOL recipients were more often White, English-speaking, higher income, and college educated. Black race (aOR 0.44, 95 % CI 0.30–0.66), non-English language (aOR 0.64, 95 % CI 0.44–0.94), lower income (aOR 0.40, 95 % CI 0.20–0.81), and lower education were associated with reduced odds of premium IOL implantation. Associations persisted after accounting for ocular comorbidities. Among bilateral cases, 4.2 % of patients switched IOL type between surgeries. Specifically, Black and lower-income patients were less likely to upgrade to a premium IOL for their second surgery.</div></div><div><h3>Conclusions</h3><div>Socioeconomic and racial factors are strongly associated with the choice of premium IOL, with toric lenses comprising the majority of premium implants. Targeted efforts to improve access and patient education may help ensure more equitable adoption of advanced lens technologies.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100209"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145747564","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}

{"title":"Impact of diabetic foot ulcers and nephropathy on risk of treatment-warranted diabetic eye disease: A retrospective cohort study","authors":"Alexander T. Hong ,&nbsp;Ivan Y. Luu ,&nbsp;Tze-Woei Tan ,&nbsp;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":"2026-04-28","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}