Transpupillary thermotherapy (TTT) is used as a focal treatment modality for smaller retinoblastoma tumors, however its efficacy in thicker tumors is limited. This study evaluated whether indocyanine green (ICG) augmentation of TTT (ICGeTTT) improves tumor regression compared to TTT alone for residual chemoreduced retinoblastomas >2 mm in height.
Methods
In this randomized controlled trial, simple randomisation table was used to allocate 28 chemoreduced tumors to treatment with either TTT (group 1) or ICGeTTT (group 2). Treatment was administered every 3–4 weeks until tumor height was <2 mm or a maximum of four sessions were completed.
Results
The baseline tumor height was higher for the ICGeTTT group. Adjusted analysis for this baseline difference showed a statistically significant greater reduction in tumor height for group 2 (44 %) as compared to group 1 (21 %) (p = 0.018). The percentage of tumors achieving complete regression was higher in group 2 but this difference did not reach statistical significance. The cumulative energy used and side effects from treatment were similar between the groups.
Conclusion
Despite the limitations of the study including the small sample size and the baseline difference, the study still demonstrated a greater tumor height reduction with the use of ICGeTTT as compared to TTT in chemoreduced thick residual tumors and hence ICGeTTT may be preferred in such cases.
{"title":"“Indocyanine green enhanced TTT Vs TTT for treatment of thicker tumors in Retinoblastoma- a randomised control trial”","authors":"Ipsita Barman , Rachna Meel , Neelam Pushker , Vinod Kumar , Neiwete Lomi , Anjolie Chhabra , Mandeep S. Bajaj","doi":"10.1016/j.ajoint.2025.100213","DOIUrl":"10.1016/j.ajoint.2025.100213","url":null,"abstract":"<div><h3>Background</h3><div>Transpupillary thermotherapy (TTT) is used as a focal treatment modality for smaller retinoblastoma tumors, however its efficacy in thicker tumors is limited. This study evaluated whether indocyanine green (ICG) augmentation of TTT (ICGeTTT) improves tumor regression compared to TTT alone for residual chemoreduced retinoblastomas >2 mm in height.</div></div><div><h3>Methods</h3><div>In this randomized controlled trial, simple randomisation table was used to allocate 28 chemoreduced tumors to treatment with either TTT (group 1) or ICGeTTT (group 2). Treatment was administered every 3–4 weeks until tumor height was <2 mm or a maximum of four sessions were completed.</div></div><div><h3>Results</h3><div>The baseline tumor height was higher for the ICGeTTT group. Adjusted analysis for this baseline difference showed a statistically significant greater reduction in tumor height for group 2 (44 %) as compared to group 1 (21 %) (<em>p</em> = 0.018). The percentage of tumors achieving complete regression was higher in group 2 but this difference did not reach statistical significance. The cumulative energy used and side effects from treatment were similar between the groups.</div></div><div><h3>Conclusion</h3><div>Despite the limitations of the study including the small sample size and the baseline difference, the study still demonstrated a greater tumor height reduction with the use of ICGeTTT as compared to TTT in chemoreduced thick residual tumors and hence ICGeTTT may be preferred in such cases.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841388","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 : 2025-12-11DOI: 10.1016/j.ajoint.2025.100205
Hye Won Jun , Sun Young Ryu , Tae Keun Yoo
Purpose
To assess whether multimodal large language models (MLLMs) can reproduce classical intraocular lens (IOL) power calculations and provide usable backup guidance when standard calculators are unavailable or for educational purposes.
Design
Methods-comparison feasibility study.
Methods
From a public IOLMaster 700 dataset, 180 eyes were sampled and stratified by axial length and anterior chamber depth. IOL powers were computed by device Sanders–Retzlaff–Kraff/Theoretical (SRK/T) (reference), Barrett Universal II (APACRS), and three MLLMs (ChatGPT-5, Gemini-2.5-Pro, ChatGPT-4o) using identical biometry. Agreement metrics included mean absolute error (MAE) and the proportion within ±0.25, ±0.50, and ±1.00 D versus device SRK/T.
Results
ChatGPT-5 and Gemini-2.5-Pro implemented SRK/T using effective lens position estimation and a vergence approach, whereas ChatGPT-4o defaulted to SRK I unless tightly constrained. ChatGPT-5 showed near-reference agreement with SRK/T (MAE 0.30 D; 78.8% within ±0.50 D vs SRK/T), while Gemini-2.5-Pro and ChatGPT-4o had larger errors. Subgroup analyses across axial length–anterior chamber depth strata showed that ChatGPT-5 did not differ significantly from SRK/T after Bonferroni correction, whereas Gemini-2.5-Pro and ChatGPT-4o exhibited significant positive biases in long and short eyes. Agreement patterns were similar when Barrett Universal II was used as the secondary comparator.
Conclusion
MLLMs, particularly ChatGPT-5, may provide a portable, stepwise backup for classical IOL power calculation (SRK/T). MLLMs may offer educational value and serve as a secondary check on conventional calculations but should not replace validated biometry platforms, especially in eyes with extreme biometry. Prospective, outcome-based validation and usability testing are warranted before any real-world clinical deployment.
{"title":"Multimodal large language models for IOL power calculation in cataract surgery: A feasibility study","authors":"Hye Won Jun , Sun Young Ryu , Tae Keun Yoo","doi":"10.1016/j.ajoint.2025.100205","DOIUrl":"10.1016/j.ajoint.2025.100205","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess whether multimodal large language models (MLLMs) can reproduce classical intraocular lens (IOL) power calculations and provide usable backup guidance when standard calculators are unavailable or for educational purposes.</div></div><div><h3>Design</h3><div>Methods-comparison feasibility study.</div></div><div><h3>Methods</h3><div>From a public IOLMaster 700 dataset, 180 eyes were sampled and stratified by axial length and anterior chamber depth. IOL powers were computed by device Sanders–Retzlaff–Kraff/Theoretical (SRK/T) (reference), Barrett Universal II (APACRS), and three MLLMs (ChatGPT-5, Gemini-2.5-Pro, ChatGPT-4o) using identical biometry. Agreement metrics included mean absolute error (MAE) and the proportion within ±0.25, ±0.50, and ±1.00 D versus device SRK/T.</div></div><div><h3>Results</h3><div>ChatGPT-5 and Gemini-2.5-Pro implemented SRK/T using effective lens position estimation and a vergence approach, whereas ChatGPT-4o defaulted to SRK I unless tightly constrained. ChatGPT-5 showed near-reference agreement with SRK/T (MAE 0.30 D; 78.8% within ±0.50 D vs SRK/T), while Gemini-2.5-Pro and ChatGPT-4o had larger errors. Subgroup analyses across axial length–anterior chamber depth strata showed that ChatGPT-5 did not differ significantly from SRK/T after Bonferroni correction, whereas Gemini-2.5-Pro and ChatGPT-4o exhibited significant positive biases in long and short eyes. Agreement patterns were similar when Barrett Universal II was used as the secondary comparator.</div></div><div><h3>Conclusion</h3><div>MLLMs, particularly ChatGPT-5, may provide a portable, stepwise backup for classical IOL power calculation (SRK/T). MLLMs may offer educational value and serve as a secondary check on conventional calculations but should not replace validated biometry platforms, especially in eyes with extreme biometry. Prospective, outcome-based validation and usability testing are warranted before any real-world clinical deployment.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100205"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736585","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 : 2025-12-11DOI: 10.1016/j.ajoint.2025.100169
Mapa Prabhath Piyasena
{"title":"Special issue on evidence-based global health in ophthalmology – AJO international","authors":"Mapa Prabhath Piyasena","doi":"10.1016/j.ajoint.2025.100169","DOIUrl":"10.1016/j.ajoint.2025.100169","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736584","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 : 2025-12-11DOI: 10.1016/j.ajoint.2025.100164
ACSB Carneiro , JM Furtado , A Leite , ALF Darcie , AC Ribeiro , LM Hopker , C Nakanami , SP Donahue , JD Rossetto
{"title":"Corrigendum to “The Brazilian experience on screening, visual assessment, and prescription of glasses in childhood: A perspective of global interest” [AJO International (2025) Volume 2, Issue 3, 100158]","authors":"ACSB Carneiro , JM Furtado , A Leite , ALF Darcie , AC Ribeiro , LM Hopker , C Nakanami , SP Donahue , JD Rossetto","doi":"10.1016/j.ajoint.2025.100164","DOIUrl":"10.1016/j.ajoint.2025.100164","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736586","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 : 2025-12-11DOI: 10.1016/j.ajoint.2025.100210
Xi Dai , Muhammad Jehanzeb Khan , Ahmed Sabit , Mustafa Iftikhar , Jiangxia Wang , Jessica Chow , Joshua D. Stein , Fasika A. Woreta
Purpose
To assess sociodemographic factors associated with the extent of VI at initial presentation from four of the most common causes of vision loss in the US.
Design
Retrospective cohort analysis
Participants
Patients ≥ age 40 in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository presenting with cataract, glaucoma, diabetic retinopathy, or age-related macular degeneration ≥ 1 eye between Jan 1, 2012 and Dec 31, 2020.
Methods
VI was categorized into none/mild (20/40 or better), moderate (< 20/40 to > 20/200), and severe (20/200 or worse) based on best recorded better acuity in the better seeing eye at initial presentation. A multinomial logistic regression model was used to evaluate risk factors associated with VI at initial presentation.
Main Outcome Measures
Odds of moderate and severe VI at initial visit.
Results
We included 331,473 patients across seven participating sites. The mean (SD) age was 67.5 (10.5) years and 58.8% were female. Across the four disease categories, compared with White patients, Black, Asian, Hispanic, and Native American patients had higher odds of moderate VI (aOR 1.32, 1.35, 1.62, 1.51) and severe VI (aOR 1.59, 1.07, 1.50, 1.56), respectively. Non English speaking patients had higher odds of presenting with moderate and severe VI (aOR 1.17 and 2.25). Patients living in less affluent communities were also more likely to present with moderate (aOR 1.12, 1.22, 1.29, 1.12) and severe VI (aOR 1.30, 1.37, 1.47, 1.42) across the four disease categories. For Native American patients with severe VI, the adjusted odds ratio was 1.56 (95% CI 1.48 to 1.65).
Conclusions
These findings highlight the importance of targeted public health strategies, including language-concordant care to address disparities in vision health and promote earlier diagnosis and treatment for vulnerable populations in the US.
{"title":"Association between sociodemographic factors and visual impairment at initial presentation: A SOURCE data repository analysis","authors":"Xi Dai , Muhammad Jehanzeb Khan , Ahmed Sabit , Mustafa Iftikhar , Jiangxia Wang , Jessica Chow , Joshua D. Stein , Fasika A. Woreta","doi":"10.1016/j.ajoint.2025.100210","DOIUrl":"10.1016/j.ajoint.2025.100210","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess sociodemographic factors associated with the extent of VI at initial presentation from four of the most common causes of vision loss in the US.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis</div></div><div><h3>Participants</h3><div>Patients ≥ age 40 in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Data Repository presenting with cataract, glaucoma, diabetic retinopathy, or age-related macular degeneration ≥ 1 eye between Jan 1, 2012 and Dec 31, 2020.</div></div><div><h3>Methods</h3><div>VI was categorized into none/mild (20/40 or better), moderate (< 20/40 to > 20/200), and severe (20/200 or worse) based on best recorded better acuity in the better seeing eye at initial presentation. A multinomial logistic regression model was used to evaluate risk factors associated with VI at initial presentation.</div></div><div><h3>Main Outcome Measures</h3><div>Odds of moderate and severe VI at initial visit.</div></div><div><h3>Results</h3><div>We included 331,473 patients across seven participating sites. The mean (SD) age was 67.5 (10.5) years and 58.8% were female. Across the four disease categories, compared with White patients, Black, Asian, Hispanic, and Native American patients had higher odds of moderate VI (aOR 1.32, 1.35, 1.62, 1.51) and severe VI (aOR 1.59, 1.07, 1.50, 1.56), respectively. Non English speaking patients had higher odds of presenting with moderate and severe VI (aOR 1.17 and 2.25). Patients living in less affluent communities were also more likely to present with moderate (aOR 1.12, 1.22, 1.29, 1.12) and severe VI (aOR 1.30, 1.37, 1.47, 1.42) across the four disease categories. For Native American patients with severe VI, the adjusted odds ratio was 1.56 (95% CI 1.48 to 1.65).</div></div><div><h3>Conclusions</h3><div>These findings highlight the importance of targeted public health strategies, including language-concordant care to address disparities in vision health and promote earlier diagnosis and treatment for vulnerable populations in the US.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100210"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798362","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 : 2025-12-10DOI: 10.1016/j.ajoint.2025.100212
Ngozi C. Chidi-Egboka , Chameen Samarawickrama , Fiona Stapleton , Laura E. Downie , Tanya Trinh , Maria Markoulli , Elsie Chan , Jern Yee Chen , Jason Holland , Stephanie L. Watson
Background
There is a need to translate evidence from randomised controlled trials (RCTs) into recommendations for prescribing topical ciclosporin A (CsA) in ocular surface disease (OSD), to inform clinicians and support improvements in Australian eyecare and research.
Methods
A systematic review with meta-analysis, review of the Therapeutic Goods Administration approvals, Pharmaceutical Benefit Scheme (Australia) and evaluation of the quality of available evidence with expert-led consensus was used to develop practical recommendations for the use of topical CsA for OSD.
Results
Most RCTs of topical CsA for OSD were available for aqueous-deficient dry eye disease (DED). In the RCTs, prior to prescribing topical CsA, patients were assessed for symptoms (e.g., Ocular Surface Disease Index) and signs (e.g., tear secretion, corneal fluorescein staining). In Australia, topical CsA was available as Ikervis® (CsA 0.1 % cationic nanoemulsion), Cequa® (CsA 0.09 % nanomicellar solution), Restasis® (CsA 0.05 % oil-in-water emulsion) and compounded products (CsA 0.02 %, 0.05 %, 0.2 %, 0.5 %, 1.0 %). Recommendations for prescribing topical CsA included that it could be considered when DED symptoms and/or signs were not adequately controlled by preservative-free artificial tear monotherapy. Timeline for an improvement with CsA treatment was noted as within 4 to 12 weeks, to inform follow-up schedules. Potential ocular side effects associated with topical CsA included stinging and irritation on instillation. Evidence was limited for topical CsA use in individuals <18 years and it was not recommended for patients planning a pregnancy, or who are pregnant or lactating.
Conclusion
Topical CsA may be used to treat OSD, with most evidence supporting its efficacy for aqueous-deficient DED. Treatment in adults, aside from pregnant or lactating patients or those planning pregnancy, was generally safe with no serious adverse events reported.
{"title":"Evidence- and consensus-based practical recommendations for use of topical ciclosporin to treat ocular surface disease in Australian clinical practice","authors":"Ngozi C. Chidi-Egboka , Chameen Samarawickrama , Fiona Stapleton , Laura E. Downie , Tanya Trinh , Maria Markoulli , Elsie Chan , Jern Yee Chen , Jason Holland , Stephanie L. Watson","doi":"10.1016/j.ajoint.2025.100212","DOIUrl":"10.1016/j.ajoint.2025.100212","url":null,"abstract":"<div><h3>Background</h3><div>There is a need to translate evidence from randomised controlled trials (RCTs) into recommendations for prescribing topical ciclosporin A (CsA) in ocular surface disease (OSD), to inform clinicians and support improvements in Australian eyecare and research.</div></div><div><h3>Methods</h3><div>A systematic review with meta-analysis, review of the Therapeutic Goods Administration approvals, Pharmaceutical Benefit Scheme (Australia) and evaluation of the quality of available evidence with expert-led consensus was used to develop practical recommendations for the use of topical CsA for OSD.</div></div><div><h3>Results</h3><div>Most RCTs of topical CsA for OSD were available for aqueous-deficient dry eye disease (DED). In the RCTs, prior to prescribing topical CsA, patients were assessed for symptoms (e.g., Ocular Surface Disease Index) and signs (e.g., tear secretion, corneal fluorescein staining). In Australia, topical CsA was available as Ikervis® (CsA 0.1 % cationic nanoemulsion), Cequa® (CsA 0.09 % nanomicellar solution), Restasis® (CsA 0.05 % oil-in-water emulsion) and compounded products (CsA 0.02 %, 0.05 %, 0.2 %, 0.5 %, 1.0 %). Recommendations for prescribing topical CsA included that it could be considered when DED symptoms and/or signs were not adequately controlled by preservative-free artificial tear monotherapy. Timeline for an improvement with CsA treatment was noted as within 4 to 12 weeks, to inform follow-up schedules. Potential ocular side effects associated with topical CsA included stinging and irritation on instillation. Evidence was limited for topical CsA use in individuals <18 years and it was not recommended for patients planning a pregnancy, or who are pregnant or lactating.</div></div><div><h3>Conclusion</h3><div>Topical CsA may be used to treat OSD, with most evidence supporting its efficacy for aqueous-deficient DED. Treatment in adults, aside from pregnant or lactating patients or those planning pregnancy, was generally safe with no serious adverse events reported.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798446","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 : 2025-12-09DOI: 10.1016/j.ajoint.2025.100209
Alaa Mohamedali , Azraa S. Chaudhury , Adovich S. Rivera , Xueqing Zhou , Joshua D. Stein , Chris A. Andrews , Yang Li , Shikha Marwah , Richa Shah , Kunal Kanwar , Charlesnika T. Evans , Abel N. Kho , Paul J. Bryar , Dustin D. French , Sight Outcomes Research Collaborative (SOURCE) Consortium
Purpose
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.
Design
Retrospective cohort study across 10 medical centers.
Participants
46,349 patients who underwent cataract surgery with IOL implantation from 2010 to 2023.
Results
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.
Conclusions
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.
目的：优质人工晶状体（iol）可以改善视力，减少对眼镜的依赖，但往往需要自费。影响他们选择的社会经济因素仍然知之甚少。利用多机构电子健康记录数据集，我们研究了与接受优质与标准IOL相关的人口统计学和社会经济因素，以及在第一次和第二次白内障手术之间转换IOL类型（优质到标准或反之亦然）的可能性。设计：10个医疗中心的回顾性队列研究。结果9.7%的患者接受了至少一个优质人工晶状体（IOL）植入。环面晶状体占79%的优质植入物。高级人工晶状体接受者通常是白人，会说英语，收入较高，受过大学教育。黑人（aOR 0.44, 95% CI 0.30-0.66）、非英语（aOR 0.64, 95% CI 0.44 - 0.94）、收入较低（aOR 0.40, 95% CI 0.20-0.81）和教育程度较低与优质人工晶体植入术的几率降低相关。在考虑眼部合并症后，相关性仍然存在。在双侧病例中，4.2%的患者在手术之间切换了IOL类型。具体来说，黑人和低收入患者不太可能在第二次手术时升级到高级人工晶状体。结论社会经济和种族因素与选择优质人工晶状体密切相关，其中环面晶状体占大多数。有针对性地努力改善获取和患者教育，可能有助于确保更公平地采用先进的隐形眼镜技术。
{"title":"Linking multicenter electronic health records with socioeconomic data to examine receipt of standard versus premium intraocular lenses","authors":"Alaa Mohamedali , Azraa S. Chaudhury , Adovich S. Rivera , Xueqing Zhou , Joshua D. Stein , Chris A. Andrews , Yang Li , Shikha Marwah , Richa Shah , Kunal Kanwar , Charlesnika T. Evans , Abel N. Kho , Paul J. Bryar , Dustin D. French , 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":"2025-12-09","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}
Retinoblastoma (RB) is the most common intraocular tumor in the pediatric age group. Aqueous humor (AH)-derived cell free (cf)DNA has recently emerged as a reliable surrogate for tumor DNA. The present study aimed to strengthen the results of our previous study on the feasibility of genetic analysis in AH derived cfDNA and compare it to peripheral blood and tumor tissue of RB patients.
Methods
Paired samples of AH, peripheral blood, and tumor tissue were collected in five patients with advanced intraocular retinoblastoma (ICRB Group D/E) undergoing primary enucleation. DNA from blood leukocytes, tumor tissue and AH cf DNA was isolated using standard protocols and QIAamp® Circulating Nucleic Acid kits respectively and subjected to next generation sequencing to identify RB1 mutations across different sample sources.
Results
The mean concentration of AH cf DNA from five group E retinoblastoma eyes was 75.56 ng/ul (range 41.3->120ng/ul). Loss-of-function RB1 mutations identified were RB1c.1363C>T (p.Arg455Ter), c.1735C>T(p.Arg579Ter), RB1cc.381–2A>G (3′ splice site), RB1c.2330del (p.Pro777LeufsTer33) in four males and RB1c.1072C>T (p.Arg358Ter) in one female patient. Concordance in the mutations identified in AH and tumor tissue was seen while no mutations were identified from blood (leucocytes) in any of the cases. Histopathology of the tumor tissue revealed poor differentiation in four and moderate differentiation in one eye with varying degrees of necrosis and calcification.
Conclusion
Our study supports previous evidence of the role of AH cfDNA in detecting tumor-specific mutations in RB with high concordance with tumor tissue, thus furnishing incremental evidence on the feasibility of genetic analysis of AH derived cfDNA of RB patients in an Indian tertiary-care context.
{"title":"Aqueous humor derived cell free DNA: A minimally invasive tool for RB tumor mutation detection","authors":"Rachna Meel , Renu Singh , Sahil Agarwal , Pooja Chauhan , Seema Kashyap , Lata Singh , Arundhati Sharma","doi":"10.1016/j.ajoint.2025.100211","DOIUrl":"10.1016/j.ajoint.2025.100211","url":null,"abstract":"<div><h3>Purpose</h3><div>Retinoblastoma (RB) is the most common intraocular tumor in the pediatric age group. Aqueous humor (AH)-derived cell free (cf)DNA has recently emerged as a reliable surrogate for tumor DNA. The present study aimed to strengthen the results of our previous study on the feasibility of genetic analysis in AH derived cfDNA and compare it to peripheral blood and tumor tissue of RB patients.</div></div><div><h3>Methods</h3><div>Paired samples of AH, peripheral blood, and tumor tissue were collected in five patients with advanced intraocular retinoblastoma (ICRB Group D/E) undergoing primary enucleation. DNA from blood leukocytes, tumor tissue and AH cf DNA was isolated using standard protocols and QIAamp® Circulating Nucleic Acid kits respectively and subjected to next generation sequencing to identify <em>RB1</em> mutations across different sample sources.</div></div><div><h3>Results</h3><div>The mean concentration of AH cf DNA from five group E retinoblastoma eyes was 75.56 ng/ul (range 41.3->120ng/ul). Loss-of-function <em>RB1</em> mutations identified were RB1c.1363C><em>T</em> (p.Arg455Ter), c.1735C><em>T</em>(p.Arg579Ter), <em>RB1</em>cc.381–2A><em>G</em> (3′ splice site), RB1c.2330del (p.Pro777LeufsTer33) in four males and RB1c.1072C><em>T</em> (p.Arg358Ter) in one female patient. Concordance in the mutations identified in AH and tumor tissue was seen while no mutations were identified from blood (leucocytes) in any of the cases. Histopathology of the tumor tissue revealed poor differentiation in four and moderate differentiation in one eye with varying degrees of necrosis and calcification.</div></div><div><h3>Conclusion</h3><div>Our study supports previous evidence of the role of AH cfDNA in detecting tumor-specific mutations in RB with high concordance with tumor tissue, thus furnishing incremental evidence on the feasibility of genetic analysis of AH derived cfDNA of RB patients in an Indian tertiary-care context.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100211"},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145798447","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 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.
Design
Retrospective observational study.
Subjects, Participants, and/or Controls
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.
Methods, Intervention, or Testing
We analyzed 38 eyes with RVO who received intravitreal injections of aflibercept (n = 31) or ranibizumab (n = 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.
Main Outcome Measures
Changes in regional retinal and choroidal thickness
Results
Post-injection, retinal thickness significantly decreased in all regions except L4 and L6 (p < 0.0056). Choroidal thickness showed a significant reduction in L2, L5, and L8 (p < 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 (n = 26) exhibited choroidal thinning in L4, L5, L6, and L8 (p < 0.0056), whereas female patients (n = 12) showed no significant changes in any region.
Conclusion
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.
{"title":"Effect of anti-VEGF therapy on wide-field retinal and choroidal thickness in macular edema secondary to retinal vein occlusion","authors":"Risa Araki , Yohei Tomita , Tomonori Yuda , Xiaoyan Jiang , Norimitsu Ban , Hiromitsu Kunimi , Atsuro Uchida , Toshihide Kurihara , Hajime Shinoda , 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> < 0.0056). Choroidal thickness showed a significant reduction in L2, L5, and L8 (<em>p</em> < 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> < 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":"2025-12-05","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}
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.
{"title":"Tele-eye care in Nigeria: interpreting acceptance through an equity and policy lens","authors":"Abha Gahlot , Sushma Narsing Katkuri , Janvi Patel , 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":"2025-12-02","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}
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