AJO International最新文献

{"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 ,&nbsp;Chameen Samarawickrama ,&nbsp;Fiona Stapleton ,&nbsp;Laura E. Downie ,&nbsp;Tanya Trinh ,&nbsp;Maria Markoulli ,&nbsp;Elsie Chan ,&nbsp;Jern Yee Chen ,&nbsp;Jason Holland ,&nbsp;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 &lt;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}

{"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":"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}

{"title":"Aqueous humor derived cell free DNA: A minimally invasive tool for RB tumor mutation detection","authors":"Rachna Meel ,&nbsp;Renu Singh ,&nbsp;Sahil Agarwal ,&nbsp;Pooja Chauhan ,&nbsp;Seema Kashyap ,&nbsp;Lata Singh ,&nbsp;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-&gt;120ng/ul). Loss-of-function <em>RB1</em> mutations identified were RB1c.1363C&gt;<em>T</em> (p.Arg455Ter), c.1735C&gt;<em>T</em>(p.Arg579Ter), <em>RB1</em>cc.381–2A&gt;<em>G</em> (3′ splice site), RB1c.2330del (p.Pro777LeufsTer33) in four males and RB1c.1072C&gt;<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}

{"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":"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}

{"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":"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}

{"title":"Optimizing glaucoma care in Ghana: a mixed-methods study of optometrists' practices, challenges, and capacity needs","authors":"Irene Nkansa-Kyeremateng ,&nbsp;Albert Kwadjo Amoah Andoh ,&nbsp;Eldrick Adu Acquah ,&nbsp;Isaiah Osei Duah Junior ,&nbsp;Beatrice Okrah ,&nbsp;Kwadwo Owusu Akuffo","doi":"10.1016/j.ajoint.2025.100204","DOIUrl":"10.1016/j.ajoint.2025.100204","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the practice patterns, challenges, and improvement strategies in glaucoma care among optometrists in Ghana.</div></div><div><h3>Design</h3><div>A cross-sectional study using a mixed-methods approach.</div></div><div><h3>Methods</h3><div>Quantitative data on demographics, clinical practices, associated factors, perceived barriers, and recommendations for improved glaucoma care were collected from 293 licensed optometrists registered with the Ghana Optometric Association using a structured questionnaire (distributed both in-person and online via Microsoft Forms), yielding a response rate of 44.1%. Qualitative insights were obtained through semi-structured interviews with nine optometrists, selected using purposive stratified sampling.</div></div><div><h3>Results</h3><div>Most respondents had formal training in glaucoma care through didactic courses and practical training in their completed degree programs. However, over one-third lacked standardized clinical care protocols. Clinical care centered on intraocular pressure measurement and optic nerve evaluation, with medical therapy as the primary treatment. Referrals were commonly triggered by poor treatment response (mainly based on IOP measurement) or advanced disease. The existence of clearly defined clinical protocols demonstrated a statistically significant association with increased provision of glaucoma care among optometrists (<em>p</em> = 0.008). Thematic analysis identified key challenges to the provision of glaucoma care, including patient noncompliance, financial barriers, and limited access to diagnostic tools. Recommended strategies for improvement included enhanced training, improved diagnostic infrastructure, and increased public education.</div></div><div><h3>Conclusion</h3><div>Optometrists play a vital role in glaucoma care in Ghana. However, gaps in guideline awareness, protocol use, and diagnostic capacity remain. Strengthening training, equipping clinics, and promoting public education are essential to improving glaucoma care nationwide.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"3 1","pages":"Article 100204"},"PeriodicalIF":0.0,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694956","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":"Xen45 gel stent versus trabeculectomy for glaucoma: A systematic review and meta-analysis of efficacy and safety","authors":"Jumanah Qedair ,&nbsp;Konrad Schargel ,&nbsp;Sami AlShahwan ,&nbsp;Ibrahim AlObaida","doi":"10.1016/j.ajoint.2025.100202","DOIUrl":"10.1016/j.ajoint.2025.100202","url":null,"abstract":"<div><h3>Purpose</h3><div>Although trabeculectomy is invasive, it remains the gold standard for refractory glaucoma. The XEN45 Gel Stent provides a minimally-invasive alternative; however, comprehensive data comparing its efficacy and safety to trabeculectomy remain limited. This meta-analysis evaluates outcomes between XEN45 and trabeculectomy.</div></div><div><h3>Design</h3><div>We conducted a systematic review and meta-analysis, following PRISMA guidelines.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science, and CENTRAL from inception to July 2025. We pooled weighted mean differences (WMDs), proportions, and odds ratios (ORs), using random-effects maximum likelihood models. Primary outcomes included intraocular pressure (IOP) reduction; complete success, qualified success, and failure rates; and risk of hyphema and hypotony.</div></div><div><h3>Results</h3><div>Twelve studies (2,381 eyes [XEN45: 1,106; trabeculectomy: 1,275]) were included. Open-angle glaucoma was the predominant diagnosis (XEN45: 78.7 %; trabeculectomy: 74.7 %). Trabeculectomy showed greater IOP reduction rates (WMD: 11.9 mmHg [95 % CI: 10.2–13.7]) compared to the XEN45 Gel Stent (WMD: 9.1 mmHg [95 % CI: 7.4–10.8], p=0.02). Trabeculectomy achieved higher complete success rates (63.0 % [95 % CI: 56.0–70.0]) than XEN45 (47.0 % [95 % CI: 40.0–55.0], p=0.004), with no significant difference in qualified success (67.0 % vs. 58.0 %, p=0.44). Failure rates were significantly lower in the trabeculectomy group (10.0 % vs. 25.0 %, p=0.002). XEN45 demonstrated a superior safety profile, with significantly reduced risks of hyphema (OR: 0.34, p=0.04), hypotony (OR: 0.31, p=0.01), bleb fibrosis (OR: 0.68, p=0.01), and bleb leak (OR: 0.16, p&lt;0.01).</div></div><div><h3>Conclusion</h3><div>Trabeculectomy demonstrates superior IOP control and higher complete success rates, but at the expense of a higher complication profile. XEN45 offers a relatively safer but less effective alternative. A patient-tailored approach is essential when selecting the optimal surgical intervention.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100202"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571350","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 structure-function correlation between vessel density on OCTA and macular sensitivity on microperimetry in sickle cell retinopathy in children, adolescents, and young adults","authors":"Naira Ikram ,&nbsp;Francisco Altamirano ,&nbsp;Celine Chaaya ,&nbsp;Hanna De Bruyn ,&nbsp;Sandra Hoyek ,&nbsp;Inès Fenniri ,&nbsp;Osama Sorour ,&nbsp;Anne Fulton ,&nbsp;Pablo Altschwager ,&nbsp;Efren Gonzalez ,&nbsp;Nimesh A. Patel","doi":"10.1016/j.ajoint.2025.100203","DOIUrl":"10.1016/j.ajoint.2025.100203","url":null,"abstract":"<div><h3>Background</h3><div>To identify associations between microvascular changes and functional macular sensitivity in children, adolescents, and young adults with sickle cell disease (SCD).</div></div><div><h3>Methods</h3><div>This analysis included patients (8–22 years) with SCD with optical coherence tomography-angiography (OCTA) and microperimetry testing between March 2023 and December 2024. Superficial (SCP) and deep (DCP) capillary plexi scans were divided into four quadrants: supero-temporal (ST), supero-nasal (SN), infero-temporal (IT), and infero-nasal (IN). Microperimetry examinations were analyzed using the 4–2 visual field method and a 68-point, 10-degree grid using the Macular Integrity Assessment (MAIA). Spearman correlation and mixed effects regression models assessed associations between vessel density (VD, measured in mm/mm²) and microperimetry sensitivity.</div></div><div><h3>Results</h3><div>Thirty-two eyes were included. Most were Black, non-Hispanic patients (71.9 %) with hemoglobin SS disease (62.5 %). The median age and best-corrected visual acuity (BCVA) at testing were 14.6 years (IQR, 12.2–17.5) and 0 logMAR (IQR, 0–0.1) (Snellen 20/20), respectively. Half of eyes (50 %) had some degree of sickle cell retinopathy. There were few cases of severe retinopathy (9.4 %). Median age was 14.54 (IQR, 9.34–13.61). Median VD in the SCP and DCP were lowest in the infero-temporal quadrant (27.64 and 23.80, respectively). After adjusting for covariates, microperimetry sensitivity remained positively associated with VD in the supero-temporal region, both for the SCP (β=0.44, <em>p</em> = 0.010) and the DCP (β =0.36, <em>p</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>In children, adolescents, and young adults with sickle cell disease, loss of vessel density in the supero-temporal region of the SCP and DCP was associated with decreased sensitivity on microperimetry. This may support a structure-function correlation, compelling further investigation of the impact of impaired retinal perfusion on subclinical vision loss.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100203"},"PeriodicalIF":0.0,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617675","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":"Paracentral acute middle maculopathy and hemodynamically significant patent foramen ovale","authors":"Chiara Muzio ,&nbsp;Federica Fossataro ,&nbsp;Stefano Erba ,&nbsp;Stefano De Angelis ,&nbsp;Manuela Mambretti ,&nbsp;Marco Pisaniello ,&nbsp;Marco Nassisi ,&nbsp;Giuseppe Casalino ,&nbsp;Francesco Viola","doi":"10.1016/j.ajoint.2025.100201","DOIUrl":"10.1016/j.ajoint.2025.100201","url":null,"abstract":"<div><h3>Purpose</h3><div>To report a possible association between paracentral acute middle maculopathy (PAMM) and hemodynamically significant patent foramen ovale (PFO), and to propose a cardiovascular screening strategy for patients with unexplained isolated PAMM.</div></div><div><h3>Design</h3><div>Retrospective multicenter case series.</div></div><div><h3>Methods</h3><div>Electronic medical records and multimodal retinal imaging findings of consecutive patients with PAMM and hemodynamically significant PFO presenting at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico and Ophthalmic Hospital, ASST Fatebenefratelli Sacco between January 2019 and December 2024. Initial spectral domain optical coherence tomography (SD-OCT) showed a band-like hyperreflective lesion at the inner nuclear layer (INL) in all cases.</div></div><div><h3>Results</h3><div>A total of five patients (three males; mean age 62 years, range 54–71) with PAMM were found to have a hemodynamically significant PFO. Four out of five had isolated PAMM and were included in this series. In three cases the PFO was discovered after the cardiologist referral; one patient was known for PFO and Factor V Leiden mutation. In all cases PFO was the only embolic source identified after an extensive workup. Management included surgical or percutaneous closure or antithrombotic therapy. Over a mean 12-month follow-up (range: 6–21), SD-OCT showed progressive attenuation and thinning of the INL; visual acuity improved or remained stable. None of the patients experienced recurrent retinal or cerebral ischemic events during follow-up.</div></div><div><h3>Conclusions</h3><div>Our series suggests that isolated PAMM is possibly linked to hemodynamically significant PFO, supporting the need for a targeted cardiovascular assessment, including bubble contrast echocardiography.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100201"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571351","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":"Workforce distribution and cataract surgical rates in the eastern mediterranean (EMR) and middle east north Africa (MENA) regions","authors":"Fatma Shakarchi ,&nbsp;John Buchan ,&nbsp;Allen Foster","doi":"10.1016/j.ajoint.2025.100200","DOIUrl":"10.1016/j.ajoint.2025.100200","url":null,"abstract":"<div><h3>Purpose</h3><div>This study analyses the distribution of ophthalmic human resources in countries of the Eastern Mediterranean Region (EMR) and the Middle East North Africa (MENA), and their productivity in relation to cataract surgery.</div></div><div><h3>Design</h3><div>Cross-sectional, secondary data analysis.</div></div><div><h3>Methods</h3><div>The analysis compiled secondary data available in the public domain, on the ophthalmic workforce and Cataract Surgical Rate (CSR), defined as the number of cataract surgeries performed annually per million population, using the International Agency for the Prevention of Blindness (IAPB) Vision Atlas and the Rapid Assessment of Avoidable Blindness (RAAB) Repository. We included data from 25 countries (<em>n</em> = 25 data points), and performed a segmented linear correlation to account for the correlation between CSR and ophthalmologist density.</div></div><div><h3>Results</h3><div>The density of ophthalmologists per million population ranged from &lt;1 per million population in Somalia and South Sudan to 70 per million in Saudi Arabia. There was a positive correlation between the number of ophthalmologists per million and CSR up to approximately 20 ophthalmologists/million, after which the association was not found. On average, ophthalmologists performed &lt;1 to 22 cataract surgery per week in countries of the region. Iran and Pakistan showed the highest CSR values and CSRs per ophthalmologist/week among the countries analysed.</div></div><div><h3>Conclusions</h3><div>There are wide variations in the availability and productivity of ophthalmic personnel in terms of cataract surgeries/ophthalmologist/week between countries in the region. These findings highlight the need to strengthen efficiency, equitable access, and data quality across eye care systems in the region. Wider adoption of newer indicators, particularly the effective cataract surgical coverage (eCSC), would provide additional information on equity and quality of cataract services.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100200"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145571349","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}