Pub Date : 2025-12-11Epub Date: 2025-12-01DOI: 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 : 2025-12-11Epub Date: 2025-11-08DOI: 10.1016/j.ajoint.2025.100200
Fatma Shakarchi , John Buchan , Allen Foster
Purpose
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.
Design
Cross-sectional, secondary data analysis.
Methods
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 (n = 25 data points), and performed a segmented linear correlation to account for the correlation between CSR and ophthalmologist density.
Results
The density of ophthalmologists per million population ranged from <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 <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.
Conclusions
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.
{"title":"Workforce distribution and cataract surgical rates in the eastern mediterranean (EMR) and middle east north Africa (MENA) regions","authors":"Fatma Shakarchi , John Buchan , 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 <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 <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":"2025-12-11","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}
Pub Date : 2025-12-11Epub Date: 2025-10-13DOI: 10.1016/j.ajoint.2025.100185
Ryan S. Huang , Andrew Mihalache , Marko M. Popovic , Clara C. Chan
Purpose
To investigate the changes in pro- and anti-inflammatory mediators following corneal collagen cross-linking (CXL) in patients with keratoconus (KC).
Design
Systematic review.
Methods
A comprehensive literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Library from inception to September 2024. Eligibility criteria included English studies reporting pre- and post-CXL changes in cytokine, chemokine, matrix metalloproteinase (MMP), and growth factor concentrations in adult patients with KC. The primary endpoint was the change in pro- and anti-inflammatory mediator concentrations following CXL. The secondary endpoint focused on correlations between post-CXL changes in inflammatory mediators and corneal tomography measurements. Descriptive statistics were used to report findings.
Results
Six prospective cohort studies were included, encompassing 173 eyes from 168 patients diagnosed with progressive KC. The mean age of participants was 25.3 years, and 69 % were male. Three studies reported on cytokine and chemokine levels, demonstrating a significant increase in interleukin-6 (IL-6) concentrations up to three months post-CXL, followed by a decline to levels below pre-CXL at 12 months. Additionally, MMP-9 levels and growth factors, such as nerve growth factor (NGF) and epidermal growth factor (EGF), significantly decreased 12 months post-CXL in two studies, respectively. Significant positive correlations were observed between changes in cytokine levels and tomographic parameters, including keratometry (Ks and Kf) and corneal thickness.
Conclusion
IL-6 levels may rise within the first three months post-CXL, followed by a decline to below baseline levels by 12 months. In contrast, MMP-13 concentrations may decrease within days of treatment, and MMP-9 levels may decline after one year. Similarly, both EGF and NGF may show post-CXL reductions, with NGF levels potentially reflecting underlying KC severity. Altogether, these patterns suggest an initial acute inflammatory response, followed by subsequent changes likely associated with the promotion of corneal healing. However, interpretation may be limited by the relatively small number of included studies and heterogeneity in patient severity, sample sizes, sampling methods, assays, and follow-up timepoints. Further research is required to elucidate their role in monitoring treatment response in patients with KC undergoing CXL.
{"title":"Evaluating changes in pro- and anti-inflammatory mediators in keratoconus following corneal collagen cross-linking: A systematic review","authors":"Ryan S. Huang , Andrew Mihalache , Marko M. Popovic , Clara C. Chan","doi":"10.1016/j.ajoint.2025.100185","DOIUrl":"10.1016/j.ajoint.2025.100185","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the changes in pro- and anti-inflammatory mediators following corneal collagen cross-linking (CXL) in patients with keratoconus (KC).</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>A comprehensive literature search was conducted using Ovid MEDLINE, Embase, and the Cochrane Library from inception to September 2024. Eligibility criteria included English studies reporting pre- and post-CXL changes in cytokine, chemokine, matrix metalloproteinase (MMP), and growth factor concentrations in adult patients with KC. The primary endpoint was the change in pro- and anti-inflammatory mediator concentrations following CXL. The secondary endpoint focused on correlations between post-CXL changes in inflammatory mediators and corneal tomography measurements. Descriptive statistics were used to report findings.</div></div><div><h3>Results</h3><div>Six prospective cohort studies were included, encompassing 173 eyes from 168 patients diagnosed with progressive KC. The mean age of participants was 25.3 years, and 69 % were male. Three studies reported on cytokine and chemokine levels, demonstrating a significant increase in interleukin-6 (IL-6) concentrations up to three months post-CXL, followed by a decline to levels below pre-CXL at 12 months. Additionally, MMP-9 levels and growth factors, such as nerve growth factor (NGF) and epidermal growth factor (EGF), significantly decreased 12 months post-CXL in two studies, respectively. Significant positive correlations were observed between changes in cytokine levels and tomographic parameters, including keratometry (Ks and Kf) and corneal thickness.</div></div><div><h3>Conclusion</h3><div>IL-6 levels may rise within the first three months post-CXL, followed by a decline to below baseline levels by 12 months. In contrast, MMP-13 concentrations may decrease within days of treatment, and MMP-9 levels may decline after one year. Similarly, both EGF and NGF may show post-CXL reductions, with NGF levels potentially reflecting underlying KC severity. Altogether, these patterns suggest an initial acute inflammatory response, followed by subsequent changes likely associated with the promotion of corneal healing. However, interpretation may be limited by the relatively small number of included studies and heterogeneity in patient severity, sample sizes, sampling methods, assays, and follow-up timepoints. Further research is required to elucidate their role in monitoring treatment response in patients with KC undergoing CXL.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100185"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320621","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 : 2025-12-11Epub Date: 2025-09-17DOI: 10.1016/j.ajoint.2025.100173
Emily Sun , Chen Dun , Susan K. Burden , Ambar Faridi , Laura K. Green , Andrea L. Kossler , Christina R. Prescott , Jamie B. Rosenberg , Erin M. Shriver , Grace Sun , Christina Y. Weng , Kimberly M. Winges , Maria A. Woodward , Fasika A. Woreta
Purpose
To examine gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. medical schools.
Design
Retrospective cross-sectional
Methods
Gender and academic rank for faculty where state laws mandate public salary disclosure for university employees were collected from department websites. Annual salary was collected from GovSalaries.com. Differences in rank and salary, by gender, were analyzed using Student’s t-test.
Results
Salaries were available from 28/122 departments (23 %) from 17 states (538 ophthalmologists, 41.1 % women). A smaller proportion of women were full professors compared to men (25.8 % vs. 46.7 %). A larger proportion were assistant professors (47.1 % vs. 30.1 %) or associate professors (27.1 % vs. 22.7 %). Medical retina, neuro-ophthalmology, and comprehensive ophthalmology had the largest gender disparity among full professors between men and women (15.4 % vs. 61.5 %; 31.3 % vs. 69.0 %; 5.9 % vs. 42.1 % respectively).
Women had lower salaries compared to men across all subspecialties ($281,718 vs. $364,017, p < 0.0001), including assistant professors ($229,389 vs. $265,974, p = 0.03). There were no significant differences among associate ($280,704 vs. $324,434, p = 0.15) or full professors ($378,264 vs. $447,531, p = 0.08). Among assistant professors, women had lower salaries in comprehensive ophthalmology ($224,755 vs. $441,742 p < 0.0001), cornea ($181,284 vs. $276,121, p = 0.05), and medical retina ($204,057 vs. $393,616, p = 0.03). Overall, women earned significantly less after controlling for subspecialty, VA status, rank, and region ($278,751 vs. $308,629, p = 0.015), and earned significantly less in comprehensive ophthalmology ($230,837 vs. $355,782, p = 0.038) and cornea ($289,211 vs. $360,546, p = 0.018).
Conclusions
Significant gender differences in rank and salary exist in several subspecialties. Further research is needed to identify effective strategies for these disparities.
{"title":"Gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. public medical schools","authors":"Emily Sun , Chen Dun , Susan K. Burden , Ambar Faridi , Laura K. Green , Andrea L. Kossler , Christina R. Prescott , Jamie B. Rosenberg , Erin M. Shriver , Grace Sun , Christina Y. Weng , Kimberly M. Winges , Maria A. Woodward , Fasika A. Woreta","doi":"10.1016/j.ajoint.2025.100173","DOIUrl":"10.1016/j.ajoint.2025.100173","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine gender differences in faculty rank and salary among ophthalmology subspecialists at U.S. medical schools.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional</div></div><div><h3>Methods</h3><div>Gender and academic rank for faculty where state laws mandate public salary disclosure for university employees were collected from department websites. Annual salary was collected from GovSalaries.com. Differences in rank and salary, by gender, were analyzed using Student’s <em>t</em>-test.</div></div><div><h3>Results</h3><div>Salaries were available from 28/122 departments (23 %) from 17 states (538 ophthalmologists, 41.1 % women). A smaller proportion of women were full professors compared to men (25.8 % vs. 46.7 %). A larger proportion were assistant professors (47.1 % vs. 30.1 %) or associate professors (27.1 % vs. 22.7 %). Medical retina, neuro-ophthalmology, and comprehensive ophthalmology had the largest gender disparity among full professors between men and women (15.4 % vs. 61.5 %; 31.3 % vs. 69.0 %; 5.9 % vs. 42.1 % respectively).</div><div>Women had lower salaries compared to men across all subspecialties ($281,718 vs. $364,017, <em>p</em> < 0.0001), including assistant professors ($229,389 vs. $265,974, <em>p</em> = 0.03). There were no significant differences among associate ($280,704 vs. $324,434, <em>p</em> = 0.15) or full professors ($378,264 vs. $447,531, <em>p</em> = 0.08). Among assistant professors, women had lower salaries in comprehensive ophthalmology ($224,755 vs. $441,742 <em>p</em> < 0.0001), cornea ($181,284 vs. $276,121, <em>p</em> = 0.05), and medical retina ($204,057 vs. $393,616, <em>p</em> = 0.03). Overall, women earned significantly less after controlling for subspecialty, VA status, rank, and region ($278,751 vs. $308,629, <em>p</em> = 0.015), and earned significantly less in comprehensive ophthalmology ($230,837 vs. $355,782, <em>p</em> = 0.038) and cornea ($289,211 vs. $360,546, <em>p</em> = 0.018).</div></div><div><h3>Conclusions</h3><div>Significant gender differences in rank and salary exist in several subspecialties. Further research is needed to identify effective strategies for these disparities.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158352","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 : 2025-12-11Epub Date: 2025-10-28DOI: 10.1016/j.ajoint.2025.100192
Anne X. Nguyen , Daniel R. Chow , Mélanie Hébert , Edsel Ing , Georges Nassrallah , Navdeep Nijhawan
Purpose
To identify disparities in access to complex oculofacial plastic care by mapping American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members’ service coverage areas (SCAs) in the United States (US).
Design
Cross-sectional analysis
Methods
We analyzed US-based ASOPRS members’ practice locations in ArcGIS Pro (Esri) to define SCAs as regions within a 60-minute drive. With American Community Survey data and chi-square tests, we compared social determinants of health within and outside SCAs.
Results
Of the 322,561,852 Americans, 260,154,031 (80.7 %) lived within a 60-minute driving time from one of the 635 ASOPRS members. The population outside 60-minute SCAs was significantly more likely to be White, Non-Hispanic, without university education, receiving social security income, residing in a household below federal poverty level, and lacking health insurance, compared to the population inside SCAs (each P < 0.001). States with the most ASOPRS members were California (n = 95, 2.4 per million residents), Texas (n = 47, 1.5/million) and Florida (n = 45, 2.0/million), while none practiced in Montana, North Dakota, South Dakota, New Mexico and Wyoming.
Conclusions
Inequitable geographic distribution of ASOPRS members disproportionately affects patients in rural areas and those with lower socio-economic status. Recognizing these geographic-social obstacles can inform policies to reduce barriers to complex oculofacial plastic care access.
{"title":"Geospatial analysis of accessibility to oculofacial plastic surgery in the United States: Driving distance and sociodemographic disparities","authors":"Anne X. Nguyen , Daniel R. Chow , Mélanie Hébert , Edsel Ing , Georges Nassrallah , Navdeep Nijhawan","doi":"10.1016/j.ajoint.2025.100192","DOIUrl":"10.1016/j.ajoint.2025.100192","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify disparities in access to complex oculofacial plastic care by mapping American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members’ service coverage areas (SCAs) in the United States (US).</div></div><div><h3>Design</h3><div>Cross-sectional analysis</div></div><div><h3>Methods</h3><div>We analyzed US-based ASOPRS members’ practice locations in ArcGIS Pro (Esri) to define SCAs as regions within a 60-minute drive. With American Community Survey data and chi-square tests, we compared social determinants of health within and outside SCAs.</div></div><div><h3>Results</h3><div>Of the 322,561,852 Americans, 260,154,031 (80.7 %) lived within a 60-minute driving time from one of the 635 ASOPRS members. The population outside 60-minute SCAs was significantly more likely to be White, Non-Hispanic, without university education, receiving social security income, residing in a household below federal poverty level, and lacking health insurance, compared to the population inside SCAs (each <em>P</em> < 0.001). States with the most ASOPRS members were California (<em>n</em> = 95, 2.4 per million residents), Texas (<em>n</em> = 47, 1.5/million) and Florida (<em>n</em> = 45, 2.0/million), while none practiced in Montana, North Dakota, South Dakota, New Mexico and Wyoming.</div></div><div><h3>Conclusions</h3><div>Inequitable geographic distribution of ASOPRS members disproportionately affects patients in rural areas and those with lower socio-economic status. Recognizing these geographic-social obstacles can inform policies to reduce barriers to complex oculofacial plastic care access.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466036","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 : 2025-12-11Epub Date: 2025-10-25DOI: 10.1016/j.ajoint.2025.100190
Ha-Neul Yu , Jocelyn He , Benjamin Kim , Gui-Shuang Ying
Purpose
While diabetic retinopathy (DR) has previously been linked to neurodegenerative diseases, it remains unclear whether DR independently reflects neurodegenerative diseases beyond those attributable to diabetes itself. In this study, we leveraged data from the All of Us Research Program to assess whether DR serves as an independent marker of neurodegenerative disease among individuals with diabetes.
Methods
A matched case-control, cross-sectional study was conducted using data from the All of Us Research Program (US-based EHR database). Three groups (exactly matched by age, sex, and race) were created and compared: individuals with both DR and DM (DR+DM, n = 7629), individuals with DM but no DR (DM-only, n = 22,887), and individuals without DM (n = 22,887). Outcomes included dementia, Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS). Univariate and multivariate logistic regression analyses were performed, adjusting for demographics, comorbidities and diabetes-related mediators.
Results
In multivariable analysis, DM-only was associated with increased odds of dementia (adjusted odds ratio [aOR] 1.28, 95 % CI: 1.08–1.51; p = 0.004). However, DR in the setting of DM (DM+DR vs. DM-only) was not associated with further increased odds of neurodegenerative disease outcome in multivariate models (aOR for dementia 1.18, 95 % CI: 0.94–1.49). No significant associations were identified for AD, PD, or MS (all p ≥ 0.10).
Conclusion
Diabetic retinopathy was not associated with increased rates of neurodegenerative diseases beyond that conferred by diabetes itself, and the relationship may be mediated by diabetes severity and related comorbidities.
虽然糖尿病视网膜病变（DR）先前已被认为与神经退行性疾病有关，但目前尚不清楚DR是否独立反映了除糖尿病本身引起的神经退行性疾病。在这项研究中，我们利用来自我们所有人研究计划的数据来评估DR是否可以作为糖尿病患者神经退行性疾病的独立标志物。方法采用匹配的病例对照横断面研究，数据来自All of Us Research Program（美国电子病历数据库）。研究人员创建了三组（按年龄、性别和种族完全匹配）进行比较：同时患有糖尿病和糖尿病的个体（DR+DM, n = 7629）、患有糖尿病但没有糖尿病的个体（仅患有糖尿病，n = 22,887）和没有糖尿病的个体（n = 22,887）。结果包括痴呆、阿尔茨海默病（AD）、帕金森病（PD）和多发性硬化症（MS）。进行单变量和多变量logistic回归分析，调整人口统计学、合并症和糖尿病相关介质。结果在多变量分析中，仅dm与痴呆风险增加相关（校正优势比[aOR] 1.28, 95% CI: 1.08-1.51; p = 0.004）。然而，在多变量模型中，DM组的DR （DM+DR vs - DM）与神经退行性疾病结局的几率进一步增加无关（痴呆的aOR为1.18,95% CI: 0.94-1.49）。未发现AD、PD或MS有显著相关性（均p≥0.10）。结论糖尿病视网膜病变与糖尿病本身引起的神经退行性疾病发生率增加无关，可能与糖尿病严重程度及相关合并症有关。
{"title":"Association between diabetic retinopathy and neurodegenerative diseases in the All of Us research program","authors":"Ha-Neul Yu , Jocelyn He , Benjamin Kim , Gui-Shuang Ying","doi":"10.1016/j.ajoint.2025.100190","DOIUrl":"10.1016/j.ajoint.2025.100190","url":null,"abstract":"<div><h3>Purpose</h3><div>While diabetic retinopathy (DR) has previously been linked to neurodegenerative diseases, it remains unclear whether DR independently reflects neurodegenerative diseases beyond those attributable to diabetes itself. In this study, we leveraged data from the All of Us Research Program to assess whether DR serves as an independent marker of neurodegenerative disease among individuals with diabetes.</div></div><div><h3>Methods</h3><div>A matched case-control, cross-sectional study was conducted using data from the All of Us Research Program (US-based EHR database). Three groups (exactly matched by age, sex, and race) were created and compared: individuals with both DR and DM (DR+DM, <em>n</em> = 7629), individuals with DM but no DR (DM-only, <em>n</em> = 22,887), and individuals without DM (<em>n</em> = 22,887). Outcomes included dementia, Alzheimer’s disease (AD), Parkinson’s disease (PD), and multiple sclerosis (MS). Univariate and multivariate logistic regression analyses were performed, adjusting for demographics, comorbidities and diabetes-related mediators.</div></div><div><h3>Results</h3><div>In multivariable analysis, DM-only was associated with increased odds of dementia (adjusted odds ratio [aOR] 1.28, 95 % CI: 1.08–1.51; <em>p</em> = 0.004). However, DR in the setting of DM (DM+DR vs. DM-only) was not associated with further increased odds of neurodegenerative disease outcome in multivariate models (aOR for dementia 1.18, 95 % CI: 0.94–1.49). No significant associations were identified for AD, PD, or MS (all <em>p</em> ≥ 0.10).</div></div><div><h3>Conclusion</h3><div>Diabetic retinopathy was not associated with increased rates of neurodegenerative diseases beyond that conferred by diabetes itself, and the relationship may be mediated by diabetes severity and related comorbidities.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416744","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 : 2025-12-11Epub Date: 2025-11-19DOI: 10.1016/j.ajoint.2025.100202
Jumanah Qedair , Konrad Schargel , Sami AlShahwan , Ibrahim AlObaida
Purpose
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.
Design
We conducted a systematic review and meta-analysis, following PRISMA guidelines.
Methods
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.
Results
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<0.01).
Conclusion
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.
{"title":"Xen45 gel stent versus trabeculectomy for glaucoma: A systematic review and meta-analysis of efficacy and safety","authors":"Jumanah Qedair , Konrad Schargel , Sami AlShahwan , 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<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":"2025-12-11","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}
Pub Date : 2025-12-11Epub Date: 2025-09-26DOI: 10.1016/j.ajoint.2025.100176
Seowoong Jun , Joon Yul Choi , Tae Keun Yoo
Purpose
To investigate the associations between serum lipid levels and diabetic retinopathy (DR) in Korean adults with diabetes.
Design
Cross-sectional analysis of a nationally representative survey.
Methods
We analyzed 1,378 adults with diabetes from the Korea National Health and Nutrition Examination Survey (2008–2011). DR was ascertained from fundus photographs and medical history. Lipids (total cholesterol, HDL, LDL, triglycerides, non-HDL) were modeled by quintiles and with restricted cubic splines. Multivariable logistic regression adjusted for age, sex, systolic blood pressure, hemoglobin A1c, and statin use. Sensitivity analyses used multiple imputation.
Results
DR was present in 301/1,378 participants (21.8%). Adjusted models showed no linear trends for cholesterol measures. In quintile analyses, total cholesterol exhibited higher odds of DR at both extremes versus the middle quintile (Q3): Q1 OR 1.63 (95% CI, 1.04–2.57); Q4 OR 1.64 (1.06–2.57); Q5 OR 1.59 (1.03–2.49); P for U-shape = 0.008 (Q2 OR 1.42 [0.90–2.23]). LDL and non-HDL also demonstrated U-shaped patterns (P for U-shape = 0.029 and 0.038). Spline models supported U-shaped association for total cholesterol (P = 0.031), LDL (P = 0.039), and non-HDL (P = 0.014). No consistent nonlinear associations were observed for HDL or triglycerides. Multiple-imputation results were concordant, reinforcing the U-shape for total cholesterol.
Conclusions
Total cholesterol, LDL, and non-HDL showed U-shaped nonlinear associations with DR, indicating elevated risk at both low and high concentrations. Maintaining lipids within an intermediate range may support retinal vascular health and refine metabolic risk stratification in diabetes.
{"title":"Non-linear association between serum lipid levels and diabetic retinopathy in a nationally representative Korean population","authors":"Seowoong Jun , Joon Yul Choi , Tae Keun Yoo","doi":"10.1016/j.ajoint.2025.100176","DOIUrl":"10.1016/j.ajoint.2025.100176","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the associations between serum lipid levels and diabetic retinopathy (DR) in Korean adults with diabetes.</div></div><div><h3>Design</h3><div>Cross-sectional analysis of a nationally representative survey.</div></div><div><h3>Methods</h3><div>We analyzed 1,378 adults with diabetes from the Korea National Health and Nutrition Examination Survey (2008–2011). DR was ascertained from fundus photographs and medical history. Lipids (total cholesterol, HDL, LDL, triglycerides, non-HDL) were modeled by quintiles and with restricted cubic splines. Multivariable logistic regression adjusted for age, sex, systolic blood pressure, hemoglobin A1c, and statin use. Sensitivity analyses used multiple imputation.</div></div><div><h3>Results</h3><div>DR was present in 301/1,378 participants (21.8%). Adjusted models showed no linear trends for cholesterol measures. In quintile analyses, total cholesterol exhibited higher odds of DR at both extremes versus the middle quintile (Q3): Q1 OR 1.63 (95% CI, 1.04–2.57); Q4 OR 1.64 (1.06–2.57); Q5 OR 1.59 (1.03–2.49); P for U-shape = 0.008 (Q2 OR 1.42 [0.90–2.23]). LDL and non-HDL also demonstrated U-shaped patterns (P for U-shape = 0.029 and 0.038). Spline models supported U-shaped association for total cholesterol (P = 0.031), LDL (P = 0.039), and non-HDL (P = 0.014). No consistent nonlinear associations were observed for HDL or triglycerides. Multiple-imputation results were concordant, reinforcing the U-shape for total cholesterol.</div></div><div><h3>Conclusions</h3><div>Total cholesterol, LDL, and non-HDL showed U-shaped nonlinear associations with DR, indicating elevated risk at both low and high concentrations. Maintaining lipids within an intermediate range may support retinal vascular health and refine metabolic risk stratification in diabetes.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100176"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220604","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 : 2025-12-11Epub Date: 2025-09-23DOI: 10.1016/j.ajoint.2025.100174
Muhammad Alfatih , Ananda Kukuh Adishabri , Ni Luh Putu Yunia Dewi , Alfiani Zukhruful Fitri Rifa'i , Michaela Kemuning , Dillan Cunha Amaral , Bruno Fortaleza de Aquino Ferreira , Ricardo Noguera Louzada , Ari Djatikusumo , Hashem Abu Serhan
Purpose
Post-traumatic endophthalmitis (PTE) is a leading cause of irreversible vision loss after ocular trauma; despite widespread vitrectomy, outcomes vary and predictors remain unclear. This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.
Design
A systematic review and meta-analysis.
Methods
We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.
Results
Nine studies (n = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; p < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (p = 0.027; p = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (p = 0.45). Certainty was low to very low.
Conclusion
Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.
目的创伤后眼内炎（PTE）是眼外伤后不可逆性视力丧失的主要原因；尽管玻璃体切除术广泛应用，但结果各不相同，预测因素仍不清楚。本研究旨在系统评估PTE玻璃体切除术后最佳矫正视力（BCVA）改善和最终BCVA≥20/200的眼睛比例，并利用meta回归研究结果的潜在决定因素。设计系统回顾和荟萃分析。方法按照PRISMA指南进行meta分析，并在PROSPERO注册该方案（CRD42024606195）。符合条件的研究包括≥80%因PTE接受玻璃体切除术的参与者。预先指定的主要结局是BCVA改善的比例；最后随访时的最终BCVA≥20/200作为附加结果进行评估。进行随机效应荟萃分析，并使用亚组和荟萃回归分析来探索结果修饰因子。使用GRADE评估证据的确定性。结果纳入9项研究（n = 448只眼）。BCVA改善的眼睛总比例为0.80 (95% CI 0.63-0.90; I²= 90%)，成人（≥18岁；0.91）显著高于儿童/青少年（18岁；0.65;p < 0.01）。meta回归显示，较高的硅油用量和IOFB比例与BCVA改善相关（p = 0.027; p = 0.017），而角膜进入和基线视网膜脱离无关。最终BCVA≥20/200的比例为0.33 (95% CI 0.23-0.45; I²= 67.9%)，无年龄差异（p = 0.45）。确定性从低到非常低。结论玻璃体切除术治疗PTE通常能改善视力，尤其是成人，而移动视力（≥20/200）较少见。考虑到单臂荟萃分析、大量异质性和低确定性评级，这些估计应谨慎解释。需要多中心随机试验来验证这些发现，并评估硅油填塞的潜在作用。
{"title":"Proportion of eyes with visual-acuity improvement after vitrectomy for post-traumatic endophthalmitis: A meta-analysis","authors":"Muhammad Alfatih , Ananda Kukuh Adishabri , Ni Luh Putu Yunia Dewi , Alfiani Zukhruful Fitri Rifa'i , Michaela Kemuning , Dillan Cunha Amaral , Bruno Fortaleza de Aquino Ferreira , Ricardo Noguera Louzada , Ari Djatikusumo , Hashem Abu Serhan","doi":"10.1016/j.ajoint.2025.100174","DOIUrl":"10.1016/j.ajoint.2025.100174","url":null,"abstract":"<div><h3>Purpose</h3><div>Post-traumatic endophthalmitis (PTE) is a leading cause of irreversible vision loss after ocular trauma; despite widespread vitrectomy, outcomes vary and predictors remain unclear. This study aims to systematically evaluate the proportion of eyes showing the best-corrected visual acuity (BCVA) improvement and final BCVA ≥ 20/200 after vitrectomy for PTE and to investigate potential determinants of outcome using meta-regression.</div></div><div><h3>Design</h3><div>A systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>We conducted a meta-analysis following the PRISMA guidelines and registered the protocol in PROSPERO (CRD42024606195). Eligible studies included ≥80 % of participants undergoing vitrectomy for PTE. The prespecified primary outcome was the proportion with any BCVA improvement; final BCVA ≥20/200 at last follow-up was assessed as an additional outcome. Random-effects meta-analysis was performed, and subgroup and meta-regression analyses were used to explore outcome modifiers. Certainty of evidence was assessed using GRADE.</div></div><div><h3>Results</h3><div>Nine studies (<em>n</em> = 448 eyes) were included. The pooled proportion of eyes with any BCVA improvement was 0.80 (95 % CI 0.63–0.90; I² = 90 %), significantly higher in adults (≥18 years; 0.91) than in children/adolescents (<18 years; 0.65; <em>p</em> < 0.01). Meta-regression suggested higher silicone-oil use and IOFB proportion correlated with BCVA improvement (<em>p</em> = 0.027; <em>p</em> = 0.017), while corneal-entry and baseline retinal detachment were not associated. The proportion achieving final BCVA ≥20/200 was 0.33 (95 % CI 0.23–0.45; I²=67.9 %) with no age difference (<em>p</em> = 0.45). Certainty was low to very low.</div></div><div><h3>Conclusion</h3><div>Vitrectomy for PTE often yielded visual improvement, particularly in adults, while ambulatory vision (≥20/200) was less common. Given the single-arm meta-analysis, substantial heterogeneity, and low-certainty ratings, these estimates should be interpreted cautiously. Multicenter randomized trials are needed to verify these findings and to evaluate the potential role of silicone-oil tamponade.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100174"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220603","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 : 2025-12-11Epub Date: 2025-10-27DOI: 10.1016/j.ajoint.2025.100194
Luis Filipe Nakayama , Lucas Zago Ribeiro , Cindy Lie Tabuse , Fernando Korn Malerbi , Caio Regatieri
Purpose: To evaluate and compare commercially available portable retinal cameras with a focus on technical specifications, clinical applications, and the integration of artificial intelligence (AI) for ophthalmic screening, especially in low- and middle-income countries (LMICs). Design: Systematic review of the literature. Methods: Systematic searches of PubMed and OpenAlex were conducted up to September 2025, without language restrictions, using terms such as portable retinal camera, handheld retinal camera, and smartphone-based fundus camera. Devices were included if they were commercially available and described in peer-reviewed publications with technical or clinical data. Prototypes and systems relying solely on external smartphone lenses without integrated optics were excluded. Data extracted included imaging specifications, ergonomics, power sources, AI functionalities, quality control features, and reported clinical applications. Devices were categorized as smartphone-attached or standalone handheld systems. Results: The search retrieved 870 records (PubMed = 277; OpenAlex = 593). After removing duplicates and screening, 509 articles were included in the review, collectively reporting on 38 portable retinal cameras, of which 17 were commercially available. The most frequently reported devices were the Volk Pictor Plus, Phelcom Eyer, Optomed Aurora, ZEISS VISUSCOUT 100, and Remidio FOP. Smartphone attached systems offered greater portability and affordability, whereas standalone handheld systems provided integrated functionality, higher imaging stability, and smoother clinical integration. AI features varied across devices, encompassing referable diabetic retinopathy detection, abnormality triage, systemic risk prediction, and automated image-quality assessment. Clinical applications extended beyond diabetic retinopathy and retinopathy of prematurity to include glaucoma, AMD, and exploratory use in systemic conditions such as sepsis and COVID-19. Conclusion: Portable retinal cameras already demonstrate clear utility in extending ophthalmic screening and diagnostic services, particularly for diabetic retinopathy and retinopathy of prematurity, while also showing potential in broader clinical and systemic applications. Their portability and cost-effectiveness make them valuable for outreach and telemedicine programs, especially in LMICs. The integration of artificial intelligence further enhances their functionality, though variability in device design, regional availability, and regulatory status highlights the need for standardized validation, recurring local assessments, and head-to-head comparative studies. Real-world evaluations remain essential to ensure effective, safe, and equitable deployment.
{"title":"A comprehensive review of portable retinal cameras: Technical features, ai integration, and clinical potential","authors":"Luis Filipe Nakayama , Lucas Zago Ribeiro , Cindy Lie Tabuse , Fernando Korn Malerbi , Caio Regatieri","doi":"10.1016/j.ajoint.2025.100194","DOIUrl":"10.1016/j.ajoint.2025.100194","url":null,"abstract":"<div><div>Purpose: To evaluate and compare commercially available portable retinal cameras with a focus on technical specifications, clinical applications, and the integration of artificial intelligence (AI) for ophthalmic screening, especially in low- and middle-income countries (LMICs). Design: Systematic review of the literature. Methods: Systematic searches of PubMed and OpenAlex were conducted up to September 2025, without language restrictions, using terms such as portable retinal camera, handheld retinal camera, and smartphone-based fundus camera. Devices were included if they were commercially available and described in peer-reviewed publications with technical or clinical data. Prototypes and systems relying solely on external smartphone lenses without integrated optics were excluded. Data extracted included imaging specifications, ergonomics, power sources, AI functionalities, quality control features, and reported clinical applications. Devices were categorized as smartphone-attached or standalone handheld systems. Results: The search retrieved 870 records (PubMed = 277; OpenAlex = 593). After removing duplicates and screening, 509 articles were included in the review, collectively reporting on 38 portable retinal cameras, of which 17 were commercially available. The most frequently reported devices were the Volk Pictor Plus, Phelcom Eyer, Optomed Aurora, ZEISS VISUSCOUT 100, and Remidio FOP. Smartphone attached systems offered greater portability and affordability, whereas standalone handheld systems provided integrated functionality, higher imaging stability, and smoother clinical integration. AI features varied across devices, encompassing referable diabetic retinopathy detection, abnormality triage, systemic risk prediction, and automated image-quality assessment. Clinical applications extended beyond diabetic retinopathy and retinopathy of prematurity to include glaucoma, AMD, and exploratory use in systemic conditions such as sepsis and COVID-19. Conclusion: Portable retinal cameras already demonstrate clear utility in extending ophthalmic screening and diagnostic services, particularly for diabetic retinopathy and retinopathy of prematurity, while also showing potential in broader clinical and systemic applications. Their portability and cost-effectiveness make them valuable for outreach and telemedicine programs, especially in LMICs. The integration of artificial intelligence further enhances their functionality, though variability in device design, regional availability, and regulatory status highlights the need for standardized validation, recurring local assessments, and head-to-head comparative studies. Real-world evaluations remain essential to ensure effective, safe, and equitable deployment.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466039","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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