This study compared the 15-month outcomes of treat-and-extend (TAE) therapy with aflibercept (Af) and faricimab (Fa) in comparable cases selected by propensity score matching (PSM).
Design
Retrospective observational study.
Methods
Forty-seven eyes in the Af and Fa groups were matched for age, sex, baseline best-corrected visual acuity (BCVA), central macular thickness (CMT), age-related macular degeneration subtype, intraretinal fluid, and subretinal hyperreflective material. The TAE regimen consisted of three monthly injections, followed by monthly interval adjustments up to a maximum of four months. Changes in BCVA and CMT were assessed after 15 months.
Results
At 15 months, dry macula was achieved in 35 eyes (74.5 %) in the AF group and 37 eyes (78.7 %) in the Fa group. Both groups revealed significant improvements in the BCVA and CMT with no intergroup differences. The mean number of injections was identical (6.4 ± 0.7). No serious systemic adverse events occurred after 303 injections in either group. One Fa-treated eye developed a large subretinal hemorrhage that required displacement surgery, and no other serious ocular complications were noted.
Conclusions
PSM analysis demonstrated that Fa-based TAE was as effective as Af-based TAE in real-world practice, providing a foundation for evaluating long-term outcomes.
{"title":"Propensity score analysis of treat-and-extend therapy with aflibercept versus faricimab in age-related macular degeneration","authors":"Akira Obana, Ryo Asaoka, Kaori Ishii, Risa Nakazawa, Kei Asaoka, Norikazu Matsumura, Yuko Gohto","doi":"10.1016/j.ajoint.2025.100178","DOIUrl":"10.1016/j.ajoint.2025.100178","url":null,"abstract":"<div><h3>Purpose</h3><div>This study compared the 15-month outcomes of treat-and-extend (TAE) therapy with aflibercept (Af) and faricimab (Fa) in comparable cases selected by propensity score matching (PSM).</div></div><div><h3>Design</h3><div>Retrospective observational study.</div></div><div><h3>Methods</h3><div>Forty-seven eyes in the Af and Fa groups were matched for age, sex, baseline best-corrected visual acuity (BCVA), central macular thickness (CMT), age-related macular degeneration subtype, intraretinal fluid, and subretinal hyperreflective material. The TAE regimen consisted of three monthly injections, followed by monthly interval adjustments up to a maximum of four months. Changes in BCVA and CMT were assessed after 15 months.</div></div><div><h3>Results</h3><div>At 15 months, dry macula was achieved in 35 eyes (74.5 %) in the AF group and 37 eyes (78.7 %) in the Fa group. Both groups revealed significant improvements in the BCVA and CMT with no intergroup differences. The mean number of injections was identical (6.4 ± 0.7). No serious systemic adverse events occurred after 303 injections in either group. One Fa-treated eye developed a large subretinal hemorrhage that required displacement surgery, and no other serious ocular complications were noted.</div></div><div><h3>Conclusions</h3><div>PSM analysis demonstrated that Fa-based TAE was as effective as Af-based TAE in real-world practice, providing a foundation for evaluating long-term outcomes.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267172","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: 2025-10-22DOI: 10.1016/j.ajoint.2025.100189
Elad Shvartz , Regina Raiyter , Amelia Goldshtein , Omri Zur , Eyal Margalit , Daniel Bahir
Purpose
Large language models (LLMs) are increasingly evaluated in ophthalmology, often using single test iterations that overlook whether responses remain consistent under repeated conditions. We aim to assess commonly used AI models under multiple testing iterations with varying conditions, including time of day, user credentials, and input type to determine their stability in ophthalmology contexts.
Design
Comparative analysis study.
Methods
We tested GPT-4o, GPT-4, and Gemini 2.0 Experimental Advanced on 111 multiple-choice questions from the “fundamentals” section of the Israeli ophthalmology residency exams. Each underwent 12 testing iterations, alternating daily testing time and user accounts to assess for potential biases. Iteration-level consistency was assessed by variation in accuracy across runs, while question-level consistency measured agreement in answers per question. Mixed-effects logistic regression estimated the effects of time of day, user account, and question modality. Question-level agreement was further analysed with Fleiss’ κ and response-pattern distributions.
Results
Gemini achieved the highest overall accuracy with smallest variation (84.5 %, SD 1.54), followed by GPT-4o (81.2 %, SD 1.75) and GPT-4 (72.4 %, SD 2.98). Mixed-effects models showed significant evening performance decline in GPT-4 (OR 1.61, p = 0.0045). No account-related differences were observed. All models performed markedly worse on image-based items than text (p < 0.001). Question-level analysis revealed high raw consistency but lower corrected consistency, especially for GPT-4.
Conclusions
LLMs tested demonstrated stable outputs across repeated questioning, though with notable model-specific variability and consistent challenges in image-based items. Future consistency testing should complement accuracy assessments when evaluating LLMs for potential integration into ophthalmology education and practice.
{"title":"Assessing consistency of AI chatbot responses in ophthalmology medical exams","authors":"Elad Shvartz , Regina Raiyter , Amelia Goldshtein , Omri Zur , Eyal Margalit , Daniel Bahir","doi":"10.1016/j.ajoint.2025.100189","DOIUrl":"10.1016/j.ajoint.2025.100189","url":null,"abstract":"<div><h3>Purpose</h3><div>Large language models (LLMs) are increasingly evaluated in ophthalmology, often using single test iterations that overlook whether responses remain consistent under repeated conditions. We aim to assess commonly used AI models under multiple testing iterations with varying conditions, including time of day, user credentials, and input type to determine their stability in ophthalmology contexts.</div></div><div><h3>Design</h3><div>Comparative analysis study.</div></div><div><h3>Methods</h3><div>We tested GPT-4o, GPT-4, and Gemini 2.0 Experimental Advanced on 111 multiple-choice questions from the “fundamentals” section of the Israeli ophthalmology residency exams. Each underwent 12 testing iterations, alternating daily testing time and user accounts to assess for potential biases. Iteration-level consistency was assessed by variation in accuracy across runs, while question-level consistency measured agreement in answers per question. Mixed-effects logistic regression estimated the effects of time of day, user account, and question modality. Question-level agreement was further analysed with Fleiss’ κ and response-pattern distributions.</div></div><div><h3>Results</h3><div>Gemini achieved the highest overall accuracy with smallest variation (84.5 %, SD 1.54), followed by GPT-4o (81.2 %, SD 1.75) and GPT-4 (72.4 %, SD 2.98). Mixed-effects models showed significant evening performance decline in GPT-4 (OR 1.61, <em>p</em> = 0.0045). No account-related differences were observed. All models performed markedly worse on image-based items than text (<em>p</em> < 0.001). Question-level analysis revealed high raw consistency but lower corrected consistency, especially for GPT-4.</div></div><div><h3>Conclusions</h3><div>LLMs tested demonstrated stable outputs across repeated questioning, though with notable model-specific variability and consistent challenges in image-based items. Future consistency testing should complement accuracy assessments when evaluating LLMs for potential integration into ophthalmology education and practice.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416834","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: 2025-11-02DOI: 10.1016/j.ajoint.2025.100197
Shirali Gokharu, Namita Kumari, Chhavi Gupta, Obaidur Rehman, Sima Das
Purpose
To identify causes of non-compliance and evaluate effectiveness of interventions in improving retinoblastoma (RB) treatment compliance.
Design
Retrospective observational analytical study.
Methods
The staging and grouping of RB were determined according to International Retinoblastoma Staging System and the International Classification of Intraocular Retinoblastoma respectively. Medical records of RB patients treated at a North Indian tertiary ocular oncology center (July 2019–June 2022) were reviewed. Compliance was defined as adherence to treatment plans and timely follow-ups. Patients in Group 1 (July 2019–Dec 2020, n = 60) received standard care, while Group 2 (Jan 2021–June 2022, n = 86) additionally received financial, logistic, and counselling support. Compliance and treatment barriers, assessed through parental interviews, were compared.
Results
Both the groups had similar demographics. Compliance improved from 67 % (Group 1) to 78 % (Group 2). Major barriers included financial constraints (69 %), refusal of enucleation (27 %), family/social issues (14 %), cultural beliefs (13 %), and COVID-19 restrictions (9 %).
Conclusion
Additional support led to better treatment compliance, though the improvement was not statistically significant. Non-compliance persisted in 22 % of patients, mainly due to advanced disease, reluctance to enucleation, and sociocultural challenges. Sustained improvements in compliance require community awareness, family education, and early detection strategies.
{"title":"Treatment compliance in retinoblastoma management – An approach to identifying and addressing barriers, and assessing compliance rate","authors":"Shirali Gokharu, Namita Kumari, Chhavi Gupta, Obaidur Rehman, Sima Das","doi":"10.1016/j.ajoint.2025.100197","DOIUrl":"10.1016/j.ajoint.2025.100197","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify causes of non-compliance and evaluate effectiveness of interventions in improving retinoblastoma (RB) treatment compliance.</div></div><div><h3>Design</h3><div>Retrospective observational analytical study.</div></div><div><h3>Methods</h3><div>The staging and grouping of RB were determined according to International Retinoblastoma Staging System and the International Classification of Intraocular Retinoblastoma respectively. Medical records of RB patients treated at a North Indian tertiary ocular oncology center (July 2019–June 2022) were reviewed. Compliance was defined as adherence to treatment plans and timely follow-ups. Patients in Group 1 (July 2019–Dec 2020, <em>n</em> = 60) received standard care, while Group 2 (Jan 2021–June 2022, <em>n</em> = 86) additionally received financial, logistic, and counselling support. Compliance and treatment barriers, assessed through parental interviews, were compared.</div></div><div><h3>Results</h3><div>Both the groups had similar demographics. Compliance improved from 67 % (Group 1) to 78 % (Group 2). Major barriers included financial constraints (69 %), refusal of enucleation (27 %), family/social issues (14 %), cultural beliefs (13 %), and COVID-19 restrictions (9 %).</div></div><div><h3>Conclusion</h3><div>Additional support led to better treatment compliance, though the improvement was not statistically significant. Non-compliance persisted in 22 % of patients, mainly due to advanced disease, reluctance to enucleation, and sociocultural challenges. Sustained improvements in compliance require community awareness, family education, and early detection strategies.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519491","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: 2025-11-13DOI: 10.1016/j.ajoint.2025.100201
Chiara Muzio , Federica Fossataro , Stefano Erba , Stefano De Angelis , Manuela Mambretti , Marco Pisaniello , Marco Nassisi , Giuseppe Casalino , Francesco Viola
Purpose
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.
Design
Retrospective multicenter case series.
Methods
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.
Results
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.
Conclusions
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.
{"title":"Paracentral acute middle maculopathy and hemodynamically significant patent foramen ovale","authors":"Chiara Muzio , Federica Fossataro , Stefano Erba , Stefano De Angelis , Manuela Mambretti , Marco Pisaniello , Marco Nassisi , Giuseppe Casalino , 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":"2025-12-11","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}
To present the clinical characteristics, management and outcomes of glaucoma following congenital cataract surgery with primary intraocular lens (IOL) implantation.
Design
Retrospective, monocentric consecutive case series
Methods
We included patients with glaucoma following congenital cataract surgery and IOL implantation before the age of one year. Therapeutic success was defined as intraocular pressure (IOP) <21 mmHg at last follow-up without sight threatening complications, with or without medication.
Results
Sixty-one eyes of 42 patients were included. Mean age at cataract surgery was 121.4 ± 82.1 days. The mean interval between cataract surgery and glaucoma diagnosis was 3.9 ± 3.9 years. During follow-up, 34 eyes were treated medically (55 %) while 27 (45 %) needed surgery. The glaucoma surgeries included: trabeculectomy in 17 eyes, laser diode in 14 eyes, Ahmed glaucoma valve in 6 eyes and MicroShunt PRESERFLO in 2 eyes. Glaucoma was treated successfully in 48 eyes (80 %). Need for glaucoma surgery was associated with: early cataract surgery (p = 0.02), early glaucoma diagnosis (p = 0.04), use of trypan blue (p = 0.03) and associated anomalies (p = 0.01). BCVA at last follow-up was worse in eyes undergoing surgery than eyes receiving medical treatment (1.4 ± 1.0 vs. 0.63±0.57 logMAR, p = 0.001).
Conclusion
Eyes that underwent cataract surgery earlier and eyes associated with other anomalies were more likely to require surgery. The earlier glaucoma developed after cataract surgery, the more likely surgery was needed in the follow-up. Age at cataract surgery and time to glaucoma diagnosis did not affect surgical success. However, visual prognosis remains poor despite IOP control.
{"title":"Clinical characteristics and management of glaucoma following congenital cataract surgery and IOL implantation","authors":"Aïda Lachelah , Thibaut Chapron , Ismael Chehaibou , Florence Metge , Pascal Dureau , Georges Caputo , Youssef Abdelmassih","doi":"10.1016/j.ajoint.2025.100193","DOIUrl":"10.1016/j.ajoint.2025.100193","url":null,"abstract":"<div><h3>Purpose</h3><div>To present the clinical characteristics, management and outcomes of glaucoma following congenital cataract surgery with primary intraocular lens (IOL) implantation.</div></div><div><h3>Design</h3><div>Retrospective, monocentric consecutive case series</div></div><div><h3>Methods</h3><div>We included patients with glaucoma following congenital cataract surgery and IOL implantation before the age of one year. Therapeutic success was defined as intraocular pressure (IOP) <21 mmHg at last follow-up without sight threatening complications, with or without medication.</div></div><div><h3>Results</h3><div>Sixty-one eyes of 42 patients were included. Mean age at cataract surgery was 121.4 ± 82.1 days. The mean interval between cataract surgery and glaucoma diagnosis was 3.9 ± 3.9 years. During follow-up, 34 eyes were treated medically (55 %) while 27 (45 %) needed surgery. The glaucoma surgeries included: trabeculectomy in 17 eyes, laser diode in 14 eyes, Ahmed glaucoma valve in 6 eyes and MicroShunt PRESERFLO in 2 eyes. Glaucoma was treated successfully in 48 eyes (80 %). Need for glaucoma surgery was associated with: early cataract surgery (<em>p</em> = 0.02), early glaucoma diagnosis (<em>p</em> = 0.04), use of trypan blue (<em>p</em> = 0.03) and associated anomalies (<em>p</em> = 0.01). BCVA at last follow-up was worse in eyes undergoing surgery than eyes receiving medical treatment (1.4 ± 1.0 vs. 0.63±0.57 logMAR, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Eyes that underwent cataract surgery earlier and eyes associated with other anomalies were more likely to require surgery. The earlier glaucoma developed after cataract surgery, the more likely surgery was needed in the follow-up. Age at cataract surgery and time to glaucoma diagnosis did not affect surgical success. However, visual prognosis remains poor despite IOP control.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100193"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466037","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: 2025-08-31DOI: 10.1016/j.ajoint.2025.100167
Huzaifa Suri , P. Connor Lentz , David A. Leske , Mostafa Mousavi , Haley S. D’Souza , Muhammad B. Qureshi , Raymond Iezzi , Yogatheesan Varatharajah , Lauren A. Dalvin
Choroidal melanoma is the most common malignant primary intraocular tumor and can develop either de novo or from a preexisting choroidal nevus, a benign pigmented lesion. Key risk factors for the transformation of choroidal nevus into melanoma include tumor diameter > 5 mm, tumor thickness > 2 mm, orange pigment, subretinal fluid, and low internal reflectivity on ultrasound. However, the assessment of many of these risk factors requires multimodal imaging equipment and skilled subspecialists, only available at tertiary referral centers. In this study, we developed and validated a deep learning approach to identifying these risk factors based solely on fundus images of choroidal nevi. Results indicate acceptable to excellent predictive performance for detection of all five risk factors. These findings suggest that deep learning models may be valuable tools for identifying high-risk choroidal nevi, particularly in resource-limited settings.
{"title":"Development of a deep learning model to classify choroidal melanoma risk factors based on color fundus photographs","authors":"Huzaifa Suri , P. Connor Lentz , David A. Leske , Mostafa Mousavi , Haley S. D’Souza , Muhammad B. Qureshi , Raymond Iezzi , Yogatheesan Varatharajah , Lauren A. Dalvin","doi":"10.1016/j.ajoint.2025.100167","DOIUrl":"10.1016/j.ajoint.2025.100167","url":null,"abstract":"<div><div>Choroidal melanoma is the most common malignant primary intraocular tumor and can develop either de novo or from a preexisting choroidal nevus, a benign pigmented lesion. Key risk factors for the transformation of choroidal nevus into melanoma include tumor diameter > 5 mm, tumor thickness > 2 mm, orange pigment, subretinal fluid, and low internal reflectivity on ultrasound. However, the assessment of many of these risk factors requires multimodal imaging equipment and skilled subspecialists, only available at tertiary referral centers. In this study, we developed and validated a deep learning approach to identifying these risk factors based solely on fundus images of choroidal nevi. Results indicate acceptable to excellent predictive performance for detection of all five risk factors. These findings suggest that deep learning models may be valuable tools for identifying high-risk choroidal nevi, particularly in resource-limited settings.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010779","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: 2025-10-14DOI: 10.1016/j.ajoint.2025.100184
Ryan S. Huang , Michael Balas , David J. Mathew
Purpose
To assess the feasibility and utility of a text-to-image artificial intelligence (AI) model in enhancing patient counseling on the cosmetic side effects of prostaglandin analogue (PGA) therapy.
Design
Cross-sectional study.
Methods
Pre- and post-treatment periocular photographs of PGA-treated patients were collected. To simulate bilateral pre-treatment appearance, untreated eyes were mirrored. The Generative Fill feature powered by Adobe Firefly was applied to masked orbital regions, using descriptive text prompts to generate visualizations of prostaglandin-associated periorbitopathy (PAP), including upper eyelid ptosis, enophthalmos, and hypertrichosis. Prompts were iteratively refined to closely replicate known treatment-related changes.
Results
The AI model successfully produced visually realistic images within two minutes that closely resembled the actual post-treatment appearance of PAP. Key manifestations such as eyelash hypertrichosis, enophthalmos, deepened upper lid sulcus, and ptosis were effectively simulated using tailored prompts.
Conclusion
This proof-of-concept study demonstrates that text-to-image AI may serve as a novel, rapid, and personalized tool for visualizing potential cosmetic side effects of PGA therapy. By enabling patients to preview changes on their own faces, this technology may enhance informed consent, set realistic expectations, and improve treatment adherence. Future research should evaluate patient perceptions, the accuracy of AI-generated outcomes, and integration into clinical workflows.
{"title":"Text-to-image model for prostaglandin-associated periorbitopathy counseling: a proof-of-concept study","authors":"Ryan S. Huang , Michael Balas , David J. Mathew","doi":"10.1016/j.ajoint.2025.100184","DOIUrl":"10.1016/j.ajoint.2025.100184","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the feasibility and utility of a text-to-image artificial intelligence (AI) model in enhancing patient counseling on the cosmetic side effects of prostaglandin analogue (PGA) therapy.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Methods</h3><div>Pre- and post-treatment periocular photographs of PGA-treated patients were collected. To simulate bilateral pre-treatment appearance, untreated eyes were mirrored. The Generative Fill feature powered by Adobe Firefly was applied to masked orbital regions, using descriptive text prompts to generate visualizations of prostaglandin-associated periorbitopathy (PAP), including upper eyelid ptosis, enophthalmos, and hypertrichosis. Prompts were iteratively refined to closely replicate known treatment-related changes.</div></div><div><h3>Results</h3><div>The AI model successfully produced visually realistic images within two minutes that closely resembled the actual post-treatment appearance of PAP. Key manifestations such as eyelash hypertrichosis, enophthalmos, deepened upper lid sulcus, and ptosis were effectively simulated using tailored prompts.</div></div><div><h3>Conclusion</h3><div>This proof-of-concept study demonstrates that text-to-image AI may serve as a novel, rapid, and personalized tool for visualizing potential cosmetic side effects of PGA therapy. By enabling patients to preview changes on their own faces, this technology may enhance informed consent, set realistic expectations, and improve treatment adherence. Future research should evaluate patient perceptions, the accuracy of AI-generated outcomes, and integration into clinical workflows.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100184"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320531","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: 2025-08-28DOI: 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 : 2025-12-11Epub Date: 2025-11-19DOI: 10.1016/j.ajoint.2025.100203
Naira Ikram , Francisco Altamirano , Celine Chaaya , Hanna De Bruyn , Sandra Hoyek , Inès Fenniri , Osama Sorour , Anne Fulton , Pablo Altschwager , Efren Gonzalez , Nimesh A. Patel
Background
To identify associations between microvascular changes and functional macular sensitivity in children, adolescents, and young adults with sickle cell disease (SCD).
Methods
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.
Results
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, p = 0.010) and the DCP (β =0.36, p = 0.04).
Conclusion
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.
背景：研究镰状细胞病（SCD）儿童、青少年和青年患者微血管变化与黄斑功能性敏感性之间的关系。方法分析2023年3月至2024年12月间行光学相干层析血管造影（OCTA）和显微视野检查的8-22岁SCD患者。浅表（SCP）和深层（DCP）毛细血管丛扫描分为四个象限：颞上（ST）、鼻上（SN）、颞下（IT）和鼻下（IN）。显微镜检查采用4-2视野法和黄斑完整性评估（MAIA）的68点10度网格进行分析。Spearman相关和混合效应回归模型评估了血管密度（VD，单位为mm/mm²）和显微测量灵敏度之间的关系。结果纳入32只眼。大多数是黑人，非西班牙裔患者（71.9%）患有血红蛋白SS病（62.5%）。测试时的中位年龄和最佳矫正视力（BCVA）分别为14.6岁（IQR, 12.2-17.5）和0 logMAR (IQR, 0 - 0.1) （Snellen 20/20）。一半的眼睛（50%）有一定程度的镰状细胞视网膜病变。严重视网膜病变病例较少（9.4%）。中位年龄为14.54岁（IQR, 9.34-13.61）。颞下象限的中位VD最低，分别为27.64和23.80。在调整协变量后，显微测量灵敏度与颞上区VD呈正相关，无论是SCP （β=0.44, p = 0.010）还是DCP （β= 0.36, p = 0.04）。结论在患有镰状细胞病的儿童、青少年和青壮年患者中，SCP和DCP颞上区血管密度降低与显微视野测量灵敏度降低有关。这可能支持结构-功能相关性，进一步研究受损视网膜灌注对亚临床视力丧失的影响。
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