Pub Date : 2025-12-11Epub Date: 2025-09-10DOI: 10.1016/j.ajoint.2025.100171
Bethania López , Ellery López-Star , Van C. Lansingh , João M Furtado
Purpose
: To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.
Design
: Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.
Methods
: A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.
Results
: Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the <20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.
Conclusions
: Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.
{"title":"Blindness and vision impairment in Querétaro, Mexico: A comparison of RAAB surveys conducted in 2015 and 2024","authors":"Bethania López , Ellery López-Star , Van C. Lansingh , João M Furtado","doi":"10.1016/j.ajoint.2025.100171","DOIUrl":"10.1016/j.ajoint.2025.100171","url":null,"abstract":"<div><h3>Purpose</h3><div><strong>:</strong> To estimate the prevalence and causes of vision impairment and blindness among individuals aged ≥50 years in Querétaro, Mexico, and to assess progress in eye health indicators since a prior survey conducted in 2015.</div></div><div><h3>Design</h3><div><strong>:</strong> Population-based cross-sectional study using the Rapid Assessment of Avoidable Blindness (RAAB) version 7 methodology.</div></div><div><h3>Methods</h3><div><strong>:</strong> A total of 6574 individuals were selected via cluster sampling. Trained teams conducted visual acuity testing, lens examination, and ocular assessment using mobile data capture tools. Effective Cataract Surgical Coverage (eCSC) and Effective Refractive Error Coverage (eREC) were calculated. Results were compared with the 2015 RAAB study.</div></div><div><h3>Results</h3><div><strong>:</strong> Of the eligible individuals, 5111 (77.8 %) completed the examination. The prevalence of blindness was 2.3 % (95 % CI: 1.7–3.0 %), and moderate-to-severe vision impairment was 11.4 % (95 % CI: 9.8–13.0 %). Cataract was the leading cause of blindness (49.2 %), while refractive error predominated among milder impairments. The eCSC at the <20/60 threshold was 26.6 % (95 % CI: 20.4–32.8 %), and eREC for distance vision was 37.6 % (95 % CI: 33.8–41.4 %). Compared to 2015, both prevalence of blindness and unmet need for cataract surgery increased. Barriers included cost, fear, and lack of awareness.</div></div><div><h3>Conclusions</h3><div><strong>:</strong> Since 2015, the burden of avoidable blindness and vision impairment in Querétaro has grown. The findings underscore the need for expanded, higher-quality cataract and refractive services integrated into public health strategies to meet the WHO 2030 eye health targets.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096496","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}
Blood tests used in workup for giant cell arteritis (GCA) have shortcomings such as lack of disease specificity. We evaluated if plasma calprotectin at first clinical presentation could predict the final clinical diagnosis of GCA as evaluated at follow-up after six months.
Design
Prospective cohort study.
Methods
Blood was drawn at presentation in consecutive patients suspected of GCA. Plasma calprotectin was measured using the Gentian GCAL® Calprotectin Reagent Kit. The final diagnosis of GCA was given at six-month follow-up.
Results
Of 110 patients reviewed, 103 were eligible for data analysis, and 76 had plasma calprotectin analysis available. Of these 76, 44 (58 %) had a final diagnosis of GCA, 31 (41 %) had no GCA, and one case (1 %) was inconclusive. Plasma median calprotectin concentration was significantly higher in those with GCA than in those without (p < 0.001). Comparing the upper reference limit of the Gentian GCAL® (≥0.970 mg/L) with the final clinical diagnosis, plasma calprotectin performed with sensitivity 67 % (95 %CI: 50–81 %) and specificity 75 % (95 %CI: 55–89 %). The area under the receiver operating characteristics curve (AUC) was 0.71 (95 %CI: 0.58–0.84). Accuracy was 70 % (95 %CI 58–81 %). Using an optimal ROC cut-off limit of 0.635 mg/L, test statistics reached sensitivity 87 % (95 %CI: 73–96 %), specificity 61 % (95 %CI: 41–79 %), AUC 0.74 (95 %CI: 0.61–0.87), and accuracy 76 % (95 %CI: 64–86 %).
Conclusions
Plasma calprotectin was elevated in cases where GCA was subsequently confirmed. The value of plasma calprotectin as an inflammatory marker in cases with suspected GCA warrants further studies.
{"title":"The value of plasma calprotectin as an inflammatory marker in giant cell arteritis","authors":"Michael Stormly Hansen , Lene Terslev , Uffe Møller Døhn , Viktoria Fana , Mads Radmer Jensen , Anne Katrine Wiencke , Steffen Heegaard , Oliver Niels Klefter , Yousif Subhi , Jane Maestri Brittain , Niklas Rye Jørgensen , Steffen Hamann","doi":"10.1016/j.ajoint.2025.100165","DOIUrl":"10.1016/j.ajoint.2025.100165","url":null,"abstract":"<div><h3>Purpose</h3><div>Blood tests used in workup for giant cell arteritis (GCA) have shortcomings such as lack of disease specificity. We evaluated if plasma calprotectin at first clinical presentation could predict the final clinical diagnosis of GCA as evaluated at follow-up after six months.</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Blood was drawn at presentation in consecutive patients suspected of GCA. Plasma calprotectin was measured using the Gentian GCAL® Calprotectin Reagent Kit. The final diagnosis of GCA was given at six-month follow-up.</div></div><div><h3>Results</h3><div>Of 110 patients reviewed, 103 were eligible for data analysis, and 76 had plasma calprotectin analysis available. Of these 76, 44 (58 %) had a final diagnosis of GCA, 31 (41 %) had no GCA, and one case (1 %) was inconclusive. Plasma median calprotectin concentration was significantly higher in those with GCA than in those without (<em>p</em> < 0.001). Comparing the upper reference limit of the Gentian GCAL® (≥0.970 mg/L) with the final clinical diagnosis, plasma calprotectin performed with sensitivity 67 % (95 %CI: 50–81 %) and specificity 75 % (95 %CI: 55–89 %). The area under the receiver operating characteristics curve (AUC) was 0.71 (95 %CI: 0.58–0.84). Accuracy was 70 % (95 %CI 58–81 %). Using an optimal ROC cut-off limit of 0.635 mg/L, test statistics reached sensitivity 87 % (95 %CI: 73–96 %), specificity 61 % (95 %CI: 41–79 %), AUC 0.74 (95 %CI: 0.61–0.87), and accuracy 76 % (95 %CI: 64–86 %).</div></div><div><h3>Conclusions</h3><div>Plasma calprotectin was elevated in cases where GCA was subsequently confirmed. The value of plasma calprotectin as an inflammatory marker in cases with suspected GCA warrants further studies.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989372","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: 2025-09-20DOI: 10.1016/j.ajoint.2025.100172
God’sglory Isoken Braimoh, Faustina Idu, Clinton Ifeanyi Okechukwu
Purpose
To assess awareness, acceptance, and perceived barriers to tele-eye care among patients and eye care practitioners in Benin City, Nigeria.
Methods
A cross-sectional survey was conducted over three months among 332 patients attending clinics and 56 licensed eye care practitioners (optometrists and ophthalmologists). A structured questionnaire, adapted from prior studies, was administered via Google Forms. Practitioners received the survey through professional WhatsApp groups, while patients completed it during clinic visits. Data were analyzed using descriptive statistics and inferential tests (chi-square, t-tests, and logistic regression) to assess associations, with significance set at p < 0.05.
Results
Awareness of tele-eye care was modest among patients (47.6 %), and prior use was low (25.3 %), yet willingness to adopt mobile-based applications was high (88.6 %). Patients’ main concerns included reduced quality of care (81.3 %), limited personal interaction (53.0 %), and privacy risks (51.5 %). Most practitioners (93 %) were familiar with telemedicine, though only 32 % reported its use in their clinics. While 84 % believed it could expand access to care, concerns included diagnostic accuracy (67.9 %), restricted service applicability (73.2 %), and insufficient practitioner training (75 %).
Conclusion
Both patients and practitioners in Benin City expressed strong interest in tele-eye care, though actual use remains limited. Adoption is constrained by service limitations, privacy concerns, and inadequate training. Targeted practitioner education, improved digital infrastructure, and clear regulatory frameworks are needed to facilitate broader integration of tele-eye care into routine practice.
{"title":"Tele-eye care: Perspective and acceptance among patients and eye care practitioners in Benin City","authors":"God’sglory Isoken Braimoh, Faustina Idu, Clinton Ifeanyi Okechukwu","doi":"10.1016/j.ajoint.2025.100172","DOIUrl":"10.1016/j.ajoint.2025.100172","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess awareness, acceptance, and perceived barriers to tele-eye care among patients and eye care practitioners in Benin City, Nigeria.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted over three months among 332 patients attending clinics and 56 licensed eye care practitioners (optometrists and ophthalmologists). A structured questionnaire, adapted from prior studies, was administered via Google Forms. Practitioners received the survey through professional WhatsApp groups, while patients completed it during clinic visits. Data were analyzed using descriptive statistics and inferential tests (chi-square, <em>t</em>-tests, and logistic regression) to assess associations, with significance set at <em>p</em> < 0.05.</div></div><div><h3>Results</h3><div>Awareness of tele-eye care was modest among patients (47.6 %), and prior use was low (25.3 %), yet willingness to adopt mobile-based applications was high (88.6 %). Patients’ main concerns included reduced quality of care (81.3 %), limited personal interaction (53.0 %), and privacy risks (51.5 %). Most practitioners (93 %) were familiar with telemedicine, though only 32 % reported its use in their clinics. While 84 % believed it could expand access to care, concerns included diagnostic accuracy (67.9 %), restricted service applicability (73.2 %), and insufficient practitioner training (75 %).</div></div><div><h3>Conclusion</h3><div>Both patients and practitioners in Benin City expressed strong interest in tele-eye care, though actual use remains limited. Adoption is constrained by service limitations, privacy concerns, and inadequate training. Targeted practitioner education, improved digital infrastructure, and clear regulatory frameworks are needed to facilitate broader integration of tele-eye care into routine practice.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145158351","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}
Using data from the 2020 and 2022 National Health Interview Survey, this study included participants aged 2-17 years with complete guardian-reported data pertaining to vision status and screen time usage. We performed logistic regressions to explore associations between screen time and vision difficulties, reporting odds ratios (ORs) and 95% confidence intervals (CIs).
Results
A total of 5,112 participants (mean age: 10.1 ± 4.7 years) were included in 2020, and 6,473 participants (mean age: 9.9 ± 4.7 years) were included in 2022. In our univariable analysis, children who had a screen time of >2 hours/day had a higher odds of guardian-reported vision difficulty in 2020 (OR=1.53, 95%CI=[1.08, 2.16], p=0.017) and in 2022 (OR=1.38, 95%CI=[1.02, 1.86], p=0.038). These findings were consistent in a subgroup of female children (p=0.002 in 2020 and p=0.014 in 2022). Our multivariable analysis of 2020 data found that the odds of guardian-reported vision difficulty among children with a screen time of >2 hours/day was significantly higher in females (OR=1.73, 95%CI=[1.02, 2.93], p=0.040) and children residing in the Midwest (OR=2.41, 95%CI=[1.11, 5.20], p=0.026). No findings were significant in our adjusted analysis of 2022 data.
Conclusion
Screen time was associated with guardian-reported vision difficulties in paediatric populations in the United States in our univariable analysis. However, this association was not consistently observed in adjusted models of 2020 data, and no associations remained significant in the multivariable analysis of 2022 data. Public health initiatives aimed at promoting healthy screen time habits and regular eye care among vulnerable groups of children and adolescents are encouraged.
{"title":"Association between screen time and guardian-reported vision difficulty in children and adolescents: A population-based analysis","authors":"Andrew Mihalache , Panthea Rahmdel , Ryan S. Huang , Marko M. Popovic , Behnam Rahmdel , Stacey Chong , Crystal S.Y. Cheung , Rajeev H. Muni","doi":"10.1016/j.ajoint.2025.100177","DOIUrl":"10.1016/j.ajoint.2025.100177","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate associations between screen time and guardian-reported vision difficulties among paediatric populations in the United States.</div></div><div><h3>Design</h3><div>Retrospective, population-based, cross-sectional study.</div></div><div><h3>Methods</h3><div>Using data from the 2020 and 2022 National Health Interview Survey, this study included participants aged 2-17 years with complete guardian-reported data pertaining to vision status and screen time usage. We performed logistic regressions to explore associations between screen time and vision difficulties, reporting odds ratios (ORs) and 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>A total of 5,112 participants (mean age: 10.1 ± 4.7 years) were included in 2020, and 6,473 participants (mean age: 9.9 ± 4.7 years) were included in 2022. In our univariable analysis, children who had a screen time of >2 hours/day had a higher odds of guardian-reported vision difficulty in 2020 (OR=1.53, 95%CI=[1.08, 2.16], p=0.017) and in 2022 (OR=1.38, 95%CI=[1.02, 1.86], p=0.038). These findings were consistent in a subgroup of female children (p=0.002 in 2020 and p=0.014 in 2022). Our multivariable analysis of 2020 data found that the odds of guardian-reported vision difficulty among children with a screen time of >2 hours/day was significantly higher in females (OR=1.73, 95%CI=[1.02, 2.93], p=0.040) and children residing in the Midwest (OR=2.41, 95%CI=[1.11, 5.20], p=0.026). No findings were significant in our adjusted analysis of 2022 data.</div></div><div><h3>Conclusion</h3><div>Screen time was associated with guardian-reported vision difficulties in paediatric populations in the United States in our univariable analysis. However, this association was not consistently observed in adjusted models of 2020 data, and no associations remained significant in the multivariable analysis of 2022 data. Public health initiatives aimed at promoting healthy screen time habits and regular eye care among vulnerable groups of children and adolescents are encouraged.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145220460","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: 2025-10-12DOI: 10.1016/j.ajoint.2025.100183
Konstantinos G. Baroutis, Gustavo Sakuno, Sandra Hoyek, Nimesh A. Patel, Joan W. Miller, Demetrios G. Vavvas
Purpose
To report the retinal findings, cumulative incidence of retinal capillary hemangioblastoma (RCH), retinal detachment (RD) outcomes, and risk factors in a large cohort of von Hippel-Lindau (VHL) patients within a major U.S. Tertiary Care Facility.
Design
A retrospective cohort study was conducted between January 2005 and August 2024.
Methods
VHL patients were identified from Mass General Brigham’s Research Patient Data Repository. Manual chart review confirmed those with ophthalmologic examinations. A nested 1:2 matched case-control study compared RD cases with controls (VHL patients with RCH but without RD). Kaplan-Meier analysis estimated cumulative RCH incidence, and conditional logistic regression identified RD risk factors. Patients without RCH were censored at the last follow-up.
Results
Among 159 VHL patients, 104 had comprehensive eye examinations with a median follow-up of 7 years [IQR, 2–11]; 95% attended at least one follow-up appointment. The incidence rate of RCH was 2.3 per 100 person-years, calculated from person-time starting at birth and ending at age of first RCH diagnosis (for cases) or last follow-up visit (for non-cases). Eighteen eyes (14 patients, 13% of the cohort; 95% CI, 8%-22%) developed RD, predominantly combined rhegmatogenous/tractional (94%), with 29% bilateral involvement. Notably, no patient without an RCH developed an RD in our cohort. A case-control study found that each additional prior focal treatment significantly lowered the risk of RD (OR = 0.15, 95% CI 0.03–0.63; p = 0.01), while the presence of renal cell carcinoma and pancreatic cysts were associated with increased risk, possibly indicating more advanced systemic disease. All RD cases exhibited proliferative vitreoretinopathy (PVR; Grade C: 89%, Grade B: 11%) at the time of diagnosis. Overall, 12 of 16 eyes (75%) achieved reattachment, 11 of which (69%) required multiple surgeries (median, 2 [IQR, 1–3]), but visual outcomes remained poor (median final logMAR BCVA, 2.3 [IQR, 0.55–2.7], counting fingers).
Conclusions
VHL patients face a high lifetime risk of RCH and associated RD. PVR frequently complicates the surgical treatment of RD and yields limited visual recovery, underscoring the need for proactive surveillance and timely therapeutic intervention. The universal presence of PVR in these RD eyes is a novel finding that warrants investigation into a possible, though currently speculative, molecular link to pVHL dysregulation.
目的报告美国一家主要三级医疗机构的von Hippel-Lindau （VHL）患者的视网膜检查结果、视网膜毛细血管母细胞瘤（RCH）的累积发病率、视网膜脱离（RD）的结局和危险因素。DesignA回顾性队列研究于2005年1月至2024年8月进行。方法从麻省总医院布里格姆研究患者数据库中识别svhl患者。手工视力表复查证实了眼科检查。一项嵌套式1:2匹配病例-对照研究将RD病例与对照组（合并RCH但无RD的VHL患者）进行了比较。Kaplan-Meier分析估计了RCH的累积发病率，条件logistic回归确定了RD的危险因素。没有RCH的患者在最后一次随访时被删除。结果159例VHL患者中，104例进行了全面眼科检查，中位随访7年[IQR， 2-11]；95%的患者至少参加了一次随访预约。RCH的发病率为每100人年2.3例，从出生时开始计算，到首次诊断为RCH的年龄（病例）或最后一次随访（无病例）时结束。18只眼（14例患者，占队列的13%；95% CI, 8%-22%）发生RD，主要是源性/牵引性合并RD(94%)，其中29%累及双侧。值得注意的是，在我们的队列中，没有没有RCH的患者发展为RD。一项病例对照研究发现，每增加一次局灶性治疗可显著降低RD的风险（OR = 0.15, 95% CI 0.03-0.63; p = 0.01），而肾细胞癌和胰腺囊肿的存在与RD的风险增加相关，可能表明全身性疾病更晚期。所有RD病例在诊断时均表现为增殖性玻璃体视网膜病变（PVR； C级：89%，B级：11%）。总体而言，16只眼中有12只（75%）实现了复位，其中11只（69%）需要多次手术（中位数，2 [IQR, 1-3]），但视力结果仍然很差（最终logMAR BCVA中位数，2.3 [IQR, 0.55-2.7]，计算手指）。结论svhl患者面临RCH和相关RD的高终生风险，PVR经常使RD的手术治疗复杂化，视力恢复有限，强调需要积极监测和及时的治疗干预。PVR在这些RD眼睛中的普遍存在是一项新发现，值得研究pVHL失调的可能分子联系，尽管目前尚在推测中。
{"title":"Retinal detachment risk in a cohort of von hippel-lindau patients at a Major U.S. tertiary care facility","authors":"Konstantinos G. Baroutis, Gustavo Sakuno, Sandra Hoyek, Nimesh A. Patel, Joan W. Miller, Demetrios G. Vavvas","doi":"10.1016/j.ajoint.2025.100183","DOIUrl":"10.1016/j.ajoint.2025.100183","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the retinal findings, cumulative incidence of retinal capillary hemangioblastoma (RCH), retinal detachment (RD) outcomes, and risk factors in a large cohort of von Hippel-Lindau (VHL) patients within a major U.S. Tertiary Care Facility.</div></div><div><h3>Design</h3><div>A retrospective cohort study was conducted between January 2005 and August 2024.</div></div><div><h3>Methods</h3><div>VHL patients were identified from Mass General Brigham’s Research Patient Data Repository. Manual chart review confirmed those with ophthalmologic examinations. A nested 1:2 matched case-control study compared RD cases with controls (VHL patients with RCH but without RD). Kaplan-Meier analysis estimated cumulative RCH incidence, and conditional logistic regression identified RD risk factors. Patients without RCH were censored at the last follow-up.</div></div><div><h3>Results</h3><div>Among 159 VHL patients, 104 had comprehensive eye examinations with a median follow-up of 7 years [IQR, 2–11]; 95% attended at least one follow-up appointment. The incidence rate of RCH was 2.3 per 100 person-years, calculated from person-time starting at birth and ending at age of first RCH diagnosis (for cases) or last follow-up visit (for non-cases). Eighteen eyes (14 patients, 13% of the cohort; 95% CI, 8%-22%) developed RD, predominantly combined rhegmatogenous/tractional (94%), with 29% bilateral involvement. Notably, no patient without an RCH developed an RD in our cohort. A case-control study found that each additional prior focal treatment significantly lowered the risk of RD (OR = 0.15, 95% CI 0.03–0.63; p = 0.01), while the presence of renal cell carcinoma and pancreatic cysts were associated with increased risk, possibly indicating more advanced systemic disease. All RD cases exhibited proliferative vitreoretinopathy (PVR; Grade C: 89%, Grade B: 11%) at the time of diagnosis. Overall, 12 of 16 eyes (75%) achieved reattachment, 11 of which (69%) required multiple surgeries (median, 2 [IQR, 1–3]), but visual outcomes remained poor (median final logMAR BCVA, 2.3 [IQR, 0.55–2.7], counting fingers).</div></div><div><h3>Conclusions</h3><div>VHL patients face a high lifetime risk of RCH and associated RD. PVR frequently complicates the surgical treatment of RD and yields limited visual recovery, underscoring the need for proactive surveillance and timely therapeutic intervention. The universal presence of PVR in these RD eyes is a novel finding that warrants investigation into a possible, though currently speculative, molecular link to pVHL dysregulation.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100183"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320533","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 evaluate and compare the performance of five AI chatbots—ChatGPT 3.5 (OpenAI), Google Gemini, Grok (xAI), DeepSeek, and Perplexity AI—in delivering accurate, clear, educational, and safe responses to pediatric ophthalmology-related queries.
Methods
Sixteen standardized caregiver-facing questions were posed to each chatbot in separate fresh sessions. Five pediatric ophthalmologists independently rated the responses across four domains—Accuracy, Clarity, Educational Value, and Safety—using a 5-point Likert scale (1–5). This produced 400 ratings per domain (5 chatbots × 16 questions × 5 raters). Inter-rater reliability was assessed using ICC(2,1), ICC(2,5), quadratic-weighted Fleiss’ κ, Gwet’s AC1, and percent agreement. Between-chatbot comparisons were analyzed with cumulative-link mixed models (CLMMs), reporting odds ratios (OR) with 95 % confidence intervals. Post-hoc pairwise contrasts were corrected using Holm adjustment.
Results
ChatGPT achieved the highest scores for Accuracy, while Google Gemini and Grok (xAI) showed modest advantages in Clarity and Educational Value. Safety ratings were similar across platforms and clustered at “adequate,” with limited probability of top scores. CLMM analyses confirmed significant between-chatbot differences in Accuracy, Clarity, and Educational Value, but not Safety. Inter-rater reliability was poor-to-fair for single raters [ICC(2,1) = 0.08–0.24], improving to moderate when averaging across all five raters [ICC(2,5) = 0.29–0.61]. Weighted Fleiss’ κ indicated only slight agreement (0.14), but Gwet’s AC1 (0.86) and high percent agreement (94 %) suggested stronger underlying consensus.
Conclusion
Performance of AI chatbots varied across domains: ChatGPT led in Accuracy, Gemini and Grok in Clarity and Educational Value, while no system excelled in Safety. Low agreement reflects the difficulty of scoring nuanced AI-generated responses rather than a lack of expert consensus. These findings support the potential of AI chatbots as educational adjuncts in pediatric ophthalmology, while underscoring the need for expert oversight, standardized rubrics, and domain-specific fine-tuning to improve reliability and safety
{"title":"Comparative evaluation of five AI chatbots in pediatric ophthalmology: A multidomain expert-based appraisal”","authors":"Shweta Dhiman , Chitaranjan Mishra , Savleen Kaur , Paromita Dutta , Prolima Thacker , Ashini Maniar , Raj Kenia , Logesh Balakrishnan","doi":"10.1016/j.ajoint.2025.100188","DOIUrl":"10.1016/j.ajoint.2025.100188","url":null,"abstract":"<div><h3>Aim</h3><div>To evaluate and compare the performance of five AI chatbots—ChatGPT 3.5 (OpenAI), Google Gemini, Grok (xAI), DeepSeek, and Perplexity AI—in delivering accurate, clear, educational, and safe responses to pediatric ophthalmology-related queries.</div></div><div><h3>Methods</h3><div>Sixteen standardized caregiver-facing questions were posed to each chatbot in separate fresh sessions. Five pediatric ophthalmologists independently rated the responses across four domains—Accuracy, Clarity, Educational Value, and Safety—using a 5-point Likert scale (1–5). This produced 400 ratings per domain (5 chatbots × 16 questions × 5 raters). Inter-rater reliability was assessed using ICC(2,1), ICC(2,5), quadratic-weighted Fleiss’ κ, Gwet’s AC1, and percent agreement. Between-chatbot comparisons were analyzed with cumulative-link mixed models (CLMMs), reporting odds ratios (OR) with 95 % confidence intervals. Post-hoc pairwise contrasts were corrected using Holm adjustment.</div></div><div><h3>Results</h3><div>ChatGPT achieved the highest scores for Accuracy, while Google Gemini and Grok (xAI) showed modest advantages in Clarity and Educational Value. Safety ratings were similar across platforms and clustered at “adequate,” with limited probability of top scores. CLMM analyses confirmed significant between-chatbot differences in Accuracy, Clarity, and Educational Value, but not Safety. Inter-rater reliability was poor-to-fair for single raters [ICC(2,1) = 0.08–0.24], improving to moderate when averaging across all five raters [ICC(2,5) = 0.29–0.61]. Weighted Fleiss’ κ indicated only slight agreement (0.14), but Gwet’s AC1 (0.86) and high percent agreement (94 %) suggested stronger underlying consensus.</div></div><div><h3>Conclusion</h3><div>Performance of AI chatbots varied across domains: ChatGPT led in Accuracy, Gemini and Grok in Clarity and Educational Value, while no system excelled in Safety. Low agreement reflects the difficulty of scoring nuanced AI-generated responses rather than a lack of expert consensus. These findings support the potential of AI chatbots as educational adjuncts in pediatric ophthalmology, while underscoring the need for expert oversight, standardized rubrics, and domain-specific fine-tuning to improve reliability and safety</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145416743","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: 2025-09-10DOI: 10.1016/j.ajoint.2025.100170
Mohammed Suhail Najm Al-Salam , Ahmed shakir Ali Al-Wassiti , Muthanna Basheer Yasir , Mohammed Tareq Mutar
Purpose
Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.
Design
Prospective Single Arm Clinical Study
Methods
The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.
Results
The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).
The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with >60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.
Conclusion
Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.
{"title":"Suprachoroidal triamcinolone in macular edema for patients with non-infectious uveitis resistant to subtenon triamcinolone","authors":"Mohammed Suhail Najm Al-Salam , Ahmed shakir Ali Al-Wassiti , Muthanna Basheer Yasir , Mohammed Tareq Mutar","doi":"10.1016/j.ajoint.2025.100170","DOIUrl":"10.1016/j.ajoint.2025.100170","url":null,"abstract":"<div><h3>Purpose</h3><div>Uveitic macular edema is a serious complication of uveitis which if not properly managed can cause visual impairment. The study aimed to assess the response of uvetic macular edema to suprachoroidal triamcinolone injections for sub-Tenon triamcinolone acetonide resistant patients. The response was measured by changes in central macular thickness (CMT) and visual acuity (VA), with measurements taken before treatment, one and three months after treatment.</div></div><div><h3>Design</h3><div>Prospective Single Arm Clinical Study</div></div><div><h3>Methods</h3><div>The study included 9 patients with non-infectious uveitis treated with systemic steroids and immunosuppressant therapy. These patients had uveitic macular edema that persisted despite adequate control of intra-ocular inflammation and showed no response to posterior sub-tenon steroids injections. Suprachoroidal triamcinolone acetonide injection was considered for those patients; 4 mg was injected into the suprachoroidal space.</div></div><div><h3>Results</h3><div>The study involved 44.4 % males; the mean age was 35 years. The underlying etiologies included Vogt–Koyanagi–Harada (VKH) syndrome in three patients (33.3 %), pars planitis in four patients (44.5 %), and Behcet disease in two (22.2 %).</div><div>The mean central macular thickness CMT decreased from 556 µm to 270 µm, and LogMAR visual acuity improved from 0.876 to 0.470 over three months. Over three months, 8 patients showed a 40 % reduction in CMT, with >60 % decline in 3 patients. In terms of VA, 6 patients gained 2 lines and 2 patients gained 4 lines.</div></div><div><h3>Conclusion</h3><div>Suprachoroidal triamcinolone demonstrated a significant improvement in visual acuity and a reduction in CMT at one and three months in patients with non-infectious uveitis.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145096495","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: 2025-10-06DOI: 10.1016/j.ajoint.2025.100180
Oase Sbei , Waleed Kojan , Ibrahim Abboud , Lana Kuziez , Asad Loya , Ahmed Amer Zanabli , Fares Alahdab , Ahmad Al-Moujahed
Purpose
To evaluate the impact of the Syrian conflict on ophthalmology services, residency training, and clinical infrastructure, and to identify areas requiring urgent reform in the post-conflict healthcare reconstruction period.
Design
A mixed-methods study combining a comprehensive scoping review with two national cross-sectional surveys of ophthalmology residents and public ophthalmology hospitals across Syria.
Methods
A scoping review of English-language ophthalmology-related literature concerning Syria (1979–2025) was conducted using five major databases and grey literature. Two structured surveys were administered: one targeting ophthalmology residents to assess training quality and educational structure, and another targeting public hospitals to evaluate equipment, service delivery, and patient volume. Descriptive statistics and thematic analysis were used to analyze survey data.
Results
The scoping review included 49 studies categorized into five themes: war-related ocular trauma, disease prevalence, refugee eye health, ophthalmology education, and public awareness. The residency survey (n = 135) revealed that 63.5 % of respondents lacked structured curricula, 67.2 % reported no surgical case tracking, and 91.9 % reported absence of formal evaluation rubrics. The facility-based survey received responses from 4 of 13 hospitals, revealing critical equipment shortages, high patient loads, and unequal access to subspecialty and surgical services. The survey revealed significant shortages of functional ophthalmic equipment, including slit lamps, fundus cameras, perimeters, OCT machines, keratometers, tonometers, and YAG lasers. Many hospitals reported outdated or non-functional devices, with essential diagnostic and surgical tools either unavailable or in critical need of repair.
Conclusion
Ophthalmology services and education in Syria have been severely affected by conflict-related damage, infrastructure collapse, and displacement. This study underscores the urgent need for national reconstruction efforts focused on standardizing residency curricula, upgrading hospital infrastructure, and ensuring equitable access to advanced ophthalmic care. International partnerships, targeted investments, and sustainable reform strategies will be critical in rebuilding Syria’s ophthalmic healthcare and education system.
{"title":"The effects of a 13-year war on the reality of ophthalmology services and education in Syria","authors":"Oase Sbei , Waleed Kojan , Ibrahim Abboud , Lana Kuziez , Asad Loya , Ahmed Amer Zanabli , Fares Alahdab , Ahmad Al-Moujahed","doi":"10.1016/j.ajoint.2025.100180","DOIUrl":"10.1016/j.ajoint.2025.100180","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of the Syrian conflict on ophthalmology services, residency training, and clinical infrastructure, and to identify areas requiring urgent reform in the post-conflict healthcare reconstruction period.</div></div><div><h3>Design</h3><div>A mixed-methods study combining a comprehensive scoping review with two national cross-sectional surveys of ophthalmology residents and public ophthalmology hospitals across Syria.</div></div><div><h3>Methods</h3><div>A scoping review of English-language ophthalmology-related literature concerning Syria (1979–2025) was conducted using five major databases and grey literature. Two structured surveys were administered: one targeting ophthalmology residents to assess training quality and educational structure, and another targeting public hospitals to evaluate equipment, service delivery, and patient volume. Descriptive statistics and thematic analysis were used to analyze survey data.</div></div><div><h3>Results</h3><div>The scoping review included 49 studies categorized into five themes: war-related ocular trauma, disease prevalence, refugee eye health, ophthalmology education, and public awareness. The residency survey (<em>n</em> = 135) revealed that 63.5 % of respondents lacked structured curricula, 67.2 % reported no surgical case tracking, and 91.9 % reported absence of formal evaluation rubrics. The facility-based survey received responses from 4 of 13 hospitals, revealing critical equipment shortages, high patient loads, and unequal access to subspecialty and surgical services. The survey revealed significant shortages of functional ophthalmic equipment, including slit lamps, fundus cameras, perimeters, OCT machines, keratometers, tonometers, and YAG lasers. Many hospitals reported outdated or non-functional devices, with essential diagnostic and surgical tools either unavailable or in critical need of repair.</div></div><div><h3>Conclusion</h3><div>Ophthalmology services and education in Syria have been severely affected by conflict-related damage, infrastructure collapse, and displacement. This study underscores the urgent need for national reconstruction efforts focused on standardizing residency curricula, upgrading hospital infrastructure, and ensuring equitable access to advanced ophthalmic care. International partnerships, targeted investments, and sustainable reform strategies will be critical in rebuilding Syria’s ophthalmic healthcare and education system.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100180"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320530","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.2025.100187
Mohamed Nasser Elshabrawi , Hashem Abu Serhan
{"title":"Reply to “Comments on “Effectiveness of intracameral antibiotics in reducing postoperative endophthalmitis risk after cataract surgery: A meta-analysis””","authors":"Mohamed Nasser Elshabrawi , Hashem Abu Serhan","doi":"10.1016/j.ajoint.2025.100187","DOIUrl":"10.1016/j.ajoint.2025.100187","url":null,"abstract":"","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 4","pages":"Article 100187"},"PeriodicalIF":0.0,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320532","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 : 2025-10-03Epub Date: 2025-07-04DOI: 10.1016/j.ajoint.2025.100155
Alexander Kai Thomsen , Maria Abildgaard Steffensen , Kathrine Gotfredsen , Henrik Vorum , Bent Honoré , Mogens Holst Nissen , Torben Lykke Sørensen
Purpose
The neutrophil-to-lymphocyte ratio (NLR) and alterations of activation surface markers on circulating neutrophils have been suggested to be involved in the pathogenesis of age-related macular degeneration (AMD). The aim of this study was to investigate the relationship between NLR, activation surface markers on neutrophils, AMD stage, and treatment response in neovascular AMD (nAMD).
Design
Prospective cohort study.
Methods
Treatment-naïve nAMD patients, intermediate AMD (iAMD) patients, and healthy controls were consecutively enrolled. Treatment response in nAMD patients was categorized as good, partial and poor based on change of retinal fluid and central retinal thickness. Treatment response was evaluated after the loading phase and after one year of treatment with aflibercept 2 mg. NLR and activation surface markers on circulating neutrophils (CD11a, CD11b, CD31, CD66b, CD162, and CD182) were examined with flow cytometry. NLR and activation surface markers were compared between healthy controls, iAMD, and nAMD patients, as well as between nAMD treatment response groups. Polymorphisms in the CFH and ARMS2 genes were compared to NLR and the surface markers in nAMD patients.
Results
NLR was significantly elevated in nAMD patients compared to healthy controls (P < 0.001). nAMD patients with poor 1-year treatment response had a significantly higher NLR compared to good 1-year treatment responders. Expression levels of CD11a, CD11b, CD31, CD66b, CD162, and CD182 on circulating neutrophils were elevated in nAMD patients compared to healthy controls (all P < 0.05), however no significant differences were found between nAMD treatment response groups. No significant associations were found between CFH or ARMS2 genotypes with NLR or neutrophil surface markers in nAMD patients.
Conclusion
Elevated NLR was associated with a poor 1-year treatment response. The NLR and expression levels of activation surface markers on circulating neutrophils were significantly elevated in treatment-naïve nAMD patients compared to healthy controls.
{"title":"Association of neutrophil-to-lymphocyte ratio and neutrophil activation with treatment response in neovascular AMD","authors":"Alexander Kai Thomsen , Maria Abildgaard Steffensen , Kathrine Gotfredsen , Henrik Vorum , Bent Honoré , Mogens Holst Nissen , Torben Lykke Sørensen","doi":"10.1016/j.ajoint.2025.100155","DOIUrl":"10.1016/j.ajoint.2025.100155","url":null,"abstract":"<div><h3>Purpose</h3><div>The neutrophil-to-lymphocyte ratio (NLR) and alterations of activation surface markers on circulating neutrophils have been suggested to be involved in the pathogenesis of age-related macular degeneration (AMD). The aim of this study was to investigate the relationship between NLR, activation surface markers on neutrophils, AMD stage, and treatment response in neovascular AMD (nAMD).</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Treatment-naïve nAMD patients, intermediate AMD (iAMD) patients, and healthy controls were consecutively enrolled. Treatment response in nAMD patients was categorized as good, partial and poor based on change of retinal fluid and central retinal thickness. Treatment response was evaluated after the loading phase and after one year of treatment with aflibercept 2 mg. NLR and activation surface markers on circulating neutrophils (CD11a, CD11b, CD31, CD66b, CD162, and CD182) were examined with flow cytometry. NLR and activation surface markers were compared between healthy controls, iAMD, and nAMD patients, as well as between nAMD treatment response groups. Polymorphisms in the CFH and ARMS2 genes were compared to NLR and the surface markers in nAMD patients.</div></div><div><h3>Results</h3><div>NLR was significantly elevated in nAMD patients compared to healthy controls (<em>P</em> < 0.001). nAMD patients with poor 1-year treatment response had a significantly higher NLR compared to good 1-year treatment responders. Expression levels of CD11a, CD11b, CD31, CD66b, CD162, and CD182 on circulating neutrophils were elevated in nAMD patients compared to healthy controls (all <em>P</em> < 0.05), however no significant differences were found between nAMD treatment response groups. No significant associations were found between CFH or ARMS2 genotypes with NLR or neutrophil surface markers in nAMD patients.</div></div><div><h3>Conclusion</h3><div>Elevated NLR was associated with a poor 1-year treatment response. The NLR and expression levels of activation surface markers on circulating neutrophils were significantly elevated in treatment-naïve nAMD patients compared to healthy controls.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100155"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144596627","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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