To quantitatively assess the consistency of conflict of interest (COI) disclosures among presenters at two major ophthalmology conferences and to analyze trends in COI reporting over a span of four years.
Design
A retrospective cross-sectional study.
Participants
Presenters at the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) annual meetings in 2018 and 2021/2022.
Methods
Publicly available COI disclosures from presenters at the AAO and ASCRS meetings were extracted and compared. The disclosures of individuals presenting at both AAO and ASCRS were analyzed, focusing on whether COIs were reported consistently across both meetings.
Main Outcome Measures
The primary outcome was the presence of discrepancies in COI disclosures amongst individuals who presented at the two selected ophthalmology conferences within the same year.
Results
Among the 260 presenters who participated in both AAO 2021 and ASCRS 2022, 95 (36.5 %) had identical disclosures, while 150 (57.7 %) exhibited at least one discrepancy. On average, these presenters had 11.23 ± 14.63 disclosures at AAO and 9.88 ± 14.68 disclosures at ASCRS. Similarly, of the 432 presenters at both AAO 2018 and ASCRS 2018, 203 (47.0 %) had consistent disclosures, while 213 (49.5 %) displayed discrepancies. On average, these presenters had 13.16 ± 19.75 disclosures at AAO and 12.49 ± 15.61 disclosures at ASCRS.
Conclusions
Significant inconsistencies in COI disclosures were observed among presenters at major ophthalmology conferences within the same year. Nearly half of the presenters exhibited discrepancies in their disclosures, with a notable portion disclosing COIs at one conference but not the other. These findings underscore the need for standardized COI reporting systems with more rigorous verification processes to ensure transparency and trustworthiness in medical conference presentations.
{"title":"Consistency of conflict of interest disclosures across two major ophthalmology conferences","authors":"Justin Grad , Amin Hatamnejad , Akashdeep Grewal , Chryssa McAlister","doi":"10.1016/j.ajoint.2025.100153","DOIUrl":"10.1016/j.ajoint.2025.100153","url":null,"abstract":"<div><h3>Purpose</h3><div>To quantitatively assess the consistency of conflict of interest (COI) disclosures among presenters at two major ophthalmology conferences and to analyze trends in COI reporting over a span of four years.</div></div><div><h3>Design</h3><div>A retrospective cross-sectional study.</div></div><div><h3>Participants</h3><div>Presenters at the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS) annual meetings in 2018 and 2021/2022.</div></div><div><h3>Methods</h3><div>Publicly available COI disclosures from presenters at the AAO and ASCRS meetings were extracted and compared. The disclosures of individuals presenting at both AAO and ASCRS were analyzed, focusing on whether COIs were reported consistently across both meetings.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the presence of discrepancies in COI disclosures amongst individuals who presented at the two selected ophthalmology conferences within the same year.</div></div><div><h3>Results</h3><div>Among the 260 presenters who participated in both AAO 2021 and ASCRS 2022, 95 (36.5 %) had identical disclosures, while 150 (57.7 %) exhibited at least one discrepancy. On average, these presenters had 11.23 ± 14.63 disclosures at AAO and 9.88 ± 14.68 disclosures at ASCRS. Similarly, of the 432 presenters at both AAO 2018 and ASCRS 2018, 203 (47.0 %) had consistent disclosures, while 213 (49.5 %) displayed discrepancies. On average, these presenters had 13.16 ± 19.75 disclosures at AAO and 12.49 ± 15.61 disclosures at ASCRS.</div></div><div><h3>Conclusions</h3><div>Significant inconsistencies in COI disclosures were observed among presenters at major ophthalmology conferences within the same year. Nearly half of the presenters exhibited discrepancies in their disclosures, with a notable portion disclosing COIs at one conference but not the other. These findings underscore the need for standardized COI reporting systems with more rigorous verification processes to ensure transparency and trustworthiness in medical conference presentations.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100153"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557325","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 : 2025-06-25DOI: 10.1016/j.ajoint.2025.100152
Andrew Mihalache , Ryan S. Huang , Marko M. Popovic , Kirill Zaslavsky , David Sarraf , SriniVas R. Sadda , Rajeev H. Muni , Edward A. Margolin
Purpose
The risk of retinal artery occlusion (RAO) as related to specific drug use is unclear. Using the Food and Drug Administration Adverse Event Reporting System (FAERS), we aimed to comprehensively elicit a list of FDA-approved drugs overreported for RAO.
Pharmacovigilance data were sourced from the FAERS database between October 2003 and March 2024 using Open Vigil 2.1 (Kiel, Germany) software. FDA-approved pharmacological agents which were recorded as the primary suspect drug for at least 10 reports of RAO were included. Disproportionality analyses were performed to identify positive adverse drug reaction signals by comparing drug-specific reports of RAO to the background rate of RAO reports across all other drugs in the database.
Results
Out of 12,345,128 adverse events reported to the FAERS database during the study period, 1,461 (0.01 %) were identified as cases of RAO. Most primary suspect drugs were indicated for eye disorders (20.7 %, n = 303/1,461), neoplasms (11.4 %, n = 166/1,461), or musculoskeletal and connective tissue disorders (7.2 %, n = 105/1,461). Notably, brolucizumab and tranexamic acid were significantly overreported for RAO events. These were followed by melphalan, triamcinolone, aflibercept, ranibizumab, lidocaine, sildenafil, epinephrine, bupivacaine, and rofecoxib.
Conclusion
Several primary suspect drugs showed disproportionately high reports of RAO in the FAERS database; however, some of these medications are indicated for conditions associated with a hypercoagulable state, a significant risk factor for RAO. These findings underscore the need for continued pharmacovigilance efforts to distinguish potential drug-related effects from the influence of underlying disease.
{"title":"A real-world pharmacovigilance analysis of the risk of retinal artery occlusion from medication use","authors":"Andrew Mihalache , Ryan S. Huang , Marko M. Popovic , Kirill Zaslavsky , David Sarraf , SriniVas R. Sadda , Rajeev H. Muni , Edward A. Margolin","doi":"10.1016/j.ajoint.2025.100152","DOIUrl":"10.1016/j.ajoint.2025.100152","url":null,"abstract":"<div><h3>Purpose</h3><div>The risk of retinal artery occlusion (RAO) as related to specific drug use is unclear. Using the Food and Drug Administration Adverse Event Reporting System (FAERS), we aimed to comprehensively elicit a list of FDA-approved drugs overreported for RAO.</div></div><div><h3>Design</h3><div>Retrospective, population-based pharmacovigilance study.</div></div><div><h3>Methods</h3><div>Pharmacovigilance data were sourced from the FAERS database between October 2003 and March 2024 using Open Vigil 2.1 (Kiel, Germany) software. FDA-approved pharmacological agents which were recorded as the primary suspect drug for at least 10 reports of RAO were included. Disproportionality analyses were performed to identify positive adverse drug reaction signals by comparing drug-specific reports of RAO to the background rate of RAO reports across all other drugs in the database.</div></div><div><h3>Results</h3><div>Out of 12,345,128 adverse events reported to the FAERS database during the study period, 1,461 (0.01 %) were identified as cases of RAO. Most primary suspect drugs were indicated for eye disorders (20.7 %, <em>n</em> = 303/1,461), neoplasms (11.4 %, <em>n</em> = 166/1,461), or musculoskeletal and connective tissue disorders (7.2 %, <em>n</em> = 105/1,461). Notably, brolucizumab and tranexamic acid were significantly overreported for RAO events. These were followed by melphalan, triamcinolone, aflibercept, ranibizumab, lidocaine, sildenafil, epinephrine, bupivacaine, and rofecoxib.</div></div><div><h3>Conclusion</h3><div>Several primary suspect drugs showed disproportionately high reports of RAO in the FAERS database; however, some of these medications are indicated for conditions associated with a hypercoagulable state, a significant risk factor for RAO. These findings underscore the need for continued pharmacovigilance efforts to distinguish potential drug-related effects from the influence of underlying disease.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100152"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524278","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 : 2025-06-24DOI: 10.1016/j.ajoint.2025.100151
Fatma Shakarchi, Ayorinde Cooley, Curtis R Martin, Traeson Brandenburg, Nicolas Zaunbrecher, Christopher L Shelby, Stephen A LoBue, Wyche T Coleman III
Purpose
To highlight the potential of openly accessible online surgical courses in strengthening global ophthalmic education. We demonstrate a case study focusing on a basic phacoemulsification training course published on Orbis Cybersight, designed to support early surgical learning for ophthalmologists worldwide.
Methods
We developed a one-hour, self-paced online course on the basics of phacoemulsification, split into six narrated modules: Incisions, Capsulorhexis, Hydrodissection, Nucleus Removal, Cortex Removal, and IOL Insertion & Wound Closure. We included quizzes for self-testing in every module. We published the course on Orbis Cybersight, a global telemedicine and training platform, and made it freely available on demand. We analyzed engagement patterns and gathered informal feedback from trainees and educators across different regions.
Results
The course was accessed by over 5,000 participants based in 162 countries across all seven continents, including Antarctica, working in diverse high-, middle-, and low-income settings. Most participants were ophthalmologists (2,238; 44.4 %), ophthalmology residents (837; 16.6 %), and optometrists (484; 9.6 %), while nearly 20 % (963) represented a variety of other professions, including drivers, teachers, medical students, and security guards. Approximately 1,340 participants (26.6 %) completed the course, while 2,709 (53.6 %) marked it as “in progress.” On average, participants made about five access attempts and spent a mean of 83.63 minutes to complete the course. The optional pre- and post-course quizzes showed a 39.5 % increase in participation and a 35 % relative increase in knowledge acquisition after completing the course.
Conclusions
Open-access platforms like Orbis Cybersight can play a key role in delivering foundational surgical education. These platforms help bridge gaps in training and promote equity in surgical education. They are impactful for sharing complex cases and essential foundational learning, without adding a financial burden for trainees globally. Our case study offers a scalable, low-cost way to help global trainees gain exposure to essential surgical steps and concepts.
{"title":"Expanding surgical training access: A phacoemulsification course via Orbis Cybersight","authors":"Fatma Shakarchi, Ayorinde Cooley, Curtis R Martin, Traeson Brandenburg, Nicolas Zaunbrecher, Christopher L Shelby, Stephen A LoBue, Wyche T Coleman III","doi":"10.1016/j.ajoint.2025.100151","DOIUrl":"10.1016/j.ajoint.2025.100151","url":null,"abstract":"<div><h3>Purpose</h3><div>To highlight the potential of openly accessible online surgical courses in strengthening global ophthalmic education. We demonstrate a case study focusing on a basic phacoemulsification training course published on Orbis Cybersight, designed to support early surgical learning for ophthalmologists worldwide.</div></div><div><h3>Methods</h3><div>We developed a one-hour, self-paced online course on the basics of phacoemulsification, split into six narrated modules: Incisions, Capsulorhexis, Hydrodissection, Nucleus Removal, Cortex Removal, and IOL Insertion & Wound Closure. We included quizzes for self-testing in every module. We published the course on Orbis Cybersight, a global telemedicine and training platform, and made it freely available on demand. We analyzed engagement patterns and gathered informal feedback from trainees and educators across different regions.</div></div><div><h3>Results</h3><div>The course was accessed by over 5,000 participants based in 162 countries across all seven continents, including Antarctica, working in diverse high-, middle-, and low-income settings. Most participants were ophthalmologists (2,238; 44.4 %), ophthalmology residents (837; 16.6 %), and optometrists (484; 9.6 %), while nearly 20 % (963) represented a variety of other professions, including drivers, teachers, medical students, and security guards. Approximately 1,340 participants (26.6 %) completed the course, while 2,709 (53.6 %) marked it as “in progress.” On average, participants made about five access attempts and spent a mean of 83.63 minutes to complete the course. The optional pre- and post-course quizzes showed a 39.5 % increase in participation and a 35 % relative increase in knowledge acquisition after completing the course.</div></div><div><h3>Conclusions</h3><div>Open-access platforms like Orbis Cybersight can play a key role in delivering foundational surgical education. These platforms help bridge gaps in training and promote equity in surgical education. They are impactful for sharing complex cases and essential foundational learning, without adding a financial burden for trainees globally. Our case study offers a scalable, low-cost way to help global trainees gain exposure to essential surgical steps and concepts.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518403","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 : 2025-06-24DOI: 10.1016/j.ajoint.2025.100150
Chaimae Khodriss , Hicham El Bouri , Reda Benmerak , Rachid Tahiri , Jaafar Bendali , Yassine Benhaddouch , Adil El Ammouri , Adil Najdi , Meriem El Bahloul
Purpose
Second Victim Syndrome (SVS) refers to the psychological, physical, and professional impact experienced by healthcare providers following involvement in an adverse patient event. This study aimed to assess the prevalence of SVS among Moroccan ophthalmologists and to identify the contributory factors associated with its occurrence.
Design
Cross-sectional survey
Methods
A 58-item web-based questionnaire was distributed via WhatsApp and e-mail to 764 registered members of the Moroccan Society of Ophthalmology, including trainees. The questionnaire was structured into three sections: demographic and practice characteristics, personal experience of intraoperative adverse events (IAEs), and assessment with the Second Victim Experience and Support Tool (SVEST). A two-step statistical analysis was performed. The first step was a descriptive analysis to calculate means and standard deviations for quantitative variables and proportions for qualitative variables. The second step was an analytical approach to compare means via ANOVA.
Results
In total, 217 complete responses were obtained, corresponding to a response rate of 28.4 %. The respondents were specialists (62.2 %) residents (26.3 %) and professors of medicine (11.5 %), and 51.6 % worked independently in the private sector. At least one IAE was reported by 94.5 % of the participants, 92.7 % of whom felt uncomfortable with these events. The mental burden of IAEs was described as exhausting by 70.7 % of respondents, and 44.9 % reported doubting their own professional skills after an IAE. Colleagues were identified as the most effective source of support, with 75.1 % of respondents considering peer interactions helpful. Vulnerability to second victim syndrome was highest among female practitioners (p = 0.027), private sector physicians (p = 0.005), and those with less than five years of surgical experience (p = 0.002).
Conclusion
This study highlights a concerning prevalence of second victim syndrome among Moroccan ophthalmologists. Prioritizing the establishment of preventive programs, peer support groups, and dedicated psychological support structures is crucial to safeguard the mental well-being of ophthalmologists and, by extension, to ensure a high quality of patient care.
{"title":"Second victim syndrome in ophthalmology: Contributory factors and insights from the first study","authors":"Chaimae Khodriss , Hicham El Bouri , Reda Benmerak , Rachid Tahiri , Jaafar Bendali , Yassine Benhaddouch , Adil El Ammouri , Adil Najdi , Meriem El Bahloul","doi":"10.1016/j.ajoint.2025.100150","DOIUrl":"10.1016/j.ajoint.2025.100150","url":null,"abstract":"<div><h3>Purpose</h3><div>Second Victim Syndrome (SVS) refers to the psychological, physical, and professional impact experienced by healthcare providers following involvement in an adverse patient event. This study aimed to assess the prevalence of SVS among Moroccan ophthalmologists and to identify the contributory factors associated with its occurrence.</div></div><div><h3>Design</h3><div>Cross-sectional survey</div></div><div><h3>Methods</h3><div>A 58-item web-based questionnaire was distributed via WhatsApp and e-mail to 764 registered members of the Moroccan Society of Ophthalmology, including trainees. The questionnaire was structured into three sections: demographic and practice characteristics, personal experience of intraoperative adverse events (IAEs), and assessment with the Second Victim Experience and Support Tool (SVEST). A two-step statistical analysis was performed. The first step was a descriptive analysis to calculate means and standard deviations for quantitative variables and proportions for qualitative variables. The second step was an analytical approach to compare means via ANOVA.</div></div><div><h3>Results</h3><div>In total, 217 complete responses were obtained, corresponding to a response rate of 28.4 %. The respondents were specialists (62.2 %) residents (26.3 %) and professors of medicine (11.5 %), and 51.6 % worked independently in the private sector. At least one IAE was reported by 94.5 % of the participants, 92.7 % of whom felt uncomfortable with these events. The mental burden of IAEs was described as exhausting by 70.7 % of respondents, and 44.9 % reported doubting their own professional skills after an IAE. Colleagues were identified as the most effective source of support, with 75.1 % of respondents considering peer interactions helpful. Vulnerability to second victim syndrome was highest among female practitioners (<em>p</em> = 0.027), private sector physicians (<em>p</em> = 0.005), and those with less than five years of surgical experience (<em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>This study highlights a concerning prevalence of second victim syndrome among Moroccan ophthalmologists. Prioritizing the establishment of preventive programs, peer support groups, and dedicated psychological support structures is crucial to safeguard the mental well-being of ophthalmologists and, by extension, to ensure a high quality of patient care.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100150"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144479987","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 : 2025-06-15DOI: 10.1016/j.ajoint.2025.100148
Fatma Shakarchi
Purpose
Vision impairment affects one in four individuals globally, disproportionately affecting low- and middle-income countries, particularly in conflict- and climate-affected settings. This brief communication uses Iraq as a case study to examine how these intersecting challenges impact eye health systems. We also aim to identify strategies for strengthening equitable, integrated primary eye health.
Design
A narrative case study.
Methods
We analyzed national health data, health system reports, and international comparator models to assess how eye care services are distributed, accessed, and integrated within Iraq’s primary healthcare system. Special attention was given to socioeconomic disparities, post-conflict infrastructure, and climate vulnerability.
Findings
Only 2 % of Iraq’s primary health centers offer eye-related services, which contributes to overburdened tertiary hospitals, and more than half of hospital consultations are for conditions manageable at the primary level.1 Access is further limited by financial barriers, uneven geographic distribution of specialists, and lack of insurance coverage. Eye health integration into primary healthcare is hindered by systemic and resource limitations.
Conclusions
Iraq’s experience highlights the urgent need for equitable, community-based eye care systems in fragile settings. Addressing these gaps is essential for advancing universal health coverage and meeting global development goals.
{"title":"Eye health in post-conflict and climate-vulnerable settings: Iraq as a case study for equitable, integrated primary eye care","authors":"Fatma Shakarchi","doi":"10.1016/j.ajoint.2025.100148","DOIUrl":"10.1016/j.ajoint.2025.100148","url":null,"abstract":"<div><h3>Purpose</h3><div>Vision impairment affects one in four individuals globally, disproportionately affecting low- and middle-income countries, particularly in conflict- and climate-affected settings. This brief communication uses Iraq as a case study to examine how these intersecting challenges impact eye health systems. We also aim to identify strategies for strengthening equitable, integrated primary eye health.</div></div><div><h3>Design</h3><div>A narrative case study.</div></div><div><h3>Methods</h3><div>We analyzed national health data, health system reports, and international comparator models to assess how eye care services are distributed, accessed, and integrated within Iraq’s primary healthcare system. Special attention was given to socioeconomic disparities, post-conflict infrastructure, and climate vulnerability.</div></div><div><h3>Findings</h3><div>Only 2 % of Iraq’s primary health centers offer eye-related services, which contributes to overburdened tertiary hospitals, and more than half of hospital consultations are for conditions manageable at the primary level.<span><span><sup>1</sup></span></span> Access is further limited by financial barriers, uneven geographic distribution of specialists, and lack of insurance coverage. Eye health integration into primary healthcare is hindered by systemic and resource limitations.</div></div><div><h3>Conclusions</h3><div>Iraq’s experience highlights the urgent need for equitable, community-based eye care systems in fragile settings. Addressing these gaps is essential for advancing universal health coverage and meeting global development goals.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100148"},"PeriodicalIF":0.0,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144364888","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 how recipient and donor characteristics influence corneal graft clearance, using serial measurements of central corneal thickness (CCT) and central graft thickness (CGT) derived from anterior segment optical coherence tomography (AS-OCT).
Design
Prospective cohort study.
Methods
Seventy-one patients (76 eyes) who underwent corneal transplantation (October 2021–April 2024) were followed for at least six months. Serial AS-OCT scans were used to extract CCT and CGT measurements, which were analyzed using mixed linear regression models with time splines to assess changes over time. These thickness parameters served as surrogate markers of corneal and graft deturgescence, respectively.
Results
Both CCT and CGT (for DSAEK grafts only) decreased significantly up to 3 months post-surgery (β = -1.73 μm/day, SE = 0.12, p < 0.001; β = -0.53 μm/day, SE = 0.05; p < 0.001), stabilizing thereafter (β = 0.063 μm/day, SE = 0.045, p = 0.156; β = 0.02 μm/day, SE = 0.02; p = 0.228). Faster clearance was observed in grafts from younger donor age (<56 years; β = 0.67 μm/day, SE = 0.23; p = 0.004) and those with higher endothelial cell density (ECD ≥3,021 cells/mm²; β = –1.14 μm/day, p = 0.001). Penetrating keratoplasty was associated with slower CCT reduction compared to Descemet stripping automated endothelial keratoplasty (β = 0.74 μm/day, SE = 0.32; p = 0.021). Other preoperative factors did not significantly influence clearance
Conclusion
CCT and CGT are useful quantitative markers of corneal graft clearance. Donor age, ECD and surgical technique significantly influence early postoperative dynamics. Serial AS-OCT imaging offers valuable, non-invasive insights into graft behavior that can inform clinical decision-making.
目的利用前段光学相干断层扫描（AS-OCT）连续测量角膜中央厚度（CCT）和中心移植物厚度（CGT），评估受体和供体特征对角膜移植物清除率的影响。前瞻性队列研究。方法对71例（76眼）角膜移植患者（2021年10月~ 2024年4月）进行随访，随访时间至少6个月。连续AS-OCT扫描用于提取CCT和CGT测量值，使用带有时间样条的混合线性回归模型对其进行分析，以评估随时间的变化。这些厚度参数分别作为角膜和移植物消肿的替代指标。结果CCT和CGT（仅用于DSAEK移植物）在术后3个月显著下降(β = -1.73 μm/d, SE = 0.12, p <；0.001;β = -0.53 μm/day, SE = 0.05；p & lt;0.001)，此后趋于稳定(β = 0.063 μm/day, SE = 0.045, p = 0.156；β = 0.02 μm/day, SE = 0.02；P = 0.228)。年龄较小的供者(56岁；β = 0.67 μm/day, SE = 0.23；p = 0.004)和内皮细胞密度较高(ECD≥3,021个细胞/mm²；β = -1.14 μm/day, p = 0.001)。与Descemet剥离自动内皮角膜移植术相比，穿透性角膜移植术的CCT降低速度较慢(β = 0.74 μm/天，SE = 0.32；P = 0.021)。结论cct和CGT是评价角膜移植清除率的有效定量指标。供体年龄、ECD和手术技术显著影响术后早期动态。连续AS-OCT成像为移植物行为提供了有价值的、无创的见解，可以为临床决策提供信息。
{"title":"Impact of recipient and donor factors on corneal graft clearance: insights from serial anterior segment optical coherence tomography","authors":"Stylianos Christodoulou , Dimitris Kola , Fedonas Herodotou , Aikaterini Athanasiadou , Chara Tzavara , Neofytos Michael , Anastasia Neokleous , Georgina Hadjilouka , Sotiria Palioura","doi":"10.1016/j.ajoint.2025.100147","DOIUrl":"10.1016/j.ajoint.2025.100147","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate how recipient and donor characteristics influence corneal graft clearance, using serial measurements of central corneal thickness (CCT) and central graft thickness (CGT) derived from anterior segment optical coherence tomography (AS-OCT).</div></div><div><h3>Design</h3><div>Prospective cohort study.</div></div><div><h3>Methods</h3><div>Seventy-one patients (76 eyes) who underwent corneal transplantation (October 2021–April 2024) were followed for at least six months. Serial AS-OCT scans were used to extract CCT and CGT measurements, which were analyzed using mixed linear regression models with time splines to assess changes over time. These thickness parameters served as surrogate markers of corneal and graft deturgescence, respectively.</div></div><div><h3>Results</h3><div>Both CCT and CGT (for DSAEK grafts only) decreased significantly up to 3 months post-surgery (β = -1.73 μm/day, SE = 0.12, p < 0.001; β = -0.53 μm/day, SE = 0.05; p < 0.001), stabilizing thereafter (β = 0.063 μm/day, SE = 0.045, p = 0.156; β = 0.02 μm/day, SE = 0.02; p = 0.228). Faster clearance was observed in grafts from younger donor age (<56 years; β = 0.67 μm/day, SE = 0.23; p = 0.004) and those with higher endothelial cell density (ECD ≥3,021 cells/mm²; β = –1.14 μm/day, p = 0.001). Penetrating keratoplasty was associated with slower CCT reduction compared to Descemet stripping automated endothelial keratoplasty (β = 0.74 μm/day, SE = 0.32; p = 0.021). Other preoperative factors did not significantly influence clearance</div></div><div><h3>Conclusion</h3><div>CCT and CGT are useful quantitative markers of corneal graft clearance. Donor age, ECD and surgical technique significantly influence early postoperative dynamics. Serial AS-OCT imaging offers valuable, non-invasive insights into graft behavior that can inform clinical decision-making.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144307023","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 : 2025-06-10DOI: 10.1016/j.ajoint.2025.100145
Charles J. Proxenos , Himal Kandel , Aanchal Gupta , Jern Yee Chen , Adam Watson , Nicholas Downie , Stephanie L. Watson
Purpose
This study reports the clinical outcomes of corneal crosslinking in children with thin corneas in the real-world setting.
Design
Retrospective, longitudinal study
Subjects
The subjects were extracted from the Save Sight Keratoconus Registry and 18 children (21 eyes) under the age of 18 with corneas of 400 µm or less were included in the study.
Methods
Using the Save Sight Keratoconus Registry data was collected from 10 practices across Australia and New Zealand. Outcomes were assessed at the final follow-up visit. The primary outcome measure was a change in corneal curvature. Secondary outcomes included a change in visual acuity, a change in corneal thickness, and adverse events.
Results
Eighteen patients (21 eyes), of which 12 (66.7 %) were male, with a median age of 16 years (IQR 4.0, Range 8 to 18) underwent CXL. Median follow-up was 10 months (IQR 8, range 3 -55). Median values in outcome measures changed from baseline to follow-up: Kmax from 70.5D (IQR 15.5) to 69.3D (IQR 20.7), K2 from 60.5D (IQR 11.3) to 58.6D (IQR 13.5), habitual visual acuity from 47 (IQR 44.0) to 50 (IQR 31.0) LogMAR letters, pinhole visual acuity from 55 (IQR 11.0) to 60 (IQR 11.0) LogMAR letters and minimum corneal thickness from 390 μm (IQR 29.0) to 370.5 μm (IQR 48.5). Three eyes experienced adverse events. Two developed corneal scarring and one developed microbial keratitis requiring corneal graft.
Conclusions
This real-world study shows that CXL in children with thin corneas can stabilise corneal parameters and vision. Adverse events occur and include scarring and microbial keratitis. The small sample size and short duration of follow-up are notable limitations, and further larger prospective studies are needed to determine the safety and efficacy of CXL in children.
{"title":"Corneal crosslinking for keratoconus in children with thin corneas: A multicentre registry study","authors":"Charles J. Proxenos , Himal Kandel , Aanchal Gupta , Jern Yee Chen , Adam Watson , Nicholas Downie , Stephanie L. Watson","doi":"10.1016/j.ajoint.2025.100145","DOIUrl":"10.1016/j.ajoint.2025.100145","url":null,"abstract":"<div><h3>Purpose</h3><div>This study reports the clinical outcomes of corneal crosslinking in children with thin corneas in the real-world setting.</div></div><div><h3>Design</h3><div>Retrospective, longitudinal study</div></div><div><h3>Subjects</h3><div>The subjects were extracted from the Save Sight Keratoconus Registry and 18 children (21 eyes) under the age of 18 with corneas of 400 µm or less were included in the study.</div></div><div><h3>Methods</h3><div>Using the Save Sight Keratoconus Registry data was collected from 10 practices across Australia and New Zealand. Outcomes were assessed at the final follow-up visit. The primary outcome measure was a change in corneal curvature. Secondary outcomes included a change in visual acuity, a change in corneal thickness, and adverse events.</div></div><div><h3>Results</h3><div>Eighteen patients (21 eyes), of which 12 (66.7 %) were male, with a median age of 16 years (IQR 4.0, Range 8 to 18) underwent CXL. Median follow-up was 10 months (IQR 8, range 3 -55). Median values in outcome measures changed from baseline to follow-up: Kmax from 70.5D (IQR 15.5) to 69.3D (IQR 20.7), K2 from 60.5D (IQR 11.3) to 58.6D (IQR 13.5), habitual visual acuity from 47 (IQR 44.0) to 50 (IQR 31.0) LogMAR letters, pinhole visual acuity from 55 (IQR 11.0) to 60 (IQR 11.0) LogMAR letters and minimum corneal thickness from 390 μm (IQR 29.0) to 370.5 μm (IQR 48.5). Three eyes experienced adverse events. Two developed corneal scarring and one developed microbial keratitis requiring corneal graft.</div></div><div><h3>Conclusions</h3><div>This real-world study shows that CXL in children with thin corneas can stabilise corneal parameters and vision. Adverse events occur and include scarring and microbial keratitis. The small sample size and short duration of follow-up are notable limitations, and further larger prospective studies are needed to determine the safety and efficacy of CXL in children.</div></div>","PeriodicalId":100071,"journal":{"name":"AJO International","volume":"2 3","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314134","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 : 2025-06-01DOI: 10.1016/j.ajoint.2025.100144
Norma E. Del Risco , Mildred Silva Zuccaro , Jade J. Livingston , Michele Heisler , Harry Levine , Maria A. Woodward , Amanda K. Bicket , Angela R. Elam , Denise A. John , Paula Anne Newman-Casey
Purpose
Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine Program (MI-SIGHT) was developed to facilitate access to glaucoma and eye disease screening and improve attendance at recommended follow-up in underserved communities. MI-SIGHT offered free eye disease screenings, low-cost glasses and for those who screened positive for glaucoma, personalized education, and language-concordant coaching grounded in motivational interviewing. The primary aims of this study were 1) To explore barriers to eye care among Latine participants with limited English proficiency (LEP) who screened positive for glaucoma, 2) to understand whether and how the MI-SIGHT program facilitated access to care and 3) to understand participant experience in MI-SIGHT to inform the development of future interventions.
Design
Qualitative study.
Subjects
21 participants who identified as Latine with low English proficiency (LEP) who screened positive for glaucoma during the MI-SIGHT program and received personalized health education about their screening results, motivational-interviewing based health coaching, and care navigation all in Spanish.
Methods
Participants were recruited from the two MI-SIGHT sites, a Federally Qualified Health Center (FQHC) and a free clinic. Semi-structured interviews were conducted in Spanish by a native Spanish speaker. Interviews were audio-recorded and transcribed verbatim in Spanish. Grounded theory was used to guide qualitative analysis. Thematic saturation was achieved after analyzing 16 interviews.
Main outcome measures
Themes regarding barriers to eye care access and facilitators to eye care access through MI-SIGHT.
Results
Between 7/11/23–12/19/23, 154 MI-SIGHT participants identified as Latine and had LEP, 22 screened positive for glaucoma and 21 agreed to be interviewed. Interviews revealed that the primary obstacles to accessing eye care among Latine participants with LEP were language barriers, financial constraints due to lack of insurance, insufficient social support, and difficulty with transportation. Additional challenges included immigration-related fears and complexities in healthcare system navigation. Participants identified key facilitators of the MI-SIGHT program as language concordance with providers, availability of interpreters, affordable eye care and glasses, and transportation services. Personalized coaching in their native language further enhanced their understanding of their eye disease and participation. High satisfaction was evident, with nearly all participants willing to recommend the program to others.
Conclusions
Eye care access for Latine participants with LEP is shaped by interconnected structural, socioeconomic, and cultural barriers. Language-concordant interventions, like the MI-SIGHT p
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Pub Date : 2025-05-31DOI: 10.1016/j.ajoint.2025.100143
Afaf Bachira Gouhiri , Mohamed A. Aldemerdash , Naila-Oulfet Zitouni , Zina Otmani , Omar F. Abbas , Weam Aldiban , Youssef Adel Youssef Ashmawi , Abdelaziz A Awad , Hashem Abu Serhan
Purpose
To evaluate the efficacy and safety of nanoemulsion cyclosporine compared to conventional cyclosporine in reducing symptoms of dry eye disease (DED).
Design
A systematic review and meta-analysis.
Methods
We searched Scopus, Web of Science, PubMed, Embase, and Cochrane for relevant randomized clinical trials (RCTs) and pooled the mean differences (MD) for continuous efficacy outcomes, including the Schirmer test, ocular surface disease index (OSDI), and tear film break-up time (TBUT), and risk ratios (RR) for dichotomous safety outcomes, such as adverse drug reactions or ocular adverse events, with their corresponding 95% confidence intervals (CI) across different time points from baseline. We used R statistical software to run the meta-analysis and I² statistic to assess heterogeneity.
Results
Seven RCTs involving 545 patients were included. At 12 weeks, nanoemulsion cyclosporine significantly improved tear production as measured by the Schirmer test (MD = 0.77 mm, 95% CI, 0.22 to 1.31, p < 0.01) and tear film stability assessed by TBUT (MD = 0.51 seconds, 95% CI, 0.32 to 0.70, p < 0.01) compared to conventional cyclosporine. Safety analysis showed no significant difference in overall adverse events between groups (RR = 1.13, 95% CI, 0.81 to 1.56, p = 0.44). However, nanoemulsion cyclosporine was associated with a significantly higher risk of ocular adverse events (RR = 3.53, 95% CI, 1.18 to 10.54, p = 0.02).
Conclusions
Our meta-analysis demonstrates that nanoemulsion cyclosporine significantly improves tear production and tear film stability at the longest available follow-up. However, it is also associated with an increased risk of ocular adverse events. These findings highlight the need to balance efficacy and safety when considering nanoemulsion cyclosporine and could help inform clinical guidelines on optimal treatment duration and monitoring.
目的比较纳米乳环孢素与常规环孢素治疗干眼症的疗效和安全性。设计系统回顾和荟萃分析。方法检索Scopus、Web of Science、PubMed、Embase和Cochrane，检索相关随机临床试验（rct），汇总持续疗效结局的平均差异（MD），包括Schirmer试验、眼表疾病指数（OSDI）和泪膜破裂时间（TBUT），以及药物不良反应或眼部不良事件等二分类安全性结局的风险比（RR）。从基线到不同时间点的相应95%置信区间（CI）。我们使用R统计软件进行meta分析，使用I²统计来评估异质性。结果纳入7项随机对照试验，共545例患者。在12周时，通过Schirmer试验，纳米乳环孢素显著改善泪液产生(MD = 0.77 mm, 95% CI， 0.22至1.31,p <；0.01)， TBUT评估泪膜稳定性(MD = 0.51秒，95% CI, 0.32 ~ 0.70, p <；0.01)，与常规环孢素比较。安全性分析显示，两组间总的不良事件发生率无显著差异（RR = 1.13, 95% CI, 0.81 ~ 1.56, p = 0.44）。然而，纳米乳环孢素与眼部不良事件的风险显著升高相关（RR = 3.53, 95% CI, 1.18 ~ 10.54, p = 0.02）。结论在最长随访时间内，纳米乳环孢素可显著改善泪液生成和泪膜稳定性。然而，它也与眼部不良事件的风险增加有关。这些发现强调了在考虑纳米乳环孢素时需要平衡疗效和安全性，并且可以帮助提供关于最佳治疗持续时间和监测的临床指南。
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