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Background/objective: Ophthalmologists rely on clinical practice guidelines to inform their practice. Not all guidelines, however, are considered trustworthy. For guidelines to be credible and evidence-based, internationally-accepted standards suggest that they must adhere to certain criteria. We aim to identify strengths and limitations of commonly used ophthalmology guidelines and provide insights to develop trustworthy, fit-for-purpose guidelines in the field.

Methods: We will search MEDLINE, Embase, Trip Database, the Royal College of Ophthalmologists ( https://www.rcophth.ac.uk/ ) and American Academy of Ophthalmology ( https://www.aao.org/clinical-statements ) websites. From these sources, we will include a purposeful sample 100 guidelines published from 2015 onwards addressing diverse areas in ophthalmology (e.g., cornea, glaucoma, retina, paediatrics, etc.) - forty guidelines from major eye care organisations and sixty from diverse ophthalmology subspecialties and regions. We will appraise each guideline according to the modified National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) instrument.

Conclusion: By identifying best practices and common pitfalls in existing guidelines, this work will provide a roadmap for creating more robust, transparent, and patient-centred clinical practice guidelines in ophthalmology.

Purpose: This study evaluated longitudinal choroidal vascular changes in dry age-related macular degeneration (dAMD) eyes using a three-dimensional (3D) algorithm.

Methods: Patients underwent swept-source optical coherence tomography during two follow-up visits. Choroidal boundaries and vessels were segmented using the ResUNet model and Phansalkar thresholding. 3D choroidal maps were created and divided into five sectors. Mean choroidal vessel diameter (MChVD), inter-vessel distance (IVD), volumetric choroidal thickness (ChT), and choroidal vascularity index (CVI) were measured in both visits.

Results: This retrospective cohort study included 30 eyes with AMD. The mean age was 72.8 ± 9.55 years. The mean follow-up duration was 11.6 ± 5.02 months. The mean MChVD increased 16.4 µm (6.8%) over time (239.2 ± 19.8 to 255.6 ± 28.2 µm, P = 0.003), particularly in the nasal and temporal sectors (P < 0.05). The mean IVD increased 21.8 µm (10.8%) over time (201.8 ± 29.0 to 223.7 ± 38.2 µm, P = 0.009), which was significant in the nasal, temporal, and superior sectors (P < 0.05). The ChT showed a decreasing trend, though not statistically significant (190.7 ± 58.0 to 183.4 ± 56.8 µm, P = 0.051). The CVI remained stable during follow-up (0.358 ± 0.034 vs. 0.357 ± 0.040, P = 0.933). MChVD positively correlated with the IVD (r = +0.501, P = 0.005). ChT exhibited a negative correlation with IVD (r = -0.426, P = 0.019).

Conclusion: Eyes with dry AMD showed increased MChVD and IVD along with decreased ChT, and we hypothesise that these changes may reflect progressive small-vessel atrophy accompanied by compensatory dilation of larger choroidal vessels during follow-up.

Purpose: To assess prevalence and associations of active central serous chorioretinopathy (CSC) and inactive CSC/pachychoroid pigment epitheliopathy (PPE) in a general population aged 50+ years.

Methods: Using optical coherent tomographic images, we assessed CSC lesions in participants of the population-based Beijing Eye Study. We differentiated between active CSC with subretinal fluid, and inactive CSC/PPE with retinal pigment epithelium irregularities and dilated large choroidal vessels and without subretinal fluid.

Results: Out of 6551 eyes, CSC/PPE was detected in 98 eyes (70 participants; 60 (86%) men) (prevalence: 1.5%; 95%CI: 1.1, 1.9), with active CSC (with/without inactive CSC/PPE) in 52 eyes (53%) and inactive CSC/PPE (with/without an active component) in 66 eyes (67%). CSC location was only foveal in 21 (21%) eyes, only extrafoveal in 44 (45%) eyes, and mixed in 33 (34%) eyes. CSC occurred bilaterally in 28 patients (56 (57%) eyes). Both eyes of all CSC patients (also those with unilateral CSC) showed markedly dilated large choroidal vessels. CSC lesion number ranged between 1 and 13 (mean:2.5 ± 2.2) per eye. Higher CSC prevalence was associated with younger age (OR: 0.95; 95%CI: 0.91, 0.99; P = 0.01), male sex (OR: 4.16; 95% CI: 1.92, 9.02; P < 0.001), thicker subfoveal choroid (OR: 1.004; 95% CI: 1.001, 1.007; P = 0.01), and higher prevalences of retinal outer nuclear layer thinning (OR: 4.08; 95% CI: 1.25, 13.3; P = 0.02), intraretinal hyperreflective foci (iHRFs) beyond the ellipsoid zone (OR: 7.11; 95% CI: 3.21, 15.8; P < 0.001), macular hypopigmentations (OR: 1.55; 95% CI: 1.30, 1.85; P < 0.001), and incomplete retinal pigment epithelium and outer retinal atrophy (iRORA) (OR: 12.3; 95% CI: 2.97, 51.1; P < 0.001).

Conclusions: Active CSC and inactive CSC/PPE together were relatively frequent in a general population consisting of Han Chinese from the Beijing region and aged 50+ years. They occurred often multifocal and were often extrafoveally located.

Objectives: Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is traditionally viewed as a uniform presentation of syphilitic posterior uveitis, though recent evidence suggests broader phenotypic variability. This study aimed to characterise ASPPC heterogeneity using multimodal imaging (MMI).

Methods: Single-centre retrospective cohort study on patients presenting with syphilitic posterior uveitis or panuveitis. MMI included fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). Cases were classified as typical ASPPC when a unifocal, well-demarcated placoid lesion was present at the posterior pole, and as atypical when multifocal lesions were funduscopically occult but evident on FAF. Macular sensitivity recovery post-antibiotic treatment was evaluated in a subset of cases using microperimetry.

Results: Among 33 eyes from 21 patients (median age: 51 years, 91% male), 55% had typical ASPPC and 45% an atypical presentation. HIV co-infection was found only in patients with a typical placoid lesion (42%). Both phenotypes consistently demonstrated hyperautofluorescent lesions on FAF, which corresponded to late-phase hypofluorescence on ICGA and ellipsoid zone disruption on OCT. Atypical cases showed a higher prevalence of vitritis (53% vs. 44%, P < 0.001), uveitic macular oedema (27% vs. 0%), and peripheral vascular leakage (73% vs. 28%, P = 0.004). Macular sensitivity improved by a mean of 1.7 dB/month (P = 0.005), with no significant difference observed between typical and atypical presentations.

Conclusion: This study broadens the clinical spectrum of ASPPC by characterising atypical funduscopically occult presentations. Despite phenotypic differences, all cases share identical MMI features, although atypical forms may exhibit more pronounced posterior segment inflammation.

Objectives: To characterise diabetic macular atrophy (DMA) and identify risk factors for progression to retinal pigment epithelium (RPE) and outer retinal atrophy.

Methods: In this retrospective longitudinal cohort study, we analysed 103 eyes from 70 patients with diabetic retinopathy (DR) and DMA, identified between 2015 and 2024. DMA was defined by clear-bordered hypopigmented RPE lesions on fundus photography with corresponding choroidal hypertransmission on optical coherence tomography (OCT). Lesions were classified as focal or diffuse and staged using modified criteria from the Classification of Atrophy Meetings for the geographic atrophy. Longitudinal OCT, fundus photos, and visual acuity were evaluated using time-to-event analysis and linear mixed-effects models.

Results: Over a mean follow-up of 91.9 months, 93% of eyes progressed to complete RPE and outer retinal atrophy (cRORA). Foveal detachment from DR-related macular structural complications, including macular oedema, epiretinal membrane, vitreomacular traction, and retinal detachment, was linked to earlier onset (p < 0.001) and faster progression (p = 0.036) to cRORA. Diffuse-type DMA, more common in females and eyes post-vitrectomy with silicone oil, was associated with worse visual acuity throughout progression (p = 0.010) and at end-stage (p = 0.029). Fundus autofluorescence in DMA revealed a characteristic diffuse hypoautofluorescence surrounding atrophic patch.

Conclusion: DMA is a vision-threatening, progressive condition in advanced DR. The diffuse-type DMA predicted worse vision throughout DMA progression and end-stage DMA. Foveal detachment of any cause was associated with earlier DMA onset and faster progression to end-stage. Structural macular complications in DR may play a pivotal role in DMA pathogenesis.

Background/objectives: To examine how multiple birth status affects the incidence and severity of retinopathy of prematurity (ROP) in preterm infants. With increasing multiple births associated with assisted reproductive technology, this study seeks to clarify these risks independently of gestational age (GA) and birth weight (BW).

Subjects/methods: This retrospective observational study included 4392 preterm infants screened for ROP between 2010 and 2023. Eligibility criteria were GA ≤ 32 weeks, BW ≤ 2000 g, or unstable clinical conditions. ROP screening results, GA, BW, gender, and multiple birth status were analysed using multivariable logistic regression to assess predictors for ROP incidence and severity.

Results: Among the cohort, 1643 infants (37.4%) were from multiple births, and 780 infants (17.8%) were diagnosed with ROP. Multivariable analysis showed that lower GA (B: -0.063, OR = 0.94), lower BW (B: -0.001, OR = 0.999), and multiple birth status (B: 0.41, OR = 1.51) were independently associated with ROP incidence. For ROP severity, only lower BW (beta: -0.17, B: -0.01) and multiple birth status (beta: 0.08, B: 2.69) were significant.

Conclusions: Multiple birth status may be independently associated with an increased risk and severity of ROP in preterm infants. These findings warrant further investigation to validate the association and to explore whether infants from multiple gestations might benefit from more tailored screening strategies.

Objective: To compare the surgical outcomes of myopic foveoschisis (MF) with preoperative attached versus detached fovea.

Design: A retrospective interventional case series.

Participants: Eyes with MF that underwent vitrectomy were included and were divided into an attached fovea group (26 eyes) and a detached fovea group (54 eyes).

Methods: Preoperative and postoperative best-corrected visual acuity (BCVA) and optical coherence tomography were analysed. The impact of cataract and posterior vitreous detachment were also assessed.

Results: Surgical complications were low and comparable between the two groups (p = 0.830), and the BCVA was similar between the groups at postoperative 6 and 12 months. Ellipsoid zone (EZ) restoration at 6 months was significantly greater in the attached fovea group (12/26 eyes, 46%) than in the detached group (12/54 eyes, 22%; p = 0.037). A trend toward greater restoration was observed at 12 months in the attached group (15/26 [58%] versus 24/54 [44%]; p = 0.098). Eliminating the effect of cataract, the pseudophakic subgroup analyses showed only those with a baseline attached fovea had improved BCVA (p = 0.028). Furthermore, only the 55 eyes with attached posterior vitreous preoperatively showed significant BCVA improvement at 12 months (p < 0.001), whereas the 25 eyes with a preoperative detached vitreous did not (p = 0.390).

Conclusions: Early vitrectomy in MF before foveal detachment preserves outer retinal integrity and may result in better visual acuity outcomes. Future studies are needed to confirm this and should investigate the impact of posterior vitreous detachment on the outcomes.

Objective: To describe a series of patients who developed retinal vein occlusion (RVO) while undergoing treatment with tyrosine kinase inhibitors (TKIs) for systemic malignancy.

Methods: A retrospective chart review was performed to identify patients at an academic medical centre from 2014 to 2024 who developed an RVO while on TKI therapy. Data collected included demographics, cancer diagnosis, TKI agent and treatment duration, ocular history, and treatment outcomes. Ophthalmic imaging obtained at the time of presentation was reviewed when available to confirm the diagnosis of an RVO.

Results: Eleven patients (12 eyes) were identified with an RVO during TKI therapy. The mean age at presentation was 75.9 ± 9.8 years, and 8 patients (72.7%) were male. TKIs included imatinib (n = 3), axitinib (n = 5), ibrutinib (n = 2), and regorafenib (n = 1). RVO developed after a mean duration of 2.8 ± 2.0 years on TKI therapy (range: 0.8-6.5 years). Of the 12 RVOs, 8 were central retinal vein occlusions (CRVOs) and 4 were branch retinal vein occlusions (BRVOs). The mean Naranjo Adverse Drug Reaction Probability Score was 5.2, suggesting a probable link between TKI use and RVO. One patient developed bilateral RVO after continuing regorafenib therapy.

Conclusions: This series highlights a possible association between TKI therapy and RVO, underscoring the need for awareness in patients with vascular risk factors.

Background/objectives: Psoriasis is a systemic immune-mediated disease with ocular involvement. While biologic therapies reduce cardiovascular and musculoskeletal comorbidities, their impact on ocular health is not well characterised. We aimed to assess whether biologic therapy is associated with reduced ocular disease risk in psoriasis patients.

Subjects/methods: We performed a large-scale, retrospective cohort study using the TriNetX Global Collaborative Network (>160 million patients worldwide). Adults with psoriasis initiating biologic therapy were compared with those receiving non-biologic systemic treatments. Cohorts were matched 1:1 by propensity scoring for demographic and clinical variables. Sixty-eight ocular outcomes were assessed over 6 to 120 months. Hazard ratios (HRs) were estimated using proportional hazards models.

Results: Among 30,911 biologic-treated and 35,832 non-biologic-treated patients with psoriasis, biologic therapy was consistently associated with reduced risk of ocular surface and corneal inflammation. The strongest associations were seen for dry eye disease (mean HR = 0.55, 95% confidence interval [CI; 0.42, 0.66], p = 0.0007), conjunctivitis (mean HR = 0.71, 95% CI [0.59, 0.86], p = 0.01), and keratitis (mean HR = 0.40, 95% CI [0.3, 0.56], p = 0.0007). These lower-risk associations were evident from 6 months and remained observable in the 10-year analysis window. No consistent reduction was observed for retinal or vitreous disease.

Conclusions: Biologic therapy in psoriasis was associated with a lower risk of ocular surface disease. These observational findings may inform interdisciplinary management and consideration of ocular outcomes in treatment decisions.