Pub Date : 2026-02-05DOI: 10.1001/jamaophthalmol.2025.5660
Lisa A. Ostrin, Alexander W. Schill
Importance Red laser therapy (ie, repeated low-level red light) has emerged as an intervention for myopia, with widespread clinical use in Asia and increasing international consideration. However, the ocular safety of commercially available devices has not been rigorously evaluated. Objective To assess the optical output and safety classification of 4 commercially available red light therapy devices for myopia management using American National Standards Institute (ANSI) guidelines. Design and Setting This quality improvement study consisted of a laboratory-based evaluation of the Sky-n1201, Future Vision, EyeRising, and AirDoc instruments and was performed from November 25, 2023, to April 30, 2024. Radiometric power was measured with an integrating sphere radiometer at 1- and 10-cm distances through a 7-mm aperture and retinal irradiance calculated for 2- to 7-mm pupil diameters. Safety classification was investigated according to ANSI Z80.36-2021 and ANSI Z136.1-2022 standards. Data were analyzed from November 25, 2023, to September 10, 2024. Main Outcomes and Measures The main outcome was assessing the time to the group 1 safety limit and the ANSI device classification. This was measured by laboratory-based evaluation of 4 instruments and measuring radiometric power at various pupil diameters. Results The Sky-n1201 and EyeRising devices reached ANSI group 1 limits within exposure times of 2.8 and 1.4 seconds, respectively, for a 7-mm pupil and are classified as Class 1 and 2M laser devices, respectively. The Future Vision device reached group 1 limits under extended exposure times of 253 seconds or longer but remained within limits for Class 1 laser classification. The light-emitting diode–based AirDoc produced diffuse illumination with a time to group 1 limit of 22 761 seconds, classifying it as group 1. Conclusions and Relevance These findings suggest that laser-based red light therapy instruments deliver irradiance levels that reach ANSI safety limits within exposure times below the recommended 180-second treatment time. These findings, combined with emerging clinical reports of retinal damage and recent regulatory reclassification of red laser devices as Class III in China, highlight the need for rigorous, independent safety validation before widespread pediatric use.
{"title":"Safety Evaluation of 4 Red Light Therapy Devices for Myopia","authors":"Lisa A. Ostrin, Alexander W. Schill","doi":"10.1001/jamaophthalmol.2025.5660","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5660","url":null,"abstract":"Importance Red laser therapy (ie, repeated low-level red light) has emerged as an intervention for myopia, with widespread clinical use in Asia and increasing international consideration. However, the ocular safety of commercially available devices has not been rigorously evaluated. Objective To assess the optical output and safety classification of 4 commercially available red light therapy devices for myopia management using American National Standards Institute (ANSI) guidelines. Design and Setting This quality improvement study consisted of a laboratory-based evaluation of the Sky-n1201, Future Vision, EyeRising, and AirDoc instruments and was performed from November 25, 2023, to April 30, 2024. Radiometric power was measured with an integrating sphere radiometer at 1- and 10-cm distances through a 7-mm aperture and retinal irradiance calculated for 2- to 7-mm pupil diameters. Safety classification was investigated according to ANSI Z80.36-2021 and ANSI Z136.1-2022 standards. Data were analyzed from November 25, 2023, to September 10, 2024. Main Outcomes and Measures The main outcome was assessing the time to the group 1 safety limit and the ANSI device classification. This was measured by laboratory-based evaluation of 4 instruments and measuring radiometric power at various pupil diameters. Results The Sky-n1201 and EyeRising devices reached ANSI group 1 limits within exposure times of 2.8 and 1.4 seconds, respectively, for a 7-mm pupil and are classified as Class 1 and 2M laser devices, respectively. The Future Vision device reached group 1 limits under extended exposure times of 253 seconds or longer but remained within limits for Class 1 laser classification. The light-emitting diode–based AirDoc produced diffuse illumination with a time to group 1 limit of 22 761 seconds, classifying it as group 1. Conclusions and Relevance These findings suggest that laser-based red light therapy instruments deliver irradiance levels that reach ANSI safety limits within exposure times below the recommended 180-second treatment time. These findings, combined with emerging clinical reports of retinal damage and recent regulatory reclassification of red laser devices as Class III in China, highlight the need for rigorous, independent safety validation before widespread pediatric use.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1001/jamaophthalmol.2025.6067
Kendra L. Hong, Benjamin Y. Xu, Wei Wang, Austin Cho, Paul J. Foster, Yuzhen Jiang, Natalia Porporato, Tin Aung, David S. Friedman, Mingguang He
Importance Ocular biometrics measured by anterior segment optical coherence tomography (AS-OCT) predicts progression from primary angle closure suspect (PACS) to primary angle closure (PAC), but obtaining these measurements is time intensive and requires specialized software. Iridotrabecular contact (ITC), a qualitative feature readily visible on AS-OCT images from multiple devices, offers a potentially more accessible method for risk stratification, but the association between ITC and progression to PAC is unclear. Objective To investigate the association of ITC presence and length on AS-OCT images with 72-month progression from PACS to PAC. Design, Setting, and Participants This was a single-center population-based retrospective cohort study using data from the prospective Zhongshan Angle Closure Prevention (ZAP) randomized clinical trial. The untreated eyes of trial participants aged 50 to 70 years with bilateral PACS were analyzed for progression to PAC, defined as development of intraocular pressure greater than 24 mm Hg, peripheral anterior synechiae, and/or acute angle closure. ITC250/500/750 was defined as angle-opening distance of 0 mm at 250, 500, and 750 µm anterior to the scleral spur, respectively. ITC less than 250 µm in length was identified by an expert grader in images without ITC250/500/750. ITC extent was defined as the number of sectors with ITC. Risk factors for progression were evaluated using age-adjusted Cox regression models. Study data were analyzed from October 2024 to April 2025. Exposures ITC presence and length on AS-OCT images. Main Outcomes and Measures The main outcome was 72-month progression from PACS to PAC. Results A total of 825 untreated eyes (791 without progression, 34 with progression) of 825 participants (mean [SD] age, 58.7 [5.0] years; 685 female [83.0%]) were eligible. In age-adjusted Cox models, ITC presence in the nasal sector was associated with greater risk of angle closure progression (hazard ratio [HR], 4.68; 95% CI, 1.80-12.17; P = .002; concordance index [C index] = 0.71). Greater ITC length in the nasal (HR, 1.64 per 250 µm in length; 95% CI, 1.23-2.20; P < .001; C index = 0.70) or superior (HR, 1.72 per 250 µm in length; 95% CI, 1.11-2.66; P = .02; C index = 0.67) sector was associated with greater risk of progression. ITC extent and cumulative gonioscopy score were not associated with progression. Conclusions and Relevance Nasal ITC presence and nasal or superior ITC length were associated with greater risk of 72-month progression from PACS to PAC. These findings suggest qualitative detection of ITC provides a practical alternative to ocular biometric analysis for identifying high-risk PACS eyes.
通过前段光学相干断层扫描（AS-OCT）测量的眼部生物特征可以预测从初级闭角可疑（PACS）到初级闭角（PAC）的进展，但获得这些测量需要耗费大量时间，并且需要专门的软件。虹膜小梁接触（ITC）是一种定性特征，在多个设备的AS-OCT图像上很容易看到，它提供了一种潜在的更容易获得的风险分层方法，但ITC与进展为PAC之间的关系尚不清楚。目的探讨AS-OCT图像中ITC的存在和长度与从PACS到PAC的72个月进展之间的关系。设计、环境和参与者这是一项基于单中心人群的回顾性队列研究，使用的数据来自前瞻性中山角闭合预防（ZAP）随机临床试验。研究人员分析了50 - 70岁双侧PACS患者未经治疗的眼睛进展为PAC的情况，PAC的定义为眼压大于24 mm Hg、周围前粘连和/或急性闭角。定义ITC250/500/750分别为距巩膜距前250、500和750µm处0 mm的开角距离。在没有ITC250/500/750的图像中，长度小于250µm的ITC由专家评分员识别。ITC程度定义为具有ITC的部门的数量。使用年龄校正Cox回归模型评估进展的危险因素。研究数据分析时间为2024年10月至2025年4月。在AS-OCT图像上曝光ITC的存在和长度。主要终点为从PACS到PAC的72个月进展情况。结果825名参与者（平均[SD]年龄58.7[5.0]岁，685名女性[83.0%]）共纳入825只未经治疗的眼睛（791只无进展，34只有进展）。在年龄校正的Cox模型中，鼻部ITC的存在与更大的闭角风险相关（风险比[HR]， 4.68; 95% CI, 1.80-12.17; P = 0.002；一致性指数[C指数]= 0.71）。鼻段ITC长度较大（HR， 1.64 / 250µm长度；95% CI, 1.23-2.20; P & lt; 0.001； C指数= 0.70）或较长的（HR， 1.72 / 250µm长度；95% CI, 1.11-2.66; P = 0.02； C指数= 0.67）与较大的进展风险相关。ITC程度和累积的关节镜评分与进展无关。鼻ITC的存在和鼻ITC的长度与从PACS发展为PAC的72个月的高风险相关。这些研究结果表明，定性检测ITC为识别PACS高风险眼提供了一种实用的替代方法。
{"title":"Iris Trabecular Contact on OCT in Angle Closure Progression","authors":"Kendra L. Hong, Benjamin Y. Xu, Wei Wang, Austin Cho, Paul J. Foster, Yuzhen Jiang, Natalia Porporato, Tin Aung, David S. Friedman, Mingguang He","doi":"10.1001/jamaophthalmol.2025.6067","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.6067","url":null,"abstract":"Importance Ocular biometrics measured by anterior segment optical coherence tomography (AS-OCT) predicts progression from primary angle closure suspect (PACS) to primary angle closure (PAC), but obtaining these measurements is time intensive and requires specialized software. Iridotrabecular contact (ITC), a qualitative feature readily visible on AS-OCT images from multiple devices, offers a potentially more accessible method for risk stratification, but the association between ITC and progression to PAC is unclear. Objective To investigate the association of ITC presence and length on AS-OCT images with 72-month progression from PACS to PAC. Design, Setting, and Participants This was a single-center population-based retrospective cohort study using data from the prospective Zhongshan Angle Closure Prevention (ZAP) randomized clinical trial. The untreated eyes of trial participants aged 50 to 70 years with bilateral PACS were analyzed for progression to PAC, defined as development of intraocular pressure greater than 24 mm Hg, peripheral anterior synechiae, and/or acute angle closure. ITC250/500/750 was defined as angle-opening distance of 0 mm at 250, 500, and 750 µm anterior to the scleral spur, respectively. ITC less than 250 µm in length was identified by an expert grader in images without ITC250/500/750. ITC extent was defined as the number of sectors with ITC. Risk factors for progression were evaluated using age-adjusted Cox regression models. Study data were analyzed from October 2024 to April 2025. Exposures ITC presence and length on AS-OCT images. Main Outcomes and Measures The main outcome was 72-month progression from PACS to PAC. Results A total of 825 untreated eyes (791 without progression, 34 with progression) of 825 participants (mean [SD] age, 58.7 [5.0] years; 685 female [83.0%]) were eligible. In age-adjusted Cox models, ITC presence in the nasal sector was associated with greater risk of angle closure progression (hazard ratio [HR], 4.68; 95% CI, 1.80-12.17; <jats:italic toggle=\"yes\">P</jats:italic> = .002; concordance index [C index] = 0.71). Greater ITC length in the nasal (HR, 1.64 per 250 µm in length; 95% CI, 1.23-2.20; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001; C index = 0.70) or superior (HR, 1.72 per 250 µm in length; 95% CI, 1.11-2.66; <jats:italic toggle=\"yes\">P</jats:italic> = .02; C index = 0.67) sector was associated with greater risk of progression. ITC extent and cumulative gonioscopy score were not associated with progression. Conclusions and Relevance Nasal ITC presence and nasal or superior ITC length were associated with greater risk of 72-month progression from PACS to PAC. These findings suggest qualitative detection of ITC provides a practical alternative to ocular biometric analysis for identifying high-risk PACS eyes.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1001/jamaophthalmol.2025.6048
Victor Bellanda, Matthew J Schulgit, Gabriel Castilho S Barbosa, Nitesh Mohan, Andrea Arline, Suraj Bala, David C Kaelber, Sunil K Srivastava, Sumit Sharma
{"title":"Relative Risk of Neovascular Age-Related Macular Degeneration Following Cataract Surgery.","authors":"Victor Bellanda, Matthew J Schulgit, Gabriel Castilho S Barbosa, Nitesh Mohan, Andrea Arline, Suraj Bala, David C Kaelber, Sunil K Srivastava, Sumit Sharma","doi":"10.1001/jamaophthalmol.2025.6048","DOIUrl":"10.1001/jamaophthalmol.2025.6048","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-05DOI: 10.1001/jamaophthalmol.2025.6047
Francisco Mendes, Sumitra S Khandelwal, Douglas D Koch
{"title":"Corneal Abrasion Leading to Stromal Melt in a Patient With Myopia.","authors":"Francisco Mendes, Sumitra S Khandelwal, Douglas D Koch","doi":"10.1001/jamaophthalmol.2025.6047","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.6047","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":9.2,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1001/jamaophthalmol.2025.5985
Darrell WuDunn
This Viewpoint discusses the potential cognitive bias of what is considered elevated intraocular pressure and consquences of this bias for clinical care.
本观点讨论了被认为是眼压升高的潜在认知偏差以及这种偏差对临床护理的影响。
{"title":"Are We Treating Pressure or Treating Patients?","authors":"Darrell WuDunn","doi":"10.1001/jamaophthalmol.2025.5985","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5985","url":null,"abstract":"This Viewpoint discusses the potential cognitive bias of what is considered elevated intraocular pressure and consquences of this bias for clinical care.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"73 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1001/jamaophthalmol.2025.5990
Zainab Rustam, Sarah Miller, Mustafa Iftikhar
This case report discusses a diagnosis of peripheral arteriolar sclerosis and nonperfusion in the left eye of a male patient in his 20s after a contusion injury and subsequent treatment for traumatic iritis and ocular hypertension.
{"title":"Traumatic Unilateral Peripheral Arteriolar Occlusions","authors":"Zainab Rustam, Sarah Miller, Mustafa Iftikhar","doi":"10.1001/jamaophthalmol.2025.5990","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5990","url":null,"abstract":"This case report discusses a diagnosis of peripheral arteriolar sclerosis and nonperfusion in the left eye of a male patient in his 20s after a contusion injury and subsequent treatment for traumatic iritis and ocular hypertension.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"86 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1001/jamaophthalmol.2025.5658
Justis P Ehlers,Kristin Josic,Lloyd P Aiello,Reem Amine,Asmita Indurkar,Alison A Martin,Karen Matar,Paolo S Silva,Jennifer K Sun,
ImportanceThis study could facilitate the generation of automated quantitative assessments, providing clinicians and clinical trials with a continuous severity scale of retinal leakage to improve the prediction of future diabetic retinopathy (DR) worsening.ObjectiveTo examine ultra-widefield fluorescein angiography (UWF-FA) retinal leakage associated with DR progression and complications.Design, Setting, and ParticipantsThis cohort study was a post hoc analysis of the DRCR Retina Network Protocol AA clinical trial. Participants were adults with nonproliferative diabetic retinopathy (NPDR). Data was collected from February 2015 to March 2020. Analysis was performed June 2023 to April 2024.InterventionsTreatment of DR or diabetic macular edema was at the investigator's discretion.Main Outcomes and MeasuresTime to Diabetic Retinopathy Severity Scale (DRSS) worsening of 2 or more steps, vitreous hemorrhage (VH), and proliferative diabetic retinopathy (PDR) over 4 years. Baseline and 1-year leakage index, calculated as the area with leakage divided by the total area in the analyzable retina on UWF-FA, were evaluated as risk factors.ResultsAmong 537 eyes (363 participants; mean [SD] age, 61 [12] years; 183 [50%] male, 180 [50%] female), the baseline leakage index (mean [SD], 3.5% [3.9%]) was associated with DRSS worsening over 4 years (hazard ratio [HR] for 1% increase, 1.09; 95% CI, 1.05-1.13; P < .001). At 1 year, 114 of 453 eyes (25%) had an absolute leakage increase 1% or greater from baseline, which was associated with a higher risk of DRSS worsening over 4 years (61% vs 33%; HR, 2.63; 95% CI, 1.90-3.64; P < .001). Baseline leakage and a 1% or greater increase at 1 year were also associated with development of VH and PDR.Conclusions and RelevanceIn eyes with NPDR, higher leakage at baseline and an increase from baseline to 1 year were associated with greater risk of DRSS worsening and vision-threatening complications, including VH and PDR. These findings support quantitative leakage assessment at baseline and over time as a promising biomarker for predicting the severity and progression of diabetic retinopathy.
重要性本研究可以促进自动化定量评估的产生，为临床医生和临床试验提供视网膜渗漏的连续严重程度量表，以提高对未来糖尿病视网膜病变（DR）恶化的预测。目的探讨超宽视场荧光素血管造影（UWF-FA）视网膜渗漏与DR进展及并发症的关系。设计、环境和参与者本队列研究是对DRCR视网膜网络协议AA临床试验的事后分析。参与者是患有非增殖性糖尿病视网膜病变（NPDR）的成年人。数据收集时间为2015年2月至2020年3月。分析于2023年6月至2024年4月进行。DR或糖尿病性黄斑水肿的干预治疗由研究者自行决定。糖尿病视网膜病变严重程度量表（DRSS）恶化2级或以上，玻璃体出血（VH）和增殖性糖尿病视网膜病变（PDR）超过4年的时间。基线和1年渗漏指数（以渗漏面积除以UWF-FA上可分析视网膜的总面积计算）作为危险因素进行评估。结果537只眼（363只受试者，平均[SD]年龄61岁，男性183只[50%]，女性180只[50%]），基线渗漏指数（平均[SD] 3.5%[3.9%]）与4年内DRSS恶化相关（风险比[HR]增加1%，1.09;95% CI, 1.05-1.13; P < 0.001）。1年后，453只眼睛中有114只（25%）的绝对渗漏比基线增加1%或更多，这与4年内DRSS恶化的高风险相关（61% vs 33%； HR, 2.63; 95% CI, 1.90-3.64; P < .001）。基线渗漏和1年后1%或更多的增加也与VH和PDR的发展有关。结论和相关性在NPDR的眼睛中，基线时较高的渗漏和从基线到1年的增加与DRSS恶化和视力威胁并发症（包括VH和PDR）的风险增加相关。这些发现支持在基线和随时间的定量泄漏评估作为预测糖尿病视网膜病变严重程度和进展的有希望的生物标志物。
{"title":"Ultra-Widefield Fluorescein Angiographic Quantitative Leakage Parameters and Clinical Outcomes in Nonproliferative Diabetic Retinopathy.","authors":"Justis P Ehlers,Kristin Josic,Lloyd P Aiello,Reem Amine,Asmita Indurkar,Alison A Martin,Karen Matar,Paolo S Silva,Jennifer K Sun, ","doi":"10.1001/jamaophthalmol.2025.5658","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5658","url":null,"abstract":"ImportanceThis study could facilitate the generation of automated quantitative assessments, providing clinicians and clinical trials with a continuous severity scale of retinal leakage to improve the prediction of future diabetic retinopathy (DR) worsening.ObjectiveTo examine ultra-widefield fluorescein angiography (UWF-FA) retinal leakage associated with DR progression and complications.Design, Setting, and ParticipantsThis cohort study was a post hoc analysis of the DRCR Retina Network Protocol AA clinical trial. Participants were adults with nonproliferative diabetic retinopathy (NPDR). Data was collected from February 2015 to March 2020. Analysis was performed June 2023 to April 2024.InterventionsTreatment of DR or diabetic macular edema was at the investigator's discretion.Main Outcomes and MeasuresTime to Diabetic Retinopathy Severity Scale (DRSS) worsening of 2 or more steps, vitreous hemorrhage (VH), and proliferative diabetic retinopathy (PDR) over 4 years. Baseline and 1-year leakage index, calculated as the area with leakage divided by the total area in the analyzable retina on UWF-FA, were evaluated as risk factors.ResultsAmong 537 eyes (363 participants; mean [SD] age, 61 [12] years; 183 [50%] male, 180 [50%] female), the baseline leakage index (mean [SD], 3.5% [3.9%]) was associated with DRSS worsening over 4 years (hazard ratio [HR] for 1% increase, 1.09; 95% CI, 1.05-1.13; P < .001). At 1 year, 114 of 453 eyes (25%) had an absolute leakage increase 1% or greater from baseline, which was associated with a higher risk of DRSS worsening over 4 years (61% vs 33%; HR, 2.63; 95% CI, 1.90-3.64; P < .001). Baseline leakage and a 1% or greater increase at 1 year were also associated with development of VH and PDR.Conclusions and RelevanceIn eyes with NPDR, higher leakage at baseline and an increase from baseline to 1 year were associated with greater risk of DRSS worsening and vision-threatening complications, including VH and PDR. These findings support quantitative leakage assessment at baseline and over time as a promising biomarker for predicting the severity and progression of diabetic retinopathy.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1001/jamaophthalmol.2025.5994
Pia Lundgren, Staffan Nilsson, Aldina Pivodic, Anders K. Nilsson, Lois E. H. Smith, Ann Hellström
This secondary analysis of a randomized clinical trial examines what risk factors for retinopathy of prematurity are influenced by supplementation with arachidonic acid and docosahexaenoic acid and their interactions with severe retinopathy of prematurity.
{"title":"Fatty Acid Supplementation and Retinopathy of Prematurity","authors":"Pia Lundgren, Staffan Nilsson, Aldina Pivodic, Anders K. Nilsson, Lois E. H. Smith, Ann Hellström","doi":"10.1001/jamaophthalmol.2025.5994","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5994","url":null,"abstract":"This secondary analysis of a randomized clinical trial examines what risk factors for retinopathy of prematurity are influenced by supplementation with arachidonic acid and docosahexaenoic acid and their interactions with severe retinopathy of prematurity.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146071500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1001/jamaophthalmol.2025.6002
Jintong Hou,Leon von der Emde,Souvick Mukherjee,Emily Vance,Elvira Agrón,Amitha Domalpally,Emily Y Chew,Tiarnán D L Keenan,
ImportanceExisting outcome measures for tracking geographic atrophy (GA) progression have disadvantages. As a functional measure, best-corrected visual acuity (BCVA) is associated with quality of life and recognized by regulators but is subjective and noisy (ie, with a high level of test-retest variability). As a structural measure, GA area is objective and less noisy (ie, with a low level of test-retest variability) but assumes all macular locations are equally important.ObjectiveTo derive and validate a novel outcome measure, the Geographic Atrophy Weighted-by-Acuity Index (GAWAIN). This was designed as a structural measure to align with BCVA by empirical weighting of macular pixels arranged in concentric annuli.ExposuresDerivation and validation of novel GA outcome measure.Design, Setting, and ParticipantsThis prognostic study included outcome measure development using in silico analyses. The data for the training/validation set were taken from participants in the Age-Related Eye Disease Study 2 (AREDS2) study (4313 visits, 1528 eyes), and for the external validation set, data were taken from participants in the GA Minocycline Trial (218 visits, 35 eyes). Study data were analyzed from April to October 2025.Main Outcomes and MeasuresPearson correlation between the novel GA outcome measure (0-100) and BCVA (35-85 letter score); area under receiver operating characteristic curve for clinical BCVA thresholds. The macula was divided into 60 concentric annuli; GA occupancy of each annulus was calculated. Annulus weights were derived using ridge regression, with GA involvement of each annulus and age as predictors and BCVA deficit (100 - BCVA) as outcome.ResultsTraining/validation was performed on 1120 participants (mean [SD] age, 77.1 [7.0] years; 645 female [57.6%]), and external validation was performed on 35 participants (mean [SD] age, 74.3 [7.1] years; 21 female [60.0%]). The annulus weights exhibited a decelerating decline with macular eccentricity. On internal validation, the novel GA outcome measure was correlated more strongly with BCVA deficit than GA area (Pearson r = 0.58 vs 0.32, difference = 0.27; 95% CI, 0.23-0.31; P < .001). This was also true on external validation for color fundus photograph-defined GA (Pearson r = 0.69 vs 0.58, difference = 0.12; 95% CI, 0.04-0.21; P = .005) and fundus autofluorescence-defined GA (Pearson r = 0.70 vs 0.56, difference = 0.13; 95% CI, 0.05-0.22; P = .002). On internal and external validation, the novel GA outcome measure predicted BCVA letter scores less than 36, 70, and 85 (20/200, 20/40, and 20/20, respectively) more accurately than GA area (each P < .001). Longitudinally, change in the novel GA outcome measure correlated more strongly with BCVA decline than change in GA area did (eg, Pearson r = 0.37 vs 0.28, difference = 0.09; 95% CI, 0.04-0.14; P < .001; internal validation).Conclusions and RelevanceIn this prognostic study, results suggest that the novel GA outcome measure aligned with BCVA, a
现有的追踪地理萎缩（GA）进展的结果测量方法有缺点。作为一种功能测量，最佳矫正视力（BCVA）与生活质量相关，并得到监管机构的认可，但它是主观的和嘈杂的（即，具有高水平的测试-重测试变异性）。作为一种结构测量，遗传面积是客观的，噪声较小（即，具有低水平的测试-重测试变异性），但假设所有黄斑位置都同样重要。目的推导并验证一种新的预后指标——地理萎缩加权视力指数（GAWAIN）。这是一种结构性措施，通过对排列在同心环空中的黄斑像素进行经验加权来与BCVA对齐。新的遗传算法结果测量的推导和验证。设计、环境和参与者本预后研究包括使用计算机分析的结果测量开发。训练/验证集的数据来自年龄相关眼病研究2 （AREDS2）研究的参与者（4313次就诊，1528只眼睛），外部验证集的数据来自GA米诺环素试验的参与者（218次就诊，35只眼睛）。研究数据分析时间为2025年4月至10月。新型GA结局指标（0-100）与BCVA（35-85字母评分）的相关性；临床BCVA阈值的受试者工作特征曲线下面积。黄斑分为60个同心环空；计算每个环的GA占用率。使用脊回归计算环的重量，以每个环的GA累及和年龄为预测因子，以BCVA缺陷（100 - BCVA）为结果。结果对1120名参与者（平均[SD]年龄77.1[7.0]岁，女性645名[57.6%]）进行了筛选/验证，对35名参与者（平均[SD]年龄74.3[7.1]岁，女性21名[60.0%]）进行了外部验证。随着黄斑偏心率的增加，黄斑环重呈减速下降趋势。在内部验证中，与GA面积相比，新的GA结果测量与BCVA缺陷的相关性更强（Pearson r = 0.58 vs 0.32，差异= 0.27;95% CI, 0.23-0.31; P < 0.001）。彩色眼底照片定义GA的外部验证也是如此(皮尔逊r = 0.69 vs 0.58，差异= 0.12;95% CI, 0.04-0.21; P =。005)和眼底自身荧光定义的GA （Pearson r = 0.70 vs 0.56，差异= 0.13;95% CI, 0.05-0.22; P = 0.002）。在内部和外部验证中，新的GA结果测量预测BCVA字母得分小于36、70和85（分别为20/200、20/40和20/20）比GA面积更准确（P < 0.001）。纵向上，与GA面积变化相比，新型GA结果测量值的变化与BCVA下降的相关性更强（例如，Pearson r = 0.37 vs 0.28，差异= 0.09;95% CI, 0.04-0.14; P < 0.001；内部验证）。结论和相关性在这项预后研究中，结果表明，通过同心环空的经验加权，新的GA结局指标与BCVA一致，BCVA是一个关键的功能结局指标。这为客观地跟踪预测功能下降提供了替代措施，比GA面积更有意义。
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