Pub Date : 2025-12-11DOI: 10.1001/jamaophthalmol.2025.5057
Shu Xu, Philippa Clarke, Michelle J. Sun, Joshua R. Ehrlich
Importance Older adults with poor vision are more likely to fall. However, there has been little research to understand whether this association is concentrated among individuals with specific exposures, such as home environmental hazards. Objective To assess the association between differences in visual function, home environmental hazards, and falls. Design, Setting, and Participants This population-based cross-sectional study used data from the National Health and Aging Trends Study, which gathers nationally representative data on Medicare beneficiaries aged 65 years and older in the US. A total of 4648 community-dwelling older adults who completed visual function tests and the home environment instrument in 2022 were included. Data were analyzed from September 2024 to March 2025. Exposure Objective measured visual function was assessed using binocular presenting distance visual acuity (DVA; logMAR) and contrast sensitivity (CS: logCS). Home hazards included absence of grab bars in the bathroom, tripping hazards, and broken flooring, as well as an ordinal variable representing cumulative hazards (0, 1, ≥2). Main Outcomes and Measures Falls were defined as any self-reported fall in the past month. Survey-weighted multivariable logistic regression assessed the associations of visual function, home hazards, and falls. Results The survey-weighted prevalence of home hazards among 4648 participants (53.6% female) was 47.0% (no grab bars), 9.5% (tripping hazards), 4.5% (broken flooring), and 7.3% (≥2 hazards). Mean (SD) DVA was 0.10 (0.18) logMAR and mean (SD) CS was 1.72 (0.23) logCS. Worse DVA and CS were associated with falling in homes with hazards, including no grab bars (DVA: OR, 1.14; 95% CI, 1.02-1.27; CS: OR, 0.91; 95% CI, 0.84-1.00), tripping hazards (DVA: OR, 1.29; 95% CI, 1.11-1.49; CS: OR, 0.87; 95% CI, 0.78-0.98), and broken flooring (DVA: OR, 1.47; 95% CI, 1.26-1.70; CS: OR, 0.79; 95% CI, 0.68-0.93). The presence of multiple hazards further strengthened this association (DVA: OR, 1.31; 95% CI, 1.12-1.53; CS: OR, 0.93; 95% CI, 0.86-1.00). Conclusions and Relevance The association between differences in visual function and falls among older adults in this study was shaped by the home environment. These findings underscore the potential importance of considering both intrinsic and extrinsic risk factors in fall prevention and highlight the potential for targeted strategies that include home safety interventions for individuals with poor visual function.
{"title":"The Role of Home Hazards in the Association Between Visual Function and Falls in Older Adults","authors":"Shu Xu, Philippa Clarke, Michelle J. Sun, Joshua R. Ehrlich","doi":"10.1001/jamaophthalmol.2025.5057","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5057","url":null,"abstract":"Importance Older adults with poor vision are more likely to fall. However, there has been little research to understand whether this association is concentrated among individuals with specific exposures, such as home environmental hazards. Objective To assess the association between differences in visual function, home environmental hazards, and falls. Design, Setting, and Participants This population-based cross-sectional study used data from the National Health and Aging Trends Study, which gathers nationally representative data on Medicare beneficiaries aged 65 years and older in the US. A total of 4648 community-dwelling older adults who completed visual function tests and the home environment instrument in 2022 were included. Data were analyzed from September 2024 to March 2025. Exposure Objective measured visual function was assessed using binocular presenting distance visual acuity (DVA; logMAR) and contrast sensitivity (CS: logCS). Home hazards included absence of grab bars in the bathroom, tripping hazards, and broken flooring, as well as an ordinal variable representing cumulative hazards (0, 1, ≥2). Main Outcomes and Measures Falls were defined as any self-reported fall in the past month. Survey-weighted multivariable logistic regression assessed the associations of visual function, home hazards, and falls. Results The survey-weighted prevalence of home hazards among 4648 participants (53.6% female) was 47.0% (no grab bars), 9.5% (tripping hazards), 4.5% (broken flooring), and 7.3% (≥2 hazards). Mean (SD) DVA was 0.10 (0.18) logMAR and mean (SD) CS was 1.72 (0.23) logCS. Worse DVA and CS were associated with falling in homes with hazards, including no grab bars (DVA: OR, 1.14; 95% CI, 1.02-1.27; CS: OR, 0.91; 95% CI, 0.84-1.00), tripping hazards (DVA: OR, 1.29; 95% CI, 1.11-1.49; CS: OR, 0.87; 95% CI, 0.78-0.98), and broken flooring (DVA: OR, 1.47; 95% CI, 1.26-1.70; CS: OR, 0.79; 95% CI, 0.68-0.93). The presence of multiple hazards further strengthened this association (DVA: OR, 1.31; 95% CI, 1.12-1.53; CS: OR, 0.93; 95% CI, 0.86-1.00). Conclusions and Relevance The association between differences in visual function and falls among older adults in this study was shaped by the home environment. These findings underscore the potential importance of considering both intrinsic and extrinsic risk factors in fall prevention and highlight the potential for targeted strategies that include home safety interventions for individuals with poor visual function.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"4 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717999","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 : 2025-12-11DOI: 10.1001/jamaophthalmol.2025.5071
Alexander T Hong,Forest Lin,Ivan Y Luu,Jay M Stewart,Jeremy D Keenan
{"title":"Prescribing Patterns of First-Line Therapy for Bacterial Keratitis.","authors":"Alexander T Hong,Forest Lin,Ivan Y Luu,Jay M Stewart,Jeremy D Keenan","doi":"10.1001/jamaophthalmol.2025.5071","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5071","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"38 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718000","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 : 2025-12-11DOI: 10.1001/jamaophthalmol.2025.5068
Warren W Pan,Ian Waters,Jonah Yousif,Zachery R Reichert,Mark W Johnson,Jason Miller,K Thiran Jayasundera
{"title":"Acute and Substantial Vision Loss After Pembrolizumab Immunotherapy for Bladder Cancer.","authors":"Warren W Pan,Ian Waters,Jonah Yousif,Zachery R Reichert,Mark W Johnson,Jason Miller,K Thiran Jayasundera","doi":"10.1001/jamaophthalmol.2025.5068","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5068","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"6 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718001","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 : 2025-12-11DOI: 10.1001/jamaophthalmol.2025.5078
Gabriella De Salvo, Peter M. Maloca
This case report discusses a diagnosis of epiretinal hyperproliferative complex in a male patient aged 75 years with a history of multiple myeloma who reported blurred vision in his left eye persisting after cataract surgery.
本病例报告讨论一名75岁男性患者，有多发性骨髓瘤病史，白内障手术后左眼视力持续模糊。
{"title":"Epiretinal Hyperproliferative Complex","authors":"Gabriella De Salvo, Peter M. Maloca","doi":"10.1001/jamaophthalmol.2025.5078","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5078","url":null,"abstract":"This case report discusses a diagnosis of epiretinal hyperproliferative complex in a male patient aged 75 years with a history of multiple myeloma who reported blurred vision in his left eye persisting after cataract surgery.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718239","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 : 2025-12-11DOI: 10.1001/jamaophthalmol.2025.5069
Adrian T. Fung, David Sarraf, Jose M. Carrillo, Alessandro Feo, Shahin Faghihi, Caroline M. Borie, Liam Lim, Alex P. Hunyor, Nicolas A. Yannuzzi
Importance Retinal toxic effects due to pentosan polysulfate sodium (PPS) have primarily been reported following oral administration of the drug. Because PPS can also be administered subcutaneously, it is important to determine whether this route of administration may also be associated with retinal toxic effects. Objective To characterize the exposure characteristics and clinical presentation of toxic maculopathy following subcutaneous administration of PPS for the treatment of arthritis. Design, Setting, and Participants This multi-institutional, retrospective case series examined 3 cases of pentosan polysulfate maculopathy (PPM) after subcutaneous administration of PPS for the treatment of arthritis at 3 centers in Miami, Florida; Los Angeles, California; and Sydney, Australia, between September 1, 2024, and July 8, 2025. Data were analyzed from July 9, 2025, to July 18, 2025. Exposure Subcutaneous administration of PPS. Main Outcomes and Measures The primary outcome was PPM after subcutaneous PPS administration for arthritis. Changes were assessed by examining drug dosage, visual acuity, and features of multimodal retinal imaging. Results Three patients with PPS toxic maculopathy presented following treatment for osteoarthritis or inflammatory arthritis. The cumulative dose was very low in all 3 cases and ranged from 45.5 to 96 g during a span of 7 to 10 years. The multimodal features in all 3 cases were classic for PPS retinal toxic effects. Conclusions and Relevance The findings of this case series suggest that PPS retinal toxic effects can occur with subcutaneous administration alone, at much lower doses than typically occurs with oral administration, potentially due to 10-fold higher bioavailability. Early recognition of this toxic maculopathy with multimodal imaging is important to limit exposure to this drug and avoid incorrect treatments. Given progression of maculopathy even following cessation, caution is advised when using subcutaneous PPS.
{"title":"Pentosan Polysulfate Maculopathy Following Subcutaneous Injections for Arthritis","authors":"Adrian T. Fung, David Sarraf, Jose M. Carrillo, Alessandro Feo, Shahin Faghihi, Caroline M. Borie, Liam Lim, Alex P. Hunyor, Nicolas A. Yannuzzi","doi":"10.1001/jamaophthalmol.2025.5069","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5069","url":null,"abstract":"Importance Retinal toxic effects due to pentosan polysulfate sodium (PPS) have primarily been reported following oral administration of the drug. Because PPS can also be administered subcutaneously, it is important to determine whether this route of administration may also be associated with retinal toxic effects. Objective To characterize the exposure characteristics and clinical presentation of toxic maculopathy following subcutaneous administration of PPS for the treatment of arthritis. Design, Setting, and Participants This multi-institutional, retrospective case series examined 3 cases of pentosan polysulfate maculopathy (PPM) after subcutaneous administration of PPS for the treatment of arthritis at 3 centers in Miami, Florida; Los Angeles, California; and Sydney, Australia, between September 1, 2024, and July 8, 2025. Data were analyzed from July 9, 2025, to July 18, 2025. Exposure Subcutaneous administration of PPS. Main Outcomes and Measures The primary outcome was PPM after subcutaneous PPS administration for arthritis. Changes were assessed by examining drug dosage, visual acuity, and features of multimodal retinal imaging. Results Three patients with PPS toxic maculopathy presented following treatment for osteoarthritis or inflammatory arthritis. The cumulative dose was very low in all 3 cases and ranged from 45.5 to 96 g during a span of 7 to 10 years. The multimodal features in all 3 cases were classic for PPS retinal toxic effects. Conclusions and Relevance The findings of this case series suggest that PPS retinal toxic effects can occur with subcutaneous administration alone, at much lower doses than typically occurs with oral administration, potentially due to 10-fold higher bioavailability. Early recognition of this toxic maculopathy with multimodal imaging is important to limit exposure to this drug and avoid incorrect treatments. Given progression of maculopathy even following cessation, caution is advised when using subcutaneous PPS.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"170 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718240","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 : 2025-12-04DOI: 10.1001/jamaophthalmol.2025.5070
Piotr K Kopinski,Paul Nathan,Mandeep S Sagoo
{"title":"Eye Safety Risks of Antibody-Drug Conjugate Cancer Therapies.","authors":"Piotr K Kopinski,Paul Nathan,Mandeep S Sagoo","doi":"10.1001/jamaophthalmol.2025.5070","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5070","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"12 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664109","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 : 2025-12-04DOI: 10.1001/jamaophthalmol.2025.5006
Omar A Mahroo,Shigeru Sato,Siying Lin
{"title":"A New Gene for Congenital Stationary Night Blindness.","authors":"Omar A Mahroo,Shigeru Sato,Siying Lin","doi":"10.1001/jamaophthalmol.2025.5006","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.5006","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"93 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145663945","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 : 2025-12-04DOI: 10.1001/jamaophthalmol.2025.4888
Sanja Boranijasevic,Vasily Smirnov,Julien Navarro,Martha Tjon-Fo-Sang,Christel Condroyer,Lonneke Haer-Wigman,Aline Antonio,Claire-Marie Dhaenens,Virginie J M Verhoeven,José-Alain Sahel,L Ingeborgh van den Born,Sabine Defoort,Isabelle Audo,Christina Zeitz
ImportanceCongenital stationary night blindness (CSNB) is a clinically and genetically heterogeneous inherited retinal disorder (IRD), and in many complete CSNB (cCSNB) cases, the underlying genetic cause remains unknown. Uncovering the genetic defects of IRDs helps to refine diagnostic methods and supports the development of specific therapeutic approaches.ObjectiveTo describe the phenotype and the underlying gene defect in patients with cCSNB from 2 unrelated families.Design, Setting and ParticipantsThis retrospective case series was conducted from January 2023 to July 2025. Data for 3 patients from cohorts of genetically unsolved IRD cases in France (n = 140 for CSNB) and the Netherlands (n = 2730 for IRD) were analyzed clinically and genetically.ExposuresComplete ocular examination, including multimodal retinal imaging and full-field electroretinography (ffERG) incorporating the International Society for Clinical Electrophysiology of Vision standards and multimodal retinal imaging, were performed. Gene defects were identified by genome sequencing (GS) and exome sequencing (ES).Main Outcomes and MeasuresThe main outcome was a gene defect, EGFLAM, underlying cCSNB. Measures included phenotyping, GS, ES, Sanger sequencing, and cosegregation analysis.ResultsThe series included 3 patients from 2 unrelated families of Moroccan ancestry showing high myopia, reduced visual acuity, and night blindness. Retinal imaging depicted myopic changes. ffERG revealed electronegative Schubert-Bornschein configuration in keeping with cCSNB with ON-bipolar cell dysfunction. Patients were lacking pathogenic variants in known genes implicated in IRDs, including CSNB. Two different homozygous pathogenic variants, c.1563_1566del, p.(Val522Glufs*18) and c.1795C>T, p.(Arg599*) in EGFLAM were identified by ES and GS. The corresponding protein is localized in the outer plexiform layer and important for ON-bipolar cell signaling in the retina.Conclusion and RelevanceThis case series reports on a gene defect in EGFLAM implicated in human cCSNB. Clinicians should be aware about this association and consider including EGFLAM in diagnostic gene panels for IRDs. This discovery may lead to faster and more accurate diagnosis of cCSNB and genetic counseling, as well as a pathway for developing therapies.
{"title":"EGFLAM Pathogenic Variants and Congenital Stationary Night Blindness.","authors":"Sanja Boranijasevic,Vasily Smirnov,Julien Navarro,Martha Tjon-Fo-Sang,Christel Condroyer,Lonneke Haer-Wigman,Aline Antonio,Claire-Marie Dhaenens,Virginie J M Verhoeven,José-Alain Sahel,L Ingeborgh van den Born,Sabine Defoort,Isabelle Audo,Christina Zeitz","doi":"10.1001/jamaophthalmol.2025.4888","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4888","url":null,"abstract":"ImportanceCongenital stationary night blindness (CSNB) is a clinically and genetically heterogeneous inherited retinal disorder (IRD), and in many complete CSNB (cCSNB) cases, the underlying genetic cause remains unknown. Uncovering the genetic defects of IRDs helps to refine diagnostic methods and supports the development of specific therapeutic approaches.ObjectiveTo describe the phenotype and the underlying gene defect in patients with cCSNB from 2 unrelated families.Design, Setting and ParticipantsThis retrospective case series was conducted from January 2023 to July 2025. Data for 3 patients from cohorts of genetically unsolved IRD cases in France (n = 140 for CSNB) and the Netherlands (n = 2730 for IRD) were analyzed clinically and genetically.ExposuresComplete ocular examination, including multimodal retinal imaging and full-field electroretinography (ffERG) incorporating the International Society for Clinical Electrophysiology of Vision standards and multimodal retinal imaging, were performed. Gene defects were identified by genome sequencing (GS) and exome sequencing (ES).Main Outcomes and MeasuresThe main outcome was a gene defect, EGFLAM, underlying cCSNB. Measures included phenotyping, GS, ES, Sanger sequencing, and cosegregation analysis.ResultsThe series included 3 patients from 2 unrelated families of Moroccan ancestry showing high myopia, reduced visual acuity, and night blindness. Retinal imaging depicted myopic changes. ffERG revealed electronegative Schubert-Bornschein configuration in keeping with cCSNB with ON-bipolar cell dysfunction. Patients were lacking pathogenic variants in known genes implicated in IRDs, including CSNB. Two different homozygous pathogenic variants, c.1563_1566del, p.(Val522Glufs*18) and c.1795C>T, p.(Arg599*) in EGFLAM were identified by ES and GS. The corresponding protein is localized in the outer plexiform layer and important for ON-bipolar cell signaling in the retina.Conclusion and RelevanceThis case series reports on a gene defect in EGFLAM implicated in human cCSNB. Clinicians should be aware about this association and consider including EGFLAM in diagnostic gene panels for IRDs. This discovery may lead to faster and more accurate diagnosis of cCSNB and genetic counseling, as well as a pathway for developing therapies.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"75 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664176","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 : 2025-12-04DOI: 10.1001/jamaophthalmol.2025.4903
Zhuoling Lin, Haotian Lin
This case report discusses a diagnosis of Axenfeld-Rieger syndrome in an 8-month-old infant who presented with bilateral abnormal pupils, posterior embryotoxon, and dental abnormalities.
{"title":"Axenfeld-Rieger Syndrome in an Infant","authors":"Zhuoling Lin, Haotian Lin","doi":"10.1001/jamaophthalmol.2025.4903","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4903","url":null,"abstract":"This case report discusses a diagnosis of Axenfeld-Rieger syndrome in an 8-month-old infant who presented with bilateral abnormal pupils, posterior embryotoxon, and dental abnormalities.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"34 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145664504","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}
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