Pub Date : 2025-11-20DOI: 10.1001/jamaophthalmol.2025.4981
John S Wittenborn,Dean VanNasdale,David B Rein
{"title":"Undiagnosed Age-Related Eye Disease in Adults in Singapore.","authors":"John S Wittenborn,Dean VanNasdale,David B Rein","doi":"10.1001/jamaophthalmol.2025.4981","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4981","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"106 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145559035","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 : 2025-11-13DOI: 10.1001/jamaophthalmol.2025.4255
Henry Rocha, Yu Jeat Chong, Arun James Thirunavukarasu, Yee Ling Wong, Shiao Wei Wong, Yin-Hsi Chang, Matthew Azzopardi, Benjamin Kye Jyn Tan, Anna Song, Andrew Malem, Nikhil Jain, Sean Zhou, Ting Fang Tan, Saaeha Rauz, Marcus Ang, Jodhbir S. Mehta, Daniel Shu Wei Ting, Darren Shu Jeng Ting
Importance There is an increasing amount of literature evaluating the clinical knowledge and reasoning performance of large language models (LLMs) in ophthalmology, but to date, investigations into its multimodal abilities clinically—such as interpreting images and tables—have been limited. Objective To evaluate the multimodal performance of the following 7 foundation models (FMs): GPT-4o (OpenAI), Gemini 1.5 Pro (Google), Claude 3.5 Sonnet (Anthropic), Llama-3.2-11B (Meta), DeepSeek V3 (High-Flyer), Qwen2.5-Max (Alibaba Cloud), and Qwen2.5-VL-72B (Alibaba Cloud) in answering offline Fellowship of the Royal College of Ophthalmologists part 2 written multiple-choice textual and multimodal questions, with head-to-head comparisons with physicians. Design, Setting, and Participants This cross-sectional study was conducted between September 2024 and March 2025 using questions sourced from a textbook used as an examination preparation resource for the Fellowship of the Royal College of Ophthalmologists part 2 written examination. Exposure FM performance. Main Outcomes and Measures The primary outcome measure was FM accuracy, defined as the proportion of answers generated by the model matching the textbook’s labeled letter answer. Results For textual questions, Claude 3.5 Sonnet (accuracy, 77.7%) outperformed all other FMs (followed by GPT-4o [accuracy, 69.9%], Qwen2.5-Max [accuracy, 69.3%], DeepSeek V3 [accuracy, 63.2%], Gemini Advanced [accuracy, 62.6%], Qwen2.5-VL-72B [accuracy, 58.3%], and Llama-3.2-11B [accuracy, 50.7%]), ophthalmology trainees (difference, 9.0%; 95% CI, 2.4%-15.6%; <jats:italic toggle="yes">P</jats:italic> = .01) and junior physicians (difference, 35.2%; 95% CI, 28.3%-41.9%; <jats:italic toggle="yes">P</jats:italic> &lt; .001), with comparable performance with expert ophthalmologists (difference, 1.3%; 95% CI, −5.1% to 7.4%; <jats:italic toggle="yes">P</jats:italic> = .72). GPT-4o (accuracy, 69.9%) outperformed GPT-4 (OpenAI; difference, 8.5%; 95% CI, 1.1%-15.8%; <jats:italic toggle="yes">P</jats:italic> = .02) and GPT-3.5 (OpenAI; difference, 21.8%; 95% CI, 14.3%-29.2%; <jats:italic toggle="yes">P</jats:italic> &lt; .001). For multimodal questions, GPT-4o (accuracy, 57.5%) outperformed all other FMs (Claude 3.5 Sonnet [accuracy, 47.5%], Qwen2.5-VL-72B [accuracy, 45%], Gemini Advanced [accuracy, 35%], and Llama-3.2-11B [accuracy, 25%]) and the junior physician (difference, 15%; 95% CI, −6.7% to 36.7%; <jats:italic toggle="yes">P</jats:italic> = .18) but was weaker than expert ophthalmologists (accuracy range, 70.0%-85.0%; <jats:italic toggle="yes">P</jats:italic> = .16) and trainees (accuracy range, 62.5%-80%; <jats:italic toggle="yes">P</jats:italic> = .35). Conclusions and Relevance Results of this cross-sectional study suggest that for textual questions, current FMs exhibited notable improvements in ophthalmological knowledge reasoning when compared with older LLMs and ophthalmology trainees, with performance co
{"title":"Performance of Foundation Models vs Physicians in Textual and Multimodal Ophthalmological Questions","authors":"Henry Rocha, Yu Jeat Chong, Arun James Thirunavukarasu, Yee Ling Wong, Shiao Wei Wong, Yin-Hsi Chang, Matthew Azzopardi, Benjamin Kye Jyn Tan, Anna Song, Andrew Malem, Nikhil Jain, Sean Zhou, Ting Fang Tan, Saaeha Rauz, Marcus Ang, Jodhbir S. Mehta, Daniel Shu Wei Ting, Darren Shu Jeng Ting","doi":"10.1001/jamaophthalmol.2025.4255","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4255","url":null,"abstract":"Importance There is an increasing amount of literature evaluating the clinical knowledge and reasoning performance of large language models (LLMs) in ophthalmology, but to date, investigations into its multimodal abilities clinically—such as interpreting images and tables—have been limited. Objective To evaluate the multimodal performance of the following 7 foundation models (FMs): GPT-4o (OpenAI), Gemini 1.5 Pro (Google), Claude 3.5 Sonnet (Anthropic), Llama-3.2-11B (Meta), DeepSeek V3 (High-Flyer), Qwen2.5-Max (Alibaba Cloud), and Qwen2.5-VL-72B (Alibaba Cloud) in answering offline Fellowship of the Royal College of Ophthalmologists part 2 written multiple-choice textual and multimodal questions, with head-to-head comparisons with physicians. Design, Setting, and Participants This cross-sectional study was conducted between September 2024 and March 2025 using questions sourced from a textbook used as an examination preparation resource for the Fellowship of the Royal College of Ophthalmologists part 2 written examination. Exposure FM performance. Main Outcomes and Measures The primary outcome measure was FM accuracy, defined as the proportion of answers generated by the model matching the textbook’s labeled letter answer. Results For textual questions, Claude 3.5 Sonnet (accuracy, 77.7%) outperformed all other FMs (followed by GPT-4o [accuracy, 69.9%], Qwen2.5-Max [accuracy, 69.3%], DeepSeek V3 [accuracy, 63.2%], Gemini Advanced [accuracy, 62.6%], Qwen2.5-VL-72B [accuracy, 58.3%], and Llama-3.2-11B [accuracy, 50.7%]), ophthalmology trainees (difference, 9.0%; 95% CI, 2.4%-15.6%; <jats:italic toggle=\"yes\">P</jats:italic> = .01) and junior physicians (difference, 35.2%; 95% CI, 28.3%-41.9%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001), with comparable performance with expert ophthalmologists (difference, 1.3%; 95% CI, −5.1% to 7.4%; <jats:italic toggle=\"yes\">P</jats:italic> = .72). GPT-4o (accuracy, 69.9%) outperformed GPT-4 (OpenAI; difference, 8.5%; 95% CI, 1.1%-15.8%; <jats:italic toggle=\"yes\">P</jats:italic> = .02) and GPT-3.5 (OpenAI; difference, 21.8%; 95% CI, 14.3%-29.2%; <jats:italic toggle=\"yes\">P</jats:italic> &amp;lt; .001). For multimodal questions, GPT-4o (accuracy, 57.5%) outperformed all other FMs (Claude 3.5 Sonnet [accuracy, 47.5%], Qwen2.5-VL-72B [accuracy, 45%], Gemini Advanced [accuracy, 35%], and Llama-3.2-11B [accuracy, 25%]) and the junior physician (difference, 15%; 95% CI, −6.7% to 36.7%; <jats:italic toggle=\"yes\">P</jats:italic> = .18) but was weaker than expert ophthalmologists (accuracy range, 70.0%-85.0%; <jats:italic toggle=\"yes\">P</jats:italic> = .16) and trainees (accuracy range, 62.5%-80%; <jats:italic toggle=\"yes\">P</jats:italic> = .35). Conclusions and Relevance Results of this cross-sectional study suggest that for textual questions, current FMs exhibited notable improvements in ophthalmological knowledge reasoning when compared with older LLMs and ophthalmology trainees, with performance co","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"51 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498692","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 : 2025-11-13DOI: 10.1001/jamaophthalmol.2025.4342
Wenjia Yan, Yuntong Li, Zhaotian Zhang
This case report describes a large choroidal excavation and outer retinal atrophy in an otherwise healthy man aged 29 years who presented with bilateral gradually worsening vision since childhood.
本病例报告描述了一个大脉络膜挖掘和外视网膜萎缩在其他健康的男性29岁，表现为双侧视力逐渐恶化自幼。
{"title":"Large Choroidal Excavation in Stargardt Disease","authors":"Wenjia Yan, Yuntong Li, Zhaotian Zhang","doi":"10.1001/jamaophthalmol.2025.4342","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4342","url":null,"abstract":"This case report describes a large choroidal excavation and outer retinal atrophy in an otherwise healthy man aged 29 years who presented with bilateral gradually worsening vision since childhood.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"54 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498694","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 : 2025-11-13DOI: 10.1001/jamaophthalmol.2025.4495
Peter R Kastl,Claire Senot,Yatish Hegde
{"title":"Distribution of Ophthalmologists and Optometrists in the US.","authors":"Peter R Kastl,Claire Senot,Yatish Hegde","doi":"10.1001/jamaophthalmol.2025.4495","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4495","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499596","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 : 2025-11-13DOI: 10.1001/jamaophthalmol.2025.4755
Rithambara Ramachandran,Stephanie Wey
{"title":"Mastering Ophthalmology in the Digital Age.","authors":"Rithambara Ramachandran,Stephanie Wey","doi":"10.1001/jamaophthalmol.2025.4755","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4755","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"27 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499591","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}
Importance Appropriately sized and well-centered capsulorhexis is key for high-quality phacoemulsification cataract surgery and can be achieved with digital-guidance devices. However, such devices are not readily available, warranting the need for a device-free manual auxiliary capsulorhexis technique. Objectives To determine if manual marking–assisted capsulorhexis (MMAC) is noninferior to a digital guidance–assisted capsulorhexis (DGAC) in capsulorhexis accuracy following phacoemulsification for age-related cataract. Design, Setting, and Participants This noninferiority randomized clinical trial was conducted between July 2021 and December 2021 at Zhongshan Ophthalmic Center, China, with follow-up through 1 month after surgery. Of 204 adults screened, 156 were included who were aged 55 to 80 years and had pupil diameter ≥6.5 mm after pupil dilation and Lens Opacities Classification System III with nuclear opalescence grade of 3.0 to 4.0. Patients were excluded if they had previous intraocular surgery or a diagnosed eye disease that might affect functions of lens suspensory ligament. Data were analyzed from September to December 2024. Interventions In the MMAC group, a lens caliper was used to measure and locate capsulorhexis position, subsequently applying its blunt head to mark the anterior lens capsule for capsulotomy guidance. In the DGAC group, a ring with predefined target diameter was projected to guide capsulorhexis. Main Outcomes and Measures The primary outcome was the median deviation of capsulorhexis diameter from the target diameter with a noninferiority margin of 0.2 mm. Secondary outcomes included ratio of ideal capsulorhexis, grades of capsulorhexis–intraocular lens (IOL) overlap, off-center distance of capsulorhexis, postoperative best-corrected visual acuity, IOL tilt, and decentration. Results Among 156 participants randomized into the MMAC group (mean [SD] age, 71 [7] years; 47 [60%] female) or DGAC group (mean [SD] age, 72 [7]; 47 [60%] female), median deviations comparing the capsulorhexis and target diameters were 0.22 mm (95% CI, 0.11-0.37) in the MMAC group vs 0.27 mm (95% CI, 0.14-0.52) in the DGAC group (difference, −0.05 mm; 95% CI, −0.16 to 0.07) for horizontal diameter and 0.27 mm (95% CI, 0.12-0.40) vs 0.33 mm (95% CI, 0.20-0.51) (difference, −0.06 mm; 95% CI, −0.17 to 0.05), respectively, for vertical diameters, both within the noninferiority margin of 0.20 mm. The proportion of ideal capsulorhexis was 96.2% (75 of 78) in the MMAC group and 88.5% (69 of 78) in the DGAC group (difference, 7.7%; 95% CI, −0.6 to 16.0), also within the noninferiority margin of −5.0%. Conclusions and Relevance The findings in this trial indicate that accuracy of capsulorhexis with MMAC was noninferior to DGAC. Since the MMAC technique does not require special equipment, it might be considered routinely in clinical practice settings if similar outcomes are obtained elsewhere. Trial Registration ClinicalTrials.gov Identifier:
{"title":"Manual Marking Guidance vs Digital Guidance System–Assisted Capsulorhexis in Phacoemulsification","authors":"Xiaoyun Chen, Zitian Liu, Ling Jin, Yingfeng Zheng, Lixia Luo, Yizhi Liu","doi":"10.1001/jamaophthalmol.2025.4448","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4448","url":null,"abstract":"Importance Appropriately sized and well-centered capsulorhexis is key for high-quality phacoemulsification cataract surgery and can be achieved with digital-guidance devices. However, such devices are not readily available, warranting the need for a device-free manual auxiliary capsulorhexis technique. Objectives To determine if manual marking–assisted capsulorhexis (MMAC) is noninferior to a digital guidance–assisted capsulorhexis (DGAC) in capsulorhexis accuracy following phacoemulsification for age-related cataract. Design, Setting, and Participants This noninferiority randomized clinical trial was conducted between July 2021 and December 2021 at Zhongshan Ophthalmic Center, China, with follow-up through 1 month after surgery. Of 204 adults screened, 156 were included who were aged 55 to 80 years and had pupil diameter ≥6.5 mm after pupil dilation and Lens Opacities Classification System III with nuclear opalescence grade of 3.0 to 4.0. Patients were excluded if they had previous intraocular surgery or a diagnosed eye disease that might affect functions of lens suspensory ligament. Data were analyzed from September to December 2024. Interventions In the MMAC group, a lens caliper was used to measure and locate capsulorhexis position, subsequently applying its blunt head to mark the anterior lens capsule for capsulotomy guidance. In the DGAC group, a ring with predefined target diameter was projected to guide capsulorhexis. Main Outcomes and Measures The primary outcome was the median deviation of capsulorhexis diameter from the target diameter with a noninferiority margin of 0.2 mm. Secondary outcomes included ratio of ideal capsulorhexis, grades of capsulorhexis–intraocular lens (IOL) overlap, off-center distance of capsulorhexis, postoperative best-corrected visual acuity, IOL tilt, and decentration. Results Among 156 participants randomized into the MMAC group (mean [SD] age, 71 [7] years; 47 [60%] female) or DGAC group (mean [SD] age, 72 [7]; 47 [60%] female), median deviations comparing the capsulorhexis and target diameters were 0.22 mm (95% CI, 0.11-0.37) in the MMAC group vs 0.27 mm (95% CI, 0.14-0.52) in the DGAC group (difference, −0.05 mm; 95% CI, −0.16 to 0.07) for horizontal diameter and 0.27 mm (95% CI, 0.12-0.40) vs 0.33 mm (95% CI, 0.20-0.51) (difference, −0.06 mm; 95% CI, −0.17 to 0.05), respectively, for vertical diameters, both within the noninferiority margin of 0.20 mm. The proportion of ideal capsulorhexis was 96.2% (75 of 78) in the MMAC group and 88.5% (69 of 78) in the DGAC group (difference, 7.7%; 95% CI, −0.6 to 16.0), also within the noninferiority margin of −5.0%. Conclusions and Relevance The findings in this trial indicate that accuracy of capsulorhexis with MMAC was noninferior to DGAC. Since the MMAC technique does not require special equipment, it might be considered routinely in clinical practice settings if similar outcomes are obtained elsewhere. Trial Registration ClinicalTrials.gov Identifier: <jats:ext-l","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"53 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498691","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}
Importance Primary congenital glaucoma (PCG) surgery often leaves residual visual impairment in children. Evidence comparing rigid gas-permeable contact lenses (RGPCLs) vs spectacles for rehabilitation is needed. Objective To compare the use of RGPCLs vs continued spectacle wear for improving visual outcomes for children after PCG surgery. Design, Setting, and Participants This randomized clinical trial was conducted at Zhongshan Ophthalmic Center, a tertiary referral center in Guangzhou, China, from April 21, 2022, to August 21, 2023. Participants comprised 56 children (aged 4-15 years) with surgically managed PCG and poor spectacle response. Data were analyzed from October 11, 2023, to March 21, 2024. Interventions RGPCLs (n = 29) vs spectacles (n = 27) for 12 months, plus standardized amblyopia patching. Main Outcomes and Measures The primary outcome was change in worse-eye best-corrected visual acuity (BCVA) at 12 months measured by the Early Treatment Diabetic Retinopathy Study chart with tumbling-E optotypes with children wearing their current best refractive correction. Secondary outcomes included contrast sensitivity function and near stereoacuity. Results Among 56 (of a total of 83 screened participants) randomized participants, 48 (85.7%) completed at least 1 follow-up visit and were included in the primary analysis. Baseline demographic and ocular characteristics for the RGPCL group vs the spectacles group included a mean (SD) age of 7.7 (2.7) vs 7.2 (3.2) years, 13 (54.2%) vs 14 (58.3%) male, and 11 (45.8%) vs 10 (41.7%) female. At 12 months, 22 of 29 participants (76.0%) in the RGPCL group and 19 of 27 participants (70.4%) in the spectacles group completed the final visit. The mean (SD) baseline worse-eye spherical equivalent was −6.55 (6.43) vs −5.17 (5.27) diopters, the mean (SD) BCVA was 0.99 (0.71) vs 1.02 (0.74) logMAR (approximate Snellen equivalent 20/200), and the mean (SD) intraocular pressure was 14.98 (3.14) vs 13.36 (3.92) mm Hg in the RGPCL vs the spectacles group, respectively. At 1 year, the RGPCL group had greater BCVA improvement (mean [SD], 0.31 [0.28] vs 0.12 [0.33] logMAR; adjusted treatment difference, −0.19 logMAR; 95% CI, −0.36 to −0.02 logMAR [approximately 10 letters]; <jats:italic>P</jats:italic> = .03). Achievement of 2 or more lines of BCVA improvement occurred in 15 of 24 participants (62.5%) in the RGPCL group vs 9 of 24 participants (37.5%) in the spectacles group (odds ratio, 6.83; 95% CI, 1.81-25.73; <jats:italic>P</jats:italic> = .01). The RGPCL group had greater contrast sensitivity function improvement (0.40 [0.27] vs 0.13 [0.32]; adjusted treatment difference, 0.24 log units; 95% CI, −0.01 to 0.49; <jats:italic>P</jats:italic> = .04). Near stereoacuity of 60 arcseconds or less was achieved by 12 participants (50.0%) vs 6 of 24 participants (25.0%) (odds ratio, 6.96; 95% CI, 2.41-6.51; <jats:italic>P</jats:italic> = .001). No serious adverse events occurred. Conclusions and Relevance These findings
{"title":"Visual Outcomes of Children With Primary Congenital Glaucoma Receiving Different Refractive Corrections","authors":"Jinyun Jiang, Yin Hu, Yingting Zhu, Yimin Zhong, Chuqi Xiang, Shuoshuo Chen, Mengting Yu, Lei Fang, Shufen Lin, Xianghua Tang, Mingxin Lu, Weiyin Chen, Ling Jin, Xing Liu, Xiao Yang","doi":"10.1001/jamaophthalmol.2025.3976","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.3976","url":null,"abstract":"Importance Primary congenital glaucoma (PCG) surgery often leaves residual visual impairment in children. Evidence comparing rigid gas-permeable contact lenses (RGPCLs) vs spectacles for rehabilitation is needed. Objective To compare the use of RGPCLs vs continued spectacle wear for improving visual outcomes for children after PCG surgery. Design, Setting, and Participants This randomized clinical trial was conducted at Zhongshan Ophthalmic Center, a tertiary referral center in Guangzhou, China, from April 21, 2022, to August 21, 2023. Participants comprised 56 children (aged 4-15 years) with surgically managed PCG and poor spectacle response. Data were analyzed from October 11, 2023, to March 21, 2024. Interventions RGPCLs (n = 29) vs spectacles (n = 27) for 12 months, plus standardized amblyopia patching. Main Outcomes and Measures The primary outcome was change in worse-eye best-corrected visual acuity (BCVA) at 12 months measured by the Early Treatment Diabetic Retinopathy Study chart with tumbling-E optotypes with children wearing their current best refractive correction. Secondary outcomes included contrast sensitivity function and near stereoacuity. Results Among 56 (of a total of 83 screened participants) randomized participants, 48 (85.7%) completed at least 1 follow-up visit and were included in the primary analysis. Baseline demographic and ocular characteristics for the RGPCL group vs the spectacles group included a mean (SD) age of 7.7 (2.7) vs 7.2 (3.2) years, 13 (54.2%) vs 14 (58.3%) male, and 11 (45.8%) vs 10 (41.7%) female. At 12 months, 22 of 29 participants (76.0%) in the RGPCL group and 19 of 27 participants (70.4%) in the spectacles group completed the final visit. The mean (SD) baseline worse-eye spherical equivalent was −6.55 (6.43) vs −5.17 (5.27) diopters, the mean (SD) BCVA was 0.99 (0.71) vs 1.02 (0.74) logMAR (approximate Snellen equivalent 20/200), and the mean (SD) intraocular pressure was 14.98 (3.14) vs 13.36 (3.92) mm Hg in the RGPCL vs the spectacles group, respectively. At 1 year, the RGPCL group had greater BCVA improvement (mean [SD], 0.31 [0.28] vs 0.12 [0.33] logMAR; adjusted treatment difference, −0.19 logMAR; 95% CI, −0.36 to −0.02 logMAR [approximately 10 letters]; <jats:italic>P</jats:italic> = .03). Achievement of 2 or more lines of BCVA improvement occurred in 15 of 24 participants (62.5%) in the RGPCL group vs 9 of 24 participants (37.5%) in the spectacles group (odds ratio, 6.83; 95% CI, 1.81-25.73; <jats:italic>P</jats:italic> = .01). The RGPCL group had greater contrast sensitivity function improvement (0.40 [0.27] vs 0.13 [0.32]; adjusted treatment difference, 0.24 log units; 95% CI, −0.01 to 0.49; <jats:italic>P</jats:italic> = .04). Near stereoacuity of 60 arcseconds or less was achieved by 12 participants (50.0%) vs 6 of 24 participants (25.0%) (odds ratio, 6.96; 95% CI, 2.41-6.51; <jats:italic>P</jats:italic> = .001). No serious adverse events occurred. Conclusions and Relevance These findings","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"38 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447164","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 : 2025-11-06DOI: 10.1001/jamaophthalmol.2025.4031
Jonathan Meinke, Kristin Raming, Carolina Kessler, Frank G. Holz, Maximilian Pfau, Kristina Pfau
Importance Pseudoxanthoma elasticum (PXE) is a rare inherited disorder marked by progressive calcification of Bruch membrane (BrM). Characteristic retinal features, such as peau d’orange and continuously calcified BrM (also called coquille d’œuf ), reflect disease severity but lack reliable in vivo cross-sectional imaging correlates. Objective To identify high-resolution optical coherence tomography (HR-OCT) correlates of peau d’orange and continuously calcified BrM in patients with PXE. Design, Setting, and Participants This prospective case-control study was conducted at the Department of Ophthalmology, University Hospital, Bonn, Germany. HR-OCT imaging was performed in 37 eyes from 22 patients with PXE and 28 eyes from 16 healthy control participants between November 2024 and March 2025. These data were analyzed March 2025 to May 2025. Exposures Diagnosis of PXE based on clinical and genetic criteria. Healthy eyes served as controls. HR-OCT (axial resolution up to 3 μm) was measured in all study eyes. Main Outcomes and Measures Identification of structural alterations in the retinal pigment epithelium (RPE)/BrM complex on HR-OCT that corresponded to peau d’orange or continuous BrM calcification visible on fundus photography and infrared imaging. Results A total of 42 eyes from 22 patients with PXE (mean age, 50.2 [SD, 13.6] years; range 25.4-77.9 years; 13 female and 9 male) and 28 healthy eyes from 16 control study participants (mean age, 56.4 [SD, 16.8] years; range 23.5-78.6 years; 11 female and 5 male) were examined. HR-OCT imaging revealed a consistent structural transition within peau d’orange zones: from a multilayered RPE/BrM complex, including distinct outer segment interdigitation zone and RPE bands, in unaffected retina to a condensed, hyperreflective monolayer overlying BrM, with hyporeflective separation. In more advanced disease, additional changes included BrM breaks, irregular RPE morphology, reticular pseudodrusen, and serous neurosensory retinal detachment in the absence of macular neovascularization. These features were absent in control eyes (0 of 28). In eyes with type 1 macular neovascularization, layer splitting confirmed anatomical identification of the RPE and BrM. Angioid streaks on fundus imaging corresponded to focal BrM disruptions on HR-OCT. Conclusions and Relevance This study demonstrated that HR-OCT can identify distinct in vivo correlates of Bruch membrane calcification in PXE. The observed transition from multilayered to monolayer RPE/BrM architecture with accompanying hyporeflective separation may serve as a sensitive imaging biomarker of disease progression in future clinical trials. These findings support HR-OCT as a valuable tool for diagnosis, monitoring, and clinical trial end point development in PXE.
{"title":"High-Resolution Optical Coherence Tomography Correlates of Peau d’Orange in Pseudoxanthoma Elasticum","authors":"Jonathan Meinke, Kristin Raming, Carolina Kessler, Frank G. Holz, Maximilian Pfau, Kristina Pfau","doi":"10.1001/jamaophthalmol.2025.4031","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4031","url":null,"abstract":"Importance Pseudoxanthoma elasticum (PXE) is a rare inherited disorder marked by progressive calcification of Bruch membrane (BrM). Characteristic retinal features, such as peau d’orange and continuously calcified BrM (also called <jats:italic toggle=\"yes\">coquille d’œuf</jats:italic> ), reflect disease severity but lack reliable in vivo cross-sectional imaging correlates. Objective To identify high-resolution optical coherence tomography (HR-OCT) correlates of peau d’orange and continuously calcified BrM in patients with PXE. Design, Setting, and Participants This prospective case-control study was conducted at the Department of Ophthalmology, University Hospital, Bonn, Germany. HR-OCT imaging was performed in 37 eyes from 22 patients with PXE and 28 eyes from 16 healthy control participants between November 2024 and March 2025. These data were analyzed March 2025 to May 2025. Exposures Diagnosis of PXE based on clinical and genetic criteria. Healthy eyes served as controls. HR-OCT (axial resolution up to 3 μm) was measured in all study eyes. Main Outcomes and Measures Identification of structural alterations in the retinal pigment epithelium (RPE)/BrM complex on HR-OCT that corresponded to peau d’orange or continuous BrM calcification visible on fundus photography and infrared imaging. Results A total of 42 eyes from 22 patients with PXE (mean age, 50.2 [SD, 13.6] years; range 25.4-77.9 years; 13 female and 9 male) and 28 healthy eyes from 16 control study participants (mean age, 56.4 [SD, 16.8] years; range 23.5-78.6 years; 11 female and 5 male) were examined. HR-OCT imaging revealed a consistent structural transition within peau d’orange zones: from a multilayered RPE/BrM complex, including distinct outer segment interdigitation zone and RPE bands, in unaffected retina to a condensed, hyperreflective monolayer overlying BrM, with hyporeflective separation. In more advanced disease, additional changes included BrM breaks, irregular RPE morphology, reticular pseudodrusen, and serous neurosensory retinal detachment in the absence of macular neovascularization. These features were absent in control eyes (0 of 28). In eyes with type 1 macular neovascularization, layer splitting confirmed anatomical identification of the RPE and BrM. Angioid streaks on fundus imaging corresponded to focal BrM disruptions on HR-OCT. Conclusions and Relevance This study demonstrated that HR-OCT can identify distinct in vivo correlates of Bruch membrane calcification in PXE. The observed transition from multilayered to monolayer RPE/BrM architecture with accompanying hyporeflective separation may serve as a sensitive imaging biomarker of disease progression in future clinical trials. These findings support HR-OCT as a valuable tool for diagnosis, monitoring, and clinical trial end point development in PXE.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"3 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447168","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 : 2025-11-06DOI: 10.1001/jamaophthalmol.2025.4214
John Placide, Sirichai Pasadhika
A previously healthy 31-year-old woman presents with acute unilateral anterior uveitis with hypopyon and an iris lesion and systemic symptoms, including headache, fatigue, and fever. What would you do next?
{"title":"Acute Unilateral Uveitis With Hypopyon and an Iris Lesion","authors":"John Placide, Sirichai Pasadhika","doi":"10.1001/jamaophthalmol.2025.4214","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2025.4214","url":null,"abstract":"A previously healthy 31-year-old woman presents with acute unilateral anterior uveitis with hypopyon and an iris lesion and systemic symptoms, including headache, fatigue, and fever. What would you do next?","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"78 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145447165","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：