Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.06.016
Anita Barikian MD , Jaya B. Kumar MD , April J. McCullough MD , Fabiana Q. Silva MD , Steven Sherman MPH , Kathryn Tanenbaum BA , Hadi Moini PhD , Rishi P. Singh MD
Objective
To assess 1-year visual outcomes of patients in routine clinical practice treated with ≥7 anti-VEGF injections for neovascular age-related macular degeneration (nAMD), baseline characteristics associated with receiving ≥7 anti-VEGF injections, and impact of treatment exposure on visual outcomes.
Design
Retrospective analysis.
Participants
Treatment-naive eyes with baseline best-corrected visual acuity (BCVA) ≥20/400, from patients aged ≥55 years with nAMD diagnosed from January 1, 2013 to December 31, 2019.
Methods
This analysis included eyes from the American Academy of Ophthalmology IRIS Registry® (Intelligent Research in Sight). Visual outcomes were evaluated by treatment exposure (≥7 or <7 intravitreal anti-VEGF injections) through year 1. Baseline factors associated with ≥7 anti-VEGF injections and impact of treatment exposure on visual outcomes were evaluated by logistic regression.
Main Outcome Measures
Best-corrected visual acuity change from baseline by treatment exposure, association between baseline factors and treatment exposure, and magnitude of BCVA change by baseline factors and treatment exposure at year 1.
Results
Of 295 561 eligible eyes, 184 258 actively treated were analyzed (≥7 anti-VEGF injections: 109 696 eyes [59.5%]; <7 injections: 74 562 eyes [40.5%]). At year 1, eyes receiving ≥7 injections achieved greater BCVA gains versus those receiving <7 injections (least squares mean change [95% confidence interval]: +3.4 [3.3–3.5] vs. −0.2 [−0.3 to 0.0] letters). Asian or Black race (vs. White); Hispanic ethnicity (vs. non-Hispanic or Latino); Medicaid insurance (vs. Medicare); and treatment by a nonretina specialist were associated with lower odds of receiving ≥7 injections. For both treatment exposure groups, BCVA <20/200 to 20/400 (vs. 20/100–20/200) was associated with greater visual gains, whereas BCVA >20/80, age ≥85 years (vs. 75–84 years), treatment by a nonretina specialist, and Medicaid insurance were associated with lower BCVA gains.
Conclusions
Over one-third of newly diagnosed eyes with nAMD received <7 anti-VEGF injections and experienced worse visual outcomes at year 1 versus eyes receiving ≥7 injections. Race, insurance type, and physician specialty impacted treatment exposure in nAMD management, whereas age, baseline BCVA, and insurance type impacted visual outcomes regardless of treatment exposure.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
{"title":"Characteristics and Outcomes of Patients with Neovascular Age-Related Macular Degeneration by Anti-VEGF Exposure in United States Clinical Practice","authors":"Anita Barikian MD , Jaya B. Kumar MD , April J. McCullough MD , Fabiana Q. Silva MD , Steven Sherman MPH , Kathryn Tanenbaum BA , Hadi Moini PhD , Rishi P. Singh MD","doi":"10.1016/j.oret.2025.06.016","DOIUrl":"10.1016/j.oret.2025.06.016","url":null,"abstract":"<div><h3>Objective</h3><div>To assess 1-year visual outcomes of patients in routine clinical practice treated with ≥7 anti-VEGF injections for neovascular age-related macular degeneration (nAMD), baseline characteristics associated with receiving ≥7 anti-VEGF injections, and impact of treatment exposure on visual outcomes.</div></div><div><h3>Design</h3><div>Retrospective analysis.</div></div><div><h3>Participants</h3><div>Treatment-naive eyes with baseline best-corrected visual acuity (BCVA) ≥20/400, from patients aged ≥55 years with nAMD diagnosed from January 1, 2013 to December 31, 2019.</div></div><div><h3>Methods</h3><div>This analysis included eyes from the American Academy of Ophthalmology IRIS Registry® (Intelligent Research in Sight). Visual outcomes were evaluated by treatment exposure (≥7 or <7 intravitreal anti-VEGF injections) through year 1. Baseline factors associated with ≥7 anti-VEGF injections and impact of treatment exposure on visual outcomes were evaluated by logistic regression.</div></div><div><h3>Main Outcome Measures</h3><div>Best-corrected visual acuity change from baseline by treatment exposure, association between baseline factors and treatment exposure, and magnitude of BCVA change by baseline factors and treatment exposure at year 1.</div></div><div><h3>Results</h3><div>Of 295 561 eligible eyes, 184 258 actively treated were analyzed (≥7 anti-VEGF injections: 109 696 eyes [59.5%]; <7 injections: 74 562 eyes [40.5%]). At year 1, eyes receiving ≥7 injections achieved greater BCVA gains versus those receiving <7 injections (least squares mean change [95% confidence interval]: +3.4 [3.3–3.5] vs. −0.2 [−0.3 to 0.0] letters). Asian or Black race (vs. White); Hispanic ethnicity (vs. non-Hispanic or Latino); Medicaid insurance (vs. Medicare); and treatment by a nonretina specialist were associated with lower odds of receiving ≥7 injections. For both treatment exposure groups, BCVA <20/200 to 20/400 (vs. 20/100–20/200) was associated with greater visual gains, whereas BCVA >20/80, age ≥85 years (vs. 75–84 years), treatment by a nonretina specialist, and Medicaid insurance were associated with lower BCVA gains.</div></div><div><h3>Conclusions</h3><div>Over one-third of newly diagnosed eyes with nAMD received <7 anti-VEGF injections and experienced worse visual outcomes at year 1 versus eyes receiving ≥7 injections. Race, insurance type, and physician specialty impacted treatment exposure in nAMD management, whereas age, baseline BCVA, and insurance type impacted visual outcomes regardless of treatment exposure.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.</div></div>","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 71-80"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.05.003
Zhenlong Ran MD , Jiayue Wang MD , Dongyan Pan MD
{"title":"Bilateral Macular Ectopia and Folds in X-Linked Retinoschisis","authors":"Zhenlong Ran MD , Jiayue Wang MD , Dongyan Pan MD","doi":"10.1016/j.oret.2025.05.003","DOIUrl":"10.1016/j.oret.2025.05.003","url":null,"abstract":"","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Page e6"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or
{"title":"Comparing Membrane Peeling Techniques in Lamellar Macular Hole Surgery","authors":"Yosra Er-reguyeg MD, MSc (C) , Elyazid Rhalem MD (C) , Eunice Linh You MD, MSc , Anas Abu-Dieh MD , Mélanie Hébert MD, MSc , Huixin Zhang MD , Serge Bourgault MD , Mathieu Caissie MD , Éric Tourville MD , Ali Dirani MD, MSc","doi":"10.1016/j.oret.2025.06.004","DOIUrl":"10.1016/j.oret.2025.06.004","url":null,"abstract":"<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or ","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 39-60"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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