Ophthalmology最新文献

Objective: To evaluate the impact of daily digital therapeutics (DTx) on the risk of rapid axial elongation (RAE) in children with amblyopia using real-world data.

Design: Retrospective cohort study.

Subjects: A total of 1,394 children aged 3 to 12 years with amblyopia, of which 477 received DTx.

Methods: Children in the DTx group underwent 30 minutes of daily vision therapy, with axial length (AL) measured at baseline and during follow-up. Cox proportional hazards models were used to assess the risk of RAE, defined as an annual axial elongation exceeding safety thresholds based on age and myopia status.

Main outcome measures: The primary outcome was the hazard ratio (HR) for RAE associated with DTx, adjusted for age, gender, best-corrected visual acuity (BCVA), cycloplegic spherical equivalent refraction (SER), amblyopic eye, type of amblyopia, and baseline AL.

Results: A total of 641 children (45.98%) experienced RAE. DTx use increased the risk of RAE by 65% (HR: 1.65; 95% CI: 1.40-1.96; P < 0.001), with consistent findings across all subgroups (P for interaction >0.05). The increased risk was particularly noted in children with hyperopia, suggesting the potential for DTx to influence axial growth in this population.

Conclusions: DTx is associated with an increased risk of RAE in children with amblyopia, highlighting the need for careful monitoring of AL during therapy. While DTx offers visual acuity improvements, its potential impact on ocular growth should be balanced, particularly in hyperopic and pre-myopic children.

Purpose: We assessed the associations of macular layer thicknesses, measured using spectral-domain OCT (SD-OCT), with incident age-related macular degeneration (AMD) and AMD polygenic risk scores (PRS).

Design: Population-based cohort study PARTICIPANTS: 653 participants of the Alienor study, with biennial eye imaging from 2009 to 2024.

Methods: Macular layer thicknesses of eight distinct layers and three compound layers were automatically segmented based on SD-OCT imaging of the macula. Total and pathway specific PRS were calculated from previous AMD genome-wide association studies summary statistics. Associations of macular layer thicknesses with incident intermediate and advanced AMD were analyzed using time-dependent Cox proportional hazards models. Associations of macular layer thicknesses with PRS were assessed using linear mixed models.

Main outcome measures: Incident intermediate and advanced AMD based on fundus colour photographs and SD-OCT.

Results: Mean age at first OCT examination of the 653 participants was 82.2 ± 4.2 years and 61.3 % were women. In multivariate adjusted models, incident intermediate AMD was associated with thicker retinal pigment epithelium (RPE) - Bruch's Membrane (BM) complex in the 1 mm central circle (Hazard ratio (HR)= 1.13 for 1 μm increase; P_FDR= 8.08 x 10^-4). Incident advanced AMD was associated with thicker RPE-BM complex in both the central circle (HR= 1.09; P_FDR= 0.005) and the inner circle (1 mm - 3 mm) (HR= 1.28; P_FDR= 1.61 x 10^-5). Over the study period, RPE-BM complex thickening in the inner circle was more pronounced in individuals with high total PRS (ß= 0.06 μm/year for 1 standard deviation increase, P_FDR= 1.61 x 10^-10), high complement pathway PRS (ß= 0.04 μm/year, P_FDR=3.23 x 10^-5), high lipid pathway PRS (ß= 0.03 μm/year, P_FDR= 3.74 x 10^-4) and ARMS2 (ß= 0.03 μm/year, P_FDR= 0.002). Further, high total PRS and high complement-specific PRS were associated with thinner photoreceptor segment layer (PSL) at baseline and with thinning of the outer nuclear layer over the study period.

Conclusion: These results highlight the importance of RPE-BM complex thickening in the pathophysiological sequence of AMD. Further longitudinal studies are needed, in particular to determine the value of RPE-BM thickening and PSL thinning measured using SD-OCT for the clinical follow-up of AMD patients.