Ophthalmology最新文献

Purpose: To evaluate the germicidal efficacy of the Saniteyes^TM ultraviolet-C (UVC) high-level disinfection system for multi-use ophthalmic equipment such as eyedropper bottles, tonometer tips, and diagnostic and laser lenses.

Design: Evaluation of technology.

Participants: Not applicable.

Methods: Disinfection efficacy was assessed using both carrier and simulated use tests against multiple bacterial, viral, and fungal microorganisms. Organisms were selected based on commonly accepted indicators for disinfection efficacy and/or ophthalmic relevance. Stainless steel carriers, eyedropper nozzles, applanation prisms, ophthalmic lenses, and other instruments were inoculated before being placed within a disinfection bay of the Saniteyes^TM system. After pre-cleaning and disinfection, the log reduction in viable organisms was measured. Tests were performed according to American Society of Testing and Materials (ASTM) International Standards for high-level disinfection (HLD). All tests were performed with negative controls, soiled controls, and three replicates for efficacy studies.

Main outcome measures: Log reduction in viable organisms following disinfection.

Results: All carrier (n=42) and simulated use tests (n=24) showed reduction by more than 6-log for all bacteria and fungi, and by more than 4-log for viruses, in accordance with efficacy cutoffs for HLD.

Conclusions: The Saniteyes^TM automated disinfection system offers fast and chemical-free HLD of multi-use ophthalmic devices to meet regulatory standards of the CDC, FDA, and Joint Commission.

Purpose: We assessed whether the Pooled Cohort Equations (PCE) cardiovascular risk score, used in primary care, is associated with the future age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), retinal vein occlusion (RVO), and hypertensive retinopathy (HTR).

Design: Retrospective cohort study.

Participants: We used electronic health record data from the All of Us (AoU) Research Program. Participants aged 40 to 79 years had to have complete variables for PCE calculation within a 6-month period between 2009 and 2015. We excluded participants with preexisting atherosclerotic cardiovascular disease or any of the 5 ocular diseases before the baseline PCE period. A total of 35 909 adults were included in this study.

Methods: Individual-level PCE score was computed and categorized into 4 PCE risk categories: low (<5%), borderline (5%-7.4%), intermediate (7.5%-19.9%), and high (≥20%). Time-to-event analyses included Kaplan-Meier curves and univariate and multivariable Cox proportional hazards regression models. The primary multivariable models adjusted for race, body mass index, chronic kidney disease, and education (not included in PCE to avoid overadjustment). Concordance index (C-index) was reported to assess model performance. Sensitivity analyses tested varied follow-up durations (5, 6, and 7 years) and, in a prespecified component-adjustment sensitivity set, sequentially added PCE components (age, smoking, diabetes).

Main outcome measures: Diagnoses of AMD, glaucoma, DR, RVO, or HTR.

Results: Higher PCE risk categories were significantly associated with increased risk of ocular diseases. In the primary models, compared with the low-risk group, the high-risk group had the highest hazard ratios for AMD (6.22), DR (5.93), glaucoma (2.33), RVO (3.38), and HTR (4.47) (all P < 0.001). Adjusted C-indices were highest for AMD (0.72), DR (0.751), and HTR (0.768), and moderate for glaucoma (0.625) and RVO (0.654). Findings were consistent in different follow-up periods. In component-adjustment sensitivity models, PCE-AMD association was largely explained by age, whereas associations for DR and HTR remained robust.

Conclusions: In the AoU population, the single composite metric PCE meaningfully stratifies future risk for multiple ocular diseases, using information already available in primary care. This suggests PCE could be incorporated into primary care settings to identify individuals who would benefit from earlier ophthalmologic evaluation and prevention strategies.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.

Topic: This systematic review and meta-analysis evaluates the rate and risk of nonarteritic anterior ischemic optic neuropathy (NAION) in adults receiving semaglutide for diabetes or weight loss.

Clinical relevance: Semaglutide is a transformative treatment for diabetes and obesity. Nonarteritic anterior ischemic optic neuropathy is a serious cause of sudden, often permanent, vision loss. A comprehensive synthesis of available and conflicting evidence of a potential link is needed to inform clinical practice.

Methods: Our comprehensive search included MEDLINE, Embase, CENTRAL, clinical trial registries, and direct contact with trial sponsors to identify unpublished data from inception to March 2025. We included randomized controlled trials (RCTs) and observational studies evaluating semaglutide versus placebo or standard therapy in adults. Incident NAION was the primary outcome. Pooled incidence rates, hazard ratios (HRs), and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using random-effects models, uniquely stratified by both clinical indication (diabetes/weight loss) and study design.

Results: Our search identified 8 RCTs (31 174 patients, including 3 RCTs not previously synthesized in meta-analyses) and 8 observational studies (1 611 278 patients) were included. Observational studies for diabetes showed a pooled NAION incidence of 26.7 per 100 000 person-years in those on semaglutide versus 18.9 per 100 000 person-years in those not on semaglutide (HR 1.85, 95% CI 1.20-2.85). Randomized controlled trials for diabetes demonstrated 5 ischemic optic neuropathy events in those on semaglutide versus one in those not, with no significant evidence of increased risk (RR 1.76, 95% CI 0.43-7.25). Observational studies of semaglutide for weight loss showed no evidence of increased NAION hazards (HR 1.57, 95% CI 0.69-3.59), and RCTs (4 ION events vs one) found no evidence of increased risk (RR 2.18, 95% CI 0.33-14.34).

Conclusion: The absolute rate of NAION in semaglutide users is low. Our novel, stratified analysis provides a more nuanced interpretation than previous pooled reviews, isolating a potential increased risk signal to observational data in the diabetes population only, a finding not corroborated by RCTs. The comprehensiveness of our search and rigorous sensitivity analyses to account for patient overlap in databases strengthen the validity of these conclusions. This synthesis highlights the need for continued pharmacovigilance while contextualizing the low absolute risk.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.