Ophthalmology and Therapy最新文献

Introduction: This study investigated the effect of axial length (AL) on peripheral retinal vessel density in children and adolescents and assessed whether deep learning can detect early vascular changes in myopia.

Methods: Non-mydriatic ultra-widefield imaging was used to capture retinal images. Deep learning models based on Nested U-Net and ResNet34 segmented the vasculature, quantified vessel density in 60-30° and 100-60° fields, and classified AL from fundus images.

Results: A total of 679 eyes from 396 children and adolescents were analyzed. Participants were categorized into normal (22.96 ± 0.65 mm), medium (24.69 ± 0.50 mm), and high (27.32 ± 0.80 mm) AL groups. Across both 60-30° and 100-60° fields, the temporal retina displayed higher vessel density, while the inferior retina showed lower density. The normal AL group had significantly higher density than the medium AL group (P < 0.05), which surpassed the high AL group (P < 0.05). In the 60-30° temporal region, vessel density decreased from 7.15 ± 1.17% (normal) to 6.70 ± 1.27% (medium) and 6.16 ± 1.82% (high). Deep learning classification achieved an AUC of 0.9651, with Grad-CAM highlighting the inferotemporal vasculature.

Conclusions: As AL increases, peripheral vessel density diminishes. This pattern may suggest a potential prioritization of blood flow to the macular region, although longitudinal studies are required to confirm this hypothesis. These findings suggest that deep learning analysis of ultra-widefield images can reveal subclinical vascular changes, offering a potential tool for early detection of high myopia risk.

Light is a major environmental signal that shapes circadian rhythms, mood regulation, and ocular growth through a network of non-visual photoreceptive pathways. Increasing evidence suggests that photic information, particularly as decoded by intrinsically photosensitive retinal ganglion cells (ipRGCs), converges on central circuits governing both affective states and refractive development. To integrate these cross-system interactions, we propose the conceptual framework of a "light-eye-brain axis," which outlines how environmental light cues are encoded by the retina and subsequently modulate neuroendocrine, autonomic, and inflammatory processes. Within this framework, mood disturbances may contribute to myopic progression through altered light-exposure behaviors, neurotransmitter imbalance, hypothalamic-pituitary-adrenal axis instability, and impaired neuroplasticity, whereas high myopia may increase vulnerability to anxiety or depressive symptoms through shared neural and immune pathways. Taken together, this integrative perspective highlights how light-dependent signaling shapes both emotional and refractive outcomes, and provides a conceptual foundation for future mechanistic studies as well as evidence-informed approaches to optimizing light exposure in the context of mood and visual health.

Smartphone-based portable slit lamps are rapidly evolving from simple add-ons into practical, low-cost front-line tools for anterior segment care beyond traditional clinical settings. By integrating high-performance smartphone cameras with compact optical attachments (e.g., slit-light converters, macro lenses, blue filters) and dedicated applications, these devices deliver slit-lamp-style imaging and video capture to environments where conventional biomicroscopes are inaccessible. Accumulating clinical evidence-most notably for the Smart Eye Camera (SEC) and iSpector MINI HE 010-21-confirms that smartphone slit lamps reliably support assessments across major anterior segment disorders. SEC-based recordings enable evaluation of tear film-related signs in dry eye disease; smartphone-acquired slit-lamp images show strong agreement with standard slit lamps for corneal ulcers, scars, and other ocular surface pathologies; slit-beam acquisition facilitates preliminary screening of shallow anterior chambers and narrow angles relevant to primary angle-closure glaucoma; and cataract screening and grading via smartphone systems align closely with conventional slit-lamp evaluations. Notably, recent advancements have transcended mere image capture to embrace artificial intelligence (AI)-enabled analysis, positioning smartphone slit lamps as scalable screening and triage solutions. Across the studies reviewed, AI models trained on smartphone slit-lamp images or videos demonstrate robust feasibility for automated dry eye diagnosis, corneal opacity detection, keratitis screening, cataract grading, pterygium detection/grading, and narrow-angle identification, typically through pipelines integrating image quality control, region-of-interest localization/segmentation, and disease-specific prediction. Despite these advances, however, key barriers remain, including incomplete replication of full slit-lamp functionality, lack of standardized acquisition protocols, and limited multicenter external validation for most AI systems. Future progress should prioritize hardware stabilization, optical design improvements, disease-specific standardized imaging workflows, and large-scale prospective validation to unlock the full potential of AI-assisted smartphone slit lamps for community screening, teleophthalmology, and care in underserved regions.

Conjunctival hyperemia is one of the most frequent ophthalmologic presentations and may adversely affect quality of life due to associated discomfort and aesthetic concerns. In many countries, the prevalence of noninfectious conjunctival hyperemia is increasing due to lifestyle factors and the shift to technology-based employment. Management of noninfectious conjunctival hyperemia is typically aimed at addressing the underlying cause while alleviating signs and symptoms. However, an underlying cause might not be identified, treatment may not immediately reduce redness, or residual redness might persist. Topical treatment options include lubricants, decongestants, antihistamines/mast cell stabilizers, and anti-inflammatory drugs. Among these, ocular decongestants provide effective short-term relief, but the use of α1- (phenylephrine, tetrahydrozoline) or mixed α1/α2- (naphazoline, oxymetazoline) adrenergic receptor agonists is associated with tachyphylaxis and rebound redness. A highly selective α2- adrenergic receptor agonist (brimonidine 0.025%) reduces ocular redness without evidence of tachyphylaxis over 29 days and with minimal rebound redness upon discontinuation; however, longer-term effectiveness has not been evaluated. Other unmet needs pertain to the management of noninfectious conjunctival hyperemia as an aesthetic issue and the need to educate patients about the risks of surgical eye-whitening procedures and national recalls. Region- or country-specific unmet needs include a lack of awareness of the need for clinical assessment and appropriate treatment of ocular redness. While many cases of noninfectious conjunctival hyperemia can be self-treated, unmet needs remain with respect to access to care and patient awareness/knowledge of safe and appropriate treatment options and the importance of clinical consultation. The development of management guidelines specific to noninfectious conjunctival hyperemia is warranted to address patients' clinical and aesthetic concerns.

Purpose: Patients with diabetic retinopathy (DR) are at risk of visual deterioration owing to systemic and financial barriers in accessing appropriate care. DR screening tools that implement artificial intelligence (AI) algorithms are gaining recognition due to their accuracy and high-throughput potential. This systematic literature review aimed to understand the economic, humanistic, and clinical burden associated with delayed DR management and the impact of AI-based screening tools for diagnosis and treatment.

Methods: MEDLINE, Embase, and Cochrane Library databases were searched per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1 January 2014 to 28 October 2024). Screening, extraction, and quality assessment were performed by two independent reviewers. Supplementary searching was conducted to evaluate visual outcomes.

Results: In total, 33 records were included. Economic evidence demonstrated that infrequent screening was initially cost-saving but decreased patient quality-adjusted life years, delayed sight-threatening DR diagnosis, and resulted in high treatment-related costs in the long term. Several studies found delayed DR treatment to adversely impact visual acuity, central subfield thickness, and time spent with vision loss. The majority of economic studies evaluating AI-based screening found its use to result in lower overall costs than conventional screening, while two noted higher costs attributable to greater screening uptake and increased specialist referrals. Most studies that modeled clinical impact found AI-based screening to reduce blindness or vision loss versus conventional screening.

Conclusions: This research underscored the considerable harms associated with delayed DR diagnosis and treatment. AI-based screening tools have the potential to become powerful instruments in supporting improved clinical outcomes for patients and economic benefits for healthcare systems.

Introduction: To determine whether macular involvement (on or off) at the time of rhegmatogenous retinal detachment (RRD) influences postoperative stereopsis and to explore factors associated with vision-related quality of life (VR-QoL).

Methods: In this prospective, single-centre observational cohort study conducted at the University Hospital of Tours, patients who underwent successful unilateral pars plana vitrectomy (PPV) for RRD were examined for 6 to 18 months postoperatively between June 2024 and March 2025. Surgical success was defined as anatomical reattachment at 3 months postoperatively. The following data were collected: intraoperative macular involvement, diplopia (orthoptic exam and optotype frame test), stereoacuity (The Netherlands Organization test), distance monocular best-corrected visual acuity, metamorphopsia (M-CHARTS), aniseikonia (New Aniseikonia Test), central retinal thickness and ellipsoid zone integrity on optical coherence tomography, retinal ghost vessels (autofluorescence), and VR-QoL assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Univariate analysis was performed to assess stereopsis, and factors associated with VR-QoL were investigated using multivariate linear regressions.

Results: Forty-five patients were included [median age (range): 67 (46-82) years; women: 18 (40%), men: 27 (60%)]. Median duration from RRD repair and assessment was 10 (range 6-18) months. Stereoacuity was significantly worse in the macula-off group than in the macula-on group (p = 0.045). Multivariate analysis revealed that diplopia correlated negatively with the NEI VFQ-25 composite score (p = 0.004). No other variable showed any significant association with the NEI VFQ-25 composite score or its subscales (p > 0.05).

Conclusion: Postoperative stereopsis is significantly reduced in patients with macula-off RRD compared to those with macula-on RDD despite successful anatomical repair. However, neither stereopsis loss nor monocular qualitative or quantitative visual loss was significantly associated with VR-QoL in this cohort. Binocular diplopia, regardless of its mechanism, particularly affects VR-QoL, highlighting the importance of tailored postoperative assessment in patients with RRD.

Introduction: The correlation between diabetic macular oedema (DMO) structural and functional assessments and their reflection of patient impact lacks consensus. This study aims to understand the ophthalmology community's thoughts on optimising patient care by improving functional and structural assessments.

Methods: The process employed a modified Delphi methodology. Following a literature review, a steering committee of six experts developed 40 statements under three consensus topics. The statements were globally distributed via an online, four-point Likert scale survey using a snowball sampling technique.

Results: Survey responses (n = 93) were collated anonymously and independently analysed. Consensus was achieved in 35 statements (88%). There was strong agreement that routinely used assessments for DMO may not accurately reflect the level of vision impairment experienced by the patient and that there is a need for a composite functional assessment (of two or more tests) to demonstrate better correlation with structural changes. The correlation of anatomical features like central subfield thickness, epiretinal membrane, intraretinal fluid, and subretinal fluid volumes with visual acuity outcomes remain uncertain.

Conclusion: This consensus supports the need to develop a composite assessment to improve patient care. Utilising contrast sensitivity, distance and near low luminance, and novel patient-reported outcome measures may improve patient-centric assessments to better understand the patient's quality of life and functional experience.

Post-surgical macular edema is a common cause of delayed visual recovery. Although its occurrence after cataract surgery is well known, the specifics on post-vitrectomy macular edema (PVME) are less readily available in the recent literature. This narrative review identifies a wide-ranging incidence due to heterogeneous surgical indications, study designs, and lack of diagnostic standards in the current literature. PVME requiring pharmacological treatment ranges from 2.0 to 27.3%. Higher rates of macular edema are encountered after vitrectomy for retinal detachment, retained lens fragments, and epiretinal membranes. The intraretinal cystic changes after epiretinal membrane removal, however, often represent remnants of tractional disease, rather than true macular edema. This review elaborates on several patient-related and surgical risk factors, mostly in retinal detachment surgery. Predisposing factors are redetachment, proliferative vitreoretinopathy, silicone oil tamponades, extensive retinopexy, and macular involvement in cases with a retinal detachment. Patients who undergo procedures for macular holes, vitreous floaters, and secondary lens implantation appear less susceptible to developing PVME. Furthermore, higher rates of PVME are seen after crystalline lens removal, both in combined phacoemulsification-vitrectomy and when cataract surgery is performed after the vitrectomy. Additional research should lead to improved risk assessment and a reduced burden of this clinical issue.

Rapid advances in the diagnosis and treatment of thyroid eye disease (TED) have led to the development of three patient care guidelines by regional professional societies: the European Group on Graves' Orbitopathy, the Oculoplastics and Orbital Diseases Group of the Chinese Medical Association Ophthalmology Branch/Thyroid Group of the Chinese Medical Association Endocrinology Branch, and the American Thyroid Association/European Thyroid Association. Although broad consensus can be found across the three guidelines, important differences could affect patient management. This review examines and compares the recommendations of these guidelines across 11 dimensions, from disease diagnosis to treatment strategies. We explore the possible root sources of these variations. The review also suggests future directions and potential implications, thus providing a comprehensive perspective of current and future management of TED.

Diabetic macular edema (DME) is a potential complication of diabetic retinopathy (DR) and a leading cause of DR-related impairment of central vision. The pathogenesis of DME is complex and multifactorial. Vascular endothelial growth factor (VEGF) has been identified as a key mediator of DME, but inflammatory and neurodegenerative processes have also been implicated. Intravitreal therapy with anti-VEGF agents is currently the recommended first-line treatment for DME. However, substantial proportions of patients either fail to respond or achieve a suboptimal response to anti-VEGF therapy. In these patients, intravitreal corticosteroids represent a valid second-line therapeutic option. Dexamethasone (0.7 mg) intravitreal implant was approved in 2014 for the treatment of adults with DME-related visual impairment who are pseudophakic, insufficiently responsive to, or unsuitable for anti-VEGF therapy. At present, there is no consensus on the optimal timing for switching from anti-VEGF therapy to dexamethasone intravitreal implant. Evidence from several studies indicates that an early switch can be associated with better visual and anatomic outcomes compared with delayed intervention. This narrative review synthesizes current data on the use of dexamethasone intravitreal implant for DME, with particular emphasis on patients with a suboptimal response to anti-VEGF therapy switching early to corticosteroid treatment.