Pub Date : 2026-03-01Epub Date: 2025-08-05DOI: 10.1016/j.survophthal.2025.07.011
Hosein Nouri , Nasiq Hasan , Seyed-Hossein Abtahi , Hamid Ahmadieh , Jay Chhablani
Less than a decade has passed since deep learning (DL) was first applied in ophthalmology. With tremendous growth in this field since then, DL is expected to transform and enhance the efficiency of traditional ophthalmology practice. Central serous chorioretinopathy (CSC) is a common chorioretinal disorder whose etiopathogenesis remains largely unknown. The diagnosis and management of CSC rely heavily on multimodal imaging data, detailed analysis of which may exceed the capacity of many practices. In this comprehensive review, we examine how DL can address such issues through automated analysis of CSC-related imaging biomarkers, including subretinal fluid, pigment epithelial detachment, subretinal hyperreflective material, hyperreflective foci, retinal pigment epithelium atrophy, ellipsoid zone loss, and choroidal layer, sublayers, vessels, and neovascularization. Their prognostic yield and therapeutic implications are covered as well. We describe how DL enables rapid, noninvasive visualization of choroidal vasculature, a primary source of pathology in CSC, in unprecedented detail. We also review the state-of-the-art DL models designed for automated CSC diagnosis, classification, prognostication, and treatment outcome prediction based on imaging data. We highlight the challenges and gaps in this field, discuss some recommended counter measures, and suggest future research directions.
{"title":"Deep learning in central serous chorioretinopathy","authors":"Hosein Nouri , Nasiq Hasan , Seyed-Hossein Abtahi , Hamid Ahmadieh , Jay Chhablani","doi":"10.1016/j.survophthal.2025.07.011","DOIUrl":"10.1016/j.survophthal.2025.07.011","url":null,"abstract":"<div><div>Less than a decade has passed since deep learning (DL) was first applied in ophthalmology. With tremendous growth in this field since then, DL is expected to transform and enhance the efficiency of traditional ophthalmology practice. Central serous chorioretinopathy (CSC) is a common chorioretinal disorder whose etiopathogenesis remains largely unknown. The diagnosis and management of CSC rely heavily on multimodal imaging data, detailed analysis of which may exceed the capacity of many practices. In this comprehensive review, we examine how DL can address such issues through automated analysis of CSC-related imaging biomarkers, including subretinal fluid, pigment epithelial detachment, subretinal hyperreflective material, hyperreflective foci, retinal pigment epithelium atrophy, ellipsoid zone loss, and choroidal layer, sublayers, vessels, and neovascularization. Their prognostic yield and therapeutic implications are covered as well. We describe how DL enables rapid, noninvasive visualization of choroidal vasculature, a primary source of pathology in CSC, in unprecedented detail. We also review the state-of-the-art DL models designed for automated CSC diagnosis, classification, prognostication, and treatment outcome prediction based on imaging data. We highlight the challenges and gaps in this field, discuss some recommended counter measures, and suggest future research directions.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 718-748"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-06DOI: 10.1016/j.survophthal.2025.09.004
Matteo Mario Carlà , Elise Philippakis , David Gaucher , Aude Couturier , Alain Gaudric
Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring across a broader spectrum of refractive conditions, including mild myopia and even emmetropia. Since its initial description in 2008, advances in imaging technologies and longitudinal studies have significantly improved our understanding of DSM. We analyzed the recent literature, focusing on publications from the last 10 years. DSM affects about 0.2 % of the general population, with a prevalence reaching 10–20 % in highly myopic eyes. Its pathophysiology involves complex mechanisms ranging from emmetropization processes in non-myopic eyes to differential scleral biomechanics and asymmetric posterior segment growth in high myopia. Polarization-sensitive optical coherence tomography provided new insights into scleral fiber architecture, showing horizontal interpapillomacular fibers corresponding to the typical horizontal DSM configuration. DSM plays a dual role in myopic complications, potentially protecting against foveal retinoschisis while predisposing to serous retinal detachment (SRD) and retinal pigment epithelium (RPE) atrophy when the dome height exceeds specific thresholds. SRD, the most common (8–50 % of cases), and RPE atrophy are the main complications directly related to DSM. There are numerous treatment approaches for SRD with variable success rates. Longitudinal studies have described DSM evolution over time and shown that an increased dome height correlated with the axial elongation. We provide updated information on the epidemiology, pathophysiology, clinical presentation and management of DSM to improve the diagnosis and treatment of this increasingly recognized condition.
{"title":"Current advances in dome-shaped macula and associated conditions","authors":"Matteo Mario Carlà , Elise Philippakis , David Gaucher , Aude Couturier , Alain Gaudric","doi":"10.1016/j.survophthal.2025.09.004","DOIUrl":"10.1016/j.survophthal.2025.09.004","url":null,"abstract":"<div><div>Dome-shaped macula (DSM) is a distinctive anatomical entity characterized by an inward convexity of the macula, initially described in highly myopic eyes within posterior staphyloma, but is now recognized as occurring across a broader spectrum of refractive conditions, including mild myopia and even emmetropia. Since its initial description in 2008, advances in imaging technologies and longitudinal studies have significantly improved our understanding of DSM. We analyzed the recent literature, focusing on publications from the last 10 years. DSM affects about 0.2 % of the general population, with a prevalence reaching 10–20 % in highly myopic eyes. Its pathophysiology involves complex mechanisms ranging from emmetropization processes in non-myopic eyes to differential scleral biomechanics and asymmetric posterior segment growth in high myopia. Polarization-sensitive optical coherence tomography provided new insights into scleral fiber architecture, showing horizontal interpapillomacular fibers corresponding to the typical horizontal DSM configuration. DSM plays a dual role in myopic complications, potentially protecting against foveal retinoschisis while predisposing to serous retinal detachment (SRD) and retinal pigment epithelium (RPE) atrophy when the dome height exceeds specific thresholds. SRD, the most common (8–50 % of cases), and RPE atrophy are the main complications directly related to DSM. There are numerous treatment approaches for SRD with variable success rates. Longitudinal studies have described DSM evolution over time and shown that an increased dome height correlated with the axial elongation. We provide updated information on the epidemiology, pathophysiology, clinical presentation and management of DSM to improve the diagnosis and treatment of this increasingly recognized condition.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 393-404"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-06DOI: 10.1016/j.survophthal.2025.08.005
Jia Gao , Wei Wang , Ya Mo
Retinal degenerative diseases (RDD) are a group of age-related blinding eye diseases characterized by progressive degeneration and functional impairment of retinal photoreceptors or ganglion cells, for which there are currently no effective treatments. The complement system is an important innate immune system in the human body, activated through 3 pathways (classical pathway, lectin pathway, and alternative pathway) to ultimately form a membrane attack complex that acts on target cells. Microglia are the innate immune cells of the retina, responsible for maintaining retinal homeostasis. Complement system activation and microglial activation have been identified in RDD. Complement activation products C3 and C5 generate anaphylatoxins C3a and C5a, whose receptors C3aR and C5aR1 can activate microglia. Activated microglia can further produce complement C1q to activate the complement system, forming a positive feedback loop that exacerbates retinal damage. In this review, we focus on the crosstalk between the complement system and microglia in age-related macular degeneration, diabetic retinopathy, glaucoma, and pathological myopia-related retinal degeneration, and summarize clinical studies targeting the complement system and microglia for the treatment of RDD.
{"title":"Retinal degenerative diseases: Complement system-microglia crosstalk","authors":"Jia Gao , Wei Wang , Ya Mo","doi":"10.1016/j.survophthal.2025.08.005","DOIUrl":"10.1016/j.survophthal.2025.08.005","url":null,"abstract":"<div><div>Retinal degenerative diseases (RDD) are a group of age-related blinding eye diseases characterized by progressive degeneration and functional impairment of retinal photoreceptors or ganglion cells, for which there are currently no effective treatments. The complement system is an important innate immune system in the human body, activated through 3 pathways (classical pathway, lectin pathway, and alternative pathway) to ultimately form a membrane attack complex that acts on target cells. Microglia are the innate immune cells of the retina, responsible for maintaining retinal homeostasis. Complement system activation and microglial activation have been identified in RDD. Complement activation products C3 and C5 generate anaphylatoxins C3a and C5a, whose receptors C3aR and C5aR1 can activate microglia. Activated microglia can further produce complement C1q to activate the complement system, forming a positive feedback loop that exacerbates retinal damage. In this review, we focus on the crosstalk between the complement system and microglia in age-related macular degeneration, diabetic retinopathy, glaucoma, and pathological myopia-related retinal degeneration, and summarize clinical studies targeting the complement system and microglia for the treatment of RDD.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 346-360"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-13DOI: 10.1016/j.survophthal.2025.09.005
Sonia Huang , Jessica Y. Tong , Valerie Juniat , Abdullah Almater , Ilse Mombaerts , Dinesh Selva
Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definitive diagnosis cannot always be reached with imaging alone, it can be particularly useful in assisting with identifying benign and malignant features and therefore guiding appropriate further investigation and management. We perform a detailed literature review and describe the radiological features of various lacrimal gland pathologies.
{"title":"Radiological features of lacrimal gland masses","authors":"Sonia Huang , Jessica Y. Tong , Valerie Juniat , Abdullah Almater , Ilse Mombaerts , Dinesh Selva","doi":"10.1016/j.survophthal.2025.09.005","DOIUrl":"10.1016/j.survophthal.2025.09.005","url":null,"abstract":"<div><div>Computed tomography and magnetic resonance imaging play a pivotal role in the investigation of lacrimal gland masses. Different lacrimal gland masses will demonstrate specific imaging characteristics. Although a definitive diagnosis cannot always be reached with imaging alone, it can be particularly useful in assisting with identifying benign and malignant features and therefore guiding appropriate further investigation and management. We perform a detailed literature review and describe the radiological features of various lacrimal gland pathologies.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 700-717"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prominence of artificial intelligence (AI) is growing exponentially, yet its implementation across research domains is uneven. To quantify AI trends in vision science, we evaluated over 100,000 PubMed article metadata spanning 35 years. Using Medical Subject Headings (MeSH) terms, we analyzed trends across four prominent ocular diseases: age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract. Most articles utilized research techniques from at least one of the following domains: biological models, molecular profiling, image-based analysis, and clinical outcomes. Our quantification reveals that AI prominence is disproportionally concentrated in the image-based analysis domain, and, additionally, among 4 diseases evaluated, AI prevalence in cataract research is lagging. Contributing factors towards these disparities include insufficient data standardization, complex data structures, limited data availability, unresolved ethical concerns, and not gaining meaningful improvements over human-based interpretations. By mapping where AI thrives and where it lags, we offer a quantitative reference for funding agencies, clinicians, and vision scientists. Connecting various research domains with multimodal and generative AI could improve diagnostic utility; enabling earlier diagnosis, personalized therapy, reduced healthcare costs, and accelerate innovation. Future work should move AI in vision science beyond image-centric pattern recognition toward integrative, mechanistic analyses that explain – rather than merely detect – disease.
{"title":"Impact of artificial intelligence in vision science: A systematic review of progress, emerging trends, data domain quantification, and critical gaps","authors":"Colby F. Lewallen PhD, Davide Ortolan PhD, Dominik Reichert MS, Ruchi Sharma PhD, Kapil Bharti PhD","doi":"10.1016/j.survophthal.2025.09.014","DOIUrl":"10.1016/j.survophthal.2025.09.014","url":null,"abstract":"<div><div>The prominence of artificial intelligence (AI) is growing exponentially, yet its implementation across research domains is uneven. To quantify AI trends in vision science, we evaluated over 100,000 PubMed article metadata spanning 35 years. Using Medical Subject Headings (MeSH) terms, we analyzed trends across four prominent ocular diseases: age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract. Most articles utilized research techniques from at least one of the following domains: biological models, molecular profiling, image-based analysis, and clinical outcomes. Our quantification reveals that AI prominence is disproportionally concentrated in the image-based analysis domain, and, additionally, among 4 diseases evaluated, AI prevalence in cataract research is lagging. Contributing factors towards these disparities include insufficient data standardization, complex data structures, limited data availability, unresolved ethical concerns, and not gaining meaningful improvements over human-based interpretations. By mapping where AI thrives and where it lags, we offer a quantitative reference for funding agencies, clinicians, and vision scientists. Connecting various research domains with multimodal and generative AI could improve diagnostic utility; enabling earlier diagnosis, personalized therapy, reduced healthcare costs, and accelerate innovation. Future work should move AI in vision science beyond image-centric pattern recognition toward integrative, mechanistic analyses that explain – rather than merely detect – disease.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 596-612"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Age-related macular degeneration (AMD) represents a leading cause of vision loss worldwide, while vitreoretinal interface (VRI) abnormalities constitute a dynamic boundary where posterior vitreous interacts with the retinal surface. We explore the intricate relationship between VRI abnormalities and AMD, examining prevalence, underlying pathophysiological mechanisms, and their reciprocal influence on disease development, progression, and treatment outcomes. Evidence suggests a higher prevalence of vitreomacular adhesion in exudative versus nonexudative AMD, while complete posterior vitreous detachment may exert protective effects against AMD progression. Tractional forces, inflammatory mediators, and structural disruption associated with VRI abnormalities may promote AMD progression and confound assessment of anti-vascular endothelial growth factor therapy efficacy. Recent findings underscore that epiretinal membranes might act as physical barriers reducing drug penetration, while VMT/VMA can alter macular morphology, potentially mimicking or obscuring therapeutic response. Surgical management of VRI abnormalities in AMD can achieve anatomical success, though visual outcomes may be limited by underlying macular pathology. Early detection and characterization of VRI abnormalities in AMD patients could improve risk stratification, guide treatment timing, and potentially lead to novel preventive strategies, highlighting the importance of comprehensive evaluation and individualized management approaches for optimizing outcomes in this complex patient population.
{"title":"Vitreoretinal interface abnormalities in age-related macular degeneration: Prevalence, pathophysiology, and reciprocal influence","authors":"Matteo Mario Carlà , Francesco Mottola MD , Mattia Cusato MD , Gianmarco Oreste MD , Giorgia Campaniello MD , Carlos Mateo , Aude Couturier , Elise Philippakis , Tomaso Caporossi , Stanislao Rizzo","doi":"10.1016/j.survophthal.2025.07.010","DOIUrl":"10.1016/j.survophthal.2025.07.010","url":null,"abstract":"<div><div>Age-related macular degeneration (AMD) represents a leading cause of vision loss worldwide, while vitreoretinal interface (VRI) abnormalities constitute a dynamic boundary where posterior vitreous interacts with the retinal surface. We explore the intricate relationship between VRI abnormalities and AMD, examining prevalence, underlying pathophysiological mechanisms, and their reciprocal influence on disease development, progression, and treatment outcomes. Evidence suggests a higher prevalence of vitreomacular adhesion in exudative versus nonexudative AMD, while complete posterior vitreous detachment may exert protective effects against AMD progression. Tractional forces, inflammatory mediators, and structural disruption associated with VRI abnormalities may promote AMD progression and confound assessment of anti-vascular endothelial growth factor therapy efficacy. Recent findings underscore that epiretinal membranes might act as physical barriers reducing drug penetration, while VMT/VMA can alter macular morphology, potentially mimicking or obscuring therapeutic response. Surgical management of VRI abnormalities in AMD can achieve anatomical success, though visual outcomes may be limited by underlying macular pathology. Early detection and characterization of VRI abnormalities in AMD patients could improve risk stratification, guide treatment timing, and potentially lead to novel preventive strategies, highlighting the importance of comprehensive evaluation and individualized management approaches for optimizing outcomes in this complex patient population.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 321-333"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-18DOI: 10.1016/j.survophthal.2025.09.007
Euna Lee BS , David Hunt BS , Yavuz Cakir MD , David Kuo MD , Ziqi Zhou BS , Miroslav Pajic PhD , Majda Hadziahmetovic MD
Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in older adults. While anti-vascular endothelial growth factor (anti-VEGF) therapy and novel treatments for geographic atrophy have improved management, timely diagnosis and personalized intervention remain a challenge. Artificial intelligence (AI), such as machine learning and deep learning models, shows promise in AMD diagnosis, classification, and treatment planning. This review summarizes AI’s recent advancements, highlights its clinical utility, and addresses key limitations for wider real-world implementation in AMD. We conducted systematic search of PubMed from its conception up to August 1, 2024. Studies utilizing AI-based algorithms for AMD management were identified and categorized into early detection/classification and prediction of disease progression/treatment response. Data extraction focused on AI model performance, imaging modalities, and clinical applicability. Of 193 records screened, 47 studies were included, in which 19 studies focused on early detection/classification and 28 on prediction of disease progression/treatment response. AI models demonstrated high accuracy in AMD classification and progression prediction, including in real-world settings. Prediction models for treatment response, particularly anti-VEGF therapy, could provide recommendations on optimizing injection timelines. Recent studies have also begun tackling previous challenges, such as algorithmic biases, limited generalizability, and AI’s "black-box" nature. AI-based models offer significant potential to transform AMD care through timely detection and personalized treatment; however, clinical integration depends on improving model interpretability and validating tools across diverse populations. As AI continues to evolve, ongoing research is needed to refine AI models and support their translation into evidence-based, real-world applicability in AMD.
{"title":"Artificial intelligence in age-related macular degeneration: Advancing diagnosis, prognosis, and treatment","authors":"Euna Lee BS , David Hunt BS , Yavuz Cakir MD , David Kuo MD , Ziqi Zhou BS , Miroslav Pajic PhD , Majda Hadziahmetovic MD","doi":"10.1016/j.survophthal.2025.09.007","DOIUrl":"10.1016/j.survophthal.2025.09.007","url":null,"abstract":"<div><div>Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in older adults. While anti-vascular endothelial growth factor (anti-VEGF) therapy and novel treatments for geographic atrophy have improved management, timely diagnosis and personalized intervention remain a challenge. Artificial intelligence (AI), such as machine learning and deep learning models, shows promise in AMD diagnosis, classification, and treatment planning. This review summarizes AI’s recent advancements, highlights its clinical utility, and addresses key limitations for wider real-world implementation in AMD. We conducted systematic search of PubMed from its conception up to August 1, 2024. Studies utilizing AI-based algorithms for AMD management were identified and categorized into early detection/classification and prediction of disease progression/treatment response. Data extraction focused on AI model performance, imaging modalities, and clinical applicability. Of 193 records screened, 47 studies were included, in which 19 studies focused on early detection/classification and 28 on prediction of disease progression/treatment response. AI models demonstrated high accuracy in AMD classification and progression prediction, including in real-world settings. Prediction models for treatment response, particularly anti-VEGF therapy, could provide recommendations on optimizing injection timelines. Recent studies have also begun tackling previous challenges, such as algorithmic biases, limited generalizability, and AI’s \"black-box\" nature. AI-based models offer significant potential to transform AMD care through timely detection and personalized treatment; however, clinical integration depends on improving model interpretability and validating tools across diverse populations. As AI continues to evolve, ongoing research is needed to refine AI models and support their translation into evidence-based, real-world applicability in AMD.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 560-571"},"PeriodicalIF":5.9,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-26DOI: 10.1016/j.survophthal.2026.02.006
Sing Yue Sim, Lik Thai Lim, Sameer Chaudhary, Muharliza Musa, Robin Hamilton, Luke Nicholson, Bishwanath Pal, Pragya Saini, Pranine Mankongcharoen, Sagnik Sen
Subthreshold micropulse laser (SML) has emerged as a valuable and effective alternative to conventional laser treatments for a variety of retinal diseases, offering therapeutic benefits while minimizing tissue damage. Unlike traditional continuous wave lasers which induce irreversible changes to photoreceptors and retinal pigment epithelial (RPE) cells due to thermal damage, SML delivers energy in short bursts with cooling intervals, maintaining subthreshold temperatures that trigger therapeutic cellular responses without causing visible retinal scarring. We have synthesized the latest evidence on SML's role in managing diabetic macular edema (DME), central serous chorioretinopathy (CSCR), macular edema secondary to retinal vein occlusion, and age-related macular degeneration. Across these conditions, SML demonstrates comparable visual and anatomical outcomes to conventional laser and anti-vascular endothelial growth factor therapies, with notable benefits, including a reduced injection burden in DME and improved choriocapillaris perfusion in CSCR. Additionally, emerging data suggests SML may hold an edge in more complex cases, such as chronic CSCR, pseudophakic macular edema, and dome-shaped maculopathy; however, inconsistencies in laser parameters including wavelength, duty cycle, fluence parameters and spot size continue to pose challenges in standardizing treatment protocols. The "reset theory" of RPE restoration, driven by heat shock protein activation or other described mechanisms, underscores SML's potential to offer sustained, long-term disease control. While current evidence is promising, larger, high-quality studies are still needed to fine-tune treatment settings, improve patient selection strategies, and clarify SML's role alongside other therapies. We provide a comprehensive overview of SML's progress, potential, and future direction in retinal disease management.
{"title":"Update on subthreshold micropulse laser treatment for retinal diseases: A narrative review.","authors":"Sing Yue Sim, Lik Thai Lim, Sameer Chaudhary, Muharliza Musa, Robin Hamilton, Luke Nicholson, Bishwanath Pal, Pragya Saini, Pranine Mankongcharoen, Sagnik Sen","doi":"10.1016/j.survophthal.2026.02.006","DOIUrl":"10.1016/j.survophthal.2026.02.006","url":null,"abstract":"<p><p>Subthreshold micropulse laser (SML) has emerged as a valuable and effective alternative to conventional laser treatments for a variety of retinal diseases, offering therapeutic benefits while minimizing tissue damage. Unlike traditional continuous wave lasers which induce irreversible changes to photoreceptors and retinal pigment epithelial (RPE) cells due to thermal damage, SML delivers energy in short bursts with cooling intervals, maintaining subthreshold temperatures that trigger therapeutic cellular responses without causing visible retinal scarring. We have synthesized the latest evidence on SML's role in managing diabetic macular edema (DME), central serous chorioretinopathy (CSCR), macular edema secondary to retinal vein occlusion, and age-related macular degeneration. Across these conditions, SML demonstrates comparable visual and anatomical outcomes to conventional laser and anti-vascular endothelial growth factor therapies, with notable benefits, including a reduced injection burden in DME and improved choriocapillaris perfusion in CSCR. Additionally, emerging data suggests SML may hold an edge in more complex cases, such as chronic CSCR, pseudophakic macular edema, and dome-shaped maculopathy; however, inconsistencies in laser parameters including wavelength, duty cycle, fluence parameters and spot size continue to pose challenges in standardizing treatment protocols. The \"reset theory\" of RPE restoration, driven by heat shock protein activation or other described mechanisms, underscores SML's potential to offer sustained, long-term disease control. While current evidence is promising, larger, high-quality studies are still needed to fine-tune treatment settings, improve patient selection strategies, and clarify SML's role alongside other therapies. We provide a comprehensive overview of SML's progress, potential, and future direction in retinal disease management.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-24DOI: 10.1016/j.survophthal.2026.02.010
Felipe Murati, Parichehr Ghahari, Tawanda Zvavamwe, Wyatt W Williams, Katie Curran, Tunde Peto, Imre Lengyel, Brian S McKay, Igor Kozak
We review the role of levodopa (L-DOPA), a dopamine precursor used to treat Parkinson disease, as a candidate for retinal neuroprotection, focusing on retinal dopamine biology, mechanisms of action, and evidence from preclinical and clinical studies. Selected experimental and clinical studies indicate that L-DOPA and related dopaminergic interventions influence multiple retinal pathways relevant to degeneration. L-DOPA, synthesized in the pigmented retinal pigment epithelium, activates GPR143 signaling and promotes the release of neuroprotective factors. In animal studies, L-DOPA supplementation rescued retinal development in albinism and reduced oxidative damage to photoreceptors. Epidemiologic analyses showed that patients on systemic L-DOPA had a delayed onset and a lower incidence of age-related macular degeneration (AMD). Small clinical studies in neovascular AMD demonstrated that adjunctive oral L-DOPA improved vision and reduced the burden of anti-vascular endothelial growth factor injections. Larger controlled trials are needed to define efficacy, optimal dosing, and long-term tolerability. Given its established pharmacology and ability to cross the blood-retinal barrier, L-DOPA is a promising candidate for therapeutic repurposing in ophthalmology.
{"title":"Levodopa in retinal disease: Dopamine pathways, neuroprotective mechanisms, and clinical evidence.","authors":"Felipe Murati, Parichehr Ghahari, Tawanda Zvavamwe, Wyatt W Williams, Katie Curran, Tunde Peto, Imre Lengyel, Brian S McKay, Igor Kozak","doi":"10.1016/j.survophthal.2026.02.010","DOIUrl":"10.1016/j.survophthal.2026.02.010","url":null,"abstract":"<p><p>We review the role of levodopa (L-DOPA), a dopamine precursor used to treat Parkinson disease, as a candidate for retinal neuroprotection, focusing on retinal dopamine biology, mechanisms of action, and evidence from preclinical and clinical studies. Selected experimental and clinical studies indicate that L-DOPA and related dopaminergic interventions influence multiple retinal pathways relevant to degeneration. L-DOPA, synthesized in the pigmented retinal pigment epithelium, activates GPR143 signaling and promotes the release of neuroprotective factors. In animal studies, L-DOPA supplementation rescued retinal development in albinism and reduced oxidative damage to photoreceptors. Epidemiologic analyses showed that patients on systemic L-DOPA had a delayed onset and a lower incidence of age-related macular degeneration (AMD). Small clinical studies in neovascular AMD demonstrated that adjunctive oral L-DOPA improved vision and reduced the burden of anti-vascular endothelial growth factor injections. Larger controlled trials are needed to define efficacy, optimal dosing, and long-term tolerability. Given its established pharmacology and ability to cross the blood-retinal barrier, L-DOPA is a promising candidate for therapeutic repurposing in ophthalmology.</p>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-24DOI: 10.1016/j.survophthal.2026.02.011
Chun Zhang, Zhuping Xu
Ultrasound imaging has played an important role in ophthalmic diagnostics due to its real-time capability, safety, and cost-effectiveness. In recent years several novel ultrasound modalities have been applied to diagnosis of ocular diseases, including contrast-enhanced ultrasound (CEUS), photoacoustic imaging (PAI), 3-dimensional ultrasound (3D-US), microvascular flow imaging (MFI), super-resolution ultrasound localization microscopy (SRULM), ultrasound elastography, and high-frequency ultrasound (HFUS). These technologies offer improvements in spatial resolution, tissue characterization, and functional imaging. Specifically, CEUS, PAI, MFI, and SRULM allow for the evaluation of ocular blood flow and vasculature, while HFUS and elastography enhance the assessment of intraocular structures and tissue stiffness. 3D-US contributes to the volumetric analysis of ocular lesions. In parallel, the integration of artificial intelligence with ultrasound has enabled automated image interpretation and disease classification, with applications in various ocular diseases, such as retinal detachment, intraocular tumor, and glaucoma. Despite these advances, limitations remain, such as the difficulty in balancing image resolution with penetration depth. Further development in multimodal imaging, algorithm optimization, and clinical validation is needed. Therefore, we review the current progress in novel ultrasound modalities, explores the clinical potential of ophthalmic application, and outlines existing challenges as well as future research directions.
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