Pub 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":"2025-09-13","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}
Pub 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":"2025-09-06","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 : 2025-09-05DOI: 10.1016/j.survophthal.2025.09.003
Nicholas Chieh Loh , William Rojas-Carabali , Yuan Heng Lim , Jo Earn Bong , Valeria Villabona-Martinez , Carlos Cifuentes-González , Meenakshi Kumar , Srinivas Sadda , Leopold Schmetterer , Chui Ming Gemmy Cheung , Vishali Gupta , Dilraj S. Grewal , Sharon Fekrat , Alejandra de-la-Torre , Bernett Lee , Xin Wei , Lisa Nivison-Smith , Rupesh Agrawal
The Choroidal Vascularity Index (CVI), derived from optical coherence tomography (OCT), has emerged as a potential biomarker for detecting vascular changes. Understanding its variability across physiological states, ocular conditions, and systemic diseases is crucial for its integration into clinical practice.
We evaluated variations in CVI across different physiological states (e.g., first-trimester pregnancy), ocular conditions (e.g., age-related macular degeneration[AMD]), and systemic diseases (e.g., diabetes mellitus) compared to healthy controls.
From 1210 identified articles, 63 studies (7316 participants: 4000 controls and 3316 cases) met inclusion criteria. Data covered 12 distinct conditions and physiological states. Most studies were conducted in Europe and Asia, predominantly using spectral-domain OCT machines with a low risk of bias. Increased CVI was seen in some physiological states (e.g., Valsalva maneuver, first-trimester pregnancy) and some disorders (e.g. active panuveitis, inactive thyroid eye disease). Reduced CVI was found in diabetes mellitus (both with or without diabetic retinopathy), hyperopic amblyopia, and AMD.
CVI demonstrates potential as a biomarker to differentiate between physiological states and pathological conditions compared to healthy controls. These findings underscore the choroid’s adaptive response to systemic and ocular challenges, highlighting CVI’s relevance in understanding disease mechanisms and monitoring health.
{"title":"Choroidal vascularity index as a marker of health and disease: systematic review and meta-analyses","authors":"Nicholas Chieh Loh , William Rojas-Carabali , Yuan Heng Lim , Jo Earn Bong , Valeria Villabona-Martinez , Carlos Cifuentes-González , Meenakshi Kumar , Srinivas Sadda , Leopold Schmetterer , Chui Ming Gemmy Cheung , Vishali Gupta , Dilraj S. Grewal , Sharon Fekrat , Alejandra de-la-Torre , Bernett Lee , Xin Wei , Lisa Nivison-Smith , Rupesh Agrawal","doi":"10.1016/j.survophthal.2025.09.003","DOIUrl":"10.1016/j.survophthal.2025.09.003","url":null,"abstract":"<div><div>The Choroidal Vascularity Index (CVI), derived from optical coherence tomography (OCT), has emerged as a potential biomarker for detecting vascular changes. Understanding its variability across physiological states, ocular conditions, and systemic diseases is crucial for its integration into clinical practice.</div><div>We evaluated variations in CVI across different physiological states (e.g., first-trimester pregnancy), ocular conditions (e.g., age-related macular degeneration[AMD]), and systemic diseases (e.g., diabetes mellitus) compared to healthy controls.</div><div>From 1210 identified articles, 63 studies (7316 participants: 4000 controls and 3316 cases) met inclusion criteria. Data covered 12 distinct conditions and physiological states. Most studies were conducted in Europe and Asia, predominantly using spectral-domain OCT machines with a low risk of bias. Increased CVI was seen in some physiological states (e.g., Valsalva maneuver, first-trimester pregnancy) and some disorders (e.g. active panuveitis, inactive thyroid eye disease). Reduced CVI was found in diabetes mellitus (both with or without diabetic retinopathy), hyperopic amblyopia, and AMD.</div><div>CVI demonstrates potential as a biomarker to differentiate between physiological states and pathological conditions compared to healthy controls. These findings underscore the choroid’s adaptive response to systemic and ocular challenges, highlighting CVI’s relevance in understanding disease mechanisms and monitoring health.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 35-52"},"PeriodicalIF":5.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016122","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 : 2025-09-04DOI: 10.1016/j.survophthal.2025.09.001
Ramesh Venkatesh Dr. , Pratibha Hande Dr. , Vishma Prabhu Dr. , Shruthi Vidyasagar Dr. , Karishma Tendulkar Dr. , Rupak Roy Dr. , Kanika Godani Dr. , Alisha Sirsikar Dr. , Preksha Biradar Dr. , Priyanka Gandhi Dr. , Naresh Kumar Yadav Dr. , Jay Chhablani Dr.
Fundus tessellation (FT)—also referred to as tigroid or mosaic fundus—is characterized by increased visibility of underlying choroidal vessels. While often a physiological finding, FT may also signal early pathology in conditions such as high myopia, choroidal atrophy, or pigmentary disorders. We synthesize current understanding of the anatomical, optical, and imaging factors influencing FT appearance, including the roles of axial elongation, melanin distribution, and media clarity. Advances in multimodal imaging—such as color fundus photography, optical coherence tomography, and fundus autofluorescence—have improved the ability to differentiate physiological FT from disease-associated changes. Furthermore, artificial intelligence–driven tools like the Fundus Tessellation Density Index (FTDI) provide quantitative support for clinical decision-making. We propose a structured framework combining clinical parameters, imaging features, and FTDI to guide diagnosis and risk assessment. We underscore the clinical relevance of accurately distinguishing physiological from pathological FT and highlights directions for future research, including the potential of FTDI as a prognostic biomarker.
{"title":"Dissecting the clinical and pathophysiological complexity of fundus tessellation","authors":"Ramesh Venkatesh Dr. , Pratibha Hande Dr. , Vishma Prabhu Dr. , Shruthi Vidyasagar Dr. , Karishma Tendulkar Dr. , Rupak Roy Dr. , Kanika Godani Dr. , Alisha Sirsikar Dr. , Preksha Biradar Dr. , Priyanka Gandhi Dr. , Naresh Kumar Yadav Dr. , Jay Chhablani Dr.","doi":"10.1016/j.survophthal.2025.09.001","DOIUrl":"10.1016/j.survophthal.2025.09.001","url":null,"abstract":"<div><div>Fundus tessellation (FT)—also referred to as tigroid or mosaic fundus—is characterized by increased visibility of underlying choroidal vessels. While often a physiological finding, FT may also signal early pathology in conditions such as high myopia, choroidal atrophy, or pigmentary disorders. We synthesize current understanding of the anatomical, optical, and imaging factors influencing FT appearance, including the roles of axial elongation, melanin distribution, and media clarity. Advances in multimodal imaging—such as color fundus photography, optical coherence tomography, and fundus autofluorescence—have improved the ability to differentiate physiological FT from disease-associated changes. Furthermore, artificial intelligence–driven tools like the Fundus Tessellation Density Index (FTDI) provide quantitative support for clinical decision-making. We propose a structured framework combining clinical parameters, imaging features, and FTDI to guide diagnosis and risk assessment. We underscore the clinical relevance of accurately distinguishing physiological from pathological FT and highlights directions for future research, including the potential of FTDI as a prognostic biomarker.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 382-392"},"PeriodicalIF":5.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008437","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 : 2025-09-04DOI: 10.1016/j.survophthal.2025.09.002
Weichen Song , Wen Chen , Jingyi Chi , Xinyu Liu , Wenwen Zhu
Lipid metabolism plays a critical role in maintaining normal physiological functions and is strongly linked to the pathogenesis of ocular vascular diseases. We examine how disorders of lipid metabolism drive progression in ocular vascular diseases, including diabetic retinopathy, age-related macular degeneration, retinal vascular occlusive diseases, and retinopathy of prematurity. These disorders are classified as a related group due to their common feature of impaired ocular vascularization. Glaucoma has also been increasingly recognized as a condition resulting from both retinal and choroidal blood flow abnormalities, with shared lipid metabolism disturbances contributing to its pathogenesis. Lipid components such as fatty acids may exacerbate retinal and choroidal damage by promoting neovascularization and inflammatory responses. Additionally, lipid metabolic dysregulation negatively influences the retinal and choroidal microenvironment by increasing oxidative stress and inhibiting autophagy. We also discuss emerging therapeutic strategies targeting lipid metabolism, highlighting their potential in preventing or mitigating ocular vascular diseases. These include lipid-modulating agents and their use in combination with established therapies. Understanding the influence of lipid metabolism on the pathophysiology of these diseases could pave the way for the development of novel treatment approaches. These advancements hold potential to improve visual prognosis in patients with ocular vascular diseases. Identifying the specific roles and molecular targets associated with lipid metabolism in ocular vascular diseases will offer valuable insights into disease mechanisms. This knowledge will lay the groundwork for personalized and more effective clinical interventions.
{"title":"The role of lipid metabolism disorder in the progression and treatment of ocular vascular diseases","authors":"Weichen Song , Wen Chen , Jingyi Chi , Xinyu Liu , Wenwen Zhu","doi":"10.1016/j.survophthal.2025.09.002","DOIUrl":"10.1016/j.survophthal.2025.09.002","url":null,"abstract":"<div><div>Lipid metabolism plays a critical role in maintaining normal physiological functions and is strongly linked to the pathogenesis of ocular vascular diseases. We examine how disorders of lipid metabolism drive progression in ocular vascular diseases, including diabetic retinopathy, age-related macular degeneration, retinal vascular occlusive diseases, and retinopathy of prematurity. These disorders are classified as a related group due to their common feature of impaired ocular vascularization. Glaucoma has also been increasingly recognized as a condition resulting from both retinal and choroidal blood flow abnormalities, with shared lipid metabolism disturbances contributing to its pathogenesis. Lipid components such as fatty acids may exacerbate retinal and choroidal damage by promoting neovascularization and inflammatory responses. Additionally, lipid metabolic dysregulation negatively influences the retinal and choroidal microenvironment by increasing oxidative stress and inhibiting autophagy. We also discuss emerging therapeutic strategies targeting lipid metabolism, highlighting their potential in preventing or mitigating ocular vascular diseases. These include lipid-modulating agents and their use in combination with established therapies. Understanding the influence of lipid metabolism on the pathophysiology of these diseases could pave the way for the development of novel treatment approaches. These advancements hold potential to improve visual prognosis in patients with ocular vascular diseases. Identifying the specific roles and molecular targets associated with lipid metabolism in ocular vascular diseases will offer valuable insights into disease mechanisms. This knowledge will lay the groundwork for personalized and more effective clinical interventions.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 1-13"},"PeriodicalIF":5.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008409","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 : 2025-09-04DOI: 10.1016/j.survophthal.2025.08.016
Amin Hatamnejad MD , Keean Nanji MD , Justin Grad MD (c) , Abdullah El-Sayes MD (c) , Andrew Mihalache MD (c) , Mohamed Gemae MD(c) , Ryan Huang MD (c) , Nadia K. Waheed MD MPH , David Sarraf MD , SrinVas R. Sadda MD , Tien Yin Wong MBBS, MPH, M Med (Ophth), PhD , Dena Zeraatkar PhD , Jinhiu Ma PhD , Sunir J. Garg MD , Marion R. Munk MD, PhD , Enrico Borrelli MD, PhD, FEBO , David H. Steel MBBS, MD, FRCOphth , Sobha Sivaprasad MBBS, DM, FRCS, FRCOphth , Charles C. Wykoff MD, PhD , Varun Chaudhary MD FRCSC
This systematic review examines the prognostic value of baseline optical coherence tomography (OCT) biomarkers in predicting visual acuity (VA) outcomes for eyes with macular edema secondary to retinal vein occlusions (RVO) treated with anti-VEGF therapies, steroids, laser photocoagulation, or combination treatments. VA predictions at 6, 12, and 24 months post-treatment were assessed using a narrative synthesis approach and vote counting based on effect direction relative to a minimal clinically important difference. Certainty of evidence was evaluated using GRADE guidelines. Confounding factors, biomarker variability, and inconsistent outcome measurements were critically analyzed.
A total of 116 studies assessing 31 unique OCT biomarkers were included. 'Low' certainty evidence indicated that an intact external limiting membrane (ELM) at baseline predicted better VA at 6 months, while baseline ellipsoid zone (EZ) integrity predicted better VA at 12 months at 5-letter change, however, these associations were not observed at thresholds of 10 and 15 letters. Certainty of evidence was often downgraded due to confounding factors, variability in biomarker definitions, and inconsistent outcomes. These findings highlight OCT biomarkers' potential for prognostication in RVO patients, but underscore the need for standardized definitions and further research to address confounders, improving the reliability and clinical utility of OCT-based biomarkers.
{"title":"Predicting treatment response in retinal vein occlusions using baseline optical coherence tomography biomarkers: A systematic review","authors":"Amin Hatamnejad MD , Keean Nanji MD , Justin Grad MD (c) , Abdullah El-Sayes MD (c) , Andrew Mihalache MD (c) , Mohamed Gemae MD(c) , Ryan Huang MD (c) , Nadia K. Waheed MD MPH , David Sarraf MD , SrinVas R. Sadda MD , Tien Yin Wong MBBS, MPH, M Med (Ophth), PhD , Dena Zeraatkar PhD , Jinhiu Ma PhD , Sunir J. Garg MD , Marion R. Munk MD, PhD , Enrico Borrelli MD, PhD, FEBO , David H. Steel MBBS, MD, FRCOphth , Sobha Sivaprasad MBBS, DM, FRCS, FRCOphth , Charles C. Wykoff MD, PhD , Varun Chaudhary MD FRCSC","doi":"10.1016/j.survophthal.2025.08.016","DOIUrl":"10.1016/j.survophthal.2025.08.016","url":null,"abstract":"<div><div>This systematic review examines the prognostic value of baseline optical coherence tomography (OCT) biomarkers in predicting visual acuity (VA) outcomes for eyes with macular edema secondary to retinal vein occlusions (RVO) treated with anti-VEGF therapies, steroids, laser photocoagulation, or combination treatments. VA predictions at 6, 12, and 24 months post-treatment were assessed using a narrative synthesis approach and vote counting based on effect direction relative to a minimal clinically important difference. Certainty of evidence was evaluated using GRADE guidelines. Confounding factors, biomarker variability, and inconsistent outcome measurements were critically analyzed.</div><div>A total of 116 studies assessing 31 unique OCT biomarkers were included. 'Low' certainty evidence indicated that an intact external limiting membrane (ELM) at baseline predicted better VA at 6 months, while baseline ellipsoid zone (EZ) integrity predicted better VA at 12 months at 5-letter change, however, these associations were not observed at thresholds of 10 and 15 letters. Certainty of evidence was often downgraded due to confounding factors, variability in biomarker definitions, and inconsistent outcomes. These findings highlight OCT biomarkers' potential for prognostication in RVO patients, but underscore the need for standardized definitions and further research to address confounders, improving the reliability and clinical utility of OCT-based biomarkers.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 100-118"},"PeriodicalIF":5.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008494","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}
Fluorescein angiography (FA) has long been a cornerstone for evaluating retinal vascular leakage in diseases like uveitis, diabetic retinopathy, and macular degeneration, but its interpretation relies on subjective grading that can vary between clinicians. With the emergence of artificial intelligence (AI), there is a push to transform this qualitative assessment into objective, quantifiable metrics. We conducted a comprehensive literature search using PubMed, Embase, and Scopus, combining keywords and MeSH terms related to fluorescein angiography leakage, artificial intelligence, and retinal vascular diseases. Studies were included if they assessed FA leakage using manual, semi-automated, or AI-based methods and were peer-reviewed, published in English, and focused on human subjects. Our review charts the evolution from manual grading to modern machine learning techniques that segment and measure leakage using various angiograms. These AI-based approaches enable standardized, reproducible leakage indices that correlate with disease severity, inform treatment decisions, stratify high-risk patients, and facilitate sensitive monitoring of therapeutic response. We also introduce the concept of “minimal residual disease” in this context. By moving from coarse, subjective estimations to precise digital biomarkers, AI-driven FA leakage quantification promises to improve clinical care and research endpoints in retinal disease.
{"title":"Detection and quantification of fluorescein angiography leakage: From manual grading to advances in machine learning","authors":"Uday Pratap Singh Parmar M.B.B.S , Atul Arora M.S , Aniruddha Agarwal M.S , Sapna Gangaputra M.D , Rupesh Agrawal F.R.C.S , Vishali Gupta M.S.","doi":"10.1016/j.survophthal.2025.08.015","DOIUrl":"10.1016/j.survophthal.2025.08.015","url":null,"abstract":"<div><div>Fluorescein angiography (FA) has long been a cornerstone for evaluating retinal vascular leakage in diseases like uveitis, diabetic retinopathy, and macular degeneration, but its interpretation relies on subjective grading that can vary between clinicians. With the emergence of artificial intelligence (AI), there is a push to transform this qualitative assessment into objective, quantifiable metrics. We conducted a comprehensive literature search using PubMed, Embase, and Scopus, combining keywords and MeSH terms related to fluorescein angiography leakage, artificial intelligence, and retinal vascular diseases. Studies were included if they assessed FA leakage using manual, semi-automated, or AI-based methods and were peer-reviewed, published in English, and focused on human subjects. Our review charts the evolution from manual grading to modern machine learning techniques that segment and measure leakage using various angiograms. These AI-based approaches enable standardized, reproducible leakage indices that correlate with disease severity, inform treatment decisions, stratify high-risk patients, and facilitate sensitive monitoring of therapeutic response. We also introduce the concept of “minimal residual disease” in this context. By moving from coarse, subjective estimations to precise digital biomarkers, AI-driven FA leakage quantification promises to improve clinical care and research endpoints in retinal disease.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 613-626"},"PeriodicalIF":5.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993309","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 : 2025-08-28DOI: 10.1016/j.survophthal.2025.08.017
Nicholas George Giannopoulos MD , Carmelo Zak Macri MBBS MPhil , Isuri Apsara Kumari Seneviratne , Stephen Bacchi MBBS PhD , Michelle Tian Sun MBBS PhD FRANZCO , Weng Onn Chan MBBS MPhil FRANZCO
Intravitreal injections (IVI) are a common, effective therapy for multiple retinal diseases although can be associated with significant psychological effects that reduce adherence to treatment. We reviewed the psychological impacts of IVI to characterise their causes, consequences, and solutions. We searched the electronic databases PubMed, OVID Medline, OVID Embase, Google Scholar and Cochrane Reviews and retrieved 1252 peer-reviewed articles. Thirty-four articles were ultimately included and analysed. The majority of retrieved articles pertained to anxiety; however, other impacts were also identified with limited available evidence regarding depression. Pre-procedural anxiety was generally mild to moderate and reported in 17.3–85 % of patients undergoing IVI. Key contributing factors to anxiety included a lack of patient education, pain and discomfort during the procedure, and travel and waiting times. Potential strategies to reduce anxiety included person-centred education, alternatives to speculum use, reducing clinic wait times, and music or handholding during the procedure. Patients experience significant anxiety from IVI, owing to multiple factors, including lack of education about the procedure, lack of procedural familiarity, and pain, which require a patient-centred approach to addressing that considers individual needs and preferences. Little data pertain to non-anxiety effects of IVI, and thus further research may identify additional barriers to adherence and their solutions.
{"title":"A narrative review of the psychological impact of intravitreal injections","authors":"Nicholas George Giannopoulos MD , Carmelo Zak Macri MBBS MPhil , Isuri Apsara Kumari Seneviratne , Stephen Bacchi MBBS PhD , Michelle Tian Sun MBBS PhD FRANZCO , Weng Onn Chan MBBS MPhil FRANZCO","doi":"10.1016/j.survophthal.2025.08.017","DOIUrl":"10.1016/j.survophthal.2025.08.017","url":null,"abstract":"<div><div>Intravitreal injections (IVI) are a common, effective therapy for multiple retinal diseases although can be associated with significant psychological effects that reduce adherence to treatment. We reviewed the psychological impacts of IVI to characterise their causes, consequences, and solutions. We searched the electronic databases PubMed, OVID Medline, OVID Embase, Google Scholar and Cochrane Reviews and retrieved 1252 peer-reviewed articles. Thirty-four articles were ultimately included and analysed. The majority of retrieved articles pertained to anxiety; however, other impacts were also identified with limited available evidence regarding depression. Pre-procedural anxiety was generally mild to moderate and reported in 17.3–85 % of patients undergoing IVI. Key contributing factors to anxiety included a lack of patient education, pain and discomfort during the procedure, and travel and waiting times. Potential strategies to reduce anxiety included person-centred education, alternatives to speculum use, reducing clinic wait times, and music or handholding during the procedure. Patients experience significant anxiety from IVI, owing to multiple factors, including lack of education about the procedure, lack of procedural familiarity, and pain, which require a patient-centred approach to addressing that considers individual needs and preferences. Little data pertain to non-anxiety effects of IVI, and thus further research may identify additional barriers to adherence and their solutions.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 179-188"},"PeriodicalIF":5.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969816","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 : 2025-08-27DOI: 10.1016/j.survophthal.2025.08.014
Alan Huang BA , Annie Zhang BA , Daniel Lee BS , Gui-shuang Ying PhD
Purpose
Dry eye disease (DED) is one of the most prevalent ophthalmic conditions. Placebo or vehicle administration is frequently used in DED trials, yet its effects remain poorly characterized. This study evaluates the presence, magnitude, and factors associated with DED vehicle or placebo effects to inform future trial design.Eligible vehicle- or placebo-controlled dry eye trials were identified using PubMed. Three authors independently extracted trial characteristics and outcome measures, including Schirmer test, tear breakup time (TBUT), conjunctival and corneal staining, and Ocular Surface Disease Index (OSDI). Random-effect models and meta-regression were used to evaluate placebo/vehicle effects and predictors. Forty-nine trials with 3529 participants in placebo/vehicle groups were included. Meta-analyses revealed significant placebo/vehicle effects on DED symptoms measured by OSDI (mean difference: −8.44; 95 % CI: −11.56 to −5.33, p < 0.01) and on signs including TBUT (0.50; 95 % CI: 0.13–0.87, p = 0.01), corneal staining (-0.55; 95 % CI: −0.90 to −0.20, p < 0.01), and conjunctival staining (-0.46; 95 % CI: −0.91 to −0.02, p = 0.04). Meta-regression revealed that a higher percentage of female participants and worse baseline OSDI scores were associated with a greater vehicle or placebo responses for OSDI (p = 0.04 and p = 0.001, respectively). No predictors were found for placebo/vehicle effects on DED signs. Placebo/vehicle effects in DED trials are substantial and should be considered in trial design. Female sex and worse baseline symptoms were associated with larger effects on OSDI. Future studies should explore mechanisms underlying these effects and approaches to mitigate their impact in DED trials.
{"title":"Placebo or vehicle effects on dry eye signs and symptoms in randomized controlled trials: A systematic review and meta-analysis","authors":"Alan Huang BA , Annie Zhang BA , Daniel Lee BS , Gui-shuang Ying PhD","doi":"10.1016/j.survophthal.2025.08.014","DOIUrl":"10.1016/j.survophthal.2025.08.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Dry eye disease (DED) is one of the most prevalent ophthalmic conditions. Placebo or vehicle administration is frequently used in DED trials, yet its effects remain poorly characterized. This study evaluates the presence, magnitude, and factors associated with DED vehicle or placebo effects to inform future trial design.Eligible vehicle- or placebo-controlled dry eye trials were identified using PubMed. Three authors independently extracted trial characteristics and outcome measures, including Schirmer test, tear breakup time (TBUT), conjunctival and corneal staining, and Ocular Surface Disease Index (OSDI). Random-effect models and meta-regression were used to evaluate placebo/vehicle effects and predictors. Forty-nine trials with 3529 participants in placebo/vehicle groups were included. Meta-analyses revealed significant placebo/vehicle effects on DED symptoms measured by OSDI (mean difference: −8.44; 95 % CI: −11.56 to −5.33, p < 0.01) and on signs including TBUT (0.50; 95 % CI: 0.13–0.87, p = 0.01), corneal staining (-0.55; 95 % CI: −0.90 to −0.20, p < 0.01), and conjunctival staining (-0.46; 95 % CI: −0.91 to −0.02, p = 0.04). Meta-regression revealed that a higher percentage of female participants and worse baseline OSDI scores were associated with a greater vehicle or placebo responses for OSDI (p = 0.04 and p = 0.001, respectively). No predictors were found for placebo/vehicle effects on DED signs. Placebo/vehicle effects in DED trials are substantial and should be considered in trial design. Female sex and worse baseline symptoms were associated with larger effects on OSDI. Future studies should explore mechanisms underlying these effects and approaches to mitigate their impact in DED trials.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 207-214"},"PeriodicalIF":5.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969769","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 term pachychoroid, derived from the Greek word pachy meaning “thick,” refers to a choroidal phenotype characterized by increased choroidal thickness, dilated outer choroidal vessels (pachyvessels), and attenuation of the overlying Sattler layer and choriocapillaris. Initially recognized in central serous chorioretinopathy, this phenotype is now acknowledged as the underlying pathophysiological basis for a broader spectrum of retinal disorders, including pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, pachydrusen and pachychoroid geographic atrophy. Collectively referred to as the pachychoroid disease spectrum, these entities share common features such as structural choroidal remodeling, choroidal vascular hyperpermeability, and outer retinal or retinal pigment epithelial changes. The introduction of enhanced depth imaging and swept-source optical coherence tomography (OCT), OCT angiography, and ultra-widefield indocyanine green angiography has significantly expanded the understanding of choroidal anatomy and function, leading to the identification of additional features such as vortex vein abnormalities, intervortex venous anastomoses, and localized choroidal hypoperfusion. These insights have prompted a reevaluation of disease classification. Moreover, pachychoroid-driven neovascularization demonstrates distinct therapeutic behaviour, including variable responses to anti-vascular endothelial growth factor agents and potential benefit from photodynamic therapy. We explore current controversies related to the etiopathogenesis, disease classification, and treatment of pachychoroid disorders, emphasize the importance of multimodal imaging in accurate diagnosis, and propose a clinically relevant algorithm to help ophthalmologists identify and manage true pachychoroid spectrum disorders effectively.
{"title":"Controversies and conundrums in pachychoroid spectrum disorders: A structured diagnostic approach","authors":"Ramesh Venkatesh , Vishma Prabhu , Pratibha Hande , Karishma Tendulkar , Shruthi Vidyasagar , Rupal Kathare , Nikitha Gurram Reddy , Naresh Kumar Yadav , Alisha Sirsikar , Preksha Biradar , Rupak Roy , Chaitra Jayadev , Soema Tehbla , Priyanka Gandhi , Jay Chhablani","doi":"10.1016/j.survophthal.2025.08.013","DOIUrl":"10.1016/j.survophthal.2025.08.013","url":null,"abstract":"<div><div>The term <em>pachychoroid</em>, derived from the Greek word <em>pachy</em> meaning “thick,” refers to a choroidal phenotype characterized by increased choroidal thickness, dilated outer choroidal vessels (pachyvessels), and attenuation of the overlying Sattler layer and choriocapillaris. Initially recognized in central serous chorioretinopathy, this phenotype is now acknowledged as the underlying pathophysiological basis for a broader spectrum of retinal disorders, including pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, polypoidal choroidal vasculopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, pachydrusen and pachychoroid geographic atrophy. Collectively referred to as the pachychoroid disease spectrum, these entities share common features such as structural choroidal remodeling, choroidal vascular hyperpermeability, and outer retinal or retinal pigment epithelial changes. The introduction of enhanced depth imaging and swept-source optical coherence tomography (OCT), OCT angiography, and ultra-widefield indocyanine green angiography has significantly expanded the understanding of choroidal anatomy and function, leading to the identification of additional features such as vortex vein abnormalities, intervortex venous anastomoses, and localized choroidal hypoperfusion. These insights have prompted a reevaluation of disease classification. Moreover, pachychoroid-driven neovascularization demonstrates distinct therapeutic behaviour, including variable responses to anti-vascular endothelial growth factor agents and potential benefit from photodynamic therapy. We explore current controversies related to the etiopathogenesis, disease classification, and treatment of pachychoroid disorders, emphasize the importance of multimodal imaging in accurate diagnosis, and propose a clinically relevant algorithm to help ophthalmologists identify and manage true pachychoroid spectrum disorders effectively.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 25-34"},"PeriodicalIF":5.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969778","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}
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