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}
Pub Date : 2025-08-20DOI: 10.1016/j.survophthal.2025.08.012
Mehrdad Mozafar , Sepehr Fekrazad , Mobina Amanollahi , Reza Samiee , Melika Jameie , Elias Khalili Pour , J. Fernando Arevalo
Thyroid eye disease (TED) is defined as a common ocular manifestation of graves’ disease, which affects the dynamics of the retinal vessels by various autoimmune and mechanical ways. Herein, we evaluate the retinal microvascular alterations in TED subjects using optical coherence tomography angiography (OCTA). PubMed, Scopus and Web of Sciences were systematically searched for relevant studies assessing OCTA measurements in TED patients and healthy controls. Meta-analysis was conducted on OCTA parameters with at least two studies using the same OCTA device. Fifteen related studies assessed the total of 771 TED eyes (13 studies evaluating inactive TED and 10 with active TED). Patients with active TED exhibited significantly reduced vessel density (VD) in both the superficial and deep capillary plexuses compared to inactive TED and healthy controls, particularly in whole image analyses and parafoveal region. Additionally, the foveal avascular zone was significantly enlarged in active TED relative to inactive TED and HCs. Radial peripapillary capillary VD was reduced in active TED compared to the inactive stage. These highlights the potential of OCTA as a valuable noninvasive tool for TED’s diagnosis assistance and disease progression monitoring. Future research should aim to assess retinal VDs in larger and more diverse samples, considering disease activity, to achieve more conclusive results.
甲状腺眼病（TED）是graves病的一种常见的眼部表现，它通过各种自身免疫和机械方式影响视网膜血管的动力学。在此，我们使用光学相干断层扫描血管造影（OCTA）评估TED受试者的视网膜微血管改变。我们系统地检索PubMed、Scopus和Web of Sciences以评估TED患者和健康对照者OCTA测量的相关研究。对使用相同OCTA装置的至少两项研究的OCTA参数进行meta分析。15项相关研究评估了总共771只TED眼睛（13项研究评估了不活跃的TED， 10项研究评估了活跃的TED）。与不活跃的TED和健康对照组相比，活跃的TED患者在浅毛细血管丛和深毛细血管丛中表现出明显的血管密度（VD）降低，特别是在全图像分析和中央凹旁区域。此外，与非活动TED和hcc相比，活动TED的中央凹无血管区明显增大。活动期TED与非活动期相比，桡动脉乳头周围毛细血管VD减少。这些突出了OCTA作为TED诊断辅助和疾病进展监测的有价值的非侵入性工具的潜力。未来的研究应着眼于在更大、更多样化的样本中评估视网膜VDs，并考虑疾病的活动性，以获得更确凿的结果。
{"title":"Optical coherence tomography angiography measurements in thyroid eye disease: A systematic review and meta-analysis","authors":"Mehrdad Mozafar , Sepehr Fekrazad , Mobina Amanollahi , Reza Samiee , Melika Jameie , Elias Khalili Pour , J. Fernando Arevalo","doi":"10.1016/j.survophthal.2025.08.012","DOIUrl":"10.1016/j.survophthal.2025.08.012","url":null,"abstract":"<div><div>Thyroid eye disease (TED) is defined as a common ocular manifestation of graves’ disease, which affects the dynamics of the retinal vessels by various autoimmune and mechanical ways. Herein, we evaluate the retinal microvascular alterations in TED subjects using optical coherence tomography angiography (OCTA). PubMed, Scopus and Web of Sciences were systematically searched for relevant studies assessing OCTA measurements in TED patients and healthy controls. Meta-analysis was conducted on OCTA parameters with at least two studies using the same OCTA device. Fifteen related studies assessed the total of 771 TED eyes (13 studies evaluating inactive TED and 10 with active TED). Patients with active TED exhibited significantly reduced vessel density (VD) in both the superficial and deep capillary plexuses compared to inactive TED and healthy controls, particularly in whole image analyses and parafoveal region. Additionally, the foveal avascular zone was significantly enlarged in active TED relative to inactive TED and HCs. Radial peripapillary capillary VD was reduced in active TED compared to the inactive stage. These highlights the potential of OCTA as a valuable noninvasive tool for TED’s diagnosis assistance and disease progression monitoring. Future research should aim to assess retinal VDs in larger and more diverse samples, considering disease activity, to achieve more conclusive results.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 131-141"},"PeriodicalIF":5.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969834","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 : 2025-08-20DOI: 10.1016/j.survophthal.2025.08.003
Alexander G. Maloof MD, BMed, MSc(Hons I), Dr , Shane Zhang BMedSci MD, Dr , Nicholas V. Pavic MD, Dr , Minas T. Coroneo MD, MS, MSc, FRACS, FRANZCO, Professor
The Miyake-Apple technique for retrolenticular video analysis has proven itself to be a valued tool in research and education for anterior segment surgery, intraocular lens (IOL) design, implantation techniques and evaluating surgical complications. Such a knowledge base could also be incorporated into surgical simulators which are generally more readily available to training ophthalmologists. We identified 139 papers in the initial search. After screening 100 papers, 94 were included in the review. In all 94 studies, the employment of the Miyake-Apple technique for visualization was used for post-mortem eye analysis, yielding information about its role in (1) teaching and training, (2), understanding the effects of IOL implantation, (3), visualizing the impacts of experimental surgical techniques on the eye, and (4), its modern technical advancements to facilitate Miyake-Apple views with lower-resource endoscopic equipment. Our findings support the conclusion that the Miyake-Apple system can play an imperative role in the training and testing of ophthalmic surgeons, devices and surgical techniques. This technology has the potential to aid in the development of newer IOL explantation and replacement techniques as well as IOL fixation techniques. With advancing technology and innovative endoscopic posterior viewing techniques, barriers have lowered for adopting the Miyake-Apple system in ophthalmic surgical training globally.
{"title":"‘Seeing both sides’: A systematic review of the Miyake-Apple video system’s role in ophthalmology","authors":"Alexander G. Maloof MD, BMed, MSc(Hons I), Dr , Shane Zhang BMedSci MD, Dr , Nicholas V. Pavic MD, Dr , Minas T. Coroneo MD, MS, MSc, FRACS, FRANZCO, Professor","doi":"10.1016/j.survophthal.2025.08.003","DOIUrl":"10.1016/j.survophthal.2025.08.003","url":null,"abstract":"<div><div>The Miyake-Apple technique for retrolenticular video analysis has proven itself to be a valued tool in research and education for anterior segment surgery, intraocular lens (IOL) design, implantation techniques and evaluating surgical complications. Such a knowledge base could also be incorporated into surgical simulators which are generally more readily available to training ophthalmologists. We identified 139 papers in the initial search. After screening 100 papers, 94 were included in the review. In all 94 studies, the employment of the Miyake-Apple technique for visualization was used for post-mortem eye analysis, yielding information about its role in (1) teaching and training, (2), understanding the effects of IOL implantation, (3), visualizing the impacts of experimental surgical techniques on the eye, and (4), its modern technical advancements to facilitate Miyake-Apple views with lower-resource endoscopic equipment. Our findings support the conclusion that the Miyake-Apple system can play an imperative role in the training and testing of ophthalmic surgeons, devices and surgical techniques. This technology has the potential to aid in the development of newer IOL explantation and replacement techniques as well as IOL fixation techniques. With advancing technology and innovative endoscopic posterior viewing techniques, barriers have lowered for adopting the Miyake-Apple system in ophthalmic surgical training globally.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 2","pages":"Pages 685-699"},"PeriodicalIF":5.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969824","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 : 2025-08-19DOI: 10.1016/j.survophthal.2025.08.010
Yuchen Qian , Xiren Lin , Yiran Wang , Yumei Mao , Ting Zou , Li Zhang
Retinal diseases represent a group of vision-threatening disorders with a complex pathogenesis that involves interactions among various cellular and molecular factors. Inflammation and immune cells play a pivotal role in the initiation, progression, and repair of retinal diseases. Recently, advancements in optical coherence tomography angiography (OCTA) technology have enabled the in vivo detection of macrophage-like cells (MLCs) at the vitreoretinal interface and allowed for assessment of retinal inflammation, representing a landmark advancement for understanding the pathophysiology of retinal diseases, particularly regarding the role of MLCs. We review the role of MLCs at the vitreoretinal interface and discuss recent advances in OCTA technology for detecting MLCs across various retinal diseases, thus demonstrating new advances in inflammatory biomarkers for retinal diseases.
{"title":"In vivo detection of macrophage-like cells at the vitreoretinal interface in retinal diseases using optical coherence tomography angiography","authors":"Yuchen Qian , Xiren Lin , Yiran Wang , Yumei Mao , Ting Zou , Li Zhang","doi":"10.1016/j.survophthal.2025.08.010","DOIUrl":"10.1016/j.survophthal.2025.08.010","url":null,"abstract":"<div><div>Retinal diseases represent a group of vision-threatening disorders with a complex pathogenesis that involves interactions among various cellular and molecular factors. Inflammation and immune cells play a pivotal role in the initiation, progression, and repair of retinal diseases. Recently, advancements in optical coherence tomography angiography (OCTA) technology have enabled the <em>in vivo</em> detection of macrophage-like cells (MLCs) at the vitreoretinal interface and allowed for assessment of retinal inflammation, representing a landmark advancement for understanding the pathophysiology of retinal diseases, particularly regarding the role of MLCs. We review the role of MLCs at the vitreoretinal interface and discuss recent advances in OCTA technology for detecting MLCs across various retinal diseases, thus demonstrating new advances in inflammatory biomarkers for retinal diseases.</div></div>","PeriodicalId":22102,"journal":{"name":"Survey of ophthalmology","volume":"71 1","pages":"Pages 89-99"},"PeriodicalIF":5.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969839","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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