Translational Vision Science & Technology最新文献

Purpose: To develop a dual-level pattern tree to characterize visual field (VF) loss subtypes that can be used to better predict glaucoma progression and glaucoma polygenic risk scores (PRSs).

Methods: This study included 113,030 patients from three datasets, each used for a specific purpose: (1) model training, (2) progression forecasting, and (3) PRS correlations. We applied archetypal analysis to cluster 24-2 VFs into trunk patterns and their branch patterns. The Cox regression model was used to forecast VF progression using mean deviation (MD) slope, MD-fast slope, total deviation (TD) pointwise slope, and visual field index (VFI) slope. Multivariable regression analyses were used to link VF patterns with glaucoma PRSs. The Akaike information criterion (AIC) was used for model comparisons.

Results: We identified 17 trunk patterns and 169 branch patterns, with a mean of 9.9 ± 1.6 branches per trunk. Trunk-branch (T-B) patterns were consistently superior to trunk patterns (all contrast P < 0.05) for forecasting 5-year progression using the area under the receiver operating characteristic curve: MD, 0.60 vs. 0.58; MD-fast, 0.84 vs. 0.78; TD pointwise, 0.68 vs. 0.65; and VFI, 0.64 vs. 0.63. The trunk-branch patterns were superior in predicting PRSs (linear regression showed AIC improvement of 26).

Conclusions: Trunk-branch VF classifiers were superior to trunk-only characterizations for predicting functional progression and glaucoma PRS.

Translational relevance: High-quality clustering of patient VF characteristics may allow physicians to better manage glaucoma patients by aligning with their goal of care and provide researchers with insights into glaucoma subtypes.

Purpose: This review evaluates the epidemiology, risk factors, and effectiveness of nursing interventions for preventing ocular surface disorders in intensive care unit (ICU) patients from 2020 to 2025.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with study quality and bias assessed using standardized tools. Comprehensive searches of 6 databases from January 2020 to May 2025 identified 40 eligible studies on ocular surface disorders in ICU patients, including randomized trials, cohort studies, and meta-analyses. Due to heterogeneity, a narrative synthesis was used. Risk of bias was assessed with ROBINS-I and Cochrane tools, with subgroup analyses based on ventilation status and ICU type.

Results: The incidence of ocular surface disorders in intensive care unit patients ranged from 20% to 60%, with dry eye disease (DED) occurring in 40%, exposure keratopathy in 23%, and conjunctivitis in 25% of cases. Major risk factors included mechanical ventilation, incomplete eyelid closure, prolonged sedation, and low environmental humidity. Multimodal nursing interventions that combined eyelid closure, ocular lubrication, moisture chamber application, and staff education effectively reduced the incidence of corneal injury from 69.7% to 13.8% in high-risk patients. Passive blinking exercises demonstrated significant effectiveness and feasibility in low-resource settings.

Conclusions: Ocular surface disorders are common in ICU patients but can be effectively prevented through standardized care, eye protection, lubrication, and staff training. Incorporating eye care into daily routines improves safety and visual outcomes, whereas simple measures like passive blinking remain practical and valuable.

Purpose: To define frailty thresholds for accelerated progression of age-related ophthalmic diseases and inform precision intervention.

Methods: Using NHANES 2005-2008 (n = 7081 adults ≥ 40 years), we constructed a 49-item frailty index (FI) via the deficit accumulation model. Missing data were addressed with complete-case analysis (n = 4120) and multiple imputation. Two analytic cohorts were defined: (1) objective diagnosis group and (2) composite diagnosis group. Multivariable logistic regression with restricted cubic splines (RCS) assessed associations between the FI and age-related macular degeneration (AMD), cataract, glaucoma, and diabetic retinopathy (DR). Bidirectional Mendelian randomization (MR) tested causality.

Results: Findings were consistent across complete-case and imputed datasets. In continuous analyses, the FI was associated with AMD (composite odds ratio [OR] = 1.17; objective OR = 1.16), cataract (OR = 1.30), DR (OR = 1.33), and glaucoma (OR = 1.12). In categorical analyses, extreme frailty (FI > 0.45) conferred the highest risks: cataract (OR = 2.51), DR (OR = 2.04), AMD (OR = 1.77), and glaucoma (OR = 1.45). RCS analyses identified nonlinear thresholds at FI = 0.20 (AMD) and FI = 0.19 (cataract), whereas DR and glaucoma showed linear trends. MR supported a causal effect of frailty on four diseases, with no evidence for reverse causation.

Conclusions: Frailty was shown to accelerate ophthalmic disease progression. Three clinical implications are proposed here: (1) prioritized screening for individuals with FI > 0.45, (2) recognizing FI thresholds around 0.19 to 0.20 as potential early warning signals for accelerated AMD and cataract, and (3) integrating geriatric and ophthalmic care.

Translational relevance: This study provides actionable FI thresholds to identify high-risk aging populations and reinforces frailty as a modifiable upstream driver of ocular aging.

Purpose: Low-pass whole genome sequencing (LP-WGS), which provides genome-wide coverage ranging from ×0.5 to ×5.0, has recently emerged as a promising tool for identifying chromosomal abnormalities in clinical samples. Here, we sought to investigate the feasibility and clinical utility of LP-WGS in detecting somatic copy number alterations (SCNAs) using formalin-fixed paraffin-embedded (FFPE) tissue samples from patients with uveal melanoma (UM) in an Asian population.

Methods: A retrospective study was conducted on 11 Taiwanese patients with UM who underwent enucleation between 2007 and 2021. Four participants had undergone additional treatment modalities prior to enucleation, including proton therapy (n = 2), external-beam radiation therapy (n = 1), and gamma knife (n = 1). LP-WGS was performed on DNA extracted from FFPE tissue sections. SCNAs were analyzed in relation to clinical outcomes, and the correlation between monosomy 3 and BAP1 protein expression was investigated.

Results: LP-WGS successfully identified SCNAs in nine of 11 (81.8%) tumor specimens, including those from patients who had received treatment before enucleation. Of the two cases yielding noninformative results, one had previously undergone proton therapy. Gain of chromosome 8q, monosomy 3, and loss of chromosome 1p were detected in all five patients who ultimately died of disease. Furthermore, a potential correlation was observed between monosomy 3 and the loss of BAP1 protein expression by immunohistochemistry.

Conclusions: LP-WGS appears feasible for SCNAs detection in FFPE uveal melanoma specimens, including cases previously treated before enucleation, and holds promise to inform prognostic stratification in this rare tumor type.

Translational relevance: The successful application of LP-WGS to FFPE uveal melanoma specimens supports prospective investigations in rare cancers and may enable the development of personalized treatment strategies.

Purpose: To establish a cell origin tracing framework for aqueous humor (AH) exosomal membrane proteins and decipher their pathological implications in retinitis pigmentosa (RP).

Methods: In this prospective cohort study, comprehensive ophthalmic evaluations were conducted in 14 patients with RP with concurrent cataracts and 7 age-matched senile cataract controls. AH samples from these cohorts underwent exosomal membrane protein profiling via EVArray technology. Integrated bioinformatics analysis incorporated single-cell RNA sequencing data sets from human ocular tissues. Gene Ontology (GO) enrichment analysis with cellular trajectory mapping was performed to elucidate disease-associated pathways.

Results: Patients with RP in this cohort predominantly exhibited characteristic fundus pathology. EVArray profiling of AH exosomes revealed nine differentially expressed membrane proteins, comprising three downregulated and six upregulated proteins. Single-cell deconvolution mapped these proteins to immune (T cells, hyalocytes, monocytes/macrophages) and retinal glial cell lineages. Key findings showed (1) CTLA4 upregulation (1.7-fold, P = 0.021), reflecting T-cell checkpoint activation; (2) CSF-1R suppression (0.36-fold, P < 0.0001), suggesting immune homeostasis disruption; and (3) DKK1 downregulation (0.72-fold, P = 0.015), indicating activation of glia-derived Wnt signaling. GO analysis highlighted cytokine signaling (GO:0019221) and MAPK cascade activation (GO:0043410) as central pathways.

Conclusions: This study demonstrates that AH exosomal membrane proteins play a role in uncovering immunopathogenic cascades and glial reactivity underpinning disease progression in RP. Furthermore, AH exosomal proteins hold promise as potential biomarkers for monitoring disease activity.

Translational relevance: These findings highlight that AH exosomal proteins hold promise as potential biomarkers and propose that immunomodulation and glial protection serve as conservative strategies to delay progression in cases of genetically unresolved RP.

Purpose: To investigate the interrelationships among malnutrition, choroidal parameters, and early-stage age-related macular degeneration (AMD), particularly the reticular pseudodrusen (RPD) phenotype, and to assess the predictive value of three nutritional scores.

Methods: A total of 177 eyes were included in the study, categorized into control (n = 54), AMD (n = 55), and AMD-RPD (n = 68) groups based on fundus features. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI). Choroidal vascular index (CVI) and choroidal thickness (ChT) were measured.

Results: Nutritional scores indicated a progressive decline in nutritional status from control to AMD to AMD-RPD. Compared with the control group, both AMD and AMD-RPD individuals had significantly worse CONUT, GNRI, and PNI scores (all P ≤ 0.01). Compared with the AMD group, AMD-RPD had significantly lower GNRI and PNI scores (both P < 0.001). CVI was positively correlated with GNRI (r = 0.308, P < 0.001) and PNI (r = 0.284, P < 0.001). The predictive value of all three nutritional scores for both AMD and AMD-RPD was demonstrated, with GNRI and PNI showing utility in differentiating RPD from AMD.

Conclusions: Malnutrition is associated with early-stage AMD phenotypes and choroidal vascular abnormalities may underlie this link. GNRI and PNI may help identify high-risk RPD individuals and support early nutritional assessment and intervention.

Translational relevance: Integrating these nutritional scores may enhance collaboration between ophthalmologists and dietitians, enabling better detection and management of AMD and RPD in clinical practice.

Purpose: To develop and validate a self-reconstructed anterior segment optical coherence tomography (AS-OCT) thickness difference map to precisely quantify corneal changes, using lenticule thickness in small-incision lenticule extraction (SMILE) as a model.

Methods: This retrospective study included 22 patients (44 eyes) who underwent SMILE. Using a self-developed R software script, we reconstructed corneal and stromal thickness difference maps from 40,000-point raw AS-OCT data spanning a 10-mm central corneal diameter. The estimated lenticule thickness (ELT) was defined as the maximum thickness change and compared against planned lenticule thickness (PLT) from the VisuMax laser readout. We also compared ELTs derived from Pentacam Scheimpflug tomography at the thinnest and vertex points.

Results: At 3 months postoperatively, the ELT retrieved form reconstructed corneal thickness difference map (CTDM) and stromal thickness difference map (STDM) from AS-OCT demonstrated smaller discrepancies with PLT (4.80 ± 9.85 µm and 1.53 ± 6.59 µm, respectively) compared to discrepancies between PLT and Pentacam thinnest point lenticule thickness (PTLT) and Pentacam vertex point lenticule thickness (PVLT) (14.21 ± 13.66 µm and 12.8 ± 13.88 µm) (both P < 0.001). STDM showed much stronger correlation with PLT (R2 = 0.88) than CTDM, PTLT, and PVLT (R2 = 0.87, 0.79, and 0.79, respectively) (analysis of variance, P = 0.039).

Conclusions: The self-reconstructed AS-OCT thickness difference map accurately measures ELT after SMILE, outperforming Scheimpflug tomography in precision and reliable monitoring of corneal thickness changes.

Translational relevance: This technique enables accurate layer-specific corneal thickness monitoring, supporting safer surgical planning and enhanced assessment of postoperative or pathological corneal changes in clinical ophthalmology.

Purpose: To assess the effect of a six-month lutein ester supplementation on children's choroidal thickness (CT).

Methods: This double-blind, randomized controlled trial recruited 180 children aged eight to twelve years in a school from April to May 2021. The follow-up was completed in November 2021. Participants were randomly assigned to the treatment group (n = 90, one sachet with 8 mg lutein ester) or the control group (n = 90, one placebo sachet). Each participant consumed one sachet daily orally for six months. Primary outcomes were between-group differences in changes in CT at six-month follow-up visits.

Results: The six-month mean subfoveal CT decrease was 1.16 (-3.32 to 5.63) µm for the treatment group and -8.92 (-13.43 to -4.41) µm for the control group, with a mean difference of 10.08 µm (95% confidence interval [CI], 3.68 to 16.47, P = 0.002, corrected P = 0.018). The six-month mean temporal 1 mm and temporal 1.5 mm CTs decrease were -2.83 (-9.63 to 3.96) µm and -1.24 (-9.64 to 7.15) µm for the treatment group and -16.76 (-24.20 to -9.33) µm and -15.77 (-22.67 to -8.88) µm for the control group, with mean differences of 13.93 µm (95% CI, 3.79-24.07, P = 0.007, corrected P = 0.030) and 14.53 µm (95% CI, 3.59-25.47, P = 0.010, corrected P = 0.030), respectively. The two groups were not significantly different in the other grids (all P > 0.05).

Conclusions: Six-month lutein ester supplementation could effectively mitigate subfoveal and temporal choroidal thinning.

Translational relevance: Given lutein's favorable safety, affordability, and global availability, our study highlights its untapped potential as a promising, adjunctive nutritional strategy to support clinical efforts in myopia prevention and management.

Optoretinography is an emerging class of methods designed to probe the function of retinal neurons using noninvasive, optical techniques. Early efforts sought to identify sources of functional signal and measure responses using advanced, research-grade imaging systems. In the past few years, some investigators have demonstrated simplified methods for measuring these signals using equipment very similar to what is used in commercial, clinical systems. The goal of this review is to introduce the reader to the sources of the photoreceptor optoretinographic signal and the technologies that have been developed to measure it.