Current Opinion in Ophthalmology最新文献

Purpose of review: This review highlights new Federal Drug Administration (FDA) approved glaucoma treatments to familiarize providers with immediately available options.

Recent findings: New FDA-approved treatments include the bimatoprost implant, travoprost implant, direct selective laser trabeculoplasty (DSLT), and ocular pressure adjusting pump. The bimatoprost implant is approved for a single administration with effects lasting for about 1 year, as opposed to the nearly 3-year effect for the travoprost implant. Meanwhile, the DSLT lowers intraocular pressure (IOP) by applying a laser through the limbus within 2 s. Lastly, the ocular pressure adjusting pump is a noninvasive, nonpharmaceutical device that lowers IOP with negative pressure within a pair of goggles. Not only do these modalities lower IOP, but they also improve the patient experience by reducing drop burden, decreasing laser duration, or lowering side effects. Although the list of therapies still in development is extensive, another two promising devices under review include a supraciliary stent and an adjustable aqueous tube shunt.

Summary: Glaucoma treatment has considerably evolved over the last decade with the introduction of novel topical medications, minimally invasive glaucoma surgeries, sustained-release drug delivery systems, and wearable devices. This expansion in glaucoma has enabled more patient-centric decision-making regarding treatment.

Purpose of review: Last year marked the development of the first foundation model in ophthalmology, RETFound, setting the stage for generalizable medical artificial intelligence (GMAI) that can adapt to novel tasks. Additionally, rapid advancements in large language model (LLM) technology, including models such as GPT-4 and Gemini, have been tailored for medical specialization and evaluated on clinical scenarios with promising results. This review explores the opportunities and challenges for further advancements in these technologies.

Recent findings: RETFound outperforms traditional deep learning models in specific tasks, even when only fine-tuned on small datasets. Additionally, LMMs like Med-Gemini and Medprompt GPT-4 perform better than out-of-the-box models for ophthalmology tasks. However, there is still a significant deficiency in ophthalmology-specific multimodal models. This gap is primarily due to the substantial computational resources required to train these models and the limitations of high-quality ophthalmology datasets.

Summary: Overall, foundation models in ophthalmology present promising opportunities but face challenges, particularly the need for high-quality, standardized datasets for training and specialization. Although development has primarily focused on large language and vision models, the greatest opportunities lie in advancing large multimodal models, which can more closely mimic the capabilities of clinicians.

Purpose of review: The objective of this review article is to ascertain the global distribution of cataract surgery and evaluate the extent of its coverage in recent years.

Recent findings: The cataract surgical rate (CSR) has been reported from 36 to 12 800 (per million population) across different countries. The average cataract surgical coverage (CSC) in the majority of countries was around 50% or lower. Additionally, in many countries, the efficient CSC (eCSC) deviates from the CSC, emphasizing the importance of attention to the quality of surgical procedures. Socioeconomic status and access to health services are key determinants in the distribution of cataract surgery. This procedure is more prevalent among older individuals, with a higher incidence among men and private insurances tend to cover a larger portion of cataract surgeries. The pandemic of COVID-19 has had a detrimental effect on cataract surgery rates in numerous countries.

Summary: The rate of cataract surgery and its extent of coverage in certain countries is inadequate. The primary factor influencing the quantity and coverage of cataract surgeries is the economic status of the countries. Additionally, government support through insurance and the provision of appropriate healthcare services can contribute to an increase in cataract surgeries.

Purpose of review: Artificial tears play a critical role in the management of dry eye disease (DED), providing patient symptomatic relief and improving ocular surface health. Its clinical importance has driven pharmaceutical innovation in terms of its formula and ingredients. The following article is an overview of the artificial tear products on the market.

Recent findings: The artificial tears on the market vary in terms of their active ingredients, inactive ingredients, preservatives, and formulation. The particular chemical composition of ingredients and formulation plays a clinical role in treating ocular pathology. Conversely, certain ingredients can cause more ocular damage than other ingredients.

Summary: Upon review of the artificial tears on the market, the authors conclude that clinicians should consider the products' composition when designating a treatment for DED. Different artificial tear composition may benefit specific causes of DED such as evaporative, aqueous-deficient, glaucoma, ocular surface tumors, corneal ulcers, and viral conjunctivitis.

Purpose of review: Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management.

Recent findings: Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement.

Summary: PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.

Purpose of review: This review summarizes the evidence on the effect of intraocular lens (IOL) material on the outcomes of cataract surgery, as well as on the surgical procedure itself.

Recent findings: Differences in capsular biocompatibility between IOL materials lead to variations in capsular stability and posterior capsule opacification (PCO), while differences in uveal biocompatibility affect postoperative inflammatory response.

Summary: Refractive outcomes are affected by both incision size and the rotational stability of toric IOLs. Small incision sizes favour hydrophilic IOLs. Rotational stability of hydrophobic and hydrophilic IOLs were comparable in recent studies. Visual outcomes are affected by chromatic aberrations, dysphotopsia, lens opacifications and PCO. Hydrophilic IOLs are associated with reduced chromatic dispersion. Hydrophobic IOL opacifications are caused by sub-surface glistenings, while hydrophilic IOL opacifications are due to surface calcifications. Some surgeries, including pars plana vitrectomy and lamellar corneal transplants, were shown to increase the risk of IOL calcifications, although the mechanism is still unknown. Hydrophilic IOLs have greater ease of manipulation, greater resistance to IOL damage, and higher uveal biocompatibility. Hydrophobic IOLs show better PCO prevention than hydrophilic IOLs, and should be preferred in highly myopic eyes where Nd:YAG capsulotomy might increase the risk of retinal detachment.

Purpose of review: This review aims to discuss recent advances in intraocular lens (IOL) power calculation, including newly introduced formulas, classification updates, comparative analyses between formulas, and emerging trends in the field.

Recent findings: A significant number of modern IOL power calculation formulas have become available, incorporating both established and novel concepts such as artificial intelligence and ray tracing. A revised classification system has been introduced, reflecting the underlying principles of each formula. Recent comparative studies demonstrate the excellent refractive outcomes achievable with modern formulas. Emerging trends, such as the use of sum-of-segments axial length and the incorporation of measured posterior corneal data, hold promise for refining predictions in cases of extreme axial lengths and nonphysiological corneas, respectively. Advances in optimization and analytical methods also have the potential to further enhance refractive results.

Summary: The field of IOL power calculation is continually evolving through iterative improvements in formula design, driven by new technologies, advanced instrumentation, and innovative analytical approaches. These advancements enable excellent refractive outcomes, even in atypical eyes.

Purpose of review: This review evaluates the surgical management of glaucoma in patients undergoing cataract surgery. Combining both procedures present challenges in balancing intraocular pressure (IOP) control, minimizing postoperative complications, and achieving optimal refractive outcomes.

Recent findings: Recent studies highlight the effectiveness of combined glaucoma and cataract surgeries, with traditional filtering surgeries and MIGS showing significant IOP reduction. The abundance of long-term studies shows that MIGS can offer an effective and safer alternative when carefully tailored to meet the specific needs of each patient.

Summary: Combining glaucoma and cataract surgery is a promising approach for patients with coexisting conditions. While traditional surgeries offer robust IOP reduction, MIGS procedures offer better safety profiles with fewer complications and more predictable refractive results. Surgeons must carefully consider the timing and choice of procedures, with further research required to develop standardized treatment algorithms.

Purpose of review: To review role of artificial intelligence in medicine.

Recent findings: Artificial intelligence is continuing to revolutionize access, diagnosis, personalization of medicine, and treatment in healthcare. As a matter of fact, artificial intelligence contributed to the research that resulted in 2024 Nobel Prizes in physics, chemistry, and economics. We are only at the tip of the iceberg in utilizing the abilities of artificial intelligence in medicine to improve accuracy of diagnoses and to enhance patient outcomes. Artificial intelligence has allowed better image analysis, prediction of progression of disease, personalized treatment plans, incorporations of genomics, and improved efficiency in care and follow-up utilizing home monitoring. In ocular health diagnosis and treatment of diabetic retinopathy, macular degeneration, glaucoma, corneal infections, and ectasia are only a few examples of how the power of artificial intelligence has been harnessed. Even though there are still challenges that need more work in the areas of patient privacy, Health Insurance Portability and Accountability Act (HIPAA) compliance, reliability, and development of regulatory frameworks, artificial intelligence has revolutionized and will continue to revolutionize medicine.

Summary: Artificial intelligence is enhancing medical diagnosis and treatment, as well as access and prevention. Ocular imaging, visual outcome, optics, intraocular pressure, and data points will continue to see growth it the field of artificial intelligence.