Current Opinion in Ophthalmology最新文献

Purpose of review: To provide an update on new glaucoma drainage devices and implants.

Recent findings: Glaucoma drainage implant devices are currently indicated for medically or surgically uncontrolled glaucoma, especially in eyes at high risk for trabeculectomy failure. The devices used can differ, but many offer similar long-term outcomes. Due to the differences in devices, some of the side effect profiles may differ.

Summary: Long-term outcomes show that nonvalved devices (Ahmed ClearPath, Baerveldt, Molteno, Paul Glaucoma Implant) achieve greater intraocular pressure reduction and lower medication burden than valved devices (Ahmed valved implant) but come with a higher risk of hypotony-related complications; all devices have similar overall complication rates and comparable surgical failure rates at 2-5  years. The most recent updates as of 2025 highlight that Ahmed ClearPath ST and Paul Glaucoma Implant (only available internationally) offer streamlined implantation and favorable safety profiles, and Molteno and Baerveldt continue to provide durable IOP control in refractory cases. Two more devices, Calibreye (Myra Vision) and VisiPlate (Avisi), are undergoing trials with promising initial outcomes. The Calibreye implant is showing promising short-term data, with less patients experiencing unwanted side effect of bleb needling and while offering the ability to titrate to maximize patient benefit. An upcoming device, GORE glaucoma drainage device implant is showing promises preclinical results and offer unique device material composition.

Purpose of review: The rapid integration of artificial intelligence (AI) into mainstream consumer devices has created new opportunities for accessible, low-cost support for individuals with visual impairment. This review examines emerging AI-driven tools that repurpose common hardware - such as smartphones and smart glasses - to deliver assistive functions traditionally reliant on costly, specialized devices.

Recent findings: Three representative technologies illustrate this shift: Ray-Ban × Meta smart glasses offering hands-free scene interpretation; Apple's iPhone Magnifier app with LiDAR-based Detection Mode providing spatial awareness and text recognition; and the Be My Eyes platform with its AI-powered virtual assistant enabling autonomous image interpretation. These tools emphasize affordability, discreet design, and seamless integration into daily life. Although widely adopted in real-world settings, formal clinical evaluation remains limited, with gaps in evidence regarding functional outcomes, safety, and performance across diverse environments. Online user-generated content has become a prominent source of practical guidance, often outpacing peer-reviewed research.

Summary: AI-enabled consumer devices are reshaping assistive technology by lowering financial barriers and enhancing usability. Clinicians should be aware of these rapidly evolving tools as patients increasingly adopt them independently. Rigorous studies are needed to assess their clinical impact, guide safe use, and inform integration into vision rehabilitation practice.

Purpose of review: Inherited retinal diseases (IRDs) are genetically and phenotypically heterogeneous disorders that cause progressive vision loss and lack broadly effective disease-modifying therapies. Increasing evidence implicates metabolic stress, oxidative injury, and photoreceptor-retinal pigment epithelium (RPE) dysfunction in IRD pathophysiology. This review evaluates the evidence and limitations surrounding nutritional and metabolic interventions for retinitis pigmentosa and Stargardt disease.A narrative review of preclinical studies, randomized controlled trials, and contemporary genetic re-analyses was performed. Nutritional interventions reviewed include vitamin A, vitamin E, N-acetylcysteine (NAC), omega-3 fatty acids (docosahexaenoic acid), carotenoids and apocarotenoids, and the deuterated vitamin A analog C20-D3-retinyl acetate (ALK-001).

Recent findings: Initial studies suggesting a protective effect of vitamin A in retinitis pigmentosa were not confirmed in subsequent trials or genetic re-analyses, which identified baseline differences between groups as a possible contributor to the original findings. In contrast, supplemental vitamin E may accelerate disease progression. NAC demonstrated acceptable tolerability and modest short-term improvements in visual function in early-phase trials, with a phase 3 study ongoing. Omega-3 fatty acids, carotenoids, and apocarotenoids have not shown consistent clinically meaningful benefit in retinitis pigmentosa or Stargardt disease despite strong mechanistic rationale. In Stargardt disease, ALK-001 reduces lipofuscin accumulation in animal models and clinical trials are ongoing to assess efficacy in patients.

Summary: Most nutritional supplements studied to date have not demonstrated durable or clinically meaningful benefit in IRDs. Vitamin A supplementation in retinitis pigmentosa is no longer supported by current evidence, while NAC remains a promising metabolic therapy under investigation. High-quality, genotype-informed clinical trials with clinically relevant endpoints are needed before nutritional interventions can be incorporated into IRD management guidelines.

Purpose of review: Emerging biobank resources allow large-scale integration of eye-specific phenotypes with clinical, genomic, and multiomic data. This convergence enables unprecedented opportunities to systematically dissect the genetic architecture, epidemiology, and mechanistic pathways of both rare monogenic and common polygenic diseases. The review aims to critically examine how contemporary data extraction, multiomics, and analytic methodologies are reshaping disease classification, genetic discovery, and translational research in ophthalmology, while highlighting the associated challenges in leveraging these advanced tools.

Recent findings: Recent literature demonstrates the utility of genome-wide and phenome-wide association studies, transcriptomic analyses, and artificial intelligence in uncovering novel risk loci, endophenotypes, and biomarkers relevant to eye diseases. Furthermore, advances in multiancestry sampling show substantial population-specific genetic variation, enriching disease models for conditions such as glaucoma and age-related macular degeneration. Finally. integrative approaches, including Mendelian randomization and enrichment analyses, are helping elucidate shared genetic architecture between ocular and systemic diseases, informing therapeutic target identification, and refining risk prediction models.

Summary: The convergence of biobank-derived multimodal data and sophisticated analytic techniques is catalyzing a path to personalized medicine in ophthalmology. For these approaches to fully translate into clinical practice ensuring scientifically robust and equitable outcomes, future research must address cohort diversity, mechanistic validation, and practical cost-effectiveness.

Purpose of review: This review provides an overview of possible complications of the most commonly performed refractive surgeries: laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and lens-based refractive surgery. While the vast majority of refractive surgeries are safe with successful outcomes, complications can still occur which requires surgeons to have an in-depth understanding of complication prevention and management.

Recent findings: Although overall rare, corneal laser refractive procedures and lens-based refractive surgeries are associated with a distinct set of potential complications. The most common complications from LASIK, PRK, and SMILE include flap issues, infectious keratitis, haze, dry eye disease, and corneal ectasia. Implantable collamer lenses (ICLs) come with a possible risk of intraocular pressure elevation and cataract formation. Refractive lens exchange (RLE) introduces younger patients to potential complications typically associated with cataract surgery, such as dysphotopsias, uveitis, and retinal detachment.

Summary: The elective nature of refractive surgery may raise expectations of patients for successful outcomes. This timely review provides relevant and detailed guidance to refractive surgeons on best practices to mitigate potential complications, and ultimately maximize patient safety and satisfaction.

Purpose of review: Subretinal hemorrhage (SRH) is most commonly associated with neovascular age-related macular degeneration (nAMD) and can cause profound vision loss in the macula through mechanical, toxic, and inflammatory mechanisms. Submacular hemorrhage (SMH) lacks consensus on management. This review summarizes current treatment options, key comparative studies, and ongoing challenges, with emphasis on SMH management.

Recent findings: Antivascular endothelial growth factor (anti-VEGF) therapy remains central to SMH management, with outcomes comparable to surgery in small to moderate hemorrhages. Pneumatic displacement (PD) with or without recombinant tissue plasminogen activator (rtPA) shows the greatest comparative benefit in more extensive SMH. Adjunctive rtPA improves hemorrhage displacement rates, and meta-analyses support its efficacy with anti-VEGF therapy. Pars plana vitrectomy (PPV) remains an option for large or refractory hemorrhages but has not consistently shown superior visual outcomes compared to less invasive modalities.

Summary: Early intervention is consistently associated with improved outcomes, but there is no universally accepted treatment algorithm. Ongoing randomized trials and advances in multimodal imaging have the potential to refine patient selection and treatment strategies. Future efforts should focus on balancing efficacy, safety, and cost-effectiveness to establish evidence-based guidelines for SMH management.

Purpose of review: Federal policy has long shaped the scope and inclusivity of vision research in the United States. This narrative review and opinion article evaluates the evolution of equity in vision research over time, from the landmark National Institutes of Health Revitalization Act of 1993 to the direct impact of federal policies in today's political landscape.

Recent findings: Equity in vision research originated from early epidemiologic studies identifying social and behavioral determinants of health in the 1970s. The post-2020 period accelerated attention to structural disparities in healthcare, catalyzed by the COVID-19 pandemic and a national conversation on race. However, recent executive orders have reversed equity oriented federal policies, restricted terminology and data access, and changed research funding operations. These ongoing developments pose risks to progress in all areas of research.

Summary: Equity in vision research in the United States remains vulnerable to federal priorities that serve to support or destabilize. The current political environment underscores the need for the ophthalmologic research community to safeguard data integrity, sustain diverse participation, and continue methodologically rigorous protocols to ensure continued progress toward equitable vision health.

Purpose of review: To summarize the recent literature on the clinical and surgical management of retinoschisis.

Recent findings: Novel analyses of the existing imaging modalities, including ultra wide-field imaging, near-infrared imaging, blue light reflectance, and color Doppler ultrasound, can be adjuncts to existing diagnostic tools such as ocular coherence tomography (OCT) and clinical examination to differentiate between rhegmatogenous retinal detachment (RRD) and retinoschisis.

Summary: Degenerative retinoschisis can be challenging to differentiate from a RRD through clinical examination. Although ocular coherence tomography (OCT) is the typical approach to diagnosing retinoschisis, there have been many promising diagnostic developments to better prognosticate and differentiate between similar entities. Given the difficulty in managing these cases, medical and surgical management are typically at the discretion of the treating physician.

Purpose of review: PED are corneal epithelial defects that fail to heal after 2 weeks and pose a significant therapeutic challenge. In recent years, insulin has emerged as a promising and effective therapy for promoting reepithelialization of the ocular surface, playing a role in the management of PED. The purpose of this article is to provide a summary of the role of topical insulin for persistent corneal epithelial defects (PED) management.

Recent findings: Based on current evidence, topical insulin merits an early placement within the therapeutic pathway and may be considered after conventional therapy, before the use of autologous serum. Several studies suggest that insulin eye drops can facilitate faster and more consistent epithelial healing, potentially offering greater efficacy than autologous serum in some cases. Moreover, patients who do not respond to insulin often require escalation to surgical interventions such as amniotic membrane transplantation. Overall, topical insulin appears to represent a well tolerated, cost-effective, and promising option that could serve as an intermediate step between standard medical treatments and surgical management in PED.

Summary: The evidence summarized in this review demonstrates that insulin shows considerable promise in managing PED, reinforcing the importance of further investigations to clarify its place in clinical practice. Ongoing clinical trials aim to validate the effectiveness of topical insulin for a range of ocular diseases and to benchmark its performance against other established treatment options.

Purpose of review: To summarize trends in supply and demand for vitreoretinal fellowship positions in the United States, describe applicant characteristics and match outcomes, and discuss future workforce needs and diversity in the field.

Recent findings: Fellowship applications and positions have increased, with medical and surgical retina programs accounting for the largest share of positions. Despite this growth, match rates have declined, and a persistent portion of positions remain unfilled, likely concentrated among less established or non Association of University Professors of Ophthalmology (AUPO) programs. Predictors of matching include completing more interviews and ranking more programs as well as completing residency training in the United States. Women and individuals underrepresented in medicine remain markedly underrepresented in the vitreoretinal pipeline relative to need. Interest in vitreoretinal fellowship is driven by advanced surgical exposure, perceived prestige, financial considerations, and mentorship during residency.

Summary: Aligning supply with demand will require expanding high-quality, AUPO-compliant training; improving transparency about medical versus surgical positions; and targeted mentorship/sponsorship to diversify the pipeline. Given projected growth in retinal disease, strategic recruitment and training are essential to ensure equitable access to imaging, injections, laser, and surgery.