Clinical and Experimental Ophthalmology最新文献

Background: To assess financial disclosures of American ophthalmology society board members by comparing self-reported disclosures with industry-reported payments and examining characteristics linked to larger financial relationships.

Methods: In this retrospective, cross-sectional study, we assessed all governance board members from American ophthalmology societies in December 2022. Board composition was identified from society websites, payment data from the Open Payments database, and conflict of interest (COI) policies from IRS Form 990 filings. Outcomes included concordance between self- and industry-reported disclosures, payment values, gender and subspecialty differences and academic characteristics.

Results: Among 871 board members from 66 societies, 566 (65.0%) had industry-reported relationships, yet only 22 (2.5%) disclosed COIs on society websites. In 2022, 13 187 payments totaling $57.8 million were reported, with 79.5% related to research. Most societies reported internal COI policies (77.8%) and annual disclosure requirements (75.6%) via IRS filings. Men received significantly higher median payments than women ($217.5 vs. $43.3; p < 0.001). Retina specialists accounted for the largest share of payment value (55.3%), while paediatric ophthalmologists received the least (0.4%). Board members with research payments had higher academic productivity (median h-index: 19 vs. 8; p < 0.001).

Conclusions: Public reporting of board members' financial relationships on ophthalmology society websites was uncommon, likely reflecting differences in society-level disclosure practices rather than individual nondisclosure. These findings underscore an opportunity for societies to enhance transparency by adopting more consistent, transparent COI reporting practices in ophthalmology governance.

Geographic atrophy (GA) causes significant vision impairment and reduction in vision-related quality of life. Fundus autofluorescence (FAF) is the gold standard of structural assessment of GA but is a surrogate marker for vision loss, which can be assessed by tests of visual function and functional vision. Best corrected visual acuity (BCVA), the most commonly used visual function test in ophthalmology, is a poor metric for assessing GA progression. This is because GA usually only affects the fovea in its late stage, grows slowly, and spared areas of retina may not 'fit' larger reading chart letters, confounding measurements. For this reason, tests of visual function have been developed, including low luminance visual acuity (LLVA), reading speed, contrast sensitivity, microperimetry, flicker perimetry, and dark adaptation. Functional vision measures are approximated through patient-reported outcomes using various questionnaires. This review explores the strength of association between FAF and tests of visual function in patients with GA. A range of targeted, prespecified endpoints of visual function testing should be included in future clinical trials for treatments of GA, focusing on GA lesion phenotypes that are known to progress rapidly in order to maximise the likelihood of identifying positive results. This is critical in jurisdictions where proof of functional benefit is required for regulatory approval of treatments for GA.

Background: Intraocular lens implantation in children with insufficient zonular support can be challenging. Scleral-fixated intraocular lens (SFIOL) implantation can be useful in these cases. We aim to report the visual and refractive outcomes of four-point sutured SFIOL in children.

Methods: A retrospective review of children who underwent primary or secondary four-point SFIOL using Akreos AO60 or Luxgood intraocular lens with polytetrafluoroethylene monofilament (PTFE, Gore-Tex) at Queensland Children's Hospital, Brisbane, Australia.

Results: Fifty-three eyes of 31 children were included for review. The mean age of SFIOL implantation was 7.86 ± 3.71 years. The median follow-up time was 24 months (IQR 35, range 1-77). The majority of children had subluxed crystalline lenses secondary to Marfan syndrome (44 eyes, 83.02%). Best corrected visual acuity (BCVA) was maintained or improved from the preoperative BCVA in 92.6% of eyes. Median postoperative BCVA improved to logMAR 0.2 (IQR 0.16) at 1-year follow-up (p < 0.01). Compared to target refraction, the postoperative refraction was more myopic, but this was not statistically significant. In 33 eyes that had more than 1 year of follow-up, residual refractive error was within 1.00D for 21 eyes, within 2.00D for 7 eyes, within 3.00D for 3 eyes and greater than 3.00D for 2 eyes. Retinal detachment occurred in three eyes (5.66%). Asymptomatic IOL tilt/decentration was noted in one eye (1.88%).

Conclusions: Four-point SFIOL implantation using Gore-Tex suture offered excellent visual and refractive outcomes. Postoperative complications were rare and there were no new cases of amblyopia during the follow-up period.

Background: The University of Sydney 'Microsurgical Skills Course' (MSC) was made mandatory to the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) Vocational Training Program in 2023. This study evaluates the MSC impact on first-year ophthalmology trainees' cataract surgical performance compared to those who did not complete the MSC.

Methods: This retrospective study analysed de-identified RANZCO surgical logbook data and EyeSi survey responses from first-year trainees across Australia and New Zealand. The intervention cohort (2023-2024 first-year trainees) completed the MSC, while the control cohort (2022 first-year trainees) did not. Data included demographics, prior surgical experience, number of cataract surgeries, surgical role, senior surgeon takeovers and intraoperative complications.

Results: Among 112 trainees (intervention = 77; control = 35), 11 613 cataract surgeries were recorded during the first 12 months of training. By 3 months, trainees in the intervention cohort performed more cataract surgeries (36.2 ± 22.6 vs. 26.0 ± 17.4, p = 0.017), assumed more senior roles in surgery (p < 0.001), required fewer senior surgeon takeovers (p < 0.001) and had a lower rate of posterior capsule tear (PCT) (1.3% vs. 2.9%, p < 0.001) compared to the control cohort. By 12 months, cataract surgery numbers and PCT rates (1.4% vs. 1.8%; p = 0.186) were similar; however, the intervention cohort still held a higher rate of leading surgical roles (p < 0.001) and less senior surgeon takeover (p < 0.001).

Conclusions: The MSC accelerates early surgical proficiency while improving patient safety. This resource will serve as a foundation for assessing surgical outcomes beyond cataract surgery and extending past the first 12 months of training.

Retinopathy of prematurity (ROP) remains a major cause of preventable blindness in premature infants worldwide, with increasing incidence due to advancements in neonatal care. Management of ROP has been revolutionised by anti-vascular endothelial growth factor (anti-VEGF) treatments. Pivotal clinical trials have demonstrated the efficacy of anti-VEGF in the management of Type 1 ROP, while investigation of safety and long-term effects is ongoing. However, infants with ROP often have persistent avascular retina (PAR) despite treatment and require lifelong monitoring for myopia, glaucoma, amblyopia, strabismus, significant refractive error, retinal tears and detachment and adult reactivation of ROP. Alternative therapeutics, including beta-blockers, polyunsaturated fatty acids and vitamin A, remain under investigation. Alongside therapeutic advancements, artificial intelligence (AI) and telemedicine programmes have the potential to expand screening accessibility, particularly in underserved regions, and improve inter-observer variability, though challenges in implementation remain. Together, advanced therapeutics and AI-enhanced screening hold promise for improving outcomes and reducing ROP-related blindness globally.