Acta Ophthalmologica最新文献

The Consortium for Refractive Error and Myopia (CREAM) was established in 2011, bringing together an international team of researchers studying more than 30 cohorts. Since its establishment, CREAM has played a pivotal role in research investigating the genetics of myopia and other refractive errors, serving as a key driver of progress in the field. The aim of this review is to highlight the latest advances and insights from CREAM, with a focus on research carried out in the past 5 years. We performed a literature review of journal articles authored by the CREAM consortium since the year 2020, when the last review of CREAM consortium findings was published. Key discoveries from recent CREAM studies were the identification of SIX6, CRX, PER3, PDCD6IP, MAPT, CHST6, GRHL2, USH2A, P4HTM, COL4A4 and ATM as high-confidence candidate genes associated with myopia development. Variants in enhancers and lncRNA regions were shown to have potential regulatory effects on refractive error; the DDIT4 gene was highlighted as a potential hotspot for future analyses. A polygenic risk score for predicting high myopia with an area under the curve (AUC) accuracy of 0.78 was made openly available; prediction accuracy was close to that required for clinical use. A shared genetic architecture for refractive error and axial length was confirmed. Novel findings were the identification of rare, large-effect gene variants through targeted and whole exome sequencing and the development of a polygenic risk score for predicting children at risk of developing high myopia. Large-scale multi-ancestry genome-wide association studies of the myopia endophenotypes axial length and corneal curvature doubled the number of common genetic variants known to be associated with these traits. Nevertheless, much remains to be done to fulfil the promise of myopia genetics research for improving the detection of children at above-average risk of high myopia, and the prevention and treatment of myopia.

Purpose: To assess whether atrial fibrillation (AF) is associated with an increased risk of age-related macular degeneration (AMD).

Methods: This multinational retrospective cohort study included individuals aged 50 years or older, with or without AF at baseline, from healthcare organisations across 21 countries during 2015-2020 in the TriNetX database. Participants were classified into those with and without AF, and followed for up to 5 years to observe the occurrence of AMD, including both dry and wet forms, and other cerebrovascular outcomes. The AF and non-AF groups were 1:1 propensity score-matched to balance baseline characteristics and comorbidities. Outcomes were assessed using Cox regression models and Kaplan-Meier analysis.

Results: A total of 113 974 individuals were included in the final analysis. The mean follow-up (standard deviation [SD]) is 4.09 (1.30) years in the AF group and 4.53 (0.95) years in the non-AF group. During follow-up, 1169 individuals developed AMD, 527 developed dry AMD, and 242 developed wet AMD. Compared to individuals without AF, those with AF have a significantly higher risk of developing AMD (hazard ratio [HR], 2.72; 95% confidence interval [CI], 2.42-3.11), dry AMD (HR, 2.55; 95% CI, 2.12-3.07), wet AMD (HR, 2.50; 95% CI, 1.90-3.28), and ischemic stroke (HR, 1.67; 95% CI, 1.60-1.73). Across most subpopulations, AF is consistently linked to higher risks of both dry and wet AMD.

Conclusion: Individuals with AF experience a higher risk of developing both dry and wet forms of AMD compared to individuals without AF.

Purpose: To analyse pain sensation after phototherapeutic keratectomy (PTK) using chilled eye drops or drops at room temperature during the early postoperative period.

Methods: Our randomised controlled, parallel-group study conducted in the Department of Ophthalmology, Goethe-University, Frankfurt (Main), Germany, with blinded participants and outcome assessors included patients undergoing PTK. Postoperatively, eye drops in one group were chilled and in the other group at room temperature (warm). Patients completed pain questionnaires six times on the first 3 postoperative days. Pain intensity was primarily assessed by means of the numerical rating scale (NRS) at 8 a.m. on Day 1. Secondary outcomes included pain on the visual analogue scale (VAS), sensory qualities of pain, overall pain intensity, epiphora, foreign body sensation and additional need for analgesics.

Results: Fifty-one patients were analysed in the chilled group and 49 in the warm group. Median NRS and VAS on Day 1 were 2 (range: 0-8) and 13 (0-76) in the chilled group and 1 (0-8) and 4 (0-79) in the warm group, respectively (p = 0.11 and 0.10). On Day 2, values were 2 (0-7) and 14 (0-52) in the chilled group and 2 (0-10) and 19 (0-99) in the warm group (p = 0.34 and 0.82). There was no significant difference in secondary outcomes. Additional painkillers on Day 1 were required by 29% and 18%, respectively (p = 0.23).

Conclusion: Using chilled eye drops following PTK does not reduce pain compared with eye drops at room temperature in the early postoperative period.

Purpose: The purpose of this study was to assess the agreement between the European Driving Test (EDT)-a new perimetry test designed to comply with the visual field requirements for Group 1 drivers outlined in the European Commission Directive 2009/113/EC-and the manner in which these standards are applied across European countries.

Methods: This was a cross-sectional study of patients with visual field loss who underwent fitness-to-drive visual field assessments at the University Hospital Zürich between 2023 and 2025. Patients completed monocular static and kinetic perimetry, as well as binocular perimetry with the Esterman test and the EDT, all performed using an Octopus 900 perimeter. We determined pass/fail outcomes according to Swiss, Swedish, Norwegian and British criteria. We analysed inter-country agreement and diagnostic accuracy of national criteria relative to the EDT using Fleiss' kappa, sensitivity and specificity.

Results: The study enrolled 243 patients. Pass rates were 65% (Switzerland), 76% (Sweden), 74% (Norway) and 86% (UK). Inter-country agreement was moderate (Fleiss' κ = 0.56), with lower agreement in central (κ = 0.57) than peripheral (κ = 0.69) visual fields. Compared to EDT results, national standards demonstrated high specificity (0.87-1.00) but variable and low sensitivity (0.39-0.76), particularly for the central visual field.

Conclusion: The application of common visual field standards for driver licensing varies across European countries, especially concerning central visual field criteria. Our findings support adopting a uniform perimetry algorithm to ensure consistent visual field evaluation in fitness-to-drive assessments.

Purpose: To determine the long-term blindness rate and related prognostic factors in eyes with open-angle glaucoma after trabeculectomy using adjunctive mitomycin C (MMC).

Methods: The retrospective cohort study included 714 eyes from 714 patients with open angle glaucoma who underwent trabeculectomy using MMC. We defined blindness based on the World Health Organization (WHO) criteria as best-corrected visual acuity (BCVA) <20/400 and/or central visual field <10°. We used Kaplan-Meier analysis to estimate the nonblindness rate postsurgery.

Results: Preoperatively, the mean (standard deviation) BCVA, intraocular pressure (IOP) and mean deviation (MD) using the central 30-2 program of Humphrey Field Analyser were 0.11 ± 0.31, 20.5 ± 7.1 mmHg, and -16.93 ± 7.16 dB. The follow-up period was 11.7 ± 7.3 years, and the mean postoperative IOP reduction rate was 41.4% ± 20.2%. The 10- and 20-year cumulative survival rates were 87.8% and 82.6%. The survival rates were significantly higher in the groups with better preoperative BCVA, preserved preoperative MD, and higher mean postoperative IOP reduction rate (all p < 0.001). Moreover, the analysis of prognostic factors for blindness showed that the multivariate hazard ratios for preoperative BCVA, preoperative MD and mean postoperative IOP reduction rate were 4.74, 0.92 and 0.97, respectively (all p < 0.001).

Conclusions: One-eighth and one-sixth of the eyes became blind at 10 and 20 years post-trabeculectomy using MMC. Preoperative severe visual impairment and visual field loss and postoperative nonsustained IOP reduction were identified as independent prognostic factors leading to blindness.

The prechoroidal cleft is a lenticular, hypo-reflective space on optical coherence tomography imaging, located between a band of fibrovascular material underneath the retinal pigment epithelium (RPE) and Bruch's membrane. It occurs in 8%-22% of neovascular age-related macular degeneration (nAMD) eyes, most often with macular neovascularization (MNV) type 1 and 3, and less often with MNV type 2 or polypoidal choroidal vasculopathy. The presence of a prechoroidal cleft is associated with poor visual prognosis, some studies report more frequent occurrence of RPE tears and subretinal haemorrhages. Eyes with a prechoroidal cleft require more frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections to treat the nAMD and more often require a switch to other anti-VEGF medication. Clinicians should be aware of the prechoroidal cleft for diagnostic and prognostic reasons, as it may be misunderstood for other (subretinal) fluid or even a choroidal lesion.

Dong, L., Zhou, W.D., Yang, Y.H., Zhang, R.H., Zhao, H.Q., Yu, C.Y., et al. (2025) Epidermal growth factor receptor antibody and axial elongation in experimental myopia. Acta Ophthalmologica, 103(6), e411–e421. Available from: 10.1111/aos.17516

In the above-mentioned article, Figure 5 contained an incorrect image. Specifically, the representative retinal section images for the 5 μL 5 g/L PMAB and 5 μL 10 g/L PMAB groups were inadvertently taken from the same eye.

This correction does not affect the quantitative results, data interpretation or conclusions of the study. We apologize for this error.

Purpose: To evaluate longitudinal changes in choroidal thickness (CT) in highly myopic eyes and their correlation with myopic maculopathy progression and visual outcomes.

Methods: Retrospective cohort study on 1228 eyes from 781 highly myopic patients with a minimum 5-year follow-up (mean 11.5 ± 3.1 years). Myopic atrophic maculopathy (MAM) was graded according to ATN classification. Subfoveal CT was measured using spectral-domain OCT with enhanced depth imaging. Staphyloma classification followed Curtin's system.

Results: Mean subfoveal CT at baseline was 54.3 ± 32.7 μm, with decreasing values by MAM category: tessellated fundus (172.5 ± 42.6 μm), diffuse chorioretinal atrophy (63.7 ± 27.3 μm), patchy atrophy (39.2 ± 18.3 μm) and macular atrophy (7.2 ± 11.3 μm, often unmeasurable). Different thinning rates were observed: diffuse atrophy (3.1 ± 0.9 μm/year), patchy atrophy (2.1 ± 0.8 μm/year), macular atrophy (1.3 ± 0.7 μm/year) and tessellated fundus (1.2 ± 0.6 μm/year). Lowest CT values were observed in eyes with type IX staphyloma (22.4 ± 12.1 μm). Axial length ≥ 29 mm was associated with lower CT (32.4 ± 18.9 vs. 78.6 ± 36.2 μm, p < 0.001). Baseline CT <40 μm independently predicted macular atrophy development (OR 3.84, p < 0.001) and visual decline (OR 2.76, p < 0.001). Eyes with dome-shaped macula showed thicker CT at dome peak compared with peridome edges (62.3 ± 34.2 vs. 48.4 ± 22.7 μm, p = 0.002). Eyes developing myopic macular neovascularization (mMNV) had lower baseline CT (32.7 ± 17.8 vs. 58.6 ± 33.1 μm, p < 0.001).

Conclusions: The fastest choroidal thinning occurred in eyes with diffuse chorioretinal atrophy, while eyes with severely reduced baseline CT had a higher risk for macular atrophy development and visual impairment. Different staphyloma types showed variable CT patterns.