American Journal of Ophthalmology最新文献

{"title":"A Randomized-Controlled Trial of the Efficacy, Safety and Tolerability of Intravitreal Brolucizumab in Patients With Chronic Central Serous Chorioretinopathy With Persistent Fluid in the Absence of Choroidal Neovascular Membrane—BRICS Trial Report II","authors":"Srishti Raksheeth Ramamurthy ,&nbsp;Saarang Hansraj ,&nbsp;Ragu Kumar ,&nbsp;Ritesh Narula ,&nbsp;SriniVas R. Sadda ,&nbsp;Sobha Sivaprasad ,&nbsp;Jay K. Chhablani ,&nbsp;Mudit Tyagi ,&nbsp;Nikitha Gurram Reddy ,&nbsp;Umesh Chandra Behera ,&nbsp;Raja Narayanan","doi":"10.1016/j.ajo.2025.12.007","DOIUrl":"10.1016/j.ajo.2025.12.007","url":null,"abstract":"<div><h3>Objective</h3><div>To study the efficacy of brolucizumab in chronic central serous chorioretinopathy (CSCR) with persistent fluid without choroidal neovascular membrane (CNVM).</div></div><div><h3>Design</h3><div>Prospective randomized-controlled trial with cross-over design.</div></div><div><h3>Subjects</h3><div>Patients with chronic CSCR (&gt;3 months duration) without CNVM confirmed on optical coherence tomography angiography were enrolled and randomized (1:1) to treatment or control arms.</div></div><div><h3>Methods</h3><div>Block randomization with stratification for disease duration and central macular thickness (CMT) was done. Patients in the treatment arm received intravitreal brolucizumab at baseline and then PRN. At 3 months follow-up, patients in the control arm with persistent fluid were crossed over to the injection arm.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was a reduction of CMT on optical coherence tomography &gt;20% compared to baseline. Secondary outcomes included proportion of eyes achieving complete fluid resolution at 1 and 3 months, mean change in CMT, subfoveal choroidal thickness (SFCT), best-corrected visual acuity, and NEI VFQ-25 scores.</div></div><div><h3>Results</h3><div>Of 42 patients (42 eyes), 3 were lost to follow-up. Final analysis included 22 patients in injection arm and 17 in control arm. Mean age was 52.3 ± 9.3 years; 92.3% were male. Greater than 20% CMT reduction at 1 month was noted in 17/22 (77.27%) in treatment arm and 6/16 eyes (37.5%) in the control arm (<em>p</em> = .01). At 1 month, 13/22 eyes (59%) achieved complete fluid resolution compared to 2/16 (12.5%) eyes in the control arm (<em>p</em> = .003). At 3 months follow-up, 12/20 eyes (60%) in the treatment arm achieved complete fluid resolution compared to 3/16 eyes (18.75%) in the control arm (<em>p</em> = .01). Mean CMT showed reduction in brolucizumab group compared to control at 1 month (158.16 ± 60 vs 318.22 ± 252.64 µm, <em>p</em> = .001) and 3 months (188.11 ± 78.83 vs 340.75.15 ± 264.52 µm, <em>p</em> = .016). Mean SFCT showed reduction in brolucizumab group compared to control at 1 month (419.53 ± 95.51 vs 472.40 ± 77.43 µm, <em>p</em> = .07) and 3 months (403.47 ± 127.36 vs 490.15 ± 105.50 µm, <em>p</em> = .05). 9 of 11 (81.82%) control eyes after crossover showed fluid resolution with brolucizumab. Change in best-corrected visual acuity and NEI VFQ-25 scores was not significant.</div></div><div><h3>Conclusions</h3><div>Brolucizumab resulted in rapid resolution of fluid in chronic CSCR without CNVM, associated with significant reduction in CMT and SFCT. Long-term studies will help understand recurrence patterns and adverse effect profile.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 149-162"},"PeriodicalIF":4.2,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Cellular-Level Assessment of Macular Development in Patients With FEVR Using Multimodal Imaging: A Prospective Cohort Study","authors":"Gongpeng Sun ,&nbsp;Meixia Zhang","doi":"10.1016/j.ajo.2025.10.041","DOIUrl":"10.1016/j.ajo.2025.10.041","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Page 336"},"PeriodicalIF":4.2,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tirzepatide is Associated With Reduced Risk of Primary Open-Angle Glaucoma and Ocular Hypertension in Patients With Type 2 Diabetes","authors":"Alexander T. Hong ,&nbsp;Forest Lin ,&nbsp;Sally Baxter ,&nbsp;Robert N. Weinreb","doi":"10.1016/j.ajo.2025.12.003","DOIUrl":"10.1016/j.ajo.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist (GLP-1 RA), has shown superior efficacy in glycemic control, weight loss, and cardiometabolic outcomes compared to GLP-1 RAs alone. While GLP-1 RAs may offer neuroprotective effects relevant to glaucoma, the impact of dual-incretin therapies like tirzepatide on glaucoma remains unknown. This study investigates the association between tirzepatide initiation and the risk of primary open-angle glaucoma (POAG), ocular hypertension (OHTN), and glaucoma treatment initiation in patients with type 2 diabetes mellitus (T2DM), compared to those initiating selective GLP-1 RAs.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study using a nationwide electronic health records network from June 2022 to May 2025.</div></div><div><h3>Subjects</h3><div>Adults with T2DM who initiated tirzepatide or selective GLP-1 RA therapy. Patients with prior exposure to either drug class, recent addition of second-line antihyperglycemic agents, previous glaucoma diagnosis or surgery, or ocular trauma were excluded.</div></div><div><h3>Methods</h3><div>Data from 71 U.S. healthcare organizations were analyzed. Propensity score matching (1:1) was conducted to balance cohorts for demographics, comorbidities, medication use, and ophthalmic encounters. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for each outcome.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of POAG, OHTN, and first-line glaucoma treatments (medications or surgery).</div></div><div><h3>Results</h3><div>We identified 41,850 patients who initiated tirzepatide and 147,828 patients who initiated selective GLP-1 RAs. After matching, 41,849 patients remained in each cohort. Tirzepatide use was associated with a significantly lower risk of POAG (RR 0.50, 95% CI 0.34-0.74), OHTN (RR 0.59, 95% CI 0.40-0.88), and need for glaucoma treatment (RR 0.54, 95% CI 0.45-0.64) compared to selective GLP-1 RAs. Risk reductions persisted in subgroups with concomitant metformin or insulin use. Sensitivity analyses limited to patients aged ≥60 years and comparisons with individual GLP-1 RAs (semaglutide and dulaglutide) yielded consistent trends.</div></div><div><h3>Conclusions</h3><div>Tirzepatide use was associated with a significantly reduced risk of developing POAG, OHTN, and need for first-line glaucoma treatment compared to selective GLP-1 RAs in patients with T2DM. These findings suggest a potential additional ocular benefit of tirzepatide and support further investigation into its role in glaucoma management.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 120-128"},"PeriodicalIF":4.2,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Episcleral Osteoma","authors":"Liangyuan Xu ,&nbsp;Jing Li ,&nbsp;Jianmin Ma","doi":"10.1016/j.ajo.2025.11.047","DOIUrl":"10.1016/j.ajo.2025.11.047","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"282 ","pages":"Pages e7-e8"},"PeriodicalIF":4.2,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capsular Tension Ring Use in High Myopic Eyes Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis","authors":"Yu-Min Chang ,&nbsp;Ke-Hung Chien ,&nbsp;Chi-Jung Wu","doi":"10.1016/j.ajo.2025.12.002","DOIUrl":"10.1016/j.ajo.2025.12.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the impact of capsular tension ring (CTR) implantation on refractive outcomes, intraocular lens (IOL) stability, and postoperative complications in high myopic patients undergoing cataract surgery.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Methods</h3><div>A systematic search of PubMed, EMBASE, Cochrane Library, and Google Scholar through March 2025 identified studies comparing cataract surgery with and without CTR implantation in high myopic eyes. The primary outcome was prediction refractive error (PE). Secondary outcomes included absolute refractive error (AE), postoperative corrected distance visual acuity (CDVA), IOL decentration, anterior chamber depth (ACD), posterior capsular opacification (PCO), and Nd:YAG capsulotomy rates. Random-effects meta-analysis, sensitivity analysis, and meta-regression were performed.</div></div><div><h3>Results</h3><div>Nine studies (4 randomized controlled trials and 5 cohort studies; 846 eyes) were included. CTR implantation did not significantly affect PE (mean difference [MD], 0.00; 95% confidence interval [CI], −0.07 to 0.08; <em>P</em> = .93) or postoperative CDVA (MD, 0.00; 95% CI, −0.06 to 0.06; <em>P</em> = 1.00). However, CTR significantly reduced AE (MD, −0.12; 95% CI, −0.20 to −0.05; <em>P</em> = .001) and IOL decentration (MD, −0.04; 95% CI, −0.07 to −0.01; <em>P</em> = .004).No covariates significantly influenced PE in meta-regression.</div></div><div><h3>Conclusions</h3><div>CTR implantation appears to modestly improve refractive predictability and IOL stability in high myopic eyes without compromising postoperative visual acuity. However, given the limited evidence base and small effect sizes, these findings should be interpreted with caution. CTR implantation may be considered in selected myopic cases with suspected zonular weakness or large capsular bags where additional capsular stability is desired.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 109-119"},"PeriodicalIF":4.2,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of SJP-0132 in Patients With Dry Eye Disease: A Phase 2b Randomized, Double-Masked, Dose-Finding Study","authors":"Yuichi Hori ,&nbsp;Tomoyuki Wada ,&nbsp;Kazunori Omatsu","doi":"10.1016/j.ajo.2025.11.036","DOIUrl":"10.1016/j.ajo.2025.11.036","url":null,"abstract":"<div><h3>Objective</h3><div>Evaluate the efficacy, safety, and optimal dose of the TRPV1 antagonist SJP-0132 ophthalmic suspension in patients with dry eye disease.</div></div><div><h3>Design</h3><div>Randomized, double-masked, multicenter, placebo-controlled, Phase 2b dose-response study in Japan.</div></div><div><h3>Participants</h3><div>Outpatients aged ≥20 years with dry eye-related subjective symptoms (eye dryness visual analog scale score ≥40; 5-item Dry Eye Questionnaire score ≥6), and objective signs (mean tear-breakup time ≤5 seconds in both eyes; corneal fluorescein staining [CFS] score using Baylor criteria: 2 to 4 for central zone of at least one eye, total score 4 to 20 for all zones, and ≥1 for at least one of the four peripheral corneal regions).</div></div><div><h3>Methods</h3><div>After a 2-week placebo run-in period, patients were randomized 1:1:1:1 to receive SJP-0132 ophthalmic suspension 0.1%, 0.3%, or 1.0%, or placebo, administered as 1 drop in each eye four times daily for 4 weeks.</div></div><div><h3>Main Outcome Measures</h3><div>The primary endpoint was the change from baseline to week 4 in CFS score for all zones with SJP-0132 0.3% vs placebo (primary analysis) and SJP-0132 0.1% or 1.0% vs placebo (secondary analysis).</div></div><div><h3>Results</h3><div>Total 344 patients were randomized and received at least one dose of SJP-0132 0.1% (<em>n</em> = 87), SJP-0132 0.3% (<em>n</em> = 87), SJP-0132 1.0% (<em>n</em> = 85), or placebo (<em>n</em> = 85). For the primary endpoint, there were no statistically significant differences between the SJP-0132 0.3% and placebo groups (between-group difference −0.8; 95% CI −1.7, 0.2; <em>P</em> = .1181), or between the SJP-0132 0.1% (−0.7; 95% CI −1.8, 0.4; <em>P</em> = .1990) or SJP-0132 1.0% (−0.1; 95% CI −1.3, 1.0; <em>P</em> = .8276) and placebo groups. Secondary endpoints showed generally dose-dependent efficacy and safety of SJP-0132. Improvements in subjective symptoms of dry eye, quality of life, and objective signs were observed after 1 week of SJP-0132 administration and maintained through to week 4, with statistically significant differences to placebo observed at some endpoints. Subgroup analyses suggested greater treatment benefits with SJP-0132 0.3% in subgroups based on baseline ocular characteristics. SJP-0132 was generally well tolerated across the dose groups.</div></div><div><h3>Conclusions</h3><div>SJP-0132 showed generally dose-dependent efficacy and safety. Based on safety and treatment benefits with SJP-0132 0.3% in the overall population and in subgroups, this dose was considered optimal for further development.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 163-175"},"PeriodicalIF":4.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Superior Corneal Melts With Iris Prolapse After Retinal Surgery in Rheumatoid Arthritis","authors":"Ritu Arora,&nbsp;Daraius Shroff,&nbsp;Sanat Kumar","doi":"10.1016/j.ajo.2025.11.048","DOIUrl":"10.1016/j.ajo.2025.11.048","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"282 ","pages":"Pages e10-e11"},"PeriodicalIF":4.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Haab Striae Point to a Pressured Past","authors":"Ronak Singh ,&nbsp;Wallace L.M. Alward ,&nbsp;Erin A. Boese","doi":"10.1016/j.ajo.2025.12.001","DOIUrl":"10.1016/j.ajo.2025.12.001","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"282 ","pages":"Page e9"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retinal Pigment Epithelium Disruption Lesions on Optical Coherence Tomography in Patients With Vitreoretinal Lymphoma","authors":"Wenwen Chen ,&nbsp;Tingting Jiang ,&nbsp;Junxiang Gu ,&nbsp;Shixue Liu ,&nbsp;Xinyi Zhou ,&nbsp;Qing Chang","doi":"10.1016/j.ajo.2025.11.044","DOIUrl":"10.1016/j.ajo.2025.11.044","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe the imaging characteristics and clinical relevance of retinal pigment epithelium (RPE) disruption lesions observed on optical coherence tomography (OCT) of patients with biopsy-proven vitreoretinal lymphoma (VRL).</div></div><div><h3>Design</h3><div>Retrospective interventional case series.</div></div><div><h3>Subjects</h3><div>Patients diagnosed with VRL at the Eye and ENT Hospital of Fudan University between July 2017 and June 2024.</div></div><div><h3>Methods</h3><div>The clinical characteristics, outcomes, and multimodal retinal imaging findings of the eligible VRL patients were collected and studied. RPE disruption lesions were defined as full-thickness RPE discontinuities on OCT and were categorized as major (&gt;300 µm) or minor (&lt;300 µm) based on OCT-measured width.</div></div><div><h3>Main Outcome Measures</h3><div>The associated features of RPE disruption lesions on OCT.</div></div><div><h3>Results</h3><div>Totally 158 eyes of 81 patients were included in the analysis. RPE disruption lesions were detected in 51 of 65 affected eyes of 36 patients. Most of the lesions (47/51 eyes) were detected at initial presentation or disease onset. On OCT scans, 17 eyes had major RPE disruption lesions, and 34 eyes only had minor disruption lesions. The RPE disruption lesions were colocalized with intraretinal or subretinal infiltration. Among the eyes with full-thickness intraretinal infiltration, 14 eyes (14/24) exhibited perivascular infiltration. Major RPE disruption lesions showed a stronger association with subretinal infiltration (<em>P</em> = .041), while minor disruptions demonstrated preferential correlation with intraretinal infiltration (<em>P</em> = .036). On fundus autofluorescence, the RPE disruption lesions sometimes manifest as characteristic hypo-autofluorescent spots accompanied by hyper-autofluorescent rings. Eyes with minor RPE disruption lesions showed a better visual outcome compared to those with major lesions (<em>P</em> = .013), with statistically significant improvement from baseline after treatment (<em>P</em> = .00017). The median recovery time for the RPE disruption lesions was 2.0 months (IQR 1.5-4.0 months). The accompanied retinal infiltration vanished with the recovery of RPE disruption lesions.</div></div><div><h3>Conclusions</h3><div>RPE disruption lesions represent frequently occurring yet underrecognized OCT findings in VRL. Notably, the lesions provide diagnostic clues for VRL identification and may reveal a potential migration pathway for lymphocytic infiltrates between sub-RPE and subretinal/intraretinal spaces.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 100-108"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ChatGPT-Assisted Glaucoma Diagnosis: A Health-Equitable Multi-Ancestry Analysis Using Visual Field and Optical Coherence Tomography Data","authors":"ANDY S. HUANG ,&nbsp;ANTHONY FAM ,&nbsp;HETINCE ZHAO ,&nbsp;NICOLE PAULESCU ,&nbsp;ANNA FABCZAK-KUBICKA ,&nbsp;JANEY L. WIGGS ,&nbsp;NAZLEE ZEBARDAST ,&nbsp;DAVID S. FRIEDMAN ,&nbsp;RON DO ,&nbsp;KANZA AZIZ ,&nbsp;JAE HEE KANG ,&nbsp;TOBIAS ELZE ,&nbsp;MENGYU WANG ,&nbsp;ALON HARRIS ,&nbsp;TAK YEE TANIA TAI ,&nbsp;JAMES C. TSAI ,&nbsp;LOUIS R. PASQUALE","doi":"10.1016/j.ajo.2025.11.046","DOIUrl":"10.1016/j.ajo.2025.11.046","url":null,"abstract":"<div><h3>Purpose</h3><div>Early glaucoma detection is challenging due to variable ocular anatomy, non-glaucomatous optic neuropathy impacting optical coherence tomography (OCT) results, and the subjective nature of visual field (VF) tests. Multimodal large language models may overcome these challenges to provide equitable and accurate screening diagnoses across ancestries and glaucoma genetic predispositions. We evaluated ChatGPT o1 Pro’s accuracy in identifying glaucoma using circumpapillary retinal nerve fiber layer (RNFL) OCT and VF data, and its consistency across ancestries and glaucoma polygenic risk scores (PRS).</div></div><div><h3>Design</h3><div>Cross-sectional diagnostic accuracy study.</div></div><div><h3>Settings and Participants</h3><div>We enrolled 204 participants from the Mount Sinai BioMe Biobank for a comprehensive ophthalmic examination from November 2022 to March 2025. This cross-sectional diagnostic accuracy study included 38% European (EUR) and 62% non-European (non-EUR) participants stratified by low/intermediate (<em>n</em> = 107) and high-risk glaucoma PRS (<em>n</em> = 97). Two glaucoma specialists masked to PRS status provided a consensus reference diagnosis. ChatGPT received only de-identified VFs and OCT-RNFL numerical outputs to determine glaucoma status. Performance metrics were compared with the reference diagnosis. Subgroup comparisons by ancestry (EUR versus non-EUR) and PRS (high versus low/intermediate) were conducted. We used logistic regression models to assess the impacts of ancestry, PRS and ocular parameters on classification accuracy.</div></div><div><h3>Main Outcome Measures</h3><div>ChatGPT o1 Pro’s diagnostic performance in detecting glaucoma compared to consensus specialist diagnoses, stratified by ancestry and genetic risk.</div></div><div><h3>Results</h3><div>ChatGPT o1 Pro exhibited 96.0% sensitivity (95% confidence interval (CI): 88.3%-100%), 83.7% specificity (95% CI: 78.3%-89.1%), 85.2% accuracy (95% CI: 80.3%-90.1%), an area under the receiver operator curve (AUC) of 0.899, a positive predictive value (PPV) of 45.3% (95% CI: 31.9%-58.7%), and a negative predictive value (NPV) of 99.3% (95% CI: 98.0%-100%); κ for agreement with the consensus reference was 0.538. No significant differences were observed between EUR and non-EUR subgroups (AUC: 0.894 vs 0.906, <em>P</em> = .79; accuracy: 88.3% vs 83.3%, <em>P</em> = .44) or high and low/intermediate-PRS subgroups (AUC: 0.889 vs 0.922, <em>P</em> = .45; accuracy: 85.4% vs 85.0%, <em>P</em> = .50). Global RNFL was the only determinant of reference disease classification (OR = 1.1 per micron, <em>P</em> &lt; .001).</div></div><div><h3>Conclusion</h3><div>ChatGPT o1 Pro diagnosed glaucoma similarly to specialists using only VF and OCT data. The model performance was similar across ancestral groups and genetic predispositions to glaucoma.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 129-137"},"PeriodicalIF":4.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}