American Journal of Ophthalmology最新文献

{"title":"Racial Disparities in Ophthalmology in Training and Practice: A Systematic Review","authors":"Angel Gao , Tasha Miller , Arturo Ortin-Martinez , Radha P. Kohly","doi":"10.1016/j.ajo.2026.01.008","DOIUrl":"10.1016/j.ajo.2026.01.008","url":null,"abstract":"<div><h3>Topic</h3><div>Ophthalmology remains one of the least diverse medical specialties, with persistent racial and ethnic disparities throughout training and practice. This review examines experiences of individuals from underrepresented racial minorities (URiM) in ophthalmology within high-income countries, focusing on barriers to representation, discrimination, and equity initiatives.</div></div><div><h3>Clinical Relevance</h3><div>Identifying and addressing barriers faced by URiM in ophthalmology is essential to advancing workforce diversity, equitable patient care, and institutional inclusivity. Understanding where inequities persist can inform systemic interventions.</div></div><div><h3>Methods</h3><div>A systematic review of the literature was conducted in MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane Library from inception to November 2024. Eligible studies included English-language publications from 2000 onwards focusing on racial or ethnic minority individuals in ophthalmology. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Newcastle-Ottawa Scale and Joanna Briggs Institute Checklist. Data were synthesized descriptively and thematically. The protocol was registered on PROSPERO (CRD42025640520).</div></div><div><h3>Results</h3><div>Forty-one eligible studies involving 500,823 responses were included. Most studies were cross-sectional, published after 2021 and conducted in the United States. Across all career stages, URiM individuals were underrepresented and faced structural barriers. In medical school, fewer URiM students pursued ophthalmology, citing lack of mentorship and role models. Minority representation among applicants has increased modestly, particularly among Hispanic students, though overall growth remains limited.</div><div>During residency and fellowship, racial disparities persisted in research access, fellowship application outcomes, and interview offers. URiM trainees reported negative experiences related to program culture and inclusivity. In practice, racialized ophthalmologists reported higher discrimination rates, reduced advancement into leadership, and underrepresentation on faculty and editorial boards.</div><div>While URiM match rates have improved, progress has been uneven. Asian representation has approached parity, while Black, Native American, and Pacific Islander individuals remain severely underrepresented. National ophthalmology mentorship programs have demonstrated high match success and participation. Residency programs that implemented structured interviews, holistic review and targeted equity strategies reported improved URiM representation, though implementation varied.</div></div><div><h3>Conclusion</h3><div>Racial and ethnic disparities remain pervasive in ophthalmology. While overall progress has occurred, gains have been concentrated among Asian individuals. Coordinated systemic reforms are urgently needed for a more represent","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 196-207"},"PeriodicalIF":4.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986455","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":"Progression of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Occurs Early and Is Unassociated With Modifiable Risk Factors","authors":"ZOË R. WILLIAMS ,&nbsp;RACHELLE MORGENSTERN ,&nbsp;ASALA N. EREKAT ,&nbsp;DAVID SZANTO ,&nbsp;MICHAEL WALL ,&nbsp;NEIL R. MILLER ,&nbsp;LEONARD A. LEVIN ,&nbsp;BRIAN WOODS ,&nbsp;MARK J. KUPERSMITH","doi":"10.1016/j.ajo.2026.01.012","DOIUrl":"10.1016/j.ajo.2026.01.012","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To report the true frequency and risk factors for acute nonarteritic anterior ischemic optic neuropathy (NAION) progression and identify modifiable features to reduce vision worsening.</div></div><div><h3>DESIGN</h3><div>Secondary case-control analysis of the QRK207 multicenter, double-masked, sham-controlled, randomized clinical trial.</div></div><div><h3>SUBJECTS</h3><div>We analyzed 599 study eyes with acute NAION (of 729 individuals prospectively enrolled in the QRK207 trial) with separate screening and Day 1 (mean 2.5-day interval) evaluations for progression. No participants included in this analysis received treatment. The Month 2 analysis included only the 167 sham-injected study eyes.</div></div><div><h3>METHODS</h3><div>Visual outcomes were assessed using best-corrected visual acuity (BCVA) using early treatment diabetic retinopathy study (ETDRS) charts and standardized automated perimetry.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>We defined progression as ≥10 ETDRS letter loss (also analyzed ≥15 ETDRS letter loss) or worsening of censored corrected average total deviation (avgTD) using quantile regression to define progression and recovery thresholds. We evaluated systemic and ophthalmic features associated with progression.</div></div><div><h3>RESULTS</h3><div>From screening to Day 1, 7.3% (43/583) of eyes had ≥ 10 ETDRS letter loss, and 4.1% eyes had ≥ 15 ETDRS letter loss. Diabetes mellitus, hypertension, hyperlipidemia (HLD), and cardiovascular risk factors did not increase the risk of progression. Previous fellow-eye (FE) NAION and obstructive sleep apnea (OSA) were significantly associated with ≥10 ETDRS letter loss. Only FE NAION remained a risk factor ≥15 ETDRS letter loss. Of the 167 sham-injected eyes with screening to Month 2 evaluation, 21.6% (36/167) had ≥10 ETDRS letter loss, and 14.4% (24/167) had ≥15 ETDRS letter loss. About 91.6% of eyes (33/36) progressed within 22 days of symptom onset (by Day 8). Of the 139 sham-injected eyes with Day 1 to Month 2 evaluation, 18.7% had ≥10 ETDRS letter loss, and 13.7% had ≥15 ETDRS letter loss. TD progression from screening to Day 1 occurred in 32.1% (192/599) eyes, 66.1% remained stable, and 1.8% improved. FE NAION and HLD were associated with TD progression.</div></div><div><h3>CONCLUSIONS</h3><div>Worsening of vision in NAION occurs acutely. The results do not support cardiovascular risk factors as important hazard features for NAION progression. The only consistent factor associated with progression for both BCVA and VF loss was previous FE NAION.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 181-195"},"PeriodicalIF":4.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986497","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":"Reply to Commentary on “Development and Evaluation of an Artificial Intelligence Model to Set Target IOP for Glaucoma”","authors":"Alex Pham, Jithin Yohannan","doi":"10.1016/j.ajo.2026.01.005","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.01.005","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"83 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961646","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 “Effect of Angle Kappa on the Refractive Prediction Accuracy in Cataract Patients After Myopic LASIK/PRK”","authors":"Carlos Cifuentes-González, Jorge E. Satizabal-García, Alejandro Tello, Virgilio Galvis","doi":"10.1016/j.ajo.2025.12.039","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.12.039","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"21 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956641","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 Development and Evaluation of an Artificial Intelligence Model to Set Target IOP for Glaucoma","authors":"Henry Bair MD","doi":"10.1016/j.ajo.2025.11.051","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.11.051","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"34 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956640","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":"Noncancerous Monogenic Mimics of Noninfectious Posterior Uveitis","authors":"Mohammad Anas ,&nbsp;Andrew C Browning ,&nbsp;Hwei Wuen Chan ,&nbsp;Margaret Reynolds ,&nbsp;Rebecca A Procopio ,&nbsp;Omar A Mahroo ,&nbsp;Jose S Pulido","doi":"10.1016/j.ajo.2026.01.003","DOIUrl":"10.1016/j.ajo.2026.01.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The eye can only respond in certain patterned ways to any insult. Because of this, it is important to have a sufficiently broad differential diagnosis that encompasses all possibilities that appear to have a similar phenotype.</div></div><div><h3>Design</h3><div>A consensus review.</div></div><div><h3>Method</h3><div>A guide to determine when to consider gentic diseases when a patient is referred as a uveitis mimic.</div></div><div><h3>Results</h3><div>It is critical to appreciate that mimics of noninfectious posterior uveitis (NIPU) are not merely academic distinctions but carry real clinical consequences.</div></div><div><h3>Conclusions</h3><div>Misdiagnosing an inherited retinal disease (IRD) as NIPU can lead to prolonged exposure to systemic corticosteroids or immunosuppressive therapies without benefit, potentially causing avoidable adverse effects. Conversely, failing to recognize a treatable inflammatory cause can lead to avoidable vision loss.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 171-180"},"PeriodicalIF":4.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956026","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":"Ablation-Guided K Measurements Improve the Accuracy of IOL Power Calculation After Clinically Decentered Myopic LASIK","authors":"Min Zhang ,&nbsp;Peimin Lin ,&nbsp;Tianhui Chen ,&nbsp;Zexu Chen ,&nbsp;Aizhu Miao ,&nbsp;Ruohong Li ,&nbsp;Yongxiang Jiang","doi":"10.1016/j.ajo.2026.01.011","DOIUrl":"10.1016/j.ajo.2026.01.011","url":null,"abstract":"<div><h3>Purposes</h3><div>Define clinical ablation decentration and construct personalized areas for K measurements to improve the accuracy of intraocular lens (IOL) power calculation after myopic laser in situ keratomileusis (LASIK).</div></div><div><h3>Design</h3><div>Retrospective, observational case series.</div></div><div><h3>Methods</h3><div>Ablation areas were delineated on smoothed corneal topographies (Pentacam AXL). Personalized areas for K measurements were constructed as the overlap between the corneal ablation area and a given apex-centered circle. K values were calculated on these personalized areas using the ring or zone method. Ablation decentration was evaluated by (1) index P: the percentage of the personalized area in the corresponding circle, and (2) index D: the distance from its maximum inscribed circle center to the corneal apex. Their absolute predictive errors (AE) were compared with those of IOLMaster-reported K in 60 cataract eyes from 48 patients with prior LASIK.</div></div><div><h3>Results</h3><div>Ablation-guided K values derived from the 3.5 mm-diameter circle and the ring methods, namely K_3.5ring, had the best predictive accuracy (Mean AE = 0.64D, Median AE = 0.47D). This method had better performance with smaller index P (ρ = -0.473, <em>P</em> = .006) and larger index D (ρ = 0.432, <em>P</em> = .014). Personalized areas with index P &lt; 95.02% (<em>P</em> = .013) or index D ≥ 1.0975 mm (<em>P</em> = .007) showed greater accuracy improvements, and were defined as clinical ablation decentration.</div></div><div><h3>Conclusions</h3><div>This study developed a novel ablation-guided K measurement method for IOL calculation in eyes with clinically decentered myopic ablation. We also provide a ready-to-use tool (<span><span>https://boluo-baba-ablation-guided-k-measurements.share.connect.posit.cloud</span><svg><path></path></svg></span>) based on this method for clinical convenience.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 161-170"},"PeriodicalIF":4.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956202","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":"Reply to Comment on Effect of Angle Kappa on the Refractive Prediction Accuracy in Cataract Patients After Myopic LASIK/PRK.","authors":"Haorui Yuan,Jiaqing Zhang,Lixia Luo,Xuhua Tan","doi":"10.1016/j.ajo.2026.01.007","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.01.007","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956207","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":"Exploring the Association Between Autoimmune and Inflammatory Diseases and Uveitis","authors":"Nitesh Mohan ,&nbsp;Sunil K. Srivastava ,&nbsp;Matthew J. Schulgit ,&nbsp;Rula A. Hajj-Ali ,&nbsp;David C. Kaelber ,&nbsp;Sumit Sharma","doi":"10.1016/j.ajo.2026.01.004","DOIUrl":"10.1016/j.ajo.2026.01.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To evaluate the association between immune-mediated inflammatory diseases (IMIDs) and uveitis.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort and case-control study using electronic health record data.</div></div><div><h3>METHODS</h3><div>The study included patients diagnosed with uveitis and/or one of the following 12 IMIDs: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, scleroderma, inflammatory bowel disease (IBD), multiple sclerosis (MS), ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis (JIA), and giant cell arteritis (GCA), anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis, and other systemic vasculitis. Controls were patients without prior uveitis diagnosis or any IMIDs. The risk of developing uveitis in patients with each IMID, the odds of prior IMID diagnoses among patients with uveitis, and the risk of developing an IMID following a uveitis diagnosis were calculated. The main outcome measures were the risk ratio (RR) and odds ratio (OR) estimates with 95% confidence intervals for associations between IMIDs and uveitis.</div></div><div><h3>RESULTS</h3><div>Patients with all 12 IMIDs had a significantly increased risk of developing uveitis. The highest risks were observed in ankylosing spondylitis (RR = 7.71, 95% CI = 5.84-10.19), JIA (RR = 5.13, 95% CI = 3.51-7.49), and systemic vasculitis (RR = 4.61, 95% CI = 3.73-5.69). Increased risk was also found in sarcoidosis (RR = 3.67, 95% CI = 3.02-4.47), GCA (RR = 3.24, 95% CI = 2.58-4.07), and ANCA vasculitis (RR = 3.18, 95% CI = 1.84-5.48). In addition, in patients with uveitis, both the odds of a prior IMID diagnosis and the risk of a future IMID diagnosis were significantly increased for all 12 IMIDs.</div></div><div><h3>CONCLUSIONS</h3><div>IMIDs are strongly associated with uveitis, with significant bidirectional risk. Patients with uveitis should be monitored for potential IMID development, and those with IMIDs should undergo ophthalmologic evaluation when appropriate.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 101-109"},"PeriodicalIF":4.2,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956036","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":"Reduced Risk of Non-Neovascular AMD in Cancer Patients Treated With Immune Checkpoint Inhibitors: A Propensity-Matched Cohort Study","authors":"Natan Lishinsky-Fischer ,&nbsp;Sima Gharra ,&nbsp;Itay Nitzan,&nbsp;Itay Chowers,&nbsp;Jaime Levy","doi":"10.1016/j.ajo.2025.12.035","DOIUrl":"10.1016/j.ajo.2025.12.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate whether immune checkpoint inhibitors (ICIs), which modulate T-cell activity in cancer therapy, influence the risk of developing age-related macular degeneration (AMD).</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>Adults aged ≥60 years with a history of cancer, identified from the TriNetX Global Collaborative Network. Only patients who remained alive throughout the follow-up period were included.</div></div><div><h3>Methods</h3><div>Two cohorts were constructed: patients who received ICIs and those who did not. Sub-analyses were conducted for patients with melanoma and for those with metastatic disease. Propensity score matching (1:1) was performed using demographic and clinical covariates. Kaplan-Meier estimates and Cox proportional hazards models assessed the association between ICI exposure and AMD incidence over 5 years.</div></div><div><h3>Main Outcome Measures</h3><div>Incidence of non-neovascular and neovascular AMD after ICI therapy.</div></div><div><h3>Results</h3><div>After matching, 36,037 patients were included in each cohort. ICI-treated patients had a significantly lower risk of developing non-neovascular AMD (hazard ratio [HR], 0.77; 95% CI, [0.63, 0.93]; log-rank <em>P</em> = .0084) over a 5-year follow-up. No significant association was observed between ICI exposure and neovascular AMD. The protective association persisted in melanoma and metastatic subgroups.</div></div><div><h3>Conclusions</h3><div>In this large, multicenter cohort, ICI therapy was associated with a reduced risk of non-neovascular AMD in older adults with cancer. These findings suggest a potential protective role of T-cell modulation in AMD pathogenesis and highlight the need for further research into the retinal effects of ICIs.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 153-160"},"PeriodicalIF":4.2,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937813","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}