Body size has been closely linked to primary open-angle glaucoma (POAG). However, the association was inconsistent, which may be due to the fact that body size defined by body mass index does not differentiate fat from lean mass or capture body composition distribution. The impact of body composition on POAG remains largely unknown.
Design
Combined cross-sectional and cohort study.
Participants
A total of 88,123 participants and 291,983 participants from the UK Biobank for the analysis of baseline intraocular pressure (IOP) and POAG incidence, respectively.
Methods
Fat and muscle mass in the arm, trunk, and leg were estimated using bioimpedance analysis. Measurements were normalized for height to derive the arm fat index, trunk fat index, leg fat index (LFI), arm muscle index, trunk muscle index, and leg muscle index. Fat-to-muscle ratios for each region were also calculated as sensitivity analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) for POAG were estimated using covariate-adjusted Cox models, and associations with IOP were additionally assessed using linear regression.
Main Outcome Measures
Baseline IOP and POAG incidence.
Results
Greater leg fat was associated with a significantly reduced risk of POAG, supported by both LFI (HR, 0.85; 95% CI, 0.76-0.95; P = .006) and leg fat-to-muscle ratio (HR, 0.35; 95% CI, 0.16-0.73; P = .005). No association was observed between muscle mass and the incidence of POAG. Greater fat mass was associated with higher IOP levels, supported by arm fat index (β, 0.14; 95% CI, 0.07-0.22, P < .001), LFI (β, 0.15; 95% CI, 0.11-0.18, P < .001), trunk fat index (β, 0.07; 95% CI, 0.04-0.09, P < .001), whereas greater muscle mass in leg (leg muscle index: β, –0.24; 95% CI, –0.29 to –0.20, P < .001) and trunk (trunk muscle index: β, –0.05; 95% CI, –0.08 to –0.01, P = .005) was associated with lower IOP.
Conclusions
POAG risk differs according to body composition. Maintaining a healthy body composition pattern may mitigate its risk.
目的：体尺寸与原发性开角型青光眼（POAG）密切相关。然而，这种关联并不一致，这可能是由于体重指数定义的体型不能区分脂肪和瘦体重，也不能捕捉到身体成分的分布。身体成分对POAG的影响在很大程度上仍然未知。设计结合横断面和队列研究。参与者：来自UK Biobank的88,123名参与者和291,983名参与者分别用于分析基线眼压（IOP）和POAG发生率。方法采用生物阻抗法测定上肢、躯干和腿部的脂肪和肌肉量。将身高数据归一化，得到手臂脂肪指数、躯干脂肪指数、腿部脂肪指数（LFI）、手臂肌肉指数、躯干肌肉指数和腿部肌肉指数。每个区域的脂肪-肌肉比率也被计算为敏感性分析。使用协变量调整的Cox模型估计POAG的风险比（hr）和95%置信区间（CIs），并使用线性回归评估与IOP的关联。主要观察指标：基线IOP和POAG发生率。结果腿部脂肪增加与POAG风险显著降低相关，两者均得到LFI的支持（HR, 0.85; 95% CI, 0.76-0.95; P = ）。006)和腿部脂肪肌肉比（HR, 0.35; 95% CI, 0.16-0.73; P = .005）。未观察到肌肉质量与POAG发生率之间的关联。较大的脂肪量与较高的IOP水平相关，其支持因素包括手臂脂肪指数（β, 0.14; 95% CI, 0.07-0.22, P < 0.001）、LFI （β, 0.15, 95% CI, 0.11-0.18, P < 0.001）、躯干脂肪指数（β, 0.07, 95% CI, 0.04-0.09, P < 0.001），而腿部肌肉量较大（腿部肌肉指数：β， -0.24, 95% CI, -0.29 - -0.20, P < 0.001）和躯干（躯干肌肉指数：β， -0.05, 95% CI, -0.08 - -0.01, P = ）。005)与较低的IOP相关。结论不同体质的人患spoag的风险不同。保持健康的身体组成模式可以减轻其风险。
{"title":"Association Between Body Composition and Risk of Primary Open-Angle Glaucoma","authors":"Jianqi Chen , Yue Xiao , Xiaohong Chen , Yingting Zhu , Zhidong Li , Shitong Huang , Hanyang Yu , Yehong Zhuo , Yunxia Leng","doi":"10.1016/j.ajo.2025.12.014","DOIUrl":"10.1016/j.ajo.2025.12.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Body size has been closely linked to primary open-angle glaucoma (POAG). However, the association was inconsistent, which may be due to the fact that body size defined by body mass index does not differentiate fat from lean mass or capture body composition distribution. The impact of body composition on POAG remains largely unknown.</div></div><div><h3>Design</h3><div>Combined cross-sectional and cohort study.</div></div><div><h3>Participants</h3><div>A total of 88,123 participants and 291,983 participants from the UK Biobank for the analysis of baseline intraocular pressure (IOP) and POAG incidence, respectively.</div></div><div><h3>Methods</h3><div>Fat and muscle mass in the arm, trunk, and leg were estimated using bioimpedance analysis. Measurements were normalized for height to derive the arm fat index, trunk fat index, leg fat index (LFI), arm muscle index, trunk muscle index, and leg muscle index. Fat-to-muscle ratios for each region were also calculated as sensitivity analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) for POAG were estimated using covariate-adjusted Cox models, and associations with IOP were additionally assessed using linear regression.</div></div><div><h3>Main Outcome Measures</h3><div>Baseline IOP and POAG incidence.</div></div><div><h3>Results</h3><div>Greater leg fat was associated with a significantly reduced risk of POAG, supported by both LFI (HR, 0.85; 95% CI, 0.76-0.95; <em>P</em> = .006) and leg fat-to-muscle ratio (HR, 0.35; 95% CI, 0.16-0.73; <em>P</em> = .005). No association was observed between muscle mass and the incidence of POAG. Greater fat mass was associated with higher IOP levels, supported by arm fat index (<em>β</em>, 0.14; 95% CI, 0.07-0.22, <em>P</em> < .001), LFI (<em>β</em>, 0.15; 95% CI, 0.11-0.18, <em>P</em> < .001), trunk fat index (<em>β</em>, 0.07; 95% CI, 0.04-0.09, <em>P</em> < .001), whereas greater muscle mass in leg (leg muscle index: <em>β</em>, –0.24; 95% CI, –0.29 to –0.20, <em>P</em> < .001) and trunk (trunk muscle index: <em>β</em>, –0.05; 95% CI, –0.08 to –0.01, <em>P</em> = .005) was associated with lower IOP.</div></div><div><h3>Conclusions</h3><div>POAG risk differs according to body composition. Maintaining a healthy body composition pattern may mitigate its risk.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 256-267"},"PeriodicalIF":4.2,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784493","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}
Pub Date : 2025-12-18DOI: 10.1016/j.ajo.2025.12.012
Lorenzo Bianco , Alessio Antropoli , Elise Boulanger-Scemama , Marco Nassisi , Amine Benadji , Grégoire Mésa , Louise O’Toole , Aline Antonio , Christel Condroyer , Camille Andrieu , José-Alain Sahel , Christina Zeitz , Isabelle Audo
Objective
To describe the clinical characteristics, natural history, and genotype-phenotype correlations of autosomal recessive bestrophinopathy (ARB).
Design
Retrospective cohort study including data collected for clinical practice.
Participants
Thirty-four consecutive patients (68 eyes) affected by ARB who had a molecularly confirmed diagnosis followed at a single referral center for inherited retinal diseases (REFERET, Quinze-Vingts Hospital, Paris, France).
Methods
We collected data from medical records, including genetic data, ophthalmologic history, clinical examinations, retinal imaging, and full-field electroretinograms (ERG). Disease severity graded on short-wavelength autofluorescence (SW-AF), and the presence of primary angle closure (PAC) was evaluated as candidate risk factors for clinical outcomes. Longitudinal outcome analysis was performed using mixed-effects linear modeling and Kaplan–Meier survival curves.
Main Outcomes Measures
ERG amplitudes; best-corrected visual acuity and degree of visual impairment according to World Health Organization criteria; central subfield thickness measured on optical coherence tomography.
Results
The median age at baseline was 32 years (interquartile range, 18.3-46.9), and 29% (10/34) of patients had PAC. On SW-AF, 21% (7/34) had isolated macular lesions (grade 1), 44% (15/34) had multifocal lesions or diffuse alterations at the posterior pole with zonal sparing (grade 2), and 35% (12/34) had panretinal alterations (grade 3). Marked attenuation of ERG amplitudes was found only in patients with grade 3 disease. Of 32 unique BEST1 variants, 11 (34%) were novel, and the p.(Thr363Pro) occurred only in grade 1 disease. The median age at onset of severe visual impairment was lower in patients with PAC (47 years) compared with those without (68 years; P = .01), whereas no such association was observed with SW-AF grade. No significant linear annual change in best-corrected visual acuity could be demonstrated over a median follow-up of 3 years.
Conclusions
ARB encompasses a wide phenotypic spectrum, ranging from mild, isolated macular involvement to severe panretinal degeneration with abnormal ERG. However, the risk of visual impairment appears to be driven primarily by the presence of PAC rather than by the severity of fundus lesions, representing an important confounding factor for future clinical trials. The very slow rate of visual acuity decline further underscores the need for more sensitive functional outcome measures in bestrophinopathies.
{"title":"Autosomal Recessive Bestrophinopathy—Phenotypic Variability, Natural History, and Genotype-Phenotype Correlations","authors":"Lorenzo Bianco , Alessio Antropoli , Elise Boulanger-Scemama , Marco Nassisi , Amine Benadji , Grégoire Mésa , Louise O’Toole , Aline Antonio , Christel Condroyer , Camille Andrieu , José-Alain Sahel , Christina Zeitz , Isabelle Audo","doi":"10.1016/j.ajo.2025.12.012","DOIUrl":"10.1016/j.ajo.2025.12.012","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical characteristics, natural history, and genotype-phenotype correlations of autosomal recessive bestrophinopathy (ARB).</div></div><div><h3>Design</h3><div>Retrospective cohort study including data collected for clinical practice.</div></div><div><h3>Participants</h3><div>Thirty-four consecutive patients (68 eyes) affected by ARB who had a molecularly confirmed diagnosis followed at a single referral center for inherited retinal diseases (REFERET, Quinze-Vingts Hospital, Paris, France).</div></div><div><h3>Methods</h3><div>We collected data from medical records, including genetic data, ophthalmologic history, clinical examinations, retinal imaging, and full-field electroretinograms (ERG). Disease severity graded on short-wavelength autofluorescence (SW-AF), and the presence of primary angle closure (PAC) was evaluated as candidate risk factors for clinical outcomes. Longitudinal outcome analysis was performed using mixed-effects linear modeling and Kaplan–Meier survival curves.</div></div><div><h3>Main Outcomes Measures</h3><div>ERG amplitudes; best-corrected visual acuity and degree of visual impairment according to World Health Organization criteria; central subfield thickness measured on optical coherence tomography.</div></div><div><h3>Results</h3><div>The median age at baseline was 32 years (interquartile range, 18.3-46.9), and 29% (10/34) of patients had PAC. On SW-AF, 21% (7/34) had isolated macular lesions (grade 1), 44% (15/34) had multifocal lesions or diffuse alterations at the posterior pole with zonal sparing (grade 2), and 35% (12/34) had panretinal alterations (grade 3). Marked attenuation of ERG amplitudes was found only in patients with grade 3 disease. Of 32 unique BEST1 variants, 11 (34%) were novel, and the p.(Thr363Pro) occurred only in grade 1 disease. The median age at onset of severe visual impairment was lower in patients with PAC (47 years) compared with those without (68 years; <em>P</em> = .01), whereas no such association was observed with SW-AF grade. No significant linear annual change in best-corrected visual acuity could be demonstrated over a median follow-up of 3 years.</div></div><div><h3>Conclusions</h3><div>ARB encompasses a wide phenotypic spectrum, ranging from mild, isolated macular involvement to severe panretinal degeneration with abnormal ERG. However, the risk of visual impairment appears to be driven primarily by the presence of PAC rather than by the severity of fundus lesions, representing an important confounding factor for future clinical trials. The very slow rate of visual acuity decline further underscores the need for more sensitive functional outcome measures in bestrophinopathies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 188-198"},"PeriodicalIF":4.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784497","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}
Pub Date : 2025-12-18DOI: 10.1016/j.ajo.2025.12.013
ZIYAO WANG , CAN CAN XUE , YIMAN LI , YOU WU , ZHE PAN , FAN LI , CAROL Y. CHEUNG , KYOKO OHNO-MATSUI , David S FRIEDMAN , DAVID GARWAY-HEATH , LINDA M. ZANGWILL , BALWANTRAY C. CHAUHAN , CLAUDE F. BURGOYNE , YIH CHUNG THAM , CHUN ZHANG , JOST B. JONAS , CHING-YU CHENG , TIEN YIN WONG , Ya Xing Wang
Purpose
To provide updated global and regional estimates of the prevalence and population burden of open-angle glaucoma (OAG), incorporating both demographic aging and the rising prevalence of myopia—a major risk factor that accelerates onset and increases OAG risk.
Design
Systematic review, meta-analysis, and global projection study.
Methods
A systematic review and meta-analysis (PROSPERO: CRD42024520990) of 77 population-based publications (1991–2023) were conducted to estimate current age- and region-specific OAG prevalence across Global Burden of Disease regions. OAG prevalence in 2060 was modeled based on associated risk ratios (RR: 1.9 [95% confidence interval (CI), 1.7–2.1]) and myopia trends synthesized from 57 publications. United Nations population data were integrated to estimate the affected population. Early-onset OAG (20–39 years) in 2060, attributable to high myopia, was estimated separately using projected high myopia prevalence and a pooled OAG prevalence of 4.4% (95% CI, 3.5%–5.3%) in this highly myopic younger population.
Results
Global OAG prevalence (≥40 years) is expected to rise from 2.8% (95% CI, 2.6%-3.0%) in 2024 to 3.5% (95% CI, 3.2%-3.8%) by 2060, with the affected population increasing from 80.5 (95% CI, 75.4-85.6) million to 186.6 (95% CI, 174.3-199.0) million. Aging and demographic changes account for an increase to 77.3 million, leaving the additional 28.9 million cases (27.2% of the total increase) attributed to the myopia epidemic. An estimated 6.1 (95% CI, 5.5-6.7) million early-onset OAG cases due to high myopia will bring the total global OAG population to 192.7 (95% CI, 180.4-205.1) million by 2060. East Asia will experience the greatest relative increase, with prevalence rising by 50.5% from 2.3% (95% CI, 1.8%-2.8%) to 3.4% (95% CI, 2.7%-4.2%).
Conclusions
There is a significant, previously underestimated, increase in OAG burden globally, driven by the rising prevalence of myopia. This adds additional OAG burden, particularly to younger populations less than 40 years. Thus, myopia prevention and new targeted screening strategies are important to tackle OAG, especially in regions with a high prevalence of myopia.
{"title":"Global Glaucoma Prevalence: Burden and Projection to 2060","authors":"ZIYAO WANG , CAN CAN XUE , YIMAN LI , YOU WU , ZHE PAN , FAN LI , CAROL Y. CHEUNG , KYOKO OHNO-MATSUI , David S FRIEDMAN , DAVID GARWAY-HEATH , LINDA M. ZANGWILL , BALWANTRAY C. CHAUHAN , CLAUDE F. BURGOYNE , YIH CHUNG THAM , CHUN ZHANG , JOST B. JONAS , CHING-YU CHENG , TIEN YIN WONG , Ya Xing Wang","doi":"10.1016/j.ajo.2025.12.013","DOIUrl":"10.1016/j.ajo.2025.12.013","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide updated global and regional estimates of the prevalence and population burden of open-angle glaucoma (OAG), incorporating both demographic aging and the rising prevalence of myopia—a major risk factor that accelerates onset and increases OAG risk.</div></div><div><h3>Design</h3><div>Systematic review, meta-analysis, and global projection study.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis (PROSPERO: CRD42024520990) of 77 population-based publications (1991–2023) were conducted to estimate current age- and region-specific OAG prevalence across Global Burden of Disease regions. OAG prevalence in 2060 was modeled based on associated risk ratios (RR: 1.9 [95% confidence interval (CI), 1.7–2.1]) and myopia trends synthesized from 57 publications. United Nations population data were integrated to estimate the affected population. Early-onset OAG (20–39 years) in 2060, attributable to high myopia, was estimated separately using projected high myopia prevalence and a pooled OAG prevalence of 4.4% (95% CI, 3.5%–5.3%) in this highly myopic younger population.</div></div><div><h3>Results</h3><div>Global OAG prevalence (≥40 years) is expected to rise from 2.8% (95% CI, 2.6%-3.0%) in 2024 to 3.5% (95% CI, 3.2%-3.8%) by 2060, with the affected population increasing from 80.5 (95% CI, 75.4-85.6) million to 186.6 (95% CI, 174.3-199.0) million. Aging and demographic changes account for an increase to 77.3 million, leaving the additional 28.9 million cases (27.2% of the total increase) attributed to the myopia epidemic. An estimated 6.1 (95% CI, 5.5-6.7) million early-onset OAG cases due to high myopia will bring the total global OAG population to 192.7 (95% CI, 180.4-205.1) million by 2060. East Asia will experience the greatest relative increase, with prevalence rising by 50.5% from 2.3% (95% CI, 1.8%-2.8%) to 3.4% (95% CI, 2.7%-4.2%).</div></div><div><h3>Conclusions</h3><div>There is a significant, previously underestimated, increase in OAG burden globally, driven by the rising prevalence of myopia. This adds additional OAG burden, particularly to younger populations less than 40 years. Thus, myopia prevention and new targeted screening strategies are important to tackle OAG, especially in regions with a high prevalence of myopia.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 324-335"},"PeriodicalIF":4.2,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784494","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}
Pub Date : 2025-12-17DOI: 10.1016/j.ajo.2025.12.009
Martin Ramirez , Ying Zheng , Victoria L. Tseng , Fei Yu , Joseph L. Demer , Anne L. Coleman
Purpose
To examine the associations between strabismus subtypes and glaucoma subtypes in California (CA) Medicare beneficiaries.
Design
Cross-sectional study.
Subjects
All 2019 CA Medicare beneficiaries who were ≥65 years old, had both Parts A & B coverage, and had ≥1 Part B claim.
Methods
The primary exposures were any strabismus and its subtypes including paralytic and vertical strabismus, esotropia, and exotropia, as defined by International Classification of Diseases, 10th revision (ICD-10) codes. Primary outcomes were any glaucoma, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG), defined by ICD-10 codes. The associations between strabismus and glaucoma were estimated using multivariable logistic regression models adjusting for age, sex, race and ethnicity, hyperopia, myopia, hyperthyroidism, and systemic disease burden defined by Charlson Comorbidity Index (CCI) score. The effect estimate was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).
Main Outcome Measures
Odds ratios between exposures and outcomes.
Results
The study population included 2,716,629 beneficiaries. Of those, 220,664 (8%) had glaucoma and 19,899 (1%) had strabismus. In the adjusted logistic regression models, beneficiaries with paralytic strabismus had a 78% increased odds of POAG (OR: 1.78; 95%; CI: 1.60-1.98; p < .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.10-3.62; p < .0001). Beneficiaries with vertical strabismus had an 80% increased odds of POAG (aOR: 1.80; 95% CI: 1.60-2.02; p < .0001) and 203% increased odds of NTG (aOR: 3.03; 95% CI: 2.28-4.02; p < .0001). Beneficiaries with esotropia had an 84% increased odds of POAG (aOR: 1.84; 95% CI: 1.66-2.03; p < .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.12-3.60; p < .0001). Beneficiaries with exotropia had a 170% increased odds of POAG (aOR: 2.70; 95% CI: 2.45-2.96; p < .0001) and 198% increased odds of NTG (aOR: 2.98; 95% CI: 2.24-3.97; p < .0001).
Conclusions
In the 2019 CA Medicare population, beneficiaries with strabismus and its subtypes were all associated with greater odds of POAG and NTG. Further investigations are needed to characterize the mechanisms between these associations, and future studies are needed to examine optimal glaucoma screening and management strategies in patients with strabismus.
目的探讨加州医保受益人斜视亚型和青光眼亚型之间的关系。DesignCross-sectional研究。所有2019年CA医疗保险受益人年龄≥65岁，同时拥有A部分和B部分保险，并且有≥1项B部分索赔。方法根据《国际疾病分类》第10版（ICD-10）规定，主要暴露对象为麻痹性斜视、垂直性斜视、内斜视和外斜视。主要结局是任何青光眼，原发性开角型青光眼（POAG）和正常张力型青光眼（NTG），由ICD-10代码定义。斜视和青光眼之间的关联使用多变量logistic回归模型进行估计，校正了年龄、性别、种族和民族、远视、近视、甲状腺功能亢进和由Charlson合并症指数（CCI）评分定义的全身性疾病负担。效应估计用校正优势比（aOR）表示，置信区间为95%。主要结果测量暴露与结果之间的比值。结果研究人群包括2716629名受益人。其中，220,664人（8%）患有青光眼，19,899人（1%）患有斜视。在调整后的logistic回归模型中，麻痹性斜视受益人POAG的几率增加78% (OR: 1.78; 95%; CI: 1.60-1.98; p < 0.0001)， NTG的几率增加175% （aOR: 2.75; 95% CI: 2.10-3.62; p < 0.0001）。垂直斜视患者POAG的发生率增加80% (aOR: 1.80; 95% CI: 1.60-2.02; p < 0.0001)， NTG的发生率增加203% （aOR: 3.03; 95% CI: 2.28-4.02; p < 0.0001）。内斜视患者POAG的发生率增加84% (aOR: 1.84; 95% CI: 1.66-2.03; p < 0.0001)， NTG的发生率增加175% （aOR: 2.75; 95% CI: 2.12-3.60; p < 0.0001）。外斜视受益人POAG的几率增加170% (aOR: 2.70; 95% CI: 2.45-2.96; p < 0.0001)， NTG的几率增加198% （aOR: 2.98; 95% CI: 2.24-3.97; p < 0.0001）。结论在2019年CA医保人群中，斜视及其亚型的受益人都与POAG和NTG的几率较大相关。需要进一步的研究来确定这些关联之间的机制，并且需要进一步的研究来检查斜视患者的最佳青光眼筛查和管理策略。
{"title":"Strabismus Increases Glaucoma Risk in California Medicare Beneficiaries","authors":"Martin Ramirez , Ying Zheng , Victoria L. Tseng , Fei Yu , Joseph L. Demer , Anne L. Coleman","doi":"10.1016/j.ajo.2025.12.009","DOIUrl":"10.1016/j.ajo.2025.12.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine the associations between strabismus subtypes and glaucoma subtypes in California (CA) Medicare beneficiaries.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Subjects</h3><div>All 2019 CA Medicare beneficiaries who were ≥65 years old, had both Parts A & B coverage, and had ≥1 Part B claim.</div></div><div><h3>Methods</h3><div>The primary exposures were any strabismus and its subtypes including paralytic and vertical strabismus, esotropia, and exotropia, as defined by International Classification of Diseases, 10th revision (ICD-10) codes. Primary outcomes were any glaucoma, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG), defined by ICD-10 codes. The associations between strabismus and glaucoma were estimated using multivariable logistic regression models adjusting for age, sex, race and ethnicity, hyperopia, myopia, hyperthyroidism, and systemic disease burden defined by Charlson Comorbidity Index (CCI) score. The effect estimate was expressed as an adjusted odds ratio (aOR) with a 95% confidence interval (CI).</div></div><div><h3>Main Outcome Measures</h3><div>Odds ratios between exposures and outcomes.</div></div><div><h3>Results</h3><div>The study population included 2,716,629 beneficiaries. Of those, 220,664 (8%) had glaucoma and 19,899 (1%) had strabismus. In the adjusted logistic regression models, beneficiaries with paralytic strabismus had a 78% increased odds of POAG (OR: 1.78; 95%; CI: 1.60-1.98; <em>p</em> < .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.10-3.62; <em>p</em> < .0001). Beneficiaries with vertical strabismus had an 80% increased odds of POAG (aOR: 1.80; 95% CI: 1.60-2.02; <em>p</em> < .0001) and 203% increased odds of NTG (aOR: 3.03; 95% CI: 2.28-4.02; <em>p</em> < .0001). Beneficiaries with esotropia had an 84% increased odds of POAG (aOR: 1.84; 95% CI: 1.66-2.03; <em>p</em> < .0001) and 175% increased odds of NTG (aOR: 2.75; 95% CI: 2.12-3.60; <em>p</em> < .0001). Beneficiaries with exotropia had a 170% increased odds of POAG (aOR: 2.70; 95% CI: 2.45-2.96; <em>p</em> < .0001) and 198% increased odds of NTG (aOR: 2.98; 95% CI: 2.24-3.97; <em>p</em> < .0001).</div></div><div><h3>Conclusions</h3><div>In the 2019 CA Medicare population, beneficiaries with strabismus and its subtypes were all associated with greater odds of POAG and NTG. Further investigations are needed to characterize the mechanisms between these associations, and future studies are needed to examine optimal glaucoma screening and management strategies in patients with strabismus.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 199-206"},"PeriodicalIF":4.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784500","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}
Pub Date : 2025-12-17DOI: 10.1016/j.ajo.2025.12.010
Claudia Wong , Urjita Das , He Forbes , Taylor Kolosky , Euna Cho , Shaiza Mansoor , Sera Chase , Madi Kore , Riva Menon , Moran Roni Levin , Larry Magder , Carolyn Drews-Botsch , Scott R. Lambert , Janet L. Alexander
Purpose
Glaucoma following congenital cataract surgery is the most common secondary form of glaucoma in children and a serious sight-threatening complication following congenital cataract surgery. Therefore, risk assessment for future glaucoma is integral to the management of infants undergoing cataract surgery. Biometry of the anterior segment may offer the opportunity to enhance estimation of an infant’s risk of developing glaucoma. This study aims to use preoperative anterior segment biometry to predict future glaucoma among infants undergoing congenital cataract surgery and provide a risk calculator based on predictive models.
Design
Posthoc cohort analysis from a multicenter randomized controlled trial in the United States (NCT00212134).
Participants
This cohort included 114 participants with unilateral congenital cataract who underwent cataract surgery between 2004 and 2007 and were followed for 10.5 years as part of the Infant Aphakia Treatment Study. A total of 110 participants were analyzed. A total of 88 participants had at least one biometry measurement available. Overall, 41% of the cohort was diagnosed as glaucoma or glaucoma suspect by study endpoint.
Methods
Preoperative biometry measured on the day of cataract surgery was used to collect anterior chamber depth (ACD) and lens thickness. Subject characteristics, corneal diameter, and axial length were included in logistic regression analysis. ACD was the primary predictor of interest, and glaucoma or glaucoma suspect status at 10.5 years was the primary outcome of interest.
Main Outcome Measures
The main outcome measures were model coefficients and odds ratios with 95% confidence intervals for glaucoma or glaucoma suspect diagnosis at 10.5 years following congenital cataract surgery.
Results
Subjects with glaucoma had ACD of 2.76 ± 0.48 mm compared to 3.08 ± 0.38 mm among subjects without glaucoma or glaucoma suspect (mean difference = 0.32 mm, P = .003). Logistic regression models found shallower ACD was a strong predictor of glaucoma (OR 5.8 [1.8, 18.9], P = .004), compared to shorter axial length (OR 1.0 [0.7, 1.4], P = .9), thinner lens (OR 1.5 [0.7, 3.1], P = .3), decreased corneal diameter (OR 1.6 [0.95, 2.9], P = .08), and younger age (OR 1.01 [1.0, 1.02], P = .04).
Conclusions
ACD has a significant association with glaucoma following congenital cataract surgery.
目的先天性白内障术后青光眼是儿童青光眼最常见的继发性形式，也是先天性白内障术后严重的视力威胁并发症。因此，对未来青光眼的风险评估对于接受白内障手术的婴儿的管理是不可或缺的。前段生物测量可以提供机会，以提高估计婴儿发展青光眼的风险。本研究旨在利用术前前段生物测量技术预测先天性白内障手术婴儿未来青光眼的发生，并提供基于预测模型的风险计算器。来自美国多中心随机对照试验（NCT00212134）的设计后队列分析。该队列包括114名单侧先天性白内障患者，他们在2004年至2007年间接受了白内障手术，作为婴儿无晶状体治疗研究的一部分，随访了10.5年。总共对110名参与者进行了分析。共有88名参与者至少有一种生物测量方法可用。总体而言，41%的队列在研究终点被诊断为青光眼或疑似青光眼。方法采用白内障手术当日行术前生物测量术，采集前房深度（ACD）和晶状体厚度。受试者特征、角膜直径和眼轴长度纳入logistic回归分析。ACD是关注的主要预测因素，青光眼或青光眼疑似状态在10.5年时是关注的主要结果。主要结局指标主要结局指标为先天性白内障手术后10.5年青光眼或疑似青光眼诊断的模型系数和优势比（95%置信区间）。结果青光眼组ACD为2.76±0.48 mm，非青光眼组和疑似青光眼组ACD为3.08±0.38 mm（平均差 = 0.32 mm, P = .003）。Logistic回归模型发现浅ACD是青光眼的重要预测因子（OR 5.8 [1.8, 18.9], P = ）。004)，与较短的轴向长度相比(OR 1.0 [0.7, 1.4], P = 。9)，更薄的透镜(OR 1.5 [0.7, 3.1], P = 。3)，角膜直径减小(OR 1.6 [0.95, 2.9], P = 。08年)和年轻的年龄(1.01 [1.0,1.02],P = .04点)。结论先天性白内障术后青光眼与sacd有显著相关性。
{"title":"Predicting 10 Year Glaucoma Using Anterior Segment Biometry for Infants with Unilateral Congenital Cataract","authors":"Claudia Wong , Urjita Das , He Forbes , Taylor Kolosky , Euna Cho , Shaiza Mansoor , Sera Chase , Madi Kore , Riva Menon , Moran Roni Levin , Larry Magder , Carolyn Drews-Botsch , Scott R. Lambert , Janet L. Alexander","doi":"10.1016/j.ajo.2025.12.010","DOIUrl":"10.1016/j.ajo.2025.12.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Glaucoma following congenital cataract surgery is the most common secondary form of glaucoma in children and a serious sight-threatening complication following congenital cataract surgery. Therefore, risk assessment for future glaucoma is integral to the management of infants undergoing cataract surgery. Biometry of the anterior segment may offer the opportunity to enhance estimation of an infant’s risk of developing glaucoma. This study aims to use preoperative anterior segment biometry to predict future glaucoma among infants undergoing congenital cataract surgery and provide a risk calculator based on predictive models.</div></div><div><h3>Design</h3><div>Posthoc cohort analysis from a multicenter randomized controlled trial in the United States (NCT00212134).</div></div><div><h3>Participants</h3><div>This cohort included 114 participants with unilateral congenital cataract who underwent cataract surgery between 2004 and 2007 and were followed for 10.5 years as part of the Infant Aphakia Treatment Study. A total of 110 participants were analyzed. A total of 88 participants had at least one biometry measurement available. Overall, 41% of the cohort was diagnosed as glaucoma or glaucoma suspect by study endpoint.</div></div><div><h3>Methods</h3><div>Preoperative biometry measured on the day of cataract surgery was used to collect anterior chamber depth (ACD) and lens thickness. Subject characteristics, corneal diameter, and axial length were included in logistic regression analysis. ACD was the primary predictor of interest, and glaucoma or glaucoma suspect status at 10.5 years was the primary outcome of interest.</div></div><div><h3>Main Outcome Measures</h3><div>The main outcome measures were model coefficients and odds ratios with 95% confidence intervals for glaucoma or glaucoma suspect diagnosis at 10.5 years following congenital cataract surgery.</div></div><div><h3>Results</h3><div>Subjects with glaucoma had ACD of 2.76 ± 0.48 mm compared to 3.08 ± 0.38 mm among subjects without glaucoma or glaucoma suspect (mean difference = 0.32 mm, <em>P</em> = .003). Logistic regression models found shallower ACD was a strong predictor of glaucoma (OR 5.8 [1.8, 18.9], <em>P</em> = .004), compared to shorter axial length (OR 1.0 [0.7, 1.4], <em>P</em> = .9), thinner lens (OR 1.5 [0.7, 3.1], <em>P</em> = .3), decreased corneal diameter (OR 1.6 [0.95, 2.9], <em>P</em> = .08), and younger age (OR 1.01 [1.0, 1.02], <em>P</em> = .04).</div></div><div><h3>Conclusions</h3><div>ACD has a significant association with glaucoma following congenital cataract surgery.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 207-213"},"PeriodicalIF":4.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784499","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}
Pub Date : 2025-12-17DOI: 10.1016/j.ajo.2025.12.004
Jarryl H.J. Tsai , Emmanuel J. Tan , Jonathan T.W. Au Eong , Sachin M. George , Kah-Guan Au Eong
Topic
This systematic review and meta-analysis evaluates whether fibrin glue provides superior outcomes compared to sutures for securing conjunctival autografts in primary pterygium surgery. We focused on recurrence rates, operative time, postoperative complications, and patient discomfort.
Clinical Relevance
Pterygium recurrence and postoperative morbidity remain significant concerns in ocular surface surgery. A growing number of surgeons are adopting fibrin glue instead of sutures to anchor conjunctival autografts, but the evidence on comparative effectiveness has evolved in recent years. This updated analysis aims to guide surgical practice with the most current data.
Methods
We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL on 8 November 2024. We included randomized controlled trials (RCTs) comparing fibrin glue versus sutures in primary pterygium surgery. Studies were screened, selected, and data-extracted by two independent reviewers. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool. The review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024520625).
Results
Twenty RCTs were included. Fibrin glue significantly reduced recurrence risk compared to sutures (pooled odds ratio: 2.46; 95% CI: 1.06-5.69; 27 P = .0352; I2 = 0%). Operative time was significantly shorter with fibrin glue (pooled mean difference: 15.65 29 minutes; 95% CI: 11.45-19.86; P < .005; I2 = 99.29%). Pain scores at postoperative day 1 were significantly lower with fibrin glue compared with sutures (pooled standardized mean difference: 1.32; 95% CI: -2.11 to -0.52; p < .001; I2 = 90%). Rates of graft retraction were inconsistent between the two groups, while subconjunctival hemorrhages were more common in the suture group.
Conclusion
Fibrin glue is associated with lower recurrence rates, reduced operative time, and less postoperative discomfort than sutures in primary pterygium surgery. However, variability in graft retraction outcomes warrants further investigation. These findings support the broader adoption of fibrin glue as a preferred technique for conjunctival autograft fixation in routine clinical practice.
本系统综述和荟萃分析评估了在原发性翼状胬肉手术中，纤维蛋白胶与缝合线相比是否能提供更好的自体结膜移植效果。我们关注的是复发率、手术时间、术后并发症和患者不适。在眼表手术中，翼状胬肉的复发和术后发病率仍然是值得关注的问题。越来越多的外科医生采用纤维蛋白胶代替缝合线来固定自体结膜移植物，但近年来关于相对有效性的证据有所进展。这一最新的分析旨在用最新的数据指导外科实践。方法于2024年11月8日检索PubMed、Embase、Cochrane CENTRAL、Web of Science和CINAHL。我们纳入了比较纤维蛋白胶和缝合线在原发性翼状胬肉手术中的疗效的随机对照试验。研究由两名独立的审稿人筛选、选择和提取数据。采用随机效应模型进行meta分析。使用Cochrane RoB 2工具评估偏倚风险。该审查按照PRISMA指南进行，并在PROSPERO （ID: CRD42024520625）上注册。结果共纳入20项随机对照试验。与缝合相比，纤维蛋白胶显著降低复发风险（合并优势比：2.46;95% CI: 1.06-5.69; 27 P = .0352;I2 = 0%）。纤维蛋白胶组手术时间明显缩短（合并平均差异：15.65 29分钟；95% CI: 11.45-19.86; P <； .005;I2 = 99.29%）。术后第1天纤维蛋白胶组疼痛评分明显低于缝合组（合并标准化平均差：1.32;95% CI: -2.11 ~ -0.52; p <； .001;I2 = 90%）。两组间移植物缩回率不一致，而结膜下出血在缝合组更为常见。结论纤维蛋白胶在原发性翼状胬肉手术中的复发率较缝合线低，手术时间短，术后不适少。然而，移植物牵伸结果的可变性值得进一步研究。这些发现支持纤维蛋白胶在常规临床实践中作为自体结膜固定的首选技术。
{"title":"Fibrin Glue Versus Sutures for Securing Conjunctival Autograft in Primary Pterygium Surgery: A Systematic Review and Meta-Analysis","authors":"Jarryl H.J. Tsai , Emmanuel J. Tan , Jonathan T.W. Au Eong , Sachin M. George , Kah-Guan Au Eong","doi":"10.1016/j.ajo.2025.12.004","DOIUrl":"10.1016/j.ajo.2025.12.004","url":null,"abstract":"<div><h3>Topic</h3><div>This systematic review and meta-analysis evaluates whether fibrin glue provides superior outcomes compared to sutures for securing conjunctival autografts in primary pterygium surgery. We focused on recurrence rates, operative time, postoperative complications, and patient discomfort.</div></div><div><h3>Clinical Relevance</h3><div>Pterygium recurrence and postoperative morbidity remain significant concerns in ocular surface surgery. A growing number of surgeons are adopting fibrin glue instead of sutures to anchor conjunctival autografts, but the evidence on comparative effectiveness has evolved in recent years. This updated analysis aims to guide surgical practice with the most current data.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL on 8 November 2024. We included randomized controlled trials (RCTs) comparing fibrin glue versus sutures in primary pterygium surgery. Studies were screened, selected, and data-extracted by two independent reviewers. Meta-analysis was performed using a random-effects model. Risk of bias was assessed using the Cochrane RoB 2 tool. The review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024520625).</div></div><div><h3>Results</h3><div>Twenty RCTs were included. Fibrin glue significantly reduced recurrence risk compared to sutures (pooled odds ratio: 2.46; 95% CI: 1.06-5.69; 27 P = .0352; I<sup>2</sup> = 0%). Operative time was significantly shorter with fibrin glue (pooled mean difference: 15.65 29 minutes; 95% CI: 11.45-19.86; P < .005; I<sup>2</sup> = 99.29%). Pain scores at postoperative day 1 were significantly lower with fibrin glue compared with sutures (pooled standardized mean difference: 1.32; 95% CI: -2.11 to -0.52; p < .001; I<sup>2</sup> = 90%). Rates of graft retraction were inconsistent between the two groups, while subconjunctival hemorrhages were more common in the suture group.</div></div><div><h3>Conclusion</h3><div>Fibrin glue is associated with lower recurrence rates, reduced operative time, and less postoperative discomfort than sutures in primary pterygium surgery. However, variability in graft retraction outcomes warrants further investigation. These findings support the broader adoption of fibrin glue as a preferred technique for conjunctival autograft fixation in routine clinical practice.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 313-323"},"PeriodicalIF":4.2,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784498","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}
Pub Date : 2025-12-16DOI: 10.1016/j.ajo.2025.11.049
KARTHIK REDDY , AMY D. ZHANG
{"title":"Comment on A Scoping Review of Ergonomics in Ophthalmology: Working Smarter","authors":"KARTHIK REDDY , AMY D. ZHANG","doi":"10.1016/j.ajo.2025.11.049","DOIUrl":"10.1016/j.ajo.2025.11.049","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 337-338"},"PeriodicalIF":4.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777357","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}
Pub Date : 2025-12-15DOI: 10.1016/j.ajo.2025.12.005
Lan Xia , Wuhong Weng , Jing Wang , Lingyu Dai , Suo Guo , Yanlin Pu , Tao Cai , Peizeng Yang
Objective
To quantify global, regional, and national burdens of blindness and vision loss among females from 1990 to 2021 and to assess age patterns, trends, causes, and risk factors contributing to sex disparities.
Design
Retrospective cohort analysis using publicly available, deidentified data from the Global Burden of Disease (GBD) 2021 study.
Participants
Females across 204 countries and territories included in GBD 2021. Sex-specific estimates were analyzed; no identifiable human subjects were involved.
Methods
Deidentified GBD 2021 data were analyzed using R (4.3.2) and Joinpoint regression. Prevalence and Years Lived with Disability (YLDs = prevalence × disability weight) were estimated globally and stratified by age, geography, and Sociodemographic Index. Descriptive analyses assessed trends from 1990 to 2021. Mapping illustrated regional distribution and estimated annual percentage change. Cause- and risk-factor analyses followed standardized GBD methods.
Main Outcome Measures
Age-standardized and age-specific prevalence and YLD rates; leading causes; risk-factor–attributable YLDs; and temporal patterns by estimated annual percentage change.
Results
In 2021, females had a 27.1% higher prevalence of blindness and vision loss and a 17.2% higher YLD rate than males. Age-standardized prevalence and YLDs were 14,510.97 and 17,010.96 per 100,000. Burdens were highest in low- and middle-Sociodemographic Index regions. Near vision loss, cataract, and refractive disorders were leading causes; major contributors included air pollution, high BMI, and household air pollution. Women ≥70 years bore the highest disability burden. Joinpoint analysis showed a persistent increase in female YLDs without a clear COVID-19–related inflection. Limitations include modeled estimates and regional data heterogeneity.
Conclusions
Females worldwide continue to experience a disproportionate burden of blindness and vision loss, especially in lower-resource settings and older age groups. Gender-responsive strategies and expanded access to eye care are urgently needed.
{"title":"The Right to Women’s Sight: Global, Regional, and National Burden of Blindness and Vision Loss in Women, 1990 to 2021","authors":"Lan Xia , Wuhong Weng , Jing Wang , Lingyu Dai , Suo Guo , Yanlin Pu , Tao Cai , Peizeng Yang","doi":"10.1016/j.ajo.2025.12.005","DOIUrl":"10.1016/j.ajo.2025.12.005","url":null,"abstract":"<div><h3>Objective</h3><div>To quantify global, regional, and national burdens of blindness and vision loss among females from 1990 to 2021 and to assess age patterns, trends, causes, and risk factors contributing to sex disparities.</div></div><div><h3>Design</h3><div>Retrospective cohort analysis using publicly available, deidentified data from the Global Burden of Disease (GBD) 2021 study.</div></div><div><h3>Participants</h3><div>Females across 204 countries and territories included in GBD 2021. Sex-specific estimates were analyzed; no identifiable human subjects were involved.</div></div><div><h3>Methods</h3><div>Deidentified GBD 2021 data were analyzed using R (4.3.2) and Joinpoint regression. Prevalence and Years Lived with Disability (YLDs = prevalence × disability weight) were estimated globally and stratified by age, geography, and Sociodemographic Index. Descriptive analyses assessed trends from 1990 to 2021. Mapping illustrated regional distribution and estimated annual percentage change. Cause- and risk-factor analyses followed standardized GBD methods.</div></div><div><h3>Main Outcome Measures</h3><div>Age-standardized and age-specific prevalence and YLD rates; leading causes; risk-factor–attributable YLDs; and temporal patterns by estimated annual percentage change.</div></div><div><h3>Results</h3><div>In 2021, females had a 27.1% higher prevalence of blindness and vision loss and a 17.2% higher YLD rate than males. Age-standardized prevalence and YLDs were 14,510.97 and 17,010.96 per 100,000. Burdens were highest in low- and middle-Sociodemographic Index regions. Near vision loss, cataract, and refractive disorders were leading causes; major contributors included air pollution, high BMI, and household air pollution. Women ≥70 years bore the highest disability burden. Joinpoint analysis showed a persistent increase in female YLDs without a clear COVID-19–related inflection. Limitations include modeled estimates and regional data heterogeneity.</div></div><div><h3>Conclusions</h3><div>Females worldwide continue to experience a disproportionate burden of blindness and vision loss, especially in lower-resource settings and older age groups. Gender-responsive strategies and expanded access to eye care are urgently needed.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 227-255"},"PeriodicalIF":4.2,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145771386","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}
Pub Date : 2025-12-13DOI: 10.1016/j.ajo.2025.12.008
Suraj Bala , Nitesh Mohan , Victor Bellanda , Andrea Arline , Gabriel Castilho S. Barbosa , Matthew Schulgit , Sumit Sharma , Sunil K. Srivastava , Danny A. Mammo , Ananth Sastry
Purpose
To determine if phacoemulsification impacts vitreomacular traction (VMT) release and VMT-related complications.
310 eyes of 249 patients with a concurrent diagnosis of VMT and cataracts at the Cole Eye Institute between 2013 and 2024.
Methods
Eligible eyes had at least 6 months of follow-up post-VMT diagnosis or phacoemulsification. The control group included eyes that did not undergo phacoemulsification after VMT diagnosis. Clinical information was collected via manual chart review. Characteristics of VMT were recorded via review of optical coherence tomography imaging.
Main Outcome Measures
The primary outcome was the hazard of VMT release. Secondary outcomes included VMT-related complications, such as macular and lamellar hole formation, retinal detachment, and subsequent vitrectomy.
Results
VMT release occurred in 49.4% of 310 eyes, with an average follow-up period of 136.7 ± 134.4 weeks. There was no significant difference in release between the phacoemulsification and control groups (adjusted hazard ratio [aHR] = 0.861; P = .380). Among eyes that released, the mean time to release was 79.4 ± 68.8 weeks postsurgery in the phacoemulsification group and 76.0 ± 81.9 weeks from diagnosis in the control group (P = .785). In multivariate analysis, younger age at diagnosis (5-year aHR = 0.773; P < .001) and smaller adhesion diameter (per 100 µm aHR = 0.951; P = .017) were significantly associated with a higher likelihood of VMT release. Black patients had a lower likelihood of VMT release compared to White patients (aHR = 0.439; P = .004). Eyes that developed a macular hole had a smaller baseline adhesion diameter than those that did not (439.1 ± 217.9 µm vs 685.7 ± 697.4 µm; P < .001).
Conclusions
Phacoemulsification was not associated with increased rates or faster timing of VMT release. These findings suggest that intrinsic patient and anatomical factors play a larger role in determining the likelihood of VMT release and should be prioritized in clinical decision-making.
目的探讨超声乳化术对玻璃体黄斑牵引力（VMT）释放及相关并发症的影响。设计：单中心、比较、回顾性临床队列研究。研究对象：2013年至2024年间在科尔眼科研究所同时诊断为VMT和白内障的249例患者共310只眼睛。方法符合条件的眼在vmt诊断或超声乳化术后随访至少6个月。对照组为VMT诊断后未行超声乳化术的眼睛。临床资料收集通过手工图表审查。通过回顾光学相干断层成像记录VMT的特征。主要观察指标：主要观察指标为VMT释放风险。次要结果包括vmt相关并发症，如黄斑和板层空洞形成，视网膜脱离，以及随后的玻璃体切除术。结果310只眼vmt释放率为49.4%，平均随访时间136.7±134.4周。超声乳化术组与对照组释放量差异无统计学意义（校正风险比[aHR] = 0.861; P = 0.380）。释放眼中，超声乳化术组平均释放时间为术后79.4±68.8周，对照组平均释放时间为诊断后76.0±81.9周（P = .785）。在多因素分析中，诊断时年龄较小（5年aHR = 0.773; P < .001）和粘连直径较小（每100µm aHR = 0.951; P = 0.017）与VMT释放的可能性较高显著相关。与白人患者相比，黑人患者VMT释放的可能性较低（aHR = 0.439; P = 0.004）。出现黄斑孔的眼睛的黏附直径基线小于未出现黄斑孔的眼睛（439.1±217.9µm vs 685.7±697.4µm; P < .001）。结论超声乳化术与VMT释放率升高或释放时间加快无关。这些发现表明，患者的内在因素和解剖因素在决定VMT释放的可能性方面起着更大的作用，应在临床决策中优先考虑。
{"title":"Impact of Phacoemulsification on Vitreomacular Traction Release and Complications","authors":"Suraj Bala , Nitesh Mohan , Victor Bellanda , Andrea Arline , Gabriel Castilho S. Barbosa , Matthew Schulgit , Sumit Sharma , Sunil K. Srivastava , Danny A. Mammo , Ananth Sastry","doi":"10.1016/j.ajo.2025.12.008","DOIUrl":"10.1016/j.ajo.2025.12.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine if phacoemulsification impacts vitreomacular traction (VMT) release and VMT-related complications.</div></div><div><h3>Design</h3><div>Single-center, comparative, retrospective clinical cohort study.</div></div><div><h3>Subjects: A total of</h3><div>310 eyes of 249 patients with a concurrent diagnosis of VMT and cataracts at the Cole Eye Institute between 2013 and 2024.</div></div><div><h3>Methods</h3><div>Eligible eyes had at least 6 months of follow-up post-VMT diagnosis or phacoemulsification. The control group included eyes that did not undergo phacoemulsification after VMT diagnosis. Clinical information was collected via manual chart review. Characteristics of VMT were recorded via review of optical coherence tomography imaging.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the hazard of VMT release. Secondary outcomes included VMT-related complications, such as macular and lamellar hole formation, retinal detachment, and subsequent vitrectomy.</div></div><div><h3>Results</h3><div>VMT release occurred in 49.4% of 310 eyes, with an average follow-up period of 136.7 ± 134.4 weeks. There was no significant difference in release between the phacoemulsification and control groups (adjusted hazard ratio [aHR] = 0.861; <em>P</em> = .380). Among eyes that released, the mean time to release was 79.4 ± 68.8 weeks postsurgery in the phacoemulsification group and 76.0 ± 81.9 weeks from diagnosis in the control group (<em>P</em> = .785). In multivariate analysis, younger age at diagnosis (5-year aHR = 0.773; <em>P</em> < .001) and smaller adhesion diameter (per 100 µm aHR = 0.951; <em>P</em> = .017) were significantly associated with a higher likelihood of VMT release. Black patients had a lower likelihood of VMT release compared to White patients (aHR = 0.439; <em>P</em> = .004). Eyes that developed a macular hole had a smaller baseline adhesion diameter than those that did not (439.1 ± 217.9 µm vs 685.7 ± 697.4 µm; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Phacoemulsification was not associated with increased rates or faster timing of VMT release. These findings suggest that intrinsic patient and anatomical factors play a larger role in determining the likelihood of VMT release and should be prioritized in clinical decision-making.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 176-187"},"PeriodicalIF":4.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731919","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}
Pub Date : 2025-12-12DOI: 10.1016/j.ajo.2025.12.006
Tracy Z. Lang , Khristina I. Lung , Kyle A. Bolo , Brian C. Toy , Benjamin Y. Xu
Objective
To evaluate the incidence and risk factors of acute angle closure (AAC) following dilation in a nationwide healthcare claims database.
Design
Retrospective cohort study.
Participants
Patients who underwent dilation by an ophthalmologist/optometrist between January 2007 and December 2021 were identified by Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System codes for comprehensive eye exam, extended ophthalmoscopy, or dilated fundus exam. Patients with AAC/primary angle closure glaucoma diagnosis before the first dilation were excluded.
Methods
AAC risk was assessed under two definitions. Definition 1 (more sensitive and inclusive): International Classification of Diseases code for AAC glaucoma within 14 days of dilation; Definition 2 (more specific and exclusive): Definition 1 plus CPT code for iridotomy/iridectomy or lens extraction within 14 days of AAC diagnosis. Dilations after the first AAC diagnosis were excluded. Multivariable logistic regression was performed to assess factors associated with AAC diagnosis by comparing patients who received an AAC diagnosis with those that did not.
Main Outcome Measures
AAC under two definitions based on International Classification of Diseases/CPT codes.
Results
A total of 11,452,733 patients underwent 26,478,250 dilations. The incidence of AAC diagnosis per dilation was 0.01% under Definition 1 and 0.004% under Definition 2. Older age compared to <40 years (OR ≥ 3.26, P < .001), Asian race and Hispanic ethnicity compared to non-Hispanic Whites (OR ≥ 1.38, P < .001), and prior angle closure diagnosis (OR ≥ 12.74, P < .001) conferred higher odds of AAC diagnosis under both definitions. Income ≥$100,000 compared to <$40,000 (OR ≤ 0.83, P < .001), non-Northeast regions (OR ≤ 0.74, P ≤ .002), and pseudophakia status (OR ≤ 0.73, P < .001) conferred lower odds of AAC diagnosis under both definitions. Female sex (OR = 1.19, P < .001), non-HMO insurance (OR ≥ 1.19, P ≤ .006), and Black race (OR = 1.18, P = .003) conferred higher odds of AAC diagnosis under Definition 1.
Conclusions
In a nationwide cohort, the risk of AAC diagnosis following dilation ranged from around 1 in 7,000 to 26,000 dilations. Given the apparent safety of dilation and its importance in comprehensive eye exams and teleretinal care, further discussions regarding concerns about AAC with dilation are warranted.
{"title":"Safety of Pharmacologic Dilation: Incidence and Risk Factors of Acute Angle Closure in a Nationwide Cohort","authors":"Tracy Z. Lang , Khristina I. Lung , Kyle A. Bolo , Brian C. Toy , Benjamin Y. Xu","doi":"10.1016/j.ajo.2025.12.006","DOIUrl":"10.1016/j.ajo.2025.12.006","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence and risk factors of acute angle closure (AAC) following dilation in a nationwide healthcare claims database.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Participants</h3><div>Patients who underwent dilation by an ophthalmologist/optometrist between January 2007 and December 2021 were identified by Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System codes for comprehensive eye exam, extended ophthalmoscopy, or dilated fundus exam. Patients with AAC/primary angle closure glaucoma diagnosis before the first dilation were excluded.</div></div><div><h3>Methods</h3><div>AAC risk was assessed under two definitions. Definition 1 (more sensitive and inclusive): International Classification of Diseases code for AAC glaucoma within 14 days of dilation; Definition 2 (more specific and exclusive): Definition 1 plus CPT code for iridotomy/iridectomy or lens extraction within 14 days of AAC diagnosis. Dilations after the first AAC diagnosis were excluded. Multivariable logistic regression was performed to assess factors associated with AAC diagnosis by comparing patients who received an AAC diagnosis with those that did not.</div></div><div><h3>Main Outcome Measures</h3><div>AAC under two definitions based on International Classification of Diseases/CPT codes.</div></div><div><h3>Results</h3><div>A total of 11,452,733 patients underwent 26,478,250 dilations. The incidence of AAC diagnosis per dilation was 0.01% under Definition 1 and 0.004% under Definition 2. Older age compared to <40 years (OR ≥ 3.26, <em>P</em> < .001), Asian race and Hispanic ethnicity compared to non-Hispanic Whites (OR ≥ 1.38, <em>P</em> < .001), and prior angle closure diagnosis (OR ≥ 12.74, <em>P</em> < .001) conferred higher odds of AAC diagnosis under both definitions. Income ≥$100,000 compared to <$40,000 (OR ≤ 0.83, <em>P</em> < .001), non-Northeast regions (OR ≤ 0.74, <em>P</em> ≤ .002), and pseudophakia status (OR ≤ 0.73, <em>P</em> < .001) conferred lower odds of AAC diagnosis under both definitions. Female sex (OR = 1.19, <em>P</em> < .001), non-HMO insurance (OR ≥ 1.19, <em>P</em> ≤ .006), and Black race (OR = 1.18, <em>P</em> = .003) conferred higher odds of AAC diagnosis under Definition 1.</div></div><div><h3>Conclusions</h3><div>In a nationwide cohort, the risk of AAC diagnosis following dilation ranged from around 1 in 7,000 to 26,000 dilations. Given the apparent safety of dilation and its importance in comprehensive eye exams and teleretinal care, further discussions regarding concerns about AAC with dilation are warranted.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"283 ","pages":"Pages 138-148"},"PeriodicalIF":4.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145731052","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}
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