Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2024.100115
Kaidi Xiang , Jingjing Wang , Zhuoting Zhu , Xinzi Zhang , Bo Zhang , Jun Chen , Jinliuxing Yang , Linlin Du , Zhijian Ai , Xiangui He , Xun Xu
Purpose
To investigate longitudinal changes in choroidal thickness (ChT) after 1-year treatment of repeated low-level red-light (RLRL) and their predictive value in efficacy on myopia prevention and myopic shift among pre-myopic children.
Methods
278 pre-myopic (-0.50 D < spherical equivalent refraction, SER ≤ 0.50 D) participants were assigned to the RLRL group and control group randomly and evenly. The OCT, visual acuity, AL, SER and other parameters were measured before enrollment and every 3 months after intervention. The data from both eyes of the included participants were analyzed.
Results
A total of 463 eyes were analyzed. Due to the COVID-19 pandemic, 176 participants in the RLRL group had treatment interrupted. The continued RLRL group, interrupted RLRL group and control group were well balanced in baseline characteristics. In the continued and interrupted RLRL group, the average ChT increased significantly at 3-month visit (all P < 0.001) and the subfoveal ChT thickened evidently. The area under the curve (AUC) for the models including gender and 3-month change in ChT to predict satisfactory myopia prevention at 12 months was 0.983. The efficacy of the models that also used the combined indicators of baseline age, gender and the 3-month change in ChT to predict AL progression control over 12 months reached 0.944.
Conclusions
Continued RLRL intervention induced notable thickening of ChT in premyopic population, especially at the subfoveal sector. For participants received RLRL treatment, the 3-month change in ChT combined with other baseline factors have acceptable predictive discrimination of myopia prevention efficacy.
目的：探讨反复低水平红灯（RLRL）治疗1年后，准近视儿童脉络膜厚度（ChT）的纵向变化及其对近视预防和近视转移效果的预测价值。方法：278例近视前期患者（-0.50 D <球面等效屈光度，SER≤0.50 D）随机均匀分为RLRL组和对照组。在入组前及干预后每3个月测量一次OCT、视力、AL、SER等参数。对被试者双眼的数据进行分析。结果：共分析463只眼。由于COVID-19大流行，RLRL组的176名参与者的治疗中断。继续RLRL组、中断RLRL组和对照组的基线特征平衡良好。在RLRL持续组和中断组，平均ChT在3个月时显著增加（均P < 0.001），中央凹下ChT明显增厚。包括性别和3个月ChT变化的模型预测12个月时满意的近视预防的曲线下面积（AUC）为0.983。同时使用基线年龄、性别、3个月ChT变化联合指标预测12个月AL进展控制的模型的疗效达到0.944。结论：持续的RLRL干预在近视人群中引起了明显的ChT增厚，特别是在中央凹下区。对于接受RLRL治疗的参与者，3个月的ChT变化结合其他基线因素对近视预防效果具有可接受的预测性区分。
{"title":"Changes in choroidal thickness in pre-myopic children after repeated low-level red-light therapy and their role in predicting myopia prevention and controlling myopic shift","authors":"Kaidi Xiang , Jingjing Wang , Zhuoting Zhu , Xinzi Zhang , Bo Zhang , Jun Chen , Jinliuxing Yang , Linlin Du , Zhijian Ai , Xiangui He , Xun Xu","doi":"10.1016/j.apjo.2024.100115","DOIUrl":"10.1016/j.apjo.2024.100115","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate longitudinal changes in choroidal thickness (ChT) after 1-year treatment of repeated low-level red-light (RLRL) and their predictive value in efficacy on myopia prevention and myopic shift among pre-myopic children.</div></div><div><h3>Methods</h3><div>278 pre-myopic (-0.50 D < spherical equivalent refraction, SER ≤ 0.50 D) participants were assigned to the RLRL group and control group randomly and evenly. The OCT, visual acuity, AL, SER and other parameters were measured before enrollment and every 3 months after intervention. The data from both eyes of the included participants were analyzed.</div></div><div><h3>Results</h3><div>A total of 463 eyes were analyzed. Due to the COVID-19 pandemic, 176 participants in the RLRL group had treatment interrupted. The continued RLRL group, interrupted RLRL group and control group were well balanced in baseline characteristics. In the continued and interrupted RLRL group, the average ChT increased significantly at 3-month visit (all <em>P</em> < 0.001) and the subfoveal ChT thickened evidently. The area under the curve (AUC) for the models including gender and 3-month change in ChT to predict satisfactory myopia prevention at 12 months was 0.983. The efficacy of the models that also used the combined indicators of baseline age, gender and the 3-month change in ChT to predict AL progression control over 12 months reached 0.944.</div></div><div><h3>Conclusions</h3><div>Continued RLRL intervention induced notable thickening of ChT in premyopic population, especially at the subfoveal sector. For participants received RLRL treatment, the 3-month change in ChT combined with other baseline factors have acceptable predictive discrimination of myopia prevention efficacy.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100115"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Utilizing generative AI in ophthalmic medical paper writing: Applications, limitations, and practical tools","authors":"Fang-Yu Hu , Le-Yu Chen , Pin-Jung Cheng, Jen-Yu Liu, Jo-Hsuan Wu, Wei-Li Chen","doi":"10.1016/j.apjo.2025.100174","DOIUrl":"10.1016/j.apjo.2025.100174","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100174"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100180
Yen-Ting Chen , Nishant V. Radke , Sohani Amarasekera , Dong Ho Park , Nelson Chen , Jay Chhablani , Nan-Kai Wang , Wei-Chi Wu , Danny S.C. Ng , Pramod Bhende , Shobhit Varma , Enne Leung , Xiulan Zhang , Fei Li , Shaochong Zhang , Dong Fang , Jia Liang , Zheming Zhang , Huanyu Liu , Peiquan Zhao , Dennis S.C. Lam
Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss globally. This is a comprehensive review focused on both medical and surgical management strategies for DR and DME. This review highlights the epidemiology of DR and DME, with a particular emphasis on the Asia-Pacific region, urban-rural disparities, ethnic variations, and grading methodologies. We examine various risk factors for DR, including glycemic control, hypertension, hyperlipidemia, obesity, chronic kidney disease, sex, myopia, pregnancy, and cataract surgery. Furthermore, we explore potential biomarkers in serum, proteomics, metabolomics, vitreous, microRNA, and genetics that may aid in the detection and management of DR. In addition to medical management, we review the evidence supporting systemic and ocular treatments for DR/DME, including anti–vascular endothelial growth factor (anti-VEGF) agents, anti-inflammatory agents, biosimilars, and integrin inhibitors. Despite advancements in treatment options such as pan-retinal photocoagulation and anti-VEGF agents, a subset of cases still progresses, necessitating vitrectomy. Challenging diabetic vitrectomies pose difficulties due to complex fibrovascular proliferations, incomplete posterior vitreous detachment, and fragile, ischemic retinas, making membrane dissection risky and potentially damaging to the retina. In this review, we address the question of challenging diabetic vitrectomies, providing insights and strategies to minimize complications. Additionally, we briefly explore newer modalities such as 3-dimensional vitrectomy and intra-operative optical coherence tomography as potential tools in diabetic vitrectomy. In conclusion, this review provides a comprehensive overview of both medical and surgical management options for DR and DME. It underscores the importance of a multidisciplinary approach, tailored to the needs of each patient, to optimize visual outcomes and improve the quality of life for those affected by these sight-threatening conditions.
{"title":"Updates on medical and surgical managements of diabetic retinopathy and maculopathy","authors":"Yen-Ting Chen , Nishant V. Radke , Sohani Amarasekera , Dong Ho Park , Nelson Chen , Jay Chhablani , Nan-Kai Wang , Wei-Chi Wu , Danny S.C. Ng , Pramod Bhende , Shobhit Varma , Enne Leung , Xiulan Zhang , Fei Li , Shaochong Zhang , Dong Fang , Jia Liang , Zheming Zhang , Huanyu Liu , Peiquan Zhao , Dennis S.C. Lam","doi":"10.1016/j.apjo.2025.100180","DOIUrl":"10.1016/j.apjo.2025.100180","url":null,"abstract":"<div><div>Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss globally. This is a comprehensive review focused on both medical and surgical management strategies for DR and DME. This review highlights the epidemiology of DR and DME, with a particular emphasis on the Asia-Pacific region, urban-rural disparities, ethnic variations, and grading methodologies. We examine various risk factors for DR, including glycemic control, hypertension, hyperlipidemia, obesity, chronic kidney disease, sex, myopia, pregnancy, and cataract surgery. Furthermore, we explore potential biomarkers in serum, proteomics, metabolomics, vitreous, microRNA, and genetics that may aid in the detection and management of DR. In addition to medical management, we review the evidence supporting systemic and ocular treatments for DR/DME, including anti–vascular endothelial growth factor (anti-VEGF) agents, anti-inflammatory agents, biosimilars, and integrin inhibitors. Despite advancements in treatment options such as pan-retinal photocoagulation and anti-VEGF agents, a subset of cases still progresses, necessitating vitrectomy. Challenging diabetic vitrectomies pose difficulties due to complex fibrovascular proliferations, incomplete posterior vitreous detachment, and fragile, ischemic retinas, making membrane dissection risky and potentially damaging to the retina. In this review, we address the question of challenging diabetic vitrectomies, providing insights and strategies to minimize complications. Additionally, we briefly explore newer modalities such as 3-dimensional vitrectomy and intra-operative optical coherence tomography as potential tools in diabetic vitrectomy. In conclusion, this review provides a comprehensive overview of both medical and surgical management options for DR and DME. It underscores the importance of a multidisciplinary approach, tailored to the needs of each patient, to optimize visual outcomes and improve the quality of life for those affected by these sight-threatening conditions.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100180"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100162
Chanchan Wang , Yong Ma , Qiong Zou , Hai He , Yaoqi Ba , Jianling Xiao , Xingtao Zhou , Shengtao Liu
Background
To assess the characteristics of the ciliary sulcus in patients with myopia with different axial lengths using ultrasound biomicroscopy (UBM).
Methods
A total of 108 eyes from 54 patients were recruited between January and March 2024. Patients were matched for age, cylinder and white-to-white (WTW) ratio, and further divided into a control axial length (AL) group (CON, AL < 26.5 mm, 54 eyes) and a long AL group (L-AL, AL ≥ 26.5 mm, 54 eyes). Anterior and posterior chamber parameters were examined based on UBM. Anterior chamber parameters included sulcus-to-sulcus distance (STS) in the horizontal and vertical orientation, lens anterior surface to ciliary sulcus distance (STSL), anterior segment length (ASL) and anterior chamber depth (ACD). Posterior chamber parameters included ciliary process length (CPL), trabecular–ciliary process distance, trabecular–ciliary angle (TCA), iris–ciliary angle (ICA) and maximum ciliary body thickness in four spatial directions.
Results
The anterior chamber parameters, including STS, STSL and ASL, were significantly lower in the horizontal direction than those in the vertical direction in both groups, whereas STS was significantly lower in the CON group than in the L-AL group. Posterior chamber parameters, including CPL, TCA and ICA, showed significant spatial differences between the two groups. Furthermore, STSL correlated significantly with ACD, mean keratometry and WTW.
Conclusions
Significant spatial differences in ciliary sulcus and ciliary body morphology were observed in patients with axial myopia. In ICL size selection and vault prediction, STS and STSL are potential indicators in preoperative ICL assessment.
背景：应用超声生物显微镜（UBM）评价不同眼轴长度近视患者睫状沟的特征。方法：2024年1月至3月，共招募54例患者的108只眼睛。将患者按年龄、圆柱体、白白比（WTW）进行匹配，进一步分为对照轴长组（CON, AL < 26.5mm， 54眼）和长轴长组（L-AL, AL≥26.5mm， 54眼）。基于UBM检查前后房参数。前房参数包括水平和垂直方向的沟到沟距离（STS）、晶状体前表面到睫状沟距离（STSL）、前房段长度（ASL）和前房深度（ACD）。后房参数包括四个空间方向上的睫状体长度（CPL）、小梁-睫状体距离、小梁-睫状体角（TCA）、虹膜-睫状体角（ICA）和最大睫状体厚度。结果：两组水平方向的前房参数STS、STSL、ASL均显著低于垂直方向，CON组的STS显著低于L-AL组。CPL、TCA、ICA等后房参数在两组间存在显著的空间差异。此外，STSL与ACD、平均角膜密度和WTW显著相关。结论：轴型近视患者睫状沟和睫状体形态存在明显的空间差异。在ICL大小选择和拱顶预测中，STS和STSL是ICL术前评估的潜在指标。
{"title":"Ciliary sulcus characteristics in patients with axial myopia using ultrasound biomicroscope","authors":"Chanchan Wang , Yong Ma , Qiong Zou , Hai He , Yaoqi Ba , Jianling Xiao , Xingtao Zhou , Shengtao Liu","doi":"10.1016/j.apjo.2025.100162","DOIUrl":"10.1016/j.apjo.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>To assess the characteristics of the ciliary sulcus in patients with myopia with different axial lengths using ultrasound biomicroscopy (UBM).</div></div><div><h3>Methods</h3><div>A total of 108 eyes from 54 patients were recruited between January and March 2024. Patients were matched for age, cylinder and white-to-white (WTW) ratio, and further divided into a control axial length (AL) group (CON, AL < 26.5 mm, 54 eyes) and a long AL group (L-AL, AL ≥ 26.5 mm, 54 eyes). Anterior and posterior chamber parameters were examined based on UBM. Anterior chamber parameters included sulcus-to-sulcus distance (STS) in the horizontal and vertical orientation, lens anterior surface to ciliary sulcus distance (STSL), anterior segment length (ASL) and anterior chamber depth (ACD). Posterior chamber parameters included ciliary process length (CPL), trabecular–ciliary process distance, trabecular–ciliary angle (TCA), iris–ciliary angle (ICA) and maximum ciliary body thickness in four spatial directions.</div></div><div><h3>Results</h3><div>The anterior chamber parameters, including STS, STSL and ASL, were significantly lower in the horizontal direction than those in the vertical direction in both groups, whereas STS was significantly lower in the CON group than in the L-AL group. Posterior chamber parameters, including CPL, TCA and ICA, showed significant spatial differences between the two groups. Furthermore, STSL correlated significantly with ACD, mean keratometry and WTW.</div></div><div><h3>Conclusions</h3><div>Significant spatial differences in ciliary sulcus and ciliary body morphology were observed in patients with axial myopia. In ICL size selection and vault prediction, STS and STSL are potential indicators in preoperative ICL assessment.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100162"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100181
Francesc March de Ribot, Vivek Pravin Dave, Tham Chee Yung Clement, Paisan Ruamviboonsuk, David Chang, Oliver Findl
{"title":"Eye sustainability here and now","authors":"Francesc March de Ribot, Vivek Pravin Dave, Tham Chee Yung Clement, Paisan Ruamviboonsuk, David Chang, Oliver Findl","doi":"10.1016/j.apjo.2025.100181","DOIUrl":"10.1016/j.apjo.2025.100181","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100181"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100177
Fan Wu , Yih-Chung Tham , Charumathi Sabanayagam , Seang-Mei Saw
The global burden of myopia continues to expand, and the prevalence of myopia in East Asian populations is of particular concern. With the substantial increase in screen-based electronic devices, screen time has emerged as a potential risk factor. This review examined the relationship between screen viewing duration and myopia risk and public health strategies to reduce screen exposure among children. We conducted an evidence-based review of only meta-analyses investigating screen time and myopia association, searching PubMed from inception to January 20, 2025. Four of the six meta-analyses reviewed supported an association between prolonged screen use (> 2 or 3 hours/day) and increased myopia risk. However, methodological limitations include the predominance of cross-sectional study designs, self-reported screen time measurements, and the lack of cycloplegic refraction in some studies within the meta-analyses. Current public health strategies focus mainly on banning mobile phones in schools and limiting screen time. Technology-based solutions, such as anti-addiction systems, support and complement these strategies. Healthcare providers play a crucial role in assessing screen time patterns in children and providing evidence-based recommendations. Future studies should employ objective screen time measurements, conduct longitudinal analyses with cycloplegic refraction, and evaluate the effectiveness of screen time interventions in myopia prevention through randomized controlled trials. In addition, examining the combined effects of traditional near-work activities and screen time may provide more comprehensive insights into myopia risk factors.
{"title":"From evidence to action: Public health approaches to reducing screen time and mitigating myopia risk","authors":"Fan Wu , Yih-Chung Tham , Charumathi Sabanayagam , Seang-Mei Saw","doi":"10.1016/j.apjo.2025.100177","DOIUrl":"10.1016/j.apjo.2025.100177","url":null,"abstract":"<div><div>The global burden of myopia continues to expand, and the prevalence of myopia in East Asian populations is of particular concern. With the substantial increase in screen-based electronic devices, screen time has emerged as a potential risk factor. This review examined the relationship between screen viewing duration and myopia risk and public health strategies to reduce screen exposure among children. We conducted an evidence-based review of only meta-analyses investigating screen time and myopia association, searching PubMed from inception to January 20, 2025. Four of the six meta-analyses reviewed supported an association between prolonged screen use (> 2 or 3 hours/day) and increased myopia risk. However, methodological limitations include the predominance of cross-sectional study designs, self-reported screen time measurements, and the lack of cycloplegic refraction in some studies within the meta-analyses. Current public health strategies focus mainly on banning mobile phones in schools and limiting screen time. Technology-based solutions, such as anti-addiction systems, support and complement these strategies. Healthcare providers play a crucial role in assessing screen time patterns in children and providing evidence-based recommendations. Future studies should employ objective screen time measurements, conduct longitudinal analyses with cycloplegic refraction, and evaluate the effectiveness of screen time interventions in myopia prevention through randomized controlled trials. In addition, examining the combined effects of traditional near-work activities and screen time may provide more comprehensive insights into myopia risk factors.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100177"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143530982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100163
Shayne S. Tan, Tina T. Wong
Glaucoma is the leading cause of irreversible visual loss worldwide, and as yet, there is no cure. The only evidence-based treatment to slow progression is by lowering intraocular pressure (IOP). Despite the development of new topical medications to reduce IOP, the major limitation of eyedrops lies in human and anatomical factors, namely patient compliance and poor bioavailability, making current medical glaucoma treatment ineffective. In this manuscript, we summarise the limitations of traditional topical anti-glaucoma therapy and study current drug delivery systems to lower IOP, with focus on the only two that have made FDA-approval- Durysta and iDose TR. We highlight their limitations and discuss real-world economic challenges that make it prohibitively difficult for these drug delivery systems to be more widely adopted in daily practice. In this perspective, we also introduce gene therapy as a novel therapeutic option to target downstream pathways of IOP regulation, neuroprotection of the optic nerve, and reducing mitochondrial stress to delay the progression of glaucoma. We discuss promising results of gene therapy for glaucoma treatment in in vivo animal models as well. We also explore the concept of novel nanoparticle-based drug delivery systems, which have the advantage of being highly modifiable and customisable, able to incorporate large amounts of cargo while maintaining a high transfection efficacy, and at a fraction of the cost. Lastly, we propose that nanomedicine, in conjunction with gene therapy, offers a promising solution to the aforementioned challenges of current glaucoma therapy, and can herald a new era of sustained glaucoma treatment.
{"title":"Drug delivery systems in glaucoma – Current innovations and future perspectives","authors":"Shayne S. Tan, Tina T. Wong","doi":"10.1016/j.apjo.2025.100163","DOIUrl":"10.1016/j.apjo.2025.100163","url":null,"abstract":"<div><div>Glaucoma is the leading cause of irreversible visual loss worldwide, and as yet, there is no cure. The only evidence-based treatment to slow progression is by lowering intraocular pressure (IOP). Despite the development of new topical medications to reduce IOP, the major limitation of eyedrops lies in human and anatomical factors, namely patient compliance and poor bioavailability, making current medical glaucoma treatment ineffective. In this manuscript, we summarise the limitations of traditional topical anti-glaucoma therapy and study current drug delivery systems to lower IOP, with focus on the only two that have made FDA-approval- Durysta and iDose TR. We highlight their limitations and discuss real-world economic challenges that make it prohibitively difficult for these drug delivery systems to be more widely adopted in daily practice. In this perspective, we also introduce gene therapy as a novel therapeutic option to target downstream pathways of IOP regulation, neuroprotection of the optic nerve, and reducing mitochondrial stress to delay the progression of glaucoma. We discuss promising results of gene therapy for glaucoma treatment in in vivo animal models as well. We also explore the concept of novel nanoparticle-based drug delivery systems, which have the advantage of being highly modifiable and customisable, able to incorporate large amounts of cargo while maintaining a high transfection efficacy, and at a fraction of the cost. Lastly, we propose that nanomedicine, in conjunction with gene therapy, offers a promising solution to the aforementioned challenges of current glaucoma therapy, and can herald a new era of sustained glaucoma treatment.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100163"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100173
Swara M. Sarvepalli , Ishani Kapoor , Kubra Sarici , Sunir J. Garg , Majda Hadziahmetovic
Purpose
This study aimed to assess the role of photodynamic therapy (PDT) as an adjunct to anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections in the treatment of neovascular age-related macular degeneration (nvAMD).
Methods
PubMed, Cochrane Library, and ClinicalTrials.gov were searched for keywords “macular degeneration” and “photodynamic therapy” and “placebo” or “ranibizumab” or “bevacizumab” or “aflibercept” from inception to 2023. Included studies were peer-reviewed primary data reporting 12-month treatment results of nvAMD with anti-VEGF and PDT, anti-VEGF alone, intravitreal triamcinolone, or placebo. 23 studies were included in the final analysis. The major outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and injection burden at 12 months.
Results
Anti-VEGF + PDT had better BCVA at 12 months compared to anti-VEGF (MD −0.07; 95 % CI −0.12, −0.01; P = 0.02). There was no significant difference in CRT at 12 months in anti-VEGF + PDT group versus anti-VEGF (MD −3.66; 95 % CI −10.28, 2.98; P = 0.28). Anti-VEGF + PDT group had significantly fewer injections compared to anti-VEGF (MD −1.76; 95 % CI −1.95, −1.58; P < 0.0001). There was no significant difference in pooled ocular adverse events between anti-VEGF + PDT versus anti-VEGF (MD 0.96; 95 % CI 0.68, 1.36; P = 0.41).
Conclusions
PDT is a successful adjunctive to anti-VEGF injections for the treatment of nvAMD. The combination of the therapies leads to improved BCVA at 12 months, decreased injection burden, and no difference in ocular safety.
目的：本研究旨在评估光动力疗法（PDT）作为抗血管内皮生长因子（Anti-VEGF）玻璃体内注射在治疗新生血管性年龄相关性黄斑变性（nvAMD）中的辅助作用。方法：检索PubMed、Cochrane Library和ClinicalTrials.gov从成立到2023年的关键词“黄斑变性”、“光动力疗法”、“安慰剂”、“雷尼单抗”、“贝伐单抗”或“阿非利塞普”。纳入的研究是同行评审的原始数据，报告了nvAMD联合抗vegf和PDT、单独抗vegf、玻璃体内曲安奈德或安慰剂12个月的治疗结果。最终分析纳入了23项研究。主要结果为12个月时最佳矫正视力（BCVA）、视网膜中央厚度（CRT）和注射负荷。结果：与抗vegf相比，抗vegf + PDT在12个月时具有更好的BCVA (MD -0.07；95% ci -0.12, -0.01；P = 0.02)。抗vegf + PDT组与抗vegf组12个月CRT无显著差异(MD -3.66；95% ci -10.28, 2.98；P = 0.28)。与抗vegf组相比，抗vegf + PDT组的注射次数明显减少(MD -1.76；95% ci -1.95, -1.58；P < 0.0001)。抗vegf + PDT组与抗vegf组的眼部综合不良事件无显著差异(MD 0.96；95% ci 0.68, 1.36；P = 0.41)。结论：PDT是抗vegf注射治疗nvAMD的有效辅助手段。联合用药可改善12个月时的BCVA，降低注射负担，且眼安全性无差异。
{"title":"Evaluating photodynamic therapy as an adjuvant treatment for neovascular AMD: A comprehensive meta-analysis","authors":"Swara M. Sarvepalli , Ishani Kapoor , Kubra Sarici , Sunir J. Garg , Majda Hadziahmetovic","doi":"10.1016/j.apjo.2025.100173","DOIUrl":"10.1016/j.apjo.2025.100173","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aimed to assess the role of photodynamic therapy (PDT) as an adjunct to anti-vascular endothelial growth factor (Anti-VEGF) intravitreal injections in the treatment of neovascular age-related macular degeneration (nvAMD).</div></div><div><h3>Methods</h3><div>PubMed, Cochrane Library, and ClinicalTrials.gov were searched for keywords “macular degeneration” and “photodynamic therapy” and “placebo” or “ranibizumab” or “bevacizumab” or “aflibercept” from inception to 2023. Included studies were peer-reviewed primary data reporting 12-month treatment results of nvAMD with anti-VEGF and PDT, anti-VEGF alone, intravitreal triamcinolone, or placebo. 23 studies were included in the final analysis. The major outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and injection burden at 12 months.</div></div><div><h3>Results</h3><div>Anti-VEGF + PDT had better BCVA at 12 months compared to anti-VEGF (MD −0.07; 95 % CI −0.12, −0.01; <em>P</em> = 0.02). There was no significant difference in CRT at 12 months in anti-VEGF + PDT group versus anti-VEGF (MD −3.66; 95 % CI −10.28, 2.98; <em>P</em> = 0.28). Anti-VEGF + PDT group had significantly fewer injections compared to anti-VEGF (MD −1.76; 95 % CI −1.95, −1.58; <em>P</em> < 0.0001). There was no significant difference in pooled ocular adverse events between anti-VEGF + PDT versus anti-VEGF (MD 0.96; 95 % CI 0.68, 1.36; <em>P</em> = 0.41).</div></div><div><h3>Conclusions</h3><div>PDT is a successful adjunctive to anti-VEGF injections for the treatment of nvAMD. The combination of the therapies leads to improved BCVA at 12 months, decreased injection burden, and no difference in ocular safety.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100173"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100182
Onnisa Nanegrungsunk, Paradee Kunavisarut
The growing environmental impact from healthcare sector necessitates the adoption of sustainable strategies to reuse, recycle, reduce waste, lower carbon emissions, etc. In ophthalmology, surgical waste poses a significant environmental challenge, particularly due to the high volume of surgeries, along with single-use instruments, packaging materials and disposable surgical supplies. Examples of practical strategies to reduce surgical waste include adopting reusable surgical instruments when safe and feasible, minimizing unnecessary packaging and optimizing operating room protocols, e.g., multidose topical drops on multiple patients. An education regarding sustainability for medical personnel can further decrease waste production in the long term. Collaboration between healthcare providers, manufacturers and policymakers is essential to developing and integrating sustainability into ophthalmic practice. By implementing these strategies, ophthalmologists can contribute to a more environmentally responsible healthcare system without compromising patient safety.
{"title":"Toward a greener vision: A review on advancing sustainability in ophthalmology","authors":"Onnisa Nanegrungsunk, Paradee Kunavisarut","doi":"10.1016/j.apjo.2025.100182","DOIUrl":"10.1016/j.apjo.2025.100182","url":null,"abstract":"<div><div>The growing environmental impact from healthcare sector necessitates the adoption of sustainable strategies to reuse, recycle, reduce waste, lower carbon emissions, etc. In ophthalmology, surgical waste poses a significant environmental challenge, particularly due to the high volume of surgeries, along with single-use instruments, packaging materials and disposable surgical supplies. Examples of practical strategies to reduce surgical waste include adopting reusable surgical instruments when safe and feasible, minimizing unnecessary packaging and optimizing operating room protocols, e.g., multidose topical drops on multiple patients. An education regarding sustainability for medical personnel can further decrease waste production in the long term. Collaboration between healthcare providers, manufacturers and policymakers is essential to developing and integrating sustainability into ophthalmic practice. By implementing these strategies, ophthalmologists can contribute to a more environmentally responsible healthcare system without compromising patient safety.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100182"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100178
Eva K. Fenwick , Ryan E.K. Man , Anna C.S. Tan , Raymond P. Najjar , Dan Milea , Ester P.X. Lee , Tien Yin Wong , Gavin S.W. Tan , Hwei Wuen Chan , Augustinus Laude , Kelvin Y.C. Teo , Shu Yen Lee , Ian Yew San Yeo , Ranjana Mathur , Gemmy C.M. Cheung , Ecosse L. Lamoureux
Purpose
To optimize the psychometric properties of age-related macular degeneration (AMD) quality of life (QoL) item banks (IBs), and evaluate their performance using computerized adaptive testing (CAT) simulations.
Design
Cross-sectional, clinical study.
Methods
261 AMD patients answered 219 items within seven IBs: Activity Limitation (AL); Lighting (LT); Mobility (MB); Emotional (EM); Concerns (CN); AMD Management (AM); and Work (WK), referred to collectively as “MacCAT”. The psychometric properties of each IB (e.g. measurement precision; item “fit”; differential item functioning (DIF)) were assessed using Rasch analysis. The mean number of items required for “high” and “moderate” measurement precision was determined using CAT simulations.
Results
Of the 261 participants (mean age 70.5 ± 7.6 years), 69 (26.4 %), 35 (13.4 %), 80 (30.7 %) and 77 (29.5 %) had no, early, intermediate and late AMD (better eye), respectively. AL, EM, CN and AM displayed good psychometric properties overall after collapsing response categories and deleting items for misfit and/or DIF. Despite similar reengineering efforts, LT and MB had suboptimal measurement precision but were retained due to otherwise good psychometric performances. Owing to unresolvable psychometric issues, WK was not considered further. Targeting for all IBs was suboptimal. In CAT simulations on the six remaining IBs, the mean number of items required per IB ranged from 8 (AL) to 13 (MB) for moderate, and 13 (AL) to19 (MB) for high measurement precision.
Conclusions
Six IBs demonstrated acceptable psychometric properties and potential CAT efficiency, suggesting MacCAT provides a comprehensive measurement of the QoL impact of AMD and associated treatments. Further testing in larger clinical cohorts is needed.
{"title":"Psychometric evaluation and computerized adaptive testing simulations of age-related macular degeneration quality of life item banks","authors":"Eva K. Fenwick , Ryan E.K. Man , Anna C.S. Tan , Raymond P. Najjar , Dan Milea , Ester P.X. Lee , Tien Yin Wong , Gavin S.W. Tan , Hwei Wuen Chan , Augustinus Laude , Kelvin Y.C. Teo , Shu Yen Lee , Ian Yew San Yeo , Ranjana Mathur , Gemmy C.M. Cheung , Ecosse L. Lamoureux","doi":"10.1016/j.apjo.2025.100178","DOIUrl":"10.1016/j.apjo.2025.100178","url":null,"abstract":"<div><h3>Purpose</h3><div>To optimize the psychometric properties of age-related macular degeneration (AMD) quality of life (QoL) item banks (IBs), and evaluate their performance using computerized adaptive testing (CAT) simulations.</div></div><div><h3>Design</h3><div>Cross-sectional, clinical study.</div></div><div><h3>Methods</h3><div>261 AMD patients answered 219 items within seven IBs: Activity Limitation (AL); Lighting (LT); Mobility (MB); Emotional (EM); Concerns (CN); AMD Management (AM); and Work (WK), referred to collectively as “MacCAT”. The psychometric properties of each IB (e.g. measurement precision; item “fit”; differential item functioning (DIF)) were assessed using Rasch analysis. The mean number of items required for “high” and “moderate” measurement precision was determined using CAT simulations.</div></div><div><h3>Results</h3><div>Of the 261 participants (mean age 70.5 ± 7.6 years), 69 (26.4 %), 35 (13.4 %), 80 (30.7 %) and 77 (29.5 %) had no, early, intermediate and late AMD (better eye), respectively. AL, EM, CN and AM displayed good psychometric properties overall after collapsing response categories and deleting items for misfit and/or DIF. Despite similar reengineering efforts, LT and MB had suboptimal measurement precision but were retained due to otherwise good psychometric performances. Owing to unresolvable psychometric issues, WK was not considered further. Targeting for all IBs was suboptimal. In CAT simulations on the six remaining IBs, the mean number of items required per IB ranged from 8 (AL) to 13 (MB) for moderate, and 13 (AL) to19 (MB) for high measurement precision.</div></div><div><h3>Conclusions</h3><div>Six IBs demonstrated acceptable psychometric properties and potential CAT efficiency, suggesting MacCAT provides a comprehensive measurement of the QoL impact of AMD and associated treatments. Further testing in larger clinical cohorts is needed.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100178"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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