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}
Pub Date : 2025-03-01DOI: 10.1016/j.apjo.2025.100175
Ting-An Chang, Ming-Shan He
{"title":"Vision loss following mountain trip with intraocular gas","authors":"Ting-An Chang, Ming-Shan He","doi":"10.1016/j.apjo.2025.100175","DOIUrl":"10.1016/j.apjo.2025.100175","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100175"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536582","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.2025.100179
Hongxi Wang , Linrong Wu , Yuancun Li , Xin Tan , Jianwei Lin , Kunliang Qiu , Yali Du , Shengjie Yin , Binyao Chen , Jiao Jiang , Hailiu Chen , Mingzhi Zhang
{"title":"Corrigendum to “Effect of school entrance age on myopia among primary schoolchildren using mixed-effect model: The Shantou Myopia Study (SMS)” [Asia-Pac J Ophthalmol 2024 13 (6) 100121]","authors":"Hongxi Wang , Linrong Wu , Yuancun Li , Xin Tan , Jianwei Lin , Kunliang Qiu , Yali Du , Shengjie Yin , Binyao Chen , Jiao Jiang , Hailiu Chen , Mingzhi Zhang","doi":"10.1016/j.apjo.2025.100179","DOIUrl":"10.1016/j.apjo.2025.100179","url":null,"abstract":"","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 2","pages":"Article 100179"},"PeriodicalIF":3.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536580","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 : 2025-01-01DOI: 10.1016/j.apjo.2025.100138
Huy D.M. Tran , Yen H. Tran , Thao T.X. Ha , Tuan D. Tran , Monica Jong , Minas Coroneo , Padmaja Sankaridurg
Purpose
To determine the role of topical caffeine in slowing progression of myopia, both as a standalone treatment and in combination with atropine.
Methods
In a prospective, randomized, dispensing clinical trial, 96 children with myopia, aged 6–13 years, spherical equivalent (SE) from –0.50 diopters (D) to –6.00 D and astigmatism less than 2.00 D were randomly assigned to nightly use of either 2 % caffeine, 0.02 % atropine with 2 % caffeine (combination) or 0.02 % atropine eye drops. An additional 86 children with myopia were enrolled in a concurrent parallel group to wear single-vision (SV) spectacles. The primary outcomes were changes in SE and axial length (AL) over a period of 12 months for each group.
Results
All groups progressed in myopia. At 12 months, the mean change in SE/AL was –0.76 ± 0.51 D / 0.37 ± 0.20 mm and –0.70 ± 0.55 D / 0.35 ± 0.23 mm with SV and 2 % caffeine, respectively. In comparison, progression was slower at –0.46 ± 0.50 D / 0.24 ± 0.19 mm and –0.47 ± 0.38 D / 0.23 ± 0.18 mm with atropine monotherapy and combination groups, respectively. Compared to the change in AL with SV, the change in AL was significantly less with 0.02 % atropine and the combination group (post hoc analysis, P = 0.024 and 0.007, respectively). Similarly, the change in SE was significantly less with 0.02 % atropine compared to the SV group (P = 0.027).
Conclusions
Used as a standalone treatment, topical 2 % caffeine did not slow myopia progression. When combined with atropine, caffeine had no impact on the efficacy of atropine in slowing myopia.
目的：确定外用咖啡因在减缓近视进展中的作用，无论是单独治疗还是与阿托品联合使用。方法：在一项前瞻性、随机、配药的临床试验中，96名6-13岁的近视儿童，眼球度数（SE）从-0.50屈光度(D)到-6.00 D，散光小于2.00 D，随机分配到每晚使用2 %咖啡因、0.02 %阿托品与2 %咖啡因（联合）或0.02 %阿托品滴眼液。另外86名近视儿童被纳入同时平行组，佩戴单视力（SV）眼镜。主要结果是每组在12个月内SE和轴向长度（AL）的变化。结果：两组近视均有进展。在12个月内,平均变化SE / AL -0.76 ±0.51 D / 0.37 ±0.20 毫米和-0.70±0.55 D / 0.35±0.23 mm SV和2 %咖啡因,分别。相比,进展慢-0.46 ±0.50 D / 0.24 ±0.19 毫米和-0.47±0.38 D / 0.23 ±0.18 毫米与单一疗法和组合阿托品组,分别。与SV组AL的变化相比，0.02 %阿托品组和联合组AL的变化明显小于0.02 %阿托品组（事后分析，P = 0.024和0.007）。同样，与SV组相比，0.02 %阿托品的SE变化显著小于SV组（P = 0.027）。结论：单独使用2 %咖啡因治疗不能减缓近视进展。当与阿托品联合使用时，咖啡因对阿托品减缓近视的效果没有影响。
{"title":"Role of caffeine in slowing progression of myopia: 1-year results from a prospective, longitudinal clinical trial","authors":"Huy D.M. Tran , Yen H. Tran , Thao T.X. Ha , Tuan D. Tran , Monica Jong , Minas Coroneo , Padmaja Sankaridurg","doi":"10.1016/j.apjo.2025.100138","DOIUrl":"10.1016/j.apjo.2025.100138","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the role of topical caffeine in slowing progression of myopia, both as a standalone treatment and in combination with atropine.</div></div><div><h3>Methods</h3><div>In a prospective, randomized, dispensing clinical trial, 96 children with myopia, aged 6–13 years, spherical equivalent (SE) from –0.50 diopters (D) to –6.00 D and astigmatism less than 2.00 D were randomly assigned to nightly use of either 2 % caffeine, 0.02 % atropine with 2 % caffeine (combination) or 0.02 % atropine eye drops. An additional 86 children with myopia were enrolled in a concurrent parallel group to wear single-vision (SV) spectacles. The primary outcomes were changes in SE and axial length (AL) over a period of 12 months for each group.</div></div><div><h3>Results</h3><div>All groups progressed in myopia. At 12 months, the mean change in SE/AL was –0.76 ± 0.51 D / 0.37 ± 0.20 mm and –0.70 ± 0.55 D / 0.35 ± 0.23 mm with SV and 2 % caffeine, respectively. In comparison, progression was slower at –0.46 ± 0.50 D / 0.24 ± 0.19 mm and –0.47 ± 0.38 D / 0.23 ± 0.18 mm with atropine monotherapy and combination groups, respectively. Compared to the change in AL with SV, the change in AL was significantly less with 0.02 % atropine and the combination group (post hoc analysis, <em>P</em> = 0.024 and 0.007, respectively). Similarly, the change in SE was significantly less with 0.02 % atropine compared to the SV group (<em>P</em> = 0.027).</div></div><div><h3>Conclusions</h3><div>Used as a standalone treatment, topical 2 % caffeine did not slow myopia progression. When combined with atropine, caffeine had no impact on the efficacy of atropine in slowing myopia.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 1","pages":"Article 100138"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142997784","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 : 2025-01-01DOI: 10.1016/j.apjo.2025.100135
Yong Woo Kim , Ki Ho Park
Myopia is rapidly escalating globally, especially in East and Southeast Asia, where its prevalence among younger populations reaches alarming levels of 80–90 %. This surge contributes to a myopia epidemic linked to several ocular complications, including glaucoma. As myopic individuals age, the risk of developing glaucoma increases, and an additional concern arises from the growing frequency of refractive surgeries among younger individuals, making precise optic nerve assessments critical before surgery. Evaluating the optic nerve head (ONH) in myopic eyes is challenging, as structural changes due to myopia often resemble glaucomatous alterations. Techniques such as optical coherence tomography (OCT) have improved the examination of ONH microstructures, but interpreting results remains complex due to potential false-positive findings. Myopic eyes exhibit unique changes, such as peripapillary atrophy and altered neuroretinal rim configurations, making it crucial to distinguish these from true glaucomatous signs. Recent advancements in OCT technology and the establishment of myopia-specific normative databases have enhanced diagnostic accuracy. Parameters such as minimum rim width, ganglion cell–inner plexiform layer thickness and temporal raphe sign show promise in differentiating between glaucomatous and nonglaucomatous changes. Ultimately, a comprehensive approach incorporating multiple OCT metrics is essential for accurately diagnosing glaucoma in myopic patients. By integrating various structural evaluations and leveraging advanced imaging techniques, clinicians can better navigate the complexities of glaucoma diagnosis amidst the challenges posed by myopia. This review highlights the need for increased attention and tailored strategies in managing glaucoma risk within this increasingly affected population.
{"title":"How to diagnose glaucoma in myopic eyes by detecting structural changes?","authors":"Yong Woo Kim , Ki Ho Park","doi":"10.1016/j.apjo.2025.100135","DOIUrl":"10.1016/j.apjo.2025.100135","url":null,"abstract":"<div><div>Myopia is rapidly escalating globally, especially in East and Southeast Asia, where its prevalence among younger populations reaches alarming levels of 80–90 %. This surge contributes to a myopia epidemic linked to several ocular complications, including glaucoma. As myopic individuals age, the risk of developing glaucoma increases, and an additional concern arises from the growing frequency of refractive surgeries among younger individuals, making precise optic nerve assessments critical before surgery. Evaluating the optic nerve head (ONH) in myopic eyes is challenging, as structural changes due to myopia often resemble glaucomatous alterations. Techniques such as optical coherence tomography (OCT) have improved the examination of ONH microstructures, but interpreting results remains complex due to potential false-positive findings. Myopic eyes exhibit unique changes, such as peripapillary atrophy and altered neuroretinal rim configurations, making it crucial to distinguish these from true glaucomatous signs. Recent advancements in OCT technology and the establishment of myopia-specific normative databases have enhanced diagnostic accuracy. Parameters such as minimum rim width, ganglion cell–inner plexiform layer thickness and temporal raphe sign show promise in differentiating between glaucomatous and nonglaucomatous changes. Ultimately, a comprehensive approach incorporating multiple OCT metrics is essential for accurately diagnosing glaucoma in myopic patients. By integrating various structural evaluations and leveraging advanced imaging techniques, clinicians can better navigate the complexities of glaucoma diagnosis amidst the challenges posed by myopia. This review highlights the need for increased attention and tailored strategies in managing glaucoma risk within this increasingly affected population.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 1","pages":"Article 100135"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969517","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 : 2025-01-01DOI: 10.1016/j.apjo.2025.100143
Yunhee Lee , Eun-Jung Ahn , Soo-Wan Chae , Ali Aijaz Hussain
Purpose
Recovery rate of rod photoreceptor sensitivity (S2 gradient) following a bleach is reduced in age-related macular degeneration (AMD) due to diminished delivery of retinol across a grossly altered Bruch's membrane. Since triterpenoid saponins are known to improve transport across Bruch's, we have assessed their possible use for reversing the visual deficits in AMD.
Altogether 11 AMD patients and seven age-matched control subjects were recruited to undertake a small proof-of-principle study. Dark adaptation curves were obtained and S2 gradients evaluated using a Humphrey Field Analyser. Following basal determination of S2 gradients, oral supplementation of saponins (200 mg/day) or placebo regime was instigated for a period of 4 months. S2 gradients were re-evaluated at two and four months.
Results
Basal S2 gradients of the AMD cohort were determined as 0.41 ± 0.24 dB/min and those of the control subjects as 1.44 ± 0.1 dB/min. After two months of the saponin treatment, AMD subjects showed improved S2 gradients of 0.92 ± 0.23 dB/min (P < 0.005) with a further increase to 1.35 ± 0.19 dB/min at four months (P < 0.01), the latter not being significantly different from control subjects. S2 gradients in placebo subjects were unaltered.
Conclusions
Oral supplementation with saponins results in reversing the reduced S2 gradients in AMD. This improvement in the transport properties of Bruch's is expected to slow, halt or reverse the progression of AMD.
{"title":"Triterpenoid saponin–mediated recovery of visual deficits in age-related macular degeneration (AMD): Double-blind, placebo-controlled, randomised clinical trial","authors":"Yunhee Lee , Eun-Jung Ahn , Soo-Wan Chae , Ali Aijaz Hussain","doi":"10.1016/j.apjo.2025.100143","DOIUrl":"10.1016/j.apjo.2025.100143","url":null,"abstract":"<div><h3>Purpose</h3><div>Recovery rate of rod photoreceptor sensitivity (S2 gradient) following a bleach is reduced in age-related macular degeneration (AMD) due to diminished delivery of retinol across a grossly altered Bruch's membrane. Since triterpenoid saponins are known to improve transport across Bruch's, we have assessed their possible use for reversing the visual deficits in AMD.</div></div><div><h3>Design</h3><div>Double-blind, placebo controlled randomised clinical trial.</div></div><div><h3>Methods</h3><div>Altogether 11 AMD patients and seven age-matched control subjects were recruited to undertake a small proof-of-principle study. Dark adaptation curves were obtained and S2 gradients evaluated using a Humphrey Field Analyser. Following basal determination of S2 gradients, oral supplementation of saponins (200 mg/day) or placebo regime was instigated for a period of 4 months. S2 gradients were re-evaluated at two and four months.</div></div><div><h3>Results</h3><div>Basal S2 gradients of the AMD cohort were determined as 0.41 ± 0.24 dB/min and those of the control subjects as 1.44 ± 0.1 dB/min. After two months of the saponin treatment, AMD subjects showed improved S2 gradients of 0.92 ± 0.23 dB/min (<em>P</em> < 0.005) with a further increase to 1.35 ± 0.19 dB/min at four months (<em>P</em> < 0.01), the latter not being significantly different from control subjects. S2 gradients in placebo subjects were unaltered.</div></div><div><h3>Conclusions</h3><div>Oral supplementation with saponins results in reversing the reduced S2 gradients in AMD. This improvement in the transport properties of Bruch's is expected to slow, halt or reverse the progression of AMD.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 1","pages":"Article 100143"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142998447","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 : 2025-01-01DOI: 10.1016/j.apjo.2025.100136
Huishan Lin , Xinbo Gao , Zhuoyi Wu , Wengian Tam , Wei Huang , Yue Dong , Xi Qin , Yao Liu , Chengguo Zuo , Mingkai Lin
To analyze the treatment modalities and trends for neovascular glaucoma (NVG) over the past 10 years, we conducted a retrospective analysis at Zhongshan Ophthalmic Center on 1331 NVG inpatients who received 1459 treatments for 1383 eyes between January 1, 2012, and December 31, 2021. Over time, we observed a progressive annual increase in both the number of patients and the volume of surgeries for NVG, with an annual percentage change (APC) of 10.23 % (95 % confidence interval [CI]: 5.5–15.2 %, P = 0.001) and 11.59 % (95 % CI: 6.6–16.9 %, P = 0.001), respectively. Drainage valve implantation (46.88 %), cyclodestructive procedures (22.55 %) and trabeculectomy (6.24 %) were the three most commonly selected treatment options. The frequency of drainage valve implantation (APC = 6.59 %, 95 % CI = 0.9–12.6 %, P = 0.028), cyclodestructive procedures (APC = 17.26 %, 95 % CI = 9.3–25.8 %, P = 0.001) and trabeculectomy (APC = 21.93 %, 95 % CI = 1.6–46.3 %, P = 0.036) increased. The proportion of drainage valve implantation gradually decreased (APC = –4.48 %, 95 % CI = –8.6 to –0.2 %, P = 0.042), while that of cyclodestructive procedures increased (APC = 5.08 %, 95 % CI = 0.6–9.8 %, P = 0.042), with no significant alteration observed in the proportion of trabeculectomy (APC = 9.26 %, 95 % CI = –8.8–30.9 %, P = 0.290). Over the course of the study, both the cases of NVG and the volume of related surgeries escalated year by year. Among the three most frequently employed procedures—drainage valve implantation, cyclodestructive procedures and trabeculectomy—annual frequency trends revealed an increase in drainage valve implantation alongside a decreasing proportion, while cyclodestructive procedures exhibited a rising trend in both frequency and proportion; simultaneously, trabeculectomy showed an increasing frequency without a significant change in its proportion.
为了分析近10年来新生血管性青光眼（NVG）的治疗方式及趋势，我们对2012年1月1日至2021年12月31日中山眼科中心1331例NVG住院患者进行了回顾性分析，这些患者接受了1459次治疗，共1383只眼。随着时间的推移，我们观察到NVG的患者数量和手术量逐年递增，年百分比变化（APC）分别为10.23%（95%置信区间[CI]: 5.5-15.2%, P = 0.001）和11.59% （95% CI: 6.6-16.9%, P = 0.001）。引流阀植入术（46.88%）、环破坏术（22.55%）和小梁切除术（6.24%）是三种最常见的治疗方案。引流阀植入术（APC = 6.59%, 95% CI = 0.9 ~ 12.6%, P = 0.028）、环破坏术（APC = 17.26%, 95% CI = 9.3 ~ 25.8%, P = 0.001）和小梁切除术（APC = 21.93%, 95% CI = 1.6 ~ 46.3%, P = 0.036）的频率增加。引流阀植入术比例逐渐下降（APC = -4.48%, 95% CI = -8.6 ~ -0.2%, P = 0.042），破坏环术比例逐渐上升（APC = 5.08%, 95% CI = 0.6 ~ 9.8%, P = 0.042），小梁切除术比例无明显变化（APC = 9.26%, 95% CI = -8.8 ~ 30.9%, P = 0.290）。在研究过程中，NVG的病例和相关手术量逐年增加。在三种最常用的手术中（引流阀植入、破坏环术和小梁切除术），每年的频率趋势显示引流阀植入增加但比例下降，而破坏环术的频率和比例均呈上升趋势；同时，小梁切除术的发生频率呈上升趋势，但比例无明显变化。
{"title":"Treatment modalities and trends for hospitalized patients with neovascular glaucoma: A retrospective study of 10 years","authors":"Huishan Lin , Xinbo Gao , Zhuoyi Wu , Wengian Tam , Wei Huang , Yue Dong , Xi Qin , Yao Liu , Chengguo Zuo , Mingkai Lin","doi":"10.1016/j.apjo.2025.100136","DOIUrl":"10.1016/j.apjo.2025.100136","url":null,"abstract":"<div><div>To analyze the treatment modalities and trends for neovascular glaucoma (NVG) over the past 10 years, we conducted a retrospective analysis at Zhongshan Ophthalmic Center on 1331 NVG inpatients who received 1459 treatments for 1383 eyes between January 1, 2012, and December 31, 2021. Over time, we observed a progressive annual increase in both the number of patients and the volume of surgeries for NVG, with an annual percentage change (APC) of 10.23 % (95 % confidence interval [CI]: 5.5–15.2 %, <em>P</em> = 0.001) and 11.59 % (95 % CI: 6.6–16.9 %, <em>P</em> = 0.001), respectively. Drainage valve implantation (46.88 %), cyclodestructive procedures (22.55 %) and trabeculectomy (6.24 %) were the three most commonly selected treatment options. The frequency of drainage valve implantation (APC = 6.59 %, 95 % CI = 0.9–12.6 %, <em>P</em> = 0.028), cyclodestructive procedures (APC = 17.26 %, 95 % CI = 9.3–25.8 %, <em>P</em> = 0.001) and trabeculectomy (APC = 21.93 %, 95 % CI = 1.6–46.3 %, <em>P</em> = 0.036) increased. The proportion of drainage valve implantation gradually decreased (APC = –4.48 %, 95 % CI = –8.6 to –0.2 %, <em>P</em> = 0.042), while that of cyclodestructive procedures increased (APC = 5.08 %, 95 % CI = 0.6–9.8 %, <em>P</em> = 0.042), with no significant alteration observed in the proportion of trabeculectomy (APC = 9.26 %, 95 % CI = –8.8–30.9 %, <em>P</em> = 0.290). Over the course of the study, both the cases of NVG and the volume of related surgeries escalated year by year. Among the three most frequently employed procedures—drainage valve implantation, cyclodestructive procedures and trabeculectomy—annual frequency trends revealed an increase in drainage valve implantation alongside a decreasing proportion, while cyclodestructive procedures exhibited a rising trend in both frequency and proportion; simultaneously, trabeculectomy showed an increasing frequency without a significant change in its proportion.</div></div>","PeriodicalId":8594,"journal":{"name":"Asia-Pacific Journal of Ophthalmology","volume":"14 1","pages":"Article 100136"},"PeriodicalIF":3.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142977396","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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