Vincent Michel Borderie,Cristina Georgeon,Nassim Louissi,Benjamin Memmi,Malika Hamrani,Nacim Bouheraoua,Anatole Chessel
AIMSTo analyse the value of the CorvisST indices in diagnosing corneal stromal and endothelial disorders (CSEDs).METHODSThis institutional retrospective case-control study included 903 eyes with a CSED and 597 normal eyes (controls), assessed with CorvisST and MS39.MAIN OUTCOME MEASURESCorvisST indices. The collected data were divided into a training set (70%) and a test set (30%). Artificial intelligence frameworks were used to distinguish each disorder from controls and to classify corneas into seven groups: keratoconus, high-risk corneas for keratoconus, laser corneal refractive surgery (LCRS), endothelial disorders, stromal opacities, glaucoma corneas and normal corneas.RESULTSStress-strain index (SSI) significantly increased with age in the control group. Compared with controls matched for age/sex, keratoconus was associated with Corvis Biomechanical Index (CBI) >0.51 (area under the curve, 0.99), Ambrósio's relational thickness horizontal (ARTh) <425.5 (0.97), deflection amplitude at the time of the first applanation (SPA-A1) <96.3 (0.97) and Pachy<522.4 µm (0.91); high-risk corneas with a difference in CBI between fellow eyes (CBI SYM) >0.14 (0.98), (L2) <1.95 (0.83) and Pachy<549.7 µm (0.71); LCRS with ARTh<455.1 (0.93) and CBI>0.35 (0.83); corneal endothelial disorders with Pachy SYM>19.7 µm (0.83), Pachy>569.1 µm (0.82) and CBI SYM>0.14 (0.77); stromal opacities with SPA-A1 SYM>11.8 (0.92), ARTh<569.9 (0.89), SSI SYM>0.14 (0.89) and CBI>0.22 (0.86). A logistic regression function using all indices reached an area under the receiver operating characteristic curve of 0.81 for glaucoma diagnosis. The TabPFN model provided the best accuracy (88.7%) for diagnosing the seven corneal conditions. SSI, SPA-A1, CBI and Pachy correlated with keratoconus grade. Keratoplasty for keratoconus improved but failed to restore normal corneal biomechanics.CONCLUSIONSCorvisST indices are relevant for diagnosing CESDs and distinguishing various disorders from each other.
{"title":"CorvisST biomechanical indices in the diagnosis of corneal stromal and endothelial disorders: an artificial intelligence-based comparative study.","authors":"Vincent Michel Borderie,Cristina Georgeon,Nassim Louissi,Benjamin Memmi,Malika Hamrani,Nacim Bouheraoua,Anatole Chessel","doi":"10.1136/bjo-2025-327855","DOIUrl":"https://doi.org/10.1136/bjo-2025-327855","url":null,"abstract":"AIMSTo analyse the value of the CorvisST indices in diagnosing corneal stromal and endothelial disorders (CSEDs).METHODSThis institutional retrospective case-control study included 903 eyes with a CSED and 597 normal eyes (controls), assessed with CorvisST and MS39.MAIN OUTCOME MEASURESCorvisST indices. The collected data were divided into a training set (70%) and a test set (30%). Artificial intelligence frameworks were used to distinguish each disorder from controls and to classify corneas into seven groups: keratoconus, high-risk corneas for keratoconus, laser corneal refractive surgery (LCRS), endothelial disorders, stromal opacities, glaucoma corneas and normal corneas.RESULTSStress-strain index (SSI) significantly increased with age in the control group. Compared with controls matched for age/sex, keratoconus was associated with Corvis Biomechanical Index (CBI) >0.51 (area under the curve, 0.99), Ambrósio's relational thickness horizontal (ARTh) <425.5 (0.97), deflection amplitude at the time of the first applanation (SPA-A1) <96.3 (0.97) and Pachy<522.4 µm (0.91); high-risk corneas with a difference in CBI between fellow eyes (CBI SYM) >0.14 (0.98), (L2) <1.95 (0.83) and Pachy<549.7 µm (0.71); LCRS with ARTh<455.1 (0.93) and CBI>0.35 (0.83); corneal endothelial disorders with Pachy SYM>19.7 µm (0.83), Pachy>569.1 µm (0.82) and CBI SYM>0.14 (0.77); stromal opacities with SPA-A1 SYM>11.8 (0.92), ARTh<569.9 (0.89), SSI SYM>0.14 (0.89) and CBI>0.22 (0.86). A logistic regression function using all indices reached an area under the receiver operating characteristic curve of 0.81 for glaucoma diagnosis. The TabPFN model provided the best accuracy (88.7%) for diagnosing the seven corneal conditions. SSI, SPA-A1, CBI and Pachy correlated with keratoconus grade. Keratoplasty for keratoconus improved but failed to restore normal corneal biomechanics.CONCLUSIONSCorvisST indices are relevant for diagnosing CESDs and distinguishing various disorders from each other.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"19 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145351493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zihan Li,Zhe Pan,Yu Huang,Hui Xie,Xiaodong Wu,Chun Zhang,Tien Yin Wong,Jost B Jonas,Ya Xing Wang
PURPOSETo examine an association of cigarette smoking on retinal layer thickness.METHODSThe population-based Beijing Eye Study 2011 included 3468 individuals aged 50+ years. All participants underwent optical coherence tomography (OCT) of the macula. Using a multiple-surface OCT segmentation algorithm, the retina was segmented into nine layers. Information about cigarette smoking was assessed in an interview with a standardised questionnaire. The exclusion criterion was the presence of any retinal or optic nerve disease.RESULTSThe study included 2173 participants (mean age: 61.7±8.4 years; mean axial length: 23.1±0.8 mm) with 660 (30.4%) participants with a smoking history and 1513 (69.6%) non-smokers. Mean duration of the smoking period was 8.7±14.9 years, and mean smoking quantity was 9.5±18.2 pack-years. In multivariable analysis, higher prevalence of smoking was associated with thinner whole retina (p=0.024; B=-1.64; 95% CIs -3.07 to -0.22), thinner ganglion cell layer (GCL) (p=.044; B=-0.39; 95% CI -0.78 to -0.01) and thinner photoreceptor outer segment layer (POS) (p=0.024; B=-0.38; 95% CI -0.72 to -0.05) with adjustments of age, gender, axial length, education level and hypertension. Similar results were obtained if the retinal thickness measurements were obtained in the various macular subfields. A longer period of smoking was related to thinner whole retina (p=0.009; B=-0.06; 95% CI -0.10 to -0.01), thinner retinal nerve fibre layer (RNFL) (p=0.011; B=-0.01; 95% CI -0.02 to -0.002), thinner GCL (p=0.006; B=-0.02; 95% CI -0.03 to -0.01) and thinner POS (p=0.025; B=-0.01; 95% CI -0.02 to -0.001) with adjustments of age, gender, axial length, education level and hypertension. Higher smoking pack-years were significantly associated with thinner GCL (p=0.022; B=-0.01; 95% CI -0.02 to -0.002).CONCLUSIONSSmoking was related to thinner GCL and POS in this population-based investigation, pointing towards and agreeing with an association between smoking and optic nerve damage or age-related macular degeneration.
目的探讨吸烟与视网膜层厚度的关系。方法2011年北京眼科研究纳入3468例50岁以上人群。所有参与者都接受了黄斑光学相干断层扫描（OCT）。采用多面OCT分割算法，将视网膜分割成9层。有关吸烟的信息是通过标准化问卷采访评估的。排除标准是存在任何视网膜或视神经疾病。结果研究纳入2173名参与者（平均年龄：61.7±8.4岁，平均轴长：23.1±0.8 mm），其中660名（30.4%）有吸烟史，1513名（69.6%）不吸烟。平均吸烟时间为8.7±14.9年，平均吸烟量为9.5±18.2包年。在多变量分析中，吸烟的高患病率与全视网膜变薄（p=0.024； B=-1.64; 95% CI -3.07 ~ -0.22）、神经节细胞层（GCL）变薄（p= 0.044； B=-0.39; 95% CI -0.78 ~ -0.01）和光感受器外段层（POS）变薄（p=0.024； B=-0.38; 95% CI -0.72 ~ -0.05）相关，与年龄、性别、轴长、文化程度和高血压相关。如果在不同的黄斑亚场中获得视网膜厚度测量，则得到类似的结果。吸烟时间越长，视网膜整体变薄（p=0.009； B=-0.06; 95% CI -0.10 ~ -0.01）、视网膜神经纤维层（RNFL）变薄（p=0.011； B=-0.01; 95% CI -0.02 ~ -0.002）、GCL变薄（p=0.006； B=-0.02; 95% CI -0.03 ~ -0.01）、POS变薄（p=0.025； B=-0.01; 95% CI -0.02 ~ -0.001）与年龄、性别、轴长、文化程度和高血压相关。较高的吸烟包年与较薄的GCL显著相关（p=0.022； B=-0.01; 95% CI -0.02 ~ -0.002）。结论吸烟与GCL和POS变薄有关，表明吸烟与视神经损伤或年龄相关性黄斑变性之间存在关联。
{"title":"Cigarette smoking and retinal ganglion cell layer and photoreceptor outer segment thickness: The Beijing Eye Study.","authors":"Zihan Li,Zhe Pan,Yu Huang,Hui Xie,Xiaodong Wu,Chun Zhang,Tien Yin Wong,Jost B Jonas,Ya Xing Wang","doi":"10.1136/bjo-2024-326789","DOIUrl":"https://doi.org/10.1136/bjo-2024-326789","url":null,"abstract":"PURPOSETo examine an association of cigarette smoking on retinal layer thickness.METHODSThe population-based Beijing Eye Study 2011 included 3468 individuals aged 50+ years. All participants underwent optical coherence tomography (OCT) of the macula. Using a multiple-surface OCT segmentation algorithm, the retina was segmented into nine layers. Information about cigarette smoking was assessed in an interview with a standardised questionnaire. The exclusion criterion was the presence of any retinal or optic nerve disease.RESULTSThe study included 2173 participants (mean age: 61.7±8.4 years; mean axial length: 23.1±0.8 mm) with 660 (30.4%) participants with a smoking history and 1513 (69.6%) non-smokers. Mean duration of the smoking period was 8.7±14.9 years, and mean smoking quantity was 9.5±18.2 pack-years. In multivariable analysis, higher prevalence of smoking was associated with thinner whole retina (p=0.024; B=-1.64; 95% CIs -3.07 to -0.22), thinner ganglion cell layer (GCL) (p=.044; B=-0.39; 95% CI -0.78 to -0.01) and thinner photoreceptor outer segment layer (POS) (p=0.024; B=-0.38; 95% CI -0.72 to -0.05) with adjustments of age, gender, axial length, education level and hypertension. Similar results were obtained if the retinal thickness measurements were obtained in the various macular subfields. A longer period of smoking was related to thinner whole retina (p=0.009; B=-0.06; 95% CI -0.10 to -0.01), thinner retinal nerve fibre layer (RNFL) (p=0.011; B=-0.01; 95% CI -0.02 to -0.002), thinner GCL (p=0.006; B=-0.02; 95% CI -0.03 to -0.01) and thinner POS (p=0.025; B=-0.01; 95% CI -0.02 to -0.001) with adjustments of age, gender, axial length, education level and hypertension. Higher smoking pack-years were significantly associated with thinner GCL (p=0.022; B=-0.01; 95% CI -0.02 to -0.002).CONCLUSIONSSmoking was related to thinner GCL and POS in this population-based investigation, pointing towards and agreeing with an association between smoking and optic nerve damage or age-related macular degeneration.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"68 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND/AIMSDiabetic retinopathy (DR) is a major ocular complication of diabetes mellitus. While artificial intelligence (AI)-based DR screening tools have gained widespread adoption, most research focuses on comparing AI performance with human, with limited attention to AI's role as assistants. This study evaluates the impact of AI-assisted decision-making on DR diagnosis and grading based on colour fundus photographs (CFP) and ultra-widefield fundus (UWF) images.METHODSA total of 224 retinal images were analysed by 21 ophthalmologists and primary care physicians (PCPs) in China. Participants independently diagnosed and graded DR based on CFP and UWF images. After a 1-week interval, they repeated the task with AI assistance. Diagnosis accuracy was compared with a gold standard before and after AI assistance. Incremental costs and accuracy improvements were assessed using generalized estimating equations (GEE) models.RESULTSAI assistance significantly improved DR diagnosis accuracy for both CFP and UWF images. For CFP, accuracy increased from 79.90% to 85.68% for PCPs, 81.19% to 88.69% for ophthalmic residents and 81.41% to 88.05% for ophthalmic attendings. Similar improvements were observed for UWF, with accuracy rising from 83.62% to 89.66% for residents and from 81.31% to 88.98% for attendings. GEE analysis revealed an incremental cost of 4.79 units and an accuracy improvement of 0.35 units with AI assistance.CONCLUSIONAI assistance shows potential in improving the accuracy of DR diagnosis and grading. Despite the associated costs, AI enables ophthalmologists to achieve superior diagnosis, facilitating earlier DR detection and treatment.
{"title":"Enhancing diabetic retinopathy diagnosis and grading: a retrospective study on AI-assisted decision making and cost analysis.","authors":"Xieyang Xu,Jiaying Zhang,Xuefei Song,Xinyi Liu,Yan Liu,Lili Feng,Yun Su,Yan Li,Linna Lu,Xianqun Fan","doi":"10.1136/bjo-2025-327442","DOIUrl":"https://doi.org/10.1136/bjo-2025-327442","url":null,"abstract":"BACKGROUND/AIMSDiabetic retinopathy (DR) is a major ocular complication of diabetes mellitus. While artificial intelligence (AI)-based DR screening tools have gained widespread adoption, most research focuses on comparing AI performance with human, with limited attention to AI's role as assistants. This study evaluates the impact of AI-assisted decision-making on DR diagnosis and grading based on colour fundus photographs (CFP) and ultra-widefield fundus (UWF) images.METHODSA total of 224 retinal images were analysed by 21 ophthalmologists and primary care physicians (PCPs) in China. Participants independently diagnosed and graded DR based on CFP and UWF images. After a 1-week interval, they repeated the task with AI assistance. Diagnosis accuracy was compared with a gold standard before and after AI assistance. Incremental costs and accuracy improvements were assessed using generalized estimating equations (GEE) models.RESULTSAI assistance significantly improved DR diagnosis accuracy for both CFP and UWF images. For CFP, accuracy increased from 79.90% to 85.68% for PCPs, 81.19% to 88.69% for ophthalmic residents and 81.41% to 88.05% for ophthalmic attendings. Similar improvements were observed for UWF, with accuracy rising from 83.62% to 89.66% for residents and from 81.31% to 88.98% for attendings. GEE analysis revealed an incremental cost of 4.79 units and an accuracy improvement of 0.35 units with AI assistance.CONCLUSIONAI assistance shows potential in improving the accuracy of DR diagnosis and grading. Despite the associated costs, AI enables ophthalmologists to achieve superior diagnosis, facilitating earlier DR detection and treatment.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDTo estimate the global, regional and national burdens of blindness and vision loss among children and adolescents from 1990 to 2021, categorised by age, severity and cause, and to project the burdens through 2030.METHODSBased on the Global Burden of Diseases, Injuries and Risk Factors Study 2021, the burden of blindness and vision loss was evaluated by case numbers, rates per 100 000 population and average annual percentage changes (AAPCs) in prevalence and years lived with disability (YLD) rates. The burden of trends from 1990 to 2021 was analysed using a joinpoint regression model, and the Bayesian age-period-cohort (BAPC) model projected the disease burden through 2030.RESULTSGlobally, there was no significant change in the prevalence rate of blindness and vision loss from 1990 to 2021, but the YLD rate significantly decreased (AAPC -0.17). The prevalence and YLD rates declined for refraction disorders and other vision loss from 1990 to 2021 but increased for near vision loss. The prevalence and YLD rates of refractive disorders show the most significant increase in East Asia. The BAPC model forecasts a rise in global blindness and vision loss prevalence and the YLD from 2021 to 2030 (1.63% and 0.03%, respectively), although refraction disorders and other vision loss are expected to decline.CONCLUSIONSOver the past three decades, global efforts have reduced the burden of blindness and vision loss among children and adolescents. Despite the overall decrease in refraction disorders, East Asia remains a challenge.
{"title":"Global burdens and causes of blindness and vision loss in children and adolescents from 1990 to 2021 and forecast for the next decade.","authors":"Yu Zhang,Wei Tang,Yan Wang,Lei Liu,Wenqian Zhang","doi":"10.1136/bjo-2025-327735","DOIUrl":"https://doi.org/10.1136/bjo-2025-327735","url":null,"abstract":"BACKGROUNDTo estimate the global, regional and national burdens of blindness and vision loss among children and adolescents from 1990 to 2021, categorised by age, severity and cause, and to project the burdens through 2030.METHODSBased on the Global Burden of Diseases, Injuries and Risk Factors Study 2021, the burden of blindness and vision loss was evaluated by case numbers, rates per 100 000 population and average annual percentage changes (AAPCs) in prevalence and years lived with disability (YLD) rates. The burden of trends from 1990 to 2021 was analysed using a joinpoint regression model, and the Bayesian age-period-cohort (BAPC) model projected the disease burden through 2030.RESULTSGlobally, there was no significant change in the prevalence rate of blindness and vision loss from 1990 to 2021, but the YLD rate significantly decreased (AAPC -0.17). The prevalence and YLD rates declined for refraction disorders and other vision loss from 1990 to 2021 but increased for near vision loss. The prevalence and YLD rates of refractive disorders show the most significant increase in East Asia. The BAPC model forecasts a rise in global blindness and vision loss prevalence and the YLD from 2021 to 2030 (1.63% and 0.03%, respectively), although refraction disorders and other vision loss are expected to decline.CONCLUSIONSOver the past three decades, global efforts have reduced the burden of blindness and vision loss among children and adolescents. Despite the overall decrease in refraction disorders, East Asia remains a challenge.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Deconstructing meibomian gland dysfunction: a case for a more precise classification.","authors":"Anat Galor,Todd Margolis","doi":"10.1136/bjo-2025-328376","DOIUrl":"https://doi.org/10.1136/bjo-2025-328376","url":null,"abstract":"","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We aimed to describe the response of chronic ocular graft versus host disease (oGVHD) to systemic belumosudil. A total of seven patients were included. Five patients underwent allogeneic stem cell transplant and two patients received allogeneic peripheral blood stem cell transplant. After starting belumodusil treatment (average treatment duration 22.3 months), three patients had reduced corneal fluorescein staining. Resolution of filamentary keratopathy was noted in four patients. Ocular discomfort score improved in four patients. Visual acuity remained stable for all patients. Our case series showed that belumosudil use in oGvHD may offer improvement or stabilisation and should be investigated further.
{"title":"Systemic Rho-kinase inhibitor belumosudil for treatment of ocular graft versus host disease.","authors":"Charlyn Gomez,Fernando Martinez Guasch,Vishal Jhanji,Sarah Brem Sunshine","doi":"10.1136/bjo-2025-327877","DOIUrl":"https://doi.org/10.1136/bjo-2025-327877","url":null,"abstract":"We aimed to describe the response of chronic ocular graft versus host disease (oGVHD) to systemic belumosudil. A total of seven patients were included. Five patients underwent allogeneic stem cell transplant and two patients received allogeneic peripheral blood stem cell transplant. After starting belumodusil treatment (average treatment duration 22.3 months), three patients had reduced corneal fluorescein staining. Resolution of filamentary keratopathy was noted in four patients. Ocular discomfort score improved in four patients. Visual acuity remained stable for all patients. Our case series showed that belumosudil use in oGvHD may offer improvement or stabilisation and should be investigated further.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"29 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose To assess the relationship between accommodative lag (defocus) and accommodative response to determine which drives emmetropisation in highly farsighted 3-month-old infants who successfully reached emmetropia in a 15-month period. Materials and methods 35 highly hyperopic (≥+5.00 D most hyperopic meridian) 3-month-old infants (57% female) were enrolled in a clinical trial ([NCT03669146][1]) to determine the effect on emmetropisation (reaching <+3.0 D) of partial refractive correction (full correction reduced by 3.0 D) and visual exercises to stimulate accommodation. Refractive error was obtained by cycloplegic (1% cyclopentolate) retinoscopy and accommodation was assessed with the monocular estimation method (MEM) at near (33 cm) and with the PlusOptix PowerRefractor (Plusoptix, Nuremberg, Germany) at distance (6 m) and near (33 cm). The effect of accommodative response and lag on emmetropisation was analysed using a repeated measures regression model of change in spherical equivalent refractive error as a function of accommodative lag and accommodative response. Results Greater loss of hyperopia was associated with more robust accommodative response at both distance (measured with the PowerRefractor) and near (measured with MEM). These relationships increased in strength with increasing age, reaching B=−0.32 and B=−0.47 diopters of loss of hyperopia per diopter of accommodative response at 18 months (interaction between response and age p=0.004 and p<0.001 for distance and near, respectively). Linear regression analyses showed no significant associations between change in refractive error and defocus at distance or near. Conclusion Contrary to defocus-based models of emmetropisation, greater accommodative response and not hyperopic defocus had the stronger influence on the rate of emmetropisation in hyperopic infants. Data are available upon reasonable request. Data are available upon request from reviewers and the corresponding author (AM) can handle requests on a case by case basis. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03669146&atom=%2Fbjophthalmol%2Fearly%2F2025%2F10%2F15%2Fbjo-2025-327682.atom
{"title":"Role of ocular accommodation in emmetropisation among highly farsighted infants","authors":"Ann M Morrison, Loraine T Sinnott, Donald O Mutti","doi":"10.1136/bjo-2025-327682","DOIUrl":"https://doi.org/10.1136/bjo-2025-327682","url":null,"abstract":"Purpose To assess the relationship between accommodative lag (defocus) and accommodative response to determine which drives emmetropisation in highly farsighted 3-month-old infants who successfully reached emmetropia in a 15-month period. Materials and methods 35 highly hyperopic (≥+5.00 D most hyperopic meridian) 3-month-old infants (57% female) were enrolled in a clinical trial ([NCT03669146][1]) to determine the effect on emmetropisation (reaching <+3.0 D) of partial refractive correction (full correction reduced by 3.0 D) and visual exercises to stimulate accommodation. Refractive error was obtained by cycloplegic (1% cyclopentolate) retinoscopy and accommodation was assessed with the monocular estimation method (MEM) at near (33 cm) and with the PlusOptix PowerRefractor (Plusoptix, Nuremberg, Germany) at distance (6 m) and near (33 cm). The effect of accommodative response and lag on emmetropisation was analysed using a repeated measures regression model of change in spherical equivalent refractive error as a function of accommodative lag and accommodative response. Results Greater loss of hyperopia was associated with more robust accommodative response at both distance (measured with the PowerRefractor) and near (measured with MEM). These relationships increased in strength with increasing age, reaching B=−0.32 and B=−0.47 diopters of loss of hyperopia per diopter of accommodative response at 18 months (interaction between response and age p=0.004 and p<0.001 for distance and near, respectively). Linear regression analyses showed no significant associations between change in refractive error and defocus at distance or near. Conclusion Contrary to defocus-based models of emmetropisation, greater accommodative response and not hyperopic defocus had the stronger influence on the rate of emmetropisation in hyperopic infants. Data are available upon reasonable request. Data are available upon request from reviewers and the corresponding author (AM) can handle requests on a case by case basis. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT03669146&atom=%2Fbjophthalmol%2Fearly%2F2025%2F10%2F15%2Fbjo-2025-327682.atom","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"106 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Edward Kang, Ji-Hye Park, Chungkwon Yoo, Yong Yeon Kim
Background/aims To investigate the biomechanical mechanisms underlying the occurrence of optic disc haemorrhage (ODH) in glaucoma by analysing the stress at the lamina cribrosa (LC)-sclera interface using patient-specific finite element models based on clinical data. Methods This was a retrospective, single-centre, simulation-based, case-control study. Finite element simulations were conducted on individualised optic nerve head models under two gaze conditions: primary gaze and 10° ocular rotation (adduction). The von Mises stress was calculated at the anterior and posterior boundaries of the LC-sclera interface. Intergroup differences in stress and their association with clinical variables were evaluated using analysis of variance, correlation and regression analyses. Results A total of 111 eyes were included: 44 eyes with primary open-angle glaucoma (POAG) and ODH, 34 eyes with POAG without ODH and 33 control eyes. We found statistically significant differences in stress at both the anterior and posterior boundaries during adduction between the POAG with ODH group and the other groups (p<0.01). Age and axial length were positively associated with stress at the temporal LC-sclera interface during adduction. Logistic regression identified adduction-induced stress as significantly associated with ODH. The multivariate analysis identified age as the strongest contributor to stress during adduction. Conclusion This study demonstrates that increased stress at the LC-sclera interface may contribute to the occurrence of ODH in glaucoma during adduction in the temporal region. We also found that ageing and longer axial lengths may increase stress, potentially leading to the disruption of small vessels at the optic nerve head. Data are available upon reasonable request. Deidentified patient data, including lamina cribrosa stress values, are available from the corresponding author upon reasonable request.
{"title":"Elevated lamina cribrosa-sclera interface stress in glaucomatous eyes with optic disc haemorrhage","authors":"Edward Kang, Ji-Hye Park, Chungkwon Yoo, Yong Yeon Kim","doi":"10.1136/bjo-2025-328125","DOIUrl":"https://doi.org/10.1136/bjo-2025-328125","url":null,"abstract":"Background/aims To investigate the biomechanical mechanisms underlying the occurrence of optic disc haemorrhage (ODH) in glaucoma by analysing the stress at the lamina cribrosa (LC)-sclera interface using patient-specific finite element models based on clinical data. Methods This was a retrospective, single-centre, simulation-based, case-control study. Finite element simulations were conducted on individualised optic nerve head models under two gaze conditions: primary gaze and 10° ocular rotation (adduction). The von Mises stress was calculated at the anterior and posterior boundaries of the LC-sclera interface. Intergroup differences in stress and their association with clinical variables were evaluated using analysis of variance, correlation and regression analyses. Results A total of 111 eyes were included: 44 eyes with primary open-angle glaucoma (POAG) and ODH, 34 eyes with POAG without ODH and 33 control eyes. We found statistically significant differences in stress at both the anterior and posterior boundaries during adduction between the POAG with ODH group and the other groups (p<0.01). Age and axial length were positively associated with stress at the temporal LC-sclera interface during adduction. Logistic regression identified adduction-induced stress as significantly associated with ODH. The multivariate analysis identified age as the strongest contributor to stress during adduction. Conclusion This study demonstrates that increased stress at the LC-sclera interface may contribute to the occurrence of ODH in glaucoma during adduction in the temporal region. We also found that ageing and longer axial lengths may increase stress, potentially leading to the disruption of small vessels at the optic nerve head. Data are available upon reasonable request. Deidentified patient data, including lamina cribrosa stress values, are available from the corresponding author upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"28 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective Blindness, a significant complication of neonatal disorders (ND) and their four subtypes, profoundly impacts individuals’ quality of life. This study assesses the global burden of blindness caused by ND to inform health policy development. Methods Data were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Age-standardised prevalence and years lived with disability (YLDs) were analysed using estimated annual percentage changes (EAPCs) and joinpoint model. Health disparities were evaluated through Sociodemographic Index (SDI) via the Slope Index of Inequality (SII) and Concentration Index (CI). Decomposition analysis identified burden changes, and Bayesian age-period-cohort (BAPC) models projected trends through 2040. Results In 2021, global ND-related blindness cases exceeded 4.26 million, reflecting a 60.92% increase in prevalence and 61.33% rise in YLDs since 1990. Age-standardised prevalence rates (ASPR) and YLDs rates (ASYR) increased, with the EAPCs of 0.29 (95% CI 0.26 to 0.32) and 0.31 (95% CI 0.28 to 0.34), respectively, primarily driven by population growth and epidemiological change. Socioeconomic disparities persisted, with higher burdens in lower SDI regions. From 2005 to 2021, prevalence peaked in the 45–54 age group. Projections to 2040 indicated contrasting trends: a decline in prevalence based on 1990–2021 trends, but a slight increase based on 1990–2019 trends, prior to the COVID-19 pandemic. Conclusions The burden of ND-related blindness remains substantial. The heavier burden in low SDI regions and the delayed onset of blindness due to the cumulative effects of ND may be underestimated. Urgent improvements in medical resource allocation and long-term eye health follow-up for ND survivors are needed. Data are available upon reasonable request. Some of the data presented here are publicly available on the Global Health Data Exchange website. The other data and analysis code are available from the corresponding author upon reasonable request.
失明是新生儿疾病（ND）及其四亚型的重要并发症，严重影响个体的生活质量。本研究评估由ND引起的全球失明负担，为卫生政策制定提供信息。方法数据来自全球疾病负担研究2021 （GBD 2021）。使用估计年度百分比变化（EAPCs）和连接点模型分析年龄标准化患病率和残疾生活年数（YLDs）。通过社会人口指数（SDI）、不平等斜率指数（SII）和浓度指数（CI）评估健康差异。分解分析确定了负担变化，贝叶斯年龄-时期-队列（BAPC）模型预测了到2040年的趋势。结果2021年，全球nd相关性失明病例超过426万例，与1990年相比，患病率上升了60.92%，YLDs上升了61.33%。年龄标准化患病率（ASPR）和YLDs率（ASYR）增加，eapc分别为0.29 （95% CI 0.26 ~ 0.32）和0.31 (95% CI 0.28 ~ 0.34)，主要受人口增长和流行病学变化的驱动。社会经济差异仍然存在，低SDI地区的负担更高。2005年至2021年，45-54岁年龄组的患病率达到高峰。到2040年的预测显示出截然不同的趋势：根据1990-2021年趋势，患病率有所下降，但在2019冠状病毒病大流行之前，根据1990-2019年趋势，患病率略有上升。结论nd相关性失明的负担仍然很大。低SDI地区较重的负担和ND累积效应导致的延迟致盲可能被低估了。迫切需要改善医疗资源分配和ND幸存者的长期眼健康随访。如有合理要求，可提供资料。这里介绍的一些数据可在全球卫生数据交换网站上公开获得。其他数据和分析代码可根据合理要求从通讯作者处获得。
{"title":"Persistent socioeconomic disparities and delayed onset in blindness due to neonatal disorders: global burden and future projections","authors":"Shanhong Li, Weiai Shen, Mingsu Shi, Yanxi Fang, Lingyun Liu, Runyi Shao, Chen Zhao, Lianqun Wu","doi":"10.1136/bjo-2025-327558","DOIUrl":"https://doi.org/10.1136/bjo-2025-327558","url":null,"abstract":"Objective Blindness, a significant complication of neonatal disorders (ND) and their four subtypes, profoundly impacts individuals’ quality of life. This study assesses the global burden of blindness caused by ND to inform health policy development. Methods Data were obtained from the Global Burden of Disease Study 2021 (GBD 2021). Age-standardised prevalence and years lived with disability (YLDs) were analysed using estimated annual percentage changes (EAPCs) and joinpoint model. Health disparities were evaluated through Sociodemographic Index (SDI) via the Slope Index of Inequality (SII) and Concentration Index (CI). Decomposition analysis identified burden changes, and Bayesian age-period-cohort (BAPC) models projected trends through 2040. Results In 2021, global ND-related blindness cases exceeded 4.26 million, reflecting a 60.92% increase in prevalence and 61.33% rise in YLDs since 1990. Age-standardised prevalence rates (ASPR) and YLDs rates (ASYR) increased, with the EAPCs of 0.29 (95% CI 0.26 to 0.32) and 0.31 (95% CI 0.28 to 0.34), respectively, primarily driven by population growth and epidemiological change. Socioeconomic disparities persisted, with higher burdens in lower SDI regions. From 2005 to 2021, prevalence peaked in the 45–54 age group. Projections to 2040 indicated contrasting trends: a decline in prevalence based on 1990–2021 trends, but a slight increase based on 1990–2019 trends, prior to the COVID-19 pandemic. Conclusions The burden of ND-related blindness remains substantial. The heavier burden in low SDI regions and the delayed onset of blindness due to the cumulative effects of ND may be underestimated. Urgent improvements in medical resource allocation and long-term eye health follow-up for ND survivors are needed. Data are available upon reasonable request. Some of the data presented here are publicly available on the Global Health Data Exchange website. The other data and analysis code are available from the corresponding author upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDChronic antigenic stimulation, including autoimmune disorders and infection, may contribute to lymphoproliferation in specific tissues. Chlamydia species have been linked to ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML), with geographic variation in prevalence. This study explores the association between Chlamydia infection and OAML and correlates the presence of Chlamydia DNA with clinical features and treatment outcomes in Taiwan.METHODSPathology specimens from 71 patients diagnosed with primary OAML were analysed for the presence of Chlamydia species, including C. psittaci, C. pneumoniae and C. trachomatis DNA, using touchdown enzyme time-release PCR. Demographic and clinical data, including age, sex, lymphoma location, staging and treatment modalities, were compared between Chlamydia DNA-positive and negative groups. Treatment outcomes such as relapse rates, survival time and treatment response were also analysed.RESULTSAmong the 71 OAML specimens, 27 (38%) tested positive for C. trachomatis DNA, with two cases also positive for C. pneumoniae DNA. Chlamydia positivity was significantly associated with orbital involvement (p=0.020). No differences were found between the two groups in terms of disease staging, treatment methods, relapse rates, survival time and treatment response at last follow-up.CONCLUSIONSThe study is the first regional report elucidating the association between Chlamydia and OAML in Taiwan. The findings suggest a possible link between C. trachomatis and orbital involvement in OAML. Further large-scale and prospective studies are needed to clarify the role of Chlamydia in OAML pathogenesis and to evaluate the potential benefits of antibiotic therapy in the patient population.
{"title":"Association of Chlamydia species with ocular adnexal mucosa-associated lymphoid tissue lymphoma in Taiwan.","authors":"Wan-Chen Tsai,Shih-Ming Jung,Hsiao-Wen Kao,Yin-Hsi Chang,Yi-Lin Liao,Yueh-Ju Tsai,Yen-Chang Chu,Ching-Hsi Hsiao","doi":"10.1136/bjo-2025-328028","DOIUrl":"https://doi.org/10.1136/bjo-2025-328028","url":null,"abstract":"BACKGROUNDChronic antigenic stimulation, including autoimmune disorders and infection, may contribute to lymphoproliferation in specific tissues. Chlamydia species have been linked to ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML), with geographic variation in prevalence. This study explores the association between Chlamydia infection and OAML and correlates the presence of Chlamydia DNA with clinical features and treatment outcomes in Taiwan.METHODSPathology specimens from 71 patients diagnosed with primary OAML were analysed for the presence of Chlamydia species, including C. psittaci, C. pneumoniae and C. trachomatis DNA, using touchdown enzyme time-release PCR. Demographic and clinical data, including age, sex, lymphoma location, staging and treatment modalities, were compared between Chlamydia DNA-positive and negative groups. Treatment outcomes such as relapse rates, survival time and treatment response were also analysed.RESULTSAmong the 71 OAML specimens, 27 (38%) tested positive for C. trachomatis DNA, with two cases also positive for C. pneumoniae DNA. Chlamydia positivity was significantly associated with orbital involvement (p=0.020). No differences were found between the two groups in terms of disease staging, treatment methods, relapse rates, survival time and treatment response at last follow-up.CONCLUSIONSThe study is the first regional report elucidating the association between Chlamydia and OAML in Taiwan. The findings suggest a possible link between C. trachomatis and orbital involvement in OAML. Further large-scale and prospective studies are needed to clarify the role of Chlamydia in OAML pathogenesis and to evaluate the potential benefits of antibiotic therapy in the patient population.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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