Eye

Background/Aims: To evaluate the impact of socioeconomic deprivation on clinical presentation and outcomes of bacterial keratitis (BK) in the United Kingdom. Methods: A retrospective multicentre cohort study of 320 patients with BK presenting to two UK tertiary ophthalmic centres. Demographic, clinical and microbiological data were extracted from electronic health records. Socioeconomic status was assigned using residential postcodes mapped to the 2019 English Index of Multiple Deprivation (IMD) and grouped into quintiles (Q1 most deprived; Q5 least deprived). Presenting severity and outcomes were compared across IMD quintiles. Results: The mean age was 54.0{+/-}20.9 years; 50.6% were male and 83.4% were White. Mean presenting CDVA was 1.10{+/-}1.01 logMAR and time to presentation was a median of 3 days (IQR 1-6). Most cases had a small infiltrate (<3 mm; 68.4%), small epithelial defect (<3 mm; 63.4%) and no hypopyon (72.5%). Hospitalisation was required in 50.0%, and 17.5% underwent surgery. Culture positivity was 36.3%. There were no significant differences in presenting CDVA, time to presentation, clinical severity, admission, microbiological profile, surgical intervention or final CDVA across IMD quintiles (all p>0.05). Final CDVA improved to 0.75{+/-}0.96 logMAR (p<0.001). On multivariable analysis, poorer final CDVA was associated with worse presenting CDVA, increasing age and Gram-positive organisms, but not IMD. Conclusion: Socioeconomic deprivation did not influence the clinical presentation or outcomes in BK. Clinical severity at presentation and microbiological profile were the principal determinants of outcome. In this acute, painful sight-threatening condition, deprivation-related disparities may be attenuated by prompt presentation and universal access to emergency ophthalmic care.

PurposeThe aim of this clinical investigation was to evaluate the safety and effectiveness of iota-carrageenan (I-C) eye drops in the treatment of mild-to-moderate dry eye disease (DED). MethodsIn this prospective, single arm, open label clinical investigation, thirty adult participants with mild-to-moderate DED applied I-C eye drops three times daily for four weeks. Before start and after end of treatment, participants rated DED symptoms (foreign body sensation, burning/stinging, itching, pain, sticky feeling, blurred vision and photophobia), both after exposure to a normal controlled environment (NCE) and to an adverse controlled environment (ACE). Additional endpoints were changes in ocular surface disease index (OSDI), Change in Dry Eye Symptoms Questionnaire (CDES-Q), corneal and conjunctival surface damage, tear film break-up time, tear evaporation and production. Tolerability was assessed by participants at start and end of treatment. Safety, including visual acuity and intraocular pressure, was monitored throughout the investigation. ResultsAfter four weeks of treatment with I-C eye drops, the mean total DED score after ACE was significantly reduced by -11.89 points (95% CI: -15.11, -8.67), p<0.001. The mean score reduction between baseline and final visit after NCE was slightly less pronounced, with -8.07 points (95% CI: -10.71; -5.43), p<0.001. The vast majority of participants (93% after ACE and 89% after NCE exposure) recorded a reduction in total DED score between baseline and final visit. Mean OSDI score significantly decreased by -7.75 points (95% CI: -10.85, -4.63), p<0.001. ACE-induced deterioration of tear film stability as well as corneal and conjunctival damage were reduced following treatment. All adverse events were mild and transient in nature. 93% of the patients described I-C eye drops as well or very well tolerated. Treatment did not negatively impact any of the safety parameters. ConclusionI-C eye drops are effective, safe and well tolerated. Treatment with I-C eye drops alleviates DED symptoms, stabilizes tear film and protects the ocular surface in patients with mild-to-moderate DED even under adverse environmental conditions. Trial RegistrationNCT06262100.

AimsPrimary objective: To determine the minimum inhibitory concentration (MIC) of key antifungal drugs (natamycin, amphotericin B, voriconazole and econazole) against fungal isolates cultured from fungal keratitis patients in South India. Secondary objective: to ascertain correlations between antifungal resistance and patient outcome. MethodsIn this prospective observational study, MIC values were determined for fungal isolates cultured from 153 patients, with samples collected between May - August 2025. Clinical characteristics were collected at baseline, one-week and one-month following enrolment to the study. Mean antifungal MIC per fungi genera were compared. Statistical differences in MIC and patient characteristics were determined via multiple logistic or linear regression. Significance for participant outcome against resistant/non-resistant fungi were determined by Fishers exact test. ResultsResistance of Fusarium spp. isolates to: natamycin: 38.3%; amphotericin B: 93.8%; voriconazole: 97.5% and econazole: 76.5%. Resistance of Aspergillus spp. isolates to: natamycin: 66.7%; amphotericin B: 87.9%; voriconazole: 6.1%; and none were resistant to econazole. Natamycin MIC correlated with worse baseline (P[&le;]0.01) and one-week (P[&le;]0.05) visual acuity and ulcer severity. Poor patient outcomes (non-healing or therapeutic keratoplasty) were elevated 6.5x where the infection was caused by natamycin resistant Aspergillus, compared to sensitive Aspergillus strains (P[&le;]0.05). ConclusionThe majority of fungal isolates were resistant to multiple antifungals, none of the Fusarium isolates were sensitive to all four drugs, and 15% were resistant to all four drugs. Aspergillus isolates had high levels of resistance to the polyenes, but remained largely susceptible to the azoles. Overall, worse patient outcomes were associated with increased natamycin MIC. Key MessagesO_ST_ABSWhat is already known on this topicC_ST_ABSFungal keratitis is a major cause of blindness worldwide, disproportionately affecting those across the tropics, with incidence increasing across temperate climates. The majority of cases are caused by the filamentous fungi Fusarium spp. and Aspergillus spp.. Antifungal resistance is poorly characterised in fungal keratitis. What this study addsWe report the fungal aetiology and the minimum inhibitory concentration (MIC) against natamycin, amphotericin B, voriconazole and econazole of isolates cultured from 153 patient corneal scrape samples between May - August 2025 at a South Indian hospital. We found high levels of fungal resistance, with Fusarium isolates having high levels of resistance to both polyenes and azoles. Aspergillus isolates showed good azole sensitivity, but high levels of resistance to polyenes. Aspergillus resistance to natamycin correlated with worse clinical outcomes at one-month. Natamycin resistance contributed to worse visual acuity and ulcer severity at baseline and one-week follow-up across all fungi. How this study might affect research, practice or policyOur study confirmed that natamycin was best available first-line treatment for Fusarium. Aspergillus isolates were mostly resistant to natamycin and amphotericin B, and this impacted patient outcomes. SynopsisWe identified high incidence of multi-drug resistant fungi, and that patients were more likely to have a poor clinical outcome if the fungal isolate was resistant to natamycin. This was most pronounced for Aspergillus isolates.

IntroductionAnti-vascular endothelial growth factor (anti-VEGF) therapies are standards of care for vision-threatening retinal diseases. This retrospective observational study describes demographics, utilization, best recorded visual acuity (BRVA), and safety among eyes with neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), or retinal vein occlusion (RVO) treated with the biosimilar aflibercept-ayyh (PAVBLU(R)) in routine clinical practice. MethodsElectronic medical records from the Retina Consultants of America database of patients receiving aflibercept-ayyh (12/1/2024-10/31/2025) were analyzed, focusing on eyes with [&ge;]84 days of follow-up. The index date was the first documented aflibercept-ayyh injection. Postindex data were used to assess treatment patterns, BRVA (Wilcoxon signed rank test), and adverse events of special interest (AESIs). ResultsA total of 1,000 consecutive eyes from 989 patients received 3,730 injections of aflibercept-ayyh; most (91%) switched from prior anti-VEGF therapy and 9% were anti-VEGF treatment-naive. Disease distribution was 58% nAMD, 19% RVO, 16% DME, and 7% DR. Among switchers, median (IQR) number of prior injections was 21 (8-46). Median (IQR) follow-up was 6.0 months (4.6-7.1). Median (IQR) number of aflibercept-ayyh injections per eye was 4 (3-5). Among eyes with [&ge;]84 days of follow-up (n=889), mean BRVA expressed as logarithm of minimum angle of resolution (logMAR) remained stable for switchers (0.4 to 0.4; P=0.96) and improved from baseline in anti-VEGF-naive eyes (0.5 to 0.4; P<0.01). Confirmed AESIs included iritis (n=2; 0.05% of injections), with no events of vitreous cells, endophthalmitis, retinal detachment, retinal vasculitis, or vitreous hemorrhage. ConclusionIn this descriptive real-world analysis, aflibercept-ayyh was associated with stable visual acuity in previously treated eyes and vision improvement in treatment-naive eyes, with no new or unexpected safety findings, consistent with expectations for aflibercept. These findings add real-world experience to preexisting evidence demonstrating no clinically meaningful differences between aflibercept-ayyh (PAVBLU(R)) and reference aflibercept (EYLEA(R)). KEY SUMMARY POINTSO_ST_ABSWhy carry out this study?C_ST_ABSO_LIThe anti-vascular endothelial growth factor (VEGF) drug aflibercept, approved in 2011 and marketed in the United States as EYLEA(R),* has demonstrated efficacy in treating retinal diseases such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), or retinal vein occlusion (RVO) and is a standard of care for these disorders. C_LIO_LIAflibercept-ayyh is a biosimilar to aflibercept that has demonstrated comparable efficacy and safety in the treatment of nAMD in a randomized controlled clinical trial. C_LIO_LIThis study describes the real-world use patterns, vision outcomes, and safety of aflibercept-ayyh in clinical settings in the United States for the treatment of nAMD, DR, DME, and RVO. C_LI What was learned from the study?O_LIIn this real-world study of 1,000 consecutive eyes treated with the biosimilar aflibercept-ayyh in patients with retinal diseases, we observed no new safety concerns and that aflibercept-ayyh maintained visual acuity in eyes switching anti-VEGF agents and improved vision in anti-VEGF-naive eyes, consistent with expected responses to aflibercept. C_LIO_LIThese findings support aflibercept-ayyh as a suitable treatment option when anti-VEGF therapy is indicated. *EYLEA(R) is a registered trademark of Regeneron Pharmaceuticals, Inc. PAVBLU(R) is a registered trademark of Amgen Inc. C_LI

Background The World Health Organisation (WHO) advocates integrating primary eye care (PEC) within community health systems, supported by task-shifting and frugal technologies. While low-cost tools such as the Arclight device and Wilson anterior segment loupe have demonstrated training and diagnostic value, their long-term impact on community health worker (CHW) roles and professional networks remain poorly understood. Methods We conducted a qualitative follow-up study 3 years after implementation of an Arclight Project enabled cascade training of the trainers (ToT) PEC programme in central Malawi. Ophthalmic Clinical Officers (OCOs) trained using the Arclight training and diagnostic package subsequently cascaded PEC training to Health Surveillance Assistants (HSAs). Semi-structured interviews were undertaken 3 years later with OCOs and HSAs to explore device use, evolving professional roles, training diffusion, and communication patterns. Data were analysed thematically, informed by concepts from social network analysis to examine changes in advice-seeking, mentorship and peer collaboration. Results Frugal eye-care technologies functioned not only as diagnostic tools but as mechanisms of professional repositioning. HSAs equipped with low-cost diagnostic devices became recognised as community eye focal persons, receiving referrals from colleagues and community members. OCOs who delivered training emerged as central hubs for clinical advice and ongoing training, creating strong vertical networks between district and community levels. However, horizontal peer-to-peer networks among HSAs remained weak and largely informal. Communication relied heavily on ad-hoc phone calls and WhatsApp messaging, with limited structured communities of practice. Despite sustained use of devices and retention of key skills, network activity often declined over time without active reinforcement. Conclusions Frugal eye-care technologies act as social as well as clinical interventions, reshaping CHW networks and professional hierarchies. Designing PEC programmes with explicit attention to strengthening and sustaining professional networks, rather than focusing solely on skills transfer, may further enhance alignment with WHO Integrated People-Centred Eye Care and improve long-term programme sustainability and impact.

Background: Despite strong evidence from controlled trials, uncertainty remains about the real-world use of 0.05% atropine in patients with lighter irises due to tolerability concerns, and predictors of treatment response are poorly understood. Here, we evaluated the effectiveness, tolerability, and early biometric response to 0.05% atropine in clinical practice among patients with predominantly light irises. Methods: This prospective cohort study included 33 patients treated with 0.05% atropine (82% with light irises). Cycloplegic spherical equivalent refraction (SER) was measured at baseline and 3-month intervals. Axial length (AL), photopic pupil diameter, accommodation amplitude, and subjective side effects were monitored more frequently initially. Results: Median age at treatment initiation was 11.97 years, SER -5.38 D, and AL 25.42 mm. Over 12 months, SER changed by -0.078 {+/-} 0.349 D (mean {+/-} SD), and AL increased by 0.052 {+/-} 0.115 mm. Eighty-eight percent of participants had a SER change of <0.5 D, and 91% had axial elongation of <0.2 mm, indicating clinically limited myopia progression. Photopic pupil diameter was larger, and accommodation amplitude was reduced throughout follow-up. Early in treatment, side effects, including photophobia and near-work difficulties, were common but minimally disruptive. Their incidence decreased rapidly and rarely required treatment modification. In exploratory analyses, early AL changes predicted 12-month AL outcomes, with associations detectable as early as 1 week and strengthening over time. Conclusions: 0.05% atropine was well tolerated and effective in this population with light irises. Early AL changes may predict 12-month treatment response. These findings support the implementation of 0.05% atropine in routine clinical practice in populations with light irises and highlight the potential for early AL monitoring to guide timely treatment adjustments.

Purpose To evaluate patient satisfaction and preferences for portable versus table-mounted visual field (VF) devices in a rural telemedicine setting and identify influencing factors. Methods We conducted a sequential explanatory mixed methods study at three Federally Qualified Health Centers (FQHCs) within the Alabama Screening and Intervention for Glaucoma and eye Health through Telemedicine (AL-SIGHT) study. Participants completed VF testing with table-mounted Humphrey Field Analyzer (HFA), tablet-based Melbourne Rapid Fields (MRF), and virtual reality (VR)-based VisuALL perimeters. Participants rated satisfaction, comfort, ease of use, and future testing preference. Chi-square tests assessed differences in device preferences. Twelve participants completed semi-structured interviews to explore reasons underlying preferences. Qualitative data were analyzed in NVivo 14 using reflexive thematic analysis. Results Among 271 respondents (mean age 60.4 years; 62.4% women), 50.6% preferred VR-based, 35.1% tablet-based, and 14.4% table-mounted for future testing ({chi}2 (2) = 53.52, p<0.001, Cramers V = 0.31). Satisfaction was highest for VR-based (56.9% very satisfied), followed by tablet-based (49.4%), and HFA (38.0%). VR-based perimeter was most frequently selected as the most comfortable (55.7%; {chi}2 (2) = 63.33, p<0.001, V = 0.34) and easiest to use (54.6%; {chi}2 (2) = 71.96, p<0.001, V = 0.36). Preferences did not vary significantly across demographic variables (all p>0.05). Qualitative themes identified four key drivers: comfort and physical experience, visual experience, ease of use and interaction, and psychological and motivational factors. Portability and community suitability were valued. Conclusion Rural underserved patients strongly preferred portable visual field devices, particularly VR-based, over table-mounted HFA. Comfort, ergonomic flexibility, immersive visual experience, and simplicity of interaction were central determinants of preference. Portable perimetry may enhance patient-centered glaucoma monitoring within telemedicine programs and access in resource-limited settings.

Purpose: To highlight the roles of intraoperative optical coherence tomography (iOCT) in managing acute corneal hydrops (ACH) and outcomes of iOCT-guided pneumodescemetopexy and corneal compression sutures. Methods: This was a retrospective, consecutive, interventional case series of patients with keratoconus who presented with significant ACH and underwent iOCT-guided pneumodescemetopexy (18% sulfur hexafluoride gas) and compression sutures at Birmingham and Midland Eye Centre, UK, between Aug 2023 and May 2025. Results: Five patients were included; mean age was 32.3+/-6.6 years old and 3 (60%) were male. The mean follow-up duration was 16.3+/-5.6 months. At presentation, the mean corrected-distance-visual-acuity (CDVA) was 1.90+/-0.67 logMAR, central corneal thickness (CCT) was 1187.6+/-372.6um, maximal corneal thickness was 1624.0+/-383.5um and maximal height and diameter of pre-Descemet layer/Descemet membrane (PDL/DM) detachment was 1014.6+/-366.4um and 4456.0+/-839.4um, respectively. The surgery successfully achieved complete PDL/DM attachment in all cases, with a mean time from surgery to ACH resolution of 17.8+/-8.0 days. iOCT successfully visualized the area of PDL/DM break/detachment, revealed the involvement of PDL (evidenced by a persistent taut type 1 DM detachment after gas tamponade), and guided the placement of compression sutures. Compared to preoperative, there was a significant improvement in the mean CDVA (0.52+/-0.32 logMAR; p=0.014) at last follow-up. One patient required a repeat procedure to fully attach the PDL/DM. Conclusions: This study demonstrated favorable outcomes of iOCT-guided pneumodescemetopexy and corneal compression sutures. iOCT revealed the involvement of PDL in ACH and provided plausible explanations why pneumodescemetopexy alone may not be able to resolve significant ACH rapidly in certain cases.

BackgroundDiabetes mellitus (DM) remains a major global health challenge and is associated with vision-threatening complications, including diabetic macular edema (DME), a leading cause of visual impairment. Dyslipidemia has been implicated in the development of macular edema through mechanisms involving vascular permeability, endothelial dysfunction, and chronic inflammation. However, evidence regarding the relationship between lipid abnormalities and macular edema remains inconsistent across studies. AimThis study aimed to evaluate the association between abnormal lipid profiles and diabetic macular edema among patients with type 2 diabetes mellitus attending Kilimanjaro Christian Medical Centre (KCMC). MethodsA hospital-based analytical cross-sectional study was conducted among 296 diabetic outpatients at KCMC. Participants underwent comprehensive ophthalmic evaluation including fundoscopy and imaging with optical coherence tomography (OCT) for assessment of macular edema. Blood samples were collected for biochemical lipid analysis. Data were cleaned and analyzed using STATA version 17. ResultsDiabetic macular edema was identified in 56.4% (167/296) of participants. Abnormal lipid parameters were common, with elevated total cholesterol observed in 48.6%, triglycerides in 43.6%, low-density lipoprotein (LDL) in 36.1%, and reduced high-density lipoprotein (HDL) in 38.9% of patients. Elevated total cholesterol, triglycerides, and LDL levels showed significant associations with macular edema (p < 0.05). After multivariable adjustment, serum triglycerides remained independently associated with macular edema (p = 0.002). ConclusionDyslipidemia demonstrated a significant association with diabetic macular edema, with serum triglycerides emerging as an independent predictor. These findings highlight the importance of lipid monitoring, lifestyle modification, and strengthened screening strategies in reducing the burden of vision-threatening diabetic complications.

PurposeTo evaluate the diagnostic performance of anterior segment optical coherence tomography (ASOCT) compared to slit lamp examination for identification of corneal perforation in microbial keratitis, and to assess ASOCT grading reproducibility. MethodsWe conducted a diagnostic concordance study of 150 eyes with microbial keratitis at a tertiary eye hospital in India. Two masked graders independently evaluated ASOCT scans for perforation, with disagreements resolved by consensus. We calculated Cohens kappa for inter-grader concordance and intra-grader repeatability. Sensitivity and specificity of slit lamp examination were calculated using ASOCT as the reference standard. Logistic regression identified factors associated with disagreement between modalities. ResultsInter-grader agreement for ASOCT was near-perfect ({kappa}=0.98; 95% CI, 0.92-1.00). ASOCT identified perforation in 24 eyes (16.0%) compared to 12 eyes (8.0%) by slit lamp examination. Using ASOCT as reference, slit lamp examination demonstrated 33.3% sensitivity (95% CI, 14.9-52.2%) and 96.8% specificity (95% CI, 93.4-99.2%). Odds of disagreement were significantly higher for eyes with stromal thinning (OR=8.19; 95% CI, 2.27-29.54), mid-stromal involvement (OR=4.44; 95% CI, 1.08-18.30), and infection within 2mm of the limbus (OR=8.81; 95% CI, 1.77-43.80). ConclusionsASOCT enables highly reproducible perforation grading and detects substantially more perforations than slit lamp examination, particularly in severe disease. These findings support ASOCT as an objective tool for clinical assessment and outcome ascertainment in microbial keratitis.

PurposeTo evaluate the performance of machine learning models for automated glaucoma detection using multimodal clinical, structural, and functional data from a West African clinical cohort. MethodsIn this retrospective observational study, we analyzed clinical records from two major eye care centers in Ghana. A total of 605 eyes from 417 patients who underwent comprehensive glaucoma evaluation were included. Extracted features included demographic data, intraocular pressure, optical coherence tomography (OCT) structural parameters, and Humphrey visual field indices. We assessed the diagnostic performance of individual parameters using receiver operating characteristic (ROC) analysis. Supervised machine learning classifiers, including support vector machine (SVM), random forest (RF), gradient boosting machine (GBM), and a multi-layer perceptron (MLP), were trained using a forward feature selection approach and evaluated using five-fold cross-validation. We assessed model performance by computing performance metrics like sensitivity, specificity, and area under the ROC curve (AUC). ResultsAmong the 605 eyes analyzed, 361 (59.7%) were glaucomatous, and 244 (40.3%) were healthy. Individual structural and functional parameters demonstrated moderate discriminative ability, while age showed no significant diagnostic value (AUC = 0.49, p = 0.841). Among machine learning models, the MLP achieved the highest diagnostic performance (AUC = 0.90 [95% CI: 0.86-0.92], sensitivity = 0.88, specificity = 0.86), outperforming SVM (AUC = 0.82), RF (AUC = 0.78), and GBM (AUC = 0.77). Multimodal integration of clinical, structural, and functional features improved discrimination compared with individual parameters. ConclusionsMultimodal machine learning models can effectively automate glaucoma detection using routinely collected clinical data. In this West African cohort, an MLP-based approach demonstrated superior diagnostic performance compared with traditional machine learning models and individual clinical metrics. These findings highlight the potential of clinically grounded artificial intelligence tools to support glaucoma diagnosis and triage in resource-constrained eye care settings.

Purpose:To improve determination of the treatment area for the personalization of subliminal transscleral cyclophotocoagulation (SL-TSCPC) procedures in glaucoma treatment, we designed a biometry based model of the human eye to find the estimated cilary body (CB) arc length (ECBAL) and the calculated CB distance (CCBD). Methods: We developed a rotationally symmetric modified two-sphere eye model based on axial length (AL), mean keratometry (mean K), anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW). ECBAL and CCBD were calculated for each eye. Fluence was calculated with standardized parameters. Results: Publicly accessible biometric measurements for 24,001 eyes were pooled for analysis. The mean ECBAL was 23.99+-1.8 mm. The correlations of ECBAL with AL and ACD were 0.723 and 0.754 respectively (p < 0.01). The number of eyes with an ECBAL 21.7-22.0 mm was 131 of 24,001 (0.55%). The mean CCBD was 4.21+-0.8 mm. The number of eyes with a CCBD of 3.8 mm was 1,445 of 24,001 (6.02%). Mean fluence was 120.33+-9.0 J/cm2. A mean difference of -8.18+-6.9%, ranging from -22.66% to +29.07% in fluence was observed with treating only the recommended 22 mm versus the ECBAL. Conclusions: This study demonstrated that use of 22.0 mm as the standard treatment arc length may under or overdose laser treatment in many eyes. Precise estimation or exact localization of the CB treatment area is required to accurately calculate fluence. Translational Relevance:The model proves that CB arc length is a variable while current guidelines consider it a constant

Aim: To evaluate the potential of a three-dimensional microscope combining Laser scanning confocal imaging and white-light interferometry for quantitative topographic characterisation of Descemet's membrane (DM) in Fuchs endothelial corneal dystrophy (FECD). Methods: Descemet's membranes were collected from 38 FECD patients undergoing endothelial keratoplasty and 4 healthy donors. After flat-mounting on glass slide and drying, specimens were analysed using the VK-X3000 system (KEYENCE). Entire samples were reconstructed by image stitching at low magnification (x10) in white-light interferometry mode (0.01nm axial resolution). Higher magnifications (x20-x150) in confocal mode (12nm axial resolution) enabled detailed structural analysis. Three-dimensional height maps were generated to calculate standardised surface roughness parameters. Guttae and other DM features were classified according to spatial organisation and elevation profiles. Results: White-light interferometry enabled full-field mapping of whole 8mm diameter DMs with nanometric vertical resolution (~2 hours/sample). Surface roughness (Sa) was higher in FECD than in controls (median{+/-}IQR: 0.571{+/-}0.259 m vs 0.239{+/-}0.161 m ; p = 0.0018). In FECD, three zones were identified: central (guttae buried in the posterior fibrillar layer; Sa 0.442 {+/-} 0.112 m), paracentral (large uncovered guttae; Sa 0.562{+/-}0.170 m ; p = 0.0423), and outer zone (no confluent guttae; Sa 0.261{+/-}0.143 m ; p < 0.0001). Confocal 3D imaging revealed radial striae, embossments and furrows in the DM, confluent central guttae, and fused or buried structures. Conclusions: Combining white-light interferometry and confocal microscopy enables label-free, high-resolution surface characterisation of DM in FECD, providing quantitative metrics to compare histological subtypes and supporting the predominance of radial structural organisation.

Purpose To evaluate associations between optical coherence tomography angiography (OCT-A) metrics and diabetic retinopathy (DR) and compare their discrimination against conventional clinical risk factors. Methods In this cross-sectional study, 108 adult eyes (right eye if both eligible) with diabetes were recruited from tertiary ophthalmology/optometry clinics. DR was clinically graded using ETDRS categories and dichotomised as no DR vs >= mild NPDR (primary outcome). Macular 6x6 mm OCT-A (Zeiss AngioPlex) was acquired; scans with signal strength >7 and without major artefact were included. Quantitative metrics from the superficial capillary plexus included vessel density (VD) and perfusion density (PD) (central/inner/outer/full regions); structural OCT measures and FAZ parameters were secondary. Associations with >= mild NPDR were assessed using multivariable logistic regression adjusted for age, sex, HbA1c, and diabetes duration. Discrimination was evaluated with ROC curves/AUC (95% CI) and DeLong comparisons of AUCs. Results DR was present in 63% of eyes. DR was associated with lower VD (central, inner, outer, full) and lower PD (central, inner, full) (all p<=0.04). After adjustment, central VD (OR 0.82, 95% CI 0.68-0.98) and central PD (OR 0.92, 95% CI 0.86-0.99) remained independently associated with DR. The OCT-A model outperformed the clinical model (AUC 0.73 vs 0.60); the combined model yielded AUC 0.76. Conclusion VD and PD from the superficial plexus are independently associated with DR and show superior discrimination versus conventional clinical factors alone, supporting OCT-A as an adjunct for earlier DR detection.

Conventional assays (questionnaires, acuity, visual fields) may be insufficient to assess the real-world impact of new glaucoma treatments. Here, we report a novel virtual reality shopping task, and assess its sensitivity to differences in mild visual field loss. Eight glaucoma patients were asked to freely navigate a virtual grocery store and place items from a shopping list into a trolley. Across a range of metrics (time, head/body movements), performance was associated with variations in binocular visual field loss [r238=0.35, P<.001]. This indicates promise for using virtual reality tasks to evaluate the benefits of new treatments. Improvements and use-cases are discussed. ONLINE ONLY SUPPLEMENTARY MATERIALThe article contains supplementary material which will be provided as a single stand-alone PDF document.

PurposeTo evaluate the three-year efficacy and safety of compound trabeculectomy for uveitic glaucoma (UG). MethodsThis retrospective study enrolled 51 patients (53 eyes) requiring compound trabeculectomy, divided into UG (25 eyes) and non-UG groups (28 eyes). Outcomes including intraocular pressure (IOP), medication use, surgical success rates, and complications were analyzed over 3 years. ResultsBaseline characteristics including age, sex, preoperative IOP and medication use were comparable (all P>0.05). At 36 months, postoperative IOP was showed no significant differences, which was 15.4{+/-}8.4 mmHg and 14.6{+/-}3.3 mmHg (P=0.73) with 54% and 55% reduction (P=0.88) in UG and non-UG groups respectively. The qualified success rate was 76.0% and 85.7% at 36 months in UG and non-UG group, and Kaplan-Meier analysis showed no significant difference. Medication reduction of UG group was significant lower than non-UG group (P=0.0058). Comparable complication rates were observed between groups (all P>0.05), yet bleb scarring and cataract progression showed elevated incidence in both cohort. ConclusionCompound trabeculectomy effectively reduced IOP and medications use in UG and non-UG. There was no significant difference in both qualified and completed success rate between UG and non-UG. Complications of filtering bleb fibrosis and cataract progression should be pay close attention for both groups.

In recent years, researchers have paid increasing attention on potential associations between respiratory and ocular diseases. To examine whether asthma is independently associated with macular degeneration (MD) and whether asthma can serve as a predictor of MD using data from the English Longitudinal Study of Ageing (ELSA). Data from the 2020-2021 wave of ELSA were analyzed. Statistical tests were performed on participants baseline characteristics. Multivariable logistic regression, stratified analysis, ROC curve analysis, smoothing curves and sensitivity analysis were conducted to assess the association, stability, predictive performance, dose-response relationship and robustness. A total of 6,703 participants were included. After adjusting for covariates, age and asthma were significantly associated with MD (p < 0.05), while diet and sex were not. Asthma was consistently linked to increased MD risk across three regression models (OR > 1, p < 0.05), with the association persisting in stratified analyses. ROC analysis showed moderate predictive performance (AUC = 0.757), and a positive dose-response relationship was observed. Sensitivity analyses confirmed the robustness of the association. Asthma may independently increase MD risk, providing novel insights into their relationship and implications for clinical risk stratification and preventive strategies.

Objective: The study aims to evaluate the real-world effectiveness of Highly Aspherical Lenslets spectacle (HAL; Essilor(R) Stellest(R)) in slowing myopia progression among Indian children and adolescents aged between 4 and 16 years. Methods and analysis: This was a multicentre retrospective study conducted across 10 leading ophthalmic centers. The study participants comprised children aged between 4 and 16 years who were prescribed HAL spectacles (Essilor(R) Stellest(R)). Data were extracted from electronic medical records at three time points: T1: One year prior to intervention; T2: Baseline at HAL spectacle prescription; T3: 6 to 24 months after prescription. The primary endpoint was the myopia progression and axial elongation in the year following prescription, compared with the untreated year and with published meta-regression models. Only data from the right eye were analysed, with the expected physiological progression estimated based on the individual progression trajectory after adjusting for age-related slowing as reported in published meta-regression models. Results: A total of 372 myopic children were included in the study. The annual myopia progression was -0.72 {+/-} 0.47 D/year during the untreated period, reducing to -0.11 {+/-} 0.29 D/year with HAL spectacle wear. The expected progression without treatment was -0.65 D/year, based on trajectory-adjusted modelling, indicating a treatment effect of 0.54 D/years and an estimated 83% slowing in myopia progression compared to expected progression. The expected axial elongation under physiological conditions was 0.29 mm/year, estimated using age-adjusted meta-regression models; with HAL lens wear, axial elongation was 0.11 {+/-} 0.16 mm/year, corresponding to a [~]62% relative slowing of elongation. Conclusion: The present study demonstrates the real-world evidence validating the efficacy of HAL lenses as an effective myopia control intervention in Indian children and adolescents. The retrospective design and limited follow-up period warrant future prospective, long-term studies to validate these findings.

ObjectiveTo determine whether uveitis shares genetic similarity with extraocular immune-mediated inflammatory diseases (IMIDs), we performed network analysis of putative causal genes associated with ocular inflammatory disease, IMIDs and eye-specific diseases, including age-related macular degeneration and monogenic disorders. MethodsWe identified putative causal genes for genome-wide significance variants from uveitis, IMIDs and ocular diseases using OpenTargets and published studies. To assess the gene-level pleiotropy between disease groups, we quantified the causal gene overlap between groups, and the Jaccard Similarity Indices for individual disease pairs. We then used a network approach to assess the molecular genetic similarity between diseases at a biological pathway level and comparative statistics to identify diseases with greater network similarity to uveitis. ResultsSeventy-five percent of the putative causal genes for uveitis are also causal for IMIDs, while no uveitis genes are shared with primary ocular disorders. Network analysis revealed that 1) uveitis genes are more closely networked with systemic IMIDs disease genes than with ocular-specific disease genes; and 2) significant network similarity links uveitis and specific IMIDs, such as ankylosing spondylitis and sarcoidosis. ConclusionsOverlapping causal genes and network similarity indicate that uveitis is predominantly an inflammatory disease, sharing genetic architecture with other IMIDs. Future studies aimed at dissecting genetic heterogeneity within uveitis may determine whether subgroups share common immune pathways that could nominate endotype-specific therapeutic approaches.

Background and Objective As optical coherence tomography (OCT) has enabled the identification of an expanding set of age related macular degeneration (AMD) risk biomarkers and become central to routine clinical practice, there remains a need for a simplified grading scheme that allows physicians to communicate and synchronize AMD grading directly from standard OCT imaging rather than relying on traditional color fundus imaging. This study aims to establish a standardized OCT based AMD classification that balances diagnostic accuracy with practicality for use across clinical and research settings. Patients and Methods Spectral domain optical coherence tomography scans were independently graded by two retinal specialists following the newly proposed Stanford OCT Based AMD Classification (SOAC). Discrepancies were adjudicated by a third independent retinal specialist. Intergrader agreement was assessed using weighted kappa coefficients. Results Among the 109 eyes from 108 patients, AMD staging based on SOAC was distributed as follows: normal aging in 9 patients (8.3%), early AMD in 16 (14.7%), intermediate AMD in 32 (29.4%), neovascular AMD (nAMD) in 18 (16.5%), geographic atrophy (GA) in 20 (18.3%), and combined nAMD and GA in 14 (12.8%). The overall intergrader agreement demonstrated robust consistency, with a weighted kappa value of 0.95 (95% CI: 0.92 to 0.98), signifying excellent intergrader reliability and reinforcing the validity of SOAC. Conclusion SOAC provides a standardized, OCT based framework for AMD grading that demonstrates high intergrader agreement. By enabling consistent classification from commonly acquired OCT scans, SOAC supports reliable disease staging and facilitates integration across clinical studies and translational research. As imaging and molecular data continue to expand, SOAC can serve as a common OCT based reference for phenotype refinement and longitudinal AMD studies.