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.

Background/Aims: Neovascular glaucoma (NVG) is an aggressive secondary glaucoma with limited longitudinal data. This study reports the aetiologies, treatments, and longitudinal outcomes in NVG. Methods: Patients with NVG were identified through electronic medical record review. Inclusion required documented rubeosis of the iris and/or anterior chamber angle, intraocular pressure (IOP) [&ge;]25 mmHg, diagnosis during 2008-2024, and follow-up at Helsinki University Hospital. Baseline data and all follow-up visits were included. Results: Of 919 patients identified, 626 met inclusion criteria, with a median follow-up of 24 months. The estimated NVG incidence was 2.2/100,000/year. The most common aetiology was central retinal vein occlusion (CRVO; 45%), followed by diabetic retinopathy (DR; 14%), central retinal artery occlusion (CRAO; 11%), and ocular ischaemic syndrome (8%). Half of patients had hand motion vision or worse at baseline, with 18% at no light perception (NLP). At 5 years, 13% of patients had Snellen 6/60 vision or better. Visual outcomes differed by aetiology, with median time to NLP ranging from 1.6 (CRAO) to 9.1 (DR) years (log-rank p=0.002). Median baseline IOP was 40 mmHg, decreasing to 21 mmHg by 1 year. Ocular pain fell from 43% at baseline to 11% at last follow-up. Structural eye loss (e.g., enucleation or phthisis) occurred in 3% by 5 years. Conclusion: The estimated incidence was lower than previously reported elsewhere. Unlike other cohorts where DR predominates, CRVO was the most common aetiology, and visual prognosis was strongly aetiology-dependent. Glaucoma drainage device surgery reached 7.6% at 3 years, despite the severity and refractory nature of NVG.

BackgroundNeurotrophic keratopathy (NK) is a rare degenerative corneal disease caused by impaired trigeminal innervation, resulting in reduced corneal sensation, impaired epithelial healing, ulceration, and risk of perforation or vision loss. Corneal innervation is essential for protective reflexes, epithelial maintenance, and ocular surface homeostasis. Conventional medical therapies may promote epithelial healing but do not directly restore corneal innervation. Corneal neurotization (CN) has emerged as a surgical strategy in which healthy donor sensory axons are transferred to denervated corneas to provide innervation. Multiple procedural variations now exist, including differences in donor nerve selection, graft use, and methods of limbal nerve insertion. A broad variety of NK etiologies is also being treated, including congenital, infectious, tumor, or other causes. However, published evidence remains limited by small case series, heterogeneous surgical methods, short follow-up periods, and inconsistent outcome reporting. ObjectiveTo address the need for standardized long-term outcome data in CN, we established the Corneal Neurotization Assessment (CorNeA) Registry, an international multicenter observational registry designed to evaluate patients undergoing CN. MethodsThe CorNeA Registry captures demographic characteristics, disease etiology, surgical technique, and longitudinal ocular outcomes in patients with NK treated with CN. Data are recorded in REDCap and include both retrospective and prospective patient enrollment across participating centers. Patients are followed longitudinally after surgery without a predefined endpoint to permit long-term assessment of corneal sensation recovery, ulcer recurrence, and visual outcomes. At the time of reporting, the registry includes 58 patients from multiple international centers, with active expansion ongoing. ConclusionBecause NK is rare and CN remains an evolving surgical field, long-term comparative data are lacking. The CorNeA Registry provides the first international platform to characterize patient selection, procedural variation, and long-term outcomes after CN, with the goal of informing future surgical decision-making and outcome standardization.

Purpose: To evaluate the safety and exploratory outcomes of a single intravitreal injection of OGX110, a peptide agonist of CXCR3, in eyes with persistent fluid secondary to neovascular age-related macular degeneration (nAMD) despite ongoing anti-vascular endothelial growth factor (anti-VEGF) therapy. Methods: This prospective, open-label, sequential dose-escalation phase I study (NCT05904691) enrolled subjects receiving standard-of-care intravitreal anti-VEGF therapy. Subjects received a single intravitreal injection of OGX110 at 0.5 mg, 1.0 mg, or 2.0 mg (n=3 per cohort), 7 to 14 days after the anti-VEGF injection. Results: All nine enrolled subjects completed follow-up through day 56. Two subjects (22%) experienced at least 1 adverse event (AE); all were mild and unrelated to study treatment. Exploratory analyses showed a BCVA change of +1.4 letters following anti-VEGF injection and +4.4 letters from OGX110 baseline to 4 weeks (P < 0.05). Six of 9 subjects gained at least 3 ETDRS letters after OGX110. Anatomic responses were heterogeneous. Four eyes showed a reduction in CRT after anti-VEGF injection that was maintained after OGX110 administration. One additional eye demonstrated a substantial reduction in CRT after OGX110 despite minimal response to anti-VEGF treatment. Conclusions: A single intravitreal injection of OGX110 was well tolerated. Exploratory functional and anatomic findings suggest biologic activity; interpretation is limited by small sample size, open-label design, absence of a concurrent control group, and inter-subject heterogeneity. These results support further study in a controlled trial. Translational Relevance: OGX110 represents a mechanistically distinct investigational approach for nAMD that may warrant further evaluation in eyes with persistent.

ObjectiveTo evaluate outcomes of lower-energy selective laser trabeculoplasty (SLT) using a titrated energy-pigmentation (TAPE) construct. MethodsThis retrospective study analyzed de-identified clinical data of 62 eyes undergoing lower-energy SLT as part of routine care. Laser energy was titrated relative to trabecular meshwork (TM) pigmentation grade and quantified as the product of the two (TAPE score). For example, grade 2 pigmentation x 40 mJ total energy yields a TAPE score of 80. The primary outcome was intraocular pressure (IOP) at 2 months, with adjustment for baseline maximum IOP (Tmax) using analysis of covariance (ANCOVA). Durability was assessed using Kaplan-Meier survival analysis and Cox proportional hazards modeling. ResultsAfter adjustment for baseline Tmax, higher TAPE scores ([&ge;]70) were associated with lower 2-month IOP (p < 0.01) and greater likelihood of achieving [&ge;]20% IOP reduction. Over longer follow-up, higher TAPE scores were associated with fewer treatment escalation events and improved survival free of additional therapy. Low-grade anterior chamber inflammation was common, transient, and self-limited. At 3 years, 85% of eyes in the high-TAPE group remained drop-free, accounting for retreatment where applicable. No clinically significant IOP spikes or sight-threatening adverse events were observed. ConclusionsHigher energy-pigmentation (TAPE) scores were associated with improved short-term IOP reduction and greater durability following lower-energy SLT. These findings are hypothesis-generating and suggest that TM pigmentation-adjusted energy delivery may enhance biologic engagement of the trabecular outflow pathway and support prospective evaluation of individualized SLT dosing strategies.

Purpose: To evaluate the impact of ''not commonly considered risk factors '' on glaucoma surgical outcomes. Methods: This study included 339 eyes that underwent glaucoma surgery. Surgical procedures included microhook ab-interno trabeculotomy (TLO), Preserflo ab-externo microshunt implantation, trabeculectomy (Trab), and Ahmed Glaucoma Valve (AGV) implantation. In addition to conventional background factors, we examined a set of ''not commonly considered risk factors, '' including very elderly age ([&ge;]85 years), avitreous status, aphakia, use of antithrombotic agents, difficulty attending frequent postoperative visits, small palpebral fissure, corneal endothelial dysfunction, poor vision in the fellow eye, dementia, hearing loss, mental illness, atopic dermatitis, pseudophacodonesis, glaucoma eye drop allergy, and conditions contraindicating {beta}-blocker use. Surgical success was defined as intraocular pressure (IOP) [&le;]21 mmHg, [&ge;]20% reduction from baseline, and no additional glaucoma surgery at 1 year. Logistic regression was performed to identify potential risk factors; significant factors were further evaluated using propensity score matching. Results: Of the 339 cases, surgical success rates were 65% for TLO, 82% for Preserflo, 91% for Trab, and 82% for AGV. Multivariate logistic regression identified two independent predictors of surgical failure: small palpebral fissure (odds ratio 2.52, p < 0.01) and hearing loss (odds ratio 3.94, p = 0.04). Propensity score matching of patients with small versus large palpebral fissures (111 per group) confirmed significantly worse postoperative outcomes in the small-palpebral-fissure group despite balanced baseline characteristics. Conclusion: Small palpebral fissure is an independent and previously unnoticed risk factor for glaucoma surgical failure, affecting both minimally invasive and filtration procedures.

Background Dry eye disease (DED) is a multifactorial condition marked by tear film instability and ocular inflammation, causing symptoms like grittiness and blurred vision. The global prevalence of Dry eye disease among pregnant women ranges from 27.4% to 89.3% and in Africa it ranges between 20% and 50%. Hormonal changes, advanced maternal age, late pregnancy and prolonged screen time play an important part in its development. Methodology A hospital-based cross-sectional study among 380 pregnant women. Systematic sampling technique was used for recruitment at the antenatal clinic in Mnazi Mmoja Hospital in Dar es Salaam. Clinical dry eye tests were performed along with the administration of a symptom questionnaire that included demographic characteristics and the OSDI tool where OSDI >13 is the threshold for diagnosis of DED. Data were analyzed using Stata version 17.0 and Modified Poisson analyses identified factors associated with dry eye disease, with statistical significance set at p-value<0.05. Results A total of 380 pregnant women were recruited and analyzed with the mean age 31.7{+/-}6.7, 196 (51.6%) were aged 31-46 years. Most were married 273 (71.8%) and 211 (55.5%) had completed secondary education. Dry eye disease (DED) prevalence was 53.2% (48.8%-58.2%). Among those with DED (n=202), 112 (55%) had mild symptoms, 26 (13%) moderate, and 64 (32%) severe. The most common DED subtype was unclassified 72 (35.6%), followed by mixed (67, 33.2%), evaporative 50 (24.8%), and aqueous deficient 13 (6.4%). Significant associations with DED were: advanced gestation age (aPR=2.18 (1.550-3.072), p<0.001), being a housewife (aPR=1.48(1.179-1.857), p=0.001), use of visual display terminals (aPR=1.36(1.219-1.845), p=0.048), working in low humidity (aPR=2.62(1.698-4.045), p=0.001), and working in air-conditioned rooms (aPR=2.40(1.685-3.415), p=0.001). Secondary education was protective against DED (aPR = 0.668 (0.466-0.958), p = 0.028). Conclusion Approximately half of pregnant women have DED, with unclassified DED being the predominant subtype. Late gestation age, occupation, extended screen time, and working environment are significantly associated factors. It is essential to integrate DED screening into antenatal care and establish standardized protocols on DED management. Also, it is essential to promote lifestyle modifications such as reduction of screen time and avoiding dry environments.

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 the incidence and baseline predictors of intraocular pressure (IOP)-lowering treatment following detection of referable glaucoma by teleretinal screening. Design: Retrospective cohort study. Methods: Participants were derived from a safety-net teleretinal diabetic retinopathy screening program (2013-2024). Participants included individuals who screened positive for referable glaucoma (cup-to-disc ratio [CDR] [&ge;]0.6 or CDR asymmetry [&ge;]0.2) and completed in-office diagnostic evaluation. The primary outcome was initiation of IOP-lowering treatment (medication, laser, or surgery) and the secondary outcome was intervention with surgery. Cumulative incidence functions were estimated, accounting for loss to follow-up. Fine-Gray models were used to identify baseline screening predictors to risk stratify each outcome. Glaucoma diagnosis was approximated using diagnostic codes and chart review. Results: 2,367 participants were included. The cumulative incidence of treatment was 19.6% (95% CI: 18.0-21.2) at Year 1 and 45.1% (42.1-48.1) at Year 8. Early treatment occurred primarily in glaucoma cases, whereas treatment accumulated longitudinally in glaucoma suspects, reaching 36.5% (31.6-41.5) by Year 8. Surgery was less common (8-year incidence: 5.3%). Baseline screening data predicted treatment and surgery, enabling risk stratification. At Year 8, cumulative incidence differed substantially between high- and low-risk groups (treatment: 59.9% vs. 31.2%; surgery: 9.7% vs. 1.0%). Older age (sub-distribution hazard ratio [SHR] 1.03 per year, p<0.001), Black race (SHR 1.50, p<0.001), and personal history of glaucoma (SHR 1.90, p<0.001) were associated with treatment; Asian race was protective (0.71, p=0.03). Older age (SHR 1.06, p<0.001), worse visual acuity (SHR 5.11 per logMAR unit, p<0.001), and screening at a hospital-based site (SHR 2.46, p=0.003) were associated with surgical treatment. Conclusion: Nearly half of safety-net diabetic patients screening positive for referable glaucoma initiated IOP-lowering treatment over 8 years, while few received surgery. Baseline screening characteristics enabled risk stratification of treatment and surgery. These findings address an evidence gap about longitudinal consequences of screening and suggest that its impact extends beyond detection of prevalent glaucoma to include identification of high-risk glaucoma suspects who warrant ongoing surveillance.

PurposeTo 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. MethodsThis 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. ResultsFive 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{+/-}372.6m, maximal corneal thickness was 1624.0{+/-}383.5m and maximal height and diameter of pre-Descemet layer/Descemet membrane (PDL/DM) detachment was 1014.6{+/-}366.4m and 4456.0{+/-}839.4m, 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. ConclusionsThis 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.

PurposeTo evaluate patient satisfaction and preferences for portable versus table-mounted visual field (VF) devices in a rural telemedicine setting and identify influencing factors. MethodsWe 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. ResultsAmong 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}{superscript 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}{superscript 2} (2) = 63.33, p<0.001, V = 0.34) and easiest to use (54.6%; {chi}{superscript 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. ConclusionRural 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.

PurposeTo evaluate the retinal safety of repeated low-level red-light (RLRL) therapy using the Eyerising Myopia Management Device (EMMD) by analysing exposure parameters relative to established thermal and photochemical retinal injury thresholds and empirical human exposure data. MethodsEmission characteristics of the EMMD were measured in an accredited laboratory under worst-case conditions. Parameters assessed included wavelength, intraocular power, corneal irradiance, and retinal image characteristics across accommodative states. These measurements were compared with international safety standards, maximum permissible exposure limits, and experimentally derived retinal injury thresholds from animal studies and validated computational models. The effects of repeated exposures from RLRL therapy using the EMMD were evaluated using photochemical additivity principles and repair kinetics, and further contextualised using human volunteer exposure data. ResultsThe EMMD emitted red laser radiation at 654-655 nm with a maximum intraocular power of approximately 1 mW through a 7 mm pupil, placing it within Class 3R and marginally above the Class 2 limit. Corneal irradiance was approximately 26 W m- 2, well below conservative photochemical exposure limits. Thermal injury modelling indicated retinal damage thresholds above device exposure, including under worst-case assumptions of minimal retinal image size and absence of eye movements. Accounting for repeated daily exposures and photochemical additivity, safety margins remained approximately 3-fold for a 7 mm pupil and approximately 8-fold for a more realistic 4 mm pupil. Human volunteer studies demonstrated no detectable structural or functional retinal injury at exposure levels approximately five times higher than those produced by the EMMD. ConclusionExposure parameters of RLRL therapy using the EMMD remain well below conservative retinal injury thresholds under prescribed use conditions. Integration of experimental, modelling, and human data indicates substantial safety margins, supporting its safe clinical use.

PurposeTo evaluate associations between optical coherence tomography angiography (OCT-A) metrics and diabetic retinopathy (DR) and compare their discrimination against conventional clinical risk factors. MethodsIn 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 [&ge;] 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 [&ge;] 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. ResultsDR was present in 63% of eyes. DR was associated with lower VD (central, inner, outer, full) and lower PD (central, inner, full) (all p[&le;]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. ConclusionVD 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.

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.

ObjectiveThe 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 analysisThis 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. ResultsA 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. ConclusionThe 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.

Objective: To assess the feasibility and acceptability of VISON-ACT, a standalone, mobile app psychosocial intervention for psychological distress in individuals with primary open-angle glaucoma (POAG). Design: Single-arm pilot. Participants: Patients (N=28) with a diagnosis of POAG, self-reporting at least mild (>3) distress on the 4-item Patient Health Questionnaire, were recruited from the Duke Eye Center between April 2025-December 2025. Methods: Patients (n=28) were consented and completed a baseline (A1) self-report assessment. VISION-ACT was comprised of 6 weekly modules. Follow-up self-report assessments occurred at post- (A2) and 1-month post-intervention (A3) and included measures of psychological distress, vision and health-related quality of life, psychological flexibility, disease acceptance, self-efficacy for symptom management, mindfulness, and social support. Participants were invited to complete an exit interview at 1-month post-intervention to gather qualitative feedback on the VISION-ACT protocol. Descriptive statistics were used to assess feasibility and acceptability metrics and patterns of pre-post change on patient reported outcomes were explored with linear mixed mdels using R Statistical Software. Main Outcome Measures: Feasibility (target accrual (n=25) in 12 months, <20% attrition at post-intervention); Acceptability (>75% reporting use of VISION-ACT skills or ideas at post-intervention, >80% reporting M>3.00/4.00 at post-intervention on the Client Satisfaction Questionnaire); Psychological Distress (Hospital Anxiety and Depression Scale [HADS], Subjective Units of Distress Scale [SUDS]). Results: VISION-ACT was highly feasible; accrual target was surpassed (N=28) in 6 months, and attrition was low (3.85%) at post-intervention (A2). Acceptability was strong with 100% of participants reporting use of VISION-ACT skills or ideas at A2 and M=3.27/4.00 intervention satisfaction. Adherence was remarkable with 88.5% of participants completing all six VISION-ACT modules. Pre-post change patterns were in the expected direction for psychological distress (HADS A1 M=13.88, A2 M=11.21; SUDS A1 M=35.54, A2 M=26.46) and all other patient-reported outcomes across baseline, post- and 1-month post-intervention assessments. Data on participant perspectives highlighted valuable aspects of VISION-ACT, and areas for refinement. Conclusions: Robust feasibility and acceptability data seen here provide support a fully-powered, randomized trial to evaluate the efficacy of VISION-ACT for reducing psychological distress and improving related patient-reported and clinical outcomes.

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.