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5 days ago
Effect of micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) on aqueous humour dynamics in patients with glaucoma and ocular hypertension: an observational study Background Glaucoma, a leading cause of irreversible blindness worldwide, affects over 60 million people globally and 700 000 in the UK. Elevated intraocular pressure (IOP) is the only modifiable risk factor for disease progression. Micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) offers a promising alternative to conventional treatments by reducing IOP with minimal complications. Although MP-TSCPC is hypothesised to lower IOP by decreasing aqueous humour production and altering aqueous outflow, the precise mechanisms remain poorly understood.Aims This study aimed to evaluate the effects of MP-TSCPC on aqueous humour dynamics in patients with open-angle glaucoma and ocular hypertension (OHT), focusing on IOP, aqueous humour production and outflow pathways 6 months post treatment.Results Of the 31 patients undergoing MP-TSCPC, 61% were men, of which 71% were of black ethnicity, with 28 patients completing the 6-month follow-up. A significant 10% reduction in mean IOP (25.08±5.06 mm Hg to 22.56±4.89 mm Hg, p=0.005) and a 26.08% reduction in aqueous humour production (from 2.34±0.64 to 1.74±0.4 µL/min, p=0.0001) were observed. There were no statistically significant changes in tonographic outflow facility or uveoscleral outflow. Treatment was well-tolerated, with few mild adverse events reported.Conclusion This study demonstrates that MP-TSCPC reduces IOP primarily through decreased aqueous humour production, with no discernible impact on outflow pathways. These findings refine the understanding of MP-TSCPC’s mechanism of action, highlighting its potential as a safe and effective treatment for glaucoma and OHT. Future studies should explore ways to enhance efficacy and long-term outcomes.

Ophthopedia Update: Effect of micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) on aqueous humour dynamics in patients with glaucoma and ocular hypertension: an observational study: Background

Glaucoma, a leading cause of irreversible blindness… #Ophthalmology #Ophthotwitter #BJO

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6 days ago
Regional-specific retinal ischaemic index guided by ultra-widefield fluorescein angiography correlates with macular oedema in retinal vein occlusion Aims To quantify the regional ischaemic index (ISI) in eyes with retinal vein occlusion (RVO) and to determine its correlation with macular oedema (ME).Methods In this retrospective study, ultra-widefield fluorescein angiography was performed in 46 eyes with RVO. The retinal ISI was calculated for the perimacular area (PMA), near-peripheral area (NPA), mid-peripheral area (MPA), and far-peripheral area (FPA), each further divided into superior-inferior and nasal-temporal segments. Central macular thickness (CMT) was measured with spectral-domain optical coherence tomography. Associations between regional ISI and CMT were analysed using Spearman’s correlation and linear regression.Results 46 eyes of 46 RVO patients were enrolled. Mean CMT was 453.73±301.48 µm. ISI in the S-NPA (superior NPA) strongly correlated with that in the I-NPA (inferior NPA) (r=0.53, p

Ophthopedia Update: Regional-specific retinal ischaemic index guided by ultra-widefield fluorescein angiography correlates with macular oedema in retinal vein occlusion: Aims

To quantify the regional ischaemic index (ISI) in eyes with retinal vein occlusion… #Ophthalmology #Ophthotwitter #BJO

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6 days ago
Baseline risk factors for the development of open-angle glaucoma in a 12-year glaucoma incidence study: the Thessaloniki Eye Study Aims To determine baseline risk factors of incident open-angle glaucoma (OAG) in an elderly white population.Methods Prospective-longitudinal population-based study. 12 years following baseline examinations, subjects were re-invited for follow-up examinations using the same methodology undertaken at baseline. 1092 (74%) were re-examined. In multivariable logistic regression analysis, factors with a p value of ≤0.2 in univariate analysis were included in the model.Results Overall, 826 subjects met final inclusion criteria. In multivariable regression analysis adjusted for potential confounders, baseline factors associated with incident glaucoma were: pseudoexfoliation (PEX) (p=0.002); higher intraocular pressure (IOP) (p140/90. Increased hours of sleep (p=0.043) and alcohol consumption (p=0.030) were found to be protective factors.Conclusion Increased IOP, PEX, increased vertical c/d ratio, family history of glaucoma, history of heart attack and BP ≤140/90 increased the risk for incident OAG. Increased hours of sleep and alcohol consumption were inversely associated with the development of incident glaucoma.

Ophthopedia Update: Baseline risk factors for the development of open-angle glaucoma in a 12-year glaucoma incidence study: the Thessaloniki Eye Study: Aims

To determine baseline risk factors of incident open-angle glaucoma (OAG) in an elderly white… #Ophthalmology #Ophthotwitter #BJO

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6 days ago
Publicly available multimodal large language models for ocular surface infections: benchmarking against corneal specialists in triage, diagnosis and treatment Background/aims Ocular surface infections remain a major cause of visual loss worldwide, yet diagnosis often relies on slow or insensitive microbiological techniques. Artificial intelligence may complement emerging molecular tools by supporting rapid triage and diagnostic reasoning. This study benchmarked publicly available multimodal large language models (LLMs) against corneal specialists for the diagnosis, treatment and urgency triage of infectious keratitis and conjunctivitis.Methods A single-centre diagnostic-accuracy study included 60 microbiologically confirmed infectious keratitis and conjunctivitis cases, each comprising a slit-lamp photograph and a paired clinical vignette. Six multimodal LLMs (GPT-4o, GPT-5, Gemini, Claude, Perplexity and Grok) were evaluated for diagnosis, treatment and urgency triage under three input conditions (image-only, text-only and image+text). Outputs were compared with two corneal specialists.Results LLM performance depended strongly on input modality. Image-only accuracy was lowest (best GPT-5, 61.4%; =0.38) with frequent misclassification of fungal and Acanthamoeba keratitis and hallucinations confined to this setting. Text input improved results (GPT-5, 83.3%; =0.78), though accuracy remained below specialists (87–90%; 0.8). Combined image+text achieved near-human accuracy without consistently surpassing corneal specialists (Perplexity 96.7%; =0.95; GPT-5 91.7%; =0.87). Treatment accuracy remained lower (81–85% vs 90–98%), while urgency triage matched experts in multimodal input.Conclusion Publicly accessible multimodal LLMs can approach expert-level performance in diagnosis and triage when provided with clinical context and slit-lamp images. Gaps in therapeutic reasoning and rare pathogen recognition underscore the need for targeted refinement and validation. These models may complement specialist care, supporting rapid triage and integration with molecular or metagenomic diagnostics, especially in resource-limited settings.

Ophthopedia Update: Publicly available multimodal large language models for ocular surface infections: benchmarking against corneal specialists in triage, diagnosis and treatment: Background/aims

Ocular surface infections remain a major cause of visual loss… #Ophthalmology #Ophthotwitter #BJO

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Ophthopedia
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6 days ago
Nomogram for predicting implant exposure risk following enucleation or evisceration with vicryl-meshed hydroxyapatite implants Aims To develop and validate a nomogram predicting the risk of implant exposure in patients receiving vicryl-meshed hydroxyapatite (HA) orbital implants following enucleation or evisceration.Methods This is a retrospective study at the University Hospital of Cologne, which included 336 patients with primary vicryl-meshed HA implants. Univariate and multivariate logistic regression analyses identified independent risk factors for implant exposure. A nomogram was constructed, and its performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA).Results Independent risk factors for implant exposure included previous ocular trauma (OR 2.08; 95% CI 1.01 to 4.31; p=0.048), diabetes mellitus (OR 4.17; 95% CI 1.81 to 9.63; p

Ophthopedia Update: Nomogram for predicting implant exposure risk following enucleation or evisceration with vicryl-meshed hydroxyapatite implants: Aims

To develop and validate a nomogram predicting the risk of implant exposure in patients receiving… #Ophthalmology #Ophthotwitter #BJO

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1 week ago
Remission in sarcoid uveitis: identification of predictive factors Objective To identify predictive factors of remission in patients with sarcoid uveitis and to evaluate recurrence rates and patterns following remission.Methods Multicentre retrospective study of patients with sarcoid uveitis and a minimum follow-up of 3 years. Remission was defined as the absence of clinical symptoms of sarcoidosis for at least 3 years without treatment. Remission-free Kaplan-Meier survival curves were constructed for selected variables. Cox proportional hazards model was then applied. HRs and 95% CIs were estimated for each variable. Statistical significance was set at the p

Ophthopedia Update: Remission in sarcoid uveitis: identification of predictive factors: Objective

To identify predictive factors of remission in patients with sarcoid uveitis and to evaluate recurrence rates and patterns following remission.Methods

Multicentre… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Efficacy of 0.01% atropine eye drops for myopia control in children of different ethnicities: a systematic review and meta-analysis Background/aims Although 0.01% atropine is widely used for myopia control, its efficacy is debated and its effectiveness across different ethnicities is unknown. We aim to evaluate its efficacy in different ethnic backgrounds.Methods The randomised clinical trials (RCTs) that compared 0.01% atropine against a placebo in myopic children from five databases through August 2025 were included. The primary outcomes included (1) the ratio of the means (RoM), defined as the RoM of annual changes in spherical equivalent refraction (SER) or ocular axial length (AL) in 0.01% atropine to the placebo groups, for accounting in the natural progression; and (2) the mean differences (MDs) in SER progression and AL elongation.Results A meta-analysis of 25 RCTs (4374 children aged 4–18) showed that 0.01% atropine reduced the SER progression by 37% annually (RoM: 0.63; 95% CI 0.54 to 0.74), with efficacy being much greater in South Asian populations (66% reduction; RoM: 0.34, 95% CI 0.27 to 0.42), than East Asian populations (35% reduction; RoM: 0.65, 95% CI 0.54 to 0.78) and white populations (28% reduction; RoM: 0.72, 95% CI 0.59 to 0.86) (p

Ophthopedia Update: Efficacy of 0.01% atropine eye drops for myopia control in children of different ethnicities: a systematic review and meta-analysis: Background/aims

Although 0.01% atropine is widely used for myopia control, its efficacy is debated and its… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Impact of cataract surgery on a delirium-related electroencephalography index in older adults The bispectral electroencephalography (BSEEG) method is a simple one-channel quantitative electroencephalography approach that yields a single index, with higher scores previously associated with more severe delirium in older adults. We prospectively measured BSEEG scores in 21 patients over 60 years old before and 1 month after cataract surgery. BSEEG scores significantly decreased after surgery (p=0.001), and this decrease significantly correlated with improvement in best-corrected visual acuity (r=0.52; p=0.02). Improved visual function after cataract surgery was associated with lower BSEEG scores.

Ophthopedia Update: Impact of cataract surgery on a delirium-related electroencephalography index in older adults: The bispectral electroencephalography (BSEEG) method is a simple one-channel quantitative electroencephalography approach that yields a single… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
At a glance Effect of low-dose atropine on young premyopic and low-myopic children: atropine treatment of myopia (ATOM3) – a randomised control trial (see page 356) In this randomised controlled trial involving pre- and low myopic children aged 5–9 years, although atropine 0.01% did not significantly reduce myopia progression over 2 years, there was a trend towards less progression in some subgroups. Time outdoors prevents myopia in hyperopic children, but protection is weaker in premyopic children: a post-hoc analysis of a cluster-randomised trial (see page 363) Increased time outdoors had a limited protective effect on myopic shift in premyopic children compared with hyperopic children, highlighting the need for longer duration of time outdoors or additional interventions. Prevalence of strabismus, nystagmus and risk factors in children and adolescents born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Study Young (see...

Ophthopedia Update: At a glance: Effect of low-dose atropine on young premyopic and low-myopic children: atropine treatment of myopia (ATOM3) – a randomised control trial (see page 356)

In this randomised controlled trial involving pre- and low myopic children… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Myopia: personalise the prevention and control at commencement Since the publication of the landmark ATOM2 (atropine for the treatment of myopia)1 and low-concentration atropine for myopia progression (LAMP) findings,2 low-concentration atropine eyedrops have been a preferred treatment method for myopia control. The ATOM series further inspired several other randomised controlled trials (figure 1), most of which showed that 0.01% atropine eyedrops have some myopia control effect. However, the efficacy of 0.01% atropine varied widely between studies, and this variation is not well explained by baseline spherical equivalent or age (figure 1). The LAMP study2 further reported slightly higher myopia control efficacy with 0.05% concentration, while maintaining a low risk profile. The crossover MOSAIC (myopia outcome study of atropine in children)3 similarly found that, in Irish children, a 0.05% concentration was more effective than a 0.01%, although with smaller effects than those observed in LAMP (

Ophthopedia Update: Myopia: personalise the prevention and control at commencement: Since the publication of the landmark ATOM2 (atropine for the treatment of myopia)1 and low-concentration atropine for myopia progression (LAMP) findings,2 low-concentration… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Effect of low-dose atropine on young premyopic and low-myopic children: atropine treatment of myopia (ATOM3) - a randomised control trial Aim To evaluate the effectiveness of atropine 0.01% in young premyopic and low-myopic children. Methods Children (5–9 years old) with premyopia (spherical equivalent refraction, SER+1.00 to –0.49D, n 156) or low myopia (SER –0.50 to –1.50D, n 52), with at least 1 parent with myopia

Ophthopedia Update: Effect of low-dose atropine on young premyopic and low-myopic children: atropine treatment of myopia (ATOM3) - a randomised control trial: Aim


To evaluate the effectiveness of atropine 0.01% in young premyopic and low-myopic children.… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Prevalence of strabismus, nystagmus and risk factors in children and adolescents born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Study Young Aims This study assessed the prevalence of strabismus, nystagmus and their risk factors in children born preterm, stratified by gestational age (GA), retinopathy of prematurity (ROP) and ROP treatment. Methods This is a retrospective cohort study with a prospective follow-up in a large cohort of children born preterm and full-term aged 4–17 years. Multivariable logistic regression analyses assessed associations of strabismus and nystagmus with perinatal parameters. Participants were divided into the following groups: controls born at term (GA ≥37 weeks, group 1), children born preterm without ROP and GA 33–36 weeks (group 2), GA 29–32 weeks (group 3), GA ≤28 weeks (group 4), GA ≤32 weeks with untreated ROP (group 5) and GA ≤32 weeks with treated ROP (group 6). Results 949 children (11.21±3.92 years, 495 females) were included. Strabismus was observed in 6% of children in group 1, 10% in group 2, 12% in group 3, 23% in group 4, 20% in group 5 and 68% in group 6. Nystagmus was observed in 0.8%, 0.4%, 1.8%, 2.6%, 5.0% and 47% in the respective groups. Strabismus was associated with earlier GA (OR=1.08; p=0.01), astigmatism (OR=2.48; p=0.02) and hypermetropia (OR=2.09; p=0.04). Esotropia was associated with weeks of prematurity (OR=1.11; p=0.02), anisometropia (OR=3.09; p=0.02) and hypermetropia (OR=4.17; p

Ophthopedia Update: Prevalence of strabismus, nystagmus and risk factors in children and adolescents born preterm with and without retinopathy of prematurity: results from the Gutenberg Prematurity Study Young: Aims


This study assessed the prevalence of… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Time outdoors prevents myopia in hyperopic children, but protection is weaker in premyopic children: a post-hoc analysis of a cluster-randomised trial Aims To investigate the effect of time outdoors on myopic shift among premyopic children. Methods Post-hoc analysis was nested in a cluster-randomised trial of the Shanghai Time Outside to Reduce Myopia (STORM) study. 6- to 9-year-old participants without myopia from the STORM study, who wore wristwatches to monitor time outdoors from 2017 to 2018, were included. Participants were all examined with cycloplegic refraction. Daily time outdoors was objectively monitored with the wearable smartwatch. Premyopia was defined as a cycloplegic spherical equivalent (SE) from –0.50 to +0.75 (inclusive) dioptres (D). Myopic shift was SE change from baseline to 1 year follow-up. Results Among 3194 participants (1369 premyopic; mean age 8.2±0.6 years; 49.5% boys), there were no statistical differences between premyopic and hyperopic children in time outdoors (p=0.303). Hyperopes showed reduced myopic shift with increasing outdoor time (plateau at about 120 min/day). However, premyopes exhibited a J-shaped relationship between time outdoors and myopic shift. In comparison to the subgroup with daily time outdoors 120 min/d, although it was still not statistically significant (>120 min/d: 0.04 (95% CI –0.05 to 0.14)). Conclusions Among premyopic children, increased time outdoors has a limited protective effect on myopic shift, suggesting longer duration of time outdoors or additional interventions to prevent or delay myopia onset in this population.

Ophthopedia Update: Time outdoors prevents myopia in hyperopic children, but protection is weaker in premyopic children: a post-hoc analysis of a cluster-randomised trial: Aims


To investigate the effect of time outdoors on myopic shift among premyopic… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Role of ocular accommodation in emmetropisation among highly farsighted infants 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) to determine the effect on emmetropisation (reaching

Ophthopedia Update: Role of ocular accommodation in emmetropisation among highly farsighted infants: Purpose


To assess the relationship between accommodative lag (defocus) and accommodative response to determine which drives emmetropisation in highly farsighted… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Global burdens and causes of blindness and vision loss in children and adolescents from 1990 to 2021 and forecast for the next decade Background To 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. Methods Based 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. Results Globally, 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. Conclusions Over 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.

Ophthopedia Update: Global burdens and causes of blindness and vision loss in children and adolescents from 1990 to 2021 and forecast for the next decade: Background


To estimate the global, regional and national burdens of blindness and vision loss among… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Systemic Rho-kinase inhibitor belumosudil for treatment of ocular graft versus host disease 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.

Ophthopedia Update: Systemic Rho-kinase inhibitor belumosudil for treatment of ocular graft versus host disease: We aimed to describe the response of chronic ocular graft versus host disease (oGVHD) to systemic belumosudil. A total of seven patients were… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
CorvisST biomechanical indices in the diagnosis of corneal stromal and endothelial disorders: an artificial intelligence-based comparative study Aims To analyse the value of the CorvisST indices in diagnosing corneal stromal and endothelial disorders (CSEDs). Methods This institutional retrospective case–control study included 903 eyes with a CSED and 597 normal eyes (controls), assessed with CorvisST and MS39. Main outcome measures: CorvisST 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. Results Stress-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) 11.8 (0.92), ARTh0.14 (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. Conclusions CorvisST indices are relevant for diagnosing CESDs and distinguishing various disorders from each other.

Ophthopedia Update: CorvisST biomechanical indices in the diagnosis of corneal stromal and endothelial disorders: an artificial intelligence-based comparative study: Aims


To analyse the value of the CorvisST indices in diagnosing corneal stromal and endothelial… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Low-concentration bimatoprost 0.01% and timolol 0.1% eye gel versus bimatoprost 0.03% and timolol 0.5% eye drops in open-angle glaucoma or ocular hypertension: a phase III randomised study Background/Aims To compare the efficacy and safety of a new preservative-free bimatoprost 0.01%/timolol 0.1% fixed combination (BTFC) eye gel with those of bimatoprost 0.03%/timolol 0.5% fixed combination ophthalmic solution (BTFC eye drops) in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT). Methods In this phase III, international, multi-centre, randomised, parallel group, investigator-masked study, patients receiving a first-line monotherapy, having insufficiently controlled intraocular pressure (IOP) and requiring dual therapy were randomised to receive either BTFC eye gel or BTFC eye drops once daily for 12 weeks. The primary efficacy endpoint was the change in IOP from baseline to week 12 at 08:00 in the assessed eye. Further efficacy and safety endpoints were assessed as secondary outcomes. Results The mean±SD change in IOP from baseline to week 12 at 08:00 was –10.96±3.43 mmHg for the BTFC eye gel group and –11.14±3.56 mmHg for the BTFC eye drop group. The least-squares mean difference (BTFC eye gel minus BTFC eye drops) was –0.04±0.24 mmHg (95% CI –0.51 to 0.43 mmHg), with the upper bound of the 95% CI lower than the predefined margin of +1.5 mmHg at week 12 at 08:00. Similar IOP-lowering efficacy was demonstrated at all other timepoints. The safety profile was comparable between the treatment groups. No patients in the BTFC eye gel group discontinued the study due to a treatment-related adverse event compared with 8 (2.9%) patients in the BTFC eye drop group. Conclusion Low-concentration BTFC eye gel can be considered as a safe and effective treatment in the therapeutic management of glaucoma and OHT.

Ophthopedia Update: Low-concentration bimatoprost 0.01% and timolol 0.1% eye gel versus bimatoprost 0.03% and timolol 0.5% eye drops in open-angle glaucoma or ocular hypertension: a phase III randomised study: Background/Aims


To compare the efficacy and safety… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Single-centre observational study of anti-adalimumab antibody development in children and young people treated for juvenile idiopathic arthritis and/or non-infectious uveitis Background Adalimumab is an effective first-line biologic therapy used to treat children and young people (CYP) with juvenile idiopathic arthritis (JIA) and non-infectious uveitis (NIU). However, the development of neutralising antibodies may compromise adalimumab’s efficacy. This study investigated the incidence and clinical relevance of anti-adalimumab antibody (AAA) development in CYP treated with adalimumab for JIA and/or NIU.Methods A retrospective observational study was conducted within a specialist paediatric rheumatology service at a tertiary UK centre. CYPs receiving adalimumab between January 2015 and January 2024 who were tested for AAAs were included. Outcome measures included AAA positivity rate, serum drug levels, concurrent disease-modifying anti-rheumatic drug (DMARD) use, timing of antibody development and patient outcomes following AAA results.Results Among 390 CYP treated with adalimumab, 112 were tested for AAAs (156 total tests). Overall, 41.0% were AAA positive (>10 mg/L). All CYP with sub-therapeutic drug levels (

Ophthopedia Update: Single-centre observational study of anti-adalimumab antibody development in children and young people treated for juvenile idiopathic arthritis and/or non-infectious uveitis: Background

Adalimumab is an effective first-line biologic therapy… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Impact of ageing on progressive thinning of the retinal nerve fibre layer in glaucoma Background/aims To determine the proportion of progressive retinal nerve fibre layer thickness (RNFLT) change that can be attributed to normal ageing.Methods This prospective, longitudinal, cohort study included one eye each of 200 patients treated for open-angle glaucoma and 73 healthy control subjects who were followed with optical coherence tomography (OCT) every 6 months. A linear mixed-effects (LME) model was used to estimate the mean RNFLT slope and the difference between the two groups to evaluate factors affecting the slope, while adjusting for other variables.Results The median (IQR) age and follow-up of all participants was 68.3 (61.8 to 74.7) years and 10.1 (6.4 to 12.9) years, respectively. The median baseline mean deviation in patients with glaucoma was –3.79 (–6.84 to –1.57) dB. Among those classified within normal limits for baseline RNFLT (39 (19.5%) patients with glaucoma and 68 (93.2%) healthy subjects), the individual RNFLT slopes were significantly steeper in patients with glaucoma (median, –0.76 (–1.13 to –0.49) µm/year) compared with healthy subjects (–0.51 (–0.72 to –0.19) µm/year, p

Ophthopedia Update: Impact of ageing on progressive thinning of the retinal nerve fibre layer in glaucoma: Background/aims

To determine the proportion of progressive retinal nerve fibre layer thickness (RNFLT) change that can be attributed to normal… #Ophthalmology #Ophthotwitter #BJO

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3 weeks ago
Exponential myopic shift over 13 years in aphakic and pseudophakic eyes after congenital cataract surgery within 6 months of birth Background/aims To characterise longitudinal refractive changes from the early postoperative period through long-term follow-up after congenital cataract surgery performed within the first 6 months of life.Methods Longitudinal refractive changes were analysed retrospectively in 219 eyes from 124 patients who underwent surgery at a mean age of 2.9±1.7 months, with a minimum follow-up of 10 years (mean: 13.6±2.3 years; range: 10–18 years). Inclusion required refraction within 1 month postoperatively, at several-month intervals during the first year, and annually thereafter. The cohort included 81 bilateral aphakia, 14 bilateral pseudophakia, 20 unilateral aphakia and nine unilateral pseudophakia cases.Results In both aphakia and pseudophakia, postoperative refractive change followed an exponential pattern, with pronounced early myopic shifts that progressed gradually thereafter. Plotting refractive change against the logarithm of elapsed postoperative time yielded a linear relationship (aphakia: r=–0.979, p

Ophthopedia Update: Exponential myopic shift over 13 years in aphakic and pseudophakic eyes after congenital cataract surgery within 6 months of birth: Background/aims

To characterise longitudinal refractive changes from the early postoperative period through… #Ophthalmology #Ophthotwitter #BJO

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4 weeks ago
Advances in the laboratory diagnosis of non-viral microbial keratitis Infectious keratitis remains a leading cause of corneal blindness and visual impairment worldwide, with bacterial, fungal, amoebic and viral pathogens presenting major diagnostic and therapeutic challenges. Early and precise pathogen identification is essential to initiate early treatment and prevent irreversible ocular damage. Direct visualisation of pathogens by microscopy of corneal scrapings has been one of the most rewarding and time-tested methods; however, ocular microbiology laboratories seem to be losing the expertise for the same. Culture methods also seem to be losing favour for their long turnaround time and low sensitivity. These have paved the way for newer, rapid and sensitive molecular techniques to make a foray into the realm of diagnosis of non-viral keratitis. This review critically evaluates recent advances in molecular diagnostics for infectious keratitis, focusing on DNA/RNA-based sequencing, real-time PCR (qPCR) and mass spectrometry (MS) and examines their clinical relevance, limitations and potential for point-of-care application. An extensive literature analysis was conducted, integrating findings from peer-reviewed studies published between 2000 and 2025. Emerging diagnostic platforms were compared with conventional microbiological methods in terms of diagnostic accuracy, turnaround time and clinical applicability across paediatric and adult cohorts. Traditional culture-based approaches exhibit limited sensitivity (30%–60%) and slow pathogen detection. In contrast, multiplex and quantitative PCR enable rapid, sensitive and specific pathogen identification, including in culture-negative cases. Next-generation sequencing offers broad-spectrum, culture-independent profiling of bacteria, fungi and protozoa, enhancing diagnostic yield and understanding of pathogen diversity. MS has transformed microbial and host proteomic/metabolomic analyses, identifying candidate biomarkers for disease severity and prognosis. Recent innovations such as portable qPCR devices, clustered regularly interspaced short palindromic repeats-based diagnostics and artificial intelligence-assisted data interpretation extend molecular testing to near-patient settings. The integration of these technologies into routine clinical workflows promises earlier intervention, personalised therapy and improved visual outcomes, particularly in resource-limited environments.

Ophthopedia Update: Advances in the laboratory diagnosis of non-viral microbial keratitis: Infectious keratitis remains a leading cause of corneal blindness and visual impairment worldwide, with bacterial, fungal, amoebic and viral pathogens presenting major… #Ophthalmology #Ophthotwitter #BJO

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@ophthalmology.bsky.social
4 weeks ago
Intracapsular metformin bioactivity and its role in posterior capsule opacification Background/aims Posterior capsule opacification (PCO) is the most frequent long-term complication after cataract surgery, caused by proliferation of residual lens epithelial cells (LECs). Metformin, a common antidiabetic drug with antifibrotic properties, may act as a pharmacological modulator of this process. The purpose was to assess whether systemically administered metformin reaches the human lens capsule and inhibits LEC proliferation at physiologically relevant concentrations.Methods Metformin concentrations were quantified in serum and lens capsule tissue of patients with type 2 diabetes mellitus undergoing cataract surgery using high performance liquid chromatography-tandem mass spectrometry. Patients were stratified into low-dose (≤1000 mg/day) and high-dose (>1000 mg/day) groups. Additionally, anterior lens capsules from non-diabetic donors were cultured with or without metformin (0.75 pg/µL), and LEC proliferation was monitored for 14 days by live-cell imaging.Results Metformin was detectable in both serum and capsule specimens, with a significant correlation between compartments (r=0.553, p=0.011). Capsule concentrations were similar across dose groups, while serum levels were higher in the low-dose group. In vitro, metformin significantly reduced LEC proliferation compared with controls (p

Ophthopedia Update: Intracapsular metformin bioactivity and its role in posterior capsule opacification: Background/aims

Posterior capsule opacification (PCO) is the most frequent long-term complication after cataract surgery, caused by proliferation of residual… #Ophthalmology #Ophthotwitter #BJO

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@ophthalmology.bsky.social
1 month ago
OCT-based myopic index: a biological predictor for the progression of high myopia Background The growth of axial length (AL) can lead to high myopia and ocular deformation, especially causing microstructural changes in the fundus, which cannot be fully quantified by AL alone. We propose an optical coherence tomography (OCT)-based modified AL (Myopic Index) to represent the extent of fundus deformation caused by AL elongation and to explore its clinical significance in myopic progression prediction.Methods A deep learning model was trained using 27 539 cases of OCT images and referred ocular biometric data to evaluate the Myopic Index. By comparing the Myopia Index with the Measured AL, the difference of two AL indices (DAL) was calculated. We further prospectively employed 2866 cases of OCT images, which were categorised into short AL (Measured AL

Ophthopedia Update: OCT-based myopic index: a biological predictor for the progression of high myopia: Background

The growth of axial length (AL) can lead to high myopia and ocular deformation, especially causing microstructural changes in the fundus, which… #Ophthalmology #Ophthotwitter #BJO

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Ophthopedia
@ophthalmology.bsky.social
1 month ago
Effects of anti-obesity medications in the retina: a gathering storm or sunshine ahead? The study by Lakhani et al1 scrutinises data from the US Food and Drug Administration (FDA) Adverse Event Reporting System, revealing formulation and sex-specific associations of the anti-obesity medication (AOM) with ischaemic optic neuropathy (ION). Interestingly, higher odds were associated with males (reporting odds ratio (ROR) 116.37), with greater risks from Wegovy which is used for obesity treatment (ROR 74.89), compared with Ozempic which is used for diabetes (ROR 18.81). These findings add to an emerging body of growing literature reporting ocular complications with AOMs2 which warrants further scrutiny and urgent clarification for ophthalmologists. The global prevalence of obesity has tripled since the mid-1970s, presenting one of the greatest healthcare challenges of our time. Obesity is associated with diminished life expectancies of ~5–20 years and the development of comorbidities including endocrinological, musculoskeletal, neurological, oncological as well as gastrointestinal diseases.3 Compared with conventional bariatric surgery, recent...

Ophthopedia Update: Effects of anti-obesity medications in the retina: a gathering storm or sunshine ahead?: The study by Lakhani et al1 scrutinises data from the US Food and Drug Administration (FDA) Adverse Event Reporting System, revealing formulation and… #Ophthalmology #Ophthotwitter #BJO

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Ophthopedia
@ophthalmology.bsky.social
1 month ago
Ischemic optic neuropathy with semaglutide: global observational analysis of sex- and formulation-specific risk Ischaemic optic neuropathy (ION) is a rare but vision-threatening complication recently linked to GLP-1 receptor agonists, particularly semaglutide. Using over 30 million reports from the FDA Adverse Event Reporting System (2017–2024), we evaluated formulation- and sex-specific associations. Among 31 774 semaglutide cases, Wegovy demonstrated the strongest signal for ION (reporting odds ratio (ROR)=74.89) compared with Ozempic (ROR=18.81). Sex-stratified analyses showed higher odds in men (ROR=116.37), and multivariable regression confirmed greater risk with Wegovy versus Ozempic (adjusted OR (AOR)=4.74) and in men versus women (AOR=3.33). These findings highlight a potential dose-dependent safety concern that warrants urgent prospective evaluation to guide prescribing and regulatory policy.

Ophthopedia Update: Ischemic optic neuropathy with semaglutide: global observational analysis of sex- and formulation-specific risk: Ischaemic optic neuropathy (ION) is a rare but vision-threatening complication recently linked to GLP-1 receptor agonists,… #Ophthalmology #Ophthotwitter #BJO

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@ophthalmology.bsky.social
1 month ago
Iberian Registry of Ocular Syphilis (IBERSOS) report 1: epidemiology, clinical spectrum and treatment outcomes of ocular syphilis in the Iberian Peninsula Purpose The Iberian Registry of Ocular Syphilis aims to describe the epidemiology, clinical manifestations and treatment outcomes of ocular syphilis in Spain and Portugal. This re-emerging condition, associated with rising global syphilis rates and HIV coinfection, presents with diverse ocular and systemic features. The study seeks to fill knowledge gaps regarding incidence, presentation and therapeutic response.Methods This multicentre, observational cohort study includes patients aged ≥18 years with newly diagnosed ocular syphilis confirmed by treponemal and nontreponemal serological tests. Conducted across 23 centres, data collection followed routine clinical practice and included demographics, ocular/systemic findings, treatment regimens and outcomes at 3–6 months post-treatment.Results In the first year, 41 patients met the inclusion criteria, of whom 39 consented to participate in the registry, with an incidence of 0.57 cases per 100 000 persons/year. Most were male (94.9%), especially men who have sex with men (66.7%) and HIV coinfection (20.5%). Bilateral ocular involvement was observed in 64.1% of patients, with anterior segment inflammation in 64.1%, vitritis in 53.8%, retinal or choroidal involvement in 69.2% and optic nerve involvement in 59.0%. Systemic syphilis stage included primary (7.7%), secondary (25.6%) and tertiary or quaternary (15.4%). Treatment was initiated after a mean of 6.2±9.3 weeks after the onset of symptoms, and 2.6±6.0 weeks after the initial presentation at the hospital. Intravenous penicillin G was used in 65.8%, and 61.3% achieved a four-fold titre reduction in the reaginic test at the final visit (3 to 6 months after antibiotic therapy). Final visual acuity improved to 0.17 LogMAR (p

Ophthopedia Update: Iberian Registry of Ocular Syphilis (IBERSOS) report 1: epidemiology, clinical spectrum and treatment outcomes of ocular syphilis in the Iberian Peninsula: Purpose

The Iberian Registry of Ocular Syphilis aims to describe the epidemiology,… #Ophthalmology #Ophthotwitter #BJO

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1 month ago
Treatment failure in herpes simplex virus type 1 keratitis Herpes simplex virus type 1 (HSV-1), one of the human herpesviruses, is a frequent cause of recurrent ocular infections. Treatment primarily relies on nucleoside analogues, such as aciclovir (ACV), with or without topical corticosteroids. Treatment failure may be attributed to non-adherence to therapy or inadequate topical corticosteroid dosing, and to a lesser extent to an incorrect diagnosis, coinfection with non-viral pathogens or therapy resistance. ACV resistance (ACVR) is relatively rare compared with other reasons for treatment failure, but has been documented in 6% of immunocompetent patients with HSV-1 keratitis. ACVR limits the prophylactic and therapeutic efficacy of nucleoside analogues, potentially leading to clinically refractory disease. In this review, we will address the normal pathogenesis of HSV-1 keratitis, the definition and causes of treatment failure in HSV-1 keratitis, a work-up algorithm to be used in the event of treatment failure, the effect of current treatment regimens on the development of ACVR keratitis and treatment options for ACVR keratitis.

Ophthopedia Update: Treatment failure in herpes simplex virus type 1 keratitis: Herpes simplex virus type 1 (HSV-1), one of the human herpesviruses, is a frequent cause of recurrent ocular infections. Treatment primarily relies on nucleoside analogues, such as… #Ophthalmology #Ophthotwitter #BJO

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@ophthalmology.bsky.social
1 month ago
Treating socket discharge and discomfort: a crossover randomised trial of vitamin A ointment, low-dose steroid eyedrops and artificial tears Purpose This study evaluated the effects of artificial tears, vitamin A ointment and low-dose steroid drops on chronic irritation and discharge in anophthalmic patients wearing ocular prostheses. It also aimed to identify patient subgroups that may benefit from specific regimens.Methods This prospective, crossover randomised trial used a Williams design with 40 ocular prostheses wearing participants aged 16 years or older who experienced chronic discharge or discomfort. Each participant underwent four 2-week intervention periods: artificial tears, vitamin A ointment, low-dose steroids (fluorometholone) and no medication as a control, separated by 2-week washout periods. Visual analogue scale questionnaires assessed discharge and irritation frequency and severity. Data were analysed using linear mixed models with Bonferroni correction for multiple comparisons and subgroup analyses were descriptive.Results In the total group, vitamin A ointment most consistently improved all outcome parameters: irritation frequency (–1.766, 95% CI (–2.857 to –0.675), p

Ophthopedia Update: Treating socket discharge and discomfort: a crossover randomised trial of vitamin A ointment, low-dose steroid eyedrops and artificial tears: Purpose

This study evaluated the effects of artificial tears, vitamin A ointment and low-dose… #Ophthalmology #Ophthotwitter #BJO

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@ophthalmology.bsky.social
1 month ago
Evaluation of corneal epithelial thickness mapping via spectral-domain OCT in patients after allogeneic haematopoietic stem cell transplantation Background Ocular chronic graft versus host disease (oGVHD) seriously affects ocular surface, which often results in corneal epithelial damage. The purpose of this study is to evaluate corneal epithelial thickness (CET) via spectral-domain optical coherence tomography (SD-OCT) in patients who underwent allogeneic haematopoietic stem cell transplantation (HSCT).Methods This study included 30 post-HSCT patients along with 20 healthy participants. CET and corneal thickness mapping were performed via SD-OCT and were obtained in multiple predefined corneal regions, namely, the central, superior, inferior, temporal and nasal zones, including both mid and the peri zones. Lid margin irregularity was assessed, and its correlation with CET was evaluated. Statistical analyses, including one-way analysis of variance and Pearson correlation, were used to assess group differences and correlations between CET and lid margin irregularity.Results Significant differences in corneal CET were observed between post-HSCT patients and healthy controls in several corneal regions, with thinning noted in multiple zones, particularly in the superior and inferior areas, prior to the clinical diagnosis of chronic oGVHD. Additionally, a positive correlation was observed between lid margin irregularity and CET in several peripheral regions, indicating that lid margin changes may contribute to alterations in epithelial distribution.Conclusion The CET map demonstrated that post-HSCT patients with or without chronic oGVHD had a relatively thicker corneal epithelium in the central and inferior regions. These changes were correlated with lid margin morphology. This SD-OCT mapping provides a better understanding of early corneal epithelial alterations following HSCT and identifies potential biomarkers for early diagnosis.

Ophthopedia Update: Evaluation of corneal epithelial thickness mapping via spectral-domain OCT in patients after allogeneic haematopoietic stem cell transplantation: Background

Ocular chronic graft versus host disease (oGVHD) seriously affects ocular surface,… #Ophthalmology #Ophthotwitter #BJO

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