Current Issue

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In this week’s issue

• Comparison of selective laser trabeculoplasty (SLT) with direct selective laser trabeculoplasty (DSLT) was unable to prove non-inferiority of DSLT. 
• Primary open angle glaucoma (POAG) patients in lower wealth quartiles and those from rural areas had lower likelihood of IOP reductions. 
• Indirect corneal neurotization can yield sustained corneal reinnervation in patients with neurotrophic keratopathy. 
• Temporary silicone oil tamponade can be effective in closing persistent full thickness macular holes. 

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Ophthalmology

Randomized noninferiority trial of DSLT in OAG and OHTN

A direct route to lower IOP? Selective Laser Trabeculoplasty (SLT), a non-invasive procedure in which an ophthalmologist uses targeted laser therapy to reshape the trabecular meshwork (TM) and increase aqueous drainage, has long been a mainstay in glaucoma therapy. The conventional procedure involves using a special lens to indirectly visualize the TM, allowing the surgeon to bounce a laser beam off a mirror within that lens onto the eye’s drainage system. Recently, however, physicians conceived of a modified procedure, called direct selective laser trabeculoplasty (DSLT), in which laser energy is passed directly through the limbus into the TM. DSLT requires significantly less technical expertise to perform, though its efficacy relative to traditional SLT remains uncertain. An international research group published a study in which they were unable to demonstrate non-inferiority of DSLT relative to SLT at 6 months, with average IOP reduction after DSLT and SLT measuring -5.5 ± 0.5 mmHg and -6.2 ± 0.5 mmHg, respectively. Notably, the authors comment that their inability to statistically prove non-inferiority of DSLT relative to SLT does not necessarily signify the inferiority of DSLT. DSLT remains an effective option for lowering IOP in scenarios when access to SLT is difficult.

JAMA Ophthalmology

Disparities underlying glaucoma care in newly diagnosed patients

Eyes on equity: understanding the social lens of glaucoma outcomes. Despite advancements in treatment, primary open-angle glaucoma (POAG) continues to disproportionately impact certain communities. To explore how nonmedical factors shape glaucoma outcomes, investigators conducted a retrospective cohort analysis of patients newly diagnosed with POAG from across 12 tertiary care health systems between 2010 and 2022, linking clinical records with socioeconomic data. Multivariable logistic regression models were used to determine associations between socioeconomic variables and two primary outcomes: achieving a ≥15% reduction in intraocular pressure (IOP) and rate of patients lost to follow-up (LTFU) within 12 to 18 months of initial diagnosis. Patients in the lowest wealth quartile had a 5- to 9-fold lower odds of achieving the IOP target compared with patients in the highest quartile. Patients from rural communities had 5-fold higher odds of being LTFU compared to those in urban settings. Notably, patients from households with at least one child had, on average, a 4 mmHg greater IOP reduction compared to those without children. Collectively, these results highlight how socioeconomic, geographic disparities, and household composition influence glaucoma outcomes, underscoring the need for initiatives dedicated to addressing financial barriers and expanding access to meaningfully impact glaucoma care.

American Journal of Ophthalmology (AJO)

Long-term outcomes of indirect corneal neurotization

​​A numb cornea can’t heal, but a new nerve could change the story. Neurotrophic keratopathy (NK) is a degenerative corneal disease caused by trigeminal nerve dysfunction, leading to impaired wound healing and progressive vision loss. Traditional treatments are largely palliative and fail to address the underlying corneal denervation, which limits the success of any subsequent corneal transplantation. Indirect corneal neurotization (ICN), using the supratrochlear nerve and a great auricular nerve graft, offers a promising approach to restore corneal innervation, but its long-term efficacy has been underexplored. In this prospective single-center interventional case series, 19 patients with NK underwent ICN with outcomes assessed at 24 months using corneal esthesiometry (measuring sensation) and in vivo confocal microscopy (IVCM). Corneal sensitivity improved in 84% of eyes, including 56% with complete baseline denervation (P = 0.011). Morphologically, IVCM confirmed corneal reinnervation in all eyes over 24 months. ICN led to sustained corneal reinnervation and enabled successful secondary penetrating keratoplasty in select patients, supporting its role in long-term NK rehabilitation.

British Journal of Ophthalmology

Can temporary silicone oil tamponade rescue macular holes?

The search for a reliable way to close persistent macular holes continues, could oil be the answer? Persistent full-thickness macular holes (FTMHs) after primary vitrectomy with ILM peeling and gas tamponade remain a challenge, and there is currently no clear consensus on the best technique for treatment. In this multicenter, retrospective study, investigators analyzed 102 eyes with persistent FTMH that underwent treatment with temporary silicone oil, without additional retinal manipulation or postoperative positioning. Closure was achieved in 92.2% of cases, and median BCVA improved significantly from 1.00 to 0.70 logMAR at final visit after oil removal. Eyes that failed to close had a significantly larger mean minimum linear diameter (614 µm vs 447 µm). Temporary silicone oil tamponade can be a practical, effective option for persistent FTMHs, particularly in patients that cannot maintain face-down positioning. 

International Journal of Clinical Oncology

Longitudinal nationwide analysis of uveal melanoma in the US

Who is at increased risk for uveal melanoma? Uveal melanoma is the most common primary adult ocular malignancy. While incidence is variable globally, there are limited epidemiologic reports in the United States. This retrospective study aimed to provide comprehensive epidemiologic data on the disease in the US by analyzing data from the North American Association of Central Cancer Registries (NAACCR) and US Cancer Statistics (USCS) program over 23 years. The study identified 37,917 patients with uveal melanoma. Men presented with significantly higher age-adjusted incidence rates per million persons than women (6.25 vs 4.97, p<0.001). Oregon and Iowa had the highest incidence of uveal melanoma. Peak incidence was in individuals aged 75-79. Most melanomas were localized at diagnosis (81.3%) and 27.4% had additional primary malignancies. This study illustrates uveal melanoma disparities by sex, geography, and age. It provides an epidemiologic baseline that is estimated to represent 98-100% of the US population.  

JAMA Network Open

AI for early detection of pediatric eye diseases using mobile photos

Can AI help kids’ eyes? Pediatric eye conditions such as myopia, strabismus, and ptosis are common causes of visual impairment and can lead to lifelong vision problems if not detected early. However, routine screening is often limited by access to specialists, especially in low-resource settings. This study developed a deep learning model using 1,419 smartphone-acquired images from 476 children to screen for these conditions. The AI demonstrated strong diagnostic performance, with sensitivity of 84% for myopia, 73% for strabismus, and 85% for ptosis, and specificity of 76%, 85%, and 95%, respectively. Its performance suggests that AI can provide accurate, rapid, and automated detection of pediatric eye disorders using only smartphone photography, outperforming standard referral-based screening in some contexts. These findings support the integration of AI tools into community and school-based eye care programs, enabling early identification and timely referral of at-risk children. By leveraging widely available smartphones, such AI-driven screening could improve access to pediatric ophthalmic care, reduce delays in diagnosis, and prevent avoidable vision loss in resource-limited regions.

Prevalence of Age-Related Maculopathy (Beaver Dam) - 1992

Does age affect retinal drusen, pigmentary abnormalities, and overall macular degeneration? In the Beaver Dam Eye study, 4926 patients from age 43 to 68 were studied using stereoscopic color fundus photography to answer this question.

Key Points

• Data indicated that individuals 75 years of age or older commonly had signs of AMD
• Identified features included large drusen, soft indistinct drusen, abnormal retinal pigmentation, exudative macular degeneration, and geographic atrophy. 
• 95.5% of the population studied had at least one drusen in the macula of one of their eyes.

Overall, the Beaver Dam Eye study is a landmark trial because it demonstrated the association between AMD and age. It was one of the first large scale prevalence studies for the disease. This association was deemed a “substantial public health problem” that previously had not been realized.