Journal of Clinical & Translational Ophthalmology

Early eye loss, congenital microphthalmia, and anophthalmia can significantly disrupt facial and psychological development in children. Timely intervention with conformers and ocular prostheses is essential for stimulating orbital growth and supporting healthy psychosocial development. This review presents evidence-based guidelines for ocularists, physicians, and allied professionals on fitting conformers and prostheses in young children, emphasizing the need for individualized treatment based on anatomical severity and age. Recommendations include initial conformer fitting within the first month of life for congenital cases or 4–6 weeks post-surgery in acquired cases, with frequent early replacements. For microphthalmia, moderate-to-severe cases require treatment similar to congenital anophthalmia cases; mild-to-moderate cases treatment within months; and mild cases are usually managed individually without urgency. A cosmetic prosthesis is advised the latest after the first year, as growth slows and self-awareness develops. Regular follow-up and adjustments support functional and psychosocial outcomes. We advocate for standardized care protocols to ensure equitable access and consistent long-term results across healthcare systems. Full article

Background: A novel titanium scleral buckle implant (TSBI) was developed for the treatment of posterior pole retinal detachments, analytically modeled and structurally tested as part of preclinical approval studies. The strength and stiffness requirements to apply pressure for retinal reattachment also suggested potential benefits for correcting high myopia greater than 8 diopters. Methods: Laboratory load testing and analytical calculations were complemented by nonlinear finite element modeling (FEM), applied for the first time to capture the interaction between the highly deformed myopic eye and the TSBI. Simulations were used to visualize posterior pole indentation and force distribution across anatomical regions. Seven TSBI units were tested in the transverse direction and six in the longitudinal direction. Results: The simulations confirmed that stable indentation is maintained even in areas distant from the sutures. The TSBI’s minimum midspan bending capacity was 40 N at yield and 60 N at ultimate. These values, together with FEM predictions, demonstrated a very large safety margin and showed that the implant deforms insignificantly under high intraocular pressure changes. Conclusions: The TSBI withstands ocular forces, cushions the sclera safely, and retains its geometry, a behavior that may differ from softer buckle materials, which can exhibit time-dependent deformation under sustained loading. Early controlled clinical applications outside the USA, followed for over three years, further validate its safety and potential effectiveness. Full article

Background: Graft-versus-host disease is the most common complication after allogeneic hematopoietic stem cell transplantation. While ocular graft-versus-host disease typically manifests as dry eye syndrome and anterior segment involvement, posterior segment complications are rare. Previously reported posterior segment complications in graft-versus-host disease have been limited to acute presentations with significant functional visual impairment. Methods: A 41-year-old man developed progressive retinal nerve fiber layer and ganglion cell layer loss four years after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. The patient had established chronic graft-versus-host disease with cutaneous involvement and ocular surface disease. Results: Despite preserved visual acuity and visual fields, and only subtle functional involvement on visual evoked potentials, optical coherence tomography revealed significant reduction in retinal nerve fiber layer thickness and ganglion cell layer. Magnetic resonance imaging showed no optic nerve or brain abnormalities. Conclusions: This case describes an uncommon presentation of chronic, subclinical posterior segment involvement in chronic GVHD and suggests that optical coherence tomography may detect progressive structural retinal changes in the absence of clinically evident visual impairment, supporting its potential role in longitudinal monitoring. Full article

Background: Accurate evaluation of the Near Point of Convergence (NPC) is essential for diagnosing and managing convergence insufficiency (CI). Conventional assessment relies on the patient’s verbal feedback and the examiner’s visual observation, making it subjective and examiner-dependent. The AI-based MobileS platform, previously validated for both diagnosis and home-based therapy of CI, enables smartphone-based measurement and visualisation of NPC through eye tracking, without the need for verbal responses or additional equipment. This study, the third stage of our research programme, examined how ophthalmologists interpret NPC data when presented as videos versus AI-derived graphs. Methods: Twenty-two ophthalmologists completed an online questionnaire with 20 NPC test cases from the validated MobileS database, presented as both silent videos and AI-derived graphs. Accuracy was analysed using mixed-effects logistic regression, and continuous error was assessed using clustered bootstrap. Results: Graph-based interpretation showed higher odds of accurate NPC identification than video-based interpretation at the primary ±5 mm threshold (OR = 19.7, 95% CI: 13.50–28.74; p < 0.0001). Absolute error was lower for graphs than videos (Graphs − Videos: −22.73 mm; 95% CI: −26.88 to −18.59; p < 0.0001). “Uncertain” responses occurred in 28.2% of video-based assessments and 0% of graph-based assessments. Off-target errors decreased from 50.2% (videos) to 3.6% (graphs). Conclusions: AI-derived graphs of eye-movement data were associated with improved NPC estimation, suggesting a potential role in supporting clinical and tele-ophthalmology workflows. Full article

Background: Given global population growth and aging, it is imperative to prioritize early eye disease detection and treatment. However, as patient volume increases, providers are facing a shortage of workforce capacity, particularly in areas where eye doctors are already scarce, making it important to consider alternative innovative solutions that could help increase eye screening capabilities. This study compared virtual reality (VR) platform of vision screening exams that are used to evaluate ocular health, such as 24-2 perimetry, Ishihara tiles, and the Amsler grid, against their in-clinic counterparts. Methods: A total of 86 subjects were recruited from Mount Sinai’s ophthalmology clinic (New York, USA) for a comparison trial that was internally controlled across healthy eyes and those with glaucoma and retinal diseases. VR and in-office tests were administered to the patients during their clinical visit, including 24-2 perimetry, Ishihara tiles, and the Amsler grid in a randomized order, and the results were compared for each test. Results: Perimetry results from Humphrey Visual Field Analyzer (HVFA) and VR suprathreshold testing demonstrated a good sensitivity both overall (80% OD, 84% OS) and across control (86% OD, 89% OS), glaucoma (69% OD, 78% OS), and retinal disease (76% OD, 80% OS) groups. A Garway-Heath anatomical map showed an overall 70–80% agreement. Ishihara plate tests did not show a significant difference between the two testing modalities (p = 0.12; Mann–Whitney U test), which remained true across all groups. Amsler grid testing differences were also non-significant within each subgroup (p = 0.81; Mann–Whitney U test). Patient time required to complete VR exams was significantly improved (p < 0.0001; Welch’s t-test) compared to the clinical standard tests. Conclusions: All VR-based exams tested in this study showed high sensitivity and percent agreement when compared to their in-office standards. Given the results of this study, VR has a promising potential in visual function screening, which, in addition to its portable design and easy use, could assist eye doctors in screening for prevalent diseases such as glaucoma and retinal conditions. Translational Relevance: VR-based vision exams that test vision fields, color vision and visual distortions provide comparable results in healthy patients, as well as those with glaucoma and retinal diseases, indicating its potential as a screening technology for different ocular pathologies. Given VR’s portable and low-profile features, it is important to consider leveraging VR to augment delivery of vision care. Full article

Background: Higher intake of omega-3 fatty acids from food sources is associated with a reduced risk of age-related macular degeneration (AMD), but there are no recommended parameters for omega-3 fatty acid supplementation. The purpose of our study was to investigate whether fish oil supplementation protects against development of AMD in the US Veteran Affairs (VA) Corporate Data Warehouse. Methods: Patients ≥ 55 years without an AMD diagnosis at the initial eye examination who also had a 5-year follow up eye examination were included in this retrospective cohort study. Patients receiving fish oil supplementation from the VA pharmacy were categorized into the fish oil exposure group and matched 1:1 to a non-exposure control group. All patients were assessed for AMD development at the 5-year follow up eye examination. Results: AMD developed in 772 of 16,172 patients (4.8%) with fish oil exposure and 635 of 16,093 (3.9%) without fish oil exposure (relative risk (RR) = 1.21, 95% confidence interval (CI) = 1.09–1.34, p = 0.0003). Compared to controls, AMD risk was similar in low-dose (RR = 0.91; 95% CI = 0.65–1.27) and moderate-dose (RR = 0.93; 95% CI = 0.79–1.10) fish oil supplementation but higher in high-dose fish oil supplementation (RR = 1.32; 95% CI = 1.19–1.47). Conclusions: Fish oil supplementation did not protect against AMD in a US veteran population. Full article

Background: The impact of cataract surgery on anterior segment structures in subjects affected by primary open-angle glaucoma (POAG) remains incompletely understood. The aim of this study was to characterize changes in anterior segment parameters after cataract surgery in POAG subjects compared with non-glaucoma subjects (control). Methods: A prospective comparative study was conducted, including patients scheduled for cataract surgery who underwent a comprehensive ophthalmic examination before and after surgery using anterior segment optical coherence tomography (OCT). Longitudinal changes and between-group comparisons were analyzed. Results: The results demonstrated a significant enlargement of the anterior chamber and iridocorneal angles after surgery in both groups (p < 0.05), with no significant differences between POAG and control eyes (p > 0.05). Several preoperative parameters, particularly angle-related metrics, were correlated with postoperative anatomical changes, suggesting their potential role as predictors of anterior segment variation (R > 0.50; p < 0.05). Conclusions: In conclusion, this study provides a detailed characterization of anterior segment changes in POAG subjects following cataract surgery, demonstrating anterior chamber enlargement comparable to that observed in non-glaucoma eyes, which may assist clinicians in the management of glaucoma. Full article

Purpose: This study evaluates the association between supervising attending surgeons’ post-residency experience and complication rates during resident-performed phacoemulsification (cataract extraction) surgeries, and to determine whether this relationship changes as the academic year progresses. Methods: A retrospective analysis of 1263 cataract surgeries performed by eight PGY-4 residents under 14 board-certified attendings was conducted at a New York City residency program over two years. Attendings were divided into four groups based on years of post-residency experience. Primary complications included posterior capsule (PC) tears, anterior vitrectomy (AV), capsulorrhexis extensions (CE), and inability to place a one-piece intraocular lens (IOL). Chi-square analyses compared complication rates between attending groups overall, and between the first and second halves of the academic year. Results: A total of 167 primary complications (13.2%) were identified. Attendings with the fewest years of experience (Group 1) supervised significantly more cases with PC tears (χ² = 8.173, p = 0.004), AV usage (χ² = 7.748, p = 0.005), and inability to place a one-piece IOL (χ² = 4.753, p = 0.029), particularly during the first half of the academic year. Notably, supervising attending experience was not correlated with resident complications in the second half of the academic year. Conclusions: Early in the academic year, less experienced attendings supervised cases with higher complication rates, underscoring the critical role of strategic case assignment and targeted mentorship during early surgical training. These findings suggest that aligning resident progression with appropriate supervision can enhance outcomes and support skill development, optimizing both education and patient safety. Full article

Objective: Assess visual acuity (VA) and strabismus changes in children after Baerveldt 350 (BV350) device placement. Methods and Analysis: Retrospective cohort study of children (<21 years of age) who had superotemporal BV350 placement (2011–2023) and >6-month follow-up. Ocular diagnoses, surgical details, and preoperative and final follow-up exam findings were collected. In bilateral cases, first eye implanted was included in analysis. Results: Ninety-seven patients underwent BV350 surgery with median age of 6.7 (interquartile (IQR) 3.1, 11.2) years and with a median of 4.2 (IQR 1.8, 6.8) years of follow-up. Most common glaucomas were secondary to non-acquired ocular anomaly (n = 31) or primary congenital glaucoma (n = 21). There was no difference in preoperative and final VA (p = 0.6583). Twenty-seven (28%) and twenty-five (26%) patients were orthophoric preoperatively and at final follow-up, respectively. Orthophoria at final follow-up was associated with preoperative (odds ratio (OR)1.8 [1.2, 2.9]) and final VA (OR1.5 [1.1, 2.3]). At final follow-up, 13 patients (13%) and 19 patients (20%) showed worsened or improved horizontal deviation (>10 prism diopter (PD) change), respectively. No patients reported postoperative diplopia. Only four patients, all with esotropia, underwent subsequent strabismus surgery. Conclusions: Children who underwent BV350 placement did not have significant change in VA, and a high percentage of patients had strabismus prior to (72%) and following (74%) glaucoma surgery. Orthophoria was associated with better VA. The majority of patients did not show worsening of strabismus postoperatively, and none reported diplopia. Full article

Background: We report an uncommon presentation of Lyme disease and highlight the importance of a detailed history in a patient with new-onset sixth nerve palsy. Methods: Case report and literature review. Results: A 46-year-old man receiving infliximab presented to the ophthalmology emergency department with horizontal binocular diplopia. History revealed a diffuse headache that had begun three weeks earlier. Ophthalmologic examination demonstrated a left sixth cranial nerve palsy. The workup showed positive Borrelia serum IgG, which was interpreted as a likely false-positive result given the limited specificity of serologic testing. At follow-up, the patient reported left-sided peripheral facial palsy, and worsening headache and diplopia. Further history revealed prior erythema migrans treated with doxycycline four months earlier. Considering these new findings, a lumbar puncture was performed and demonstrated intrathecal production of Borrelia antibodies. Neuroborreliosis, a neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi, was diagnosed. The patient was treated with oral doxycycline for 28 days with complete resolution of symptoms. Conclusions: Lyme disease may present with progressive neuro-ophthalmologic symptoms, underscoring the crucial role of ophthalmologists in its diagnosis. Moreover, immunosuppression may delay diagnosis and allow neurological progression, highlighting the need for careful history taking and close follow-up. Full article

Background: The recently defined pachychoroid disease spectrum (PDS), which includes central serous chorioretinopathy (CSCR), is a group of retinal disorders that share the common characteristic of a thick, dilated, hyperpermeable choroid. This study aimed to evaluate the efficacy of difluprednate and loratadine in the treatment of pachychoroid disease spectrum (PDS). Methods: A retrospective study of 27 eyes from 19 patients with macular edema secondary to chronic PDS were treated with topical difluprednate and oral loratadine at a tertiary medical center. Visual acuity and optical coherence tomography (OCT) images were analyzed at baseline, 1-, 2-, 3-, 6-, 12-month, and final follow-up. Baseline was defined as the initiation of topical difluprednate. Patients with neovascularization or who had other concurrent treatments for PDS were excluded. Subfoveal choroidal thickness was measured at each time point. Response was defined as eyes that showed a reduction in intra- or subretinal fluid. Results: All 27 eyes studied responded to treatment. Of these, 70.4% resolved by 4 months and 81.5% by 6 months, with 52.2% of these patients having recurrences related to cessation or tapering of topical steroids. Visual acuity remained stable (p > 0.05) while subfoveal choroidal thickness decreased compared to baseline (p < 0.001) across all time points. Eleven (40.7%) of the eyes developed increased intraocular pressure, for which seven (25.9%) required incisional surgery. Conclusions: Chronic PDS can be treated with a combination of topical difluprednate and oral antihistamines to reduce retinal edema and subfoveal choroidal thickness. The effectiveness of therapy could be linked to the regulation of mast cell degranulation, necessitating a well-powered prospective randomized clinical trial. Full article

Objective: The purpose of this study is to investigate the effect of low-dose atropine and dual-focus MiSight contact lenses on myopia control. Methods: This study included a retrospective review of patients (5–13 years old) started on MiSight contacts or 0.05% atropine with a ≥1-year follow-up. Outcomes included cycloplegic refraction, axial length measurement, and side effects. The right eyes were included in analyses. Results: One hundred children were treated with MiSight lenses (n = 55) or 0.05% atropine (n = 45) at an average age of 10.4 ± 2.1 years and 8.4 ± 2.5 years, respectively. At the 1-year follow-up, there was no difference from baseline in spherical equivalent or axial length in the MiSight group (p = 0.61, p = 0.98) or in the atropine group (p = 0.78, p = 0.97). Further, subgroup analysis based on age at treatment initiation (<9.5 years vs. ≥9.5 years) showed no age difference in baseline or final spherical equivalent and axial length in either the MiSight group or the atropine group. Linear regression analysis demonstrated no association between initial age and baseline spherical equivalent, baseline axial length, or the change in spherical equivalent in either the MiSight or atropine group. Conclusions: There was no significant difference in spherical equivalent or axial length after 1 year of treatment with either the MiSight contact lenses or 0.05% atropine eye drops. However, the limited sample size, the difference in age and ethnicity, and baseline refraction prevent a direct comparison between the two treatment groups. Full article

Background: Trabeculectomy and minimally invasive glaucoma surgery (MIGS) such as goniotomy aim to reduce intraocular pressure (IOP) and medication burden but are often performed in patients with differing disease severity. Methods: We retrospectively reviewed 100 eyes from 76 adults with glaucoma that underwent either goniotomy (n = 50; Kahook Dual Blade = 42, OMNI = 8) or trabeculectomy ab externo (n = 50) at a tertiary center between May 2022 and June 2023, with at least six months of follow-up. Baseline and six-month IOP, number of medications, and postoperative complications were recorded. Eyes undergoing trabeculectomy had higher preoperative IOP than those undergoing goniotomy (22.6 ± 7.7 vs. 19.1 ± 5.9 mmHg). Results: At six months, trabeculectomy achieved a greater absolute IOP reduction (8.8 ± 0.8 vs. 5.4 ± 0.8 mmHg; p = 0.004), likely reflecting higher baseline IOP, while goniotomy yielded a larger medication reduction (1.47 ± 0.30 vs. 0.72 ± 0.20; p = 0.041). Hyphema occurred more often after trabeculectomy, and the small number of OMNI cases precluded device comparison. Conclusions: In this short-term retrospective series, trabeculectomy achieved larger absolute IOP reduction whereas goniotomy offered greater medication reduction, highlighting the need to individualize surgical choice and confirm these findings in larger prospective studies. Full article

Background: This study evaluates the incidence and outcomes of patients with dropped nucleus/nuclear fragment during phacoemulsification surgery; Methods: Retrospective review of continuous cases with dropped nucleus/nuclear fragment during phacoemulsification cataract surgery from January 2020 to December 2024. Demographic and perioperative data were collected and analysed. A good visual outcome was defined as a postoperative best-distance visual acuity of ≥6/12; Results: A total of 91,883 cases of planned phacoemulsification cataract surgery were identified, of which 175 (0.19%) were complicated by a dropped nucleus/lens fragment. Mean age was 71 years and median number of days from primary procedure to secondary fragmatome was 5 days. Good visual outcomes were achieved in 127 cases (73%). Median final intraocular pressure was 13 mmHg. Most patients required two (63%) or three (29%) operations in total and none developed endophthalmitis. Hypermature cataracts were present in 70 cases (40%) and were significantly associated with poor visual outcomes (p = 0.003). Surgeon grade and other pre-existing ocular co-pathologies known to increase posterior capsular rupture risk were not significantly associated with poor visual outcomes; Conclusions: Overall incidence and outcomes of cases complicated with dropped nucleus/fragment were favourable despite the presence of pre-existing risk factors. Emergent management is paramount to ensure good outcomes in patients. Full article

Background/Purpose: Ophthalmic triage is challenging for non-specialists due to limited training and rising global eye disease burden. This study evaluates a multimodal framework integrating clinical text and ophthalmic imaging with large language models (LLMs). Textual consistency filtering and chain-of-thought (CoT) reasoning were incorporated to improve diagnostic accuracy. Methods: A dataset of 56 ophthalmology cases from a Singapore restructured hospital was pre-processed with acronym expansion, sentence reconstruction, and textual consistency filtering. To address dataset size limitations, 100 synthetic cases were generated via one-shot GPT-4 prompting, validated by semantic checks and ophthalmologist review. Three diagnostic approaches were tested: Text-Only, Image-Assisted, and Image with CoT. Diagnostic performance was quantified using a novel SNOMED-CT-based dissimilarity score, defined as the shortest path distance between predicted and reference diagnoses in the ontology, which was used to quantify semantic alignment. Results: The synthetic dataset included anterior segment (n = 40), posterior segment (n = 35), and extraocular (n = 25) cases. The text-only approach yielded a mean dissimilarity of 6.353 (95% CI: 4.668, 8.038). Incorporation of image assistance reduced this to 5.234 (95% CI: 3.930, 6.540), while CoT prompting provided further gains when imaging cues were ambiguous. Conclusions: The multimodal pipeline showed potential in improving diagnostic alignment in ophthalmology triage. Image inputs enhanced accuracy, and CoT reasoning reduced errors from ambiguous features, supporting its feasibility as a pilot framework for ophthalmology triage. Full article

Diabetes mellitus (DM) is a debilitating chronic disorder that results in ocular microvascular complications, including diabetic retinopathy (DR) and diabetic macular edema (DME). Early detection and timely intervention for DR and DME are crucial for improving visual outcomes in affected patients. Ophthalmic imaging plays a vital role in the screening, diagnosis, and management of DR and DME. In this review, a comprehensive overview of the imaging modalities frequently utilized in the assessment of DR and DME, encompassing both structural and functional imaging techniques are presented. The key imaging findings that are associated with the various stages of DR and DME are underscored and their diagnostic utility in assessing disease progression and visual function are evaluated. Additionally, we discuss emerging imaging biomarkers that are currently under investigation, which hold significant potential for improving the diagnostic and prognostic capabilities of imaging for DR and DME patients. Finally, the advent of new imaging methods, such as ultrawide-field imaging (UWFI) and deep learning models, which have markedly improved the detection of retinal pathologies are considered. Full article

Smartphone-based fundus cameras and telemedicine are an opportunity for accessing ocular health inequalities in under-resourced areas. The objective of this study is to evaluate the prevalence of retinal findings in a community in the Amazon and propose strategies to enhance ocular health. A retrospective study was conducted in a riverside community. Retinal photos from the posterior pole and optic disc were captured using a portable fundus camera. All photos and data were analyzed remotely by a retina specialist. The final sample was 107 participants, aged 52 ± 17. Retinal findings were detected in 37.4% (95%CI 28.7–46.8) of the sample; the three main retinal findings were epithelial changes (10.3%, 95%CI 5.6–17.1), chorioretinal scars (8.4%, 95%CI 4.2–14.8), and dry age-related macular degeneration (7.5%, 95%CI 3.6–13.6). This study detected retinal alterations in a similar prevalence to that of other under-resourced areas. Telemedicine is an opportunity to address health inequities, especially in ophthalmology, through relatively low-cost portable devices, supporting clinical decisions in areas with low health access; however, maintaining assistance after implementation is a challenge. Enhancing medical education and training local non-specialized health professionals in risk assessment, device handling, and data base use is reasonable to ensure follow-up. Full article

Background: Uveitis, although a rare complication of multiple sclerosis (MS), poses a significant challenge in clinical management. Traditional treatments like corticosteroids, immunosuppressants, and surgical interventions often provide limited efficacy. Treatment for MS-associated uveitis involves a combination of traditional and emerging therapies, with a growing emphasis on monoclonal antibodies (mAbs). While there is an increasing use of disease-modifying therapies for MS such as interferon-beta (IFN-β), mAbs are gaining attention for their potential to address both neurological and ophthalmological symptoms. Methods: We conducted a systematic review of the existing literature and analyzed the clinical effect of IFN-β and mAb therapies in the context of MS-associated uveitis, assessing their efficacy in reducing inflammation, maintaining visual acuity (VA), and minimizing steroid dependency. Results: MS-associated uveitis had improved or maintained VA in 95% (35/37) of eyes (21 patients) after an average of 34.7 months (range of 7.9 to 78.7 months) of IFN-β treatment. One hundred percent (10/10) of patients (19/19 eyes) had improved or maintained VA after a mean of 25 months (range 8 to 43 months) of mAb treatment. We also found that IFN-β effect on MS-associated uveitis is comparable to mAbs. Conclusions: We outline the need for further research through human data to strengthen current findings and guide evidence-based clinical practice. Full article

Optogenetics is a field that emerged with the goal of studying the physiology of nerve cells by selectively expressing opsins—channel proteins that can be activated by light exposure. Once the methodology was established, several research groups sought to express these proteins in damaged nerve tissue to restore proper signal transmission. Over the years, numerous efforts have been made to restore vision in patients with chronic degenerative diseases, particularly retinitis pigmentosa, with clinical trials yielding encouraging results. However, significant challenges remain, such as the difficulty of delivering the signal to specific retinal cells and the complexity of replicating the physiological activation of the target cells. As research continues, optogenetics remains a promising yet evolving field. This review aims to highlight the therapeutic advantages of optogenetics over currently available strategies and to promote further scientific exploration of this emerging discipline. Full article