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Optical coherence tomography angiography (OCTA) has emerged as a novel, non-invasive imaging modality that allows the detailed study of flow within the vascular structures of the eye. Compared to conventional dye angiography, OCTA can produce more detailed, higher resolution images of the vasculature without the added risk of dye injection. In our review, we discuss the advantages and disadvantages of this new technology in comparison to conventional dye angiography. We provide an overview of the current OCTA technology available, compare the various commercial OCTA machines technical specifications and discuss some future software improvements. An approach to the interpretation of OCTA images by correlating images to other multimodal imaging with attention to identifying potential artefacts will be outlined and may be useful to ophthalmologists, particularly those who are currently still unfamiliar with this new technology. This review is based on a search of peer-reviewed published papers relevant to OCTA according to our current knowledge, up to January 2017, available on the PubMed database. Currently, many of the published studies have focused on OCTA imaging of the retina, in particular, the use of OCTA in the diagnosis and management of common retinal diseases such as age-related macular degeneration and retinal vascular diseases. In addition, we describe clinical applications for OCTA imaging in inflammatory diseases, optic nerve diseases and anterior segment diseases. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical applications of this imaging technology.

The study of retinal hemodynamics is pivotal for understanding both physiological and pathological conditions affecting the eye. Microcirculation in the retina exhibits unique rheological properties and flow dynamics compared to larger vessels. This computational study investigates the possible impact of elevated blood lipids on retinal vascular flow characteristics, focusing on viscosity increases and potential blockage effects. We utilized computational fluid dynamics to solve the incompressible Navier-Stokes equations for an image-based retinal vessel network under healthy conditions. Our findings reveal that arterial vessels have a higher average mainstream flow velocity than venous vessels, however, the latter experience higher wall shear stress (WSS) in those fine branch vessels, which are far away from the optical disc. Notably, vessels with more branches in the venous network are subjected to greater WSS. Then, we simulated the effect of elevated blood lipids by increasing venous viscosity by about 10-20%, which led to a proportional rise in WSS. Furthermore, we explored the potential blockage that may caused by elevated blood lipids, leading to localized increases in velocity and WSS. This study provides insights into the hemodynamic alterations induced by hyperlipidemia, highlighting the importance of considering systemic health parameters in ocular disease research and treatment.

Congenital anterior segment anomalies are disorders that affect the development of the eye and cause severe visual impairment. The molecular basis of congenital anterior segment anomalies is not well known. In this study, genome sequencing was performed on 27 families from diverse ethnicities with congenital anterior segment anomalies and 11 variants were identified, most of which were novel and family specific. These variants included single nucleotide variants CPAMD8 :c.4825 C > T, c.534 G > A, CRYBB1 : c.683 C > A , NHS :c.1180 C > T, GJA3 :c.176 C > T, CRYGC :c.470 G > A, COL2A1 :c.2819 G > A, c.1693 C > T, EPHA2 :c.2864 A > C, a splice donor variant in COL11A1 :c.933 + 1del, and a copy number variant in FBN1 . The observed inheritance patterns were predominantly dominant, with a few recessive cases and a single instance of X-linked inheritance. Genome sequencing identified variants in 40.74% of diverse cases, offering valuable insights for enhancing the diagnosis and management of this disorder.

The purpose of this study was to evaluate corneal irregular astigmatism of patients with granular and lattice corneal dystrophy (GCD and LCD). 70 GCD, 35 LCD, and 81 control eyes were included. Anterior and posterior corneal topographic data obtained from anterior segment optical coherence tomography were expanded into four components via Fourier harmonic analysis. These components were compared with healthy eyes and the association between each component and best-corrected visual acuity (BCVA) was investigated. Anterior and posterior components increased in both GCD and LCD eyes. Anterior and posterior components of GCD2, anterior of LCD type 1 (LCD1), posterior of LCD type IIIA (LCD 3A), and type IV (LCD4) significantly increased. BCVA was significantly associated with anterior and posterior components in LCD eyes but not in GCD. The anterior components of LCD1, anterior and posterior of LCD3A, and posterior of LCD4 , were positively correlated with BCVA. As conclusions, in GCD eyes, anterior and posterior components differed from those of the control but BCVA was not significantly associated with them. In LCD eyes, the anterior and posterior components increased, and BCVA was significantly associated with the anterior and posterior components.

The purpose of this study is to examine and interpret machine learning models that predict dry eye (DE)-related clinical signs, subjective symptoms, and clinician diagnoses by heavily weighting lifestyle factors in the predictions. Machine learning models were trained to take clinical assessments of the ocular surface, eyelids, and tear film, combined with symptom scores from validated questionnaire instruments for DE and clinician diagnoses of ocular surface diseases, and perform a classification into DE-related outcome categories. Outcomes are presented for which the data-driven algorithm identified subject characteristics, lifestyle, behaviors, or environmental exposures as heavily weighted predictors. Models were assessed by 5-fold cross-validation accuracy and class-wise statistics of the predictors. Age was a heavily weighted factor in predictions of eyelid notching, Line of Marx anterior displacement, and fluorescein tear breakup time (FTBUT), as well as visual analog scale symptom ratings and a clinician diagnosis of blepharitis. Comfortable contact lens wearing time was heavily weighted in predictions of DE symptom ratings. Time spent in near work, alcohol consumption, exercise, and time spent outdoors were heavily weighted predictors for several ocular signs and symptoms. Exposure to airplane cabin environments and driving a car were predictors of DE-related symptoms but not clinical signs. Prediction accuracies for DE-related symptoms ranged from 60.7 to 86.5%, for diagnoses from 73.7 to 80.1%, and for clinical signs from 66.9 to 98.7%. The results emphasize the importance of lifestyle, subject, and environmental characteristics in the etiology of ocular surface disease. Lifestyle factors should be taken into account in clinical research and care to a far greater extent than has been the case to date.

This retrospective observational study compared long-term topographic changes after recurrent- and primary-pterygium surgery depending on pterygium size. Patients who underwent recurrent-pterygium excision between 2002–2013 and age, sex, and pterygium size-matched controls who underwent primary-pterygium surgery were included (33 eyes of 33 patients in each group). Pterygium size was graded per advancing edge position: <1/3 of corneal diameter (grade 1), outside the pupil (grade 2), and within the pupillary area (grade 3). Surface asymmetry index (SAI), surface regularity index (SRI) in corneal topography, and uncorrected and best-spectacle-corrected visual acuity were compared before and 1, 3, 6, and 12 months postoperatively. Three, 17, and 13 eyes had grades 1, 2, and 3, respectively. In grade 2, the SAI and SRI were respectively significantly larger at all observation points (p = 0.01, 0.03, 0.02, 0.02, and 0.004) and before and 6 and 12 months postoperatively (p = 0.02, 0.04, and 0.03) in recurrent pterygium. In grade 3, the SAI was significantly larger before and 1, 3, and 12 months postoperatively (p = 0.04, 0.01, 0.01, and 0.02) and the SRI was significantly larger before and 12 months postoperatively (p < 0.001, 0.02) in recurrent pterygium. Corneal irregularity persisted 12 months after recurrent-pterygium surgery compared with that in same-size primary pterygium.

High myopia is a leading cause of blindness worldwide. Myopia progression may lead to pathological changes of lens and affect the outcome of lens surgery, but the underlying mechanism remains unclear. Here, we find an increased lens size in highly myopic eyes associated with up-regulation of β/γ-crystallin expressions. Similar findings are replicated in two independent mouse models of high myopia. Mechanistic studies show that the transcription factor MAF plays an essential role in up-regulating β/γ-crystallins in high myopia, by direct activation of the crystallin gene promoters and by activation of TGF-β1-Smad signaling. Our results establish lens morphological and molecular changes as a characteristic feature of high myopia, and point to the dysregulation of the MAF-TGF-β1-crystallin axis as an underlying mechanism, providing an insight for therapeutic interventions. High myopia is associated with lens changes, but the underlying mechanisms are unclear. Here, the authors show increased equatorial diameter of the lens in subjects affected by high myopia, and find that these changes are associated with an increase in crystallin expression driven by the transcription factor MAF and TGF-β1 signaling.

Objectives To evaluate the accuracy of tele-ophthalmic examination (TOE) for common ocular conditions in comparison with the gold-standard in-person examination (IPE) for diagnosis and treatment advice. Methods In a prospective, diagnostic accuracy validation study, we recruited 339 consecutive new patients, aged ≥16 years, visiting a vision centre (VC) associated with Aravind Eye Hospital in south India during January and February, 2020. All participants underwent the TOE, followed by IPE on the same visit. The in-person ophthalmologist was masked to the TOE diagnosis and treatment advice. Data were analysed via the sensitivity specificity of TOE versus the gold-standard IPE. Results TOE achieved high sensitivity and specificity for identifying normal eyes with 87.4% and 93.5%, respectively. TOE had high sensitivity for cataracts (91.7%), infective conjunctivitis (72.2%), and moderate sensitivity for pterygium (62.5%), DR (57.1%), non-serious injury (41.7%), but low sensitivity for glaucoma (12.5%). TOE had high specificity ranging from 93.5% to 99.8% for all diagnoses. The sensitivity for treatment advice ranged from 58.1% to 77.2% and specificity from 96.9% to 100%. Conclusions The TOE in VCs has acceptable accuracy to an IPE by an ophthalmologist for correctly identifying and treating major eye ailments. Through providing universal eye care to rural populations, this model may contribute to work toward achieving Universal Health Coverage, which is a linchpin of the health-related U.N. Sustainable Development Goals (SDG).

Cataract is a leading cause of irreversible vision loss, particularly among the elderly, with drug-induced cataract being an underrecognized yet significant contributor to visual impairment. This study investigates the associations between medications and cataract development using real-world data from the FDA Adverse Event Reporting System (FAERS) from Q1 2004 to Q3 2024. A total of 54,800 reports were analyzed, including 2,336 cases involving 691 drugs in individuals aged 0–45 years. Disproportionality analysis identified 24 drugs significantly associated with cataract risk, with the highest risks linked to glucocorticoids (e.g., fluticasone furoate, triamcinolone), insulin analogs (e.g., insulin glargine, insulin human), and other agents like nitisinone and ranibizumab. Difluprednate showed the strongest association (Bayesian Confidence Propagation Neural Network [BCPNN] = 7.83), followed by prednisolone (BCPNN = 6.84) and erdafitinib (BCPNN = 5.44). Difluprednate had the shortest median onset time (74 days), while prednisolone’s median onset was 141 days. Antineoplastic agents demonstrated the fastest average onset of cataracts (533.89 days). The majority of cases were reported in females (57.9%), with a noticeable annual increase in cases. This study provides a comprehensive pharmacovigilance evaluation, offering insights into high-risk medications, their onset patterns, and demographic trends, contributing to improved clinical decision-making and cataract prevention strategies.

To investigate the prevalence of meibomian gland dysfunction (MGD) in patients presenting with subjective dry eye-related symptoms at their first-time consultation in a Norwegian specialized ocular surface clinic. Additionally, to explore the accuracy of the ocular surface disease index score (OSDI) as an extensively applied tool to assess the severity of dry eye symptoms and MGD diagnosis. Patients with subjective dry eye-related complaints (n = 900) attending the clinic for the first time, from 2012 to 2016, were included in the study. At the baseline, patients completed the OSDI questionnaire. Subsequently, objective clinical tests, including fluorescein break-up time (FBUT), Schirmer-I test, ocular surface staining (OSS), and meibomian gland function assessment using gland expressibility and meibum quality were performed. The association between MGD and its severity in relation to symptom severity defined by OSDI-score was examined. MGD was found in 93.8% of the study group. MGD prevalence was not significantly different between groups based on age (p = 0.302) or sex (p = 0.079). There was a significant association between severity of MGD and dry eye-related symptoms (p = 0.014). OSS was significantly higher in patients with severe symptoms (p = 0.031). Sensitivity and specificity of positive symptom-score (OSDI ≥ 13) for disclosing MGD were 85.5% and 30.4%, respectively. MGD was highly prevalent, not associated with age and sex. OSDI ≥ 13 had high sensitivity and high positive predictive value (PPV), but low specificity and negative predictive value (NPV) for disclosing MGD. This underscores the importance of meibomian gland assessment in patients with dry eye-related symptoms.