ImportancePattern recognition of pediatric retinal diseases can streamline the workup and guide the prognosis.ObjectiveTo characterize the clinical features, retinal imaging findings, and 1-year prognosis of pediatric patients who experienced sudden, severe bilateral vision loss with diffuse ellipsoid zone (EZ) and external limiting membrane (ELM) disruptions after fever.Design, Setting, and ParticipantsThis

Importance Disparities in eye health are associated with lower-income and minoritized populations, many of whom seek care at federally qualified health centers (FQHCs). Objective To examine the literature addressing vision and eye health care provided at FQHCs, identify barriers to providing care at FQHCs, and highlight recommendations on how FQHCs can decrease disparities in eye health. Evidence Review

ImportanceTumor thickness is a well-established risk factor for malignant transformation of choroidal nevus into melanoma. To date, reliable evaluation of tumor thickness relies on B-scan ultrasonography, which is frequently unavailable at nonsubspecialty clinics where most melanocytic choroidal lesions (MCLs) are first diagnosed.ObjectiveTo describe a technique for potential rapid and reliable estimation

ImportanceThe COVID-19 pandemic has altered health care delivery, including ophthalmic care. Understanding how the pandemic has changed the rates of commonly performed ophthalmic procedures is crucial for assessing the broader implications for patient care and resource allocation.ObjectiveTo estimate the changes in the rates of the 10 most prevalent ophthalmic procedures among Medicare beneficiaries

This case report describes a rapidly growing conjunctival lesion in a 3-year-old patient, which was incompletely resected and diagnosed as rhabdomyosarcoma.

This survey study describes the postprocedure conditions experienced by individuals who received eye screening from the mobile Casey Outreach Program clinics in Oregon.

ImportanceNearly 2% of the US population received a prescription for semaglutide in 2023. There has been a recent concern that this drug and other similar medications may be associated with ophthalmic complications.ObjectiveTo report ophthalmic complications associated with the use of semaglutide or tirzepatide.Design, Setting, and ParticipantsThis was a retrospective case series. All patients were

This Viewpoint examines results from the LIGHTSIDE trials for photobiomodulation to treat age-related macular degeneration and raises questions regarding the trial protocols and the efficacy and safety of the therapy.

ImportanceRandomized clinical trials have shown the safety and efficacy of faricimab as a novel vascular endothelial growth factor and angiopoietin-2 inhibitor in the treatment of neovascular age-related macular degeneration (nAMD) and macular edema of various etiologies. However, more rare adverse events may not be considered in clinical trials.ObjectiveTo describe 3 eyes that developed irreversible

This Viewpoint discusses the ophthalmic device, red light therapy, for myopia treatment in children and adolescents in China, including its development and use, safety concerns, and implications surrounding recent regulatory changes and reclassification of this device.

ImportanceAfter cataract surgery, postoperative residual astigmatism can influence a patient’s visual quality and satisfaction. Finding ways to minimize this astigmatism is important.ObjectiveTo compare the clinical outcomes of femtosecond laser arcuate keratotomy (FSAK) and toric intraocular lens (TIOL) implantation for astigmatism correction in patients undergoing femtosecond laser-assisted cataract

Importance For myopia control to be beneficial, it would be important that the benefit of treatment (slowed eye growth) is not lost because of faster than normal growth (rebound) after discontinuing treatment. Objective To determine whether there is a loss of treatment effect (rebound) after discontinuing soft multifocal contact lenses in children with myopia. Design, Setting, and Participants The

This case report discusses a diagnosis of optic nerve melanocytoma in a woman aged 55 years who presented with progressive painless vision loss over a 7-month period.

ImportanceSome patients worldwide are asked to acquire an anti–vascular endothelial growth factor (anti-VEGF) agent from a pharmacy, store it, and then bring it to a physician for intravitreal injection (IVT). Anti-VEGF agents must be stored in the refrigerator to avoid bacterial contamination or denaturation. Some cases of severe intraocular inflammation have been reported following IVT of more recently

ImportanceA diverse ophthalmic workforce is key to equitable care, and identifying areas of underrepresentation is important in tackling vision care disparities.ObjectiveTo evaluate the diversity of applicants and matriculants in ophthalmology residency programs relative to medical school graduates and analyze the intersection of race and gender within this pathway.Design, Setting, and ParticipantsThis

This case report describes a diagnosis of retinal vasculitis associated with Castleman disease in a man who presented with 6 months of progressive floaters bilaterally and no change in visual acuity.

A 56-year-old woman presents with fever, headache, nausea, and vomiting. Computed tomography scan of the head shows multiple coarse, dystrophic calcifications, and she reports floaters with normal vision. What would you do next?

ImportanceAdditional data are required regarding atropine treatment regimens for control of myopia progression.ObjectiveTo investigate the efficacy and safety of different atropine regimens for myopia in children.Design, Setting, and ParticipantsThis was a secondary analysis of the 3-year results of the 24-Month Myopia Outcome Study of Atropine in Children (MOSAIC) trial, called the MOSAIC2 trial.

ImportanceBietti crystalline dystrophy (BCD) is a severe genetic retinopathy caused by variants in the CYP4V2 gene. Currently, there is no approved treatment for BCD.ObjectiveTo evaluate safety and vision outcomes following gene therapy with adeno-associated virus (AAV) encoding CYP4V2 (rAAV-hCYP4V2, NGGT001 [Next Generation Gene Therapeutics]).Design, Setting, and ParticipantsThis open-label, dose-escalation

A 13-year-old male patient was referred for evaluation of an optic nerve mass with decreased central vision and occasional pain. Examination revealed an afferent pupillary defect, a few vitreous cells, and an optic nerve lesion associated with a small peripapillary hemorrhage, peripapillary subretinal fluid, and scattered white lesions in the inferior retinal periphery. What would you do next?

ImportanceWhile urban counties maintain higher densities of ophthalmologists than rural counties, the geographic distribution of ophthalmic surgical subspecialists has not yet been elucidated. A potential workforce discrepancy may impact the burden of care faced by rural surgeons.ObjectiveTo assess the geographic distribution of the ophthalmic subspecialist surgeon workforce and evaluate factors associated

ImportanceCapturing high-quality images of the entire peripheral retina while minimizing the use of scleral depression could increase the quality of examinations for retinopathy of prematurity (ROP) while reducing neonatal stress.ObjectiveTo evaluate whether an investigational handheld ultra-widefield optical coherence tomography (UWF-OCT) device without scleral depression can be used to document high-quality

ImportanceCommercial mydriatics administered in preterm infants during retinopathy of prematurity (ROP) screening have been associated with various cardiorespiratory and gastrointestinal adverse events.ObjectiveTo examine whether microdrops of a combined mixture of 1.67% phenylephrine and 0.33% tropicamide are noninferior to standard drops regarding mydriatic efficacy at 45, 90, and 120 minutes. The

A 14-year old girl presents with sudden painless vision decline in the left eye for 5 days and reports constant fatigue, occasional dizziness, mild pain in the lower limbs, and intermittent claudication over the past 12 months with no history of trauma, surgery, COVID-19 infection, influenza, or other infection. What would you do next?

A middle-aged Hispanic woman presented for evaluation of an asymptomatic epiretinal membrane in the left eye. She had an ocular history of amblyopia in the left eye, a medical history significant for chronic neuropathy, ataxia, and myelopathy of unknown etiology, and nystagmus on examination. Genetic testing revealed variants in the SACS and SLC5A7 genes. What is your diagnosis?

ImportanceDiabetic retinopathy (DR) is the leading cause of blindness among adults in the US. The US Centers for Disease Control and Prevention recommends annual DR monitoring for all individuals with diabetes, yet monitoring rates remain below 70%.ObjectiveTo evaluate how patient preferences and expectations about DR monitoring are associated with expected monitoring adherence behaviors.Design, Setting

Importance Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON). Objective To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration. Design, Setting, and Participants The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from

This case report describes an outer retinal abnormality associated with taking a RET inhibitor during a clinical trial in a 52-year-old patient with right lung adenocarcinoma and a RET gene fusion.

ImportanceIn-office suprachoroidal viscopexy (SCVEXY) is a relatively new procedure for rhegmatogenous retinal detachment (RRD), but minimal information is available regarding outcomes and safety.ObjectiveTo report outcomes with in-office SCVEXY for primary acute RRD.Design, Setting, and ParticipantsThis retrospective case series was conducted at St Michael’s Hospital in Toronto, Ontario, Canada from

A 75-year-old woman with a history of essential thrombocythemia presented with 3 months of progressively enlarging right upper eyelid lesions. Examination revealed a thickened eyelid margin, madarosis, and erythema with some tenderness to palpation but an otherwise normal ocular examination. What would you do next?

ImportanceDiscrimination in the workforce is a barrier to achieving diversity, equity, and inclusion. A previous study of ophthalmologists in Australia and New Zealand reported high rates of discrimination, but little is known about discrimination among ophthalmologists in the US.ObjectiveTo describe the frequency, nature, and outcomes of discrimination experienced by US ophthalmologists and trainees

ImportanceEmpagliflozin might lower the risk of diabetic retinopathy (DR) by preventing retinal pericyte loss. However, the role of empagliflozin with respect to DR in patients with type 2 diabetes (T2D) remains unclear.ObjectiveTo compare the risk of incident nonproliferative DR (NPDR) and DR progression in patients with T2D initiating empagliflozin vs a dipeptidyl peptidase 4 inhibitor (DPP4i).Design

This case report describes a patient whose autopsy revealed that the posterior choroid of the right eye had a focal eosinophil-rich inflammatory infiltrate with a cross-section of a possible degenerating Strongyloides stercoralis larva and a coiled, incompletely sectioned, filariform larva in a medium-caliber choroidal artery.

ImportanceIndividuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients.ObjectiveTo determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI.Design, Setting, and ParticipantsThis prospective, observational

ImportanceSome eyes with proliferative diabetic retinopathy (PDR) treated to stability with panretinal photocoagulation (PRP) continue to lose vision without diabetic macular edema. One presumed cause is macular capillary nonperfusion (CNP)–associated ischemia or infarction. Natural history data of macular CNP might guide treatment trials for it.ObjectiveTo assess visual function and optical coherence

A 63-year-old woman with a history of type 1 diabetes presents with gradually progressive vision loss in the right eye for the past year. What would you do next?

ImportanceEarly detection of glaucoma is essential to timely monitoring and treatment, and primary open-angle glaucoma risk can be assessed by measuring intraocular pressure (IOP) or optic nerve head vertical cup-disc ratio (VCDR). Polygenic risk scores (PRSs) could provide a link between genetic effects estimated from genome-wide association studies (GWASs) and clinical applications to provide estimates

This case report describes a diagnosis of iatrogenic fluorescein dosing error in a girl aged 10 months who presented for routine fluorescein angiography examination in the setting of incontinentia pigmenti.

Importance Primary open-angle glaucoma (POAG) polygenic risk scores (PRSs) continue to be evaluated in primarily European-ancestry populations despite higher prevalence and worse outcomes in African-ancestry populations. Objective To evaluate how established POAG PRSs perform in African-ancestry samples from the Genetics in Glaucoma Patients of African Descent (GIGA), Genetics of Glaucoma in Individuals