You might be interested in…Ophthalmology

Glaucoma is the leading cause of irreversible blindness worldwide and, in the US, disproportionately affects people from racial and ethnic minority groups. Glaucoma prevalence has not been estimated for the US in more than a decade.

The objective of this meta-analysis1 was to estimate glaucoma and vision-affecting glaucoma prevalence by demographic factors and US state and county for the Centres for Disease Control and Prevention’s Vision and Eye Health Surveillance System. PubMed was searched for population-based studies of glaucoma prevalence published between 1991 and 2016.

The results were that for 2022, an estimated 4.22 million people in the US were living with glaucoma, with a prevalence of 1.62 per cent among people 18 years or older and 2.56 per cent among people 40 years or older. An estimated 1.49 million people were living with vision-affecting glaucoma, with a prevalence of 0.57 per cent among people 18 years or older and 0.91 per cent among people 40 years or older.

Dr Ray O’Connor

It was found also that African-American individuals were disproportionately affected.

The aim of this retrospective, nationwide, population-based cohort study2 was to investigate the association between long-term exposure to ambient air pollution and the risk of primary open-angle glaucoma (POAG). The study included 590,338 individuals aged 20 years and older who had no prior diagnosis of glaucoma and at least 10 years of air pollution exposure data.

Seven air pollutants were examined: sulphur dioxide, carbon monoxide, particles less than 10 micrometers in diameter, particles less than 2.5 micrometers in diameter, nitrogen oxides, nitrogen monoxide, and nitrogen dioxide. The authors utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan.

Participants were followed from January 1, 2000, to December 31, 2013. Air pollution data were linked to patients’ residential postal codes recorded in insurance registration records. The cumulative daily average level of each pollutant was calculated for each participant over the 10-year exposure period.

During the follow-up period, 3,158 patients with POAG were identified (0.53 per cent incidence). A 1-standard-deviation increase in the 10-year average pollutant level was associated with a significant increase in POAG risk, ranging from 40 per cent to 108 per cent.

This association was consistently observed across pollutants, with the highest risk linked to carbon monoxide exposure. The authors’ conclusion is that long-term exposure to air pollution is significantly associated with an increased risk of POAG. The authors call for further research and public health interventions to mitigate this risk, particularly in regions with high pollution levels.

This review3 highlights treatment options, both under investigation and currently available, for the treatment of dry age-related macular degeneration (AMD). Advanced dry AMD, characterized by geographic atrophy (GA), is a leading cause of blindness in the developed world, though prior to 2023 there was no approved treatment.

There are now two approved treatments in the United States for GA. These drugs target the complement cascade and stop it from attacking the retina and have recently been approved by the FDA. They are Pegcetacoplan and avacincaptad pegol. Like currently available treatments for wet AMD, these drugs are injected directly into the patient’s eye. While they have been shown to slow the development of geographic atrophy by up to 20 per cent, they do not improve vision. These drugs can also cause side effects or complications ranging from mild to severe.

Finally, the authors also describe how there are several studies and trials to investigate therapeutic potential and effects of therapies for earlier intervention in dry AMD. Approaches to therapy include inhibiting the complement system, utilizing gene therapy, stem cell therapy, laser therapy, and surgical implants.

Neuro‑ophthalmology is a medical specialty that combines ophthalmology and neurology to diagnose and treat vision problems related to the nervous system. It has evolved considerably as a specialty in the recent past due to the availability of newer diagnostic and therapeutic modalities. This review article4 discusses some of the recent advances of clinical relevance.

The authors describe how, among the most significant advancements is the rise of optical coherence tomography (OCT), now recognized as an indispensable tool in neuro-ophthalmological research, providing unparalleled insights into optic nerve and central nervous system pathologies.

Gene therapy, marks a new frontier in personalized medicine, offering hope for previously untreatable conditions. The article also examines the transformative role of telemedicine and artificial intelligence (AI) in clinical practice, which are revolutionizing patient care and enhancing diagnostic precision.

Furthermore, it highlights the impact of novel serological biomarkers on the understanding and management of immune-mediated optic neuritis and discusses the introduction of new therapeutic agents like Tocilizumab and Teprotumumab, which are redefining treatment paradigms.

The term ‘foundation model’ was coined in 2021 by researchers at the Stanford University Institute for Human-Centred AI. It describes a large AI model trained on vast quantities of diverse data, which can then be adapted to a wide range of downstream tasks. The authors of this review paper5 discuss how ophthalmology as a specialty has the potential to act as an exemplar for other medical specialties, offering a blueprint for integrating foundation models broadly into clinical practice. The review serves as a roadmap for eyecare professionals seeking to better understand foundation models.

The authors outline the key concepts and technological advances which have enabled the development of these models, providing an overview of novel training approaches and modern AI architectures. They also summarise existing literature on the topic of foundation models in ophthalmology and discuss major challenges relating to privacy, bias and clinical validation.

References:

1. Ehrlich J et al. Prevalence of Glaucoma Among US Adults in 2022. JAMA Ophthalmol 2024 Nov 1;142(11):1046-1053. DOI: 10.1001/jamaophthalmol.2024.3884.
2. Chuang S et al. Association Between Long-Term Ambient Air Pollution and Primary Open-Angle Glaucoma: A Nationwide Cohort Study in Taiwan. Am J Ophthalmol 2025 Sep:277:441-450. DOI: 10.1016/j.ajo.2025.05.031. Epub 2025 May 31.
3. Wheeler S et al. Treatment for dry age-related macular degeneration: where we stand in 2024. Curr Opin Ophthalmol 2024 Sep 1;35(5):359-364. DOI:10.1097/ICU.0000000000001064.     Epub 2024 Jun 13.
4. Bassi S et al. Review Article. Recent advances in neuro‑ ndian J Ophthalmol 2024;72:1544-59.
5. Chia MA et al. Foundation models in ophthalmology. Chia MA, et al. Br J Ophthalmol 2024;0:1–8. DOI:10.1136/bjo-2024-325459.