Singapore National Eye Center

This article showed the data of ocular clinical parameters, tear fluid cytokines, and topical cyclosporine-A 0.1% (Ikervis®) compliance in allogeneic hematopoietic stem cell transplant (allo-HSCT) patients. Study visits were conducted at 3-5 weeks pre-allo-HSCT (screening), pre-allo-HSCT, and 3/6/12 months post-allo-HSCT, with data collected at each time point. At each visit, tear samples were assessed for 96 cytokines by the Proximity Extension Assay O-linked target 96 platform.

To assess the outcomes of surgical management of aqueous misdirection (AM) by endoscopic pars plana vitrectomy with hyaloido-zonulo-iridectomy. In this prospective, longitudinal, noncomparative interventional study, 53 eyes from 46 patients with AM refractory to medical and laser therapy after intraocular surgery were enrolled. All eyes underwent lens removal (if phakic), endoscopic pars plana vitrectomy, and hyaloido-zonulo-iridectomy. Primary outcomes included intraocular pressure (IOP), best-corrected visual acuity (BCVA), anterior chamber depth (ACD), postoperative complications, relapse rate, and composite surgical success. Surgical success was defined as the combination of IOP control and anterior chamber reformation, using two alternative IOP thresholds ( ≥ 6 and ≤18 mmHg, or ≥6 and ≤21 mmHg). Continuous variables were analysed using linear mixed models and expressed as estimated means (est)± standard error. Mean age was 59.7 ± 12.2 years. The est. IOP decreased from 34.36 ± 0.82 mmHg to 17.47 ± 0.82 mmHg at 12 months (p < 0.001). The est. BCVA improved from 1.50 ± 0.07 to 0.70 ± 0.07 logMAR at 12 months (p < 0.001). The est. ACD increased from 0.70 ± 0.06 to 3.34 ± 0.06 mm (p < 0.001), with complete anterior chamber reformation in all eyes. Postoperative complications occurred in 22 eyes (41.8%), mostly transient and resolved with medical or YAG laser treatment; only one required glaucoma surgery. At 12 months, overall success was 98.1% using the ≤21 mmHg criterion and 75.5% using the ≤18 mmHg criterion. No relapses were observed. Surgical management using lens removal, endoscopic anterior vitrectomy, and hyaloido-zonulo-iridectomy is a significantly effective and safe treatment for AM.

PurposePharmacodynamic biomarkers of sirolimus were investigated using omics analysis of tear fluids from Japanese patients with meibomian gland dysfunction (MGD).MethodsIn a Phase 2a trial, sirolimus or vehicle eyedrops were administered twice daily for 12 weeks. Tear samples from 29 patients (15 sirolimus, 14 vehicle) were collected pre- and post-treatment. LC-MS/MS-based proteomics and lipidomics were performed. Within-group changes were analyzed, followed by differential expression and pathway analysis. Key candidates were evaluated using estimation plots (Registration ID: UMIN000049186).ResultsOver 3000 proteins and 55 lipids were quantified. mTOR signaling components (ATP6V1D, RRAGC, DEPTOR) were significantly modulated. ATP6V1D showed a significant decrease in the sirolimus group (p = 0.0024), but not in the vehicle group (p = 0.528). Lipids 12-HETE and 13-HpODE significantly increased post-treatment in the sirolimus group.ConclusionResults suggested that sirolimus inhibited the mTOR pathway. ATP6V1D, 12-HETE, and 13-HpODE were suggested to be pharmacodynamic biomarkers for sirolimus. These findings may facilitate pharmacodynamic monitoring of mTOR-targeted therapies for ocular surface disorders.

To compare the performance and safety of six LLM-based scribing tools in generating ophthalmological clinical notes from simulated physician-patient encounters. This cross-sectional comparative study involved seven ophthalmic encounters, transcribed by six scribing tools (Heidi AI, Whisper GPT-4o, Whisper Gemini 1.5 Pro, i-scribe, Lyrebird, Twofold). Scribing tools were prompted to generate notes using Subjective, Objective, Assessment, and Plan (SOAP) format. Consultant-level ophthalmologists evaluated note quality using the Physician Documentation Quality Instrument (PDQI-9), which evaluates eight dimensions: "accurate", "thorough", "useful", "organized", "comprehensive", "succinct", "synthesized", "internally consistent" on a 5-point scale (with a maximum sum of 40). Text-generation metrics (ROUGE-L, BERTScore, BARTScore, AlignScore) were also used. Safety analysis was conducted to identify documentation errors categorised as omissions, incorrect information, and extraneous content. Heidi AI achieved the highest overall documentation quality (PDQI-9: 38.524, 95%CI: 37.815-39.233), followed by Whisper GPT-4o (38.048, 95%CI: 36.747-39.349). It scored highest in accuracy, usefulness, organisation, comprehensiveness, and succinctness, and led in ROUGE-L (0.326, 95%CI: 0.276-0.374), BERTScore (0.727, 95%CI: 0.707-0.747), and AlignScore (0.704, 95%CI: 0.650-0.758). All tools, however, exhibited errors. The most common were omissions of clinically relevant details, including disease severity, coexisting ocular conditions, systemic comorbidities, and management specifics. Some tools also generated incorrect or extraneous content, such as hallucinated patient requests or incorrect patient names. Among the evaluated LLM based scribing tools, Heidi AI demonstrated the highest performance and shows promise for supporting ophthalmology documentation. However, persistent errors, particularly omissions of critical details, were observed across all tools and could compromise patient care. Human oversight and rigorous verification processes remain essential before clinical integration.

To identify genomic risk factors for diabetic retinopathy (DR), proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), in South Indians. Phenotyping, including optical coherence tomography (OCT), of South Indians (n = 2538) with type 2 diabetes (T2D) was obtained. Genome-wide association studies (GWAS) were performed for DR, PDR, and DME with covariate adjustment. The results were replicated in two cohorts. T2D polygenic risk scores (PRS) were examined to determine if DR cases were enriched for T2D loci. A novel locus on chromosome 10 [rs11199996 (OR = 4.10, P = 2.88 × 10–8)] was associated with PDR, replicated in other cohorts, and is located near genes involved in retinal light transduction and growth hormone signaling. Several near genome-wide significant loci were identified, including rs76323047 in the glucokinase gene (GCK, P = 3.89 × 10–7), a glucose sensor; this risk variant displays higher frequency in Asian populations. T2D PRS showed consistent associations with DR, particularly PDR, suggesting that DR cases have a higher genetic load for T2D. This first DR GWAS in South Indians identified a significant association between a chromosome 10 variant and PDR. We also found notable associations of T2D PRS with DR.

Glaucoma, an irreversible neurodegenerative disorder, can lead to vision loss and blindness. Visual field (VF) tests are crucial for quantifying functional damage in glaucoma, but the tests are time-consuming and the results have high variations, influenced by subjective behaviors and psychological states of patients. Consequently, predicting VF test results using objective, non-invasive, reproducible optical coherence tomography (OCT) data coupled with deep learning modeling is promising in improving clinical care. However, existing methods only focus on predicting single VF indicators, such as threshold sensitivities or deviation maps, and have poor performance in severe glaucoma. Since different VF indicators are correlated, developing a joint prediction model is beneficial. Furthermore, the availability of more VF test data than corresponding OCTs in most datasets poses a challenge in utilizing unpaired VF test data. This study proposes a multi-modal, multi-task learning framework based on OCT data for VF prediction. We introduce a dynamic weighted loss function to improve prediction performance for eyes with severe glaucoma. Additionally, we construct a novel PairMatcher model for augmenting unpaired VF data. Extensive experiments demonstrate that our framework outperforms existing methods, showcasing its potential for VF prediction in glaucoma.