Glaucoma, a leading cause of irreversible blindness, is primarily managed by lowering intraocular pressure, yet treatment remains limited by poor adherence, ocular surface toxicity, and systemic adverse effects. This review focuses specifically on treatment simplification strategies in topical glaucoma therapy, exploring the paradigm shift towards a "Less is better" approach in glaucoma care, with particular emphasis on the use of preservative -free formulations, lower active ingredient concentrations, and fixed combinations. These approaches aim to improve treatment tolerability, adherence, and clinical outcomes while minimizing toxicity, complexity, and environmental burden. Although barriers such as higher costs and limited long-term data remain, this new approach represents a patient-centred, sustainable, and clinically effective model for the future of glaucoma management.

PurposePregnancy induces hormonal changes that can affect various organ systems, including ocular structures. This study aimed to evaluate changes in anterior segment (AS) parameters, higher-order aberrations (HOAs), and aqueous humour (AH) optical density (OD) in pregnant women compared to healthy controls.MethodsThis prospective case-control study included 45 healthy pregnant women and 47 age-matched non-pregnant controls. Comprehensive ophthalmological examinations were performed, including best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent, axial length, central corneal thickness, corneal volume, corneal curvature (K1, K2, Km), AS parameters, and endothelial cell metrics. HOAs (coma, trefoil, spherical aberration) and AH OD were also assessed. Ocular surface evaluations included the OSDI questionnaire, Schirmer test and tear break-up time. Pregnant participants were assessed in each trimester and three months postpartum, with comparisons conducted both cross-sectionally against healthy controls and longitudinally within the pregnancy cohort across trimesters and postpartum.ResultsRMS-HOA was higher in the third trimester (0.41 ± 0.19 µm, p = 0.003) and postpartum (0.39 ± 0.31 µm, p = 0.041). RMS-total increased in the second (1.64 ± 0.21 µm, p = 0.031) and third trimesters (1.63 ± 0.46 µm, p = 0.022). Coma was higher in the second (1.64 ± 0.34 µm, p = 0.045) and third trimesters (1.61 ± 0.29 µm, p = 0.040), and trefoil increased in the third trimester (1.50 ± 0.35 µm, p = 0.027). AH OD was higher than in controls at every time point, measuring 4.74 ± 0.41% in the first trimester (p = 0.007), 4.81 ± 0.50% in the second (p = 0.001), 4.96 ± 0.42% in the third (p = 0.001), and 4.79 ± 0.46% postpartum (p = 0.020). BCVA was unchanged.ConclusionIn pregnancy, small increases in HOAs and AH OD are typically subclinical and reflect physiological change rather than pathology.

BackgroundOptic disc melanocytoma is a rare, typically benign pigmented tumor that may occasionally lead to vision loss or tumor enlargement. Despite its usually indolent nature, the clinical behavior and risk factors associated with progression remain incompletely defined.MethodsA retrospective cohort study was conducted involving 21 patients diagnosed with optic disc melanocytoma at Sheba Medical Center, Israel, between 2009 and 2024. Data were collected on demographics, presenting symptoms, imaging characteristics, and visual outcomes. Tumor features were analyzed using fundus photography, optical coherence tomography (OCT), and B-scan ultrasonography. Statistical tests were performed to explore associations between tumor behavior and clinical variables.ResultsThe cohort had a mean age of 60.1 years; Fourteen (66.7%) were female. Most tumors appeared flat and were located inferiorly or nasally. Over a mean follow-up of 64 months, five (23.8%) patients exhibited measurable tumor growth, with one case (4.7%) resulting in severe visual decline. Vision loss of two or more Snellen lines was significantly associated with floaters at presentation (p = 0.04), optic disc edema (p = 0.002), and pigmented vitreous seeds (p = 0.04). No significant associations were found with demographic or iris pigmentation variables.ConclusionWhile optic disc melanocytoma typically follows a benign course, certain clinical features-such as floaters, disc edema, and vitreous seeding-may indicate a higher risk for tumor progression and vision loss. These findings highlight the importance of targeted surveillance strategies in patients presenting with these features to facilitate early detection and optimized management.

PurposeTo investigate the association between age-related macular degeneration (AMD), retinal artery occlusion (RAO), and retinal vein occlusion (RVO) and the future development of Alzheimer's disease (AD), vascular dementia (VaD), and all-cause dementia (ACD).MethodsRetrospective propensity score-matched cohort study using TriNetX, a confederated healthcare network. The study population included 91,296 AMD, 15,372 RAO, 35,862 RVO, and 3,076,291 population control (PC) patients aged 65 and older. Propensity score matching was applied to control for baseline demographics and health characteristics. The primary outcome was the measured risk of developing AD, VaD, and ACD following incident diagnosis of AMD, RAO, or RVO.Major FindingsAMD was associated with a significantly elevated risk of AD (HR, 1.25; 95% CI, 1.17-1.34; P < 0.001), VaD (HR, 1.20; 95% CI, 1.11-1.31; P < 0.001), and ACD (HR, 1.12; 95% CI, 1.08-1.16; P < 0.001) following diagnosis with an average follow up of 45.0 ± 36.7 months. RVO patients also displayed higher risks across all dementia types (AD: HR, 1.46; 95% CI, 1.22-1.74; P < 0.001; VaD: HR, 1.51; 95% CI, 1.23-1.87; P < 0.001; ACD: HR, 1.34; 95% CI, 1.22-1.47; P < 0.001) with an average follow up of 46.6 ± 37.9 months.ConclusionsRetinal disease diagnoses may correlate with increased dementia risk. While AMD and RVO are associated with all dementias (AD, VaD, and ACD), RAO did not increase dementia risk.

Purpose Anterior Segment Dysgenesis (ASD) encompasses a heterogeneous group of congenital ocular malformations resulting from disrupted differentiation of neural crest–derived tissues. These disorders frequently lead to developmental glaucoma, a major cause of childhood blindness. This review summarizes the current clinical, genetic, and management perspectives on ASD associated with glaucoma. Methods A comprehensive literature search of PubMed, Scopus, and Web of Science (January 2000–August 2025) identified 186 relevant studies reporting clinical, molecular, and therapeutic findings. Data were synthesized across major ASD subtypes: aniridia, Axenfeld–Rieger anomaly, Peters anomaly, primary aphakia, and related entities. Results Mutations in key transcriptional and structural genes—including PAX6, FOXC1, PITX2, CYP1B1, LTBP2, PXDN, and GJA8 —account for the majority of ASD cases. Novel associations involving CPAMD8, JAG1, and ADAMTS18 have broadened the known genetic spectrum. Genotype–phenotype correlations explain the variability in glaucoma onset and treatment response among subtypes. Modern diagnostic strategies integrating anterior segment imaging with next-generation sequencing have improved early detection and prognostic accuracy. Management requires individualized surgical and medical approaches based on the underlying genetic mechanism. Conclusion ASD-associated glaucoma exemplifies the interface between developmental genetics and clinical ophthalmology. Understanding gene-specific mechanisms aids precision diagnosis, risk stratification, and multidisciplinary care. Continued advances in molecular diagnostics and targeted therapies promise to transform outcomes for children with congenital anterior segment anomalies. Collaborative registries and functional genomics will be pivotal in translating molecular discoveries into targeted therapies and improved lifelong vision outcomes.

PurposeTo assess the long-term stability of the color and pattern of corneal tattooing by dermal ink, designed to mimic the iris of the normal eye.MethodsA retrospective study was performed, recruiting cases with minimum follow-up of 10 years. Patients were examined and subjected to a questionnaire assessing satisfaction. The initial procedure was selected for patients with disfiguring corneal opacity with no hope for vision and a normal fellow eye. The punctures were performed by passing a spatulated needle tip through a drop of colored dermal ink on the corneal surface, targeting the superficial one-third of the cornea. When indicated, re-shaping of corneal contour was performed to improve the angle of exotropia or normalize the corneal diameter in microcornea and macrocornea.ResultsFifty patients were enrolled; 24 males (48%) and 26 females (52%). Mean age was 25.43 ± 13.55 years (4-62 years). Mean follow up was 10.50 ± 0.62 years. Most patients (38, 72%) needed two sessions, 6 (12%) needed one session and 6 (12%) needed 3 sessions. Thirteen cases had preoperative exotropia (XT) of 14.5 ± 3.5 PD, 11 of which (84.6%) had successful nasal shift of the corneal circumference to correct the XT. The satisfaction score was 5/5 in 42 patients (84%), 4/5 in 7 patients (14%), and 2/5 in one patient (2%). No aggressive early/late postoperative reactions were reported.ConclusionCorneal tattooing by micropuncture with dermal ink is a well-tolerated technique with high patient satisfaction up to 10 years after surgery. One session is generally insufficient.

BackgroundTo present our results using a novel "flapless" trocar-assisted intrascleral fixation technique for Carlevale intraocular lens (IOL) Implantation without conjunctival opening.MethodsRetrospective, non-comparative study of consecutive patients undergoing this technique. Patients older than 18 years who had at least two years post-operative follow-up were included.Results61 eyes of 61 consecutive patients were included in the analysis. The study sample included 55.74% males with a median age of 76 years (interquartile range (IQR): 67-82 years). The mean follow-up period was 48.9 months (SD ± 14.38) and the range was between 26 and 76 months. A statistically significant difference was observed between the median pre-operative visual acuity value (1.8LogMAR, IQR: 1.0-1.8) and the median postoperative value visual acuity (0.05 LogMAR, IQR: 0.0-0.1). No intraoperative complications occurred and, the Carlevale IOL was well centered in all cases. No haptic exposure was observed during the follow-up period.ConclusionThe results of our study demonstrate that the proposed technique is a simplified, safe and effective surgical approach for placement of the Carlevale IOL. Further studies are needed to validate our data and explore the results of a longer follow-up.