ABSTRACT Purpose Eyelid trauma often necessitates surgical intervention, yet remains understudied, with postoperative complications poorly described. This study aims to identify factors associated with complications following surgical treatment of traumatic eyelid injuries. Methods A retrospective non-concurrent cohort study was conducted to analyze complications in patients undergoing surgical repair of eyelid injuries at two ophthalmology centers in Cali, Colombia, from January 2017 to December 2021. Factors associated with postoperative complications were identified using multivariable logistic regression clustered by care site. Results A total of 365 patients underwent surgical intervention for eyelid traumas; with a mean age of 31±18 years. Most cases were covered by public insurance (58.1%) or employer-sponsored insurance (12.1%). Unintentional injuries comprised 60.6%; while intentional injuries accounted for 37%, primarily due to interpersonal violence (36.7%). The postoperative complication rate was 11%, including impaired healing (3.29%), tearing (3.29%), surgical site infection (2.74%), stent extrusion (1.10%), lagophthalmos (0.55%), and eyelid malposition (0.82%). Multivariable analysis showed that female sex (Odds ratio [OR]=3.00, 95% Confidence Interval [95%CI]=2.93–3.06), presence of fractures (OR=2.01, 95%CI=1.5–2.7), anterior segment damage (OR=2.29, 95%CI=1.83–2.86), and greater tissue loss (25–49%: OR=2.55, 95%CI=2.17–2.99; ≥50%: OR=1.41, 95%CI=1.09–1.81) were associated withhigher odds of postoperative complications. Conclusion Postoperative complication were associated with palpebral tissue loss, involvement of both upper and lower eyelid, orbital fractures, and anterior segment injuries. Future studies should use prospective designs with standardize follow-up after reconstruction.

ABSTRACT Purpose To evaluate associations between social determinants of health (SDOH) and treatment rates among patients with exudative age-related macular degeneration (exAMD). Methods Retrospective cohort study of patients with exAMD utilizing data from the NIH All of Us Research Program. The primary outcome was annual rate of intravitreal injections abstracted from the EHR. Negative binomial regression was used to assess associations between the treatment rate and individual SDOH constructs developed from survey responses among other sociodemographic factors, adjusting for bilateral disease status and follow-up duration. An exploratory factor analysis (EFA) of all SDOH constructs was performed to identify potential latent constructs associated with the primary outcome. Results Among sociodemographic factors, Black individuals had significantly lower injection rates (IRR: 0.32, 95% CI: 0.13–0.79) compared to White individuals. When correcting for multiple comparisons, among the SDOH constructs, there were none that were significantly associated with treatment rate. Within the exploratory factor analysis, a factor identified by poor English proficiency, transportation difficulty, rural care access issues, worse health literacy, and provider concordance issues was associated with a significantly decreased rate of treatment (IRR: 0.73, 95% CI: 0.55–0.96), as well as a factor identified by high neighborhood disorder, high loneliness, high perceived health care and everyday discrimination, and high stress (IRR: 0.74, 95% CI: 0.60–0.92). Conclusions This study identifies significant racial disparities and SDOH constructs associated with exAMD treatment rates. These findings underscore the complexity of sociodemographic influences on treatment and suggest potential inequities which warrant additional study.

ABSTRACT Purpose Optic disc hemorrhages (DH) are one of the hallmark signs of primary open-angle glaucoma (POAG). However, due to the scarcity of longitudinal reports, the influence of baseline DH on the progression of POAG and its subtype, normal tension glaucoma (NTG), remains unclear. We conducted a systematic review with meta-analysis to determine the association of baseline DH with progression of POAG and NTG. Methods PubMed, Embase, Cochrane, SCOPUS, and Web of Science were searched from inception till July 1, 2025. POAG and NTG progressions were defined based on functional or structural changes. Following the PRISMA guidelines and a PROSPERO-registered protocol (CRD42021292572), two authors selected observational studies reporting glaucomatous progression in patients aged 18 years and above. We performed random-effects meta-analysis to estimate the pooled odds ratio (OR) for the association between baseline DH and progression of POAG and NTG. Additionally, we also performed a qualitative analysis for data on the location of DH and its association with visual field deterioration. Results We included 22 papers comprising seven prospective cohort studies and 15 retrospective cohort studies. Baseline DH was associated with the progression of POAG (OR = 4.51; 95% CI (confidence interval) = 3.24 to 6.26; I2 = 44.2%) and NTG (OR = 5.15; 95% CI = 3.72–7.14; I2 = 29%). DH were most commonly observed inferotemporally, with a topological association between the location of DH and the site of visual field deterioration. Conclusion DH is an important predictor for POAG progression, particularly for NTG. The presence of baseline DH in POAG patients may warrant closer monitoring of retinal nerve fibre layer thinning and visual field loss.

ABSTRACT Purpose To investigate the key features of electronic device use in the AACE (acute acquired concomitant esotropia) population and compare them with those in normal and other strabismus populations, while further exploring the pathogenesis of AACE. Methods A case-control study was conducted on patients admitted to the strabismus department of our hospital from March 2023 to March 2024. The cohort comprised 48 acute acquired concomitant esotropia (AACE) patients, 55 intermittent exotropia (IXT) patients, and 48 healthy controls. Their refractive status and strabismus histories were documented. Additionally, a multiple logistic regression analysis was performed using a questionnaire on electronic device usage to identify the risk factors for AACE. Results Regardless of adjustments, patients in the AACE group used digital devices for 7.74 ± 4.33 hours per day, significantly longer than those in the IXT and normal groups (p < 0.001). Multivariate logistic regression analysis revealed that long-term use of electronic devices was a risk factor for AACE (OR, 1.28; 95% CI, 1.09,1.49; p < 0.001). Among the 48 patients with AACE, 29 (63.04%) engaged in near-vision tasks without refractive correction, which was significantly higher than in the other two groups, and the difference was statistically significant (p = 0.005). Conclusion Prolonged and excessive use of electronics serves as a risk factor for acute acquired concomitant esotropia. This finding provides valuable information for clinicians on how to prevent AACE in daily life, such as minimizing electronic device use and wearing prescription glasses when engaging in near-vision tasks.

ABSTRACT Objective: To screen influencing factors of dry eye and evaluate a new diagnosis and treatment model combining tertiary hospitals with community health management. Methods: A total of 500 community residents from two Chinese hospitals between January – September, 2023 were included. Dry eye was diagnosed based on the presence of typical symptoms, an OSDI score > 13, a tear film break-up time (BUT) < 10 seconds, and/or a Schirmer I test (SIT) result < 10 mm/5 min, following the 2020 Chinese Dry Eye Expert Consensus. Diagnosed patients were randomized into a management group (community health management) and a control group (self-management). Both received standardized hospital treatment for six months. Disease cognition, symptom improvement, psychological state, eye comfort, satisfaction, and quality of life were compared. Results: Dry eye prevalence was 26.40% (132/500). Univariate analysis identified age, sex, drug use, connective tissue disease, laser corneal surgery, vitamin A deficiency, hepatitis C, mite infection, anxiety, depression, sleep disorder, and diabetes as influencing factors (p < 0.05). After six months, the management group showed better disease cognition, improved BUT and SIT, and lower OSDI scores than the control group (p < 0.05). SAS and SDS scores were lower, and VAS scores were reduced, while GQLI and management satisfaction were higher (p < 0.05). Conclusion: Factors such as drug use, laser surgery, vitamin A deficiency, hepatitis C, mite infection, and psychological and metabolic conditions influence dry eye. A combined hospital-community management model improves symptoms, psychological well-being, disease awareness, quality of life, and treatment satisfaction.

ABSTRACT Purpose A knowledge gap persists regarding the utilization of corneal transplant surgery among enrollees in Affordable Care Act (ACA) plans and the factors influencing associated costs and complications post-ACA implementation. This study investigates the demographics, costs, and complications of cornea transplant for patients insured under the ACA from 2015 to 2019. Methods A novel claims dataset of Affordable Care Act (ACA) marketplace plan subscribers was utilized. Multivariable logistic and linear regression models were used to assess demographics, cost, and complication rates of corneal transplant using demographic/clinical data and insurance plan type. Results Among 26,997,610 enrollees, 0.005% (n = 1266) underwent cornea transplant. About 32.9% (n = 416) of patients experienced a postoperative complication, the most common being corneal transplant failure (15.6%) and infectious keratitis (11.5%). Insurance plan type was not associated with rate of postoperative complications (p = 0.87). Patients with different plan types incurred significantly different out-of-pocket (OOP) cost (p < 0.001), with patients on Silver cost-sharing reduction plans paying the lowest ($4). Conclusion This study is the first to assess the demographics, costs, and complications of corneal transplant patients within the ACA population. Our findings suggest that patients with higher cost-sharing subsidies experience lower OOP costs and may be more inclined to pursue corneal transplant than those on lower actuarial value plans.

ABSTRACT Purpose To determine the magnitude and temporal trends of the prevalence of blindness and vision impairment (VI) in East Asia from 1990 to 2020. Methods A systematic review and meta-analysis of population-based studies was performed to estimate the prevalence and affected population of blindness (presenting visual acuity < 3/60 in the better eyes), moderate-to-severe vision impairment (MSVI; 3/60≤ presenting visual acuity < 6/18), mild VI (6/18≤ presenting visual acuity < 6/12) and near VI due to uncorrected presbyopia (presenting near vision <N6 or N8 at 40 cm) for 1990, 2000, 2010 and 2020. A total of 74 studies were included. Results In 2020, East Asia’s age-standardized prevalence of blindness, MSVI, mild VI and near VI due to uncorrected presbyopia was 0.47% (95% uncertainty interval [UI], 0.41% to 0.52%), 2.77% (95% UI, 2.49% to 3.07%), 3.41% (95% UI, 3.06% to 3.78%), 7.38% (95% UI, 5.32% to 9.70%), with a higher prevalence in females compared to males. East Asians had lower prevalence of blindness and MSVI than the world population. Despite the decrease (27.7% for males and 27.1% for females) in age-standardized blindness prevalence in East Asia, the number of people with blindness and MSVI has increased from 7.0 to 9.1 million and 30.8 to 53.9 million from 2000 to 2020. Conclusions While age-standardized blindness rates have declined in the past two decades, yet the number of people affected by blindness and MSVI continues to rise, indicating unmet eye care demands in East Asia amid population growth and aging.

ABSTRACT Purpose To characterize differences in identification of diabetic retinopathy examinations using administrative claims and electronic health record data. Methods Adult patients ≥18 years with diabetes seen in the ophthalmology department at Johns Hopkins Hospital were included. Two methodologies were used to identify diabetic retinopathy examinations across the hospital system. First, a pre-specified set of Current Procedural Terminology (CPT) codes from administrative claims data were used. Second, natural language processing (NLP) was used to parse ophthalmology provider notes for mention of diabetic retinopathy screening or follow-up. The percentage of visits meeting each set of criteria was determined. Cohen’s kappa of agreement between the two methodologies was calculated. Results A total of 59,538 patients and 1,926,828 office visits, of which 485,228 (25%) were in the ophthalmology department, were included. Most patients (86%) had at least one diabetic retinopathy examination identified using administrative codes, and 84% using the NLP-based methodology. Of all ophthalmology visits, administrative codes identified more diabetic retinopathy examinations compared to the NLP-based methodology (60%, versus 48%). Cohen’s kappa for agreement was 0.57 (standard error 0.001, p < 0.001). Conclusion This study found only moderate agreement between the two methodologies for identifying diabetic retinopathy examinations. Given the imprecision of administrative codes, this suggests that prior studies reporting eye care utilization using only administrative claims may be over-estimating receipt of diabetic retinopathy examinations.

ABSTRACT Purpose We sought to determine the prevalence of strabismus and the esotropia/exotropia ratio in Down syndrome. Wide ranges of an increased strabismus prevalence have been reported and it is unclear by how much esotropia exceeds exotropia in people with Down syndrome. Methods We compiled in a systematic review and meta-analysis results of over 100 studies that report the strabismus prevalence and ratio of esotropia/exotropia in cohorts of Down syndrome. We calculated the pooled global prevalence and established the geographical distribution of the strabismus prevalence and the esotropia/exotropia ratio. Results The ethnically-adjusted global prevalence of strabismus in Down syndrome is 30.2%. In subjects 15 years and older, the global prevalence is 53.2%, and the lifetime prevalence is 51.0%. In populations which normally have more esotropia than exotropia (e.g. Caucasians), Down syndrome subjects have a further increased bias towards esotropia. In populations which normally have more exotropia (e.g. West Africans, Asians and Hispanics), Down syndrome subjects have a significantly lower esotropia/exotropia ratio (3.21) than reported in Caucasians with Down syndrome (9.98). Conclusion Worldwide, about 1.81 million people with Down syndrome have strabismus: 1.42 million of them have esotropia, and 0.37 million have exotropia. Differences in the esotropia/exotropia ratio between ethnicities point to the orbital anatomy as a major contributing factor to the etiology of strabismus in Down syndrome. The narrow-set eyes (reduced orbital width) in Down syndrome favor esotropia over exotropia, especially in Caucasians, thus explaining why Down syndrome patients from different ethnicities have different prevalences of esotropia and exotropia.

ABSTRACT Purpose : Previous studies have shown a conflicting association between body mass index and myopia. This study aimed to analyze the possible association between Body Mass Index (BMI) and myopia in the observational design and genetic evidence. Methods : In the observational investigation, 5,710 participants (12–25 years) from the 2001–2006 National Health and Nutrition Examination Survey (NHANES) were included. Weighted logistic regression models, restricted cubic spline (RCS) and stratified analysis were conducted in the NHANES. A two-sample Mendelian Randomization (MR) study using Genome-Wide Association Studies (GWAS) summary statistics and GWAS catalog was performed. The inverse-variance weighted (IVW) method was used as the main analysis method, and the sensitivity analysis was performed to detect pleiotropy and heterogeneity bias. Results : In the fully adjusted model, individuals with obesity had a higher risk of myopia [OR = 1.253, 95% CI= (1.049, 1.496), p = 0.014] and mild and moderate myopia [OR = 1.305, 95% CI= (1.094, 1.558), p = 0.004]. BMI was correlated with refractive spherical equivalent and showed a linear relationship (P for nonlinearity = 0.468, p = 0.002,β=-0.016). In males, obesity had an association with myopia, while there was no statistical significance in females. In the subgroup with an education level of < 9th Grade, obesity and myopia exhibited consistent results. Two-sample MR showed that obesity had no statistically significant with myopia and refractive error. Conclusions : This study suggests that the associations between BMI and the risk of myopia differ based on gender and education levels in an observational study, while there are no associations in genetic evidence.