In this week’s issue

• Adverse events after corneal transplantation continue to decline, reflecting improvements in surgical techniques and eye banking.
• Eyes undergoing early congenital cataract surgery show progressive, long-term myopic shift over time.
• OCT-based telemedicine shows strong agreement with in-person care for managing idiopathic intracranial hypertension.

Ophthalmology

The natural course of vitreous hemorrhage due to PVD

To wait or to operate? Only time will tell. Vitreous hemorrhage (VH), often caused by posterior vitreous detachment (PVD), typically presents with sudden, painless vision loss. VH can complicate diagnosis and treatment of PVD, but its natural course is not well understood. Limited research has created uncertainty in choosing between observation and or surgical management, especially with an obscured fundus view. To better characterize the natural course of VH due to PVD, this retrospective study analyzed 366 patients with first-episode of presumed PVD-related VH, who were followed for at least two years. The main outcome measures were rates of spontaneous clearance, development of rhegmatogenous retinal detachment (RRD), vitrectomy for persistent VH, or referral to a medical retina service. VH cleared spontaneously in 62% of eyes, often taking several months. RRD developed in 17% of cases with most occurring within the first three weeks. Male sex significantly increased the risk of RRD (HR 2.90), whereas older age was associated with a lower risk (HR 0.27). Ten percent of patients ultimately required vitrectomy for nonclearing VH. Overall, most cases of VH due to PVD resolve without surgery; however, careful monitoring for retinal detachment in the first month is essential. Higher risk patients, particularly younger men, should have close follow-up and may benefit from early vitrectomy.

JAMA Ophthalmology 

Are academic ophthalmologists being paid fairly?

Equal work but not always equal pay. Gender pay gaps exist across medicine, but trends in ophthalmology are less well defined. Understanding these differences is critical for trainees entering academic careers, where compensation, promotion, and representation may be influenced by systemic factors. This retrospective analysis used data from the AAMC Faculty Salary Survey (2016-2024), including ~1,470 US academic ophthalmologists annually. Salary compensation was compared by rank and gender, and trends were analyzed over time relative to inflation, with projections estimating when pay equity might be achieved. Women consistently earned less than men at every rank across all years. In 2024, women earned $0.91 per dollar at assistant professor and chair levels and $0.85 per dollar at associate professor and professor levels, equating to an estimated $1.04 million career earnings gap. While trends suggest lower-rank parity may be achievable with time, gender pay equity at the professor and chair levels appears unlikely under current trajectories. These findings underscore persistent compensation disparities in academic ophthalmology and highlight the need for structural reforms to ensure equitable pay and career advancement at all levels.

American Journal of Ophthalmology (AJO)

Safety trends in corneal transplants over 17 years

The odds are looking better, year over year. Corneal transplantation is the most commonly performed tissue transplant procedure in the United States. Corneal tissue is closely monitored and regulated for donor tissue safety and suitability. This longitudinal retrospective study analyzed 126,072 donor tissues from a U.S. eye bank between May 2007 and December 2024 to evaluate the current rates and trends of tissue-related adverse events (AEs) from transplant procedures. A total of 176 tissue-related AEs were identified during the 17-year period, corresponding to a prevalence of 0.14%, and a consistent year-over-year reduction of 6.7%. Although AE rates improved across DSAEK (7.4%), DMEK (13.3%), and PKP (9.0%), DSAEK and DMEK had significantly higher odds of AEs than PKP. Rates of infectious keratitis (OR: 0.91) and primary graft failure (OR: 0.90) also significantly improved yearly, while endophthalmitis rates remained unchanged. Corneal transplantation continues to become safer with improved processing techniques, such as pre-cut or preloaded grafts, and standardized eye bank processing.

British Journal of Ophthalmology

Refractive error change after congenital cataract surgery in infancy

Early surgery is only the beginning of a long refractive journey. Predicting refractive outcomes after congenital cataract surgery remains a challenge due to ongoing ocular development and variability in postoperative myopic shift. In this multicenter, retrospective, longitudinal study, 219 eyes from 124 patients who underwent cataract surgery within the first 6 months of life were followed for a mean of 13.6 years, with serial refractions from the early postoperative period through adolescence. Postoperative refractive change in aphakic and pseudophakic eyes both followed an exponential pattern, with a rapid early myopic shift that gradually slowed but persisted for over a decade. When plotted against the logarithm of time, refractive change showed a strong linear relationship (r=-0.98 for aphakia, r=-0.89 for pseudophakia), supporting an exponential model of ocular growth. By final follow-up, bilateral cases demonstrated substantial myopic shifts (median -8.4 D in aphakia and -11.5 D in pseudophakia), while unilateral cases developed significant anisometropia. Myopic progression was generally greater in pseudophakic eyes, particularly in bilateral cases. These findings highlight that refractive change after infantile cataract surgery follows a predictable exponential trajectory, with clinically meaningful progression continuing into adolescence, underscoring the importance of long-term refractive planning and follow-up.

Eye
Management of IIH using an OCT-based telemedicine model

Can OCT-based telemedicine lighten the follow-up burden for IIH? Idiopathic intracranial hypertension (IIH) requires long-term neuro-ophthalmic follow-up, but access to specialists is often limited. IIH is a strong candidate for telemedicine, as disease monitoring relies heavily on objective data such as OCT retinal nerve fibre layer (RNFL) measurements and visual fields. In this prospective cohort study, treatment recommendations from simulated remote consults based on clinical history, OCT RNFL, and Humphrey visual field data were compared to those made during in-person clinic visits for established IIH patients. In 62 IIH follow-up visits, OCT-based telemedicine recommendations agreed with in-person clinic decisions 87% of the time (κ=0.763). Disagreement was more likely for large OCT RNFL changes (≥10 μm) or enlarged blind spots on visual field testing. Stable patients not receiving intracranial pressure lowering medication were more likely to have matching decisions across both visit types. In conclusion, OCT-based telemedicine appears most promising for routine follow-up of clinically stable IIH, while patients with active or changing disease likely still warrant closer in-person assessment.

Journal of Neuro-Ophthalmology

Contraception in IIH patients prior to neuro-ophthalmology referral

To take or not to take? The question persists, even when the evidence does not. Patients with idiopathic intracranial hypertension (IIH) are sometimes advised to discontinue hormonal contraception despite a lack of convincing evidence supporting a causal relationship. We surveyed female patients aged 18–50 years who had received counseling on IIH and contraception, assessing contraceptive use at diagnosis, the presence of counseling, and the recommendations provided. Of 230 patients contacted, 85 responded (37% response rate), with 61 included in the final analysis. Nearly half reported using hormonal contraception at the time of diagnosis, and approximately one-quarter recalled receiving counseling. Among those using contraception, 10% reported being advised to discontinue it prior to neuro-ophthalmologic evaluation. Improved education among referring providers along with proactive counseling by ophthalmologists and neuro-ophthalmologists may help reduce unnecessary discontinuation of contraception. 

Advanced Science

 Can AI help read ocular ultrasounds?

Ocular B-scan ultrasonography is a useful tool for evaluating posterior segment pathology, especially when the fundus cannot be directly visualized, but image interpretation can be difficult and highly user-dependent. In this study, investigators developed OBUSight, a generative AI model designed to both generate ophthalmic ultrasound reports and predict diagnoses from ocular B-scan images. The model was trained and validated on a large multicenter dataset of 39,654 images and 17,586 reports from 11,381 patients, then compared against eight existing report-generation and vision-language models. OBUSight outperformed all comparator models for report generation on the internal test set and achieved an AUC of 0.907 for identifying key findings. In diagnostic testing, it matched ophthalmologist-level performance, outperformed residents and students, and reduced diagnostic time with AI assistance. In retrospective testing, OBUSight alone achieved 77.6% accuracy, and with model assistance, residents approached model-level performance while ophthalmologists exceeded it. Overall, this study suggests that generative AI may serve as a valuable assistive tool for ophthalmic ultrasound interpretation, particularly for improving efficiency and supporting less experienced clinicians. 

United Kingdom Prospective Diabetes Study (UKPDS)

This UKPDS sought to answer a variety of questions related to the natural history and impact of hyperglycemia control for patients with Type II Diabetes. Such questions included what risk factors dictate the incidence and progression of diabetic retinopathy, in addition to what impact intensive glycemic control would yield on incidence and progression.

Key Points

• Risk factors for development and progression of diabetic retinopathy were noted to be higher blood glucose levels, high blood pressure, and interestingly, not smoking
• The intensive glycemic control group had a lower A1c at study endpoints than the conventional diet-control group (7.0% versus 7.9%)
• The intensive glycemic control group had lower likelihood of development of microvascular complications (need for PRP), but did have elevated risk of hypoglycemia

Overall, the UKPDS is a landmark study because it highlighted the important risk factors of high blood pressure and hyperglycemia in promoting the onset or progression of retinopathy in patients with Type II (non-insulin-dependent) diabetes mellitus. Furthermore, along with the DCCT (which studied Type I Diabetics), these studies helped to identify a new target for blood glucose control in Diabetic patients.