In this week’s issue

• After globe removal for US service members, there were higher rates of suicidal ideation, alcohol use disorder, anxiety/depression, among other behavioral health diagnoses
• As compared to European populations, Hispanic populations had lower success rates and higher bleb leaks with trabeculectomy
• H. pylori-positive patients developed temporal RNFL thinning at slightly higher rates and also developed signs of macular degeneration at a significantly younger age than H. pylori-negative patients

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 August 27, 2025

Ophthalmology

Behavioral health status after globe removal in US service members

What is the hidden behavioral health cost of globe removal? Globe removal may be performed in military populations, where combat injuries such as blast or penetrating trauma from shrapnel or bullets can occur. Beyond the physical and cosmetic impact, the psychological toll has been poorly understood. This retrospective cohort study utilized the Military Health System database (2017–2022) to investigate behavioral health outcomes in active-duty service members undergoing GR. Of 103 patients with globe removal, 27 developed new behavioral health diagnoses post-surgery. Compared to non-globe removal peers, globe removal patients had higher rates of suicide or suicidal ideation (RR 47.2), alcohol use disorder (RR 17.3), anxiety (RR 12.8), adjustment disorder (RR 10.5), substance use disorder (RR 5.29), and depression (RR 8.0). Notably, the time to behavioral health diagnosis was shorter post-globe removal (median 49 days) compared with those who had a behavioral diagnosis before surgery (351 days). While limited by the rarity of globe removal, these findings highlight the acute psychiatric vulnerability following traumatic eye loss. These findings underscore the need for early and proactive behavioral health screening during post-operative care for this high-risk population.

JAMA Ophthalmology

Do glaucoma surgery outcomes differ by ethnicity?

All eyes are created equal? Think again. Trabeculectomy  remains a standard treatment method for lowering intraocular pressure in glaucoma, but long-term outcomes may vary across patient populations. This retrospective, single-center, matched cohort study assessed whether patients of Hispanic descent experience different outcomes than those of European descent after initial trabeculectomy with MMC. A total of 222 eyes (111 Hispanic, 111 European) were matched by surgeon, age, lens status, and surgery date and were followed over the course of 5 years. Definition of successful surgery was stratified into 4 groups according to absolute IOP cutoff: A (≤18mmhg), B (≤15mmhg), C (≤12mmHg), complete success (≤12 without medication use). Hispanic patients had significantly lower surgical success rates compared to patients of European descent across all groups and were more likely to experience early bleb leaks (14 vs. 6 eyes, p = .10). Additionally, multivariable analysis showed higher failure rates in Hispanic patients in all groups (hazard ratio 2.07-3.03, P <.001). These findings suggest Hispanic patients may be at greater risk for trabeculectomy failure, potentially due to differences in genetics such as having darker skin pigmentation, a risk factor for an overactive wound healing response, or other factors including social determinants of health. 

American Journal of Ophthalmology (AJO)

Age and glaucoma risk after unilateral congenital cataract surgery

When planning the timing for congenital cataract surgery in infants, it’s not just how old they are, it’s how early they arrived. Glaucoma is a common adverse effect of congenital cataract surgery that can be vision-threatening. The Infant Aphakia Treatment Study (IATS) was a randomized controlled clinical trial that compared the outcomes of unilateral cataract surgery with or without an intraocular lens implant in infants between 1 and 6 months of age and found a 20% incidence of glaucoma at 10.5 years after surgery. This study aimed to examine whether younger gestational age was associated with glaucoma development and improved visual acuity. This was a post hoc analysis of the IATS data that evaluated 112 infants with congenital cataracts, adjusting chronological age for gestational age at birth, to assess the association between age at surgery and glaucoma-related adverse events and visual acuity at 10.5 years after surgery. Gestational age was not associated with glaucoma or visual acuity association. Younger adjusted age (more premature born patients) was significantly associated with higher glaucoma risk (p=0.04) but better visual acuity (p=0.03). Both chronological and gestational age–adjusted measures should be considered to guide surgical timing for congenital cataract surgery.

Investigative Ophthalmology & Visual Science (IOVS)

Impact of H. pylori infection on retinal nerve fiber layer and macula

Helicobacter pylori on the prowl: this stomach bug may be eyeing your retina! Helicobacter pylori, the spiral-shaped bacterium that causes stomach ulcers, has been linked to various eye diseases, but its effects on retinal structure remain unclear. This cross-sectional study examined 3,386 participants using optical coherence tomography to assess retinal nerve fiber layer (RNFL) thickness and macular degeneration in H. pylori-positive vs. negative individuals. H. pylori-positive subjects showed significantly thinner inferior temporal RNFL (149.79 μm vs 152.76 μm), a region critical for early glaucoma detection. While both H. pylori-positive and negative groups developed macular degeneration at similar rates, those with H. pylori infection had it at a significantly younger age (54.66 vs 60.22 years). The findings suggest chronic bacterial inflammation may accelerate retinal neurodegeneration and macular aging. Early screening of H. pylori-positive patients could identify those at risk for accelerated eye disease progression.

JAAPOS

Can comedy boost ophthalmology training? Edutainment videos show promise

Who knew laughter could align more than just eyes? There is a growing shortage of pediatric ophthalmologists in the U.S., yet interest in this subspecialty continues to decline. Strabismus, a complex but common condition. remains a particularly challenging topic for trainees, often limiting comfort with pediatric eye exams. To address this, researchers at six U.S. academic centers tested short “edutainment” videos that blended humor and clinical teaching. In this prospective study, 52 participants (44 medical students, 8 residents) completed pre- and post-video assessments after watching three short episodes on pediatric ophthalmology and strabismus. Medical student scores rose from 44% to 74%, while residents improved from 76% to 96%; nearly 90% of respondents felt more comfortable examining pediatric patients, and 58% reported increased interest in the subspecialty. Most also preferred videos over traditional formats like book chapters or lectures. These findings suggest that edutainment videos are not only effective for knowledge gain but also for sparking enthusiasm in an underserved field. By engaging trainees with humor and relatable scenarios, this approach could help improve recruitment into pediatric ophthalmology while enhancing trainee confidence in caring for children.

JAMA Ophthalmology

Using AI to diagnose optic nerve conditions

What’s up with that nerve? An international collaboration sought to use deep learning to distinguish healthy optic nerves from optic nerve head atrophy due to glaucoma, nonarteritic anterior ischemic optic neuropathy, and optic neuritis. To accomplish this, they used a ResNet-3D model to analyze entire unsegmented OCT scans obtained from multiple clinical trials and referral centers over a 17-year time period. The researchers developed 3 ResNet-3D models: one looked at the full OCT volume, a second looked only at the peripapillar region, and a third looked only at the optic nerve head. These models analyzed 7014 OCT scans from eyes with glaucoma (113 eyes), nonarteritic anterior ischemic optic neuropathy (311 patients), optic neuritis (163 patients), and healthy controls (715 patients). Researchers tested their ability to distinguish these conditions from each other. Accuracy was similar for all 3 models and ranged from 85.9% to 88.9%; area under the curve were also similar, ranging from 0.970 to 0.977. Optic neuritis was the most challenging to classify correctly. The models were also able to pick up on distinct patterns in the regions of the retina that may also help differentiate these conditions. This study supports the progression of structural changes in these diseases and helps demonstrate utility of such models in settings with limited access to subspecialty care.

The Age-Related Eye Disease Study (AREDS 1) - 2001

Take your vitamins every day, free of advanced AMD you’ll stay. The Age-Related Eye Diseases Study (AREDS) was designed to study the clinical course of age-related macular degeneration (AMD) and age-related cataract. It included two double-masked, placebo-controlled, randomized clinical trials to test the effect of a vitamin formulation (500 mg vitamin C, 400 IU vitamin E, 15 mg β-carotene, with or without 80 mg zinc and 2mg copper) on the progression of these two conditions. AREDS enrolled 4,757 people aged 55-80 years to the long-term multicenter study, following them for an average of 6.3 years.

Key Points

• Smoking and hypertension were found to be associated with AMD and suggest modifiable factors that could reduce the risk of AMD progression.
• Long-term treatment with AREDS supplements reduced the risk of progression from moderate to advanced AMD by 25%, and reduced odds of severe vision loss by 27%
• Among participants with no AMD or only early-stage AMD, there was no measurable benefit
• AREDS vitamin supplements did not reduce the development of lens opacities

AREDS was a landmark study because it confirmed the effectiveness of this popular antioxidant formulation in decreasing the progression of severe AMD in the high-risk elderly population. It also left more to follow with AREDS2.