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In this week’s issue

• CorNeat EverPatch shows high exposure and revision rates compared to human donor cornea grafts.
• Diversified segmental defocus optimization lenses show promise in preventing development of myopia in children.
• Screening and stroke workups in the ED for patients with central retinal artery occlusion have increased in the USA.
• IL-7 blockade outperforms IL-15 in treating chronic autoimmune uveitis.
• Modest IOP elevations in myopic normal tension glaucoma eyes may lead to progressive retinal nerve fiber layer thinning.

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Ophthalmology
EverPatch shows higher early exposure & revision rates than donor cornea

A temporary cover up or a real solution? The EverPatch isn’t forever. Implantation of synthetic materials, such as scleral buckles, glaucoma tube shunts, and sutures, into the sclera during surgery is generally well-tolerated if covered by conjunctiva. Human tissue patch grafts, while common for covering synthetic implants, are susceptible to enzymatic degradation and may only provide temporary protection. Exposure of synthetic implants leads to high risk of infection, so alternative patch materials are currently being explored. This retrospective study compared the early exposure and surgical revision rates of the CorNeat EverPatch, a nondegradable patch made from synthetic material, to human donor cornea. The study included 30 eyes implanted with EverPatch, matched with 58 control eyes receiving donor grafts. Within 5 months post-operatively, exposure occurred in 48.3% of cases compared to 1.7% of controls (P < 0.0001), and EverPatch had a 27.9% surgical revision rate compared to 1.7% in controls (P < 0.0001). Analysis of the EverPatch devices showed limited tissue integration. Thus, this study shows that caution should be used when considering EverPatch and that using human donor grafts more often leads to better outcomes.

JAMA Ophthalmology

Can a new lens design delay the onset of myopia?

Putting the “focus” back on prevention. Myopia is on the rise globally, with early-onset cases leading to higher risk of vision-threatening complications later in life. While current treatments like low-dose atropine have been well studied to slow progression, few interventions have been studied on their role in preventing the onset of myopia. In a new randomized clinical trial from Peking University, researchers tested a novel optical intervention: diversified segmental defocus optimization (DSDO) lenses, which use small lenslets in the periphery to alter the focus of light on the retina and signal the eye to slow its growth. A total of 450 children (ages 5-12) without myopia were randomized to receive DSDO lenses + placebo drops, DSDO lenses + 0.01% atropine, or single-vision lenses + placebo. After 1 year, the incidence of myopia and fast myopic shift was significantly lower in both DSDO groups compared to controls. Myopia incidence was 5.8% (DSDO) and 4.8% (DSDO + atropine) vs 15.3% in controls, and fast myopic shift occurred in 15.7% and 9.6% vs 42.7%, respectively, without any clear benefit from the added atropine. These findings suggest DSDO lenses are a promising, noninvasive option for delaying myopia onset in children and could expand the toolkit for pediatric myopia prevention. 

American Journal of Ophthalmology (AJO)

Stroke workup trends in the ED for CRAO

Vision critical… our work isn’t done here! While the B.E. FAST campaign has raised awareness of stroke symptoms, central retinal artery occlusion (CRAO) is a less well-recognized stroke precursor. A new retrospective study of 3,736 patients investigated trends in stroke workups of patients with CRAO as the primary diagnosis over a five-year period. The authors found a significant increase in rates of stroke workup over the five-year period for all modalities, including CT/CTA (P = 0.024), carotid CTA (P = 0.008), carotid MRA (P = 0.024), ECG (P = 0.024), and echocardiogram (P = 0.024). Notably, male patients were significantly more likely to receive a stroke workup than female patients. Despite this progress, stroke workups decreased over time from 66.75% to 57.87% by the end of the study period. These findings underscore the need for greater awareness and more consistent screening for CRAO patients.

Investigative Ophthalmology & Visual Sciences

Towards precision targeted therapy for chronic uveitis

Turns out, not all cytokines are created equal in the world of eye inflammation. Chronic noninfectious uveitis often presents as a treatment-resistant relapsing condition causing significant visual impairment. Memory CD4+ T cells expressing the IL-7 receptor (IL-7R) and IL-15R maintain inflammation and promote disease recurrence. Therefore, specifically inhibiting these pathways may offer more precise and long lasting disease control without the adverse events of broadly immunosuppressive agents. In a mouse model of chronic autoimmune uveitis, researchers compared the effects of IL-7 versus IL-15 blockade with neutralizing antibodies and assessed retinal inflammation, structure, function, and T cell infiltration over four weeks. IL-7 blockade led to a significant reduction in retinal lesions, faster functional recovery measured by electroretinography, and better OCT scores than IL-15 blockade. Both treatments decreased memory Th17 cell populations in the retina and lymph nodes, but IL-7 inhibition had a more rapid, sustained impact on disease. These findings suggest that IL-7 may be a more potent target, and thus more promising therapeutic strategy than IL-15 in modulating memory T cells and providing relief in chronic uveitis.

Eye

When dry eye meets glaucoma: How drops may dampen IPL efficacy

Intense pulsed light (IPL) has become a popular therapy for stubborn meibomian gland dysfunction. Do chronic glaucoma medications interfere with its long-term benefits? Meibomian gland dysfunction (MGD) is a common contributor to chronic dry eye. IPL therapy has gained traction as a treatment for cases unresponsive to traditional therapies. However, many patients with glaucoma, who often suffer from MGD as well, use long-term topical hypotensive agents, raising the question of whether these medications affect IPL’s efficacy. This retrospective study compared 21 eyes of 21 glaucoma patients with MGD to 21 matched eyes of 21 non-glaucoma MGD patients, all of whom underwent IPL therapy combined with meibomian gland expression (MGX). Outcomes such as SPEED scores, tear film breakup time (TBUT), lid telangiectasia, and meibum quality were tracked over a 12-month period. Both groups saw significant improvement in dry eye symptoms and tear film stability at 9 months. However, only the non-glaucoma group maintained those improvements at 12 months and demonstrated continued improvement in lid telangiectasia and meibum expressibility. These findings suggest that IPL therapy is beneficial for treating refractory MGD in both glaucoma and non-glaucoma patients. However, the diminished long-term response in those using hypotensive eye drops points to a potential interaction that may reduce IPL’s sustained effectiveness in these patients.

Journal of Glaucoma

Progression without pressure: Myopic NTG eyes worsen despite normal IOP

How low can you go? For myopic normal tension glaucoma, maybe lower than you think. While normal-tension glaucoma (NTG) is characterized by intraocular pressure (IOP) within normal limits, this study followed 111 treatment-naïve myopic NTG eyes over two years to assess natural disease progression without IOP-lowering treatment. Progression occurred in 22.5% of eyes, with higher mean and peak IOP, along with a positive family history, emerging as significant risk factors. Notably, no eyes with a mean IOP below 11 mmHg progressed, and a critical threshold of 14.2 mmHg was identified, above which the rate of RNFL thinning significantly increased. These findings suggest that even a modest elevation in IOP may lead to structural damage, highlighting the need for early intervention and tighter IOP control, even when IOP appears to be “normal.” 

Journal: Scientific Reports

AI derived grading of mustard gas induced corneal injury & opacity

In this preclinical study, researchers developed and validated deep learning models to grade sulfur mustard (mustard gas)-induced corneal injury in live rabbits using stereomicroscope images. The goal: enable objective, reproducible classification of corneal pathology severity - an essential tool for future therapeutic development and translation to human care. The team collected 401 corneal images across four grades (healthy, mild, moderate, severe), manually segmented the cornea with Mask R-CNN, and trained multiple CNN architectures. The best-performing model, ResNet50, achieved accuracy of 87% (T1) and 85% (T2) across two test sets, with ROC-AUC up to 0.95. Misclassifications mostly occurred between adjacent severity grades, reflecting the subtlety of image features. Validated against Scheimpflug imaging, the AI’s predictions aligned with clinical features of corneal opacity. This work shows promise for AI-assisted pathology grading in toxic or trauma-related eye injury models, supporting both preclinical research and future clinical AI tools in anterior segment disease.

The Herpetic Eye Disease Study (HEDS) - Part I

Can corticosteroids get you aHEaD of the curve for HSV stromal keratitis? In the HEDS trial, patients with active herpes simplex stromal keratitis were randomly assigned to either a placebo group (n = 49) or topical prednisolone phosphate group (n = 57). Both groups received topical trifluridine and a 10-week tapered regimen of the treatment drug/placebo.

Key Points

• Compared to placebo, the steroid group had a reduced risk of persistent stromal keratouveitis by 68%
• The time to resolution was significantly shorter in the steroid group
• At 6 months, there were no clinically or statistically significant differences in visual outcome or recurrent herpetic eye disease between both groups

Overall, this subset of the HEDS is a landmark study because it demonstrated how administering topical corticosteroids were efficacious in treating herpes simplex stromal keratitis. Before this trial, it was unclear whether topical corticosteroids were safe and effective for these patients. In the HEDS, researchers found steroids were specifically advantageous in hindering the progression of stromal inflammation and shortening the duration of stromal keratitis.