In this week’s issue

• Most PVD-related vitreous hemorrhages resolve, but young men may be at higher risk of complications such as retinal detachment.
• Women in academic ophthalmology earn less than men at all ranks, with persistent gaps at senior levels.
• Dazdotuftide drops reduce uveitic inflammation with fewer IOP side effects than steroids, but may be less effective overall.
• CMV uveitis stems from overactive T cells that appear to both protect and harm the eye

Spotify Link:

https://open.spotify.com/episode/5eO5pWnueB3tcHu20MbHrp?si=BO6LLb4vQ0WoepnHOOvxdQ

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)

Novel steroid sparing agent shows promise in phase 3 clinical trial  

Finding a new path through the fog of inflammation. Noninfectious uveitis (NIU) is a potentially blinding condition responsible for 10-15% of cases of legal blindness in developed countries. Corticosteroids remain the standard of care, but they have significant side effects, most notably accelerated cataract development and elevated intraocular pressure (IOP), which can lead to permanent glaucomatous damage. This phase 3 clinical trial evaluated dazdotuftide (TRS01), a first-in-class, steroid-free eye drop that utilizes a dual-action peptide conjugate to "reprogram" macrophages from a pro-inflammatory M1 state to an anti-inflammatory, IL-10-secreting M2 state. The study found that 46% of TRS01-treated patients achieved zero inflammation compared to 68% for steroids (P=0.01), while significantly fewer TRS01-treated patients experienced an IOP increase ≥10 mmHg (0% vs 15.6%). Unlike systemic biologics such as adalimumab, which target specific cytokines to control chronic disease, TRS01 provides a localized, topical alternative for acute flares. Long-term efficacy relative to established systemic therapies remains to be determined in broader clinical settings.

Investigative Ophthalmology & Visual Science (IOVS)   

Are T Cells protecting or damaging the eye in CMV anterior uveitis?

Turns out the same T cells fighting the virus might also be fueling the disease. Cytomegalovirus anterior uveitis (CMV AU) is a chronic inflammatory eye disease that can lead to glaucoma and corneal endothelial loss, even in immunocompetent patients. While CMV infection is common, CMV AU is rare, suggesting a key role for host immune response in disease development. In this study, T cells from 31 CMV AU patients and 32 CMV-seropositive controls were stimulated with CMV antigens IE1 and pp65, and responses were measured via IFN-γ, TNF-α, granzyme B. These immune responses were correlated with disease duration, visual field loss, and corneal endothelial density. Although baseline immune profiles were similar, CMV-specific T cell responses in CMV AU patients were hyper-reactive and appeared to increase over time, suggesting progressive immune sensitization. Stronger T cell responses were associated with worse glaucoma but better preservation of corneal endothelial cells. Overall, CMV AU appears to be driven by antigen-specific T cell hyper-responsiveness, with T cells playing a dual role - both protective and pathogenic. Disease severity reflects the balance between viral control and immune-mediated injury.

The Lancet Global Health
Global analysis of access and effectiveness of cataract surgery

How well is cataract surgery reaching the people who need it most around the world? Cataract remains the leading cause of avoidable blindness worldwide, yet many face barriers to both surgery and achieving good visual outcomes. This study pooled 233 population‑based surveys from 68 countries between 2003 to 2024 to estimate effective cataract surgical coverage (eCSC), which measures both access to surgery and the proportion of surgeries restoring good vision. Country-level eCSC varied widely, from 2.1% in the lowest-performing countries to 77.7% in the highest, illustrating stark disparities worldwide. Globally, eCSC increased from 43.9% in 2020 to an estimated 48.2% in 2025, with projections suggesting an 8% rise by 2030, still falling short of the 30-point increase target set by the World Health Assembly. These findings underscore persistent inequities in cataract care and emphasize the urgent need to expand access to high-quality surgery, improve surgical outcomes, and accelerate progress toward reducing preventable vision loss worldwide.

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. 

Mycotic Ulcer Treatment Trial II (MUTT II)

Oral vs topical antifungals for corneal ulcers - MUTT ado about nothing? Following MUTT I, in which topical natamycin demonstrated superior efficacy compared to topical voriconazole, the Mycotic Ulcer Treatment Trial II was designed to determine the benefit of oral voriconazole in addition to topic anti-fungal regimens in cases of severe mycotic keratitis. 240 patients from 6 clinical sites in Nepal and India were randomized to the oral voriconazole treatment group (n=119) and the control, placebo group (n=121); both received topical natamycin and topical voriconazole.

Key Points

• Oral voriconazole did lead to a statistically significant reduction in the rate of corneal perforation or need for therapeutic penetrating keratoplasty (HR 0.82, 95% CI, 0.57-1.18, P=0.29)
• No significant improvement in the mean BSCVA of the oral voriconazole group after 3 months of follow-up
• A total of 58 adverse events (48.7%) were recorded in the PO voriconazole arm vs. 28 adverse events (23.1%) in the placebo group

Overall, the MUTT II demonstrated that oral voriconazole did lead to an appreciable decrease in the rates of perforation or need for therapeutic penetrating keratoplasty. in fact, its use was associated with increased risk for adverse events. Given the drug’s high-cost profile as well, adjunct oral voriconazole was not recommended in the treatment of mycotic keratitis after this study.