This study aimed to evaluate the 48-month visual and anatomical outcomes, as well as the number of clinic visits and intravitreal injections, in patients treated with three consecutive loading doses of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for diabetic macular edema (DME) under real-world conditions in Türkiye. In this retrospective, multicenter study conducted by the BOSPHORUS-DME Study Group, the medical records of 2,424 eyes of 1,696 patients who experienced vision loss due to DME and were treated with intravitreal anti-VEGF injections between January 2019 and January 2023 were reviewed. The study was carried out across eight tertiary referral hospitals located on the European side of İstanbul and in the province of Kocaeli. Seven cohort groups were created based on follow-up at baseline and months 3, 6, 12, 18, 24, 36, and 48. Best-corrected visual acuity (BCVA), central macular thickness (CMT), the number of clinic visits and injections, and the rates of anti-VEGF or dexamethasone switching were analyzed. The study included a total of 2,424 eyes of 1,696 patients (mean age: 60.6±10.0 years; 46.4% female). The mean baseline BCVA and CMT were 0.34±0.24 (decimal) and 400±134 μm, respectively. At month 48, these values improved to 0.49±0.29 (p<0.0001) and 324±115 μm (p<0.0001). The mean cumulative number of injections at years 1, 2, 3, and 4 were 6.5, 9.6, 12.2, and 15.7, respectively. A switch in anti-VEGF therapy occurred between month 3 and 6 in 43.5% of eyes, mostly due to mandatory transition to on-label agents. This is the largest and longest real-world study on DME treatment conducted in Türkiye. It demonstrates that visual and anatomical gains can be sustained over a 48-month period. While the overall trend aligns with previous real-world studies, the higher injection frequency in our cohort appears to have contributed to more favorable outcomes. These findings underscore the importance of early intensive therapy and sustained treatment adherence in the real-world management of DME.

To evaluate and compare the on-eye performance and comfort of two lotrafilcon B contact lenses, each manufactured using different surface moisturizing technologies, in individuals who use digital platforms for more than 3 hours daily. Twenty-nine asymptomatic habitual contact lens wearers participated in a randomized, double-masked crossover study. Each subject wore either Air Optix Aqua or Air Optix Plus HydraGlyde contact lenses for a month before switching to the other lens type for another month. Contact Lens Dry Eye Questionnaire 8 (CLDEQ-8) scores, biomicroscopic examination, tear function tests, and blink rates were recorded at baseline and at the end of each month. The patients were asked to complete a Likert-type questionnaire evaluating vision and comfort, along with first-impression ratings for visual clarity, comfort, and dryness with each lens. The mean age of patients was 25.5±7.2 years. Tarsal papillary grade was significantly lower, and tear-film break up time was higher with Air Optix Plus HydraGlyde lenses compared to Air Optix Aqua lenses (p<0.05). There were no significant differences between the two lenses in terms of slit-lamp findings, Schirmer's test, blink rate, or CLDEQ-8 scores (p>0.05). Air Optix Plus HydraGlyde lenses provided significantly better end-of-day comfort and less blurred vision, dryness, and eye tiredness (p<0.05). Air Optix Plus HydraGlyde lenses with advanced surface moisturizing technology were superior in terms of end-of-day comfort, end-of-month comfort, and visual clarity. Technological advances in silicone hydrogel lens surface treatments seem to be helpful in improving contact lens comfort in lens wearers with moderate daily exposure to digital devices.

Ophthalmology significantly contributes to the healthcare sector's carbon footprint. Despite recent increases in sustainability research in ophthalmology, there remains limited information on initiatives specific to pediatric ophthalmology and strabismus. This review aims to examine the existing literature and provide insights into sustainability and reducing carbon footprints in these areas. Although there has been no specific assessment of carbon emissions associated with congenital and developmental cataracts, measures related to cataract surgery and operating room practices remain relevant. Strabismus surgeries can be considered environmentally friendly, affordable, and energy-efficient procedures. Involving non-ophthalmologist personnel, expanding telemedicine applications, and restructuring outpatient services could reduce clinic congestion, lower costs, and improve sustainability. Some amblyopia examinations requiring long-term follow-up could be performed at local healthcare centers. While compliance and effectiveness are primary concerns in patching treatment, it is crucial to acknowledge that the patches generate significant waste and carbon footprints. Therefore, exploring alternative solutions is essential. Anesthesia poses an additional challenge for pediatric examinations, and various strategies have been suggested to reduce carbon dioxide emissions. Additionally, artificial intelligence is promising and its integration into pediatric ophthalmic examinations could further enhance sustainability. In brief, although pediatric ophthalmology and strabismus are considered environmentally friendly subspecialties of ophthalmology, especially in the operating room, there are many steps that can be taken for "sustainable ophthalmology," from anesthesia to amblyopia treatment and outpatient clinic services.

This study compared the 12-month real-world effectiveness of defocus incorporated multiple segments (DIMS) spectacle lenses, Myopi-X progressive addition lenses, and single-vision (SV) lenses in slowing myopia progression in children. This retrospective observational study included 385 eyes using one of the three spectacle types. Baseline age, spherical equivalent refraction (SER), and axial length (AL) were recorded. Twelve-month changes in SER and AL were analyzed using the Kruskal-Wallis test with Bonferroni-adjusted pairwise comparisons. Generalized estimating equations (GEE) were used to assess the effects of treatment group, age group, sex, and baseline AL group on SER and AL changes. The study population consisted of 118 Myopi-X eyes (32.4%), 107 SV eyes (29.4%), and 139 DIMS eyes (38.2%). Baseline demographic and ocular characteristics (including age, sex, SER, AL, age group, and baseline AL group) were comparable among the groups (all p>0.05). After 12 months, mean SER progression was -0.35±0.34 diopters (D) in the Myopi-X group, -0.46±0.37 D in the SV group, and -0.24±0.33 D in the DIMS group (p<0.001). Mean AL elongation was 0.21±0.12 mm, 0.24±0.17 mm, and 0.17±0.16 mm, respectively (p=0.004). GEE analyses demonstrated a significant treatment effect for both SER and AL change (p<0.001 for both). The least progression occurred in the DIMS group, followed by Myopi-X, while the SV group showed the highest progression. Baseline AL group was the only significant predictor of AL elongation (β=0.210, 95% confidence interval: 0.189-0.231, p<0.001), with greater elongation in eyes with high baseline AL. Age group and sex did not significantly influence SER or AL outcomes. DIMS spectacle lenses were more effective than Myopi-X and SV lenses in reducing both refractive progression and axial elongation over 12 months. Baseline AL was a key determinant of axial growth, supporting the use of individualized risk assessment in pediatric myopia management.

This study aimed to compare year-over-year change in ChatGPT's performance on nationwide ophthalmology exams with the performance change among residents over the same period. This observational study included ophthalmology residents in Türkiye who participated in both the 2023 and 2024 Resident Training Development Exams organized by the Turkish Ophthalmological Association Qualifications Committee. The 2023 examination consisted of 69 single-best-answer multiple-choice questions and was administered to ChatGPT-3.5. The 2024 version, containing 72 questions, was administered to ChatGPT-4o. The success rates of ChatGPT and the residents who participated in both exams were compared. ChatGPT's accuracy improved from 53.6% in 2023 to 84.7% in 2024. Among the 501 residents who participated in both years, the average score increased from 48.2% to 53.1%. ChatGPT ranked 292nd among residents in 2023 but achieved the top score in 2024. Based on percentage improvement in scores, ChatGPT-4o ranked 8th overall. The most notable performance gains for ChatGPT were seen in the areas of strabismus (+75%), neuro-ophthalmology (+40%), and optics (+40%). Among residents, the largest improvement occurred in oculoplastics (+33.5%), while a decrease was observed in cornea and ocular surface (-4.1%). ChatGPT-4o showed a marked improvement in answering ophthalmology questions compared to its predecessor, whereas resident learning progressed more gradually. This rapid advancement in ChatGPT highlights the potential speed with which artificial learning can progress within defined boundaries. In contrast, human learning remains a deeper and more time-intensive process. Results suggest that evolving large language models will play an increasingly significant role in medical education and clinical support.

This retrospective case series presents the characteristic features of superior segmental optic nerve hypoplasia (SSONH) in four patients who were initially misdiagnosed with normal-tension glaucoma (NTG), aiming to raise awareness of this rare condition in Türkiye. Four patients (two females and two males) with a mean age of 38 years were included. All were initially diagnosed with NTG and treated with brimonidine drops for three years. Comprehensive ophthalmological examinations were performed, including optic disc photography, optical coherence tomography retinal nerve fiber layer (RNFL) analysis, and visual field testing, with follow-up evaluations conducted over at least one year. Bilateral involvement was observed in two cases, and unilateral involvement in the other two. History of maternal diabetes was noted in 50% of the patients. During medication-free follow-up, all patients demonstrated stable structural and functional parameters, supporting the diagnosis of SSONH. These findings suggest that SSONH should be considered in young patients presenting with superior RNFL thinning and corresponding inferior visual field defects. The non-progressive nature of the condition helps differentiate it from glaucomatous optic neuropathy. Recognizing unilateral cases is essential for avoiding misdiagnosis.

To demonstrate the efficacy and safety of repeated dexamethasone (DEX) implants in eyes with naïve diabetic macular edema (DME) using real-life data over a minimum of 36 months follow-up. This retrospective cohort study included treatment-naïve DME patients treated with intravitreal DEX monotherapy and followed for at least 36 months. Main outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT) change. Secondary outcomes were optical coherence tomography findings, including serous macular detachment, hard exudate, hyperreflective foci, cystoid degeneration, pearl necklace sign, epiretinal membrane (ERM), disorganization of the retinal inner layers (DRIL), ellipsoid zone and external limiting membrane (EZ-ELM) integrity, and intra-cystic hyperreflective material, as well as intraocular pressures and lens status. The study included 74 eyes of 52 patients. The mean follow-up period and number of injections were 49.24±13.51 months and 6.83±2.76, respectively. Both BCVA and CMT improved significantly throughout follow-up (p=0.009; p<0.001). The mean BCVA increased by 7.9±2.1 letters, and 38 patients (51.3%) gained ≥10 letters. Hyperreflective foci (p<0.001), pearl necklace sign (p=0.012), and intra-cystic hyperreflective material (p=0.042) decreased significantly, while ERM (p=0.006), DRIL (p<0.001), and EZ-ELM defects (p<0.001) increased significantly. Intravitreal DEX monotherapy is a safe and effective treatment option for treatment-naïve DME patients in long-term follow-up.

To evaluate the results and effectiveness of the intraoperative subretinal dual dye-assisted technique in patients treated in our clinic for recurrent rhegmatogenous retinal detachment (RRD), where small hidden retinal tears could not be detected before or during surgery. This retrospective observational study included 11 patients who underwent surgery in our clinic for recurrent RRD and in whom no retinal tears were detected during either preoperative or intraoperative examinations. Data from patients who underwent surgery using the modified subretinal MembraneBlue-Dual® (trypan blue 0.15% + Brilliant Blue G 0.025% + PEG 4%) dye method applied with a 41-gauge cannula were examined. Postoperative outcomes were analyzed. In 38.4% of patients, retinal tears were located at the posterior edge of a previous laser retinopexy scar. Dye leakage was seen from the edge of a previously lasered retinal tear in 30.7% and from a new tear in 30.7%. At 1-year follow-up, anatomical success and permanent retinal reattachment were achieved in all of the patients. At postoperative 1 year, best corrected visual acuity had increased from 2.0±0.3 logarithm of the minimum angle of resolution (logMAR) to 0.7±0.1 logMAR. Occult small retinal tears that are undetectable in recurrent RRD can be successfully identified using the subretinal dye-assisted technique.