The article by Han and associates highlights a frequently neglected consequence of type 2 diabetes mellitus (T2D): Dry eye disease associated with corneal neuropathy. Their findings indicate that patients with T2D exacerbated by dry eye disease exhibit substantial decreases in corneal nerve density, length, and count, accompanied by heightened tortuosity, all of which correlate strongly with clinical severity scores. This study contributes to the expanding literature that regards ocular surface disease not only as a secondary effect of systemic illness but also as a direct indication of neurovascular and metabolic impairment. Clinically, these findings underscore the importance of regularly evaluating dry eye in patients with T2D, extending beyond diabetic retinopathy, and incorporating ocular surface assessments into comprehensive diabetes management. This study demonstrates that the diabetic eye exhibits both tear film instability and corneal neurodegeneration, thereby expanding our understanding of diabetic eye disease and emphasizing the need for multidisciplinary care to preserve vision and improve quality of life.

The development of ophthalmology in Georgia was strongly influenced by physicians who brought European medical education and clinical experience to the region. Among them, Jozef Talko played a significant role in establishing modern ophthalmic practice. This paper aims to highlight the professional activity and contributions of Jozef Talko as one of the first practicing ophthalmologists and a key figure in the formation of ophthalmology in Georgia. The study is based on the analysis of historical medical literature, archival sources, and secondary historical accounts related to the early development of ophthalmology in Georgia and Talko's professional activity. Jozef Talko received foreign medical education and subsequently practiced ophthalmology in Georgia from the 1890s onward. He provided specialized eye care, introduced contemporary diagnostic and therapeutic approaches, and actively contributed to the recognition of ophthalmology as an independent medical discipline. His work laid practical foundations for the training and development of future ophthalmologists. Talko's activity represents a transition from general medical eye care to structured ophthalmic practice. His role as a practicing clinician helped establish professional standards and increased public and academic awareness of eye diseases and their treatment. Jozef Talko is a highly respected and acknowledged figure in the history of Georgian ophthalmology. His clinical work and professional influence created a foundation for the further development of the specialty and for future generations of ophthalmologists.

Teprotumumab, a monoclonal antibody targeting the insulin-like growth factor-1 receptor, has demonstrated significant efficacy in treating thyroid eye disease. While its ophthalmic benefits are well established, limited data exist regarding its effects on thyroid hormone regulation. To characterize changes in thyroid function associated with teprotumumab therapy in thyroid eye disease patients. We performed a retrospective comparative study of 46 thyroid eye disease patients treated with teprotumumab and 46 thyroid eye disease patients treated with orbital decompression at a tertiary care facility between January 2020 and December 2023. Thyroid function tests (thyroid-stimulating hormone and free thyroxine) were analyzed at pretreatment and posttreatment. Subgroup analysis was conducted based on prior thyroidectomy or radioactive iodine therapy. Clinical outcomes, including proptosis and Clinical Activity Score, were also evaluated. The teprotumumab cohort had a mean age of 55.9 years, with 80.5% female and 65.2% hyperthyroid at presentation. The orbital decompression cohort mean age was 49.8 years, with 89.1% female and 80.4% hyperthyroid. Both groups showed significant improvements in Clinical Activity Score and proptosis. In the teprotumumab group, free thyroxine levels significantly declined posttreatment (1.7 ± 1.2 to 1.3 ± 0.4, p = 0.049), particularly in patients without prior thyroidectomy/radioactive iodine (1.8 ± 1.4 to 1.2 ± 0.3, p = 0.041). The orbital decompression group showed no significant change in free thyroxine levels (p = 0.63). Over half (52.2%) of teprotumumab patients required medication adjustments during therapy, compared with 12.5% in the orbital decompression group (p < 0.001). Teprotumumab may impact thyroid hormone homeostasis, especially in patients with functioning thyroid tissue, suggesting a need for endocrine monitoring with treatment.

Changes in proptosis and eyelid position following orbital fat decompression for thyroid eye disease.

Autoimmune thyroid diseases (AITDs) represent T cell-mediated, organ-specific autoimmune disorders caused by immune dysregulation, culminating in an immune-mediated attack on thyroid tissue. AITD etiopathogenesis is the result of the interplay between a genetic susceptibility and environmental factors; hypothyroidism and thyrotoxicosis are the respective clinical hallmarks of autoimmune thyroiditis and Graves’disease, the two main forms of AITD. The application of nanomedicine in the context of thyroid disorders ranges from nanodiagnosis and nanotherapy to nanotheranostics. Nanomedicine has been used to develop new sensitive methods for the determination of the TSH, iodine and TSAb. Furthermore, other studies have used nanomedicine to explore new treatments of autoimmune thyroiditis, Graves’disease and also thyroid eye disease. In the future, the application of nanomedicine will be personalized in accordance with individual genetic profiles, thus improving the therapeutic effectiveness and reducing the undesirable side effects with improved patient outcomes.

To evaluate contrast sensitivity function in patients with thyroid eye disease (TED) associated compressive optic neuropathy (CON) who achieved full recovery of conventional visual function following three-wall orbital decompression and to evaluate its impact on vision-related quality of life. In this prospective matched case-control study, 22 TED eyes (18 TED-CON, 4 TED-non-CON) were compared to 22 healthy eyes matched on age, sex, and refraction. All TED patients had recovered 10/10 best-corrected visual acuity (BCVA), normal visual fields, and no OCT abnormalities after three-wall decompression surgery. CS was assessed using CSV-1000E, and quality of life was measured with the GO-QOL visual function subscale. Despite normal BCVA and visual fields, TED-CON eyes showed significantly reduced CS versus controls (p < 0.01), especially at low spatial frequencies. TED-non-CON eyes also exhibited subnormal CSF, suggesting early or subclinical dysfunction. CS strongly correlated with lower GO-QOL scores (ρ =-1.00,p < 0.001), highlighting its functional relevance beyond standard tests. TED patients with previous compressive optic neuropathy show persistent contrast sensitivity deficits despite complete recovery of visual acuity potentially reflecting irreversible or subclinical optic nerve injury. Even TED eyes without CON may exhibit subtle functional impairment. CS testing could serve as a sensitive functional marker of optic nerve stress in TED, with direct impact on patients' quality of life.

Neurotrophin-4 as a Promising Therapy for Corneal Injuries: Enhancing Epithelial Repair and Nerve Regeneration in Abrasion and Alkali Burn Models.

Analysis of tear inflammatory proteins following Low-Level light therapy in dry eye disease patients.

This meta-analysis aims to determine the clinical manifestations, prevalence, and risk factors of asthenopia across diverse populations. We systematically searched PubMed up to April 2024 for studies published within the last five years on asthenopia, without language or design restrictions. Reference lists were also reviewed. The study quality was evaluated using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to calculate proportions, prevalence rates, odds ratios (ORs) and their 95% confidence intervals (CIs). Overall, 63 studies were included. The pooled prevalence of asthenopia detected via questionnaires or symptom report was 51% (95% CI = 50%, 52%). Subgroup analyses showed high prevalence among digital device users (90%) and computer workers (77%). During the COVID-19 pandemic, prevalence rose among adults (39%-45%), university students (36%-57%), and school-aged children (45%-64%). The most frequent ocular symptoms were eye tiredness (65%, 95% CI = 46%, 84%), eye strain (47%, 95% CI = 37%, 58%), and burning/irritation (43%, 95% CI = 35%, 51%). Musculoskeletal symptoms, including neck pain (45%, 95% CI = 28%, 62%) and shoulder pain (30%, 95% CI = 12%, 48%) were also prevalent. Neuropsychological symptoms included headache (50%, 95% CI = 41%, 59%) and difficulty concentrating (44%, 95% CI = 32%, 56%). Risk factors included short sleep duration (OR = 1.28; 95% CI = 1.04, 1.57), prior eye disease (OR = 2.59; 95% CI = 1.43, 4.69), prolonged screen time (OR = 1.15; 95% CI = 1.09, 1.21), and ambient conditions like air conditioning use (OR = 23.02; 95% CI = 4.94, 107.18). Protective measures included anti-glare filters (OR = 0.34; 95% CI = 0.19, 0.64), regular breaks (OR = 0.21; 95% CI = 0.09, 0.51), and computer use knowledge (OR = 0.20; 95% CI = 0.13, 0.30). Asthenopia is prevalent across diverse populations, characterised by a wide range of symptoms and influenced by modifiable risk factors. Our findings support a unified definition to improve clinical recognition and offer preliminary evidence to help shape future research on preventive strategies. PROSPERO: CRD42024536841.

Thyroid eye disease (TED) is an autoimmune disease involving periocular and orbital tissue. The symptoms of TED include proptosis, diplopia, visual disturbance, and lacrimal symptoms. Dry/gritty eyes, light sensitivity, and tearing are prominent lacrimal system-related symptoms. They can be misdiagnosed as dry eye syndrome, chronic conjunctivitis, or allergies. Multiple therapeutic interventions can be utilized in the management of lacrimal symptoms of TED. Lacrimal gland dysfunction occurs from immune cell infiltration of glandular tissues as well as from poor eyelid draping function causing excess exposure of the globe surface. Noninvasive treatments for lacrimal system abnormalities include local supportive measures aimed at preserving eye surface tear film, systemic and topical medications such as corticosteroids, which target inflammation, and biologicals which modify local immune responses. Surgical interventions can mitigate the negative impact of proptosis and poor eyelid draping on corneal exposure. These procedures include orbital decompression and eyelid repair. Nonmedical interventions include smoking cessation and patient education. Multidisciplinary care can reduce misdiagnoses, improve management, and reduce the negative impact on quality of life in TED. Several treatment options are currently available to mitigate lacrimal system dysfunction in TED. More targeted therapies are emerging or have recently appeared in the clinic. Patients with mild TED can benefit from supportive care aimed at symptomatic relief. An inter-disciplinary approach to managing patients with lacrimal system abnormalities can minimize the impact of lacrimal insufficiency in TED.

Psoriasis is a systemic immune-mediated disease with ocular involvement. While biologic therapies reduce cardiovascular and musculoskeletal comorbidities, their impact on ocular health is not well characterised. We aimed to assess whether biologic therapy is associated with reduced ocular disease risk in psoriasis patients. We performed a large-scale, retrospective cohort study using the TriNetX Global Collaborative Network (>160 million patients worldwide). Adults with psoriasis initiating biologic therapy were compared with those receiving non-biologic systemic treatments. Cohorts were matched 1:1 by propensity scoring for demographic and clinical variables. Sixty-eight ocular outcomes were assessed over 6 to 120 months. Hazard ratios (HRs) were estimated using proportional hazards models. Among 30,911 biologic-treated and 35,832 non-biologic-treated patients with psoriasis, biologic therapy was consistently associated with reduced risk of ocular surface and corneal inflammation. The strongest associations were seen for dry eye disease (mean HR = 0.55, 95% confidence interval [CI; 0.42, 0.66], p = 0.0007), conjunctivitis (mean HR = 0.71, 95% CI [0.59, 0.86], p = 0.01), and keratitis (mean HR = 0.40, 95% CI [0.3, 0.56], p = 0.0007). These lower-risk associations were evident from 6 months and remained observable in the 10-year analysis window. No consistent reduction was observed for retinal or vitreous disease. Biologic therapy in psoriasis was associated with a lower risk of ocular surface disease. These observational findings may inform interdisciplinary management and consideration of ocular outcomes in treatment decisions.

Abstract Purpose Rare diseases (RD) produce an important public health impact, but their specific morbimortality burden remains unknown. Based on Death Certificates (1997–2017), the secular trend (ST) and spatial distribution of deaths due to RD are analyzed. Methods The ICD-10 classified Death Certificates were obtained from the Ministry of Health. A Python web scraper was developed to query the orpha.net web catalogue to establish a correspondence between Orpha and ICD-10 codes. The RDs mortality rate per 1,000 deaths (RD*1000) was calculated by sex, age groups, and by ICD-10 chapters for the five regions of Argentina (Northwest, Northeast, Centro, Cuyo, and Patagonia), as well as for its 24 provinces and 513 departments. Secular trend (ST) was analyzed using Joinpoint software, while spatiality was assessed through Moran’s and LISA indices. Results The RD*1000 death rate at country level was 189.4. Patagonia exhibited the highest rate, followed by Cuyo, Centro, Northeast and Northwest, being these conditions higher in women. The ST was negative between 1997 and 2009 and positive between 2009 and 2017. The geographical distribution of the clusters exhibiting high and low rates was mainly observed in the central and northern regions of the country, respectively. According to ICD-10, the prevalent categories were neoplasms, followed by eye diseases, congenital malformations, diseases of the nervous and digestive systems and diseases of the blood. Conclusion The geographical distribution of RD deaths in Argentina exhibits significant heterogeneity, characterized by a latitudinal arrangement. This phenomenon can be attributed to socioeconomic inequalities, intricately linked to population dynamics and migratory patterns. Clinical trial registration Not applicable. This study involved the analysis of secondary data and did not require clinical trial registration.

Investigating conjunctival immune pathways in Sjögren and non-Sjögren disease associated dry eye.

Knowledge and practice of community pharmacists in identifying and managing dry eye disease in Klang Valley of Malaysia. A cross-sectional study

IntroductionPublic understanding of eye diseases is crucial in preventing avoidable blindness. This study aimed to assess the awareness and knowledge of cataract, glaucoma and diabetic retinopathy (DR), identify common sources of eye health information and examine the association between the sociodemographic factors and the level of awareness and knowledge.MethodA cross-sectional study was conducted in clinics in the Lagos State University Teaching Hospital, Nigeria. Of 500 participants approached in the various clinics, 404 completed the questionnaires (response rate: 80.8%). Outpatients were recruited using consecutive convenience sampling. The data were collected using a structured questionnaire. The association between sociodemographic factors and the levels of awareness and knowledge of cataract, glaucoma and DR was assessed using the χ² test. Pearson’s correlation analysis and one-way analysis of variance were conducted to determine the relationships and differences in awareness and knowledge of the eye disorders across the various clinics.ResultsThe awareness of cataracts (83.4%) and glaucoma (64.4%) was significantly higher than DR (48.3%). Awareness of DR was the lowest, with only 30.4% recognising its link to diabetes. Family members were the most frequently cited source of information. Significant associations (p<0.05 for all comparisons) were seen between awareness and knowledge of the eye disorders with clinics attended (cataract: p=0.003, OR=1.45; 95% CI 1.12 to 1.88, glaucoma: p=0.005, OR=1.38; 95% CI 1.10 to 1.73, DR: p=0.001, OR=1.52; 95% CI 1.20 to 1.92). A positive association existed between educational level and cataract (p=0.012, OR=1.29, 95% CI 1.06 to 1.57) and DR with occupation (p=0.009, OR=1.34, 95% CI 1.08 to 1.66). Correlation Analysis showed a positive relationship between awareness and knowledge of cataract and glaucoma (r (404)=0.533, p=0.005); a weak relationship was seen between cataract and DR (r (404)=0.405, p<0.001); glaucoma and DR (r (404)=0.333, p<0.001). Regression analysis indicated that age (OR=2.36, 95% CI 1.08 to 5.18, p=0.032) and clinic (OR=5.25, 95% CI 1.90 to 14.53, p=0.001) were significantly associated with levels of awareness and knowledge of eye diseases.ConclusionsSignificant gaps exist in public awareness and knowledge of major eye diseases, most notably for DR, which has the lowest recognition of its link to diabetes. Given that family members are the primary source of information, targeted health campaigns using social networks are essential. Educational level, employment status and clinic attendance are key determinants of awareness and should be leveraged to inform highly specific, evidence-based public health interventions in the Lagos State population to promote early diagnosis and reduce avoidable blindness.

Complement in brain and eye disease: shared mechanisms, convergent pathologies, and common therapeutic opportunities.

Autologous serum (AS) tears are an effective therapeutic option for advanced DED, mimicking the biochemical composition of natural tears. However, the absence of universally accepted guidelines has resulted in variability in AS tear concentration, diluents, processing of collected blood, and storage conditions, raising questions regarding the optimal parameters for AS tear use. This perspective provides a framework to inform clinical implementation and to guide future research on AS tear therapy optimization. PubMed, Scopus, and the Cochrane Library were searched for English-language articles from January 2022 through September 2025 using the terms "autologous serum," "dry eye disease," "dry eye syndrome," "dry eye," and "DED." Evidence suggests that AS tears diluted to 20% are widely used for moderate DED, whereas higher concentrations may provide faster, more pronounced and more durable improvements, particularly in severe cases. Levofloxacin-containing eye drops, artificial tears without emphasis on a specific component, sodium hyaluronate (SH)-containing eye drops, cyclosporine A (CsA)-containing ultra-nano emulsions, and methylcellulose have been investigated as alternatives to conventional diluents. Standardization of clotting, centrifugation and storage parameters is expected to enhance efficacy of AS tears and ensure stability of growth factors. Combination with estrogen replacement therapy in perimenopausal women or with topical insulin eye drops, as well as perioperative prophylactic use in patients with graft-versus-host disease (GVHD)-associated dry eye undergoing cataract surgery, represent emerging applications of AS tears that demonstrate potential to improve therapeutic outcomes. Overall, this perspective highlights the need for consensus protocols, supports severity-based concentration tailoring, and notes that diluents and processing methods require further refinement.

Retinal detachment (RD) is a sight-threatening emergency requiring urgent intervention to prevent permanent vision loss. While both environmental and genetic risk factors contribute to RD, its complete genetic architecture remains unknown. Here, we performed the largest whole genome sequencing-based case-control study in RD to date, including data from 7,276 RD cases and 236,741 controls in the UK Biobank. Through variant- and gene-level association analyses, we identified VSX2 as a genetic determinant of RD risk while confirming established associations including FAT3, RDH5, and COL2A1. Gene-level collapsing analysis revealed that rare heterozygous missense variants in VSX2 confer a 2.8-fold increased risk of RD (p = 2.4x10-10; odds ratio (OR) = 2.8; 95% confidence interval (CI): [2.1, 3.7]). One missense variant in this gene, p.Glu218Asp, demonstrated a particularly strong effect size (p = 9.3x10-10; OR = 5.9; 95% CI: [3.7, 9.4]). Replication analyses in two additional cohorts, totaling 1,331 cases and 52,355 controls strengthened both the gene- and variant-level associations even further (p = 1.4x10-10 and 1.1x10-11, respectively). Other contributory heterozygous variants included previously reported pathogenic homozygous variants for anophthalmia and microphthalmia. These findings thus reveal a previously unknown gene dosage curve for VSX2, where homozygous mutations cause severe developmental eye disorders and heterozygous mutations cause adult-onset retinal detachment. Extending this observation, we found a significant enrichment for other known recessive Mendelian eye disease genes among nominally significant (p < 0.05) genes associated with RD in the collapsing analysis. This work provides a compelling example of how heterozygous variants in recessive disease genes can be associated with less severe clinical phenotypes.

Metformin has been identified as a potential treatment for age-related macular degeneration (AMD). Photographic screening for diabetic retinopathy provides an opportunity to conduct a case-control study with systematic AMD grading. We aimed to investigate associations between metformin use and incidence and progression of AMD at different grades. We randomly sampled 2600 participants from 10 336 people aged ≥50 years with diabetes who attended retinopathy screening in 2011 (baseline) and were enrolled to the Individualised Screening for Diabetic Retinopathy study. 2545 of these participants had type 2 diabetes and gradable fundus photographs at baseline, which were graded using modified age related eye disease study grading. We used data including those on metformin prescription from general practitioner records. We used multivariate logistic regression to investigate associations between metformin and incidence or progression of early, intermediate and late AMD. Of 2545 participants, 2089 attended and had gradable fundus images on year 5. Metformin was associated with reduced incidence of intermediate AMD by 5 years after adjusting for confounders (complete record OR 0.63, 95% CI 0.43 to 0.92, p=0.02). In univariate analysis, metformin was associated with reduced incidence of late AMD (OR 0.43, 95% CI 0.21 to 0.88, p=0.02) but this did not remain significant after adjusting for age and sex. The numbers progressing to late AMD were small. There was no association between metformin and the incidence of early AMD. We have found a significant association between metformin use and reduction in incidence of intermediate AMD by 37% in people with diabetes over 5 years. Previous epidemiological studies of metformin and AMD have used secondary data on AMD. In this observational study, there were baseline differences between groups, although significant findings remained after adjusting for important confounders. Given metformin's anti-ageing therapeutic effects, the reduction in risk is plausible and warrants prospective clinical trials.

Improvement of an eye disease detection model by using the denoising diffusion implicit model.