Ophthalmology

Tirzepatide associated with substantially lower POAG and OHTN risk versus selective GLP-1 receptor agonists

In a nationwide EHR-based cohort, 41,850 tirzepatide initiators were propensity-matched 1:1 to selective GLP-1 RA users with similar comorbidities. Tirzepatide users had lower incident POAG (RR 0.50, 95% CI 0.34–0.74) and ocular hypertension (RR 0.59, 95% CI 0.40–0.88). Risk of initiating first-line glaucoma treatment was also reduced (RR 0.54, 95% CI 0.45–0.64) versus selective GLP-1 RAs. Protective associations persisted in subgroups using metformin or insulin, in patients ≥60 years, and versus individual agents semaglutide and dulaglutide. 1

AI-defined DME phenotypes show distinct responses to anti-VEGF and dexamethasone

Among 114 treatment-naïve DME eyes, Gaussian mixture modeling of quantitative OCT metrics identified three structural phenotypic clusters. Cluster 2 had diffuse, high-volume intraretinal fluid, marked ellipsoid zone disruption, and poorest baseline VA, whereas cluster 1 showed localized central fluid and better vision. Anti-VEGF produced the largest VA gains in cluster 2, with a nonsignificant trend favoring anti-VEGF over dexamethasone for vision in this group. In clusters with localized or intermediate fluid and less structural damage, VA outcomes with dexamethasone and anti-VEGF were similar, but dexamethasone reduced central thickness more in one phenotype. 2

Phase 2b SJP-0132 trial suggests signal on secondary dry eye endpoints but misses primary outcome

This multicenter, double-masked phase 2b trial randomized 344 dry eye patients to SJP-0132 0.1%, 0.3%, 1.0%, or placebo four times daily for four weeks. The primary endpoint, change in total corneal fluorescein staining at week 4, was not significantly improved versus placebo at any dose. Nevertheless, several secondary endpoints showed dose-dependent improvements in symptoms, quality of life, and some objective signs compared with placebo. Benefits appeared by week 1 and persisted through week 4, with the 0.3% dose showing favorable efficacy and safety balance overall. 3

Structured systemic workup in acute isolated PAMM yields frequent serious cerebrovascular findings

This retrospective cohort included 37 patients with new acute visual symptoms and isolated PAMM on multimodal imaging. Among 36 patients undergoing at least partial systemic workup, abnormal findings were identified in 21 of 33 (63.6%). Brain imaging was abnormal in 55% of imaged patients, while carotid disease and echocardiographic abnormalities were found in roughly one-quarter and one-fifth, respectively. Nearly half of cerebrovascular abnormalities on brain imaging were previously undiagnosed despite prior stroke history in some patients. 4