Ophthalmology

Switching to noncombustible nicotine/tobacco linked to modestly higher vision-impairing disease risk

In a Korean nationwide cohort of smokers who quit combustible cigarettes, switching to noncombustible nicotine or tobacco products (NNTPs) associated with higher incident major vision-impairing eye disease than complete quitters. Among 32,316 propensity-matched participants followed a mean 4.6 years, incidence was 44.0 vs 41.1 per 1,000 person-years for switchers versus complete quitters. Adjusted subdistribution hazard ratio for major vision-impairing disease with NNTP switching was 1.07 (95% CI, 1.02–1.13). Risk elevation was strongest for diabetic retinopathy and refractive/accommodation disorders, and results persisted across sensitivity analyses. 1

Glaucoma associations stronger when diagnosis plus treatment is required in UK Biobank

In 503,325 UK Biobank participants, glaucoma defined by diagnosis plus treatment had larger biomarker and risk-factor associations than diagnosis alone. For participants in the highest 5% IOPcc, odds were 23.6 for diagnosed-and-treated versus 11.4 for diagnosis-only. Similar magnified odds were seen for the thinnest 5% mRNFL, thinnest 5% mGCL, and highest 5% PRS. These findings indicate glaucoma definitions affect effect sizes in population-scale research and may influence study interpretation. 2

Optometrist-led community monitoring of quiescent nAMD meets noninferiority

The FENETRE randomized trial found community optometrist–led monitoring of quiescent neovascular AMD was noninferior to hospital monitoring for missed reactivation. Among 635 participants with follow-up, false-negative decisions occurred in 3.8% (community) versus 7.8% (hospital), risk difference -3.9 percentage points. Trained, accredited optometrists performed OCT, exams, and online reporting with central reading-center adjudication. Results support redistribution of routine quiescent nAMD monitoring into accredited community settings with quality assurance. 3