Ozawa Yoko

Abstract Background Retinal pigment epithelial and outer retinal atrophy (RORA) and complete RORA (cRORA) are major determinants of long-term vision in neovascular age-related macular degeneration (nAMD), but their development across subtypes is poorly defined, especially in Asian populations, in whom pachychoroid-driven disease is common. We compared long-term visual outcomes and atrophy burden between the conventional and novel nAMD classifications. Methods One hundred twenty eyes of 120 treatment-naïve patients with nAMD followed at least six years were classified by conventional (typical nAMD [tAMD], polypoidal choroidal vasculopathy [PCV], retinal angiomatous proliferation [RAP]) and novel (drusen type, pachychoroid type, mixed type, other type) schemes. All eyes received three loading anti-VEGF injections followed by a pro re nata regimen. RORA within the central 1 mm was graded on optical coherence tomography; lesions ≥ 250 μm were defined as cRORA. Visual acuity (VA) retention, atrophy prevalence, and VA around atrophy onset were assessed. Results Mean age was 78.0 ± 9.2 years and overall VA retention was 71%. VA retention did not differ among conventional subtypes, but under the novel classification was significantly lower in the drusen type and higher in the pachychoroid type ( P  < 0.01). VA declined significantly after both RORA and cRORA onset (both P  < 0.001). Final RORA/cRORA prevalence was 44.4%/29.6% in tAMD, 50.0%/28.3% in PCV, 83.3%/50.0% in RAP and 76.9%/61.5% in the drusen type, in which cRORA was highest ( P  < 0.05). Conclusions The novel classification distinguished long-term visual outcomes that the conventional classification did not: the drusen type showed the poorest VA retention and highest cRORA prevalence, whereas the pachychoroid type fared best.

AIM: Although growing epidemiological evidence suggests that metabolic risk factors may influence the intraocular pressure (IOP), the specific effects of individual lipid components on IOP regulation remain unclear. In this study, we examined the associations between the serum lipid profiles, individually and in combination, and IOP among 6,786 ophthalmologically healthy adults aged ≥ 40 years residing in Chikusei City, Japan. METHODS: Participants with a history of glaucoma, the use of IOP-lowering medications, or previous ocular surgery were excluded. Comprehensive systemic and ophthalmological evaluations, including blood tests and measurements of IOP and central corneal thickness, were performed. An analysis of covariance was used to assess the associations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels with IOP. RESULTS: After adjusting for several potential confounders, higher LDL-C, HDL-C, and TG levels were significantly associated with increased IOP. Specifically, every 10 mg/dL increase in LDL-C, HDL-C, and TG corresponded to IOP increases of 0.04±0.011 mmHg, 0.13±0.026 mmHg, and 0.02±0.006 mmHg, respectively. Notably, the positive association between LDL-C and IOP was more pronounced in individuals aged ≥ 65 years than in those aged ＜65 years (P for interaction = 0.009). CONCLUSION: These findings suggest that lipid homeostasis may contribute to IOP regulation, particularly in older populations.

Abstract Retinal thickness measured using optical coherence tomography (OCT) is a major parameter to evaluate retinal diseases. However, it may be influenced by systemic factors. We retrospectively analyzed OCT images and blood sample data from 266 participants (49.1 ± 10.5 years) including 181 (68.0%) males who underwent medical checkups at Fujita Medical Innovation Center, Tokyo. Those with retinal pathological findings were excluded. Males had thicker retinas in the center and inner circles of Early Treatment Diabetic Retinopathy Study grid (P < 0.01 for all). Mean thicknesses of the superior areas were greater than those of the inferior areas in inner and outer circles (P < 0.01 for both). However, there were eyes with thicker inner inferior areas (72 eyes, 27.1%), which was observed more frequently in males (P = 0.018). Thicker retinas were associated with lower hemoglobin A1c levels in the center (P = 0.012), and inner temporal (P = 0.042) and inferior (P = 0.047) areas; lower creatinine levels in the inner temporal (P = 0.002), superior (P = 0.026), and inferior (P < 0.001) areas; and higher high-density lipoprotein cholesterol levels in the inner nasal (P = 0.029) and inferior (P = 0.029) areas after adjusting for age and sex. These results may be kept in mind in evaluating OCT data during clinical practice and future clinical trials, although further studies are warranted.