Background: Blindness and vision impairment (BVI) continue to pose significant global public health challenges, disproportionately impacting vulnerable populations and further widening socioeconomic disparities. This study conducts a comprehensive evaluation of the global burden of BVI and the socioeconomic inequalities in its distribution from 1990 to 2021, aiming to provide insights for targeted intervention strategies. Methods: Using data from Global Burden of Disease 2021, this study performed a multiscale analysis of BVI burden, examining patterns at the global, regional and national levels. We quantified the disease burden using disability-adjusted life years DALY and prevalence rates. Temporal trends were analyzed by calculating estimated annual percentage changes (EAPC). Stratified assessments were carried out by sex and age group across 21 regions and 204 countries. The study also included comparative analyses of six major eye conditions and evaluated their associations with socio-demographic index (SDI). Results: Globally, the age-standardized prevalence of BVI increased from 12,453.52 per million (95% UI: 10,287.58-15,226.09) in 1990 to 15,784.33 per million (12,761.44-19,502.32) in 2021, with an EAPC of 1.09% (95% UI: 0.97-1.20). During this period, global DALYs attributable to BVI increased by 37.7%. Disease trends exhibited significant divergence, with near vision loss showing the steepest increase (EAPC: 1.47%), while the prevalence of glaucoma declined (EAPC: -0.73%). Geographic disparities were pronounced, with substantial improvements observed in Equatorial Guinea (EAPC: -1.75) and worsening burdens in Benin (+0.54). Disease distribution demonstrated strong regional clustering, with near vision loss being predominant in Sub-Saharan Africa (64.47%) and East Asia (50.97%), while cataract was the most common condition in Oceania (33.86%). Females consistently bore a higher burden, particularly in South Asia (646.3 vs 563.2 DALYs). Moreover, we identified a strong inverse correlation between SDI and BVI burden (ρ=-0.772 for DALYs). Conclusions: This study highlights the severe global burden of BVI and the significant cross-country inequality, particularly in low- and middle-income countries. It emphasizes the urgent need for targeted interventions and the integration of eye care into universal health policies to promote global health equity in the post-pandemic era.

Background: Blindness and vision impairment (BVI) continue to pose significant global public health challenges, disproportionately impacting vulnerable populations and further widening socioeconomic disparities. This study conducts a comprehensive evaluation of the global burden of BVI and the socioeconomic inequalities in its distribution from 1990 to 2021, aiming to provide insights for targeted intervention strategies. Methods: Using data from Global Burden of Disease 2021, this study performed a multiscale analysis of BVI burden, examining patterns at the global, regional and national levels. We quantified the disease burden using disability-adjusted life years DALY and prevalence rates. Temporal trends were analyzed by calculating estimated annual percentage changes (EAPC). Stratified assessments were carried out by sex and age group across 21 regions and 204 countries. The study also included comparative analyses of six major eye conditions and evaluated their associations with socio-demographic index (SDI). Results: Globally, the age-standardized prevalence of BVI increased from 12,453.52 per million (95% UI: 10,287.58-15,226.09) in 1990 to 15,784.33 per million (12,761.44-19,502.32) in 2021, with an EAPC of 1.09% (95% UI: 0.97-1.20). During this period, global DALYs attributable to BVI increased by 37.7%. Disease trends exhibited significant divergence, with near vision loss showing the steepest increase (EAPC: 1.47%), while the prevalence of glaucoma declined (EAPC: -0.73%). Geographic disparities were pronounced, with substantial improvements observed in Equatorial Guinea (EAPC: -1.75) and worsening burdens in Benin (+0.54). Disease distribution demonstrated strong regional clustering, with near vision loss being predominant in Sub-Saharan Africa (64.47%) and East Asia (50.97%), while cataract was the most common condition in Oceania (33.86%). Females consistently bore a higher burden, particularly in South Asia (646.3 vs 563.2 DALYs). Moreover, we identified a strong inverse correlation between SDI and BVI burden (ρ=-0.772 for DALYs). Conclusions: This study highlights the severe global burden of BVI and the significant cross-country inequality, particularly in low- and middle-income countries. It emphasizes the urgent need for targeted interventions and the integration of eye care into universal health policies to promote global health equity in the post-pandemic era.

Backgrounds: With the rapid development of artificial intelligence (AI), large language models (LLMs) have emerged as a potent tool for invigorating ophthalmology across clinical, educational, and research fields. Their accuracy and reliability have undergone tested. This bibliometric analysis aims to provide an overview of research on LLMs in ophthalmology from both thematic and geographical perspectives. Methods: All existing and highly cited LLM-related ophthalmology research papers published in English up to 24th April 2025 were sourced from Scopus, PubMed, and Web of Science. The characteristics of these publications, including publication output, authors, journals, countries, institutions, citations, and research domains, were analyzed using Biblioshiny and VOSviewer software. Results: A total of 277 articles from 1,459 authors and 89 journals were included in this study. Although relevant publications began to appear in 2019, there was a significant increase starting from 2023. He M and Shi D are the most prolific authors, while Investigative Ophthalmology & Visual Science stands out as the most prominent journal. Most of the top-publishing countries are high-income economies, with the USA taking the lead, and the University of California is the leading institution. VOSviewer identified 5 clusters in the keyword co-occurrence analysis, indicating that current research focuses on the clinical applications of LLMs, particularly in diagnosis and patient education. Conclusions: While LLMs have demonstrated effectiveness in retaining knowledge, their accuracy in image-based diagnosis remains limited. Therefore, future research should investigate fine-tuning strategies and domain-specific adaptations to close this gap. Although research on the applications of LLMs in ophthalmology is still in its early stages, it holds significant potential for advancing the field.

Backgrounds: With the rapid development of artificial intelligence (AI), large language models (LLMs) have emerged as a potent tool for invigorating ophthalmology across clinical, educational, and research fields. Their accuracy and reliability have undergone tested. This bibliometric analysis aims to provide an overview of research on LLMs in ophthalmology from both thematic and geographical perspectives. Methods: All existing and highly cited LLM-related ophthalmology research papers published in English up to 24th April 2025 were sourced from Scopus, PubMed, and Web of Science. The characteristics of these publications, including publication output, authors, journals, countries, institutions, citations, and research domains, were analyzed using Biblioshiny and VOSviewer software. Results: A total of 277 articles from 1,459 authors and 89 journals were included in this study. Although relevant publications began to appear in 2019, there was a significant increase starting from 2023. He M and Shi D are the most prolific authors, while Investigative Ophthalmology & Visual Science stands out as the most prominent journal. Most of the top-publishing countries are high-income economies, with the USA taking the lead, and the University of California is the leading institution. VOSviewer identified 5 clusters in the keyword co-occurrence analysis, indicating that current research focuses on the clinical applications of LLMs, particularly in diagnosis and patient education. Conclusions: While LLMs have demonstrated effectiveness in retaining knowledge, their accuracy in image-based diagnosis remains limited. Therefore, future research should investigate fine-tuning strategies and domain-specific adaptations to close this gap. Although research on the applications of LLMs in ophthalmology is still in its early stages, it holds significant potential for advancing the field.

Objective: Accurate intraocular pressure (IOP) measurement is a cornerstone of glaucoma diagnosis and management. While Goldmann applanation tonometry (GAT) remains the accepted gold standard, technological advancements have introduced alternative methods such as noncontact tonometry (NCT) and the dynamic Scheimpflug-based Corvis ST (CST). This study aims to conduct a rigorous comparative analysis of IOP measurements obtained by NCT, GAT, and CST across a wide spectrum of intraocular pressures. The primary objectives were to evaluate the performance of these devices in both healthy and glaucomatous eyes, assess their intra- and interobserver variability, and determine their level of agreement with the established reference. Methods: In this prospective, comparative study, a total of 212 eyes from 212 subjects were enrolled, comprising 137 eyes of patients with glaucoma and 75 eyes of healthy individuals. All participants underwent IOP measurement using the three devices in a randomized order to minimize bias. Based on the initial GAT readings, eyes were systematically classified into one of four predefined IOP levels: Level A (low, < 10 mmHg), Level B (normal range, 10 – 21 mmHg), Level C (moderately elevated, > 21 to 40 mmHg), and Level D (severely elevated, > 40 mmHg). A mixed-model analysis of variance (ANOVA) was employed to statistically analyze the differences in IOP measurements among the three tonometers at each distinct pressure level. The agreement between each pair of devices (CST vs. GAT, CST vs. NCT, and NCT vs. GAT) was meticulously assessed using Bland-Altman plots, which provide metrics for bias (mean difference) and the 95% limits of agreement (LoA). Results: CST and GAT exhibited better intra- and interobserver variability compared to NCT.  Significant differences in IOP measurements were observed among CST, NCT, and GAT at levels A and D (P<0.001, P=0.030). Bland-Altman analysis revealed biases between CST and GAT, CST and NCT, and NCT and GAT at different levels (level A: -0.61, 0.94, and -1.55 mmHg; level B: 0.16, -0.7, and 0.8; level C: 0.5, 0.5, and -0.1; level D: 0.83, -3.4, and 4.2). Notably, NCT tended to overestimate IOP more at higher levels (level D) and underestimate at lower levels (level A) compared to CST. CST demonstrated better agreement with GAT than NCT did. Conclusions: This study confirms that the Corvis ST (CST) shows superior agreement with the Goldmann applanation tonometer than noncontact tonometry, particularly at low and high IOP ranges. It also exhibits greater measurement consistency. While NCT remains a useful screening tool, its significant over- and underestimation at pressure extremes is a critical limitation. The findings strongly suggest that CST may serve as a more suitable and reliable alternative to NCT for measuring IOP across a broad clinical range. However, the results underscore that these three methods are not directly interchangeable. Clinicians must therefore exercise careful interpretation of IOP values, taking into account the specific tonometer used and the patient's probable pressure level for accurate diagnosis and management of glaucoma.

Objective: Accurate intraocular pressure (IOP) measurement is a cornerstone of glaucoma diagnosis and management. While Goldmann applanation tonometry (GAT) remains the accepted gold standard, technological advancements have introduced alternative methods such as noncontact tonometry (NCT) and the dynamic Scheimpflug-based Corvis ST (CST). This study aims to conduct a rigorous comparative analysis of IOP measurements obtained by NCT, GAT, and CST across a wide spectrum of intraocular pressures. The primary objectives were to evaluate the performance of these devices in both healthy and glaucomatous eyes, assess their intra- and interobserver variability, and determine their level of agreement with the established reference. Methods: In this prospective, comparative study, a total of 212 eyes from 212 subjects were enrolled, comprising 137 eyes of patients with glaucoma and 75 eyes of healthy individuals. All participants underwent IOP measurement using the three devices in a randomized order to minimize bias. Based on the initial GAT readings, eyes were systematically classified into one of four predefined IOP levels: Level A (low, < 10 mmHg), Level B (normal range, 10 – 21 mmHg), Level C (moderately elevated, > 21 to 40 mmHg), and Level D (severely elevated, > 40 mmHg). A mixed-model analysis of variance (ANOVA) was employed to statistically analyze the differences in IOP measurements among the three tonometers at each distinct pressure level. The agreement between each pair of devices (CST vs. GAT, CST vs. NCT, and NCT vs. GAT) was meticulously assessed using Bland-Altman plots, which provide metrics for bias (mean difference) and the 95% limits of agreement (LoA). Results: CST and GAT exhibited better intra- and interobserver variability compared to NCT.  Significant differences in IOP measurements were observed among CST, NCT, and GAT at levels A and D (P<0.001, P=0.030). Bland-Altman analysis revealed biases between CST and GAT, CST and NCT, and NCT and GAT at different levels (level A: -0.61, 0.94, and -1.55 mmHg; level B: 0.16, -0.7, and 0.8; level C: 0.5, 0.5, and -0.1; level D: 0.83, -3.4, and 4.2). Notably, NCT tended to overestimate IOP more at higher levels (level D) and underestimate at lower levels (level A) compared to CST. CST demonstrated better agreement with GAT than NCT did. Conclusions:This study confirms that the Corvis ST (CST) shows superior agreement with the Goldmann applanation tonometer than noncontact tonometry, particularly at low and high IOP ranges. It also exhibits greater measurement consistency. While NCT remains a useful screening tool, its significant over- and underestimation at pressure extremes is a critical limitation. The findings strongly suggest that CST may serve as a more suitable and reliable alternative to NCT for measuring IOP across a broad clinical range. However, the results underscore that these three methods are not directly interchangeable. Clinicians must therefore exercise careful interpretation of IOP values, taking into account the specific tonometer used and the patient's probable pressure level for accurate diagnosis and management of glaucoma.

Objectives: To evaluate the performance of orthokeratology (ortho-k) lens reordering using software-designed system, so as to determine the feasibility of ortho-k lens reordering without discontinuing lens wear. Methods: This study is a retrospective analysis of data of ortho-k lens wearers who had a history of short-term discontinuation of lens wear. A total of 94 individuals aged over 8 years with spherical equivalent refraction ranging from -0.50 to -6.50 diopters were included. The corneal topography data at baseline (before ortho-k) and after lens wear discontinuation (cessation of ortho-k treatment) were imported separately into the lens-design software, along with corresponding refraction data. Subsequently, corneal and lens parameters were generated and compared. Intraclass correlation coefficients (ICC) were calculated, and Bland and Altman analyses were conducted. Results: All 94 children were involved in the retrospective analysis. Compared with baseline data, there was a high level of consistency between Rwo (without discontinuation) and Rwith (with discontinuation), with an ICC of 0.96 (P<0.001). Furthermore, the comparison of lens parameters generated by the Easyfit software between baseline and after short-term discontinuation showed a high degree of  consistency, with all of the ICC values exceeding 0.90. Similar results were obtained using the WAVE software, as both ICC values and Bland-Altman plots demonstrated a high level of consistency in lens parameters between two conditions (nearly all data points fell within the 95% LoAs ). Conclusions: It is feasible to directly reorder new ortho-k lenses using software fitting approaches. However, further investigations are ncessary to validate their practicability in a clinical setting.

Objectives: To evaluate the performance of orthokeratology (ortho-k) lens reordering using software-designed system, so as to determine the feasibility of ortho-k lens reordering without discontinuing lens wear. Methods: This study is a retrospective analysis of data of ortho-k lens wearers who had a history of short-term discontinuation of lens wear. A total of 94 individuals aged over 8 years with spherical equivalent refraction ranging from -0.50 to -6.50 diopters were included. The corneal topography data at baseline (before ortho-k) and after lens wear discontinuation (cessation of ortho-k treatment) were imported separately into the lens-design software, along with corresponding refraction data. Subsequently, corneal and lens parameters were generated and compared. Intraclass correlation coefficients (ICC) were calculated, and Bland and Altman analyses were conducted. Results: All 94 children were involved in the retrospective analysis. Compared with baseline data, there was a high level of consistency between Rwo (without discontinuation) and Rwith (with discontinuation), with an ICC of 0.96 (P<0.001). Furthermore, the comparison of lens parameters generated by the Easyfit software between baseline and after short-term discontinuation showed a high degree of  consistency, with all of the ICC values exceeding 0.90. Similar results were obtained using the WAVE software, as both ICC values and Bland-Altman plots demonstrated a high level of consistency in lens parameters between two conditions (nearly all data points fell within the 95% LoAs ). Conclusions: It is feasible to directly reorder new ortho-k lenses using software fitting approaches. However, further investigations are ncessary to validate their practicability in a clinical setting.

Background: The study aimed to report the distinctive fundus appearance of bilateral asymmetric choroidal melanocytosis and reviewed the clinical and multimodal imaging characteristics to differentiate choroidal melanocytosis from malignant pigmented retinal lesions. Methods: An observational case report and literature review.  Results: A 60-year-old patient underwent comprehensive ophthalmologic examinations.Underfunduscopic examination, bilateral choroidal melanocytosis with asymmetry choroidal pigmentation change was observed. In the right eye, there was diffuse darker coloration extending from posterior pole to the mid-peripheral retina. In the left eye, flat patches of choroidal hyperpigmentation were present, involving superior and inferior hemisphere region, while other regions were depigmented. Spectral-domain optical coherence tomography revealed that the layers of retina and choroid were basically normal, with no elevation of the retinal pigment epithelium.Near infrared reflectance images provided a clearer view of mottled focal hyperpigmentation area, which corresponded to the choroidal hyperpigmentation. Conclusions: This case highlights the effectiveness of multimodal imaging in distinguishing choroidal melanocytosis from malignant entities. It emphasizes the crucial role of multimodal imaging in guiding clinical management to prevent vision-threatening complications and monitor potential malignant transformation.

Background: The study aimed to report the distinctive fundus appearance of bilateral asymmetric choroidal melanocytosis and reviewed the clinical and multimodal imaging characteristics to differentiate choroidal melanocytosis from malignant pigmented retinal lesions. Methods: An observational case report and literature review.  Results: A 60-year-old patient underwent comprehensive ophthalmologic examinations.Underfunduscopic examination, bilateral choroidal melanocytosis with asymmetry choroidal pigmentation change was observed. In the right eye, there was diffuse darker coloration extending from posterior pole to the mid-peripheral retina. In the left eye, flat patches of choroidal hyperpigmentation were present, involving superior and inferior hemisphere region, while other regions were depigmented. Spectral-domain optical coherence tomography revealed that the layers of retina and choroid were basically normal, with no elevation of the retinal pigment epithelium.Near infrared reflectance images provided a clearer view of mottled focal hyperpigmentation area, which corresponded to the choroidal hyperpigmentation. Conclusions: This case highlights the effectiveness of multimodal imaging in distinguishing choroidal melanocytosis from malignant entities. It emphasizes the crucial role of multimodal imaging in guiding clinical management to prevent vision-threatening complications and monitor potential malignant transformation.

Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic ocular syndrome, often associated with significant vision loss and poor prognosis^[1].  BDUMP is typically linked to systemic malignancies, including ovarian, lung, pancreatic, and colorectal cancers^[1]. Here, we reported a case of BDUMP in a 59-year-old male patient who had been misdiagnosed with a nonfunctional adrenal adenoma. This man, with a history of diabetes mellitus and high blood pressure, complained of progressive visual loss in both eyes. He was diagnosed with BDUMP after undergoing comprehensive ophthalmic assessments at our eye center. After being referred to the urology department, he was initially diagnosed with a right nonfunctional adrenal adenoma because his renin-aldosterone levels and serum potassium levels were normal. However, three months later, the adrenal mass rapidly increased in size, and liver metastasis was confirmed. Despite normal tumor marker levels, a histopathological diagnosis ultimately confirmed adrenocortical carcinoma. This case underscores the importance of considering underlying malignancies in patients with BDUMP and highlights the necessity for early systemic evaluation, including imaging studies and multidisciplinary consultations. Timely diagnosis of underlying cancers may improve patient outcomes. It is worth noting that normal hormone levels and a tumor small-sized cannot be used as conclusive evidence that the tumor is a nonfunctional adrenal adenoma; patients with BDUMP should be closely followed up to identify the primary malignancy.

Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic ocular syndrome, often associated with significant vision loss and poor prognosis^[1].  BDUMP is typically linked to systemic malignancies, including ovarian, lung, pancreatic, and colorectal cancers^[1]. Here, we reported a case of BDUMP in a 59-year-old male patient who had been misdiagnosed with a nonfunctional adrenal adenoma. This man, with a history of diabetes mellitus and high blood pressure, complained of progressive visual loss in both eyes. He was diagnosed with BDUMP after undergoing comprehensive ophthalmic assessments at our eye center. After being referred to the urology department, he was initially diagnosed with a right nonfunctional adrenal adenoma because his renin-aldosterone levels and serum potassium levels were normal. However, three months later, the adrenal mass rapidly increased in size, and liver metastasis was confirmed. Despite normal tumor marker levels, a histopathological diagnosis ultimately confirmed adrenocortical carcinoma. This case underscores the importance of considering underlying malignancies in patients with BDUMP and highlights the necessity for early systemic evaluation, including imaging studies and multidisciplinary consultations. Timely diagnosis of underlying cancers may improve patient outcomes. It is worth noting that normal hormone levels and a tumor small-sized cannot be used as conclusive evidence that the tumor is a nonfunctional adrenal adenoma; patients with BDUMP should be closely followed up to identify the primary malignancy.