Ophthalmology articles
The most-asked questions in clinic, distilled into readable notes. Based on international literature and clinical guidelines.
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Ophthalmology Board Exam: BCSC Notes and Question Explanations
BCSC chapter notes (public) and explained board-exam questions (sign-in required), with question frequency, disease search and study progress.
Childhood High Myopia: 1-in-3 Maculopathy Progression in 8 Years
A 2026 Am J Ophthalmol 8-year prospective cohort at Zhongshan Ophthalmic Center: 155 high-myopia children, 310 eyes. 31.3% had myopic-maculopathy progression in 8 years; adding the «2-year axial-length change rate» raised prediction accuracy from AUC 0.772 to 0.829, with a best cut-off of ~0.325 mm/year. This article explains how axial length becomes an early-warning tool for maculopathy, the mechanism, high-risk groups, and practical steps for Taiwanese parents.
Refractory Noninfectious Uveitis — RUBI Biologics Trial
The 2026 multicentre RUBI trial compared adalimumab, tocilizumab, and anakinra. Adalimumab and tocilizumab showed no clear difference on the primary endpoint; anakinra was stopped early for insufficient efficacy. This article explains the limitations and why an adult trial cannot be directly extrapolated to Taiwan's paediatric NHI criteria.
Does Sleep Apnea Raise the Risk of AMD? — 2026 Meta-Analysis
A May 2026 systematic review in Am J Ophthalmol by Yaldo et al., pooling 8 studies (3.5M people, incl. Taiwan NHIRD). Key findings: OSA significantly associated with AMD — adjusted aOR 1.44 (moderate certainty, I²=0%); adjusted aHR 1.66; nAMD OR 1.76, non-neovascular 1.95. Mechanisms: intermittent hypoxia → oxidative stress + complement activation + choroidal hypoperfusion. OSA is one of few treatable systemic AMD risk factors, but evidence does not yet support routine screening.
Pterygium Surgery: Recurrence vs Stability — 2026 NMA of 35 RCTs
A network meta-analysis of 35 RCTs (2,501 eyes): recurrence OR 0.39 (95% CI 0.22–0.69) for fibrin glue versus Vicryl. Consider efficacy, safety and cost together.
Diabetic Retinopathy and Dementia Risk — 2026 TriNetX 770K Cohort
A May 2026 TriNetX 770K cohort by Khangura et al.: DR severity tracks stepwise with all-cause and vascular dementia risk; PDR all-cause HR 1.58, VD 2.08; AD risk driven by diabetes itself, no gradient by DR severity. Retinal microvasculature is a visible proxy for systemic microvascular damage — fundus exams can serve as an early dementia risk marker.
Recurrent Stromal Keratitis After HZO — Some recurrent cases had recently stopped steroid drops (2026 ZEDS Trial)
In the ZEDS recurrence analysis, 18 of 48 people not using steroids at the event (38%) had stopped them within the preceding 3 months; this is not the recurrence rate among everyone who stopped. Oral antivirals were newly added at event management in 11/105. This does not mean the others were not already taking them or that all HZO patients can omit antivirals. Treatment and tapering require individualized ophthalmic assessment.
Ophthalmic Trauma — The Overlooked Cause of Preventable Blindness: 2026 AJO Perspective + IGATES Registry
A May 2026 hybrid perspective in Am J Ophthalmol (Agrawal et al., APOTS taskforce) integrating IGATES registry data from 12 countries, 32 centers, 8,238 cases. Key numbers: closed-globe 56.9%, open-globe 34.0%; 70% presented > 12 h after injury; 30% had a final BCVA worse than 6/60 and 7% no light perception; 99% wore no eye protection; home 38.2% > work 19.4% > RTA 8.8% > fireworks 3.5%; AAO estimates up to 90% of eye injuries are preventable with appropriate eyewear. Plus high-risk groups, timing of care, and Taiwan-specific items flagged as needing local verification.
Toric IOL for Cataract — Is It Worth It? Who, How Well, What Risks (2026 International Review)
A June 2026 narrative review in American Journal of Ophthalmology by the ESCRS Functional Vision Working Group integrates 13 systematic reviews, 10+ RCTs, and a 6,431-eye registry. Covers: who is a candidate (regular corneal astigmatism ≥ 1.0 D), preoperative workup, toric IOL vs LRI / FSAK, rotation risk (90–97% within 5°, 0.65% need repositioning), special populations (post-LASIK, keratoconus, PEX, post-keratoplasty, Fuchs/DMEK), and Taiwan's self-pay difference situation.
Why Do My Dry-Eye Symptoms Not Match the Exam? — 2026 DREAM Study, 535 Patients
A February 2026 secondary analysis of the DREAM trial (Matar et al., Am J Ophthalmol; 535 moderate-to-severe DED patients) used 3 methods to evaluate symptom-sign discordance and found 77% of patients had mismatched subjective and objective severity. Covers the 4 phenotypes, who falls where, treatment implications, and Taiwan NHI coverage rules.
Monitoring Childhood Myopia: SER or Axial Length? A 2026 Meta-Analysis Perspective
Published March 2026 in Am J Ophthalmol (Clark & Wong; 70 population-based studies): SER should be the primary monitoring metric for most children; AL should be reserved for the minority entering the long-eye tail. Covers the 'AL 26 mm is not a universal threshold' point, the '90% vs 10%' framework, and which metric best predicts each of retinal pathology / cataract / glaucoma.
Are DIMS Lenses Effective for Pediatric Myopia? Axial Length, Diopters, Evidence & Who Benefits
A new systematic review and meta-analysis (Al-Shammari et al., Am J Ophthalmol, Feb 2026) pooling 6 studies and 1224 children: DIMS lenses preserved ~0.37 D more diopters and ~0.16 mm less axial elongation than single-vision over 12 months. Clinic-friendly digest of the new paper.
Cataract Surgery Deep Selection — Modality, IOL, NHI vs Self-pay
Once you are told you need cataract surgery, what is the next decision? Integrates 2021 AAO PPP, 2025 AAPPO, ESCRS 2024, FEMCAT and Taiwan NHI: 3-modality comparison, IOL classification, monovision warning, astigmatism deep-dive, IOL formula detail, post-LASIK calculation, NHI vs self-pay with sales-pitch warnings, decision tree, 8 Q&As.
Glaucoma Treatment Selection — Decision Logic, Side Effects & Taiwan Reality
Glaucoma treatment is more than 'here's a bottle of drops.' Integrates 2025 AAO PPP, 2022 NICE, LiGHT 6-year, PTVT, EAGLE: SLT vs drops first-line, 5-PGA comparison, PAP warning, other drug-class side effects, Taiwan combination drops list, add-vs-switch logic, MIGS brand guide (iStent, Hydrus, XEN, PreserFlo, Kahook), traditional surgery ladder, angle-closure pathway, Taiwan NHI reality, 8 decision Q&As.
Glaucoma — The Silent Thief of Sight, Red Flags & Treatment Ladder
Glaucoma is a major cause of blindness worldwide; Taiwan elderly prevalence 8.7%. Integrates 2025 AAO POAG/ACG PPPs, 2022 NICE NG81 and European EGS guidelines: types, Taiwan epidemiology (high NTG share), acute angle-closure red flags, diagnostic workup, treatment ladder (SLT first-line, PGA drops, MIGS, trabeculectomy), home self-care and 8 myths debunked.
Cataract Surgery — When, IOL Choice, Complications & Recovery
Integrates 2021 AAO PPP, 2025 AAPPO consensus and 31 GRADE-rated ESCRS recommendations: the three cataract types, risk factors, surgical timing (not by Snellen alone), phaco vs FLACS vs MSICS, monofocal/toric/EDOF/multifocal IOL trade-offs with a radar chart, realistic complication rates (endophthalmitis 0.04-0.2%), PCO and YAG laser, and 8 common myths debunked.
Thyroid Eye Disease — Pathogenesis, Red Flags & Treatment Ladder
20-25% of Graves' patients develop clinically apparent eye disease; smoking raises risk 7-8 fold. Integrating 2021 EUGOGO, 2022 ATA/ETA consensus, and 2025 comparative review — active vs inactive staging, CAS, severity grading, treatment ladder (IVMP+mycophenolate, teprotumumab, emergency decompression), smoking cessation and thyroid control.
6 Key Questions on Lacrimal Gland Tumor — Why pain? Can the eye be saved?
About 20% of lacrimal gland masses are epithelial (half malignant — ~9% overall primary malignancy). Adenoid cystic carcinoma has high perineural invasion and metastasis risk. Reviewing IJO 2024 meta-analysis, MD Anderson proton therapy, and intra-arterial chemotherapy evidence.
6 Floater Red Flags — when do floaters mean retinal emergency?
Will floaters disappear? What does a sudden increase mean? 6 misconceptions about floaters and retinal detachment, citing AAO 2019 PPP and JAMA 2009.
8 pediatric myopia control myths — atropine, ortho-K, red light, outdoor time
Is 0.05% atropine the most effective? Is Ortho-K safe? Should we try red light? Does outdoor time really help? Citing LAMP, ATOM, DIMS, and RLRL — the most complete answer for parents.
8 dry-eye myths — do artificial tears really make eyes drier?
Watery eyes are never dry? Lutein cures dry eye? Warm compresses are pseudoscience? 8 common misconceptions, debunked.