Miguel Angel Zapata

Purpose To evaluate the prevalence, severity, and temporal trends of myopia among patients attending optometric telemedicine screenings across Spain, and to describe age-specific distributions over time. Methods This retrospective, observational study analysed refractive data from 500,432 eyes of 269,868 patients evaluated at optometric centres nationwide in Spain within the UpRetina network between 2016 and 2024. Spherical equivalent (SE) values classified eyes into mild (SE ≤ − 0.50 D to − 3.00 D), moderate (–3.00 D to − 6.00 D), and high myopia (SE ≤ − 6.00 D). Both eyes were included when valid refractive data were available. Temporal trends were assessed by year and age. Descriptive and inferential statistics determined prevalence, SE distributions, and temporal changes. Results Among 500,432 eyes analysed, 104,497 (20.9%) were myopic. Of these, 60.1% were mild, 30.3% moderate, and 14.1% high myopia. Mean SE values were − 1.57 D (SD 0.68) for mild, − 4.18 D (SD 0.84) for moderate, and − 8.58 D (SD 2.92) for high myopia. High myopia was most prevalent in adults aged 20–40 years (16.2–16.9%). Mild myopia predominated in the youngest (< 10 years) and oldest (> 70 years) age groups. Temporal trends in myopia prevalence and severity were analysed across the study period (2016–2024) and stratified by age groups, revealing a slight increase in mild myopia (55.2% to 58.9%), stability in moderate myopia (28.9% to 28.7%), and a gradual decrease in high myopia (15.9% to 12.4%). Conclusions This nationwide study provides an updated overview of myopia prevalence and severity in Spain, highlighting a substantial burden, particularly of high myopia among young adults. Telemedicine in optometric centres offers a potential efficient approach for population-based screening, enabling early detection and targeted public health strategies to manage myopia and its complications.

BACKGROUND The use of Artificial intelligence (AI) algorithms for detecting different ophthalmic diseases, especially diabetic retinopathy (DR), has become increasingly popular. OBJECTIVE To evaluate the screening performance of different AI algorithms based on convolutional neural networks (CNNs) in a real-world scenario METHODS Observational and cross-sectional study conducted on patients aged ≥18 years with type-2 diabetes mellitus, who had undergone fundus examination for DR screening using a teleophthalmology program between May and August 2021 in four Catalan primary care centers. Color fundus photos were acquired, using a non-mydriatic camera, and transmitted to the reading center of the ophthalmological clinic. We used the UPRETINA diagnostic system, which consists of 8 AI algorithms based on CNN's. Sensitivity and specificity; inter- and intra-observer agreement; and area under the receiver operating characteristic curve (AUROC) were calculated. RESULTS A total of 1652 eyes from 871 patients [1652 images] were analyzed. The AI algorithms had a sensitivity/specificity of 86.8%/95.6% for detecting DR; 94.9%/94.3% for detecting age-related macular degeneration (AMD); 82.7%/92.4% for detecting glaucomatous optic neuropathy (GON); 87.0%/87.5% for detecting epiretinal membrane; and 89.7%/98.0% for detecting nevus. Additionally, the sensitivity/specificity for correctly classify images as right eye/left eye and to correctly classify images gradeability (medium or high quality) were 100% /100% and 92.9%/90.5%, respectively. The AUROC of the AI algorithms ranged between 0.9777 (AMD) and 0.9122 (GON). CONCLUSIONS UPRETINA system algorithms were capable to automatically and accurately classify the screening retinographies, which obviously have a significant impact on reducing workload. In addition, it has been shown to be able to distinguish pathological images from non-pathological ones, leading to a scenario of more efficient optimization of resources, in which retina specialists will be focused on assessing only pathological images. This would also reduce primary-care burden. The incorporation of a greater spectrum of data, always maintaining and guaranteeing patient confidentiality, will help to establish a patient-tailored health care. CLINICALTRIAL ClinicalTRials. Gov NCT04132401. INTERNATIONAL REGISTERED REPORT RR2-10.2196/12539

Aim To explore associations between artificial intelligence (AI)-based fluid compartment quantifications and 12 months visual outcomes in OCT images from a real-world, multicentre, national cohort of naïve neovascular age-related macular degeneration (nAMD) treated eyes. Methods Demographics, visual acuity (VA), drug and number of injections data were collected using a validated web-based tool. Fluid compartment quantifications including intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelial detachment (PED) in the fovea (1 mm), parafovea (3 mm) and perifovea (6 mm) were measured in nanoliters (nL) using a validated AI-tool. Results 452 naïve nAMD eyes presented a mean VA gain of +5.5 letters with a median of 7 injections over 12 months. Baseline foveal IRF associated poorer baseline (44.7 vs 63.4 letters) and final VA (52.1 vs 69.1), SRF better final VA (67.1 vs 59.0) and greater VA gains (+7.1 vs +1.9), and PED poorer baseline (48.8 vs 57.3) and final VA (55.1 vs 64.1). Predicted VA gains were greater for foveal SRF (+6.2 vs +0.6), parafoveal SRF (+6.9 vs +1.3), perifoveal SRF (+6.2 vs −0.1) and parafoveal IRF (+7.4 vs +3.6, all pConclusion This real-world study describes an AI-based analysis of fluid dynamics and defines baseline OCT-based patient profiles that associate 12-month visual outcomes in a large cohort of treated naïve nAMD eyes nationwide.

The purpose of this study is evaluate the efficacy and safety of medicinal products containing the original Age-Related Eye Disease group (AREDS) formulation at doses approved in Europe (EU, control group; n = 59) with a product that adds DHA, lutein, zeaxanthin, resveratrol and hydroxytyrosol to the formula (intervention group; n = 50). This was a multicenter, randomized, observer-blinded trial conducted in patients aged 50 years or older diagnosed with unilateral exudative Age related Macular Degeneration AMD. At month 12, the intervention did not have a significant differential effect on visual acuity compared with the control group, with an estimated treatment difference in Early Treatment Diabetic Retinopathy Study (ETDRS) of −1.63 (95% CI −0.83 to 4.09; p = 0.192). The intervention exhibited a significant and, in most cases, relevant effect in terms of a reduction in some inflammatory cytokines and a greater improvement in the fatty acid profile and serum lutein and zeaxantin concentration. In patients with unilateral wet AMD, the addition of lutein, zeaxanthin, resveratrol, hydroxytyrosol and DHA to the AREDS EU recommended doses in the short-term did not have a differential effect on visual acuity compared to a standard AREDS EU formula but, in addition to improving the fatty acid profile and increasing carotenoid serum levels, may provide a beneficial effect in improving the proinflammatory and proangiogenic profile of patients with AMD.

Purpose To evaluate the prevalence of AMD among optometric telemedicine users in Spain and to identify risk factors. Methods Retrospective analysis of a nationwide database conducted on subjects attending to optometry centers, between January 2013 and December 2019. Fundus photographs were performed by optometrists, using non-mydriatic cameras, and evaluated by a group of 12 retina specialists. Results Among the 119,877 subjects included, the overall prevalence of AMD was 7.6%. The prevalence of early, intermediate, and advanced AMD was 2.9%, 2.7%, and 2.0%, respectively. Of the 9129 AMD subjects, 1161 (12.7%) had geographic atrophy, and 1089 (11.9%) had neovascular AMD, either scar (4.5%) or exudative (7.4%). There was a significant association between AMD and age (per year older, adjusted odds ratio, OR 1.116; 95% CI 1.114 to 1.119, ppp=0.0074). Presence of diabetes was associated with a lower AMD prevalence (p<0.0001). Conclusions The prevalence of AMD (any eye and any severity) was 7.6%, with a prevalence of advanced AMD of 2.0%. Older age and women were significantly associated with a higher prevalence of AMD, whereas myopia and presence of diabetes were associated with significantly lower odds of any AMD.

Purpose To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers. Methods Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24–48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex. Results A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50–59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092–1322). Conclusions Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.