Salem Abu Al-Burak

Purpose: To evaluate the bidirectional association between obstructive sleep apnea (OSA) and keratoconus (KC) in young adults using matched-cohort designs. Methods: Multicenter retrospective cohort study using the TriNetX Research Network. In the forward direction, adults aged 18 to 45 with OSA (ICD-10: G47.33) and evidence of polysomnography were compared with 3 propensity-score–matched comparators: polysomnography-evaluated controls, with and without age restriction, and a general encounter control. In the reverse direction, patients with KC and evidence of corneal imaging (H18.6 with topography, anterior segment OCT, or pachymetry) were compared with 3 parallel cohorts. Comparisons used 1:1 propensity-score matching (caliper 0.2) on demographics, body mass index strata, atopic/metabolic comorbidities, and health care utilization. Hazard ratios (HRs) were estimated at 5 and 10 years. Acute appendicitis served as the prespecified negative control outcome in all comparisons; ingrown nail was additionally evaluated in the general encounter comparator. Results: The forward primary analysis matched 48,954 patients per arm. The 5-year HR for incident KC was 2.01 (95% CI: 1.21–3.32; P = 0.006), stable at 10 years (HR: 2.03, 1.28–3.21), with concordant sensitivity HRs of 1.72 and 1.88. The reverse primary analysis matched 4350 patients per arm. The 5-year HR for incident OSA was nonsignificant (HR: 1.13, 0.91–1.40); the 10-year HR was 1.29 (1.07–1.55; P = 0.008). The negative control was null in all primary comparisons. The E-value for the forward primary HR was 3.45. Conclusions: OSA with evidence of polysomnography was associated with incident KC after adjustment for measured confounders. The reverse direction showed a weaker, time-delayed association requiring cautious interpretation given detection bias. These findings support consideration of sleep evaluation in young adults with suspected corneal ectatic disease; they do not address whether treating OSA alters progression in established KC.

Topic: Do photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) differ in induced ocular higher-order aberrations (HOAs) in myopic adults, and does this vary by ablation profile or excimer laser platform? Clinical Relevance: PRK and LASIK are among the most widely performed refractive procedures worldwide, and both remain standard-of-care options for myopic correction. Despite comparable refractive outcomes, patients frequently report glare, halos, and reduced contrast sensitivity, symptoms linked to induced ocular HOAs. Whether PRK or LASIK confers an optical advantage at the whole-eye level remains unresolved, with prior syntheses focusing primarily on visual acuity and refractive outcomes rather than whole-eye wavefront metrics. Methods: MEDLINE, Embase, CENTRAL, and Web of Science were searched from inception to September 2, 2025 (PROSPERO: CRD420251018863). Comparative studies of PRK vs LASIK in myopic adults reporting induced ocular HOAs were eligible, including randomized trials, prospective cohorts, contralateral-eye studies, and matched retrospective designs. Risk of bias was assessed using Cochrane Risk of Bias 2 and Risk Of Bias In Nonrandomized Studies of Interventions, and random-effects meta-analyses were performed with prespecified subgroup analyses by ablation profile and meta-regression. Results: 13 studies contributed to the primary analysis. PRK induced fewer total ocular HOAs than LASIK overall (mean difference [MD] −0.05 μm; 95% CI: −0.08 to −0.02; I ² = 71%). Wavefront-guided treatments consistently favored PRK (10 comparisons; 411 PRK vs 393 LASIK eyes; MD −0.07 μm; 95% CI: −0.11 to −0.03), while wavefront-optimized treatments showed a nonsignificant trend favoring LASIK (3 comparisons; MD +0.02 μm; 95% CI: −0.04 to +0.08). Platform analyses favored PRK on Technolas 217z and showed no clear difference on VISX Star systems. Ocular spherical aberration and coma did not differ significantly, although leave-one-out sensitivity analyses favored PRK for both. Conclusions: Evidence quality was low, limited by high heterogeneity and predominantly observational designs. The overall PRK advantage in total ocular HOAs is small and dependent on ablation profile and platform rather than procedure type alone. Wavefront-guided PRK may offer a modest optical advantage over LASIK, while wavefront-optimized outcomes are less certain. PRK and LASIK should not be considered optically equivalent, and procedure selection should incorporate ablation strategy and excimer platform rather than procedural preference alone.

Purpose: To describe the longitudinal ophthalmic findings of a maternally related triad with neuropathy, ataxia, and retinitis pigmentosa and explore potential relationships between phenotype and heteroplasmy levels. Methods: A mother, daughter, and son with genetically confirmed neuropathy, ataxia, and retinitis pigmentosa due to the m.8993T>G MT-ATP6 variant (heteroplasmy levels: 38.8%, 76.8%, and 87%, respectively) were followed for 5 years. Assessments included best-corrected visual acuity, slitlamp examination, dilated fundus examination, optical coherence tomography, widefield color fundus imaging, fundus autofluorescence, full-field and multifocal electroretinography, and Goldmann visual field testing. Results: Longitudinal evaluation demonstrated marked intrafamilial variability. Patient 1 demonstrated widespread ellipsoid zone loss and rod–cone dysfunction; Patient 2 exhibited retinal thinning and cone-predominant dysfunction. Patient 3 showed initially normal retinal structure with subtle fundus autofluorescence changes and mild asymmetric functional loss. Conclusions: Despite harboring the same pathogenic MT-ATP6 variant, affected family members exhibited substantial variability in ophthalmic disease severity. Clinical manifestations did not correlate with blood heteroplasmy levels, highlighting the importance of longitudinal multimodal ophthalmic surveillance in patients with neuropathy, ataxia, and retinitis pigmentosa.