https://ericpazo.orgPublications of Emmanuel Eric Pazo, Associate Professor at Tianjin Medical University Eye Hospital, on myopia, ocular surface disease, retinal imaging, cataract surgery and artificial intelligence in ophthalmology.https://ericpazo.org/publications/2026-an-analysis-of-the-influence-of/https://ericpazo.org/publications/2026-an-analysis-of-the-influence-of/Sun, 01 Mar 2026 00:00:00 GMTChen Zhang, Zijie Fang, Emmanuel Eric Pazo, Fei Li, Shaozhen Zhao. Journal of Refractive Surgery 2026. PURPOSE: To investigate the effect of corneal flap margin space width after femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) on corneal nerve regeneration using in vivo confocal microscopy (IVCM). METHODS: This study assessed 46 consecutive patients who underwent FS-LASIK surgery. Routine examinations after myopic laser surgery were performed. IVCM was performed before and after surgery to observe the flap margin space and regeneration of the corneal subbasal nerve. The average of corneal flap margin space was calculated. Patients were divided into two groups: the wide-space group (> 20 µm) and the narrow-space group (⩽ 20 µm). Central and peripheral (average of 3-, 6-, and 9-o'clock positions) corneal sensitivity was tested by the Cochet-Bonnet esthesiometer and corneal subbasal nerve regeneration was quantitatively analyzed. RESULTS: Postoperatively at days 1 to 90, the incision edge of the narrow-space group showed a high-density linear structure without obvious epithelial cells filling in the space, and the corneal nerve gradually grew from the outside of the flap through the incision edge to the inside of the flap. In the wide-space group, obvious epithelial cells filling in the space were observed from 1 day postoperatively, and the corneal nerve grew less from the outside of the flap through the incision edge to the inside of the flap. There was no significant intergroup difference in the central corneal nerve fiber length. However, the peripheral corneal nerve fiber length in the narrow-space group was significantly higher at both 30 and 90 days postoperatively. No statistically significant differences were observed between groups in central and peripheral corneal sensitivity. There was no significant difference in spherical equivalent between groups at each time point. CONCLUSIONS: Although the postoperative flap margin space significantly affects corneal nerve regeneration, it does not influence corneal sensitivity or the refractive outcome after FS-LASIK.https://ericpazo.org/publications/2026-association-between-mean-ocular-perfusion-pressure/https://ericpazo.org/publications/2026-association-between-mean-ocular-perfusion-pressure/F Gao, H Bo, EE Pazo, H Liying, C Chen, Y Shi, X Zhu, X Li, J Liu. Frontiers in Endocrinology 2026. https://ericpazo.org/publications/2026-automated-deep-learning-based-retinoschisis-and/https://ericpazo.org/publications/2026-automated-deep-learning-based-retinoschisis-and/Tue, 30 Jun 2026 00:00:00 GMTMengdi Chai, Hua Rong, Danyang Yu, Xiu Wang, Di Wu, Emmanuel Eric Pazo, Jiachen Zhang, Ying Liu, Yifan Zhou, Y Y Chen, Anquan Xue, Ruihua Wei. British Journal of Ophthalmology 2026. Purpose This study developed an automated deep learning-based system to quantify retinoschisis and detachment volume (RDV) in pathological myopia (PM) patients undergoing posterior scleral contraction (PSC). Methods A prospective study included 51 PM patients (36 PSC-treated and 15 controls). Based on the myopic traction maculopathy staging system classification, PSC-treated patients were divided into retinoschisis (RS, Stage 2, n=21) and retinal detachment (RD, Stages 3–4, n=15), while controls were classified as Stage 1 (n=15). Swept-source optical coherence tomography (OCT) and angiography imaging was used to acquire retinal data, and a Mask R-CNN model was trained to segment and calculate RDV. The primary outcome measures were regional macular recovery rate, defined as the percentage reduction in RDV at 12 months postoperatively. Clinical parameters such as axial length (AL) and best-corrected visual acuity (BCVA) were analysed. Result The model achieved an Intersection over Union of 80.9%. RDV increased with more advanced stages of myopic traction maculopathy (MTM). As MTM stage advanced, RDV distribution shifted from predominantly parafoveal/perifoveal involvement to foveal involvement. Macular RDV increased progressively with MTM stage (control: 0.94 mm 3 , RS: 5.24 mm 3 , RD: 9.50 mm 3 ; p<0.001). Postoperative AL decreased significantly and BCVA improved significantly (all p<0.001). Postoperative RDV decreased significantly, achieving macular and foveal recovery rates as 80.90% and 99.50%, respectively. AL reduction demonstrated the strongest correlation with foveal RDV changes (r=0.479, p=0.003). Conclusion The Mask R-CNN-based RDV measurement provides a sensitive 3D biomarker for assessing PSC efficacy and monitoring MTM progression. The system offers objective, high-precision quantification of retinal structural changes, addressing limitations of manual OCT analysis. Trial registration number ChiCTR2200065561.https://ericpazo.org/publications/2026-automatic-measurement-and-evaluation-of-anterior/https://ericpazo.org/publications/2026-automatic-measurement-and-evaluation-of-anterior/S Chen, X Chu, EE Pazo, Y Huang, H Liu, C Zhang, R Yang, S Zhao. Graefe's Archive for Clinical and Experimental Ophthalmology 2026. Purpose To develop a deep-learning model capable of measuring essential anterior segment (AS) parameters derived from preoperative ultrasound biomicroscopy (UBM) images of candidates for implantable collamer lens (ICL) surgery. Setting Tianjin Medical University Eye Hospital, Tianjin, China. Design Cross-sectional retrospective study. Methods A dataset comprising 1,480 preoperative panoramic UBM images taken from 638 eyes of 320 subjects was collected and was divided into training and testing subsets at a proportion of 7:3. Using the YOLOv8-pose algorithm, the model identified ten anatomical key point coordinates and computed six relevant AS parameters. Both manual and anterior segment optical coherence tomography-based non-contact measurements served as reference standards for evaluating the model's accuracy. The relationship between postoperative vault and preoperative parameters measured by the model was analyzed using multiple linear regression. Results On the test dataset, the model achieved an intraclass correlation coefficient (ICC) exceeding 0.978, with a mean Euclidean distance of 67.65 ± 54.25 μm across all point locations. The ICC values for anterior chamber depth (ACD), pupil diameter, and sulcus-to-sulcus distance were above 0.980 (95% CI: 0.975 to 0.985), with average relative error below 1.7%. Additionally, postoperative vault at one month was significantly correlated with model-measured parameters, including crystalline lens rise, iris concavity, and ACD (P Conclusion This study introduces a robust program capable of quantitatively measuring AS parameters with accuracy comparable to that of experienced ophthalmologists. The findings provide valuable guidance for ICL sizing and vault prediction.https://ericpazo.org/publications/2026-comparison-between-the-effect-of-intense/https://ericpazo.org/publications/2026-comparison-between-the-effect-of-intense/Wed, 18 Mar 2026 00:00:00 GMTShekhar Jha, Qiwei Li, Yan Jin, Zheng Yang, Hui Liu, Emmanuel Eric Pazo, Shaozhen Zhao, Yue Huang. Photobiomodulation Photomedicine and Laser Surgery 2026. Purpose: Demodex folliculorum infestation is an important contributor to meibomian gland dysfunction (MGD) and chronic ocular surface disease. This study evaluated and compared the therapeutic efficacy of intense pulsed light (IPL) and eyelid hygiene (ELH) for Demodex-associated MGD. Methods: In this prospective, randomized comparative trial, 50 patients (100 eyes) with Demodex-associated MGD were allocated to two arms. Group A ( n = 25) received three Eyesis IPL sessions at baseline, week 2, and week 4. Group B ( n = 25) performed daily eyelid hygiene with OCuSOFT Lid Scrub for 6 weeks. Ocular surface parameters, including ocular surface disease index (OSDI), tear film lipid layer thickness (TFLL), noninvasive tear film break-up time (NITBUT), meibomian gland dropout, meibum quality and expressibility, corneal fluorescein staining (CFS), Schirmer’s I, and Demodex count, were assessed from baseline to week 6. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were recorded at each visit. Results: Both treatments significantly improved OSDI, NITBUT, TFLL, Schirmer’s I, and CFS over 6 weeks (all p < 0.001). Compared with ELH, IPL achieved larger and earlier reductions in symptoms, greater increases in TFLL, and superior improvements in meibum quality and expressibility from week 4 onward (between-group p ≤ 0.021). Demodex counts decreased significantly in both groups with no between-group difference at week 6. BCVA, IOP, and adverse events remained stable, indicating a favorable short-term safety profile. Conclusion: IPL and ELH are effective for Demodex-related MGD, but IPL provides faster and more pronounced improvements in meibomian gland function, tear film stability, and patient-reported symptoms over 6 weeks.https://ericpazo.org/publications/2026-development-of-a-predictive-model-based/https://ericpazo.org/publications/2026-development-of-a-predictive-model-based/Fri, 13 Mar 2026 00:00:00 GMTFuhua Yang, Yi Gong, Xiaoying Pan, Jinzhi Zhao, Rongguo Yu, Liangzhang Tan, Emmanuel Eric Pazo, Xiaomin Zhang, Xiaorong Li. Eye and Vision 2026. BACKGROUND: Intravitreal anti-vascular endothelial growth factor (VEGF) agents improve visual acuity in diabetic macular edema (DME). However, resistance, non-response, or recurrence occurs in many patients. Predictive biomarkers for anti-VEGF response are lacking. We aim to identify cytokine markers predictive of anti-VEGF response and elucidate cytokines involved in poor-response DME pathogenesis. METHODS: A luminex assay was carried out to measure the concentration of cytokines in the aqueous humor. A predictive model based on baseline cytokines was constructed in a discovery set that comprised 46 responders and 20 non-responders. In addition, an analysis of baseline cytokines of 15 responders and 12 non-responders was conducted as a validation set. The performance of the nomogram was determined using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness of fit test. RESULTS: Baseline concentrations of angiogenesis-related cytokines VEGF (P < 0.0001), placenta growth factor (PIGF) (P < 0.0001), angiopoietin-2 (Ang-2) (P < 0.0001), inflammatory factor interleukin-6 (IL-6) (P < 0.0001), IL-8 (P < 0.0001), chemokine monocyte chemoattractant protein-1 (MCP-1) (P < 0.0001), and adhesion factor intercellular adhesion molecule-1 (ICAM-1) (P < 0.001) were significantly increased compared to controls. The prediction nomogram model included five baseline cytokines: VEGF, IL-6, Ang-2, MCP-1, and ICAM-1 were constructed. The AUC for the discovery set was 0.85 (95% CI: 0.74-0.96) and for the internal validation was 0.84, indicating that the prediction model has good predictive accuracy. The Hosmer-Lemeshow goodness of fit test showed good model calibration (P = 0.295). The levels of Ang-2 (P = 0.0042), IL-6 (P < 0.0001), IL-8 (P < 0.0001), MCP-1 (P < 0.0001), and PIGF (P < 0.0001) were still significantly increased at the 6-month timepoint after multiple injections of anti-VEGF drugs for non-response group patients. CONCLUSION: The baseline cytokine-based model helped to assess the individual probability of response to anti-VEGF therapy. There are cytokines beyond VEGF that are involved in the pathogenesis of DME, therapeutic regimens targeting these cytokines may improve the visual acuity and reduce macular edema.https://ericpazo.org/publications/2026-long-term-follow-up-adherence-after/https://ericpazo.org/publications/2026-long-term-follow-up-adherence-after/Thu, 02 Jul 2026 00:00:00 GMTTongxin Niu, Xin Li, Ying Liu, Xin Li, Jingran Cao, Emmanuel Eric Pazo, S Z Zhao, Zhe Jia, Ruibo Yang. Research Square 2026. Abstract Background High myopia carries the risk of sight-threatening complications, including glaucoma, retinal degeneration, and peripheral retinal breaks. Although phakic intraocular lens (PIOL) implantation surgery effectively corrects refractive error and provides good visual outcomes, it does not reduce the ocular risks associated with high myopia. Therefore, regular long-term follow-up remains important for the timely detection of high myopia–related complications in these patients. Methods This mixed-methods study included 2,393 patients with high myopia who underwent V4c implantable collamer lens (ICL) implantation between 2016 and 2023 at a single tertiary center. Long-term follow-up attendance trends were analyzed in a subgroup of 133 patients with available longitudinal follow-up records. A separate subgroup of 128 patients with more than 1 year of completed follow-up was assessed for detected ocular complications. A cross-sectional Knowledge–Attitude–Practice (KAP) survey was conducted among postoperative patients. Of 1,064 distributed questionnaires, 174 valid responses were included in the analysis. Logistic regression was performed to identify factors associated with follow-up adherence. Results Long-term follow-up attendance declined progressively over time, with rates falling below 15% after four years and to 3% by nine years. A total of 174 valid KAP questionnaires were collected and analyzed, with a valid response rate of 16.35% (1,064 questionnaires were distributed). Major barriers included a lack of eye healthcare awareness, absence of symptoms, and limited access to follow-up care. Ocular complications, including normal-tension glaucoma (2.34%) and retinal lesions associated with high myopia (3.13%), were detected during postoperative follow-up examinations. Notably, all confirmed glaucoma cases occurred in patients aged ≥ 40 years. In patients with high myopia, normal intraocular pressure, normal central visual acuity, atypical optic disc morphology, myopic peripapillary atrophy, and a thinner retina may contribute to delayed detection. Logistic regression showed that better knowledge and a positive attitude toward monitoring were independent protective factors for adherence. Conclusions Poor long-term follow-up after ICL implantation may lead to delayed detection of high myopia–related ocular complications. Targeted health education, risk-stratified monitoring for middle-aged and high myopia subgroups, and improved access to care are urgently needed to enhance early detection and prevent irreversible vision loss in these patients.https://ericpazo.org/publications/2026-machine-learning-based-prediction-of-cycloplegic/https://ericpazo.org/publications/2026-machine-learning-based-prediction-of-cycloplegic/Tue, 25 Aug 2026 00:00:00 GMTMengmeng Xia, Boxue Yao, Yumei Wang, Fengwei Liang, Wuxia Zhao, Li Qin, Shoukuan Liu, Muhammad Usama, Zhihui Zhang, Wu Guo, Emmanuel Eric Pazo, Xinjun Ren. Ophthalmology and Therapy 2026. A cross-sectional comparative device study to compare the Eyerobo Vision Screener (VS), a portable handheld photorefractor, against a conventional auto-refractor for machine-learning-based prediction of cycloplegic spherical equivalent (SE) and power vector components (J0, J45) in a pediatric myopia cohort, to evaluate whether supplementary IOL Master biometry narrows the performance gap between devices, and to report screening-oriented classification metrics (sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve [AUC]) at clinically meaningful referral thresholds that quantify the device–model combination’s triage performance. Data from 1129 eyes of 574 patients aged 6–18 years were collected using three ophthalmic devices before and after pharmacological dilation. All refractive measurements were decomposed into power vectors (SE, J0, J45) following Thibos et al. Twelve clinically motivated feature scenarios were constructed from a symmetric framework comparing the Eyerobo VS and auto-refractor (each under predilation, post-dilation, and combined conditions), with and without IOL Master biometry. TabPFN, a tabular foundation model requiring no hyperparameter tuning, was evaluated alongside seven conventional machine-learning algorithms using patient-level five-fold grouped cross-validation repeated over three random seeds. Agreement was assessed using Bland–Altman analysis, Pearson correlation, and clinical threshold analysis. In addition to regression metrics, a screening-classification analysis was performed at three prespecified clinical thresholds (cycloplegic SE $$\le -0.50$$ D, $$\le -3.00$$ D, and $$\le -6.00$$ D), reporting sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and AUC with 95% paired bootstrap confidence intervals. Formal paired statistical comparison between TabPFN and the next-best algorithm and a one-eye-per-patient sensitivity analysis are also reported. TabPFN achieved the lowest mean absolute error (MAE) on all Eyerobo scenarios and was competitive with Ridge on auto-refractor scenarios; on the headline Eyerobo Pre + IOL scenario, the per-eye paired difference in MAE between TabPFN (0.425 D) and the next-best gradient-boosting learner (XGBoost, 0.542 D) was 0.117 D in favour of TabPFN, with paired Wilcoxon signed-rank $$p<0.001$$ . For predilation SE prediction, the auto-refractor achieved an MAE of 0.295 D (87.4% within ± 0.50 D), compared with 0.657 D (61.6%) for the Eyerobo VS. Adding IOL Master biometry to the Eyerobo reduced this gap by 64%, yielding an MAE of 0.425 D (72.0%). For astigmatic power vector components, the gap narrowed further: J0 MAE was 0.106 D (auto-refractor) versus 0.143 D (Eyerobo + IOL), and J45 MAE was 0.060 D versus 0.088 D. Auto-refractor post-dilation predictions approached cycloplegic accuracy (MAE = 0.203 D, 96.0% within ± 0.50 D). Subgroup analysis showed the Eyerobo performed best for mild myopia (MAE = 0.398 D, 75.6% within ± 0.50 D) and degraded for high myopia and the small nonmyopic stratum. In the screening-classification analysis, the Eyerobo and the auto-refractor were operationally equivalent at the any-myopia threshold (Eyerobo AUC 0.964 [95% CI 0.939–0.982], sensitivity 0.946, specificity 0.894; auto-refractor AUC 0.969 [0.948–0.986], sensitivity 0.960, specificity 0.886; paired AUC difference 0.005 [95% CI $$-0.022$$ to $$+0.034$$ ], formally noninferior under a prespecified $$\delta =0.05$$ margin). Within this single-center pediatric referral cohort, the Eyerobo VS combined with machine learning produced cycloplegic SE estimates of a precision consistent with use as a triage adjunct to identify children who should proceed to a full cycloplegic examination, with near-equivalent performance to the auto-refractor for astigmatic components. The addition of IOL Master biometry narrowed the device gap by 64%. TabPFN achieved the best performance among the evaluated algorithms within this cohort and requires no hyperparameter tuning, but the modest margin over linear and gradient-boosting baselines and the absence of external validation preclude any recommendation as the definitive algorithm of choice. The proposed approach is not a substitute for cycloplegic refraction; prospective external validation in a general pediatric screening cohort is required before clinical deployment.https://ericpazo.org/publications/2026-new-approach-for-the-quantitative-assessment/https://ericpazo.org/publications/2026-new-approach-for-the-quantitative-assessment/Wed, 07 Jan 2026 00:00:00 GMTDi Wu, Xu Chu, Qing He, Mengdi Chai, Haoru Li, Xu He, Danyang Yu, Hua Rong, Emmanuel Eric Pazo, Xuejun Zhang, Yue Huang, Ruihua Wei. Translational Vision Science & Technology 2026. Purpose: Current methods for evaluating scleral staphyloma morphology fail to provide curvature data of global scleral deformation. This study aimed to develop a quantitative method based on discrete differential geometry for analyzing scleral deformation caused by staphyloma. Methods: This study retrospectively analyzed 128 eyes of 73 patients with pathological myopia. All patients underwent orbital magnetic resonance imaging and three-dimensional (3D) reconstruction. The discrete Gaussian curvature measures (DGCMs) and discrete mean curvature measures (DMCMs) of all vertices on the ocular 3D model were calculated. We further established a computational method for the degree of scleral staphyloma expansion (E/U ratio). Results: The posterior scleral DGCM (pDGCM) and DMCM (pDMCM) standard deviations (SDs) were significantly greater in the staphyloma group than in the non-staphyloma group (0.069 ± 0.026 vs. 0.025 ± 0.005 and 0.335 ± 0.096 vs. 0.154 ± 0.027, respectively; both P < 0.0001). The E/U ratio was strongly linearly correlated with both the pDGCM and pDMCM SDs (both P < 0.01). For staphyloma diagnosis, the areas under the receiver operating characteristic (ROC) curves for pDGCM and pDMCM SDs were 0.994 (95% confidence interval [CI], 0.984-1.000) and 0.993 (95% CI, 0.982-1.000), respectively (both P < 0.001). Conclusions: The variation in the curvature of the posterior sclera is significantly greater in eyes with staphyloma than in those without. This variation is highly specific and sensitive for staphyloma diagnosis. Translational Relevance: This method, based on discrete differential geometry, enables the direct quantification of scleral deformation, potentially providing a quantitative basis for the diagnosis and evaluation of staphyloma.https://ericpazo.org/publications/2026-predicting-pediatric-myopia-progression-from-single/https://ericpazo.org/publications/2026-predicting-pediatric-myopia-progression-from-single/Sat, 26 Sep 2026 00:00:00 GMTNan Wei, Chaoran Li, Salissou Moutari, Muhammad Usama, Jing Li, Qiaoyan Chen, Emmanuel Eric Pazo, 钱学翰. Journal of Translational Medicine 2026. Pediatric myopia screening captures refractive and biometric measurements but rarely converts them into individualised risk estimates. Whether automated biometric features (pupil diameter, interpupil distance, gaze deviation) add predictive value beyond standard refraction is unevaluated. We developed and internally validated a calibrated multi-outcome risk model using 4,220 screening records from 2,373 children (ages 6–13) from 2018 to 2021. Six outcomes were predicted: high myopia (spherical equivalent $$\:\le\:-3.00$$ D) at 1, 2 and 3 years, mild-to-moderate progression, myopia onset, and rapid progression. Progressively richer feature tiers were compared with patient-grouped cross-validation, patient-clustered bootstrap, DeLong tests with Holm-Bonferroni correction, temporal validation, six comparators, and a pre-specified sex-stratified fairness assessment. Reporting followed TRIPOD + AI. The clinical refraction model (age, sex, spherical equivalent) achieved AUC 0.878 (95% CI 0.815–0.931) for 1-year high myopia, 0.828 at 2 years and 0.795 at 3 years; mild-to-moderate progression reached 0.782 and onset 0.739. Temporal validation preserved discrimination, and no comparator was significantly superior. Biometric features added no discrimination on any outcome, no single feature changing AUC beyond 0.005. After isotonic recalibration, decision curve analysis showed net benefit; at a 30% threshold the 2-year model reached 83.4% sensitivity and 97.1% negative predictive value, without disparity by sex. A parsimonious logistic regression model using only routine screening data predicts pediatric high myopia across multiple horizons. Screening-device biometric features add no incremental value, being correlated with the dominant age and refractive predictors.https://ericpazo.org/publications/2026-repeatability-of-cone-photoreceptor-metrics-with/https://ericpazo.org/publications/2026-repeatability-of-cone-photoreceptor-metrics-with/Fri, 05 Jun 2026 00:00:00 GMTJinyi Jia, Bei Du, Hua Rong, Biying Wang, Emmanuel Eric Pazo, Guihua Liu, Ruihua Wei. British Journal of Ophthalmology 2026. PURPOSE: To evaluate the repeatability of the adaptive optics scanning laser ophthalmoscopy (AO-SLO) system (Mona II) in measuring cone photoreceptor parameters and compare repeatability differences in different retinal regions. METHODS: A total of 126 healthy adults aged between 18 and 36 years with cycloplegic spherical equivalent refraction ≤+0.50 D and >-6.00 D were enrolled. Retinal images were captured at the macular fovea centre (0°, 0°), the temporal, nasal, superior and inferior regions at 1.5° and 3.0° eccentricity. At each region, multiple 2.4°×2.4° images were sequentially captured with 0.9°×2.4° overlap between adjacent regions, covering the detection area within 4.2° centred on the fovea. Three images with clear cone photoreceptors and image quality scores of 0.8 or above were selected from each region for analysis. RESULTS: All parameters of the cone photoreceptors demonstrated excellent repeatability, with intraclass correlation coefficient (ICC) ranging from 0.967 to 0.994. The cone density exhibited good repeatability, with the fovea and the nasal region at 1.5° eccentricity showing the highest ICC (0.992). For the cone spacing, regularity and dispersion also demonstrated high repeatability across all regions (all ICC >0.90). CONCLUSIONS: The Mona II AO-SLO system showed high repeatability in measuring parameters of cone photoreceptors in healthy adults, with consistent performance across retinal area within a 4.2° range. TRIAL REGISTRATION NUMBER: ChiCTR2500114249.https://ericpazo.org/publications/2026-retinal-and-choroidal-changes-in-diabetic/https://ericpazo.org/publications/2026-retinal-and-choroidal-changes-in-diabetic/Fri, 27 Feb 2026 00:00:00 GMTMingming Ma, Yanfei Feng, Juping Liu, Fei Gao, Emmanuel Eric Pazo, Xiaomin Zhang, Xiaorong Li. Journal of Endocrinological Investigation 2026. https://ericpazo.org/publications/2026-stage-specific-associations-of-outdoor-time/https://ericpazo.org/publications/2026-stage-specific-associations-of-outdoor-time/Mon, 14 Sep 2026 00:00:00 GMTBei Du, Desheng Song, Nan Jin, Lin Liu, Xuan Li, Bo Zhang, Jinghui Wang, Meinan He, Lei Wang, Ziyu Zhang, Shuwei Zhang, Emmanuel Eric Pazo, Hua Yan, Ruihua Wei. BMC Public Health 2026. To determine how outdoor time, reading duration, and screen exposure, individually and in combination, affect stage-specific transitions in myopia development among schoolchildren. The longitudinal study included 404,297 primary school students (grades 1–6) participating in the Tianjin Child and Adolescent Research of Eye (TCARE) program from 2021 to 2024. Non-cycloplegic spherical equivalent (SE) was used to classify refractive states (non-myopia, mild, moderate, and high myopia). Cox proportional hazards models were used to quantify the associations with first incident mild, moderate, and high myopia. Multistate Markov models (MSMs) further estimated transition-specific associations for non-myopia, mild to moderate, and moderate to high myopia. The models were adjusted for age, sex, baseline SE, parental myopia, socioeconomic status, and NDVI. Over three years, 148,952 students progressed from non-myopia to mild myopia, 61,480 from mild to moderate myopia, and 7,847 from moderate to high myopia. Outdoor time exceeding 2 h per day was consistently associated with a lower risk of transition from non-myopia to mild myopia (HR, 0.90; 95% CI, 0.86–0.91), corresponding to a population attributable fraction (PAF) of 8.6% (95% CI, 7.2%–10.0%). In contrast, ≥ 2 h per day of reading (HR, 1.05; 95% CI, 1.03–1.06) and screen exposure (HR, 1.03; 95% CI, 1.01–1.04) at baseline were associated with the higher risk of this early transition. Although these associations were statistically significant, their magnitudes were modest and should be interpreted cautiously in terms of individual-level clinical relevance. None of these behaviors showed statistically significant associations with transitions between later myopia stages in multistate analyses. However, complementary analyses of continuous refractive change suggested that baseline outdoor time and screen exposure remained modestly associated with subsequent myopic progression among children with established myopia. All findings were robust across stratified and sensitivity analyses. Behavioral exposures showed stronger associations with the transition from non-myopia to mild myopia than with later transitions. This pattern should be interpreted cautiously because non-cycloplegic refraction may introduce misclassification around the onset threshold and may not necessarily reflect biological differences between myopia onset and progression. These findings underscore the potential relevance of behavioral factors during early refractive development, while suggesting that the strength of behavioral associations may vary across refractive transition stages.https://ericpazo.org/publications/2026-structure-preserving-super-resolution-of-retinal/https://ericpazo.org/publications/2026-structure-preserving-super-resolution-of-retinal/Fri, 30 Jan 2026 00:00:00 GMTEmmanuel Eric Pazo, Salissou Moutari, Fei Gao, Liying Hu, Muhammad Usama, Xiaorong Li, Juping Liu. Frontiers in Medicine 2026. High-resolution retinal fundus images are critical for diagnosing diabetic retinopathy, yet clinical datasets often contain low-resolution images that obscure fine vascular structures essential for accurate diagnosis. Existing super-resolution methods face a fundamental trade-off: convolutional neural networks produce overly smooth results, while generative adversarial networks (GANs) risk creating hallucinated artifacts. We propose the Dual-Transformer Residual Super-Resolution Network (DTRSRN), a hybrid architecture combining Swin Transformers for global context modeling with a parallel residual Convolutional Neural Network (CNN) pathway for fine-grained vascular detail preservation. Our key innovation lies in using Fractal Dimension analysis to quantitatively measure retinal vascular morphology preservation. Experimental results on three benchmark datasets demonstrate that DTRSRN achieves 33.64 dB PSNR for 2 × super-resolution, out performing state-of-the-art methods including SwinIR (+0.96 dB), HAT (+0.37 dB), and ResShift (+0.30 dB). Critically, DTRSRN achieves 17.0% improvement in vascular structure preservation (Δ D f = 0.0987) compared to the best baseline, demonstrating superior clinical relevance for retinal image enhancement.https://ericpazo.org/publications/2026-validation-of-the-eyerobo-fc-portable/https://ericpazo.org/publications/2026-validation-of-the-eyerobo-fc-portable/Wed, 11 Mar 2026 00:00:00 GMTEmmanuel Eric Pazo, Xiangying Liu, Shoukuan Liu, Qinru Zhang, Mingxuan Zhang, Zhihui Zhang, Salissou Moutari, Muhammad Usama, Xinjun Ren. Ophthalmology and Therapy 2026. To validate the diagnostic performance of the Eyerobo FC, a new portable non-mydriatic fundus camera for diabetic retinopathy (DR) screening, against an established desktop fundus camera benchmark using a transfer-learning approach in which artificial intelligence (AI)-based detection algorithms trained on desktop images were applied to Eyerobo FC images. This prospective validation study employed a three-tier experimental design. Tier 1 involved training a deep learning model (EfficientNet-B4) on standard desktop camera images from EyePACS and APTOS 2019 datasets. Tier 2 established the reference standard by evaluating the trained model on the Messidor-2 dataset (N = 1748 eyes) captured with a Topcon TRC NW6 desktop camera (sensitivity 92.7%, 95% CI 91.2–94.2%; AUC 0.952, 95% CI 0.943–0.961). Tier 3 validated the same AI model (without retraining) on images from the Eyerobo FC in a prospective cohort (N = 104 eyes: 52 referable DR, 52 non-referable). The primary outcome was noninferiority of sensitivity and specificity (margin $$\Delta$$ = 10%) compared with the desktop benchmark. Statistical analysis included bootstrap resampling (1000 iterations) for confidence intervals and a one-sided Z-test for the difference of proportions to assess noninferiority. In a balanced cohort of 104 eyes (52 referable DR, 52 non-referable), the Eyerobo FC achieved sensitivity of 92.3% (95% CI 84.4–98.2%) and specificity of 94.2% (95% CI 87.0–100%), demonstrating noninferior performance compared with the desktop benchmark (sensitivity 92.7%, specificity 94.3%). The sensitivity difference of $$-0.4$$ percentage points and the specificity difference of $$-0.1$$ percentage points were both within the noninferiority margin. AUC was 0.977 (95% CI 0.945–0.997) versus 0.952 for the desktop benchmark. The AI model correctly classified 97 of 104 eyes (93.3% accuracy, 95% CI 88.5–98.1%), with 4 false negatives and 3 false positives. Noninferiority was statistically confirmed for both sensitivity and specificity (P < 0.05). Inter-grader agreement was excellent (Cohen’s kappa = 0.917). Nonmydriatic image gradability rate was 94.4%. Grad-CAM visualization confirmed appropriate model attention to hemorrhages, exudates, and microaneurysms rather than artifacts. The Eyerobo fundus camera demonstrates noninferior diagnostic performance (sensitivity 92.3%, specificity 94.2%, AUC 0.977) compared with desktop systems when evaluated with AI algorithms trained exclusively on desktop images. These findings support deploying portable AI-assisted screening in resource-constrained and point-of-care settings, with successful cross-domain transfer learning enabling algorithmic generalizability across imaging platforms.https://ericpazo.org/publications/2025-an-exploration-of-alanine-aminotransferase-alt/https://ericpazo.org/publications/2025-an-exploration-of-alanine-aminotransferase-alt/Sat, 01 Mar 2025 00:00:00 GMTLimei Chen, Xiaoxia Miao, Manqiao Wang, Fei Gao, Emmanuel Eric Pazo, Liying Hu, Chen Chen, Yu Shi, Xiuqing Zhu, Xiaorong Li, Juping Liu. Diabetes Metabolic Syndrome and Obesity 2025. Background and Purpose: Liver metabolism is closely linked to glucose levels. Studies have shown that the aspartate aminotransferase to platelet ratio index (APRI), as a marker of liver fibrosis, is associated with type 2 diabetes mellitus (T2DM). However, the existing evidence remains insufficient to establish this association definitively. Furthermore, no prior studies have investigated the potential relationship between APRI and diabetic retinopathy (DR). This study aimed to investigate the association of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to platelet ratio index (APRI) scores with dysglycemia and DR. Methods: This cross-sectional study analyzed data from 5828 participants aged 50 and older. All participants underwent laboratory blood tests, ophthalmological examinations, and interviews using questionnaires. Multiple linear regression models and receiver operating characteristic (ROC) curves explored the association between ALT and AST APRI scores and dysglycemia. Binary logistic regression was used to analyze the association between ALT and AST APRI scores and DR. Analyses were conducted for males and females separately to examine sex-specific effects. Results: In the multiple linear regression models, ALT and AST APRI scores were associated with fasting blood glucose after adjusting various potential confounders in the whole population or subgroup analysis (all P <0.05). ALT APRI score was superior to AST APRI score in the discrimination of hyperglycemic participants. In the univariate analysis, the ALT and AST APRI scores were associated with DR in the female participants with diabetes (P = 0.043, P=0.022). However, binary logistic regression models found no evident significant association between the ALT and AST APRI scores and DR in the female participants with diabetes (all P>0.05). Conclusion: ALT and AST APRI scores are potential markers for the diagnosis of hyperglycemia, and ALT APRI score is superior to AST APRI score. ALT and AST APRI scores are not independent risk factors for DR.https://ericpazo.org/publications/2025-aqueous-humor-proteome-in-rvo-associated/https://ericpazo.org/publications/2025-aqueous-humor-proteome-in-rvo-associated/Thu, 06 Nov 2025 00:00:00 GMTShoukuan Liu, Mingxuan Zhang, Yifeng Ke, Liangzhang Tan, Emmanuel Eric Pazo, Yongtao Li, Yingxiang Zhao, Xinjun Ren, Xiaorong Li. ACS Omega 2025. High Resolution Image Download MS PowerPoint Slide Purpose: This exploratory study aimed to assess the aqueous humor (AH) proteome in patients with retinal vein occlusion (RVO) and macular edema (ME) receiving three consecutive intravitreal injections of Conbercept, to identify potential molecular pathways, and to generate hypotheses. Methods: Label-free quantitative liquid chromatography-tandem mass spectrometry was applied to analyze the AH of patients with RVO and ME who underwent three consecutive Conbercept intravitreal injections (IVI) and age-matched controls. The alterations in BCVA, central retinal thickness (CRT), and AH proteins were ascertained through a permutation-based calculation (the false discovery rate was set at 0.05). A repeated-measures analysis determined the most significantly changed protein in the AH (α = 0.05). Results: Compared to controls, 45 proteins were regulated in the RVO cohort, with 19 and 48 proteins differentially expressed in the branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) subgroups, respectively. The plasma kallikrein ( P = 0.0007, R = 0.775) and desmocollin-3 ( P = 0.006, R = −0.673) levels were significantly correlated with CRT during treatment in the BRVO. SPARC ( P = 0.007, R = −0.686), vasorin ( P = 0.002, R = −0.759), desmocollin-2 ( P = 0.008, R = −0.676), Neurotrimin ( P = 0.007, R = −0.685), desmocollin-3 ( P = 0.042, R = −0.549), fibulin-1 ( P = 0.011, R = −0.656), and follistatin-related protein-1 ( P = 0.048, R = −0.536) were significantly correlated with CRT during treatment, and desmocollin-2 ( P = 0.025, R = −0.610), desmocollin-3 ( P = 0.021, R = −0.610), plasma kallikrein ( P = 0.0006, R = 0.8), and Neurotrimin ( P = 0.017, R = −0.623) were significantly correlated with changes in patients’ BCVA during treatment in the CRVO. Conclusions: This exploratory proteomic analysis identified distinct pathway alterations in early RVO pathogenesis─metabolic in BRVO and inflammatory in CRVO─and common treatment-related changes: plasma kallikrein was downregulated, while desmocollin-3 was up-regulated.https://ericpazo.org/publications/2025-assessing-the-impact-of-ai-assisted/https://ericpazo.org/publications/2025-assessing-the-impact-of-ai-assisted/Wed, 05 Feb 2025 00:00:00 GMTSile Yu, Chunhong Yan, Guanghao Qin, Emmanuel Eric Pazo, Xiangdong He, Xiangdong He, Peng Qi, Mingze Li, Dongming Han, Wei He, Xingru He, Xingru He. Current Eye Research 2025. PURPOSE: To investigate the effect of an AI-assisted portable slit lamp (iSpector) and basic ophthalmology training on cataract detection, referral, and surgery rate in rural areas. METHODS: This randomized control trial randomly assigned 63 village doctors to either the AI-assisted group (providing iSpector and training) or the control group (providing training). Doctors were followed for 1 year before intervention as a baseline and 1 year after to make the comparison. Multivariable Poisson regression was applied to compare the difference in cataract detection, referral, and surgery rate between the two groups, adjusted for primary doctors' baseline characteristics. We further conducted subgroup analysis to estimate the change after the intervention. RESULTS: Compared to the control group, the detection, referral, and surgery rate of cataracts among the AI-assisted group was comparable, 1.7 times higher, and 4.9 times higher, respectively. Providing iSpector and training increased the detection, referral, and surgery rate of cataracts. However, only based on training to elevate the detection rate of cataracts did not change the referral and surgery rate. CONCLUSIONS: iSpector helps village doctors detect and refer cataract patients appropriately, thus increasing the probability that patients receive cataract surgery.https://ericpazo.org/publications/2025-association-between-maternal-pre-pregnancy-body/https://ericpazo.org/publications/2025-association-between-maternal-pre-pregnancy-body/Mon, 01 Sep 2025 00:00:00 GMTYuanyuan Han, Hongyu Lv, Yidan Cao, Jing Tao Wu, Xiaoyu Zeng, Emmanuel Eric Pazo, Yaxin Zhao, Jia Lv, Wenli Lu, Xuehan Qian, Nan Wei. Clinical ophthalmology 2025. Purpose: To investigate the association between maternal pre-pregnancy body mass index (BMI) and astigmatism and corneal curvature in offspring. Patients and Methods: Corneal topography and an optical biometer were used to measure ocular parameters, while cycloplegic autorefraction was performed to assess cylindrical diopter and axis. Demographic, pregnancy, and offspring-related information was collected through questionnaires. Multiple linear regression analyses were conducted to evaluate the association. Results: A total of 213 mother-child pairs were included. Maternal pre-pregnancy BMI was categorized as underweight (11.3%), normal weight (66.7%), overweight (16.0%), and obese (6.1%). The mean age of the offspring was 6.80 ± 2.44 years (males 49.3%). Offspring born to mothers with overweight or obese pre-pregnancy BMI exhibited significantly higher steep corneal curvature, average corneal curvature, corneal astigmatism, and total astigmatism compared to those in the normal pre-pregnancy BMI group. In multiple linear regression analysis, after adjusting for relevant covariates, pre-pregnancy BMI was positively associated with steep corneal curvature (β=0.35, P=0.005), corneal astigmatism (β=0.21, P=0.001), and total astigmatism (β=0.22, P<0.001). Compared to normal pre-pregnancy BMI, pre-pregnancy obesity was positively associated with offspring steep corneal curvature (β=1.52, P=0.002) and those born to mothers with overweight or obese pre-pregnancy BMI had a significantly higher prevalence of corneal astigmatism (overweight: β=0.56, P=0.001; obese: β=0.55, P=0.038) and total astigmatism (overweight: β=0.47, P=0.002; obese: β=0.59, P=0.010). Conclusion: Offspring of mothers with overweight or obese pre-pregnancy BMI show higher prevalence of developing corneal and total astigmatism compared to the normal.https://ericpazo.org/publications/2025-characteristics-of-biological-parameters-and-implantable/https://ericpazo.org/publications/2025-characteristics-of-biological-parameters-and-implantable/Mon, 03 Mar 2025 00:00:00 GMTFei Ran Li, Yueni Ma, Wenjie Qi, Emmanuel Eric Pazo, Ruibo Yang, Shaozhen Zhao. BMC Ophthalmology 2025. OBJECTIVE: To analyze the characteristics of anterior segment biometric parameters in moderate, high, and super-high myopia eyes for ICL size selection. METHODS: A total of 246 eyes of 131 patients were included in this prospective observational cohort study. Preoperative axis length (AL), central keratometry (Kc), central corneal thickness (CCT), white-to-white (WTW), internal anterior chamber depth (ACD), trabecular iris angle (TIA), anterior chamber width (ACW), angle-to-angle distance (ATA), crystalline lens rise (CLR), lens thickness (LT), sulcus-to-sulcus (STS), ICL size, and postoperative vault at 1 month were recorded and compared among the different degrees of myopia groups. RESULTS: The moderate myopia showed smaller ACD and TIA than high and super-high myopia (P < 0.05). A higher proportion of CLR positive (+) was in the moderate myopia group (65%), while the super-high myopia group had a higher proportion of CLR negative (-) (55.3%). (P = 0.047). There were no statistical differences among the myopia groups in WTW, ATA, ACW, STS, LT, and postoperative vault (P>0.05). In different degrees of myopia groups, vertical ATA, ACW and STS were longer than horizontal ATA, ACW and STS (P < 0.001), and horizontal-STS showed a higher correlation with horizontal-ATA (r = 0.655) and horizontal-ACW (r = 0.660) than with WTW (r = 0.591). The 12.1 mm size ICL was slightly selected in moderate myopia (35.8%) more than high myopia (14.6%) and super-high myopia (26.3%) (P = 0.013). CONCLUSION: Compared to high and super-high myopia, moderate myopic eyes exhibited smaller ACD, TIA while similar WTW, ATA, ACW and STS, with the lens positioned more anteriorly. It should be concerned to the effect of sagittal axis parameters ACD and CLR on the ICL size in different degrees of myopia.https://ericpazo.org/publications/2025-clinicopathological-and-genetic-analysis-of-orbital/https://ericpazo.org/publications/2025-clinicopathological-and-genetic-analysis-of-orbital/Mon, 14 Jul 2025 00:00:00 GMTQing Wang, Zonghan Nan, Xun Liu, Limin Zhu, Emmanuel Eric Pazo, Tianming Jian, Liang Zhao, Jinzhi Zhao, Tingting Lin. BMC Ophthalmology 2025. PURPOSE: To investigate the clinicopathological and genetic characteristics of patients with orbital solitary fibrous tumor (SFT) for clinical reference. METHODS: This single-center retrospective case-series study assessed clinical manifestations, imaging features, treatment, and prognosis of patients with orbital SFT. Immunohistochemical staining and fusion gene detection were also performed. RESULTS: The mean age of monocular orbital SFT patients was 38.89 ± 19.69 years (10 males and 8 females). The most common complaint was unilateral proptosis (68%). Tumors were 2.47 ± 0.67 cm in diameter, primarily oval-like (72%), and located in the upper part of the orbit (82%). Immunohistochemical staining results are as follows: STAT6 + (100%), CD99 + (100%), GRIA2 + (100%), ALDH1 + (95%), CD34 + (86%), Bcl-2 + (62%), EMA + (57%), S-100 + (10%), SMA + (10%), CD31 + (0%), Desmin + (0%), P53 + ( 2-44%), Ki-67( 1-10%), VEGFR1 + (100%), VEGFR2 + (100%), VEGFR3 + (0%), PDGFRα + (90%), PDGFRβ + (100%). Among them, CD99 (95%), ALDH1 (90%), and CD34 (86%) were relatively high in moderate and strong positive expression. Bcl-2 staining score of the primary group was higher than that of the recurrent group, and the difference was statistically significant (P < 0.05). Bcl-2 staining score of the benign group was higher than that of the malignant group, and the difference was statistically significant (P < 0.05). Four NAB2-STAT6 fusion variants were detected in 21 paraffin samples, including 1 case each of NAB2ex4-STAT6ex2 and NAB2ex6-STAT6ex16 and 2 cases each of NAB2ex6-STAT6ex17 and NAB2ex7-STAT6ex4. CONCLUSION: Orbital SFT were found in younger cohorts and smaller in size than other SFT. STAT6, CD99, GRIA2, ALDH1, CD34, and Bcl-2 are sensitive indications for orbital SFT, while CD99, ALDH1 and CD34 are more sensitive. High Bcl-2 expression is more common in primary and benign orbital SFT. The orbital SFT gene fusion variants include NAB2ex4-STAT6ex2, NAB2ex6-STAT6ex16, NAB2ex6-STAT6ex17, and NAB2ex7-STAT6ex4. An in-depth clinicopathological study can help explain orbital SFT.https://ericpazo.org/publications/2025-cognitive-function-correlates-with-retinal-structural/https://ericpazo.org/publications/2025-cognitive-function-correlates-with-retinal-structural/Tue, 01 Jul 2025 00:00:00 GMTManqiao Wang, Li-Mei Chen, Yi Gong, Emmanuel Eric Pazo, Fei Gao, Liying Hu, Chen Chen, Yan Xia Shao, Juping Liu, Xiaorong Li. Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring 2025. Abstract AIM To investigate associations between cognitive status and retinal parameters in older adults. METHODS The population‐based Beichen Eye Study (BCES) recruited 5840 older adults from Tianjin, China. Retinal thickness and vessel density (VD) were measured using optical coherence tomography angiography (OCT/OCTA). Cognitive function was assessed via the Mini‐Mental State Examination (MMSE). Participants with gradable images and valid MMSE scores (n = 3606) were analyzed. RESULTS Cognitive impairment (CI) was identified in 32.7% of participants. Compared to non‐CI individuals, those with CI exhibited reduced average retinal thickness (p = 0.007) and choroid thickness (p < 0.001). Superficial VD (VDSVP) was significantly higher in moderate to severe CI compared to mild CI (p = 0.030). Linear mixed‐effects regression demonstrated positive correlations between MMSE scores and retinal parameters (r = 0.518 to 0.530). CONCLUSION Retinal thinning may occur in mild CI, with VD changes as CI progresses. Choroidal thinning is a potential cognitive indicator. OCT/OCTA, as a non‐invasive tool, offers potential for early cognitive disorder screening in aging populations. Highlights Retinal thinning (average retinal thickness: p = 0.007) and choroidal thinning (p < 0.001) are significantly associated with CI in older adults. A paradoxical increase in VDSVP was observed in moderate to severe CI (p = 0.030), suggesting compensatory vascular remodeling. Choroidal thickness emerges as a robust biomarker for cognitive decline (correlation coefficient range: 0.518 to 0.530). The large‐scale population‐based study (n = 5840) was conducted integrating OCT/OCTA imaging with MMSE cognitive assessments. The study supports OCT/OCTA as a noninvasive, cost‐effective screening tool for early detection of cognitive disorders in resource‐limited settings. The study highlights vascular risk management (e.g., glycemic control, smoking cessation) as a dual target for retinal and cognitive health.https://ericpazo.org/publications/2025-development-and-psychometric-properties-of-a/https://ericpazo.org/publications/2025-development-and-psychometric-properties-of-a/Mon, 06 Jan 2025 00:00:00 GMTLiangzhang Tan, Wenrui Linghu, Meiqi Xu, Shoukuan Liu, Yongtao Li, Yifeng Ke, Emmanuel Eric Pazo, Xinjun Ren. Retina 2025. PURPOSE: To develop and assess the psychometric properties of a quality-of-life (QoL) assessment tool for Chinese patients treated with intravitreal injection (IVI) of anti-vascular endothelial growth factor. METHODS: We developed a 31-item IVI-QoL questionnaire using semistructured patient interviews and expert panel consultation, drawing on a study of the literature. After pretesting on a subset of patients undergoing IVI, the questionnaire was pared down to 23 items. In total, 364 completed questionnaires were received. The IVI-QoL was further developed and evaluated using Rasch analysis. RESULTS: The final IVI-QoL version was constructed with 23 items in four dimensions: visual function, emotional subscale, social function, and healthy behavior, based on item reduction and exploratory factor analysis. The person separation indices for the four subscales ranged from 2.05 to 2.60. No items had a differential item functioning contrast >0.5 logits. The IVI-QoL-23 scale showed satisfactory internal consistency (Cronbach alpha >0.9). CONCLUSION: The IVI-QoL-23 is reliable and valid for evaluating the QoL of Chinese patients treated with IVI of anti-vascular endothelial growth factor drugs.https://ericpazo.org/publications/2025-differential-expression-of-tear-lymphotoxin-immunoglobulin/https://ericpazo.org/publications/2025-differential-expression-of-tear-lymphotoxin-immunoglobulin/Tue, 26 Aug 2025 00:00:00 GMTXiting Jiao, Ning Gao, Dan Wang, Emmanuel Eric Pazo, Yuanyuan Qi, Yueni Ma, Chen Zhang, Ruibo Yang. Current Eye Research 2025. Purpose To evaluate the expression differences of tear lymphotoxin-α (LT-α), total immunoglobulin E (IgE), and matrix metalloproteinase-9 (MMP-9) in seasonal/perennial allergic conjunctivitis-associated dry eye (S/PAC-DE) and their clinical relevance, probing the underlying pathogenesis of S/PAC-DE.Methods This study enrolled 37 S/PAC-DE patients, 23 dry eye (DE) patients, and 24 healthy controls (HC). Assessing the clinical parameters, tear LT-α, total IgE, MMP-9, and nine other inflammatory cytokines in the three groups. Correlations between tear cytokines and clinical parameters were also analyzed.Results Tear LT-α levels were significantly lower in S/PAC-DE compared to DE and HC groups. Tear total IgE, TNF-α, and MMP-9 levels were significantly upregulated in the S/PAC-DE group than those in the DE (all p < 0.001) and HC groups (p = 0.005, p < 0.001, and p = 0.048). In the S/PAC-DE group, total IgE was positively correlated with MMP-9 (r = 0.652, p = 0.008). Total IgE and LT-α were positively correlated in the DE group (r = 0.498, p = 0.016), while the two showed a negative correlation trend in the S/PAC-DE group (r=-0.272, p = 0.103). LT-α was positively correlated with tear film break-up time and negatively correlated with corneal fluorescein staining score in both the S/PAC-DE and DE groups.Conclusions In the S/PAC-DE co-morbid state, the inhibition of tear LT-α expression and the upregulation of the pro-inflammatory cytokines total IgE, TNF-α, and MMP-9 may collectively contribute to the disruption of the ocular surface epithelial barrier, further promoting and exacerbating DE. Additionally, the differences in correlation between LT-α and total IgE in the S/PAC-DE and common DE patients may be related to the distinct ocular immune microenvironments.https://ericpazo.org/publications/2025-efficacy-of-intravitreal-conbercept-in-vitrectomy/https://ericpazo.org/publications/2025-efficacy-of-intravitreal-conbercept-in-vitrectomy/Mon, 01 Sep 2025 00:00:00 GMTGuangda Li, Mingxuan Zhang, Yifeng Ke, Chuanzhen Zheng, Liangzhang Tan, Yongtao Li, Emmanuel Eric Pazo, Chunli Chen, Xinjun Ren. Clinical ophthalmology 2025. Purpose: To evaluate the effectiveness of intravitreal Conbercept administered before or during vitrectomy in patients with proliferative diabetic retinopathy (PDR), additionally, a bibliometric analysis was performed. Methods: The literature search was conducted using keywords and terms combined as follows: "conbercept", "vitrectomy", and "proliferative diabetic retinopathy", from January 2012 to August 2024. Additionally, we conducted three different comparisons. Data for the bibliometric analysis were obtained from the Web of Science database and analyzed using VOSviewer and Bibliometrix applications. Results: A total of 16 studies encompassing 1,215 cases were analyzed in this review. Patients in the Conbercept group demonstrated significantly greater improvements in best corrected visual acuity (BCVA) compared to the no injection group at six-month follow-ups (MD = -0.36, 95% CI -0.45 to -0.28, P < 0.01). Additionally, the Conbercept group experienced fewer intraoperative complications, including reduced incidences of intraoperative bleeding (OR = 0.12, 95% CI 0.07 to 0.21), use of endodiathermy (OR = 0.26, 95% CI 0.15 to 0.47), silicone oil tamponade (OR = 0.50, 95% CI 0.35 to 0.73), and iatrogenic breaks (OR = 0.25, 95% CI 0.13 to 0.48). Both early and late postoperative vitreous hemorrhages were less common in the Conbercept group. When administered during vitrectomy, Conbercept still showed superior BCVA improvement at six months (MD = -0.32, 95% CI -0.46 to -0.18, P < 0.01). No significant difference was found between Conbercept and Ranibizumab in BCVA or intraoperative outcomes. From 2015 to 2025, 5,065 publications on Conbercept emerged, with declining growth but strong global collaboration and relevance in anti-VEGF ocular therapy. Conclusion: This systematic review revealed that, similarly to other anti-VEGF injections, Conbercept injection improved BCVA and had lower rates of intraoperative and postoperative complications. Conbercept research shows strong global collaboration and evolving focus on clinical applications in retinal vascular disease management.https://ericpazo.org/publications/2025-exploring-machine-learning-models-for-vault/https://ericpazo.org/publications/2025-exploring-machine-learning-models-for-vault/Tue, 10 Jun 2025 00:00:00 GMTQing Zhang, Qi Li, Zhilong Yu, Ruibo Yang, Emmanuel Eric Pazo, Yue Huang, Hui Liu, Chen Zhang, Salissou Moutari, Shaozhen Zhao. Ophthalmology and Therapy 2025. INTRODUCTION: Accurate prediction of postoperative vault height following implantable collamer lens (ICL) V4c implantation is critical for minimizing complications and achieving optimal surgical outcomes. This study aims to evaluate the performance of machine learning models in predicting postoperative vault height, focusing on both regression and classification approaches. METHODS: This retrospective study analyzed biometric and demographic data, including anterior chamber depth, white-to-white distance, and ICL size, among other variables. Regression and classification models were developed using gradient boosting, random forest, and CatBoost algorithms. Regression models predicted vault height as a continuous variable, while classification models categorized vault heights into binary and multi-class tasks. Model performance was evaluated using metrics including the mean absolute error (MAE) and root mean squared error (RMSE) for regression models, while accuracy, F1-score, and area under the curve (AUC) were used for classification models. RESULTS: Regression models demonstrated moderate predictive performance, with random forest delivering the best performance (MAE: 134.0 µm, RMSE: 171.3 µm, Pearson's correlation coefficient: 0.45). On the other hand, classification models exhibited greater clinical applicability than regression approaches. For the binary classification task (vault < 250 µm vs. ≥ 250 µm), gradient boosting achieved the highest overall performance, with accuracy of 89 ± 12% and an AUC of 0.89. In the task of predicting vault > 750 µm vs. ≤ 750 µm, random forest emerged as the most effective classifier, achieving accuracy of 86 ± 9% and an AUC of 0.88. In multi-class classification, models demonstrated superior performance in predicting intermediate vault heights (250 µm ≤ vault ≤ 750 µm). Random forest achieved the highest accuracy of 94.6% in this category. However, all models faced challenges in accurately classifying extreme vault categories. CONCLUSIONS: Classification models, particularly gradient boosting and random forest, demonstrated strong potential for predicting clinically significant vault categories, enabling personalized surgical planning and improved risk management. While regression models offered moderate insights, their limitations suggest that classification approaches are better suited for clinical applications. Future research should focus on enhancing model accuracy for extreme vault prediction and integrating advanced techniques, such as ensemble deep learning, to further refine outcomes.https://ericpazo.org/publications/2025-hyaluronic-acid-hydrogel-as-a-retinal/https://ericpazo.org/publications/2025-hyaluronic-acid-hydrogel-as-a-retinal/Mon, 07 Jul 2025 00:00:00 GMTBoshi Liu, Manqiao Wang, Liangzhang Tan, Emmanuel Eric Pazo, Lili Yuan, Qingli Shang, Jingxue Ma, Jianmin Wang, Xiang Ma, Cong Ma, Qinghuai Liu, Jiangdong Ji, Yao Lu, Yong Kang Tao, L Chen, Peiquan Zhao, Jiao Lyn, Qiang Lu, Yan Xia Shao, Xinjun Ren, Xiaorong Li. Clinical and Experimental Ophthalmology 2025. BACKGROUND: To evaluate the efficacy and safety of a linearly cross-linked sodium hyaluronic acid (HA) hydrogel used as a retinal patch in the treatment of rhegmatogenous retinal detachment (RRD). METHODS: This multicenter, randomised, parallel-controlled trial included 313 participants diagnosed with RRD classified as PVR grade A or B, excluding those with giant retinal tears (defined as tears spanning more than one quadrant). Participants were randomly assigned to either an experimental group or a control group. Following laser photocoagulation to retinal breaks, the experimental group received intraocular tamponade with a combination of linearly cross-linked sodium HA hydrogel and sterile air, whereas the control group received intraocular tamponade with perfluoropropane gas (C3F8). According to the intention-to-treat (ITT) principle, the final analysis included 155 subjects in the experimental group and 158 in the control group. The primary outcome measure was the retinal reattachment rate within 24 weeks postoperatively. RESULTS: At 24 weeks, retinal reattachment rates were 91.8% in the experimental group and 91.4% in the control group (p = 0.903), with no statistically significant differences at any follow-up time point. Additionally, there were no significant differences between the two groups regarding best-corrected visual acuity (BCVA), intraocular pressure (IOP), or postoperative complications. CONCLUSIONS: The application of linearly cross-linked sodium HA hydrogel as a retinal patch demonstrated effectiveness comparable to traditional gas tamponade in the treatment of RRD. Furthermore, this method exhibited a favourable safety profile. The technique obviates the need for postoperative prone positioning, significantly improving the patient's postoperative comfort and quality of life. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2000037030.https://ericpazo.org/publications/2025-impact-of-ocular-massage-on-intraocular/https://ericpazo.org/publications/2025-impact-of-ocular-massage-on-intraocular/Tue, 09 Sep 2025 00:00:00 GMTMingxuan Zhang, Luning Qin, Liangzhang Tan, Yongtao Li, Qing Zhang, Shuhan Wang, Zhihui Zhang, Emmanuel Eric Pazo, Xinjun Ren. JMIR Research Protocols 2025. BACKGROUND: Ocular massage has been reported to lower intraocular pressure (IOP) temporarily. This effect could be related to enhanced aqueous humor outflow; however, the mechanism is unclear. OBJECTIVE: This study aims to examine the impact of digital and EyePeace ocular massage on IOP fluctuations and investigate whether the observed reduction in IOP is attributable to morphological changes in the Schlemm canal (SC). METHODS: Participants were randomly assigned in a 1:1:1 ratio to 1 of 3 groups: digital ocular massage, EyePeace ocular massage, or no ocular massage. The primary outcome measure will be IOP. The secondary outcome measures will include anterior segment optical coherence tomography assessment of the SC and trabecular meshwork. In addition, adverse events in the quality of vision will be monitored and documented using a mobile app-based questionnaire. All assessments will be performed at baseline and 10 minutes after the assigned interventions. RESULTS: Data collection was completed in the summer of 2025. The study results are expected to be published by the end of 2025. CONCLUSIONS: This study will investigate the impact of ocular massage on IOP and SC dimensions by using a randomized controlled design. As preliminary evidence suggests that ocular massage may transiently reduce IOP by enhancing aqueous humor outflow, this study will aim to clarify the underlying mechanism. By comparing digital ocular massage, EyePeace ocular massage, and no ocular massage, the study will assess changes in IOP and SC morphology. The findings are expected to provide insights into the role of mechanical manipulation in modulating aqueous humor outflow, potentially informing nonpharmacological strategies for possible glaucoma management. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2400093512; https://www.chictr.org.cn/showproj.html?proj=250459. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/78864.https://ericpazo.org/publications/2025-influence-of-corneal-diameter-on-corneal/https://ericpazo.org/publications/2025-influence-of-corneal-diameter-on-corneal/Thu, 20 Nov 2025 00:00:00 GMTHuanmin Cheng, Qiwei Li, Fan Yang, Emmanuel Eric Pazo, Jonathan Edward Moore, Zhanglin Liu, Ming Sun, Shaozhen Zhao, Yue Huang. Translational Vision Science & Technology 2025. Purpose: The purpose of this study was to investigate the influence of corneal diameter (CD) on corneal biomechanics and biometry parameters to allow more accurate evaluation of refractive surgery patients. Methods: In this cross-sectional study, 203 Chinese participants were categorized into four groups based on CD (group A = CD ≤11.1 mm, group B = CD = 11.2-11.5 mm, group C = CD = 11.6-12 mm, and group D = CD >12.0 mm). Data collected included age, gender, intraocular pressure, spherical equivalent, and parameters from the Pentacam and Corvis ST. Statistical analysis was performed using SPSS software. Results: The study included 203 eyes. For the Pentacam examination, corneal curvature, thinnest pachymetry (TP), back elevations (BEs), corneal elevation difference (front and back), pachymetry progression indices (PPIs), index of surface variance (ISV), keratoconus percentage index (KISA%), and most of the Belin/Ambrósio Enhanced Ectasia Display (BAD) parameters were negatively correlated with CD (linear regression analysis, P < 0.05). The abnormal rate of Pentacam parameters in the CD ≤11.1 mm group was higher than other groups. For Corvis ST, CD was positively correlated with peak distance (PD) and Ambrósio relational thickness to the horizontal profile (Arth), but negatively correlated with tomographic and biomechanical index (TBI) and Corvis biomechanical index (CBI; linear regression analysis, P < 0.05). The CD ≤11.1 mm group demonstrated the highest CBI and TBI values, although these parameters remained within the normal range. Conclusions: Corneal diameter significantly influences Pentacam and Corvis ST parameters, particularly on BE, BAD-D, PPIs, CBI, and TBI. Translational Relevance: Incorporating corneal diameter into preoperative screening may help improve the specificity of keratoconus detection and reduce unnecessary exclusion of eligible refractive surgery candidates with small corneas.https://ericpazo.org/publications/2025-intense-pulsed-light-for-the-treatment/https://ericpazo.org/publications/2025-intense-pulsed-light-for-the-treatment/Mon, 26 May 2025 00:00:00 GMTJunran Li, Bo Yu, Muyao Xin, Yu Sun, Emmanuel Eric Pazo, Xiaoli Xing. Photobiomodulation Photomedicine and Laser Surgery 2025. Objective:Bibliometric study of intense pulsed light (IPL) for dry eye disease (DED) and meibomian gland dysfunction (MGD) to characterize current worldwide patterns and offer visual representations of previous and emerging trends. Background:DED is a prevalent eye condition and IPL has been reported to be an effective therapy for dry eyes. Method:This cross-sectional study examined IPL for DED research evolution and theme trends from 2015 to 2024, using bibliometric analysis of WoSCC data. We examined 4334 IPL articles for publication year, journals, authors, institutions, countries/regions, references, and keywords. Results:We found 111 articles from 2015 to 2024 articles and the annual publication rate was less than 10 from 2015 to 2017, but has steadily increased after 2018. Global publication volumes have increased by 1300% in the past decade, from 2 in 2015 to 28 in 2022. Currently, the number of articles stands at 10 in 2024. IPL for DED was published in 43 journals. Currently, the top journals publishing on this topic according to volume include Photobiomodulation, Photomedicine, and Laser Surgery, Journal of Clinical Medicine, and Cornea. Conclusions:The number of publications and citations on research related to IPL for DED treatment has steadily increased across numerous countries, institutions, and authors over the past decade. The current study illuminates the current trends, global collaboration patterns, fundamental knowledge, research hotspots, and emerging frontiers of IPL treatment. The primary focus now has been the development of innovative solutions for the treatment of DED and MGD by combining IPL with presenting DED treatment regime.