This Week in Ophthalmology — May 21, 2026

Welcome to This Week in Ophthalmology. This week we're covering 10 notable papers spanning the intersection of systemic disease and the eye, new insights in pediatric ophthalmology, and updates in both anterior and posterior segment disease management. Let's dive in.

Our first theme explores the profound connections between systemic health and ophthalmic disease, with large-scale studies on post-COVID complications, atopic dermatitis, and the risks associated with a widely used diabetes medication.

First, a massive binational cohort study published in *The British Journal of Ophthalmology* investigated the long-term ophthalmic risks after SARS-CoV-2 infection [10]. Using data from over 15 million people in South Korea and over 12 million in Japan, researchers found that a prior COVID-19 infection was associated with a long-term increased risk for a host of eye problems. Specifically, the hazard ratio for any ophthalmic disease was 1.23, indicating about a 23% increased risk in the post-acute phase. This included elevated risks for glaucoma, diseases of the cornea and conjunctiva, blepharitis, retinopathy, uveitis, and neuro-ophthalmic conditions. The risk was more pronounced in patients who had experienced severe COVID-19, and while it did decrease over time, it remained significant. These findings were consistent across the pre-Delta, Delta, and Omicron eras, underscoring the need for sustained clinical vigilance for a broad range of eye issues in patients recovering from SARS-CoV-2 infection.

Continuing this theme, a study in *Ophthalmology: Retina* used a large United States health research network to examine the link between atopic dermatitis and retinal detachment [9]. After propensity-score matching over 274,000 patients with atopic dermatitis to controls, the results were striking. At 5 years, patients with atopic dermatitis had a nearly three-fold higher risk of being diagnosed with a retinal detachment and a more than four-and-a-half-fold higher risk of undergoing retinal detachment repair. Furthermore, among those who had surgery, the atopic dermatitis cohort had a higher risk of developing postoperative proliferative vitreoretinopathy, or PVR, and requiring complex retinal detachment repair within six months. The clinical takeaway here is clear: patients with a history of atopic dermatitis may warrant heightened vigilance for symptoms of retinal detachment and may require closer postoperative monitoring after repair.

Finally, a topic of significant current interest: the potential risks of GLP-1 receptor agonists. A systematic review and meta-analysis in *PLoS Medicine* evaluated the association between semaglutide use in patients with type 2 diabetes and the risk of nonarteritic anterior ischemic optic neuropathy, or NAION [4]. Analyzing five observational studies, the researchers found that semaglutide use was associated with a significantly increased hazard of NAION, roughly doubling the relative risk compared to other glucose-lowering therapies. However, it is crucial to put this in perspective. The authors calculated that the absolute risk remains very low, corresponding to approximately one additional case of NAION for every 7,000 semaglutide-treated patients annually. While the evidence certainty is low due to the retrospective nature of the included studies, the findings suggest clinicians should be aware of this potential adverse event, especially in patients with a high baseline risk for optic neuropathies.

Speaking of NAION, our next section takes a deeper dive into new diagnostic and prognostic insights in neuro-ophthalmology and retina.

Building on the discussion of NAION, a study in *Ophthalmology* provides a valuable prognostic tool [8]. This was a secondary analysis of data from a large multicenter NAION trial, including over 700 participants imaged with OCT within 14 days of symptom onset. The key finding was that the early rate of change in optic nerve head swelling was associated with later visual outcomes. Specifically, a greater rate of swelling between the screening visit and the enrollment visit—just a few days apart—was linked to higher odds of both visual field and visual acuity worsening by month six. Conversely, an early reduction in swelling was associated with better outcomes. This suggests that serial OCT scans in the very acute phase of NAION can provide powerful prognostic information. The study also noted that macular ganglion cell-inner plexiform layer thinning was detectable within the first 14 days, preceding more obvious structural atrophy.

Shifting from the optic nerve to the broader retina, a position paper in *Progress in Retinal and Eye Research* outlines the goals of the 'Diabetic Retinal Disease Cure Accelerator' [2]. This initiative, a collaboration between the Mary Tyler Moore Vision Initiative and other groups, brought together over 100 international experts to modernize how we stage diabetic retinal disease. The consensus highlights the urgent need to move beyond current staging systems and validate new structural and functional endpoints. The focus is on early biomarkers that reflect the health of the retinal neurovascular unit, such as retinal nonperfusion, inner retinal thinning, and disorganization of retinal layers on OCT. For function, priorities include contrast sensitivity and electrophysiology. The ultimate goal is to establish a framework that enables precision phenotyping and accelerates the development of targeted, curative therapies. This paper doesn't present new trial data, but it sets the agenda for the next decade of diabetic eye disease research.

Now, let's move to the front of the eye, with three papers covering the cornea, ocular surface, and surgical adjuvants.

First, a landmark publication in the journal *Cornea* presents the second edition of the Global Consensus on Keratoconus and Ectatic Diseases [1]. Ten years after the original, this massive undertaking involved 128 experts from 12 international societies across six continents. Using a formal Delphi method, the panels established updated consensus statements on everything from definition, diagnosis, and staging to clinical management and surgical treatment. This comprehensive document provides revised definitions and expert recommendations that will serve as a foundational guide for ophthalmologists managing keratoconus and other ectatic corneal disorders worldwide.

Complementing this, a review in *Progress in Retinal and Eye Research* provides a comprehensive overview of amniotic membrane in ophthalmology [7]. From its first use in the 1940s, amniotic membrane has become a cornerstone of anterior segment surgery. The review details its biological properties—including its anti-inflammatory, anti-fibrotic, and anti-angiogenic effects—which stem from a rich mix of cytokines and growth factors. While widely used for ocular surface disorders like persistent epithelial defects, chemical burns, and pterygium surgery, the review highlights its expanding applications in other areas, including glaucoma filtration surgery, orbital and eyelid reconstruction, and even strabismus and vitreoretinal surgery. It's a useful summary of the science and broad clinical utility of this versatile biological scaffold.

Finally, a paper in *Ophthalmology* sheds light on a challenging subset of dry eye patients [3]. The study identified what it calls a 'pain-predominant phenotype' in about 7% of patients diagnosed with dry eye disease. This group is characterized by severe symptoms despite having minimal clinical signs. Importantly, this phenotype was strongly associated with a history of migraine and psychiatric disorders, but had a *lower* prevalence of traditional autoimmune conditions. This finding helps clinicians frame the diagnosis for these patients, suggesting that their experience may be driven more by neuropathic pain mechanisms than by classical surface inflammation, which has significant implications for treatment strategies.

Our final theme this week is pediatric ophthalmology, with two papers offering practical guidance on screening and new insights into the genetics of strabismus.

First, a head-to-head diagnostic accuracy study in *JAMA Ophthalmology* compared two common pediatric photoscreening devices [5]. The study, conducted at a single academic center, randomized 139 children to screening with the Spot Vision Screener, which uses traditional autorefraction, and the Blinq vision scanner, which uses a newer mechanism called retinal birefringence scanning. The results were definitive. The traditional autorefraction device demonstrated significantly higher sensitivity for detecting both amblyopia and visually significant refractive error. There was no difference in specificity between the devices. The area under the curve, a measure of overall diagnostic ability, was also lower for the retinal birefringence scanner. The authors conclude that the traditional autorefraction device may be more reliable for comprehensive pediatric vision screening.

Lastly, a study in *Ophthalmology* explored the familial patterns of strabismus by examining the parents of affected children [6]. In a cohort of over 480 parents who underwent orthoptic examination, the rates of abnormal findings were remarkably high. Over 50% of mothers and 60% of fathers had an abnormal sensorimotor exam. Specifically, strabismus itself was diagnosed in 22% of mothers and 28% of fathers. Another key finding was that subnormal stereopsis was very common in the parents, suggesting that reduced stereoacuity may be a subclinical form or endophenotype of strabismus. This is important because it could be used as a measurable trait in large-scale genetic studies to help uncover the complex genetic underpinnings of strabismus. The study powerfully highlights the strong familial nature of the condition.

Editor's Pick

If you only have time for one paper this week, make it the *PLoS Medicine* meta-analysis on semaglutide and NAION risk [4]. With the explosion in GLP-1 agonist use, this paper provides the best current data on a potential link to ischemic optic neuropathy, helping you quantify and communicate that risk to patients.

Clinical Bottom Line

Here are the key takeaways from this week in Ophthalmology.

First: Be aware that patients with a history of SARS-CoV-2 infection, particularly severe cases, may have a modestly increased long-term risk for a range of ophthalmic conditions including glaucoma and retinopathy [10].

Second: In patients with atopic dermatitis, maintain a higher index of suspicion for retinal detachment, as they have a nearly three-fold increased risk. If they undergo retinal detachment repair, monitor them more closely for postoperative PVR [9].

Third: Counsel patients on semaglutide about a possible doubled relative risk of NAION, but emphasize that the absolute risk remains very low, at about one additional case per 7,000 patient-years [4]. For patients who do develop NAION, the rate of optic nerve swelling on OCT in the first two weeks can help prognosticate visual outcomes [8].

Fourth: For pediatric vision screening, a traditional autorefraction-based photoscreener like the Spot Vision Screener demonstrated higher diagnostic sensitivity for amblyopia and refractive error compared to a newer retinal birefringence scanner [5].

And finally: Remember that a subset of dry eye patients, about 7%, present with a pain-predominant phenotype characterized by severe symptoms but minimal signs, which is more strongly linked to migraine and psychiatric conditions than to traditional autoimmune disease [3].

That's your roundup for This Week in Ophthalmology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.