Charles Bonnet Syndrome in Patients with Open-Angle Glaucoma
Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS.
Summary
Prevalence and Correlation to Visual Field Loss
[Posted 20/Jul/2022]
AUDIENCE: Ophthalmology, Family Medicine
KEY FINDINGS: Charles Bonnet Syndrome was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, 1 of 3 patients with CBS had a BCVA of >=0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms of CBS in patients with glaucomatous VFL even when visual acuity is preserved.
BACKGROUND: Objective of this study is to determine the prevalence and characteristics of Charles Bonnet Syndrome (CBS) and its relation to visual field loss (VFL) in patients with open-angle glaucoma (OAG).
DETAILS: Patients attending the glaucoma outpatient department of the Skane University hospital, Malmo, Sweden, between April 1, 2018, and December 31, 2018, were consecutively evaluated for inclusion. Potentially eligible patients admitting to having complex visual hallucinations were interviewed to explore the characteristics of their hallucinatory experiences. Recent automated visual field examinations were available for all participants, and swept-source OCT was performed in participants with CBS to rule out previously undiagnosed macular pathology. The correlation between potential risk factors and CBS was evaluated with logistic regression analysis. Charles Bonnet Syndrome was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, 1 of 3 patients with CBS had a BCVA of >=0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms of CBS in patients with glaucomatous VFL even when visual acuity is preserved.
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Source: Peters, D., Molander, S., Lomo, T., et al. (2022). Charles Bonnet Syndrome in Patients with Open-Angle Glaucoma: Prevalence and Correlation to Visual Field Loss. Ophthalmology Glaucoma. 2022; 5(3): 337-344. Published: May 1, 2022. DOI: Charles Bonnet Syndrome in Patients with Open-Angle Glaucoma.
Myasthenia Gravis Following the Initiation of Statin Therapy
In this multinational SCCS study, statin initiation may be associated with a significantly increased risk of incident MG during the first 612 months, with a greater magnitude of risk elevation for higher intensity of statin therapy. Considering the rarity of MG as an adverse event, the potential benefits of statin therapy are expected to outweigh the associated risk. Consideration of the possibility of new-onset MG may be advisable within the first 612 months after initiation of statins, especially for medium-to-high-intensity statin therapy.
Summary
A Multinational Self-Controlled Case Series Study
[Posted 2/Apr/2026]
AUDIENCE: Internal Medicine, Neurology
KEY FINDINGS: In this multinational SCCS study, statin initiation may be associated with increased risk of new-onset MG during the first 6-12 months, with greater magnitude of risk elevation for higher intensity statin therapy. Consideration of the possibility of new-onset MG may be advisable within first 6-12 months after initiating statins, especially for medium-to-high-intensity statin therapy.
BACKGROUND: Evidence regarding the risk of new-onset myasthenia gravis (MG) following statin therapy initiation is limited. Purpose of this study is to investigate this potential adverse effect using multinational real-world population-based data.
DETAILS: A self-controlled case series (SCCS) study was conducted using electronic medical records and claims databases from Hong Kong, the United Kingdom (UK) and Japan. Individuals aged >=18 years with first diagnosis of MG and initiated statins were included. Conditional Poisson regression compared the risk of MG in different risk periods (up to 2 years after initiation) with non-exposure period, adjusted for age. Pooled results based on meta-analysis across all study sites were reported. In total, 2267 MG cases were analysed. Combined across all study sites, a significantly increased risk of incident MG was observed during the first year after statin initiation compared to non-exposure period, with a higher risk from Days 0-179 (pooled incidence rate ratio [IRR] [95% CI]: 2.662 [1.276-5.553]) than Days 180-364 (1.407 [1.014-1.954]). No increased risk of MG was observed more than 1 year after statin initiation (1.011 [0.848-1.206]). Moreover, the magnitude of MG risk elevation within the first 180 days after statin initiation was more pronounced with higher intensity statin regimens.
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Copyright © John Wiley & Sons, Inc. All rights reserved
Source: Ka Chun Yan, V., Xu, W., Taniguchi, Y., et al. Myasthenia Gravis Following the Initiation of Statin Therapy: A Multinational Self-Controlled Case Series Study. Journal of Internal Medicine. 2026; 299(4):502-514. Published: April, 2026. DOI: 10.1111/joim.70072Digital Object Identifier (DOI)
Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy
Topical MB-mediated PDT successfully managed HPV-related FEH in an immunocompromised individual with history of valve disease. This outcome supports the need for further validation through clinical trials.
KEY FINDINGS: PDT mediated by MB is an effective and affordable approach for treating FEH associated with HPV in immunosuppressed patients, offering favorable outcomes and improved quality of life.
BACKGROUND: Human papillomavirus (HPV) infections are a major cause of oral lesions, and in individuals living with HIV, lesions such as focal epithelial hyperplasia (FEH) may persist or exhibit atypical features, potentially progressing to more severe conditions if untreated. Managing oral HPV lesions in immunocompromised patients is challenging, as conventional therapies may carry higher risks or show limited efficacy.
DETAILS: This study reports the case of a 49-year-old HIV-positive male with valve disease and arthritis, requiring crutches for mobility. He presented with multiple painless oral lesions, diagnosed as FEH associated with oral HPV, and had previously undergone unsuccessful treatments. Photodynamic therapy (PDT) using methylene blue (MB) and a red laser was proposed as a treatment. Topical MB-mediated PDT successfully cleared the FEH lesions, with no recurrence observed over 24 months.
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Source: de Araújo, J. C., Paiva, H. C., Faara, P. M. M., et al. Long-Term Control of Human Papillomavirus-Related Focal Epithelial Hyperplasia in an Human Immunodeficiency Virus-Positive Patient Using Methylene Blue-Mediated Photodynamic Therapy. A Case Report. Lasers in Surgery and Medicine. 2026; 58(2): 70-73. Published: February, 2026. DOI: 10.1002/lsm.70091
Iris Trabecular Contact on OCT in Angle Closure Progression
Nasal ITC presence and nasal or superior ITC length were associated with greater risk of 72-month progression from PACS to PAC. These findings suggest qualitative detection of ITC provides a practical alternative to ocular biometric analysis for identifying high-risk PACS eyes.
KEY FINDINGS: Nasal ITC presence and nasal or superior ITC length were associated with greater risk of 72-month progression from PACS to PAC. These findings suggest qualitative detection of ITC provides a practical alternative to ocular biometric analysis for identifying high-risk PACS eyes.
BACKGROUND: Ocular biometrics measured by anterior segment optical coherence tomography (AS-OCT) predicts progression from primary angle closure suspect (PACS) to primary angle closure (PAC), but obtaining these measurements is time intensive and requires specialized software. Iridotrabecular contact (ITC), a qualitative feature readily visible on AS-OCT images from multiple devices, offers a potentially more accessible method for risk stratification, but the association between ITC and progression to PAC is unclear. Purpose of this study was to investigate the association of ITC presence and length on AS-OCT images with 72-month progression from PACS to PAC.
DETAILS: This was a single-center population-based retrospective cohort study using data from the prospective Zhongshan Angle Closure Prevention (ZAP) randomized clinical trial. The untreated eyes of trial participants aged 50 to 70 years with bilateral PACS were analyzed for progression to PAC, defined as development of intraocular pressure greater than 24 mm Hg, peripheral anterior synechiae, and/or acute angle closure. ITC250/500/750 was defined as angle-opening distance of 0 mm at 250, 500, and 750 µm anterior to the scleral spur, respectively. ITC less than 250 µm in length was identified by an expert grader in images without ITC250/500/750. ITC extent was defined as the number of sectors with ITC. Risk factors for progression were evaluated using age-adjusted Cox regression models. Study data were analyzed from October 2024 to April 2025. A total of 825 untreated eyes (791 without progression, 34 with progression) of 825 participants (mean [SD] age, 58.7 [5.0] years; 685 female [83.0%]) were eligible. In age-adjusted Cox models, ITC presence in the nasal sector was associated with greater risk of angle closure progression (hazard ratio [HR], 4.68; 95% CI, 1.80-12.17; P = .002; concordance index [C index] = 0.71). Greater ITC length in the nasal (HR, 1.64 per 250 µm in length; 95% CI, 1.23-2.20; P < .001; C index = 0.70) or superior (HR, 1.72 per 250 µm in length; 95% CI, 1.11-2.66; P = .02; C index = 0.67) sector was associated with greater risk of progression. ITC extent and cumulative gonioscopy score were not associated with progression.
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Acute Angle Closure Incidence in a Large Countywide Safety Net Teleretinal Screening Program
AAC risk was less than 1 in 40,000 per dilation in a high-volume TDRS program serving a diverse safety net population, supporting the overall safety of dilation in this setting. Further discussion about AAC risk as a contraindication to dilation is warranted.
KEY FINDINGS: AAC risk was less than 1 in 40,000 per dilation in a high-volume TDRS program serving a diverse safety net population, supporting the overall safety of dilation in this setting. Further discussion about AAC risk as a contraindication to dilation is warranted.
BACKGROUND: Pharmacologic pupillary dilation is vital for eye disease screening but is often avoided due to concerns about triggering acute angle closure (AAC), a sight-threatening ophthalmic emergency. Aim of this study was to assess AAC incidence after dilation and validate the use of International Classification of Diseases (ICD) codes for identifying AAC cases.
DETAILS: his retrospective cohort study used data from a primary care–based teleretinal diabetic retinopathy screening (TDRS) program. Eligible participants were Los Angeles County Department of Health Services patients who underwent teleretinal screening by dilated fundus photography between August 23, 2013, and March 1, 2024. Potential AAC cases were identified using ICD codes for angle closure, including AAC glaucoma, primary angle-closure glaucoma, and anatomical narrow angle, within 3 months of dilation. All urgent care, emergency department, and eye clinic encounters within the next calendar day after TDRS and encounters with Current Procedural Terminology codes for iridectomy/iridotomy or lens extraction within 14 calendar days of TDRS were also identified. Manual medical record review was conducted to verify AAC cases and extract clinical information. Data were analyzed from July 2024 to June 2025. Of 84,008 included patients, 46,255 (55.1%) were female, and the mean (SD) age was 55.4 (10.7) years. There were a total of 168,796 dilations, with a mean (SD) of 2.01 (1.50) dilations per patient. Manual medical record review confirmed 4 AAC cases after dilation: 3 coded as AAC glaucoma and 1 as anatomical narrow angle. The AAC risk was 2.4 (95% CI, 0.05-4.69) per 100,000 dilations (0.002%) or 4.8 (95% CI, 0.10-9.43) per 100,000 patients (0.005%). All 4 AACs occurred in female patients, had narrow angles in the nonpresenting eye on gonioscopy, and presented within 1 day with AAC symptoms, including eye pain and blurry vision.
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Source: Lang, T. Z., Xu, B. Y., Li, Z., et al. Acute Angle Closure Incidence in a Large Countywide Safety Net Teleretinal Screening Program. JAMA Ophthalmology. 2025; 143(11): 883-890. Published: December, 2025. DOI: 10.1001/jamaophthalmol.2025.3162.
Optic Disc Size and Circumpapillary Retinal Nerve Fiber Layer Thinning in Glaucoma
Larger optic disc size is associated with faster cpRNFL thinning in glaucoma, independent of race. Although previous studies have indicated that Black individuals may be at higher risk for glaucoma development, the present study suggests that race may not be a significant predictor of faster cpRNFL thinning when controlling for optic disc size and other clinical and demographic factors in glaucoma.
KEY FINDINGS: Larger optic disc size is associated with faster cpRNFL thinning in glaucoma, independent of race. Although previous studies have indicated that Black individuals may be at higher risk for glaucoma development, the present study suggests that race may not be a significant predictor of faster cpRNFL thinning when controlling for optic disc size and other clinical and demographic factors in glaucoma.
BACKGROUND: Aim of this study is to investigate the association between optic disc size and circumpapillary retinal nerve fiber layer (cpRNFL) thinning in eyes with preperimetric glaucoma and glaucoma.
DETAILS: A total of 841 eyes (554 primary open angle glaucoma and 287 preperimetric glaucoma) from 553 patients who had at least 4 visits and 2 years of follow-up using OCT participated in the study. Multivariable linear mixed-effects modeling was used to estimate the effect of optic disc size on cpRNFL thinning while controlling for covariates. To eliminate the floor effect, eyes with baseline visual field mean deviation less than -14 dB were excluded. Of the participants, 189 (34.2%) were Black, 338 (61.1%) were White, 20 (3.6%) were Asian, and 6 (1.1%) were another race or ethnicity. Mean follow-up period was 5.3 (95% confidence interval [CI], 5.2-5.5) years, and the mean rate of cpRNFL change was -0.54 (95% CI, -0.61 to 0.47) µm/year. After adjusting for covariates with the Littmann's formula correction, larger optic disc size was associated with faster cpRNFL thinning (-0.03; 95% CI, -0.05 to 0.00) µm/year faster per 0.1 mm2 larger; P = 0.034), while no significant differences were found for race and its interaction with optic disc size.
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Source: Nishida, T., Vincent Q., Moghimi, S., et al. (2024). Optic Disc Size and Circumpapillary Retinal Nerve Fiber Layer Thinning in Glaucoma. Ophthalmology Glaucoma. 2025; 8(4): 343-350. Published: July-August, 2025. DOI: 10.1016/j.ogla.2025.02.003.
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