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Presbyopia-correcting intraocular lenses (IOLs) represent a fast-growing segment of ophthalmic surgery. The evaluation of lens performance has undergone a fundamental shift: best-corrected visual acuity alone is an insufficient measure of the clinical benefit of premium IOLs, whose true value lies in spectacle independence, visual quality, and visual function in daily activities. In that regard, patient-reported outcome measures (PROMs) are a cornerstone of presbyopia-correcting IOL assessment. This review provides an overview of the current landscape of IOLs, PROM instruments and their limitations, visual function outcomes across IOL types and comorbidities, and future directions. Higher near performance often comes at the cost of greater dysphotopsia, and no single IOL design dominates across all PROM domains. Optimal IOL selection or combination therefore requires identifying which PROM domain matters most to the individual patient. While not absolute contraindications, dry eye disease and prior refractive surgery are the strongest predictors of suboptimal outcomes and therefore warrant careful preoperative consideration. As visual demands increasingly shift toward near and intermediate distances with growing digital device use, clinicians and manufacturers must align IOL design priorities and patient selection with evolving patient needs. The visual function index (VF)-14 questionnaire and most other vision-specific PROM instruments were developed in a pre-digital era and require modernization to remain valid measures of patient success. In an aging active population, multifocal and extended depth of focus IOLs, when matched to the right patients, represent one of surgery's most impactful quality-of-life interventions.

Indonesia faces 3 interlocking medical workforce crises: an absolute specialist deficit projected to reach 70,000 by 2032 (national density of 0.18 per 1000 population vs the Ministry of National Development Planning [Bappenas] target of 0.28), severe maldistribution (with nearly 59% of specialists concentrated in Java), and a structural anomaly in which residents pay tuition while performing essential clinical work. The 2023 Health Law (Law 17/2023) authorized a transformative reform: a hospital-based residency pathway (Rumah Sakit Pendidikan Penyelenggara Utama [primary teaching hospital; RSPPU]) operating in parallel with the long-established university-based system. This study aimed to examine the rationale, policy design, and early implementation of Indonesia's dual hospital-university specialist medical education reform, interpreted through an 8-step change management framework developed by Kotter, and to identify transferable lessons for low- and middle-income countries. We conducted an integrative qualitative policy process review combining two evidence streams: (1) systematic documentary analysis of 19 source documents (17 primary legal, regulatory, and policy instruments plus 2 interministerial joint monitoring site-visit reports) and (2) engagement of 34 key informants through semistructured interviews and focus group discussions (45-120 min), comprising policymakers, collegium representatives, hospital leaders, and residents across all 6 pilot sites, recruited purposively until thematic saturation. Interview and focus group data were analyzed using a hybrid deductive-inductive thematic approach with an 8-step change management framework developed by Kotter as an a priori coding frame, and member checking was completed with 7 of the 34 informants. The reform designated 6 top-tier national referral hospitals as RSPPUs and enrolled 52 residents from 412 applicants (an acceptance rate of 12.6%) across 6 high-need specialties (ophthalmology, cardiology, pediatrics, orthopedics, neurology, and oncology). All 6 pilot sites established functional education units and designated institutional officials, adopted dual accreditation, and operationalized an integrated e-logbook for competency tracking, real-time monitoring of 80-hour duty limits, and anonymous bullying reporting. An interministerial joint monitoring team visited all 6 sites and scored each site as satisfactory or better across governance, curriculum, faculty, infrastructure, and learner support. Four cross-cutting themes emerged: financial-barrier removal, dual-governance pragmatism, accreditation strain, and equity-anchored deployment. Persistent tensions include variable educator compensation across hospitals; however, a standardized national framework remains under development. Mapping to the framework developed by Kotter demonstrated strong evidence for steps 1 to 6 and early evidence for steps 7 to 8. Indonesia's dual hospital-university residency model is a scalable, equity-oriented, and competency-based reform that is operationally feasible and globally aligned in its early implementation. While long-term effectiveness and sustainability await longitudinal evaluation, the design offers a transferable, not yet definitively replicable, template for low- and middle-income countries confronting parallel workforce crises.

Terrestrial carnivores have repeatedly evolved similar ecomorphologies, yet the relationship between dental morphology and diet remains inconsistently predictive and seemingly at odds with this observation. Here we examine the presence of carnivore adaptive zones and this form/function mismatch using a total-evidence phylogeny of living and extinct feliforms, modelling the evolution of body mass and dental toolkit (relative blade length of the lower carnassial). We identify three adaptive zones within feliforms: (1) an ancestral cataract of carnivory, comprising small-bodied, ecologically flexible taxa with largely stochastic dental evolution; (2) the broad ecology cursor, associated with restricted forelimb dexterity and increased reliance on cranial prey processing; and (3) the soft-flesh specialist, defined by strong selection for slicing-dominated dentitions in hypercarnivores. Extending beyond feliforms, we propose a fourth zone, the versatile omnivore, representing a distinct adaptive zone of dietary and morphological flexibility at large size. Across these regimes, dental morphology receives strong selection only in hypercarnivores, resulting in reliable predictions of diet. In contrast, taxa with broader diets show stochastic dental evolution, leading to the frequent misclassification observed in recent studies. This framework reconciles longstanding links between morphology and ecology with their inconsistencies, providing a predictive model for terrestrial carnivore evolution.

To determine whether adults with type 2 diabetes mellitus (T2DM) using cetirizine, ibuprofen, or prednisone have a reduced incidence of diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Retrospective propensity score-matched cohort study. Adults with T2DM and documented eye-care in the TriNetX US Collaborative Network who had two documented uses of cetirizine, ibuprofen, prednisone, fenofibrate, or gabapentin between January 1, 2005, and March 1, 2025. Each drug cohort was 1:1 propensity score-matched on 44 covariates against non-users; fenofibrate served as a positive control, and gabapentin served as both a negative control and an active comparator. Residual confounding was assessed using eight ophthalmic negative-control outcomes (NCOs) and E-values. Nine sensitivity analyses tested comparison to users of gabapentin, alternative outcome windows, a new-user design, glycemic strata, matching for drug indication, and exposure duration. Incident DME and PDR within 3 years of the index date. Matched-pair counts ranged from 18,762 to 86,846. Cetirizine was associated with reduced DME (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.51-0.74) and PDR (HR, 0.59; 95% CI, 0.46-0.77); ibuprofen with reduced DME (HR, 0.63; 95% CI, 0.56-0.69) and PDR (HR, 0.48; 95% CI, 0.41-0.56); and prednisone with reduced DME (HR, 0.46; 95% CI, 0.41-0.52) and PDR (HR, 0.36; 95% CI, 0.30-0.43). Fenofibrate showed associations of similar magnitude (DME HR, 0.57; 95% CI, 0.48-0.68; PDR HR, 0.59; 95% CI, 0.45-0.77); gabapentin showed no association (DME HR, 0.95; 95% CI, 0.88-1.02; PDR HR, 1.04; 95% CI, 0.93-1.15). Point E-values for the investigational drugs ranged from 2.57 to 4.97 (lower 95% CI bound, 1.93 to 4.06). The NCO panel was near null for cetirizine and ibuprofen and showed mild protective bias for prednisone and fenofibrate. Findings persisted across the nine sensitivity analyses. Cetirizine, ibuprofen, and prednisone were associated with reduced incidence of DME and PDR in adults with T2DM, with effect sizes comparable to those of the fenofibrate positive control. These findings support prospective evaluation of anti-inflammatory medications for the prevention of vision-threatening diabetic retinopathy.

Type 1 diabetes is an autoimmune disease that targets and destroys insulin-producing beta cells in the pancreatic islets. The incidence of type 1 diabetes is rising globally. At the clinical diagnosis of type 1 diabetes, between 20% and 67% of children and adolescents present with diabetic ketoacidosis (DKA) requiring hospitalisation, and one-third of these require intensive care. Type 1 diabetes can be detected in early stages, prior to the insulin-requiring clinical diagnosis, through screening for islet autoantibodies (IAbs). Identifying individuals with early-stage type 1 diabetes, combined with monitoring of and education on disease progression, prevents DKA and results in a milder clinical onset. This allows for timely insulin initiation in outpatient settings and improved long-term glucose management. Early diagnosis also enables access to novel disease-modifying therapies that can delay the clinical onset of diabetes. In this international consensus, we provide guidance on the principles and practice of implementing general population screening for IAbs to diagnose early-stage type 1 diabetes. We also outline the minimum requirements for establishing effective population screening programmes to diagnose early-stage type 1 diabetes through IAb detection. This consensus statement has been endorsed by the following professional associations: Advanced Technologies & Treatments for Diabetes (ATTD); Association of Diabetes Care and Education Specialists (ADCES); Association Belge Du Diabète; Associazione Medici Diabetologi (AMD); Australian Diabetes Society (ADS); Belgian Diabetes Liga; Breakthrough T1D; Czech Diabetes Society (ČDS); EASD; Finnish Diabetes Association (FDS); Fondazione Italiana Diabete (FID); International Diabetes Federation (IDF)-Europe; International Society of Paediatric and Adolescent Diabetes (ISPAD); Paediatric Endocrinology Nursing Society (PENS); Polish Diabetes Society; Portuguese Diabetes Association (APDP); Sociedade Portuguesa de Diabetologia (SPD); Società Italiana di Diabetologia (SID); Société Francophone du Diabète (SFD) and Type 1 Diabetes Exchange (T1D Exchange).

In the global phase III TROPION-Breast01 study, datopotamab deruxtecan (Dato-DXd) demonstrated a statistically significant and clinically meaningful improvement in progression-free survival (PFS) by blinded independent central review (BICR) versus investigator's choice of chemotherapy (ICC) in patients with previously treated, inoperable/metastatic hormone receptor(HR)-positive human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer. At the final analysis, overall survival (OS) was not statistically significant. We report final results from the prespecified analysis of patients enrolled in mainland China. Patients with inoperable/metastatic HR+/HER2- breast cancer, who had disease progression on endocrine therapy and for whom endocrine therapy was unsuitable and who had received 1-2 prior lines of chemotherapy in the inoperable/metastatic setting, were randomly assigned 1 : 1 to Dato-DXd (6 mg/kg every 3 weeks) or ICC (eribulin/capecitabine/vinorelbine/gemcitabine). Dual primary endpoints were PFS by BICR and OS. Overall, 83 patients were enrolled in mainland China (Dato-DXd, n = 44; ICC, n = 39). PFS by BICR numerically favored Dato-DXd versus ICC [hazard ratio (HR) 0.54, 95% confidence interval (CI) 0.30-0.96, nominal P = 0.0329; median PFS: 8.1 versus 4.2 months]. OS numerically favored Dato-DXd versus ICC [HR 0.83 (95% CI 0.49-1.43), nominal P = 0.5028]. The rate of grade ≥3 treatment-related adverse events (TRAEs) was lower with Dato-DXd versus ICC (29.5% versus 58.3%). The most common TRAEs (any grade/grade 3-4) were nausea (47.7%/4.5%) and increased aspartate aminotransferase (40.9%/2.3%) with Dato-DXd, and neutropenia (grouped term, 58.3%/36.1%) and anemia (52.8%/8.3%) with ICC. With Dato-DXd, treatment-related AEs of special interest (grouped terms) oral mucositis/stomatitis and ocular surface events occurred in 43.2% and 47.7% of patients, respectively. In this China cohort, Dato-DXd demonstrated numerically improved efficacy versus ICC and a manageable safety profile, consistent with the global population, supporting Dato-DXd as a new treatment option for Chinese patients with previously treated metastatic HR+/HER2- breast cancer.

Doyne honeycomb retinal dystrophy or malattia leventinese (DHRD/ML) is an autosomal dominant retinal disorder caused by a single recurrent p.Arg345Trp (NM_001039348.3:c.1033C>T) variant in EFEMP1 and characterized by early-onset, nearly confluent, large central retinal drusen. Other variants in EFEMP1 have not been reported to cause retinal disease. To define the topography of the anatomical and functional phenotype of another variant in EFEMP1, p.Arg140Trp (c.418C>T), associated with retinal degeneration. This multi-institutional case series was conducted at 3 inherited retinal disease clinics (Philadelphia, Pennsylvania; Basel, Switzerland; and Prague, Czech Republic) from October 1998 to May 2026. Participants included 3 unrelated families with the p.Arg140Trp variant and 1 comparator family with canonical DHRD/ML caused by the p.Arg345Trp variant. Analyses were conducted from November 2019 to May 2026. Heterozygosity for pathogenic EFEMP1 variants. Color fundus photography and optical coherence tomography, light- and dark-adapted chromatic perimetry, and rod-mediated dark adaptation kinetics. The EFEMP1 p.Arg140Trp variant segregated with disease in all 3 families. In family 1, the index case developed nyctalopia in the sixth decade with progressive field loss and abnormal ERG. Among 5 at-risk relatives (ages 50 to 58 years), 4 heterozygous carriers had delayed rod-mediated dark adaptation kinetics despite best-corrected visual acuity of 20/20 OU and normal fundus appearance; the noncarrier had normal imaging and function. Additional heterozygous carriers from families 2 (age 42 years; symptom onset at 40 years) and 3 (age 69 years; symptom onset at 55 years) had nyctalopia and peripheral lobular chorioretinal atrophy initially labeled gyrate atrophy-like or choroideremia-like. Topographically matched testing in temporal retina without visible atrophy showed severe rod dysfunction and markedly delayed dark adaptation at 15°, 30°, and 46° with increasing severity toward the periphery. For comparison, the patient with DHRD/ML exhibited normal light- and dark-adapted visual function outside the central 10° and an increasing delay in rod recovery kinetics toward the fovea. This study found that the EFEMP1 p.Arg140Trp variant was associated with a late-onset, predominantly peripheral retinal degeneration with features overlapping the late-onset retinal degeneration phenotype and was distinct from canonical DHRD/ML; it spares relatively central macular structure and function while preferentially affecting the periphery. Functional evidence suggests preferential rod involvement, with rod dysfunction observed at retinal loci without detectable outer nuclear layer loss.

Intraocular pressure (IOP) is amenable to direct regulation and a critical indicator for numerous ocular disorders. Continuous, long-term IOP monitoring provides indispensable clinical data, supporting early diagnosis, risk stratification, and personalized treatment. This review comprehensively summarizes the working principles, key performance metrics, and clinical progress of wearable and implantable IOP sensors. The text elucidates the structural integration of wireless power supplies, signal transmission, and artificial intelligence within wireless IOP monitoring systems. Furthermore, manufacturing and optimization strategies are highlighted, and the considerable advantages of nanomaterials and micro/nanostructures are comprehensively summarized, emphasizing their crucial role in current IOP monitoring devices. Additionally, the diverse applications of IOP sensors in disease diagnosis and therapeutic management are discussed, underscoring their potential for personalized and precision medicine, alongside the challenges remaining in their clinical translation. Finally, current bottlenecks and limitations are addressed, outlining potential solutions, future trends, and potential breakthroughs in next-generation IOP monitoring.