Introduction: Age-related macular degeneration (AMD) is a leading cause of vision impairment. A Mediterranean diet (MD) has been suggested to provide protective effects against AMD development and progression due to its antioxidant and anti-inflammatory properties. However, inconsistencies in findings across observational studies have been reported. This systematic review and meta-analysis aim to synthesize the existing evidence on the relationship between adherence to the MD and AMD development or progression. Methods: A systematic search was conducted using MEDLINE (via PubMed), Web of Science, and SCOPUS, following PRISMA guidelines. Observational studies assessing MD adherence in relation to AMD risk or progression were included. Meta-analyses were performed separately for each study design using odds ratios (ORs) for cross-sectional and case–control studies and hazard ratios (HRs) for prospective cohort studies. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated via funnel plots. Results: Eight studies were included: two cross-sectional, three case–control, and three prospective cohort studies. The meta-analysis of cross-sectional studies (pooled OR = 0.96; 95% CI: 0.83–1.11; p = 0.6243; I² = 0%) found no significant association between MD adherence and AMD. However, the weight distribution was highly imbalanced, limiting interpretability. Meta-analyses of case–control and prospective cohort studies demonstrated a significant protective effect of MD adherence: case–control studies showed a 34% reduction in the odds of AMD progression (OR = 0.66; 95% CI: 0.54–0.81; p < 0.0001; I² = 41.5%), while prospective cohort studies indicated a 23% reduced risk of AMD progression (HR = 0.77; 95% CI: 0.67–0.88; p < 0.0001; I² = 0%). Conclusions: This systematic review and meta-analysis suggest an inverse association between adherence to the MD and AMD progression, particularly in case–control and prospective cohort studies. Despite the small number of included studies, these findings highlight the potential role of diet in AMD management. Future research should focus on larger, well-controlled prospective studies with standardized dietary assessments. Key Points: 1. Higher adherence to the MD is associated with a reduced risk of AMD progression, with meta-analyses of case–control and prospective cohort studies showing 34% lower odds (OR = 0.66) and 23% reduced risk (HR = 0.77) of disease progression, respectively. 2. No significant association was found in cross-sectional studies (OR = 0.96; 95% CI: 0.83–1.11), likely due to methodological limitations and the challenge of establishing a temporal relationship between diet and AMD progression. 3. Despite the limited number of studies, findings suggest a potential role of diet in AMD management. Future research should prioritize larger, well-controlled prospective studies with standardized dietary assessments.

Pseudoexfoliation (PEX) syndrome is a systemic disorder characterized by the accumulation of fibrillar material in ocular and extraocular tissues, primarily affecting the eye’s anterior segment. While PEX is a known risk factor for open-angle glaucoma, its impact on retinal structures is less understood. This study aims to evaluate macular, circumpapillary retinal nerve fiber layer (cRNFL), and choroidal thickness in PEX patients without glaucoma. This cross-sectional study involved two groups: PEX group and a control group, both without glaucoma damage and with intraocular pressure (IOP) below 19 mmHg. Participants underwent full ophthalmic evaluations. Spectral-domain optical coherence tomography (SD-OCT) was used to measure cRNFL, macular, Bruch’s membrane opening-minimum rim width (BMO-MRW), and choroidal thickness. A total of 60 eyes were included: 38 with PEX and 22 controls. Demographic and clinical characteristics were similar across groups. PEX group had a thinner nasal-inferior cRNFL compared to the control group (p < 0.05). Furthermore, PEX group exhibited significantly reduced thickness in superior, inferior, nasal-inferior, nasal-superior, and total ganglion cell layer (GCL), as well as in nasal-inferior, nasal-superior, and total inner plexiform layer (IPL) compared to the control group (p < 0.05). BMO-MRW thickness tended to be thinner across all sectors in PEX group, although no significant differences were found (p > 0.05). Regarding choroidal thickness, the temporal site was significantly thicker in PEX group (p < 0.05). This study highlights a significant association between PEX syndrome and the thickness reduction of the GCL and IPL, suggesting that these retinal changes could serve as early indicators of glaucoma or reflect broader neurodegenerative processes. Findings also reveal reduced cRNFL thickness in PEX eyes, further supporting the potential for early glaucomatous damage detection. These findings underscore the need for long-term studies to explore PEX-related neurodegeneration and its possible links to broader neurological conditions.

Background/Objectives: Diabetic retinopathy (DR) is the leading cause of preventable blindness among working-age adults. Early detection through screening programs is essential for managing the condition and preventing visual impairment. In Portugal, the national DR screening program (DR SP) targets diabetic patients, aiming to detect DR at an early stage and refer patients requiring intervention for an ophthalmology appointment. This study aims to assess the effectiveness of the Portuguese DR SP by analyzing patients referred for a hospital appointment following a positive screening result. Methods: An observational retrospective cohort study was conducted at Unidade Local de Saúde de São João (ULS-SJ), including patients referred to a DR SP hospital appointment between January 2020 and December 2023. Data were collected from hospital records upon approval by the Hospital Ethics Committee. Screening and hospital diagnoses were compared for agreement. The Chi-Square test and Cohen’s Kappa were used to assess the association between screening and hospital diagnoses. Results: A total of 1126 patients (2251 retinographies) were analyzed. The median time from screening to hospital consultation was 63 days (Interquartile Range = 39–99), though referral times varied widely within the same classifications (ranging from 8 to 354 days). The most common screening classifications were R2 (pre-proliferative DR, 47.8%) and M1 (maculopathy, 24.6%). In eyes with DR, agreement between screening and hospital diagnoses was highest for R2 (40.1%) and M1 (32.3%), while proliferative DR (R3) showed 30% agreement. The positive predictive value (PPV) of the screening program was 55.9%, with a false positive rate of 44.1%. A statistically significant association between screening and hospital diagnoses was observed (p < 0.001, Chi-Square test), though Cohen’s Kappa values (0.167 Right Eye, 0.157 Left eye) indicated only slight agreement. Conclusions: Our study found that DR SP effectively identifies patients needing ophthalmologic evaluation with moderate diagnostic agreement and a relatively high false positive rate, leading to unnecessary referrals. While this ensures that sight-threatening cases are not missed, improvements in grader training, classification protocols, and Optical Coherence Tomography (OCT) integration could improve results. Strengthening screening adherence and optimizing referral pathways would further improve the program’s impact on early DR detection and management.

Purpose: Dupilumab-associated ocular surface disease (DAOSD) is a reported side effect with several manifestations and uncertain risk factors. This study uses objective assessments and a patient-reported questionnaire to evaluate ocular surface disease (OSD) in Dupilumab-treated patients. Methods: A case-control study at São João Local Health Unit (ULS São João), Porto, Portugal, included 58 Dupilumab-treated adults categorized by the DAOSD Questionnaire. Cases (Group A, n=40) had ≥ 3 symptoms or ≥ 1 severe symptom, while controls (Group B, n=18) had < 3 symptoms without daily impact. Ocular surface parameters were assessed, including eye redness score, non-invasive break-up time (NIBUT), tear meniscus thickness, tear film stability evaluation (TFSE^®), and tear osmolarity. The Ocular Surface Disease Index (OSDI) classified symptom severity. Results: Group A had significantly higher tear osmolarity (303.43± 7.61 vs 293.31± 5.11 mOsm/L, p< 0.001) and eye redness (2.00 (1.00) vs 1.00 (1.00) points, p= 0.036). TFSE values were higher (252.76± 3.30 vs 138.74± 3.43 points, p=0.094), while NIBUT was lower (1.00 (4.00) vs 6.50 (10.00) s, p=0.078). Conjunctivitis was more frequent in Group A (57.50% vs 33.33%, p= 0.089), followed by posterior blepharitis (40.00% vs 5.56%, p= 0.008). OSDI scores had significantly different mean in Group A (27.32± 20.24 vs 2.11± 3.24 points, p< 0.001), with 37.5% exhibiting severe disease classification. Conclusion: DAOSD is associated with increased symptom burden. The DAOSD questionnaire correlated with OSDI scores and ocular surface changes, supporting its role in early detection and referral for ophthalmological management.

To report a case of unintended fluence test laser activation during planned laser-assisted in situ keratomileusis (LASIK) and its refractive and visual consequences. A 49-year-old female presented for elective LASIK surgery. Her ophthalmic and systemic history were unremarkable. Treatment refraction was −3.75 -0.50 × 85° in the right eye and −3.25 -1.00 × 75° in the left, with 20/20 best corrected visual acuity (BCVA) in both eyes. Preoperative workup confirmed she was a suitable candidate. The patient opted for sequential surgery, beginning with the right eye. Following uneventful flap creation, the excimer laser was inadvertently activated in fluence test mode instead of performing the programmed ablation. Post–fluence test refraction in the right eye was −4.00 −1.50 × 75°, with BCVA of 1.0. Corneal tomography demonstrated a 7 μm reduction in central corneal thickness and localized superior thinning of up to 22 μm, consistent with the fluence test pattern. The patient remained asymptomatic. After disclosure of the event, LASIK was subsequently performed in the same eye. Postoperative refraction was plano, with uncorrected visual acuity of 1.0. This case underscores the critical importance of procedural verification in refractive surgery and illustrates the safety margins of excimer laser platforms in the event of unintended laser activation, while emphasizing the need for transparent disclosure and comprehensive postoperative assessment after unexpected intraoperative events.

We report a case of neurosarcoidosis in a patient with a prior history of acute zonal occult outer retinopathy (AZOOR), using multimodal imaging, including