Rising morbidity and mortality from cardiovascular disease (CVD) have increased interest in precision and preventive management to reduce long-term sequelae. While retinal imaging has traditionally been recognized for identifying vascular changes in systemic conditions such as hypertension and type 2 diabetes mellitus, a new ophthalmologic field, cardiac-oculomics, has associated retinal biomarker changes with other cardiovascular diseases with retinal manifestations. Several imaging modalities visualize the retina, including color fundus photography (CFP), optical coherence tomography (OCT), and OCT angiography (OCTA), which visualize the retinal surface, the individual retinal layers, and the microvasculature within those layers, respectively. In these modalities, imaging-derived biomarkers can present due to CVD and have been linked to the presence, progression, or risk of developing a range of CVD, including hypertension, carotid artery disease, valvular heart disease, cerebral infarction, atrial fibrillation, and heart failure. Promising artificial intelligence (AI) models have been developed to complement existing risk-prediction tools, but standardization and clinical trials are needed for clinical adoption. Beyond risk estimation, there is growing interest in assessing real-time cardiovascular status to track vascular changes following pharmacotherapy, surgery, or acute decompensation. This review offers an up-to-date assessment of the cardiac-oculomics literature and aims to raise awareness among cardiologists and encourage interdepartmental collaboration.

Objective: BrighT STAR was a diagnostic stewardship collaborative of 14 pediatric intensive care units (PICUs) across the United States designed to standardize and reduce unnecessary blood cultures and study the impact on patient outcomes and broad-spectrum antibiotic use. We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs. Design: A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR. Setting: 14 PICUs enrolled in BrighT STAR. Participants: Site leads at each enrolled site. Methods: An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative. Results: 10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior. Conclusions: BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment. Clinical trial registry information: Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). NCT03441126. https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1

Purpose: To evaluate sociodemographic and clinical factors with postoperative complications after cataract surgery at academic medical centers in the United States. Setting: 16 U.S. academic medical centers contributing to the Sight Outcomes Research Collaborative (SOURCE) big data repository. Design: Retrospective, multicenter cohort study. Methods: Adults undergoing cataract surgery between 2010 and 2023 were identified from the SOURCE database. Sociodemographic and clinical predictors including race, ethnicity, primary language, and prior intraocular surgery were assessed. Postoperative complications within 6 months were identified using Current Procedural Terminology/International Classification of Diseases codes. Multivariate cox regression estimated hazard ratios with 95% confidence intervals. Results: 78 565 eyes were analyzed (mean age 70.8 ± 8.9 years, 59% female, 12.6% Black). At 6 months, 1.49% of eyes developed a complication and 0.10 developed a severe adverse complication. Independent predictors of any complication included male sex (hazard ratio [HR] 1.14; P < .01), Black race (HR 1.66; P < .01), complex surgery (HR 1.23; P < .01), combined intraocular procedures (HR 1.33; P < .01), prior intraocular surgery (HR 1.18; P < .01), and poorer preoperative vision (HR 1.10; P < .01). Severe adverse complications were more likely among men (HR 1.54; P = .02) and those with poorer vision (HR 1.62; P < .01), but less likely with increasing age (HR 0.95; P < .01), urban residence (HR 0.33; P < .01), and having 1 or more children in the household (HR 0.32; P = .03). Conclusions: Sociodemographic and clinical factors that increased risk of postoperative outcomes after cataract surgery included Black race, male sex, and poor preoperative vision. Older age, urban residence, and children in the household were protective. Incorporating social determinants of health into perioperative risk stratification may improve surgical equity and outcomes.

Background: Many multidose eyedrops in the clinic and operating room are discarded after single use due to cross-contamination concerns. This practice contributes to significant hospital costs, drug shortages, and unnecessary greenhouse gas emissions. Methods: 9-week, prospective, observational study of 97 patients. Objective: To validate the safety of multidose eyedrops in the ophthalmology clinic by ASORN-trained technicians using a videographic and microbiological analysis. Secondly, to determine optimal culturing conditions to prevent environmental contamination. Results: During eyedrop administration, no videos demonstrated bottle-to-patient contact. 12/96 (12.5%) plates demonstrated growth, likely due to environmental contamination. Mass spectrometry revealed non-pathogenic and common species for 8 identifiable growths. Environmental contamination is minimized by use of a biosafety cabinet. Conclusion: We found no clinical correlation between the use of multidose eyedrop bottles and infection on multiple patients in the ophthalmology clinic. We recommend using a biosafety cabinet to establish a national consensus for multidosing eyedrops and to improve inter-study comparisons.

Background/Objectives: While ocular albinism (OA) is usually associated with reduced vision, nystagmus, and foveal hypoplasia, there is phenotypic variability in iris and fundus hypopigmentation. Hemizygous pathogenic/likely pathogenic (P/LP) variants in GPR143 at X: 151.56–151.59 have been shown in the literature to be associated with OA. The purpose of this study was to report the case of a Hispanic male with X-linked inherited OA associated with a hemizygous GPR143 variant and to review the literature relating to genotype–phenotype associations with GPR143 and OA. Methods: After consent to an IRB-approved protocol, a 14-year-old Hispanic male patient with OA and his parents underwent whole genome sequencing (WGS) in 2023. Two maternal uncles with nystagmus underwent targeted variant testing in 2024. A literature review of reported GPR143 variants was completed. Results: A male with reduced visual acuity, infantile-onset nystagmus, foveal hypoplasia, and iris hypopigmentation was identified to have the variant GPR143, c.455+3A>G, which was also present in his mother and two affected maternal uncles. This variant has been previously identified in other Hispanic patients of Mexican descent. Additionally, 127 variants were identified in the literature and reported to be associated with OA. All patients had reduced visual acuity (average 0.71 ± 0.23 logMAR), 99% had nystagmus, 97% foveal hypoplasia, 79% fundus hypopigmentation, and 71% iris hypopigmentation. Of those patients with reported optotype best corrected visual acuity (BCVA), eight (9%) had VA from 20/25 to 20/40, 24 (24%) had VA from 20/50 to 20/80, and 63 (67%) had VA from 20/100 to 20/200. The most frequent type of variant was missense (31%, n = 39). Frameshift and nonsense variants were associated with the lowest rates of iris hypopigmentation (50% [n = 11] and 44% [n = 8], respectively; p = 0.0068). Conclusions: This case represents phenotypic variability of GPR143-associated OA and highlights the importance of repeat genetic testing and independent analyses of test results for accurate variant classification, particularly in non-White and Hispanic patients. Further studies in more diverse populations are needed to better develop genotype–phenotype associations for GPR143-associated OA.