(1) Background: Dry eye is a multifactorial disease of the ocular surface, the incidence of which has been increasing sharply. The pathogenesis of dry eye, especially in terms of the bacterial flora, has drawn great attention. Additionally, the potential treatment methods need to be explored. (2) Methods: We reviewed more than 100 studies and summarized them briefly in a review. (3) Results: We summarized the bacterial communities found on the ocular surface in the general population and patients with dry eye and found a relationship between dry eye and antibiotic therapy. We identified the possible mechanisms of bacteria in the development of dry eye by discussing factors such as the destruction of the antibacterial barrier, infectious diseases, microbiome homeostasis, inflammatory factors on the ocular surface and vitamin deficiency. (4) Conclusion: We systematically reviewed the recent studies to summarize the bacterial differences between patients with dry eye and the general population and brought up several possible mechanisms and possible treatment targets.

Purpose: To analyze the correlation between eye movements and asthenopia so as to explore the possibility of using eye-tracking techniques for objective assessment of asthenopia. Methods: This prospective observational study used the computer visual syndrome questionnaire to assess the severity of asthenopia in 93 enrolled college students (age 20–30) who complained about asthenopia. Binocular accommodation and eye movements during the reading task were also examined. The correlations between questionnaire score and accommodation examination results and eye movement parameters were analyzed. Differences in eye movement parameters between the first and last reading paragraphs were compared. The trends in eye movement changes over time were observed. Results: About 81.7% of the subjects suffered from computer visual syndrome. Computer visual syndrome questionnaire total score was positively correlated with positive relative accommodation (p < 0.05). In the first reading paragraph, double vision was positively correlated with unknown saccades (all p < 0.05). Difficulty focusing at close range was positively correlated with total fixation duration, total visit duration, and reading speed (all p < 0.05). Feeling that sight was worsening was positively correlated with regressive saccades (p < 0.05). However, visual impairment symptoms were not significantly correlated with any accommodative function. In a total 20 min reading, significantly reduced eye movement parameters were: total fixation duration, fixation count, total visit duration, visit count, fixation duration mean, and reading speed (all p < 0.01). The eye movement parameters that were significantly increased were: visit duration mean and unknown saccades (all p < 0.001). Conclusion: Eye tracking could be used as an effective assessment for asthenopia. Among the various eye movement parameters, a decrease in fixation duration and counts may be one of the potential indicators related to asthenopia.

To evaluate choroidal and optic disc alterations in eyes with thyroid eye disease (TED) compared with healthy eyes by using TowardPi widefield optical coherence tomography angiography (OCTA). This was a retrospective cross-sectional cohort study. A total of 112 participants (60 TED patients and 52 healthy controls) underwent TowardPi widefield OCTA, which provided detailed demographic and clinical data. Three-dimensional choroidal data, including thickness, vascular metrics, and optic disc measurements, were obtained from the built-in software. The study included 24 eyes with dysthyroid optic neuropathy (DON), 24 eyes with active non-DON TED, 71 eyes with inactive TED, and 104 healthy eyes. Choroidal thickness significantly decreased in the optic disc region during the DON phase (148.71 ± 78.98 µm) compared to normal eyes (182.35 ± 51.98 µm) and inactive TED eyes (191.34 ± 58.86 µm) (P = 0.030). In DON, choroidal stromal volume was reduced (34,183.81 ± 10,649.01 × 106 µm3) compared to normal (46,339.53 ± 16,711.99 × 106 µm3) (P = 0.002), whereas the choroidal vascular index increased (42.67% ± 3.41%) compared to normal (38.53% ± 6.35%) (P = 0.002). Optic disc area increased in DON (1.99 ± 1.24 mm2) compared to inactive TED (1.39 ± 0.38 mm2) (P < 0.001), along with reduced retinal nerve fiber layer blood-flow density in DON (45.09% ± 3.07%,) compared to normal (47.84% ± 1.41%) (P < 0.001). This study highlights the critical role of choroidal and optic disc alterations in TED pathophysiology and underscore the utility of widefield OCTA in identifying these changes, particularly in DON-risk patients.

Heterogeneity in treatment responses to standard treatment regimens poses a critical challenge in clinical practice, compounded by the unobservability of counterfactual outcomes. To address this, we present temporal causal precision medication (TCPM), a generalist framework translating routine physiological indicators into personalized treatment strategies. Central to TCPM is the treatment-free physiological profile (TFPP), a representation of heterogeneous physiological states trained using counterfactual prediction and adversarial learning to model patient's intrinsic, unbiased physiological state while eliminating the confounding effects of existing therapies from the routine clinical data. Validated across four public datasets and two private datasets, TCPM significantly outperformed standard clinical protocols and state-of-the-art reinforcement learning methods in therapeutic efficacy and physician simulation studies. Furthermore, TCPM identified patient subgroups with divergent response patterns, and elucidated evolving physiological network dynamics to uncover mechanistic heterogeneity. By integrating data-driven precision with actionable physiological insights, TCPM establishes a clinically practical, evidence-based framework for delivering an optimal individual clinical benefit through personalized treatment allocation in acute and chronic diseases, advancing the clinical implementation of precision medication.

This study evaluates the relationship between choroidal and optic disc alterations and visual function metrics (visual acuity, pattern visual evoked potential [P-VEP], and visual field) in patients with dysthyroid optic neuropathy (DON). A retrospective cross-sectional study included 38 patients with thyroid eye disease (TED). Three-dimensional choroidal data, including thickness, vascular metrics, and optic disc measurements, were obtained using TowardPi wide-field optical coherence tomography angiography (OCTA). Visual function was assessed using P-VEP and automated perimetry. The study analyzed 27 eyes with inactive TED, 22 with active non-DON TED, and 27 with DON. Visual acuity worsened with TED severity (P = 0.024), and mean sensitivity (MS) decreased (P = 0.024). P-VEP amplitude at 0.25 degrees was lower in DON (P = 0.024). Significant correlations were found between optic disc choroidal vascularity index and MS (R = 0.413, P < 0.001), nasal superior region choroidal metrics and MS (R = 0.450, P < 0.001), and retinal nerve fiber layer blood flow density with MS (R = 0.387, P = 0.001) and P-VEP amplitude at 0.25 degrees (R = 0.311, P = 0.021). Choroidal alterations are closely linked to visual function in DON. Choroidal thickness (CT) and vascularity may serve as biomarkers for assessing disease activity and visual impairment, aiding clinical management. This study identifies choroidal alterations as potential biomarkers for assessing disease activity and visual impairment in DON, which can aid in clinical decision making and personalized patient management.