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Grand RoundsWeekly Evidence Brief

Ophthalmology

Edition

30-Second Takeaway

  • Epi-off CXL yields sustained 5-year visual and tomographic gains with low complications across pediatric to adult keratoconus.
  • DIMS lenses slow 12‑month pediatric myopia progression and axial elongation versus single-vision lenses, supporting first-line use in myopia control.
  • Preoperative brimonidine use is linked to substantially higher trabeculectomy failure from high IOP at 3 years.
  • Aflibercept 8 mg for DME maintains or improves vision while extending treatment intervals, with some mild inflammation in pretreated eyes.
  • Vitamin D deficiency, ophthalmic drug shortages, and AI-based DR screening have measurable implications for dry eye risk and care access.

Week ending March 7, 2026

New evidence on crosslinking durability, myopia-control optics, glaucoma surgery risk, high-dose aflibercept, novel infection diagnostics, and systemic links to ocular care

Five-year outcomes support standard epi-off CXL across pediatric to adult keratoconus

JOURNAL OF CATARACT AND REFRACTIVE SURGERYMar 3, 2026

In 243 eyes with progressive keratoconus, standard epithelium-off CXL produced significant CDVA improvement maintained through 60 months. Kmax flattening was greatest in the first two years and remained stable through 48 months, indicating durable biomechanical effect. Central corneal thickness decreased initially but showed gradual re-thickening after 24 months while remaining below baseline, suggesting stromal remodeling. Wavefront aberrations were stable and adverse events were minimal across pediatric, adolescent, and adult subgroups. These data support timely referral and intervention for progressive keratoconus with standard epi-off CXL in a diverse U.S. population.

DIMS lenses modestly slow pediatric myopia progression over 12 months

AMERICAN JOURNAL OF OPHTHALMOLOGYMar 2, 2026

This meta-analysis of six studies including 1,224 myopic children compared DIMS spectacle lenses with single-vision lenses over 12 months. DIMS lenses reduced spherical equivalent progression by a pooled mean difference of 0.37 D versus single-vision lenses. They also reduced axial elongation by 0.16 mm, indicating structural impact on eye growth during the first treatment year. Most participants were from China, and heterogeneity was moderate to high, limiting global generalizability. Durability of effect beyond one year and performance versus other defocus spectacle designs remain uncertain.

Preoperative brimonidine linked to higher trabeculectomy failure from high IOP

AMERICAN JOURNAL OF OPHTHALMOLOGYFeb 28, 2026

This retrospective cohort of 501 eyes undergoing primary trabeculectomy evaluated the impact of preoperative glaucoma medications on surgical success. Preoperative brimonidine use was associated with an increased hazard of high IOP failure (HR 2.87; p = 0.002). Higher baseline IOP also increased failure risk, whereas beta-blockers, prostaglandins, and carbonic anhydrase inhibitors showed no significant effect. At three years, probability of success from high-IOP failure was 81.9% with brimonidine versus 93.36% without brimonidine. These findings support critically reviewing and potentially modifying brimonidine use before trabeculectomy.

Aflibercept 8 mg allows interval extension in DME with maintained vision

OPHTHALMOLOGY SCIENCEMar 5, 2026

In this multicenter real-world cohort, 156 DME eyes received aflibercept 8 mg for 12 months, including treatment-naïve and pretreated patients. Treatment-naïve eyes gained vision, improving from 72.9 to 77.7 ETDRS letters, while pretreated eyes maintained vision without significant loss. Central subfield thickness decreased significantly in both groups, and up to 38.1% of naïve and 27.2% of pretreated eyes became fluid-free centrally. Treatment intervals extended to about 15 weeks in naïve eyes and from 7.6 to 13.0 weeks in pretreated eyes. Noninfectious intraocular inflammation and acute IOP rises occurred only in pretreated eyes, but overall adverse events were infrequent.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Long-term CXL outcomes in a diverse U.S. cohort support early referral and standard epi-off treatment for progressive keratoconus across age groups.
  • DIMS lenses provide clinically meaningful one-year myopia control, though durability beyond year one and non-Asian data remain limited.
  • Medication history before trabeculectomy—especially brimonidine exposure—may influence long-term success and warrants careful review.