Citations

ABSTRACT Artificial intelligence (AI) has emerged as a transformative technology in the fields of medicine and ophthalmology. Recent advances in machine learning, deep learning and convolutional neural networks have significantly improved cataract detection and grading, intraocular lens power calculations, surgical decision‐making, risk prediction and patient education. Intraoperative AI‐assisted surgical phase recognition, workflow analysis, real‐time guidance, robotic technologies and femtosecond laser integration can improve surgical precision, efficiency and safety. AI has shown promise in predicting visual outcomes, detecting postoperative complications and facilitating telemedicine follow‐up. Though challenges with AI include transparency, data diversity, regulatory oversight and clinical validation, continued advances are expected to further personalise cataract surgery, support clinical decision‐making, optimise surgical performance and improve patient outcomes. This narrative summarises the current and emerging applications of AI in preoperative, intraoperative and postoperative management of cataracts.

Abstract Standard of care RPT may result in dose-limiting side effects of the salivary glands include sialadenitis and xerostomia that are inconsistent with outcomes from external beam for equivalent ADs. This work develops a parametrizable ‘Macro-to-Micro’ (M2μ) model that demonstrates the consideration of small-scale dosimetry in comparison to conventional methods that typically assume uniform voxel or organ-level uptake. Anatomical features of the salivary gland are represented by annular structures (a centralized branching network of ducts, including excretory, lobar, interlobular) and small-scale voxels (intralobular ducts and acinar cells) with dimensions set to reproduce ex-vivo murine histopathology measurements and scaled up in size for extrapolation to humans. Simulations were performed by scoring and recording S-value histograms to the target ductal and acinar cells, for two beta emitters (177Lu, 131I) and one alpha emitter (225Ac). Four idealized activity distributions were created to assign activity to surface and volumes of the annuli, and GEANT4 v11 was used for radiation transport calculations. Comparisons against whole gland uniform spherical self-dose S-value calculations were conducted to validate the radiation transport and to highlight differences between M2μ and conventional dosimetry approaches. Analyses for both models showed greater S-value variation in comparison to the homogeneously distributed activity S-value calculation. The most notable result was that the calculated S-values differed between different branches, depending on the geometric size of the annuli. For the surrounding acinar cells, S-values from ductal cells decreased as a function of distance from the branching structures. High variability of S-values, depending on ductal cell dimensions as well as within the acinar cell distribution of the salivary gland highlights the potential clinical utility of small-scale approaches to RPT salivary gland dosimetry, contingent on clinical translation and validation. To this end, future work should further refine the model and incorporate small-scale activity distributions from pre-clinical and translational studies.

Abstract Germinal center (GC)-derived lymphomas arise within a specialized immune ecosystem, yet whether malignant cells direct its remodeling remains unclear. Integrating genomic, transcriptomic, spatial, and functional analyses across follicular lymphoma and diffuse large B-cell lymphoma, we define a developmental framework linking malignant B-cell differentiation state to tumor microenvironment (TME) organization. Rather than segregating by histology, lymphomas align along a shared differentiation continuum in which proliferative dark zone (DZ) states associate with immune-depleted TMEs, whereas post-GC/memory B-cell (MBC) states drive inflamed but immunosuppressed TMEs. Spatial profiling reveals collapse of GC architecture and emergence of suppressive myeloid niches along this trajectory. Single-cell lineage reconstruction uncovers a DZ-to-MBC developmental axis underlying lymphoma evolution. Genetic reprogramming in vivo demonstrates that malignant differentiation state is sufficient to instruct TME remodeling. Collectively, these findings establish malignant differentiation state as a causal determinant of immune architecture across GC-derived lymphomas and identify lineage-directed immune reprogramming as a potential therapeutic strategy.

ABSTRACT Clinical pharmacists are increasingly recognized as vital contributors to acute stroke care, yet their role remains inconsistently defined and underutilized across health care systems. This consensus statement explores the expanding presence of clinical pharmacists within interdisciplinary stroke teams, particularly in the management of both acute ischemic stroke ( AIS ) and hemorrhagic stroke. This consensus statement panel was composed of clinical pharmacists, emergency medicine physicians, and a vascular neurologist. The Grading of Recommendations, Assessment, Development, and Evaluation ( GRADE ) approach was used to assess the level of certainty and strength of recommendations. We focused on two questions regarding the clinical pharmacist's role in caring for adult patients presenting to the emergency department ( ED ) with AIS or hemorrhagic stroke. Despite the very low level of evidence, a consensus was reached for the following recommendations: (1) clinical pharmacist involvement in AIS care for adult patients presenting to the ED and (2) clinical pharmacist involvement in hemorrhagic stroke care for adult patients presenting to the ED . Based on the available literature, we believe optimizing the clinical pharmacist role is a critical factor in improving time‐sensitive treatment and equity in care delivery.

ABSTRACT As emergency department (ED) crowding and patient boarding reach critical levels nationwide, the role of the emergency medicine pharmacist (EMP) must be both defined and safeguarded. While EMPs are increasingly valued for their contributions to acute care, their responsibilities often unintentionally expand during periods of operational strain, particularly when admitted patients remain in the ED for prolonged durations. EMPs should ideally be resourced to remain focused on time‐sensitive, high‐risk medication management where their expertise is most impactful and not be used as default providers for all pharmacotherapy needs during ED boarding. This perspective outlines our position on the ideal scope of EMP practice during times of congestion, advocating for clearly defined role boundaries, strategic collaboration with other pharmacy team members, and system‐level support to prevent dilution of emergency care. EMPs must be empowered to prioritize critical ED workflows, support resuscitations, and lead initiatives in education, protocol development, and patient safety, without being overextended by responsibilities that can be absorbed by other team members.

Importance Amblyopia is the leading cause of monocular decreased best-corrected vision in children. Early detection and intervention are key for optimal treatment outcomes; however, limited access to pediatric eye specialists may hinder timely care and affect visual outcomes. Given the shortage of specialty-trained eye care professionals in the US, there is need to support comprehensive eye care professionals who are willing to examine and treat children with amblyopia. Objective A panel from the Pediatric Eye Disease Investigator Group synthesized relevant literature and incorporated consensus opinion where direct evidence was lacking to create the Amblyopia Navigator Decision-Support Instrument, a free, web-based amblyopia decision support tool for eye care professionals. Evidence Review The decisions related to optimal diagnostic measures, pass/refer criteria, and management recommendations were informed by 147 publications. In areas where direct evidence was lacking, guidance was supplemented with clinical trial protocols or existing professional guidelines. When data were conflicting or unavailable, recommendations were established through committee consensus. A single reviewer independently performed standardized (though not systematic) literature reviews to avoid missing pertinent recent publications. Findings Presented are the process used, supporting evidence, and recommendations for testing methods, refractive correction, amblyopia treatment options, treatment adjustments, and monitoring schedules. Conclusions and Relevance Because amblyopia is common and typically responds well to treatment, decision support tools that optimize its management could increase access to pediatric eye care by facilitating earlier detection, enabling broader participation of primary eye care professionals, and ultimately improving visual outcomes. Through this work and the development of the forthcoming free, web-based application version, Amblyopia Navigator Decision-Support Instrument, the Pediatric Eye Disease Investigator Group has created decision support tools designed to assist optometrists and ophthalmologists in the care of children aged 3 to 17 years with amblyopia.

ABSTRACT Purpose To validate a custom smartphone application for at‐home visual acuity (VA) measurement in children. Methods A total of 452 children aged 3–17.5 years participated. Certified examiners measured in‐office test–retest VA (logMAR) using gold‐standard Amblyopia Treatment Study HOTV (3‐to‐6‐year‐olds, younger cohort) or electronic Early Treatment of Diabetic Retinopathy Study (7‐to‐17.5‐year‐olds, older cohort) protocols at 3–4.5 m and app‐based VA at 1.5 m. Caregivers measured at‐home app‐based VA at 1.5 m. Results Comparing at‐home app‐based with gold‐standard VA, in eyes 20/40 or better, 95% (143/151) and 93% (91/98) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = −0.03, older = −0.04; 95% limits‐of‐agreement half‐width (LOA): younger = ±0.26, older = ±0.22). In eyes 20/50 or worse, 66% (42/64) and 75% (76/101) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.11, older = 0.13, LOA: younger = ±0.50, older = ±0.51). Comparing in‐office app‐based VA with gold‐standard VA, in eyes 20/40 or better, 98% (160/164) and 94% (99/105) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = −0.03, older = −0.03; LOA: younger = ±0.22; older = ±0.24). In eyes 20/50 or worse, 85% (60/71) and 91% (101/111) of the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.04; older = 0.04; LOA: younger = ±0.39; older = ±0.24). For gold‐standard test–retest, in eyes 20/40 or better, 99% (163/164) and 99% (104/105) of the younger and older cohorts had retest within 2 lines, respectively (mean differences: younger = 0.00; older = 0.01; LOA: younger = ±0.17; older = ±0.11). For 20/50 or worse, 92% (66/72) and 100% (111/111) in the younger and older cohorts were within 2 lines, respectively (mean differences: younger = 0.01; older = 0.02; LOA: younger = ±0.35; older = ±0.15). Conclusions Our app demonstrated good concordance with the gold standard at home and in the office for eyes with VA of 20/40 or better. However, concordance decreased considerably for eyes with VA 20/50 or worse, particularly at home.

Background: Enteral phosphate replacement offers multiple advantages over intravenous phosphate replacement, but optimal dosing and administration are unclear. Objective: This study aimed to compare 2 different dosing strategies (PRE vs POST) of enteral phosphate replacement for mild hypophosphatemia (serum phosphorus = 2.1-2.5 mg/dL) and to evaluate our dosing strategy for moderate hypophosphatemia (serum phosphorus = 1.5-2 mg/dL) in critically ill patients. Methods: This single-center quasiexperimental, institutional review board–approved study was conducted in adult patients admitted to an intensive care unit (ICU) who received enteral phosphate replacement with a follow-up serum phosphorus level obtained within 24 hours of replacement. Patients were excluded if they had diabetic ketoacidosis, acute kidney injury, or received total parenteral nutrition or targeted temperature management. The mild PRE and POST groups received 48 and 72 mmol of enteral phosphate, respectively. The moderate group received 72 mmol of enteral phosphate. Effectiveness outcomes included normalization of serum phosphorus, defined as 2.6 to 4.5 mg/dL, and median change in phosphorus concentration. Safety outcomes included the incidence of new onset diarrhea and hyperphosphatemia (serum phosphorus >4.5 mg/dL) within 24 hours after phosphate replacement. Results: Of the 138 patients included, the median age was 59 (44-70) years and 69.6% were admitted to the surgical trauma ICU. Normalization of serum phosphorus occurred in 55 (58.2%) patients in mild PRE and 44 (72.7%) patients in mild POST ( P = 0.13). Change in serum phosphorus was 0.4 (0.1-0.9) mg/dL in mild PRE vs 0.7 (0.3-1.2) mg/dL in mild POST ( P = 0.06). Normalization occurred in 39 (66.7%) patients in the moderate group with a change in serum phosphorus of 1.0 (0.6-1.6) mg/dL. Rates of new onset diarrhea and hyperphosphatemia were not significantly different between groups. Conclusion and Relevance: Enteral phosphate replacement appears safe and effective in critically ill patients with mild-to-moderate hypophosphatemia and may serve as an alternative to intravenous phosphate.