Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Scientific reports
Prevalence and Risk Factors for Cytomegalovirus Retinitis Among People Living with HIV in Sub-Saharan Africa in the Antiretroviral Therapy Era: A Systematic Review and Meta-Analysis
Cytomegalovirus retinitis has remained an alarming and potentially vision-threatening opportunistic disease in the population living with HIV, especially in cases of extreme immunosuppression. Although the introduction of antiretroviral therapy has led to a drastic decline in the number of cytomegalovirus retinitis cases reported in most parts of the world, the current epidemiology of cytomegalovirus retinitis in sub-Saharan Africa has seemed unusual in early reports, unexpectedly portraying low disease prevalence rates despite the high number of HIV cases in the concerned region. This systematic review and meta-analysis aimed to estimate the pooled prevalence of cytomegalovirus retinitis among people living with HIV in sub-Saharan Africa in the antiretroviral therapy era, and to identify associated risk factors. The search of databases included Medline using the search engine PubMed, Google Scholar, and the African Journals Online database named AJOL. For inclusion, studies must have included an eye examination to verify the presence of cytomegalovirus retinitis. The data was combined using the logit transformation model. Heterogeneity was tested using the I-squared test and the Cochran Q test. A total of ten studies involving 1,931 participants from nine sub-Saharan Africa countries were found eligible. The proportion of cytomegalovirus retinitis varied from 0.34% to 15.8%. Pooled prevalence was found to be 3% (95% CI: 1.6-5.4%) with low to moderate inter-study variation (I² = 17.8%). Substantial variation in the proportion was found in different sub-Saharan Africa regions; it was found to be less than 1% in West Africa, 3-4% in Southern Africa, 7% in East Africa and 6% in Central Africa. Across all studies, the strongest and most consistent risk factors for cytomegalovirus retinitis were profound immunosuppression, particularly CD4 < 50 cells/µL. Antiretroviral therapy-naïve status, poor adherence, and presence of advanced AIDS-defining illnesses were additional contextual risk markers. Cytomegalovirus retinitis is an under-recognized but important source of preventable blindness among people living with HIV. Prevalence in sub-Saharan Africa differed from that in Asian early antiretroviral therapy era cohorts but is relevant in settings where late HIV presentation occurs. Systematic retinal screening in people living with HIV with low CD4 counts < 50 cells/µL and expanded HIV care and treatment services are important to prevent blindness due to cytomegalovirus retinitis.
31 May 2026
Read appraisal →PloS one
Using deep learning to identify inherited retinal diseases based on wide-field retinal imaging data
OBJECTIVE: To evaluate a novel image-based deep learning method for the automated identification of inherited retinal diseases (IRDs) and to explore the feasibility of predicting selected causative gene groups using a multimodal analysis of wide-field fundus autofluorescence (FAF) and pseudocolor fundus (pCF) images. DESIGN: The method was evaluated using a retrospective dataset of patient studies containing FAF and pCF images, as well as genetic tests for IRD. PARTICIPANTS: Patients with confirmed IRD for which both wide-field FAF and pCF images and genetic tests for IRD performed at Hadassah University Medical Center were included. The dataset consisted of 409 patients (330 patients with IRD with the 25 most commonly affected genes in our population and patients without IRD, and 79 patients without IRD). METHODS: Nine EfficientNet-V2-m convolutional neural networks were trained for the following three classification tasks: a binary IRD vs. non-IRD classification, and classification into two groups of five causative genes (Groups 1 and 2). For each task, three models were trained on the FAF images only, the pCF images only, and both the FAF and pCF images. The performance of the models was then evaluated and compared using 5-fold cross-validation. MAIN OUTCOME MEASURES: Accuracy, precision, F1 scores, AUC, and confusion matrices. RESULTS: The multimodal classification models that were trained on both the FAF and pCF images yielded the best results. The binary classification model had a mean (±SD) accuracy of 0.95 ± 0.01, a mean precision of 0.92 ± 0.01, and a mean F1 score of 0.90 ± 0.02. The Group 1 classification model had a mean accuracy of 0.92 ± 0.03, a mean precision of 0.93 ± 0.03, and a mean F1 score of 0.89 ± 0.03. Finally, the Group 2 classification model had a mean accuracy of 0.85 ± 0.03, a mean precision of 0.87 ± 0.04, and a mean F1 score of 0.83 ± 0.04. CONCLUSIONS: Our results indicate that determining whether a patient has IRD can be performed with high accuracy within this retrospective cohort based on FAF and pCF images using image-based deep learning classifiers. This image-based approach may assist clinicians during the patient's initial visit by providing decision support prior to genetic testing. It may also help prioritize patients for genetic workup, particularly in settings in which genetic testing is not readily available. Further prospective and external validation is required before clinical implementation.
13 May 2026
Read appraisal →Ophthalmology
Special AAO Report: Recommendations on Screening for Hydroxychloroquine Retinopathy (2025 Revision)
BACKGROUND: The American Academy of Ophthalmology recommendations on screening for hydroxychloroquine (HCQ) retinopathy are now a decade old. This revision provides an update based on current knowledge. Major points and changes are as follows. NATURE OF TOXICITY: The retina typically remains clinically normal for many years on HCQ, but there is an unpredictable point at which signs of toxicity may develop. PATTERN OF TOXICITY: Most eyes of patients of European heritage have a parafoveal pattern of toxicity, whereas eyes of East Asian patients tend to present with pericentral toxicity, but there are many exceptions, and screening examinations should look for both patterns. DOSAGE: The recommended daily dosage remains unchanged at ≤5.0 mg/day/kg real weight. Keep under 400 mg/day for severely obese patients. RISK FACTORS: Beyond dose and duration, concurrent renal disease and tamoxifen use increase risk, as does initiation of HCQ therapy at an older age. CLINICAL TESTS: The primary screening tool should be OCT, along with wide-pattern fundus autofluorescence (FAF). Visual field (VF) and multifocal electroretinography (mfERG) are secondary confirmatory tests. Newer VF algorithms such as 24-2C can screen parafoveal and pericentral regions simultaneously. SCREENING: A baseline screening examination, including fundus, OCT, and FAF, is advised soon after HCQ is begun, not only to rule out preexisting conditions but also for comparison with later results. Annual screening with OCT and FAF is recommended while using HCQ, but may be deferred during the first 5 years if there are no significant risk factors. PROGRESSION: Mild retinopathy is unlikely to progress after discontinuation of HCQ, but severe retinopathy may continue to worsen for many years. IMPLICATIONS OF EARLY SIGNS OF TOXICITY: With earlier recognition comes greater need to communicate with patients and their medical providers regarding options to stop HCQ or continue with cautious monitoring. NEW TECHNOLOGY: There have been experimental advances in imaging and artificial intelligence analysis for HCQ screening, but none have been validated for general use or are widely available at this time. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
1 Apr 2026
Read appraisal →Surv Ophthalmol
Relentless placoid chorioretinitis
Relentless placoid chorioretinitis (RPC) is a rare, vision-threatening posterior uveitis that predominantly affects young adults. The hallmark clinical findings are numerous scattered placoid chorioretinal lesions involving the midperipheral and far peripheral fundus as well as the posterior pole and a persistent or recurrent course resulting in lesions at different chronological stages, with fresh creamy placoid lesions and healing pigmented lesions being present at the same time. Although RPC is frequently described as a disease that is intermediate between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis, it more closely resembles APMPPE. It is important to identify those patients with RPC who present with an APMPPE phenotype so that appropriate immunomodulatory therapy is instituted without delay, as most cases of RPC are refractory to corticosteroid monotherapy. Examination findings may help differentiate RPC and APMPPE. Multimodal imaging, including ultra-widefield imaging, and selective investigations aid in distinguishing RPC from other placoid diseases and types of posterior uveitis.
1 Jan 2026
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