Ophthopedia shows OCT biomarkers for fungus

Optical coherence tomography — basically the retina’s cross-sectional scan — just got a lot more useful in one of ophthalmology’s nastiest infections. Endogenous fungal endophthalmitis is rare, but when fungus seeds the eye from the bloodstream, vision can collapse quickly. The hard part is that the two big culprits, Candida and Aspergillus, can look messy and overlapping at the bedside. A new multicenter analysis in the *American Journal of Ophthalmology*, published in early May 2026, argues that OCT can give clinicians an earlier clue about which organism they are dealing with. (ajo.com) ### What is the actual problem here? This is an infection that starts somewhere else in the body, reaches the bloodstream, and then seeds the eye. Candida is the most common fungal cause in the U.S., with Aspergillus another major pathogen, but the two infections do not behave the same way and can demand different levels of urgency, systemic workup, and local treatment. The catch is that blood cultures can be negative by the time the eye findings show up, and retinal appearance alone is not always enough. (eyewiki.org) ### What did the new paper do? The new study pulled OCT images from multiple centers and looked for repeatable imaging biomarkers that track with microbiology. That matters because most earlier OCT descriptions in fungal endophthalmitis were single-center series, mixed-organism reviews, or case reports. This paper’s angle was narrower and more practical — can the scan pattern itself push you toward Candida or Aspergillus before lab confirmation catches up? (ajo.com) What does Candida look like on OCT? Candida tends to look more retinal and preretinal. The paper highlights lesions centered in the inner retina with hyperreflective material projecting into the vitreous or sitting on the retinal surface — the kind of pattern earlier authors have described with “cloud” or “snowing” language. In plain English, Candida more often looks like something blooming upward from the retina into the vitreous. (ajo.com)s look like instead? Aspergillus tends to look deeper and more destructive. The OCT signature leaned toward subretinal, choroidal, and full-thickness involvement rather than a mainly inner-retinal lesion. That fits the broader clinical picture — Aspergillus is often linked to more aggressive posterior segment disease and can present with lesions that feel like they are coming from below the retina rather than erupting above it. (ajo.com)is that distinction useful? Because treatment decisions often start before perfect proof arrives. If an OCT pattern strongly suggests Candida, that may support one level of organism suspicion and management planning. If the scan instead looks like Aspergillus, clinicians may worry sooner about a more invasive course, deeper tissue involvement, and the need to move faster with targeted therapy or surgery. OCT is not replacing cultures — but it can shorten the guesswork window. (ajo.com) ### Does this change screening? Not really. The big AAO point still stands — routine eye screening for every patient with candidemia is low-yield, with endophthalmitis found in less than 1% of routinely screened cases. But once a patient has ocular symptoms or suspicious lesions, better pattern recognition on OCT becomes much more valuable. This is a diagnosis-speed tool, not a mass-screening argument. (aao.org)tion? It is still an imaging study in a rare disease. OCT can raise or lower suspicion, but it cannot by itself prove the organism. Real patients also arrive after partial antifungal treatment, with mixed inflammation, poor media clarity, or incomplete microbiology. So the scan helps most when it is folded into the whole picture — bloodstream history, immune status, exam, and sampling when possible. (ajo([aao.org)s simple: retina specialists may not have to wait for culture confirmation to start thinking “this looks more like Candida” or “this smells like Aspergillus.” In a disease where delay can cost vision, that is a real upgrade. (ajo.com)