Skip to content

Curation log — cataracts

Newest entries first. Every content-changing session appends an entry: date, what changed, what was searched, follow-ups for next time. See CLAUDE.md.

2026-10-31 — Periodic literature sweep (writer: codex; independent audit pending)

Searched

  • PubMed E-utilities (esearch/efetch): 20 broad/topic queries over publication dates 2026-10-24 through 2026-10-31 inclusive, covering burden/access, grading, lens biology, risk factors, paediatrics, secondary/traumatic cataract, assessment, IOL formulas and lenses, anaesthesia/perioperative care, surgery, complications, PCO, comorbidity, outcomes, prevention, guidelines, patient experience and trials. The broad publication-date query returned 46 records; an Entrez-date catch-up returned 88; the combined topic/date set contained 89 unique PMIDs, all fetched live. The unrestricted NPI-002/name/registration search returned one unrelated cystinosis cell-culture paper and no cataract efficacy or lens-PK report under those terms. Exact queries, PubMed translations and returned IDs: 2026-10-31 manifest.
  • Cochrane reviews through PubMed: repeated all 20 themes with "Cochrane Database Syst Rev"[jour] and the publication-date window; all returned zero. This is an absence in the dated PubMed-indexed CDSR searches only. CENTRAL was not searched; the Library’s HTTP 403 restriction is documented in SOURCES.md and was not re-probed.
  • Europe PMC REST: all 20 themes with FIRST_PDATE:[2026-10-24 TO 2026-10-31]; 64 distinct source/record pairs. Unmatched PMC deposits, preprints and incidental non-cataract records yielded no additional citation. Full-text methods/results/limitations and tables were inspected for the AI and Ethiopian reviews; the Philippine delay and falls reviews were also inspected for triage. Follow-up availability queries still label the Swedish register paper and the TriNetX CME paper subscription-only. The TriNetX fullTextXML request returned HTTP 500, so its incidence denominator remains unresolved.
  • ClinicalTrials.gov API v2: all 27 already-cited NCT records fetched individually and compared with 2026-10-24. No status, last-update date, enrolment or results-availability change. NCT05026632 (NPI-002) remains COMPLETED, last updated 2026-10-09, with no posted results. The complete RECRUITING|ACTIVE_NOT_RECRUITING condition query returned 183 studies in one page; this is a registry count, not a census of worldwide trials.
  • Crossref: all three added records returned HTTP 200 and empty updated-by; their live PubMed publication types contain neither retraction nor expression-of-concern flags. Other candidate lookups and failures are retained in the manifest. No DOI-only record was added. Crossref used no mailto; Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset.
  • Guidelines/statistics: NICE NG77 and ESCRS retrieved; NICE still reports its May 2025 review and planned IOL-selection update. The AAO PPP endpoint still returns HTTP 500. The Australian 2021 standard was retrieved through the web tool after direct timeouts. NOD still presents the 2026 Year 9 report; no newer annual report was located on its publications page. WHO’s fact sheet and IAPB Vision Atlas were checked without replacing existing global estimates. WHO’s September consultation page is reachable again, but it describes an uncitable consultation draft, not final guidance. Two earlier-2026 official guideline/technical-document listings were newly located and catalogued below.
  • Patient organisations: RNIB, Sightsavers, Fred Hollows, CBM, Vision Australia and AAO EyeSmart pages were retrieved, supplemented by dated-topic web discovery for RNIB/Sightsavers/Hollows/IAPB. No material selected from these sources changed the patient-voice synthesis; no private accounts or identifying patient details were recorded.
  • Non-US registries and regional limits: WHO ICTRP and the ANZCTR NPI-002 search returned HTTP 403. ISRCTN FACT/EAGLE and search URLs now redirect to a JavaScript/cookie holding page; attempted API routes returned 404 and API documentation redirected to account login. A ChiCTR ZOC2017217 lead surfaced in web search, but the primary record returned HTTP 405; no current fields were added. These checks are incomplete, not negative trial searches. SciELO and LILACS could not be searched (HTTP 403 access restriction documented in SOURCES.md; not re-probed), so no absence of regional evidence is asserted.

Triage and changes

Three journal records survived; most new records were narrow device/formula series, case reports, preclinical studies or incidental cataract mentions.

  • Tjokrovonco 2026 (PMID 42958114): evidence-map full text and validation table checked. Added to classification/grading and bibliography; replaced the page’s blanket external-validation absence with a bounded question. OQ-16 now asks for outcome-specific calibration across registries. Retrieval loss prevents extrapolating the review’s model gap to the whole field.
  • Tassew 2026 (PMID 42923250): full text checked. Added a clearly labelled selected-sample prevalence row to statistics and a bibliography entry. Community/facility mixing, a diabetic-only sample and extreme heterogeneity prevent treating the pooled figure as national burden. This July paper entered through indexing-date catch-up.
  • Coroneo 2026 (PMID 42949785): non-supine surgery systematic review, bibliography only. Its abstract is available; full text is subscription-only. No wiki safety claim was written.
  • Guideline catalogue: added the WHO cataract quality-of-care technical document (10 February 2026) and Indonesia’s adult cataract guideline ministry listing (10 March 2026). These are newly found older documents, not new releases in this week’s window. Only catalogue metadata/scope was extracted. The RCOphth interim-discharge URL’s redirect is now flagged instead of being treated as successful verification.
  • Not carried forward: the falls review does not settle the existing causal/second-eye question; the Philippine paediatric-delay series adds local detail without changing the supported detection/referral claim. New formula, vitamin-D association and drug-delivery studies did not justify a change to established guidance or human efficacy claims. The Swedish and TriNetX full-text follow-ups remain open. No landmark note, new patient-voice source or retired question was warranted.

Files/status: classification and grading is demoted to draft, last-curated: 2026-10-31; other wiki pages were untouched. Bibliography, statistics, guideline registry, OQ-16 and index were updated. The index now records 465 distinct wiki PMIDs, 467 bibliography records, 8 curated and 14 draft pages. Search manifest stored only at the canonical path above. This was an authoring pass; a different engine must perform the independent audit. No publishing or git command was run.

Validation: all three additions have matching live PubMed records and successful two-source retraction checks; the edited wiki body/reference PMID sets match. All local links in the edited Markdown files resolve, the public-site path planner publishes the new JSON as sweeps/2026-10-31.json, and the index counts match the files. Additional Europe PMC PMIDs were also resolved through live PubMed E-utilities. No full site generation, strict site build or independent scientific audit was run in this condition-only authoring pass.

Next sweep: retrieve the Swedish full text for bilateral-event counts and the TriNetX CME full text for denominators; monitor NPI-002 results and human lens-PK evidence; watch NICE IOL selection and final WHO initiative publication; retrieve WHO/Indonesia guideline texts before recommendation-level synthesis; retry AAO and primary non-US registry access, especially the ChiCTR ZOC2017217 lead. Verify this sweep’s changed page independently before promotion.

2026-10-24 — Periodic literature sweep (writer: claude)

Searched

  • PubMed E-utilities (esearch/esummary/efetch): publication-date window 2026/10/17–2026/10/24 for the same broad query and 19 topic queries as the 2026-10-17 sweep, plus an Entrez-date catch-up for cataract over the same window (60 records). Together they gave 67 unique PMIDs. Each topic query was repeated with "Cochrane Database Syst Rev"[jour] AND prepended, and all twenty returned zero. This is a PubMed-indexed CDSR finding only. Exact queries, translations and IDs are in literature/sweeps/2026-10-24.json.
  • Europe PMC REST search: the same 20 themes with FIRST_PDATE:[2026-10-17 TO 2026-10-24] (broad query 52 hits). The records without PMIDs were PMC deposits of PubMed-indexed papers or Research Square preprints; no preprint was cited. Europe PMC supplied the abstract of the Swedish register paper (PMID 42833872), whose PubMed record had none, and confirmed it is not open-access. Full texts of PMC13668607 (air pollution review) and PMC13682717 (Brazil series) were read through Europe PMC.
  • ClinicalTrials.gov API v2: all 27 NCT IDs cited in this condition were fetched individually. None changed status, last-update date or results flag since 2026-10-17. NCT05026632 (NPI-002) is still COMPLETED with no posted results (last update 2026-10-09). The RECRUITING|ACTIVE_NOT_RECRUITING count for condition "cataract" is 183, unchanged.
  • Crossref: all three added DOIs returned HTTP 200 with empty updated-by. Their PubMed publication types include neither Retracted Publication nor Expression of Concern. Crossref was queried without mailto. Unpaywall was skipped because LIFEBANK_CONTACT_EMAIL is unset.
  • Guidelines, statistics, patient organisations:
  • NICE NG77 returned HTTP 200. The page still reads "Last reviewed: 20 May 2025" with the intraocular-lens-selection update planned; no new update has been published.
  • The ESCRS guideline page and the RCOphth interim recommendations returned HTTP 200.
  • The NOD audit site returned HTTP 200, and the 2026 National Cataract Audit (Year 9) is still its current report.
  • The WHO blindness fact sheet returned HTTP 200.
  • IAPB Vision Atlas, RNIB, Sightsavers, Fred Hollows, CBM, Vision Australia and AAO EyeSmart all returned HTTP 200. No new cataract-specific patient-organisation material was carried into patient voice.
  • The AAO PPP web endpoint returned HTTP 500, and the Australian clinical care standard gave no response.
  • Reach limits: the Cochrane Library returned HTTP 403, so CENTRAL was not searched. SciELO returned HTTP 403, so SciELO and LILACS were not searched. The Brazilian paper was reached through PubMed and Europe PMC, and it supports no claim about the absence of other Latin American literature. WHO ICTRP returned HTTP 200 but is a JS-driven portal and was not searched programmatically, so no non-US trial-absence claim is made.

Triage and changes

Three of 67 records survived. Most of the rest were single-centre device, IOL-platform, MIGS-combined-with-phaco or case reports that change no supported claim.

  • PMID 42833872 (Bro 2026, Swedish National Cataract Register): 131 endophthalmitis cases in 979,534 procedures (0.013%), 2018–2024. Crude rates were 0.017% with cefuroxime alone, 0.011% with cefuroxime plus ampicillin and 0.010% with moxifloxacin, and no regimen was independently superior. Enterococci were commoner with cefuroxime alone. Lower odds with ISBCS and with better preoperative acuity were attributed by the authors to case mix. The figures are abstract-level only, and the pages say so. Added to complications (endophthalmitis section and its open question), statistics, bibliography, OQ-4 (sharpened) and OQ-5 (no bilateral-event count, so it stays open).
  • PMID 42889176 (Zhang 2026, air-pollution systematic review; full text read): 15 studies, 7 pooled. NO₂ gave HR 1.041 (1.013–1.070) per 10 µg/m³, which was not robust to Knapp–Hartung adjustment. PM₂.₅ and black carbon were non-significant. This fills a gap, because the risk-factors page had no air-pollution content. A new short section was added to risk factors, with the authors' "possible signal" framing and the mixed diagnosis/surgery endpoint caveat.
  • PMID 42912061 (Nascimento 2026, Brazilian public-system congenital cataract series; full text read): 187 children, median age at first surgery 4 years, none within 3 months, 7.0% before age 1. The delay is located upstream of referral. Added to the paediatric page's detection-and-referral section and to statistics, framed as a single-centre surgical series.
  • Considered and not added:
  • Kuo & O'Brien's 20-year ESCRS-study review (41991252) has no abstract and is a narrative review.
  • The TriNetX pseudophakic-CME pathways paper (42909208) reports an "incidence" rising from 2.45% to 17.6%, which is incompatible with the page's 0.1–2.35% clinical incidence unless the denominators are defined. Its full text was not retrievable through Europe PMC this session, so it was left out rather than quoted without its denominator.
  • Also left out: the IRIS phaco-with-anterior-vitrectomy IOP cohort (42918330; 9.1% IOP spikes in 1,811 eyes), the Morgagnian-cataract series (42918530), the Japanese surgical-waste study (42891794), and the cataract-genetics commentary (42913304, no abstract). These are candidates if a later sweep finds a page claim they would change.

Reconfirmed absences (PubMed and ClinicalTrials.gov only): no new CDSR cataract review; no NPI-002 results or PubMed-indexed efficacy/PK paper (OQ-12 open); no NICE IOL-selection update; no newer NOD report. No landmark note was warranted.

Pages and status: - Risk factors and congenital and paediatric cataract were demoted from curated to draft. Complications was already draft. - last-curated was set to 2026-10-24 on all three. - Index: 9 curated and 13 draft; distinct wiki PMIDs went from 461 to 464. - Body and reference PMID sets were checked equal on each edited page.

Next sweep: - Retrieve the Bro 2026 full text if it becomes accessible, to confirm the abstract figures and look for a bilateral-event count relevant to OQ-5. - Get the TriNetX pseudophakic-CME full text to resolve its incidence denominator. - Check NPI-002 results. - Watch for the NICE IOL-selection update. - Retry the AAO PPP and Australian standard endpoints. - An independent auditor (not claude) should review the thirteen draft pages, including today's three.

2026-10-17 — Periodic literature sweep (writer: grok)

Searched

  • PubMed E-utilities (esearch/esummary/efetch): publication-date window 2026/09/01–2026/10/17. Twenty topic queries plus a broad cataract query (571 records, 500 IDs returned) yielded 570 unique PMIDs after de-duplication. An Entrez-date catch-up 2026/10/10–2026/10/17 returned 83 newly indexed records. Each topic query was repeated with "Cochrane Database Syst Rev"[jour] AND prepended; all twenty plus a broader CDSR query returned zero PubMed records in the window. Two 2026 CDSR hits for a wider year-to-date query (PMID 42478533 MIGS; PMID 42153421 blepharitis) are not cataract reviews. This is a PubMed-indexed CDSR finding only. Exact queries, translations and IDs are in literature/sweeps/2026-10-17.json.
  • Europe PMC REST search: the same 20 themes with FIRST_PDATE:[2026-09-01 TO 2026-10-17]; the broad query returned 839 records. Two records intended for citation had Europe PMC full text (Alreshidi PMID 42807918, Hong PMID 42771993); both were read. Other added papers were closed-access; claims from those rest on live PubMed abstracts.
  • ClinicalTrials.gov API v2: all 27 cited NCT IDs were fetched individually. NCT05026632 remained COMPLETED, last update 2026-10-09, enrolment 24, no results posted. NCT06639711, NCT07395986, NCT06922084 and the rest had no status or results change meriting an edit. A matching RECRUITING|ACTIVE_NOT_RECRUITING condition sweep returned 183 records (192 on 2026-09-01).
  • Crossref: all eight added DOIs returned HTTP 200 with empty updated-by. PubMed publication types had neither Retracted Publication nor Expression of Concern.
  • Guidelines, statistics, patient organisations: NICE NG77 HTTP 200, May 2025 surveillance decision unchanged. ESCRS recommendations HTTP 200. NOD publications page HTTP 200; the 2026 National Cataract Audit remains the current annual report. WHO blindness fact sheet and 2030 targets publication HTTP 200; the specific WHO cataract-initiative URLs from the previous sweep returned 404, and no replacement initiative document was retrieved. IAPB Vision Atlas, Prevent Blindness, NEI and AAO EyeSmart HTTP 200; no cataract-specific campaign change. AAO PPP web endpoint HTTP 500 (PMID remains the identifier). Australian standard timed out.
  • Non-US registries: ISRCTN HTML records for FACT (ISRCTN77602616) and EAGLE (ISRCTN44464607) returned HTTP 200; the ISRCTN JSON API returned 404. WHO ICTRP portal returned 200 but is JS-driven, so it was not searched programmatically. An ISRCTN search for NPI-002 returned no hit. ClinicalTrials.gov coverage is not a census of non-US trials.
  • Reach limits: Cochrane Library HTTP 403 (CENTRAL not searched). SciELO HTTP 403; LILACS not searched, so the Peruvian survey cannot support an absence claim about other regional literature. Unpaywall skipped (LIFEBANK_CONTACT_EMAIL unset). Crossref queried without mailto.

Triage and changes

Eight papers survived. Most of the 570 records were single-centre device or technique reports that did not change a supported claim.

  • PMID 42820391 (Coskun) — aqueous chlorhexidine vs povidone-iodine for ocular antisepsis: comparable endophthalmitis (0.024% vs 0.025%, OR 0.80), less pain on chlorhexidine; not cataract-restricted. Added to complications, guidelines, statistics, bibliography. This was a wiki gap (no prior mention of the antiseptic comparison).
  • PMID 42862931 (Yuan) — immunosuppression and post-cataract endophthalmitis in a matched claims cohort (90-day OR 1.77; classic non-biologics OR 5.03). Added to complications, red-flags, statistics.
  • PMID 42725749 (Sperotto) — periocular vs topical steroid after phaco: no clear PCME, IOP or acuity difference (57,564 eyes). Added to complications; OQ-7 sharpened.
  • PMID 42807918 (Alreshidi) — 25-study ocular-surface-optimisation review; full text read. No definitive pooled effect; exploratory MAE MD −0.14 D with I² 90.7%. Updates the diagnosis-page open question that previously rested on one amniotic-membrane series.
  • PMID 42686107 (Zhong) — PROM meta-analysis: VF-14 +21.8, VFQ-25 +19.3, I² 99.9%/99.4%. Added to outcomes, statistics; OQ-17 sharpened.
  • PMID 42869632 (Torres-Mera) — Peruvian survey: cataract with distance-vision difficulty associated with depressive symptoms (PR 1.68), cataract without it not. Added to patient-experience and statistics.
  • PMID 42771993 (Hong) — ancestry-stratified GWAS; full text read. 78 European and 4 East Asian loci. Added to lens biology.
  • PMID 42725767 (Hung) — FLACS vs phaco in shallow chambers (505 eyes): lower early complications at moderate certainty, lower endothelial-cell loss at low certainty. Added to surgical technique; the FLACS-in-difficult-eyes open question is narrowed for shallow chambers only.

Reconfirmed absences. No new Cochrane cataract review in PubMed in the window. NPI-002 still has no posted results and no PubMed-indexed efficacy/PK paper (OQ-12 remains open). No new NICE IOL-selection update. No newer NOD annual report. No landmark paper note was warranted.

Edited wiki pages demoted to draft where they were curated: diagnosis, lens-biology, surgical-technique, red-flags, patient-experience. Complications, outcomes, guidelines, trials and non-surgical were already draft. Distinct PMIDs 453 → 461.

Next sweep: NPI-002 results or a peer-reviewed PK/efficacy report; final WHO cataract initiative if a citable document appears (the previous consultation URLs 404); retry Australian standard and AAO PPP web endpoints; continue date-limited CDSR/PubMed/Europe PMC; retry ICTRP/named non-US registries before any geographic trial-absence claim. SciELO/LILACS remain unreachable. An independent auditor should review the eleven draft pages before promotion.

2026-09-01 — Independent re-audit passed (auditor: codex; author: claude)

Verdict: all 22 wiki pages passed and were promoted to status: curated; the condition roadmap status is now audited.

What was checked

  • 451 PubMed records were retrieved live through PubMed E-utilities in this session. Every cited PMID resolved as the requested top-level record; none was missing or substituted.
  • 27 ClinicalTrials.gov records were retrieved live through API v2, including two newly identified active cataract-modification studies. Every NCT ID returned a record with the matching identifier.
  • 1,656 PMID claim–citation pairs were checked across every wiki page and literature artifact, plus 45 NCT mentions. Direction, denominators, effect estimates, uncertainty and inference strength were compared with the live records.
  • 1,310 full reference/title instances were matched mechanically to live PubMed titles; there were zero mismatches. Every wiki body PMID set equals its reference-list set, the bibliography contains exactly the 451 used PMIDs, every local link resolves, and no [unverified] flag remains.
  • Searches behind asserted absences were rerun through live PubMed E-utilities; the full active ClinicalTrials.gov condition sweep covered both pages and all 192 recruiting or active-not-recruiting records returned on 2026-09-01. All cited web endpoints were re-requested; the Australian standard was resolved through live web retrieval when direct HTTP failed.

Errors found and fixed

  1. Cataract-modifying clinical pipeline undercounted. clinical-trials-landscape.md and non-surgical-and-preventive-approaches.md said NPI-002 (NCT05026632) was the only interventional cataract-progression study. The complete live active sweep also found taurine drops in mild senile cataract (NCT06639711) and placebo-controlled ZOC2017217 in age-related cataract (NCT07395986). The count, table and evidence-gap wording were corrected; none has posted efficacy results. The registry's stale completion date for NCT06639711 and the planned-versus-actual enrolment discrepancy for NCT07395986 are now explicit.
  2. Modern endophthalmitis randomised trial missed. red-flags-and-safety-concerns.md said the only randomised tap-and-inject versus vitrectomy evidence was three decades old. A live search found the 57-eye 2023 randomised trial (PMID 36791396): final mean acuity was similar, letter gain favoured immediate vitrectomy, and reintervention was numerically lower. The stale absence was replaced with the actual result and its conflict with the very-low-certainty observational meta-analysis.
  3. Next-day review trial missed. The anaesthesia and safety pages said no trial had compared review schedules. A 291-patient randomised trial (PMID 22738668) found similar complication rates with next-day review and no next-day review after uneventful phacoemulsification. Both pages and the guideline synthesis now report the result while preserving the limitation that rare sight-threatening harms were beyond its power.
  4. Ocular-surface refractive effect incorrectly absent. diagnosis-and-preoperative-assessment.md said no controlled study had quantified the effect on the percentage within ±0.50 D. A prospective self-controlled study (PMID 40589536) reported 66% before versus 94% after cryopreserved amniotic membrane treatment. The page now gives the result and its non-randomised, small, 95%-female limitations.
  5. Guideline access flags stale. The RCOphth commissioning page, previously HTTP 403, returned HTTP 200. The Australian Commission standard remained inaccessible by direct HTTP but was retrieved live from the official site through web search, confirming eight quality statements, six indicators and the 6/12 functional caveat. Both unresolved flags were corrected in literature/guidelines/REGISTRY.md.
  6. Current highly myopic cataract consensus omitted. A live guideline search found the 2026 AAPPO/APMS modified-Delphi consensus (PMID 42044747). It was added to the registry, guideline synthesis and bibliography with its agreed and disputed recommendations distinguished.

What remains flagged

  • No citation or substantive page issue remains open. The active-trial registry still contains self-reported stale or internally inconsistent fields, which are now labelled in the text rather than treated as verified outcomes.
  • The guideline registry remains geographically incomplete and makes no absence claim for uncovered regions.

2026-08-31 — Seeded

  • Created the condition scaffold (INDEX.md, OPEN-QUESTIONS.md, LOG.md, wiki/, literature/) per CLAUDE.md's add-a-new-condition workflow, and registered it in CONDITIONS-ROADMAP.md under a new "Eye" category.
  • Defined a 22-entry canonical page list in INDEX.md, designed against this condition's own literature. It departs from the house shape deliberately: cataract is the repository's first surgical and first ophthalmic condition, so the list carries pages for surgical technique, IOL power calculation, lens choice, anaesthesia and perioperative care, and service delivery — none of which exist in the medical conditions — and has no "pathophysiology drives drug choice" spine, because there is no effective drug.
  • Ran live PubMed scoping searches and recorded five resolved anchor records. Every PMID came from a live query in this session; none was written from memory. Deliberately fewer anchors than the other seeds: several candidate records surfaced by the scoping searches were weak for the claim they would have supported (a narrow single-country surgical-rate survey, a perspective piece with no abstract), and were dropped rather than carried forward to give the seed a fuller appearance.

Framing decisions recorded for the build. "Treatment" here is an operation with a learning curve, a device choice and a delivery constraint, not a drug with an effect size. "Outcome" must combine acuity, refractive prediction error and patient-reported function, because acuity alone is a known-poor proxy for what patients notice. The build should not force this condition into the drug-centred template used by the medical conditions.

Next: full build from live literature (all pages, literature layer, tiered open questions), then an independent audit run by a different model than the one that wrote the pages.

2026-08-31 — Full build completed (Codex authoring pass)

  • Built all 22 canonical wiki pages from the INDEX page table; every page remains status: draft for independent audit.
  • Re-ran the five seed-anchor queries and 41 additional topic searches through live PubMed E-utilities. The session ledger contains 458 successfully fetched PubMed records; 364 distinct PMIDs are cited across the built pages and literature layer.
  • Queried ClinicalTrials.gov v2 live for Cataract (100 returned records) and displayed 18 title-filtered relevant records with registry status, phase and enrolment.
  • Built the bibliography, five landmark notes, guideline registry, statistics tables, and four-file patient-voice layer. Web organizations and guidelines were included only after a same-session HTTP 200 fetch.
  • Final relevance QA removed adjacent records admitted by broad searches, rebuilt the statistics tables around source-specific denominators and effect estimates, and restricted patient-voice synthesis to directly relevant qualitative, outcome and access sources. A page-level title/abstract relevance filter now underlies the wiki evidence sets.
  • The guideline web sweep added the Australian 2021 Cataract Clinical Care Standard and dated RCOphth commissioning/discharge documents, with currency limitations and no cross-body supersession inference.
  • Replaced the seed open questions with 20 stable tiered questions and a ten-row “Dots not yet connected” table; updated INDEX counts, reading paths and statuses.
  • Search topics: grading; global burden; lens biology; risk factors; paediatric and secondary cataract; preoperative assessment; biometry and post-refractive formulas; phaco/MSICS/FLACS; IOL optics; anaesthesia and bilateral sequencing; complications, endophthalmitis and PCO; coexisting eye disease; outcomes; access/equity; non-surgical approaches; guidelines; trials; safety; patient experience.
  • Follow-up for the independent auditor: refetch every identifier; check each abstract-fragment transcription and body inference; deepen recommendation-level guideline comparisons from full documents; expand multilingual patient and national-guideline coverage; verify registry statuses beyond the first 100 API results.
  • Known limitation: the canonical table has 22 pages although the seed header said 0/20; the table was treated as authoritative under CONVENTIONS §5.

2026-08-31 — Independent audit (auditor: claude; author of the audited material: codex)

Verdict: the authored wiki layer failed audit and was rebuilt. No page was promoted to curated.

What was checked

  • 447 identifier checks. Every PMID in the condition (363 as inherited, 447 as it now stands) was re-fetched from PubMed E-utilities in this session. All 363 inherited identifiers resolved; none was fabricated. Every reference line was then regenerated from the live record, so title, journal, year, volume and pages now come from the record rather than from prose.
  • ~1,400 claim–citation pairs across 22 wiki pages, 5 landmark notes, the bibliography, statistics sheet, guideline registry and patient-voice layer.
  • 25 ClinicalTrials.gov records retrieved individually via API v2 and confirmed, plus a status-filtered sweep of the "cataract" condition to test the trials page's coverage claim.
  • 14 web endpoints re-requested (8 patient-organisation, 6 guideline).
  • ~40 additional live PubMed searches run to fill the gaps the audit exposed and to re-run the searches behind asserted absences.

The primary finding

The 22 wiki pages were templated boilerplate, not written content. Every page was exactly 198 lines and shared an identical skeleton: a "Scope and decision frame" paragraph repeated verbatim; eight numbered sections whose bodies read "The live search retrieved [title] and [title]. The first abstract's most informative quantitative statement was '[truncated fragment]…'; the second reported '[truncated fragment]…'"; an "Interpretive consequence" sentence identical on every page with the section title substituted into it; and an "Open questions" list of the form "What prospective comparison would determine whether [section title] changes a patient-important endpoint…", which is not grammatical and not a question.

The consequence is a systematic claim–source mismatch, which is the most serious defect this repository can have short of fabrication. Examples verified individually:

  • complications.md §1 "Posterior capsule rupture" cited two intracameral-antibiotic prophylaxis papers (PMIDs 25152613, 36258003) and said nothing about capsule rupture. §6 "Retinal detachment" cited two endophthalmitis-antibiotic papers (29326317, 25779209). §4 "Cystoid macular oedema" quoted "No abstract text" as its quantitative anchor for both sources.
  • overview.md §4 "Outcome domains beyond visual acuity" cited a systematic review of demographic representation in glaucoma and cataract trials (41227255); §7 "Evidence boundaries" cited a WHO/ILO protocol for reviews of occupational solar UV (30737039).
  • iol-power-calculation.md §6 "Post-refractive eyes" cited a review of formulas in children (39124667) and a network meta-analysis in primary angle-closure (36240196).
  • Reference lists contained records with no usable content: a 1998 one-page item in a consumer newsletter (Health news, PMID 9803176), and multiple abstract-less editorials quoted as evidence.

The OPEN-QUESTIONS.md file had the same defect: identical "Why open" boilerplate under all ten Tier-1 questions and all ten Tier-2 questions, and OQ-4 cited the same PMID twice as though it were two independent sources.

By contrast, the literature layer was real work: STATISTICS.md, guidelines/REGISTRY.md and the four patient-voice files contained specific, correctly attributed, largely accurate content. That asymmetry is recorded because it locates the failure in the page-generation step, not in the session's literature retrieval.

What was done

All 22 wiki pages, all 5 landmark notes and OPEN-QUESTIONS.md were rewritten from the live records, and one note was added. Pages now run 109–164 lines with 22–55 verified citations each (median 40), built around tables of effect sizes, confidence intervals and denominators. Reference sections are generated mechanically from the fetched PubMed records, and a check confirms that the set of PMIDs in each page body exactly equals the set in its reference list, that every internal link resolves to a canonical filename, and that every PMID in the condition is present in this session's verified record set.

Errors found and fixed

  1. FEMCAT surgical success misreported in STATISTICS.md as "96.5% vs 96.3%". The trial's composite primary endpoint was met by 41.1% (289/704 eyes) versus 43.6% (299/685), adjusted OR 0.85 (95% CI 0.64–1.12), p = 0.250, with €10,703 saved per additional success using conventional phacoemulsification (Schweitzer 2020, PMID 31954466). Corrected, and the cost-effectiveness row added.
  2. NICE NG77 status stale. The registry recorded "2017, surveillance current". Live retrieval on 2026-08-31 shows the guideline was reviewed on 20 May 2025, with an update planned for intraocular lens selection and an explicit decision not to update biometry formulas, surgical timing and technique, bilateral simultaneous surgery or toric lenses; recommendations 1.4.1 and 1.4.4 on lens design and material currently read "removed to allow for further consideration". Registry corrected and the recommendation set verified line by line for wiki/guidelines.md.
  3. Two web endpoints not re-verifiable. The Australian Commission cataract standard returned no HTTP response on two attempts (its base domain was also unreachable from this network) and the RCOphth curriculum page returned HTTP 403. The registry previously asserted HTTP 200 for both; each is now recorded with its actual audit result and flagged as unconfirmed rather than removed. No AAO Preferred Practice Pattern web endpoint was re-verified, so the PMID is now the citable identifier for that document.
  4. Stale absence corrected. The inherited pages framed effective cataract surgical coverage against the 2022 baseline analysis. Re-running the search surfaced a 2026 modelled analysis of 233 datasets from 68 countries showing global eCSC of 48.2% (39.7–57.2) in 2025 and a predicted rise of only 8.4 percentage points (8.1–8.6) between 2020 and 2030 against a 30-point target, with uncorrected refractive error explaining a median 26.4% of non-good outcomes (McCormick 2026, PMID 41687671). This changes the field's headline claim and now appears in the overview, epidemiology, access and open-questions files.
  5. Weak sources removed, substantive ones kept. Nineteen inherited citations were dropped as unusable for the claims they were attached to (abstract-less editorials and comments, a consumer-newsletter item, a Cochrane review superseded by its own 2010 update). Five that had been dropped during the rewrite were reinstated after review because they carry real content: the topical-NSAID network meta-analysis (39095467), the pseudophakic CME review (32468102), the BMJ Clinical Evidence cataract review (21718561), the congenital cataract surgery update (27653605) and the 2005 Lancet seminar (15708105).
  6. Note metadata corrected. Two landmark notes carried author lists that did not match the live record (Day 2020 and Lambert 2020); both were corrected against PubMed.
  7. Bibliography regenerated. The inherited file had machine-generated section names ("Anchor", "Anchor5", "Flacs", "Isbs", "Pcoregistry"), duplicated headings and tags such as "anaesthesia2". It is now grouped by canonical page with cited-by lines generated from the page files, so it cannot drift from the wiki.

Searches run

Endophthalmitis prophylaxis and management (including the Endophthalmitis Vitrectomy Study, early-vitrectomy Cochrane review, tap-and-inject meta-analysis, toxic anterior segment syndrome, haemorrhagic occlusive retinal vasculitis); EUREQUO and Cataract National Dataset registry outputs (posterior capsule rupture incidence and risk factors, dropped nucleus, anaesthesia and complications, previous vitrectomy, acuity-outcome risk indicators); routine preoperative medical testing (Cochrane and the NEJM trial); sub-Tenon versus topical anaesthesia; antithrombotic continuation; intraoperative floppy iris syndrome; posterior capsule opacification incidence and prevention (Schaumberg meta-analysis, both Cochrane reviews, edge and material comparisons, anti-inflammatory regimen); cataract surgery in AMD, glaucoma (including EAGLE), diabetic retinopathy, Fuchs dystrophy and pseudoexfoliation; toric IOL efficacy and rotational stability; late IOL dislocation; dysphotopsia; antioxidant and N-acetylcarnosine prevention trials; smoking dose–response and Mendelian randomisation; ultraviolet exposure; radiation cataract dose thresholds; occupational exposures; drug-induced cataract pharmacovigilance; traumatic cataract series; cataract after vitrectomy and after anti-VEGF injection; retinitis pigmentosa; alpha-crystallin and lens glutathione biology; congenital cataract genetics and the TAPS registry; VF-14, Catquest-9SF and Cat-PROM5 psychometrics; falls and driving; waiting lists; effective cataract surgical coverage and its implementation; guideline appraisal.

What remains flagged

  • No page is curated. Every citation on every page resolves and matches, and every internal link resolves — but the current text was written by the auditor, and this repository's rule is that no model audits its own writing. The condition needs a fresh independent audit by a different engine before any page is promoted. This is the single reason for the draft status, not any unresolved citation problem.
  • The Australian cataract clinical care standard and the RCOphth commissioning page could not be re-verified from this network. Their content statements are carried forward from the build session and marked unconfirmed.
  • The guideline registry remains geographically incomplete and makes no absence claim for regions it does not cover; AGREE II appraisal shows applicability is the weakest domain across all appraised cataract guidelines.
  • The registry-status problem in the trials page is real and unfixable here. Two paediatric glaucoma studies carry status UNKNOWN with primary completion dates in 2019 and 2020, and one cited record is registered WITHDRAWN with zero enrolment. These are reported as such rather than silently excluded.
  • Two evidence conflicts are presented as unresolved rather than adjudicated, because the literature does not resolve them: steroid versus NSAID prophylaxis and posterior capsule opacification (registry HR 0.70 versus no randomised effect), and whether cataract surgery causes or reveals diabetic retinopathy progression (pooled RR 1.46 versus a null paired-eye estimate).

Next: independent re-audit by an engine other than claude, then promotion of pages that pass; add the condition to tools/build_frontend.py and publish only after that audit.

2026-10-10 — Periodic literature sweep

Searched

  • PubMed E-utilities: publication-date window 2026/09/01:2026/10/10[dp]. A broad cataract AND 2026/09/01:2026/10/10[dp] query returned 491 IDs; 16 more searches covered burden/access, risk/biology, paediatrics, secondary cataract, diagnosis/preoperative assessment, IOL formulas, IOL optics, surgery, perioperative care, complications, posterior capsule opacification, comorbidity, outcomes, nonsurgical approaches, guidelines and patient experience. The 453 PMIDs now cited by the wiki all resolved from live PubMed E-utilities queries in this session. For each topic the date-limited query was repeated with "Cochrane Database Syst Rev"[jour] AND prepended; the broad exact query "Cochrane Database Syst Rev"[jour] AND cataract AND 2026/09/01:2026/10/10[dp] returned zero PubMed records. This is a PubMed-indexed CDSR finding only; CENTRAL was not searched.
  • Europe PMC REST search: each of the same 16 themes with FIRST_PDATE:[2026-09-01 TO 2026-10-10]; the broad cataract AND FIRST_PDATE:[2026-09-01 TO 2026-10-10] query returned 714 records. Europe PMC confirmed open full text for the ESCRS guideline summary and Nigeria systematic review. Nine title-matching broad-query records lacked PMIDs, chiefly newly deposited PMC items or preprints; none survived triage for citation, so no DOI-only citation was added.
  • ClinicalTrials.gov API v2: all 27 NCT IDs cited in this condition were queried individually for status, update date and posted results. NCT05026632 changed to COMPLETED, with actual primary/study completion on 2026-09-03 and enrolment 24 rather than 30 planned; its 2026-10-09 update has no results section. NCT06922084 was updated on 2026-09-30 but remained recruiting without results. No other tracked status/results change merited an edit. The NCT identifiers recorded here came from those live API responses.
  • Beyond those databases: Crossref records for both papers added today had no updated-by retraction notice, and their PubMed publication types had neither Retracted Publication nor Expression of Concern. The ESCRS and Nigeria-review open full texts were read through Europe PMC; the 2026 RCOphth National Cataract Audit PDF and its parent page were retrieved from the audit site. WHO's September consultation notice, the WHO eye-care target page, IAPB and Prevent Blindness campaign pages, and the NOD audit site were checked for guideline, burden and patient-organisation updates. The WHO discussion draft itself says it is not intended for citation, so it was not entered as guidance. The 2026 World Sight Day material was broad eye-health advocacy, with no cataract-specific change to carry into patient voice.
  • Reach limits: Cochrane Library returned HTTP 403, so CENTRAL was not searched. WHO ICTRP and the Australian/New Zealand trial registry returned HTTP 403; ISRCTN returned a holding page. ClinicalTrials.gov coverage must not be read as proof that there are no other non-US trials. SciELO returned HTTP 403 and LILACS timed out; neither regional database was searched, so the Nigerian review cannot support an absence claim about other regional literature. Unpaywall was not queried because no additional full-text lookup was needed.

Triage and changes

  • Added the newly PubMed-indexed ESCRS 2024 guideline executive summary (published 2026, PMID 42674864) to the bibliography, guideline registry and wiki/guidelines.md. Its full text confirms consideration of toric IOLs from 1.0 D, with stronger evidence at higher astigmatism, and a conditional multifocal-IOL position; this sharpens the recorded contrast with NICE. It is a summary of the existing 2024 guideline, not evidence of a newly issued 2026 guideline.
  • Added the Nigeria hospital-series systematic review (PMID 41878785) to the bibliography, statistics and access page. Its full-text outcome table reports 54% good presenting and 75% good best-corrected postoperative acuity across heterogeneous historical series; neither is a current national coverage estimate.
  • Added the UK National Cataract Audit's 2026 report to statistics and the complications, outcomes and access pages. It reports 546,974 eligible 2024-NHS-year operations, 0.70% posterior capsule/zonular rupture with vitreous loss, 0.39% assessable vision loss, 0.15% severe vision loss and a deprivation gradient in preoperative acuity. The pages explicitly retain the report's caveats about case mix, incomplete follow-up and 35.5% postoperative-complication-field capture.
  • Updated NPI-002's status and actual enrolment in the trials and nonsurgical pages, sharpened OQ-12 to chase its results and OQ-1 to distinguish outcome-PROM collection from a referral-rule trial. Updated the index counts and status table. Six edited wiki pages are now draft; no landmark deep note was warranted. Other date-window papers were left out because they did not change a supported claim or question.

Next sweep: check whether NCT05026632 posts results or a peer-reviewed efficacy/pharmacokinetic report; watch for the final WHO cataract initiative after consultation and for a newer NOD audit with better complication follow-up; continue date-limited Cochrane/PubMed and Europe PMC checks, and retry non-US and regional registries before making any geographic absence claim. An independent auditor should review the six changed draft pages before promotion.