Life-course pathways from childhood starvation to late-life depressive symptoms: a double machine learning approach.

Primary vitreoretinal lymphoma (PVRL) is a rare ocular malignancy, with an incidence of 0.5-2 cases per million. However, its reported frequency has increased in recent decades due to improved diagnostic methods, greater disease awareness, longer life expectancy, and a higher prevalence of immunosuppression [,]. It represents a heterogeneous and often underrecognized group of tumors, frequently misdiagnosed because of its subtle presentation and ability to mimic other ocular conditions, which also limits research and standardized management []. Central nervous system (CNS) involvement is common, occurring in 60-80% of cases, and a significant proportion of patients with PVRL will develop or present with CNS disease during the course of illness [,]. Primary vitreoretinal lymphoma commonly presents with floaters and progressive vision loss, often accompanied by characteristic retinal findings, including multifocal creamy-white lesions and a “leopard-skin” pattern []. It is an aggressive malignancy that frequently involves both eyes, with vitreous infiltration observed in most cases []. Primary vitreoretinal lymphoma should be suspected in elderly or immunosuppressed patients with visual symptoms that fail to respond to corticosteroid therapy []. Diagnosis is often challenging due to its variable presentation, as it can mimic a wide range of ocular conditions, including uveitis, viral retinitis, macular degeneration, white dot syndrome (WDS), and other inflammatory or infectious diseases. Therefore, careful clinical assessment and attention to subtle diagnostic clues are essential for early and accurate diagnosis []. Multiple evanescent white dot syndrome (MEWDS) is a rare, idiopathic, self-limiting inflammatory disorder of the outer retina that typically affects young women, often after a viral illness. It presents with foveal granularity and small gray-white lesions at the posterior pole, usually sparing the periphery []. Although MEWDS is typically benign, its clinical and imaging features may overlap with those of PVRL, creating diagnostic confusion. Both entities can present with gray-white outer retinal lesions and visual disturbances. In some cases, PVRL may initially mimic MEWDS, especially in its early stages. However, unlike MEWDS, PVRL occurs more in older or immunocompromised patients, tends to have a progressive course, may be associated with vitritis, and does not resolve spontaneously. Recognizing this overlap is essential, as misdiagnosis can delay appropriate management of PVRL, a potentially life-threatening malignancy [,].