{"title":"Normative retinal thickness values in children, measured by swept-source optical coherence tomography.","authors":"Sanna Svensson, Asa S Minor, Hanna Maria V Ohnell","doi":"10.51329/mehdiophthal1523","DOIUrl":"10.51329/mehdiophthal1523","url":null,"abstract":"<p><strong>Background: </strong>Although optical coherence tomography (OCT) has become essential in pediatric ophthalmology, normative data for children are lacking in most device databases. Due to ongoing ocular growth and developmental changes that occur during childhood and adolescence, adult reference values are not appropriate for pediatric use. Additionally, OCT measurements vary across devices, indicating the need for device-specific norms. In this study, we aimed to establish normative values for total macular retinal thickness, macular ganglion cell layer (GCL+) thickness, and circumpapillary retinal nerve fiber layer (cpRNFL) thickness in children aged 5-17 years relevant to the Topcon DRI Triton Plus swept-source OCT device.</p><p><strong>Methods: </strong>We recruited children aged 5-17 years with normal ocular health, adequate visual acuity, and refractive errors within ±3.00 diopters (D) spherical and ≤ -1.00 D cylindrical under cycloplegia. Each child underwent comprehensive eye examinations and four OCT scans (two macular and two optic disc scans) using the Topcon DRI Triton Plus. Retinal thickness measurements were obtained from the eye with better visual acuity, or from a randomly selected eye in cases where both eyes had similar acuity. Scans were included if image quality was ≥40 and were free from artifacts or segmentation errors. Measurements were compared between age groups (5-7 and 8-17 years). Intra-visit repeatability was assessed using test-retest correlations based on repeated measurements obtained by the same examiner during a single visit.</p><p><strong>Results: </strong>Sixty-nine children (n = 33, 48% girls), with a median age of 7 years (5-7-year age group) and 13 years (8-17-year age group) were included. The total macular thickness was 287.5 µm (11.1) and 290.5 µm (13.8), GCL+ thickness was 75.7 µm (4.2) and 74.9 µm (5.2), and cpRNFL thickness was 111.5 µm (10.2) and 108.3 µm (7.9) for the 5-7-year and 8-17-year age groups, respectively (mean [standard deviation]). Mean retinal thickness measures did not differ significantly by age or sex (all <i>P</i> > 0.05). Correlation between repeated measurements showed excellent repeatability: 0.991 for both total macular and GCL+ thickness, and 0.954 for cpRNFL (all <i>P</i> < 0.001). Spherical equivalent did not correlate significantly with retinal thickness measures (all <i>P</i> > 0.05).</p><p><strong>Conclusions: </strong>This study provided normative values for macular total retinal thickness, macular GCL+ thickness, and cpRNFL thickness in children aged 5-17 years, measured using the Topcon DRI Triton Plus OCT device. We observed no significant age- or sex-based differences in these values, and measurement repeatability was excellent. Given the variability in retinal thickness across populations and devices, region- and device-specific pediatric norms are essential. These findings fill a critical gap in pediatric OCT normative databases and contribute to the develo","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"50-59"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yara Abukhaled, Tharaa M Allawama, Hashem Abu Serhan
{"title":"Ethical integrity in systematic reviews and meta-analyses: challenges, pitfalls, and best practices in ophthalmology.","authors":"Yara Abukhaled, Tharaa M Allawama, Hashem Abu Serhan","doi":"10.51329/mehdiophthal1522","DOIUrl":"10.51329/mehdiophthal1522","url":null,"abstract":"<p><strong>Background: </strong>Systematic reviews and meta-analyses (SRMAs) are central to evidence-based ophthalmology, influencing clinical guidelines and treatment decisions. However, the rapid increase in SRMA publications has exposed serious ethical concerns, including selective reporting, duplicate publication, plagiarism, authorship misconduct, and undeclared conflicts of interest. Despite established frameworks such as Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), International Prospective Register of Systematic Reviews (PROSPERO), and International Committee of Medical Journal Editors (ICMJE), ethical compliance remains inconsistent, undermining the credibility of synthesized evidence. We aimed to examine the ethical landscape of SRMAs with a particular focus on ophthalmology, highlighting common pitfalls, evaluating current guidelines, and providing practical recommendations to ensure that these reviews are conducted and reported with the highest ethical standards-ultimately safeguarding the integrity of the evidence base that underpins clinical eye care.</p><p><strong>Methods: </strong>A structured literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar through May 2025 using combinations of the terms \"systematic review,\" \"meta-analysis,\" \"ethics,\" \"research integrity,\" and \"ophthalmology.\" Relevant guidelines, peer-reviewed studies, and editorials were synthesized to identify ethical pitfalls and propose best practice solutions.</p><p><strong>Results: </strong>We illustrate these challenges with ophthalmology-specific examples and highlight the downstream impact of unethical SRMAs on clinical practice and public trust. We also propose actionable recommendations for researchers, editors, and institutions to enhance the ethical quality of SRMAs, including improved training in research integrity, stricter enforcement of reporting guidelines, and increased editorial oversight. By addressing these ethical dimensions, the ophthalmic community can ensure that SRMAs not only meet methodological benchmarks but also reflect the core values of scientific honesty, accountability, and patient-centeredness. Approximately one-third of ophthalmology SRMAs fail to assess bias or comply with PRISMA guidelines. Industry-sponsored reviews have shown a tendency to favor commercially linked interventions, raising objectivity concerns. Key ethical concerns include: lack of protocol registration, selective inclusion of studies, inclusion of retracted or flawed trials, duplicate or plagiarized data, and authorship and disclosure misconduct.</p><p><strong>Conclusions: </strong>To protect the integrity of ophthalmic evidence synthesis, SRMAs must adhere to the highest ethical standards. Researchers should commit to transparent, methodologically rigorous, and ethically sound practices. Journals and institutions must enforce compliance, provide oversight, and support education in research integrity. Fi","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"40-49"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Visual impairment and blindness in diabetic retinopathy.","authors":"Janitha Plackal Ayyappan, Zoelfigar Dafalla Mohamed, Gopi Suresh Vankudre, Galal Mohamed Ismail","doi":"10.51329/mehdiophthal1519","DOIUrl":"10.51329/mehdiophthal1519","url":null,"abstract":"<p><strong>Background: </strong>Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a leading cause of preventable visual impairment (VI) and blindness worldwide. The rising global prevalence of DM, particularly in low- and middle-income regions such as the Middle East, necessitates the collection of localized data on DR-related VI. Despite growing public health concerns, limited research has been conducted in the Gulf region, including Oman. This study aimed to assess the prevalence and severity of VI associated with DR and identify its key risk factors among patients with types I and II DM in Al Buraimi, Sultanate of Oman.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted at Buraimi Hospital and Polyclinic in Oman between June 2023 and January 2024. Medical records of patients with type I or II DM and a confirmed diagnosis of DR were reviewed. Best-corrected distance visual acuity was assessed using a Snellen chart, and fundus examinations were performed using both direct and indirect ophthalmoscopy for DR detection and staging. VI was classified according to the WHO criteria. Relevant demographic and clinical data, including age, duration of DM, and duration of DR, were extracted. Coexisting ocular conditions were also documented.</p><p><strong>Results: </strong>A total of 218 participants were included, with a mean age of 57.5 years; 52.3% (n = 114) were male and 47.7% (n = 104) female. Most participants had no VI (n = 131, 60.1%), whereas mild VI (n = 58, 26.6%) was the most frequent type of VI. A significant association was detected between DR severity and VI levels (<i>P</i> < 0.01); blindness occurred only in patients with severe nonproliferative DR (n = 1) and proliferative DR (n = 8). Age and DR duration were significantly associated with increasing VI severity (both <i>P</i> < 0.05), with each additional year increasing the odds by 4% and 12%, respectively. No significant association was observed between DM duration and VI severity (<i>P</i> > 0.05). Cataract (n = 131) was the most common coexisting ocular condition.</p><p><strong>Conclusions: </strong>The frequency of VI among patients with DR was relatively high, and its severity was significantly associated with older age and longer DR duration. Blindness occurred only in more severe DR stages, reinforcing the value of early screening and immediate care in mitigating disease severity. These findings indicate the need to optimize resources for early DR management and to promote screening, even in diabetic individuals with normal vision, to prevent disease progression and reduce visual disability. Further community-based research is needed to achieve a robust, practical understanding of the preventable causes of VI, guide national eye health policies, and enhance long-term patient outcomes.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"9-16"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multilayered fresh amniotic membrane transplantation in resistant fungal corneal ulceration.","authors":"Ezzeldin Ramadan Ezzeldin, Ehab Tharwat, Hazem Elbadry Mohammed Mohammed, Esam Sayed Ahmed, Akram Fekry Elgazzar, Riad Elzaher Hassan Ahmed, Haitham Beshr Soliman, Mohamed Yahia Omran, Ramy Saleh Amer, Hazem Mohamed Abdelhameed, Walid Shaban Abdella, Amr Mohammed Elsayed Abdelkader","doi":"10.51329/mehdiophthal1518","DOIUrl":"10.51329/mehdiophthal1518","url":null,"abstract":"<p><strong>Background: </strong>Resistant fungal keratitis is a major cause of corneal blindness, particularly in resource-limited regions where donor tissue is scarce. Amniotic membrane transplantation (AMT) offers potential benefits through its anti-inflammatory, anti-proteolytic, and epithelialization-promoting effects. This study evaluated the efficacy and safety of AMT for treatment-resistant fungal corneal ulcers.</p><p><strong>Methods: </strong>This prospective, single‑arm study enrolled consecutive patients with microbiologically confirmed, treatment‑resistant fungal corneal ulcers at Al‑Azhar University Hospital, Damietta, between January 2022 and October 2023. All patients underwent standardized single- or double-layer AMT. Baseline and follow-up assessments included best-corrected distance visual acuity (BCDVA, logarithm of the minimum angle of resolution [logMAR]), ulcer size, anterior chamber reaction and depth, and presence of blepharospasm or pain (visual analog scale). Clinical evaluations were performed at baseline, 1 day, and 1, 3, and 6 months postoperatively. Treatment success was defined as complete resolution or significant improvement over 6 months.</p><p><strong>Results: </strong>A total of 24 patients (mean [standard deviation] age, 59 [7.5] years; 3:1 male-to-female ratio) with resistant fungal corneal ulcers were studied. Most were rural residents (n = 17, 70.8%), and nearly half were farmers (n = 11, 45.8%). Common comorbidities included hypertension and diabetes mellitus. The median baseline ulcer area was 3 mm²; most ulcers were central (n = 10, 41.7%) or paracentral (n = 8, 33.3%), and 12.5% (n = 3) had perforations. At 6 months, significant improvements were observed: median BCDVA improved from 3.0 logMAR to 2.0 logMAR (<i>P</i> = 0.001), ulcers completely closed (<i>P</i> = 0.001), and the pain score dropped from 2 to 0 (<i>P</i> = 0.001). Anterior chamber reaction and blepharospasm also improved significantly (both <i>P</i> = 0.001). Overall, 91.7% (n = 22) achieved complete resolution or marked improvement, and two patients required further surgery. The results showed progressive benefits throughout the follow-up period.</p><p><strong>Conclusions: </strong>AMT is a safe and effective adjunctive treatment for resistant fungal keratitis, particularly when corneal donors are scarce. The procedure promotes ulcer healing, relieves pain, and improves visual outcomes. Controlled trials are required to confirm these findings and refine patient selection.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Triston B Crook, Mina M Sitto, Ethan J Lindberg, Phillip C Hoopes, Majid Moshirfar
{"title":"A comparative study and review of visual outcomes with enhanced versus standard monofocal intraocular lenses following cataract surgery.","authors":"Triston B Crook, Mina M Sitto, Ethan J Lindberg, Phillip C Hoopes, Majid Moshirfar","doi":"10.51329/mehdiophthal1521","DOIUrl":"10.51329/mehdiophthal1521","url":null,"abstract":"<p><strong>Background: </strong>Recent innovations in intraocular lens (IOL) design have introduced extended depth of focus lenses, which has shown promise in improving visual acuity at multiple distances while preserving the distance vision provided by a standard monofocal IOL. This study aimed to evaluate the visual outcomes of TECNIS Eyhance, a monofocal IOL with enhanced intermediate function, and a standard TECNIS monofocal 1-piece IOL, and to review published studies comparing the clinical performance between the TECNIS Eyhance and standard IOLs.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent cataract extraction with bilateral implantation of either TECNIS Eyhance IOLs or TECNIS Monofocal 1-Piece IOLs. Primary outcomes included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA), and manifest refraction. Outcomes such as glare, halos, and dry eye were also assessed. A literature review was performed to identify studies evaluating the clinical outcomes of TECNIS Eyhance and standard TECNIS monofocal IOLs.</p><p><strong>Results: </strong>In total 108 patients (216 eyes) underwent bilateral implantation with either TECNIS Eyhance (104 eyes) or TECNIS Monofocal 1-Piece (112 eyes) IOLs. The mean (standard deviation [SD]) binocular UNVA was better in the Eyhance group at 1 month (0.18 [0.13] logMAR) compared to the standard monofocal group (0.24 [0.14] logMAR; <i>P</i> < 0.05). A greater proportion of Eyhance patients achieved binocular UNVA of 20/25 or better (46.9% vs 21.8%; <i>P</i> < 0.01), and 20/32 or better (65.3% vs 45.5%; <i>P</i> < 0.05). However, there was no significant difference for 20/20 visual acuity (20.4% vs 18.2%; <i>P</i> > 0.05). No significant differences were observed in postoperative UDVA or CDVA between groups (both <i>P</i> > 0.05). The mean (SD) monocular UNVA showed a slight, but non-significant, advantage in the Eyhance group (0.26 [0.15] logMAR vs 0.29 [0.15] logMAR; <i>P</i> > 0.05). Eyhance eyes demonstrated less residual refractive cylinder at 1 month (<i>P</i> < 0.01), which may be attributed to a higher rate of toric IOL use (<i>P</i> < 0.01). Patient-reported visual symptoms did not differ between groups. Thirteen studies were identified that compared the Eyhance and standard monofocal IOLs. Across the studies analyzed, the Eyhance group showed better monocular and binocular UNVA with mean (SD) differences of - 0.10 (0.20) logMAR and - 0.10 (0.21) logMAR, respectively (both <i>P</i> < 0.01), as well as improved binocular uncorrected intermediate visual acuity (UIVA) (mean difference [SD]: -0.10 [0.18] logMAR; <i>P</i> < 0.01). These studies also showed low rates of glare and halos for both IOLs.</p><p><strong>Conclusions: </strong>Patients receiving the TECNIS Eyhance IOL had better binocular UNVA compared to those with a standard monofocal IOL, consistent with publ","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"28-39"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seher Koksaldi, Mustafa Kayabasi, Omer Karti, Ali Osman Saatci
{"title":"Clinical anatomy of the macula.","authors":"Seher Koksaldi, Mustafa Kayabasi, Omer Karti, Ali Osman Saatci","doi":"10.51329/mehdiophthal1520","DOIUrl":"10.51329/mehdiophthal1520","url":null,"abstract":"<p><strong>Background: </strong>The macula is located at the center of the retina and is crucial for high-resolution color vision. Its complex anatomical structure supports a dense array of cone photoreceptors and specialized neuronal pathways essential for central vision. A thorough understanding of macular microanatomy is vital for accurate interpretation of retinal imaging and effective management of macular diseases. This narrative review provides a detailed and integrative overview of macular anatomy, emphasizing clinically relevant microanatomical features and their implications in retinal imaging and macular disease management.</p><p><strong>Methods: </strong>A PubMed/MEDLINE search was performed using relevant keywords (e.g., \"anatomy,\" \"fovea,\" \"foveal avascular zone,\" \"foveola,\" \"Henle fiber layer,\" \"macula,\" \"macular anatomy,\" \"macula lutea,\" \"optical coherence tomography,\" \"parafovea,\" \"perifovea,\" and \"retina\") to identify English-language articles published up to February 28, 2025. The reference lists of the included papers were manually reviewed to identify additional relevant sources. The review considered a wide range of study types, including clinical trials, systematic and narrative reviews, meta-analyses, observational studies, case series, and experimental animal studies.</p><p><strong>Results: </strong>This review highlights the remarkable characteristics of the fovea and foveola, which are densely packed with cone photoreceptors, making them uniquely suited for sharp vision. The surrounding parafoveal and perifoveal regions offer critical structural and functional support, while the Henle fiber layer facilitates the oblique course of photoreceptor axons, further refining central vision. Moreover, high-resolution optical coherence tomography has revolutionized visualization of the macular architecture, enabling a detailed assessment of previously undetectable retinal layers. This review explores key anatomical features, such as the foveal avascular zone, precise photoreceptor organization, and the role of Muller glial cells, in the context of high-resolution imaging. These associations between anatomy and imaging enhance diagnostic precision and may inform targeted treatment approaches for macular diseases.</p><p><strong>Conclusions: </strong>Comprehensive knowledge of macular anatomy is crucial for the accurate interpretation of retinal imaging and management of central retinal disorders. The bridging of classic histological findings with modern imaging enhances comprehension of the healthy macula and the detection and management of pathological changes. This review serves as a practical anatomical reference for clinicians and researchers in macular diagnostics and therapeutics. Further studies are warranted to explore how emerging imaging technologies can enhance early detection and treatment strategies for macular disorders.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 2","pages":"17-27"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12330045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial intelligence in ophthalmology: opportunities, challenges, and ethical considerations.","authors":"Kimia Kazemzadeh","doi":"10.51329/mehdiophthal1517","DOIUrl":"10.51329/mehdiophthal1517","url":null,"abstract":"<p><strong>Background: </strong>By leveraging the imaging-rich nature of ophthalmology and optometry, artificial intelligence (AI) is rapidly transforming the vision sciences and addressing the global burden of ocular diseases. The ability of AI to analyze complex imaging and clinical data allows unprecedented improvements in diagnosis, management, and patient outcomes. In this narrative review, we explore the current and emerging opportunities of utilizing AI in the vision sciences, critically examine the associated challenges, and discuss the ethical implications of integrating AI into clinical practice.</p><p><strong>Methods: </strong>We searched PubMed/MEDLINE and Google Scholar for English-language articles published from January 1, 2005, to March 31, 2025. Studies on AI applications in ophthalmology and optometry, focusing on diagnostic performance, clinical integration, and ethical considerations, were included, irrespective of study design (clinical trials, observational studies, validation studies, systematic reviews, and meta-analyses). Articles not related to the use of AI in vision care were excluded.</p><p><strong>Results: </strong>AI has achieved high diagnostic accuracy across different ocular domains. In terms of the cornea and anterior segment, AI models have detected keratoconus with sensitivity and accuracy exceeding 98% and 99.6%, respectively, including in subclinical cases, by analyzing Scheimpflug tomography and corneal biomechanics. For cataract surgery, machine learning-based intraocular lens power calculation formulas, such as the Kane and ZEISS AI formulas, reduce refractive errors, achieving mean absolute errors below 0.30 diopters and performing particularly well in highly myopic eyes. AI-based retinal screening systems, such as the EyeArt and IDx-DR, can autonomously detect diabetic retinopathy with sensitivities above 95%, while deep learning models can predict age-related macular degeneration progression with an area under the receiver operating characteristic curve exceeding 0.90. In glaucoma detection, fundus and optical coherence tomography-based AI models have reached pooled sensitivity and specificity exceeding 90%, although performance varies with disease stage and population diversity. AI has also advanced strabismus detection, amblyopia risk prediction, and myopia progression forecasting by using facial analysis and biometric data. Currently, key challenges in implementing AI in ophthalmology include dataset bias, limited external validation, regulatory hurdles, and ethical issues, such as transparency and equitable access.</p><p><strong>Conclusions: </strong>AI is rapidly transforming vision sciences by improving diagnostic accuracy, streamlining clinical workflow, and broadening access to quality eye care, particularly in underserved regions. Its integration into ophthalmology and optometry thus holds significant promise for enhancing patient outcomes and optimizing healthcare delivery. However, to harnes","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 1","pages":"255-272"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arturo Ramirez-Miranda, Alberto Haber-Olguin, Juan A Moya-Villamar, Lucero Pedro-Aguilar, Guillermo Raul Vera-Duarte, Gustavo Ortiz-Morales, Alejandro Navas, Denise Loya-Garcia, Enrique O Graue-Hernandez
{"title":"Stapler for corneal transplantation: a hypothesis.","authors":"Arturo Ramirez-Miranda, Alberto Haber-Olguin, Juan A Moya-Villamar, Lucero Pedro-Aguilar, Guillermo Raul Vera-Duarte, Gustavo Ortiz-Morales, Alejandro Navas, Denise Loya-Garcia, Enrique O Graue-Hernandez","doi":"10.51329/mehdiophthal1515","DOIUrl":"10.51329/mehdiophthal1515","url":null,"abstract":"<p><strong>Background: </strong>Corneal transplantation requires exquisite microsurgical precision, particularly during the suturing of donor and recipient tissues. In corneal transplantation procedures such as penetrating keratoplasty, the donor cornea is traditionally secured using ultrafine 10-0 nylon sutures, meticulously placed under an operating microscope to achieve precise tension and promote optimal wound healing. Although this technique remains the reference standard, it is inherently time-intensive and requires advanced microsurgical expertise. To enhance surgical efficiency and maintain clinical outcomes, recent innovations have proposed the use of a modified stapling device equipped with ultrafine nylon staples as an alternative to conventional suturing. Although experimental stapling systems have been engineered to facilitate graft fixation, widespread clinical adoption or regulatory approval has not yet been achieved, largely because of unresolved concerns regarding precision, stability, and long-term safety.</p><p><strong>Hypothesis: </strong>To address these challenges, we propose an adaptation of the skin stapler mechanism, employing nylon-based staples specifically engineered for corneal application. This study hypothesizes that the development of a specialized corneal stapler as a viable, time-efficient alternative to manual suturing in keratoplasty is feasible, contingent upon addressing critical challenges. These include replicating the biomechanical finesse and tension control of sutures, ensuring the biocompatibility of staple materials with ocular tissues, and minimizing the risk of postoperative complications such as astigmatism, wound dehiscence, and infection. The specialized corneal stapler utilizing ultrafine, biocompatible nylon staples can replicate the precision, tension control, and wound stability achieved by traditional 10-0 nylon suturing in penetrating keratoplasty, while significantly reducing operative time and technical demands. Rigorous preclinical testing and clinical validation are essential to evaluate whether stapling technology can match or exceed the standards established by traditional suturing techniques in corneal transplantation.</p><p><strong>Conclusions: </strong>The conceptual model for a specialized corneal stapler presents a promising alternative to traditional suturing techniques. However, substantial technological innovation is necessary to meet the intricate anatomical and surgical requirements of the cornea. Further research, including iterative prototyping and preclinical validation, is essential before clinical applications can be realized. Moreover, further research and clinical validation are necessary to determine whether staplers can safely and effectively replace traditional sutures during corneal transplantation.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 1","pages":"239-246"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"COVID-19 pandemic and ophthalmology: insights from the IVORC Academic Foundation.","authors":"Fatemeh Heidary, Reza Gharebaghi","doi":"10.51329/mehdiophthal1516","DOIUrl":"10.51329/mehdiophthal1516","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic posed unprecedented challenges for the global academic community. The International Virtual Ophthalmic Research Center (IVORC) Academic Foundation, which is committed to advancing vision science through international collaboration, research, and education, played a pivotal role in addressing these disruptions. Central to its mission are 2 affiliated journals in ophthalmology and optometry that serve as key platforms for innovative research on ocular disease management. In response to the pandemic, the IVORC implemented a series of strategic initiatives to support the vision science community, while ensuring research continuity and safety. This report reviews COVID-19-related publications in these journals and highlights the key actions of the IVORC in strengthening preparedness for future global health crises.</p><p><strong>Methods: </strong>We reviewed COVID-19-related articles published in IVORC-affiliated journals from the onset of the pandemic through February 2025. Key findings were analyzed, focusing on the reported ocular manifestations of COVID-19 and potential ophthalmic complications associated with COVID-19 vaccination.</p><p><strong>Results: </strong>To sustain academic engagement and research productivity, the IVORC expanded its virtual meetings, webinars, and digital outreach initiatives, with a strong emphasis on academic writing and publication ethics. The foundation actively promoted COVID-19-related ophthalmic research, published a clinical guideline, reported ocular manifestations of the disease, encouraged the adoption of teleophthalmology, and strengthened collaborations with regional and national societies. Between early 2020 and February 2025, IVORC-affiliated journals published 19 COVID-19-related articles from researchers across 10 countries, primarily in North America, Asia, and the Middle East. These comprised 6 original articles, 5 reviews, 2 case reports, 2 editorials, 2 short communications, and 2 letters, most of which appeared in <i>Medical hypothesis, discovery & innovation in ophthalmology</i>. Among the early contributions was a widely cited guideline for ophthalmic practice, published within months of the onset of the pandemic.</p><p><strong>Conclusions: </strong>The proactive response of the IVORC to the COVID-19 crisis highlights the essential role of academic leadership in maintaining research continuity and scholarly communication during global health emergencies. The diverse and internationally authored IVORC publications reflect a commitment to innovation, collaboration, and the inclusion of perspectives from underrepresented regions. This experience reinforces the importance of prioritizing original research over publication volume-particularly clinical guidelines and studies detailing disease manifestations. Fast-track publication models must maintain rigorous editorial standards to ensure that scientific contributions rema","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 1","pages":"247-254"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Salma Tamer, Ahmed Mohamed Kamal Elshafei, Raafat Mohyeldeen Abdelrahman Abdallah, Ismail Omar, Amr Ahmed Mohamed Abdelrahman
{"title":"Dynamic changes in tear film parameters after upper eyelid blepharoplasty measured with anterior segment optical coherence tomography.","authors":"Salma Tamer, Ahmed Mohamed Kamal Elshafei, Raafat Mohyeldeen Abdelrahman Abdallah, Ismail Omar, Amr Ahmed Mohamed Abdelrahman","doi":"10.51329/mehdiophthal1512","DOIUrl":"10.51329/mehdiophthal1512","url":null,"abstract":"<p><strong>Background: </strong>Upper eyelid blepharoplasty, a corrective procedure for dermatochalasis, may transiently affect eyelid function and tear film stability. This study assessed the effect of upper eyelid blepharoplasty, subjectively through questionnaires, and objectively through tear film stability and production.</p><p><strong>Methods: </strong>This non-randomized, prospective, interventional study consecutively recruited the right eyes of patients with dermatochalasis who underwent bilateral upper eyelid blepharoplasty at a tertiary center. Preoperative assessments included a standardized ophthalmic examination, ocular surface disease index (OSDI) questionnaire, Schirmer's test I, tear break-up time (TBUT) test, and anterior segment optical coherence tomography (AS-OCT) to measure tear meniscus height (TMH) and tear meniscus area (TMA). Postoperative evaluations were conducted at 1, 3, and 6 months. At the final follow-up, scar quality and patient satisfaction were assessed using the Patient and Observer Scar Assessment Scale.</p><p><strong>Results: </strong>Fifty eyes of 50 patients with a mean (standard deviation) age of 47.1 (1.6) years were included. Statistically significant postoperative changes were observed in the OSDI score, Schirmer's test value, TBUT, and TMH at the 6-month follow-up (all P < 0.001). These parameters initially worsened at 1 month and then improved significantly at 3 and 6 months, returning to or surpassing baseline levels. TMA showed a transient postoperative decline, with full recovery at 6 months. Exceptionally strong positive correlations were found between TMH or TMA and TBUT or the Schirmer's test value at most follow-up visits (all <i>P</i> > 0.05). Patient satisfaction was high, with 95% reporting satisfaction with cosmetic outcomes, and no cases of visible or hypertrophic scarring were observed at final follow-up.</p><p><strong>Conclusions: </strong>We observed significant yet transient changes in tear film parameters and subjective assessments following upper eyelid blepharoplasty. A strong correlation was observed between AS-OCT measurements and parameters of tear film stability and production. High patient satisfaction and favorable cosmetic outcomes, with no visible scarring, further support the safety and tolerability of this procedure. Further studies with larger cohorts, longer follow-up periods, and comparative designs are warranted to validate these findings and further explore the long-term effects on ocular surface health and patient-reported outcomes.</p>","PeriodicalId":36524,"journal":{"name":"Medical Hypothesis, Discovery, and Innovation in Ophthalmology","volume":"14 1","pages":"213-222"},"PeriodicalIF":0.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}