Medical hypothesis discovery and innovation in ophthalmology

Topical tacrolimus versus dexamethasone in managing shield ulcer of vernal keratoconjunctivitis

Nima Rastegar Rad, Nazanin Rastgarrad — Sat, 01 Feb 2025 00:00:00 +0330

Background: Vernal keratoconjunctivitis (VKC) is a bilateral, chronic, allergic inflammation of the ocular surface with debilitating ocular signs and symptoms. We compared the efficacies and safeties of 1% tacrolimus eye drops and 1% dexamethasone eye drops in managing unilateral shield ulcers and corneal epitheliopathy secondary to VKC.

Methods: We recruited patients with unilateral shield ulcer and corneal epitheliopathy secondary to VKC in a tertiary referral center in southeast Iran during a 12-month period. All eligible patients underwent a detailed eye examination. Participants were randomly assigned to receive either topical tacrolimus 1% or dexamethasone 1% twice daily. We recorded the best-corrected distance visual acuity (BCDVA) in decimal notation, area of the shield ulcer in square millimeters, presence or absence of re-epithelialization, and clinical symptoms of watering, mucus discharge, photophobia, burning, redness, and itching, along with any potential complications at five follow-up visits during a period of four months.

Results: Thirty patients (30 eyes) were allocated to each treatment group. The groups had comparable mean ages and sex distributions (both P > 0.05). Both groups experienced a decreasing trend in frequencies of all symptoms, and at most follow-up visits, ocular symptoms were less frequent in the tacrolimus group than in the dexamethasone group, reaching statistically significant differences at some time points (all P < 0.05). No re-epithelialization was detected in either group at the second week post-treatment. However, an increasing trend was observed thereafter in both groups, with significantly more re-epithelialization in tacrolimus-treated eyes at the second and third months post-treatment (P < 0.05). Re-epithelialization remained significantly more frequent in tacrolimus-treated eyes one month after cessation of treatment (P < 0.05). The mean BCDVA was significantly better in tacrolimus-treated eyes than in the dexamethasone group at all follow-up visits (all P < 0.01). The mean shield ulcer size tended to decrease in both groups, with lesser numerical values in tacrolimus-treated eyes at the one-, two-, three-, and four-month follow-up visits. The difference reached statistical significance at the last two follow-up visits (both P < 0.05).

Conclusions: Topical tacrolimus is superior to topical dexamethasone with regard to symptoms, visual acuity, shield ulcer size, and corneal epitheliopathy associated with VKC. This suggests that tacrolimus could be administered as monotherapy for managing this debilitating ocular inflammatory condition. Further studies are required to determine the long-term safety and efficacy of this promising treatment modality.

Visio-spatial intelligence skills in non-athletes versus amateur boxers

S’bongile Mahlangu, Musa Lewis Mathunjwa, Gerrit Jan Breukelman, Lourens Millard — Sat, 01 Feb 2025 00:00:00 +0330

Background: Visio-spatial intelligence (VSI) skills, including abilities such as spatial awareness, visual processing, and motor coordination, are crucial for athletic performance, particularly in combat sports such as boxing. Amateur boxers require efficient visio-spatial skills (VSS) to quickly process visual information, track opponents’ movements, and execute precise techniques. However, the extent to which amateur boxing experience enhances VSS remains unclear. This study compared the VSI skills of amateur boxers to those of non-athletes.

Methods: This cross-sectional, observational study recruited amateur boxers and non-athletes in the King Cetshwayo District, KwaZulu-Natal, Republic of South Africa. Participants, aged 18 to 27 years, underwent a detailed optometric screening and VSS tests, including accommodation facility, saccadic eye movements, speed of recognition, hand-eye coordination, peripheral awareness, and visual memory.

Results: The study included 90 participants, consisting of 45 amateur boxers (28 [62%] men aged 18 to 25 years and 17 [38%] women aged 18 to 27 years) and 45 non-athletes (29 [64%] men aged 18 to 26 years and 16 [36%] women aged 18 to 27 years). The mean (standard deviation) age of the boxers was 20.7 (2.2) years, whereas the mean age of the non-athletes was 21.9 (2.4) years (P < 0.05). Amateur boxers were superior in VSS, with marked advantages in accommodation facility, saccadic eye movement, speed of recognition, peripheral awareness, and hand-eye coordination (all P < 0.001). However, no significant difference was found in visual memory (P > 0.05). The greatest difference was observed in speed of recognition (88% higher in boxers), and the least difference was observed in visual memory (4% higher in boxers).

Conclusions: VSS differ between amateur boxers and non-athletes, indicating the importance of these skills for athletic performance. These findings emphasize the potential advantages of boxing training in enhancing VSS, which could impact athletic training and performance-enhancement strategies. This underscores the value of integrating visio-spatial training into athletic programs. The observed superiority of boxers in specific VSS areas has broad implications for theories of sports vision, the selection of appropriate tests, and the development of sport-specific VSS testing protocols. Further longitudinal studies with larger sample sizes are required to verify these findings and assess changes in these skills over time.

Vascular supply of the eye: clinical anatomy

Omer Karti , Isil Saatci, Ali Osman Saatci — Sat, 01 Feb 2025 00:00:00 +0330

Background: Eye function is vitally dependent on an adequate blood supply, primarily provided by the ophthalmic artery, an internal carotid artery branch. This review provides an overview of the vascular supply of the eye.

Methods: A targeted search of PubMed / MEDLINE was performed using the terms “central retinal vein,” “central retinal artery,” “internal carotid artery,” “ophthalmic artery,” “ophthalmic vein,” “posterior ciliary arteries,” “retinal capillaries,” “vascular supply of the eye,” “ocular vascular supply,” “external carotid artery,” and “vortex vein”. Studies published between 1960 and 2024 were reviewed. Relevant references cited in these publications were also analyzed.

Results: Overall, 62 publications were reviewed. The ophthalmic artery branches into several arteries—the central retinal artery supplies the retina, whereas the posterior ciliary arteries supply the posterior choroid and optic nerve. The anterior ciliary arteries mainly supply the conjunctiva, sclera, ciliary body, and iris. Extraocular muscles receive their primary blood supply from the muscular branches of the ophthalmic artery, lacrimal artery, and infraorbital artery. The lacrimal gland is perfused by the lacrimal artery. The eyelids receive blood from both the internal and external carotid arteries. The superficial vascular network of the medial eyelid skin is established primarily through anastomoses between the branches of the internal carotid artery. The superficial vascular network of the lateral upper and lower eyelids is primarily derived from branches emanating from the superficial temporal artery (a branch of the external carotid artery) and the lacrimal artery. Venous drainage follows a complex pathway, beginning with the central retinal vein and the vortex veins, then draining into the ophthalmic veins, and finally into the internal jugular vein.

Conclusions: The eye features a complex arterial supply and venous drainage that can vary greatly among individuals. This complex vascular system is critical for the oxygenation and nutrition of ocular tissues and the maintenance of ocular health. The arterial and venous circulation coordinate to support different regions of the eye, including the retina, choroid, and optic nerve. Understanding this intricate vascular network is essential for the diagnosis and treatment of various ocular pathologies. Abnormalities in these pathways can cause substantial problems, including vision loss.

Ocular Surface Disease Index questionnaire in different languages

Sat, 01 Feb 2025 00:00:00 +0330

Background: The Ocular Surface Disease Index (OSDI) questionnaire was first introduced and developed in 1997 by the Outcomes Research Group, and was adopted by Allergan, Inc. (Irvine, Goleta, CA). While several tools are available for evaluating dry eye syndrome (DES), the OSDI questionnaire is known to have high reliability and validity. Additionally, although more complex questionnaires are available, the goal of the OSDI is to ensure a rapid diagnosis of ocular surface disease. The OSDI consists of a 12-item questionnaire designed to assess the visual disability caused by DES. The OSDI score can range from 0 to 100, with higher scores indicating greater disability. This language-inclusive mini-review aimed to provide an overview of previous studies that translated the OSDI into various languages and validated the translated versions.

Methods: OSDI validation studies were identified through a PubMed / MEDLINE and Google Scholar search spanning the 27 years since the establishment of the OSDI, using the broad term “Ocular Surface Disease Index-12 questions” and keywords that is “ocular surface disease index-12,” “translation and validation,” “transcultural validation,” “development,” “cross-cultural adaptation,” and “reliability and validity.” We included original studies that validated the translated version of the OSDI in various languages, presenting the key findings with a focus on reliability and repeatability outcomes.

Results: Thirteen full-text articles were thoroughly reviewed, including those identified through targeted keyword searches and the reference lists of these studies. The papers examined the translation of the English version of the OSDI-12 questionnaire into nine languages: Italian, Arabic, Chinese, Chilean Spanish, Japanese, Filipino, Farsi, Bahasa Melayu, and Brazilian Portuguese. Key details regarding the development, translation, and validation phases were summarized. Most of the included studies adhered to standard guidelines throughout the translation process to create a final version of the OSDI questionnaire. This was followed by clinical validation of the final translated version. The majority of the translated versions were assessed for internal consistency, reliability, test–retest repeatability, and discriminant validity.

Conclusions: The original English version of the OSDI was translated into validated versions to achieve a final version in nine different languages. The majority of the translated versions demonstrated high reproducibility and reliability. The different language versions of the questionnaire removed language barriers in informing the eye-care community, evaluating DES, and assisting physicians in advising and managing their patients more suitably. Therefore, the validated versions of OSDI can be used as tools for clinical practice and DES research. Validating the OSDI questionnaire in various languages is essential to eliminate the language barrier in the assessment of dry eye disease.

A review on retinopathy of prematurity

Pegah Rashidian, Shaghayegh Karami, Seyyed Amirhossein Salehi — Sat, 01 Feb 2025 00:00:00 +0330

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. It predominantly affects preterm infants with very low birth weights or extreme prematurity. Aberrant retinal vascular development, driven by hyperoxia and hypoxia-induced neovascularization, is central to ROP pathogenesis. This review explores the relationship between maternal health and ROP, evaluates current prevention strategies, assesses innovations in diagnostic and screening technologies, reviews contemporary treatments, and identifies future research directions.

Methods: A literature review was conducted in the PubMed / MEDLINE, Scopus, Web of Science, and Google Scholar databases using related keywords, i.e., “retinopathy of prematurity,” “retinal development,” “pathophysiology,” “vascular growth,” “complications,” “visual outcomes,” “maternal health factors,” “obstetrics,” “preeclampsia,” “risk factors,” “preterm birth,” “corticosteroids,” “oxygen management,” “treatment strategies,” “laser therapy,” “anti-VEGF agents,” “surgical approaches”, and “artificial intelligence (AI)” and targeting English studies published in the last 20 years. Additionally, the references from the selected articles were manually reviewed. Clinical trials, meta-analyses, systematic reviews, case–control studies, case series, narrative reviews, pilot studies, and relevant animal studies were included.

Results: Maternal factors, such as diabetes, smoking, and preeclampsia, along with neonatal factors, such as low gestational age and extreme prematurity, are critical contributors to ROP. Key preventative strategies to reduce the risk of ROP and improve neonatal outcomes include: 1. prenatal care involves screening and managing maternal conditions, providing maternal education, and administering antenatal corticosteroids. 2. Neonatal care encompasses nutritional support, supplementation with essential fatty acids, and regulated oxygen administration. By focusing on these strategies, we can enhance the health of newborns at risk for ROP. Advances in screening, including artificial intelligence (AI)-assisted diagnostics and advanced imaging, are improving early detection. Treatment modalities such as laser photocoagulation, cryotherapy, and anti-vascular endothelial growth factor therapies have shown promise but pose challenges, including recurrence risk and systemic side effects.

Conclusions: ROP continues to pose a major threat to the vision of preterm infants, particularly in regions with limited healthcare resources. Addressing ROP requires multidisciplinary team approaches that integrate obstetric and neonatal care. Preventative strategies, including prenatal care optimization, oxygen management, and nutritional support, are essential. Future efforts should focus on integrating emerging technologies and recent findings to ensure global relevance and currency.