Medical hypothesis, discovery & innovation in optometry

Background: Ocular injury is a clinically significant complication of facial trauma, yet its burden and predictors in polytrauma remain undercharacterized. Understanding these associations is essential for optimizing early ophthalmic assessment, particularly in settings with high rates of road traffic injuries.
Methods: This retrospective cross-sectional study included polytrauma patients (injury severity score [ISS] >15) admitted to a tertiary trauma center over a five-year period. Eligible patients sustained blunt injuries and underwent standardized craniofacial CT and ophthalmic assessment. Facial trauma was identified using International Classification of Diseases, Tenth Revision (ICD-10) codes and radiologic confirmation. Ocular injuries were classified according to Birmingham Eye Trauma Terminology System criteria. Data on demographics, injury mechanisms, and clinical findings were extracted for analysis.
Results: Among 7456 polytrauma patients (mean age 38.7 years), 68.2% (5085) were male and 1491 (20.0%) had blunt facial trauma. Ocular injury occurred in 20.9% (n = 312) of patients with facial trauma versus 4.2% (n = 251) without. Midface fractures were strongly associated with orbital injury, whereas mandibular fractures were associated with ocular adnexal trauma (both P < 0.001). The most frequent ocular findings were orbital fracture (n = 312/142, 45.5%), subconjunctival hemorrhage (n = 312/88, 28.2%), hyphema (n = 312/46, 14.7%), and globe rupture (n = 312/12, 3.8%). Subgroup analyses further demonstrated that road traffic accidents (RTAs) mechanism conferred more than twice the risk of ocular injury compared with other mechanisms. Multivariate logistic regression analysis identified blunt facial trauma (adjusted odds ratio [OR], 3.82; 95% confidence interval [CI], 2.91–5.02; P < 0.001), RTAs (adjusted OR, 2.14; 95% CI, 1.67–2.75; P < 0.001), male sex (adjusted OR, 1.45; 95% CI, 1.12–1.88; P = 0.005), higher ISS (adjusted OR, 1.06 per point; CI, 95%, 1.03–1.09; P < 0.001), and increasing age (adjusted OR, 1.02 per year; 95% CI, 1.00–1.04; P < 0.005) as independent predictors of ocular injury. Baseline visual impairment (VA < 20/40) was present in 38.2% of affected patients. The incidence of facial trauma showed a slight upward trend from 2021 to 2025, albeit not statistically significant (P > 0.05).
Conclusions: Ocular injury represents a substantial and clinically important component of polytrauma involving the face. Patients with blunt facial trauma, particularly those with RTAs mechanisms, are at markedly elevated risk of ocular injury. Age, sex, fracture pattern, injury mechanism, and overall trauma severity are key determinants of ocular morbidity, underscoring the need for integrated maxillofacial-ophthalmic management strategies within trauma care systems.

Background: Keratoconus is a progressive corneal ectasia commonly treated with corneal collagen cross-linking (CXL) to halt further progression. Although transient anterior stromal haze frequently develops after CXL, its impact on visual recovery remains unclear. This study aimed to examine the correlation between postoperative changes in corneal densitometry, visual acuity, topography, and pachymetry in eyes with keratoconus undergoing CXL.
Methods: This retrospective study included eyes with progressive keratoconus undergoing epithelium-off accelerated CXL. Pre- and postoperative assessments included measuring corrected distance visual acuity (CDVA), manifest refraction, and slit-lamp biomicroscopy examination, along with Pentacam HR imaging. Densitometry was quantified across three stromal depths and four annular zones. Follow-up evaluations were performed at day 1, week 1, and months 1, 3, and 6 post-CXL.
Results: Twenty-four eyes from 24 patients with progressive keratoconus (median age, 21.9 years; 79.2% male) were evaluated over a six-month period following CXL. At six months, significant improvements were observed in CDVA, accompanied by reductions in flat keratometry, central corneal thickness, and thinnest pachymetry (all P < 0.05). Corneal densitometry increased significantly at one month and partially regressed by six months across all stromal depths and within all concentric annular zones from 0.0–2.0 mm to 6.0–10.0 mm and their corresponding total values (all P < 0.05). Baseline anterior 0.0–2.0 mm densitometry demonstrated a significant inverse correlation with CDVA (r = –0.50, P < 0.05). At one month, CDVA correlated inversely with densitometry in the anterior (r = –0.47, P = 0.003) and mid-stromal (r = –0.58, P = 0.006) depths of the 0.0–2.0 mm zone, and with anterior densitometry in the 2.0–6.0 mm zone (r = –0.45, P = 0.045). By six months, no significant correlations were found between CDVA or absolute keratometric parameters and densitometry at any depth, zone, or total value (all P > 0.05), indicating stabilization of both visual and structural recovery.
Conclusions: Accelerated epithelium-off CXL yielded significant visual and structural improvements in progressive keratoconus over six months. Corneal densitometry followed a characteristic postoperative pattern, with an early peak at one month followed by partial regression. Early stromal backscatter increases were significantly correlated with visual acuity, but these relationships diminished by six months, consistent with recovery of corneal clarity and vision. Longer-term studies are warranted to clarify the prognostic utility of densitometry for visual and tomographic outcomes after CXL.

Background: Keratoconus is increasingly recognized as a condition that may affect not only corneal structure but also posterior segment parameters. This study aimed to evaluate alterations in central macular, choroidal, and peripapillary retinal nerve fiber layer thicknesses, as well as peripapillary vessel densities (VDs), in eyes with keratoconus using optical coherence tomography (OCT) and OCT angiography (OCTA).
Methods: This cross-sectional study included eyes with keratoconus and healthy control eyes. Participants underwent Scheimpflug corneal tomography (Pentacam HR) to assess central corneal thickness (CCT) and keratometry; spectral-domain OCT (SD-OCT) for central macular thickness (CMT), choroidal thickness, and peripapillary retinal nerve fiber layer thickness (RNFLT) measurements; and swept-source OCT angiography (SS-OCTA) to quantify peripapillary VD centrally and across four quadrants at the superficial and deep capillary plexuses (pSCP, pDCP), the peripapillary choriocapillaris (pCC), and the global radial peripapillary capillary plexus (nRPCP).
Results: Eighty-six eyes with keratoconus and 86 age-, sex-, axial-length-, and laterality-matched healthy controls (all P > 0.05) were analyzed. The keratoconus group showed significantly higher spherical equivalent, higher keratometry parameters, higher astigmatism, and lower CCT, along with worse best-corrected distance visual acuity (all P < 0.001). Mean choroidal thickness was significantly greater in eyes with keratoconus (P < 0.001), whereas CMT, global RNFLT, and most quadrant RNFLT measures were comparable (all P > 0.05), except for a thinner inferonasal RNFLT (P < 0.05). Central VD in the pSCP, pDCP, pCC, and global nRPCP were significantly reduced (all P < 0.05). Eyes with keratoconus additionally demonstrated a non-significant (all P > 0.05) but characteristic pattern of regional VD alterations across peripapillary sectors.
Conclusions: Keratoconus was associated with significant microvascular and structural alterations extending beyond the cornea, including reduced VDs in central peripapillary plexuses, localized thinning of inferonasal RNFL, and increased choroidal thickness. These findings support a broader pathophysiologic framework in which keratoconus involves not only anterior corneal remodeling but also measurable changes in blood supply within the macular and lamina cribrosa regions. The characteristic, though nonsignificant, regional VD patterns further underscore potential sectoral vulnerability. Future longitudinal and multimodal imaging studies are warranted to clarify the temporal evolution, clinical relevance, and prognostic utility of these microvascular changes in keratoconus.

Background: Strabismus is a common ocular disorder and a major cause of visual impairment and amblyopia. Its prevalence varies widely across populations and may differ by age, ethnicity, and underlying risk factors. Despite its clinical and psychosocial impact, data on strabismus in Iranian adults remain limited. This study aimed to determine the prevalence of strabismus and its associated demographic factors in southeastern Iran.
Methods: This cross-sectional analysis used baseline data from an adult eye cohort in Zahedan, southeastern Iran. A stratified cluster sampling design, based on socioeconomic status, was used to recruit residents aged 35–70 years between 2015 and 2019. Of 10 016 screened individuals, 9296 met inclusion criteria, which required Iranian nationality, ?9 months of local residency, and completion of baseline assessments; participants with prior ocular surgery or active ocular disease were excluded. All participants completed a standardized ocular history questionnaire and underwent comprehensive visual assessment, including Snellen visual acuity testing, objective and subjective non-cycloplegic refraction, automated lensometry for habitual correction, external examination, slit-lamp biomicroscopy, and Goldmann applanation tonometry. Ocular alignment was evaluated using cover–uncover and alternate cover tests at distance and near. Strabismus was classified based on manifest deviations detected under best correction.
Results: Among 9296 adults, the overall prevalence of strabismus was 2.8% (262 cases; 95% CI: 2.5–3.2). The prevalence of exotropia, esotropia, hypertropia, intermittent exotropia, and intermittent esotropia was 1.3% (129 cases, 95% CI: 0.00–3.20), 0.2% (18 cases, 95% CI: 0.00–2.20), 0.3% (26 cases, 95% CI: 0.00–2.40), 0.8% (77 cases, 95% CI: 0.00–2.70), and 0.1% (12 cases, 95% CI: 0.00–1.80), respectively. Strabismus occurred most frequently in the 45–54-year age group (n = 92, 35.1%) and least often in those aged 65–75 years (n = 14, 8.3%). Women accounted for 61.8% (n = 162) of all cases, with all subtypes more common in women except esotropia, which was equally distributed. Strabismus was most frequent among individuals with high school education (n = 89, 34.0%) and least common in those with university degrees (n = 46, 17.6%). The Sistani ethnic group demonstrated the highest prevalence (n = 141, 53.8%) across all subtypes.
Conclusions: Strabismus affected 2.8% of adults, with exotropia the most common subtype. Prevalence varied by age, sex, education, and ethnicity, with the highest burden in adults aged 45–54 years and among the Sistani group. Most cases were previously undiagnosed, underscoring the need for targeted screening and early detection. Ongoing longitudinal follow-up will clarify incidence, progression, and treatment outcomes, supporting improved clinical decision-making, resource allocation, and long-term visual outcomes.

 
Background: Persistent corneal epithelial defects (PCEDs) represent a significant clinical challenge characterized by the failure of the corneal epithelium to heal within the normal period, leading to potential sight-threatening complications. These defects arise from a variety of underlying etiologies, including limbal stem cell deficiency, neurotrophic keratopathy, dry eye syndrome, and systemic diseases such as diabetes mellitus. Despite advances in ophthalmic care, PCEDs remain difficult to treat due to diverse pathophysiological mechanisms and variable response to conventional therapies. Recent developments in growth factor therapies, biological treatments, surgical techniques, and regenerative medicine have expanded therapeutic options but necessitate comprehensive review to guide clinical practice.
Methods: A comprehensive narrative review was conducted through a systematic search of major electronic databases including PubMed/MEDLINE, Embase, Scopus, and Google Scholar. The search incorporated keywords and Medical Subject Headings related to “persistent corneal epithelial defects”, “corneal epithelial healing”, “limbal stem cell deficiency”, “neurotrophic keratopathy”, “amniotic membrane transplantation”, and “emerging treatments”. Peer-reviewed original studies, clinical trials, reviews, and meta-analyses published between 2000 and 2025 were included. Articles were critically appraised and selected according to their relevance, methodological quality, and contribution to understanding PCED pathophysiology, diagnosis, and treatment advancements.
Results: The review delineates the anatomy and physiological roles of the corneal epithelium, highlighting mechanisms that lead to epithelial defect persistence, including impaired basement membrane integrity, stem cell deficiency, inflammation, and neurotrophic factors. Clinical presentation and diagnostic modalities such as fluorescein staining and advanced imaging techniques are discussed. Standard management with lubricants, therapeutic contact lenses, infection control, and autologous serum eye drops is described, alongside medical therapies targeting epithelial regeneration, including recombinant human nerve growth factor and platelet-rich plasma. Surgical interventions like amniotic membrane transplantation and novel regenerative approaches involving stem cell therapy and corneal neurotization show promising results in refractory cases. Emerging molecular therapies and bioengineered drug delivery systems represent the forefront of innovation in PCED treatment.
Conclusion: PCEDs pose complex therapeutic challenges necessitating a multifaceted treatment approach. Advances in molecular, cellular, and surgical therapies have substantially expanded management options and improved healing outcomes. However, continued research into personalized therapies, optimization of delivery methods, and long-term safety is essential. This review provides a comprehensive synthesis of current knowledge and emerging trends to inform clinicians and researchers in the effective management of PCEDs, ultimately aiming to preserve vision and enhance quality of life. Future research should focus on minimally invasive sustained-release therapies, biomarker-guided personalized interventions, and combination approaches targeting epithelium, inflammation, and nerves.

Background: Pregnancy induces profound hormonal, hemodynamic, and metabolic changes that can trigger or exacerbate retinal disorders, some of which may signal systemic complications. This narrative review summarizes current knowledge on retinal diseases specifically induced or worsened during pregnancy.
Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Google Scholar up to 31 September 2025, supplemented by manual screening of reference lists of included records. Search terms included “pregnancy”, “preeclampsia”, “eclampsia”, “HELLP syndrome”, “hemolysis, elevated liver enzyme levels, and low platelets syndrome”, “retinal disease”, “retinopathy”, “hypertensive retinopathy”, “serous retinal detachment”, “central serous chorioretinopathy”, “diabetic retinopathy”, “Valsalva retinopathy”, “retinal vein occlusion”, “retinal artery occlusion”, “idiopathic intracranial hypertension”, and “artificial intelligence”. Eligible articles included case reports, case series, observational studies, reviews, and meta-analyses describing retinal conditions specifically induced or worsened during pregnancy. Data were synthesized narratively.
Results: Pregnancy can precipitate sight-threatening retinal pathology or accelerate pre-existing disease. Hypertensive retinopathy associated with preeclampsia and eclampsia is among the most clinically significant conditions, presenting with arteriolar narrowing, retinal hemorrhages, cotton-wool spots, and, in severe cases, serous retinal detachment. Metabolic adaptations, particularly in women with pregestational diabetes, may accelerate the progression of diabetic retinopathy, with some patients advancing from nonproliferative to proliferative stages over short intervals. Pregnancy has also been implicated in serous retinal detachment, central serous chorioretinopathy, Valsalva retinopathy, retinal vascular occlusions, and, less commonly, papilledema secondary to idiopathic intracranial hypertension. These disorders range from transient, self-limited entities to sight-threatening events and often reflect systemic pathology, including preeclampsia, eclampsia, or hypercoagulable states. Optical coherence tomography, optical coherence tomography angiography, and fundus photography provide safe, noninvasive diagnostic and monitoring modalities. Artificial intelligence (AI)-based retinal imaging offers accurate, noninvasive assessment of diabetic and hypertensive retinopathy and demonstrates expert-level performance across clinical settings. Management emphasizes stabilization of maternal systemic disease, optimization of glycemic and blood pressure control, and multidisciplinary care. Most conditions improve postpartum, but prompt recognition is essential to prevent permanent visual loss.
Conclusions: Pregnancy can precipitate or exacerbate a range of retinal disorders, reflecting the complex vascular, hormonal, and metabolic changes of gestation. Noninvasive imaging, interdisciplinary collaboration, and vigilant monitoring are essential to optimizing maternal and fetal outcomes. Awareness and early detection of pregnancy-associated retinal disorders, together with emerging AI-based tools, may further improve outcomes. Longitudinal studies are needed to establish evidence-based screening and management protocols.