Medical hypothesis discovery and innovation in ophthalmology

Background: 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.
Methods: 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.
Results: 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 P > 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.
Conclusions: 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.

Background: Intracorneal ring segment (ICRS) implantation is a promising and effective treatment option for keratoconus. However, a corneal thickness of less than 400 microns presents a unique challenge. This study assessed the clinical course and visual outcomes in patients with Amsler–Krumeich stage 2 or greater keratoconus and clear corneas, with a minimal corneal stromal thickness of 350 microns but less than 400 microns in the proposed implantation area, up to 6 months after ICRS implantation.
Methods: This non-randomized, prospective, interventional case series was conducted at a single tertiary center, consecutively recruiting patients with keratoconus scheduled for ICRS implantation who fulfilled the eligibility criteria. Detailed ophthalmological assessments were performed at baseline and 6 months postoperatively, including measurements of uncorrected distance visual acuity (UCDVA), best corrected distance visual acuity (BCDVA), and manifest refraction with documentation of the spherical component of the refractive error (in diopters [D]), cylindrical component of refractive error (in diopter cylinder [DC]), and axis of astigmatism (in degrees). Corneal topographic and pachymetric evaluations were performed using Pentacam HR, including keratometry (K) values in D (flat K or K1, steep K or K2, and mean K or Km), corneal astigmatism in DC, central corneal thickness (CCT), and corneal asphericity coefficient (Q value).
Results: We included nine eyes of nine patients with keratoconus and a mean (standard deviation) age of 33.2 (8.2) years (range: 25–44 years). Five patients were women (56%), and four were men (44%). All eyes experienced a statistically significant improvement in the mean visual and refractive outcomes at the 6-month postoperative visit, including UCDVA, BCDVA, sphere, and cylinder (all P < 0.05). Similarly, we recorded a statistically significant improvement in the mean corneal tomographic and topographic data, including the K1, K2, Km, CCT, and Q values (all P < 0.05). No serious complications occurred for up to 6 months of follow-up. Only one patient complained of night glare, which was successfully treated with pilocarpine 1% eyedrops for 3 months.
Conclusions: ICRS implantation may offer a safe and effective option for selected patients with keratoconus and corneal thickness less than 400 microns, as evidenced by short-term improvements in visual, refractive, topographic, and tomographic parameters. No vision-threatening complications occurred. However, given the case-series study design, limited sample size, and short follow-up period, these findings should be interpreted with caution. Further controlled trials are required to validate these preliminary results.
 

Background: Despite the common association between bilateral retinal hemorrhage and shaken baby syndrome (SBS), unilateral retinal hemorrhage does not necessarily exclude this diagnosis. This study used computational simulations to elucidate the biomechanical phenomena within the eye under asymmetrical shaking forces.
Methods: Finite element analysis (FEA) incorporating the vitreous, vitreoretinal interface, retinal layers, and retinal vessels was performed under asymmetrical shaking conditions. To assess the stress-strain response at the preretinal, intraretinal, and subretinal locations, we divided the retinal mesh into three equally spaced layers with an element height of 0.083 mm. The remaining space within the retina was filled with the vitreous humor and attached to it via the main retinal vessels extracted from a standard fundus image. The resulting changes in shear stress and intraocular pressure (IOP) were quantified.
Results: The FEA model demonstrated that increasing the rotational radius from 10 cm to 14 cm or 17 cm led to a significant increase in shear stress and IOP across the vitreoretinal interface and within the retinal layers. Specifically, shear stress in the preretinal layer increased by 70.2% (8.0 kPa vs. 4.7 kPa), in the intraretinal layer by 20.0% (5.4 kPa vs. 4.5 kPa), and in the subretinal layer by 6.1% (3.5 kPa vs. 3.3 kPa). Simultaneously, IOP in the central region increased by 157.5% (39.4 mmHg vs. 15.3 mmHg) and in the posterior region by 162.3% (41.7 mmHg vs. 15.9 mmHg) when the rotational radius was increased to 17 cm from 10 cm. Increasing the rotational radius to 17 cm led to more pronounced changes in peak IOPs, with the central region showing a change of 39.4 mmHg and the posterior region a change of 41.7 mmHg. These results indicate a direct correlation between the rotational radius and the magnitude of IOP changes in the vitreous.
Conclusions: These findings highlight the critical impact of rotational radius on the biomechanical forces exerted within the eye during asymmetrical shaking events, leading to variations in shear stress and IOP that could contribute to unilateral retinal hemorrhage in SBS. These insights reveal the complexity of diagnosing SBS and emphasize the need for careful consideration of the biomechanical evidence in patients presenting with asymmetrical or unilateral retinal hemorrhage.

Background: 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.
Hypothesis: 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.
Conclusions: 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.

Background: 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.
Methods: 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.
Results: 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 Medical hypothesis, discovery & innovation in ophthalmology. Among the early contributions was a widely cited guideline for ophthalmic practice, published within months of the onset of the pandemic.
Conclusions: 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 remain timely and reliable during public health crises.

Background: Artificial intelligence (AI) is rapidly transforming vision sciences, leveraging the imaging-rich nature of ophthalmology and optometry to address the global burden of ocular diseases. AI’s ability to analyze complex imaging and clinical data offers unprecedented improvements in diagnosis, management, and patient outcomes. This narrative review aims to explore the current and emerging opportunities of AI in vision sciences, critically examine the associated challenges, and discuss the ethical implications of its integration into clinical practice.
Methods: A narrative review was conducted by searching PubMed/MEDLINE and Google Scholar for English-language articles published from January 1, 2005, to March 31, 2025. Studies with any design (clinical trials, observational studies, validation studies, systematic reviews, and meta-analyses) on AI applications in ophthalmology and optometry, focusing on diagnostic performance, clinical integration, and ethical considerations were included. Articles not related to AI in vision care were excluded.
Results: AI has achieved high diagnostic accuracy across ocular domains. In the cornea and anterior segment, AI models analyzing Scheimpflug tomography and corneal biomechanics detect keratoconus with over 98% sensitivity and 99.6% accuracy, including subclinical cases. For cataract surgery, machine learning-based intraocular lens formulas such as Kane and ZEISS AI reduce refractive errors, achieving mean absolute errors below 0.30 diopters, especially in highly myopic eyes. Retinal AI systems like EyeArt and IDx-DR autonomously detect diabetic retinopathy with sensitivities above 95%, while deep learning models predict age-related macular degeneration progression with an area under the ROC curve exceeding 0.90. In glaucoma, fundus and optical coherence tomography based AI models reach pooled sensitivity and specificity above 90%, but performance varies by disease stage and population diversity. AI also advances strabismus detection, amblyopia risk prediction, and myopia progression forecasting using facial analysis and biometric data. Key challenges include dataset bias, limited external validation, regulatory hurdles, and ethical issues such as transparency and equitable access.
Conclusions: AI is rapidly transforming vision sciences by improving diagnostic accuracy, streamlining clinical workflows, and broadening access to quality eye care, particularly in underserved regions. Its integration into ophthalmology and optometry holds significant promise for enhancing patient outcomes and optimizing healthcare delivery. However, to fully harness AI’s transformative potential, sustained multidisciplinary collaboration is essential—bringing together clinicians, data scientists, ethicists, and policymakers. Equally important are rigorous validation processes, transparency in algorithm development, and strong ethical oversight to mitigate risks such as bias, data misuse, and unequal access. Responsible implementation will be key to ensuring AI serves all populations equitably.