Medical hypothesis discovery and innovation in ophthalmology

Background: 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.
Methods: 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.
Results: 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 (P = 0.001), ulcers completely closed (P = 0.001), and the pain score dropped from 2 to 0 (P = 0.001). Anterior chamber reaction and blepharospasm also improved significantly (both P = 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.
Conclusions: 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.

Background: 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.
Methods: 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.
Results: 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 (P < 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 P < 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 (P > 0.05). Cataract (n = 131) was the most common coexisting ocular condition.
Conclusions: 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.

Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.

Background: 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.
Methods: 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.
Results: 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; P < 0.05). A greater proportion of Eyhance patients achieved binocular UNVA of 20/25 or better (46.9% vs 21.8%; P < 0.01), and 20/32 or better (65.3% vs 45.5%; P < 0.05). However, there was no significant difference for 20/20 visual acuity (20.4% vs 18.2%; P > 0.05). No significant differences were observed in postoperative UDVA or CDVA between groups (both P > 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; P > 0.05). Eyhance eyes demonstrated less residual refractive cylinder at 1 month (P < 0.01), which may be attributed to a higher rate of toric IOL use (P < 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 P < 0.01), as well as improved binocular uncorrected intermediate visual acuity (UIVA) (mean difference [SD]: -0.10 [0.18] logMAR; P < 0.01). These studies also showed low rates of glare and halos for both IOLs.
Conclusions: Patients receiving the TECNIS Eyhance IOL had better binocular UNVA compared to those with a standard monofocal IOL, consistent with published literature. The Eyhance IOL also showed better binocular UIVA and monocular UNVA across the studies reviewed. Both enhanced and standard monofocal IOLs demonstrate excellent distance vision and have similar levels of photic phenomena. Nevertheless, the Eyhance IOL shows promising potential for improving intermediate and near vision.

Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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. Field-specific adaptations of reporting standards may further support ethical clarity. Ultimately, ethical SRMAs are critical to preserving trust, guiding responsible care, and fulfill their intended role as trustworthy instruments in advancing evidence-based ophthalmology.

Background: 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.
Methods: 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 or less 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.
Results: 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 P > 0.05). Correlation between repeated measurements showed excellent repeatability: 0.991 for both total macular and GCL+ thickness, and 0.954 for cpRNFL (all P < 0.001). Spherical equivalent did not correlate significantly with retinal thickness measures (all P > 0.05).
Conclusions: 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 development of reliable pediatric reference standards for swept-source OCT imaging. This may enhance diagnostic accuracy and clinical decision-making in pediatric ophthalmology.