Medical hypothesis discovery and innovation in ophthalmology

Background: Visio-spatial intelligence (VSI) plays an important role in athletic performance and may vary according to sport-specific training exposure. However, there is limited research comparing VSI between field hockey players and non-athletes using a comprehensive test battery that assesses accommodation facility, saccadic eye movements, speed of recognition, visual memory, hand-eye coordination, and peripheral awareness. Most studies have focused on mixed sports or recreational activities, leaving sport-specific VSI profiles in field hockey insufficiently characterized. This study aimed to compare VSI between field hockey players and non-athletes.
Methods: A comparative analytical cross-sectional study used a convenience sampling approach, and recruited 80 adults aged 18–34 years from the Zululand District, KwaZulu-Natal, South Africa, including 40 field hockey athletes and 40 non-athlete controls. VSI was assessed across six domains: accommodation facility, saccadic eye movements, speed of recognition, visual memory, hand-eye coordination, and peripheral awareness. All participants underwent a comprehensive ocular examination performed by a registered optometrist to assess their ocular status. Visual assessments were conducted using Spectrum Eyecare software to identify any visual abnormalities or limitations in either eye.
Results: Eighty participants completed the study, with an equal distribution of field hockey athletes and non-athlete controls (n = 40 each) and an equal sex distribution (20 men and 20 women per group). Mean (SD) age was 20.4 (2.3) and 21.8 (2.8) years for men and women field hockey players, respectively, and 22.1 (2.2) and 21.3 (1.8) years for men and women non-athletes, respectively. Field hockey athletes demonstrated significantly superior VSI in accommodation facility, saccadic eye movements, speed of recognition, peripheral awareness, and hand-eye coordination than non-athletes (all P < 0.001), with performance differences ranging from 22% to 66%. In contrast, visual memory did not differ significantly between groups (45.9 [5.2] vs. 44.8 [5.5]; P > 0.05), representing only a 2% difference. Overall, field hockey athletes demonstrated significantly better VSI than non-athletes in all assessed domains except visual memory.
Conclusions: Field hockey players demonstrated superior performance across five of the six VSI domains evaluated, including accommodative facility, speed of recognition, peripheral awareness, hand-eye coordination, and saccadic eye movements, whereas visual memory did not differ significantly from that of non-athletes. These findings suggest that participation in field hockey is associated with higher performance in selected visuomotor and perceptual tasks. Nevertheless, the comparable visual memory performance observed between groups indicates that the association between field hockey participation and performance may differ across VSI domains. Visuo-spatial assessment may therefore warrant further evaluation as a potential adjunct to talent identification and athlete development programmes.

Background: Dry eye symptoms are common among populations exposed to prolonged stress and adverse living conditions, yet brief patient-reported symptom assessment instruments have rarely been evaluated in conflict-affected settings. This study aimed to conduct a preliminary psychometric evaluation of the Arabic Dry Eye Questionnaire-5 (DEQ-5) among internally displaced adults in the southern Gaza Strip, with an emphasis on internal consistency, internal structure, and exploratory cross-language agreement.
Methods: A cross-sectional observational study was conducted in the Al-Mawasi camps among internally displaced adults using snowball sampling. Data were collected through face-to-face interviews using paper-based questionnaires. The Arabic DEQ-5 was administered to the primary study sample, while a bilingual subset completed the Arabic version first and the English version 72 hours later for an exploratory fixed-order bilingual agreement analysis. Internal consistency was evaluated using Cronbach’s alpha and McDonald’s omega total. Item-level analyses included corrected item-total correlations and Cronbach’s alpha if item deleted. Internal structure was examined using eigenvalue decomposition, scree plot inspection, and parallel analysis. Bilingual agreement was assessed using the intraclass correlation coefficient (ICC[2,1]), quadratic weighted kappa, and Bland–Altman analysis.
Results: Complete Arabic DEQ-5 responses were obtained from 234 participants. Mean (SD) total DEQ-5 score was 8.52 (3.65). Overall, 181 participants (77.4%) met the prespecified symptom-screening threshold of a DEQ-5 score greater than or equal to 6, including 49 (20.9%) with scores greater than or equal to 12. The Arabic DEQ-5 showed acceptable internal consistency (Cronbach’s alpha = 0.73; McDonald’s omega total = 0.82) and a dominant one-factor structure supported by eigenvalue decomposition, scree plots, and parallel analysis. In the fixed-order bilingual subset, total scores showed good point-estimate agreement (ICC[2,1] = 0.763), with weighted kappa values ranging from 0.364 to 0.840. Bland–Altman analysis showed minimal mean English–Arabic score bias but relatively wide limits of agreement.
Conclusions: The Arabic DEQ-5 demonstrated acceptable internal consistency and supportive evidence of a dominant one-factor structure in this conflict-affected displaced population. In the bilingual subset, total scores showed good point-estimate agreement; however, variable item-level agreement and wide limits of agreement do not support individual-level interchangeability between the Arabic and English versions. These findings suggest that the Arabic DEQ-5 may serve as a practical brief instrument for assessing dry eye symptoms in humanitarian and field research settings. However, because external validation measures, clinical assessments, confirmatory psychometric analyses, and test-retest reliability were beyond the scope of this study, the findings should be interpreted as a preliminary psychometric evaluation rather than a comprehensive validation. Further multicenter psychometric validation in diverse Arabic-speaking populations, including larger bilingual samples, is warranted.

Background: The pachychoroid disease spectrum comprises a group of chorioretinal disorders characterized by structural and hemodynamic alterations of the choroid that may ultimately lead to dysfunction of the retinal pigment epithelium, choroidal neovascularization, and vision loss. This narrative review aims to summarize the recent advances in the understanding of pachychoroid spectrum diseases, with particular emphasis on pathophysiology, multimodal imaging, and current therapeutic approaches.
Methods: Relevant English-language literature on pachychoroid spectrum disorders published up to 31 May 2026 was reviewed through PubMed/MEDLINE, supplemented by Google Scholar to identify additional relevant studies; relevant conference abstracts presented by that date and published subsequently were also included. Focus was on recent developments in disease mechanisms, imaging characteristics, clinical phenotypes, and management strategies. Search terms included “pachychoroid” and individual pachychoroid spectrum entities in combination with terms related to imaging, pathophysiology, diagnosis, and treatment. Relevant Medical Subject Headings (MeSH) terms were also used where applicable. Particular emphasis was placed on recently published studies reflecting current concepts and advances in pachychoroid disease. Earlier landmark studies with substantial scientific and historical relevance were additionally included to provide the original descriptions and foundational evidence underlying the pachychoroid spectrum.
Results: The pachychoroid spectrum is increasingly recognized as a continuum of disorders associated with choroidal vascular remodeling, venous congestion, and choriocapillaris attenuation. Characteristic multimodal imaging findings include pachyvessels, choroidal hyperpermeability, intervortex venous anastomoses, and variable inner choroidal thinning, while increased choroidal thickness alone may not reliably define the pachychoroid phenotype. Pachychoroid pigment epitheliopathy may occur as an isolated manifestation or coexist with other pachychoroid entities. Central serous chorioretinopathy represents a pivotal entity within the pachychoroid spectrum and may progress toward neovascular complications, including pachychoroid neovasculopathy and polypoidal choroidal vasculopathy. Advances in multimodal imaging, particularly optical coherence tomography angiography and ultra-widefield indocyanine green angiography, have substantially improved the detection of subclinical vascular alterations and disease progression. Although anti-vascular endothelial growth factor therapy and photodynamic therapy remain central treatment approaches, emerging modalities, including no-dose photodynamic therapy and photobiomodulation, are being investigated as potential therapeutic options, but current evidence does not support their routine clinical use.
Conclusions: Pachychoroid spectrum disorders share common choroidal vascular and hemodynamic abnormalities despite considerable phenotypic variability. Ongoing advances in multimodal imaging and evolving therapeutic strategies continue to refine the understanding and management of these disorders.

Background: Vision is fundamental to cricket performance, enabling players to process complex visual information and execute accurate motor responses under severe temporal constraints. Although numerous visual skills have been associated with cricket performance, uncertainty remains regarding their relative importance and practical application in talent identification and player development. This review critically examines the visual skills associated with cricket performance and evaluates their relevance for talent identification and player development.
Methods: A structured literature search was conducted across multiple electronic sources, including PubMed/MEDLINE, ScienceDirect, Google Scholar, NRC-CISTI, SPORTDiscus via EBSCOhost, and the Cochrane Database of Systematic Reviews. Where available, Medical Subject Headings (MeSH), together with free-text keywords related to cricket, vision, and visual performance were combined using Boolean operators. Eligible English-language sources included cross-sectional, longitudinal, cohort, and intervention studies; narrative and systematic reviews; and relevant books, book chapters, dissertations, theses, and conference proceedings. Retrieved publications were screened for eligibility, and data were extracted and synthesized narratively according to the visual skills examined and their reported associations with cricket performance, talent identification, and player development. For narrative synthesis, the identified visual skills were conceptually classified into visual hardware skills, comprising fundamental, non-task-specific optometric and binocular visual abilities, and visual software skills, encompassing task-related gaze-control, visual-information-processing, perceptual-cognitive, and visuomotor abilities.
Results: A total of 85 records were identified through the literature search, of which 15 duplicates were removed. Of the 70 records screened, 50 underwent full-text assessment, and 30 publications met the inclusion criteria and were included in the final narrative synthesis. The identified visual skills were organized into two broad conceptual categories: visual hardware skills, comprising fundamental, non-task-specific optometric and binocular visual abilities, and visual software skills, encompassing task-related gaze-control, visual-information-processing, perceptual-cognitive, and visuomotor abilities. The available literature suggested that these complementary skill domains may contribute to cricket performance, with visual hardware skills supporting visual input and visual software skills supporting the interpretation and translation of visual information into sport-specific motor responses. However, the strength and directness of the evidence varied across individual skills.
Conclusions: This review highlights the possible complementary roles of visual hardware and visual software skills in cricket performance and provides a conceptual framework for examining the sport’s visual demands. The 14 visual skills identified from the available literature may inform the future development and evaluation of cricket-specific visual assessment batteries and targeted vision training programs. Further direct research is required to determine whether assessment or enhancement of these skills improves talent identification, player development, or performance in competitive cricket.

Background: Several recent clinical studies have directly compared TECNIS PureSee with lenses from the Vivity platform; however, direct comparative clinical data specifically involving AcrySof IQ Vivity remain limited. Therefore, we aimed to indirectly compare the visual and patient-reported outcomes of two non-diffractive extended depth of focus (EDOF) intraocular lenses (IOLs), AcrySof IQ Vivity and TECNIS PureSee, using data from their respective FDA premarket approval (PMA) studies.
Methods: In this indirect cross-trial comparison, aggregate 6-month outcomes were compared from the FDA Summary of Safety and Effectiveness Data for the Vivity (107 implanted subjects) and PureSee (116 subjects in the intent-to-treat population; 115 in the safety population) PMA studies. The principal binocular visual-acuity threshold comparisons included 106 Vivity subjects from the All-Implanted population and 113 PureSee subjects from the Safety Population with observed 6-month data. Both were prospective, randomized, masked trials of bilateral implantation against a monofocal control from the same manufacturer. Outcomes included binocular visual acuity thresholds at distance, intermediate, and near, depth of focus at the 0.20 logarithm of the minimum angle of resolution (logMAR) threshold, mesopic contrast sensitivity, ISO 11979-7 safety endpoints, visual symptoms, and spectacle independence. Categorical visual acuity outcomes were compared using chi-square or Fisher’s exact tests, with absolute risk differences and 95% confidence intervals (CIs) and Holm adjustment for multiple comparisons. Contrast sensitivity, visual symptoms, spectacle independence, and defocus curves were summarized descriptively.
Results: At distance, the PureSee FDA trial reported more subjects reaching 0.00 logMAR or better for uncorrected distance visual acuity (68.1% versus 44.3%; risk difference [RD], -23.8 percentage points [pp]; 95% CI, -35.8 to -10.7; Holm-adjusted P < 0.05) and best-corrected distance visual acuity (92.0% versus 73.6%; RD, -18.5 pp; 95% CI, -28.3 to -8.6; Holm-adjusted P < 0.05). At intermediate distance, the Vivity FDA trial reported more subjects reaching distance-corrected intermediate visual acuity of 0.00 logMAR or better (40.6% versus 10.6%; RD, +29.9 pp; 95% CI, +18.6 to +40.4; Holm-adjusted P < 0.001). No near-vision threshold comparison remained significant after Holm adjustment. Monocular depth of focus was 1.53 D for Vivity and 1.77 D for PureSee, representing gains of +0.54 D and +0.64 D over their respective monofocal controls. Descriptively, more Vivity eyes were unable to detect the mesopic contrast reference pattern at 6 and 12 cpd with and without glare. Visual symptoms and spectacle independence were also reported descriptively because the trials used different questionnaires. Each trial met the safety and performance endpoint limits applicable to its respective ISO 11979-7 edition.
Conclusions: At the 0.00 logMAR threshold, PureSee reported higher proportions of subjects reaching corrected and uncorrected distance acuity, while Vivity reported a higher proportion reaching distance-corrected intermediate acuity. No near-vision threshold difference remained significant after multiplicity adjustment. Contrast sensitivity and patient-reported outcomes were interpreted descriptively because of differences in testing and questionnaire methods. Overall, the two FDA trials showed different patterns of visual performance, supporting the need for prospective head-to-head comparison.

Background: Amniotic membrane transplantation (AMT) is a recognized technique in ocular surface reconstruction. Its application in pediatric patients remains less extensively documented across a range of ocular-surface indications. There is a literature gap regarding its use for rehabilitating symptomatic, post-traumatic corneal thinning with surface irregularity, where the goal shifts from visual recovery to achieving a painless, stable ocular surface amenable to prosthetic fitting. We detail the surgical strategy aimed at achieving rapid surface stabilization and highlight the considerations unique to managing such complex corneal pathology in a pediatric population.
Case Presentation: An 11-year-old girl presented with left ocular pain, epiphora, and profound intolerance of a previously fitted ocular prosthesis. Her history was significant for a penetrating corneal injury six years prior that was treated with primary repair. The affected eye subsequently had no light perception and developed progressive corneal opacification, with marked corneal thinning noted at the current presentation. Examination revealed a leukomatous cornea with a linear area of significant stromal thinning and marked surface irregularity, explaining the prosthetic intolerance. After failed medical management, surgical intervention with a two-layer cryopreserved amniotic membrane overlay was performed. Two layers of membrane were secured with absorbable sutures and tailored to the irregular corneal contour. The membrane remained well attached, underwent gradual resorption over the subsequent weeks, and was followed by a smoother, clinically stable corneal surface. This allowed for successful and comfortable refitting of the ocular prosthesis. At the three-month follow-up, the patient was asymptomatic, and the ocular surface remained clinically stable.
Conclusions: In this pediatric patient, a two-layer sutured amniotic membrane overlay was associated with resolution of ocular discomfort, clinical improvement in surface regularity, and successful prosthetic rehabilitation. The clinical objective was patient comfort and prosthetic tolerance rather than improvement in visual acuity. This case suggests that a two-layer sutured amniotic membrane overlay may be considered for selected pediatric patients with symptomatic post-traumatic corneal thinning and surface irregularity; however, its effectiveness and long-term structural outcomes require further evaluation.