Medical hypothesis, discovery & innovation in optometry

Background: Myopia, a condition of growing concern in Asian populations, has been linked to ocular structural changes that may affect corneal endothelial morphology. Endothelial cell density (ECD), shape, and size changes have been observed in cases of high myopia. However, population-specific data, particularly in Malaysia, remain limited. In this study, we evaluated corneal endothelial morphology across different severities of myopia in young Malaysian adults.
Methods: For this cross-sectional study, we categorized individuals with myopia, aged 19–24 years, attending the International Islamic University Malaysia Optometry Clinic, into low, moderate, and high myopia groups, based on spherical equivalent. They underwent non-cycloplegic refraction, axial length, intraocular pressure, and slit-lamp assessments. Using a non-contact specular microscope, we measured corneal endothelial parameters, ECD (cells/mm²), coefficient of variation (CV) of the cell area, percentage of hexagonal cells (HEX, %), and central corneal thickness (CCT, micrometer) centrally, in triplicate, and averaged the values. All assessments were conducted by an experienced optometrist under controlled environmental conditions.
Results: We analyzed data from 374 eyes of 187 young adults (mean [standard deviation] age: 20.16 [0.75] years) across varying degrees of myopia. Axial length increased with myopia severity, while best-corrected visual acuity remained comparable among groups. Statistically significant differences in mean ECD, CCT, and HEX (all P < 0.05), but not in CV, were observed across the three myopia groups. Post-hoc analysis revealed that, compared to low myopia, the high myopia group had significantly lower ECD, HEX, and CCT (all P < 0.05), while the moderate myopia group showed significantly reduced ECD and HEX (both P < 0.05). ECD, CCT, and HEX did not differ significantly between the moderate and high myopia groups (all P > 0.05).
Conclusions: We demonstrated that higher myopia severity in young Malaysian adults was significantly associated with lower ECD, reduced HEX, and thinner CCT, whereas CV did not differ across myopia levels. These findings indicated that increasing myopia severity is associated with notable morphological changes in the corneal endothelium. Thus, progressive axial elongation in myopia may adversely impact corneal endothelial morphology and biomechanical stability. Given the cross-sectional nature and limited demographic scope of the study, further longitudinal and multi-ethnic studies are warranted to clarify the causal pathways and long-term implications of myopia-related endothelial changes.

Background: Dry eye disease (DED) is a multifactorial condition with a globally rising prevalence. Diagnosis relies on both symptoms and clinical tests, but these methods demonstrate variability. Strip meniscometry (SMTube) represents a rapid, non-invasive alternative method, but its diagnostic value remains uncertain. We evaluated the correlation of its findings with those of established DED evaluations.
Methods: In this cross-sectional study, we recruited 100 individuals with and without DED (n = 50 each) who visited a tertiary ophthalmology clinic. Diagnosis of DED was based on symptomatology and standard criteria, including a tear break-up time (TBUT) < 5 s or Schirmer test I result < 5 mm, along with an Ocular Surface Disease Index (OSDI) score > 12 and corneal fluorescein staining grade > 1. The exclusion criteria included ocular surgery, allergy, or contact lens use. All participants underwent comprehensive ophthalmic examination and standardized DED assessments (OSDI, tear meniscus height [TMH], SMTube, TBUT, corneal fluorescein staining, and Schirmer test I), conducted in a controlled setting by a single examiner during 9–11 AM to ensure consistency.
Results: The DED group was significantly older (P < 0.05). No significant sex difference was observed between groups (P > 0.05). The OSDI, TMH, SMTube, TBUT, corneal fluorescein staining, and Schirmer test I findings differed significantly (all P < 0.001), while SMTube application discomfort rates were similar between groups (P > 0.05). In the DED group, SMTube correlated moderately with TBUT (r = + 0.41, P < 0.05) and OSDI (r = + 0.43, P < 0.05), while the Schirmer test I correlated weakly with TBUT (r = + 0.34, P < 0.05) and moderately with TMH (r = + 0.52, P < 0.05). In the controls, no significant correlations were observed between tear metrics and SMTube or Schirmer test I findings (all P > 0.05), except for corneal fluorescein staining, which showed a weak negative correlation with SMTube (r = - 0.28, P < 0.05) and a moderate positive correlation with Schirmer test I findings (r = + 0.51, P < 0.05).
Conclusions: SMTube findings differed significantly between the DED and control groups and correlated moderately with those of established diagnostic assessments, particularly the TBUT and OSDI. Unlike Schirmer testing, SMTube results are closely associated with symptom severity, suggesting its utility in reflecting patient-reported discomfort. Given its simplicity, non-invasiveness, and correlation with key clinical indicators, SMTube may serve as a valuable adjunct in the multimodal assessment of DED. However, further studies are needed to establish its diagnostic accuracy and to confirm its clinical utility.

Background: Keratoconus is a progressive corneal ectasia causing visual impairment, often initially managed using spectacles or rigid gas permeable contact lenses, which do not halt disease progression. Corneal collagen cross-linking (CXL) is the only treatment proven to stabilize the condition. Although its efficacy is well documented globally, data from Nepal are limited. This study evaluated visual and keratometric parameters before and after CXL in Nepali patients with varying severities of keratoconus.
Methods: This retrospective, hospital-based study analyzed visual acuity and keratometric outcomes in patients with keratoconus who underwent epithelium-off CXL at Biratnagar Eye Hospital, Biratnagar, Nepal, between January 2019 and March 2023. Secondary data were extracted from medical records. Only eyes with minimum corneal thickness greater than or equal to 400 µm were included. Patients were classified into Amsler–Krumeich stages I–IV. Pre- and 1-month post-CXL assessments included uncorrected and best-corrected distance visual acuity (UCDVA and BCDVA, respectively) both recorded in logarithm of the minimum angle of resolution, keratometry, slit-lamp biomicroscopy, corneal topography, and fundus evaluation.
Results: A total of 195 eyes from 106 patients with keratoconus were analyzed; 84.0% (n = 89) underwent bilateral CXL. The mean (standard deviation [SD]) age was 19.4 (4.9) years, with most (n = 43, 40.6%) aged 16–20 years. Male patients comprised 71.7% (n = 76) of the cohort. The mean (SD) follow-up duration after CXL was 7.5 (2.6) months. Following CXL, overall BCDVA improved, with statistically significant gains in stages I and IV (both P < 0.05). UCDVA significantly improved in stage II (P < 0.05). In stage I and II eyes, the average keratometry became flatter by –0.4 D and –0.2 D, respectively (both P < 0.05). The mean average keratometry remained comparable to baseline in stage III and IV eyes (both P > 0.05).
Conclusions: CXL is effective in stabilizing keratoconus in Nepali patients, particularly in early stages. Significant improvements in BCDVA, as well as keratometric flattening, were observed in stage I and IV and in stage I and II eyes, respectively. Although advanced-stage eyes (III and IV) showed keratometric stability without significant flattening, the results suggest that CXL can slow or halt disease progression even in later stages. These findings highlight the importance of early diagnosis and timely intervention. Further prospective, multicenter studies are warranted to optimize treatment protocols and expand the understanding of CXL outcomes in this patient population.

Background: Glaucoma, a leading cause of irreversible blindness, is increasingly prevalent, with pseudoexfoliation glaucoma (PEXG) presenting more severe optic nerve damage than primary open-angle glaucoma (POAG). Phacoemulsification reduces intraocular pressure (IOP), especially in PEXG; however, its effects on retinal structure remain unclear. This study compared the effects of IOP reduction post-phacoemulsification on the ganglion cell complex (GCC) in eyes with PEXG and cataract, POAG and cataract, and cataract alone over 12 months.
Methods: This prospective, quasi-experimental study included age- and axial length-matched patients with PEXG, POAG, or cataract alone undergoing standardized phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation by a single surgeon using consistent techniques. Comprehensive ophthalmic assessments and spectral-domain optical coherence tomography imaging were performed preoperatively and at 3, 6, and 12 months postoperatively. Outcome measures included IOP, GCC thickness, retinal nerve fiber layer (RNFL) thickness, and vertical cup-to-disc ratio (CDR).
Results: Ninety eyes (30 per group) were analyzed. The mean (standard deviation [SD]) ages were 57.8 (5.8) years in the PEXG group, 58.0 (6.3) years in the POAG group, and 56.2 (4.6) years in the control group. There were 14 men (46.7%) and 16 women (53.3%) in both the PEXG and POAG groups, and 12 men (40.0%) and 18 women (60.0%) in the control group. The mean (SD) axial lengths were statistically similar at 23.9 (1.2) mm in the PEXG group, 23.9 (1.8) mm in the POAG group, and 23.8 (1.2) mm in the control group. Preoperatively, the PEXG group displayed higher IOP and thinner RNFL, whereas the POAG group featured thinner GCC and greater vertical CDR. Phacoemulsification significantly reduced IOP in both glaucoma groups (both P < 0.05), with a greater reduction in PEXG. However, no significant postoperative changes were observed in GCC thickness, RNFL thickness, or vertical CDR within any group (all P > 0.05). Despite this, intergroup differences in GCC, RNFL, and vertical CDR persisted at all follow-up points (all P < 0.05), although the PEXG and POAG groups did not significantly differ from each other (P > 0.05).
Conclusions: Phacoemulsification with PCIOL implantation significantly reduced IOP in eyes with PEXG and POAG, with a greater reduction observed in PEXG. However, this IOP reduction did not translate into significant changes in GCC thickness, RNFL thickness, or vertical CDR over 12 months. These findings suggest that although cataract surgery offers IOP-lowering benefits in early-stage glaucoma, it may not influence short-term structural progression, highlighting the need for ongoing postoperative monitoring and adjunctive management in glaucomatous eyes.
 

Background: Idiopathic intracranial hypertension (IIH), characterized by increased intracranial pressure (ICP) without a clear cause, typically affects obese women of reproductive age. Although lumbar puncture (LP) is diagnostic, its invasiveness limits its repeated use. Consequently, a non-invasive alternative is essential. Therefore, we assessed whether optic nerve sheath diameter (ONSD) measurement via orbital ultrasonography could serve as an alternative method for monitoring changes in ICP in patients with IIH.
Methods: In this prospective observational study, patients with IIH, diagnosed using the modified Dandy criteria, underwent ONSD assessment using B-scan ultrasonography. Bilateral measurements were performed 3 mm posterior to the optic disc with the probe and sterile gel placed on the closed upper eyelid. ONSD was recorded before LP and one month after initiation of medical treatment. Comprehensive ophthalmologic examinations were also conducted. Patients with ocular pathology, neuroimaging abnormalities, or contraindications to LP were excluded.
Results: Twenty-four eyes from 12 female patients with IIH were evaluated. The mean (standard deviation [SD]) age was 27.3 (6.9) years, and the mean ICP was 34.8 (10.3) cm H2O. Although the ONSD decreased one month after LP, changes in mean ONSD of the right eye, left eye, and their average were not statistically significant (all P > 0.05). No significant correlations were observed between baseline ICP and ONSD values (all P > 0.05).
Conclusion: Although ONSD measurement via ultrasonography provides a noninvasive method for assessing ICP in IIH, our findings revealed no significant change one month after treatment initiation. ONSD may gradually decrease following LP; however, a return to baseline values appears to require a prolonged period, even after ICP normalization. This should be considered during patient follow-up. Our findings underscore the limitations of using ONSD as a standalone marker for monitoring therapeutic response. Further research is warranted to explore the factors influencing ONSD dynamics and to establish standardized, patient-centered measurement protocols.

Background: Curcumin, a natural polyphenol derived from Curcuma longa L., has gained considerable attention in ophthalmology because of its potent anti-inflammatory, antioxidant, and immunomodulatory properties. This review evaluates the therapeutic potential of curcumin in ocular diseases and explores innovative strategies to enhance its bioavailability.
Methods: A comprehensive search was conducted in four major electronic databases—PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar—using keywords related to curcumin, ophthalmology, and drug delivery systems. Studies published in English up to March 10, 2025, were included. Relevant articles were selected based on their focus on the therapeutic effects of curcumin and the application of advanced delivery methods.
Results: Curcumin shows promising therapeutic potential in various ocular conditions due to its anti-inflammatory, antioxidant, and anti-angiogenic properties. Studies highlight its beneficial effects in corneal neovascularization, promoting corneal wound healing, and dry eye disease. It also demonstrates efficacy against allergic and bacterial conjunctivitis, pterygium recurrence, anterior uveitis, and cataracts. Moreover, curcumin may be beneficial in glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy, offering a multi-targeted approach to preserving vision and ocular health. However, its poor bioavailability remains a major limitation. Strategies to overcome this challenge include the development of structural analogs, bioavailability enhancers, and advanced drug delivery systems such as nanoparticles, liposomal systems, micelles, hydrogel-based systems, and nanoemulsions, all of which may enhance the stability, bioavailability, and controlled release of curcumin.
Conclusions: Curcumin has garnered attention in ophthalmology because of its multifaceted therapeutic properties, including anti-inflammatory, antioxidant, apoptosis regulating, antibacterial, and immunomodulatory actions. These properties have demonstrated promising results, highlighting the potential of curcumin in treating various ophthalmic conditions. Despite the promising potential of curcumin in ophthalmic therapies, addressing its poor bioavailability by using innovative drug delivery systems is crucial for maximizing its clinical efficacy. To address these challenges, substantial research has focused on enhancing the bioavailability of curcumin through the development of structural analogs, bioavailability enhancers, and advanced drug delivery systems. Innovative formulations, including nanoparticles, liposomal systems, micellar solutions, hydrogel-based systems, nanoemulsions, microspheres, and transferosomes, are promising approaches to improve the stability, bioavailability, and controlled release of curcumin, offering a hopeful avenue for its future application in ocular therapies.