Orthokeratology (OK) is considered an effective intervention for slowing the progression of myopia. It provides users with unaided corrected daytime vision by wearing contact lenses overnight. This review summarizes contemporary evidence on OK in several aspects, including treatment efficacy, biological mechanisms, lens design, safety, and the use of combination therapies. A structured literature search of PubMed and the Cochrane Library was conducted to identify eligible studies. Studies investigating the efficacy of OK in myopia control demonstrated advantages in reducing axial growth. The mechanisms underlying this effect include the induction of peripheral myopic defocus, changes in higher-order aberrations, and alterations in choroidal thickness. This review synthesizes the zones and fitting considerations of OK lenses. Main and novel lens designs are also discussed. Common adverse events associated with OK use, including corneal staining and lens binding, as well as less frequent but serious adverse events, such as microbial keratitis, are listed in this article. In addition, this review summarizes current evidence for combination therapy, demonstrating additive effects with low-concentration atropine and early findings with repeated low-level red light therapy; however, further investigations regarding rebound and safety are required.
Abstract: Rhegmatogenous retinal detachment (RD) repair techniques have improved rapidly over the past few decades, leading to high anatomical success rates. However, the structural and functional alterations in retinal microstructure may lead to the absence of concurrent functional recovery. The functional outcomes of RD are inadequately represented by routinely measured visual acuity (VA). Defects in color vision contrast discrimination, metamorphopsia, and aniseikonia are prevalent even after a successful RD repair, especially in macula-off RDs. Retinal sensitivity measurement with microperimetry reveals depressed areas and scotomas. This review aims to understand these visual function tests and assess the changes in functional status beyond VA after successful surgical repair of RDs.
India, the epicenter of diabetes, faces a daunting projection of 100 million diabetic individuals by 2030. Burden of diabetic macular edema (DME) as a part of diabetic retinopathy is significant and continues to impose substantial challenges in management vis a vis protocols and treatment affordability. In developing nations, the utilization of multiple intravitreal anti-VEGF and steroids injections as a primary therapeutic modality is impeded by financial constraints. To address these issues, we proposed a novel technique with a drug which not only mitigates cost constraints but is also efficacious in the management of DME. Using easily available material like 22G and 26G needles, this makeshift apparatus can be used for targeted delivery of triamcinolone acetonide (TA) in the suprachoroidal space. Applying this technique on 4 patients, we noted resolution of edema on post-injection OCT with concurrent improvement in visual acuity, which further culminated in a prospective study comparing suprachoroidal TA versus intravitreal dexamethasone with 25 patients each.
Abstract: Intravitreal antivascular endothelial growth factors like ranibizumab have been shown to be efficacious and safe for treating retinal diseases, but high cost limits their use. Biosimilar drugs provide a more affordable alternative. Razumab (Intas Pharmaceuticals Ltd., Ahmedabad, India), a ranibizumab biosimilar, was approved in India in 2015. Despite promising results, there is a lack of unbiased, independent systematic reviews and meta-analyses on its safety and efficacy.Systematic searches were conducted on Ovid MEDLINE, PUBMED, Web of Science, EMBASE, SCOPUS, and Cochrane. Eighteen studies with a total of 3740 eyes, and one safety trial with 9406 injections were included in this systematic review and meta-analysis. Razumab injections led to a significant improvement in best corrected visual acuity, a decrease in central macular thickness in patients with neovascular age-related macular degeneration, macular edema due to diabetes and retinal vein occlusion, and a significant regression in retinopathy of prematurity, but there was heterogeneity between the studies and potential publication biases. The overall proportion of adverse events was around 17.1%, with the majority being nonserious. This study showed that Razumab led to improvement in visual outcomes and a decrease in retinal thickness with an acceptable safety profile, but there was variability and potential publication biases in the studies included. Long-term and independent trials are needed for greater evidence.
Nanophthalmos presents a significant management challenge when complicated by angle-closure glaucoma, primarily due to the high risk of sight-threatening perioperative complications such as malignant glaucoma and uveal effusion syndrome. This review aims to address the key question of optimal evidence-based surgical strategies for Nanophthalmos secondary to angle-closure glaucoma (NSACG) that effectively mitigate these characteristic risks. The main contribution of this review is the proposal of a novel modular surgical approach, which selectively integrates phacoemulsification (phaco), irido-zonulo-hyaloid-vitrectomy, goniosynechialysis or Ahmed glaucoma valve implantation, and scleral windows. Grounded in the pathophysiological mechanisms underlying surgical complications, this modular framework synthesizes current evidence to provide a personalized and scientifically grounded strategy for managing this refractory glaucoma subtype.
Abstract: In proliferative diabetic retinopathy (PDR), vitreous hemorrhage (VH) becomes a common complication and remains an ongoing challenge in achieving optimal surgical outcomes. This meta-analysis aims to analyse the intra- and postoperative outcome of adding intravitreal injection of ranibizumab before small-gauge pars plana vitrectomy (PPV), particularly to reduce VH incidence. We conducted systematic searching on five eligible databases using Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols to find studies which compared outcome of small-gauge vitrectomy with and without preoperative intravitreal ranibizumab (IVR). The outcomes were assessed using mean difference (MD) and risk ratio (RR). Six studies were included in this meta-analysis with a total of 584 patients. Combination therapy of small-gauge vitrectomy with preoperative IVR significantly reduced the incidence of severe intraoperative bleeding (RR= 0.37; 95% confidence interval [CI] 0.22, 0.62; P = 0.0002), mild-severe early VH (RR= 0.47; 95% CI 0.24, 0.89; P = 0.002), and iatrogenic retinal break (RR= 0.47; 95% CI 0.31, 0.71; P = 0.0003). IVR significantly improved the best-corrected visual acuity after 1 and 3 months of PPV (MD= −0.15; 95% CI −0.24, −0.06; P = 0.0006). The mean of surgery time also significantly reduced in the IVR group (MD = −20.50; 95% CI −36.48, −4.52; P = 0.01). In conclusion, small-gauge PPV with preoperative IVR injection offers significant intra-and postoperative outcomes in PDR patients.
Increased time outdoors has been convincingly associated with less myopia in observational studies. School-based interventions using increased time outdoors have been shown to reduce myopia onset, even in large-scale implementation. While each of the studies on which these conclusions are based has limitations, the consistent evidence has established that increasing time outdoors provides a powerful approach to controlling the current epidemic of myopia. A causal pathway for protection has been confirmed in studies on experimental myopia in animals, involving increased release of retinal dopamine by brighter outdoor light during daylight hours. This does not preclude involvement of other mechanisms, and initial results suggest that interventions to increase lighting in classrooms, or to provide environments rich in higher spatial frequencies similar to natural environments outdoors, may provide synergistic benefits. Whether increased time outdoors slows myopia progression is more controversial. Observational epidemiology and intervention trials have given inconsistent evidence, but studies on seasonal variations suggest that progression may also be regulated by light exposures and near workloads. At present, the evidence is sufficient to consider increased time outdoors as an adjunct therapy for myopia control, but primary control should be based on well-validated interventions. As increased time outdoors is increasingly used, one research priority should be to establish optimal protocols for school-based interventions. Another should be to explore the impact of these interventions on learning outcomes, since modern educational theory suggests that more play-based learning in the early years may lead to better long-term educational outcomes. The broader impacts on student mental and physical health should also be investigated. Little attention has so far been paid to how to reduce myopiagenic pressures associated with schooling, without compromising educational outcomes. This is an important area for future research, which should involve collaboration between experts in vision and ophthalmology and experts in education.
Myopia is a major global health concern, projected to affect nearly half of the world’s population by 2050. While axial elongation is known to be the underlying pathology in myopia, the pathophysiology of factors that drive axial elongation is not fully understood. Factors driving axial elongation include genetic factors and environmental factors such as outdoor activity time and the amount of near work. With advances in ocular imaging technology, there is interest in the role of anterior segment biomarkers in the onset and progression of axial elongation in myopia. Imaging modalities such as corneal tomography, anterior segment optical coherence tomography, optical biometry, and corneal biomechanical analyzers have enabled the precise measurement of corneal shape, anterior chamber depth, lens parameters, and biomechanical properties. These biomarkers have been implicated in myopia development, progression risk prediction, and response to interventions such as orthokeratology. In this review, we explore contemporary anterior segment imaging modalities and seek to better understand the complex relationship between anterior segment biomarkers and axial elongation in myopia. By understanding the role of these biomarkers, we may be better equipped in predicting myopia onset and progression and pave the way for potential treatments in myopia.
Myopia and pathological myopia (PM) have been recognized as one of the leading causes of visual impairment globally. Optical coherence tomography (OCT) provides high-resolution imaging of retinal and choroidal structural changes and plays an increasing role in the diagnosis and prognostication of PM and myopia-related complications. Recent advances in OCT technology have produced a potential platform for artificial intelligence (AI), particularly deep learning (DL), to enhance diagnostic accuracy and prognostic capabilities. First, AI-assisted detection of myopia based on OCT-derived biomarkers such as retinal curvature, optic nerve morphology, and inner retinal thinning have the potential to detect high myopia. However, precise refractive error estimation or differentiation of lower-grade myopia remains modest. Future integration of OCT angiography may refine the prediction of myopia progression. Second, AI may improve automated segmentation and quantification of the choroid, with DL algorithms consistently delineating choroidal boundaries and quantifying region-specific choroidal thicknesses. Recent algorithms have extended beyond basic segmentation to choroidal sublayer segmentation and calculating choroidal vascularity indices, enhancing structural characterization in myopic eyes. Third, AI methods have advanced the detection of PM-related OCT lesions, reliably identifying critical lesions including myopic traction maculopathy, myopic choroidal neovascularization, and dome-shaped macula. Recent models have also shown the ability to categorize disease severity according to validated clinical frameworks, such as the Atrophy-Traction-Neovascularization and myopic tractional maculopathy staging systems. Despite these advances, current AI methods face challenges including inconsistent OCT protocols, limited longitudinal data, inadequate external validation, and difficulties handling poor-quality scans. Addressing these limitations could facilitate clinical integration, enhancing early diagnosis, prognostication, and possibly, personalized myopia management in the future.
Repeated low-level red-light (RLRL) therapy has emerged as an effective intervention for myopia control, yet concerns regarding its safety remain. This review summarizes the current high-level evidence on the efficacy and safety of RLRL therapy. Randomized controlled trials consistently demonstrate that RLRL therapy significantly reduces axial elongation and slows myopic onset and progression in children, with network meta-analyses indicating superior efficacy compared with established interventions. The short-term safety profile appears favorable, and no irreversible damage has been reported. However, uncertainties persist regarding the clinical significance of observed structural changes, such as transient foveal hyperreflectivity and cystoid abnormality on optical coherence tomography, as well as functional changes on multifocal electroretinogram. Addressing critical knowledge gaps, including long-term monitoring, dose optimization, and device design refinement, will be essential for realizing the full potential of this therapy while ensuring its safety.
