Purpose:To evaluate the effect of caffeine intake on intraocular pressure (IOP). Methods:The PubMed, Cochrane, Scopus, and ProQuest databases were searched for publications of randomized trials investigating the effect of caffeine consumption on IOP in healthy and glaucomatous populations until February 1, 2025. Outcomes at 30 min, 1, 1.5, 2, and 3 h were analyzed using a random-effects model. Subgroup analysis was done for different types of caffeine-containing beverages and different amounts of caffeine. Results:Sixteen studies, including 599 healthy participants and 63 glaucomatous patients (with primary open-angle glaucoma, ocular hypertension, and normotensive glaucoma), were included in this meta-analysis. The weighted mean difference (WMD) with 95% confidence intervals of IOP in the healthy population at 30 min, 1 h, 1.5 h, and 2 h were significant at 0.61 (0.07; 1.16), 0.87 (0.40; 1.33), 1.60 (0.40; 2.80), and 0.63 (0.03; 1.22), respectively. In glaucomatous patients, WMD at 1 and 1.5 h time points were significant at 1.51 (0.83; 2.18) and 1.39 (0.99; 1.78), respectively. Ingestion of >100 mg of caffeine significantly increased IOP at 30 min, 1, and 1.5 h, whereas ingestion of ≤100 mg did not significantly increase IOP in healthy populations. All included studies with glaucomatous populations used >100 mg of caffeine. Conclusion:Caffeine ingestion, especially of >100 mg, acutely elevates IOP in both healthy and glaucomatous populations.
Purpose:To report a case of progressive anatomical improvement documented over 3 years after epiretinal membrane (ERM) peeling and to describe how fundus autofluorescence (FAF) imaging contributed to the documentation and evaluation of this long-term recovery. Methods:A retrospective case report was conducted. Results:This case report describes a 70-year-old male patient with decreased visual acuity due to idiopathic ERM. Preoperative FAF demonstrated vessel displacement, and optical coherence tomography showed Grade 3 tractional changes. The patient underwent pars plana vitrectomy with ERM and internal limiting membrane peeling. Visual acuity improved rapidly, while FAF follow-up over 3 years demonstrated progressive centrifugal repositioning of retinal vessels toward their predisplacement locations. Conclusions:This finding illustrates the utility of FAF in documenting long-term anatomical recovery beyond macular thickness normalization. FAF may serve as a valuable complementary tool to monitor retinal remodeling and vessel realignment following membrane peeling, supporting its role in postoperative assessment of ERM surgery outcomes.
Purpose:To investigate the prevalence, clinical course, and prognostic significance of hyporeflective micro-elevations and irregularity of the ellipsoid zone (MEEZ) in blunt ocular trauma. Methods:Patients with blunt ocular trauma underwent standard ophthalmological examination and optical coherence tomography angiography. MEEZ was defined as small hyporeflective foci at the level of the ellipsoid and interdigitation zone, with disappearance of the thin hyporeflective band between these layers. The prevalence and spatial distribution of MEEZ, choriocapillaris perfusion, and associated findings were evaluated. Results:MEEZ was identified in 62 (40.3%) out of 154 eyes with blunt trauma, including nine eyes with MEEZ as the only form of posterior segment injury, and 53 eyes where MEEZ was found with other posterior segment injuries. Mean best-corrected visual acuity in eyes with MEEZ only was 0.0 logMAR (20/20 of Snellen equivalent). In eyes where MEEZ was associated with other posterior segment injuries, mean best-corrected visual acuity was 0.9 ± 0.64 logMAR (approximately 20/160 of Snellen equivalent). Choriocapillaris perfusion area in eyes with MEEZ only and healthy fellow eyes was 21.1 ± 1.3 and 20.4 ± 1.2 mm2 (P > 0.05), respectively. During the follow-up, MEEZ showed complete resolution in all cases with available follow-up data (n = 15) after a median period of 34.0 days. Conclusions:MEEZ is an important part of the spectrum of traumatic retinal changes frequently observed in blunt ocular trauma. As the only manifestation of blunt ocular trauma, MEEZ is associated with a favorable prognosis.
Purpose:To evaluate the differences in intraocular pressure (IOP) response to the water drinking test (WDT) in advanced glaucoma patients following trabeculectomy or Preserflo MicroShunt implantation. Methods:This prospective study included 30 eyes from 29 advanced glaucoma patients: 15 underwent trabeculectomy, and 15 received the Preserflo MicroShunt. Baseline IOP was measured using Goldmann applanation tonometry, followed by WDT involving the consumption of 10 mL of water per kilogram of body weight over 5 min. IOP was measured at 15-min intervals until it returned to baseline. Outcomes included peak IOP, time to peak IOP, IOP fluctuation, and time to return to baseline. Results:Baseline IOP was comparable between groups (trabeculectomy: 14.83 ± 2.28 mmHg; Preserflo: 15 ± 1.23 mmHg, P = 0.515). The peak IOP and IOP fluctuation were also similar (P = 0.978 and P = 0.614, respectively). However, trabeculectomy patients exhibited a shorter time to peak IOP (27 ± 5.6 min vs. 36.25 ± 9.8 min, P = 0.017) and faster return to baseline (55 ± 4.8 min vs. 57.25 ± 9.8 min, P = 0.03). Conclusions:Both trabeculectomy and the Preserflo MicroShunt effectively controlled IOP during WDT, with the Preserflo MicroShunt demonstrating noninferiority in overall IOP control. Trabeculectomy exhibited superior dynamic outflow capacity, making it suitable for patients requiring aggressive IOP reduction.
Purpose:To evaluate long-term outcomes of bilateral medial rectus recession in infantile esotropia (IET) using survival analysis of real-world data to identify predictors of surgical failure. Methods:This retrospective study included 121 IET patients with ≥12 months of follow-up. Motor success was defined as alignment within ±10 prism diopters at 6 months (early) and final visit (late). Sensory success was defined as binocular single vision (BSV), including fusion with or without stereopsis. Long-term motor stability was evaluated using survival analysis and Cox regression, while sensory outcomes were analyzed using multivariable regression. Results:Median surgical age was 24 months; the mean follow-up was 77.8 ± 59.6 months. Motor success was 56.2% at 6 months and 52.9% at the final follow-up. Cumulative success declined from 95.9% at 1 year to 54.9% at 10 years (median survival: 130 months). Male sex (P = 0.009), larger initial deviation (P = 0.035), and recession ≥6 mm (P = 0.022) were independently associated with failure, whereas surgical timing within the age range represented in this cohort was not. At the last follow-up, 33.1% of patients were undercorrected and 14.0% overcorrected, with overcorrection more frequent in longer follow-up (P = 0.001). Stereopsis was achieved in 9.3% of patients, and 70.9% of patients demonstrated BSV. Amblyopia independently reduced the likelihood of achieving BSV (odds ratio = 0.26, P = 0.015). Conclusions:Long-term motor alignment is maintained in about half of IET patients, though stability declines over time. Male sex, larger deviation, and higher surgical dose predict failure. Peripheral fusion is frequent, fine stereopsis remains rare, and amblyopia adversely affects sensory outcome.
Purpose:To determine the discriminative abilities of macular and retinal nerve fiber layer (RNFL) thicknesses in multiple sclerosis (MS) from normal and to identify optic neuritis (ON) in MS patients. Methods:This cross-sectional case-control study included 133 participants aged 30-45 years: 66 definite MS patients (18 with ON) and 67 age- and sex-matched healthy controls. MS diagnosis was established ≥5 years before enrollment. Exclusion criteria were other neurological/retinal diseases, high refractive error (> ±6.00 diopter), media opacities, glaucoma, or intraocular surgery. All underwent spectral-domain optical coherence tomography (Cirrus High-Definition Optical Coherence Tomography) under pharmacologic mydriasis to measure RNFL and macular thicknesses. Results:MS patients without ON showed significantly reduced macular thickness in inner superior, outer inferior, outer superior, outer nasal, and outer temporal sectors versus controls. MS patients with ON had significantly thinner inner superior and outer superior macular sectors than those without ON. For distinguishing MS from controls, an average RNFL ≤94 μm yielded a sensitivity of 87.9%, a specificity of 70.2%, and the area under the receiver operating characteristic curve (AUC) of 0.836 (P < 0.001). For differentiating MS with versus without ON, the average RNFL ≤83 μm achieved the highest RNFL performance: AUC of 0.836, sensitivity of 72.2%, and specificity of 81.3%. Among macular subregions, outer nasal (AUC = 0.680) and outer superior (AUC = 0.670) sectors best distinguished MS from controls. For ON detection, the outer superior sector performed best (AUC = 0.736, sensitivity: 61.1%, and specificity: 79.2%). Conclusion:RNFL thinning is a robust structural biomarker for MS and prior ON, whereas average macular thickness has limited standalone diagnostic utility for ON, though specific outer macular sectors show moderate discriminative value.
Purpose:To describe a novel technique for repairing large iris defects using an allogenic corneal iris segment (ACIS), referred to as the Antep procedure, and to present its application in two challenging clinical cases. Methods:Two cases with significant iris loss and photic symptoms underwent ACIS implantation. The ACIS was shaped into a crescent-shaped segment specifically designed to cover the iris defect and stained with trypan blue. It was then positioned in the anterior chamber and secured with three-point fixation at the nasal and temporal positions to the residual iris and superiorly to the sclera. Results:In both patients, ACIS implantation provided effective anatomical reconstruction of the iris defect and led to meaningful functional improvement, particularly in photic symptoms. The segments remained well positioned throughout follow-up, and no intraoperative or postoperative complications were observed. Conclusions:The Antep procedure offers a biologically integrated, low-cost, and technically feasible option for reconstruction of large iris defects. Further studies with longer follow-up are warranted to evaluate long-term outcomes and broader applicability.
Purpose:To characterize the structural, functional, and optical coherence tomography angigraphy (OCTA) phenotype associated with the OPA1 c3011T>C (p.Leu1004Pro) variant in a multigenerational family with autosomal dominant optic atrophy. Methods:In this retrospective familial case series, four affected female relatives across three generations underwent ophthalmic examination including best-corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) imaging, Humphrey 24-2 visual fields, and 6 mm × 6 mm swept-source OCTA (SS-OCTA). Quantitative OCTA assessed parafoveal vessel density in the superficial capillary plexus (SCP). Next-generation sequencing in the index case and intrafamilial Sanger sequencing confirmed segregation. Results:All subjects carried the heterozygous OPA1 c.3011T>C variant and showed a consistent optic neuropathy pattern with temporal disc pallor, selective temporal RNFL thinning, and macular GCC loss on a preserved outer retina without microcystic changes. BCVA ranged from 0.22 to 0.82 logMAR, indicating marked intrafamilial functional variability. Visual fields demonstrated central/centrocecal or paracentral defects with relative peripheral sparing, with more extensive central depression in the oldest case. On exploratory 6 mm × 6 mm SS-OCTA, parafoveal SCP vessel density values showed intercase variation without frank macular nonperfusion; findings are interpreted descriptively in the absence of device and age-matched internal controls. Conclusion:The OPA1 p.Leu1004Pro variant was associated with a stereotyped structural optic neuropathy pattern, whereas functional impairment showed marked intrafamilial variability. Exploratory SCP OCTA findings are descriptive only, given the absence of device and age-matched internal controls.
Purpose:To evaluate the potential choroidal vascular changes in newly diagnosed subclinical Cushing syndrome (SCS) patients and to assess whether choroidal parameters correlate with hormonal parameters. Methods:Twenty-one right eyes of 21 patients with SCS and 22 right eyes of 22 healthy individuals were included in the study. Results of the 1 mg dexamethasone suppression test, basal cortisol, basal adrenocorticotropic hormone, and 24-h urine-free cortisol levels were recorded from the patient files. Choroidal thicknesses (CTs) were measured from the subfoveal, 500 μm nasal, and 500 μm temporal quadrants with enhanced depth imaging-optical coherence tomography (OCT). The ImageJ program calculated the choroidal vascularity index (CVI). The choriocapillaris (CC) flow area was evaluated with OCT-angiography. The primary outcome measure was the CVI. Results:There were no significant differences in subfoveal, nasal, or temporal CT between groups (P > 0.05). In addition, there was no statistically significant difference between the SCS group and the control group in terms of total choroidal area, luminal area, stromal area, and CVI values (P = 0.827, P = 0.466, P = 0.343, and P = 0.065, respectively). The mean difference in subfoveal CVI between the groups was -1.78 (95% confidence interval: -3.8-0.2). No statistical difference was found between the SCS and control groups in terms of CC flow area, with a radius of 1, 2, and 3 mm (P > 0.05). No statistically significant correlation was detected between the examined choroidal and biochemical parameters (P > 0.05). Conclusion:According to the results of this study, subclinical hormonal changes in newly diagnosed SCS patients do not affect choroidal vascular status.
Purpose:To report the successful use of an autologous Tenon's capsule graft for recurrent retinal detachment associated with a cavitary optic disc anomaly following failed amniotic membrane grafting. Methods:A 23-year-old woman presented with macula-off retinal detachment in the left eye caused by a large peripapillary break associated with a congenital optic disc anomaly. Initial pars plana vitrectomy with cryopreserved amniotic membrane grafting and silicone oil tamponade resulted in temporary reattachment. However, progressive shrinkage of two sequential amniotic membrane grafts led to recurrent retinal detachment complicated by proliferative vitreoretinopathy. Definitive repair was achieved through repeat vitrectomy, scleral buckling, removal of the residual amniotic membrane, and placement of a free autologous Tenon's capsule graft under perfluorocarbon liquid, followed by fluid-air exchange and 20% sulfur hexafluoride gas endotamponade. Results:The postoperative course was uncomplicated. The retina remained fully attached throughout the 6-month follow-up period, with the Tenon's capsule graft maintaining a stable position over the defect. Best-corrected visual acuity improved to 20/50 at the final visit. Conclusion:Autologous Tenon's capsule grafting may be a useful adjunct in selected cases of recurrent retinal detachment associated with cavitary optic disc anomalies after failed amniotic membrane grafting.
Purpose:To determine the disease prevalence rate and clinical characteristics of central retinal vein occlusion (CRVO) among new patients before and after the declaration of a state of emergency due to coronavirus disease 2019 on April 7, 2020, in Japan. Methods:New patients and patients with newly diagnosed CRVO were categorized into "Before" and "After" groups based on the initial visit. The prevalence rate, sex ratio, and age of patients newly diagnosed with CRVO were compared between the groups. The prevalence rate of patients newly diagnosed with rhegmatogenous retinal detachment (RRD) and pseudoexfoliation glaucoma (PEX) was also examined in the before and after groups. The best-corrected visual acuity (BCVA) at the initial visit, retinal photocoagulation, and BCVA after treatment were compared among 232 eyes observed in 12 ± 2 months after treatment. Results:No significant differences in prevalence rates of CRVO among newly diagnosed patients (P = 0.232), patients with RRD (P = 0.560), or patients with PEX (P = 0.972) were observed in both groups. No significant differences in sex ratio and age were observed in both groups. Although BCVA at the initial visit (P = 0.142) and after treatment (P = 0.155) showed no significant differences, retinal photocoagulation (P < 0.01) significantly increased in the after group. Conclusion:Although the coronavirus disease 2019 pandemic did not affect the prevalence of CRVO among new patients compared with that of RRD and PEX, it may be associated with a greater need for retinal photocoagulation, suggesting changes in disease severity.
Purpose:To compare choroidal vascular index (CVI) measurements obtained using manual ImageJ-based Niblack thresholding and protocol-standardized Otsu thresholding in patients with pachychoroid pigment epitheliopathy (PPE), employing a full-length choroidal region of interest (ROI) approach. Methods:This retrospective observational study included 30 eyes of 30 patients diagnosed with PPE. Enhanced depth imaging-optical coherence tomography (EDI-OCT) scans were acquired using Heidelberg Spectralis. Both horizontal and vertical fovea-centered B-scans were analyzed. The ROI was manually delineated on the OCT device using the polygon selection tool to include the entire visible choroid from the retinal pigment epithelium/Bruch's membrane complex to the choroidoscleral junction across the full scan width. CVI was calculated as the ratio of luminal area-to-total choroidal area. Manual ImageJ-based Niblack local thresholding was compared with protocol-standardized Otsu global thresholding using identical manually defined ROIs. Agreement was evaluated using paired t-tests, Pearson correlation, intraclass correlation coefficient (ICC), and Bland-Altman analysis. Results:A total of 60 OCT B-scans were analyzed. Mean CVI values were 0.615 ± 0.030 for ImageJ-Niblack and 0.626 ± 0.052 for Otsu thresholding. The mean intermethod difference was +0.011 ± 0.028, with no statistically significant difference between methods (P = 0.085). A strong linear association was observed (r = 0.90, P < 0.001), and ICC (2,1) demonstrated good agreement (0.76). Bland-Altman analysis showed a small mean bias (+0.012) with 95% limits of agreement from -0.049 to +0.073. Because no external reference standard or prespecified clinical equivalence margin was available, the findings support methodological consistency rather than interchangeability or accuracy equivalence. Conclusions:Protocol-standardized Otsu thresholding yielded CVI measurements that were directionally consistent with manual ImageJ-based Niblack analysis in PPE when a full-length choroidal ROI strategy was applied. This approach may support standardized group-level research analyses, but it should not be interpreted as establishing accuracy equivalence or full clinical interchangeability.
Purpose:To describe the clinical progression of choroidal osteoma (CO) in seven eyes using multimodal imaging and to assess treatment outcomes. Methods:An observational case series. Results:Seven eyes were diagnosed with CO with lesions predominantly located in the macular region. Initial visual acuity ranged from 20/20 to 20/150, and most eyes exhibited choroidal neovascularization, including polypoidal choroidal vasculopathy in two cases. Antivascular endothelial growth factor (anti-VEGF) therapy was administered to 86% of the affected eyes, leading to visual acuity stabilization or improvement. One eye experienced choroidal neovascular recurrence. Final visual acuity ranged from 20/20 to counting fingers after a follow-up period of 2-10 years. Multimodal imaging approaches were tailored to clinical and healthcare system needs rather than applied uniformly across all cases; therefore, slight differences were observed in the types of imaging used for each case. Conclusions:COs can lead to vision-threatening complications, particularly choroidal neovascularization, which responds well to anti-VEGF therapy. Multimodal imaging is essential for accurate diagnosis and disease monitoring. Early recognition and long-term follow-up are crucial for optimizing visual outcomes.
Purpose:To systematically review and meta-analyze the outcomes of vitreoretinal surgery for X-linked retinoschisis (XLRS)-related complications. Methods:A systematic search of PubMed, Cochrane Library, CINAHL, Web of Science, and OVID was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Studies reporting surgical outcomes in patients with XLRS-associated retinal detachment or schisis were included. Primary outcomes were anatomic success (primary and final reattachment rates) and best-corrected visual acuity (BCVA). Random-effects meta-analysis was performed using RevMan. Subgroup analyses by surgical approach and age group were prespecified, and their feasibility was assessed according to the number of contributing studies. Results:Fourteen studies comprising over 200 eyes were included. The pooled primary reattachment rate was 0.73 (95% confidence interval [CI]: 0.46-0.99; I 2 = 83%), reflecting substantial heterogeneity across cohorts; formal subgroup analyses were not feasible given the small number of contributing studies. The pooled final reattachment rate was 0.89 (95% CI: 0.84-0.94; I 2 = 0%). Reoperation was frequently required, with rates of 20%-40% across series, predominantly due to proliferative vitreoretinopathy. Visual outcomes are reported narratively; approximately 50%-80% of eyes demonstrated BCVA improvement, although recovery was often limited by preexisting macular pathology, chronic disease, and amblyopia. Conclusions:Vitreoretinal surgery for XLRS-related complications can achieve favorable final anatomical outcomes in most cases, although multiple procedures are frequently required and visual recovery is variable and often modest. Anatomical success does not guarantee functional recovery, underscoring the importance of realistic prognostic counseling. These findings should be interpreted with caution, given that all included studies are small, observational case series with significant clinical heterogeneity. Standardized, prospective, multicenter studies are needed to optimize surgical strategies in this population.
Purpose:To report the clinical outcomes of patients who experienced scleral rupture following cryoretinopexy and to highlight potential risk factors, management strategies, and prognosis. Methods:This retrospective case series includes patients who developed scleral rupture during cryoretinopexy for symptomatic retinal tear(s) across multiple ophthalmology units in the United Kingdom and internationally, between September 2003 and May 2025. Data collected included patient demographics, medical and ocular history, clinical examination findings, surgical management, and postoperative outcomes. Results:Four cases of scleral perforation were included in this series. The median age was 61 years, with an equal distribution of males and females. All patients underwent scleral repair and pars plana vitrectomy (PPV) with silicone oil tamponade. Three patients achieved a final visual acuity of at least 20/25, while one patient had a final visual acuity of 20/200. None of the cases had a history of systemic disorders, while myopia was noted in three patients. Conclusions:Immediate scleral rupture repair combined with PPV and silicone oil tamponade is the preferred management approach and is associated with favorable postoperative outcomes. Comprehensive patient counseling and informed consent are crucial when planning cryoretinopexy.
Purpose: To ascertain the effect of Ramadan fasting on the anterior segment. Fasting can affect anterior segment parameters because of altered hydration and metabolism. Methods: We searched online databases such as PubMed, Cochrane Library, Web of Science, Scopus, Embase, and Google Scholar for relevant records by suitable keywords. Overall, 21 eligible articles were included for the final assessment. Outcomes included types of fasting, tear film, corneal biomechanics, anterior chamber parameters, refraction, and visual acuity. Results: All 21 articles were conducted after Ramadan fasting. The outcomes revealed that tear breakup time (TBUT) diminished and basal tear secretion (BTS) decreased. Predawn fluid intake temporarily improved tear production. A study revealed that ocular surface disease index (OSDI) scores degraded. Increases in tear osmolarity and inflammatory markers were reported. Transient corneal steepening and reduced corneal hysteresis suggested dehydration effects, while advanced imaging revealed posterior curvature changes. Furthermore, inconsistent results included diminished or augmented anterior chamber depth. No significant changes were reported in refraction or visual acuity. Conclusions: The results indicated that fasting could alter various ocular structures and functions in the eye. Fasting could change the ocular surface condition, especially during the hotter seasons and longer fasting periods, along with lower parameters such as TBUT, BTS, and result in higher ocular discomfort, as measured by indices such as the OSDI scores. In addition, although the refraction and visual acuity seem to be stable along the fasting period, fasting could alter keratometric values and intraocular lens calculation, leading to suboptimal refractive results after surgeries.
Purpose:To evaluate the use of topical tacrolimus as an adjunct therapy to corticosteroids in preventing graft rejection in high-risk penetrating keratoplasty (PKP). Methods:A comprehensive search was conducted through PubMed®, EMBASE®, Cochrane Central Register of Controlled Trials, and Google Scholar® databases from 2000 to 2023. Eligible studies included meta-analysis, systematic review, clinical trial, and case presentations that compared graft rejection rates in high-risk PKP patients treated with corticosteroid versus corticosteroid plus tacrolimus. Studies with a control group using noncorticosteroid therapy were excluded from the study. The study selection process followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using Cochrane Risk of Bias 2.0 (RoB 2.0), Newcastle-Ottawa Scale, and RoB for Nonrandomized Intervention Studies. Results:Five studies comprising 298 eyes were included in the study. Rejection rates were found significantly lower in the tacrolimus group (RR: 0.63; 95% confidence interval [CI]: 0.46-0.88; P = 0.006). Tacrolimus also significantly reduced irreversible rejection (RR: 0.50; 95% CI: 0.27-0.93; P = 0.03) and improved visual acuity (RR: 1.45; 95% CI: 1.08-1.93; P = 0.01). Conclusions:Tacrolimus successfully reduces the rejection rate and irreversible rejection in high-risk PKP patients. Improved visual acuity was observed. There were no significant side effects; however, further studies are still needed to achieve more quantitative results, like recommended concentrations.
Purpose:To provide insights for targeted public health interventions and future research. This review synthesizes recent evidence on the causes of childhood blindness in Indian schools for the visually impaired, highlighting emerging trends, regional disparities, and the role of socioeconomic and genetic factors. Methods:A structured literature review of studies published from 2009 to 2023 was conducted across PubMed, Scopus, and IndMed. The review followed systematic literature search and study selection principles, with methodology aligned to Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines where applicable. Eleven cross-sectional and observational studies conducted in blind schools across India were included, all employing World Health Organization/International Classification of Diseases criteria for classifying childhood blindness and severe visual impairment. Data on sample size, demographics, and anatomical/etiological causes of blindness were systematically extracted and compared. Results:Across the included studies (a total of 3051 children), the proportion of preventable blindness has declined, whereas genetic and congenital causes have risen. Whole globe anomalies (22%-40%) are most common in socioeconomically disadvantaged regions, whereas optic nerve disorders (18%-24%) and retinal dystrophies (14%-19%) predominate in areas with high consanguinity. Corneal scarring has decreased to 8%-26% due to public health programs, but lens pathologies (up to 30%) and untreated refractive errors (9%-17%) remain significant. Retinopathy of prematurity accounts for up to 15% of cases in urban Maharashtra. Conclusions:Childhood blindness in India is shifting from preventable to genetic and congenital causes, with clear regional patterns influenced by socioeconomic and cultural factors. Strengthening region-specific screening, genetic counseling, and early intervention programs is essential to further reduce the burden and meet VISION 2020 targets.
