ABSTRACT Background Blepharoptosis is among the most common disorders of eyelid malposition that may influence appearance and damage visual function, and both of these can have negative effects on the quality of life. Various types of blepharoptosis have been reported, including neurogenic, traumatic, congenital, mechanical, psychogenic, and myogenic, while about 15%–25% remain uncertain. Method To determine the targets for preventing blepharoptosis and its associated disease burden, we employed a two‐sample Mendelian randomization approach to explore the causal relationships between reported potential risk factors and lifestyle behaviors and blepharoptosis. We chose genetic variants ( p < 5 × 10 −8 ) related to prediabetic status, obesity parameters, smoking, alcohol and coffee consumption, hypertension, education level, physical activity, and sleep duration from European‐descent genome‐wide association studies. The genetic associations with blepharoptosis were derived from the FinnGen Study, included 1349 cases and 203,231 controls. Inverse‐variance weighted was mainly used for statistical analyses. Results Genetically predicted leisure screen time (odds ratio per 1 standard deviation [95% confidence interval], 1.79 [1.23–2.60]) was associated with higher odds of blepharoptosis. There is indicative evidence that a higher body mass index (BMI) and current smoking are associated with higher blepharoptosis odds, whereas physical activity and smoking cessation are associated with lower blepharoptosis odds. No association with other genetically predicted factors was observed. Conclusion The Mendelian randomization study identified current smoking status and BMI as causal risk factors, and smoking cessation as protective factor for blepharoptosis. This suggests that these modifiable risk factors are crucial targets for preventing blepharoptosis.
ABSTRACT Artificial intelligence (AI) is increasingly reshaping ophthalmology because the specialty depends heavily on structured imaging, quantitative measurements, and repeatable diagnostic workflows. This review provides a clinically grounded and translationally oriented synthesis of AI in ophthalmology, covering methodological foundations, ophthalmic imaging modalities, public datasets, disease‐specific applications, evaluation metrics, deployment barriers, and future directions. Unlike reviews that mainly summarize algorithmic performance by disease category or model type, this article organizes ophthalmic AI through an integrated framework that emphasizes clinical use cases, evidence maturity, translational readiness, and real‐world implementation requirements. The review examines applications across population screening, referral triage, disease grading, progression monitoring, prognosis, treatment guidance, workflow support, and automated reporting. Major disease domains include diabetic retinopathy, glaucoma, age‐related macular degeneration, cataract, infectious keratitis, and keratoconus. Particular attention is given to the distinction between retrospective proof‐of‐concept studies, external validation, multicenter evaluation, prospective trials, and real‐world deployment. The review also interprets evaluation metrics from a clinical perspective, highlighting the importance of threshold selection, sensitivity, specificity, false referral burden, missed disease, calibration, uncertainty, segmentation adequacy, robustness, and generalization. Key translational challenges include dataset bias, domain shift, interpretability, privacy, regulatory oversight, infrastructure constraints, workflow integration, and post‐deployment monitoring. Emerging paradigms such as multimodal AI, foundation models, generative AI, and edge‐based point‐of‐care systems are discussed cautiously, with emphasis on hallucination risk, clinical grounding, accountability, and the gap between benchmark performance and deployment readiness. Overall, the review argues that the next phase of ophthalmic AI should move beyond high accuracy values toward prospective validation, external generalization, clinician‐centered design, calibrated uncertainty, and accountable integration into real‐world eye‐care pathways.
ABSTRACT Background Keratoconus is a progressive corneal ectatic disorder. Accelerated transepithelial corneal cross‐linking (ATE‐CXL) aims to halt progression while preserving the epithelium, but evidence on its 12‐month efficacy requires further evaluation. Purpose To evaluate the 12‐month topographic, visual, biomechanical, and safety outcomes of ATE‐CXL in eyes with progressive keratoconus. Method This prospective interventional study included 126 eyes from 63 patients with documented progressive keratoconus. Both eyes of each patient were included when the eligibility criteria were met. Progression before treatment was defined as at least one of the following during the preceding 12 months: an increase in maximum keratometry (Kmax) of ≥ 1.0 diopter (D), a decrease in minimum corneal thickness of > 10 μm, or a loss of more than two lines of corrected distance visual acuity (CDVA). All eyes underwent epithelium‐on ATE‐CXL using a two‐step transepithelial riboflavin protocol followed by pulsed ultraviolet‐A irradiation at 45 mW/cm2 for 320 s, delivering 7.2 J/cm2. Outcomes included Kmax, flat keratometry (K1), steep keratometry (K2), uncorrected distance visual acuity (UDVA), CDVA, corneal hysteresis (CH), corneal resistance factor (CRF), central corneal thickness (CCT), progression, and adverse events. Outcomes were summarized descriptively using aggregate values. Results Kmax decreased from 52.3 ± 1.8 D at baseline to 49.7 ± 1.5 D at 12 months. CDVA improved from 0.35 ± 0.10 logMAR to 0.20 ± 0.08 logMAR, and UDVA improved by 30.9% from baseline. CH increased from 8.4 ± 1.0 mmHg to 9.1 ± 1.2 mmHg, and CRF increased from 8.0 ± 1.1 mmHg to 8.8 ± 1.3 mmHg. Disease progression, defined as Kmax increase ≥ 1.0 D at 12 months, occurred in 8 of 126 eyes (6.3%). Accordingly, 118 of 126 eyes (93.7%) remained stable by the prespecified Kmax criterion. No severe adverse events were documented. Conclusion ATE‐CXL was associated with 12‐month improvements in corneal topography, visual acuity, and ocular‐response‐analyzer biomechanical parameters in this prospective cohort of eyes with progressive keratoconus. These findings should be interpreted cautiously because the study lacked an epithelium‐off or untreated control group, had only 12 months of follow‐up, and included both eyes from each patient. Longer‐term controlled studies with paired‐eye‐adjusted statistical analysis are needed to confirm durability and comparative efficacy.
ABSTRACT Myopia is an increasingly prevalent public health concern in India, particularly among school‐aged children in urban and academically demanding environments. Early‐onset myopia is associated with rapid progression and an increased lifetime risk of vision‐threatening complications such as retinal detachment, myopic maculopathy, glaucoma, and early cataract. Low‐dose atropine has emerged as an effective pharmacological intervention for controlling myopia progression; however, the applicability of global evidence to Indian pediatric populations requires careful evaluation. This structured narrative review synthesized evidence from randomized controlled trials, prospective studies, retrospective multicentric cohorts, and real‐world clinical investigations evaluating low‐dose atropine (≤ 0.05%) for myopia control in Indian children. Literature searches were conducted in PubMed, Scopus, Web of Science, Google Scholar, and the Indian Journal of Ophthalmology archive for studies published between January 2005 and October 2025. Study quality was assessed using Joanna Briggs Institute critical appraisal tools, and findings were synthesized narratively due to heterogeneity in study designs and outcome measures. Indian studies consistently demonstrate that 0.01% atropine reduces myopia progression by approximately 50%–65% with minimal adverse effects. Higher concentrations such as 0.05% atropine provide greater efficacy but are associated with slightly increased mild ocular side effects. These findings align with major international trials, including Atropine for the Treatment of Myopia (ATOM) and Low‐Concentration Atropine for Myopia Progression (LAMP). Low‐dose atropine, particularly 0.01%, is an effective and safe therapy for controlling myopia progression in Indian children and represents a practical strategy for national myopia‐control programs.
ABSTRACT Background Recurrent epistaxis is a common pediatric condition that is typically managed with conservative therapies, but a subset of patients require surgical intervention after treatment failure. We seek to describe the efficacy of septal release for refractory pediatric epistaxis patients. Objective To compare outcomes of septal release for refractory epistaxis in pediatric patients with and without underlying bleeding disorders. Method A retrospective review was performed of 19 pediatric patients who underwent septal release for recurrent epistaxis from 2014 to 2024. We compared demographics, number of pre‐operative epistaxis episodes, pre‐operative treatments (ointments, nasal saline, chemical decongestants, chemical cauterizations), and post‐operative annual epistaxis episodes among patients with and without bleeding disorders. Bleeding disorders included von Willebrand disease, thalassemia, platelet dysfunction, and dysfibrinogenemia. Results Five patients had bleeding disorders; 14 did not. There was a significantly lower rate of epistaxis post‐septal release in patients without bleeding disorders (p = 0.016). Patients with bleeding disorders showed a decrease in episodes, though not statistically significant. Conclusion Septal release is an effective and safe treatment for refractory pediatric epistaxis, providing the most significant benefit to those without underlying coagulopathies.
ABSTRACT Human metapneumovirus (HMPV) is a respiratory virus that predominantly affects the pediatric population. Its role as an infective agent in ear, nose, and throat (ENT) diseases is not yet well understood. To systematically review the available literature on the association between HMPV and ENT manifestations, following PRISMA guidelines, a detailed search was conducted on PubMed/Medline from January 1, 2000 to May 25, 2025. Studies reporting ENT conditions associated with laboratory confirmed HMPV infection were included. Data were synthesized descriptively due to heterogeneity in study designs, populations, diagnostic methods, and reported outcomes, which precluded formal meta‐analysis. Twelve studies were included in the final analysis out of 1345 initially identified records. All percentages represent study‐level proportions unless otherwise specified. Quality assessment was performed using the Joanna Briggs Institute checklist and Newcastle‐Ottawa Scale. Twelve studies including a total of 2302 patients were identified, the majority of whom were pediatric (88.3%). The USA contributed half of the studies. Acute otitis media was reported in 50.0% of included studies, followed by upper respiratory tract infections in 25.0%. The most frequently used test to confirm infection was RT‐PCR (41.67% of studies). Antibiotic use was reported in all included studies (100.0% of studies), regardless of confirmed bacterial infection. Outcomes were inconsistently reported with 33.3% of studies lacking follow‐up data. This systematic review highlights a possible association between HMPV and ENT manifestations; however, due to limited and heterogeneous evidence, no causal relationship can be established, and further well‐designed studies are required.
ABSTRACT Background Bilateral congenital cataracts are a major cause of preventable childhood blindness. Although delayed sequential bilateral cataract surgery (DSBCS) has traditionally been the preferred approach, immediate sequential bilateral cataract surgery (ISBCS) is increasingly being considered to reduce anesthesia exposure and healthcare burden. Method We performed a systematic review and meta‐analysis on four studies involving 224 patients. A comprehensive literature search was conducted on PubMed, Embase, Cochrane Library, and ScienceDirect. Analysis was conducted on RevMan 5.4. Moreover, the risk of bias was assessed via RoB 2.0. The primary outcomes were operating room (OR) time, procedure time, anesthesia‐related complications, number of follow‐up visits, and incidence of postoperative glaucoma. Results ISBCS was associated with significantly shorter OR time compared with DSBCS (mean difference, −34.69 min; p < 0.001). There were no significant differences in procedure time or anesthesia‐related complications between groups. Postoperative glaucoma incidence was significantly lower in the ISBCS group (odds ratio, 0.34; p = 0.02). Follow‐up visit burden was comparable between the two approaches. Conclusion In pediatric patients with bilateral congenital cataracts, ISBCS was associated with reduced OR time and a lower risk of postoperative glaucoma without increasing intraoperative risks. These findings support the consideration of ISBCS as a safe and effective surgical option in appropriately selected pediatric cases. However, these results should be considered with caution due to heterogeneity and lack of prospective cohort studies and further research in this field is warranted.
ABSTRACT Background Hearing loss affects 1.5 billion people globally, with sensorineural hearing loss (SNHL) linked to hypertension. Hypertension affects 1.39 billion people worldwide and its prevalence is rising sharply in Sub‐Saharan Africa. While 12% of Tanzanian population has cardiovascular diseases, including hypertension and recent studies showed 28% of adults from the northern parts have hypertension. However, data on SNHL in this population are scarce. This study examines SNHL prevalence and associated factors among hypertensive adults in Northern Tanzania. Objective This study aims to determine the magnitude, patterns and factors associated with SNHL among hypertensive adults at a tertiary hospital in northern Tanzania. Methods This hospital‐based cross‐sectional study involved 201 hypertensive adults attending Kilimanjaro Christian Medical Center clinics from October 2023 to May 2024. Data on demographics, hypertension duration, cigarette smoking, alcohol use, ototoxic drug history, otoscopic findings, and SNHL by pure‐tone audiometry were collected. Analysis was done using SPSS version 26, with logistic regression assessing risk factors for SNHL. Results SNHL prevalence was 23.9%. Risk factors included female gender, prolonged hypertension, alcohol use, cigarette smoking, and ototoxic drug use. Conclusion SNHL, predominantly bilateral and mild, was common among hypertensive adults. Older age, female gender, long‐standing hypertension, alcohol use, cigarette smoking, and ototoxic drugs increased SNHL risk. Addressing modifiable risk factors may reduce SNHL prevalence.
ABSTRACT Malignant otitis externa (MOE), necrotizing otitis externa (NOE), or skull base osteomyelitis (SBO) is a severe ear infection, primarily caused by Pseudomonas aeruginosa with 5%–20% of cases due to fungal species. Fungal NOE affects immunocompromised patients. This study systematically reviews fungal NOE management, addressing: (1) when to suspect it and start treatment; (2) the most appropriate anti‐fungal; (3) treatment duration. We searched Medline, the Cochrane Library, PubMed, and Embase for English articles up to June 2024, supplemented by Google Scholar and manual reference checks. Using PRISMA, 516 articles were identified in which 387 were screened, 54 full texts reviewed, and 32 included after excluding duplicates and irrelevant studies. Fungal NOE is hard to diagnose. Suspect it with aggressive symptoms and sterile cultures unresponsive to antibiotics. Voriconazole is effective due to bone penetration. Treatment should be continued for > 12 weeks with multiple swabs, aural toileting, and thorough examinations.
ABSTRACT Background Laser‐assisted in situ keratomileusis (LASIK) and contact lenses are commonly used to correct refractive errors, but their effects on quality of life, patient satisfaction, and dry eye disease remain variable. This study compares these outcomes between LASIK and contact lens users. Objective This study aims to bridge the knowledge gaps by evaluating the effects of LASIK versus contact lenses on vision‐related quality of life, patient satisfaction, and dry eye disease. Methods Our protocol was registered prospectively on PROSPERO (CRD42025636623). A comprehensive literature search was conducted across four electronic databases (Web of Science, Scopus, PubMed, and the Cochrane Library) to find eligible articles. The primary outcome assessed was quality of life, while the secondary outcomes included the prevalence of dry eyes and patient satisfaction. A meta‐analysis was conducted using R Statistical Software (version 2024.04.2 Build 764) and the “meta” package (version 7.0‐0). The quality of the included studies was assessed using the Newcastle‐Ottawa Scale. Results Of 1806 initial records, four studies met the inclusion criteria, enrolling 2141 participants, and were included in our meta‐analysis. Meta‐analysis revealed moderate improvement in quality of life for LASIK users (standardized mean difference [SMD] = 0.45; p < 0.0001), while patient satisfaction was notably higher in the LASIK group (88% vs. 54% for contact lenses). Complication rates were lower in LASIK patients (6.7% vs. 19.9% for contact lenses), although LASIK was associated with a higher incidence of acute dry eye disease. Conclusion This meta‐analysis demonstrated that LASIK significantly enhances quality of life compared to contact lens use and yields markedly higher patient satisfaction. Moreover, LASIK was associated with lower overall complication rates, though it carried a greater risk of acute dry eye disease.
ABSTRACT Artificial intelligence holds promise for addressing the uneven distribution of medical resources across different regions. Compared with convolutional neural network models, foundation models offer significant advantages: on one hand, their pre‐training does not rely on massive labeled data; on the other hand, they possess the capability to fuse multimodal images with clinical metadata. This review systematically searched PubMed and IEEE databases to select five representative foundation models for ophthalmology. We focus on analyzing their core architectural design strategies and diagnostic performance, while summarizing technical approaches for enhancing generalization capabilities and explainability across different models. Foundation models typically employ masked autoencoders techniques for self‐supervised learning. This paradigm expands diagnostic coverage from common ophthalmic diseases to rare conditions and even systemic diseases. However, challenges persist: homogeneity in training data can lead to unstable performance, and more prospective trials are required to validate their efficacy in real clinical settings.
ABSTRACT Background Contact lenses (CLs) are increasingly used worldwide for refractive error correction because of their optical, cosmetic, and functional advantages over spectacles. However, although their safe and effective use depends on adequate knowledge and proper hygiene practices, there is limited evidence on contact lens‐related knowledge, attitudes, and practices among university students in Ghana. Objectives This study sought to assess the knowledge, attitudes, and practices related to CL wear among students in selected schools at the College of Health Sciences (CHS), University of Ghana. Method A cross‐sectional study among CHS students on the Korle Bu campus, University of Ghana, from April 21 to May 19, 2023. The sociodemographic characteristics (age, sex, and education) of the participants were documented using a predesigned questionnaire. Descriptive and inferential statistics were performed on the data using SPSS version 26. p‐values < 0.05 were considered statistically significant. Results Data from 236 students were analyzed, with the majority (83.1%, 196) aged 18–24 years. Females made up 58.9% (139). The highest education level among participants was a university degree (171, 72.5%). A significant relationship was found between education level and overall acceptability of CLs (p = 0.007). Although 231 (97.9%) participants knew about CLs, only 5 (2.7%) actually used them. Overall understanding of proper contact lens care and usage was 26.8% (64). Spectacle wearers mainly hesitated to switch to CLs due to concerns about maintenance. Conclusion The overall knowledge of the proper care and usage of CLs was low (26.8%), and the prevalence in the study population was low (2.7%). Most individuals who wear glasses are reluctant to use CLs, mainly due to the extensive maintenance they require.
ABSTRACT Background Specific facial changes are known to occur in microgravity. A higher lower eyelid position has been observed during short‐term microgravity but has not been analyzed in astronauts during spaceflight. Purpose To describe the effect of spaceflight on lower eyelid position. Method Images of astronauts captured on Earth and in space were collected from the National Aeronautics and Space Administration online image library. For each astronaut, at least 6 front‐facing portraits (at least 3 captured on Earth and at least 3 in space) were selected. Measurements from the center of the pupil to the lower eyelid margin (margin reflex distance 2 [MRD2]) were determined digitally for each image and compared between Earth and space images using a Wilcoxon signed‐rank test. Additionally, per‐astronaut pooled mean values were descriptively compared with reference values from parabolic flight. Results 115 photographs (52 Earth, 63 space) from 13 astronauts (12 men, 1 woman; mean age 46 ± 7 years, range 35–60) were retrieved from the database. Microgravity induced a mean MRD2 decrease of 1.0 mm (p < 0.001). Conclusion Spaceflight led to a significant decrease in MRD2. These findings are comparable to those obtained from short‐term microgravity experiments on parabolic flights. Further studies implementing standardized imaging techniques are needed to uncover the mechanism and health implications.
ABSTRACT Background Thyroid‐associated ophthalmopathy (TAO) may lead to severe exophthalmos and dysthyroid optic neuropathy (DON), which can threaten visual function. Orbital decompression surgery is often required when medical therapy is insufficient; however, traditional deep lateral wall decompression techniques remain associated with several complications. Objective To evaluate the clinical efficacy and safety of modified deep lateral wall decompression surgery in patients with TAO and DON. Method This retrospective single‐arm study included sixteen patients who underwent modified deep lateral wall decompression at the Third Affiliated Hospital of Sun Yat‐sen University between January 2022 and May 2023, with a 3‐month postoperative follow‐up. Postoperative assessments included visual acuity, intraocular pressure, exophthalmos, ocular motility, diplopia, and complications. Results At 3 months postoperatively, patients showed significant improvement in visual acuity, exophthalmos, and intraocular pressure (p < 0.001). The remission rate of postoperative limited ocular motility symptoms was 60% (n = 10). Among the twelve patients with preoperative diplopia, 6 showed improvement in symptoms. No cases of cerebrospinal fluid (CSF) leakage or vibration‐induced diplopia occurred, and only one patient experienced temporary periorbital skin numbness, which resolved by 3 months. Conclusion The modified deep lateral wall decompression surgery shows promise as a potentially safer and effective treatment option for patients with TAO and DON, demonstrating improvements in vision, exophthalmos, and intraocular pressure with a low incidence of complications. However, these preliminary results warrant further validation in prospective or comparative controlled trials.
