Introduction: A cyclodialysis cleft, a rare complication of ocular trauma, is characterised by the separation of the ciliary body from the scleral spur. This abnormal communication between the anterior chamber and the suprachoroidal space leads to ocular hypotony and visual impairment. While many cases respond to conservative management, persistent hypotony may require surgery. Direct cyclopexy effectively treats persistent cases when conservative methods fail. Patient presentation: A 20-year-old man presented 5 days after blunt trauma to the right eye with light perception vision, grade 2 hyphaema, afferent pupillary defect, and intraocular pressure (IOP) of 15 mmHg; the left eye was unremarkable. After 1 week of medical management, vision improved to hand motions and hyphaema improved, but IOP fell to 7 mmHg. Three weeks later, with IOP 6 mmHg, subluxated lens and vitreous haemorrhage, he underwent pars plana vitrectomy and lensectomy. Persistent hypotony (IOP ≈ 3 mmHg) and hypotony maculopathy developed. Management and outcome: Gonioscopy confirmed a traumatic cyclodialysis cleft spanning two clock hours. After 6 weeks of unsuccessful cycloplegia and topical steroids, direct cyclopexy was performed 3 months after trauma. A transient postoperative IOP spike to 58 mmHg was controlled medically. Moreover, IOP stabilised at 12–16 mmHg on topical medication, hypotony maculopathy resolved and final best-corrected acuity was counting fingers, limited by macular atrophy. Conclusion: Direct cyclopexy offers a safe, effective and durable surgical solution when conservative management fails, particularly in young patients with visually significant hypotony. Contribution: This case highlights the importance of considering cyclodialysis cleft in patients with persistent hypotony after ocular trauma and shows that timely direct cyclopexy can lead to successful anatomical and functional outcomes.
Background: Driving is a visually demanding task, and in South Africa, gaps in driver licensing policies, particularly the limited integration of optometrists, Driver Licensing Testing Centres, and systematic visual assessments, persist despite clear evidence linking vision and road safety. Aim: This study aimed to develop an evidence-based framework to strengthen South Africa’s vision screening standards for driving, integrating clinical, regulatory, and public health perspectives through empirical research and policy analysis. Method: A mixed-methods approach was used, comprising a systematic review and meta-analysis, stakeholder interviews with policy analysis, a quantitative study on visual function and road traffic accidents, and an online survey of optometrists’ practices. Findings were synthesised through thematic analysis and methodological triangulation to identify gaps and develop an integrated framework for strengthening vision screening in South Africa’s driver licensing system. Results: The resulting framework comprises five strategic pillars: (1) expanded screening criteria, (2) policy alignment, (3) stakeholder engagement, (4) infrastructure and technology enhancement, and (5) public awareness, underpinned by continuous monitoring and evaluation to ensure national scalability. It supports standardised, evidence-based vision screening, advancing early detection of visual impairments and contributing to South Africa’s road safety goals. Conclusion: The proposed framework enhances the relevance and consistency of vision screening for drivers by standardising protocols, addressing systemic and clinical gaps, and introducing evidence-based assessments aligned with licensing regulations to better capture visual functions critical to driving performance. Contribution: This study provides a strategic foundation for national policy and legislative reform, enabling scalable adoption of standardised, evidence-based vision screening programmes, strengthening driver fitness assessment, and enhancing road safety in South Africa.
Background: Exposure to light has been identified as an important factor in the control of eye growth and the development of refractive error. Aim: The aim of this article is to examine the short-term impact of natural daylight exposure on choroidal thickness (ChT). Setting: The study was conducted at Qassim University, Saudi Arabia. Methods: In this prospective study, 60 healthy emmetropic adults aged 19 years – 26 years completed comprehensive eye examinations. Choroidal thickness was measured using Swept-Source Optical Coherence Tomography with radial scans across macular regions. Two experimental sessions were conducted under indoor illumination (200 lux) and another involving 1 h of outdoor daylight exposure (~20 060 lux). Baseline indoor Optical Coherence Tomography scans were collected, followed by post-exposure scans obtained after 1 h of either indoor or outdoor light conditions. General linear model-repeated measure was used to examine ChT changes across light conditions and macular regions. Results: Across all macular regions, no statistically significant differences were found between baseline and post-exposure measurements (all p > 0.05), except in the inner temporal macular region (p = 0.046). Baseline subfoveal ChT was similar between sessions (297 μm ± 69 μm indoors; 298 μm ± 67 μm outdoors), with no changes after 1 h in both light conditions. Conclusion: The results showed that natural daylight exposure for 1 h produced no measurable changes in ChT under the conditions of this study, with all variations considered within normal diurnal fluctuations. Future research should consider factors that influence ocular responses, including diurnal variations in ChT and the characterisation of choroidal responses to light exposure. Contribution: This study provides evidence that the human choroid shows limited short-term responsiveness to light exposure, with all variations considered within normal diurnal fluctuations.
Background: Effective communication is a core component of quality healthcare, influencing patient satisfaction, treatment adherence and health outcomes. The global shift toward patient-centred care, health equity and interprofessional collaboration has further elevated communication as a critical skill. However, in optometry education, formal structured communication training remains limited. Aim: This narrative review synthesis the existing literature to support the development of an evidence-based, standardised framework that promotes communication competence among undergraduate optometry students across diverse clinical contexts. Method: A comprehensive search was conducted across multiple databases, including MEDLINE, Academic Search Ultimate, CINAHL with Full Text and Scopus. A keyword-based search strategy employed Boolean operators and truncation (e.g., communicat*, undergrad*, optom*, train*) to capture variations in terminology across disciplines. The search covered the period from 1 January 2014 to 31 December 2024. Results: In total, 1053 records were retrieved and 412 duplicates removed. The remaining 641 titles and abstracts were screened, with 30 studies meeting the full-text inclusion criteria. Conclusion: The review highlights that structured communication skills training, particularly when supported by feedback, simulation interactions and reflective learning, can enhance clinical preparedness and professional confidence. However, the effectiveness of these interventions is influenced by factors such as student characteristics, resources and learning objectives. Contribution: Although several strategies show promise, there remains a need for longitudinal research to assess the long-term effects of communication skills training interventions. Establishing a structured, context-sensitive framework is essential to address current gaps and support optometry students in developing the communication skills required for effective, patient-centred practice.
Background: Dry eye disease (DED) is a common, yet largely underdiagnosed, disorder of the eye encountered in healthcare facilities. It disrupts the tear film, causing ocular discomfort symptoms such as itching, tearing and irritation. Aim: This study aimed to determine the clinical profile of DED patients at a tertiary eye hospital to inform a public sector intervention strategy. Setting: The study was conducted at McCord Provincial Eye Hospital (MPEH). Methods: A quantitative, descriptive study design was undertaken and included 602 patients. The standardised patient evaluation of eye dryness (SPEED) questionnaire was administered, after which the tear break-up time (TBUT), Schirmer 2, blink rate, tear meniscus height (TMH) and meibography clinical tests were done. Data were managed using Statistical Package for Social Sciences (SPSS) version 28.0. Results: The prevalence of DED was 83.2%, with the majority being in the age group 41 years – 55 years (mean = 48.54 ± 18.76) and female (84.1%). The disease increased significantly with age (p = 0.02) and the prevalence of aqueous deficient, evaporative and mixed DED was 3.2%, 62.7% and 34.1%, respectively. Irrespective of the associated risk factors, the majority had either moderate (45.3%) or severe (30.9%) DED, with those with a history of glaucoma, hypertension and post-cataract surgery mostly having severe DED (p 0.001). Conclusion: Noting the chronic discomfort and other complications of DED, the high prevalence found among public sector hospital patients warrants a strategic intervention. Interventions could include a DED management protocol with clinical guidelines for interventions from primary to tertiary levels of care. Further, as most older patients presented with systemic diseases such as diabetes and hypertension, DED clinical guidelines should be extended to multidisciplinary teams managing systemic diseases. Contribution: In addition to contributing to the scholarship of DED, the study provides empirical data to assist the provincial hospital and its eleven catchment district facilities in developing a comprehensive DED management strategy. Although conducted in the eThekwini District, the guideline has generic features which may be applied to health districts throughout the province of KwaZulu-Natal.
