Medical hypothesis discovery and innovation in ophthalmology <p>Founded in 2012, “<a href=",_Discovery_%26_Innovation_in_Ophthalmology_Journal"><strong>Medical hypothesis discovery and innovation in ophthalmology</strong></a>” (indexed in <a href=";size=200&amp;term=%22Med+Hypothesis+Discov+Innov+Ophthalmol%22%5Bjour%5D&amp;sort_order=desc"><strong>PubMed</strong></a> and <a href=""><strong>Scopus</strong></a>), is an international, open-access, peer-reviewed (double-blind), quarterly journal that considers publications related to ophthalmology. The aim of this journal is to present a scientific medium of communication for researchers in the field of ophthalmology. The journal is of interest to a broad audience of visual scientists and publishes original articles, reviews, case reports, and commentaries. The Journal is affiliated with and published by the "<strong><a href="">International Virtual Ophthalmic Research Center</a>"</strong> (Registration File Number 803630055).</p> <p><a href=",_Discovery_%26_Innovation_in_Ophthalmology"><strong>Journal Link in Wikipedia</strong></a></p> <p><a href=""><strong>Journal Link in PubMed</strong></a></p> <p><a href=""><strong>Journal Link in Scopus</strong></a></p> <p><strong>Submission to first decision:</strong> 27 days</p> <p><strong>Acceptance to online publications:</strong> 49 days</p> <p><strong>Downloads:</strong> 99,850 (2023)</p> <p><a href=";hl=en"><strong>Citation Analysis at Scholar Google</strong></a></p> <p><a href=""><strong>ISSN portal</strong></a></p> <p><a href=""><strong>Citation Analysis in "Dimensions"</strong></a></p> en-US <p>Authors who publish with us agree to the following terms: Authors retain copyright and grant Journal the exclusive license and right of first publication with the work simultaneously licensed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (<a href="" target="_blank"></a>) which permits copy and redistributing the material just in noncommercial usages, provided the original work is properly cited.</p> (Editorial Office) (Editorial Office) Mon, 01 Jul 2024 16:59:57 +0330 OJS 60 Visual, ocular surface, and extraocular diagnostic criteria for determining the prevalence of computer vision syndrome: a cross-sectional smart-survey-based study <p><strong>Background: </strong>The American Optometric Association defines computer vision syndrome (CVS), also known as digital eye strain, as “a group of eye- and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use”. We aimed to create a well-structured, valid, and reliable questionnaire to determine the prevalence of CVS, and to analyze the visual, ocular surface, and extraocular sequelae of CVS using a novel and smart self-assessment questionnaire.</p> <p>&nbsp;</p> <p><strong>Methods: </strong>This multicenter, observational, cross-sectional, descriptive, survey-based, online study included 6853 complete online responses of medical students from 15 universities. All participants responded to the updated, online, fourth version of the CVS questionnaire (CVS-F4), which has high validity and reliability. CVS was diagnosed according to five basic diagnostic criteria (5DC) derived from the CVS-F4. Respondents who fulfilled the 5DC were considered CVS cases. The 5DC were then converted into a novel five-question self-assessment questionnaire designated as the CVS-Smart.</p> <p>&nbsp;</p> <p><strong>Results:</strong> Of 10000 invited medical students, 8006 responded to the CVS-F4 survey (80% response rate), while 6853 of the 8006 respondents provided complete online responses (85.6% completion rate). The overall CVS prevalence was 58.78% (n = 4028) among the study respondents; CVS prevalence was higher among women (65.87%) than among men (48.06%). Within the CVS group, the most common visual, ocular surface, and extraocular complaints were eye strain, dry eye, and neck/shoulder/back pain in 74.50% (n = 3001), 58.27% (n = 2347), and 80.52% (n = 3244) of CVS cases, respectively. Notably, 75.92% (3058/4028) of CVS cases were involved in the Mandated Computer System Use Program. Multivariate logistic regression analysis revealed that the two most statistically significant diagnostic criteria of the 5DC were greater than or equal to 2 symptoms/attacks per month over the last 12 months (odds ratio [OR] = 204177.2; <em>P</em> &lt;0.0001) and symptoms/attacks associated with screen use (OR = 16047.34; <em>P</em> &lt;0.0001). The CVS-Smart demonstrated a Cronbach’s alpha reliability coefficient of 0.860, Guttman split-half coefficient of 0.805, with perfect content and construct validity. A CVS-Smart score of 7–10 points indicated the presence of CVS.</p> <p>&nbsp;</p> <p><strong>Conclusions: </strong>The visual, ocular surface, and extraocular diagnostic criteria for CVS constituted the basic components of CVS-Smart. CVS-Smart is a novel, valid, reliable, subjective instrument for determining CVS diagnosis and prevalence and may provide a tool for rapid periodic assessment and prognostication. Individuals with positive CVS-Smart results should consider modifying their lifestyles and screen styles and seeking the help of ophthalmologists and/or optometrists. Higher institutional authorities should consider revising the Mandated Computer System Use Program to avoid the long-term consequences of CVS among university students. Further research must compare CVS-Smart with other available metrics for CVS, such as the CVS questionnaire, to determine its test-retest reliability and to justify its widespread use.</p> Mohammed Iqbal, Ahmed Elmassry, Mervat Elgharieb, Omar Said, Ahmed Saeed, Tamer Ibrahim, Ahmed Kotb, Mahmoud Abdelhalim, Samir Shoughy, Akram Elgazzar, Hassan Shamselden, Abdallah Hammour, Mohammed Eid, Hosam Elzembely, Khaled Abdelaziz Copyright (c) Mon, 01 Jul 2024 00:00:00 +0330 Aflibercept or ranibizumab for diabetic macular edema <p><strong>Background:</strong> Vascular endothelial growth factor (VEGF) is the primary substance involved in retinal barrier breach. VEGF overexpression may cause diabetic macular edema (DME). Laser photocoagulation of the macula is the standard treatment for DME; however, recently, intravitreal anti-VEGF injections have surpassed laser treatment. Our aim was to evaluate the efficacy of intravitreal injections of aflibercept or ranibizumab for managing treatment-naive DME.</p> <p>&nbsp;</p> <p><strong>Methods: </strong>This single-center, retrospective, interventional, comparative study included eyes with visual impairment due to treatment-naive DME that underwent intravitreal injection of either aflibercept 2 mg/0.05 mL or ranibizumab 0.5 mg/0.05 mL at Al-Azhar University Hospitals, Egypt between March 2023 and January 2024. Demographic data and full ophthalmological examination results at baseline and 1, 3, and 6 months post-injection were collected, including the best-corrected distance visual acuity (BCDVA) in logarithm of the minimum angle of resolution (logMAR) notation, slit-lamp biomicroscopy, dilated fundoscopy, and central subfield thickness (CST) measured using spectral-domain optical coherence tomography.</p> <p>&nbsp;</p> <p><strong>Results: </strong>Overall, the 96 eyes of 96 patients with a median (interquartile range [IQR]) age of 57 (10) (range: 20–74) years and a male-to-female ratio of 1:2.7 were allocated to one of two groups with comparable age, sex, diabetes mellitus duration, and presence of other comorbidities (all <em>P</em> &gt;0.05). There was no statistically significant difference in baseline diabetic retinopathy status or DME type between groups (both <em>P</em> &gt;0.05). In both groups, the median (IQR) BCDVA significantly improved from 0.7 (0.8) logMAR at baseline to 0.4 (0.1) logMAR at 6 months post-injection (both <em>P</em> = 0.001), with no statistically significant difference between groups at all follow-up visits (all <em>P </em>&gt;0.05). The median (IQR) CST significantly decreased in the aflibercept group from 347 (166) µm at baseline to 180 (233) µm at 6 months post-injection, and it decreased in the ranibizumab group from 360 (180) µm at baseline to 190 (224) µm at 6 months post-injection (both <em>P</em> = 0.001), with no statistically significant differences between groups at all follow-up visits (all <em>P</em> &gt;0.05). No serious adverse effects were documented in either group.</p> <p>&nbsp;</p> <p><strong>Conclusions: </strong>Ranibizumab and aflibercept were equally effective in achieving the desired anatomical and functional results in patients with treatment-naive DME in short-term follow-up without significant differences in injection counts between both drugs. Larger prospective, randomized, double-blinded trials with longer follow-up periods are needed to confirm our preliminary results.<strong>&nbsp;</strong></p> Mahmoud Abdelhalim Ali Ali, Hanan Saied Hegazy, Mohammed Othman Abdelkhalek Elsayed, Ehab Tharwat, Mona Nabeh Mansour, Mohamed Hassanein, Ezzeldin Ramadan Ezzeldin, Ashraf Mohammed GadElkareem, Essam Mahmoud Abd Ellateef, Ahmed A. Elsayed, Ibrahim Hassan Elabd, Mahmoud H Abd Rbu, Ramy Saleh Amer, Abdel Ghany Ali El Gabbar, Hatem Mahmoud, Hazem Mohamed Abdelhameed, Amr Mohammed Elsayed Abdelkader Copyright (c) Mon, 01 Jul 2024 00:00:00 +0330 Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus <p><strong>Background:</strong> Intrastromal corneal ring segments are commonly implanted in the corneas of eyes with mild-to-moderate keratoconus; however, changes in corneal densitometry (CD) after implantation are a matter of debate in the current literature. We evaluated the changes in CD 1 and 3 months after femtosecond laser-assisted Keraring implantation.</p> <p>&nbsp;</p> <p><strong>Methods:</strong> This retrospective, non-comparative, multicenter, case series study included patients with keratoconus who underwent femtosecond laser-assisted implantation of double segments with 90° and 160° arc lengths or two 160° arc length Keraring segments. Demographic and baseline clinical ophthalmic data were recorded. Corneal topography and tomography data acquired using a Pentacam HR Scheimpflug tomography system (Pentacam High Resolution; Oculus, Wetzlar, Germany) with a best-fit sphere were used as a reference surface. Using the Pentacam HR, CD measurements were acquired over a corneal area of 12 mm in total and at four concentric zones (0–2, 2–6, 6–10, and 10–12 mm) of three corneal stromal depths: 120 micrometers of the anterior corneal stromal layer, 60 micrometers of the posterior corneal stromal layer, and the central layer of stroma lying between these two layers.</p> <p>&nbsp;</p> <p><strong>Results:</strong> We included 40 eyes of 40 patients, including 8 (20%) male and 32 (80%) female individuals, with a mean (standard deviation) age of 21.0 (6.4) years. We observed a significant improvement in the topographic values of steep keratometry (K), flat K, maximum K, and corneal astigmatism (all <em>P</em> &lt; 0.05), but not in the mean K, thinnest corneal pachymetry, corneal thickness at the apex, back elevation, or front elevation (all <em>P</em> &gt; 0.05). The mean total anterior, central, and posterior CD differed significantly among the time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all <em>P</em> &lt; 0.05) and no difference between those of the 1-month and 3-month postoperative visits (all <em>P</em> &gt; 0.05). The mean CD for the anterior layer in the central, paracentral, and mid-peripheral zones, and the central layer in all four zones, differed significantly among time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all <em>P</em> &lt; 0.05), which remained unchanged from the 1-month to the 3-month postoperative visit (all <em>P</em> &lt; 0.05), except for the central 2–6-mm zone, which decreased significantly from the 1-month to the 3-month postoperative visit (<em>P</em> &lt; 0.001). The CD of the central 10–12-mm zone did not differ significantly in each pairwise comparison (all <em>P</em> &gt; 0.05). In contrast, CD for the posterior layer in the paracentral zone decreased significantly from the preoperative to the 1-month and 3-month postoperative visits but increased, to a lesser extent, from the 1-month to the 3-month postoperative visit (all <em>P</em> &lt; 0.05).</p> <p>&nbsp;</p> <p><strong>Conclusions:</strong> Femtosecond laser-assisted Keraring implantation significantly changes CD, with improvement in most topography parameters. Further longitudinal studies with larger sample sizes are required to verify these preliminary findings.</p> Amr Mounir, Engy Mohamed Mostafa, Ibrahim Amer, Ahmed Abdelaleem Abdelgbar, Hamdy Osman Osman, Mostafa Abdelrahman Ahmed, Hossam Ziada, Abdel Ghany Ali El Gabbar, Mohamed Alsadawy Hassan, Alaa Mahmoud Copyright (c) Mon, 01 Jul 2024 00:00:00 +0330 Fenofibrate and diabetic retinopathy <p><strong>Background: </strong>Diabetic retinopathy (DR), a sight-threatening ocular complication of diabetes mellitus, is one of the main causes of blindness in the working-age population. Dyslipidemia is a potential risk factor for the development or worsening of DR, with conflicting evidence in epidemiological studies. Fenofibrate, an antihyperlipidemic agent, has lipid-modifying and pleiotropic (non-lipid) effects that may lessen the incidence of microvascular events.</p> <p>&nbsp;</p> <p><strong>Methods:</strong> Relevant studies were identified through a PubMed/MEDLINE search spanning the last 20 years, using the broad term “diabetic retinopathy” and specific terms “fenofibrate” and “dyslipidemia”. References cited in these studies were further examined to compile this mini-review. These pivotal investigations underwent meticulous scrutiny and synthesis, focusing on methodological approaches and clinical outcomes. Furthermore, we provided the main findings of the seminal studies in a table to enhance comprehension and comparison.</p> <p>&nbsp;</p> <p><strong>Results:</strong> Growing evidence indicates that fenofibrate treatment slows DR advancement owing to its possible protective effects on the blood-retinal barrier. The protective attributes of fenofibrate against DR progression and development can be broadly classified into two categories: lipid-modifying effects and non-lipid-related (pleiotropic) effects. The lipid-modifying effect is mediated through peroxisome proliferator-activated receptor-alpha activation, while the pleiotropic effects involve the reduction in serum levels of C-reactive protein, fibrinogen, and pro-inflammatory markers, and improvement in flow-mediated dilatation. In patients with DR, the lipid-modifying effects of fenofibrate primarily involve a reduction in lipoprotein-associated phospholipase A2 levels and the upregulation of apolipoprotein A1 levels. These changes contribute to the anti-inflammatory and anti-angiogenic effects of fenofibrate. Fenofibrate elicits a diverse array of pleiotropic effects, including anti-apoptotic, antioxidant, anti-inflammatory, and anti-angiogenic properties, along with the indirect consequences of these effects. Two randomized controlled trials—the Fenofibrate Intervention and Event Lowering in Diabetes and Action to Control Cardiovascular Risk in Diabetes studies—noted that fenofibrate treatment protected against DR progression, independent of serum lipid levels.</p> <p>&nbsp;</p> <p><strong>Conclusions:</strong> Fenofibrate, an oral antihyperlipidemic agent that is effective in decreasing DR progression, may reduce the number of patients who develop vision-threatening complications and require invasive treatment. Despite its proven protection against DR progression, fenofibrate treatment has not yet gained wide clinical acceptance in DR management. Ongoing and future clinical trials may clarify the role of fenofibrate treatment in DR management.</p> Omer Karti , Ali Osman Saatci Copyright (c) Mon, 01 Jul 2024 00:00:00 +0330 Keratoconus: imaging modalities and management <p><strong>Background</strong><strong>:</strong> Keratoconus (KCN) is characterized by gradual thinning and steepening of the cornea, which can lead to significant vision problems owing to high astigmatism, corneal scarring, or even corneal perforation. The detection of KCN in its early stages is crucial for effective treatment. In this review, we describe current advances in the diagnosis and treatment of KCN.</p> <p>&nbsp;</p> <p><strong>Methods: </strong>This narrative review focuses on recent advancements in the diagnosis and treatment of KCN, especially evolving approaches and strategies. To ensure the inclusion of the most recent literature, relevant publications discussing advanced imaging techniques and treatment options for KCN were extensively gathered from the PubMed/MEDLINE and Google Scholar databases. The following index terms and keywords were used for the online search: keratoconus, diagnosis of keratoconus, advances in the diagnosis of keratoconus, topography or tomography, anterior segment optical coherence tomography, treatment of keratoconus, advances in the treatment of keratoconus, collagen crosslinking, intrastromal ring, keratoplasty, and new techniques in keratoconus.</p> <p>&nbsp;</p> <p><strong>Results:</strong> Various screening methods such as corneal topography, tomography, anterior segment optical coherence tomography, and assessment of corneal biomechanics have been developed to identify KCN in its early stages. After diagnosis, KCN management focuses on preventing disease progression. Corneal collagen crosslinking is a minimally invasive treatment that can slow or stop the progression of the condition. Recent research has also explored the use of copper sulfate eye drops (IVMED-80) as a noninvasive treatment to prevent the progression of KCN. Current treatment options for visual improvement include scleral lenses, intracorneal ring segments, corneal allogeneic intrastromal ring segments, and deep anterior lamellar keratoplasty. Recently, novel alternative procedures, such as isolated Bowman layer transplantation, either as a corneal stromal inlay or onlay, have demonstrated encouraging outcomes. Artificial intelligence has gained acceptance for providing best practices for the diagnosis and management of KCN, and the science of its application is contentiously debated; however, it may not have been sufficiently developed.</p> <p>&nbsp;</p> <p><strong>Conclusions:</strong> Early detection and advancements in screening methods using current imaging modalities have improved diagnosis of KCN. Improvement in the accuracy of current screening or diagnostic tests and comparison of their validities are achievable by well-designed, large-scale, prospective studies. The safety and effectiveness of emerging treatments for KCN are currently being investigated. There is an ongoing need for studies to track progress and evaluate clinicians’ knowledge and practices in treating patients with KCN. Artificial intelligence capabilities in management approach considering the currently available imaging modalities and treatment options would best benefit the patient.</p> Noor Alqudah Copyright (c) 2024 Mon, 01 Jul 2024 00:00:00 +0330 Surgical management of chronic sixth cranial nerve palsy: case report and literature review <p><strong>Background: </strong>Esotropia resulting from sixth cranial nerve palsy can substantially impact an individual’s visual acuity and overall quality of life. If the condition does not resolve in 6–10 months, surgical intervention may be necessary. Various muscle surgeries may be considered, with vertical rectus muscle transposition emerging as the primary option for treatment of complete palsy. However, this technique carries the risk of anterior segment ischemia and post-surgery deviations. Herein, we present a successful treatment of chronic complete sixth nerve palsy using a modified Nishida procedure, without splitting or tenotomy, and an adjunct botulinum toxin A (BTA) injection in the ipsilateral medial rectus muscle.</p> <p>&nbsp;</p> <p><strong>Case Presentation:</strong> A 59-year-old woman with a history of traumatic sixth nerve palsy had previously undergone horizontal muscle strabismus surgeries. Following multiple left medial rectus recessions, lateral rectus resection, and BTA injections, esotropia persisted. The worsening of her condition led to emotional distress and impaired social interaction. Initial examination revealed marked esotropia and limited left eye abduction. Magnetic resonance imaging (SIGNA MR750w, GE Healthcare, Waukesha, WI, USA) of the left eye revealed a contracted medial rectus muscle and substantial atrophy of the left lateral rectus muscle. A modified Nishida procedure was performed with an injection of 3 units of BTA into the ipsilateral medial rectus muscle, resulting in improved ocular alignment and stable findings after nine postoperative months. Furthermore, we supported our successful outcome with a summary of similar reported cases of sixth nerve palsy managed using the modified Nishida procedure with or without adjunctive procedures.</p> <p>&nbsp;</p> <p><strong>Conclusions:</strong> Following the modified Nishida procedure, the patient experienced a reduction in diplopia, improved ocular alignment and stability, and an increased binocular diplopia-free field. This case underscores the importance of an individualized approach to complex strabismus cases and highlights the modified Nishida procedure as a valuable tool in such circumstances. In the future, strabismus management will focus on refining personalized treatment and exploring innovative techniques for complex cases. Our success in using a combination of Nishida procedure and BTA injection should be further investigated in large-scale studies.</p> Christine Hakimeh, Kourosh Shahraki, Luc Courtois, Donny W. Suh Copyright (c) 2024 Mon, 01 Jul 2024 00:00:00 +0330