Medical hypothesis, discovery & innovation in optometry

Background: Early reports during the lockdown associated with the coronavirus disease 2019 (COVID-19) pandemic indicated a shift in the trends of ocular injuries. This study examined the demographics and clinical characteristics of patients who presented with ocular trauma during the lockdown period in 2020, and compared them to those seen during the same months in the next year, after the lockdown had been lifted, at Farwaniya Hospital in Kuwait.
Methods: This retrospective hospital-based chart review was a comparative observational study that examined individuals who presented to the Ophthalmology Department's emergency room during two distinct periods: from March 22, 2020, the day quarantine measures were announced, until August 30, 2020, when the quarantine ended, and the same time frame in the following year. Demographic characteristics, diagnoses, mechanisms of ocular trauma, and the locations where the eye injuries had occurred were recorded. Local injuries were classified as either mechanical or non-mechanical. Mechanical injuries were further subdivided by their cause. Non-mechanical injuries encompassed those caused by burns or corrosive substances.
Results: The incidence of ocular trauma increased from 18.9% (1470 out of 7763 cases) during the lockdown to 21.5% (3595 out of 16 748 cases) in the post-lockdown period. The mean age of the study population was slightly lower during the lockdown compared to the post-lockdown period, although this difference did not reach statistical significance (P > 0.05). Ocular trauma among children < 18 years was significantly higher during the lockdown period, accounting for 39.1% (575 of 1470 cases), compared to 36.0% (1293 of 3595 cases) in the post-lockdown period (P < 0.05). During both periods, injuries predominantly occurred at home, but the percentage of injuries decreased significantly during the post-lockdown period (P < 0.05). Workers were the most affected group, representing nearly 50% of cases during both periods. During the lockdown, 29.9% (439 cases) of ocular trauma cases involved work-related injuries, but this percentage increased significantly to 33.7% (1213 cases) post-lockdown (P < 0.05). Mechanical injuries constituted the majority of cases in both periods, accounting for almost 95% of the incidents, with a significant difference between the two periods (P < 0.05). Non-mechanical eye injuries did not differ between the two periods (P > 0.05). Most ocular trauma cases involved the anterior segment of the eye, with superficial corneal and conjunctival injuries being predominant, accounting for > 50% of cases during both periods.
Conclusions: The COVID-19 pandemic significantly impacted the trends in cases visiting ophthalmic emergency departments. After the lockdown, the incidence of ocular trauma increased. Ocular trauma among children was significantly higher during the lockdown period. The frequency of home-related ocular injuries was greater during the lockdown than in the post-lockdown phase. Work-related injuries showed a marked increase after the lockdown. Long-term, retrospective multicenter epidemiological studies in Kuwait could shed light on changes in the use of eye emergency department services during pre- and post-pandemic periods.

Background: Severe visual impairment is reportedly detrimental to mental health. Blind individuals are expected to have poorer mental health status compared to those with low vision. However, most mental health studies have focused on people with low vision, leaving a substantial gap in our understanding of the mental health status of the blind. Therefore, this study compared the mental health status of individuals with low vision to that of blind individuals.
Methods: This cross-sectional, questionnaire-based investigation involved individuals with low vision or blindness who were registered with the Social Welfare Department, Federal Territory of Kuala Lumpur, Malaysia. Participants were recruited using a simple random sampling method. The medical records of each participant were screened. Participants were individually interviewed, and their socio-demographic details, education level, working status, marital status, type and duration of impairment, and rehabilitation status were collected. Additionally, the Depression, Anxiety, and Stress Scale (DASS-21) was administered to each individual.
Results: Of the 30 participants, 20 (66.7%) had low vision and 10 (33.3%) had blindness, 16 (53.3%) were men, and most participants were single (n = 20, 66.7%). Congenital and acquired causes of visual impairment each accounted for 50% of cases. Most participants (n = 26, 86.7%) had not received psychosocial rehabilitation. The mean DASS-21 scores for the depression, anxiety, and stress subscales were significantly higher in patients with low vision than in those with blindness (all P < 0.05). Considering the clinical cut-off increments to determine emotional states for the DASS-21 subscales, individuals with low vision were in the mild, moderate, and mild categories for the depression, anxiety, and stress subscales, respectively. Individuals with blindness were categorized as normal in all subscales. The mean DASS-21 scores for the depression, anxiety, and stress subscales among individuals with congenital and acquired causes of visual impairment were comparable (all P > 0.05). Individuals with congenital visual impairment were in the normal, moderate, and normal categories for the depression, anxiety, and stress subscales, respectively. Those with acquired visual impairment were categorized as mild, moderate, and normal for the depression, anxiety, and stress subscales, respectively.
Conclusions: Individuals with low vision experienced mild to moderate levels of mental health issues, which may consist of depression, anxiety, stress, or a combination of these. The blind individuals in this study demonstrated no similar mental health issues. The small number of participants in certain racial and age groups prevents us from concluding how these factors might influence mental health. Further research with a larger sample size should consider the severity of visual impairment, age groups, and ethnicity, as these factors may impact the outcomes.

Background: Surgical intervention for an idiopathic epiretinal membrane (iERM) could alleviate metamorphopsia or improve vision. We evaluated changes in vision in patients undergoing treatment for monocular iERMs during a 6-month period. We investigated the rate of posterior vitreous detachment (PVD) using optical coherence tomography (OCT) imaging in eyes with iERM and in normal fellow eyes. We also examined the intraoperative rate of PVD in iERM eyes following the administration of triamcinolone acetonide (TA).
Methods: This prospective interventional case series recruited all eligible individuals with treatment-naive monocular iERM who were scheduled for pars plana vitrectomy (PPV) due to reduced best-corrected distance visual acuity (BCDVA) or metamorphopsia. OCT at baseline was used to determine the presence and stage of PVD in the eyes with iERM and the normal fellow eyes. Intraoperative TA-based PVD staging was performed for affected eyes.
Results: Participants comprised 32 cases, with 32 eyes with iERM and 32 normal fellow eyes. The mean (standard deviation [SD]) age was 60.9 (9.7) years, and the majority were men (n = 18, 56.2%). The baseline mean (SD) of BCDVA in affected eyes was 0.50 (0.21) logarithm of the minimum angle of resolution (logMAR), which improved to 0.34 (0.20) logMAR at the 1-month visit, representing a significant mean difference of 0.15 (0.20) logMAR (P < 0.001). At the 6-months visit, the mean (SD) BCDVA had further improved to 0.26 (0.19) logMAR, representing a significant mean difference of 0.23 (0.26) logMAR (P < 0.001) from the baseline value. The mean (SD) visual improvement between the 1- and 6-months follow-ups was 0.07 (0.14) logMAR, which was statistically significantly (P < 0.05). The mean changes in BCDVA were more pronounced in patients aged < 60 years than in those aged ? 60 years. The proportion of eyes at each stage of PVD detected by preoperative OCT in eyes with iERM differed from that detected by intraoperative TA staining. By both methods, the stages advanced significantly with increasing age (both P < 0.001). Similarly, the proportion of eyes at each stage of PVD detected by preoperative OCT in the normal fellow eyes was also higher and advanced significantly with increasing age (P < 0.001).
Conclusions: Continuous visual improvement is anticipated up to 6 months after surgery in eyes with iERM, and this improvement is likely to be more significant in younger individuals. The incidences of each PVD stage varies depending on the use of preoperative OCT or intraoperative TA in these cases. A higher rate of PVD observed in fellow eyes may suggest that PVD progresses through its stages simultaneously and without complications in normal eyes. Further studies are needed to validate our preliminary results and confirm these conclusions.

Background: The novel coronavirus disease 2019 (COVID-19) is significant not only for its life-threatening impact, but also for its association with serious eye disorders, including retinal artery occlusion. This language-inclusive narrative review analyzed the available clinical literature on retinal artery occlusion linked to COVID-19, highlighting it as a serious vision-threatening complication of this disease during the recent pandemic.
Methods: A targeted literature search was conducted in the PubMed / MEDLINE and Google Scholar databases from January 1, 2020, to January 1, 2025, to gather the most recent evidence. Studies were identified through various combinations of the following search terms: “eye diseases in COVID-19,” “ocular findings,” “ocular manifestations in COVID-19,” “posterior segment alterations in COVID-19,” and “retinal artery occlusion in COVID-19.” Articles with relevant clinical significance were selected for review. The reference lists of these papers also manually checked for other relevant papers. We included case reports, case series, and both prospective and retrospective studies that reported cases of central retinal artery occlusion (CRAO) or branch retinal artery occlusion (BRAO) in patients of any age, sex, and race with confirmed COVID-19.
Results: We found 27 records, of which 21 reported cases of CRAO in patients with COVID-19. The mean (standard deviation) age of these patients was 54.1 (13.4) years (range: 30–77 years). Off the 21 patients, 18 (86%) were men and three (14%) were women. In three cases, bilateral involvement was noted; in one such instance, CRAO was diagnosed sequentially: in the left eye while the patient had COVID-19, and in the right eye 1.5 months later. Among the cases of unilateral CRAO, the left eye was the most frequently affected. Additionally, four cases of BRAO were reported in patients with COVID-19, with most of these patients being women. Most of these cases were diagnosed in the left eye within 1 month of a COVID-19 diagnosis. Notably, in the majority of cases involving CRAO or BRAO, vascular thromboembolic events were not reported. Additionally, two case series reported a total of 17 patients with COVID-19 who were diagnosed with CRAO.
Conclusions: Although strong evidence of a causal relationship is lacking, healthcare specialists should be aware that CRAO or BRAO may be ocular complications of COVID-19. This is particularly important with the emergence of new subvariants of SARS-CoV-2 and in asymptomatic patients, and considering the availability of rapid viral antigen tests will make it easier to check if the patient with CRAO or BRAO actually have asymptomatic COVID-19.

Background: Systemic medications, which are crucial for managing a wide range of diseases from hypertension and diabetes to infections and cancers, can induce substantial ocular side effects. These effects impact visual function and quality of life, necessitating awareness and monitoring by healthcare professionals. The current review summarizes the range and mechanisms of these ocular toxicities.
Methods: This narrative review was derived from a targeted literature search using major electronic databases including PubMed/MEDLINE, Embase, Scopus, and Google Scholar. Keywords related to ocular side effects of systemic medications were utilized to identify relevant studies published from January 1, 2000, to December 30, 2024. The included articles pertained to ocular manifestations of systemic drug use, their mechanisms of toxicity, and associated management strategies.
Results: This study identified notable ocular side effects related to various systemic medications. Amiodarone was consistently linked to corneal deposits and colored halos, prompting recommendations for regular eye examinations. Isotretinoin was frequently associated with dry mucous membranes and blepharoconjunctivitis. Chloroquine and hydroxychloroquine were found to cause corneal changes and irreversible retinal damage with prolonged use. Studies of allopurinol presented conflicting evidence regarding its relationship with cataract risk. Corticosteroid use was associated with cataract formation and potential elevation of intraocular pressure. Ethambutol has been identified as a potential cause of optic neuritis. Topiramate was linked to acute angle-closure glaucoma, particularly early in treatment. Anticholinergic drugs can impact various parts of the eye. They cause ciliary muscle relaxation, leading to temporary blurred vision. This loss of accommodation, also known as “iatrogenic presbyopia,” results from paralysis of the ciliary muscle. Phosphodiesterase type 5 inhibitors, such as sildenafil, may cause pupil dilation, redness, dryness, blurred vision, and temporary cyanopsia. Additionally, patients taking vigabatrin may experience progressive constriction of the visual fields, necessitating regular visual field assessments. Epidemiological studies indicate that approximately 15% of patients taking systemic medications experience dry eye syndrome. These findings underscore the diverse range and impact of drug-induced ocular toxicities. However, vigilant monitoring and prompt management can help mitigate vision-threatening complications and preserve patients’ visual health. Addressing these ocular side effects requires strong interdisciplinary communication among ophthalmologists, optometrists, primary care physicians, and other specialists.
Conclusions: The wide range of ocular manifestations of systemic medication use emphasizes the importance of monitoring patients for these side effects. Collaborative management by eye care professionals and prescribing physicians is vital to mitigate risks. Further research must focus on the mechanisms of drug-induced ocular toxicity and developing effective preventive measures.

Letter to the Editor