Aims and Scope: Founded in the summer of 2020, Medical hypothesis, discovery & innovation in optometry, is an international, open-access, double-blinded peer-reviewed, quarterly journal that considers publications related to optometry. The aim is to present a scientific medium of communication for researchers in the field of optometry. The journal is of interest to a broad audience of visual scientists and publishes original articles, reviews, case reports, and commentaries after a rigorous peer-review process with more interest in original articles. The journal is affiliated with and published by the "IVORC" (Registration File Number: 803630055), a registered non-profit corporation in Austin, Texas, United States. We provide English editing for papers as a complimentary free-of-charge service.

Read More


Journal Info

Validation of the Arabic version of the Contact Lens Dry-Eye Questionnaire-8 in Palestine

Mohammed Aljarousha, Waleed M Alghamdi, Mohd Zaki Awg Isa , Noor Ezailina Badarudin, Fairuz Mohd Nordin, Mohd Ferdaus Bin Sari, Ebrahim Nangarath Kottakal Cheriya, Sara Attaallah, Mohammed Abdelfatah Alhoot

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 93-102

Background: The Tear Film and Ocular Surface Society International Workshop on Contact Lens Discomfort has stated that the Contact Lens Dry Eyes Questionnaire (CLDEQ-8) is the only validated clinical tool for assessing dry eye related to the use of soft contact lenses. Although translations of this questionnaire into various languages have been validated, the translation into Arabic has not been validated. We aimed to translate and validate the Arabic version of the CLDEQ-8 questionnaire in a clinical context among a sample of Arabic-speaking soft contact lens wearers residing in Palestine.
Methods: The CLDEQ-8 was translated into Arabic via a five-stage process: forward translation, translation revision, backward translation, refinement, and prefinal testing. The content validity of the questionnaire was assessed by a panel of 19 experts by using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). After reviewing the pre-test results, the Arabic-CLDEQ-8 was finalized. For clinical validation, a web-based version of the Arabic-CLDEQ-8 was distributed to eligible soft contact lens wearers in Gaza, Palestine. Internal consistency was evaluated using Cronbach’s alpha and the Corrected Homogeneity Index.
Results: Thirty-four soft contact lens wearers, with a mean (standard deviation [SD]) age of 23.9 (5.7) years and with a mean (SD) contact lens-wear time was 10.5 (7.5) hours, including 30 (88.2%) women, completed the questionnaires. The mean (SD) score on the Arabic-CLDEQ-8 was 17.00 (6.69) (range: 2–30). Cronbach's alpha, indicating internal consistency, was 0.900, and the corrected homogeneity index exceeded 0.50 for all assessed domains, except for domain 4 (D4). The CVI and CVR were 0.73 and 0.87, respectively. Domains D1a, D1b, D2a, D3a, D3b, and D4 were found to be clear and simple, while domain D2b demonstrated an average level of content validity.
Conclusions: The trans-cultural adaptation of the CLDEQ-8 questionnaire led to the development of a reliable and valid tool for assessing the contact lens comfort among Arabic-speaking soft contact lens wearers. This Arabic-CLDEQ-8 was culturally adapted for Arabic-speaking contact lens wearers living in Palestine; thus, future studies should aim to confirm its validity in other Arabic-speaking regions.

Accommodative functions in opium users and non-users

Tahereh Sadat Khoshnazar, Mehdi Sharifzadeh Kermani, Monireh Mahjoob, Masoud Sadeghi

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 103-111

Background: Emerging evidence highlights a concerning prevalence of accommodative and convergence anomalies in individuals with opioid use disorder. However, there remains a significant scarcity of data comparing accommodative functions of opium users and non-users. Hence, we investigated potential changes in accommodative functions of opium users compared to that of non-users. Furthermore, we evaluated changes in these parameters after administering 5% phenylephrine eye drops, both within and between the two groups.
Methods: This cross-sectional case-control study recruited opium users and non-users. The binocular amplitude of accommodation (AA), monocular estimate method (MEM), negative and positive relative accommodation (NRA and PRA, respectively), and monocular and binocular accommodative facility (AF) were assessed and documented. All measurements were repeated 30 min after instillation of one drop of 5% phenylephrine hydrochloride eye drops.
Results: We recruited 103 opium users and 107 non-users, with comparable mean ages (P > 0.05) but significantly different sex ratios (P < 0.05), with men outnumbering women among the opium users. All accommodative functions measured before and after the instillation of 5% phenylephrine, along with the differences in their values between the two time points, were comparable between the two groups (all P > 0.05), with the exception of the right-eye AF, which was significantly higher in non-users than in opium users after instillation (P < 0.05). Within the opium user group, all accommodative functions exhibited significant differences between pre- and post-instillation measurements (all P < 0.05), except for NRA, which did not change (P > 0.05). In contrast, the non-user group showed no significant differences between pre- and post-instillation measurements for all accommodative functions (all P > 0.05), except in the AA and the right-eye MEM (both P < 0.05).
Conclusions: We observed small but significant changes in most baseline accommodative functions after the application of 5% phenylephrine eye drops in opium users. In contrast, most parameters remained unchanged in healthy non-users. When comparing the results between the two groups pre- and post-application of phenylephrine, we found similar accommodative functions overall. However, non-users had a significantly higher value for the right-eye AF following the instillation. To better understand potential binocular anomalies in opium users, further longitudinal studies that are matched for age and sex should be conducted, focusing on additional aspects of binocular vision and ocular motility.

Refractive and visual outcomes of traumatic cataract surgery: a ten-year perspective

Seyed Hashem Daryabari, Khosrow Jadidi, Hamidreza Torabi, Mahmood Hassani, Mohammad Yaser Kiarudi, Mohammadreza Saeedifar

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 112-118

Background: Traumatic cataract is a major consequence of penetrating and blunt ocular injuries, often requiring surgical intervention. We evaluated the visual and refractive outcomes of traumatic cataract surgery and intraocular lens (IOL) implantation in adults who sustained open- or closed-globe injuries.
Methods: Patients who underwent cataract surgery and IOL implantation due to closed or open eye injuries were included in this descriptive-analytical, retrospective, case-series study. Eligible patients were scheduled for re-evaluation and a complete ocular re-examination, and individuals who returned and had a follow-up of at least 6 months were ultimately recruited. Because the accuracy of IOL power calculation was a primary outcome, patients who were left aphakic were excluded. Medical records were also reviewed to document baseline data, surgical details, and complications.
Results: We included 72 eyes of 72 patients with a mean (standard deviation [SD]) age of 39.5 (13.6) years and a male-to-female ratio of approximately 6:1. Forty-one (56.9%) eyes sustained open-globe injuries and 31 (43.1%) closed-globe injuries. The mean (SD) initial best-corrected distance visual acuity (BCDVA) was 1.1 (0.6) logarithm of the minimum angle of resolution (logMAR) and improved significantly to 0.3 (0.3) logMAR at the final visit (P < 0.001). A final BCDVA better than 20/40 was detected in 43 (59.7%), 23 (74.2%), and 20 (48.8%) eyes in the entire series, eyes sustaining closed-globe injuries, and those with open-globe injuries, respectively. The absolute prediction error was 1.0 diopter or less in 42 (58.3%) eyes in the entire series. A mean absolute prediction error of 1.0 D or less was more frequent in closed-globe than in open-globe injuries (n = 22 [71.0%] vs. n = 20 [48.8%], respectively). The mean absolute prediction error differed significantly between groups (P < 0.05). Eyes that sustained open-globe injury were less likely to obtain a BCDVA better than 20/40 (odds ratio, 0.33; 95% confidence interval, 0.12 – 0.91; P < 0.05).
Conclusions: Visual acuity significantly improved after traumatic cataract extraction with IOL implantation. Most cases achieved satisfactory visual and refractive outcomes. Eyes with open-globe injuries might have less favorable visual prognosis. These initial findings must be confirmed through large-scale, multi-center longitudinal studies.

Relationship between central corneal thickness and optic nerve head parameters in primary open-angle glaucoma

Naseh Hakimzadeh, Sakineh Kadivar, Mohammad Reza Panjtan Panah

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 119-126

Background: Primary open-angle glaucoma (POAG) is an ocular entity that causes optic neuropathy. Thin central corneal thickness (CCT) in patients with POAG correlates with changes in various optic nerve head structural parameters. Additionally, racial differences exist in CCT and optic disc parameters. Herein, we assessed the potential relationship between CCT and optic nerve head parameters in treatment-naive patients of Persian ethnicity who were diagnosed with POAG of varying severity levels.
Methods: This hospital-based analytical cross-sectional study recruited patients of Persian ethnicity diagnosed with treatment-naive POAG. Participants underwent detailed optometric and ophthalmic examinations. Visual field testing was performed using a Humphrey perimeter. Spectral-domain optical coherence tomography (OCT) was performed using a Cirrus OCT device to record optic nerve head parameters: disc area, rim area, vertical cup-to-disc ratio, average cup-to-disc ratio, cup volume, and average retinal nerve fiber layer thickness (RNFLT). The CCT was measured using an ultrasonic pachymeter.
Results: We recruited 168 eyes of 84 patients with POAG with a mean (standard deviation) age of 60.30 (12.50) years, comprising 33 (39.29%) men and 51 (60.71%) women. While weak but statistically significant inverse correlations of CCT with the vertical cup-to-disc ratio (r = - 0.19; P < 0.05), average cup-to-disc ratio (r = - 0.17; P < 0.05), and cup volume (r = - 0.17; P < 0.05) were found, other optic nerve parameters showed no significant correlations with CCT (all P > 0.05). Stepwise multiple linear regression analysis indicated that, for each unit increase in the vertical cup-to-disc ratio, the CCT decreased by 54.98 µm (P < 0.05).
Conclusions: The CCT in eyes with treatment-naive POAG of varying severity levels in a Persian ethnic group was weakly but statistically significantly inversely correlated with the vertical cup-to-disc ratio, average cup-to-disc ratio, and cup volume. For every unit increase in the vertical cup-to-disc ratio, the CCT decreased by 54.98 µm. Our findings indicate that in patients with POAG, CCT correlates with some changes in structural optic nerve head parameters, including the cup volume and vertical/average cup-to-disc ratios. Further longitudinal studies including individuals from various racial backgrounds and POAG severity levels are needed to verify the relationship between CCT and optic nerve parameters at different time points of disease progression.

Grading scales for vitreous haze

Omer Karti, Ali Osman Saatci

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 127-135

Background: Grading scales for vitreous haze are crucial for the diagnosis, monitoring, and management of uveitis. The presence of inflammatory cells within the vitreous cavity is widely recognized as a key indicator of disease activity and severity, offering valuable insights into the underlying inflammatory processes. This mini-review aims to explore the evolution of vitreous haze grading scales systematically, emphasizing conventional grading methods, advances in imaging technologies, and the integration of artificial intelligence (AI) into the grading process.
Methods: The PubMed/MEDLINE database was comprehensively searched for studies published between 1959 and 2024, using keywords such as “AI-based grading systems,” “artificial intelligence,” “automated grading,” “grading scales for vitreous cells,” “inflammation,” “uveitis,” and “vitreous haze.” Relevant studies were identified, and additional articles were selected by reviewing the reference lists of the included publications. The selection of articles for inclusion in the mini-review was limited to those written in English.
Results: In the current literature, two grading methods are used: the National Institutes of Health (NIH) scale and the Miami scale. Despite their widespread utilization, both scales entail subjective assessments of vitreous haze, which renders them susceptible to observer bias and interobserver variability. The NIH scale uses six levels, while the Miami scale employs nine levels, both of which require subjective assessments of vitreous haze. Recent advances in objective imaging technologies, namely ultrawide-field fundus photography and advanced optical coherence tomography-based analysis, have given rise to increasingly consistent and standardized grading systems, which may enhance the reliability of these assessments. Innovative techniques have been developed to enhance accuracy and sensitivity, thereby facilitating the early detection and precise monitoring of vitreous inflammation. Despite these advances, challenges remain, including the difficulty of distinguishing subtle variations in vitreous haze and the variability of inflammatory presentations. The incorporation of AI-driven tools and state-of-the-art imaging technologies into the vitreous cell grading signifies a substantial advance in the evaluation and management of uveitis.
Conclusions: The development of more objective, reproducible, and quantitative grading scales is imperative for optimizing uveitis evaluation and grading vitreous haze in clinical settings and clinical trials. These innovations will also provide robust endpoints for clinical studies, ultimately improving patient care. Moreover, objective grading criteria will enhance diagnostic precision, facilitate better management of ocular inflammatory diseases, and promote further advances in uveitis research and treatment.

Choroidal melanoma treatment: a shift towards vision preservation

Kimia Kazemzadeh

Medical hypothesis, discovery & innovation in optometry, Vol. 5 No. 3 (2024), 25 January 2025 , Page 136-144

Background: Choroidal melanoma is the most common primary intraocular malignancy in adults, and is known for its aggressive nature and potential for metastasis. Historically, enucleation was the primary treatment, which resulted in significant morbidity and psychological distress. Recent advances have led to a paradigm shift towards vision-preserving therapies. This review aimed to explore advances in choroidal melanoma treatment and their impact on patient care and quality of life.
Methods: For this narrative review, we conducted a literature search of major databases, including PubMed/MEDLINE, Embase, and Scopus, from January 1, 1998, to December 30, 2024. The search strategy employed the following keywords: “choroidal melanoma,” “vision preservation,” “plaque brachytherapy,” “proton beam therapy,” “stereotactic radiosurgery,” “enucleation,” “ocular oncology,” “retinal health,” “visual acuity,” “quality of life,” “computational intelligence,” and “AI (artificial intelligence).” We included English-language studies of any design focusing on choroidal melanoma treatment, particularly treatment involving vision-preserving strategies.
Results: Advances in vision-preserving therapies, such as plaque brachytherapy, proton-beam irradiation, and stereotactic radiosurgery, have revolutionized the management of choroidal melanoma. These modalities offer improved patient outcomes by reducing the need for enucleation and preserving visual acuity. Plaque brachytherapy achieves high tumor-control rates with minimal side effects, while proton-beam irradiation provides precise tumor targeting, which is particularly beneficial for large tumors. Stereotactic radiosurgery is effective for smaller tumors, but may result in decreased visual acuity over time. Emerging therapies, such as Bel-Sar (AU-011), show promise in controlling tumor growth while preserving vision. The ability of Bel-Sar to control tumors while preserving vision could provide patients with a more favorable prognosis and improved quality of life. Immunotherapy holds significant promise, particularly with the potential for use of immune checkpoint inhibitors and vaccine therapies. Additionally, artificial intelligence (AI) is becoming increasingly important in the management of choroidal melanoma.
Conclusions: The shift from enucleation to vision-preserving therapies has significantly improved outcomes and quality of life for patients with choroidal melanoma. Future research should focus on optimizing current therapies for better visual acuity preservation and on exploring new targeted therapies to enhance tumor control while minimizing side effects. Moreover, studies on AI applications for managing this sight- and life-threatening eye condition could significantly transform treatment outcomes.