Journal of Ophthalmic and Vision Research

Clinical Practice, Challenges, and the Future of Ophthalmic Genetics in Saudi Arabia

2025-04-09T12:17:17+00:00

Purpose: Ophthalmic genetics is vital for diagnosing and managing inherited eye disorders, contributing to personalized treatments.
Methods: This cross-sectional study assessed 131 healthcare professionals in Saudi Arabia through an online questionnaire to evaluate clinical practices, referral patterns, and challenges in genetic ophthalmology.
Results: Our study showed that 61.7% of participants reported the availability of ophthalmic genetics services in their hospitals, with an equal percentage referring patients to genetic specialists. However, significant barriers were identified, including limited budgets for genetic testing (69.6%), a lack of trained physicians (70.9%), low community awareness (50.6%), and a perceived lack of treatment options (27.8%). Additionally, concerns about patient access to genetic testing (54.3%) and genetic counseling (50.6%) were highlighted.
Conclusion: This is the first study on ophthalmic genetics in Saudi Arabia, and its findings emphasize the need for policy reforms and targeted interventions. Proposed solutions include innovative financial models for genetic testing, expanded training programs for healthcare providers, and public awareness campaigns to improve access to genetic services. Addressing these challenges can enhance early diagnosis, treatment strategies, and patient outcomes in ophthalmic genetics.

Effect of Occupational Exposure to Low-frequency Electromagnetic Fields on Cataract Development

2024-10-15T08:05:06+00:00

Purpose: Cataracts are the second leading cause of visual impairment worldwide. This study aimed to examine the impact of occupational exposure to low-frequency electromagnetic fields on cataract development.
Methods: One hundred employees of Zahedan Electricity Company participated in this study. They were assigned to four groups based on their level of exposure: regular, operational, operator personnel, and non-exposure. Based on LOCS III grading, the risk of developing different types of cataracts (i.e., nuclear, posterior subcapsular, and cortical) was evaluated for all participants.
Results: The frequency of cataracts was 62.2% in the exposure group (which includes three subgroups: the regular, operational, and operator personnel) and 53.8% in the non-exposure group. There was a significant difference between the study groups in terms of nuclear opacity grading (P = 0.003). The correlation between nuclear and posterior subcapsular cataract grading and work experience duration in the exposure group was statistically significant (P < 0.018).
Conclusion: This study’s findings indicate that exposure to low-frequency electromagnetic fields such as power lines, power plants, and power distribution posts may be a risk factor for cataract development, particularly nuclear cataracts.

Case–Control Study of Toric Intraocular Lens Implantation in Congenital Cataract

2024-06-13T19:39:57+00:00

Purpose: To evaluate the visual and refractive outcomes after toric intraocular lens (IOL) implantation compared to monofocal IOLs in pediatric eyes with cataracts and preexisting corneal astigmatism.
Methods: This case–control study was performed on 37 eyes of 37 children older than six years with visually significant congenital cataracts and corneal astigmatism greater than 1.75 diopters (D). The patients underwent lens aspiration with either monofocal (19 eyes) or toric (18 eyes) IOL implantation between June 2021 and December 2022. Uncorrected distance visual acuity (UCVA), corrected distance visual acuity (CDVA), near visual acuity, keratometry data, and residual astigmatism were evaluated preoperatively and on the fifth day as well as the first, third, and sixth months postoperatively.
Results: Preoperative mean corneal astigmatism was 2.84 ± 0.51 D in the toric group and 3.05 ± 0.79 D in the non-toric group (P = 0.563). At the final follow-up, postoperative refractive astigmatism was 0.53 ± 0.33 D in the toric group and 2.33 ± 0.8 D in the non-toric group (P < 0.001). CDVA of 20/40 or better was achieved in 83.3% (n = 15) and 47.4% (n = 9) of eyes in the toric and non-toric groups, respectively (P = 0.038). Also, corrected near visual acuity of 20/40 or better was achieved in 100% (n = 18) and 78.9% (n = 15) of eyes in the toric and non-toric groups, respectively (P = 0.105).
Conclusion: The study shows that pediatric cataract surgery with toric IOL implantation is an effective method of correcting preexisting corneal astigmatism. Compared to monofocal IOL implantation, it achieves better CDVA and near visual acuity

A New Complementary Touch for the Temporal Inverted Internal Limiting Membrane Flap Technique

2024-07-08T09:43:07+00:00

The temporal inverted internal limiting membrane (ILM) flap technique was developed to improve vitreoretinal surgery for large macular holes (MH). However, in addition to the difficulty of the surgical procedure, the main concern is the displacement of the ILM flap due to small fluid leakage into the posterior pole, even in the short time required to close the sclerotomies after fluid–air exchange. A new approach to the temporal inverted ILM flap technique is described here. In this approach, when the ILM flap is inverted over the MH, ILM forceps, while it is closed, are gently pressed over the folded edge and passed over ( just like folding a paper in half), creating an ILM fold mark like the ones used in origami. Thus, it can be seen that the minimal fluid leaking into the posterior pole ventilates the free edge of the flap, but the force formed along the folded edge prevents the flap turnover.

Utilizing ChatGPT-3.5 to Assist Ophthalmologists in Clinical Decision-making

2024-08-02T16:39:55+00:00

Purpose: ChatGPT-3.5 has the potential to assist ophthalmologists by generating a differential diagnosis based on patient presentation.
Methods: One hundred ocular pathologies were tested. Each pathology had two signs and two symptoms prompted into ChatGPT-3.5 through a clinical vignette template to generate a list of four preferentially ordered differential diagnoses, denoted as Method A. Thirty of the original 100 pathologies were further subcategorized into three groups of 10: cornea, retina, and neuroophthalmology. To assess whether additional clinical information affected the accuracy of results, these subcategories were again prompted into ChatGPT-3.5 with the same previous two signs and symptoms, along with additional risk factors of age, sex, and past medical history, denoted as Method B. A one-tailed Wilcoxon signed-rank test was performed to compare the accuracy between Methods A and B across each subcategory (significance indicated by P < 0.05).
Results: ChatGPT-3.5 correctly diagnosed 51 out of 100 cases (51.00%) as its first differential diagnosis and 18 out of 100 cases (18.00%) as a differential other than its first diagnosis. However, 31 out of 100 cases (31.00%) were not included in the differential diagnosis list. Only the subcategory of neuro-ophthalmology showed a significant increase in accuracy (P = 0.01) when prompted with the additional risk factors (Method B) compared to only two signs and two symptoms (Method A).
Conclusion: These results demonstrate that ChatGPT-3.5 may help assist clinicians in suggesting possible diagnoses based on varying complex clinical information. However, its accuracy is limited, and it cannot be utilized as a replacement for clinical decision-making.

A Biometric Comparison Between Myopic and Non-myopic Eyes Treated for Retinopathy of Prematurity

2024-10-01T08:25:12+00:00

Purpose: This study aims to assess the biometric alterations contributing to myopia in children who have undergone treatment for retinopathy of prematurity (ROP) and compare these changes with those observed in full-term myopic children.
Methods: Children who had undergone ROP treatment were recruited and classified according to their treatment methods. An age-matched group of myopic patients with no history of ROP treatment was also included. Complete perinatal history was collected, and a comprehensive ophthalmic examination, including cycloplegic refraction, was conducted. The biometric data of children in each study group were gathered using the IOL Master and Pentacam.
Results: The study recruited 14 patients in the intravitreal bevacizumab (IVB) group, 17 patients in the laser-treated group, and 13 individuals in the control group. There was no significant difference between the two patient groups regarding gestational age, birth weight, and age. In the IVB group, 50% of patients were myopic, compared to 52.9% in the laser-treated group. The incidence of high myopia was significantly higher in the laser-treated group (P < 0.001). In the non-myopic group, changes in refractive error were solely related to changes in axial length (P = 0.003). However, in the myopic group, changes in refractive error were significantly associated with changes in anterior chamber depth (P < 0.001), lens thickness (P < 0.001), and axial length (P = 0.018). Furthermore, myopic children in the ROP group had significantly shorter axial lengths, shallower anterior chambers, thicker lenses, and steeper corneas compared to the control group (all P < 0.001).
Conclusion: Eyes with a history of ROP treatment, whether myopic or non-myopic, should be considered distinct entities. In patients who have undergone ROP treatment and have not developed myopia, changes in refractive error are primarily influenced by alterations in axial length, rather than changes in the anterior segment. Furthermore, children with myopia and a history of treatment for ROP (either IVB or laser) exhibit different biometric changes compared to myopic children without a history of ROP treatment, further underscoring their unique characteristics.

Star of the Diabetic Macular Show: Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis (SNIFR)

2024-09-28T18:21:13+00:00

This is an Photo Essay and does not have an abstract. Please download the PDF or view the article in HTML

Successful Use of Upadacitinib, a Selective JAK Inhibitor, in the Treatment of Two Cases of Recalcitrant Chronic Uveitis

2024-10-28T18:16:11+00:00

Purpose: Immunomodulatory agents, including conventional immunosuppressive treatment and biologics, are the mainstay of treating chronic uveitis. Janus kinase ( JAK) inhibitors, one of the newest biologics, have shown successful outcomes in treating autoimmune diseases such as rheumatoid arthritis and inflammatory bowel diseases by suppressing the JAK/signal transducers and transcription (STAT) pathway. We present two cases of recalcitrant chronic uveitis with significant improvement in intraocular inflammation by using upadacitinib, a selective JAK1 inhibitor.
Case Reports: The first case is a 59-year-old female with HLA-B27-positive Chron’s disease and chronic anterior and intermediate uveitis who experienced an improvement in visual acuity, anterior chamber and vitreous inflammation, and cystoid macular edema on upadacitinib. The second patient is a 71-year-old female with birdshot chorioretinopathy, intolerant of initially used systemic immunosuppressive agents who showed significant improvement in vitreous inflammation, retinal phlebitis, and choroiditis after treatment with upadacitinib.
Conclusion: Utilizing JAK inhibitors such as upadacitinib in treating uveitis, whether in isolated forms or in the context of systemic autoimmune diseases, may require further evaluation by controlled cohort studies.

Bulbar Conjunctival Thickness in Eyes with Pseudoexfoliation Measured by Anterior Segment OCT

2024-08-30T10:38:05+00:00

Purpose: Eyes with pseudoexfoliation demonstrate fragile intraocular structures. The current study evaluated conjunctival thickness in pseudoexfoliation eyes as compared to a control group.
Methods: In this cross-sectional study, patients with pseudoexfoliation and an age-matched control group underwent measurement of bulbar conjunctival thickness in the superior and temporal quadrants, 1, 2, and 3 mm posterior to the limbus using anterior segment OCT.
Results: A total of 140 eyes of 140 subjects including 68 eyes of 68 patients with pseudoexfoliation and 72 eyes of 72 control subjects without pseudoexfoliation were studied. Both study groups were divided into two subgroups – those using glaucoma drops versus medication-free eyes. Total conjunctival thickness in pseudoexfoliation eyes was significantly lower than control eyes across all comparisons. Conjunctival thickness in the superior quadrant 1, 2, and 3 mm from the limbus was 177.62 ± 41.30, 235 ± 48.41, and 231.40 ± 49.81 μm, respectively in the pseudoexfoliation group versus 207.49 ± 48.92, 265.67 ± 52.66, and 262.74 ± 59.43 μm in the control group (P <0.001, <0.001, and 0.001, respectively). In the temporal quadrant, conjunctival thickness 1, 2, and 3 mm from the limbus was 193.62 ± 46.97, 198.19 ± 54.67, and 178.59 ± 57.90 μm, respectively in the pseudoexfoliation group versus 213.76 ± 47.06, 224.50 ± 56.24, and 210.26 ± 63.70 μm in the control group (P = 0.012, 0.006, and 0.003, respectively).
Conclusion: Conjunctival thickness was significantly less in pseudoexfoliation eyes than an age-matched control group which supports clinical observations of thinner and more fragile conjunctiva in these eyes with implications for glaucoma surgery.