Ocular Features Research Articles

An analytical study of ophthalmological manifestations in hematological malignancies in a tertiary care centre, India

: The objective of the study was to describe the ophthalmological manifestations associated with various haematological malignancies at a tertiary care centre. This analytical cross-sectional study was conducted with 60 patients diagnosed with various types of haematological malignancies, including leukaemia, lymphomas, and multiple myeloma. Patients who had ocular media opacities which precluded fundus view like dense corneal opacity, cataracts, absolute glaucoma, and systemic conditions like hypertension, and diabetes were excluded from this study. All 60 patients underwent a comprehensive ocular examination and the collected data were analysed using IBM SPSS software version 25. Out of the 60 patients with haematological malignancies, 27 (45%) exhibited ocular features. Ocular involvement was more common in males (63%) and in the paediatric age group (1-10 years) (100%). Ocular findings were prevalent in leukaemia patients especially with chronic myeloid leukaemia showing the highest incidence (80%), compared to lymphomas and multiple myeloma. The most common ocular manifestations were in the posterior segment, such as retinal haemorrhages and Roth spots, observed across all age groups. Neurological involvement, specifically III and VI cranial nerve palsy, were also notable. At the time of presentation, the majority of patients with ocular features had good visual acuity, ranging from 6/6 to 6/9 (43%). With advancements in diagnostic and therapeutic methods, the survival rates for patients with haematological malignancies have considerably improved. This has led to an increase in the variability of ocular presentations. Consequently, routine ocular examination is essential at the time of diagnosis of haematological malignancies to prevent vision-threatening complications and improve the overall quality of life for these patients.

Research progress on the development of myopia prediction models and their predictive performance

The incidence of myopia is continuously increasing worldwide, especially in China, where the prevention and control of myopia is of great significance. Accurate prediction of myopia and early intervention are of great importance for slowing down the development of myopia and reducing the social burden. This article reviews the research progress of myopia prediction models and their predictive performance in recent years. It includes models based on refractive power and ocular biological characteristics, such as those using parameters such as refractive power, axial length, and percentile curves for prediction; models combined with environmental factors, which explore the relationship between myopia in school-age children and the age of onset, parents' myopia, education, and various living environmental factors; models based on genetic factors, which predict by evaluating parents' myopia status and single nucleotide polymorphisms discovered in genome-wide association studies. In addition, the article also introduces the application of artificial intelligence in myopia prediction, such as machine learning and deep learning algorithms that can predict changes in axial length growth and refractive power. These research advances provide a reference for establishing more accurate myopia prediction models and help achieve precise and personalized myopia prevention and control.

Effect of the iris-ciliary angle on the prediction of the vault for phakic implantable collamer lens in the manufacturer's calculator.

This study aims to explore the effects of the iris-ciliary angle (ICA) on the accurate prediction of the vault after implantable collamer lens (ICL) using the manufacturer's online calculation and ordering system (OCOS). The participants were categorized into three groups according to the size of ICA as follows: narrow ICA group (< 40°); normal ICA group (40°-60°); wide ICA group (> 60°). We compared the preoperative ocular characteristics and postoperative vault at 3 months among the three groups. Bivariate correlation was used to analyze the correlation between vault and ICA, and multiple linear regression was used to further analyze the correlation between vault and preoperative parameters. Ordered multicategorical logistic regression analyses were used to further illustrate the effect of different ICA groups on postoperative vault distribution. This study included 278 eyes of 157 individuals. There were no statistically significant differences in preoperative ocular parameters among the three ICA groups, while the postoperative vault was minimal in the wide ICA group, followed by the normal and then the narrow ICA group (p < 0.001). The correlation between ICA and vault at 3 months postoperatively was significant in both bivariate correlation and multiple linear regression analysis (both P < 0.001). Ordered multicategorical logistic regression analyses showed that the odds of having a higher vault were 2.586 (P = 0.002) and 5.534 (P < 0.001) times in the normal and narrow ICA groups, respectively, compared to the wide ICA group. The size of the ICA has a significant impact on vault created by the recommended ICL size for OCOS. Therefore, ICA should be considered when selecting ICL size using the OCOS recommended sizes preoperatively.

Comparison of choroidal detachment with and without hypotony after Ahmed valve implantation.

To compare the clinical manifestations of and risk factors for choroidal detachment (CD) with or without hypotony after Ahmed valve implantation (AVI). Retrospective, consecutive case series. We enrolled patients with glaucoma who underwent AVI, and divided them into CD and non-CD groups. The patients with CD were divided into those with and without hypotony. Data collected from the chart review before and after AVI included patient demographics and ocular characteristics. We analyzed the risk factors for CD development. The relationship between hypotony and CD development was also analyzed. Among the 387 eyes, 63 developed CD. Among these 63 eyes, 42 had CD with hypotony and 21 had CD without hypotony. Multivariate regression analysis revealed that age (P < 0.001), lens status (P < 0.001), history of diabetes mellitus (DM) (P = 0.011), and history of hypertension (HTN) (P = 0.002) were significant predictors of CD development. Neovascular glaucoma (NVG) showed 42.9% of CD cases without hypotony. This rate was higher than primary open angle glaucoma (POAG) and exfoliative glaucoma (XFG). The rate of anterior chamber formation as treatment of CD was significantly higher in CD with hypotony than in CD without hypotony. Older age, pseudophakic eyes, DM, and HTN are significantly associated with CD development after AVI. NVG has higher incidence rates of CD without hypotony compared with POAG and XFG. Therefore, clinicians should pay attention to CD development after AVI especially in NVG, even if a patient is not in a hypotonic state.

Clinically Probable Multiple System Atrophy Presenting Ptosis as an Early Manifestation

Many ocular features were found in patients with multiple system atrophy (MSA), which include dry eye, blepharospasm, eye movement problems, and blink reflex dysfunction. Some of these symptoms are associated with autonomic dysfunctions seen in MSA. We report a young clinically-probable MSA patient with bilateral ptosis at an early disease stage. Although there is no clear evidence that ptosis, in this case, was caused by abnormalities in the sympathetic cholinergic system, the selective impairment of sudomotor function implied an injured sympathetic cholinergic system secondary to MSA pathology. Ocular manifestations need more attention in clinical examinations of patients with MSA.

The Proportion of Ocular Involvement and Characteristics of Dry Eye Parameters in Primary Sjögren's Syndrome Referred from the Rheumatology Department.

To report the proportion of ocular involvement in primary Sjögren's syndrome (pSS) and to analyze various dry eye indexes and serum titers of markers depending on whether ocular involvement has occurred or not. This retrospective study considered 214 patients referred from the rheumatology department for pSS workup. Symptom questionnaires, ocular surface stain score (OSS), Schirmer test, tear break-up time (TBUT), meibomian gland (MG) dropout, meibum quality, meibum expressibility, lid margin abnormalities, and lipid layer thickness were evaluated. Anti-Ro Ab, anti-La Ab, ANA, RF, ESR, and CRP were included as systemic serum titers of markers. Patients with (Group 1) and without (Group 2) ocular involvement were compared. We conducted a further subgroup analysis of group 1 by dividing it into two groups based on whether or not the cases met all the ocular criteria for pSS diagnosis. Among the 214 referred patients, 118 were diagnosed as pSS: 87 out of 118 (74%) in group 1 and 31 (25%) in group 2. Group 1 showed higher meibum quality scores (p=0.016), meibum expressibility (p=0.01), and lid margin abnormalities on the lower lid (p=0.029) and lower TBUT (p=0.016) than group 2. Among the serum titers of markers, anti-Ro Ab negatively correlated with TBUT (r=-0.211, p=0.028). OSS, TBUT, and the schirmer test statistically differed between the patients who satisfied both ocular criteria (N=46) and those who satisfied only one criterion (N=41) (p=<0.001, 0.041, 0043, respectively). There were no statistical differences in serum titers of markers between the two groups. About half of patients referred from the rheumatology department for diagnosis of pSS were diagnosed with pSS. The proportion of ocular involvement in the pSS patients was 74%, and half of these patients met both ocular criteria. Only anti-Ro Ab negatively correlated with TBUT. Also, OSS, TBUT, and schirmer test were statistically different between the two subgroups.

Comparative analysis of pre-operative findings and post-operative outcomes in primary and secondary macular holes at a tertiary eye hospital in South India

PurposeThis study aimed to compare demographics, clinical characteristics, and post-surgical outcomes between idiopathic and secondary full-thickness macular holes (MHs).MethodsA retrospective analysis of 348 eyes from 339 patients treated between June 2017 and December 2023 was conducted. The study included both idiopathic and secondary MHs, excluding cases where surgery was not performed or lacked sufficient follow-up. Demographic data, visual acuity (VA), ocular characteristics, and optical coherence tomography measurements were analyzed.ResultsIdiopathic MHs were identified in 308 eyes (89%), and secondary MHs in 40 eyes (11%). Idiopathic MH patients were older (mean age: 68.26 vs. 60.13 years; p = 0.001) and more commonly female (63% vs. 40%; p = 0.005). Post-surgical closure was achieved in 86% of all MHs, with a median VA improvement of 15 ETDRS letters (3 Snellen lines). However, secondary MHs had a lower closure rate (67% vs. 89%, p = 0.001) and less VA improvement (2 lines vs. 3 lines, p = 0.001) compared to idiopathic MHs. Significant differences in maximal basal diameter and diameter hole index were noted between the groups.ConclusionsSecondary MHs, accounting for 11% of surgical cases, show poorer anatomical and visual outcomes than idiopathic MHs. Despite lower success rates, early surgical intervention in secondary MHs is recommended to enhance outcomes. Differentiating between idiopathic and secondary MHs is crucial for optimal management.

Ocular and Systemic Abnormalities in Punctal Agenesis

Background: Punctal agenesis (PA) is a rare congenital anomaly that can occur in isolation or as part of an underlying syndrome. The benefit of genetic assessment in individuals with PA and clinical features that should prompt molecular workup has not been systematically studied. The aim of this study was to identify ocular and extraocular features associated with PA and determine its association with an underlying syndrome. Methods: A retrospective medical records review of ocular and extraocular medical histories in all patients diagnosed with PA at the Children’s Hospital of Philadelphia between 2009 and 2023 was conducted. Results: Forty-four patients were included, ages 3.3 ± 3.3 years. Our cohort was 31 males (70%). Twenty patients had isolated PA (45.5%), while 24 patients (54.5%) had other associated ocular or extraocular abnormalities. The most common ocular comorbidities were refractive disorders (n = 8, 33%), ptosis (n = 8, 33%), strabismus (n = 7, 29%), other eyelid disorders (n = 9, 38%), and amblyopia (n = 6, 25%). Nineteen (43%) individuals had systemic disorders and 18 (41%) underwent genetic testing. An associated genetic diagnosis was found in 17 (39%) individuals. The most common associated syndrome was ectodermal dysplasia. Systemic disorders were more prevalent in individuals with syndromic PA (4, 20% isolated PA vs. 15, 63%, PA-plus, p = 0.005). Conclusions: The presence of additional ocular abnormalities was associated with an increased rate of systemic disorders (63%). In individuals with PA who also exhibit additional ocular disorders, systemic evaluation and genetic workup should be considered.

Risk factors for hyphema following goniotomy or trabecular bypass stent placement combined with phacoemulsification.

To report the rates and risk factors for layered hyphemas after goniotomy (PG) and trabecular bypass stent (PTBS) surgery combined with phacoemulsification. Patient data was obtained using a retrospective chart review from adult patients (18years of age or older) undergoing either PG or PTBS at the West Virginia University Eye Institute between 2013 and 2023. Generalized estimating equations were used to identify significant predictors of layered hyphema on post-operative day one. Predictors evaluated included age, race, glaucoma severity, glaucoma type, surgical time, complex cataract extraction, pre-operative intraocular pressure, post-operative day one intraocular pressure, peri-operative anti-thrombotic therapy (ATT) use, body mass index, and surgery type (i.e., PG or PTBS). Of the 405 eyes from 279 patients included in the study, the overall layered hyphema rate was 10.1% in the whole sample. In multivariate generalized estimating equation model controlling for glaucoma stage and preoperative IOP, only surgery type (PG vs PTBS) predicted post-operative day one hyphema (β = 2.47, SE = 1.01, p = 0.02). The hyphema rates in the PG group and PTBS groups were 40/316 (12.7%) and 1/89 (1.1%), respectively. Eyes of patients on ATT had a hyphema rate of 16/189 (8.5%) compared to 25/216 (11.6%) in eyes of patients not on ATT. Performing PG over PTBS was a significant predictor of a post-operative day one layered hyphema. No other systemic or ocular features, including the use of ATT, showed a statistically significant relationship with post-operative hyphemas. What is Known. • The prevalence of minimally invasive glaucoma surgery has significantly increased in recent years. • Hyphema is a common postoperative complication of minimally invasive glaucoma surgery, however risk factors for hyphema in this setting have not been thoroughly evaluated. • The use of perioperative antithrombotic therapy did not significantly increase the risk for postoperative hyphema following angle based minimally invasive glaucoma surgery. • Hyphema risk was significantly higher in patients undergoing goniotomy combined with phacoemulsification compared to trabecular bypass stent surgery with phacoemulsification.

Baseline characteristics associated with the first year treatment interval of intravitreal faricimab in neovascular age-related macular degeneration (nAMD)

AimsTo identify baseline characteristics that best correlate to treatment interval for naive neovascular age-related macular degeneration patients treated with faricimab in the first year (Y1) of the TENAYA and LUCERNE...

Ophthalmic manifestations of ROSAH syndrome - A case report

Retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and headache (ROSAH) syndrome is an autosomal dominant disorder, and genome-wide sequencing has identified the ALPK1 gene as the cause of this rare systemic ocular disorder.[1] We report a unique case of ROSAH syndrome with genetic positivity of both the ALPK1 and ABCA4 genes, exhibiting phenotypical ocular features of retinal degeneration, optic disc involvement, ocular inflammation, and headache.

Non-arteritic anterior ischemic optic neuropathy in Black patients

Prior studies have shown that non-arteritic anterior ischemic optic neuropathy (NAION) is uncommon in persons of Black race compared to those of White race, but the reasons behind this discrepancy remain unknown. Our goal was to analyze the systemic and ocular features of Black NAION patients compared to White patients. Retrospective cross-sectional study METHODS: Self-reported race was collected from all NAION patients seen between 2014-2022 from a single US neuro-ophthalmology service. All Black NAION patients and a randomly selected sample of White NAION patients were included. We collected information on hypertension, hyperlipidemia, diabetes mellitus, hypothyroidism, obesity, ischemic heart disease, atrial fibrillation, pacemaker insertion, chronic kidney disease, dialysis, anemia, obstructive sleep apnea, deep vein thrombosis, stroke, use of phosphodiesterase inhibitors, and smoking status. We reviewed color fundus photographs and optic nerve OCT images to assess cup-to-disc ratio and document the presence of optic disc drusen. Counterfactual random forest was used to estimate associations for each characteristic of interest by race controlling for the other exposures. We included 32 Black NAION patients (mean age 57 ± 11 years, 38% men) and 69 of 432 White patients (mean age 57 ± 15 years, 59% men). Time between NAION onset and neuro-ophthalmic examination was significantly longer in Black patients (1.5 to <3 months: OR 4.07, P = 0.03; 6 to <12 months: OR 6.05, P = 0.007). Chronic kidney disease (OR 7.53, P = 0.003) and hemodialysis (OR 13.69, P = 0.02) were significantly more frequent in Black patients. No significant differences in cup-to-disc ratio were present (0.15 to <0.25: OR 2.83, P = 0.09; 0.25 to <0.35: OR 0.56, P = 0.46; ≥0.35: OR 0.66, P = 0.44). Referral delay occurs in Black patients with NAION, likely due to its relative rarity and concern for alternate diagnoses. Black NAION patients were substantially more likely to have chronic kidney disease and be on dialysis than White patients. Despite known racial differences in cup-to-disc ratio, we found no difference between Black and White NAION patients, suggesting that the underlying proposed compartment mechanism is the same between races.

Phacoemulsification with Either Endocyclophotocoagulation or Ab-Interno Canaloplasty with or without Trabeculotomy in Uveitic Glaucoma

ABSTRACT Purpose Understanding the current role and efficacy of endocyclophotocoagulation (ECP) compared to ab-interno canaloplasty with or without trabeculotomy (OMNI), combined with cataract extraction and lens implantation (CEIOL), for the management of uveitic glaucoma (UG) is limited. Methods All UG patients ≥18 years old with ≥6 months of follow-up data (15.2 ± 5.9 months) after CEIOL combined with either ECP or OMNI from August 2019 to May 2022 at a single academic center were retrospectively reviewed [22 eyes of 15 patients (8 ECP, 14 OMNI)]. Surgical success was considered intraocular pressure (IOP) ≤21 mmHg and a reduction of baseline by ≥20% for two consecutive final visits without hypotony, additional surgery, or loss of light perception. Uveitic control was considered a <2-step increase in anterior chamber (AC) cell grade, <3+ AC cell grade, and no increase in steroid drop use at 3 months postoperatively. Secondary outcome measurements included postoperative change in IOP, glaucoma medications, best corrected visual acuity (VA), AC cell grade, and steroid drop frequency. Results Baseline ocular and preoperative characteristics of eyes (age, sex, laterality, uveitic location, systemic immunomodulating therapy, visual acuity, IOP, number of glaucoma medications, AC cell grade, and steroid drop frequency) did not significantly differ except for greater racial diversity in the ECP group. 62.5% eyes were surgically successful in the ECP group and 85.71% in the OMNI. Between-group analysis showed greater IOP reduction in the OMNI group (p < .05), but no difference in reduction of glaucoma medications (p = .33). No eyes displayed a two-step increase in or >3+ AC cell grade, however, 50% and 64.29%, respectively, increased steroid drop use. Between groups, no difference in the change of AC cell grade (p = .98) or steroid drop use (p = .84) was seen. Conclusions Both interventions improved visual acuity, IOP, and glaucoma medication use, however, OMNI was more successful at reducing IOP long term. An increase in steroid drop frequency may be the cost of a prolonged post-surgical inflammatory course related to underlying uveitis regardless of surgical approach.

Clinical characteristics and diagnostic test for spherophakia: A retrospective analysis

BackgroundThis study aimed to analyze ocular characteristics in patients diagnosed with spherophakia, establish effective diagnostic criteria, and aid clinicians in prompt identification and management. MethodsA retrospective case series identified spherophakia cases through medical records and literature searches. The case group included spherophakia patients, and the control group comprised individuals with similar eye conditions. Intraocular lens calculations used the SRK-T formula, and statistical analyses were performed using SPSS. Diagnostic efficacy was assessed through receiver operating characteristic (ROC) curve analysis. ResultsThe study included 12 cases (23 eyes) from medical records and 86 patients (142 eyes) from literature sources. Characteristics of spherophakia included bilateral involvement, younger age, shallow anterior chamber depth, lens dislocation, and secondary glaucoma. A diagnostic criterion based on lens power demonstrated high sensitivity (94.3 %) and specificity (91.9 %). ROC analysis yielded area under the ROC curve (AUROC) values of 0.974 for lens power, outperforming refractive error (0.119), corneal curvature (0.465) and axial length (0.496). The lens power cutoff for diagnosing spherophakia was 31.25D. ConclusionThe study offers crucial insights into spherophakia's clinical characteristics and presents a practical diagnostic criterion using lens power, enhancing early detection and management. Further research is needed to validate and refine these findings, establishing standardized diagnostic criteria for spherophakia.

Loss-of-function variants in JPH1 cause congenital myopathy with prominent facial and ocular involvement

BackgroundWeakness of facial, ocular and axial muscles is a common clinical presentation in congenital myopathies caused by pathogenic variants in genes encoding triad proteins. Abnormalities in triad structure and function...

Letter to the Editor: Comment on Bocanegra-Oyola et al’s “Clinical Characteristics of Ocular Mucous Membrane Pemphigoid: A Systematic Review and Meta-Analysis”

ABSTRACT The work by Bocanegra-Oyola et al. provides a qualitative analysis and meta-analysis of ocular pemphigoid characteristics. This correspondence discusses the need for diagnostic process optimization to better differentiate between ocular pemphigoid and its mimicker pseudopemphigoid.

Retinal nerve fiber layer defects and chronic kidney disease: the Kailuan Eye Study.

To investigate whether retinal nerve fiber layer defects (RNFLDs) is a potential risk factor for chronic kidney disease (CKD) in Chinese adults. The Kailuan Eye Study was a population-based study that included 14 440 participants. All participants underwent detailed assessments, RNFLDs were diagnosed using color fundus photographs. Overall, 12 507 participants [8533 males (68.23%)] had complete systemic examination data and at least one evaluable fundus photograph. RNFLDs were found in 621 participants [5.0%; 95% confidence interval (CI): 4.6%-5.34%], and 70 cases of multiple RNFLDs were found (11.27%). After adjusting multiple factors, RNFLDs was significantly associated with CKD severity, the ORs of CKD stage 3, stage 4 and stage 5 were 1.698, 4.167, and 9.512, respectively. Multiple RNFLDs were also associated with CKD severity after adjusting multiple factors, the ORs of CKD stage 3 and stage 5 were 4.465 and 11.833 respectively. Furthermore, 2294 participants had CKD (18.34%, 95%CI: 17.68%-18.99%). After adjusting for other factors, CKD presence was significantly correlated with the presence of RNFLDs. The strongest risk factors for RNFLDs are CKD and hypertension. Conversely, RNFLDs can be an ocular feature in patients with CKD. Fundoscopy can help detect systemic diseases, and assessment for RNFLDs should be considered in CKD patients.

Age-related analysis of corneal biomechanical parameters in healthy Chinese individuals

To report the correlation between corneal biomechanical parameters and age in healthy Chinese individuals. This cross-sectional study was conducted on 864 eyes of 543 healthy participants. A comprehensive ophthalmic examination and corneal biomechanics examination using Corneal Visualization Scheimpflug Technology (Corvis ST) were conducted. Based on age, all participants were further divided into five age groups (n) as follows: group A, 11–20 years (105); group B, 21–30 years (112); group C, 31–40 years (113); group D, 41–50 years (100); and group E, > 50 years (113). Using Corvis ST, we examined 35 corneal biomechanical parameters and compared them across the different age groups. Spearman’s correlation coefficients and stepwise multivariate linear regression models were used to investigate whether the corneal biomechanical parameters were related to demographic and ocular characteristics. A correlation analysis between the left and right eyes revealed that 13 parameters were significantly associated with eye differences. Among the 35 corneal biomechanical parameters, 28 exhibited significant differences across the age groups, with stiffness parameter at applanation 1(SPA1) showing an upward trend after the age of 30 and stress–strain index (SSI) demonstrates a statistically significant upward trend when comparing the five age groups in the study. Additionally, Spearman’s correlation analysis and stepwise multivariate linear regression analysis revealed that 11 corneal biomechanical parameters were positively correlated with age and 10 were negatively correlated with age. Corvis biomechanical index (CBI) was significantly negatively correlated with intraocular pressure (IOP) and central corneal thickness (CCT), SSI was significantly positively correlated with age and IOP, and SPA1 were positively correlated with IOP and CCT. In conclusion, most corneal biomechanical parameters showed a significant correlation with age, with corneal stiffness progressively increasing alongside advancing age, IOP, or CCT.

Management of aortic disease in children with FBN1-related Marfan syndrome.

Marfan syndrome (MFS) is a hereditary connective tissue disorder with an estimated prevalence of 1:5000-1:10 000 individuals. It is a pleiotropic disease characterized by specific ocular, cardiovascular, and skeletal features. The most common cardiovascular complication is aortic root dilatation which untreated can lead to life-threatening aortic root dissection, mainly occurring in adult patients. Prompt diagnosis, appropriate follow-up, and timely treatment can prevent aortic events. Currently there are no specific recommendations for treatment of children with MFS, and management is greatly based on adult guidelines. Furthermore, due to the scarcity of studies including children, there is a lack of uniform treatment across different centres. This consensus document aims at bridging these gaps of knowledge. This work is a joint collaboration between the paediatric subgroup of the European Network of Vascular Diseases (VASCERN, Heritable Thoracic Aortic Disease Working Group) and the Association for European Paediatric and Congenital Cardiology (AEPC). A group of experts from 12 different centres and 8 different countries participated in this effort. This document reviews four main subjects, namely, (i) imaging of the aorta at diagnosis and follow-up, (ii) recommendations on medical treatment, (iii) recommendations on surgical treatment, and (iv) recommendations on sport participation.

Risk factors for cardiometabolic health in Ghana: Cardiometabolic Risks Study Protocol-APTI Project.

Cardiometabolic diseases are rapidly becoming primary causes of death in developing countries, including Ghana. However, risk factors for these diseases, including obesity phenotype, and availability of cost-effective diagnostic criteria are poorly documented in an African-ancestry populations in their native locations. The extent to which the environment, occupation, geography, stress, and sleep habits contribute to the development of Cardiometabolic disorders should be examined. The overall goal of this study is to determine the prevalence of undiagnosed diabetes, prediabetes, and associated cardiovascular risks using a multi-sampled oral glucose tolerance test. The study will also investigate the phenotype and ocular characteristics of diabetes and prediabetes subgroups, as well as determine if lifestyle changes over a one-year period will impact the progression of diabetes and prediabetes. The study employs a community-based quasi-experimental design, making use of pre- and post-intervention data, as well as a questionnaire survey of 1200 individuals residing in the Cape Coast metropolis to ascertain the prevalence and risk factors for undiagnosed diabetes and prediabetes. Physical activity, dietary habits, stress levels, sleep patterns, body image perception, and demographic characteristics will be assessed. Glucose dysregulation will be detected using oral glucose tolerance test, fasting plasma glucose, and glycated hemoglobin. Liver and kidney function will also be assessed. Diabetes and prediabetes will be classified using the American Diabetes Association criteria. Descriptive statistics, including percentages, will be used to determine the prevalence of undiagnosed diabetes and cardiovascular risks. Inferential statistics, including ANOVA, t-tests, chi-square tests, ROC curves, logistic regression, and linear mixed model regression will be used to analyze the phenotypic variations in the population, ocular characteristics, glycemic levels, sensitivity levels of diagnostic tests, etiological cause of diabetes in the population, and effects of lifestyle modifications, respectively. Additionally, t-tests will be used to assess changes in glucose regulation biomarkers after lifestyle modifications. Ethics approval was granted by the Institutional Review Board of the University of Cape Coast, Ghana (UCCIRB/EXT/2022/27). The findings will be disseminated in community workshops, online learning platforms, academic conferences and submitted to peer-reviewed journals for publication.