Kidney transplantation remains the optimal treatment for children with end-stage renal disease (ESRD), 25%-40% of which are estimated to be caused by congenital malformations and genetic syndromes. Given the widespread nature of this surgical procedure, ocular complications may arise from the operation itself or from subsequent medical treatments. The aim of this study is to determine whether there are postoperative refractive changes in pediatric patients who have undergone kidney transplantation and to detect the presence of refractive changes that may cause amblyopia in patient follow-ups. The electronic medical records of 1144 patients who underwent kidney transplantation at the Akdeniz University Hospital Organ Transplant Center between January 2019 and January 2024 were reviewed retrospectively. Of these, 84 pediatric patients who had undergone a complete ophthalmologic examination at least 1 year after kidney transplantation and had no missing data were included in the study. For both eyes, all data were recorded, including Best Corrected Visual Acuity (BCVA), refractive error (measured with the KR-8900; Topcon, Tokyo, Japan), spherical equivalent refractions (SER), slit-lamp examination of the anterior segment, and a dilated fundus examination. The average age of patients who underwent kidney transplantation in the study is 13.01 ± 3.43 (6-18). The average follow-up period was 51.81 ± 33.5 (45-129) months. Thirty-five (41.7%) of the patients are female, and 49 (58.3%) are male. Cataracts were observed in 9 (10.7%) patients during follow-up after transplantation. Cataract development was observed on average in 5.6 years. Posterior subcapsular cataracts were observed in seven patients, cortical cataract in one patient, and anterior polar cataract in one patient. The mean preoperative visual acuity value in patients who developed cataracts after kidney transplantation was 0.00 logMAR, while it was measured as 0.19 logMAR in the postoperative period, and this decrease is statistically significant (p = 0.027). In patients who did not develop cataracts during the follow-up period, there was no statistically significant change in visual acuity in both eyes (p = 0.109). When all eyes are evaluated, the change in SER after kidney transplantation is not statistically significant compared with before (p = 0.689 for the right eye, p = 0.596 for the left eye). Although children receive longer-term immunosuppressive treatment, their cataract development rates are lower than those of adults. Despite intensive and prolonged immunosuppression therapy after kidney transplantation, cataract development and refractive changes in the pediatric age group are at an acceptable level. Especially in children who are too young to express themselves clearly, monitoring refractive changes is crucial to prevent permanent vision loss.

Changes in choroidal thickness are currently used to predict future refractive error development but there is incomplete knowledge about the communication between choroid and sclera. We studied how choroidal thickness changes interact with scleral thickness changes and how the abundance of dopamine (DA)- and all-trans retinoic acid (atRA)-synthetizing choroidal cells varies when choroidal thickness is altered by drugs. Changes in choroidal thickness were induced by a single intravitreal injection in the morning of the muscarinic antagonist atropine, the DA agonist apomorphine or the DA antagonist spiperone. Thickness of the choroid and the scleral layers was measured by spectral domain optical coherence tomography (SD-OCT). Immunocytochemistry was used to study the distribution of dopamine-synthetizing structures in the choroid and their colocalisation with retinaldehyde dehydrogenase 2 (RADLH2), the key synthetizing enzyme of atRA. (1) Both atropine and apomorphine increased choroidal thickness over the day while spiperone resulted in a decrease. (2) For apomorphine and spiperone, choroidal thickness changes were positively correlated with thickness changes in both the cartilaginous and fibrous layers of the sclera. With atropine, only the cartilaginous layer thickened. (3) DA was co-localized with RALDH2 in stromal cells in the choroid in a few cases but the numbers of double-stained cells increased massively after drug injections. (4) RALDH2-immunoreactivity (indicating atRA activity) increased, no matter whether the choroid and the sclera thickened or thinned. Following drug injections, thickness changes of choroid and sclera were correlated and occurred without phase delay. Numbers of DA and RALDH2 co-expressing cells in the choroid increased. Choroidal dopaminergic cells that synthesize atRA appear to act as activators of scleral metabolic activity during both scleral growth stimulation and inhibition.

Purpose: To systematically evaluate and compare the effectiveness and safety of small incision lenticule extraction (SMILE), laser in situ keratomileusis (LASIK), and photorefractive keratectomy (PRK) for myopic correction through thorough synthesis of contemporary evidence. Methods: Systematic review was conducted following PRISMA guidelines. Comprehensive scarches were performed in PubMed/MEDLINE, Embase, Cochrane Library, Web of Science and Scopus from January 2020 to December 2025. Eligible studies included randomized controlled trials, prospective comparative studies, retrospective comparative studies, and meta- analysis comparing at least two of the three techniques for myopic correction with minimum 6-month follow-up. Primary outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive predictability (+0.50 D and +1.OO D), efficacy index and safety index. Secondary outcomes encompassed intraoperative and postoperative complications, corneal ectasia, contrast sensitivity, higher-order aberrations (coma, spherical aberration, total HOAs), and dry eye parameters (tear break-up time, Schirmer test, Ocular Surface Disease Index). Results: From 1,034 initially identified records, 230 unique studies underwent full-text review, with 30 studies meeting inclusion criteria for qualitative synthesis. AlI techniques achieved excellent visual outcomes with efficacy indices 0.94 and comparable postoperative UDVA and CDVA SMILE produced significantly larger effective optical zones (22.18 + 2.61 mm) compared to LASIK (19.54 + 1.44 mm) and PRK (19.39 + 1.66 mm), correlating with reduced spherical aberration induction. Post-refractive ectasia incidence without identifiable preoperative risk factors was lowest for SMILE (11 per 100.000 eyes), followed by PRK (20 per 100.000), and highest for LASIK (90 per 100.000), with LASIK demonstrating 4.5-fold higher risk than PRK Dry eye symptoms were most pronounced following LASIK due to extensive corneal nerve disruption, while SMILE showed superior preservation of corneal biomechanical integrity. Conclusions: SMILE, LASIK, and PRK achieve comparable refraction results for myopic correction with efficacy indices exceeding 0.94 across all modalities However SMILE offers distinct advantages including larger effective optical zones, reduced higher-order aberration induction, lower ectasia risk and better preservation of corneal biomechanics and tear film stability: LASIK remains associated with higher ectasia rates and more pronounced dry eye symptoms PRK demonstrates intermediate safety profiles with prolonged visual recovery. Technique selection should be individualized based on preoperative corneal parameters, refraction error magnitude, patient occupation, and risk tolerance for specific complications.

Laser refractive surgery- encompassing both LASIK (Laser-Assisted in Situ Keratomileusis) and PRK (Photorefractive Keratectomy) - represents one of the most widely performed elective procedures for correcting refractive errors worldwide. The wound healing response following these interventions involves intricate molecular cascades, with transforming growth factor-beta (TGF-β) playing a pivotal regulatory role in stromal remodeling. This cytokine orchestrates the transformation of quiescent keratocytes into contractile myofibroblasts, modulates extracellular matrix synthesis, and influences the development of corneal haze-a complication that can compromise visual outcomes. The present review examines the mechanistic underpinnings of TGF-β action in corneal wound healing, compares the differential stromal responses between LASIK and PRK, and analyzes the clinical implications of these processes. Understanding TGF- β-mediated pathways provides a foundation for developing targeted therapeutic strategies aimed at minimizing fibrotic responses and optimizing clinical outcomes following refractive surgery. By elucidating the molecular distinctions between these two surgical approaches, we can better predict healing trajectories and tailor interventions to individual patient needs.

To evaluate the integrity of the peripapillary (pp) and macular (m) retinal nerve fibre layer (RNFL) and the macular ganglion cell layer (GCL) in young adults with low myopia. The study was observational and cross-sectional in design. A total of 122 participants (61 emmetropes and 61 low myopes) were recruited, with a mean age 20.5 ± 1.86 years. Low myopia was defined as a spherical equivalent refraction (SER) between -0.75 and -3.00 D; controls had SER between +0.50 and -0.50 D. Refractive error was measured using the Essilor AKR550 Auto Kerato-Refractor. Axial length (AL) was assessed with the NIDEK AL-Scan Optical Biometer. Retinal layers were imaged using the Heidelberg Spectralis OCT, capturing macular RNFL (mRNFL), peripapillary RNFL (ppRNFL), Bruch's membrane opening-RNFL (BMO-RNFL) and macular GCL (mGCL) thickness. Independent t tests/Mann-Whitney Utests compared thicknesses; multivariate linear regression evaluated associations between AL, SER, RNFL and GCL measures. The Holm-Bonferroni correction was applied for all p values. Mean SER was -0.25 ± 0.25 D (emmetropes) and -1.25 ± 0.57 D (low myopes); mean AL in the same groups was 23.41 ± 0.77 and 23.76 ± 0.82 mm, respectively. Low myopes showed significant thinning in the inferior (p = 0.03); Cohen's d effect size = -0.23 and temporal (p = 0.01); Cohen's d effect size = -0.61 regions of the outer mGCL. AL showed positive associations mostly with mRNFL and mGCL, although they were weaker in low myopes. Similarly, weaker positive correlations were also found in low myopes between AL and global ppRNFL (p = 0.02) when compared with near-emmetropes. Significant differences in the inferior and temporal GCL layers in low myopes may suggest early structural changes. These findings highlight that myopia is not solely a refractive issue and suggest early intervention strategies may not be limited to high myopia cases.

To evaluate the clinical outcomes of femtosecond laser-created corneal allogenic intrastromal ring segments (femto-CAIRS) in keratoconic eyes using a newly described nomogram. This retrospective case series recruited 85 eyes from 75 patients. Corrected and uncorrected visual acuity (CDVA/UDVA), refractive error, corneal topography, and higher-order aberrations were measured prior to surgery and ≥ 3 months postoperatively. All CAIRS were created using a femtosecond laser and the Brisbane nomogram was used to determine segment width, thickness, arc length, implantation axis and channel depth based on individual corneal topography. The mean follow-up time was 7.5 ± 5.0 months; 18 eyes had prior cross-linking (CXL), 30 underwent simultaneous CXL, and 37 had no CXL. Postoperatively, UDVA improved by 0.4 logMAR (p < 0.001) and CDVA by 0.2 logMAR (p < 0.001). There was an improvement of 5 or more lines in 31 eyes (43.7%), 8 eyes (11.3%) had no change in UDVA, 1 eye lost 1 line, and 1 eye lost 2 lines. There was a significant reduction in the mean spherical equivalent, refractive astigmatism, flat K, steep K, mean K, and KMax, and an improvement in total higher order aberrations and vertical coma (all p < 0.001). Reduction in KMax was greater in eyes that underwent simultaneous CXL compared to those without CXL (-4.28D vs. -0.70D; p = 0.018). No significant complications occurred. Femto-CAIRS guided by the Brisbane nomogram provides a tailored treatment approach that improved visual acuity and regularisation of the central cornea. Further studies are required to validate our nomogram and clarify the effect of cross-linking on CAIRS.

Distance visual acuity (VA) has been associated with refractive error in older children, but less is known about children <6 years of age and those without a history of refractive correction. This study examined the utility of VA testing and its relationship to refractive error in children aged 3 to <10 years without a history of refractive correction. Unaided monocular distance VA testing was performed at 3 m (age 3-6 years: ATS-HOTV chart; 7-<10 years: E-ETDRS chart) and near VA at 40 cm (ATS-4 Near VA). Cycloplegic autorefraction was used to categorise participants as myopic (sphere ≤ -0.75 dioptres (D)), hyperopic (sphere ≥2 D), astigmatic (cylinder ≥1.50 D) and emmetropic (< 0.75 D myopia and <2 D hyperopia). Receiver operating characteristic curves assessed the utility of VA testing in classifying children by refractive error type. Linear regressions examined the predictive value of refractive error magnitude in determining distance and near VA while accounting for age. Of 358 children, 84 (23.5%) had hyperopia, 30 (8.4%) myopia, 39 (10.9%) astigmatism and 229 (64.0%) emmetropia. Reduced distance VA was associated with myopia (area under the curve (AUC) = 91%, optimal cut-off = 0.15 logMAR) and astigmatism (AUC = 87%, cut-off = 0.25 logMAR), but not hyperopia (AUC = 63%, cut-off = 0.05 logMAR). Near VA showed only mildly higher performance for hyperopia (AUC = 70%, cut-off = 0.15 logMAR). For every 0.36 D increase in myopia, distance VA declined by 0.10 logMAR (p < 0.001). Distance and near VA were not predicted by the magnitude of hyperopia (distance: p = 0.30; near: p = 0.30) or astigmatism (distance: p = 0.35; near: p = 0.06). In children 3 to <10 years of age without prior refractive correction, reduced distance VA was associated with myopia and astigmatism, but not hyperopia; an incremental decline in VA with increasing refractive error magnitude was seen only in myopia.

To compare the efficacy and safety of 0.50% and 0.75% pilocarpine ophthalmic solutions for treating presbyopia. In this prospective study, 22 presbyopic subjects (44 eyes) were assigned to use 0.50% or 0.75% pilocarpine bilaterally, once daily for 2 weeks. Primary outcomes included distance-corrected intermediate visual acuity (DCIVA) at 66 cm and distance-corrected near visual acuity (DCNVA) at 40 cm under photopic and mesopic conditions, pupil size, refractive error, intraocular pressure (IOP) and patient-reported adverse events. Assessments were conducted at baseline, day 1 (after 1 and 6 h) and week 2 (after 1 h). No serious adverse events occurred. Neither formulation affected IOP or refractive error significantly. Pupil constriction was greater in the 0.75% group than the 0.50% group (2.8 ± 1.1 vs. 2.0 ± 0.8 mm, p = 0.02). After 2 weeks, the gain in photopic DCNVA was 0.18 logMAR for both concentrations (p = 0.70). The respective gain in visual acuity measures for the 0.75% and 0.50% groups was: mesopic DCNVA, 0.14 and 0.19 logMAR (p = 0.25); photopic DCIVA, 0.14 and 0.09 logMAR (p = 0.02); mesopic DCIVA, 0.12 and 0.10 logMAR (p = 0.18). Both 0.50% and 0.75% pilocarpine improved visual performance in presbyopia significantly, suggesting it is a promising treatment option. Chinese Clinical Trial Registry (ChiCTR), 2023/3/2, No.ChiCTR2300068971.

Visual and refractive outcomes with intrascleral haptic fixation of the light adjustable lens.

To evaluate the prevalence of achromatopsia (ACHM) associated with variants of RPGRIP1 , especially c.2710+374_2895+78del ( RPGRIP1 -ex18-DEL), and to confirm that these phenotypes were consistent with ACHM in Japanese patients. This retrospective observational study involved a review of medical records from 52 patients across 47 Japanese families; all clinically diagnosed with ACHM. Causative variants for ACHM were identified in 39 families via whole-exome sequencing, whole-genome sequencing, or polymerase chain reaction: PDE6C (13 families), RPGRIP1 -ex18-DEL (11 families), CNGA3 (11 families), CNGB3 (2 families), and GNAT2 (2 families). Patients with ACHM associated with RPGRIP1 -ex18-DEL variants did not exhibit significant difference in phenotype, including spherical equivalent refractive error, best-corrected visual acuity (BCVA), fundus appearance, ellipsoid zone grading of optical coherence tomography, and fundus autofluorescence pattern, compared to those with variants in CNGA3 or PDE6C at baseline (all, P > 0.05). For five ACHM patients with RPGRIP1 -ex18-DEL variants, no change in BCVA or ellipsoid zone grading was noted over a follow-up period of >10 years (all, P > 0.05). Variants in RPGRIP1 -ex18-DEL are unique hotspots with a high prevalence among Japanese patients with ACHM. Clinical findings in these patients are consistent with those in patients with ACHM from other causative genes.

To determine whether individuals with developmental dyslexia present differences in visual and oculomotor functions compared with age-matched controls. Developmental dyslexia affects a substantial proportion of school-aged children, with prevalence estimates ranging between 3% and 6%, depending on diagnostic criteria. It is characterised by persistent reading difficulties despite normal intelligence and education. Although phonological deficits are well established, the contribution of visual and oculomotor anomalies remains debated. Identifying consistent visual differences may support more comprehensive assessments and targeted interventions alongside educational strategies. This systematic review and meta-analysis, registered in PROSPERO (CRD420251119429), included observational case-control studies comparing visual and oculomotor functions in individuals with developmental dyslexia and age-matched controls. Searches were conducted in PubMed, Web of Science, and Scopus. Outcomes included binocular vision, oculomotor performance, accommodation, visual acuity, refractive error and contrast sensitivity. Methodological quality was assessed using the MINORS tool and certainty of evidence using GRADE. Twenty-six studies with 8 to 124 participants per group were included. Dyslexic individuals showed significantly greater near exophoria (mean difference 0.84 prism diopters, 95% CI: 0.22 to 1.46) and reduced near fusional vergence ranges, including negative (-6.42 prism diopters, 95% CI: -8.65 to -4.19) and positive fusional vergence (-6.72 prism diopters, 95% CI: -8.66 to -4.77), all p < 0.01. Oculomotor differences included a higher number of fixations, longer fixation duration, more regressions and reduced saccade amplitude. No significant group differences were found for refractive error or visual acuity. Children with developmental dyslexia exhibit consistent binocular and oculomotor anomalies that may increase visual effort during reading. Incorporating targeted assessment of these functions into vision care may complement multidisciplinary management. Further research is needed to clarify their clinical relevance.

The aim of this study was to assess the effect of including lens thickness (LT) in modern intraocular lens (IOL) formulas and evaluate the influence of ocular biometric parameters on IOL power calculation accuracy in short and normal axial length (AL) eyes. This retrospective cohort study included 174 eyes (74 short AL < 22mm, 100 normal AL 22-24mm). Preoperative biometry was obtained using IOLMaster 700. Predicted refractions were calculated using SRK/T, Haigis, Barrett Universal II (BUII), Kane, and Emmetropia Verifying Optical (EVO) formulas, with and without LT. Spearman correlation and multivariate regression analyses were performed to identify biometric predictors of refractive error. Short eyes had significantly shallower anterior chamber depth (ACD), smaller white-to-white (WTW), thicker LT, and higher mean keratometry (Km) and corneal astigmatism (CA) (all p < 0.01). No significant differences in mean absolute error (MAE) were detected between most formula pairs after adjustment in either subgroup. LT inclusion resulted in a less myopic mean prediction error in both subgroups (all p < 0.01), but MAE improvements were only seen in normal eyes (p < 0.05). AL and WTW were consistent predictors of absolute prediction error (APE) overall, with shorter AL and smaller WTW associated with greater APE. In short eyes, AL showed the strongest association with APE, whereas in normal eyes, WTW was most strongly correlated with APE. Short eyes exhibited greater biometric variability. Incorporation of LT improved the overall prediction accuracy of modern IOL formulas, particularly in normal AL eyes. AL and WTW were the most influential biometric factors affecting refractive prediction outcomes. Chinese Clinical Trial Registry (ChiCTR), ChiCTR2600116749; retrospectively registered on 14 January 2026.

Visual impairment caused by refractive errors and retinal diseases such as diabetic retinopathy and glaucoma remains a major global health concern. Early detection and accurate refractive assessment are essential to prevent irreversible vision loss; however, conventional diagnostic procedures require specialized equipment and trained professionals, limiting accessibility in remote and resource-constrained regions. This paper presents a Hybrid Eye Power and Disease Prediction System that integrates convolutional neural network (CNN)-based retinal image analysis with machine learning-driven perception testing. A DenseNet-121 model is employed for refractive error regression and classification from retinal fundus images, while a K-Nearest Neighbors (KNN) model analyzes structured visual acuity test responses to estimate eye power. A weighted fusion mechanism combines predictions from both modalities to enhance accuracy and robustness. Additionally, a MobileNetV2-based module performs multi-class retinal disease detection, further fused with symptom-based inputs to generate a comprehensive disease risk score. Experimental results demonstrate that the proposed hybrid framework outperforms single-modality approaches, achieving reduced regression error and improved classification metrics for both refractive estimation and disease detection. The multimodal design enhances stability against image variability and subjective response inconsistencies. The system is intended as a non-invasive, screening-support tool suitable for telemedicine, school health programs, and large-scale preliminary eye assessment. While not a replacement for clinical diagnosis, it offers a scalable and accessible solution for early ocular evaluation and risk stratification.

To review literature on anisometropia, concentrating on diagnostic criteria, contemporary prevalence and progression with regard to the changing distribution of refractive errors in many countries. Also, to consider anisometropia with respect to myopia and hyperopia control, regions/race/ethnicity, effects on visual function and associated conditions. Scoping review based on searches of PubMed, Embase and Cochrane databases. Various diagnostic criteria have been used for anisometropia, most commonly a SER difference ≥1.00 D. Anisometropia is more common in people with higher refractive errors, and therefore, its prevalence changes with the frequency distribution of refractive errors. Anisometropia is traditionally mostly associated with hyperopia, and this is still the case in some populations. In East and South-East Asia, the rapid increase in myopia has resulted in increased anisometropia. This is associated with impaired stereopsis and binocularity, as well as increased rates of strabismus and amblyopia. When anisometropia is corrected with spectacles, there is an increased risk of spectacle non-tolerance arising from aniseikonia (different image sizes in each eye) and prismatic effects. Contact lenses alleviate most of the problems associated with anisometropia, but are under-prescribed for this condition. The increased association between anisometropia and myopia has led to trials of myopia control interventions, which show promise for reducing anisometropia in myopic cases. However, since myopia in one eye is often a precursor of bilateral myopia, the likelihood of pre-myopia in the non-myopic eye should be considered. The association between anisometropia and the magnitude of refractive error means that in populations with a high prevalence of myopia, anisometropia has largely become a feature of that refractive error, in contrast to the traditional association with hyperopia. This has important implications for myopia control. Vision screening and/or routine professional eye care are recommended because anisometropia is under-diagnosed.

Beta-blockers in post-myocardial infarction patients: refractive errors in reading the evidence.

PurposeELITA Femtosecond Laser System (Johnson & Johnson) is a next-generation ophthalmic laser platform designed for Smooth Incision Lenticular Keratomileusis (SILK). A retrospective study evaluated refractive outcomes, visual acuity, higher-order aberrations (HOAs), tear film parameters, and dry eye symptoms 30 days postoperatively.Patients and MethodsA retrospective, non-comparative, case series analyzing real-world data from patients with myopia treated using the SILK procedure with the ELITA femtosecond laser. The study included 144 eyes from 73 consecutive patients (47 female, 26 male) with myopia (−4.51 ± 1.36 D; range −1.50 D to −8.250 D). Refraction and uncorrected distance visual acuity (UDVA) were assessed preoperatively and at 1, 7, and 30 days postoperatively. A subset of 18 patients (36 eyes) underwent additional evaluation of tear film (Keratograph, LipiView, Schirmer II, NIBUT), dry eye symptoms (OSDI), and HOAs/contrast sensitivity (iTrace).ResultsAt 30-days, 96.5% of eyes (139/144) achieved 20/20 UDVA while the remaining 3.5% achieved 20/25. The mean spherical equivalent was −0.22 ± 0.68 D. No significant changes were observed in tear film metrics, HOAs, or contrast sensitivity. A statistically significant difference in vertical coma was noted (0.05 ± 0.04 µm vs 0.1 ± 0.09 µm, P = 0.008), though not clinically relevant. No serious adverse events occurred.ConclusionThe SILK procedure with the ELITA femtosecond laser platform is safe and effective for myopia correction (with and without astigmatism), with no detrimental effect on tear film stability, dry eye symptoms, or visual quality at 30 days post-surgery.

The effect of mode of delivery on refractive errors in preschool children

Purpose The eye dominance distribution in humans varies according to the assessment method. Although the correlation between refractive asymmetry and eye dominance has long been investigated, the results are inconsistent. Here, we analyzed the relationships between refractive asymmetry and eye dominance measured by fixation and sensory methods and assessed the concordance of the two methods. Methods One hundred and twelve subjects were enrolled to evaluate their refractive asymmetry and eye dominance. Refractive error was determined through objective and subjective refraction. The assessment of fixation eye dominance was conducted using the hole-in-card method, while the binocular orientation combination task was used to assess sensory dominance. Subgroups of anisometropia and non-anisometropia patients were established to evaluate the influence of the magnitude of refractive asymmetry. Results Among all subjects, the right eye exhibited greater fixation eye dominance than the left eye (p = 0.001), while sensory eye dominance was more even (p = 0.85). The concordance between these two methods was nonsignificant (p = 0.952). Only the spherical equivalent power difference in the non-anisometropia group was significant between the sensory dominant and nondominant eyes (p = 0.015). The right eye showed greater myopic spherical and spherical equivalent power (spherical power: p = 0.004, spherical equivalent power: p = 0.003). The absolute balance point was greater in individuals with anisometropia (p = 0.015). Moreover, a positive correlation was found between sensory eye imbalance and refractive asymmetry (r = 0.239, p = 0.011). Conclusion We assessed the difference between two assessments of eye dominance and determined that the sensory eye imbalance was greater in individuals with anisometropia. Additionally, a larger absolute balance point value indicated a greater refractive asymmetry.

The effect of mode of delivery on refractive errors in preschool children

Visual impairment (VI) affects more than 600 million people globally and significantly reduces quality of life. In Singapore, 20% of adults aged 60 years and older (~180,000 people) have VI, a figure expected to double by 2030 due to population aging. While about half of VI cases are due to uncorrected refractive errors, the rest are caused by age-related diseases. The current traditional screening model is a 2-visit, labor-intensive approach with low follow-up rates and frequent unnecessary referrals. Although AI for Disease-related Visual Impairment Screening Using Retinal Imaging, the deep learning model in this study, has demonstrated strong diagnostic performance in retrospective datasets (area under the curve=0.942), key aspects of real-world implementation such as operational efficiency, patient acceptability, workflow feasibility, and cost remain insufficiently studied. As a result, real-world evidence directly comparing artificial intelligence (AI)-assisted and traditional screening pathways is limited. This study aims to evaluate the referral accuracy, operational efficiency, acceptability, feasibility, and cost of an AI-assisted screening model compared with the current traditional screening model. This study aims to recruit 1000 participants aged 50 years and older using a 2-arm pragmatic randomized controlled trial design. Participants with presenting visual acuity worse than 6/12 (L2) will be randomized 1:1 into either the AI-assisted or traditional screening arms. In the AI-assisted arm, the AI model will analyze retinal photos on-site, with positive cases referred to an optometrist for secondary evaluation. The AI model, previously developed with promising diagnostic accuracy and further validated using community-acquired data, has been integrated with a custom user interface for use in this study. Traditional screening will include pinhole visual acuity, intraocular pressure, slit lamp examination, auto refraction, and retinal photography. All L2 participants will complete a patient-acceptance questionnaire and undergo assessments to determine ground truth. The study was funded in 2022. Participant recruitment commenced in July 2024, with 487 participants enrolled as of September 14, 2024. Recruitment is ongoing, with study completion anticipated by March 2026 and data analysis expected to begin in April 2026. This study will provide critical evidence on the clinical utility, feasibility, and cost analysis of AI-assisted VI screening. Our findings may contribute real-world evidence to inform scalable, sustainable screening strategies that enhance efficiency, accuracy, and health system outcomes.