OphthaTherapy. Therapies in Ophthalmology

Screening tests for early school-age children

Karolina Stanienda-Sokół — 2025-09-08

In young children, symptoms of eye diseases often go unnoticed. Disorders such as amblyopia, strabismus, and anisometropia can be detected during screening tests, which are crucial for early diagnosis and treatment. The most common cause of amblyopia is strabismus, but other vision defects can also cause it. High myopia, increasingly common among children, is associated with prolonged screen time. Screening tests have shown that 23.28% of children require further ophthalmological evaluation. Early examinations are crucial for proper visual development, so every child should be examined annually.

Contrast sensitivity from infancy to adulthood and its impact on selected eye diseases

Ewa Witowska Jelen — 2025-10-02

Contrast sensitivity is a key visual function that develops rapidly during infancy and plays a significant role in everyday visual activities. Unlike visual acuity, contrast sensitivity often deteriorates earlier and may remain reduced despite normal visual acuity. This review outlines the developmental trajectory of contrast perception and highlights its clinical importance in selected eye diseases such as glaucoma, age-related macular degeneration, and amblyopia. The article also emphasizes the importance of including contrast sensitivity testing in standard ophthalmic examinations.

Comparison of Snellen and ETDRS charts in visual acuity assessment: a systematic review

Przemysław Ciszewski — 2025-10-21

The aim of this review is to compare the two most commonly used tools for assessing visual acuity: the Snellen chart and the ETDRS chart, in terms of their accuracy, reproducibility, and clinical utility in ophthalmic diagnostics. The Snellen chart, introduced in 1862, is widely used but its design can lead to interpretative errors, particularly when assessing patients with various eye conditions. The ETDRS chart, developed for diabetic retinopathy studies, offers greater precision due to its uniform progression in letter size and the use of the logMAR scale. A systematic review of the literature demonstrates that the ETDRS chart is characterised by higher accuracy, lower variability in results, and better reproducibility compared to the Snellen chart, especially in patient populations with cataracts, amblyopia, macular degeneration, and other retinal disorders. Although the ETDRS test takes longer to perform, its superior precision makes it the preferred choice for clinical studies, whereas the Snellen chart remains more practical for routine diagnostics. This review highlights the importance of selecting the appropriate tool for visual acuity assessment depending on the clinical context, suggesting that the ETDRS chart may be a better option in more demanding diagnostic cases.

Uncorrected visual acuity in patients with simple myopic astigmatism based on the power and axis of the astigmatism

Hadis Pourchamani — 2025-10-29

Purpose: The aim of the current study is to assess uncorrected visual acuity in eyes with simple myopic astigmatism.

Methods: patients with simple myopic astigmatism who had no history of surgery or pathology with best-corrected visual acuity of logMAR 0.0 (or 6/6) were included in this study. In the present study, eyes were classified into three groups; with-the-rule (WTR) (180 ±30), against-the-rule (ATR) (90 ±30) and oblique. The comparison of uncorrected visual acuity among these three groups was made based on the power and type of refractive and corneal astigmatism.

Results: Only right eye per participant was chosen, providing a final sample of 1435 eyes. The number (percentage) of eyes with WTR, ATR and oblique astigmatism were 555 (38.7%), 681 (47.5%) and 199 (13.9%) respectively. The mean uncorrected visual acuity was different among three groups (p <0.001). Mean logMAR visual acuity in eyes with 1 D of astigmatism or less were 0.06 (±0.09), 0.07 (±0.09) and 0.06 (±0.08) in WTR, ATR and oblique astigmatism respectively. Mean logMAR visual acuity in eyes with greater than 3 D of astigmatism were 0.51 (±0.12), 0.17 (±0.06) and 0.43 (±0.19) in WTR, ATR and oblique astigmatism respectively which showed a significant difference among them (p <0.001).

Conclusion: The magnitude and axis of astigmatism both were associated with uncorrected visual acuity in eyes with simple myopic astigmatism so that increasing the power of astigmatism reduces vision.

Ocular decompression retinopathy solely following medical treatment in steroid induced glaucoma

Navjot Singh Ahluwalia — 2025-10-28

An 18-year-old male developed bilateral, steroid induced glaucoma and steroid induced cataract following topical steroid usage. Best corrected visual acuity was 6/60 and perception of light in right eye and left eye respectively. Both eyes had clear cornea, 7–8 mm sluggishly reacting pupil with an immature cortical cataract and advanced glaucomatous optic neuropathy in right eye and a near mature cortical cataract in left eye. Intraocular pressure (IOP) was ≥50 mmHg and angles were open on gonioscopy in both eyes. Tablet acetazolamide 250 mg q.i.d. for 1 week along with brimonidine 0.15% and timolol 0.5% fixed combination eye drops b.d, brinzolamide 1% eye drops t.d.s and netarsudil 0.02% eye drops o.d. were prescribed for both eyes. At 2 weeks follow up, IOP reduced to 14 mmHg and 18 mmHg in right eye and left eye respectively. However, surprisingly, the right eye showed multiple intraretinal blot haemorrhages, in greater numbers temporally and extending towards the equator in all quadrants. Post phacoemulsification, the left eye fundoscopy revealed very advanced glaucomatous optic neuropathy with two intraretinal blot haemorrhages. The best corrected visual acuity improved only marginally upto 6/36 (post phacotrabeculectomy) and hand movement (post phacoemulsification) in right eye and left eye respectively. At 8 weeks post right eye phacotrabeculectomy, all the haemorrhages resolved completely in both eyes without any intervention. This case developed ocular decompression retinopathy (ODR) solely following oral and topical IOP lowering therapy which is rare. It shows that an aggressive IOP reduction, meant to reduce the risk of postoperative ODR, can occasionally itself become the cause of ODR. This case also demonstrates that, such a reduction can still be exercised in crucial situations, in order to preserve vision and prevent blindness, since ODR is usually a self-resolving condition having a benign course.

Ocular toxoplasmosis: A review of current treatment options

Anthony Ueno — 2025-10-28

Ocular toxoplasmosis (OT), a global health concern due to the protozoan T. gondii, disproportionately affects immunocompromised individuals, causing severe eye infections and potential vision loss. This review aims to evaluate current treatment options, highlighting challenges in managing both congenital and acquired forms of the infection. Our analysis synthesizes findings from 21 recent studies and a key specialty textbook, selected through systematic searches on databases including PubMed and ScienceDirect, focusing on treatments developed since 2018 to ensure relevance in the field of OT management. While diagnosis relies heavily on clinical assessments, advanced imaging like optical coherence tomography and fluorescein angiography, as well as serological and PCR testing, have improved detection. Treatment primarily involves antiparasitic and antibacterial drugs, yet standard protocols, such as pyrimethamine and sulfadiazine combinations, often fail due to severe side effects and high recurrence rates. The emergence of drug-resistant strains complicates therapy, underscoring the necessity for novel treatment approaches. Recent advancements suggest potential in mitochondrial inhibitors and histone deacetylase inhibitors, yet further research is essential to minimize toxicity and enhance specificity. OT management is hindered by the complexity of its clinical presentation and the suboptimal efficacy of traditional treatments. Personalized treatment strategies, considering patient history and local drug availability, are critical for improving outcomes in those afflicted by this debilitating infection.

Is tolerance in glaucoma therapy overestimated and drug effectiveness underestimated?

Marta Misiuk-Hojło — 2025-09-30

Glaucoma pharmacotherapy is a long-term process in which subjective symptoms (related to medication intolerance) are being reported by patients with increasing frequency. As a result, therapeutic decisions made by clinicians may favor better-tolerated agents, even if they are potentially less effective. Intensification of glaucoma therapy is required when the target intraocular pressure is not achieved. This can be accomplished by adding another medication, switching to a fixed-combination preparation, or replacing the current drug with a more effective agent within the same class. The last approach is particularly relevant for prostaglandin analogues – a group that includes four active substances. Comparative analyses consistently show that bimatoprost provides a statistically significant, though relatively modest, additional intraocular pressure reduction compared with latanoprosts.

Red eye. Ophthalmologist’s and General Practitioner’s point of view. Therapy with low-dose brimonidine

Monika Udziela — 2025-10-29

Red eye is a symptom which may indicated different disorders. Mild hyperemia may occur without any defined aetiology and may cause esthetical and psychological problems for the patients. Diagnostics is crucial before implementing the symptomatic treatment to exclude any disease requiring targeted therapy. All cases of red eye symptom with pain and visual disturbances require special attention. Eyedrops with low-dose brimonidine are good alternative to other vasoconstrictors, as safe and well-tolerated medication not leading to hypoxia, tachyphylaxis and rebound effect.

Allergic conjunctivitis. How to alleviate symptoms. The perspective of an allergist and ophthalmologist

Anna Groblewska — 2025-09-30

Allergic ocular diseases (AO), such as seasonal (SAC) and perennial (PAC), are common, estimated to affect 14–45% of the general population, yet are often underdiagnosed and inadequately treated. Diagnosis is based on the history and the presence of symptoms such as itching, tearing, congestion, watery discharge, and discomfort, as well as a physical examination. Infections, especially viral infections, should be considered in the differential diagnosis. Skin prick testing and/or specific IgE testing are helpful in diagnosing the allergen and potentially initiating specific immunotherapy, the sole causal treatment. Symptomatic treatment of AO is gradual, with the goal of symptom control and improved quality of life. The first step is allergen avoidance and non-pharmacological interventions (cold compresses, artificial tears – preferably preservative-free). In mild cases, a preparation combining ectoine and hyaluronic acid can be effective, stabilizing the tear film and reducing inflammation, while being safe for children and pregnant women. The second step includes topical medications (H1 receptor blockers and mast cell stabilizers) and oral second-generation antihistamines (LH1). Azelastine (topical) deserves consideration due to its strong affinity for H1 receptors and dual antiallergic mechanism (rapid relief, convenient dosing). Oral LH1 is recommended to be initiated two weeks before the pollen season in the SAC. In more severe cases (third step), topical glucocorticosteroids (GCs) are used, always under the supervision of an ophthalmologist. Fludrocortisone acetate ointment is the only GC in this form approved for the treatment of allergic conjunctivitis and blepharitis. Intranasal GCs can alleviate ocular symptoms via the nasal-ocular reflex, especially in concomitant allergic rhinitis. In SAC and PAC, ophthalmological consultation is not usually required, but in other forms of AO, cooperation is essential.

Current methods of treating bacterial conjunctivitis

Marek E. Prost — 2025-10-28

One of the reasons for the development of antibiotic resistance in ophthalmology is the indiscriminate use of antibiotics in the treatment of conjunctivitis, among other things. Therefore, in infectious conjunctivitis, the first-line treatment should be antiseptics rather than antibiotics. This should significantly reduce the development of antibiotic resistance, but also increase the effectiveness of treatment.

Epidemiology of ocular trauma in a population-based study

Hadi Ostadimoghaddam — 2025-10-21

Purpose: the aim of this study was to determine the prevalence of ocular trauma in Iran through a population-based study.

Method: The target population of this population-based study was all the residents of Mashhad that were above 1 year of age. The randomized stratified cluster sampling method was used to select the participants. The study samples were selected proportional to each district of the city according to the 2006 census. The participants were interviewed to determine ocular trauma. The design effect was considered to calculate 95% confidence intervals.

Results: The prevalence of ocular trauma was 6.9%, 9.5%, and 5.5% in the whole population, men, and women, respectively. The prevalence of ocular trauma was lower in individuals with higher education. In addition, 2.3% of all the participants, 1.1% of women, and 4.6% of men had a history of hospitalization due to ocular trauma. The results of logistic regression showed a direct relationship between the history of ocular trauma and hospitalization with older age and female sex.

Conclusion: The prevalence of ocular trauma and the rate of hospitalization due to it are higher in men than women. The reason seems to be more exposure of men to environmental risk factors, especially at work environments.

Immediate effects of panretinal photocoagulation laser on intraocular pressure in proliferative diabetic retinopathy

Mehmona Asgher — 2025-10-28

Introduction: Diabetic retinopathy (DR), a major cause of global blindness, affecting approximately 93 million people worldwide. Its advanced stage, proliferative diabetic retinopathy (PDR), involves abnormal blood vessel growth, treated with PRP laser and anti-VEGF therapy. PRP uses Nd:YAG lasers to target retinal areas treatment.

Objectives: To find out the Immediate effects of panretinal photocoagulation (PRP) laser on intraocular pressure (IOP) in PDR and to check its association with age group, power group and number of shots group of PRP laser.

Materials and methods: A quasi-experimental pre and post-interventional study was carried out in Vitreo-retina Department of Tertiary Eye Care Hospital, from September 2020 to March 2021. A consecutive sampling technique was used. IOP was measured just before and after 20 min of laser with Goldmann applanation tonometer (GAT). Along with IOP, power, pulses/shots and spot size applied during PRP laser were also noted in the self-structured proforma. Data was analyzed using SPSS.

Results: Out of total 90 subjects, the rise in IOP was observed in 54 (60%) subjects while IOP was decreased in 27 (30%) and in 9 (10%) subjects there were no changes noted in IOP after PRP laser. Paired t-test results showed that IOP before (16.10 [±4.11] mmHg) and IOP after (17.90 [±5.23] mmHg) had statistically significant differences t (89) = 4.179; p = 0.001. Independent samples t-test results showed that IOP differences had significant association with number of shots group of PRP laser p = 0.02, while it showed non-significant association with age group p 0.09 and power group of PRP laser p = 0.97 respectively.

Conclusion: Acute elevation in IOP was observed after PRP laser, number of shots applied during PRP laser had significant association with differences in IOP.