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Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 15 February 2027 | Viewed by 8290

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Special Issue Editors

Prof. Dr. Jesús Merayo-Lloves

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Guest Editor

Instituto Universitario Fernández-Vega, University of Oviedo, 33012 Oviedo, Spain
Interests: ocular surface; ocular inflammation; allergy; dry eye; refractive surgery; uveitis; ocular regenerative medicine; ocular pharmacology; ocular immunology; ophthalmology education

Dr. Rodrigo Martin Torres

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Guest Editor Assistant

Colonia Avellaneda (Entre Ríos) Argentina Consejo Argentino de Oftalmología, Research and Developments, Buenos Aires city, Argentina
Interests: visual sciences; ophthalmology; medical devices; ocular surface, ocular immunology; ocular pharmacology; translational research; methodology; evidence-based medicine; epidemiology

Special Issue Information

Dear Colleagues,

Scientific evidence is continuing to emerge highlighting the impact of the environment and lifestyle on overall health, including the visual system. For example, during and after the COVID-19 pandemic, natural light was recognized as a key factor in myopia progression, while excessive screen use was linked to dry eye. Diet and nutrition remain a topic of debate, with challenges in separating science from myth. Meanwhile, technological advancements such as artificial intelligence are transforming diagnostics and treatment.

From early life stages to aging populations, environmental and lifestyle factors shape ocular health, influencing risks for preventable blindness. These factors can act as protective or risk elements for various visual conditions.

We invite the scientific community to contribute original research, narrative reviews, and systematic reviews focusing on epidemiology, diagnostics, and treatment and exploring the environment–lifestyle–vision nexus. Clinical cases offering unique insights into this relationship are also welcome as we expand our understanding of how to protect and optimize visual health.

Prof. Dr. Jesús Merayo-Lloves
Guest Editor

Dr. Rodrigo Martin Torres
Guest Editor Assistant

Manuscript Submission Information

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Keywords

vision science
ophthalmology
environment
lifestyle
aging

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Published Papers (6 papers)

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Research

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22 pages, 1421 KB

Open AccessArticle

Long-Term Outcomes of Intermittent Exotropia: A Real-World Longitudinal Cohort Study of 415 Patients

by Fatma Gul Yilmaz Cinar, Umay Guvenc, Rabia Akmaz, Yasemin Topalak and Ayse Burcu

Medicina 2026, 62(3), 481; https://doi.org/10.3390/medicina62030481 - 4 Mar 2026

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Abstract

Background and Objectives: Intermittent exotropia (IXT) is a common childhood strabismus with variable natural history and no universally accepted first-line management. We aimed to characterize long-term real-world outcomes and identify factors associated with alignment stability across surgical and non-surgical strategies. Materials and Methods: This retrospective single-center cohort study reviewed consecutive patients with IXT managed between January 2008 and March 2024. Clinical data included IXT subtype, prism and alternate cover test measurements, binocular control (ECS), stereopsis, refractive error, and treatments (observation, over-minus lenses, and surgery). Postoperative success was defined as ≤10 prism diopters (PD) of eso/exophoria without diplopia. Longitudinal refractive change was analyzed using linear mixed-effects modeling, and time to alignment failure (≤±10 PD at near and distance) was evaluated using Kaplan–Meier and Cox regression analyses. Results: A total of 415 patients were included (mean follow-up 53.2 ± 47.8 months). Over-minus therapy was used in 252 (60.7%) patients for a median of 24 months, and 61 (14.7%) achieved spontaneous alignment. At the final visit, combined near-and-distance alignment success was 41.0% (170/415). Among surgically treated patients (n = 167), motor success was 65.3% (109/167), with reoperation required in 12.6% (21/167). Kaplan–Meier analysis showed cumulative alignment survival of 0.899 at 1 year, 0.563 at 5 years, and 0.302 at 10 years (median 70 ± 4.7 months). In Cox modeling, surgery was strongly protective (HR 0.174), while older age (HR 1.040 per year) and poor baseline distance control (HR 1.421) increased the risk of failure; over-minus therapy was not independently associated with survival. Both treatment groups showed a similar myopic shift over time (β = −0.25 D/year), with no between-group difference. Conclusions: In this longitudinal cohort, intermittent exotropia showed a variable course, with many patients ultimately requiring surgery despite initial non-surgical management. Long-term success was more closely tied to preoperative control quality than age. These findings support an individualized, control-based approach to treatment planning and timing of intervention. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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14 pages, 1978 KB

Open AccessArticle

Real-World Transition to a Preservative-Free Fixed Combination of Dorzolamide/Timolol: Impact on the Ocular Surface Microenvironment, Safety, Tolerability, and Efficacy

by Ana Sanseau, Arturo Burchakchi, Fernando Cataldi, Héctor Fontana, Alejo Peyret, Giselle Rodríguez, Ailín Fantacone, María Silvia Passerini and Javier F. Casiraghi

Medicina 2026, 62(1), 184; https://doi.org/10.3390/medicina62010184 - 16 Jan 2026

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Abstract

Background and Objectives: This study evaluates the safety, tolerability, and efficacy of preservative-free Dorzolamide 2%-Timolol 0.5% (PF-DT), with a focus on improving the ocular microenvironment in a real-world transition setting. Materials and Methods: A prospective, multicenter, open-label study involving thirty patients with dry eye disease previously treated with BAK-DT was conducted. Participants were transitioned to PF-DT, and evaluated at weeks 4, 12, and 24. The primary endpoint was the Ocular Surface Disease Index (OSDI) score. Secondary outcomes included Break-Up Time (BUT), Schirmer test results, corneal staining, conjunctival hyperemia, intraocular pressure (IOP), and patient satisfaction. Results: Twenty-five patients completed the study. The OSDI improved from 21.5 to 12.5 (p < 0.001), with 60.0% of patients showing improvement and 52.0% achieving complete symptom resolution. Among eyes with corneal staining, 78.4% demonstrated a reduction of at least one grade, and 50.0% of those with conjunctival redness showed similar improvement. By week 24, 78.0% exhibited no corneal staining, and 50.0% had no conjunctival redness. BUT increased from 5.0 to 7.0 (p < 0.01), while IOP decreased by 1 mmHg (p < 0.01). Satisfaction regarding comfort (≥80%) and handling (≥50%) was high, with 88.0% preferring PF-DT. Conclusions: Transitioning to PF-DT improved ocular surface health while maintaining IOP control, supporting the benefits of preservative-free formulations in restoring microenvironment homeostasis and enhancing tolerability and patient satisfaction. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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12 pages, 907 KB

Open AccessArticle

Temperature, Humidity and Regional Prevalence of Dry Eye Disease in Argentina

by María C. Marini, Belén Liviero, Rodrigo M. Torres, Jeremías G. Galletti, Gustavo Galperin, Monica Alves and Jesús Merayo-Lloves

Medicina 2025, 61(12), 2226; https://doi.org/10.3390/medicina61122226 - 17 Dec 2025

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Abstract

Background and Objectives: To evaluate whether regional climatic factors, particularly relative humidity (RH) and temperature, are associated with geographic variation in dry eye disease (DED) prevalence in Argentina. Materials and Methods: A secondary analysis of a nationwide voluntary online cross-sectional survey of DED in Argentina (April 2022; non-probability sample; n = 10,812) was performed. Participants were assigned to one of five standard geopolitical regions. DED prevalence (%) was estimated at regional levels. Monthly mean, maximum, and minimum temperature and RH for April 2022 were obtained from the National Meteorological Service; for each province/region, data corresponded to the principal synoptic station in the provincial capital. Because the survey and climate data were restricted to April, seasonal effects could not be evaluated. Region-level analyses of climate–DED patterns were prespecified as exploratory and descriptive given the small number of regional units (n = 5). Weighted descriptive models were used to compare RH–DED patterns while accounting for regional age and sex distributions. Results: Regional DED prevalence ranged from 37.7% (Northwest) to 49.8% (Cuyo). RH showed a clear inverse pattern with regional DED prevalence, whereas temperature showed no consistent relationship. Weighted descriptive models showed a similar qualitative RH–DED pattern, although residual confounding cannot be excluded. Conclusions: DED prevalence in Argentina shows geographic variability and a descriptive inverse pattern with ambient RH. These ecological findings are hypothesis-generating and must be interpreted cautiously due to sampling bias. Future seasonal, longitudinal, or individual-level studies are needed to confirm and quantify these preliminary signals. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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12 pages, 1055 KB

Open AccessArticle

Analysis of Risk Factor Changes for Myopia in Korean Adolescents Before and After the COVID-19 Pandemic

by Seeun Lee, So Ra Kim and Mijung Park

Medicina 2025, 61(10), 1798; https://doi.org/10.3390/medicina61101798 - 6 Oct 2025

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Abstract

Background and Objectives: To analyze changes in risk factors for refractive errors among Korean adolescents before and after the COVID-19 pandemic and examine the impact of lifestyle modifications on myopia development, Methods: this cross-sectional study utilized nationally representative data from the Korea National Health and Nutrition Examination Survey (KNHANES) VII (2016) and VIII (2021). We analyzed 691 adolescents aged 10–18 years from 2016 (pre-COVID-19) and 490 from 2021 (post-COVID-19). Refractive errors were categorized as hyperopia (≥+0.50 D), emmetropia (−0.50 to +0.50 D), myopia (−6.00 to −0.50 D), and high myopia (≤−6.00 D). Complex sample linear regression analyses identified factors associated with spherical equivalent (SE) refractive errors. Results: At the population level, overall myopia prevalence declined from 84.2% in 2016 to 77.4% in 2021, whereas the prevalence of high myopia increased from 10.0% to 11.5% (p = 0.047). This indicates that although the absolute proportion of adolescents with myopia decreased, the relative contribution of high myopia to the overall myopia burden within this population increased. Mean SE was −2.77 ± 0.11 D in (−10.63~+3.00 D/median: −2.00 D) 2016 and −2.63 ± 0.13 D (−14.00~+1.63/median: −1.75 D) in 2021 (p = 0.443). Age-related myopia progression accelerated post-pandemic (−0.193 D to −0.324 D per year in univariate regression and −0.185 D to −0.312 D, in multivariate regression analysis, p < 0.001). In both the 3 h and ≥4 h near work groups, statistically significant associations were observed at both time points, but a greater myopic shift was evident after COVID-19 (B = –0.853 and –0.757 in 2016; B = –1.311 and –1.167 in 2021, p < 0.05). Conclusions: The COVID-19 pandemic altered myopia risk factors among Korean adolescents. High myopia prevalence increased despite overall myopia with underweight status and environmental factors such as digital device time and urban living identified as important considerations for post-pandemic myopia prevention. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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17 pages, 3119 KB

Open AccessArticle

The Effect of Physical Activity on Anterior Segment Structures and the Retinal Nerve Fiber Layer: A Comparison of Elite Athletes and Sedentary Individuals

by Çiğdem Deniz Genç, Esra Korkmaz Salkılıç, Berna Anıl, Enes Akdemir, Coşkun Yılmaz and Ali Kerim Yılmaz

Medicina 2025, 61(9), 1623; https://doi.org/10.3390/medicina61091623 - 8 Sep 2025

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Abstract

Background and Objectives: The study aims to evaluate the effects of regular physical activity on ocular structures by comparing eye anterior segment structures and retinal nerve fiber layer (RNFL) parameters between elite individual athletes and sedentary persons. Materials and Methods: This cross-sectional observational study included 75 participants (33 female and 42 male) aged 18–32 years. Participants consisted of 33 elite individual athletes (66 eyes) aged 18–32 years and 42 sedentary individuals (84 eyes) aged 18–28 years. The elite athlete group consisted of participants who had trained ≥ 3 times per week for the past 5 years and had competition experience in tennis (n = 11), badminton (n = 8), and short/middle distance running (n = 14). Sedentary participants had not engaged in regular physical activity for the last 2 years. Anterior segment structures were measured with ultrasound biomicroscopy (UBM), RNFL parameters were measured with spectral-domain optical coherence tomography (SD-OCT), and intraocular pressure (IOP) was measured with a non-contact pneumotonometer. Results: When the anterior segment parameters were compared, a significance was found in the group effect (p = 0.021,

ƞ_{p}^{2}

= 0.036) in the TIA500 value, but the effects of side and gender were insignificant (p > 0.05). While the gender effect was found to be significant for the AOD500 (p = 0.030,

ƞ_{p}^{2}

= 0.032) and ARA500 (p = 0.019,

ƞ_{p}^{2}

= 0.038) variables, the group and side effects were statistically insignificant (p > 0.05). There was a significant difference in IOP values between sedentary individuals (15.82 ± 2.69) and athletes (14.61 ± 1.80) (p = 0.004,

ƞ_{p}^{2}

= 0.057). There was a significant difference between the right (15.71 ± 2.70) and left (14.87 ± 2.02) sides (p = 0.027,

ƞ_{p}^{2}

= 0.033). The effect of gender was not significant (p > 0.05). When the results were evaluated, a significant effect of the TEMPORAL side in RNFL parameters (p = 0.003,

ƞ_{p}^{2}

= 0.058) was observed. Correlations were seen between the anterior segment and RNFL parameters in both groups (p < 0.05). Conclusions: Athletes exhibited lower IOP compared with sedentary individuals, with similar RNFL parameters but distinct correlation patterns with anterior segment structures. These findings suggest that ocular parameters should be evaluated in an integrated manner and that physical activity may support ocular health by contributing to IOP reduction and potentially slowing the progression of eye diseases. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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21 pages, 398 KB

Open AccessReview

Occlusion Break Surge and Anterior Chamber Stability in the Intraocular Environment of Modern Phacoemulsification: A Narrative Review

by Hugo Scarfone, Emilia Carolina Rodríguez, Javier Diez, Ana Scarfone and Franco Scarfone

Medicina 2026, 62(2), 298; https://doi.org/10.3390/medicina62020298 - 2 Feb 2026

Viewed by 770

Abstract

Phacoemulsification is performed within a highly dynamic intraocular environment, in which fluid exchange, pressure regulation, and tissue biomechanics interact continuously. Although modern cataract surgery is considered safe and efficient, disruption of this delicate intraoperative microenvironment remains a major source of complications. Among fluidics-related events, post-occlusion break surge represents one of the most critical destabilizing factors of the anterior chamber. A surge occurs when the sudden release of an occluded aspiration port generates an abrupt pressure–volume imbalance that cannot be immediately compensated by infusion, leading to a transient collapse of the intraocular environment. This narrative review integrates current experimental and clinical evidence on the pathophysiology, quantification, and technological control of surge, framing it as a model of environmentally driven intraoperative stress. The evolution of phacoemulsification fluidics, from gravity-based systems to active, adaptive, and predictive platforms, is analyzed in relation to their ability to preserve a stable and physiologic intraocular environment. Comparative data from contemporary devices are reviewed, highlighting differences in surge volume, recovery time, and pressure restitution. Special emphasis is placed on the impact of surge on the microenvironments of both the anterior and posterior segments, including endothelial stress, capsular instability, vitreoretinal traction, and macular perfusion. Emerging strategies such as handpiece-integrated pressure sensors, predictive fluidics algorithms, intraoperative imaging, and artificial intelligence are reshaping environmental control during surgery. Despite substantial technological progress, the complete elimination of surge remains an unmet need. Continued innovation, standardized biomechanical models, and robust clinical validation will be essential to further protect the intraoperative intraocular environment and improve long-term visual outcomes. Full article

(This article belongs to the Special Issue Ophthalmology, Environment, and Lifestyle: New Pathways in Diagnosis and Treatment)

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