Search Results (178)

Objectives: Visual Evoked Potential (VEP) abnormalities in Friedreich Ataxia (FA) may result from dysfunction of retinal ganglion cells (RGC), post-retinal visual pathways, or both. Therefore, we aimed to clarify whether in Friedreich Ataxia (FA), abnormal neural conduction is due to dysfunctional RGC, impaired conduction along the post-retinal visual pathways, or both. The secondary aim of the study was to clarify the relationship between a possible RGC and/or post-retinal dysfunction and the patient’s age, age at disease onset, and disease duration. Method: Fourteen FA patients (14 eyes; mean age 38.64 ± 8.21 years) without functional or structural macular abnormalities, confirmed by multifocal electroretinogram (mfERG) and spectral domain–optical coherence tomography (SD-OCT), and 20 age-matched healthy controls were enrolled. Patients were classified as late-onset (FA1, disease onset > 25 years) or early-onset (FA2, disease onset < 25 years). All participants underwent comprehensive ophthalmological and neurological evaluations. RGC function and visual pathway conduction were assessed through simultaneous pattern electroretinogram (PERG) and VEP recordings using 60′ and 15′ checkerboard stimuli. Retino-cortical time (RCT) was calculated as the difference between VEP P100 and PERG P50 implicit times. Statistical analyses included a general linear model. Results: 60′ PERG amplitude (A) was significantly (p < 0.01) reduced in the FA group compared to the Control group. FA patients showed significantly delayed 60′ and 15′ VEP ITs and significantly increased 60′ and 15′ RCT values, particularly in the FA1 group. In late-onset patients, no significant relationships were found between age at onset of disease and all electrophysiological parameters (60′ and 15′ VEP and PERG ITs and As and RCTs). Conclusions: In our selected FA, RCG function and neural conduction along the post-retinal visual pathways are impaired. The abnormal neuronal conduction is greater in late-onset FA patients and is not related to patients’ age and the age at the onset of the disease. The duration of the disease has a slight effect on the post-retinal neural conduction on small optic nerve fibers. Full article

Diabetic retinopathy (DR) is one of the main causes of vision impairment globally, and it is increasingly recognized as a neurovascular disease characterized by both microvascular and neural dysfunction. Traditional assessment approaches primarily focus on structural retinal alterations and visual acuity, which may fail to identify early functional impairments. Contrast sensitivity (CS), which measures the capacity to distinguish subtle luminance differences, is increasingly recognized as an early manifestation of retinal dysfunction in diabetes mellitus. This narrative review seeks to describe current knowledge on the role of CS in DR, including its pathophysiological foundation, clinical importance, and link to structural retinal alterations. A systematic literature search of PubMed, Scopus, and Google Scholar (2000–2026) was performed to identify studies on CS in diabetes mellitus and diabetic retinopathy. Multiple investigations found that diabetic patients, including those with no clinically evident DR and normal visual acuity, had lower contrast sensitivity. CS impairment was associated with retinal neurodegeneration, ganglion cell dysfunction, microvascular alterations, and diabetic macular edema severity. OCT and OCT-A findings showed important structure–function correlations between reduced CS and retinal thinning, capillary dropout, and impaired perfusion. CS testing may provide additional functional information beyond standard visual acuity assessment and may improve early disease detection and monitoring. In conclusion, contrast sensitivity represents a promising functional biomarker for early diabetic retinal dysfunction and may complement structural imaging and visual acuity testing in DR evaluation. Although methodological variability currently limits widespread clinical implementation, advances in digital technologies and multimodal assessment strategies may facilitate its future integration into routine ophthalmologic practice. Full article

Background/Objectives: We aimed to describe clinical phenotypes, imaging distribution, treatment time window, and short-term outcomes of ophthalmic–cerebral artery embolic stroke caused by cosmetic facial injections or fillers in a tertiary neurology-referred cohort. Methods: This single-center retrospective observational case series included 33 consecutive eligible patients with ophthalmic artery embolism complicated by cerebral infarction or optic nerve ischemia after cosmetic facial injections. All 33 patients had cerebral infarction. Demographic, clinical, imaging, treatment-timing, and discharge-outcome data were extracted from medical records and analyzed descriptively. Results: Mean age was 31.1 ± 7.5 years (median 30.0, IQR 25.0–37.0); 29 (87.9%) were female. The injected materials were as follows: hyaluronic acid (24, 72.7%), autologous fat (8, 24.2%), and unknown (1, 3.0%). Anterior circulation involvement occurred in 32 patients (97.0%), posterior in 16 (48.5%) (an exploratory observation of uncertain mechanism; 15/16 co-occurred with anterior involvement), both in 15 (45.5%), multifocal/multi-territorial infarction in 24 (72.7%), and hemorrhagic transformation in six (18.2%). Optic nerve ischemia co-occurred in 25/33 patients (75.8%); no patient had isolated optic nerve ischemia without cerebral infarction. Median time from onset to intervention was 25.4 h (IQR 9.0–34.5); only two of 28 (7.1%) received intervention within 6 h. Within our cohort, earlier intervention was not associated with visual improvement (≤24 h 3/10 vs. >24 h 2/14; Fisher’s p = 0.61). At discharge, as a within-patient change between admission and discharge (not a controlled treatment-effect estimate), ocular motility abnormalities improved (17/26, 65.4%, p < 0.001), skin abnormalities improved (17/27, 63.0%, p < 0.001), and severe visual impairment improved (6/29, 20.7%, p = 0.031). Conclusions: Cosmetic facial injection/filler-related stroke is a specific type of iatrogenic embolic stroke caused by the dissemination of exogenous materials through facial–orbital–intracranial anastomotic pathways. Because the cohort was ascertained through a tertiary neurology department, the phenotype reflects the severe, brain-involved end of the spectrum and the distribution estimates are not generalizable to the full spectrum of filler-related vascular events. For patients presenting with acute blindness accompanied by skin ischemia, ocular muscle abnormalities, or neurological symptoms following cosmetic injections, early referral to both the stroke green channel and emergency ophthalmology for multidisciplinary evaluation is recommended, primarily to limit cutaneous necrosis, support extraocular muscle recovery, and monitor and control infarct progression and hemorrhagic transformation rather than to restore vision. Full article

Background/Objectives: Metabolic syndrome (MetS) and dry eye disease (DED) share inflammatory mechanisms, yet few studies have examined objective tear function and serum inflammatory markers together in this population. The aim of this study was to compare tear function tests and a panel of systemic inflammatory indices between patients with MetS who did and did not have DED. Methods: This observational comparative study enrolled 104 adults with MetS (52 MetS-DED and 52 MetS-nonDED), with group-level comparability for age and sex. All participants underwent ophthalmologic evaluation, including the Ocular Surface Disease Index (OSDI), the Schirmer I test, and fluorescein tear break-up time (TBUT). DED was defined by a mean Schirmer I value of ≤5 mm/5 min. Routine blood tests were used to derive the neutrophil-, platelet-, monocyte-, and eosinophil-to-lymphocyte ratios (NLR, PLR, MLR, ELR), the neutrophil–lymphocyte–platelet ratio (NLPR), the C-reactive protein (CRP)-to-albumin ratio, and the monocyte-to-high density lipoprotein cholesterol (HDL) ratio. Between-group comparisons, receiver operating characteristic (ROC) analysis with Youden’s index, and age- and sex-adjusted binary logistic regression were performed. Results: TBUT and Schirmer I values were significantly lower in the MetS-DED group, whereas OSDI scores did not differ between the groups. NLR, MLR, NLPR, CRP, and the CRP-to-albumin ratio were significantly higher in MetS-DED patients (all p < 0.05), while classic metabolic parameters were comparable. ROC analysis revealed statistically significant but weak-to-modest discriminatory ability (areas under the curve (AUCs) 0.617–0.652). In age- and sex-adjusted models, MLR (odds ratio (OR) = 1.072 per 0.01 unit, p = 0.046), the CRP-to-albumin ratio (OR = 1.062 per 0.01 unit, p = 0.011), and NLPR (OR = 1.123 per 0.001 unit, p = 0.038) remained significantly associated with MetS-DED. Conclusions: Among individuals with MetS, the presence of DED was accompanied by impaired tear function and a more pronounced systemic inflammatory profile despite similar metabolic parameters. However, the modest discriminatory performance and borderline adjusted associations indicate that these findings should be regarded as preliminary signals rather than evidence supporting the clinical use of these markers for screening or risk identification. Full article

Background/Objectives: Multiple age-related systemic conditions, including frailty, cognitive impairment, and comorbid diseases, have been suggested to be associated with glaucoma. However, their relationship with corneal biomechanical properties in patients with glaucoma remains unclear. Methods: This retrospective cross-sectional study included patients with glaucoma who attended the Department of Ophthalmology at Shimane University Hospital between May 2019 and August 2024. Corneal biomechanical parameters, including corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOPcc), and Goldmann-correlated intraocular pressure (IOPg), were measured using the Ocular Response Analyzer (ORA; Reichert Technologies, Depew, NY, USA). Geriatric assessments, including the Geriatric 8 (G8), Mini-Cog, and Charlson Comorbidity Index (CCI), were also evaluated. Associations between geriatric assessment measures and ocular parameters were examined using multivariable linear mixed-effects models adjusted for age, sex, medication score, and glaucoma subtype. Results: A total of 280 patients (456 eyes) were included. The mean age was 70.2 ± 11.1 years, and 126 patients (45.0%) were women. In multivariable linear mixed-effects models, lower G8 scores were significantly associated with lower CRF (β = 0.18, 95% CI: 0.05 to 0.30), lower IOPcc (β = 0.55, 95% CI: 0.18 to 0.92), and lower IOPg (β = 0.62, 95% CI: 0.25 to 1.00). In contrast, no significant association was observed between G8 scores and CH (β = −0.02, 95% CI: −0.12 to 0.09). Neither Mini-Cog nor CCI was significantly associated with any ocular parameters. Conclusions: In patients with glaucoma, frailty may be associated with corneal biomechanical properties, particularly CRF and intraocular pressure-related parameters. Full article

Background/Objectives: Visual impairment is an underrecognized but functionally disabling complication of stroke that adversely affects rehabilitation potential, autonomy, and quality of life. Clinical, anatomical, and ophthalmologic determinants of post-stroke visual recovery remain incompletely defined, particularly in Eastern European tertiary stroke units where structured visual follow-up is not standardized. This study aimed to identify clinical, imaging, and ophthalmologic predictors of favorable visual recovery and to evaluate whether integrating these domains improves early prognostic stratification beyond standard neurological assessment. Methods: We conducted a retrospective single-center cohort study of 71 consecutive adult patients admitted with acute stroke and a documented visual complication between January 2022 and September 2025 at Pius Brinzeu Emergency County Hospital and Victor Babes University of Medicine and Pharmacy Timisoara. Favorable recovery was defined as ≥50% improvement in visual field index (VFI) at 6 months. Group comparisons used Student’s t-test, Mann–Whitney U test, chi-square test, and Fisher’s exact test. Multivariable logistic regression, Cox proportional hazards modeling, and unsupervised k-means clustering were performed. Results: Twenty-nine patients (40.8%) achieved favorable recovery, while 42 (59.2%) had persistent impairment. Responders were younger (62.8 ± 10.7 vs. 70.4 ± 10.8 years, p = 0.005) and had lower admission National Institutes of Health Stroke Scale (NIHSS) (6.4 ± 2.9 vs. 10.3 ± 4.4, p < 0.001), smaller lesion volumes (18.7 ± 11.4 vs. 33.2 ± 18.7 mL, p < 0.001), thicker peripapillary retinal nerve fiber layer (89.3 ± 7.6 vs. 78.2 ± 9.4 μm, p < 0.001), and earlier rehabilitation initiation (11.4 ± 5.3 vs. 21.7 ± 9.8 days, p < 0.001). NIHSS, time to rehabilitation, and optical coherence tomography (OCT) pRNFL thickness remained independent predictors. The full integrated model achieved an area under the receiver operating characteristic curve (AUC) of 0.87. Cluster analysis identified three distinct phenotypes with favorable recovery rates of 79.2%, 34.8%, and 8.3%. Conclusions: Combined clinical, neuroimaging, and ophthalmologic profiling—particularly OCT pRNFL—meaningfully refines early prediction of post-stroke visual recovery and supports phenotype-driven rehabilitation planning. Full article

Keratoconus, a progressive corneal ectasia, remains a major cause of irreversible visual impairment worldwide. Conventional corneal cross-linking (CXL) with riboflavin/ultraviolet A (UVA) has revolutionized clinical management, yet its efficacy is still constrained by epithelial barriers, oxygen dependence, and safety concerns in thin corneas. Emerging nanotechnology provides a transformative opportunity to overcome these bottlenecks. This review highlights the enhancement of riboflavin delivery efficiency by nanocarriers, the photodynamic optimization of nano-enhanced cross-linking agents, and the synergistic strengthening effect of nanocomposites on corneal mechanical strength. We emphasize not only their potential to enhance drug penetration, improve cross-linking efficiency, and extend clinical indications, but also their role in advancing toward a new generation of personalized, intelligent, and minimally invasive corneal therapy. Finally, we discuss translational challenges, including manufacturing, long-term biosafety, and regulatory frameworks, and present a theoretical roadmap that integrates nanotechnology, real-time imaging, and artificial intelligence (AI)-assisted decision-making to achieve a closed-loop “sense–decide–act” therapeutic system. By situating nanomaterial-enhanced CXL within precision ophthalmology, this review highlights its capacity to redefine the standard of care for keratoconus and related ectatic disorders. Full article

This study aimed to characterize cortical dysfunction and frequency-specific network reorganization following optic nerve injury using spin-exchange relaxation-free magnetoencephalography (SERF-MEG), and to assess the potential of MEG-derived multiscale features as sensitive functional biomarkers for clinical evaluation. In this prospective case–control study, SERF-MEG recordings were acquired during a pattern-reversal visual stimulation paradigm. Time-domain evoked components (M100/M135), global electrophysiological indices, energy-based metrics, and alpha- and beta-band phase-based functional connectivity were extracted. Network topology was quantified using graph-theoretical measures, including global and local efficiency, clustering coefficient, and assortativity. Group-level differences between patients and healthy controls were statistically analyzed. Patients showed significantly reduced M100/M135 amplitudes, prolonged M100 latency, and a lower early-component energy ratio. Functional connectivity was significantly decreased in the alpha and beta bands, accompanied by reduced global and local efficiency, mean strength, and clustering coefficient. Seed-based analyses revealed reduced connectivity predominantly in occipito-parietal and occipito-temporal pathways. SERF-MEG provides sensitive identification of cortical- and network-level functional impairments following optic nerve damage. MEG has significant clinical potential for disease diagnosis and therapy monitoring, providing a novel objective assessment tool for neuro-ophthalmological disorders. Full article

Background: Digital exclusion remains a key barrier to equitable access to digital health services, particularly among individuals with visual impairment. Limited access to devices and digital literacy restricts participation in increasingly digital-first healthcare systems. This study aimed to evaluate the feasibility and exploratory service impact of a device recycling and digital inclusion pilot at a tertiary ophthalmic hospital. Materials and Methods: The six-month pilot at Moorfields Eye Hospital involved the refurbishment and distribution of donated electronic devices (laptops and mobile phones) alongside personalised digital literacy training delivered by trained volunteers. Twenty-two patients with visual impairment were enrolled; 18 completed the programme. Pre- and post-intervention questionnaires assessed digital engagement and confidence across key domains. Paired data were analysed using the Wilcoxon signed-rank test. Results: Across 216 item-level engagement responses, the number of responses indicating daily engagement increased from 31 to 49. Mean self-reported confidence scores improved from 3.1 to 5.1 out of 10 (Wilcoxon signed-rank test, V = 148, p = 0.0008; r = 0.81). Patients reported increased use of email, messaging, online forms, and General Practice (GP) appointment systems. Using secondary lifecycle data and modelled estimates, the reuse of refurbished laptops was associated with an indicative saving of approximately 5.3 tonnes of CO₂-equivalent emissions. Conclusions: This service evaluation suggests that a multi-component intervention combining device provision with tailored support may improve digital engagement and confidence among patients with visual impairment. These findings support the feasibility of integrating digital inclusion initiatives within ophthalmology services, with potential co-benefits for environmental sustainability. Full article

Background: Cataract diagnosis and management pose a significant global health challenge, contributing to 17 million cases of blindness and over 83 million cases of vision impairment worldwide in 2020. This issue is particularly acute in regions lacking adequate ophthalmological services, where a shortage of eye care clinicians and specialized equipment like slit-lamp cameras leads to late diagnoses. To address this accessibility gap, we developed a computer-assisted cataract grading system using smartphone-acquired external eye photographs. This approach utilizes image processing and deep learning on a standard, hardware-free smartphone, offering a low-cost and portable alternative to traditional equipment. Methods: The study introduces a new advanced algorithm to stratify cataract severity into three distinct stages: normal, pre-mature, and mature. The methodology was developed using a combined dataset of 799 images sourced from the Cataract v01 Computer Vision Project and the Indian Institute of Technology, Delhi. A key step is isolating the iris and lens using a region of interest (ROI) extraction procedure powered by the open-source MediaPipe framework. Key to the algorithm’s efficacy is the use of transfer learning, adapting four customized ResNet architectures (ResNet-18, ResNet-34, ResNet-50, and ResNet-101) to address medical image analysis intricacies. These models were fine-tuned with specific modifications, including dropout layers and the Adam optimizer, for analyzing the digital periocular images. Results: Evaluation of the models shows varied performance across the various architectures when classifying cataract stages. While the simpler ResNet-18 model exhibited the lowest performance, the deeper models showed significant improvement. The ResNet-50 architecture achieved the highest accuracy of 94%. This model also demonstrated excellent precision (94%), recall (95%), and an F1-score of 95% in multi-class classification, outperforming the other tested models. Its depth enables precise cataract classification, positioning it as a robust and reliable tool for potential medical diagnostic deployment. Conclusions: Deep learning-based analysis of smartphone-acquired external eye images demonstrated feasibility for cataract detection in this study. This method could be a scalable and easy-to-use addition to screening, especially in places where resources are limited. Further work is needed to expand the dataset and to validate the algorithm against established clinical grading systems before broader clinical implementation. Full article

Primary open-angle glaucoma (POAG) is rarely recognized in large felids, yet it may cause severe vision loss and chronic pain. This case report presents the ophthalmological evaluation of a four-year-old Siberian tiger (Panthera tigris altaica) maintained under human care that exhibited signs of visual impairment and altered sensorium. Under neuroleptic analgesia, clinical findings included bilateral convergent strabismus, persistent mydriasis, pathologically elevated intraocular pressure (48–52 mmHg), extensive map-like retinopathy, and focal retinal degeneration, supporting a diagnosis of advanced-stage bilateral POAG with irreversible vision loss. Pupillary light reflexes were absent, while fluctuations in pupil size were attributed to ketamine. Although medical and surgical options used in domestic cats may be applicable to non-domestic felids, frequent topical treatment was impracticable and unsafe, vision-preserving surgery was no longer indicated, and advanced diagnostics and specialist ophthalmic surgery were unavailable on site. The therapeutic goal was therefore shifted from vision preservation to long-term pain surveillance and welfare maintenance, including housing adaption and a defined threshold for humane euthanasia. Two types of neurological episodes were also documented as secondary findings; however, their causal relationship with the ocular disease could not be established without advanced neuroimaging. This case highlights the need for accessible on-site or referral-based ophthalmic diagnostics and surgical capacity in zoo settings. Full article

Background: Orbital rhabdomyosarcoma (RMS) is the most common primary pediatric malignant orbital tumor, typically curable with chemotherapy and radiation. Data regarding MRI chemotherapy response and long-term ophthalmologic outcomes remain limited in non-cooperative-group settings. Methods: We retrospectively reviewed children with primary orbital RMS treated at King Hussein Cancer Center (2002–2025) with vincristine, actinomycin-D, and cyclophosphamide (VAC). Pre-local-control MRI responses were classified as complete (CR), partial (PR), stable/minor (SD/MR), or progressive disease (PD). Survival and ophthalmologic outcomes were analyzed. Results: Twenty-two patients (median age 5.6 years) were included. All had localized disease (77% low-risk). All received VAC; 20 (91%) received radiotherapy (median 45 Gy). Pre-radiotherapy MRI showed 8 (36%) CR and 11 (50%) PR. Four patients (18%) died. Five-year event-free survival (EFS) and overall survival (OS) were 73% and 84%, respectively. Cataracts developed in 45% of the cohort (50% of irradiated patients) at a median of 39.1 months (range 9.4–95.1). At last assessment, visual acuity was good in 60%, moderate in 25%, and severely impaired in 15%. Conclusions: Excellent survival in orbital RMS is achievable in resource-stratified settings. Induction MRI progressive disease (PD) was associated with poor outcomes in this cohort and may represent an early prognostic signal warranting further validation in larger studies. Furthermore, the documented maximum cataract latency of 95 months suggests that the standard 5-year surveillance window is insufficient. These findings support extending ophthalmologic surveillance beyond the standard 5-year window. We propose, based on our retrospective institutional data, a 10-year functional survivorship framework. Full article

Background/Objectives: Diabetic retinopathy (DR) is a major microvascular complication of type 1 diabetes mellitus (T1DM) and remains an important cause of preventable visual impairment. Region-specific data on the incidence and clinical predictors of DR among patients with T1DM in Saudi Arabia remain limited. This study aimed to determine the incidence of DR and identify associated demographic and systemic risk factors among patients with T1DM at a tertiary care center in Riyadh, Saudi Arabia. Methods: This retrospective cohort study included 449 patients with T1DM aged ≥9 years who were followed at King Abdulaziz Medical City, Riyadh, between 2015 and 2025. Patients were selected using a consecutive non-probability sampling technique. Data were extracted from the BESTCare 2.0A electronic medical record system and supplemented, when required, by phone-based interviews to verify selected clinical and demographic variables. Patients were classified as controls without DR or cases with DR, including non-vision-threatening DR and vision-threatening DR (VTDR), according to the International Clinical Diabetic Retinopathy Severity Scale. Multivariable logistic regression, Cox proportional hazards models, and temporal trend analysis were performed, with statistical significance set at p < 0.05. Results: The overall incidence rate of DR was 92.66 per 1000 person-years, with similar rates among males and females. In multivariable logistic regression, older age at T1DM diagnosis, longer diabetes duration, hypertension, hyperlipidemia, and albuminuria were independently associated with DR. Mean HbA1c and HbA1c variability were not independently associated with DR after adjustment. In Cox regression, older age at T1DM diagnosis was associated with higher hazards of both DR and VTDR, while hypertension was associated with VTDR. Among patients with DR, younger age at T1DM diagnosis was associated with higher odds of proliferative disease in exploratory severity analysis. Conclusions: DR was common among patients with T1DM in this tertiary-care cohort and was mainly associated with disease duration, age at diagnosis, and systemic vascular comorbidities. These findings support the importance of routine ophthalmologic screening and integrated management of systemic risk factors in patients with T1DM. Full article

Background and Clinical Significance: Acute retinal pigment epitheliitis is a retinal disorder considered as part of a larger group named idiopathic choroidopathies. Little gray round macular lesions at the retinal pigment epithelium can be found, which are self-limited, resolving within 6–12 weeks. It can decrease best corrected visual acuity (BCVA), but visual quality has not been studied yet. Case Presentation: A 17-year-old Caucasian boy who came to our ophthalmology department and presented with acute retinal pigment epitheliitis in his right eye (OD). BCVA under mesopic lighting was 0.18 logMAR in his OD and −0.18 in his OS. With a neutral density filter, it was 0.52 and 0.04, respectively. Contrast sensitivity was assessed with the CSV-1000E test, but OD outcomes were worse only in the case of mesopic lighting. Chromatic discrimination was assessed with the Farnsworth–Munsell 100 test and revealed marked impairment of both red-green and yellow-blue axes. No central scotoma was detected on a 10.2 visual field, nor was any halo perception detected with the Halometer test. Conclusions: BCVA under low illumination and color perception in the yellow-blue axis may be affected in patients with acute retinal pigment epitheliitis to a greater extent than previously described. Contrast sensitivity may also be altered, but to a lesser extent. Full article

Background/Objectives: Uncorrected refractive errors (UREs) are a primary cause of preventable visual impairment in children globally, impacting education and quality of life. In Jakarta, prevalence has surged to 40% post-pandemic, categorizing it as a serious public health problem. This study aimed to develop and validate the CIPSEL questionnaire as a rapid, culturally adapted screening tool for identifying visual impairment consistent with possible UREs among Indonesian school-aged children. Methods: A cross-sectional study was conducted in South Jakarta with 131 students aged 8–12 years. The 10-item CIPSEL questionnaire, exploring visual behaviors and symptoms, was administered via face-to-face interviews. Visual acuity was assessed using a standard Snellen chart by medical personnel blinded to the questionnaire results. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis, with optimal thresholds determined via the Youden Index and the shortest distance to (0, 1). Results: Visual impairment was identified in 26 students (19.8%). Mean CIPSEL scores were significantly higher in students with visual impairment (4.73) compared to those with normal vision (1.95). ROC analysis showed considerable diagnostic accuracy with an AUC of 0.887 (95% CI: 0.829–0.946). A safety-first cutoff of 2.5 prioritized sensitivity (96.2%), while a balanced cutoff of 3.5 provided 80.8% sensitivity and 79.0% specificity. A tiered risk system (Low, Medium, and High) demonstrated a robust statistical association with actual clinical findings (Cramer’s V = 0.534, p < 0.001). Conclusions: CIPSEL is a reliable and scalable screening tool for the early detection of visual impairment in Indonesian children. Its tiered risk stratification framework facilitates nuanced clinical decision-making and efficient resource allocation in school-based settings. Its accessibility for non-medical personnel and potential for digital integration support national efforts toward universal eye health. Full article