Search Results (44)

Objectives: Virtual reality (VR) enables controlled, interactive, and ecologically valid visual tasks, offering potential advantages over static clinical tests. This systematic review synthesized current evidence on the use of VR technologies for assessing visual capacities across ocular, neurological, and low-vision populations, with particular attention to technological approaches, clinical domains, methodological quality, safety, and future translational needs. Methods: Following PRISMA 2020, PubMed, Scopus, and Web of Science were searched from inception to 2 August 2025, using database-specific strategies for virtual reality and visual function. Three reviewers independently screened reports, extracted data, and appraised completed studies using design-appropriate NIH Study Quality Assessment Tools or Cochrane Risk of Bias 2 Owing to methodological heterogeneity, findings were synthesized narratively. The review was not registered and no protocol was prepared. Results: Of 364 records, 36 completed studies met the eligibility criteria and were included in the narrative synthesis (publication years 2014–2024); one additional randomized-trial protocol was catalogued separately as ongoing evidence. Most completed studies employed immersive head-mounted displays, while others used semi-immersive or desktop VR. Assessed domains included visual fields, visual acuity, contrast sensitivity, oculomotor and vergence function, postural control, functional navigation, spatial orientation, and obstacle avoidance. The most mature evidence concerned VR-based perimetry and functional visual assessment in glaucoma and low-vision populations. Reported adverse events were uncommon and mild, mainly transient cybersickness, dizziness, or visual discomfort. Among completed studies, methodological appraisal was favorable for 10, intermediate for 25, and unfavorable for 1. Overall, evidence supports feasibility, user acceptability, and convergent validity versus selected conventional tools, but substantial heterogeneity remains in hardware, calibration, exposure duration, outcome metrics, and follow-up. Conclusions: This systematic review highlights the growing role of VR in assessment, showing potential for controlled, ecologically oriented evaluations across domains like perimetry and functional vision. While promising, VR is currently a complementary framework rather than a replacement for established clinical tools, requiring stronger validation, repeatability testing, and calibration standardization for routine implementation. Full article

Background/Aims: This study set out to compare patient experiences and attitudes toward virtual reality (VR) versus in-office ophthalmic functional testing, as well as their eye exam visit preferences. Methods: A total of 64 patients undergoing a comparative clinical trial including VR and in-office versions of 24-2 visual field perimetry, Pelli–Robson contrast sensitivity, ETDRS visual acuity, Ishihara plates, and Amsler Grid tests were given a survey that included Likert-scaled questions regarding overall experience, speed, and comfort of broad VR testing versus in-office tests, as well as binary modality preference, like or dislike of various exam modality aspects, ease of understanding each test, distance traveled to their appointment, visit frequency, and remote care preferences. Results: In terms of overall experience, 59 (93.7%) participants rated VR as “Liked” or “Very Much Liked” compared to 38 (60.3%) for in-office tests (χ² p < 0.0001). Regarding comfort, 59 (93.7%) and 38 (60.3%) participants at least “Liked” VR and in-office tests, respectively (χ² p < 0.0001). For speed, 60 (95.2%) and 36 (57.1%) participants at least “Liked” VR and in-office tests, respectively (χ² p < 0.0001). Accordingly, 11 (17.5%) patients liked all aspects of in-office tests, while 54 (85.7%) patients said the same for VR (χ² p < 0.0001). Overall, 33 (52.4%) patients disliked something about in-office tests, while 20 (31.7%) said the same for VR (χ² p < 0.0001). There were no differences in ability to understand tests between the two modalities. We noted a variable distribution of distance traveled and visits per year in our population, yet there was also a strong preference for implementing more remote eye testing options. Conclusions: Development and implementation of virtual reality analogs to in-office, functional ophthalmic exams can improve patient experience and facilitate remote care delivery. Full article

Diabetic retinopathy (DR) and glaucoma, globally leading causes of irreversible blindness, can be detected and managed early with timely screening. In low-resource settings, access to ophthalmological examination is limited by a variety of constraints, including scarcity of specialists, equipment costs, geographic distance from care centers, and limited patient awareness. This narrative review examines the principal barriers to early detection of glaucoma and DR and evaluates evidence-based strategies to overcome them, including low-cost portable ophthalmic testing tools, artificial intelligence (AI) analytics, risk-based resource allocation, teleophthalmology, and targeted patient education. In different populations, these strategies have been shown to meaningfully increase access to ophthalmologic screening and follow-up at a significantly lower cost. We describe these approaches, demonstrate previously successful initiatives, and propose various combined approaches adapted to the specific needs of the various low-resource settings. Full article

Background: Convergence insufficiency (CI) is a common binocular vision disorder that causes eye strain, headaches, and blurriness. Although pencil push-ups (PPU) are widely used to treat CI, their real-world effectiveness may be limited by inconsistent performance and poor adherence. MobileS (the App) is an AI-based smartphone application that tracks eye movements through the front camera, enabling guided “digital push-ups” with instant visual feedback and automatic performance monitoring. This follow-up study evaluated the feasibility, recorded adherence, and preliminary clinical signals of MobileS as a home-based therapy for CI compared with conventional PPU. Methods: Twenty-five participants with CI were randomly assigned to either the App group (n = 12) or the PPU group (n = 13) for 8 weeks of home-based training. Both groups performed convergence push-ups—using the app or a pencil. NPC was measured using a RAF ruler at baseline, mid-point, and endpoint. Symptom severity was assessed using the Convergence Insufficiency Symptom Survey (CISS), and adherence was recorded automatically by the app or manually by participants. Results: All 25 randomized participants completed all three NPC assessment points. The App group showed a statistically significant improvement in NPC from baseline to study completion (mean improvement = 2.81 cm, p = 0.007), whereas the PPU group showed no significant change. Recorded adherence was higher in the App group compared with the PPU group (90.1% vs. 75.4%, p = 0.0069). The App group showed a significant reduction in symptom severity (p = 0.049). Between-group differences in symptom change were not statistically significant. Conclusions: MobileS appears feasible as a home-based CI management tool, and was associated with higher recorded adherence and preliminary NPC improvement signals. Larger, adequately powered studies are needed to confirm efficacy, particularly for symptoms, and guide teleophthalmology implementation. Full article

Background: Over the past two decades, teleophthalmology has become an effective approach for glaucoma screening and follow-up, with its adoption markedly accelerated by the COVID-19 pandemic. Objectives: The aim of the present study was to explore and analyze the attitudes of ophthalmologists in Bulgaria toward the application of teleglaucoma, digital communication, and artificial intelligence in clinical practice. Methods: A cross-sectional survey study was conducted among 113 ophthalmologists between September 2024 and March 2025, representing 10.5% of all licensed ophthalmologists in Bulgaria (n = 1074). Results: Age, professional experience, and specialization influenced the level of involvement in managing glaucoma patients. The level of awareness regarding the term ‘teleophthalmology’ was higher among respondents with a specialization in ophthalmology and those holding a doctoral degree (p = 0.001). Among the ophthalmologists surveyed, 35.4% (n = 40) provided teleophthalmology services, while an additional 19.5% (n = 22) reported no prior provision of such services but planned to do so in the future. The most preferred method for conducting teleophthalmology consultations was telephone communication (n = 27; 67.5%), followed by communication via Skype, Viber, or Messenger (n = 23; 57.5%). Physicians with longer professional experience more frequently conducted remote consultations with patients they already knew (p = 0.006). A substantial proportion of respondents (85.0%, n = 96) expressed willingness to participate in training related to contemporary trends and the provision of remote medical services. More than half of respondents expressed positive attitudes toward the use of artificial intelligence in ophthalmology, although practical implementation remained limited. Conclusions: The present study outlined the current landscape of attitudes among ophthalmologists in Bulgaria toward teleglaucoma, digital communication, and the use of artificial intelligence in clinical practice. The findings indicated a moderately positive yet cautious stance—remote services were perceived primarily as complementary tools, particularly for the follow-up of previously known patients and for real-time collaboration between specialists. 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

Smartphone-based portable slit lamp microscopes are increasingly used as low-cost tools for anterior segment imaging in teleophthalmology, yet the literature combines heterogeneous study designs, comparator standards, and deployment contexts. Because the evidence base spans engineering reports, basic science, clinical validation studies, implementation research, and case-based telemedicine, we structured a narrative review rather than a pooled meta-analysis. We searched PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, Cochrane Library, ScienceDirect, and DOAJ for literature available on or before 28 February 2026, supplemented by manual reference list screening and targeted retrieval of relevant technical standards. Peer-reviewed English original studies formed the core evidence base; contextual non-English and gray literature sources were retained only when explicitly labeled as non-core. To improve interpretability, the results were grouped by synthesis domain, clinical task, comparator standard, telemedicine scenario, and artificial intelligence (AI) dataset/validation characteristics. The highest-confidence evidence concerned nuclear cataract grading, tear film breakup time and corneal staining assessment, anterior chamber depth screening, tear meniscus height measurement, allergic conjunctival grading, and selected corneal disorders. Agreement with conventional slit lamp examination or anterior segment optical coherence tomography was generally moderate to high within task-specific comparisons, and telemedicine deployment was feasible for screening, follow-up, remote consultation, emergency triage, house visits, and outreach. However, illumination reporting remains inconsistent, explicit ISO-aligned dosimetry is sparse, and most AI studies remain retrospective, single-center, and device family-specific. Current evidence, therefore, supports smartphone-based portable slit lamp microscopes primarily as adjunctive teleophthalmology tools rather than replacements for comprehensive in-clinic microscopy. The synthesis clarifies where conclusions are supported by comparative validation data, where they remain exploratory, and which methodological gaps should be prioritized in future multicenter studies. Full article

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

Background: Accurate evaluation of the Near Point of Convergence (NPC) is essential for diagnosing and managing convergence insufficiency (CI). Conventional assessment relies on the patient’s verbal feedback and the examiner’s visual observation, making it subjective and examiner-dependent. The AI-based MobileS platform, previously validated for both diagnosis and home-based therapy of CI, enables smartphone-based measurement and visualisation of NPC through eye tracking, without the need for verbal responses or additional equipment. This study, the third stage of our research programme, examined how ophthalmologists interpret NPC data when presented as videos versus AI-derived graphs. Methods: Twenty-two ophthalmologists completed an online questionnaire with 20 NPC test cases from the validated MobileS database, presented as both silent videos and AI-derived graphs. Accuracy was analysed using mixed-effects logistic regression, and continuous error was assessed using clustered bootstrap. Results: Graph-based interpretation showed higher odds of accurate NPC identification than video-based interpretation at the primary ±5 mm threshold (OR = 19.7, 95% CI: 13.50–28.74; p < 0.0001). Absolute error was lower for graphs than videos (Graphs − Videos: −22.73 mm; 95% CI: −26.88 to −18.59; p < 0.0001). “Uncertain” responses occurred in 28.2% of video-based assessments and 0% of graph-based assessments. Off-target errors decreased from 50.2% (videos) to 3.6% (graphs). Conclusions: AI-derived graphs of eye-movement data were associated with improved NPC estimation, suggesting a potential role in supporting clinical and tele-ophthalmology workflows. Full article

Cataract diagnosis requires a comprehensive dilated examination by an ophthalmologist using a slit lamp; there is currently no effective means to objectively screen for cataracts in the community using portable devices without dilation. We hypothesized that it would be possible to predict cataract severity using deep learning on images taken using a portable smartphone-based slit lamp prototype, with and without dilation. In this prospective cross-sectional pilot study, slit lamp images were captured from eligible patients with cataracts in a tertiary clinic using a portable slit lamp prototype attached to a smartphone. The Pentacam nuclear staging score (PNS, Pentacam^®, Oculus, Inc., Arlington, WA, USA) was taken from the dilated pupils and served as ground truth. A transformer prototypical network with the Swin transformer on the images was trained to assign the class label corresponding to the highest predicted probability. Heat maps were generated based on attribution masks to identify the anatomical areas of concern. A total of 1900 images from 198 eyes of 99 patients were captured. The average age was 65.3 ± 10.4 years (range, 41.0 to 88.0 years) and the average PNS score was 1.57 ± 0.81 (range, 0 to 4). The model achieved an average accuracy of 81.25% and 74.38% for undilated and dilated eyes, respectively. Heat map visualization using the integrated gradient method successfully identified the anatomical area of interest in certain images. This study suggests the possibility of estimating cataract density using a portable smartphone slit lamp device without dilation. Further work is under way to validate this technique in a larger and more diverse group of eyes with cataracts. Full article

Background: Diabetic retinopathy (DR) poses a significant global health challenge that needs scalable and efficient screening pathways beyond the current limitations of teleophthalmology. This study retrospectively evaluated the diagnostic performance of an artificial intelligence (AI) DRISTi system (Version 2.1) against ophthalmologist grading for more-than-mild diabetic retinopathy (mtmDR), vision-threatening diabetic retinopathy (vtDR), and diabetic macular edema (DME). Methods: The methods involved a retrospective, observational, non-interventional validation comparing the AI DRISTi system’s output to ophthalmologist grading on 739 colour fundus images acquired using Topcon NWC 400, CrystalVue NFC 600/700, Canon CR2/CR2 AF, and Zeiss VISUCAM 500 cameras. Results: Primary outcomes included sensitivity and specificity, with statistical analyses utilizing 2 × 2 contingency tables and 95% confidence intervals. The AI system achieved an accuracy of 93.36% (sensitivity 95.03%; specificity 92.90%) for mtmDR, 98.64% (sensitivity 96.92%; specificity 99.01%) for vtDR, and 97.97% (sensitivity 92.85%; specificity 98.88%) for DME. Performance was robust and consistent across all evaluated camera types. Conclusions: In conclusion, the AI DRISTi system (Version 2.1) demonstrates strong diagnostic performance for mtmDR, vtDR, and DME, comparable to leading commercial AI systems, from fundus photographs acquired across multiple camera platforms. This system holds significant promise as an adjunctive screening tool for large-scale DR screening programs, contributing to early detection, appropriate triage, and the prevention of vision loss in at-risk populations. Full article

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare users during the period from May 2023 until December 2024. Descriptive statistics, parametric, and non-parametric tests for hypothesis testing were used. Results: The present study outlined predominantly positive attitudes towards the use of telemedicine services in ophthalmology, with 69.6% of respondents reporting a positive overall opinion in the final assessment. The greatest support was observed during remote consultations with a familiar doctor (77.4%) and during continuous follow-up of eye conditions (55.2%). Willingness to use such services was lower in emergencies or when contacting an unfamiliar specialist. A significant correlation was established between socio-demographic characteristics and attitudes—respondents with greater education levels (p = 0.006), men, and younger participants were more positive towards telemedicine (p < 0.05). The high level of awareness about glaucoma, particularly among those with university-level education, served as a positive prerequisite for the implementation of teleophthalmology services related to its monitoring. Mobile applications and digital solutions were evaluated as beneficial means of facilitating communication and increasing adherence to treatment. Regarding the use of artificial intelligence, certain skepticism and insufficient awareness levels were observed, which required additional efforts to increase trust and digital literacy among users. Conclusions: The implementation of telemedicine services into ophthalmology has potential but outlines the necessity of considering the individual attitudes of applying coherent quality and safety standards and of directed awareness campaigns, especially towards the groups of lower technological and healthcare literacy. Full article

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020–2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition. Full article

Background and Objectives: Mobile Eye Units (MEUs) have emerged as practical innovations to overcome geographic, financial, and systemic obstacles to eye care. Although numerous programs operate across the United States and Canada, a narrative review describing their structure, implementation and services, remain limited. This narrative review examines various MEUs models in the United States and Canada, using real-world examples to highlight each model’s structure, services, populations served, and key benefits and limitations. Methods: We performed a narrative review of peer-reviewed and gray literature published from 1990 to August 2025, identifying mobile eye units in the United States and Canada. Programs were grouped into four operational models based on services, equipment, and implementation characteristics. Ophthalmology residency program websites in the United States were also reviewed to assess academic involvement in mobile outreach. Results: We identified four operational MEU models: Fully Equipped Mobile Units (FEMUs), Semi-Mobile Outreach Units (SMOUs), School-Based Vision Mobile Units (SBVMUs), and Hybrid Teleophthalmology Units (HTOUs). FEMUs provide comprehensive on-site diagnostic capabilities but require substantial financial and logistical resources. SMOUs are lower-cost and flexible but offer more limited diagnostics. SBVMUs facilitate early detection in children and reduce school-based access barriers but depend on school coordination. HTOUs expand specialist interpretation through remote imaging, although their success relies on reliable digital infrastructure. Across all models, follow-up and continuity of care remain major implementation challenges. Approximately 21% of U.S. ophthalmology residency programs publicly report involvement in mobile outreach. Conclusions: MEUs play a critical role in reducing geographic and structural barriers to eye care for underserved populations across United States and Canada. However, limited outcome reporting, particularly regarding follow-up rates and continuity of care, hinders broader assessment of their effectiveness. Strengthening the integration of MEUs with patient navigators, integrated electronic health record, insurance support and support of local health networks is essential for improving long-term sustainability and impact. Full article

Glaucoma remains a leading cause of irreversible blindness. We reviewed more than 150 peer-reviewed studies (January 2019–July 2025) that applied artificial or augmented intelligence (AI/AuI) to glaucoma care. Deep learning systems analyzing fundus photographs or OCT volumes routinely achieved area-under-the-curve values around 0.95 and matched—or exceeded—subspecialists in prospective tests. Sequence-aware models detected visual field worsening up to 1.7 years earlier than conventional linear trends, while a baseline multimodal network integrating OCT, visual field, and clinical data predicted the need for incisional surgery with AUROC 0.92. Offline smartphone triage in community clinics reached sensitivities near 94% and specificities between 86% and 94%, illustrating feasibility in low-resource settings. Large language models answered glaucoma case questions with specialist-level accuracy but still require human oversight. Key obstacles include algorithmic bias, workflow integration, and compliance with emerging regulations, such as the EU AI Act and FDA GMLP. With rigorous validation, bias auditing, and transparent change control, AI/AuI can augment—rather than replace—clinician expertise, enabling earlier intervention, tailored therapy, and more equitable access to glaucoma care worldwide. Full article