PURPOSE: To investigate the use of surgical loupes in the clinical practice of Turkish ophthalmologists and to understand their perspectives on the use of surgical loupes.
METHODS: This descriptive study was conducted between April and May 2024 and comprised 106 ophthalmologists who completed the survey. A link to a questionnaire, in which demographic characteristics as well as loupe usage patterns and perspectives were evaluated, was sent to the members of the Turkish Ophthalmology Association through email, WhatsApp, and Instagram. Google Forms was used to collect survey responses.
RESULTS: 44.5% of participants felt loupes improve surgery, and 45% were undecided. 54.8% found loupes useful for surgical residency training, while only 7.5% disagreed. Nonetheless, only 14% made a purchase. The loupe was mainly used in oculoplastic procedures such as dacryocystorhinostomy (60%), nasolacrimal duct surgeries (66%), and ptosis repair (60%). The most cited benefits were as follows: The magnification of the image (73.6%), the improved recognition of anatomical structures (66%), enhanced visual acuity (30.2%), and improved posture and ergonomics (22.6%). The most common reasons for not purchasing a loupe were lack of need in clinical practice (68%) and high cost-performance ratio (20.9%). While 39 (36.8%) of respondents reported no negative experiences using a loupe, the most common issues cited were discomfort (20.8%), difficulty with adjustments (17.9%), and limited depth perception (12.3%).
CONCLUSION: The loupe is an auxiliary instrument known to be helpful in varying surgeries, including oculoplastic surgery. This study is the first to explore the perspectives on the use of loupes among ophthalmologists in Turkey and to examine the advantages, limitations, and obstacles to their use.

PURPOSE: The purpose of this study was to evaluate the competence of ophthalmic healthcare professionals in the self-administration of eye drops.
METHODS: Doctors and nurses from the ophthalmology department constituted the study group, while age-, gender-, and visual acuity-matched healthy individuals formed the control group. None of the participants were patients. All participants were given single-dose (monodose) sodium hyaluronate drops and were asked to self-administer the drops in both eyes. Eye drop instillation was assessed based on three criteria: (1) successful delivery of at least one drop onto the ocular surface or conjunctival fornix, (2) avoiding contact of the bottle tip with the ocular surface or surrounding tissues, and (3) instillation of one drop at a time. “Successful drop instillation” was defined as meeting all three criteria.
RESULTS: Eighty-six cases were included (43 in each group). Successful instillation was observed in 26 participants (60.4%) in the study group, compared to 12 participants (27.9%) in the control group (p=0.002). Contact of the dropper tip with any surface occurred in 7 (16.2%) versus 23 cases (53.4%) in the study group and the control group (p<0.001).
CONCLUSION: Despite clinical experience, approximately 40% of the study group failed in proper self-instillation. The study group performed significantly better at steps requiring fine motor control, such as not allowing the bottle tip to touch any surface. These findings highlight the need for structured patient education to promote safer and more effective eye drop use.

PURPOSE: The purpose of this study was to determine the prevalence and clinical characteristics of microtropia (M) within a Turkish preschool screening cohort and to identify objective, data-driven diagnostic thresholds for the condition.
METHODS: This retrospective study reviewed the comprehensive refraction and orthoptic examination records of 2106 children (median age 61 months) who underwent preschool eye screenings at a single tertiary hospital between January 2023 and September 2025. Key variables included cycloplegic spherical equivalent (SE), visual acuity (VA), amount of deviation, near stereopsis (Frisby test), and accommodative response (dynamic retinoscopy). Statistical analysis, including receiver operating characteristic (ROC) curves, was used to compare strabismic and non-strabismic groups and define diagnostic cutoffs for M.
RESULTS: Strabismus was detected in 307 children (14.6% of the cohort). The prevalence of M was 1.6% (34 children) within the total sample, accounting for 11.0% of all strabismus cases. The strabismus group had significantly higher SE values (p<0.001), a greater prevalence of astigmatism (32.5% vs. 24.9%, p=0.048), and a significantly higher rate of weak accommodation (22.1% vs. 1.7%, p<0.001) compared to the non-strabismic group. The M group exhibited significantly lower VA and poorer stereopsis than the esophoria group (p=0.046 and p=0.012, respectively). ROC analysis identified an optimal deviation cutoff for diagnosing M at ≤8 prism diopters (PD) (100% sensitivity, 70.1% specificity) and a stereopsis cutoff of >75 seconds of arc (88.2% sensitivity).
CONCLUSION: In this tertiary clinic cohort, M was found in 1.6% of preschool children, suggesting it is a significant and potentially underestimated health burden. It is strongly associated with refractive errors (hyperopia and astigmatism), impaired accommodation, and reduced stereopsis. The ROC-defined threshold of ≤8 PD offers a robust, objective criterion for its diagnosis.

PURPOSE: This study reports changes in macular and optic disc microvascular parameters using optical coherence tomography angiography (OCTA) in pseudophakic patients undergoing pediatric cataract surgery.
METHODS: This observational, controlled, cross-sectional study included patients who had previously undergone pediatric cataract surgery and age-matched healthy controls. Seventeen subjects aged 5–18 years were recruited to the treatment group (Group 1). Sixteen volunteers of similar age were recruited to the control group (Group 2). A total of 33 subjects underwent detailed ophthalmologic examinations and OCTA scans. The two groups were compared in terms of their foveal, parafoveal, and optic disc blood flow and vascular density (VD) parameters on OCTA images.
RESULTS: The mean ages of the participants in Groups 1 and 2 were similar (11.88±3.60 years vs. 11.63±2.24 years, respectively). Foveal superficial and deep blood flow were lower in Group 1 than in Group 2 (1.33±0.12 vs. 1.47±0.13 and 1.23±0.34 vs. 1.56±0.23, respectively, p<0.05). A wider deep layer foveal avascular zone was observed in Group 1 than in Group 2 (0.41±0.19 vs. 0.31±0.12, respectively, p=0.02). Parafoveal superficial VD and optic disc head VD were lower in Group 1 than in Group 2 (51.46±4.00 vs. 55.35±4.69 and 56.46±3.01 vs. 59.37±3.06, respectively, p<0.05).
CONCLUSION: Macular and optic disc vascular parameters were lower in patients who had undergone pediatric cataract surgery than in healthy controls. This result may be insightful for investigating processes that may affect retinal microvascular circulation.

PURPOSE: The purpose of the study was to evaluate the results of Keratoconus End-Points Assessment Questionnaire (KEPAQ) in patients who did or did not have any surgery for keratoconus.
METHODS: This cross-sectional, single-center, observational study included 127 patients with keratoconus at the Cornea Service, Department of Ophthalmology, Dokuz Eylul University. Patients were classified as Group 1 (no ocular surgery) and Group 2 (any surgery for keratoconus). Best-corrected visual acuity (BCVA), spherical equivalent (SE), keratometry readings (Kmean), asphericity coefficient (Q value), and central corneal thickness values were recorded. Patients were asked to answer the questions of emotional (E) and functional (F) KEPAQ subscales.
RESULTS: Group 1 consisted of 59 patients (46.5%), and Group 2 consisted of 68 patients (53.5%). In Group 2, 33 patients had cross-linking (CXL), 16 had intrastromal corneal ring segment (ICRS) implantation, 4 had both CXL and ICRS implantation, 5 had deep anterior lamellar keratoplasty (DALK), and 10 had penetrating keratoplasty (PK). KEPAQ-E scores were positively correlated with BCVA (r=0.34, p<0.01) and SE (r=0.20, p=0.04). KEPAQ-F scores were positively correlated only with BCVA (r=0.25, p=0.01). In Group 2, the worst E and F scores were found in patients who had ICRS implantation and PK, whereas the best E and F scores were obtained in patients who underwent DALK.
CONCLUSION: In this study, BCVA appeared to be the most important predictor of emotional and functional QoL, followed by SE. Other clinical parameters used to stage disease severity did not show any significant correlation with functional or emotional QoL measures.

PURPOSE: Eye examination and vision screening are an important part of screening programs, which are recommended for infants and children in family medicine practice. In the present study, it was aimed to assess the demographic features, working status, knowledge levels, awareness, attitudes, behaviors, and practice patterns of family physicians regarding neonatal vision screening.
METHODS: The link to the questionnaire, consisted of 27 items pertaining to the demographic features, working status, knowledge levels, awareness, attitudes, behaviors and practice patterns of family physicians regarding neonatal vision screening was sent through WhatsApp to family medicine specialists and general practitioner family physicians working in Community Health and Family Health Centers across Turkey, family medicine specialists working in public/university hospitals, and family medicine medical residency students.
RESULTS: Among 104 physicians, 55.8% performed neonatal vision screening while 44.2% did not. Ninety (86.5%) physicians reported that they evaluate infants through inspection, 66 (63.5%) obtain a medical history, 71 (68.3%) assess the blink reflex, fixation, and follow-up, and 57 (54.8%) perform the red reflex test. Forty-seven physicians (45.2%) who reported that they do not perform the red reflex test indicated that the most common reason was a lack of necessary equipment and experience, cited by 20 physicians (42.5%). All steps of the vision screening were performed by trained physicians at higher rates than untrained physicians, and this difference was statistically significant (p<0.05).
CONCLUSION: Although awareness of neonatal vision screening exists among family physicians in Turkey, actual practice varies significantly due to structural, educational, and logistical barriers. Targeted training, improved access to diagnostic tools, integration of structured referral pathways, and collaboration between primary and tertiary care is essential to ensure effective implementation of the vision screening.

PURPOSE: This study aimed to evaluate trends in the procurement, preservation, and utilization of corneal tissues at a tertiary eye bank in Turkey over a 7-year period.
METHODS: A retrospective review of eye bank records was conducted from January 2017 to December 2023. Variables analyzed included donor demographics (age, gender), cause of death, death-to-preservation interval (DPI), voluntary organ donor status, serological test results, preservation-to-utilization interval (PUI), endothelial cell density, donor tissue source, reasons for corneal discards, contamination status, indications for keratoplasty, usage rate of full-thickness vs. split grafts, keratoplasty types, and annual keratoplasty trends.
RESULTS: A total of 775 donors (69% male) and 1342 corneal grafts were analyzed. The mean donor age was 51.35±13.80 years, with the majority aged between 50 and 69 years. Only 5.4% of donors had voluntarily pledged organ donation. Serological screening was negative in 99.2% of cases. The mean DPI was 4.74±2.67 h, and the mean PUI was 4.64 days. The overall corneal utilization rate was 95.5%. Over the study period, the proportion of lamellar keratoplasty increased significantly, while penetrating keratoplasty declined. Logistic regression analysis demonstrated that calendar year was significantly associated with increased use of lamellar keratoplasty (odds ratio: 1.18, 95% confidence interval: 1.11–1.25; p<0.001). Approximately 30% of donor corneas were used in a split manner. The most common indications for transplantation were graft failure, corneal scarring, keratoconus, and bullous keratopathy.
CONCLUSION: The low rate of voluntary cornea donation and the limited utilization of split graft techniques highlight important areas for improvement and underscore the need for strategies to enhance donor awareness and optimize tissue utilization.

PURPOSE: Optic nerve head changes can be observed due to direct involvement or as a result of complications of intermediate uveitis (IU) and can lead to visual impairment. The purpose of this study was to investigate retinal nerve fiber layer thickness (RNFLT) and microvasculatory changes in the peripapillary region, and to determine their relationship with disease activity.
METHODS: This study was a cross-sectional analysis. The peripapillary RNFLT and radial peripapillary capillary (RPC) vessel densities (VDs) of IU patients, presented to our clinic between December 2017 and March 2023, were retrospectively analyzed using optical coherence tomography angiography (Avanti RTVue-XR; Optovue, Fremont, CA) and compared with healthy subjects.
RESULTS: Twenty-eight eyes with IU (12 in active, 16 in quiescent phase) and 23 healthy control eyes were included. Decreased RPC VDs were observed in the quiescent phase of IU compared with the healthy control group in the whole image, superior hemisphere, and inferior hemisphere areas (p=0.002, p=0.003, and p=0.007, respectively). Peripapillary VD values were reduced in the quiescent phase compared with the active phase and control eyes (p=0.013 and p=0.002, respectively). No significant differences were observed between the active and control groups (p>0.05 for all). Increased RNFLT was observed in the active phase compared with quiescent and control groups (p<0.001).
CONCLUSION: RNFLT increases during the active phase of IU due to possible inflammation in the peripapillary area, whereas vascular parameters do not change quantitatively. In the quiescent phase, the resolution of inflammation and possible permanent vascular changes may affect the vascular structure.

PURPOSE: The objective of the study was to evaluate the potential role of systemic inflammatory indices in distinguishing patients with retinal vein occlusion (RVO) from healthy individuals.
METHODS: This retrospective study included 75 patients diagnosed with RVO and 80 age- and sex-matched healthy controls. Complete blood counts were analyzed to calculate systemic inflammation indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), systemic inflammation modulation index (SIMI), and aggregate index of systemic inflammation (AISI). Group comparisons were performed, and receiver operating characteristic (ROC) analysis was used to assess the diagnostic value of each marker.
RESULTS: Significant differences were observed between RVO patients and controls across all inflammatory indices. Notably, NLR (2.22 vs. 1.86), PLR (130.9 vs. 113.3), SII (485.3 vs. 440.3), SIRI (1.13 vs. 0.91), SIMI (65.48 vs. 56.00), and AISI (282.33 vs. 215.94) were all elevated in the RVO group (p<0.05). However, ROC analysis revealed only limited discriminative power, with AUC values ranging from 0.602 to 0.640 and sensitivities/specificities around 55–61%.
CONCLUSION: Systemic inflammation-based indices were significantly elevated in patients with RVO compared with healthy controls. Although these markers demonstrated limited discriminative performance, their consistent elevation may reflect the presence of systemic inflammatory activity associated with RVO. To the best of our knowledge, this study is among the first to evaluate SIMI and AISI in this context. Further prospective studies are needed to better clarify their clinical relevance and potential role in the inflammatory background of RVO.

PURPOSE: To investigate alterations in choroidal structure, including changes in choroidal microvasculature and thickness, in patients with hypertensive retinopathy (HR) of Grades I–III.
METHODS: This retrospective study included 110 eyes from 63 patients with HR and 56 eyes from 30 healthy controls. The mean choroidal vascularity index (CVI), choroidal stromal index (CSI), and subfoveal choroidal thickness (SFCT) were assessed using enhanced depth imaging optical coherence tomography.
RESULTS: Lower CVI and SFCT values were associated with higher HR grades (p<0.001 and p=0.001, respectively). The mean luminal area was significantly lower in both the Grade II and Grade III HR groups than in the controls (p<0.008 and p<0.001, respectively). Although the CSI was significantly higher in the Grade II and Grade III HR groups than in the controls (p<0.009 and p<0.002, respectively), the stromal area (SA) did not differ between groups. After adjusting for relevant confounders, age, axial length, and diastolic blood pressure (DBP) were determined to be negatively associated with the CVI in individuals with HR (all, p<0.05).
CONCLUSION: A lower CVI and choroidal thickness were associated with higher-grade HR; however, the SA was similar between groups. Greater HR severity can lead to more profound disruptions in choroidal structure due to the enhanced severity of choroidal microvascular damage, and elevated DBP can exacerbate damage to the choroidal microvasculature.

PURPOSE: To evaluate the effect of corneal suture removal timing after phacoemulsification on refractive and corneal astigmatism and best-corrected visual acuity (BCVA).
METHODS: This prospective, single-center comparative study included 34 patients (34 eyes, aged 40–60 years). All eyes underwent uncomplicated phacoemulsification through a 2.75-mm superior corneal incision closed with a single 10-0 nylon suture. Patients were randomized into two groups: Suture removal at 1 week (Group 1) or at 1 month (Group 2). Refractive astigmatism, keratometric astigmatism, and BCVA were evaluated immediately before suture removal and at 1 h, 1 week, and 1 month afterward.
RESULTS: Baseline characteristics were similar between groups (p>0.05), and no wound-related complications occurred. In Group 1, refractive astigmatism decreased significantly from 2.18±0.87 D to 0.88±0.42 D at 1 month after suture removal (p<0.001), with most of the reduction occurring within the first post-operative week. In Group 2, refractive astigmatism showed only a minimal change and did not reach statistical significance (1.61±0.68 D to 1.31±0.53 D; p=0.057). Corneal astigmatism reduction was also more pronounced in Group 1. At 1 month, Group 1 demonstrated significantly lower refractive astigmatism than Group 2. (p=0.037) Vector analysis further supported these findings. The early removal group demonstrated significantly greater surgically induced astigmatism correction (SIA 1.68±0.51 D vs. 1.43±0.54 D; p=0.041) and a lower difference vector (0.49±0.28 D vs. 0.77±0.31 D; p=0.012), indicating more effective reduction of suture-induced astigmatism.
CONCLUSION: Early corneal suture removal after cataract surgery provides a faster and greater reduction in post-operative astigmatism and accelerates visual rehabilitation. When wound stability is adequate, suture removal at approximately 1 week post-operatively may be recommended to optimize early refractive outcomes.

PURPOSE: To describe the clinical characteristics, visual outcomes, prescribed low-vision aids, and vision-related quality of life of patients referred to a tertiary low-vision unit.
METHODS: This single-center retrospective study included 94 patients referred between January 2023 and November 2024. Clinical, demographic, diagnostic, and visual function data were extracted from medical records. Baseline best-corrected visual acuity (BCVA) and distance- and near-visual acuity after correction with low-vision aids were collected. Vision-related quality of life was evaluated using the low vision quality of life questionnaire (LVQOL).
RESULTS: The mean age was 43.6±28.0 years (median, 34), and 55.3% of patients were male. The most common diagnoses were age-related macular degeneration (27.6%), retinitis pigmentosa (17.0%), Stargardt disease (14.9%), and albinism (12.8%). The mean baseline BCVA of the better eye was 0.96±0.47 LogMAR. With low-vision aids, BCVA was 0.28±0.21 LogMAR (P<0.001), and near visual acuity improved from 0.58±0.30 to 0.18±0.13 LogMAR (p<0.001). Telescopic devices for distance vision were prescribed to 68 patients (72.3%), including Galilean (n=56) and Keplerian (n=12) telescopes. Near-vision aids were prescribed to 34 patients (36.2%), mainly high-diopter near spectacles (n=28). Magnifiers were prescribed to 26 patients (27.7%), and filtered lenses to 22 patients (23.4%). LVQOL subscales for reading/fine work, activities of daily living, and distance/mobility/illumination correlated significantly with age and best-eye visual acuity (p<0.05).

CONCLUSION: Task-specific optical aids provide meaningful improvements in distance and near visual functions in low-vision rehabilitation. Quality-of-life outcomes were associated with age and visual acuity, underscoring the importance of timely referral to low-vision units and a multidimensional approach to low-vision care.

PURPOSE: The purpose of the study was to evaluate the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique in patients with large macular holes (MHs) and identify independent prognostic factors that predict post-operative visual acuity.
METHODS: This retrospective study included 48 eyes of 48 patients who underwent pars plana vitrectomy and inverted ILM flap technique for idiopathic MHs ≥400 μm. Pre-operative and post-operative best-corrected visual acuity (BCVA), swept-source optical coherence tomography (SS-OCT) parameters, and various clinical factors were evaluated. Multivariate regression analysis was performed to identify independent prognostic factors for the post-operative BCVA.
RESULTS: The mean BCVA improved significantly from 1.27±0.41 logMAR preoperatively to 0.62±0.37 logMAR at 6 months postoperatively (p<0.001). U-shaped closure was associated with better BCVA than V- and W-shaped closures (p=0.001). Patients with symptom duration ≤6 months and complete post-operative restoration of the external limiting membrane (ELM) and ellipsoid zone demonstrated significantly better BCVA (p<0.01). Pre-operative BCVA (β=0.637, p<0.001) and MH index (MHI) (β=−0.261, p=0.029) were significant independent determinants of post-operative BCVA.
CONCLUSION: The inverted ILM flap technique provides high anatomical closure rates and significant visual improvement in large MH surgery. Pre-operative BCVA and MHI were significant independent prognostic factors for post-operative visual outcomes. Structural SS-OCT parameters can be clinically useful in predicting post-operative functional outcomes.

Acute angle-closure glaucoma (ACG) is an ocular emergency that can result in vision loss. In the literature, there are a limited number of studies reporting that sulfonamide-derived drugs could cause ACG. The case was a 68-year-old male who was started to be followed up with a diagnosis of bilateral primary open-angle glaucoma 3 years ago, and whose intraocular pressures were within normal limits with topical treatments. He presented with bilateral ocular pain, redness, blurred vision, headache, and nausea that started the day before. On examination, a sudden onset of bilateral myopic shift, choroidal effusion, and ACG was detected. Medical history revealed hydrochlorothiazide initiation 3 days ago for hypertension. Hydrochlorothiazide was suspected to be the cause of this clinical picture. After discontinuation of hydrochlorothiazide, along with administration of antiglaucomatous, anti-inflammatory, and cycloplegic agents, these changes were resolved within 2 weeks. It would be better for physicians to inform patients about these potential risks when prescribing hydrochlorothiazide-containing medications.

Aneurysmal bone cyst (ABC) is a rare, benign but expansile osteolytic lesion that most commonly involves the long bones, vertebrae, and cranial bones. Orbital and craniofacial involvement is exceptionally rare and may present with rapidly progressive symptoms due to mass effect. We report the case of a 15-year-old patient who presented with a progressive swelling extending from the nasal cavity to the right orbit and frontal region over a period of 3 months. Ophthalmic examination revealed proptosis, restricted ocular motility, and decreased visual acuity in the right eye. Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a multiloculated, cystic, and solid lesion with fluid–fluid levels, destroying the frontal, ethmoidal, maxillary, and orbital bones, and displacing the right globe laterally. Multidisciplinary surgical excision via fronto-orbital craniotomy was performed, and histopathological evaluation confirmed the diagnosis of ABC. Postoperatively, significant regression of proptosis and improvement in visual acuity were observed. Orbital involvement of ABC is extremely rare but should be considered in the differential diagnosis of destructive craniofacial masses in children and adolescents. Radiological identification of characteristic fluid–fluid levels combined with histopathological confirmation is essential for accurate diagnosis. Early surgical intervention can prevent further visual deterioration and provide favorable functional and cosmetic outcomes.

The purpose of this study was to evaluate the spontaneous closure and recurrence of idiopathic macular holes. This was a single-patient case report with optical coherence tomography imaging analysis. Written informed consent was obtained from the patient for participation and publication of this report. A 40-year-old healthy female experienced spontaneous closure of an idiopathic macular hole, followed by re-opening after several years. Surgical intervention successfully resolved the recurrent macular hole, with visual acuity improving significantly postoperatively. Spontaneous closure and recurrence of idiopathic macular holes are rare phenomena with complex underlying mechanisms. Observation may be an option in certain cases, but surgical treatment remains effective for recurrences.

To report a rare case of spontaneous bleeding in a hidden orbital deep infantile hemangioma (IH) presenting with acute swelling and ptosis following retinopathy of prematurity (ROP) screening. A 2-month-old baby presented with progressive swelling in the left medial canthus and glabella immediately following a ROP screening. Ophthalmological evaluation revealed swelling in the superior nasal region of the left eye, causing ptosis, with an underlying superficial lesion on the forehead. Spontaneous hemorrhage was considered, prompting Pediatric Cardiology consultation. Ultrasound demonstrated a highly vascularized, hypoechoic lesion (3 × 1 cm) extending from the supraorbital region. The patient was diagnosed with orbital mixed IH, and oral propranolol therapy (1 mg/kg, twice daily) was initiated. ROP screening tools (speculums/indenters) may induce spontaneous bleeding in underlying orbital IH. Early identification of vision-threatening orbital hemangiomas and prompt pediatric cardiology consultation for systemic propranolol are critical for preventing amblyopia and optimal functional outcomes.