Joanna Przybek-Skrzypecka

Introduction: Gestational Dry Eye Disease (DED) affects up to 50% of expectant mothers, yet current diagnostic tools are generic and fail to capture pregnancy-specific symptom patterns. Developing and validating new instruments in this population is logistically and ethically challenging due to recruitment barriers. This study describes the development and computational prototyping of the Dry Eye Disease in Pregnancy Questionnaire (DED-PREG) using a Generative Artificial Intelligence (GenAI) framework. Methods: We utilized a multi-stage in silico framework involving two independent synthetic cohorts. First, a qualitative focus group cohort was generated to simulate clinical dialogues for content derivation, followed by semantic vectorization for algorithmic item reduction. Subsequently, an independent validation cohort of 500 pregnant personas was instantiated. We evaluated the resulting 20-item instrument for internal consistency, structural validity, and test-retest reliability via a longitudinal simulation engine utilizing temporal context injection to model gestational progression across five distinct timepoints (T1–T5). Results: The DED-PREG mapped to three distinct domains: Ocular Symptoms, Functional Impact, and Lifestyle & Environmental Modulators. The instrument demonstrated satisfactory internal consistency (Cronbach’s alpha = 0.89) and excellent temporal stability in a strictly stable subsample (ICC = 0.99). Confirmatory Factor Analysis indicated acceptable model fit for synthetic high-dimensional data (CFI = 0.82; RMSEA = 0.11). Longitudinal analysis confirmed the instrument’s responsiveness to gestational change (Global Cohen’s d = 0.44), with Linear Mixed Models (LMM) revealing a significant interaction between low socioeconomic status and symptom exacerbation (β=0.053, p < 0.001). Conclusion: This study presents the first pregnancy-specific DED instrument structurally optimized via AI simulation. While human validation remains the gold standard, this computational approach demonstrates that GenAI can serve as a rigorous “stress-test” for instrument design, enabling the rapid prototyping of robust clinical tools prior to in vivo deployment. Plain Language Summary: Dry Eye Disease affects nearly 50% of pregnant women, but current diagnostic tools fail to capture specific pregnancy-related symptoms. Developing new tests is difficult due to the logistical and ethical barriers in recruiting expectant mothers for research. This study used Generative AI to design and validate a new questionnaire, called DED-PREG. By testing the tool on 500 “digital personas” simulating pregnancy, researchers found the survey was accurate, reliable, and effective at tracking symptom changes across trimesters. This approach proves AI can rigorously “stress-test” medical instruments, enabling the rapid creation of better clinical tools before testing on real patients.

Age-related macular degeneration is one of the most common causes of severe vision loss in the developed world. Advanced forms of age-related macular degeneration are seen in primarily 2 types, exudative type involving the presence of choroidal neovascularization, and nonexudative age-related macular degeneration with geographic atrophy. The more prevalent form of age-related macular degeneration is nonexudative type, yet with less definitive treatment options. The emergence of anti-VEGF has revolutionized the treatment of exudative type. For nonexudative age-related macular degeneration, vitamins and minerals supplementation known as the AREDS 2 formulation remains a primary care strategy. Recently, two intravitreal anti-complement factors have been approved as a novel treatment – pegcetacoplan and avacincaptad pegol. Many other therapeutic pathways are still being investigated, including stem cell therapy, gene therapy, laser treatment, photobiomodulation, neuroprotective and antioxidant agents, and also surgical options. In this review, we provide an update on prospective treatment options for the management of nonexudative age-related macular degeneration and preventing the progression of geographic atrophy.

As intraocular lens (IOL) technology continues to evolve, the selection of an optimal refractive target has become increasingly complex and critical to achieving patient satisfaction following cataract surgery or refractive lens exchange. A recently proposed classification system divides IOLs into partial- and full-range-of-field categories based on defocus curve characteristics. However, this framework does not fully capture the diversity of modern IOL designs or account for key optical factors such as spherical aberration and lens-specific tolerance to residual refractive error. This review highlights the importance of understanding the interaction between IOL optical properties—particularly spherical aberration profiles—and refractive target strategies. It examines how different IOL designs, including enhanced monofocal, extended depth-of-field (EDOF), and full-range-of-vision lenses (eg, multifocal or spiral optics), respond to various refractive targets. The evidence suggests that a universal refractive target (eg, plano) may be suboptimal for many advanced IOLs and that customized refractive planning—often incorporating mini-monovision or asymmetrical targets—can improve visual outcomes. Future research should aim to standardize defocus measurement techniques and refine classification systems to better guide clinical decision-making.

Background: Physician rating websites (PRWs) are increasingly used by patients to assess healthcare providers, yet little is known about the factors influencing patient feedback in ophthalmology across different healthcare systems. Objective: This study aimed to identify variables associated with patient reviews of ophthalmologists, with a particular focus on soft skill-related feedback, and to compare trends between Polish and British healthcare systems. Methods: We analyzed data on 461 verified ophthalmologists—261 from ZnanyLekarz.pl (Poland) and 200 from Doctify.com (UK)—collected between March and July 2024 with the highest number of reviews. Physician characteristics, including sex, academic title, years of experience, practice setting, specialization, and online presence, were examined. Review content was categorized into soft skills, professional abilities, or both. Statistical and multivariate analyses were performed to determine factors influencing (a) soft review frequency and (b) the profile of a top-rated ophthalmologist, defined as one with the highest overall ratings and a minimum of 100 reviews. Results: We analyzed a total of 70,176 patient reviews—55,786 from a Polish physician rating website (PRW) and 14,390 from a British PRW. Polish ophthalmologists received significantly more reviews than their British counterparts, with a median of 141 reviews per physician compared to 44 in the UK (p < 0.001). Feedback focused on soft skills accounted for 74% of Polish reviews and 59% of British reviews. Key predictors of soft skill-focused reviews included female gender, higher average ratings, practice in pediatric ophthalmology, and affiliation with the private sector. In contrast, fewer soft reviews were associated with area of surgical expertise, public sector employment, and practicing in the UK. Academic title also influenced the content of reviews: physicians holding PhDs received more feedback focused on soft skills, while full professors received less and years of experience had no significant effect. In the multivariate model assessing predictors of being a top-rated ophthalmologist for the whole cohort, each additional review containing substantive content or soft skill-related feedback increased the odds by 29% and 14%, respectively (p < 0.001 for both). Conclusions: Patient reviews are largely influenced by perceived interpersonal qualities rather than professional credentials or clinical experience. The active solicitation of patient feedback, as implemented on Polish physician rating platforms, results in over three times the volume of reviews compared to the British approach, which relies on passive voluntary submission without direct prompts.

A healthy ocular surface is inhabited by microorganisms that constitute the ocular microbiome. The core of the ocular microbiome is still a subject of debate. Numerous culture-dependent and gene sequencing studies have revealed the composition of the ocular microbiome. There was a confirmed correlation between the ocular microbiome and ocular surface homeostasis as well as between ocular dysbiosis and pathologies such as blepharitis, microbial keratitis, and conjunctivitis. However, the role of the ocular microbiome in the pathogenesis and treatment of ocular surface diseases remains unclear. This article reviews available data on the ocular microbiome and microbiota, their role in maintaining ocular homeostasis, and the impact of dysbiosis on several ophthalmic disorders. Moreover, we aimed to discuss potential treatment targets within the ocular microbiota.

Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.

Objective: Ring infiltrates usually accompany numerous infectious and sterile ocular disorders. Nevertheless, systemic conditions, drugs toxicity and contact lens wear may present with corneal ring infiltrate in substantial part. Considering its detrimental effect on vision, detailed knowledge on etiology, pathophysiology, differential diagnosis, and management should be considered essential for every ophthalmologist.Methods: The PUBMED database was searched for “corneal ring infiltrate” and “ring infiltrate” phrases, “sterile corneal infiltrate” and “corneal infiltrate”. We analyzed articles written in English on risk factors, pathophysiology, clinical manifestation, morphological features, ancillary tests (anterior-segment optical coherence tomography, corneal scraping, in vivo confocal microscopy), differential diagnosis and management of corneal ring infiltrate.Results: Available literature depicts multifactorial origin of corneal ring infiltrate. Dual immunological pathophysiology, involving both antibodies-dependent and -independent complement activation, is underlined. Furthermore, we found that the worldwide most prevalent among non-infectious and infectious ring infiltrates are ring infiltrates related to contact-lens wear and bacterial keratitis respectively. Despite low incidence of Acanthamoeba keratitis, it manifests with corneal ring infiltrate with the highest proportion of the affected patients (one third). However, similar ring infiltrate might appear as a first sign of general diseases manifestation and require targeted treatment. Every corneal ring infiltrate with compromised epithelium should be scraped and treat as an infectious infiltrate until not proven otherwise. Of note, microbiological ulcer might also lead to immunological ring and therefore require anti-inflammatory treatment.Conclusion: Corneal ring infiltrate might be triggered not only by ocular infectious and non-infectious factors, but also by systemic conditions. Clinical assessment is crucial for empirical diagnosis. Furthermore, treatment is targeted towards the underlying condition but should begin with anti-infectious regimen until not proven otherwise.

Background: To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first healthcare provider (HCP) seen. Methods: Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and Acanthamoeba subspecies. Results: Forty-one patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4– 14 days), while mean time to the correct diagnosis of AK was 15 days (IQR 7– 29 days). Patients saw an optician, optometrist or ophthalmologists significantly earlier than GPs (median 4 days, vs 15 or 5 days, respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the ophthalmologists’ group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36). Conclusion: AK patients often seek ocular help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP seen, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.

Background To assess the difference in course and final visual outcome of Acanthamoeba keratitis (AK) patients based on the first health care provider (HCP) seen. Methods Retrospective observational cohort study of AK patients admitted to the Manchester Royal Eye Hospital between 2003 and 2017. HCPs were grouped (Group 1: Optometrists, Opticians; Group 2: General Practitioners (GPs); Group 3: Ophthalmologists) and the data analyzed on demographics, risk factors, clinical history, clinical features, and Acanthamoeba subspecies. Results 41 patients with unilateral culture-proven AK were included. Median time to consultation with first HCP was 7 days (IQR 4–14 days) while mean time to the correct diagnosis of AK was 15 days (IQR 7–29 days). Patients saw an optician/optometrist significantly earlier than GPs or ophthalmologists (median 4 days, vs 15 or 5 days respectively, p = 0.04). Bacterial keratitis was the most common initial clinical diagnosis (43%). The shortest time to making the AK diagnosis (median 11 days) and the highest rate of initiating AK treatment started at the first visit (38%) were both in the Ophthalmologists’ group. No significant differences were observed in initial and final visual acuity between HCP groups (p = 0.36). Conclusions AK patients often seek help earlier from optometrists and opticians than medical doctors. Final clinical outcomes did not significantly differ based on the first HCP, but ophthalmologists were more likely to make the diagnosis of AK and initiate anti-amoebal therapy faster than other HCPs. Greater education and collaboration between ophthalmologists and other HCPs to increase awareness of AK are needed.

Background: The COVID-19 pandemic led to the reorganization of the health care system. A decline in health- and life-saving procedures has been reported in various medical specialties. However, data on ophthalmic emergencies during lockdowns is limited. Methods: We conducted a retrospective, observational, case-control study of 2351 patients registered at the ophthalmic emergency department of a tertiary hospital in Poland during three national COVID-19 lockdowns (March/April 2020, November 2020, and March/April 2021) and corresponding months in 2019. Results: The total number of visits declined from a mean of 720/month in the non-COVID era to 304/month during COVID-19 lockdowns (p < 0.001). Ocular trauma incidence dropped significantly from 2019 (non-COVID months) to 2020/2021 (COVID group mean 201 vs. 97 patients monthly, respectively, p = 0.03). Of note, the percentage of foreign bodies removal was significantly higher during lockdowns than corresponding time in the non-COVID era. A downward trend for vitreous detachment and macular disorders cases was observed between COVID and non-COVID time. Uveitis and optic neuritis patients were seen more often during lockdowns (p < 0.001 and p = 0.0013, respectively). In contrast, the frequency of conjunctivitis and keratitis, potentially COVID-related problems, decreased significantly in COVID-19 time (mean 138 vs. 23 per month in non-COVID vs. COVID lockdowns, respectively, p < 0.001). Conclusions: The overall number of eye emergency visits declined during COVID-19 lockdowns. Conjunctivitis and keratitis rates dropped during the lockdowns. Interestingly, the frequency of immune-mediated ocular conditions (uveitis, optic neuritis) increased significantly which might be triggered by SARS-CoV2 infection.