Neurotrophic keratitis (NK) is a degenerative corneal disease caused by damage of trigeminal corneal innervation, which leads to spontaneous epithelial breakdown and corneal ulceration. The impairment of corneal sensory innervation causes the reduction of both protective reflexes and trophic neuromodulators that are essential for the vitality, metabolism, and wound healing of ocular surface tissues. A wide range of ocular and systemic conditions, including herpetic keratitis, ocular chemical burns, corneal surgery, diabetes, multiple sclerosis, and neurosurgical procedures, can cause NK by damaging trigeminal innervation. Diagnosis of NK requires careful investigation of any ocular and systemic condition associated with the disease, complete ocular surface examination, and quantitative measurement of corneal sensitivity. The clinical stages of NK range from corneal epithelial alterations (stage 1) to persistent epithelial defect (stage 2) and ulcer (stage 3), which may progress to corneal perforation. Management of NK is based on clinical severity, and the aim of the therapy is to halt the progression of corneal damage and promote epithelial healing. Although several medical and surgical treatments have been proposed, no therapies are currently available to restore corneal sensitivity, and thus, NK remains difficult and challenging to treat. The purpose of this review is to summarize available evidence on the pathogenesis, diagnosis, and treatment of NK. Novel medical and surgical therapies including the topical administration of nerve growth factor and corneal neurotization are also described.

Remarkable improvements in optical coherence tomography (OCT) technology have resulted in highly sophisticated, noninvasive machines allowing detailed and advanced morphological evaluation of all retinal and choroidal layers. Postproduction semiautomated imaging analysis with dedicated public-domain software allows precise quantitative analysis of binarized OCT images. In this regard, the choroidal vascularity index (CVI) is emerging as a new imaging tool for the measurement and analysis of the choroidal vascular system by quantifying both luminal and stromal choroidal components. Numerous reports have been published so far regarding CVI and its potential applications in healthy eyes as well as in the evaluation and management of several chorioretinal diseases. Current literature suggests that CVI has a lesser variability and is influenced by fewer physiologic factors as compared to choroidal thickness. It can be considered a relatively stable parameter for evaluating the changes in the choroidal vasculature. In this review, the principles and the applications of this advanced imaging modality for studying and understanding the contributing role of choroid in retinal and optic nerve diseases are discussed. Potential advances that may allow the widespread adoption of this tool in the routine clinical practice are also presented.

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The novel coronavirus (2019-nCoV) that originated in Wuhan (China) has quickly spread all over the world. As of April 12, 2020, there have been with more than 1,600,000 confirmed cases and 100,000 deaths globally [1]. To restrict contact among individuals, governments have imposed unprecedented public health measures such as travel bans, workplace distancing, and schools closure. The aim of these measures is to reduce the size of the outbreak as well as its peak in order to decrease the amount of stress on healthcare systems.In a recent correspondence on Lancet, Wang and colleagues pointed out that the measures ordered by the Chinese government to limit the spread of the novel coronavirus, and in particular schools closure, might have negative effects on children's physical and mental health [2]. In fact, the authors stated that when children are out of school, they are physically less active and have longer screen time, irregular sleep pattern, and less favorable diets resulting in weight gain and loss of cardiorespiratory fitness. In addition, the psychological sphere can also be affected by this forced change of lifestyle.We would like to add another piece to the puzzle of potential impacts of home confinement on children, which is the increased risk of myopia (namely, "quarantine myopia"). The prevalence of myopia has rapidly increased over the past few decades, particularly in countries from East and Southeast Asia. Insufficient time spent outdoors is recognized as an important risk factor for its development [3]. Furthermore, the duration and intensity of near work activities (e.g., reading and writing) are also associated with myopia [4]. The mechanisms of visual feedback regulating the eye growth are complex and not completely understood. Factors that may mediate the relationship between time spent outdoors and myopia include the brightness and chromatic spectrum of light, the energy at high spatial frequencies, the peripheral defocus, and the circadian rhythms [3].According to UNESCO, more than 160 countries have closed schools in the attempt at containing the spread of COVID-19, and this measure involves over 87% of world's student population [5]. An important consequence of home confinement on children's health could be the development and/or the worsening of myopia. Since the exact duration of exposure is currently undetermined, it is difficult to estimate the effect from a refractive standpoint. A recent modeling study on influenza reported that in case of severe pandemics, the reduction of the cumulative disease incidence could be possible only with school dismissal lasting 16 weeks or longer [6]. A prolonged home confinement would very likely have a significant impact on the global incidence of myopia. This represents a serious public health concern for two main reasons. First, uncorrected myopia represents a major cause of visual disability in children, particularly in low-and middleincome countries. Second, high myopia in the current pediatric population is linked to a high risk of potentially si...

Purpose: To assess whether omega-3 fatty acid (FA) supplementation is more efficacious than placebo in amelioration of signs and symptoms of dry eye disease. Methods: We performed a systematic literature search in PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases. We included randomized clinical trials comparing omega-3 FA supplementation with placebo in patients with dry eye disease. The outcome measures were dry eye symptoms, breakup time (BUT), Schirmer test, and corneal fluorescein staining. The pooled effect sizes were estimated using a random-effects model. Heterogeneity was evaluated using the Q and I2 tests. Sensitivity analysis and assessment of publication bias were performed. Meta-regression was performed to evaluate the source of heterogeneity. Results: Seventeen randomized clinical trials involving 3363 patients were included. Compared with placebo, omega-3 FA supplementation decreased dry eye symptoms [standardized difference in mean values (SDM) = 0.968; 95% confidence interval (CI) 0.554–1.383; P < 0.001] and corneal fluorescein staining (SDM = 0.517; 95% CI, 0.043–0.991; P = 0.032), whereas it increased the BUT (SDM = 0.905; 95% CI, 0.564–1.246; P < 0.001) and Schirmer test values (SDM = 0.905; 95% CI, 0.564–1.246; P < 0.001). No evidence of publication bias was observed, and sensitivity analyses indicated the robustness of results obtained. Meta-regression analysis showed a higher improvement of dry eye symptoms and BUT in studies conducted in India. Conclusions: This meta-analysis provides evidence that omega-3 FA supplementation significantly improves dry eye symptoms and signs in patients with dry eye disease. Therefore, our findings indicate that omega-3 FA supplementation may be an effective treatment for dry eye disease.