Aluminum oxide nanoparticles (Al₂O₃ NPs) were synthesized using a simple, eco-friendly green synthesis approach in an alkaline medium from the extract of grapefruit peel waste. The pre-synthesized, nano-crystalline Al₂O₃ NPs were characterized by using spectroscopic (UV–vis, FTIR, XRD, and EDX) and microscopic (SEM and TEM) techniques. The formed Al₂O₃ NPs exhibited a pronounced absorption peak at 278 nm in the UV–vis spectrum. The average particle size of the as-prepared Al₂O₃ NPs was evaluated to be 57.34 nm, and the atomic percentages of O and Al were found to be 54.58 and 45.54, respectively. The fabricated Al₂O₃ NPs were evaluated for antioxidant, anti-inflammatory, and immunomodulatory properties. The Al₂O₃ NPs showed strong antioxidant potential towards all the four tested assays. The anti-inflammatory and immunomodulatory potential of Al₂O₃ NPs was investigated by measuring the production of nitric oxide and superoxide anion (O₂^•−), as well as proinflammatory cytokines tumour necrosis factor (TNF-α, IL-6) and inhibition of nuclear factor kappa B (NF- κB). The results revealed that Al₂O₃ NPs inhibited the production of O₂^•− (99.4%) at 100 μg mL⁻¹ concentrations and intracellular NO^•− (55%), proinflammatory cytokines IL-6 (83.3%), and TNF-α (87.9%) at 50 μg mL⁻¹ concentrations, respectively. Additionally, the Al₂O₃ NPs inhibited 41.8% of nuclear factor kappa B at 20 μg mL⁻¹ concentrations. Overall, the outcomes of current research studies indicated that Al₂O₃ NPs possess anti-inflammatory and immunomodulatory properties and could be used to treat chronic and acute anti-inflammatory conditions.

Purpose: The purpose of this study was to assess UV corneal crosslinking (CXL) treatment outcomes for keratoconus by evaluating the corneal regularity in patients through follow-up using the Oculus Pentacam. Patients and methods: A total of 18 eyes from CXL patients with keratoconus were studied before and after CXL treatment, and six eyes from six patients who were not treated with CXL served as controls. Treated patients had Pentacam images taken before CXL treatment and regularly 3 months post treatment up to the 12th month. Controls were imaged during their first appointment and after 12 months. Symmetry and asphericity were evaluated and correlated with both best-corrected visual acuity (BCVA) and maximum K-readings. Results: In the CXL-treated group, there was a significant improvement in the index of symmetrical variation (ISV) and keratoconus index (KI) at 3 months and in the index of height asymmetry (IHA) and minimum radius of curvature (R_min) at 9 months post treatment. On the contrary, the untreated group’s indices showed some significant worsening in ISV, KI, central keratoconus index (CKI), and R_min. A novel finding in our study was a slight positive shift of anterior asphericity in the 6 mm, 7 mm, and 8 mm 3 months after treatment, which had a correlation with BCVA (R₂=0.390, p=0.053) and a strong correlation with maximum K-reading (R²=0.690, p=0.005). However, the untreated group had no significant changes after 1 year. Conclusion: The corneal asymmetrical shape is associated with the spherical aberration alteration influenced by temporal evolution of surface ablation and increased corneal haze. However, insignificant changes in symmetry attest the stabilization effect on cornea postoperatively as compared with controls.

Background: Health apps have the potential to enable people with diabetes to access care more easily, monitor their condition, and reduce the number of times they need to attend health care appointments. However, the development pipeline for apps may differ widely before the apps are released for use, due to limited funding, difficulty in obtaining iterative feedback from patients/users, and varying levels of developer expertise. In response to concerns about the quality and consistency of apps being released, two guidelines were created: the Digital Technology Assessment Criteria (DTAC) and the National Institute for Health and Care Excellence (NICE) Evidence Standards Framework. These two frameworks aim to standardize the development and evaluation of digital health technologies (DHTs). They outline core requirements, such as accessibility, clinical safety, data protection, interoperability, usability, and safeguarding, which help ensure that digital health apps are accessible, safe, effective, and suitable for real-world use. Objective: This systematic review evaluated the performance of diabetes digital health apps, as presented in published studies, in terms of adherence to DTAC 2021 and NICE 2022 guidelines during development. Methods: We systematically searched Embase and MEDLINE and identified 43 studies that met the inclusion criteria. Each study was assessed against 13 binary scoring criteria derived from the two frameworks. Results: Our findings highlighted that 93% (n=40) of the studies met fewer than 40% of the recommended criteria. Specifically, 88.4% (n=38) studies did not report accurate and reliable measurements, 86% (n=37) omitted app accuracy validation, and 83.7% (n=36) failed to address inequalities considerations. Only 3 (7%) studies achieved scores between 7 and 9 out of a possible 13, and none fully adhered to the guideline criteria. Conclusions: These results suggest a significant gap between digital health guidelines and real-world app development practices. We recommend the adoption of DTAC and NICE guidelines more widely and consistently during design and development. Additionally, we suggest that journals request that authors submit an adherence checklist alongside their manuscript to improve standardization and transparency across digital health publications. Trial Registration: PROSPERO CRD42022322040; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022322040

Background/Objectives: The search for biomarkers of cognition has garnered significant interest over the past decade, owing to their objective nature, in contrast to the currently available cognition screening tools, which are based on subjective measures. Retina imaging is used in this field because its tissue is considered as an extension of the brain’s vascular and neural structures, reflecting overall brain health. In cognitive disorders, early detection and intervention are essential for achieving the best possible outcomes. To evaluate the physiological correlates of cognitive function in healthy young adults by assessing retinal structures as a non-invasive biomarker of cognitive health. Methods: Eighty healthy young adults participated in this study. Optical Coherence Tomography (OCT) was used to measure retinal morphology, including macular thickness, volume, and retinal nerve fiber layer thickness; then, OCT results were correlated with cognitive assessments using the Montreal Cognitive Assessment (MoCA). Results: Participants with mild cognitive impairment exhibited thinner macular thickness and lower macular volume (p < 0.05, p < 0.001) than participants with normal cognitive function. We also found that macular thickness is positively associated with cognitive function in healthy adults (p < 0.001). The RNFL was found to be normal in all groups, despite changes in macular thickness, indicating that cognitive function in normal individuals depends on macular changes rather than the optic nerve. Conclusions: Macular OCT, which is a cost-effective and widely available tool, can be used to screen for mild cognitive impairment. A clinical trial is recommended to validate these findings and to generate guidelines for assessing cognitive physiology through the retina.

Background/Objectives: To investigate the effect of different sound types on pattern visual evoked potential (VEP) responses among healthy adults. Methods: This prospective cross-sectional trial was conducted at the Retina Clinic, Ophthalmology Department, tertiary Hospital in Riyadh, Saudi Arabia. Healthy adults with no systemic or ocular diseases aged 20-60 years were included. All participants underwent comprehensive visual and ocular assessment including best-corrected visual acuity (BCVA), slit-lamp examination, optical coherence tomography (OCT), screening audiometry, and pattern-reversal visual evoked potential (VEP) test conducted under three auditory conditions: silence, Quran recitation, and music exposure. P100 latency and amplitude were recorded using 1° and 0.25° stimulation sizes. Statistical analysis was performed using non-parametric statistical tests including the Friedman test and Bonferroni-corrected post-hoc comparisons. Results: Significant differences in VEP amplitude responses were observed across auditory conditions, particularly at the 1° stimulation size indicated 95% confidence intervals and exact P value for effects. The Friedman test demonstrated significant amplitude differences at the 1° stimulation size (χ²(2)=16.379, p<0.001), with silence producing significantly higher amplitudes compared with Quran recitation and music exposure (p=0.001). Significant positive correlations were identified between BCVA and P100 amplitude at music exposure (r=0.218, p<0.001) only at the 0.25° stimulation size. Conclusion: Different auditory stimulation significantly influenced VEP responses. Stimulation size could be sensitive in detecting the functional visual pathway in healthy adults, but it could be great sensitive for detecting abnormalities in ocular conditions. Further studies are required to assess the potential value of VEP as a non-invasive test for early neural dysfunction.

Aims: To determine the acceptability and identify potential concerns and barriers of using a hypothetical smartphone application (app) for home monitoring (HM) of visual function among patients with diabetes. Methods: Quantitative, cross-sectional study using a self-administered questionnaire. Patients diagnosed with diabetes aged between 20 and 70 years were included. The research was conducted across five regions in Saudi Arabia. The questions were adapted from a validated, published questionnaire and translated into Arabic. It focused on socio-demographic factors and barriers which associated with the acceptance of the hypothetical visual function HM app, using descriptive statistics. Results: A total of 240 patients with diabetes participated in this study. About half of the participants (40.4%) ranged between 40 and 59 years; 42.5% were male, and most of the participants (93.8%) lived within 2 h of their healthcare facility. The rejection to the use of a hypothetical HM app was associated with increased age ( p = 0.025), lower education level ( p = 0.023), urbanicity ( p = 0.011), residing closer to health centres ( p = 0.021), and never experiencing telehealth services previously ( p = 0.025). Logistic regression revealed that accepting a hybrid clinic approach was more likely to be acceptable by younger patients (20–39 years: OR, 5.01; 95% CI, 1.82–13.82; p < 0.001; and 40–59 years: OR, 2.28; 95% CI, 0.084–5.00; p = 0.48), as well as patients who attended primary healthcare or specialised governmental clinics ( p = 0.038 and p = 0.019, respectively). Conclusion: Factors that altered patients’ acceptance of the hypothetical app included their age, educational level, urbanicity, traveling distance, and telehealth experience. Therefore, careful consideration of acceptability and barriers is essential before implementing such an intervention.