This review focuses on the contribution of medical imaging in the diagnosis of peripheral vestibular disorders. This is a narrative review based on a focused literature search conducted using PubMed and the Cochrane Library. Imaging is not usually recommended in initial consultations for vestibular disorders because only 5–10% of MRI scans reveal findings directly related to the disease. The study is a review of the literature that highlights the utility and limitations of imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). It follows the diagnostic approach from history and physical examination to laboratory tests and imaging. Some conditions like vestibular neuritis and benign paroxysmal positional vertigo (BPPV) have limited imaging utility due to the fine details required. Conversely, high-resolution CT and MRI are important for diagnosing Meniere’s disease, acoustic neuroma, and superior canal dehiscence. The role of imaging varies a lot among specific conditions. Advances in imaging technology, particularly high-resolution MRI, promise enhanced diagnostic capabilities.

Background and Objectives: This study reviews the current literature on ocular movements, specifically focusing on nystagmus associated with peripheral vestibular disorders, to enhance diagnostic accuracy. The evaluation of ocular movements, particularly nystagmus, provides essential insights into the function and dysfunction of the vestibular system, helping clinicians distinguish between peripheral and central causes of vertigo and imbalance. Materials and Methods: A comprehensive search of PubMed was conducted using key terms such as “ocular movements”, “nystagmus”, “vestibular nystagmus”, and “peripheral vestibular disorders”. Results: The search yielded 2739 titles, and after a rigorous selection process, 52 articles were reviewed in full. Discussion: The review highlights different classifications and types of nystagmus, including physiological and pathological forms, and their diagnostic relevance in vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere’s disease. Diagnostic techniques like video/electro-oculography are emphasized for their role in assessing vestibular function and identifying abnormalities. The study underscores the importance of detailed ocular examination in the diagnosis of peripheral vestibular disorders and proposes an algorithm to aid this process. Conclusions: While not a systematic review, this study highlights the importance of detailed ocular examination in diagnosing peripheral vestibular disorders and presents an algorithm to facilitate this process. It also emphasizes the need for continued research and advancements in vestibular medicine to further understand ocular movements and their clinical significance, ultimately contributing to improved patient outcomes.

Background and Objectives: Due to the evolution of cataract surgery into a refractive procedure in which optimizing visual quality extends beyond achieving good visual acuity, high-order aberrations have been increasingly recognized as important contributors to postoperative visual performance. This scoping review aims to map and synthesize the available evidence on higher-order aberrations in the context of cataract surgery, with a focus on the surgical techniques, intraocular lens (IOL) design, measurement factors, and their association with the visual outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. A search of electronic databases was performed using a predefined Boolean strategy, complemented by a manual screening of reference lists and independent searches. Studies evaluating higher-order aberrations (HOAs) before and/or after cataract surgery were included. Data were charted descriptively, and findings were synthesized narratively. Results: A total of 94 studies were included. The evidence shows that differences in HOA profiles are based on the surgical techniques, IOL designs (monofocal, multifocal, toric, and extended depth-of-focus), and measurement devices. Increased HOAs were frequently associated with reduced contrast sensitivity, especially under mesopic conditions. Tear-film instability and pupil size were additional factors contributing to dynamic changes in wavefront aberrations. Considerable methodological heterogeneity was observed across studies. Conclusions: The current body of evidence suggests a strong connection between corneal characteristics, IOL design, surgical techniques, patient-specific factors, and postoperative visual quality. HOAs play an important but not an exclusive role. Future research should focus on standardized measurement approaches, population-specific optical considerations, and personalized strategies to optimize visual quality after cataract surgery.

Background: This narrative review aims to assess multiple strategies available to evaluate and manage corneal astigmatism in the context of cataract surgery, with a focus on the surgical techniques, intraocular lens (IOL) selection, and the integration of advanced new technologies. Methods: A narrative review based on a literature search in PubMed/MEDLINE and the Cochrane Library, covering publications from 1990 to 2025, was conducted. Eligible studies included randomized controlled trials, observational studies, prospective and retrospective analyses, and systematic reviews. Key search terms included “astigmatism”, “cataract surgery”, “keratometry”, and “refraction.” Studies were screened and selected by two independent reviewers. Results: Corneal astigmatism is the most common form of astigmatism. While the anterior corneal astigmatism plays a more important role, the posterior corneal astigmatism and the posterior-to-anterior corneal ratio (Gullstrand ratio) can impact the postoperative refractive results in a very important way. While planning the cataract surgery, surgically induced astigmatism (SIA), especially on the posterior cornea, must be taken into consideration. Various approaches, such as opposite clear corneal incisions (OCCIs), toric intraocular lens (IOLs), intraoperative aberrometry, and the integration of artificial intelligence and robotic-assisted surgery, are increasing the precision of astigmatism correction and surgical outcomes. Conclusions: Individualized surgical planning and precise measurement are key factors in reducing residual astigmatism and obtaining the best visual outcomes in patients with corneal astigmatism undergoing cataract surgery. By taking into consideration the posterior corneal data, refining IOL calculations, and embracing the rapidly developing technological innovations, patient satisfaction and visual quality can be substantially improved, and the predictability of the surgical outcome can be enhanced.

Background/Objectives: Artificial Intelligence (AI) technology—in the form of Machine Learning (ML) models and other models specialized in image recognition and processing, such as Convolutional Neural Networks Visual Transformers (CNN-ViTs)—is increasingly being used in ophthalmology. This review summarizes the main AI applications for laser-assisted refractive surgery. Methods: A wide-ranging literature search on the PubMed and ISI Thompson Web of Science databases was conducted. Results: AI is an all-encompassing technological concept that refers to either specific applications of ML/CNN models, such as in keratoconus screening or diagnosis, or agentic/multimodal AI applications that process different data types using a variety of AI models. The most clinically established applications found were corneal ectasia and keratoconus screening, in which AI models can reliably exceed 95% diagnostic accuracy, specificity, and sensitivity; nomogram-derived laser ablation programming; optimization of ray-tracing calculations for ray-traced ablation profiles; patient screening and selection for refractive surgery; visual and refractive result prediction; assessment of postoperative corneal ectasia risk; detection of intraoperative complications; research on the laser coupling effect; and other applications such as monitoring eye rubbing behavior in corneal ectasia suspects. Thus, singular, specific applications of AI models have made the largest clinical contributions. These results must be interpreted with a comparison of internal versus external validation, calibration, and generalizability. Overall the technology is highly promising. Agentic/multimodal AI frameworks are currently being discussed, with pilot studies published and applicability proposed in the context of large, high-patient-volume clinical practices. The technological advent of SHAP force plot graphs and saliency maps has improved understanding of the factors that contribute mechanistically to AI model reasoning, leading to more informed clinical decisions or research applicability, such as in finding parameters or factors linked to postoperative ectasia. Conclusions: AI is already established in laser-assisted refractive surgery in the form of models specialized in data-intensive analysis. At present, the best-performing novel AI models originate from the domain of large or multi-hospital settings due to requirements for multiple latest-generation diagnostic devices, high-volume patient data, computing expertise, and resources. Future directions could include clinical standardization and trickle-down dissemination of the technology. Agentic/multimodal AI has the potential to benefit large clinical/patient settings or offer access to expert knowledge in smaller practice settings. Agentic/multimodal AI implementation is offset by challenges in complexity, the technological limitations of LLMs (“hallucinations”), and ethical and legislative factors.

Background/Objectives: Dry eye disease is more common in diabetes than in non-diabetic populations (pooled odds ratio 2.30), and its risk rises with diabetes duration. We aim to examine if diabetes duration potentiates the association between tear osmolarity and tear film stability. Methods: Cross-sectional study of 60 consecutive adult patients with type 2 diabetes mellitus on stable therapy for ≥3 months, who discontinued artificial tears 1 week before assessment. Worse-eye Non-Invasive-Break-Up-Time (NIBUT) was modelled by Tobit regression with left-censoring at the 1 s instrument floor. We adjusted for body mass index, age, diabetes duration and maximum osmolarity. Results: The duration × osmolarity interaction was significantly associated with NIBUT (β = 0.023, 95% CI 0.005–0.040; Wald p = 0.010; likelihood-ratio p = 0.002). At a normal osmolarity of 290 mOsm/L, expected NIBUT declined from 3.19 s at 5 years to 1.10 s at 20 years; at the 308 mOsm/L cut-point from 2.15 s to 1.35 s; and at an elevated 320 mOsm/L it was essentially unchanged (1.70 s to 1.73 s). Conclusions: The association between a longer diabetes duration and a shorter NIBUT is confined to patients whose osmolarity remains normal and is not detectable once hyperosmolarity is established. Instability is already severe in hyperosmolar patients; what attenuates as osmolarity rises is the association with additional duration, not the instability itself. Osmolarity assessment may therefore be most informative in longstanding diabetes with still-normal osmolarity. Given our limited sample size, our results should be interpreted with caution and are hypothesis-generating for future external validation.