Open research questions in Ocular Surface and Contact Lens

What the literature leaves open

•  Standardizing pharmacognostic and physicochemical parameters.  Developing sterile, preservative-free ophthalmic formulations.  Integrating Ayurvedic principles with modern ophthalmic research.  Encouraging interdisciplinary collaboration between Ayurveda and modern medicine (Patil et al., 2023). 6. CONCLUSION Anjana exemplifies Ayurveda’s integrated approach to preventive and curative ocular therapy. Its pharmacological potential—supported by antioxidant, antimicrobial, and lubricating properties—positions it as a viable complementary approach in ophthalmic practice. When standardized and validated scientifically, Anjana could bridge the gap between traditional wisdom and modern evidence-based medicine, promoting holistic ocular health. REFERENCES 1. Al-Waili, N. S. (2014). Topical honey application vs. acyclovir for recurrent herpes simplex lesions. Medical Science Monitor, 20: 147–152. 2. Biswas, N. R., Gupta, S. K., Das, G. K., Kumar, N., Mongre, P. K., & Agarwal, S. S. (2018). Evaluation of ophthalmic formulations of Triphala in experimental models. Indian Journal of Experimental Biology, 56(6): 431–438. 3. Charaka. Charaka Samhita, Sutra Sthana, Chapter 5. Chaukhambha Orientalia; Varanasi. 4. Kumar, A., Singh, P., & Sharma, R. (2021). Pharmacological evaluation of Triphala eye drops for ocular disorders. Journal of Ethnopharmacology, 275: 114091. 5. Mishra, B., & Tripathi, R. (2017). Bhaishajya Ratnavali (Vol. 2). Chaukhambha Sanskrit Bhawan. www.wjpr.net │ Vol 15, Issue 13, 2026. │ ISO 9001: 2015 Certified Journal │ 4 Praveen et al. World Journal of Pharmaceutical Research 6. Patgiri, B. J., Prajapati, P. K., & Shukla, V. J. (2016). Standardization of Ayurvedic formulations: An update. AYU Journal, 37(3): 165–171. 7. Patel, V., Desai, T., & Joshi, K. (2017). Pharmacological review of Ayurvedic ocular formulations. International Journal of Ayurveda Research, 8(2): 75–82. 8. Patil, A., Gupta, P., & Kulkarni, R. (2023). Integration of Ayurveda and modern ophthalmology: A translational approach. Journal of Integrative Health Sciences, 7(1): 45–53. 9. Rastogi, S., & Sharma, R. (2020). Traditional Ayurvedic approaches to eye care: Relevance in the modern context. Ancient Science of Life, 39(3): 172–179. 10. Saha, D., Choudhury, P., & Ghosh, S. (2022). Herbal ophthalmic formulations: Advances and perspectives. Journal of Herbal Medicine, 30: 100512. 11. Sharma, P. V. (2018). Dravyaguna Vijnana. Chaukhambha Bharati Academy, Varanasi. 12. Singh, R., Bansal, V., & Rajput, R. (2019). Comparative study of herbal collyrium and antibiotic eye drops in conjunctivitis. AYU Journal, 40(2): 102–108. 13. Sushruta.

  ANJANA: A REVIEW OF AYURVEDIC COLLYRIUM IN CLASSICAL AND MODERN CONTEXTS · 2026 · DOI

• e study has inherent limitations. As a hospital-based study, there is a potential for selection bias toward more severe cases, as mild cases may not seek tertiary care. Hence, the study could not classify disease severity, which limits clinical correlations with risk factors. Consequently, the prevalence of complications may be higher in our cohort than in the general community. Furthermore, specific IgE testing or skin prick testing was not universally performed due to resource constraints, limiting our ability to identify specific offending allergens. CONCLUSION is study highlights that VKC in the rural population of North-East India is a significant ocular morbidity affecting predominantly male children and adolescents. e disease in this region is characterized by a high prevalence of the Limbal phenotype and a distinct seasonal exacerbation during the hot, humid months of summer. Crucially, our findings establish a strong link between VKC severity and rural environmental factors, specifically the use of biomass fuels (firewood and kerosene) for indoor cooking and close animal contact. is suggests that indoor air pollution acts as a potent modifiable risk factor that may lower the threshold for allergic sensitization or exacerbate existing ocular surface inflammation. Management of VKC in this demographic cannot rely solely on pharmacological intervention. Public health initiatives must focus on parental counseling regarding “avoidance Journal of Ophthalmic Research and Practice | Article in Press 6 therapy,” which should include minimizing exposure to indoor smoke and close animal contact. Future community- based studies are warranted to further quantify the impact of indoor air quality on ocular allergies and to investigate genetic susceptibility patterns specific to the North-East Indian population. Acknowledgment: We would like to express our sincere gratitude to the Principal and Superintendent of the tertiary care teaching hospital situated in a rural region of North-East India for permitting us to conduct this study. We are deeply thankful to the faculty members, residents, optometrists, and staff of the Department of Ophthalmology for their assistance in data collection and patient evaluation. Most importantly, we extend our heartfelt thanks to the children and their parents who participated in this study for their cooperation and patience during the examination process. Author contributions: JB, ID: Conceptualization, methodology, validation, writing - review & editing, data curation; JB: Formal analysis, visualization, supervision; ID: Software, investigation, writing - original draft. All authors provided final approval to the work. Ethical approval: e research/study was approved by the Institutional Ethics Committee, Gauhati Medical College and Hospital, Guwahati, number MC/190/2007/Pt11/Jun 2022/29, dated July 25, 2022. Declaration of patient consent: e authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. e patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: ere are no conflicts of interest.

  A clinical study on patterns of vernal keratoconjunctivitis among children in rural part of North-East India · 2026 · DOI

• e future of contact lens technology is increasingly focused on multifunctionality, personalization, and integration with digital health systems. Emerging innovations include stimuli- responsive lenses capable of releasing drugs in response to environmental triggers such as pH or temperature, as well as hybrid lenses that combine vision correction, drug delivery, and biosensing capabilities within a single platform. Advances in three-dimensional printing are enabling the production of highly customized lenses tailored to individual ocular anatomy, thereby improving fit and comfort. Journal of Ophthalmic Research and Practice | Article in Press 3 Mangla: Transforming contact lenses into therapeutic and diagnostic devices: A comprehensive review integration of artificial internet- intelligence and e connected systems is expected to enhance predictive diagnostics and enable real-time clinical decision-making. Research into gene therapy-compatible lenses is also gaining momentum, offering a novel, non-invasive approach to treating genetic and degenerative ocular diseases. ese developments highlight the expanding role of contact lenses as versatile tools in modern healthcare. CLINICAL IMPLICATIONS Advancements in contact lens technology have significantly improved clinical outcomes by enhancing safety, comfort, and therapeutic effectiveness. Improved oxygen permeability reduces the risk of hypoxia-related complications, while advanced designs allow effective management of complex ocular conditions. Drug-delivering lenses offer a practical solution to compliance issues associated with traditional therapies, and smart lenses provide new opportunities for early diagnosis and continuous monitoring. e successful implementation of these technologies depends on appropriate patient selection, accurate lens fitting, and strict adherence to hygiene practices. Eye care professionals must remain informed about evolving technologies to optimize patient outcomes and minimize the risk of complications. CONCLUSION Contact lenses have undergone a remarkable transformation from basic vision correction devices to advanced biomedical platforms that play a critical role in modern eye care. Innovations in material science, particularly the development of silicone hydrogel lenses, have significantly improved oxygen delivery and wearer comfort, while specialized designs such as scleral lenses have expanded therapeutic applications for complex ocular conditions. e emergence of drug-eluting and smart contact lenses further underscores the shift toward multifunctional systems capable of delivering targeted therapy and enabling real-time physiological monitoring. Despite these advancements, challenges related to cost, long-term safety, and regulatory approval accessibility, continue limit widespread adoption. Addressing to these barriers will require sustained research efforts and collaboration across disciplines. As technology continues to evolve, contact lenses are expected to become increasingly integral to personalized and preventive eye care, offering innovative solutions that extend far beyond traditional vision correction. Author contributions: LM: Solely responsible for conceptualization, manuscript writing, review, editing, and approval of the final version. Journal of Ophthalmic Research and Practice | Article in Press 4 Ethical approval: Institutional Review Board approval is not required. Declaration of patient consent: Patient’s consent is not required as there are no patients in this study. Financial support and sponsorship: Nil. Conflicts of interest: ere are no conflicts of interest.

  Transforming contact lenses into therapeutic and diagnostic devices: A comprehensive review · 2026 · DOI

• thermore, the incomplete reporting of syndrome differentiation may reflect the lack of standardized clinical applica- tion and reporting of TCM syndrome classification in dry eye dis- ease research.

  Evidence map for randomized controlled trials of treatment of acupuncture and moxibustion for dry eye disease · 2026 · DOI

• Wogonoside (WGS), a flavonoid glycoside derived from Scutellaria baicalensis , has reported anti-inflammatory and cytoprotective properties; however, its role and mechanism in dry eye–related epithelial injury remain insufficiently defined.

  Wogonoside alleviates hyperosmotic stress-induced inflammation and apoptosis in human corneal epithelial cells via PI3K/AKT signaling · 2026 · DOI

• Prior work shows NGF stimulates proliferation of human LSCs, which express TrkA and p75NTR receptors, but the precise role of NGF signaling in epithelial repair remains unclear.

  A Novel Topical NGF Receptor-mediated Therapy For Neurotrophic Keratopathy · 2026 · DOI

• this study is the lack of a comprehensive, A limitation of standardised assessment of DED, including both symptom evaluation and full clinical signs. Although participants with known ocular surface disease were excluded, subclinical DED cannot be entirely ruled out and may have acted as a confounding the sampling sequence was not factor.

  Diurnal Variation of Tear and Meibum Lipids in Healthy Subjects · 2026 · DOI

• This study has several limitations, including the small sample size and limited follow-up duration. The enrollment of both centrally and peripheral-dominant pain phenotypes may also have diluted treatment effects, as suggested by the larger improvements observed in the peripheral-dominant subgroup. Larger, longer- term studies that focus on peripheral-dominant pain and include sham controls will be needed to confirm these findings. CONCLUSIONS In this exploratory pilot trial, treatment with the ETX-4143 device was associated with reductions in ocular surface pain and improvements in cor- neal sensitivity and BCVA in adults with COSP, with an acceptable short-term safety profile. These preliminary findings support further evaluation of ETX-4143 in adequately powered, phenotype- stratified trials. ACKNOWLEDGEMENTS The authors thank Saadiah Goolam, MBBS (Westmead Hospital); Luke Chehade, MBBS (Sunshine Eye Surgeons); Brendan Cronin, MBBS (Ophthalmic Trial Australia); and Ben LaHood, MBBS, and Millie Meegan, OD (Innovative Eye Care) for their contributions to study treatments and clinical assessments at the participating sites. Medical Writing/ Editorial Assistance. Edi- torial assistance in the preparation of this article was provided by Laura Fletcher, PhD of Regula- tory Pathways Group Inc. Support for this assis- tance was funded by EyeCool Therapeutics. Author Contributions. All authors con- tributed to the study conception and design. Material preparation, data collection and analy- sis were performed by Anat Galor, Mark Hinds, Pooja Bhindi, Cristos Ifantides, Tomasz Stryjew- ski, James A. Stefater, and Bonnie Henderson. The first draft of the manuscript was written by Anat Galor and Cristos Ifantides, Tomasz Stryjewski, and James A. Stefater. Christopher Rapuano, Alice Epitropoulos, Jayne Weiss, Ste- phen Pflugfelder, Preeya Gupta, Deepinder Dhaliwal, Laura Periman, Bonnie An Hender- son, Thanh T. Nguyen, Chameen Samarawick- rama, and Helen Wu commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding. Sponsorship for this study was provided by EyeCool Therapeutics. EyeCool Therapeutics also provided funding for profes- sional writing support and Rapid Service Fee for publication in Ophthalmology and Therapy.

  A Randomized Double-Masked Study Evaluating Safety and Efficacy of a Novel Topical Cooling Device for Chronic Ocular Surface Pain · 2026 · DOI

• A major strength of this systematic review is the inclusion of multiple clinical study designs, ranging from placebo-controlled and sham-controlled randomized trials to prospective comparative © The Indonesian Journal of General Medicine 35 Research Article Volume 40, Issue No.01 . 2026 ISSN : 3048-104X studies and mechanistic clinical investigations. This allows the effectiveness of IPL to be examined from several complementary perspectives, including symptom response, tear film parameters, meibomian gland function, inflammatory biomarkers, and safety outcomes. The inclusion of studies evaluating IPL alone, IPL combined with meibomian gland expression, IPL combined with low-level light therapy, and different IPL devices also provides a broad overview of how IPL has been applied in meibomian gland dysfunction-related dry eye. Another strength is that several included studies used controlled and masked designs, which improves confidence in the observed treatment effects. Placebo-controlled or sham-controlled studies are particularly important in dry eye research because subjective symptoms can be influenced by placebo effects, patient expectations, and concurrent supportive therapies. The presence of objective outcomes such as TBUT, NIBUT, lipid layer thickness, meibum quality, gland expressibility, and inflammatory markers also strengthens the assessment of IPL effectiveness beyond patient-reported symptoms alone.2,5,6 However, several limitations should be acknowledged. First, the included studies were heterogeneous in treatment protocol, IPL device, number of sessions, treatment interval, treatment area, adjunctive procedures, and comparator type. Some studies evaluated IPL as a standalone intervention, while others used IPL with meibomian gland expression or low-level light therapy. This heterogeneity limits direct comparison across studies and prevents a clear estimation of the independent effect of IPL in all included evidence. Second, the outcome measures were not standardized across studies. Although many studies assessed tear breakup time, symptoms, and meibomian gland function, the specific instruments and scoring systems differed. Symptom outcomes were measured using OSDI, SPEED, SANDE, Eye Dryness Score, or other symptom scales, while meibomian gland outcomes used different expressibility, secretion, and meibum quality grading systems. These differences limited the ability to pool findings quantitatively and required narrative synthesis. Third, not all included studies had the same methodological strength. Several studies were uncontrolled, open-label, or single-arm prospective designs, which increases the possibility of confounding, placebo effects, regression to the mean, and measurement bias. Even among © The Indonesian Journal of General Medicine 36 Research Article Volume 40, Issue No.01 . 2026 ISSN : 3048-104X randomized studies, some used active comparators without sham treatment, and some had limitations related to masking, sample size, or paired-eye design. Therefore, findings from lower-risk controlled studies should carry greater interpretive weight than findings from uncontrolled studies. Fourth, the follow-up duration varied substantially, ranging from short-term assessment at 14 days to longer follow-up over several months. This makes it difficult to determine the durability of IPL effects across all protocols. While some studies reported sustained improvement, the available evidence remains limited for long-term recurrence, maintenance therapy, and delayed adverse events. Finally, patient selection differed across studies, particularly in baseline MGD severity, skin type eligibility, use of concomitant therapy, and exclusion criteria. Many studies excluded patients with darker Fitzpatrick skin types or contraindications to IPL, which may limit generalizability to broader clinical populations. As a result, the findings are most applicable to selected patients who meet the safety criteria used in the included clinical studies.

  Effectiveness of Intense Pulsed Light (IPL) in Meibomian Gland Dysfunction Related Dry Eye: A Systematic review · 2026 · DOI

• The study was limited to mild-to-moderate dry eye severity in a specific geographic population. Comparative effectiveness studies are needed to evaluate Jyothi Trataka as an adjunct to standard dry eye therapies (artificial tears, topical cyclosporine, punctal plugs) to define its incremental clinical benefit and role in comprehensive dry eye management across severity levels.

  Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · 2026 · DOI

• The open-label design was unblinded, introducing expectancy-related and detection biases particularly for subjective dry eye symptom measures. Future trials must employ single-blind or assessor-blinded designs where outcome assessors are masked to treatment allocation when measuring ocular surface disease index scores and tear film stability in Jyothi Trataka interventions.

  Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · 2026 · DOI

• The study observed improvements in patient-reported symptoms and TBUT but found no change in aqueous tear parameters in mild-to-moderate dry eye subjects. Future research must incorporate objective biomarkers (tear osmolality, tear protein composition, meibomian gland imaging) alongside patient-reported outcomes to clarify the mechanistic pathway by which yogic visual concentration practices affect tear film stability.

  Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · 2026 · DOI

• The 12-week intervention period with no periodic follow-up assessments prevented evaluation of sustained or delayed effects of Jyothi Trataka on dry eye symptoms. Future studies should extend practice duration beyond 12 weeks and incorporate periodic evaluations (e.g., monthly or quarterly assessments) to determine whether improvements in tear film stability (TBUT) and symptom relief persist or deteriorate over time.

  Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · 2026 · DOI

• The study used a no-intervention control group that does not account for non-specific effects (time, attention, expectancy, environmental influences) on subjective measures in yoga-based dry eye treatment. Future studies must incorporate active comparator interventions or sham yoga protocols to isolate the specific therapeutic effects of Jyothi Trataka from placebo effects.

  Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · 2026 · DOI

• The differential effects of estrogen receptor α versus β in ocular tissues require further characterization to understand tissue-specific hormone sensitivity during the perimenopausal period.

  Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · 2026 · DOI

• The effect of pro-inflammatory and anti-inflammatory cytokines on the development of age-related cataract remains understudied, as well at their role in predicting the course of the postoperative period after extraction of age-related cataract has not been fully stu­died, which determines the relevance of the study.

  Systemic profile of pro-inflammatory and anti-inflammatory cytokines and its changes in patients with cataract after surgery · 2024 · DOI

• Future community- based studies are warranted to further quantify the impact of indoor air quality on ocular allergies and to investigate genetic susceptibility patterns specific to the North-East Indian population.

  A clinical study on patterns of vernal keratoconjunctivitis among children in rural part of North-East India · 2026 · DOI

• These findings underscore the importance of nerve reconstruction in treating neurotrophic keratopathy, while suggesting further investigation into the role of pharmacologic adjuncts.

  Surgical Versus Pharmacologic Management Of Congenital Neurotrophic Keratopathy In Pediatric Patients · 2026 · DOI

• Studies examining the interaction between sex hormones and other risk factors (age-related morphological changes, environmental factors, systemic diseases) in the development of dry eye during perimenopause are limited.

  Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · 2026 · DOI

• The optimal timing, dosage, and formulation of hormone replacement therapy for preventing or treating dry eye disease in perimenopausal women requires further clinical investigation and standardized protocols.

  Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · 2026 · DOI

• Long-term longitudinal studies tracking sex hormone levels and dry eye symptoms across the entire perimenopausal transition are needed to establish causal relationships and identify critical windows of vulnerability.

  Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · 2026 · DOI

• While estrogen and androgen effects on meibomian gland and lacrimal gland function have been demonstrated in animal models and some human studies, the precise molecular mechanisms by which sex hormone fluctuations during perimenopause lead to dry eye disease require further investigation.

  Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · 2026 · DOI

• These results highlight the feasibility of micelle-loaded contact lenses for efficient ocular drug delivery, warranting further exploration into their long-term effectiveness and safety.

  PREPARATION AND IN-VITRO CHARACTERIZATION OF CONTACT LENSES CONTAINING COENZYME Q10 LOADED MICELLES · 2023 · DOI

Most-cited papers in Ocular Surface and Contact Lens

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• Prevalence and risk factors associated with dry eye disease among adults in a population-based setting in South-West Nigeria · Nigerian Journal of Clinical Practice · 2022 · 15 citations
• Prolonged Face Mask Wearing Worsens Self-Reported Dry Eye Symptoms during the COVID-19 Pandemic in Dental Healthcare Practitioners · Acta Stomatologica Croatica · 2023 · 5 citations
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Most recent work

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• Factors Influencing Intraocular Pressure Elevation During Hemodialysis · Translational Vision Science & Technology · 2026
• Polysaccharide-based Hydrogel Formed via In situ Schiff Base Reaction with Contact Lens-like Ocular Surface Coverage for Sustained Ophthalmic Drug Delivery · Chinese Journal of Polymer Science · 2026
• Focus on sex hormone axis disorder: exploring the susceptibility mechanism of dry eye in perimenopausal women · Frontiers in Medicine · 2026
• Dry Eye Disease: Bridging Systemic Inflammation, Ocular Surface Biology, and Clinical Innovation · Biomedicines · 2026
• Depression induces ocular surface inflammation and dry eye-like changes in mice · International Journal of Ophthalmology · 2026
• Dry Eye Disease: From Mechanisms to Management and Future Directions · Journal of Clinical Medicine · 2026
• Yoga as a cost-effective adjunct therapy for dry eye: clinical outcomes from a 12-week randomized controlled trial · Frontiers in Medicine · 2026
• Evidence map for randomized controlled trials of treatment of acupuncture and moxibustion for dry eye disease · Frontiers in Medicine · 2026
• Randomized Controlled Trial of Intradermal Pressing Needle Plus Artificial Tears for Perimenopausal Dry Eye · Acupuncture & Electro-Therapeutics Research: International Journal of Integrated Medicine · 2026

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