The paper is clean, simple and helpful for practitioners.

I selected this systematic review because it was the research topic of my PhD. Neurofibromatosis type 1 (NF1) is a relatively common hereditary disease with a birth incidence of 1 in 2700 and an estimated prevalence of 1 in 4560 people worldwide. Patients are prone to develop both benign and malignant tumours of the central and peripheral nervous system. For timely diagnosis and treatment of these tumours, lifelong follow-up is required. Ophthalmologists play an important role in the surveillance of these patients, particularly in the early detection of optic pathway gliomas (OPGs). NF1-associated OPGs have a variable clinical course—some remain asymptomatic and require no intervention, while others may progress and lead to visual or systemic complications. There remains ongoing debate between centres regarding whether routine MRI screening should be performed in asymptomatic children. Key learning points: • 38 studies met the inclusion criteria. • The pooled prevalence of OPG in children and adolescents under 18 years of age with NF1 was 17% (95% CI, 14%–20%) using a random-effects model. • No statistically significant association was found between MRI surveillance strategies and OPG detection, reinforcing that there is no clear detection advantage with routine MRI screening. This study provides the first pooled estimate of OPG prevalence in children and adolescents with NF1 and supports the value of a symptom-based MRI surveillance approach.

This paper assessed dynamic depth perception (stereopsis) in adults with treated anisometropic amblyopia. It demonstrates that even after visual acuity is restored, binocular deficits can persist well into adulthood. These findings highlight the need to address binocular impairments during treatment in childhood. Improving binocularity in amblyopia may help alleviate ocular motor and visuomotor deficits associated with impaired binocular vision. Key learning points: 1. Restoring visual acuity does not restore binocular vision. 2. Dynamic stereoacuity deficits persist independently of anisometropia or static stereoacuity. 3. Amblyopia treatment must evolve beyond visual acuity restoration alone.

This paper was selected for its scientific rigor in comparing two pediatric anesthesia approaches and for presenting an alternative that can be readily incorporated into clinical practice. The study addresses important considerations in pediatric anesthesia, including discomfort during propofol administration, the need for improved postoperative analgesia, and achieving a shorter recovery period. Esketamine also has anti-inflammatory properties and may reduce the incidence of emergence agitation. Study design: Randomized controlled trial of pediatric patients undergoing strabismus surgery. Comparison: • Propofol alone • Low-dose esketamine combined with propofol Key findings: 1. Improved hemodynamic stability with fewer intraoperative hypotension episodes. 2. Reduced total propofol requirements (propofol-sparing effect). 3. Lower postoperative pain scores and reduced need for additional analgesics. 4. Smoother recovery with reduced emergence agitation. 5. No significant increase in respiratory complications or severe adverse events. Overall, the combination offers improved anesthesia quality without compromising safety.

Myopia is on the rise, and with predictions suggesting that its prevalence may double by 2050, it has become a global health concern. As myopia is multifactorial, extensive research is ongoing to study the contributory factors associated with its development and progression. One study that caught my attention was a paper titled, “A Novel Comparative Study of Inflammatory Cytokines Through Noninvasive Tear Analysis in Children with Myopia Versus Emmetropia” by Nishanth S. et al., published in the American Journal of Ophthalmology (2025). In this study, the authors hypothesized the concept of “para-inflammation,” a subthreshold inflammatory response, as a possible contributor to childhood myopia. They evaluated the OSDI (Ocular Surface Disease Index) questionnaire, tear meniscus height (TMH), tear film break-up time (TBUT), and inflammatory cytokines (IL-1β, IL-6, IL-10, MMP-9, ICAM-1, IL-17A, TNF-α, and VEGF-A) in the tear fluid of myopic children and compared them with hyperopic and emmetropic children. The study demonstrated a positive trend in all inflammatory cytokines except IL-17 and VEGF-A, with significantly increased levels of TNF-α and ICAM-1 in the tear film of myopes. Both molecules are classical mediators of ocular surface inflammation, and their elevated levels in tears suggest a low-grade inflammatory response and a probable link to myopia. In addition, children with moderate and high myopia showed lower TMH and TBUT values, and those with moderate myopia had significantly higher OSDI scores. In summary, this study highlights an interplay between dry eye, low-grade inflammation, and myopia. The emerging evidence from this study suggests the need to move beyond purely optical and environmental factors. This expands the conventional approach—from simply correcting refractive error and prescribing low dose atropine eyedrops or defocus glasses—to adopting a more holistic strategy that includes assessment of ocular surface health, lifestyle evaluation, and optimization of inflammatory status. In daily clinical practice, attention should also be directed toward evaluating tear film stability and dry eye parameters in myopic children, including routine assessment of TBUT, meibomian gland function, and blink patterns (particularly in high screen users), along with age-appropriate OSDI questionnaires to enhance comprehensive myopia care. Ocular surface optimization—through lubricants, management of meibomian gland dysfunction (MGD), blink training, and inflammation control when indicated—may be particularly relevant before initiating therapies such as orthokeratology or contact lens wear. Additionally, the role of the lid margin microbiome in ocular inflammation and pediatric MGD warrants further exploration. Although tear cytokine testing is not yet clinically applicable due to cost and lack of standardization, the concept that dry eye signs and inflammation may influence axial elongation has practical counseling value. Appropriate blinking and structured lifestyle advice—limiting recreational screen time (<2 hours/day), encouraging ≥2 hours/day of outdoor activity, maintaining an appropriate reading distance (30–40 cm), and following the 20-20-20 rule—should form an integral part of myopia management. Furthermore, recognition that atropine may exert anti-inflammatory effects, in addition to its established role in myopia control, provides additional reassurance in its use for progressive myopia. While this study does not yet mandate changes in therapeutic protocols, it reinforces the importance of integrating ocular surface evaluation and lifestyle modification with blinking into routine pediatric myopia management. Ultimately, this evidence supports a multifactorial, preventive, and personalized approach to myopia care rather than a purely refractive model, and it highlights the potential of tear analysis as a non-invasive method for identifying biomarkers.