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All Journal Dinasti Health and Pharmacy Science
Mohammad Aulia Molid Ogest Putra Calisanie
Universitas Sriwijaya, Palembang, Indonesia
Health Professions

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Refractive Errors in Down Syndrome: An Integrative Review of Emmetropization Failure, Corneal Biomechanics, and Accommodative Dysfunction Mohammad Aulia Molid Ogest Putra Calisanie; Ramzi Amin; Rusdianto Rusdianto
Dinasti Health and Pharmacy Science Vol. 4 No. 1 (2026): Dinasti Health and Pharmacy Science (July - September 2026)
Publisher : Dinasti Research & Yayasan Dharma Indonesia Tercinta (DINASTI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/dhps.v4i1.3840

Abstract

Down syndrome is the most common chromosomal disorder compatible with life and is associated with multisystem manifestations, including visual abnormalities. Refractive errors are among the most frequent ocular manifestations in Down syndrome, occurring at substantially higher rates than in the general population. Unlike typically developing children, who largely achieve emmetropia through a homeostatic process called emmetropization, children with Down syndrome show a low proportion of emmetropia and persistently heterogeneous refractive errors. This integrative review searched PubMed/MEDLINE, Scopus, Google Scholar, and the Cochrane Library to synthesize evidence on three domains hypothesized to interact in producing emmetropization failure in Down syndrome: corneal biomechanical alteration, accommodative dysfunction, and disrupted retinal blur signalling. Available evidence suggests that trisomy 21 is associated with dysregulated extracellular matrix and collagen organization that reduces corneal biomechanical stability, together with accommodation lag markedly greater than in children without Down syndrome. Both mechanisms appear to converge on persistent retinal image degradation, which may disrupt the visual signals required for refractive growth regulation and contribute to persistent ametropia, increased amblyopia risk, and long-term impairment of visual development. An integrated understanding of these mechanisms has important implications for longitudinal ophthalmologic screening strategies, early amblyopia detection, and more routine evaluation of accommodative function in the Down syndrome population.
Anti-VEGF Therapy in Diabetic Retinopathy: A Synthesis of Efficacy, Durability, and a Clinical Decision-Making Framework in the Context of Developing Countries Mohammad Aulia Molid Ogest Putra Calisanie; Ramzi Amin; Petty Purwanita
Dinasti Health and Pharmacy Science Vol. 4 No. 1 (2026): Dinasti Health and Pharmacy Science (July - September 2026)
Publisher : Dinasti Research & Yayasan Dharma Indonesia Tercinta (DINASTI)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.38035/dhps.v4i1.3850

Abstract

Diabetic retinopathy is a leading cause of preventable blindness in working-age populations, with vascular endothelial growth factor (VEGF) playing a central role in its progression. This critical narrative review aims to synthesize comparative evidence on the efficacy and durability of anti-VEGF agents and to formulate a contextual clinical decision-making framework for developing countries, particularly Indonesia. A literature search through PubMed/MEDLINE, Google Scholar, and ClinicalTrials.gov identified 143 articles; after stepwise screening with qualitative appraisal based on study design, sample size, and clinical relevance, 40 articles were included. Findings show that aflibercept demonstrated meaningful superiority in patients with poor baseline visual acuity of 20/50 or worse (approximately 2.7 ETDRS letters compared to bevacizumab, PROTOCOL T), while all three major agents yielded comparable outcomes at better baseline vision. Faricimab offered clinical durability up to 16 weeks in 53% of patients (YOSEMITE/RHINE). Approximately 30 to 40% of patients exhibit inadequate response, classifiable as primary non-response or secondary loss of response, each carrying distinct therapeutic implications. Optimal agent selection requires stratification by baseline visual acuity, durability profile, and cost-effectiveness considerations within Indonesia's National Health Insurance (JKN) system. Prospective research in the Indonesian population remains an urgent priority.
Co-Authors Petty Purwanita Ramzi Amin Rusdianto Rusdianto