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Prevalence and Etiology of Ocular Morbidity in Maritime Environments: A Systematic Review and Meta-Analysis of Passenger and Crew Data Iska Novi Udayani; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 3 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i3.1526

Abstract

Background: The maritime environment constitutes a unique epidemiological enclosure characterized by isolation, specific occupational hazards, and distinct environmental stressors including hyper-salinity and high ultraviolet (UV) albedo. While gastrointestinal and respiratory outbreaks at sea are well-documented, the burden of ocular morbidity remains under-quantified. This study aims to determine the prevalence and etiology of ocular emergencies, stratifying risks between industrial seafarers (crew) and recreational travelers (passengers). Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Data were extracted from eight observational studies (2014–2024) covering expedition cruises, commercial shipping, and leisure voyages. To address population heterogeneity, a stratified analysis was performed: Track A analyzed occupational trauma in crew, while track B analyzed environmental morbidity in passengers. A random-effects model was used to calculate pooled proportions with 95% Confidence Intervals (CI), accompanied by a leave-one-out sensitivity analysis. Results: The dataset represented a combined population of over 5,000 maritime subjects. The pooled prevalence of ocular involvement in maritime trauma cases was 18.4% (95% CI: 12.1%–25.5%). Etiological analysis of crew injuries revealed a dominance of mechanical trauma, specifically metallic foreign bodies (40.5%), followed by chemical burns (26.2%). In contrast, passenger morbidity was driven by environmental factors (photokeratitis, dry eye) and infectious conjunctivitis. Conclusion: Ocular emergencies represent a significant, preventable burden in maritime travel, with distinct risk profiles for crew and passengers. The high rate of occupational trauma suggests a failure in personal protective equipment (PPE) compliance, while the environmental burden reflects the dry ship phenomenon. Mandatory protective eyewear policies and the integration of anterior-segment tele-ophthalmology are critical interventions.
The Ocular Toll of Drug Tourism: A Systematic Review and Meta-Analysis of Cannabis and Methamphetamine Impact on Retinal Architecture and Pupillary Dynamics Fransiska Lavinia Gracella; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 5 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i5.1584

Abstract

Background: Drug tourism involves individuals traveling across international borders to access recreational illicit substances. While psychiatric and cardiovascular toxicities of substances like cannabis and methamphetamine are established, quantitative data regarding their impact on ocular microstructures and functional dynamics remain scarce. This study aims to systematically review and meta-analyze the structural and functional ocular alterations induced by these substances. Methods: A systematic review and meta-analysis complying with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were conducted. Electronic databases (PubMed, Scopus, Web of Science, Cochrane Library) were searched from inception to January 2026. Data extraction targeted pupillary dynamics and structural optical coherence tomography measurements. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tools. A DerSimonian-Laird random-effects model was utilized in Review Manager 5.4 to pool continuous data, calculating Standardized Mean Differences and 95% Confidence Intervals. Heterogeneity was evaluated via the I-squared statistic. Results: Nine primary research articles were included. The mean Newcastle-Ottawa Scale score was 8.1, indicating a low risk of bias. Chronic cannabis users exhibited significantly reduced pupillary constriction velocity (Standardized Mean Difference -0.85, 95% Confidence Interval -1.20 to -0.50, p < 0.001), prolonged reaction latency (Standardized Mean Difference 0.65, 95% Confidence Interval 0.30 to 1.00, p < 0.01), and decreased corneal endothelial cell density (Standardized Mean Difference -0.78, 95% Confidence Interval -1.15 to -0.41, p < 0.001). Methamphetamine abuse was associated with profound global retinal nerve fiber layer thinning (Standardized Mean Difference -1.12, 95% Confidence Interval -1.55 to -0.69, p < 0.001) and reduced minimum rim width (Standardized Mean Difference -0.95, p < 0.001). Conclusion: Recreational cannabis and methamphetamine abuse cause significant, quantifiable ocular morbidity. Methamphetamine induces ischemic neurodegenerative retinal loss, while cannabis disrupts autonomic pupillary pathways and corneal integrity. Comprehensive ophthalmological screening is critical for individuals with substance abuse histories.
Co-Authors Akatsu, Haruko Ariana, Putu Agus Aryanita, Made Ayu Ratih Astawastini, I Dewa Ayu Mas Manik Bagus Komang Satriyasa Carolyna Mairing Cokorda Agung Wahyu Purnamasidhi Cokorda Bagus Jaya Lesmana Cokorda Bagus Jaya Lesmana, Cokorda Bagus Jaya Desak Nyoman Widyanthini Desak Putu Yulita Kurniati Deswandri Deswandri Dewa Nyoman Wirawan Dewa Nyoman Wirawan, Dewa Nyoman Dinar Lubis Dyah Pradnyaparmita Duarsa Egiya Goldarosa Sinuraya Erawati, Ni Kadek Erna Ervan Suryanti Umbu Lapu Fabiola Supit Florensia, Maria Frangklin Refelino Jotlely Fransiska Lavinia Gracella Futi Nurul Destya Ganesa Puput Dinda Kurniawan Gede Parta Kinandana Gunawan, I Made Abdi HARI MULYAWAN I Dewa Ayu Inten Dwi Primayanti I Gusti Agung Dyah Ambarawati I Gusti Ayu Made Julari I Gusti Ayu Made Juliari I Kadek Pendi Aprinta I Ketut Indra Wiguna Cakera I Ketut Suyasa I Komang Widarma Atmaja I Made Artana I Made Bakta I Made Jawi I Made Kerta Duana I Made Krisna Dinata I MADE MULIARTA . I Made Niko Winaya I Made Pande Dwipayana I Made Sukawinaca I Nyoman Mangku Karmaya I Putu Adiartha Griadhi I Putu Dedy Kastama Hardy I Wayan Putu Sutirta Yasa I Wayan Weta Ida Ayu Ary Pramita Ida Bagus Subanada Ida Bagus Yorky Brahmantya IKW. Suryawan Indra Wiguna Cakera, I Ketut Isabella Soerjanto Putri Iska Novi Udayani Istiana Marfianti J. A. Pangkahila Jelly Vianti Fransisca Oeitano Josua Aditya Manuel Kadek Dena Ayu Ersafira Kadek Tresna Adhi Karya, I Kadek Jony Dwi Ketut Ariawati Ketut Suarjana Komang Ayu Kartika Sari Lesmana, Cokorda Agung Bagus Jaya LMIS. Handari Adiputra Louise Cinthia Hutomo Luh Pitriyanti Luh Pitriyanti Luh Yulia Adiningsih Luh Yulia Adiningsih Made Agus Hendrayana MADE RATNA SARASWATI . Malcolm Abernethy Marfianti, Istiana Mia Ayustina Prasetya Nadila Sari, Putri Ngurah Agus Sanjaya ER Ni Kadek Dian Candra Dewi Ni Kadek Erna Erawati Ni Kadek Sutini Ni Ketut Sri Lestari Ni Luh Made Susanthi Pramandani Ni Luh Putu Mira Anggriani Ni Luh Putu Nurhaeni Ni Made Dian Kurniasari Ni Made Sri Nopiyani Ni Made Suasti Wulanyani Ni Nyoman Sri Budayanti Ni Putu Ita Mahayati Ni Wayan Mega Sri Wahyuni Ni Wayan Septarini Nijyoti, Nitya Nitya Nijyoti Nurhaeni, Ni Luh Putu Pande Putu Januraga Paramita, Ni Putu Pradnya Peter Larsen Prihandhani, I Gusti Agung Ayu Sherlyna Purnamawati, Susy Putu Astawa Putu Ayu Indrayathi Putu Ayu Sani Utami Putu Eka Arimbawa Putu Ika Anggaraeni Putu Imas Audina Putu Intan Tillama Putu Lestari Sudirman Putu Ratna Kusumadewi Giri Putu Rima Adilitha Widyasari Putu Wulan Putri Amerta R. A.T. Kuswardhani Rania Ayu Permata Putri Kornia Rataya Paramitha Maliawan Rodney Wu Rosita, Ni Putu Indah Santosa, I Gusti Ngurah Putra Eka Sarah Aldington Saraswati, Ni Luh Putu Gita Karunia Sari, Komang Ayu Kartika Sawitri, Anak Agung Sagung Sugijanto - Sukawinaca, I Made Sulawa, I Ketut Susy Purnawati Tiara Alexander Vina Yuwanda Wahyuddin, Wahyuddin Wahyudin - Wahyuni, Ni Wayan Mega Sri Wayan Citra Wulan Sucipta Putri Widowati, I Gusti Ayu Rai - Yenny Kandarini Yuntari, Gusti Ayu Krisma