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All Journal Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Majalah Kedokteran Sriwijaya Syntax Literate: Jurnal Ilmiah Indonesia Buletin Farmatera International Journal of Retina Jurnal Biomedika dan Kesehatan Scientia Psychiatrica Sriwijaya Journal of Surgery Sriwijaya Journal of Ophthalmology Eureka Herba Indonesia Jurnal Pengabdian Masyarakat: Humanity and Medicine Open Access Indonesian Journal of Medical Reviews Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Community Medicine and Education Journal Journal of Anesthesiology and Clinical Research Conferences of Medical Sciences Dies Natalis IJRETINA - International Journal of Retina Sriwijaya Journal of Forensic and Medicolegal Ophthalmologica Indonesiana
Ramzi Amin, Ramzi
Universitas Sriwijaya
Humanities Biochemistry, Genetics & Molecular Biology Dentistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Impact of Systemic Glycemic Control (HbA1c Levels) on Long-Term Outcomes of Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review and Meta-Analysis of Observational Studies Ramzi Amin; Widya Wira Putri
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 6 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i6.733

Abstract

Diabetic macular edema (DME) is a leading cause of vision impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard first-line treatment, but response variability exists. Systemic glycemic control, measured by Hemoglobin A1c (HbA1c), is crucial in diabetes management, yet its specific impact on long-term anti-VEGF outcomes in DME requires synthesized evidence from real-world settings. This meta-analysis aimed to evaluate the association between baseline HbA1c levels and long-term (≥12 months) visual and anatomical outcomes following anti-VEGF therapy for DME in observational studies. A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Library databases for observational studies published between January 2013 and December 2023, reporting on baseline HbA1c levels and visual acuity (VA) and/or central retinal thickness (CRT) outcomes at 12 months or longer in DME patients treated with anti-VEGF agents. Primary outcomes were the mean difference in Best-Corrected Visual Acuity (BCVA) change (ETDRS letters) and CRT reduction (microns) between patients with 'better' (HbA1c < 7.5% or lower strata) versus 'poorer' (HbA1c ≥ 7.5% or higher strata) baseline glycemic control at ≥12 months. Heterogeneity was assessed using the I² statistic. Six observational cohort studies, encompassing a total of 1850 patients, met the inclusion criteria. Follow-up durations ranged from 12 to 36 months. The quality assessment indicated moderate-to-high quality across the studies (NOS scores 6-8). Meta-analysis indicated that patients with better baseline glycemic control (HbA1c < 7.5%) achieved significantly greater improvement in BCVA compared to those with poorer control (HbA1c ≥ 7.5%) at ≥12 months (Weighted Mean Difference [WMD]: 4.82 ETDRS letters; 95% Confidence Interval [CI]: 2.95 to 6.69; P < 0.0001). Significant heterogeneity was observed (I² = 68%). Similarly, patients with better baseline HbA1c showed a trend towards greater CRT reduction, although the difference was not statistically significant (WMD: -25.5 µm; 95% CI: -55.2 to 4.2; P = 0.09; I² = 75%). Subgroup analyses suggested the association was consistent across different anti-VEGF agents used. In Conclusion, this meta-analysis of observational data suggests that better baseline glycemic control (lower HbA1c levels) is significantly associated with superior long-term visual acuity gains following anti-VEGF therapy for DME. While a similar trend was observed for anatomical improvement (CRT reduction), it did not reach statistical significance. These findings highlight the critical importance of optimizing systemic glycemic control alongside local anti-VEGF treatment to maximize long-term visual outcomes in patients with DME.
Internal Limiting Membrane (ILM) Peeling versus No Peeling during Vitrectomy for Idiopathic Epiretinal Membrane: A Meta-Analysis of Visual Outcomes and Recurrence Rates Ramzi Amin; Mistur Rozian
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 5 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i5.734

Abstract

The benefit of internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) remains a subject of debate. While proponents suggest ILM peeling reduces ERM recurrence and may improve anatomical outcomes, opponents highlight potential risks such as mechanical retinal trauma, visual field defects, and dissociative optic nerve fiber layer defects (DONFL). This meta-analysis aimed to synthesize current evidence comparing the efficacy and safety of PPV with ILM peeling versus PPV without ILM peeling for idiopathic ERM, focusing on postoperative best-corrected visual acuity (BCVA) and ERM recurrence rates. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between January 2013 and December 2023. We included randomized controlled trials (RCTs) and comparative cohort studies comparing PPV with ILM peeling (Peel group) to PPV without ILM peeling (No-Peel group) for primary idiopathic ERM. Studies reporting BCVA (in logMAR) and/or ERM recurrence rates with a minimum follow-up of 6 months were included. Data were extracted independently by two reviewers. The primary outcomes were the mean difference (MD) in final BCVA (logMAR) and the pooled risk ratio (RR) for ERM recurrence. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Heterogeneity was assessed using the I² statistic. Quality assessment was performed using the Cochrane Risk of Bias tool (for RCTs) and the Newcastle-Ottawa Scale (for cohort studies). Seven studies involving a total of 855 eyes (430 Peel, 425 No-Peel) met the inclusion criteria. The mean follow-up duration ranged from 12 to 36 months. The meta-analysis revealed a statistically significant, albeit small, improvement in final BCVA favoring the Peel group (MD = -0.05 logMAR; 95% CI: -0.09 to -0.01; P = 0.02). Moderate heterogeneity was observed for this outcome (I² = 58%). The pooled analysis of recurrence rates demonstrated a significantly lower risk of ERM recurrence in the Peel group compared to the No-Peel group (RR = 0.18; 95% CI: 0.07 to 0.48; P < 0.001). Heterogeneity for this outcome was low (I² = 15%). Quality assessment indicated a generally moderate to high quality across the included studies, though some concerns regarding blinding and allocation concealment were noted in certain studies. In conclusion, ILM peeling during vitrectomy for idiopathic ERM appears to be associated with a statistically significant, though modest, improvement in final BCVA and a substantially lower rate of ERM recurrence compared to no peeling. The clinical significance of the small BCVA improvement requires careful consideration against potential risks associated with peeling.
Tele-ophthalmology versus Traditional Fundus Photography for Diabetic Retinopathy Screening: A Comparative Meta-analysis of Diagnostic Accuracy, Cost-Effectiveness, and Health Policy Uptake Ramzi Amin; Dio Asgira Rizky
Community Medicine and Education Journal Vol. 5 No. 2 (2024): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v5i2.729

Abstract

Diabetic retinopathy (DR) remains a leading cause of preventable blindness globally, imposing a significant public health burden. Effective screening is paramount for early detection and timely intervention. Traditional fundus photography (TFP), often requiring specialized equipment and personnel, faces access challenges. Tele-ophthalmology (TO) has emerged as a potential solution to improve screening coverage. However, rigorous comparative evidence regarding its diagnostic accuracy relative to established TFP methods, its economic viability, and factors influencing its adoption into health policy and routine practice remains fragmented. This systematic review and meta-analysis aimed to synthesize the evidence comparing TO and TFP for DR screening across these critical domains. We conducted a systematic literature search adhering to PRISMA guidelines across PubMed, EMBASE, and Web of Science databases for studies published between January 1st, 2013, and December 31st, 2023. Keywords included "diabetic retinopathy," "screening," "teleophthalmology," "telemedicine," "fundus photography," "digital imaging," "diagnostic accuracy," "cost-effectiveness," and "policy." Inclusion criteria mandated studies directly comparing TO (any modality involving remote image grading) with TFP (in-person acquisition and grading or local grading) for detecting any DR or referable DR (RDR) in diabetic populations. Outcomes of interest were diagnostic accuracy (sensitivity, specificity), cost-effectiveness metrics (e.g., ICER), and reported health policy uptake or implementation factors. Study quality was assessed using adapted QUADAS-2 criteria for accuracy studies and relevant checklists for economic evaluations. 6 studies met the full inclusion criteria for this meta-analysis. Pooled sensitivity for detecting RDR using TO was 0.90 (95% CI: 0.87-0.93), compared to 0.92 (95% CI: 0.89-0.95) for TFP. Pooled specificity for TO was 0.91 (95% CI: 0.88-0.94) versus 0.93 (95% CI: 0.90-0.95) for TFP. Moderate heterogeneity was observed (I² > 50%). Health policy uptake varied significantly, influenced by factors such as established reimbursement frameworks, governmental support, integration with electronic health records, availability of trained non-ophthalmic personnel, and robust quality assurance protocols. In conclusion, tele-ophthalmology demonstrates high diagnostic accuracy for DR screening, comparable, albeit potentially slightly lower on average, to traditional fundus photography. Economic evaluations largely favor TO, suggesting significant potential for efficient resource allocation in DR screening programs. However, successful translation into widespread, effective public health policy requires addressing implementation barriers related to infrastructure, workforce training, reimbursement parity, and quality assurance.
Health System Factors Influencing the Adoption and Sustainability of Evidence-Based Retinal Care Guidelines: A Systematic Review and Meta-Synthesis Ramzi Amin; Rafika
Community Medicine and Education Journal Vol. 6 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i1.730

Abstract

Evidence-based guidelines (EBGs) are crucial for optimizing care and outcomes for highly prevalent retinal diseases like diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinopathy of prematurity (ROP). However, their translation into routine clinical practice remains inconsistent. Understanding the health system factors that facilitate or impede the adoption and long-term sustainability of these guidelines is critical for improving population eye health. This systematic review and meta-synthesis aimed to identify and synthesize qualitative evidence on health system-level determinants influencing the implementation of retinal care EBGs. We conducted a systematic review following PRISMA guidelines. Major biomedical databases (PubMed, Scopus, Embase, Web of Science) and grey literature sources were searched from January 2013 to December 2024 using keywords related to retinal diseases, guidelines, implementation, adoption, sustainability, and health systems. Inclusion criteria focused on qualitative or mixed-methods studies exploring factors influencing the uptake or continued use of formal retinal care guidelines within clinical settings. Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed study quality using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist. A thematic synthesis approach, following Noblit and Hare's methodology for meta-ethnography, was employed to synthesize findings across studies, involving familiarization, coding, theme generation, and synthesizing translations between studies. 7 studies met the inclusion criteria. These studies originated from diverse healthcare systems and focused primarily on DR and AMD guidelines. Quality assessment indicated moderate to high methodological rigor across the included studies. The meta-synthesis identified six interconnected key themes representing health system factors influencing guideline adoption and sustainability: leadership engagement and organizational culture prioritizing evidence-based practice; resource allocation and infrastructure adequacy, including staffing, funding, and integrated IT systems; inter-professional collaboration and streamlined communication pathways across disciplines and care settings; alignment with external policy levers and financial incentives; perceived guideline characteristics and adaptability within local workflows; and robust feedback mechanisms and continuous quality improvement cycles integrated into the system. Lack of resources, fragmented communication, conflicting financial incentives, and inadequate leadership support emerged as primary barriers. In conclusion, the successful adoption and sustainability of evidence-based retinal care guidelines are profoundly influenced by a complex interplay of health system factors. Effective implementation requires more than guideline dissemination. Addressing these system-level determinants is paramount for bridging the evidence-practice gap and reducing preventable vision loss from retinal diseases globally. Policymakers and healthcare administrators must consider these multifaceted factors when designing and implementing strategies to enhance retinal care quality.
Prognostic Value of Retinal Microvascular Alterations Detected by Fundus Examination in Critically Ill Patients: A Meta-Analysis Ramzi Amin; Faiz Muhammad Ikhsan
Journal of Anesthesiology and Clinical Research Vol. 5 No. 2 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i2.728

Abstract

Introduction: The ocular fundus provides a unique window into the human microcirculation. Retinal microvascular alterations (RMVAs), such as hemorrhages, cotton wool spots, and vessel caliber changes, are observed in critically ill patients and may reflect systemic microvascular dysfunction, a key element in the pathophysiology of critical illness and organ failure. However, the prognostic significance of these findings in the intensive care unit (ICU) setting remains uncertain due to variability among individual studies. This meta-analysis aimed to synthesize existing evidence on the association between RMVAs detected by fundus examination and mortality in critically ill adult patients. Methods: We conducted a systematic literature search across PubMed, Embase, Scopus, and Web of Science databases for observational studies published between January 1st, 2013, and December 31st, 2023. Studies evaluating the association between RMVAs during ICU stay and mortality in adult ICU patients were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the Newcastle-Ottawa Scale (NOS). Data on the presence versus absence of any significant RMVA and mortality were pooled using a random-effects model to calculate an overall odds ratio (OR) with a 95% confidence interval (CI). Heterogeneity was assessed using the I² statistic and Cochrane's Q test. Results: Our search yielded 1,872 unique records, of which 28 were assessed in full text. Six cohort studies, published between 2015 and 2023, met the inclusion criteria, encompassing a total of 1,358 critically ill patients. The included studies varied in population characteristics (medical, surgical, mixed ICUs) and methods of RMVA assessment. The overall quality of included studies was moderate to good (median NOS score 7, range 6-8). The prevalence of any significant RMVA ranged from 18% to 45% across studies. The pooled analysis demonstrated a statistically significant association between the presence of any RMVA detected on fundus examination and increased odds of mortality (Pooled OR = 2.48; 95% CI: 1.65–3.71; p < 0.0001). Moderate heterogeneity was observed among the studies (I² = 58%; p = 0.03 for Cochran's Q test). Conclusion: The presence of retinal microvascular alterations identified through fundus examination during ICU stay is significantly associated with an increased risk of short-term mortality in critically ill adult patients. These alterations may serve as an accessible marker of underlying systemic microvascular pathology and disease severity. Further large-scale, prospective studies with standardized protocols are warranted to confirm these findings and explore the utility of specific retinal signs.
Purtscher-like Retinopathy in Critically Ill Patients (Non-Traumatic Etiologies): A Systematic Review and Meta-analysis of Incidence, Associated Conditions, and Visual Outcomes Ramzi Amin; Dina Fatwa
Journal of Anesthesiology and Clinical Research Vol. 5 No. 1 (2024): Journal of Anesthesiology and Clinical Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/jacr.v5i1.732

Abstract

Introduction: Purtscher-like retinopathy (PLR) is an occlusive microvasculopathy presenting with funduscopic findings similar to Purtscher's retinopathy but occurring in the absence of direct head or chest trauma. Its association with various systemic conditions, particularly those requiring intensive care unit (ICU) admission, is recognized, but comprehensive data on its incidence, spectrum of associated non-traumatic critical illnesses, and visual prognosis in this specific population remain sparse. This study aimed to systematically review the literature and perform a meta-analysis to estimate the incidence of PLR among critically ill patients with non-traumatic conditions, identify commonly associated systemic diseases, and quantify visual outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Scopus, and Web of Science databases were searched from January 1st, 2013, to December 31st, 2023, for studies reporting PLR in critically ill adult patients admitted for non-traumatic reasons. Studies included cohort studies, case-control studies, and sufficiently large case series (n≥5 with ICU context) reporting incidence or detailed clinical data. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale (NOS). Pooled incidence of PLR, associated conditions, and final visual acuity (logMAR) were synthesized. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Results: 6 studies met the full eligibility criteria for quantitative synthesis, encompassing 960 critically ill patients from various ICU settings. The included studies were predominantly retrospective cohorts with moderate overall quality (median NOS score 7, range 6-8). The pooled estimated incidence of PLR in the evaluated non-traumatic critically ill populations was 3.4% (95% Confidence Interval [CI]: 2.1% - 5.5%), exhibiting substantial heterogeneity (I² = 80%, p < 0.001). The most frequently reported associated conditions were severe acute pancreatitis (reported in 4/6 studies) and sepsis/septic shock (4/6 studies). Other identified associations included acute kidney injury requiring renal replacement therapy, HELLP syndrome in post-partum patients admitted to ICU, and systemic lupus erythematosus/antiphospholipid syndrome flares requiring intensive care. Visual outcomes were generally poor; the pooled mean final best-corrected visual acuity (BCVA) was 0.85 logMAR (approx. Snellen 20/140; 95% CI: 0.65 - 1.05 logMAR), again with significant heterogeneity (I² = 75%). Approximately 45% of affected eyes had a final BCVA of less than 20/200. Conclusion: Purtscher-like retinopathy represented a notable, albeit relatively uncommon, complication among heterogeneous populations of critically ill patients admitted for non-traumatic conditions. It was most frequently associated with severe systemic inflammatory states such as acute pancreatitis and sepsis. Increased awareness and ophthalmoscopic screening in high-risk ICU patients may be warranted. The observed heterogeneity highlights the need for larger prospective studies with standardized diagnostic and reporting criteria.
Penyuluhan mengenai pencegahan kebutaan akibat katarak di Puskesmas Merdeka Palembang Amin, Ramzi; Maya Sari, prima; salim, muhammad usman; nindita, dezca
Jurnal Pengabdian Masyarakat: Humanity and Medicine Vol 6 No 1 (2025): Jurnal Pengabdian Masyarakat: Humanity and Medicine
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/Hummed.V6I1.166

Abstract

Unoperated cataracts and uncorrected refractive errors are the most common causes of visual impairment worldwide. Currently, around 94 million elderly people in the world (50 years and above) experience visual impairment or blindness that could be addressed through access to cataract surgery. The Community Ophthalmology Team from the Department of Ophthalmic Health at the Faculty of Medicine, Sriwijaya University, conducted an educational program aimed at enhancing participants' understanding of cataracts, with the goal of increasing awareness regarding prevention and improving community readiness for surgical intervention. A total of 45 participants, who are patients at Puskesmas Merdeka, engaged in the educational session effectively. The participants demonstrated high enthusiasm during the question-and-answer session, and observations indicated an improvement in their knowledge about cataracts. This educational program successfully enhanced public understanding of cataracts and preventive measures.
Edukasi komprehensif penyakit mata kering di Puskesmas Dempo Palembang Purwanita, Petty; Amin, Ramzi; Tribowo, Anang; Cicilia, Monica Putri
Jurnal Pengabdian Masyarakat: Humanity and Medicine Vol 6 No 1 (2025): Jurnal Pengabdian Masyarakat: Humanity and Medicine
Publisher : Fakultas Kedokteran Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32539/Hummed.V6I1.167

Abstract

Educational Outreach on Dry eye disease at Puskesmas Dempo Palembang. Dry eye disease is one of the most common eye health concerns worldwide, including in our community. With modern lifestyle changes, such as increased use of digital devices and exposure to less favorable environmental conditions, the prevalence of dry eye is rising. This condition not only causes daily discomfort but can also lead to serious vision problems if not properly addressed. The Community Ophthalmology Team from the Department of Ophthalmology, Faculty of Medicine, Sriwijaya University, conducted an outreach program to enhance participants' understanding of dry eye disease, covering its causes, symptoms, prevention, and treatment. Through effective education, we can help the community recognize early signs of the disease, adopt habits that support eye health, and seek appropriate treatment early on. A total of 32 participants, who were patients of Puskesmas Dempo, actively participated in the outreach program. The participants showed great enthusiasm during the Q&A session, and observations revealed an increase in their knowledge about dry eye disease. This outreach program successfully enhanced the community's awareness of dry eye disease and the steps to prevent it.
Intravitreal Anti-VEGF Injection Monotherapy for Wet Age-Related Macular Degeneration: A Case Report Demonstrating Successful Visual and Anatomical Outcomes Ramzi Amin; Linda Tri Wulandari
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 4 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i4.735

Abstract

Neovascular (wet) age-related macular degeneration (nAMD) is a leading cause of severe vision loss in the elderly, characterized by choroidal neovascularization (CNV). Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionized nAMD management. This report details a case of nAMD successfully managed with anti-VEGF monotherapy. A 61-year-old male smoker with a history of hypertension presented with a two-year history of progressive blurred vision in his right eye (OD). Best-corrected visual acuity (BCVA) was 1/300 OD and 6/60 (pinhole 6/30) OS. Fundus examination OD revealed drusen, hard exudates, and reduced foveal reflex. Optical Coherence Tomography (OCT) OD confirmed intraretinal and sub-RPE fluid, pigment epithelial detachment (PED), and features suggestive of Type II CNV. The patient was diagnosed with nAMD OD and immature senile cataract bilaterally. He received intravitreal anti-VEGF injection OD. Seven days post-injection, BCVA OD improved to <1/60, with subjective improvement in vision. In conclusion, this case demonstrates the efficacy of intravitreal anti-VEGF monotherapy in improving visual and anatomical outcomes in a patient with nAMD. Despite known risk factors, timely intervention led to a favorable short-term response. Long-term management and monitoring remain crucial.
Stargardt Disease Unmasked During Primigravida Pregnancy: A Case Report on Diagnosis and Low Vision Management Ramzi Amin; Ginda Chitra
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 3 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i3.739

Abstract

Stargardt disease (STGD1), the most prevalent inherited macular dystrophy in juveniles and young adults, typically results from biallelic mutations in the ABCA4 gene. It leads to progressive central vision loss due to lipofuscin accumulation in the retinal pigment epithelium (RPE) and subsequent photoreceptor degeneration. While onset often occurs in the first two decades, presentation can vary. Managing STGD1 involves optimizing remaining vision through low vision rehabilitation and addressing the psychosocial impact, particularly crucial during significant life events like pregnancy. We report the case of a 23-year-old Indonesian female, primigravida at 35 weeks of gestation, referred from obstetrics for evaluation of a longstanding visual impairment before delivery planning. She reported progressive bilateral blurred vision since age 7, significantly worsening over the past three years, accompanied by photophobia and difficulty reading, requiring close proximity to text. Her younger sibling also had similar visual complaints. Best-corrected visual acuity was 1/60 OD and 2/60 OS, unamenable to refractive correction. Fundus examination revealed bilateral macular atrophy with a "beaten bronze" appearance, surrounding pisciform yellowish flecks extending towards the mid-periphery, and peripheral retinal dystrophy. Optical Coherence Tomography (OCT) confirmed foveal atrophy and RPE disruption. Fundus autofluorescence (FAF) showed hypoautofluorescence corresponding to atrophy, surrounded by areas of hyperautofluorescence (flecks). Amsler grid testing indicated bilateral central scotomas. Contrast sensitivity was severely reduced (1.25% Pelli-Robson bilaterally), and Ishihara testing revealed dyschromatopsia. Based on the clinical findings, family history, and characteristic imaging features, a diagnosis of Low Vision secondary to suspected Stargardt Disease was made. Obstetric examination was normal, and no contraindications for vaginal delivery were identified from an ophthalmic perspective. Low vision management included counseling, prescription of photochromic lenses, and demonstration of non-optical aids (typoscope, large print materials, handheld/stand magnifiers, glare control measures like hats/sunglasses, and a white cane for mobility). In conclusion, this case highlights the presentation of suspected Stargardt disease in a young primigravida woman, emphasizing the importance of thorough ophthalmic evaluation and multimodal imaging for diagnosis, even when symptoms have been present since childhood. Pregnancy provided the context for a formal diagnosis and initiation of low vision rehabilitation. Management focused on maximizing functional vision using appropriate aids, patient education regarding the condition's nature and inheritance, and addressing safety during mobility. Multidisciplinary care involving ophthalmology, obstetrics, and low vision services is crucial for optimal patient outcomes.
Co-Authors A.A. Ketut Agung Cahyawan W A.K Ansyori Ahmad Ghiffari Alfin Radhian Alfurqon Alfurqon Ammar Fardhana Ansyori, A.K. Ansyori, AK Ansyori, AK. Ashita Hulwah A Ayu Aliyah Aziztama, Rezandi Budi Santoso Chairil Anwar Chairil Anwar Charil Anwar Cicilia, Monica Putri Cindy Kesty Defayudina Dafilianty Rosataria Devi Eryanti Devi Eryanti Dezca Nindita Dian Ariani Dian Puspita Sari Dina Fatwa Dio Asgira Rizky Dita Mintardi Dwiana Ocviyanti Dyah Rahayu Utami Elisa Taurisia Elza Iskandar, Elza Evasha, Agung Putra Faika Novadianaz Faiz Muhammad Ikhsan Faneisha Febrina Art Fensilia Yolanda, Gina Sonia Ferry Yusrizal Fidalia Galuh Ismayanti Ginda Chitra H. A. K. Ansyori H. A.K Ansyori Haloho, Agustina Br. Hamzah Hasyim Handayani, Retno Tharra Hartati Hartati Herdana, Nova Indiarsih, Tiara Bunga Indri Seta Septadina Irsan Saleh Kms Yusuf Effendi Krisna Murti Laksono Trisnantoro Linda Tri Wulandari M. Usman Salim Mandy Putriyudi Maria Ulfa Maya Ija Maya Sari, prima Mgs. Irsan Saleh, Mgs. Irsan Mistur Rozian Mufida Muzakkie Muhammad Baqir MUHAMMAD FAHMI Muhammad Irsan Saleh mulyati mulyati Mutiara, Ria Nailul Authoriyah Naufallah Dinda Harumi Nova Herdana Nur Farida Rahmawati Nyayu Fauziah Zen Oliffa Salma Atthahiroh Petty Purwanita Prima Maya Sari Purwanita, Purwanita Putra, Chani Sinaro Putri, Dwi Octaverina Radiyati Umi Partan Rafika Rafika Novianti Rahmah, Meidina Rajendra Ekki Maulana Reny Violeta Rika Anggraini Rika Anggraini Ririn Rahayu Ririn Rahayu MS Rizma Adlia Syakurah Roland Iqbal Rosataria, Defayudina Dafilianty Salim, Muhammad Usman Shaelva Lassa Sabatini Shariff, Muhammad Apriliandy Silvia Rahmi Siti Pradyta Phiskanugrah Sukmono, Nafila Mahida Syarif Husin Theodorus Tiara Mayasari Tribowo, Anang Vicela Patricia Virgyna Widya Wira Putri Yuanita Windusari Yuanita Windusari Zamzam, Avizena Muhammad Zen Hafy