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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

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.

Intraocular Pressure Dynamics and Ischaemic Risks During Air Travel Post-Gas Tamponade: A Systematic Review and Meta-Analysis Vina Yuwanda; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1606

Background: Gas tamponade is a widely used surgical intervention for retinal detachment repair. However, intraocular gas bubbles expand at altitude owing to Boyle's law, potentially causing severe intraocular pressure (IOP) elevation and ischaemic complications. The safety of air travel for patients with residual intraocular gas remains insufficiently characterised. Methods: We conducted a systematic review and meta-analysis of empirical and computational studies examining IOP dynamics during simulated or actual altitude exposure in eyes with intraocular gas. We searched MEDLINE, Embase, Web of Science, Scopus and PubMed Central through March 2024 for peer-reviewed publications without language restrictions. Study selection followed PRISMA 2020 guidelines with predefined eligibility criteria. Data were extracted in duplicate, and risk of bias assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis calculated standardised mean differences (SMD) with 95% confidence intervals (CI). Sensitivity analyses stratified findings by study type. Results: The primary analysis included three empirical studies (n = 47 eyes) showing IOP increase of SMD = 3.03 (95% CI: 2.18–3.89; I² = 17.16%, τ² = 0.11). Sensitivity analysis including all four studies (one computational model) yielded SMD = 4.67 (95% CI: 1.52–7.82; I² = 95.67%, τ² = 9.81). Individual study estimates ranged from SMD = 2.52 (Mills 2001) to SMD = 8.65 (Gsellman 2016, computational). Risk of bias was generally low to moderate. No significant publication bias was detected. Conclusion: Patients with residual intraocular gas who undertake air travel face meaningful IOP elevation at altitude. The risk of anterior segment ischaemic complications warrants careful patient counselling, altitude restriction recommendations, and prophylactic pharmacotherapy. Future prospective studies should evaluate optimal clinical protocols.

High-Altitude Maculopathy in Mountaineers: A Systematic Review and Meta-Analysis Rataya Paramitha Maliawan; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1613

Background: High-altitude maculopathy (HAM) represents a distinct form of high-altitude retinopathy affecting mountaineers at extreme elevations. Despite increased mountaineering activity, the prevalence and clinical significance of HAM remain poorly characterised in systematic reviews. Methods: A comprehensive systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, and manual review of reference lists through April 2026. Eligible studies were prospective and retrospective cohorts reporting HAM prevalence in mountaineers at altitude ≥3,500 metres. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis employed the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling. Results: Three prospective studies (n=50 mountaineers) were analysed with a pooled prevalence of 73.37% (95% confidence interval: 60.28–84.72%). Heterogeneity was absent (I²=0%, Q=0.78, p=0.678). Subgroup analysis demonstrated a higher prevalence at extreme altitude (≥5,000 m: 78.6%) versus very high altitude (3,500–4,999 m: 70%). Sensitivity ranged 67.48–83.76%. Funnel plot inspection revealed no evidence of publication bias. Conclusion: Approximately three-quarters of mountaineers experience HAM at high altitude, with prevalence increasing at extreme elevations. HAM represents a common but underrecognised altitude-related ocular complication. Future prospective studies should employ standardised diagnostic criteria and investigate the mechanistic pathways of macular involvement.

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

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.

Intraocular Pressure Dynamics and Ischaemic Risks During Air Travel Post-Gas Tamponade: A Systematic Review and Meta-Analysis Vina Yuwanda; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita; I Made Ady Wirawan
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1606

Background: Gas tamponade is a widely used surgical intervention for retinal detachment repair. However, intraocular gas bubbles expand at altitude owing to Boyle's law, potentially causing severe intraocular pressure (IOP) elevation and ischaemic complications. The safety of air travel for patients with residual intraocular gas remains insufficiently characterised. Methods: We conducted a systematic review and meta-analysis of empirical and computational studies examining IOP dynamics during simulated or actual altitude exposure in eyes with intraocular gas. We searched MEDLINE, Embase, Web of Science, Scopus and PubMed Central through March 2024 for peer-reviewed publications without language restrictions. Study selection followed PRISMA 2020 guidelines with predefined eligibility criteria. Data were extracted in duplicate, and risk of bias assessed using the Newcastle-Ottawa Scale. Random-effects meta-analysis calculated standardised mean differences (SMD) with 95% confidence intervals (CI). Sensitivity analyses stratified findings by study type. Results: The primary analysis included three empirical studies (n = 47 eyes) showing IOP increase of SMD = 3.03 (95% CI: 2.18–3.89; I² = 17.16%, τ² = 0.11). Sensitivity analysis including all four studies (one computational model) yielded SMD = 4.67 (95% CI: 1.52–7.82; I² = 95.67%, τ² = 9.81). Individual study estimates ranged from SMD = 2.52 (Mills 2001) to SMD = 8.65 (Gsellman 2016, computational). Risk of bias was generally low to moderate. No significant publication bias was detected. Conclusion: Patients with residual intraocular gas who undertake air travel face meaningful IOP elevation at altitude. The risk of anterior segment ischaemic complications warrants careful patient counselling, altitude restriction recommendations, and prophylactic pharmacotherapy. Future prospective studies should evaluate optimal clinical protocols.

High-Altitude Maculopathy in Mountaineers: A Systematic Review and Meta-Analysis Rataya Paramitha Maliawan; I Made Ady Wirawan; I Gusti Ayu Made Juliari; Ida Ayu Ary Pramita
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (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.v10i6.1613

Background: High-altitude maculopathy (HAM) represents a distinct form of high-altitude retinopathy affecting mountaineers at extreme elevations. Despite increased mountaineering activity, the prevalence and clinical significance of HAM remain poorly characterised in systematic reviews. Methods: A comprehensive systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Cochrane Library, and manual review of reference lists through April 2026. Eligible studies were prospective and retrospective cohorts reporting HAM prevalence in mountaineers at altitude ≥3,500 metres. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-analysis employed the Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling. Results: Three prospective studies (n=50 mountaineers) were analysed with a pooled prevalence of 73.37% (95% confidence interval: 60.28–84.72%). Heterogeneity was absent (I²=0%, Q=0.78, p=0.678). Subgroup analysis demonstrated a higher prevalence at extreme altitude (≥5,000 m: 78.6%) versus very high altitude (3,500–4,999 m: 70%). Sensitivity ranged 67.48–83.76%. Funnel plot inspection revealed no evidence of publication bias. Conclusion: Approximately three-quarters of mountaineers experience HAM at high altitude, with prevalence increasing at extreme elevations. HAM represents a common but underrecognised altitude-related ocular complication. Future prospective studies should employ standardised diagnostic criteria and investigate the mechanistic pathways of macular involvement.

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