A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India

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Cataracts with pseudoexfoliation are age-related and are associated with open-angle glaucoma. Therefore, pseudoexfoliation is expected to occur more frequently. Pseudoexfoliation is occasionally associated with the development of thick nuclear cataracts, which may make surgery challenging. risks of cataract extraction in patients with pseudoexfoliation include zonular weakness and inadequate pupillary dilation. This may cause vitreous loss, and intraoperative or postoperative lens displacement. It could also lead to a rise in postoperative intraocular pressure (IOP), progressing to long-term inflammation, phimosis of the capsular tissue, glaucoma, and surgical corneal decompensation. Recurrent secondary cataracts are typically caused by some remaining cortical tissue and decreased zonular support, which may lead to lens epithelial cell migration. Surgery for glaucoma and cataracts is complicated by the presence of pseudoexfoliative debris. Objectives To determine the prevalence of pseudoexfoliation in cataract patients visiting the ophthalmic OPD, AVBRH hospital, to locate patients with pseudoexfoliative cataracts, to evaluate their likelihood of progressing to open-angle glaucoma, and to examine the various ocular characteristics of these patients. Methodology The study participants will undergo ophthalmological examination after considering the inclusion and exclusion criteria. This examination will include sac syringing on the lacrimal gland, estimation of the highest corrected visual acuity, slit-lamp examination, application tonometer assessment of intraocular pressure (IOP), and fundus examination using an indirect ophthalmoscope. All individuals with cataracts visiting the ophthalmology department of AVBRH will be examined under a slit-lamp to determine the presence of pseudoexfoliation in the operating eye. Expected Results Hospital statistics from India indicated that the percentage of patients with pseudoexfoliation, in addition to cataracts, ranges from 1.87% to 13.5%. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-483", "name": "A study of clinical profile in patients of cataracts with pseudoexfoliation..." } } ] } Home Browse A study of clinical profile in patients of cataracts with pseudoexfoliation... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Pawar Y and Thool A. A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.12688/f1000research.149563.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Revised A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] Yuga Pawar https://orcid.org/0000-0003-0023-9452 1 , Archana Thool 1 Yuga Pawar https://orcid.org/0000-0003-0023-9452 1 , Archana Thool 1 PUBLISHED 16 May 2025 Author details Author details 1 Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India Yuga Pawar Roles: Conceptualization, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Archana Thool Roles: Conceptualization, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Eye Health gateway. This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Background Ophthalmologists deal with daily pseudoexfoliation (PXF) due to severe secondary glaucoma, which arises after cataract surgery. Cataracts with pseudoexfoliation are age-related and are associated with open-angle glaucoma. Therefore, pseudoexfoliation is expected to occur more frequently. Pseudoexfoliation is occasionally associated with the development of thick nuclear cataracts, which may make surgery challenging. risks of cataract extraction in patients with pseudoexfoliation include zonular weakness and inadequate pupillary dilation. This may cause vitreous loss, and intraoperative or postoperative lens displacement. It could also lead to a rise in postoperative intraocular pressure (IOP), progressing to long-term inflammation, phimosis of the capsular tissue, glaucoma, and surgical corneal decompensation. Recurrent secondary cataracts are typically caused by some remaining cortical tissue and decreased zonular support, which may lead to lens epithelial cell migration. Surgery for glaucoma and cataracts is complicated by the presence of pseudoexfoliative debris. Objectives To determine the prevalence of pseudoexfoliation in cataract patients visiting the ophthalmic OPD, AVBRH hospital, to locate patients with pseudoexfoliative cataracts, to evaluate their likelihood of progressing to open-angle glaucoma, and to examine the various ocular characteristics of these patients. Methodology The study participants will undergo ophthalmological examination after considering the inclusion and exclusion criteria. This examination will include sac syringing on the lacrimal gland, estimation of the highest corrected visual acuity, slit-lamp examination, application tonometer assessment of intraocular pressure (IOP), and fundus examination using an indirect ophthalmoscope. All individuals with cataracts visiting the ophthalmology department of AVBRH will be examined under a slit-lamp to determine the presence of pseudoexfoliation in the operating eye. Expected Results Hospital statistics from India indicated that the percentage of patients with pseudoexfoliation, in addition to cataracts, ranges from 1.87% to 13.5%. READ ALL READ LESS Keywords Pseudoexfoliation, prevalence, glaucoma, Postoperative complications, cataract, Pseudoexfoliation-syndrome, intra ocular pressure, rural population Corresponding Author(s) Yuga Pawar ( [email protected] ) Close Corresponding author: Yuga Pawar Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Pawar Y and Thool A. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Pawar Y and Thool A. A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.12688/f1000research.149563.2 ) First published: 17 May 2024, 13 :483 ( https://doi.org/10.12688/f1000research.149563.1 ) Latest published: 16 May 2025, 13 :483 ( https://doi.org/10.12688/f1000research.149563.2 ) Revised Amendments from Version 1 We have updated and revised my whole manuscript as suggested by the peer reviewer. We have detailed the methodology of data collection for the study. We have also replaced the word prevalence with proportion in the given data. We have also written statistical formula details and references as asked by the reviewer. We have also updated the analysis and results part. We have changed the discussion part as opined by the reviewers. We have updated and revised my whole manuscript as suggested by the peer reviewer. We have detailed the methodology of data collection for the study. We have also replaced the word prevalence with proportion in the given data. We have also written statistical formula details and references as asked by the reviewer. We have also updated the analysis and results part. We have changed the discussion part as opined by the reviewers. See the authors' detailed response to the review by Ngozika Esther Ezinne See the authors' detailed response to the review by Yuanbo Liang READ REVIEWER RESPONSES Introduction Background A systemic condition known as pseudoexfoliation (PXF) syndrome was initially noted by Finnish ophthalmologist Lindberg in 1917, and Alfred Vogt provided more data in 1923. The development of a whitish-grey fibrogranular amyloid-like substance on the corneal endothelium, pupillary margin on the iris, anterior portion of the lens capsule, zonules, ciliary body, anterior vitreous, and trabecular meshwork are indicators of age-related ocular disorder pseudoexfoliation (PXF) syndrome. 1 Histologically, Fibrillin is an elastin that creates elastic fibers, and fibrils are non-collagenous materials. 2 According to histological analysis, the deposits are composed of laminin, glycosaminoglycans, and hyaluronic acid coatings on fibrils, a non-collagenous component utilized to create the basement membrane. “Three-Ring Sign” is frequently seen on the anterior lens capsule consisting of an outer region that is granularly foggy, an essentially uniform center region, and a clear zone in the middle. White-gray flaky debris on the anterior side of the lens or the pupillary border of the iris is the most widely recognized and easily identifiable diagnostic sign of pseudoexfoliation. 3 The diagnosis is supported by pigment deposition in the anterior chamber structures and pigment loss from the iris sphincter area. The examiner was primarily responsible for providing an accurate diagnosis of pseudo-exfoliation. Pseudoexfoliation syndrome can remain undiagnosed due to the absence of early signs. Identifying pseudoexfoliation during routine ophthalmic examinations is crucial because it can increase the risk of problems during cataract surgery. The coexistence of cataract and pseudoexfoliation (PEX) syndrome presents unique surgical challenges. The accumulation of pseudoexfoliative material can weaken the zonular fibers that support the lens, increasing the risk of intraoperative complications such as lens dislocation. Inadequate pupillary dilation is common in PEX patients, necessitating the use of specialized surgical techniques and devices to ensure adequate visualization and access during surger. 4 Open-angle glaucoma with pseudoexfoliation (PXF) is a moderately frequent type of glaucoma that can result in an abnormally high eye pressure. This disorder is identified by the presence of a dust-like substance on the surface of the iris and lens inside the eye. The trabecular meshwork, which is the drainage system of the eye, also becomes coated with this “fibrillar” material, raising intraocular pressure. Growing research also suggests that other organs within the body are affected by this basement membrane disease. Although pseudoexfoliation tends to be extraordinarily asymmetrical and is most frequently found in adults aged > 70 years, it can also occur in one or both eyes. Pseudoexfoliation, despite being long believed to be an illness only affecting persons of Scandinavian origin, glaucoma is now present in all ethnic groups. The anterior lens capsule and pupillary edge are often covered in pseudoexfoliative material. Pseudoexfoliation syndrome, which includes weak zonules, posterior synechiae, dislocation of the lens, and poor or deficient pupillary dilation, is thought to be among the leading causes of ocular hypertension, early cataract development, and secondary open-angle glaucoma. 4 PEG may result from congestion of the trabecular meshwork, according to specific theories. Less zonular support and some lingering cortical tissue often cause secondary cataracts by allowing lens epithelial cells to migrate. The abundance of pseudoexfoliative matter in the anterior area has made cataract and glaucoma surgeries more challenging. The more frequent secondary cataract is typically caused by less zonular support and some remaining cortical tissue, which allows the lens epithelial cells to migrate. The anterior portion contains pseudoexfoliative material, which complicates surgical operations for cataracts and glaucoma. Pseudoexfoliation syndrome is widely recognized as a significant risk factor for the development of glaucoma, particularly primary open-angle glaucoma. This association is primarily due to the accumulation of abnormal fibrillar extracellular material in various ocular structures, most notably within the trabecular meshwork. Over time, this buildup can interfere with the normal drainage of aqueous humor from the anterior chamber of the eye. As the outflow becomes increasingly obstructed, intraocular pressure rises, which is a key pathogenic factor in the development of glaucomatous optic neuropathy. Cataract surgeries may be difficult because of the changes that pseudoexfoliative deposits cause in the anterior segment tissues. Tissue changes may result in vitreous loss, capsular phimosis, intraoperative or postoperative lens displacement, protracted inflammation following surgery, spikes in intraocular pressure (IOP) that cause damage to the glaucomatous disc, or postoperative corneal decompensation. Research has shown that compared to normal cases, patients with PXF syndrome are five times more likely to experience intraoperative problems after cataract surgery. Therefore, in patients with pseudoexfoliation syndrome, appropriate preoperative workup and intraoperative care will lower the risk of complications during cataract surgery. 5 Understanding the clinical characteristics of these patients is crucial for developing effective management strategies and improving surgical outcomes. Therefore, this study aims to analyze the proportion of pseudoexfoliation among patients with cataracts visiting our hospital in a specific period, clinical profile, and association of pseudo-exfoliative glaucoma in patients with PXF in rural central India providing insights that could enhance patient care and inform public health initiatives in similar settings. The findings will contribute to better patient care strategies, improved surgical planning, and targeted public health interventions, ultimately enhancing visual outcomes and quality of life for affected individuals in resource-limited settings. Aims and objectives 1. To know the proportion of pseudoexfoliation in cataract patients, visiting to AVBRH hospital. 2. To determine how common open-angle glaucoma is among cataract patients who have pseudoexfoliation 3. To study the various ocular features in patients of cataracts with pseudoexfoliation. Methods Study design - Cross-sectional study Setting Participants will be chosen from the Acharya Vinobha Bhave Hospital Sawangi, Meghe, Wardha, Maharashtra, for this hospital-based study. This single-center study will follow the guidelines of the Helsinki Declaration and will obtain institutional ethics committee approval from DMIMSU. All volunteers will be asked for written consent signed by them after being informed of the study’s purpose and any potential adverse effects. The procedure site will be the Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Department of Ophthalmology. After considering the inclusion and exclusion criteria, all cataract patients who visited the ophthalmology department of AVBRH will be chosen for study. Eligibility criteria Candidates who visit AVBRH Sawangi and meet the inclusion and exclusion requirements are qualified to participate in this study. Inclusion criteria 1. Patients of cataract with psuedoexfoliation of age 50 years and above 2. Patient who is willing to provide informed consent. Exclusion criteria 1. Traumatic cataract 2. Congenital or developmental cataract 3. Complicated cataract, which includes lens-induced, subluxated lens, etc. 4. Previous intraocular surgery 5. Age younger than 50 years 6. Patients lost to follow-up 7. Long-term use of topical medication 8. Patients with diabetes mellitus 9. Patients with Pterygium 10. Chronic uveitis Data sources The institutional ethics committee of the DMIMSU will authorize the study, following the principles of the Declaration of Helsinki. • Patients with cataracts visiting the ophthalmology OPD will be selected based on inclusion and exclusion criteria. • Informed consent will be obtained from all subjects after the nature of the study was explained to them. • Consent will be in the local language to ensure validity. • Relevant and detailed medical and ocular histories will be taken. • Each participant will go through a thorough eye examination measuring their best corrected visual acuity with the Snellen chart, intraocular pressure, slit-lamp assessment, and fundus examination. • Intraocular pressure (IOP) will be measured using a non-contact tonometer before pupil dilation. The IOP will be measured three times if it is higher than 21 mmHg. • Gonioscopy will be done for every patient. • After putting dilating drops (tropicamide plus) to dilate the pupil, the anterior segment and fundus examination will be done. • A slit lamp will be used for anterior segment examination of the eye, searching for pseudoexfoliative material on the anterior segment structures. • A fundus examination will be conducted using a slit lamp biomicroscopy or indirect ophthalmoscopy. The optic disc and retina will be examined. The following factors will be taken into account while diagnosing glaucoma: An imbalance in the cup-to-disc ratio of the two eyes (> 0.2). A regional notch or thinned neuroretina rim. Higher cup-to-disc ratios (>0.5), particularly when the cups are aligned with the vertical axis. A paler retinal nerve margin Acquired cupping which is defined by vascular indications, such as the ’overpass’ of central vessels and the barring of circumlunar vessels Bias Observational bias: Observational bias can be minimized by examining the patients by the same examiner. Objective bias: Objective bias can be minimized by using the same slit lamp for each patient vising the ophthalmic OPD. Outcomes Primary outcome 1. Intraocular pressure Intraocular pressure (IOP) is the fluid pressure in the eye. As pressure is a measure of force per area, IOP is a measure of the magnitude of the force exerted by aqueous humor on the internal surface area of the anterior eye. Each normal eye produces about 2 μl of aqueous solution per minute, that is, about 70 l during the course of a lifetime. Normal intraocular pressure is 10-21 mmHg, but it can drop as low as 0 mmHg in hypotony and can exceed 70 mmHg in some glaucomas. 2. Characteristics of the lens Pseudoexfoliation syndrome is a chronic age-related disorder of the extracellular matrix that results in the deposition of abnormal fibrillary (pseudoexfoliative) material within various body tissues. This condition primarily manifests in the anterior segment of the eye. The intraocular lens shoes poor dilation with peri-pupillary transillumination defect, fibrillar white flaky deposits on the anterior lens capsule (Hoarfrost Ring), and fibrillar white flaky deposits on the pupillary border. Secondary outcome 1. Atrophic patches on the iris Iris atrophy is a very rare, progressive disorder of the eye characterized by a pupil that is out of place and/or distorted areas of degeneration on the iris (atrophy) and/or holes in the iris. This disorder develops slowly over time in pseudo-exfoliation syndrome. 2. Phacodonesis Phacodonesis is present if the lens trembles upon movement of the eye during slit-lamp examination. The zonular apparatus is the main support system of the human lens, and weakness in the zonules can cause instability of the lens, leading to complications during cataract extraction surgery. Quantitative variable 1. Patient will be selected on the basis of inclusion and exclusion criteria 2. After obtaining consent, patients will be examined for the highest corrected visual acuity with the Snellen chart, and intraocular pressure > 21 mmHg will be considered as raised. 3. During slit-lamp assessment, dilated pupils with cataracts with pseudoexfoliative material on the anterior lens capsule or pupillary margins or iris or anterior chamber will be considered as having cataract with pseudoexfoliation. 4. On fundus examination, the difference between cup-to-disc ratios of both eyes is more than 0.2, regional notch or thinned neuroretina rim, higher cup: disc ratios (>0.5), particularly when the cups are aligned with the vertical axis, a paler retinal nerve margin will be considered as an eye with glaucomatous changes. Sample size calculation To calculate the sample size n = Z 2 P ( 1 − P ) d 2 Where, n = sample size, Z = Z statistic for a level of confidence, P = Expected prevalence or proportion (If the expected prevalence is 20%, then P = 0.2), and d = Precision (if the precision is 5%, then d = 0.05). 6 Z is the threshold of significance at 5%, which is equal to 1.95 with a 95% confidence interval. P = prevalence of patients of cataract with pseudoexfoliation = 5.92% = 0.0592 7 The desired margin error is 5%, or 0.05 n = ( 1.96 ) 2 × 0.0592 × ( 1 − 0.0592 ) / ( 0.05 ) 2 = 85.58 n = 90 n = 90 patients needed in this study Formula reference 8 . Analysis Observational research, known as a “cross-sectional study,” examines information gathered from a population or an appropriate group at a particular period. 9 After collecting the demographical and ocular features data collection chi-square test will be applied and the significance of the clinical profile will be studied. Expected results After collecting the data of patients with cataracts with pseudoexfoliation syndrome out of the total patients visiting the AVBRH Ophthalmology OPD over a span of 2 years, the prevalence will be calculated according to a cross-sectional study. Clinical profiling of pseudoexfoliation in patients with cataracts will be done. Additionally, the frequency and association of pseudoexfoliative glaucoma will be studied. Discussion Ophthalmologists deal with pseudoexfoliation (PXF) conditions on a regular basis because of severe secondary glaucoma and problems that arise after cataract surgery. Despite the fact that it has been recognized since the beginning of the 20th century, interest in its study has only grown in the past several decades. Shweta Kosamia et al (2016) conducted a study at MGM Hospital & Medical College, Aurangabad, and found the overall prevalence of PXF was 5.92%, with a higher occurrence in males (9.05%) compared to females (3.98%). 7 The prevalence increased with age, peaking at 11.56% in the 61–70 years age group, with the youngest case reported at 55 years old. Among the 32 PXF cases, 78.1% resided in rural areas, and 53.1% had bilateral involvement. Intraocular pressure was normal (10–21 mmHg) in 96.9% of cases, with 3.1% having elevated IOP. Lens subluxation was noted in 3.1% of cases. PXF presents significant challenges, particularly in cataract surgery, due to zonular instability and poor pupillary dilation, emphasizing the need for early detection and careful surgical management to minimize complications. Arvind H et al. (2003) conducted a population-based study in a rural area of southern India analyzed 2,850 individuals aged 40 years or older to assess the clinical profile of pseudoexfoliation syndrome (PXF). PXF was identified in 108 subjects (3.8%), with a significant increase in prevalence with age but no sex predilection. The condition was unilateral in 49.1% (53 cases) and bilateral in 50.9% (55 cases). Elevated intraocular pressure (>21 mm Hg) was found in 16.7% (18 cases), while 14.8% (16 cases) had occludable angles, and 13% (14 cases) were diagnosed with pseudoexfoliation glaucoma. 10 Panigrahi S et al. (2024) conducted A cross-sectional study conducted at Hitech Medical College and Hospital, Western Odisha, between January 1, 2021, and December 31, 2022, included 340 OPD patients to determine the prevalence of pseudoexfoliation syndrome (PEX) and associated cataract characteristics. The study found that 74 out of 340 patients (23%) had PEX, with a higher prevalence in males (58%, 42 cases) compared to females (42%, 32 cases), resulting in a male-to-female ratio of 1.3:1. The mean age of presentation was 67 years (range 51–84 years), with the highest prevalence (41%) in the 61–70 years age group. Increased intraocular pressure (IOP) was observed in 11 cases (15%), while two patients each had open-angle glaucoma and lens-induced glaucoma. The most common cataract type among PEX patients was nuclear cataract (27%), followed by cortical cataract with nuclear sclerosis (19%). The findings indicate that PEX is more common in males and is strongly associated with increasing age, with nuclear cataract being the most prevalent form of cataract in PEX patients. 11 This population-based cross-sectional study in rural southern India assessed the prevalence and risk factors of pseudoexfoliation (PXF) among 5,150 individuals aged 40 and above. The overall prevalence of PXF was 6.0%, increasing significantly with age and being more common in males. Of those with PXF, 25.7% were bilaterally blind despite correction, mostly due to cataracts. Glaucoma was present in 7.5% of PXF cases, and PXF was seen in 26.7% of primary open-angle glaucoma patients. Age and male gender were independently associated with PXF. Given its association with glaucoma and cataract-related complications, targeted screening for PXF in older adults may help reduce vision loss in this population. 12 According to hospital records from India, the incidence of PXF ranges from 1.87% to 13.5%. 13 The current study found that 5.92% of participants had pseudoexfoliation syndrome. There were more men than women in this population. It has been observed that PXF becomes more common as people age. Most patients with PXF live in rural areas. Pseudoexfoliation was more common among the patients who participated in outdoor activities. In 100 consecutive PEX patients, Kozart and Yanoff conducted a clinic-based investigation and found that glaucoma was 7% common and ocular hypertension 15% common. in their investigation, however, elevated IOP was required for the diagnosis of glaucomaSimilar to our results, the Blue Mountains Eye research revealed 9.3% OHT and 14.2% glaucoma. This population-based study used optic neuropathy with or without elevated IOP to diagnose pseudoexfoliative glaucoma. Pseudoexfoliation syndrome is known to cause IOP spikes, which may not appear in a single IOP record. 14 The following consequences are the subject of clinical-histopathologic correlations: lens involvement (PEX-phacopathy), zonular apparatus involvement (zonulopathy), iris involvement (iridopathy), trabecular meshwork involvement (trabeculopathy), ciliary body involvement (cyclopathy),and cornea involvement (corneal endotheliopathy): (1) angle-closure glaucoma and open-angle glaucoma brought on by ciliary and pupillary block; (2) changes to the zonular apparatus and its insertion into the ciliary body and lens during extracapsular cataract surgery can result in phacodonesis, lens displacement, and an increased incidence of vitreous loss; (3) breakdown of the blood-aqueous barrier (pseudouveitis), production of posterior synechiae owing to involvement of all iris cell populations, anterior chamber hypoxia, iris stromal bleeding, pigment epithelium melanin dispersion, inadequate or asymmetric pupillary dilatation; and (4) A damaged and numerically decreased endothelium explains early diffuse corneal endothelial decompensation. 15 Pseudoexfoliation is known to weaken the zonular fibers, making them more susceptible to stress and leading to partial or complete dislocation of the lens. This can pose significant surgical challenges, including poor capsular support, difficulty in lens nucleus manipulation, increased risk of capsular rupture, and the need for alternative intraocular lens (IOL) fixation techniques. Proper preoperative assessment using anterior segment optical coherence tomography (AS-OCT) or ultrasound biomicroscopy (UBM) can help evaluate zonular integrity and guide the surgical approach. Given these complexities, cataract surgery in PEX patients with lens subluxation requires meticulous surgical planning, use of pupil expansion devices, careful phacoemulsification techniques, and postoperative monitoring for complications such as intraocular pressure spikes, corneal decompensation, and late IOL decentration. These cases emphasize the need for a multidisciplinary approach and individualized surgical strategies to achieve the best possible visual outcomes while minimizing complications. Therefore understanding the clinical characteristics of these patients is crucial for developing effective management strategies and improving surgical outcomes and, providing insights that could enhance patient care and inform public health initiatives in similar settings. Dissemination The results will be presented at a national conference and published in an indexed journal. Study status The recruitment procedure is still in the early stages. Ethics and consent The research protocol got approval from the Datta Meghe Institute of Higher Education and Research (Deemed to be University) Institutional ethical committee in the meeting held on 31-03-2023 with DMIHER (DU)/IEC/2023/877. All the participants will be educated about the research, and written and verbal informed consent will be obtained from all the participants before the intervention. Data availability No data are associated with this article. Repository name: Figshare File name: STROBE check list for A STUDY OF CLINICAL PROFILE IN PATIENTS OF CATARACTS WITH PSEUDOEXFOLIATION IN RURAL POPULATIONS OF CENTRAL INDIA DOI: 10.6084/m9.figshare.25391719 URL: https://figshare.com/account/items/25391719/edit Acknowledgements I would like to express my gratitude to Dr. Sachin Daigavane, HOD of the Ophthalmology Department, for his kind permission and unwavering support. I am grateful to Mr. Laxmikant Umate Sir for assisting me in conducting data analysis and determining the sample size. References 1. Ahmed KN: Outcome of Phaco Surgeries in Patients with Pseudoexfoliation. JOJ Ophthalmol. 2017 Nov 20 [cited 2023 Aug 1]; 5 (4). Publisher Full Text Reference Source 2. Gupta RK, Sharma R, Gupta RK, et al. : Prevalence and Ocular Manifestations of Pseudoexfoliation Syndrome Among Patients Scheduled for Cataract Surgery in a Teaching Hospital in North India.2022; 9 (2). 3. Manalil AG, Mishra P, Manavalan S, et al. : CATARACT SURGERY IN PSEUDOEXFOLIATION SYNDROME. J. Evol. Med. Dent. Sci. 2014 Oct 17; 3 (54): 12403–12410. Publisher Full Text 4. Sandinha T, Weir C, Holding D:A delayed complication of cataract surgery in a patient with pseudoexfoliation: dislocation of the intraocular lens. Eye. 2003 Mar; 17 (2):272–273. PubMed Abstract | Publisher Full Text 5. Data collection: Wikipedia.2023 [cited 2023 Aug 2]. Reference Source 6. 1509511098944.pdf: [cited 2023 Aug 2]. Reference Source 7. Kosamia S, Mishrikotkar JP, Phadke Y, et al. : The Study of clinical Profile of Patients Presenting with Pseudoexfoliation in Ophthalmology OPD at MGM’s Hospital Aurangabad. Int. J. Curr. Med. Appl. Sci. 2016; 12 (3): 166–171. [cited 2023 Sep 29]. Reference Source 8. Pourhoseingholi MA, Vahedi M, Rahimzadeh M:Sample size calculation in medical studies. Gastroenterol. Hepatol. Bed Bench. 2013; 6 (1):14–17. PubMed Abstract 9. Sullivan K, Dean A, Soe MM: OpenEpi - a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009; 124 (3): 471–474. PubMed Abstract | Publisher Full Text | Free Full Text 10. Arvind H, Raju P, Paul PG, et al. : Pseudoexfoliation in South India. Br. J. Ophthalmol. 2003 Nov; 87 (11): 1321–1323. PubMed Abstract | Publisher Full Text | Free Full Text 11. Panigrahi S, Mishra TR, Mishra PP:STUDY OF CLINICAL PROFILE OF PSEUDO-EXFOLIATION SYNDROME AND PSEUDO-EXFOLIATION CATARACT IN A TERTIARY HEALTH CARE HOSPITAL IN WESTERN ODISHA. Int. J. Curr. Pharm. Res. 2024 Jul 15; 16 (4): 26–29. Publisher Full Text 12. Krishnadas R, Nirmalan PK, Ramakrishnan R, et al. : Pseudoexfoliation in a rural population of southern India: the Aravind Comprehensive Eye Survey. Am. J. Ophthalmol. 2003 Jun 1; 135 (6): 830–837. PubMed Abstract | Publisher Full Text 13. Thomas R: Glaucoma in India: Current status and the road ahead. Indian J. Ophthalmol. 2011 Jan; 59 Suppl (Suppl1): S3–S4. PubMed Abstract | Publisher Full Text 14. Kozart DM, Yanoff M: Intraocular pressure status in 100 consecutive patients with exfoliation syndrome. Ophthalmology. 1982 Mar; 89 (3): 214–218. PubMed Abstract | Publisher Full Text 15. Naumann GO, Schlötzer-Schrehardt U, Küchle M: Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations. Ophthalmology. 1998 Jun; 105 (6): 951–968. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 May 2024 ADD YOUR COMMENT Comment Author details Author details 1 Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India Yuga Pawar Roles: Conceptualization, Resources, Writing – Original Draft Preparation, Writing – Review & Editing Archana Thool Roles: Conceptualization, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 16 May 2025, 13:483 https://doi.org/10.12688/f1000research.149563.2 version 1 Published: 17 May 2024, 13:483 https://doi.org/10.12688/f1000research.149563.1 Copyright © 2025 Pawar Y and Thool A. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Pawar Y and Thool A. A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.12688/f1000research.149563.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 16 May 2025 Revised Views 0 Cite How to cite this report: Esehiyb B. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r394099 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-394099 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 18 Aug 2025 Bahjah Esehiyb , Ophthalmology Department, Omar Al-Mukhtar University, Albayda, Jabal al Akhdar District, Libya Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.180312.r394099 I appreciate the chance to review this article Please find my comments below: 1- Objectives: inconsistent objectives: the abstract and introduction are not properly matched. The objective should be to focus on association rather than "likelihood of progression," ... Continue reading READ ALL I appreciate the chance to review this article Please find my comments below: 1- Objectives: inconsistent objectives: the abstract and introduction are not properly matched. The objective should be to focus on association rather than "likelihood of progression," which requires a longitudinal study-type research. 2. Methodology: Insufficient The criteria for diagnosis of PEX and PEX glaucoma lack detailed description (e.g., dilation status, bilaterality, iris signs, angle appearance), and diagnosis of glaucoma is ambiguous and not based on established guidelines. Methodological contradictions: The sampling method is not described. Phacodonesis is listed as a secondary outcome, while lens subluxation is part of the exclusion ???. It's unclear whether IOP was measured using non-contact or applanation tonometry. Missing Key Variables: No evaluation of visual field abnormalities (a critical component of glaucoma diagnosis), angle appearance, poor dilatation, or bilateral findings. There is no uniform grading or staging for glaucoma. There are some certain corrections that are recommended for improving the clarity and clinical accuracy of the article. Sac syringing correction: The phrase “sac syringing on the lacrimal gland” should be replaced by “sac syringing of the nasolacrimal duct,” as the lacrimal gland does not get involved in this procedure. Clarify tonometry type: change the ambiguous phrase “application tonometer” to applanation tonometry (Goldmann or otherwise) or non-contact tonometry, and specify which method was used. Add gonioscopy findings in the outcome measures: Gonioscopy findings (e.g., angle configuration, pseudoexfoliative material, trabecular pigmentation, Sampaolesi’s line) should be included in primary outcomes, as they help confirm open-angle mechanism in suspected PXG. Standardize optic disc terminology: “Paler retinal nerve margin” should be changed to “pallor of the neuroretinal rim,” which is a standard clinical parameter of glaucomatous damage. Update the descriptions of optic nerve changes in glaucoma by replacing terms like “overpass of central vessels” and “barring of circumlunar vessels” with clearer modern terms like nasalization of central vessels and baring of circumlinear vessels. Improve glaucoma diagnostic criteria: Glaucoma diagnosis should be clearly based on recognized structural signs and qualified as “suspected” if visual field testing or OCT imaging is not available. Harmonize term: Use either “PXF” or “PEX” consistently throughout the article to avoid confusion. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: opthalmology , Medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Esehiyb B. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r394099 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-394099 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Warjri GB. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r386151 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-386151 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Jun 2025 Gazella Bruce Warjri , Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.180312.r386151 There are numerous studies on the prevalence of pseudoexfoliation. This study will not add much to literature. Introduction: The first line describing about Lindberg in 1917 has no reference. Reference has to be added. ... Continue reading READ ALL There are numerous studies on the prevalence of pseudoexfoliation. This study will not add much to literature. Introduction: The first line describing about Lindberg in 1917 has no reference. Reference has to be added. The grammar and sentence structure of the whole manuscript has to be revised. Most of the manuscript doesn’t have any proper flow. At one point the authors describe pseudoexfoliation glaucoma and in the next sentence abruptly describe secondary cataracts. It makes no sense. The authors have written the acronym of pseudoexfoliation as PXF in some places and as PEX in others. They should stick to one of the acronyms. Introduction: “PEG”. The authors have not spelled out the acronym PEG in the manuscript. 2/3 of the sentences in the manuscript have no references attached. This reflects poorly on the writing quality of a scientific paper. Methods: IOP should be checked by the gold standard, “Goldman applanation tonometer”. Diagnosis of glaucoma: “Imbalance in cup-to-disc ratio of >0.2, higher CDR >0.5, paler retinal nerve margin”. Are all of these part of the diagnosis of glaucoma? According to which guidelines? Exclusion criteria: subluxated lens: Many cases of pseudoexfoliation present as subluxated lens. Why should this be in the exclusion criteria? Exclusion criteria: “Patients lost to follow up”. How can patients be lost to follow up in a cross sectional study?? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Glaucoma and Neuro-ophthalmology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Warjri GB. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r386151 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-386151 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 17 May 2024 Views 0 Cite How to cite this report: Ezinne NE. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r367674 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-367674 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 Mar 2025 Ngozika Esther Ezinne , Discipline of Optometry, University of KwaZulu-Natal, Durban, South Africa; Optometry Unit, Department of Clinical Surgical Science, The University of the West Indies at St Augustine, Saint Augustine, Tunapuna/Piarco Municipal Corporation, Trinidad and Tobago Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.164042.r367674 Thank you for the opportunity to review this study. Please find my comments below: Introduction The background information provided is insufficient. It would be beneficial to include details on the previously recorded prevalence of the ... Continue reading READ ALL Thank you for the opportunity to review this study. Please find my comments below: Introduction The background information provided is insufficient. It would be beneficial to include details on the previously recorded prevalence of the condition both globally and in the specific study area. Additionally, the manuscript would benefit from an explanation of the mechanisms by which cataracts may lead to the condition or to open-angle glaucoma. Methods The manuscript requires a thorough review of its grammar. The methods section should be presented narratively rather than in a list format to improve readability and clarity. The study lacks detailed information on the steps taken for data collection. A more comprehensive description of the methodology is necessary. It is unclear how participants will be recruited for the study. This needs to be clarified. The sampling procedure is not specified. Please provide more information on how participants will be selected. The manuscript does not mention potential confounding factors. It would be helpful to discuss any anticipated confounders and the strategies that will be employed to control for them. It is not specified whether this will be a multicenter or single-center study. This distinction should be made clear. Results There is no information on how the results will be presented. It is important to include details on the data analysis and presentation methods. Discussion The discussion section should address the strengths and limitations of the study to provide a more balanced assessment of the findings. Recommendation Overall, the study has merit, but it requires significant revisions to meet the journal's standards. I recommend a major revision of the manuscript before it can be considered for indexing. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Ocular health, Diabetes, Ocular diseases, Binocular vision, children vision, rural health, public health, mental health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Ezinne NE. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r367674 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-367674 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 16 May 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 16 May 2025 Author Response Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation ... Continue reading Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation may lead to open-angle glaucoma in the attached manuscript. I have corrected my manuscript and have explained detailed information on the steps taken for data collection. I have also recruited patients on the basis of inclusion and exclusion criteria. Now I have also specified the sampling procedure. All the corrections that you have specified are done and attached to the manuscript. Thank you for your valuable corrections. I have corrected and mentioned the additional points in the analysis and result as you have suggested in the attached manuscript. I have also revised the discussion part. Thank you so much for your valuable opinion regarding my study. Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation may lead to open-angle glaucoma in the attached manuscript. I have corrected my manuscript and have explained detailed information on the steps taken for data collection. I have also recruited patients on the basis of inclusion and exclusion criteria. Now I have also specified the sampling procedure. All the corrections that you have specified are done and attached to the manuscript. Thank you for your valuable corrections. I have corrected and mentioned the additional points in the analysis and result as you have suggested in the attached manuscript. I have also revised the discussion part. Thank you so much for your valuable opinion regarding my study. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 16 May 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 16 May 2025 Author Response Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation ... Continue reading Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation may lead to open-angle glaucoma in the attached manuscript. I have corrected my manuscript and have explained detailed information on the steps taken for data collection. I have also recruited patients on the basis of inclusion and exclusion criteria. Now I have also specified the sampling procedure. All the corrections that you have specified are done and attached to the manuscript. Thank you for your valuable corrections. I have corrected and mentioned the additional points in the analysis and result as you have suggested in the attached manuscript. I have also revised the discussion part. Thank you so much for your valuable opinion regarding my study. Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation may lead to open-angle glaucoma in the attached manuscript. I have corrected my manuscript and have explained detailed information on the steps taken for data collection. I have also recruited patients on the basis of inclusion and exclusion criteria. Now I have also specified the sampling procedure. All the corrections that you have specified are done and attached to the manuscript. Thank you for your valuable corrections. I have corrected and mentioned the additional points in the analysis and result as you have suggested in the attached manuscript. I have also revised the discussion part. Thank you so much for your valuable opinion regarding my study. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Liang Y. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r344696 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-344696 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Dec 2024 Yuanbo Liang , Wenzhou Medical University, Wenzhou, China Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.164042.r344696 This protocol show us a study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India which is interesting. And there are some recommendations for this protocol to clarify the protocol more clearly. 1. ... Continue reading READ ALL This protocol show us a study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India which is interesting. And there are some recommendations for this protocol to clarify the protocol more clearly. 1. For the objective of the study，it seem confused. The aim mentioned in the introduction section of the article is different from that in the abstract. In the introduction part, the aim is "the aim of our study was to compare surgical outcomes (intraoperative problems, postoperative problems, and visual results) among patients." . In the abstract, the objective is "To determine the prevalence of pseudoexfoliation in cataract patients ...., to locate patients with pseudoexfoliative cataracts, to evaluate their likelihood of progressing to open-angle glaucoma, and to examine the various ocular characteristics of these patients. ". Please clarify it. 2. As the definition of prevalence, it is not suitable to use it as the percentage of PXF combined with cataract patients among the total cataract patients in this hospital. 3. In this protocol, the method may be not provided with sufficient details. A detailed flow chart of this study could be better for replication by others. 4. The P-value for the sample size calculation is 5.92%. Please provide more information about the source of this data. 5.Statistical methods for the collecting data is provvided. Please provide it. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: glaucoma I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Liang Y. Reviewer Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r344696 ) The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-344696 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 17 Feb 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 17 Feb 2025 Author Response YES, I agree with your opinion and will correct it. thank you for suggestion Competing Interests: No competing interests were disclosed. YES, I agree with your opinion and will correct it. thank you for suggestion YES, I agree with your opinion and will correct it. thank you for suggestion Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 16 May 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 16 May 2025 Author Response Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative ... Continue reading Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative glaucoma among these patients. I have corrected the objectives of my study in the manuscript. You are right, as prevalence typically refers to the proportion of individuals in a population who have a specific disease or condition at a particular time or over a specified period. It's used in epidemiology to describe disease burden in a defined population. But as I am doing a hospital-based study, I should use proportion or frequency. I have corrected and maintained a detailed method of data collection in the attached manuscript. Thank you for correcting me. I have taken the reference of P-value from a similar study that was held in a tertiary care hospital. I have corrected my reference in the manuscript. Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative glaucoma among these patients. I have corrected the objectives of my study in the manuscript. You are right, as prevalence typically refers to the proportion of individuals in a population who have a specific disease or condition at a particular time or over a specified period. It's used in epidemiology to describe disease burden in a defined population. But as I am doing a hospital-based study, I should use proportion or frequency. I have corrected and maintained a detailed method of data collection in the attached manuscript. Thank you for correcting me. I have taken the reference of P-value from a similar study that was held in a tertiary care hospital. I have corrected my reference in the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 17 Feb 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 17 Feb 2025 Author Response YES, I agree with your opinion and will correct it. thank you for suggestion Competing Interests: No competing interests were disclosed. YES, I agree with your opinion and will correct it. thank you for suggestion YES, I agree with your opinion and will correct it. thank you for suggestion Competing Interests: No competing interests were disclosed. Close Report a concern Author Response 16 May 2025 Yuga Pawar , Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India 16 May 2025 Author Response Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative ... Continue reading Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative glaucoma among these patients. I have corrected the objectives of my study in the manuscript. You are right, as prevalence typically refers to the proportion of individuals in a population who have a specific disease or condition at a particular time or over a specified period. It's used in epidemiology to describe disease burden in a defined population. But as I am doing a hospital-based study, I should use proportion or frequency. I have corrected and maintained a detailed method of data collection in the attached manuscript. Thank you for correcting me. I have taken the reference of P-value from a similar study that was held in a tertiary care hospital. I have corrected my reference in the manuscript. Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative glaucoma among these patients. I have corrected the objectives of my study in the manuscript. You are right, as prevalence typically refers to the proportion of individuals in a population who have a specific disease or condition at a particular time or over a specified period. It's used in epidemiology to describe disease burden in a defined population. But as I am doing a hospital-based study, I should use proportion or frequency. I have corrected and maintained a detailed method of data collection in the attached manuscript. Thank you for correcting me. I have taken the reference of P-value from a similar study that was held in a tertiary care hospital. I have corrected my reference in the manuscript. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 May 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 Version 2 (revision) 16 May 25 read read Version 1 17 May 24 read read Yuanbo Liang , Wenzhou Medical University, Wenzhou, China Ngozika Esther Ezinne , University of KwaZulu-Natal, Durban, South Africa; The University of the West Indies at St Augustine, Saint Augustine, Trinidad and Tobago Gazella Bruce Warjri , Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India Bahjah Esehiyb , Omar Al-Mukhtar University, Albayda, Libya Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Esehiyb B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Aug 2025 | for Version 2 Bahjah Esehiyb , Ophthalmology Department, Omar Al-Mukhtar University, Albayda, Jabal al Akhdar District, Libya 0 Views copyright © 2025 Esehiyb B. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the chance to review this article Please find my comments below: 1- Objectives: inconsistent objectives: the abstract and introduction are not properly matched. The objective should be to focus on association rather than "likelihood of progression," which requires a longitudinal study-type research. 2. Methodology: Insufficient The criteria for diagnosis of PEX and PEX glaucoma lack detailed description (e.g., dilation status, bilaterality, iris signs, angle appearance), and diagnosis of glaucoma is ambiguous and not based on established guidelines. Methodological contradictions: The sampling method is not described. Phacodonesis is listed as a secondary outcome, while lens subluxation is part of the exclusion ???. It's unclear whether IOP was measured using non-contact or applanation tonometry. Missing Key Variables: No evaluation of visual field abnormalities (a critical component of glaucoma diagnosis), angle appearance, poor dilatation, or bilateral findings. There is no uniform grading or staging for glaucoma. There are some certain corrections that are recommended for improving the clarity and clinical accuracy of the article. Sac syringing correction: The phrase “sac syringing on the lacrimal gland” should be replaced by “sac syringing of the nasolacrimal duct,” as the lacrimal gland does not get involved in this procedure. Clarify tonometry type: change the ambiguous phrase “application tonometer” to applanation tonometry (Goldmann or otherwise) or non-contact tonometry, and specify which method was used. Add gonioscopy findings in the outcome measures: Gonioscopy findings (e.g., angle configuration, pseudoexfoliative material, trabecular pigmentation, Sampaolesi’s line) should be included in primary outcomes, as they help confirm open-angle mechanism in suspected PXG. Standardize optic disc terminology: “Paler retinal nerve margin” should be changed to “pallor of the neuroretinal rim,” which is a standard clinical parameter of glaucomatous damage. Update the descriptions of optic nerve changes in glaucoma by replacing terms like “overpass of central vessels” and “barring of circumlunar vessels” with clearer modern terms like nasalization of central vessels and baring of circumlinear vessels. Improve glaucoma diagnostic criteria: Glaucoma diagnosis should be clearly based on recognized structural signs and qualified as “suspected” if visual field testing or OCT imaging is not available. Harmonize term: Use either “PXF” or “PEX” consistently throughout the article to avoid confusion. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise opthalmology , Medical education I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Esehiyb B. Peer Review Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r394099) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-394099 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Warjri G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Jun 2025 | for Version 2 Gazella Bruce Warjri , Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India 0 Views copyright © 2025 Warjri G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions There are numerous studies on the prevalence of pseudoexfoliation. This study will not add much to literature. Introduction: The first line describing about Lindberg in 1917 has no reference. Reference has to be added. The grammar and sentence structure of the whole manuscript has to be revised. Most of the manuscript doesn’t have any proper flow. At one point the authors describe pseudoexfoliation glaucoma and in the next sentence abruptly describe secondary cataracts. It makes no sense. The authors have written the acronym of pseudoexfoliation as PXF in some places and as PEX in others. They should stick to one of the acronyms. Introduction: “PEG”. The authors have not spelled out the acronym PEG in the manuscript. 2/3 of the sentences in the manuscript have no references attached. This reflects poorly on the writing quality of a scientific paper. Methods: IOP should be checked by the gold standard, “Goldman applanation tonometer”. Diagnosis of glaucoma: “Imbalance in cup-to-disc ratio of >0.2, higher CDR >0.5, paler retinal nerve margin”. Are all of these part of the diagnosis of glaucoma? According to which guidelines? Exclusion criteria: subluxated lens: Many cases of pseudoexfoliation present as subluxated lens. Why should this be in the exclusion criteria? Exclusion criteria: “Patients lost to follow up”. How can patients be lost to follow up in a cross sectional study?? Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Glaucoma and Neuro-ophthalmology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Warjri GB. Peer Review Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.180312.r386151) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-483/v2#referee-response-386151 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Ezinne N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 Mar 2025 | for Version 1 Ngozika Esther Ezinne , Discipline of Optometry, University of KwaZulu-Natal, Durban, South Africa; Optometry Unit, Department of Clinical Surgical Science, The University of the West Indies at St Augustine, Saint Augustine, Tunapuna/Piarco Municipal Corporation, Trinidad and Tobago 0 Views copyright © 2025 Ezinne N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review this study. Please find my comments below: Introduction The background information provided is insufficient. It would be beneficial to include details on the previously recorded prevalence of the condition both globally and in the specific study area. Additionally, the manuscript would benefit from an explanation of the mechanisms by which cataracts may lead to the condition or to open-angle glaucoma. Methods The manuscript requires a thorough review of its grammar. The methods section should be presented narratively rather than in a list format to improve readability and clarity. The study lacks detailed information on the steps taken for data collection. A more comprehensive description of the methodology is necessary. It is unclear how participants will be recruited for the study. This needs to be clarified. The sampling procedure is not specified. Please provide more information on how participants will be selected. The manuscript does not mention potential confounding factors. It would be helpful to discuss any anticipated confounders and the strategies that will be employed to control for them. It is not specified whether this will be a multicenter or single-center study. This distinction should be made clear. Results There is no information on how the results will be presented. It is important to include details on the data analysis and presentation methods. Discussion The discussion section should address the strengths and limitations of the study to provide a more balanced assessment of the findings. Recommendation Overall, the study has merit, but it requires significant revisions to meet the journal's standards. I recommend a major revision of the manuscript before it can be considered for indexing. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? No Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Ocular health, Diabetes, Ocular diseases, Binocular vision, children vision, rural health, public health, mental health. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 16 May 2025 Yuga Pawar, Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India Thank you for suggesting the correction, I have provided data on the previously recorded prevalence of the condition and provided an explanation of the mechanisms by which cataracts with pseudoexfoliation may lead to open-angle glaucoma in the attached manuscript. I have corrected my manuscript and have explained detailed information on the steps taken for data collection. I have also recruited patients on the basis of inclusion and exclusion criteria. Now I have also specified the sampling procedure. All the corrections that you have specified are done and attached to the manuscript. Thank you for your valuable corrections. I have corrected and mentioned the additional points in the analysis and result as you have suggested in the attached manuscript. I have also revised the discussion part. Thank you so much for your valuable opinion regarding my study. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Ezinne NE. Peer Review Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r367674) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-367674 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Liang Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Dec 2024 | for Version 1 Yuanbo Liang , Wenzhou Medical University, Wenzhou, China 0 Views copyright © 2024 Liang Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (2) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This protocol show us a study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India which is interesting. And there are some recommendations for this protocol to clarify the protocol more clearly. 1. For the objective of the study，it seem confused. The aim mentioned in the introduction section of the article is different from that in the abstract. In the introduction part, the aim is "the aim of our study was to compare surgical outcomes (intraoperative problems, postoperative problems, and visual results) among patients." . In the abstract, the objective is "To determine the prevalence of pseudoexfoliation in cataract patients ...., to locate patients with pseudoexfoliative cataracts, to evaluate their likelihood of progressing to open-angle glaucoma, and to examine the various ocular characteristics of these patients. ". Please clarify it. 2. As the definition of prevalence, it is not suitable to use it as the percentage of PXF combined with cataract patients among the total cataract patients in this hospital. 3. In this protocol, the method may be not provided with sufficient details. A detailed flow chart of this study could be better for replication by others. 4. The P-value for the sample size calculation is 5.92%. Please provide more information about the source of this data. 5.Statistical methods for the collecting data is provvided. Please provide it. Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Partly Are the datasets clearly presented in a useable and accessible format? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise glaucoma I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (2) Author Response 17 Feb 2025 Yuga Pawar, Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India YES, I agree with your opinion and will correct it. thank you for suggestion View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Author Response 16 May 2025 Yuga Pawar, Ophthalmology, Jawaharlal Nehru Medical College; Datta Meghe Institute of Higher Education and Research, Wardha, 442001, India Thank you for your suggestion. My study is related to knowing the prevalence of pseudoexfoliation in patients with cataracts visiting our hospital, their clinical profiling, and the association of pseudoexfoliative glaucoma among these patients. I have corrected the objectives of my study in the manuscript. You are right, as prevalence typically refers to the proportion of individuals in a population who have a specific disease or condition at a particular time or over a specified period. It's used in epidemiology to describe disease burden in a defined population. But as I am doing a hospital-based study, I should use proportion or frequency. I have corrected and maintained a detailed method of data collection in the attached manuscript. Thank you for correcting me. I have taken the reference of P-value from a similar study that was held in a tertiary care hospital. I have corrected my reference in the manuscript. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Liang Y. Peer Review Report For: A study of clinical profile in patients of cataracts with pseudoexfoliation in rural populations of central India [version 2; peer review: 3 approved with reservations, 1 not approved] . F1000Research 2025, 13 :483 ( https://doi.org/10.5256/f1000research.164042.r344696) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-483/v1#referee-response-344696 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. 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