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New molecular tests could improve the speed and accuracy of diagnosing non-viral microbial keratitis, according to a review by researchers in India.

Writing in the British Journal of Ophthalmology, authors from the LV Prasad Eye Institute said infectious keratitis remains a leading cause of corneal blindness and visual impairment, while delayed or imprecise pathogen identification can hinder early treatment and increase the risk of irreversible ocular damage.

Reviewing studies published between 2000 and 2025, the team found conventional culture-based methods remain important but are limited by slow turnaround and relatively low sensitivity, with reported detection rates of 30–60%. They also warned that ocular microbiology laboratories appear to be losing expertise in microscopy of corneal scrapings, despite it being a long-established and rewarding diagnostic method.

The review said multiplex and quantitative polymerase chain reaction (qPCR) can provide rapid, sensitive and specific pathogen detection, including in culture-negative cases, while next-generation sequencing can broaden identification of bacterial, fungal and protozoal pathogens. Mass spectrometry was also highlighted for its potential to identify biomarkers linked to disease severity and prognosis. The authors said portable qPCR devices, diagnostics based on technology and artificial intelligence-assisted interpretation may help extend testing closer to the point of care, with potential to support earlier intervention and more personalised treatment.