Category: 3. Business

Clinical Topics:
Cardiovascular Care Team, Arrhythmias and Clinical EP, Prevention

Keywords:
CardiaCast

Vietnam’s gross domestic product (GDP) surged by a remarkable 8.23 percent in Q3 2025, the fastest growth rate in Southeast Asia, prompting major financial institutions to revise their forecasts upward.

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In Q3 2025, Vietnam’s economy grew by 8.23 percent, lifting the nine-month year-on-year expansion to 7.85 percent. Following this performance, several international research institutions have upgraded their economic forecasts for Vietnam.

The Asian Development Bank (ADB) has raised its 2025 GDP projection for Vietnam from 6.6 percent to 6.7 percent, while forecasting a possible moderation to six percent in 2026. Likewise, United Overseas Bank (UOB) has upgraded its 2025 estimate for Vietnam to 7.7 percent, citing sustained recovery in manufacturing and exports as key growth drivers.

Despite global uncertainties and recent natural disasters, Vietnam’s economy continued to demonstrate resilient and broad-based growth through the third quarter of 2025.

Vietnam’s GDP growth performance

According to the Ministry of Finance, Vietnam’s GDP grew by 8.23 percent in Q3 2025, bringing nine-month growth to 7.85 percent year-on-year, closely tracking the government’s full-year target of around 8 percent. Positive growth across all three main sectors contributed to the robust GDP growth of Vietnam in both Q3 and the first nine months of 2025

Among them, industrial output, particularly manufacturing and processing, remained the primary growth driver, expanding 10 percent in Q3 and nearly 9.9 percent over the nine-month period, in line with growth targets.

Vietnam’s GDP Growth by Sector, Q3 2025
Sector	Growth in Q3 2025 (%)	Growth in first 9 months 2025 (%)
Agriculture, forestry, and fisheries	3.7	3.8
Industry and construction	9.4	8.6
Services	8.5	8.4
Overall	8.23	7.85

Inflation

Inflation remained under control. Vietnam’s consumer price index (CPI) increased by 3.27 percent over the first 10 months of 2025 compared to the previous year, according to data from the National Statistics Office (NSO) released on Thursday.

In October, the CPI grew by 0.2 percent from September and was up 2.82 percent from December 2024, with a year-on-year increase of 3.25 percent. The NSO also noted that core inflation rose by 3.2 percent during this period.

CPI Movements of Key Goods and Services, October 2025
Category	Monthly change (%)	Notes/Drivers
Food and catering services	+0.59	Contributed +0.20 ppts to total CPI
Education	+0.51	Higher tuition fees at some private schools and universities (2025–26 year)
Household equipment and appliances	+0.20	General price increases
Clothing, hats, and footwear	+0.18	Higher seasonal demand as weather cooled
Beverages and tobacco	+0.12	–
Culture, entertainment, and tourism	+0.06	Higher hotel, venue, and entertainment costs
Housing, utilities, and construction materials	+0.01	Slight uptick
Transport	–0.81	Lower domestic fuel prices; dragged CPI by –0.08 ppts

Credit growth

Bank credit in Vietnam has kept climbing this year, rising faster than the same period in 2024 and maintaining a steady upward trend. According to the State Bank of Vietnam (SBV), as of September 29, the country’s bank credit increased by 13.37 percent compared to the end of 2024, the majority directed toward the production and business sectors.

Approximately 78 percent of Vietnam’s outstanding loans during this period supported production and business activities, aligning with the broader economic structure as follows:

Vietnam’s Bank Credit Distribution by Priority Sector
Priority sector	Share (%)
Agriculture (priority classification)	22.76
Small & medium enterprises (SMEs)	19.04
Supporting industries (growth rate)	23.14
High-tech application enterprises (growth rate)	25.02
Source: SBV

Foreign direct investment

Vietnam attracted US$31.52 billion in foreign direct investment (FDI) during the first 10 months of 2025, marking a 15.6 percent year-on-year increase. FDI disbursements reached US$21.3 billion in the first 10 months, an 8.8 percent increase year-on-year.

Existing investors added US$12.11 billion to 1,206 projects, up 45 percent in capital injections. Combining new and adjusted capital, manufacturing and processing accounted for US$16.37 billion, or 62.5 percent of total FDI. Real estate attracted US$5.32 billion (20.3 percent).

Meanwhile, capital contributions and share purchases surged 45.1 percent to US$5.34 billion through 2,918 transactions.

Strong momentum in new projects

Vietnam attracted US$14.07 billion in newly registered capital across 3,321 projects, marking a 21.1 percent increase in project count, though total capital value fell 7.6 percent year-on-year.

Notably, manufacturing and processing dominated, accounting for 55.9 percent of new capital at US$5.61 billion, followed by real estate at US$2.75 billion (19.5 percent).

Top Sources of Newly Registered Capital, Jan–Oct 2025
Country/Territory	Newly registered capital (US$ million)
Singapore	3,760
Mainland China	3,210
Hong Kong (China)	1,380
Japan	1,170
Sweden	1,000
Chinese Taipei	901.2
South Korea	627

Trade

Vietnam posted US$762.44 billion in total trade turnover during January–October 2025. The country recorded a US$19.56 billion trade surplus, compared with US$23.18 billion in the same period last year. The domestic sector registered a US$22.83 billion deficit, while the foreign-invested sector (including crude oil) maintained a robust US$42.39 billion surplus.

Export

Vietnam’s exports in October were estimated at US$42.05 billion, down 1.5 percent month-on-month but up 17.5 percent year-on-year. Over the first 10 months of 2025, exports rose 16.2 percent to US$391 billion, including:

• Domestic sector: US$94.17 billion (24.1 percent of total); and
• Foreign-invested sector (including crude oil): US$296.83 billion (75.9 percent), up 22.5 percent.

A total of 36 export commodities exceeded US$1 billion, accounting for 94.1 percent of export turnover. Of these, seven items exceeded US$10 billion, accounting for 67.9 percent of total exports.

Vietnam’s Export Structure by Goods Category, Jan–Oct 2025
Category	Export value (US$ billion)	Share (%)
Processed & manufactured goods	346.73	88.7
Agricultural & forestry products	32.62	8.3
Aquatic products	9.33	2.4
Fuels & minerals	2.32	0.6

Import

Imports reached US$39.45 billion in October, down one percent month-on-month but up 16.8 percent compared to last year. For the January–October period, imports climbed 18.6 percent to US$371.44 billion, which includes:

• Domestic sector: US$117 billion, up 2.8 percent; and
• Foreign-invested sector: US$254.44 billion, up 27.6 percent

Vietnam imported 47 product categories valued at over US$1 billion each, accounting for 93.9 percent of the total import value. Among these, four categories exceeded US$10 billion, representing 52.7 percent of the total.

Vietnam’s import structure in the first 10 months of 2025 is as follows:

• Capital goods: US$348.23 billion (93.8 percent)
  • Machinery, equipment, tools, spare parts: 52.6 percent
  • Raw materials & fuels: 41.2 percent
• Consumer goods: US$23.21 billion (6.2 percent)

Additionally, China remained Vietnam’s largest supplier, providing goods worth US$150.9 billion.

Takeaway

Vietnam’s economic performance in 2025 has been robust, with a notable GDP growth of 8.23 percent in Q3, primarily driven by strong industrial output and manufacturing. Business sentiment in the country appears positive, as its FDI grew significantly to $31.52 billion in the first 10 months.

Overall, despite global challenges, Vietnam continues to demonstrate resilience and promising growth prospects across various sectors.

See also: Reshaping Vietnam’s Socio-Economic Zones: A Post-Merger Outlook

 

Key takeaways:

• • • Legal aid is leading on AI adoption — Legal aid organizations are leading the way in leveraging AI with 74% using AI in their work, driven by the need to serve millions of citizens who lack legal help.

    • Lone Star Legal Aid creates Juris — A new AI-powered tool Juris from Lone Star Legal Aid improves accuracy and trust through retrieval-augmented generation, source-cited answers, and a secure Azure-based architecture with an integrated citation viewer.

    • Keeping costs low — A phased, two-year build-and-test process kept costs low (at about $2,000 a year in infrastructure costs, plus about 300 staff hours) and produced dependable results.

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A new study finds that under-resourced legal aid nonprofits are adopting AI at nearly twice the rate of the broader legal field because of the urgency of the need to serve millions of Americans who may lack legal help. The study shows that almost three-quarters (74%) of legal aid organizations already use AI in their work, compared with a 37% adoption rate for generative AI (GenAI) across the wider legal profession. Lone Star Legal Aid (LSLA), a legal aid non-profit serving easter Texas, is one of early adopters of AI.

According to LSLA, its attorneys were spending too much time and money hunting for answers across pricey platforms and scattered PDFs. Key materials lived in research databases, internal drives, and static repositories, while individual worker-vetted documents were not centrally accessible. Without a single, trusted hub, staff experienced slower research time that affected clients through duplicated effort and delays.

These strains are not unique to LSLA. In fact, court help centers and self‑help portals face the same fragmentation, licensing costs, and uneven access to authoritative guidance. A verifiable, consolidated knowledge hub that could stabilize quality while reducing spending would be a needed solution.

To solve this problem, LSLA turned to AI to create a legal tool called Juris built to return fast, source‑cited answers. Juris was designed to centralize high‑value legal materials, cut reliance on expensive third‑party platforms, and lay a flexible foundation that the organization could reuse beyond legal research for internal operations and future client tools.

Multifaceted approach to ensuring accuracy and reliability

There were several aspects of Juris that designers used to help its mission to increase access to justice, including:

Design methods fuel trustworthy output — Juris was built to ensure accuracy using a number of methods, such as a retrieval-augmented generation (RAG) pipeline to ensure the chatbot delivers fact-based, source-cited answers. It also uses semantic chunking, a process that breaks a document into natural, meaning‑based sections (for example, a heading plus the paragraphs that belong to it) so the original context stays together.

When a user asks a question, Juris retrieves only the most relevant of these sections. Limiting the AI to evidence from those passages improves accuracy and reduces hallucinations because the model is not guessing from memory. Instead, it is grounding answers in the text it just accessed.

Solid technical architecture helps reliability — Juris’s technical architecture also ensures reliable results because it combines Azure OpenAI for secure, stateless access to AI models to better handle document ingestion, processing, and vector storage. Users interact through a custom internal web interface that integrates a PDF viewer alongside the chat experience that enables seamless citation and document navigation. The platform is securely hosted on Azure App Service with continuous deployment orchestrated through GitHub, which provides reliable operations and streamlined updates.

Phased approach to building and testing yielded dependability — Also to ensure trustworthy results, LSLA developed Juris by following a structured, phased approach over two years. It began with a concept phase that was focused on clearly identifying the problem, followed by a platform evaluation that compared open-source and commercial solutions. A prototype was then created and demonstrated as proof of concept.

In addition, internal testing included adversarial exercises, hallucination detection, and rigorous validation of citation reliability. Based on these findings, the team implemented enhancements, such as moving from size-based to semantic chunking, improving the interface, and expanding the set of source materials. Juris is now in pilot preparation and undergoing final refinements before its release to a select group of subject matter experts.

Efficient resourcing and sharing learnings

LSLA’s phased method to building and testing also made sure that sustainability was built in from the beginning. Indeed, ongoing maintenance is minimal, and Microsoft’s nonprofit Azure credits keep infrastructure costs around $2,000 per year.

The most significant cost was in staff time. Development so far totals roughly 300 staff hours (or about 0.5 full-time equivalent, plus 0.3 FTE over two years). Once Juris enters phase two, which has been funded by a Legal Services Corporation (LSC) technology initiative grant, expected benefits will include faster, more consistent research and reduced workload for frontline and administrative staff, plus a modular framework that others can adapt.

Other legal service organizations that face similar challenges can learn from the Juris development, testing, and implementation as well as other related case studies. These recurring lessons include:

• • • beginning with a small, manageable scope
    • inviting end users in from the start, and
    • carving out protected time so staff can innovate alongside daily duties.

Looking ahead, the LSLA team will continue to roll Juris out in phases, while building sister tools. LSLA also plans to share lessons learned through LSC’s AI Peer Learning Labs to help other organizations replicate the model.

Real change at scale, such as this, will only come from collaborating across organizations to share playbooks, pool datasets, and co‑design tools that lift quality while lowering cost. It is only with such partnership and sharing lessons from early adopters of AI that peers can adapt the model and, together, scale solutions that narrow the justice gap.

Angela Tripp, Program Officer for Technology for the Legal Services Corporation contributed to this article.

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Washington, DC, November 10, 2025 – Global law firm Clyde & Co today announced the appointment of Kirsten Wilkerson as a partner in its Washington, DC, office. Her arrival marks a strategic expansion of the firm’s North American Trial & Defense practice, reinforcing Clyde & Co’s position as a leading legal advisor to the insurance sector and deepening its litigation capabilities in a key market.

Kirsten Wilkerson is a seasoned litigator with 25 years of experience defending complex, high-value, and emerging tort claims. Her practice spans personal injury, mass torts, toxic exposure, and premises liability, among other areas. She also has extensive mediation experience, having negotiated structured settlements in complex cases across the country.

Eileen King Bower, Partner and Chair of Clyde & Co’s North American Board commented: “Kirsten brings a proven ability to craft and execute litigation strategies in some of the most complex and high-stakes cases. Her appointment reflects our ongoing commitment to expanding our insurance capabilities across the US and will further enhance our ability to deliver outstanding service and results for our clients.”

Kirsten Wilkerson commented: “Joining Clyde & Co offers an exciting opportunity to contribute to its highly respected Trial & Defense practice. My experience handling complex tort claims, from environmental and toxic exposure to premises liability, aligns closely with the firm’s strategic focus. I’m looking forward to working alongside talented colleagues across the firm and helping clients navigate the challenges of high-stakes litigation.”

Clyde & Co is a leading global law firm with a robust North American practice that offers clients industry-leading advisory and dispute resolution services. The firm opened its first North American office in New York in 2006. Since then, the firm has grown to 19 offices with more than 400 attorneys across the US and Canada, including more than 100 partners.

 

Introduction

More than half a billion people with distance vision impairment caused by anterior segment pathologies^1–3 live in low- and middle-income countries (LMICs).⁴ Vision impairments from cataracts and the sequelae of microbial keratitis and trauma are the fourth most common disability in Uganda, affecting 6.7% of the population.^3,5–7 This significantly reduces the ability of those affected to contribute to the country’s productivity.⁵ The situation is mainly due to the low number of ophthalmologists (fewer than two per million people), with the vast majority based in urban areas.⁶ Although task shifting, through the expansion of a trained ophthalmic clinical officer (OCO) cadre, has been established, many healthcare workers cannot access functioning diagnostic devices, such as slit lamps, which limits the potential impact of this capacity strengthening strategy.⁸

The handheld slit lamp is suitable for both clinical and community outreach use and is a portable version of the gold standard (slit lamp) for diagnosing anterior segment eye diseases.^9,10 However, it is costly, easily broken, and requires regular maintenance with access to often hard-to-find and expensive consumables. It is also perceived as challenging to operate, requiring a relatively long training period to reach competence. These factors together limit its use in resource-limited settings, especially among primary and mid-level healthcare workers, who are typically the first to see patients with anterior segment eye diseases.^8,11 Additionally, Uganda has very few (<20) working slit lamps in public hospitals, which delays the diagnosis of preventable and curable anterior segment diseases.^11,12 The Lancet commission and Vision 2020 initiative recommend developing low-cost, portable devices for LMICs that are independent of scarce and expensive consumables without compromising core function.^1,13

In response to the issues outlined above, the Arclight device has been designed and developed. It is a portable (weighs 18g), solar-powered, low-cost combination anterior segment loupe, ophthalmoscope, and otoscope.^14,15 The time to fully charge the device is 4–6 hours in the sun or 45–60 minutes via USB. Several studies have demonstrated the direct ophthalmoscope function to be equal to traditional direct ophthalmoscopes in performing the fundal “red” reflex and fundoscopy.^16–20 Additionally, it is easier to use, with a shorter learning curve for those with minimal eye care training.^16,18,21,22 These features make the Arclight potentially suitable for use by generalists and mid-level eye care workers in delivering primary eye care. In addition, the otoscope function has been evaluated in both high- and low-resource settings and has also been shown to be of equivalent function to traditional, more expensive devices.^17,23 As yet, however, evidence for the Arclight’s use in the examination of anterior segment disease has not been explored. Therefore, this study aimed to evaluate the accuracy and acceptability of the Arclight anterior segment loupe compared to the handheld slit lamp in the diagnosis of common anterior segment eye diseases seen by OCOs in Uganda.

Methods

Study Design

This was a mixed-methods cross-sectional study employing both qualitative and quantitative techniques conducted in June 2022.

Study Site

The study was carried out at the ophthalmology outpatient clinics of Mulago National Super Specialised Hospital (MNSH). MNSH is the only public hospital providing specialized ophthalmic services in central Uganda and also serves as the teaching hospital for Makerere University.

Study Population

The study recruited Ophthalmic Clinical Officers (OCOs) from three districts in the central region of Uganda: Wakiso District, Mukono District, and Kampala District, which were purposively selected. Ophthalmic Clinical Officers (OCOs) undergo a one-year diploma specialized training in clinical ophthalmology, including diagnosis and non-surgical treatment of eye diseases.

Sample Size Estimation

A total of 21 OCOs were recruited. The sample size was calculated using a desired precision of 0.05, a mean diagnosis time with the Arclight device of 93.19 seconds,¹⁶ and adjustments for the expected number of subjects during the study period, as well as a 10% non-response rate.²⁴ Participants were sampled consecutively from the list of the National Association of Ophthalmic Clinical Officers and Cataract Surgeons.

Three focus group discussions (FGDs) were planned to be conducted face-to-face, with each FGD consisting of six participants to ensure theme saturation. Participants were purposively sampled from the OCOs who took part in the quantitative phase of the study.

Study Procedures

Arclight Training Session

A one-day workshop on both the hand-held slit lamp and the Arclight device was conducted for the participants. The workshop emphasized examination techniques and diagnosis of common anterior segment eye diseases.

Selection of Patients

Two ophthalmologists with over 5 years of experience (AK and CN) recruited patients with the following diagnoses made on a table-mounted slit lamp: normal eye, chronic anterior uveitis, pterygium, corneal ulcer, corneal laceration, corneal scar, hypopyon, hyphema, trachomatous trichiasis, pupil abnormality, cataract, and papillary conjunctivitis.

Data Collection Stage

After obtaining written informed consent from both the OCOs and patients, research assistants (CN & AK) administered a questionnaire to collect data on the OCOs’ age, gender, length of practice in ophthalmology, district of practice, and experience with the Arclight device.

Each OCO was randomly assigned to use either the Arclight or a handheld slit lamp first. Then, each participant examined all 12 patients and recorded the diagnosis. To reduce the chance of recall from short-term memory, the order of patients was changed before switching to the other device and conducting the second set of examinations. Patients were also disguised with a gown, a theatre cap, and masks, leaving only their eyes visible to the participants. To minimize patient fatigue, each patient’s eye was examined a maximum of 11 participants using each device, and thus 2 groups of patients with the predetermined conditions were recruited; however, every OCO examined the same set of patients with the 2 devices. Within each group, each participant was examined by 2 devices.

Focus Group Discussions

FGDs were facilitated by a doctor trained in qualitative research data collection (AWS) and a trained note-taker (PAO). Each session lasted 80 minutes, with participants seated around a round table and the moderator among them. Before each FGD began, the moderator explained the study’s objectives to the participants.

A questionnaire based on Sekhon’s Model of Acceptability of Health Intervention²⁵ was used to collect data (S1), with all FGDs recorded and field notes taken by the PAO.25 FGDs were conducted until thematic saturation was reached. The recordings were transcribed by a skilled transcriber and reviewed by the investigators to ensure they conformed to the submissions from the FGDs.

Data Analysis

Quantitative

Descriptive statistics were summarized as frequencies, percentages, medians, and interquartile ranges. Data was visualized using bar graphs. The performance of the devices was presented as the percentage of diagnoses correctly identified and compared using McNemar’s test.

Qualitative

All audio recordings were transcribed verbatim in English and verified by two research assistants. All qualitative data were analyzed using a thematic approach in NVIVO software. De-identified data, organized in transcripts, were read multiple times by JM to identify relevant text segments and group them into codes. We also combined similar paragraphs into meaning units, which were then synthesized to create codes. These codes were further analyzed to identify themes using constructs from Sekhon’s Theoretical Framework of Acceptability.²⁵ This framework includes seven constructs, which are adapted as shown in Table 1.

Table 1 Table Showing the Adaptation of Sekhon’s Framework to Our Study

We developed a narrative of our qualitative data based on the identified themes and included quotes from the FGDs to illustrate the participants’ views. Participants did not provide feedback on our findings. We present our results following the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.²⁶

Results

Study Participant Characteristics

In this cross-sectional study, 21 OCOs (13 females) were recruited, with a median age of 39 years. All OCOs had practiced for more than 5 years and had experience using a handheld slit lamp. Only 6 participants had previous exposure to Arclight. The details of the participant characteristics are displayed in Table 2.

Table 2 Characteristics of the Study Participants

Diagnostic Accuracy of the Arclight Loupe versus the Handheld Slit Lamp

Most conditions were accurately identified by the OCOs: Arclight (71.2%) and handheld slit lamp (72.3%). The percentages of correct diagnoses are displayed in Table 3 and Figure 1.

Table 3 Proportion of Participants Who Correctly or Wrongly Diagnosed Eye Conditions Using Arclight Device versus Handheld Slit Lamp

Figure 1 The percentage of OCOs who got the correct diagnoses using Arclight device versus hand-held slit lamp. Note: *p-value <0.05.

The median time taken to make the diagnosis was comparable between the devices: handheld slit lamp 26 seconds and Arclight 25 seconds. An almost perfect agreement between devices was observed for diagnosing Endophthalmitis/hypopyon (Cohen’s Kappa: 1.00 (1.000—1.000)) and Trachomatous trichiasis (Cohen’s Kappa: 0.8966 (0.700—1.000)), while substantial agreement was noted for diagnosing corneal ulcer (Cohen’s Kappa: 0.7667 (0.461—1.000)) (Table 4). More OCOs misdiagnosed corneal scars using Arclight compared to the slit lamp (13 [61.9%], 95% CI [38.3—80.9] vs 6 [28.6%], 95% CI [12.5—52.9], p-value 0.019). No agreement was observed between devices in diagnosing cataract (Cohen’s Kappa: 0.000 [−Infinity—1.000]) or Pterygium (Cohen’s Kappa: 0.000 [−Infinity—1.000]).

Table 4 Agreement Between the Arclight Device and Slit Lamp per Anterior Segment Eye Condition

Acceptability of Using the Arclight Device in the Diagnosis of Common Anterior Segment Eye Disease

We used Sekhon’s Theoretical Framework of Acceptability to assess findings from the FGDs on the acceptability of using Arclight. In summary, the use of the Arclight device in diagnosing common anterior segment eye diseases was acceptable to the OCOs.

Affective Attitude

User Friendliness

Participants used the Arclight device with ease and made the diagnosis in a shorter time. The quotes illustrate this:

My experience with Arclight was that it was easy for me to come up with the diagnosis within a short time. You get the gadget (Arclight), you focus quickly on the patient’s eye, and you have the right diagnosis. (FGD 1)

It Requires Minimal Training

Generally, almost all participants stated that they required minimal training to use the device efficiently in their clinical practice. The techniques to arrive at a correct diagnosis were easy to grasp in a short time. One participant reiterated

In a short time, I learnt and acquired skills on how to use the Arclight very well on the anterior segment examination and fundoscopy. (FGD 3)

Portability

One participant shared, “I can even move with it in my small bag and do my community work.”

Most of the OCOs said that Arclight was easy to carry from one place to another. They attributed this to its smaller size compared to the slit lamp, which they used for diagnosing anterior eye segment diseases.

The Arclight is light (in terms of weight) compared to the Slight lamp, and you can move with it. Now we can even do home-to-home visits, looking at people’s eyes. (FGD 1)

The Arclight Is an Affordable and Easy-to-Maintain Device

Cost also emerged as another factor that the OCOs preferred over the slit lamp. The participants felt that it was more realistic to purchase an Arclight for their practice.

Of course, the cost attached will always affect my decision to use it because when you compare the two, 50,000 Uganda shillings (for the Arclight) is easily obtained than 35 million Uganda shillings, and they almost use the same time to arrive at the diagnosis, apart from a few cases. You will choose the Arclight. (FGD 1)

The Arclight’s capacity to be recharged using solar power was viewed as a significant innovation that would enable participants to use it in hard-to-reach areas with limited access to electricity.

since it is solar charged, I can use it anywhere, even in the villages, and I wouldn’t bother about the availability of electricity in the area where I am. (FGD 3)

Self-Efficacy

Able to Use It to Diagnose Anterior Segment Conditions

The participants regarded the Arclight as a valuable device that would aid in diagnosing anterior segment diseases. As two participants observed:

I found the Arclight device easy to manoeuvre and use to make diagnoses for anterior segment conditions. I did not have to make a lot of adjustments like when I use the slit lamp (FGD 3)

Arclight can be used in mass screening exercises

The participants believed they could use the Arclight device in their clinics and medical outreach efforts to evaluate a large number of patients quickly. Two participants mentioned this.

I would prefer the Arclight device (to the portable slit lamp) because it is simpler to use, and you can handle many patients within the shortest time. The Arclight device would also be better (than the slit lamp) If I go for an outreach or camp (FGD 1)

It Can Be Used to Examine a Wide Range of Patients

The ability of participants to use the Arclight device with different patient groups emerged as a key issue during the focus group discussions (FGDs). The majority of the OCOs who had undergone training before using the Arclight felt that they could use the device with children who may not be cooperative or have limited ability to follow instructions.

It can be used to examine both the cooperative and uncooperative patient. The portable slit lamp may not provide accurate results if the patient is uncooperative. The Arclight device is a good device to use to examine children who easily get tired, and they are moving up and about. (FGD 2)

However, some participants experienced challenges in adjusting to using the Arclight device for diagnosing common anterior segment eye diseases.

My challenge was to adjust because we are used to these (instruments), which have a bigger working surface area. So, for me to focus on that small area in the beginning was hard for me. (FGD 2)

Burden

High Time Efficiency

For most participants, the average time to reach a diagnosis was shorter with the Arclight than with the slit lamp. The participants noted:

The duration (to reach a diagnosis using the Arclight) was quite short. It is less than one minute, and you are already there. (FGD 1)

Perceived Effectiveness and Opportunity Cost

Our analysis found themes that overlapped in these constructs and hence are presented jointly:

High Preference for the Arclight

Participants in our study stated that they were able to use the Arclight to identify the common anterior segment conditions. In addition, some of the OCOs felt that the Arclight provided good magnification, enabling them to make a diagnosis in a very short time.

I would prefer to use the Arclight to the slit lamp. (With the Arclight device), I was able to examine the depth and everything in the anterior segment. (FGD 3)

In comparison with other alternative devices used in eye care in Uganda, the participants in the FGDs felt that Arclight would provide them with the opportunity to diagnose their patients. This is despite their acknowledgment that the slit lamp remains the gold standard.

For the case of our settings, the fact that we lack infrastructure and equipment, I guess the Arclight device is more flexible to use compared to other tools. But as the gold standard, the slit lamp stands out better because it comes with other accessories and magnifications. When it comes to eye care (in our settings), which runs largely on outreaches, I think Arclight makes a difference. (FGD 2)

However, participants also noted potential limitations with the effectiveness of Arclight:

Perceived Technical Limitations of the Arclight

Arclight Increases Exposure to Pathogenic Aerosols

To obtain accurate results, the participants had to stand close to the patients, which made them (OCOs) uncomfortable The OCOs felt that this increased their exposure to possible pathogens (especially aerosols from infected patients) for their patients. One participant reiterated:

In cases where I suspect infections or in cases where I suspect flu because of the proximity of the patient to me, I might be discouraged from using the Arclight device for fear of acquiring an infection from the patient. (FGD 1)

It Cannot Make a Slit

For some conditions, the participants noted that the Arclight device might not be the most suitable device for providing sufficient depth for an extensive examination of the anterior segments of the eye. One participant noted:

There are scenarios where I think I would not use the Arclight device to examine a patient. For example, if I want to locate a specific pathology at a certain layer of the cornea, I might not use the device. This is because the Arclight device does not provide the necessary slit to enable localization of the corneal layer where the pathology is located. So, I would prefer the Slit lamp. (FGD 1)

It Is Monocular

The participants regarded the fact that Arclight was monocular as a limitation of its use in clinical practice.

The Arclight device is a monocular equipment as you use one eye to examine but with the slit lamp, you can use two eyes. There is an added advantage of depth perception (using the slit lamp) where you are going to see things very well using the two eyes. (FGD-1)

Intervention Coherence

Comprehensible Description of the Technique of Use

Participants in the FGDs demonstrated excellent comprehension of the process of using Arclight to perform anterior segment eye examinations. Two participants noted:

You establish rapport with the patient. Explain the purpose of the examination, you switch on the light, of course you go structure by structure, beginning from outside, eye lashes, eyebrows, lids, eye lashes, then like that you go to the cornea, conjunctiva then you can go to look at the anterior chamber so basically that is what it entails from outside to inwards. (FGD 2)

Ethicality

Willingness to Use the Arclight in the Future

Participants stated that based on their experiences using the Arclight, they would implement it in clinical practice for the diagnosis of anterior segment eye conditions. They hoped to use this in conjunction with the slit lamps for their practice.

I would use this device in practice always because it is easy to manage, use and carry. I do not have any reservations (FGD3)

I have access to the slit lamp already. I have been provided with an Arclight and I would definitely be using it in my practice (FGD2)

Discussion

This mixed-methods study shows that Ugandan ophthalmic clinical officers can diagnose common anterior-segment diseases with the low-cost, solar-powered Arclight loupe as accurately and quickly as with a portable slit-lamp. Across 231 examinations, the overall proportion of correct diagnoses differed by only 1.1 percentage points (71.2% vs 72.3%), and median examination times were essentially the same with the majority reporting a short learning curve. The findings therefore position the Arclight as a credible alternative to handheld slit-lamps where these are scarce, expensive, or difficult to maintain.

Our results build on previous research demonstrating the Arclight’s usefulness for posterior segment assessment and red reflex screening.^{16,18–21,27} Those studies involved medical students and general health workers. In contrast, the current trial included experienced mid-level eye-care providers and compared performance against a more advanced and costly gold standard for anterior segment examination—a handheld slit lamp—rather than an equivalent “loupe” device. The high agreement levels for inflammatory disease, trauma, trichiasis, and pseudophakia indicate that the loupe’s monocular, broad-beam optics are effective for most pathologies seen in primary eye care. The only significant clinical limitation observed was a case of corneal scarring, where examiners using the Arclight were less likely to identify it correctly. This reflects OCOs’ concerns about the absence of a slit beam and binocular depth perception.

Acceptability data help explain why diagnostic performance was maintained after only a single day of training. Participants valued the loupe’s light weight, pocket size, solar recharging, and negligible running costs—attributes that directly align with the Technology Acceptance Model’s constructs of perceived usefulness and ease of use.²⁸ Cost is especially important: purchasing one portable slit lamp costs roughly the same as 600 Arclight devices, a difference that could significantly expand access to anterior-segment screening in district hospitals and outreach programs.⁸ Additionally, users recognized the potential for quick, high-volume assessments during community eye-health camps and appreciated the practical benefit of examining children and uncooperative adults without needing chin rests or access to often hard-to-reach mains electricity.

Nevertheless, three technical limitations were identified. First, the absence of a slit beam limits the ability to locate stromal lesions and measure anterior-chamber depth, functions still best performed with a slit lamp when available. Second, monocular viewing reduces judgment of depth, which may partly explain the lower accuracy for corneal scarring. Third, clinicians need to stand very close to the patient, raising concerns about aerosol transmission of respiratory pathogens. These limitations suggest that the Arclight loupe is best used as a supplementary tool rather than a replacement: it can address a gap in diagnostic resources in health clinics and outreach settings, while slit lamps remain the preferred choice for examinations in district and tertiary hospitals, if available.

Several strengths of this study increase our confidence in the conclusions: the patient sample represents a realistic case mix, the device use order was randomized, patients were masked, and the order of cases was varied between rounds of examination. Additionally, triangulating quantitative accuracy with qualitative acceptability was employed. Limitations include the modest sample size of OCOs from districts near Kampala, the brief familiarization period with the Arclight compared to many years of slit-lamp experience, and the cross-sectional design, which cannot track changes in proficiency, device durability, or infection control practices over time. Future studies should (i) follow users longitudinally to observe learning curves and sustained acceptability; (ii) assess diagnostic accuracy for subtler conditions such as early keratoconus or Fuchs endothelial dystrophy; (iii) evaluate cost-effectiveness and effects on referral patterns; and (iv) test simple infection-control measures, such as disposable breath shields, to reduce perceived aerosol risk.

In summary, when used by trained OCOs, the Arclight loupe provides diagnostic accuracy and speed similar to a portable slit lamp, while offering clear benefits in cost, portability, and independence from mains power. Adopting this economical technology in eye-care task-shifting strategies could significantly increase the timely diagnosis of anterior-segment disease in low-resource settings, supporting blindness reduction efforts and advancing the goals of the Vision 2020[15] and Lancet Global Health Commission agendas[1].

Conclusion

Compared to the Slit lamp, OCOs found the Arclight device acceptable and time-saving, but technical limitations such as the inability to create a slit and its monocular design could be potential barriers to its use. In settings with limited access to slit lamps, the Arclight devices should be considered an alternative tool for diagnosing anterior eye segment diseases.

Abbreviations

OCO, Ophthalmic clinical officer; FGD, Focus group discussion; MNSH, Mulago National Super Specialised Hospital; LMIC, Low- and Middle-income countries.

Data Sharing Statement

The datasets used and analyzed in this study are available from the corresponding author upon reasonable request.

Ethical Approval

This research was a minimal risk study conducted in accordance with the Declaration of Helsinki. Ethical Approval was sought from the Mulago Hospital Research and Ethics Committee (MHREC 2021-58) and the Uganda National Council of Science and Technology (HS2007ES) before data collection. Administrative clearance was sought from the MNSH administration. The study team members are trained in the principles of Good Clinical Practice and the Protection of Human Subjects. Participants were informed about the aim of the study, the methods employed, the nature of their participation, and that anonymized responses and direct quotations would be published. Written informed consent was then obtained from all study participants. All information collected from participants during the research was kept strictly confidential with no name /personal identifiers of any person who took part in this study to be used in any report or publications resulting from the study. Participation in the study was voluntary.

Acknowledgment

We appreciate the administration of Mulago Hospital and its Ophthalmology department for approving the study to be carried out in their facility. We are further grateful to the patients and Ophthalmic clinical officers who participated in the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that was in conception, study design, execution, data acquisition, analysis, interpretation, or all these areas; participated in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; agreed on the journal to which the article was submitted; and accept responsibility for all aspects of the work.

Funding

The study was funded by the Makerere Research & Innovations Fund 3 (MAKRIF/CH/02/21). Matched funding was also secured from the University of St. Andrews in Scotland for purchasing Arclight medical devices. AWS was a research fellow of the MakNCD program(D43TW011401) supported by the Fogarty International Centre of the National Institutes of Health. JM was a Ph.D. student awarded under the Nurturing Genomics and Bioinformatics Research Capacity in Africa (BRECA) grant (U2RTW010672) from the Fogarty International Centre of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Disclosure

Dr. Andrew Blaikie is employed by the University of St Andrews, where Arclight has been commercialized under a subsidiary company within the University. He does not, however, have any direct financial gain from sales. The authors report no other conflicts of interest in this work.

References

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Hello, everybody—this is Gavin Verhey on behalf of the Pauper Format Panel. Today, we are making a change in Pauper. We want to walk you through the background of the change and why we’re making it.

We’ll start with the top line: High Tide is banned in Pauper. This ban takes effect immediately and will be live shortly on Magic Online.

Back in March, we unbanned High Tide as part of something new called trial unbans. The idea was that we could unban a card on a probationary basis, see how it performed, and then decide if we wanted to keep it off or return it to the banned list. This is a great way to investigate cards and potentially bring cards back into the format that people enjoy. At that time, we unbanned Prophetic Prism, which has been a success. It’s seen some play and helped decks like Urzatron, but ultimately it has been just fine. The format is very different than when Prophetic Prism was initially banned.

High Tide is a much more nuanced discussion.

At the time, we said this:

“Our hope is that the deck ends up, at best, an option in the metagame beneath the very best decks. If it ends up not being played after some experimentation, that’s a fine outcome. If it ends up fringe or playable but not in the best decks, that’s the ideal outcome. These scenarios will leave it unbanned.

“If it breaks through and enables one of the three most successful decks in the metagame, however, we will likely ban High Tide again at the end of the trial—having a kill-from-hand combo deck as one of the best three decks can be frustrating. Not every color can interact with that stretch super well.”

Event Results

First, let’s dive into data and results.

High Tide’s results started off slow as people began working to coalesce on the best versions. Eventually, players have refined the deck into a strong Psychic Puppetry and splice engine that casts High Tide and splices Psychic Puppetry onto Arcane spells to stay even or net mana, generating an immense amount of mana in a single long turn to eventually kill by looping Stream of Thought. This usually kills, when unimpeded, on turn four or five, but very occasionally on turn three.

There are a couple flexible card slots, but the majority of decklists tend to have near-identical main decks. Here’s a recent version that won a Magic Online challenge:

4 Brainstorm
1 Deep Analysis
1 Gigadrowse
3 Hidden Strings
4 High Tide
4 Ideas Unbound
13 Island
4 Merchant Scroll
4 Lórien Revealed
1 Muddle the Mixture
4 Peer Through Depths
3 Pieces of the Puzzle
4 Preordain
4 Psychic Puppetry
2 Reach Through Mists
2 Snow-Covered Island
2 Stream of Thought


1 Deep Analysis
2 Blue Elemental Blast
2 Dispel
1 Envelop
3 Fallaji Archaeologist
2 Gigadrowse
1 Muddle the Mixture
3 Snap

In terms of win rate, the deck started at just above 50% when it comes to its Magic Online win rate and didn’t have a large real-world showing at events like Paupergeddon—that’s more than fine. However, I’m really glad we took the extra time, because we have watched High Tide‘s success rate tick increasingly upward. It has crept some weeks on Magic Online to above 55%, sitting at or near the top of the metagame.

Unlike many other decks, it tends to vary a lot from week to week—despite its success, it has a smaller portion of the metagame and can be very matchup dependent (more on that later). It’s a deck that takes a large amount of play skill and experience to pilot optimally, and it’s very possible that it has taken time to slowly rise for that reason. While, as far as we can tell, the play rates online and in real life tend to be lower, historically complicated and slow combo decks tend to not show up as much in droves.

The success of High Tide alone debatably meets our threshold for banning. It is the other elements in concert with its success, however, that push it over the edge.

Problematic Gameplay and Tournament Logistics

High Tide is a card which certainly has a pedigree of slow turns—any longtime Legacy player can tell you about that. Some of that is not a surprise. However, Pauper’s version is likely even potentially more egregious than versions we’ve seen in the past.

It’s not uncommon for a High Tide combo turn to take ten or even fifteen minutes to execute, even in the hands of a skilled pilot. Unlike other formats which often have some big hammer card that helps make it clear to the opponent it’s time to pack things in, like a large Mind’s Desire, the incredibly incremental nature of the combo in Pauper means that things don’t really come to that major turning point. There is a version with a single Petals of Insight, so you can start generating infinite mana with it and enough copies of Psychic Puppetry, but many would say that’s suboptimal to play—drawing an ineffectual card with this deck can be the difference between winning and losing.

Speaking from my own personal experience, I have played a lot of High Tide now. I even played eleven rounds worth of it at in-person side events during this past Paupergeddon. I would be executing my combo for ten minutes and still not be sure if I was going to win the game. I had multiple opponents concede to me during moments where I thought I was more likely to fizzle. And while I don’t want to ascribe too much to an individual game or situation, the fact that the right play is always to fully force the opponent to play it out further compounds the time it takes.

The High Tide player will always try to combo off if they look like they’re about to lose the next turn, which means that you can expect some amount of a combo turn in every game of a match. This all boils down to a miserable gameplay experience, where the High Tide player takes up the majority of gameplay time while the other player sits there.

While it’s far from the only deck that can take a lot of time to execute—a deck like Familiars can also make games go long and monopolize the clock—at least in those cases you get to take another turn and play Magic. With High Tide, you will often watch for minutes on end with the result often being you don’t get another turn. Additionally, a deck like Familiars still leans on creatures for its combo, which the Pauper card pool is better suited to handle than something entirely from hand.

This additionally compounds in matters of tournament logistics. Because a single turn can take so long, even when plays are made at a reasonable pace, if the High Tide player begins their combo as the round is running out of time, it can cause the event to run over on time. This provides a poor event experience for everybody. While this happening is mostly situational, having it happen even just a couple times in an event can cause large delays.

While neither of these on their own are reasons for a ban—for example, we’re not taking action against Cycle Storm for its long turns—these factors in conjunction with it being a strong deck to play make it a serious problem and compound the issues.

Format Impact

While High Tide has not been the most played deck, that doesn’t mean its effects haven’t rippled across the entire format.

High Tide is a deck with extremely polar matchups. Many matchups, Game 1 is just a near-automatic loss, as the opponent has no interaction with the stack or hand, so unless they can kill by turn four, they’re relying on sideboarded games—unless your deck has a good Game 1 matchup against Tide, in which case Tide is probably in very rough shape.

To give some examples, against Mono-Blue Faeries, Tide’s worst matchup, some weeks its win rate has dipped below 20%. That is massively polar! While other matchups that don’t have Game 1 interaction have done the opposite. You sit down for Game 1 and you already often know who is going to win the first game (unless there’s a horrendous draw involved).

The result of this has been twofold.

The first is that decks that are advantaged or have a chance against High Tide in Game 1—Faeries, Tolarian Terror, Mono-Red—gain a large boost in the metagame. That’s not inherently bad. Decks becoming better because they beat up on other decks happens all the time. But it has contributed to the popularity of already popular decks and cemented Terror as a top deck.

The second piece, though, which is problematic, is that it has made it a lot more about decks racing past one another to see who can win first. Something a lot of players enjoy about Pauper is the incremental nature of the format. But if you’re trying to beat High Tide, you can either disrupt it or just try and run past it since it won’t interact with you. More decks doing the latter means the whole format gets more compressed and less interactive as people are zooming to die before High Tide’s fundamental turn.

Put another way: High Tide preys on midrange, meaning decks that can go under it but are weak to midrange become good counters. But we’ve been doing so much work over the past couple years to help slow down the format and make it more interactive: the more Pauper is about people just throwing cards at one another and seeing who wins as opposed to interactive games, generally the worse off it is. That doesn’t mean fast decks shouldn’t exist, but incentivizing the format to try to win quickly and interact very little is a negative.

Of course, after sideboarding, players gain access to options against and disruption for High Tide. Often it turns into how many sideboard cards you draw—though the deck is more resilient than many would give it credit. But this gameplay isn’t the best either when you have these very polar matchups where you lose Game 1 and then sideboard in a ton of cards to try and flip them. We’ve previously banned cards out of Mono-Red (like Monastery Swiftspear) for causing a level of polarity within the format that is lower than what High Tide is bringing to the table.

Despite the play rates being moderate, the impact on the format is outsized.

The High Tide Ban and Beyond

Ultimately, we had to ask ourselves the question, “Is High Tide making the format better or more enjoyable?” In the aggregate, and in looking at all the above reasons, the answer is no.

It’s a deck that has had outlier win rates, is hard to interact with, has caused large ripple effects, and creates a poor play and tournament experience.

Taking these elements into account together, we collectively made the decision to ban High Tide.

I want to stress that we are still happy with the experiment here. Trying something out, letting the community experiment with a card, creating discussion, and learning an outcome about a card that has essentially never been legal in the wider Pauper format is a positive result, even if the outcome was banning the card again. We have no plans for future trial unbans at this time, but I also wouldn’t be surprised to see us try it again in the future.

I will say that while we did need extra time to see how the format evolved with a deck this complicated and that took time to fully see the impact of, we do want to apologize for the moving window here. While each individual reason made sense—asking for more time over the summer to see how the deck played out and aligning with the regular announcement cadence once the window moved up two weeks—it still created a shifting date as players were trying to make plans and understand if they should invest time into learning this deck and acquiring the cards. This isn’t generally what you should expect from us, and we’ll try to not let this happen in any future trial unbans.

So, what about the other cards in the format?

Well, we looked across the whole format for any other changes to be made at this time. The deck which most caught our eye as potentially in the range of a ban is the Tolarian Terror decks. These decks have been consistently strong for most of this year and over the past six months have risen to the top in both play and win rate.

However, as mentioned earlier, we believe High Tide had an outsized impact on the format and what decks people chose. Many of the decks advantaged against Terror were ones that couldn’t compete with the speed of a deck like High Tide, and many sideboard slots that could have been used for Terror were taken up by hate for Tide. We want to monitor this now that we’ve removed High Tide as an arm of the format and see how it evolves from here.

The other deck we have had our eye on are the new Spy Combo decks that have been showing up. Here’s an example from a recent Magic Online Challenge, noting there is still experimentation with the exact mix of cards.

3 Avenging Hunter
4 Balustrade Spy
2 Dread Return
2 Elves of Deep Shadow
3 Forest
2 Gatecreeper Vine
4 Generous Ent
4 Land Grant
4 Lead the Stampede
2 Lotleth Giant
3 Masked Vandal
1 Mesmeric Fiend
4 Overgrown Battlement
3 Quirion Ranger
3 Saruli Caretaker
1 Snow-Covered Forest
4 Sagu Wildling
1 Swamp
3 Tinder Wall
3 Wall of Roots
4 Winding Way


2 Faerie Macabre
2 Fang Dragon
1 Flaring Pain
3 Healer of the Glade
3 Mesmeric Fiend
2 Nylea’s Disciple
2 Scattershot Archer

This fairly new hybrid combo deck can kill fast with Balustrade Spy setting up a lethal (or at least highly damaging) Dread Return on Lotleth Giant after milling most of its library; it also has the secondary plan of Walls accelerating into its big threats. It has definitely caught our eye as something to watch. Balustrade Spy and Dread Return both have a pedigree as extremely strong cards that can fuel problematic decks. However, there are still plenty of moments to interact with the combo and some clear sideboard options. We’ll want to continue watching to see how this develops, but it certainly looks a lot more appropriate in terms of overall impact than High Tide so far.

Overall, the format has looked healthy—which is partially why we were reserved about making this change. The impacts of a deck like High Tide are a lot less surface level than other problematic decks. Our hope is that this will nudge the format back a bit more toward interaction and drop a few percentage points off the decks that were preying on Tide being around. But, as with all things, we’ll have to wait and see.

Pauper Championships kick off this week on Magic Online, and I know we’ll eagerly be watching to see what happens both there and at Paupergeddon later this month out in Italy. As always, we’ll be out there reading everything you all have to write about this as well.

Thanks for reading, playing the format, and being up for trying something as experimental as a trial unban. It was a worthwhile experiment, and maybe we’ll try it again in the future.

This has been Gavin Verhey, now signing off on behalf of the Pauper Format Panel.

Alex Ullman
Alexandre Weber
Emma Partlow
Gavin Verhey
Mirco Ciavatta
Paige Smith
Ryuji Saito