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Blind people face difficulties with independent mobility, impacting employment prospects, social inclusion, and quality of life. Given the advancements in computer vision, with more efficient and effective automated information extraction from visual scenes, it is important to determine what information is worth conveying to blind travelers, especially since people have a limited capacity to receive and process sensory information. We aimed to investigate which objects in a street scene are useful to describe and how those objects should be described. Thirteen cane-using participants, five of whom were early blind, took part in two urban walking experiments. In the first experiment, participants were asked to voice their information needs in the form of questions to the experimenter. In the second experiment, participants were asked to score scene descriptions and navigation instructions, provided by the experimenter, in terms of their usefulness. The descriptions included a variety of objects with various annotations per object. Additionally, we asked participants to rank order the objects and the different descriptions per object in terms of priority and explain why the provided information is or is not useful to them. The results reveal differences between early and late blind participants. Late blind participants requested information more frequently and prioritized information about objects’ locations. Our results illustrate how different factors, such as the level of detail, relative position, and what type of information is provided when describing an object, affected the usefulness of scene descriptions. Participants explained how they (indirectly) used information, but they were frequently unable to explain their ratings. The results distinguish between various types of travel information, underscore the importance of featuring these types at multiple levels of abstraction, and highlight gaps in current understanding of travel information needs. Elucidating the information needs of blind travelers is critical for the development of more useful assistive technologies.

Purpose To assess the early clinical outcomes of central hole phakic posterior chamber intraocular lens(ICL V4c) implantation for correction low and moderate myopia, and to explore the relationship among arch height, intraocular pressure(IOP), and central anterior chamber depth(ACD). Methods This retrospective clinical study included 27 patients (47 eyes)which underwent implantation of ICL V4c for correction of myopia with spherical equivalent between -1.75 D and -6.0 D, From January 2017 to December 2018. Preoperative corrected distance visual acuity (CDVA), postoperative uncorrected visual acuity (UCVA), and IOP were evaluated at one day, one week, three mouths, six mouths, and twelve months. ACD, arch height, and endothelial cell density (ECD) were evaluated at one, three and twelve months. Results At 1 year follow-up, the UCVA of 75% eyes are larger than the preoperative CDVA, and that of 25% eyes are equal to the preoperative CDVA. The postoperative UCVA of the patients was higher than the preoperative BCVA and showed a stable trend. There was no significant difference in ECD (P > 0.05). One month after surgery, the arch height was (0.77 ±0.32) mm, and decreased to (0.63 ± 0.26) mm at the one-year after surgery. ACD was (3.24±0.25) mm in the preoperative, decreased significantly to (2.05±0.39) mm at one month, and rose to (2.2± 0.39) mm at one year after surgery. There was no significant correlation between IOP and ACD and arch height at 1 month and 1 year after operation. The correlation coefficient between ACD and arch height was -0.72 at 1 month after surgery, and it was -0.71 at 1 year. One patient had visual fatigue, one patient had glare, and none of subjects developed cataract, glaucoma and decompensation of corneal endothelium. Conclusion ICL implantation is a safe, effective and stable method for the correction of low and moderate myopia, and it may be a good alternative for patients with low and moderate myopia who cannot undergo corneal refractive surgery.

Background: In Egypt, both pregabalin and tramadol misuse increased in the last decade. Although many studies have confirmed the neurotoxic effects of tramadol, those of pregabalin are understudied. Aim of the study: evaluation of the neurotoxic effects of pregabalin compared with tramadol.Material and method: Thirty male albino rats were included in this experimental study, and they were randomly allocated into three equal groups; Group I (normal saline), Group II (Tramadol addicted), and Group III (pregabalin addicted). All rats received the commenced drugs for 1 month. Open-field tests were performed on the day of scarification, and after that, cortical samples were taken for immunohistochemical analysis and quantification of dopamine receptors' gene expression.Results: The addicted groups showed a significant decrease in weight gain at the end of the study. Open-field testing showed the upper hand of controls regarding all of the tested parameters. Tramadol has a more negative impact on the locomotor parameters compared with pregabalin. Both drugs induced relatively low dopamine-1 receptors (D1Rs) expression to dopamine-2 receptors (D2Rs), mimicking the schizophrenia model.Conclusion: Both tramadol and pregabalin were associated with neurotoxic effects in male albino rats. These effects were less noticed with pregabalin. It is suggested that long-term abuse may end in psychosis.

BACKGROUND: Computerized cognitive training (CCT) is an emerging alternative intervention for stroke survivors. OBJECTIVE: This study investigated the effects of CCT on the cognition, activity, and participation of stroke survivors and compared the findings with those of match-dosed conventional cognitive training. METHODS: This randomized controlled trial included 39 patients with stroke who were divided into the intervention group (n = 19; receiving CCT with Lumosity software) and the control group (n = 20; receiving conventional cognitive training). Both the groups were trained for 20 min, twice a week, for 12 weeks. Participants were evaluated at pretest, posttest, and 4-week follow-up. Outcome measures included various cognitive function tests and the Stroke Impact Scale scores. RESULTS: The CCT group exhibited significant improvement in global cognitive function (evaluated using the Mini-Mental State Examination and Montreal Cognitive Assessment) and specific cognitive domains: verbal working memory (backward digit span test), processing speed (Symbol Digit Modalities Test), and three MoCA subtests (attention, naming, and delayed recall). CCT exerted no significant effect on activities and participation. No significant between-group differences in changes in cognitive function were noted. However, CCT significantly improved cognitive function domains immediately after training, and these effects were sustained at the 4-week follow-up. CONCLUSIONS: Cognitive function of individuals with chronic stroke could improve after administration of CCT. However, future studies with a more rigorous design and higher training dose are warranted to validate our findings.

Clinical Scenario: Chronic ankle instability (CAI) is a condition that involves feelings of the ankle “giving way,” pain, and decreased self-reported function. Individuals with CAI often demonstrate persistent biomechanical impairments during gait that are associated with repetitive lateral ankle sprains (LAS) and the development of early onset ankle posttraumatic osteoarthritis (OA). Traditional rehabilitation strategies have not successfully improved these reported aberrant gait biomechanics; thus, traditional rehabilitation may not effectively reduce the risk of recurrent LAS and ankle OA among individuals with CAI. Conversely, targeted gait training with biofeedback may be effective at decreasing the risk of recurring LAS and ankle OA if these rehabilitation strategies can promote individuals with CAI to develop a gait strategy that protects against subsequent LAS and ankle OA. Clinical Question: Can targeted gait biofeedback interventions cause individuals with CAI to implement a walking gait pattern that is not associated with recurrent LAS and ankle OA? Summary of Findings: Five studies assessed gait biofeedback interventions targeting plantar pressure and/or ankle kinematics involving visual biofeedback (n = 3), auditory biofeedback (n = 1), and haptic biofeedback (n = 1). Plantar pressure was medially shifted during a single session while receiving biofeedback (n = 2), immediately after biofeedback (n = 1), and 5 minutes after receiving biofeedback (n = 1) in 3 studies. One study demonstrated reduced ankle inversion after 8 sessions of biofeedback training. One study did not substantially improve plantar pressure while receiving visual feedback. Clinical Bottom Line: Targeted gait training strategies appear effective in acutely altering gait biomechanics in individuals with CAI while receiving, and immediately after, biofeedback has been removed. Long-term outcomes are not currently established for gait training strategies in those with CAI. Strength of Recommendation: Limited evidence (grade B) suggests that targeted gait biofeedback strategies can alter specific CAI gait biomechanics to a strategy not associated with recurrent LAS, and ankle OA immediately, and after, multiple sessions of gait training.

Objectives: While racial residential segregation has played a role in structuring material conditions in communities of color, associations documenting racialized inequities in greenness tend to be...

PURPOSE: Upper blepharoplasty may be related to dry eye symptoms since the function of the orbicularis oculi muscle may affect the tear film. We aimed to assess the effect of blepharoplasty with or without the removal of a strip of orbicularis oculi muscle on tear film dynamics and dry eye symptoms.METHODS: A double-blind, randomized, controlled trial comparing upper blepharoplasty without (group A) or with (group B) orbicularis oculi muscle excision was performed on 54 healthy Caucasian patients. Tear film dynamics and dry eye symptoms were evaluated using multiple dry eye parameters, i.e. tear osmolarity, Schirmer test I, corneal/conjunctival staining, tear break-up time (TBUT), Oxford Scheme, Sicca Ocular Staining Score and Ocular Surface Disease Index questionnaire. All the parameters were assessed preoperatively and 6 and 12 months after upper blepharoplasty. All the groups' outcomes were compared.RESULTS: The differences were not significant between the two upper blepharoplasty techniques regarding most of the above-mentioned outcomes. Subjective symptoms of ocular irritation, consistent with dry eye disease and vision-related impairment, were reduced after upper blepharoplasty independent of the type of the technique applied, while the pre and postoperative outcomes of the objective tear dynamics did not differ 12 months after surgery. However, group B demonstrated a significant increase in tear osmolarity and TBUT at the 6-month follow-up visit.CONCLUSION: An upper blepharoplasty alleviates subjective dry eye complaints in the long term, while not changing the tear dynamics. The improvement was independent of the blepharoplasty technique used.

Purpose: The aim of our study is to evaluate local tumour control rates, radiation side-effects, visual preservation and disease-free survival (DFS) of uveal melanoma (UM) patients treated with fractionated stereotactic radiotherapy (fSRT). Methods: A retrospective study of UM patients, who were treated with fSRT (N = 189), was performed by the Rotterdam Ocular Melanoma Study group (ROMS), the Netherlands, between 1999 and 2014 with a follow-up of at least 5 years. Results: The 1-, 3-, 5-, 10- and 15-year local tumour control rates were as follows: 99.4%, 92.8%, 92.2%, 89.3% and 89.3%, respectively. Cataract (67.8%) was the most common side-effect of fSRT followed by retinopathy (35.1%), maculopathy (23.8%), vitreous haemorrhage (20.1%), neovascular glaucoma (NVG) (20.0%) and optic neuropathy (12.4%). Patients with anterior located UMs developed cataract more frequently (p = 0.047, multivariable analysis). By multivariable analysis, significant factors for secondary enucleation were tumour recurrence (p

The glaucoma is an eye disease that causes blindness when it progresses in an advanced stage. Early glaucoma diagnosis is essential to prevent the vision loss. However, early detection is not covered due to the lack of ophthalmologists and the limited accessibility to retinal image capture devices. In this paper, we present an automated method for glaucoma screening dedicated for Smartphone Captured Fundus Images (SCFIs). The implementation of the method into a smartphone associated to an optical lens for retina capturing leads to a mobile aided screening system for glaucoma. The challenge consists in insuring higher performance detection despite the moderate quality of SCFIs, with a reduced execution time to be adequate for the clinical use. The main idea consists in deducing glaucoma based on the vessel displacement inside the Optic Disk (OD), where the vessel tree remains sufficiently modeled on SCFIs. Within this objective, our major contribution consists in proposing: (1) a robust processing for locating vessel centroids in order to adequately model the vessel distribution, and (2) a feature vector that relevantly reflect two main glaucoma biomarkers in terms of vessel displacement. Furthermore, all processing steps are carefully chosen based on lower complexity, to be suitable for fast clinical screening. A first evaluation of our method is performed using the two public DRISHTI-DB and DRIONS-DB databases, where 99% and 95% accuracy, 96.77% and 97,5% specificity and 100% and 95% sensitivity are respectively achieved. Thereafter, the method is evaluated using two fundus image databases respectively captured through a smartphone and retinograph for the same persons. We achieve 100% accuracy using both databases which assesses the robustness of our method. In addition, the detection is performed on 0.027 and 0.029 second when executed respectively on the Samsung-M51 on the Samsung-A70 smartphone devices. Our proposed smartphone app provides a cost-effective and widely accessible mobile platform for early screening of glaucoma in remote clinics or areas with limited access to fundus cameras and ophthalmologists.

The emotional attentional blink (EAB), also referred to as emotion-induced blindness, refers to a transient impairment in the ability to discriminate a single target when it is presented closely in time to an emotional distractor. Although the EAB has typically been characterized as representing a complete loss of target information due to attentional capture by the emotional distractors, it is unclear whether the impact of the emotional distractor is in fact discrete or graded. Here, we tested whether the emotional distractor of the EAB interfered with target processing in a continuous or all-or-none manner by measuring changes in both reaction time (RT) and target-vividness ratings in addition to target-discrimination accuracy. Rapid sequences of landscape images were presented centrally, and participants reported the orientation of a ± 90° rotated target as quickly and accurately as possible. Replicating the classic EAB phenomenon, we found a strong impairment in target discrimination when an emotional distractor shortly preceded the target, and we also found a moderate impairment when the target preceded an emotional distractor. This decrement in accuracy at short lags was accompanied by increases in RT to the target as well as lower ratings of subjective target vividness even when the target was detected, indicating that emotional distractors impacted target processing in a lag-dependent, graded manner. We argue that these results are consistent with an interactive race model of the competition between stimulus representations in the conflict between top-down and bottom-up attentional mechanisms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective To evaluate the safety of performing cataract surgery prior to eyelid (entropion/ectropion) surgery in patients with concurrent cataract and lower eyelid malposition. Design Retrospective case series. Participants and Methods Patients with concurrent lower eyelid malposition and cataract undergoing cataract surgery before lower eyelid repair from 2013 to 2020 were identified from two ophthalmologists (M.L.W., G.R.). Both surgeries were performed by the same ophthalmologist, with eyelid repair completed at least 1 month following cataract extraction. Data analysis was performed with two-parameter estimations. The primary outcome was the postoperative endophthalmitis rate in this cohort. Results 129 cases in 90 patients were found (86 involutional entropion and 43 involutional ectropion). No cases of endophthalmitis were encountered. Statistical analysis using the 95% Jeffreys interval for one-sample binomial proportion revealed an upper limit of 1.9%. The Agresti-Caffo interval of the proportional difference between the study procedure and historical incidence data of postoperative endophthalmitis following cataract surgery alone yielded an estimate of 0.8% with an upper confidence limit of 2.2%. Conclusion We present preliminary evidence on the endophthalmitis risk in patients with concurrent lower eyelid malposition and cataract who undergo cataract surgery prior to eyelid repair. We propose that this strategy may be a viable option to expedite vision restoration and reduce the risk of recurrent lower eyelid malposition in select patients. More data are required to reach statistically significant noninferiority and show that a malpositioned lower eyelid is not a risk factor for postoperative endophthalmitis following cataract surgery.

To compare primary selective laser trabeculoplasty (SLT) response in uveitic, steroid-induced, primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEX).Single-centre retrospective case-control study.Patients with uveitic glaucoma, steroid-induced glaucoma, POAG, or PEX who had their first SLT.Eyes with POAG or PEX were in control groups. Eyes with steroid-induced or uveitic glaucoma were in experimental groups. Change in intraocular pressure from baseline, treatment failure, complication rates, and medication use were compared using rank-sum and log-rank tests.Six-hundred and eight eyes of 433 patients were enrolled. Steroid-induced glaucoma eyes had higher mean baseline pressure and a decrease in pressure at 3-8 weeks (27.6-17.4 mm Hg) than those with PEX (21.7-16.5 mm Hg; p0.001) or POAG (18.6-14.9 mm Hg; p ≤ 0.025). Failure rates after 2 years were lower in steroid-induced glaucoma (54%) than in PEX (84%; p = 0.01) or POAG (84%; p = 0.005). This survival benefit persisted when excluding patients with changes to their steroid dosing (p ≤ 0.03) but showed mixed results when compared with patients with a baseline pressure of 25mm Hg or greater (p = 0.020 vs PEX; p = 0.67 vs POAG). At 18 months, the steroid-induced group decreased ocular hypotensive medication use (3.5-1.9; p = 0.005); the uveitic group increased medication use (2.7-3.5; p = 0.02).SLT is an effective treatment for steroid-induced glaucoma, with greater response and a lower failure rate than in PEX and primary POAG, although high baseline intraocular pressure may be a confounder. Judicious use of SLT can be considered in uveitic glaucoma.

Postoperative pulmonary complications (PPC) remain a main issue after cardiac surgery. The objective was to report the incidence and identify risk factors of PPC after cardiac surgery. An international multicenter prospective study (42 international centers in 9 countries). A total of 707 adult patients who underwent cardiac surgery under cardiopulmonary bypass. None MEASUREMENTS AND MAIN RESULTS: During a study period of 2 weeks, the investigators included all patients in their respective centers and screened for PPCs. PPC was defined as the occurrence of at least 1 pulmonary complication among the following: atelectasis, pleural effusion, respiratory failure, respiratory infection, pneumothorax, bronchospasm, or aspiration pneumonitis. Among 676 analyzed patients, 373 patients presented with a PPC (55%). The presence of PPC was significantly associated with a longer intensive care length of stay and hospital length of stay. One hundred ninety (64%) patients were not intraoperatively ventilated during cardiopulmonary bypass. Ventilation settings were similar regarding tidal volume, respiratory rate, inspired oxygen. In the regression model, age, the Euroscore II, chronic obstructive pulmonary disease, preoxygenation modality, intraoperative positive end-expiratory pressure, the absence of pre- cardiopulmonary bypass ventilation, the absence of lung recruitment, and the neuromuscular blockade were associated with PPC occurrence. Both individual risk factors and ventilatory settings were shown to explain the high level of PPCs. These findings require further investigations to assess a bundle strategy for optimal ventilation strategy to decrease PPC incidence.

Objective: To describe the spectrum of Leber congenital amaurosis (LCA) and cone-rod dystrophy (CORD) associated with the GUCY2D gene and to identify potential end points and optimal patient selection for future therapeutic trials.Design: International, multicenter, retrospective cohort study.Subjects: Eighty-two patients with GUCY2D-associated LCA or CORD from 54 families.Methods: Medical records were reviewed for medical history, best-corrected visual acuity (BCVA), ophthalmoscopy, visual fields, full-field electroretinography, and retinal imaging (fundus photography, spectral -domain OCT [SD-OCT], fundus autofluorescence).Main Outcomes Measures: Age of onset, evolution of BCVA, genotype-phenotype correlations, anatomic characteristics on funduscopy, and multimodal imaging.Results: Fourteen patients with autosomal recessive LCA and 68 with autosomal dominant CORD were included. The median follow-up times were 5.2 years (interquartile range [IQR] 2.6-8.8 years) for LCA and 7.2 years (IQR 2.2-14.2 years) for CORD. Generally, LCA presented in the first year of life. The BCVA in patients with LCA ranged from no light perception to 1.00 logarithm of the minimum angle of resolution (logMAR) and remained relatively stable during follow-up. Imaging for LCA was limited but showed little to no structural degeneration. In patients with CORD, progressive vision loss started around the second decade of life. The BCVA declined annually by 0.022 logMAR (P < 0.001) with no difference between patients with the c.2513G>A and the c.2512C>T GUCY2D variants (P = 0.798). At the age of 40 years, the probability of being blind or severely visually impaired was 32%. The integrity of the ellipsoid zone (EZ) and that of the external limiting membrane (ELM) on SD-OCT correlated signifi-cantly with BCVA (Spearman r = 0.744, P = 0.001, and r = 0.712, P < 0.001, respectively) in those with CORD.Conclusions: Leber congenital amaurosis associated with GUCY2D caused severe congenital visual impairment with relatively intact macular anatomy on funduscopy and available imaging, suggesting long pres-ervation of photoreceptors. Despite large variability, GUCY2D-associated CORD generally presented during adolescence, with a progressive loss of vision, and culminated in severe visual impairment during mid-to-late adulthood. The integrity of the ELM and EZ may be suitable structural end points for therapeutic studies of GUCY2D-associated CORD. Ophthalmology Retina 2022;6:711-722 (c) 2022 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

PurposeObjectives of this study are to clarify the beliefs and perceptions of parenteral nutrition and hydration (PNH) by patients with advanced cancer and to examine the relationships between their beliefs and perceptions and cachexia stages.MethodsWe conducted a questionnaire survey. We asked about patient characteristics and anthropometric measurements. We subsequently asked patients to answer 15 items regarding their beliefs and perceptions. The proportions of patients were calculated. Comparisons were performed using the Mann-Whitney U test. We conducted an explanatory factor analysis and calculated Cronbach’s alpha coefficients to assess the internal consistency. A multiple logistic regression analysis was performed to identify the independent factors affecting cancer cachexia stages.ResultsAmong 495 patients, 378 responded. Due to missing data, 357 remained in the frequency distribution analysis and explanatory factor analysis, and 344 were classified into the non-cachexia group (n = 174) and cachexia group (n = 170). Approximately 60% of patients thought that PNH were beneficial. Approximately 70% considered PNH as a standard medical practice. Approximately 70% did not feel that they received a sufficient explanation. There were no significant differences in any items between the two groups. We extracted four conceptual groups and Cronbach’s alpha coefficients were 0.87, 0.73, 0.71, and 0.48, respectively. The concept of ‘Belief that PNH are harmful’ was identified as an independent factor [odds ratio 2.57 (95% confidence interval 1.10-6.01), P = 0.030].ConclusionsThis study revealed that patients had a strong preference for receiving PNH with or without cancer cachexia.

In the two-cup one-item task, subjects are shown a food item, which is then hidden inside one of two cups. Several species spontaneously select the baited cup above chance levels if shown that the other cup is empty. Although this response may indicate inference by exclusion (if not A, then B), another possibility is that subjects simply avoid choosing the empty cup, not because they expect the food to be in the other cup but because they have seen that cup to be empty. I tested whether this hypothesis explains great apes' responses in a three-cup one-item task. Subjects saw three opaque cups on a platform, with two of them located behind a barrier during baiting. After baiting one of the cups behind the barrier, I revealed the identity of the empty cup that had been located behind the barrier (Experiment 1) or revealed the contents of the center cup (baited in half of the trials), but always removed it before the subjects' choice (Experiment 2). In Experiment 1, subjects preferentially selected the baited cup even though one of the other two cups had not been shown to be empty. In Experiment 2, subjects' preference for the cup that had been located behind the barrier during baiting was modulated by the contents of the removed cup. These results suggest that expectations about the food's location, not just the sight of the empty cup, as postulated by the "avoid the empty cup" hypothesis, determine apes' responses in the three-cup one-item task. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

This is the peer reviewed version of the following article: Kawashima, T., Shibusawa, S., & Amano, K. (2022). Frequency- and phase-dependent effects of auditory entrainment on attentional blink. European Journal of Neuroscience, 56(4), 4411– 4424, which has been published in final form at https://doi.org/10.1111/ejn.15760. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited., Attentional blink (AB) is the impaired detection of a second target (T2) after a first target has been identified. In this paper, we investigated the functional roles of alpha and theta oscillations on AB by determining how much preceding rhythmic auditory stimulation affected the performance of AB. Healthy young adults participated in the experiment online. We found that when two targets were embedded in rapid serial visual presentation (RSVP) of distractors at 10 Hz (i.e., alpha frequency), the magnitude of AB increased with auditory stimuli. The increase was limited to the case when the frequency and phase of auditory stimuli matched the following RSVP stream. On the contrary, when only two targets were presented without distractors, auditory stimuli at theta, not alpha, increased the AB magnitude. These results indicate that neural oscillations at two different frequencies, namely, alpha and theta, are involved in attentional blink.

Purpose We investigated the treatment outcomes of patients with acute Vogt–Koyanagi–Harada (VKH) disease and assessed the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated.Methods We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for >300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute–resolved [AR]) and inflammation worsening (chronic–recurrent [CR]) groups based on conditions after 6 months from disease onset.Results This study assessed 62 eyes from 31 patients (mean age: 52.8 years). One patient was treated with topical treatment alone and showed poor visual outcomes. In total, 30 patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of them developed AR and 27% CR. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final best-corrected visual acuity (BCVA). Among the patients receiving systemic steroid, five eyes had a final BCVA of ≤0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. Conclusions Patients with acute VKH disease treated with corticosteroid pulse followed by the slow tapering of prednisolone appear to demonstrate good visual outcomes, including patients with CR; most eyes with low visual outcomes have pre-existing conditions that explain low vision.

Starting from a nonlinear 2D/1D fluid–structure interaction problem between a thin layer of a viscous fluid and a thin elastic structure, in the vanishing limit of the relative fluid thickness, we rigorously derive a sixth-order thin-film equation describing the dynamics of vertical displacements of the structure. The procedure is essentially based on quantitative energy estimates in terms of the relative fluid thickness and a uniform no-contact result between the structure and the solid substrate. The sixth-order thin-film equation is justified in the sense of strong convergence of rescaled structure displacements to the unique positive classical solution of the thin-film equation. Moreover, the limiting fluid velocity and pressure can be expressed solely in terms of the solution to the thin-film equation.

PURPOSE: Pseudophakic cystoid macular edema (CME) occurs in up to 2% of uneventful cataract surgeries. This study evaluates changes in macular blood flow succeeding uneventful phacoemulsification cataract extraction among otherwise visually healthy subjects.METHODS: This prospective study included 18 eyes of 18 patients undergoing routine phacoemulsification. Optical coherence tomography angiography (OCT-A) was performed using the Angio-Retina 6x6mm protocol with the XR Avanti Angio-Vue system (Optovue Inc., Fremont, California) prior to the surgery and 4-8 weeks thereafter. Exclusion criteria included motion artifacts, segmentation errors and signal strength index (SSI) ˂40. The main outcome measure was change in flow index (FI) measured in all 4 retinal segmentation layers within an area of 1mm diameter around the foveal center.RESULTS: Following surgery, a significant increase in SSI (46.65±8.62 versus 53.12±8.07, p=0.01), superficial plexus FI (0.98±0.23 versus 1.16±0.16, p=0.02) and deep plexus FI (0.54±0.46 versus 0.93±0.39, p=0.01) was found. No significant changes were noted in the outer retina or the choriocapillaris. CONCLUSION: The study demonstrates a significant increase in FI in the superficial and deep retinal plexus following uneventful cataract surgery, with the greatest changes occurring in the latter. These findings corroborate evidence from structural imaging and support the vascular etiology of pseudophakic CME.

Purpose. To compare the total corneal astigmatism (TCA) measured by IOLMaster 700 and Pentacam and to investigate the consistency of corneal keratometry (CK) measured by IOLMaster and Pentacam. Methods. Cataract patients were retrospectively enrolled in March and April, 2021. Retrospective analysis was performed on those patients with binocular and monocular CK measured by IOLMaster and Pentacam. Results. A total of 102 patients (204 eyes) were included, 64 of whom were female (62.75%). The flat (K1) and steep (K2) CK of anterior corneal surface (ACS) and flat (TK1) and steep (TK2) of total cornea measured with IOLMaster 700 were 44.16 ± 1.60 D , 45.09 ± 1.68 D , 44.12 ± 1.62 D , and 45.14 ± 1.69 D , respectively. Those measured with Pentacam were 44.31 ± 1.57 D , 45.22 ± 1.65 D , 44.15 ± 1.67 D , and 45.19 ± 1.82 D , respectively. The astigmatism of ACS and TCA were − 0.94 ± 0.63 D and − 1.02 ± 0.69 D ( p < 0.01 ) in the IOLMaster group and − 0.90 ± 0.59 D and − 1.05 ± 0.81 D in the Pentacam group, respectively ( p < 0.01 ). TCA measurement results of IOLMaster and Pentacam were consistent ( Pearson = 0.710 , p < 0.01 ), and there was no significant difference ( p = 0.591 ). Conclusions. Total corneal astigmatism measured by IOLMaster was consistent with that measured by Pentacam. The difference between the astigmatism of anterior corneal surface and total cornea was detected in the measurement of IOLMaster and Pentacam, respectively.

Purpose: To evaluate the effects of Duloxetine on anterior segment parameters and intraocular pressure(IOP) in open angle eyes.Methods: 38 eyes of 38 patients with fibromyalgia who had open or wide open angles according to the Shaffer classification. Anterior segment optic coherence tomography was performed before and after (month 3) Duloxetine treatment. IOP, central corneal thickness(CCT), corneal endothelial cell density(CECD) and anterior chamber depth(ACD) were also recorded and evaluated. Results: No statistically significant difference was determined in IOP, CCT and CECD(p > 0.05). However, a statistically significant increase was determined in both the temporal and nasal anterior chamber angle, angle opening distance, nasal trabecular-iris space area and ACD values between the baseline and month 3 (p < 0.001). Conclusion: We think that the short term use of Duloxetine does not lead to clinically significant changes despite their statistically significant effects on the anterior chamber parameters.

This retrospective study investigated superficial retinal vessel density (SRVLD) and foveal avascular zone (FAZ) area using optical coherence tomography angiography (OCTA) in children with myopic anisometropia. We included 84 eyes of 42 individuals with myopic anisometropia and no posterior segment abnormalities. All eyes underwent OCTA. Individual SRVLD and FAZ area were measured on OCTA. Using a paired t -test, we compared the interocular difference between the fellow eyes for all the measurements. SRVLD was significantly higher in the relatively more myopic eyes than in the fellow eyes in the whole population and in patients with an interocular difference of >1.5 D ( p = 003 and 0.01, respectively). In patients with an interocular difference of ≤1.5 D in spherical equivalent refraction, only the nasal sector showed higher SRVLD in the less myopic eyes. SRVLD in the whole image and parafoveal sector was significantly lower in the dominant eye (paired t -test, p = 003 and 0.03, respectively), while other locations showed no difference. The area, perimeter, and circularity index in FAZ parameters showed no difference. SRVLD showed no significant differences between the two types of eyes, with an interocular difference of ≤1.5 D but increased in the relatively more myopic eyes than in the fellow eyes in children with myopic anisometropia, with an interocular difference of >1.5 D. Increasing SRVLD may show a compensatory increase to maintain retinal function and thus maintain normal visual function in the relatively more myopic fellow eyes. As the study to use patients as self-control with OCTA analysis in both eyes, this study provides some reference value for further interpretation of the pathogenesis of anisometropia.

Purpose: The aim of this study was to describe the anatomical outcomes of Brilliant Blue G (BBG)–assisted extensive internal limiting membrane peeling (eILMp) for proliferative vitreoretinopathy (PVR) under three-dimensional (3D) visualization. Methods: This study constitutes a retrospective case series conducted in a private retina practice, of 14 consecutive patients (14 eyes) with rhegmatogenous retinal detachment (RRD) complicated by PVR who underwent pars plana vitrectomy between January 2019 and January 2020. The internal limiting membrane (ILM) was selectively stained with BBG, and perspectives were enhanced with a 3D visualization system. We peeled off the ILM beyond the vascular arcades up to the periphery. The main outcome was anatomical success, defined as persistent retinal reattachment after removal of the silicone oil tamponade.Results: Anatomic success was achieved with a single surgery in 11 of 14 (78.6%) eyes, and eventual success was achieved in all eyes. The mean patient follow-up time was 12.3 months (range, 7–16 months). The mean preoperative logMAR BCVA was 2.09 (range, 2.8–1.3), which decreased to 1.54 (range, 2.8–0.6) at the last follow-up. Conclusion: This technique allowed the creation of a cleavage plane underlying the PVR membranes that facilitated its complete ILM removal, thereby reducing the risk of recurrence of retinal detachment.

Age-related macular degeneration (AMD) is a leading cause of severe, irreversible vision impairment in developed countries, and its prevalence is rising all over the world, increasing sharply with age. AMD represents an acquired degeneration of the retina that causes significant central visual impairment through a combination of non-neovascular and neovascular derangement. The main risk factors for the development of advanced AMD are increasing age, genetic factors, and cigarette smoking; however, the exact pathophysiology of AMD is yet relatively poorly understood. In recent years, the gut microbiota has been intensively studied and linked to several pathologic processes, including ocular diseases. In this sense, the aim of this review is to gather published evidence about the relationship between gut microbiota and AMD.

PURPOSE To evaluate extraocular muscle response to teprotumumab using orbital echography in thyroid eye disease. METHODS This retrospective study included adult thyroid eye disease patients with pre- and post-teprotumumab orbital echography. Data collected included: age, Hertel measurements, clinical activity score, Gorman diplopia scores, ocular motility, and recti muscle diameters measured by echography. The patient's more proptotic eye before treatment initiation was designated as the study orbit. Ocular motility was assessed by totaling the ductions in all 4 cardinal directions. Orbital echography was obtained pre- and post-treatment to assess response of extraocular muscle diameters. RESULTS Six patients with a mean age of 67 years were included. There was a mean improvement in proptosis of 4.3 mm in the study eye with 11/12 orbits showing improvement in globe position (p < 0.05). All patients had a decrease in clinical activity score with a mean reduction of 2.5. Four patients had an improvement in Gorman diplopia score. Ocular motility in the study orbits improved by a total mean of 26.9° (p < 0.05). Mean total extraocular muscle diameter was reduced from 27.4 to 23.4 mm (p < 0.001). On average, superior recti were largest pre- and post-treatment, followed by inferior, medial, then lateral recti. However, inferior recti showed the greatest reduction of 23% (p < 0.02). CONCLUSIONS Orbital echography demonstrated extraocular muscle reduction in all patients after teprotumumab, correlating with improved clinical activity score, ocular motility, and proptosis. Orbital echography is a safe and cost-effective imaging alternative to monitor therapeutic response to teprotumumab.

PURPOSE To demonstrate phenotypic discordance between a monozygotic twin pair, one of whom exhibited pigmented paravenous chorioretinal atrophy (PPCRA). METHODS A patient and his identical twin brother, attending Moorfields Eye Hospital, were reviewed. Clinical assessment included visual acuity and color vision testing, fundus imaging including autofluorescence, spectral-domain optical coherence tomography and static perimetry. In addition, the affected sibling underwent pattern and full field electroretinography (PERG and ERG) according to ISCEV standards. Zygosity testing was performed using short tandem repeat (STR) analysis. RESULTS The 48-year old proband was referred with abnormal visual fields and difficulty reading at near. Examination revealed 20/20 Snellen visual acuity bilaterally, normal colour vision and bilateral asymmetric outer retinal atrophy with intra-retinal pigment migration along the course of the retinal veins, consistent with PPCRA. The visual field defects were contiguous with the blind spot and mirrored the retinal involvement in both eyes. Pattern ERG showed mild macular dysfunction and full field ERG was within normal limits. Blood testing for common uveitic entities was non-contributory. The proband's twin brother's clinical assessment and retinal imaging showed no abnormality. Zygosity testing showed the twins to be identical for 24 short tandem repeat (STR) microsatellite markers, indicative of monozygosity. CONCLUSION Some cases of PPCRA, without an obvious inflammatory etiology, do not have a clear Mendelian inheritance pattern and may represent an acquired disorder.

Over the past two decades, genome-wide association studies (GWASs) have successfully advanced our understanding of genetic basis of complex traits. Despite the fruitful discovery of GWASs, most GWAS samples are collected from European populations, and these GWASs are often criticized for their lack of ancestry diversity. Trans-ancestry association mapping (TRAM) offers an exciting opportunity to fill the gap of disparities in genetic studies between non-Europeans and Europeans. Here we propose a statistical method, LOG-TRAM, to leverage the local genetic architecture for TRAM. By using biobank-scale datasets, we showed that LOG-TRAM can greatly improve the statistical power of identifying risk variants in under-represented populations while producing well-calibrated p-values. We applied LOG-TRAM to the GWAS summary statistics of 29 complex traits/diseases from Biobank Japan (BBJ) and UK Biobank (UKBB), and achieved substantial gains in power (the effective sample sizes increased by 49% in average compared to the BBJ GWASs) and effective correction of confounding biases compared to existing methods. Finally, we demonstrated that LOG-TRAM can be successfully applied to identify ancestry-specific loci and the LOG-TRAM output can be further used for construction of more accurate polygenic risk scores (PRSs) in under-represented populations.

Purpose To present a surgical technique and case presentation of internal chandelier-assisted macular buckling for myopic foveoschisis. Methods Review of patient clinical features, visual-acuity and optical coherence tomography (OCT) results following internal chandelier-assisted macular buckling for myopic foveoschisis. Results A 48-year-old highly myopic female (axial length 29.85mm) underwent internal chandelier-assisted macular buckling for myopic foveoschisis with macular detachment. The best-corrected visual acuity improved from 20/150 to 20/40. Post-operative OCT confirmed central buckle positioning and demonstrated resolved foveoschisis and macular detachment. There were no complications. Conclusions Internal chandelier-assisted macular buckling is a valuable tool to optimize buckle position and patient outcomes.

Exosomes, nanosized extracellular vesicles with a size of 30–150nm, contain many biological materials, such as messenger RNA (mRNA), microRNA (miRNA), proteins, and transcription factors. It has been identified in all biological fluids and recognized as an important part of intercellular communication. While the role of exosomes in cancer has been studied in-depth, our understanding of their relevance for ocular tissues has just begun to evolve. Intraocular fluids, including aqueous humor and vitreous humor, play a role in nourishing eye tissues and in expelling metabolites. In the pathological state, intraocular exosomes can mediate pathological processes such as ECM remodeling, retinal inflammation, and blood-retinal barrier dysfunction. Herein, we reviewed the latest advances of intraocular exosomes in the research of several eye diseases, including glaucoma, age-related macular degeneration, myopia, and ocular tumors, and discuss how intraocular exosomes contribute to the pathogenesis and progression of multiple eye diseases.

Pulmonary venous thrombosis (PVT) is a rare but potentially devastating disease state with a largely unknown incidence. The most common etiologies of PVT are secondary to complications of lung surgery, malignancy, catheter ablation for atrial fibrillation, and idiopathic causes. Diagnosis can be challenging because presenting symptoms often are vague and nonspecific, or even asymptomatic, and traditional diagnostic modalities, such as chest radiography and arterial phase computed tomography scans, are poor techniques for diagnosis. The authors present a case of a patient presenting for pulmonary thromboendarterectomy for a presumed diagnosis of chronic thromboembolic pulmonary hypertension who was found incidentally to have a PVT, on intraoperative transesophageal echocardiography. Due to significant thrombus burden, the new finding of PVT, and known association of PVT and malignancy, a biopsy of mediastinal lymph nodes was obtained, which revealed metastatic cervical carcinoma. The pulmonary endarterectomy procedure was aborted.

To evaluate the visual and refractive outcomes of laser corneal enhancement after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/hyperopic laser corneal refractive surgery (LCRS).Clinica Baviera-AIER-Eye Group, Spain.Retrospective comparative case series.Patients were divided by primary LCRS into myopic and hyperopic groups. The outcomes evaluated were uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), and uncorrected near visual acuity (UNVA), and predictability, safety, efficacy, and satisfaction after implantation of 2 trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement.186 eyes (89 myopic and 97 hyperopic eyes) from 146 patients were assessed. At the last visit, refractive outcomes were better in myopic than those in hyperopic eyes, with statistically significant differences for sphere ( P.001), cylinder ( P.001), manifest refraction spherical equivalent (MRSE) ( P = .003), CDVA ( P = .005), UDVA ( P = .047), and UNVA ( P = .003) but not for UIVA ( P = .580), binocular UIVA ( P = .660), or binocular UNVA ( P = .836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 diopters (D) and ±1.0 D (P = .167 and .502, respectively). Efficacy and safety were similar in both groups ( P = .235 and P = .080). A greater myopic MRSE was present after trifocal implantation in myopic than in hyperopic eyes (MRSE = -0.93 vs -0.69 D, P = .013), and the statistically significant differences were maintained after enhancement between both groups (MRSE -0.00 vs 0.00 D, P = .003). Overall satisfaction was similar in both groups ( P.05 all items).Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia or hyperopia with LCRS was safe, effective, predictable, and highly satisfactory.

Purpose To elucidate the non-inferiority of ab interno microhook trabeculotomy (μTLO) using a recently developed reusable stainless spatula-type microhook device to incise the trabecular meshwork to trabectome (TOM) in terms of the 1-year postoperative outcomes of Japanese patients with glaucoma by means of propensity score analyses. Design A multicenter retrospective cohort study. Participants We enrolled 553 and 392 patients who underwent TOM and μTLO, respectively, between January 2014 and March 2020 at 10 facilities. Methods Logistic regression analysis was conducted to calculate the propensity score, which indicates the likelihood of treatment assignment (TOM or μTLO). We set the following factors as outcome-related covariates: age, sex, facility, glaucoma disease types, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation of the Humphrey visual field test and antithrombotic drug use, the presence or absence of combined cataract surgery, and incision range of trabecular meshwork (one or two quadrants). We analyzed four different methods (matching, inverse probability of treatment weighting (IPTW), stratification, and regression adjustment) using the propensity score. We set 15% as the non-inferiority margin based on previous trabectome meta-analysis results. Main outcome measures The primary outcome was surgical success at 1 year postoperatively. We defined surgical success as satisfying all three criteria: (1) IOP within 5–21 mmHg; (2) IOP reduction of ≥20% from preoperative IOP; and (3) no additional glaucoma surgery. Results The 95% confidence interval of risk difference of surgical failure in μTLO in reference to TOM was −12.1 to +9.5% in matching, −12.7 to +11.1% in IPTW, −12.2 to +7.0 in stratification, and −9.7 to +8.1% in regression adjustment, all of which fell within the predetermined non-inferiority margin of 15%. Conclusions Surgical success of μTLO at 1-year postoperatively was not inferior to that of TOM.

This study explored urokinase’s effect on the production of heat shock protein 27 in chronic glaucoma rats. 45 SD rats were equally assigned into healthy group, glaucoma group, and urokinase group followed by analysis of intraocular pressure by TONO-PENAVVI tonometer, apoptosis of retinal ganglion cells by TUNEL staining, pathological morphology by H&E staining, levels of SOD, MDA, and NO as well as the expression of HSP27 and p-p38MAPK. After treatment, the intraocular pressure was increased in glaucoma group and decreased in urokinase group (P < 0.05). In addition, glaucoma group showed significantly increased apoptosis rate (P < 0.05) which was decreased in urokinase group (P < 0.05). In glaucoma group, the nerve fibers were disorderly arranged and ganglion cells were greatly reduced which were improved in urokinase group. Compared to healthy group, glaucoma group had lower MDA level and higher SOD levels (P < 0.05) which were reversed in urokinase group (P < 0.05). HSP27 and P-P38MAPK levels in glaucoma group were higher than healthy group (P < 0.05) and urokinase group (P < 0.05). In conclusion, urokinase can reduce the apoptosis of retinal ganglion cells in glaucoma rats and protect the function of the optic nerve by reducing the level of HSP27.

The choroid is one of the body's most bloody tissues, located between the retina and the sclera. The oxygen and nutrient needs of the outer retinal segments, including the photoreceptors, are provided by the choroid. In addition to these functions, it plays a role in light absorption, thermoregulation, and positioning of the retina. Therefore, any pathology affecting the choroid layer may impair retinal and retinal functions.

A 54-year-old man with early repolarization syndrome (ERS) implanted with an implantable cardioverter-defibrillator (ICD) developed persistent atrial fibrillation (AF) three years after the implantation. Similarly, the remote monitoring system begun frequently detecting ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PVT). Longer RR intervals were repeatedly observed just before the initiation of PVT/VF. Catheter ablation for AF successfully diminished both the PVT and VF events.

Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.

To report a case of nonleaking cystoid macular edema (CME) associated with pentosan polysulfate sodium (PPS)-induced pigmentary maculopathy.Multimodal imaging, including optical coherence tomography, fundus photography, autofluorescence, and fluorescein angiography, was used to substantiate our diagnosis, further characterize the cystoid macular edema showed by our patient and to monitor the response to treatment.A 59-year-old woman was referred for decreased visual acuity and bilateral macular edema. She had been treated for interstitial cystitis with PPS for 10 years. Multimodal imaging showed the characteristic features of PPS-induced pigmentary maculopathy. Moreover, fluorescein angiogram showed nonleaking cystoid macular edema in both eyes. She was treated successfully with intravitreal injections of bevacizumab.To our knowledge, this report is the first to demonstrate that PPS-associated cystoid macular edema can be nonleaking on fluorescein angiography and responds well to intravitreal anti-vascular endothelial growth factor injections.

Purpose To establish if Difluprednate 0.05% nanoemulsion (DIFL) twice a day (BID) is as effective as Prednisolone acetate 1% + Phenylephrine hydrochloride 0.12% suspension (PRED) four times a day (QID) on postsurgical inflammation treatment. Setting 4 private Argentine ophthalmological centers. Design Non-inferiority, prospective, multicenter, double-blind, randomized, parallel-group, comparative trial. Methods A total of 259 patients who underwent phacoemulsification randomly received DIFL or PRED starting the day before surgery and continuing for 28 days. The primary endpoint was central corneal thickness. Non-inferior anti-inflammatory efficacy was considered if the difference of corneal thickness between baseline and Day 4 did not differ beyond 17 µm between treatments. Secondary endpoints were cell & flare, corrected distance visual acuity (CDVA), endothelial cell count, OCT-central macular thickness, and intraocular pressure (IOP). All outcomes were evaluated at baseline, day 1, 4, and 28 after surgery. Results 225 patients finished the study. The difference in corneal thickness at baseline and Day 4 did not differ beyond 17 µm between treatments (IC95% -2.78µm - 14,84 µm), with no statistically significant difference between treatments (p = 0.523). There were not statistically significant differences between groups on total anterior chamber clearance at any study time (p > 0.05). No statistically significant differences were reported between treatments in CDVA (p = 0.455), endothelial cell count (p = 0.811), OCT-central macular thickness (p = 0.869), and in intraocular pressure outcome (p = 0.316). Conclusions Difluprednate administered BID is at least as effective as Prednisolone acetate administered QID on inflammatory treatment following cataract surgery.

Purpose: To evaluate the diagnostic accuracy and reliability of a telemedicine approach for detecting keratoconus patients' progression in the era of coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: A retrospective study, comparing the office and telemedicine evaluations in determining whether keratoconus patients were at risk of progression and indicated for further treatment of corneal crosslinking, was conducted. The clinic examination included best spectacle corrected visual acuity measurement and manifest refraction, full ophthalmic examination, and corneal topography, which provided with the gold-standard diagnosis. The remote assessment included two decisions of keratoconus progression or stability: the first evaluation after revealing patient demographics and topography images, and the second with the manifest refraction and clinical findings as documented in the outpatient clinic visit. Results: Two-hundred and four eyes of 102 keratoconus patients were included. There was an agreement of assessment between the in-person and the remote diagnostic decisions in 192 (94%) of the eyes. Among the remaining 12 eyes, a false-positive diagnosis was made in 8 (3.9%) eyes, whereas a false-negative diagnosis was made in 4 (1.9%) eyes. The remote assessment showed a sensitivity and specificity of 69% and 96%, respectively. In no case was remote diagnostic decision 2 different from remote decision 1. Conclusions: The telemedicine model yielded high specificity, but low sensitivity values, therefore, not suitable as an alternative for keratoconus patient follow-up (Clinical trial number TLV-0363-20).

To resolve inconsistencies in the literature regarding the dominance of the right cerebral hemisphere (RH) in emotional face perception, specifically investigating the role of the intensity of emotional expressions, different emotions, and conscious perception.The study used an online version of the well-established emotional chimeric face task (ECFT) in which participants judged which side of a chimeric face stimulus was more emotional. We tested the laterality bias in the ECFT across six basic emotions and experimentally modified the intensity of the emotional facial expression from neutral to fully emotional expressions, in incremental steps of 20%.The results showed an overall left hemiface bias across all emotions, supporting the RH hypothesis of emotional lateralization. However, the left hemiface bias decreased with decreasing intensity of the emotional facial expression.The results provide further support for the RH hypothesis and suggest that the RH dominance in emotional face perception may be affected by task difficulty and visual perception strategy. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

To describe the case of a 12-year-old woman with vitreoretinal manifestations of Type 3 Gaucher disease.A retrospective case report including multimodal imaging and histologic examination of the vitreous.A 12-year-old woman with a history of Gaucher disease Type 3 was referred to the ophthalmology service for evaluation of vitreous deposits in both eyes. Funduscopic examination was notable for white vitreous opacities in both eyes. Ultra-widefield fluorescein angiography demonstrated areas of blockage associated with the deposits and focal areas of leakage. Optical coherence tomography angiography showed shadow artifact without intrinsic flow at these sites. Three years after presentation, she developed a right hemorrhagic posterior vitreous detachment, requiring pars plana vitrectomy with scleral buckle. A vitreous sample was sent to pathology, which demonstrated Gaucher cells.Gaucher disease is a rare metabolic condition caused by an autosomal recessive deficiency of glucocerebrosidase. To the best of our knowledge, this is the first report of hemorrhagic posterior vitreous detachment in Type 3 Gaucher disease, including ultra-widefield imaging, optical coherence tomography angiography, and histopathology.

Juvenile-onset open-angle glaucoma (JOAG) is a subset of primary open-angle glaucoma that is diagnosed before 40 years of age. The disease may be familial or non-familial, with proportions varying among different populations. Myocilin mutations are the most commonly associated. JOAG is characterized by high intraocular pressures (IOP), with many patients needing surgery. The mean age at diagnosis is in the 3(rd) decade, with a male preponderance. Myopia is a common association. The pathophysiology underlying the disease is immaturity of the conventional outflow pathways, which may or may not be observed on gonioscopy and anterior segment optical coherence tomography. The unique optic nerve head features include large discs with deep, steep cupping associated with high IOP-induced damage. Progression rates among JOAG patients are comparable to adult primary glaucomas, but as the disease affects younger patients, the projected disability from this disease is higher. Early diagnosis, prompt management, and life-long monitoring play an important role in preventing disease progression. Gene-based therapies currently under investigation offer future hope.

PURPOSE Prophylactic enucleation of a ruptured globe with no light perception within 14 days of injury to prevent sympathetic ophthalmia (SO) has been an established dictum in academic teaching for more than 100 years. This treatment strategy was originally based on observation, speculation, and careful thought, but there was never any scientific proof. This review summarizes and updates the current state of our knowledge about globe rupture and SO, examines the origin and validity of the 14-day rule, and emphasizes the importance of trying to save the traumatized eye whenever possible. METHODS A comprehensive literature review of SO and globe rupture was performed. RESULTS SO is a rare disorder that may potentially occur following traumatic globe rupture as well as following a variety of other intraocular surgeries. Vitreoretinal surgery may be a more common cause than trauma according to some studies. SO may still occur despite having the eye removed within 14 days of the trauma. A variety of new medications including biologic agents are now available to treat SO with improved efficacy in suppressing the associated ocular inflammation and allowing retention of some useful vision. Removing the traumatized, blind eye may have other important psychological consequences associated with it that require consideration before eye removal is carried out. Retaining the blind, phthisical, disfigured eye avoids phantom vision and phantom pain associated with enucleation as well as providing a good platform to support and move an overlying prosthetic eye. Data on the occurrence of SO following evisceration and enucleation with and without predisposing factors confirms the exceedingly low risk. CONCLUSION Most civilian open globe injuries can be successfully repaired with modern, advanced microsurgical techniques currently available. Because of the exceedingly low risk of SO, even with the severity of open globe trauma during military conflicts being more devastating as a result of the blast and explosive injuries, today every attempt is made to primarily close the eye rather than primarily enucleate it, providing there is enough viable tissue to repair. The 14-day rule for eye removal after severe globe ruptures is not scientifically supported and does not always protect against SO, but the safe time period for prophylactic eye removal is not definitively known. In the exceptional cases where SO does occur, several new medications are now available that may help treat SO. We advocate saving the ruptured globe whenever possible and avoiding prophylactic enucleation to prevent the rare occurrence of SO. When an eye requires removal, evisceration is an acceptable alternative to enucleation in cases that do not harbor intraocular malignancy.

Doubling of the optic disc is rare in clinic, which appears as true doubling or pseudo-doubling. Bilateral doubling of the optic discs is even more less seen in clinic. Here, we report the case of a 35-year-old woman who presented to the clinic for a physical examination. The patient's best-corrected visual acuity was 0.6 OD with +2.25 DS/3.50 DC×175°, and 0.9 OS with -3.00 DS/0.50 DC×145°. The intraocular pressure of each eye was normal. Fundoscopy examination revealed an enlarged suspected optic disc in both eyes. Visual field examination revealed an additional blind spot in each eye. Optical coherence tomography (OCT) analysis showed a normal macular thickness and profile. B-scan ultrasound revealed a single optic nerve shadow in each eye. Cranial computed tomography (CT) showed only 1 optic foramen and 1 optic nerve in each eye. Although double-blind spots were demonstrated by visual field examination, and pits in both optic disc regions for both eyes were shown by OCT, it was not enough to support the diagnosis of true doubling of the optic disc. Consequently, the diagnosis of bilateral pseudo-doubling of optic discs was made based on the clinical evidence, leading to the consideration of possible causality of other ophthalmic diseases.

Exposure to a recession can have persistent, negative consequences, but does the severity of those consequences depend on when in the life cycle a person is exposed? I estimate the effects of exposure to the Great Recession on employment and earnings outcomes for groups defined by year of birth over the ten years following the beginning of the recession. With the exception of the oldest workers, all groups experience reductions in earnings and employment due to local unemployment rate shocks during the recession. Younger workers experience the largest earnings losses in percent terms (up to 13 percent), in part because recession exposure makes them persistently less likely to work for high-paying employers even as their overall employment recovers more quickly than older workers’. Younger workers also experience reductions in earnings and employment due to changes in local labor market structure associated with the recession. These effects are substantially smaller in magnitude but more persistent than the effects of unemployment rate increases.

Purpose To report a case of Coccidioides immitis endophthalmitis with severe vision loss and a return to excellent vision following aggressive intervention. Methods Case report. Results A 41-year-old male with a history of solid organ transplantation who complained of floaters and decreased vision in the setting of disseminated Coccidioides infection was found to have presumed coccidioidal endophthalmitis with visual acuities (VA) of 20/20 in the right eye and 20/200 in the left eye. The patient was managed with intravenous amphotericin B, oral voriconazole, and intravitreal injections of amphotericin B and voriconazole in the left eye every three days. Five weeks after presentation, VA remained 20/20 in the right eye and improved to 20/40 in the left eye. The patient was transitioned to twice weekly intravitreal injections and oral voriconazole upon hospital discharge. One week later, vision in the left eye decreased to 20/500 with worsening vitritis, prompting vitrectomy. Vision in the left eye subsequently improved to 20/30. Five weeks later, the patient developed a macula-on inferior rhegmatogenous retinal detachment in the left eye and underwent a second vitrectomy, with scleral buckle, laser, and gas injection. Vision in the left eye returned to 20/25. In total, the patient received 22 amphotericin B and 17 voriconazole intravitreal injections in the left eye with two vitrectomies. Vision in the right eye remained 20/20 throughout his treatment course. At four months after presentation, the patient remained on oral voriconazole with no evidence of active intraocular infection on exam. Conclusions Aggressive medical and surgical management can be successful in ocular conservation and restoration of vision in coccidioidal endophthalmitis. Very mild disease may be conservatively monitored and managed with systemic antifungal therapy alone. In severe disease, early diagnosis and prompt and aggressive use of systemic and intravitreal antifungals may spare panophthalmitis and preserve vision.

Purpose. This study aimed to describe and analyze the clinical features of 20 eyes of 15 primary vitreoretinal lymphoma (PVRL) patients. Methods. This was a retrospective case series and a review of the literature. Fifteen PVRL patients (20 affected eyes) referred between February 2011 and December 2019 were recruited, and their medical records were retrospectively reviewed. Results. Among these 15 PVRL patients, seven were men (46.67%), and five had bilateral PVRL (33.33%). The median onset age was 66 ± 9.26 years and six (40%) patients had central nervous system (CNS) involvement, and two of them died of CNS-related complications. The ocular symptoms varied from decreased vision to binocular diplopia. The ocular manifestations were diverse and involved both the anterior and posterior segments, including the vitreous cells, subretinal white-yellow lesions, cotton-wool spots, and ophthalmoplegia. The rate of misdiagnosis and failure to diagnose was 100%, and 30% of them were misdiagnosed as uveitis. We found five cases revealing rare characteristics of this malignancy. Among them, there were two cases with mild hypertensive retinopathy exhibiting cotton-wool spots, one case mimicking age-related macular degeneration (AMD), one case with systemic lupus erythematosus (SLE), and one patient had extraocular muscle involvement. To the best of our knowledge, we reported PVRL exhibiting cotton-wool spots as the main manifestation and coexisting with extraocular myopathy for the first time. Conclusions. PVRL is a rare intraocular malignancy that commonly masquerades as uveitis. As the clinical signs and symptoms are atypical, ophthalmologists must carefully examine patients to avoid misdiagnosis or a failure to diagnose. Cotton-wool spots and extraocular myopathy might be the dominant initial symptoms in PVRL patients, and AMD should be considered a differential diagnosis of PVRL. SLE patients under immunosuppressive treatment could have spontaneous PVRL.

Carbon fiber composite continuous sucker rod string is more and more widely used in deep and ultradeep wells because of its light weight, high strength, and corrosion resistance. In order to analyze the dynamic problems of carbon fiber sucker rod string in actual oil wells, a transverse vibration simulation model of carbon fiber and steel (carbon-steel) hybrid rod string excited by buckling deformation in vertical wells is established with the compression buckling deformation of weighting rod. Considering the influence of wellbore trajectory and the constraint of tubing, the transverse vibration simulation model of carbon-steel hybrid rod string in directional wells under borehole trajectory excitation is also established in this paper. The finite difference method is used to discretize the well depth node, the numerical integration method (Newmark-β) is used to discretize the reciprocating periodic time node, and simulation methods for the contact and collision dynamics of rod-tubing in vertical wells and directional wells are formed. Through programming calculation, the distribution laws of transverse displacement, contact force, collision force, and bending stress of carbon-steel hybrid sucker rod string in vertical wells and directional wells along well depth are obtained. The simulation results in vertical wells show that the strong collision between the rod and tubing occurs near the bottom steel rod, while the upper load is small and the rod-tubing collision load of the upper rod of the carbon-steel hybrid rod string is much lower than that of the traditional steel rod string at the same position. Furthermore, the bending stress of the upper carbon fiber is also much less than that of the bottom steel rod. The simulation results in directional wells show that the collision phenomenon of the deflecting section and the bottom weighting rod compression section are the strongest and the rod-tubing contact pressure is also the largest. Second, the impact force of the upper carbon fiber rod is also much lower than that of the steel rod. Again, the maximum bending stress of the whole well occurs near the deviation section where the deviation angle changes suddenly. The transverse vibration mechanical model in directional wells in this paper lays a theoretical foundation and provides theoretical support for the optimal design of fracture and splitting prevention measures of carbon fiber sucker rod.

Objective. To assess the clinical efficacy of auricular acupressure plus eye exercises in the treatment of adolescent pseudomyopia, to discover an easier and safer way to treat pseudomyopia. Methods. Forty adolescent patients with pseudomyopia were randomly recruited and assigned (1 : 1) to receive either eye exercises (single group, including 11 males and 9 females) or auricular acupressure plus eye exercises (combined group, including 12 males and 8 females). The clinical endpoint was the clinical efficacy after 28 days of treatment. Results. The baseline characteristics of the combined group were comparable with those of the single group ( P > 0.05 ). Auricular acupressure plus eye exercises was associated with a significantly higher clinical efficacy versus eye exercises alone ( P < 0.05 ). Conclusion. Ear acupressure plus eye exercises features promising clinical efficacy in the treatment of adolescent pseudomyopia, effectively arresting the progression of pseudomyopia to true myopia.