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To assess the reliability and validity of gray level co-occurrence matrices (GLCM) in the quantification of choriocapillaris and describe GLCM features in normal and eyes with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis (SC).In this, multicenter, reliability, validity and comparative study; OCTA was performed on eyes with resolved APMPPE and SC and normal individuals. CC texture classification, low flow area measurements and GLCM feature extraction were performed.A total of 13 normal, 8 APMPPE and 15 SC eyes were analyzed. All GLCM parameters demonstrated an excellent reliability. GLCM parameters were differently distributed across the three groups. Decision-tree based on the random forest predictive model provided an overall accuracy of 86% in classifying the three groups using GLCM features.These data demonstrated an excellent reliability and validity of GLCM features in quantifying the choriocapillaris in healthy and diseased eyes.

BACKGROUND AND OBJECTIVE: To evaluate the flow characteristics and textural properties of choriocapillaris (CC) on optical coherence tomography angiography in eyes with resolved inflammatory choriocapillaropathies and Vogt-Koyanagi-Harada (VKH) disease. PATIENTS AND METHODS: A cohort of eyes with healed acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and VKH disease were included. A 3 mm × 3 mm OCT angiogram of CC was acquired and graded for flow characteristics and textural properties. RESULTS: This study included 16 patients. Texture was heterogeneous in all eyes in the SC and VKH groups, and in four eyes (40%) in the APMPPE group. Most of the eyes with VKH disease had severe low flow, whereas most of the SC and APMPPE eyes demonstrated mild low flow. Heal duration had a strong negative correlation with severity of CC low flow and a weak, statistically nonsignificant correlation with texture heterogeneity. CONCLUSION: Despite the resolution of active inflammation, partial CC hypoperfusion and texture disruptions persist for longer durations and may resolve in a time dependent manner. [ Ophthalmic Surg Lasers Imaging Retina . 2019;50:566–572.]

To determine the prevalence and factors influencing vitreomacular adhesion (VMA) or vitreomacular traction (VMT) in subjects without maculopathy older than age 40 years.In a prospective cross-sectional study, 1,950 eyes in 1,090 participants aged 40 to 89 years representing various ethnic groups from 14 centers in the United States underwent a comprehensive eye examination, including spectral domain optical coherence tomography. A team of independent, masked readers classified the presence or absence of VMA/VMT on spectral domain optical coherence tomography based on the International Vitreomacular Traction Study Group rubric.Across all eyes, the prevalence of VMA or VMT was 39% or 1%, respectively. For every 1-year increase in age, there was a statistically significant 7% decreased odds of having VMA or VMT (95% confidence interval [CI]: 0.89-0.96; P0.001), whereas African Americans had 55% significantly reduced odds of having VMA or VMT when than whites (95% CI: 0.23-0.90; P = 0.025). Vitreomacular adhesion1,500 μm was significantly more likely than VMA1,500 μm in younger adults (95% CI: 0.70-0.86; P0.001), hyperopes versus emmetropes (95% CI: 1.49-35.9; P = 0.01), primary eye care versus tertiary practices (95% CI: 0.03-0.92; P = 0.04), and patients without hyperlipidemia (95% CI: 0.04-0.83; P = 0.03).Vitreomacular adhesion is highly prevalent among middle-aged adults. Diagnostic screening with spectral domain optical coherence tomography may help to accurately detect VMA or VMT, prompting routine monitoring and timely therapeutic intervention.

Introduction: Recent innovations in ophthalmic imaging have led to new alternatives to conventional ocular angiography. We describe different methods of label-free angiography and their clinical utility in ophthalmic practice.Areas covered: The aim of this paper is to review the current literature on Optical Coherence Tomography Angiography (OCTA). A review of the literature was performed, including the physical principles and algorithms and OCTA features of different ocular diseases. The literature reviewed was found by searching Pubmed and Google Scholar for optical coherence tomography, OCT angiography, and label-free angiography. All results in the English language were read in full-text.Expert commentary: OCTA is an emerging, non-invasive imaging modality which can display ocular vasculature with good sensitivity and may help us detect vascular disorders of the retina and choroid. The technique’s depth-resolving ability allows us to localize the origin of several disorders to the individual v...

Purpose Best vitelliform macular dystrophy, also known as Best disease, is a macular dystrophy characterized by bilateral yellowish egg yolk-like lesion(s) present within the maculae. It is a slowly progressive disease that usually presents at childhood. Best vitelliform macular dystrophy frequently proceeds through stages, beginning with a classic presentation described as vitelliform. A similar condition, known as adult-onset foveomacular vitelliform dystrophy, has been described among adult patients. Although the two maculopathies may look similar, they are considered two separate entities, because of the age of onset and overall clinical presentation. Case report A 54-year-old man presented with gradual-onset blurred near vision in each eye. Previous records showed a history of unremarkable dilated fundus examinations for the past 8 years. Best-corrected distance acuities measured 20/20 OD and 20/20 OS. Amsler grid testing revealed a mild metamorphopsia OD and OS. Dilated fundoscopy revealed macular pseudohypopyon in each eye. In vivo imaging of the maculae was obtained with spectral-domain optical coherence tomography findings. Electrooculography findings were consistent with Best vitelliform macular dystrophy of atypical, late onset. Conclusions Best vitelliform macular dystrophy may vary in its presentation. Electrooculography and spectral-domain optical coherence tomography can aid in establishing the definitive diagnosis.

Polypoidal choroidal vasculopathy (PCV), a disease of the choroidal vascular network, presents clinically with polyp-like reddish orange lesions, as well as retinal pigment epithelial (RPE) and/or neurosensory retinal detachments. Optical coherence tomography (OCT) is a useful diagnostic tool that provides cross-sectional and volumetric imaging of posterior segment microstructure. Typical OCT findings in PCV may reveal a classic hyperreflectivity in the choroidal layers known as the "double-layer" sign. This sign is indicative of an abnormal choroidal vascular network. Indocyanine green angiography is also useful for the diagnosis of PCV and clearly identifies the polyp-like lesions arising from the choroidal vasculature.A 53-year-old African American woman presented with complaints of gradually decreasing vision in the left eye (OS). Clinical examination revealed moderately reduced acuity OS with a small central scotoma found on Amsler grid testing. Dilated fundus examination revealed a hemorrhagic RPE detachment with suspicion of a choroidal neovascular membrane in the foveal region of the OS. Exudative leakage appeared circumferentially around the macula OS. Optical coherence tomography of the OS also revealed two highly reflective layers: one at the level of the RPE and another beneath the RPE ("double-layer" sign). The patient was referred to a retina subspecialist for angiography and treatment consideration.It is important to distinguish PCV from other variants of choroidal neovascularization. The polyp-like lesions found in the PCV are a unique and classic characteristic. Proper diagnostic workup includes stereoscopic posterior fundus evaluation and imaging studies, including OCT and indocyanine green angiography.

Vitamin D is good for bones and teeth. It may also have a role in preventing and treating diabetes, certain cancers, atherosclerosis, multiple sclerosis, hip fractures and ocular conditions such as age-related macular degeneration.

Toxocariasis was first reported in the early 1950s.1 Distribution is worldwide but the incidence is highest in the south‐eastern United States, Puerto Rico and the West Indies.2 Serological surveys...

Purpose The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. Methods Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. Results The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (chi(2) = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (chi(2) = 11.67, P > .11). Conclusions Patients who participated in the educational intervention demonstrated an increase in knowledge across time. Patients may benefit from education emphasizing the importance of dilated eye examinations in the absence of ocular symptoms.

Purpose Intravitreal injection of triamcinolone acetonide has increasingly become a therapeutic option for neovascular, inflammatory, and edematous intraocular diseases. A common side effect of this treatment is a steroid-induced elevation of intraocular pressure. In most of these patients, the rise in intraocular pressure can be treated topically. Those cases that cannot be treated medically have been treated with filtering surgery. This report presents a case of intraocular pressure elevation after intravitreal triamcinolone acetonide injection that was successfully treated with selective laser trabeculoplasty. Case report A 63-year-old white man presented with brow ache on the right side approximately 3 months after undergoing intravitreal injection of triamcinolone acetonide for diabetic macular edema in the right eye. Applanation tonometry revealed an intraocular pressure of 45 mm Hg in the involved eye. After initial treatment with topical medications, the patient underwent selective laser trabeculoplasty. Now, 6 months postlaser treatment, the intraocular pressure in the involved eye is stable at 15 mm Hg without topical medications. Conclusions A steroid-induced elevation of intraocular pressure is a common and widely reported side effect of treatment with intravitreal triamcinolone acetonide. This case report suggests that selective laser trabeculoplasty has potential as first- or second-line therapy for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

This study investigates factors affecting handheld human – computer interaction (HCI) for older adults with Age-related Macular Degeneration (AMD). This is largely an uncharted territory, as empiri...

Sleep apnea syndrome (SAS) is a disease characterized by recurrent complete or partial upper airway obstructions during sleep. The majority of patients with SAS demonstrate this obstruction either at the nasopharynx or the oropharynx. Risk factors for SAS include obesity, male gender, upper airway abnormalities, alcohol use, snoring, and neck girth of more than 17 in. in men or 16 in. in women. Reported ophthalmic findings in patients with SAS include floppy eyelid syndrome (FES), glaucoma, and non-arteritic anterior ischemic optic neuropathy (NAION).

Central corneal thickness (CCT) imparts information about an individual's risk of conversion to glaucoma from ocular hypertension, progression of established glaucoma, and the likelihood of developing structural and functional abnormalities in patients with ocular hypertension. Most typically, CCT is measured through ultrasound (US) pachymetry. Currently, optical coherence tomography (OCT) has the ability to image the anterior segment, cornea, and anterior chamber angle. With this ability comes the option of determining CCT. The purpose of this study is to ascertain any significant difference in CCT measurement results as well as quantify the reproducibility of measurements of the two technologies. In addition, by measuring CCT both with traditional US pachymetry as well as spectral domain (SD) OCT technology, we sought to determine if CCT measurement by SD-OCT is an accurate, comparable and viable option;Eighty eyes of forty healthy volunteers were used to determine CCT with both SD-OCT and US pachymetry. Three consecutive measurements were collected with each method on every eye.CCT measurements made by US pachymetry and SD-OCT were similar and consistent (r=0.99 for both methods). CCT measurements made by SD-OCT were consistently thinner by approximately 12 micrometers than measurements made by US pachymetry. Repeated measurements of CCT obtained by SD-OCT were more reproducible and had less variability than measurements obtained by US pachymetry. The mean within-subject standard deviation among SDOCT was significantly smaller than that in US pachymetry (1.92 in SD-OCT vs. 2.04 in US pachymetry, p=0.036);Measurement of CCT by SD-OCT compares favorably with and is at least as accurate as measurements made by US pachymetry. Repeat measurements of CCT by SD-OCT have less variability than those obtained by US pachymetry, are more reproducible, possibly more reliable, and may better represent actual CCT.

Stargardt’s disease (Stargardt’s macular dystrophy, juvenile macular degeneration) was originally described by Stargardt in the early 1900s and is known as the most common congenital macular dystrophy, with an incidence of one in every 10,000. Stargardt’s disease (STGD) is characterised as a widespread lipofusin storage disease of the retinal pigment epithelium (RPE). Typically, it presents between the first to third decades of life and is associated with a progressive, bilateral decrease in visual acuity leading to legal blindness and central visual acuity of 6/60 to 6/120. Though it is typically associated with an autosomal recessive (AR) inheritance pattern, autosomal dominant (AD) cases have been reported with later onset and less severe acuity loss. Classic findings include bilateral macular changes that begin as granular mottling with progression toward a ‘beaten bronze’ maculopathy. The late stage of the disease is associated with macular atrophic degeneration. Yellow-white flecks in the posterior pole may be noted; they are described as tri-radiating ‘fish tail’ (pisciform) flecks. Traditionally, Stargardt’s disease has been diagnosed through clinical evaluation and fluorescein angiography (IVFA), which demonstrates a dark or ‘silent’ choroid due to the blockage of the fluorescein by the lipofusin deposition in the RPE. Though fluorescein angiography has been considered the ‘gold standard’ in verifying the presence of the disease, the characteristic dark choroid pattern is seen in only 85 per cent of patients with Stargardt’s disease. There have been reports of patients with autosomal dominant inheritance pattern who fail to demonstrate this classic fluorescein angiography finding. Newer and minimally invasive procedures, such as the multifocal electroretinogram (mfERG) and optical coherence tomography (OCT), may aid in diagnosing and managing patients with the disease. These ancillary tests may be used in the event that fluorescein angiography cannot be performed or used in conjunction with traditional fluorescein angiography as a complementary procedure. Multifocal electroretinography (mfERG) is a minimally invasive procedure that has been shown to be helpful in the diagnosis of Stargardt’s disease. Unlike traditional flash electroretinography (fERG), this technology has proved extremely reliable in diagnosing and monitoring various forms of macular dystrophy. In the case of Stargardt’s disease, the patient presents with significant variation in presentation; from normal to reduced acuity, minimal to significant fundus findings and normal to slightly reduced full field flash electrophysiological findings. Regardless of the presentation, Stargardt’s patients typically have a significant reduction of the foveal response and central approximately 10 degrees in both eyes on mfERG, even early in the disease process with relatively good visual acuity and minimal fundus findings. In addition to electrophysiology, retinal imaging technology such as OCT has proved effective in correlating structural damage with functional visual loss. The OCT findings of patients with Stargardt’s disease include decreased thickness of the retina, most notably in the foveola. The OCT also reveals photoreceptor loss and external nuclear layer changes, as well as abnormalities in the retinal pigment epithelium.

BACKGROUND Viruses are one of the most common causes of infections involving the posterior segment of the eye. Viral infections can be congenital or acquired and can affect the retina, choroid, or optic nerve. Herpes simplex virus has been implicated in a number of posterior segment conditions, including serpiginous choroiditis (SC), which has generally been described as idiopathic. CASE REPORT A 57-year-old black female presented with decreased and distorted vision in both eyes, of 10 months duration. Funduscopy revealed radial, deep grayish lesions emanating off of the optic disc in a peripapillary fashion. The clinical appearance was suggestive of SC, which was confirmed by fluorescein angiography. Serologic testing was positive for herpes simplex virus and thus may suggest a causative link between the virus and the choroiditis. CONCLUSIONS SC has been historically cited as an idiopathic process. There have been only rare reports linking this process with a viral etiology. Laboratory testing and clinical work-up needs to be obtained in any patient suspected of having SC, to detect a viral etiology. Treatment of an underlying condition may lead to optimum resolution in these patients.

Background. Potent antiretroviral therapy can lead to improved immunity in patients with acquired immune deficiency syndrome. However, ocular inflammation can occur in predisposed individuals. This inflammation is referred to as immune-recovery uveitis. Cystoid macular edema (CME) is a complication that can result from this inflammation and is emerging as a major cause of visual loss in human immunodeficiency virus (HIV)-infected patients. Case Report. A 52-year-old man presented with complaints of intermittent decreased vision that had coincided with the initiation of antiviral treatment. He also reported metamorphopsia and floaters in both eyes of several years duration. He had a history of HIV for 20 years and was only recently started on Highly Active Antiretroviral Therapy (HAART). He reported a vague history of ocular problems involving his retina. Retinal examination revealed bilateral areas of peripheral scarring from presumed past ocular inflammation and thickening and irregularity at each macula. Ancillary testing was performed, and CME was diagnosed. Conclusions. Immune-recovery uveitis is a leading cause of visual disturbance in HIV-infected patients with a history of cytomegalovirus (CMV) retinitis on HAART. Although the immune recovery associated with the advent of HAART has decreased the need for potent CMV medications, the heightened immune response can be associated with sight-threatening inflammation.

Diabetic eye disease is a leading cause of acquired blindness in the United States. Most cases of blindness secondary to diabetes mellitus are preventable. In addition to exercise, proper diet, and aggressive glycemic control, patients with diabetes mellitus should be educated to adhere to established guidelines for an annual dilated retinal evaluation. The ideal model of care for patients with diabetic eye disease is an interdisciplinary, team-oriented approach with the patient as the central member of the healthcare team. The primary purpose of this paper is to present an interdisciplinary approach to management of the ocular complications of diabetes mellitus and to educate clinicians about diabetic eye disease.

This study explores factors affecting handheld computer interaction for older adults with Age-related Macular Degeneration (AMD). This is largely uncharted territory, as empirical investigations of human-computer interaction (HCI) concerning users with visual dysfunction and/or older adults have focused primarily on desktop computers. For this study, participants with AMD and visually-healthy controls used a handheld computer to search, select and manipulate familiar playing card icons under varied icon set sizes, inter-icon spacing and auditory feedback conditions. While all participants demonstrated a high rate of task completion, linear regression revealed several relationships between task efficiency and the interface, user characteristics and ocular factors. Two ocular measures, severity of AMD and contrast sensitivity, were found to be highly predictive of efficiency. The outcomes of this work reveal that users with visual impairments can effectively interact with GUIs on small displays in the presence of low-cost, easily implemented design interventions. This study presents a rich data set and is intended to inspire future work exploring the interactions of individuals with visual impairments with non-traditional information technology platforms, such as handheld computers.

Central serous chorioretinopathy (CSC) is a condition characterized by serous detachment of the neurosensory retina in the posterior pole. Corticosteroids administered by various routes is reported as a possible cause of CSC. We report the cases of two patients who developed CSC after receiving a corticosteroid injection in the epidural space for the treatment of back pain. In both patients, the accumulation of subretinal fluid spontaneously resolved within several weeks. Patients who develop CSC after epidural analgesia with corticosteroids should be alerted to the possible relationship between CSC and this treatment. Clinicians should advise all patients with CSC to avoid systemic corticosteroids administered by any route, unless they have a compelling medical indication. Pharmacists should advise patients to seek evaluation if visual changes occur during or after corticosteroid therapy.

Video display terminals (VDTs) have Gaussian display characteristics. Research suggests that patients accommodate differently to Gaussian images. In the present study, we asked if the accommodative response to the PRIO Computer Vision Tester (a Gaussian image) is different than the accommodative response to a Monocular Estimation Method (MEM) printed text target.A normally sighted prepresbyopic group of subjects (N = 60) was recruited from the student body of Nova Southeastern University. Low neutral retinoscopy was performed on each subject at a distance of 50 cm. using both the PRIO vision tester and an MEM target.The PRIO vision tester and the printed text provided essentially the same measures of accommodative response. In addition, the luminance of the PRIO dropped by nearly 40% over the course of 1 hour of intermittent use.The PRIO vision tester and traditional nearpoint retinoscopy provided essentially the same measures of accommodative response in prepresbyopic subjects. Further studies should be considered to evaluate whether the change in luminance of the PRIO system has any effect on the measurement of accommodative response.

This paper examines factors that affect performance of a basic menu selection task by users who are visually healthy and users with Diabetic Retinopathy (DR) in order to inform better interface design. Interface characteristics such as multimodal feedback, Windows® accessibility settings, and menu item location were investigated. Analyses of Variance (ANOVA) were employed to examine the effects of interface features on task performance. Linear regression was used to further examine and model various contextual factors that influenced task performance. Results indicated that Windows® accessibility settings significantly improved performance of participants with more progressed DR. Additionally, other factors, including age, computer experience, visual acuity, and menu location were significant predictors of the time required for subjects to complete the task.