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PurposeTo construct a comprehensive reference database (RDB) for a novel binocular automated perimeter.DesignA four-site prospective randomized clinical trial.Subjects and controlsThree hundred fifty-six healthy subjects without ocular conditions that might affect visual function were categorized into 7 age groups.MethodsSubjects underwent comprehensive ocular examination of both eyes before enrollment. Using the TEMPO/IMOvifa automated perimeter (Topcon Healthcare/CREWT Medical Systems), each subject completed 4 binocular threshold visual field (VF) tests during a single visit: First, practice 24-2 and 10-2 tests were obtained from both eyes. Next, study 24-2 and 10-2 tests were obtained from both eyes. Test order of each sequence was randomized, and the tests were conducted under standard automated perimetry testing conditions: Goldmann stimulus size III, 3183 cd/m2 maximum stimulus intensity, and background intensity of 10 cd/m2, using AIZE-Rapid test strategy. Standard VF reliability indices were assessed. For each subject, 24-2 and 10-2 test results from 1 randomly selected eye were analyzed.Main outcome measuresPerimetric threshold sensitivity and reference limits for each test analysis parameter.ResultsThe ages of the study cohort were widely distributed, with a mean age (standard deviation [SD]) of 52.3 (18.5) years. Sex assignment was 44.0% male and 56.0% female. The majority of subjects self-identified as White (67.4%), followed by Black or African American (13.5%) and Asian (8.7%), with 14.6% self-identified as Hispanic or Latino ethnicity. Mean sensitivity (SD) was 29.1 (1.3) decibels (dB) for the 24-2 and 32.4 (1.0) dB for the 10-2 test. For the 24-2 and 10-2, mean sensitivity (SD) age-related changes averaged -0.06 (0.01) dB and -0.05 (0.01) dB per year, respectively. The normal range of pointwise threshold sensitivity increased with eccentricity and showed asymmetry around the mean, particularly notable in the 24-2 test. Mean (SD) binocular test duration was 3.18 (0.38) minutes (1 minute 35 seconds per eye) for the 24-2 test and 3.58 (0.43) minutes (1 minute 47 seconds per eye) for the 10-2 test.ConclusionsAn RDB for the TEMPO/IMOvifa perimeter was established, highlighting the significance of considering both age and stimulus eccentricity in interpreting threshold VF test results.Financial disclosuresProprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

ObjectiveTo investigate whether functional upper eyelid malposition is associated with unrecognized deficits in automated perimetry among glaucoma patients by examining patients undergoing eyelid surgery who had not been identified as requiring eyelid taping during glaucoma field testing.MethodsIn this retrospective pre-post study, an automated database search followed by manual chart review was used to identify eligible patients from January 2012 to March 2020. Included patients had reliable visual field testing within two years before and after functional upper blepharoplasty or ptosis repair and no comorbid ocular diagnoses. As part of routine practice, glaucoma visual field technicians taped patients with pupil-obstructing eyelid malposition; taped examinations were excluded from analysis. Clinical and demographic characteristics, mean deviation, and pattern standard deviation were evaluated within a two year period before and after eyelid surgery.ResultsThe final analysis included 60 eyes of 38 patients. Change in visual field parameters after eyelid surgery did not reach statistical significance in crude or adjusted analyses. Among patients with ptosis, the margin reflex distance-1 was not associated with change in mean deviation after surgery (Pearson R2 ​= ​0.0061; P ​= ​0.700). Five of 17 eyes excluded from analysis due to unreliable pre-operative visual fields demonstrated substantial improvement after surgery.ConclusionsFunctional upper eyelid malposition does not appear to cause spurious visual field abnormalities among glaucoma patients with reliable visual fields who were determined not to require eyelid taping at the time of their visual fields. Unreliable visual fields could be a sign of eyelid interference in this population.

Purpose: Frequency‐of‐seeing (FoS) curves (psychometric functions) for perimetric stimuli have been widely used in computer simulations of new visual field test procedures. FoS curves for age‐related macular degeneration (AMD) are not available in the literature and are needed for the development of improved microperimetry test procedures, which are of particular interest for use as clinical trial endpoints. Methods: Data were refitted from a previous study to generate FoS curves for 20 participants with AMD, each tested at nine locations within the central 10°. Stimulus parameters, background luminance and dB scale were matched to the MAIA‐2 microperimeter, and stimuli were presented in a method of constant stimuli to build up FoS curves over multiple runs. FoS curves were fitted with a modified cumulative Gaussian function. The relationship between sensitivity and slope of fitted FoS curves was modelled by robust linear regression, producing models both with and without an eccentricity parameter. Results: FoS curves were satisfactorily fitted to data from 174 visual field locations in 20 participants (age 65–83 years, 11 female). Each curve was made up of a median of 243 (range 177–297) stimulus presentations over a median of 12 (range 9–32) levels. Median sensitivity was 25.5 dB (range 3.8–31.4 dB). The median slope (SD of fitted function) was 1.6 dB (range 0.5–8.5 dB). As in previous studies of other conditions, the slope of fitted FoS curves increased as sensitivity decreased (p < 0.001). Conclusions: FoS are provided for participants with AMD, as well as models of the relationship between sensitivity and slope. These fitted models and data may be useful for computer simulation studies of microperimetry procedures. Full details of the fitted curves are provided as supporting information. [ABSTRACT FROM AUTHOR]

This study assessed the impact of race and ethnicity on longitudinal test variability and time to detect glaucoma progression using standard automated perimetry (SAP) and optical coherence tomography (OCT). The sample consisted of 47,003 SAP tests from 5402 eyes and 25,480 OCT tests from 4125 eyes, with 20% of participants self-identifying as Black or African American and 80% as White; 29% as Hispanic or Latino and 71% as Not Hispanic or Latino. Variability was measured using standard deviations of residuals from linear regression models for SAP mean deviation (MD) and OCT retinal nerve fiber layer (RNFL) thickness over time. Results showed significantly greater SAP variability in Black or African American (1.80 ± 1.30 dB) compared to White participants (1.56 ± 1.21 dB; P < 0.001) and in Hispanic or Latino (1.81 ± 1.46 dB) compared to Not Hispanic or Latino individuals (1.52 ± 1.10 dB; P < 0.001). OCT variability was higher in Black or African American (2.3 ± 1.5 μm) compared to White (2.1 ± 1.3 μm; P < 0.001) and in Not Hispanic or Latino (2.2 ± 1.3 μm) compared to Hispanic or Latino (2.1 ± 1.2 μm; P = 0.029). Increased SAP variability delayed progression detection, while OCT showed minimal differences. These findings suggest that higher perimetric variability in Black or African American and Hispanic or Latino may affect glaucoma progression detection using SAP. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluates differences in the visual field performance when wearing the Defocus Incorporated Multiple Segments (DIMS) spectacle lens compared to wearing a conventional single vision (SV) spectacle lens. Methods: Twenty-one children aged 9–14 years with spherical equivalent refraction (SER) between −1.13D to −4.75D were recruited. Mid-peripheral near visual acuity (NVA) under room lighting condition (500 lux ±10%) was measured using DIMS and SV lenses, respectively. Automated static perimetry (Zeiss, Humphrey Visual Field HFA 750i) with SITA Fast 30–2 protocol was used to investigate the visual field sensitivity. During the test, the study lens (Plano DIMS or SV lens) were inserted into the lens holder in front of the trial lenses with each child's compensated prescription. Results: Three children were not able to complete the reliable visual tests due to fixation losses (>20%) or high false positive rate (>15%) while 18 children successfully completed the test. The mean visual field sensitivity was 29.2 ± 3.7 decibels (dB) and 29.3 ± 3.5 dB when wearing DIMS and SV lens, respectively. The mean sensitivity differences between DIMS and SV lens among 76 locations ranged from −2.4 ± 3.9 dB to 1.6 ± 3.9 dB. No statistically significant difference in sensitivity was observed across 76 locations within the central 30o between DIMS and SV lens (Wilcoxon signed rank test with bonferroni correction for multiple comparisons, p > 0.00065). Compared to SV lens, 0.05 logarithm of minimal angle of resolution (logMAR) reduction in mid-peripheral NVA in all 4 quadrants (Superior, Temporal, Inferior and nasal, p < 0.05) was noted with the DIMS lens (N = 18). However, no statistically significant correlation was found between the mid-peripheral NVA and visual sensitivity at the specific locations. Conclusion: Although the mid-peripheral NVA was slightly reduced using DIMS lens, wearing DIMS lens did not change the children's visual sensitivity to detect the static stimulus within 30o visual field when compared to wearing SV lens. [ABSTRACT FROM AUTHOR]

To assess the short-term effects of Multiwavelength Photobiomodulation (LumiThera Valeda Light Delivery System) on retinal functional behavior in patients with retinitis pigmentosa (RP). Materials and Methods: Twelve RP patients (24 eyes) underwent treatment involving nine photobiomodulation (PBM) sessions using the Valeda system, which emits three distinct wavelengths within the yellow (590 nm; 4 mW/cm2), red (660 nm; 65 mW/cm2), and near-infrared (NIR) (850 nm; 0.6 mW/cm2) spectrum. All evaluations were conducted four weeks post-therapy. The treated eye was compared with baseline (pre-therapy). Following nine PBM sessions, assessments included best-corrected visual acuity (BCVA), retinal sensitivity, and characteristics of the correction area via fundus automated perimetry using the Compass system. Additionally, a functional and structural assessment of the retina was performed using multifocal electroretinography (ERG), optical coherence tomography (OCT), fluorescence retinography (FR), and autofluorescence (AF). Statistical analysis employed the Student's t-test for paired samples at a 95% confidence level (p-value ≤ 0.05). Results: LogMAR-based visual acuity assessment demonstrated an improvement in mean value from 0.62 to 0.53 logMAR, with a statistically significant p-value of 0.001. Visual field examination, based on mean deviation (MD), pattern standard deviation (PSD), and fundal perimeter deviation index (FPDI) parameters, showed improvement from − 19.87 dB to − 19.45 dB, 9.77 dB to 9.76 dB, and 37% to 39%, respectively, although with non-significant p-values of 0.366, 0.446, and 0.245, respectively. No adverse effects or abnormalities in optical coherence tomography (OCT) and electroretinogram (ERG) were observed during the follow-up period. Conclusion: In this short-term study, PBM appeared to have the potential to enhance BCVA and fundus automated perimeter in RP patients without causing significant adverse events. However, further assessment with a larger patient cohort and longer follow-up is warranted to ascertain the efficacy of this technique in these patients. [ABSTRACT FROM AUTHOR]

Purpose: Online circular contrast perimetry provides visual field testing on any computer or tablet without additional hardware. This study compared outcomes of online circular contrast perimetry (OCCP) and standard automated perimetry (SAP) in a developing world setting. Methods: The longitudinal and observation study was conducted on patients sampled during 2023 at Hanoi Medical University Hospital. Participants were either healthy volunteers as controls or stable glaucoma patients with either primary angle closure or primary open-angle glaucoma. They underwent a comprehensive ocular examination, retinal nerve fiber layer optical coherence tomography scan, and visual field tests performed at baseline and after 3 months and 6 months, using OCCP and SAP in clinic. Results: The current study was carried out in 168 eyes of 87 patients at baseline, 133 eyes of 69 patients at 3 months, and 121 eyes of 63 patients at 6 months. At baseline, OCCP mean deviation (MD) (R2 = 0.804, p < 0.001) and visual index (VI) (R2 = 0.892, p < 0.001) were strongly correlated with SAP MD and visual field index (VFI) respectively. There was strong agreement and correlation between MD and VI/VFI for SAP and OCCP on repeated testing after 6 months. At 6 months AUC of SAP VFI (0.79) was superior to AUC of OCCP VI (0.67, p = 0.036); otherwise there was no difference in AUC of MD or VI/VFI at baseline, 3 and 6 months, when comparing OCCP and SAP. Conclusion: OCCP parameters are significantly correlated with those of SAP. OCCP has the potential to provide a complementary role to SAP in glaucoma screening and monitoring. [ABSTRACT FROM AUTHOR]

The article evaluates the responses of ChatGPT-4 to questions from glaucoma patients, aiming to determine if artificial intelligence can serve as a reliable intermediary between doctors and patients. The study involved assessing the accuracy and quality of responses generated by ChatGPT-4 to common questions about glaucoma. Results show a high level of concordance between ChatGPT-4 responses and evaluations by ophthalmologists, with generally accurate responses across different categories of questions. While ChatGPT's instant responses may help address patient concerns, the importance of professional medical oversight remains paramount in ensuring patient safety and well-being as AI technologies are integrated into ophthalmology. [Extracted from the article]

Background: 30 years ago, a paper chart was developed in Edinburgh by Cullen et al. and validated as a swift, supplementary method for perimetric evaluation of visual fields. We have re-developed this concept in digital form (on smartphone screen) and assessed its sensitivity and specificity in detecting visual field loss, by comparison with formal machine-based perimetry. Methods: Patients with sellar and parasellar tumours, being managed in a single neurosurgical centre, underwent formal visual field perimetry as part of standard care. They also underwent assessment using the smartphone-based Cullen chart. 37 eye testing episodes were assessed, incorporating pre- and post-treatment assessments for a range of potentially compressive pathologies (non-secretory and secretory pituitary adenoma, craniopharyngioma, and parasellar meningioma). The smartphone-based Cullen chart was compared with formal machine-based perimetry for concordance in detecting visual field loss. Results: The digital Cullen chart had a sensitivity of 75% and specificity of 98% compared with machine-based perimeters. The positive predictive value was 93% and the negative predictive value was 92%. Conclusions: For the visual field assessment of patients with sellar/parasellar tumours, this simple and swift smartphone-based chart shows good concordance with machine-based perimeters. With amendments to the user interface, there may be potential for telemetric patient-led visual field monitoring. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Understanding test–retest variability (TRV) of mesopic microperimetry is critical for defining meaningful treatment effects in retinitis pigmentosa (RP) trials. This study uniquely evaluates intra‐ and intervisit TRV and coefficients of repeatability (CoRs) for microperimetry parameters in RP patients with varying best‐corrected visual acuity (BCVA) levels.In this single‐centre prospective cohort study, RP patients were assessed on two visits, 14.0 days apart. Patients were grouped by BCVA: low (≤20/50 Snellen; ≥0.4 logMAR) or moderate (>20/50 Snellen; <0.4 logMAR). Using Bland–Altman analyses, the CoRs for intra‐ and intervisit variability were determined for pointwise (dB), mean (dB), and volume sensitivity (dB*deg2) on mesopic microperimetry.Intravisit CoRs for mean, volume, and pointwise sensitivity were 1.7 dB, 353.2 dB*deg2, and 8.6 dB, respectively, in the low‐BCVA group (n = 32), and 0.9 dB, 254.5 dB*deg2, and 7.3 dB in the moderate‐BCVA group (n = 15).Intervisit CoRs for mean, volume, and pointwise sensitivity were 2.4 dB, 355.2 dB*deg2, and 10.2 dB in the low‐BCVA group (n = 31). The moderate‐BCVA group (n = 16) showed smaller CoRs of 1.6 dB, 386.8 dB*deg2, and 7.7 dB for mean, volume, and pointwise sensitivity. BCVA and mean sensitivity, but not fixation stability, are predictors of TRV for volume sensitivity.Due to significant TRV, pointwise sensitivity is an unreliable endpoint for RP patients, irrespective of BCVA. Mean sensitivity is suitable as an endpoint when BCVA is relatively preserved.Volume sensitivity provides additional spatial information, and shows promise as a clinical endpoint for assessing macular sensitivity changes on mesopic microperimetry in patients with RP. [ABSTRACT FROM AUTHOR]

This study presents the horizontal spatial specifications required for developing ideal head-mounted displays (HMDs) that provide visual experiences indistinguishable from those obtained without wearing HMDs. We investigated the minimum specifications for pixel density and field of view (FoV) such that users cannot perceive any degradation in these aspects. Conventional studies have measured visual acuity in the periphery and FoV size without eye movement. However, these results are not sufficient to determine the spatial specifications because users may notice a degradation in the quality of images displayed in the periphery when shifting their gaze away from the front. In this study, we measured visual characteristics under practical conditions, wherein participants moved their eyes naturally in coordination with their head movements, as observed when viewing natural scenes. Using a cylindrical display that covered the participant's entire horizontal visual field with high resolution images, we asked participants to identify degraded spatial resolution or narrowed FoV. Results showed that ideal HMDs do not have to provide spatial frequency components above 0.5 and 2 cycles per degree outside the visual fields of approximately 210° and 120° horizontally, respectively. These results suggest that a resolution equivalent to one-fifteenth of the frontal area is sufficient for the lateral areas of the head. In addition, we found that ideal HMDs require a FoV of at least 240°. This is considerably smaller than a naive estimate of 310° based on previous studies, obtained by integrating the FoV size during fixation and the movable range of the eyes. We believe that these findings will be helpful in developing ideal HMDs. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate the interobserver agreement among glaucoma subspecialists in diagnosing glaucoma and to explore the causes of diagnostic discrepancies. Methods: Three experienced glaucoma subspecialists independently assessed frequency domain optical coherence tomography, fundus color photographs, and static perimetry results from 464 eyes of 275 participants, adhering to unified glaucoma diagnostic criteria. All data were collected from the Wenzhou Glaucoma Progression Study between August 2014 and June 2021. Results: The overall interobserver agreement among the three experts was poor, with a Fleiss' kappa value of 0.149. The kappa values interobserver agreement between pairs of experts ranged from 0.133 to 0.282. In 50 cases, or approximately 10.8%, the three experts reached completely different diagnoses. Agreement was more likely in cases involving larger average cup-to-disc ratios, greater vertical cup-to-disc ratios, more severe visual field defects, and thicker retinal nerve fiber layer measurements, particularly in the temporal and inferior quadrants. High myopia also negatively impacted interobserver agreement. Conclusions: Despite using unified diagnostic criteria for glaucoma, significant differences in interobserver consistency persist among glaucoma subspecialists. To improve interobserver agreement, it is recommended to provide additional training on standardized diagnostic criteria. Furthermore, for cases with inconsistent diagnoses, long-term follow-up is essential to confirm the diagnosis of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the progression of structural and functional retinal impairment in type 1 diabetes mellitus (T1DM) patients with no clinical signs of diabetic retinopathy (DR) during a 3-year follow-up. Methods: This was an observational longitudinal study. Post-pediatric T1DM patients without clinical signs of DR, and sex- and age-matched healthy subjects were recruited at San Raffaele Hospital (Milan, Italy). Each patient underwent a comprehensive ophthalmological evaluation, including optical coherence tomography (OCT), OCT-angiography (OCT-A), retinal static and dynamic vessel analysis (DVA), and microperimetry. Results: 21 eyes of 21 T1DM patients (10 females; 24 ± 2 years old), and 21 age and sex-matched healthy subjects were enrolled. At baseline, T1DM eyes revealed a significantly decreased vessel length density using OCT-A (p < 0.001 and p = 0.046 in 3 × 3 and 6 × 6 mm images) and a significantly increased vessel density index (p = 0.013 and p = 0.087 in 3 × 3 and 6 × 6 mm images) of deep capillary plexus. DVA detected a significantly decreased vessel response to flicker light (p = 0.002). A significantly increased thickness of ganglion cellular layer 6-mm-diameter subfields in inferior and superior quadrants was found in diabetic patients (p < 0.001 in both subfields). At 3-years-follow-up no significant longitudinal changes were disclosed in all analyses. Conclusions: Concomitant subclinical microvascular and neurodegenerative damages could be early signs of DR onset that precede functional alterations and clinical signs of DR development. These alterations demonstrated a stable trend over time. [ABSTRACT FROM AUTHOR]

Virtual reality presents an efficient and engaging approach to ophthalmological diagnosis and treatment in children. This systematic review investigates the current state of eye tracking technology integrated into virtual reality for the spectrum of pediatric ophthalmology. The search encompassed the MEDLINE database via PubMed, without imposing any time restrictions. A total of 20 relevant studies that met our inclusion criteria were incorporated and categorized into the following domains: diagnosis, examination, treatment, and rehabilitation use of virtual reality devices within the realm of pediatric ophthalmology. Strabismus examinations and postoperative monitoring, inherited retinal degeneration examination and visual function testing, therapy of amblyopia, glaucoma visual field testing, cerebral visual impairment rehabilitation, and neuro-ophthalmic disease examination were included in the final analysis. Pediatric ophthalmology offers a promising landscape for the integration of eye tracking technology within virtual reality, with accelerated, quantifiable, and objective examination and diagnosis, and precise, real-time measurements that are crucial in children. Virtual reality is an engaging experience, easily applied in a pediatric setting and facilitating compliance during examination and adherence to therapy. Although our systematic review provides insights into the current state of research, it is anticipated that further exploration is required for the widespread utilization of eye tracking in virtual reality within pediatric ophthalmology. [J Pediatr Ophthalmol Strabismus. 2024;61(6):381–390.] [ABSTRACT FROM AUTHOR]

Abstract This study assessed the impact of race and ethnicity on longitudinal test variability and time to detect glaucoma progression using standard automated perimetry (SAP) and optical coherence tomography (OCT). The sample consisted of 47,003 SAP tests from 5402 eyes and 25,480 OCT tests from 4125 eyes, with 20% of participants self-identifying as Black or African American and 80% as White; 29% as Hispanic or Latino and 71% as Not Hispanic or Latino. Variability was measured using standard deviations of residuals from linear regression models for SAP mean deviation (MD) and OCT retinal nerve fiber layer (RNFL) thickness over time. Results showed significantly greater SAP variability in Black or African American (1.80 ± 1.30 dB) compared to White participants (1.56 ± 1.21 dB; P

AIM: To observe the preliminary application of fully automatic feedback perimeter based on the eye gaze tracking technique in the college students and to verify its test performance.METHODS: Home computer, monitor and eye tracker were used to complete the new automatic feedback perimeter meter. Based on the two characteristic eye movements of fixation and pulsation, the abnormal visual field is determined by analyzing whether the participant perceives the visual target, line-of-sight scan path and the fixation towards the visual target. RESULTS: A total of 63 participants(119 eyes)were collected with valid eye movement data. The average time for all participants was 82.46±14.68 s, the average time for right eyes was 88.21±15.30 s, and average time for the left eyes was 76.42±11.29 s(P

The integration of virtual reality (VR) technology into visual field (VF) testing has introduced innovative head-mounted perimetry devices, which offer numerous advantages over traditional methods. This review examines the features, accuracy, and reliability of commercially available head-mounted VR perimeters and compares them with the gold standard, the Humphrey Visual Field Analyzer (HFA). While traditional devices like the HFA and Goldmann Perimeter have been reliable for glaucoma management, they are limited by fixed testing environments, long testing durations, and high costs. VR-based perimetry addresses these limitations by providing portable, cost-effective, and engaging testing environments that can be conducted in various settings, including patients’ homes. Head-mounted displays (HMDs) equipped with high-resolution screens, motion sensors, and eye-tracking technology create an immersive testing experience that minimizes distractions and external light interference, potentially enhancing test accuracy. These devices also offer customizable testing protocols, improving patient comfort and compliance, especially among children and elderly patients. However, concerns remain about the reproducibility and accuracy of VR perimetry compared to established standards. Variability among VR platforms and the lack of large normative databases for visual fields pose challenges to their widespread adoption. This review highlights the need for further validation studies and the development of standardized testing protocols to ensure the reliability and accuracy of VR perimetry. Despite these challenges, the flexibility, reduced testing times, and potential for telemedicine applications make VR head-mounted perimetry a promising tool for improving glaucoma management and expanding access to VF testing in diverse clinical environments.

Artificial intelligence (AI) has great potential for diagnosing and managing glaucoma, a disease that causes irreversible vision loss. Early detection is paramount to prevent visual field loss. AI algorithms demonstrate promising capabilities in analyzing various glaucoma investigations. In analyzing retinal fundus photographs, AI achieves high accuracy in detecting glaucomatous optic nerve cupping, a hallmark feature. AI can also analyze optical coherence tomography (OCT) images of the retinal nerve fiber layer(RNFL) and ganglion cell complex, identifying structural changes indicative of glaucoma and also Anterior Segment OCT(AS-OCT) for angle closure disease. OCT interpretation may even be extended to diagnose early features of systemic neurodegenerative diseases such as Alzheimer’s Disease and Parkinson’s Disease. Furthermore, AI can assist in interpreting visual field (VF) tests, including predicting future VF loss patterns for the next 5 years. The ability of AI to integrate data from multiple modalities, including fundus photographs, Intra Ocular Pressure(IOP) measurements, RNFL OCT, AS-OCT, and VF tests, paves the way for a more comprehensive glaucoma assessment. This approach has the potential to revolutionize ophthalmology by enabling teleophthalmology and facilitating the development of personalized treatment plans. However, the authors emphasize the crucial role of human judgement and oversight in interpreting AI-generated results. Ultimately, ophthalmologists must make the final decisions regarding diagnosis and treatment strategies.

The Rapid Campimetry (RC), a kinetic visual field test proved to reliably detect visual field defects within the central 10° degrees, the most crucial part for visual acuity and quality of life, affected even at very early stages of glaucoma, within a short measurement epoch, ~ 1 min. This study aims to further investigate RC correspondence with standard tests in glaucoma, namely standard automated perimetry (SAP) and optical coherence tomography (OCT) within 10° of visual field (VF). For this purpose, we included 41 participants, [21 glaucoma (GLA, mean age: 65.9 ± 12.4; 12 preperimetric eyes and 11 with VF defects) and 20 healthy controls (HC; mean age: 65.0 ± 10.3); 20 eyes]. At first, we compared the rate of detection/exclusion of VF defects in RC vs. SAP. Then, for those with VF defects (11 eyes), we investigated the 68-pointwise correspondence of 10 − 2 layout of RC and SAP. For functional and structural (SF) correspondence, pointwise correspondence of RC, SAP vs. OCTmacula [ macular ganglion cell thickness (GCL)] was also performed. Further, we compared sector-based correspondence of RC, SAP vs. OCTmacula accounting for GCL displacement at the fovea as well as sector-based correspondence with OCTdisc [peripapillary retinal nerve fiber layer thickness (pRNFL)]. Agreement estimates were reported along with Cohen Kappa () statistic. For overall performance, RC and SAP showed 100% agreement () for the exclusion of VF defects (HC and preperimetric GLA) and for detection of VF defects [11 eyes of 9 GLA, ( ]. Further, RC outperformed SAP in detection of arcuate scotomas, 7 vs. 5, respectively. Pointwise correspondence of VF defects (11 eyes), RC-SAP agreement reached 90% accuracy (). For SF correspondence, RC [SAP] showed 62% [69%] pointwise agreement with OCTmacula, (). For macular sector-based correspondence, SF correspondence improved and reached 83% [83%] agreement, (). For OCTdisc sector-based analysis, SF correspondence was highest, 100% [100%] agreement, (). Rapid Campimetry gave reproducible results in comparison to SAP and OCT with high potential as a screening VF method given its short testing duration, ~ 1 min in screening mode, and compatibility with telemedicine technologies upon future optimization and automation. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To determine whether we could establish evidence‐based pass/fail criteria for perimetry in the context of the European visual field standards for driving.This two‐centre, cross‐sectional study included participants with binocular visual field loss that had led to revocation of a group‐1 driving licence. The participants underwent cognitive and binocular visual testing, including the European Driving Test (EDT), a perimetry algorithm that adheres to the European visual field standards. We used a high‐fidelity driving simulator to compare the driving ability of these participants with healthy controls. Two driving instructors classified each driving test as passed or failed. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) determined the ability of perimetry to discriminate between passed and failed driving tests.The study included 70 participants with visual field loss and 37 controls. A non‐significantly higher proportion of controls passed the driving test (75% vs. 63%; p = 0.22). In ROC analysis, contrast sensitivity performed best (AUC of 0.73), followed by NEI VFQ‐25 (AUC of 0.64). Peripheral visual field (AUC of 0.56) and central visual field (AUC of 0.47) performed weaker. Combining the central and peripheral visual field, and their interaction, increased AUC to 0.63.Perimetry was a poor predictor of simulator‐based driving test result, and we could not establish appropriate pass/fail criteria for the European visual field standards. Because perimetry is not an accurate diagnostic tool for fitness to drive, a practical driving assessment should be performed in case of doubt. [ABSTRACT FROM AUTHOR]

L-cone opsin expression by gene therapy is a promising treatment for blue cone monochromacy (BCM) caused by congenital lack of long- and middle-wavelength-sensitive (L/M) cone function. Eight patients with BCM and confirmed pathogenic variants at the OPN1LW/OPN1MW gene cluster participated. Optical coherence tomography (OCT), chromatic perimetry, chromatic microperimetry, chromatic visual acuity (VA), and chromaticity thresholds were performed with unmodified commercial equipment and/or methods available in the public domain. Adaptive optics scanning laser ophthalmoscope (AOSLO) imaging was performed in a subset of patients. Outer retinal changes were detectable by OCT with an age-related effect on the foveal disease stage. Rod and short-wavelength-sensitive (S) cone functions were relatively retained by perimetry, although likely impacted by age-related increases in the pre-retinal absorption of short-wavelength lights. The central macula showed a large loss of red sensitivity on dark-adapted microperimetry. Chromatic VAs with high-contrast red gratings on a blue background were not detectable. Color vision was severely deficient. AOSLO imaging showed reduced total cone density with majority of the population being non-waveguiding. This study developed and evaluated specialized outcomes that will be needed for the determination of efficacy and safety in human clinical trials. Dark-adapted microperimetry with a red stimulus sampling the central macula would be a key endpoint to evaluate the light sensitivity improvements. VA changes specific to L-opsin can be measured with red gratings on a bright blue background and should also be considered as outcome measures in future interventional trials. [ABSTRACT FROM AUTHOR]

Purpose: To explore patterns of disease expression in Alagille syndrome (ALGS). Methods: Patients underwent ophthalmic examination, optical coherence tomography (OCT) imaging, fundus intravenous fluorescein angiography (IVFA), perimetry and full-field electroretinograms (ffERGs). An adult ALGS patient had multimodal imaging and specialized perimetry. Results: The proband (P1) had a heterozygous pathogenic variant in JAG1; (p.Gln410Ter) and was incidentally diagnosed at age 7 with a superficial retinal hemorrhage, vascular tortuosity, and midperipheral pigmentary changes. The hemorrhage recurred 15 months later. Her monozygotic twin sister (P2) had a retinal hemorrhage at the same location at age 11. Visual acuities for both patients were 20/30 in each eye. IVFA was normal. OCT showed thinning of the outer nuclear in the peripapillary retina. A ffERG showed normal cone-mediated responses in P1 (rod-mediated ERGs not documented), normal ffERGs in P2. Coagulation and liver function were normal. An unrelated 42-year-old woman with a de-novo pathogenic variant (p. Gly386Arg) in JAG1 showed a similar pigmentary retinopathy and hepatic vascular anomalies; rod and cone function was normal across large expanses of structurally normal retina that sharply transitioned to a blind atrophic peripheral retina. Conclusion: Nearly identical recurrent intraretinal hemorrhages in monozygotic twins with ALGS suggest a shared subclinical microvascular abnormality. We hypothesize that the presence of large areas of functionally and structurally intact retina surrounded by severe chorioretinal degeneration, is against a predominant involvement of JAG1 in the function of the neurosensory retina, and that instead, primary abnormalities of chorioretinal vascular development and/or homeostasis may drive the peculiar phenotypes. [ABSTRACT FROM AUTHOR]

To describe visual field outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. Cohort analysis. A total of 155 eyes (155 subjects) randomly assigned to treatment with tube shunt surgery (n = 84) or trabeculectomy with mitomycin C (n = 71). The PTVT Study was a multicenter randomized clinical trial comparing the safety and efficacy of trabeculectomy and tube shunt surgery in eyes without previous intraocular surgery. Subjects underwent standard automated perimetry (SAP) at baseline and annually for 5 years. Standard automated perimetry tests were deemed reliable if the false-positive rate was ≤ 15%. Tests were excluded if visual acuity was ≤ 20/400 or loss of ≥ 2 Snellen lines from baseline because of a nonglaucomatous etiology. Linear mixed-effects models were used to compare rates of change in SAP mean deviation (MD) between the 2 groups. Intraocular pressure (IOP) control was assessed by percentage of visits with IOP < 18 mmHg and mean IOP. Rate of change in SAP MD during follow-up. A total of 730 SAP tests were evaluated (average of 4.7 tests per eye). The average SAP MD at baseline was –12.8 ± 8.3 decibels (dB) in the tube group and –12.0 ± 8.4 dB in the trabeculectomy group (P = 0.57). The mean rate of change in SAP MD was –0.32 ± 0.39 dB/year in the trabeculectomy group and –0.47 ± 0.43 dB/year in the tube group (P = 0.23). Eyes with mean IOP 14 to 17.5 mmHg had significantly faster rates of SAP MD loss compared with eyes with mean IOP < 14 mmHg (–0.59 ± 0.13 vs. –0.27 ± 0.08 dB/year; P = 0.012), and eyes with only 50% to 75% of visits with IOP < 18 mmHg had faster rates than those with 100% of visits with IOP < 18 mmHg (–0.90 ± 0.16 vs. –0.29 ± 0.08 dB/year; P < 0.001). Multivariable analysis identified older age and worse IOP control as risk factors for faster progression in both treatment groups. No statistically significant difference in mean rates of visual field change was observed between trabeculectomy and tube shunt surgery in the PTVT Study. Worse IOP control was significantly associated with faster rates of SAP MD loss during follow-up. Older patients were also at risk for faster progression. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Although urgent orbital decompression surgery for sight-threatening Graves' orbitopathy unresponsive to available medical treatments continues to evolve, post-operative new-onset or worsened pre-operative strabismus or diplopia remains a significant complication. At present, the optimal surgical technique remains debatable. Here, we sought to compare long-term outcomes after balanced medial–lateral wall versus selective 3-wall decompression as an urgent treatment for unresponsive sight-threatening GO. Methods: This retrospective study examined the post-operative outcome of 102 eyes (57 patients) that underwent urgent orbital decompression for sight-threatening GO. Treatment effectiveness was measured by visual acuity, proptosis, perimetry, and strabismus/diplopia, while fundus findings were detected by fundus color photography and optical coherence tomography and followed up for more than 12 months. Results: Fifty-seven patients (102 orbits) with an average age of 52.7 ± 10.2 years were evaluated. Balanced medial–lateral wall (BMLW-OD) or selective 3-wall decompression(S3W-OD) were performed in 54 and 48 eyes, respectively. Twelve months after orbital decompression, all parameters significantly improved in both groups, including best-corrected visual acuity (BCVA), mean defect of visual field (VF-MD), pattern standard deviation of visual field (VF-PSD), and proptosis (all P < 0.01). However, new-onset esotropia occurred in 25.8% and 3.8% of patients who underwent BMLW-OD surgery or S3W-OD, respectively. Moreover, 6.5% and 38.5% of patients improved after decompression in the medial–lateral wall decompression group and the selective 3-wall decompression group, respectively. Conclusions: We demonstrated that S3W-OD provides a lower rate of new-onset strabismus/diplopia as compared with BMLW-OD surgery, while still allowing for satisfactory visual outcomes. Trial registration number : NCT05627401. Date of registration: November 25, 2022. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This cross-sectional study describes the ophthalmological and general phenotype of 10 patients from six different families with a comparatively mild form of Zellweger spectrum disorder (ZSD), a rare peroxisomal disorder. Methods: Ophthalmological assessment included best-corrected visual acuity (BCVA), perimetry, microperimetry, ophthalmoscopy, fundus photography, spectral-domain optical coherence tomography (SD-OCT), and fundus autofluorescence (FAF) imaging. Medical records were reviewed for medical history and systemic manifestations of ZSD. Results: Nine patients were homozygous for c.2528 G > A (p.Gly843Asp) variants in PEX1 and one patient was compound heterozygous for c.2528 G>A (p.Gly843Asp) and c.2097_2098insT (p.Ile700TyrfsTer42) in PEX1. Median age was 22.6 years (interquartile range (IQR): 15.9 – 29.9 years) at the most recent examination, with a median symptom duration of 22.1 years. Symptom onset was variable with presentations of hearing loss (n = 7) or nyctalopia/reduced visual acuity (n = 3) at a median age of 6 months (IQR: 1.9–8.3 months). BCVA (median of 0.8 logMAR; IQR: 0.6–0.9 logMAR) remained stable over 10.8 years and all patients were hyperopic. Fundus examination revealed a variable retinitis pigmentosa (RP)-like phenotype with rounded hyperpigmentations as most prominent feature in six out of nine patients. Electroretinography, visual field measurements, and microperimetry further established the RP-like phenotype. Multimodal imaging revealed significant intraretinal fluid cavities on SD-OCT and a remarkable pattern of hyperautofluorescent abnormalities on FAF in all patients. Conclusion: This study highlights the ophthalmological phenotype resembling RP with moderate to severe visual impairment in patients with mild ZSD. These findings can aid ophthalmologists in diagnosing, counselling, and managing patients with mild ZSD. [ABSTRACT FROM AUTHOR]

At the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China. On 11 March 2020, the World Health Organization declared COVID-19 a pandemic. This virus affects many organs, including the eye, and can manifest through various clinical manifestations. Multiple neuro-ophthalmological manifestations have been reported in association with COVID-19, including, Optic Neuritis, cranial nerve palsies, eye movement abnormalities, and visual field defects. In this article, we report a case of bilateral neuroretinitis in association with (SARS-CoV-2). [ABSTRACT FROM AUTHOR]

Purpose: To compare diagnostic power for different severities of age-related macular degeneration (AMD) of two-dimensional macular pigment optical densities (2D-MPOD) and spatially matched objective perimetry, with standard perimetry and best-corrected visual acuity (BCVA). Methods: The ObjectiveField Analyser (OFA) provided objective perimetry, and a Heidelberg Spectralis optical coherence tomography (OCT) measured 2D-MPOD in AMD patients, both completed twice over 0.99 ± 0.16 years. From each 2D-MPOD image, we extracted 20 regions/macula, matched to the 20 OFA stimuli/macula. For each region, we calculated 7 measures from the 2D-MPOD pixel values and correlated those with OFA sensitivities and delays. We quantified 2D-MPOD changes, the ability of 2D-MPOD and OFA to discriminate AMD stages, and the discriminatory power of Matrix perimetry and BCVA using percentage area under receiver operator characteristic plots (%AUROC). Results: In 58 eyes of 29 subjects (71.6 ± 6.3 years, 22 females), we found significant correlations between 2D-MPOD and OFA sensitivities for Age-Related Eye Disease Studies (AREDS)-3 and AREDS-4 severities. Delays showed significant correlations with AREDS-2. For AREDS-4, correlations extended across all eccentricities. Regression associated with the Bland–Altman plots showed significant changes in 2D-MPOD over the study period, especially variability measures. MPOD per-region medians discriminated AREDS-1 from AREDS-3 eyes at a %AUROC of 80.0 ± 6.3%, outperforming OFA, Matrix perimetry, and BCVA. Conclusions: MPOD changes correlated with central functional changes and significant correlations extended peripherally in later-stage AMD. Good diagnostic power for earlier-stage AMD and significant change over the study suggest that 2D-MPOD and OFA may provide effective biomarkers. [ABSTRACT FROM AUTHOR]

Standard automated perimetry, a psychophysical task performed routinely in eyecare clinics, requires observers to maintain fixation for several minutes at a time in order to measure visual field sensitivity. Detection of visual field damage is confounded by eye movements, making the technique unreliable in poorly attentive individuals and those with pathologically unstable fixation, such as nystagmus. Microperimetry, which utilizes 'partial gaze-contingency' (PGC), aims to counteract eye movements but only corrects for gaze position errors prior to each stimulus onset. Here, we present a novel method of visual field examination in which stimulus position is updated during presentation, which we refer to as 'continuous gaze-contingency' (CGC). In the first part of this study, we present three case examples that demonstrate the ability of CGC to measure the edges of the physiological blind spot in infantile nystagmus with greater accuracy than PGC and standard 'no gaze-contingency' (NoGC), as initial proof-of-concept for the utility of the paradigm in measurements of absolute scotomas in these individuals. The second part of this study focused on healthy observers, in which we demonstrate that CGC has the lowest stimulus positional error (gaze-contingent precision: CGC = ± 0.29°, PGC = ± 0.54°, NoGC = ± 0.81°). CGC test–retest variability was shown to be at least as good as both PGC and NoGC. Overall, CGC is supported as a reliable method of visual field examination in healthy observers. Preliminary findings demonstrate the spatially accurate estimation of visual field thresholds related to retinal structure using CGC in individuals with infantile nystagmus. [ABSTRACT FROM AUTHOR]

PurposeThis study evaluates differences in the visual field performance when wearing the Defocus Incorporated Multiple Segments (DIMS) spectacle lens compared to wearing a conventional single vision (SV) spectacle lens.MethodsTwenty-one children aged 9–14 years with spherical equivalent refraction (SER) between −1.13D to −4.75D were recruited. Mid-peripheral near visual acuity (NVA) under room lighting condition (500 lux ±10%) was measured using DIMS and SV lenses, respectively. Automated static perimetry (Zeiss, Humphrey Visual Field HFA 750i) with SITA Fast 30–2 protocol was used to investigate the visual field sensitivity. During the test, the study lens (Plano DIMS or SV lens) were inserted into the lens holder in front of the trial lenses with each child’s compensated prescription.ResultsThree children were not able to complete the reliable visual tests due to fixation losses (>20%) or high false positive rate (>15%) while 18 children successfully completed the test. The mean visual field sensitivity was 29.2 ± 3.7 decibels (dB) and 29.3 ± 3.5 dB when wearing DIMS and SV lens, respectively. The mean sensitivity differences between DIMS and SV lens among 76 locations ranged from −2.4 ± 3.9 dB to 1.6 ± 3.9 dB. No statistically significant difference in sensitivity was observed across 76 locations within the central 30o between DIMS and SV lens (Wilcoxon signed rank test with bonferroni correction for multiple comparisons, p > 0.00065). Compared to SV lens, 0.05 logarithm of minimal angle of resolution (logMAR) reduction in mid-peripheral NVA in all 4 quadrants (Superior, Temporal, Inferior and nasal, p

Purpose: To construct a comprehensive reference database (RDB) for a novel binocular automated perimeter. Design: A four-site prospective randomized clinical trial. Subjects and Controls: Three hundred fifty-six healthy subjects without ocular conditions that might affect visual function were categorized into 7 age groups. Methods: Subjects underwent comprehensive ocular examination of both eyes before enrollment. Using the TEMPO/IMOvifa automated perimeter (Topcon Healthcare/CREWT Medical Systems), each subject completed 4 binocular threshold visual field (VF) tests during a single visit: First, practice 24-2 and 10-2 tests were obtained from both eyes. Next, study 24-2 and 10-2 tests were obtained from both eyes. Test order of each sequence was randomized, and the tests were conducted under standard automated perimetry testing conditions: Goldmann stimulus size III, 3183 cd/m2 maximum stimulus intensity, and background intensity of 10 cd/m2, using AIZE-Rapid test strategy. Standard VF reliability indices were assessed. For each subject, 24-2 and 10-2 test results from 1 randomly selected eye were analyzed. Main Outcome Measures: Perimetric threshold sensitivity and reference limits for each test analysis parameter. Results: The ages of the study cohort were widely distributed, with a mean age (standard deviation [SD]) of 52.3 (18.5) years. Sex assignment was 44.0% male and 56.0% female. The majority of subjects self-identified as White (67.4%), followed by Black or African American (13.5%) and Asian (8.7%), with 14.6% self-identified as Hispanic or Latino ethnicity. Mean sensitivity (SD) was 29.1 (1.3) decibels (dB) for the 24-2 and 32.4 (1.0) dB for the 10-2 test. For the 24-2 and 10-2, mean sensitivity (SD) age-related changes averaged −0.06 (0.01) dB and −0.05 (0.01) dB per year, respectively. The normal range of pointwise threshold sensitivity increased with eccentricity and showed asymmetry around the mean, particularly notable in the 24-2 test. Mean (SD) binocular test duration was 3.18 (0.38) minutes (1 minute 35 seconds per eye) for the 24-2 test and 3.58 (0.43) minutes (1 minute 47 seconds per eye) for the 10-2 test. Conclusions: An RDB for the TEMPO/IMOvifa perimeter was established, highlighting the significance of considering both age and stimulus eccentricity in interpreting threshold VF test results. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

This study presents the horizontal spatial specifications required for developing ideal head-mounted displays (HMDs) that provide visual experiences indistinguishable from those obtained without wearing HMDs. We investigated the minimum specifications for pixel density and field of view (FoV) such that users cannot perceive any degradation in these aspects. Conventional studies have measured visual acuity in the periphery and FoV size without eye movement. However, these results are not sufficient to determine the spatial specifications because users may notice a degradation in the quality of images displayed in the periphery when shifting their gaze away from the front. In this study, we measured visual characteristics under practical conditions, wherein participants moved their eyes naturally in coordination with their head movements, as observed when viewing natural scenes. Using a cylindrical display that covered the participant’s entire horizontal visual field with high resolution images, we asked participants to identify degraded spatial resolution or narrowed FoV. Results showed that ideal HMDs do not have to provide spatial frequency components above 0.5 and 2 cycles per degree outside the visual fields of approximately 210° and 120° horizontally, respectively. These results suggest that a resolution equivalent to one-fifteenth of the frontal area is sufficient for the lateral areas of the head. In addition, we found that ideal HMDs require a FoV of at least 240°. This is considerably smaller than a naive estimate of 310° based on previous studies, obtained by integrating the FoV size during fixation and the movable range of the eyes. We believe that these findings will be helpful in developing ideal HMDs.

Classically, data interpolation with a parametrizedmodel class is possible as long as the number of parameters is larger than the number of equations to be satisfied. A puzzling phenomenon in deep learning is that models are trained with many more parameters than what this classical theory would suggest. We propose a partial theoretical explanation for this phenomenon.We prove that for a broad class of data distributions and model classes, overparametrization is necessary if one wants to interpolate the data smoothly. Namely we show that smooth interpolation requires d times more parameters than mere interpolation, where d is the ambient data dimension. We prove this universal law of robustness for any smoothly parametrized function class with polynomial size weights, and any covariate distribution verifying isoperimetry (or a mixture thereof). In the case of two-layer neural networks and Gaussian covariates, this law was conjectured in prior work by Bubeck, Li, and Nagaraj. We also give an interpretation of our result as an improved generalization bound for model classes consisting of smooth functions. [ABSTRACT FROM AUTHOR]

Nowadays many patients are choosing EDOF or multifocal lenses for replacement of natural lens in cataract surgery. This can result in issues such as presence of dysphotopsias, namely halo and glare. In this work, we propose a new perimetry method to describe dysphotopsias in far-field region in a presence of bright, point-like light source. We constructed a custom device and designed measurement procedure for quantitative measurement of dysphotopias in the center of visual field and used it to examine patients with mild cataracts or implanted IOLs. Our approach may help in establishing an objective method to study and compare dysphotopsias. [ABSTRACT FROM AUTHOR]

Clinical imaging provided by optical coherence tomography (OCT) and its variant, OCT-angiography (OCT-A), has revolutionised eyecare practice. The imaging techniques allow for the identification and quantification of ocular structures, supporting the diagnosis and prognosis of eye disease. In this review, an overview of the usefulness of OCT-A imaging in the diagnosis and management of a range of ocular conditions is provided when used in isolation or in combination with other imaging modalities and measures of visual function (visual field results). OCT-A imaging has the capacity to identify and quantify ocular vasculature non-invasively, thereby assisting the clinician in the diagnosis or to determine the efficacy of intervention in ocular conditions impacting retinal vasculature. Thus, additional clinically useful information can be obtained in eye diseases involving conditions such as those impacting retinal vessel occlusion, in diabetic retinopathy, inherited retinal dystrophy, age-related macular degeneration, choroidal neovascularisation and optic nerve disorders. Through a clinical case series, various ocular conditions are reviewed, and the impact of OCT-A imaging is discussed. Although OCT-A imaging has great promise and is already used in clinical management, there is a lack of set standards to characterise altered vascular features in disease and consequently for prognostication, primarily due to a lack of large-scale clinical trials and variability in OCT-A algorithms when generating quantitative parameters. [ABSTRACT FROM AUTHOR]

Aims: Previous structural, vascular density, and perfusion studies have mostly comprised type 1 and type 2 diabetes, even in the absence of retinopathy. The current study aimed to compare macular vessel density (VD) measurements between maturity-onset diabetes of the young (MODY) patients and controls. Methods: The macular VD of superficial, deep retina, and choriocapillaris (CC), and central macular thickness (CMT), foveal avascular zone (FAZ), FAZ perimetry, VD of the total retina at 300 µm around the FAZ (FD), and acirculatory index (AI) measurements were taken and analyzed via OCT-A (RTVue XR 100-2 Avanti, AngioVue) and were compared between molecularly confirmed MODY (glucokinase (GCK) variants) patients and healthy controls. Results: Twenty-five MODY patients and 30 healthy controls were included in the study. The mean plasma hemoglobin A1c level in the MODY group was 6.39 ± 0.38. The mean age was 13.8 ± 2.1 in the MODY group and was 12.6 ± 2.5 years among controls. There was no significant difference in terms of the age, superficial and deep retinal VD, FAZ, FAZ perimetry, CMT, FD, or AI between the groups. Compared to the healthy controls, a slight but significant increase in the CC-VD was detected in the MODY group, but only in the parafoveal and perifoveal regions (p = 0.034, p = 0.009). Conclusion: The significant CC-VD increase in the MODY group might be associated with hyperglycemia and/or relatively poor and vulnerable peripheral vascular CC perfusion compared to the central. Previous thickness and VD results of childhood or adolescent diabetes were distributed in a wider range, suggesting that various factors, including some not yet clearly defined, may affect the choroidal vasculature independently of glycemia or as a contributing factor. [ABSTRACT FROM AUTHOR]

Introduction: Pituitary apoplexy is a rare endocrine emergency that is occasionally life-threatening, most often involving pituitary macroadenomas. Most pituitary macroadenomas are nonsecretory and are diagnosed in the late stages. They remain undiagnosed until they cause compression of the surrounding vital structures and lead to subsequent symptoms. The clinical feature depends on the size of the tumor and the direction of the spread. There are two approaches for surgery. The less invasive endoscopic transnasal transsphenoidal approach is favored more than the transcranial approach. Case Report: 46-year-old female patient presented to the outpatient department (OPD) with complaints of headache and drooping of the right eyelid for 1.5 months. On neurological examination, right severe ptosis was present and extraocular movements of the right eye are restricted for the muscles supplied by the third nerve. Pupils were reactive to light. On perimetry, the left eye showed temporal hemianopia. Right eye perimetry was not done due to ptosis. MRI Brain gave differential diagnosis as pituitary macroadenoma with hemorrhage or necrosis and pituitary apoplexy without macroadenoma. Endoscopic transnasal transsphenoidal excision of the tumor under general anesthesia was performed. Conclusion: MRI brain is the preferred imaging for cases with high suspicion of pituitary apoplexy. Endoscopic transnasal transsphenoidal excision of the tumor is an excellent choice for surgical resection of pituitary adenomas, with improved rates of complete tumor removal and reduced incidence of complication. [ABSTRACT FROM AUTHOR]

Purpose: To determine normal threshold values for the 24-2 program of the VisuALL-K (Olleyes, Inc), a portable static automated virtual reality perimeter that uses a video game–based testing modality on an updated version of the algorithm and to repeat the test to assess retest variability. Methods: This prospective cohort study included 19 participants (aged 8 to 17 years) with healthy afferent systems. Participants performed two 24-2 automated perimetry tests on the virtual reality perimeter device. Results: Mean age was 12.7 ± 2.5 years; 53% were boys and 47% were girls. Mean test location threshold was 30.5 ± 4.0 dB for test 1 and 31.3 ± 2.8 dB for test 2. Sensitivity decreased with eccentricity as expected (−0.17 dB per degree). Bland-Altman analysis showed a repeatability coefficient of ±5.1 dB for mean deviation, meaning that 95% of retest values were within ±5 dB of the threshold value for the first test. Higher thresholds for the first test regressed toward the mean values in the second test, indicating a learning effect. Intraclass correlation coefficient for mean deviation between test 1 and test 2 was 0.70 (0.55 to 0.80, P <.0001). Mean time to completion for the virtual reality perimeter was 5.1 ± 1.5 min/eye. Conclusions: The VisuALL-K virtual reality perimeter provided an assessment of the visual field in normal children aged 8 to 17 years. A shallow hill of vision was demonstrated. A notable learning effect was demonstrated, with repeatability difference wider than other published head-mounted display perimeters. [J Pediatr Ophthalmol Strabismus. 2024:61(4):262–266.] [ABSTRACT FROM AUTHOR]

Background: To investigate anatomical and functional changes of the macula caused by epiretinal membrane (ERM) peeling procedures in patients with or without posterior vitreous detachment (PVD). Methods: This is a multicentric prospective observational study on thirty-seven (37) patients affected by symptomatic ERM who underwent 25-gauge pars plana vitrectomy (PPV), induction of a PVD (as needed) and peeling of both the internal limiting membrane (ILM) and ERM. Optical coherence tomography–angiography (OCT-A) (RS 3000, Nidek, Japan) and microperimetry (MP-3, Nidek, Japan) were performed; central retinal thickness (CRT), foveal avascular zone (FAZ) area and perimeter, vessel density and perfusion density, retinal sensitivity and fixation stability (as a total mean retinal sensitivity (MRS), and MRS in the ellipse area and bivariate contour ellipse area (BCEA)) were recorded at baseline and up to postoperative month 3. Results: Eyes were classified as having complete PVD (51.4%) or incomplete PVD (48.6%). At baseline, patients with incomplete PVD had worse best-corrected distance visual acuity (BCDVA), total MRS, MRS in the ellipse area and BCEA, and higher CRT than patients with complete PVD. At month 3, the differences in BCDVA between the two groups remained statistically significant, with patients with incomplete PVD having worse results (difference: 0.199 logMAR, p < 0.001). The difference in the MRS in the ellipse area was statistically significant at month 3 (−3.378 Db, p = 0.035), with greater improvement in patients with complete PVD. Conclusions: Our study shows that patients with incomplete PVD have worse conditions at baseline than patients with complete PVD, and the differences in visual acuity and retinal sensitivity were maintained postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the diagnostic ability of retinal superficial vasculature evaluation by optic coherence tomography angiography (OCTA) combined with visual field (VF) testing for early primary open-angle glaucoma (POAG). Patients and methods: In this cross-sectional study, 84 participants were included, including 11 in the ocular hypertension (OHT) group, 11 in the preperimetric POAG (pre-POAG) group, 29 in the early POAG group and 33 in the control group. All participants underwent 6 × 6 mm2 scans of macula and optic nerved head by optic coherence tomography (OCT) and OCTA, along with white-on-white and blue-on-yellow VF testing by static automated perimetry. The ability of diagnosing early glaucoma by either various examinations separately or combination of examinations in both terms of function and structure was studied using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results: The superficial retinal vessel densities (VD) in peri-nasal, para-temporal, peri-temporal and peri-inferior regions around the macula, as well as vessel area densities (VAD) in all peripapillary regions, were significantly different among the four groups, with lower VD or VAD in the early POAG patients compared to the normal individuals. The diagnostic ability of peripapillary superficial retinal VAD alone or VF testing alone was limited for early POAG only. However, the combination of these two was more effective in distinguishing normal individuals from OHT subjects or pre-POAG patients without VF defects, with better performance than the combination of peripapillary retinal nerve fiber layer (RNFL) thickness and VF indicators. Conclusions: Peripapillary retinal vessel densities were generally lower in early POAG patients compared to normal individuals. The combination of peripapillary superficial retinal VAD by OCTA with white-on-white VF testing improved the ability to distinguish POAG patients at early stage without function impairment, which may help in providing reference and guidance for the following-up and treatment of suspected POAG patients. [ABSTRACT FROM AUTHOR]

Background: Despite being oncologically acceptable for esophagogastric junction adenocarcinoma with an esophageal invasion length of 3–4 cm, the transhiatal approach has not yet become a standard method given the difficulty of reconstruction in a narrow space and the risk of severe anastomotic leakage. This study aimed to clarify the safety and feasibility of the open left diaphragm method during the transhiatal approach for esophagogastric junction adenocarcinoma. Methods: This retrospective study compared the clinical outcomes of patients who underwent proximal or total gastrectomy with lower esophagectomy for Siewert type II/III adenocarcinomas with esophageal invasion via the laparoscopic transhiatal approach with or without the open left diaphragm method from April 2013 to December 2021. Results: Overall, 42 and 13 patients did and did not undergo surgery with the open left diaphragm method, respectively. The median operative time was only slightly shorter in the open left diaphragm group than in the non-open left diaphragm group (369 vs. 482 min; P = 0.07). Grade ≥ II postoperative respiratory complications were significantly less common in the open left diaphragm group than in the non-open left diaphragm group (17% vs. 46%, P = 0.03). Neither group had grade ≥ IV anastomotic leakage, and two cases of anastomotic leakage requiring reoperation were drained using the left diaphragmatic release technique. Conclusions: Transhiatal lower esophagectomy with gastrectomy using the open left diaphragm method is safe, highlighting its advantages for Siewert type II/III esophagogastric junction adenocarcinoma with an esophageal invasion length of ≤ 4 cm. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to determine if the rise in new surgical procedures for glaucoma is changing the baseline features of patients. Methods: In this retrospective study, we reviewed the baseline features of patients undergoing their first glaucoma surgery in 2011 and 2021, collecting data regarding intraocular pressure (IOP), visual field (VF) parameters, stage of disease, and the type of surgery. Results: In the study, 455 patients were included in the analysis. From these, 230 eyes had glaucoma surgery performed in 2011 (Group A) and 225 eyes in 2021 (Group B). When considering the baseline features, Group A was older than Group B (72.7 ± 10.7 and 70 ± 12.4 years; p = 0.02, respectively), and showed a significantly more advanced VF mean defect (−16.4 ± 8.8 and −13.8 ± 8.7 dB; p < 0.01, respectively) and a higher IOP (25.9 ± 6.6 and 24.9 ± 7.8 mmHg; p = 0.02, respectively). Overall, severe VF damage at the time of surgery was more frequent in Group A (74.3%) than in Group B (60.8%) (p < 0.01). The overall number of traditional glaucoma surgeries was 211 in 2011, reducing to 94 ten years later, with similar severe pre-operative VF defects. In 2021, minimally invasive bleb surgery (MIBS) represented 58% of all surgeries. Conclusions: In the last ten years, patients receiving glaucoma surgery for the first time were younger, had less severe disease, and a more contained IOP. The baseline feature modifications were probably related to the diffusion of new procedures, especially MIBS, which allowed for treating patients at an earlier stage, reserving traditional procedures for advanced cases. [ABSTRACT FROM AUTHOR]

Familial hemiplegic migraine (FHM), an autosomal dominant subtype of hemiplegic migraine, is a channelopathy presenting with severe headache, visual field defect, paresthesia, unilateral motor deficit, encephalopathy, seizures and aphasia. This cross-sectional study was conducted over 10 months in children aged 1–18 years suspected of hemiplegic migraine at a tertiary care pediatric hospital. Fourteen children were screened and five children with genetically confirmed FHM were included. The symptoms in the study population were paroxysmal hemiparesis (5/5), headache (5/5) and focal seizures (1/5). The hemiplegia episodes lasted from 4 h to 7 days. The mean age at the onset of neurological symptoms was 6.8 ± 0.7 years and the mean age at diagnosis was 12.8 ± 1.7 years, with a mean delay of 6.1 ± 1.9 years for the diagnosis. Neuroimaging during acute episodes revealed accentuated gray, white differentiation in the contralateral cerebral hemisphere with mild effacement of sulcal spaces in T2/fluid-attenuated inversion recovery (FLAIR) images. Genetic testing revealed ATP1A2 mutations (FHM2) in 4/5 and SCN1A (FHM3) in 1/5 patients. All of them (5/5) were initiated on oral topiramate and had favorable treatment responses with a mean follow-up duration of 7 ± 1.4 months. Diagnosis of FHM is mainly clinical and can be confirmed by genetic analysis. Perfusion and diffusion-weighted MRI should be considered during acute headache episodes, as it is mostly normal in symptom-free periods. Routine MRI sequences like T1 weighted, T2 weighted, FLAIR and contrast remain normal even during acute attacks. [ABSTRACT FROM AUTHOR]

To evaluate the performance of an intensive, clustered testing approach in identifying eyes with rapid glaucoma progression over 6 months in the Fast Progression Assessment through Clustered Evaluation (Fast-PACE) Study. Prospective cohort study. A total of 125 eyes from 65 primary open-angle glaucoma (POAG) subjects. Subjects underwent 2 sets of 5 weekly visits (clusters) separated by an average of 6 months and then were followed with single visits every 6 months for an overall mean follow-up of 25 months (mean of 17 tests). Each visit consisted of testing with standard automated perimetry (SAP) 24-2 and 10-2, and spectral-domain OCT (SD-OCT). Progression was assessed using trend analyses of SAP mean deviation (MD) and retinal nerve fiber layer (RNFL) thickness. Generalized estimating equations were applied to adjust for correlations between eyes for confidence interval (CI) estimation and hypothesis testing. Diagnostic accuracy of the 6-month clustering period to identify progression detected during the overall follow-up. A total of 19 of 125 eyes (15%, CI, 9%–24%) progressed based on SAP 24-2 MD over the 6-month clustering period. A total of 14 eyes (11%, CI, 6%–20%) progressed on SAP 10-2 MD, and 16 eyes (13%, CI, 8%–21%) progressed by RNFL thickness, with 30 of 125 eyes (24%, CI, 16%–34%) progressing by function, structure, or both. Of the 35 eyes progressing during the overall follow-up, 25 had progressed during the 6-month clustering period, for a sensitivity of 71% (CI, 53%–85%). Of the 90 eyes that did not progress during the overall follow-up, 85 also did not progress during the 6-month period, for a specificity of 94% (CI, 88%–98%). Of the 14 eyes considered fast progressors by SAP 24-2, SAP 10-2, or SD-OCT during the overall follow-up, 13 were identified as progressing during the 6-month cluster period, for a sensitivity of 93% (CI, 66%–100%) for identifying fast progression with a specificity of 85% (CI, 77%–90%). Clustered testing in the Fast-PACE Study detected fast-progressing glaucoma eyes over 6 months. The methodology could be applied in clinical trials investigating interventions to slow glaucoma progression and may be of value for short-term assessment of high-risk subjects. Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]