Characteristics of Eyes With CRB1-Associated EOSRD/LCA: Age-Related Changes.

PURPOSE: To evaluate ocular and retinal features of CRB1-associated early onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA) for age-related changes. DESIGN: Retrospective cohort study. METHODS: Sixteen pediatric patients with biallelic CRB1 EOSRD/LCA who had been followed for up to 18 years were reviewed. Results of comprehensive ophthalmic examinations-including visual acuity, refractive error, dark-adapted visual threshold, Goldmann perimetry, and macular optical coherence tomography (OCT)-were analyzed for significant age-related changes using mixed-effects models. RESULTS: Visual acuity dark-adapted visual sensitivity, and area of seeing visual field (all subnormal from the earliest ages recorded) declined with increasing age. Hyperopia was stable through childhood and adolescence. In CRB1 EOSRD/LCA, OCT extrafoveal inner and outer laminar thicknesses exceeded those in controls but varied little with age, and foveal metrics (depth, breadth, thickness at rim) differed significantly from those in controls, but variations in foveal metrics were not associated with declines in acuity. CONCLUSIONS: From the youngest ages, retinal and visual function is significantly subnormal and becomes progressively compromized. A goal of future therapies should be intervention at young ages, when there is more function to be rescued.

An Adjustable Magnetic Levator Prosthesis for Customizable Eyelid Reanimation in Severe Blepharoptosis II: Randomized Evaluation of Angular Translation.

Purpose: Examine the effect of force modulation via angular translation of a static magnetic field for customizable treatment of severe blepharoptosis. Methods: Prototype adjustable-force magnetic levator prostheses (aMLP) consisted of a spectacle-mounted magnet in rotatable housing and small eyelid-attached magnets embedded in a biocompatible polymer. Interpalpebral fissure (IPF) of 17 participants with severe blepharoptosis was continuously measured for one minute at five spectacle magnet angles, with order randomized and participant and data analyst masked. The hypothesis that angular position affected opening IPF (o-IPF), minimum blink IPF (m-IPF), and comfort ratings (1-10) was tested. Results: The aMLP improved o-IPF from 4.5 mm without the device to 6.2 mm on the lowest force setting (P < 0.001) and 7.1 mm on the highest setting (P < 0.001) and allowed for complete volitional blink regardless of setting (average m-IPF 0.4 mm and no change with aMLP; P = 0.76). Spontaneous blink without the device (2.0 mm) was affected on the highest force setting (m-IPF 3.9 mm; P < 0.001) but only marginally so on the lowest setting (3.0 mm; P = 0.06). Comfort (7.6/10) did not vary with the angle (P > 0.36). Profile analysis found substantial individual responses to angle (P < 0.001), confirming the value of customization. Conclusions: Angular translation provided adjustable force, which had a statistically and clinically meaningful impact on eye opening and the completeness of the spontaneous blink. This quantitative evidence supports continued use of the angular translation mechanism for force adjustment in the customizable magnetic correction of severe blepharoptosis. Translational Relevance: Evidence for the benefit of customizable magnetic force via angular translation in a larger sample of participants than reported previously.

Microcephaly and chorioretinopathy associated with TUBGCP4: a case report and a review of the literature.

BACKGROUND: Microcephaly and chorioretinopathy (MCCRP) is a rare autosomal recessive (AR) disorder characterized by microcephaly, developmental delay, chorioretinopathy, and visual impairment. We characterized the long-term phenotype of an additional patient with MCCRP associated with TUBCGP4 pathogenic variants and analysed previously reported cases in the literature. MATERIALS AND METHODS: Analysis of clinical and genetic data of a patient with TUBGCP4-related MCCRP followed for more than 19 years and literature search for previously reported patients with TUBCGP4 variants using PubMed, Scopus, and Google Scholar. RESULTS: Molecular diagnosis using exome sequencing demonstrated two TUBCGP4 variants in trans: c.1669C>T (p.Arg557*) and c.1746 G>T (p.Leu582=). Clinical characteristics included microcephaly, microphthalmia, punched-out chorioretinal lesions, vision impairment, nystagmus, Tetralogy of Fallot and neurodevelopmental delay. Another six previously reported cases of TUBCGP4-related MCCRP were identified. Their clinical and genetic characteristics are compared. CONCLUSIONS: TUBCGP4-related microcephaly and chorioretinopathy, is a rare autosomal recessive neuro-ophthalmic disorder. Clinical characteristics in our proband have remained stable for two decades. The pathophysiology of this syndrome is not yet fully understood.

Further evaluation of narrative description as a measure of cognitive function in Alzheimer's disease.

OBJECTIVE: The narrative description (ND) test objectively measures the ability to understand and describe visual scenes. As subtle differences in speech occur early in cognitive decline, we analyzed linguistic features for their utility in detecting cognitive impairment and predicting downstream decline. METHOD: Participants (n = 52) with normal cognition to mild dementia performed the ND test (watched twenty 30-s video clips and described the visual content). Cognitive function was followed for up to 5 years. We computed simple linguistic features such as content efficiency, speech rate, and part of speech and unique word counts. We examined (a) relationships between cognitive status and ND score and linguistic features; (b) ability to discriminate early cognitive impairment from normal cognition using ND score and linguistic features; and (c) whether ND score and linguistic features were associated with future cognitive functional decline. RESULTS: Many of the linguistic-feature metrics were related to cognitive status. Many of the linguistic features could distinguish between the cognitively normal group and the mild cognitive impairment (MCI) and Dementia groups. The area under the curve (AUC) for ND score alone was 0.74, with a nonsignificant increase to 0.78 when adding mean word length. Among participants with subjective cognitive decline (SCD) at the first visit, a smaller number of words plus more interjections or a lower ND score at baseline were predictive of future cognitive decline. CONCLUSIONS: While many linguistic features were associated with cognitive status, and some were able to detect early cognitive impairment or predictive of future cognitive decline, all the features we tested seem to have been captured by the ND score. Thus, adding linguistic measures to the ND test score did not add to its value in assessing current or predicting future cognitive status. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of Perceptual-motor Training on Collision Judgments with Peripheral Prism Expanded Vision.

SIGNIFICANCE: Peripheral prisms (p-prisms) improve blind-side detection of hazards in hemianopia by shifting the image of the hazard into the intact visual field. Collision judgments can be made accurately after detection by using a gaze shift to fixate the hazard in the prism-free portion of the lens, but this is slow relative to normal peripheral vision. A prior study found that prism adaptation for visual direction did not occur with general wear. We developed a perceptual-motor training regimen that resulted in accurate pointing at p-prism targets after six 1-hour sessions. PURPOSE: This study aimed to determine if improvements in pointing accuracy from perceptual-motor training generalized to collision judgments during simulated walking. METHODS: Participants with hemianopia (n = 13) made collision judgments in virtual reality for a person appearing 0.4 to 13.5° from the walking path. Judgments were measured under fixed gaze, requiring collision judgments via the p-prism image only, and free gaze, representing a more natural scenario. Measurements were made without and with p-prisms immediately after fitting, after a 2-week acclimation, after training, and 3 months later. Controls (n = 13) did one visit without p-prisms. RESULTS: Controls had 100% detection and symmetrically distributed collision judgments for the central 33 and 36% of hazards under fixed gaze and free gaze, respectively. In hemianopia, the seeing side was not different from controls. Blind-side detection was reduced without p-prisms to 40% fixed gaze and 82% free gaze and improved with p-prisms to 99% fixed gaze and 97% free gaze (P < .001). When first worn, fixed-gaze prism side collisions were 63 versus 37% on the seeing side and 41 versus 39% for free gaze (P < .001). There was a small improvement for fixed gaze after the 2-week acclimation (53%, P < .001), but no improvements from training or an additional 3 months of use. CONCLUSIONS: P-prisms improved detection, but collision judgments were inaccurate when seen only via the p-prisms and did not improve with perceptual-motor training. Patients should continue to be advised to turn their head and eyes to fixate the hazard after detection.

The Effect of Zoom Magnification and Large Display on Video Comprehension in Individuals With Central Vision Loss.

Purpose: A larger display at the same viewing distance provides relative-size magnification for individuals with central vision loss (CVL). However, the resulting large visible area of the display is expected to result in more head rotation, which may cause discomfort. We created a zoom magnification technique that placed the center of interest (COI) in the center of the display to reduce the need for head rotation. Methods: In a 2 × 2 within-subject study design, 23 participants with CVL viewed video clips from 1.5 m (4.9 feet) shown with or without zoom magnification, and with a large (208 cm/82" diagonal, 69°) or a typical (84 cm/33", 31°) screen. Head position was tracked and a custom questionnaire was used to measure discomfort. Results: Video comprehension was better with the large screen (P < 0.001) and slightly worse with zoom magnification (P = 0.03). Oddly, head movements did not vary with screen size (P = 0.63), yet were greater with zoom magnification (P = 0.001). This finding was unexpected, because the COI remains in the center with zoom magnification, but moves widely with a large screen and no magnification. Conclusions: This initial attempt to implement the zoom magnification method had flaws that may have decreased its effectiveness. In the future, we propose alternative implementations for zoom magnification, such as variable magnification. Translational Relevance: We present the first explicit demonstration that relative-size magnification improves the video comprehension of people with CVL when viewing video.

Saccade Landing Point Prediction Based on Fine-Grained Learning Method.

The landing point of a saccade defines the new fixation region, the new region of interest. We asked whether it was possible to predict the saccade landing point early in this very fast eye movement. This work proposes a new algorithm based on LSTM networks and a fine-grained loss function for saccade landing point prediction in real-world scenarios. Predicting the landing point is a critical milestone toward reducing the problems caused by display-update latency in gaze-contingent systems that make real-time changes in the display based on eye tracking. Saccadic eye movements are some of the fastest human neuro-motor activities with angular velocities of up to 1,000°/s. We present a comprehensive analysis of the performance of our method using a database with almost 220,000 saccades from 75 participants captured during natural viewing of videos. We include a comparison with state-of-the-art saccade landing point prediction algorithms. The results obtained using our proposed method outperformed existing approaches with improvements of up to 50% error reduction. Finally, we analyzed some factors that affected prediction errors including duration, length, age, and user intrinsic characteristics.

Combined blockade of complement C5 and TLR co-receptor CD14 synergistically inhibits pig-to-human corneal xenograft induced innate inflammatory responses.

Inadequate supplies of donor corneas have evoked an escalating interest in corneal xenotransplantation. However, innate immune responses contribute significantly to the mechanism of xenograft rejection. We hypothesized that complement component C5 and TLR co-receptor CD14 inhibition would inhibit porcine cornea induced innate immune responses. Therefore, we measured cytokine release in human blood, induced by three forms of corneal xenografts with or without inhibitors. Native porcine cornea (NPC) induced interleukins (IL-1ß, IL-2, IL-6, IL-8, IL-1ra), chemokines (MCP-1, MIP-1α, MIP-1ß) and other cytokines (TNF, G-CSF, INF-γ, FGF-basic). Decellularized (DPC) and gamma-irradiated cornea (g-DPC) elevated the release of those cytokines. C5-blockade by eculizumab inhibited all the cytokines except G-CSF when induced by NPC. However, C5-blockade failed to reduce DPC and g-DPC induced cytokines. Blockade of CD14 inhibited DPC-induced cytokines except for IL-8, MCP-1, MIP-1α, and G-CSF, while it inhibited all of them when induced by g-DPC. Combined blockade of C5 and CD14 inhibited the maximum number of cytokines regardless of the xenograft type. Finally, by using the TLR4 specific inhibitor Eritoran, we showed that TLR4 activation was the basis for the CD14 effect. Thus, blockade of C5, when combined with TLR4 inhibition, may have therapeutic potential in pig-to-human corneal xenotransplantation. STATEMENT OF SIGNIFICANCE: Bio-engineered corneal xenografts are on the verge of becoming a viable alternative to allogenic human-donor-cornea, but the host's innate immune response is still a critical barrier for graft acceptance. By overruling this barrier, limited graft availability would no longer be an issue for treating corneal diseases. We showed that the xenograft induced inflammation is initiated by the complement system and toll-like receptor activation. Intriguingly, the inflammatory response was efficiently blocked by simultaneously targeting bottleneck molecules in the complement system (C5) and the TLR co-receptor CD14 with pharmaceutical inhibitors. We postulate that a combination of C5 and CD14 inhibition could have a great therapeutic potential to overcome the immunologic barrier in pig-to-human corneal xenotransplantation.

An implementation of Bubble Magnification did not improve the video comprehension of individuals with central vision loss.

PURPOSE: People with central vision loss (CVL) watch television, videos and movies, but often report difficulty and have reduced video comprehension. An approach to assist viewing videos is electronic magnification of the video itself, such as Bubble Magnification. METHODS: We created a Bubble Magnification technique that displayed a magnified segment around the centre of interest (COI) as determined by the gaze of participants with normal vision. The 15 participants with CVL viewed video clips shown with 2× and 3× Bubble Magnification, and unedited. We measured video comprehension and gaze coherence. RESULTS: Video comprehension was significantly worse with both 2× (p = 0.01) and 3× Bubble Magnification (p < 0.001) than the unedited video. There was no difference in gaze coherence across conditions (p ≥ 0.58). This was unexpected because we expected a benefit in both video comprehension and gaze coherence. This initial attempt to implement the Bubble Magnification method had flaws that probably reduced its effectiveness. CONCLUSIONS: In the future, we propose alternative implementations of Bubble Magnification, such as variable magnification and bubble size. This study is a first step in the development of an intelligent-magnification approach to providing a vision rehabilitation aid to assist people with CVL.

The Impact of Field of View on Understanding of a Movie Is Reduced by Magnifying Around the Center of Interest.

Purpose: Magnification is commonly used to reduce the impact of impaired central vision. However, magnification limits the field of view (FoV) which may make it difficult to follow the story. Most people with normal vision look in about the same place at about the same time, the center of interest (COI), when watching "Hollywood" movies. We hypothesized that if the FoV was centered at the COI, then this view would provide more useful information than either the original image center or an unrelated view location (the COI locations from a different video clip) as the FoV reduced. Methods: The FoV was varied between 100% (original) and 3%. To measure video comprehension as the FoV reduced, subjects described 30-second video clips in response to two open-ended questions. A computational, natural-language approach was used to provide an information acquisition (IA) score. Results: The IA scores reduced as the FoV decreased. When the FoV was around the COI, subjects were better able to understand the content of the video clips (higher IA scores) as the FoV decreased than the other conditions. Thus, magnification around the COI may serve as a better video enhancement approach than simple magnification of the image center. Conclusions: These results have implications for future image processing and scene viewing, which may help people with central vision loss view directed dynamic visual content ("Hollywood" movies). Translational Relevance: Our results are promising for the use of magnification around the COI as a vision rehabilitation aid for people with central vision loss.

Validation of a vision-related activity scale for patients with retinitis pigmentosa.

PURPOSE: There have been few systematic reports of vision-related activity limitations of people with retinitis pigmentosa (RP). We report a merging of data from the National Eye Institute Visual Function Questionnaire (NEI-VFQ) obtained in five previous studies. We asked whether the Vision Function Scale (VFS; Pesudovs et al., 2010) which was developed for cataract patients would apply in this new population (condition). METHODS: Five hundred ninety-four individuals completed a total of 1753 questionnaires, with 209 participants providing responses over at least 4 years. Rasch analysis showed that the 15-item VFS was poorly targeted. A new instrument created by adding four driving-related items to the VFS had better targeting. As an indirect validation, VFS-plus person scores were compared to visual field area measured using a Goldmann perimeter, to the summed score for the combined 30-2 and 30/60-1 Humphrey Field Analyzer programs (HFA), to 30-Hz full-field cone electroretinogram (ERG) amplitude, and to ETDRS visual acuity. Changes in VFS-plus person scores with age and between four common heredity groups were also examined. RESULTS: The Rasch model of responses to the 19 VFS-plus items had person and item separation of 2.66 and 24.43 respectively. The VFS-plus person scores were related to each vision measure (p < 0.001). Over a five-year period, there was a reduction in person scores of 0.5 logits (p < 0.001). Person scores fell by an average of 0.34 logits per decade (p < 0.0001). Participants with an X-linked hereditary pattern had, on average, lower person scores (p < 0.001). CONCLUSIONS: The VFS-plus instrument quantified a highly-significant annual reduction in perceived vision-related ability over a five-year period. The outcome was consistent with clinical measures of vision, and detected lower perceived vision-related ability in participants with X-linked disease. It may be of use in future studies, but this needs to be tested in a representative population sample.

Evaluation of Two Strategies for Alleviating the Impact on the Circadian Cycle of Smartphone Screens.

SIGNIFICANCE: Electronic display devices used before bed may negatively affect sleep quality through the effects of short-wavelength (blue) light on melatonin production and the circadian cycle. We quantified the efficacy of night-mode functions and blue-light-reducing lenses in ameliorating this problem. PURPOSE: The purpose of this study was to compare the radiation produced by smartphones that reaches the eye when using night-mode functions or blue-light-reducing spectacle lenses. METHODS: Radiant flux of 64 smartphones was measured with an integrating sphere. The retinal illuminance was calculated from the radiant flux of the smartphones. For the night-mode functions, the spectra produced by the smartphones were measured. The transmittance of four blue-light-reducing spectacle lenses, which filter light with either antireflective coatings or tints, was measured using a spectrometer. To determine the impact of blue-light-reducing spectacles, the radiant flux of the smartphone was weighted by the transmission spectrum of these glasses. Visual and nonvisual (circadian) parameters were calculated to compute the melatonin suppression values (MSVs) through a logistic fitting of previously published data. The MSV was used as the figure of merit to evaluate the performance of blue-light spectacles and smartphone night-mode functions. RESULTS: Night-mode functions in smartphones reduced MSVs by up to 93%. The warmest mode produced the least suppression. Blue-light-reducing spectacles reduced melatonin suppression by 33%, the coated lenses being more efficient than tinted lenses. CONCLUSIONS: All smartphones in this study emit radiant power in the short-wavelength region of the visible spectrum. Such smartphones may impair the regulation of circadian cycles at nighttime. The activation of night-mode functions was more efficient than the commercially available blue-light-reducing spectacle lenses in reducing the amount of short-wavelength light (up to 2.25 times). These results can be extrapolated to most electronic devices because they share the same type of white radiant sources with smartphones.

Narrative video scene description task discriminates between levels of cognitive impairment in Alzheimer's disease.

The process of interpreting and acting upon the visual environment requires both intact cognitive and visual systems. The narrative description (ND) task, initially developed to detect changes in ecologically relevant visual function in people with impaired vision, is an objective measure of the ability to perceive, understand, and describe a visual scene in a movie clip. OBJECTIVE: Because the ND task draws heavily on semantic and working memory ability in addition to basic visual perception, we aimed to assess the discriminative performance of this task across levels of cognitive impairment. METHOD: We recruited 56 participants with cognitive status ranging from normal cognition to mild dementia (median age 82, range 66 to 99 years) to watch 20 30-s video clips and describe the visual content without time constraints. These verbal responses were transcribed and processed to generate ND shared word scores using a "wisdom of the crowd," natural-language processing approach. We compared ND scores across diagnostic groups, and used linear mixed models to examine decrements in task performance. RESULTS: There was a stepwise decline of ND scores with increasing levels of cognitive impairment. Additional analyses showed that ND performance was highly related to performance on the Montreal Cognitive Assessment (MoCA) and domain-specific neuropsychological tests for semantic fluency and set shifting. Other models demonstrated differences in ND performance related video content between cognitively normal and impaired participants. CONCLUSION: The ND test was able to detect decrements in task performance between levels of cognitive impairment and was related to other global neuropsychological measures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Orientation of the preferred retinal locus (PRL) is maintained following changes in simulated scotoma size.

Although macular lesions often enlarge, we know little about what happens when the preferred retinal locus (PRL) is enveloped by the lesion. We present a prospective study of subjects with normal vision who were trained to develop a PRL using simulated scotomas with a gaze-contingent visual display. We hypothesized that, when subjects had developed a robust PRL and the scotoma size was increased, the PRL would move to remain outside the scotoma and in a direction that maintained the orientation (theta) of the PRL relative to the fovea. Nine subjects with normal vision were trained to develop a PRL and were then exposed to scotoma sizes that ranged from 4° to 24° in diameter. Subjects tracked a stimulus using saccades or smooth pursuits. Fixation stability was measured by calculating the bivariate contour ellipse area (BCEA). To measure the reassignment of the oculomotor reference (OMR) to the PRL, we analyzed the spread (BCEA) of saccade first landing points. All subjects developed a robust PRL that did not vary more than 0.8° on average between blocks of trials of a scotoma size, and they maintained the orientation of the PRL as the simulated scotoma size varied (±9° median standard deviation in theta, defined as orientation angle). Fixation stability and OMR to the PRL worsened (larger BCEA) with increasing scotoma size. This, and related studies, could guide development of a PRL training method to help people with central vision loss.

A free database of eye movements watching "Hollywood" videoclips.

The provided database of tracked eye movements was collected using an infra-red, video-camera Eyelink 1000 system, from 95 participants as they viewed 'Hollywood' video clips. There are 206 clips of 30-s and eleven clips of 30-min for a total viewing time of about 60 hours. The database also provides the raw 30-s video clip files, a short preview of the 30-min clips, and subjective ratings of the content of the videos for each in categories: (1) genre; (2) importance of human faces; (3) importance of human figures; (4) importance of man-made objects; (5) importance of nature; (6) auditory information; (7) lighting; and (8) environment type. Precise timing of the scene cuts within the clips and the democratic gaze scanpath position (center of interest) per frame are provided. At this time, this eye-movement dataset has the widest age range (22-85 years) and is the third largest (in recorded video viewing time) of those that have been made available to the research community. The data-acquisition procedures are described, along with participant demographics, summaries of some common eye-movement statistics, and highlights of research topics in which the database was used. The dataset is freely available in the Open Science Framework repository (link in the manuscript) and can be used without restriction for educational and research purposes, providing that this paper is cited in any published work.

People With Central Vision Loss Have Difficulty Watching Videos.

Purpose: People with central vision loss (CVL) often report difficulties watching video. We objectively evaluated the ability to follow the story (using the information acquisition method). Methods: Subjects with CVL (n = 23) or normal vision (NV, n = 60) described the content of 30-second video clips from movies and documentaries. We derived an objective information acquisition (IA) score for each response using natural-language processing. To test whether the impact of CVL was simply due to reduced resolution, another group of NV subjects (n = 15) described video clips with defocus blur that reduced visual acuity to 20/50 to 20/800. Mixed models included random effects correcting for differences between subjects and between the clips, with age, gender, cognitive status, and education as covariates. Results: Compared to both NV groups, IA scores were worse for the CVL group (P < 0.001). IA reduced with worsening visual acuity (P < 0.001), and the reduction with worsening visual acuity was greater for the CVL group than the NV-defocus group (P = 0.01), which was seen as a greater discrepancy at worse levels of visual acuity. Conclusions: The IA method was able to detect difficulties in following the story experienced by people with CVL. Defocus blur failed to recreate the CVL experience. IA is likely to be useful for evaluations of the effects of vision rehabilitation.

Evaluation of choroidal lesions with swept-source optical coherence tomography.

AIMS: The aim of our study was to image choroidal lesions with swept-source optical coherence tomography (SS-OCT) and to identify the morphological characteristics associated with optimal visualisation. METHODS: This was a prospective, cross-sectional study. Patients with choroidal melanocytic lesions <3 mm in thickness on B-scan ultrasonography were recruited. All participants underwent SS-OCT. On SS-OCT we evaluated qualitative (eg, lesion outline, detection of scleral-choroidal interface and quality of the image) and quantitative (measurement of maximum lesion thickness and the largest basal diameter) parameters. Probability of optimal image quality was examined using ordered logistic regression models. The main outcome measure was quality of the choroidal lesion images on SS-OCT, defined as: optimal, suboptimal or poor. RESULTS: We included 85 choroidal lesions of 82 patients. There were 24 choroidal lesions (29%) for which image quality was classified as optimal, 31 lesions (37%) as suboptimal and 30 lesions (36%) as poor. The factors associated with optimal image quality were distance closer to the fovea (OR 0.76, p<0.001), posterior pole location (OR 3.87, p=0.05), lower ultrasonography thickness (OR 0.44, p=0.04), lighter lesion pigmentation (OR 0.12, p=0.003) and smaller lesion diameter (OR 0.73, p<0.001). In the multivariable analysis, closer distance to the fovea (OR 0.81, p=0.005), lighter lesion pigmentation (OR 0.11, p=0.01) and smaller lesion diameter (OR 0.76, p=0.006) remained statistically significant. CONCLUSION: SS-OCT is useful in imaging most choroidal melanocytic lesions. Image quality is best when the choroidal lesion is closer to the fovea, has a smaller diameter and a lighter choroidal pigmentation.

Peripheral Prisms Improve Obstacle Detection during Simulated Walking for Patients with Left Hemispatial Neglect and Hemianopia.

SIGNIFICANCE: The first report on the use of peripheral prisms (p-prisms) for patients with left neglect and homonymous visual field defects (HVFDs). PURPOSE: The purpose of this study was to investigate if patients with left hemispatial neglect and HVFDs benefit from p-prisms to expand the visual field and improve obstacle detection. METHODS: Patients (24 with HVFDs, 10 of whom had left neglect) viewed an animated, virtual, shopping mall corridor and reported if they would have collided with a human obstacle that appeared at various offsets up to 13.5° from their simulated walking path. There were 40 obstacle presentations on each side, with and without p-prisms. No training with p-prisms was provided, and gaze was fixed at the center of expansion. RESULTS: Detection on the side of the HVFD improved significantly with p-prisms in both groups, from 26 to 92% in the left-neglect group and 43 to 98% in the non-neglect group (both P < .001). There was a tendency for greater improvement in the neglect patients with p-prisms. For collision judgments, both groups exhibited a large increase in perceived collisions on the side of the HVFD with the prisms (P < .001), with no difference between the groups (P = .93). Increased perceived collisions represent a wider perceived safety margin on the side of the HVFD. CONCLUSIONS: Within the controlled conditions of this simulated, collision judgment task, patients with left neglect responded well to initial application of p-prisms exhibiting improved detection and wider safety margins on the side of the HVFD that did not differ from non-neglect patients. Further study of p-prisms for neglect patients in free-gaze conditions after extended wear and in real-world mobility tasks is clearly warranted.

Measuring the Difficulty Watching Video With Hemianopia and an Initial Test of a Rehabilitation Approach.

PURPOSE: If you cannot follow the story when watching a video, then the viewing experience is degraded. We measured the difficulty of following the story, defined as the ability to acquire visual information, which is experienced by people with homonymous hemianopia (HH). Further, we proposed and tested a novel rehabilitation aid. METHODS: Participants watched 30-second directed video clips. Following each video clip, subjects described the visual content of the clip. An objective score of information acquisition (IA) was derived by comparing each new response to a control database of descriptions of the same clip using natural language processing. Study 1 compared 60 participants with normal vision (NV) to 24 participants with HH to test the hypothesis that participants with HH would score lower than NV participants, consistent with reports from people with HH that describe difficulties in video watching. In the second study, 21 participants with HH viewed clips with or without a superimposed dynamic cue that we called a content guide. We hypothesized that IA scores would increase using this content guide. RESULTS: The HH group had a significantly lower IA score, with an average of 2.8, compared with 4.3 shared words of the NV group (mixed-effects regression, P < 0.001). Presence of the content guide significantly increased the IA score by 0.5 shared words (P = 0.03). CONCLUSIONS: Participants with HH had more difficulty acquiring information from a video, which was objectively demonstrated (reduced IA score). The content guide improved information acquisition, but not to the level of people with NV. TRANSLATIONAL RELEVANCE: The value as a possible rehabilitation aid of the content guide warrants further study that involves an extended period of content-guide use and a randomized controlled trial.

People with Hemianopia Report Difficulty with TV, Computer, Cinema Use, and Photography.

SIGNIFICANCE: Our survey found that participants with hemianopia report more difficulties watching video in various formats, including television (TV), on computers, and in a movie theater, compared with participants with normal vision (NV). These reported difficulties were not as marked as those reported by people with central vision loss. PURPOSE: The aim of this study was to survey the viewing experience (e.g., frequency, difficulty) of viewing video on TV, computers and portable visual display devices, and at the cinema of people with hemianopia and NV. This information may guide vision rehabilitation. METHODS: We administered a cross-sectional survey to investigate the viewing habits of people with hemianopia (n = 91) or NV (n = 192). The survey, consisting of 22 items, was administered either in person or in a telephone interview. Descriptive statistics are reported. RESULTS: There were five major differences between the hemianopia and NV groups. Many participants with hemianopia reported (1) at least "some" difficulty watching TV (39/82); (2) at least "some" difficulty watching video on a computer (16/62); (3) never attending the cinema (30/87); (4) at least some difficulty watching movies in the cinema (20/56), among those who did attend the cinema; and (5) never taking photographs (24/80). Some people with hemianopia reported methods that they used to help them watch video, including video playback and head turn. CONCLUSIONS: Although people with hemianopia report more difficulty with viewing video on TV and at the cinema, we are not aware of any rehabilitation methods specifically designed to assist people with hemianopia to watch video. The results of this survey may guide future vision rehabilitation.