IMPACT OF RETINAL FLUID-FREE MONTHS ON OUTCOMES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: A Treatment Agnostic Analysis of the HAWK and HARRIER Studies.

PURPOSE: To assess the effect of the total number of fluid-free months after loading on visual and anatomical outcomes in neovascular age-related macular degeneration patients receiving anti-vascular endothelial growth factor therapy. METHODS: This post hoc analysis pooled patient-level data from the brolucizumab 6 mg (n = 718) and aflibercept 2 mg (n = 715) arms of the HAWK and HARRIER randomized clinical trials. Based on data from Weeks 12 to 96, patients were assigned to one of five categories based on fluid-free visits (FFVs; the total number of monthly visits at which they were observed to be without retinal fluid). Three definitions of "fluid-free" were explored based on the location of the fluid observed. RESULTS: Patients allocated to Categories 4 (15-21 FFV) and 5 (22 FFV, always dry) consistently had the best visual and anatomical outcomes at Week 96, whereas patients allocated to Categories 1 (0 FFV, never dry) and 2 (1-7 FFV) consistently had the worst visual and anatomical outcomes. Variability in retinal thickness over time was lowest in Categories 4 and 5. CONCLUSION: Absence of retinal fluid at more visits after loading has a positive association with visual and anatomic outcomes in neovascular age-related macular degeneration patients, regardless of fluid type.

Associations between age-related macular degeneration and sleep dysfunction: A systematic review.

BACKGROUND: Age-related macular degeneration, a prevalent degenerative retinal disease, is associated with non-visual and psychosocial impairments that may affect sleep. In this systematic review, we evaluated associations between age-related macular degeneration (AMD) and sleep, highlighted knowledge gaps and provided evidence-based recommendations to clinicians to enable holistic management of AMD patients. METHODS: We searched PubMed, Embase and the Cochrane Central registries for papers published before May 2022. Non-English, qualitative studies and grey literature were excluded. Studies evaluating the association between AMD and sleep (including sleep disorders like insomnia and sleep apnea), and vice versa, were included. The quality of shortlisted studies was evaluated using the Newcastle Ottawa Scale. RESULTS: Six (two case-control studies, three longitudinal cohort studies and one cross-sectional study) of 551 studies were included in this review. Four studies found that AMD was associated with increased rates of sleep apnea and poorer reported sleep quality, while five studies showed that patients with sleep apnea or insomnia were at higher risk of developing AMD. Associations between self-reported sleep quantity and AMD were conflicting. No study evaluated the relationship between AMD and sleep using objective sleep assessment tools. CONCLUSION: Only a limited number of studies investigated associations between AMD and sleep. These studies suggest a bidirectional relationship between AMD and sleep dysfunction yet disagree on the relationship between sleep quantity and the likelihood of AMD. Additional studies, using objective characterisation of sleep in patients with AMD are required to confirm these findings.

Pulse waveform analysis on temporal changes in ocular blood flow due to caffeine intake: a comparative study between habitual and non-habitual groups.

PURPOSE: To evaluate and compare the temporal changes in pulse waveform parameters of ocular blood flow (OBF) between non-habitual and habitual groups due to caffeine intake. METHOD: This study was conducted on 19 healthy subjects (non-habitual 8; habitual 11), non-smoking and between 21 and 30 years of age. Using laser speckle flowgraphy (LSFG), three areas of optical nerve head were analyzed which are vessel, tissue, and overall, each with ten pulse waveform parameters, namely mean blur rate (MBR), fluctuation, skew, blowout score (BOS), blowout time (BOT), rising rate, falling rate, flow acceleration index (FAI), acceleration time index (ATI), and resistive index (RI). Two-way mixed ANOVA was used to determine the difference between every two groups where p < 0.05 is considered significant. RESULT: There were significant differences between the two groups in several ocular pulse waveform parameters, namely MBR (overall, vessel, tissue), BOT (overall), rising rate (overall), and falling rate (vessel), all with p < 0.05. In addition, the ocular pulse waveform parameters, i.e., MBR (overall), skew (tissue), and BOT (tissue) showed significant temporal changes within the non-habitual group, but not within the habitual group. The temporal changes in parameters MBR (vessel, tissue), skew (overall, vessel), BOT (overall, vessel), rising rate (overall), falling rate (overall, vessel), and FAI (tissue) were significant for both groups (habitual and non-habitual) in response to caffeine intake. CONCLUSION: The experiment results demonstrated caffeine does modulate OBF significantly and response differently in non-habitual and habitual groups. Among all ten parameters, MBR and BOT were identified as the suitable biomarkers to differentiate between the two groups.

Shared genetic variants for polypoidal choroidal vasculopathy and typical neovascular age-related macular degeneration in East Asians.

Polypoidal choroidal vasculopathy (PCV), a subtype of age-related macular degeneration (AMD) more frequently seen in East Asians, has both common and distinct clinical manifestations with typical neovascular AMD (tAMD). We aim to examine the extent to which common genetic variants are shared between these two subtypes. We performed the meta-analysis of association in a total of 1062 PCV patients, 1157 tAMD patients and 5275 controls of East Asian descent from the Genetics of AMD in Asians Consortium at the 34 known AMD loci. A total of eight loci were significantly associated with PCV, including age-related maculopathy susceptibility 2 (ARMS2)-HtrA serine peptidase 1 (HTRA1), complement factor H (CFH), C2-CFB-SKIV2L, CETP, VEGFA, ADAMTS9-AS2 and TGFBR1 (P<5 × 10-4) from the single-nucleotide polymorphism-based test and COL4A3 from the gene-based tests (Pgene=2.02 × 10-4). PCV and tAMD are genetically highly correlated (rg=0.69, P=4.68 × 10-3), with AMD known loci accounting for up to 36% variation. Weaker association for PCV was observed at ARMS2-HTRA1 (Pdif=4.39 × 10-4) and KMT2E-SRPK2(Pdif=4.43 × 10-3), compared with tAMD. Variants at CFH, CETP and VEGFA exhibited different association signals in East Asians, in contrast to those in European individuals. Our data suggest a substantially shared genetic susceptibility for PCV and tAMD, while also highlight the unique associations for PCV, which is useful in understanding the pathogenesis of PCV.

Blood vessel segmentation in color fundus images based on regional and Hessian features.

PURPOSE: To propose a new algorithm of blood vessel segmentation based on regional and Hessian features for image analysis in retinal abnormality diagnosis. METHODS: Firstly, color fundus images from the publicly available database DRIVE were converted from RGB to grayscale. To enhance the contrast of the dark objects (blood vessels) against the background, the dot product of the grayscale image with itself was generated. To rectify the variation in contrast, we used a 5 × 5 window filter on each pixel. Based on 5 regional features, 1 intensity feature and 2 Hessian features per scale using 9 scales, we extracted a total of 24 features. A linear minimum squared error (LMSE) classifier was trained to classify each pixel into a vessel or non-vessel pixel. RESULTS: The DRIVE dataset provided 20 training and 20 test color fundus images. The proposed algorithm achieves a sensitivity of 72.05% with 94.79% accuracy. CONCLUSIONS: Our proposed algorithm achieved higher accuracy (0.9206) at the peripapillary region, where the ocular manifestations in the microvasculature due to glaucoma, central retinal vein occlusion, etc. are most obvious. This supports the proposed algorithm as a strong candidate for automated vessel segmentation.

Cost-effectiveness of a National Telemedicine Diabetic Retinopathy Screening Program in Singapore.

PURPOSE: To determine the incremental cost-effectiveness of a new telemedicine technician-based assessment relative to an existing model of family physician (FP)-based assessment of diabetic retinopathy (DR) in Singapore from the health system and societal perspectives. DESIGN: Model-based, cost-effectiveness analysis of the Singapore Integrated Diabetic Retinopathy Program (SiDRP). PARTICIPANTS: A hypothetical cohort of patients aged 55 years with type 2 diabetes previously not screened for DR. METHODS: The SiDRP is a new telemedicine-based DR screening program using trained technicians to assess retinal photographs. We compared the cost-effectiveness of SiDRP with the existing model in which FPs assess photographs. We developed a hybrid decision tree/Markov model to simulate the costs, effectiveness, and incremental cost-effectiveness ratio (ICER) of SiDRP relative to FP-based DR screening over a lifetime horizon. We estimated the costs from the health system and societal perspectives. Effectiveness was measured in terms of quality-adjusted life-years (QALYs). Result robustness was calculated using deterministic and probabilistic sensitivity analyses. MAIN OUTCOME MEASURES: The ICER. RESULTS: From the societal perspective that takes into account all costs and effects, the telemedicine-based DR screening model had significantly lower costs (total cost savings of S$173 per person) while generating similar QALYs compared with the physician-based model (i.e., 13.1 QALYs). From the health system perspective that includes only direct medical costs, the cost savings are S$144 per person. By extrapolating these data to approximately 170 000 patients with diabetes currently being screened yearly for DR in Singapore's primary care polyclinics, the present value of future cost savings associated with the telemedicine-based model is estimated to be S$29.4 million over a lifetime horizon. CONCLUSIONS: While generating similar health outcomes, the telemedicine-based DR screening using technicians in the primary care setting saves costs for Singapore compared with the FP model. Our data provide a strong economic rationale to expand the telemedicine-based DR screening program in Singapore and elsewhere.

IMPROVED SPECIFICITY OF POLYPOIDAL CHOROIDAL VASCULOPATHY DIAGNOSIS USING A MODIFIED EVEREST CRITERIA.

PURPOSE: To evaluate the performance of polypoidal choroidal vasculopathy (PCV) diagnosis using fundus camera-based indocyanine green angiography, comparing a single sign of "subretinal focal hyperfluorescence" on indocyanine green angiography with a modification of the EVEREST criteria. METHODS: Color fundus photograph, flash fundus camera-based fluorescein angiography, and indocyanine green angiography of 241 eyes of 230 consecutive patients with exudative maculopathy due to PCV or typical age-related macular degeneration were graded independently by 2 retinal specialists using a modified EVEREST criteria, which requires the presence of subretinal focal hyperfluorescence plus any 1 of 5 additional criteria. Discordant cases were adjudicated by a senior retinal specialist to arrive at the final diagnosis. Sensitivity, specificity, and area under the receiver operating curve of subretinal focal hyperfluorescence versus the EVEREST criteria and combinations of individual EVEREST criteria were compared. RESULTS: Among the 241 eyes with exudative maculopathy, 131 eyes had PCV and 110 eyes had typical age-related macular degeneration. Using a single sign of subretinal focal hyperfluorescence alone for the diagnosis of PCV, sensitivity was 85.3% and specificity was 80.9%, with an area under the receiver operating curve of 83.1%. When applying the EVEREST definition, sensitivity was reduced to 78.4% but specificity improved to 87.1% with a similar area under the receiver operating curve of 82.8%. The frequency of individual criteria was highly variable, with stereo nodular appearance (73.7%) and orange nodule (55.0%) being the most common and branching vascular network, massive hemorrhage, and hypofluorescent halo in the presence of subretinal focal hyperfluorescence being less common (21.5%-28.1%). CONCLUSION: The EVEREST criteria have a higher specificity for the diagnosis of PCV than subretinal focal hyperfluorescence alone and may be applied to flash fundus camera-based indocyanine green angiography in a clinical setting. Stereo nodular appearance is the most important additional criterion.

KESTREL and KITE Phase 3 Studies: 100-Week Results With Brolucizumab in Patients With Diabetic Macular Edema.

PURPOSE: To report the 100-week outcomes from the KESTREL and KITE trials. DESIGN: Two phase 3, double-masked, active-controlled, randomized trials. METHODS: Patients with diabetic macular edema (DME) were randomized 1:1:1 to brolucizumab 3 mg/6 mg (BRO3/BRO6) or aflibercept 2 mg (AFL) in KESTREL (N = 566) or 1:1 to BRO6 or AFL in KITE (N = 360). BRO3/BRO6 arms received 5 loading doses every 6 weeks (q6w) followed by q12w dosing, with an option to adjust to q8w at predefined disease activity assessment visits. In KITE, at week 72, based on the disease stability assessment, treatment intervals could be extended by 4 weeks in the BRO6 arm. AFL arms received 5 monthly loading doses followed by fixed q8w dosing. RESULTS: At week 100, change from baseline in BCVA (letters) was +8.8 for BRO6 and +10.6 for AFL in KESTREL; and +10.9 for BRO6 and +8.4 for AFL in KITE. In both studies, fewer BRO6 subjects had intraretinal fluid and/or subretinal fluid than AFL subjects. Results were achieved with 32.9% (KESTREL) and 47.5% (KITE) of BRO6 subjects maintained on q12w and q12w/q16w dosing, respectively. Intraocular inflammation rates for BRO6 vs AFL were 4.2% vs 1.1% (KESTREL) and 2.2% vs 1.7% (KITE), of which retinal vasculitis rates were 0.5% vs 0% in KESTREL, with no cases in KITE. Retinal vascular occlusion rates were 1.6% vs 0.5% (KESTREL) and 0.6% in both treatment arms in KITE. CONCLUSIONS: Results show the long-term efficacy and durability of brolucizumab in improving visual and anatomical outcomes in DME; the overall safety profile of brolucizumab remained unchanged through year 2.

Rationale and protocol paper for the Asia Pacific Network for inherited eye diseases.

PURPOSE: There are major gaps in our knowledge of hereditary ocular conditions in the Asia-Pacific population, which comprises approximately 60% of the world's population. Therefore, a concerted regional effort is urgently needed to close this critical knowledge gap and apply precision medicine technology to improve the quality of lives of these patients in the Asia-Pacific region. DESIGN: Multi-national, multi-center collaborative network. METHODS: The Research Standing Committee of the Asia-Pacific Academy of Ophthalmology and the Asia-Pacific Society of Eye Genetics fostered this research collaboration, which brings together renowned institutions and experts for inherited eye diseases in the Asia-Pacific region. The immediate priority of the network will be inherited retinal diseases (IRDs), where there is a lack of detailed characterization of these conditions and in the number of established registries. RESULTS: The network comprises 55 members from 35 centers, spanning 12 countries and regions, including Australia, China, India, Indonesia, Japan, South Korea, Malaysia, Nepal, Philippines, Singapore, Taiwan, and Thailand. The steering committee comprises ophthalmologists with experience in consortia for eye diseases in the Asia-Pacific region, leading ophthalmologists and vision scientists in the field of IRDs internationally, and ophthalmic geneticists. CONCLUSIONS: The Asia Pacific Inherited Eye Disease (APIED) network aims to (1) improve genotyping capabilities and expertise to increase early and accurate genetic diagnosis of IRDs, (2) harmonise deep phenotyping practices and utilization of ontological terms, and (3) establish high-quality, multi-user, federated disease registries that will facilitate patient care, genetic counseling, and research of IRDs regionally and internationally.

Retinal nerve fiber layer thickness and cognitive ability in older people: the Lothian Birth Cohort 1936 study.

BACKGROUND: This study aims to examine the relationship between the retinal nerve fiber layer (RNFL) thickness as measured by optical coherence tomography (OCT) and lifetime cognitive change in healthy older people. METHODS: In a narrow-age sample population from the Lothian Birth Cohort 1936 who were all aged approximately 72 years when tested, participants underwent RNFL measurements using OCT. General linear modeling was used to calculate the effect of RNFL thickness on three domains; general cognitive ability (g-factor), general processing speed (g-speed) and general memory ability (g-memory) using age at time of assessment and gender as co-variates. RESULTS: Of 105 participants, 96 completed OCT scans that were of suitable quality for assessment were analyzed. Using age and gender as covariates, we found only one significant association, between the inferior area RNFL thickness and g-speed (p = 0.049, η2 = 0.045). Interestingly, when we included age 11 IQ as a covariate in addition to age and gender, there were several statistically significant associations (p = 0.029 to 0.048, η2 = 0.00 to 0.059) in a negative direction; decreasing scores on measures of g-factor and g-speed were associated with increasing RNFL thickness (r = -0.229 to -0.243, p < 0.05). No significant associations were found between RNFL thickness and g-memory ability. When we considered the number of years of education as a covariate, we found no significant associations between the RNFL thickness and cognitive scores. CONCLUSIONS: In a community dwelling cohort of healthy older people, increased RNFL thickness appeared to be associated with lower general processing speed and lower general cognitive ability when age 11 IQ scores were included as a covariate.

Automated detection of optic disk in retinal fundus images using intuitionistic fuzzy histon segmentation.

The human eye is one of the most sophisticated organs, with perfectly interrelated retina, pupil, iris cornea, lens, and optic nerve. Automatic retinal image analysis is emerging as an important screening tool for early detection of eye diseases. Uncontrolled diabetic retinopathy (DR) and glaucoma may lead to blindness. The identification of retinal anatomical regions is a prerequisite for the computer-aided diagnosis of several retinal diseases. The manual examination of optic disk (OD) is a standard procedure used for detecting different stages of DR and glaucoma. In this article, a novel automated, reliable, and efficient OD localization and segmentation method using digital fundus images is proposed. General-purpose edge detection algorithms often fail to segment the OD due to fuzzy boundaries, inconsistent image contrast, or missing edge features. This article proposes a novel and probably the first method using the Attanassov intuitionistic fuzzy histon (A-IFSH)-based segmentation to detect OD in retinal fundus images. OD pixel intensity and column-wise neighborhood operation are employed to locate and isolate the OD. The method has been evaluated on 100 images comprising 30 normal, 39 glaucomatous, and 31 DR images. Our proposed method has yielded precision of 0.93, recall of 0.91, F-score of 0.92, and mean segmentation accuracy of 93.4%. We have also compared the performance of our proposed method with the Otsu and gradient vector flow (GVF) snake methods. Overall, our result shows the superiority of proposed fuzzy segmentation technique over other two segmentation methods.

Decisional answer tree analysis of exudative age-related macular degeneration treatment outcomes.

The use of intravitreal ranibizumab in exudative age-related macular degeneration (eAMD) has become commonplace. We aim to investigate the early predictors of this treatment outcome. Seventy-one treatment-naive eyes of 71 patients with eAMD of all lesion subtypes who received intravitreal ranibizumab treatment and completed 12 months of follow-up were included. All patients were loaded with three injections of ranibizumab at monthly intervals. Further injections were given if clinically indicated based on logMAR best-corrected visual acuity (BCVA) and optical coherence tomography findings. Casenotes of eligible patients were reviewed retrospectively. The main outcome measure was logMAR BCVA change at month 12. The mean number of injections given over 12 months was 5.4 ± 1.9. A total of 88.7 % of the patients achieved visual stabilisation (loss of <15 letters) and 15.0 % achieved visual improvement (gain of ≥15 letters). The mean letter change at 12 months was +0.3 letters. Regression analysis showed that baseline BCVA and letter change at month 3 predicted visual acuity outcome at month 12 (baseline BCVA: t = 6.97, p < 0.001; letter change: t = 5.84, p < 0.01) but age, gender and eAMD in the fellow eye were not predictive. Finally, a decisional answer tree model demonstrated that letter change at month 3 was a strong predictor of visual outcome at month 12 with an overall accuracy of 69 %. We found that letter change from baseline at month 3 was strongly predictive of visual outcome at month 12.

Asian age-related macular degeneration phenotyping study: rationale, design and protocol of a prospective cohort study.

BACKGROUND: Current knowledge of the phenotypic characteristics (e.g. clinical features, risk factors, natural history and treatment response) of age-related macular degeneration (AMD) in Asians remains limited. This report summarizes the rationale and study design of a prospective observational study of Asian neovascular AMD, including polypoidal choroidovasculopathy variant. DESIGN: The Asian AMD phenotyping study is a prospective, observational clinical study of Asian patients with neovascular AMD or polypoidal choroidovasculopathy in three tertiary eye centres in Singapore. PARTICIPANTS: The study aims to recruit 500 consecutive patients from the retinal clinics of three tertiary eye centres in Singapore. METHODS: Standardized examination procedures include interviews, a comprehensive eye examination, digital photography of the retina, fundus fluorescein and indocyanine green angiography and spectral domain optical coherence tomography using a standardized protocol. Blood samples were collected for biochemical analyses and stored for genetic and proteomic studies. MAIN OUTCOME MEASURES: The aim of the study was to build a comprehensive database of clinical, angiographic, functional and natural history data of Asian AMD over a 12-month follow-up period. RESULTS: This article discusses the methodology and design of this prospective multi-centred study. CONCLUSION: This study will provide in-depth longitudinal data of the evolution of clinical features, risk factors, natural history and treatment pattern and response of Asian AMD and polypoidal choroidovasculopathy, allowing unique insights into pathogenesis and the design of new treatment strategies.

Fish-hook injury of the eye.

The objective of this case report is to report two cases of fish-hook injury to the eye and ocular adnexa with review of literature. Both patients with fish-hook injuries were professional fishermen. The first subject was hit in his right eye by a hook which became embedded in the right cornea. He cut off the line but made no attempt to remove the hook and presented to the emergency department with the hook hanging from his right eye. Under general anaesthesia, the hook was rotated out without causing any further damage to the cornea and intraocular structures. The second subject was reeling the hook back to shore when it hit him in the face and embedded itself in the upper eyelid. He was immediately taken to the emergency department and after careful examination the eye was found to be unharmed and the hook was removed through a small incision under local anaesthesia. Fish-hook injuries, though rare, can result in visual morbidity. The hook should be removed under careful examination using the correct technique. The shaft of the hook should be left long and no attempt should be made by the subject or any non-trained person to remove it as doing so can result in further damage.

Optical coherence tomography patterns as predictors of visual outcome in dengue-related maculopathy.

PURPOSE: The purpose of this study was to characterize the presentations, long-term outcomes, and visual prognostic factors in dengue-related maculopathy of 41 patients with dengue fever and impaired vision from dengue-related maculopathy in a retrospective noninterventional and observational series. METHODS: The medical records of patients with dengue-related maculopathy diagnosed over 18 months between July 2004 and December 2005 at The Eye Institute, Tan Tock Seng Hospital and Communicable Disease Center, Singapore, were reviewed and followed up for 24 months. Visual acuity and symptoms (presence of scotoma on automated visual fields and Amsler grid) were correlated with optical coherence tomography evaluation. RESULTS: Mean age was 28.7 years and there were more men (53.7%). The most common visual complaints were blurring of vision (51.2%) and central scotoma (34.1%). Most patients recovered best-corrected visual acuity >20/40. Optical coherence tomography showed 3 patterns of maculopathy: 1) diffuse retinal thickening; 2) cystoid macular edema; and 3) foveolitis. The visual outcome was independent of the extent of edema, but scotomata persisted longest in patients with foveolitis and shortest with those with diffuse retinal thickening. CONCLUSION: Dengue-associated ocular inflammation is an emerging ophthalmic condition and often involves the posterior segment. Prognosis is variable. Patients usually regain good vision but may retain persistent scotomata even at 2 years despite clinical resolution of the disease. Optical coherence tomography patterns in dengue maculopathy are useful for characterization, monitoring, and prognostication of the visual defect.

Diabetic Macular Edema Management in Asian Population: Expert Panel Consensus Guidelines.

PURPOSE: The aim of this consensus article was to provide comprehensive recommendations in the management of diabetic macular edema (DME) by reviewing recent clinical evidence. DESIGN: A questionnaire containing 47 questions was developed which encompassed clinical scenarios such as treatment response to anti-vascular endothelial growth factor and steroid, treatment side effects, as well as cost and compliance/reimbursement in the management of DME using a Dephi questionnaire as guide. METHODS: An expert panel of 12 retinal specialists from Singapore, Malaysia, Philippines, India and Vietnam responded to this questionnaire on two separate occasions. The first round responses were compiled, analyzed and discussed in a round table discussion where a consensus was sought through voting. Consensus was considered achieved, when 9 of the 12 panellists (75%) agreed on a recommendation. RESULTS: The DME patients were initially profiled based on their response to treatment, and the terms target response, adequate response, nonresponse, and inadequate response were defined. The panellists arrived at a consensus on various aspects of DME treatment such as need for classification of patients before treatment, first-line treatment options, appropriate time to switch between treatment modalities, and steroid-related side effects based on which recommendations were derived, and a treatment algorithm was developed. CONCLUSIONS: This consensus article provides comprehensive, evidence-based treatment guidelines in the management of DME in Asian population. In addition, it also provides recommendations on other aspects of DME management such as steroid treatment for stable glaucoma patients, management of intraocular pressure rise, and recommendations for cataract development.

Effects of primary glaucoma on sleep quality and daytime sleepiness of patients residing at an equatorial latitude.

AIM: To investigate the impact of primary glaucoma on sleep quality and daytime sleepiness of patients. METHODS: Prospective cross-sectional study with consecutive sampling in South-East Asian population was performed. Validated questionnaires: the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were administered prospectively. Subjects with non-glaucomatous optic neuropathy or concomitant retinal pathology were excluded. Glaucoma severity was based on HVF 24-2 perimetry. Binocular single vision was represented based on the better eye. Frequency of and predictive factors for poor sleep quality and excessive daytime sleepiness were compared. RESULTS: A total of 79 primary open angle glaucoma (POAG), 27 primary angle-closure glaucoma (PACG) patients, and 89 controls were recruited. PACG patients had higher median PSQI scores (P=0.004) and poorer sleep quality (P<0.001). Compared to controls, PACG patients were 3.34 times more likely to have poor sleep quality (P=0.008), which remained significant after adjustment for demographics (P=0.016) and predictive variables (P=0.013). PACG patients have poorer sleep quality when visual acuity (VA) was 6/15 or worse (P=0.009). Univariate and multivariate analysis of predictive variables for poor sleep quality and daytime sleepiness did not find statistical significance. CONCLUSION: PACG patients have poorer sleep quality but not daytime sleepiness. This is important in South-East Asian population with heavy disease burden. Evaluations on sleep disturbances can be considered to provide more holistic care.

A longitudinal study of choroidal changes following cataract surgery in patients with diabetes.

OBJECTIVE: To study the structural changes in the choroid of diabetic patients following cataract surgery, using choroidal vascularity index and choroidal thickness. METHODS: A prospective case-control study was conducted in 18 diabetic and 18 non-diabetic patients undergoing cataract surgery (phacoemulsification) in one eye. Enhanced depth imaging optical coherence tomography images were obtained before and after surgery. Niblack's image binarization of images was performed to derive the choroidal vascularity index. Independent sample T-test compared the differences of choroidal vascularity index and choroidal thickness between diabetic and non-diabetic patients. RESULTS: The baseline choroidal vascularity index was significantly lower in diabetic patients for both operated (mean difference vs non-diabetic: 0.0184, 95% CI: 0.004-0.0324, p = 0.012) and non-operated (mean difference vs non-diabetic: 0.0145, 95% CI: 0.003-0.0256, p = 0.012) eyes. Choroidal thickness increased following cataract surgery (diabetes: mean difference = 12.4, 95% CI: 0.70-24.0, adjusted p = 0.036; non-diabetic: mean difference = 21.0, 95% CI: 4.39-37.6, adjusted p = 0.011). CONCLUSION: Diabetic patients have reduced choroidal vascularity index than non-diabetic patients, suggestive of possible reduction in choroidal vascularity in diabetes. Choroidal thickness increased following cataract surgery in both diabetic and non-diabetic patients.

Automatic Detection of Preferred Retinal Locus (PRL) for Low Vision Rehabilitation using Oculometrics Analysis.

Low vision rehabilitation is an important step towards individuals with Age-related macular degeneration (AMD) regaining useful functional vision and quality of life. One of the key steps in low vision rehabilitation is the determination of the preferred retinal locus (PRL). Currently, localization of PRL is performed manually though the guidance of a low vision therapist and the process is highly time-consuming, labour-intensive and subjective. In this paper, we present an automated system to objectively and accurately locate an individual's PRL with the aid of gaze tracking technology. We also propose a graph-based method for false fixation detection to improve the system robustness. We validated the reliability of the system by using eye tracking technology to simulate central vision loss on people with normal vision. Experimental results show the potential use of eye tracking in detecting PRL for low vision rehabilitation.

Tissue engineering of retina and Bruch's membrane: a review of cells, materials and processes.

The biological, structural and functional configuration of Bruch's membrane (BM) is significantly relevant to age-related macular degeneration (AMD) and other chorioretinal diseases, and AMD is one of the leading causes of blindness in the elderly worldwide. The configuration may worsen along with the ageing of retinal pigment epithelium and BM that finally leads to AMD. Thus, the scaffold-based tissue-engineered retina provides an innovative alternative for retinal tissue repair. The cell and material requirements for retinal repair are discussed including cell sheet engineering, decellularised membrane and tissue-engineered membranes. Further, the challenges and potential in realising a whole tissue model construct for retinal regeneration are highlighted herein. This review article provides a framework for future development of tissue-engineered retina as a preclinical model and possible treatments for AMD.