Retinal Nerve Fiber Layer Optical Texture Analysis and 10-2 Visual Field Assessment in Glaucoma.

PURPOSE: To apply retinal nerve fiber layer (RNFL) optical texture analysis (ROTA) to 1) investigate the association between papillomacular and papillofoveal bundle defects with 10-2 visual field (VF) sensitivity abnormalities, and 2) integrate the information from RNFL bundle defect and 24-2 VF central test locations to determine the likelihood of 10-2 VF sensitivity abnormalities. DESIGN: Cross-sectional. METHODS: A total of 841 eyes (144 healthy, 317 glaucoma suspect, and 380 glaucoma) of 442 participants were included. Eyes underwent 24-2, and 10-2 VF testing and OCT for ROTA. The borders of RNFL defects were delineated from ROTA, and the involvement of the arcuate, papillomacular, and papillofoveal bundles was determined for each eye. Multilevel logistic regression analysis was applied to evaluate the structure-function association. RESULTS: Papillomacular (92.1%) and papillofoveal (37.9%) RNFL bundle defects were prevalent in eyes with glaucoma. A 10-2 VF location that was projected onto a papillomacular or a papillofoveal RNFL bundle defect had a significantly increased likelihood of reduced sensitivity (ORs of 18.61 at PDP < 5%, and 20.17 at TDP < 5%, respectively, P < .001 for both). When predicting the likelihood of VF abnormality in a 10-2 test location, noticeably higher odds ratios were observed when overlapping with an RNFL bundle defect, compared to when an abnormal corresponding 24-2 central point was present. CONCLUSIONS: Papillomacular and papillofoveal RNFL bundle defects are present in a considerable proportion of eyes with glaucoma. When detected, they significantly increase the likelihood of abnormality in the corresponding central VF test locations assessed by the 10-2 test.

Digital Technology Use Among Older Adults With Vision Impairment.

Importance: Telehealth has the potential to improve health for older adults, but many access disparities exist, including for those with vision impairment (VI). Objective: To examine the associations between VI and digital technology access measures in US older adults. Design, Setting, and Participants: This was a cross-sectional study that included Medicare beneficiaries 65 years and older. Beneficiary data were obtained from the National Health and Aging Trends Study (NHATS) 2021; data collection was conducted from June 2020 through January 2021. Data were analyzed September 2023. Exposure: VI, measured on categorical (distance and near VI [>0.30 logMAR], contrast sensitivity impairment [CSI; <1.55 logCS], and any VI [distance VI, near VI, or CSI]), and continuous (distance and near acuity [logMAR] and contrast sensitivity [logCS]) scales. Main Outcomes: Self-reported outcomes of digital technology access from the technological environment component of the NHATS. Results: Of the 2822 Medicare beneficiaries (mean [SD] age, 78.5 [5.6] years; 1605 female [54.7%]) included in this study, patients self-identified with the following race and ethnicity categories (weighted percentages): 575 non-Hispanic Black (8.0%), 132 Hispanic (7.0%), 2019 non-Hispanic White (81.7%), and 63 non-Hispanic other race (3.4%), which included American Indian, Alaska Native, Asian, multiracial, Native Hawaiian, Pacific Islander, or other specified race. A total of 1077 of 2822 patients (32.3%) had any VI. In multivariable logistic regression models, older adults with any VI had lower odds of having or knowing how to use a cellphone (odds ratio [OR], 0.58; 95% CI, 0.38-0.88), computer (OR, 0.61; 95% CI, 0.47-0.79), or tablet (OR, 0.68, 95% CI = 0.54-0.85) than peers without VI. In other models, near VI was associated with lower odds of having and knowing how to use a phone (OR, 0.56; 95% CI, 0.36-0.87), computer (OR, 0.57; 95% CI, 0.44-0.75), or tablet (OR, 0.65; 95% CI, 0.52-0.81) compared with no near VI. CSI was associated with lower odds of having and knowing how to use a phone (OR, 0.66; 95% CI, 0.45-0.99) or computer (OR, 0.72; 95% CI, 0.55-0.93) compared with no CSI. Distance VI was only associated with lower odds of having and knowing how to use a cellphone (OR, 0.63; 95% CI, 0.41-0.95). Any VI and individual categorical VI measures were not associated with other outcomes of digital health- and nonhealth-related experiences. Similar associations were noted when vision was examined on a continuous scale. However, worse distance acuity (per 0.1 logMAR) was associated with being less likely to visit with family or friends on a video call (OR, 0.91; 95% CI, 0.84-0.98) and to order or refill prescriptions online (OR, 0.90; 95% CI, 0.83-0.97). Conclusions and Relevance: Results suggest that older US adults with VI were less likely to have access to digital technology than peers without VI, although no differences were noted in the report of digital health- and nonhealth-related activities. These findings highlight the potential for inequities that may arise in telehealth for older adults with VI and the necessity to develop strategies to improve accessibility of telemedicine for all.

Assessment of visual function using mobile Apps.

With the advances in smartphone and tablet screens, as well as their processing power and software, mobile apps have been developed reporting to assess visual function. This review assessed those mobile apps that have been evaluated in the scientific literature to measure visual acuity, reading metrics, contrast sensitivity, stereoacuity, colour vision and visual fields; these constitute just a small percentage of the total number of mobile apps reporting to measure these metrics available for tablets and smartphones. In general, research suggests that most of the mobile apps evaluated can accurately mimic most traditionally paper-based tests of visual function, benefitting from more even illumination from the backlit screen and aspects such as multiple tests and versions (to minimise memorisation) being available on the same equipment. Some also utilise the in-built device sensors to monitor aspects such as working distance and screen tilt. As the consequences of incorrectly recording visual function and using this to inform clinical management are serious, clinicians must check on the validity of a mobile app before adopting it as part of clinical practice.

VALIDATION OF M-CHARTS FOR QUANTITATIVE ASSESSMENT OF METAMORPHOPSIA FOLLOWING RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

PURPOSE: To validate the quantitative assessment of metamorphopsia in rhegmatogenous retinal detachment (RRD) using M-CHARTS by determining its correlation with subjective reporting of metamorphopsia with a validated metamorphopsia questionnaire (modified MeMoQ). METHODS: The Research Ethics Board approved a prospective observational study carried out at St. Michael's Hospital, Toronto, Canada. Patients with primary, unilateral RRD and healthy controls were included. Metamorphopsia at 3 months was assessed with modified MeMoQ and M-CHARTS. RESULTS: One hundred patients (50 with RRD, 50 controls) were included. Seventy percent (35/50) of the RRD group had metamorphopsia with M-CHARTS and 80% (40/50) with MeMoQ. The modified MeMoQ and total M-CHARTS scores were significantly higher in patients with RRD compared with controls ( P < 0.0001). Cronbach's alpha reliability coefficient was 0.934 in the RRD group. Horizontal, vertical, and total M-CHARTS scores were significantly correlated with MeMoQ scores (r s  = 0.465, P = 0.0007; r s  = 0.405, P = 0.004; r s  = 0.475, P = 0.0005, respectively). M-CHARTS was 72.7% sensitive and 94.6% specific for detection of metamorphopsia (positive score ≥ 0.2), with an area under the receiver operating characteristic curve = 0.801. A stronger correlation was found in patients who scored ≥0.2 on the M-CHARTS and reported metamorphopsia with the MeMoQ (r s  = 0.454, P = 0.001). CONCLUSION: The authors have validated M-CHARTS as a tool to quantitatively assess metamorphopsia in patients with RRD, which is significantly correlated with patient-reported outcomes using the MeMoQ. A total score of ≥0.2 with M-CHARTS was more strongly correlated with MeMoQ.

Do Black and Asian individuals wait longer for treatment? A survival analysis investigating the effect of ethnicity on time-to-clinic and time-to-treatment for diabetic eye disease.

AIMS/HYPOTHESIS: This study explored the impact of ethnicity on time-to-clinic, time-to-treatment and rates of vision loss in people referred to hospital with diabetic eye disease. METHODS: A survival analysis was performed on all referrals from an inner-city diabetic eye screening programme to a tertiary hospital eye service between 1 October 2013 and 31 December 2017. Exclusion criteria were failure to attend hospital, distance visual acuity in both eyes too low to quantify with the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart and treatment received prior to referral. Demographic and screening grade data were collected at the point of referral. Small-area statistics and census data were used to calculate indices of multiple deprivation. The main outcome measures were time taken from the date of referral for an individual to achieve the following: (1) attend the first hospital clinic appointment; (2) receive the first macular laser, intravitreal anti-vascular endothelial growth factor injection or pan-retinal photocoagulation treatment, in either eye; and (3) lose at least ten ETDRS letters of distance visual acuity, in either eye. RESULTS: Of 2062 referrals, 1676 individuals were included. Mean age (± SD) was 57.6 ± 14.7 years, with 52% male sex and 86% with type 2 diabetes. The ethnicity profile was 52% Black, 30% White, 10% Asian and 9% mixed/other, with similar disease severity at the time of referral. Time-to-clinic was significantly longer for Asian people than for Black people (p = 0.03) or White people (p = 0.001). Time-to-treatment was significantly longer for Black people than for White people (p = 0.02). Social deprivation did not significantly influence time-to-treatment. There were no significant differences in the rates of vision loss between ethnic groups. CONCLUSIONS/INTERPRETATION: Black people wait longer for hospital eye treatment compared with their White counterparts. The reasons for this delay in treatment warrant further investigation.

A Strategy for Seeding Point Error Assessment for Retesting (SPEAR) in Perimetry Applied to Normal Subjects, Glaucoma Suspects, and Patients With Glaucoma.

PURPOSE: We sought to determine the impact of seeding point errors (SPEs) as a source of low test reliability in perimetry and to develop a strategy to mitigate this error early in the test. DESIGN: Cross-sectional study. METHODS: Visual field test results from 1 eye of 364 patients (77 normal eyes, 178 glaucoma suspect eyes, and 109 glaucoma eyes) were used to develop models for identifying SPE. Two test cohorts (326 undertaking Swedish interactive thresholding algorithm [SITA]-Faster and 327 glaucoma eyes undertaking SITA-Standard) were used to prospectively evaluate the models for identifying SPEs. Global visual field metrics were compared among reliable and unreliable results. Regression models were used to identify factors distinguishing SPEs from non-SPEs. Models were evaluated using receiver operating characteristic (ROC) curves. RESULTS: In the test cohorts, SITA-Faster produced a higher rate of unreliable visual field results (30%-49.7%) compared with SITA-Standard (10.8%-16.6%). SPEs contributed to most of the unreliable results in SITA-Faster (57.5%-64.9%) compared with gaze tracker deviations accounting for most of the unreliable results in SITA-Standard (40%-77.8%). In SITA-Faster, results with SPEs had worse global indices and more clusters of sensitivity reduction than reliable results. Our best model (using 9 test locations) can identify SPEs with an area under the ROC curve of 0.89. CONCLUSION: SPEs contribute to a large proportion of unreliable visual field test results, particularly when using SITA-Faster. We propose a useful model for identifying SPEs early in the test that can then guide retesting using both SITA algorithms. We provide a simplified framework for the perimetrist to improve the overall fidelity of the test result.

Self-reported visual difficulties in Europe and related factors: a European population-based cross-sectional survey.

PURPOSE: There is a relative paucity of self-reported vision problems data in European countries. METHODS: In this context, we investigated self-reported vision problems through European Health Interview Survey 2, a cross-sectional European population survey based on a standardized questionnaire including 147 medical, demographic and socioeconomic variables applied to non-institutionalized individuals aged 15 years or more in 28 European countries, in addition to Iceland and Norway. RESULTS: The survey included 311 386 individuals (54.18% women), with overall crude prevalence of self-reported vision problems of 2.07% [95% CI; 2.01-2.14]. Among them, 1.70 % [1.61-1.78] of men, 2.41% [2.31-2.51] of women and 4.71% [4.53-4.89] of individuals aged 60 or more reported to have a lot of vision problems or to be not able to see. The frequency of self-reported vision problems was the highest in Eastern European countries with values of 2.43% [2.30-2.56]. In multivariate analyses, limiting long-standing illness, depression, daily smoking, lack of physical activity, lower educational level and social isolation were associated with self-reported vision problems with ORs of 2.66 [2.42-2.92], 2.16 [2.01-2.32], 1.11 [1.01-1.23], 1.31 [1.21-1.42], 1.29 [1.19-1.40] and 1.45 [1.26-1.67], respectively, while higher income was associated with less self-reported vision problems with OR of 0.80 [0.73-0.86]. CONCLUSIONS: This study demonstrated inequalities in terms of prevalence of self-reported vision problems in Europe, with higher prevalence in Eastern European countries and among women and older individuals.

Role of socio-economic factors in visual impairment and progression of diabetic retinopathy.

BACKGROUND: To investigate the longitudinal associations between person-level and area-level socioeconomic status (PLSES and ALSES, respectively) with diabetic retinopathy (DR) and visual impairment (VI) in Asians with diabetes mellitus (DM). METHODS: In this population-based cohort study, we included 468 (39.4%) Malays and 721 (60.6%) Indians with DM, with a mean age (SD) of 58.9 (9.1) years; 50.6% were female and the mean follow-up duration was 6.2 (0.9) years. Individual PLSES parameters (education, monthly income and housing type) were quantified using questionnaires. ALSES was assessed using the Socioeconomic Disadvantage Index derived from Singapore's 2010 areal census (higher scores indicate greater disadvantage). Incident DR and VI were defined as absent at baseline but present at follow-up, while DR and VI progression were defined as a ≥1 step increase in severity category at follow-up. Modified Poisson regression analysis was used to determine the associations of PLSES and ALSES with incidence and progression of DR and VI, adjusting for relevant confounders. RESULTS: In multivariable models, per SD increase in ALSES score was associated with greater DR incidence (risk ratio (95% CI) 1.27 (1.13 to 1.44)), DR progression (1.10 (1.00 to 1.20)) and VI incidence (1.10 (1.04 to 1.16)), while lower PLSES variables were associated with increased DR (low income: 1.68 (1.21 to 2.34)) and VI (low income: 1.44 (1.13 to 1.83); ≤4 room housing: 2.00 (1.57 to 2.54)) incidence. CONCLUSIONS: We found that both PLSES and ALSES variables were independently associated with DR incidence, progression and associated vision loss in Asians. Novel intervention strategies targeted at low socioeconomic status communities to decrease rates of DR and VI are warranted.

Association of Vision Impairment With Preventive Care Use Among Older Adults in the United States.

Importance: Preventive care is associated with decreased morbidity and mortality among older adults. Vision impairment may be a barrier to accessing care and health promotion information and therefore may contribute to decreased preventive care uptake. Objective: To examine the association between self-reported vision impairment and uptake of preventive care services (ie, breast and colon cancer screenings and influenza and pneumococcal vaccinations). Design, Setting, and Participants: Cross-sectional study using the 2015 and 2018 National Health Interview Survey (NHIS) and 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) data, national surveys of US residents conducted through in-person household interviews in NHIS, and state-based telephone interviews in BRFSS. Participants included respondents 50 years and older based on eligibility for each preventive care service examined. Exposures: Vision impairment, defined as self-reported trouble seeing, in NHIS, and self-reported blindness/serious difficulty seeing in BRFSS. Main Outcomes and Measures: Self-reported uptake of breast cancer screening (women aged 50-74 years), colon cancer screening (aged 50-74 years), influenza vaccination (50 years and older), and pneumococcal vaccination (65 years and older). Multivariable regression models adjusted for relevant confounders, including age, were used to examine the uptake of each preventive care service by vision impairment status. Results: Among NHIS participants, older US individuals with vision impairment (prevalence between 14.3% and 16.3% in the different age groups; n = 12 120-29 654) were less likely to report breast cancer screening (odds ratio [OR], 0.82; 95% CI, 0.71-0.96) and colon cancer screening (OR, 0.89; 95% CI, 0.79-0.99) but not influenza (OR, 1.06; 95% CI, 0.97-1.15) and pneumococcal vaccination (OR, 1.03; 95% CI, 0.91-1.16), as compared with their counterparts without vision impairment. In BRFSS (n = 228 649-530 027), those with vision impairment (5.9%-6.8%) were less likely than those without vision impairment to report breast cancer screening (OR, 0.67; 95% CI, 0.59-0.75), colon cancer screening (OR, 0.70; 95% CI, 0.65-0.76), and pneumococcal vaccination (OR, 0.89; 95% CI, 0.81-0.99) but not influenza vaccination (OR, 0.95; 95% CI, 0.89-1.00). Conclusions and Relevance: Older Americans with vision impairment may be less likely to use cancer-related preventive services as compared with their counterparts without vision impairments. These findings suggest that interventions to improve access to health information and health care services for individuals with vision impairment may be needed to improve cancer screening among this population.

Clinical Features and Burden Scores in Japanese Pediatric Migraines With Brainstem Aura, Hemiplegic Migraine, and Retinal Migraine.

BACKGROUND: Migraines are a broad spectrum of disorders classified by the type of aura with some requiring attentive treatment. Vasoconstrictors, including triptans, should be avoided in the acute phase of migraines with brainstem aura, in hemiplegic migraine, and in retinal migraine. This study investigated the characteristics and burden of these migraines. METHODS: Medical charts of 278 Japanese pediatric patients with migraines were retrospectively reviewed. Migraine burden of migraines with brainstem aura, hemiplegic migraines, and retinal migraine was assessed using the Headache Impact Test-6™ (HIT-6) and the Pediatric Migraine Disability Assessment scale (PedMIDAS). RESULTS: Of 278 patients screened, 12 (4.3%) patients with migraines with brainstem aura (n = 5), hemiplegic migraines (n = 2), and retinal migraine (n = 5) were enrolled in the study. All patients had migraine with/without typical aura, whereas some patients had coexisting migraine with another type of headache (chronic tension-type headache in 3 patients, and 1 each with frequent episodic tension-type headache, headache owing to medication overuse, and chronic migraine). Migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients with coexisting headaches had higher HIT-6 or PedMIDAS scores, whereas migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients without coexisting headache did not show high HIT-6 or PedMIDAS scores. CONCLUSION: All migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients experienced migraine with or without typical aura, and some patients having other coexisting headaches also had high PedMIDAS and HIT-6 scores. PedMIDAS and HIT-6 should not be considered diagnostic indicators of migraines with brainstem aura, hemiplegic migraines, or retinal migraine. In clinical practice for headaches in children, careful history taking and proactive assessment of the aura are needed for accurate diagnosis of migraines with brainstem aura, hemiplegic migraines, and retinal migraine.

Relationship Between Contact Lens Sensor Output Parameters and Visual Field Progression in Open-angle Glaucoma: Assessment of a Practical Tool to Guide Clinical Risk-assessment.

PURPOSE: In recent years, new technologies have emerged to better analyze and interpret intraocular pressure (IOP) fluctuations. Among them is the progression report (PR), an algorithm based on continuous contact lens sensor (CLS) readings to estimate the likelihood of fast visual field (VF) glaucomatous progression. The objective of this study is to validate the PR. METHODS: In this retrospective study, 30 open-angle glaucoma patients were enrolled. Twenty-four hours IOP-related variations were recorded using a CLS. Recordings were used to generate PR. The likelihood of fast VF progression (<-1 dB/y mean deviation) was estimated by 2 masked assessors based on clinical parameters. At least 3 VF were performed over the 2 years following the initial assessment, to determine actual progression. RESULTS: Mean age was 65.9±10.45 years, with a mean baseline mean deviation of -5.4±5.1. After a mean follow-up of 29.5±12.9 months, 26.7% of eyes were assessed as fast progressors (-2.9±1.9 dBs/y). The average risk-score attributed by the PR was 42% [41% (slow) vs. 44% (fast); P=0.035]. Correlations between the 2 assessors were good (r=0.59), and identical to that between PR and the averaged assessors' gradings. Correlations between mean deviation progression rates and PR, Assessor 1 and Assessor 2's gradings were, r=0.57, 0.31, and 0.43, respectively. CONCLUSIONS: PR provided comparable predictions of the risk of fast VF progression as did physician estimates based on all available clinical data. With their relationship to the eye's biomechanical properties and the ocular tissues' response to pressure variations, CLS recordings may offer new information that complements conventional examinations.

Clinical Assessment of Scleral Canal Area in Glaucoma Using Spectral-Domain Optical Coherence Tomography.

PURPOSE: To investigate anterior scleral canal (ASC) area in the eyes with glaucoma using spectral-domain optical coherence tomography (SDOCT). DESIGN: Cross-sectional study. METHODS: This study included 206 eyes of 103 patients with glaucoma, classified as 66 eyes of 33 patients with unilateral glaucoma and 140 eyes of 70 patients with bilateral glaucoma. Radial scan enhanced depth imaging SDOCT centered on the optic disc was performed, and parameters that present ASC area such as ASC opening and the largest ASC area were obtained in each eye. The largest ASC area was the largest cross-sectional area of the ASC region identified between the ASC opening and anterior lamina cribrosa insertion. These parameters were compared between eyes with and without glaucoma in unilateral glaucoma, and eyes with worse and better visual field defect (VFD) in bilateral glaucoma. RESULTS: In the patients with unilateral glaucoma, ASC opening and largest ASC area were significantly larger in the eyes with glaucoma than in those without glaucoma (both P < .001). In bilateral glaucoma, these parameters were significantly larger in the eyes with worse VFD than in those with better VFD (P = .0080 and P = .0018, respectively). Intereye differences of the ASC parameters in the glaucoma patients were significantly greater than that in the normal subjects. CONCLUSIONS: Significantly larger ASC area was first observed in the living human eyes with glaucoma compared to the normal eyes. Further longitudinal studies are required to determine if the ASC area is useful in the prevention and treatment of glaucoma.

Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review.

AIMS: To synthesize the evidence on the impact of diabetic retinopathy and diabetic macular oedema from the patient perspective. METHODS: A systematic literature review was conducted using MEDLINE Complete, PsycINFO, EMBASE and AMED. We included articles investigating the impact of the condition on quality of life, symptoms, visual functioning, activities of daily living, well-being, social functioning, and financial status. The studies evaluated were observational, including cross-sectional, prospective cohort and retrospective cohort designs. Outcome data were extracted and synthesized. RESULTS: Searches yielded 5114 publications. After screening, 85 studies were included, measuring the following outcomes: visual functioning (n=46); quality of life (n=22); well-being (n=16); functional status (n=5); work (n=4); and visual task performance (n=2). Diabetic retinopathy has a considerable impact on visual functioning and this is greater in people with greater disease severity. Diabetic retinopathy significantly limits activities including working, driving, walking and reading, and has the potential to have a negative impact on psychological well-being. CONCLUSIONS: Diabetic retinopathy is associated with poor self-reported visual functioning, well-being, and health-related quality of life. Ability to perform basic everyday tasks appears to diminish with disease severity. Some studies suggest impaired mobility and problems with work, but there are gaps in this evidence.

Cerebral Visual Impairment and Clinical Assessment: The European Perspective.

This paper summarizes the multidisciplinary pediatric assessment methods of 3 European centers for identifying and assessing cerebral visual impairment in childhood. It describes a comprehensive neurodevelopmental assessment evaluation in which visual aspects play an important part. Developmental trajectories and the heterogeneity of the clinical picture are emphasized. Multidisciplinary ophthalmology and neurodisability/neurology teamwork together with the parent and teachers, to reach an integrated and individualized perspective for the individual child, are described. This comprehensive assessment is the starting point for habilitation programs and interventions, that can support and meet the child's needs and help them reach their optimal potential. Future developments in classification of the cerebral visual impairment conditions, building on the child's individual assessment profile, will further enhance the direction of clinical, educational, and research progress.

The Assessment of Visual Function and Functional Vision.

The complete assessment of vision-related abilities should consider visual function (the performance of components of the visual system) and functional vision (visual task-related ability). Assessment methods are highly dependent upon individual characteristics (eg, the presence and type of visual impairment). Typical visual function tests assess factors such as visual acuity, contrast sensitivity, color, depth, and motion perception. These properties each represent an aspect of visual function and may impact an individual's level of functional vision. The goal of any functional vision assessment should be to measure the visual task-related ability under real-world scenarios. Recent technological advancements such as virtual reality can provide new opportunities to improve traditional vision assessments by providing novel objective and ecologically valid measurements of performance, and allowing for the investigation of their neural basis. In this review, visual function and functional vision evaluation approaches are discussed in the context of traditional and novel acquisition methods.

Profiling Children With Cerebral Visual Impairment Using Multiple Methods of Assessment to Aid in Differential Diagnosis.

Cerebral (cortical) visual impairment (CVI), the primary cause of visual impairment in children in high-income countries, is increasing globally due to improved life-saving measures for premature and full-term infants. Yet the consequences of this condition are only beginning to be understood and addressed. According to the topography, site, and the extent of the pathology, the deficit may variably concern central visual functions, visual field, perception of movement, visual analysis, visual exploration, attention, or visual memory, as well as visual guidance of movement. Each affected child has a unique clinical picture, which needs to be identified and individually profiled. This is probably the underlying reason that CVI is commonly underdiagnosed or misdiagnosed, especially in children, and, as a consequence, the full range of potential behavioral outcomes are not identified and adequately addressed. The present paper shows how the use of multiple methods of assessment can improve understanding of children with CVI.

NGRID: A novel platform for detection and progress assessment of visual distortion caused by macular disorders.

This paper presents a new graphical macular interface system (GMIS) for accurate, rapid, and quantitative measurement of visual distortion (VD) in the central vision of patients suffering from macular disorders. In this system, a series of predefined graphical patterns or multiple grids (NGRID) are randomly selected from a library of patterns and visualized on the screen, then the VDs identified by the patient are recorded as binary codes using various control methods including speech recognition. Scalable Vector Graphics (SVG) is used to generate the patterns and save them into a central library. Based on the projected patterns and the patients' responses, a VD graph or so-called heatmap is generated for eye-care purposes. We demonstrate and discuss the functionality of the proposed system for the detection and progress assessment of a macular condition in patients suffering from Central Serous Chorioretinopathy (CSR). Also, we characterize the proposed technique to evaluate the systematic error and response time on healthy human subjects with normal vision. Based on these results, the voice recognition input method exhibits a lower error but a higher response time compared to other input devices. We run the proposed NGRID VD technique to evaluate the effect of CSR on the visual field of a CSR patient. The generated heatmaps are in agreement with standard Optical Coherence Tomography (OCT) images obtained at different times from both the left and right eyes. These results reveal the applicability of the proposed technique for the detection and assessment of macular disorders. Based on these results, the proposed NGRID platform shows great promise for use as an alternative solution for in-home monitoring of various macular disorders and as a means of forwarding responses to secured cloud facilities for future data analysis.

Optical Coherence Tomography Assessment of Risk Factors for Visual Acuity Decline After Trabeculectomy in Patients With Advanced Open-Angle Glaucoma.

PRéCIS:: Thinning of the macular retinal nerve fiber layer (mRNFL) and ganglion cell complex in the papillomacular bundle area contributed significantly to visual acuity (VA) decline in advanced glaucoma patients after trabeculectomy. PURPOSE: To identify structural parameters that could predict VA decline after trabeculectomy in patients with advanced open-angle glaucoma. PATIENTS AND METHODS: Retrospective review of 74 eyes of 74 patients with advanced glaucoma (defined as mean deviation -12 dB or worse) and best-corrected VA (BCVA) of ≥40/200. All patients underwent trabeculectomy between 2013 and 2016. Measurements included intraocular pressure, BCVA, visual field parameters, and optical coherence tomography-derived parameters [(in both the overall macula and within the papillomacular bundle (PMB)], including mRNFL thickness (mRNFLT), ganglion cell layer/inner plexiform layer thickness, and ganglion cell complex thickness. Measurements were obtained before and after surgery, and follow-up was at least 6 months. We grouped the patients according to whether they underwent VA decline of >3 lines of BCVA after 6 months. We then compared the VA-decline group and the stable-VA group and performed a receiver operating characteristic analysis to determine optimal cut-off values for predicting VA decline. RESULTS: The VA-decline group comprised 7 eyes (9.5%) and had lower preoperative mean deviation (P=0.021) and thinner mRNFL, ganglion cell layer/inner plexiform layer, and ganglion cell complex in the PMB (P=0.003, 0.135, and 0.023, respectively) than the stable-VA group. The cut-off values for predicting VA decline were 9.5 µm for mRNFLT in the PMB. CONCLUSIONS: This study found that thin mRNFLT in the PMB were risk factors for VA decline after trabeculectomy.

Quantitative assessment of outer retinal folds on enface optical coherence tomography after vitrectomy for rhegmatogenous retinal detachment.

We aimed to investigate the possible causes of metamorphopsia for rhegmatogenous retinal detachment (RRD) based on findings of enface optical coherence tomography (OCT). The study was a retrospective, consecutive case series of 33 eyes with macula-off RRD. Metamorphopsia was measured by M-CHARTS and enface OCT images covering a macular area of 6 × 6 mm square obtained at 1, 3, and 6 months postoperatively. Within the outer retinal slabs of enface OCT, multiple lines that looked like folds were delineated in all eyes at month 1, and we succeeded in extracting images of folds by subtracting retinal vessels. We calculated their density by an image-processing technique. The mean M-CHARTS scores were 0.62 ± 0.47 at month 1 and 0.30 ± 0.29 at month 6 (P < 0.001). The fold density was 8.3 ± 4.2 at month 1 and 6.1 ± 3.1 at month 6 (P = 0.0044). The M-CHARTS scores at 6 months were significantly associated with the fold density at 1 month (r = 0.515, P = 0.002). In conclusion, enface OCT visualized the outer retinal folds in eyes that had undergone successful RRD surgery, and a larger number of folds was related to the remaining metamorphopsia.

Light disturbance analysis in the controlled randomized clinical trial MiSight® Assessment Study Spain (MASS).

PURPOSE: To evaluate the perception of light disturbances (LD) in children wearing Dual Focus (DF) MiSight® contact lenses (CLs) for myopia control compared with children wearing single vision spectacles (SV). METHODS: This was a randomized, controlled clinical trial involving subjects aged 8-12 with myopia of -0.75 to -4.00D and astigmatism <1.00D allocated to MiSight® study CLs group or control group wearing SV. LD was determined at baseline, 12 and 24 months visit with a validated device, Light Disturbance Analyzer (LDA) to determine the shape, size and regularity of the LD phenomena with parameters of Light Disturbance Index (LDI) Best Fit Circle (BFC) and Standard Deviation between LD and BFC (BFCIrreg.SD). RESULTS: 74 children completed the study, 41 in the CL group and 33 in the SV group. SV group didn´t show any significant differences between monocular and binocular LD measurements throughout the study. Binocular BFCRadius was smaller at 24 months visit compared with 12 month visit (p < 0.05) and for BFCIrreg.SD was significantly smaller at 24 month visit compared with baseline (p < 0.05). In MiSight® group, binocular and monocular LDI, BFCRadius and BFCIrreg.SD measurements didn't show any significant change between 12 and 24 month visits (p > 0.05). However, monocular BFCIrreg. as well as monocular and binocular BFCIrreg.SD showed a significant decrease at 24 month visit compared with 12 month visit. CONCLUSIONS: DF lenses increase the monocular light disturbance perception compared with a single vision spectacle correction. However, this effect decreased over the follow-up time and presented a significant binocular attenuation effect.