Standard automated perimetry for glaucoma and diseases of the retina and visual pathways: current and future perspectives.

Static automated perimetry (SAP) remains a mainstay of functional assessment of the visual field in diseases of the visual pathway, such as glaucoma and age-related macular degeneration. The fundamental psychophysical task of responding to stimuli of different levels of contrast has remained minimally changed since its inception in the 1980s, and this is potentially the root of several unresolved issues involving the technique. Enduring issues include the optimisation of SAP parameters for maximising defect detection, the influence of subjective behaviour on the response, structure-function discordance, and ageing- and disease-related changes of the visual pathway. Addressing these issues has been a focus of our research program and is the subject of this manuscript. We will review some of the basic psychophysical principles and methods that have contributed to the development of SAP and their contributions to its output measurements. Parameters that are interrogated include stimulus size and background luminance and their modification to improve defect defection in glaucoma and age-related macular degeneration. We propose frameworks for optimising testing parameters and leveraging the results for changing clinical care. In our pursuit of optimising the structure-function relationship in the eye, several areas of research have been developed and explored, including: the reconciliation of subjective responses in perimetry; by minimising sources of biases, such as Method of Limits we have been able to equate static and kinetic perimetry outputs in relation to underlying structural loci. This also formed the basis for our clustering framework, which groups together statistically similar structural and functional test locations to maximise structure-function concordance. Throughout the manuscript, we review the scientific underpinnings of clinical measurements, framing application into real-world patients to improve clinical practice.

Exploring the relationship between 24-2 visual field and widefield optical coherence tomography data across healthy, glaucoma suspect and glaucoma eyes.

PURPOSE: To utilise ganglion cell-inner plexiform layer (GCIPL) measurements acquired using widefield optical coherence tomography (OCT) scans spanning 55° × 45° to explore the link between co-localised structural parameters and clinical visual field (VF) data. METHODS: Widefield OCT scans acquired from 311 healthy, 268 glaucoma suspect and 269 glaucoma eyes were segmented to generate GCIPL thickness measurements. Estimated ganglion cell (GC) counts, calculated from GCIPL measurements, were plotted against 24-2 SITA Faster visual field (VF) thresholds, and regression models were computed with data categorised by diagnosis and VF status. Classification of locations as VF defective or non-defective using GCIPL parameters computed across eccentricity- and hemifield-dependent clusters was assessed by analysing areas under receiver operating characteristic curves (AUROCCs). Sensitivities and specificities were calculated per diagnostic category. RESULTS: Segmented linear regression models between GC counts and VF thresholds demonstrated higher variability in VF defective locations relative to non-defective locations (mean absolute error 6.10-9.93 dB and 1.43-1.91 dB, respectively). AUROCCs from cluster-wide GCIPL parameters were similar across methods centrally (p = 0.06-0.84) but significantly greater peripherally, especially when considering classification of more central locations (p < 0.0001). Across diagnoses, cluster-wide GCIPL parameters demonstrated variable sensitivities and specificities (0.36-0.93 and 0.65-0.98, respectively), with the highest specificities observed across healthy eyes (0.73-0.98). CONCLUSIONS: Quantitative prediction of VF thresholds from widefield OCT is affected by high variability at VF defective locations. Prediction of VF status based on cluster-wide GCIPL parameters from widefield OCT could become useful to aid clinical decision-making in appropriately targeting VF assessments.

Retinal sensitivity changes in early/intermediate AMD: a systematic review and meta-analysis of visual field testing under mesopic and scotopic lighting.

Visual fields under mesopic and scotopic lighting are increasingly being used for macular functional assessment. This review evaluates its statistical significance and clinical relevance, and the optimal testing protocol for early/intermediate age-related macular degeneration (AMD). PubMed and Embase were searched from inception to 14/05/2022. All quality assessments were performed according to GRADE guidelines. The primary outcome was global mean sensitivity (MS), further meta-analysed by: AMD classification scheme, device, test pattern, mesopic/scotopic lighting, stimuli size/chromaticity, pupil dilation, testing radius (area), background luminance, adaptation time, AMD severity, reticular pseudodrusen presence, and follow-up visit. From 1489 studies screened, 42 observational study results contributed to the primary meta-analysis. Supported by moderate GRADE certainty of the evidence, global MS was significantly reduced across all devices under mesopic and scotopic lighting with large effect size (-0.9 [-1.04, -0.75] Hedge's g, P < 0.0001). The device (P < 0.01) and lighting (P < 0.05) used were the only modifiable factors affecting global MS, whereby the mesopic MP-1 and MAIA produced the largest effect sizes and exceeded test-retest variabilities. Global MS was significantly affected by AMD severity (intermediate versus early AMD; -0.58 [-0.88, -0.29] Hedge's g or -2.55 [3.62, -1.47] MAIA-dB) and at follow-up visit (versus baseline; -0.62 [-0.84, -0.41] Hedge's g or -1.61[-2.69, -0.54] MAIA-dB). Magnitudes of retinal sensitivity changes in early/intermediate AMD are clinically relevant for the MP-1 and MAIA devices under mesopic lighting within the central 10° radius. Other factors including pupil dilation and dark adaptation did not significantly affect global MS in early/intermediate AMD.

Pupil size change in agricultural workers exposed to pesticides.

CLINICAL RELEVANCE: Pupil size evaluation using clinical examination may be important for detecting and monitoring individuals at risk of neurotoxic effects from chemical exposure, as it may enable early intervention and the implementation of preventive measures. BACKGROUND: This work aimed to investigate the association between pesticide exposure and pupil size. Pupil size is regulated by muscarinic and nicotinic receptors, and it is well-established that common pesticide chemicals disrupt this regulation. METHODS: Twenty agricultural workers exposed to pesticides, and twenty participants not exposed, underwent visual screening, and pupil size evaluation under mesopic and photopic conditions. Additionally, signs of neurotoxicity and pesticide exposure in both groups were evaluated using the modified version of the neurotoxic symptoms questionnaire (Q16) and measuring cholinesterase (AChE) levels in blood, respectively. RESULTS: Agricultural workers exposed to pesticides had a score indicating medium-high level of neurotoxicity (49.85 (SD ± 8.94)) which was significantly higher (t (36) = 7.659, p ≤ 0.0001) than non-exposed participants who had low levels of neurotoxicity (27.25 SD ± 8.86). There was a significant difference in pupil size (mm) under mesopic (t (19) 4.42 p = 0.003) and scotopic (t (19) 4.63, p = 0.0002) conditions between the two groups. Additionally, there was a significant difference in AChE blood levels (t (19) 2.94 p = 0.008) between exposed and non-exposed participants, indicating that exposed workers had low levels of this enzyme (average exposed group 3381 U/L (SD ± 1306)) compared to the non-exposed group (average non-exposed group 4765 U/L (SD ± 1300)). A significant negative correlation between AChE levels, years of exposure, and pupil size was found. The latter finding importantly showed that smaller pupils are associated with the accumulation of acetylcholine or a decrease in the activity of the enzyme AChE. CONCLUSION: Pupil size of agricultural workers exposed to pesticides can be abnormal and is associated with neurotoxicity as indicated by symptomatology and cholinesterase levels. Evaluation of pupil size may be useful for clinically detecting neurotoxicity.

A systematic review and meta-analysis of the efficacy of different optical interventions on the control of myopia in children.

To compare the treatment efficacy of childhood myopia control optical interventions [spectacles, soft contact lenses (SCLs) and orthokeratology (OK) lenses], explore the consistency of treatment efficacies during the treatment period and evaluate the impact of baseline spherical equivalent refraction (SER), axial length (AL) and age on the treatment effect. A literature search of EMBASE, PubMed and Google Scholar databases identified 220 articles published between January 2000 and April 2022, which reported the treatment efficacy by differences in the SER and AL change between intervention and control groups. Thirty-five articles were included in the analysis. Treatment effect sizes (ESs) were calculated, where more positive and negative directions indicated greater treatment efficacy for SER and AL respectively. For SER, the ESs with peripheral add design spectacles (0.66) and SCLs (0.53) were large but not significantly different between treatment types (p = 0.69). For AL, ESs with peripheral add design spectacles (-0.37), SCLs (-0.55) and OK lenses (-0.93) were large, but OK lenses had a significantly greater effect than peripheral add design spectacles (p ≤ 0.001). ESs were large during the first 12 months of treatment for all interventions [peripheral add design SCLs and OK (F ≥ 5.39, p ≤ 0.01), peripheral add design spectacles (F = 0.47, p = 0.63)] but reduced towards the end of 24-36 months of treatment. Baseline SER had an impact on the treatment effect with peripheral add design spectacles only. Optical interventions are efficacious in controlling childhood myopia progression. However, treatment effects were largest only during the first 12 months of treatment and reduced over time.

Characterisation of the normal human ganglion cell-inner plexiform layer using widefield optical coherence tomography.

PURPOSE: To describe variations in ganglion cell-inner plexiform layer (GCIPL) thickness in a healthy cohort from widefield optical coherence tomography (OCT) scans. METHODS: Widefield OCT scans spanning 55° × 45° were acquired from 470 healthy eyes. The GCIPL was automatically segmented using deep learning methods. Thickness measurements were extracted after correction for warpage and retinal tilt. Multiple linear regression analysis was applied to discern trends between global GCIPL thickness and age, axial length and sex. To further characterise age-related change, hierarchical and two-step cluster algorithms were applied to identify locations sharing similar ageing properties, and rates of change were quantified using regression analyses with data pooled by cluster analysis outcomes. RESULTS: Declines in widefield GCIPL thickness with age, increasing axial length and female sex were observed (parameter estimates -0.053, -0.436 and -0.464, p-values <0.001, <0.001 and 0.02, respectively). Cluster analyses revealed concentric, slightly nasally displaced, horseshoe patterns of age-related change in the GCIPL, with up to four statistically distinct clusters outside the macula. Linear regression analyses revealed significant ageing decline in GCIPL thickness across all clusters, with faster rates of change observed at central locations when expressed as absolute (slope = -0.19 centrally vs. -0.04 to -0.12 peripherally) and percentage rates of change (slope = -0.001 centrally vs. -0.0005 peripherally). CONCLUSIONS: Normative variations in GCIPL thickness from widefield OCT with age, axial length and sex were noted, highlighting factors worth considering in further developments. Widefield OCT has promising potential to facilitate quantitative detection of abnormal GCIPL outside standard fields of view.

Impairment of visual and neurologic functions associated with agrochemical use.

To determine whether exposure to occupational levels of agrochemicals is associated with a range of low- (contrast and colour) and higher-level visual functions, particularly the detection of global form and motion coherence. We compared the performance of workers exposed to occupational levels of pesticides and non-exposed individuals on visual tasks that measured colour discrimination (Farnsworth Munsell 100 and Lanthony D15 desaturated) and the contrast sensitivity function (1-16 cpd). Global form and motion detection thresholds were measured using Glass-pattern and global dot motion stimuli. Neurotoxicity symptoms and biological markers associated with pesticide exposure were quantified using the Q16 modified questionnaire and via tests for levels of acetylcholinesterase in blood and substance P from the tear film, respectively. Workers exposed to pesticides had significantly more neurotoxic symptoms than non-exposed workers. No significant difference between groups for acetylcholinesterase levels was found, but there was a significant group difference in Substance P. The exposed group also had significantly poorer contrast sensitivity, colour discrimination and higher coherence detection thresholds for global form and motion perception. Exposure to occupational levels of agrochemicals in workers with signs of neurotoxicity is associated with low and high visual perception deficits.

Visualising structural and functional characteristics distinguishing between newly diagnosed high-tension and low-tension glaucoma patients.

PURPOSE: To determine whether there are quantifiable structural or functional differences that can distinguish between high-tension glaucoma (HTG; intraocular pressure [IOP] > 21 mm Hg) and low-tension glaucoma (LTG; IOP ≤ 21 mm Hg) at diagnosis. METHOD: This was a retrospective, cross-sectional study. Clinical results of one eye from 90 newly diagnosed HTG and 319 newly diagnosed LTG patients (117 with very-low-tension glaucoma [vLTG; ≤15 mm Hg] and 202 with middling LTG [mLTG; >15 mm Hg, ≤21 mm Hg]) were extracted, which included relevant demographic covariates of glaucoma, quantitative optical coherence tomography (including the optic nerve head, retinal nerve fibre layer and ganglion cell-inner plexiform layer) measurements and standard automated perimetry global metrics. We used binary logistic regression analysis to identify statistically significant clinical parameters distinguishing between phenotypic groups for inclusion in principal component (PC) (factor) analysis (PCA). The separability between each centroid for each cohort was calculated using the Euclidean distance (d(x,y)). RESULTS: The binary logistic regression comparing HTG and all LTG identified eight statistically significant clinical parameters. Subsequent PCA results included three PCs with an eigenvalue >1. PCs 1 and 2 accounted for 21.2% and 20.2% of the model, respectively, with a d(x,y) = 0.468, indicating low separability between HTG and LTG. The analysis comparing vLTG, mLTG and HTG identified 15 significant clinical parameters, which were subsequently grouped into five PCs. PCs 1 and 2 accounted for 24.1% and 17.8%, respectively. The largest separation was observed between vLTG and HTG (d(x,y) = 0.581), followed by vLTG and mLTG (d(x,y) = 0.435) and lastly mLTG and HTG (d(x,y) = 0.210). CONCLUSION: Conventional quantitative structural or functional parameters could not distinguish between pressure-defined glaucoma phenotypes at the point of diagnosis and are therefore not contributory to separating cohorts. The overlap in findings highlights the heterogeneity of the primary open-angle glaucoma clinical presentations among pressure-defined groups at the cohort level.

The impact of traumatic brain injury on inhibitory control processes assessed using a delayed antisaccade task.

It has been well established that traumatic brain injury (TBI) can affect cognitive function such as attention, working memory and executive functions. In the present study, we further investigated TBI-related changes in cognitive functions by investigating the ability to reorient visuospatial attention using a modified antisaccade task. Performing an antisaccade requires disengaging attention, inhibiting a reflexive saccade, and then engaging attention to execute a voluntary saccade in a direction opposite to a peripheral target. Particularly we quantified the time (latency), and accuracy (directional and disinhibition errors) of 26 TBI and 33 normal participants in making an antisaccade after a variable period of delay (0, 0.0625, 0.125, 0.250, 0.500 or 1.0 s). Changing the delay period allowed to systematically quantify the temporal and spatial characteristics of preparing and initiating an antisaccade and whether this process is affected by TBI. TBI participants took longer (approximately 33-66 ms for variable delays) to generate correct delayed antisaccades and showed increased directional errors (2-11 % for variable delays) and increased disinhibition prosaccade errors (2-6 % for variable delays) compared to controls. However, both groups made similar disinhibition antisaccade errors. These findings indicate that TBI participants required a longer time to process information, and a possible poorer response inhibition and poor spatial information processing due to head injury.

High sampling resolution optical coherence tomography reveals potential concurrent reductions in ganglion cell-inner plexiform and inner nuclear layer thickness but not in outer retinal thickness in glaucoma.

PURPOSE: To analyse optical coherence tomography (OCT)-derived inner nuclear layer (INL) and outer retinal complex (ORC) measurements relative to ganglion cell-inner plexiform layer (GCIPL) measurements in glaucoma. METHODS: Glaucoma participants (n = 271) were categorised by 10-2 visual field defect type. Differences in GCIPL, INL and ORC thickness were calculated between glaucoma and matched healthy eyes (n = 548). Hierarchical cluster algorithms were applied to generate topographic patterns of retinal thickness change, with agreement between layers assessed using Cohen's kappa (κ). Differences in GCIPL, INL and ORC thickness within and outside GCIPL regions showing the greatest reductions and Spearman's correlations between layer pairs were compared with 10-2 mean deviation (MD) and pattern standard deviation (PSD) to determine trends with glaucoma severity. RESULTS: Glaucoma participants with inferior and superior defects presented with concordant GCIPL and INL defects demonstrating mostly fair-to-moderate agreement (κ = 0.145-0.540), which was not observed in eyes with no or ring defects (κ = -0.067-0.230). Correlations (r) with MD and PSD were moderate and weak in GCIPL and INL thickness differences, respectively (GCIPL vs. MD r = 0.479, GCIPL vs. PSD r = -0.583, INL vs. MD r = 0.259, INL vs. PSD r = -0.187, p = <0.0001-0.002), and weak in GCIPL-INL correlations (MD r = 0.175, p = 0.004 and PSD r = 0.154, p = 0.01). No consistent patterns in ORC thickness or correlations were observed. CONCLUSIONS: In glaucoma, concordant reductions in macular INL and GCIPL thickness can be observed, but reductions in ORC thickness appear unlikely. These findings suggest that trans-synaptic retrograde degeneration may occur in glaucoma and could indicate the usefulness of INL thickness in evaluating glaucomatous damage.

Deficits in the pupillary response associated with abnormal visuospatial attention allocation in mild traumatic brain injury.

INTRODUCTION: The ability to allocate visual attention is known to be impaired in patients with mild traumatic brain injury (mTBI). In the present study, we investigated a possible neural correlate of this cognitive deficit by examining the pupil response of patients with mTBI whilst performing a modified Posner visual search task. METHOD: Two experiments were conducted in which the target location was either not cued (Experiment 1) or cued (Experiment 2). Additionally, in Experiment 2, the type of cue (endogenous vs exogenous cue) and cue validity were treated as independent variables. In both experiments, search efficiency was varied by changing shape similarity between target and distractor patterns. The reaction time required to judge whether the target was present or absent and pupil dilation metrics, particularly the pupil dilation latency (PDL) and amplitude (PDA), were measured. Thirteen patients with chronic mTBI and 21 age-, sex-, and IQ -matched controls participated in the study. RESULTS: In Experiment 1, patients with mTBI displayed a similar PDA for both efficient and inefficient search conditions, while control participants had a significantly larger PDA in inefficient search conditions compared to efficient search conditions. As cognitive load is positively correlated with PDA, our findings suggest that mTBI patients were unable to apply more mental effort whilst performing visual search, particularly if the task is difficult when visual search is inefficient. In Experiment 2, when the target location was cued, patients with mTBI displayed no significant pupil dilation response to the target regardless of the efficiency of the search, nor whether the cue was valid or invalid. These results contrasted with control participants, who were additionally sensitive to the validity of the cue in which PDA was smaller for cue-valid conditions than invalid conditions, particularly for efficient search conditions. CONCLUSION: Pupillometry provided further evidence of attention allocation deficits following mTBI.

Deficits in visuospatial attentional cueing following mild traumatic brain injury.

Visual attentional deficits are frequently reported in patients with mild traumatic brain injury (TBI). In the present study, the ability to orient visual attention (i.e., the use of endogenous and exogenous visual cues) was investigated using a modified Posner visual search task, in which the participant was required to search for a target shape (radial frequency patterns) amongst distractor shapes. Participants were required to determine whether a target radial frequency pattern was present or absent from an array of distractors. Attention to the target location was cued using central or peripheral cueing procedures to investigate endogenous or exogenous attention allocation. Predictability was not manipulated between central and peripheral cues. Search difficulty was varied by systematically changing the radial frequency difference between target and distractors (and thereby shape difference), and cues could be valid or invalid in that they correctly or incorrectly indicated the position of the target shape. Both target discriminability (i.e., identifying the presence or absence of the target) and reaction times were measured. Thirteen patients with chronic mild TBI and 21 age-, sex-, and IQ -matched healthy controls participated in the study. For control participants, both discrimination accuracy and reaction times improved with visual search efficiency, and they were sensitive to the type of cue, with performance worst for cue invalid conditions than valid conditions. However, the results for TBI patients were strikingly different; we find that discrimination accuracy slightly improved with visual search difficulty (compared to controls), but not reaction times, and TBI patients were largely insensitive to the type of visual cue, and did not show a selective deficit for central or peripheral cues, suggesting an impairment in both endogenous and exogenous visual attention. In conclusion, patients with mild TBI exhibit a poor ability to orient visual attention.

Deficits in multiple object-tracking and visual attention following mild traumatic brain injury.

Difficulty in the ability to allocate and maintain visual attention is frequently reported by patients with traumatic brain injury (TBI). In the present study, we used a multiple object tracking (MOT) task to investigate the degree to which TBI affects the allocation and maintenance of visual attention to multiple moving targets. Fifteen adults with mild TBI and 20 control participants took part in this study. All participants were matched for age, gender, and IQ. The sensitivity and time taken to perform the MOT task were measured for different conditions in which the duration of the tracking, number of target, and distractor dots were systematically varied. When the number of target dots required to be tracked increased, sensitivity in correctly detecting them decreased for both groups but was significantly greater for patients with mild TBI. Similarly, increasing the number of distractor dots had a greater effect on reducing task sensitivity for patients with mild TBI than control participants. Finally, across all conditions, poorer detection performance was observed for patients with mild TBI when the tracking duration was longer compared to control participants. The present study showed that patients with mild TBI have greater deficits (compared to control participants) in their ability to maintain visual attention on tracking multiple moving objects, which was particularly hindered by increased tracking load and distraction.

Changes in the components of visual attention following traumatic brain injury: A systematic review and meta-analysis.

PURPOSE: We conducted a systematic review and meta-analysis to understand the impact of traumatic brain injury (TBI) on visual attention and whether different components and processes of visual attention (such as selective, sustained, divided, and covert orientation of visual attention) are affected following brain injury. METHODS: A literature search between January 1980 to May 2021 was conducted using Medline, Scopus, PubMed, and Google Scholar databases was undertaken for studies that assessed visual attention using different tasks that target specific or multiple components of visual attention. Three hundred twenty-nine potentially relevant articles were identified, and 20 studies met our inclusion criteria. RESULTS: A total of 123 effect sizes (ES) were estimated from 20 studies that included 519 patients with TBI and 530 normal participants. The overall combined ES was statistically significant and large (ES = 0.92), but with high heterogeneity (Q = 614.83, p < 0.0001, I2 = 80.32%). Subgroup analysis showed that the impact of TBI severity, with the ES for moderate-severe TBI significantly higher than mild TBI (t (112) = 3.11, p = 0.002). Additionally, the component of visual attention was differentially affected by TBI (F (2, 120) = 10.25, p<0.0001); the ES for selective attention (ES = 1.13) and covert orientation of visual attention (ES = 1.14) were large, whilst for sustained attention, the ES was medium at 0.43. A subgroup analysis comparing outcome measures showed that reaction time (ES = 1.12) was significantly more affected compared to performance accuracy (ES = 0.43), F (1, 96) = 25.98, p<0.0001). CONCLUSION: Large and significant deficits in visual attention was found following TBI which can last for years after the initial injury. However, different components of visual attention were not affected to the same extent, with selective visual attention and orientation of visual attention most affected following TBI.

Prediction of Retinal Ganglion Cell Counts Considering Various Displacement Methods From OCT-Derived Ganglion Cell-Inner Plexiform Layer Thickness.

Purpose: To compare various displacement models using midget retinal ganglion cell to cone (mRGC:C) ratios and to determine viability of estimating RGC counts from optical coherence tomography (OCT)-derived ganglion cell-inner plexiform layer (GCIPL) measurements. Methods: Four Drasdo model variations were applied to macular visual field (VF) stimulus locations: (1) using meridian-specific Henle fiber length along the stimulus circumference; (2) using meridian-specific differences in RGC receptive field and counts along the stimulus circumference; (3) per method (2), averaged across principal meridians; and (4) per method (3), with the stimulus center displaced only. The Sjöstrand model was applied (5) along the stimulus circumference and (6) to the stimulus center only. Eccentricity-dependent mRGC:C ratios were computed over displaced areas, with comparisons to previous models using sum of squares of the residuals (SSR) and root mean square error (RMSE). RGC counts estimated from OCT-derived ganglion cell layer (GCL) and GCIPL measurements, from 143 healthy participants, were compared using Bland-Altman analyses. Results: Methods 1, 2, and 5 produced mRGC:C ratios most consistent with previous models (SSR 3.82, 4.07, and 3.02; RMSE 0.22, 0.23, and 0.20), while central mRGC:C ratios were overestimated by method 3 and underestimated by methods 4 and 6. RGC counts predicted from GCIPL measurements were within 16% of GCL-based counts, with no notable bias with increasing RGC counts. Conclusions: Sjöstrand displacement and meridian-specific Drasdo displacement applied to VF stimulus circumferences produce mRGC:C ratios consistent with previous models. RGC counts can be estimated from OCT-derived GCIPL measurements. Translational Relevance: Implementing appropriate displacement methods and deriving RGC estimates from relevant OCT parameters enables calculation of the number of RGCs responding to VF stimuli from commercial instrumentation.

Clinical Evaluations of Macular Structure-Function Concordance With and Without Drasdo Displacement.

Purpose: The purpose of this study was to compare concordance between ganglion cell-inner plexiform layer (GCIPL) data from the Cirrus optical coherence tomographer (OCT) Ganglion Cell Analysis (GCA) and visual fields (VFs), with and without Drasdo displacement. Methods: From 296 open-angle glaucoma participants, GCIPL deviation and raw thickness data were extracted over locations per the 10-2 VF test grid, with and without application of Drasdo displacement, with global and eccentricity-dependent sensitivities and specificities calculated for both. With OCT and VF data classified as within or outside normative limits, pattern deviation values were compared using paired t-tests and Spearman correlations. Regression models were applied to pattern deviation values as a function of GCIPL thickness, and differences in model performance with and without displacement were compared using extra sums-of-squares F tests. Results: There were small but significant improvements in global specificity without displacement (0.58-0.59 with displacement and 0.61 without displacement), without notable differences in sensitivity (0.77-0.78 with displacement and 0.76-0.78 without displacement). At abnormal VF locations and without displacement, a higher proportion of correct OCT classifications (P = 0.0008) and significant correlation with worsening pattern deviation values were observed (r = 0.50, P = 0.002). Regression models indicated significantly steeper slopes with Drasdo displacement centrally (P = 0.002-0.04). Conclusions: With GCA deviation maps, small improvements in structure-function concordance were observed without displacement, which are unlikely to be clinically meaningful. Using GCIPL thickness data, significantly better structure-function concordance was observed centrally with Drasdo displacement. Translational Relevance: Applying Drasdo displacement on probability-based reports is unlikely to alter clinical impressions of structure-function concordance, but applying displacement with GCIPL thickness data may improve detection of structure-function concordance.

Evaluating the extent of change in near point of convergence in traumatic brain injury: a systematic review and meta-analysis.

OBJECTIVE: Traumatic brain injury (TBI) causes significant impact on visual system. This study reports the impact of TBI on the near point of convergence (NPC) measure in individuals with mild TBI. METHODS: A systematic review and meta-analysis were conducted for studies that quantified NPC changes in mild TBI. The relevant studies were searched using search engines such as PubMed, EMBASE, Medline and Google Scholar. Thirty studies fulfilled the criteria for systematic review while twelve studies were included in the meta-analysis from 444 patients with mild TBI and 881 controls. RESULTS: This study showed a large and significant impact of head injury on the clinical measure of NPC in patients with mild TBI with a combined effect size of 0.98(95% CI: 0.67-1.29) and significantly moderate heterogeneity (Q(18) = 60.84,P = .001,I2 = 72.06%). Moderator analysis and subgroup analysis showed no difference in effect size with age and post-injury period. CONCLUSIONS: This study demonstrated that NPC is largely affected by the impact of TBI. Given the ease with which it can be measured and without the need of specialists and dedicated equipment, NPC measure might provide a supplementary measure of oculomotor function in addition to less sensitive and more subjective questionnaires and personal reports.

Modelling the effect of light through commercially available blue-blocking lenses on the human circadian system.

CLINICAL RELEVANCE: Wearing blue-blocking lenses (BBLs) in the evening hours may not be effective in improving sleep quality. Optometrists need to be informed in prescribing BBLs by highlighting the consequences of their wear to the circadian system. BACKGROUND: Excessive exposure to artificial light, particularly at short wavelengths, during the evening, may disrupt normal nocturnal melatonin production, which is a natural process of the circadian rhythm and affect sleep quality. Current BBLs have been designed to limit blue-light exposure and may offer a means to minimise disruption to the circadian system. The purpose of this study was to evaluate the impact of BBLs on a normal sleep-wake circadian rhythm. METHODS: Seven different commercial brands of BBLs (Crizal Prevencia, Smart Blue Filter, Blu-OLP, Blue Control, UV++Blue Control, SeeCoat Blue UV and Blue Guardian) and powers (+2.00 D, -2.00 D and Plano) were evaluated by quantifying the degree to which they reduce light radiation from lamps and electronic devices. In particular, the non-linear circadian index and the circadian stimulus was determined for various light sources to establish changes in melatonin production that occur while viewing through different BBLs. RESULTS: A large difference was shown in the effectiveness of different BBL brands in reducing the spectral sensitivity of the circadian system. The BBL brand was shown to selectively affect the non-linear circadian index and circadian stimulus, particularly with those with transmittance profiles that block the most blue light having the lowest effect on the suppression of nocturnal melatonin secretion. CONCLUSION: BBLs may not improve sleep quality, because they continue to allow the transmittance of blue light that may suppress nocturnal melatonin secretion and hence disrupt the normal sleep-wake circadian rhythm.

The effect of blue light filtering lenses on speed perception.

Blue-light filtering lenses (BFLs) are marketed to protect the eyes from blue light that may be hazardous to the visual system. Because BFLs attenuate light, they reduce object contrast, which may impact visual behaviours such as the perception of object speed which reduces with contrast. In the present study, we investigated whether speed perception is affected by BFLs. Using a two-interval forced-choice procedure in conjunction with Method of Constant Stimuli, participants (n = 20) judged whether the perceived speed of a moving test stimulus (1.5-4.5°/s) viewed through a BFL was faster than a reference stimulus (2.75°/s) viewed through a clear lens. This procedure was repeated for 3 different BFL brands and chromatic and achromatic stimuli. Psychometric function fits provided an estimate of the speed at which both test and reference stimuli were matched. We find that the perceived speed of both chromatic and achromatic test stimuli was reduced by 6 to 20% when viewed through BFLs, and lenses that attenuated the most blue-light produced the largest reductions in perceived speed. Our findings indicate that BFLs whilst may reduce exposure to hazardous blue light, have unintended consequences to important visual behaviours such as motion perception.