Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c.

SIGNIFICANCE: Suspected clinically significant macular edema (SCSME) from exudates differed among ethnic groups in our underserved population. African American and Asian subjects had higher prevalence than Hispanics and non-Hispanic Caucasians, from the same clinics. Men had higher prevalence than women. Highly elevated blood glucose was frequent and associated with SCSME. PURPOSE: We investigated the association between the presence of SCSME from exudates and hemoglobin A1c (HbA1c), as well as demographic factors such as age, sex, and ethnic group. Our population was underserved diabetic patients from the same geographic locations. Ethnic groups were White Hispanic, non-Hispanic Caucasian, African American, and Asian, with a high proportion of underrepresented minorities. METHODS: In a diabetic retinopathy screening study at four community clinics in Alameda County, California, nonmydriatic 45° color fundus images were collected from underserved diabetic subjects following the EyePACS imaging protocol. Images were analyzed for SCSME from exudates by two certified graders. Logistic regression assessed the association between SCSME from exudates and age, sex, ethnic group, and HbA1c. RESULTS: Of 1997 subjects, 147 (7.36%) had SCSME from exudates. The mean ± standard deviation age was 53.4 ± 10.5 years. The mean ± standard deviation HbA1c level was 8.26 ± 2.04. Logistic regression analysis indicated a significant association between presence of SCSME from exudates and HbA1c levels (p<0.001), sex (p=0.027), and ethnicity (p=0.030). African Americans (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06 to 2.50; p=0.025) and Asians (OR, 1.63; 95% CI, 1.05 to 2.54; p=0.029) had a higher risk than Hispanics. After adjusting for ethnicity, sex, and age, the odds of developing SCSME from exudates increased by 26.5% with every 1% increase in HbA1c level (OR, 1.26; 95% CI, 1.18 to 1.36; p<0.001). CONCLUSIONS: In our underserved population, many diabetic patients had very high HbA1c values. Ethnic background (African American > Asians > Hispanics), sex (male > female), and HbA1c level were strong indicators for identifying who is at increased risk of developing SCSME from exudates.

Reading performance in Portuguese children from second to tenth grade with the MNREAD reading acuity test

Purpose: To assess reading performance and report normative values for normal sighted Portuguese schoolchildren using the Portuguese version of the MNREAD reading acuity chart. Methods Children in the 2nd, 4th, 6th, 8th, and 10th grade in Portugal were recruited for this study. One hundred and sixty-seven children from 7 to 16 years of age participated. The Portuguese version of the printed MNREAD reading acuity chart was used to measure reading performance in these children. The non-linear mixed effects model with negative exponential decay function was used to compute maximum reading speed (MRS) and critical print size (CPS) automatically. Reading acuity (RA) and reading accessibility index (ACC) were computed manually. Results The mean MRS in words-per-minute (wpm) for the 2nd grade was 55 wpm (SD = 11.2 wpm), 104 wpm (SD = 27.9) for the 4th grade, 149 wpm (SD = 22.5) for 6th grade, 172 wpm (SD = 24.6) for 8th grade and 180 wpm for the 10th grade (SD = 16.8). There was a significant difference in MRS between school grades (p < 0.001). Participants’ reading speed increased by 14.5 wpm (95% CL: 13.1–15.9) with each year of increase in age. We found a significant difference between RA and school grades, but not for CPS. Conclusions This study provides normative reading performance values for the Portuguese version of the MNREAD chart. The MRS increased with increasing age and school grade, while RA shows initial improvement from early school years and gradually stabilizes in the more mature children. Normative values for the MNREAD test can now be used to determine reading difficulties or slow reading speed in, for example, children with impaired vision. (AU)

Reading performance in Portuguese children from second to tenth grade with the MNREAD reading acuity test.

PURPOSE: To assess reading performance and report normative values for normal sighted Portuguese schoolchildren using the Portuguese version of the MNREAD reading acuity chart. METHODS: Children in the 2nd, 4th, 6th, 8th, and 10th grade in Portugal were recruited for this study. One hundred and sixty-seven children from 7 to 16 years of age participated. The Portuguese version of the printed MNREAD reading acuity chart was used to measure reading performance in these children. The non-linear mixed effects model with negative exponential decay function was used to compute maximum reading speed (MRS) and critical print size (CPS) automatically. Reading acuity (RA) and reading accessibility index (ACC) were computed manually. RESULTS: The mean MRS in words-per-minute (wpm) for the 2nd grade was 55 wpm (SD = 11.2 wpm), 104 wpm (SD = 27.9) for the 4th grade, 149 wpm (SD = 22.5) for 6th grade, 172 wpm (SD = 24.6) for 8th grade and 180 wpm for the 10th grade (SD = 16.8). There was a significant difference in MRS between school grades (p < 0.001). Participants' reading speed increased by 14.5 wpm (95% CL: 13.1-15.9) with each year of increase in age. We found a significant difference between RA and school grades, but not for CPS. CONCLUSIONS: This study provides normative reading performance values for the Portuguese version of the MNREAD chart. The MRS increased with increasing age and school grade, while RA shows initial improvement from early school years and gradually stabilizes in the more mature children. Normative values for the MNREAD test can now be used to determine reading difficulties or slow reading speed in, for example, children with impaired vision.

Effects of NO2 aging on bismuth nanoparticles and bismuth-loaded silica xerogels for iodine capture.

The capture of long-lived radioactive iodine (129I) from oxidizing off-gasses produced from reprocessing used nuclear fuel is paramount to human health and environmental safety. Bismuth has been investigated as a viable iodine getter but the phase stability of bismuth-based sorbents in an oxidizing environment have not yet been researched. In the current work, bismuth nanoparticle-based sorbents, as free particles (Bi-NPs) and embedded within silica xerogel monoliths made with a porogen (TEO-5), were exposed to I2(g) before and after aging in 1 v/v% NO2 at 150 °C. For unaged sorbents, BiI3 was the dominant phase after iodine capture with 8-30 mass% BiOI present due to native Bi2O3 on the surface of the unaged nanoparticles. After 3 h of aging, 82 mass% of the Bi-NPs was converted to Bi2O3 with only a small amount of iodine captured as BiOI (18 mass%). After aging TEO-5 for 3 h, iodine was captured as both BiI3 (26 %) and BiOI (74 %) and no Bi2O3 was detected.". Additionally, bismuth lining the micrometer-scale pores in the TEO-5 led to enhanced iodine capture. In a subsequent exposure of the sorbents to NO2 (secondary aging), all BiI3 converted to BiOI. Thus, direct capture of iodine as BiOI is desired (over BiI3) to minimize loss of iodine after capture.

Comparison of an open view autorefractor with an open view aberrometer in determining peripheral refraction in children

Purpose: The aim of this study was to compare central and peripheral refraction using an open view Shin-Nippon NVision-K 5001 autorefractor and an open view COAS-HD VR aberrometer in young children.MethodsCycloplegic central and peripheral autorefraction was measured in the right eye of 123 children aged 8 to 16 years. Three measurements each were obtained with both Shin-Nippon NVision-K 5001 autorefractor and COAS-HD VR aberrometer along the horizontal visual field up to 30° (nasal and temporal) in 10° steps. The refraction from the autorefractor was compared with aberrometer refraction for pupil analysis diameters of 2.5-mm and 5.0-mm.ResultsThe Shin-Nippon was 0.30 D more hyperopic than COAS-HD VR at 2.5-mm pupil and 0.50 D more hyperopic than COAS-HD VR at 5-mm pupil for central refraction. For both pupil sizes, the 95% limits of agreement were approximately 0.50 D for central refraction, and limits were wider in the nasal visual field compared to the temporal visual field. The mean difference for both J0 and J45 were within 0.15 D and the 95% limits of agreement within 0.90 D across the horizontal visual field.ConclusionDefocus components were similar between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 2.5-mm pupil for most visual field angles. However, there was a significant difference in defocus component between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 5.0-mm pupil, wherein the autorefractor measured more hyperopia. The astigmatic components J0 and J45 were similar between instruments for both central and peripheral refraction. (AU)

The effect of intrinsically photosensitive retinal ganglion cell (ipRGC) stimulation on axial length changes to imposed optical defocus in young adults

Purpose: The intrinsically photosensitive retinal ganglion cells (ipRGCs) regulate pupil size and circadian rhythms. Stimulation of the ipRGCs using short-wavelength blue light causes a sustained pupil constriction known as the post-illumination pupil response (PIPR). Here we examined the effects of ipRGC stimulation on axial length changes to imposed optical defocus in young adults.Materials and methodsNearly emmetropic young participants were given either myopic (+3 D, n = 16) or hyperopic (-3 D, n = 17) defocus in their right eye for 2 h. Before and after defocus, a series of axial length measurements for up to 180 s were performed in the right eye using the IOL Master following exposure to 5 s red (625 nm, 3.74 × 1014 photons/cm2/s) and blue (470 nm, 3.29 × 1014 photons/cm2/s) stimuli. The pupil measurements were collected from the left eye to track the ipRGC activity. The 6 s and 30 s PIPR, early and late area under the curve (AUC), and time to return to baseline were calculated.ResultsThe PIPR with blue light was significantly stronger after 2 h of hyperopic defocus as indicated by a lower 6 and 30 s PIPR and a larger early and late AUC (all p<0.05). Short-wavelength ipRGC stimulation also significantly exaggerated the ocular response to hyperopic defocus, causing a significantly greater increase in axial length than that resulting from the hyperopic defocus alone (p = 0.017). Neither wavelength had any effect on axial length with myopic defocus.ConclusionsThese findings suggest an interaction between myopiagenic hyperopic defocus and ipRGC signaling. (AU)

Comparison of an open view autorefractor with an open view aberrometer in determining peripheral refraction in children.

PURPOSE: The aim of this study was to compare central and peripheral refraction using an open view Shin-Nippon NVision-K 5001 autorefractor and an open view COAS-HD VR aberrometer in young children. METHODS: Cycloplegic central and peripheral autorefraction was measured in the right eye of 123 children aged 8 to 16 years. Three measurements each were obtained with both Shin-Nippon NVision-K 5001 autorefractor and COAS-HD VR aberrometer along the horizontal visual field up to 30° (nasal and temporal) in 10° steps. The refraction from the autorefractor was compared with aberrometer refraction for pupil analysis diameters of 2.5-mm and 5.0-mm. RESULTS: The Shin-Nippon was 0.30 D more hyperopic than COAS-HD VR at 2.5-mm pupil and 0.50 D more hyperopic than COAS-HD VR at 5-mm pupil for central refraction. For both pupil sizes, the 95% limits of agreement were approximately 0.50 D for central refraction, and limits were wider in the nasal visual field compared to the temporal visual field. The mean difference for both J0 and J45 were within 0.15 D and the 95% limits of agreement within 0.90 D across the horizontal visual field. CONCLUSION: Defocus components were similar between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 2.5-mm pupil for most visual field angles. However, there was a significant difference in defocus component between the Shin-Nippon autorefractor and the COAS-HD VR aberrometer with a 5.0-mm pupil, wherein the autorefractor measured more hyperopia. The astigmatic components J0 and J45 were similar between instruments for both central and peripheral refraction.

The effect of intrinsically photosensitive retinal ganglion cell (ipRGC) stimulation on axial length changes to imposed optical defocus in young adults.

PURPOSE: The intrinsically photosensitive retinal ganglion cells (ipRGCs) regulate pupil size and circadian rhythms. Stimulation of the ipRGCs using short-wavelength blue light causes a sustained pupil constriction known as the post-illumination pupil response (PIPR). Here we examined the effects of ipRGC stimulation on axial length changes to imposed optical defocus in young adults. MATERIALS AND METHODS: Nearly emmetropic young participants were given either myopic (+3 D, n = 16) or hyperopic (-3 D, n = 17) defocus in their right eye for 2 h. Before and after defocus, a series of axial length measurements for up to 180 s were performed in the right eye using the IOL Master following exposure to 5 s red (625 nm, 3.74 × 1014 photons/cm2/s) and blue (470 nm, 3.29 × 1014 photons/cm2/s) stimuli. The pupil measurements were collected from the left eye to track the ipRGC activity. The 6 s and 30 s PIPR, early and late area under the curve (AUC), and time to return to baseline were calculated. RESULTS: The PIPR with blue light was significantly stronger after 2 h of hyperopic defocus as indicated by a lower 6 and 30 s PIPR and a larger early and late AUC (all p<0.05). Short-wavelength ipRGC stimulation also significantly exaggerated the ocular response to hyperopic defocus, causing a significantly greater increase in axial length than that resulting from the hyperopic defocus alone (p = 0.017). Neither wavelength had any effect on axial length with myopic defocus. CONCLUSIONS: These findings suggest an interaction between myopiagenic hyperopic defocus and ipRGC signaling.

The intrinsically photosensitive retinal ganglion cell (ipRGC) mediated pupil response in young adult humans with refractive errors

Purpose: The intrinsically photosensitive retinal ganglion cells (ipRGCs) signal environmental light, with axons projected to the midbrain that control pupil size and circadian rhythms. Post-illumination pupil response (PIPR), a sustained pupil constriction after short-wavelength light stimulation, is an indirect measure of ipRGC activity. Here, we measured the PIPR in young adults with various refractive errors using a custom-made optical system.Methods: PIPR was measured on myopic (−3.50 ± 1.82 D, n = 20) and non-myopic (+0.28 ± 0.23 D, n = 19) participants (mean age, 23.36 ± 3.06 years). The right eye was dilated and presented with long-wavelength (red, 625 nm, 3.68 × 1014 photons/cm2/s) and short-wavelength (blue, 470 nm, 3.24 × 1014 photons/cm2/s) 1 s and 5 s pulses of light, and the consensual response was measured in the left eye for 60 s following light offset. The 6 s and 30 s PIPR and early and late area under the curve (AUC) for 1 and 5 s stimuli were calculated.Results: For most subjects, the 6 s and 30 s PIPR were significantly lower (p < 0.001), and the early and late AUC were significantly larger for 1 s blue light compared to red light (p < 0.001), suggesting a strong ipRGC response. The 5 s blue stimulation induced a slightly stronger melanopsin response, compared to 1 s stimulation with the same wavelength. However, none of the PIPR metrics were different between myopes and non-myopes for either stimulus duration (p > 0.05).Conclusions: We confirm previous research that there is no effect of refractive error on the PIPR. (AU)

All retinas are not created equal: Fovea-to-macula thickness ratio and foveal microvasculature in healthy young children.

PURPOSE: Markers for the relationships between structural and microvasculature measures given by optical coherence tomography angiography are necessary to increase the diagnostic and prognostic value of this technique. The aim of this study was to investigate relationships between structural and microvasculature measures around the fovea in healthy eyes of healthy children. METHODS: Observational cross-sectional study involving children aged 8-17 years, born at full-term, with no eye disease. The better of two 3 × 3 mm macular scans obtained with a Cirrus 5000HD-OCT was analysed. Images were corrected for lateral magnification errors. Vessel density and perfusion were measured with ImageJ/Fiji software for the superficial capillary plexus. Structural measures including foveal and macular thicknesses were performed manually. RESULTS: The sample included 86 participants, 51 (59%) females. Mean age was 12.4 years (SD = 2.5); mean best-corrected acuity was -0.10 logMAR (SD = 0.09); mean refractive error was +0.59 D (SD = 1.3) and mean axial length was 23.1 mm (SD = 0.86). Mean area of the foveal avascular zone (AFAZ) was 0.20 mm2 (SD = 0.88); median fovea-to-macula thickness ratio (FMTR) was 0.63 (IQR = 0.08); mean central vessel density was 12.42 mm-1 (SD = 2.78) and mean central perfusion was 38.66% (SD = 3.83). AFAZ was correlated with central vessel density (p < 0.001), perfusion (p < 0.001), foveal thickness (p < 0.001) and FMTR (p < 0.001). Central vessel density was correlated with foveal thickness (p < 0.001) and FMTR, (p = 0.01). Central perfusion was correlated with foveal thickness (p < 0.001) and FMTR, (p = 0.003). CONCLUSION: In this study, foveal thickness, FMTR and foveal microvasculature measurements were correlated. Clinicians need to be aware that shallow foveal pits and persistent foveal microvasculature are likely to occur in optical coherence tomography angiography images. In healthy eyes from healthy children, an atypical high FMTR and a small AFAZ may be associated with incomplete foveal development. The mechanism and functional implications of this remain unknown.

The intrinsically photosensitive retinal ganglion cell (ipRGC) mediated pupil response in young adult humans with refractive errors.

PURPOSE: The intrinsically photosensitive retinal ganglion cells (ipRGCs) signal environmental light, with axons projected to the midbrain that control pupil size and circadian rhythms. Post-illumination pupil response (PIPR), a sustained pupil constriction after short-wavelength light stimulation, is an indirect measure of ipRGC activity. Here, we measured the PIPR in young adults with various refractive errors using a custom-made optical system. METHODS: PIPR was measured on myopic (-3.50 ± 1.82 D, n = 20) and non-myopic (+0.28 ± 0.23 D, n = 19) participants (mean age, 23.36 ± 3.06 years). The right eye was dilated and presented with long-wavelength (red, 625 nm, 3.68 × 1014 photons/cm2/s) and short-wavelength (blue, 470 nm, 3.24 × 1014 photons/cm2/s) 1 s and 5 s pulses of light, and the consensual response was measured in the left eye for 60 s following light offset. The 6 s and 30 s PIPR and early and late area under the curve (AUC) for 1 and 5 s stimuli were calculated. RESULTS: For most subjects, the 6 s and 30 s PIPR were significantly lower (p < 0.001), and the early and late AUC were significantly larger for 1 s blue light compared to red light (p < 0.001), suggesting a strong ipRGC response. The 5 s blue stimulation induced a slightly stronger melanopsin response, compared to 1 s stimulation with the same wavelength. However, none of the PIPR metrics were different between myopes and non-myopes for either stimulus duration (p > 0.05). CONCLUSIONS: We confirm previous research that there is no effect of refractive error on the PIPR.

Refractive error, axial length, environmental and hereditary factors associated with myopia in Swedish children.

Clinical relevance: Investigation of refractive errors amongst Swedish schoolchildren will help identify risk factors associated with myopia development.Background: Genetic and hereditary aspects have been linked with the development of myopia. Nevertheless, in the case of 'school myopia' some authors suggest that environmental factors may affect gene expression, causing school myopia to soar. Additional understanding about which environmental factors play a relevant role can be gained by studying refractive errors in countries like Sweden, where prevalence of myopia is expected to be low.Methods: Swedish schoolchildren aged 8-16 years were invited to participate. Participants underwent an eye examination, including cycloplegic refraction and axial length (AL) measurements. Predictors such as time spent in near work, outdoor activities and parental myopia were obtained using a questionnaire. Myopia was defined as spherical equivalent refraction (SER) ≤ -0.50D and hyperopia as SER ≥ +0.75D.Results: A total of 128 children (70 females and 58 males) participated in this study with mean age of 12.0 years (SD = 2.4). Based on cycloplegic SER of the right eye, the distribution of refractive errors was: hyperopia 48.0% (CI95 = 38.8-56.7), emmetropia 42.0% (CI95 = 33.5-51.2) and myopia 10.0%. (CI95 = 4.4-14.9). The mean AL was 23.1 mm (SD = 0.86), there was a correlation between SER and AL, r = -0.65 (p < 0.001). Participants with two myopic parents had higher myopia and increased axial length than those with one or no myopic parents. The mean time spent in near work, outside of school, was 5.3 hours-per-day (SD = 3.1), and mean outdoor time reported was 2.6 hours-per-day (SD = 2.2) for all the participants. The time spent in near work and outdoor time were different for different refractive error categories.Conclusion: The prevalence of myopia amongst Swedish schoolchildren is low. Hereditary and environmental factors are associated with refractive error categories. Further studies with this sample are warranted to investigate how refractive errors and environmental factors interact over time.

Scoring reading parameters: An inter-rater reliability study using the MNREAD chart.

PURPOSE: First, to evaluate inter-rater reliability when human raters estimate the reading performance of visually impaired individuals using the MNREAD acuity chart. Second, to evaluate the agreement between computer-based scoring algorithms and compare them with human rating. METHODS: Reading performance was measured for 101 individuals with low vision, using the Portuguese version of the MNREAD test. Seven raters estimated the maximum reading speed (MRS) and critical print size (CPS) of each individual MNREAD curve. MRS and CPS were also calculated automatically for each curve using two different algorithms: the original standard deviation method (SDev) and a non-linear mixed effects (NLME) modeling. Intra-class correlation coefficients (ICC) were used to estimate absolute agreement between raters and/or algorithms. RESULTS: Absolute agreement between raters was 'excellent' for MRS (ICC = 0.97; 95%CI [0.96, 0.98]) and 'moderate' to 'good' for CPS (ICC = 0.77; 95%CI [0.69, 0.83]). For CPS, inter-rater reliability was poorer among less experienced raters (ICC = 0.70; 95%CI [0.57, 0.80]) when compared to experienced ones (ICC = 0.82; 95%CI [0.76, 0.88]). Absolute agreement between the two algorithms was 'excellent' for MRS (ICC = 0.96; 95%CI [0.91, 0.98]). For CPS, the best possible agreement was found for CPS defined as the print size sustaining 80% of MRS (ICC = 0.77; 95%CI [0.68, 0.84]). Absolute agreement between raters and automated methods was 'excellent' for MRS (ICC = 0.96; 95% CI [0.88, 0.98] for SDev; ICC = 0.97; 95% CI [0.95, 0.98] for NLME). For CPS, absolute agreement between raters and SDev ranged from 'poor' to 'good' (ICC = 0.66; 95% CI [0.3, 0.80]), while agreement between raters and NLME was 'good' (ICC = 0.83; 95% CI [0.76, 0.88]). CONCLUSION: For MRS, inter-rater reliability is excellent, even considering the possibility of noisy and/or incomplete data collected in low-vision individuals. For CPS, inter-rater reliability is lower. This may be problematic, for instance in the context of multisite investigations or follow-up examinations. The NLME method showed better agreement with the raters than the SDev method for both reading parameters. Setting up consensual guidelines to deal with ambiguous curves may help improve reliability. While the exact definition of CPS should be chosen on a case-by-case basis depending on the clinician or researcher's motivations, evidence suggests that estimating CPS as the smallest print size sustaining about 80% of MRS would increase inter-rater reliability.

Central Macular Thickness in Diabetic Patients: A Sex-based Analysis.

SIGNIFICANCE: The pathological changes in clinically significant diabetic macular edema lead to greater retinal thickening in men than in women. Therefore, male sex should be considered a potential risk factor for identifying individuals with the most severe pathological changes. Understanding this excessive retinal thickening in men may help preserve vision. PURPOSE: The purpose of this study was to investigate the sex differences in retinal thickness in diabetic patients. We tested whether men with clinically significant macular edema had even greater central macular thickness than expected from sex differences without significant pathological changes. This study also aimed to determine which retinal layers contribute to abnormal retinal thickness. METHODS: From 2047 underserved adult diabetic patients from Alameda County, CA, 142 patients with clinically significant macular edema were identified by EyePACS-certified graders using color fundus images (Canon CR6-45NM). First, central macular thickness from spectral domain optical coherence tomography (iVue; Optovue Inc.) was compared in 21 men versus 21 women without clinically significant macular edema. Then, a planned comparison contrasted the greater values of central macular thickness in men versus women with clinically significant macular edema as compared with those without. Mean retinal thickness and variability of central macular layers were compared in men versus women. RESULTS: Men without clinically significant macular edema had a 12-µm greater central macular thickness than did women (245 ± 21.3 and 233 ± 13.4 µm, respectively; t40 = -2.18, P = .04). Men with clinically significant macular edema had a 67-µm greater central macular thickness than did women (383 ± 48.7 and 316 ± 60.4 µm, P < .001); that is, men had 55 µm or more than five times more (t20 = 2.35, P = .02). In men, the outer-nuclear-layer thickness was more variable, F10,10 = 9.34. CONCLUSIONS: Underserved diabetic men had thicker retinas than did women, exacerbated by clinically significant macular edema.

Improved wide-field emmetropic human eye model based on ocular wavefront measurements and geometry-independent gradient index lens.

There is a need to better understand the peripheral optics of the human eye and their correction. Current eye models have some limitations to accurately predict the wavefront errors for the emmetropic eye over a wide field. The aim here was to develop an anatomically correct optical model of the human eye that closely reproduces the wavefront of an average Caucasian-only emmetropic eye across a wide visual field. Using an optical design program, a schematic eye was constructed based on ocular wavefront measurements of the right eyes of thirty healthy young emmetropic individuals over a wide visual field (from 40° nasal to 40° temporal and up to 20° inferior field). Anatomical parameters, asymmetries, and dispersion properties of the eye's different optical components were taken into account. A geometry-independent gradient index model was employed to better represent the crystalline lens. The RMS wavefront error, wavefront shapes, dominant Zernike coefficients, nasal-temporal asymmetries, and dispersion properties of the developed schematic eye closely matched the corresponding measured values across the visual field. The developed model can help in the design of wide-field ophthalmic instruments and is useful in the study and simulations of the peripheral optics of the human eye.

Absent Foveal Pit, Also Known as Fovea Plana, in a Child without Associated Ocular or Systemic Findings.

The purpose of this report is to describe a case of bilateral foveal hypoplasia in the absence of other ophthalmological or systemic manifestations. We characterize the case of a 9-year-old Caucasian male who underwent full ophthalmologic examination, including functional measures of vision and structural measurements of the eye. Best corrected visual acuity was 0.50 logMAR in the right eye and 0.40 logMAR in the left eye. Ophthalmoscopy revealed a lack of foveal reflex that was further investigated. Optical coherence tomography (OCT) confirmed the absence of foveal depression (pit). OCT images demonstrated the abnormal structure of retina in a region in which we expected a fovea; these findings were decisive to determine the cause of reduced acuity in the child.

Comparison of Cysts in Red and Green Images for Diabetic Macular Edema.

PURPOSE: To investigate whether cysts in diabetic macular edema are better visualized in the red channel of color fundus camera images, as compared with the green channel, because color fundus camera screening methods that emphasize short-wavelength light may miss cysts in patients with dark fundi or changes to outer blood retinal barrier. METHODS: Fundus images for diabetic retinopathy photoscreening were acquired for a study with Aeon Imaging, EyePACS, University of California Berkeley, and Indiana University. There were 2047 underserved, adult diabetic patients, of whom over 90% self-identified as a racial/ethnic identify other than non-Hispanic white. Color fundus images at nominally 45 degrees were acquired with a Canon Cr-DGi non-mydriatic camera (Tokyo, Japan) then graded by an EyePACS certified grader. From the 148 patients graded to have clinically significant macular edema by the presence of hard exudates in the central 1500 µm of the fovea, we evaluated macular cysts in 13 patients with cystoid macular edema. Age ranged from 33 to 68 years. Color fundus images were split into red, green, and blue channels with custom Matlab software (Mathworks, Natick, MA). The diameter of a cyst or confluent cysts was quantified in the red-channel and green-channel images separately. RESULTS: Cyst identification gave complete agreement between red-channel images and the standard full-color images. This was not the case for green-channel images, which did not expose cysts visible with standard full-color images in five cases, who had dark fundi. Cysts appeared more numerous and covered a larger area in the red channel (733 ± 604 µm) than in the green channel (349 ± 433 µm, P < .006). CONCLUSIONS: Cysts may be underdetected with the present fundus camera methods, particularly when short-wavelength light is emphasized or in patients with dark fundi. Longer wavelength techniques may improve the detection of cysts and provide more information concerning the early stages of diabetic macular edema or the outer blood retinal barrier.

Non-mydriatic confocal retinal imaging using a digital light projector.

A digital light projector is implemented as an integrated illumination source and scanning element in a confocal non-mydriatic retinal camera, the Digital Light Ophthalmoscope (DLO). To simulate scanning, a series of illumination lines are rapidly projected on the retina. The backscattered light is imaged onto a 2-dimensional rolling shutter CMOS sensor. By temporally and spatially overlapping the illumination lines with the rolling shutter, confocal imaging is achieved. This approach enables a low cost, flexible, and robust design with a small footprint. The 3rd generation DLO technical design is presented, using a DLP LightCrafter 4500 and USB3.0 CMOS sensor. Specific improvements over previous work include the use of yellow illumination, filtered from the broad green LED spectrum, to obtain strong blood absorption and high contrast images while reducing pupil constriction and patient discomfort.

Objectively determined refraction improves peripheral vision.

PURPOSE: The purpose of this study was twofold: to verify a fast, clinically applicable method for determining off-axis refraction and to assess the impact of objectively obtained off-axis refractive correction on peripheral low-contrast visual acuity. METHODS: We measured peripheral low-contrast resolution acuity with Gabor patches both with and without off-axis correction at 20 degrees in the nasal visual field of 10 emmetropic subjects; the correction was obtained using a commercial open-field Hartmann-Shack wavefront sensor, the COAS-HD VR aberrometer. Off-axis refractive errors were calculated for a 5-mm circular pupil inscribed within the elliptical wavefront by COAS using the instruments' inbuilt "Seidel sphere" method. RESULTS: Most of the subjects had simple myopic astigmatism, at 20 degrees in the nasal visual field ranging from -1.00 to -2.00 DC, with axis orientations generally near 90 degrees. The mean uncorrected and corrected low-contrast resolution acuities for all subjects were 0.92 and 0.86 logMAR, respectively (an improvement of 0.06 logMAR). For subjects with a scalar power refractive error of 1.00 diopters or more, the average improvement was 0.1 logMAR. The observed changes in low-contrast resolution acuity were strongly correlated with off-axis astigmatism (Pearson r = 0.95; p < 0.0001), the J180 cross-cylinder component (Pearson r = 0.82; p = 0.0034), and power scalar (Pearson r = -0.75; p = 0.0126). CONCLUSIONS: The results suggest that there are definite benefits in correcting even moderate amounts of off-axis refractive errors; in this study, as little as -1.50 DC of off-axis astigmatism gave improvements of up to a line in visual acuity. It may be even more pertinent for people who rely on optimal peripheral visual function, specifically those with central visual field loss; the use of open-field aberrometers could be clinically useful in rapidly determining off-axis refractive errors specifically for this patient group who are generally more challenging to refract.

Evident stabilization of the clinical profile in HIV/AIDS as evaluated in an open label clinical trial using a polyherbal formulation.

BACKGROUND & OBJECTIVES: The complementary and alternative medicines (CAM) have not been systematically evaluated for the management of HIV/AIDS patients. In a prospective, single-site, open-label, non-randomized, controlled, pilot trial, we evaluated a polyherbal formulation (PHF) for its safety and efficacy in treating subjects with HIV-AIDS. METHODS: A total of 32 and 31 subjects were enrolled under the PHF and highly active antiretroviral treatment (HAART) arms, respectively, and followed up for a period of 24 months. Plasma viral RNA, CD4 cell count and blood chemistry were monitored at 3-month intervals. Following mid-term safety evaluation, 12 subjects from the PHF arm were shifted to HAART and were followed separately as PHF-to-HAART arm, for the rest of the period. RESULTS: The HAART arm was characterized by significant improvements in CD4 cell count (154.4 cells/µl/year, P<0.001) and reduction in plasma viral load within 3 to 6 months (-0.431+ 0.004 log 10 IU/month, P<0.001). In contrast, the PHF arm showed a profile of CD4 cell loss at remarkably slower kinetics (14.3 cells/µl/year, P=0.021) and insignificant reduction in the viral load. The PHF and HAART arms did not differ significantly in the occurrence of AIDS-related illnesses over the study period of 24 months. In the PHF-to-HAART arm, the rates of CD4 count and reduction in viral load were significant and comparable to that of the HAART group. In the PHF arm, at 1 month, a significant increase in CD4 cell count and a concomitant decrease in viral load were seen. INTERPRETATION & CONCLUSIONS: The PHF appears to have provided protection by delaying the kinetics of CD4 cell reduction. Given the several study limitations, drawing assertive inferences from the data is challenging. Future studies with a stringent study design are warranted to confirm these findings.