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An 81-year-old woman developed painful vision loss to hand motions in the right eye over a several-day period. Dilated fundus examination revealed no acute pathology, but automated perimetry showed a superotemporal visual field defect in the asymptomatic left eye, suggestive of a junctional scotoma. Magnetic resonance imaging demonstrated enhancement of the right optic nerve extending to its junction with the optic chiasm. The patient's vision failed to improve with intravenous corticosteroids, but demonstrated significant improvement with therapeutic plasma exchange. She was subsequently found to be seropositive for aquaporin-4 autoantibodies, confirming the diagnosis of neuromyelitis optic spectrum disorder.

PurposeTo investigate the effect of smoking on rates of progressive visual field (VF) damage over time in glaucoma.DesignRetrospective cohort study.ParticipantsFive hundred eleven eyes of 354 patients with glaucoma followed up from multicenter glaucoma registries.MethodsIn this longitudinal study, 354 patients with primary open-angle glaucoma with a minimum of 3 years of follow-up and 5 VF tests were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Univariate and multivariate linear mixed models were used to investigate the effects of smoking on rates of 24-2 VF mean deviation loss. Visual field progression was defined using pointwise linear and significant negative VF mean deviation loss. Logistic regression was used to identify baseline factors and whether different levels of smoking intensity were associated with VF progression. Kaplan-Meier survival analysis and the log-rank test were used to compare the cumulative risk ratio of progression between smoker and never smoker groups.Main outcome measuresVisual field progression.ResultsFive hundred eleven eyes of 354 patients were included over the median follow-up of 12.5 years. Median baseline age was 64.8 years. Of the 354 patients, 124 (35%) were Black, and 149 (42.1%) and 168 (59.8%) had reported a history of smoking or alcohol consumption, respectively. In a multivariate model, higher smoking intensity was associated with faster VF loss (coefficient, -0.05 decibels (dB)/year per 10 pack-years; 95% confidence interval [CI], -0.08 to -0.01 dB/year per 10 pack-years; P= 0.010). Developing VF progression in eyes of heavy smokers (≥ 20 pack-years) was 2.2 times more than in eyes of patients without smoking history (odds ratio, 2.21; 95% CI, 1.02-4.76; P= 0.044). Statistically significant differences were found between heavy smokers (≥ 20 pack-years) and never smokers by Kaplan-Meier analysis (P= 0.011, log-rank test).ConclusionsHeavy smokers are more likely to sustain VF loss in eyes with glaucoma. The prospective longitudinal design of this study supports the hypothesis that levels of smoking may be a significant predictor for glaucoma progression. Additionally, this information can be used for clinically relevant tobacco prevention and intervention messages.

To report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after intravitreal injection in a patient with a history of fellow-eye NAION.Observational case report.An 82-year-old woman with a history of fellow eye NAION developed an inferior visual field defect 1 day after an intravitreal aflibercept injection for neovascular age-related macular degeneration. She was found to have optic disk edema and an inferior altitudinal defect, consistent with NAION. The mechanism may have involved compromised perfusion to the optic nerve head related to elevated intraocular pressure or vasoconstriction because of antivascular endothelial growth factor activity.Nonarteritic anterior ischemic optic neuropathy is a rare complication of intravitreal injection and may be related to postinjection elevation in intraocular pressure. Monitoring of intraocular pressure postinjection with low-threshold for preinjection aqueous suppression or postinjection anterior chamber paracentesis for persistently elevated intraocular pressure is recommended in patients with a history of NAION.

One of the essential needs of humans that is influenced by architectural geometry is visibility in indoor areas. Prayer hall geometry dominates the mosque typology and morphology. The spatial–volumetric shapes of interior prayer halls affect worshipers’ visual comfort and spirituality. In this study, a new integrative framework is developed to quantitatively describe various mosque typo-morphologies affecting the visual comfort of worshipers, including spaciousness and consciousness, to obtain prayer hall typo-morphological patterns that may provide higher levels of visual comfort. Spatial and volumetric metrics from various prayer hall vantage points are used in this study. A two-dimensional isovist (VGA) map in depthmapX.10 collects spatial metrics, while the grasshopper script in Rhinoceros-7 collects 3D isovist volumetric metrics. The findings confirm the feasibility of creating a prominent area in barrier-free mosque layout designs centered on a central domed roof form.

PURPOSE To demonstrate phenotypic discordance between a monozygotic twin pair, one of whom exhibited pigmented paravenous chorioretinal atrophy (PPCRA). METHODS A patient and his identical twin brother, attending Moorfields Eye Hospital, were reviewed. Clinical assessment included visual acuity and color vision testing, fundus imaging including autofluorescence, spectral-domain optical coherence tomography and static perimetry. In addition, the affected sibling underwent pattern and full field electroretinography (PERG and ERG) according to ISCEV standards. Zygosity testing was performed using short tandem repeat (STR) analysis. RESULTS The 48-year old proband was referred with abnormal visual fields and difficulty reading at near. Examination revealed 20/20 Snellen visual acuity bilaterally, normal colour vision and bilateral asymmetric outer retinal atrophy with intra-retinal pigment migration along the course of the retinal veins, consistent with PPCRA. The visual field defects were contiguous with the blind spot and mirrored the retinal involvement in both eyes. Pattern ERG showed mild macular dysfunction and full field ERG was within normal limits. Blood testing for common uveitic entities was non-contributory. The proband's twin brother's clinical assessment and retinal imaging showed no abnormality. Zygosity testing showed the twins to be identical for 24 short tandem repeat (STR) microsatellite markers, indicative of monozygosity. CONCLUSION Some cases of PPCRA, without an obvious inflammatory etiology, do not have a clear Mendelian inheritance pattern and may represent an acquired disorder.

PurposeTo compare the rates of visual field (VF) progression between individuals of Black and White race and to investigate whether treatment effects may help explain differences previously reported between racial groups.DesignMulticenter prospective observational cohort study.MethodsParticipants were patients in referral tertiary care glaucoma clinics with open angle glaucoma. Eyes were excluded who had

Doubling of the optic disc is rare in clinic, which appears as true doubling or pseudo-doubling. Bilateral doubling of the optic discs is even more less seen in clinic. Here, we report the case of a 35-year-old woman who presented to the clinic for a physical examination. The patient's best-corrected visual acuity was 0.6 OD with +2.25 DS/3.50 DC×175°, and 0.9 OS with -3.00 DS/0.50 DC×145°. The intraocular pressure of each eye was normal. Fundoscopy examination revealed an enlarged suspected optic disc in both eyes. Visual field examination revealed an additional blind spot in each eye. Optical coherence tomography (OCT) analysis showed a normal macular thickness and profile. B-scan ultrasound revealed a single optic nerve shadow in each eye. Cranial computed tomography (CT) showed only 1 optic foramen and 1 optic nerve in each eye. Although double-blind spots were demonstrated by visual field examination, and pits in both optic disc regions for both eyes were shown by OCT, it was not enough to support the diagnosis of true doubling of the optic disc. Consequently, the diagnosis of bilateral pseudo-doubling of optic discs was made based on the clinical evidence, leading to the consideration of possible causality of other ophthalmic diseases.

The Limbertwig family of AI-Imaginary OS and linguistic programming branches provides a novel way for semantically nuanced permutations of math-based AI configurative branching on data structures from a principles-first approach. E-CNN linguistic analog branching on mathematical transforms allows for symbolic cross-configuration via OCR and scanning to cross check validity of symbol analysis. Made on DaVinci GPT-3.5

Brain tumors are the most common solid tumors in children with an estimated age-adjusted incidence of 6.21 per 100,000. Recent advances in the diagnosis, treatment and surveillance of childhood brain tumors have considerably improved survival, with a current five-year survival rate reaching 75% in developed countries. This improved survival rate stresses the importance of awareness of the adverse effects coinciding with the brain tumor or its treatment. One of these adverse effects is an impaired visual function, which poses a substantial burden on the health, quality of life, and participation in daily life of children with a brain tumor. This thesis provides insight into the ophthalmological consequences in children with a newly diagnosed brain tumor and in the potential role of retinal optical coherence tomography (OCT) as an objective, non-invasive testing method of the visual function. To investigate these aims, we designed and conducted the CCISS study (‘Child Central nervous tumors InSight in Sight’), a prospective nationwide longitudinal cohort study investigating visual impairment in 170 children newly diagnosed with a brain tumor between May 2019 and August 2021 in the Netherlands. Our analyses have shown that a major part of the children (79%) have ophthalmological abnormalities at brain tumor diagnosis and that ophthalmological abnormalities during examination were present in the majority of children (65%) who initially presented without visual symptoms. These findings stress the importance of standardized ophthalmological examination and the awareness of clinicians for latent ophthalmological abnormalities in children with a newly diagnosed brain tumor. In addition, we investigated the value of retinal OCT thickness measurements to discriminate an abnormal visual function in children with a newly diagnosed brain tumor. We found relatively high negative predictive values of average circumpapillary RNFL thickness (83%) and average macular GCL-IPL thickness (82%), but the positive predictive values (respectively 33% and 57%) were low, demonstrating a moderate diagnostic accuracy. This is also is in line with the low to moderate sensitivity and specificity. Therefore, at this moment, RNFL thickness and GCL-IPL thickness measurements cannot be used for clinical care decision making in children with a newly diagnosed brain tumor, nor should these measurements replace the thorough standard ophthalmological examination.

Purpose To determine the prevalence and characteristics of Charles Bonnet Syndrome (CBS) and its relation to visual field loss (VFL) in patients with open-angle glaucoma (OAG). Design Prospective, cross-sectional study. Participants Adult patients (n=337) with manifest OAG with verified VFL and without significant macular disease or extraocular conditions known to cause visual hallucinations. Methods Patients attending the glaucoma outpatient department of the Skane University hospital, Malmo, Sweden, between April 1st 2018 and December 31st 2018 were consecutively evaluated for inclusion. Potentially eligible patients admitting to having complex visual hallucinations were interviewed to explore the characteristics of their hallucinatory experiences. Recent automated visual field examinations were available for all participants and swept source optical coherence tomography was performed in participants with CBS to rule out previously undiagnosed macular pathology. The correlation between potential risk factors and CBS was evaluated with logistic regression analysis. Main outcome measure Prevalence of CBS in patients with OAG. Results CBS was found in 7.1% (95% CI: 4.7% - 10.6%) of patients with OAG. Participants with CBS were more likely to have at least one eye with a visual field index (VFI) of ≤ 30% compared to those without CBS (71% vs. 34.2%; P = 0.001). Although the best-corrected visual acuity (BCVA) in the worse eye was significantly lower in participants with CBS (decimal equivalent of Snellen BCVA: 0.25 vs. 0.6, P = 0.003), 33% of these participants had a BCVA of ≥ 0.5 in the worse eye. In multivariable analysis, CBS was correlated to the VFI of the better eye (odds ratio 0.984; 95% CI: 0.969 - 0.998, P = 0.030) and the BCVA of the worse-seeing eye (odds ratio 0.210; 95% CI: 0.046 - 0.952, P = 0.043). Conclusions CBS was not a rare condition in patients with glaucoma. Patients with a combination of advanced VFL and low BCVA had the highest risk of CBS; however, one out of three patients with CBS had a BCVA of ≥ 0.5 in both eyes. These findings emphasize the importance of being attentive to symptoms of CBS in patients with glaucomatous VFL even when visual acuity is preserved.

Purpose Information regarding the views of patients, on visual field testing is limited, and no information exists regarding their preferences for test developments. This study aimed to increase knowledge of patients’ experiences of visual field assessment and to explore their opinions and priorities regarding current areas of research and development. Design Online questionnaire with purposive sampling design. Participants Adults who regularly undergo visual field tests in Australia who report having glaucoma or being at glaucomatous risk. Methods An anonymous survey, implemented using the Qualtrics webtool, with both closed- and-open ended questions designed to explore opinions regarding visual field testing, visit attendance for perimetry, as well as priorities for developments. Main Outcome Measures The survey assessed 3 domains: (1) opinions regarding test duration and visit frequency, (2) subjective experience, and (3) perspectives on future developments. Results One hundred fifty-two complete survey responses were obtained. The median age of participants was 66 years (interquartile range [IQR], 60–72 years). Most participants (70%) had experience of undergoing more than 11 visual field tests. Participants recalled that they completed visual field tests in median of 6 minutes (IQR, 5–8 minutes) and were willing to accept additional time (median, 5 minutes; IQR, 3–6 minutes) to obtain more information. Participants were prepared to increase both the number of visual field tests per eye and the frequency of visual field tests (median, 3 visits per year; IQR, 2–4 visits per year) to gain more information about their visual status. Regarding future developments, the most preferred option was “similar test times but an increase in the level of information about my visual field,” which ranked significantly higher than all other options, including “shorter test times that maintain the currently available level of information about my visual field.” Conclusions Our study confirms, in a different population and health care system, previous research reporting patient perspectives on visual field assessment. We further revealed that health care consumers show a strong preference for accurate information about their vision and report being prepared to undergo longer visual field tests or more visual field tests to achieve that outcome.

Purpose This study aimed to evaluate the radiation-induced adverse effects on ocular structures in head and neck cancer patients and investigate the radiation dose-volume effects on the cornea, lacrimal gland, retina, optic nerve and chiasm.Materials and Methods A total of 38 eyes of 19 patients were included in this prospective, cohort study. All patients underwent complete ophthalmological examination in addition to contrast sensitivity, visual field and visual evoked potentials (VEP) tests. Ophthalmological examinations and psychophysical tests were performed in 6th, 12th, 18th, 24th months and in the last visit. The relationship between the ophthalmologic findings, and the radiation doses below and above the cut-off values was evaluated.Results Contrast sensitivity decrease and visual field deterioration were observed in 42% of the patients in the last visit (median 26 months) whereas a prolonged latency and decreased amplitude of P100 wave in VEP was observed in 58% and 33% of the eyes, respectively at 24th month. Totally 16 patients (84.2%) developed dry eye disease and eight of them received radiotherapy below tolerance doses and had mild to moderate dry eye findings. Radiation-induced retinopathy was observed in three of the eyes in eight patients who received radiation above tolerance dose.Conclusion Head and neck cancers treated with radiotherapy, resulted in various ophthalmic complications. All patients who are treating with radiotherapy should be evaluated by an ophthalmologist in terms of anterior and posterior segment damage, even if the radiation dose is below the tolerance limit.

To evaluate the correlation between structural parameters and visual acuity (VA) in advanced glaucoma.Prospective, cross-sectional study.A total of 238 eyes from 238 patients (82 were men and mean ± SD age was 59.9 ± 13.8 years) from a tertiary center were divided into an advanced (mean deviation of 24-2 visual field tests from -12.01 to -20.0 dB) and severe (-20 dB) glaucoma group. Structural parameters were obtained by RTVue (Optovue Inc) optical coherence tomography and angiography. Pearson correlation, partial correlation adjusted for age and axial length, and receiver operating characteristic curves to detect decreased VA (20/25) were performed.In the advanced glaucoma group (133 eyes), superficial (Pearson correlation coefficient, r = -0.46, P.001; partial correlation coefficient, r' = -0.30, P.001) and deep macular vessel densities (VDs) (r = -0.47, P.001; r' = -0.30, P.001) showed highest correlation with VA. The area under the receiver operating characteristic curves of the superficial parafoveal/macular VDs were 0.816 (95% CI, 0.735-0.897) and 0.808 (95% CI, 0.725-0.891), respectively. In the severe glaucoma group (105 eyes), deep nasal grid VD (r = -0.31, P = 0.002; r' = -0.35, P.001) showed highest correlation with VA. Deep macular VD showed better correlation with VA than other structural parameters. The area under the receiver operating characteristic curves of deep macular VD and deep nasal grid VD were 0.740 (95% CI, 0.632-0.849) and 0.748 (95% CI, 0.640-0.857), respectively.Macular VD showed better correlation with VA in advanced glaucoma. Deep macular VD, especially nasal grid, may be a promising structural parameter in severe glaucoma.

Introduction The aim of the study was to evaluate the associated patterns of orbital wall fractures, diagnostic parameters of Traumatic optic neuropathy and its progress with Mega dose steroid therapy. Materials and Methods 25 patients with unilateral orbital wall fractures of traumatic aetiology were evaluated with ophthalmologic and radiographic parameters. All patients were prescribed Mega Dose Intravenous steroids irrespective of the timing of presentation. Ophthalmic assessment was repeated for same parameters every alternate day upto 2 weeks. Results Lateral orbital wall was found to be most commonly involved. Visual acuity, Pupillary Reactivity, Visual Field and Visual Evoked Potential showed statistically significant improvement post steroid therapy in early as well as late presenters. Discussion Highest incidence of Traumatic optic neuropathy was noted in multiple linear orbital wall fractures with highest incidence with lateral orbital wall involvement. Literature regarding Choice and timing of initiation of steroids based on timing of presentation is inadequate to justify skipping steroids to observe or undertake surgical intervention. In the present study marked improvement was noted post steroid therapy regardless of timing of presentation. The authors conclude that Visual evoked potential should be objectively tested and Mega dose steroid therapy should be initiated for all patients with Traumatic optic neuropathy for maximum benefit to the patient.

( limit 350 words) Objective To determine which patient reported symptoms best distinguishes patients with and without glaucoma and explains the most variance in visual field (VF) damage, and compare the amount of variance that can be explained by symptoms vs. retinal nerve fiber layer (RNFL) thickness. Design Cross-sectional study. Participants Adults diagnosed with glaucoma or suspicion of glaucoma (controls). Methods Worse-eye VF damage was defined based on perimetric testing. RNFL thickness was defined by OCT imaging. Patients rated their visual symptoms on questions collated from several published questionnaires, rating the frequency and severity of 28 symptoms on a scale of 1 (never/not at all) to 4 (very often/severe). Multivariable regression models identified patient reported symptoms that contributed the highest variance in VF damage. Main Outcome Measures Patient reported symptoms that explained the most variance in VF damage; amount of variance in VF damage explained by patient reported symptoms and RNFL Results A total of 170 patients (mean age= 64; 58% female; 47% employed) completed testing, including 95 glaucoma suspects and 75 glaucoma patients. In glaucoma patients, median mean deviation of VF damage in the worse eye was -19.3 and ranged from -5.3 to -34.7 dB. Symptoms more common amongst glaucoma patients compared to glaucoma suspects included better vision in one eye, blurry vision, glare, sensitivity to light, cloudy vision, and little peripheral vision. Worse severity ratings for the symptom ‘little peripheral vision’ explained the most variance in VF damage (43%). A multivariable model including the frequency of cloudy vision, severity of having little peripheral vision, missing patches, one eye having better vision, and vision worsening, plus sociodemographic features explained 62% of the variance in VF damage. Comparatively, a multivariable model of worse-eye RNFL thickness and sociodemographic features explained 42% of the variance in VF damage, while a model including only sociodemographic features explained 8% of the variance in VF damage. Conclusions Five patient reported symptoms explain a significant amount of the variance in VF damage. Asking patients about their symptoms may optimize patient-physician communication and be a useful adjunct to clinical testing in some patients to estimate disease severity.

PURPOSE: To characterize the change of ganglion cell complex (GCC) thickness and macula vessel density in eyes diagnosed as being glaucoma suspect eyes with ocular hypertension (OHT) or glaucomatous optic neuropathy (GON). DESIGN: Prospective, longitudinal study. PARTICIPANTS: 83 eyes (24 healthy eyes, 30 OHT eyes, and 29 GON eyes) of 65 subjects who had at least 3 visits were included from the Diagnostic Innovations in Glaucoma Study. The mean follow-up was at least 3 years. METHODS: Optical coherence tomography angiography (OCTA)-based vessel density and OCT-based structural thickness of the 3×3 mm(2) GCC scan slab were evaluated at each visit. The rates of vessel density and thickness change were compared across diagnostic groups using linear mixed-effects model. MAIN OUTCOME MEASURES: Change rates of macula GCC thickness and superficial macula vessel density. RESULTS: Significant mean rates of both GCC thinning and macula vessel density loss were detectable in OHT and GON groups. 49.1% of the individual suspect eyes showed significant loss (P0.2). Higher mean intraocular pressure during follow-up was associated with a faster rate of GCC thinning in the OHT group (P=0.065) and GON groups (P=0.015), but was not associated with the rate of vessel density decrease. CONCLUSIONS: While the rate of GCC thinning was faster on average in suspect eyes than in healthy eyes, some suspect eyes had significant loss of vessel density and faster vessel density loss than GCC thinning. OCT and OCTA are complementary and useful for evaluating eyes with OHT or GON.

Purpose To develop and validate a multimodal artificial intelligence algorithm, FusionNet, using the pattern deviation probability plots from visual field (VF) reports and circular peripapillary OCT scans to detect glaucomatous optic neuropathy (GON). Design Cross-sectional study. Subjects Two thousand four hundred sixty-three pairs of VF and OCT images from 1083 patients. Methods FusionNet based on bimodal input of VF and OCT paired data was developed to detect GON. Visual field data were collected using the Humphrey Field Analyzer (HFA). OCT images were collected from 3 types of devices (DRI-OCT, Cirrus OCT, and Spectralis). Two thousand four hundred sixty-three pairs of VF and OCT images were divided into 4 datasets: 1567 for training (HFA and DRI-OCT), 441 for primary validation (HFA and DRI-OCT), 255 for the internal test (HFA and Cirrus OCT), and 200 for the external test set (HFA and Spectralis). GON was defined as retinal nerve fiber layer thinning with corresponding VF defects. Main Outcome Measures Diagnostic performance of FusionNet compared with that of VFNet (with VF data as input) and OCTNet (with OCT data as input). Results FusionNet achieved an area under the receiver operating characteristic curve (AUC) of 0.950 (0.931–0.968) and outperformed VFNet (AUC, 0.868 [95% confidence interval (CI), 0.834–0.902]), OCTNet (AUC, 0.809 [95% CI, 0.768–0.850]), and 2 glaucomatologists (glaucomatologist 1: AUC, 0.882 [95% CI, 0.847–0.917]; glaucomatologist 2: AUC, 0.883 [95% CI, 0.849–0.918]) in the primary validation set. In the internal and external test sets, the performances of FusionNet were also superior to VFNet and OCTNet (FusionNet vs VFNet vs OCTNet: internal test set 0.917 vs 0.854 vs 0.811; external test set 0.873 vs 0.772 vs 0.785). No significant difference was found between the 2 glaucomatologists and FusionNet in the internal and external test sets, except for glaucomatologist 2 (AUC, 0.858 [95% CI, 0.805–0.912]) in the internal test set. Conclusions FusionNet, developed using paired VF and OCT data, demonstrated superior performance to both VFNet and OCTNet in detecting GON, suggesting that multimodal machine learning models are valuable in detecting GON.

Background Blepharoplasty has both aesthetic and functional benefits in patients with pseudoptosis; however, previous studies could not demonstrate its beneficial effects quantitatively and objectively. The authors objectively analyzed the visual field before and after surgery and investigated whether measurements of the visual field can be applied as a suitable predictor of surgical outcomes. Methods In total, 18 eyelids in nine patients with pseudoptosis who had undergone simple skin excision blepharoplasty were evaluated prospectively from February to May 2016. The visual fields were analyzed preoperatively and 3 months postoperatively using the Goldmann kinetic perimetry test. The visual field test area was assessed using Adobe Photoshop. Results Blepharoplasty had an average 4.99-fold beneficial effect on the superior visual field. In particular, more improvement was seen in the superior temporal quadrant than in the nasal quadrant. No correlation was found between the preoperative margin-to-reflex distance 1 (MRD1) and the surgical outcome (P=0.119). However, there was a strong correlation between the preoperative superior visual field and the surgical outcome (P=0.001). Conclusions Using the Goldmann kinetic perimetry test, we objectively and quantitatively proved the beneficial effect of blepharoplasty on patients with pseudoptosis. Furthermore, we demonstrated that the preoperative visual field is a better preoperative surgical outcome predictive factor than the preoperative MRD1.

Coordinated and ordered collective behaviors that emerge from decentralized and local self-organizing interactions among individuals widely exists in many biological groups. The classical models often focus on the imitation of biological phenomena with the given position and velocity, but ignore the modeling of individual perception during the emergence of collective behaviors. Based on the mechanism of visual perception, we present a model named visual perception-decision-propulsion (VPDP) and clearly define several evaluation indicators to explore the emergence of collective obstacle avoidance in flocks. Within this model, there is no centralized control and no information exchange among individuals. Instead, individuals interacting with others merely rely on the perceptual information represented by whether the visual field is occupied by neighbors. We demonstrate that our model effectively achieves collective obstacle avoidance, preserving a safe distance between individuals and obstacles while maintaining relatively good coherence. Moreover, the sensitivity analysis of the parameters indicates the robustness of our VPDP model. Hence, this paper provides a novel model for collective obstacle avoidance based on visual perception as well as a detailed analysis.

Background/aimsTo investigate the relationship between the foveal avascular zone (FAZ) parameters assessed by optical coherence tomography angiography (OCTA) and central visual field parameters in glaucoma and healthy subjects.MethodsOne hundred and eighty-eight subjects (248 eyes), including 24 healthy (38 eyes), 37 glaucoma suspect (42 eyes, and 127 primary open angle glaucoma (POAG) patients (168 eyes), underwent imaging using OCTA and standard automated perimetry using the 24-2 and 10-2 Swedish Interactive Thresholding Algorithm. OCTA-based and OCT-based FAZ parameters (superficial FAZ area, FAZ circumference), foveal vessel density (FD300) and foveal thickness were measured. The correlation between FAZ parameters and visual field parameters was assessed using linear mixed model.ResultsAxial length adjusted-FAZ area was not different among the three groups (mean (95% CI)): in healthy 0.31 (0.27 to 0.36) mm2, glaucoma suspect 0.29 (0.26 to 0.31) mm2and POAG eyes 0.28 (0.27 to 0.30) mm2(p=0.578). FD300 was lower in glaucoma suspect 49.1% (47.9% to 50.4%) and POAG eyes 48.7% (48.1% to 49.4%) than healthy eyes 50.5% (49.3% to 51.7%) though the difference was not statistically significant (p=0.071). Lower FD300 was associated with worse 24-2 and 10-2 visual field mean deviation and foveal threshold in multivariable linear mixed models (all pConclusionsThe FD300, but not the FAZ area was correlated with 10° central visual field mean deviation and foveal threshold in healthy, glaucoma suspect and POAG eyes. In contrast, a smaller FAZ area was associated with lower IOP.

Most well-established eye-tracking research paradigms adopt remote systems, which typically feature regular flat screens of limited width. Limitations of current eye-tracking methods over a wide area include calibration, the significant loss of data due to head movements, and the reduction of data quality over the course of an experimental session. Here, we introduced a novel method of tracking gaze and head movements that combines the possibility of investigating a wide field of view and an offline calibration procedure to enhance the accuracy of measurements. A 4-camera Smart Eye Pro system was adapted for infant research to detect gaze movements across 126° of the horizontal meridian. To accurately track this visual area, an online system calibration was combined with a new offline gaze calibration procedure. Results revealed that the proposed system successfully tracked infants’ head and gaze beyond the average screen size. The implementation of an offline calibration procedure improved the validity and spatial accuracy of measures by correcting a systematic top-right error (1.38° mean horizontal error and 1.46° mean vertical error). This approach could be critical for deriving accurate physiological measures from the eye and represents a substantial methodological advance for tracking looking behaviour across both central and peripheral regions. The offline calibration is particularly useful for work with developing populations, such as infants, and for people who may have difficulties in following instructions.

Functional magnetic resonance imaging (fMRI) of the human brain provides images of changes in local blood flow and oxygenation that are evoked by sensory, motor, or cognitive events. Functional MRI has been used since 1991 [1] to identify areas of the brain that respond to visual stimulation and the performance of vision-related tasks. Increasingly, fMRI is accompanied by diffusion tensor imaging (DTI), which provides images of the speed and direction of diffusion of water molecules in the brain. Fortuitously, this allows remarkable differentiation of cerebral white mater and the delineation of a variety of major white matter tracts including vision-related pathways such as the optic radiations. This chapter focuses primarily on fMRI, but DTI data are also discussed where relevant. Together, the two methods provide a wealth of information about the anatomical and functional status of key components of the visual system in individual patients even in the presence of pathology. For example, an imaging-based map of the visual system can be helpful for planning and guiding surgical resection of tumors impacting critical vision-related brain structures. This is especially true when mass effects or previous surgeries have distorted the normal anatomy making it difficult to know where key structures are located and if they are still functional. In difficult cases, identifying the region of “closest approach” of a planned resection to the cortical representation of central vision or to the optic radiations can help to minimize the risk to eloquent neural tissue and thereby avoid significant treatment-induced vision loss while still permitting maximum therapeutic effect.

Problemstellung: Die vorliegende Bachelorarbeit beschäftigt sich mit kurz- und langfristigen Auswirkungen von Alkoholkonsum auf das visuelle und okulomotorische System aus orthoptischer Sicht. Es wird eine Übersicht über alkohol-induzierte Beeinträchtigungen verschiedener Bereiche des visuellen und okulomotorischen Systems dargeboten, darunter die Sehschärfe, das Binokularsehen, die zentrale Okulomotorik, die Kontrastwahrnehmung sowie das Gesichtsfeld. Methode: Als methodische Vorgehensweise zur Beantwortung der Forschungsfrage wird eine systematische Literaturrecherche durchgeführt. Im Zuge dieser wird in diversen Datenbanken und Bibliotheken nach Fachbüchern, Fachzeitschriften und Studien zum Thema Alkoholkonsum im Zusammenhang mit visuellen und okulomotorischen Symptomen und Störungen recherchiert. Ergebnisse: Hinsichtlich der Sehschärfe wird eine durch Alkoholkonsum ausgelöste Herabsetzung der retinalen Abbildungsqualität sowie eine Beeinträchtigung des visuellen Unterscheidungsvermögens beschrieben. Zusätzlich kann Alkoholkonsum das Risiko diverser Augenerkrankungen, durch welche die Sehschärfe reduziert wird, fördern. Die Minderung der Qualität des Binokularsehens zeigt sich in Form einer Reduktion des Stereosehens und der horizontalen Fusionsbreite. Zudem kommt es durch Alkoholeinfluss zu Winkelveränderungen bei horizontalen Heterophorien. Alkohol-induzierte Störungen der zentralen Okulomotorik äußern sich als Auftreten eines allseitigen Blickrichtungsnystagmus, als Sakkadierung der langsamen Folgebewegungen sowie als Beeinträchtigung der Fixationssuppression des vestibulo-okulären Reflexes. Es kann zu einem positionellen Alkoholnystagmus kommen. Übermäßiger Alkoholkonsum erhöht das Risiko, an einer Wernicke-Enzephalopathie zu erkranken, die mit Störungen der zentralen Okulomotorik einhergeht. Durch Alkoholkonsum ausgelöste Einschränkungen der Kontrastwahrnehmung zeigen sich als Minderung der Kontrastsensitivität für verschiedene Ortsfrequenzen. Das Gesichtsfeld kann nach Alkoholkonsum konzentrische Einschränkungen aufweisen. Diskussion: Es gelten Limitationen der vorliegenden Bachelorarbeit sowie der verwendeten Literatur zu berücksichtigen. In Studien werden gegensätzliche Auswirkungen von Alkohol auf unterschiedliche Augenerkrankungen, welche die Sehschärfe mindern können, beschrieben. Einige Autor*innen legen alkohol-induzierte Störungen der zentralen Okulomotorik dar, ohne konkrete Aussagen über die dazu führende Trinkmenge oder Trinkfrequenz zu tätigen. Allgemein muss berücksichtigt werden, dass einige Aspekte des visuellen und okulomotorischen Systems bislang noch nicht ganzheitlich erforscht sind. Objective: This bachelor thesis deals with short- and long-term effects of alcohol consumption on the visual and oculomotor system from an orthoptic point of view. A review of alcohol-induced impairments of different areas of the visual and oculomotor system is presented, including visual acuity, binocular vision, central oculomotor function, contrast perception, and visual field. Methods: As a methodological approach to answer the research question, a systematic literature review is conducted. In the course of this, various databases and libraries are used to find reference books, journals and studies on the topic of alcohol consumption in connection with visual and oculomotor symptoms and disorders. Results: Regarding the visual acuity, a reduction in retinal image quality triggered by alcohol consumption and an impairment of visual discrimination are described. In addition, alcohol consumption may promote the risk of various ocular diseases by which visual acuity is reduced. The reduction in the quality of binocular vision is manifested in the form of a reduction in stereo vision and horizontal fusion width. In addition, alcohol influence causes angular changes in horizontal heterophoria. Alcohol-induced disturbances of central oculomotor function manifest as the occurrence of an all-sided gaze direction nystagmus, saccadic slow following movements, and impaired fixation suppression of the vestibulo-ocular reflex. Positional alcohol nystagmus may occur. Excessive alcohol consumption increases the risk of developing Wernicke's encephalopathy, which is associated with central oculomotor dysfunction. Impairments in contrast perception triggered by alcohol consumption manifest as a reduction in contrast sensitivity to different spatial frequencies. The visual field may show concentric limitations after alcohol consumption. Discussion: Limitations of the bachelor thesis as well as of the used literature must be considered. Studies describe opposite effects of alcohol on different eye diseases, which can reduce visual acuity. Some authors describe alcohol-induced disturbances of central oculomotor function without making concrete statements about the amount or frequency of drinking leading to these disturbances. In general, it must be considered that some aspects of the visual and oculomotor system have not yet been researched holistically.

STUDY OBJECTIVES: This study aimed to identify prospectively the correlation between obstructive sleep apnea (OSA) severity, ocular microcirculation changes, and visual function changes in patients with glaucoma. METHODS: We prospectively enrolled patients with glaucoma who were willing to undergo overnight polysomnography. The enrolled patients were further divided into normal tension glaucoma, high-tension glaucoma, and control. Visual field progression was analyzed using sequential standard automated perimetry. Peripapillary and macular vessel density were assessed through optical coherence tomography angiography (OCT-angiography). The associations between polysomnography parameters, OCT-angiography parameters, and visual field progression were analyzed. RESULTS: A total of 22 patients with normal tension glaucoma, 30 patients with high-tension glaucoma, and 24 control patients were enrolled. Through regression analysis, glaucoma was found to be an independent predictor of moderate-to-severe OSA (P = .035); furthermore, moderate-to-severe OSA was significantly associated with visual field progression (P = .008 in the high-tension glaucoma subgroup and P = .008 in the overall glaucoma). Additionally, OSA severity was negatively correlated with the ganglion cell complex thinning rate in the normal tension glaucoma subgroup. CONCLUSIONS: Presence of glaucoma increased the risk of moderate-to-severe OSA compared with the control group. OSA severity was related to visual field deterioration in patients with glaucoma and further associated with structural progression in the normal tension glaucoma subgroup. Careful monitoring of the comorbid OSA status of patients with glaucoma is essential to prevent disease progression. CITATION: Chan Y-H, Chuang L-H, Yu C-C, et al. Prospective evaluation of the comorbidity of obstructive sleep apnea in patients with glaucoma. J Clin Sleep Med. 2022;18(1):47–56.

In this work, algorithms have been developed to: 1. Compare visual field coordinate data, presented in different representation systems; 2. Determine the distance in degrees between any two points in the visual field; 3. Predict new coordinates of a given point in the visual field after the rotation of the head, around axes that pass through the nodal point of the eye. Formulas are proposed for the transformation of Polar coordinates into Zenithal Equatorial coordinates and vice versa; of Polar coordinates into Gnomic Equatorial of double meridians and vice versa; and projections of double meridians system into Zenithal Equatorial and vice versa. Using the transformation of polar coordinates into Cartesian coordinates, we can also propose algorithms for rotating the head or the visual field representation system around the dorsoventral, lateral-lateral and anterior-posterior axes, in the mediolateral, dorsoventral and clockwise directions, respectively. In addition, using the concept of the scalar product in linear algebra, we propose new algorithms for calculating the distance between two points and to determine the area of receptive fields in the visual field.

High myopia is of worldwide concern due to its high prevalence, and myopia is an independent risk factor for glaucoma. The purpose of this paper is to review the mechanism and clinical manifestations of optic disc tilt and rotation in high myopia and its relationship with glaucoma, to provide clues for monitoring fundus changes in high myopia and the early diagnosis of high myopia with glaucoma.

OBJECTIVE Due to the proximity of craniopharyngioma to the optic apparatus, one of the most common complications after surgery is visual deterioration. Intraoperative visual evoked potential (VEP), as a means of real-time visual function monitoring, has been integrated into transsphenoidal surgery for pituitary adenoma to predict postoperative visual outcome. Compared with pituitary tumor, craniopharyngioma often adheres to optic nerves, with increased risk of postoperative visual impairment. Furthermore, extended endoscopic endonasal surgery (EEES) can provide direct visualization of the surgical plane between the craniopharyngioma and the optic nerves, which contributes to analysis of the mechanism of real-time VEP changes during surgery. Therefore, VEP monitoring applied during EEES for craniopharyngioma may have more clinical value. However, only 9 patients who underwent EEES with VEP monitoring for craniopharyngioma have been sporadically reported to date. In this paper, the authors present the largest series to date analyzing the clinical value of VEP to predict postoperative visual outcome in adult patients with craniopharyngioma. METHODS Sixty-five adult patients who underwent EEES with intraoperative VEP monitoring for primary craniopharyngioma were retrospectively reviewed. The association between changes in VEP amplitude and postoperative visual outcome was determined. In addition, other potential prognostic factors with regard to postoperative visual outcomes were included in the analysis. RESULTS Gross-total resection was achieved in 59 patients (90.8%). Reproducible and stable VEP was recorded in 128 of 130 eyes (98.5%). During surgery, VEP remained stable in 108 eyes, 10 (9.3%) of which had new visual acuity (VA) and/or visual field (VF) defects after surgery. Transient VEP decrease was recorded in 15 eyes, 4 (26.7%) of which had visual deterioration. Of the 5 eyes with permanent VEP decrease, 3 (60%) experienced postoperative visual impairment. Permanent VEP decrease (OR 19.868, p = 0.007) and tight adhesion (OR 6.104, p = 0.040) were independent adverse factors for postoperative VA deterioration. Tight adhesion (OR 7.150, p = 0.002) and larger tumor volume (OR 1.066, p = 0.001) were significant risk factors for postoperative VF defects. CONCLUSIONS Intraoperative VEP monitoring can serve as a real-time warning to guide surgeons to avoid postoperative visual impairment. It effectively predicted VA changes in adult patients with craniopharyngioma after EEES. Tight adhesion and larger tumor volume were also strong predictors of postoperative visual impairment.

1AbstractComputational models which predict the neurophysiological response from experimental stimuli have played an important role in human neuroimaging. One type of computational model, the population receptive field (pRF), has been used to describe cortical responses at the millimeter scale using functional magnetic resonance imaging (fMRI) and electrocorticography (ECoG). However, pRF models are not widely used for non-invasive electromagnetic field measurements (EEG/MEG), because individual sensors pool responses originating from several centimeter of cortex, containing neural populations with widely varying spatial tuning. Here, we introduce a forward-modeling approach in which pRFs estimated from fMRI data are used to predict MEG sensor responses. Subjects viewed contrast-reversing bar stimuli sweeping across the visual field in separate fMRI and MEG sessions. Individual subject’s pRFs were modeled on the cortical surface at the millimeter scale using the fMRI data. We then predicted cortical time series and projected these predictions to MEG sensors using a biophysical MEG forward model, accounting for the pooling across cortex. We compared the predicted MEG responses to observed visually evoked steady-state responses measured in the MEG session. We found that pRF parameters estimated by fMRI could explain a substantial fraction of the variance in steady-state MEG sensor responses (up to 60% in individual sensors). Control analyses in which we artificially perturbed either pRF size or pRF position reduced MEG prediction accuracy, indicating that MEG data are sensitive to pRF properties derived from fMRI. Our model provides a quantitative approach to link fMRI and MEG measurements, thereby enabling advances in our understanding of spatiotemporal dynamics in human visual field maps.

The standard version of Wittgenstein’s Tractatus Logico–Philosophicus has a certain picture as an iconic continuation of TLP 5.6331. In that picture, the eye is located within the visual field. In various papers as well as in his last edition of the TLP (2021), Luciano Bazzocchi has maintained that the picture must be replaced by another picture locating the eye at the origin of the visual field, on the basis of certain important evidences involving other sketches made by Wittgenstein himself. Whoever is exegetically right, however, the issue is not theoretically decisive. For, what Wittgenstein basically wants to claim there is that, in its having no definite boundaries, the visual field necessarily depends on a point of view. This claim will be partially disputed by Wittgenstein himself in the later phase of his philosophy., {"references":["Bazzocchi, Luciano (2021). \"Foreword\" to Tractatus Logico-Philosophicus, Centenary Edition. London: Anthem Press, ix-xxvii.","Husserl, Edmund (2012). Ideas. General Introduction to Pure Phenomenology. London: Routledge.","Mach, Ernst (1914). The Analysis of Sensations. Chicago and Vienna: Open Court.","Russell, Betrand (1961). \"Introduction\". In TLP, ix-xxv.","Wittgenstein Ludwig (1922/1961). Tractatus Logico-Philosophicus [TLP]. London: Routledge and Kegan Paul.","Wittgenstein, Ludwig (1964). Philosophical Remarks. Oxford: Blackwell.","Wittgenstein Ludwig (1953/2009). Philosophical Investigations. Oxford: Blackwell."]}

Purpose There is growing interest in functional testing for early/intermediate age-related macular degeneration (iAMD). However, systematic evaluation of existing clinical functional tests is lacking. This systematic review examines evidence for using clinical automated perimetry in routine assessment of early/iAMD. Recent findings PubMed, Web of Science Core Collection, and Embase were searched from inception to October 2020 to answer, is there evidence of visual field defects in early/iAMD, and if so, are early/iAMD visual field defects linked to real-world patient outcomes? Articles using clinical automated perimetry (commercially accessible and non-modified devices/protocols) were included. Microperimetry was excluded as this has yet to be incorporated into clinical guidelines. The primary outcome was global visual field indices including mean deviation (MD), pattern standard deviation (PSD), mean sensitivity (MS) and frequency of defects. The secondary outcome was any real-world patient outcome including quality of life and/or activities of daily living indices. Twenty-six studies were eligible for inclusion and all studies were observational. There was consistent evidence of worsened MD, PSD, MS and frequency of defects for early/iAMD compared to normal eyes under photopic, low-photopic and scotopic conditions. Meta-analysis of studies using standard automated perimetry (SAP) under photopic conditions revealed worsened MD (-1.52dB [-2.27, -0.78 dB]) and MS (-1.47dB [-2, -0.94 dB]) in early/iAMD compared to normal eyes, representing large statistical effect sizes but non-clinically meaningful reductions. There was insufficient data for meta-analyses regarding other clinical automated perimetry protocols. Only one study assessed a real-world patient outcome (on-road driving performance), with no significant link to visual field outcomes in early/iAMD. Summary Significant reduction of global visual field indices is present in early/iAMD, but not clinically meaningful using SAP under photopic conditions. Translational relevance of visual field outcomes to patient outcomes in early/iAMD remains unclear. Thus, SAP under photopic conditions is unlikely to be useful for routine assessment of early/iAMD.

Introduction To evaluate the correlation between macular integrity assessment (MAIA) and standard automated perimetry (SAP) in detecting macular function damage in glaucoma and to explore the relationship between macular structure and functional damage by using spectral domain optical coherence tomography (SD-OCT). Methods This was a cross-sectional study. Seventy patients with glaucoma, with hemifield defects verified by Humphrey 24-2 examination, and 60 normal subjects underwent Humphrey 10-2 and MAIA expert 10-2 examinations. Patients with glaucoma with normal hemifields, as detected by SAP, were divided into a normal hemifield group and a visual field (VF) defect group. The difference in the retina and ganglion cell complex (GCC) thicknesses was analyzed between the abnormal and normal hemifields. Results Among the 70 glaucoma eyes, the results of MAIA and SAP were consistent for 66 (66/70, 94.3%). The others showed SAP hemifield defects, while MAIA was normal (4/70, 5.7%). There was a good correlation of the mean sensitivity between MAIA and SAP (P

To develop methods to assess the effects of epiretinal membranes (ERM) and macular holes (MH) coexisting with glaucoma on pre-operative retinal structure and function and evaluate post-operative outcomes. Seven eyes of 7 patients with glaucoma, 6 with ERMs and 1 with MH, were enrolled; 4 underwent vitrectomy for ERM and one for MH. Visual fields (VFs) and optical coherence tomography (OCT) scans were obtained pre- and post-operatively. The 10-2VF deviation map was overlayed on ganglion cell and inner plexiform layer (GCL + IPL) and retinal nerve fiber layer (RNFL) deviation maps derived from OCT macula and disc cube scans. Optic nerve circle scans were obtained to assess RNFL thickness, and OCT b-scans associated with VF defects were compared pre- and post-operatively. Examination of pre-operative VFs and OCT scans showed the importance of determining the extent to which glaucomatous damage contributed to VF loss; verifying automated segmentation of the GCL + IPL and RNFL; and assessing foveal anatomy. Evaluation of post-operative structure–function outcomes required correction of magnification changes in OCT scans and repeated follow-up visits to clarify the origin of VF changes. Pre-operative comparisons of VFs and OCT scans may be beneficial in guiding surgical planning, and evaluating outcomes, in eyes with glaucoma undergoing macular surgery.

Purpose: As routine health examinations become more common, many patients first diagnosed with glaucoma have advanced glaucoma. We analyzed the routes to diagnosis and the characteristics of patients initially diagnosed with advanced glaucoma.Methods: We retrospectively retrieved the medical records of patients first diagnosed with advanced glaucoma in our tertiary care center. The inclusion criteria were a mean deviation (MD) less than -12 dB on the visual field test, accompanied by structural damage. All patients were classified in terms of unilateral/bilateral disease, the intraocular pressure before medication, and lens status. We divided patients into those with monocular or binocular advanced glaucoma, high- or normal-pressure glaucoma, and those who were pseudophakic or phakic.Results: We included 73 patients of mean age 69.3 years. The visual field test MD was -19.6 dB. In those with binocular advanced glaucoma, incidental ophthalmic examination was the most common means of diagnosis (52.2%). Central-island visual field defects were the most common defects (54.2%). In those with monocular advanced glaucoma, glaucoma-associated symptoms most commonly triggered diagnosis (46.9%). Both superior and inferiorvisual field defects were the most common defects (42.8%). Glaucoma-associated symptoms were present in 68.2 and 22.8% of patients with high- and normal-pressure glaucoma, respectively. Central-island visual field defects were present in 43.6 and 29.4% of those with high- and normal-pressure glaucoma, respectively.Conclusions: We analyzed the routes to diagnosis and the clinical characteristics of patients with advanced glaucoma. In those with binocular disease, glaucoma was most commonly diagnosed on incidental ophthalmic examination. Central-island visual field defects were the most common defects in patients with binocular and high-pressure glaucoma, and the pseudophakic group. A multi-center longitudinal study on risk factors for delayed glaucoma diagnosis is needed.

Purpose To describe a transient positive scotoma and corresponding optical coherence tomography (OCT) structural and angiographic findings. Methods The patient was evaluated with a comprehensive ophthalmic examination to include OCT structural and angiographic imaging with two different instruments, the Zeiss Plex Elite and the Optovue RTVue XR Avanti. Results A 45-year-old man had a sudden onset of a positive scotoma in the visual field of the left eye. No abnormalities were noted by ophthalmoscopy or fundus photography. Optical coherence tomography angiography was performed to evaluate the macular perfusion status. With each instrument, a small hyperreflective area, 175 μm in diameter, was imaged in the inner nuclear layer. The OCT angiographic images suggested a small area of decreased perfusion in the deep capillary plexus. Except for the diminutive size, the lesion had an appearance suggestive of paracentral acute middle maculopathy. The symptoms lessened rapidly, and when examined 4 days later, the lesion was less hyperreflective. Two weeks after presentation, the positive scotoma was not present and there was no longer any hyperreflectivity in the inner nuclear layer. Conclusion Detection of the lesion was aided by using OCT angiographic scans, which have a much higher scan density than conventional OCT evaluations. The diminutive abnormality was consistent with a paracentral acute middle maculopathy lesion, although smaller than those previously reported. Micro-paracentral acute middle maculopathy lesions should be considered in the differential diagnosis of positive scotomas.

Background. Hypertensive glaucoma (HTG) causes damage to the retinal ganglion cells and eventually to the entire visual pathway due to high intraocular pressure (IOP). However, increased IOP will also affect the vessel density (VD) of the posterior pole of the eye and the related retinal ganglion nerve fibres (RNFL). In normotensive glaucoma (NTG), the retinal ganglion cells are relatively intact. The pathology is at the level of ganglion fibres. The unanswered question is what has altered ganglion cell fibres at the level of the retina and optic nerve head in NTG? Aim. The aim of this study was to determine whether there is a correlation between the retinal nerve fibre layer (RNFL) and vessel density (VD) at the same altitudinal half of the retina and the sum of sensitivities of the contralateral half of the visual field of the same eye in hypertensive and normotensive glaucoma (NTG). Methods. Our group included 20 patients with HTG and 20 patients with NTG. The Pearson's correlation coefficient r was used for evaluation of the relationship of the peripapillary RNFL and VD, visual field (using the fast threshold glaucoma program) as the sum of sensitivities in apostilbs (asb) to the extent of 0-22 degrees. The results of sensitivity were compared with the RNFL and VD of the contralateral altitudinal half of the retina in the same eye. Results. In the HTG group there was a moderate relationship between RNFL and VD (both hemifields), but no relationship between RNFL and VF. VD SH and VF IH showed weak correlation and VD IH and VF SH showed no correlation. In patients with NTG, we found a strong correlation between RNFL and VD (both hemifields), between VD SH and VF IH a moderate correlation, between VD IH and VF SH also a moderate correlation and a weak correlation between RNFL and VF. Conclusion. By comparing the RNFL and VD at the same altitudinal halves of the retina, we found a moderate correlation in HTG and a strong correlation in NTG. We found no or a weak correlation between VD and VF in HTG. In NTG the relationship between VD and VF showed a strong correlation. These findings reveal the differences in the diagnostic groups.

Purpose In this study, we describe common demographic and clinical characteristics of the glaucoma patient population attending vision rehabilitation. Design Cross-sectional study. Participants Patients attending a hospital-based vision rehabilitation center with a primary ocular diagnosis of glaucoma. Methods Participants’ charts were retrospectively reviewed. Data extracted from medical records included demographics, referring physician, ocular history, glaucoma diagnosis, past ocular surgery, intraocular pressure, optic nerve findings, results of a functional intake assessing activities of daily living, depression, visual hallucinations, best-corrected visual acuity (BCVA), mean deviation (MD) scores on visual field testing, and log contrast sensitivity (CS). Main Outcome Measures Participant demographic information, ocular history, self-reported difficulty with activities of daily living, depression, visual hallucinations, BCVA, visual field, and CS. Results The mean age of patients in this study was 77 years and ranged from 8 to 103 years. Ninety percent of patients were referred to vision rehabilitation by an ophthalmologist. Median BCVA was 20/50. Fifty-five percent of patients were functionally monocular, and for all patients, there was a median 9-line difference in BCVA between eyes. Median MD score was −13.95 decibels (dB). Median CS was 1.05. Patients reported having the greatest difficulty with reading (88%), writing (72%), and mobility (67%). Seventy-eight percent of patients stopped driving, and 12% reported difficulty driving. Among those experiencing depression, there was a 4:1 ratio of depressed patients having difficulty with mobility. One-third of patients experienced visual hallucinations. Conclusions Most glaucoma patients attending vision rehabilitation are not legally blind, but many are functionally monocular. This may cause greater difficulty performing functions that require the use of binocularity. Increasing the referral of younger glaucoma patients to vision rehabilitation may help patients learn to cope with the loss of visual function that occurs over time.

Background There are few clinical data on retinal involvement after acute exposure to high concentrations mercury and the available reports are based on a small number of patients suffering chronic exposure. The purpose of this paper is to report findings in workers acutely exposed to very high concentrations of mercury vapor with the aim of providing data on a possible direct retinal involvement. Methods Twenty-nine patients and 16 controls were evaluated in a comparative case series. Mercury levels in blood and urine samples, visual acuity (VA), contrast sensitivity (CS), visual field (VF), color discrimination and optical coherence tomography (OCT) were recorded. The pattern reversal visual-evoked potentials (PRVEP), full-field and multifocal electroretinography (ffERG/mfERG), pattern electroretinography (PERG), systemic symptoms, presence of erethism, and electromyography (EMG) were also gathered. A descriptive analysis was performed. The correlations between variables also were studied. In addition, electrophysiological data from those patients with deeper VF defects (group 1) were compared with a normal control group. Results Twenty-six workers exhibited symptoms of erethism. The EMG showed sensorimotor polyneuropathy and multiple mononeuropathy. The VA was slightly affected in 48.27% (n = 14) of subjects. Loss of CS in at least one of four spatial frequencies and color vision alterations occurred in 96.5% (n = 28) and 44.8% (n = 13), respectively. VF alterations were identified in 72.4% (n = 21) patients. No morphologic changes were seen in the OCT scans. Latencies over 100 milliseconds and reduced amplitudes of P100 were found in the PRVEP (p Conclusions In this case series, showed that acute exposure to mercury vapor had a hazardous effect on the visual system. Although neurologic and visual pathway involvement was clearly demonstrated, the differences found compared to control support the existence of a direct functional retinal damage and participation in impaired vision in mercury poisoning.

A case of solar maculopathy is described in a 36-year-old man with a history of bipolar disorder. The patient reported directly looking at the sun for several hours in the setting of a bipolar disorder decompensation. The visual acuity was 0.3 in both eyes (BE). Intraocular pressure and anterior segment were normal. In the fundus exam, a peri-macular halo with loss of the foveolar reflex was observed in BE. The macular optical coherence tomography revealed a disruption of the ellipsoid line and the retinal pigment epithelium. Bilateral central defects were seen in the Humphrey 24-2 visual field. After 6 months of follow-up, the visual clinical picture remains stable with the same degree of visual acuity. Solar maculopathy is a disorder due to the phototoxic effects of radiation, which cause a decrease in visual acuity by disrupting the retinal photoreceptor layer.

PurposeTo investigate the characteristics and rate of central visual field loss after optic disc hemorrhage (DH).DesignProspective cohort study.MethodsThree hundred forty-three eyes of 220 subjects who had ≥3 years of follow-up with a minimum of 5 visits with 10-2 and 24-2 visual field (VF) were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and predefined zones were compared using linear mixed-effects models in DH and non-DH eyes. Clustered pointwise regression analysis was also used to define central VF progressors and compared with 24-2 VF loss using guided progression analysis.ResultsThirty-nine eyes with DH and 304 eyes without DH had a mean follow-up of 5.2 years. Eyes with DH had rates of 10-2 MD loss that were 3 times faster than non-DH eyes (mean difference -0.36 dB/year [95% confidence interval 0.54-0.18]; P < .001) and were 3.7 times more likely to progress (P=.002). A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression in the DH group (30.8% vs. 20.5%) compared with the non-DH group (10.9% vs. 9.2%). In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (P < .001). Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes.ConclusionCentral VF loss is accelerated in glaucoma eyes with DH and it corresponds topographically to the DH location. In patients with glaucoma with DH, one should consider supplementing 10-2 VFs with 24-2 VFS to monitor the disease.

Purpose To evaluate whether changes to contrast, line spacing, or font size can improve reading performance in patients with glaucoma. Design Cross-sectional study. Participants Thirty-five patients with glaucoma and 32 healthy control participants. Methods A comprehensive ophthalmologic examination was performed followed by reading speed assessment using the Minnesota Low Vision Reading (MNREAD) test under a range of contrasts (10%, 20%, 30%, 40%, and 50%), line spacings (1.0, 1.5, 2.0, 2.5, and 3.0 lines), and font sizes (0.8, 0.9, 1.0, 1.1, and 1.2 logarithm of the minimum angle of resolution), for a total of 15 tests. Regression analyses were performed to examine the effect of varying test conditions on reading speed (measured in words per minute [wpm]). Results Participants’ mean age was 63.0 ± 12.6 years. Patients with glaucoma showed a visual field mean deviation in the better eye of –6.29 ± 6.35 dB. Reading speeds were significantly slower in patients with glaucoma versus control participants for 14 of the 15 MNREAD tests, despite no significant differences in age, gender, or education between groups. Increased contrast (from 10% to 50%) was associated with faster reading speed in patients with glaucoma (10.6-wpm increase per 10% increase in contrast; 95% confidence interval, 7.4–13.8 wpm; P Conclusions Patients with glaucoma showed significantly slower reading speeds than similarly aged control participants. Reading speed was improved by increasing contrast, but not by increases in line spacing or font size.

This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma. A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp–Parrish–Anderson scores. Kaplan–Meier survival and Cox proportional hazard regression analyses were performed. Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively. The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.

A 60-year-old woman, who experienced progressive right visual loss, was diagnosed with an unruptured large cerebral aneurysm. Magnetic resonance imaging (MRI) and angiography revealed a large partially thrombosed anterior communicating artery (Acom) aneurysm. The aneurysmal neck was located at the junction of the left A1–A2 segments, and the aneurysmal dome communicated with the right A1–A2 junction by the Acom. Endovascular treatment using the flow alteration technique was selected. Following an oral antiplatelet therapy for 9 days, balloon test occlusion (BTO) of the medial portion of the left A1 segment was performed under local anesthesia. After confirming the tolerance of the BTO, internal trapping of the medial portion of the left A1 segment by detachable coils was performed following intra-aneurysmal coil embolization. Oral antiplatelet treatment was continued for 19 days postoperatively. Within 3 months following the operation, her right visual acuity dramatically improved to the original level. Owing to aneurysmal recanalization and the disappearance of the thrombus, the second and third embolization was performed through the Acom route, 4 months and 3 years following the first embolization, respectively, and followed up for an additional 7 years by MRI; no deterioration of her visual acuity and no aneurysmal recanalization was observed. Thus, endosaccular embolization combined with flow alteration is considered a useful alternative treatment for large and partially thrombosed Acom aneurysms.

Purpose: To compare onset times of glaucoma progression among different glaucoma tests: disc photography (DP), visual field (VF) testing, 2-dimensional (2D) retinal nerve fiber layer (RNFL) thickness, and 3-dimensional (3D) spectral-domain (SD) OCT neuroretinal rim measurements. Design: Prospective, longitudinal cohort study. Participants: One hundred twenty-four eyes of 124 patients with open-angle glaucoma. Methods: Over a 5-year period, 124 patients with open-angle glaucoma underwent yearly DP, VF testing, SD OCT RNFL thickness scans, and optic nerve volume scans (Spectralis; Heidelberg Engineering), all performed on the same day. From high-density optic nerve volume scans, custom-built software calculated the minimum distance band (MDB) thickness, a 3D neuroretinal rim parameter. Patients were classified as glaucoma progressors or nonglaucoma progressors using event-based analysis. Progression by DP and VF testing occurred when 3 masked glaucoma specialists unanimously concurred. Progression by RNFL and MDB thickness occurred if change of more than test–retest variability was observed. Kaplan-Meier curves were constructed to analyze time-to-progression data. Kappa Coefficients were used to measure agreement of progressing eyes among methods. Main Outcome Measures: Time to glaucoma progression among all 4 methods. Results: Global MDB thickness detected glaucoma progression in the highest percentage of eyes (52.4%) compared with DP (16.1%; P < 0.001) and global RNFL thickness (15.3%; P < 0.001). Global MDB thickness detected glaucoma progression earlier than either DP (23 months vs. 44 months; P < 0.001) or global RNFL thickness (23 months vs. 33 months; P < 0.001). Among MDB progressing eyes, 46.2% were confirmed simultaneously or later by other conventional methods. Agreement of glaucoma-progressing eyes for all 4 methods in paired fashion were slight to fair (κ = 0.095–0.300). Conclusions: High-density 3D SD OCT neuroretinal rim measurements detected glaucoma progression approximately 1 to 2 years earlier compared with current clinically available structural tests (i.e., DP and 2D RNFL thickness measurements).

Supplemental Digital Content is available in the text., Background and Purpose: Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage. Methods: Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage. Results: OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0. Conclusions: Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.

Combining studies of animal visual systems with exact imaging of their visual environment can get us a step closer to understand how animals see their “Umwelt”. Here, we have combined both methods to better understand how males of the speckled wood butterfly, Pararge aegeria, see the surroundings of their perches. These males are well known to sit and wait for a chance to mate with a passing females, in sunspot territories in European forests. We provide a detailed description of the males' body and head posture, viewing direction, visual field and spatial resolution, as well as the visual environment. Pararge aegeria has sexually dimorphic eyes, the smallest interommatidial angles of males are around 1°, those of females 1.5°. Perching males face the antisolar direction with their retinal region of the highest resolution pointing at an angle of about 45° above the horizon; thus, looking at a rather even and dark background in front of which they likely have the best chance to detect a sunlit female passing through the sunspot. Supplementary Information The online version contains supplementary material available at 10.1007/s00359-021-01520-3.

To gain insight into how human observers select items in the visual field we pitted two attentional biases against one another in a single free choice design. The first bias is the nasal-temporal asymmetry during free choice tasks, where observers tend to choose targets that appear in their temporal hemifield over targets appearing in their nasal hemifield. The second is the choice bias found in studies of attentional priming. When observers have to select between a stimulus that shares features with a preceding target and a stimulus sharing features with previous distractors, they have a strong tendency to choose the preceding search target and this bias increases the more often the same search is repeated. Our results show that both biases affect saccadic choice, but they also show that the nasal-temporal bias can modulate the strength of the priming effects, but not vice versa. The priming effect was stronger for stimuli appearing in the temporal than in the nasal hemifield, but the nasal-temporal bias was similar for primed and unprimed targets. Additionally, our findings are the first to show how search repetition leads to faster saccades. The observed difference between the effects of the NTA and priming biases may reflect the difference in neural mechanisms thought to be behind these biases and that biases at lower levels may outrank higher-level biases, at least in their effect on visual attention.

PURPOSE The purpose of the study was to evaluate glaucoma patients' quality of life (QoL) as measured by National Eye Institute Visual Functioning Questionnaire (NEI VFQ-39) and to examine the influence of patient characteristics and disease stage measured by visual field loss on QoL. METHODS A prospective survey of patients with an established diagnosis of glaucoma without concomitant eye disease was conducted. Patients completed a validated German translation of the NEI VFQ-39 questionnaire. Visual field defects were graded using simplified Hodapp's classification. VFQ-39 scores were compared between groups. RESULTS We included 60 patients, 28 of whom were classified as early, 16 as moderate, and 16 as advanced stage glaucoma. No differences were found in sex, visual acuity of the better eye, near visual acuity, treatment type, and VFQ rating for "General health" between groups. In the advanced group, VFQ-39 (p = 0.01) and VFQ-25 (p = 0.01) composite scores were significantly lower than in the early group. In addition, distance visual acuity (worse eye) was significantly worse in the advanced than in early stage patients (p = 0.04, Table 4). Patients with advanced glaucoma had significantly lower VFQ-39 subscale scores for "General vision" (p = 0.023), "Near activities" (p = 0.02), "Distance activities" (p = 0.003), "Mental health" (p = 0.008), "Driving" (p = 0.011), and "Peripheral vision" (p = 0.017) than early glaucoma patients. Patients with moderate glaucoma had significantly lower scores for "Distance activities" (p = 0.028) than early stage glaucoma patients. VFI (better eye: r = 0.65, worse eye: r = 0.5) and MD (better eye: r = 0.6, worse eye: r = 0.49) were significantly (p

We tested how a stimulus gestalt, defined by the neuronal interaction between local and global features of a stimulus, is represented within human primary visual cortex (V1). We used high-resolution fMRI, which serves as a surrogate of neuronal activation, to measure co-fluctuations within subregions of V1 as (male and female) subjects were presented with peripheral stimuli, each with different global configurations. We found stronger cross-hemisphere correlations when fine-scale V1 cortical subregions represented parts of the same object compared with different objects. This result was consistent with the vertical bias in global processing and, critically, was independent of the task and local discontinuities within objects. Thus, despite the relatively small receptive fields of neurons within V1, global stimulus configuration affects neuronal processing via correlated fluctuations between regions that represent different sectors of the visual field.SIGNIFICANCE STATEMENTWe provide the first evidence for the impact of global stimulus configuration on cross-hemispheric fMRI fluctuations, measured in human primary visual cortex. Our results are consistent with changes in the level of γ-band synchrony, which has been shown to be affected by global stimulus configuration, being reflected in the level fMRI co-fluctuations. These data help narrow the gap between knowledge of global stimulus configuration encoding at the single-neuron level versus at the behavioral level.

This study aimed to develop a valid and reliable instrument that measures the functional vision of students with low vision. Thus, an assessment tool and performance activities were developed for three vision skill groups (near vision skills, distance vision skills, and visual field) that include functional vision skills. The universe was 1485 students studying in various primary and middle schools (from 2nd to 7th grades) affiliated to the Ministry of National Education, and simple random sampling was used to select 310 students. The data were collected using the Gazi Functional Vision Assessment Instrument developed by the researchers. Many-facet Rasch model and generalizability theory were used for the rater reliability of the measurements obtained from the instrument, while discriminant analysis was used for the validity of the measurements. The analysis showed that the measurements were reliable, and the inferences based on these measurements were valid. Thus, this instrument can be used to identify and assess the functional vision status of students with low vision.