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The growth of deep learning technologies allows us to achieve higher accuracy in the classification of plant diseases, as well as in other domains. This research reveals the performance of several DL approaches, including custom convolutional neural networks (CNNs) and models which are pre-trained namely VGG16 and ResNet34, which were used for the recognition of diseases in plants that are depicted through the images. These models may obtain the necessary growing environment for training and assessing the models by using a publicly accessible dataset that includes pictures of both healthy and diseased plants, in total there are 14 unique plants used. The results of the experiment suggest that all the models combinedly gave 98.46% accuracy in the classification of diverse plant diseases. In addition to this, the paper discusses the hyperparameters like learning rate and optimizer choice that affect the model furthermore, the project discusses the methods involved in training deep learning models on GPU devices computationally speaking. Thereby, this project can be added to the field of agriculture vision by showing that deep learning methods are good for plant disease classification.

Contrast demodulation and phase distortions are exaggerated in retinal images blurred by the higher-order wavefront aberrations of keratoconic eyes. While the performance loss from the former parameter is well understood, little is known about the impact of the latter on visual functions in this disease condition. The present study investigated the impact of phase distortions on the monocular logMAR visual acuity, letter discriminability and random-dot stereoacuity of seventeen visually healthy adults (ten for visual acuity and letter discriminability; ten for stereoacuity and three common to both experiments) using images that were computationally blurred by four different higher-order wavefront aberration profiles of keratoconic eyes that showed significant distortions in the phase spectrum. Participants viewed these images through 2 mm artificial pupils to negate their native ocular wavefront aberrations. The results showed progressive losses in visual acuity and stereoacuity with increasing blur, a third of which could be recovered following phase nullification. Letter discriminability also improved following phase nullification, more so for smaller than larger optotypes. Stereoacuity loss and, consequently, its recovery following phase nullification was more prominent for profiles simulating unilateral asymmetric keratoconus than for profiles simulating bilateral symmetric keratoconus. These results agree with previous reports obtained from blur induced with lower-order aberrations and indicate that a similar trend may be observed for more complex patterns of blur like keratoconus. Overall, both contrast demodulation and misalignment of the local features of the blurred image may contribute to losses of spatial and depth vision in keratoconus. Phase nullification may partially mitigate these losses, thereby allowing the processing of finer spatial details and veridical disparity estimations for improved depth perception., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Optometry, a nearly century-old profession in India, plays an important role in determining the eye health status in the country. Professional regulation is in sight for optometry through the establishment of the National Commission for Allied and Healthcare Professions Act (NCAHP), 2021. The review offers critical insights on the present status of Indian optometric education - its strengths, weaknesses, opportunities, and threats - and identifies several areas of improvement for continued growth. Strong and diverse clinical exposure, international collaborations, and a young, dynamic, and geographically diverse workforce of optometrists is a strength for the profession in India. Impending long awaited accreditation of the profession is a weakness and cause for concern. That the optometry training programs can now build graduates who will be able to function with increasing scope of clinical responsibility based on the 'World Council of Optometry Global competency model of scope of practice' to cater to the eye care needs of the grass root-level population of India is an opportunity. Infrequent curricular upgradation and lack of uniform implementation are a threat. Putative solutions are identified for overcoming the challenges engulfing the profession and ways in which these solutions may be implemented in parallel with the current legislative changes witnessed in the profession. Appeal is made to the different stakeholders of the profession to critically review its present status and build a larger coherent vision that will place the profession on a continuous growth trajectory in the 21 st century.

Purpose: To describe the construction and diagnostic accuracy of a modularized, virtual reality (VR)-based, pupillometer for detecting relative afferent pupillary defect (RAPD) in unilateral optic neuropathies, vis-à-vis, clinical grading by experienced neuro-ophthalmologists., Methods: Protocols for the swinging flashlight test and pupillary light response analysis used in a previous stand-alone pupillometer was integrated into the hardware of a Pico Neo 2 Eye ® VR headset with built-in eye tracker. Each eye of 77 cases (mean ± 1SD age: 39.1 ± 14.9yrs) and 77 age-similar controls were stimulated independently thrice for 1sec at 125lux light intensity, followed by 3sec of darkness. RAPD was quantified as the ratio of the direct reflex of the stronger to the weaker eye. Device performance was evaluated using standard ROC analysis., Results: The median (25th - 75th quartiles) pupil constriction of the affected eye of cases was 38% (17 - 23%) smaller than their fellow eye (p<0.001), compared to an interocular difference of +/-6% (3 - 15%) in controls. The sensitivity of RAPD detection was 78.5% for the entire dataset and it improved to 85.1% when the physiological asymmetries in the bilateral pupillary miosis were accounted for. Specificity and the area under ROC curve remained between 81 - 96.3% across all analyses., Conclusions: RAPD may be successfully quantified in unilateral neuro-ophthalmic pathology using a VR-technology-based modularized pupillometer. Such an objective estimation of RAPD provides immunity against biases and variability in the clinical grading, overall enhancing its value for clinical decision making., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Negi, Kalivemula, Bisht, Bhate, Sachdeva and Bharadwaj.)

Purpose: Do one-eyed (uniocular) humans use monocular depth cues differently from those with intact binocularity to perform depth-related visuomotor tasks that emulate complex activities of daily living? If so, does performance depend on the participant's age, duration of uniocularity and head movements?, Methods: Forty-five uniocular cases (age range 6-37 years; 2.4 months-31.0 years of uniocularity) and 46 age-similar binocular controls performed a task that required them to pass a hoop around an electrified wire convoluted in depth multiple times, while avoiding contact as indicated by auditory feedback. The task was performed with and without head restraint, in random order. The error rate and speed were calculated from the frequency of contact between the hoop and wire and the total task duration (adjusting for error time), respectively, all determined from video recordings of the task. Head movements were analyzed from the videos using face-tracking software., Results: Error rate decreased with age (P < 0.001) until the late teen years while speed revealed no such trend. Across all ages, the error rate increased and speed decreased in the absence of binocularity (P < 0.001). There was no additional error reduction with duration of uniocularity (P = 0.16). Head movements provided no advantage to task performance, despite generating parallax disparities comparable to binocular viewing., Conclusions: Performance in a dynamic, depth-related visuomotor task is reduced in the absence of binocular viewing, independent of age-related performance level. This study finds no evidence for a prolonged experience with monocular depth cues being advantageous for such tasks over transient loss of binocularity.

While adenotonsillectomy is the primary treatment of pediatric obstructive sleep apnea (OSA), persistent OSA after surgery is common and may be due to residual obstruction at the nose, nasopharynx, and/or palate. Comprehensive evaluation for persistent pediatric OSA ideally includes clinical examination (with or without awake nasal endosocpy) as well as drug-induced sleep endoscopy in order to accurately identify sources of residual obstruction. Depending on the site of obstruction, some of the surgical management options include submucous inferior turbinate resection, septoplasty, adenoidectomy, and expansion sphincter pharyngoplasty., Competing Interests: Disclosures E.M. Kirkham, is an author for UpToDate and is supported by the National Heart Lung and Blood Institute of the National Institutes of Health (K23HL153897). C.M. Baldassari reports involvement in the Inspire Registry. No other financial disclosures or conflicts of interest exist., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Free-fusion stereograms are routinely used for demonstrating various stereoscopic effects. Yet, untrained observers find it challenging to perform this task. This study showed that only less than 1/3rd of sixty-one pre-presbyopic adults with normal binocular vision could successfully free-fuse random-dot image pairs and identify the stereoscopic shapes embedded in these patterns. Another one-third of participants performed the task with poor success rates, while the remaining could not perform the task. There was a clear dissociation of vergence and accommodative responses in participants who were successful with free-fusion, as recorded using a dynamic infrared eye tracker and photorefractor. Those in the unsuccessful cluster either showed strong vergence and accommodation or weak vergence and strong accommodation during the task. These response patterns, however, were specific to the free-fusion task because all these participants generated good convergence/accommodation to real-world targets and to conflicting vergence and accommodative demands stimulated with prisms or lenses. Task performance of the unsuccessful cluster also improved significantly following pharmacological paralysis of accommodation and reached the performance levels of the successful cluster. A minority of participants also appeared to progressively learn to dissociate one of the two directions of their vergence and accommodation crosslinks with repeated free-fusion trials. These results suggest that successful free-fusion might depend upon how well participants generate a combination of volitional and reflex vergence responses to large differences in disparity with conflicting static accommodative demands. Such responses would require that only one direction of the vergence-accommodation crosslinks be active at any given time. The sequence of near-responses could also be learnt through repeated trials to optimize task performance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to determine changes in spatial and depth vision with increasing severity of keratoconus and to model the structure-function relationship to identify distinct phases of loss in visual function with disease severity., Methods: Best-spectacle corrected, monocular high-contrast visual acuity, contrast sensitivity function (CSF) and stereoacuity of 155 cases (16-31 years) with mild to advanced bilateral keratoconus was determined using standard psychophysical tests. Disease severity was quantified using the multimetric D-index. The structure-function relationship was modeled using linear, positive exponential, negative exponential, and logistic nonlinear regression equations., Results: The logistic regression model explained the highest proportion of variance for spatial vision, without bias in the residual plots (R2 ≥ 66%, P < 0.001). Visual acuity showed a distinct ceiling phase and a steeper loss rate with increasing D-index (1.8 units/D-index) in this model. The area under the CSF lacked this ceiling phase and had a shallower loss rate (0.28 units/D-index). Stereoacuity loss with D-index was poorly explained by all models tested (P ≤ 0.2). Cases with lower and bilaterally symmetric D-index had better stereoacuity (181.6-376 arc seconds) than those with higher D-index (>400 arc second); both were significantly poorer than controls (approximately 30 arc second)., Conclusions: Vision loss in keratoconus varies with the visual function parameter tested. Contrast sensitivity may be an earlier indicator of spatial vision loss than visual acuity. Depth perception is significantly deteriorated from very early stages of the disease., Translational Relevance: The study outcomes may be used to forecast longitudinal vision loss in keratoconus and to apply appropriate interventions for timely preservation/enhancement of vulnerable visual functions.

Clinical Relevance: High-contrast visual acuity is disproportionately poor in patients with accommodative spasm subtype of near reflex (SNR-A), relative to uncorrected refractive errors of equivalent magnitude. This exaggerated loss of performance in SNR-A may be explained by the combination of pseudomyopia and its fluctuations, vis-à-vis, each factor considered separately., Background: To determine how combinations of pseudomyopic refraction and its temporal variations in SNR-A impact high-contrast visual acuity by inducing these patterns in healthy cyclopleged adults, relative to their baseline acuity., Methods: Refractive profiles of 15 patients with SNR-A were obtained from a previous study, averaged, and induced before the right eye of 14 cyclopleged adults (mean ±1 SD age: 22.7 ± 2.6 yrs) by feeding the profile into a coaxially placed, motorised, Badal optometer. LogMAR acuity was measured using the method of constant stimuli: (1) before cycloplegia, (2) after cycloplegia and post-cycloplegia with (3) combination of pseudomyopia and its temporal fluctuations, (4) only pseudomyopia, (5) only temporal fluctuations in refraction about emmetropia, (6) condition 5 with double the amplitude of induced fluctuations and (7) condition 5 with half the amplitude of induced fluctuations., Results: The induced refractive fluctuations ranged from -0.80 to -1.75D, around a mean pseudomyopia of -1.20D. Visual acuity deterioration was maximum for the combination of pseudomyopia and temporal fluctuations condition (0.51 ± 0.07logMAR), followed by only pseudomyopia (0.27 ± 0.05logMAR) and only refractive fluctuations conditions (0.17 ± 0.04logMAR), all relative to baseline post-cycloplegia (0.13 ± 0.04logMAR) (p < 0.001). Visual acuity loss increased with doubling of refractive fluctuations (0.20 ± 0.04logMAR), relative to native fluctuations or halving the amplitude (0.15 ± 0.03logMAR) (p < 0.01). Task precision, as adjudged from the slope of psychometric function, followed a similar pattern of loss as visual acuity., Conclusion: Combination of induced pseudomyopia and temporal fluctuations in refraction produces an additive loss of visual acuity and task precision, relative to baseline and each factor considered separately.

A recent template-matching model hypothesized that simulated visual acuity loss with uncorrected refractive errors may be recovered by adding temporal defocus fluctuations up to the magnitude of the refractive error. Acuity recovery saturates or gets attenuated beyond this magnitude. These predictions were confirmed for monocular high-contrast visual acuity of 10 young, cyclopleged adults with 0.5-2.0D of induced myopia combined with the same range of temporal defocus fluctuations at 4.0 Hz frequency. The outcomes reinforce that spatial resolution may be optimized by averaging time-varying defocus over the entire stimulus presentation epoch or around the point of least defocus within this epoch.

Contrast detection thresholds are elevated with optical quality loss in keratoconus. This study hypothesized that suprathreshold contrast perception is also impaired in keratoconus, with the impairment being predictable from the pattern of loss in threshold-level performance. Contrast detection thresholds were determined across a range of spatial frequencies in 12 cases with mild to severe keratoconus and 12 age-similar controls. These values were used to predict the contrast needed to achieve perceptual matches between reference and test spatial frequency pairs (peak of CSF Vs. 0.3x, 0.5x, 2x or 3x spatial frequency from the peak) for stimuli at 10% and 50% suprathreshold contrast. Contrast thresholds predicted a 1.5 to 6.7-fold increase in the test pattern's contrast to obtain a perceptual match with the reference pattern in keratoconus, relative to controls. Contrary to predictions, the empirical data of contrast matches between test and reference patterns were similar for higher than peak spatial frequencies at both contrast levels. However, as predicted, test patterns required higher contrast than the reference pattern for a perceptual match for lower than peak spatial frequencies. These results were similar to controls and invariant of disease severity, interocular asymmetry and short-term changes in optical quality. Unlike thresholds, suprathreshold contrast perception of resolvable high spatial frequencies appears immune to optical quality losses in keratoconus. These results are discussed in the context of the prevailing models of contrast constancy in healthy humans. Breakdown of contrast constancy at lower than peak spatial frequencies may reflect the properties of the testing paradigm employed here., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Significance: Objective pupillometry with standardized light intensities allows a comprehensive assessment of the relative afferent pupillary defect in patients with unilateral neuro-ophthalmic pathology., Purpose: This study aimed to determine the impact of varying light intensities on the grade of relative afferent pupillary defect in unilateral neuro-ophthalmic pathology vis-à-vis healthy controls., Methods: Monocular pupillary light reflexes of 20 controls (14 to 50 years) and 31 cases (12 to 72 years) with clinically diagnosed relative afferent pupillary defect were measured thrice using 1-second-long light pulses, followed by 3 seconds of darkness, at eight light intensities (6.4 to 1200 lux) using objective pupillometry. The relative afferent pupillary defect was quantified as the ratio of the percentage change in the direct light reflexes of the left and right eyes. Its change with light intensity was described using standard exponential fits., Results: The median (25th to 75th interquartile range) defect score of 54.8% cases decreased from baseline values of 1.58 (1.25 to 1.87) for right eye pathology and 0.45 (0.39 to 0.55) for left eye pathology to saturation values of 1.18 (1.05 to 1.31) and 0.98 (0.95 to 1.06), respectively, at light intensities between 56.9 and 300.5 lux. Like controls (1.01 [1.00 to 1.06]), the defect scores of the remaining 45.2% cases were constant with light intensity at 1.23 (1.18 to 1.46) and 0.87 (0.86 to 0.89) for right and left eye pathologies, respectively., Conclusions: Relative afferent pupillary defects may decrease with test light intensity in a significant proportion of patients with unilateral neuro-ophthalmic pathology. This highlights the importance of objective pupillometry with standardization light intensities for clinical assessment of afferent pupillary defects., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2023 American Academy of Optometry.)

Purpose: To determine 1) the relative differences in optical quality of keratoconic eyes fitted with four routinely used CL designs and 2) the Zernike coefficients in the residual wavefront aberration map that may be responsible for differences in the optical quality of keratoconic eyes fitted with these CLs., Methods: Wavefront aberrations over a 3-mm pupil diameter were measured without and with Kerasoft IC®, Rose K2®, conventional spherical Rigid Gas Permeable (RGP), and Scleral CLs in 15 mild to moderate keratoconic eyes (20 - 28 years) and under unaided viewing in 10 age-similar non-contact lens wearing controls. The resultant through-focus curves constructed for the logarithm of Neural Sharpness (logNS) Image Quality (IQ) metric were quantified in terms of peak value, best focus, and depth of focus. Sensitivity analyses determined the impact of the residual Zernike coefficients of keratoconic eyes fitted with CLs on the IQ of controls at emmetropic refraction., Results: The peak IQ and depth of focus were similar with Rose K2®, conventional RGP, and Scleral CLs (p > 0.05, for all) but significantly better than Kerasoft IC® CLs (p < 0.01 for all). Best focus was similar across all four CLs (p > 0.2 for all). However, the IQ parameters of all the lenses remained significantly poorer than the controls (p < 0.01, for all). The IQ of the controls dropped to keratoconic levels with induced residual lower-order Zernike terms and 3rd-order coma across all lenses in the sensitivity analysis (p < 0.001)., Conclusions: IQ of keratoconic eyes remain suboptimal with routinely dispensed CL designs, largely due to residual lower-order aberrations and coma, all relative to the controls. The performance drop appears greater for the Kerasoft IC® CL relative to the other CL designs. These results may provide the optical basis for psychophysical spatial visual performance reported earlier across these four CL designs for keratoconus., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Significance: Partial improvement in stereoacuity may be achieved by balancing the contrast input to the two eyes of patients with bilaterally asymmetric keratoconus., Purpose: Interocular differences in image quality, characterized by dissimilar contrast loss and phase shifts, are implicated in stereoacuity loss in keratoconus. This study determined whether contrast balancing improves stereoacuity in this disease condition and, if so, whether it is dependent on the baseline interocular contrast imbalance., Methods: Interocular contrast imbalance and stereoacuity of 43 subjects (16 to 33 years) with bilaterally asymmetric keratoconus were tested with spectacle correction as baseline using a binocular rivalry paradigm and random-dot stereograms, respectively. Stereoacuity measurements were repeated in a subset of 33 subjects at their contrast balance point (i.e., contrast level in stronger eye allowing balanced rivalry with 100% contrast in weaker eye) and with contrast levels biased in favor of stronger or weaker eye, all conditions in randomized order., Results: Contrast imbalance level was significantly correlated with the subject's stereoacuity at baseline ( r = -0.47, P = .002). The median (25th to 75th interquartile range) stereoacuity improved by 34.6% (19.0 to 65.1%) from baseline (748.8 arc sec [261.3 to 1257.3 arc sec]) to the contrast balanced condition (419.0 arc sec [86.6 to 868.9 arc sec]) ( P < .001), independent of their baseline stereoacuity or contrast imbalance levels ( r < 0.2, P > .26 for both). Contrast bias in favor of the weaker eye (881.3 arc sec [239.6 to 1707.6 arc sec]) worsened stereoacuity more than a bias toward the stronger eye (502.6 arc sec [181.9 to 1161.4 arc sec]), both relative to the contrast balanced condition ( P < .002)., Conclusions: Interocular contrast balancing partially improves stereoacuity in bilaterally asymmetric keratoconus, independent of their baseline contrast imbalance level. Cyclopean viewing may be inherently biased toward the input from the stronger eye in keratoconus., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2023 American Academy of Optometry.)

Optical defocus in human eyes is seldom steady during naturalistic steady-state viewing. It fluctuates by 0.3 to 0.5 diopters (D) from accommodative microfluctuations and by 1.5 to 2.5 D in dysfunctions such as spasm of near reflex, both with ≤2 Hz low-pass frequency spectra. This study observed losses in monocular visual acuity of cyclopleged adults who encountered varying amplitude (0.25-2.0 D) and temporal frequency (0.25-2.0 Hz) combinations of sinusoidal defoci induced using an electrically tunable lens. Visual acuity, recorded for 300-ms flashes of Sloan optotype presentation using the method of constant stimuli, deteriorated with defocus amplitude at a rate steeper for lower than higher temporal frequencies. A template matching model of acuity, incorporating optical and neural low-pass filters, neural noise, and a cross-correlated decision operator, showed the best match with empirical data when acuity was governed by the minimum defocus available during optotype display. This criterion minimized acuity loss for higher temporal frequencies due to the increased probability of zero-defocus encounters within the presentation duration. Other decision criteria such as defocus averaging across the entire or parts of the presentation duration yielded less satisfactory results. These results imply that vision loss in humans encountering broadband time-varying defocus is dictated by the dominant low frequencies, with higher frequencies largely compensated using the least defocus decision strategy.

Binocular summation of luminance contrast signals in the spatial domain has been investigated in many studies, but less attention has been paid to the analogous interactions in the temporal domain. The present study determined the impact of monocular sensitivity on the binocular detection of luminance-modulated flickering stimuli. Binocular summation ratios (BSRs) were determined in 13 visually-normal adults for a range of monocular flicker modulation thresholds (FMTs), generated by changing stimulus size (7'- 60') and luminance (mesopic and photopic). Monocular and binocular FMTs were measured at the point of regard and in each of the four quadrants at 5° eccentricity for each target size and luminance using the Flicker-Plus test. Monocular and binocular FMT's increased with decreasing target size for all retinal locations (p<0.001), and were overall larger for mesopic than for photopic condition (p<0.001). BSRs for mesopic (mean±SD: 1.50±0.21) and photopic (1.60±0.24) stimuli were greater than unity (p<0.001), with the latter showing larger estimates than former (p<0.001). BSRs showed no significant trend across target sizes for both luminance conditions (p>0.12). The results demonstrate that the visual system successfully summates inputs from the two eyes to enhance flicker detection, independent of their absolute monocular detection thresholds. These findings may serve as a predictive baseline for further experiments designed to determine how other stimulus properties and interocular differences in monocular thresholds may affect the binocular perception of flicker., Competing Interests: JLB is the director of City Occupational Ltd. None of the other authors have any commercial relationships to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Reena Durai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Significance: Nonlinearity in the luminance profile of eccentric, infrared photorefraction may be used to differentiate corneal diseases such as keratoconus that distort the cornea, relative to regular refractive errors., Purpose: This study aimed to determine the profile of eccentric, infrared photorefraction in keratoconus as a prototypical disease model for distorted corneas and identify a parameter in this profile for differentiating such disease conditions from healthy controls., Methods: Photorefraction reflex of 75 eyes with forme fruste to advanced keratoconic cases and that of 75 eyes of controls with regular refractive errors (spherical equivalent, +0.50 to -11.75 D; astigmatism, -0.50 to -4.50 D across 0 to 180° axes) were obtained over their natural pupils under unaided viewing using a custom-designed photorefractor placed at 1 m from the subject. The test was repeated in 10 controls with 4 and 6 D of trial-lens-induced myopia and myopic astigmatism at 0, 90, 45, and 135°. Linear regression was performed on the luminance profile across the pupil, and the departure of the data from linearity was estimated using the average residual error of the fit (Res avg )., Results: Photorefraction profiles varied linearly across the pupil in controls, with slopes increasing with refractive error ( r = 0.87; P < .001) and Res avg remaining invariant of refractive error ( r = -0.29; P > .4). Corresponding profiles in keratoconus significantly departed from linearity, with Res avg progressively increasing with disease severity ( r = 0.66; P < .001). Res avg of 0.03 gray-scale units/pixel distinguished keratoconus from controls with sensitivity increasing from 66.7 to 100% for mild to advanced keratoconus and specificity remaining ≥97.1% across disease severity. Induced myopia and myopic astigmatism produced predictable changes in luminance profile slopes but with no change in Res avg values., Conclusions: Unlike regular myopia and astigmatism, the photorefraction reflex is significantly nonlinear in keratoconus because of the distorted cornea. Measures of nonlinearity in luminance profile may be incorporated in commercial photorefractors for differentiating such disease conditions from regular refractive errors., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2022 American Academy of Optometry.)

Purpose: Optical imperfections of the eye, characterized by higher-order wavefront aberrations, are exaggerated in corneal disease (e.g., keratoconus) and iatrogeny (e.g., keratorefractive surgery for myopia correction, keratoplasty for optical clarity restoration). This article reviews the recent advances on this topic for a comprehensive understanding of how optical degradations in disease models impact retinal image quality and monocular and binocular visual performance., Methods: Published literature over the last decade on retinal image quality and/or monocular and binocular visual functions with corneal irregularity was reviewed based on their relevance to the current topic, study population and strength of study design. The literature was summarized into four themes: 1) wavefront errors and retinal image quality of highly aberrated eyes, 2) monocular and binocular vision loss consequent to degraded optics and visual strategies to optimize performance, 3) impact of optical correction modalities on visual performance and 4) implications for clinical management of patients., Results: Across the 46 articles reviewed, the results clearly indicated that an increase in higher-order aberrations across these conditions had a significant negative impact on the patient's retinal image quality, and monocular and binocular visual functions. Interocular differences in retinal image quality deteriorated visual performance more than an overall worsening of image quality bilaterally. Minimizing optical degradation using rigid contact lenses and adaptive optics technology significantly improves retinal image quality and monocular and binocular vision, but performance remains sub-optimal relative to age-similar healthy controls., Conclusion: Corneal disease and iatrogeny are useful models to understand the impact of optical degradation on retinal image quality and visual performance. Clinical management will greatly benefit from equalizing retinal image quality of both eyes of these patients. Future studies that deepen our understanding of the structure-function relation in these conditions are desirable for advancing vision science in this area and for developing novel clinical management strategies.

Objective: This study aims to assess early adverse events and patient factors associated with complications following mandible distraction osteogenesis (MDO)., Materials and Methods: The American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-Pediatric) database, years 2012 to 2019, was queried for patients undergoing mandible advancement via relevant Current Procedural Terminology and postoperative diagnosis codes. Thirty-day adverse events and co-morbidities are assessed., Results: A total of 208 patients were identified with 17.3% (n = 36) experiencing an adverse event, reoperation (n = 14), and readmission (n = 11) being most common. Patients < 365 days old at the time of operation were more likely to experience an adverse event (26.1% vs 10.8%; P  = .005). However, among patients less than 1 year of age, differences in the complication rates between patients  ≤ 28 days and >28 days (30.2% vs 22.2%; P  = .47) and those weighing  ≤ 4 kg and >4 kg (31.7% vs 11.5%; P  = .063) did not reach statistical significance., Conclusions: Adverse events following mandible advancement are relatively common, though often minor. In our analysis of the NSQIP-Pediatric database, neonatal age ( ≤ 28 days) or weight  ≤ 4 kg did not result in a statistically significant increase in complications among patients less than 1 year of age. Providers should consider early intervention in patients who may benefit from MDO.

Accommodative responses of humans operate seamlessly to ensure clear vision of targets at different viewing distances, up until the onset of presbyopia. To achieve this, the visual system must correctly decipher the polarity and magnitude of retinal defocus in real-time, and often under very challenging viewing conditions. The past seven decades of research in this area has identified several retinotopic cues that may potentially provide the desired odd- and even-error information to the visual system for solving these challenges. These studies have used a variety of technology, experimental paradigms and outcome measures to determine the putative contribution of a given cue, or set of cues, in solving this problem. A variety of results, some offering consensus and others conflicting, have been observed in these studies. The present review distils this large volume of literature into specific, take-away points for the early reader of this topic, acknowledging that the problem is non-trivial and far from being solved. The review also reveals that many of these studies may not have used appropriate/sensitive methodology or outcome measures to tease apart the relative contribution of a cue in solving the direction and magnitude challenge. The review concludes with the proposal that, since a multitude of cues may be used by the visual system for solving these problems, future studies could employ a Bayesian statistical cue-combination approach to address this problem. Such approaches have yielded very meaningful insights in other areas of human decision-making involving multiple inter- and intra-modal combination of cues., (Copyright © 2022 Elsevier Ltd. All rights reserved.)