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Purpose: To investigate structure-function associations between contrast sensitivity (CS) and widefield swept-source optical coherence tomography angiography (WF SS-OCTA) vascular metrics across stages of non-proliferative (NPDR) and proliferative diabetic retinopathy (PDR), without diabetic macular oedema. Methods: Prospective cross-sectional study in 140 eyes of 99 patients: 33 mild NPDR, 24 moderate/severe NPDR, 15 PDR, 33 diabetic without DR (DMnoDR) and 46 control eyes. Mixed-effects multivariable regression models to evaluate associations between quantitative contrast sensitivity function (Adaptive Sensory Technology) and vessel density (VD) and vessel skeletonised density (VSD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP) on same-day imaging with WF SS-OCTA (Plex Elite 9000, Carl Zeiss Meditec). Results: Standardised β coefficients for area under the logarithm of contrast sensitivity function curve (AULCSF) versus visual acuity (VA) at 3×3 mm scans: SCP VSD (β=0.32, p<0.001 vs -0.18, p=0.044), DCP VSD (β=0.30, p<0.001 vs -0.21, p=0.02), SCP VD (β=0.25, p=0.004 vs -0.13, p=0.129), DCP VD (β=0.26, p=0.003 vs -0.19, p=0.034). AULCSF was significantly reduced in mild NPDR (β=-0.28, p<0.001) and DMnoDR (β=-0.19, p=0.005) versus controls, while VA was not significantly different. AULCSF performed better than VA in differentiating between controls and DMnoDR (0.69 vs 0.50), controls and mild NPDR (0.76 vs 0.61) and controls and moderate/severe NPDR (0.89 vs 0.73). Conclusions: DR-induced microvascular changes on OCTA are associated with larger changes on CS than in VA. CS is affected earlier than VA in the course of DR and performed better in discriminating between controls, DMnoDR and across DR stages. [ABSTRACT FROM AUTHOR]

Background and Objective: Three-dimensional heads-up display (HUD) systems have emerged as an alternative to standard operating microscope (SOM) in the operating room. The goal of this study was to quantitatively measure vitreoretinal surgeon posture across visualization methods. Methods: Ergonomic data was collected from 64 cases at two tertiary eye care centers. Surgeons wore an Upright Go 2TM posture training device while operating either using the NGENUITY 3D heads-up display visualization system or the SOM. Results: Total percentage of time with upright posture as primary surgeon was significantly higher in surgeries performed using HUD (median 100%, interquartile range [IQR], 85.1% to 100.0%) as compared to surgeries performed using the SOM (median 60.0%, IQR 1.8% to 98.8%) (P = 0.001, Wilcoxon rank-sum test). Percent time with upright posture was significantly higher in surgeries performed using HUD for two of the three surgeons when assessed independently across systems. Results remained significant when accounting for length of surgery (P < 0.001, multiple linear regression). Conclusions: Ergonomic positioning was improved for surgeons operating using HUD. Given the high prevalence of back and neck pain among vitreoretinal surgeons, increased use of HUD systems may limit musculoskeletal pain and long-term disability from poor ergonomics. [Ophthalmic Surg Lasers Imaging Retina 2024;55:638–645.] [ABSTRACT FROM AUTHOR]

Background/aims Pathological myopia (PM) is a leading cause of blindness worldwide. We aimed to evaluate microvascular and chorioretinal changes in different stages of myopia with wide-field (WF) sweptsource (SS) optical coherence tomography angiography (OCTA). Methods This prospective cross-sectional observational study included 186 eyes of 122 patients who had undergone imaging between November 2018 and October 2020. Vessel density (VD) and vessel skeletonised density (VSD) of superficial capillary plexus, deep capillary plexus and whole retina, as well as foveal avascular zone parameters, retinal thickness (RT) and choroidal thickness (CT), were calculated. results This study evaluated 75 eyes of 48 patients with high myopia (HM), 43 eyes of 31 patients with mild to moderate myopia and 68 eyes of 53 age-matched controls. Controlling for age and the presence of systemic hypertension, we found that HM was associated with decrease in VD and VSD in all layers on 12×12 mm² scans. Furthermore, HM was associated with a VD and VSD decrease in every Early Treatment Diabetic Retinopathy Study grid, with a larger decrease temporally (βVD=-0.39, βVSD=-10.25, p<0.01). HM was associated with decreased RT and CT. Reduction in RT was outside the macular region, while reduction in CT was in the macular region. Conclusion Using WF SS-OCTA, we identified reduction in microvasculature and structural changes associated with myopia. Decrease in VD and VSD was greater in the temporal quadrant, and reductions in RT and CT were uneven across the retina. Further work may help identify risk factors for the progression of PM and associated vision-threatening complications. [ABSTRACT FROM AUTHOR]

Background and Objective: This study compares the ability of resident ophthalmologists to identify neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) using widefield swept-source optical coherence tomography angiography (SS-OCTA) and fluorescein angiography (FA)., Patients and Methods: Fluorescein angiography and SS-OCTA images were scrambled to create a grading set consisting of 1) early and late phase FA images, 2) B-scan videos, and 3) vitreoretinal interface (VRI) slab. Participants were asked to identify NV., Results: Twelve resident physicians participated in the study. Resident physicians correctly identified 75.6% of NV using FA, 65.3% of NV using SS-OCTA B-scans, and 90.7% of NV using the SSOCTA VRI slab. There was no statistically significant difference in participants' ability to detect NV across imaging modalities ( P = 0.08)., Conclusion: Detection rates of NV using SS-OCTA were comparable to that of using FA. Results suggest that SS-OCTA may be an appropriate imaging modality for detection of NV in PDR patients. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.] .

Background and Objective: A cross-sectional prospective study to examine ergonomic differences in vitreoretinal settings: surgery, clinic, and dedicated procedure clinic., Patients and Methods: Three vitreoretinal surgeons, three fellows, and one resident at a tertiary eye care facility. Participants wore an Upright Go 2 posture device and posture was recorded in each setting between July 1 to August 31, 2023., Results: Time in upright and poor postures was tracked. Significant differences were found in postural score for attendings between work settings ( P < 0.01). Trainees showed no significant difference between settings. Poor posture in surgery was linked to microscope use and scleral buckle placement; in the clinic, it was associated with pan-retinal photocoagulation and injection minutes; in procedure clinic, it was ophthalmologist-dependent and those performing injections., Conclusions: Ergonomic considerations are crucial in vitreoretinal practice. Attendings and trainees should focus on posture in surgery and clinic settings to enhance career longevity. [ Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.] .

Purpose: We describe three different approaches for lens management in cases of metallic IOFBs involving the posterior segment., Methods: All consecutive posterior segment metallic IOFB cases from 2012 to 2023 at a single institution were included in this retrospective case series. Surgical outcomes and surgical videos are presented., Results: A total of 25 metallic IOFB cases were included. In 9 cases, there was no significant lens involvement, therefore not requiring lens extraction at the time of IOFB removal. In 8 cases with traumatic cataract, lens extraction sparing the anterior lens capsule was performed with IOFB removal. In 8 cases, both lens extraction and lens capsule removal were required at the time of IOFB removal., Conclusion: We demonstrate our algorithm to capsular management in patients who present with IOFB with good visual outcomes in follow-up., Competing Interests: Declaration of Conflicting Interests: All authors have no conflict of interest to report., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)