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Older individuals with macular diseases, such as age-related macular degeneration, experience central vision loss (CVL) due to degeneration of their photoreceptors and retinal cells. Patients with CVL may experience various vision impairments, including of visual acuity, fixation stability, contrast sensitivity, and stereoacuity. After CVL, most patients develop a preferred retinal locus outside the affected macular region, which serves as a new visual reference. In this review, we provide an overview of the visual function and impairment in individuals with CVL. In addition, the important role of biofeedback training on the visual function and activity of individuals with CVL is also reviewed. Accordingly, the location and development of the preferred retinal loci are discussed. Finally, this review discusses how to conduct biofeedback training to treat individuals with CVL.

AIM: To evaluate the application of optical coherence tomography angiography(OCTA)in diabetic patients without retinopathy(NDR)by Meta-analysis.METHODS: CNKI, WanFang Data, VIP, CBM, PubMed, and Embase databases were searched for relevant studies. The retrieval time was from the establishment of the database to October 2021. Two investigators independently screened the literature, extracted data and evaluated the quality of the included studies using the NOS scale. Meta-analysis and publication bias evaluation was performed using RevMan 5.3 and STATA, and sensitivity analysis was performed for results with large heterogeneity to ensure the accuracy of the results.RESULTS: A total of 44 studies, including 2 053 patients(2 600 eyes)with NDR and 1 775 healthy control patients(2 117 eyes), were included. The Meta-analysis was performed on 17 indexes including the area and perimeters of the foveal avascular zone(FAZ), the vascular density(VD)of FAZ-300um(FD300), acircularity index(AI), VD of macular area, ganglion cell complex(GCC)thickness and retinal nerve fiber layer(RNFL)thickness. Meta-analysis results showed that the area and perimeter of FAZ in superficial capillary plexus(SCP)and deep capillary plexus(DCP)in the NDR group were higher than those of healthy control patients, and FD300, VD of macular area and RNFL thickness were all lower than those in the control group(all P0.05).CONCLUSIONS: Compared to the healthy control group, NDR patients had increased FAZ area and perimetry, decreased VD of macular area and RNFL thickness and early retinal microvascular damage and neurodegenerative lesions. OCTA could be used as an auxiliary tool for early diagnosis of DR.

AIM: To explore the changes of retinal optical coherence tomography angiography(OCTA)vessel density in Patients with Alzheimer's disease(AD)by Meta-analysis, and to explore the value of OCTA in early diagnosis of AD patients.METHODS: Embase, PubMed and Cochrane Library data were searched from January 2016 to September 2021 for relevant studies on vessel density in macular area of AD patients. Two researchers independently screened the literature, extracted the data, and evaluated the risk of inclusion bias using Newcastle-Ottawa Scale(NOS). Meta-analysis was performed using RevMan 5.3 software.RESULTS: A total of 740 cases(eyes)were included in 10 literatures, including 321 cases from the AD group and 419 cases from the control group(age-matched people with normal cognitive abilities). The results of the Meta-analysis showed that the superficial vessel density in macular area of AD patients was lower than that in control group(MD=-1.58, 95%CI -2.60- -0.55, P=0.003). The deep vessel density in macular area of AD patients was lower than that in control group(MD=-2.72, 95%CI -4.36- -1.07, P=0.001). The parafoveal vessel density in AD patients was lower than that in control group(MD=-1.44, 95%CI -1.94- -0.94, P

AIM: To preliminary evaluate retinal sensitivity and the fixation alterations in patients with diabetic macular edema(DME)under Xiaozhong decoction combined intravitreal conbercept therapy. METHODS: The 40 patients with DME were randomly divided into two groups. Treatment group: 20 patients(20 eyes), Xiaozhong decoction combined with conbercept group and treatment group; 20 patients(20 eyes), placebo combined with conbercept group in our hospital from January to October in 2017. The two groups were taken oral Chinese medicinals or placebo for 3mo respectively. BCVA(ETDRS visual acuity test)and CRT(OCT)of the two groups were observed, and the retinal sensitivity and fixation stability(P1, P2)were measured by MAIA microperimetry.RESULTS: After 3mo of treatment, BCVA of treatment group and control group increased by 4(-1, 11.5)and 0(-4, 0.75)letters compared with baseline(PPP>0.05). The sensitivity of retina in treatment group was the highest(20.11±4.98dB)at 2mo. P1 and P2 in the two groups increased significantly after treatment. The increase of P1 in the treatment group was significantly higher than that in the control group at 2mo(PP>0.05).CONCLUSION: Intravitreal conbercept could improve the fixation stability in DME patients, combined with Xiaozhong decoction was conducive to maintain fixation stability.

AIM: To respectively evaluate macular morphological features and functional parameters by using spectral-domain optical coherence tomography (SD-OCT) and macular integrity assessment (MAIA) in patients with diabetic macular edema (DME). METHODS: This prospective, non-controlled, open study included 61 eyes of 38 consecutive patients with DME. All patients underwent best-corrected visual acuity (BCVA) measurement, MAIA microperimetry, and SD-OCT. DME morphology, including central retinal thickness (CRT) and central retinal volume (CRV); integrity of the external limiting membrane (ELM) and photoreceptor inner segment/outer segment (IS/OS) junction; and the deposition of hard macular exudates were assessed within a 1000-μm central subfield area. MAIA microperimetry parameters evaluated were average threshold (AT)-retinal sensitivity, macular integrity index (MI), fixation points within a circle of radius 1° (P1) and 2° (P2), and bivariate contour ellipse area considering 63% and 95% of the fixation points (A63 and A95, respectively). RESULTS: MI was significantly higher in eyes with disrupted ELM or IS/OS, compared with eyes with intact ELM and IS/OS. Values of BCVA (logMAR), total AT, AT within 1000-μm diameter, P2, A63, A95, and CRT were significantly worse in eyes with disrupted IS/OS, compared with eyes with intact IS/OS. The values of BCVA (logMAR), AT within 1000-μm diameter, and CRT were significantly worse in eyes with disrupted ELM, compared with eyes with intact ELM. These parameters were not significantly different between eyes with or without hard macular exudate deposition. CRV was not significantly different in the presence or absence of the integrity of ELM, IS/OS, or deposition of hard macular exudates. At the center, nasal and temporal sectors of the fovea, significant negative correlations were observed between retinal thickness and AT of the corresponding area. At the inferior and superior sectors of the fovea, no correlations were observed between retinal thickness and AT of the corresponding area. In the intact IS/OS group, significant negative correlations were observed between CRT and central AT. There was no correlation between retinal sensitivity and thickness when the IS/OS layer was disrupted. Multiple linear regression analyses revealed that IS/OS integrity was an independent factor affecting MI. CONCLUSION: Functional (BCVA and visual field) and morphological parameters (retinal thickness) were significantly associated with an intact IS/OS. Local photoreceptor integrity was a strong predictor of local visual function throughout the retina. MI revealed the functional status in DME, reflecting the IS/OS juction status in the macula.

Vitreoushumour(VH)is a transparent, highly hydrated gel, which occupies the vitreous cavity. The protein composition of the VH would change in pathological conditions of the retina, which has been testified in many studies. In the last decade, proteomics analyses have been performed to study the proteome of the human VH and hope to find some specific proteins in the aetiology of diabeticretinopathy(DR). Recent proteomic studies on the VH from animal models of autoimmune uveitis have identified some specific proteins in related entophthalmia.