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Purpose: To adapt the Quality of Vision Questionnaire (QoV) for measuring negative dysphotopsia and to validate the original and modified versions in the Dutch population. Methods: The QoV was translated into Dutch according to standardized methodology. Negative dysphotopsia items were constructed based on focus group interviews, literature review and clinical data. The questionnaire was completed by 404 subjects, including contact lens wearers, patients with cataract and after cataract surgery (95.5% with a monofocal, 4.5% with a multifocal intraocular lens). Rasch analysis was applied for evaluation of reliability and validity of the original QoV and modified version, Negative Dysphotopsia QoV (ND‐QoV). Results: The frequency, severity and bothersome scales of the QoV and ND‐QoV demonstrated good measurement precision, good fit statistics for all but one item, but significant mistargeting of more than one logit. Item estimations were stable across the study groups and scales were unidimensional with more than 50% of variance explained by the measurements. There was a positive correlation between questionnaire scores and best corrected visual acuity (r = 0.3, p < 0.01). The quality of vision measured by all three scales was significantly poorer (p < 0.01) in patients with negative dysphotopsia compared to asymptomatic pseudophakic patients. Conclusion: The Dutch version of the QoV questionnaire has shown good psychometric properties comparable to the native version as well as good reliability and validity. The addition of negative dysphotopsia items is a valuable modification for the reliable assessment of quality of vision in pseudophakic patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this systematic literature review was to describe patient‐reported outcomes, mental health and caregiver burden in patients with neovascular age‐related macular degeneration (nAMD) treated with anti‐vascular endothelial growth factor (VEGF) agents in routine clinical practice. Methods: Electronic searches were conducted in Embase and MEDLINE according to pre‐defined criteria. Results: Of 856 records identified, 63 met inclusion criteria. Depression or depressive symptoms were reported in up to 42% of patients with nAMD. Of 25/63 (40%) studies evaluating quality of life (QoL) and using various tools, eight studies reported composite National Eye Institute Visual Functioning Questionnaire scores following anti‐VEGF treatment. Of these, seven reported a statistically significant improvement at the earliest time point measured (Month 3–12) and approximately 50% reported sustained QoL benefits at 12 months. In studies comparing the attributed or different regimens, the most important factor from the patient's perspective was the likelihood that a particular regimen would maintain vision. There was a preference towards treat and extend, which was associated with a perceived reduction in patient and caregiver burden, compared to fixed dosing. Conclusions: A coordinated holistic approach to patient care is key to optimizing patient well‐being as well as visual outcomes. Further research regarding the patient‐reported impact of nAMD management outside the trial setting (particularly international longitudinal studies) is warranted. Standardization of QoL studies would assist in establishing whether sustained QoL improvement, rather than prevention of QoL decline, should be a realistic expectation of treatment of nAMD in the longer term. [ABSTRACT FROM AUTHOR]

Purpose: A vignette study to examine treatment decisions made by UK hospital optometrists in patients with neovascular age‐related macular degeneration (nAMD) and the effect of optometrists' experience on agreement. Methods: Patients with nAMD attending Manchester Royal Eye Hospital, Manchester, UK were identified as potential candidates for the case series of vignettes. The cases were chosen to reflect a varied case‐mix with respect to difficulty as well as ensuring good quality of the images. Each vignette included a history summary consisting of the number of previous injections given and visual acuity measurements at baseline, the previous visit, and the current visit. Images were compiled to show baseline fundus photographs and ocular coherence tomography (OCT) images with the current visit images on which the treatment decision was to be made along with the images from the previous visit. Hospital optometrists were recruited and asked to complete the series of vignettes, deciding if treatment was required at that visit and how confident they felt with that decision. Their responses were compared to the reference standard created by a consensus of consultant ophthalmologists with a sub‐speciality interest in medical retina. Results: Regarding treatment decision for optometrists, the percentage correct value was 75% with the sensitivity being 75.6% (95% CI 70.1–80.3) and the specificity as 75.1% (95% CI 72.1–77.8). No statistically significant difference was found between differing levels of experience. However, there was a significant difference in confidence levels between groups. Potentially sight threatening decisions accounted for 6.4% of the optometrists' decisions, 3.5% were made with a high confidence rating suggesting no discussion with an ophthalmologist was required. Conclusions: Although the optometrists showed modest agreement with the reference standard in a series of cases that have higher than average complexity, the optometrists showed a similar amount of variability within their treatment decisions compared to the reference standard. The optometrists were therefore not inferior in their performance compared to the ophthalmologists and this can be seen as supporting evidence for their extended role within this clinical area. Experience did not have an effect on 'correct' treatment decisions although there was a statistically significant effect on increasing confidence of treatment decision. [ABSTRACT FROM AUTHOR]

Importance: The study highlights the role of optical coherence angiography in the management of patients with neovascular age‐related macular degeneration (nAMD) who have developed sub‐retinal fibrosis. Background: Development of sub‐retinal fibrosis in the context of nAMD is known to adversely affect visual function. The aim of this study is to assess structure and flow features obtained through swept‐source optical coherence tomography angiography (OCTA) in patients with sub‐retinal fibrosis and associate these with visual acuity (VA). Design: Institutional retrospective cohort study. Participants: A total 39 eyes of 39 patients with nAMD with sub‐retinal fibrosis imaged with OCTA were included in this study. Methods: Patients underwent swept‐source OCTA. Thickness of sub‐retinal hyper‐reflective material (SHRM) and presence and configuration of a choroidal neovascular membrane were recorded in each case. Main Outcome Measures: A univariate multiple regression was performed seeking associations between VA and structural and flow OCTA features. Results: Average VA on the date of OCTA was 53 ± 22 ETDRS letters. Average thickness of centre‐involving SHRM was 157 ± 73 μm. A choroidal neovascular membrane was detectable in 26 cases and not detectable in 13. VA was independently influenced by thickness of SHRM (P = 0.034) and presence of a detectable choroidal neovascular membrane (P = 0.02) on OCTA. Conclusions and Relevance: Poorer VA in patients with nAMD and sub‐retinal fibrosis is associated with presence of a detectable neovascular membrane on OCTA. The role of OCTA to guide nuanced management decisions in this patient population may be significant. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To determine whether the ocular phenotype in patients with mucopolysaccharidosis type I (MPSI) Hurler is affected by the efficacy of previous haemopoietic stem cell transplantation (HSCT). Design: A retrospective cohort study of patients with MPSI who had undergone treatment with HSCT. Methods: Ocular phenotype was documented for each patient and compared to levels of biomarkers representing efficacy of previous transplantation. Main outcome measures: Assessment of visual acuity (VA), severity of corneal clouding and the presence of optic neuropathy or retinopathy. Biomarker assessment included dermatan sulphate/chondroitin sulphate (DS/CS) ratio and iduronidase enzyme level. Results: Severe corneal clouding was significantly greater in patients with lower iduronidase levels (p = 0.023) and raised DS/CS ratio (R2 = 0.28 p = 0.043). Better VA was related to a higher iduronidase levels (R2 = 0.15, p = 0.004) and lower DS/CS ratio (R2 = 0.38, p = 0.001). Conclusion: Improved ocular phenotypes in MPSI are associated with markers signifying efficacy of prior transplant. Early and effective HSCT may result in a better visual prognosis and reduction in ocular complications for patients with MPSI. [ABSTRACT FROM AUTHOR]

The aim of this review is to summate the eye involvement in patients with mucopolysaccharidoses ( MPS) using current ocular imaging techniques, their advantages and disadvantages and how they may aid diagnosis, management and monitoring. We critically reviewed the current literature surrounding MPS and recent imaging technology as well as histology. Primary searches of PubMed and Web of Science were performed. We reviewed all papers on the topic published and summarized the findings of each medical device as well as the advantages and disadvantages of using these for the MPS patient. We discussed the potential of each of these devices to monitor potential ocular pathology in the MPS cohorts in the order of MPS subtype. We reviewed imaging techniques involving use of the Iris Camera, Pentacam, Optical Coherence Tomography ( OCT) as well as ultrasound and Heidelberg OCT. The need for reliable objective quantification of eye findings in MPS has led to utilization of new imaging technologies described here, and future use will enhance our understanding of the unique eye features in MPS. In particular, we note that the Pentacam and iris camera are able to provide objective measurements of corneal haze and monitor ocular response to treatment. [ABSTRACT FROM AUTHOR]

Purpose Computer-assisted assessment of vessel tortuosity is clinically useful in retinopathy of prematurity (ROP). However, poor image quality is often prohibitive for accurate segmentation by fully automated systems and semi-automated systems are prone to unreliability. In the present work, we describe a method of retinal vessel tortuosity measurement by means of purpose-built image analysis software that does not require high image quality yet is also reliable. Methods Images were obtained from neonates at risk of ROP with Retcam Shuttle®. Individual vessels were assessed with the semi-automated Novel Evidenced Assessment of Tortuosity (NEAT) system by two masked experimenters. Scores were compared to assess reliability. They were also compared against clinical scoring of individual vessels by two ROP screeners to assess relationship with clinical assessment. In a second image cohort, the mean of the most tortuous vessel in each of four quadrants in each eye (NEAT-O) was compared against the documented gold standard clinical grading of plus disease. Results Reliability of the NEAT system for 50 individual vessels using Bland-Altman plots was excellent. NEAT tortuosity scores for 50 individual vessels compared to clinical scoring showed strong correlation (0.706). Correlation between the NEAT-O score for average tortuosity and gold standard for 167 eyes was modest (0.578). Conclusions The NEAT system is intuitive, user-friendly and robust enough to be clinically useful in poor-quality images. It allows for a rapid, valid and reliable assessment of tortuosity of individual vessels and produces a tortuosity score that correlates well with severity of plus disease. [ABSTRACT FROM AUTHOR]

We present methods for computing either the level set function or volume fraction field from the other at second-order accuracy. Both algorithms are optimal in that O( N) computations are needed for N total grid points and both algorithms are easily parallelized. This work includes a novel interface reconstruction algorithm in three dimensions that requires a smaller local block of volume fractions than existing algorithms. A compact local solver leads to better algorithm portability and efficiency: for example, fewer restrictions must be imposed on an adaptive mesh, and fewer grid cells must be communicated between processors in a parallel implementation. We also present a fast sweeping method for computing a unique approximation of the signed distance function to a piecewise linear interface. All of the numerical examples confirm second-order accuracy on both uniform and tree-based adaptive grids. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An accurate assessment of retinopathy of prematurity (ROP) is essential in ensuring correct and timely treatment of this potentially blinding condition. Current modes of assessment are based upon clinical grading by expert examination of retinal changes. However, this may be subjective, unreliable and difficult and there has been significant interest in alternative means of measurement. These have been made possible through technological advancements in image capture and analysis as well as progress in clinical research, highlighting the specific importance of plus disease in ROP. Progress in these two fields has highlighted the potential for digital image analysis of plus disease to be used as an objective, reliable and valid measurement of ROP. The potential for clinical and scientific advancement through this method is argued and demonstrated in this article. Along with the potential benefits, there are significant challenges such as in image capture, segmentation, measurement of vessel width and tortuosity; these are also addressed. After discussing and explaining the challenges involved, the research articles addressing digital image analysis of ROP are critically reviewed. Benefits and limitations of the currently published techniques for digital ROP assessment are discussed with particular reference to the validity and reliability of outcome measures. Finally, the general limitations of current methods of analysis are discussed and more diverse potential areas of development are discussed. [ABSTRACT FROM AUTHOR]

Disability glare describes the loss of retinal image contrast as a result of intraocular light scatter, or straylight. It has increasingly important modern implications such as with cataract and refractive surgery or high-intensity lighting. However, its measurement has proven difficult despite many varying approaches. This article aims to explain the principles and problems associated with glare testing that are important for assessment and use of glare measures. After defining disability glare, this article discusses the importance of its measurement to current clinical practice. It explains the principles and mechanisms that underlie disability glare and its measurement. Finally, some examples of available glare tests are described to illustrate the principles discussed. [ABSTRACT FROM AUTHOR]

The retinal and cerebral microvasculatures share many morphological and physiological properties. Assessment of the cerebral microvasculature requires highly specialized and expensive techniques. The potential for using non-invasive clinical assessment of the retinal microvasculature as a marker of the state of the cerebrovasculature offers clear advantages, owing to the ease with which the retinal vasculature can be directly visualizedin vivoand photographed due to its essential two-dimensional nature. The use of retinal digital image analysis is becoming increasingly common, and offers new techniques to analyse different aspects of retinal vascular topography, including retinal vascular widths, geometrical attributes at vessel bifurcations and vessel tracking. Being predominantly automated and objective, these techniques offer an exciting opportunity to study the potential to identify retinal microvascular abnormalities as markers of cerebrovascular pathology. In this review, we describe the anatomical and physiological homology between the retinal and cerebral microvasculatures. We review the evidence that retinal microvascular changes occur in cerebrovascular disease and review current retinal image analysis tools that may allow us to use different aspects of the retinal microvasculature as potential markers for the state of the cerebral microvasculature. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of volume used in sub-Tenon's anaesthesia on efficacy and intraocular pressure (IOP).Methods: A prospective, randomised clinical trial was conducted on 52 eyes of 52 consecutive patients undergoing sub-Tenon's anaesthetic for cataract surgery. Eyes were randomly assigned to either 3 mL or 5 mL volume of anaesthetic solution (0.5% bupivacaine/2% lidocaine in a 50:50 mixture). The main outcome measures were akinesia 5 min post-administration of anaesthetic, changes in IOP immediately after and 5 min after anaesthetic administration, and patient pain perception during procedure.Results: The level of kinesia was greater in the 3 mL group (n = 25) compared to the 5 mL group (n = 27) (P = 0.001, Mann–;WhitneyU-test). There was no significant difference in pain perception between the two groups (P = 0.464, studentt-test). Although there was great variation in IOP changes following sub-Tenon's anaesthetic, there was a trend for a larger rise in mean IOP immediately after anaesthetic administration in the 5 mL group (mean ± SD+5.6 ± 4.2 mmHg) compared to the 3 mL group (+4.3 ± 3.8 mmHg), but this did not reach statistical significance (P = 0.25, studentt-test).Conclusions: A 5 mL volume of anaesthetic provides akinesia superior to a 3 mL volume in sub-Tenon's anaesthesia for cataract surgery. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on optical coherence tomography (OCT) in patients suffering from macular telangiectasia type 2 (MacTel) disease.