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Background Visual outcomes after primary tumour treatment of uveal melanoma (UM) have been investigated repeatedly. This study evaluates the correlation between best-corrected visual acuity (BCVA) before treatment with clinicopathological factors and patient survival. Subjects/Methods Pre-treatment BCVA was examined in relation to tumour dimensions and location, and survival in a retrospective cohort of 1809 patients who underwent plaque brachytherapy. BCVA was also correlated to tumour histological factors in a second cohort of 137 enucleated eyes. Results The mean BCVA of the tumour eye prior to plaque brachytherapy was LogMAR 0.42 (SD 0.46). Patients with low BCVA (LogMAR ≥ 1.00) did not differ in age (p = 0.19) and had similar frequency of ciliary body involvement (p = 0.99) but had tumours with greater apical thickness (p p p p > 0.004). Patients with low BCVA had greater incidence of UM-related mortality in competing risk analysis (p = 0.0019) and shorter overall survival (p Conclusions UM patients with low BCVA before primary tumour treatment have a worse prognosis, likely related to increased tumour dimensions. Future studies should examine the prognostic significance of BCVA in relation to macula-involving retinal detachment and genetic factors.

Purpose: To evaluate the precision of individual and combined macula and optic disc volumetric analysis, and the agreement between these two scan modes with spectral domain optical coherence tomography (OCT).Methods: Macular and optic disc volumetric measurements were performed with individual and combined scan protocols in one eye of 75 healthy subjects. Three repeated measurements were performed with each protocol. From the macular area, retinal thickness in nine different sectors and ganglion cell complex thickness in eight different sectors were analyzed from both scan modes. From the optic disc area, the peripapillary retinal nerve fiber layer (pRNFL) thickness in 12 clock sectors and the optic disc parameters were evaluated. For all the parameters, repeatability limit and agreement analysis were performed.Results: For the retinal thickness measurements in macula, the combined scan had two to three times larger repeatability limit than the individual scan for all the sectors except the central sector, where the repeatability limit was five times larger. The limits of agreement intervals were lower than 20 μm for all sectors, except the central. The ganglion cell complex measurements also had larger repeatability limits for the combined scans, and the limits of agreement intervals were Conclusion: The individual macula and optic disc scans had better repeatability than the combined scan mode, and the two scan modes cannot be used interchangeability due to the wide limits of agreement.

Visual outcomes after treatment of uveal melanoma have been investigated repeatedly. In this paper, we evaluate the correlation between visual acuity (VA) prior to enucleation, presenting symptoms and findings upon histopathological examination of eyes and tumors. Sixty nine patients were included. Their mean best corrected visual acuity (BCVA) prior to enucleation was LogMAR 0.80 (SD 0.70). Patients that reported low VA or blurry vision did not have lower BCVA upon refraction (p=0.34). Patients with low BCVA had tumors with greater apical tumor thickness (p=0.027), basal diameter (p=0.012) and stage (p=0.014). The experience of a shadow in the visual field correlated with presence of vasculogenic mimicry in the tumor (p

Background: To evaluate the precision and accuracy of objective refraction measurement obtained with combinations of instrument design and technique. We also compared the performance of the instruments with subjective refraction measurements. Method and analysis: The objective refraction was measured in 71 subjects with three autorefractometers that have different designs and measurement principles (binocular with fogging, binocular without fogging, and monocular with fogging). Repeatability and reproducibility metrics were calculated for the objective refraction measurements. The agreement of the objective refraction measurements between the three instruments and the agreement with the subjective refraction measurements were evaluated. Results: All three autorefractometers had repeatability and reproducibility limits smaller than 0.70D. The smallest difference (0.10D) in the spherical equivalent was seen between the two binocular instruments. Compared with the subjective refraction, the binocular without fogging technique had the smallest mean difference in spherical equivalent (&lt, 0.20D) whereas the binocular fogging technique had the smallest limit of agreement interval (1.00D). For all comparisons, the mean difference and limit of agreement interval for the cylindrical components were lower than 0.10D and 0.75D, respectively. Conclusion: All three instruments evaluated had good repeatability and reproducibility. The binocular fogging technique provided the best agreement with subjective refraction.

Background: People living with HIV (PLHIV) on antiretroviral therapy (ART) without retinitis may not have a healthy retinal structure. Aim: To examine the impact of the virus together with the ART medication in PLHIV without retinitis. Methods: This review used the following databases: PubMed, Google Scholar and EBSCOhost. Search terms included: HIV and/or retinal nerve fibre layer (RNFL); perimetry; colour vision; contrast sensitivity (CS); visual evoked potentials (VEPs); electroretinograms (ERGs); and the brain. All peer-reviewed studies related to PLHIV on ART without retinitis, up until September 2019, were included. Results: The mean RNFL thickness, and superior and inferior zones showed thinning. Affected visual functions include transient pattern VEP and ERG; contrast sensitivity; reduced total error scores on colour vision evaluation; and reduced mean deviation and pattern standard deviations on perimetry. Studies also showed concurrent thinning of the peripapillary retinal nerve fibre layer (ppRNFL) and perimetry, contrast sensitivity and colour vision. All these significant observations were seen at a cluster of differentiation 4 (CD4) count of less than 200 cells/mm 3 in PLHIV on ART with no retinitis. Further to this, studies have also related the retina to grey and white matter changes in PLHIV in the era of ART. A gap in research involves studies on the vascular impact of ART on the retina, which should be factored into studies going forward when studying PLHIV on ART. Conclusion: The decrease in visual function, the RNFL changes and neuro-ophthalmic involvement in PLHIV allow us to recognise the threat to vision loss when factoring in the expected longer lifespan that PLHIV on ART are afforded today.

Background Working in front of computer screens is visually demanding and related to adverse eye symptoms. Occurrence of glare further increases visual fatigue. Objective This paper presents results from an examination of visual ergonomics in control room environments at two Swedish process industries. Methods Visual conditions were examined and evaluated in nine control rooms and eighteen process operators answered questions about their perceived workload and visual experiences. Results When working in the control rooms, the mental workload was rated significantly higher by the participants, compared to experienced performance. The operators further experienced significantly higher visual fatigue and blurred vision compared to double vision and sore eyes. Visual demands were increased in conditions where contrast glare was present, as well as frequent changes of focusing distances, and low contrast between background and characters in computer screens. Conclusions Suboptimal visual working conditions in the control rooms contributes to increased visual demands on the operators. Presence of glare is leading to visual fatigue and an unnecessary high mental load. The findings support the relevance of considering principles of general and visual ergonomics when designing and organizing work in control rooms. Workstation design should also be flexible to allow for individual and contextual adjustments.

[Excerpt] The world’s population is growing older, with persons over the age of 65 being the fastest-growing age group. According to data from World Population Prospects 2019 [1], one in 11 people in the world was over the age of 65 in 2019 (9%), and this number is expected to increase to one in six (16%) by 2050 since life expectancy is also expected to increase from current 72.6 years to 77.1. In 2018, for the first time in history, persons aged 65 or above outnumbered children under five years of age.[...]

BACKGROUND To assess the repeatability and agreement between a new high-resolution optical coherence tomographer (OCT) and a Scheimpflug topographer. MATERIAL AND METHODS Sixty phakic and healthy participants were measured in this study, and one eye per participant was analyzed. Depending on their refractive error, each participant was allocated into a myopic, hyperopic, or emmetropic group. The Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Jena, Germany), and the Sirius Scheimpflug topographer (Costruzione Strumenti Oftalmici, Florence, Italy) were used to take all measurements. RESULTS The repeatability of these instruments to measure the anterior chamber depth, angle-to-angle, thinnest pachymetry, and both nasal and temporal angles was smaller than 0.15 mm, 0.40 mm, 10 µm, and 10 degrees, respectively. However, the repeatability of the Scheimpflug instrument to measure the apex pachymetry was about 15 µm, and for the OCT, it was about 4 µm for all groups. On average, the Sirius Scheimpflug instrument measured shallower anterior chamber depth (about 0.10 mm), shorter angle-to-angle (about 0.5 mm), thinner corneas (approximately 10 µm), and narrower angles (around 5 degrees) for all refractive groups. CONCLUSIONS The repeatability of the Cirrus OCT and Sirius Scheimpflug instrument was good and independent of the refractive error. Nevertheless, to judge whether these instruments could be used interchangeable, clinical criteria are needed.

PurposeTo evaluate the repeatability of the new spectral domain optical coherence tomography (HOCT-1F), and also to evaluate the agreement between vertical and horizontal scan protocols. In addition, we also evaluated the relation between the repeatability and age.MethodsThree consecutive measurements of the inner limiting membrane-retinal pigment epithelium (ILM-RPE), inner limiting membrane-inner plexiform layer (ILM-IPL) from macular horizontal and vertical scans, and inner limiting membrane-retinal nerve fiber layer (ILM-RNFL) from optic disc horizontal scan. 159 subjects were included in the analysis. The within subject standard deviation (Sw) and the repeatability limits (Rlimit) are used to represent the repeatability of the parameters for the different sectors.ResultsThe Sw for the ILM-RPE thickness was less than 3.5 μm for each sector and scan direction. The Sw values varied within the sectors and scan modes, with horizontal scan modes resulting in better values for the horizontal sectors, and vice versa. The Sw for the GCL-IPL thickness was less than 2 μm, and was similar between the vertical and horizontal scan modes for each sector map. For the optic disc scan, the Sw was not symmetric along the clock-hour map sectors, the largest Sw values were seen in the vertical sectors (8.6 μm). The mean difference between the vertical and horizontal scans was less than 2 μm for each retinal thickness sector map. Significant but weak correlation between the Sw and the subject's age was seen in both macular and optic disc scans.ConclusionsThe repeatability of the HOCT-1F to measure the ILM-RPE-, ILM-IPL- and ILM-RNFL-thickness is good. The repeatability of the ILM-RPE thickness is dependent on the scan direction, which should be taken into account when calculating retinal thickness. There is a weak correlation between the repeatability and the subject's age.

Purpose.The aim of the present study was to compare macular thickness in patients with keratoconus (KC) with macular thickness in healthy subjects.Subjects and Methods.Twenty-six patients with KC and 52 control subjects were included. The macular structure was evaluated using a Zeiss Cirrus HD-OCT. The scan pattern used was 512 × 128, which covers an area of approximately 6 × 6 mm of the retina. The cube volume was assessed as well as macular thickness in each of the 9 sectors defined by the software.Results.The mean signal strength was significantly lower in the KC group (mean 8.4, range 6–10) compared with the control group (mean 9.7, range 7–10),P<0.0001(unpairedt-test). There were no significant differences in cube volume (unpairedt-test), cube average thickness, or macular thickness between the KC group and the control subjects in any of the retinal locations (one-way ANOVA).Conclusion.Macular structure as measured by OCT in KC subjects should be expected to lie within the range of age and sex matched controls.

Purpose: To AU3 evaluate the subjective satisfaction in visual stability, night vision complains, and light distortion phenomena, and also the number of hours and days per week of lens wear, in patients with myopia undergoing orthokeratology (OK) treatment for at least 1 year. Methods: A visual analog scale (VAS) questionnaire containing 18 items was administered to 44 patients, 29 women and 15 men (mean age, 24.39 6 9.11 years), with a baseline spherical equivalent refractive error of 22.40 6 0.94 diopters and astigmatism up to 20.5 diopters. Average treatment period by the time of data collection was 19 6 7 months. Patients rated their satisfaction with the correction, with complaints of visual distortion being graded on a scale of 0 to 10, where 0 indicated no discomfort at all. Results: More than 50% of patients skipped lens wear at least 1 night per week. The most common wearing pattern was 6–8 hours a day for 72.7% with 54.5% of patients wearing lenses every 2–3 nights only. Subjective vision scores after lens removal was 9.1 6 1.1 after having worn the lenses and 8.1 6 1.4 after skipping lens wear for 1 night. Subjective vision scores before lens insertion at the end of the day was 6.9 6 2.0 and 5.8 6 2.4, respectively. The number of hours until noticeable blur reduced with increased level of baseline myopia (r = 0.396; P , 0.001). Conclusion: Orthokeratology patients show an irregular wearing pattern after 1 year of treatment that has significant effects on the subjective visual performance over the next day of skipping lens wear. Light distortion under low-light conditions seems to be a transient complication of the treatment and most of the patients report an improvement after the first weeks of treatment., Supported in part by projects PTDC/SAU-BEB/098391/2008//FCOMP-01-0124-FEDER-010897 and PTDC/SAU-BEB/098392/2008//FCOMP-01-0124-FEDER-010898 funded by Fundacao para a Ciencia e Tecnologia (FCT) of Portugal.

Implantation of phakic intraocular lenses (pIOLs) is a reversible refractive procedure, preserving the patient’s accommodative function with minimal induction of higher order aberrations compared with corneal photoablative procedures. Despite this, as an intraocular procedure, it has potential risks such as cataracts, chronic uveitis, pupil ovalization, corneal endothelial cell loss, pigmentary dispersion syndrome, pupillary block glaucoma, astigmatism, or endophthalmitis. Currently, only two models of posterior chamber pIOLs are commercially available, the implantable collammer lens (STAAR Surgical Co.) and the phakic refractive lens (PRL; Zeiss Meditec). The number of published reports on the latter is very low, and some concerns still remain about its long-term safety. The present article reviews the published literature on the outcomes after PRL implantation in order to provide a general overview and evaluate its real potential as a surgical refractive option.

Reading ability in the elderly means independence, and quality of life. In age-related macular degeneration (AMD), the main deficit is the loss of reading ability. The neovascular form is the leading cause of vision loss in the developed world among people over 50 years of age. With ranibizumab (Lucentis) a drug treatment has become available, but, despite good outcome of visual acuity, patients often report that their reading ability has been affected. We aimed therefor to study reading performance with Tobii Eye Tracker in patients, treated with intravitrial Lucentis. Twenty patients, 15 female and 5 male (range 74 - 98 year), were recruited from St. Erik Eye Hospital. All had, before and after treatment, their reading speed, comprehension, fixations, saccadic eye movements measured while reading two texts with an equal readability rating. For all eye movement parameters, except the number of regressions per word, there was no statistically significant difference when comparing the results from before and after treatment. However, a statistically significant increase in the number of regressions per word after treatment as well as increased visual acuity and comprehension, were found. Reading is fundamental in our society and should be tested in order to fully understand a patient’s complaints; however, an increased VA will not necessarily equal an increased reading ability. The results also show that the Tobii system is suitable for evaluation of reading performance in a clinical setting, and can together with other tests, give valuable information about the patients complains and the outcome of a treatment.

Purpose To assess nuclear and cortical opacities through the objective analysis of Scheimpflug images, and to check the correlation with the Lens Opacity Classification System III (LOCS III). Methods Nuclear and cortical opacities were graded according to the LOCS III rules after pupil dilation. The maximum and average pixel intensity values along an elliptical mask within the lens nucleus were taken to analyse nuclear cataracts. A new metric based on the percentage of opaque pixels within a region of interest was used to analyse cortical cataracts. The percentage of opaque pixels was also calculated for half, third and quarter areas from the region of interest’s periphery. Results The maximum and average intensity values along the nucleus were directly proportional to the LOCS III grade: The larger the LOCS III value, the larger maximum and average intensity ones. These metrics showed a positive and significant correlation with the LOCS grade: The larger the LOCS grade, the higher was percentage of opaque pixels along the cortex within the same mask’s size. This metric showed a significant correlation to the LOCS grade. Conclusion The metrics used to assess nuclear opacities showed good correlation with the LOCS III. The percentage of opaque pixels showed to be a useful metric to measure objectively the severity of the cortical opacity. These metrics could be implemented in an algorithm to detect and grade lens opacities automatically and objectively.

Purpose Compare the retinal nerve fibre layer (RNFL) thickness in multiple sclerosis (MS) patients, with and without previous episodes of optic neuritis (ON), to disease-free controls, using optical coherence tomography (OCT). Methods The RNFL was measured with a spectral domain OCT (Canon HS-100) in 433 MS patients and in 70 controls. The MS eyes were sorted into three groups: MS non ON eyes (MSON−), MS ON eyes (MSON+) and the fellow eye of MS ON (MSON_fellow). One eye of each patient in the MSON-group and in the control group was selected randomly for analysis. Results Seventy control eyes, 327 MSON- eyes, 106 MSON+ eyes and 106 MSON_fellow eyes were analysed in a linear regression adjusting for age. The average RNFL thickness was found to be statistically thinner in the MSON− group (88.2 ± 13.0 µm) compared to the controls (98.1 ± 9.0 µm; p

Purpose To evaluate the outcomes of two methods for measurements of macular pigment optical density (MPOD). Methods In 33 subjects (mean age 51.85 years ±17.79; 4 men and 29 women), without any signs of ocular pathologies, MPOD was measured in the right eye using single-wavelength reflectometry (Visucam 500) and heterochromatic flicker photometry (MacuLux®). In 13 subjects with discrete signs of age-related macuolopathy (ARM), i.e., soft drusen and/or hyper-/hypopigmentation of the retinal pigment epithelium (RPE), MPOD was measured after 6 and 12 methods of supplementation with MacuShield® (lutein 10 mg and zeaxanthin 2 mg and the non-dietary carotenoid meso-zeaxanthin 10 mg). Results There was a statistical significant difference (p

Purpose Reduced macular pigment (MP) density is related to an increased risk of developing age-related macular degeneration (AMD). The aim of this study was to measure the macular response to a MP supplement by measuring macular pigment optical density (MPOD) before and after consumption. Methods Fifty-one healthy subjects (age 18-62 years) participated in the study and were divided in two groups, one control group and one supplementary group. MPOD values were measured using heterochromatic flicker photometry (HFP) at baseline and after 90 days of supplementation with the dietary supplement MacuShield® (10 mg lutein, 10 mg meso-zeaxanthin and 2 mg zeaxanthin). Results Mean MPOD values did not change significantly in any of the groups. A correlation between low MPOD values at baseline and a larger increase of MPOD values after supplementation was found in the supplementary group (r = -0.52, p = 0.008). Increased MPOD values also correlated with increasing age (r = 0.40, p = 0.0454). Conclusion The results of the present study indicate that older subjects with low MPOD values increase their MPOD values after supplementation. As increased age and low MPOD values increase the risk of developing AMD, it might be beneficial for these individuals to consume macular pigments to reduce the risk of developing AMD.

Roman seals associated with collyria (Latin expression for eye drops/washes and lotions for eye maintenance) provide valuable information about eye care in the antiquity. These small, usually stone-made pieces bore engravings with the names of eye doctors and also the collyria used to treat an eye disease. The collyria seals have been found all over the Roman empire and Celtic territories in particular and were usually associated with military camps. In Hispania (Iberian Peninsula), only three collyria seals have been found. These findings speak about eye care in this ancient Roman province as well as about of the life of the time. This article takes a look at the utility and social significance of the collyria seals and seeks to give an insight in the ophthalmological practice of in the Roman Empire.

Aim Accommodation is the ability of the eye to change focus in order to maintain a sharp image of objects at various distances. The accommodative process is largely unknown in children and requires new assessment techniques. The aim of the study was to investigate this process in children with and without cerebral palsy (CP). Method In a descriptive case–control study, children with CP (n=15; nine females, six males; median age 14y) and 21 typically developing children (11 females, 10 males; median age 12y) underwent standard ophthalmological examination and examination by the PowerRefractor. Six of the children had spastic bilateral CP, five had spastic unilateral CP, and four had dyskinetic CP. The children's Gross Motor Function Classification System (GMFCS) levels were as follows: level I, seven children; level II, two children; level III, three children; and level IV, three children. The PowerRefractor measures accommodation in response to minus lens stimuli. Continuous measurements of refraction/accommodation, eye position, and pupil size are obtained. The Kruskal–Wallis analysis of variance (ANOVA) and Mann–Whitney U test were used for between-group analysis (α=0.05), and Friedman ANOVA was used for within-group analysis. Results The stimuli–response gain (input/output) was approximately 80% in typical children inducing a focusing error (0.2–0.5D) increasing with minus lens power. Children with CP accommodated significantly less (gain: ~30%; p

Roman seals associated with collyria (Latin expression for eye drops /washes and lotions for eye maintenance) provide valuable information about eye care in the antiquity. These small, usually stone-made pieces bore engravings with the names of eye doctors and also the collyria used to treat an eye disease. The collyria seals have been found all over the Roman empire and Celtic territories in particular and were usually associated with military camps. In Hispania (Iberian Peninsula), only three collyria seals have been found. These findings speak about eye care in this ancient Roman province as well as about of the life of the time. This article takes a look at the utility and social significance of the collyria seals and seeks to give an insight in the ophthalmological practice of in the Roman Empire., Rimski pečati kojima su se pečatili koliriji (lat. collyrium – kapi, losioni, voda za oči) daju vrijedan uvid u postupke njege i liječenja očiju u antička vremena. U ove su se male kamene pečate obično gravirala imena očnih liječnika i naziv kolirija koji se rabio za pojedinu očnu bolest. Pečati za kolirije pronađeni su posvuda u Rimskom Carstvu, a ponajviše na okupiranim keltskim teritorijima i to u vojnim logorima. U Hispaniji (na Iberijskom poluotoku) pronađena su tek tri takva pečata. Ovi nam nalazi govore o njezi očiju u ovoj staroj rimskoj provinciji i o životu u to doba. Cilj je članka razmotriti korisnost i društvenu važnost pečata za kolirije i pružiti čitatelju uvid u oftalmološku praksu u Rimskom Carstvu.

PURPOSE. To evaluate the effect of orthoptic treatment on the AC/A (A, accommodation; C, convergence) and CA/C ratios in subjects with convergence insufficiency (CI). METHODS. The change in AC/A and CA/C ratios after a 12-week period of home-based orthoptic treatment was examined in 10 subjects (mean age, 25.4 ± 4.1 years [SD]). Both the AC/A and CA/C ratios were measured by using gradient response methods. For the AC/A ratio, the gradient phoria method was used, and for the CA/C ratio the prism-induced change in accommodation was measured with a refractometer. RESULTS. No change in the AC/A and CA/C ratios (P > 0.05) were found after orthoptic treatment. However, improvements were found (P < 0.05) in the fast and slow vergence mechanisms. CONCLUSIONS. Despite improvements in the fast and slow vergence mechanisms no change was found in the AC/A and CA/C ratios after orthoptic treatment in CI subjects. This finding is unexpected in light of the present understanding of CI, and an alternative theory is proposed.