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Summary Purpose With increasing soft tissue clearance in pancreatic cancer surgery, postoperative chyle leak (CL) has become a more commonly observed complication. Recently, a new consensus definition was established by the International study group of pancreatic surgery (ISGPS). The aim of the present analysis was to evaluate risk factors and treatment options of patients with CL after pancreatic surgery. Methods Two hundred and twenty-eight patients with serous or chylous drainage after pancreatic surgery were included in this analysis of a prospectively collected database between 01/2014 and 12/2016. Risk factors for CL and treatment options were compared. A subgroup analysis on those patients, who had drain removal despite of persistent CL with respect to the need of subsequent percutaneous drainage or reoperation within three months postoperatively, was performed. Results Sixty patients with CL were identified. Of those, 41 patients were treated with medium-chain triglyceride-diet, with a median duration of therapy of 12 days. In patients with CL, the type of treatment had no effect on time to drain removal (P = 0.29) and morbidity (P = 0.15). Furthermore, morbidity was not increased in patients who had their drains removed despite persistent CL (P = 0.84). None of the latter patients had percutaneous drainage or reoperation for CL after removal of the surgical drains. Conclusions Dietary treatment may not be very effective in treating CL. Further research is warranted to explore the effect and necessity of CL treatment.

Heinrich Muller was a nineteenth-century German retinal anatomist who, during his short career, was one of the discoverers of the rod photopigment rhodopsin and neuroglia in the retina, now known as Muller cells. He also described the ocular muscles and double foveae of some birds. An important, but largely neglected, insight by Muller was to combine careful psychophysical measurements and geometrical optics to find the location of the photosensitive layer of the retina in the living eye. Here, we provide translated passages from Muller's (1855) publication and compare his entoptic observations with retinal imaging using optical coherence tomography. Muller correctly deduced from his careful experiments that vision is initiated in the photoreceptors located in the back of the retina.

Im aktuellen klinischen Alltag haben zystische Pankreaslasionen (PCNs) einen zunehmend relevanten Stellenwert, da sie aufgrund der sich stetig verbessernden Bildgebung haufig als Zufallsbefund diagnostiziert werden. Man unterscheidet zwischen nichtneoplastischen und neoplastischen Pankreaszysten, wobei letztere in unterschiedlicher Auspragung zur malignen Entartung neigen und damit als Vorlauferlasionen des duktalen Adenokarzinoms des Pankreas (PDAC) gelten. Zur Differenzialdiagnose werden neben einer genauen Anamnese und Untersuchung vor allem bildgebende Verfahren wie die Computertomographie (CT) und Magnetresonanztomographie (MRT) sowie der endoskopische Ultraschall mit Feinnadelaspiration herangezogen. Die Indikationen zur chirurgischen Resektion dieser Lasionen richten sich nach den aktuellen europaischen Leitlinien, deren Inhalte sind jedoch nicht evidenzbasiert, sondern stutzen sich auf Erkenntnisse und Empfehlungen von Experten. Gemas den Konsensusempfehlungen kann die asymptomatische seros-zystische Neoplasie (SCN) als serose Lasion mit niedriger Tendenz zur Entartung beobachtet werden. Im Gegensatz dazu sollten alle muzinos-zystischen Neoplasien (MCN) >4 cm sowie alle solid-pseudopapillaren Neoplasien (SPN) reseziert werden. Intraduktal papillar-muzinose Neoplasien (IPMNs), die aufgrund ihres Bezugs zum Pankreasgangsystem in Haupt(MD)- oder Seitengang(BD)-IPMNs unterteilt werden, sollten als MD-IPMN und als Mixed-type(MT)-IPMN reseziert werden. Das Entartungsrisiko der BD-IPMN ist variabler und abhangig von Risikofaktoren, die klinisch und bildmorphologisch definiert werden. Das therapeutische Management erfolgt daher individuell nach Risikoabschatzung. Um die Indikationsqualitat bei PCNs quantifizieren zu konnen und damit auch zu einer optimierten Versorgung beizutragen, werden dringend prospektive Langzeitstudien benotigt.

Die Implementierung technologischer Innovationen in der Chirurgie wie roboterassistierte Eingriffe, neuartige Implantate, Navigation oder moderne Visualisierungstechniken stellen fur Klinken eine okonomische Herausforderung dar, da sie selten per se kostendeckend sind. Im deutschen DRG(„diagnosis related groups“)-System sind die Kosten zahlreicher neuartiger Technologien und Innovation in der Chirurgie kurzfristig und auch oft mittel- und langfristig nicht oder nicht ausreichend gedeckt. Dieser Ubersichtsartikel beschreibt die okonomischen Aspekte chirurgischer Innovationen und zeigt mogliche Wege fur Kliniken auf, die Kosten zu decken. In einem simulierten Fallbeispiel wird veranschaulicht, inwieweit das aktuelle deutsche DRG-Tarifsystem die Kosten minimal-invasiver Techniken (laparoskopisch, roboterassistiert) im Rahmen einer elektiven Sigmaresektion bei benigner Indikation widerspiegelt.

In vivo functional imaging of human photoreceptors is an emerging field, with compelling potential applications in basic science, translational research, and clinical management of ophthalmic disease. Measurements of light-evoked changes in the photoreceptors has been successfully demonstrated using adaptive optics (AO) coherent flood illumination (CFI), AO scanning light ophthalmoscopy (SLO), AO optical coherence tomography (OCT), and full-field OCT with digital AO (dAO). While the optical principles and data processing of these systems differ greatly, and while these differences manifest in the resulting measurements, we believe that the underlying physiological processes involved in each of those techniques are likely the same. AO-CFI and AO-SLO systems are more widely used than OCT systems. However, those systems produce only two-dimensional images and so, less can be said about the anatomical and physiological origins of the observed signal. OCT signal, on the other hand, provides 3D imaging but at a cost of high volume of data, making it impractical to clinical purposes. In light of this, we employed a combined AO-OCT-SLO system–with point-for-point correspondence between the OCT and SLO images–to measure functional responses simultaneously with both and investigate SLO retinal functional biomarkers based on OCT response. The resulting SLO images reveal reflectance changes in the cones which are consistent with those previously reported using AO-CFI and AO-SLO. The resulting OCT volumes show phase changes in the cone outer segment (OS) consistent with those previously reported by us and others. We recapitulate a model of the cone OS previously proposed to explain AO-CFI reflectance changes, and show how this model can be used to predict the signal in AO-SLO. The limitations of the model is also discussed in this manuscript.

Background An increasing body of evidence suggests that microbiota may promote progression of pancreatic ductal adenocarcinoma (PDAC). It was hypothesized that gammaproteobacteria (such as Klebsiella pneumoniae) influence survival in PDAC, and that quinolone treatment may attenuate this effect. Methods This was a retrospective study of patients from the Massachusetts General Hospital (USA) and Ludwig-Maximilians-University (Germany) who underwent preoperative treatment and pancreatoduodenectomy for locally advanced or borderline resectable PDAC between January 2007 and December 2017, and for whom a bile culture was available. Associations between tumour characteristics, survival data, antibiotic use and results of intraoperative bile cultures were investigated. Survival was analysed using Kaplan-Meier curves and Cox regression analysis. Results Analysis of a total of 211 patients revealed that an increasing number of pathogen species found in intraoperative bile cultures was associated with a decrease in progression-free survival (PFS) (-1·9 (95 per cent c.i. -3·3 to -0·5) months per species; P = 0·009). Adjuvant treatment with gemcitabine improved PFS in patients who were negative for K. pneumoniae (26·2 versus 15·3 months; P = 0·039), but not in those who tested positive (19·5 versus 13·2 months; P = 0·137). Quinolone treatment was associated with improved median overall survival (OS) independent of K. pneumoniae status (48·8 versus 26·2 months; P = 0·006) and among those who tested positive for K. pneumoniae (median not reached versus 18·8 months; P = 0·028). Patients with quinolone-resistant K. pneumoniae had shorter PFS than those with quinolone-sensitive K. pneumoniae (9·1 versus 18·8 months; P = 0·001). Conclusion K. pneumoniae may promote chemoresistance to adjuvant gemcitabine, and quinolone treatment is associated with improved survival.

Noninvasive, objective measurement of rod function is as significant as that of cone function, and for retinal diseases such as retinitis pigmentosa and age-related macular degeneration, rod function may be a more sensitive biomarker of disease progression and efficacy of treatment than cone function. Functional imaging of single human rod photoreceptors, however, has proven difficult because their small size and rapid functional response pose challenges for the resolution and speed of the imaging system. Here, we describe light-evoked, functional responses of human rods and cones, measured noninvasively using a synchronized adaptive optics optical coherence tomography (OCT) and scanning light ophthalmoscopy (SLO) system. The higher lateral resolution of the SLO images made it possible to confirm the identity of rods in the corresponding OCT volumes.

Neuroendocrine tumors (NETs) are rare neoplasms, which represent complex challenges in diagnosis and treatment. Even in the metastatic stage there are important differences in the type of tumor in comparison to gastrointestinal and pancreatic adenocarcinomas. Therefore, the disease courses are substantially different depending on the grade of differentiation. Even in the metastatic stage the 5‑year survival rates of G1 tumors is up to 83%. Approximately 20% of small intestine NETs additionally show hormone activity, which can compromise survival and the quality of life. For individual treatment decisions the special tumor biology of these tumors must be taken into consideration more so than for other tumor entities. Surgery always becomes important for these tumors when a R0 resection appears possible. Oligometastasis of the liver and the lymph drainage system can be meaningfully approached by surgical treatment. In selected patients with an isolated liver involvement, a liver transplantation can be considered; however, even tumor debulking can lead to improvement in the quality of life and survival, especially for hormone active tumors with a carcinoid syndrome which cannot be conservatively controlled. The aim of this review is to present the value of surgical treatment options in the case of (oligo)metastasized NETs.

Background Approximately 11% of the German population are convinced that certain moon phases and moon signs may impact their health and the onset and clinical course of diseases. Before elective surgery, a considerable number of patients look to optimize the timing of the procedure based on the lunar cycle. Especially patients awaiting living donor kidney transplantation (LDKT) commonly look for an adjustment of the date of transplantation according to the moon calendar. This study therefore investigated the perioperative and long-term outcome of LDKT dependent on moon phases and zodiac signs. Methods Patient data were prospectively collected in a continuously updated kidney transplant database. Two hundred and seventy-eight consecutive patients who underwent LDKT between 1994 and December 2009 were selected for the study and retrospectively assigned to the four moon phases (new-moon, waxing-moon, full-moon, and waning-moon) and the corresponding zodiac sign (moon sign Libra), based on the date of transplantation. Preexisting comorbidities, perioperative mortality, surgical outcome, and long-term survival data were analyzed. Results Of all LDKT procedures, 11.9, 39.9, 11.5, and 36.5% were performed during the new, waxing, full, and waning moon, respectively, and 6.2% during the moon sign Libra, which is believed to interfere with renal surgery. Survival rates at 1, 5, and 10 years after transplantation were 98.9, 92, and 88.7% (patient survival) and 97.4, 91.6, and 80.6% (graft survival) without any differences between all groups of lunar phases and moon signs. Overall perioperative complications and early graft loss occurred in 21.2 and 1.4%, without statistical difference (p > 0.05) between groups. Conclusion Moon phases and the moon sign Libra had no impact on early and long-term outcome measures following LDKT in our study. Thus, concerns of patients awaiting LDKT regarding the ideal time of surgery can be allayed, and surgery may be scheduled independently of the lunar phases.

OSA is aware that some authors, as a condition of their funding, must publish their work under a Creative Commons license. We therefore offer a CC BY license for authors who indicate that their work is funded by agencies that we have confirmed have this requirement. Authors must enter their funder(s) during the manuscript submission process. At that point, if appropriate, the CC BY license option will be available to select for an additional fee. Maximum likelihood difference scaling was used to measure suprathreshold contrast response difference scales for low-frequency Gabor patterns, modulated along luminance and L–M color directions in normal, protanomalous, and deuteranomalous observers. Based on a signal-detection model, perceptual scale values, parameterized as 𝑑�′, were estimated by maximum likelihood. The difference scales were well fit by a Michaelis–Menten model, permitting estimates of response and contrast gain parameters for each subject. Anomalous observers showed no significant differences in response or contrast gain from normal observers for luminance contrast. For chromatic modulation, however, anomalous observers displayed higher contrast and lower response gain compared to normal observers. These effects cannot be explained by simple pigment shift models, and they support a compensation mechanism to optimize the mapping of the input contrast range to the neural response range. A linear relation between response and contrast gain suggests a neural trade-off between them. National Eye Institute; Agence Nationale de la Recherche

Rods contribute crucially to human vision and their dysfunction precedes cones’ in several retinal diseases. Here we describe light-evoked, functional responses of human rods and cones, measured noninvasively using adaptive optics optical coherence tomography.

We describe the details of a multimodal retinal imaging system which combines adaptive optics (AO) with an integrated scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT) imaging system. The OCT subsystem consisted of a swept-source, Fourier-domain mode-locked (FDML) laser, with a very high A-scan rate (1.6MHz), whose beam was raster scanned on the retina by two scanners-one resonant scanner and one galvanometer. The high sweep rate of the FDML permitted the SLO and OCT to utilize the same scanners for in vivo retinal imaging and, unlike existing multimodal systems, concurrently acquired SLO frames and OCT volumes with approximate en face correspondence at a rate of 6Hz. The AO provided diffraction-limited cellular resolution for both imaging channels.

Objective optical assessment of photoreceptor function may permit earlier diagnosis of retinal disease than current methods such as perimetry, electrophysiology, and clinical imaging. Recent work with adaptive optics (AO) flood imaging, conventional OCT and phase-sensitive full-field OCT have revealed apparent changes in photoreceptor outer segment (OS) length in response to visible stimuli. In this work, we describe an AO-OCT system designed to measure these stimulus-evoked OS length changes. The OCT subsystem consisted of a Fourier-domain mode-locked laser that acquires A-scans at 1.64MHz and an AO subsystem providing diffraction-limited imaging with a closed-loop correction rate of 20Hz. To our knowledge this is the highest-speed AO-OCT system developed to date. Visible stimuli were delivered using a LED-based Maxwellian view channel incorporated into the system. In a dark-adapted healthy subject, 1-deg square volumetric images were acquired at a rate of 32Hz. Images were acquired for 10s, with a 10ms bleaching stimulus flash with variable intensity. Strip-based registration was used to track individual cones in the volume series, and time series of the resulting depth-resolved complex signal were analyzed. Stimulus-evoked changes in the morphology of OS and RPE were observed in the M-scan amplitude. In the M-scan phase, the difference between the IS/OS and COST was shown to increase in response to the stimulus flash, and the magnitude of the phase change depended upon flash intensity. These results suggest that cone OS elongates in response to visible stimuli, and that the length change scales with stimulus intensity.

For over 150 years, spectrally selective filters have been proposed to improve the vision of observers with color vision deficiencies [1]. About 6% of males and

Metastasis is the major cause of death in patients with colorectal carcinoma (CRC). The most common sites of metastasis are the liver and the peritoneum. Peritoneal carcinomatosis is often considered the end stage of the disease after the tumor has spread to the liver. However, almost half of CRC patients with peritoneal carcinomatosis do not present with liver metastasis. This brings up the question of whether peritoneal spread can still be considered as the end stage of a metastasized CRC or whether it should just be interpreted as a site of metastasis alternative to the liver. This review tries to discuss this question and summarize the current status of literature on potential characteristics in tumor biology in the primary tumor, i.e., factors (transcription factors and direct and indirect E-cadherin repressors) and pathways (WNT, TGF-β, and RAS) modulating EMT, regulation of EMT on a posttranscriptional and posttranslational level (miRNAs), and angiogenesis. In addition to tumor-specific characteristics, factors in the tumor microenvironment, immunological markers, ways of transport of tumor cells, and adhesion molecules appear to differ between hematogenous and peritoneal spread. Factors such as integrins and exosomal integrins, cancer stem cell phenotype, and miRNA expression appear to contribute in determining the metastatic route. We went through each step of the metastasis process comparing hematogenous to peritoneal spread. We identified differences with respect to organotropism, epithelial-mesenchymal transition, angiogenesis and inflammation, and tumor microenvironment which will be further elucidated in this review. A better understanding of the underlying mechanisms and contributing factors of metastasis development in CRC has huge relevance as it is the foundation to help find specific targets for treatment of CRC.

Objective optical assessment of photoreceptor function may permit earlier diagnosis of retinal disease than current methods such as perimetry, electrophysiology, and clinical imaging. In this work, we describe an adaptive optics (AO) optical coherence tomography (OCT) system designed to measure functional responses of single cones to visible stimuli. The OCT subsystem consisted of a raster-scanning Fourier-domain mode-locked laser that acquires A-scans at 1.64MHz with a center wavelength of 1063nm, and an AO subsystem providing diffraction-limited imaging. Analysis of serial volumetric images revealed phase changes of cone photoreceptors consistent with outer segment elongation and proportional to stimulus intensity, as well as other morphological changes in the outer segment and retinal pigment epithelium.

Impulse response functions for an incremental luminous pulse (ON flash) or a decremental luminous pulse (OFF flash) were derived for twelve young (19–24 years old) and ten old (65–84 years old) observers. Thresholds were measured for two pulses separated by stimulus-onset-asynchronies from 13.3 to 186.7 ms. The pulses had a spatial Gaussian shape and were presented as increments or decrements on a 15 cd/m2 equal-energy white background, having the same chromaticity as the pulse. A spatial four-alternative forced-choice method was combined with a staircase procedure. Retinal illuminance was equated individually by heterochromatic flicker photometry and using a 2.3-mm exit pupil in a Maxwellian-view optical system to reduce the effects of age-related changes and individual variations in lens density and pupil size. Luminance ON- and OFF-impulse response functions calculated from the threshold data revealed significant age-related changes in the response amplitude of both first excitatory and first inhibitory phases. However, there were no significant changes in the time to the first peak or the second peak. These age-related changes in luminance varying ON- and OFF-impulse response functions (IRFs), reflecting putative properties of the magnocellular pathway, are discussed in relation to motion detection and the balance of ON and OFF pathways across the life span.

This feature issue of the Journal of the Optical Society of America A (JOSA A) reflects the basic and applied research interests of members of the color vision community. Most of the articles stem from presentations at the 24th Biennial Symposium of the International Colour Vision Society (ICVS).

We have designed and implemented a dual-mode adaptive optics (AO) imaging system that combines spectral domain optical coherence tomography (OCT) and scanning laser ophthalmoscopy (SLO) for in vivo imaging of the human retina. The system simultaneously acquires SLO frames and OCT B-scans at 60Hz with an OCT volume acquisition time of 4.2s. Transverse eye motion measured from the SLO is used to register the OCT B-scans to generate three-dimensional (3-D) volumes. Key optical design considerations include: minimizing system aberrations through the use of off-axis relay telescopes, conjugate pupil plane requirements, and the use of dichroic beam splitters to separate and recombine the OCT and SLO beams around the nonshared horizontal scanning mirrors. To demonstrate system performance, AO-OCT-SLO images and measurements are taken from three normal human subjects ranging in retinal eccentricity from the fovea out to 15-deg temporal and 20-deg superior. Also presented are en face OCT projections generated from the registered 3-D volumes. The ability to acquire high-resolution 3-D images of the human retina in the midperiphery and beyond has clinical importance in diseases, such as retinitis pigmentosa and cone-rod dystrophy.

Hintergrund Das Pankreaskarzinom ist weiterhin mit einer sehr schlechten Prognose verbunden. Die chirurgische Resektion ist der einzige kurative Therapieansatz. Gleichwohl wurden in den letzten Jahren zunehmende Fortschritte im Bereich neuer onkologischer Therapiekonzepte gemacht, welche nachfolgend detailliert dargestellt werden sollen.

In retinal raster imaging modalities, fixational eye movements manifest as image warp, where the relative positions of the beam and retina change during the acquisition of single frames. To remove warp artifacts, strip-based registration methods-in which fast-axis strips from target images are registered to a reference frame-have been applied in adaptive optics (AO) scanning light ophthalmoscopy (SLO) and optical coherence tomography (OCT). This approach has enabled object tracking and frame averaging, and methods have been described to automatically select reference frames with minimal motion. However, inconspicuous motion artifacts may persist in reference frames and propagate themselves throughout the processes of registration, tracking, and averaging. Here we test a previously proposed method for removing movement artifacts in reference frames, using biases in stripwise cross-correlation statistics. We applied the method to synthetic retinal images with simulated eye motion artifacts as well as real AO-SLO images of the cone mosaic and volumetric AO-OCT images, both affected by eye motion. In the case of synthetic images, the method was validated by direct comparison with motion-free versions of the images. In the case of real AO images, performance was validated by comparing the correlation of uncorrected images with that of corrected images, by quantifying the effect of motion artifacts on the image power spectra, and by qualitative examination of AO-OCT B-scans and en face projections. In all cases, the proposed method reduced motion artifacts and produced more faithful images of the retina.

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We demonstrate OCT angiography (OCTA) and Doppler OCT imaging of the choroid in the eyes of two healthy volunteers and in a geographic atrophy case. We show that visualization of specific choroidal layers requires selection of appropriate OCTA methods. We investigate how imaging speed, B-scan averaging and scanning density influence visualization of various choroidal vessels. We introduce spatial power spectrum analysis of OCT en face angiographic projections as a method of quantitative analysis of choroicapillaris morphology. We explore the possibility of Doppler OCT imaging to provide information about directionality of blood flow in choroidal vessels. To achieve these goals, we have developed OCT systems utilizing an FDML laser operating at 1.7 MHz sweep rate, at 1060 nm center wavelength, and with 7.5 μm axial imaging resolution. A correlation mapping OCA method was implemented for visualization of the vessels. Joint Spectral and Time domain OCT (STdOCT) technique was used for Doppler OCT imaging.

Eye Movements, Strabismus, Amblyopia, and Neuro-Ophthalmology Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial, Part II: Correlations and Relationship to Clinical Features OCT Sub-Study Committee for the NORDIC Idiopathic Intracranial Hypertension Study Group Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, New York, New York, United States Correspondence: Mark J. Kuper- smith, Departments of Neurology and Ophthalmology, Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, 1000 10th Avenue, New York, NY 10019, USA; mkuper@chpnet.org. See the appendix for the members of the OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group. Submitted: June 5, 2014 Accepted: September 8, 2014 Citation: OCT Sub-Study Committee; for the NORDIC Idiopathic Intracra- nial Hypertension Study Group. Base- line OCT measurements in the Idiopathic Intracranial Hypertension Treatment Trial, part II: correlations and relationship to clinical features. Invest Ophthalmol Vis Sci. 2014;55:8173–8179. DOI:10.1167/ iovs.14-14961 P URPOSE . The accepted method to evaluate and monitor papilledema, Fris´en grading, uses an ordinal approach based on descriptive features. Part I showed that spectral-domain optical coherence tomography (SD-OCT) in a clinical trial setting provides reliable measurement of the effects of papilledema on the optic nerve head (ONH) and peripapillary retina, particularly if a 3-D segmentation method is used for analysis. 1 We evaluated how OCT parameters are interrelated and how they correlate with vision and other clinical features in idiopathic intracranial hypertension (IIH) patients. M ETHODS . A total of 126 subjects in the IIH Treatment Trial (IIHTT) OCT substudy had Cirrus SD-OCT optic disc and macula scans analyzed by using a 3-D segmentation algorithm to derive retinal nerve fiber layer (RNFL) thickness, total retinal thickness (TRT), retinal ganglion cell layer plus inner plexiform layer (GCLþIPL) thickness, and ONH volume. The SD-OCT parameter values were correlated with high- and low-contrast acuity, perimetric mean deviation, Fris´en grading, and IIH features. R ESULTS . At study entry, the average RNFL thickness, TRT, and ONH volume showed significant strong correlations (r ‡ 0.90) with each other. The same OCT parameters showed a strong (r > 0.76) correlation with Fris´en grade and a mild (r > 0.24), but significant, correlation with lumbar puncture opening pressure. For all eyes at baseline, neither visual acuity (high or low contrast) nor mean deviation correlated with any OCT measure of swelling or GCLþIPL thickness. C ONCLUSIONS . In newly diagnosed IIH, OCT demonstrated alterations of the peripapillary retina and ONH correlate with Fris´en grading of papilledema. At presentation, OCT measures of papilledema, in patients with newly diagnosed IIH and mild vision loss, do not correlate with clinical features or visual dysfunction. (ClinicalTrials.gov number, NCT01003639.) Keywords: papilledema, intracranial hypertension, OCT, lumbar puncture n the preceding report, 1 we have shown that spectral-domain optical coherence tomography (SD-OCT) can provide high- quality data in patients with papilledema due to idiopathic intracranial hypertension (IIH), from multiple clinical sites working with an experienced OCT reading center. Optical coherence tomography imaging reliably and reproducibly demonstrates alterations in the optic nerve head (ONH) and retinal layers in IIH, which includes measurement of the average peripapillary retina nerve fiber layer (RNFL) thickness, average total peripapillary retinal thickness (TRT), ONH volume, and the ganglion cell plus inner plexiform layer thickness (GCLþIPL) in the macular region. Moreover, inter- ocular comparisons for all OCT parameters reflecting swelling of the ONH or peripapillary retina were significant and highly correlated. As expected, 90% of eyes (220/244 with Zeiss algorithm–derived RNFL thickness values) of the enrolled subjects exhibited significant (>95th percentile) thickening of the RNFL. Only 7% of the study eyes showed significant thinning (

Eye Movements, Strabismus, Amblyopia, and Neuro-Ophthalmology Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial, Part I: Quality Control, Comparisons, and Variability OCT Sub-Study Committee for the NORDIC Idiopathic Intracranial Hypertension Study Group Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, New York, New York, United States Correspondence: Mark J. Kuper- smith, Icahn School of Medicine at Mount Sinai, NORDIC Headquarters, 1000 10th Avenue, New York, NY 10019, USA; mkuper@chpnet.org. P URPOSE . Optical coherence tomography (OCT) has been used to investigate papilledema in single-site, mostly retrospective studies. We investigated whether spectral-domain OCT (SD- OCT), which provides thickness and volume measurements of the optic nerve head and retina, could reliably demonstrate structural changes due to papilledema in a prospective multisite clinical trial setting. Submitted: June 5, 2014 Accepted: October 13, 2014 M ETHODS . At entry, 126 subjects in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) with mild visual field loss had optic disc and macular scans, using the Cirrus SD-OCT. Images were analyzed by using the proprietary commercial and custom 3D-segmentation algorithms to calculate retinal nerve fiber layer (RNFL), total retinal thickness (TRT), optic nerve head volume (ONHV), and retinal ganglion cell layer (GCL) thickness. We evaluated variability, with interocular comparison and correlation between results for both methods. Citation: OCT Sub-Study Committee for the NORDIC Idiopathic Intracra- nial Hypertension Study Group. Base- line OCT measurements in the Idiopathic Intracranial Hypertension Treatment Trial, part I: quality control, comparisons, and variability. Invest Ophthalmol Vis Sci. 2014;55:8180– 8188. DOI:10.1167/iovs.14-14960 R ESULTS . The average RNFL thickness > 95% of normal controls in 90% of eyes and the RNFL, TRT, ONH height, and ONHV showed strong (r > 0.8) correlations for interocular comparisons. Variability for repeated testing of OCT parameters was low for both methods and intraclass correlations > 0.9 except for the proprietary GCL thickness. The proprietary algorithm–derived RNFL, TRT, and GCL thickness measurements had failure rates of 10%, 16%, and 20% for all eyes respectively, which were uncommon with 3D-segmentation–derived measurements. Only 7% of eyes had GCL thinning that was less than fifth percentile of normal age-matched control eyes by both methods. See the appendix for the members of the OCT Sub-Study Committee for the NORDIC Idiopathic Intracranial Hy- pertension Study Group. C ONCLUSIONS . Spectral-domain OCT provides reliable continuous variables and quantified assessment of structural alterations due to papilledema. (ClinicalTrials.gov number, NCT01003639.) Keywords: papilledema, intracranial hypertension, optical coherence tomography, OCT I diopathic intracranial hypertension (IIH) is a disorder that affects overweight women of childbearing age, 1,2 with a rising incidence in parallel with the current obesity epidemic in the United States. 3 Patients have headaches, pulsatile tinnitus, transient visual obscurations, and diplopia in association with optic disc edema (papilledema). Some degree of vision loss occurs in 86% of patients and 10% develop severe visual loss. 2 The effectiveness of treatment had not been verified by properly designed clinical trials until the implementation of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT), sponsored by the National Eye Institute. This trial has shown that acetazolamide plus weight management improves the visual fields more than weight management plus placebo at the 6-month study outcome. 4 The accepted objective method for evaluating papilledema and monitoring the alterations in the optic nerve head (ONH) is the Fris´en scale, a noncontinuous ordinal grading based on specific features described in fundus photographs or on ophthalmoscopy. 5 The scale has been clinically useful but lacks sensitivity to small changes in the degree of disc edema and varies among observers. 6,7 In contrast, optical coherence tomography (OCT) measurement of the peripapillary retina nerve fiber layer (RNFL) thickness provides a continuous quantitative assessment of papilledema that correlates with Fris´en grading. 6,8,9 Typically, OCT assessments are used to evaluate thinning of the RNFL due to optic nerve injury from many causes. 10–12 Although prior smaller studies of IIH have shown that lower-resolution time-domain OCT imaging of the RNFL thickness can monitor changes in papilledema over time, 13,14 other studies 15 suggest the commercially available algorithms used in both time-domain and newer spectral- domain (SD) OCT units to calculate RNFL thickness can be unreliable and fail with severe papilledema (Mandel G, et al. IOVS 2010;51:ARVO E-Abstract 555). The OCT substudy of the IIHTT was designed to systemat- ically explore potential continuous measures of alterations in the structures of the ONH and macula due to papilledema, and monitor changes in the ONH, peripapillary and macular retinal layer thicknesses during treatment. Since the SD-OCT instru- ment and proprietary two-dimensional segmentation software methods are not designed to measure swelling of the ONH or the peripapillary retina, we evaluated a variety of approaches via a pilot study. We explored SD-OCT parameters and procedures that could be applied across multiple study sites to provide uniform data collection that measured the effects of papilledema (see Supplementary Appendix Pilot study file). In Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc. www.iovs.org j ISSN: 1552-5783 Downloaded From: http://iovs.arvojournals.org/pdfaccess.ashx?url=/data/Journals/IOVS/933678/ on 02/10/2016

Background Autoimmune pancreatitis (AIP) is characterized by diffuse or focal swelling of the pancreas. AIP has been divided into types 1 and 2. The aim of the study was to evaluate and compare the clinicopathological characteristics, therapy and outcome of patients with AIP. Methods The medical records of patients diagnosed with AIP between January 2003 and July 2011 were reviewed. Characteristics of patients with AIP types 1 and 2 were compared with those of patients with pancreatic ductal adenocarcinoma (PDAC). Results AIP was classified as type 1 in 40 patients and type 2 in 32 according to the HISORt (Histology, Imaging, Serology, Other organ involvement, Response to therapy) criteria. Patients with histologically confirmed AIP type 2 were younger than those with type 1 (P = 0·005). Some 30 of 32 patients with AIP type 2 were found to have a localized tumour-like pancreatic mass and underwent pancreatectomy, compared with only 16 of 40 with type 1 (P < 0·001). Three of 25 patients with AIP type 2 presented with raised serum levels of IgG4 compared with 21 of 38 with type 1 (P < 0·001). There was no difference in symptoms and involvement of other organs between AIP types 1 and 2. Presentation with weight loss was more common among patients with PDAC than those with AIP, but there was no difference in pain or jaundice between the groups. Raised serum carbohydrate antigen 19-9 levels were more prevalent in patients with PDAC. Conclusion Patients with AIP type 2 frequently present with abdominal pain and a tumour-like mass. Differentiating AIP from PDAC is difficult, so making the clinical decision regarding operative versus conservative management is challenging.

Retroperitoneale Weichgewebssarkome neigen in hohem Mase zum Lokalrezidiv. Die komplette chirurgische Tumorresektion stellt die einzige potenziell kurative Therapieoption dar. Bei der systematischen abdominellen Kompartmentresektion wird der Tumor en bloc mit einem Saum von nicht infiltriertem Gewebe und Organen entfernt. Hierzu gehoren haufig eine Niere, ein Hemikolon, linksseitig der Pankreasschwanz sowie Anteile des Zwerchfells und des Musculus psoas. Weitere Organe und Gefase werden je nach Infiltration mitentfernt. Durch dieses aggressive Vorgehen konnen im Vergleich zu weniger radikalen Operationsverfahren haufiger histologisch tumorfreie Resektionsrander und letztlich eine geringere Lokalrezidivrate erreicht werden. Der Artikel beschreibt detailliert das chirurgische Vorgehen und die perioperative Behandlung der Patienten sowie die Ergebnisse der operativen Therapie. Ausfuhrlich werden die Einbindung in ein immer notwendiges onkologisches Therapiekonzept und die Bedeutung spezialisierter Zentren diskutiert.

Objective optical assessment of photoreceptor function may permit earlier diagnosis of retinal disease than current methods such as perimetry, electrophysiology, and clinical imaging. In this work, we describe an adaptive optics (AO) optical coherence tomography (OCT) system designed to measure functional responses of single cones to visible stimuli. The OCT subsystem consisted of a raster-scanning Fourier-domain mode-locked laser that acquires A scans at 1.64 MHz with a center wavelength of 1063 nm and an AO system operating in closed-loop. Analysis of serial volumetric images revealed phase changes of cone photoreceptors consistent with outer segment elongation and proportional to stimulus intensity, as well as other morphological changes in the outer segment and retinal pigment epithelium.

Purpose: Phase-variance optical coherence tomography (PV-OCT) provides volumetric imaging of the retinal vasculature without the need for intravenous injection of a fluorophore. We compare images from PV-OCT and fluorescein angiography (FA) for normal individuals and patients with age-related macular degeneration (AMD) and diabetic retinopathy. Design: This is an evaluation of a diagnostic technology. Participants: Four patients underwent comparative retinovascular imaging using FA and PV-OCT. Imaging was performed on 1 normal individual, 1 patient with dry AMD, 1 patient with exudative AMD, and 1 patient with nonproliferative diabetic retinopathy. Methods: Fluorescein angiography imaging was performed using a Topcon Corp (Tokyo, Japan) (TRC-50IX) camera with a resolution of 1280 (H) × 1024 (V) pixels. The PV-OCT images were generated by software data processing of the entire cross-sectional image from consecutively acquired B-scans. Bulk axial motion was calculated and corrected for each transverse location, reducing the phase noise introduced from eye motion. Phase variance was calculated through the variance of the motion-corrected phase changes acquired within multiple B-scans at the same position. Repeating these calculations over the entire volumetric scan produced a 3-dimensional PV-OCT representation of the vasculature. Main Outcome Measures: Feasibility of rendering retinal and choroidal microvasculature using PV-OCT was compared qualitatively with FA, the current gold standard for retinovascular imaging. Results: Phase-variance OCT noninvasively rendered a 2-dimensional depth color-coded vasculature map of the retinal and choroidal vasculature. The choriocapillaris was imaged with better resolution of microvascular detail using PV-OCT. Areas of geographic atrophy and choroidal neovascularization imaged by FA were depicted by PV-OCT. Regions of capillary nonperfusion from diabetic retinopathy were shown by both imaging techniques; there was not complete correspondence between microaneurysms shown on FA and PV-OCT images. Conclusions: Phase-variance OCT yields high-resolution imaging of the retinal and choroidal microvasculature that compares favorably with FA.

We explored the perception of image focus in patients with cataracts, and how this perception changed following cataract removal and implantation of an intraocular lens. Thirty-three patients with immature senile cataract and with normal retinal function were tested before surgery and 2 days after surgery, with 18 of the patients retested again at 2 months following surgery. The subjective focus of natural images was quantified in each session by varying the slope of the image amplitude spectra. At each time, short-term adaptation to the spectral slope was also determined by repeating the measurements after exposure to images with blurred or sharpened spectra. Despite pronounced acuity deficits, before surgery images appeared “best-focused” when they were only slightly blurred, consistent with a strong compensation for the acuity losses. Post-operatively, the image slopes that were judged “in focus” before surgery appeared too sharp. This bias remained strong at 2 months, and was independent of the rapid blur aftereffects induced by viewing filtered images. The focus settings tended to renormalize more rapidly in patients with higher post-operative acuity, while acuity differences were unrelated to the magnitude of the short-term blur aftereffects. Our results suggest that subjective judgments of image focus are largely compensated as cataracts develop, but potentially through a very long-term form of adaptation that results in persistent biases after the cataract is removed.

Background The risk of optic disc haemorrhages on visual outcome in idiopathic intracranial hypertension (IIH) is unknown. We report the type and frequency of optic disc haemorrhages and other funduscopic abnormalities at baseline in the study eye of the 133 subjects enrolled in the Idiopathic Intracranial Hypertension Treatment Trial completing 6 months of follow-up. Methods We reviewed optic disc photographs to tabulate the frequency and type of optic disc haemorrhages, other funduscopic abnormalities and papilloedema grades of the study eye at baseline and analyse if their presence is associated with a poor visual outcome. Results 27.2% of subjects had nerve fibre layer haemorrhages in at least one eye. Five of seven, 71% of subjects that met criteria for treatment failure, had nerve fibre layer haemorrhages in at least one eye (Fisher9s exact test: p=0.02). There was a good correlation between presence of nerve fibre layer haemorrhages and Frisen grade (Spearman9s correlation, p=0.002; r=0.271). Subjects with nerve fibre layer haemorrhages had a higher cerebrospinal fluid pressure (40.0 mm water, p=0.04). There was poor correlation between nerve fibre layer haemorrhages at baseline and the perimetric mean deviation change at 6 months. Cotton wool spots were present in 4% of subjects, exudates in 3% and pseudodrusen in 4%. Conclusions Nerve fibre layer haemorrhages are common in patients with IIH with mild visual loss and correlate with the severity of the papilloedema. They occur more frequently in treatment failure subjects and therefore may be associated with poor visual outcomes. Trial registration number NCT01003639, Post-results.

We experimentally investigate the influence of speed and resolution on OCT imaging of the capillary networks of the human retina and choroid. The experiments were performed with OCT systems operating at 1.7MHz and 100kHz imaging speeds and with an adaptive optics OCT setup.

Susana Marcos et al. -- 31 pags., 13 figs., Adaptive optics is a relatively new field, yet it is spreading rapidly and allows new questions to be asked about how the visual system is organized. The editors of this feature issue have posed a series of question to scientists involved in using adaptive optics in vision science. The questions are focused on three main areas. In the first we investigate the use of adaptive optics for psychophysical measurements of visual system function and for improving the optics of the eye. In the second, we look at the applications and impact of adaptive optics on retinal imaging and its promise for basic and applied research. In the third, we explore how adaptive optics is being used to improve our understanding of the neurophysiology of the visual system., John S. Werner: NIH Grants R01 EY 024239, AG04058, P-30 EY012576 and Research to Prevent Blindness. Susana Marcos: European Research Council under the European Union’s Seventh Framework Program (FP/2007–2013)/ERC Grant Agreement [ERC- 2011-AdC 294099]. Spanish Government Grants FIS2011-25637 & FIS2014-56643-R, Spanish Government FPU and FPI Predoctoral Fellowships, CSIC JAE-Pre program., Pablo Artal: European Research Council Advanced Grant ERC-2013-AdG-339228 (SEECAT) and the Spanish SEIDI, grant FIS2013-41237-R. David Atchison: Australian Research Council Discovery Grants DP110102018 and DP140101480. Karen Hampson: UK College of Optometrists; EPSRC (Engineering and Physical Sciences Research Council), Grants EP/ D036550/1and EP/G015473/1. Linda Lundstrom: Swedish Agency for Innovation Systems (VINNMER 2008–00992) and Swedish Research Council (621-2011-4094). Geungyoung Yoon: NIH/NEI, NYSTAR. Stephen Burns and Ann Elsner NIH Grants EY007624, EY026105, EY024315 and EY004395. P30EY019008 and Foundation Fighting Blindness., Joseph Carroll: NIH R01EY017607, Foundation Fighting Blindness, and Research to Prevent Blindness. Stacey S. Choi and Nathan Doble: support by NIH EY020901 and Department of Defense (DoD) Telemedicine and Advanced Technology Research Center (TATRC) grant W81XWH-10-1-0738. Alfredo Dubra: the Burroughs Wellcome Fund, Research to Prevent Blindness, Glaucoma Research Foundation and National Eye Institute. Ravi Jonnal NEI K99 EY 026068. Donald Miller NEI R01-EY018339 and P30-EY019008. Michel Paques: Institut National de la Santé et de la Recherche Médicale (Contrat d’Interface 2011) the Agence Nationale de la Recherche (ANR-09-TECS-009, ANR-12-TECS-0015- 03 and LabEx LifeSenses ANR-10-LABX-65). Hannah Smithson and Laura K. Young: the John Fell Fund (University of Oxford), Fight for Sight, and the Wellcome Trust Institutional Strategic Support Fund. Yuhua Zhang: NIH Grants EY021903, EY024378, P30 EY003039) and NSF IIA-1539034., Melanie Campbell: Canadian Institutes of Health Research and Natural Sciences and Engineering Research Council of Canada Collaborative Health Research Program. Jennifer Hunter: NIH R44 AG043645, R01 EY022371, R01 EY004367, P30 EY001319, and BRP-EY014375. Also supported by an unrestricted grant to the University of Rochester Department of Ophthalmology from Research to Prevent Blindness, New York, New York. Andrew Metha: Supported by an Australia Research Council (ARC) Discovery Project Grant (DP0984649), an ARC Discovery Early Career Researcher Award (DE120101931), an A.E. Rowden White Foundation benevolent bequest, and the University of Melbourne Interdis- ciplinary Seed Fund. Grazyna Palczewska: NIH NEI R44 AG043645, European Private Foundation. Jesse Schallek: NIH Grants EY023496-01, EY014375, EY001319, The Schmitt Program on Integrative Brain Research, the Research to Prevent Blindness Stein Innovation award, Research to Prevent Blindness Career Development award (Schallek), an unrestricted grant to the University of Rochester Department of Ophthalmology from Research to Prevent Blindness, New York, New York, and Canon Inc. Lawrence Sincich: National Eye Institute, Eyesight Foundation of Alabama.William H. Merigan: NIH R44 AG043645, R01 EY021166, and P30 EY001319. Also by an unrestricted grant to the University of Rochester Department of Ophthalmology from Research to Prevent Blindness, New York, New York.

Special Issue A Review of Adaptive Optics Optical Coherence Tomography: Technical Advances, Scientific Applications, and the Future Ravi S. Jonnal, 1 Omer P. Kocaoglu, 2 Robert J. Zawadzki, 1 Zhuolin Liu, 2 Donald T. Miller, 2 and John S. Werner 1 1 Vision Science and Advanced Retinal Imaging Laboratory, University of California-Davis, Sacramento, California, United States School of Optometry, Indiana University, Bloomington, Indiana, United States Correspondence: Ravi S. Jonnal, 4860 Y Street, Suite 2400, Sacra- mento, CA 95817, USA; rsjonnal@ucdavis.edu. Submitted: January 8, 2016 Accepted: May 29, 2016 Citation: Jonnal RS, Kocaoglu OP, Zawadzki RJ, Liu Z, Miller DT, Werner JS. A review of adaptive optics optical coherence tomography: technical ad- vances, scientific applications, and the future. Invest Ophthalmol Vis Sci. 2016;57:OCT51–OCT68. DOI:10.1167/iovs.16-19103 P URPOSE . Optical coherence tomography (OCT) has enabled ‘‘virtual biopsy’’ of the living human retina, revolutionizing both basic retina research and clinical practice over the past 25 years. For most of those years, in parallel, adaptive optics (AO) has been used to improve the transverse resolution of ophthalmoscopes to foster in vivo study of the retina at the microscopic level. Here, we review work done over the last 15 years to combine the microscopic transverse resolution of AO with the microscopic axial resolution of OCT, building AO-OCT systems with the highest three-dimensional resolution of any existing retinal imaging modality. M ETHODS . We surveyed the literature to identify the most influential antecedent work, important milestones in the development of AO-OCT technology, its applications that have yielded new knowledge, research areas into which it may productively expand, and nascent applications that have the potential to grow. R ESULTS . Initial efforts focused on demonstrating three-dimensional resolution. Since then, many improvements have been made in resolution and speed, as well as other enhancements of acquisition and postprocessing techniques. Progress on these fronts has produced numerous discoveries about the anatomy, function, and optical properties of the retina. C ONCLUSIONS . Adaptive optics OCT continues to evolve technically and to contribute to our basic and clinical knowledge of the retina. Due to its capacity to reveal cellular and microscopic detail invisible to clinical OCT systems, it is an ideal companion to those instruments and has the demonstrable potential to produce images that can guide the interpretation of clinical findings. Keywords: adaptive optics, optical coherence tomography, retinal imaging T he 25 years since the advent of optical coherence tomography (OCT) 1 have brought countless improvements in its axial resolution, speed, and sensitivity. The main effort to improve OCT’s transverse (or lateral) resolution has been to combine it with adaptive optics (AO), a union that has been investigated in just a few labs. Nevertheless, AO-OCT now plays important roles in the production of knowledge about the retina and its diseases. Chief among these is its potential to resolve ambiguities present in clinical and research-grade conventional (non-AO) OCT systems. Because AO-OCT reveals the microstructure that makes up clinically observable features, it is indispensable as a scientific companion to conventional OCT. Understanding the differences between the OCT image and the AO-OCT image requires that we describe some of the technical details of AO-OCT imaging and image processing, and how these are motivated by the fundamental biological and physical properties of the living human retina. the retina’s laminar structure. Because retinal diseases often impact this laminar structure, OCT has been used extensively to detect and assess disease and monitor therapeutic efficacy, to such an extent that it has become a standard of ophthalmic care. Each retinal layer contains structural and functional subunits such as cells, organelles, and capillaries, most of which are too small to be resolved by conventional OCT systems such as the commercial systems employed in the clinic (Fig. 1). While cellular imaging is presently of limited interest to clinicians, it is of great interest to basic science researchers, who stand to learn much about these structures and their functions by imaging them in situ. Moreover, an understanding of the gross structural changes observed in clinical OCT images of disease and recovery depends crucially on knowing their microscopic constituents. Cellular imaging of the retina will continue to expand our understanding of retinal disease, and is therefore of great translational significance. The Spatial Scale of Retinal Features Optical Factors Affecting Transverse Resolution The human retina consists of approximately a dozen layers of mostly transparent tissue, together less than half a millimeter thick. The axial resolution afforded by OCT lends itself to imaging The point-spread function (PSF) is a measure of the quality of an imaging system, describing how light originating from a point in tissue manifests in the image of that tissue. The PSF has both iovs.arvojournals.org j ISSN: 1552-5783 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Downloaded From: http://iovs.arvojournals.org/pdfaccess.ashx?url=/data/Journals/IOVS/935468/ on 11/08/2016 OCT51

PurposeTo quantify the response dynamics of fast adaptation mechanisms of the scotopic ERG in younger and older adults using full-field m-sequence flash stimulation.MethodsScotopic ERGs were measured for a series of flashes separated by 65ms over a range of 260ms in 16 younger (20-26, 22.2±2.1; range mean ±1 SD) and 16 older (65-85, 71.2±7) observers without retinal pathology. A short-wavelength (λ peak=442nm) LED was used for scotopic stimulation, and the flashes ranged from 0.0001 to 0.01cdsm(-2). The complete binary kernel series was derived from the responses to the m-sequence flash stimulation, and the first- and second-order kernel responses were analyzed. The first-order kernel represented the response to a single, isolated flash, while the second-order kernels reflected the adapted flash responses that followed a single flash by one or more base intervals. B-wave amplitudes of the adapted flash responses were measured and plotted as a function of interstimulus interval to describe the recovery of the scotopic ERG. A linear function was fitted to the linear portion of the recovery curve, and the slope of the line was used to estimate the rate of fast adaptation recovery.ResultsThe amplitudes of the isolated flash responses and rates of scotopic fast adaptation recovery were compared between the younger and older participants using a two-way ANOVA. The isolated flash responses and rates of recovery were found to be significantly lower in the older adults. However, there was no difference between the two age groups in response amplitude or recovery rate after correcting for age-related changes in the density of the ocular media.ConclusionsThese results demonstrated that the rate of scotopic fast adaptation recovery of normal younger and older adults is similar when stimuli are equated for retinal illuminance.

© 2016 Optical Society of America. Age-related changes in chromatic discrimination along dichromatic confusion lines were measured with the Cambridge Colour Test (CCT). One hundred and sixty-two individuals (16 to 88 years old) with normal Rayleigh matches were the major focus of this paper. An additional 32 anomalous trichromats classified by their Rayleigh matches were also tested. All subjects were screened to rule out abnormalities of the anterior and posterior segments. Thresholds on all three chromatic vectors measured with the CCT showed age-related increases. Protan and deutan vector thresholds increased linearly with age while the tritan vector threshold was described with a bilinear model. Analysis and modeling demonstrated that the nominal vectors of the CCT are shifted by senescent changes in ocular media density, and a method for correcting the CCT vectors is demonstrated. A correction for these shifts indicates that classification among individuals of different ages is unaffected. New vector thresholds for elderly observers and for all age groups are suggested based on calculated tolerance limits.

Color perception is known to remain largely stable across the lifespan despite the pronounced changes in sensitivity from factors such as the progressive brunescence of the lens. However, the mechanisms and timescales controlling these compensatory adjustments are still poorly understood. In a series of experiments, we tracked adaptation in observers after introducing a sudden change in lens density by having observers wear glasses with yellow filters that approximated the average spectral transmittance of a 70-year-old lens. Individuals were young adults and wore the glasses for 5 days for 8 hours per day while engaged in their normal activities. Achromatic settings were measured on a CRT before and after each daily exposure with the lenses on and off, and were preceded by 5 minutes of dark adaptation to control for short-term chromatic adaptation. During each day, there was a large shift in the white settings consistent with a partial compensation for the added lens density. However, there was little to no evidence of an after-image at the end of each daily session, and participants’ perceptual nulls were roughly aligned with the nulls for short-term chromatic adaptation, suggesting a rapid renormalization when the lenses were removed. The long-term drift was also extinguished by brief exposure to a white adapting field. The results point to distinct timescales and potentially distinct mechanisms compensating for changes in the chromatic sensitivity of the observer.

This feature issue of the Journal of the Optical Society of America A (JOSA A) stems from the 22nd Biennial Symposium of the International Colour Vision Society (ICVS) and reflects the basic and applied research interests of members of the color vision community. A profile is included of the 2013 Verriest Medal recipient. © 2014 Optical Society of America.

Structurally and functionally, the short-wave-sensitive (S) cone pathways are thought to decline more rapidly with normal aging than the middle- and long-wave-sensitive cone pathways. This would explain the celebrated results by Verriest and others demonstrating that the largest age-related color discrimination losses occur for stimuli on a tritan axis. Here, we challenge convention, arguing from psychophysical data that selective S-cone pathway losses do not cause declines in color discrimination. We show substantial declines in chromatic detection and discrimination, as well as in temporal and spatial vision tasks, that are mediated by S-cone pathways. These functional losses are not, however, unique to S-cone pathways. Finally, despite reduced photon capture by S cones, their postreceptoral pathways provide robust signals for the visual system to renormalize itself to maintain nearly stable color perception across the life span.

© 2016 Optical Society of America. We compared the performance of three OCT angiography (OCTA) methods: speckle variance, amplitude decorrelation and phase variance for imaging of the human retina and choroid. Two averaging methods, split spectrum and volume averaging, were compared to assess the quality of the OCTA vascular images. All data were acquired using a swept-source OCT system at 1040 nm central wavelength, operating at 100,000 A-scans/s. We performed a quantitative comparison using a contrast-to-noise (CNR) metric to assess the capability of the three methods to visualize the choriocapillaris layer. For evaluation of the static tissue noise suppression in OCTA images we proposed to calculate CNR between the photoreceptor/RPE complex and the choriocapillaris layer. Finally, we demonstrated that implementation of intensity-based OCT imaging and OCT angiography methods allows for visualization of retinal and choroidal vascular layers known from anatomic studies in retinal preparations. OCT projection imaging of data flattened to selected retinal layers was implemented to visualize retinal and choroidal vasculature. User guided vessel tracing was applied to segment the retinal vasculature. The results were visualized in a form of a skeletonized 3D model.

Die Neufassung der Arztlichen Approbationsordnung im Jahr 2012 anderte die Rahmenbedingungen des Praktischen Jahres (PJ), vor allem im Sinne einer deutlichen Flexibilisierung fur die Medizinstudierenden. Treibende Kraft fur diese und kommende Veranderungen ist jedoch nicht der Gesetzgeber; es sind die Studierenden selbst, die einen Zuschnitt der Ausbildung gemas ihren Bedurfnissen und Wunschen mit Nachdruck einfordern. Die Verwirklichung personlicher Ziele, eine aktive Freizeitgestaltung, Zeit fur Familie und soziale Kontakte zu haben sowie eine insgesamt ausgeglichene Work-Life-Balance haben das berufliche Vorankommen als Pramissen der Lebensgestaltung in der Generation Y abgelost. Zahlreiche Krankenhauser, vor allem in privater Tragerschaft, locken Studierende mit attraktiven Angeboten – die Universitatskliniken sind gefordert, sich im Werben um die gefragten Studierenden zu positionieren. Dieser Artikel beschreibt die Umsetzung der Anderungen von 2012 als Teil eines Programms zur nachhaltigen Steigerung der Attraktivitat des chirurgischen PJ-Tertials an der Ludwig-Maximilians-Universitat (LMU).

The spectral sensitivity of the visual system varies markedly between the fovea and surrounding periphery owing in part to the rapid fall in macular pigment density with eccentricity. We examined how colour appearance changes between the fovea and near periphery (8°) by measuring achromatic loci and the loci of unique and binary hues. Chosen colours remained much more similar at the two locations than predicted by the change in spectral sensitivity. Compensation for white may reflect long-term gain changes within the cones that equate sensitivity for the local average stimulus in the fovea and periphery. However, adjusting only to the average stimulus cannot correct for all of the effects of a spectral sensitivity change, and predicts differences in colour percepts between the fovea and periphery that were not observed. The similarities in hue percepts at 0 and 8° thus suggest that additional processes help compensate colour appearance to maintain constancy in the near periphery. We model the results of previous studies to show that similar adjustments are implied by age-related changes in lens pigment, and to show that these adjustments are consistent with previous measurements of peripheral colour appearance based on hue cancellation.

Optical coherence tomography (OCT) was introduced to ophthalmologists in 1995 as a diagnostic tool capable of in vivo imaging of a cross-section of the retina.1 The commercially available Stratus OCT (OCT-3, Carl Zeiss, Meditec, Inc., Dublin, CA) is routinely used to diagnose macular holes and cysts and to quantitate macular thickening among subjects treated for macular edema or choroidal neovascularization. 2,3 The main limitation of the Stratus OCT is that the data are acquired slowly as a result of implementation in the time domain. The resulting relatively long data acquisition time (0.5 to 1.0 B-scans/s, 400 A-scans/s) limits the ability to sample the retina completely because only a limited number of A- and B-scans can be acquired.4 Stratus OCT uses only six radial B-scans to create a macular thickness map. Thus, the entire macula is not imaged, and small macular lesions may be visualized incorrectly or missed when using this imaging modality.4 Fourier-domain, or spectral-domain, OCT (Fd-OCT) is an alternative imaging modality developed recently.4 This method of data acquisition reduces the image data acquisition time by a factor of 20 to 40 while maintaining high axial resolution. The rapid data acquisition allows serial B-scans of the macula such that the entire macula can be imaged in high resolution with minimal motion artifact. This technology has been shown to improve visualization of the entire macular lesion and to provide more information on anatomic structural changes in the retina that may be missed with conventional time-domain OCT.4 In this report, we used a high-resolution Fd-OCT instrument developed at our institution to image the maculae of subjects with previously unexplained vision loss based on funduscopy, fluorescein angiography, and Stratus OCT. These eyes were compared with eyes from age-matched control subjects.