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Background: Uncorrected refractive error (URE) is one of the main causes of visual impairments. URE may reduce interaction and learning in the classroom, leading to social isolation, irreversible amblyopia, lack of external knowledge, and restrictions on education and employment opportunities. Our aim was to investigate the prevalence and related factors of URE in adolescents using epidemiological surveys and questionnaire surveys related to lifestyle habits. Methods: A cross-sectional school-based study was conducted in Nantong, China, including adolescents 12–19 years of age from 16 schools. URE was defined as presenting visual acuity worse than 6/12 and improving to ≥ 1 lines after correction in either eye. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between URE and related lifestyle parameters. Non-cycloplegic autorefraction was assessed for each adolescent. Results: A total of 2,910 adolescents were analyzed, of which 50.3% (n = 1,465) were male, and 49.7% (n = 1,445) were female. The mean age was 15.23 ± 1.77 years. The overall prevalence of URE was 23.7%. The total prevalence of REC and eREC was 85.1% and 71.7%, respectively, and both of them showed an increasing trend with age (Ptrend = 0.018 and Ptrend = 0.019, respectively). A higher prevalence of URE was related to myopia, anisometropia, and increased daily use of electronic products. Timely visual examination by medical institutions, more extracurricular homework, and older age were protective factors for URE. Among the 689 adolescents with URE, 362 (52.5%) did not receive any refractive correction, and 327 (47.5%) used corrected glasses. Conclusion: URE was highly prevalent among adolescents in China. Myopia was the most important risk factor for URE. The impact of anisometropia and increased daily use of electronic devices on URE was significant. Timely visual examinations by medical institutions served as an effective protective factor against URE. Further research on adjusting intervention strategies is therefore needed to eliminate preventable visual impairments. [ABSTRACT FROM AUTHOR]

Glaucoma is a leading cause of irreversible visual impairment worldwide, characterized by the progressive death of retinal ganglion cells (RGCs). Deubiquitinating enzyme (DUB) inhibitors have shown promise as pharmacological interventions for neurodegenerative disorders. Our study focuses on the pan-DUB inhibitor PR-619 and its potential neuroprotective effects on RGCs through modulation of parkin-mediated mitophagy in experimental glaucoma models. The results show that impaired mitophagy exists in RGCs of our experimental glaucomatous model. In vivo, PR-619 increased RGCs survival in glaucomatous rats. In vitro, it protected RGCs against excitotoxicity and reduced ubiquitin-specific protease (USP) 15 expression. Additionally, PR-619 upregulated parkin expression, increased LC3-II/LC3-I ratios, and elevated LAMP1 levels, indicating enhanced mitophagy in vivo and in vitro. Moreover, numbers of mitophagosomes were increased in optic nerves of PR-619-treated ocular hypertensive rats in vivo. Furthermore, parkin knockdown negated the salutary effects of PR-619 and attenuated expression of parkin-dependent mitophagy effectors in RGCs subjected to glutamate excitotoxicity in vitro. Collectively, these findings implicate augmented parkin-mediated mitophagy as the mechanistic substrate underscoring the neuroprotective capacity of PR-619 in experimental glaucoma. These revelations engender the prospect that pharmacological agents or biotherapeutics augmenting parkin-mediated mitophagy may proffer viable therapeutic modalities for glaucomatous neurodegeneration characterized by impaired mitophagy. [ABSTRACT FROM AUTHOR]

Age-related cataracts is a highly prevalent eye disorder that results in the clouding of the crystalline lens and is one of the leading causes of visual impairment and blindness. The disease is influenced by multiple factors including genetics, prolonged exposure to ultraviolet radiation, and a history of diabetes. However, the extent to which each of these factors contributes to the development of cataracts remains unclear. Our study identified 101 independent genome-wide significant loci, 57 of which are novel. We identified multiple genes and biological pathways associated with the cataracts, including four drug-gene interactions. Our results suggest a causal association between type 1 diabetes and cataracts. Also, we highlighted a surrogate measure of UV light exposure as a marker of cataract risk in adults. Here, the authors expand knowledge of the genetic architecture of age-related cataracts, exploring associated pathways and drug-gene interactions, and clarify the roles of type 1 diabetes and UV exposure in cataract etiology. [ABSTRACT FROM AUTHOR]

Diabetic Retinopathy (DR) poses a critical health concern, affecting millions of individuals globally, particularly in light of the increasing prevalence of diabetes. Early diagnosis and treatment can prevent vision loss in up to 95% of DR patients. However, the shortage of ophthalmologists, coupled with the limitations of traditional DR diagnostic methods, necessitates innovative solutions to provide timely and accessible DR screening and diagnosis, especially in underserved regions. In this study, we present a deep learning (DL) based framework for DR screening, with a specific focus on its suitability for resource-constrained edge devices. Our methodology is built upon addressing five key research questions to enhance the model's accuracy, ensure scalability, establish robustness, optimize computational complexity, and provide a thorough performance comparison with existing models. The developed framework attains a very high accuracy of 98.4%, accompanied by a sensitivity of 95.6% and a specificity of 98.6%. It not only exhibits efficient resource utilization, with a 40-fold improvement in the accuracy-to-size ratio, but also excels with minimal CPU and GPU inference times, and low memory requirements. Our proposed framework combines enhanced accuracy and faster inference times with a lean DL model. Its adaptability facilitates inferences on edge devices in remote areas, even when cloud connectivity is intermittent. Looking forward, our focus will be on enhancing model generalization through cross-validation and hybrid databases, integrating security through federated learning, and implementing adaptive learning to ensure the model's continued relevance in evolving healthcare scenarios. This work represents a significant contribution to the field of DR screening, providing an accessible and efficient solution for mass screening, particularly in regions with limited access to healthcare resources. [ABSTRACT FROM AUTHOR]

Background: The Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF). Case presentation: A 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision. Conclusion: Preoperative evaluation of the patient's hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery. [ABSTRACT FROM AUTHOR]

This research looked into the lived experiences of individuals wedded to visually impaired partners. This study employed face-to-face interview using a semi-structured questionnaires as an interview guide flow. This research employed a phenomenological approach where thematic analysis was utilized, and responses were qualitatively evaluated as means for developing subthemes, and superordinate themes. With this type of data analysis, the researchers were able to identify common patterns that provide significant answers to the research questions addressed in the study. Results presented eight (8) dominant themes centering on the participants, namely; (1) Life of a Dim Sighted Individual, (2) Foundation of Love Ideation, (3) Walk down the Lover's Lane, (4) Road to be Missus, (5) Art of living the Married Life, (6) Love in the Reflection of Two People, (7) Envisioning Future with Clear Sight, and (8) Valuable Lessons from Life Experience. Findings shows that compassion, acceptance, and love are a momentous decree in sustaining marriage relationships. In light of the findings, programs that can be establish is an optical/medical mission for at least during every quarter in order to lessen the financial burden of check ups for individuals with visual impairment with the support of Local Government Units (LGUs). [ABSTRACT FROM AUTHOR]

Calcium is involved in vision processes in the retina and implicated in various pathologies, including glaucoma. Rod cells rely on store-operated calcium entry (SOCE) to safeguard against the prolonged lowering of intracellular calcium ion concentrations. Zebrafish that lacked the endoplasmic reticulum Ca2+ sensor Stim2 (stim2 knockout [KO]) exhibited impaired vision and lower light perception-related gene expression. We sought to understand mechanisms that are responsible for vision impairment in stim2 KO zebrafish. The single-cell RNA (scRNA) sequencing of neuronal cells from brains of 5 days postfertilization larvae distinguished 27 cell clusters, 10 of which exhibited distinct gene expression patterns, including amacrine and γ-aminobutyric acid (GABA)ergic retinal interneurons and GABAergic optic tectum cells. Five clusters exhibited significant changes in cell proportions between stim2 KO and controls, including GABAergic diencephalon and optic tectum cells. Transmission electron microscopy of stim2 KO zebrafish revealed decreases in width of the inner plexiform layer, ganglion cells, and their dendrites numbers (a hallmark of glaucoma). GABAergic neuron densities in the inner nuclear layer, including amacrine cells, as well as photoreceptors significantly decreased in stim2 KO zebrafish. Our study suggests a novel role for Stim2 in the regulation of neuronal insulin expression and GABAergic-dependent vision causing glaucoma-like retinal pathology. [ABSTRACT FROM AUTHOR]

Background: Penicillin has remained the most effective treatment for syphilis for several decades. Syphilitic retinal manifestations may persist following treatment and cause visual problems. In this case series, we describe three syphilis patients with persistent posterior segment manifestations due to chronic inflammation, incomplete treatment, and reinfection. Case series: Recommended initial treatment for all patients was 14 days of intravenous penicillin. Oral prednisone was added 48 h after initiation of penicillin therapy. Case 1: A 48-year-old female presented with gradual vision loss for two months. Fundus imaging revealed syphilitic outer retinopathy (SOR), papillitis, and acute syphilitic posterior placoid chorioretinopathy (ASPPC). After treatment, she had persistent cystoid macular edema (CME) and was treated with intravitreal triamcinolone injections and ketorolac drops. Case 2. A 24-year-old male presented with sudden vision loss for two days. On imaging, he had ASPPC, papillitis, and SOR. IV penicillin treatment was given for 10 days only. He had persistent SOR and was retreated with doxycycline and prednisone. Case 3: A 52-year-old male presented with eye pain and visual loss for one week. There was evidence of ASPPC and papillitis on imaging. One month after treatment, he had persistent papillitis and was restarted on oral prednisone. One year later, he was found to have recurrent ASPPC and was confirmed to be reinfected with syphilis, for which he was retreated. Conclusion: When treating persistent syphilitic ocular manifestations, we recommend checking that the penicillin treatment was complete and the RPR titers are declining. If both hold true, then the affected eye should be treated with anti-inflammatory therapy. Other factors that contribute to poor visual prognosis include treatment delay, poor initial visual acuity, macular edema, and HIV coinfection. [ABSTRACT FROM AUTHOR]

AbstractIndividuals with color vision deficiency (CVD) face many difficulties and limitations in their daily lives and professional activities, some of which may prove life-threatening. These negative factors necessitate the development of methods for the identification and classification of CVD. Because CVD is a vision impairment, it is crucial to determine if its presence can be predicted with eye behavior. An experiment was conducted using a driving simulator and eye-tracking glasses. The experiment included 27 people with CVD (12 with deuteranopia, 9 with deuteranomaly, 3 with protanopia, and 3 with protanomaly) and 10 people with normal color vision. Each participant performed multiple driving attempts with color-coded guidelines on the navigator to assess visual search ability. Based on data recorded by an eye tracker, the following three types of cross-validated models were developed: binary classification (presence and absence of CVD), a three-class model to recognize the absence of CVD, protanopia, and deuteranopia, and a five-class model to predict the absence of CVD, deuteranopia, deuteranomaly, protanopia, and protanomaly. These three models yielded respective accuracy levels of over 95%, 66%–78%, and 43%–52%. Overall, it was found that eye-tracking metrics have the potential to classify and predict CVD. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR) is a leading cause of visual impairment globally among working-aged individuals. This study aims to update data on DR prevalence in Bulgaria. Methods: The present cross-sectional study was conducted between 1 January 2022 and 1 January 2023, using a local diabetes registry from the city of Varna as a sampling framework. In total, 587 diabetic patients underwent DR examination. Data included demographics, diabetes type/duration, treatment, and ophthalmic history. DR status was assessed using indirect slit-lamp biomicroscopy or digital fundus photography, graded by the International Clinical Diabetic Retinopathy Scale. Results: Of 587 participants, 13 were excluded due to cataract-related ungradable images. The median age was 65 years (IQR 56–73), with a slight female predominance (54%). The overall prevalence of any DR was 39.9% (95% CI 35.9–44.0), with non-proliferative DR (NPDR) at 27.5%, proliferative DR (PDR) at 7.3%, and macular edema (DME) at 5%. Type 1 diabetes patients had significantly higher DR prevalence (68.8%) than type 2 (34.1%, p < 0.001). Men exhibited higher DR prevalence. Age and diabetes duration correlated positively with DR prevalence. Insulin treatment was associated with higher DR prevalence (55.6%) than oral antidiabetic treatment (22.5%, p < 0.001) for type 2 diabetes patients. Among those diagnosed with DR, 70.9% received treatment, mainly laser therapy. Conclusions: These findings provide epidemiological insights for future research and emphasize the need for a comprehensive national DR screening program in Bulgaria. Technological advancements enable proactive measures to mitigate DR-related visual impairment and blindness, including widespread screening, even in rural areas. [ABSTRACT FROM AUTHOR]

Background/Objectives: Stroke survivors often experience various visual consequences that impact their daily life and may benefit from visual interventions. However, some of these usually go unaddressed as optometrists are rarely included in the post-stroke care pathway. Yet, optometrists are interested in contributing to the care of these patients. This survey evaluated the readiness of optometrists in diagnosing and managing visual disorders specific to stroke survivors. Methods: A questionnaire was developed by the researchers, pilot tested by 5 research optometrists and 15 community optometrists, and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, the US, Hong Kong, India, and the UK. Results: Most respondents displayed strong knowledge, but 61.6% indicated that enhancing their knowledge would be helpful. The majority (87%) agreed that stroke is related to an increased incidence of falls. Participants' knowledge regarding the natural history of post-stroke visual disorders was poorer. There were also inconsistencies regarding what optometrists considered ideal interventions and what they undertook in practice. More than 50% of respondents reported that the quality of published evidence on post-stroke visual consequences was low or nonexistent. Conclusions: Overall, survey respondents displayed sufficient knowledge. However, there are areas of uncertainty in their knowledge, which in many cases correspond to real gaps in the available evidence. There is a need to identify and remediate these gaps to enable optometrists to deliver quality optometric care as collaborative members of the post-stroke professional team, which would eventually improve the rehabilitation of stroke survivors. [ABSTRACT FROM AUTHOR]

Keratoconus (KC) is a corneal thinning dystrophy that leads to visual impairment. While the cause of KC remains poorly understood, changes in sex hormone levels have been correlated with KC development. This study investigated circulating gonadotropin-releasing hormone (GnRH) in control and KC subjects to determine if this master hormone regulator is linked to the KC pathology. Plasma and saliva were collected from KC subjects (n = 227 and n = 274, respectively) and non-KC controls (n = 58 and n = 101, respectively), in concert with patient demographics and clinical features. GnRH levels in both plasma and saliva were significantly lower in KC subjects compared to controls. This finding was retained in plasma when subjects were stratified based on age, sex, and KC severity. Control and KC corneal fibroblasts (HKCs) stimulated with recombinant GnRH protein in vitro revealed significantly increased luteinizing hormone receptor by HKCs and reduced expression of α-smooth muscle actin with treatment suggesting that GnRH may modulate hormonal and fibrotic responses in the KC corneal stroma. Further studies are needed to reveal the role of the hypothalamic–pituitary–gonadal axis in the onset and progression of KC and to explore this pathway as a novel therapeutic target. [ABSTRACT FROM AUTHOR]

The detection of defects on the copper chain in the production process of tobacco cutters is crucial for ensuring product quality. Traditional defect detection methods often rely on spatial domain image analysis, which not only has a large computational load but also performs poorly in handling high‐frequency noise and complex backgrounds. To address this issue, this paper proposes a novel neural network model based on frequency domain analysis, called frequency domain attention network. This network first utilizes discrete cosine transform to transform the image from the spatial domain to the frequency domain, effectively reducing computational complexity and improving processing speed. Subsequently, through the innovative frequency domain attention module, the network automatically identifies and enhances key discriminative features in the frequency domain, thereby strengthening the model's ability to identify defects. Finally, the frequency domain attention map, after feature extraction and integration, is inputted into the coupling detection head to achieve high‐precision defect detection. The experimental results show that our method outperforms the SOTA method with an increase of 0.03 in AP and 21 in FPS. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONPeople with visual impairments commonly rely on the use of a white cane to navigate and avoid obstacles. Although this analog tool is highly reliable and easy to use, its drawback is the impossibility to anticipate obstacles beyond reach and routes, as well as obstacles above waist level. Electronic travel aids (ETAs) and sensory substitution devices (SSDs) are new technological solutions designed to enhance the tactile and/or auditory capabilities to access the information needed to overcome those drawbacks. In the present study, 25 individuals with visual impairments used the T-Sight, a vibrotactile SSD, and/or the white cane in a navigation task involving obstacle avoidance. While the performance achieved with the device, measured by the number of collisions and walking speed, did not surpass the white cane, the SSD did have a positive impact on ambulation. Participants reduced the number of white cane touches towards environmental obstacles and performed obstacle avoidance maneuvers earlier. These results demonstrate the potential of vibrotactile devices to address the limitations of the white cane. Assessments of secondary travel aids for people with visual impairments should include performance measures beyond speed and number of collisions.These include the number of alerts, white cane touches, and trajectory analysis.Our vibrotactile secondary ETA allows improvements in navigation and obstacle avoidance shown as a reduction in the use of the white cane and an anticipation of the avoidance maneuvers.Assessments of secondary travel aids for people with visual impairments should include performance measures beyond speed and number of collisions.These include the number of alerts, white cane touches, and trajectory analysis.Our vibrotactile secondary ETA allows improvements in navigation and obstacle avoidance shown as a reduction in the use of the white cane and an anticipation of the avoidance maneuvers. [ABSTRACT FROM AUTHOR]

This study developed a prototype for an electronic travel aids (ETAs) system named Navigation Assisting Vest (NaVest) using Bluetooth Low Energy (BLE) beacons and a smartphone application to address the challenges faced by blind or visually impaired individuals (BVIP) whilst navigating unfamiliar indoor environments. The NaVest employs ultrasonic sensors for obstacle avoidance and indoor navigation functions. Testing and evaluation of the prototype were conducted with 12 BVIP and blindfolded participants in a local university building in the United Arab Emirates. The developed prototype improved the efficiency and safety of navigation tasks, and participants were overall satisfied with the system. Future research should focus on developing ETA systems that combine several functions to help BVIP travel more independently in indoor or outdoor environments. Additionally, ETA systems with multi-language support should be considered to improve accessibility for BVIP. [ABSTRACT FROM AUTHOR]

Purpose: Many older dogs (Canis lupus familiaris) develop cognitive impairment. Dog owners often describe impairments in multiple sensory functions, yet the relationships between sensory and cognitive function in older dogs is not well understood. Methods: We performed assessments of dog vision and hearing, both clinically (n = 91, electroretinography and brainstem auditory evoked potential) and via validated questionnaire (n = 238). We determined prevalence of sole and dual hearing/vision impairments in younger (<8 years) and older (≥8 years) dogs. Impairment cutoffs were determined using data from young dogs. We assessed the relationships between questionnaire-assessed vision and/or hearing impairments and cognitive impairment using logistic regression. Results: Younger and older dog groups had similar distributions of sex and purebred/mixed breed status. Sex had no relationship to prevalence of sensory impairments. Older dogs had higher prevalence of hearing, vision, and dual sensory impairments, assessed both clinically and by questionnaire (P<0.001), and cognitive impairment assessed by questionnaire (P<0.001). Dogs had higher prevalence of reported cognitive impairment when owners reported dual vision and hearing impairments (79–94%, versus 25–27% in dogs with no sensory impairments), which was most consistent in dogs aged ≥8 years. In these older dogs, dual vision/hearing impairments were associated with a significantly increased risk of cognitive impairment (1.8–2.0 odds ratio). Conclusion: Dogs aged ≥8 years are at higher risk for dual hearing/vision impairments and associated cognitive impairments. The causal relationship between these impairments is not defined, but clinical consideration of these multimorbidity risks should be made in older dogs. [ABSTRACT FROM AUTHOR]

Orbital tuberculosis is a rare form of extra pulmonary TB and may arise either by hematogenous route or spread directly from the paranasal sinus. We herein report two cases of orbital TB with a vision threatening complication. Case-1 is a 31-year-old female with a headache, a diminution of vision in the right eye, and pain in ocular movement. On examination, there was no proptosis with RAPD present in right eye and tenderness on palpation. CEMRI revealed a diffuse infiltrating lesion at the orbital apex, suggesting of inflammatory pathology. Case-2 is a 40-year-old male with similar complaints in the left eye, CECT showed edema and swelling in the optic nerve and extraocular muscle of the left eye. A detailed investigation was done, and a diagnosis of orbital tuberculosis was made in both patients. They were started on ATT and oral steroids but lost follow-up initially and due to delayed treatment, it led to irreversible vision loss. A long-term follow-up showed resolution of ocular symptoms with occasional headaches. [ABSTRACT FROM AUTHOR]

The article evaluates ChatGPT-4 responses to glaucoma patients' questions to determine if artificial intelligence can serve as a trusted advisor between doctors and patients. The study involved identifying 50 frequently asked questions by glaucoma patients, categorizing them into five groups, and assessing the accuracy of ChatGPT responses. Results showed a high level of concordance between ChatGPT-4 predictions and evaluations, with generally accurate responses across different question categories. The study highlights the potential of AI like ChatGPT in providing instant and relevant medical information to patients, emphasizing the importance of professional medical oversight despite the utility of AI in addressing medical concerns. [Extracted from the article]

This study compared treatment outcomes of slow coagulation transscleral cyclophotocoagulation (SC-CPC, 65 eyes) and micropulse transscleral laser treatment (MPL, 134 eyes) in patients with medically uncontrolled glaucoma. Success was defined as achieving an intraocular pressure (IOP) of 6–21 mmHg with a ≥ 20% reduction from baseline, no reoperation for glaucoma, and no loss of light-perception vision. Visual acuity, number of glaucoma medication, corneal endothelial cell count, aqueous flare values, and complications were analyzed. At 12 months, mean IOP decreased from 32.2 ± 13.4 to 17.9 ± 8.3 mmHg in the SC-CPC group and from 26.4 ± 10.8 to 16.5 ± 6.8 mmHg in the MPL group. No significant changes were observed in visual acuity, medication count, or corneal endothelial cell count. Aqueous flare values increased immediately after the procedure and gradually decreased in both groups, with greater changes at 1 week significantly associated with greater IOP reduction (p < 0.05). Pupillary abnormalities were found in 5 eyes (4.5%) of the MPL group, with no severe complications. The 12-month success rates were 50.1% for SC-CPC and 38.2% for MPL (p = 0.131). Both SC-CPC and MPL effectively controlled IOP, with early postoperative aqueous flare values predicting treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil. Methods: Data from the "Ver na Escola" Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models. Results: A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01–1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16–1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93–0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years. Conclusions: Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) is a condition in which people with vision loss experience complex visual hallucinations. These complex visual hallucinations may be caused by increased excitability in the visual cortex that are present in some people with vision loss but not others. Objectives: We aimed to evaluate the association between γ-aminobutyric acid (GABA) in the visual cortex and CBS. We also tested the relationship among visually evoked responses, functional connectivity, and CBS. Design: This is a prospective, case-controlled, cross-sectional observational study. Methods: We applied 3-Tesla magnetic resonance spectroscopy, as well as task-based and resting state (RS) connectivity functional magnetic resonance imaging in six participants with CBS and six controls without CBS. GABA+ was measured in the early visual cortex (EVC) and in the lateral occipital cortex (LOC). Participants also completed visual acuity and cognitive tests, and the North-East Visual Hallucinations Interview. Results: The two groups were well-matched for age, gender, visual acuity and cognitive scores. There was no difference in GABA+ levels between groups in the visual cortex. Most participants showed the expected blood oxygenation level dependent (BOLD) activation to images of objects and the phase-scrambled control. Using a fixed effects analysis, we found that BOLD activation was greater in participants with CBS compared to controls. Analysis of RS connectivity with LOC and EVC showed little difference between groups. A fixed effects analysis showed a correlation between the extent of functional connectivity with LOC and hallucination strength. Conclusion: Overall, our results provide no strong evidence for an association between GABAergic inhibition in the visual cortex and CBS. We only found subtle differences in visual function and connectivity between groups. These findings suggest that the neurochemistry and visual connectivity for people with Charles Bonnet hallucinations are comparable to a sight loss population. Differences between groups may emerge when investigating subtle and transient changes that occur at the time of visual hallucinations. Plain language summary: Brain imaging in Charles Bonnet syndrome In Charles Bonnet Syndrome (CBS), people with sight loss start to see hallucinations that they know are not real but can be disturbing. In this study we used MRI scanning to measure how the chemistry in the visual brain differs in people with CBS and those who have sight loss but no hallucinations. Surprisingly we did not find any differences in chemistry between these groups, suggesting that their brains do not differ greatly. Any differences in how their visual brain works may be too small to measure, or only present when people hallucinate. [ABSTRACT FROM AUTHOR]

Background: Digital devices significantly contribute to vision-related problems. In addition, prolonged postural imbalance, owing to excessive use of digital devices, can lead to the tightening of head and neck muscles, resulting in neck pain, a common musculoskeletal discomfort that significantly affects individuals with poor vision. This study aimed to evaluate the prevalence and interrelationships of screen time, visual disorders, and neck pain among students at Majmaah University. Methods: A cross-sectional study was conducted at Majmaah University, Saudi Arabia, enrolling students aged 18 to 25 years. Exclusion criteria included neurological or musculoskeletal disorders. Demographic data and information on visual and neck pain symptoms were collected. The Neck Disability Index questionnaire was used to assess neck pain, and data were analyzed using SPSS version 24.0. Results: Among 263 participants, 53.6% were female. Nearsightedness (38.0%) and dry/itchy eyes (49.0%) were the most common visual disorders and symptoms, respectively. Visual disorders were prevalent in 62.0% of students, while neck pain was reported by 79.5%. Females and those studying for more than 5 h using electronic screens daily reported higher neck disability index scores. A significant association was found between >5 h of study duration [screen time] and neck disability (OR 3.703, 95% CI 1.500–9.144, p = 0.005). Conclusion: The study highlights a relationship between visual problems and neck pain among university students, emphasizing the need for addressing vision-related issues to reduce neck discomfort. High screen time could substantially increase the odds of developing neck disability. However, authors warrant cautious interpretation in the light of following limitations: cross-sectional study, small sample size, lack of statistical power, and self-reported data. [ABSTRACT FROM AUTHOR]

Background: The 2022 world guidelines for falls prevention and management suggest measuring sensory function including dizziness, vision, and hearing. These variables are not included in the falls risk stratification algorithm. This study sought to investigate the utility of the guidelines and potential avenues for improvement. This study applied the falls risk stratification recommendations and reviewed the individual sensory impairment risk factor variables predictive of falls and falls risk grouping in those assessed by a frailty intervention team (FIT) based in an emergency department (ED). Methods: Patients over 65 years old who attended the ED and had a comprehensive geriatric assessment carried out by FIT over a period of four months were included in this retrospective cross-sectional study. Patient characteristics, medication, physical and sensory function status data was retrieved and analysed with respect to falls and falls risk grouping. Results: Data was gathered retrospectively from 392 patients. Excluding those with missing data, almost all attendees were in the high-risk of falls category (n = 170, 43.4%), or the low-risk category (n = 149, 38.0%). Few people were in the intermediate-risk category (n = 19, 4.8%). Hearing loss and dizziness were significantly associated with falls incidence, whereas vision and balance were not. Hearing loss, balance and dizziness were significantly associated with risk grouping, whereas vision was not. Conclusions: Most older adults included in the analysis fell into the low- or high-risk categories, with a minority in the intermediate-risk category. This suggests that the inclusion criteria for the intermediate category could be altered for greater sensitivity. While impaired balance and vision were the most common impairments, hearing status, balance and dizziness were associated with risk group. These results, through a practical application of the world guidelines for falls to an acute clinical sample, raise the possibility of refining the falls risk stratification criteria, and highlight the capacity for additional sensory intervention to mitigate falls risk. [ABSTRACT FROM AUTHOR]

Purpose: In patients with diabetic macular edema (DME) from YOSEMITE/RHINE, dual angiopoietin-2/vascular endothelial growth factor-A (VEGF-A) inhibition with faricimab resulted in visual/anatomic improvements with extended dosing. The SWAN trial (jRCTs031230213) will assess the efficacy, durability, and safety of faricimab during the treatment maintenance phase in patients with DME using a treat-and-extend (T&E)-based regimen adapted to clinical practice and the characteristics of patients achieving extended dosing intervals. Methods: SWAN is a 2-year, open-label, single-arm, interventional, multicenter trial enrolling adults with center-involving DME. All patients will receive three initial faricimab 6.0 mg doses every 4 weeks (Q4W). From week 12 onwards, in patients without active DME, dosing intervals will be extended in 8-week increments up to Q24W. In contrast, patients with active DME (central subfield thickness [CST] >325 μm and intraretinal fluid [IRF] or subretinal fluid [SRF] resulting in vision loss/disease aggravation) will receive a dose within a day and the dosing interval will be shortened by 4 weeks to a minimum of Q8W relative to the previous dosing interval. Recruitment commenced in August 2023 across a planned 16 sites in Japan. Results: The primary endpoint is change in best-corrected visual acuity (BCVA) from baseline at 1 year (averaged over weeks 52, 56, and 60). Key secondary endpoints include: change from baseline in BCVA, CST, and National Eye Institute Visual Function Questionnaire scores over time; proportion of patients with BCVA (decimal visual acuity) ≥0.5, ≥0.7, ≥1.0, or ≤0.1; proportion of patients with absence of DME, and IRF and/or SRF over time. Safety endpoints include incidence/severity of ocular/nonocular adverse events. Conclusions: The SWAN trial is expected to provide evidence to support individualized faricimab dosing regimens, with the potential to reduce the burden of frequent treatments on patients, caregivers, and healthcare systems. [ABSTRACT FROM AUTHOR]

Background: Src family kinases (SFKs) contribute to migraine pathogenesis, yet its role in regulating photophobia behaviour, one of the most common forms of migraine, remains unknown. Here, we addressed whether SFKs antagonism alleviates photophobia behavior and explored the underlying mechanism involving hypothalamus and trigeminal ganglion activity, as measured by the alteration of neuropeptide levels and transcriptome respectively. Methods: A rapid-onset and injury-free mouse model of photophobia was developed following intranasal injection of the TRPA1 activator, umbellulone. The role of SFKs antagonism on light aversion was assessed by the total time the mouse stays in the light and transition times between the dark and light compartments. To gain insight to the preventive mechanism of SFKs antagonism, hypothalamic neuropeptides levels were assessed using enzyme linked immunofluorescent assay and trigeminal ganglion activity were assessed using RNA-sequencing and qPCR analysis. Results: SFKs antagonism by a clinically relevant SFKs inhibitor saracatinib reduced the total time in light and transition times in male mice, but not in females, suggesting SFKs play a crucial role in photophobia progressing and exhibit a male-only effect. SFKs antagonism had no effect on hypothalamic calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide levels of all mice investigated, suggesting the gender-different effect of saracatinib on light aversion appears to be independent of these hypothalamic neuropeptide levels. In trigeminal ganglion of male mice, photophobia is associated with profound alteration of differentially expressed genes, part of which were reversed by SFKs antagonism. Subsequent qPCR analysis showed SFKs antagonism displayed gender-different modulation of expression in some candidate genes, particularly noteworthy those encoding ion channels (trpm3, Scn8a), ATPase signaling (crebbp, Atp5α1) and kinase receptors (Zmynd8, Akt1). Conclusions: In conclusion, our data revealed that SFKs antagonism reduced photophobia processing in male mice and exhibited gender-different modulation of trigeminal ganglion activity, primarily manifesting as alterations in the transcriptome profile. These findings underscore the potential of SFKs antagonism for allieving photophobia in males, highlighting its value in the emerging field of precision medicine. [ABSTRACT FROM AUTHOR]

Pathological myopia is a major cause of blindness among people under 50 years old and can result in severe vision loss in extreme cases. Currently, its detection primarily relies on manual methods, which are slow and heavily dependent on the expertise of physicians, making them impractical for large-scale screening. To tackle these challenges, we propose SMLS-YOLO, an instance segmentation method based on YOLOv8n-seg. Designed for efficiency in largescale screenings, SMLS-YOLO employs an extremely lightweight model. First, StarNet is introduced as the backbone of SMLS-YOLO to extract image features. Subsequently, the StarBlock from StarNet is utilized to enhance the C2f, resulting in the creation of the C2f-Star feature extraction module. Furthermore, shared convolution and scale reduction strategies are employed to optimize the segmentation head for a more lightweight design. Lastly, the model incorporates the Multi-Head Self-Attention (MHSA) mechanism following the backbone to further refine the feature extraction process. Experimental results on the pathological myopia dataset demonstrate that SMLS-YOLO outperforms the baseline YOLOv8n-seg by reducing model parameters by 46.9%, increasing Box mAP@0.5 by 2.4%, and enhancing Mask mAP@0.5 by 4%. Furthermore, when compared to other advanced instance segmentation and semantic segmentation algorithms, SMLS-YOLO also maintains a leading position, suggesting that SMLS-YOLO has promising applications in the segmentation of pathological myopia images. [ABSTRACT FROM AUTHOR]

Background: Chronic anterior uveitis (CAU) carries a significant risk for eye complications and vision loss. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) introduced consensus treatment plans (CTPs) to standardize treatment for CAU and facilitate future comparative effectiveness studies. Two CTPs were developed to address: 1) initiation of methotrexate (MTX) in patients with CAU naïve to steroid-sparing therapy, and 2) initiation of a TNF inhibitor (TNFi) in patients with severe uveitis or uveitis refractory to MTX. We evaluated implementation of the uveitis CTPs using existing CARRA Registry infrastructure and assessed feasibility of the CTPs for comparative effectiveness research. Methods: This prospective observational cohort study was conducted at nine pilot sites between February 2020 and August 2022. Patients with JIA-associated CAU (JIA-U) were treated according to either the MTX or TNFi CTP. Uveitis activity and medication use were recorded at 0, 3, and 6 months. We assessed patient enrollment rates, CTP arm selection, uveitis control, and quality of data collection. We also evaluated CTP arm selection in a retrospective cohort of similar JIA-U patients enrolled in the CARRA Registry during the same study period. Results: Seventeen patients were included in the pilot cohort. Eight were treated with the MTX CTP (4 oral MTX, 4 subcutaneous MTX), and 9 with the TNFi CTP (9 received standard-dose adalimumab, none selected high-dose adalimumab or infliximab). Uveitis was controlled in 13 of 17 patients by 6 months. Query of the CARRA-wide Registry identified 42 patients with JIA-U who were treated according to the MTX or TNFi CTPs. Among these, 26 were treated with MTX (8 oral, 18 subcutaneous) and 16 with TNFi (12 standard dose adalimumab, 2 high dose adalimumab, and 2 infliximab). Conclusion: Both the MTX and TNFi uveitis CTPs can practically be implemented in clinical settings and are currently being utilized across Registry sites. However, in patients starting TNFi therapy, all pilot study participants and most patients across the CARRA Registry were treated with a standard dose of adalimumab. This consensus on the treatment approach underscores its broad acceptance but also limits the applicability of the uveitis TNFi CTP for comparative effectiveness research. [ABSTRACT FROM AUTHOR]

Abstract\nIMPLICATIONS FOR REHABILITATIONIn this study, 3D printing-based solutions are sought to improve the durability of guide canes of visually impaired individuals. The financial inaccessibility of technological white canes is a challenge that this study addresses by integrating additive manufacturing. The proposed solutions are designing a ball caster tip with a suspension mechanism, manufacturing a barrier detection and vibration alert system, and a 3D-printed flexible cover for the guide cane. Each solution is specially prototyped for this study using Computer-Aid Design (CAD). It aims to produce accessories that can upgrade any regular cane to a more durable and comfortable state by easily clipping them onto any cane. The solutions were assessed under three criteria, for which the visually impaired consultee of the research was assigned weights for further evaluation. The assessment has been conducted based on each solution’s effectiveness, cost, and comfort. According to the evaluation of the visually impaired consultee, the ball caster with suspension mechanism yielded the highest score for the assessment criteria. Further recommendations have been made for each solution to decrease the volume occupancy and increase lifespan, durability, and comfort.Modular Computer-Aid Designing (CAD) of white cane accessoriesNovel ball caster module with a suspension mechanismSensitive barrier detection with ultrasonic sensors and alerting with vibration3D printing flexible thermoplastic polyurethane (TPU) cover for cane segment [ABSTRACT FROM AUTHOR]

Introduction: Calciphylaxis is a condition that causes vascular calcification and intimal proliferation with thrombotic occlusion of small-to-medium-sized vessels. Case Presentation: We describe a case of a 64-year-old woman who presented with a clinical picture that was suggestive of anterior arteritic ischemic optic neuropathy due to giant cell arteritis (GCA), but was found to have calciphylaxis confirmed by histologic examination. When calciphylaxis affects the blood supply to the eye, commonly it causes sudden vision loss, pallid optic disk edema, and a relative afferent pupillary defect, all of which were observed in our patient. Conclusion: There is no known cure for calciphylaxis, while in GCA, high-dose corticosteroid therapy is essential to prevent involvement of the contralateral eye. As the management approaches for these two diseases are different, it is important to have performed a thorough clinical examination along with detailed histopathological testing to rule out calciphylaxis of the temporal artery in patients suspected to have GCA. [ABSTRACT FROM AUTHOR]

This study examined the extent and nature of parental involvement in the education of students with visual impairment in the city of Woldia, Ethiopia, as well as the associated challenges these parents face. A qualitative approach was employed, utilising a case‐study design. A purposive sample of 14 participants, consisting of parents of students with visual impairment, was selected for in‐depth interviews and focus group discussions. The collected data underwent thematic analysis to identify key themes and patterns. The results indicate that parents of children with visual impairment actively engage in their child's education by providing materials, creating supportive environments and maintaining communication with schools. Challenges to parental involvement included poor communication with schools, a lack of involvement in at‐home learning, limited participation in volunteer activities and minimal involvement in decision‐making. These challenges were influenced by factors such as time constraints, false beliefs, scant knowledge of Braille‐related activities and negative attitudes towards parental involvement. Additionally, the study revealed a lack of collaboration between parents and communities in the education of children with visual impairment. These challenges need addressing and parental involvement in the education of these students should be enhanced. Improving communication, providing support and resources, fostering inclusivity, and promoting collaboration among parents, teachers, schools and the community are key to improving educational outcomes and societal inclusion for students with visual impairment. [ABSTRACT FROM AUTHOR]

Background: Apart from the conventional utilization of ICL implantation for the correction of refractive errors, its recent applications extend to correcting refractive errors post laser refractive surgery. Notably, the development of cataracts stands out as a prevalent postoperative complication, often associated with low vault. Previous cases have demonstrated successful management of cataracts with ICL through the combination of FLACS and ICL removal coupled with IOL implantation, resulting in favorable postoperative visual outcomes. Herein, we present a case of cataract with low vault ICL following LASIK and its subsequent management. Case presentation: A 46-year-old male presented with vision loss in the right eye for 9 months, and he had undergone LASIK 22 years prior and had ICL implantation in both eyes 2 years ago to correct refractive error. One day after ICL implantation, both eyes exhibited the UDVA of 1.2 and 1.0, well-positioned ICLs, and approximate vault of 150 μm and 200 μm. Six months ago, the patient became aware of blurred vision in the right eye for a duration of 3 months. Examination revealed cloudy lens cortex in the right eye. During the current review, the UDVA of the right eye was 0.6, where nasal wedge-shaped clouding was evident and worsened, while the left eye lens remained transparent. AS-OCT demonstrated the vault of 54 μm in the right eye and 83 μm in the left eye. Considering the patient's history of LASIK and the presence of right eye cataract, a monovision approach was adopted. The patient underwent FLACS combined with ICL extraction and monofocal IOL lens implantation in the right eye. At 10 days postoperatively, the patient exhibited the UDVA of 1.0. Conclusions: Our report confirms the feasibility of FLACS in managing cataracts in patients with low vault ICL following LASIK. This procedure does not pose significantly greater challenges than in typical cataract cases, although meticulous care remains essential throughout every step of the surgery, particularly during laser scanning and positioning. With adequate preoperative preparation and precise calculation of the IOL power, surgical outcomes can meet expectations fully. [ABSTRACT FROM AUTHOR]

Introduction: Cataract is a leading cause of visual impairment and blindness, mainly affecting older adults in sub-Saharan Africa (SSA). This scoping review aims to map evidence on the prevalence, contextual factors, and management strategies for cataracts among older adults in SSA. Method: Four central databases (PubMed, Scopus, Medline, and Google Scholar) were searched, yielding 383 records. Additional searches produced eight records. After screening and applying inclusion criteria, 26 full-text articles were eligible for further review. Finally, seven full-text records were included in the thematic analysis and synthesis. Results: Cataract prevalence among older adults in SSA ranged from 13.5–62.5% across different countries. Surgery remains the primary management strategy, but cataract surgical coverage varies widely (12.1–96%). Significant barriers to effective management include lack of awareness, limited access to healthcare, economic constraints, gender disparities, and cultural misconceptions about cataract surgery. Conclusion: There is a significant burden of cataracts among older adults in SSA, with considerable variations in prevalence and surgical coverage across the region. Comprehensive strategies addressing awareness, accessibility, affordability, and cultural factors are needed to improve cataract management and reduce visual impairment in SSA. [ABSTRACT FROM AUTHOR]

Introduction: Reduction in visual acuity and glare are common indications for cataract surgery in patients with strabismus. The amblyopic eye is particularly sensitive to blur, despite reduced visual acuity and contrast sensitivity. However, the impact of cataracts on visual functions in strabismus patients is not well documented. Aim: To evaluate the Vision-related Quality of Life (VRQoL) after cataract surgery in strabismus patients. Materials and Methods: The present quasi-experimental study was conducted in the Department of Ophthalmology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India, from August 2023 to September 2023. Study included 44 strabismus patients, which was assessed by Hirschberg and alternate cover tests. All patients underwent unilateral manual small incision cataract surgery on the worse eye. VRQoL was assessed using the Indian Vision-related Quality of Life Functioning Questionnaire-33 (IND-VFQ-33) questionnaire preoperatively and postoperatively. Statistical significance was determined using paired t-tests (p-value<0.05). Results: In the present study, the mean±Standard Deviation (SD) age of patients was 64.34±8.09 years (range: 42-79 years), with a predominance of females, 29 (66%). All patients underwent unilateral manual small incision cataract surgery on their worse eye. The degree of strabismus among the patients varied: 27 (61.36%) exhibited a 15° deviation, 12 (27.27%) had a 30° deviation and 5 (11.36%) exhibited a 45° deviation. A total of 41 (93.1%) patients presented with exotropia, while 3 (6.9%) exhibited esotropia. The results demonstrated significant improvements in Corrected Distance Visual Acuity (CDVA) from the preoperative to postoperative period. The IND-VFQ-33 questionnaire revealed substantial reductions in scores for general functioning, mobility, activity limitation, psychosocial impact and visual symptoms across the entire study population and in all strabismus groups (15°, 30° and 45° deviations), with a p-value of <0.05. Overall, 84.09% of patients had no to mild visual impairment postoperatively, with 27 (100%) patients with 15° strabismus, 7 (58.3%) patients with 30° strabismus, and 3 (60%) patients with 45° strabismus reporting no to mild visual impairment. 3 (25%) patients with 30° strabismus and 1 (20%) patient with 45° strabismus had moderate vision impairment postoperatively. Two (16.66%) patients with 30° strabismus and one patient with 45° strabismus had severe vision impairment postoperatively. Conclusion: A significant proportion of strabismus patients with cataracts were elderly, predominantly females. Exotropia and 15° strabismus were the most common findings. Cataract surgery significantly improved VRQoL, with the most substantial benefits observed in patients with a 15° deviation and the least in those with a 45° deviation. [ABSTRACT FROM AUTHOR]

Currently, all eligible goalball players compete together irrespective of their level of vision impairment, yet it remains unclear whether those with more impairment are disadvantaged during competition. Following the International Paralympic Committee's requirement for evidence-based, sport-specific classification, this study assessed whether individual goalball performance relates to the level of visual impairment. Using results from the 2016 and 2020 Paralympic Games, players' sport classes and in-competition key performance statistics (minutes played, throws per minute, goals per minute, penalties conceded per minute, blocks per minute, and goals per throw) were extracted. Players' visual acuity and visual field results were obtained through the IBSA Sport Administration System. Results showed no statistically significant differences in performance between classes. Further, there were no significant relationships between vision and performance for all six variables for female players. A small but significant positive correlation was found between visual acuity and the number of penalties conceded for male players. Collectively, the results suggest that currently eligible players compete fairly against one another during competitive goalball matches. Results provide support for the existing system of classification whereby all eligible athletes compete against each other irrespective of their level of impairment. [ABSTRACT FROM AUTHOR]

With an ongoing focus on accessibility and usability, many academic libraries have developed new ways to improve services for students with disabilities. Library technical services departments contribute to the accessibility of library resources through materials selection, cataloging, and the acquisition of assistive technologies. Library partnerships with an institution’s office of disability services have also proven particularly effective and can help libraries to better identify potential barriers to accessibility and find workable solutions. For students with visual impairments, screen readers, magnifiers, voice recognition software, and braille texts are some of the methods that libraries can use to improve accessibility. This paper offers a case study of the collaboration between the Office of Disability Resources for Students and the University Libraries at the University of Memphis to make a discrete collection of braille textbooks more widely available to students, including the collection management considerations, system configurations, and cataloging procedures that went into the process. This case study provides a simple and cost-efficient example of how libraries can improve services for users with visual impairments that readers will find easy to implement in their own libraries. [ABSTRACT FROM AUTHOR]

Although numerous studies exist on the sibling relationships of children with disabilities, much less research has examined the sibling relationships of children with visual impairments. Considering the contributions of siblings to each other in terms of personality development and social functioning, the impact of visual impairments on the quality and dynamics of sibling relationships needs to be studied. We therefore investigated the sibling relationships of children with visual impairments. We performed a case study by conducting semi-structured interviews with a total of 24 participants including siblings with visual impairments, sighted sibling(s), and their parents from six families. Inductive thematic analysis was conducted for data analysis. Four superordinate themes emerged from the interviews: diverse aspects of the relationship, differing roles, mutual support, and transformative experiences. The results reveal that although the dynamics of the relationships between children with visual impairments and their siblings were similar to those of sibling relationships of typical dyads, visual impairments disturbed the natural flow of the relationship between siblings. The sibling relationships were mostly guided by feelings, and sighted siblings were a powerful source of support. Sibling dyads had a limited social life and their shared activities and times were mostly home-based. Within the context of sibling relationships of children with visual impairments, the relationships were characterized by challenges, differing roles, and positive aspects. Family members of children with visual impairments perceived the sibling relationships on a spectrum including non-disability experiences at one end and the challenge to manage typical relationships at the other end. For future directions, longitudinal research may be conducted to examine the development of sibling relationships across life, while practitioners can provide support to sibling dyads about how to spend time together and manage their relationship more effectively. Highlights: Sibling relationships of children with visual impairments were characterized by challenges, differing roles, and positive aspects. The sibling relationship was mostly guided by feelings, and sighted siblings were a powerful source of support. Sibling dyads had a limited social life and their shared activities and times were mostly home-based. Sighted siblings' excessive caregiving and assumption of parent-like duties derived from sibling-focused parentification. The use of a multi-respondent approach provided a more comprehensive insight into the sibling relationship of children with visual impairments. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) is a retinal condition that occurs due to diabetes mellitus and might lead to blindness. Early identification and treatment are crucial to slow down or prevent vision loss and degeneration. However, categorizing DR into several levels of severity remains a challenging problem due to the complexity of the disease. The Diabetic Retinopathy Grading System divides retinal pictures into five severity categories: No DR, Mild Non-Proliferative Diabetic Retinopathy (NPDR), Moderate NPDR, Severe NPDR, and Proliferative Diabetic Retinopathy. In this study, three deep learning models, namely ResNet50, Densenet201, and InceptionV3, were utilized for the classification of the APTOS 2019 diabetic retinopathy image dataset. For the individual experiments of the models, transfer learning with fine-tuning and layer freezing was applied. Additionally, a decision-level fusion idea using soft voting was implemented across the three pre-trained models. The maximum accuracy achieved for the classification of the original imbalanced dataset was 85% with the fusion idea. To further improve the classification performance, a balancing technique based on oversampling with augmentation operations was applied to the original APTOS 2019 dataset. The proposed approach, which involves the idea of soft voting-based fusion across models along with data balancing, improved the classification performance and achieved an accuracy of 90%. [ABSTRACT FROM AUTHOR]

Purpose: To assess spatial contrast sensitivity (CS) in suspected primary open-angle glaucoma (POAG) patients. Methods: CS was measured using sinusoidal gratings of 4 cycles/degree. First, foveal and peripheral CS were assessed in 34 suspected POAG patients and compared with 71 and 28 age-matched healthy individuals for foveal and peripheral conditions, respectively. Second, foveal CS was assessed in 34 early POAG patients age-matched with suspected POAG patients. Analyses were performed considering two age ranges: Under and Over 50 y.o. Correlations were evaluated between CS and clinical parameters. Diagnostic accuracy was also analyzed. Results: Peripheral CS was lower in older suspected POAG patients (23.4 ± 16.1) than the control group (39.1 ± 28.2) (p = 0.040). Foveal CS was reduced in suspected POAG participants (Under 50: 146.8 ± 63.3; p = 0.004. Over 50: 110.5 ± 65.0; p = 0.044) and in early POAG patients (Under 50: 141.2 ± 72.6; p = 0.002. Over 50: 80.2 ± 54.5 p < 0.001), both compared to the control group (Under 50: 213.5 ± 66.2. Over 50: 138.6 ± 71.7). CS was lower in early POAG than in POAG suspected in older patients (p = 0.042). Foveal CS was correlated with age (Early: p = 0.001. Suspect: p = 0.002) and with the cup–disc ratio only in early POAG patients (p < 0.001). Foveal CS had fair (AUC = 0.74) diagnostic accuracy for early POAG patients. Conclusions: CS in suspected POAG patients is lower than in healthy individuals. Our findings evidence the spatial vision loss before the onset of POAG. [ABSTRACT FROM AUTHOR]

Background: Diabetic macular edema (DME) causes vision impairment and significant vision loss. Portable optical coherence tomography (OCT) has the potential to enhance the accessibility and frequency of DME screening, facilitating early diagnosis and continuous monitoring. This study aimed to evaluate the reliability of a portable OCT device (ACT100) in assessing DME compared with a traditional stationary OCT device (Cirrus 5000 HD-OCT plus). Methods: This prospective clinical investigation included 40 eyes of 33 patients with DME. Participants with significant refractive errors (myopia > −6.0 diopters or hyperopia > +3.0 diopters), vitreous hemorrhage, tractional retinal detachment, or other ocular diseases affecting imaging were excluded. Spectral-domain OCT was performed by a single examiner using both devices to capture macular volume scans under mydriasis. Central macular thickness (CMT) was evaluated using the analysis software for each device: Cirrus used version 6.0.4, and ACT100 used version V20. We analyzed inter-evaluator and inter-instrument agreements for qualitative assessments of the intraretinal fluid (IRF), subretinal fluid (SRF), and epiretinal membrane (ERM) using Cohen's kappa coefficient, whereas quantitative CMT assessments were correlated using Spearman's correlation coefficient. Results: Substantial inter-evaluator agreement for IRF/SRF (κ = 0.801) and ERM (κ = 0.688) with ACT100 and inter-instrument agreement (κ = 0.756 for IRF/SRF, κ = 0.684 for ERM) were observed. CMT values measured using ACT100 were on average 29.6 μm lower than that of Cirrus (285.8 ± 56.6 vs. 315.4 ± 84.7 μm, p < 0.0001) but showed a strong correlation (R = 0.76, p < 0.0001). Conclusions: ACT100 portable OCT demonstrated high reliability for DME evaluations, comparable to that of stationary systems. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the relationship between the plant-based dietary index and vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) among Chinese aged 65 and older. Methods: Based on the 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a cross-sectional study was conducted on 14,859 samples. The assessment of dietary quality utilized the plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Logistic regression analysis was used to examine the associations between PDIs and sensory impairments. Additionally, restricted cubic spline analysis was utilized to investigate the nonlinear association between PDIs and sensory impairments. Results: Participants in the highest quintile of PDI exhibited reduced prevalence of VI (OR 0.78, 95% CI: 0.67–0.90, ptrend <0.001), HI (OR 0.83, 95% CI: 0.70–0.99, ptrend <0.001), and DSI (OR 0.62, 95% CI: 0.51–0.77, ptrend <0.001) relative to those in the lowest quintile. Moreover, individuals who ranked in the highest quintile for hPDI exhibited a 25% reduced risk of VI disease. Conversely, those in the highest quintile of uPDI were associated with increased prevalence of VI (OR 1.37, 95% CI: 1.17–1.61, ptrend <0.001), HI (OR 1.36, 95% CI: 1.12–1.65, ptrend <0.001), and DSI (OR 1.56, 95% CI: 1.25–1.95, ptrend <0.001). The relationship between PDIs increasing by every 10 units and sensory impairments showed similar patterns. Notably, hPDI demonstrated a nonlinear relationship with HI (pfor nonlinearity = 0.001), while the others exhibited linear associations. Conclusion: The increase in PDI and hPDI correlates with a reduced prevalence of one or more sensory impairments. Conversely, an increase in uPDI is associated with an elevated prevalence of multiple sensory impairments. Our study findings emphasize the significance of plant-based food quality, advocating for adherence to a plant-based dietary pattern while reducing the intake of less healthy plant foods and animal-based products. [ABSTRACT FROM AUTHOR]

Key Clinical Message: The discovery of compound heterozygous NMNAT1 mutations (c.245T>C; p.Val82Ala and c.575A>G; p.Asp192Gly) provides a genetic explanation for Leber congenital amaurosis 9 in an Iranian patient. The proband's symptoms—including severe visual impairment, nystagmus, night blindness, and retinal degeneration—align with Leber congenital amaurosis 9 clinical features. This case underscores the value of exome‐sequencing in diagnosing rare genetic disorders and highlights its role in guiding personalized genetic counseling and potential treatments. Leber congenital amaurosis is a severe early‐onset inherited retinal dystrophy. This study delves into the genetic basis of Leber congenital amaurosis, pinpointing compound heterozygous mutations in the NMNAT1 gene as significant causative factors. While one mutation validates previous findings (c.245T>C; p.Val82Ala), the second (c.575A>G; p.Asp192Gly) proves novel, expanding the genetic landscape of Leber congenital amaurosis 9. Both mutations, inherited independently from nonconsanguineous parents, contribute to the intricate genetic basis of light on Leber congenital amaurosis 9 in this case. The identified mutations shed light on Leber congenital amaurosis genetics in the Iranian population, showcasing the efficacy of exome‐sequencing for molecular diagnoses in hereditary retinal degeneration. These findings provide valuable insights for tailored genetic counseling and potential therapeutic interventions. [ABSTRACT FROM AUTHOR]

Objective: The incidence of work-related falls on the same level is increasing, particularly among middle-aged and older female workers. Vision is an important risk factor of falls. We investigated whether objectively measured visual acuity was associated with the incidence of falls. Methods: This cohort study included 7317 female employees aged 20-69 in Japanese supermarket stores. Monocular acuity measured during health checkups was classified into three levels (=0.7, 0.3-0.7, <0.3). Incidence rate ratios of work-related falls within 1 year were estimated. Results: Incidence rate ratios were 1.26 (95%CI: 0.92-1.72) in the 0.3-0.7 group and 2.27 (95%CI: 1.15-4.48) in the <0.3 group. Conclusions: Risk of work-related fall was higher in those with low visual acuity. Vision correction may contribute to fall prevention in workplaces. [ABSTRACT FROM AUTHOR]

Background Chemical eye injuries are a critical ophthalmic emergency requiring urgent treatment. This study aims to examine the demographic and clinical profile and evaluate the visual outcomes of patients with ocular chemical injuries in a rural medical setting. Methods A hospital-based cross-sectional observational study was conducted at a tertiary rural medical hospital from June 2022 to May 2023. The study included 24 patients with chemical ocular injuries. Data were collected on demographics, clinical presentation, type of chemical involved, and visual outcomes. Injuries were classified using the Roper-Hall classification system. Statistical analysis was performed using SPSS 17.0. Results Of the 24 patients, 71% were males, with a mean age of 40.29 years. The majority of injuries were unilateral (71%) and occurred at home (41.66%) and construction sites (33.33%). Alkali injuries were the most common (58.33%), followed by acid injuries (33.33%). According to the Roper-Hall classification, 50% of injuries were Grade I, 38% were Grade II, 8% were Grade III, and 4% were Grade IV. At presentation, 29% of patients had mild or no visual impairment, 54% had moderate impairment, 13% had severe impairment, and 4% were blind. Post-treatment, 88% of patients achieved mild or no impairment, 8% had moderate impairment, 4% had severe impairment, and none remained blind. Conclusion Chemical ocular injuries pose a major risk of visual impairment, particularly in occupational settings. Early intervention and preventive measures are crucial for improving visual outcomes and reducing the incidence of these injuries. Public health initiatives focusing on safety protocols and awareness campaigns are essential to mitigate the risks associated with chemical eye injuries. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the predictors of employment and earnings for college graduates with visual impairments, with an emphasis on the impact of college degree major on these outcomes. We utilized American Community Survey data to conduct a multinomial logistic regression analysis predicting employment (full-time/full-year versus less than full-time/full-year and not working) and a multiple regression analysis predicting annual earnings. Our predictor variables included demographic factors previously related to employment outcomes plus 25 college degree majors. Degree majors explained little variance in employment and earnings, although several specific majors were associated with these outcomes. Five majors predicted both: Computer Science, Electrical Engineering, Nursing, Accounting, and Finance. Age, gender, race, receipt of Social Security benefits, additional disabilities, having an advanced degree, and class of worker (earnings model only) were stronger predictors of employment outcomes than degree major. Degree majors that had significant relationships with earnings and employment in our study generally coincide with those for the general population. Vocational rehabilitation counselors should inform their consumers with visual impairments who are pursuing a college degree of differences in earnings and employment rates based on degree major. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 23-year-old male with juvenile parkinsonism and cognitive impairment due to compound heterozygous variants in the BTD gene, leading to biotinidase deficiency. The patient showed symptoms of stiffness, tremors, delayed development milestones, and cognitive impairments. Treatment with biotin supplementation and dopaminergic therapy showed improvement in motor symptoms but not in cognitive functions. The study highlights the importance of considering biotinidase deficiency in cases of juvenile parkinsonism, especially when accompanied by developmental delays, cognitive impairments, and specific MRI findings. [Extracted from the article]

Visual impairment affects 55%–80% of medial sphenoid wing meningiomas (mSWMs) patients, making optic nerve decompression a critical surgical goal. Complete resection often leads to better visual outcomes. However, involvement of critical neurovascular structures increases postoperative morbidity and mortality, with vascular injury reported in 18%–20% of cases. This study aims to evaluate the relationship between the extent of resection (EOR), visual outcomes, and the incidence of vascular injury, seeking to identify the optimal surgical approach for mSWMs. We retrospectively analyzed data from patients undergoing surgery for mSWM at our tertiary care center from January 2001 to December 2021. Inclusion criteria included histopathologically confirmed globoid mSWMs (N = 89). Patients with recurrent tumors (n = 14) or lost to follow-up (n = 9) were excluded. We classified patients into 2 groups based on EOR using Simpson's grade: Group 1 (good-resection,Simpson Grade-I/II,n = 51) and Group 2 (poor-resection,Simpson Grade III/IV, n = 15). Among 66 (=N) patients, visual impairment was the most common symptom (81.8%), followed by headaches (77.3%) and seizures (27%). T2-hyperintensity on magnetic resonance imaging [(OR:5.4, 95%CI:1.5–18.6) (P -value<0.01)] and cavernous sinus-extension [(OR:3.9, 95%CI:1.1–13.1) (p-value-0.02)] were independent significant predictors of poor resection. Visual status was preserved in 90.3% of Group-1 and 86.6% of Group-2, with no significant difference based on EOR. Vascular involvement was noted in 87.9%, higher than the vessel encasement (>1800) (57.6%, P = 0.04). Vessel injury occurred in 7.8% of Group-1 and 6.6% of Group-2, with no significant impact on EOR. Cavernous sinus-extension and T2-hyperintensity predict poor resection rates in mSWMs. While visual outcomes are not directly affected by EOR, long-term visual status may decline due to tumor recurrence and radiotherapy. Vascular injury incidence is not associated with EOR. Thus, the "maximal safe resection" of mSWMs involves a surgical strategy balancing targeted aggressive and conservative resection for maximal cytoreduction and functional preservation. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study investigated the frequency and timing of optic neuritis (ON) episodes in relation to the onset of multiple sclerosis (MS) and examined the occurrence of Uhthoff's phenomenon and Lhermitte's sign to understand their roles in early diagnosis and disease progression. Methods: A longitudinal study was conducted with 127 MS patients. Clinical data, including ophthalmological examinations for ON, were collected and questionnaires assessed the presence of Uhthoff's phenomenon and Lhermitte's sign. Results: Results showed that 37% of patients experienced demyelinating retrobulbar ON, with 25.53% having ON as the initial symptom of MS. Residual visual acuity impairment (below 20/40) and dyschromatopsia were reported by 25.53% and 17.02% of patients, respectively. Uhthoff's phenomenon and Lhermitte's sign were present in 26.77% and 36.22% of patients, respectively. The findings underscore the importance of early ophthalmological assessments in diagnosing MS, as ON can be an initial indicator of the disease. Conclusions: The study highlights the need for precise diagnostic tools and personalized therapeutic strategies focused on specific biomarkers and pathways involved in neuroinflammation and demyelination. Early diagnosis through vigilant ophthalmologic evaluation can lead to interventions that significantly alter disease progression, improving patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Ocular and periocular tattoos, involving ink application to the eyeball or surrounding skin, have gained popularity as forms of self-expression. However, this trend raises significant concerns about potential complications that can adversely affect ocular health and esthetics. Awareness of these risks is crucial for both patients and practitioners. Methods: A comprehensive literature review was conducted, focusing on studies discussing complications related to ocular and periocular tattooing. Relevant studies were identified through the MEDLINE, PubMed, and Ovid databases. The reviewed papers were evaluated based on study design, including blinding, sample size, control use, randomization, and objective endpoints, and classified according to the Oxford Center for Evidence-Based Medicine evidence hierarchy. Results: The review identified a wide range of complications, including immediate issues like bleeding, infections (conjunctivitis, endophthalmitis), and allergic reactions. Delayed reactions included granuloma formation, often requiring further treatment. The most serious risk identified was potential visual impairment due to improper technique or ink placement. Conclusions: With the growing trend in ocular and periocular tattooing, there is an urgent need for increased awareness of associated risks. It is crucial to ensure that only qualified professionals perform these procedures, emphasizing the importance of understanding ocular anatomy. Developing strict regulatory guidelines and prioritizing research on the long-term effects of these tattoos are essential for patient safety. A collaborative approach among healthcare providers, regulatory bodies, and educational institutions is needed to mitigate risks and promote best practices in cosmetic tattooing. [ABSTRACT FROM AUTHOR]

The research investigated the obstacles faced by undergraduates with visual impairments while studying at a Nigerian university striving to establish an inclusive learning environment for students with disabilities. The aim was to generate empirical evidence that can inform policies at the university and other similar institutions. The research is anchored in Bronfenbrenner's ecological systems theory, and a qualitative descriptive research design was employed. Using purposive sampling, 11 (male = 7; female = 4) undergraduate students living with blindness were recruited. Data were collected using semi‐structured interviews and subjected to inductive data analysis. It was found that students encounter various challenges, emanating from peers, lecturers, the university and their families. The results demonstrate how different contexts influence the learning outcomes of students with visual impairments, warranting more comprehensive intervention programmes. [ABSTRACT FROM AUTHOR]

Purpose: Bilateral pediatric cataract (BPC) is one of the most common causes of childhood visual impairment and blindness worldwide. A significant percentage of pediatric cataracts are caused by genetic alterations. We aim to characterize the set of genes and variants that cause BPC in the Israeli and Palestinian populations and to assess genotype-phenotype correlation. Methods: Retrospective study in a multidisciplinary center for visual impairment, located in a tertiary medical center. Medical charts of families who underwent genetic counseling because of BPC in a family member were reviewed. Clinical characteristics and genetic tests results were obtained from medical records of affected subjects. Results: Twenty-two families (47 patients) underwent genetic counseling and completed genetic testing. Causative variants were identified in 18/22 (81.8%) of the families, including 3 novel variants. Genetic testing used included mainly panel for congenital cataracts and whole exome sequencing. Eleven families performed genetic testing with the intention of future pregnancy planning. Main causative genes identified were crystalline genes followed by transcription factor genes. BCOR gene variants were associated with persistent fetal vasculature (PFV) cataract in two of three families. Conclusions: Combined molecular techniques are useful in identifying variants causing pediatric cataracts and showed a high detection rate in our population. BCOR gene variants might be associated with PFV type of cataracts. The study of pathogenic variants may aid in family planning and prevention of pediatric cataracts in future pregnancies. Additionally, in certain cases, it assists in diagnosing non-suspected syndromic types of pediatric cataracts. Key message: What is known • Bilateral pediatric cataracts are often inherited. • Detection rate of causative variants is high. • Correlation between genes and phenotype is still scarce. What is new • First evidence of possible correlation between BCOR gene and persistent fetal vasculature cataract. • Additional data supporting recently published relationship between GJA3 gene variant (c.199G > T) and glaucoma. • Importance of genetic testing in diagnosing "non-suspected syndromic types of pediatric cataracts". • Three novel causative variants identified. [ABSTRACT FROM AUTHOR]