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To investigate demographic and clinical factors influencing the longitudinal changes of retinal pigment epithelium (RPE) dehiscence area after RPE tears, including the presence of RPE tear-associated repair proliferation (TARP), and identify factors associated with TARP development over follow-up.Retrospective, single-center, observational cohort study of patients with a history of macular neovascularization and RPE tear. The area of RPE dehiscence was measured on repeated short-wavelength fundus autofluorescence imaging. Associations between covariates and RPE dehiscence areas were tested with multivariable linear mixed models. Associations between TARP development and clinical variables were investigated with Cox regression models. Factors associated with visual acuity changing rates were explored with linear mixed models.Thirty-seven eyes of 36 patients were included in this study and followed for a median time of 18 months. Tear-associated repair proliferation was identified in 27 eyes (73%). The median time for TARP detection was 112 days; none of the investigated factors was significantly associated with TARP occurrence. The presence of TARP (estimate: -0.042 mm2/month; P = 0.001) and female gender (estimate: -0.035 mm2/month; P = 0.006) were associated with slower rates of RPE dehiscence enlargement over time. Faster rates of visual improvement were observed in eyes with TARP compared with those without TARP (estimate = -0.010 logarithm of the minimum angle of resolution/month if TARP was present; P = 0.008).Retinal pigment epithelium tear repair with TARP and female gender were associated with slower RPE degeneration after RPE tears. The presence of TARP was associated better visual prognosis. Additional research on factors promoting TARP development may have therapeutic and prognostic implications.

Purpose This study aims to evaluate whether the use of citicoline oral solution could improve quality of life in patients with chronic open-angle glaucoma (OAG). Design Randomized, double-masked, placebo-controlled, cross-over study was used. Patients were randomized to one of the two sequences: either citicoline 500 mg/day oral solution-placebo or placebo-citicoline 500 mg/day oral solution. Switch of treatments was done after 3 months; patients were then followed for other 6 months. Follow-up included 3-month, 6-month, and 9-month visits. Outcomes The primary outcome was the mean change of “intra-patient” composite score of the Visual Function Questionnaire-25 (VFQ-25). after citicoline oral solution vs placebo at 6-month visit as compared with baseline. Methods The trial was multicenter, conducted at 5 European Eye Clinics. OAG patients with bilateral visual field damage, a mean deviation (MD) ranging from − 5 to − 13 dB in the better eye, and controlled IOP were included. VFQ-25 and SF-36 questionnaires were administered at baseline and at 3-, 6-, and 9-month visits. A mixed effect model, with a random effect on the intercept, accounted for correlations among serial measurements on each subject. Results The primary pre-specified outcome of the analysis reached statistical significance (p = 0.0413), showing greater improvement after citicoline oral solution. There was an increase in the composite score in both arms compared to baseline, but it was significant only for the placebo-citicoline arm (p = 0.0096, p = 0.0007, and p = 0.0006 for the three time-points compared to baseline). The effect of citicoline was stronger in patients with vision-related quality of life more affected by glaucoma at baseline. Conclusions This is the first placebo-controlled clinical study evaluating the effect of a medical treatment aiming at improving vision-related quality of life in glaucomatous patients.

Introdução: Problemas associados ao uso de medicamentos são frequentes, ocasionando impacto na Saúde. Prevenir e minimizar requer ações no processo da farmacoterapia para redução de erros de medicação. No entanto, há necessidade de mudanças da prática profissional. Objetivo: Conhecer o processo de transformação do profissional e a implementação das atividades clínicas. Métodos: Estudos sobre os serviços farmacêuticos clínicos no Brasil nos últimos anos. Resultados: Atividades de farmácia clínica no Brasil ocorrem de forma desigual nas regiões. Ressalta-se a importância do registro das atividades que sistematiza o acompanhamento da terapia medicamentosa e possibilita avaliar necessidade, segurança e efetividade da utilização de medicamentos, proporcionando resultados favoráveis. No entanto, as dificuldades na implementação dos serviços clínicos comprometem o desempenho do farmacêutico. Conclusão: importância do farmacêutico nos Serviços de Farmácia Clínica, de forma a promover o acesso e uso racional de medicamentos e prevenção de eventos adversos, com melhoria da qualidade de vida.

Objectives This study quantifies the effect of trabeculectomy on the rate of progression (RoP) of visual field (VF) damage utilising pre- and post-operative visual function as the outcome instead of surrogate outcomes of success. Methods Clinical and VF data from 199 sequential patients who underwent trabeculectomy between 2015 and 2016 were extracted from the network of sites of Moorfields Eye Hospital NHS Foundation Trust. Of these, we analysed 80 eyes of 74 patients who met our inclusion criteria of at least three reliable VFs before and after surgery (false positive rate Results We analysed 10 [9,12] VFs per subject (Median [Interquartile Range]). At surgery, the age was 67 [57, 72] years, mean deviation was −10.84 [−14.7, −5.6] dB and the IOP was 18 [15, 20] mmHg. One year after surgery, the IOP was 10 [8,13] mmHg (p = 0.002). Mean RoP before surgery was −0.94 [−1.20, −0.69] dB/year (Mean [95% credible intervals]) and it was slowed down by 0.62 [0.26, 0.97] dB/year (p Conclusions Trabeculectomy leads to a significant reduction in the RoP of VF loss postoperatively.

Purpose\ud To assess differences in rod-mediated dark adaptation (RMDA) between different grades of age-related macular degeneration (AMD) severity using an Optical Coherence Tomography (OCT)-based criterion compared to the Beckman Colour Fundus Photography-based (CFP) classification. To assess association between subretinal drusenoid deposit (SDD) presence and RMDA at different AMD severity grades, using an OCT-based classification.\ud \ud Design\ud Cross-sectional study\ud \ud Participants\ud Participants from the Northern Ireland Sensory Aging study (NISA; Queen's University Belfast).\ud \ud Methods\ud Complete RMDA (rod-intercept time [RIT; AdaptDx; Maculogix, USA]) data, CFP (Canon CX-1 Digital Fundus Camera; Canon, USA) and spectral domain OCT (Heidelberg Spectralis SD-OCT; Heidelberg Engineering, Germany) images were extracted. Participants were stratified into four Beckman groups (omitting late-stage AMD) and three OCT-based groups. OCT grading included: participants with no drusen/retinal pigment epithelium (RPE) abnormalities (OCT0), participants with drusen present but no RPE abnormalities (OCT1) and participants with drusen and RPE abnormalities present (OCT2). SDD presence and stage was identified via OCT.\ud \ud Main Outcome Measure\ud RIT data (age-corrected) assessed across AMD severity groups\ud \ud Results\ud Data from the eye with the worse visual acuity in 459 participants (median [interquartile range[IQR]) age 65[59,71] years) were stratified by both classifications. SDDs were detected in 109 eyes. Median (IQR) RMDA for Beckman classification (Beckman0-3, with 3 being intermediate AMD[iAMD]) groups were 6.0(4.5,8.7), 6.6(4.7,10.5), 5.7(4.4,7.4) and 13.2(6,21.1)minutes, respectively. OCT classifications OCT0-OCT2 yielded - different median (IQR)values: 5.8(4.5,8.5), 8.4(5.2,13.3) and 11.1(5.3,20.1) minutes, respectively. After correcting for age, eyes in Beckman 3 (iAMD) had statistically significantly worse RMDA compared to other Beckman groups (p=

Purpose\ud To evaluate if an artificial intelligence (AI) model can better select candidates that would demonstrate visual field (VF) progression in order to shorten the duration or the number of patients needed for a clinical trial\ud \ud Design\ud Retrospective cohort study\ud \ud Methods\ud 7,428 eyes of 3,871 patients from the University of Washington Department of Ophthalmology VF Dataset were included. Progression was defined as at least 5 locations with greater than 7 dB of change compared to baseline on two consecutive tests. Progression for all patients, a subgroup of the fastest progressing based on survival curves, and patients selected based on an elastic net Cox regression model were compared. The model was trained on pointwise threshold deviation values of the first VF, age, gender, laterality and the mean total deviation (MD) at baseline.\ud \ud Results\ud 13% of all patients met the criteria for progression at five years. Differences in survival were observed when stratified by MD and age (p < 0.0001). Those at risk of progression included patients 60 to 80 years old with an initial MD < -5.0. This subgroup decreased the sample size required to detect progression compared to the entire cohort. The AI model-selected patients required the lowest number of patients for all effect sizes and trial lengths. For a trial length of 3 years and effect size of 30%, the number of patients required was 1656 [95% confidence interval (CI), 1638–1674], 903 [95% CI, 884–922], and 636 [95% CI, 625–646] for the entire cohort, the subgroup, and the model-selected patients, respectively.\ud \ud Conclusion\ud An AI model can identify high risk patients to substantially reduce the number of patients needed or study duration required to meet clinical trial endpoints.

Purpose: Serum lipids are modifiable, routinely collected blood test features associated with cardiovascular health. We examined the association of commonly collected serum lipid measures (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglycerides) with intraocular pressure (IOP). Design: Cross-sectional study in the UK Biobank and European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohorts. Participants: We included 94 323 participants from the UK Biobank (mean age, 57 years) and 6230 participants from the EPIC-Norfolk (mean age, 68 years) cohorts with data on TC, HDL-C, LDL-C, and triglycerides collected between 2006 and 2009. Methods: Multivariate linear regression adjusting for demographic, lifestyle, anthropometric, medical, and ophthalmic covariables was used to examine the associations of serum lipids with corneal-compensated IOP (IOPcc). Main Outcome Measures: Corneal-compensated IOP. Results: Higher levels of TC, HDL-C, and LDL-C were associated independently with higher IOPcc in both cohorts after adjustment for key demographic, medical, and lifestyle factors. For each 1-standard deviation increase in TC, HDL-C, and LDL-C, IOPcc was higher by 0.09 mmHg (95% confidence interval [CI], 0.06–0.11 mmHg; P < 0.001), 0.11 mmHg (95% CI, 0.08–0.13 mmHg; P < 0.001), and 0.07 mmHg (95% CI, 0.05–0.09 mmHg; P < 0.001), respectively, in the UK Biobank cohort. In the EPIC-Norfolk cohort, each 1-standard deviation increase in TC, HDL-C, and LDL-C was associated with a higher IOPcc by 0.19 mmHg (95% CI, 0.07–0.31 mmHg; P = 0.001), 0.14 mmHg (95% CI, 0.03–0.25 mmHg; P = 0.016), and 0.17 mmHg (95% CI, 0.06–0.29 mmHg; P = 0.003). An inverse association between triglyceride levels and IOP in the UK Biobank (–0.05 mmHg; 95% CI, –0.08 to –0.03; P < 0.001) was not replicated in the EPIC-Norfolk cohort (P = 0.30). Conclusions: Our findings suggest that serum TC, HDL-C, and LDL-C are associated positively with IOP in 2 United Kingdom cohorts and that triglyceride levels may be associated negatively. Future research is required to assess whether these associations are causal in nature.

Spatial summation of perimetric stimuli has been used to derive conclusions about the spatial extent of retinal-cortical convergence, mostly from the size of the critical area of summation (Ricco’s area, RA) and critical number of Retinal Ganglion Cells (RGCs). However, spatial summation is known to change dynamically with stimulus duration. Conversely, temporal summation and critical duration also vary with stimulus size. Such an important and often neglected spatio-temporal interaction has important implications for modelling perimetric sensitivity in healthy observers and for formulating hypotheses for changes measured in disease. In this work, we performed experiments on visually heathy observers confirming the interaction of stimulus size and duration in determining summation responses in photopic conditions. We then propose a simplified computational model that captures these aspects of perimetric sensitivity by modelling thetotal retinal input, the combined effect of stimulus size, duration and retinal cones-to-RGC ratio. We additionally show that, in the macula, the enlargement of RA with eccentricity might not correspond to a constant critical number of RGCs, as often reported, but to a constant criticaltotal retinal input. We finally compare our results with previous literature and show possible implications for modelling disease, especially glaucoma.

PurposeUsing the Idiopathic Intracranial Hypertension Weight Trial (IIH:WT) data, this study aimed to determine if point analysis of the Humphrey visual field (HVF) could be more informative than the perimetric mean deviation (PMD) as an IIH trial outcome measure.MethodsIIH:WT was a randomized controlled trial that recruited 66 people with active IIH (mean ± standard deviation age 32 ± 7.8 years). Event-based analysis using a pointwise analysis of the numerical sensitivity data was performed. The number of participants that would be eligible for analysis was calculated when the data were enriched to reflect a medically treated cohort defined as a PMD between -2dB to -7dB.ResultsThe HVF 24-2 mean ± standard deviation PMD in the worse eye was ™3.5 ± 1.1dB, (range,™2.0 to ™6.4dB), and point sensitivity showed a preference for peripheral and blind spot locations. Those points between 0 and -10dB demonstrated negligible ability to improve compared with those between -10dB and -25dB. In evaluating feasibility for a medical intervention trial, 346 points were available for analysis between -10dB and -25dB bilaterally compared with 4123 in baseline sensitivities of 0 to -10dB.ConclusionsMildly affected baseline sensitivities were unlikely to show considerable change over 24 months. There were fewer points available for analysis and greater variability if moderately affected baseline points were chosen. If point analysis was used as an outcome measure in a medical intervention trial, the majority of points would not demonstrate clinically meaningful change, thus offering little advantage over PMD.

to compare visual field (VF) progression between the 2 arms of the Treatment of Advanced Glaucoma Study (TAGS).Post hoc analysis of VF data from a 2-arm, multicenter, randomized controlled clinical trial.A total of 453 patients with newly diagnosed advanced open-angle glaucoma in at least 1 eye from 27 centers in the United Kingdom were randomized to either trabeculectomy (n = 227) or medication in their index eye (n = 226) and followed-up for 2 years with 2 24-2 VF tests at baseline, 4, 12, and 24 months. Data were analyzed for participants with a reliable VF (false positive rate15%) at baseline and at least 2 other time points. Average difference in rate of progression (RoP) was analyzed using a hierarchical Bayesian model. Time for each eye to progress from baseline beyond specific cut-offs (0.5, 1, 1.5, and 2 dB) was compared using survival analysis.This study analyzed 211 eyes in the trabeculectomy first arm and 203 eyes in the medication first arm. The average RoP (estimate [95% credible intervals]) was -0.59 [-0.88, -0.31] dB/year in the medication first arm and -0.40 [-0.67, -0.13] dB/year in the trabeculectomy first arm. The difference was not significant (Bayesian P-value = .353). More eyes progressed in the medication first arm, but this difference was not significant.There was no significant difference in the average RoP at 2 years.

To objectively grade posterior segment inflammation by measuring vitreous cells and haze on optical coherence tomography (OCT) scans and to compare OCT-based results with clinical grading.Evaluation of a diagnostic test.OCT scans of patients with uveitis were collected at 3 timepoints: with active (T0), clinically improving (T1), and resolved (T2) inflammation. At each visit, visual acuity and clinical grading of the vitreous haze (National Eye Institute [NEI] scale) were assessed. The density of vitreous cells was calculated on each OCT scan manually and automatically through a bespoke algorithm. Vitreous haze was indirectly measured on OCT scans by calculating the vitreous/retinal pigmented epithelium (VIT/RPE)-relative intensity manually and automatically. The variation of OCT-derived measurements over time was assessed. OCT-derived measurements were compared with clinical grading.A total of 222 scans from 74 eyes were analyzed. Both vitreous cell density and VIT/RPE-relative intensity significantly decreased over time. Cell density correlated with the clinical grading with a significant increase at each grade of the NEI scale. By contrast, the VIT/RPE-relative intensity was positively correlated with the clinical grade overall but there was no significant difference when comparing contiguous grades of the NEI scale. Infectious uveitis had a higher cell density. The intraclass correlation coefficient between manual and automatic assessment was 0.83 for cell density and 0.423 for the VIT/RPE-relative intensity.Posterior segment inflammation could be objectively graded through OCT scans. Vitreous cell density was assessed manually and automatically with good agreement and correlated better with NEI clinical grading compared with VIT/RPE-relative intensity.

Purpose: Vitreous haze (VH) is a key marker of inflammation in uveitis but limited by its subjectivity. Optical coherence tomography (OCT) has potential as an objective, noninvasive method for quantifying VH. We test the hypotheses that OCT can reliably quantify VH and the measurement is associated with slit-lamp based grading of VH. \ud \ud Methods: In this prospective study, participants underwent three repeated OCT macular scans to evaluate the within-eye reliability of the OCT vitreous intensity (VI). Association between OCT VI and clinical findings (including VH grade, phakic status, visual acuity [VA], anterior chamber cells, and macular thickness) were assessed. \ud \ud Results: One hundred nineteen participants were included (41 healthy participants, 32 patients with uveitis without VH, and 46 patients with uveitis with VH). Within-eye test reliability of OCT VI was high in healthy eyes and in all grades of VH (intraclass correlation coefficient [ICC] > 0.79). Average OCT VI was significantly different between healthy eyes and uveitic eyes without and uveitic eyes with VH, and was associated with increasing clinical VH grade (P < 0.05). OCT VI was significantly associated with VA, whereas clinical VH grading was not. Cataract was also associated with higher OCT VI (P = 0.03). \ud \ud Conclusions: OCT VI is a fast, noninvasive, objective, and automated method for measuring vitreous inflammation. It is associated with clinician grading of vitreous inflammation and VA, however, it can be affected by media opacities. \ud \ud Translational Relevance: OCT imaging for quantifying vitreous inflammation shows high within-eye repeatability and is associated with clinical grading of vitreous haze. OCT measurements are also associated with visual acuity but may be affected by structures anterior to the acquisition window, such as lens opacity and other anterior segment changes.

OBJECTIVES This study aimed to evaluate the progression of electrophysiotogicat phenomena in a cohort of patients with paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PsAF). BACKGROUND Electrical remodeling has been conjectured to determine atrial fibrillation (AF) progression. METHODS High-density electroanatomic maps during sinus rhythm of 20 patients with AF (10 PAF, 10 PsAF) were compared with 5 healthy control subjects (subjects undergoing ablation of a left-sided accessory pathway). A computational postprocessing of electroanatomic maps was performed to identify specific electrophysiological phenomena: stow conductions corridors, defined as discrete areas of conduction velocity 2.5 1/s. RESULTS A progressive decrease of mean conduction velocity was recorded across the groups (111.6 +/- 55.5 cm/s control subjects, 97.1 +/- 56.3 cm/s PAF, and 84.7 +/- 55.7 cm/s PsAF). The number and density of slow conduction corridors increase in parallel with the progression of AF (8.6 +/- 2.2 control subjects, 13.3 +/- 3.2 PAF, and 20.5 +/- 4.5 PsAF). In PsAF the atrial substrate is characterized by a higher curvature of wave-front propagation (0.86 +/- 0.71 1/s PsAF vs 0.74 +/- 0.63 1/s PAF; P = 0.003) and higher number of pivot points (25.1 +/- 13.8 PsAF vs 9.5 +/- 6.7 PAF; P < 0.0001). Slow conductions: corridors were mostly associated with pivot sites tending to cluster around pulmonary veins antra. CONCLUSIONS The electrical remodeling hinges mainly on corridors of slow conduction and higher curvature of wave-front propagation. Pivot points associated to SC corridors may be the major determinants for functional localized re-entrant circuits creating the substrate for maintenance of AF. (C) 2022 by the American College of Cardiology Foundation.

Purpose: To develop a Bayesian model (BM) for visual field (VF) progression accounting for the hierarchical, censored and heteroskedastic nature of the data. \ud \ud Methods: Three versions of a hierarchical BM were developed: a simple linear (Hi-linear); censored at 0 dB (Hi-censored); heteroskedastic censored (Hi-HSK). For the latter, we modeled the test variability according to VF sensitivity using a large test-retest cohort (1396 VFs, 146 eyes with glaucoma). We analyzed a large cohort of 44,371 VF tests from 3352 eyes from five glaucoma clinics. We quantified the bias in the estimated rate-of-progression, the detection of progression (Hit-rate [HR]), the median time-to-progression and the prediction error of future observations (mean absolute error [MAE]). HR and time-to-progression were compared at matched false-positive-rate (FPR), quantified using permutations of a separate test-retest cohort (360 tests, 30 eyes with glaucoma). BMs were compared to simple linear regression and Permutation-Analyses-of Pointwise-Linear-Regression. Differences in time-to-progression were tested using survival analysis.\ud \ud Results: Censored models showed the smallest bias in the rate-of-progression. The three BMs performed very similarly in terms of HR and time-to-progression and always better than the other methods. The average reduction in time-to-progression was 37% with the BMs (P < 0.001) at 5% FPR. MAE for prediction was very similar among methods.\ud \ud Conclusions: Bayesian hierarchical models improved the detection of VF progression. Accounting for censoring improves the precision of the estimates, but minimal effect is provided by accounting for heteroskedasticity.\ud \ud Translational Relevance: These results are relevant for quantification of VF progression in practice and for clinical trials.

Screening programs may be useful to reduce the rate of undetected glaucoma. Compass (CMP, CenterVue, Padova, Italy) Standard Suprathreshold strategy (SST) analyses the visual function at 52 retinal locations. A new Quick Suprathreshold strategy (QST) reduces the number of tested locations to 24. With both tests, the CMP also provides an image of the central retina and a detail of the optic nerve head. The aim of this paper is to measure the performances of SST and QST compared with clinical diagnosis. 63 consecutive healthy subjects and 60 consecutive patients with perimetric defects from glaucoma in both eyes were recruited. They received one test per eye (SST or QST in randomized order), results were classified into normal, suspect and abnormal according to a global index provided in the report and called SupraThreshold Response (STR). Agreement between clinical diagnosis and test output were calculated, and test time was also measured. The agreement with the clinical diagnosis was 95.7% for SST and 95.1% for QST. When two suspect tests were excluded, agreement for QST increased to 96.7%. Test duration was 164 ± 82 s for SST and 71 ± 41 s for QST (p &lt, 0.0001). Such a difference was similar in both glaucoma patients (respectively 231 ± 65 s vs 105 ± 33 s, p&nbsp, &lt, 0.0001) and normal subjects (98 ± 17 and 39 ± 9 s, p &lt, 0.0001). In conclusion, SST and QST showed similar, high agreement with clinical judgement. Morphological analysis is potentially helpful in further improving the clinical usefulness of suprathreshold tests. QST is characterized by a strong time saving compared with SST.

Glaucoma is a progressive optic neuropathy with characteristic changes to the optic nerve head and the visual field (VF). Detecting progression of VF damage with Standard Automated Perimetry (SAP) is of paramount importance for clinical care. One common approach to detecting progression is to compare each new VF test to a baseline SAP test (event analysis). This comparison is made difficult by the test–retest variability of SAP, which increases with the level of VF damage, and the limited range of measurement, meaning that damage cannot be assessed below a certain level. We performed a prospective international multi-centre data collection of SAP data on 90 eyes from 90 people with glaucoma and different levels of VF damage over a short period of time (6 tests in 60 days). Data were collected using a fundus tracked perimeter (Compass, CenterVue). We used these data (minus the first test) to develop an improved event analysis that accounts for both the change in variability with damage and the lower bound on the measurement imposed by SAP. Using simulations, we show that our approach is more sensitive compared to previously developed methods, especially in the case of advanced glaucoma, while retaining similar specificity.

To develop and validate a deep learning method of predicting visual function from spectral domain optical coherence tomography (SD-OCT)-derived retinal nerve fiber layer thickness (RNFLT) measurements and corresponding SD-OCT images.Development and evaluation of diagnostic technology.Two deep learning ensemble models to predict pointwise VF sensitivity from SD-OCT images (model 1: RNFLT profile only; model 2: RNFLT profile plus SD-OCT image) and 2 reference models were developed. All models were tested in an independent test-retest data set comprising 2181 SD-OCT/VF pairs; the median of ∼10 VFs per eye was taken as the best available estimate (BAE) of the true VF. The performance of single VFs predicting the BAE VF was also evaluated. The training data set comprised 954 eyes of 220 healthy and 332 glaucomatous participants, and the test data set, 144 eyes of 72 glaucomatous participants. The main outcome measures included the pointwise prediction mean error (ME), mean absolute error (MAE), and correlation of predictions with the BAE VF sensitivity.The median mean deviation was -4.17 dB (-14.22 to 0.88). Model 2 had excellent accuracy (ME 0.5 dB, SD 0.8) and overall performance (MAE 2.3 dB, SD 3.1), and significantly (paired t test) outperformed the other methods. For single VFs predicting the BAE VF, the pointwise MAE was 1.5 dB (SD 0.7). The association between SD-OCT and single VF predictions of the BAE pointwise VF sensitivities was ROur method outperformed standard statistical and deep learning approaches. Predictions of BAEs from OCT images approached the accuracy of single real VF estimates of the BAE.

PURPOSE: To develop and validate a deep learning (DL) system for predicting each point on visual fields (VF) from disc and optical coherence tomography (OCT) imaging and derive a structure-function mapping. DESIGN: Retrospective, cross-sectional database study PARTICIPANTS: 6437 patients undergoing routine care for glaucoma in three clinical sites in the UK. METHODS: OCT and infrared reflectance (IR) optic disc imaging was paired with the closest VF within 7 days. Efficient-Net B2 was used to train two single modality DL models to predict each of the 52 sensitivity points on the 24-2 VF pattern. A policy DL model was designed and trained to fuse the two model predictions. MAIN OUTCOME MEASURES: Pointwise Mean Absolute Error (PMAE) RESULTS: A total of 5078 imaging to VF pairs were used as a held-out test set to measure the final performance. The improvement in PMAE with the policy model was 0.485 [0.438, 0.533] dB compared to the IR image of the disc alone and 0.060 [0.047, 0.073] dB compared to the OCT alone. The improvement with the policy fusion model was statistically significant (p < 0.0001). Occlusion masking shows that the DL models learned the correct structure function mapping in a data-driven, feature agnostic fashion. CONCLUSIONS: The multimodal, policy DL model performed the best; it provided explainable maps of its confidence in fusing data from single modalities and provides a pathway for probing the structure-function relationship in glaucoma.

PURPOSE: To evaluate the ability of additional central testing locations to improve detection of macular visual field (VF) defects in glaucoma. \ud \ud DESIGN: Prospective cross-sectional study. \ud \ud PARTICIPANTS: Four hundred forty healthy people and 499 patients with glaucomatous optic neuropathy (GON) were tested with a fundus tracked perimeter (CMP; CenterVue) using a 24-2 grid with 12 additional macular locations (24-2+). \ud \ud METHODS: Glaucomatous optic neuropathy was identified based on expert evaluation of optic nerve head photographs and OCT scans, independently of the VF. We defined macular defects as locations with measurements outside the 5% and 2% normative limits on total deviation (TD) and pattern deviation (PD) maps within the VF central 10°. Classification was based on the total number of affected macular locations (overall detection) or the largest number of affected macular locations connected in a contiguous cluster (cluster detection). Criteria based on the number of locations and cluster size were used to obtain equivalent specificity between the 24-2 grid and the 24-2+ grids, calculated using false detections in the healthy cohort. Partial areas under the receiver operating characteristic curve (pAUCs) were also compared at specificities of 95% or more. \ud \ud MAIN OUTCOME MEASURES: Matched specificity comparison of the ability to detect glaucomatous macular defects between the 24-2 and 24-2+ grids. \ud \ud RESULTS: At matched specificity, cluster detection identified more macular defects with the 24-2+ grid compared with the 24-2 grid. For example, the mean increase in percentage of detection was 8% (95% confidence interval, 5%-11%) and 10% (95% confidence interval [CI], 7%-13%) for 5% TD and PD maps, respectively, and 5% (95% CI, 2%-7%) and 6% (95% CI, 4%-8%) for the 2% TD and PD maps, respectively. Good agreement was found between the 2 grids. The improvement measured by pAUCs was also significant but generally small. The percentage of eyes with macular defects ranged from about 30% to 50%. Test time for the 24-2+ grid was longer (21% increase) for both cohorts. Between 74% and 98% of defects missed by the 24-2 grid had at least 1 location with sensitivity of < 20 dB. \ud \ud CONCLUSIONS: Visual field examinations with additional macular locations can improve the detection of macular defects in GON modestly without loss of specificity when appropriate criteria are selected.

A study of the numerical modeling and prediction of nonlinear unsteady combustion instability within the combustion chamber of a solid rocket motor (SRM) is the main objective. The numerical model consists of a three-dimensional finite-element representation of a cylindrical-grain motor, coupled to a quasi-one-dimensional internal ballistic flow (IBF) model, where a quasi-steady rapid kinetic rate burning rate algorithm is used to model the propellant combustion and regression. Fluid-structure-combustion interaction subroutines are also employed to control the simulated motor firings and the data transferred between the fluid, structure and burning rate model components. Results illustrating the significant effects of structural vibrations on the burning rate and consequently the IBF are shown and compared to experimental data. Modeling considerations are illustrated, giving insight into the physical phenomena of SRM combustion instability.

Glaucoma is a progressive optic neuropathy determining characteristic changes to the optic nerve head and the visual field (VF). Detecting progression of VF damage with Standard Automated Perimetry (SAP) is of paramount importance for clinical care. One common approach to detecting progression is to compare each new VF test to a baseline SAP test (event analysis). This comparison is made difficult by the test-retest variability of SAP, which increases with the level of VF damage, and the lower bounds on the range of measurement, meaning that damage cannot be assessed below a certain level. We performed a prospective international multi-centre data collection of SAP data on 90 eyes from 90 people with glaucoma and different levels of VF damage over a short period of time (6 tests in 60 days). Data were collected using a fundus tracked perimeter (Compass, CenterVue). We used these data (minus the first test) to develop an improved event analysis that accounts for both the change in variability with damage and the lower bound on the measurement imposed by SAP. Using simulations, we show that our approach is more sensitive compared to previously developed methods, especially in the case of advanced glaucoma, while retaining similar specificity.

In age-related macular degeneration (AMD) research, dark adaptation has been found to be a promising functional measurement. In more severe cases of AMD, dark adaptation cannot always be recorded within a maximum allowed time for the test (~ 20–30 min). These data are recorded either as censored data-points (data capped at the maximum test time) or as an estimated recovery time based on the trend observed from the data recorded within the maximum recording time. Therefore, dark adaptation data can have unusual attributes that may not be handled by standard statistical techniques. Here we show time-to-event analysis is a more powerful method for analysis of rod-intercept time data in measuring dark adaptation. For example, at 80% power (at α = 0.05) sample sizes were estimated to be 20 and 61 with uncapped (uncensored) and capped (censored) data using a standard t-test; these values improved to 12 and 38 when using the proposed time-to-event analysis. Our method can accommodate both skewed data and censored data points and offers the advantage of significantly reducing sample sizes when planning studies where this functional test is an outcome measure. The latter is important because designing trials and studies more efficiently equates to newer treatments likely being examined more efficiently.