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Introduction: SMART syndrome is a rare complication of brain radiotherapy. This is the first described presentation of SMART syndrome with metamorphopsia, which responded to aspirin, verapamil, and high-dose L-arginine therapy. Case Presentation: A 43-year-old man presented with 3 weeks of migraine headaches with metamorphopsia and complex visual hallucinations affecting the left lower quadrant of both visual fields. This occurred on a background of high-dose radiotherapy for right cerebellar astrocytoma 32 years ago. MRI brain demonstrated unilateral gyriform enhancement and FLAIR hyperintense cortical swelling in the right occipital lobe consistent with SMART syndrome. Conclusion: Unusual presentations of SMART syndrome exist and require consideration in all patients with focal neurological deficit post-brain radiotherapy. Validated diagnostic and treatment modalities for SMART syndrome are urgently required.

Abstract This study aimed to evaluate visual function and perform multimodal imaging on patients with focal choroidal excavation without any chorioretinal disease (idiopathic focal choroidal excavation [iFCE]). Seventeen eyes of 15 patients with iFCE (8 men, 7 women; mean ± standard deviation age, 56.0 ± 10.8 years) were assessed for visual function including visual acuity, metamorphopsia, aniseikonia, and retinal sensitivity. Multimodal imaging included optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography. This study found that the maximum width and depth of the excavation were 597 ± 330 (238–1809) µm and 123 ± 45 (66–231) µm, respectively, and that FAF showed normal or hypoautofluorescence corresponding to iFCE. The fundus examination findings were stable during the follow-up period (96 ± 48 months). None of the eyes showed any abnormalities in central retinal sensitivity or aniseikonia. Metamorphopsia was detected using Amsler grid testing and M-CHARTS in two eyes. Therefore, this study is the first to quantitatively and qualitatively study metamorphopsia of patients with iFCE. Our results showed that most patients with iFCE did not have visual impairments, despite the presence of morphological changes in the outer retina and choroid.

This study aimed to evaluate visual function and perform multimodal imaging on patients with focal choroidal excavation without any chorioretinal disease (idiopathic focal choroidal excavation [iFCE]). Seventeen eyes of 15 patients with iFCE (8 men, 7 women; mean ± standard deviation age, 56.0 ± 10.8 years) were assessed for visual function including visual acuity, metamorphopsia, aniseikonia, and retinal sensitivity. Multimodal imaging included optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography. This study found that the maximum width and depth of the excavation were 597 ± 330 (238–1809) µm and 123 ± 45 (66–231) µm, respectively, and that FAF showed normal or hypoautofluorescence corresponding to iFCE. The fundus examination findings were stable during the follow-up period (96 ± 48 months). None of the eyes showed any abnormalities in central retinal sensitivity or aniseikonia. Metamorphopsia was detected using Amsler grid testing and M-CHARTS in two eyes. Therefore, this study is the first to quantitatively and qualitatively study metamorphopsia of patients with iFCE. Our results showed that most patients with iFCE did not have visual impairments, despite the presence of morphological changes in the outer retina and choroid. [ABSTRACT FROM AUTHOR]

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Introduction: The aim of the study was to determine the prevalence of metamorphopsia following rhegmatogenous retinal detachment (RRD) surgery, as well as associated predictive factors. Methods: A total of 107 eyes successfully operated for RRD underwent metamorphopsia severity assessment using M-CHARTS, and foveal microstructure analysis by spectral domain optical coherence tomography, at 1 and 6 months postoperatively. Univariate and multivariate logistic regression rendered evaluation of preoperative risk factors. The correlation between metamorphopsia score and outer retinal layer (ORL) integrity was investigated and preoperative risk factors evaluated. Results: The prevalence of postoperative metamorphopsia decreased from 51.4 to 29.9% and the median metamorphopsia score significantly improved (0.5, 95% CI: 0.3; 0.9, to 0.2, 95% CI: 0; 0.5, p < 0.001) from 1 to 6 months, respectively. Preoperative macular detachment was the only predictor found (OR 11.0, 95% CI: 3.1; 39.4, p < 0.001). Metamorphopsia severity was significantly associated with outer nuclear layer thickness and the status of the ellipsoid and cone interdigitation zones. One-month M-CHARTS had 81% sensitivity and 87% specificity in predicting full metamorphopsia recovery at 6 months (0.45 cut-off score). Conclusion: The prevalence of metamorphopsia decreased in parallel to ORL restoration, thus demonstrating the etiological role of photoreceptor-level morphological changes. M-CHARTS allowed for monitoring and predicting metamorphopsia recovery after RRD. [ABSTRACT FROM AUTHOR]

Purpose: The objective is to determine the effect of ectopic inner foveal layer (EIFL) thickness on preoperative and postoperative best-corrected visual acuity (BCVA) and metamorphopsia scores in stage 3 epiretinal membranes (ERM). Methods: Thirty eyes of 28 patients were included in the study. All patients underwent uncomplicated vitrectomy and membrane peeling. EIFL, central foveal thickness (CFT), outer nuclear layer (ONL), inner nuclear layer (INL), inner plexiform layer (IPL) thicknesses were measured preoperatively and postoperatively at 3 months using Spectralis spectral-domain optical cohorence tomography. Horizontal line (MH) and vertical line (MV) metamorphopsia scores were calculated using M-CHARTS. Postoperative changes in OCT parameters and visual functions and the correlations between them were analyzed. Results: EIFL thickness, ONL thickness, and CFT were 143.1±19.1 µm, 189.3±48 µm, and 431.7±58 µm preoperatively, respectively. In the postoperative 3rd month, they were 131.2±17.3 µm, 163.5±45.1 µm, and 388.2±52.6 µm (P=0.004, P=0.001, P=0.001 respectively). BCVA (logMAR: Logarithm of the minimal angle of resolution), MH, and MV scores at the postoperative 3rd month were significantly lower than their preoperative values (P<0.001 in all three). Preoperative CFT was found to be correlated with preoperative MH and MV (P=0.031, P=0.02, respectively). Preoperative ONL thickness was correlated with MH and MV scores (P=0.049, P=0.014, respectively). Preoperative INL thickness was only positively correlated with the MH score (P=0.004). There was no correlation between preoperative - postoperative OCT parameters and postoperative visual functions. Conclusion: EIFL thickness had no effect on metamorphopsia and BCVA in stage 3 ERM patients. It was thought that the formation of metamorphopsia in these patients might be due to changes in the outer retinal layers. [ABSTRACT FROM AUTHOR]

Introduction: We compared postoperative metamorphopsia and optical coherence tomography (OCT) findings between eyes that underwent internal limiting membrane (ILM) peeling and the inverted flap (IF) technique for macular hole (MH). Methods: This retrospective analysis included 64 eyes of 64 patients with idiopathic MH whose MH was closed after initial surgery. Thirty-nine patients were treated with pars plana vitrectomy (PPV) with ILM peeling, and 25 patients were treated with PPV with the IF technique. Best corrected visual acuity (BCVA), severity of metamorphopsia, and OCT images were collected before and 3, 6, and 12 months postoperatively. Based on the OCT images, the status of the external limiting membrane (ELM) and ellipsoid zone and the presence of hyperreflective plugs were assessed. Results: At baseline and 3, 6, and 12 months postoperatively, BCVA and severity of metamorphopsia were not significantly different between groups. The status of the ELM was significantly worse in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Significantly more hyperreflective plugs were observed in the IF group than in the ILM peeling group at 3 and 6 months postoperatively. Stepwise multiregression analysis revealed that hyperreflective plugs were significantly associated with the severity of metamorphopsia at 12 months postoperatively. Discussion/Conclusion: The alterations on the OCT were fewer in the ILM peeling group than in the IF group, while no significant differences were observed in postoperative severity of metamorphopsia between groups. Metamorphopsia was worse in eyes with hyperreflective plugs. [ABSTRACT FROM AUTHOR]

The article discusses a study on metamorphopsia severity in patients undergoing vitrectomy for vitreoretinal disorders, including epiretinal membrane (ERM), macular hole (MH), cystoid macular edema with branch retinal vein occlusion (BRVO-CME), diabetic macular edema (DME), and rhegmatogenous retinal detachment (RD). The quantitative study reveals that preoperative metamorphopsia scores were correlated with postoperative scores, with ERM showing the highest preoperative severity.

Introduction: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). Methods: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. Results: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). Conclusions: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients. [ABSTRACT FROM AUTHOR]

Laura Hoffmann,1,2,&ast; Susanne Müller,1,3,&ast; Lucas M Bachmann,4,5 Daniela Claessens,6 Katja Hatz1,7 1Medical Retina & Research Department, Vista Eye Clinic Binningen, Binningen, Switzerland; 2Department of Ophthalmology, University Hospital Charité - Campus Benjamin Franklin, Berlin, Germany; 3Department for Health Sciences, Donau University Krems, Krems, Austria; 4Oculocare Medical, Medignition AG, Zurich, Switzerland; 5Faculty of Medicine, University of Zurich, Zurich, Switzerland; 6Gemeinschaftspraxis Augenheilkunde Lindenthal, Cologne, Germany; 7Faculty of Medicine, University of Basel, Basel, Switzerland&ast;These authors contributed equally to this workCorrespondence: Katja Hatz, Vista Augenklinik, Hauptstrasse 55, Binningen, 4102, Switzerland, Tel +41 61 426 60 79, Fax +41 61 426 60 01, Email katja.hatz@unibas.ch; katja.hatz@vista.chPurpose: To assess the ability of two self-monitoring digital devices to detect metamorphopsia in myopic choroidal neovascularization (mCNV) and compare their usability.Patients and Methods: This was a 12-month prospective observational study at a tertiary care eye hospital, Switzerland. Twenty-three Caucasian patients with mCNV were recruited, 21 eyes were analyzed. Primary and secondary outcome measures: Primary outcome measures were the metamorphopsia index scores as assessed by the two self-monitoring digital devices (Alleye App and AMD – A-Metamorphopsia-Detector software) at baseline, at 6 and 12 months and individual optional visits in between. Secondary outcome measures included best corrected visual acuity and morphological parameters (including disease activity) as evaluated by spectral-domain optical coherence tomography and fundus autofluorescence imaging. Location of mCNV was graded using the Early Treatment of Diabetic Retinopathy Study grid overlay. A usability questionnaire was administered at 12 months. Bland-Altman plots evaluated the limits of agreement of both devices. Linear regression analysis assessed the correlation between the difference and the average of the two scores.Results: A total of 202 tests were performed. Disease activity of mCNV was observed at least once in 14 eyes. Both scores concordantly detected metamorphopsia exhibiting a displaced scale of measurement yielding a coefficient of determination of 0.99. Concordance rate for pathological scores was 73.3%. Both scores were not significantly different in active and inactive mCNV. Overall, the usability scores were higher for the Alleye App than the AMD – A-Metamorphopsia-Detector software (4.61± 0.56 vs 3.31± 1.20; p< 0.001). In subjects aged > 75 years, scores were slightly lower (4.08± 0.86 vs 2.97± 1.16; p= 0.032).Conclusion: Whilst both self-monitoring devices concordantly identified metamorphopsia, they might act as an adjunct to hospital visits, but due to slight reactivations in mCNV and presence of metamorphopsia also in inactive disease the ability of detecting early mCNV activity might be limited.Keywords: myopic CNV, metamorphopsia, disease activity, self-monitoring, optical coherence tomography

Purpose: The pathology of branch retinal vein occlusion (BRVO), a retinal circulatory disease, is related to monocular metamorphopsia-related vision impairment of the affected eyes, but the association of binocular metamorphopsia in such patients is unclear. This study aimed to examine the frequency of binocular metamorphopsia and its association with the clinical characteristics of patients with BRVO. Methods: A total of 87 patients who were treated for BRVO-associated macular edema (ME) were included in this study. At baseline and 1 and 3 months after the initiation of anti-vascular endothelial growth factor (VEGF) treatment, we quantified metamorphopsia in the affected eyes and binocular metamorphopsia using the M-CHARTS® diagnostic tool. Results: At baseline, 53 and 7 patients had metamorphopsia in the affected eyes and binocular metamorphopsia, respectively. Although the visual acuity improved significantly after the initiation of anti-VEGF treatment, the mean M-CHARTS score in the affected eyes did not change from the baseline score. At 3 months, 9 patients showed binocular metamorphopsia; it was significantly associated with metamorphopsia in the affected eyes with a 95% confidence interval of 0.021–0.122 (β = 0.306, p = 0.006). Conclusion: Metamorphopsia in the affected eyes can cause binocular metamorphopsia in patients with BRVO-ME. [ABSTRACT FROM AUTHOR]

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects.

AIM: To explore the correlation between the integrity of the macular microstructures and the visual outcomes before and after idiopathic macular epiretinal membrane(IMEM)surgery.METHODS: A total of 43 patients(43 eyes)with IMEM who were treated in our hospital between January 2017 and December 2019 were selected. The best corrected visual acuity(BCVA)of each patient was examined preoperatively and at 3, 6, 9mo after surgery. Moreover, metamorphopsia(M-chart)examination was given, and spectral domain-optical coherence tomography(SD-OCT)was used to measure central foveal thickness(CFT), subfoveal choroidal thickness(SFCT), the thickness of ganglion cells-inner plexiform layer(GC-IPL)and the length of interdigitation zone(IZ)defect.RESULTS: The BCVA and the metamorphopsia were gradually improved at postoperative 3, 6 and 9 mo(all P0.05). The metamorphopsia assessment was positively correlated with the CFT at postoperative 3, 6, and 9mo(P0.05).CONCLUSIONS: The CFT and the length of IZ defect were significantly correlated with the BCVA after IMEM surgery, which can be used as indicators to predict the recovery of visual function after IMEM surgery.

Purpose: To investigate the involvement of retinal traction in the pathogenesis of lamellar macular hole (LMH) and related diseases based on OCT–based consensus definition. Design: Retrospective, observational study. Participants: Seventy-two eyes with LMH, epiretinal membrane foveoschisis (ERM-FS), or macular pseudohole (MPH). Methods: To quantitatively evaluate the involvement and strength of retinal traction in their pathogenesis, retinal folds were visualized with en face OCT imaging, and the maximum depth of the parafoveal retinal folds (MDRF) was measured. Metamorphopsia was quantified by measuring the minimum visual angle of dotted lines needed to cause it to disappear using M-CHARTS (Inami). Main Outcome Measures: Maximum depth of retinal folds and M-CHARTS scores. Results: Of the 72 eyes, 26 were classified as having LMH, 25 as having ERM-FS, and 21 as having MPH. Parafoveal retinal folds were observed in 7 (26.9%) eyes with LMH, 25 (100%) with ERM-FS, and 21 (100%) with MPH. The MDRF (7.5 ± 17.6 μm) was significantly smaller in LMH than in ERM-FS (86.3 ± 31.4 μm) and MPH (74.5 ± 24.6 μm) (both P

Retinal displacement following the repair of rhegmatogenous retinal detachment (RRD) has been reported in recent studies. It was described as vertical movement of the retinal relative to its original location, as evidenced by retinal vessel printing on fundus autofluorescence imaging. This review reports the current literature on retinal displacement. We conducted an English literature search using Medline, PubMed, Embase, and Web of Science. We have reviewed 22 articles describing the diagnosis, frequency, and possible risk factors for retinal displacement. The reported rate of retinal displacement ranged from 6.4% to 62.8%, and the possible risk factors included the detachment-to-repair time, location and extent of RRD, macula-off RD, presence of subretinal fluid, use of perfluorocarbon, use of tamponade, postoperative facedown positioning, type of RRD repair, and presence of proliferative vitreoretinopathy, especially high grade. This review increases awareness of retinal displacement and its associated visual effects. [ABSTRACT FROM AUTHOR]

Even after successful surgery, the stereopsis of retinal detachment (RD) patients is inferior to that of normal subjects. However, it is unclear which visual dysfunction in the affected eye is responsible for the postoperative stereopsis impairment. This study included 127 patients after successful surgery for unilateral RD. Stereopsis, best-corrected visual acuity (BCVA), severity of metamorphopsia, letter contrast sensitivity and amount of aniseikonia were examined at 6-month postoperatively. Stereopsis was assessed using the Titmus Stereo Test (TST) and TNO stereotest (TNO). Postoperative stereopsis (log) in patients with RD were 2.09 ± 0.46 in the TST and 2.56 ± 0.62 in the TNO. Multivariate analysis with stepwise regression revealed postoperative TST was associated with BCVA, and TNO was associated with BCVA, letter contrast sensitivity, metamorphopsia and absolute values of aniseikonia. In a subgroup analysis that selected those with more impaired stereopsis, postoperative TST was associated with BCVA (p < 0.001), and TNO was associated with letter contrast sensitivity (p < 0.005) and absolute values of aniseikonia (p < 0.05) by multivariate analysis. Deterioration of stereopsis after RD surgery was affected by a variety of visual dysfunctions. The TST was affected by visual acuity, while the TNO was affected by contrast sensitivity and aniseikonia. [ABSTRACT FROM AUTHOR]

PurposeIn order to monitor visual defects associated with macular degeneration (MD), we present a new psychophysical assessment called multiline adaptive perimetry (MAP) that measures visual field integrity by simultaneously estimating regions associated with perceptual distortions (metamorphopsia) and visual sensitivity loss (scotoma).MethodsWe first ran simulations of MAP with a computerized model of a human observer to determine optimal test design characteristics. In experiment 1, predictions of the model were assessed by simulating metamorphopsia with an eye-tracking device with 20 healthy vision participants. In experiment 2, eight patients (16 eyes) with macular disease completed two MAP assessments separated by about 12 weeks, while a subset (10 eyes) also completed repeated Macular Integrity Assessment (MAIA) microperimetry and Amsler grid exams.ResultsResults revealed strong repeatability of MAP and high accuracy, sensitivity, and specificity (0.89, 0.81, and 0.90, respectively) in classifying patient eyes with severe visual impairment. We also found a significant relationship in terms of the spatial patterns of performance across visual field loci derived from MAP and MAIA microperimetry. However, there was a lack of correspondence between MAP and subjective Amsler grid reports in isolating perceptually distorted regions.ConclusionsThese results highlight the validity and efficacy of MAP in producing quantitative maps of visual field disturbances, including simultaneous mapping of metamorphopsia and sensitivity impairment.Translational relevanceFuture work will be needed to assess applicability of this examination for potential early detection of MD symptoms and/or portable assessment on a home device or computer.

Macular degeneration is defined as the degeneration of the macula, that is, the center for clear vision. Macular degeneration is age-related and is the most common cause of severe irreversible vision loss in people over 60 years old. This form of degeneration is one of the leading causes of blindness worldwide. The macula is the center for clear vision, a small area in the central retina that allows us central vision. This type of disease develops as part of the body's natural aging process. Macular degeneration means damage to the part of the eye that is responsible for central vision and the fine details we see. The changes that occur during macular degeneration are permanent or irreversible, Permanent damage to central vision. The disease does not cause total blindness because it affects central vision, thus preserving peripheral vision. In developed countries, macular diseases are the leading cause of blindness. The most common types of macular disease occur in: high myopia, age-related maculopathy, juvenile macular dystrophy, central serous retinopathy, disciform macular degeneration, macular hemorrhages, retinal vein occlusion, and diabetic retinopathy. Risk factors for macular disease: In addition to age, other risk factors are smoking, gender, ethnicity (whites are at higher risk), cardiovascular disease, and farsightedness. It is characteristic that when reading one letter or word appears lower or higher than the adjacent ones. Regarding the clinical characteristics of the disease, which are also related to the final prognosis in terms of visual acuity and consequences, it is divided into two main forms: dry form (non-exudative), which has a favorable prognosis, and wet form (exudative-neovascular), which is present only in about 10% of the population. The main symptoms that occur are: metamorphopsia (distortion of the image, objects and letters), micropsia (reduction in the size of objects), the appearance of dark spots in front of the eyes and the inability to see, that is, patients complain that they cannot see them on the street recognize people's faces, cannot read, and usually turn away so they can focus on something they want to see. Treatment for the dry form does not have a special therapy. Frequent monitoring and controls as well as the reception of antioxidant vitamin therapy from the group of Lutein and Zeaxanthin are recommended in the prevention of the accumulation of toxic radicals from the metabolism of the cells of the vision center. In the wet form, intravitreal applications of drugs from the anti VEGF (anti vascular endothelial growth factor) group are applied, which works and blocks the mediators responsible for the appearance of new abnormal blood vessels. [ABSTRACT FROM AUTHOR]

Purpose To analyse the relationship between the extent of metamorphopsia and optical coherence tomography (OCT) parameters including the ectopic inner foveal layer (EIFL) in patients with epiretinal membrane (ERM) who underwent pars plana vitrectomy (PPV). Methods: This study included 63 eyes of 62 patients who underwent PPV for ERM. Metamorphopsia was assessed by measuring the metamorphopsia score for vertical lines (MV) and metamorphopsia score for horizontal lines (MH) using M‐CHARTS. Central retinal thickness (CRT), EIFL thickness and disruption of outer retinal layers were measured before and after surgery, and the relationship of these parameters with metamorphopsia scores at 3 months after vitrectomy was analysed. Results: Preoperative MV correlated with preoperative CRT and EIFL (p = 0.005 and 0.045 respectively). Postoperative MH correlated with preoperative CRT (p = 0.048), while postoperative MV correlated with preoperative CRT and EIFL (p = 0.002 and 0.0006 respectively). Postoperative MH correlated with postoperative CRT and EIFL (p = 0.001 and 0.002 respectively), and postoperative MV also correlated with postoperative CRT and EIFL (p = 0.0008 and < 0.0001 respectively). MH and MV did not correlate with outer retinal layer disruptions, both before and after vitrectomy. When multiple regression analysis was performed on preoperative and postoperative OCT parameters that correlated with postoperative metamorphopsia scores, only postoperative EIFL was identified as an independent factor associated with postoperative MV (p = 0.042). Conclusion: When PPV was conducted for ERM, postoperative EIFL was found to be a significant factor associated with postoperative metamorphopsia score. [ABSTRACT FROM AUTHOR]

AIM: To analyze the effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane(ILM)peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane(IMEM).METHODS: Totally 88 patients(88 eyes)with IMEM admitted to the hospital were selected between January 2016 and January 2020. They were divided into group A and group B by random number table method with 44 eyes in each group. Patients in group A were treated with vitrectomy and macular epiretinal membrane dissection combined with ILM peeling, while patients in group B were treated with vitrectomy and macular epiretinal membrane dissection. The choroid thickness, vision, metamorphopsia, central macular thickness(CMT), ellipsoid zone(EZ)continuity were compared between the two groups.RESULTS: Compared with preoperative, the sub-foveal choroidal thickness(SFCT), choroidal thickness 1 000μm from nasal side central of fovea(NFCT)and choroidal thickness 1 000μm from temporal side central of fovea(TFCT)were significantly reduced in the two groups at 3mo and 6mo after operation(P0.5). Compared with preoperative, the best corrected visual acuity(BCVA)LogMAR was reduced, while mean sensitivity(MS)was increased in the two groups. The number of scotoma points(SP)increased in group A and decreased in group B. Group A had significantly lower MS and higher SP than group B at 1mo, 3mo, and 6mo after operation(P0.05). Compared with preoperative, CMT was significantly reduced in the two groups at 1, 3 and 6mo after operation. The ratio of EZ continuity in group A at 1mo after operation was significantly lower than that before operation. The CMT of group A was larger than that of group B at 3mo and 6mo after operation(P0.05).CONCLUSION: Vitrectomy and macular epiretinal membrane dissection combined with or without ILM peeling both can improve vision and metamorphopsia in patients with IMEM, with similar effects on choroid thickness and safety. However, combined use of ILM peeling will lower MS and increase SP as well as CMT. Therefore, it has no significant advantages in the treatment of patients with IMEM.

Background: Rhegmatogenous retinal detachment (RRD) affects 1 in 10,000 populations per year. It is characterized by neurosensory retinal detachment from the retinal pigment epithelium due to a retinal break. Retinal detachment is present in 0.5 to 1% eyes after cataract surgery. Objective: To evaluate metamorphopsia and its association with Optical Coherence Tomography (OCT) findings after Rhegmatogenous Retinal Detachment surgery by Pars Plana Vitrectomy using gas tamponade (Sf6). Methods: Prospective, interventional study was carried out in Ophthalmology unit, Dow University of Health Sciences and Dr. Ruth K. M. Pfau Civil Hospital, Karachi from 22nd February 2021 to 1st August 2021. Thirty patients aged between 30 to 60 years, either gender and pseudophakic that underwent Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment using 20% sulfur hexafluoride tamponade were included. Metamorphopsia was assessed using Amsler grid and OCT was performed to evaluate retinal images 2 months postoperatively. Fisher's exact test was used for association between metamorphopsia and OCT findings. Results: The mean age of the patients was 47.43 ± 8.39 years. At 2 months of surgery, metamorphopsia was present in 16/30 (53.3%) patients of which 11/16 (69%) had abnormal macula on OCT(disruption of photoreceptor junction (4 eyes, 26%), epiretinal membrane (2 eyes, 13%), subretinal fluid (2 eyes, 13%), retinal folds (1 eye, 6%), cystoid macular edema (1 eye, 6%) and macular hole (1 eye, 6%) and 5/16 (31%) exhibited a normal macula. In the non-metamorphopsia group of 14 patients, 3/14 (21%) showed abnormal macula and 11/14 (79%) had normal macula on OCT (p = 0.014; Fisher's exact test) Conclusion: Metamorphopsia after pars plana vitrectomy with gas tamponade is more common in patients with abnormal retinal morphology on OCT. [ABSTRACT FROM AUTHOR]

Purpose: To compare the surgical outcomes of epiretinal membranes (ERMs) associated with retinal break and idiopathic ERMs. Methods: This retrospective study included patients with an idiopathic ERM or an ERM associated with retinal break, who were followed up for ≥ 6 months after ERM removal. The postoperative functional and anatomical outcomes were compared between the groups. Results: A total of 160 and 38 eyes (198 patients) were in the idiopathic and retinal break groups, respectively. There was no significant difference in the baseline anatomical and functional parameters between the groups. At 6 months after surgery and at the final follow-up, best-corrected visual acuity, central foveal thickness, and ectopic inner foveal layer improved significantly in both groups, but there was no significant difference between the groups. In latter 49.0% of patients, tests for metamorphopsia and aniseikonia were performed. There was a significant improvement in the scores of metamorphopsia (0.40 ± 0.38 to 0.27 ± 0.28; p < 0.001) and aniseikonia (6.07 ± 4.46 to 4.11 ± 3.52; p < 0.001) in the idiopathic group at 6 months after surgery, but not in the retinal break group. The idiopathic group had significantly greater circularity of ERM extent compared to the retinal break group (p = 0.025). Conclusion: Visual and anatomical improvements after removal of ERMs associated with retinal break and idiopathic ERMs were comparable. However, metamorphopsia and aniseikonia improved only after removal of idiopathic ERMs. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to quantitatively evaluate metamorphopsia pre- and postoperatively in patients with idiopathic epiretinal membrane(iERM) using M-CHARTS™ and to evaluate the relationship between morphological changes in retinal layers on optical coherence tomography (OCT) and metamorphopsia scores., Materials and Methods: This prospective study included 42 patients followed in Akdeniz University Hospital Ophthalmology Clinic diagnosed with iERM by fundus examination and OCT between 2020-2022. Detailed ophthalmologic findings, visual acuities, metamorphopsia scores, and OCT parameters of all patients were recorded. The relationship between pre- and postoperative visual acuity, metamorphopsia scores and OCT parameters was investigated. Changes in OCT parameters were compared by evaluating patients with stable or increasing metamorphopsia scores as one group (group1) and patients with decreasing metamorphopsia scores as the other group (group 2)., Results: In "group 2", preoperative Ganglion Cell Layer+Inner Plexiform Layer (Central) (GCL+IPL (C)) was significantly (P: 0.028) higher than in "group 1"., Conclusion: A statistically significant preoperative thickness difference in the OCT parameters of the GCL+IPL (C) layer was associated with the quantitative metamorphopsia complaints of the patients. The thickness of the preoperative GCL+IPL (C) layer can be considered an important indicator of symptoms of metamorphopsia determining functional success after surgery., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: SMART syndrome is a rare complication of brain radiotherapy. This is the first described presentation of SMART syndrome with metamorphopsia, which responded to aspirin, verapamil, and high-dose L-arginine therapy., Case Presentation: A 43-year-old man presented with 3 weeks of migraine headaches with metamorphopsia and complex visual hallucinations affecting the left lower quadrant of both visual fields. This occurred on a background of high-dose radiotherapy for right cerebellar astrocytoma 32 years ago. MRI brain demonstrated unilateral gyriform enhancement and FLAIR hyperintense cortical swelling in the right occipital lobe consistent with SMART syndrome., Conclusion: Unusual presentations of SMART syndrome exist and require consideration in all patients with focal neurological deficit post-brain radiotherapy. Validated diagnostic and treatment modalities for SMART syndrome are urgently required., Competing Interests: The authors declare that there is no conflict of interest., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Alice in Wonderland syndrome (AIWS) is extremely rare, occurring more often in young individuals than in older adults. Symptoms of this syndrome typically include an altered body image, size perception, and time perception. However, the pathophysiology and lesions responsible for this syndrome remain unclear. In most cases, specific lesions cannot be identified using computed tomography or magnetic resonance imaging. Two patients with isolated cortical venous thrombosis in the right occipital area experienced transient visual symptoms of AIWS. Furthermore, a literature search indicated that AIWS with visual distortions is associated with right occipital lobe lesions, supporting the findings of our study.

Introduction: Pathologic myopia (PM) is one of the leading causes of visual impairment worldwide. The pathophysiology of PM is not fully understood, but the axial elongation of the eye followed by chorioretinal thinning is suggested as a key mechanism. PM may lead to many complications such as chorioretinal atrophy, foveoschisis, choroidal neovascularization, rhegmatogenous retinal detachment, cataract, and glaucoma. Case Report: A 66-year-old female came to the Ophthalmology Clinic for a routine ophthalmologic check-up. She mentioned experiencing an ocular trauma in her right eye (RE) during her youth. Measured refraction was RE: - 19.50 Sf, -4.75 cyl 5° while LE: -19.00 Sf, -2.75 cyl 180°. Best corrected visual acuity (BCVA) RE was counting fingers at 30 cm and LE 0.4 with correction. Anterior segment examination revealed RE: stage 5 hypermature cataract while LE: stage 2+ cortico-nuclear cataract. Ocular fundus examination RE: exibited extensive macular atrophy extending close to the temporal vascular arcades, and LE: temporal papillary staphyloma, with a parafoveolar atrophic area. Optical coherence tomography (OCT) showed LE: hyperreflective material in the parafoveolar area, above the pigment epithelium. OCT angiography (OCTA) LE highlighted a hyperreflective material in the central outer retina, consistent with a choroidal neovascular membrane. Given the absence of symptoms and lack of activity in the neovascular membrane, it has been decided to closely monitor the patient. One month later, she reports the onset of metamorphopsia LE (BCVA = 0.2). On OCT section, an increase in retinal thickness is observed, with persistent membrane on OCTA. Therefore, it has been decided to initiate treatment with intraocular injection of aflibercept anti-VEGF 0.05 ml. At the one month follow-up, BCVA improved to 0.4, accompanied by a decrease in retinal thickness observed on OCT. Discussions : The particularity of the case comes from the single functional eye and the absence of symtoms. We chose to reduce the risks for our patient and monitor her closely. Once the first symtoms appeared, prompt treatment with a single intravitreal injection of anti-VEGF therapy was performed. Conclusions: The choice to closely monitor the pacient and start Aflibercept treatment once the onset of metamorphopsia appeard led to the most favourable response: a significant improvement of visual acuity with a visible decrease in retinal thickness OCT. [ABSTRACT FROM AUTHOR]

Metamorphopsia patients experience distortions in their views. The number of metamorphopsia patients is arising with the increase in the elderly population. For early detection of metamorphopsia, examination approaches have been proposed. However, none of the existing methods can be employed to precisely assess the perceptions of patients. We propose LineM as a novel method to precisely measure the distorted views of metamorphopsia patients based on interactive line manipulation task involving the patients. To explore the potential of LineM, a case study which uses the measured results from LineM to visualize the distorted views of metamorphopsia patients is presented. Furthermore, a novel technique for compensating the distorted views of individual metamorphopsia patients using the results from LineM is also presented. Considering that elderly individuals account for the majority of metamorphopsia patients, an intuitive and user-friendly prototype system has been implemented. The effectiveness and usability of LineM and the compensation method were demonstrated via a qualitative and subjective experiment that involved metamorphopsia patients and elderly participants. [ABSTRACT FROM AUTHOR]

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AIM: To identify factors associated with metamorphopsia in patients with rhegmatogenous retinal detachment(RRD)who underwent primary vitrectomy(PPV). METHODS:This retrospective study included 94 patients(94 eyes)who underwent 23G PPV for repair of RRD between January, 2017 and January, 2019. Each patient were examined both eyes preoperatively and postoperatively(at 1, 6, 12mo and last visits). At each time-point, patients received a complete ophthalmological examination, including best corrected visual acuity(BCVA), intraocular pressure, slit-lamp biomicroscopy, optical coherence tomography(OCT), and M-chart examination.RESULTS: One month after surgery, metamorphopsia occurred in 53%(n=50), the mean M value was 0.68±0.28. The metamorphopsia rate differed significantly between macula-off and macula-on RRD(P

Purpose: To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI). Methods: In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI). Results: Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM. Conclusion: POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift.

Even after successful surgery, the stereopsis of retinal detachment (RD) patients is inferior to that of normal subjects. However, it is unclear which visual dysfunction in the affected eye is responsible for the postoperative stereopsis impairment. This study included 127 patients after successful surgery for unilateral RD. Stereopsis, best-corrected visual acuity (BCVA), severity of metamorphopsia, letter contrast sensitivity and amount of aniseikonia were examined at 6-month postoperatively. Stereopsis was assessed using the Titmus Stereo Test (TST) and TNO stereotest (TNO). Postoperative stereopsis (log) in patients with RD were 2.09 ± 0.46 in the TST and 2.56 ± 0.62 in the TNO. Multivariate analysis with stepwise regression revealed postoperative TST was associated with BCVA, and TNO was associated with BCVA, letter contrast sensitivity, metamorphopsia and absolute values of aniseikonia. In a subgroup analysis that selected those with more impaired stereopsis, postoperative TST was associated with BCVA (p < 0.001), and TNO was associated with letter contrast sensitivity (p < 0.005) and absolute values of aniseikonia (p < 0.05) by multivariate analysis. Deterioration of stereopsis after RD surgery was affected by a variety of visual dysfunctions. The TST was affected by visual acuity, while the TNO was affected by contrast sensitivity and aniseikonia.

Metamorphopsia, perceived as distortion of a shape, is experienced in age‐related macular degeneration (AMD): straight lines appear to be curved and wavy to AMD patients and some other retinal pathologies. Conventional clinical assessment largely relies on asking patients to identify irregularities in Amsler Grids ‐ a standardized set of equally spaced vertical and horizontal lines. Perceived distortions or gaps in the grid are a sign of macular pathology. Here, we developed an iterative Amsler Grid (IAG) procedure to obtain a quantifiable map of visual deformations. Horizontal and vertical line segments representing metamorphopsia are displayed on a computer screen. Line segments appearing distorted are adjusted by participants using the computer mouse to change their orientation in several iteratively such that they appear straight. Control participants are able to reliably correct deformations that simulate metamorphopsia while maintaining fixation in the center. In a pilot experiment, we attempted to obtain deformation maps from a small number of AMD patients. Whereas some patients with extensive scotomas found this procedure challenging, others were comfortable using the IAG and generating deformation maps corresponding to their subjective reports. This procedure may potentially be used to quantify local distortions and map them reliably in patients with early AMD. [ABSTRACT FROM AUTHOR]

Purpose: Macular diseases often lead to metamorphopsia, which is traditionally tested using the Amsler grid. This study evaluates a novel method for assessing metamorphopsia, based on the software AMD-A Metamorphopsia Detector, application MacuFix®. Methods: In this observational study, the usability of a new smartphone-based testing method to assess metamorphopsia was evaluated in 45 patients experiencing metamorphopsia in at least one eye using the questionnaire "System Usability Score (SUS)." Additionally, the diagnostic adherence of self-monitoring with the Amsler grid was compared to self-monitoring with the novel software MacuFix®. Results: The average score of the SUS questionnaire in this study was 76.7 ± 15.5, corresponding to the "good" score on the grading scale. The average interval between two home administered tests was significantly shorter (6 days) when the application was used as compared to using the Amsler grid (19 days). The odds ratio of the frequency of patients using the application to the patients using the home test was 4. Conclusion: MacuFix® application can help in effective home monitoring of macular function as high user satisfaction and increased testing frequency was observed in its use in patients with macular diseases. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of idiopathic bilateral serous retinal pigment epithelial detachments. Observations: We present a case of a 43-year-old female patient with metamorphopsia with the presence of innumerable bilateral serous retinal pigment epithelial detachments. Detailed ocular and systemic clinical work-up revealed no underlying disease. Conclusions: /Importance: Idiopathic multiple serous retinal pigment epithelial detachments are an extremely rare condition, that has been observed as an incidental clinical finding in asymptomatic patients. Multimodal imaging and detailed systemic work up are essential to rule out an underlying disease. Initial symptoms, as in our case, are uncommon and usually occur only in patients with complications such as choroidal neovascularization or hemorrhages. Therefore, regular follow ups are recommended to early detect and treat possible complications.

Abstract Metamorphopsia, perceived as distortion of a shape, is experienced in age‐related macular degeneration (AMD): straight lines appear to be curved and wavy to AMD patients and some other retinal pathologies. Conventional clinical assessment largely relies on asking patients to identify irregularities in Amsler Grids ‐ a standardized set of equally spaced vertical and horizontal lines. Perceived distortions or gaps in the grid are a sign of macular pathology. Here, we developed an iterative Amsler Grid (IAG) procedure to obtain a quantifiable map of visual deformations. Horizontal and vertical line segments representing metamorphopsia are displayed on a computer screen. Line segments appearing distorted are adjusted by participants using the computer mouse to change their orientation in several iteratively such that they appear straight. Control participants are able to reliably correct deformations that simulate metamorphopsia while maintaining fixation in the center. In a pilot experiment, we attempted to obtain deformation maps from a small number of AMD patients. Whereas some patients with extensive scotomas found this procedure challenging, others were comfortable using the IAG and generating deformation maps corresponding to their subjective reports. This procedure may potentially be used to quantify local distortions and map them reliably in patients with early AMD.

Purpose: To compare conventional 360° internal limiting membrane (ILM) peeling and temporal inverted ILM flap technique with regard to postoperative foveal displacement. Methods: Patients who underwent 23 G vitrectomy with either 360° ILM peeling (Group 1) or temporal inverted ILM technique (Group 2) for idiopathic macular hole with a minimum follow up of 12 months were included. The metamorphopsia rates and distances between fovea and 3 retinal landmarks: the first retinal vascular bifurcation or crossover located superonasal and inferonasal to the fovea and ciliary vessel at the temporal margin of the disc, were compared on MultiColor SLO and near-infrared reflectance images. In addition, papillofoveal distance was measured on B-scan optical coherence tomography (OCT). Results: A total of 57 eyes were recruited (Group 1, n = 25; Group 2, n = 32). The visual acuity at month-1 was significantly higher in Group 2 than Group 1 (p =.007). A significant postoperative foveal displacement towards the disc was observed in Group 1 and Group 2 (p <.001 and p =.002 respectively). Shortening of the papillofoveal distance was greater in Group 1 than Group 2 at all postoperative visits (p <.05 for all). Furthermore, significant changes in papillofoveal distance continued until 6 months in Group 1 (p <.05 for all), whereas no significant changes occurred in Group 2 after month-1 (p >.05 for all). The complaints of metamorphopsia was significantly higher in Group 1 (n = 18/25) compared with Group 2 (n = 10/32) (p =.002). Conclusion: Temporal inverted ILM flap appear to be superior to 360° ILM peeling with regard to faster visual rehabilitation, lower rates of subjective metamorphopsia and less foveal displacement. [ABSTRACT FROM AUTHOR]

Purpose: To discuss the pathophysiology of metamorphopsia, its characterisation using retinal imaging and methods of assessment of patient symptoms and visual function. Methods: A literature search of electronic databases was performed Results: Metamorphopsia has commonly been associated with vitreomacular interface disorders (such as epiretinal membrane) and has also regularly been noted in diseases of the retina and choroid, particularly age-related macular degeneration and central serous chorioretinopathy. Developments in optical coherence tomography retinal imaging have enabled improved imaging of the foveal microstructure and have led to the localisation of the pathophysiology of metamorphopsia within the retinal layers of the macula. Alteration of alignment of inner and outer retinal layers at various retinal loci has been identified using multimodal imaging in patients with metamorphopsia in a range of conditions. Although the Amsler Grid assessment of metamorphopsia is a useful clinical indicator, new emerging methods of metamorphopsia assessment with psychophysical tests such as M-CHARTS and preferential hyperacuity perimetry, have been developed. Conclusions: It appears that there is a complex relationship between visual acuity and metamorphopsia symptoms that vary between retinal conditions. Although metamorphopsia has traditionally been challenging to measure in the clinic, advances in technology promise more robust, easy-to-use tests. It is possible that home assessment of metamorphopsia, particularly in conditions such as age-related macular degeneration, may help to guide the need for further clinic evaluation and consideration of treatment. [ABSTRACT FROM AUTHOR]

Purpose: To assess the retinal features in eyes with postoperative metamorphopsia (POM) following rhegmatogenous retinal detachment (RRD) repair using multimodal imaging (MMI).Methods: In this cross-sectional; case-control study, patients after successful RRD repair following 25-gauge vitrectomy, clear vitreous cavity, and corrected distance visual acuity (CDVA)>20/200 were categorized using Amsler chart: cases with POM and controls without POM. MMI was performed on swept-source platform (Triton, Topcon Inc) and the confocal scanning laser ophthalmoscope system (Spectralis HRA, Heidelberg). The measures assessed were CDVA, morphological features on optical coherence tomography, autofluorescence, and multicolor imaging (MCI).Results: Thirty-nine eyes were included in each group. Cases had greater number of eyes with total RRD (P = 0.029) preoperatively; abnormal foveal contour (P = 0.036), ellipsoid zone (EZ) disruption (P < 0.001) and poorer postoperative CDVA (P = 0.046) as compared to controls. Outer retinal folds and retinal shift (unintentional translocation of retina after reattachment surgery for RRD) did not differ significantly between the groups (P = 0.48 and 0.35, respectively). On MCI, the distribution of detected ERM was similar between the groups (P = 0.25). Postoperative CDVA was significantly worse in eyes with POM.Conclusion: POM is affected by extent of RRD, postoperative foveal contour, and EZ status but not by retinal shift. [ABSTRACT FROM AUTHOR]