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Vision is the most powerful sense guiding our interaction with the environment. Its process starts with the retinal image as input and results in visually guided behaviors as output. This paper summarizes insights I gained over >40 years dealing with clinical ophthalmology, visual science, and vision rehabilitation, disciplines that all involve vision, but from different points of view. The retinal image contains 2-dimensional forms that have no inherent meaning. The brain matches this input to stored concepts, to create a Mental Model that is filled with 3-dimensional objects that are meaningful and linked to other senses. Ultimately this leads to the output of goal-directed visually guided behavior. The processes involved are too complex to be covered by a single practitioner. Optimal vision rehabilitation requires teamwork that includes contributions from various professions. It also requires an understanding, as well as possible, of the cerebral processes involved. The visual sciences study mostly the input-driven process from retinal image to visual percepts. Their studies deal mostly with groups and group averages and only occasionally with individual disease conditions. Clinical ophthalmology deals mostly with individuals, rather than group averages. The motto of the American Academy of Ophthalmology reminds us that the end point of patient care goes beyond “preserving sight.” It also includes “empowering lives” by creating the conditions for goal-directed interaction with the environment through visually directed behavior. Traditionally, the study of vision has mainly involved the conscious part of vision, handled mostly in the ventral stream. However, the subconscious part of vision, handled mostly in the dorsal stream must also be considered. This is further stimulated by the demands of computer vision, image processing, and artificial intelligence. Vision rehabilitation traditionally deals with the input side through better illumination and various magnification devices. This is the domain of low vision aids. Increasingly, however, it must also address the output side, and the involvement of other senses (braille, long cane, and talking books). This requires better understanding of the goal-directed higher visual processes. The supplemental material covers the development of numerical scales to quantify not only visual acuity but also visual abilities, and the use of different tests. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Background: South Africa has a high mortality rate because of road traffic accidents (RTAs) compared to other countries. Aim: To determine the visual functions and their association with the occurrence of RTAs among vehicle drivers in the Gauteng province of South Africa. Setting: Eight driver’s license testing centres (DLTCs) in the Gauteng province. Methods: A cross-sectional study involving a multi-stage random sampling approach was conducted. Data collected using the questionnaire included participants’ demographic details. Ocular health examination included the measurement of visual acuity (VA), refractive errors, visual fields, colour vision, stereopsis, contrast and glare sensitivity. Results: A total of 579 motor vehicle drivers were enrolled in this study. Drivers who reported daily alcohol consumption had a higher risk of being involved in RTAs (odds ratio [OR] = 1.8, 95% confidence interval [95%CI] = 1.09–2.99, P = 0.02). Visual acuity (OR = 1.43, 95%CI = 0.99–2.06, P = 0.05), refractive errors (P = 0.03, χ2 = 61.57), abnormal contrast sensitivity (OR = 0.53, 95%CI = 0.31–0.93, P = 0.03) and deutan colour vision defects (P = 0.002, χ2 = 31.42) were significantly associated with RTAs. Visual field defects (OR = 0.98, 95%CI = 0.97–1.00, P = 0.09), stereopsis anomaly (OR = 1.00, 95%CI = 0.99–1.00, P = 0.35) and abnormal glare sensitivity (OR = 1.00, 95%CI = 0.99–1.01, P = 0.32) were not significantly associated with the occurrence of RTAs. Conclusion: These results suggest reviewing the visual requirements for obtaining a driver’s license by incorporating colour vision and contrast sensitivity assessment. Contribution: The study addresses a gap in the country’s current vision testing standards for driving.

Virtual reality (VR) can challenge the visual system, leading to temporary oculomotor changes, though the degree of change varies among individuals. While the vergence and accommodation system plays a crucial role in VR perception, it remains unclear whether individuals whose visual functions fall outside clinical norms experience larger changes. Thus, our study aimed to investigate whether changes in vergence and accommodation responses following VR gameplay differ between individuals with and without non-strabismic binocular and accommodative disorders. To assess this, both subjective and objective measurements were conducted before and after 20 min of playing Beat Saber. Results revealed significant alterations across both subjective measurements—near point of convergence and near point of accommodation—and objective measurements, including eye refraction, accommodation lag, and accommodative microfluctuations at far. Moreover, individuals with non-strabismic binocular and accommodative disorders exhibited larger accommodative microfluctuations at far compared to the control group. Overall, these findings indicate that considering individual differences in vergence and accommodation responses is important when evaluating the impact of VR on the visual system and can be helpful in the design and use of VR systems, particularly for individuals with binocular and accommodative disorders.

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Introduction: glaucoma is an essential international social and medical problem, as it leads to irreversible blindness in patients worldwide. Organization of treatment and prevention of complications using the most effective methods is the most important task of ophthalmologists at the present stage of the fight against glaucoma. The purpose of the study: to evaluate the management of assistance under the monitoring program «STOP! Glaucoma» to patients with suspected glaucoma, open-angle glaucoma, and more advanced stages of glaucoma. To compare the effectiveness of therapeutic and surgical methods of glaucoma treatment. Materials and methods: To detect and prevent the progression of glaucoma in patients, the LLC «VISIOBUD» Clinic developed and implemented the monitoring program «Stop! Glaucoma». The main task of program was to analyze the dynamics of glaucomatous changes in the optic nerve and, based on this, to determine whether glaucoma compensation is complete and whether the patient does not need a more radical treatment method to preserve visual functions. The following methods of empirical research were used: systematic approach - to determine the research elements between which there are relationships of objects and their properties; observation - to identify signs and external manifestations of facts; comparison – to determine similarities and differences and identify regularities; measurement; monitoring. Results: In the course of the study, the dynamics of changes in intraocular pressure in patients who follow the annual monitoring program «Stop! Glaucoma» in the clinic of LLC «VISIOBUD». 4 groups of patients (116 patients – 156 eyes) were under observation. Installed that in 75% of cases, patients need surgical treatment of glaucoma to preserve their visual functions. Surgical treatment of patients with open-angle glaucoma effectively preserves vision in 89% of cases. Conclusions: Timely detection, monitoring, and treatment of initial signs of open-angle glaucoma and symptoms of its progression affects the preservation and prolongation of visual functions in patients. In the long term, surgical treatment of glaucoma is more cost-effective, as the need to use expensive hypotensive drops is significantly reduced (by 2.5 times).

AIM: To determine the effects of change in light conditions on refractive error and visual functions including visual acuity, stereopsis and contrast sensitivity. METHODS: This cross-sectional study was conducted in the optometry clinic of the Shahid Beheshti School of Rehabilitation on 48 students in 2021-2022. All of them had eye health and normal visual function and could have refractive errors or not. Light intensity of 4 lx was considered equivalent to photopic light condition and light intensity of 1 lx was considered to be equivalent to mesopic light condition. The amount of refractive error was checked by auto refractometer and its changes in mesopic light condition were subjectively measured. Also, visual acuity, stereopsis and contrast sensitivity (in five spatial frequencies of 1.5, 3, 6, 12, and 18 cycles per degree), were measured first in photopic light condition and then in mesopic light condition, by Snellen control vision chart, stereo butterfly test and the M&S technology monitor test respectively. RESULTS: In the 48 student subjects with an average age of 22.69±3.56y, mean of refractive error as sphere equivalent, visual acuity and stereopsis were -1.25±1.74 diopters, 0 logMAR, 44.37±13.03 seconds of arc, respectively in photopic light condition while in mesopic light was equal to -1.56±1.75 diopters, 0.12±0.09 logMAR and 50.62±33.35 seconds of arc, respectively. The mean of contrast sensitivity measured at spatial frequencies of 1.5, 3, 6, 12, and 18 cycles per degree in photopic condition was equal to 2.38±0.04, 2.37±0.07, 2.04±0.21, 1.27±0.32, 0.82±0.27 logarithm of contrast sensitivity, respectively and in mesopic lighting condition was equal to 2.34±0.12, 2.30±0.16, 1.84±0.28, 1.02±0.28, 0.63±0.24 logarithm of contrast sensitivity, respectively. Statistical analysis showed a significant difference between the two lighting conditions in all evaluated variables [refractive error (P

Regardless of the sport, maintaining and improvement of visual functions in athletes act an important role in achieving personal records.In this article, the interrelationships between sports results and the state of visual functions were determined, as well as devices and methods were analyzed, thanks to which it is possible to improve functions of the visual analyzer.

Purpose: To report a case with epiretinal membrane (ERM) treated with audio-luminous Biofeedback training (BT) which resulted in improvement of monocular and binocular visual functions. Observations: We report a case of ERM with distance Best Corrected Visual Acuity (BCVA) of 20/40 in the right dominant eye, and 20/20 in the left eye. The main symptom was binocular blurry vision, and the patient did not desire to pursue posterior vitrectomy due to its risks. Using a 10-2 microperimetry test with the MAIA Microperimeter, it was possible to identify an inferior paracentral relative scotoma in the right eye with splitting fixation. The right eye was trained with five 20-minute sessions with Biofeedback training towards a trained retinal locus (TRL) with better retinal sensitivity and 1.46° superior and temporal to the current preferred retinal locus (PRL). After training, the patient reported total improvement of symptoms, and BCVA was 20/25 in the right eye and 20/20 in the left eye. Conclusions and importance: Biofeedback training is a valuable treatment with no known adverse effects that can be performed as an alternative to patients with ERM with no surgical indication and debilitating symptoms, or as a post-surgery adjuvant treatment.

Copyright of Turkiye Klinikleri Journal of Forensic Medicine & Forensic Sciences / Türkiye Klinikleri Adli Tıp ve Adli Bilimler Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Exotropia is an eye misalignment in which one or both of the eyes turn outward due to congenital or acquired abnormalities of orbital structure, globe structure, extraocular muscle attachment and/or extraocular muscle location. Different treatment modalities are used in the treatment for exotropia: overminus lens therapy, prism therapy, occlusion therapy, extraocular muscle surgery, and orthoptic vision therapy. Purpose: To assess the efficacy of conservative treatment for exotropia depending on the baseline status of visual and binocular functions. Material and Methods: The study sample consisted of 51 patients with exotropia with their age ranging from 10 to 21 years. Of these, 24 (47.05%) had constant exotropia and 27 (52.95%) had intermittent exotropia (IXT). Of the 51 patients, 33 had a hyperopic refractive error of 0.5 to 6.5 diopters (D), and 18, a myopic refractive error of greater than −0.50 D to less than −5.5 D. Of the 51 patients, 27 had mild amblyopia, 22, moderate amblyopia, and 2, no amblyopia. The mean exotropia was 11.8 ± 3.12º by Hirschberg. Patients underwent a routine ophthalmological evaluation. In addition, the near point of convergence (NPC) was determined by the proximeter; the accommodative convergence–accommodation (AC/A) ratio was calculated by the heterophoria method (AC/A = ipd + (phoria at distance – phoria at near)/3, where ipd is the interpupillary distance in centimeters) and expressed in PD/D; fusional reserves were measured using the synoptophore; and binocular vision at distance and near, using the color test. Stereoacuity thresholds were assessed with the Lang-Stereotest II and Titmus Stereo Fly (circles and animals) tests at daylight at a viewing distance of 30 cm, and a Huvitz CCP3100 Chart Projector was used to assess whether stereopsis was present at a 5-m distance. Treatment procedures included optical correction, pleoptics, and direct occlusion in the presence of amblyopia, and orthoptic and diploptic treatment aimed at an improvement and strengthening of binocular functions (synoptophore, binocular vision training, Fialka apparatus, electric stimulation of the medial recti using Amplipuls apparatus, image fusion training using Mirage apparatus, electric stimulation of the medial recti, and computer-aided stereopsis training). Results: The angle of deviation at near and at distance decreased significantly in the constant exotropia group (р = 0.0001 and р = 0.0065, respectively). In the IXT group, the angle of deviation at distance decreased significantly (р = 0.0001), and the angle of deviation at near, not significantly. Binocular vision restored in 38% and 70% of patients in the constant exotropia group and the IXT group, respectively. Convergence and AC/A ratio values improved, but not statistically significantly (p > 0.05). Fusional reserves improved significantly, stereo vision restored, and stereopsis at near (stereoacuity threshold as assessed by the Lang II Stereotest) improved in both groups, whereas stereopsis at distance improved only in the IXT group, and was present in 65.6% of patients in this group (р = 0.01). In the group with orthotropia after conservative treatment, there were 32/51 children (62.7%) with a deviation less than 6º (12.0 PD). The group with post-treatment exotropia included 19/51 children (37.3%) with post-treatment deviation exceeding 6º (12.0 PD); these children underwent subsequent surgery. The model of conservative treatment success was found to (1) include four variables (the NPC, fusion on the synoptophore, AC/A ratio, and stereoacuity threshold as assessed by the Lang II Stereotest) and (2) to predict the outcome of conservative treatment in 80.9% of cases (R= 0.80902535).

Purpose: To study and compare the macular visual functions among the subjects with and without risk for Obstructive Sleep Apnea Syndrome. Methods: Prospective case–control study involving 20 cases and 17 controls. Subjects were classified as cases with the presence of snoring and controls in the absence of it. Cases were administered with a standardized Berlin Questionnaire and were grouped as high risk and low risk based on their scores. Color discrimination, contrast sensitivity, and photo stress recovery test were measured following a comprehensive eye examination. Body mass index and neck circumference were also measured. Results: There were 13 subjects in the high-risk category, 7 subjects in the low-risk category, and 17 subjects in the control group. The total error score in color discrimination was significantly different among high risk (112 ± 84.17), low risk (74 ± 43.98), and controls (56 ± 39.43) (P = 0.04) whereas, contrast sensitivity (P = 0.897), visual acuity (P = 0.95), and photo stress recovery test (P = 0.32) did not show any significant difference. Conclusion: High-risk category subjects showed poor color discrimination than controls hence, these individuals must undergo a detailed ophthalmic examination with a color discrimination test and must be evaluated in a sleep clinic.

An imbalance of homeostasis in the retina leads to neuron loss and this eventually results in a deterioration of vision. If the stress threshold is exceeded, different protective/survival mechanisms are activated. Numerous key molecular actors contribute to prevalent metabolically induced retinal diseases—the three major challenges are age-related alterations, diabetic retinopathy and glaucoma. These diseases have complex dysregulation of glucose-, lipid-, amino acid or purine metabolism. In this review, we summarize current knowledge on possible ways of preventing or circumventing retinal degeneration by available methods. We intend to provide a unified background, common prevention and treatment rationale for these disorders and identify the mechanisms through which these actions protect the retina. We suggest a role for herbal medicines, internal neuroprotective substances and synthetic drugs targeting four processes: parainflammation and/or glial cell activation, ischemia and related reactive oxygen species and vascular endothelial growth factor accumulation, apoptosis and/or autophagy of nerve cells and an elevation of ocular perfusion pressure and/or intraocular pressure. We conclude that in order to achieve substantial preventive or therapeutic effects, at least two of the mentioned pathways should be targeted synergistically. A repositioning of some drugs is considered to use them for the cure of the other related conditions. [ABSTRACT FROM AUTHOR]

Early life stress (ELS) is defined as a period of severe and/or chronic trauma, as well as environmental/social deprivation or neglect in the prenatal/early postnatal stage. Presently, the impact of ELS on the retina in the adult stage is unknown. The long‐term consequences of ELS at retinal level were analyzed in an animal model of maternal separation with early weaning (MSEW), which mimics early life maternal neglect. For this purpose, mice were separated from the dams for 2 h at postnatal days (PNDs) 4–6, for 3 h at PNDs 7–9, for 4 h at PNDs 10–12, for 6 h at PNDs 13–16, and weaned at PND17. At the end of each separation period, mothers were subjected to movement restriction for 10 min. Control pups were left undisturbed from PND0, and weaned at PND21. Electroretinograms, visual evoked potentials, vision‐guided behavioral tests, retinal anterograde transport, and retinal histopathology were examined at PNDs 60–80. MSEW induced long‐lasting functional and histological effects at retinal level, including decreased retinal ganglion cell function and alterations in vision‐guided behaviors, likely associated to decreased synaptophysin content, retina‐superior colliculus communication deficit, increased microglial phagocytic activity, and retinal ganglion cell loss through a corticoid‐dependent mechanism. A treatment with mifepristone, injected every 3 days between PNDs 4 and16, prevented functional and structural alterations induced by MSEW. These results suggest that retinal alterations might be included among the childhood adversity‐induced threats to life quality, and that an early intervention with mifepristone avoided ELS‐induced retinal disturbances. [ABSTRACT FROM AUTHOR]

The term "glaucoma" unites a large group of eye diseases of various origins with a progradient, chronic course. The aim of this study was to study the neuroprotective effect of Cytoflavin in patients with POAG with normalized IOP based on the clinical and functional parameters of the organ of vision. Material and methods. The study involved 60 patients diagnosed with primary open-angle glaucoma (POAG) stage I, II and III. All patients were divided into 2 groups depending on the treatment received. Results. Cytoflavin has a pronounced neuroprotective effect in POAG, effectively protecting the nervous tissue and slowing down apoptosis. In addition to improving the clinical and functional indicators of the organ of vision, we noted an improvement in overall well-being, attention and overall performance in all patients. Conclusions. Analysis of the obtained results indicates a rather high clinical efficacy of Cytoflavin in the conservative treatment of patients with POAG with compensated IOP and can be recommended as a background neuroprotective therapy. [ABSTRACT FROM AUTHOR]

Background: The presence of subclinical optic nerve (ON) injury in youth living with pediatric-onset MS has not been fully elucidated. Magnetization transfer saturation (MTsat) is an advanced magnetic resonance imaging (MRI) parameter sensitive to myelin density and microstructural integrity, which can be applied to the study of the ON. Objective: The objective of this study was to investigate the presence of subclinical ON abnormalities in pediatric-onset MS by means of magnetization transfer saturation and evaluate their association with other structural and functional parameters of visual pathway integrity. Methods: Eleven youth living with pediatric-onset MS (ylPOMS) and no previous history of optic neuritis and 18 controls underwent standardized brain MRI, optical coherence tomography (OCT), Magnetoencephalography (MEG)-Visual Evoked Potentials (VEPs), and visual battery. Data were analyzed with mixed effect models. Results: While ON volume, OCT parameters, occipital MEG-VEPs outcomes, and visual function did not differ significantly between ylPOMS and controls, ylPOMS had lower MTsat in the supratentorial normal appearing white matter (−0.26 nU, p = 0.0023), and in both in the ON (−0.62 nU, p < 0.001) and in the normal appearing white matter of the optic radiation (−0.56 nU, p = 0.00071), with these being positively correlated (+0.57 nU, p = 0.00037). Conclusions: Subclinical microstructural injury affects the ON of ylPOMS. This may appear as MTsat changes before being detectable by other currently available testing. [ABSTRACT FROM AUTHOR]

Background: Exotropia is an eye misalignment in which one or both of the eyes turn outward due to congenital or acquired abnormalities of orbital structure, globe structure, extraocular muscle attachment and/or extraocular muscle location. Different treatment modalities are used in the treatment for exotropia: overminus lens therapy, prism therapy, occlusion therapy, extraocular muscle surgery, and orthoptic vision therapy. Purpose: To assess the efficacy of conservative treatment for exotropia depending on the baseline status of visual and binocular functions. Material and Methods: The study sample consisted of 51 patients with exotropia with their age ranging from 10 to 21 years. Of these, 24 (47.05%) had constant exotropia and 27 (52.95%) had intermittent exotropia (IXT). Of the 51 patients, 33 had a hyperopic refractive error of 0.5 to 6.5 diopters (D), and 18, a myopic refractive error of greater than -0.50 D to less than -5.5 D. Of the 51 patients, 27 had mild amblyopia, 22, moderate amblyopia, and 2, no amblyopia. The mean exotropia was 11.8 ± 3.12° by Hirschberg. Patients underwent a routine ophthalmological evaluation. In addition, the near point of convergence (NPC) was determined by the proximeter; the accommodative convergence-accommodation (AC/A) ratio was calculated by the heterophoria method (AC/A = ipd + (phoria at distance - phoria at near)/3, where ipd is the interpupillary distance in centimeters) and expressed in PD/D; fusional reserves were measured using the synoptophore; and binocular vision at distance and near, using the color test. Stereoacuity thresholds were assessed with the Lang-Stereotest II and Titmus Stereo Fly (circles and animals) tests at daylight at a viewing distance of 30 cm, and a Huvitz CCP3100 Chart Projector was used to assess whether stereopsis was present at a 5-m distance. Treatment procedures included optical correction, pleoptics, and direct occlusion in the presence of amblyopia, and orthoptic and diploptic treatment aimed at an improvement and strengthening of binocular functions (synoptophore, binocular vision training, Fialka apparatus, electric stimulation of the medial recti using Amplipuls apparatus, image fusion training using Mirage apparatus, electric stimulation of the medial recti, and computer-aided stereopsis training). Results: The angle of deviation at near and at distance decreased significantly in the constant exotropia group (p = 0.0001 and p = 0.0065, respectively). In the IXT group, the angle of deviation at distance decreased significantly (p = 0.0001), and the angle of deviation at near, not significantly. Binocular vision restored in 38% and 70% of patients in the constant exotropia group and the IXT group, respectively. Convergence and AC/A ratio values improved, but not statistically significantly (p > 0.05). Fusional reserves improved significantly, stereo vision restored, and stereopsis at near (stereoacuity threshold as assessed by the Lang II Stereotest) improved in both groups, whereas stereopsis at distance improved only in the IXT group, and was present in 65.6% of patients in this group (p = 0.01). In the group with orthotropia after conservative treatment, there were 32/51 children (62.7%) with a deviation less than 6° (12.0 PD). The group with post-treatment exotropia included 19/51 children (37.3%) with post-treatment deviation exceeding 6° (12.0 PD); these children underwent subsequent surgery. The model of conservative treatment success was found to (1) include four variables (the NPC, fusion on the synoptophore, AC/A ratio, and stereoacuity threshold as assessed by the Lang II Stereotest) and (2) to predict the outcome of conservative treatment in 80.9% of cases (R= 0.80902535). [ABSTRACT FROM AUTHOR]

We aimed to investigate whether associations between deficits in "mid-range" visual functions and deficits in higher-order visual cognitive functions in stroke patients are more in line with a hierarchical, two-pathway model of the visual brain, or with a patchwork model, which assumes a parallel organization with many processing routes and cross-talk. A group of 182 ischemic stroke patients was assessed with a new diagnostic set-up for the investigation of a comprehensive range of visuosensory mid-range functions: color, shape, location, orientation, correlated motion, contrast and texture. With logistic regression analyses we investigated the predictive value of these mid-range functions for deficits in visuoconstruction (Copy of the Rey-Complex Figure Test), visual emotion recognition (Ekman 60 Faces Test of the FEEST) and visual memory (computerized Doors-test). Results showed that performance on most mid-range visual tasks could not predict performance on higher-order visual cognitive tasks. Correlations were low to weak. Impaired visuoconstruction and visual memory were only modestly predicted by a worse location perception. Impaired emotion perception was modestly predicted by a worse orientation perception. In addition, double dissociations were found: there were patients with selective deficits in mid-range visual functions without higher-order visual deficits and vice versa. Our findings are not in line with the hierarchical, two-pathway model. Instead, the findings are more in line with alternative "patchwork" models, arguing for a parallel organization with many processing routes and cross-talk. However, future studies are needed to test these alternative models. [ABSTRACT FROM AUTHOR]

We reviewed the current state of knowledge regarding visual function and its suitability as part of medical examinations for driving licenses. We focused only on Group 1 drivers. According to previous studies, visual acuity, which is the most common test, is weakly associated with a higher risk of road accidents, with a greater role of visual field. The inclusion of the visual field test in medical examinations is therefore important, but the actual limit value is still unclear and further research in specific situations is needed. Color vision impairment was not found a threat to traffic safety. Contrast sensitivity decreases with age and is affected by abnormal eye conditions. Resulting glare can lead to an increased risk of traffic accidents during night driving in the elderly and others with conditions that impair contrast sensitivity. However, the universal cut-off limits have not been established either. The current European Union (EU) regulations therefore reflect minimum common denominator across the member states which may not entirely translate to optimal driving safety. Due to these open questions, standardized testing in simulators or on polygons that simulate real life conditions would be needed to better determine safe limits of visual function in different conditions. As there is a need to have better standardization across Europe regarding the requirements and rules regarding driving licenses in European countries, we first analyzed existing rules and compared them with each other, also in terms of deviations from the EU directive itself. We reviewed the literature in this field and prepared proposals for a more optimal regulation of the rules in the future. Particular attention is paid to the new method of examining the visual field that was created to respect the European directive. The paper can serve as a basis of information for research teams to design further protocols, as it gathers research findings to date on the importance and impact of various visual functions on driving safety, as well as a starting point for a debate on revising existing rules for obtaining and maintaining licenses, as it compares the current regulations in European countries and differences between them. [ABSTRACT FROM AUTHOR]

Visual and cognitive skills are key to successful functioning in highly demanding settings such as elite sports. However, their mutual influence and interdependencies are not sufficiently understood yet. This crosssectional study examined the relationship between visual skills and executive functions in elite soccer players. Fifty-nine male elite soccer players (age: 18-34 years) performed tests assessing visual clarity (left-, right-, and both eyes), contrast sensitivity, near-far quickness, and hand-eye coordination. Executive function measures included working memory capacity, cognitive flexibility, inhibition and selective attention. Overall, visual abilities were largely correlated with executive functions. Near-far quickness performance showed a large correlation with an executive function total score as well as with cognitive flexibility, working memory, and especially selective attention. Visual clarity and contrast sensitivity were moderately correlated with the cognition total score. Most consistent correlations with the visual functions were present for working memory. These findings present an overall vision-cognition relationship but also very specific linkages among subcategories of these functions, especially meaningful relations between near-far quickness, selective attention and cognitive flexibility. Further studies are needed to investigate the neuropsychological mechanisms accounting for the correlations and possible improvements of the executive functions by training specific visual skills. [ABSTRACT FROM AUTHOR]

We reviewed the current state of knowledge regarding visual function and its suitability as part of medical examinations for driving licenses. We focused only on Group 1 drivers. According to previous studies, visual acuity, which is the most common test, is weakly associated with a higher risk of road accidents, with a greater role of visual field. The inclusion of the visual field test in medical examinations is therefore important, but the actual limit value is still unclear and further research in specific situations is needed. Color vision impairment was not found a threat to traffic safety. Contrast sensitivity decreases with age and is affected by abnormal eye conditions. Resulting glare can lead to an increased risk of traffic accidents during night driving in the elderly and others with conditions that impair contrast sensitivity. However, the universal cut-off limits have not been established either. The current European Union (EU) regulations therefore reflect minimum common denominator across the member states which may not entirely translate to optimal driving safety. Due to these open questions, standardized testing in simulators or on polygons that simulate real life conditions would be needed to better determine safe limits of visual function in different conditions. As there is a need to have better standardization across Europe regarding the requirements and rules regarding driving licenses in European countries, we first analyzed existing rules and compared them with each other, also in terms of deviations from the EU directive itself. We reviewed the literature in this field and prepared proposals for a more optimal regulation of the rules in the future. Particular attention is paid to the new method of examining the visual field that was created to respect the European directive. The paper can serve as a basis of information for research teams to design further protocols, as it gathers research findings to date on the importance and impact of various visual functions on driving safety, as well as a starting point for a debate on revising existing rules for obtaining and maintaining licenses, as it compares the current regulations in European countries and differences between them.

Visual and cognitive skills are key to successful functioning in highly demanding settings such as elite sports. However, their mutual influence and interdependencies are not sufficiently understood yet. This cross-sectional study examined the relationship between visual skills and executive functions in elite soccer players. Fifty-nine male elite soccer players (age: 18–34 years) performed tests assessing visual clarity (left-, right-, and both eyes), contrast sensitivity, near-far quickness, and hand-eye coordination. Executive function measures included working memory capacity, cognitive flexibility, inhibition and selective attention. Overall, visual abilities were largely correlated with executive functions. Near-far quickness performance showed a large correlation with an executive function total score as well as with cognitive flexibility, working memory, and especially selective attention. Visual clarity and contrast sensitivity were moderately correlated with the cognition total score. Most consistent correlations with the visual functions were present for working memory. These findings present an overall vision-cognition relationship but also very specific linkages among subcategories of these functions, especially meaningful relations between near-far quickness, selective attention and cognitive flexibility. Further studies are needed to investigate the neuropsychological mechanisms accounting for the correlations and possible improvements of the executive functions by training specific visual skills.

The aim of the study was to verify the hypotheses that vergence-accommodation conflict (VAC) induced with head-mounted device (HMD) could cause symptoms in relation to changes in the accommodative-vergence system. In order to test this hypothesis, the Virtual Reality (VR) exposures were carried out in two types of VAC: VAC small and VAC large. Eighteen females, with a mean age of 22.5 ± 2.0 years, participated in two 30-minutes sessions with VR, which were separated by at least one week. Two sessions were differentiated by intensity of VAC presented in the VR system (VAC small and VAC large). Visual parameters were measured such as associated and dissociated phoria, accommodative response, the near point of convergence (NPC), fusional vergence ranges (FVR) and subjective complaints were measured using Simulator Sickness Questionnaire (SSQ). The parameters were measured immediately before (Pre-test) and after (Post-test) the VR exposure. The subjective symptoms as nausea, oculomotor disorders and disorientation increased significantly after 30-minutes of exposure on VAC large (P <0.05). The associated and dissociated phoria, lag of accommodation, FVR and the NPC did not significantly change after the VR exposure (P >0.05). Short-term use of HMD (30-min) did not significantly affect accommodative-vergence functions regardless of the size of VAC (VAC small and VAC large). However, the level of symptoms increased after VR sessions, which was probably related to inappropriate oculo-vestibular relationship. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of type 2 diabetes mellitus (T2DM) on visual functions, identify different modifiers as risk or protective factors, and find out how these factors affect patients' visual symptoms and visual functions as a whole. Methods: We performed an online survey among 1030 participants (400 patients, 630 non-patients). Demographic features and severity of disease were documented, while visual functions were evaluated using National Eye Institute Visual Functioning questionnaire-25 (NEI VFQ-25). Independent t-test, analysis of variance, linear and nonlinear regression models were used to assess all data. Results: Scores other than color vision among T2DM patients were significantly lower compared with non-T2DM participants. There was significant difference after stratification of age and education, but no significant difference between different genders was observed. Parameters including duration of T2DM, fasting plasma glucose (FPG) and glycosylated hemoglobin A1c (HbA1c) negatively impacted on the scores, with 20 years' of diabetic duration, 10 mmol/L of FPG, 7.5% of HbA1c being potential cut-off points. Poorer best corrected visual acuity (BCVA) and diagnosis of diabetic retinopathy were risk factors, while they simultaneously produced mediation effect, contributing 5%-78% of effect in the deterioration of visual functions caused by longer diabetic duration and higher blood glucose. Conclusion: Significant visual impairments and faster deterioration in visual functions were seen in T2DM patients, with older age, lower educational level, longer diabetic duration, poorer blood glucose administration, limited BCVA, and the presence of diabetic retinopathy identified as risk factors. Average BCVA and diabetic retinopathy also yielded mediation effect as diabetic duration lengthened and blood glucose elevated. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and Methods: We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age = 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic. Results: Based on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458). Conclusion: In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. [ABSTRACT FROM AUTHOR]

All sports have positive effects on health; however, in some cases, they may also have negative effects on the human body. In this narrative review, I explored the topics of vision and sun protection against sunlight in outdoor sports. The results on both eyes and skin protection against ultraviolet light were included. Accumulated knowledge in this area can help maintain health and improve competitiveness in the specialized field of outdoor sports. Visual functions and visual search strategies are important factors in outdoor and indoor sports events. Sports participants play and compete by relying on visual information. In outdoor sports, sunlight has a large effect on the eyes; thus, participants need to protect their eyes when playing sports. Participants in outdoor sports feel glare from the sunlight, which affects their performance and health. It is important to protect eyes with sunglasses because participants will be exercising outside for long periods of time. In addition, outdoor sports participants should protect their skin from ultraviolet light. Sunlight exposure is considered a serious risk factor for skin. The effectiveness of educational approaches for sun protection has also been examined in recent years. There have been reports on efforts to promote sun protection using the apps and wearable sensors. The current situation and issues related to sun protection for each outdoor sports event should be clarified. It is desirable for people to enjoy outdoor sports in an efficient and healthy manner. Thus, it is important to provide information about ultraviolet rays and ways to protect eyes and skin from childhood. [ABSTRACT FROM AUTHOR]

Purpose The aim was to assess visual functions in patients with retinoblastoma (Rb) after treatment and complete cure and the effect of this on quality of life by means of visual functioning questionnaire-39 (VFQ-39). Patients and methods A cross-sectional study was carried out in the period from July 2017 to February 2018 in Ophthalmology Department, Ain Shams University Hospital, Retinoblastoma Clinic. A total of 30 patients were recruited at least after 1 year of complete cure from Rb. They were classified into two groups: group I included unilateral cases (15 patients), and group II included bilateral cases (15 patients). All children were subjected to detailed history, and ophthalmological examination included best-corrected visual acuity (BCVA), binocular and color vision assessment, and dilated fundus examination. Scoring of VFQ-25 and VFQ-39 subscales was conducted by the parents. Results Mean overall vision-related quality of life scores were 90.5±10.45 (range: 60.9–100) and 89.1±8.59 (range: 76.1–100) in groups I and II, respectively, with no difference of statistical significance being found between them (P=0.86), with marked affection of mental health in group II. A highly statistically significant negative correlation was found between each of BCVA (logMAR) and duration of therapy and the mean total score (r: −0.57, P=0.001, and (r: −0.41, P=0.04, respectively). Conclusion High scores regarding VFQ-25 and VFQ-39 subscales were achieved in older children with Rb, with no difference between unilateral and bilateral cases. BCVA and duration of therapy had a big influence on the results.

AIM: To investigate the effect of cardiovascular risk factors on the occurrence of nonarteritic anterior ischemic optic neuropathy(NAION)and visual functions of the patients.METHODS: Sixty-eight patients diagnosed as initial ipsilateral NAION(68 eyes)in NAION group and another 68 patients(68 eyes)matched in age, gender and systemic diseases in Control group were selected from June 2014 to June 2016 were enrolled in this study and evaluated for their levels of homocysteine(Hcy), blood lipids, folic acid and vitamin B12, as well as carotid Doppler ultrasonography. The visual functions were also examined in patients with NAION.RESULTS: The levels of Hcy(24.8±13.9μmol/L), total plasma cholesterol(4.5±1.0mmol/L), triglyceride(2.0±0.9 mmol/L)and low-density lipoprotein(2.9±0.8mmol/L)in NAION patients were significantly higher(PPCONCLUSION: Hyperhomocysteinemia, hyperlipidemia and low vitamin B12 are the risk factors of in NAION patients. These risk factors, however, are not related to the extent of visual field damage. To some extent, the amplitude and peak latency of visual evoked potentials can reflect the extent of visual field damage.

The article focuses on the structure and the dynamics of partial functions of visual skills (visual segmentation – visual differentiation of the figure/background, visual differentiation of shapes and visual memory) children during their last year at nursery school and their first two years of school attendance as a part of the research project of the Faculty of Education, Palacký University Olomouc. The stimulus material of the investigation was made up of diagnostic and reeducation instruments by Viennese professor B. Sindelar. The Sindelar’s instrument has no norms, the aim of the investigation was to determine the median values of the performances in the aforementioned areas of visual perception of children and thus to determine the dynamics of the development of these functions in the intact population. The research sample consisted of children from pupils of Moravian and Prague schools – the last year of kindergarten and the first two years of elementary school, it was a deliberate and institutional sample selection. Since the survey had a quantitative design, a statistical procedure was used to analyze the collected data (median value, statistically significant difference between respondent groups was determined by the Mann–Whitney test). The results of the investigation were demonstrated by a table and a graph for each subtest.

Background: Age-related vision changes significantly contribute to fatal crashes at night among older drivers. However, the effects of lighting conditions on age-related vision changes and associated driving performance remain unclear., Objective: This pilot study examined the associations between visual function and driving performance assessed by a high-fidelity driving simulator among drivers 60 and older across 3 lighting conditions: daytime (photopic), nighttime (mesopic), and nighttime with glare., Methods: Active drivers aged 60 years or older participated in visual function assessments and simulated driving on a high-fidelity driving simulator. Visual acuity (VA), contrast sensitivity function (CSF), and visual field map (VFM) were measured using quantitative VA, quantitative CSF, and quantitative VFM procedures under photopic and mesopic conditions. VA and CSF were also obtained in the presence of glare in the mesopic condition. Two summary metrics, the area under the log CSF (AULCSF) and volume under the surface of VFM (VUSVFM), quantified CSF and VFM. Driving performance measures (average speed, SD of speed [SDspeed], SD of lane position (SDLP), and reaction time) were assessed under daytime, nighttime, and nighttime with glare conditions. Pearson correlations determined the associations between visual function and driving performance across the 3 lighting conditions., Results: Of the 20 drivers included, the average age was 70.3 years; 55% were male. Poor photopic VA was significantly correlated with greater SDspeed (r=0.26; P<.001) and greater SDLP (r=0.31; P<.001). Poor photopic AULCSF was correlated with greater SDLP (r=-0.22; P=.01). Poor mesopic VUSFVM was significantly correlated with slower average speed (r=-0.24; P=.007), larger SDspeed (r=-0.19; P=.04), greater SDLP (r=-0.22; P=.007), and longer reaction times (r=-0.22; P=.04) while driving at night. For functional vision in the mesopic condition with glare, poor VA was significantly correlated with longer reaction times (r=0.21; P=.046) while driving at night with glare; poor AULCSF was significantly correlated with slower speed (r=-0.32; P<.001), greater SDLP (r=-0.26; P=.001) and longer reaction times (r=-0.2; P=.04) while driving at night with glare. No other significant correlations were observed between visual function and driving performance under the same lighting conditions., Conclusions: Visual functions differentially affect driving performance in different lighting conditions among older drivers, with more substantial impacts on driving during nighttime, especially in glare. Additional research with larger sample sizes is needed to confirm these results., (©Jingzhen Yang, Enas Alshaikh, Deyue Yu, Thomas Kerwin, Christopher Rundus, Fangda Zhang, Cameron G Wrabel, Landon Perry, Zhong-Lin Lu. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.06.2024.)

Purpose. Analysis of visual functions in children in remote postoperative period after laser coagulation (LC) of threshold stages of retinopathy of prematurity (ROP).Patients and methods. In 2017, we selected and investigated 18 children, who previously had an LC of threshold stages of ROP in 2008–2009 in the Khabarovsk branch of the S.N. Fyodorov State Institution Eye Microsurgery Complex (continuous sampling method). There were 5 boys and 13 girls aged from 8 to 9 years at the time of LC. Anterior and posterior eye segments of the eyes (biomicroscopy, ophthalmoscopy), visual acuity, clinical refraction, concomitant pathology were evaluated.Results. We have revealed that regressive ROP after LC is characterized by the presence of serious anatomical and functional changes in the eyes. First, these are refractive disorders, which revealed in 90.5% of cases. Most often revealed: myopic refraction — 61% of all cases, of which more than half (53%) is its high degree; or its combination with compound myopic astigmatism (77% eyes); anisometropia was detected in 39% children. These refractive disorders led to the development of strabismus (61% children) and mixed amblyopia (60%). Despite the combined ophthalmologic pathology, 17% children developed visual functions with achievement of binocular vision, in most children visual functions still continue to develop, although they are not high due to amblyopia. High visual acuity (from 0.8 and above) in both eyes was formed in 22% children; visual acuity in the range of 0.5–0.7 in both eyes was formed in 17% children. Unfortunately, 44.5% children at the time of examination had low visual functions (in the range of 0.05–0.4) in both eyes. Extremely low visual acuity (from 0.01 to 0.04) in both eyes was identified in 11% children; absolute blindness in one of the eyes was in 11% children.Conclusions. LC is reliable way to prevent vision loss from retinal detachment in children with threshold stages of ROP.

Aim of the study: The purpose of this study was to investigate the influence of multifocal contact lenses with medium and high additions (ADD: +2.00 D and +4.00 D) on short-term visual functions in a young, healthy adult population. Additionally, the impact of central zone size (3 mm and 4.5 mm) on visual functions was analyzed. Material and methods: Each subject (N = 24) was fitted with three different designs of soft contact lenses: (1) distance power plano with ADD +2.00 D (Relax, SwissLens) - ADD2, (2) distance power plano with ADD +4.00 D (Relax, SwissLens) - ADD4, (3) single vision spherical plano lenses (Orbis, SwissLens) - ADD0. In each pair of lenses, near and distance visual acuity (VA), the consensual response of accommodation (using the photorefraction method), accommodation facility and peripheral contrast sensitivity were measured. Results: Mean distance VA decreased with lenses with a 3 mm central zone size compared to a 4.5 mm central zone size (p = 0.019) and with ADD2 power compared to ADD0 (p = 0.004) in both central zone size groups. There was no statistically significant effect of ADD power or central zone size on near VA. The size of the central zone influenced contrast sensitivity functions (the area under the log contrast sensitivity function was 5.8 vs. 6.7, for 3 mm and 4.5 mm central zone size, respectively, p < 0.001). The mean lag of accommodation increased with ADD (p = 0.003). The slope of the linear function of accommodation was lower for ADD2 and ADD4 lenses (p = 0.005) and this effect was observed for both central zone sizes. Conclusions: Higher addition (ADD4) powers influenced shortterm visual functions in a similar way to that of medium (ADD2) addition powers in tested multifocal lens. The decrease of distant VA and increase in accommodative lag were observed with higher and medium addition powers. Because the size of the central distance zone negatively influenced some visual functions, this parameter should be considered individually in the fitting of soft multifocal contact lenses for myopia control. [ABSTRACT FROM AUTHOR]

Background: Blue-blocking lenses (BBLs) are marketed as providing retinal protection from acute and cumulative exposure to blue light over time. The selective reduction in visible wavelengths transmitted through BBLs is known to influence the photosensitivity of retinal photoreceptors, which affects both visual and non-visual functions. This study measured the spectral transmittance of BBLs and evaluated their effect on blue perception, scotopic vision, circadian rhythm, and protection from photochemical retinal damage.Methods: Seven different types of BBLs from six manufacturers and untinted control lenses with three different powers (+2.00 D, -2.00 D and Plano) were evaluated. The whiteness index of BBLs used in this study was calculated using Commission International de l'Eclairage (CIE) Standard Illuminates D65, and CIE 1964 Standard with a 2° Observer. The protective qualities of BBLs and their effect on blue perception, scotopic vision, and circadian rhythm were evaluated based on their spectral transmittance, which was measured with a Cary 5,000 UV-Vis-NIR spectrophotometer.Results: BBLs were found to reduce blue light (400-500 nm) by 6-43 per cent, providing significant protection from photochemical retinal damage compared to control lenses (p ≤ 0.05). All BBLs were capable of reducing the perception of blue colours, scotopic sensitivities and circadian sensitivities by 5-36 per cent, 5-24 per cent, and 4-27 per cent, respectively depending on the brand and power of the lens.Conclusion: BBLs can provide some protection to the human eye from photochemical retinal damage by reducing a portion of blue light that may affect visual and non-visual performances, such as those critical to scotopic vision, blue perception, and circadian rhythm. [ABSTRACT FROM AUTHOR]

Background: Vision is an adaptive function and should be considered a prerequisite for neurodevelopment because it permits the organization and the comprehension of the sensory data collected by the visual system during daily life. For this reason, the influence of visual functions on neuromotor, cognitive, and emotional development has been investigated by several studies that have highlighted how visual functions can drive the organization and maturation of human behavior. Recent studies on animals and human models have indicated that visual functions mature gradually during post-natal life, and its development is closely linked to environment and experience. Discussion: The role of vision in early brain development and some of the neuroplasticity mechanisms that have been described in the presence of cerebral damage during childhood are analyzed in this review, according to a neurorehabilitation prospective. [ABSTRACT FROM AUTHOR]

The aims of this paper were to determine the development dynamics of visual organization ability and its relation to success in Serbian Language, Mathematics, and The World around Us subjects in younger schoolchildren. The sample included 80 typically developing students, 7-11 years of age (age in months: M=113.8; SD=14.5), attending 1st-4th grade of elementary school. Visual organization was assessed by a set of four tasks in which the participants were expected to complete images and shapes, identify unclear and incomplete drawings, identify elements on folded drawings, and observe the differences between visual stimuli. The maximum number of points for each task was 20, and thus the maximum total score of visual organization was 80 points. Descriptive statistical measures, Pearson correlation coefficient, χ2 test, single-factor and multivariate analysis of variance were used in data processing. The results analysis determined the presence of low and moderate statistically significant correlations between achievements on all tasks assessing visual organization. School age was a significant factor of total achievement on tasks assessing visual organization (p≤000), accounting for somewhat more than 35% of achievement variability, with statistical significance being based on poorer achievements (p≤0,000) of the youngest group of participants (first grade students). Achievement on tasks involving completing images and shapes, identifying unclear and incomplete drawings, and observing differences, significantly correlated with success in Serbian Language and Mathematics, while the total score significantly correlated with success in The World around Us.

Purpose: clinical monitoring of functional parameters in patients with early stage of age-related macular degeneration (AMD) receiving the dietary supplement Retinorm. Patients and methods: clinical monitoring was conducted during 5 months in 40 patients aged 42–75 years with AMD-manifestations in the form of dry drusen and pigment epithelium defects typed as «geographic atrophy». The main group (20 subjects, 35 eyes) received dietary supplement Retinorm (1 capsule 3 times daily for two months with a month break and repeated admission rate, similar to the first). Patients also received instillations of Visomitin® with3 time daily by such mode: using of instillations 2 months, 1 month break, after that — continuation of instillations during 2 months. The control group (20 subjects, 34 eyes) received only Visomitin® instillations 3 times daily by the same scheme as group I. Checking of visual acuity with maximal correction, static computer perimetry, the optical coherent tomography of retina central area, definition of critical flicker frequency (CFF), retinal electrical sensitivity and optic nerve electrical lability were used as the examination methods. Results: Indicated therapy in the main group improved the monitored functional parameters. Increase of uncorrected visual acuity and the best corrected visual acuity, decrease of relative and absolute scotomas amount in central area of the visual field, increasing of CFF (p

Background and Objective Addiction to computer gaming has become a social problem in Korea and elsewhere, and it has been enlisted as a mental health disorder by the World Health Organization. Most studies related to computer use and vision have individually assessed physical and ocular symptoms and binocular vision. Accordingly, the present study comprehensively assessed subjective physical and ocular symptoms and functions related to binocular vision after prolonged continuous computer gaming. This study aimed to investigate the effects of prolonged continuous computer gaming on physical and ocular health and visual functions in young healthy individuals. Methods Fifty healthy college students (35 male/15 female), aged 19–35 years old, were enrolled in this study. The inclusion criteria were no binocular vision problems and no reported history of ocular disease. Participants played continuously for 4 h from 6:00 to 10:00 p.m. Physical and ocular symptoms and visual functions such as convergence, accommodation, phoria, and the blink rate were assessed before and after continuous computer gaming for 4 h. Results Continuous computer gaming for 4 h resulted in convergence and accommodation disturbances and increased physical and ocular discomfort. Near phoria showed an exophoric shift, whereas distance phoria showed no change. Moreover, the accommodative and vergence facilities and blink rate were significantly decreased. All visual functions recovered to the baseline levels by the following morning. Discussion Our findings suggest that excessive and continuous computer gaming impairs visual functions and causes ocular and physical fatigue. Our findings further the understanding of the adverse effects of excessive computer use on physical and ocular health, and adequate breaks are necessary to reduce physical and visual discomfort during computer gaming.

Purpose The aim was to assess visual functions in patients with retinoblastoma (Rb) after treatment and complete cure and the effect of this on quality of life by means of visual functioning questionnaire-39 (VFQ-39). Patients and methods A cross-sectional study was carried out in the period from July 2017 to February 2018 in Ophthalmology Department, Ain Shams University Hospital, Retinoblastoma Clinic. A total of 30 patients were recruited at least after 1 year of complete cure from Rb. They were classified into two groups: group I included unilateral cases (15 patients), and group II included bilateral cases (15 patients). All children were subjected to detailed history, and ophthalmological examination included best-corrected visual acuity (BCVA), binocular and color vision assessment, and dilated fundus examination. Scoring of VFQ-25 and VFQ-39 subscales was conducted by the parents. Results Mean overall vision-related quality of life scores were 90.5±10.45 (range: 60.9-100) and 89.1±8.59 (range: 76.1-100) in groups I and II, respectively, with no difference of statistical significance being found between them (P=0.86), with marked affection of mental health in group II. A highly statistically significant negative correlation was found between each of BCVA (logMAR) and duration of therapy and the mean total score (r: -0.57, P=0.001, and (r: -0.41, P=0.04, respectively). Conclusion High scores regarding VFQ-25 and VFQ-39 subscales were achieved in older children with Rb, with no difference between unilateral and bilateral cases. BCVA and duration of therapy had a big influence on the results. [ABSTRACT FROM AUTHOR]

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Purpose: Visual evoked potential (VEP) is an important non-invasive tool used to augment the functions of the visual system. The present study aims to present the VEP recorded among Nepalese subjects with oculocutaneous albinism (OCA) and its correlation with clinical findings. Methods: In a cross-sectional study, 10 consecutive subjects with OCA and 10 age-/sexmatched normal subjects were selected for a pattern reversal VEP test using the Retiscan Roland electrophysiological diagnostic system. Apart from VEP, OCA subjects' anterior and posterior segments were examined to record clinical findings. Contrast sensitivity with the Pelli-Robson chart, colour vision with the Farnsworth D-15 test, stereopsis with the Titmus vectographic plates, and cycloplegic refraction were also performed. Statistical analysis included paired t-test, independent sample t-test, and multiple linear regression analysis. Results: Clinical OCA features seen in study patients included horizontal pendular nystagmus in seven subjects, strabismus in four subjects, iris transillumination in seven subjects, disc hypoplasia in two subjects, and macular hypoplasia in four subjects. The mean VEP amplitudes were found to be significantly lower in subjects with albinism than in normal subjects in both right and left eyes for all frequencies. Strabismus (p<0.001 for N75-P100, low frequency; p<0.001 for N75-P100, high frequency; and p=0.021 for P100-N135, high frequency) and nystagmus (p=0.004 for P100-N135, high frequency and p=0.044 for P100-N135, low frequency) were significantly correlated with the amplitudes of pattern VEP. Mostly, P100-N135 high frequency was associated with clinical findings. Conclusion: The amplitude of pattern reversal VEP is significantly reduced in albinism, which is correlated with strabismus and nystagmus. [ABSTRACT FROM AUTHOR]

Background: The cone adaptation test is to detect retinitis pigmentosa (RP) cases confirmed by electroretinogram (ERG). We present the validity and cost-effectiveness of cone adaptation test as a screening tool for detecting RP. Methods: This cross-sectional study was conducted between November 2013 and December 2013. All RP cases diagnosed by ophthalmologists of H. V. Desai Eye Hospital in the last 5 years were participated in this study. The cone adaptation test was done in photopic and scotopic illumination. Failed test means 10 s or more to complete the test under scotopic illumination. A technician who was masked for cone adaptation test finding carried out ERG. Demographics, symptoms, and history of treatment were inquired. Those with flat ERG wave in scotopic condition and corresponding clinical findings were defined as having RP. Sensitivity, specificity, and false-positive and false-negative parameters of validity were estimated. The unit cost of performing test and ERG was calculated. Results: All 32 RP patients (28 male, age median 23.5 ΁ 14.5 years) had a vision more than 6/60 and flat wave in ERG under mesopic/scotopic illumination. Thirty-one participants failed cone adaptation test. The sensitivity was 31/32 Χ 100 = 97%. The specificity was 100%. There was no false-positive case. Consanguinity rate among parents was 43%. The cost of testing one child using "cone adaptation test kit" was 2.5 US $. The unit cost of diagnosing RP using ERG was 10 US $. Conclusion: Cone adaptation is a valid and cost-effective screening tool test for RP. The consanguinity rate among parents of an RP patient was high.

Purpose: To investigate the visual functions of truck drivers of the Kingdom of Saudi Arabia (KSA) in the region of Qassim and Dammam and to see if is there any association between these visual functions and self-reported road traffic accidents (RTA)., Methods: It is a cross-sectional, descriptive study. LogMAR visual acuity, refractive error, color vision, stereopsis, and confrontation visual fields were measured in 300 truck drivers in the Qassim and Dammam regions of KSA. Driving-related history and incidence of RTA from the past 3 years, systemic history, and general eye compliance history were collected through a self-reporting questionnaire., Results: Among 300 truck drivers examined, 54 (18.4%) subjects have a refractive error, 14 (4.7%) subjects have color vision deficiency, 37 (12.2%) subjects have abnormal stereo acuity, and none of them have confrontation visual field defect. RTA was reported in 25 (8.3%) subjects. The current study has found RTA is significantly associated with refractive error ( P = 0.01) and abnormal stereopsis ( P < 0.01). Systemic history revealed that 11% of the subjects had diabetes mellitus., Conclusion: The current study is the first to report on the visual functions of KSA truck drivers. Hence, the current study has found a significant association between visual functions and RTA among truck drivers, we recommend a comprehensive examination need to be part of issuing driver's licenses in KSA. More studies with larger samples from different regions of KSA are needed to extrapolate these findings., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Saudi Journal of Ophthalmology.)

AIM:To compare posterior capsule opacification (PCO) degree and visual functions after phacoemulsification in eyes implanted with 360-degree square edge hydrophilic acrylic intraocular lens (IOL) (570C C-flex, Rayner) and sharp edge hydrophobic acrylic IOL (Sensar AR40e, AMO) in diabetic patients.METHODS:Sixty diabetic patients underwent uneventful phacoemulsification and randomly implanted one of the two IOLs. The PCO value was measured by retroillumination photographs and Evaluation of Posterior Capsule Opacification (EPCO) 2000 image-analysis software at 1, 6, 12, and 24mo after surgery. Visual acuity, and contrast sensitivity in photopic and mesopic conditions were also examined at each follow up time point. The incidence of eye that required Nd:YAG laser posterior capsulotomy were also compared.RESULTS:There was not any statistically significant difference in PCO scores between Rayner C-flex 570C group and Sensar AR40e group at each follow up time point. Visual acuity, Nd:YAG capsulotomy incidence and contrast sensitivity also had no significant difference during the 24mo follow-up.CONCLUSION: For diabetic patients, Rayner 570C C-flex and Sensar AR40e IOLs are same effective for prevent PCO. The 360-degree square edge design maybe is a good alternative technique to improve PCO prevention.

Background The aim of this study was to report the vision-related quality of life (QoL) in Pakistani subjects with early or moderate glaucoma. Methods This case control study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from 1 January 2014 to 31 December 2015. All the patients having early or moderate glaucoma, with a disease duration of at least 6 mo, and presenting during the study period, were included. Subjects in the control group were recruited from the hospital volunteer staff, spouses and friends of patients. QoL assessment was done using the NEIVFQ25 questionnaire translated into the Urdu language. A two-tailed t-test was used to test the significance of difference between the mean QoL scores and a p-value of ≤0.05 was considered significant. Multiple linear regression was carried out to assess the predictors of QoL scores. Results A total of 698 participants were enrolled, including 247 cases and 451 controls. The mean QoL score was higher in controls 81.31 (mean=81.31, SD=26.33) than in cases (mean=53.89, SD=30.32), p<0.001. The lowest NEIVFQ-25 scores for glaucoma patients were for mental health (mean=23.88, SD=28.80) followed by general vision (mean=27.73, SD=29.74). The difference in all the mean subscale scores of two groups was statistically significant (p<0.001). Conclusion QoL scores are significantly reduced in Pakistani glaucoma patients with early and moderate glaucoma, with more pronounced effect on mental health and general vision. [ABSTRACT FROM AUTHOR]

Purpose: One of the main reasons for apoptosis and dormant cell phases in degenerative retinal diseases such as retinitis pigmentosa (RP) is growth factor withdrawal in the cellular microenvironment. Growth factors and neurotrophins can significantly slow down retinal degeneration and cell death in animal models. One possible source of autologous growth factors is platelet-rich plasma. The purpose of this study was to determine if subtenon injections of autologous platelet-rich plasma (aPRP) can have beneficial effects on visual function in RP patients by reactivating dormant photoreceptors.Material and methods: This prospective open-label clinical trial, conducted between September 2016 and February 2017, involved 71 eyes belonging to 48 RP patients with various degrees of narrowed visual field. Forty-nine eyes belonging to 37 patients were injected with aPRP. A comparison group was made up of 11 patients who had symmetrical bilateral narrowed visual field (VF) of both eyes. Among these 11 patients, one eye was injected with aPRP, while the other eye was injected with autologous platelet-poor plasma (aPPP) to serve as a control. The total duration of the study was 9 weeks: the aPRP or aPPP subtenon injections were applied three times, with 3-week intervals between injections, and the patients were followed for three more weeks after the third injection. Visual acuity (VA) tests were conducted on all patients, and VF, microperimetry (MP), and multifocal electroretinography (mfERG) tests were conducted on suitable patients to evaluate the visual function changes before and after the aPRP or aPPP injections.Results: The best-corrected visual acuity values in the ETDRS chart improved by 11.6 letters (from 70 to 81.6 letters) in 19 of 48 eyes following aPRP application; this result, however, was not statistically significant (p = 0.056). Following aPRP injections in 48 eyes, the mean deviation of the VF values improved from − 25.3 to − 23.1 dB (p = 0.0001). Results regarding the mfERG P1 amplitudes improved in ring 1 from 24.4 to 38.5 nv/deg2 (p = 0.0001), in ring 2 from 6.7 to 9.3 nv/deg2 (p = 0.0301), and in ring 3 from 3.5 to 4.5 nv/deg2 (p = 0.0329). The mfERG P1 implicit times improved in ring 1 from 40.0 to 34.4 ms (p = 0.01), in ring 2 from 42.5 to 33.2 ms (p = 0.01), and in ring 3 from 42.1 to 37.9 ms (p = 0.04). The mfERG N1 amplitudes improved in ring 1 from 0.18 to 0.25 nv/deg2 (p = 0.011) and in ring 2 from 0.05 to 0.08 nv/deg2 (p = 0.014). The mfERG N1 implicit time also improved in ring 1 from 18.9 to 16.2 ms (p = 0.040) and in ring 2 from 20.9 to 15.5 ms (p = 0.002). No improvement was seen in the 11 control eyes into which aPPP was injected. In the 23 RP patients with macular involvement, the MP average threshold values improved with aPRP injections from 15.0 to 16.4 dB (p = 0.0001). No ocular or systemic adverse events related to the injections or aPRP were observed during the follow-up period.Conclusion: Preliminary clinical results are encouraging in terms of statistically significant improvements in VF, mfERG values, and MP. The subtenon injection of aPRP seems to be a therapeutic option for treatment and might lead to positive results in the vision of RP patients. Long-term results regarding adverse events are unknown. There have not been any serious adverse events and any ophthalmic or systemic side effects for 1 year follow-up. Further studies with long-term follow-up are needed to determine the duration of efficacy and the frequency of application. [ABSTRACT FROM AUTHOR]

Background : We assessed visual functioning of the children with special needs in Oman between 2009 and 2012. We present the methods of assessing different visual functions, outcomes and interventions carried out to improve their functioning. Materials and Methods : In this case series type of study, optometrists assessed visual functions of children of "day care centers" in Oman. Experts further assessed them and provided low vision care. Ocular movements, refractive corrections, near, distance, contrast color, motion, field of vision and cognitive, visual function test results were noted. Feedback to caregivers was given to improving visual functioning of these children. Results: We grouped 321 participants, (196 (61.1%) boys, age range of 3-18 years) into 61; Down syndrome (DS), 72 with intellectual disabilities, 67; hearing impaired and 121 with other conditions. Refractive error and lag of accommodation was 26 (42.6%) and 14 (22.6%) among children with DS. Contrast sensitivity was impaired in 8 (12.7%) among hearing impaired children. Defective distant and near vision was in 162 (70%) and 104 (42%) of our cohort. Children with intellectual disability were most difficult to assess. Children in group of other disabilities′′ had a higher proportion of impaired visual functioning. They were given low vision aids (telescopes (22), filters (7) and magnifiers (3)) in large numbers compared to those in other groups. Conclusions : The outcomes of assessment of visual functioning of children with other disabilities show great variation and difficult to group. The care therefore should be individual. All visual functions cannot be assessed at one time.

Purpose: This study was undertaken to find correlations between visual functions and visual disabilities in patients with diabetic retinopathy. Method: A cross-sectional study was carried out among 38 visually impaired diabetic retinopathy subjects at the Low Vision Clinic of B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu. The subjects underwent assessment of distance and near visual acuity, objective and subjective refraction, contrast sensitivity, color vision, and central and peripheral visual fields. The visual disabilities of each subject in their daily lives were evaluated using a standard questionnaire. Multiple regression analysis between visual functions and visual disabilities index was assessed. Result: The majority of subjects (42.1%) were of the age group 60–70 years. Best corrected visual acuity was found to be 0.73 ± 0.2 in the better eye and 0.93 ± 0.27 in the worse eye, which was significantly different at p = 0.002. Visual disability scores were significantly higher for legibility of letters (1.2 ± 0.3) and sentences (1.4 ± 0.4), and least for clothing (0.7 ± 0.3). Visual disability index for legibility of letters and sentences was significantly correlated with near visual acuity and peripheral visual field. Contrast sensitivity was also significantly correlated with the visual disability index, and total scores. Conclusion: Impairment of near visual acuity, contrast sensitivity, and peripheral visual field correlated significantly with different types of visual disability. Hence, these clinical tests should be an integral part of the visual assessment of diabetic eyes.