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Scientific Reports Nov 2023Glaucoma is a slowly progressing optic neuropathy that may eventually lead to blindness. To help patients receive customized treatment, predicting how quickly the...
Glaucoma is a slowly progressing optic neuropathy that may eventually lead to blindness. To help patients receive customized treatment, predicting how quickly the disease will progress is important. Structural assessment using optical coherence tomography (OCT) can be used to visualize glaucomatous optic nerve and retinal damage, while functional visual field (VF) tests can be used to measure the extent of vision loss. However, VF testing is patient-dependent and highly inconsistent, making it difficult to track glaucoma progression. In this work, we developed a multimodal deep learning model comprising a convolutional neural network (CNN) and a long short-term memory (LSTM) network, for glaucoma progression prediction. We used OCT images, VF values, demographic and clinical data of 86 glaucoma patients with five visits over 12 months. The proposed method was used to predict VF changes 12 months after the first visit by combining past multimodal inputs with synthesized future images generated using generative adversarial network (GAN). The patients were classified into two classes based on their VF mean deviation (MD) decline: slow progressors (< 3 dB) and fast progressors (> 3 dB). We showed that our generative model-based novel approach can achieve the best AUC of 0.83 for predicting the progression 6 months earlier. Further, the use of synthetic future images enabled the model to accurately predict the vision loss even earlier (9 months earlier) with an AUC of 0.81, compared to using only structural (AUC = 0.68) or only functional measures (AUC = 0.72). This study provides valuable insights into the potential of using synthetic follow-up OCT images for early detection of glaucoma progression.
Topics: Humans; Deep Learning; Visual Fields; Intraocular Pressure; Disease Progression; Glaucoma; Visual Field Tests; Blindness; Vision Disorders; Tomography, Optical Coherence
PubMed: 37968437
DOI: 10.1038/s41598-023-46253-2 -
Progress in Retinal and Eye Research Jul 2024Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic... (Review)
Review
Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic diagnosis and therapy, and because a significant lack of comparability between reading charts still exists, there is an increasing need for a worldwide standard in the form of a norm for diagnostic reading charts. Already, applied advancements such as digital print, which allow a calibration of the print sizes of reading charts in correctly progressing geometric proportions by using the actual height of a lower case "x" in millimeters (x-height), and psychophysically standardizing reading charts and their test items by applying modern statistical methods have significantly contributed to establishing a norm for reading charts. In 2020, a proposal of the British delegation was accepted by the International Organization for Standardization (ISO) group "Visual Optics and Optical Instruments," and a working group was established. Bearing in mind the efforts of the ISO with regard to an international norm, this review article is intended to (a) give an overview of the historical background and related normative approaches for diagnostic reading tests used in ophthalmology and optometry, (b) explain psychophysical and technical concerns, and (c) discuss the possibilities and limits of concepts that seem relevant to developing a modern standard for reading charts.
Topics: Humans; Reading; Vision Tests; Visual Acuity; Ophthalmology; Reference Standards
PubMed: 38574851
DOI: 10.1016/j.preteyeres.2024.101262 -
Survey of Ophthalmology 2024Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with... (Review)
Review
Microperimetry is an emerging technology that provides concurrent analysis of retinal structure and function by combining retinal sensitivity and fixation analysis with fundus imaging. We summarize the substantial evidence validating the evolving role of microperimetry as an adjunctive assessment of visual function in the perioperative setting. We show that microperimetry provides useful complementary information to other established imaging and functional modalities in the perioperative setting for a wide range of vitreoretinal surgical procedures, as well as in cataract and refractive surgeries. This includes preoperative uses such as prognostication of visual and anatomical outcomes, timing of surgical intervention, and assessment of patient suitability for surgery-as well as postoperative uses including quantification of visual recovery, investigation of unexplained postoperative vision loss, and informing expected long term functional outcomes.
Topics: Humans; Visual Fields; Visual Field Tests; Retina; Fundus Oculi; Vision, Ocular; Vision Disorders
PubMed: 37918576
DOI: 10.1016/j.survophthal.2023.10.011 -
Optometry and Vision Science : Official... Nov 2023Recently, novel refraction technology allows subjective refractions to be performed with a higher-resolution. It is unclear, however, if these benefits are noticed and... (Randomized Controlled Trial)
Randomized Controlled Trial
SIGNIFICANCE
Recently, novel refraction technology allows subjective refractions to be performed with a higher-resolution. It is unclear, however, if these benefits are noticed and appreciated by the patient during the examination and after dispensing.
PURPOSE
This study investigated benefits and drawbacks of high-resolution refraction technology over standard, specifically in terms of the refraction, glasses prescription, and participant's perceptions of the technology.
METHODS
Sixty progressive-addition-lens wearers (aged 35 to 70 years) and 60 single-vision wearers (18 years or older) were randomized to a high-resolution refraction (Vision-R 800; Essilor Instruments, Dallas, TX; essilorinstrumentsusa.com ) and standard refraction in a 2-week crossover dispensing design. Refractive results were converted to M, J0, and J45 and analyzed using multivariate t tests. Bayesian estimation was used to analyze differences between refraction type and age group for subjective outcomes.
RESULTS
Differences in refractive error between the two refractions were small, and none differed statistically ( P > .05) or clinically (e.g., <0.25 D) in either subgroup. Visual acuities at distance and near were better than 0.00 logMAR; none of the mean differences between the refractions reached statistical or clinical (e.g., <0.10 D) significance. Participants significantly preferred the high-resolution refraction for its quickness and efficiency, improved comfort, and less stress. Bayesian analysis indicated a 76% probability that participants had higher confidence in the high-resolution refraction, 93% probability that they would seek it out for their care, and 94% probability that they would recommend an optometrist using this technology.
CONCLUSIONS
Refractive and acuity endpoints were similar with the high-resolution and standard refraction. Participants, however, perceived several key benefits of the high-resolution refraction and prescription for their care, the care of their friends/family, and the practice itself.
Topics: Humans; Bayes Theorem; Prescriptions; Refraction, Ocular; Refractive Errors; Reproducibility of Results; Vision Tests; Visual Acuity; Adult; Middle Aged; Aged; Adolescent
PubMed: 37861987
DOI: 10.1097/OPX.0000000000002076 -
International Ophthalmology Sep 2023To evaluate fixation characteristics in amblyopia using macular analyzer integrity assessment (MAIA) microperimetry and to investigate the factors affecting fixation...
PURPOSE
To evaluate fixation characteristics in amblyopia using macular analyzer integrity assessment (MAIA) microperimetry and to investigate the factors affecting fixation stability.
METHODS
This prospective, cross-sectional study enrolled a total of 58 amblyopic patients who were between 8 and 55 years old. Average threshold macular sensitivity (AT) and fixation characteristics were assessed using MAIA microperimetry. Two Bivariate contour ellipse area (BCEA) fixation indices (63% and 95% proportional values) and the percentage of fixation points within 1° and 2° from the fovea (P1 and P2) were used to assess fixation stability. Non-amblyopic fellow eyes were used as the control group for comparison.
RESULTS
AT and fixation stability indices (P1, P2, BCEA 63%, BCEA 95%) were worse in the amblyopic eyes than in the fellow eyes (p < 0.05, for all indices). There was a moderate positive correlation between best corrected visual acuity (BCVA), and AT, and P2, and a moderate negative correlation between BCVA, and BCEA indices. 48% of the eyes were eccentrically fixating (the percentage was 25% in the anisometropic group, 52% in the strabismic group, and 69% in the combined group) and 32% in the non-amblyopic eye (p = 0.052). The preferred fixation eccentricity in amblyopic eyes was significantly greater than the non-amblyopic eyes (p = 0.004), and there was a negative correlation between preferred fixation eccentricity and BCVA (p = 0.012, r = - 0.327).
CONCLUSIONS
Our data showed a decrease in fixation stability, a positive correlation between fixation stability and BCVA, and a negative correlation between preferred fixation eccentricity and BCVA in amblyopic eyes.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Middle Aged; Amblyopia; Visual Acuity; Visual Field Tests; Fixation, Ocular; Cross-Sectional Studies; Prospective Studies; Fovea Centralis
PubMed: 37184805
DOI: 10.1007/s10792-023-02748-5 -
Vision Research Aug 2023Adaptation to contrast has been known and studied for 50 years, and the functional importance of dynamic gain control mechanisms is widely recognized. Understanding of...
Adaptation to contrast has been known and studied for 50 years, and the functional importance of dynamic gain control mechanisms is widely recognized. Understanding of binocular combination and binocular fusion has also advanced in the last 20 years, but aside from interocular transfer (IOT), we still know little about binocular properties of contrast adaptation. Our observers adapted to a high contrast 3.6 c/deg grating, and we assessed contrast detection and discrimination across a wide range of test contrasts (plotted as threshold vs contrast [TvC] functions). For each combination of adapt/test eye(s), the adapted TvC data followed a 'dipper' curve similar to the unadapted data, but displaced obliquely to higher contrasts. Adaptation had effectively re-scaled all contrasts by a common factor Cs that varied with the combination of adapt and test eye(s). Cs was well described by a simple 2-parameter model that had separate monocular and binocular gain controls, sited before and after binocular summation respectively. When these two levels of adaptation were inserted into an existing model for contrast discrimination, the extended 2-stage model gave a good account of the TvC functions, their shape invariance with adaptation, and the contrast scaling factors. The underlying contrast-response function is of almost constant shape, and adaptation shifts it to higher contrasts by the factor log(Cs) - a 'pure contrast gain control'. Evidence of partial IOT in cat V1 cells supports the 2-stage scheme, but is not consistent with a classic (single-stage) model.
Topics: Humans; Vision, Binocular; Contrast Sensitivity; Sensory Thresholds; Vision, Ocular; Vision, Monocular
PubMed: 37300947
DOI: 10.1016/j.visres.2023.108261 -
Graefe's Archive For Clinical and... Mar 2024The purpose of this study is to investigate test-retest reliability and agreement of the quantitative contrast sensitivity function test (qCSF) in the retina clinic.
PURPOSE
The purpose of this study is to investigate test-retest reliability and agreement of the quantitative contrast sensitivity function test (qCSF) in the retina clinic.
METHODS
A total of 121 right eyes of 121 patients were tested and consecutively re-tested with qCSF in the retina clinic. Outcomes included area under the logarithm of contrast sensitivity function curve (AULCSF), contrast acuity, and contrast sensitivity thresholds at 1-18 cycles per degree (cpd). Test-retest means were compared with paired t-test, variability was compared with the Brown-Forsythe test, and intraclass correlation coefficient (ICC) and Bland Altman plots evaluated reliability and agreement.
RESULTS
Mean test-retest differences for all qCSF metrics ranged from 0.02 to 0.05 log units without statistically significant differences in variability. Standard deviations ranged from 0.08 to 0.14. Coefficients of repeatability ranged from 0.16 to 0.27 log units. ICC > 0.9 for all metrics except 1cpd (ICC = 0.84, all p < 0.001); AULCSF ICC = 0.971.
CONCLUSION
qCSF-measured contrast sensitivity shows great test-retest repeatability and agreement in the retina clinic.
Topics: Humans; Contrast Sensitivity; Reproducibility of Results; Vision Tests; Retina
PubMed: 37955702
DOI: 10.1007/s00417-023-06291-y -
Contact Lens & Anterior Eye : the... Oct 2023This study aimed to evaluate the visual performance and image quality of concentric dual-focus-designed contact lenses (CLs) compared with single-vision CLs in myopic...
OBJECTIVE
This study aimed to evaluate the visual performance and image quality of concentric dual-focus-designed contact lenses (CLs) compared with single-vision CLs in myopic Chinese people.
METHODS
Twenty myopic volunteers aged between 18 and 26 years were recruited at a university eye hospital to wear both defocus-incorporated soft contact (DISC) lenses and single-vision CLs for 1 week in random order. High- and low-contrast visual acuity (VA), contrast sensitivity (CS), ocular higher-order aberrations (HOA), Strehl ratio and the Quality of Vision (QoV) questionnaire were assessed with each type of CL at weekly follow-up.
RESULTS
Distance VA was not affected by DISC lenses compared to single-vision CLs in either high (p = 0.414) or low contrast (p = 0.431). However, there was a significant reduction in low-contrast near VA with DISC lenses compared with single-vision CLs (p = 0.011). The differences of CS between DISC lenses and single-vision CLs were significantly associated with lighting conditions and spatial frequencies (F = 128.81, P < 0.001). Compared with single-vision CLs, wavefront aberrations of DISC lenses were significantly increased in total HOA, trefoil, and spherical aberrations for either 3.0 mm or 6.0 mm pupil size. The Strehl ratio wearing DISC lenses reduced significantly compared to the single-vision CLs (p < 0.001) at a pupil diameter of 6.0 mm. QoV scores were higher overall (p = 0.026) and frequency (p = 0.019) with DISC lenses than with single-vision CLs, indicating poorer visual performance.
CONCLUSION
DISC lenses provide satisfactory distance VA. However, the higher scores of the QoV questionnaire with DISC lenses may be related to decreased CS at medium or high spatial frequencies and increased higher-order aberrations.
Topics: Humans; Contact Lenses, Hydrophilic; Contrast Sensitivity; Myopia; Vision Disorders; Vision, Ocular; Visual Acuity; Adolescent; Young Adult; Adult
PubMed: 37574330
DOI: 10.1016/j.clae.2023.101891 -
Current Opinion in Ophthalmology Jan 2024Options for addressing presbyopia with intraocular lens (IOL) implantation have become more varied and sophisticated. We reviewed recent literature on multifocal and... (Review)
Review
PURPOSE OF REVIEW
Options for addressing presbyopia with intraocular lens (IOL) implantation have become more varied and sophisticated. We reviewed recent literature on multifocal and extended depth of focus (EDOF) IOLs in order to provide insight on their respective advantages, with emphasis on the visual outcomes of each design.
RECENT FINDINGS
Increased patient age, spectral domain optical coherence tomography (SD-OCT) abnormalities, abnormal optical axis measurements, and better preoperative visual acuity have been implicated as predictors of worse postoperative vision or visual quality in multifocal IOLs. Despite differences in objective outcomes, patient-reported outcomes such as satisfaction are consistently similar between multifocal and EDOF IOLs. EDOFs may have slightly lower rates of spectacle independence than trifocals, but there is more support for their use in the setting of with other ocular conditions.
SUMMARY
Multifocal and EDOF IOLs are both viable options for patients who wish to preserve near vision. Given their similar objective performance in many aspects, enabling patients to make informed decisions based on their expectations and visual requirements is critical to postoperative satisfaction. Evidence for advanced technology IOL implantation in pediatric patients remains inconclusive.
Topics: Humans; Intraocular Lymphoma; Lens Implantation, Intraocular; Lenses, Intraocular; Multifocal Intraocular Lenses; Patient Satisfaction; Phacoemulsification; Presbyopia; Prosthesis Design; Pseudophakia; Refraction, Ocular; Visual Acuity
PubMed: 37910172
DOI: 10.1097/ICU.0000000000001013 -
Journal of Optometry 2024To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in...
PURPOSE
To compare the eye defocus curves (DCs) obtained with stimuli on red, green, and white backgrounds and to investigate the applicability of the duochrome test (DT) in different age groups.
METHODS
12 elderly (ELD: 59.3 ± 3.9 years) and 8 young (YG: 22.1 ± 1.1 years) subjects were recruited. An optometric assessment with the DT was carried out to obtain the subjective refraction at distance. DCs at distance on green, white, and red backgrounds were measured and the following parameters were deduced: dioptric difference between red-green, green-white, red-white focal positions (minima of the DCs), best corrected visual acuity (BCVA), and widths of the DCs for red, green, and white.
RESULTS
The DC difference between the green-white focal positions (mean ± standard deviation) was -0.12±0.17 diopters (D) (ELD, p= 0.012) and -0.11±0.12 D (YG, p= 0.039), while the red-white difference was not statistically significant. The DC red-green difference was 0.20±0.16 D (ELD, p= 0.002) and 0.18±0.18 D (YG, p = 0.008). The ELD BCVA with green background was significantly worse than BCVA with red (p = 0.007) and white (p = 0.007). The mean value of the DC's width in ELD for green (1.01±0.36 D) was higher than for red (0.77±0.21 D) and for white (0.84±0.35 D), but with no statistical significance.
CONCLUSION
Both age groups showed a slight focusing preference for red when using white light. Moreover, ELD showed a worse BCVA with a green compared to a red background. Despite these results deduced by DC analyses, these aspects do not compromise the possibility of using the DT in clinical practice both in the young and in the elderly. Furthermore, the difference of about 0.20 D between red-green DC in both groups confirms the clinical appropriateness of the widespread use of 0.25 D step as the standard minimum difference in power between correcting lenses.
Topics: Humans; Middle Aged; Young Adult; Visual Acuity; Male; Female; Refraction, Ocular; Adult; Aged; Vision Tests; Aging
PubMed: 38128434
DOI: 10.1016/j.optom.2023.100497