Acuity Function Research Articles

CREG Protects Retinal Ganglion Cells loss and Retinal Function Impairment Against ischemia-reperfusion Injury in mice via Akt Signaling Pathway.

The irreversible death of retinal ganglion cells (RGCs) plays an important role in the pathogenesis of glaucoma. Cellular repressor of E1A-stimulated genes (CREG), a secreted glycoprotein involved in cellular proliferation and differentiation, has been shown to protect against myocardial and renal ischemia-reperfusion damage. However, the role of CREG in retinal ischemia-reperfusion injury (RIRI) remains unknown. In this study, we aimed to explore the effect of CREG on RGCs apoptosis after RIRI. We used male C57BL/6J mice to establish the RIRI model. Recombinant CREG was injected at 1day before RIRI. The expression and distribution of CREG were examined by immunofluorescence staining and western blotting. RGCs survival was assessed by immunofluorescence staining of flat-mounted retinas. Retinal apoptosis was measured by the staining of TdT-mediated dUTP nick-end labeling and cleaved caspase-3. Electroretinogram (ERG)analysis and optomotor response were conducted to evaluate retinal function and visual acuity. The expressions of Akt, phospho-Akt (p-Akt), Bax, and Bcl-2 were analyzed by western blotting to determine the signaling pathways of CREG. We found that CREG expression was decreased after RIRI, and intravitreal injection of CREG attenuated RGCs loss and retinal apoptosis. Besides, the amplitudes of a-wave, b-wave, and photopic negative response (PhNR) in ERG, as well as visual function, were significantly restored after treatment with CERG. Furthermore, intravitreal injection of CREG upregulated p-Akt and Bcl-2 expression and downregulated Bax expression. Our results demonstrated that CREG protected RGCs from RIRI and alleviated retinal apoptosis by activating Akt signaling. In addition, CREG also improved retinal function and visual acuity.

Collective endpoint of visual acuity and contrast sensitivity function from hierarchical Bayesian joint modeling.

Clinical trials typically analyze multiple endpoints for signals of efficacy. To improve signal detection for treatment effects using the high-dimensional data collected in trials, we developed a hierarchical Bayesian joint model (HBJM) to compute a five-dimensional collective endpoint (CE5D) of contrast sensitivity function (CSF) and visual acuity (VA). The HBJM analyzes row-by-row CSF and VA data across multiple conditions, and describes visual functions across a hierarchy of population, individuals, and tests. It generates joint posterior distributions of CE5D that combines CSF (peak gain, peak frequency, and bandwidth) and VA (threshold and range) parameters. The HBJM was applied to an existing dataset of 14 eyes, each tested with the quantitative VA and quantitative CSF procedures in four Bangerter foil conditions. The HBJM recovered strong correlations among CE5D components at all levels. With 15 qVA and 25 qCSF rows, it reduced the variance of the estimated components by 72% on average. Combining signals from VA and CSF and reducing noises, CE5D exhibited significantly higher sensitivity and accuracy in discriminating performance differences between foil conditions at both the group and test levels than the original tests. The HBJM extracts valuable information about covariance of CSF and VA parameters, improves precision of the estimated parameters, and increases the statistical power in detecting vision changes. By combining signals and reducing noise from multiple tests for detecting vision changes, the HBJM framework exhibits potential to increase statistical power for combining multi-modality data in ophthalmic trials.

Executive Function Predicts Older Adults' Lure Discrimination Difficulties on the Mnemonic Similarity Task.

Older adults often have difficulty remembering the details of recently encountered objects. We previously found this with the Mnemonic Similarity Task (MST). Surprisingly, the older adults' MST Lure Discrimination Index (LDI) was significantly correlated with visual acuity but not with memory or executive function. Here we ran a replication with new, larger samples of young (N = 45) and older adults (N = 70). We then combined the original and replication older adult samples (N = 108) to critically examine the relative contributions of visual acuity, memory, and executive function composite scores to LDI performance using dominance analysis. This provided, to our knowledge, the first direct statistical comparison of all 3 of these factors and their interactions on LDI. Participants completed the MST and a battery assessing visual acuity, memory, and executive function. We examined age group differences on MST performance in the new (i.e., replication) young and older adult samples and performed multiple regression and dominance analysis on the combined older adult sample. Consistent with previous findings, the older adults showed significantly poorer LDI but preserved item recognition. LDI was significantly correlated with both memory and executive function but not with visual acuity. In the combined older adult sample, all 3 composites predicted LDI, but dominance analysis indicated that executive function was the most important predictor. Older adults' MST LDI difficulty may be predicted by their executive function and visual acuity. These factors should be considered when interpreting older adults' MST performance.

Acrysof IQ Vivity (Alcon) extended depth-of-focus intraocular lens: implantation experience

Aim to evaluate the results of the AcrySof IQ Vivity (Alcon) extended-focus intraocular lens implantation in cataract surgery with regard to visual acuity at three distances, independence from glasses, severity of photopic phenomena, and patient satisfaction.
 Material and methods. 20 patients (20 eyes) with cataract were examined and operated. All patients underwent phacoemulsification with implantation of IOL with extended focus depth AcrySof IQ Vivity, with the following analysis of treatment results. The follow-up period lasted for 6 months.
 Results. In 6 months after surgery, the uncorrected far distance visual acuity was 0.880.04, the middle distance acuity 0.770.01, the near distance acuity 0.610.05. The maximum corrected far distance visual acuity was 0.930.06, the middle distance acuity 0.810.09, near distance acuity 0.650.02.
 Conclusion. The IOL provides excellent visual acuity at far and middle distances, as well as functional visual acuity at near distance, which increases the independence from glasses. The target refraction was achieved in 91% of cases. The patients expressed high satisfaction with postoperative results. This lens can be recommended for use in clinical practice.

Associations between biopsychosocial factors and transportation patterns of older adults residing in Klang Valley, Malaysia.

Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults. One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking). Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs. The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p < 0.001); (b) being Malay (AdjOR 21.72, 95% CI 0.36-16.12, p < 0.001); (c) having higher number of comorbidities (AdjOR 14.01, 95% CI 0.20-13.21, p = 0.007); and (d) being dependent in IADL (AdjOR 13.48, 95% CI 0.51-1.78, p = 0.002).

Effect of Yellow Filter On Contrast Sensitivity Function In High Myopes

Background: This study examines the influence of yellow filter on the contrast sensitivity function in individuals with high myopia. Through a comprehensive analysis, we explore the potential enhancement of visual perception and contrast sensitivity in this population. The findings con-tribute to our understanding of effective interventions to optimize visual outcomes for high myopes. Purpose: A cross-sectional study was conducted where thirty-four (n=34) healthy young subjects (age range 17-25 years old) having high myopia (SER ≥ 6.00D) without any ocular pathology. Contrast sensitivity func-tion (CSF) was assessed using the Functional Acuity Contrast Test (FACT). First, the CSF was measured without the filter (baseline) then immediately after using a yellow filter (50% transmittance) and then after five minutes of adaptation of the yellow filter. The room illumination was constant at 150lux across all the subjects. Results: One-way repeated measure ANOVA showed that there was no statistically significant difference in contrast sensitivity function for spa-tial frequencies 1.5cpd, and 12cpd. However, there was a statistically significant difference in contrast sensitivity for spatial frequencies 3cpd; F(1.46, 48.20) =28.80, 6cpd; F (1.44, 47.43) =39.99 and 18cpd F (1.53, 50.47) = 44.26. Conclusion: There was an improvement at the moderate and high spatial frequencies (3cpd, 6cpd and 18cpd) but no changes were found at other spatial frequencies. This shows that yellow filter can help to improve the contrast sensitivity function in high myopes at moderate and high spatial frequencies.

Visual function in eyes with diffractive extended depth-of-focus and monofocal intraocular lenses: 2-year comparison.

To compare long-term visual function after implantation of diffractive extended depth-of-focus (EDF) intraocular lenses (IOLs) using echelett optics and monofocal IOLs with the same platform. In this prospective comparative case series, diffractive EDF or monofocal IOLs were implanted binocularly and followed up for 2years. At the last visit, distance-corrected binocular visual acuities were measured at distances of 0.3, 0.5, 0.7, 1, 2, 3, and 5m. Photopic and mesopic contrast sensitivity was also examined. Dynamic visual function was evaluated in terms of functional visual acuity (FVA), standard deviation of visual acuity (SDVA), visual maintenance ratio (VMR), mean response time, and number of blinks. The outcomes were compared between the two IOLs, and the influence of posterior capsule opacification (PCO) on contrast sensitivity and FVA was examined. Binocular visual acuity of eyes with EDF IOLs was better at distances of 0.5 and 0.7m than that of eyes with monofocal IOL (P < 0.026). There were no differences in binocular visual acuity at other distances, contrast sensitivities, or dynamic visual functions. The influence of PCO on the visual functions was not found in eyes with EDF IOLs. Up to 2years postoperatively, eyes with diffractive EDF IOLs sustained superior intermediate visual acuity together with visual function comparable to that of eyes with monofocal IOLs.

Simultaneous real-time analysis of tear film optical quality dynamics and functional visual acuity in dry eye disease

BackgroundTo assess the effect of tear film instability in dry eye disease (DED) by measuring visual performance and tear film optical quality in a simultaneous real-time analysis system.MethodsThirty-seven DED participants and 20 normal controls were recruited. A simultaneous real-time analysis system was developed by adding a functional visual acuity (FVA) channel to a double-pass system. Repeated measurements of FVA and objective scatter index (OSI) were performed simultaneously with this system under blink suppression condition for 20 s. Patient-reported symptoms was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Mean FVA, mean OSI, and visual acuity break-up time were defined. The OSI maintenance ratio was calculated as an evaluation index to assess the difference between dynamic OSI changes and baseline OSI. The visual maintenance ratio was also calculated in the same way.ResultsModerate correlations were noted between mean OSI and FVA-related parameters (mean FVA, visual maintenance ratio, visual acuity break-up time: 0.53, − 0.56, − 0.53, respectively, P < 0.01 for all). Moderate to high correlations were noted between OSI maintenance ratio and FVA-related parameters (mean FVA, visual maintenance ratio, visual acuity break-up time: − 0.62, 0.71, 0.64, respectively, all P < 0.01). The metrics derived from the simultaneous real-time analysis system were moderately correlated with the patient-reported symptoms and the visual acuity break-up time possessed the highest correlation coefficients with OSDI total, ocular symptoms, and vision-related function (− 0.64, − 0.63, − 0.62, respectively, P < 0.01). The OSI-maintenance ratio alone appeared to exhibit the best performance of the metrics for the detection of DED with sensitivity of 95.0% and specificity of 83.8% and the combinations of FVA parameters and OSI parameters were valid and can further improve the discriminating abilities.ConclusionsOSI-related metrics were found to be potential indicators for assessing and diagnosing DED which correlated with both subjective visual performance and patient-reported symptoms; the FVA-related metrics were quantifiable indicators for evaluating visual acuity decline in DED.Trial registration number: Chinese Clinical Trial Registry, ChiCTR2100051650. Registered 29 September 2021, https://www.chictr.org.cn/showproj.aspx?proj=134612

Resection and Reconstruction of a Giant Paranasal Osteoma in a Pediatric Patient

Study Design Case Report. Objective Paranasal osteomas are rare, benign bony tumors of the craniofacial skeleton and most are treated endoscopically without the need for reconstruction. In rare cases, open traditional craniofacial approaches are required with a paucity of literature describing extirpative maneuvers in this setting. We present a unique case of a rapidly growing, paranasal bony tumor in a pediatric patient and describe our surgical technique for resection and reconstruction. Methods A 13-year old male presented with eight months of progressive, painless right periorbital swelling and proptosis. Trans-nasal biopsy confirmed an osteoma of the right ethmoid sinus and endoscopic resection was recommended. Due to interval tumor growth, there was worsening visual acuity that precluded a minimally invasive approach. Pre-operative and post-operative 3D computed tomography (CT) scans were completed, and a 3D printed skull model was produced to aid in surgical planning. A multi-disciplinary team of Otolaryngology, Neurosurgery, and Plastic Surgery was employed. The majority of the extirpation was performed with a highspeed carbide burr. Results Post-operative course was unremarkable and CT scan demonstrated a complete resection. Pathology confirmed the diagnosis of an osteoma. Six-month follow-up demonstrated normal ophthalmologic function and visual acuity with excellent aesthetic results. Conclusions This is a rare, complex presentation of a paranasal osteoma that was successfully managed with an open, multi-disciplinary approach. We highlight pearls gleaned from this extirpative and reconstructive technique. Due to the tumor density and location, a multidisciplinary team, Stealth navigation, an open, intra- and extra-cranial approach and use of a highspeed carbide burr were essential.

Cognitive impairment in patients with heart failure: molecular mechanism and therapy.

Heart failure (HF) is associated with multiple organ dysfunction and many comorbidities. Its incidence is high among the elderly and is a major health burden worldwide. Cognitive impairment (CI) is highly prevalent in older patients with HF, which is an abnormality in one or more of the items of cognition, attention, memory, language, psychomotor function, and visual spatial acuity. Studies have shown that the incidence of CI in HF patients is between 13 and 54%, and patients with both conditions have poor self-care ability and prognosis, as well as increased mortality rates. However, the mechanisms of CI development in HF patients are still unclear. In this review, we describe the epidemiology and risk factors as well as measures of improving CI in HF patients. We update the latest pathophysiological mechanisms related to the neurocognitive changes in HF patients, expounding on the mechanisms associated with the development of CI in HF patients.

Effects of diet containing astaxanthin on visual function in healthy individuals: a randomized, double-blind, placebo-controlled, parallel study.

Visual display terminal work has increased rapidly in recent years. Loss of visual acuity is an unfortunate associated effect. Here, we performed a randomized, placebo-controlled study in 60 healthy adults. Participants received a diet containing astaxanthin (9 mg/day) or placebo for 6 weeks. Visual acuity, functional visual acuity, and pupil constriction rate were measured before and after visual display terminal work. In participants aged ≥40 years, corrected visual acuity of the dominant eye after visual display terminal work at 6 weeks after intake demonstrated a higher protective effect of astaxanthin in the astaxanthin group vs the control group (p<0.05). In participants aged <40 years, no significant difference was seen between the astaxanthin and control groups. Moreover, no significant difference was found in functional visual acuity and pupil constriction rate between the astaxanthin and control groups. These results suggest astaxanthin reduces oxidative stress caused by visual display terminal work. Age-related reduction in ciliary muscle strength is likely the main detractor of visual acuity. Correspondingly, astaxanthin reduced visual display terminal work-induced visual stress in the middle-aged and elderly. This study was registered in the UMIN-CTR database (UMIN000043089).

Management of Post-LASIK Ectasia.

Corneal ectasia is a sight-threatening complication of corneal refractive surgery characterized by progressive steepening and thinning of the cornea and subsequent loss of best-corrected visual acuity. To report the clinical outcomes following treatment of post-laser in situ keratomileusis (LASIK) induced ectasia. This is a retrospective case series of 7 patients (10 eyes) which developed post-LASIK ectasia. In these cases of postoperative ectasia, the presented clinical signs were either forme fruste keratoconus, thin cornea, posterior elevation map value > +15.0µm, or residual stromal bed < 300µm. All cases were treated with either collagen crosslinking (CXL) alone or combined with PRK or CXL and phakic intraocular implant using the Dresden protocol and a slight modification thereof. In all cases, the flap was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15±12.88µm), and refractive error was corrected using the Wavelight Allegretto excimer laser. Average preoperative corrected visual acuity (CDVA) was 0.75 (±0.26) Snellen. Postoperative CDVA significantly increased to 0.86 (±0.13) Snellen (p=0.04, paired t-test). One eye lost three lines of its baseline CDVA (before ectasia), while all other eyes regained lines of CDVA. All cases remained stable during the follow-up. Several surgical procedures are used for the management of corneal ectasia. However, the best surgical approach should be determined based on the state of progression of the disease. Although ectasia remains a potentially devastating complication after refractive surgery, most patients can regain functional visual acuity with appropriate management, and corneal transplantation is infrequently indicated.

Phacoemulsification in phacomorphic angle closure: Our experience.

To evaluate intraocular pressure (IOP) control, visual prognosis, and complications following phacoemulsification in eyes with phacomorphic angle closure of <10 days' duration. Prospective, nonrandomized interventional consecutive case series included all patients with phacomorphic glaucoma who presented between November 2020 and November 2021. All patients underwent slit-lamp biomicroscopy, applanation tonometry, and gonioscopy of the other eye. Phacoemulsification with IOL implantation under topical anesthesia was performed in all cases. A complete ophthalmic examination was done at each follow-up visit. A total of 50 eyes with phacomorphic glaucoma were included in this study. The preoperative mean IOP was 41.12 ± 8.20 mmHg and the mean IOP at last visit was 13.84 ± 2.08 mmHg. There was a statistically significant difference between IOP at presentation and IOP at last follow-up (P < 0.001) (Wilcoxon Signed-Ranks Test). There was no requirement of long-term anti-glaucoma medications in any patients. No significant intraoperative complications were noted. The final postoperative best-corrected visual acuity was 6/12 or better in 32 patients. Sixteen eyes had corneal edema and 20 eyes had anterior chamber inflammation on postoperative day one that resolved with standard medical therapy. Phacoemulsification is safe and effective in controlling IOP and achieving good functional visual acuity with minimal complications in the management of phacomorphic glaucoma in expert hands. Our study also lays emphasis on public awareness, early detection, and management of advanced cataract, so that the incidence of this potentially blinding entity can be reduced.

Validation of a novel iPhone application for evaluating near functional visual acuity

Monitoring dynamic changes in near vision is important for early detection of presbyopia. This study assessed the accuracy and reliability of a new smartphone-based application, the Smart Vision Check (SVC), compared with those of a conventional device (AS-28; Kowa, Aichi, Japan), for measuring near functional visual acuity (NFVA). We enrolled 115 healthy volunteers aged ≥ 20 years with bilateral best-corrected visual acuity of ≥ 20/25. The SVC was designed for use on an Apple iPhone SE2 to measure NFVA by tapping on the orientation icon manually. Conventional FVA was measured using the AS-28 with − 2.50 D added to the best distance correction at baseline. There was no significant difference in NFVA-related measurements between the AS-28 and SVC (P > 0.05). The Spearman correlation coefficients of NFVA measurements between the two devices were over 0.60 (P < 0.001). The Bland–Altman plot indicated minimal bias with limits of agreements of ± 0.34 logMAR for NFVA with habitual correction when comparing the AS-28 and SVC. The intraclass correlation coefficient of the repeated SVC-measured NFVA was 0.915 (95% CI 0.800–0.969). In summary, the SVC has the potential to evaluate NFVA in a relatively easy manner. Applied clinically, the SVC can be useful for presbyopia screening.

Application of the CNS vital signs test and WISC-IV in the cognitive assessment of Chinese pediatric patients with intra-cranial space occupying lesion

Background A fast and reliable neurocognitive assessment tool is required for pediatric patients with an intracranial space-occupying lesion (ICSOL). Methods A cross-sectional study was conducted on 41 pediatric patients having ICSOL. Cognitive abilities were assessed using both WISC-IV and CNS Vital Signs (CNS VS). All domains are compared to the normative data. Spearman’s correlation analysis is performed between domains in two batteries. Results In the WISC-IV, CPI, PSI, and WMI are significantly lower than the normative level. In the CNS VS, NCI, Memory domains, Reaction Time, Social Acuity, and Sustained Attention are significantly lower. Six domains in the CNS VS, including Complex Attention, Sustained Attention, Cognitive Flexibility, Executive Function, Processing Speed, and Social Acuity, positively correlate to the PSI or CPI in the WISC-IV. Sixty percent (9/15) of domains in the CNS VS negatively correlate to the size of ISCOL. The FSIQ in the WISC-IV is significantly associated with patients’ parent education level. Conclusion Compared to the WISC-IV, CNS VS takes less time, but measures more domains. CNS VS is more sensitive to the size of ICSOL but is not affected by patients’ parent education level. A healthy control group is warranted for interpreting the results in Chinese participants.

Loss of colour vision in patients at risk of developing diabetes

AbstractRecent studies carried out in diabetic patients with no more than moderate maculopathy revealed that over 70% had significant losses of both Yellow/Blue (YB) and Red/Green (RG) colour vision (https://doi.org/10.1111/j.1755-3768.2012.F073.x). The purpose of this study was to investigate whether clinically ‘normal’ subjects, identified as being at ‘risk’ of developing diabetes show significant changes in rod‐ and cone‐mediated rapid flicker sensitivity as well as RG and YB colour vision.Three groups of subjects were recruited; a normal subject group (n = 40), a ‘high‐risk’ group (n = 150) and subjects diagnosed with diabetes (n = 23). The inclusion criteria for ‘high‐risk’ group required 3 or more recognized risk factors for diabetes (e.g., age &gt; 45, HbA1C &gt;5.7, high blood pressure, smoking history, high BMI, family history of diabetes, FPG levels &gt;100 mg/dL). All subjects had full ophthalmic assessment and their RG and YB colour vision, Functional Contrast Sensitivity (FCS), Visual Acuity (VA) and Rod‐ and Cone‐mediated flicker sensitivity were measured using AVOT tests (https://researchcentres.city.ac.uk/applied-vision/avot).Consistent with previous findings, the diabetic group show significant loss of both RG and YB colour vision. Our findings show that these subjects also exhibit higher thresholds for rod and cone mediated vision. In addition, the ‘high‐risk’ group who are clinically classified as ‘normal’, also show significant loss of colour vision and rod and cone sensitivity. The latter group, do not, however, show significant differences in either VA or FCS. These findings suggest that accurate assessment of colour vision and rod‐ and cone‐ mediated rapid flicker sensitivity qualify as important risk factors in prediabetic screening.

Assessment of visual function and the neuroretina in subjects diagnosed with colour blindness

AbstractPurpose: To assess whether the existence of colour vision deficiency or colour blindness involves impairment of visual acuity, contrast sensitivity and colour vision and results in variations in retinal nerve fibre layer (RNFL) thickness, macular area, retinal ganglion cell complex and retinal layers that contain photoreceptors (bastons and cones) versus subjects with normal colour vision within the same age and gender distribution.Methods: Cross‐sectional and observational study including 50 eyes of subjects with colour blindness and 50 eyes of control subjects. Visual function (visual acuity, contrast sensitivity and colour vision) and neuroretinal structure were assessed in all subjects using optical coherence tomography (OCT).Results: Significant thinning of the retinal nerve fibre layer, ganglion cell layer and retina were observed in the colour blindness group. Significant thinning was also recorded in layers that involve photoreceptor nuclei (between the outer limiting layer and the Bruch membrane and between the outer plexiform layer and the outer limiting membrane).Conclusions: Significantly reduced thicknesses in the RNFL and several retinal layers (ganglion cell and photoreceptor layers) were found, demonstrating that colour blindness is associated with thinning in retinal and RNFL thickness, and in the retinal layers that involve photoreceptor nuclei. OCT study with retinal segmentation therefore seems to be a marker of colour blindness of utility in clinical practice in the case of doubt regarding diagnosis. This analysis could be useful in evaluating the effectiveness of potential therapies such as gene treatment.

Options and considerations for the correction of presbyopia in the absence of cataract

AbstractPRESBYOND Laser Blended Vision is a treatment option for presbyopic patients that combines micro‐anisometropia with increased depth of field through non‐linear aspheric ablation profiles. This technique substantially improves visual outcomes in comparison with the conventional monovision approach. Trials show that PRESBYOND is effective in presbyopic patients with refractive errors between +5.75 and −9.00 D, including emmetropic presbyopes. With the safety advantages of modern femtosecond LASIK, retention of functional stereo acuity, contrast sensitivity and quality of vision, the rapid bilateral surgical procedure and a recovery time of a few hours, patient satisfaction is extremely high. In patients with no visually significant cataract, performing a corneal treatment avoids the increased risks associated with intraocular surgery, particularly risks that are relatively higher in younger presbyopic patients such as retinal detachment.

The long and short‐‘sightedness’ of BMP3 in eye development

AbstractPurpose: Following genome‐wide association study for risk factors for retinal detachment, a locus overlapping the BMP3 gene, previously reported to be associated with myopia, was identified and selected for further examination. We prioritized an associated missense plausibly deleterious variant within the BMP3 gene for functional analysis. The BMP signalling pathway has long been implicated in the patterning and development of the eye, but BMP3's role both within this pathway and during eye development and disease is unclear.Methods: The region around the associated missense variant is conserved between human and mouse, and the missense variation was introduced using CRISPR‐cas9 genome editing; loss of function mutations were also produced in the process. Our unit is uniquely equipped to analyse mouse eye phenotypes and using Optical Coherence Tomography (OCT), electroretinogram (ERG) and Optokinetic Drum (OKD) these mice were comprehensively phenotyped through to adulthood. RNA sequencing analysis was also used in cell lines and in primary mouse tissue to further investigate disrupted signalling pathways and potential downstream targets of Bmp3.Results: OCT of mice showed no gross morphological abnormalities in either mice carrying the missense variant or loss of function mutations. ERG and OKD also showed that retinal function and visual acuity was unaltered in either line. However axial length measurements of adult mice showed a significant increase in length of the eye – indicative of myopia. Transcriptional analysis of two different retinal pigmented epithelial cell lines carrying loss of function mutations have been compared to results obtained from whole eye cups of mutant mice, and we have highlighted potential differences and similarities between the two.Conclusions: Future work is required to assess how much the mouse and human cell line results converge, but our mouse results support a role for a BMP pathway in myopia development.

Assessing the impact of long‐term idebenone treatment on various visual acuity outcomes in Leber's hereditary optic neuropathy (LHON): Results, according to disease stage, from the prospective, natural history‐controlled LEROS study

AbstractPurpose: For patients with LHON, preservation of functional visual acuity (VA) and/or recovery of lost VA are desirable outcomes. Beyond this, prevention of further VA worsening is also important. In LEROS, VA outcomes following 24 months of idebenone treatment were compared to an external, matched, natural history (NH) cohort. Here, we report results from a cumulative frequency analysis to understand the impact of idebenone across the range of possible VA outcomes.Methods: Patients with LHON onset ≤5 years prior were enrolled and stratified by time since onset: subacute/dynamic (≤1 year) and chronic (&gt;1 year). Data from 181 patients treated up to 24 months were compared to retrospective data from an external natural history (NH) cohort (372 patients), matched by time since onset. In a cumulative frequency analysis, VA change was assessed from baseline to month 24. A change of ≥0.2 logMAR was considered a clinically relevant recovery or worsening, depending on the direction of change.Results: In subacute/dynamic eyes treated with idebenone for 24 months, 47.9% (58/121) experienced a recovery of VA, and 25.8% (24/93) experienced VA worsening. This compared to 33.3% (25/75), and 51.0% (25/49) of untreated subacute/dynamic eyes displaying a recovery or worsening, respectively. In chronic eyes, recovery was observed in 31.9% (37/116) that had undergone treatment versus 16.1% (15/93) when untreated. A VA worsening was observed for 2.9% (2/68) of treated chronic eyes versus 20.0% (12/60) of untreated. The majority of treatment emergent adverse events were considered of mild to moderate intensity, with only 11.3% considered to be related to idebenone treatment.Conclusions: In both the subacute/dynamic and chronic stages of LHON, idebenone treatment was able to boost VA recovery and prevent further VA deterioration. Consistent with previous findings, idebenone was well tolerated with no new safety concerns observed.