Acuity Testing Research Articles

Development and Performance Evaluation of a Bengali-Adapted mHealth App for Early Detection of Impaired Visual Acuity

This paper presents a comprehensive study on the development and performance evaluation of “Dristi,” a mobile health (mHealth) app designed to facilitate eye screening for impaired visual acuity (VA) in Bangladesh. Recognizing the critical importance of vision and the challenges posed by visual impairments, particularly in low-resource settings, this study explores an innovative solution to enhance eye care accessibility. The app, developed for Android devices, integrates features such as VA testing using adapted Bengali letters, color blindness tests, and eye health education, aiming to make eye care more user-friendly and accessible. Inspired by the Snellen chart, the app employs a simplified method for VA assessment, suitable for the constraints of mobile devices. The study involved a cross-sectional comparative design, conducted between June and September 2022, to clinically validate the app's feature of testing distant vision and near vision. Participants were recruited from one government eye hospital, one semi-private eye hospital, one high school, and a private clinic in Bangladesh, encompassing a diverse demographic. The validation study revealed promising results in terms of the app's accuracy, sensitivity, and specificity in both distant and near vision testing, although some variability was observed across different data sources. The study also identified a significant number of participants with diabetes and hypertension, common comorbidities affecting eye health. Overall, “Dristi” demonstrates potential as a valuable tool in the early detection and management of visual impairments in Bangladesh. Its development marks a significant step towards utilizing mHealth solutions to overcome healthcare barriers and improve eye care services in low-resource settings. Future directions include expanding the app's features, enhancing its integration with healthcare systems, and extending its reach to other similar contexts.

Hiding in plain sight: children with visual perceptual difficulties in schools

Cerebral visual impairment (CVI) is increasingly being recognized as a significant cause of visual difficulties in children, particularly those with typical visual acuity, who nonetheless struggle in educational settings. This narrative review aims to elucidate the nature and impact of visual perceptual difficulties (VPD) associated with CVI in school-aged children, who often remain undiagnosed due to the current erroneous focus on visual acuity as a required diagnostic criterion for CVI. The review synthesizes findings from recent studies, highlighting that up to 3.4% of children in mainstream schools and a higher percentage in special educational settings may experience VPD, which significantly impacts upon their learning and development. The manifestations of VPDs, such as difficulties in motion perception, recognition, and visuospatial processing, are often subtle and can thus be overlooked, leading to misconceptions about the origins of the affected child’s abilities and behaviors. The review also discusses the challenges in current diagnostic processes, emphasizing the need for comprehensive history taking and assessments that go beyond standard visual acuity tests. It proposes a multi-faceted approach to identification and support, incorporating both clinical assessments and teacher/parental observations, to better address the needs of affected children. Furthermore, this paper advocates for the inclusion of VPDs in the International Classification of Diseases (ICD 11) to ensure children with these visual issues receive appropriate educational support. By integrating lived experiences of individuals with CVI and the latest research findings, this review underscores the urgent need for awareness and tailored educational strategies designed to support children with VPDs. The findings suggest that without such recognition and intervention, many children with VPDs will continue to “hide in plain sight,” facing unnecessary challenges in their educational and social development. The review concludes with recommendations for policy changes and future research directions to improve the identification, classification, and support of children with VPDs within the educational system.

Prevalence and profile of astigmatism in individuals availing ophthalmic services at Central Regional Referral Hospital, Gelephu, Bhutan: A cross-sectional, hospital-based study

Introduction: Astigmatism has been defined as a type of refractive error when parallel rays of light entering the eye are not focused at one point of the retina when accommodation is at rest due to irregular curvature of the cornea or lens surface. All-age data on the prevalence and types of astigmatism is not available in Bhutan. This study was carried out to determine the prevalence and determinants of astigmatism in the Central Regional Referral Hospital (CRRH) of Bhutan. Methods: This was a cross- sectional study done between November 2021 and August 2022 in CRRH with 302 participants. Routine visual acuity testing and refraction were done for all the individuals availing ophthalmic services and type of astigmatism was diagnosed. Results: The overall prevalence of astigmatism in individuals availing ophthalmic services at CRRH was found to be 4.18% and the most common types of astigmatism were compound myopic, with-the-rule (WTR) and mild astigmatism. Conclusion: Prevalence of astigmatism was found to be low in individuals availing ophthalmic services at CRRH. The most common types of astigmatism were compound myopic, WTR and mild astigmatism.

Visual acuity in the context of retinal neuroaxonal loss in people with epilepsy

Recent studies reported a significant retinal neuroaxonal loss in people with epilepsy (PWE). However, the impact of these structural alterations on visual function, i.e., visual acuity is yet unknown. In this prospective cohort study, 70 PWE and 76 healthy controls (HC), all aged 18-55 years, underwent an assessment of visual acuity with 100 % high contrast (HCVA) and 2.5 % low contrast (LCVA) Sloan letter charts. Thickness of the global peripapillary retinal nerve fiber layer (G-pRNFL) and volume of the ganglion cell inner plexiform layer (GCIP) were assessed with spectral-domain optical coherence tomography (OCT). For the statistical analyses, the epilepsy group was subdivided into PWE with sodium channel blocking (SCB)-drug intake (n = 52) and PWE without SCB-drug intake (n = 18), since an effect of SCB-drugs on visual perception has been reported previously. The overall PWE cohort presented significantly lower structural retinal measures, i.e., G-pRNFL thickness (97.57 ± 9.06 µm) and GCIP volume (1.99 ± 0.13 mm3) than HC (101.31 ± 8.28 µm, p = .01; 2.10 ± 0.15 mm3, p < .001). Subgroup analyses revealed that PWE who were treated with SCB-drugs had a significantly reduced G-pRNFL thickness (96.61 ± 9.70 µm, p = .01) and GCIP volume (1.98 ± 0.14mm3, p < .001) compared to HC, while PWE without SCB-drugs (100.36 ± 6.32 µm, 2.01 ± 0.13 mm3) did not differ from HC or PWE with SCB-drugs. In visual acuity tests (HCVA and LCVA), the overall PWE cohort (52.28 ± 8.56; 31.71 ± 8.49) scored significantly lower than HC (56.57 ± 4.74, p = .001; 35.13 ± 5.50, p = .04). In subgroup analyses only PWE with SCB-drugs presented significantly lower HCVA (51.25 ± 9.35, p = .003) and LCVA (30.04 ± 8.93, p = .03) scores compared to HC, while visual acuity scores did not differ between PWE without SCB-drugs (55.25 ± 4.75, 36.53 ± 4.50) and HC. PWE with SCB-drugs had significantly lower LCVA scores than PWE without SCB-drugs (p = .03). Importantly, no association was found between visual acuity scores and structural parameters, neither in the overall sample, nor in any of the subgroups. Retinal neuroaxonal loss in PWE was not associated with reduced visual acuity under high and low contrast. Instead, our findings reinforce SCB-drug intake as an important factor for reduced visual acuity under high and low contrast.

Spectrum of Visual Dysfunction Detected by a Novel Testing Protocol Within a Special School Eye Care Service.

Children with special educational needs are more likely to have vision problems than peers in mainstream education. Reports focus on visual acuity and refraction, overlooking visuoperceptual difficulties, including cerebral visual impairment. This article reports on the feasibility and outcomes of visual function testing performed during in-school visual assessments. A retrospective chart review was undertaken of children participating in a special school vision programme. The testing strategy included acuity, fields, contrast sensitivity, eye movements, accommodation, stereopsis, visual attention, refraction and a parent-completed questionnaire. The testing method was chosen based on the child's ability to engage with testing. 78 cases were identified (mean age 9.6 years). Low vision (worse than 6/19) was identified in 31%. All six tests of visual function were completed by 44% (mean 5.1; range 2-6). The mean number of atypical responses was 1 (range 0-4). Almost half (49%) showed at least one atypical response, most commonly visual attention (35%) and 25% had atypical eye movements. Overall, only 20% of children in the special school setting demonstrated a normal response to each test they were able to complete. Acuity testing alone does not demonstrate the atypical visual function of a child with special needs. Using techniques which require minimal cognitive, speech or motor function, a range of visual functions can be elicited during in-school testing. This testing strategy has the advantage of demonstrating areas of visual (dys)function impacting on the child's ability to access learning which can be immediately fed back to teaching staff and carers.

Evaluation of Visual Disturbances After Mild Traumatic Brain Injury-A One-Year Follow-up Study.

To examine the persistence of visual symptoms in mild traumatic brain injury (MTBI) during the first months after injury. It is important to recognize visual disturbances because they can delay return to normal activities, while they might be simultaneously treated by visual therapy. Here we describe the results from a 1-year follow-up study of visual disturbances after MTBI. The study group comprised 26 patients from the Brain Injury Clinic of the Helsinki University Hospital. Inclusion criterion was a high score (≥21p) on the Convergence Insufficiency Symptom Survey (CISS) at an appointment with a neurologist within 6months after injury. The patients underwent baseline vision evaluation at 4months on average and follow-up at 14months after injury. The evaluation included tests for visual acuity, near point of convergence, convergence facility, near point of accommodation, accommodative facility, motility, heterophoria, binocular vision, dynamic visual acuity, and fusional vergence width at near and far distances. Further assessments included the Rivermead Post Concussion Questionnaire for posttraumatic symptoms, a visual analog scale for visual fatigue, and the Developmental Eye Movement Test for saccadic eye movements. Both CISS and Rivermead Post Concussion Questionnaire scores improved significantly from baseline to follow-up. The overall level of visual fatigue according to visual analog scale score was lower at follow-up, but the increase in visual fatigue (comparing fatigue before and after assessment session) was significant both at baseline and follow-up. In visual function assessments, spontaneous recovery from baseline to follow-up could be seen in vergence facility and pursuit eye movement but not in near point of convergence, near fusion, distance fusion, heterophoria, and dynamic visual acuity. The results point out the importance of evaluation of visual disturbances after MTBI. Early detection of these disturbances may provide an opportunity to provide visual therapy.

Evaluation of the diagnostic parameters of the amblyopia and risk factors for amblyopia screening protocol in 3-year-olds according to recommendations from the French Association for Pediatric Ophthalmology and Strabismus (AFSOP) compared with reference ophthalmological examination: the ORTHOPHTALMO study

ABSTRACT Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560. Number: NCT04395560.

Comparison of Vessel Density and Retinal Sensitivity After Scleral Buckling and Phacovitrectomy in the Management of Macula-on Primary Rhegmatogenous Retinal Detachment.

The choice of surgical method for rhegmatogenous retinal detachment (RRD) may have a significant impact on the retina. In this study, we aimed to compare retinal function and structure after scleral buckling (SB) and phacovitrectomy (phaco-PPV) for macula-on RRD. This cross-sectional study included patients who underwent anatomically successful repair of macula-on RRD managed with SB (n=35) and phaco-PPV (n=35) between 2019-2023. All participants were examined within 6-20 months of surgery to evaluate the retinal structure using spectral domain optical coherence tomography (SD-OCT) and vessel density (VD) by OCT angiography (OCTA). Best-corrected visual acuity (BCVA) and microperimetry (MP) tests were used to assess the retinal function. Analysis of the microvascular network with OCTA between eyes after surgery and healthy eyes showed a decrease in VD. Significant changes in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) were observed only in eyes after SB surgery (p <0.001 and p=0.02, respectively). Analysis of retinal function assessed by MP showed a significant decrease (p<0.05) in retinal sensitivity after phaco-PPV (24.81±2.25 dB) and SB (24.18±2.14 dB) operations compared to the healthy control group (25.97 ± 1.51 dB), whereas postoperative BCVA showed no differences (p>0.05). Changes in retinal sensitivity were accompanied by impairment of the microvascular network in the eyes after SB and phaco-PPV surgeries due to macula-on RRD. Disorders were more pronounced in eyes following SB surgery, possibly secondary to mechanical stress.

The Short- and Long-Term Perceptual Learning of Clinical Dynamic Visual Acuity Test.

The purpose of this study was to investigate the short- and long-term learning effect of dynamic visual acuity (DVA) tests. Participants between 18 and 30years with corrected to normal visual acuity were enrolled in this study. Three repeated sessions were performed, with 15 minutes and 15 days' intervals between sessions. Each session included 9 DVA tests of horizontal, vertical, and diagonal motions of E optotypes at 20, 40, and 80degrees per second (dps). The short- and long-term learning effects were analyzed from repeated DVA tests. Of the 58 enrolled participants, the mean age was 23.1 ± 2.1years. DVA significantly varied among motion types and velocities (P < 0.05, respectively). There was a significant short-term learning effect for 20 (P = 0.004), 40 (P < 0.001), and 80 (P = 0.014) dps DVA test of horizontal motion, 40dps DVA test of vertical (P = 0.003), and diagonal motion (P = 0.036). The long-term learning effect was detected in the 40dps diagonal motion DVA test (P = 0.015). The short- and long-term learning effects were positively associated with initial DVA in most combinations of motion type and velocity tests (P < 0.05, respectively). The short- (P = 0.031) and long-term (P = 0.024) learning effect of 80dps horizontal motion DVA test was greater in male than female participants. There is a significant short-term learning effect in the DVA test of various motion types, but the long-term learning effect was rarely observed, and it is greater in participants with worse initial DVA.

Real-world application of a smartphone-based visual acuity test (WHOeyes) with automatic distance calibration

BackgroundTo develop and assess the usability of a smartphone-based visual acuity (VA) test with an automatic distance calibration (ADC) function, the iOS version of WHOeyes.MethodsThe WHOeyes was an upgraded version...

Delayed high-altitude retinal hemorrhages in well-acclimatized lowlanders: A hidden risk unveiled.

High-altitude retinal hemorrhage (HARH), a frequent entity of high-altitude retinopathy (HAR), is associated with acute exposure to high altitudes (HAs) with rapid ascent. However, the delayed occurrence of HARH in well-acclimatized individuals has received less attention. This study explored the prevalence and characteristics of HARH in individuals who were acclimatized to HA for extended periods, aiming to elucidate the physiological responses of the retina to chronic hypoxic conditions. We conducted an observational cross-sectional study involving 1,457 male participants who had resided at altitudes above 3353 meters (11,000 ft) in the Himalayan region for more than three months. Patients who had ocular or systemic diseases affecting the retina, chronic retinotoxic medication use or smoking were excluded. Participants underwent comprehensive ophthalmic examination, including the best corrected visual acuity test, dilated fundus examination and photography. A total of 1,457 males were screened, and the mean age was 34 ± 2 years. Of all the participants screened, 12 (0.82%) had HAR, with all cases occurring at altitudes above 4267 meters (14,000 ft). Seventy-five percent (75%) of the HAR patients had retinal hemorrhage and venous dilatation. Macular involvement and cotton wool spots were observed in 34% and 25% of HAR patients, respectively. Only four participants had foveal involvement with significant visual impairment. Delayed HARH in acclimatized individuals underscores the importance of long-term ocular monitoring for those exposed to HA, despite acclimatization, to prevent and manage potential visual impairments.

Web-based vs. conventional: a comprehensive analysis of visual acuity assessment using the PocDoc tool in a tertiary eye care centre.

Visual acuity (VA) represents a fundamental measure of visual function. The significant prevalence of underdiagnosed ocular disorders underscores the importance of effective VA assessment. This study evaluates the efficacy of a web-based VA assessment tool ("PocDoc") versus conventional VA testing. Prospective observational study including 353 participants recruited from various eye clinics in a tertiary referral centre. Age, diagnosis, and VA related information (i.e. VA measurements from PocDoc and conventional VA test [Snellen chart], test type, etc) were collected. Spearman's rank correlation, Intraclass Correlation, and Bland-Altman plot compared outcomes of both tests. One-way ANOVA and paired-T test were used to compare means. Most patients were males (59.2%) with a mean age of 52.2 ± 20.6 years. PocDoc had moderate positive correlation to conventional testing (rho = 0.50, p < 0.001). PocDoc led to higher logMAR scores compared to conventional testing (mean logMAR 0.19 and 0.13 respectively, p < 0.01). Moreover, PocDoc demonstrated a sensitivity of 82.8% and specificity of 79% for detecting visual impairment. The discrepancy between PocDoc and conventional VA testing increased with higher logMAR values, indicating greater inconsistency between the tests for patients with poorer VA. Age, test type, and disease type contributed to this variability. The concordance between PocDoc and conventional testing for VA measurement across various ages and conditions makes it a suitable screening tool. Future technological inventions should consider age, test type, and disease type as critical factors related to the level of agreement and correlation between digital and conventional VA testing methods.

An investigation on choroidal and retinal thickness alterations in Posner-Schlossman syndrome patients

BackgroundWe aimed to compare choroidal thickness (ChT) and retinal nerve fiber layer (RNFL) thickness in the affected and contralateral eyes of patients with Posner-Schlossman Syndrome (PSS) during acute, remission, and intermittent phases.MethodsThis prospective observational study included 18 patients(36 eyes) diagnosed with PSS. These patients underwent a comprehensive ophthalmologic evaluation including slit lamp examination, visual acuity testing, intraocular pressure (IOP) measurement, and funduscopic examination, and assessment of RNFL thickness, macular thickness, and macular ChT. Patient data collected included gender, age, number of keratic precipitates (KPs), and number of episodes. Optical coherence tomography (OCT) was used to measure RNFL thickness, macular thickness, and macular ChT in both eyes during the acute, remission, and intermittent phases. The affected eye was compared with the unaffected eye at each phase.ResultsIn affected eyes, macular ChT was lower in the acute phase compared to the remission phase at N1500, N1000, N500, and subfoveal locations (allp < 0.05).The central macular recess ChT was also significantly thinner in the acute phase compared to the intermittent and remission phases. Age significantly correlated with ChT in the central recess (p = .024). Macular thickness was thinner during the acute phase in the affected eye (p = .048). The RNFL in the affected eye was thinner in the intermittent phase than in the acute phase at the inferior-temporal (p = .011) and global sectors (p = .044). During the acute phase, RNFL in the affected eye was thinner at the superior-nasal (p = .049), inferior-temporal (p = .003), and global (p = .041) sectors compared to the unaffected eye. In the intermittent phase, the affected eye’s RNFL was thinner at the superior-nasal, inferior-temporal, inferior-nasal, and global sectors compared to the unaffected eye (allp < 0.05), while no difference was observed in both eyes at the nasal, superior-temporal, and temporal sectors. The number of episodes and age were significantly associated with RNFL thickness (p < .05).ConclusionThis study demonstrated that in eyes affected by PSS, RNFL, macular ChT, and macular thickness thinned during the acute phase. The number of episodes and age are significant factors in the development of PSS.

Visual and anatomical outcomes following vitrectomy with subretinal tPA injection in patients with submacular haemorrhages secondary to wet AMD

Purpose: Submacular haemorrhages (SMHs) are most commonly associated with wet age-related macular degeneration (AMD) and their size and duration are strong prognostic factors for visual outcome. The aim of this audit was to evaluate outcomes of direct injection of submacular tissue plasminogen activator (t-PA) into these lesions during pars plana vitrectomy (PPV). Methods: All patients presenting to the Mater Misericordiae Hospital from January 2017 to December 2019 with large SMHs secondary to wet AMD who underwent this treatment were included for review. All ten patients underwent complete PPV, injection of 0.2ml (50µg) subretinal t-PA and air tamponade. Pre-operative and post-operative evaluations included visual acuity testing (VA), optical coherence tomography (OCT) and slit lamp examination. Results: Eight patients (80%) showed improvement of their VA, with 4 patients achieving a VA of ≤0.4 LogMAR (20/50). Six patients had a total clearing of the macular haemorrhage, with a further 2 having sub-total clearance. One patient subsequently developed a retinal detachment requiring oil tamponade. Conclusions: SMH secondary to wet AMD is a sight threatening event with a varied prognosis but in most cases, vitrectomy with subretinal t-PA injection results in improved anatomical and visual outcomes.

Exploring Scotopic Microperimetry as an Outcome Measure in Choroideremia.

Choroideremia is an X-linked outer retinal degeneration. Early symptoms include nyctalopia and progressive visual field loss, but visual acuity is preserved until late disease stages. Dark-adapted two-color fundus-controlled perimetry (also known as scotopic microperimetry) has been developed to enable spatial assessment of rod and cone photoreceptor function. This study explores the use of scotopic microperimetry in patients with choroideremia. Twenty patients with choroideremia and 21 age-matched healthy controls completed visual acuity and scotopic microperimetry testing, which used the Scotopic Macular Integrity Assessment (S-MAIA) microperimeter. A subset of participants completed repeat scotopic testing to enable Bland-Altman repeatability analyses. Test reliability was assessed using fixation stability, fixation losses, and assessment of the rod-free zones. Pointwise sensitivity, mean sensitivity, and volume sensitivity indices were analyzed. False positive responses were the main source of poor test reliability, indicated by stimuli responses in the physiological blind spot and lack of rod-free mapping. Scotopic cyan and red sensitivities were significantly reduced in choroideremia participants (n = 17) compared to healthy controls (n = 16) (P < 0.01, Mann-Whitney U test). Scotopic cyan sensitivity was statistically lower than scotopic red sensitivity in both healthy controls and choroideremia (P < 0.01, Wilcoxon signed rank test). Interpretation of scotopic cyan-red differences should be used with caution due to high test-retest variability. Scotopic microperimetry could be a useful outcome measure in patients with early choroideremia. Careful selection of test grid design and sensitivity indices is required. Scotopic microperimetry may be a useful outcome measure in clinical trials for patients with early stage choroideremia.

Qualitative somatosensory evaluation of recipient and donor sites of subepithelial connective tissue grafts: a preliminary study.

The subepithelial connective tissue graft (SCTG) plus coronal advanced flap is commonly evaluated by clinical parameters, but potential sensory changes (patients' perception of painful or painless sensations) need to be further explored. This preliminary study aimed to qualitatively evaluate the somatosensory profile of recipient and palatal donor sites of SCTG. Sensory tests were applied at SCTG recipient and donor sites at baseline, after 3 and 6 months. A single calibrated examiner applied Douleur Neuropathique 4 questionnaire (DN4), qualitative sensory test (QualST), discriminating the areas as hypersensitive, hyposensitive or normosensitive, and two-point acuity test. Descriptive statistics, non-parametric Kruskal Wallis test for QualST evaluation and ANOVA for Two-point test (p < 0.05) were used. QualST revealed that recipient areas presented no significant differences in tactile, pressure and thermal tests. Brush test revealed hyposensitivity after 3 months (p = 0.03). In donor areas, only thermal evaluation showed a significant difference (p = 0.01), being hypersensitive after 3 months and hyposensitive after 6 months. At baseline, all evaluations in recipient and donor areas were normosensitive. According to DN4, no patient reported pain in recipient and donor sites. Non-painful sensory perception was reported as numbness in recipient (3.14% of patients) and donor (18.4%) areas. No significant differences were found for two-point acuity test values. Somatosensory variations were observed in donor and recipient areas using qualitative tests, with no detection of painful sensations, only non-painful sensations of numbness and electric shock. This preliminary study demonstrated that alterations of hypo- and hypersensitivity may occur in donor and recipient areas of gingival grafts. However, when present, these alterations were non-painful and did not impact oral functions. ReBEC #RBR-7zz3b6p.

Cardio-ocular syndrome: Retinal microvascular changes in acutely decompensated heart failure.

To investigate the changes in retinal microvasculature by contemporary imaging techniques during episodes of acute decompensated heart failure (ADHF) and following recompensation compared to age-matched controls without known cardiac or retinal disease. Adult patients hospitalized with a primary diagnosis of ADHF, regardless of left ventricular ejection fraction (LVEF) and treated with a minimum dose of 40 mg of intravenous furosemide or equivalent were included. Transthoracic echocardiography was conducted in all patients. Eye examinations were performed out within the initial 24 h after admission and after recompensation before discharge. All eyes underwent a general examination, including a best corrected visual acuity test, dilated fundoscopy, spectral-domain optical coherence tomography (OCT) as well as OCT angiography (OCT-A). In addition, 40 participants without documented cardiac or retinal diseases served as controls. Forty patients with ADHF (mean age 78.9 ± 8.8 years; 32% female) with a mean LVEF of 43 ± 12.8% were included. All patients were treated with intravenous diuretics for a median of 4.3 ± 2.8 days. There was a significant reduction in N-terminal pro-B-type natriuretic peptide from baseline up to discharge (10 396 [interquartile range 6410] vs. 6380 [interquartile range 3933] pg/ml, p ≤ 0.001) and inferior vena cava diameters (2.13 ± 0.4 vs. 1.63 ± 0.3 cm, p = 0.003). Compared to the control group, patients with ADHF showed on admission impaired visual acuity (0.15 ± 0.1 vs. 0.35 ± 0.1 logMAR, p < 0.001), reduced macular vessel density (18.0 ± 1.9 vs. 14.3 ± 3.6 mm/mm2, p < 0.001) and perfusion density (42.6 ± 3.2 vs. 35.2 ± 9.7%, p < 0.001). After recompensation, the mean overall vessel density and mean overall perfusion density were markedly increased at discharge (14.3 ± 3.6 vs. 19.7 ± 2.6 mm/mm2, p = 0.001, and 35.2 ± 9.7 vs. 39.2 ± 6.5%, p = 0.005, respectively). The mean diameter of the superior temporal retinal vein at admission was significantly larger compared to the control group (136 ± 19 vs. 124 ± 22 μm, p = 0.008) and decreased significantly to 122 ± 15 μm at discharge (p < 0.001). This analysis revealed a remarkable reversible change in retinal microvasculature after ADHF. This could provide a valuable evidence for use of OCT-A in the assessment of overall microperfusion and haemodynamic status in patients with acute heart failure.

Comparison between Different Visual Acuity Tests and Validation of a Digital Device.

To compare different visual acuity (VA) tests (printed and digital, symbols and letters) and to validate a new device for VA testing called DIVE (Devices for an Integral Visual Examination). VA was tested in a wide spectrum of adult people with printed tests (ETDRS and LEA Symbols) and with two implemented tests in DIVE (HOTV and DIVE Symbols). We measured agreement between the different VA tests using the intraclass correlation coefficient and Bland-Altman method. In addition, we measured the repeatability of all tests. Right eyes from 51 adult participants were included in the study. Correlation between tests was high (ICC from 0.95 to 0.97). Bland-Altman analysis showed good agreement among the different tests, with differences within reasonable clinical limits. However, slightly better VA values were obtained with DIVE HOTV and ETDRS, followed by LEA and DIVE Symbols. ETDRS had the best repeatability. The four evaluated VA tests provide comparable outcomes. In an adult sample, letter optotypes obtained better VA values than symbol optotypes. DIVE VA tests are reliable and well-correlated with printed VA tests.

Cranio-Orbital Approach and Decompression of the Optic Nerves: A 2-Stage, 4-by-4-Step Approach to Improve Vision in Sellar and Parasellar Lesions.

Despite advances in cranial base techniques, surgery of the sellar and parasellar regions remains challenging because of complex neurovascular relationships. Lesions within this region frequently present with progressive visual deterioration caused by distortion and compression of the optic chiasm and nerves. In addition to the direct mass effect from mechanical forces acting on the optic apparatus, these lesions alter blood supply and reduce vascular perfusion, prompting surgical treatment to remove the lesion, alleviate compression, and improve blood flow to the optic nerve. We sought to describe a 2-stage, 4-by-4-step approach, broken down and described as a "four-by-four" technique for optic apparatus decompression and a wide approach to different sellar and parasellar lesions. We describe the operative nuances and key anatomic points in the microsurgical removal of sellar and parasellar lesions. The technique is illustrated with examples of different cases with pre- and follow-up MRI imaging and a brief overview of visual outcomes. The described technique has been demonstrated in various lesions in 5 patients. Patients presented with bilateral visual loss in 4 (80.0%) cases and with unilateral visual loss in 1 (20.0%) case. Improvement in visual function was noted in all cases, confirmed with visual acuity and visual field testing. The transcranial approach ("from above") remains an important surgical option for patients with excellent exposure and visualization of the sellar and parasellar regions. It permits early access to the optic canal for careful microsurgical decompression and relaxation of the optic nerve to preserve and improve its microvascularization and ultimately vision. The authors augmented the 2-stage, 4-by-4-step technique of decompression with elaborate illustrations of diverse sellar and parasellar lesions to demonstrate the versatility of this approach.

Refractive errors in Tianjin youth aged 6-18 years: exploring urban-rural variations and contributing factors.

Refractive errors, particularly myopia, constitute a significant global public health concern, contributing to morbidity and disability. A more comprehensive understanding of the determinants of refractive errors and the differences between urban and rural areas is essential to develop effective preventive measures for youth. This study aimed to compare the prevalence and risk factors of refractive errors among youth in urban and rural Tianjin, China. This school-based cross-sectional study was conducted in 2022. Elementary, middle, and high school students aged 6-18 years from both urban and rural areas of Tianjin were included. All participants underwent visual acuity testing and refractive measurement and completed comprehensive questionnaires. A total of 346,146 participants (176,628 boys) were included in this investigation (50.36% for urban and 49.64% for rural, respectively). Myopia, hyperopia, astigmatism, and anisometropia were present in 56.8, 9.7, 56.64, and 21.3% of urban students, respectively. Similarly, rural students had a prevalence of 57.6, 11.5, 56.48, and 22.0% for the respective conditions. Compared to rural students, after adjusting for age, sex, and other significant variables, urban students were 1.05 times more likely to have myopia (95% CI: 1.03-1.07, p < 0.0001), 0.71 times less likely to have hyperopia (95% CI: 0.69-0.73, p < 0.0001), and 1.02 times more likely to have astigmatism (95% CI: 0.69-0.73, p < 0.0001). There was no significant association between anisometropia and residence (OR: 1.00, 95% CI: 0.98-1.02, p = 0.9850). Sociodemographic and physiological factors contribute to the disparities in the prevalence of refractive errors between urban and rural areas. Age, increased near-work activities, and Decreased outdoor time were identified as risk factors for myopia, astigmatism, and anisometropia. Conversely, the absence of a parental history of refractive errors emerged as a protective factor for myopia and astigmatism among students. Lower parental education levels were negatively correlated with the risk of myopia and anisometropia in their children. Specifically, the lower the parental education, the greater the risk of myopia in their offspring. For urban students only, lower parental education was associated with an increased risk of astigmatism. Crude prevalence estimates May not accurately reflect the true burden of refractive error due to confounding factors such as age and sex. Accounting for these factors revealed that urban students were more likely to have myopia and astigmatism but less likely to have hyperopia compared to their rural counterparts. These disparities highlight the importance of considering geographical variations when implementing strategies for myopia control and prevention.