Central Vision Research Articles

Occlusion-aware deep convolutional neural network via homogeneous Tanh-transforms for face parsing

Face parsing infers a pixel-wise label map for each semantic facial component. Previous methods generally work well for uncovered faces, however, they overlook facial occlusion and ignore some contextual areas outside a single face, especially when facial occlusion has become a common situation during the COVID-19 epidemic. Inspired by the lighting phenomena in everyday life, where illumination from four distinct lamps provides a more uniform distribution than a single central light source, we propose a novel homogeneous tanh-transform for image preprocessing, which is made up of four tanh-transforms. These transforms fuse the central vision and the peripheral vision together. Our proposed method addresses the dilemma of face parsing under occlusion and compresses more information from the surrounding context. Based on homogeneous tanh-transforms, we propose an occlusion-aware convolutional neural network for occluded face parsing. It combines information in both Tanh-polar space and Tanh-Cartesian space, capable of enhancing receptive fields. Furthermore, we introduce an occlusion-aware loss to focus on the boundaries of occluded regions. The network is simple, flexible, and can be trained end-to-end. To facilitate future research of occluded face parsing, we also contribute a new cleaned face parsing dataset. This dataset is manually purified from several academic or industrial datasets, including CelebAMask-HQ, Short-video Face Parsing, and the Helen dataset, and will be made public. Experiments demonstrate that our method surpasses state-of-the-art methods in face parsing under occlusion.

Peripheral vision contributes to implicit attentional learning: Findings from the "mouse-eye" paradigm.

The central visual field is essential for activities like reading and face recognition. However, the impact of peripheral vision loss on daily activities is profound. While the importance of central vision is well established, the contribution of peripheral vision to spatial attention is less clear. In this study, we introduced a "mouse-eye" method as an alternative to traditional gaze-contingent eye tracking. We found that even in tasks requiring central vision, peripheral vision contributes to implicit attentional learning. Participants searched for a T among Ls, with the T appearing more often in one visual quadrant. Earlier studies showed that participants' awareness of the T location probability was not essential for their ability to learn. When we limited the visible area around the mouse cursor, only participants aware of the target's location probability showed learning; those unaware did not. Adding placeholders in the periphery did not restore implicit attentional learning. A control experiment showed that when participants were allowed to see all items while searching and moving the mouse to reveal the target's color, both aware and unaware participants acquired location probability learning. Our results underscore the importance of peripheral vision in implicitly guided attention. Without peripheral vision, only explicit, but not implicit, attentional learning prevails.

Stitched vision transformer for age-related macular degeneration detection using retinal optical coherence tomography images.

Age-related macular degeneration (AMD) is an eye disease that leads to the deterioration of the central vision area of the eye and can gradually result in vision loss in elderly individuals. Early identification of this disease can significantly impact patient treatment outcomes. Furthermore, given the increasing elderly population globally, the importance of automated methods for rapidly monitoring at-risk individuals and accurately diagnosing AMD is growing daily. One standard method for diagnosing AMD is using optical coherence tomography (OCT) images as a non-invasive imaging technology. In recent years, numerous deep neural networks have been proposed for the classification of OCT images. Utilizing pre-trained neural networks can speed up model deployment in related tasks without compromising accuracy. However, most previous methods overlook the feasibility of leveraging pre-existing trained networks to search for an optimal architecture for AMD staging on a new target dataset. In this study, our objective was to achieve an optimal architecture in the efficiency-accuracy trade-off for classifying retinal OCT images. To this end, we employed pre-trained medical vision transformer (MedViT) models. MedViT combines convolutional and transformer neural networks, explicitly designed for medical image classification. Our approach involved pre-training two distinct MedViT models on a source dataset with labels identical to those in the target dataset. This pre-training was conducted in a supervised manner. Subsequently, we evaluated the performance of the pre-trained MedViT models for classifying retinal OCT images from the target Noor Eye Hospital (NEH) dataset into the normal, drusen, and choroidal neovascularization (CNV) classes in zero-shot settings and through five-fold cross-validation. Then, we proposed a stitching approach to search for an optimal model from two MedViT family models. The proposed stitching method is an efficient architecture search algorithm known as stitchable neural networks. Stitchable neural networks create a candidate model in search space for each pair of stitchable layers by inserting a linear layer between them. A pair of stitchable layers consists of layers, each selected from one input model. While stitchable neural networks had previously been tested on more extensive and general datasets, this study demonstrated that stitching networks could also be helpful in smaller medical datasets. The results of this approach indicate that when pre-trained models were available for OCT images from another dataset, it was possible to achieve a model in 100 epochs with an accuracy of over 94.9% in classifying images from the NEH dataset. The results of this study demonstrate the efficacy of stitchable neural networks as a fine-tuning method for OCT image classification. This approach not only leads to higher accuracy but also considers architecture optimization at a reasonable computational cost.

A Long-Term Retrospective Natural History Study of EFEMP1-Associated Autosomal Dominant Drusen.

To analyze the natural history of EFEMP1-associated autosomal dominant drusen (ADD). In this retrospective observational study of molecularly confirmed patients with ADD, data and retinal imaging were extracted from an in-house database. The main outcome measurements were best-corrected visual acuity (BCVA), refraction, and retinal imaging, including quantitative analyses of the outer nuclear layer (ONL) thickness and pigmented epithelium detachment area, as well as qualitative analyses. The study included 44 patients (34 females and 10 males). The mean ± SD age of symptom onset was 40.1 ± 6.59 years of age (range, 25-52). Fourteen patients were asymptomatic during their entire follow-up. The most common symptoms at presentation were reduced vision (70%) and distortion in central vision (53%). Most subjects were emmetropic. The mean BCVA (logMAR) at baseline was 0.27 ± 0.41 (range, -0.1 to 2.1) in right eyes and was 0.19 ± 0.32 (range, -0.2 to 1.3) in left eyes. After a mean follow-up of 7.9 years, BCVA was reduced to 0.59 ± 0.66 (range, -0.1 to 2.1) in right eyes and 0.5 ± 0.72 (range, -0.1 to 2.4) in left eyes, values that were significantly different than baseline (P<0.0001 and P<0.0014, respectively). Fifteen eyes showed active or inactive choroidal neovascularization (CNV). BCVA differed significantly (P = 0.0004) between eyes with and without CNV at a comparable mean age. The ONL had a slow rate of thinning longitudinally, which significantly correlated with BCVA. Despite the late onset and relatively good prognosis of ADD, CNVs are more frequent than previously reported and are associated with a worse prognosis. Further research is necessary to elucidate gender associations.

Efficacy of perceptual learning in low vision: A systematic review and meta-analysis.

Visual perceptual learning (PL) shows promise for enhancing visual functions in individuals with visual impairment. This systematic review aimed to evaluate the effectiveness of PL in improving visual function. Eligible studies were those examining the efficacy of PL in individuals with low vision. The review protocol was registered with the international Prospective Register of Systematic Reviews (ID CRD42022327545) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Screened studies were synthesized using random-effects meta-analysis and narrative synthesis following Synthesis Without Meta-analysis guidelines. The quality of the evidence was assessed using the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tool for Quasi-Experimental studies. Fifty studies were included, covering various visual impairments and employing different PL interventions. Most studies had low risk of bias. Meta-analysis showed significant improvement in visual search for individuals with cortical blindness (Hedges' g = 0.71; 95% confidence interval, 0.48 to 0.93; p=0.002); all other analyses did not show significant improvements-reading in central vision loss and cortical blindness, and visual field in peripheral vision loss and cortical blindness. However, the narrative synthesis provided evidence showing effectiveness, particularly in individuals with central vision loss and cortical blindness, demonstrating positive effects on reading, contrast sensitivity, visual field, and motion perception. Variations in study design, PL protocols, outcome measures, and measurement methods introduced heterogeneity, limiting the analysis. The efficacy of PL in vision rehabilitation remains uncertain. Although meta-analysis results were mostly inconclusive, the narrative synthesis indicated improved visual functions following PL, consistent with individual study findings. Future research should optimize intervention parameters, explore long-term effects, and assess generalizability across diverse populations and visual impairment etiologies. Larger randomized controlled trials using standardized outcome measures are needed to advance the field.

Comparison of Functional, Structural, and Microvascular Features in Different Stages of Idiopathic Epiretinal Membrane.

Background: Idiopathic epiretinal membrane (ERM) often leads to visual symptoms such as metamorphopsia and decreased central vision. This study aimed to evaluate functional, structural, and microvascular characteristics in patients with different stages of idiopathic ERM who were candidates for surgery, with a focus on identifying potential indicators for surgical timing. Methods: A retrospective cohort study was conducted on consecutive patients with unilateral idiopathic ERM who were candidates for surgery. Patients underwent comprehensive ophthalmological assessments, including OCT grading, reading performance evaluation, and OCT angiography. Data analysis included comparisons between different ERM stages for functional, structural, and microvascular parameters. Results: A total of 44 eyes were included, classified into four ERM stages according to the Govetto grading system. Functional parameters, including distance and near visual acuity, worsened significantly with higher ERM stages, particularly in the transition from Stage 3 to Stage 4. Structural assessments revealed significant increases in central macular thickness (CMT) from Stage 3 to Stage 4. No significant differences were observed in microvascular features across different ERM stages. Conclusions: This study highlights the significant functional and anatomical impact of OCT staging in idiopathic ERM, particularly during the transition from Stage 3 to Stage 4, characterized by notable reductions in visual acuity and increases in CMT. These findings underscore the importance of considering both functional and structural parameters in surgical decision-making for ERM management. However, further research with larger cohorts is needed to confirm these observations and inform clinical practice.

A call for increased surveillance: monitoring the use of hydroxychloroquine to prevent retinopathy

Dear Sir / Madam. Hydroxychloroquine (HCQ) and chloroquine (CQ) are the main drugs used in the control and treatment of malaria. Although the toxicity of these drugs is rare, it has been reported in high-dose ingestions or chronic intravenous administration. Of these retinal manifestations are one of the most common following the poisoning of CQ. A recent study by Melles et al. found that the overall risk of hydroxychloroquine retinopathy is 8.6% after chronic use with higher dose of HCQ dose being associated with a progressively greater risk for incident retinopathy (1). Retinopathy can lead to serious complications in patients; in fact in most patient’s vision loss. In Melles et al’s study, it mostly led to complaints like reading difficulties, diminished vision, missing center vision, glare, hazy vision, light flashes, and metamorphopsia, while some patients were asymptomatic. The majority of patients exhibited a fundoscopic bull's-eye sign. Other signs include paracentral, central, and peripheral visual field loss, which were present in almost all patients. In the early stages of retinopathy, color vision is typically unaffected, but it too begins to be compromised in the later stages. (2) Malaria is endemic in Pakistan. In 2023 pooled malaria prevalence in Pakistan was found to be 23.3%, with Plasmodium vivax, Plasmodium falciparum, and mixed infection rates of 79.13%, 16.29%, and 3.98%, respectively. According to the World Health Organization (WHO), Pakistan is one of the seven countries in the Eastern Mediterranean Region that account for 98% of the total malaria burden in the region. Around 217 million people in Pakistan are at moderate risk of malaria and 63 million are at high risk. Approximately 0.47 million malaria cases and 800 deaths have been reported in 2020(3). The recent rise in climate change-induced flooding and other weather changes, waterborne diseases such as malaria, are also rising leading to higher HCQ use. Furthermore, CQ and HCQ are also being used in treating covid 19(4). This, combined with factors such as lack of surveillance, self-medication practises, and rampant over-the-counter use in Pakistan greatly increase the risk of patients taking improperly high doses of HCQ or CQ and, consequently, suffering from retinopathy. To prevent the HCQ-associated retinal toxicity proper surveillance methods should be employed, and the prescription and distribution of these drugs should be monitored. Patients and physicians prescribing HCQ should be aware of its toxicity risks (5). ---Continue

One-year outcomes and safety assessment of faricimab in treatment-naïve patients with neovascular age-related macular degeneration in Japan

This multicentre retrospective study evaluated the 1-year outcomes and safety profile of faricimab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD). Fifty-five patients (57 eyes) underwent loading therapy comprising three monthly faricimab injections. If dryness was achieved by the third month, subsequent treat-and-extend (TAE) follow-up continued at a minimum 8-week interval thereafter. If wet macula persisted at the third month, a fourth dose was administered, followed by the TAE regimen. After 1 year, improvements in visual acuity (0.44 ± 0.46 [baseline] to 0.34 ± 0.48; p < 0.01) and central foveal thickness (326 ± 149 [baseline] to 195 ± 82 μm; p < 0.0001) were significant. Dry macula, characterised by the absence of intraretinal or subretinal fluid, was achieved in 65% of cases. Treatment intervals varied, ranging from 8 to 16 weeks, with 44% of eyes extending to a 16-week interval, followed by 33% at 8 weeks, 16% at 12 weeks, 5% at 14 weeks, and 2% at 10 weeks. Notably, 50% of the polypoidal choroidal vasculopathy patients exhibited complete regression of polypoidal lesions between 12 and 15 months. Faricimab treatment in nAMD patients induced significant improvements in central vision and retinal morphology. Two cases of retinal pigment epithelial tears and one case of iritis were reported as ocular complications.

Imaging of human parafoveal area with large field of view in adaptive optics line scanning ophthalmoscope

The parafoveal area, with its high concentration of photoreceptors and fine retinal capillaries, is crucial for central vision and often exhibits early signs of pathological changes. The current adaptive optics scanning laser ophthalmoscope (AOSLO) provides an excellent tool to acquire accurate and detailed information about the parafoveal area with cellular resolution. However, limited by the scanning speed of two-dimensional scanning, the field of view (FOV) in the AOSLO system was usually less than or equal to 2∘, and the stitching for the parafoveal area required dozens of images, which was time-consuming and laborious. Unfortunately, almost half of patients are unable to obtain stitched images because of their poor fixation. To solve this problem, we integrate AO technology with the line-scan imaging method to build an adaptive optics line scanning ophthalmoscope (AOLSO) system with a larger FOV. In the AOLSO, afocal spherical mirrors in pairs are nonplanar arranged and the distance and angle between optical elements are optimized to minimize the aberrations, two cylinder lenses are orthogonally placed before the imaging sensor to stretch the point spread function (PSF) for sufficiently digitizing light energy. Captured human retinal images show the whole parafoveal area with [Formula: see text] FOV, 60[Formula: see text]Hz frame rate and cellular resolutions. Take advantage of the 5∘ FOV of the AOLSO, only 9 frames of the retina are captured with several minutes to stitch a montage image with an FOV of [Formula: see text], in which photoreceptor counting is performed within approximately 5∘ eccentricity. The AOLSO system not only provides cellular resolution but also has the capability to capture the parafoveal region in a single frame, which offers great potential for noninvasive studying of the parafoveal area.

Sense of agency at a gaze-contingent display with jittery temporal delay.

Inconsistent jittery temporal delays between action and subsequent feedback, prevalent in network-based human-computer interaction (HCI), have been insufficiently explored, particularly regarding their impact on the sense of agency (SoA). This study investigates the SoA in the context of eye-gaze HCI under jittery delay conditions. Participants performed a visual search for Chinese characters using a biresolutional gaze-contingent display, which displayed a high-resolution image in the central vision and a low-resolution in the periphery. We manipulated the delay between eye movements and display updates using a truncated normal distribution (μ to μ + 2 σ) with μ ranging from 0 to 400 ms and σ fixed at 50 ms. Playback of recorded gaze data provided a non-controllable condition. The study revealed that both reported authorship and controllability scores, as well as the fixation count per second, decreased as μ increased, aligning with trends observed under constant delay conditions. The subjective authorship weakened significantly at a μ of 94 ms. Notably, the comparison between jittery and constant delays indicated the minimum value (μ) of the distribution as a critical parameter influencing both authorship perception and visual search time efficiency. This finding underscores the importance of the shortest delay in modulating SoA. Further examining the relative distribution for fixation duration and saccade amplitude suggests an adaptation in action planning and attention distribution in response to delay. By providing a systematic examination of the statistical attributes of jittery delays that most significantly affect SoA, this research offers valuable implications for the design of efficient, delay-tolerant eye-gaze HCI, expanding our understanding of SoA in technologically mediated interactions. Moreover, our findings highlight the significance of considering both constant and variable delay impacts in HCI usability design, marking a novel contribution to the field.

The Effects of Eye Illuminance Distribution in the Horizontal Field of View on Human Performance in a Home Paper-Based Learning Situation

Previous studies have focused on task/ambient illumination for visual effects and eye illumination for non-visual effects. In this context, eye illumination within the non-visual realm was defined as vertical non-visual eye illuminance. Considering the functional specificity of central vision and peripheral vision, this study aims to explore whether the distribution of eye illuminance in the horizontal field of view (FOV) affects human performance in home paper-based learning settings. In this study, a within-subject design was used to investigate the effects of eye illuminance distribution on mental perception, task performance, and physiological health while maintaining constant task illuminance and correlated color temperature (CCT). The findings revealed that eye illuminance and its distribution in the horizontal FOV had complex effects on visual fatigue, Landolt ring performance, heart rate variability, and luminous environment appraisal. A relatively optimal lighting configuration was suggested—Scene 4, which was characterized by an eye illuminance level in central FOV of 186 lx and an “m” shaped eye illuminance distribution pattern. This indicates the importance of considering eye illuminance distribution in the horizontal FOV, rather than solely focusing on vertical eye illuminance.

Circulating Anti-Endothelial Cell Antibodies in Patients with Geographic Atrophy Related to Dry Age-Related Macular Degeneration.

Background and Objectives: Age-related macular degeneration (AMD) is one of the leading causes of central vision loss among elderly patients, and its dry form accounts for the majority of cases. Although several causes and mechanisms for the development and progression of AMD have previously been identified, the pathogenesis of this complex disease is still not entirely understood. As inflammation and immune system involvement are strongly suggested to play a central role in promoting the degenerative process and stimulating the onset of complications, we aimed to analyze the frequency of serum anti-retinal (ARAs) and anti-endothelial cell antibodies (AECAs) in patients with dry AMD and to determine their relationship with the clinical features of the disease, notably the area of geographic atrophy (GA). Materials and Methods: This study included 41 patients with advanced-stage dry AMD and 50 healthy controls without AMD, matched for gender and age. ARAs were detected by indirect immunofluorescence using monkey retina as an antigen substrate, and the presence of AECAs was determined using cultivated human umbilical vein endothelial cells and primate skeletal muscle. Results: ARAs were detected in 36 (87.8%) AMD patients (titers ranged from 1:20 to 1:320) and in 16 (39.0%) (titers ranged from 1:10 to 1:40) controls (p = 0.0000). Twenty of the forty-one patients (48.8%) were positive for AECAs, while in the control group, AECAs were present only in five sera (10.0%). The titers of AECAs in AMD patients ranged from 1:100 to 1:1000, and in the control group, the AECA titers were 1:100 (p = 0.0001). There were no significant correlations between the presence of AECAs and disease activity. Conclusions: This study demonstrates a higher prevalence of circulating AECAs in patients with dry AMD; however, no correlation was found between the serum levels of these autoantibodies and the area of GA.

Age-related dysregulation of the retinal transcriptome in African turquoise killifish.

Age-related vision loss caused by retinal neurodegenerative pathologies is becoming more prevalent in our ageing society. To understand the physiological and molecular impact of ageing on retinal homeostasis, we used the short-lived African turquoise killifish, a model known to naturally develop central nervous system (CNS) ageing hallmarks and vision loss. Bulk and single-cell RNA-sequencing (scRNAseq) of three age groups (6-, 12-, and 18-week-old) identified transcriptional ageing fingerprints in the killifish retina, unveiling pathways also identified in the aged brain, including oxidative stress, gliosis, and inflammageing. These findings were comparable to observations in the ageing mouse retina. Additionally, transcriptional changes in genes related to retinal diseases, such as glaucoma and age-related macular degeneration, were observed. The cellular heterogeneity in the killifish retina was characterized, confirming the presence of all typical vertebrate retinal cell types. Data integration from age-matched samples between the bulk and scRNAseq experiments revealed a loss of cellular specificity in gene expression upon ageing, suggesting potential disruption in transcriptional homeostasis. Differential expression analysis within the identified cell types highlighted the role of glial/immune cells as important stress regulators during ageing. Our work emphasizes the value of the fast-ageing killifish in elucidating molecular signatures in age-associated retinal disease and vision decline. This study contributes to the understanding of how age-related changes in molecular pathways may impact CNS health, providing insights that may inform future therapeutic strategies for age-related pathologies.

Bioinformatics analysis for constructing a cellular senescence-related age-related macular degeneration diagnostic model and identifying relevant disease subtypes to guide treatment.

Age-related macular degeneration (AMD) is a condition causing progressive central vision loss. Growing evidence suggests a link between cellular senescence and AMD. However, the exact mechanism by which cellular senescence leads to AMD remains unclear. Employing machine learning, we established an AMD diagnostic model. Through unsupervised clustering, two distinct AMD subtypes were identified. GO, KEGG, and GSVA analyses explored the diverse biological functions associated with the two subtypes. By WGCNA, we constructed a coexpression network of differential genes between the subtypes, revealing the regulatory role of hub genes at the level of transcription factors and miRNAs. We identified 5 genes associated with inflammation for the construction of the AMD diagnostic model. Additionally, we observed that the level of cellular senescence and pathways related to programmed cell death (PCD), such as ferroptosis, necroptosis, and pyroptosis, exhibited higher expression levels in subtype B than A. Immune microenvironments also differed between the subtypes, indicating potentially distinct pathogenic mechanisms and therapeutic targets. In summary, by leveraging cellular senescence-associated gene expression, we developed an AMD diagnostic model. Furthermore, we identified two subtypes with varying expression patterns of senescence genes, revealing their differential roles in programmed cell death, disease progression, and immune microenvironments within AMD.

Enhancing statistical chart accessibility for people with low vision: insights from a user test

AbstractA remote user test was performed with two versions (one accessible and one non-accessible) of three types of web-based charts (horizontal bar chart, vertical stacked bar chart, and line chart). The objectives of the test were: (a) to validate a set of heuristic indicators for the evaluation of the accessibility of statistical charts presented in a previous work (Fariñas Falcón et al. in Mediocentro Electrónica 21(1):65–68, 2017); (b) to identify new barriers and preferences for users with low vision in the access and use of this content not previously contemplated. 12 users were tested, with a variety of conditions associated with low vision: low visual acuity (6 users), reduced central vision (2 users), reduced peripheral vision (2 users), blurry vision (1 user), sensitivity to light (3 users), Nystagmus (2 users) and color vision deficiency (CVD) (4 users). From a quantitative standpoint, accessible versions of charts were more efficient, effective, and satisfactory. From a qualitative point of view, results verify the relevance of heuristics H2, Legend; H3, Axes; H6, Data source (as data table); H10, Safe colors; H11, Contrast; H12, Legibility; H13, Image quality; H14, Resize; H16, Focus visible; H17, Independent navigation; related to the proposed tasks. As new observations, tooltips were highly valued by all users, but their implementation must be improved to avoid covering up significant parts of the charts when displayed. The data table has also been frequently used by all users, especially in the non-accessible versions, allowing them to carry out tasks more efficiently. The position and size of the legend can be a significant barrier if it is too small or appears in an unusual position. Finally, despite the limitations related to color perception, some users prefer color graphics to black and white, so, to target all profiles, it is necessary to redundantly encode categories with colors and patterns as well.

Antioxidants and Mechanistic Insights for Managing Dry Age-Related Macular Degeneration.

Age-related macular degeneration (AMD) severely affects central vision due to progressive macular degeneration and its staggering prevalence is rising globally, especially in the elderly population above 55 years. Increased oxidative stress with aging is considered an important contributor to AMD pathogenesis despite multifaceted risk factors including genetic predisposition and environmental agents. Wet AMD can be managed with routine intra-vitreal injection of angiogenesis inhibitors, but no satisfactory medicine has been approved for the successful management of the dry form. The toxic carbonyls due to photo-oxidative degradation of accumulated bisretinoids within lysosomes initiate a series of events including protein adduct formation, impaired autophagy flux, complement activation, and chronic inflammation, which is implicated in dry AMD. Therapy based on antioxidants has been extensively studied for its promising effect in reducing the impact of oxidative stress. This paper reviews the dry AMD pathogenesis, delineates the effectiveness of dietary and nutrition supplements in clinical studies, and explores pre-clinical studies of antioxidant molecules, extracts, and formulations with their mechanistic insights.

Closure of Full-thickness Macular Hole after Pars Plana Vitrectomy (23G) with Cataract Phacoemulsification, Artificial Intraocular Lens Implantation, and Silicone Oil Administration Due to Rhegmatogenous Retinal Detachment in the Right Eye in a 67-year-old Patient – a Case Report

Macular holes pose a significant threat to central vision, necessitating precise diagnosis and intervention with an occurrence of 1 per 1000 patients over the age of 55. This manuscript presents a case study of a 66-year-old man with a retinal detachment in the right eye and full-wall macular hole. The patient underwent a multi-step surgical intervention involving pars plana vitrectomy, internal limiting membrane peeling with silicone oil tamponade, retinal endophotocoagulation, and administration and removal of the perfluorocarbon liquid DK-line in the first step. The second stage of treatment comprised silicone oil removal via posterior access vitrectomy, injection of 25% SF6 into the right eye, and treatment of intraoperatively found macular hole with an inverted flap method. The case underscores the association between macular hole and rhegmatogenous retinal detachment, with potential iatrogenic causes during vitrectomy. The inverted internal limiting membrane flap technique emerged as a superior strategy for managing full-thickness macular holes, demonstrating high closure rates and improved visual acuity postoperatively. This case study contributes to the evolving understanding of macular hole pathogenesis and reinforces the significance of tailored surgical approaches for optimal patient outcomes.

Homonymous Central Scotomatous Visual Field Defect in a Patient with Lateral Geniculate Nucleus Infarction

Incongruous visual field defects, such as sectoranopia, can result from lateral geniculate nucleus infarction. We present a rare case of right lateral geniculate nucleus infarction that manifests as a left inferior homonymous paracentral scotoma. According to the retinotopic organization of the visual tract, central vision from the macula is delivered to the occipital pole via the posterior portion of the lateral geniculate nucleus. Consequently, not only can occipital pole infarction lead to central visual loss, but partial lateral geniculate nucleus infarction can also produce similar manifestations of central visual loss.

Effectiveness of Mp-3 Microperimetric Biofeedback Fixation Training For Low Vision Rehabilitation in Patients Treated With Corticosteroid Ivt in Retinal Vein Occlusions.

The success of fixation training using microperimetric biofeedback (MP-3 MBFT) in the realm of visual rehabilitation for patients with central vision loss caused by macular pathologies is well established. This study aimed to assess the effectiveness and safety of visual rehabilitation with microperimetric biofeedback in consolidating the benefits obtained, with the goal of reducing the need for repeated intravitreal injections (IVT). Specifically, the focus is on the eyes of patients with central vision loss treated with slow-release corticosteroid IVT following retinal venous thrombosis (RVO), aiming to enhance and maintain postoperative efficacy. This retrospective review involved the examination of 44 eyes affected by macular edema due to RVO associated with central vision loss. Patients were divided into two groups, with only one undergoing ten sessions of 10-minute visual rehabilitation with a microperimeter (MP-3 MBFT) after IVT over a period of 20 weeks. All the treated patients demonstrated good tolerance to the procedure, with no reported complications. A comparison of best-corrected visual acuity (BCVA), retinal sensitivity recorded with a microperimeter, and pre-IVT fixation stability revealed statistically significant improvements at the end of the first month after IVT. However, the treatment group continued to exhibit superior and more enduring results at four months post-IV. The synergistic use of MP-3 MBFT rehabilitation after IVT with slow-release corticosteroids has proven particularly effective in improving BCVA and long-term fixation stability. This led to a significant reduction in the number of required IVTs, with no related adverse events. The authors argue that biofeedback utilization represents a noninvasive therapeutic option devoid of contraindications and easy to implement and that it positively contributes to the overall patient experience regarding quality of life in advanced stages of macular diseases.

Age-Related Macular Degeneration: A Disease of Cellular Senescence and Dysregulated Immune Homeostasis.

Age-related macular degeneration (AMD) is a degenerative ocular disease primarily affecting central vision in the elderly. Its pathogenesis is complex, involving cellular senescence and immune homeostasis dysregulation. This review investigates the interaction between these two critical biological processes in AMD pathogenesis and their impact on disease progression. Initially, cellular senescence is analyzed, with particular emphasis on retinal damage induced by senescent retinal pigment epithelial cells. Subsequently, the occurrence of immune homeostasis dysregulation within the retina and its mechanistic role in AMD areis explored. Furthermore, the paper also discusses in detail the interplay between cellular senescence and immune responses, forming a vicious cycle that exacerbates retinal damage and may influence treatment outcomes. In summary, a deeper understanding of the interrelation between cellular senescence and immune dysregulation is vital for the developing innovative therapeutic strategies for AMD.