Visual Field Research Articles

An unusual case of primary pituitary abscess due to Corynebacterium pseudodiphtheriticum.

Pituitary abscesses are an uncommon cause of pituitary lesions. A 77-year-old woman presented for elective resection of a presumed non-functioning pituitary macroadenoma in the context of a progressive left-sided visual field deficit. She proceeded to trans-sphenoidal resection of the pituitary lesion, with purulent fluid found upon opening the pituitary capsule. Culture of operative samples yielded Corynebacterium pseudodiphtheriticum, susceptible to penicillin. Following debridement, treatment with 10-weeks of directed antimicrobials achieved good clinical response. This is the first reported case of primary C. pseudodiphtheriticum infection of the central nervous system, representing a rare but important differential for a slow growing pituitary lesion.

Review: Clinical findings and genetic characterization of children affected with X-linked retinoschisis in the Spanish population.

X-linked retinoschisis (XLRS) is an inherited retinal disorder due to mutations in retinoschisin 1, characterized by impaired central vision secondary to parafoveal cystic cavities and visual field loss by splitting through the retinal nerve fibre layer in the peripheral retina. It is the leading cause of juvenile macular degeneration in males, and currently there is no approved treatment but carbonic anhydrase inhibitors can be used. A retrospective review of the medical records of 17 children with confirmed XLRS seen in the Paediatric Ophthalmology Department of La Paz University Hospital from the 1st of January 2009 to the 1st of June of 2023 was conducted. Complete ophthalmological studies, genetic testing and full-field electroretinogram were performed. Topical brinzolamide was given to patients with foveoschisis, adding oral acetazolamide in those who did not improve with topical treatment alone or with very extensive foveoschisis at diagnosis. Surgical treatment was performed in retinal detahment (RD) or in no clearing hemovitreous cases. Mean age at diagnosis was 5,86 years and the most common reason for consultation was strabismus, followed by RD. The most frequently affected retinal later on Optic coherence tomography was the inner nuclear layer and throughout the follow-up we observed a decrease in central macular thickness. We found some genotype-phenotype correlation in our series and more severe phenotypes if the first amino acid of the protein is affected or in frameshift mutations. We found that medical treatment (topical and oral) improves foveoschisis, and that surgery shows poor outcomes, especially in younger patients.

Visuoperceptual rehabilitation with repetitive transcranial magnetic stimulation in chronic cortical blindness: a case report

ABSTRACT This study aims to reveal the effect of visuoperceptual rehabilitation combined with neuromodulation on visual impairment recovery in chronic cortical blindness. A 71-year-old patient with cortical blindness was assessed using perimetry, pattern electroretinogram (pERG), Canadian Occupational Performance Measurement (COPM), and Montreal Cognitive Assessment (MoCA) at baseline and after treatment. After 12 rTMS sessions and 50 visual perceptual rehabilitation sessions, perimetry, pERG, COPM, and MoCA significantly improved the visual field and daily functioning. Both COPM-MoCA scores exceeded clinical significance. The results indicate that combining vision therapy with rTMS may improve vision field, daily function, and satisfaction in a chronic blindness case.

Latanoprostene bunod: the first nitric oxide-donating antiglaucoma medication

Glaucoma is a chronic optic neuropathy that causes characteristic visual field defects and is considered one of the leading causes of irreversible vision loss worldwide. Lowering intraocular pressure is the only proven treatment for glaucoma. Medical therapy is usually the first-line treatment for open-angle glaucoma and ocular hypertension. Latanoprostene bunod ophthalmic drop 0.024% is a nitric oxide-donating prostaglandin F2α analog. It lowers the intraocular pressure via a dual mechanism of enhancing aqueous humor outflow through both the trabecular meshwork and uveoscleral pathways. Additionally, the nitric oxide component has shown promise in regulating ocular blood flow and promoting the survival of retinal ganglionic cells. Herein, the mechanism of action, efficacy, safety, and tolerability of the latanoprostene bunod and its effects on ocular blood flow are reviewed. Latanoprostene bunod has demonstrated strong efficacy and a favorable safety profile in both clinical trials and real-world studies. Given the promising results of latanoprostene bunod and advancements in drug delivery, topical fixed-combination and sustained-release formulations containing latanoprostene bunod and other agents targeting different intraocular pressure-lowering mechanisms may become available in the future.

Supervised Automated Kinetic Perimetry (SAKP) Using Simulated Visual Field Data - Presentation of a New Examination Technique.

The aim of this study was to develop, optimise, train, and evaluate an algorithm for performing Supervised Automated Kinetic Perimetry (SAKP) using digitalised perimetric simulation data. The original SAKP algorithm was based on findings from a multicentre study to establish reference values by semi-automated kinetic perimetry (SKP) combined with an automated examination method with moving stimuli ("Program K", developed in Japan). The algorithm evaluated the outer angles of isopter segments and responded to deviations from expected values by placing examination vectors to measure the outer boundaries of the visual field (VF). Specialised interpolation methods were also used to create individual 3D hills of vision and local "probing vectors" to optimise the eccentricity of the vector origins. This algorithm was trained iteratively on seven representative digitalised 3D VF results from five typical classes and optimised in each step: (1) Normal VF, (2) Central scotoma, (3) Concentric VF constriction, (4) Retinal nerve fibre layer defects in the visual field (VFDs), (5) VFDs with respect to the vertical meridian. The optimised SAKP algorithm was then applied to a new set of twenty 3D VF results of varying origin and severity. The primary targets were measured in agreement between actual calculated VF expressed as accuracy (A), that is, the ratio between the area containing correct predictions and total area of predictions measured between 0 = worst and 1 = best, and examination duration (T). The results are given as median (and interquartile range). We also verified the test's robustness by varying individual error rates (ERs) and error magnitudes (EMs). The median and interquartile range (IQR, in brackets) for the total of representative VFs were 0.93 (0.02) for A and 7.0 min (5.2 min) for T, respectively. A gave the best result for altitudinal VFDs and VFDs with hemianopic character and macular sparing (0.98 each) and worst in superior wedge-shaped VFDs (0.78); T was shortest in blind spot displacement (3.9 min) and longest in hemianopic VFDs with hemianopic character and macular sparing with preserved temporal crescent (12.1 min). Error rate and magnitude (up to 30% each) only showed a comparatively low influence on A and T. The SAKP algorithm presented here achieves a comparatively high degree of accuracy and robustness for actual, simulated visual field data within acceptable examination times. This algorithm is currently being prepared for application in real patient examinations under clinical conditions.

Comparative analysis of clinical characteristics of symptomatic pituitary adenomas in elderly patients: a consecutive series of 114 patients

BackgroundPituitary adenomas (PAs) present with clinical features such as neuroendocrine abnormalities and mass effects, common in the general morbidity population. However, in elderly patients, the disease progression renders some clinical features difficult to detect and identify in time. Consequently, elderly patients with PAs are often not identified and receive sufficient intervention on time to achieve a satisfactory outcome.MethodsClinical data were collected from 114 consecutive patients older than 70 years with PAs who had undergone surgery. Based on the average age, the patients were categorized into a younger group and an elder group, and were statistically analyzed and compared.ResultsSixty-five males (57.0%) and 49 females (43.0%) were included in the study, with an average age of 73.2 years. Their common preoperative symptoms included vision impairment, followed by headache and vomiting, and visual field defect. The milder the preoperative visual impairment, the greater the possibility of post-operative visual improvement (P=0.001). The tumors were primarily non-functional pituitary adenomas (NFPAs, 73.7%), with a high degree of suprasellar invasion but a low degree of parasellar invasion (P<0.0001). For further analysis, based on the average age, we categorized the patients into younger (age< 73 years, 59 cases) and elder (age≥ 73 years, 55 cases) groups. The elder group was more likely to have preoperative vision impairment problems (P=0.044), whilst post-operative visual improvement was worse (P=0.001). The elder group also had a more severe suprasellar invasion (P=0.009), with a higher proportion of NFPA than the younger group (P=0.006). Compared to the younger group, the tumors in the elder group were larger (P=0.039), and had a higher rate of apoplexy (P=0.039), and were more likely to have comorbid postoperative complications (P=0.031), such as fever and cerebrospinal fluid (CSF) leakage, compared to the younger group.ConclusionsElderly patients with PA had specific clinical characteristics. Their relatively worse pre- and post-operative conditions and intraoperative findings illustrated the need for early surgery.

Application of Digital Twin Technology in Substations: High Voltage Reactor Meter Visual Field Analysis of Phase A

This paper explores the application of Digital Twin (DT) technology in the monitoring and maintenance of high-voltage reactor meters within substations. Traditional inspection methods face limitations in covering the extensive areas and complex structures within substations, which DT technology can address by providing real-time monitoring, predictive analytics, and data-driven insights. The study focuses on visual field analysis for optimizing camera placement and configuration around high-voltage reactors, enhancing inspection accuracy and operational efficiency. Key components include IoT sensors, real-time analytics, and advanced visualization techniques. The findings suggest that DT-enabled systems significantly improve the reliability, safety, and efficiency of substation management, demonstrating potential for broader smart grid applications.

Perimetric visual field testing reveals deficits in contrastsensitivity in workers exposed to occupational levelsof pesticides.

This case-control study investigated whether defects in visual field contrast sensitivity are associated with exposure to occupational levels of pesticides in agricultural workers. Twenty-seven individuals exposed to occupational levels of pesticides (exposed group) from 14 agricultural systems and 27 non-exposed individuals (non-exposed group) were measured using standard automated perimetry (30-2 full threshold). Visual sector analysis, targeting regions of the optic nerve head, was performed to examine for potential region-specific sensitivity differences. Participants also underwent comprehensive assessments, including general optometric examinations and demographic surveys. Symptoms and signs of neurotoxicity were assessed using the modified Q16 neurotoxic symptom questionnaire and biological testing for abnormal levels of Substance P in tears (an inflammatory marker associated with chemical exposure) and cholinesterase (which is inhibited by pesticides) in blood samples. Signs of chemical exposure were found as indicated by significantly higher levels of neurotoxic symptoms, higher concentrations of Substance P and lower levels of cholinesterase in the exposed group. Visual field global indices showed differences in contrast sensitivity between the exposed and non-exposed groups, with the exposed group demonstrating significantly lower means and larger pattern-standard deviations. Notably, visual field sector analysis revealed comparatively lower contrast sensitivity at nasal locations surrounding the optic nerve head in the exposed group. This study found deficits in visual field contrast sensitivity to be associated with pesticide exposure, and selective loss at nasal locations centred on the optic nerve head may indicate retinal toxicity. These findings suggest the utility of visual field assessment as a potential method to evaluate pesticide-related health implications. The results highlight the need for ongoing monitoring and protective measures for agricultural workers exposed to pesticides to prevent potential visual and neurological damage.

Efficacy and safety of minocycline in retinitis pigmentosa: a prospective, open-label, single-arm trial

Retinitis pigmentosa (RP) is characterized by progressive photoreceptor cells death accelerated by the proliferation and activation of microglia pathologically. No consensus exists on the treatment. Minocycline is recognized as a microglia inhibitor with great anti-inflammatory and neuro-protective functions. However, efficacy of minocycline in RP patients is lacking. We conducted a prospective, open-label, and single-arm trial, in which daily oral minocycline of 100 mg was administered for 12 months in RP patients with light-adapted 30 Hz flicker electroretinography (ERG) amplitude >0 µV in at least one eye (NCT04068207). The primary outcome was the proportion of participants with improvement in the ERG amplitude at month 12. The secondary outcomes included improvements of the following items: other ERGs amplitudes, visual field, best-corrected visual acuity, contrast sensitivity, color vision, and NEI-VFQ-25. 35 of 288 patients met inclusive criteria were enrolled (median [IQR] age, 36 [31–45] years; 17 female [48.6%]). 32 participants completed all examinations, while 3 participants completed the 12-month online visit via conducting NEI-VFQ-25. The primary outcome showed improvement was 34.3% (12 of 35 [95% CI 19.1–52.2]). Similarly, all secondary outcomes showed improvements. Adverse events were reported in 22 participants (62.9%) and were all resolved without extra medication during the study period. No severe adverse events were recorded. Our findings identified daily oral minocycline of 100 mg for 12 months was beneficial in improving the visual function of RP patients with good safety. This study indicates minocycline may be a promising therapy for RP, but a randomized controlled trial is still needed of further exploration.

Human leukocyte antigen, isotype DR (HLA-DR) expression in the normal endometrium and in endometrial pathology

BACKGROUND: Human leukocyte antigen, isotype DR (HLA-DR) expression is associated with inflammatory and autoimmune diseases. It is also found on the surface of tumor cells. The role of HLA-DR in endometrial pathology has not been sufficiently studied. AIM: The aim of this study was to determine HLA-DR expression features in the endometrium under normal and pathological conditions. MATERIALS AND METHODS: We performed immunohistochemical examination of endometrial biopsy specimens, namely, 18 cases of endometrioid carcinomas, 139 cases of chronic endometritis, and 37 cases of endometrial polyps. The control group included 50 cases of the endometrium without pathology. Positive HLA-DR expression was detected as brown staining of varying intensity of immune cells of the cytogenic stroma, as well as the cytoplasm and membranes of endometrial epithelial cells. The average number of positively stained stromal cells in ten visual fields was counted. HLA-DR expression in the cytoplasm and on the membrane of endometrial epithelial cells was assessed semi-quantitatively as weak (low) (with staining up to 50% of the glands) or pronounced (high) (with staining more than 50% of the glands). RESULTS: HLA-DRim expression was detected on immune cells of the cytogenic stroma of the endometrium in all of the study groups. HLA-DR expression in the endometrial epithelium was characterized by two main immunophenotypes — negative and positive. Negative HLA-DR expression was found in 55.6% of endometrial cancer cases, in 25.2% of chronic endometritis cases, in 27.7% of endometrial polyp cases, and in all cases of the normal endometrium. The positive HLA-DR (high) immunophenotype was found in 21.6% of chronic endometritis cases, in 28.6% of endometrial polyp cases, and in 16.7% of endometrial cancer cases. Pronounced HLA-DR expression in the epithelium was associated with a high HLA-DR level in the cytogenic stroma and a significantly frequent detection of HLA-DR+ lymphoid follicles in endometrial cancer. The positive HLA-DR (low) immunophenotype was established in 51.8% of chronic endometritis cases and in 27.8% of endometrial polyp cases, and in 27.7% of endometrial cancer cases, and was associated with low HLA-DR levels in the stroma. CONCLUSIONS: The revealed heterogeneity of HLA-DR expression in chronic inflammation and endometrial cancer allows for distinguishing two main immunophenotypes of endometrial cancer, namely, with negative and positive HLA-DR expression. HLA-DR may be an early predictor of adverse background endometrium and endometrial cancer. The positive HLA-DR immunophenotype of endometrial cancer probably indicates a specific mechanism of carcinogenesis associated with chronic inflammation and requires further comprehensive clinical, morphological and molecular genetic research.

Efficient Assessment of Progression in Clinical Trials in Retinitis Pigmentosa.

To conduct a simulation study to evaluate the effect of disease stage, frequency, and clustering of visual field (VF) tests, and inclusion of one or both eyes on sample size calculation in clinical trials on retinitis pigmentosa. A series of VFs were simulated on the basis of test-retest VF data in the early, moderate, and advanced stages of retinitis pigmentosa. VF measurements were scheduled 8 times in approximately 2 years. The probability to detect significant difference between treatment and control groups was measured. The investigation was conducted for 50%, 40%, 30%, 20% and 10% treatment effects. When only one eye was used in each patient with a treatment effect of 50%, 80% probability of significance was observed in the moderate stage when sample size was 70 eyes in each arm (140 eyes in both arms). Early stage disease and inclusion of both eyes decreased this number to 30 eyes (60 eyes in both arms); these decreasing effects were larger than performing additional VFs at the beginning and end of the observation. A similar tendency was observed with 40%, 30%, 20% and 10% treatment effects. When planning a clinical trial, it is important to consider disease stage, in addition to VF schedule and inclusion of one or both eyes.

Understanding Factors Contributing to Glaucoma in Populations of African Descent

Glaucoma is the leading cause of irreversible blindness globally, with the commonest subtype being primary open angle glaucoma (POAG). POAG is characterised by an increase in intraocular pressure (IOP), optic nerve damage and irreversible visual field loss. People of African descent (AD) are significantly more susceptible to POAG when compared to people of European descent (ED), and the reasons for this are complex and multifaceted. The vast level of genetic diversity in AD populations has allowed, through genome-wide association studies (GWAS), for the identification of several single nucleotide polymorphisms (SNPs) as well as differences in mitochondrial haplogroups, which could explain the pathophysiology underlying the increased susceptibility of AD populations to POAG. The altered expression of genes such as MYOC as well as the expression of inflammatory mediators influencing reactive astrocytes have also been implicated. There are also several differences in morphology between AD and ED eyes which must be considered, including differences in central corneal thickness (CCT) and corneal hysteresis (CH) as well as variation in properties of optic discs. The link between all the aforementioned factors and the increased prevalence of POAG in AD populations will be explored in this review.

Relating Standardized Automated Perimetry Performed With Stimulus Sizes III and V in Eyes With Field Loss Due to Glaucoma and NAION.

Standard automated perimetry (SAP) visual field (VF) results are more repeatable using Goldmann stimulus size V (size V) in eyes with moderate/severe deficits due to glaucoma. There are few reports relating VFs using stimulus size V and III, typically used in the clinic for glaucoma, and none for non-arteritic anterior ischemic optic neuropathy (NAION). We hypothesized that we could compare and relate the VFs with both stimuli for glaucoma and NAION. We utilized 1992 same-day pairs of size III and size V SAP VFs using the 24-2 strategy for eyes with glaucoma or NAION. We explored the optimal threshold to censor the raw sensitivities, prior to calculating age-standardized total deviations (TDs). We determined the mean and standard deviation of the differences among all TD pairs. We computed a line of best fit to determine closeness to the line of unity. The ideal censoring conversion threshold was 21 decibel (dB) for size III and 24 dB for size V. The difference between size V and size III censored (0.0 ± 1.9 dB) and uncensored (0.4 ± 2.6 dB) TD pairings highly correlate with each other (r2 = 0.70, P < 0.001). The line of best fit from these pairings has a slope of 0.92, which is close to that of the line of unity (m = 1). Censoring plus age correction is a valid method of comparison between size III and size V SAP VFs with moderate to severe VF loss due to optic nerve disorders. Size III and size V TDs are comparable in clinical practice.

Cranial vault expansion in treatment of paediatric idiopathic intracranial hypertension.

Idiopathic intracranial hypertension (IIH) is a rare clinical entity in the paediatric population. Clinical presentation is mostly similar to adult counterpart and can include headaches, vomiting, papilloedema, deterioration in visual acuity or fields, and 6th cranial nerve palsy, leading to significant morbidity. Therapeutic lumbar puncture and medical treatment with acetazolamide are usually the first-line treatments. In a minority of refractory cases, particularly where visual function is threatened, CSF diversion has been traditionally used in clinical practice. CSF diversion in IIH patients can be associated with high rate of shunt malfunction and revision due to small ventricular size leading to repeated procedures. We describe our experience with cranial vault expansion as a method of treatment of paediatric IIH cases refractory to medical treatment as a CSF diversion sparing method. Following review of IIH cases undergoing surgical treatment in our unit over 15years (years 2009-2024), cases receiving cranial vault expansion as primary surgical treatment were selected and further analysed. Inclusion criteria were paediatric cases (age < 16) undergoing vault expansion as first surgical treatment for IIH refractory to pharmacological treatment for vision-threatening papilloedema. All cases were discussed within multidisciplinary meeting and selected following consideration of all management options. Over the studied period, we identified two cases of refractory IIH with severe papilloedema undergoing cranial vault expansion as primary shunt-sparing surgery. Both patients presented with symptoms of headaches, vomiting, and blurred vision with ophthalmological confirmation of severe papilloedema despite pharmacological therapy. Following multidisciplinary discussions, both underwent successful supratentorial vault expansion. Pharmacological treatment was discontinued in both cases following surgery. Evaluation at latest follow-up showed resolution of symptoms and papilloedema with no need for subsequent cerebrospinal fluid diversion at the latest follow-up. Cranial vault expansion is a viable and safe alternative surgical option in paediatric IIH cases refractory to medical treatment obviating the need for repeated shunt procedures. In cases with extremely small ventricles or where parental choice precludes CSF diversion, cranial vault expansion can be considered.

Author Response: Effect of Depth-Dependent Integrated Visual Field on Vision-Related Quality of Life in Glaucoma

Author Response: Effect of Depth-Dependent Integrated Visual Field on Vision-Related Quality of Life in Glaucoma

The Strain Response to Intraocular Pressure Increase in the Lamina Cribrosa of Control Subjects and Glaucoma Patients.

The purpose of this study was to measure biomechanical strains in the lamina cribrosa (LC) of living human eyes undergoing intraocular pressure (IOP) increase. Healthy control subjects and patients with glaucoma underwent optical coherence tomographic (OCT) imaging of the LC before and after wearing of swim goggles that increased IOP (57 image pairs, 39 persons). Digital volume correlation was used to measure biomechanical strains in optic nerve head tissue and change in depth of the anterior border of the LC. The mean IOP increase in both glaucoma and control eyes was 7.1 millimeters of mercury (mm Hg) after application of the goggles. Among glaucoma eyes, strains that were significant were: contractile Ezz (average = -0.33%, P = 0.0005), contractile Eθθ (average = -0.23%, P = 0.03), Emax (average = 0.83%, P < 0.0001), and Γmax (average = 0.95%, P < 0.0001), whereas the average anterior LC depth (ALD) decreased by 2.39µm (anterior; P = 0.0002). In glaucoma eyes, shear strain Ezθ was greater with worse mean deviation (MD) and visual function index (P = 0.044 and P = 0.006, respectively, multivariate models). Strain compliance for Erθ, Ezθ, and Eθθ all increased with greater MD worsening prior to imaging (P = 0.04, P = 0.007, and P = 0.03). LC strains were measurable 20 minutes after IOP increase, producing axial compression and greater peripheral strain than centrally. Some strain compliances were greater with worse existing visual field loss or with more progressive past field loss. Biomechanical strains are related to measures of glaucoma damage, supporting the hypothesis that optic nerve head biomechanical responses represent a noninvasive biomarker for glaucoma.

Predictive model for converting optic neuritis to multiple sclerosis; decision tree in focus.

Optic neuritis (ON) can be an initial clinical presentation of multiple sclerosis This study aims to provide a practical predictive model for identifying at-risk ON patients in developing MS. We utilized data from the Optic Neuritis Treatment Trial study, which enrolled 457 patients aged from 18 to 46 years, all diagnosed with acute ON. These patients underwent up to 15 years of neurological and ophthalmologic examinations and imaging. The selection of variables for the developing model was based on clinical importance and statistical significance, and any missing values were appropriately addressed. We developed a Decision Tree (DT) classifier as the primary model and manually tuned its hyperparameters for optimal performance. We employed SHapley Additive exPlanations (SHAP) for feature importance evaluation. All analysis was performed using Python version 3.10.9 and its associated libraries. A total of 388 patients completed the study, of which 154 developed clinically definite multiple sclerosis (CDMS). It was observed that 61% of patients with magnetic resonance imaging (MRI) lesions developed CDMS. The final variables selected for analysis were MRI lesions, neurologic history, ON type, gender, and visual field mean deviation. The DT model achieved an accuracy of 70.1% during cross-validation and 69.1% on the test set, with an area under the curve of 74.9% and 71.7%, respectively. Comparative analysis of DT with other models showed similar performance. SHAP analysis revealed that MRI lesions and ON type emerged as the two most significant features, with relative importance of 61% and 18%, respectively. The decision tree model, with satisfactory performance, effectively stratifies patients, based on baseline findings and offers valuable insights for informed decision-making by physicians.

Visual Field Progression in the Ocular Hypertension Treatment Study.

To determine the rate of visual field (VF) loss before and after the diagnosis of primary open angle glaucoma (POAG) in the Ocular Hypertension Treatment Study (OHTS). Pre-specified analyses of data collected prospectively in a clinical trial with extended follow-up. Participants who developed POAG during OHTS 1 and 2 (February 1994 to December 2008) constitute an inception cohort. Follow-up data were collected in OHTS 3 (January 2016 to April 2019). Analyses were performed from July 2021 to August 2022. In OHTS 1 and 2, visual field (VF) tests were performed every 6 months and stereoscopic optic disc photographs were taken every 12 months. These tests were repeated in OHTS 3. Slopes of mean deviation (MD) were calculated by linear regression for all eyes in OHTS 1 and 2: eyes that did not develop POAG, eyes that developed optic disc POAG only, and eyes that developed VF POAG with/without optic disc POAG. Mean pre- and post-POAG slopes were calculated for eyes with a minimum of 5 VFs for each period. Mean age at diagnosis of POAG was 66.4 ± 9.5 SD years (n= 282 participants), (56%) were male, 61% were White non-Hispanic and 32% were Black not Hispanic by self-report. The post-POAG slope was -0.40 ± 0.64 SD dB/year for all POAG eyes (n=280 eyes), -0.19 ± 0.4 SD dB/yr. for optic disc POAG only eyes (n=112 eyes), and -0.54 ± 0.7 SD dB/yr. for VF POAG eyes with or without optic disc POAG (n=168 eyes). Among the VF POAG eyes, 69 (41%) had post-POAG MD slopes worse than or equal to -0.5 dB/year, 35 (21%) had slopes worse than or equal to -1.0 dB/year, and 9 (5.4%) had slopes worse than or equal to -2.0 dB/year. Some participants in OHTS had rapid rates of VF loss in one or both eyes despite being followed in a clinical study. This emphasizes that ocular hypertensive patients require careful follow-up, especially those at high risk of developing POAG to ensure early diagnosis and appropriate treatment of POAG.

Biomechanics-Function in Glaucoma: Improved Visual Field Predictions from IOP-Induced Neural Strains

Purpose(1) To assess whether neural tissue structure and biomechanics could predict functional loss in glaucoma; (2) To evaluate the importance of biomechanics in making such predictions. DesignClinic-based cross-sectional study. MethodsWe recruited 238 glaucoma subjects (Chinese ethnicity, more than 50 years old). For one eye of each subject, we imaged the optic nerve head (ONH) using spectral-domain OCT under the following conditions: (1) primary gaze and (2) primary gaze with acute IOP elevation (to approximately 35 mmHg) achieved through ophthalmo-dynamometry. We utilized automatic segmentation of optic nerve head (ONH) tissues and digital volume correlation (DVC) analysis to compute intraocular pressure (IOP)-induced neural tissue strains. A robust geometric deep learning approach, known as Point-Net, was employed to predict the full Humphrey 24-2 pattern standard deviation (PSD) maps from ONH structural and biomechanical information. For each point in each PSD map, we predicted whether it exhibited no defect or a PSD value of less than 5%. Predictive performance was evaluated using 5-fold cross-validation and the F1-score. We compared the model's performance with and without the inclusion of IOP-induced strains to assess the impact of biomechanics on prediction accuracy. ResultsIntegrating biomechanical (IOP-induced neural tissue strains) and structural (tissue morphology and neural tissues thickness) information yielded a significantly better predictive model (F1-score: 0.76 ± 0.02) across validation subjects, as opposed to relying only on structural information, which resulted in a significantly lower F1-score of 0.71 ± 0.02 (p < 0.05). Our subjects had a mean age of 69±5 years. Among them, 88 were female. The cohort included a wide range of glaucoma severity, with Mean Deviation (MD) values ranging from -1.8 (mild) to -25.2 (severe), and an average MD value of -7.25±5.05. ConclusionOur study has shown that the integration of biomechanical data can significantly improve the accuracy of visual field loss predictions and highlights the importance of the biomechanics-function relationship in glaucoma.

The Unsecular Yellow in Richard Marsh's The Joss : A Reversion

Abstract: This article examines the way visions of the Yellow Peril upend the metanarratives of liberal secularism, via a reading of Richard Marsh's 1901 novel, The Joss: A Reversion . Following the movements of a bloodthirsty East Asian cult, The Joss occasions reflection on the extent to which its Orientalized villains continue to shape a secular project that remains indebted to Christianity. Against the backdrop of the Victorian empire's turn to secularism, Marsh's novel anticipates what I call the unsecular yellow, a visual field whose sinister occupants pull the basis for post-Christian secular dominion away from tolerant universalism and toward stark racial binaries. Foreshadowing the anti-Asian paranoia of today's religious and post-religious right, The Joss prompts consideration of how contemporary talk of massing Asian bodies reinvigorates the late Victorian intertwining of secular and Christian conceptions of yellow heathenness.