Normative Databases Research Articles

Cross-Linguistic Nasalance Comparisons: A Review of Speech Sample Sets and Preliminary Consideration of Effect of Lexical Tone

Introduction: Nasalance is an acoustic representation of perceived nasality with proven clinical and research utility. Its validity is contingent on appropriate speech sample sets and distinct normative databases based on known impact factors such as language and phonetic environment, but little is known about the potential effects of lexical tone on nasalance. Its use in international cross-linguistic studies necessitates definition and added considerations of speech sampling protocol. Methods: Part I: a methodological review was undertaken using PRISMA (2020), the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist for evaluating the risk of bias, and calculation of effect sizes and/or visual displays using tables showing the grouping of similar data for the synthesis of findings. Part II: a pilot study explored the effect of lexical tone on nasalance in Cantonese, a lexical tone language. Results: Part I: a total of 17 studies met the inclusion criteria. In addressing possible confounders and minimizing the risk of bias, 13 studies were assigned an overall quality rating of acceptable (+) and the remaining 4, a high rating (++). For the 9-word string, there was a (non-clinical) difference of 3–5% between Swedish and Brazilian-Portuguese, and a moderate effect size for age (d = 0.49); for the consonant-vowel syllables set, clinical differences across languages were identified for adults and between 5 and 10% for children and adolescents. Part II: the pilot study showed a significant effect of lexical tone on nasalance, where nasalance for the high-level tone 1 was significantly higher than that for high-rising tone 2, low-rising tone 5, and low-falling tone 4. Discussion: There is a need for further evidence from other languages, including tonal languages, to better define the evidence and speech methodology of international cross-linguistic nasalance studies.

Effect of Age and Gender on Nasalance Across the Lifespan: A Systematic Review.

The Nasometer® is a widely used clinical and research tool with diagnosis and outcome measurement utility. The objective of this study was to systematically examine the effect of age and gender on nasalance across the lifespan. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA 2020). University. Children, adolescents, adults, and older adults. Covidence Better Systematic Review Management; Scottish Intercollegiate Guidelines Network Methodology (SIGN) Checklist 3 for risk of bias; Levels of evidence, Oxford Centre for Evidence-Based Medicine Levels of Evidence hierarchy; and effect size calculations using G*Power 3. Nasalance (%) from the Nasometer™. 50 studies (from N = 1884) were included in the review. All were Level 3 (non-randomized controlled cohort) observational-analytic type studies. Only 10 (20%) of studies met a High Quality (low risk of bias) rating. Effect sizes were moderate for adults versus children ( d = 0.717) and adults versus adolescents ( d = 0.521) for oral text/passage. Gender differences were clinically significant for adolescent males and females with a moderate effect size ( d = 0.545) for oronasal text/passage. The systematic review provides objective and defined evidence as to the effects of age and gender on nasalance. Separate normative databases are implicated for specific age subgroups across the lifespan and for gender, particularly in adolescence. Review findings are applicable to other clinical groups where acquisition and/or progression occurs in adulthood/older adulthood.

Comparing Optical Coherence Tomography Angiography Metrics in Healthy Chinese and Caucasian Adults.

The goal of the present study was to identify differences in retinal microvasculature between healthy Caucasians and healthy Asians in order to provide a better understanding of the variability between different ethnic groups. In this cross-sectional study, 191 healthy Chinese and Caucasian participants were enrolled. They underwent optical coherence tomography angiography (OCTA) scans with Zeiss Cirrus HD-5000 Spectral-Domain with AngioPlex. Linear regression models were used to investigate the association of OCTA metrics with potential risk factors. Whereas participants in both groups are comparable in age and sex, Chinese participants had a longer axial length, higher spherical equivalent, higher intraocular pressure (p < 0.001), and a significantly higher perfusion density of large vessels in the superficial capillary plexus (p < 0.001). Regarding the foveolar avascular area (FAZ), Chinese participants had a larger superficial FAZ, a wider superficial FAZ perimeter, and a more circular deep FAZ shape (p < 0.001). There are significant differences in the retinal vasculature between Caucasian and Asian eyes as measured using OCTA. This needs to be considered when developing normative databases. Whether such findings relate to inter-racial differences in the incidence of retinal vascular disease remains to be shown.

Values of peripapillary retinal nerve fibre layer thickness are different in children and adults

ABSTRACT Clinical relevance The detection of abnormal values of peripapillary nerve fibre layer (pRNFL) thickness measured with optical coherence tomography (OCT) is important for detecting optic nerve disease in children. Background To evaluate the level of agreement between the adult reference database supplied with an OCT device and the present paediatric study database for the measurement of pRNFL thickness in children. This study also aimed to provide reference values for pRNFL thickness according to the spherical equivalent in the paediatric population. Methods This was a cross-sectional study. One hundred and twenty-six healthy children were included, who had undergone a full ophthalmological examination including cycloplegic refraction and examination of pRNFL thickness using the Topcon 3D OCT 2000 device (Topcon Corporation, Tokyo, Japan). Values equal to or below the fifth percentile (≤p5) and above the 95th percentile (>p95) were considered abnormal. Observed agreement and specific agreement were investigated between OCT measurements classified with paediatric and adult reference values for normality. Results Values ≤ p5 in the adult database were recorded for 2 of the 30 values (6.6%) of the pRNFL values by quadrants ≤p5 in the paediatric database and 17 of the 88 (19.3%) values by sectors ≤p5. For values >p95 in the adult database, 88% by quadrants and 72% by sectors would have been classified as being within the normal range using the paediatric database. Conclusion The use of adult reference values currently available in OCT devices can lead to classification errors concerning the normal range of pRNFL thickness in a large proportion of paediatric patients. The use of normative paediatric databases, such as the one discussed in this study, should be taken into consideration.

Biometric description of 34 589 eyes undergoing cataract surgery: sex differences.

To describe gender differences in the biometric parameters of a large sample of patients with cataract. Cataract surgery has evolved from a vision restoration to a refractive procedure, and population-based studies are vital to optimize normative databases and postsurgical outcomes. Miguel Servet University Hospital, Zaragoza, Spain. Retrospective single-center observational study. The study included 34 589 eyes (20 004 patients with cataract). Biometric data were obtained from IOL Master 700 and Pentacam HR. Linear mixed models were used to account for intereye correlation. HofferQST formula was used to calculate the hypothetical distribution of intraocular lens (IOL) power (arbitrary lens; A = 119.2). Most biometric variables showed significant differences between sexes ( P < .0001), such as 0.53 mm shorter eyes found in females, of which 0.16 mm are explained by shorter aqueous depth. Steeper anterior keratometries (∼0.75 diopter [D]) were found in women, to end up in no difference on anterior astigmatism magnitude, but different orientation ( P < .0001). The distribution of IOL power differed between sexes ( P < .001), with the interquartile range shifting 1 D toward more powerful lenses in women and odds ratio (power >26 D) = 2.26, P < .0001 (Fisher). Large sample size studies provide smaller margin of error, higher power, and controlled risk of reporting false (negative or positive) findings. Highly significant differences between sexes in ocular biometry were found; this supports the idea that including sex as a parameter in IOL calculation should be explored and may improve results. In addition, the distribution of IOL powers was provided, which may be useful for manufacturers and hospital stock planning.

Exploring Head-Mounted Virtual Visual Fields for Glaucoma: How do They Stack Up Against Humphrey Tests?

Abstract The integration of virtual reality (VR) technology into visual field (VF) testing has introduced innovative head-mounted perimetry devices, which offer numerous advantages over traditional methods. This review examines the features, accuracy, and reliability of commercially available head-mounted VR perimeters and compares them with the gold standard, the Humphrey Visual Field Analyzer (HFA). While traditional devices like the HFA and Goldmann Perimeter have been reliable for glaucoma management, they are limited by fixed testing environments, long testing durations, and high costs. VR-based perimetry addresses these limitations by providing portable, cost-effective, and engaging testing environments that can be conducted in various settings, including patients’ homes. Head-mounted displays (HMDs) equipped with high-resolution screens, motion sensors, and eye-tracking technology create an immersive testing experience that minimizes distractions and external light interference, potentially enhancing test accuracy. These devices also offer customizable testing protocols, improving patient comfort and compliance, especially among children and elderly patients. However, concerns remain about the reproducibility and accuracy of VR perimetry compared to established standards. Variability among VR platforms and the lack of large normative databases for visual fields pose challenges to their widespread adoption. This review highlights the need for further validation studies and the development of standardized testing protocols to ensure the reliability and accuracy of VR perimetry. Despite these challenges, the flexibility, reduced testing times, and potential for telemedicine applications make VR head-mounted perimetry a promising tool for improving glaucoma management and expanding access to VF testing in diverse clinical environments.

IGF-I assay methods and biologic variability: evaluation of acromegaly treatment response.

Serum insulin-like growth factor (IGF-I) is the primary biochemical measure of disease activity in patients with acromegaly, and the 2014 Endocrine Society guidelines recommended normal age-adjusted serum IGF-I as the biochemical target of treatment. However, quantification and interpretation of IGF-I levels are subject to limitations that may affect therapeutic decisions. Techniques for measuring IGF-I have evolved greatly over the past 40 years and continue to do so. Results can vary substantially for different assays, procedures, and laboratories. For any assay, the interpretation of IGF-I values requires robust reference ranges. Using currently available large normative databases, the upper limit of normal (ULN) for IGF-I in middle-aged and elderly individuals is lower than historical reference ranges. Thus, the goal of achieving IGF-I < 1× ULN is more demanding than in the past, and some patients with acromegaly who were classified as "normal" (IGF-I < 1× ULN) in previous studies would be reclassified as above the ULN based on newer normative data. In addition, substantial intra-individual, week-to-week variation in serum IGF-I levels (unrelated to assay performance) has been observed. With changes over time in the measurement of IGF-I and the advent of updated reference ranges derived from large normative databases, it is difficult to justify rigid adherence to the goal of maintaining IGF-I below the ULN for all patients with acromegaly. Instead, symptoms, comorbidities, and quality of life should be considered, along with growth hormone and IGF-I levels, when evaluating the need for further treatment.

Rates of retinal nerve fiber layer loss in early-stage pseudoexfoliation and primary open-angle glaucoma patients using optical coherence tomography.

To characterize glaucoma progression in early-stage patients with retinal nerve fiber layer (RNFL) using the change analysis software (CAS), which was utilized to track RNFL thinning. We retrospectively analyzed 92 eyes of 92 patients with early-stage glaucoma. Patients were divided into two subgroups based on their diagnosis of pseudoexfoliation glaucoma (PEG) and primary open-angle glaucoma (POAG). A complete ophthalmologic examination was performed on all patients. Additionally, automated perimetry was conducted on each patient. Furthermore, Fourier-domain optical coherence tomography (OCT) was employed to measure RNFL and central corneal thickness. Using the OCT device's CAS, we computed the annual rate of total and glaucomatous RNFL thinning for each patient. A total of 44 PEG and 48 POAG patients were included in the study. The right eye measurements of these patients were analyzed and compared. The two groups were not significantly different in age, gender, and the number of visits per year (p > 0.05, for each). However, the difference between the mean RNFL thickness at baseline (91.39 ± 10.71 and 96.9 ± 8.6µm) and at the last visit (85.2 ± 15.76µm and 91.56 ± 9.58µm) was statistically significant between the two groups (p = 0.043, p = 0.039, respectively). Additionally, the difference in annual RNFL thinning rates (1.43 ± 0.81µm and 1.07 ± 0.32µm) between the two groups was statistically significant (p = 0.009). The annual rate of glaucomatous RNFL loss in early-stage PEG patients (1.23µm) was higher than in POAG patients (0.87µm). However, despite these loss rates, scotoma was not detected in the visual field tests of these patients. Therefore, using CAS in the follow-up of early-stage glaucoma patients is a useful alternative for monitoring glaucomatous progression. Furthermore, this method can be utilized in future research for the diagnosis and follow-up of glaucoma in special populations (e.g., those with pathological myopia or high hyperopia) that are not included in normative databases.

Anatomical Features can Affect OCT Measures Used for Clinical Decisions and Clinical Trial Endpoints.

To understand the association between anatomical parameters of healthy eyes and optical coherence tomography (OCT) circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements. OCT cpRNFL thickness was obtained from 396 healthy eyes in a commercial reference database (RDB). The temporal quadrant (TQ), superior quadrant (SQ), inferior quadrant (IQ), and global (G) cpRNFL thicknesses were analyzed. The commercial OCT devices code these values based on percentiles (red, <1%; yellow, ≥1% and <5%), after taking age and disc area into consideration. Four anatomical parameters were assessed: fovea-to-disc distance, an estimate of axial length, and the locations of the superior and the inferior peaks of the cpRNFL thickness curve. Pearson correlation values were obtained for the parameters and the thickness measures of each of the four cpRNFL regions, and t-tests were performed between the cpRNFL thicknesses coded as abnormal (red or yellow, <5%) versus normal (≥5%). For each of the four anatomical parameters, the correlation with the thickness of one or more of the TQ, SQ, IQ, and G regions exceeded the correlation with age or disc area. All four parameters were significantly (P < 0.001) associated with the abnormal cpRNFL values. The significant parameters were not the same for the different regions; for example, a parameter could be negatively correlated for the TQ but positively correlated with the SQ or IQ. In addition to age and disc area, which are used for inferences in normative databases, four anatomical parameters are associated with cpRNFL thickness. Taking these additional anatomical parameters into consideration should aid diagnostic accuracy.

An anterior segment optical coherence tomography study of lower lacrimal punctal stenosis

Aims To assess the lower lacrimal punctal measurements in patients with punctal stenosis versus normal participants using anterior segment optical coherence tomography (AS-OCT). Patients and methods The study included 39 puncti of 21 healthy asymptomatic volunteers attending the general and oculoplastic outpatient clinics (group I: control group) and 30 puncti of 17 patients with a clinical diagnosis of punctal stenosis defined as the punctal diameter less than 0.3 mm measured by slit-lamp biomicroscopy (group II: cases group). The punctal diameter is measured by slit-lamp biomicroscopy in all participants. The external punctal diameter, the inner punctal diameter at three depths (100, 200, and 500 μm), the punctal depth and tear meniscus height were measured using AS-OCT. Results The internal punctal diameter at 100 μm (239.51±91.14 vs. 168.77±118.07 µm), 200 μm (156.67±75.20 vs. 71.63±76.41 µm), and 500 μm (74.92±60.99 vs. 24.07±34.30 µm) showed statistically significant lower measurements in the cases group compared with the control group. No statistically significant differences were found comparing both groups regarding external punctal diameter otherwise. In the cases group, the punctal diameter measured by slit-lamp biomicroscopy had highly significant statistical evidence of positive correlation with the internal punctal diameter at 200 μm. Conclusion AS-OCT provides a superior ability to assess the patency of the proximal lacrimal drainage system over the routine slit-lamp examination, especially when the internal punctal diameter is measured at a depth of 200 µm. Further research is required to build consensus on standard terminologies, define the standard measurements, and acquire more extensive normative databases. This would mostly be useful in diagnosis of cases of epiphora with externally nonstenosed puncti and distally patent passages.

Repurposing verbal fluency: Word‐property analysis reveals neurocognitive markers of Hispanics with Alzheimer’s disease and mild cognitive impairment

AbstractBackgroundThough central to dementia assessments, verbal fluency tasks are suboptimally exploited. Performance is typically measured by counting valid responses. This precludes insights on which word types are least accessible to patients, while failing to discriminate among disorders. Alternatively, each word can be decomposed into relevant properties that drive semantic memory retrievability. Recently, our team has combined objective lexical measures with multimodal imaging to examine whether this approach is sensitive to Hispanics with Alzheimer’s disease (AD) and mild cognitive impairment (MCI), vis‐à‐vis others with behavioral variant frontotemporal dementia (bvFTD).MethodIn Experiment‐1, we recruited 32 AD patients and 32 bvFTD patients, matched with 27 HCs. Experiment‐2 involved 60 persons with MCI and 60 matched HCs. Participants performed phonemic and semantic fluency tasks. We counted valid responses and, using normative databases, extracted quantitative data of six word properties: frequency (occurrences in everyday use), granularity (conceptual specificity), neighborhood (words with similar phonological structure), length (number of syllables), familiarity (subjective recognizability), and imageability (ease of mental visualization). We examined whether these variables were robust to discriminate between groups (via ANOVAs), identify individuals from each cohort (via linear regressions), and capture cognitive, neuroanatomical, and functional connectivity disruptions.ResultsIn Experiment‐1, while both patient groups produced fewer valid responses than HCs, only AD patients showed distinct word properties (higher frequency, lower granularity, more phonological neighbors). Multivariate word properties robustly identified individual AD (but not bvFTD) patients from HCs (AUC = .89), driven by the abovementioned properties. These features correlated with executive outcomes only in AD, and they predicted patients’ anatomical and functional disruptions along temporal, frontal, and cingulate regions. In Experiment‐2, the same word properties differentiated MCI individuals from HCs, with multivariate classification reaching an AUC of .75. These features correlated with the volume of, and connectivity between, temporal and frontal regions that partly overlapped with those observed in AD.ConclusionVerbal fluency tasks can be repurposed to reveal condition‐specific markers of persons with and at increased risk for AD. New avenues emerge towards scalable, low‐cost assessment of Hispanics and, potentially, other underrepresented populations.

Clinical reading-related oculomotor assessment in visual snow syndrome

PurposeVisual snow syndrome (VSS) is a complex neurological condition presenting with an array of sensory, motor, and perceptual dysfunctions and related visual and non-visual symptoms. Recent laboratory studies have found subtle, basic, saccadic-based abnormalities in this population. The objective of the present investigation was to determine if saccadic-related problems could be confirmed and extended using three common clinical reading-related eye movement tests having well-developed protocols and normative databases. MethodsThis was a retrospective analysis of 32 patients (ages 16–56 years) diagnosed with VSS in the first author's optometric practice. There was a battery of three reading-related tests: the Visagraph Reading Eye Movement Test, the Developmental Eye Movement (DEM) Test, and the RightEye Dynamic Vision Assessment Test, all performed using their standard documented protocols and large normative databases. ResultsA high frequency of oculomotor deficits was found with all three tests. The greatest percentage was revealed with the Visagraph (56%) and the least with the RightEye (23%). A total of 77% of patients failed at least one of the three tests. ConclusionThe present findings confirm and extend earlier investigations revealing a high frequency of saccadic-based oculomotor problems in the VSS population, now including reading-related tasks. This is consistent with the more general oculomotor/motor problems found in these individuals.

Normative Percentiles of Retinal Nerve Fiber Layer Thickness and Glaucomatous Visual Field Loss.

Circumpapillary retinal nerve fiber layer thickness (RNFLT) measurement aids in the clinical diagnosis of glaucoma. Spectral domain optical coherence tomography (SD-OCT) machines measure RNFLT and provide normative color-coded plots. In this retrospective study, we investigate whether normative percentiles of RNFLT (pRNFLT) from Spectralis SD-OCT improve prediction of glaucomatous visual field loss over raw RNFLT. A longitudinal database containing OCT scans and visual fields from Massachusetts Eye & Ear glaucoma clinic patients was generated. Reliable OCT-visual field pairs were selected. Spectralis OCT normative distributions were extracted from machine printouts. Supervised machine learning models compared predictive performance between pRNFLT and raw RNFLT inputs. Regional structure-function associations were assessed with univariate regression to predict mean deviation (MD). Multivariable classification predicted MD, pattern standard deviation, MD change per year, and glaucoma hemifield test. There were 3016 OCT-visual field pairs that met the reliability criteria. Spectralis norms were found to be independent of age, sex, and ocular magnification. Regional analysis showed significant decrease in R2 from pRNFLT models compared to raw RNFLT models in inferotemporal sectors, across multiple regressors. In multivariable classification, there were no significant improvements in area under the curve of receiver operating characteristic curve (ROC-AUC) score with pRNFLT models compared to raw RNFLT models. Our results challenge the assumption that normative percentiles from OCT machines improve prediction of glaucomatous visual field loss. Raw RNFLT alone shows strong prediction, with no models presenting improvement by the manufacturer norms. This may result from insufficient patient stratification in tested norms. Understanding correlation of normative databases to visual function may improve clinical interpretation of OCT data.

Muscle morphology and architecture of the medial gastrocnemius between typically developing children with different ancestral background.

Muscle ultrasonography is frequently used to improve the understanding of musculoskeletal impairments in children with spastic cerebral palsy (SCP). So far, most studies on muscle morphology and architecture have included typically developing children and children with SCP with similar ancestry, being mainly Caucasian. Less is known about differences in muscle morphology between children with different ancestral backgrounds. Therefore, the aim of this study was to compare muscle morphology and architecture of the medial gastrocnemius in typically developing children with African, South Asian and Southeast Asian descent from Suriname. This explorative cohort study identified children as Maroon (Ghana, African descent), Hindustani (India, South Asian) or Javanese (Indonesia, Southeast Asian), aged 5-10 years. Using 3D freehand ultrasound with the subject prone, the following medial gastrocnemius parameters were defined: muscle tendon unit (MTU) length, muscle belly length, tendon length, muscle volume, muscle thickness, anatomical cross-sectional area (ACSA), fascicle length, pennation angle, and physiological cross-sectional area (PCSA). In addition, differences between ancestral groups were assessed for the length of the MTU, muscle, tendon and fascicles in two passive stretch conditions corresponding to an externally applied joint torque of 1Nm and 4Nm. One-way ANOVA with post hoc t-tests were used to investigate differences between the ancestral groups. In total, 100 Hindustani (n = 34), Javanese (n = 34) and Maroon (n = 32) children were included. For statistical analyses, we matched the children by age, which resulted in groups of 25 children per ancestral group (n = 75). There were no differences found in MTU length, muscle belly length, ACSA, PCSA and muscle volume. Tendon length, fascicle length and pennation angle were different between ancestral groups. Compared to Javanese children, tendon length was longer (p = 0.001) and pennation angle (p = 0.001) was larger in Maroon children and fascicle length was shorter in both Maroon and Hindustani children (p < 0.001). While there was a difference found in MTU length at different conditions of passive stretch between ancestries, no differences were found in the muscle, tendon and fascicles. This is the first study that investigated macroscopic morphological and architectural parameters for the medial gastrocnemius in one extended cohort of typically developing children, stratified in three ancestral subgroups. The current results imply that ancestry-specific reference data for children are needed, especially for tendon length, fascicle length and pennation angle when investigating altered muscle morphology in neurological or neuromuscular pathologies, such as SCP. Future studies should report the ancestral background when describing muscle morphology and architecture of children and ancestral specifications should be included in normative databases.

Fairness and generalizability of OCT normative databases: a comparative analysis

PurposeIn supervised Machine Learning algorithms, labels and reports are important in model development. To provide a normality assessment, the OCT has an in-built normative database that provides a color base scale from the measurement database comparison. This article aims to evaluate and compare normative databases of different OCT machines, analyzing patient demographic, contrast inclusion and exclusion criteria, diversity index, and statistical approach to assess their fairness and generalizability.MethodsData were retrieved from Cirrus, Avanti, Spectralis, and Triton’s FDA-approval and equipment manual. The following variables were compared: number of eyes and patients, inclusion and exclusion criteria, statistical approach, sex, race and ethnicity, age, participant country, and diversity index.ResultsAvanti OCT has the largest normative database (640 eyes). In every database, the inclusion and exclusion criteria were similar, including adult patients and excluding pathological eyes. Spectralis has the largest White (79.7%) proportionately representation, Cirrus has the largest Asian (24%), and Triton has the largest Black (22%) patient representation. In all databases, the statistical analysis applied was Regression models. The sex diversity index is similar in all datasets, and comparable to the ten most populous contries. Avanti dataset has the highest diversity index in terms of race, followed by Cirrus, Triton, and Spectralis.ConclusionIn all analyzed databases, the data framework is static, with limited upgrade options and lacking normative databases for new modules. As a result, caution in OCT normality interpretation is warranted. To address these limitations, there is a need for more diverse, representative, and open-access datasets that take into account patient demographics, especially considering the development of supervised Machine Learning algorithms in healthcare.

Racial differences in quantitative optical coherence tomography angiography findings between older non-diabetics with co-morbidities.

This cross-sectional study compared optical coherence tomography angiography (OCTA) parameters between older Black and White adults with systemic comorbidities in an effort to further understand racial differences in the retinal microvasculature. We analyzed vessel density at the superficial (SCP), intermediate (ICP), and deep capillary plexuses (DCP), foveal avascular zone (FAZ) parameters, and blood flow area (BFA) at the choriocapillaris. We used a mixed-effects linear regression model, controlling for hypertension and two eyes from the same subject, to compare OCTA parameters. Black subjects had lower foveal vessel density at the SCP and ICP, while no differences were observed at the parafovea or 3x3 mm macular area of any capillary layer. Black subjects had greater FAZ area, perimeter, and FD-300, a measurement of vessel density in a 300 μm wide ring around the FAZ. Black subjects also had lower BFA at the choriocapillaris. Within a cohort of subjects without hypertension, these differences remained statistically significant, with the exception of foveal vessel density at the SCP and foveal BFA of the choriocapillaris. These findings suggest that normative databases of OCTA parameters must strive to be diverse in nature to adequately capture differences across patient populations. Further study is required to understand if baseline differences in OCTA parameters contribute to epidemiological disparities in ocular diseases.

Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer

The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program. Observational cross-sectional study. Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers. Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared. Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity. Overall, 79 participants (133 eyes) with a mean age of 61±13 years (range, 26-79 years) were included; 59% of the participants were female, and the mean HFA MD was-2.7±3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet. Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

The Resting State of Taiwan EEG Normative Database: Z-Scores of Patients with Major Depressive Disorder as the Cross-Validation

This study referred to the standard of electroencephalography (EEG) collection of normative databases and collected the Taiwan normative database to examine the reliability and validation of the Taiwan EEG normative database. We included 260 healthy participants and divided them into five groups in 10-year age-group segments and calculated the EEG means, standard deviation, and z-scores. Internal consistency reliability was verified at different frequencies between the three electrode locations in the Taiwan normative database. We recruited 221 major depressive disorder (MDD) patients for cross-validation between the Taiwan and NeuroGuide normative databases. There were high internal consistency reliabilities for delta, theta, alpha, beta, and high-beta at C3, Cz, and C4 in the HC group. There were high correlations between the two z-scores of the Taiwan and NeuroGuide normative databases in the frontal, central, parietal, temporal, and occipital lobes from MDD patients. The beta z-scores in the frontal lobe and central area, and the high-beta z-scores in the frontal, central, parietal, temporal, and occipital lobes were greater than one for MDD patients; in addition, the beta and high-beta absolute value z-scores in the whole brain were greater than the ones of MDD patients. The Taiwan EEG normative database has good psychometric characteristics of internal consistency reliability and cross-validation.

Corneal Fourier and Belin-Ambrósio Enhanced Ectasia Analysis in Healthy 4-Year-Old White Children.

The aim of this study was to provide normative databases of Fourier analysis (FA) and Belin-Ambrósio enhanced ectasia display (BAD) in healthy White 4-year-old emmetropic children. FA parameters analyzed were spherical component (SRmin), spherical eccentricity (SEcc), maximal decentration (MD), regular astigmatism at the center (Astigm. C) and periphery (Astigm. P), and irregularity (I). The parameters obtained by BAD included summary indicator BAD D, anterior corneal curvature (K1 and K2, D), maximal keratometry (Kmax, D), maximal Ambrósio relational thinnest (ART max), and pachymetric and BAD indices. Eighty-nine eyes of eighty-nine 4-year-old children were included. The mean values of FA parameters were the following: SRmin 7.77, SEcc 0.600, MD 0.160, Astigm. C 0.070, Astigm. P 0.050, and I 0.019. The mean K1 and K2 in our study group were 42.92 ± 1.29 D and 43.75 ± 1.41 D, with the mean BAD D value 0.42 ± 0.67. The mean PPI min 0.629 ± 0.117, PPI max 1.059 ± 0.155, PPI avg 0.847 ± 0.103, Kmax 44.10 ± 1.39, and median of ART max 515.0 were recorded. No statistically significant differences between male and female sex in any of FA or BAD parameters were found. This is the first study providing large normative data on FA and BAD in 4-year-old White emmetropic children. We proposed a cutoff D value for early ectasia and clinical keratoconus in 4-year-old children.

Extracting spacing-derived estimates of rod density in healthy retinae.

Quantification of the rod photoreceptor mosaic using adaptive optics scanning light ophthalmoscopy (AOSLO) remains challenging. Here we demonstrate a method for deriving estimates of rod density and rod:cone ratio based on measures of rod spacing, cone numerosity, and cone inner segment area. Twenty-two AOSLO images with complete rod visualization were used to validate this spacing-derived method for estimating density. The method was then used to estimate rod metrics in an additional 105 images without complete rod visualization. The spacing-derived rod mosaic metrics were comparable to published data from histology. This method could be leveraged to develop large normative databases of rod mosaic metrics, though limitations persist with intergrader variability in assessing cone area and numerosity.