Reversible Visual Loss Research Articles

Bioengineering strategy to promote CNS nerve growth and regeneration via chronic glutamate signaling

Being part of the mature mammalian central nervous system, impairments of the retina and optic nerves caused by trauma or diseases often cannot be restored. Progressive degeneration of retinal ganglion cells (RGCs) in glaucoma and other optic neuropathies gradually leads to permanent vision loss, which currently has no cure. The purpose of this study is to develop a biocompatible scaffold to support RGC survival and guide axon growth, facilitating optic nerve repair and regeneration. We here report that electrical stimulation (ES) significantly promoted neurite outgrowth and elongation from primary RGCs, mediated through glutamate receptor signaling. To mimic prolonged glutamate stimulation and facilitate sustained nerve growth, we fabricated biocompatible poly-γ-benzyl-L-glutamate (PBG) scaffolds for controlled glutamate release. These PBG scaffolds supported RGC survival and robust long-distance nerve growth in both retinal explants and isolated RGC cultures. In contrast, control polycaprolactone (PCL) scaffolds with similar physical structures showed little benefits on RGC survival or nerve growth. Moreover, PBG scaffolds promoted the differentiation and neurite outgrowth from embryonic stem cell-derived RGC progenitors. The aligned PBG scaffold drove directed nerve elongation along the fiber alignment. Transplantation of PBG-coated biocompatible conduits induced robust optic nerve regeneration in adult mice following nerve transection. Together, the findings present the exciting possibility of driving optic nerve regeneration and RGC progenitor cell differentiation by imitating ES or glutamate signaling. PBG presents a permissive biomaterial in supporting robust and directed axon growth with promising clinical applications in the future. Statement of SignificanceWe here reported compelling findings that demonstrate the potent regenerative effects of a bioengineered scaffold incorporating poly-γ-benzyl-L-glutamate (PBG) on the optic nerve. Retinal ganglion cell (RGC) axons, which form the optic nerve, are incapable of regenerating in adulthood, posing a significant hurdle in restoring vision for patients with optic nerve diseases or injuries. Built upon the finding that electrical stimulation promotes RGC axonal growth through glutamate signaling, we developed PBG scaffolds to provide sustained glutamate stimulation and showed their exceptional effects on driving directed axonal elongation in cultured RGCs and neural progenitors, as well as supporting robust optic nerve regeneration after transection in vivo. The findings hold great promise for reversing vision loss in patients with optic nerve conditions.

Posterior Ischemic Optic Neuropathy

Posterior ischemic optic neuropathy (PION) is one of the rare optic neuropathies that occurs as a result of hypoperfusion of the optic nerve posterior to the optic nerve head. It usually causes acute, painless vision loss, and no features are detected at the optic nerve head during fundus examination. PION is a multifactorial disease that combines vascular and local risk factors, develops on the basis of various systemic diseases, and is accompanied by inadequate autoregulation in the optic nerve. Etiologically; it is divided into three subtypes: nonarteritic PION, which develops on the basis of vascular disease, arteritic PION, which is associated with giant cell arteritis (GCA), and perioperative PION, which occurs after surgical procedures. Diffusion restriction can be detected in the acute phase with diffusion-weighted magnetic resonance (MR) imaging. Diffusion MRI can be considered as the first technique to diagnose PION by identifying acute ischemic lesions of the optic nerve. Since there is no effective treatment method that can reverse vision loss, steroid treatment should be started immediately when the diagnosis of GCA is considered, and surgical risk factors such as anemia, hypovolemia, and hypotension should be corrected quickly and effectively in the perioperative period and the disease should be prevented before it occurs.

Glaucoma (Eye Disease) and its Associated Diagnosis and Treatment Process: A Schematic Concise Review

A class of eye conditions known as glaucoma can result in blindness and visual loss by harming the optic nerve, a nerve located at the back of the eye. You might not notice the symptoms at first because they can appear so slowly. A thorough dilated eye exam is the only way to determine if you have glaucoma. While there is no known cure for glaucoma, vision protection and damage can frequently be stopped with early intervention. Primary open-angle and angle-closure glaucoma, as well as secondary open and angle-closure glaucoma, are the four main types of adult glaucoma. Prescription eye drops are the most popular form of treatment for glaucoma. They function by reducing intraocular pressure and shielding your optic nerve from harm. Although these eye drops cannot reverse vision loss or treat glaucoma, they can prevent glaucoma from worsening. Prostaglandins are one type of prescription eye drop medication. By increasing the fluid's outflow from your eye, they aid in lowering intraocular pressure. Latanoprost (Xalatan), Travoprost (Travatan Z), Tafluprost (Zioptan), Bimatoprost (Lumigan), and Latanoprostene bunod (Vyzulta) are among the medications in this category. Alpha-adrenergic agonists, such as brimonidine (Altagan P) or Qoliana (Iopidine, apraclonidine) Beta-blockers such as Betimol, Istalol, Timoptic (timolol), and Betoptic (betaxolol) Inhibitors of carbonic anhydrases, such as Azopt (brinzolamide) and Trusopt (dorzolamide). In this review study, we discuss the aetiology, epidemiology, current management, and pathophysiology of glaucoma.

ORAL CORTICOSTEROIDS AND THE LONG-TERM RISK OF CATARACT: A COMPREHENSIVE SYSTEMATIC REVIEW

Background: A cataract can lead to visual deterioration, resulting in reduced vision capacity and partial or complete reversible vision loss. The most commonly associated risk factors for cataract include aging, diabetic retinopathy, glaucoma, and some medications such as glucocorticoids. Glucocorticoids are utilized in a variety of disorders, as long- and short-term, treatment such as topical ocular steroid usage, allergic rhinitis and inflammatory bowel disease as a result, the chance of cataract may increase and put a significant burden in countries. The aim: This study aims to show about oral corticosteroids and the long-term risk of cataract. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 79 articles, whereas the results of our search on SagePub brought up 208 articles, on Google Scholar brought up 26.000 articles. The results of the search conducted for the last year of 2014 yielded a total 25 articles for PubMed, 73 articles for SagePub, and 18.000 articles for Google Scholar. The result based on title screening, a total 2 articles for PubMed, 36 articles for SagePub, and 397 for Google Scholar. In the end, we get a total of 10 papers. We included five research that suitable the criteria. Conclusion: Using glucocorticoids either as inhaler and/or orally will increase the risk and prevalence of posterior subcapsular cataract and other ocular complications such as glaucoma.

Awareness of the Risk of Chronic Use of Steroid Causing Cataract in Al Ahsa City, Saudi Arabia.

Introduction The lens, essential for vision, can be impaired by cataracts, leading to partial or complete reversible vision loss. Common risk factors include aging, diabetes, and steroid use, with significant financial implications. Limited awareness in Saudi Arabia necessitates further research to reduce cataract prevalence and increase knowledge about steroid-induced cataracts. Methodology This was a cross-sectional study in Al Ahsa City, Saudi Arabia that aims to assess awareness of cataracts induced by long-term steroid use. Data was collected via an online survey and analyzed using Statistical Package for Social Sciences (SPSS) version 29 (IBM Corp., Armonk, NY, USA). Results Our study results show that 69.8% (n=291) of participants were female, and 30.2% (n=126) were male, with the majority (62.6%, n=261) having a university education. Notably, 91.1% (n=380) reported no steroid use, while 8.9% (n=37) reported long-term use, and 10.1% (n=42) used steroids topically. There are moderate awareness levels regarding cataract and steroid associations, with 68.1% (n=284) recognizing topical steroids as the common culprits. Logistic regression highlighted the positive correlation between knowledge of cataract risks due to steroid use and actual steroid use, corroborated by a notable 73.0% (n=27) steroid usage among high-awareness individuals. Conclusion Our study underscores moderate awareness regarding steroid-related cataract risks in Al Ahsa City. Educational status significantly influenced understanding, highlighting the importance of targeted health education initiatives.

Cocaine induced PRES – A 25-year-old woman with reversible vision loss

Drug abuse is a frequent cause of stroke in the young adults. The more commonly associated drugs with stroke are cocaine, heroin, and psychotomimetic drugs as cannabis, etc., Cocaine is reported more commonly to be associated with ischemic as well as hemorrhagic stroke, though association with posterior reversible encephalopathy syndrome (PRES) like presentation is very uncommon as seen in our patient. She was a young lady who presented to us with headache, seizure, and vision loss after consuming cocaine.

Development and validation of a convolutional neural network to identify blepharoptosis

Blepharoptosis is a recognized cause of reversible vision loss and a non-specific indicator of neurological issues, occasionally heralding life-threatening conditions. Currently, diagnosis relies on human expertise and eyelid examination, with most existing Artificial Intelligence algorithms focusing on eyelid positioning under specialized settings. This study introduces a deep learning model with convolutional neural networks to detect blepharoptosis in more realistic conditions. Our model was trained and tested using high quality periocular images from patients with blepharoptosis as well as those with other eyelid conditions. The model achieved an area under the receiver operating characteristic curve of 0.918. For validation, we compared the model's performance against nine medical experts—oculoplastic surgeons, general ophthalmologists, and general practitioners—with varied expertise. When tested on a new dataset with varied image quality, the model's performance remained statistically comparable to that of human graders. Our findings underscore the potential to enhance telemedicine services for blepharoptosis detection.

Corneal confocal microscopy in the diagnosis of non-infectious etiology uveitis

Uveitis is one of the leading causes of blindness worldwide. Uveitis accounts for 10 to 15% of cases of complete vision loss and up to 35% of reversible vision loss. Particularly alarming is the fact that the debut of uveitis is recorded at a young working age. Uveitis includes a heterogeneous group consisting of at least 30 nosologies associated with various etiologies. The prognosis of the disease directly depends on the timely detection of its etiology. The review analyzes widely used methods for diagnosing patients with non-infectious uveitis. Special attention is paid to the advantages of confocal microscopy of the cornea, as the most modern non-invasive method that allows a detailed quantitative assessment of corneal subepithelial nerve plexuses and dendritic cells, the number of which increases during inflammatory processes, as well as a qualitative analysis of corneal precipitates and endothelial cells. Early detection of uveitis, which is an extra-articular manifestation of spondyloarthritis, allows appropriate treatment of severe systemic disease. It is assumed that the use of new approaches in the diagnosis of uveitis will prevent the development of severe complications up to complete loss of vision and improve the quality of life of patients.

Reversible Vision Loss Following Nonsurgical Filler Rhinoplasty

The increase in the frequency and popularity of aesthetic filler injections is accompanied by a high risk of complications, including ophthalmological sequalae. Of these, loss of vision is considered the most dangerous and, in most cases, irreversible. We present a case report of a patient who experienced acute vision loss due to suspected partial occlusion of the ophthalmic artery following nonsurgical rhinoplasty with hyaluronic acid filler injection. It differs from others in that treatment in the form of a combination of multiple subcutaneous hyaluronidase injections into the periocular region, a single retrobulbar injection of hyaluronidase, and hyperbaric oxygen therapy led to a significant recovery of ophthalmic symptoms with only residual visual field defects remaining.

Timed Notch Inhibition Drives Photoreceptor Fate Specification in Human Retinal Organoids.

PurposeTransplanting photoreceptors from human pluripotent stem cell–derived retinal organoids have the potential to reverse vision loss in affected individuals. However, transplantable photoreceptors are only a subset of all cells in the organoids. Hence, the goal of our current study was to accelerate and synchronize photoreceptor differentiation in retinal organoids by inhibiting the Notch signaling pathway at different developmental time-points using a small molecule, PF-03084014 (PF).MethodsHuman induced pluripotent stem cell– and human embryonic stem cells–derived retinal organoids were treated with 10 µM PF for 3 days starting at day 45 (D45), D60, D90, and D120 of differentiation. Organoids were collected at post-treatment days 14, 28, and 42 and analyzed for progenitor and photoreceptor markers and Notch pathway inhibition by immunohistochemistry (IHC), quantitative PCR, and bulk RNA sequencing (n = 3–5 organoids from three independent experiments).ResultsRetinal organoids collected after treatment showed a decrease in progenitor markers (KI67, VSX2, PAX6, and LHX2) and an increase in differentiated pan-photoreceptor markers (OTX2, CRX, and RCVRN) at all organoid stages except D120. PF-treated organoids at D45 and D60 exhibited an increase in cone photoreceptor markers (RXRG and ARR3). PF treatment at D90 revealed an increase in cone and rod photoreceptors markers (ARR3, NRL, and NR2E3). Bulk RNA sequencing analysis mirrored the immunohistochemistry data and quantitative PCR confirmed Notch effector inhibition.ConclusionsTiming the Notch pathway inhibition in human retinal organoids to align with progenitor competency stages can yield an enriched population of early cone or rod photoreceptors.

Understanding Amblyopia in Ayurveda Perspective: A Review Article

Vision is prime sense to have facile life and abnormalities of vision are very common in all populations with various pathologies in different parts of eye such as cornea, lens, and vitreous retina. Amblyopia is one such condition which is characterized by reversible loss of vision affecting one or both the eyes. Examination is important to rule out any organic defect in various parts of the eye. In Ayurveda, many of the visual differences are coined under the heading of Timira which is characterized by blurred vision. The Vataja Timira symptoms can be correlated to Amblyopia hence the management.

Erdheim–Chester disease and vemurafenib: a review of ophthalmic presentations and clinical outcomes

ABSTRACT Purpose To provide a comprehensive review of ocular and orbital manifestations of Erdheim–Chester Disease (ECD) and compare clinical outcomes with vemurafenib (INN) to historical treatments (HT). Primary outcomes are ophthalmic findings on presentation, changes in visual acuity, and mortality rate. Secondary outcomes include the progression of ocular findings, systemic involvements, and treatment modalities. Methods All published literature from January 1983 to March 2021 was searched for ophthalmic manifestations of ECD. Clinical outcomes following HT were collected and compared with INN. Results Forty-seven patients with ECD and ophthalmic presentations were identified. The mean age was 49.6 years (SD = 15.0). Proptosis (65.6%) and extraocular muscle restrictions (42.5%) were the most common presenting signs. Of 41 (87.2%) patients with orbital masses on radiologic examination, 90.2% were bilateral, and 53.7% were located in the intraconal space. Ophthalmic examination was significant for xanthelasma (27.2%), optic disc edema (34.0%), and subretinal changes (21.3%). Common treatments were systemic steroids (76.6%), interferon-α (17.0%), and cyclophosphamide (14.9%). INN was less commonly used (12.8%). The mean change in logMAR visual acuity declined with HT (29.9%) but improved with INN (79.1%) (p > 0.05). The proportion of eyes with complete vision loss increased after HT (p < 0.05). The overall mortality rate was 27.7% and notably higher in the HT group (29.3%) when compared to the INN group (16.7%) (p > 0.05). Conclusion ECD presents with many ophthalmic manifestations. Although the intraocular treatments remain controversial, INN should be highly considered in treating orbital ECD patients with BRAF-V600E mutations to prevent and reverse vision loss.

REMARKABLE RESULT TOWARDS RETINOPATHY ASSOCIATED AUTOIMMUNE HEMOLYTIC ANEMIA

Introduction: To present the clinical findings of Autoimmune hemolytic anemia (AIHA) Retinopathy and its rapid resolutions following treatment with steroid. &#x0D; Case report: A 14-year-old female patient presented with decreased vision in the left eye. There was history of AIHA. Visual acuity was 1/60 in LE and 6/6 in RE. There was conjunctival pallor, and the other anterior segment were unremarkable. Fundus examination of left eye revealed flame shaped and dot blot hemorrhage, roth’s spots, optic disc swelling, venous turtuosity, and elevated macula. There were afferent pupil defect, red green deficiency, and contrast sensitivity decline. Hematological evaluation revealed anemia. A MRI Head and Orbital examination were unremarkable.&#x0D; Discussion: This patient was assessed with LE Anemic retinopathy due to AIHA. The patient’s visual acuity improved as the retinopathy resolved after 1 month of oral steroid therapy.&#x0D; Conclusion: Anemia may play a role in the occurrence of retinopathy. The diagnosis of retinopathy can be made by linking ophthalmic fndings with positive serological test. Accurate comprehensive examination can establish the systemic diagnosis, and control of systemic parameters will improve retinopathy, reverse vision loss, and avoid permanent blindness

Systemic Treatment with Pioglitazone Reverses Vision Loss in Preclinical Glaucoma Models.

Neuroinflammation significantly contributes to the pathophysiology of several neurodegenerative diseases. This is also the case in glaucoma and may be a reason why many patients suffer from progressive vision loss despite maximal reduction in intraocular pressure. Pioglitazone is an agonist of the peroxisome proliferator-activated receptor gamma (PPARγ) whose pleiotrophic activities include modulation of cellular energy metabolism and reduction in inflammation. In this study we employed the DBA2/J mouse model of glaucoma with chronically elevated intraocular pressure to investigate whether oral low-dose pioglitazone treatment preserves retinal ganglion cell (RGC) survival. We then used an inducible glaucoma model in C57BL/6J mice to determine visual function, pattern electroretinographs, and tracking of optokinetic reflex. Our findings demonstrate that pioglitazone treatment does significantly protect RGCs and prevents axonal degeneration in the glaucomatous retina. Furthermore, treatment preserves and partially reverses vision loss in spite of continuously elevated intraocular pressure. These data suggest that pioglitazone may provide treatment benefits for those glaucoma patients experiencing continued vision loss.

Iron deficiency anaemia: A not so uncommon cause of reversible vision loss

Idiopathic intracranial hypertension (IIH) can cause disabling and permanent vision loss if it is not diagnosed and managed early.These findings are applicable only once the secondary causes of raised ICP are ruled out. Here we describe a patient of raised ICP secondary to severe iron deficiency anaemia causing vision loss.

Reversible Total Vision Loss Caused by Severe Metformin-associated Lactic Acidosis: A Case Report.

IntroductionMetformin is a biguanide used to treat diabetes mellitus (DM). Metformin-associated lactic acidosis (MALA) carries a high mortality and can occur in patients with renal failure from drug bioaccumulation. Reversible vision loss is a highly unusual, rarely reported complication of MALA. We present a case of a patient whose serum metformin concentration was unusually high and associated with vision loss.Case ReportA 60-year-old woman presented to an outside hospital emergency department with acute vision loss after being found at home confused, somnolent, and hypoglycemic, having last being seen normal two days prior. She reported vomiting and diarrhea during that time and a recently treated urinary tract infection. The visual loss resolved with continuous renal replacement therapy.ConclusionThis novel case of a patient with Type II DM prescribed metformin and insulin who developed reversible vision loss while suffering from MALA highlights the potential for vision loss in association with MALA.

National Eye Institute

The National Eye Institute was established by Congress in 1968 to support projects that research ways to prevent, treat, or reverse vision loss. The National Eye Institute is on the front lines of vision research and provides consumer health information to the public to educate users on vision problems and how to keep their eyes healthy.

A deep learning approach to identify blepharoptosis by convolutional neural networks

PurposeBlepharoptosis is a known cause of reversible vision loss. Accurate assessment can be difficult, especially amongst non-specialists. Existing automated techniques disrupt clinical workflow by requiring user input, or placement of reference markers. Neural networks are known to be effective in image classification tasks. We aim to develop an algorithm that can accurately identify blepharoptosis from a clinical photo. MethodsA total of 500 clinical photographs from patients with and without blepharoptosis were sourced from a tertiary ophthalmic center in Taiwan. Images were labeled by two oculoplastic surgeons, with an independent third oculoplastic surgeon to adjudicate disagreements. These images were used to train a series of convolutional neural networks (CNNs) to ascertain the best CNN architecture for this particular task. ResultsOf the models that trained on the dataset, most were able to identify ptosis images with reasonable accuracy. We found the best performing model to use the DenseNet121 architecture without pre-training which achieved a sensitivity of 90.1 % with a specificity of 82.4 %, compared to the worst performing model which was used a Resnet34 architecture with pre-training, achieving a sensitivity of 74.1 %, and specificity of 63.6 %. Models with and without pre-training performed similarly (mean accuracy 82.6 % vs. 85.8 % respectively, p = 0.06), though models with pre-training took less time to train (1-minute vs. 16 min, p < 0.01). ConclusionsWe report the use of AI to accurately diagnose blepharoptosis from a clinical photograph with no external reference markers or user input requirement. Most current-generation CNN architectures performed reasonably on this task, with the DenseNet121, and Resnet18 architectures without pre-training performing best in our dataset.

Ocular side effects in tuberculosis patients receiving direct observed therapy containing ethambutol

Background: India is among the largest countries to implement the revised national tuberculosis (TB) control program (RNTCP). Ocular toxicity of ethambutol has been known since 1962. It can be halted with early detection and cessation of the contributing drug. Aims and Objectives: This study aims to detect early ocular toxicity of ethambutol in TB patients under directly observed treatment strategy (DOTS). Materials and Methods: This was a prospective cross-sectional study of 30 patients getting AKT including ethambutol along with isoniazid, rifampicin, and pyrazinamide under RNTCP‑DOTS center at a tertiary care hospital. The detailed history, best-corrected visual acuity (BCVA), color vision, fundus examination, visual field, retinal nerve fiber layer (RNFL) thickness, and central subfield macular thickness were carried out in all patients pretreatment and then at the 2nd month of treatment. Results: The mean age of patient was 44.87 years. Reduced visual acuity from the baseline was noted at the second in 23.33% of the right eyes (P = 0.01) and 30% of the left eyes (P < 0.01). Mean temporal RNFL thickness was significantly reduced from baseline after 2 months of treatment (P = 0.046). No significant difference was observed with color vision and visual fields pre- and post-treatment. Conclusion: The assessment of BCVA, color vision, visual field, RNFL, and macular thickness is essential at baseline and thereafter at frequent intervals to detect early ethambutol toxicity and probable reversible visual loss.

Reprogramming to recover youthful epigenetic information and restore vision.

Ageing is a degenerative process that leads to tissue dysfunction and death. A proposed cause of ageing is the accumulation of epigenetic noise that disrupts gene expression patterns, leading to decreases in tissue function and regenerative capacity1–3. Changes to DNA methylation patterns over time form the basis of ageing clocks4, but whether older individuals retain the information needed to restore these patterns—and, if so, whether this could improve tissue function—is not known. Over time, the central nervous system (CNS) loses function and regenerative capacity5–7. Using the eye as a model CNS tissue, here we show that ectopic expression of Oct4 (also known as Pou5f1), Sox2 and Klf4 genes (OSK) in mouse retinal ganglion cells restores youthful DNA methylation patterns and transcriptomes, promotes axon regeneration after injury, and reverses vision loss in a mouse model of glaucoma and in aged mice. The beneficial effects of OSK-induced reprogramming in axon regeneration and vision require the DNA demethylases TET1 and TET2. These data indicate that mammalian tissues retain a record of youthful epigenetic information—encoded in part by DNA methylation—that can be accessed to improve tissue function and promote regeneration in vivo.