Perimetry Research Articles

Central contrast sensitivity perimetry discriminates between glaucomatous and non-glaucomatous eyes.

Glaucoma is an optic neuropathy which causes irreversible vision loss. Standard perimetry, which is essential for glaucoma diagnosis, can only detect glaucomatous visual filed loss when considerable structural damage has occurred. Contrast sensitivity is one of the visual function tests that is reduced in eyes with glaucoma. It is known to be affected in pre-perimetric stages of glaucoma. The objective of this study was to investigate the discriminating ability of central contrast sensitivity perimetry in eyes with and without glaucoma. The study employed a cross-sectional study design. The study participants were made of two groups; eyes diagnosed with glaucoma by an ophthalmologist based on visual field test and optical coherence tomography (OCT) and age- and sex-matched controls who were declared free from glaucoma. Static contrast sensitivity (CS) was measured in the central 10° of visual field using a custom psychophysical test. There were 45 eyes with glaucoma and 45 age- and sex-matched controls in this study. The static CS in the glaucoma group was significantly reduced in 9 out of the 13 tested locations in the central 10° of the visual field. The mean static CS at 5°, 10°, superior hemifield and inferior hemifield were all significantly reduced in the glaucoma patients compared to the controls. Static CS measurement is a sensitive approach that can be utilized to aid in the detection of glaucoma. The use of static CS can be adopted in the development of a cost-effective yet sensitive screening tool for the detection of glaucoma.

PS-C12-3: OPEN-ANGLE GLAUCOMATOUS OPTIC DAMAGE IN RELATION TO SYSTEMIC AND OCULAR PERFUSION PRESSURE

Objective: Glaucoma is the leading cause of irreversible blindness worldwide. One of the pivotal physiopathological mechanisms involved is reduced ocular perfusion pressure (OPP) at the optic nerve head, which depends on the mean arterial pressure (MAP) and intraocular pressure levels. The interplay association of variability and dips in the 24-h MAP with OPP in relation to glaucoma progression remains undocumented. Therefore, we conducted a retrospective longitudinal study to investigate variability and dips in the 24-h MAP and OPP in relation to the progression of open-angle glaucoma damage. Methods: A total of 265 patients with normal-tension glaucoma (NTG; n = 155) and primary open-angle glaucoma (POAG; n = 110) followed at the University Hospital Leuven with longitudinal visual field tests (n = 7000 measures, including both eyes) who underwent ambulatory blood pressure monitoring were studied. The main outcome was longitudinal changes in the mean deviation (MD), expressed in decibels (dB), which was retrieved from visual field tests. The intraocular pressure (IOP) was measured with applanation tonometry. MAP variability independent of the mean (VIMmap) was computed and the five lowest dips in MAP readings were further analyzed. OPP was the difference between 2/3 of the 24-h MAP minus 24-h intraocular pressure levels. Statistics methods included mixed models. Results: The mean age was 64.0y (53% were women). The IOP during eight years of follow-up was 11.3 mmHg. All IOP measures were higher in POAG than NTG (P < 0.046). POAG patients had lower OPP than NTG (P < 0.045). In adjusted mixed models, higher 24-h VIMmap was associated with longitudinal changes in MD in POAG (-2.07 dB changes, P < 0.001). The longitudinal changes in MD associated with dip measures ranged from -2.84 dB (95% confidence interval [CI], -4.12, -1.57; P < 0.001) to -2.16 dB (95% CI, -3.46,-0.85; P = 0.001) in POAG. Lower 24-h MAP combined with high variability and extreme dips in MAP resulted in worse progression of MD (P = 0.009). Reduced OPP was associated with -2.51 to -2.00 dB changes in the MD (P < 0.001) in POAG. Progression in MD was worse in patients experiencing reduced OPP along with high variability and dips in MAP. Conclusions: Progression of open-angle glaucoma damage is associated with high variability and dips in MAP, and reduced OPP. This progression exacerbates if the lower OPP occurs along with extreme dips in the MAP. 24-h ambulatory blood pressure and intraocular pressure should be implemented in the follow-up of glaucoma patients experiencing progression of the disease despite the intraocular pressure remaining normal.

Optic nerve head diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient values as measuring tools for papilledema grade in idiopathic intracranial hypertension

Aim The aim of this study was to explore if there is a relationship between the grade of papilledema and MRI diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values of the optic nerve head (ONH) in patients having idiopathic intracranial hypertension (IIH). Patients and methods This is a prospective study that was conducted between March 2020 and June 2022 on 285 patients diagnosed as having IIH, who were subjected to meticulous clinical examination, visual field testing, color vision testing, and orbital MRI done within one week of diagnosis. ONH signal intensity was graded and then compared with papilledema grade, and the results were analyzed. Results The study included 285 patients (156 females and 129 males), with a mean age of 30.8±9.6 years, definitely diagnosed as having IIH with lumbar puncture opening pressure ranging from 18 to 58 cmH2O (mean=35.6±9.8 cmH2O). The papilledema grades were grade I (121 patients), grade II (136 patients), grade III (21 patients), and grade IV (seven patients). ADC values of the ONH were found to be gradually decreased with higher papilledema grades among cases. In addition, according to papilledema grading, in grade I, 67% of the patients showed no DWI changes, whereas in grade II, 97% of the patients showed DWI changes in the ONH. In grades III and IV, all patients showed DWI changes. Conclusion MRI can be considered as a diagnostic tool for papilledema. In addition, low ADC values and diffusion restriction can be used as indicators for the severity of ONH insult in cases of increased intracranial tension.

Structure-Function Relationship between Steady-State Pattern Electroretinogram, Optical Coherence Tomography, and Visual Field Test

Structure-Function Relationship between Steady-State Pattern Electroretinogram, Optical Coherence Tomography, and Visual Field Test

The Patterns of Visual Field Defects in Primary Angle-Closure Glaucoma Compared to High-Tension Glaucoma and Normal-Tension Glaucoma

Introduction: The aim of this study was to compare the patterns of visual field (VF) defects in primary angle-closure glaucoma (PACG) to control groups of eyes with high-tension glaucoma (HTG) and normal-tension glaucoma (NTG). Methods: Forty-eight eyes with PACG were enrolled, and control eyes with HTG and NTG matched for age, sex, and mean deviation of VF defect were selected. VF tests were performed using the 24-2 program of the Humphrey field analyzer. VF defects were classified into six patterns with the Ocular Hypertension Treatment Study classification system and were categorized into three stages (early, moderate, and advanced). Each hemifield was divided into five regions according to the Glaucoma Hemifield Test (GHT). The mean total deviation (TD) of each GHT region was calculated. Results: Compared with HTG and NTG groups, the partial arcuate VF defects were more common in the PACG group. In the PACG group, the nasal GHT region in the inferior hemifield had the worst mean TD (−8.48 ± 8.62 dB), followed by the arcuate 1 (−7.81 ± 7.91 dB), arcuate 2 (−7.46 ± 7.43 dB), paracentral (−7.19 ± 7.98 dB), and central (−5.14 ± 6.24 dB) regions; the mean TD of the central region was significantly better than those for all other regions (all p < 0.05). A similar trend was observed in the superior hemifield in the PACG group but not the VF hemifields of the HTG and NTG groups. Conclusion: Patterns of VF defect in PACG patients differ from those with HTG and NTG. This discrepancy might be due to the differences in the pathogenic mechanisms of glaucomatous optic neuropathy.

Vision-Related Quality of Life in Primary Angle-Closure Glaucoma Patients with or without Visual Field Dysfunction.

To evaluate the association between visual-related quality of life (VRQoL) and visual field (VF) loss in patients with primary angle-closure glaucoma (PACG). In this case-control study, a total of 79 patients with PACG (with or without VF detects) and 35 healthy controls were included. The patients underwent the 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), clinical examination, and VF testing. VF defects were identified by simplified Hodapp's classification. NEI VFQ-25 scores were compared between the three groups. No significant differences were found in gender, VFQ rating for "composite score" and "color vision" between the three groups. PACG patients with VF loss were most likely to be older and had lower best corrected visual acuity (BCVA), spherical equivalent (SE), mean deviation (MD), and visual field index (VFI), but higher pattern standard deviation (PSD) (all P < 0.05). Furthermore, patients with VF loss had significantly lower NVE-VFQ-25 subscale scores for general health, general vision, ocular pain, near activities, distance activities, social functioning, mental health, role difficulties, dependency, driving, and peripheral vision than PACG patients without VF loss and healthy controls (all P < 0.05). VFI (β = 1.498, P=0.003) and MD (β = -3.891, P=0.016) were significantly correlated with Role Difficulties scores. Additionally, PSD was significantly correlated with Peripheral Vision scores (β = -1.346, P=0.003). PACG patients with VF loss reported lower NEI VFQ-25 composite and subscale scores. VF indices including VFI, MD, and PSD were strongly correlated with VRQoL as assessed by NEI VFQ-25; thus, VRQoL may be significantly impacted by glaucomatous VF defects.

Real-world efficacy of the intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma: a 1-year retrospective study.

Suprachoroidal surgery can lower intraocular pressure and medication use. There is currently no commercial suprachoroidal product on the market. Here, we report our 1 year results of a novel ciliary sulcus suprachoroidal microtube technique. To determine the real-world efficacy of intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma refractory to topical ocular hypertensive medications. A retrospective non-comparative single center study of 36 Black and Afro-Latinx patients with glaucoma and pseudophakia who underwent intrascleral ciliary sulcus suprachoroidal microtube surgery for glaucoma as a stand-alone procedure at a single practice. Investigated parameters were number of medications, visual acuity (VA), intraocular pressure (IOP), mean deviation on visual field (VF) test. Success was defined as (a) IOP ⩽ 15 mmHg and or ⩾ 20% reduction in IOP and (b) a reduction in number of medications. We used paired t-test to compare baseline and follow-up parameters. We reviewed a total of 36 patients who had undergone the procedure. Twenty had success with 12-month follow-up in the study. The mean number of medications decreased significantly from 4.2 ± 1.0 preoperatively to 2.4 ± 1.7 in 12 months (p = 0.021) with five patients being medication free. In addition, the IOP decreased significantly from 21 ± 8.2 to 13.5 ± 4.4 mmHg (p = 0.032). In the 20 patients who had 12-month follow-up, the VA remained stable from Log Mar 0.62 ± 0.6-0.46 ± 0.6 (p = 0.052). VF in patients with successful procedure (no further interventions) remained stable from baseline mean deviation of -16.53 ± 10.04 to -16.82 ± 9.80 dB at 6-12 months. Adverse effects were transient and included IOP spike, hypotony, hyphema, and cornea edema that were treated and resolved. This 12-month retrospective study demonstrated that intrascleral ciliary sulcus suprachoroidal microtube surgery can reduce IOP and medication burden in pseudophakic patients with glaucoma. However, despite several successes, surveillance should take place for IOP spikes, possible tube obstruction, and need for additional glaucoma surgery.

Multimodal Deep Learning Model of Predicting Future Visual Field for Glaucoma Patients

Glaucoma is one of the most common reasons for blindness worldwide, especially in elderly people. Glaucoma can be monitored using visual field (VF) tests. Therefore, predicting the future VF to monitor progression of glaucoma is important. In this paper, we proposed a deep learning model to predict future VF based on previous VF and optical coherence tomography (OCT) images (including thickness map, vertical tomogram, and horizontal tomogram). The image data were analyzed using a ResNet-50 model. Image features and previous VFs were combined, and a long short-term memory (LSTM) network was used to predict future VF. A weighted method was used to detect noisy data. The proposed method was improved when applying weighted loss. The mean absolute error (MAE) was 3.31 ± 1.37, and the root mean square error (RMSE) was 4.58 ± 1.77. The model showed high performance when combining VF data and OCT image data. Furthermore, the model was useful for detecting and re-weighting noisy data.

Medications Damaging Retinal Pigment Epithelium and Photoreceptor Complex-1: Pathogenesis, Diagnosis, and Treatment (Chloroquine/hydroxychloroquine)

Hydroxychloroquine and chloroquine are frequently used in the treatment of rheumatic and parasitic diseases as a result of their immunomodulatory effects. Due to their high plasma distribution volumes, they cause irreversible side effects by accumulating in the tissues containing melanin following long-term use. Currently, these side effects can be detected before they reach advanced stages (bull’s eye maculopathy) thanks to new developments in diagnosis and imaging methods. Patients with concomitant tamoxifen use, impaired renal function, a dose of hydroxychloroquine greater than 5mg per kg per day or the dose of chloroquine greater than 2,3 mg per kg per day, older age, long-term use (10-25 years) have increased risk of retinopathy. Patients should be reviewed annually thereafter whilst on therapy and they should undergo imaging with optical coherence tomography (OCT), widefield fundus autofluorescence imaging (FAF), and 10-2 visual field testing at each monitoring visit. If the evidence of toxicity cannot be completely excluded patients should undergo multifocal electroretinography (mfERG). Of the tests used in the diagnosis of hydroxychloroquine/chloroquine retinopathy, mfERG has the highest sensitivity and specificity, followed by SD-OCT and 10-2 visual field tests, respectively. Once the precise signs of early retinopathy are detected, the decision to stop the medication should be taken in conjunction with prescribing physician. It should not be forgotten that retinopathy findings will progress even if the treatment is ceased. Following the screening, guidelines allow early detection of retinopathy before leading to irreversible retinal damage.

PS-C12-4: OPEN-ANGLE GLAUCOMATOUS OPTIC DAMAGE ASSOCIATED WITH DAYTIME AND NOCTURNAL DIPS IN BLOOD PRESSURE

Background: Impaired ocular perfusion pressure via systemic hypoperfusion plays a pivotal role in the pathogenesis of open-angle glaucoma (OAG). Extreme dips in mean arterial pressure (MAP) during 24-h are associated with OAG, however, whether this is driven by diurnal or nocturnal dips remains undocumented. We aimed this study to investigate the association of OAG damage with daytime and nocturnal dips in MAP. Methods: We conducted a retrospective longitudinal study that included 110 primary OAG patients who underwent 24-h ambulatory blood pressure monitoring. OAG damage was defined as changes in mean deviation (MD) of visual field tests during follow-up. MAP variability independent of the mean (VIMmap) was computed for daytime and nighttime. Dips were the five daytime and three nighttime lowest drops in MAP. We also calculated the night-to-day ratio and defined low diurnal and nocturnal MAP levels. We applied mixed models to evaluate changes in MD (expressed as decibels [dB]) during follow-up in relation to diurnal and nocturnal variability and dips in MAP. Results: The mean age was 64.0y (53% women). The median follow-up was nine years. In adjusted mixed models, every + 3 mmHg increase in daytime VIMmap was associated with a -2.57 dB longitudinal change in MD (P &lt; 0.001). The longitudinal changes in MD associated with daytime dip measures ranged from -2.56 dB (95% confidence interval [CI], -3.61 to -1.51; P &lt; 0.001) to -3.19 dB (95% CI, -4.53 to -1.84; P &lt; 0.001). For nighttime measures, the MD changed -0.71 dB (CI, -1.24 to -0.17; P = 0.009) per every -5 decrease in the nighttime MAP level. Nocturnal MAP level &lt; 74 mmHg and every 0.05 decrease in the night-to-day ratio were related to -7.23 (P = 0.003) and -0.96 (P = 0.011) changes in MD. Nighttime VIMmapP and nocturnal dips were not associated with changes in MD (P &gt; 0.097). Conclusions: Extreme daytime dips in MAP relate to OAG damage independently of the MAP level. Whereas, the association between OAG damage and nocturnal measures is driven by the nocturnal MAP level rather than variability or dips in MAP. The assessment of diurnal patterns in MAP might offer an opportunity to understand the pathogenesis of OAG. This is also critical as the perfusion pressure to the eyes is physiological 30% lower than at the brachial level in the standing or sitting positions. Therefore, a physiological lower perfusion pressure combined with extreme diurnal dips in MAP would exacerbate the hypoperfusion state in the optic nerve, leading to further glaucoma damage.

Longitudinal evaluation of RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma and stable visual fields.

To longitudinally compare isolated structural parameters obtained using RTVue optical coherence tomography in patients with glaucoma and suspected glaucoma with stable visual fields. All patients were required to have a reliable SITA Standard 24-2 Humphrey Visual Field test. Visual field stability was defined as having <5 points with p<5% and/or having no points with p<1% and/or p<0.05% in the glaucoma progression analysis comparison graph. Furthermore, the glaucoma assessment strategy was used in optical coherence tomography. The study included 75 eyes from 75 patients, 43 of which had glaucoma and 32 had suspected glaucoma. The mean visual field intervals were 29.57 ± 9.65 months between the first and third tests. No visual field parameter variations (mean deviation, pattern standard deviation, and visual field index) and no retinal nerve fiber layer or optic disk parameter variations between the first and third tests were observed (p>0.05 for all), and no retinal nerve fiber layer parameter variations throughout the study were observed, except for optic disk parameters presenting with cup volume changes (p=0.004). However, ganglion complex cells presented a progressively decreased average ganglion cell complex parameter, with a variability of -0.98% ± 3.71% (p=0.04) between the first and third tests. By contrast, the global loss volume progressively increased throughout the study, with a variability of 14.71% ± 44.52% (p=0.04) between the first and third tests. The inferior ganglion cell complex parameter was significantly decreased between the first and third tests (p=0.02). The present findings suggest that patients with glaucoma or suspected glaucoma with stable visual fields may present structural ganglion complex cell progression as assessed using RTVue optical coherence tomography.

Minimum Ganglion Cell Layer Thickness is the Best Structural Predictor of Visual Function in Leber Hereditary Optic Neuropathy

Background: Patients with Leber hereditary optic neuropathy, a genetic cause of severe optic atrophy and blindness, demonstrate characteristic structural changes measurable through optical coherence tomography, including initial swelling of the retinal nerve fiber layer and progressive thinning of the ganglion cell layer. After symptomatic conversion, patients experience progressive vision loss, often with dense central scotomas. Aims: This study aims to explore the predictive potential of ocular structural measurements to visual function in patients with Leber hereditary optic neuropathy. Methods: Medical records were reviewed retrospectively for patients with Leber hereditary optic neuropathy clinical testing. Structural measurements, including the average thickness of the ganglion cell layer, the retinal nerve fiber layer, and minimum thickness of the ganglion cell layer, measured through optical coherence tomography were obtained along with measures of visual function such as visual acuity and mean deviation of visual field testing. Simple and multivariable linear regressions were performed to determine correlations between structural measurements and visual functions. Analyses were conducted for all patients, and subgroup of symptomatic patients. Results: Overall, 92 eyes were included with 78 symptomatic eyes. Across all patients, the minimum ganglion cell layer thickness had the highest correlation coefficient with visual acuity (Beta -0.632, adjusted R2 0.396) and with visual field function (Beta 0.572, adj. R2 0.320) compared to the average thickness of the ganglion cell layer (Beta 0.474, adj. R2 0.216) and retinal nerve fiber layer (Beta 0.481, adj. R2 0.223). In multivariate analysis, the minimum ganglion cell layer thickness was the only significant measurement that correlated with visual acuity across all eyes (Beta -0.527, P&lt;0.001) and symptomatic eyes (Beta -0.479, P&lt;0.001). The minimum ganglion cell layer thickness (Beta 0.440, P&lt;0.001) and retinal nerve fiber layer average thickness (0.258, P=0.023) were significant structural measurements correlating to visual field function. Conclusion: The minimum ganglion cell layer thickness is the best structural measure predictor for visual field and visual acuity compared to other common structural measurements in patients with Leber hereditary optic neuropathy. It is a good predictor even when evaluating only symptomatic eyes. Additional attention toward the minimum ganglion cell layer thickness may offer further insight into a patient’s visual potential and the natural history of this disease.

Data Preprocessing and Augmentation Improved Visual Field Prediction of Recurrent Neural Network with Multi-Central Datasets

Introduction: The purpose of this study was to determine whether data preprocessing and augmentation could improve visual field (VF) prediction of recurrent neural network (RNN) with multi-central datasets. Methods: This retrospective study collected data from five glaucoma services between June 2004 and January 2021. From an initial dataset of 331,691 VFs, we considered reliable VF tests with fixed intervals. Since the VF monitoring interval is very variable, we applied data augmentation using multiple sets of data for patients with more than eight VFs. We obtained 5,430 VFs from 463 patients and 13,747 VFs from 1,076 patients by setting the fixed test interval to 365 ± 60 days (D = 365) and 180 ± 60 days (D = 180), respectively. Five consecutive VFs were provided to the constructed RNN as input and the 6th VF was compared with the output of the RNN. The performance of the periodic RNN (D = 365) was compared to that of an aperiodic RNN. The performance of the RNN with 6 long- and short-term memory (LSTM) cells (D = 180) was compared with that of the RNN with 5-LSTM cells. To compare the prediction performance, the root mean square error (RMSE) and mean absolute error (MAE) of the total deviation value (TDV) were calculated as accuracy metrics. Results: The performance of the periodic model (D = 365) improved significantly over aperiodic model. Overall prediction error (MAE) was 2.56 ± 0.46 dB versus 3.26 ± 0.41 dB (periodic vs. aperiodic) (p < 0.001). A higher perimetric frequency was better for predicting future VF. The overall prediction error (RMSE) was 3.15 ± 2.29 dB versus 3.42 ± 2.25 dB (D = 180 vs. D = 365). Increasing the number of input VFs improved the performance of VF prediction in D = 180 periodic model (3.15 ± 2.29 dB vs. 3.18 ± 2.34 dB, p < 0.001). The 6-LSTM in the D = 180 periodic model was more robust to worsening of VF reliability and disease severity. The prediction accuracy worsened as the false-negative rate increased and the mean deviation decreased. Conclusion: Data preprocessing with augmentation improved the VF prediction of the RNN model using multi-center datasets. The periodic RNN model predicted the future VF significantly better than the aperiodic RNN model.

Atypical Posterior Reversible Encephalopathy Syndrome Following COVID-19 Vaccination

Purpose: This report describes a visual field defect associated with atypical posterior reversible encephalopathy syndrome (PRES) after coronavirus disease 2019 (COVID-19) vaccination.Case summary: A 25-year-old man presented with visual field defects in both eyes 1 week after COVID-19 vaccination. He had brief chest discomfort following the vaccination. His best-corrected visual acuity was 20/25 in both eyes without relative afferent pupillary defects. The color vision test was normal. The Humphrey visual field test showed a bitemporal visual field defect respecting the vertical midline. A slit-lamp examination revealed no abnormality in the anterior eyes. Funduscopic examination revealed no abnormalities in the posterior parts of the eyes, including the optic discs. Orbital and brain magnetic resonance imaging were normal. Hematological tests, including two auto-antibodies related to optic neuritis (myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies) were normal. Two months after the initial symptoms, the visual field defects had improved. At the 6-month follow-up, there was more improvement. Atypical PRES was diagnosed.Conclusions: Patients may develop visual field defects due to encephalopathy following COVID-19 vaccination. A detailed history and proper imaging studies are needed to diagnose PRES.

Single nucleotide polymorphisms in LOXL1 as biomarkers for progression of exfoliation glaucoma in Sweden.

Exfoliation glaucoma is a common and aggressive type of glaucoma with high prevalence in Scandinavia. The aim of this study was to elucidate whether the allele frequencies of two single nucleotide polymorphisms (SNPs) located in LOXL1 were associated with the progression of exfoliation glaucoma in Swedish patients. In this non-randomised cohort study, we enrolled patients with exfoliation glaucoma, and they performed at least five reliable visual field tests. Blood samples were collected, and genotyping was performed using competitive allele-specific PCR genotyping. Glaucoma progression was evaluated using the guided glaucoma progression analysis (GPA), mean deviation (MD) difference and rate of progression (ROP). In addition, associations between allele frequencies and glaucoma progression were tested using logistic regression for GPA and linear regression for MD and ROP. We enrolled a total of 130 patients in the study. The general genetic model showed statistical significance for LOXL1_rs2165241 (p=8 × 10-7 , Fisher's exact test) and LOXL1_rs1048661 (p=2 × 10-6 , Fisher's exact test). Regression analyses using an additive genetic model showed significant values for LOXL1_rs2165241SNP in relation to GPA, MD and ROP as outcomes (p=1.8 × 10-4 , 4 × 10-2 , 6 × 10-4 ) and for LOXL1_rs1048661 SNP in relation to GPA, MD and ROP (p=7 × 10-5 , 8 × 10-3 , 2 × 10-4 ). This was the first study to show an association of the SNPs LOXL1_rs2165241 and LOXL1_rs1048661 with the progression of exfoliation glaucoma. Further large-scale studies are required to verify these findings.

Usability and Clinician Acceptance of a Deep Learning-Based Clinical Decision Support Tool for Predicting Glaucomatous Visual Field Progression.

We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study. To evaluate clinician perceptions of a prototyped clinical decision support (CDS) tool that integrates visual field (VF) metric predictions from artificial intelligence (AI) models. Ten ophthalmologists and optometrists from the University of California San Diego participated in 6 cases from 6 patients, consisting of 11 eyes, uploaded to a CDS tool ("GLANCE", designed to help clinicians "at a glance"). For each case, clinicians answered questions about management recommendations and attitudes towards GLANCE, particularly regarding the utility and trustworthiness of the AI-predicted VF metrics and willingness to decrease VF testing frequency. Mean counts of management recommendations and mean Likert scale scores were calculated to assess overall management trends and attitudes towards the CDS tool for each case. In addition, system usability scale scores were calculated. The mean Likert scores for trust in and utility of the predicted VF metric and clinician willingness to decrease VF testing frequency were 3.27, 3.42, and 2.64, respectively (1=strongly disagree, 5=strongly agree). When stratified by glaucoma severity, all mean Likert scores decreased as severity increased. The system usability scale score across all responders was 66.1±16.0 (43rd percentile). A CDS tool can be designed to present AI model outputs in a useful, trustworthy manner that clinicians are generally willing to integrate into their clinical decision-making. Future work is needed to understand how to best develop explainable and trustworthy CDS tools integrating AI before clinical deployment.

Decreased macular deep capillary plexus is associated with functional progression of normal tension glaucoma patients with unilateral visual field loss

PurposeTo investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina are associated with the development of visual field (VF) loss in the fellow eyes of...

Childhood-Onset Leber Hereditary Optic Neuropathy—Clinical and Prognostic Insights

To investigate the clinical and molecular genetic features of childhood-onset Leber hereditary optic neuropathy (LHON) to gain a better understanding of the factors influencing the visual outcome in this atypical form of the disease. Retrospective cohort study. We retrospectively included 2 cohorts of patients with LHON with onset of visual loss before the age of 12 years from Italy and the United Kingdom. Ophthalmologic evaluation, including best-corrected visual acuity, orthoptic evaluation, slit-lamp biomicroscopy, visual field testing, and optical coherence tomography, was considered. Patients were classified based on both the age of onset and the pattern of visual loss. A total of 68 patients were stratified based on the age of onset of visual loss: group 1 (<3 years): 14 patients (20.6%); group 2 (≥3 to <9 years): 27 patients (39.7%); and group 3 (≥9 to ≤12 years): 27 patients (39.7%). Patients in group 2 achieved a better visual outcome than those in group 3. Patients in groups 1 and 2 had better mean deviation on visual field testing than those in group 3. The mean ganglion cell layer thickness on optical coherence tomography in group 2 was higher than those in groups 1 and 3. Patients were also categorized based on the pattern of visual loss as follows: Subacute Bilateral: 54 patients (66.7%); Insidious Bilateral: 14 patients (17.3%); Unilateral: 9 patients (11.1%); and Subclinical Bilateral: 4 patients (4.9%). Children who lose vision from LHON before the age of 9 years have a better visual prognosis than those who become affected in later years, likely representing a "form frustre" of the disease.

Analysis of Vessel Density Using OCTA in Nonarteritic Anterior Ischemic Optic Neuropathy

Purpose: To investigate the intraocular vessel density in patients with nonarteritic anterior ischemic optic neuropathy (NAION) using optical coherence tomography angiography (OCTA).Methods: Medical records of patients with NAION were retrospectively analyzed. Their age, sex, best corrected visual acuity, color vision results, mean deviation of visual field test were analyzed. Using results of OCT and OCTA that was performed at first visit within 3 weeks of symptom onset, vessel densities in eyes with NAION were evaluated by comparing contralateral unaffected eyes. Furthermore, in only affected eyes, the correlation between visual acuity at the time of diagnosis and anatomical factors such as mean vessel density and retinal nerve fiber layer (RNFL) thickness was investigated.Results: Twenty-five patients (11 males and 14 females) were enrolled in this study and the mean age was 65.92 ± 9.37 years. Whole RNFL thickness in affected eye was significantly lower than that in unaffected eye (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The average peripapillary vessel density was also significantly lower in affected eyes, 45.63% ± 7.60% compared to that in the contralateral eyes, 51.44% ± 3.40% (&lt;i&gt;p&lt;/i&gt; = 0.004). In analysis of only 25 affected eyes, there was no significant correlation between each sectoral peripapillary RNFL thickness and vessel density. There was also no significant correlation between the visual acuity and the vessel density and retinal nerve fiber layer thickness in the ischemic peripapillary hemisphere. However, there was a significant negative correlation between the visual acuity and the un-ischemic peripapillary hemisphere with a coefficient of -0.608 (&lt;i&gt;p&lt;/i&gt; = 0.001).Conclusions: The higher vessel density of nonaffected sector, the better visual acuity at the time of diagnosis in patients with NAION. Patency of blood supply in the preserved peripapillary intraretinal vessel density sector may affect the visual function.

Visual Function Tests: Visual Fields.

Visual field tests, also known as perimetry tests, are used to assess progression of ophthalmic diseases such as retinitis pigmentosa (RP) by monitoring changes in a patient's visual field (VF). VF loss corresponds to damage at any point in the visual pathway, including the retina, such as in RP. Damage to different parts of this pathway corresponds to characteristic VF defects. Perimetry tests are subjective, as they are functional tests that help physicians identify abnormal fields as well as quantitatively assess VF sensitivity. The results may also be informative of a patient's visual function crucial for performing day-to-day activities. Automated perimetry tests are among the most commonly used, with the most common being automated static perimetry.