Visual Function Research Articles

Principal test for color sensation: clinical aspects.

Visual function comprises three principles: light sensation, color sensation, and minimum separable sensation. Although clinical evaluation of light sensation and visual acuity have been remarkably developed through comprehensive application of various methods, the test methods to evaluate color sensation in the clinical field have not reflected these various significant developments after their recommendation at the International Congress of Ophthalmology in 1933. To date, various research methods in color vision have been invented on the basis of clinical evaluation methods, most of which were limited to laboratory investigations and were not applied to the clinical field. In this review, the author focuses on both the currently clinical available evaluation methods and the clinically applicable methods based on the present laboratory research studies.

Cognitive Assessment in Grappling Athletes Following Choke Versus Non-Choke Submissions.

Participation in Brazilian jiu-jitsu (BJJ) and mixed martial arts has increased over the last 3 decades. These sports feature submission attacks, including strangles. These strangles, termed "chokes" in this context, primarily limit blood flow to the brain via compression of neck vasculature. There has been discussion in literature of the possibility of measurable cognitive effects following transient choking episodes. The present study used the King-Devick test (KDT) platform, a tablet-based reaction time and accuracy task designed to measure participants' number recognition, cognition, and verbal expression. This task requires functional vision, saccadic eye movements, comprehension and expression. Volunteer participants were screened for exclusion (prior brain injury) criteria and survey information prior to testing. Athletes were tested with the KDT immediately prior to a BJJ training session, again immediately after succumbing to either a choke ("Choke" arm) or non-choke ("Non-Choke" arm) submission while sparring, and again after a 10-minute rest period following the post-submission test. Analysis was done on Test Failures, Total Test Times, and Individual Difference Scores between baseline and subsequent testing. 62 (32 Choke, 30 Non-Choke) participants were analyzed. There was no significant difference between Choke and Non-Choke in Test failures (X2(1,62) = 1.25, p = 0.263), Total Times (t(60) = 0.62, p = 0.540, 95% CI [-3.44, 6.51]), and Individual Difference Scores (t(60) = 0.29, p = 0.776, 95% CI [-2.41, 3.21]). There were no significant differences between study arms in any of the 3 analyzed measures. This suggests that cognitive functioning, as measured by the King-Devick test, is not affected by transient choking episodes.

Optimal gamma-band entrainment of visual cortex.

Visual entrainment is a powerful and widely used research tool to study visual information processing in the brain. While many entrainment studies have focused on frequencies around 14-16 Hz, there is renewed interest in understanding visual entrainment at higher frequencies (e.g., gamma-band entrainment). Notably, recent groundbreaking studies have demonstrated that gamma-band visual entrainment at 40 Hz may have therapeutic effects in the context of Alzheimer's disease (AD) by stimulating specific neural ensembles, which utilize GABAergic signaling. Despite such promising findings, few studies have investigated the optimal parameters for gamma-band visual entrainment. Herein, we examined whether visual stimulation at 32, 40, or 48 Hz produces optimal visual entrainment responses using high-density magnetoencephalography (MEG). Our results indicated strong entrainment responses localizing to the primary visual cortex in each condition. Entrainment responses were stronger for 32 and 40 Hz relative to 48 Hz, indicating more robust synchronization of neural ensembles at these lower gamma-band frequencies. In addition, 32 and 40 Hz entrainment responses showed typical patterns of habituation across trials, but this effect was absent for 48 Hz. Finally, connectivity between visual cortex and parietal and prefrontal cortices tended to be strongest for 40 relative to 32 and 48 Hz entrainment. These results suggest that neural ensembles in the visual cortex may resonate at around 32 and 40 Hz and thus entrain more readily to photic stimulation at these frequencies. Emerging AD therapies, which have focused on 40 Hz entrainment to date, may be more effective at lower relative to higher gamma frequencies, although additional work in clinical populations is needed to confirm these findings. PRACTITIONER POINTS: Gamma-band visual entrainment has emerged as a therapeutic approach for eliminating amyloid in Alzheimer's disease, but its optimal parameters are unknown. We found stronger entrainment at 32 and 40 Hz compared to 48 Hz, suggesting neural ensembles prefer to resonate around these relatively lower gamma-band frequencies. These findings may inform the development and refinement of innovative AD therapies and the study of GABAergic visual cortical functions.

Lycium Barbarum Polysaccharide-Derived Nanoparticles Protect Visual Function by Inhibiting RGC Ferroptosis and Microglial Activation in Retinal Ischemia‒Reperfusion Mice.

Retinal ischemia‒reperfusion (IR) is a major contributor to vision impairment and irreversible vision loss due to retinal ganglion cell (RGC) injury or loss. Contemporary therapeutic approaches predominantly focus on the amelioration of symptoms rather than addressing the fundamental etiological factors. Oxidative stress is a notable feature and an important mediator of IR damage. Lycium barbarum polysaccharide (LBP), the main active ingredient of Lycium barbarum, has various pharmacological effects, including antioxidation, immunoregulation, and neuroprotective effects. In this study, the ROS-consumable moiety phenylboronic acid pinacol ester (PBA) is introduced to LBP molecules, which can self-assemble into nanoparticles in aqueous solution. This nanoparticle (termed PLBP) can reduce the cellular ROS levels and enhance the antioxidant capability of RGCs by activating the NRF2 pathway, thus protecting RGCs from ferroptosis and preserving visual function in response to IR injury. PLBP also reduces neuroinflammation by inhibiting the ability of microglia to phagocytose, migrate, secrete inflammatory cytokines, and activate the NF-κB pathway. In conclusion, this approach can be used as an inspiration for the future development of neuroprotective drugs.

Deep Embedding Koopman Neural Operator-Based Nonlinear Flight Training Trajectory Prediction Approach

Accurate flight training trajectory prediction is a key task in automatic flight maneuver evaluation and flight operations quality assurance (FOQA), which is crucial for pilot training and aviation safety management. The task is extremely challenging due to the nonlinear chaos of trajectories, the unconstrained airspace maps, and the randomization of driving patterns. In this work, a deep learning model based on data-driven modern koopman operator theory and dynamical system identification is proposed. The model does not require the manual selection of dictionaries and can automatically generate augmentation functions to achieve nonlinear trajectory space mapping. The model combines stacked neural networks to create a scalable depth approximator for approximating the finite-dimensional Koopman operator. In addition, the model uses finite-dimensional operator evolution to achieve end-to-end adaptive prediction. In particular, the model can gain some physical interpretability through operator visualization and generative dictionary functions, which can be used for downstream pattern recognition and anomaly detection tasks. Experiments show that the model performs well, particularly on flight training trajectory datasets.

An Arduino-Powered Device for the Study of White Perception beyond the Visual Chromatic Critical Flicker Fusion Frequency

Arduino microcontrollers are used for a wide range of technological and biomedical applications, such as image classification, computer vision, brain–computer interaction and vision experiments. Here, we present a new cost-effective mini-device based on RGB LED flicker stimulation for the assessment of the chromatic temporal resolution of the visual function based on the concept of critical flicker fusion frequency (CFF). The assembly of the device and its testing in thirty young subjects demonstrate the steady white visual perception of a trichromatic flicker stimulus (mixture of red, green and blue stimuli) beyond the CFF. Macular function as measured by photo-stress recovery time (PRT) was found to be independent of the CFF measurements for red, green and blue lights. However, a statistical correlation was found between the contrast modulation for CFF for red and green stimuli and PRT. Finally, wavefront measurements demonstrate that high-order aberrations improve the temporal resolution of the visual function.

Problems and prospects for restoration of the optic nerve

Restoring visual function after damage or complete destruction of the optic nerve in adult patients has many natural barriers to neuroregeneration. Research to restore vision has focused on maintaining retinal ganglion cells (RGCs), stimulating axonal growth toward the brain, and restoring their proper synaptic connections. Unfortunately, mammalian RGC axons under normal conditions do not regenerate after injury and ultimately die. In this review, we summarize the currently known mechanisms of RGC survival and axonal regeneration in mammals, including specific intrinsic signaling pathways, key transcription factors, reprogramming genes, inflammation-related regeneration factors, and stem cell therapy. We also review the current understanding of the phenomena impeding optic nerve regeneration and possible ways to overcome these obstacles. The most important research results obtained in recent decades may be informative for the development of methods for treating the damaged visual system.

Change in Visual Acuity of Patients With Fuchs Endothelial Corneal Dystrophy Over 1 Year.

To determine whether the clinical and paraclinical course of Fuchs endothelial corneal dystrophy (FECD) over 1 year is related to the extent of triplet repetition in the transcription factor 4 (TCF4) gene. A prospective study with a 1-year follow-up was conducted. A total of 104 patients (160 eyes) with FECD and an equivalent number of age- and sex-matched control subjects without FECD were included. At inclusion, the corneas were graded using the modified Krachmer grade (KG) and patients were genotyped for the number of trinucleotide repeats (TNRs) in the TCF4 gene by the short tandem repeat assay. Visual acuity, Scheimpflug tomographic features, and the Visual Function and Corneal Health Status using a visual disability instrument were measured on 2 visits at 1-year intervals. KGs ranged from 1 to 6, and 46% of eyes had grades 1 to 4. 71% of the patients harbored TNR expansion (>40) versus 13% in control subjects (P < 0.001). Severity at inclusion was higher in the presence of TNR expansion when considering eyes independently (mean grade ±SD, 4.08 ± 1.42) without TNR expansion and 4.66 ± 1.27 with TNR expansion (P = 0.024). In 1 year, the ETDRS score significantly decreased by -2.97 (95% confidence interval -4.69 to -1.26, P = 0.001) and the ETDRS score with glare by -4.25 (95% confidence interval -6.22 to -2.27, P < 10-5). There was no relationship between the rate of decline and TNR expansion or KG. Central corneal thickness and Visual Function and Corneal Health Status scores did not significantly vary. It is possible to measure a subtle progression of FECD over a period as short as 1 year. We did not find a relationship between the presence of TNR expansion and the speed of deterioration over 1 year. This work should facilitate the design of future clinical trials on FECD.Trial Registration-URL: ClinicalTrials.gov. Identifier: French Fuchs Follow-up Study (F3S): NCT03974230.

Change in Visual Acuity of Patients With Fuchs Endothelial Corneal Dystrophy Over 1 Year.

To determine whether the clinical and paraclinical course of Fuchs endothelial corneal dystrophy (FECD) over 1 year is related to the extent of triplet repetition in the transcription factor 4 (TCF4) gene. A prospective study with a 1-year follow-up was conducted. A total of 104 patients (160 eyes) with FECD and an equivalent number of age- and sex-matched control subjects without FECD were included. At inclusion, the corneas were graded using the modified Krachmer grade (KG) and patients were genotyped for the number of trinucleotide repeats (TNRs) in the TCF4 gene by the short tandem repeat assay. Visual acuity, Scheimpflug tomographic features, and the Visual Function and Corneal Health Status using a visual disability instrument were measured on 2 visits at 1-year intervals. KGs ranged from 1 to 6, and 46% of eyes had grades 1 to 4. 71% of the patients harbored TNR expansion (>40) versus 13% in control subjects (P < 0.001). Severity at inclusion was higher in the presence of TNR expansion when considering eyes independently (mean grade ±SD, 4.08 ± 1.42) without TNR expansion and 4.66 ± 1.27 with TNR expansion (P = 0.024). In 1 year, the ETDRS score significantly decreased by -2.97 (95% confidence interval -4.69 to -1.26, P = 0.001) and the ETDRS score with glare by -4.25 (95% confidence interval -6.22 to -2.27, P < 10-5). There was no relationship between the rate of decline and TNR expansion or KG. Central corneal thickness and Visual Function and Corneal Health Status scores did not significantly vary. It is possible to measure a subtle progression of FECD over a period as short as 1 year. We did not find a relationship between the presence of TNR expansion and the speed of deterioration over 1 year. This work should facilitate the design of future clinical trials on FECD.Trial Registration-URL: ClinicalTrials.gov. Identifier: French Fuchs Follow-up Study (F3S): NCT03974230.

Design and Realization of Visual and Contact-Type Fast Charging Power Source.

Charging power supplies with both fast and visualization functions have a wide range of applications in the information and new energy industries. In this paper, the visualized and contact-type fast charging power supply based on WO3 film and Zn sheet is presented, and the prototype devices are fabricated. Different with the charging method of conventional batteries, charging is achieved by a Zn sheet contacting with a WO3 film moistened with water, resulting in a rapid discoloration of WO3. Theoretical investigation indicates that the interaction between Zn sheet and water molecules is the primary cause of the color change in the WO3 film. The WO3 film completes the colouring state within 10 s in the presence of Zn sheet and water, and the open-circuit voltage of the device is 0.7 V, which can be used to drive various electronics by series-parallel connection. This research introduces a novel method to induce colouring of WO3 films and proposes a fast charging mode different from traditional power sources. It provides valuable insights for the future development of fast charging in the field of electrical energy.

Design and Realization of Visual and Contact-Type Fast Charging Power Source.

Charging power supplies with both fast and visualization functions have a wide range of applications in the information and new energy industries. In this paper, the visualized and contact-type fast charging power supply based on WO3 film and Zn sheet is presented, and the prototype devices are fabricated. Different with the charging method of conventional batteries, charging is achieved by a Zn sheet contacting with a WO3 film moistened with water, resulting in a rapid discoloration of WO3. Theoretical investigation indicates that the interaction between Zn sheet and water molecules is the primary cause of the color change in the WO3 film. The WO3 film completes the colouring state within 10 s in the presence of Zn sheet and water, and the open-circuit voltage of the device is 0.7 V, which can be used to drive various electronics by series-parallel connection. This research introduces a novel method to induce colouring of WO3 films and proposes a fast charging mode different from traditional power sources. It provides valuable insights for the future development of fast charging in the field of electrical energy.

The Measurement of Contrast Sensitivity in Near Vision: The Use of a Digital System vs. a Conventional Printed Test

In recent years, there has been intense development of digital diagnostic tests for vision. All of these tests must be validated for clinical use. The current study enrolled 51 healthy individuals (age 19–72 years) in which achromatic contrast sensitivity function (CSF) in near vision was measured with the printed Vistech VCTS test (Stereo Optical Co., Inc., Chicago, IL, USA) and the Optopad-CSF (developed by our research group to be used on an iPad). Likewise, chromatic CSF was evaluated with a digital test. Statistically significant differences between tests were only found for the two higher spatial frequencies evaluated (p = 0.012 and &lt;0.001, respectively). The mean achromatic index of contrast sensitivity (ICS) was 0.02 ± 1.07 and −0.76 ± 1.63 for the Vistech VCTS and Optopad tests, respectively (p &lt; 0.001). The ranges of agreement between tests were 0.55, 0.76, 0.78, and 0.69 log units for the spatial frequencies of 1.5, 3, 6, and 12 cpd, respectively. The mean chromatic ICS values were −20.56 ± 0.96 and −0.16 ± 0.99 for the CSF-T and CSF-D plates, respectively (p &lt; 0.001). Furthermore, better achromatic, red–green, and blue–yellow CSF values were found in the youngest groups. The digital test allows the fast measurement of near-achromatic and chromatic CSF using a colorimetrically calibrated iPad, but the achromatic measures cannot be used interchangeably with those obtained with a conventional printed test.

Long-Term Follow-Up before and during Riluzole Treatment in Six Patients from Two Families with Spinocerebellar Ataxia Type 7.

Currently no curative treatment exists for spinocerebellar ataxias (SCAs). Riluzole repurposing was proposed as a symptomatic treatment in different types of cerebellar ataxia. We report a long-term-follow up under riluzole treatment in SCA type 7. Six patients received Riluzole 50mg twice daily on a compassionate use program for a mean of 4.8 years (range 3.5-9). We measured ataxia onset and progression through the Scale for the Assessment and Rating of Ataxia (SARA), and collected extensive ophthalmological data before and after Riluzole treatment. Electrocardiogram and laboratory profile for drug safety were performed every six months. Riluzole treatment showed no effect on visual function in two patients with an advanced retinal damage. Improvements of visual function occurred in four patients followed by ophthalmologic stability up to 5 years after starting treatment. Two patients had a less steep deterioration of ataxia after treatment compared to pre-treatment, during the first 2,5 years of therapy. One showed soon after therapy an improvement of the SARA score, and then overall stability lasting 3,5 years, followed by ataxia worsening. One visually impaired patient without neurological impairment did not worse until the last visit after 3,5 years of follow-up. The remaining 2 patients showed an improvement of SARA scores soon after therapy, and an overall stability lasting respectively 5 and 3 years. No adverse event was registered during the observation period. This study suggests a possible beneficial action of Riluzole in SCA7 and provides a detailed description of the ophthalmologic profile of these patients.

Sex-specific alterations in visual properties induced by single prolonged stress model

Patients with post-traumatic stress disorder (PTSD) exhibit sex differences in symptomology, with women more likely to report higher rates of intrusive and avoidance symptoms than men, underscoring the need for sex-informed approaches to research and treatment. Our study delved into the sex-specific aspects of stress-induced visual impairments using the single prolonged stress (SPS) model, a partially validated rodent model for PTSD. Male SPS mice exhibit heightened optimal spatial frequency (SF) of primary visual cortex (V1) neurons, while female counterparts exhibit decreased optimal temporal frequency (TF) of V1 neurons. This phenomenon persisted until the 29th day after SPS modeling, and it may be the physiological basis for the observed increase in visual acuity in male SPS mice in visual water task. Furthermore, our study found that corticotropin-releasing factor receptor 1 regulated optimal TF and optimal SF of V1 in mice, but did not exhibit sex differences. These findings indicated that severe stress induces sex-specific effects on visual function.

Landscaping the digital twin technology: Patent-based networks and technology reference model

The digital twin (DT) is a core technology for supporting digital transformation (DX) across industrial domains that has functions of monitoring, control, simulation, visualization, and prediction. However, there exist conceptual and terminological inconsistencies in DT due to industrial heterogeneity and technological complexity. We conduct patent-based network analysis to develop a technology reference model for DT technologies in order to uncover the core enabling technologies and technological structure. Two types of network analysis, co-word and co-citation, are constructed based on the 1201 DT-related patents. The co-word network analysis identifies 13 technology clusters, and the co-citation network analysis reveals 16 technology clusters. The combined results yield 17 technology components structured into three layers: (a) enabling technology, (b) core functionality, and (c) service according to technological role. A DT technology reference model is then developed based on the structured technology components. The proposed DT technology reference model offers comprehensive insights into the landscape of DT technologies and serves as a guide for researchers and policymakers seeking to systematically understand DT technologies for the DX paradigm.

Microglia are dispensable for experience-dependent refinement of mouse visual circuitry.

To test the hypothesized crucial role of microglia in the developmental refinement of neural circuitry, we depleted microglia from mice of both sexes with PLX5622 and examined the experience-dependent maturation of visual circuitry and function. We assessed retinal function, receptive field tuning of visual cortex neurons, acuity and experience-dependent plasticity. None of these measurements detectibly differed in the absence of microglia, challenging the role of microglia in sculpting neural circuits.

Microglia are dispensable for experience-dependent refinement of mouse visual circuitry.

To test the hypothesized crucial role of microglia in the developmental refinement of neural circuitry, we depleted microglia from mice of both sexes with PLX5622 and examined the experience-dependent maturation of visual circuitry and function. We assessed retinal function, receptive field tuning of visual cortex neurons, acuity and experience-dependent plasticity. None of these measurements detectibly differed in the absence of microglia, challenging the role of microglia in sculpting neural circuits.

Natural History of Visual Acuity and Microperimetry-Based Functional Outcome Measures of the Macula in Patients with Geographic Atrophy: A Retrospective Chart Review Study in Germany.

Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2-5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm2 to 11.8 mm2 (1.08 mm2/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA.

Natural History of Visual Acuity and Microperimetry-Based Functional Outcome Measures of the Macula in Patients with Geographic Atrophy: A Retrospective Chart Review Study in Germany

Background/Objectives: Geographic atrophy (GA) is an advanced form of age-related macular degeneration (AMD) leading to the progressive and irreversible loss of visual function. Characteristics of GA include atrophic lesions resulting from the loss of photoreceptors, retinal pigment epithelium, and choriocapillaris. During GA progression, atrophic lesions typically advance from the macular periphery to the center, affecting foveal light sensitivity and visual acuity. This study analyzed changes in light sensitivity and visual acuity during the natural course of GA progression using the topographic analysis of structural and functional changes based on Early Treatment Diabetic Retinopathy Study (ETDRS) charts, multimodal imaging, and microperimetry assessment. Methods: Medical chart data of GA patients between 2014 and 2022 from the Internationale Innovative Ophthalmochirurgie GbR (I.I.O.) research center (Düsseldorf, Germany) were retrospectively analyzed. All patient eyes fulfilling the phase 3 OAKS study inclusion criteria were included and followed up for 60 months. The imputation of missing measurements and dropouts was performed by linear mixed models. Results: A total of 20 GA eyes from 13 GA patients were included in the study. At the index, 53.8% of patients had bilateral GA, with 70.0% of the eyes showing multifocal GA and 30.0% subfoveal encroachment (SFE). A total of 35.0% of the eyes had 2–5, and 15.0% over 20, areas of atrophy. Over time, the GA lesion size increased from 6.4 mm2 to 11.8 mm2 (1.08 mm2/year). After an average observation time of 2.9 years, 78.6% of the initially unaffected study eyes developed SFE. The percentage of study eyes without visual impairment decreased from 55.0% to 30.0%, with mean normal-luminance best-corrected visual acuity (NL-BCVA) reducing from 63.7 to 55.7 ETDRS letters. The share of absolute scotoma points in microperimetry assessment increased from 15.7% to 43.5% while overall average macular sensitivity declined from 15.7 dB to 7.4 dB. Conclusions: The substantial deterioration of macular outcomes and visual function was comprehensively detected. The results were a documentation of structural and functional aspects of the natural progression of GA for a 60-month follow-up, providing a typical outline for AMD patients with GA.

Assessment of objective visual function following idebenone administration in patients with leber hereditary optic neuropathy.

To objectively assess visual function in Leber's Hereditary Optic Neuropathy (LHON) patients; this study evaluated pre- and post-idebenone treatment changes in primary visual cortical (V1) responses using functional magnetic resonance imaging (fMRI), given the challenges in subjective testing due to central retinal ganglion cell damage. A descriptive study involving four confirmed LHON patients. Four patients received 900 mg/day of oral idebenone for 24 weeks. Baseline and post-treatment visual acuity, visual fields, and BOLD fMRI responses while passively viewed drifting contrast pattern visual stimuli were compared with self-reported symptoms. Post-idebenone, one patient showed positive trends across subjective tests, reported symptoms, and fMRI. Two patients had stable symptoms and fMRI responses; one improved on subjective tests, and another worsened slightly. Another patient improved in visual field tests despite worsening symptoms and fMRI trends. fMRI may offer a valuable objective measure of visual functions in LHON and appears to be more relevant in assessing symptoms. Further research with more participants is needed to ascertain fMRI's role in developing objective visual assessments and treatment evaluation.