Vision

14 pages, 1402 KB

Open AccessArticle

Short-Term Effects of Low-Level Red-Light Therapy on Central Retinal Function: A Combined Pattern ERG and Photopic ERG Study

by Muhammad Qasim, Paulo Fernandes and Jorge Jorge

Vision 2026, 10(2), 26; https://doi.org/10.3390/vision10020026 - 8 May 2026

Abstract

Background: Low-level red-light therapy (RLRT) has emerged as a potential therapy in myopia management. However, its effects on retinal structure and function following repeated exposure remain incompletely understood. Purpose: To evaluate the short-term effects of RLRT on central retinal function in myopes and [...] Read more.

Background: Low-level red-light therapy (RLRT) has emerged as a potential therapy in myopia management. However, its effects on retinal structure and function following repeated exposure remain incompletely understood. Purpose: To evaluate the short-term effects of RLRT on central retinal function in myopes and non-myopes using retinal electrophysiology and structural parameters. Methods: Thirty-six subjects underwent RLRT exposures. Retinal function was assessed using pattern electroretinography (PERG) and photopic full-field electroretinography (Photopic 3.0 ERG). Structural measurements, including axial length (AL), obtained with an optical biometer and choroidal thickness (CT), were measured using MOPTIM 3000. Outcomes were compared between baseline and post-RLRT conditions (single 3 min and single 1 min exposure), across refractive groups, and correlated with AL and CT. This study was conducted at the University of Minho in accordance with the Declaration of Helsinki. Results: In myopic subjects, PERG N35–P50 amplitude significantly increased after 3 min of RLRT (baseline:0.88 ± 0.21µV; post: 1.40 ± 0.25µV; p = 0.013), whereas no significant changes were observed in non-myopes (baseline: 1.32 ± 0.19µV; post: 1.39 ± 0.21µV; p = 0.47). Latencies remained stable across all groups (p > 0.05). No significant correlations were found between PERG and AL (ρ = –0.18, p = 0.44) or CT (ρ = 0.12, p = 0.52). Photopic 3.0 ERG showed an increase in b-wave amplitude after 3 min of RLRT in myopes (Δ = +2.42µV, p = 0.06), but not in non-myopes. In myopes, AL was negatively correlated with post-therapy latency (ρ = –0.624, p = 0.060), while CT showed strong correlations with photopic a-wave responses after 1 min RLRT (CT vs. latency: ρ = –0.873, p = 0.010; CT vs. amplitude: ρ = 0.821, p = 0.034). Conclusions: Short-term exposure to RLRT, particularly at 3 min, enhances PERG and Photopic ERG responses in myopic subjects, suggesting transient improvements in retinal function with differential effects between refractive groups. Full article

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11 pages, 371 KB

Open AccessArticle

Visual Field Loss and Self-Reported Driving Restriction in Glaucoma

by Mladena Radeva, Preslava Encheva, Elitsa Hristova, Daliya Stefanova, Igor Resnick and Zornitsa Zlatarova

Vision 2026, 10(2), 25; https://doi.org/10.3390/vision10020025 - 29 Apr 2026

Abstract

Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma [...] Read more.

Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma underwent standard automated perimetry. Visual function was assessed using Mean Deviation (MD) and Visual Field Index (VFI) from the better eye. Driving status, driving limitation, and self-reported driving difficulties were assessed using a structured questionnaire. Multivariable logistic regression was performed to determine independent associations between visual field parameters and driving limitation, adjusting for age, sex, cataract status, and systemic comorbidities. Because MD and VFI are closely related indices of visual field loss, separate multivariable models were constructed for each parameter. Receiver operating characteristic (ROC) analysis was used to explore threshold values associated with driving limitation. Results: Driving limitation increased progressively with worsening functional severity, affecting 17% of participants with preserved function, 48% of those with borderline impairment, and 72% of those with definite impairment (p < 0.001). Reduced VFI was independently associated with driving limitation (OR = 0.972, 95% CI: 0.948–0.996; p = 0.021). In a separate model, more negative MD was also independently associated with driving limitation (OR = 0.924, 95% CI: 0.875–0.976; p = 0.004). Male sex was associated with a lower likelihood of driving limitation. ROC analysis identified threshold values of VFI ≤ 71% (AUC = 0.663) and MD ≤ −13.36 dB (AUC = 0.650), both characterized by high specificity but limited sensitivity. Participants who had ceased driving demonstrated worse visual field indices than active drivers, whereas never-drivers showed no consistent association with visual field loss. Conclusions: Glaucomatous visual field loss was significantly associated with self-reported driving limitation and behavioural self-regulation. Objective perimetric parameters, particularly VFI and MD in the better eye, may help identify patients more likely to report driving difficulties. The reported threshold values should be interpreted as exploratory reference points rather than clinically actionable criteria and require further validation before clinical application. Full article

(This article belongs to the Topic New Developments in Glaucoma Diagnostics and Therapeutics)

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29 pages, 409 KB

Open AccessReview

Comorbidities in Age-Related Cataract: Epidemiological Burden and Public Health Implications

by Matteo Ripa, Matteo Forlini, Chiara Schipa and Neeraj Apoorva Shah

Vision 2026, 10(2), 24; https://doi.org/10.3390/vision10020024 - 28 Apr 2026

Abstract

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological [...] Read more.

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

13 pages, 707 KB

Open AccessArticle

Exploring Visual Discrimination and Performance Adaptation in First-League Futsal Players via LUMMICS

by Bruno Monteiro, Ana Roque, Henrique Nacimento and Clara Martinez-Perez

Vision 2026, 10(2), 23; https://doi.org/10.3390/vision10020023 - 23 Apr 2026

Abstract

Background/Objectives: Perceptual–cognitive abilities such as visual discrimination, reaction time, and attentional control are important for performance in dynamic sports. However, evidence remains limited regarding how simplified visual tasks capture performance variability and dynamics under repeated exposure. This study examined session-to-session performance changes and [...] Read more.

Background/Objectives: Perceptual–cognitive abilities such as visual discrimination, reaction time, and attentional control are important for performance in dynamic sports. However, evidence remains limited regarding how simplified visual tasks capture performance variability and dynamics under repeated exposure. This study examined session-to-session performance changes and individual trajectories in a programmable visual discrimination task of increasing complexity in elite futsal players. Methods: An exploratory repeated-measures study was conducted with ten first-league futsal players. Participants completed between six and ten sessions of a color-cue visual discrimination task (“Follow the Color”) under one- and two-stimulus conditions. Outcomes included correct responses, errors, and reaction time per session. A total of 465 observations were analyzed using linear mixed-effects models to assess changes across sessions and the influence of task complexity. Individual analyses were also performed to explore player-specific trajectories. Results: Mean session accuracy was 63.8 ± 9.8 correct responses, with a mean error rate of 3.6 ± 6.1 and a mean reaction time of 0.63 ± 0.15 s. Error rates declined significantly across sessions (β = −0.008, p < 0.001), while reaction time improved modestly (β = −0.00011, p = 0.025). Correct responses showed a small negative trend over time. Increased task complexity was associated with fewer correct responses, higher error rates, and slower reaction times (all p < 0.001). Conclusions: This programmable visual discrimination task captured variability in visuomotor responses under controlled conditions and may support monitoring of performance dynamics in sports vision research. Full article

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18 pages, 566 KB

Open AccessArticle

One Year Longitudinal Assessment of Subjective and Objective Accommodation After Phakic IOL Implantation

by Esther López-Artero, María García-Montero, Blanca Poyales, Ricardo Pérez-Izquierdo, Alba Sáez and Nuria Garzón

Vision 2026, 10(2), 22; https://doi.org/10.3390/vision10020022 - 16 Apr 2026

Abstract

Purpose: To evaluate the 1 year behavior of accommodation and optical quality one year after the implantation of phakic intraocular lenses, specifically the implantable collamer lens (ICL), in myopic patients, comparing outcomes between low- and high-myopia groups. Methods: This comparative longitudinal study included [...] Read more.

Purpose: To evaluate the 1 year behavior of accommodation and optical quality one year after the implantation of phakic intraocular lenses, specifically the implantable collamer lens (ICL), in myopic patients, comparing outcomes between low- and high-myopia groups. Methods: This comparative longitudinal study included 38 eyes of 38 patients who underwent ICL implantation for myopia correction. Patients were divided into two groups based on preoperative manifest sphere: low myopia (−2.50 D to −6.25 D) and high myopia (>−6.25 D to −12.50 D). The amplitude of accommodation (AA), subjective accommodative response (AR), optical quality parameters including the modulation transfer function (MTF) cut-off, objective scatter index (OSI) and Strehl ratio (SR), and objective accommodative response with a double-pass system (HD Analyzer, Visiometrics) were assessed preoperatively, 1 month, and 1 year postoperatively. Results: Both groups achieved postoperative refractive outcomes close to emmetropia, with high efficacy and safety indices. A statistically significant decrease in the amplitude of accommodation was observed at 1 month and remained stable at 1 year in both groups; however, this change was not clinically meaningful. The optical quality parameters (MTF cut-off, OSI, and Strehl ratio) and objective accommodative response with the HD Analyzer showed no clinically relevant changes over time, with no significant intergroup differences detected (p-value > 0.05). Conclusions: An initial reduction in accommodative amplitude was observed after ICL implantation without recovery over time; however, it was not clinically relevant, as it fell within the test–retest variability in the minus lens technique. Other accommodative parameters and optical quality remained stable at 1 year in both low and high myopia. Full article

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16 pages, 3719 KB

Open AccessArticle

OCT and Autofluorescence Phenotypic Features in Autosomal Dominant RHO-Associated Retinitis Pigmentosa Variants

by Christina Karakosta, Saoud Al-Khuzaei, Penny Clouston, Morag Shanks and Susan M. Downes

Vision 2026, 10(2), 21; https://doi.org/10.3390/vision10020021 - 10 Apr 2026

Abstract

Background/Objectives: To describe retinal imaging characteristics and the natural history of rhodopsin (RHO)-associated autosomal dominant retinitis pigmentosa (ADRP) by evaluating ellipsoid zone (EZ) width loss and measuring the degree of constriction of the area within and including the hyperautofluorescent ring. Methods: [...] Read more.

Background/Objectives: To describe retinal imaging characteristics and the natural history of rhodopsin (RHO)-associated autosomal dominant retinitis pigmentosa (ADRP) by evaluating ellipsoid zone (EZ) width loss and measuring the degree of constriction of the area within and including the hyperautofluorescent ring. Methods: Eighteen patients with molecularly confirmed RHO variants were retrospectively evaluated. EZ width on spectral-domain optical coherence tomography (SD-OCT) and the area within and including the hyperfluorescent ring on fundus autofluorescence (FAF) were measured. The correlation between EZ width and hyperfluorescent ring area was assessed using a linear mixed-effects model. Results: Mean best corrected visual acuity (BCVA) (logMAR) was 0.21 at baseline and 0.29 at last visit over a mean follow-up of 5 years. Nine patients presented with sectoral RP, eight with typical RP, and one with unilateral RP. The mean EZ width constriction rate was −93.43 µm/year (SD = 130.58), and the area within and including the hyperautofluorescent ring decreased by −0.54 mm²/year (SD = 0.50). A strong positive association was observed between the EZ width and hyperfluorescent ring area at baseline (β = 151.7 ± 17.9, p < 0.001) and at the final visit (β = 185.7 ± 18.2, p < 0.001). Conclusions: In this study, patients with RHO-associated ADRP appeared to show a relatively slow rate of progression. Quantitative imaging markers, such as EZ width and the area within and including the hyperautofluorescent ring, may offer potentially reproducible measures of disease progression. These imaging biomarkers could be useful as outcome measures in future natural history studies and therapeutic trials, pending further validation. Full article

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13 pages, 1522 KB

Open AccessSystematic Review

Epidemiology of Keratoconus in India: A Systematic Review and Meta-Analysis of Indian Study Populations

by Matteo Ripa, Chiara Schipa, Paola Aceto, Sushad Prasad and Neeraj Apoorva Shah

Vision 2026, 10(2), 20; https://doi.org/10.3390/vision10020020 - 9 Apr 2026

Abstract

(1) Background: To synthesize available evidence on the prevalence of keratoconus (KC) reported in Indian study populations and describe its demographic distribution. (2) Methods: PubMed, Embase, and Scopus were checked using free text and controlled vocabulary. A random-effect meta-analysis of pooled prevalence and [...] Read more.

(1) Background: To synthesize available evidence on the prevalence of keratoconus (KC) reported in Indian study populations and describe its demographic distribution. (2) Methods: PubMed, Embase, and Scopus were checked using free text and controlled vocabulary. A random-effect meta-analysis of pooled prevalence and its 95% confidence intervals (CIs) for KC among study participants recruited in India was conducted using exact binomial distributions and the Freeman–Tukey double-arcsine transformation. To identify potential sources of variability, we conducted subgroup analyses by dividing the data by geographic region, KC assessment, and study population. The methodological quality of each study was assessed using the Newcastle–Ottawa scale (NOS). Evidence quality was evaluated using the GRADE system. (3) Results: Across included studies, the total number of KC cases was 16,164, and sample sizes ranged from 152 to 2,384,523 participants. Prevalence estimates varied markedly across studies, reflecting substantial heterogeneity in study design, diagnostic criteria, and population characteristics. Most studies were conducted in high-risk clinical settings, limiting generalizability to the general population. Subgroup analyses showed no significant differences by geographic region or diagnostic modality (p = 0.79 and 0.07, respectively). There was a statistically significant subgroup effect (p < 0.001) in the study population. The reported prevalence among females ranged from 0.00 to 0.04, while the pooled prevalence estimate was 0.02 (95% CI: 0.00–0.04). Four cross-sectional studies scored 8–10 on the NOS. (4) Conclusions: Our meta-analysis synthesized the currently available evidence on keratoconus prevalence across Indian study populations, highlighting substantial variability across studies and emphasizing that estimates should be interpreted within their specific study contexts rather than as representative of the national population. Full article

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12 pages, 387 KB

Open AccessArticle

Real-World Effectiveness of CARE-Based Spectacle Lenses for Myopia Control in a Turkish Pediatric Cohort

by Nilay Akagun and Ugur Emrah Altiparmak

Vision 2026, 10(2), 19; https://doi.org/10.3390/vision10020019 - 31 Mar 2026

Abstract

Childhood myopia progression remains a major global public health concern, and spectacle lenses designed to induce peripheral myopic defocus have emerged as a non-pharmacological strategy for myopia control; however, real-world evidence from European populations remains limited. This retrospective observational study evaluated the 12-month [...] Read more.

Childhood myopia progression remains a major global public health concern, and spectacle lenses designed to induce peripheral myopic defocus have emerged as a non-pharmacological strategy for myopia control; however, real-world evidence from European populations remains limited. This retrospective observational study evaluated the 12-month real-world effectiveness of cylindrical annular refractive element spectacle lenses in a Turkish pediatric cohort. Children aged 5–15 years who wore myopia-control spectacle lenses from the CARE platform or single-vision lenses were included. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 12 months. The primary outcomes were 12-month changes in SER and AL. Multivariable generalized estimation equations were applied to account for inter-eye correlation and to adjust for age and gender. A total of 168 eyes were analyzed (85 with single-vision lenses; 83 with myopia-control lenses). After 12 months, the myopia-control group demonstrated significantly slower progression than the single-vision group, with mean SER changes of −0.40 ± 0.92 D versus −0.77 ± 0.74 D and axial elongation of 0.17 ± 0.25 mm versus 0.31 ± 0.30 mm, respectively. Treatment group remained a significant predictor of both refractive progression (p = 0.008) and axial elongation (p = 0.003). Age was independently associated with axial length change (p < 0.001), whereas gender was not. These findings provide real-world European evidence supporting the role of defocus-modulating spectacle lenses in pediatric myopia management. Full article

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24 pages, 1711 KB

Open AccessArticle

Adverse Events Reported with Standard-Dose and High-Dose Aflibercept: A FAERS Pharmacovigilance Study

by Minali Prasad and David J. Ramsey

Vision 2026, 10(2), 18; https://doi.org/10.3390/vision10020018 - 31 Mar 2026

Cited by 1

Abstract

This pharmacovigilance study drew upon the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to compare the reporting patterns of ocular and systemic adverse events (AEs) for the 2 mg (standard-dose [SD]) and 8 mg (high-dose [HD]) formulations of aflibercept [...] Read more.

This pharmacovigilance study drew upon the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to compare the reporting patterns of ocular and systemic adverse events (AEs) for the 2 mg (standard-dose [SD]) and 8 mg (high-dose [HD]) formulations of aflibercept given for any ocular indication. Disproportionality analysis, including reporting odds ratios (ROR), was used to compare each dose individually to the background reporting rate for the AE. Statistical significance of the RORs was evaluated using Bonferroni correction, alongside signal detection based on Evans criteria, and Bayesian information components. The Breslow–Day test was used to conduct a head-to-head comparison of RORs between each dose. We identified 953 SD and 314 HD AE reports within the 750-day period after the approval of HD by the U.S. Food and Drug Administration (FDA; 8/18/2023). Compared to SD, HD had a higher ROR for endophthalmitis (HD: ROR 767.56 [95% CI, 466.11–1263.95]; SD: ROR 331.64 [95% CI, 216.71–507.51]), eye inflammation (HD: ROR 118.45 [95% CI, 55.85–251.20]; SD: 43.98 [95% CI, 21.87–88.44]), retinal vasculitis (HD: ROR 769.87 [95% CI, 337.13–1758.04]; SD: ROR 124.80 [95% CI, 39.67–392.63]), and systemic vasculitis (HD: ROR 28.40 [95% CI, 14.63–55.14]; SD: ROR 4.05 [1.52–10.82]). These results, based on FAERS, indicate associations rather than causal relationships. Further studies are needed to quantify the absolute risks and elucidate the mechanisms underlying differences in safety signals, if any. Full article

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26 pages, 17618 KB

Open AccessArticle

Foveated Retinotopy Improves Classification and Localization in Convolutional Neural Networks

by Jean-Nicolas Jérémie, Emmanuel Daucé and Laurent U. Perrinet

Vision 2026, 10(2), 17; https://doi.org/10.3390/vision10020017 - 30 Mar 2026

Abstract

From falcons spotting prey to humans recognizing faces, the ability to rapidly process visual information depends on a foveated retinal organization that provides high-acuity central vision while preserving low-resolution peripheral vision. This organization is conserved along early visual pathways, yet remains under-explored in [...] Read more.

From falcons spotting prey to humans recognizing faces, the ability to rapidly process visual information depends on a foveated retinal organization that provides high-acuity central vision while preserving low-resolution peripheral vision. This organization is conserved along early visual pathways, yet remains under-explored in machine learning. Here, we examine the impact of embedding a foveated retinotopic transformation as a preprocessing layer on convolutional neural networks (CNNs) for image classification. By applying a log-polar mapping to off-the-shelf models and retraining them, we achieve comparable accuracy while improving robustness to scale and rotation. We demonstrate that this architecture is highly sensitive to shifts in the fixation point and that this sensitivity provides an effective proxy for defining saliency maps that facilitate object localization. Our results demonstrate that foveated retinotopy encodes prior geometric knowledge, providing a solution for visual searches and a meaningful classification robustness and localization trade-off. These findings provides a proof of concept in order to connect principles of biological vision with artificial networks, suggesting new, robust and efficient approaches for computer vision systems. Full article

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14 pages, 2177 KB

Open AccessArticle

by Anait S. Khalatyan, Yusef Yusef, Khadishat K. Altemirova, Liubov V. Machekhina, Alexandra A. Melnitskaya and Irina D. Strazhesko

Vision 2026, 10(1), 16; https://doi.org/10.3390/vision10010016 - 3 Mar 2026

Abstract

Background: This research compared the relationship between foveal optical coherence tomography (OCT) parameters and two age measures—biological and chronological—in healthy adults. Methods: This cross-sectional study analyzed swept-source optical coherence tomography (OCT) data from 308 eyes of 154 healthy adults aged 22–89 years. Parameters [...] Read more.

Background: This research compared the relationship between foveal optical coherence tomography (OCT) parameters and two age measures—biological and chronological—in healthy adults. Methods: This cross-sectional study analyzed swept-source optical coherence tomography (OCT) data from 308 eyes of 154 healthy adults aged 22–89 years. Parameters assessed: foveal thickness, foveal pit depth and diameter, pit slope steepness, and the presence or absence of the foveal bulge. Biological age was calculated using the PhenoAge algorithm. Results: The core geometry of the foveal pit showed no significant dependence on either type of age (all p ≥ 0.66). In contrast, the foveal bulge prevalence declined significantly with age (adjusted p = 0.011 for chronological age, p = 0.005 for biological age; OR per year ≈0.95, 95% CI 0.92–0.98 for both age models). Model-predicted prevalence decreased from approximately 93% in younger adults to 60–68% in the 60–74-year-old group. Conclusion: The foveal architecture remains structurally stable throughout adulthood. The foveal bulge emerges as a sensitive qualitative marker of age-related changes. Biological age does not provide additional predictive value over chronological age for foveal structural parameters under physiological aging conditions. Full article

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13 pages, 1100 KB

Open AccessArticle

Real-World Comparison of Overall Survival Among Patients With and Without Inherited Retinal Diseases

by Byron L. Lam, Carlos E. Mendoza-Santiesteban, Dominic Pilon, Dejan Milentijevic, Laura Morrison, Samuel Schwartzbein, Claire Vanden Eynde, Marie-Hélène Lafeuille, Patrick Lefebvre and Ninel Z. Gregori

Vision 2026, 10(1), 15; https://doi.org/10.3390/vision10010015 - 1 Mar 2026

Cited by 1

Abstract

This study compared real-world overall survival and the risk of physical comorbidities and mental health conditions among patients aged <65 years with versus without inherited retinal diseases (IRDs) in the United States (US). Optum^® Electronic Health Record data (January 2014–January 2023) were [...] Read more.

This study compared real-world overall survival and the risk of physical comorbidities and mental health conditions among patients aged <65 years with versus without inherited retinal diseases (IRDs) in the United States (US). Optum^® Electronic Health Record data (January 2014–January 2023) were evaluated for IRD (patients with ≥2 medical visits with an IRD diagnosis; index date: second such medical visit) and non-IRD (patients without an IRD diagnosis; index date: random medical visit) cohorts. Baseline demographics were balanced between cohorts using propensity score matching (2:1). Outcome measures were overall survival (date of death due to any cause) and presence of physical comorbidities and mental health conditions (medical visit with a corresponding diagnosis code). In total, 4594 patients with IRD were matched to 9188 patients without IRD (mean age: 38.7 vs. 38.2 years, 53.9% vs. 55.1% female, mean follow-up: 53.1 vs. 52.8 months). Over 84 months, patients with versus without IRD had a 24% higher risk of death (overall survival: 95.8% vs. 96.7%; hazard ratio: 1.24; 95% confidence interval: 1.00–1.53; p = 0.046) and were at significantly higher risk for each evaluated physical comorbidity and mental health condition (all p < 0.05). The development of novel therapies is thus needed to address the clinical burden of IRD. Full article

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12 pages, 446 KB

Open AccessReview

Functional Visual Symptoms, Accommodative Dysfunction, and Visual Performance Alterations in Chronic Work-Related Stress: A Narrative Review

by Mariaelena Malvasi, Elena Pacella, Simone De Sio and Gian Piero Covelli

Vision 2026, 10(1), 14; https://doi.org/10.3390/vision10010014 - 19 Feb 2026

Abstract

Background: Chronic work-related stress, including exposure to mobbing, is associated with a wide range of psychological and somatic consequences. However, its potential impact on visual function, particularly in the absence of structural ocular damage, remains underexplored. This narrative review critically examines the evidence [...] Read more.

Background: Chronic work-related stress, including exposure to mobbing, is associated with a wide range of psychological and somatic consequences. However, its potential impact on visual function, particularly in the absence of structural ocular damage, remains underexplored. This narrative review critically examines the evidence linking chronic stress, autonomic nervous system (ANS) dysregulation, and functional visual disorders, focusing on accommodative function and asthenopia. Methods: A qualitative narrative review of the literature published between 2000 and 2025 was conducted using major biomedical databases. Studies addressing chronic stress, ANS activity, accommodative function, digital eye strain, and functional ocular symptoms were identified and integrated into a coherent pathophysiological framework. Results: The ocular system, being richly innervated by the ANS, may represent a peripheral target of prolonged stress-related autonomic alterations. Available evidence suggests that chronic stress is associated with asthenopia, accommodative inefficiency, and ocular discomfort even in the absence of overt ocular pathology. In particular, altered parasympathetic control of the ciliary muscle emerges as a plausible mediating mechanism. Conclusions: Functional visual disorders may represent peripheral manifestations of stress-related ANS dysregulation. Although causality cannot be established conclusively, the proposed framework supports the need for multidisciplinary research to clarify the clinical and medico-legal relevance of stress-related visual dysfunction. Full article

(This article belongs to the Special Issue Visual Discomfort: Perceptual, Neural, and Functional Perspectives)

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14 pages, 988 KB

Open AccessArticle

Associations Between Eye-Movement Patterns, Pupil Dynamics, and the Interpretation of a Single Mixed-Dentition Panoramic Radiograph Among Dental Students: An Exploratory Eye-Tracking Study

by Satoshi Tanaka, Hiroyuki Karibe, Yuichi Kato, Ayuko Okamoto and Tsuneo Sekimoto

Vision 2026, 10(1), 13; https://doi.org/10.3390/vision10010013 - 14 Feb 2026

Abstract

Eye tracking can provide quantitative indices of visual exploration and cognitive processing during radiographic image interpretation. This study examined eye-movement patterns and pupil dynamics and their associations with task performance while fifth-year dental students interpreted a single mixed-dentition panoramic radiograph under free-viewing conditions. [...] Read more.

Eye tracking can provide quantitative indices of visual exploration and cognitive processing during radiographic image interpretation. This study examined eye-movement patterns and pupil dynamics and their associations with task performance while fifth-year dental students interpreted a single mixed-dentition panoramic radiograph under free-viewing conditions. Task performance was defined as the number of correctly identified pre-specified items (three radiographic findings plus two interpretive items: dental age estimation and the presence/absence of congenital anomalies). Eye-movement patterns were classified into four groups: clockwise (R, 29.6%), counterclockwise (L, 44.4%), saccadic (S, 16.7%), and concentrated (C, 9.3%). Clockwise scan paths were associated with higher task scores and more globally distributed fixations than other patterns (p < 0.001). Linear mixed-effects modeling suggested that task scores increased up to 120 s of viewing time, whereas longer viewing times were not associated with further improvements. Furthermore, ordinal logistic regression analysis revealed that higher task scores were significantly associated with a smaller mean pupil area across the entire viewing time, combined with a larger pupil area specifically during fixations, suggesting more selective allocation of cognitive resources. These findings indicate associations between global scan structure, time allocation, pupil dynamics, and task performance in this single-image setting. Generalization to overall diagnostic competence or other radiographs requires replication using multiple panoramic images and a broader range of verified findings. Full article

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15 pages, 4056 KB

Open AccessArticle

Perimetry of the Central Visual Field Using a Head-Mounted Open-Source Perimeter in Patients with Inherited Retinal Diseases

by Cord Huchzermeyer, Friedrich Kruse and Jan Kremers

Vision 2026, 10(1), 12; https://doi.org/10.3390/vision10010012 - 14 Feb 2026

Abstract

Head-mounted (“virtual reality”) perimeters (HMPs), based on standard consumer electronic hardware, are a cheaper alternative to standard automated perimetry. They have not been validated in patients with inherited retinal disease (IRDs), yet. We evaluated the Iowa-HMP in a first pilot study. It consists [...] Read more.

Head-mounted (“virtual reality”) perimeters (HMPs), based on standard consumer electronic hardware, are a cheaper alternative to standard automated perimetry. They have not been validated in patients with inherited retinal disease (IRDs), yet. We evaluated the Iowa-HMP in a first pilot study. It consists of a legacy smartphone, a headset, and freely available, open-source software. We used the 10-2 grid, the ZEST algorithm, and a background of 10 cd/m² to measure central visual fields in one normal subject, and in patients with occult macular dystrophy (n = 2), Stargardt’s disease (n = 3) and retinitis pigmentosa (n = 6). Results were compared with those from an Octopus 900 perimeter. The typical patterns of visual field loss were clearly discernible, but head-mounted perimeters generally have a limited dynamic range. Within the dynamic range of the Iowa-HMP (14 to 30 dB Octopus sensitivity), the Limits of Agreement (Bland-Altman) were ±7.5 dB. The Iowa-HMP had a diagnostic sensitivity of 0.67 for detecting locations with low perimetric sensitivity (<14 dB in the Octopus perimetry) with a diagnostic specificity of 0.95. Although the Iowa-HMP cannot be directly compared to standard perimetry in IRDs, open software greatly facilitates research in this area. Full article

(This article belongs to the Section Retinal Function and Disease)

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15 pages, 371 KB

Open AccessArticle

Knowledge and Awareness of Myopia Among Parents and Teachers of Schoolchildren Aged 6–15 Years in Beirut, Lebanon

by Ameer Abou Adela, Vanessa R. Moodley and Yazan Gammoh

Vision 2026, 10(1), 11; https://doi.org/10.3390/vision10010011 - 12 Feb 2026

Abstract

Background: Using a cross-sectional design, this study assessed and compared myopia knowledge among parents and teachers of schoolchildren aged 6–15 years in Beirut, Lebanon. Methods: Two cross-sectional surveys were conducted between October 2022 and February 2024 among parents (n = 1256) and [...] Read more.

Background: Using a cross-sectional design, this study assessed and compared myopia knowledge among parents and teachers of schoolchildren aged 6–15 years in Beirut, Lebanon. Methods: Two cross-sectional surveys were conducted between October 2022 and February 2024 among parents (n = 1256) and teachers (n = 366) of children aged 6–15 years. Using validated online Google Form questionnaires, data were collected on demographics, awareness, risk factors, and myopia knowledge, and analyzed with Statistical Package for the Social Sciences version 28 (SPSS v28) through descriptive statistics and logistic regression. Results: Findings showed that 78.3% of parents and 79.5% of teachers had poor knowledge of myopia. Among teachers, better knowledge was linked to being male, having a family history of myopia, positive attitudes toward eyeglasses use, and attending regular or occasional eye care visits (all statistically significant). Among parents, higher knowledge was associated with having previously heard of myopia, higher income and education levels, and a family history of myopia, while parents of private-school children were less knowledgeable. Odds ratios below 1 indicate lower odds of good myopia knowledge relative to the reference category. Conclusions: Both groups showed inadequate knowledge, underscoring the urgent need for targeted educational interventions to improve myopia awareness and prevention. Full article

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13 pages, 731 KB

Open AccessArticle

Demographic Disparities in AI-Generated Versus Search-Engine-Sourced Images of Ophthalmologists: A Cross-Sectional Analysis

by Siddharth Gandhi, Katherine Jung, Michael Balas and Parnian Arjmand

Vision 2026, 10(1), 10; https://doi.org/10.3390/vision10010010 - 10 Feb 2026

Abstract

Purpose: To evaluate demographic representation in AI-generated and search-engine-sourced images of North American ophthalmologists, overall and stratified by subspecialty, and compare these with actual demographic data. Methods: This cross-sectional analysis examined 2000 images (1000 AI-generated and 1000 search-engine-sourced) across ten North [...] Read more.

Purpose: To evaluate demographic representation in AI-generated and search-engine-sourced images of North American ophthalmologists, overall and stratified by subspecialty, and compare these with actual demographic data. Methods: This cross-sectional analysis examined 2000 images (1000 AI-generated and 1000 search-engine-sourced) across ten North American ophthalmology subspecialties. Images were sourced from four AI platforms (DALL·E 3, Firefly, Midjourney, Grok-2) and four search engines (Google, Bing, DuckDuckGo, Yahoo!). Using a standardized framework, reviewers assessed gender, race, age group, and professional attire. Pearson chi-squared tests were used to compare image sets with actual demographic data from the Association of American Medical Colleges and Canadian Institute for Health Information. Results: AI-generated images depicted 69% men compared to 64% in search-engine-sourced images (p = 0.047), though both were lower than the actual proportion of male ophthalmologists in North America (71–73%, p < 0.001). White individuals were overrepresented in AI-generated images (81%) relative to both search-engine-sourced images (74%, p = 0.001) and actual demographic data (69%, p < 0.001). Younger individuals (under 50 years) were significantly overrepresented in both image sets, with 82% in AI-generated images and 73% in search-engine-sourced images, compared to only 45–46% in actual demographic data (p < 0.001 for both). AI-generated images also depicted ophthalmologists with significantly more stereotypical medical accessories, including stethoscopes (17% vs. 2%, p < 0.001), glasses (45% vs. 30%, p < 0.001), and white coats (68% vs. 53%, p < 0.001), compared to search-engine-sourced images. Conclusions: AI-generated images diverge from actual demographics, presenting a younger, more stereotypical workforce that paradoxically aligns closer to gender parity than reality. Full article

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17 pages, 685 KB

Open AccessReview

Applications of Large Language Models in Glaucoma: A Scoping Review

by Giovanni Rubegni, Alessandra Cartocci, Alessio Luschi, Niccolò Castellino, Francesco Cappellani, Dario Romano, Benedetta Colizzi, Luca Rossetti and Gian Marco Tosi

Vision 2026, 10(1), 9; https://doi.org/10.3390/vision10010009 - 9 Feb 2026

Abstract

Background: Large language models (LLMs) and vision-language models (VLMs) have recently been applied to ophthalmology for patient education, diagnosis, and surgical decision support. Their ability to generate, interpret, and synthesize medical information positions them as promising assistive tools in glaucoma care. This [...] Read more.

Background: Large language models (LLMs) and vision-language models (VLMs) have recently been applied to ophthalmology for patient education, diagnosis, and surgical decision support. Their ability to generate, interpret, and synthesize medical information positions them as promising assistive tools in glaucoma care. This scoping review aims to consolidate current evidence on the applications of LLMs and VLMSs in glaucoma, summarizing their tasks, inputs, performance metrics, and limitations to guide future clinical and research developments. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, arXiv, and IEEE Xplore from 2014 to July 2025. Eligible studies included original research and research letters employing LLMs or VLMs/MM-LLMs in any glaucoma-related application, including diagnostic reasoning, image interpretation, patient education, or surgical decision support. Screening and full-text review were independently performed by two reviewers following PRISMA-ScR methodology, with discrepancies resolved by consensus. Results: In total, 316 records were identified across five databases, with 27 studies meeting the inclusion criteria. The selected studies focused on three main domains: patient education (n = 11), diagnosis and risk prediction (n = 10), and surgical management (n = 6). Conclusions: Current LLMs serve best as assistive rather than autonomous tools in glaucoma care. They demonstrate strong potential in patient communication and text-based clinical decision support but remain constrained by variable accuracy, limited multimodal integration, and a lack of ophthalmology-specific fine-tuning. Future research should focus on developing domain-trained and retrieval-augmented LLMs, enhancing multimodal (text-image) fusion, ensuring readability adaptation for patients, and establishing ethical and regulatory frameworks for clinical implementation. Full article

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14 pages, 625 KB

Open AccessArticle

Perceived Transparency from Dynamic Luminance Modulation in Uniform Center–Surround Displays

by Soomin Kim and Sung-Ho Kim

Vision 2026, 10(1), 8; https://doi.org/10.3390/vision10010008 - 6 Feb 2026

Abstract

We report a novel phenomenon in which dynamic changes in luminance are perceived as changes in transparency rather than as changes in surface lightness. Participants viewed an achromatic disc on a uniform gray background and indicated whether the observed change was best described [...] Read more.

We report a novel phenomenon in which dynamic changes in luminance are perceived as changes in transparency rather than as changes in surface lightness. Participants viewed an achromatic disc on a uniform gray background and indicated whether the observed change was best described in terms of lightness or transparency. In Experiment 1, transparency-change responses were more frequent at low contrast and were strongly biased toward sequences in which contrast decreased over time, revealing a pronounced asymmetry between decreasing and increasing contrast trajectories. Experiment 2 introduced a size manipulation, such that the disc either expanded or contracted during the luminance modulation. Transparency-change responses were highest when contrast decreased and the disc expanded, indicating that spatial expansion further amplifies transparency-related interpretations of the disc’s surface appearance. Overall, the results reveal a systematic asymmetry in how contrast-change direction shapes visual appearance, consistent with a forward bias in the processing of continuously changing visual signals. When contrast dynamically approached the background level, perceptual representations appeared to be weighted toward the upcoming low-contrast state, enhancing impressions of increasing transparency. These findings demonstrate that even minimal displays lacking traditional geometric cues to transparency can evoke strong transparency impressions, driven by predictive weighting of spatiotemporal contrast trajectories rather than by static image properties alone. Full article

(This article belongs to the Section Visual Neuroscience)

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