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Vision

Vision is an international, peer-reviewed, open access journal on vision published quarterly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within ESCI (Web of Science), Scopus, PubMed, PMC, and other databases.
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 23.2 days after submission; acceptance to publication is undertaken in 3.7 days (median values for papers published in this journal in the first half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.

Impact Factor: 1.8 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2411-5150

Latest Articles

22 pages, 3021 KiB

Open AccessArticle

Uncovering the Characteristics of Pupil Cycle Time (PCT) in Neuropathies and Retinopathies

by Laure Trinquet, Suzon Ajasse, Frédéric Chavane, Richard Legras, Frédéric Matonti, José-Alain Sahel, Catherine Vignal-Clermont and Jean Lorenceau

Vision 2025, 9(3), 51; https://doi.org/10.3390/vision9030051 - 30 Jun 2025

Pupil cycle time (PCT) estimates the dynamics of a biofeedback loop established between pupil size and stimulus luminance, size or colour. The PCT is useful for probing the functional integrity of the retinopupillary circuits, and is therefore potentially applicable for assessing the effects [...] Read more.

Pupil cycle time (PCT) estimates the dynamics of a biofeedback loop established between pupil size and stimulus luminance, size or colour. The PCT is useful for probing the functional integrity of the retinopupillary circuits, and is therefore potentially applicable for assessing the effects of damage due to retinopathies or neuropathies. In previous studies, PCT was measured by manually counting the number of pupil oscillations during a fixed period to calculate the PCT. This method is scarce, requires a good expertise and cannot be used to estimate several PCT parameters, such as the oscillation amplitude or variability. We have developed a computerised setup based on eye-tracking that expands the possibilities of characterising PCT along several dimensions: oscillation frequency and regularity, amplitude and variability, which can be used with a large palette of stimuli (different colours, sizes, shapes or locations), and further allows measuring blinking frequency and eye movements. We used this method to characterise the PCT in young control participants as well as in patients with several pathologies, including age-related macular degeneration (AMD), diabetic retinopathy (DR), retinitis pigmentosa (RP), Stargardt disease (SD), and Leber hereditary optic neuropathy (LHON). We found that PCT is very regular and stable in young healthy participants, with little inter-individual variability. In contrast, several PCT features are altered in older healthy participants as well as in ocular diseases, including slower dynamics, irregular oscillations, and reduced oscillation amplitude. The distinction between patients and healthy participants based on the calculation of the area under the curve of the receiver operating characteristics (AUC of ROC) were dependent on the pathologies and stimuli (0.7 < AUC < 1). PCT nevertheless provides relevant complementary information to assess the physiopathology of ocular diseases and to probe the functioning of retino-pupillary circuits. Full article

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

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15 pages, 1264 KiB

Open AccessReview

State-Dependent Brain Stimulation for Visual Neurorehabilitation: Principles and Applications

by Kuzma Strelnikov and Juha Silvanto

Vision 2025, 9(3), 50; https://doi.org/10.3390/vision9030050 - 20 Jun 2025

The effects of Transcranial Magnetic Stimulation (TMS) depend on stimulation parameters such as intensity, location, frequency, and duration. In clinical practice, these parameters are often adapted from studies carried out in healthy individuals. However, in this narrative review, we indicate that the impact [...] Read more.

The effects of Transcranial Magnetic Stimulation (TMS) depend on stimulation parameters such as intensity, location, frequency, and duration. In clinical practice, these parameters are often adapted from studies carried out in healthy individuals. However, in this narrative review, we indicate that the impact of TMS is also highly state-dependent, meaning it is influenced by the excitability of the targeted brain region at the time of stimulation. This state-dependency complicates the translation of findings from healthy individuals to clinical populations, as neurological disorders often alter brain states, limiting the applicability of standard stimulation protocols. To address this challenge, stimulation parameters must be chosen within a framework that accounts for the interaction between external stimulation and the brain’s internal state. Such an approach enhances the specificity of interventions, allowing for targeted modulation of neural populations by manipulating brain states prior to stimulation. State-dependent TMS has shown promise in conditions like cortical blindness and amblyopia, where tailored approaches based on the brain state associated with the condition have facilitated more precise and effective treatments. We advocate that integrating state-dependent knowledge tailored to the specifics of visual disorders alongside judicious selection of stimulation parameters holds the potential to establish a comprehensive paradigm for future investigations. Full article

(This article belongs to the Section Visual Neuroscience)

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15 pages, 600 KiB

Open AccessArticle

A Comparison of All-Cause Mortality in Patients Who Required Glaucoma Surgery for Neovascular Glaucoma or Primary Open-Angle Glaucoma: A Retrospective Cohort Study

by Laura D. Palmer, Levi D. Kauffman, Gregory B. Russell, Atalie C. Thompson and Gillian G. Treadwell

Vision 2025, 9(2), 49; https://doi.org/10.3390/vision9020049 - 13 Jun 2025

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, [...] Read more.

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health. Full article

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19 pages, 1648 KiB

Open AccessArticle

Oculomotor-Related Measures Are Predictive of Reading Acquisition in First Grade Early Readers

by Avi Portnoy and Sharon Gilaie-Dotan

Vision 2025, 9(2), 48; https://doi.org/10.3390/vision9020048 - 4 Jun 2025

Some estimates suggest that one in seven good readers and the majority of children with reading difficulties suffer from oculomotor dysfunction (OMD), an umbrella term for abnormalities in comfortable and accurate fixations, pursuits, and saccades. However, national vision evaluation programs worldwide are often [...] Read more.

Some estimates suggest that one in seven good readers and the majority of children with reading difficulties suffer from oculomotor dysfunction (OMD), an umbrella term for abnormalities in comfortable and accurate fixations, pursuits, and saccades. However, national vision evaluation programs worldwide are often limited to distance visual acuity (dVA), not testing for OMD despite its high prevalence and the ease of detecting it in brief optometric evaluations. We hypothesized that reading acquisition is dependent on good oculomotor functions, and therefore inadequate oculomotor control will be associated with reading difficulties. We retrospectively examined and compared oculomotor evaluations (using DEM and NSUCO) and reading assessments (using standardized national reading norms) of a normative class (28 first graders (6–7 yr. olds)) that were independently obtained while blind to the other assessment. Better oculomotor performance as estimated by DEM was associated with better reading performance, and almost a third (29.6%) of the children were categorized by DEM as having OMD-related difficulties. Control analysis revealed dVA was not positively associated with reading performance. Linear regression analyses further corroborated these findings. Since this study is based on a small cohort and since there are studies suggesting that DEM may actually reflect visual processing speed or cognitive factors rather than oculomotor function, replications are needed to substantiate the direct contribution of oculomotor functions to reading acquisition. Young children struggling with reading may benefit from a comprehensive visual evaluation, including oculomotor testing, to provide a more thorough assessment of their learning-related difficulties. Full article

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25 pages, 14027 KiB

Open AccessReview

Revealing the Concealed in Monocular and Binocular Vision

by Nicholas J. Wade

Vision 2025, 9(2), 47; https://doi.org/10.3390/vision9020047 - 3 Jun 2025

Concealing images has been a concern of artists and scientists, as have the conditions that can reveal them. It is relatively easy to hide images in pictures, but this is of little value if they remain hidden. The skill is in revealing previously [...] Read more.

Concealing images has been a concern of artists and scientists, as have the conditions that can reveal them. It is relatively easy to hide images in pictures, but this is of little value if they remain hidden. The skill is in revealing previously concealed images. Three aspects of hiding images are examined, two of which are monocular and the third is binocular. Firstly, high-contrast patterns, like Street figures and Mooney faces, have been used in psychological tests of pattern recognition, and Gestalt grouping principles can result in concealing images. Second, it is possible to hide low spatial frequency content carried by high-spatial-frequency patterns. A wider range of carriers than gratings can be used, like graphics, photographs, and combinations of them (photo-graphics). Pictorial images can be concealed in terms of detection or recognition. In both cases, there is interplay between the global features of the concealed image and the local elements that carry it. Third, randomly textured stereograms reveal to two eyes what is concealed from each one alone—stereoscopic depth. The dimension of stereoscopic depth can be manipulated, as can that of binocular rivalry, to conceal images. Full article

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10 pages, 3422 KiB

Open AccessArticle

Predicted Visual Impact of a Small Aperture Intraocular Lens in Reducing Higher Order Aberrations in Post-Radial Keratotomy Patients

by Roberta M. van den Berg, Sarah DeVaro, Karolinne Maia Rocha, Marcela Fetrin de Barros and Stephen D. Klyce

Vision 2025, 9(2), 46; https://doi.org/10.3390/vision9020046 - 29 May 2025

The purpose of this study is to evaluate the potential impact of small aperture optics on corneal aberrations in post-RK patients. Preoperative data was evaluated from 32 eyes of 23 post-RK patients. Scheimpflug tomography was used to obtain measurements of corneal HOAs at [...] Read more.

The purpose of this study is to evaluate the potential impact of small aperture optics on corneal aberrations in post-RK patients. Preoperative data was evaluated from 32 eyes of 23 post-RK patients. Scheimpflug tomography was used to obtain measurements of corneal HOAs at 6-mm, 4-mm, and 2-mm corneal plane aperture diameters. The data was extrapolated using a non-linear fit to estimate HOAs that would be obtained with the 1.6 mm effective pinhole IOL aperture at the corneal plane for individual patients. The average RMS HOAs estimated for the 1.6 mm aperture was 0.063 ± 0.015 μm compared to 0.185 ± 0.029 μm for the natural pupil size. A postoperative RK case with an IC-8^® Apthera™ unilateral implantation demonstrated a 70% reduction in HOAs by objective measurement and prediction, plus a 2-line improvement in CDVA. Prediction modeling revealed that HOAs may be reduced in post-RK patients following pinhole IOL implantation, compared to the natural photopic pupil size. Furthermore, the approach can be used to guide which post-RK patients would benefit from a small aperture IOL during cataract surgery. Full article

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8 pages, 821 KiB

Open AccessArticle

Anatomical and Functional Outcomes of Human-Amniotic Membrane Graft in Refractory Macular Hole Cases

by Soefiandi Soedarman, Sandi Muslim, Waldensius Girsang, Elvioza, Referano Agustiawan, Alberthus Donni Budi Prasetya and Ichsan Fauzi Triyoga

Vision 2025, 9(2), 45; https://doi.org/10.3390/vision9020045 - 22 May 2025

Macular hole (MH) surgery generally has a high success rate, but finding anatomical plug for refractory cases remains challenging. The human amniotic membrane (hAM), with its anti-inflammatory and regenerative properties, has emerged as a potential option. This study aims to report the anatomical [...] Read more.

Macular hole (MH) surgery generally has a high success rate, but finding anatomical plug for refractory cases remains challenging. The human amniotic membrane (hAM), with its anti-inflammatory and regenerative properties, has emerged as a potential option. This study aims to report the anatomical and functional outcomes of human amniotic membrane (hAM) graft as an intervention to repair refractory macular hole cases where wide internal limiting membrane (ILM) peeling was unsuccessful. A retrospective chart review was conducted at a single center, with the main outcomes being closure rate and postoperative BCVA at 6 months. Eleven eyes of 11 patients with refractory macular holes were identified and included in the study. Participants were predominantly males (72.73%) with a mean age of 49.27 years. Nine eyes achieved successful MH closure with a single intervention and showed no recurrence during the 6-month follow-up. Mean BCVA at 3 and 6 months improved significantly (p = 0.0207) from 1.747 ± 0.74 logMAR to 1.210 ± 0.51 logMAR and 0.939 ± 0.47 logMAR (range 2.079–0.301 logMAR). The use of human amniotic membrane (hAM) graft seems to be a viable and effective alternative for the treatment of refractory macular holes. However, further larger prospective controlled studies are necessary to confirm our results. Full article

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23 pages, 4658 KiB

Open AccessReview

Ocular and General Proprioception in Dyslexic Children: A Review of Their Diurnal and Nocturnal Dysfunctions and Their Repercussions

by Patrick Quercia, Kalvin Chavet and Jérémie Gaveau

Vision 2025, 9(2), 44; https://doi.org/10.3390/vision9020044 - 20 May 2025

We provide a summary of the research conducted in our laboratory on the relationship between ocular proprioception, general proprioception, and dyslexia. Dyslexic children show a marked proprioceptive deficit which affects motor control, attention and spatial perception. The spatial disturbances are expressed by the [...] Read more.

We provide a summary of the research conducted in our laboratory on the relationship between ocular proprioception, general proprioception, and dyslexia. Dyslexic children show a marked proprioceptive deficit which affects motor control, attention and spatial perception. The spatial disturbances are expressed by the presence of a vertical microheterophoria which has very specific characteristics. It is associated with abnormal tone of the oblique muscles and can be modified by means of very low powered prisms and/or remote sensory stimulation. When ocular proprioception is modified, sounds cause stochastic visual losses. This may interfere with the association between phonemes and graphemes, which is necessary for learning to read. The effects of a generalized nocturnal proprioceptive disorder may play a role in the abnormal brain development that has been observed in dyslexic children. Full article

(This article belongs to the Section Visual Neuroscience)

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17 pages, 2749 KiB

Open AccessArticle

Perception and Decision-Making in Virtual Telepsychology Spaces and Professionals

by Luis-Lucio Lobato Rincón, Maria Ángeles Medina Sánchez and Rubén Tovar Bordón

Vision 2025, 9(2), 43; https://doi.org/10.3390/vision9020043 - 6 May 2025

Humans interact with virtual environments for a variety of purposes, and the use of telemedicine services and e-health platforms has become increasingly significant in recent years. Telepsychology is an emerging service and is understood as the provision of psychological aid and counseling through [...] Read more.

Humans interact with virtual environments for a variety of purposes, and the use of telemedicine services and e-health platforms has become increasingly significant in recent years. Telepsychology is an emerging service and is understood as the provision of psychological aid and counseling through the use of telecommunication technologies. This study investigates the impact of visual backgrounds in a mental health simulation app and explores the decision-making of potential patients for telepsychology. In this experimental study, we developed an instrument to assess the preferences for manipulated features of photomontages and portraits. A total of 310 participants from diverse backgrounds were surveyed about their preferences regarding visual backgrounds and silhouettes for this hypothetical service, with key independent variables such as complexity, naturalness, and color hues being manipulated. Our findings represent the first example of data collected on background preferences in telepsychology. The results suggest a preference for backgrounds with medium complexity and naturalness for clinical settings. Additionally, we observed variations in preferences based on gender and age. These findings highlight the importance of customizing visual elements to enhance patient engagement in telepsychology. Full article

(This article belongs to the Section Visual Neuroscience)

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13 pages, 3709 KiB

Open AccessSystematic Review

Latin American Prevalence of Glaucoma: A Systematic Review and Meta-Analysis

by Denisse J. Mora-Paez, Jaime Guedes, Dillan Cunha Amaral, Marcelo Alves Ferreira, Bruno F. Fernandes, Sacha F. Pereira, Bruno Botton, Alisha Desai, Helena Messinger Pakter, Fabio Lavinsky and Adroaldo Alencar Costa Filho

Vision 2025, 9(2), 42; https://doi.org/10.3390/vision9020042 - 5 May 2025

We conducted a systematic review and meta-analysis to estimate the prevalence of all types of glaucoma in Latin America (LATAM) and evaluate potential demographic associations. This study followed PRISMA guidelines and was registered in PROSPERO (CRD42024506330). A comprehensive search of PubMed, SciELO, and [...] Read more.

We conducted a systematic review and meta-analysis to estimate the prevalence of all types of glaucoma in Latin America (LATAM) and evaluate potential demographic associations. This study followed PRISMA guidelines and was registered in PROSPERO (CRD42024506330). A comprehensive search of PubMed, SciELO, and Web of Science was conducted to identify population-based or cross-sectional studies reporting glaucoma prevalence in LATAM. Studies were categorized into two groups: Group 1 included general population studies without selection based on visual acuity (VA), and Group 2 included studies limited to individuals with VA < 20/60. Data from five studies in Group 1 (25,288 individuals) and eight studies in Group 2 (29,882 individuals) were analyzed using R software. The pooled prevalence of glaucoma was 4% (95% CI: 1–3%) in Group 1 and 1% (95% CI: 0–1%) in Group 2. No statistically significant associations were found between glaucoma prevalence and sex (p = 0.08) or age (p = 0.5669). Although our findings highlight the relevance of glaucoma as a public health concern in LATAM, the limited number of available studies and methodological variability reduce the certainty of the estimates. Full article

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14 pages, 534 KiB

Open AccessArticle

The Influence of the Level of Monovision upon Early Outcomes Following the Bilateral Implantation of an Enhanced Monovision Intraocular Lens

by Richard N. McNeely, Stephen Stewart, Niraj Mandal, Salissou Moutari, Allon Barsam and Jonathan E. Moore

Vision 2025, 9(2), 41; https://doi.org/10.3390/vision9020041 - 3 May 2025

This article provides an assessment of the impact of different levels of monovision upon early visual outcomes and quality of vision (QoV) following the bilateral implantation of enhanced monovision intraocular lenses (IOLs). Consecutive patients implanted bilaterally with the Rayone EMV (Rayner) were recruited. [...] Read more.

This article provides an assessment of the impact of different levels of monovision upon early visual outcomes and quality of vision (QoV) following the bilateral implantation of enhanced monovision intraocular lenses (IOLs). Consecutive patients implanted bilaterally with the Rayone EMV (Rayner) were recruited. The dominant eye was targeted for emmetropia, and myopia was targeted in the nondominant eye. Patients were categorized based upon the postoperative refractive outcome in the nondominant eye as follows: Group A: −0.50 to −1.0 D (n = 40), Group B: <−1.00 = D (n = 46). Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, and QoV were compared 3 months postoperatively. Binocular UIVA was 0.05 ± 0.10 and −0.01 ± 0.11logMAR (p = 0.03) in the two respective groups, and binocular UNVA was 0.23 ± 0.09 and 0.14 ± 0.09logMAR (p < 0.001). Day QoV was 8.77 ± 1.33 and 8.13 ± 1.34 for night QoV in group A, and 8.85 ± 0.99 and 7.85 ± 1.35, respectively, in group B. Group A had a lower spectacle independence rate of 55% compared to 89.1%. This IOL provides a satisfactory range of vision with high QoV satisfaction. A postoperative refractive error of −1.0 D or more in the nondominant eye significantly improves binocular UIVA, UNVA, and spectacle independence, without negatively impacting QoV. Full article

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8 pages, 180 KiB

Open AccessArticle

The Association Between Sensory Impairment and Adherence to COVID-19 Prevention Measures in the Adult California Health Interview Survey Population

by Catherine T. Cascavita, Ahmad Santina, Ken Kitayama, Fei Yu, Victoria L. Tseng and Anne L. Coleman

Vision 2025, 9(2), 40; https://doi.org/10.3390/vision9020040 - 2 May 2025

This study explores the association between vision/hearing impairment and COVID-19 prevention strategies in the 2020 and 2021 California Health Interview Survey (CHIS). This cross-sectional study used data from the 2020 and 2021 CHIS. The exposure of interest was self-reported history of sensory impairment. [...] Read more.

This study explores the association between vision/hearing impairment and COVID-19 prevention strategies in the 2020 and 2021 California Health Interview Survey (CHIS). This cross-sectional study used data from the 2020 and 2021 CHIS. The exposure of interest was self-reported history of sensory impairment. The outcome of interest was adherence to COVID-19 mitigation strategies defined as obtaining a COVID-19 vaccine, face mask adherence, hand washing, social distancing, and not gathering with non-household members. Logistic regression models examined the association between sensory impairment and adherence to COVID-19 mitigation strategies, controlling for age, sex, race and ethnicity, general health status, and household income. All analyses were weighted according to the CHIS sampling design. With 24,453 California adults representing 29,649,837 people, the weighted prevalence of sensory impairment was 6.1% (1,808,640/29,649,837). The regression revealed that adults with sensory impairment were 80% more likely not to maintain social distancing (odds ratio: 1.80, 95%CI: 1.03–3.13, p = 0.04) compared to those without impairment. No significant differences were found for adherence to other COVID-19 strategies. Individuals with sensory impairment may have increased difficulty with physical distancing due to their underlying impairment. Further studies are needed to explore risk reduction strategies for COVID-19 and the transmission of other infections for those with sensory impairment. Full article

19 pages, 3446 KiB

Open AccessArticle

Training Improves Avoidance of Natural Sick Faces: Changes in Visual Attention and Approach Decisions

by Tiffany S. Leung, Krisztina V. Jakobsen, Sarah E. Maylott, Arushi Malik, Shuo Zhang and Elizabeth A. Simpson

Vision 2025, 9(2), 39; https://doi.org/10.3390/vision9020039 - 2 May 2025

Cited by 1

Humans evolved a behavioral immune system to avoid infectious disease, including the ability to detect sickness in faces. However, it is unclear whether the ability to recognize and avoid facial cues of disease is malleable, flexibly calibrated by experience. Thus, we experimentally tested [...] Read more.

Humans evolved a behavioral immune system to avoid infectious disease, including the ability to detect sickness in faces. However, it is unclear whether the ability to recognize and avoid facial cues of disease is malleable, flexibly calibrated by experience. Thus, we experimentally tested whether we can improve adults’ (N = 133) lassitude (sick) face perception, measuring their recognition, avoidance, and visual attention to naturally sick and healthy faces. Participants randomly assigned to a training about disease, but not a control group, were better at avoiding sick people. The disease-trained group also looked more equally between sick and healthy faces when identifying who was sick compared to the control group who looked longer at the sick faces than the healthy faces. Though we detected no group differences in time looking at the eyes and at the mouths, the disease-trained group used these features more to decide who was sick, reflecting key features of the lassitude expression. Our findings suggest that facial sickness perception may be flexible, influenced by experience, and underscore the need for future studies to test how to further strengthen this skill. Ultimately, developing interventions that use this sick face plasticity may reduce disease transmission. Full article

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10 pages, 2293 KiB

Open AccessArticle

Short-Wavelength and Infrared Autofluorescence Imaging in Pachychoroid Neovasculopathy

by Norihiko Nakagawa, Takuya Shunto, Issei Nishiyama, Kohei Maruyama and Miki Sawa

Vision 2025, 9(2), 38; https://doi.org/10.3390/vision9020038 - 21 Apr 2025

Purpose: The purpose of this paper is to investigate the relationship between short-wavelength autofluorescence (SWAF) and infrared autofluorescence (IRAF) patterns in pachychoroid neovasculopathy (PNV) with serous retinal detachment (SRD). Methods: This study used an observational case series of 62 eyes of 58 consecutive [...] Read more.

Purpose: The purpose of this paper is to investigate the relationship between short-wavelength autofluorescence (SWAF) and infrared autofluorescence (IRAF) patterns in pachychoroid neovasculopathy (PNV) with serous retinal detachment (SRD). Methods: This study used an observational case series of 62 eyes of 58 consecutive patients diagnosed with symptomatic PNV from January 2019 and October 2021 at a single institution. SWAF and IRAF patterns were analyzed with disease chronicity, and autofluorescence changes in macular neovascularization (MNV) were assessed in two images. Results: SWAF patterns and the mean duration of symptoms were as follows: blocked (15 eyes, 24%), 1.0 months; mottled (8 eyes, 13%), 2.8 months; hyper (24 eyes, 39%), 5.0 months; hyper/hypo (10 eyes, 16%), 7.0 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). IRAF patterns and the mean duration of symptoms were as follows: blocked (17 eyes, 27%), 1.0 months; hyper (22 eyes, 35%), 4.0 months; mixed/hyper dominant (9 eyes, 15%), 5.0 months; mixed/hypo dominant (9 eyes, 15%), 6.8 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). Abnormal autofluorescence corresponding to MNV lesion was seen in 34 eyes (55%) with SWAF and 59 eyes (95%) with IRAF (p < 0.01). Conclusions: SWAF and IRAF show multiple patterns and are related to disease chronicity in symptomatic PNV. IRAF could be helpful in detecting the lesion of MNV. Full article

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

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17 pages, 2799 KiB

Open AccessArticle

The Phenomenology of Offline Perception: Multisensory Profiles of Voluntary Mental Imagery and Dream Imagery

by Maren Bilzer and Merlin Monzel

Vision 2025, 9(2), 37; https://doi.org/10.3390/vision9020037 - 21 Apr 2025

Both voluntary mental imagery and dream imagery involve multisensory representations without externally present stimuli that can be categorized as offline perceptions. Due to common mechanisms, correlations between multisensory dream imagery profiles and multisensory voluntary mental imagery profiles were hypothesized. In a sample of [...] Read more.

Both voluntary mental imagery and dream imagery involve multisensory representations without externally present stimuli that can be categorized as offline perceptions. Due to common mechanisms, correlations between multisensory dream imagery profiles and multisensory voluntary mental imagery profiles were hypothesized. In a sample of 226 participants, correlations within the respective state of consciousness were significantly bigger than across, favouring two distinct networks. However, the association between the vividness of voluntary mental imagery and vividness of dream imagery was moderated by the frequency of dream recall and lucid dreaming, suggesting that both networks become increasingly similar when higher metacognition is involved. Additionally, the vividness of emotional and visual imagery was significantly higher for dream imagery than for voluntary mental imagery, reflecting the immersive nature of dreams and the continuity of visual dominance while being awake and asleep. In contrast, the vividness of auditory, olfactory, gustatory, and tactile imagery was higher for voluntary mental imagery, probably due to higher cognitive control while being awake. Most results were replicated four weeks later, weakening the notion of state influences. Overall, our results indicate similarities between dream imagery and voluntary mental imagery that justify a common classification as offline perception, but also highlight important differences. Full article

(This article belongs to the Special Issue Visual Mental Imagery System: How We Image the World)

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14 pages, 542 KiB

Open AccessArticle

The Relationship Between Anxiety Sensitivity, Emotional States, and Dry Eye Disease Symptom Severity: A Cross-Sectional Study

by Marko Toth, Nataša Jokić-Begić and Sandro Krašić

Vision 2025, 9(2), 36; https://doi.org/10.3390/vision9020036 - 18 Apr 2025

Dry eye disease (DED) is often comorbid with psychiatric conditions and psychological disturbances like anxiety and depression. The psychological symptoms are mostly considered to be a consequence of DED or a side-effect of medication. However, the possible psychological etiology of DED is seldom [...] Read more.

Dry eye disease (DED) is often comorbid with psychiatric conditions and psychological disturbances like anxiety and depression. The psychological symptoms are mostly considered to be a consequence of DED or a side-effect of medication. However, the possible psychological etiology of DED is seldom explored. This study explores the relationship between anxiety sensitivity (AS), unpleasant emotional states, and the severity of DED symptoms in a healthy general population sample in Croatia. A total of 766 adults (62.27% females) aged between 18 and 88 years completed an online survey consisting of the Ocular Surface Disease Index (OSDI), Anxiety Sensitivity Index (ASI), and Depression Anxiety Stress Scales (DASS21) together with socio-demographic data. The results revealed significant positive correlations between ASI, emotional states, and OSDI (r = 0.25–0.29, p < 0.01). Mediation analysis showed that DASS21 significantly mediates the relationship between ASI and OSDI (B = 0.1, CI = [0.004, 0.2]). Highly anxiety sensitive people are more sensitive to DED symptoms, which additionally increases in a state of emotional stress. Thus, DED symptoms are perceived more intensely and frequently than in less sensitive people. Understanding these associations is crucial for comprehensive DED management, indicating potential benefits from addressing psychological health in DED patients and eye health in psychiatric patients. Full article

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18 pages, 755 KiB

Open AccessReview

Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration

by Deokho Lee, Soo Jin Kim and Junyeop Lee

Vision 2025, 9(2), 35; https://doi.org/10.3390/vision9020035 - 17 Apr 2025

Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular [...] Read more.

Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). To date, anti-vascular endothelial growth factor (VEGF) treatment has been widely used to manage neovascular diseases associated with retinal ischemia. Nonetheless, a substantial number of patients with DR or AMD still suffer from incomplete response and adverse effects related to its therapy with limitations. Therefore, research scientists have been developing and finding novel treatments to protect against or prevent vision loss in those diseases. In this review article, we summarize the recent novel therapeutic approaches for the treatment of ischemic retinopathy (e.g., cell therapy, advanced molecular targeting, or drug delivery). This summary enables further research to obtain more solid evidence of novel effective drug development in retinal ischemic diseases. Full article

(This article belongs to the Special Issue Retinal and Optic Nerve Diseases: New Advances and Current Challenges)

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26 pages, 3351 KiB

Open AccessArticle

Reconciling the Neurophysiological and Cognitive Theories of Stimulus–Response Spatial Compatibility Effects: A Visual–Motor Dissociation Approach

by Elton H. Matsushima and Jose Antonio Aznar-Casanova

Vision 2025, 9(2), 34; https://doi.org/10.3390/vision9020034 - 17 Apr 2025

This study investigated the differential impact of two visual dimensions (direction and spatial location) in two spatial Stroop tasks, where the relevant dimension for the response varied. Three studies compared the interactions between spatial compatibility and congruence effects on reaction time performances to [...] Read more.

This study investigated the differential impact of two visual dimensions (direction and spatial location) in two spatial Stroop tasks, where the relevant dimension for the response varied. Three studies compared the interactions between spatial compatibility and congruence effects on reaction time performances to infer how the dorsal pathway (DP) and ventral pathway (VP) of visual processing interfered with one another in processing relevant and irrelevant spatial information. This allowed us to bridge neurophysiological mechanisms with dual-process models of spatial compatibility. The participants responded from an avatar’s perspective, manipulated through rotations relative to the forward position, along with independent rotations of the avatar’s screen and keyboard. The results revealed two distinct response patterns: in the Direction Stroop, the performance was influenced equally by the relevant direction (VP) and the automatic processing of irrelevant location (DP); in the Location Stroop, the VP exerted minimal interference on the DP. Furthermore, the Only Keyboard rotation disrupted hand–eye coordination, modulating the DP interference on the VP in the Direction Stroop. These findings provide insights into the functional interaction of these visual pathways and their contributions to spatial compatibility effects, along with evidence for the dual-process model of spatial compatibility. Some issues about the separation of visual pathways are discussed based on our results. Full article

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11 pages, 1764 KiB

Open AccessArticle

Coherent Interpretation of Entire Visual Field Test Reports Using a Multimodal Large Language Model (ChatGPT)

by Jeremy C. K. Tan

Vision 2025, 9(2), 33; https://doi.org/10.3390/vision9020033 - 11 Apr 2025

This study assesses the accuracy and consistency of a commercially available large language model (LLM) in extracting and interpreting sensitivity and reliability data from entire visual field (VF) test reports for the evaluation of glaucomatous defects. Single-page anonymised VF test reports from 60 [...] Read more.

This study assesses the accuracy and consistency of a commercially available large language model (LLM) in extracting and interpreting sensitivity and reliability data from entire visual field (VF) test reports for the evaluation of glaucomatous defects. Single-page anonymised VF test reports from 60 eyes of 60 subjects were analysed by an LLM (ChatGPT 4o) across four domains—test reliability, defect type, defect severity and overall diagnosis. The main outcome measures were accuracy of data extraction, interpretation of glaucomatous field defects and diagnostic classification. The LLM displayed 100% accuracy in the extraction of global sensitivity and reliability metrics and in classifying test reliability. It also demonstrated high accuracy (96.7%) in diagnosing whether the VF defect was consistent with a healthy, suspect or glaucomatous eye. The accuracy in correctly defining the type of defect was moderate (73.3%), which only partially improved when provided with a more defined region of interest. The causes of incorrect defect type were mostly attributed to the wrong location, particularly confusing the superior and inferior hemifields. Numerical/text-based data extraction and interpretation was overall notably superior to image-based interpretation of VF defects. This study demonstrates the potential and also limitations of multimodal LLMs in processing multimodal medical investigation data such as VF reports. Full article

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15 pages, 3569 KiB

Open AccessArticle

Cup and Disc Segmentation in Smartphone Handheld Ophthalmoscope Images with a Composite Backbone and Double Decoder Architecture

by Thiago Paiva Freire, Geraldo Braz Júnior, João Dallyson Sousa de Almeida and José Ribamar Durand Rodrigues Junior

Vision 2025, 9(2), 32; https://doi.org/10.3390/vision9020032 - 11 Apr 2025

Glaucoma is a visual disease that affects millions of people, and early diagnosis can prevent total blindness. One way to diagnose the disease is through fundus image examination, which analyzes the optic disc and cup structures. However, screening programs in primary care are [...] Read more.

Glaucoma is a visual disease that affects millions of people, and early diagnosis can prevent total blindness. One way to diagnose the disease is through fundus image examination, which analyzes the optic disc and cup structures. However, screening programs in primary care are costly and unfeasible. Neural network models have been used to segment optic nerve structures, assisting physicians in this task and reducing fatigue. This work presents a methodology to enhance morphological biomarkers of the optic disc and cup in images obtained by a smartphone coupled to an ophthalmoscope through a deep neural network, which combines two backbones and a dual decoder approach to improve the segmentation of these structures, as well as a new way to combine the loss weights in the training process. The models obtained were numerically evaluated through Dice and IoU measures. The dice values obtained in the experiments reached a Dice of 95.92% and 85.30% for the optical disc and cup and an IoU of 92.22% and 75.68% for the optical disc and cup, respectively, in the BrG dataset. These findings indicate promising architectures in the fundus image segmentation task. Full article

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

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Special Issue in Vision

Effects of Optical and Behavioral Factors on the Ocular Accommodation Response Guest Editors: Beatriz Redondo Cabrera, Niall Hynes
Deadline: 31 July 2025

Special Issue in Vision

Light-Induced Retinal Injury Guest Editor: Malgorzata Rozanowska
Deadline: 31 October 2025

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Retinal and Optic Nerve Diseases: New Advances and Current Challenges Guest Editor: Livio Vitiello
Deadline: 31 December 2025

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