Vision

Limbal dermoids are congenital, benign, choristomatous growths affecting the corneal-limbal junction. Conventional excision techniques often result in persistent epithelial defects, corneal thinning, and vascularization due to sectoral limbal stem cell deficiency. This study investigated a novel surgical approach for limbal dermoid excision, utilizing Bowman’s membrane lenticule and autologous limbal stem cell transplantation, aimed at improving epithelial healing and visual outcomes. Thirty-four subjects (24 females, 10 males; mean age 8.33 ± 6.47 years) with limbal dermoids underwent the procedure. After dermoid excision, a Bowman’s membrane lenticule was placed over the defect and tucked 1 mm beneath the surrounding tissue. Sectoral limbal reconstruction was then performed using the AutoSLET technique. Pre- and postoperative assessments included visual acuity, corneal thickness, and epithelialization time. Statistical analysis employed paired t-tests. The mean epithelialization time was 3.36 ± 0.74 weeks, indicating rapid healing. Best-corrected visual acuity (BCVA) significantly improved from a preoperative mean of 0.136 ± 0.121 decimal units to a postoperative mean of 0.336 ± 0.214 decimal units (p < 0.001). Corneal thickness also demonstrated a significant increase, rising from a preoperative mean of 294 ± 49.68 microns to a postoperative mean of 484 ± 5.037 microns (p < 0.001). There is a transient edema below the Bowman lenticule observed in many cases, which resolves with deposition of granulation tissue. The findings suggest that the combined use of Bowman’s membrane lenticule and autologous limbal stem cell transplantation offers a promising surgical strategy for limbal dermoid excision. This technique promotes rapid epithelialization and leads to significant improvements in visual acuity and corneal thickness compared to conventional methods. The utilization of Bowman’s membrane as a natural basement membrane and the direct application of limbal stem cells facilitate enhanced epithelial healing and visual rehabilitation. While the study is limited by its small sample size, the results demonstrate the potential of this novel approach in managing limbal dermoids effectively. Full article

Introduction: Visual impairment impacts millions of people around the world, with the vast majority of problems being treatable. Disadvantaged communities are unable to utilize the same resources to treat these problems due to a lack of knowledge or resources, in addition to the presence of barriers preventing access. The objective of this paper is to assess eye health awareness and evaluate the barriers for individuals from disadvantaged communities in order to inform future interventions and increase access to care. Methods: This is a pilot study utilizing an online anonymous questionnaire designed to assess the demographics, eye health awareness, and access to eye care of community-based patients. A comprehensive literature review was also conducted using PubMed, Scopus, and Google Scholar to evaluate barriers to eye care and methods to improve community health outcomes. The primary goal was to improve understanding of eye health awareness and access in order to inform future strategies that can help in improving eye health awareness and service availability. Results: The results indicated that 61.2% of respondents believed that eye exams are very important, and only 7.7% of participants believed that regular eye exams are not important. The majority of participants (75%) agree that regular eye exams help prevent serious eye conditions and 84.5% believe that eye health can affect quality of life. 35.6% of participants reported they had their eyes checked by a healthcare professional within the last year, while 21.2% reported never having an eye exam. Although the majority of participants found access to eye care services in their community somewhat or very easy, 8.6% and 9.5% of participants found access difficult and very difficult, respectively. Even though 45.6% of participants reported not facing any barriers regarding access to eye care, the cost of services, long waiting times, and lack of nearby eye care providers were often cited as barriers from the remainder of the participants. Moving forward, local interventions such as mobile eye clinics, public health workshops, and telehealth are viable options to obtain an understanding of the community’s health status in addition to creating opportunities to educate and provide health screenings. Conclusion: The results indicate that although there is awareness of the importance of eye health for the majority of participants, there is still a sizable minority who have insufficient understanding. Barriers to healthcare such as cost, waiting times, and proximity to providers are common problems that are preventing many from seeking eye care. Future interventions should be created to increase access and literacy amongst the community through telehealth, mobile eye clinics, and public health workshops. Additional efforts should be taken by healthcare stakeholders to enhance care delivery, implement policies, and improve awareness. Full article

Dry eye disease (DED) is a hallmark of primary Sjögren’s disease (SjD) and often resists conventional treatments like lubricant eye drops. Insulin nanoemulsions offer a potential solution by improving drug penetration and retention on the ocular surface. In animal models, insulin has shown benefits in promoting tear secretion and corneal healing. This study evaluated the safety and efficacy of insulin nanoemulsion eye drops (20 IU/mL, three times daily for 30 days) in patients with SjD. Thirty-two patients were randomized in a double-masked design to receive either insulin or placebo drops. Symptoms (assessed by OSDI questionnaire) and objective measures (tear film breakup time, corneal and conjunctival staining, and Schirmer Test) were recorded at baseline, after 4 weeks of treatment, and at a 4-week follow-up. Twenty-three participants completed the study. Both groups showed significant improvement in symptoms and objective signs after treatment (p < 0.05), but no significant differences were found between the insulin and placebo groups. No clinically relevant adverse effects were reported. Insulin nanoemulsion eye drops are safe for SjD patients, but their therapeutic advantage remains unclear. Further studies with larger samples, extended follow-up, and dose adjustments are needed to better understand their potential. Full article

Reports of individual differences in vividness of visual mental imagery (VMI) scores raise complex questions: Are Vividness of Visual Imagery Questionnaire (VVIQ) score differences actually measuring anything? What functions do these differences serve? What is their neurological foundation? A new analysis examined visual short-term memory (VSTM) and volumes of the hippocampi, primary visual cortices, and other cortical regions among vivid and non-vivid visual imagers. In a sample of 53 volunteers aged 54 to 80 with MRI scans, the performance of ten Low VVIQ scorers was compared to that of ten High VVIQ scorers. The groups included an aphantasic with a minimum VVIQ score and a hyperphantasic with a maximum VVIQ score. The study examined volumes for 12 hippocampal subfields, 11 fields implicated in visual mental imagery including area V1 and the fusiform gyrus, and 7 motor regions. In comparison to the Low VVIQ group, High VVIQ group yielded: (i) significantly more accurate VSTM performance; and (ii) significantly larger volumes of the hippocampi and primary visual cortex. Across 47 brain regions, the average volume for the High VVIQ group exceeded that of the Low VVIQ group by 11 percent. For 47 subfields, the volumes of the hphantasic exceeded those of the aphantasic person by an average of 57 percent. Females had more accurate visual short-term memory than males and younger people were more accurate than older people. The larger visual memory capacity of females was unmatched by larger regional volume differences, which suggests that the sex difference in visual memory is caused by factors other than cortical regional size. The study confirms the existence of robust empirical associations between VMI vividness, short-term memory, regional volume of hippocampal subfields and area V1. Full article

Evidence based practice enhances healthcare delivery and prevents unsafe procedures. While competency based assessments of resident cataract surgery are standard, evidence based analysis of refractive outcomes remains underutilized in educational curricula. This retrospective single center study evaluated refractive outcomes from 21 novice ophthalmology resident surgeons. Three independent groups were compared based on formal constant optimization for intraocular lens (IOL) calculation: non-optimized Haigis (n = 216), a0-optimized (n = 94), and a0/a1/a2-optimized (n = 121). All surgeries were supervised by a single attending surgeon. Mean absolute error (MAE) and the percentage of eyes within ±0.25 D and ±0.50 D of predicted spherical equivalent (SEQ) were calculated. Also, systematic bias in effective lens position (ELP) was analyzed to update manufacturer IOL constants. MAE improved from 0.44 D (non-optimized) to 0.35 D (a0-optimized p = 0.009) and 0.19 D (a0/a1/a2-optimized p < 0.001). The percentage within ±0.50 D increased from 65.7% to 74.4% to 95.0%, respectively. With ELP bias correction, updated A constant and ACD were 119.266 and 5.755 mm. a0/a1/a2-optimized outcomes were comparable to ELP bias correction for the Barrett UII, Kane, and Hill-RBF formulas. Evidence based optimization of IOL constants significantly enhances novice resident surgical outcomes, achieving parity with prediction models. A formal curriculum on IOL calculation and optimization is warranted. Full article

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

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 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

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

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

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

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

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

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

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

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

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

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

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