Search Results (23)

Background: Optical neuropathy is a severe complication in patients with type 2 diabetes mellitus (T2DM) undergoing vitreoretinal surgeries. Early diagnostic indicators are critical to preventing irreversible vision loss. This study aimed to evaluate the alterations in blood serum amino acid profiles, with a specific focus on serine levels, and their potential clinical association with the severity of neuroretinal impairment. Methods: The clinical cohort included 28 patients aged 32 to 77 years with T2DM following vitreoretinal interventions. Visual field functional status was assessed using Humphrey automated perimetry, with mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). Structural changes were quantified using optical coherence tomography (OCT) to measure peripapillary retinal nerve fiber layer (RNFL) thickness. Serum amino acid profiles were determined using an ion-exchange chromatography amino acid analyzer, alongside a reference group (n = 12). Results: All patients presented with moderate-to-severe visual field impairment. A profound decline in serum serine levels was observed in diabetic patients compared to the reference group (p < 0.001). The reduction in serine content closely mirrored both the degree of retinal sensitivity loss (MD and PSD values) and the number of thinned peripapillary RNFL sectors. Notably, the compensatory synthesis of serine via glycine cleavage appeared insufficient, as evidenced by a concomitant statistical decrease in glycine content (p < 0.05). No significant differences in serine levels were found between the subgroups when stratified strictly by age or isolated severity stages. Conclusions: It was demonstrated that the decline in serum serine levels in patients with T2DM following vitreoretinal interventions is significantly associated with the severity of optic neuropathy as assessed by optical coherence tomography (OCT). Consequently, serum serine may serve as a valuable dual biomarker, acting as a prognostic indicator for retinopathy progression and a predictive marker for early-stage neuropathy development. Full article

Background: Given global population growth and aging, it is imperative to prioritize early eye disease detection and treatment. However, as patient volume increases, providers are facing a shortage of workforce capacity, particularly in areas where eye doctors are already scarce, making it important to consider alternative innovative solutions that could help increase eye screening capabilities. This study compared virtual reality (VR) platform of vision screening exams that are used to evaluate ocular health, such as 24-2 perimetry, Ishihara tiles, and the Amsler grid, against their in-clinic counterparts. Methods: A total of 86 subjects were recruited from Mount Sinai’s ophthalmology clinic (New York, USA) for a comparison trial that was internally controlled across healthy eyes and those with glaucoma and retinal diseases. VR and in-office tests were administered to the patients during their clinical visit, including 24-2 perimetry, Ishihara tiles, and the Amsler grid in a randomized order, and the results were compared for each test. Results: Perimetry results from Humphrey Visual Field Analyzer (HVFA) and VR suprathreshold testing demonstrated a good sensitivity both overall (80% OD, 84% OS) and across control (86% OD, 89% OS), glaucoma (69% OD, 78% OS), and retinal disease (76% OD, 80% OS) groups. A Garway-Heath anatomical map showed an overall 70–80% agreement. Ishihara plate tests did not show a significant difference between the two testing modalities (p = 0.12; Mann–Whitney U test), which remained true across all groups. Amsler grid testing differences were also non-significant within each subgroup (p = 0.81; Mann–Whitney U test). Patient time required to complete VR exams was significantly improved (p < 0.0001; Welch’s t-test) compared to the clinical standard tests. Conclusions: All VR-based exams tested in this study showed high sensitivity and percent agreement when compared to their in-office standards. Given the results of this study, VR has a promising potential in visual function screening, which, in addition to its portable design and easy use, could assist eye doctors in screening for prevalent diseases such as glaucoma and retinal conditions. Translational Relevance: VR-based vision exams that test vision fields, color vision and visual distortions provide comparable results in healthy patients, as well as those with glaucoma and retinal diseases, indicating its potential as a screening technology for different ocular pathologies. Given VR’s portable and low-profile features, it is important to consider leveraging VR to augment delivery of vision care. Full article

Background/Objectives: The aim of this study was to investigate the longitudinal visual field (VF) and circumpapillary retinal nerve fiber layer thickness (cpRNFLT) changes in open-angle glaucomatous (OAG) participants with unilateral peripapillary intrachoroidal cavitation (PICC) and to identify factors associated with VF progression. Methods: Sixty eyes of 30 OAG patients with unilateral PICC were included in this retrospective longitudinal observational study. Humphrey 24–2 VF testing and optical coherence tomography scanning were performed in all eyes over a period exceeding 5 years. VF progression was assessed using mean deviation (MD) and superior and inferior total deviation (TD) slopes. Structural progression was evaluated using global, superior, and inferior cpRNFLT thinning rates. Longitudinal changes were compared between PICC eyes and their contralateral non-PICC eyes. Factors associated with superior or inferior TD slopes were analyzed using linear mixed-effects models. The following variables were included as explanatory variables: age, sex, intraocular pressure, axial length, Bruch’s membrane opening (BMO) and scleral flange opening (SFO) area, SFO/BMO offset magnitude, disk tilt, disk rotation, baseline superior or inferior TD, baseline corresponding cpRNFLT, and the presence of PICC. Results: MD slope was −0.24 ± 0.35 dB/year in PICC eyes and −0.35 ± 0.53 dB/year in contralateral eyes. There was no significant difference in MD slope, superior and inferior TD slope, or the rate of cpRNFLT thinning (all p > 0.05). In multivariable analysis, the presence of PICC was associated with slower progression in the corresponding superior VF (p = 0.037), whereas greater SFO/BMO offset magnitude was associated with faster progression (p = 0.047). Conclusions: OAG eyes with PICC exhibited modest functional and structural progression over 5 years, comparable to that of contralateral non-PICC eyes. The presence of PICC was associated with slower corresponding superior VF progression, whereas greater myopia-associated structural change was related to faster progression. Our findings characterize the clinical course of eyes with pronounced myopic ONH deformation, highlighting the importance of detailed ONH structural assessment in the management of myopic glaucoma. Full article

Background: Automated visual field testing is fundamental in ophthalmology, but differences in stimulus scaling and luminance between devices hinder direct comparison of sensitivity values. Virtual reality (VR)-based perimetry has emerged as a portable alternative, yet its relationship with conventional perimetry requires clarification. Methods: This prospective cross-sectional study included 60 healthy participants stratified into younger (<50 years) and older (≥50 years) groups. Differential light sensitivity was assessed in the right eye using Humphrey Automated Perimetry (HFA) with the 30-2 test pattern and a VR-based perimeter (Dicopt-Pro) in randomized order. Pointwise sensitivity values were analyzed using linear regression and Bland–Altman analysis, and sensitivity profiles were examined as a function of visual field eccentricity. Results: A strong linear relationship was observed between HFA and Dicopt-Pro sensitivity values in both age groups (R ≥ 0.96). A systematic and approximately constant inter-device offset was identified, with mean differences of 15.7 ± 0.4 dB in younger subjects and 13.7 ± 0.5 dB in older subjects. Bland–Altman analysis showed consistent bias without proportional error. Dicopt-Pro sensitivity profiles demonstrated an eccentricity-dependent decline comparable to HFA while preserving age-related differences. Conclusions: VR-based perimetry using Dicopt-Pro shows sensitivity patterns closely aligned with conventional Humphrey perimetry when a systematic, age-specific inter-device offset is considered, enabling clinically meaningful interpretation of Dicopt-Pro results within an HFA-referenced framework. Full article

Background: This study compared the performance of a Head-mounted Virtual Reality Perimeter (HVRP) with the Humphrey Field Analyzer (HFA), the standard in automated perimetry. The HFA is the established standard for automated perimetry but is constrained by lengthy testing, bulky equipment, and limited patient comfort. Comparative data on newer head-mounted virtual reality perimeters are limited, leaving uncertainty about their clinical reliability and potential advantages. Aim: The aim was to evaluate parameters such as visual field outcomes, portability, patient comfort, eye tracking, and usability. Methods: Participants underwent testing with both devices, assessing metrics like mean deviation (MD), pattern standard deviation (PSD), and duration. Results: The HVRP demonstrated small but statistically significant differences in MD and PSD compared to the HFA, while maintaining a consistent trend across participants. MD values were slightly more negative for HFA than HVRP (average difference −0.60 dB, p = 0.0006), while pattern standard deviation was marginally higher with HFA (average difference 0.38 dB, p = 0.00018). Although statistically significant, these differences were small in magnitude and do not undermine the clinical utility or reproducibility of the device. Notably, HVRP showed markedly shorter testing times with HVRP (7.15 vs. 18.11 min, mean difference 10.96 min, p < 0.0001). Its lightweight, portable design allowed for bedside and home testing, enhancing accessibility for pediatric, geriatric, and mobility-impaired patients. Participants reported greater comfort due to the headset design, which eliminated the need for chin rests. The device also offers potential for AI integration and remote data analysis. Conclusions: The HVRP proved to be a reliable, user-friendly alternative to traditional perimetry. Its advantages in comfort, portability, and test efficiency support its use in both clinical settings and remote screening programs for visual field assessment. Its portability and user-friendly design support broader use in clinical practice and expand possibilities for bedside assessment, home monitoring, and remote screening, particularly in populations with limited access to conventional perimetry. Full article

Virtual reality (VR) technology has emerged as a promising alternative to conventional perimetry for assessing visual fields. However, the clinical validity of commercially available VR-based perimetry devices remains uncertain due to variability in hardware, software, and testing protocols. A systematic review was conducted following PRISMA guidelines to evaluate the validity of VR-based perimetry compared to the Humphrey Field Analyzer (HFA). Literature searches were performed across MEDLINE, Embase, Scopus, and Web of Science. Studies were included if they assessed commercially available VR-based visual field devices in comparison to HFA and reported visual field outcomes. Devices were categorized by regulatory status (FDA, CE, or uncertified), and results were synthesized narratively. Nineteen studies were included. Devices such as Heru, Olleyes VisuALL, and the Advanced Vision Analyzer showed promising agreement with HFA metrics, especially in moderate to advanced glaucoma. However, variability in performance was observed depending on disease severity, population type, and device specifications. Limited dynamic range and lack of eye tracking were common limitations in lower-complexity devices. Pediatric validation and performance in early-stage disease were often suboptimal. Several VR-based perimetry systems demonstrate clinically acceptable validity compared to HFA, particularly in certain patient subgroups. However, broader validation, protocol standardization, and regulatory approval are essential for widespread clinical adoption. These devices may support more accessible visual field testing through telemedicine and decentralized care. Full article

Objectives: To evaluate changes in intraocular pressure (IOP) before versus after a visual field test in glaucoma patients. Methods: A total of 132 patients with glaucoma and 103 control subjects who visited Konyang University Hospital between August 2024 and May 2025 were included in the study. the right eye of each patient was selected for analysis. Visual field tests were conducted using the Humphrey Visual Field (HVF) analyzer (Zeiss Humphrey, San Leandro, CA, USA) with the SITA standard program (Central 24-2). Intraocular pressure was measured by two ophthalmologists at five time points: before the test and immediately, 10 min, 30 min, and 60 min after the test. Results: The average intraocular pressure decreased from 15.09 mmHg before the test to 14.29 mmHg immediately afterward; it declined further to 13.59 mmHg at 10 min in glaucoma patients. It then gradually increased to 15.01 mmHg at 60 min, returning to pre-test levels. Participants were divided into three age groups (40s, 50s, and 60s) for analysis. Across all groups, the IOP followed a similar pattern: a significant decrease for up to 10 min, followed by recovery at 60 min. Although a reduction in IOP was also observed in the control group after visual field testing, the magnitude of the decrease was smaller compared to the glaucoma patients. Conclusions: IOP declined immediately after the visual field test and remained lower for up to 10 min. It subsequently returned to baseline by 60 min. Therefore, when measuring the IOP after a visual field test, there is no need to adjust for temporary fluctuations if the measurement is performed 60 min after the test. Full article

Visual field (VF) testing remains a cornerstone in assessing retinal function by measuring how well different parts of the retina detect light. It is essential for early detection, monitoring, and management of many retinal diseases. By mapping retinal sensitivity, VF exams can reveal functional loss before structural changes become visible. This review summarizes how VF testing is applied across key conditions: hydroxychloroquine (HCQ) retinopathy, age-related macular degeneration (AMD), diabetic retinopathy (DR) and macular edema (DME), and inherited disorders including inherited dystrophies such as retinitis pigmentosa (RP). Traditional methods like the Goldmann kinetic perimetry and simple tools such as the Amsler grid help identify large or central VF defects. Automated perimetry (e.g., Humphrey Field Analyzer) provides detailed, quantitative data critical for detecting subtle paracentral scotomas in HCQ retinopathy and central vision loss in AMD. Frequency-doubling technology (FDT) reveals early neural deficits in DR before blood vessel changes appear. Microperimetry offers precise, localized sensitivity maps for macular diseases. Despite its value, VF testing faces challenges including patient fatigue, variability in responses, and interpretation of unreliable results. Recent advances in artificial intelligence, virtual reality perimetry, and home-based perimetry systems are improving test accuracy, accessibility, and patient engagement. Integrating VF exams with these emerging technologies promises more personalized care, earlier intervention, and better long-term outcomes for patients with retinal disease. Full article

Background/Objectives: The aim of this study was to evaluate the associations between optical coherence tomography angiography (OCTA)-based retinal vessel diameter (RVD) measurements, with retinal ganglion cell (RGC) function assessed by means of steady-state pattern electroretinography (ssPERG) using ganglion cell layer-inner plexiform layer thickness (GCL-IPLT) measurements and with Humphrey field analyzer (HFA) global indices in glaucoma suspects (GSs). Methods: Thirty-one eyes (20 participants) underwent a comprehensive ophthalmologic examination, ssPERG measurements utilizing the PERGLA paradigm, HFA, optical coherence tomography (OCT), and OCTA. The OCTA scans were processed using ImageJ software, Version 1.53, allowing for measurement of the RVD. Multiple linear regression models were used. Results: After controlling for age, race, central corneal thickness (CCT), and spherical equivalent (SE), a linear regression analysis found that the RVD explained the 4.7% variance in magnitude (Mag) (p = 0.169), 9.2% variance in magnitudeD (MagD) (p = 0.021), and 16.9% variance in magnitudeD/magnitude (p = 0.009). After controlling for age, CCT, and signal strength (SS), a linear regression analysis found that the RVD was significantly associated with the GCL-IPLT measurements (average GCL-IPL, minimum GCL-IPL, superior, superonasal, inferior, and inferonasal sectors) (p ≤ 0.023). An identical regression analysis where the RVD was replaced with the PERG parameters showed a significant association between the MagD and almost all GCI-IPLT measurements. RVD measurements were significantly associated with HFA VFI 24-2 (p = 0.004), MD 24-2 (p < 0.001), and PSD 24-2 (p = 0.009). Conclusions: Decreased RVD measurements were significantly associated with RGC dysfunction, decreased GCL-IPLT, and all HFA global indices in the GSs. Full article

Background and Objectives: Glaucoma (GL) classification is crucial for early diagnosis and treatment, yet relying solely on stand-alone models or International Classification of Diseases (ICD) codes is insufficient due to limited predictive power and inconsistencies in clinical labeling. This study aims to improve GL classification using stacked weight-based machine learning models. Materials and Methods: We analyzed a subset of 33,636 participants (58% female) with 340,444 visual fields (VFs) from the Mass Eye and Ear (MEE) dataset. Five clinically relevant GL detection models (LoGTS, UKGTS, Kang, HAP2_part1, and Foster) were selected to serve as base models. Two multi-layer perceptron (MLP) models were trained using 52 total deviation (TD) and pattern deviation (PD) values from Humphrey field analyzer (HFA) 24-2 VF tests, along with four clinical variables (age, gender, follow-up time, and race) to extract model weights. These weights were then utilized to train three meta-learners, including logistic regression (LR), extreme gradient boosting (XGB), and MLP, to classify cases as GL or non-GL. Results: The MLP meta-learner achieved the highest performance, with an accuracy of 96.43%, an F-score of 96.01%, and an AUC of 97.96%, while also demonstrating the lowest prediction uncertainty (0.08 ± 0.13). XGB followed with 92.86% accuracy, a 92.31% F-score, and a 96.10% AUC. LR had the lowest performance, with 89.29% accuracy, an 86.96% F-score, and a 94.81% AUC, as well as the highest uncertainty (0.58 ± 0.07). Permutation importance analysis revealed that the superior temporal sector was the most influential VF feature, with importance scores of 0.08 in Kang’s and 0.04 in HAP2_part1 models. Among clinical variables, age was the strongest contributor (score = 0.3). Conclusions: The meta-learner outperformed stand-alone models in GL classification, achieving an accuracy improvement of 8.92% over the best-performing stand-alone model (LoGTS with 87.51%), offering a valuable tool for automated glaucoma detection. Full article

Background/Objectives: This study aimed to serve as a reference for establishing glaucoma evaluation standards for the Korean by analyzing the results of visual field tests and optical coherence tomography (OCT). We also determined the correlation between these test results and patient demographics, such as age and sex, which is crucial for early glaucoma detection and management. Methods: This study was conducted at a national hospital in Seoul and analyzed 1510 visual field tests and 1337 OCT tests. The patients underwent the Humphrey automated visual field test and OCT measurements. Glaucoma was classified into early, moderate, and advanced stages based on the mean deviation (MD) value. Statistical analyses were performed to assess the relationships between age, sex, and test results. Results: The visual field test results showed that the visual field index and MD values decreased as age increased for both males and females, with a more significant decrease observed in males. The OCT findings revealed gradual thinning of the ganglion cell–inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) with increasing age, although, compared to males, thicker GCIPLs and RNFLs were maintained in females until their 60s. Conclusion: This study indicates that there may be an association between age and sex in glaucoma progression and provides valuable insights for establishing diagnostic and management modalities specifically for Korean patients. These findings support the use of both visual field testing and OCT in glaucoma diagnosis, emphasizing the importance of early detection and personalized treatment strategies for effective glaucoma management in Korea. Full article

Objectives: This study aimed to study the inner retina functional and morphological impairment of retinal ganglion cells (RGCs) from specific macular rings and sectors to identify whether selective macular regions were more vulnerable than others within the 20 central degrees in patients with open-angle glaucoma (OAG). Methods: In total, 21 OAG patients [mean age 50.19 ± 7.86 years, Humphrey Field Analyzer (HFA) 24-2 mean deviation (MD) between −5.02 and −22.38 dB, HFA 10-2 MD between −3.07 and −17.38 dB], providing 21 eyes, were enrolled in this retrospective case–control study. And 20 age-similar healthy subjects, providing 20 eyes, served as controls. The multifocal photopic negative response (mfPhNR) response amplitude density (RAD) from concentric rings and macular sectors and ganglion cell layer thickness (GCL-T) assessed by Spectral Domain–Optical Coherence Tomography (SD-OCT) was measured. Mean RAD and GCL-T values were compared between OAG and control ones by ANOVA. In OAG eyes, the relationship between mfPhNR and SD-OCT data was examined by linear regression analysis, and Pearson’s correlation coefficients were computed. Results: In considering all rings and sectors, compared to the controls, the OAG group showed a significant (p < 0.01) reduction in mean mfPhNR RAD and in GCL-T values with the greatest reduction in the central area. In OAG eyes, a significant (p < 0.01) correlation between all mfPhNR RAD and GCL-T values, with significant (p < 0.01) correlation coefficients, were found. Conclusions: In OAG eyes, RGC dysfunction was detectable by abnormal mfPhNR responses in localized macular areas, mainly in the central one. Localized macular RGC dysfunction was linearly correlated with the GCL morphological changes. Full article

Background/Objectives: Juvenile Open Angle Glaucoma (JOAG) is a condition that presents peculiar issues because it starts at a very early age and, in the end, causes substantial vision loss. This study aimed to analyze the age and gender distribution and treatment outcomes in JOAG patients. Methods: We carried out a retrospective study at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, from 2015 to 2022. We extracted data from the medical records. Visual acuity data were converted to the logarithm of the minimum angle resolution (LogMAR) for standardized analysis. The CARL ZEISS Humphrey 745i Field Analyzer/HFA II-i Visual Field Analyzer was used to perform visual field examinations under the 24-2 program SITA standard. Results: The study involved 45 JOAG patients (87 affected eyes) with a mean age of 26.91 years. Myopia was the prevailing trait (93%), and a family history of glaucoma was found in 51.1% of cases. Most of the patients presented with severe visual field defects in both eyes (right—57.1%, left—44.4%). Regarding visual acuity, we found that the majority of affected categories belonged to either mild or moderate in both eyes. Initial and final Intraocular pressure (IOP) measurements together showed a significant reduction (p < 0.001) and clearly demonstrated the need for IOP control. Surgical and non-surgical treatments significantly reduced IOP, with no gender or eye differences Conclusions: This research offers important data concerning JOAG demographics (age and gender), clinical picture, and treatment results. Though early-onset presents challenges, multidimensional therapeutic methods have great potential to get JOAG under control and maintain visual function. Additional research is needed to study the genetic causes of JOAG and assess the long-term treatment outcomes. Full article

Background: Thickening of the inner nuclear layer (INL) or microcystic macular changes has been reported to be implicated in glaucoma patients, but their potential impact on disease progression remains unclear. We investigated the relationship between baseline microcystic macular edema in the INL or INL thickness and subsequent visual field (VF) progression in glaucoma patients. Methods: This retrospective observational study included primary open-angle glaucoma with follow-up exceeding 3 years. We identified macular cystic changes through Spectralis optical coherence tomography and measured the INL thickness using automated segmentation. Glaucoma progression was determined using the Guided Progression Analysis program of the Humphrey filed analyzer, calculating the mean deviation (MD) changes (dB/year). Results: Microcystic macular changes were observed in 12 (7.5%) of 162 patients. Patients with microcystic macular change had thicker INL thickness than those without it (p = 0.010). Progressors had a higher probability of having microcystic macular changes and a thicker average INL thickness than nonprogressors (p = 0.003, p = 0.019). Thicker INL thickness was associated with faster VF progression based on MD slope (dB/year) in the multivariate regression analysis (p = 0.045). Additionally, greater intraocular pressure (IOP) fluctuation was found to be associated with both a thicker INL and the presence of microcystic changes in the multivariate regression analysis (p = 0.003, 0.028). Conclusions: Increased macular INL thickness indicative of INL changes was linked to subsequent VF progression in glaucoma patients. These findings suggest that retinal inner nuclear change could serve as an indicator of progressive glaucoma. Full article

Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from −22.24 ± 6.5 dB to −18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes. Full article