Search Results (466)

Purpose: To evaluate anatomical and functional outcomes after switching from aflibercept to faricimab in patients with neovascular age-related macular degeneration (nAMD) with suboptimal response. Methods: This retrospective study included 72 eyes of 66 patients with nAMD previously treated with intravitreal aflibercept using a treat-and-extend regimen. Indications for switching included persistent retinal fluid, pigment epithelial detachment (PED), lack of best-corrected visual acuity (BCVA) improvement, or inability to extend treatment intervals beyond four weeks. Patients received three monthly loading doses of faricimab followed by individualized 8- to 16-week dosing. Follow-up comprised six visits over a mean of 8.5 ± 1.4 months. Outcomes included BCVA (logMAR), retinal morphology (subretinal fluid—SRF; intraretinal fluid—IRF; pigment epithelial detachment—PED), central subfoveal thickness (CST), and treatment interval changes. Results: Switching to faricimab led to significant short-term anatomical improvement, primarily reduction in subretinal fluid (p < 0.0001), with maximal effect during the loading phase. Resolution of SRF was significant at the end of the follow up; however, IRF changes were transient and not sustained beyond three months. PED reduction reached borderline significance (p = 0.0455). CST decreased during the loading phase (p < 0.0001) but returned to baseline thereafter. BCVA improved only after loading (p = 0.0287) but not at final follow-up. Treatment intervals were extended by a mean of ~2 weeks (p < 0.0001), increasing in 80% of eyes. Eyes with fewer prior injections and better baseline BCVA achieved superior final visual outcomes. Conclusions: Switching to faricimab provides short-term anatomical benefits and treatment-interval extension without sustained visual gain. Functional improvements tended to be greater in patients with fewer injections and shorter treatment duration prior to switch. Full article

Visual skills are increasingly recognized as critical to athletic performance, yet it remains unclear whether participation in specific team sports is associated with enhanced visual function. This cross-sectional study compared visual acuity, peripheral vision, stereoacuity, ocular alignment, and refractive error among 52 participants aged 15–56 years: basketball (n = 10), futsal (n = 9), hockey (n = 12), roller derby (n = 9), and non-athlete controls (n = 12). Standardized assessments included best-corrected visual acuity (logMAR), Hirschberg shift, peripheral perception using a tachistoscope, stereoacuity with the Randot^® test, and non-cycloplegic autorefraction. Group comparisons were conducted using ANOVA, post hoc analyses, and regression models adjusted for age. Significant differences were observed only for visual acuity (F(4, 47) = 4.46, p = 0.003, η² = 0.275): non-athlete controls (0.00 ± 0.08 logMAR) and basketball players (0.02 ± 0.05) showed the best performance, while roller derby athletes demonstrated the poorest (0.16 ± 0.12). No significant group differences were found for peripheral vision, stereoacuity, Hirschberg deviation, or refractive error, and the poorer acuity in roller derby remained after adjustment for age. These findings suggest that participation in team sports does not universally confer superior visual function and that static clinical measures may overlook the dynamic visual–motor strategies that underlie athletic performance. Full article

Real-world navigation depends on coordinated head–eye behaviour that standard tests of visual function miss. We investigated how visual impairment affects traffic navigation, whether behaviour differs by visual impairment type, and whether this functional grouping better explains performance than WHO categorisation. Using a virtual reality (VR) headset with integrated head and eye tracking, we evaluated detection of moving cars and safe road-crossing opportunities in 40 patients with central, peripheral, or combined visual impairment and 19 controls. Only two patients with a combination of very low visual acuity and severely constricted visual fields failed both visual tasks. Overall, patients identified safe-crossing intervals 1.3–1.5 s later than controls (p ≤ 0.01). Head-eye movement profiles diverged by visual impairment: patients with central impairment showed shorter, more frequent saccades (p < 0.05); patients with peripheral impairment showed exploratory behaviour similar to controls; while patients with combined impairment executed fewer microsaccades (p < 0.05), reduced total macrosaccade amplitude (p < 0.05), and fewer head turns (p < 0.05). Classification by impairment type explained behaviour better than WHO categorisation. These findings challenge acuity/field-based classifications and support integrating functional metrics into risk stratification and targeted rehabilitation, with VR providing a safe, scalable assessment tool. Full article

Background/Objectives: Cystoid macular lesion (CML) is a treatable cause of central vision loss in inherited retinal diseases (IRDs). We aimed to determine the frequency of CML in a large Hungarian IRD cohort and examine associations with causative genes. Methods: This longitudinal, retrospective, monocentric study included patients with genetically confirmed IRD identified from our database. Targeted next-generation sequencing (351-gene panel) and comprehensive ophthalmic evaluation were performed, including best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT). CML was defined as intraretinal hyporeflective spaces with well-defined borders visible on at least two B-scans within the SD-OCT macular volume and was categorized as cystoid macular edema (CME) or non-CME. Results: We enrolled 430 patients with genetically confirmed IRDs. CML was detected in 93 eyes of 57 patients. Mean age at OCT was 36.6 ± 18.7 years (range, 3–76); 32 were male (56.1%). Inheritance patterns were autosomal recessive in 24 (42.1%), X-linked in 19 (33.3%), and autosomal dominant in 14 (24.6%). Frequently implicated genes were RS1 (12/57), USH2A (7/57), NR2E3 (7/57), PRPF31 (4/57), RPGR (4/57), and RHO (4/57). CME predominated in retinitis pigmentosa (32/57, 56%), with mean BCVA 0.44 ± 0.29 (decimal) and central retinal thickness (CRT) 401 ± 181 µm. Non-CME CML occurred in 25/57 (44%)—notably in X-linked retinoschisis and enhanced S-cone syndrome—with BCVA 0.40 ± 0.23 and CRT 465 ± 258 µm. BCVA did not correlate with CRT (r_S = 0.18). Conclusions: CML occurred in 13.2% of patients within a large Hungarian cohort of genetically confirmed IRDs. Patients with IRD—mainly RP—are at higher risk for CML. Gene therapy is promising for retinal diseases, but CMLs can compromise effectiveness. Reducing and managing CME before gene therapy corroborates retinal stability and the functional state essential for the proper delivery and penetration of corrective genes to the target cells. Full article

Introduction: The management of neovascular age-related macular degeneration (nAMD) is constrained by diminishing therapeutic options for retina specialists and their patients when the disease reaches its end stages. Methods: Clinical insights emerge from two case narratives in which patients benefitted from discontinuation of anti-VEGF therapy. Results: Long-term management of nAMD with intravitreal injections of agents targeting vascular endothelial growth factor (VEGF) is crucial for slowing progression of the disease and is generally well-tolerated. However, vision often declines as the disease progresses over time, even with treatment. This article presents strategies for aligning therapeutic goals with their expected visual outcome when an eye has reached end-stage disease. It addresses considerations for how and when to stop treatment when vision becomes limited, taking into consideration the visual status of the fellow eye and incorporating input from low vision specialists who can better assess best-corrected visual acuity (BCVA) and optimize the visual function of patients. We also acknowledge the potential benefits of switching either the dose or the agent that targets VEGF to alter the long-term visual outcome of treatment. Finally, we discuss the importance of taking into consideration related manifestations of the disease, such as macular scarring, geographic atrophy, or other retinal or optic nerve diseases which may limit vision and thus the utility of continued nAMD treatment. Conclusions: Building a strong patient–physician relationship is essential for navigating the shared decision-making process of when to stop treatment for nAMD. Full article

In this paper, the iterative Gerchberg–Saxton (GS) phase-retrieval algorithm is employed to reconstruct the amplitude spread function (ASF) of hololenses (HLs) recorded on a sustainable PVA/acrylate-based photopolymer, Biophotopol, when working with a CCD sensor. The main objective of this work is to characterize the spatial resolution of HLs, which are key components in a wide range of optical systems, including augmented reality (AR) glasses, combined information displays, and holographic solar concentrators. The GS algorithm, known for its efficiency in phase retrieval without prior knowledge of the phase of the optical system, is used to reconstruct the ASF, which is critical for mitigating information loss during imaging. Spatial resolution is quantified by convolving the ASFs obtained with two resolution tests (objective and subjective) and analyzing the resulting image using a CCD sensor. The convolution process allows an accurate assessment of lens performance, highlighting the resolution limits of manufactured lenses. The results show that the iterative GS algorithm provides a reliable method to improve image quality by recovering phase and amplitude information that might otherwise be lost, especially when using CCD or CMOS sensors. In addition, the recorded hololenses exhibit a spatial resolution of 8.9 lp/mm when evaluated with the objective Siemens star chart, and 30 cycles/degree when evaluated with the subjective Random E visual acuity test, underscoring the ability of Biophotopol-based HLs to meet the performance requirements of advanced optical applications. This work contributes to the development of sustainable high-resolution holographic lenses for modern imaging technologies, offering a promising alternative for future optical systems. Full article

Inherited retinal dystrophies (IRDs) are a diverse group of monogenic disorders associated with dysfunction of the retina. High myopia, commonly defined as a spherical equivalent ≤ −6.00 D or axial length ≥ 26.5 mm, is a recurring clinical feature across several IRDs, and could serve as an early diagnostic clue. This review provides a summary of IRDs associated with high myopia to guide the clinician in establishing a molecular diagnosis for patients. We performed a comprehensive literature review of articles in PubMed, ScienceDirect, and JAMA Network to identify associations between monogenic IRDs and high myopia. Genes associated with IRDs and high myopia clustered into functional categories that included collagen/structural integrity (COL2A1, COL9A1, COL11A1, COL18A1, P3H2), phototransduction and visual cycle (PDE6C, PDE6H, GUCY2D, ARR3, RBP3), ciliary trafficking and microtubule-associated genes (RPGR, RP2, IFT140, CFAP418, FAM161A), synaptic ribbon and bipolar cell signaling (NYX, CACNA1F, TRPM1, GRM6, LRIT3, GPR179), opsin-related genes (OPN1LW, OPN1MW), and miscellaneous categories (VPS13B, ADAMTS18, LAMA1). Associations between IRDs and high myopia spanned stationary and progressive retinal disorders and included both cone-dominant and rod-dominant diseases. High myopia accompanied by other visual symptoms and signs such as nyctalopia, photophobia, or reduced best-corrected visual acuity should heighten suspicion for an underlying IRD. Earlier diagnosis of IRDs for patients could facilitate timely genetic counseling, participation in clinical trials, and interventions for patients to preserve vision.: Full article

Background/Objectives: The aim of this study was to evaluate the correlation between the visual curve (ViC) and Area of the Curve (AoC) indices and the subjective perception of vision-related quality of life in patients who had undergone pseudophakic presbyopia correction. The central hypothesis was that AoC indices would show stronger correlations with vision-specific quality-of-life measures than single-point visual acuity (VA) assessments. Methods: A total of 100 patients who underwent bilateral pseudophakic presbyopia correction at the University Hospital of Alexandroupolis, Greece, were included in the study. Six months following surgery, visual acuity was assessed at nine distances using the DDART tool. The AoC was calculated using VA data from four, five, six, and nine distances, and further categorized into Near Vision AoC (AoCN) and Distance Vision AoC (AoCD). Participants also completed the NEI-VFQ-25 questionnaire to evaluate their subjective vision-related quality of life. Results: Statistically significant correlations were observed between AoC values and NEI-VFQ-25 total scores (r = 0.668–0.682, p < 0.001), near activity subscale scores (r = 0.656–0.686, p < 0.001), and distance activity subscale scores (r = 0.733–0.758, p < 0.001). In all analyses, the AoC indices derived from ViC demonstrated stronger correlations with quality-of-life scores than those observed with AoC-derived DCT and single VA measurements, even when the AoC was computed using only four measurement points. Conclusions: The AoC metric is a superior indicator of vision-specific quality of life compared to isolated VA measurements. AoC effectively captures the multifaceted nature of functional vision following presbyopia correction. Full article

Background: To assess the agreement among prediction models for the functional classification of intraocular lenses (IOLs) and discuss their limitations in evaluating pupil dependency of a sinusoidal IOL. Methods: An ISO-compliant optical bench setup with modifications to characterize the modulation transfer function area (MTFa) across pupil diameters from 1.5 to 5.5 mm was used to measure the Acriva Trinova Pro C Pupil Adaptive IOL. Six prediction models (Vega et al., 2018, Fernández et al., 2019, Alarcón et al., 2016, Armengol et al., 2020 were applied to estimate visual acuity defocus curves from MTFa and functional classification based on the depth-of-field (DOFi) and the increase in visual acuity (ΔVA) from intermediate to near. Results: Defocus curves for all prediction models consistently demonstrated a Full-DOFi response (>2.3 D at 0.2 logMAR), with differences in ΔVA emerging across pupil diameters. Continuous decreases (ΔVA < 0.05 logMAR) were observed at pupil diameters <2.5 mm, while Smooth transitions (ΔVA from 0.05 to 0.14 logMAR) occurred between 2.5–3.0 mm for all models except for Vega. At pupil diameters >3.5 mm, most models transitioned to a Steep classification (ΔVA ≥ 0.14 logMAR), except Fernández, which remained Smooth, and Armengol 2020a, which shifted to Steep at 4.0 mm. Conclusions: Visual acuity prediction models provide useful means of reporting optical bench data in clinically familiar metrics. However, outcomes should be interpreted with caution as functional classifications can vary depending on the optical bench setup and prediction model used. Full article

Background: This prospective pilot study included four participants with chronic visual impairment and assessed functional and electrophysiological recovery following visual evoked potential (VEP)-guided auditory biofeedback across diverse etiologies. Low vision affects more than two billion people worldwide and imposes a sustained personal and socioeconomic burden. Conventional rehabilitation emphasizes optical aids and environmental modification without directly stimulating the visual pathway. Emerging evidence indicates that auditory biofeedback based on real-time cortical activity can leverage adult neuroplasticity. Methods: Four men (mean age 58 ± 12 years) with chronic visual impairment attributable to occipital stroke, stage IV macular hole, end-stage open-angle glaucoma, or diabetic maculopathy completed ten 10-min monocular sessions with the Retimax Vision Trainer over three weeks (15 Hz pattern reversal, 90% contrast). Primary end points were best corrected visual acuity (BCVA, ETDRS letters) and P100 amplitude/latency. Fixation stability was recorded with MAIA microperimetry when feasible. A focused PubMed review (2010–2025) mapped current evidence and research gaps. Results: Median BCVA improved by seven letters (IQR 0–15); three of eight eyes gained ≥ 10 letters and none lost vision. Mean P100 amplitude increased from 1.0 ± 1.2 µV to 3.0 ± 1.1 µV, while latency shortened by 3.9 ms. Electrophysiological improvement paralleled behavioural gain irrespective of lesion site. No adverse events occurred. Conclusions: A concise course of VEP-guided auditory biofeedback produced concordant functional and neurophysiological gains across retinal, optic nerve, and cortical pathologies. These pilot data support integration of closed-loop biofeedback into routine low vision care and justify larger sham-controlled trials. Full article

Background: To present the management of upside–down Descemet membrane endothelial keratoplasty (DMEK) with intraoperative optical coherence tomography (iOCT). Methods: We report the case of a 74-year-old woman who underwent DMEK for Fuchs’ endothelial corneal dystrophy (FECD) of the right eye. Preoperative corrected distance visual acuity (CDVA) was 20/1500 (counting fingers [CF]), and the central corneal thickness (CCT) was 637 μm. No graft markings were made. Graft positioning was determined using iOCT. An improper graft position was suspected due to the lack of postoperative anatomical and functional improvements. The CDVA noted at that time was 20/1500 (CF), and the CCT was 708 μm. The graft was subsequently repositioned. This procedure was performed 33 days after the primary surgery. Results: The central corneal thickness and CDVA were 495 μm and 20/40 sc, respectively, at the final 18-month postoperative follow-up. Conclusions: Incorrect positioning of the transplanted corneal graft should be considered if no improvement is observed after DMEK. The learning curve significantly affects the occurrence of these complications. Graft repositioning, even 33 days after surgery, is associated with a favorable prognosis. Full article

The anatomical and physiological similarities between human and canine eyes suggest that dogs may serve as a valuable model for studying retinopathies and developing future gene therapies. This study aims to evaluate the similarities and differences between humans with GUCY2D gene variants causing Leber’s congenital amaurosis (LCA) and a group of German Spitz dogs with hereditary retinopathy due to variants in the same gene, to assess their potential as an animal model for gene therapy research. A review of medical records, genetic testing, and ophthalmological examinations was conducted, including data such as age, genotyping, fundus photography, visual acuity (VA), fundus autofluorescence, optical coherence tomography (OCT), and electroretinography (ERG). Both groups presented subtle fundus abnormalities and severely reduced or absent ERG responses. In humans, OCT scans revealed decreased retinal thickness and structural alterations in the outer retinal layers. Similarly, the affected dogs exhibited focal neurosensory retinal detachments. The German Spitz model with GUCY2D variants shows significant parallels in retinal structure and functional impairment and may represent a promising candidate for preclinical gene therapy studies for LCA. Full article

Background: Intraocular lens (IOL) alignment is crucial for optimal performance in presbyopia-correcting designs. The aim was to report a case of a patient with a high angle kappa implanted with the continuous transitional focus (CTF) Precizon Prebyopic NVA IOL. Case presentation: A 51-year-old patient presenting large angle kappa values (0.6/0.8 mm) was implanted with the Precizon Prebyopic NVA IOL and followed-up 1 and 10 months post-surgery. This IOL is designed with a butterfly-shaped central area that allows the orientation of the lens so that the visual axis passes through the wider diameter of the optic zone. Postoperative refraction was −0.25D of cyl at 80° for the right eye and +0.25D −0.50D cyl at 170°. Corrected distance visual acuity (CDVA) at the last visit was −0.1 logMAR monocularly and −0.2 logMAR binocularly. Binocular uncorrected distance (UDVA), intermediate (UIVA) and near visual acuities (UNVA) were −0.1, 0.1 and 0.1 logMAR, respectively. The corrected binocular defocus curve exhibited outstanding vision at the 0.00D defocus level and showed a continuous range of functional vision from distance to near. Overall excellent satisfaction was reported, along with low levels of photopic phenomena. Conclusions: Precizon Presbyopic NVA IOL provided satisfactory vision and low levels of photic phenomena in a high angle kappa patient who would potentially be excluded from presbyopia-correcting IOL implantation. Full article

Dry eye disease (DED) represents one of the most prevalent ocular manifestations associated with systemic lupus erythematosus (SLE), with reported incidence rates ranging from 15% to 35%. DED constitutes a multifactorial condition that significantly impairs both visual function and health-related quality of life. The objective of this study was to assess the impact of DED symptoms on vision-related quality of life in patients diagnosed with SLE, employing the Ocular Surface Disease Index (OSDI) as a disease-specific instrument. Additionally, the study aimed to evaluate correlations between clinical diagnostic tests and OSDI scores, and to determine the frequency of abnormalities affecting individual ocular structures. This study included 35 SLE patients, identifying DED in 37.1%. Common ophthalmic abnormalities included lens opacification (22.9%) and hyaloid degeneration (34.3%). Astigmatism (>0.50 D cyl) was prevalent (60.0%), being significantly higher in DED patients. While visual acuity and intraocular pressure were comparable, DED patients showed significantly lower Schirmer I test values, reduced tear break-up time, and higher van Bijsterveld scores, indicating impaired tear film and surface integrity. OSDI scores were significantly elevated in the DED group, with 51.4% reporting moderate to severe dysfunction. Strong, statistically significant correlations between the OSDI and objective tear film parameters confirmed a robust association between subjective symptoms and clinical signs. These findings highlight the significant impact of DED on visual function in SLE patients, underscoring the importance of routine ophthalmological evaluation and timely intervention. Full article

Augmented reality features, such as overlaying information in real time, modifying the projected scene, or dynamically adjusting parameters like contrast, zoom, and brightness, show promise in addressing the specific challenges faced by people with low vision. These tailored solutions enhance their visual experiences. When combined with mobile technology, these features significantly improve the personalization of visual aids and the monitoring of patients with low vision. Retiplus emerges as a personalized visual aid and rehabilitation system, utilizing smart glasses and augmented reality technology for visual aid functions, along with a mobile app for visual assessment, aid customization, and usage monitoring. This wearable system quickly assesses visual conditions, providing deep insights into the visual perception of patients with low vision. Designed to enhance autonomy and quality of life, Retiplus seamlessly integrates into indoor and outdoor environments, enabling the programming of rehabilitation exercises for both static and ambulatory activities at home. In collaboration with specialists, the system meticulously records patient interaction data for subsequent evaluation and feedback. A clinical study involving 30 patients with low vision assessed the effect of Retiplus, analyzing its impact on visual acuity, contrast sensitivity, visual field, and ambulation. The most notable finding was an average increase of 61% in visual field without compromising ambulation safety. Retiplus introduces a new user-centered approach that emphasizes collaboration among a multidisciplinary team for the customization of visual aids, thereby minimizing the gap between the perceptions of low vision specialists and technologists regarding user needs and the actual requirements of users. Full article