Translational Vision Science & Technology最新文献

Purpose: To investigate whether pupil area influences the effectiveness of peripheral defocus spectacle lenses in controlling axial elongation and refractive error progression among myopic children.

Methods: This retrospective analysis included 310 myopic children ages 7 to 14 years. Each participant wore one of three myopia control lens types for at least 12 months: type A, defocus incorporated multiple segments (DIMS) lenses; type B, highly aspherical lenslets; or type C, personalized freeform optical design. Participants were grouped by pupil area (above or below the mean). Axial length and spherical equivalent refractive error were measured at baseline, 6 months, and 12 months. A linear mixed-effects model was used to evaluate the effect of the interaction between pupil area and lens type on axial elongation.

Results: Among children with larger pupils, lens type B was associated with less axial elongation and refractive error progression at 12 months compared with types A and C (P < 0.001). In contrast, no significant differences among lens types were observed in children with smaller pupils. An interaction term (β = -0.086, P = 0.002) indicated that the efficacy of lens type B may be influenced by pupil area.

Conclusions: Pupil area may influence the efficacy of peripheral defocus spectacle lenses for myopia control. Children with larger pupils demonstrated greater benefit from highly aspherical lenslets, suggesting that pupil area should be considered in clinical decision-making.

Translational relevance: Pupil area may influence the clinical performance of peripheral defocus lenses, supporting personalized myopia management in children.

Purpose: Halos are the most common source of discomfort after implantation of diffractive multifocal intraocular lenses (MIOLs). Although multiple causes are attributed to halos, there is no clear consensus about the specific role of each factor, especially the diffractive profile. This study aims to quantify the isolated effect of the diffractive profile on halo formation using numerical modeling.

Methods: A simplified model eye was implemented in Zemax OpticStudio to simulate the optical performance of two different diffractive designs (sinusoidal and apodized kinoform) obtained from commercially available MIOLs. Simulations were performed for three pupil diameters under both monochromatic (green) and polychromatic illumination. To evaluate halo size, the half intensity diameter (HD) metric was used.

Results: At the far focus, the kinoform MIOL exhibited a reduction in halo size as the pupil diameter increased. In contrast, the sinusoidal MIOL performed best at the intermediate focus for 6.0 mm, whereas at 3.0 mm and 4.5 mm the HD was nearly three times higher. In both cases, no significant difference was observed between monochromatic and polychromatic illumination.

Conclusions: The observed differences in halo formation between the diffractive profiles studied can be primarily attributed to the way each design distributes optical energy across its diffraction orders.

Translational relevance: This study shows that diffractive profile of MIOLs significantly affects halo formation, aiding surgeons in interpreting patient complaints and evaluating lens designs critically. This approach also offers a useful tool for designers to minimize halos in new lenses.

Purpose: Early lesions caused by age-related macular degeneration (AMD) are imaged by optical coherence tomography (OCT) in unprecedented detail. Most probably, however, the sampling plane of an OCT scan meets a given lesion noncentrally, and the observed sizes of its diameter, cross-sectional area, and volume must be stereologically corrected.

Methods: Stereological corrections are obtained by a simulation procedure, which is applied to the leading scans in a consecutive sample of 100 early AMD participants.

Results: Mean corrections for lesion diameter, cross-sectional area and volume amount to +9.1%, +32.0%, and +46.6%, respectively. After correction, AMD stage classifications with respect to the 125-µm diameter cutpoint had to be changed for seven participants.

Conclusions: Simulation results confirm that for lesions pictured and measured in OCT scans - regardless of the accuracy of OCT imaging - stereological correction of observed sizes is compelling and unavoidable.

Translational relevance: Categorial AMD classifications based on observed OCT data must be reexaminated after stereological correction.

Purpose: The purpose of this study was to evaluate change in visual functions over 3 years in normal macular health, and early and intermediate age-related macular degeneration (AMD) including tests of rod-, cone-, and mixed rod-cone-mediated visions; and to evaluate whether visual function change over 3 years meets the minimal clinically important difference (MCID), defined as meaningful to patients in everyday life.

Methods: Eight visual functions were evaluated at baseline and 3-year follow-up (acuity, low luminance acuity, photopic and mesopic contrast sensitivity, mesopic and scotopic light sensitivity, and rod-mediated dark adaptation [RMDA] at 5 degrees and 12 degrees). The Age-Related Eye Disease Study (AREDS) 9-step classification system defined AMD severity.

Results: In normal aging and intermediate AMD, 6 of 8 visual functions had statistically significant worsening over 3 years; mesopic contrast sensitivity and mesopic light sensitivity, respectively, showed no change. In early AMD, five of eight visual functions showed worsening over time, with photopic and mesopic contrast sensitivity and scotopic sensitivity unchanged. The largest percentage of eyes in each group meeting MCID was RMDA at 5 degrees or 12 degrees (38%-55%). The lowest percentage of eyes meeting MCID was visual acuity and photopic contrast sensitivity (0%-10%).

Conclusions: Whereas most visual functions evaluated have statistically significant worsening over 3 years in normal aging to intermediate eyes, the percentage of eyes reaching MCID was low for most visual functions except RMDA, which met MCID for almost half the eyes.

Translational relevance: The natural history of change in visual function over time in normal aging to intermediate AMD should be characterized in terms of MCID, not only statistical significance.

Purpose: To evaluate treatment group differences in Rasch-calibrated and non-Rasch-calibrated health-related quality-of-life domain scores and visual acuity (VA) across randomized clinical trials of laser versus anti-vascular endothelial growth factor (VEGF) in proliferative diabetic retinopathy.

Methods: We simulated 10,000 randomized controlled trials (RCTs), using random sample-and-replace bootstrapping methods from open-source data obtained from individual patient VA and National Eye Institute Visual Function Questionnaire-25 (VFQ-25) responses in the Diabetic Retinopathy Clinical Research (DRCR) Retina Network Protocol S, comparing ranibizumab with panretinal photocoagulation for proliferative diabetic retinopathy. We calculated Pearson correlation coefficients between treatment group differences in mean VA and mean domain scores and ranked them. We also calculated mean effect sizes for each domain and composite across RCTs.

Results: Correlations between treatment group differences (mean VA vs. mean domain score) in rank order were as follows: Rasch combined, 0.408; Rasch socioemotional, 0.394; original composite, 0.388; near activities, 0.385; Rasch visual function, 0.383; and mental health, 0.380. Correlations were weaker for the remaining 10 domains. The largest effect sizes were found with the original composite, mental health, dependency, and peripheral vision, slightly larger than Rasch combined and Rasch socioemotional scales.

Conclusions: Treatment group differences in Rasch calibrated VFQ-25 domains (visual function, socioemotional, combined) had the highest correlation with differences in VA, although the original multidimensional non-Rasch composite and near activities were similar.

Translation relevance: Use of Rasch calibrated scores is recommended for desirable psychometrics, but it may be acceptable to use the raw scored original composite instrument.

Purpose: This work aims to evaluate the relative contribution of the amplitude and phase of both ON- and OFF-pathway biased steady-state visually evoked potentials (SSVEPs) to the classification of patients with glaucoma from healthy controls.

Methods: SSVEPs were recorded for sawtooth luminance increments (ON-biasing) and decrements (OFF-biasing), modulating at a temporal frequency of 2.73 Hz. SSVEP data from 98 adults with glaucoma and 71 controls were used to train a set of logistic regressions. Data were partitioned prior to training to investigate the relative contribution to classification for amplitude and phase features derived from ON- versus OFF-pathway stimulation.

Results: We report moderate overall classification accuracy (area under the curve ∼0.7). Classification based solely on signal phase features significantly outperformed classification based solely on signal amplitude features. Classification using OFF-pathway biasing features produced a statistically significant improvement in classification only when training on signal amplitude features. This OFF advantage was not conserved in a dataset with low signal-to-noise eyes removed.

Conclusions: Our findings highlight the informational value of signal phase, a metric often omitted in applications of the SSVEP to glaucoma and other optic neuropathies. Additionally, our results suggest that OFF-pathway amplitude features may be less vulnerable to the limitations imposed by a low signal-to-noise ratio. However, they are not indicative of a gross difference in glaucoma classification performance between ON- and OFF-pathway biased features.

Translational relevance: Electrophysiological estimates of visual signal delay should be considered in future clinical diagnostic tools as they make a material contribution to the classification of glaucomatous eyes.

Purpose: The purpose of this study was to evaluate the accuracy of large language model (LLM) LLaMA 2-70B in summarizing glaucoma clinic notes into patient-friendly language and generating educational material.

Methods: A random sample of 147 clinic notes from unique patients who visited Glaucoma Service at a tertiary center was analyzed. LLaMA 2 generated paragraph and bullet-point summaries in five subjects: (1) glaucoma diagnosis and type, (2) disease progression, (3) treatment plan, (4) treatment changes, and (5) surgical/laser interventions. Two ophthalmologists reviewed responses for accuracy and categorized them as "correct," "partially correct," or "incorrect." Discrepancies were adjudicated by a glaucoma specialist. A comparison using identical prompts was performed on a subset (n = 50) with ChatGPT-4.

Results: LLaMA 2 correctly summarized 97 notes (66%) in paragraph and 103 (70%) in bullet format. Another 44 (30%) and 41 (28%) were partially correct, respectively. Paragraph summaries were more accurate and complete for glaucoma suspects than diagnosed patients (82% vs. 53%, P < 0.001). For targeted clinical questions, LLaMA 2 accurately identified glaucoma diagnosis in 118 notes (80%), disease stability/progression in 129 (88%), treatment plans in 127 (87%), treatment changes in 134 (91%), and surgical/laser interventions in 124 (84%). ChatGPT-4 achieved 46% correct paragraph summaries, 50% correct bullet summaries, and accuracies of 96%, 88%, 64%, 78%, and 82%, respectively, for targeted questions.

Conclusions: Although LLaMA 2 is not yet reliable as a standalone clinical tool, it shows promise to improve clinical communication.

Translation relevance: LLMs may enhance patient experience and health literacy by standardizing patient-friendly language in clinical care.

Purpose: To evaluate the 1-year progression of retinal capillary nonperfusion in eyes with mild to severe nonproliferative diabetic retinopathy (NPDR) using noninvasive retinal imaging.

Methods: The CHART study (Clinicaltrials.gov: NCT04636307) is a multicenter, observational, longitudinal study involving five European research centers and included 202 eyes from 155 participants with type 2 diabetes and mild to severe NPDR. Participants underwent comprehensive ophthalmologic examinations at baseline and 3, 6, and 12 months, including best-corrected visual acuity, color fundus photography (Early Treatment Diabetic Retinopathy Study [ETDRS] severity scale), optical coherence tomography (OCT), and OCT angiography (OCTA). Disease progression was evaluated using mixed-effects models.

Results: Of the 202 eyes, 81 eyes were graded as ETDRS level 35, 63 eyes as level 43, 46 eyes as level 47, and 12 eyes as level 53. At baseline, significant differences were observed in OCTA metrics between diabetic retinopathy severity groups. A total of 169 eyes (84%) completed the 1-year follow-up. Over 1 year, eyes with ETDRS levels 35 and 43 showed significant increases in capillary nonperfusion, identified by decreases in skeletonized vessel density in the superficial capillary plexus (rates of progression: β = -0.217 mm-1/y, P = 0.006 and β = -0.310 mm-1/y, P = 0.002, respectively). Eyes with level 47 showed only a borderline statistically significant decrease (P = 0.074), while eyes with level 53 remained stable. Microaneurysm turnover (MAT), formation, and disappearance rates increased in more severe NPDR stages (levels 47 and 53).

Conclusions: Retinal capillary nonperfusion progresses significantly over 1 year in mild to moderate NPDR, identified by changes in rates of progression of vessel and perfusion densities. In more severe stages (levels 47 and 53), capillary nonperfusion stabilizes, and a hyperperfusion response is identified by increases in MAT associated with the development of intraretinal microvascular abnormalities.

Translational relevance: This study provides quantitative data on 1-year progression of retinal capillary nonperfusion in NPDR using noninvasive imaging, offering the basis for future interventional trials.

Purpose: Current methods for evaluating scleral staphyloma morphology fail to provide curvature data of global scleral deformation. This study aimed to develop a quantitative method based on discrete differential geometry for analyzing scleral deformation caused by staphyloma.

Methods: This study retrospectively analyzed 128 eyes of 73 patients with pathological myopia. All patients underwent orbital magnetic resonance imaging and three-dimensional (3D) reconstruction. The discrete Gaussian curvature measures (DGCMs) and discrete mean curvature measures (DMCMs) of all vertices on the ocular 3D model were calculated. We further established a computational method for the degree of scleral staphyloma expansion (E/U ratio).

Results: The posterior scleral DGCM (pDGCM) and DMCM (pDMCM) standard deviations (SDs) were significantly greater in the staphyloma group than in the non-staphyloma group (0.069 ± 0.026 vs. 0.025 ± 0.005 and 0.335 ± 0.096 vs. 0.154 ± 0.027, respectively; both P < 0.0001). The E/U ratio was strongly linearly correlated with both the pDGCM and pDMCM SDs (both P < 0.01). For staphyloma diagnosis, the areas under the receiver operating characteristic (ROC) curves for pDGCM and pDMCM SDs were 0.994 (95% confidence interval [CI], 0.984-1.000) and 0.993 (95% CI, 0.982-1.000), respectively (both P < 0.001).

Conclusions: The variation in the curvature of the posterior sclera is significantly greater in eyes with staphyloma than in those without. This variation is highly specific and sensitive for staphyloma diagnosis.

Translational relevance: This method, based on discrete differential geometry, enables the direct quantification of scleral deformation, potentially providing a quantitative basis for the diagnosis and evaluation of staphyloma.

Purpose: Posterior capsule opacification (PCO) rates are higher in young cataract patients compared to adults, a phenomenon attributed to a higher proliferative potential of young lens epithelial cells (LECs). This study investigates the hypothesis that implanting standard (adult-sized) intraocular lenses (IOLs) in pediatric patients, whose lenses are smaller and more spherical, results in a low contact between the IOL and the posterior lens capsule (PLC), thus contributing to elevated pediatric PCO rates.

Methods: Simulated PLCs (sPLC) modeling the size and curvatures of human lenses of eight-year-old (8y-sPLC), 25-year-old (25y-sPLC), and 65-year-old (65y-sPLC) individuals were fabricated. The physical interactions between standard IOL and the sPLCs were quantified using optical coherence tomography (OCT) and adhesion force testing. Furthermore, the influence of age-dependent lens shape on young and adult primary mouse LEC responses (infiltration, proliferation, and epithelial-mesenchymal transdifferentiation [EMT]) was investigated.

Results: The 8y-sPLC exhibited the least contact with IOLs, followed by 25y-sPLC and 65y-sPLC. Consequently, despite an inherent difference in cell activity, both young and adult LECs exhibited higher responses at the IOL-8y-sPLC interface compared to the 25y- and 65y-sPLC interfaces. Regression analyses confirmed that low IOL-PLC contact, observed only with 8y-sPLC, accompanied by higher cell responses from both young and adult LECs.

Conclusions: The findings suggest that the mismatch in size and curvature between pediatric PLCs and standard IOLs may be a key factor contributing to higher PCO rates observed in young cataract patients.

Translational relevance: Our findings provide foundational knowledge for designing age-specific IOLs that optimize IOL-PLC contact, potentially reducing pediatric PCO incidence.