Translational Vision Science & Technology最新文献

Purpose: This work characterizes two extended-depth-of-focus (EDoF) intraocular lenses, the Alcon IQ Vivity and the Bausch & Lomb LuxSmart, using virtual retinal imaging. A simulation-based examination tests these lenses under various conditions, while including dispersion and color effects.

Methods: A custom sequential Monte-Carlo Ray Tracer simulates the propagation of a broadband daylight spectrum through a mathematical eye model. Realistic color images of a pinhole and resolution chart were generated, with variations in object distances and pupil size. A comparison is made with the monofocal Alcon IQ to highlight the benefits of EDoF models.

Results: Simulated images clearly demonstrate the superior acuity and reduced aberrations of these lenses at intermediate vision. There are notable differences between both models: the LuxSmart lens exhibits an increased depth-of-focus under both mesopic and photopic conditions. Conversely, the IQ Vivity lens shows minimal aberrations for far vision under mesopic conditions, making it ideal for night-time driving, albeit with a lesser depth-of-focus compared to the LuxSmart.

Conclusions: Our in silico investigation proves to be a valuable tool for evaluating intraocular lens performance. This study underscores the importance of characterizing lenses under both photopic and mesopic conditions and highlights the impact of chromatic aberration and color vision.

Translational relevance: The simulation-based approach expands the range of methods for assessing intraocular lenses. By providing realistic images, it allows both ophthalmologists and patients to more intuitively understand the aspects of these lenses. The simulation derives visual predictions from a purely mathematical model, thus bridging the gap from technology to clinical application.

Purpose: To investigate the clinical features, antifungal susceptibility patterns, and treatment outcomes of pediatric fungal keratitis (FK) at a tertiary eye center in North China.

Methods: A retrospective study of pediatric FK cases diagnosed between July 2000 and October 2023 at Beijing Tongren Hospital, confirmed by fungal culture or microscopy. Data on demographics, predisposing factors, clinical signs, microbiological findings, treatment, and prognosis were analyzed.

Results: Eighty-eight pediatric FK cases (66 males, 22 females; mean age 10.8 ± 2.3 years) were collected. Trauma history (35.2%) was primarily from toys and writing tools. Dense infiltrates (100%), feathery margins (69.2%), and multifocal lesions (38.5%) were the common features. Hypopyon was less frequent (15.5%); no endothelial plaques, collar-button lesions, and pigment deposits were observed. Fusarium (43.9%) and Aspergillus (25.8%) were the predominant isolates. Amphotericin B demonstrated both in vitro and clinical efficacy. Treatment duration (median 48.1 days) varied by risk factors (P < 0.001), age (P = 0.013), and fungal type (P = 0.016). Multivariate analysis identified ocular surgery (hazard ratio [HR] = 0.04, P < 0.001) and toddler age (HR = 3.67, P = 0.013) as the strongest predictors of prolonged and faster treatment duration, respectively.

Conclusions: Trauma is the leading risk factor of pediatric FK in North China, with Fusarium and Aspergillus being the predominant pathogens. Amphotericin B is the most effective antifungal, and early diagnosis and treatment are critical for improving outcomes.

Translational relevance: This study provides evidence-based data on fungal trends, antifungal susceptibility, and treatment outcomes, guiding optimal drug selection and therapeutic strategies to reduce visual impairment in pediatric FK.

Purpose: This study was based on the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR) to explore the link between cataract and urinary sodium-potassium ratio (Na/K) ratio.

Methods: This study included 3,482 subjects from the 2003 to 2006 survey, with 305 cataract patients and 3177 controls. Baseline characteristics were analyzed using weighted χ2 or t-tests. Three models and stratified analyses assessed the association between Na/K ratio and cataracts. Receiver operating characteristic (ROC) curves and a k-nearest neighbor (KNN) model were used to evaluate the predictive value of the Na/K ratio for cataracts. MR analysis was conducted to explore the causal relationship between Na/K ratio and cataracts.

Results: The Na/K ratio was significantly higher in cataract patients (P < 0.001). Three models-Model 1 (P = 2.64 × 10-5, odds ratio [OR] = 0.860), Model 2 (P = 3.60 × 10-4, OR = 0.872), and Model 3 (P = 5.14 × 10-3, OR = 0.895)-and stratified analyses (P = 0.00514, OR = 0.900) showed a significant association with cataract. The ROC curve (area under the curve value = 0.790) and KNN model confirmed the strong predictive value of the Na/K ratio. MR analysis indicated a causal relationship with cataract, suggesting the Na/K ratio as a protective factor.

Conclusions: The present study demonstrated a remarkable causal relationship between Na/K ratio and cataract, offering a new direction for the diagnosis and treatment of cataract.

Translational relevance: Using MR with NHANES, causal hypotheses from basic research can be validated in a broader population, advancing personalized treatment in clinical care.

Purpose: Perfluorocarbon liquid (PFCL) is widely used in retinal surgery; however, it can be complicated by subretinal retention that can affect/threaten fovea. A number of different approaches have been explored to remove retained PFCL. Here, we investigate the use of microneedles with internal diameters as small as 49 G.

Methods: An in vitro model was used to examine the rate of aspiration of a fixed volume of 250 µL PFCL, whereby 30, 41, 43, and 49 gauge needles were examined. An ex vivo porcine model was then used to confirm whether subretinal PFCL could be consistently aspirated without blockage. Finally, this technique was used during pars plana vitrectomy (PPV) in 10 patients presenting with subfoveal or parafoveal retained PFCL.

Results: Mean aspiration of 250 µL PFCL required 0.22, 0.33, and 0.78 minutes for the 30, 41, and 43 gauge needles at 200 mm Hg extraction pressure. Microneedle aspiration of 250 µL required maximal vacuum settings of 650 mm Hg to obtain a measurable average time to aspiration of 3.34 minutes. Ex vivo aspiration of subretinal PFCL required 400-650 mm Hg vacuum, where this was repeatable without any needle blockage. In 10 patients treated with PPV and microneedle subretinal PFCL aspiration, all cases were successful. Mean visual acuity change was of LogMAR -0.08 (±0.12).

Conclusions: We recommend the clinical use of microneedles as a minimally invasive surgical option when considering direct retained PFCL removal.

Translational relevance: We confirmed the flow properties of microneedles for PFCL aspiration in vitro and ex vivo before successfully applying this to treat retained PFCL in patients.

Purpose: To validate the accuracy of a lens-viewpoint extraction method and demonstrate its feasibility for tracking users' visual behavior on progressive addition lenses (PALs). This aims to provide a quantifiable fitting solution for PAL wearers in the future.

Methods: We evaluated a method using eye-tracking technology to extract the viewpoint on the lens, implemented with a self-made setup. Accuracy verification experiments were performed using a mechanical artificial eye, and a clinical test on 10 subjects was performed to assess the accuracy of the method and explored its feasibility.

Results: The accuracy of the lens-viewpoint extraction method was verified to be 0.21 ± 0.06 mm and 0.30 ± 0.07 mm on the lens in the mechanical artificial eye experiment and clinical test, respectively. An exemplary analysis of user eye behavior on the lens was provided.

Conclusions: These results demonstrate that the lens-viewpoint extraction method achieves high accuracy and is feasible for tracking users' personalized visual habits on the lens.

Translational relevance: The lens-viewpoint extraction method introduced in this study shows significant potential for providing a quantifiable solution to improve wearing comfort for the presbyopia population, holding important translational value in the field of precision optometry.

Purpose: To quantify determinants of intergrader agreement for key retinal photography and optical coherence tomography (OCT) biomarkers in early to intermediate age-related macular degeneration (AMD) and to inform future consensus definitions and grading protocol.

Methods: Single eyes from 269 participants with early to intermediate AMD were consecutively sampled. Retinal photographs were evaluated for the presence of large drusen and pigmentary abnormalities. OCT B-scans were graded for reticular pseudodrusen (RPD), outer retinal band abnormality (external limiting membrane [ELM], ellipsoid zone [EZ], and retinal pigment epithelium [RPE]), nascent geographic atrophy (nGA), intraretinal hyperreflective foci (IHRFs), hyporeflective drusen cores (hDCs), shallow irregular RPE elevations (SIREs), and drusenoid pigment epithelial detachment (DPED). Biomarkers were classified using a trinary certainty system: "definitely present" (≥90%), "questionably present" (50%-90%), or "absent" (<50%). The main outcome was odds of intergrader agreement from generalized estimating equations adjusting for intraparticipant correlations, biomarker type, and eye- and participant-level factors.

Results: Odds of agreement were comparable for large drusen, nGA, RPE abnormality, IHRF, and ELM abnormality; higher for RPD (odds ratio [95% confidence interval], 3.17 [1.56-6.45], P < 0.01); and lower for SIRE, EZ abnormality, pigmentary abnormalities, hDC, and DPED (up to 0.5 [0.32-0.78], P < 0.01). Agreement improved with higher grading certainty (1.4 [1.22-1.6], P < 0.0001) but declined with age (per decade, 0.8 [0.7-0.93], P < 0.01).

Conclusions: Biomarker type, grading certainty, and participant age influence OCT agreement. Consensus definitions and grading protocols, including the use of high certainty thresholds (≥90%), may improve consistency.

Translational relevance: Implementing consensus definitions and protocols can improve agreement and strengthen the clinical utility of OCT biomarkers in AMD.

Purpose: Diabetic retinopathy (DR) is a leading cause of blindness. Fundus lesions are key clinical signs of DR, and their accurate segmentation is crucial for screening, grading, and monitoring the disease. However, segmenting different lesions simultaneously is challenging owing to their varying shapes, sizes, and appearances. This work aimed to segment four types of DR lesions simultaneously.

Methods: We propose a shallow-deep collaboration network with a wavelet-guided attention mechanism for simultaneous segmentation of four DR-related lesions. Our end-to-end framework integrates shallow and deep networks to enhance multiscale feature extraction. The deep network uses a wavelet-based attention mechanism to fuse multiscale context representations. Additionally, a super-resolution auxiliary task is introduced to improve training accuracy.

Results: Extensive experiments are conducted on the IDRiD, DDR, and FGADR public datasets for evaluation. The average Dice scores of SDC-Net on the three datasets are 60.27, 39.98, and 42.57, with average intersection over union scores of 44.53, 25.71, and 28.58, and average area under the receiver operating characteristic curve values of 68.75, 57.37, and 64.21.

Conclusions: The dual-branch design in the proposed framework enables better capture of multiscale features and improves segmentation. The dual wavelet attention module of the deep branch can enhance the extraction of detailed lesion features, and the introduced super-resolution task further improves the accuracy and robustness.

Translational relevance: The SDC-Net framework has the potential to enhance the clinical diagnosis of DR by offering more precise segmentation of multiple types of fundus lesions, thereby aiding in early detection and management of the disease.

Purpose: The purpose of this study was to introduce novel dynamic structural parameters and evaluate their integration within a multimodal deep learning (DL) framework for predicting postoperative visual recovery in patients with idiopathic full-thickness macular hole (iFTMH).

Methods: We utilized a publicly available longitudinal optical coherence tomography (OCT) dataset at five stages (preoperative, 2 weeks, 3 months, 6 months, and 12 months). A stage-specific segmentation model delineated related structures, and an automated pipeline extracted quantitative, composite, qualitative, and dynamic features. Binary logistic regression models, constructed with and without dynamic parameters, assessed their incremental predictive value for best-corrected visual acuity (BCVA). A multimodal DL model combining clinical variables, OCT-derived features, and raw OCT images was developed and benchmarked against regression models.

Results: The segmentation model achieved high accuracy across all time points (mean Dice ≥ 0.89). Univariate and multivariate analyses identified base diameter, ellipsoid zone integrity, and macular hole area as significant BCVA predictors (P < 0.05). Incorporating dynamic recovery rates consistently improved logistic regression area under the receiver operating characteristic curve (AUC), especially at the 3-month follow-up. The multimodal DL model outperformed logistic regression, yielding higher AUCs and overall accuracy at each stage. The difference is as high as 0.12, demonstrating the complementary value of raw image volume and dynamic parameters.

Conclusions: Integrating dynamic parameters into the multimodal DL model significantly enhances the accuracy of predictions. This fully automated process therefore represents a promising clinical decision support tool for personalized postoperative management in macular hole surgery.

Translational relevance: The integration of dynamic OCT-derived structural parameters into the multimodal DL framework enables personalized prediction of visual outcomes after macular hole surgery.

Purpose: The purpose of this study was to investigate the characteristics of sustained drug release systems established by polylactic acid (PLLA)/RGD/mitomycin C (MMC) electrospun nanofiber membrane in vitro, and confirm its anti-scarring effect in a rabbit model of glaucoma filtration surgery (GFS).

Methods: In vitro experiments: (1) PLLA/RGD/MMC nanofiber membrane drug delivery system was prepared by electrospinning technology. (2) Characterization of nanofiber membrane. (3) Biocompatibility detection of nanofiber membrane. In vivo experiment: construct a surgical model for rabbit eye GFS, divided into four groups: the control group, the PLLA/RGD membrane group, the 0.4 mg/mL MMC group, and the PLLA/RGD/MMC membrane group. The morphology of filtering blebs and wound healing were observed on the 7th, 14th, and 28th days after the operation. At 28 days after the operation, histological and immunohistochemical staining were performed to observe the scar formation. Finally, the results were statistically analyzed.

Results: The composition, structure, hydrophily, thermal behaviors, degradability, and mechanical properties of the membrane were investigated in detail. In vitro cell culture assay indicated that the PLLA/RGD/MMC2 membrane could release MMC in a sustained manner for over 25 days. In vitro cell culture assay proved the superior cytocompatibility of the membrane with Human embryonic Tenon's capsule fibroblasts (HFTFs). Histology and immunohistochemistry indicated that the membrane could efficiently inhibit scaring formation after GFS and showed significant advantage over the conventional MMC cotton pad.

Conclusions: The as-prepared PLLA/RGD/MMC membrane could be a potential candidate for inhibiting scaring formation after GFS in the future.

Translational relevance: This work shed some light to the developments and applications of MMC loaded electrospinning membrane for inhibiting postoperative fibrosis in GFS.

Purpose: To evaluate the associations of hypertension history, blood pressure (BP) levels, and parameters with retinal vascular occlusion (RVAO) risk, and to identify potential mediating plasma proteins.

Methods: The cohort study used data from 439,057 UK Biobank participants. Multivariable Cox regression was used to evaluate associations between incident RVAO and exposures: hypertension history (with stratification of control status and disease duration), hypertension stages (per 2017 guidelines), systolic BP (SBP), diastolic BP (DBP), mean arterial BP (MABP), and pulse pressure (PP). Mendelian randomization (MR) was subsequently used to assess causality and identify mediating plasma proteins.

Results: In observational analysis, hypertension history (uncontrolled and long/unknow duration), stage 1 hypertension, stage 2 hypertension, higher BP parameters (SBP, MABP, and PP) were associated with an increased risk of RVAO, whereas DBP showed no significant association. The MR analysis supported the causal relationships for hypertension history and SBP but not for DBP. Six plasma proteins were identified as potential mediators for the hypertension history, with secretory leukocyte peptidase inhibitor (SLPI) explaining the largest proportion of the effect (13.3%). Ankyrin Repeat and SOCS Box Containing 9 (ASB9) was found to mediate the effects for both hypertension history (3.56%) and SBP (4.31%) to RVAO.

Conclusions: Hypertension history and elevated SBP were significant risk factors for RVAO. Specific plasma proteins, notably SLPI and ASB9, may serve as mediators and represent potential targets for therapeutic intervention.

Translational relevance: The identification of mediating plasma proteins, such as SLPI and ASB9, provides novel therapeutic targets and biomarkers for preventing RVAO among individuals with hypertension.