Eye and Brain最新文献

Artificial intelligence (AI) is rapidly reshaping neuro-ophthalmic care by extracting clinically significant information from imaging, biomarkers, and patient-level clinical data. We review recent advances across neurodegenerative disease detection using retinal biomarkers, automated recognition of optic disc swelling and its mimics, glaucoma screening and quantification, and classification of hereditary optic neuropathies. Using fundus photography and optical coherence tomography (OCT), contemporary machine learning (ML) systems, including deep learning as well as other supervised learning models, report strong discrimination for papilledema versus pseudopapilledema, non-arteritic anterior ischemic optic neuropathy (NAION) against similar presenting entities, and glaucomatous damage including indirect estimation of retinal nerve fiber layer (RNFL) thickness. Early work also suggests that retinal features can aid detection of mild cognitive impairment (MCI) and major neurocognitive disease. However, despite promising results, most studies remain retrospective and single-center, while focusing on imaging-only, limiting generalizability and clinical interpretability. Therefore a variety of challenges related to dataset heterogeneity, overfitting, limited external validation, and the gap between high diagnostic accuracy and practical clinical utility remain unresolved. Future prospective, multicenter evaluations focusing on integrating multimodal clinical data through explainable AI systems are necessary to improve diagnostic consistency, shorten time to care, and expand access for underserved populations.

Introduction: Precortical vision loss remains a major global health challenge. Advances in brain-computer interfaces (BCIs) offer a new pathway towards restoring functional vision by bypassing damaged structures in the visual pathway.

Methods: This narrative review aims to synthesize the current evidence on BCIs for precortical vision recovery, including non-invasive and invasive techniques. Device design, testing, and outcomes are discussed, with an emphasis on developments in technology and engineering.

Results: Non-invasive BCIs induce neuroplasticity and may restore vision in conditions of precortical vision loss such as glaucoma and optic neuropathy. Cortical visual prostheses demonstrate the ability to evoke visual precepts and recover functional vision. Integration of artificial intelligence and high-density electrode arrays has improved image encoding and device adaptability to enhance user experience and rehabilitation potential. Patient selection, safety, and long-term outcomes remain active areas of investigation.

Discussion: BCIs present a paradigm shift in treating precortical blindness that offers hope for patients with no alternative options. Yet, challenges persist, including surgical risks, durability, and variability in response. Personalization of stimulation protocols and further technical refinement are needed to optimize efficacy and accessibility.

Conclusion: BCIs are a promising experimental modality for precortical vision restoration. Continued research and interdisciplinary collaboration are essential to address current limitations.

Background: Idiopathic intracranial hypertension (IIH) is an enigmatic syndrome of raised intracranial pressure and papilledema with metabolic underpinnings, although the exact etiology remains obscure. We aimed to evaluate routine blood and cerebrospinal fluid (CSF) markers covering several organ systems in newly diagnosed IIH and compared to controls.

Methods: We registered the results of routine blood and CSF analyses in patients consecutively included in a prospective cohort by clinically suspected IIH. We compared females with confirmed IIH (2013 criteria) to "IIH mimics" in whom IIH was refuted (controls). We excluded patients with secondary pseudotumor cerebri syndrome, pregnancy, IIH relapse, age >50 years, male sex, other significant disease, or use of medications associated with multiorgan biochemical abnormalities with a prevalence of >1%.

Results: We compared 139 females with IIH to 78 controls of similar sex, age, and body mass index (BMI). In IIH, we found relatively higher plasma levels of leukocytes (p=0.02), neutrophils (p=0.04), and alkaline phosphatase (p=0.03), and lower levels of plasma urea (p=0.04) and CSF protein (p=0.02). Leukocytes and neutrophils correlated with lumbar opening pressure and were significantly higher in severe papilledema. Findings were not explained by BMI, smoking, or statistically influential covariates.

Conclusion: In a well-defined prospective cohort of newly diagnosed IIH restricted by careful censoring of secondary cases and confounding factors, we found relatively increased systemic inflammation in plasma which correlated with markers of more severe IIH disease activity. IIH is likely a heterogeneous and complex disease in which inflammation seems to be involved.

Diagnosing and treating ocular malignancies-such as uveal melanoma, retinoblastoma, intraocular lymphoma, and conjunctival tumors-can be very difficult given their rarity, complicated pathophysiology, and a high potential for complications that threaten vision or life. Traditional treatments such as chemotherapy, radiation, and surgery result in limited clinical value because of systemic toxicity, versatile drug resistance, and insufficient local control. Exosomes (EXOs)-naturally occurring nanoscale vesicles held in biocompatible structures-represent a uniquely advantageous platform for targeting and delivering miRNAs, proteins and/or gene editing molecules across ocular barriers to create corrective, sustained, and targeted diagnostics, drug delivery, and immune modulation. Mesenchymal stem cell-derived exosomes (MSC-EXOs) also possess regenerative potential in both animal and human models of retinal and ocular injury, engaging biological pathways involved in modulating inflammation and neuroprotection such as HMGB1 and PI3K/AKT pathways. While the use of EXOs presents a promising option for ocular treatment application, several factors complicate actual clinical translation, including standardization of isolation, scalable manufacture, and regulatory issues. In general, EXO-based nanomedicine may be a promising new direction for precision therapy and regenerative ophthalmology with the increasing introduction of synthetic and bioengineered EXOs introducing precursor paving new avenues for clinically scalable and biologically customizable EXO therapeutics.

Purpose: Women with preeclampsia are at risk of developing cognitive changes and dementia later in life. The retina - an extension of the brain - may provide insight about structural changes associated with preeclampsia and serve as a biomarker of long-term neural and vascular consequences. Our goal was to compare retinal thickness measurements between women with and without history of preeclampsia, and to determine associations with cognitive performance.

Patients and methods: This prospective cohort study recruited preeclampsia (N=17) and normotensive (N=18) women 10-15 years after delivery. We assessed retinal thickness using spectral-domain optical coherence tomography (SD-OCT). Principal component analysis was used to detect retinal regional patterns. Cognitive performance was evaluated to assess memory (Wechsler Memory immediate and delayed), working memory-Letter-Number Sequencing, information processing speed (Digit Symbol, Stroop Word and Color) and executive (WAIS similarities, matrix reasoning, and Stroop interference) domains. Regression models estimated associations between retina measurements, preeclampsia history and cognitive performance.

Results: Using the standard early treatment diabetic retinopathy study grid, compared to normotensive, preeclampsia women had thinner outer retina subfields. Similarly, two out of three principal components suggested different patterns of retinal changes at the outer vs central region. The thinner inner nasal and superior quadrants were associated with lower scores on the executive function domain - Stroop Color test (β=12.2, p=0.032; β=12.9, p=0.037, respectively). In the memory domain, Letter-Number sequencing test, preE history significantly altered the relationship with the maximum fovea central subfield (β=-17.3, p=0.013).

Conclusion: Our study provides a novel, integrated assessment of preeclampsia by simultaneously evaluating retina and cognitive markers. Retinal imaging 10-15 years after delivery in women with a history of preeclampsia showed a decreased thickness in the outer region of the retina. Selective vulnerability of peripheral retinal regions to persistent microvascular changes after preeclampsia may reflect broader central nervous system changes associated with impairments in information processing speed, executive functioning and working memory.

Introduction: Repetitive head impacts (RHIs) and visual system dysfunction are often associated. Interventions to prevent or limit visual deficits following RHIs are not well understood. This study examined visual structure and function following exposure to RHIs and the effectiveness of a supplemental intervention of macular pigment carotenoids (MPCs) and omega-3 fatty acids in attenuating visual changes from pre- to post-season in collegiate rugby players. Additionally, blood biomarkers associated with neurodegeneration were examined.

Methods: Optical coherence tomography measured visual structure through ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) thickness. Bioavailability of the supplement was assessed through skin carotenoid concentration (SC). Contrast sensitivity (CS) and critical flicker-fusion frequency (CFF) were used to measure visual function. NF-L, GFAP, Tau, and UCH-L1 concentrations in blood samples were analyzed.

Results: Thirty-one rugby players (15M/16F; 19±1.4 years) were randomly assigned to supplement (n = 15) or placebo (n = 16) groups. Left eye GCC inferior region was thinner at post-season in supplement (102.1±4.4 vs 102.9±4.7 μm; p = 0.002) and placebo groups (101.4±5.3 vs 102.6±5.0 μm, p < 0.001). The supplement group had a higher SC score at post-season versus the placebo group (409.2±76.3 vs 323.4±61.3; p = 0.04). With regards to visual function, CFF approached a significant increase in the supplemental group versus placebo (27.6±1.8 vs 25.7±2.2 Hz, p = 0.08), but there were no differences found between groups in MPOD or CS. NF-L was different at post-season in the placebo (10.05 vs 7.21 pg/mL; p = 0.003) but not the supplement group (7.07 vs 7.78 pg/mL; p = 0.40). Tau was different between groups at pre- (1.2 vs 0.87 pg/mL; p = 0.04) and post-season (1.33 vs 1.01 pg/mL; p = 0.02) with greater concentrations in the supplement group. GFAP and UCH-L1 were not different. One season of collegiate rugby resulted in retinal thinning and increased concentrations of NF-L and Tau. Supplementation with MPCs and omega-3s may be useful in limiting retinal thinning and preventing increases in biomarkers of neurodegeneration.

Dementia and cataract are two of the most prevalent conditions in older adults, together representing a substantial global health burden. Increasing evidence suggests a potential link between cataract and dementia, and this narrative review synthesizes current epidemiological and mechanistic evidence on their association. Recent cohort and case-control studies report a modestly increased risk of dementia in individuals with cataracts, though inconsistencies persist across populations. Mechanistic insights highlight roles for visual impairment and protein aggregation in this association. Importantly, cataract surgery shows a robust, protective effect against incident dementia, potentially via restoration of sensory input and enhanced cognitive engagement. Future studies may examine longitudinal, multi-ethnic cohorts that integrate genetic, imaging, and molecular data to investigate causality and the underlying biological mechanisms. In summary, our narrative review shows that cataract and dementia may be linked through multifactorial pathways, and maintaining visual health, particularly through timely cataract surgery, represents a potentially modifiable factor in dementia prevention strategies.

Purpose: Microgravity-induced headward fluid shifts are one of the mechanisms implicated in spaceflight-associated eye conditions, including intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness changes. In this longitudinal study, we investigated IOP and RNFL thickness changes over time in a mouse model of microgravity-induced headward fluid shifts.

Methods: The study involved 20 adult male B6(Cg)-Tyr ^{c -2J} /J mice, randomly assigned to two groups: the hindlimb unloading (HU) mice, unloaded for 21 days followed by 14 days of release, and control mice kept under the same conditions except HU for 35 days. IOP and RNFL thickness in peripapillary and peripheral rings of right and left eyes were measured before and once a week after HU. Our analysis utilized mixed linear models to compare the estimated marginal means of IOP and RNFL thickness on each day with baseline values for each eye. Post hoc splined mixed linear models with a knot at day 14 were employed to assess the rate of IOP change in each segment.

Results: IOP was significantly elevated in both eyes of the HU mice on day 14 compared to baseline. The splined analysis revealed a bilateral positive rate of IOP change up to day 14, followed by a negative rate of change thereafter. In contrast, control mice displayed no significant differences in IOP at any timepoint. RNFL thicknesses of right eye peripapillary and peripheral rings were reduced after 1 week and 2 weeks, respectively. In contrast, left eye RNFL thickness measurements did not show any significant change compared to baseline.

Conclusion: The HU mouse model displays a distinct ocular phenotype that may be useful for understanding IOP and RNFL changes in microgravity and their relevance to Spaceflight-Associated Neuro-ocular Syndrome.

Idiopathic Intracranial Hypertension (IIH) is characterized by elevated intracranial pressure in the absence of secondary causes. The treatment of IIH entails a combination of lifestyle modifications, medical therapy, and surgical intervention. This article aims to evaluate the role of acetazolamide in the treatment of IIH and identify its mechanism of action, efficacy, and side effect profile. This article also aims to discuss acetazolamide's role in conjunction with other treatment modalities.

Purpose: To investigate the impact of mild visual acuity loss on the Müller-Lyer illusion in adults and evaluate its potential as a clinical indicator for visual-cognitive integration mechanisms.

Methods: Three experiments were conducted. Experiment 1 measured illusion intensity in 49 young adults (25.08 ± 3.38 years) before and after inducing transient visual acuity loss (0.40 logMAR) via Bangerter occlusion foils. Experiment 2 compared 26 cataract patients (65.19 ± 3.87 years) with 59 age-matched controls (63.98 ± 5.57 years). Experiment 3 tracked 14 cataract patients (69.50 ± 6.14 years) pre- and post-surgery. Illusion intensity was quantified using a two-alternative forced-choice task.

Results: Illusion intensity remained stable across conditions: no differences were observed before /after wearing occlusion glasses (4.33% vs 3.75%, p = 0.141), between cataract patients and controls (8.79% vs 8.20%, p = 0.301), or pre-/post-surgery (9.46% vs 9.87%, p = 0.357). However, normally-sighted elderly participants exhibited stronger illusions than young adults (8.20% vs 4.33%, p < 0.001). Multivariate regression confirmed age as the sole predictor of illusion intensity (β = 0.088, p = 0.001), independent of visual acuity.

Conclusion: The intensity of Müller-Lyer illusion in adults is modulated by age but resistant to mild visual acuity loss, implicating its utility in studying visual-cognitive integration.