Vision Latest open access articles published in Vision at https://www.mdpi.com/journal/vision https://www.mdpi.com/journal/vision MDPI en Creative Commons Attribution (CC-BY) MDPI support@mdpi.com Vision, Vol. 10, Pages 32: Wouldn’t It Be Nice to Not Fall for It Twice? Prior Experience Does Not Abolish the Impact of Expectancy Violations on Attention Capture https://www.mdpi.com/2411-5150/10/2/32 In the current study, the impact of an unexpected color swap (from target to distractor color and vice versa) on reaction times (RTs) and eye fixations was investigated. Within a visual search task, participants reported the location of a shape-defined target letter above or below a distractor letter. Across time, participants learned the consistent relationships between the visual target features (shape and color), establishing an according expectancy. To that end, fixed colors were first assigned to both a fixed-shape target (e.g., red) and a fixed-shape distractor (e.g., green). Next, this expectancy was violated by an unannounced swapping of target- and distractor-associated colors in the critical trial. In addition, subsequent color swaps estimated the costs of better anticipated color swaps. Eye movements showed longer fixation times on the distractor letter during and immediately after the critical trial compared to trials before the color swap (precritical trials), and, in line with prior research, we also found longer RTs in critical trials compared to consecutive (postcritical) trials without color swaps (Experiment 1). Finally, varying the number of distractors per trial indicated no set-size effect (Experiment 2), but again costs for all expectancy violations were found. In sum, our results indicate that humans tend to fall for expectancy violations more than once, and costs associated with color swaps cannot be avoided entirely. 2026-05-29 Vision, Vol. 10, Pages 32: Wouldn’t It Be Nice to Not Fall for It Twice? Prior Experience Does Not Abolish the Impact of Expectancy Violations on Attention Capture

Vision doi: 10.3390/vision10020032

Authors: Isabella Fuchs-Leitner Gernot Horstmann Ulrich Ansorge

In the current study, the impact of an unexpected color swap (from target to distractor color and vice versa) on reaction times (RTs) and eye fixations was investigated. Within a visual search task, participants reported the location of a shape-defined target letter above or below a distractor letter. Across time, participants learned the consistent relationships between the visual target features (shape and color), establishing an according expectancy. To that end, fixed colors were first assigned to both a fixed-shape target (e.g., red) and a fixed-shape distractor (e.g., green). Next, this expectancy was violated by an unannounced swapping of target- and distractor-associated colors in the critical trial. In addition, subsequent color swaps estimated the costs of better anticipated color swaps. Eye movements showed longer fixation times on the distractor letter during and immediately after the critical trial compared to trials before the color swap (precritical trials), and, in line with prior research, we also found longer RTs in critical trials compared to consecutive (postcritical) trials without color swaps (Experiment 1). Finally, varying the number of distractors per trial indicated no set-size effect (Experiment 2), but again costs for all expectancy violations were found. In sum, our results indicate that humans tend to fall for expectancy violations more than once, and costs associated with color swaps cannot be avoided entirely.

]]> Wouldn’t It Be Nice to Not Fall for It Twice? Prior Experience Does Not Abolish the Impact of Expectancy Violations on Attention Capture Isabella Fuchs-Leitner Gernot Horstmann Ulrich Ansorge doi: 10.3390/vision10020032 Vision 2026-05-29 Vision 2026-05-29 10 2 Article 32 10.3390/vision10020032 https://www.mdpi.com/2411-5150/10/2/32 Vision, Vol. 10, Pages 31: Evaluation of the Efficacy of Treatment for Convergence Insufficiency with a New Digital Mobile Platform: A Comparative Preliminary Study https://www.mdpi.com/2411-5150/10/2/31 The objective of this study was to evaluate the efficacy of a novel digital platform (Visitrain VG, Alicante, Spain) as a visual rehabilitation tool for patients with convergence insufficiency (CI), in comparison with conventional in-office vision therapy (VT) supplemented with home reinforcement exercises. A retrospective comparative study was conducted comprising 33 patients diagnosed with CI, allocated into two groups: a digital group (DG; n = 16) receiving treatment with the aforementioned digital platform and a conventional group (CG; n = 17) undergoing conventional vision therapy. Binocular vision clinical parameters were assessed at baseline, one month, and three months of follow-up, including near point of convergence (NPC), positive fusional vergence (PFV), and binocular accommodative facility (BAF). Both groups demonstrated significant improvements following three months (p < 0.050). At the one-month evaluation, the CG showed a more rapid clinical response, with statistically significant between-group differences being observed in the NPC (p = 0.004) and near PFV (p = 0.040) compared with the DG. Nevertheless, at the three-month follow-up, no significant differences were found between the groups (p ≥ 0.060). The digital platform under investigation appears to constitute an effective therapeutic alternative to conventional vision therapy, albeit with a comparatively slower initial clinical response rate. It may be particularly indicated for patients requiring greater scheduling flexibility or those with limited access to in-office clinical care. Prospective controlled clinical trials are warranted to corroborate these preliminary outcomes. 2026-05-17 Vision, Vol. 10, Pages 31: Evaluation of the Efficacy of Treatment for Convergence Insufficiency with a New Digital Mobile Platform: A Comparative Preliminary Study

Vision doi: 10.3390/vision10020031

Authors: Alba Pina-Balofer David P. Piñero Miranda Buigues Carlo Cavaliere-Ballesta Sergio Viudes Laurent Bataille

The objective of this study was to evaluate the efficacy of a novel digital platform (Visitrain VG, Alicante, Spain) as a visual rehabilitation tool for patients with convergence insufficiency (CI), in comparison with conventional in-office vision therapy (VT) supplemented with home reinforcement exercises. A retrospective comparative study was conducted comprising 33 patients diagnosed with CI, allocated into two groups: a digital group (DG; n = 16) receiving treatment with the aforementioned digital platform and a conventional group (CG; n = 17) undergoing conventional vision therapy. Binocular vision clinical parameters were assessed at baseline, one month, and three months of follow-up, including near point of convergence (NPC), positive fusional vergence (PFV), and binocular accommodative facility (BAF). Both groups demonstrated significant improvements following three months (p < 0.050). At the one-month evaluation, the CG showed a more rapid clinical response, with statistically significant between-group differences being observed in the NPC (p = 0.004) and near PFV (p = 0.040) compared with the DG. Nevertheless, at the three-month follow-up, no significant differences were found between the groups (p ≥ 0.060). The digital platform under investigation appears to constitute an effective therapeutic alternative to conventional vision therapy, albeit with a comparatively slower initial clinical response rate. It may be particularly indicated for patients requiring greater scheduling flexibility or those with limited access to in-office clinical care. Prospective controlled clinical trials are warranted to corroborate these preliminary outcomes.

]]> Evaluation of the Efficacy of Treatment for Convergence Insufficiency with a New Digital Mobile Platform: A Comparative Preliminary Study Alba Pina-Balofer David P. Piñero Miranda Buigues Carlo Cavaliere-Ballesta Sergio Viudes Laurent Bataille doi: 10.3390/vision10020031 Vision 2026-05-17 Vision 2026-05-17 10 2 Article 31 10.3390/vision10020031 https://www.mdpi.com/2411-5150/10/2/31 Vision, Vol. 10, Pages 30: Variations in Macular Pigment Optical Density in Children and Adolescents Depending on Time Spent on Smartphones https://www.mdpi.com/2411-5150/10/2/30 Background: Children and teenagers use electronic devices daily, especially smartphones. The use of these devices exposes children and adolescents to excess blue light, which can alter the structures of the eye, especially the retina. As a protective mechanism, the macular region contains pigments represented by lutein, zeaxanthin, and meso-zeaxanthin. In this study, we aimed to analyze the relationship between the Macular Pigment Optical Density (MPOD) levels in the macula and the time spent on smartphones in children and adolescents. Methods: Fifty-seven children and teenagers aged between 8 and 18 were evaluated, with a total of 114 eyes. The patients included in the study were divided into two groups: those who spent less than two hours a day on the device and those who exceeded this period. To determine the amount of macular pigment, the Heterochromatic Flicker Photometry technique was used. Results: We found a statistically significant difference in screen time between weekdays and weekends in favor of the latter. We compared the different refractive categories with respect to pigment levels and screen time and found no significant differences between groups. When comparing the patients with respect to environment, we found a slight difference in macular pigmentation in the favor of rural areas and also in the screen time which was shorter in rural areas. We found a strong association at all levels between longer screen time (both weekdays and weekend) and lower macular pigment quantities for both eyes. When comparing the groups with more/less than 2 h of screen time, the MPOD was lower for both eyes in the group with over 2 h screen time. Conclusions: In this study we demonstrated that smartphone use is a risk factor leading to a decrease in MPOD in children and adolescents. The amount of lutein in the retina, brain and serum are correlated, therefore MPOD can be considered a natural biomarker of lutein and zeaxanthin levels in the body. 2026-05-15 Vision, Vol. 10, Pages 30: Variations in Macular Pigment Optical Density in Children and Adolescents Depending on Time Spent on Smartphones

Vision doi: 10.3390/vision10020030

Authors: Livia Hopîrcă Alexandru Țîpcu Mădălina-Claudia Hapca Iulia-Andrada Nemeș-Drăgan Cosmina Teodora Lazăr Simona Delia Nicoară

Background: Children and teenagers use electronic devices daily, especially smartphones. The use of these devices exposes children and adolescents to excess blue light, which can alter the structures of the eye, especially the retina. As a protective mechanism, the macular region contains pigments represented by lutein, zeaxanthin, and meso-zeaxanthin. In this study, we aimed to analyze the relationship between the Macular Pigment Optical Density (MPOD) levels in the macula and the time spent on smartphones in children and adolescents. Methods: Fifty-seven children and teenagers aged between 8 and 18 were evaluated, with a total of 114 eyes. The patients included in the study were divided into two groups: those who spent less than two hours a day on the device and those who exceeded this period. To determine the amount of macular pigment, the Heterochromatic Flicker Photometry technique was used. Results: We found a statistically significant difference in screen time between weekdays and weekends in favor of the latter. We compared the different refractive categories with respect to pigment levels and screen time and found no significant differences between groups. When comparing the patients with respect to environment, we found a slight difference in macular pigmentation in the favor of rural areas and also in the screen time which was shorter in rural areas. We found a strong association at all levels between longer screen time (both weekdays and weekend) and lower macular pigment quantities for both eyes. When comparing the groups with more/less than 2 h of screen time, the MPOD was lower for both eyes in the group with over 2 h screen time. Conclusions: In this study we demonstrated that smartphone use is a risk factor leading to a decrease in MPOD in children and adolescents. The amount of lutein in the retina, brain and serum are correlated, therefore MPOD can be considered a natural biomarker of lutein and zeaxanthin levels in the body.

]]> Variations in Macular Pigment Optical Density in Children and Adolescents Depending on Time Spent on Smartphones Livia Hopîrcă Alexandru Țîpcu Mădălina-Claudia Hapca Iulia-Andrada Nemeș-Drăgan Cosmina Teodora Lazăr Simona Delia Nicoară doi: 10.3390/vision10020030 Vision 2026-05-15 Vision 2026-05-15 10 2 Article 30 10.3390/vision10020030 https://www.mdpi.com/2411-5150/10/2/30 Vision, Vol. 10, Pages 29: Beyond Glycemic Control: Ocular Effects of Glucagon-like Peptide-1 Receptor Agonists https://www.mdpi.com/2411-5150/10/2/29 Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and newer dual-incretin therapies have become central to the treatment of diabetes mellitus and obesity, with benefits extending beyond glycemic control. Their expanding use has prompted growing interest in their potential ocular effects. Experimental data support plausible protective mechanisms, including reduction in oxidative stress and neuroprotective effects on retinal and optic nerve tissues. Clinical evidence, however, remains heterogeneous. In diabetic retinopathy, the main concern appears to be transient early worsening associated with rapid glycemic improvement rather than direct retinal toxicity. A potential semaglutide-associated signal for non-arteritic anterior ischemic optic neuropathy has raised concern, although the absolute risk appears low and causality remains unproven. Emerging studies also suggest possible beneficial associations with glaucoma, ocular surface diseases, and certain retinal vascular outcomes, whereas the evidence regarding age-related macular degeneration and cataract remains conflicting or preliminary. Overall, ocular outcomes associated with incretin-based therapies seem to reflect a complex interplay among drug-specific pharmacology, systemic metabolic changes, and individual patient susceptibility rather than a class effect. Baseline ophthalmic assessment and individualized follow-up may be advisable in selected high-risk patients. Further prospective ophthalmology-focused studies are needed to clarify long-term safety and identify the patients most likely to benefit or develop adverse events. 2026-05-14 Vision, Vol. 10, Pages 29: Beyond Glycemic Control: Ocular Effects of Glucagon-like Peptide-1 Receptor Agonists

Vision doi: 10.3390/vision10020029

Authors: Filippo Lixi Mario Troisi Valerio Calabresi Anina Giagoni Costanza Rossi Mihaela-Madalina Timofte-Zorila Tudor-Corneliu Tarași Livio Vitiello Mara-Ioana Tomi Alina-Gabriela Gheorghe Giulia Coco Giulia Lanzolla Giuseppe Giannaccare

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and newer dual-incretin therapies have become central to the treatment of diabetes mellitus and obesity, with benefits extending beyond glycemic control. Their expanding use has prompted growing interest in their potential ocular effects. Experimental data support plausible protective mechanisms, including reduction in oxidative stress and neuroprotective effects on retinal and optic nerve tissues. Clinical evidence, however, remains heterogeneous. In diabetic retinopathy, the main concern appears to be transient early worsening associated with rapid glycemic improvement rather than direct retinal toxicity. A potential semaglutide-associated signal for non-arteritic anterior ischemic optic neuropathy has raised concern, although the absolute risk appears low and causality remains unproven. Emerging studies also suggest possible beneficial associations with glaucoma, ocular surface diseases, and certain retinal vascular outcomes, whereas the evidence regarding age-related macular degeneration and cataract remains conflicting or preliminary. Overall, ocular outcomes associated with incretin-based therapies seem to reflect a complex interplay among drug-specific pharmacology, systemic metabolic changes, and individual patient susceptibility rather than a class effect. Baseline ophthalmic assessment and individualized follow-up may be advisable in selected high-risk patients. Further prospective ophthalmology-focused studies are needed to clarify long-term safety and identify the patients most likely to benefit or develop adverse events.

]]> Beyond Glycemic Control: Ocular Effects of Glucagon-like Peptide-1 Receptor Agonists Filippo Lixi Mario Troisi Valerio Calabresi Anina Giagoni Costanza Rossi Mihaela-Madalina Timofte-Zorila Tudor-Corneliu Tarași Livio Vitiello Mara-Ioana Tomi Alina-Gabriela Gheorghe Giulia Coco Giulia Lanzolla Giuseppe Giannaccare doi: 10.3390/vision10020029 Vision 2026-05-14 Vision 2026-05-14 10 2 Review 29 10.3390/vision10020029 https://www.mdpi.com/2411-5150/10/2/29 Vision, Vol. 10, Pages 28: Advancing AMD Detection: Dataset Design and Deep Learning Optimization for Unconstrained Retinal Images https://www.mdpi.com/2411-5150/10/2/28 Age-related macular degeneration (AMD) is one of the leading causes of vision impairment worldwide, making early and accurate detection essential for effective clinical intervention. Recent advances in deep learning have demonstrated promising results in automated retinal image analysis; however, most existing approaches rely on datasets acquired under controlled conditions, limiting their generalizability to real-world clinical environments. In this paper, we propose a novel AMD dataset designed to simulate unconstrained imaging conditions, by incorporating noise, luminance variations, and device-related artifacts commonly encountered during retinal scan acquisition. Using this dataset, we conduct a comprehensive comparative evaluation of six widely adopted deep learning architectures: VGG16, VGG19, InceptionV3, MobileNetV2, ResNet50, and DenseNet. Experimental results indicate notable performance variations across models, highlighting the impact of architectural design on robustness to image degradation. Among the evaluated approaches, VGG16 achieved the best overall performance. By further optimizing this architecture through targeted training and fine-tuning strategies, the proposed system reached an accuracy of 88% in AMD detection. These findings demonstrate the effectiveness of the optimized VGG16 model and underline the importance of realistic datasets for developing reliable deep learning-based diagnostic tools for practical clinical settings. 2026-05-14 Vision, Vol. 10, Pages 28: Advancing AMD Detection: Dataset Design and Deep Learning Optimization for Unconstrained Retinal Images

Vision doi: 10.3390/vision10020028

Authors: Hala Nafie Fathee Reyhan Babayev Shaaban Sahmoud Nazim Ağaoğlu

Age-related macular degeneration (AMD) is one of the leading causes of vision impairment worldwide, making early and accurate detection essential for effective clinical intervention. Recent advances in deep learning have demonstrated promising results in automated retinal image analysis; however, most existing approaches rely on datasets acquired under controlled conditions, limiting their generalizability to real-world clinical environments. In this paper, we propose a novel AMD dataset designed to simulate unconstrained imaging conditions, by incorporating noise, luminance variations, and device-related artifacts commonly encountered during retinal scan acquisition. Using this dataset, we conduct a comprehensive comparative evaluation of six widely adopted deep learning architectures: VGG16, VGG19, InceptionV3, MobileNetV2, ResNet50, and DenseNet. Experimental results indicate notable performance variations across models, highlighting the impact of architectural design on robustness to image degradation. Among the evaluated approaches, VGG16 achieved the best overall performance. By further optimizing this architecture through targeted training and fine-tuning strategies, the proposed system reached an accuracy of 88% in AMD detection. These findings demonstrate the effectiveness of the optimized VGG16 model and underline the importance of realistic datasets for developing reliable deep learning-based diagnostic tools for practical clinical settings.

]]> Advancing AMD Detection: Dataset Design and Deep Learning Optimization for Unconstrained Retinal Images Hala Nafie Fathee Reyhan Babayev Shaaban Sahmoud Nazim Ağaoğlu doi: 10.3390/vision10020028 Vision 2026-05-14 Vision 2026-05-14 10 2 Article 28 10.3390/vision10020028 https://www.mdpi.com/2411-5150/10/2/28 Vision, Vol. 10, Pages 27: Optimal Dimension of Peripheral Iridotomy for Anatomical Efficacy in Primary-Angle-Closure Disease https://www.mdpi.com/2411-5150/10/2/27 The aim of this study is to determine the optimal functional size of laser peripheral iridotomy (LPI) for anterior chamber parameter improvement in primary angle-closure disease (PACD). This study evaluated 109 eyes from 62 consecutive phakic patients. Baseline and one-week post-LPI anterior segment OCT were utilized to measure anterior chamber volume (ACV), anterior chamber angle (ACA), and iridotomy dimensions. Data was analyzed using linear mixed-effects models (LMMs), generalized additive models (GAMs), and receiver operating characteristic (ROC) curves. Post-LPI, significant increases occurred in ACA 500 (+7.54°), ACV (+11.09 mm3), and gonioscopic grade. LMMs confirmed a positive association between iridotomy size and anatomical expansion. GAMs demonstrated a saturation effect for ACV improvement, plateauing at 0.1 mm2 (narrow area) and 0.25–0.30 mm2 (superficial area), while the ACA relationship remained predominantly linear. ROC analysis identified preliminary superficial area cutoffs of 0.14 mm2 and 0.12 mm2 as discriminators of above-median volumetric and angular response, respectively. These findings suggest that LPI size is an independent determinant of anatomical response, beyond simple patency. As a preliminary, hypothesis-generating target, a superficial iridotomy area of approximately 0.12–0.14 mm2 was associated with above-median volumetric and angular response in this cohort. Prospective validation is required before these thresholds can be incorporated into clinical practice. 2026-05-13 Vision, Vol. 10, Pages 27: Optimal Dimension of Peripheral Iridotomy for Anatomical Efficacy in Primary-Angle-Closure Disease

Vision doi: 10.3390/vision10020027

Authors: Ludovico Alisi Premanand Chandran Mrunali M. Dhavalikar Niklank Mehta Padmavathy A. Sivakumar Abhipsa Sahu Rohan A. J. Daniel Ganesh V. Raman

The aim of this study is to determine the optimal functional size of laser peripheral iridotomy (LPI) for anterior chamber parameter improvement in primary angle-closure disease (PACD). This study evaluated 109 eyes from 62 consecutive phakic patients. Baseline and one-week post-LPI anterior segment OCT were utilized to measure anterior chamber volume (ACV), anterior chamber angle (ACA), and iridotomy dimensions. Data was analyzed using linear mixed-effects models (LMMs), generalized additive models (GAMs), and receiver operating characteristic (ROC) curves. Post-LPI, significant increases occurred in ACA 500 (+7.54°), ACV (+11.09 mm3), and gonioscopic grade. LMMs confirmed a positive association between iridotomy size and anatomical expansion. GAMs demonstrated a saturation effect for ACV improvement, plateauing at 0.1 mm2 (narrow area) and 0.25–0.30 mm2 (superficial area), while the ACA relationship remained predominantly linear. ROC analysis identified preliminary superficial area cutoffs of 0.14 mm2 and 0.12 mm2 as discriminators of above-median volumetric and angular response, respectively. These findings suggest that LPI size is an independent determinant of anatomical response, beyond simple patency. As a preliminary, hypothesis-generating target, a superficial iridotomy area of approximately 0.12–0.14 mm2 was associated with above-median volumetric and angular response in this cohort. Prospective validation is required before these thresholds can be incorporated into clinical practice.

]]> Optimal Dimension of Peripheral Iridotomy for Anatomical Efficacy in Primary-Angle-Closure Disease Ludovico Alisi Premanand Chandran Mrunali M. Dhavalikar Niklank Mehta Padmavathy A. Sivakumar Abhipsa Sahu Rohan A. J. Daniel Ganesh V. Raman doi: 10.3390/vision10020027 Vision 2026-05-13 Vision 2026-05-13 10 2 Article 27 10.3390/vision10020027 https://www.mdpi.com/2411-5150/10/2/27 Vision, Vol. 10, Pages 26: Short-Term Effects of Low-Level Red-Light Therapy on Central Retinal Function: A Combined Pattern ERG and Photopic ERG Study https://www.mdpi.com/2411-5150/10/2/26 Background: Low-level red-light therapy (RLRT) has emerged as a potential therapy in myopia management. However, its effects on retinal structure and function following repeated exposure remain incompletely understood. Purpose: To evaluate the short-term effects of RLRT on central retinal function in myopes and non-myopes using retinal electrophysiology and structural parameters. Methods: Thirty-six subjects underwent RLRT exposures. Retinal function was assessed using pattern electroretinography (PERG) and photopic full-field electroretinography (Photopic 3.0 ERG). Structural measurements, including axial length (AL), obtained with an optical biometer and choroidal thickness (CT), were measured using MOPTIM 3000. Outcomes were compared between baseline and post-RLRT conditions (single 3 min and single 1 min exposure), across refractive groups, and correlated with AL and CT. This study was conducted at the University of Minho in accordance with the Declaration of Helsinki. Results: In myopic subjects, PERG N35–P50 amplitude significantly increased after 3 min of RLRT (baseline:0.88 ± 0.21 µV; post: 1.40 ± 0.25 µV; p = 0.013), whereas no significant changes were observed in non-myopes (baseline: 1.32 ± 0.19 µV; post: 1.39 ± 0.21 µV; p = 0.47). Latencies remained stable across all groups (p > 0.05). No significant correlations were found between PERG and AL (ρ = −0.18, p = 0.44) or CT (ρ = 0.12, p = 0.52). Photopic 3.0 ERG showed an increase in b-wave amplitude after 3 min of RLRT in myopes (Δ = +2.42 µV, p = 0.06), but not in non-myopes. In myopes, AL was negatively correlated with post-therapy latency (ρ = −0.624, p = 0.060), while CT showed strong correlations with photopic a-wave responses after 1 min RLRT (CT vs. latency: ρ = −0.873, p = 0.010; CT vs. amplitude: ρ = 0.821, p = 0.034). Conclusions: Short-term exposure to RLRT, particularly at 3 min, enhances PERG and Photopic ERG responses in myopic subjects, suggesting transient improvements in retinal function with differential effects between refractive groups. 2026-05-08 Vision, Vol. 10, Pages 26: Short-Term Effects of Low-Level Red-Light Therapy on Central Retinal Function: A Combined Pattern ERG and Photopic ERG Study

Vision doi: 10.3390/vision10020026

Authors: Muhammad Qasim Paulo Fernandes Jorge Jorge

Background: Low-level red-light therapy (RLRT) has emerged as a potential therapy in myopia management. However, its effects on retinal structure and function following repeated exposure remain incompletely understood. Purpose: To evaluate the short-term effects of RLRT on central retinal function in myopes and non-myopes using retinal electrophysiology and structural parameters. Methods: Thirty-six subjects underwent RLRT exposures. Retinal function was assessed using pattern electroretinography (PERG) and photopic full-field electroretinography (Photopic 3.0 ERG). Structural measurements, including axial length (AL), obtained with an optical biometer and choroidal thickness (CT), were measured using MOPTIM 3000. Outcomes were compared between baseline and post-RLRT conditions (single 3 min and single 1 min exposure), across refractive groups, and correlated with AL and CT. This study was conducted at the University of Minho in accordance with the Declaration of Helsinki. Results: In myopic subjects, PERG N35–P50 amplitude significantly increased after 3 min of RLRT (baseline:0.88 ± 0.21 µV; post: 1.40 ± 0.25 µV; p = 0.013), whereas no significant changes were observed in non-myopes (baseline: 1.32 ± 0.19 µV; post: 1.39 ± 0.21 µV; p = 0.47). Latencies remained stable across all groups (p > 0.05). No significant correlations were found between PERG and AL (ρ = −0.18, p = 0.44) or CT (ρ = 0.12, p = 0.52). Photopic 3.0 ERG showed an increase in b-wave amplitude after 3 min of RLRT in myopes (Δ = +2.42 µV, p = 0.06), but not in non-myopes. In myopes, AL was negatively correlated with post-therapy latency (ρ = −0.624, p = 0.060), while CT showed strong correlations with photopic a-wave responses after 1 min RLRT (CT vs. latency: ρ = −0.873, p = 0.010; CT vs. amplitude: ρ = 0.821, p = 0.034). Conclusions: Short-term exposure to RLRT, particularly at 3 min, enhances PERG and Photopic ERG responses in myopic subjects, suggesting transient improvements in retinal function with differential effects between refractive groups.

]]> Short-Term Effects of Low-Level Red-Light Therapy on Central Retinal Function: A Combined Pattern ERG and Photopic ERG Study Muhammad Qasim Paulo Fernandes Jorge Jorge doi: 10.3390/vision10020026 Vision 2026-05-08 Vision 2026-05-08 10 2 Article 26 10.3390/vision10020026 https://www.mdpi.com/2411-5150/10/2/26 Vision, Vol. 10, Pages 25: Visual Field Loss and Self-Reported Driving Restriction in Glaucoma https://www.mdpi.com/2411-5150/10/2/25 Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma underwent standard automated perimetry. Visual function was assessed using Mean Deviation (MD) and Visual Field Index (VFI) from the better eye. Driving status, driving limitation, and self-reported driving difficulties were assessed using a structured questionnaire. Multivariable logistic regression was performed to determine independent associations between visual field parameters and driving limitation, adjusting for age, sex, cataract status, and systemic comorbidities. Because MD and VFI are closely related indices of visual field loss, separate multivariable models were constructed for each parameter. Receiver operating characteristic (ROC) analysis was used to explore threshold values associated with driving limitation. Results: Driving limitation increased progressively with worsening functional severity, affecting 17% of participants with preserved function, 48% of those with borderline impairment, and 72% of those with definite impairment (p < 0.001). Reduced VFI was independently associated with driving limitation (OR = 0.972, 95% CI: 0.948–0.996; p = 0.021). In a separate model, more negative MD was also independently associated with driving limitation (OR = 0.924, 95% CI: 0.875–0.976; p = 0.004). Male sex was associated with a lower likelihood of driving limitation. ROC analysis identified threshold values of VFI ≤ 71% (AUC = 0.663) and MD ≤ −13.36 dB (AUC = 0.650), both characterized by high specificity but limited sensitivity. Participants who had ceased driving demonstrated worse visual field indices than active drivers, whereas never-drivers showed no consistent association with visual field loss. Conclusions: Glaucomatous visual field loss was significantly associated with self-reported driving limitation and behavioural self-regulation. Objective perimetric parameters, particularly VFI and MD in the better eye, may help identify patients more likely to report driving difficulties. The reported threshold values should be interpreted as exploratory reference points rather than clinically actionable criteria and require further validation before clinical application. 2026-04-29 Vision, Vol. 10, Pages 25: Visual Field Loss and Self-Reported Driving Restriction in Glaucoma

Vision doi: 10.3390/vision10020025

Authors: Mladena Radeva Preslava Encheva Elitsa Hristova Daliya Stefanova Igor Resnick Zornitsa Zlatarova

Background: To evaluate the association between glaucomatous visual field loss and self-reported driving limitation, and to explore potential threshold ranges of visual field loss associated with an increased likelihood of driving restriction. Methods: In this cross-sectional study, 100 patients with primary open-angle glaucoma underwent standard automated perimetry. Visual function was assessed using Mean Deviation (MD) and Visual Field Index (VFI) from the better eye. Driving status, driving limitation, and self-reported driving difficulties were assessed using a structured questionnaire. Multivariable logistic regression was performed to determine independent associations between visual field parameters and driving limitation, adjusting for age, sex, cataract status, and systemic comorbidities. Because MD and VFI are closely related indices of visual field loss, separate multivariable models were constructed for each parameter. Receiver operating characteristic (ROC) analysis was used to explore threshold values associated with driving limitation. Results: Driving limitation increased progressively with worsening functional severity, affecting 17% of participants with preserved function, 48% of those with borderline impairment, and 72% of those with definite impairment (p < 0.001). Reduced VFI was independently associated with driving limitation (OR = 0.972, 95% CI: 0.948–0.996; p = 0.021). In a separate model, more negative MD was also independently associated with driving limitation (OR = 0.924, 95% CI: 0.875–0.976; p = 0.004). Male sex was associated with a lower likelihood of driving limitation. ROC analysis identified threshold values of VFI ≤ 71% (AUC = 0.663) and MD ≤ −13.36 dB (AUC = 0.650), both characterized by high specificity but limited sensitivity. Participants who had ceased driving demonstrated worse visual field indices than active drivers, whereas never-drivers showed no consistent association with visual field loss. Conclusions: Glaucomatous visual field loss was significantly associated with self-reported driving limitation and behavioural self-regulation. Objective perimetric parameters, particularly VFI and MD in the better eye, may help identify patients more likely to report driving difficulties. The reported threshold values should be interpreted as exploratory reference points rather than clinically actionable criteria and require further validation before clinical application.

]]> Visual Field Loss and Self-Reported Driving Restriction in Glaucoma Mladena Radeva Preslava Encheva Elitsa Hristova Daliya Stefanova Igor Resnick Zornitsa Zlatarova doi: 10.3390/vision10020025 Vision 2026-04-29 Vision 2026-04-29 10 2 Article 25 10.3390/vision10020025 https://www.mdpi.com/2411-5150/10/2/25 Vision, Vol. 10, Pages 24: Comorbidities in Age-Related Cataract: Epidemiological Burden and Public Health Implications https://www.mdpi.com/2411-5150/10/2/24 Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. 2026-04-28 Vision, Vol. 10, Pages 24: Comorbidities in Age-Related Cataract: Epidemiological Burden and Public Health Implications

Vision doi: 10.3390/vision10020024

Authors: Matteo Ripa Matteo Forlini Chiara Schipa Neeraj Apoorva Shah

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide.

]]> Comorbidities in Age-Related Cataract: Epidemiological Burden and Public Health Implications Matteo Ripa Matteo Forlini Chiara Schipa Neeraj Apoorva Shah doi: 10.3390/vision10020024 Vision 2026-04-28 Vision 2026-04-28 10 2 Review 24 10.3390/vision10020024 https://www.mdpi.com/2411-5150/10/2/24 Vision, Vol. 10, Pages 23: Exploring Visual Discrimination and Performance Adaptation in First-League Futsal Players via LUMMICS https://www.mdpi.com/2411-5150/10/2/23 Background/Objectives: Perceptual–cognitive abilities such as visual discrimination, reaction time, and attentional control are important for performance in dynamic sports. However, evidence remains limited regarding how simplified visual tasks capture performance variability and dynamics under repeated exposure. This study examined session-to-session performance changes and individual trajectories in a programmable visual discrimination task of increasing complexity in elite futsal players. Methods: An exploratory repeated-measures study was conducted with ten first-league futsal players. Participants completed between six and ten sessions of a color-cue visual discrimination task (“Follow the Color”) under one- and two-stimulus conditions. Outcomes included correct responses, errors, and reaction time per session. A total of 465 observations were analyzed using linear mixed-effects models to assess changes across sessions and the influence of task complexity. Individual analyses were also performed to explore player-specific trajectories. Results: Mean session accuracy was 63.8 ± 9.8 correct responses, with a mean error rate of 3.6 ± 6.1 and a mean reaction time of 0.63 ± 0.15 s. Error rates declined significantly across sessions (β = −0.008, p < 0.001), while reaction time improved modestly (β = −0.00011, p = 0.025). Correct responses showed a small negative trend over time. Increased task complexity was associated with fewer correct responses, higher error rates, and slower reaction times (all p < 0.001). Conclusions: This programmable visual discrimination task captured variability in visuomotor responses under controlled conditions and may support monitoring of performance dynamics in sports vision research. 2026-04-23 Vision, Vol. 10, Pages 23: Exploring Visual Discrimination and Performance Adaptation in First-League Futsal Players via LUMMICS

Vision doi: 10.3390/vision10020023

Authors: Bruno Monteiro Ana Roque Henrique Nacimento Clara Martinez-Perez

Background/Objectives: Perceptual–cognitive abilities such as visual discrimination, reaction time, and attentional control are important for performance in dynamic sports. However, evidence remains limited regarding how simplified visual tasks capture performance variability and dynamics under repeated exposure. This study examined session-to-session performance changes and individual trajectories in a programmable visual discrimination task of increasing complexity in elite futsal players. Methods: An exploratory repeated-measures study was conducted with ten first-league futsal players. Participants completed between six and ten sessions of a color-cue visual discrimination task (“Follow the Color”) under one- and two-stimulus conditions. Outcomes included correct responses, errors, and reaction time per session. A total of 465 observations were analyzed using linear mixed-effects models to assess changes across sessions and the influence of task complexity. Individual analyses were also performed to explore player-specific trajectories. Results: Mean session accuracy was 63.8 ± 9.8 correct responses, with a mean error rate of 3.6 ± 6.1 and a mean reaction time of 0.63 ± 0.15 s. Error rates declined significantly across sessions (β = −0.008, p < 0.001), while reaction time improved modestly (β = −0.00011, p = 0.025). Correct responses showed a small negative trend over time. Increased task complexity was associated with fewer correct responses, higher error rates, and slower reaction times (all p < 0.001). Conclusions: This programmable visual discrimination task captured variability in visuomotor responses under controlled conditions and may support monitoring of performance dynamics in sports vision research.

]]> Exploring Visual Discrimination and Performance Adaptation in First-League Futsal Players via LUMMICS Bruno Monteiro Ana Roque Henrique Nacimento Clara Martinez-Perez doi: 10.3390/vision10020023 Vision 2026-04-23 Vision 2026-04-23 10 2 Article 23 10.3390/vision10020023 https://www.mdpi.com/2411-5150/10/2/23 Vision, Vol. 10, Pages 22: One Year Longitudinal Assessment of Subjective and Objective Accommodation After Phakic IOL Implantation https://www.mdpi.com/2411-5150/10/2/22 Purpose: To evaluate the 1 year behavior of accommodation and optical quality one year after the implantation of phakic intraocular lenses, specifically the implantable collamer lens (ICL), in myopic patients, comparing outcomes between low- and high-myopia groups. Methods: This comparative longitudinal study included 38 eyes of 38 patients who underwent ICL implantation for myopia correction. Patients were divided into two groups based on preoperative manifest sphere: low myopia (−2.50 D to −6.25 D) and high myopia (>−6.25 D to −12.50 D). The amplitude of accommodation (AA), subjective accommodative response (AR), optical quality parameters including the modulation transfer function (MTF) cut-off, objective scatter index (OSI) and Strehl ratio (SR), and objective accommodative response with a double-pass system (HD Analyzer, Visiometrics) were assessed preoperatively, 1 month, and 1 year postoperatively. Results: Both groups achieved postoperative refractive outcomes close to emmetropia, with high efficacy and safety indices. A statistically significant decrease in the amplitude of accommodation was observed at 1 month and remained stable at 1 year in both groups; however, this change was not clinically meaningful. The optical quality parameters (MTF cut-off, OSI, and Strehl ratio) and objective accommodative response with the HD Analyzer showed no clinically relevant changes over time, with no significant intergroup differences detected (p-value > 0.05). Conclusions: An initial reduction in accommodative amplitude was observed after ICL implantation without recovery over time; however, it was not clinically relevant, as it fell within the test–retest variability in the minus lens technique. Other accommodative parameters and optical quality remained stable at 1 year in both low and high myopia. 2026-04-16 Vision, Vol. 10, Pages 22: One Year Longitudinal Assessment of Subjective and Objective Accommodation After Phakic IOL Implantation

Vision doi: 10.3390/vision10020022

Authors: Esther López-Artero María García-Montero Blanca Poyales Ricardo Pérez-Izquierdo Alba Sáez Nuria Garzón

Purpose: To evaluate the 1 year behavior of accommodation and optical quality one year after the implantation of phakic intraocular lenses, specifically the implantable collamer lens (ICL), in myopic patients, comparing outcomes between low- and high-myopia groups. Methods: This comparative longitudinal study included 38 eyes of 38 patients who underwent ICL implantation for myopia correction. Patients were divided into two groups based on preoperative manifest sphere: low myopia (−2.50 D to −6.25 D) and high myopia (>−6.25 D to −12.50 D). The amplitude of accommodation (AA), subjective accommodative response (AR), optical quality parameters including the modulation transfer function (MTF) cut-off, objective scatter index (OSI) and Strehl ratio (SR), and objective accommodative response with a double-pass system (HD Analyzer, Visiometrics) were assessed preoperatively, 1 month, and 1 year postoperatively. Results: Both groups achieved postoperative refractive outcomes close to emmetropia, with high efficacy and safety indices. A statistically significant decrease in the amplitude of accommodation was observed at 1 month and remained stable at 1 year in both groups; however, this change was not clinically meaningful. The optical quality parameters (MTF cut-off, OSI, and Strehl ratio) and objective accommodative response with the HD Analyzer showed no clinically relevant changes over time, with no significant intergroup differences detected (p-value > 0.05). Conclusions: An initial reduction in accommodative amplitude was observed after ICL implantation without recovery over time; however, it was not clinically relevant, as it fell within the test–retest variability in the minus lens technique. Other accommodative parameters and optical quality remained stable at 1 year in both low and high myopia.

]]> One Year Longitudinal Assessment of Subjective and Objective Accommodation After Phakic IOL Implantation Esther López-Artero María García-Montero Blanca Poyales Ricardo Pérez-Izquierdo Alba Sáez Nuria Garzón doi: 10.3390/vision10020022 Vision 2026-04-16 Vision 2026-04-16 10 2 Article 22 10.3390/vision10020022 https://www.mdpi.com/2411-5150/10/2/22 Vision, Vol. 10, Pages 21: OCT and Autofluorescence Phenotypic Features in Autosomal Dominant RHO-Associated Retinitis Pigmentosa Variants https://www.mdpi.com/2411-5150/10/2/21 Background/Objectives: To describe retinal imaging characteristics and the natural history of rhodopsin (RHO)-associated autosomal dominant retinitis pigmentosa (ADRP) by evaluating ellipsoid zone (EZ) width loss and measuring the degree of constriction of the area within and including the hyperautofluorescent ring. Methods: Eighteen patients with molecularly confirmed RHO variants were retrospectively evaluated. EZ width on spectral-domain optical coherence tomography (SD-OCT) and the area within and including the hyperfluorescent ring on fundus autofluorescence (FAF) were measured. The correlation between EZ width and hyperfluorescent ring area was assessed using a linear mixed-effects model. Results: Mean best corrected visual acuity (BCVA) (logMAR) was 0.21 at baseline and 0.29 at last visit over a mean follow-up of 5 years. Nine patients presented with sectoral RP, eight with typical RP, and one with unilateral RP. The mean EZ width constriction rate was −93.43 µm/year (SD = 130.58), and the area within and including the hyperautofluorescent ring decreased by −0.54 mm2/year (SD = 0.50). A strong positive association was observed between the EZ width and hyperfluorescent ring area at baseline (β = 151.7 ± 17.9, p < 0.001) and at the final visit (β = 185.7 ± 18.2, p < 0.001). Conclusions: In this study, patients with RHO-associated ADRP appeared to show a relatively slow rate of progression. Quantitative imaging markers, such as EZ width and the area within and including the hyperautofluorescent ring, may offer potentially reproducible measures of disease progression. These imaging biomarkers could be useful as outcome measures in future natural history studies and therapeutic trials, pending further validation. 2026-04-10 Vision, Vol. 10, Pages 21: OCT and Autofluorescence Phenotypic Features in Autosomal Dominant RHO-Associated Retinitis Pigmentosa Variants

Vision doi: 10.3390/vision10020021

Authors: Christina Karakosta Saoud Al-Khuzaei Penny Clouston Morag Shanks Susan M. Downes

Background/Objectives: To describe retinal imaging characteristics and the natural history of rhodopsin (RHO)-associated autosomal dominant retinitis pigmentosa (ADRP) by evaluating ellipsoid zone (EZ) width loss and measuring the degree of constriction of the area within and including the hyperautofluorescent ring. Methods: Eighteen patients with molecularly confirmed RHO variants were retrospectively evaluated. EZ width on spectral-domain optical coherence tomography (SD-OCT) and the area within and including the hyperfluorescent ring on fundus autofluorescence (FAF) were measured. The correlation between EZ width and hyperfluorescent ring area was assessed using a linear mixed-effects model. Results: Mean best corrected visual acuity (BCVA) (logMAR) was 0.21 at baseline and 0.29 at last visit over a mean follow-up of 5 years. Nine patients presented with sectoral RP, eight with typical RP, and one with unilateral RP. The mean EZ width constriction rate was −93.43 µm/year (SD = 130.58), and the area within and including the hyperautofluorescent ring decreased by −0.54 mm2/year (SD = 0.50). A strong positive association was observed between the EZ width and hyperfluorescent ring area at baseline (β = 151.7 ± 17.9, p < 0.001) and at the final visit (β = 185.7 ± 18.2, p < 0.001). Conclusions: In this study, patients with RHO-associated ADRP appeared to show a relatively slow rate of progression. Quantitative imaging markers, such as EZ width and the area within and including the hyperautofluorescent ring, may offer potentially reproducible measures of disease progression. These imaging biomarkers could be useful as outcome measures in future natural history studies and therapeutic trials, pending further validation.

]]> OCT and Autofluorescence Phenotypic Features in Autosomal Dominant RHO-Associated Retinitis Pigmentosa Variants Christina Karakosta Saoud Al-Khuzaei Penny Clouston Morag Shanks Susan M. Downes doi: 10.3390/vision10020021 Vision 2026-04-10 Vision 2026-04-10 10 2 Article 21 10.3390/vision10020021 https://www.mdpi.com/2411-5150/10/2/21 Vision, Vol. 10, Pages 20: Epidemiology of Keratoconus in India: A Systematic Review and Meta-Analysis of Indian Study Populations https://www.mdpi.com/2411-5150/10/2/20 (1) Background: To synthesize available evidence on the prevalence of keratoconus (KC) reported in Indian study populations and describe its demographic distribution. (2) Methods: PubMed, Embase, and Scopus were checked using free text and controlled vocabulary. A random-effect meta-analysis of pooled prevalence and its 95% confidence intervals (CIs) for KC among study participants recruited in India was conducted using exact binomial distributions and the Freeman–Tukey double-arcsine transformation. To identify potential sources of variability, we conducted subgroup analyses by dividing the data by geographic region, KC assessment, and study population. The methodological quality of each study was assessed using the Newcastle–Ottawa scale (NOS). Evidence quality was evaluated using the GRADE system. (3) Results: Across included studies, the total number of KC cases was 16,164, and sample sizes ranged from 152 to 2,384,523 participants. Prevalence estimates varied markedly across studies, reflecting substantial heterogeneity in study design, diagnostic criteria, and population characteristics. Most studies were conducted in high-risk clinical settings, limiting generalizability to the general population. Subgroup analyses showed no significant differences by geographic region or diagnostic modality (p = 0.79 and 0.07, respectively). There was a statistically significant subgroup effect (p < 0.001) in the study population. The reported prevalence among females ranged from 0.00 to 0.04, while the pooled prevalence estimate was 0.02 (95% CI: 0.00–0.04). Four cross-sectional studies scored 8–10 on the NOS. (4) Conclusions: Our meta-analysis synthesized the currently available evidence on keratoconus prevalence across Indian study populations, highlighting substantial variability across studies and emphasizing that estimates should be interpreted within their specific study contexts rather than as representative of the national population. 2026-04-09 Vision, Vol. 10, Pages 20: Epidemiology of Keratoconus in India: A Systematic Review and Meta-Analysis of Indian Study Populations

Vision doi: 10.3390/vision10020020

Authors: Matteo Ripa Chiara Schipa Paola Aceto Sushad Prasad Neeraj Apoorva Shah

(1) Background: To synthesize available evidence on the prevalence of keratoconus (KC) reported in Indian study populations and describe its demographic distribution. (2) Methods: PubMed, Embase, and Scopus were checked using free text and controlled vocabulary. A random-effect meta-analysis of pooled prevalence and its 95% confidence intervals (CIs) for KC among study participants recruited in India was conducted using exact binomial distributions and the Freeman–Tukey double-arcsine transformation. To identify potential sources of variability, we conducted subgroup analyses by dividing the data by geographic region, KC assessment, and study population. The methodological quality of each study was assessed using the Newcastle–Ottawa scale (NOS). Evidence quality was evaluated using the GRADE system. (3) Results: Across included studies, the total number of KC cases was 16,164, and sample sizes ranged from 152 to 2,384,523 participants. Prevalence estimates varied markedly across studies, reflecting substantial heterogeneity in study design, diagnostic criteria, and population characteristics. Most studies were conducted in high-risk clinical settings, limiting generalizability to the general population. Subgroup analyses showed no significant differences by geographic region or diagnostic modality (p = 0.79 and 0.07, respectively). There was a statistically significant subgroup effect (p < 0.001) in the study population. The reported prevalence among females ranged from 0.00 to 0.04, while the pooled prevalence estimate was 0.02 (95% CI: 0.00–0.04). Four cross-sectional studies scored 8–10 on the NOS. (4) Conclusions: Our meta-analysis synthesized the currently available evidence on keratoconus prevalence across Indian study populations, highlighting substantial variability across studies and emphasizing that estimates should be interpreted within their specific study contexts rather than as representative of the national population.

]]> Epidemiology of Keratoconus in India: A Systematic Review and Meta-Analysis of Indian Study Populations Matteo Ripa Chiara Schipa Paola Aceto Sushad Prasad Neeraj Apoorva Shah doi: 10.3390/vision10020020 Vision 2026-04-09 Vision 2026-04-09 10 2 Systematic Review 20 10.3390/vision10020020 https://www.mdpi.com/2411-5150/10/2/20 Vision, Vol. 10, Pages 19: Real-World Effectiveness of CARE-Based Spectacle Lenses for Myopia Control in a Turkish Pediatric Cohort https://www.mdpi.com/2411-5150/10/2/19 Childhood myopia progression remains a major global public health concern, and spectacle lenses designed to induce peripheral myopic defocus have emerged as a non-pharmacological strategy for myopia control; however, real-world evidence from European populations remains limited. This retrospective observational study evaluated the 12-month real-world effectiveness of cylindrical annular refractive element spectacle lenses in a Turkish pediatric cohort. Children aged 5–15 years who wore myopia-control spectacle lenses from the CARE platform or single-vision lenses were included. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 12 months. The primary outcomes were 12-month changes in SER and AL. Multivariable generalized estimation equations were applied to account for inter-eye correlation and to adjust for age and gender. A total of 168 eyes were analyzed (85 with single-vision lenses; 83 with myopia-control lenses). After 12 months, the myopia-control group demonstrated significantly slower progression than the single-vision group, with mean SER changes of −0.40 ± 0.92 D versus −0.77 ± 0.74 D and axial elongation of 0.17 ± 0.25 mm versus 0.31 ± 0.30 mm, respectively. Treatment group remained a significant predictor of both refractive progression (p = 0.008) and axial elongation (p = 0.003). Age was independently associated with axial length change (p < 0.001), whereas gender was not. These findings provide real-world European evidence supporting the role of defocus-modulating spectacle lenses in pediatric myopia management. 2026-03-31 Vision, Vol. 10, Pages 19: Real-World Effectiveness of CARE-Based Spectacle Lenses for Myopia Control in a Turkish Pediatric Cohort

Vision doi: 10.3390/vision10020019

Authors: Nilay Akagun Ugur Emrah Altiparmak

Childhood myopia progression remains a major global public health concern, and spectacle lenses designed to induce peripheral myopic defocus have emerged as a non-pharmacological strategy for myopia control; however, real-world evidence from European populations remains limited. This retrospective observational study evaluated the 12-month real-world effectiveness of cylindrical annular refractive element spectacle lenses in a Turkish pediatric cohort. Children aged 5–15 years who wore myopia-control spectacle lenses from the CARE platform or single-vision lenses were included. Cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 12 months. The primary outcomes were 12-month changes in SER and AL. Multivariable generalized estimation equations were applied to account for inter-eye correlation and to adjust for age and gender. A total of 168 eyes were analyzed (85 with single-vision lenses; 83 with myopia-control lenses). After 12 months, the myopia-control group demonstrated significantly slower progression than the single-vision group, with mean SER changes of −0.40 ± 0.92 D versus −0.77 ± 0.74 D and axial elongation of 0.17 ± 0.25 mm versus 0.31 ± 0.30 mm, respectively. Treatment group remained a significant predictor of both refractive progression (p = 0.008) and axial elongation (p = 0.003). Age was independently associated with axial length change (p < 0.001), whereas gender was not. These findings provide real-world European evidence supporting the role of defocus-modulating spectacle lenses in pediatric myopia management.

]]> Real-World Effectiveness of CARE-Based Spectacle Lenses for Myopia Control in a Turkish Pediatric Cohort Nilay Akagun Ugur Emrah Altiparmak doi: 10.3390/vision10020019 Vision 2026-03-31 Vision 2026-03-31 10 2 Article 19 10.3390/vision10020019 https://www.mdpi.com/2411-5150/10/2/19 Vision, Vol. 10, Pages 18: Adverse Events Reported with Standard-Dose and High-Dose Aflibercept: A FAERS Pharmacovigilance Study https://www.mdpi.com/2411-5150/10/2/18 This pharmacovigilance study drew upon the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to compare the reporting patterns of ocular and systemic adverse events (AEs) for the 2 mg (standard-dose [SD]) and 8 mg (high-dose [HD]) formulations of aflibercept given for any ocular indication. Disproportionality analysis, including reporting odds ratios (ROR), was used to compare each dose individually to the background reporting rate for the AE. Statistical significance of the RORs was evaluated using Bonferroni correction, alongside signal detection based on Evans criteria, and Bayesian information components. The Breslow–Day test was used to conduct a head-to-head comparison of RORs between each dose. We identified 953 SD and 314 HD AE reports within the 750-day period after the approval of HD by the U.S. Food and Drug Administration (FDA; 8/18/2023). Compared to SD, HD had a higher ROR for endophthalmitis (HD: ROR 767.56 [95% CI, 466.11–1263.95]; SD: ROR 331.64 [95% CI, 216.71–507.51]), eye inflammation (HD: ROR 118.45 [95% CI, 55.85–251.20]; SD: 43.98 [95% CI, 21.87–88.44]), retinal vasculitis (HD: ROR 769.87 [95% CI, 337.13–1758.04]; SD: ROR 124.80 [95% CI, 39.67–392.63]), and systemic vasculitis (HD: ROR 28.40 [95% CI, 14.63–55.14]; SD: ROR 4.05 [1.52–10.82]). These results, based on FAERS, indicate associations rather than causal relationships. Further studies are needed to quantify the absolute risks and elucidate the mechanisms underlying differences in safety signals, if any. 2026-03-31 Vision, Vol. 10, Pages 18: Adverse Events Reported with Standard-Dose and High-Dose Aflibercept: A FAERS Pharmacovigilance Study

Vision doi: 10.3390/vision10020018

Authors: Minali Prasad David J. Ramsey

This pharmacovigilance study drew upon the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to compare the reporting patterns of ocular and systemic adverse events (AEs) for the 2 mg (standard-dose [SD]) and 8 mg (high-dose [HD]) formulations of aflibercept given for any ocular indication. Disproportionality analysis, including reporting odds ratios (ROR), was used to compare each dose individually to the background reporting rate for the AE. Statistical significance of the RORs was evaluated using Bonferroni correction, alongside signal detection based on Evans criteria, and Bayesian information components. The Breslow–Day test was used to conduct a head-to-head comparison of RORs between each dose. We identified 953 SD and 314 HD AE reports within the 750-day period after the approval of HD by the U.S. Food and Drug Administration (FDA; 8/18/2023). Compared to SD, HD had a higher ROR for endophthalmitis (HD: ROR 767.56 [95% CI, 466.11–1263.95]; SD: ROR 331.64 [95% CI, 216.71–507.51]), eye inflammation (HD: ROR 118.45 [95% CI, 55.85–251.20]; SD: 43.98 [95% CI, 21.87–88.44]), retinal vasculitis (HD: ROR 769.87 [95% CI, 337.13–1758.04]; SD: ROR 124.80 [95% CI, 39.67–392.63]), and systemic vasculitis (HD: ROR 28.40 [95% CI, 14.63–55.14]; SD: ROR 4.05 [1.52–10.82]). These results, based on FAERS, indicate associations rather than causal relationships. Further studies are needed to quantify the absolute risks and elucidate the mechanisms underlying differences in safety signals, if any.

]]> Adverse Events Reported with Standard-Dose and High-Dose Aflibercept: A FAERS Pharmacovigilance Study Minali Prasad David J. Ramsey doi: 10.3390/vision10020018 Vision 2026-03-31 Vision 2026-03-31 10 2 Article 18 10.3390/vision10020018 https://www.mdpi.com/2411-5150/10/2/18 Vision, Vol. 10, Pages 17: Foveated Retinotopy Improves Classification and Localization in Convolutional Neural Networks https://www.mdpi.com/2411-5150/10/2/17 From falcons spotting prey to humans recognizing faces, the ability to rapidly process visual information depends on a foveated retinal organization that provides high-acuity central vision while preserving low-resolution peripheral vision. This organization is conserved along early visual pathways, yet remains under-explored in machine learning. Here, we examine the impact of embedding a foveated retinotopic transformation as a preprocessing layer on convolutional neural networks (CNNs) for image classification. By applying a log-polar mapping to off-the-shelf models and retraining them, we achieve comparable accuracy while improving robustness to scale and rotation. We demonstrate that this architecture is highly sensitive to shifts in the fixation point and that this sensitivity provides an effective proxy for defining saliency maps that facilitate object localization. Our results demonstrate that foveated retinotopy encodes prior geometric knowledge, providing a solution for visual searches and a meaningful classification robustness and localization trade-off. These findings provides a proof of concept in order to connect principles of biological vision with artificial networks, suggesting new, robust and efficient approaches for computer vision systems. 2026-03-30 Vision, Vol. 10, Pages 17: Foveated Retinotopy Improves Classification and Localization in Convolutional Neural Networks

Vision doi: 10.3390/vision10020017

Authors: Jean-Nicolas Jérémie Emmanuel Daucé Laurent U. Perrinet

From falcons spotting prey to humans recognizing faces, the ability to rapidly process visual information depends on a foveated retinal organization that provides high-acuity central vision while preserving low-resolution peripheral vision. This organization is conserved along early visual pathways, yet remains under-explored in machine learning. Here, we examine the impact of embedding a foveated retinotopic transformation as a preprocessing layer on convolutional neural networks (CNNs) for image classification. By applying a log-polar mapping to off-the-shelf models and retraining them, we achieve comparable accuracy while improving robustness to scale and rotation. We demonstrate that this architecture is highly sensitive to shifts in the fixation point and that this sensitivity provides an effective proxy for defining saliency maps that facilitate object localization. Our results demonstrate that foveated retinotopy encodes prior geometric knowledge, providing a solution for visual searches and a meaningful classification robustness and localization trade-off. These findings provides a proof of concept in order to connect principles of biological vision with artificial networks, suggesting new, robust and efficient approaches for computer vision systems.

]]> Foveated Retinotopy Improves Classification and Localization in Convolutional Neural Networks Jean-Nicolas Jérémie Emmanuel Daucé Laurent U. Perrinet doi: 10.3390/vision10020017 Vision 2026-03-30 Vision 2026-03-30 10 2 Article 17 10.3390/vision10020017 https://www.mdpi.com/2411-5150/10/2/17 Vision, Vol. 10, Pages 16: Age-Related Associations of Foveal Structural Parameters in Healthy Adults: A Comparative Analysis of Biological and Chronological Age https://www.mdpi.com/2411-5150/10/1/16 Background: This research compared the relationship between foveal optical coherence tomography (OCT) parameters and two age measures—biological and chronological—in healthy adults. Methods: This cross-sectional study analyzed swept-source optical coherence tomography (OCT) data from 308 eyes of 154 healthy adults aged 22–89 years. Parameters assessed: foveal thickness, foveal pit depth and diameter, pit slope steepness, and the presence or absence of the foveal bulge. Biological age was calculated using the PhenoAge algorithm. Results: The core geometry of the foveal pit showed no significant dependence on either type of age (all p ≥ 0.66). In contrast, the foveal bulge prevalence declined significantly with age (adjusted p = 0.011 for chronological age, p = 0.005 for biological age; OR per year ≈0.95, 95% CI 0.92–0.98 for both age models). Model-predicted prevalence decreased from approximately 93% in younger adults to 60–68% in the 60–74-year-old group. Conclusion: The foveal architecture remains structurally stable throughout adulthood. The foveal bulge emerges as a sensitive qualitative marker of age-related changes. Biological age does not provide additional predictive value over chronological age for foveal structural parameters under physiological aging conditions. 2026-03-03 Vision, Vol. 10, Pages 16: Age-Related Associations of Foveal Structural Parameters in Healthy Adults: A Comparative Analysis of Biological and Chronological Age

Vision doi: 10.3390/vision10010016

Authors: Anait S. Khalatyan Yusef Yusef Khadishat K. Altemirova Liubov V. Machekhina Alexandra A. Melnitskaya Irina D. Strazhesko

Background: This research compared the relationship between foveal optical coherence tomography (OCT) parameters and two age measures—biological and chronological—in healthy adults. Methods: This cross-sectional study analyzed swept-source optical coherence tomography (OCT) data from 308 eyes of 154 healthy adults aged 22–89 years. Parameters assessed: foveal thickness, foveal pit depth and diameter, pit slope steepness, and the presence or absence of the foveal bulge. Biological age was calculated using the PhenoAge algorithm. Results: The core geometry of the foveal pit showed no significant dependence on either type of age (all p ≥ 0.66). In contrast, the foveal bulge prevalence declined significantly with age (adjusted p = 0.011 for chronological age, p = 0.005 for biological age; OR per year ≈0.95, 95% CI 0.92–0.98 for both age models). Model-predicted prevalence decreased from approximately 93% in younger adults to 60–68% in the 60–74-year-old group. Conclusion: The foveal architecture remains structurally stable throughout adulthood. The foveal bulge emerges as a sensitive qualitative marker of age-related changes. Biological age does not provide additional predictive value over chronological age for foveal structural parameters under physiological aging conditions.

]]> Age-Related Associations of Foveal Structural Parameters in Healthy Adults: A Comparative Analysis of Biological and Chronological Age Anait S. Khalatyan Yusef Yusef Khadishat K. Altemirova Liubov V. Machekhina Alexandra A. Melnitskaya Irina D. Strazhesko doi: 10.3390/vision10010016 Vision 2026-03-03 Vision 2026-03-03 10 1 Article 16 10.3390/vision10010016 https://www.mdpi.com/2411-5150/10/1/16 Vision, Vol. 10, Pages 15: Real-World Comparison of Overall Survival Among Patients With and Without Inherited Retinal Diseases https://www.mdpi.com/2411-5150/10/1/15 This study compared real-world overall survival and the risk of physical comorbidities and mental health conditions among patients aged <65 years with versus without inherited retinal diseases (IRDs) in the United States (US). Optum® Electronic Health Record data (January 2014–January 2023) were evaluated for IRD (patients with ≥2 medical visits with an IRD diagnosis; index date: second such medical visit) and non-IRD (patients without an IRD diagnosis; index date: random medical visit) cohorts. Baseline demographics were balanced between cohorts using propensity score matching (2:1). Outcome measures were overall survival (date of death due to any cause) and presence of physical comorbidities and mental health conditions (medical visit with a corresponding diagnosis code). In total, 4594 patients with IRD were matched to 9188 patients without IRD (mean age: 38.7 vs. 38.2 years, 53.9% vs. 55.1% female, mean follow-up: 53.1 vs. 52.8 months). Over 84 months, patients with versus without IRD had a 24% higher risk of death (overall survival: 95.8% vs. 96.7%; hazard ratio: 1.24; 95% confidence interval: 1.00–1.53; p = 0.046) and were at significantly higher risk for each evaluated physical comorbidity and mental health condition (all p < 0.05). The development of novel therapies is thus needed to address the clinical burden of IRD. 2026-03-01 Vision, Vol. 10, Pages 15: Real-World Comparison of Overall Survival Among Patients With and Without Inherited Retinal Diseases

Vision doi: 10.3390/vision10010015

Authors: Byron L. Lam Carlos E. Mendoza-Santiesteban Dominic Pilon Dejan Milentijevic Laura Morrison Samuel Schwartzbein Claire Vanden Eynde Marie-Hélène Lafeuille Patrick Lefebvre Ninel Z. Gregori

This study compared real-world overall survival and the risk of physical comorbidities and mental health conditions among patients aged <65 years with versus without inherited retinal diseases (IRDs) in the United States (US). Optum® Electronic Health Record data (January 2014–January 2023) were evaluated for IRD (patients with ≥2 medical visits with an IRD diagnosis; index date: second such medical visit) and non-IRD (patients without an IRD diagnosis; index date: random medical visit) cohorts. Baseline demographics were balanced between cohorts using propensity score matching (2:1). Outcome measures were overall survival (date of death due to any cause) and presence of physical comorbidities and mental health conditions (medical visit with a corresponding diagnosis code). In total, 4594 patients with IRD were matched to 9188 patients without IRD (mean age: 38.7 vs. 38.2 years, 53.9% vs. 55.1% female, mean follow-up: 53.1 vs. 52.8 months). Over 84 months, patients with versus without IRD had a 24% higher risk of death (overall survival: 95.8% vs. 96.7%; hazard ratio: 1.24; 95% confidence interval: 1.00–1.53; p = 0.046) and were at significantly higher risk for each evaluated physical comorbidity and mental health condition (all p < 0.05). The development of novel therapies is thus needed to address the clinical burden of IRD.

]]> Real-World Comparison of Overall Survival Among Patients With and Without Inherited Retinal Diseases Byron L. Lam Carlos E. Mendoza-Santiesteban Dominic Pilon Dejan Milentijevic Laura Morrison Samuel Schwartzbein Claire Vanden Eynde Marie-Hélène Lafeuille Patrick Lefebvre Ninel Z. Gregori doi: 10.3390/vision10010015 Vision 2026-03-01 Vision 2026-03-01 10 1 Article 15 10.3390/vision10010015 https://www.mdpi.com/2411-5150/10/1/15 Vision, Vol. 10, Pages 14: Functional Visual Symptoms, Accommodative Dysfunction, and Visual Performance Alterations in Chronic Work-Related Stress: A Narrative Review https://www.mdpi.com/2411-5150/10/1/14 Background: Chronic work-related stress, including exposure to mobbing, is associated with a wide range of psychological and somatic consequences. However, its potential impact on visual function, particularly in the absence of structural ocular damage, remains underexplored. This narrative review critically examines the evidence linking chronic stress, autonomic nervous system (ANS) dysregulation, and functional visual disorders, focusing on accommodative function and asthenopia. Methods: A qualitative narrative review of the literature published between 2000 and 2025 was conducted using major biomedical databases. Studies addressing chronic stress, ANS activity, accommodative function, digital eye strain, and functional ocular symptoms were identified and integrated into a coherent pathophysiological framework. Results: The ocular system, being richly innervated by the ANS, may represent a peripheral target of prolonged stress-related autonomic alterations. Available evidence suggests that chronic stress is associated with asthenopia, accommodative inefficiency, and ocular discomfort even in the absence of overt ocular pathology. In particular, altered parasympathetic control of the ciliary muscle emerges as a plausible mediating mechanism. Conclusions: Functional visual disorders may represent peripheral manifestations of stress-related ANS dysregulation. Although causality cannot be established conclusively, the proposed framework supports the need for multidisciplinary research to clarify the clinical and medico-legal relevance of stress-related visual dysfunction. 2026-02-19 Vision, Vol. 10, Pages 14: Functional Visual Symptoms, Accommodative Dysfunction, and Visual Performance Alterations in Chronic Work-Related Stress: A Narrative Review

Vision doi: 10.3390/vision10010014

Authors: Mariaelena Malvasi Elena Pacella Simone De Sio Gian Piero Covelli

Background: Chronic work-related stress, including exposure to mobbing, is associated with a wide range of psychological and somatic consequences. However, its potential impact on visual function, particularly in the absence of structural ocular damage, remains underexplored. This narrative review critically examines the evidence linking chronic stress, autonomic nervous system (ANS) dysregulation, and functional visual disorders, focusing on accommodative function and asthenopia. Methods: A qualitative narrative review of the literature published between 2000 and 2025 was conducted using major biomedical databases. Studies addressing chronic stress, ANS activity, accommodative function, digital eye strain, and functional ocular symptoms were identified and integrated into a coherent pathophysiological framework. Results: The ocular system, being richly innervated by the ANS, may represent a peripheral target of prolonged stress-related autonomic alterations. Available evidence suggests that chronic stress is associated with asthenopia, accommodative inefficiency, and ocular discomfort even in the absence of overt ocular pathology. In particular, altered parasympathetic control of the ciliary muscle emerges as a plausible mediating mechanism. Conclusions: Functional visual disorders may represent peripheral manifestations of stress-related ANS dysregulation. Although causality cannot be established conclusively, the proposed framework supports the need for multidisciplinary research to clarify the clinical and medico-legal relevance of stress-related visual dysfunction.

]]> Functional Visual Symptoms, Accommodative Dysfunction, and Visual Performance Alterations in Chronic Work-Related Stress: A Narrative Review Mariaelena Malvasi Elena Pacella Simone De Sio Gian Piero Covelli doi: 10.3390/vision10010014 Vision 2026-02-19 Vision 2026-02-19 10 1 Review 14 10.3390/vision10010014 https://www.mdpi.com/2411-5150/10/1/14 Vision, Vol. 10, Pages 13: Associations Between Eye-Movement Patterns, Pupil Dynamics, and the Interpretation of a Single Mixed-Dentition Panoramic Radiograph Among Dental Students: An Exploratory Eye-Tracking Study https://www.mdpi.com/2411-5150/10/1/13 Eye tracking can provide quantitative indices of visual exploration and cognitive processing during radiographic image interpretation. This study examined eye-movement patterns and pupil dynamics and their associations with task performance while fifth-year dental students interpreted a single mixed-dentition panoramic radiograph under free-viewing conditions. Task performance was defined as the number of correctly identified pre-specified items (three radiographic findings plus two interpretive items: dental age estimation and the presence/absence of congenital anomalies). Eye-movement patterns were classified into four groups: clockwise (R, 29.6%), counterclockwise (L, 44.4%), saccadic (S, 16.7%), and concentrated (C, 9.3%). Clockwise scan paths were associated with higher task scores and more globally distributed fixations than other patterns (p < 0.001). Linear mixed-effects modeling suggested that task scores increased up to 120 s of viewing time, whereas longer viewing times were not associated with further improvements. Furthermore, ordinal logistic regression analysis revealed that higher task scores were significantly associated with a smaller mean pupil area across the entire viewing time, combined with a larger pupil area specifically during fixations, suggesting more selective allocation of cognitive resources. These findings indicate associations between global scan structure, time allocation, pupil dynamics, and task performance in this single-image setting. Generalization to overall diagnostic competence or other radiographs requires replication using multiple panoramic images and a broader range of verified findings. 2026-02-14 Vision, Vol. 10, Pages 13: Associations Between Eye-Movement Patterns, Pupil Dynamics, and the Interpretation of a Single Mixed-Dentition Panoramic Radiograph Among Dental Students: An Exploratory Eye-Tracking Study

Vision doi: 10.3390/vision10010013

Authors: Satoshi Tanaka Hiroyuki Karibe Yuichi Kato Ayuko Okamoto Tsuneo Sekimoto

Eye tracking can provide quantitative indices of visual exploration and cognitive processing during radiographic image interpretation. This study examined eye-movement patterns and pupil dynamics and their associations with task performance while fifth-year dental students interpreted a single mixed-dentition panoramic radiograph under free-viewing conditions. Task performance was defined as the number of correctly identified pre-specified items (three radiographic findings plus two interpretive items: dental age estimation and the presence/absence of congenital anomalies). Eye-movement patterns were classified into four groups: clockwise (R, 29.6%), counterclockwise (L, 44.4%), saccadic (S, 16.7%), and concentrated (C, 9.3%). Clockwise scan paths were associated with higher task scores and more globally distributed fixations than other patterns (p < 0.001). Linear mixed-effects modeling suggested that task scores increased up to 120 s of viewing time, whereas longer viewing times were not associated with further improvements. Furthermore, ordinal logistic regression analysis revealed that higher task scores were significantly associated with a smaller mean pupil area across the entire viewing time, combined with a larger pupil area specifically during fixations, suggesting more selective allocation of cognitive resources. These findings indicate associations between global scan structure, time allocation, pupil dynamics, and task performance in this single-image setting. Generalization to overall diagnostic competence or other radiographs requires replication using multiple panoramic images and a broader range of verified findings.

]]> Associations Between Eye-Movement Patterns, Pupil Dynamics, and the Interpretation of a Single Mixed-Dentition Panoramic Radiograph Among Dental Students: An Exploratory Eye-Tracking Study Satoshi Tanaka Hiroyuki Karibe Yuichi Kato Ayuko Okamoto Tsuneo Sekimoto doi: 10.3390/vision10010013 Vision 2026-02-14 Vision 2026-02-14 10 1 Article 13 10.3390/vision10010013 https://www.mdpi.com/2411-5150/10/1/13 Vision, Vol. 10, Pages 12: Perimetry of the Central Visual Field Using a Head-Mounted Open-Source Perimeter in Patients with Inherited Retinal Diseases https://www.mdpi.com/2411-5150/10/1/12 Head-mounted (“virtual reality”) perimeters (HMPs), based on standard consumer electronic hardware, are a cheaper alternative to standard automated perimetry. They have not been validated in patients with inherited retinal disease (IRDs), yet. We evaluated the Iowa-HMP in a first pilot study. It consists of a legacy smartphone, a headset, and freely available, open-source software. We used the 10-2 grid, the ZEST algorithm, and a background of 10 cd/m2 to measure central visual fields in one normal subject, and in patients with occult macular dystrophy (n = 2), Stargardt’s disease (n = 3) and retinitis pigmentosa (n = 6). Results were compared with those from an Octopus 900 perimeter. The typical patterns of visual field loss were clearly discernible, but head-mounted perimeters generally have a limited dynamic range. Within the dynamic range of the Iowa-HMP (14 to 30 dB Octopus sensitivity), the Limits of Agreement (Bland-Altman) were ±7.5 dB. The Iowa-HMP had a diagnostic sensitivity of 0.67 for detecting locations with low perimetric sensitivity (<14 dB in the Octopus perimetry) with a diagnostic specificity of 0.95. Although the Iowa-HMP cannot be directly compared to standard perimetry in IRDs, open software greatly facilitates research in this area. 2026-02-14 Vision, Vol. 10, Pages 12: Perimetry of the Central Visual Field Using a Head-Mounted Open-Source Perimeter in Patients with Inherited Retinal Diseases

Vision doi: 10.3390/vision10010012

Authors: Cord Huchzermeyer Friedrich Kruse Jan Kremers

Head-mounted (“virtual reality”) perimeters (HMPs), based on standard consumer electronic hardware, are a cheaper alternative to standard automated perimetry. They have not been validated in patients with inherited retinal disease (IRDs), yet. We evaluated the Iowa-HMP in a first pilot study. It consists of a legacy smartphone, a headset, and freely available, open-source software. We used the 10-2 grid, the ZEST algorithm, and a background of 10 cd/m2 to measure central visual fields in one normal subject, and in patients with occult macular dystrophy (n = 2), Stargardt’s disease (n = 3) and retinitis pigmentosa (n = 6). Results were compared with those from an Octopus 900 perimeter. The typical patterns of visual field loss were clearly discernible, but head-mounted perimeters generally have a limited dynamic range. Within the dynamic range of the Iowa-HMP (14 to 30 dB Octopus sensitivity), the Limits of Agreement (Bland-Altman) were ±7.5 dB. The Iowa-HMP had a diagnostic sensitivity of 0.67 for detecting locations with low perimetric sensitivity (<14 dB in the Octopus perimetry) with a diagnostic specificity of 0.95. Although the Iowa-HMP cannot be directly compared to standard perimetry in IRDs, open software greatly facilitates research in this area.

]]> Perimetry of the Central Visual Field Using a Head-Mounted Open-Source Perimeter in Patients with Inherited Retinal Diseases Cord Huchzermeyer Friedrich Kruse Jan Kremers doi: 10.3390/vision10010012 Vision 2026-02-14 Vision 2026-02-14 10 1 Article 12 10.3390/vision10010012 https://www.mdpi.com/2411-5150/10/1/12 Vision, Vol. 10, Pages 11: Knowledge and Awareness of Myopia Among Parents and Teachers of Schoolchildren Aged 6–15 Years in Beirut, Lebanon https://www.mdpi.com/2411-5150/10/1/11 Background: Using a cross-sectional design, this study assessed and compared myopia knowledge among parents and teachers of schoolchildren aged 6–15 years in Beirut, Lebanon. Methods: Two cross-sectional surveys were conducted between October 2022 and February 2024 among parents (n = 1256) and teachers (n = 366) of children aged 6–15 years. Using validated online Google Form questionnaires, data were collected on demographics, awareness, risk factors, and myopia knowledge, and analyzed with Statistical Package for the Social Sciences version 28 (SPSS v28) through descriptive statistics and logistic regression. Results: Findings showed that 78.3% of parents and 79.5% of teachers had poor knowledge of myopia. Among teachers, better knowledge was linked to being male, having a family history of myopia, positive attitudes toward eyeglasses use, and attending regular or occasional eye care visits (all statistically significant). Among parents, higher knowledge was associated with having previously heard of myopia, higher income and education levels, and a family history of myopia, while parents of private-school children were less knowledgeable. Odds ratios below 1 indicate lower odds of good myopia knowledge relative to the reference category. Conclusions: Both groups showed inadequate knowledge, underscoring the urgent need for targeted educational interventions to improve myopia awareness and prevention. 2026-02-12 Vision, Vol. 10, Pages 11: Knowledge and Awareness of Myopia Among Parents and Teachers of Schoolchildren Aged 6–15 Years in Beirut, Lebanon

Vision doi: 10.3390/vision10010011

Authors: Ameer Abou Adela Vanessa R. Moodley Yazan Gammoh

Background: Using a cross-sectional design, this study assessed and compared myopia knowledge among parents and teachers of schoolchildren aged 6–15 years in Beirut, Lebanon. Methods: Two cross-sectional surveys were conducted between October 2022 and February 2024 among parents (n = 1256) and teachers (n = 366) of children aged 6–15 years. Using validated online Google Form questionnaires, data were collected on demographics, awareness, risk factors, and myopia knowledge, and analyzed with Statistical Package for the Social Sciences version 28 (SPSS v28) through descriptive statistics and logistic regression. Results: Findings showed that 78.3% of parents and 79.5% of teachers had poor knowledge of myopia. Among teachers, better knowledge was linked to being male, having a family history of myopia, positive attitudes toward eyeglasses use, and attending regular or occasional eye care visits (all statistically significant). Among parents, higher knowledge was associated with having previously heard of myopia, higher income and education levels, and a family history of myopia, while parents of private-school children were less knowledgeable. Odds ratios below 1 indicate lower odds of good myopia knowledge relative to the reference category. Conclusions: Both groups showed inadequate knowledge, underscoring the urgent need for targeted educational interventions to improve myopia awareness and prevention.

]]> Knowledge and Awareness of Myopia Among Parents and Teachers of Schoolchildren Aged 6–15 Years in Beirut, Lebanon Ameer Abou Adela Vanessa R. Moodley Yazan Gammoh doi: 10.3390/vision10010011 Vision 2026-02-12 Vision 2026-02-12 10 1 Article 11 10.3390/vision10010011 https://www.mdpi.com/2411-5150/10/1/11 Vision, Vol. 10, Pages 10: Demographic Disparities in AI-Generated Versus Search-Engine-Sourced Images of Ophthalmologists: A Cross-Sectional Analysis https://www.mdpi.com/2411-5150/10/1/10 Purpose: To evaluate demographic representation in AI-generated and search-engine-sourced images of North American ophthalmologists, overall and stratified by subspecialty, and compare these with actual demographic data. Methods: This cross-sectional analysis examined 2000 images (1000 AI-generated and 1000 search-engine-sourced) across ten North American ophthalmology subspecialties. Images were sourced from four AI platforms (DALL·E 3, Firefly, Midjourney, Grok-2) and four search engines (Google, Bing, DuckDuckGo, Yahoo!). Using a standardized framework, reviewers assessed gender, race, age group, and professional attire. Pearson chi-squared tests were used to compare image sets with actual demographic data from the Association of American Medical Colleges and Canadian Institute for Health Information. Results: AI-generated images depicted 69% men compared to 64% in search-engine-sourced images (p = 0.047), though both were lower than the actual proportion of male ophthalmologists in North America (71–73%, p < 0.001). White individuals were overrepresented in AI-generated images (81%) relative to both search-engine-sourced images (74%, p = 0.001) and actual demographic data (69%, p < 0.001). Younger individuals (under 50 years) were significantly overrepresented in both image sets, with 82% in AI-generated images and 73% in search-engine-sourced images, compared to only 45–46% in actual demographic data (p < 0.001 for both). AI-generated images also depicted ophthalmologists with significantly more stereotypical medical accessories, including stethoscopes (17% vs. 2%, p < 0.001), glasses (45% vs. 30%, p < 0.001), and white coats (68% vs. 53%, p < 0.001), compared to search-engine-sourced images. Conclusions: AI-generated images diverge from actual demographics, presenting a younger, more stereotypical workforce that paradoxically aligns closer to gender parity than reality. 2026-02-10 Vision, Vol. 10, Pages 10: Demographic Disparities in AI-Generated Versus Search-Engine-Sourced Images of Ophthalmologists: A Cross-Sectional Analysis

Vision doi: 10.3390/vision10010010

Authors: Siddharth Gandhi Katherine Jung Michael Balas Parnian Arjmand

Purpose: To evaluate demographic representation in AI-generated and search-engine-sourced images of North American ophthalmologists, overall and stratified by subspecialty, and compare these with actual demographic data. Methods: This cross-sectional analysis examined 2000 images (1000 AI-generated and 1000 search-engine-sourced) across ten North American ophthalmology subspecialties. Images were sourced from four AI platforms (DALL·E 3, Firefly, Midjourney, Grok-2) and four search engines (Google, Bing, DuckDuckGo, Yahoo!). Using a standardized framework, reviewers assessed gender, race, age group, and professional attire. Pearson chi-squared tests were used to compare image sets with actual demographic data from the Association of American Medical Colleges and Canadian Institute for Health Information. Results: AI-generated images depicted 69% men compared to 64% in search-engine-sourced images (p = 0.047), though both were lower than the actual proportion of male ophthalmologists in North America (71–73%, p < 0.001). White individuals were overrepresented in AI-generated images (81%) relative to both search-engine-sourced images (74%, p = 0.001) and actual demographic data (69%, p < 0.001). Younger individuals (under 50 years) were significantly overrepresented in both image sets, with 82% in AI-generated images and 73% in search-engine-sourced images, compared to only 45–46% in actual demographic data (p < 0.001 for both). AI-generated images also depicted ophthalmologists with significantly more stereotypical medical accessories, including stethoscopes (17% vs. 2%, p < 0.001), glasses (45% vs. 30%, p < 0.001), and white coats (68% vs. 53%, p < 0.001), compared to search-engine-sourced images. Conclusions: AI-generated images diverge from actual demographics, presenting a younger, more stereotypical workforce that paradoxically aligns closer to gender parity than reality.

]]> Demographic Disparities in AI-Generated Versus Search-Engine-Sourced Images of Ophthalmologists: A Cross-Sectional Analysis Siddharth Gandhi Katherine Jung Michael Balas Parnian Arjmand doi: 10.3390/vision10010010 Vision 2026-02-10 Vision 2026-02-10 10 1 Article 10 10.3390/vision10010010 https://www.mdpi.com/2411-5150/10/1/10 Vision, Vol. 10, Pages 9: Applications of Large Language Models in Glaucoma: A Scoping Review https://www.mdpi.com/2411-5150/10/1/9 Background: Large language models (LLMs) and vision-language models (VLMs) have recently been applied to ophthalmology for patient education, diagnosis, and surgical decision support. Their ability to generate, interpret, and synthesize medical information positions them as promising assistive tools in glaucoma care. This scoping review aims to consolidate current evidence on the applications of LLMs and VLMSs in glaucoma, summarizing their tasks, inputs, performance metrics, and limitations to guide future clinical and research developments. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, arXiv, and IEEE Xplore from 2014 to July 2025. Eligible studies included original research and research letters employing LLMs or VLMs/MM-LLMs in any glaucoma-related application, including diagnostic reasoning, image interpretation, patient education, or surgical decision support. Screening and full-text review were independently performed by two reviewers following PRISMA-ScR methodology, with discrepancies resolved by consensus. Results: In total, 316 records were identified across five databases, with 27 studies meeting the inclusion criteria. The selected studies focused on three main domains: patient education (n = 11), diagnosis and risk prediction (n = 10), and surgical management (n = 6). Conclusions: Current LLMs serve best as assistive rather than autonomous tools in glaucoma care. They demonstrate strong potential in patient communication and text-based clinical decision support but remain constrained by variable accuracy, limited multimodal integration, and a lack of ophthalmology-specific fine-tuning. Future research should focus on developing domain-trained and retrieval-augmented LLMs, enhancing multimodal (text-image) fusion, ensuring readability adaptation for patients, and establishing ethical and regulatory frameworks for clinical implementation. 2026-02-09 Vision, Vol. 10, Pages 9: Applications of Large Language Models in Glaucoma: A Scoping Review

Vision doi: 10.3390/vision10010009

Authors: Giovanni Rubegni Alessandra Cartocci Alessio Luschi Niccolò Castellino Francesco Cappellani Dario Romano Benedetta Colizzi Luca Rossetti Gian Marco Tosi

Background: Large language models (LLMs) and vision-language models (VLMs) have recently been applied to ophthalmology for patient education, diagnosis, and surgical decision support. Their ability to generate, interpret, and synthesize medical information positions them as promising assistive tools in glaucoma care. This scoping review aims to consolidate current evidence on the applications of LLMs and VLMSs in glaucoma, summarizing their tasks, inputs, performance metrics, and limitations to guide future clinical and research developments. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, arXiv, and IEEE Xplore from 2014 to July 2025. Eligible studies included original research and research letters employing LLMs or VLMs/MM-LLMs in any glaucoma-related application, including diagnostic reasoning, image interpretation, patient education, or surgical decision support. Screening and full-text review were independently performed by two reviewers following PRISMA-ScR methodology, with discrepancies resolved by consensus. Results: In total, 316 records were identified across five databases, with 27 studies meeting the inclusion criteria. The selected studies focused on three main domains: patient education (n = 11), diagnosis and risk prediction (n = 10), and surgical management (n = 6). Conclusions: Current LLMs serve best as assistive rather than autonomous tools in glaucoma care. They demonstrate strong potential in patient communication and text-based clinical decision support but remain constrained by variable accuracy, limited multimodal integration, and a lack of ophthalmology-specific fine-tuning. Future research should focus on developing domain-trained and retrieval-augmented LLMs, enhancing multimodal (text-image) fusion, ensuring readability adaptation for patients, and establishing ethical and regulatory frameworks for clinical implementation.

]]> Applications of Large Language Models in Glaucoma: A Scoping Review Giovanni Rubegni Alessandra Cartocci Alessio Luschi Niccolò Castellino Francesco Cappellani Dario Romano Benedetta Colizzi Luca Rossetti Gian Marco Tosi doi: 10.3390/vision10010009 Vision 2026-02-09 Vision 2026-02-09 10 1 Review 9 10.3390/vision10010009 https://www.mdpi.com/2411-5150/10/1/9 Vision, Vol. 10, Pages 8: Perceived Transparency from Dynamic Luminance Modulation in Uniform Center–Surround Displays https://www.mdpi.com/2411-5150/10/1/8 We report a novel phenomenon in which dynamic changes in luminance are perceived as changes in transparency rather than as changes in surface lightness. Participants viewed an achromatic disc on a uniform gray background and indicated whether the observed change was best described in terms of lightness or transparency. In Experiment 1, transparency-change responses were more frequent at low contrast and were strongly biased toward sequences in which contrast decreased over time, revealing a pronounced asymmetry between decreasing and increasing contrast trajectories. Experiment 2 introduced a size manipulation, such that the disc either expanded or contracted during the luminance modulation. Transparency-change responses were highest when contrast decreased and the disc expanded, indicating that spatial expansion further amplifies transparency-related interpretations of the disc’s surface appearance. Overall, the results reveal a systematic asymmetry in how contrast-change direction shapes visual appearance, consistent with a forward bias in the processing of continuously changing visual signals. When contrast dynamically approached the background level, perceptual representations appeared to be weighted toward the upcoming low-contrast state, enhancing impressions of increasing transparency. These findings demonstrate that even minimal displays lacking traditional geometric cues to transparency can evoke strong transparency impressions, driven by predictive weighting of spatiotemporal contrast trajectories rather than by static image properties alone. 2026-02-06 Vision, Vol. 10, Pages 8: Perceived Transparency from Dynamic Luminance Modulation in Uniform Center–Surround Displays

Vision doi: 10.3390/vision10010008

Authors: Soomin Kim Sung-Ho Kim

We report a novel phenomenon in which dynamic changes in luminance are perceived as changes in transparency rather than as changes in surface lightness. Participants viewed an achromatic disc on a uniform gray background and indicated whether the observed change was best described in terms of lightness or transparency. In Experiment 1, transparency-change responses were more frequent at low contrast and were strongly biased toward sequences in which contrast decreased over time, revealing a pronounced asymmetry between decreasing and increasing contrast trajectories. Experiment 2 introduced a size manipulation, such that the disc either expanded or contracted during the luminance modulation. Transparency-change responses were highest when contrast decreased and the disc expanded, indicating that spatial expansion further amplifies transparency-related interpretations of the disc’s surface appearance. Overall, the results reveal a systematic asymmetry in how contrast-change direction shapes visual appearance, consistent with a forward bias in the processing of continuously changing visual signals. When contrast dynamically approached the background level, perceptual representations appeared to be weighted toward the upcoming low-contrast state, enhancing impressions of increasing transparency. These findings demonstrate that even minimal displays lacking traditional geometric cues to transparency can evoke strong transparency impressions, driven by predictive weighting of spatiotemporal contrast trajectories rather than by static image properties alone.

]]> Perceived Transparency from Dynamic Luminance Modulation in Uniform Center–Surround Displays Soomin Kim Sung-Ho Kim doi: 10.3390/vision10010008 Vision 2026-02-06 Vision 2026-02-06 10 1 Article 8 10.3390/vision10010008 https://www.mdpi.com/2411-5150/10/1/8 Vision, Vol. 10, Pages 4: Signal-to-Noise Efficiency Explains Inter-Observer Variability in Orientation Discrimination https://www.mdpi.com/2411-5150/10/1/4 Background: Orientation discrimination tasks provide a core measure of visual sensitivity and are widely used to study how perceptual performance varies with stimulus uncertainty and visual field location. Here, we examined how external noise, retinal eccentricity, and individual perceptual efficiency shape orientation discrimination thresholds. Methods: Forty-two adults (mean age = 32.35 years, SD = 7.23) completed a two-alternative forced-choice task judging the orientation (clockwise vs. counterclockwise) of briefly presented Gabor patches under varying levels of external noise (low, medium, high) and eccentricity (0°, 5°, 10°). Orientation offsets ranged from −8° to +8°. Thresholds were estimated using psychometric functions and analyzed via rm ANOVA, linear mixed-effects models, and supervised machine learning. Results: Accuracy declined with increasing noise (ω2 = 0.48, p < 0.001) and improved with larger orientation offsets (ω2 = 0.62, p < 0.001). Thresholds increased with both noise (ω2 = 0.31, p = 0.002) and eccentricity (ω2 = 0.27, p = 0.003). Signal-to-noise efficiency was the strongest predictor (β = −0.72, p < 0.001); age alone was nonsignificant, but its interaction with eccentricity showed selective peripheral declines. Mixed-effects models confirmed spatial effects (β = 0.058, p < 0.001) and residual between-subject variability (σ2 = 0.14). Predictive models generalized well (R2 = 0.54). Conclusions: Orientation discrimination is shaped by both stimulus-level difficulty and individual differences in perceptual efficiency, which account for variability in sensitivity across visual conditions. Age-related differences emerge primarily under spatial load and depend on interactions between observer traits and task demands. 2026-01-29 Vision, Vol. 10, Pages 4: Signal-to-Noise Efficiency Explains Inter-Observer Variability in Orientation Discrimination

Vision doi: 10.3390/vision10010004

Authors: Thiago P. Fernandes Natanael A. Santos Linnea N. Dahlgren

Background: Orientation discrimination tasks provide a core measure of visual sensitivity and are widely used to study how perceptual performance varies with stimulus uncertainty and visual field location. Here, we examined how external noise, retinal eccentricity, and individual perceptual efficiency shape orientation discrimination thresholds. Methods: Forty-two adults (mean age = 32.35 years, SD = 7.23) completed a two-alternative forced-choice task judging the orientation (clockwise vs. counterclockwise) of briefly presented Gabor patches under varying levels of external noise (low, medium, high) and eccentricity (0°, 5°, 10°). Orientation offsets ranged from −8° to +8°. Thresholds were estimated using psychometric functions and analyzed via rm ANOVA, linear mixed-effects models, and supervised machine learning. Results: Accuracy declined with increasing noise (ω2 = 0.48, p < 0.001) and improved with larger orientation offsets (ω2 = 0.62, p < 0.001). Thresholds increased with both noise (ω2 = 0.31, p = 0.002) and eccentricity (ω2 = 0.27, p = 0.003). Signal-to-noise efficiency was the strongest predictor (β = −0.72, p < 0.001); age alone was nonsignificant, but its interaction with eccentricity showed selective peripheral declines. Mixed-effects models confirmed spatial effects (β = 0.058, p < 0.001) and residual between-subject variability (σ2 = 0.14). Predictive models generalized well (R2 = 0.54). Conclusions: Orientation discrimination is shaped by both stimulus-level difficulty and individual differences in perceptual efficiency, which account for variability in sensitivity across visual conditions. Age-related differences emerge primarily under spatial load and depend on interactions between observer traits and task demands.

]]> Signal-to-Noise Efficiency Explains Inter-Observer Variability in Orientation Discrimination Thiago P. Fernandes Natanael A. Santos Linnea N. Dahlgren doi: 10.3390/vision10010004 Vision 2026-01-29 Vision 2026-01-29 10 1 Article 4 10.3390/vision10010004 https://www.mdpi.com/2411-5150/10/1/4 Vision, Vol. 10, Pages 7: An Exploratory Study of Six-Month Niacinamide Supplementation on Macular Structure and Electrophysiology in Primary Open-Angle Glaucoma https://www.mdpi.com/2411-5150/10/1/7 Background and Objectives: Primary open-angle glaucoma (POAG) is one of the leading ocular diseases leading to irreversible blindness and is often asymptomatic until advanced cases. While intraocular pressure reduction remains the cornerstone of treatment, neuroprotective strategies targeting retinal ganglion cell metabolism are actively investigated. Niacinamide (nicotinamide, vitamin B3), a precursor of NAD+, has shown neuroprotective potential in preclinical models. This exploratory study evaluated the short-term functional, structural, and electrophysiological effects of oral niacinamide supplementation in POAG. Materials and Methods: In this interventional study, patients with POAG received oral niacinamide 500 mg daily for six months. Visual field (VF) global and localized sensitivity (Mean Deviation [MD], Pattern Standard Deviation [PSD]), Optic Coherence Tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), and Visual evoked potentials (VEP) latency parameters (P2 1.4 Hz, P100 1°, and P100 15′) were assessed at baseline and at six months. Because both eyes from some participants were included, primary longitudinal inference was based on clustered analyses using generalized estimating equations and linear mixed-effects models to account for inter-eye correlation. Eye-level paired analyses were used for exploratory comparison. Change–change relationships across modalities were explored using Spearman correlation. Results: After accounting for inter-eye correlation, no statistically significant change in MD was detected (mean ΔMD +0.43 dB; GEE p = 0.099; LME p = 0.101), and PSD remained stable. RNFL thickness showed a small decrease (−1.26 µm; GEE p = 0.046), while GCC did not change significantly. VEP P100 latencies remained stable, whereas P2 latency showed a small increase (+3.9 ms; GEE p = 0.039). Correlation analysis revealed a moderate association between changes in GCC and MD (ρ = 0.44), suggesting concordance between macular structural stability and global visual field performance. Conclusions: When inter-eye correlation is appropriately accounted for, six months of niacinamide supplementation in POAG is associated with overall functional, structural, and electrophysiological stability, without evidence of clinically meaningful improvement or progression. These findings support short-term safety and highlight the importance of clustered analytical approaches and macular-centered biomarkers in future glaucoma neuroprotection trials. 2026-01-28 Vision, Vol. 10, Pages 7: An Exploratory Study of Six-Month Niacinamide Supplementation on Macular Structure and Electrophysiology in Primary Open-Angle Glaucoma

Vision doi: 10.3390/vision10010007

Authors: Constantin Alin Nicola Maria Cristina Marinescu Cristina Alexandrescu Anne Marie Firan Walid Alyamani Mihaela Simona Naidin Radu Constantin Ciuluvica Radu Antoniu Patrascu Anca Maria Capraru Adina Turcu-Stiolica

Background and Objectives: Primary open-angle glaucoma (POAG) is one of the leading ocular diseases leading to irreversible blindness and is often asymptomatic until advanced cases. While intraocular pressure reduction remains the cornerstone of treatment, neuroprotective strategies targeting retinal ganglion cell metabolism are actively investigated. Niacinamide (nicotinamide, vitamin B3), a precursor of NAD+, has shown neuroprotective potential in preclinical models. This exploratory study evaluated the short-term functional, structural, and electrophysiological effects of oral niacinamide supplementation in POAG. Materials and Methods: In this interventional study, patients with POAG received oral niacinamide 500 mg daily for six months. Visual field (VF) global and localized sensitivity (Mean Deviation [MD], Pattern Standard Deviation [PSD]), Optic Coherence Tomography (OCT)-derived peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC), and Visual evoked potentials (VEP) latency parameters (P2 1.4 Hz, P100 1°, and P100 15′) were assessed at baseline and at six months. Because both eyes from some participants were included, primary longitudinal inference was based on clustered analyses using generalized estimating equations and linear mixed-effects models to account for inter-eye correlation. Eye-level paired analyses were used for exploratory comparison. Change–change relationships across modalities were explored using Spearman correlation. Results: After accounting for inter-eye correlation, no statistically significant change in MD was detected (mean ΔMD +0.43 dB; GEE p = 0.099; LME p = 0.101), and PSD remained stable. RNFL thickness showed a small decrease (−1.26 µm; GEE p = 0.046), while GCC did not change significantly. VEP P100 latencies remained stable, whereas P2 latency showed a small increase (+3.9 ms; GEE p = 0.039). Correlation analysis revealed a moderate association between changes in GCC and MD (ρ = 0.44), suggesting concordance between macular structural stability and global visual field performance. Conclusions: When inter-eye correlation is appropriately accounted for, six months of niacinamide supplementation in POAG is associated with overall functional, structural, and electrophysiological stability, without evidence of clinically meaningful improvement or progression. These findings support short-term safety and highlight the importance of clustered analytical approaches and macular-centered biomarkers in future glaucoma neuroprotection trials.

]]> An Exploratory Study of Six-Month Niacinamide Supplementation on Macular Structure and Electrophysiology in Primary Open-Angle Glaucoma Constantin Alin Nicola Maria Cristina Marinescu Cristina Alexandrescu Anne Marie Firan Walid Alyamani Mihaela Simona Naidin Radu Constantin Ciuluvica Radu Antoniu Patrascu Anca Maria Capraru Adina Turcu-Stiolica doi: 10.3390/vision10010007 Vision 2026-01-28 Vision 2026-01-28 10 1 Article 7 10.3390/vision10010007 https://www.mdpi.com/2411-5150/10/1/7 Vision, Vol. 10, Pages 6: Wavefront Automated Refraction Comparison of Three Different IOLs: Aspheric Monofocal and Two Enhanced Monofocal IOLs https://www.mdpi.com/2411-5150/10/1/6 The objective of this study was to compare subjective manifest refraction with wavefront-based automated refraction using iTrace (ray tracing) and LadarWave (Hartmann–Shack) in eyes implanted with two enhanced monofocal intraocular lenses (IOLs) and a standard aspheric monofocal IOL, emphasizing agreement and refractive variability across optical designs. This retrospective cohort included 84 eyes from 42 patients implanted with Tecnis Eyhance (DIB00), RayOne EMV (RAO200E), or Tecnis ZCB00 IOLs. Postoperative evaluation (1–3 months) included uncorrected and corrected distance visual acuity and subjective manifest refraction, followed by automated refraction with iTrace and LadarWave. Outcomes were sphere, cylinder, and spherical equivalent (SE). Agreement was assessed using mean signed difference, mean absolute error, root mean square error, Bland–Altman limits of agreement, proportions within clinically relevant thresholds, and vector astigmatism (J0, J45). Linear mixed-effect modeling evaluated SE differences across methods and IOL types while accounting for within-subject correlation. Subjective SE differed among IOLs (p = 0.027), with RAO200E more myopic than ZCB00 (−0.20 ± 0.32 D vs. −0.08 ± 0.44 D, p = 0.035). Automated refraction showed greater variability and poorer agreement in enhanced monofocal IOLs, particularly for cylinder and SE, with wider limits of agreement and fewer eyes within ±0.50 D compared with ZCB00. In mixed-effect contrasts (three-method repeated-measures model), iTrace and LadarWave showed a consistent myopic bias versus manifest refraction in DIB00 and RAO200E, whereas in ZCB00 the iTrace–manifest difference was not significant and LadarWave retained a significant myopic bias. Enhanced monofocal IOLs exhibit reduced agreement between wavefront-based automated and subjective manifest refraction compared with a standard aspheric monofocal IOL. Manifest refraction remains essential for postoperative assessment, and automated measurements should be interpreted as complementary, particularly in IOL designs that modify aberrations. 2026-01-26 Vision, Vol. 10, Pages 6: Wavefront Automated Refraction Comparison of Three Different IOLs: Aspheric Monofocal and Two Enhanced Monofocal IOLs

Vision doi: 10.3390/vision10010006

Authors: Arthur Buffara van den Berg Roberta Matschinske van den Berg Bernardo Kaplan Moscovici Maya Dodhia Larissa Gouvea Wallace Chamon Karolinne Maia Rocha

The objective of this study was to compare subjective manifest refraction with wavefront-based automated refraction using iTrace (ray tracing) and LadarWave (Hartmann–Shack) in eyes implanted with two enhanced monofocal intraocular lenses (IOLs) and a standard aspheric monofocal IOL, emphasizing agreement and refractive variability across optical designs. This retrospective cohort included 84 eyes from 42 patients implanted with Tecnis Eyhance (DIB00), RayOne EMV (RAO200E), or Tecnis ZCB00 IOLs. Postoperative evaluation (1–3 months) included uncorrected and corrected distance visual acuity and subjective manifest refraction, followed by automated refraction with iTrace and LadarWave. Outcomes were sphere, cylinder, and spherical equivalent (SE). Agreement was assessed using mean signed difference, mean absolute error, root mean square error, Bland–Altman limits of agreement, proportions within clinically relevant thresholds, and vector astigmatism (J0, J45). Linear mixed-effect modeling evaluated SE differences across methods and IOL types while accounting for within-subject correlation. Subjective SE differed among IOLs (p = 0.027), with RAO200E more myopic than ZCB00 (−0.20 ± 0.32 D vs. −0.08 ± 0.44 D, p = 0.035). Automated refraction showed greater variability and poorer agreement in enhanced monofocal IOLs, particularly for cylinder and SE, with wider limits of agreement and fewer eyes within ±0.50 D compared with ZCB00. In mixed-effect contrasts (three-method repeated-measures model), iTrace and LadarWave showed a consistent myopic bias versus manifest refraction in DIB00 and RAO200E, whereas in ZCB00 the iTrace–manifest difference was not significant and LadarWave retained a significant myopic bias. Enhanced monofocal IOLs exhibit reduced agreement between wavefront-based automated and subjective manifest refraction compared with a standard aspheric monofocal IOL. Manifest refraction remains essential for postoperative assessment, and automated measurements should be interpreted as complementary, particularly in IOL designs that modify aberrations.

]]> Wavefront Automated Refraction Comparison of Three Different IOLs: Aspheric Monofocal and Two Enhanced Monofocal IOLs Arthur Buffara van den Berg Roberta Matschinske van den Berg Bernardo Kaplan Moscovici Maya Dodhia Larissa Gouvea Wallace Chamon Karolinne Maia Rocha doi: 10.3390/vision10010006 Vision 2026-01-26 Vision 2026-01-26 10 1 Article 6 10.3390/vision10010006 https://www.mdpi.com/2411-5150/10/1/6 Vision, Vol. 10, Pages 5: E-MOTE: A Conceptual Framework for Emotion-Aware Teacher Training Integrating FACS, AI and VR https://www.mdpi.com/2411-5150/10/1/5 This paper proposes E-MOTE (Emotion-aware Teacher Education Framework), an ethically grounded conceptual model aimed at enhancing teacher education through the integrated use of the Facial Action Coding System (FACS), Artificial Intelligence (AI), and Virtual Reality (VR). As a conceptual and design-oriented proposal, E-MOTE is presented as a structured blueprint for future development and empirical validation, not as an implemented or evaluated system. Grounded in neuroscientific and educational research, E-MOTE seeks to strengthen teachers’ emotional awareness, teacher noticing, and social–emotional learning competencies. Rather than reporting empirical findings, this article offers a theoretically structured framework and an operational blueprint for the design of emotion-aware teacher training environments, establishing a structured foundation for future empirical validation. E-MOTE articulates three core contributions: (1) it clarifies the multi-layered construct of emotion-aware teaching by distinguishing between emotion detection, perception, awareness, and regulation; (2) it proposes an integrated AI–FACS–VR architecture for real-time and post hoc feedback on teachers’ perceptual performance; and (3) it outlines a staged experimental blueprint for future empirical validation under ethically governed conditions. As a design-oriented proposal, E-MOTE provides a structured foundation for cultivating emotionally responsive pedagogy and inclusive classroom management, supporting the development of perceptual micro-skills in teacher practice. Its distinctive contribution lies in proposing a shift from predominantly macro-behavioral simulation toward the deliberate cultivation of perceptual micro-skills through FACS-informed analytics integrated with AI-driven simulations. 2026-01-19 Vision, Vol. 10, Pages 5: E-MOTE: A Conceptual Framework for Emotion-Aware Teacher Training Integrating FACS, AI and VR

Vision doi: 10.3390/vision10010005

Authors: Rosa Pia D’Acri Francesco Demarco Alessandro Soranzo

This paper proposes E-MOTE (Emotion-aware Teacher Education Framework), an ethically grounded conceptual model aimed at enhancing teacher education through the integrated use of the Facial Action Coding System (FACS), Artificial Intelligence (AI), and Virtual Reality (VR). As a conceptual and design-oriented proposal, E-MOTE is presented as a structured blueprint for future development and empirical validation, not as an implemented or evaluated system. Grounded in neuroscientific and educational research, E-MOTE seeks to strengthen teachers’ emotional awareness, teacher noticing, and social–emotional learning competencies. Rather than reporting empirical findings, this article offers a theoretically structured framework and an operational blueprint for the design of emotion-aware teacher training environments, establishing a structured foundation for future empirical validation. E-MOTE articulates three core contributions: (1) it clarifies the multi-layered construct of emotion-aware teaching by distinguishing between emotion detection, perception, awareness, and regulation; (2) it proposes an integrated AI–FACS–VR architecture for real-time and post hoc feedback on teachers’ perceptual performance; and (3) it outlines a staged experimental blueprint for future empirical validation under ethically governed conditions. As a design-oriented proposal, E-MOTE provides a structured foundation for cultivating emotionally responsive pedagogy and inclusive classroom management, supporting the development of perceptual micro-skills in teacher practice. Its distinctive contribution lies in proposing a shift from predominantly macro-behavioral simulation toward the deliberate cultivation of perceptual micro-skills through FACS-informed analytics integrated with AI-driven simulations.

]]> E-MOTE: A Conceptual Framework for Emotion-Aware Teacher Training Integrating FACS, AI and VR Rosa Pia D’Acri Francesco Demarco Alessandro Soranzo doi: 10.3390/vision10010005 Vision 2026-01-19 Vision 2026-01-19 10 1 Review 5 10.3390/vision10010005 https://www.mdpi.com/2411-5150/10/1/5 Vision, Vol. 10, Pages 3: Mapping the Outcomes of Low-Vision Rehabilitation: A Scoping Review of Interventions, Challenges, and Research Gaps https://www.mdpi.com/2411-5150/10/1/3 Introduction: Low vision affects more than visual acuity; it substantially disrupts daily functioning and may contribute to long-term cognitive, emotional, and social consequences. When medical or surgical treatment options are no longer effective, structured low-vision rehabilitation becomes essential, providing strategies and tools that support functional adaptation and promote independence. This review aims to map the current outcomes of rehabilitation services, identify gaps in existing research, and highlight opportunities for further study. Methods: An article search was conducted via PubMed, Scopus, PsycInfo, and Google Scholar. Then, title, abstract, and full-text screenings for inclusion were performed by all the authors independently, and disagreements were resolved through discussion. The relevant outcomes from the eligible publications were extracted by four authors and then cross-checked by the other authors. The results are presented via the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist. Results: A total of 13 studies met the inclusion criteria. Most were randomized controlled trials (n = 10,77%), with the majority conducted in the United States and the United Kingdom. Study populations consisted of adults aged 18 years and older. Across the included studies, low-vision rehabilitation interventions particularly visual training, magnification-based programs, and multidisciplinary approaches, were associated with significant improvements in visual function, activities of daily living, and vision-related quality of life. Conclusions: Low vision rehabilitation interventions demonstrate clear benefits for visual acuity, contrast sensitivity, reading speed, and functional independence. However, substantial gaps remain, including limited evidence on long-term outcomes, inconsistent assessment of psychosocial influences, and underrepresentation of diverse populations. Standardized outcome measures and long-term, inclusive research designs are needed to better understand the sustained and equitable impact of low-vision rehabilitation. 2026-01-12 Vision, Vol. 10, Pages 3: Mapping the Outcomes of Low-Vision Rehabilitation: A Scoping Review of Interventions, Challenges, and Research Gaps

Vision doi: 10.3390/vision10010003

Authors: Kingsley Ekemiri Onohomo Adebo Chioma Ekemiri Samuel Osuji Maureen Amobi Linda Ekwe Kathy-Ann Lootawan Carlene Oneka Williams Esther Daniel

Introduction: Low vision affects more than visual acuity; it substantially disrupts daily functioning and may contribute to long-term cognitive, emotional, and social consequences. When medical or surgical treatment options are no longer effective, structured low-vision rehabilitation becomes essential, providing strategies and tools that support functional adaptation and promote independence. This review aims to map the current outcomes of rehabilitation services, identify gaps in existing research, and highlight opportunities for further study. Methods: An article search was conducted via PubMed, Scopus, PsycInfo, and Google Scholar. Then, title, abstract, and full-text screenings for inclusion were performed by all the authors independently, and disagreements were resolved through discussion. The relevant outcomes from the eligible publications were extracted by four authors and then cross-checked by the other authors. The results are presented via the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist. Results: A total of 13 studies met the inclusion criteria. Most were randomized controlled trials (n = 10,77%), with the majority conducted in the United States and the United Kingdom. Study populations consisted of adults aged 18 years and older. Across the included studies, low-vision rehabilitation interventions particularly visual training, magnification-based programs, and multidisciplinary approaches, were associated with significant improvements in visual function, activities of daily living, and vision-related quality of life. Conclusions: Low vision rehabilitation interventions demonstrate clear benefits for visual acuity, contrast sensitivity, reading speed, and functional independence. However, substantial gaps remain, including limited evidence on long-term outcomes, inconsistent assessment of psychosocial influences, and underrepresentation of diverse populations. Standardized outcome measures and long-term, inclusive research designs are needed to better understand the sustained and equitable impact of low-vision rehabilitation.

]]> Mapping the Outcomes of Low-Vision Rehabilitation: A Scoping Review of Interventions, Challenges, and Research Gaps Kingsley Ekemiri Onohomo Adebo Chioma Ekemiri Samuel Osuji Maureen Amobi Linda Ekwe Kathy-Ann Lootawan Carlene Oneka Williams Esther Daniel doi: 10.3390/vision10010003 Vision 2026-01-12 Vision 2026-01-12 10 1 Systematic Review 3 10.3390/vision10010003 https://www.mdpi.com/2411-5150/10/1/3 Vision, Vol. 10, Pages 2: Drawing and Soccer Tactical Memorization: An Eye-Tracking Investigation of the Moderating Role of Visuospatial Abilities and Expertise https://www.mdpi.com/2411-5150/10/1/2 Dynamic drawing has emerged as a strategy to communicate tactical diagrams, yet its effectiveness remains uncertain and appears to depend on individual differences. This study investigated how the memorization and visual processing of tactical soccer scenes are influenced by drawing format (static drawing vs. dynamic drawing) and moderated by visuospatial abilities (VSA) and expertise. Expert (N = 57) and novice (N = 54) participants were randomly assigned to one of two conditions. In the static drawing condition, participants viewed a pre-drawn, completed tactical diagram accompanied by an oral explanation. In the dynamic drawing condition, they observed the coach drawing the diagram in real time while delivering the same explanation. VSA was first assessed using a control test. Then, in the main test, participants memorized and reproduced the tactical scene while their eye movements were recorded using an eye tracker. Key findings revealed a three-way interaction, highlighting the occurrence of an expertise reversal effect: high VSA novices performed better with dynamic drawing, whereas low VSA experts benefited more from static drawing, showing distinct visual processing patterns across groups. Overall, the results highlight the need to tailor drawing strategies to individual characteristics, particularly VSA and expertise, to optimize visual attention and tactical memorization. 2026-01-01 Vision, Vol. 10, Pages 2: Drawing and Soccer Tactical Memorization: An Eye-Tracking Investigation of the Moderating Role of Visuospatial Abilities and Expertise

Vision doi: 10.3390/vision10010002

Authors: Sabrine Tlili Hatem Ben Mahfoudh Bachir Zoudji

Dynamic drawing has emerged as a strategy to communicate tactical diagrams, yet its effectiveness remains uncertain and appears to depend on individual differences. This study investigated how the memorization and visual processing of tactical soccer scenes are influenced by drawing format (static drawing vs. dynamic drawing) and moderated by visuospatial abilities (VSA) and expertise. Expert (N = 57) and novice (N = 54) participants were randomly assigned to one of two conditions. In the static drawing condition, participants viewed a pre-drawn, completed tactical diagram accompanied by an oral explanation. In the dynamic drawing condition, they observed the coach drawing the diagram in real time while delivering the same explanation. VSA was first assessed using a control test. Then, in the main test, participants memorized and reproduced the tactical scene while their eye movements were recorded using an eye tracker. Key findings revealed a three-way interaction, highlighting the occurrence of an expertise reversal effect: high VSA novices performed better with dynamic drawing, whereas low VSA experts benefited more from static drawing, showing distinct visual processing patterns across groups. Overall, the results highlight the need to tailor drawing strategies to individual characteristics, particularly VSA and expertise, to optimize visual attention and tactical memorization.

]]> Drawing and Soccer Tactical Memorization: An Eye-Tracking Investigation of the Moderating Role of Visuospatial Abilities and Expertise Sabrine Tlili Hatem Ben Mahfoudh Bachir Zoudji doi: 10.3390/vision10010002 Vision 2026-01-01 Vision 2026-01-01 10 1 Article 2 10.3390/vision10010002 https://www.mdpi.com/2411-5150/10/1/2 Vision, Vol. 10, Pages 1: N-Acetyl-Aspartyl Glutamic Acid (NAAGA)-Based Eye Drops for Contact Lens Wearers with Dry Eye Symptoms and Discomfort https://www.mdpi.com/2411-5150/10/1/1 The aim of this study was to evaluate the performance and safety of T2769 (Thealoz® Total), a preservative-free eye drop combining 0.15% sodium hyaluronate, 3% trehalose, and 2.45% N-acetylaspartyl-glutamate (NAAGA), in contact lens wearers with dry eye symptoms and discomfort. This prospective, single-arm investigation enrolled 34 adult contact lens wearers with Ocular Surface Disease Index (OSDI) scores ≥ 18 and Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) scores ≥ 12. Patients instilled one drop of T2769 three to six times daily for 36 days. Performance assessments included CLDEQ-8, ocular discomfort and symptoms, OSDI, soothing sensation, and ocular signs. Safety assessments included adverse events (AEs), far BCVA, and ocular tolerance. CLDEQ-8 improved from the baseline at Day 36 (−12.6 ± 5.0; p < 0.001) and as early as D15, with similar improvements in ocular discomfort, OSDI, and total symptom score. Soothing sensation was judged important by 79.4% of patients at D36. Ocular surface staining, tear break-up time, and the Schirmer test improved at D15 and D36, while conjunctival hyperaemia improved in 82.4% of patients at D36. Two non-serious treatment-related AEs (photophobia and blurred vision) occurred in one patient. BCVA was unchanged, and tolerance was rated very satisfactory/satisfactory. In conclusion, T2769 was safe and effective for reducing contact lens-associated dry eyes and discomfort. 2025-12-22 Vision, Vol. 10, Pages 1: N-Acetyl-Aspartyl Glutamic Acid (NAAGA)-Based Eye Drops for Contact Lens Wearers with Dry Eye Symptoms and Discomfort

Vision doi: 10.3390/vision10010001

Authors: Ioanna Misheva Vesselin Daskalov Dimitar Dzhelebov Kalina Ilieva Ralitsa Kermedchieva Malina Topchiyska Petar Yanev Christina Grupcheva

The aim of this study was to evaluate the performance and safety of T2769 (Thealoz® Total), a preservative-free eye drop combining 0.15% sodium hyaluronate, 3% trehalose, and 2.45% N-acetylaspartyl-glutamate (NAAGA), in contact lens wearers with dry eye symptoms and discomfort. This prospective, single-arm investigation enrolled 34 adult contact lens wearers with Ocular Surface Disease Index (OSDI) scores ≥ 18 and Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) scores ≥ 12. Patients instilled one drop of T2769 three to six times daily for 36 days. Performance assessments included CLDEQ-8, ocular discomfort and symptoms, OSDI, soothing sensation, and ocular signs. Safety assessments included adverse events (AEs), far BCVA, and ocular tolerance. CLDEQ-8 improved from the baseline at Day 36 (−12.6 ± 5.0; p < 0.001) and as early as D15, with similar improvements in ocular discomfort, OSDI, and total symptom score. Soothing sensation was judged important by 79.4% of patients at D36. Ocular surface staining, tear break-up time, and the Schirmer test improved at D15 and D36, while conjunctival hyperaemia improved in 82.4% of patients at D36. Two non-serious treatment-related AEs (photophobia and blurred vision) occurred in one patient. BCVA was unchanged, and tolerance was rated very satisfactory/satisfactory. In conclusion, T2769 was safe and effective for reducing contact lens-associated dry eyes and discomfort.

]]> N-Acetyl-Aspartyl Glutamic Acid (NAAGA)-Based Eye Drops for Contact Lens Wearers with Dry Eye Symptoms and Discomfort Ioanna Misheva Vesselin Daskalov Dimitar Dzhelebov Kalina Ilieva Ralitsa Kermedchieva Malina Topchiyska Petar Yanev Christina Grupcheva doi: 10.3390/vision10010001 Vision 2025-12-22 Vision 2025-12-22 10 1 Article 1 10.3390/vision10010001 https://www.mdpi.com/2411-5150/10/1/1 Vision, Vol. 9, Pages 100: Investigation of the Visual Acuity Test Success Rate of a New Child-Friendly Minimum-Separable Chart for 2- and 3-Year-Old Children https://www.mdpi.com/2411-5150/9/4/100 Background/Objectives: Early detection and timely treatment of amblyopia require reliable visual acuity testing in toddlers; however, conventional Landolt ring charts often show poor testability in 2–3-year-old children. Therefore, we aimed to verify the practicality of a new Child-Friendly Minimum-Separable (CFMS) chart for 2–3-year-old children by comparing cooperation rates with the standard Landolt ring visual acuity chart. Methods: A prospective pilot study was conducted on 20 children aged 2 years (30.6 ± 3.2 months) and 20 children aged 3 years (41.8 ± 3.9 months). Right-eye visual acuity was tested in random order using the Landolt ring (four options, 3/5 considered correct) and the CFMS chart (two options, 3/3 considered correct). Test cooperation rates and visual acuity were analyzed. Results: In the 2-year-olds, the cooperation rate was 15% and 75% for the Landolt ring and CFMS chart, respectively (p = 0.0005). Twelve children refused to cooperate with the Landolt ring but cooperated with the CFMS chart; the reverse did not occur. In the 3-year-olds, the cooperation rate was 60% and 90% for the Landolt ring and CFMS chart, respectively (p = 0.031); six children cooperated only with the CFMS chart. The odds ratio for cooperation per additional month of age was 1.34 (95% confidence interval [CI]: 1.12–1.59; p = 0.001) and 1.24 (95% CI: 1.03–1.50; p = 0.026) for the Landolt ring and CFMS chart, respectively. Conclusions: Compared to the Landolt ring, the CFMS chart significantly improves cooperation rates for visual acuity testing in 2−3-year-old children, especially among 2-year-olds. 2025-12-17 Vision, Vol. 9, Pages 100: Investigation of the Visual Acuity Test Success Rate of a New Child-Friendly Minimum-Separable Chart for 2- and 3-Year-Old Children

Vision doi: 10.3390/vision9040100

Authors: Yo Iwata

Background/Objectives: Early detection and timely treatment of amblyopia require reliable visual acuity testing in toddlers; however, conventional Landolt ring charts often show poor testability in 2–3-year-old children. Therefore, we aimed to verify the practicality of a new Child-Friendly Minimum-Separable (CFMS) chart for 2–3-year-old children by comparing cooperation rates with the standard Landolt ring visual acuity chart. Methods: A prospective pilot study was conducted on 20 children aged 2 years (30.6 ± 3.2 months) and 20 children aged 3 years (41.8 ± 3.9 months). Right-eye visual acuity was tested in random order using the Landolt ring (four options, 3/5 considered correct) and the CFMS chart (two options, 3/3 considered correct). Test cooperation rates and visual acuity were analyzed. Results: In the 2-year-olds, the cooperation rate was 15% and 75% for the Landolt ring and CFMS chart, respectively (p = 0.0005). Twelve children refused to cooperate with the Landolt ring but cooperated with the CFMS chart; the reverse did not occur. In the 3-year-olds, the cooperation rate was 60% and 90% for the Landolt ring and CFMS chart, respectively (p = 0.031); six children cooperated only with the CFMS chart. The odds ratio for cooperation per additional month of age was 1.34 (95% confidence interval [CI]: 1.12–1.59; p = 0.001) and 1.24 (95% CI: 1.03–1.50; p = 0.026) for the Landolt ring and CFMS chart, respectively. Conclusions: Compared to the Landolt ring, the CFMS chart significantly improves cooperation rates for visual acuity testing in 2−3-year-old children, especially among 2-year-olds.

]]> Investigation of the Visual Acuity Test Success Rate of a New Child-Friendly Minimum-Separable Chart for 2- and 3-Year-Old Children Yo Iwata doi: 10.3390/vision9040100 Vision 2025-12-17 Vision 2025-12-17 9 4 Article 100 10.3390/vision9040100 https://www.mdpi.com/2411-5150/9/4/100 Vision, Vol. 9, Pages 99: Impact of Simulated Astigmatism on Visual Acuity, Stereopsis, and Reading in Young Adults https://www.mdpi.com/2411-5150/9/4/99 This study investigated the functional visual impact of simulated astigmatic blur using cylindrical powers of 0.50 D, 1.00 D, and 2.00 D, applied in against-the-rule (ATR), with-the-rule (WTR), and oblique (OBL) axes, in adults aged 18 to 35 years with no known ocular disease. Forty-five young adults were randomly divided into three groups (n = 15). Binocular best-corrected visual acuity (distance and near) was recorded in logMAR using the ETDRS acuity chart at 5 m and 40 cm, supported by acuity optotypes displayed in a Bailey–Lovie chart format. Depth-fusion and disparity discrimination were measured using polarized stereopsis thresholds with the Randot® Stereo Test from Stereo Optical Company, Inc. Reading performance was quantified as a continuous binocular rate metric (words per minute) using the validated Portuguese digital reading curve provided by the MNREAD iPad App by Precision Vision at 40 cm. The results were preserved verbatim as follows: Distance and near BCVA were significantly affected by ATR astigmatisms (−0.50 + 1.00 90°, −1.00 + 2.00 90°), WTR astigmatisms (−0.25 + 0.50 180°, −0.50 + 1.00 180°, −1.00 + 2.00 180°), and OBL astigmatisms (OD: −0.25 + 0.50 45°, OS: −0.25 + 0.50 135°; OD: −0.50 + 1.00 45°, OS: −0.50 + 1.00 135°; OD: −1.00 + 2.00 45°, OS: −1.00 + 2.00 135°). Stereopsis was significantly influenced by high-power OBL astigmatism (−1.00 + 2.00). Reading rate was also negatively impacted by OBL astigmatisms ≥1.00 D. Simulated astigmatism of different powers and axes reduced high-contrast distance and near BCVA, stereopsis, and reading speed in adults aged 18–35 years. Higher-power astigmatism, particularly along oblique axes, caused the most significant functional impairment. 2025-12-16 Vision, Vol. 9, Pages 99: Impact of Simulated Astigmatism on Visual Acuity, Stereopsis, and Reading in Young Adults

Vision doi: 10.3390/vision9040099

Authors: Chow Wang Ming Shato Ricardo Noguera Louzada Pedro Lucas Machado Magalhães Dillan Cunha Amaral Daniel Oliveira Dantas Daniel Alves Montenegro Melanie May Chow David Tayah Milton Ruiz Alves

This study investigated the functional visual impact of simulated astigmatic blur using cylindrical powers of 0.50 D, 1.00 D, and 2.00 D, applied in against-the-rule (ATR), with-the-rule (WTR), and oblique (OBL) axes, in adults aged 18 to 35 years with no known ocular disease. Forty-five young adults were randomly divided into three groups (n = 15). Binocular best-corrected visual acuity (distance and near) was recorded in logMAR using the ETDRS acuity chart at 5 m and 40 cm, supported by acuity optotypes displayed in a Bailey–Lovie chart format. Depth-fusion and disparity discrimination were measured using polarized stereopsis thresholds with the Randot® Stereo Test from Stereo Optical Company, Inc. Reading performance was quantified as a continuous binocular rate metric (words per minute) using the validated Portuguese digital reading curve provided by the MNREAD iPad App by Precision Vision at 40 cm. The results were preserved verbatim as follows: Distance and near BCVA were significantly affected by ATR astigmatisms (−0.50 + 1.00 90°, −1.00 + 2.00 90°), WTR astigmatisms (−0.25 + 0.50 180°, −0.50 + 1.00 180°, −1.00 + 2.00 180°), and OBL astigmatisms (OD: −0.25 + 0.50 45°, OS: −0.25 + 0.50 135°; OD: −0.50 + 1.00 45°, OS: −0.50 + 1.00 135°; OD: −1.00 + 2.00 45°, OS: −1.00 + 2.00 135°). Stereopsis was significantly influenced by high-power OBL astigmatism (−1.00 + 2.00). Reading rate was also negatively impacted by OBL astigmatisms ≥1.00 D. Simulated astigmatism of different powers and axes reduced high-contrast distance and near BCVA, stereopsis, and reading speed in adults aged 18–35 years. Higher-power astigmatism, particularly along oblique axes, caused the most significant functional impairment.

]]> Impact of Simulated Astigmatism on Visual Acuity, Stereopsis, and Reading in Young Adults Chow Wang Ming Shato Ricardo Noguera Louzada Pedro Lucas Machado Magalhães Dillan Cunha Amaral Daniel Oliveira Dantas Daniel Alves Montenegro Melanie May Chow David Tayah Milton Ruiz Alves doi: 10.3390/vision9040099 Vision 2025-12-16 Vision 2025-12-16 9 4 Article 99 10.3390/vision9040099 https://www.mdpi.com/2411-5150/9/4/99 Vision, Vol. 9, Pages 98: Curcumin-Based Supplement for Vitreous Floaters Post-Nd:YAG Capsulotomy: A Pilot Study https://www.mdpi.com/2411-5150/9/4/98 Background: To evaluate the short-term effects of a dietary supplement containing curcumin, bromelain, glucosamine, chondroitin sulphate, sodium hyaluronate, type II collagen, and vitamin C on symptomatic vitreous floaters (SVFs) following Nd:YAG laser capsulotomy. Methods: Forty eyes with SVFs on the first postoperative day were randomized into a control group (standard topical therapy, n = 20) and a treatment group (oral supplement plus standard therapy, n = 20). Outcomes included best-corrected visual acuity (BCVA), contrast sensitivity (CS), and subjective scores from a non-standardized questionnaire on floater perception (QS1), interference with daily activities (QS2), and foreign body sensation (QS3). Objective evaluation was performed using two novel ultrasound-based methods: mean number of vitreous peaks (MVP) from A-scans and mean grey intensity (MGI) from B-scan images processed with ImageJ. Results: At 2 months, the treatment group showed greater improvement in CS (Δ = 0.26 LogCS, CI, 0.14–0.38; p < 0.01), QS1 (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), QS2 (Δ = 0.90; 95% CI, 0.40–1.40; p < 0.01), QS3 (Δ = 0.90; 95% CI, 0.44–1.36; p < 0.01), MVP (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), and MGI (Δ = 12.89 units; 95% CI, 7.84–17.93; p < 0.01). BCVA was comparable between groups (p = 0.478). Conclusions: Short-term dietary supplementation with vitreous-specific nutrients is well tolerated and associated with improvements in reducing SVFs and foreign body sensations after Nd:YAG capsulotomy and may represent a promising non-invasive therapeutic option. 2025-12-16 Vision, Vol. 9, Pages 98: Curcumin-Based Supplement for Vitreous Floaters Post-Nd:YAG Capsulotomy: A Pilot Study

Vision doi: 10.3390/vision9040098

Authors: Alex Malandrini Giovanni Rubegni Davide Marini Giulia Spadavecchia Gian Marco Tosi

Background: To evaluate the short-term effects of a dietary supplement containing curcumin, bromelain, glucosamine, chondroitin sulphate, sodium hyaluronate, type II collagen, and vitamin C on symptomatic vitreous floaters (SVFs) following Nd:YAG laser capsulotomy. Methods: Forty eyes with SVFs on the first postoperative day were randomized into a control group (standard topical therapy, n = 20) and a treatment group (oral supplement plus standard therapy, n = 20). Outcomes included best-corrected visual acuity (BCVA), contrast sensitivity (CS), and subjective scores from a non-standardized questionnaire on floater perception (QS1), interference with daily activities (QS2), and foreign body sensation (QS3). Objective evaluation was performed using two novel ultrasound-based methods: mean number of vitreous peaks (MVP) from A-scans and mean grey intensity (MGI) from B-scan images processed with ImageJ. Results: At 2 months, the treatment group showed greater improvement in CS (Δ = 0.26 LogCS, CI, 0.14–0.38; p < 0.01), QS1 (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), QS2 (Δ = 0.90; 95% CI, 0.40–1.40; p < 0.01), QS3 (Δ = 0.90; 95% CI, 0.44–1.36; p < 0.01), MVP (Δ = 1.10; 95% CI, 0.60–1.60; p < 0.01), and MGI (Δ = 12.89 units; 95% CI, 7.84–17.93; p < 0.01). BCVA was comparable between groups (p = 0.478). Conclusions: Short-term dietary supplementation with vitreous-specific nutrients is well tolerated and associated with improvements in reducing SVFs and foreign body sensations after Nd:YAG capsulotomy and may represent a promising non-invasive therapeutic option.

]]> Curcumin-Based Supplement for Vitreous Floaters Post-Nd:YAG Capsulotomy: A Pilot Study Alex Malandrini Giovanni Rubegni Davide Marini Giulia Spadavecchia Gian Marco Tosi doi: 10.3390/vision9040098 Vision 2025-12-16 Vision 2025-12-16 9 4 Article 98 10.3390/vision9040098 https://www.mdpi.com/2411-5150/9/4/98 Vision, Vol. 9, Pages 97: Exploring Structural and Vascular Changes of the Optic Nerve Head After Trabeculectomy in Primary Open-Angle Glaucoma https://www.mdpi.com/2411-5150/9/4/97 Background: Trabeculectomy remains gold-standard surgical approach for intraocular pressure (IOP) control in glaucoma, yet its impact on optic nerve head (ONH) morphology and retinal microvasculature has not been fully clarified. This study aimed to investigate structural and vascular changes of the ONH and macula after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). Methods: In this retrospective study, data from 22 patients with primary open-angle glaucoma who underwent uncomplicated trabeculectomy were reviewed. The fellow eye served as control. Structural parameters, including Bruch’s membrane opening (BMO), maximum cup depth (MCD), and cup area, were measured with SD-OCT. Vessel density (VD) of the optic disc, peripapillary retina, and macular superficial (SCP) and deep (DCP) capillary plexuses were analyzed with OCTA. Preoperative and two-month postoperative data were compared using paired statistical tests. Results: Mean IOP decreased from 23.1 ± 3.9 mmHg to 13.2 ± 3.2 mmHg (p < 0.001). Significant postoperative reductions were observed in BMO (−5 ± 6%, p = 0.004), MCD (−31 ± 8%, p < 0.001), and cup area (−44 ± 18%, p < 0.001). RNFL thickness and ONH vascular parameters remained stable. In contrast, DCP vessel density increased in the foveal (p = 0.002) and parafoveal (p = 0.023) regions, while SCP density showed no significant change. Conclusions: Trabeculectomy was associated with measurable reversal of optic disc cupping, indicating partial structural recovery of the ONH following IOP reduction. The selective improvement in deep retinal vessel density suggests a layer-specific microvascular response. These findings provide further insight into the interplay between mechanical and vascular mechanisms in glaucoma and may inform postoperative monitoring strategies. 2025-12-07 Vision, Vol. 9, Pages 97: Exploring Structural and Vascular Changes of the Optic Nerve Head After Trabeculectomy in Primary Open-Angle Glaucoma

Vision doi: 10.3390/vision9040097

Authors: Francesco Cappellani Niccolò Castellino Marco Zeppieri Fabiana D’Esposito Alessandro Avitabile Giovanni Rubegni Ludovica Cannizzaro Giuseppe Gagliano Antonio Longo

Background: Trabeculectomy remains gold-standard surgical approach for intraocular pressure (IOP) control in glaucoma, yet its impact on optic nerve head (ONH) morphology and retinal microvasculature has not been fully clarified. This study aimed to investigate structural and vascular changes of the ONH and macula after trabeculectomy using spectral-domain optical coherence tomography (SD-OCT) and OCT angiography (OCTA). Methods: In this retrospective study, data from 22 patients with primary open-angle glaucoma who underwent uncomplicated trabeculectomy were reviewed. The fellow eye served as control. Structural parameters, including Bruch’s membrane opening (BMO), maximum cup depth (MCD), and cup area, were measured with SD-OCT. Vessel density (VD) of the optic disc, peripapillary retina, and macular superficial (SCP) and deep (DCP) capillary plexuses were analyzed with OCTA. Preoperative and two-month postoperative data were compared using paired statistical tests. Results: Mean IOP decreased from 23.1 ± 3.9 mmHg to 13.2 ± 3.2 mmHg (p < 0.001). Significant postoperative reductions were observed in BMO (−5 ± 6%, p = 0.004), MCD (−31 ± 8%, p < 0.001), and cup area (−44 ± 18%, p < 0.001). RNFL thickness and ONH vascular parameters remained stable. In contrast, DCP vessel density increased in the foveal (p = 0.002) and parafoveal (p = 0.023) regions, while SCP density showed no significant change. Conclusions: Trabeculectomy was associated with measurable reversal of optic disc cupping, indicating partial structural recovery of the ONH following IOP reduction. The selective improvement in deep retinal vessel density suggests a layer-specific microvascular response. These findings provide further insight into the interplay between mechanical and vascular mechanisms in glaucoma and may inform postoperative monitoring strategies.

]]> Exploring Structural and Vascular Changes of the Optic Nerve Head After Trabeculectomy in Primary Open-Angle Glaucoma Francesco Cappellani Niccolò Castellino Marco Zeppieri Fabiana D’Esposito Alessandro Avitabile Giovanni Rubegni Ludovica Cannizzaro Giuseppe Gagliano Antonio Longo doi: 10.3390/vision9040097 Vision 2025-12-07 Vision 2025-12-07 9 4 Article 97 10.3390/vision9040097 https://www.mdpi.com/2411-5150/9/4/97 Vision, Vol. 9, Pages 96: Big Data on Climatic and Environmental Parameters Associated with Acute Ocular Surface Symptoms and Therapeutic Assessment: Eye Drops Sales, Google Trends and Environmental Changes https://www.mdpi.com/2411-5150/9/4/96 Ocular surface (OS) and dry eye (DE) symptoms are frequent ophthalmic complaints influenced by climate and pollution related with acute and chronic ocular surface symptoms. This study assessed their association with environmental conditions in São Paulo metropolitan area (2016–2020), including air temperature, humidity, atmospheric pressure, ozone (O3), particulate matter (PM), using IQVIA eye drop sales data and Google search trends. Sympathomimetic decongestant sales correlated with higher temperature (r = 0.434, p = 0.0021), UV radiation (r = 0.643, p < 0.0001), and ozone (r = 0.491, p = 0.0004). Artificial tears and lubricants correlated with ozone (r = 0.452, p = 0.0012) and with searches for “red eye” (r = 0.505, p = 0.0005) and “stye” (r = 0.599, p < 0.0001). To address multicollinearity, Principal Component Analysis (PCA) was applied, with the first two components (PC1 and PC2) explaining 87.3% of variance. Regression models using these components were significant for decongestant sales and “stye” searches. Eye drop sales and search trends thus emerge as potential indicators of OS and DE symptoms, reflecting environmental conditions and informing prevention strategies. 2025-11-28 Vision, Vol. 9, Pages 96: Big Data on Climatic and Environmental Parameters Associated with Acute Ocular Surface Symptoms and Therapeutic Assessment: Eye Drops Sales, Google Trends and Environmental Changes

Vision doi: 10.3390/vision9040096

Authors: Felipe Barbosa Galvão Azzem Ferraz Mateus Maia Marzola Marina Zilio Fantucci Adriana de Andrade Batista Murashima Beatriz Carneiro Cintra Denny Marcos Garcia Eduardo Melani Rocha

Ocular surface (OS) and dry eye (DE) symptoms are frequent ophthalmic complaints influenced by climate and pollution related with acute and chronic ocular surface symptoms. This study assessed their association with environmental conditions in São Paulo metropolitan area (2016–2020), including air temperature, humidity, atmospheric pressure, ozone (O3), particulate matter (PM), using IQVIA eye drop sales data and Google search trends. Sympathomimetic decongestant sales correlated with higher temperature (r = 0.434, p = 0.0021), UV radiation (r = 0.643, p < 0.0001), and ozone (r = 0.491, p = 0.0004). Artificial tears and lubricants correlated with ozone (r = 0.452, p = 0.0012) and with searches for “red eye” (r = 0.505, p = 0.0005) and “stye” (r = 0.599, p < 0.0001). To address multicollinearity, Principal Component Analysis (PCA) was applied, with the first two components (PC1 and PC2) explaining 87.3% of variance. Regression models using these components were significant for decongestant sales and “stye” searches. Eye drop sales and search trends thus emerge as potential indicators of OS and DE symptoms, reflecting environmental conditions and informing prevention strategies.

]]> Big Data on Climatic and Environmental Parameters Associated with Acute Ocular Surface Symptoms and Therapeutic Assessment: Eye Drops Sales, Google Trends and Environmental Changes Felipe Barbosa Galvão Azzem Ferraz Mateus Maia Marzola Marina Zilio Fantucci Adriana de Andrade Batista Murashima Beatriz Carneiro Cintra Denny Marcos Garcia Eduardo Melani Rocha doi: 10.3390/vision9040096 Vision 2025-11-28 Vision 2025-11-28 9 4 Article 96 10.3390/vision9040096 https://www.mdpi.com/2411-5150/9/4/96 Vision, Vol. 9, Pages 95: Geographic Atrophy Progression in Clinical Practice Before and After Pegcetacoplan Treatment https://www.mdpi.com/2411-5150/9/4/95 This retrospective study evaluated changes in ocular characteristics and retinal pigment epithelium (RPE) and photoreceptor ellipsoid zone (EZ) depletion rates before and after intravitreal pegcetacoplan initiation in clinical practice. A total of 168 eyes from 110 patients with GA secondary to age-related macular degeneration (AMD) who received at least 3 pegcetacoplan injections were included. Data was collected from 5 years before to 9 months after pegcetacoplan initiation. RPE and EZ depletion areas were measured using an automated artificial intelligence (AI) algorithm on optical coherence tomography (OCT) images. At baseline, 76 eyes (45.2%) had concurrent neovascular AMD (nAMD), with mean RPE and EZ depletion areas of 3.3 mm2 and 4.9 mm2, respectively. By pegcetacoplan initiation, these increased to 8.6 mm2 and 11.2 mm2, respectively, with 151 eyes (89.9%) having concurrent nAMD and 155 eyes (92.3%) having subfoveal GA. Pre-treatment to post-treatment RPE and EZ square root depletion rates decreased from 0.25 mm/year to 0.096 mm/year, and 0.26 mm/year to 0.049 mm/year, respectively. Mean best-recorded visual acuity (BRVA) worsened by 0.05 logMAR annually before and after treatment. These real-world findings align with data from the pegcetacoplan phase 3 trials, showing reduced RPE and EZ depletion rates without changes in rates of BRVA loss. Additional studies are warranted. 2025-11-18 Vision, Vol. 9, Pages 95: Geographic Atrophy Progression in Clinical Practice Before and After Pegcetacoplan Treatment

Vision doi: 10.3390/vision9040095

Authors: Jessica A. Cao Avery W. Zhou Gail M. Teagle Liisa M. Baumann Ryan A. Sahraravand Calvin W. Wong Sandro De Zanet Natasa Jovic Patrick Steiner Sagar B. Patel Samuel A. Minaker Mathew W. MacCumber David M. Brown Hasenin Al-khersan Charles C. Wykoff

This retrospective study evaluated changes in ocular characteristics and retinal pigment epithelium (RPE) and photoreceptor ellipsoid zone (EZ) depletion rates before and after intravitreal pegcetacoplan initiation in clinical practice. A total of 168 eyes from 110 patients with GA secondary to age-related macular degeneration (AMD) who received at least 3 pegcetacoplan injections were included. Data was collected from 5 years before to 9 months after pegcetacoplan initiation. RPE and EZ depletion areas were measured using an automated artificial intelligence (AI) algorithm on optical coherence tomography (OCT) images. At baseline, 76 eyes (45.2%) had concurrent neovascular AMD (nAMD), with mean RPE and EZ depletion areas of 3.3 mm2 and 4.9 mm2, respectively. By pegcetacoplan initiation, these increased to 8.6 mm2 and 11.2 mm2, respectively, with 151 eyes (89.9%) having concurrent nAMD and 155 eyes (92.3%) having subfoveal GA. Pre-treatment to post-treatment RPE and EZ square root depletion rates decreased from 0.25 mm/year to 0.096 mm/year, and 0.26 mm/year to 0.049 mm/year, respectively. Mean best-recorded visual acuity (BRVA) worsened by 0.05 logMAR annually before and after treatment. These real-world findings align with data from the pegcetacoplan phase 3 trials, showing reduced RPE and EZ depletion rates without changes in rates of BRVA loss. Additional studies are warranted.

]]> Geographic Atrophy Progression in Clinical Practice Before and After Pegcetacoplan Treatment Jessica A. Cao Avery W. Zhou Gail M. Teagle Liisa M. Baumann Ryan A. Sahraravand Calvin W. Wong Sandro De Zanet Natasa Jovic Patrick Steiner Sagar B. Patel Samuel A. Minaker Mathew W. MacCumber David M. Brown Hasenin Al-khersan Charles C. Wykoff doi: 10.3390/vision9040095 Vision 2025-11-18 Vision 2025-11-18 9 4 Article 95 10.3390/vision9040095 https://www.mdpi.com/2411-5150/9/4/95 Vision, Vol. 9, Pages 94: Clinical Evaluation of an Affordable Handheld Wavefront Autorefractor in an Adult Population in a Low-Resource Setting in the Amazonas https://www.mdpi.com/2411-5150/9/4/94 This study evaluates the ability of the QuickSee Free (QSF) portable autorefractor (PlenOptika) to detect and measure refractive error compared to subjective clinical refractometry (SCR) in a Brazilian adult population in a low-resource setting in Amazonas. A total of 100 participants aged 18–65 years underwent visual acuity screening and autorefraction with and without cycloplegia using the QSF, alongside a complete ophthalmic examination including SCR. Refractive error measurements included spherical component (SC), cylindrical component (CC), cylindrical axis (CA), spherical equivalent (SE), and vector powers (MV90 and MV135). Accuracy was assessed for hyperopia ≥ +2.00 D, myopia ≤ −0.75 D, astigmatism ≥ 1.00 DC, and anisometropia ≥ 1.00 D using receiver operating characteristic (ROC) curve analysis. The area under the curve for detecting significant refractive errors ranged from 0.538 to 0.930. The mean difference between QSF without cycloplegia and SCR was −1.08 ± 1.17 D for SC and −1.15 ± 1.15 D for SE (p < 0.0001), and with cycloplegia, it was −0.81 ± 1.07 D and −0.83 ± 1.02 D, respectively. The QSF exhibited a moderate negative bias for both SC and SE with and without cycloplegia, underestimating these values, but it showed good predictability for detecting refractive errors in a low-resource setting. 2025-11-06 Vision, Vol. 9, Pages 94: Clinical Evaluation of an Affordable Handheld Wavefront Autorefractor in an Adult Population in a Low-Resource Setting in the Amazonas

Vision doi: 10.3390/vision9040094

Authors: David Tayah Ricardo Noguera Louzada Pedro Lucas Machado Magalhães Youssef Tayah Dillan Cunha Amaral Chow Wang Ming Shato Daniel Oliveira Dantas Milton Ruiz Alves

This study evaluates the ability of the QuickSee Free (QSF) portable autorefractor (PlenOptika) to detect and measure refractive error compared to subjective clinical refractometry (SCR) in a Brazilian adult population in a low-resource setting in Amazonas. A total of 100 participants aged 18–65 years underwent visual acuity screening and autorefraction with and without cycloplegia using the QSF, alongside a complete ophthalmic examination including SCR. Refractive error measurements included spherical component (SC), cylindrical component (CC), cylindrical axis (CA), spherical equivalent (SE), and vector powers (MV90 and MV135). Accuracy was assessed for hyperopia ≥ +2.00 D, myopia ≤ −0.75 D, astigmatism ≥ 1.00 DC, and anisometropia ≥ 1.00 D using receiver operating characteristic (ROC) curve analysis. The area under the curve for detecting significant refractive errors ranged from 0.538 to 0.930. The mean difference between QSF without cycloplegia and SCR was −1.08 ± 1.17 D for SC and −1.15 ± 1.15 D for SE (p < 0.0001), and with cycloplegia, it was −0.81 ± 1.07 D and −0.83 ± 1.02 D, respectively. The QSF exhibited a moderate negative bias for both SC and SE with and without cycloplegia, underestimating these values, but it showed good predictability for detecting refractive errors in a low-resource setting.

]]> Clinical Evaluation of an Affordable Handheld Wavefront Autorefractor in an Adult Population in a Low-Resource Setting in the Amazonas David Tayah Ricardo Noguera Louzada Pedro Lucas Machado Magalhães Youssef Tayah Dillan Cunha Amaral Chow Wang Ming Shato Daniel Oliveira Dantas Milton Ruiz Alves doi: 10.3390/vision9040094 Vision 2025-11-06 Vision 2025-11-06 9 4 Article 94 10.3390/vision9040094 https://www.mdpi.com/2411-5150/9/4/94 Vision, Vol. 9, Pages 93: Comparative Analysis of Transformer Architectures and Ensemble Methods for Automated Glaucoma Screening in Fundus Images from Portable Ophthalmoscopes https://www.mdpi.com/2411-5150/9/4/93 Deep learning for glaucoma screening often relies on high-resolution clinical images and convolutional neural networks (CNNs). However, these methods face significant performance drops when applied to noisy, low-resolution images from portable devices. To address this, our work investigates ensemble methods using multiple Transformer architectures for automated glaucoma detection in challenging scenarios. We use the Brazil Glaucoma (BrG) and private D-Eye datasets to assess model robustness. These datasets include images typical of smartphone-coupled ophthalmoscopes, which are often noisy and variable in quality. Four Transformer models—Swin-Tiny, ViT-Base, MobileViT-Small, and DeiT-Base—were trained and evaluated both individually and in ensembles. We evaluated the results at both image and patient levels to reflect clinical practice. The results show that, although performance drops on lower-quality images, ensemble combinations and patient-level aggregation significantly improve accuracy and sensitivity. We achieved up to 85% accuracy and an 84.2% F1-score on the D-Eye dataset, with a notable reduction in false negatives. Grad-CAM attention maps confirmed that Transformers identify anatomical regions relevant to diagnosis. These findings reinforce the potential of Transformer ensembles as an accessible solution for early glaucoma detection in populations with limited access to specialized equipment. 2025-11-03 Vision, Vol. 9, Pages 93: Comparative Analysis of Transformer Architectures and Ensemble Methods for Automated Glaucoma Screening in Fundus Images from Portable Ophthalmoscopes

Vision doi: 10.3390/vision9040093

Authors: Rodrigo Otávio Cantanhede Costa Pedro Alexandre Ferreira França Alexandre César Pinto Pessoa Geraldo Braz Júnior João Dallyson Sousa de Almeida António Cunha

Deep learning for glaucoma screening often relies on high-resolution clinical images and convolutional neural networks (CNNs). However, these methods face significant performance drops when applied to noisy, low-resolution images from portable devices. To address this, our work investigates ensemble methods using multiple Transformer architectures for automated glaucoma detection in challenging scenarios. We use the Brazil Glaucoma (BrG) and private D-Eye datasets to assess model robustness. These datasets include images typical of smartphone-coupled ophthalmoscopes, which are often noisy and variable in quality. Four Transformer models—Swin-Tiny, ViT-Base, MobileViT-Small, and DeiT-Base—were trained and evaluated both individually and in ensembles. We evaluated the results at both image and patient levels to reflect clinical practice. The results show that, although performance drops on lower-quality images, ensemble combinations and patient-level aggregation significantly improve accuracy and sensitivity. We achieved up to 85% accuracy and an 84.2% F1-score on the D-Eye dataset, with a notable reduction in false negatives. Grad-CAM attention maps confirmed that Transformers identify anatomical regions relevant to diagnosis. These findings reinforce the potential of Transformer ensembles as an accessible solution for early glaucoma detection in populations with limited access to specialized equipment.

]]> Comparative Analysis of Transformer Architectures and Ensemble Methods for Automated Glaucoma Screening in Fundus Images from Portable Ophthalmoscopes Rodrigo Otávio Cantanhede Costa Pedro Alexandre Ferreira França Alexandre César Pinto Pessoa Geraldo Braz Júnior João Dallyson Sousa de Almeida António Cunha doi: 10.3390/vision9040093 Vision 2025-11-03 Vision 2025-11-03 9 4 Article 93 10.3390/vision9040093 https://www.mdpi.com/2411-5150/9/4/93 Vision, Vol. 9, Pages 92: Biases in Perceiving Positive Versus Negative Emotions: The Influence of Social Anxiety and State Affect https://www.mdpi.com/2411-5150/9/4/92 Models suggest social anxiety is characterized by negative processing biases. Negative biases also arise from negative mood, i.e., state affect. We examined how social anxiety influences emotional processing and whether state affect, or mood, modified the relationship between social anxiety and perceptual bias. We quantified bias by determining the point of subjective equality, PSE, the face judged equally often as happy and as angry. We found perceptual bias depended on social anxiety and state affect. PSE was greater in individuals high (mean PSE: 8.69) versus low (mean PSE: 3.04) in social anxiety. The higher PSE indicated a stronger negative bias in high social anxiety. State affect modified this relationship, with high social anxiety associated with stronger negative biases, but only for individuals with greater negative affect. State affect and trait anxiety interacted such that social anxiety status alone was insufficient to fully characterize perceptual biases. This raises several issues such as the need to consider what constitutes an appropriate control group and the need to consider state affect in social anxiety. Importantly, our results suggest compensatory effects may counteract the influences of negative mood in individuals low in social anxiety. 2025-11-01 Vision, Vol. 9, Pages 92: Biases in Perceiving Positive Versus Negative Emotions: The Influence of Social Anxiety and State Affect

Vision doi: 10.3390/vision9040092

Authors: Vivian M. Ciaramitaro Erinda Morina Jenny L. Wu Daniel A. Harris Sarah A. Hayes-Skelton

Models suggest social anxiety is characterized by negative processing biases. Negative biases also arise from negative mood, i.e., state affect. We examined how social anxiety influences emotional processing and whether state affect, or mood, modified the relationship between social anxiety and perceptual bias. We quantified bias by determining the point of subjective equality, PSE, the face judged equally often as happy and as angry. We found perceptual bias depended on social anxiety and state affect. PSE was greater in individuals high (mean PSE: 8.69) versus low (mean PSE: 3.04) in social anxiety. The higher PSE indicated a stronger negative bias in high social anxiety. State affect modified this relationship, with high social anxiety associated with stronger negative biases, but only for individuals with greater negative affect. State affect and trait anxiety interacted such that social anxiety status alone was insufficient to fully characterize perceptual biases. This raises several issues such as the need to consider what constitutes an appropriate control group and the need to consider state affect in social anxiety. Importantly, our results suggest compensatory effects may counteract the influences of negative mood in individuals low in social anxiety.

]]> Biases in Perceiving Positive Versus Negative Emotions: The Influence of Social Anxiety and State Affect Vivian M. Ciaramitaro Erinda Morina Jenny L. Wu Daniel A. Harris Sarah A. Hayes-Skelton doi: 10.3390/vision9040092 Vision 2025-11-01 Vision 2025-11-01 9 4 Article 92 10.3390/vision9040092 https://www.mdpi.com/2411-5150/9/4/92 Vision, Vol. 9, Pages 91: In-Vivo Characterization of Healthy Retinal Pigment Epithelium and Photoreceptor Cells from AO-(T)FI Imaging https://www.mdpi.com/2411-5150/9/4/91 We provide an automated characterization of human retinal cells, i.e., RPE’s based on the non-invasive AO-TFI retinal imaging and PR’s based on the non-invasive AO-FI retinal imaging on a large-scale study involving 171 confirmed healthy eyes from 104 participants of 23 to 80 years old. Comprehensive standard checkups based on SD-OCT and Fondus imaging modalities were carried out by Ophthalmologists from the Luzerner Kantonsspital (LUKS) to confirm the absence of retinal pathologies. AO imaging imaging was performed using the Cellularis® device and each eye was imaged at various retinal eccentricities. The images were automatically segmented using a dedicated software and RPE and PR cells were identified and morphometric characterizations, such as cell density and area were computed. The results were stratified based on various criteria, such as age, retinal eccentricity, visual acuity, etc. The automatic segmentation was validated independently on a held-out set by five trained medical students not involved in this study. We plotted cell density variations as a function of eccentricity from the fovea along both nasal and temporal directions. For RPE cells, no consistent trend in density was observed between 0° to 9° eccentricity, contrasting with established histological literature demonstrating foveal density peaks. In contrast, PR cell density showed a clear decrease from 2.5° to 9°. RPE cell density declined linearly with age, whereas no age-related pattern was detected for PR cell density. On average, RPE cell density was found to be ≈6313 cells/mm2 (±σ=757), while the average PR cell density was calculated as ≈10,207 cells/mm2 (±σ=1273). 2025-11-01 Vision, Vol. 9, Pages 91: In-Vivo Characterization of Healthy Retinal Pigment Epithelium and Photoreceptor Cells from AO-(T)FI Imaging

Vision doi: 10.3390/vision9040091

Authors: Sohrab Ferdowsi Leila Sara Eppenberger Safa Mohanna Oliver Pfäffli Christoph Amstutz Lucas M. Bachmann Michael A. Thiel Martin K. Schmid

We provide an automated characterization of human retinal cells, i.e., RPE’s based on the non-invasive AO-TFI retinal imaging and PR’s based on the non-invasive AO-FI retinal imaging on a large-scale study involving 171 confirmed healthy eyes from 104 participants of 23 to 80 years old. Comprehensive standard checkups based on SD-OCT and Fondus imaging modalities were carried out by Ophthalmologists from the Luzerner Kantonsspital (LUKS) to confirm the absence of retinal pathologies. AO imaging imaging was performed using the Cellularis® device and each eye was imaged at various retinal eccentricities. The images were automatically segmented using a dedicated software and RPE and PR cells were identified and morphometric characterizations, such as cell density and area were computed. The results were stratified based on various criteria, such as age, retinal eccentricity, visual acuity, etc. The automatic segmentation was validated independently on a held-out set by five trained medical students not involved in this study. We plotted cell density variations as a function of eccentricity from the fovea along both nasal and temporal directions. For RPE cells, no consistent trend in density was observed between 0° to 9° eccentricity, contrasting with established histological literature demonstrating foveal density peaks. In contrast, PR cell density showed a clear decrease from 2.5° to 9°. RPE cell density declined linearly with age, whereas no age-related pattern was detected for PR cell density. On average, RPE cell density was found to be ≈6313 cells/mm2 (±σ=757), while the average PR cell density was calculated as ≈10,207 cells/mm2 (±σ=1273).

]]> In-Vivo Characterization of Healthy Retinal Pigment Epithelium and Photoreceptor Cells from AO-(T)FI Imaging Sohrab Ferdowsi Leila Sara Eppenberger Safa Mohanna Oliver Pfäffli Christoph Amstutz Lucas M. Bachmann Michael A. Thiel Martin K. Schmid doi: 10.3390/vision9040091 Vision 2025-11-01 Vision 2025-11-01 9 4 Article 91 10.3390/vision9040091 https://www.mdpi.com/2411-5150/9/4/91 Vision, Vol. 9, Pages 90: Birefringence of the Human Cornea: A Review https://www.mdpi.com/2411-5150/9/4/90 Background: This paper aims to provide an overview of corneal birefringence (CB), systematize the knowledge and current understanding of CB, and identify difficulties associated with introducing CB into mainstream clinical practice. Methods: Literature reviews were conducted, seeking articles focused on CB published between the early 19th century and the present time. Secondary-level searches were made examining relevant publications referred to in primary-level publications, ranging back to the early 17th century. The key search words were “corneal birefringence” and “non-invasive measurements”. Results: CB was first recorded by Brewster in 1815. Orthogonally polarized rays travel at different speeds through the cornea, creating a slow axis and a fast axis. The slow axis aligns with the pattern of most corneal stromal collagen fibrils. In vivo, it is oriented along the superior temporal–inferior nasal direction at an angle of about 25° (with an approximate range of −54° to 90°) from the horizontal. CB has been reported to (i) influence the estimation of retinal nerve fiber layer thickness; (ii) be affected by corneal interventions; (iii) be altered in keratoconus; (iv) vary along the depth of the cornea; and (v) be affected by intra-ocular pressure. Conclusions: Under precisely controlled conditions, capturing the CB pattern is the first step in a non-destructive process used to model the ultra-fine structure of the individual cornea, and changes thereof, in vivo. 2025-10-28 Vision, Vol. 9, Pages 90: Birefringence of the Human Cornea: A Review

Vision doi: 10.3390/vision9040090

Authors: Sudi Patel Larysa Tutchenko Igor Dmytruk

Background: This paper aims to provide an overview of corneal birefringence (CB), systematize the knowledge and current understanding of CB, and identify difficulties associated with introducing CB into mainstream clinical practice. Methods: Literature reviews were conducted, seeking articles focused on CB published between the early 19th century and the present time. Secondary-level searches were made examining relevant publications referred to in primary-level publications, ranging back to the early 17th century. The key search words were “corneal birefringence” and “non-invasive measurements”. Results: CB was first recorded by Brewster in 1815. Orthogonally polarized rays travel at different speeds through the cornea, creating a slow axis and a fast axis. The slow axis aligns with the pattern of most corneal stromal collagen fibrils. In vivo, it is oriented along the superior temporal–inferior nasal direction at an angle of about 25° (with an approximate range of −54° to 90°) from the horizontal. CB has been reported to (i) influence the estimation of retinal nerve fiber layer thickness; (ii) be affected by corneal interventions; (iii) be altered in keratoconus; (iv) vary along the depth of the cornea; and (v) be affected by intra-ocular pressure. Conclusions: Under precisely controlled conditions, capturing the CB pattern is the first step in a non-destructive process used to model the ultra-fine structure of the individual cornea, and changes thereof, in vivo.

]]> Birefringence of the Human Cornea: A Review Sudi Patel Larysa Tutchenko Igor Dmytruk doi: 10.3390/vision9040090 Vision 2025-10-28 Vision 2025-10-28 9 4 Review 90 10.3390/vision9040090 https://www.mdpi.com/2411-5150/9/4/90 Vision, Vol. 9, Pages 89: Prevalence of Keratoconus and Associated Risk Factors Among High School Students in Couva, Trinidad: A Cross-Sectional Study https://www.mdpi.com/2411-5150/9/4/89 Purpose: This study aimed to determine the prevalence and associated risk factors of keratoconus (KC) among high school students in Couva, Trinidad and Tobago. Method: A cross-sectional, school-based approach was used, involving a simple random sampling technique to select schools and students. A structured questionnaire assessed KC risk factors, while clinical assessments, including visual acuity, refraction, slit lamp biomicroscopy, and topography, were performed. Data were analyzed using R. Exact tests were used for KC (n = 2 cases) and robust Poisson regression estimated adjusted prevalence ratios for the ‘at-risk’ screening endpoint. Results: A total of 432 students aged 12–17 years participated, with a response rate of 97.5%. Most participants were of East Indian descent (48.1%), female (52.1%), and 14 years old (23.1%). Approximately 47.7% (95% CI 43.0–52.5%) were at risk of KC, with 0.5% (2/432; exact 95% CI 0.06–1.67%) diagnosed with the condition. The most common risk factors were eye rubbing (87.4%), over eight hours of sun exposure weekly (71.8%), and atopy (68.4%). KC was observed to be significantly higher among people with a family history (p = 0.018). Conclusions: The study highlights a low prevalence and a high risk of KC among high school students, with a strong link to family history and common risk factors such as eye rubbing and sun exposure. These findings emphasize the urgent need for regular KC screening in schools to ensure early diagnosis and effective management. 2025-10-20 Vision, Vol. 9, Pages 89: Prevalence of Keratoconus and Associated Risk Factors Among High School Students in Couva, Trinidad: A Cross-Sectional Study

Vision doi: 10.3390/vision9040089

Authors: Ngozika Esther Ezinne Shinead Phagoo Ameera Roopnarinesingh Michael Agyemang Kwarteng

Purpose: This study aimed to determine the prevalence and associated risk factors of keratoconus (KC) among high school students in Couva, Trinidad and Tobago. Method: A cross-sectional, school-based approach was used, involving a simple random sampling technique to select schools and students. A structured questionnaire assessed KC risk factors, while clinical assessments, including visual acuity, refraction, slit lamp biomicroscopy, and topography, were performed. Data were analyzed using R. Exact tests were used for KC (n = 2 cases) and robust Poisson regression estimated adjusted prevalence ratios for the ‘at-risk’ screening endpoint. Results: A total of 432 students aged 12–17 years participated, with a response rate of 97.5%. Most participants were of East Indian descent (48.1%), female (52.1%), and 14 years old (23.1%). Approximately 47.7% (95% CI 43.0–52.5%) were at risk of KC, with 0.5% (2/432; exact 95% CI 0.06–1.67%) diagnosed with the condition. The most common risk factors were eye rubbing (87.4%), over eight hours of sun exposure weekly (71.8%), and atopy (68.4%). KC was observed to be significantly higher among people with a family history (p = 0.018). Conclusions: The study highlights a low prevalence and a high risk of KC among high school students, with a strong link to family history and common risk factors such as eye rubbing and sun exposure. These findings emphasize the urgent need for regular KC screening in schools to ensure early diagnosis and effective management.

]]> Prevalence of Keratoconus and Associated Risk Factors Among High School Students in Couva, Trinidad: A Cross-Sectional Study Ngozika Esther Ezinne Shinead Phagoo Ameera Roopnarinesingh Michael Agyemang Kwarteng doi: 10.3390/vision9040089 Vision 2025-10-20 Vision 2025-10-20 9 4 Article 89 10.3390/vision9040089 https://www.mdpi.com/2411-5150/9/4/89 Vision, Vol. 9, Pages 88: Comparing Visual Search Efficiency Across Different Facial Characteristics https://www.mdpi.com/2411-5150/9/4/88 Face recognition is an important skill that helps people make social judgments by identifying both who a person is and other characteristics such as their expression, age, and ethnicity. Previous models of face processing, such as those proposed by Bruce and Young and by Haxby and colleagues, suggest that identity and other facial features are processed through partly independent systems. This study aimed to compare the efficiency with which different facial characteristics are processed in a visual search task. Participants viewed arrays of two, four, or six faces and judged whether one face differed from the others. Four tasks were created, focusing separately on identity, expression, ethnicity, and gender. We found that search times were significantly longer when looking for identity and shorter when looking for ethnicity. Significant correlations were found among almost all tests in all outcome variables. Comparison of target-present and target-absent trials suggested that performance in none of the tests seems to follow a serial-search-terminating model. These results suggest that different facial characteristics share early processing but differentiate into independent recognition mechanisms at a later stage. 2025-10-15 Vision, Vol. 9, Pages 88: Comparing Visual Search Efficiency Across Different Facial Characteristics

Vision doi: 10.3390/vision9040088

Authors: Navdeep Kaur Isabella Hooge Andrea Albonico

Face recognition is an important skill that helps people make social judgments by identifying both who a person is and other characteristics such as their expression, age, and ethnicity. Previous models of face processing, such as those proposed by Bruce and Young and by Haxby and colleagues, suggest that identity and other facial features are processed through partly independent systems. This study aimed to compare the efficiency with which different facial characteristics are processed in a visual search task. Participants viewed arrays of two, four, or six faces and judged whether one face differed from the others. Four tasks were created, focusing separately on identity, expression, ethnicity, and gender. We found that search times were significantly longer when looking for identity and shorter when looking for ethnicity. Significant correlations were found among almost all tests in all outcome variables. Comparison of target-present and target-absent trials suggested that performance in none of the tests seems to follow a serial-search-terminating model. These results suggest that different facial characteristics share early processing but differentiate into independent recognition mechanisms at a later stage.

]]> Comparing Visual Search Efficiency Across Different Facial Characteristics Navdeep Kaur Isabella Hooge Andrea Albonico doi: 10.3390/vision9040088 Vision 2025-10-15 Vision 2025-10-15 9 4 Article 88 10.3390/vision9040088 https://www.mdpi.com/2411-5150/9/4/88 Vision, Vol. 9, Pages 87: Development of a Neural Network to Predict Optimal IOP Reduction in Glaucoma Management https://www.mdpi.com/2411-5150/9/4/87 Glaucoma management relies on lowering intraocular pressure (IOP), but determining the target reduction at presentation is challenging, particularly in normal-tension glaucoma (NTG). We developed and internally validated a neural network regression model using retrospective clinical data from Qiu et al. (2015), including 270 patients (118 with NTG). A single-layer artificial neural network with five nodes was trained in MATLAB R2024b using the Levenberg–Marquardt algorithm. Inputs included demographic, refractive, structural, and functional parameters, with IOP reduction as the output. Data were split into 65% training, 15% validation, and 20% testing, with training repeated 10 times. Model performance was strong and consistent (average RMSE: 1.90 ± 0.29 training, 2.18 ± 0.34 validation, 2.11 ± 0.30 testing; Pearson’s r: 0.92 ± 0.02, 0.88 ± 0.02, 0.88 ± 0.04). The best-performing model achieved RMSEs of 1.57, 2.90, and 1.77 with r values of 0.93, 0.91, and 0.93, respectively. Feature ablation revealed significant contributions from IOP, axial length, CCT, diagnosis, VCDR, spherical equivalent, mean deviation, and laterality. This study demonstrates that a simple neural network can reliably predict individualized IOP reduction targets, supporting personalized glaucoma management and improved outcomes. 2025-10-15 Vision, Vol. 9, Pages 87: Development of a Neural Network to Predict Optimal IOP Reduction in Glaucoma Management

Vision doi: 10.3390/vision9040087

Authors: Raheem Remtulla Sidrat Rahman Hady Saheb

Glaucoma management relies on lowering intraocular pressure (IOP), but determining the target reduction at presentation is challenging, particularly in normal-tension glaucoma (NTG). We developed and internally validated a neural network regression model using retrospective clinical data from Qiu et al. (2015), including 270 patients (118 with NTG). A single-layer artificial neural network with five nodes was trained in MATLAB R2024b using the Levenberg–Marquardt algorithm. Inputs included demographic, refractive, structural, and functional parameters, with IOP reduction as the output. Data were split into 65% training, 15% validation, and 20% testing, with training repeated 10 times. Model performance was strong and consistent (average RMSE: 1.90 ± 0.29 training, 2.18 ± 0.34 validation, 2.11 ± 0.30 testing; Pearson’s r: 0.92 ± 0.02, 0.88 ± 0.02, 0.88 ± 0.04). The best-performing model achieved RMSEs of 1.57, 2.90, and 1.77 with r values of 0.93, 0.91, and 0.93, respectively. Feature ablation revealed significant contributions from IOP, axial length, CCT, diagnosis, VCDR, spherical equivalent, mean deviation, and laterality. This study demonstrates that a simple neural network can reliably predict individualized IOP reduction targets, supporting personalized glaucoma management and improved outcomes.

]]> Development of a Neural Network to Predict Optimal IOP Reduction in Glaucoma Management Raheem Remtulla Sidrat Rahman Hady Saheb doi: 10.3390/vision9040087 Vision 2025-10-15 Vision 2025-10-15 9 4 Article 87 10.3390/vision9040087 https://www.mdpi.com/2411-5150/9/4/87 Vision, Vol. 9, Pages 86: Clinical Assessment of a Virtual Reality Perimeter Versus the Humphrey Field Analyzer: Comparative Reliability, Usability, and Prospective Applications https://www.mdpi.com/2411-5150/9/4/86 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. 2025-10-11 Vision, Vol. 9, Pages 86: Clinical Assessment of a Virtual Reality Perimeter Versus the Humphrey Field Analyzer: Comparative Reliability, Usability, and Prospective Applications

Vision doi: 10.3390/vision9040086

Authors: Marco Zeppieri Caterina Gagliano Francesco Cappellani Federico Visalli Fabiana D’Esposito Alessandro Avitabile Roberta Amato Alessandra Cuna Francesco Pellegrini

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.

]]> Clinical Assessment of a Virtual Reality Perimeter Versus the Humphrey Field Analyzer: Comparative Reliability, Usability, and Prospective Applications Marco Zeppieri Caterina Gagliano Francesco Cappellani Federico Visalli Fabiana D’Esposito Alessandro Avitabile Roberta Amato Alessandra Cuna Francesco Pellegrini doi: 10.3390/vision9040086 Vision 2025-10-11 Vision 2025-10-11 9 4 Article 86 10.3390/vision9040086 https://www.mdpi.com/2411-5150/9/4/86 Vision, Vol. 9, Pages 85: Comparative Assessment of Large Language Models in Optics and Refractive Surgery: Performance on Multiple-Choice Questions https://www.mdpi.com/2411-5150/9/4/85 This study aimed to evaluate the performance of seven advanced AI Large Language Models (LLMs)—ChatGPT 4o, ChatGPT O3 Mini, ChatGPT O1, DeepSeek V3, DeepSeek R1, Gemini 2.0 Flash, and Grok-3—in answering multiple-choice questions (MCQs) in optics and refractive surgery, to assess their role in medical education for residents. The AI models were tested using 134 publicly available MCQs from national ophthalmology certification exams, categorized by the need to perform calculations, the relevant subspecialty, and the use of images. Accuracy was analyzed and compared statistically. ChatGPT O1 achieved the highest overall accuracy (83.5%), excelling in complex optical calculations (84.1%) and optics questions (82.4%). DeepSeek V3 displayed superior accuracy in refractive surgery-related questions (89.7%), followed by ChatGPT O3 Mini (88.4%). ChatGPT O3 Mini significantly outperformed others in image analysis, with 88.2% accuracy. Moreover, ChatGPT O1 demonstrated comparable accuracy rates for both calculated and non-calculated questions (84.1% vs. 83.3%). This is in stark contrast to other models, which exhibited significant discrepancies in accuracy for calculated and non-calculated questions. The findings highlight the ability of LLMs to achieve high accuracy in ophthalmology MCQs, particularly in complex optical calculations and visual items. These results suggest potential applications in exam preparation and medical training contexts, while underscoring the need for future studies designed to directly evaluate their role and impact in medical education. The findings highlight the significant potential of AI models in ophthalmology education, particularly in performing complex optical calculations and visual stem questions. Future studies should utilize larger, multilingual datasets to confirm and extend these preliminary findings. 2025-10-09 Vision, Vol. 9, Pages 85: Comparative Assessment of Large Language Models in Optics and Refractive Surgery: Performance on Multiple-Choice Questions

Vision doi: 10.3390/vision9040085

Authors: Leah Attal Elad Shvartz Alon Gorenshtein Shirley Pincovich Daniel Bahir

This study aimed to evaluate the performance of seven advanced AI Large Language Models (LLMs)—ChatGPT 4o, ChatGPT O3 Mini, ChatGPT O1, DeepSeek V3, DeepSeek R1, Gemini 2.0 Flash, and Grok-3—in answering multiple-choice questions (MCQs) in optics and refractive surgery, to assess their role in medical education for residents. The AI models were tested using 134 publicly available MCQs from national ophthalmology certification exams, categorized by the need to perform calculations, the relevant subspecialty, and the use of images. Accuracy was analyzed and compared statistically. ChatGPT O1 achieved the highest overall accuracy (83.5%), excelling in complex optical calculations (84.1%) and optics questions (82.4%). DeepSeek V3 displayed superior accuracy in refractive surgery-related questions (89.7%), followed by ChatGPT O3 Mini (88.4%). ChatGPT O3 Mini significantly outperformed others in image analysis, with 88.2% accuracy. Moreover, ChatGPT O1 demonstrated comparable accuracy rates for both calculated and non-calculated questions (84.1% vs. 83.3%). This is in stark contrast to other models, which exhibited significant discrepancies in accuracy for calculated and non-calculated questions. The findings highlight the ability of LLMs to achieve high accuracy in ophthalmology MCQs, particularly in complex optical calculations and visual items. These results suggest potential applications in exam preparation and medical training contexts, while underscoring the need for future studies designed to directly evaluate their role and impact in medical education. The findings highlight the significant potential of AI models in ophthalmology education, particularly in performing complex optical calculations and visual stem questions. Future studies should utilize larger, multilingual datasets to confirm and extend these preliminary findings.

]]> Comparative Assessment of Large Language Models in Optics and Refractive Surgery: Performance on Multiple-Choice Questions Leah Attal Elad Shvartz Alon Gorenshtein Shirley Pincovich Daniel Bahir doi: 10.3390/vision9040085 Vision 2025-10-09 Vision 2025-10-09 9 4 Article 85 10.3390/vision9040085 https://www.mdpi.com/2411-5150/9/4/85 Vision, Vol. 9, Pages 84: Myopia Prediction Using Machine Learning: An External Validation Study https://www.mdpi.com/2411-5150/9/4/84 We previously developed machine learning (ML) models for predicting cycloplegic spherical equivalent refraction (SER) and myopia using non-cycloplegic data and following a standardized protocol (cycloplegia with 0.5% tropicamide and biometry using NIDEK A-scan), but the models’ performance may not be generalizable to other settings. This study evaluated the performance of ML models in an independent cohort using a different cycloplegic agent and biometer. Chinese students (N = 614) aged 8–13 years underwent autorefraction before and after cycloplegia with 0.5% tropicamide (n = 505) or 1% cyclopentolate (n = 109). Biometric measures were obtained using an IOLMaster 700 (n = 207) or Optical Biometer SW-9000 (n = 407). ML models were evaluated using R2, mean absolute error (MAE), sensitivity, specificity, and area under the ROC curve (AUC). The XGBoost model predicted cycloplegic SER very well (R2 = 0.95, MAE (SD) = 0.32 (0.30) D). Both ML models predicted myopia well (random forest: AUC 0.99, sensitivity 93.7%, specificity 96.4%; XGBoost: sensitivity 90.1%, specificity 96.8%) and accurately predicted the myopia rate (observed 62.9%; random forest: 60.6%; XGBoost: 58.8%) despite heterogeneous cycloplegia and biometry factors. In this independent cohort of students, XGBoost and random forest performed very well for predicting cycloplegic SER and myopia status using non-cycloplegic data. This external validation study demonstrated that ML may provide a useful tool for estimating cycloplegic SER and myopia prevalence with heterogeneous clinical parameters, and study in additional populations is warranted. 2025-10-09 Vision, Vol. 9, Pages 84: Myopia Prediction Using Machine Learning: An External Validation Study

Vision doi: 10.3390/vision9040084

Authors: Rajat S. Chandra Bole Ying Jianyong Wang Hongguang Cui Guishuang Ying Julius T. Oatts

We previously developed machine learning (ML) models for predicting cycloplegic spherical equivalent refraction (SER) and myopia using non-cycloplegic data and following a standardized protocol (cycloplegia with 0.5% tropicamide and biometry using NIDEK A-scan), but the models’ performance may not be generalizable to other settings. This study evaluated the performance of ML models in an independent cohort using a different cycloplegic agent and biometer. Chinese students (N = 614) aged 8–13 years underwent autorefraction before and after cycloplegia with 0.5% tropicamide (n = 505) or 1% cyclopentolate (n = 109). Biometric measures were obtained using an IOLMaster 700 (n = 207) or Optical Biometer SW-9000 (n = 407). ML models were evaluated using R2, mean absolute error (MAE), sensitivity, specificity, and area under the ROC curve (AUC). The XGBoost model predicted cycloplegic SER very well (R2 = 0.95, MAE (SD) = 0.32 (0.30) D). Both ML models predicted myopia well (random forest: AUC 0.99, sensitivity 93.7%, specificity 96.4%; XGBoost: sensitivity 90.1%, specificity 96.8%) and accurately predicted the myopia rate (observed 62.9%; random forest: 60.6%; XGBoost: 58.8%) despite heterogeneous cycloplegia and biometry factors. In this independent cohort of students, XGBoost and random forest performed very well for predicting cycloplegic SER and myopia status using non-cycloplegic data. This external validation study demonstrated that ML may provide a useful tool for estimating cycloplegic SER and myopia prevalence with heterogeneous clinical parameters, and study in additional populations is warranted.

]]> Myopia Prediction Using Machine Learning: An External Validation Study Rajat S. Chandra Bole Ying Jianyong Wang Hongguang Cui Guishuang Ying Julius T. Oatts doi: 10.3390/vision9040084 Vision 2025-10-09 Vision 2025-10-09 9 4 Article 84 10.3390/vision9040084 https://www.mdpi.com/2411-5150/9/4/84 Vision, Vol. 9, Pages 83: Oculomotor Training Improves Reading and Associated Cognitive Functions in Children with Learning Difficulties: A Pilot Study https://www.mdpi.com/2411-5150/9/4/83 In the first years of schooling, inefficient eye movements can impair the development of reading skills. Nonetheless, the improvement of these abilities has been little investigated in children. This pilot study aimed to verify the effectiveness of Office Based Oculomotor Training (OBOT) in enhancing reading skills in ‘poor’ readers. Twenty-one children (aged 7–12 years) underwent an assessment of reading, visual, and perceptual abilities before and after a training of oculomotor skills (i.e., execution of saccadic movements with symbol charts in various modes and types; 14 participants) or a simple reading exercise (7 participants). The overall duration of the training was six weeks. The results showed a specific improvement, in the group subjected to oculomotor training only, not only in oculomotor abilities but also in reading, visuo-perceptual skills, and the ability to resolve crowding. These primary results suggest that the improvement of oculomotor abilities can lead to an indirect increase in reading in developmental age. 2025-10-07 Vision, Vol. 9, Pages 83: Oculomotor Training Improves Reading and Associated Cognitive Functions in Children with Learning Difficulties: A Pilot Study

Vision doi: 10.3390/vision9040083

Authors: Alessio Facchin Silvio Maffioletti Marta Maffioletti Gabriele Esposito Marta Bonetti Luisa Girelli Roberta Daini

In the first years of schooling, inefficient eye movements can impair the development of reading skills. Nonetheless, the improvement of these abilities has been little investigated in children. This pilot study aimed to verify the effectiveness of Office Based Oculomotor Training (OBOT) in enhancing reading skills in ‘poor’ readers. Twenty-one children (aged 7–12 years) underwent an assessment of reading, visual, and perceptual abilities before and after a training of oculomotor skills (i.e., execution of saccadic movements with symbol charts in various modes and types; 14 participants) or a simple reading exercise (7 participants). The overall duration of the training was six weeks. The results showed a specific improvement, in the group subjected to oculomotor training only, not only in oculomotor abilities but also in reading, visuo-perceptual skills, and the ability to resolve crowding. These primary results suggest that the improvement of oculomotor abilities can lead to an indirect increase in reading in developmental age.

]]> Oculomotor Training Improves Reading and Associated Cognitive Functions in Children with Learning Difficulties: A Pilot Study Alessio Facchin Silvio Maffioletti Marta Maffioletti Gabriele Esposito Marta Bonetti Luisa Girelli Roberta Daini doi: 10.3390/vision9040083 Vision 2025-10-07 Vision 2025-10-07 9 4 Article 83 10.3390/vision9040083 https://www.mdpi.com/2411-5150/9/4/83 Vision, Vol. 9, Pages 82: Ocular Manifestations in Pediatric Traumatic Brain Injury Admitted to the ICU: A Prospective Analysis https://www.mdpi.com/2411-5150/9/4/82 Background: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality worldwide. Ocular manifestations are common but often overlooked, despite their potential to cause long-term visual impairment. This study aimed to evaluate the prevalence and characteristics of ocular findings in pediatric TBI patients admitted to the intensive care unit (ICU). Method: We prospectively reviewed records of pediatric patients (≤16 years) with TBI admitted to the Neurosurgery ICU at King Abdullah University Hospital (January 2022–December 2024). TBI was defined using U.S. CDC criteria and confirmed by clinical and radiological findings. Ocular manifestations were identified from ophthalmology consultations, neurosurgical notes, and bedside examinations. Demographics, injury details, and clinical outcomes were recorded. Statistical analyses included Chi-square, Fisher’s exact, and Mann–Whitney U tests, with significance set at p ≤ 0.05. Results: Thirty-eight patients (median age: 8 years; 55.3% male) were included. Ocular findings were present in 20 patients (52.6%). These patients were significantly older (median age 10 vs. 6 years, p = 0.007) and had lower admission GCS scores (11 vs. 14, p = 0.016). Male predominance was higher in the ocular group (75.0% vs. 33.3%, p = 0.030). Ocular findings were significantly associated with surgical intervention (60.0% vs. 22.2%, p = 0.025), orbital fractures (40.0% vs. 5.6%, p = 0.021), basal skull fracture signs (p = 0.036), and extraocular muscle limitation (p = 0.048). On multivariable analysis, orbital fracture remained the only independent predictor of ocular findings (aOR 2.22, 95% CI 1.17–3.57, p = 0.02). Conclusion: Over half of pediatric ICU TBI patients demonstrated ocular manifestations, closely linked to greater injury severity and craniofacial trauma. Routine, comprehensive ophthalmological evaluation should be integrated into the multidisciplinary management of severe pediatric TBI to optimize visual and functional outcomes. 2025-10-04 Vision, Vol. 9, Pages 82: Ocular Manifestations in Pediatric Traumatic Brain Injury Admitted to the ICU: A Prospective Analysis

Vision doi: 10.3390/vision9040082

Authors: Amer Jaradat Rami Al-Dwairi Adam Abdallah Atef F. Hulliel Rawhi Alshaykh Mahmood Al Nuaimi Ala’ Al Barbarawi Seren Al Beiruti Abdelwahab Aleshawi

Background: Traumatic Brain Injury (TBI) in children is a major cause of morbidity and mortality worldwide. Ocular manifestations are common but often overlooked, despite their potential to cause long-term visual impairment. This study aimed to evaluate the prevalence and characteristics of ocular findings in pediatric TBI patients admitted to the intensive care unit (ICU). Method: We prospectively reviewed records of pediatric patients (≤16 years) with TBI admitted to the Neurosurgery ICU at King Abdullah University Hospital (January 2022–December 2024). TBI was defined using U.S. CDC criteria and confirmed by clinical and radiological findings. Ocular manifestations were identified from ophthalmology consultations, neurosurgical notes, and bedside examinations. Demographics, injury details, and clinical outcomes were recorded. Statistical analyses included Chi-square, Fisher’s exact, and Mann–Whitney U tests, with significance set at p ≤ 0.05. Results: Thirty-eight patients (median age: 8 years; 55.3% male) were included. Ocular findings were present in 20 patients (52.6%). These patients were significantly older (median age 10 vs. 6 years, p = 0.007) and had lower admission GCS scores (11 vs. 14, p = 0.016). Male predominance was higher in the ocular group (75.0% vs. 33.3%, p = 0.030). Ocular findings were significantly associated with surgical intervention (60.0% vs. 22.2%, p = 0.025), orbital fractures (40.0% vs. 5.6%, p = 0.021), basal skull fracture signs (p = 0.036), and extraocular muscle limitation (p = 0.048). On multivariable analysis, orbital fracture remained the only independent predictor of ocular findings (aOR 2.22, 95% CI 1.17–3.57, p = 0.02). Conclusion: Over half of pediatric ICU TBI patients demonstrated ocular manifestations, closely linked to greater injury severity and craniofacial trauma. Routine, comprehensive ophthalmological evaluation should be integrated into the multidisciplinary management of severe pediatric TBI to optimize visual and functional outcomes.

]]> Ocular Manifestations in Pediatric Traumatic Brain Injury Admitted to the ICU: A Prospective Analysis Amer Jaradat Rami Al-Dwairi Adam Abdallah Atef F. Hulliel Rawhi Alshaykh Mahmood Al Nuaimi Ala’ Al Barbarawi Seren Al Beiruti Abdelwahab Aleshawi doi: 10.3390/vision9040082 Vision 2025-10-04 Vision 2025-10-04 9 4 Article 82 10.3390/vision9040082 https://www.mdpi.com/2411-5150/9/4/82 Vision, Vol. 9, Pages 81: Too Bright to Focus? Influence of Brightness Illusions and Ambient Light Levels on the Dynamics of Ocular Accommodation https://www.mdpi.com/2411-5150/9/4/81 Can brightness illusions modulate ocular accommodation? Previous studies have shown that brightness illusions can influence pupil size as if caused by actual luminance increases. However, their effects on other ocular responses—such as accommodative or focusing dynamics—remain largely unexplored. This study investigates the influence of brightness illusions, under two ambient lighting conditions, on accommodative and pupillary dynamics (physiological responses), and on perceived brightness and visual comfort (subjective responses). Thirty-two young adults with healthy vision viewed four stimulus types (blue bright and non-bright, yellow bright and non-bright) under low- and high-contrast ambient lighting while ocular responses were recorded using a WAM-5500 open-field autorefractor. Brightness and comfort were rated after each session. The results showed that high ambient contrast (mesopic) and brightness illusions increased accommodative variability, while yellow stimuli elicited a greater lag under photopic condition. Pupil size decreased only under mesopic lighting. Perceived brightness was enhanced by brightness illusions and blue color, whereas visual comfort decreased for bright illusions, especially under low light. These findings suggest that ambient lighting and visual stimulus properties modulate both physiological and subjective responses, highlighting the need for dynamic accommodative assessment and visually ergonomic display design to reduce visual fatigue during digital device use. 2025-09-30 Vision, Vol. 9, Pages 81: Too Bright to Focus? Influence of Brightness Illusions and Ambient Light Levels on the Dynamics of Ocular Accommodation

Vision doi: 10.3390/vision9040081

Authors: Antonio Rodán Angélica Fernández-López Jesús Vera Pedro R. Montoro Beatriz Redondo Antonio Prieto

Can brightness illusions modulate ocular accommodation? Previous studies have shown that brightness illusions can influence pupil size as if caused by actual luminance increases. However, their effects on other ocular responses—such as accommodative or focusing dynamics—remain largely unexplored. This study investigates the influence of brightness illusions, under two ambient lighting conditions, on accommodative and pupillary dynamics (physiological responses), and on perceived brightness and visual comfort (subjective responses). Thirty-two young adults with healthy vision viewed four stimulus types (blue bright and non-bright, yellow bright and non-bright) under low- and high-contrast ambient lighting while ocular responses were recorded using a WAM-5500 open-field autorefractor. Brightness and comfort were rated after each session. The results showed that high ambient contrast (mesopic) and brightness illusions increased accommodative variability, while yellow stimuli elicited a greater lag under photopic condition. Pupil size decreased only under mesopic lighting. Perceived brightness was enhanced by brightness illusions and blue color, whereas visual comfort decreased for bright illusions, especially under low light. These findings suggest that ambient lighting and visual stimulus properties modulate both physiological and subjective responses, highlighting the need for dynamic accommodative assessment and visually ergonomic display design to reduce visual fatigue during digital device use.

]]> Too Bright to Focus? Influence of Brightness Illusions and Ambient Light Levels on the Dynamics of Ocular Accommodation Antonio Rodán Angélica Fernández-López Jesús Vera Pedro R. Montoro Beatriz Redondo Antonio Prieto doi: 10.3390/vision9040081 Vision 2025-09-30 Vision 2025-09-30 9 4 Article 81 10.3390/vision9040081 https://www.mdpi.com/2411-5150/9/4/81 Vision, Vol. 9, Pages 80: Evaluating the Clinical Validity of Commercially Available Virtual Reality Headsets for Visual Field Testing: A Systematic Review https://www.mdpi.com/2411-5150/9/4/80 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. 2025-09-24 Vision, Vol. 9, Pages 80: Evaluating the Clinical Validity of Commercially Available Virtual Reality Headsets for Visual Field Testing: A Systematic Review

Vision doi: 10.3390/vision9040080

Authors: Jesús Vera Alan N. Glazier Mark T. Dunbar Douglas Ripkin Masoud Nafey

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.

]]> Evaluating the Clinical Validity of Commercially Available Virtual Reality Headsets for Visual Field Testing: A Systematic Review Jesús Vera Alan N. Glazier Mark T. Dunbar Douglas Ripkin Masoud Nafey doi: 10.3390/vision9040080 Vision 2025-09-24 Vision 2025-09-24 9 4 Systematic Review 80 10.3390/vision9040080 https://www.mdpi.com/2411-5150/9/4/80 Vision, Vol. 9, Pages 79: A Simulated Visual Field Defect Impairs Temporal Processing: An Effect Not Modulated by Emotional Faces https://www.mdpi.com/2411-5150/9/3/79 Temporal processing is fundamental to visual perception, yet little is known about how it functions under compromised visual field conditions or whether emotional stimuli, as reported in the literature, can modulate it. This study investigated temporal resolution using a two-flash fusion paradigm with a static, semi-transparent overlay that degraded the right visual hemifield of opacity 0.60 and examined the potential modulatory effects of emotional faces. In Experiment 1, participants were asked to report if they perceived one or two flashes presented at either −6° (normal vision) or +6° (beneath a scotoma) across eight interstimulus intervals, ranging from 10 to 80 ms with a step size of 10 ms. Results showed significantly impaired temporal discrimination in the degraded vision condition, with elevated thresholds 52.29 ms vs. 34.78 ms and reduced accuracy, particularly at intermediate ISIs 30–60 ms. In Experiment 2, we introduced emotional faces before flash presentation to determine whether emotional content would differentially affect temporal processing. Our findings indicate that neither normal nor scotoma-impaired temporal processing was modulated by the specific emotional content (angry, happy, or neutral) of the facial primes. 2025-09-16 Vision, Vol. 9, Pages 79: A Simulated Visual Field Defect Impairs Temporal Processing: An Effect Not Modulated by Emotional Faces

Vision doi: 10.3390/vision9030079

Authors: Mohammad Ahsan Khodami Luca Battaglini

Temporal processing is fundamental to visual perception, yet little is known about how it functions under compromised visual field conditions or whether emotional stimuli, as reported in the literature, can modulate it. This study investigated temporal resolution using a two-flash fusion paradigm with a static, semi-transparent overlay that degraded the right visual hemifield of opacity 0.60 and examined the potential modulatory effects of emotional faces. In Experiment 1, participants were asked to report if they perceived one or two flashes presented at either −6° (normal vision) or +6° (beneath a scotoma) across eight interstimulus intervals, ranging from 10 to 80 ms with a step size of 10 ms. Results showed significantly impaired temporal discrimination in the degraded vision condition, with elevated thresholds 52.29 ms vs. 34.78 ms and reduced accuracy, particularly at intermediate ISIs 30–60 ms. In Experiment 2, we introduced emotional faces before flash presentation to determine whether emotional content would differentially affect temporal processing. Our findings indicate that neither normal nor scotoma-impaired temporal processing was modulated by the specific emotional content (angry, happy, or neutral) of the facial primes.

]]> A Simulated Visual Field Defect Impairs Temporal Processing: An Effect Not Modulated by Emotional Faces Mohammad Ahsan Khodami Luca Battaglini doi: 10.3390/vision9030079 Vision 2025-09-16 Vision 2025-09-16 9 3 Article 79 10.3390/vision9030079 https://www.mdpi.com/2411-5150/9/3/79 Vision, Vol. 9, Pages 78: Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review of Ophthalmic Management and Treatment https://www.mdpi.com/2411-5150/9/3/78 Background: Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, life-threatening mucocutaneous disorders often associated with severe ophthalmic complications. Ocular involvement occurs in 50–68% of cases and can result in permanent vision loss. Despite this, optimal management strategies remain unclear, and treatment practices vary widely. Methods: A systematic review was conducted in accordance with PRISMA guidelines and prospectively registered on PROSPERO (CRD420251022655). Medline, Embase, and CENTRAL were searched from 1998 to 2024 for English-language studies reporting treatment outcomes for ocular SJS/TEN. Results: A total of 194 studies encompassing 6698 treated eyes were included. Best-corrected visual acuity (BCVA) improved in 52.2% of eyes, epithelial regeneration occurred in 16.8%, and symptom relief was reported in 26.3%. Common treatments included topical therapy (n = 1424), mucosal grafts (n = 1220), contact lenses (n = 1134), amniotic membrane transplantation (AMT) (n = 889), systemic medical therapy (n = 524), and punctal occlusion (n = 456). Emerging therapies included TNF-alpha inhibitors, anti-VEGF agents, photodynamic therapy, and 5-fluorouracil. Conclusions: Disease-stage-specific therapy is crucial in ocular SJS/TEN. Acute interventions such as AMT may prevent long-term complications, while chronic care targets structural and tear-film abnormalities. Further prospective studies are needed to standardize care and optimize visual outcomes. 2025-09-11 Vision, Vol. 9, Pages 78: Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review of Ophthalmic Management and Treatment

Vision doi: 10.3390/vision9030078

Authors: Korolos Sawires Brendan K. Tao Harrish Nithianandan Larena Menant-Tay Michael O’Connor Peng Yan Parnian Arjmand

Background: Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, life-threatening mucocutaneous disorders often associated with severe ophthalmic complications. Ocular involvement occurs in 50–68% of cases and can result in permanent vision loss. Despite this, optimal management strategies remain unclear, and treatment practices vary widely. Methods: A systematic review was conducted in accordance with PRISMA guidelines and prospectively registered on PROSPERO (CRD420251022655). Medline, Embase, and CENTRAL were searched from 1998 to 2024 for English-language studies reporting treatment outcomes for ocular SJS/TEN. Results: A total of 194 studies encompassing 6698 treated eyes were included. Best-corrected visual acuity (BCVA) improved in 52.2% of eyes, epithelial regeneration occurred in 16.8%, and symptom relief was reported in 26.3%. Common treatments included topical therapy (n = 1424), mucosal grafts (n = 1220), contact lenses (n = 1134), amniotic membrane transplantation (AMT) (n = 889), systemic medical therapy (n = 524), and punctal occlusion (n = 456). Emerging therapies included TNF-alpha inhibitors, anti-VEGF agents, photodynamic therapy, and 5-fluorouracil. Conclusions: Disease-stage-specific therapy is crucial in ocular SJS/TEN. Acute interventions such as AMT may prevent long-term complications, while chronic care targets structural and tear-film abnormalities. Further prospective studies are needed to standardize care and optimize visual outcomes.

]]> Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review of Ophthalmic Management and Treatment Korolos Sawires Brendan K. Tao Harrish Nithianandan Larena Menant-Tay Michael O’Connor Peng Yan Parnian Arjmand doi: 10.3390/vision9030078 Vision 2025-09-11 Vision 2025-09-11 9 3 Systematic Review 78 10.3390/vision9030078 https://www.mdpi.com/2411-5150/9/3/78 Vision, Vol. 9, Pages 77: Predicting Pattern Standard Deviation in Glaucoma: A Machine Learning Approach Leveraging Clinical Data https://www.mdpi.com/2411-5150/9/3/77 Visual field (VF) testing is crucial for the management of glaucoma. However, the process is often hindered by technician shortages and reliability issues. In this study, we leveraged machine learning to predict pattern standard deviation (PSD) using clinical inputs. This machine learning retrospective study used publicly accessible data from 743 eyes (541 glaucoma and 202 non-glaucoma controls). An automated neural network (ANN) model was trained using seven clinical input features: mean retinal nerve fiber layer (RNFL), IOP, patient age, CCT, glaucoma diagnosis, study protocol, and laterality. The ANN demonstrated efficient training across 1000 epochs, with consistent error reduction in training and test sets. Mean RMSEs were 1.67 ± 0.05 for training, and 2.27 ± 0.27 for testing. The r was 0.89 ± 0.01 for training, and 0.81 ± 0.04 for testing, indicating strong predictive accuracy with minimal overfitting. The LOFO analysis revealed that the primary contributors to PSD prediction were RNFL, CCT, IOP, glaucoma status, study protocol, and age, listed in order of significance. Our neural network successfully predicted PSD from RNFL and clinical data with strong performance metrics, in addition to demonstrating construct validity. This work demonstrates that neural networks hold the potential to predict or even generate VF estimations based solely on RNFL and clinical inputs. 2025-09-01 Vision, Vol. 9, Pages 77: Predicting Pattern Standard Deviation in Glaucoma: A Machine Learning Approach Leveraging Clinical Data

Vision doi: 10.3390/vision9030077

Authors: Raheem Remtulla Patrik Abdelnour Daniel R. Chow Andres C. Ramos Guillermo Rocha Paul Harasymowycz

Visual field (VF) testing is crucial for the management of glaucoma. However, the process is often hindered by technician shortages and reliability issues. In this study, we leveraged machine learning to predict pattern standard deviation (PSD) using clinical inputs. This machine learning retrospective study used publicly accessible data from 743 eyes (541 glaucoma and 202 non-glaucoma controls). An automated neural network (ANN) model was trained using seven clinical input features: mean retinal nerve fiber layer (RNFL), IOP, patient age, CCT, glaucoma diagnosis, study protocol, and laterality. The ANN demonstrated efficient training across 1000 epochs, with consistent error reduction in training and test sets. Mean RMSEs were 1.67 ± 0.05 for training, and 2.27 ± 0.27 for testing. The r was 0.89 ± 0.01 for training, and 0.81 ± 0.04 for testing, indicating strong predictive accuracy with minimal overfitting. The LOFO analysis revealed that the primary contributors to PSD prediction were RNFL, CCT, IOP, glaucoma status, study protocol, and age, listed in order of significance. Our neural network successfully predicted PSD from RNFL and clinical data with strong performance metrics, in addition to demonstrating construct validity. This work demonstrates that neural networks hold the potential to predict or even generate VF estimations based solely on RNFL and clinical inputs.

]]> Predicting Pattern Standard Deviation in Glaucoma: A Machine Learning Approach Leveraging Clinical Data Raheem Remtulla Patrik Abdelnour Daniel R. Chow Andres C. Ramos Guillermo Rocha Paul Harasymowycz doi: 10.3390/vision9030077 Vision 2025-09-01 Vision 2025-09-01 9 3 Article 77 10.3390/vision9030077 https://www.mdpi.com/2411-5150/9/3/77 Vision, Vol. 9, Pages 76: Gaze Dispersion During a Sustained-Fixation Task as a Proxy of Visual Attention in Children with ADHD https://www.mdpi.com/2411-5150/9/3/76 Aim: The aim of this preliminary study was to explore the visual attention in children with ADHD using eye-tracking, and to identify a relevant quantitative proxy of their attentional control. Methods: Twenty-two children diagnosed with ADHD (aged 7 to 12 years) and their 24 sex-, age-matched control participants with typical development performed a visual sustained-fixation task using an eye-tracker. Fixation stability was estimated by calculating the bivariate contour ellipse area (BCEA) as a continuous index of gaze dispersion during the task. Results: Children with ADHD showed a significantly higher BCEA than control participants (p < 0.001), reflecting their increased gaze instability. The impairment in gaze fixation persisted even in the absence of visual distractors, suggesting intrinsic attentional dysregulation in ADHD. Conclusions: Our results provide preliminary evidence that eye-tracking coupled with BCEA analysis, provides a sensitive and non-invasive tool for quantifying visual attentional resources of children with ADHD. If replicated and extended, the increased use of gaze instability as an indicator of visual attention in children could have a major impact in clinical settings to assist clinicians. This analysis focuses on overall gaze dispersion rather than fine eye micro-movements such as microsaccades. 2025-09-01 Vision, Vol. 9, Pages 76: Gaze Dispersion During a Sustained-Fixation Task as a Proxy of Visual Attention in Children with ADHD

Vision doi: 10.3390/vision9030076

Authors: Lionel Moiroud Ana Moscoso Eric Acquaviva Alexandre Michel Richard Delorme Maria Pia Bucci

Aim: The aim of this preliminary study was to explore the visual attention in children with ADHD using eye-tracking, and to identify a relevant quantitative proxy of their attentional control. Methods: Twenty-two children diagnosed with ADHD (aged 7 to 12 years) and their 24 sex-, age-matched control participants with typical development performed a visual sustained-fixation task using an eye-tracker. Fixation stability was estimated by calculating the bivariate contour ellipse area (BCEA) as a continuous index of gaze dispersion during the task. Results: Children with ADHD showed a significantly higher BCEA than control participants (p < 0.001), reflecting their increased gaze instability. The impairment in gaze fixation persisted even in the absence of visual distractors, suggesting intrinsic attentional dysregulation in ADHD. Conclusions: Our results provide preliminary evidence that eye-tracking coupled with BCEA analysis, provides a sensitive and non-invasive tool for quantifying visual attentional resources of children with ADHD. If replicated and extended, the increased use of gaze instability as an indicator of visual attention in children could have a major impact in clinical settings to assist clinicians. This analysis focuses on overall gaze dispersion rather than fine eye micro-movements such as microsaccades.

]]> Gaze Dispersion During a Sustained-Fixation Task as a Proxy of Visual Attention in Children with ADHD Lionel Moiroud Ana Moscoso Eric Acquaviva Alexandre Michel Richard Delorme Maria Pia Bucci doi: 10.3390/vision9030076 Vision 2025-09-01 Vision 2025-09-01 9 3 Article 76 10.3390/vision9030076 https://www.mdpi.com/2411-5150/9/3/76 Vision, Vol. 9, Pages 75: A Comparative Study Between Clinical Optical Coherence Tomography (OCT) Analysis and Artificial Intelligence-Based Quantitative Evaluation in the Diagnosis of Diabetic Macular Edema https://www.mdpi.com/2411-5150/9/3/75 Recent advances in artificial intelligence (AI) have transformed ophthalmic diagnostics, particularly for retinal diseases. In this prospective, non-randomized study, we evaluated the performance of an AI-based software system against conventional clinical assessment—both quantitative and qualitative—of optical coherence tomography (OCT) images for diagnosing diabetic macular edema (DME). A total of 700 OCT exams were analyzed across 26 features, including demographic data (age, sex), eye laterality, visual acuity, and 21 quantitative OCT parameters (Macula Map A X-Y). We tested two classification scenarios: binary (DME presence vs. absence) and multiclass (six distinct DME phenotypes). To streamline feature selection, we applied paraconsistent feature engineering (PFE), isolating the most diagnostically relevant variables. We then compared the diagnostic accuracies of logistic regression, support vector machines (SVM), K-nearest neighbors (KNN), and decision tree models. In the binary classification using all features, SVM and KNN achieved 92% accuracy, while logistic regression reached 91%. When restricted to the four PFE-selected features, accuracy modestly declined to 84% for both logistic regression and SVM. These findings underscore the potential of AI—and particularly PFE—as an efficient, accurate aid for DME screening and diagnosis. 2025-09-01 Vision, Vol. 9, Pages 75: A Comparative Study Between Clinical Optical Coherence Tomography (OCT) Analysis and Artificial Intelligence-Based Quantitative Evaluation in the Diagnosis of Diabetic Macular Edema

Vision doi: 10.3390/vision9030075

Authors: Camila Brandão Fantozzi Letícia Margaria Peres Jogi Suda Neto Cinara Cássia Brandão Rodrigo Capobianco Guido Rubens Camargo Siqueira

Recent advances in artificial intelligence (AI) have transformed ophthalmic diagnostics, particularly for retinal diseases. In this prospective, non-randomized study, we evaluated the performance of an AI-based software system against conventional clinical assessment—both quantitative and qualitative—of optical coherence tomography (OCT) images for diagnosing diabetic macular edema (DME). A total of 700 OCT exams were analyzed across 26 features, including demographic data (age, sex), eye laterality, visual acuity, and 21 quantitative OCT parameters (Macula Map A X-Y). We tested two classification scenarios: binary (DME presence vs. absence) and multiclass (six distinct DME phenotypes). To streamline feature selection, we applied paraconsistent feature engineering (PFE), isolating the most diagnostically relevant variables. We then compared the diagnostic accuracies of logistic regression, support vector machines (SVM), K-nearest neighbors (KNN), and decision tree models. In the binary classification using all features, SVM and KNN achieved 92% accuracy, while logistic regression reached 91%. When restricted to the four PFE-selected features, accuracy modestly declined to 84% for both logistic regression and SVM. These findings underscore the potential of AI—and particularly PFE—as an efficient, accurate aid for DME screening and diagnosis.

]]> A Comparative Study Between Clinical Optical Coherence Tomography (OCT) Analysis and Artificial Intelligence-Based Quantitative Evaluation in the Diagnosis of Diabetic Macular Edema Camila Brandão Fantozzi Letícia Margaria Peres Jogi Suda Neto Cinara Cássia Brandão Rodrigo Capobianco Guido Rubens Camargo Siqueira doi: 10.3390/vision9030075 Vision 2025-09-01 Vision 2025-09-01 9 3 Article 75 10.3390/vision9030075 https://www.mdpi.com/2411-5150/9/3/75 Vision, Vol. 9, Pages 74: Modulating Multisensory Processing: Interactions Between Semantic Congruence and Temporal Synchrony https://www.mdpi.com/2411-5150/9/3/74 Presenting information to multiple sensory modalities often facilitates or interferes with processing, yet the mechanisms remain unclear. Using a Stroop-like task, the two reported experiments examined how semantic congruency and incongruency in one sensory modality affect processing and responding in a different modality. Participants were presented with pictures and sounds simultaneously (Experiment 1) or asynchronously (Experiment 2) and had to respond whether the visual or auditory stimulus was an animal or vehicle, while ignoring the other modality. Semantic congruency and incongruency in the unattended modality both affected responses in the attended modality, with visual stimuli having larger effects on auditory processing than the reverse (Experiment 1). Effects of visual input on auditory processing decreased under longer SOAs, while effects of auditory input on visual processing increased over SOAs and were correlated with relative processing speed (Experiment 2). These results suggest that congruence and modality both impact multisensory processing. 2025-09-01 Vision, Vol. 9, Pages 74: Modulating Multisensory Processing: Interactions Between Semantic Congruence and Temporal Synchrony

Vision doi: 10.3390/vision9030074

Authors: Susan Geffen Taylor Beck Christopher W. Robinson

Presenting information to multiple sensory modalities often facilitates or interferes with processing, yet the mechanisms remain unclear. Using a Stroop-like task, the two reported experiments examined how semantic congruency and incongruency in one sensory modality affect processing and responding in a different modality. Participants were presented with pictures and sounds simultaneously (Experiment 1) or asynchronously (Experiment 2) and had to respond whether the visual or auditory stimulus was an animal or vehicle, while ignoring the other modality. Semantic congruency and incongruency in the unattended modality both affected responses in the attended modality, with visual stimuli having larger effects on auditory processing than the reverse (Experiment 1). Effects of visual input on auditory processing decreased under longer SOAs, while effects of auditory input on visual processing increased over SOAs and were correlated with relative processing speed (Experiment 2). These results suggest that congruence and modality both impact multisensory processing.

]]> Modulating Multisensory Processing: Interactions Between Semantic Congruence and Temporal Synchrony Susan Geffen Taylor Beck Christopher W. Robinson doi: 10.3390/vision9030074 Vision 2025-09-01 Vision 2025-09-01 9 3 Article 74 10.3390/vision9030074 https://www.mdpi.com/2411-5150/9/3/74 Vision, Vol. 9, Pages 73: Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer https://www.mdpi.com/2411-5150/9/3/73 Background: Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects. Objectives: To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). Methods: In this retrospective case–control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. Results: On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls (p < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. Conclusions: In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals. 2025-08-28 Vision, Vol. 9, Pages 73: Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer

Vision doi: 10.3390/vision9030073

Authors: Assaf Kratz Tom Kornhauser Eyal Walter Ran Abuhasira Ivan Goldberg Aviel Hadad

Background: Transient intraocular pressure (IOP) elevations frequently occur after cataract surgery and may raise concerns, especially in patients susceptible to glaucomatous damage or pressure-related complications. These IOP spikes have also been linked to postoperative discomfort and headache. Oral acetazolamide is often used prophylactically, despite its known systemic side effects. Objectives: To evaluate the clinical benefit of routine prophylactic oral acetazolamide in reducing IOP after uncomplicated phacoemulsification performed with an anterior chamber maintainer (ACM). Methods: In this retrospective case–control study, 196 eyes from 196 patients were included. All underwent standard phacoemulsification with an ACM. Patients either received oral acetazolamide postoperatively (n = 98) or no IOP-lowering medication (n = 98). IOP was measured preoperatively, and on postoperative days one and seven. Results: On day one, mean IOP was 14.0 ± 3.8 mmHg in the acetazolamide group versus 15.4 ± 3.8 mmHg in controls (p < 0.005). By day seven, IOP was identical in both groups (13.5 mmHg), with no statistically significant difference (p = 0.95). No participant in either group reported headache or serious adverse effects, though 10% in the acetazolamide group experienced mild, transient systemic symptoms. Conclusions: In low-risk patients undergoing uneventful cataract surgery with ACM, routine use of oral acetazolamide yields only a modest, short-lived IOP reduction without evident clinical benefit. Its use may be unnecessary in this setting, though targeted prophylaxis could be considered for high-risk individuals.

]]> Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer Assaf Kratz Tom Kornhauser Eyal Walter Ran Abuhasira Ivan Goldberg Aviel Hadad doi: 10.3390/vision9030073 Vision 2025-08-28 Vision 2025-08-28 9 3 Article 73 10.3390/vision9030073 https://www.mdpi.com/2411-5150/9/3/73 Vision, Vol. 9, Pages 72: Three-View Relative Pose Estimation Under Planar Motion Constraints https://www.mdpi.com/2411-5150/9/3/72 Vision-based relative pose estimation serves as a core technology for high-precision localization in autonomous vehicles and mobile platforms. To overcome the limitations of conventional three-view pose estimation methods that rely heavily on dense feature matching and incur high computational costs, this paper proposes an efficient three-point correspondence algorithm based on planar motion constraints. The method constructs trifocal tensor constraint equations and develops a linearized three-point solution framework, enabling rapid relative pose estimation using merely three corresponding points in three views. In simulation experiments, we systematically analyzed the robustness of the algorithm under complex conditions that included image noise, angular deviation, and vibration. The method was further validated in real-world scenarios using the KITTI public dataset. Experimental results demonstrate that under the condition of satisfying the planar motion assumption, the proposed method achieves significantly improved computational efficiency compared with traditional methods (including general three-view methods, two-view planar motion estimation methods, and classical two-view methods), with the single-solution time reduced by more than 80% compared to general three-view methods. In the public dataset, our algorithm achieves a median rotation estimation error of less than 0.0545 degrees and maintains a translation estimation error of less than 2.1319 degrees. The proposed method exhibits higher computational efficiency and better numerical stability compared to conventional algorithms. This research provides an effective pose estimation solution with real-time performance and high accuracy for planar motion platforms such as autonomous vehicles and indoor mobile robots, demonstrating substantial engineering application value. 2025-08-25 Vision, Vol. 9, Pages 72: Three-View Relative Pose Estimation Under Planar Motion Constraints

Vision doi: 10.3390/vision9030072

Authors: Ziqin Dai Weimin Lv Liang Liu

Vision-based relative pose estimation serves as a core technology for high-precision localization in autonomous vehicles and mobile platforms. To overcome the limitations of conventional three-view pose estimation methods that rely heavily on dense feature matching and incur high computational costs, this paper proposes an efficient three-point correspondence algorithm based on planar motion constraints. The method constructs trifocal tensor constraint equations and develops a linearized three-point solution framework, enabling rapid relative pose estimation using merely three corresponding points in three views. In simulation experiments, we systematically analyzed the robustness of the algorithm under complex conditions that included image noise, angular deviation, and vibration. The method was further validated in real-world scenarios using the KITTI public dataset. Experimental results demonstrate that under the condition of satisfying the planar motion assumption, the proposed method achieves significantly improved computational efficiency compared with traditional methods (including general three-view methods, two-view planar motion estimation methods, and classical two-view methods), with the single-solution time reduced by more than 80% compared to general three-view methods. In the public dataset, our algorithm achieves a median rotation estimation error of less than 0.0545 degrees and maintains a translation estimation error of less than 2.1319 degrees. The proposed method exhibits higher computational efficiency and better numerical stability compared to conventional algorithms. This research provides an effective pose estimation solution with real-time performance and high accuracy for planar motion platforms such as autonomous vehicles and indoor mobile robots, demonstrating substantial engineering application value.

]]> Three-View Relative Pose Estimation Under Planar Motion Constraints Ziqin Dai Weimin Lv Liang Liu doi: 10.3390/vision9030072 Vision 2025-08-25 Vision 2025-08-25 9 3 Article 72 10.3390/vision9030072 https://www.mdpi.com/2411-5150/9/3/72 Vision, Vol. 9, Pages 71: Clinical Applications of Artificial Intelligence in Corneal Diseases https://www.mdpi.com/2411-5150/9/3/71 We evaluated the clinical applications of artificial intelligence models in diagnosing corneal diseases, highlighting their performance metrics and clinical potential. A systematic search was conducted for several disease categories: keratoconus (KC), Fuch’s endothelial corneal dystrophy (FECD), infectious keratitis (IK), corneal neuropathy, dry eye disease (DED), and conjunctival diseases. Metrics such as sensitivity, specificity, accuracy, and area under the curve (AUC) were extracted. Across the diseases, convolutional neural networks and other deep learning models frequently achieved or exceeded established diagnostic benchmarks (AUC > 0.90; sensitivity/specificity > 0.85–0.90), with a particularly strong performance for KC and FECD when trained on consistent imaging modalities such as anterior segment optical coherence tomography (AS-OCT). Models for IK and conjunctival diseases showed promise but faced challenges in heterogeneous image quality and limited objective training criteria. DED and tear film models benefited from multimodal data yet lacked direct comparisons with expert clinicians. Despite high diagnostic precision, challenges from heterogeneous data, a lack of standardization in disease definitions, imaging acquisition, and model training remain. The broad implementation of artificial intelligence must address these limitations to improve eye care equity. 2025-08-18 Vision, Vol. 9, Pages 71: Clinical Applications of Artificial Intelligence in Corneal Diseases

Vision doi: 10.3390/vision9030071

Authors: Omar Nusair Hassan Asadigandomani Hossein Farrokhpour Fatemeh Moosaie Zahra Bibak-Bejandi Alireza Razavi Kimia Daneshvar Mohammad Soleimani

We evaluated the clinical applications of artificial intelligence models in diagnosing corneal diseases, highlighting their performance metrics and clinical potential. A systematic search was conducted for several disease categories: keratoconus (KC), Fuch’s endothelial corneal dystrophy (FECD), infectious keratitis (IK), corneal neuropathy, dry eye disease (DED), and conjunctival diseases. Metrics such as sensitivity, specificity, accuracy, and area under the curve (AUC) were extracted. Across the diseases, convolutional neural networks and other deep learning models frequently achieved or exceeded established diagnostic benchmarks (AUC > 0.90; sensitivity/specificity > 0.85–0.90), with a particularly strong performance for KC and FECD when trained on consistent imaging modalities such as anterior segment optical coherence tomography (AS-OCT). Models for IK and conjunctival diseases showed promise but faced challenges in heterogeneous image quality and limited objective training criteria. DED and tear film models benefited from multimodal data yet lacked direct comparisons with expert clinicians. Despite high diagnostic precision, challenges from heterogeneous data, a lack of standardization in disease definitions, imaging acquisition, and model training remain. The broad implementation of artificial intelligence must address these limitations to improve eye care equity.

]]> Clinical Applications of Artificial Intelligence in Corneal Diseases Omar Nusair Hassan Asadigandomani Hossein Farrokhpour Fatemeh Moosaie Zahra Bibak-Bejandi Alireza Razavi Kimia Daneshvar Mohammad Soleimani doi: 10.3390/vision9030071 Vision 2025-08-18 Vision 2025-08-18 9 3 Review 71 10.3390/vision9030071 https://www.mdpi.com/2411-5150/9/3/71 Vision, Vol. 9, Pages 70: Color Vision in Schoolchildren with Low Birth Weight and Those Born Full-Term with Appropriate Weight for Gestational Age https://www.mdpi.com/2411-5150/9/3/70 Purpose: To evaluate color discrimination in schoolchildren with low birth weight (LBW) and those born full-term and at a weight appropriate for gestational age (AGA). Methods: LBW children aged 5–11 years and school-, grade-, sex-, and age-matched full-term (birth weight ≥ 2500 g) AGA controls from 14 randomly selected schools from a low-income region were tested. Examinations included visual acuity, ocular motility, and color vision testing using the Farnsworth D-15 test. Color score and interocular color score difference (ICD) were compared between the groups. Multiple logistic regression was used to analyze associations between color vision deficit and group, adjusting for age, sex, visual acuity, strabismus, and amblyopia. Results: A total of 291 LBW children (age = 8.5 ± 1.3 yrs; 55.7% females) and 265 AGA children (age = 8.5 ± 1.4 yrs; 56.2% females) were examined. Dyschromatopsia was detected in 10.3% of LBW and 7.9% of AGA children, primarily involving tritan and non-specific defects. Color scores were comparable between the groups, and color deficit was significantly associated with younger age and worse visual acuity. The ICD was statistically larger (p = 0.004) in the LBW group, in which the frequencies of strabismus and amblyopia were also higher. Conclusions: Most LBW children demonstrated normal color discrimination, but their interocular color score difference was larger than that of AGA children. 2025-08-12 Vision, Vol. 9, Pages 70: Color Vision in Schoolchildren with Low Birth Weight and Those Born Full-Term with Appropriate Weight for Gestational Age

Vision doi: 10.3390/vision9030070

Authors: Paula Yuri Sacai Maria Cecília Saccomani Lapa Rosana Fiorini Puccini Nívea Nunes Ferraz

Purpose: To evaluate color discrimination in schoolchildren with low birth weight (LBW) and those born full-term and at a weight appropriate for gestational age (AGA). Methods: LBW children aged 5–11 years and school-, grade-, sex-, and age-matched full-term (birth weight ≥ 2500 g) AGA controls from 14 randomly selected schools from a low-income region were tested. Examinations included visual acuity, ocular motility, and color vision testing using the Farnsworth D-15 test. Color score and interocular color score difference (ICD) were compared between the groups. Multiple logistic regression was used to analyze associations between color vision deficit and group, adjusting for age, sex, visual acuity, strabismus, and amblyopia. Results: A total of 291 LBW children (age = 8.5 ± 1.3 yrs; 55.7% females) and 265 AGA children (age = 8.5 ± 1.4 yrs; 56.2% females) were examined. Dyschromatopsia was detected in 10.3% of LBW and 7.9% of AGA children, primarily involving tritan and non-specific defects. Color scores were comparable between the groups, and color deficit was significantly associated with younger age and worse visual acuity. The ICD was statistically larger (p = 0.004) in the LBW group, in which the frequencies of strabismus and amblyopia were also higher. Conclusions: Most LBW children demonstrated normal color discrimination, but their interocular color score difference was larger than that of AGA children.

]]> Color Vision in Schoolchildren with Low Birth Weight and Those Born Full-Term with Appropriate Weight for Gestational Age Paula Yuri Sacai Maria Cecília Saccomani Lapa Rosana Fiorini Puccini Nívea Nunes Ferraz doi: 10.3390/vision9030070 Vision 2025-08-12 Vision 2025-08-12 9 3 Article 70 10.3390/vision9030070 https://www.mdpi.com/2411-5150/9/3/70 Vision, Vol. 9, Pages 69: Form and Temporal Integration in the Perception of Simple Glass Patterns https://www.mdpi.com/2411-5150/9/3/69 This study presents a reanalysis of existing data to clarify how the visual system processes simple dynamic Glass patterns (GPs), with a particular focus on translational configurations. By combining datasets from previous studies, we apply a mixed-effects modeling approach—which offers advantages over the statistical methods used in previous studies—to investigate the contributions of pattern update rate and number of unique frames to perceptual sensitivity. Our findings indicate that the number of unique frames is the most robust predictor of discrimination thresholds, supporting the idea that the visual system integrates global form information across multiple frames—a process consistent with spatiotemporal summation. In contrast, the pattern update rate showed a weaker, though statistically significant, effect. This suggests that faster updates help preserve temporal consistency between frames, facilitating global form extraction. These results align with previous observations on complex dynamic GPs, where discrimination thresholds decrease with more unique frames, suggesting that the summation of form signals across time plays a key role in form–motion perception. By adopting a mixed-effects modeling approach, our reanalysis provides new insights into the mechanisms underlying global form perception in dynamic GPs. 2025-08-04 Vision, Vol. 9, Pages 69: Form and Temporal Integration in the Perception of Simple Glass Patterns

Vision doi: 10.3390/vision9030069

Authors: Rita Donato Michele Vicovaro Massimo Nucci Marco Roccato Gianluca Campana Andrea Pavan

This study presents a reanalysis of existing data to clarify how the visual system processes simple dynamic Glass patterns (GPs), with a particular focus on translational configurations. By combining datasets from previous studies, we apply a mixed-effects modeling approach—which offers advantages over the statistical methods used in previous studies—to investigate the contributions of pattern update rate and number of unique frames to perceptual sensitivity. Our findings indicate that the number of unique frames is the most robust predictor of discrimination thresholds, supporting the idea that the visual system integrates global form information across multiple frames—a process consistent with spatiotemporal summation. In contrast, the pattern update rate showed a weaker, though statistically significant, effect. This suggests that faster updates help preserve temporal consistency between frames, facilitating global form extraction. These results align with previous observations on complex dynamic GPs, where discrimination thresholds decrease with more unique frames, suggesting that the summation of form signals across time plays a key role in form–motion perception. By adopting a mixed-effects modeling approach, our reanalysis provides new insights into the mechanisms underlying global form perception in dynamic GPs.

]]> Form and Temporal Integration in the Perception of Simple Glass Patterns Rita Donato Michele Vicovaro Massimo Nucci Marco Roccato Gianluca Campana Andrea Pavan doi: 10.3390/vision9030069 Vision 2025-08-04 Vision 2025-08-04 9 3 Article 69 10.3390/vision9030069 https://www.mdpi.com/2411-5150/9/3/69 Vision, Vol. 9, Pages 68: Is Combined PhacoAhmed Less Effective than Ahmed Surgery Alone? A 5-Year Retrospective Study of Long-Term Effects https://www.mdpi.com/2411-5150/9/3/68 Combined trabeculectomy–phacoemulsification is known to provoke more inflammation and yield a poorer long-term efficacy than trabeculectomy alone. This study evaluates whether a similar trend exists for Ahmed glaucoma valve implantation when performed with or without concurrent phacoemulsification. We retrospectively analyzed 51 eyes from patients who underwent either Ahmed-Alone (n = 25) or PhacoAhmed (n = 26) surgery over a 5-year period. The primary outcomes included intraocular pressure (IOP), the use of IOP-lowering medications, and the need for further surgical intervention. Absolute success was defined as IOP reduction > 20% and IOP < 21 mmHg without medication; relative success allowed for continued pharmacologic therapy. Both groups showed a significant IOP reduction, with similar final mean IOP values (Ahmed-Alone: 14.02 ± 4.76 mmHg; PhacoAhmed: 13.89 ± 4.17 mmHg; p = 0.99) and comparable reductions in medication use (p = 0.52). Reinterventions occurred less frequently and later in the PhacoAhmed group (12% vs. 27.3%; median time: 27.1 vs. 12 months). Absolute success was not achieved in any PhacoAhmed case but occurred in 9.3% of Ahmed-Alone cases; relative success rates were similar (83.3% vs. 81.4%; p = 0.291). These findings suggest that combining phacoemulsification with Ahmed valve implantation does not significantly alter efficacy or safety profiles. Additional prospective studies are warranted to assess long-term outcomes. 2025-08-04 Vision, Vol. 9, Pages 68: Is Combined PhacoAhmed Less Effective than Ahmed Surgery Alone? A 5-Year Retrospective Study of Long-Term Effects

Vision doi: 10.3390/vision9030068

Authors: Maria Vivas José Charréu Bruno Pombo Tomás Costa Ana Sofia Lopes Fernando Trancoso Vaz Maria João Santos Isabel Prieto

Combined trabeculectomy–phacoemulsification is known to provoke more inflammation and yield a poorer long-term efficacy than trabeculectomy alone. This study evaluates whether a similar trend exists for Ahmed glaucoma valve implantation when performed with or without concurrent phacoemulsification. We retrospectively analyzed 51 eyes from patients who underwent either Ahmed-Alone (n = 25) or PhacoAhmed (n = 26) surgery over a 5-year period. The primary outcomes included intraocular pressure (IOP), the use of IOP-lowering medications, and the need for further surgical intervention. Absolute success was defined as IOP reduction > 20% and IOP < 21 mmHg without medication; relative success allowed for continued pharmacologic therapy. Both groups showed a significant IOP reduction, with similar final mean IOP values (Ahmed-Alone: 14.02 ± 4.76 mmHg; PhacoAhmed: 13.89 ± 4.17 mmHg; p = 0.99) and comparable reductions in medication use (p = 0.52). Reinterventions occurred less frequently and later in the PhacoAhmed group (12% vs. 27.3%; median time: 27.1 vs. 12 months). Absolute success was not achieved in any PhacoAhmed case but occurred in 9.3% of Ahmed-Alone cases; relative success rates were similar (83.3% vs. 81.4%; p = 0.291). These findings suggest that combining phacoemulsification with Ahmed valve implantation does not significantly alter efficacy or safety profiles. Additional prospective studies are warranted to assess long-term outcomes.

]]> Is Combined PhacoAhmed Less Effective than Ahmed Surgery Alone? A 5-Year Retrospective Study of Long-Term Effects Maria Vivas José Charréu Bruno Pombo Tomás Costa Ana Sofia Lopes Fernando Trancoso Vaz Maria João Santos Isabel Prieto doi: 10.3390/vision9030068 Vision 2025-08-04 Vision 2025-08-04 9 3 Article 68 10.3390/vision9030068 https://www.mdpi.com/2411-5150/9/3/68 Vision, Vol. 9, Pages 65: CPAP Use and Retinal Disease Risk in Obstructive Apnea: A Cohort Study https://www.mdpi.com/2411-5150/9/3/65 Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) therapy reduces retinal disease incidence among adults with OSA and BMI between 25.0 and 30.0 kg/m2. After 1:1 propensity score matching, 101,754 patients were included in the analysis. Retinal outcomes included diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vein occlusion (RVO), and central serous chorioretinopathy (CSC). CPAP use was associated with a modest but statistically significant reduction in DR (3.2% vs. 3.4%, RR: 0.922, p = 0.016) and AMD (2.1% vs. 2.3%, RR: 0.906, p = 0.018), while no significant differences were found for RVO or CSC. These findings support prior evidence linking CPAP to improved retinal microvascular health and suggest a protective effect against specific retinal complications. Limitations include a lack of data on CPAP adherence, OSA severity, and imaging confirmation. Still, this study highlights the importance of interdisciplinary care between sleep and eye health, and the need for further prospective studies to validate CPAP’s role in preventing retinal disease progression in OSA patients. 2025-08-01 Vision, Vol. 9, Pages 65: CPAP Use and Retinal Disease Risk in Obstructive Apnea: A Cohort Study

Vision doi: 10.3390/vision9030065

Authors: Dillan Cunha Amaral Pedro Lucas Machado Magalhães Muhammad Alfatih Bruna Gabriel Miranda Hashem Abu Serhan Raíza Jacometti Bruno Fortaleza de Aquino Ferreira Letícia Sant’Ana Diogo Haddad Santos Mário Luiz Ribeiro Monteiro Ricardo Noguera Louzada

Obstructive sleep apnea (OSA) is a common condition associated with intermittent hypoxia, systemic inflammation, and vascular dysfunction; mechanisms implicated in retinal disease pathogenesis. This real-world retrospective cohort study used data from the TriNetX Research Network to assess whether continuous positive airway pressure (CPAP) therapy reduces retinal disease incidence among adults with OSA and BMI between 25.0 and 30.0 kg/m2. After 1:1 propensity score matching, 101,754 patients were included in the analysis. Retinal outcomes included diabetic retinopathy (DR), age-related macular degeneration (AMD), retinal vein occlusion (RVO), and central serous chorioretinopathy (CSC). CPAP use was associated with a modest but statistically significant reduction in DR (3.2% vs. 3.4%, RR: 0.922, p = 0.016) and AMD (2.1% vs. 2.3%, RR: 0.906, p = 0.018), while no significant differences were found for RVO or CSC. These findings support prior evidence linking CPAP to improved retinal microvascular health and suggest a protective effect against specific retinal complications. Limitations include a lack of data on CPAP adherence, OSA severity, and imaging confirmation. Still, this study highlights the importance of interdisciplinary care between sleep and eye health, and the need for further prospective studies to validate CPAP’s role in preventing retinal disease progression in OSA patients.

]]> CPAP Use and Retinal Disease Risk in Obstructive Apnea: A Cohort Study Dillan Cunha Amaral Pedro Lucas Machado Magalhães Muhammad Alfatih Bruna Gabriel Miranda Hashem Abu Serhan Raíza Jacometti Bruno Fortaleza de Aquino Ferreira Letícia Sant’Ana Diogo Haddad Santos Mário Luiz Ribeiro Monteiro Ricardo Noguera Louzada doi: 10.3390/vision9030065 Vision 2025-08-01 Vision 2025-08-01 9 3 Article 65 10.3390/vision9030065 https://www.mdpi.com/2411-5150/9/3/65 Vision, Vol. 9, Pages 67: Contrast Sensitivity Comparison of Daily Simultaneous-Vision Center-Near Multifocal Contact Lenses: A Pilot Study https://www.mdpi.com/2411-5150/9/3/67 Our purpose is to evaluate the binocular contrast sensitivity function (CSF) in a presbyopic population and compare the results obtained with four different simultaneous-vision center-near multifocal contact lens (MCL) designs for distance vision under two illumination conditions. Additionally, chromatic CSF (red-green and blue-yellow) was evaluated. A randomized crossover pilot study was conducted. Four daily disposable lens designs, based on simultaneous-vision and center-near correction, were compared. The achromatic contrast sensitivity function (CSF) was measured binocularly using the CSV1000e test under two lighting conditions: room light on and off. Chromatic CSF was measured using the OptoPad-CSF test. Comparison of achromatic results with room lighting showed a statistically significant difference only for 3 cpd (p = 0.03) between the baseline visit (with spectacles) and all MCLs. Comparison of achromatic results without room lighting showed no statistically significant differences between the baseline and all MCLs for any spatial frequency (p > 0.05 in all cases). Comparison of CSF-T results showed a statistically significant difference only for 4 cpd (p = 0.002). Comparison of CSF-D results showed no statistically significant difference for all frequencies (p > 0.05 in all cases). The MCL designs analyzed provided satisfactory achromatic contrast sensitivity results for distance vision, similar to those obtained with spectacles, with no remarkable differences between designs. Chromatic contrast sensitivity for the red-green and blue-yellow mechanisms revealed some differences from the baseline that should be further investigated in future studies. 2025-08-01 Vision, Vol. 9, Pages 67: Contrast Sensitivity Comparison of Daily Simultaneous-Vision Center-Near Multifocal Contact Lenses: A Pilot Study

Vision doi: 10.3390/vision9030067

Authors: David P. Piñero Ainhoa Molina-Martín Elena Martínez-Plaza Kevin J. Mena-Guevara Violeta Gómez-Vicente Dolores de Fez

Our purpose is to evaluate the binocular contrast sensitivity function (CSF) in a presbyopic population and compare the results obtained with four different simultaneous-vision center-near multifocal contact lens (MCL) designs for distance vision under two illumination conditions. Additionally, chromatic CSF (red-green and blue-yellow) was evaluated. A randomized crossover pilot study was conducted. Four daily disposable lens designs, based on simultaneous-vision and center-near correction, were compared. The achromatic contrast sensitivity function (CSF) was measured binocularly using the CSV1000e test under two lighting conditions: room light on and off. Chromatic CSF was measured using the OptoPad-CSF test. Comparison of achromatic results with room lighting showed a statistically significant difference only for 3 cpd (p = 0.03) between the baseline visit (with spectacles) and all MCLs. Comparison of achromatic results without room lighting showed no statistically significant differences between the baseline and all MCLs for any spatial frequency (p > 0.05 in all cases). Comparison of CSF-T results showed a statistically significant difference only for 4 cpd (p = 0.002). Comparison of CSF-D results showed no statistically significant difference for all frequencies (p > 0.05 in all cases). The MCL designs analyzed provided satisfactory achromatic contrast sensitivity results for distance vision, similar to those obtained with spectacles, with no remarkable differences between designs. Chromatic contrast sensitivity for the red-green and blue-yellow mechanisms revealed some differences from the baseline that should be further investigated in future studies.

]]> Contrast Sensitivity Comparison of Daily Simultaneous-Vision Center-Near Multifocal Contact Lenses: A Pilot Study David P. Piñero Ainhoa Molina-Martín Elena Martínez-Plaza Kevin J. Mena-Guevara Violeta Gómez-Vicente Dolores de Fez doi: 10.3390/vision9030067 Vision 2025-08-01 Vision 2025-08-01 9 3 Article 67 10.3390/vision9030067 https://www.mdpi.com/2411-5150/9/3/67 Vision, Vol. 9, Pages 66: Behavioral Interference by Emotional Stimuli: Sequential Modulation by Perceptual Conditions but Not by Emotional Primes https://www.mdpi.com/2411-5150/9/3/66 Previous studies observed that emotional scenes, presented as distractors, capture attention and interfere with an ongoing task. This behavioral interference has been shown to be elicited by the semantic rather than by the perceptual properties of a scene, as it resisted the application of low-pass spatial frequency filters. Some studies observed that the visual system can adapt to perceptual conditions; however, little is known concerning whether attentional capture by emotional stimuli can also be modulated by the sequential repetition of viewing conditions or of emotional content. In the present study, we asked participants to perform a parity task while viewing irrelevant natural scenes, which could be either emotional or neutral. These scenes could be either blurred (low-pass filter) or perceptually intact, and the order of presentation was balanced to study the effects of sequential repetition of perceptual conditions. The results indicate that affective modulation was most pronounced when the same viewing condition (either intact or blurred) was repeated, with faster responses when perceptual conditions were repeated for neutral distractors, but to a lesser extent for emotional ones. These data suggest that emotional interference in an attentional task can be modulated by serial sensitization in the processing of spatial frequencies. 2025-08-01 Vision, Vol. 9, Pages 66: Behavioral Interference by Emotional Stimuli: Sequential Modulation by Perceptual Conditions but Not by Emotional Primes

Vision doi: 10.3390/vision9030066

Authors: Andrea De Cesarei Virginia Tronelli Serena Mastria Vera Ferrari Maurizio Codispoti

Previous studies observed that emotional scenes, presented as distractors, capture attention and interfere with an ongoing task. This behavioral interference has been shown to be elicited by the semantic rather than by the perceptual properties of a scene, as it resisted the application of low-pass spatial frequency filters. Some studies observed that the visual system can adapt to perceptual conditions; however, little is known concerning whether attentional capture by emotional stimuli can also be modulated by the sequential repetition of viewing conditions or of emotional content. In the present study, we asked participants to perform a parity task while viewing irrelevant natural scenes, which could be either emotional or neutral. These scenes could be either blurred (low-pass filter) or perceptually intact, and the order of presentation was balanced to study the effects of sequential repetition of perceptual conditions. The results indicate that affective modulation was most pronounced when the same viewing condition (either intact or blurred) was repeated, with faster responses when perceptual conditions were repeated for neutral distractors, but to a lesser extent for emotional ones. These data suggest that emotional interference in an attentional task can be modulated by serial sensitization in the processing of spatial frequencies.

]]> Behavioral Interference by Emotional Stimuli: Sequential Modulation by Perceptual Conditions but Not by Emotional Primes Andrea De Cesarei Virginia Tronelli Serena Mastria Vera Ferrari Maurizio Codispoti doi: 10.3390/vision9030066 Vision 2025-08-01 Vision 2025-08-01 9 3 Article 66 10.3390/vision9030066 https://www.mdpi.com/2411-5150/9/3/66 Vision, Vol. 9, Pages 64: The Retinal Complications of C3 Dense Deposit Disease: A Scoping Review https://www.mdpi.com/2411-5150/9/3/64 People with C3 Dense Deposit Disease (C3DDD), a rare autoimmune disease, often also have ocular complications. Due to the rarity of this disease, there is little known about ocular complications in populations across the world. This paper aimed to assess literature on retinal complications in people with C3 Dense Deposit Disease. A scoping review was conducted and three databases (Embase, Medline All, and Web of Science) were searched using agreed search terms and Boolean operators. All references were imported into Covidence for screening by two reviewers. Any conflicts were resolved by a third reviewer. Data were extracted into an Excel spreadsheet and analysis was conducted using SPSS Version 29. After full text screening, 38 studies were included in the review. These studies were from 1990–2023 and most (67%) being case reports. All studies were conducted in the United States (55%) or Europe (45%). Most studies reported drusen-like deposits in the retina (75%) and retinal pigment epithelial detachment (18%) and macular atrophy (11%). Choroidal Neovascularisation (CNV) was found in 16% of cases. People with C3 Dense Deposit Disease are at risk of ocular complications, primarily drusen-like deposits. Further population-based research and progression is needed. 2025-08-01 Vision, Vol. 9, Pages 64: The Retinal Complications of C3 Dense Deposit Disease: A Scoping Review

Vision doi: 10.3390/vision9030064

Authors: Jolene McCarney Katie Curran Tunde Peto Giuliana Silvestri Laura N. Cushley

People with C3 Dense Deposit Disease (C3DDD), a rare autoimmune disease, often also have ocular complications. Due to the rarity of this disease, there is little known about ocular complications in populations across the world. This paper aimed to assess literature on retinal complications in people with C3 Dense Deposit Disease. A scoping review was conducted and three databases (Embase, Medline All, and Web of Science) were searched using agreed search terms and Boolean operators. All references were imported into Covidence for screening by two reviewers. Any conflicts were resolved by a third reviewer. Data were extracted into an Excel spreadsheet and analysis was conducted using SPSS Version 29. After full text screening, 38 studies were included in the review. These studies were from 1990–2023 and most (67%) being case reports. All studies were conducted in the United States (55%) or Europe (45%). Most studies reported drusen-like deposits in the retina (75%) and retinal pigment epithelial detachment (18%) and macular atrophy (11%). Choroidal Neovascularisation (CNV) was found in 16% of cases. People with C3 Dense Deposit Disease are at risk of ocular complications, primarily drusen-like deposits. Further population-based research and progression is needed.

]]> The Retinal Complications of C3 Dense Deposit Disease: A Scoping Review Jolene McCarney Katie Curran Tunde Peto Giuliana Silvestri Laura N. Cushley doi: 10.3390/vision9030064 Vision 2025-08-01 Vision 2025-08-01 9 3 Review 64 10.3390/vision9030064 https://www.mdpi.com/2411-5150/9/3/64 Vision, Vol. 9, Pages 63: Case Series: Reactivation of Herpetic Keratitis After COVID-19 mRNA Vaccination During Herpetic Prophylaxis https://www.mdpi.com/2411-5150/9/3/63 This report presents two cases of herpes simplex keratitis recurrence after COVID-19 mRNA vaccination in patients on herpetic prophylaxis due to recurrent herpetic keratitis. A 58-year-old man with a history of a previous penetrating keratoplasty presented with blurred vision and evidence of corneal endothelitis 48 h after the first dose of the m-RNA vaccination, and a 24-year-old male student came with a dendritic ulcer 72 h post first vaccination dose. The original prophylactic treatment of 400 mg of acyclovir twice daily was increased to five times per day for a week for both patients. The grafted patient additionally received an increase in Dexamethasone 0.1% from twice daily to four times a day. Improvement was noted within two days and documented at the weekly review, during which both patients returned to their prophylactic antiviral regime without further recurrence. At the time of their second dose of vaccination, both patients followed the same regime with an increase in treatment as per the first dose of vaccination without recurrence. Our findings suggest that patients with recurrent herpetic disease receiving prophylactic treatment need close monitoring when experiencing even subtle symptoms of recurrence and may benefit from an increase in their dose to therapeutic levels during the first days after the COVID-19 mRNA vaccination. 2025-07-28 Vision, Vol. 9, Pages 63: Case Series: Reactivation of Herpetic Keratitis After COVID-19 mRNA Vaccination During Herpetic Prophylaxis

Vision doi: 10.3390/vision9030063

Authors: Michael Tsatsos Efthymia Prousali Athanasios Karamitsos Nikolaos Ziakas

This report presents two cases of herpes simplex keratitis recurrence after COVID-19 mRNA vaccination in patients on herpetic prophylaxis due to recurrent herpetic keratitis. A 58-year-old man with a history of a previous penetrating keratoplasty presented with blurred vision and evidence of corneal endothelitis 48 h after the first dose of the m-RNA vaccination, and a 24-year-old male student came with a dendritic ulcer 72 h post first vaccination dose. The original prophylactic treatment of 400 mg of acyclovir twice daily was increased to five times per day for a week for both patients. The grafted patient additionally received an increase in Dexamethasone 0.1% from twice daily to four times a day. Improvement was noted within two days and documented at the weekly review, during which both patients returned to their prophylactic antiviral regime without further recurrence. At the time of their second dose of vaccination, both patients followed the same regime with an increase in treatment as per the first dose of vaccination without recurrence. Our findings suggest that patients with recurrent herpetic disease receiving prophylactic treatment need close monitoring when experiencing even subtle symptoms of recurrence and may benefit from an increase in their dose to therapeutic levels during the first days after the COVID-19 mRNA vaccination.

]]> Case Series: Reactivation of Herpetic Keratitis After COVID-19 mRNA Vaccination During Herpetic Prophylaxis Michael Tsatsos Efthymia Prousali Athanasios Karamitsos Nikolaos Ziakas doi: 10.3390/vision9030063 Vision 2025-07-28 Vision 2025-07-28 9 3 Perspective 63 10.3390/vision9030063 https://www.mdpi.com/2411-5150/9/3/63 Vision, Vol. 9, Pages 62: Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome https://www.mdpi.com/2411-5150/9/3/62 Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive syndrome caused by loss-of-function mutations in the Neurotrophic Tyrosine Kinase Receptor 1 gene, characterized by recurrent episodes of infections and unexplained fever, anhidrosis, absence of reactions to noxious stimuli, intellectual disability, self-mutilating behaviors, and damage to many body organs, including the eyes. Main text: We systematically searched the Medline/PubMed, Scopus, and Web of Science databases from their inception until March 2025 for papers describing the clinical manifestations of patients with CIPA. The inclusion criterion was papers reporting ocular manifestations of patients diagnosed with CIPA. We excluded non-English papers or those reporting ocular manifestations of patients diagnosed with syndromes other than CIPA. Also, we excluded review articles, clinical trials, gray literature, or any paper that did not report ocular manifestations of patients with CIPA or that reported patients with previous ocular surgeries. Out of 6243 studies, 28 were included in the final analysis, comprising 118 patients. The mean age was 7.37 years, and males represented 63.5% (n = 75). Of the patients, fifty-six had bilateral ocular manifestations. The most common ocular manifestations were the absence of corneal reflex in 56 patients (47.5%, bilateral in 56), whereas corneal ulcerations were the second most common manifestation in 46 patients (38.98%, bilateral in 8), followed by corneal opacity in 32 patients (27.11%, bilateral in 19). Topical lubricants, topical antibiotics, and lateral tarsorrhaphy were common management modalities for these patients. Absent corneal sensitivity, corneal ulcers, and corneal opacities, among other manifestations, are common ocular presentations in patients with CIPA. Conclusions: Self-mutilation, intellectual disability, decreased lacrimation, and absence of the corneal reflex are factors that may explain the development of these manifestations in CIPA. The early detection of these manifestations can improve patient conditions and prevent further complications, in addition to helping to guide the clinical diagnosis of CIPA in these patients. 2025-07-21 Vision, Vol. 9, Pages 62: Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome

Vision doi: 10.3390/vision9030062

Authors: Mohammed Baker Kenda Abedal-Kareem Sadeen Eid Mahmoud Alkhawaldeh Yahya Albashaireh Jihan Joulani Sara Bani Amer Ethar Hazaimeh Omar F. Jbarah Abdelwahab Aleshawi Rami Al-Dwairi

Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive syndrome caused by loss-of-function mutations in the Neurotrophic Tyrosine Kinase Receptor 1 gene, characterized by recurrent episodes of infections and unexplained fever, anhidrosis, absence of reactions to noxious stimuli, intellectual disability, self-mutilating behaviors, and damage to many body organs, including the eyes. Main text: We systematically searched the Medline/PubMed, Scopus, and Web of Science databases from their inception until March 2025 for papers describing the clinical manifestations of patients with CIPA. The inclusion criterion was papers reporting ocular manifestations of patients diagnosed with CIPA. We excluded non-English papers or those reporting ocular manifestations of patients diagnosed with syndromes other than CIPA. Also, we excluded review articles, clinical trials, gray literature, or any paper that did not report ocular manifestations of patients with CIPA or that reported patients with previous ocular surgeries. Out of 6243 studies, 28 were included in the final analysis, comprising 118 patients. The mean age was 7.37 years, and males represented 63.5% (n = 75). Of the patients, fifty-six had bilateral ocular manifestations. The most common ocular manifestations were the absence of corneal reflex in 56 patients (47.5%, bilateral in 56), whereas corneal ulcerations were the second most common manifestation in 46 patients (38.98%, bilateral in 8), followed by corneal opacity in 32 patients (27.11%, bilateral in 19). Topical lubricants, topical antibiotics, and lateral tarsorrhaphy were common management modalities for these patients. Absent corneal sensitivity, corneal ulcers, and corneal opacities, among other manifestations, are common ocular presentations in patients with CIPA. Conclusions: Self-mutilation, intellectual disability, decreased lacrimation, and absence of the corneal reflex are factors that may explain the development of these manifestations in CIPA. The early detection of these manifestations can improve patient conditions and prevent further complications, in addition to helping to guide the clinical diagnosis of CIPA in these patients.

]]> Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome Mohammed Baker Kenda Abedal-Kareem Sadeen Eid Mahmoud Alkhawaldeh Yahya Albashaireh Jihan Joulani Sara Bani Amer Ethar Hazaimeh Omar F. Jbarah Abdelwahab Aleshawi Rami Al-Dwairi doi: 10.3390/vision9030062 Vision 2025-07-21 Vision 2025-07-21 9 3 Systematic Review 62 10.3390/vision9030062 https://www.mdpi.com/2411-5150/9/3/62 Vision, Vol. 9, Pages 61: Third-Generation Trabecular Micro-Bypass Implantation and Phacoemulsification in Patients with Glaucoma: A Multicenter Study https://www.mdpi.com/2411-5150/9/3/61 This multicenter study evaluated the effectiveness and safety of third-generation trabecular micro-bypass implantation (iStent® infinite) combined with phacoemulsification (n = 233 eyes). Key outcomes through 12 months included the mean change in intraocular pressure (IOP) and the number of topical medications, as well as proportions achieving IOPs ≤ 18/15/12 mmHg or using 0/1/2/ ≥ 3 medications. In all eyes with 12-month follow-up data (n = 96, consistent cohort), the mean IOP reduced from 17.2 ± 4.2 mmHg preoperatively to 13.8 ± 3.0 mmHg at Month 12 (p = 0.001), while the mean number of medications reduced from 1.24 ± 0.91 preoperatively to 0.61 ± 0.96 at Month 12 (p = 0.001). The proportions of eyes achieving IOP ≤ 18/15/12 mmHg increased from 63.5%, 34.4%, and 14.6% preoperatively to 92.7%, 71.9%, and 37.5%, respectively at Month 12, (all p = 0.001). The proportions of eyes off medication increased from 16.7% preoperatively to 62.5% at Month 12 (p = 0.001). This study provides clinically relevant, real-world results that demonstrate significant reductions in IOP and the number of topical glaucoma medications required following iStent infinite trabecular micro-bypass and phacoemulsification. 2025-07-19 Vision, Vol. 9, Pages 61: Third-Generation Trabecular Micro-Bypass Implantation and Phacoemulsification in Patients with Glaucoma: A Multicenter Study

Vision doi: 10.3390/vision9030061

Authors: Mitchell Shultz Zachary M. Vest Valerie Trubnik Steven R. Sarkisian Dana M. Hornbeak

This multicenter study evaluated the effectiveness and safety of third-generation trabecular micro-bypass implantation (iStent® infinite) combined with phacoemulsification (n = 233 eyes). Key outcomes through 12 months included the mean change in intraocular pressure (IOP) and the number of topical medications, as well as proportions achieving IOPs ≤ 18/15/12 mmHg or using 0/1/2/ ≥ 3 medications. In all eyes with 12-month follow-up data (n = 96, consistent cohort), the mean IOP reduced from 17.2 ± 4.2 mmHg preoperatively to 13.8 ± 3.0 mmHg at Month 12 (p = 0.001), while the mean number of medications reduced from 1.24 ± 0.91 preoperatively to 0.61 ± 0.96 at Month 12 (p = 0.001). The proportions of eyes achieving IOP ≤ 18/15/12 mmHg increased from 63.5%, 34.4%, and 14.6% preoperatively to 92.7%, 71.9%, and 37.5%, respectively at Month 12, (all p = 0.001). The proportions of eyes off medication increased from 16.7% preoperatively to 62.5% at Month 12 (p = 0.001). This study provides clinically relevant, real-world results that demonstrate significant reductions in IOP and the number of topical glaucoma medications required following iStent infinite trabecular micro-bypass and phacoemulsification.

]]> Third-Generation Trabecular Micro-Bypass Implantation and Phacoemulsification in Patients with Glaucoma: A Multicenter Study Mitchell Shultz Zachary M. Vest Valerie Trubnik Steven R. Sarkisian Dana M. Hornbeak doi: 10.3390/vision9030061 Vision 2025-07-19 Vision 2025-07-19 9 3 Article 61 10.3390/vision9030061 https://www.mdpi.com/2411-5150/9/3/61 Vision, Vol. 9, Pages 60: Efficacy of Small Incision Cataract Surgery: A Multicenter Retrospective Study of Visual Outcomes in Coastal Ecuador https://www.mdpi.com/2411-5150/9/3/60 Cataracts remain one of the leading causes of reversible blindness in low- and middle-income countries such as Ecuador. This study assessed the efficacy of Small Incision Cataract Surgery (SICS) and analyzed sociodemographic and clinical factors associated with postoperative visual outcomes. A retrospective multicenter analysis was conducted across six ophthalmology clinics along the Ecuadorian coast between 2023 and 2024, including 558 patients aged 30 years or older. Postoperative visual acuity, measured using the LogMAR scale, improved significantly (mean improvement of 0.525 LogMAR units in the right eye (OD) and 0.489 LogMAR units in the left eye; p < 0.001). Ages between 60 and 69 years were associated with better outcomes in the right eye, while male sex was a protective factor against poor visual acuity in the left eye. Although diabetes mellitus and hypertension were prevalent, neither condition showed a significant association with postoperative visual outcomes. The findings confirm that SICS is a safe, effective, and cost-efficient surgical approach for restoring vision in resource-limited settings, supporting its inclusion in national public health strategies to reduce avoidable blindness in developing countries. 2025-07-15 Vision, Vol. 9, Pages 60: Efficacy of Small Incision Cataract Surgery: A Multicenter Retrospective Study of Visual Outcomes in Coastal Ecuador

Vision doi: 10.3390/vision9030060

Authors: Roberto Ernesto Alcívar-Viteri Verónica Dolores Moreira-Pico Carlos Iván Gómez-Cedeño Julia Patricia Duran-Ospina Aline Siteneski Karime Montes-Escobar

Cataracts remain one of the leading causes of reversible blindness in low- and middle-income countries such as Ecuador. This study assessed the efficacy of Small Incision Cataract Surgery (SICS) and analyzed sociodemographic and clinical factors associated with postoperative visual outcomes. A retrospective multicenter analysis was conducted across six ophthalmology clinics along the Ecuadorian coast between 2023 and 2024, including 558 patients aged 30 years or older. Postoperative visual acuity, measured using the LogMAR scale, improved significantly (mean improvement of 0.525 LogMAR units in the right eye (OD) and 0.489 LogMAR units in the left eye; p < 0.001). Ages between 60 and 69 years were associated with better outcomes in the right eye, while male sex was a protective factor against poor visual acuity in the left eye. Although diabetes mellitus and hypertension were prevalent, neither condition showed a significant association with postoperative visual outcomes. The findings confirm that SICS is a safe, effective, and cost-efficient surgical approach for restoring vision in resource-limited settings, supporting its inclusion in national public health strategies to reduce avoidable blindness in developing countries.

]]> Efficacy of Small Incision Cataract Surgery: A Multicenter Retrospective Study of Visual Outcomes in Coastal Ecuador Roberto Ernesto Alcívar-Viteri Verónica Dolores Moreira-Pico Carlos Iván Gómez-Cedeño Julia Patricia Duran-Ospina Aline Siteneski Karime Montes-Escobar doi: 10.3390/vision9030060 Vision 2025-07-15 Vision 2025-07-15 9 3 Article 60 10.3390/vision9030060 https://www.mdpi.com/2411-5150/9/3/60 Vision, Vol. 9, Pages 59: Introduction to Special Issue: Visual Mental Imagery System: How We Image the World https://www.mdpi.com/2411-5150/9/3/59 The aim of this Special Issue is to provide new perspectives on the role of visual mental imagery in how we image the world, past, present and future [...] 2025-07-14 Vision, Vol. 9, Pages 59: Introduction to Special Issue: Visual Mental Imagery System: How We Image the World

Vision doi: 10.3390/vision9030059

Authors: David F. Marks

The aim of this Special Issue is to provide new perspectives on the role of visual mental imagery in how we image the world, past, present and future [...]

]]> Introduction to Special Issue: Visual Mental Imagery System: How We Image the World David F. Marks doi: 10.3390/vision9030059 Vision 2025-07-14 Vision 2025-07-14 9 3 Editorial 59 10.3390/vision9030059 https://www.mdpi.com/2411-5150/9/3/59 Vision, Vol. 9, Pages 58: Impact of Preoperative Conjunctival Vascular Area on Surgical Outcomes in Trabeculectomy with Mitomycin C for Glaucoma: A Comprehensive Analysis https://www.mdpi.com/2411-5150/9/3/58 Trabeculectomy with mitomycin C is a key surgical intervention for managing glaucoma when conservative treatments fail. The success of trabeculectomy is influenced by various factors, including preoperative ocular characteristics like conjunctival vascularity. This study aims to explore the relationship between the preoperative conjunctival vascular area and post-trabeculectomy outcomes in glaucoma patients. By analyzing the conjunctival vascular density, intraocular pressure (IOP), bleb morphology, laser suture lysis (LSL) frequency, and postoperative eye drops, this research sheds light on the impact of preoperative vascularity on surgical success. Results show that lower preoperative conjunctival vessel density is associated with favorable outcomes, such as better bleb formation and reduced need for postoperative interventions, while higher conjunctival vessel density correlates with complications like hyphema. These findings emphasize the importance of assessing preoperative conjunctival vascularity to optimize trabeculectomy outcomes and personalize treatment strategies for glaucoma patients. 2025-07-14 Vision, Vol. 9, Pages 58: Impact of Preoperative Conjunctival Vascular Area on Surgical Outcomes in Trabeculectomy with Mitomycin C for Glaucoma: A Comprehensive Analysis

Vision doi: 10.3390/vision9030058

Authors: Yasunari Hayakawa Takayuki Inada

Trabeculectomy with mitomycin C is a key surgical intervention for managing glaucoma when conservative treatments fail. The success of trabeculectomy is influenced by various factors, including preoperative ocular characteristics like conjunctival vascularity. This study aims to explore the relationship between the preoperative conjunctival vascular area and post-trabeculectomy outcomes in glaucoma patients. By analyzing the conjunctival vascular density, intraocular pressure (IOP), bleb morphology, laser suture lysis (LSL) frequency, and postoperative eye drops, this research sheds light on the impact of preoperative vascularity on surgical success. Results show that lower preoperative conjunctival vessel density is associated with favorable outcomes, such as better bleb formation and reduced need for postoperative interventions, while higher conjunctival vessel density correlates with complications like hyphema. These findings emphasize the importance of assessing preoperative conjunctival vascularity to optimize trabeculectomy outcomes and personalize treatment strategies for glaucoma patients.

]]> Impact of Preoperative Conjunctival Vascular Area on Surgical Outcomes in Trabeculectomy with Mitomycin C for Glaucoma: A Comprehensive Analysis Yasunari Hayakawa Takayuki Inada doi: 10.3390/vision9030058 Vision 2025-07-14 Vision 2025-07-14 9 3 Article 58 10.3390/vision9030058 https://www.mdpi.com/2411-5150/9/3/58 Vision, Vol. 9, Pages 57: The Impact of Preoperative Corneal Epithelial Refraction Toricity on Transepithelial Photorefractive Keratectomy for the Treatment of Hyperopia or Mixed Astigmatism https://www.mdpi.com/2411-5150/9/3/57 This study analyzed the impact of corneal epithelial refraction on the correction of hyperopic and mixed astigmatism eyes treated with transepithelial photorefractive keratectomy. From the epithelial refraction provided by the diagnostic device, OCT correlations were evaluated with respect to manifest refraction. The postoperative outcomes showed a mean sphere of −0.03 D and a mean cylinder of −0.33 D, with 93% and 98% having 0.5 D, 1 D, or less spherical equivalent refractive error. The epithelium showed preoperative toricity: at 6 mm, the epithelium showed a compensational effect of ~15% for the refractive astigmatism, whereas at 3 mm, the compensation accounted for ~25% of the refractive astigmatism. No correlation was found between preoperative epithelial refraction and refractive deviation after hyperopic or mixed astigmatic transepithelial photorefractive treatment. This work provides insight into the refractive compensatory impact of the epithelium, suggests how one can benefit from that in transepithelial corrections, and sets a framework for the potential induction of errors in non-transepithelial corrections. 2025-07-11 Vision, Vol. 9, Pages 57: The Impact of Preoperative Corneal Epithelial Refraction Toricity on Transepithelial Photorefractive Keratectomy for the Treatment of Hyperopia or Mixed Astigmatism

Vision doi: 10.3390/vision9030057

Authors: Diego de Ortueta Samuel Arba-Mosquera

This study analyzed the impact of corneal epithelial refraction on the correction of hyperopic and mixed astigmatism eyes treated with transepithelial photorefractive keratectomy. From the epithelial refraction provided by the diagnostic device, OCT correlations were evaluated with respect to manifest refraction. The postoperative outcomes showed a mean sphere of −0.03 D and a mean cylinder of −0.33 D, with 93% and 98% having 0.5 D, 1 D, or less spherical equivalent refractive error. The epithelium showed preoperative toricity: at 6 mm, the epithelium showed a compensational effect of ~15% for the refractive astigmatism, whereas at 3 mm, the compensation accounted for ~25% of the refractive astigmatism. No correlation was found between preoperative epithelial refraction and refractive deviation after hyperopic or mixed astigmatic transepithelial photorefractive treatment. This work provides insight into the refractive compensatory impact of the epithelium, suggests how one can benefit from that in transepithelial corrections, and sets a framework for the potential induction of errors in non-transepithelial corrections.

]]> The Impact of Preoperative Corneal Epithelial Refraction Toricity on Transepithelial Photorefractive Keratectomy for the Treatment of Hyperopia or Mixed Astigmatism Diego de Ortueta Samuel Arba-Mosquera doi: 10.3390/vision9030057 Vision 2025-07-11 Vision 2025-07-11 9 3 Article 57 10.3390/vision9030057 https://www.mdpi.com/2411-5150/9/3/57 Vision, Vol. 9, Pages 56: Novel Surgical Approach for Limbal Dermoid Excision: Utilizing Bowman’s Membrane Lenticule and Autologous Limbal Stem Cell Transplantation for Enhanced Epithelial Healing and Visual Outcomes https://www.mdpi.com/2411-5150/9/3/56 Limbal dermoids are congenital, benign, choristomatous growths affecting the corneal-limbal junction. Conventional excision techniques often result in persistent epithelial defects, corneal thinning, and vascularization due to sectoral limbal stem cell deficiency. This study investigated a novel surgical approach for limbal dermoid excision, utilizing Bowman’s membrane lenticule and autologous limbal stem cell transplantation, aimed at improving epithelial healing and visual outcomes. Thirty-four subjects (24 females, 10 males; mean age 8.33 ± 6.47 years) with limbal dermoids underwent the procedure. After dermoid excision, a Bowman’s membrane lenticule was placed over the defect and tucked 1 mm beneath the surrounding tissue. Sectoral limbal reconstruction was then performed using the AutoSLET technique. Pre- and postoperative assessments included visual acuity, corneal thickness, and epithelialization time. Statistical analysis employed paired t-tests. The mean epithelialization time was 3.36 ± 0.74 weeks, indicating rapid healing. Best-corrected visual acuity (BCVA) significantly improved from a preoperative mean of 0.136 ± 0.121 decimal units to a postoperative mean of 0.336 ± 0.214 decimal units (p < 0.001). Corneal thickness also demonstrated a significant increase, rising from a preoperative mean of 294 ± 49.68 microns to a postoperative mean of 484 ± 5.037 microns (p < 0.001). There is a transient edema below the Bowman lenticule observed in many cases, which resolves with deposition of granulation tissue. The findings suggest that the combined use of Bowman’s membrane lenticule and autologous limbal stem cell transplantation offers a promising surgical strategy for limbal dermoid excision. This technique promotes rapid epithelialization and leads to significant improvements in visual acuity and corneal thickness compared to conventional methods. The utilization of Bowman’s membrane as a natural basement membrane and the direct application of limbal stem cells facilitate enhanced epithelial healing and visual rehabilitation. While the study is limited by its small sample size, the results demonstrate the potential of this novel approach in managing limbal dermoids effectively. 2025-07-11 Vision, Vol. 9, Pages 56: Novel Surgical Approach for Limbal Dermoid Excision: Utilizing Bowman’s Membrane Lenticule and Autologous Limbal Stem Cell Transplantation for Enhanced Epithelial Healing and Visual Outcomes

Vision doi: 10.3390/vision9030056

Authors: Dharamveer Singh Choudhary Maya Hada Kavita Ghanolia Jeba Shaheen Ajay Dhakad Bhuvanesh Sukhlal Kalal

Limbal dermoids are congenital, benign, choristomatous growths affecting the corneal-limbal junction. Conventional excision techniques often result in persistent epithelial defects, corneal thinning, and vascularization due to sectoral limbal stem cell deficiency. This study investigated a novel surgical approach for limbal dermoid excision, utilizing Bowman’s membrane lenticule and autologous limbal stem cell transplantation, aimed at improving epithelial healing and visual outcomes. Thirty-four subjects (24 females, 10 males; mean age 8.33 ± 6.47 years) with limbal dermoids underwent the procedure. After dermoid excision, a Bowman’s membrane lenticule was placed over the defect and tucked 1 mm beneath the surrounding tissue. Sectoral limbal reconstruction was then performed using the AutoSLET technique. Pre- and postoperative assessments included visual acuity, corneal thickness, and epithelialization time. Statistical analysis employed paired t-tests. The mean epithelialization time was 3.36 ± 0.74 weeks, indicating rapid healing. Best-corrected visual acuity (BCVA) significantly improved from a preoperative mean of 0.136 ± 0.121 decimal units to a postoperative mean of 0.336 ± 0.214 decimal units (p < 0.001). Corneal thickness also demonstrated a significant increase, rising from a preoperative mean of 294 ± 49.68 microns to a postoperative mean of 484 ± 5.037 microns (p < 0.001). There is a transient edema below the Bowman lenticule observed in many cases, which resolves with deposition of granulation tissue. The findings suggest that the combined use of Bowman’s membrane lenticule and autologous limbal stem cell transplantation offers a promising surgical strategy for limbal dermoid excision. This technique promotes rapid epithelialization and leads to significant improvements in visual acuity and corneal thickness compared to conventional methods. The utilization of Bowman’s membrane as a natural basement membrane and the direct application of limbal stem cells facilitate enhanced epithelial healing and visual rehabilitation. While the study is limited by its small sample size, the results demonstrate the potential of this novel approach in managing limbal dermoids effectively.

]]> Novel Surgical Approach for Limbal Dermoid Excision: Utilizing Bowman’s Membrane Lenticule and Autologous Limbal Stem Cell Transplantation for Enhanced Epithelial Healing and Visual Outcomes Dharamveer Singh Choudhary Maya Hada Kavita Ghanolia Jeba Shaheen Ajay Dhakad Bhuvanesh Sukhlal Kalal doi: 10.3390/vision9030056 Vision 2025-07-11 Vision 2025-07-11 9 3 Article 56 10.3390/vision9030056 https://www.mdpi.com/2411-5150/9/3/56 Vision, Vol. 9, Pages 55: Analysis of the Awareness and Access of Eye Healthcare in Underserved Populations https://www.mdpi.com/2411-5150/9/3/55 Introduction: Visual impairment impacts millions of people around the world, with the vast majority of problems being treatable. Disadvantaged communities are unable to utilize the same resources to treat these problems due to a lack of knowledge or resources, in addition to the presence of barriers preventing access. The objective of this paper is to assess eye health awareness and evaluate the barriers for individuals from disadvantaged communities in order to inform future interventions and increase access to care. Methods: This is a pilot study utilizing an online anonymous questionnaire designed to assess the demographics, eye health awareness, and access to eye care of community-based patients. A comprehensive literature review was also conducted using PubMed, Scopus, and Google Scholar to evaluate barriers to eye care and methods to improve community health outcomes. The primary goal was to improve understanding of eye health awareness and access in order to inform future strategies that can help in improving eye health awareness and service availability. Results: The results indicated that 61.2% of respondents believed that eye exams are very important, and only 7.7% of participants believed that regular eye exams are not important. The majority of participants (75%) agree that regular eye exams help prevent serious eye conditions and 84.5% believe that eye health can affect quality of life. 35.6% of participants reported they had their eyes checked by a healthcare professional within the last year, while 21.2% reported never having an eye exam. Although the majority of participants found access to eye care services in their community somewhat or very easy, 8.6% and 9.5% of participants found access difficult and very difficult, respectively. Even though 45.6% of participants reported not facing any barriers regarding access to eye care, the cost of services, long waiting times, and lack of nearby eye care providers were often cited as barriers from the remainder of the participants. Moving forward, local interventions such as mobile eye clinics, public health workshops, and telehealth are viable options to obtain an understanding of the community’s health status in addition to creating opportunities to educate and provide health screenings. Conclusion: The results indicate that although there is awareness of the importance of eye health for the majority of participants, there is still a sizable minority who have insufficient understanding. Barriers to healthcare such as cost, waiting times, and proximity to providers are common problems that are preventing many from seeking eye care. Future interventions should be created to increase access and literacy amongst the community through telehealth, mobile eye clinics, and public health workshops. Additional efforts should be taken by healthcare stakeholders to enhance care delivery, implement policies, and improve awareness. 2025-07-11 Vision, Vol. 9, Pages 55: Analysis of the Awareness and Access of Eye Healthcare in Underserved Populations

Vision doi: 10.3390/vision9030055

Authors: Karen Allison Abdullah Virk Asma Alamri Deepkumar Patel

Introduction: Visual impairment impacts millions of people around the world, with the vast majority of problems being treatable. Disadvantaged communities are unable to utilize the same resources to treat these problems due to a lack of knowledge or resources, in addition to the presence of barriers preventing access. The objective of this paper is to assess eye health awareness and evaluate the barriers for individuals from disadvantaged communities in order to inform future interventions and increase access to care. Methods: This is a pilot study utilizing an online anonymous questionnaire designed to assess the demographics, eye health awareness, and access to eye care of community-based patients. A comprehensive literature review was also conducted using PubMed, Scopus, and Google Scholar to evaluate barriers to eye care and methods to improve community health outcomes. The primary goal was to improve understanding of eye health awareness and access in order to inform future strategies that can help in improving eye health awareness and service availability. Results: The results indicated that 61.2% of respondents believed that eye exams are very important, and only 7.7% of participants believed that regular eye exams are not important. The majority of participants (75%) agree that regular eye exams help prevent serious eye conditions and 84.5% believe that eye health can affect quality of life. 35.6% of participants reported they had their eyes checked by a healthcare professional within the last year, while 21.2% reported never having an eye exam. Although the majority of participants found access to eye care services in their community somewhat or very easy, 8.6% and 9.5% of participants found access difficult and very difficult, respectively. Even though 45.6% of participants reported not facing any barriers regarding access to eye care, the cost of services, long waiting times, and lack of nearby eye care providers were often cited as barriers from the remainder of the participants. Moving forward, local interventions such as mobile eye clinics, public health workshops, and telehealth are viable options to obtain an understanding of the community’s health status in addition to creating opportunities to educate and provide health screenings. Conclusion: The results indicate that although there is awareness of the importance of eye health for the majority of participants, there is still a sizable minority who have insufficient understanding. Barriers to healthcare such as cost, waiting times, and proximity to providers are common problems that are preventing many from seeking eye care. Future interventions should be created to increase access and literacy amongst the community through telehealth, mobile eye clinics, and public health workshops. Additional efforts should be taken by healthcare stakeholders to enhance care delivery, implement policies, and improve awareness.

]]> Analysis of the Awareness and Access of Eye Healthcare in Underserved Populations Karen Allison Abdullah Virk Asma Alamri Deepkumar Patel doi: 10.3390/vision9030055 Vision 2025-07-11 Vision 2025-07-11 9 3 Review 55 10.3390/vision9030055 https://www.mdpi.com/2411-5150/9/3/55 Vision, Vol. 9, Pages 54: Insulin Nanoemulsion Eye Drops for the Treatment of Dry Eye Disease in Sjögren’s Disease: A Randomized Clinical Trial Phase I/II https://www.mdpi.com/2411-5150/9/3/54 Dry eye disease (DED) is a hallmark of primary Sjögren’s disease (SjD) and often resists conventional treatments like lubricant eye drops. Insulin nanoemulsions offer a potential solution by improving drug penetration and retention on the ocular surface. In animal models, insulin has shown benefits in promoting tear secretion and corneal healing. This study evaluated the safety and efficacy of insulin nanoemulsion eye drops (20 IU/mL, three times daily for 30 days) in patients with SjD. Thirty-two patients were randomized in a double-masked design to receive either insulin or placebo drops. Symptoms (assessed by OSDI questionnaire) and objective measures (tear film breakup time, corneal and conjunctival staining, and Schirmer Test) were recorded at baseline, after 4 weeks of treatment, and at a 4-week follow-up. Twenty-three participants completed the study. Both groups showed significant improvement in symptoms and objective signs after treatment (p < 0.05), but no significant differences were found between the insulin and placebo groups. No clinically relevant adverse effects were reported. Insulin nanoemulsion eye drops are safe for SjD patients, but their therapeutic advantage remains unclear. Further studies with larger samples, extended follow-up, and dose adjustments are needed to better understand their potential. 2025-07-09 Vision, Vol. 9, Pages 54: Insulin Nanoemulsion Eye Drops for the Treatment of Dry Eye Disease in Sjögren’s Disease: A Randomized Clinical Trial Phase I/II

Vision doi: 10.3390/vision9030054

Authors: Mateus Maia Marzola Diego Rocha Gutierrez Beatriz Carneiro Cintra Adriana de Andrade Batista Murashima Luciana Facco Dalmolin Denny Marcos Garcia Renata Fonseca Vianna Lopez Fabiola Reis Oliveira Eduardo Melani Rocha

Dry eye disease (DED) is a hallmark of primary Sjögren’s disease (SjD) and often resists conventional treatments like lubricant eye drops. Insulin nanoemulsions offer a potential solution by improving drug penetration and retention on the ocular surface. In animal models, insulin has shown benefits in promoting tear secretion and corneal healing. This study evaluated the safety and efficacy of insulin nanoemulsion eye drops (20 IU/mL, three times daily for 30 days) in patients with SjD. Thirty-two patients were randomized in a double-masked design to receive either insulin or placebo drops. Symptoms (assessed by OSDI questionnaire) and objective measures (tear film breakup time, corneal and conjunctival staining, and Schirmer Test) were recorded at baseline, after 4 weeks of treatment, and at a 4-week follow-up. Twenty-three participants completed the study. Both groups showed significant improvement in symptoms and objective signs after treatment (p < 0.05), but no significant differences were found between the insulin and placebo groups. No clinically relevant adverse effects were reported. Insulin nanoemulsion eye drops are safe for SjD patients, but their therapeutic advantage remains unclear. Further studies with larger samples, extended follow-up, and dose adjustments are needed to better understand their potential.

]]> Insulin Nanoemulsion Eye Drops for the Treatment of Dry Eye Disease in Sjögren’s Disease: A Randomized Clinical Trial Phase I/II Mateus Maia Marzola Diego Rocha Gutierrez Beatriz Carneiro Cintra Adriana de Andrade Batista Murashima Luciana Facco Dalmolin Denny Marcos Garcia Renata Fonseca Vianna Lopez Fabiola Reis Oliveira Eduardo Melani Rocha doi: 10.3390/vision9030054 Vision 2025-07-09 Vision 2025-07-09 9 3 Article 54 10.3390/vision9030054 https://www.mdpi.com/2411-5150/9/3/54 Vision, Vol. 9, Pages 53: Stronger Short-Term Memory, Larger Hippocampi and Area V1 in People with High VVIQ Scores https://www.mdpi.com/2411-5150/9/3/53 Reports of individual differences in vividness of visual mental imagery (VMI) scores raise complex questions: Are Vividness of Visual Imagery Questionnaire (VVIQ) score differences actually measuring anything? What functions do these differences serve? What is their neurological foundation? A new analysis examined visual short-term memory (VSTM) and volumes of the hippocampi, primary visual cortices, and other cortical regions among vivid and non-vivid visual imagers. In a sample of 53 volunteers aged 54 to 80 with MRI scans, the performance of ten Low VVIQ scorers was compared to that of ten High VVIQ scorers. The groups included an aphantasic with a minimum VVIQ score and a hyperphantasic with a maximum VVIQ score. The study examined volumes for 12 hippocampal subfields, 11 fields implicated in visual mental imagery including area V1 and the fusiform gyrus, and 7 motor regions. In comparison to the Low VVIQ group, High VVIQ group yielded: (i) significantly more accurate VSTM performance; and (ii) significantly larger volumes of the hippocampi and primary visual cortex. Across 47 brain regions, the average volume for the High VVIQ group exceeded that of the Low VVIQ group by 11 percent. For 47 subfields, the volumes of the hphantasic exceeded those of the aphantasic person by an average of 57 percent. Females had more accurate visual short-term memory than males and younger people were more accurate than older people. The larger visual memory capacity of females was unmatched by larger regional volume differences, which suggests that the sex difference in visual memory is caused by factors other than cortical regional size. The study confirms the existence of robust empirical associations between VMI vividness, short-term memory, regional volume of hippocampal subfields and area V1. 2025-07-07 Vision, Vol. 9, Pages 53: Stronger Short-Term Memory, Larger Hippocampi and Area V1 in People with High VVIQ Scores

Vision doi: 10.3390/vision9030053

Authors: David F. Marks

Reports of individual differences in vividness of visual mental imagery (VMI) scores raise complex questions: Are Vividness of Visual Imagery Questionnaire (VVIQ) score differences actually measuring anything? What functions do these differences serve? What is their neurological foundation? A new analysis examined visual short-term memory (VSTM) and volumes of the hippocampi, primary visual cortices, and other cortical regions among vivid and non-vivid visual imagers. In a sample of 53 volunteers aged 54 to 80 with MRI scans, the performance of ten Low VVIQ scorers was compared to that of ten High VVIQ scorers. The groups included an aphantasic with a minimum VVIQ score and a hyperphantasic with a maximum VVIQ score. The study examined volumes for 12 hippocampal subfields, 11 fields implicated in visual mental imagery including area V1 and the fusiform gyrus, and 7 motor regions. In comparison to the Low VVIQ group, High VVIQ group yielded: (i) significantly more accurate VSTM performance; and (ii) significantly larger volumes of the hippocampi and primary visual cortex. Across 47 brain regions, the average volume for the High VVIQ group exceeded that of the Low VVIQ group by 11 percent. For 47 subfields, the volumes of the hphantasic exceeded those of the aphantasic person by an average of 57 percent. Females had more accurate visual short-term memory than males and younger people were more accurate than older people. The larger visual memory capacity of females was unmatched by larger regional volume differences, which suggests that the sex difference in visual memory is caused by factors other than cortical regional size. The study confirms the existence of robust empirical associations between VMI vividness, short-term memory, regional volume of hippocampal subfields and area V1.

]]> Stronger Short-Term Memory, Larger Hippocampi and Area V1 in People with High VVIQ Scores David F. Marks doi: 10.3390/vision9030053 Vision 2025-07-07 Vision 2025-07-07 9 3 Article 53 10.3390/vision9030053 https://www.mdpi.com/2411-5150/9/3/53 Vision, Vol. 9, Pages 52: Evidence Based Analysis Enhances Surgical Outcomes of Novice Resident Surgeons https://www.mdpi.com/2411-5150/9/3/52 Evidence based practice enhances healthcare delivery and prevents unsafe procedures. While competency based assessments of resident cataract surgery are standard, evidence based analysis of refractive outcomes remains underutilized in educational curricula. This retrospective single center study evaluated refractive outcomes from 21 novice ophthalmology resident surgeons. Three independent groups were compared based on formal constant optimization for intraocular lens (IOL) calculation: non-optimized Haigis (n = 216), a0-optimized (n = 94), and a0/a1/a2-optimized (n = 121). All surgeries were supervised by a single attending surgeon. Mean absolute error (MAE) and the percentage of eyes within ±0.25 D and ±0.50 D of predicted spherical equivalent (SEQ) were calculated. Also, systematic bias in effective lens position (ELP) was analyzed to update manufacturer IOL constants. MAE improved from 0.44 D (non-optimized) to 0.35 D (a0-optimized p = 0.009) and 0.19 D (a0/a1/a2-optimized p < 0.001). The percentage within ±0.50 D increased from 65.7% to 74.4% to 95.0%, respectively. With ELP bias correction, updated A constant and ACD were 119.266 and 5.755 mm. a0/a1/a2-optimized outcomes were comparable to ELP bias correction for the Barrett UII, Kane, and Hill-RBF formulas. Evidence based optimization of IOL constants significantly enhances novice resident surgical outcomes, achieving parity with prediction models. A formal curriculum on IOL calculation and optimization is warranted. 2025-07-03 Vision, Vol. 9, Pages 52: Evidence Based Analysis Enhances Surgical Outcomes of Novice Resident Surgeons

Vision doi: 10.3390/vision9030052

Authors: Neel K. Patel Kenneth L. Cohen

Evidence based practice enhances healthcare delivery and prevents unsafe procedures. While competency based assessments of resident cataract surgery are standard, evidence based analysis of refractive outcomes remains underutilized in educational curricula. This retrospective single center study evaluated refractive outcomes from 21 novice ophthalmology resident surgeons. Three independent groups were compared based on formal constant optimization for intraocular lens (IOL) calculation: non-optimized Haigis (n = 216), a0-optimized (n = 94), and a0/a1/a2-optimized (n = 121). All surgeries were supervised by a single attending surgeon. Mean absolute error (MAE) and the percentage of eyes within ±0.25 D and ±0.50 D of predicted spherical equivalent (SEQ) were calculated. Also, systematic bias in effective lens position (ELP) was analyzed to update manufacturer IOL constants. MAE improved from 0.44 D (non-optimized) to 0.35 D (a0-optimized p = 0.009) and 0.19 D (a0/a1/a2-optimized p < 0.001). The percentage within ±0.50 D increased from 65.7% to 74.4% to 95.0%, respectively. With ELP bias correction, updated A constant and ACD were 119.266 and 5.755 mm. a0/a1/a2-optimized outcomes were comparable to ELP bias correction for the Barrett UII, Kane, and Hill-RBF formulas. Evidence based optimization of IOL constants significantly enhances novice resident surgical outcomes, achieving parity with prediction models. A formal curriculum on IOL calculation and optimization is warranted.

]]> Evidence Based Analysis Enhances Surgical Outcomes of Novice Resident Surgeons Neel K. Patel Kenneth L. Cohen doi: 10.3390/vision9030052 Vision 2025-07-03 Vision 2025-07-03 9 3 Article 52 10.3390/vision9030052 https://www.mdpi.com/2411-5150/9/3/52 Vision, Vol. 9, Pages 51: Uncovering the Characteristics of Pupil Cycle Time (PCT) in Neuropathies and Retinopathies https://www.mdpi.com/2411-5150/9/3/51 Pupil cycle time (PCT) estimates the dynamics of a biofeedback loop established between pupil size and stimulus luminance, size or colour. The PCT is useful for probing the functional integrity of the retinopupillary circuits, and is therefore potentially applicable for assessing the effects of damage due to retinopathies or neuropathies. In previous studies, PCT was measured by manually counting the number of pupil oscillations during a fixed period to calculate the PCT. This method is scarce, requires a good expertise and cannot be used to estimate several PCT parameters, such as the oscillation amplitude or variability. We have developed a computerised setup based on eye-tracking that expands the possibilities of characterising PCT along several dimensions: oscillation frequency and regularity, amplitude and variability, which can be used with a large palette of stimuli (different colours, sizes, shapes or locations), and further allows measuring blinking frequency and eye movements. We used this method to characterise the PCT in young control participants as well as in patients with several pathologies, including age-related macular degeneration (AMD), diabetic retinopathy (DR), retinitis pigmentosa (RP), Stargardt disease (SD), and Leber hereditary optic neuropathy (LHON). We found that PCT is very regular and stable in young healthy participants, with little inter-individual variability. In contrast, several PCT features are altered in older healthy participants as well as in ocular diseases, including slower dynamics, irregular oscillations, and reduced oscillation amplitude. The distinction between patients and healthy participants based on the calculation of the area under the curve of the receiver operating characteristics (AUC of ROC) were dependent on the pathologies and stimuli (0.7 < AUC < 1). PCT nevertheless provides relevant complementary information to assess the physiopathology of ocular diseases and to probe the functioning of retino-pupillary circuits. 2025-06-30 Vision, Vol. 9, Pages 51: Uncovering the Characteristics of Pupil Cycle Time (PCT) in Neuropathies and Retinopathies

Vision doi: 10.3390/vision9030051

Authors: Laure Trinquet Suzon Ajasse Frédéric Chavane Richard Legras Frédéric Matonti José-Alain Sahel Catherine Vignal-Clermont Jean Lorenceau

Pupil cycle time (PCT) estimates the dynamics of a biofeedback loop established between pupil size and stimulus luminance, size or colour. The PCT is useful for probing the functional integrity of the retinopupillary circuits, and is therefore potentially applicable for assessing the effects of damage due to retinopathies or neuropathies. In previous studies, PCT was measured by manually counting the number of pupil oscillations during a fixed period to calculate the PCT. This method is scarce, requires a good expertise and cannot be used to estimate several PCT parameters, such as the oscillation amplitude or variability. We have developed a computerised setup based on eye-tracking that expands the possibilities of characterising PCT along several dimensions: oscillation frequency and regularity, amplitude and variability, which can be used with a large palette of stimuli (different colours, sizes, shapes or locations), and further allows measuring blinking frequency and eye movements. We used this method to characterise the PCT in young control participants as well as in patients with several pathologies, including age-related macular degeneration (AMD), diabetic retinopathy (DR), retinitis pigmentosa (RP), Stargardt disease (SD), and Leber hereditary optic neuropathy (LHON). We found that PCT is very regular and stable in young healthy participants, with little inter-individual variability. In contrast, several PCT features are altered in older healthy participants as well as in ocular diseases, including slower dynamics, irregular oscillations, and reduced oscillation amplitude. The distinction between patients and healthy participants based on the calculation of the area under the curve of the receiver operating characteristics (AUC of ROC) were dependent on the pathologies and stimuli (0.7 < AUC < 1). PCT nevertheless provides relevant complementary information to assess the physiopathology of ocular diseases and to probe the functioning of retino-pupillary circuits.

]]> Uncovering the Characteristics of Pupil Cycle Time (PCT) in Neuropathies and Retinopathies Laure Trinquet Suzon Ajasse Frédéric Chavane Richard Legras Frédéric Matonti José-Alain Sahel Catherine Vignal-Clermont Jean Lorenceau doi: 10.3390/vision9030051 Vision 2025-06-30 Vision 2025-06-30 9 3 Article 51 10.3390/vision9030051 https://www.mdpi.com/2411-5150/9/3/51 Vision, Vol. 9, Pages 50: State-Dependent Brain Stimulation for Visual Neurorehabilitation: Principles and Applications https://www.mdpi.com/2411-5150/9/3/50 The effects of Transcranial Magnetic Stimulation (TMS) depend on stimulation parameters such as intensity, location, frequency, and duration. In clinical practice, these parameters are often adapted from studies carried out in healthy individuals. However, in this narrative review, we indicate that the impact of TMS is also highly state-dependent, meaning it is influenced by the excitability of the targeted brain region at the time of stimulation. This state-dependency complicates the translation of findings from healthy individuals to clinical populations, as neurological disorders often alter brain states, limiting the applicability of standard stimulation protocols. To address this challenge, stimulation parameters must be chosen within a framework that accounts for the interaction between external stimulation and the brain’s internal state. Such an approach enhances the specificity of interventions, allowing for targeted modulation of neural populations by manipulating brain states prior to stimulation. State-dependent TMS has shown promise in conditions like cortical blindness and amblyopia, where tailored approaches based on the brain state associated with the condition have facilitated more precise and effective treatments. We advocate that integrating state-dependent knowledge tailored to the specifics of visual disorders alongside judicious selection of stimulation parameters holds the potential to establish a comprehensive paradigm for future investigations. 2025-06-20 Vision, Vol. 9, Pages 50: State-Dependent Brain Stimulation for Visual Neurorehabilitation: Principles and Applications

Vision doi: 10.3390/vision9030050

Authors: Kuzma Strelnikov Juha Silvanto

The effects of Transcranial Magnetic Stimulation (TMS) depend on stimulation parameters such as intensity, location, frequency, and duration. In clinical practice, these parameters are often adapted from studies carried out in healthy individuals. However, in this narrative review, we indicate that the impact of TMS is also highly state-dependent, meaning it is influenced by the excitability of the targeted brain region at the time of stimulation. This state-dependency complicates the translation of findings from healthy individuals to clinical populations, as neurological disorders often alter brain states, limiting the applicability of standard stimulation protocols. To address this challenge, stimulation parameters must be chosen within a framework that accounts for the interaction between external stimulation and the brain’s internal state. Such an approach enhances the specificity of interventions, allowing for targeted modulation of neural populations by manipulating brain states prior to stimulation. State-dependent TMS has shown promise in conditions like cortical blindness and amblyopia, where tailored approaches based on the brain state associated with the condition have facilitated more precise and effective treatments. We advocate that integrating state-dependent knowledge tailored to the specifics of visual disorders alongside judicious selection of stimulation parameters holds the potential to establish a comprehensive paradigm for future investigations.

]]> State-Dependent Brain Stimulation for Visual Neurorehabilitation: Principles and Applications Kuzma Strelnikov Juha Silvanto doi: 10.3390/vision9030050 Vision 2025-06-20 Vision 2025-06-20 9 3 Review 50 10.3390/vision9030050 https://www.mdpi.com/2411-5150/9/3/50 Vision, Vol. 9, Pages 49: A Comparison of All-Cause Mortality in Patients Who Required Glaucoma Surgery for Neovascular Glaucoma or Primary Open-Angle Glaucoma: A Retrospective Cohort Study https://www.mdpi.com/2411-5150/9/2/49 This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health. 2025-06-13 Vision, Vol. 9, Pages 49: A Comparison of All-Cause Mortality in Patients Who Required Glaucoma Surgery for Neovascular Glaucoma or Primary Open-Angle Glaucoma: A Retrospective Cohort Study

Vision doi: 10.3390/vision9020049

Authors: Laura D. Palmer Levi D. Kauffman Gregory B. Russell Atalie C. Thompson Gillian G. Treadwell

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health.

]]> A Comparison of All-Cause Mortality in Patients Who Required Glaucoma Surgery for Neovascular Glaucoma or Primary Open-Angle Glaucoma: A Retrospective Cohort Study Laura D. Palmer Levi D. Kauffman Gregory B. Russell Atalie C. Thompson Gillian G. Treadwell doi: 10.3390/vision9020049 Vision 2025-06-13 Vision 2025-06-13 9 2 Article 49 10.3390/vision9020049 https://www.mdpi.com/2411-5150/9/2/49 Vision, Vol. 9, Pages 48: Oculomotor-Related Measures Are Predictive of Reading Acquisition in First Grade Early Readers https://www.mdpi.com/2411-5150/9/2/48 Some estimates suggest that one in seven good readers and the majority of children with reading difficulties suffer from oculomotor dysfunction (OMD), an umbrella term for abnormalities in comfortable and accurate fixations, pursuits, and saccades. However, national vision evaluation programs worldwide are often limited to distance visual acuity (dVA), not testing for OMD despite its high prevalence and the ease of detecting it in brief optometric evaluations. We hypothesized that reading acquisition is dependent on good oculomotor functions, and therefore inadequate oculomotor control will be associated with reading difficulties. We retrospectively examined and compared oculomotor evaluations (using DEM and NSUCO) and reading assessments (using standardized national reading norms) of a normative class (28 first graders (6–7 yr. olds)) that were independently obtained while blind to the other assessment. Better oculomotor performance as estimated by DEM was associated with better reading performance, and almost a third (29.6%) of the children were categorized by DEM as having OMD-related difficulties. Control analysis revealed dVA was not positively associated with reading performance. Linear regression analyses further corroborated these findings. Since this study is based on a small cohort and since there are studies suggesting that DEM may actually reflect visual processing speed or cognitive factors rather than oculomotor function, replications are needed to substantiate the direct contribution of oculomotor functions to reading acquisition. Young children struggling with reading may benefit from a comprehensive visual evaluation, including oculomotor testing, to provide a more thorough assessment of their learning-related difficulties. 2025-06-04 Vision, Vol. 9, Pages 48: Oculomotor-Related Measures Are Predictive of Reading Acquisition in First Grade Early Readers

Vision doi: 10.3390/vision9020048

Authors: Avi Portnoy Sharon Gilaie-Dotan

Some estimates suggest that one in seven good readers and the majority of children with reading difficulties suffer from oculomotor dysfunction (OMD), an umbrella term for abnormalities in comfortable and accurate fixations, pursuits, and saccades. However, national vision evaluation programs worldwide are often limited to distance visual acuity (dVA), not testing for OMD despite its high prevalence and the ease of detecting it in brief optometric evaluations. We hypothesized that reading acquisition is dependent on good oculomotor functions, and therefore inadequate oculomotor control will be associated with reading difficulties. We retrospectively examined and compared oculomotor evaluations (using DEM and NSUCO) and reading assessments (using standardized national reading norms) of a normative class (28 first graders (6–7 yr. olds)) that were independently obtained while blind to the other assessment. Better oculomotor performance as estimated by DEM was associated with better reading performance, and almost a third (29.6%) of the children were categorized by DEM as having OMD-related difficulties. Control analysis revealed dVA was not positively associated with reading performance. Linear regression analyses further corroborated these findings. Since this study is based on a small cohort and since there are studies suggesting that DEM may actually reflect visual processing speed or cognitive factors rather than oculomotor function, replications are needed to substantiate the direct contribution of oculomotor functions to reading acquisition. Young children struggling with reading may benefit from a comprehensive visual evaluation, including oculomotor testing, to provide a more thorough assessment of their learning-related difficulties.

]]> Oculomotor-Related Measures Are Predictive of Reading Acquisition in First Grade Early Readers Avi Portnoy Sharon Gilaie-Dotan doi: 10.3390/vision9020048 Vision 2025-06-04 Vision 2025-06-04 9 2 Article 48 10.3390/vision9020048 https://www.mdpi.com/2411-5150/9/2/48 Vision, Vol. 9, Pages 47: Revealing the Concealed in Monocular and Binocular Vision https://www.mdpi.com/2411-5150/9/2/47 Concealing images has been a concern of artists and scientists, as have the conditions that can reveal them. It is relatively easy to hide images in pictures, but this is of little value if they remain hidden. The skill is in revealing previously concealed images. Three aspects of hiding images are examined, two of which are monocular and the third is binocular. Firstly, high-contrast patterns, like Street figures and Mooney faces, have been used in psychological tests of pattern recognition, and Gestalt grouping principles can result in concealing images. Second, it is possible to hide low spatial frequency content carried by high-spatial-frequency patterns. A wider range of carriers than gratings can be used, like graphics, photographs, and combinations of them (photo-graphics). Pictorial images can be concealed in terms of detection or recognition. In both cases, there is interplay between the global features of the concealed image and the local elements that carry it. Third, randomly textured stereograms reveal to two eyes what is concealed from each one alone—stereoscopic depth. The dimension of stereoscopic depth can be manipulated, as can that of binocular rivalry, to conceal images. 2025-06-03 Vision, Vol. 9, Pages 47: Revealing the Concealed in Monocular and Binocular Vision

Vision doi: 10.3390/vision9020047

Authors: Nicholas J. Wade

Concealing images has been a concern of artists and scientists, as have the conditions that can reveal them. It is relatively easy to hide images in pictures, but this is of little value if they remain hidden. The skill is in revealing previously concealed images. Three aspects of hiding images are examined, two of which are monocular and the third is binocular. Firstly, high-contrast patterns, like Street figures and Mooney faces, have been used in psychological tests of pattern recognition, and Gestalt grouping principles can result in concealing images. Second, it is possible to hide low spatial frequency content carried by high-spatial-frequency patterns. A wider range of carriers than gratings can be used, like graphics, photographs, and combinations of them (photo-graphics). Pictorial images can be concealed in terms of detection or recognition. In both cases, there is interplay between the global features of the concealed image and the local elements that carry it. Third, randomly textured stereograms reveal to two eyes what is concealed from each one alone—stereoscopic depth. The dimension of stereoscopic depth can be manipulated, as can that of binocular rivalry, to conceal images.

]]> Revealing the Concealed in Monocular and Binocular Vision Nicholas J. Wade doi: 10.3390/vision9020047 Vision 2025-06-03 Vision 2025-06-03 9 2 Review 47 10.3390/vision9020047 https://www.mdpi.com/2411-5150/9/2/47 Vision, Vol. 9, Pages 46: Predicted Visual Impact of a Small Aperture Intraocular Lens in Reducing Higher Order Aberrations in Post-Radial Keratotomy Patients https://www.mdpi.com/2411-5150/9/2/46 The purpose of this study is to evaluate the potential impact of small aperture optics on corneal aberrations in post-RK patients. Preoperative data was evaluated from 32 eyes of 23 post-RK patients. Scheimpflug tomography was used to obtain measurements of corneal HOAs at 6-mm, 4-mm, and 2-mm corneal plane aperture diameters. The data was extrapolated using a non-linear fit to estimate HOAs that would be obtained with the 1.6 mm effective pinhole IOL aperture at the corneal plane for individual patients. The average RMS HOAs estimated for the 1.6 mm aperture was 0.063 ± 0.015 μm compared to 0.185 ± 0.029 μm for the natural pupil size. A postoperative RK case with an IC-8® Apthera™ unilateral implantation demonstrated a 70% reduction in HOAs by objective measurement and prediction, plus a 2-line improvement in CDVA. Prediction modeling revealed that HOAs may be reduced in post-RK patients following pinhole IOL implantation, compared to the natural photopic pupil size. Furthermore, the approach can be used to guide which post-RK patients would benefit from a small aperture IOL during cataract surgery. 2025-05-29 Vision, Vol. 9, Pages 46: Predicted Visual Impact of a Small Aperture Intraocular Lens in Reducing Higher Order Aberrations in Post-Radial Keratotomy Patients

Vision doi: 10.3390/vision9020046

Authors: Roberta M. van den Berg Sarah DeVaro Karolinne Maia Rocha Marcela Fetrin de Barros Stephen D. Klyce

The purpose of this study is to evaluate the potential impact of small aperture optics on corneal aberrations in post-RK patients. Preoperative data was evaluated from 32 eyes of 23 post-RK patients. Scheimpflug tomography was used to obtain measurements of corneal HOAs at 6-mm, 4-mm, and 2-mm corneal plane aperture diameters. The data was extrapolated using a non-linear fit to estimate HOAs that would be obtained with the 1.6 mm effective pinhole IOL aperture at the corneal plane for individual patients. The average RMS HOAs estimated for the 1.6 mm aperture was 0.063 ± 0.015 μm compared to 0.185 ± 0.029 μm for the natural pupil size. A postoperative RK case with an IC-8® Apthera™ unilateral implantation demonstrated a 70% reduction in HOAs by objective measurement and prediction, plus a 2-line improvement in CDVA. Prediction modeling revealed that HOAs may be reduced in post-RK patients following pinhole IOL implantation, compared to the natural photopic pupil size. Furthermore, the approach can be used to guide which post-RK patients would benefit from a small aperture IOL during cataract surgery.

]]> Predicted Visual Impact of a Small Aperture Intraocular Lens in Reducing Higher Order Aberrations in Post-Radial Keratotomy Patients Roberta M. van den Berg Sarah DeVaro Karolinne Maia Rocha Marcela Fetrin de Barros Stephen D. Klyce doi: 10.3390/vision9020046 Vision 2025-05-29 Vision 2025-05-29 9 2 Article 46 10.3390/vision9020046 https://www.mdpi.com/2411-5150/9/2/46 Vision, Vol. 9, Pages 45: Anatomical and Functional Outcomes of Human-Amniotic Membrane Graft in Refractory Macular Hole Cases https://www.mdpi.com/2411-5150/9/2/45 Macular hole (MH) surgery generally has a high success rate, but finding anatomical plug for refractory cases remains challenging. The human amniotic membrane (hAM), with its anti-inflammatory and regenerative properties, has emerged as a potential option. This study aims to report the anatomical and functional outcomes of human amniotic membrane (hAM) graft as an intervention to repair refractory macular hole cases where wide internal limiting membrane (ILM) peeling was unsuccessful. A retrospective chart review was conducted at a single center, with the main outcomes being closure rate and postoperative BCVA at 6 months. Eleven eyes of 11 patients with refractory macular holes were identified and included in the study. Participants were predominantly males (72.73%) with a mean age of 49.27 years. Nine eyes achieved successful MH closure with a single intervention and showed no recurrence during the 6-month follow-up. Mean BCVA at 3 and 6 months improved significantly (p = 0.0207) from 1.747 ± 0.74 logMAR to 1.210 ± 0.51 logMAR and 0.939 ± 0.47 logMAR (range 2.079–0.301 logMAR). The use of human amniotic membrane (hAM) graft seems to be a viable and effective alternative for the treatment of refractory macular holes. However, further larger prospective controlled studies are necessary to confirm our results. 2025-05-22 Vision, Vol. 9, Pages 45: Anatomical and Functional Outcomes of Human-Amniotic Membrane Graft in Refractory Macular Hole Cases

Vision doi: 10.3390/vision9020045

Authors: Soefiandi Soedarman Sandi Muslim Waldensius Girsang Elvioza Referano Agustiawan Alberthus Donni Budi Prasetya Ichsan Fauzi Triyoga

Macular hole (MH) surgery generally has a high success rate, but finding anatomical plug for refractory cases remains challenging. The human amniotic membrane (hAM), with its anti-inflammatory and regenerative properties, has emerged as a potential option. This study aims to report the anatomical and functional outcomes of human amniotic membrane (hAM) graft as an intervention to repair refractory macular hole cases where wide internal limiting membrane (ILM) peeling was unsuccessful. A retrospective chart review was conducted at a single center, with the main outcomes being closure rate and postoperative BCVA at 6 months. Eleven eyes of 11 patients with refractory macular holes were identified and included in the study. Participants were predominantly males (72.73%) with a mean age of 49.27 years. Nine eyes achieved successful MH closure with a single intervention and showed no recurrence during the 6-month follow-up. Mean BCVA at 3 and 6 months improved significantly (p = 0.0207) from 1.747 ± 0.74 logMAR to 1.210 ± 0.51 logMAR and 0.939 ± 0.47 logMAR (range 2.079–0.301 logMAR). The use of human amniotic membrane (hAM) graft seems to be a viable and effective alternative for the treatment of refractory macular holes. However, further larger prospective controlled studies are necessary to confirm our results.

]]> Anatomical and Functional Outcomes of Human-Amniotic Membrane Graft in Refractory Macular Hole Cases Soefiandi Soedarman Sandi Muslim Waldensius Girsang Elvioza Referano Agustiawan Alberthus Donni Budi Prasetya Ichsan Fauzi Triyoga doi: 10.3390/vision9020045 Vision 2025-05-22 Vision 2025-05-22 9 2 Article 45 10.3390/vision9020045 https://www.mdpi.com/2411-5150/9/2/45 Vision, Vol. 9, Pages 44: Ocular and General Proprioception in Dyslexic Children: A Review of Their Diurnal and Nocturnal Dysfunctions and Their Repercussions https://www.mdpi.com/2411-5150/9/2/44 We provide a summary of the research conducted in our laboratory on the relationship between ocular proprioception, general proprioception, and dyslexia. Dyslexic children show a marked proprioceptive deficit which affects motor control, attention and spatial perception. The spatial disturbances are expressed by the presence of a vertical microheterophoria which has very specific characteristics. It is associated with abnormal tone of the oblique muscles and can be modified by means of very low powered prisms and/or remote sensory stimulation. When ocular proprioception is modified, sounds cause stochastic visual losses. This may interfere with the association between phonemes and graphemes, which is necessary for learning to read. The effects of a generalized nocturnal proprioceptive disorder may play a role in the abnormal brain development that has been observed in dyslexic children. 2025-05-20 Vision, Vol. 9, Pages 44: Ocular and General Proprioception in Dyslexic Children: A Review of Their Diurnal and Nocturnal Dysfunctions and Their Repercussions

Vision doi: 10.3390/vision9020044

Authors: Patrick Quercia Kalvin Chavet Jérémie Gaveau

We provide a summary of the research conducted in our laboratory on the relationship between ocular proprioception, general proprioception, and dyslexia. Dyslexic children show a marked proprioceptive deficit which affects motor control, attention and spatial perception. The spatial disturbances are expressed by the presence of a vertical microheterophoria which has very specific characteristics. It is associated with abnormal tone of the oblique muscles and can be modified by means of very low powered prisms and/or remote sensory stimulation. When ocular proprioception is modified, sounds cause stochastic visual losses. This may interfere with the association between phonemes and graphemes, which is necessary for learning to read. The effects of a generalized nocturnal proprioceptive disorder may play a role in the abnormal brain development that has been observed in dyslexic children.

]]> Ocular and General Proprioception in Dyslexic Children: A Review of Their Diurnal and Nocturnal Dysfunctions and Their Repercussions Patrick Quercia Kalvin Chavet Jérémie Gaveau doi: 10.3390/vision9020044 Vision 2025-05-20 Vision 2025-05-20 9 2 Review 44 10.3390/vision9020044 https://www.mdpi.com/2411-5150/9/2/44 Vision, Vol. 9, Pages 43: Perception and Decision-Making in Virtual Telepsychology Spaces and Professionals https://www.mdpi.com/2411-5150/9/2/43 Humans interact with virtual environments for a variety of purposes, and the use of telemedicine services and e-health platforms has become increasingly significant in recent years. Telepsychology is an emerging service and is understood as the provision of psychological aid and counseling through the use of telecommunication technologies. This study investigates the impact of visual backgrounds in a mental health simulation app and explores the decision-making of potential patients for telepsychology. In this experimental study, we developed an instrument to assess the preferences for manipulated features of photomontages and portraits. A total of 310 participants from diverse backgrounds were surveyed about their preferences regarding visual backgrounds and silhouettes for this hypothetical service, with key independent variables such as complexity, naturalness, and color hues being manipulated. Our findings represent the first example of data collected on background preferences in telepsychology. The results suggest a preference for backgrounds with medium complexity and naturalness for clinical settings. Additionally, we observed variations in preferences based on gender and age. These findings highlight the importance of customizing visual elements to enhance patient engagement in telepsychology. 2025-05-06 Vision, Vol. 9, Pages 43: Perception and Decision-Making in Virtual Telepsychology Spaces and Professionals

Vision doi: 10.3390/vision9020043

Authors: Luis-Lucio Lobato Rincón Maria Ángeles Medina Sánchez Rubén Tovar Bordón

Humans interact with virtual environments for a variety of purposes, and the use of telemedicine services and e-health platforms has become increasingly significant in recent years. Telepsychology is an emerging service and is understood as the provision of psychological aid and counseling through the use of telecommunication technologies. This study investigates the impact of visual backgrounds in a mental health simulation app and explores the decision-making of potential patients for telepsychology. In this experimental study, we developed an instrument to assess the preferences for manipulated features of photomontages and portraits. A total of 310 participants from diverse backgrounds were surveyed about their preferences regarding visual backgrounds and silhouettes for this hypothetical service, with key independent variables such as complexity, naturalness, and color hues being manipulated. Our findings represent the first example of data collected on background preferences in telepsychology. The results suggest a preference for backgrounds with medium complexity and naturalness for clinical settings. Additionally, we observed variations in preferences based on gender and age. These findings highlight the importance of customizing visual elements to enhance patient engagement in telepsychology.

]]> Perception and Decision-Making in Virtual Telepsychology Spaces and Professionals Luis-Lucio Lobato Rincón Maria Ángeles Medina Sánchez Rubén Tovar Bordón doi: 10.3390/vision9020043 Vision 2025-05-06 Vision 2025-05-06 9 2 Article 43 10.3390/vision9020043 https://www.mdpi.com/2411-5150/9/2/43 Vision, Vol. 9, Pages 42: Latin American Prevalence of Glaucoma: A Systematic Review and Meta-Analysis https://www.mdpi.com/2411-5150/9/2/42 We conducted a systematic review and meta-analysis to estimate the prevalence of all types of glaucoma in Latin America (LATAM) and evaluate potential demographic associations. This study followed PRISMA guidelines and was registered in PROSPERO (CRD42024506330). A comprehensive search of PubMed, SciELO, and Web of Science was conducted to identify population-based or cross-sectional studies reporting glaucoma prevalence in LATAM. Studies were categorized into two groups: Group 1 included general population studies without selection based on visual acuity (VA), and Group 2 included studies limited to individuals with VA < 20/60. Data from five studies in Group 1 (25,288 individuals) and eight studies in Group 2 (29,882 individuals) were analyzed using R software. The pooled prevalence of glaucoma was 4% (95% CI: 1–3%) in Group 1 and 1% (95% CI: 0–1%) in Group 2. No statistically significant associations were found between glaucoma prevalence and sex (p = 0.08) or age (p = 0.5669). Although our findings highlight the relevance of glaucoma as a public health concern in LATAM, the limited number of available studies and methodological variability reduce the certainty of the estimates. 2025-05-05 Vision, Vol. 9, Pages 42: Latin American Prevalence of Glaucoma: A Systematic Review and Meta-Analysis

Vision doi: 10.3390/vision9020042

Authors: Denisse J. Mora-Paez Jaime Guedes Dillan Cunha Amaral Marcelo Alves Ferreira Bruno F. Fernandes Sacha F. Pereira Bruno Botton Alisha Desai Helena Messinger Pakter Fabio Lavinsky Adroaldo Alencar Costa Filho

We conducted a systematic review and meta-analysis to estimate the prevalence of all types of glaucoma in Latin America (LATAM) and evaluate potential demographic associations. This study followed PRISMA guidelines and was registered in PROSPERO (CRD42024506330). A comprehensive search of PubMed, SciELO, and Web of Science was conducted to identify population-based or cross-sectional studies reporting glaucoma prevalence in LATAM. Studies were categorized into two groups: Group 1 included general population studies without selection based on visual acuity (VA), and Group 2 included studies limited to individuals with VA < 20/60. Data from five studies in Group 1 (25,288 individuals) and eight studies in Group 2 (29,882 individuals) were analyzed using R software. The pooled prevalence of glaucoma was 4% (95% CI: 1–3%) in Group 1 and 1% (95% CI: 0–1%) in Group 2. No statistically significant associations were found between glaucoma prevalence and sex (p = 0.08) or age (p = 0.5669). Although our findings highlight the relevance of glaucoma as a public health concern in LATAM, the limited number of available studies and methodological variability reduce the certainty of the estimates.

]]> Latin American Prevalence of Glaucoma: A Systematic Review and Meta-Analysis Denisse J. Mora-Paez Jaime Guedes Dillan Cunha Amaral Marcelo Alves Ferreira Bruno F. Fernandes Sacha F. Pereira Bruno Botton Alisha Desai Helena Messinger Pakter Fabio Lavinsky Adroaldo Alencar Costa Filho doi: 10.3390/vision9020042 Vision 2025-05-05 Vision 2025-05-05 9 2 Systematic Review 42 10.3390/vision9020042 https://www.mdpi.com/2411-5150/9/2/42 Vision, Vol. 9, Pages 41: The Influence of the Level of Monovision upon Early Outcomes Following the Bilateral Implantation of an Enhanced Monovision Intraocular Lens https://www.mdpi.com/2411-5150/9/2/41 This article provides an assessment of the impact of different levels of monovision upon early visual outcomes and quality of vision (QoV) following the bilateral implantation of enhanced monovision intraocular lenses (IOLs). Consecutive patients implanted bilaterally with the Rayone EMV (Rayner) were recruited. The dominant eye was targeted for emmetropia, and myopia was targeted in the nondominant eye. Patients were categorized based upon the postoperative refractive outcome in the nondominant eye as follows: Group A: −0.50 to −1.0 D (n = 40), Group B: <−1.00 = D (n = 46). Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, and QoV were compared 3 months postoperatively. Binocular UIVA was 0.05 ± 0.10 and −0.01 ± 0.11logMAR (p = 0.03) in the two respective groups, and binocular UNVA was 0.23 ± 0.09 and 0.14 ± 0.09logMAR (p < 0.001). Day QoV was 8.77 ± 1.33 and 8.13 ± 1.34 for night QoV in group A, and 8.85 ± 0.99 and 7.85 ± 1.35, respectively, in group B. Group A had a lower spectacle independence rate of 55% compared to 89.1%. This IOL provides a satisfactory range of vision with high QoV satisfaction. A postoperative refractive error of −1.0 D or more in the nondominant eye significantly improves binocular UIVA, UNVA, and spectacle independence, without negatively impacting QoV. 2025-05-03 Vision, Vol. 9, Pages 41: The Influence of the Level of Monovision upon Early Outcomes Following the Bilateral Implantation of an Enhanced Monovision Intraocular Lens

Vision doi: 10.3390/vision9020041

Authors: Richard N. McNeely Stephen Stewart Niraj Mandal Salissou Moutari Allon Barsam Jonathan E. Moore

This article provides an assessment of the impact of different levels of monovision upon early visual outcomes and quality of vision (QoV) following the bilateral implantation of enhanced monovision intraocular lenses (IOLs). Consecutive patients implanted bilaterally with the Rayone EMV (Rayner) were recruited. The dominant eye was targeted for emmetropia, and myopia was targeted in the nondominant eye. Patients were categorized based upon the postoperative refractive outcome in the nondominant eye as follows: Group A: −0.50 to −1.0 D (n = 40), Group B: <−1.00 = D (n = 46). Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, and QoV were compared 3 months postoperatively. Binocular UIVA was 0.05 ± 0.10 and −0.01 ± 0.11logMAR (p = 0.03) in the two respective groups, and binocular UNVA was 0.23 ± 0.09 and 0.14 ± 0.09logMAR (p < 0.001). Day QoV was 8.77 ± 1.33 and 8.13 ± 1.34 for night QoV in group A, and 8.85 ± 0.99 and 7.85 ± 1.35, respectively, in group B. Group A had a lower spectacle independence rate of 55% compared to 89.1%. This IOL provides a satisfactory range of vision with high QoV satisfaction. A postoperative refractive error of −1.0 D or more in the nondominant eye significantly improves binocular UIVA, UNVA, and spectacle independence, without negatively impacting QoV.

]]> The Influence of the Level of Monovision upon Early Outcomes Following the Bilateral Implantation of an Enhanced Monovision Intraocular Lens Richard N. McNeely Stephen Stewart Niraj Mandal Salissou Moutari Allon Barsam Jonathan E. Moore doi: 10.3390/vision9020041 Vision 2025-05-03 Vision 2025-05-03 9 2 Article 41 10.3390/vision9020041 https://www.mdpi.com/2411-5150/9/2/41 Vision, Vol. 9, Pages 40: The Association Between Sensory Impairment and Adherence to COVID-19 Prevention Measures in the Adult California Health Interview Survey Population https://www.mdpi.com/2411-5150/9/2/40 This study explores the association between vision/hearing impairment and COVID-19 prevention strategies in the 2020 and 2021 California Health Interview Survey (CHIS). This cross-sectional study used data from the 2020 and 2021 CHIS. The exposure of interest was self-reported history of sensory impairment. The outcome of interest was adherence to COVID-19 mitigation strategies defined as obtaining a COVID-19 vaccine, face mask adherence, hand washing, social distancing, and not gathering with non-household members. Logistic regression models examined the association between sensory impairment and adherence to COVID-19 mitigation strategies, controlling for age, sex, race and ethnicity, general health status, and household income. All analyses were weighted according to the CHIS sampling design. With 24,453 California adults representing 29,649,837 people, the weighted prevalence of sensory impairment was 6.1% (1,808,640/29,649,837). The regression revealed that adults with sensory impairment were 80% more likely not to maintain social distancing (odds ratio: 1.80, 95%CI: 1.03–3.13, p = 0.04) compared to those without impairment. No significant differences were found for adherence to other COVID-19 strategies. Individuals with sensory impairment may have increased difficulty with physical distancing due to their underlying impairment. Further studies are needed to explore risk reduction strategies for COVID-19 and the transmission of other infections for those with sensory impairment. 2025-05-02 Vision, Vol. 9, Pages 40: The Association Between Sensory Impairment and Adherence to COVID-19 Prevention Measures in the Adult California Health Interview Survey Population

Vision doi: 10.3390/vision9020040

Authors: Catherine T. Cascavita Ahmad Santina Ken Kitayama Fei Yu Victoria L. Tseng Anne L. Coleman

This study explores the association between vision/hearing impairment and COVID-19 prevention strategies in the 2020 and 2021 California Health Interview Survey (CHIS). This cross-sectional study used data from the 2020 and 2021 CHIS. The exposure of interest was self-reported history of sensory impairment. The outcome of interest was adherence to COVID-19 mitigation strategies defined as obtaining a COVID-19 vaccine, face mask adherence, hand washing, social distancing, and not gathering with non-household members. Logistic regression models examined the association between sensory impairment and adherence to COVID-19 mitigation strategies, controlling for age, sex, race and ethnicity, general health status, and household income. All analyses were weighted according to the CHIS sampling design. With 24,453 California adults representing 29,649,837 people, the weighted prevalence of sensory impairment was 6.1% (1,808,640/29,649,837). The regression revealed that adults with sensory impairment were 80% more likely not to maintain social distancing (odds ratio: 1.80, 95%CI: 1.03–3.13, p = 0.04) compared to those without impairment. No significant differences were found for adherence to other COVID-19 strategies. Individuals with sensory impairment may have increased difficulty with physical distancing due to their underlying impairment. Further studies are needed to explore risk reduction strategies for COVID-19 and the transmission of other infections for those with sensory impairment.

]]> The Association Between Sensory Impairment and Adherence to COVID-19 Prevention Measures in the Adult California Health Interview Survey Population Catherine T. Cascavita Ahmad Santina Ken Kitayama Fei Yu Victoria L. Tseng Anne L. Coleman doi: 10.3390/vision9020040 Vision 2025-05-02 Vision 2025-05-02 9 2 Article 40 10.3390/vision9020040 https://www.mdpi.com/2411-5150/9/2/40 Vision, Vol. 9, Pages 39: Training Improves Avoidance of Natural Sick Faces: Changes in Visual Attention and Approach Decisions https://www.mdpi.com/2411-5150/9/2/39 Humans evolved a behavioral immune system to avoid infectious disease, including the ability to detect sickness in faces. However, it is unclear whether the ability to recognize and avoid facial cues of disease is malleable, flexibly calibrated by experience. Thus, we experimentally tested whether we can improve adults’ (N = 133) lassitude (sick) face perception, measuring their recognition, avoidance, and visual attention to naturally sick and healthy faces. Participants randomly assigned to a training about disease, but not a control group, were better at avoiding sick people. The disease-trained group also looked more equally between sick and healthy faces when identifying who was sick compared to the control group who looked longer at the sick faces than the healthy faces. Though we detected no group differences in time looking at the eyes and at the mouths, the disease-trained group used these features more to decide who was sick, reflecting key features of the lassitude expression. Our findings suggest that facial sickness perception may be flexible, influenced by experience, and underscore the need for future studies to test how to further strengthen this skill. Ultimately, developing interventions that use this sick face plasticity may reduce disease transmission. 2025-05-02 Vision, Vol. 9, Pages 39: Training Improves Avoidance of Natural Sick Faces: Changes in Visual Attention and Approach Decisions

Vision doi: 10.3390/vision9020039

Authors: Tiffany S. Leung Krisztina V. Jakobsen Sarah E. Maylott Arushi Malik Shuo Zhang Elizabeth A. Simpson

Humans evolved a behavioral immune system to avoid infectious disease, including the ability to detect sickness in faces. However, it is unclear whether the ability to recognize and avoid facial cues of disease is malleable, flexibly calibrated by experience. Thus, we experimentally tested whether we can improve adults’ (N = 133) lassitude (sick) face perception, measuring their recognition, avoidance, and visual attention to naturally sick and healthy faces. Participants randomly assigned to a training about disease, but not a control group, were better at avoiding sick people. The disease-trained group also looked more equally between sick and healthy faces when identifying who was sick compared to the control group who looked longer at the sick faces than the healthy faces. Though we detected no group differences in time looking at the eyes and at the mouths, the disease-trained group used these features more to decide who was sick, reflecting key features of the lassitude expression. Our findings suggest that facial sickness perception may be flexible, influenced by experience, and underscore the need for future studies to test how to further strengthen this skill. Ultimately, developing interventions that use this sick face plasticity may reduce disease transmission.

]]> Training Improves Avoidance of Natural Sick Faces: Changes in Visual Attention and Approach Decisions Tiffany S. Leung Krisztina V. Jakobsen Sarah E. Maylott Arushi Malik Shuo Zhang Elizabeth A. Simpson doi: 10.3390/vision9020039 Vision 2025-05-02 Vision 2025-05-02 9 2 Article 39 10.3390/vision9020039 https://www.mdpi.com/2411-5150/9/2/39 Vision, Vol. 9, Pages 38: Short-Wavelength and Infrared Autofluorescence Imaging in Pachychoroid Neovasculopathy https://www.mdpi.com/2411-5150/9/2/38 Purpose: The purpose of this paper is to investigate the relationship between short-wavelength autofluorescence (SWAF) and infrared autofluorescence (IRAF) patterns in pachychoroid neovasculopathy (PNV) with serous retinal detachment (SRD). Methods: This study used an observational case series of 62 eyes of 58 consecutive patients diagnosed with symptomatic PNV from January 2019 and October 2021 at a single institution. SWAF and IRAF patterns were analyzed with disease chronicity, and autofluorescence changes in macular neovascularization (MNV) were assessed in two images. Results: SWAF patterns and the mean duration of symptoms were as follows: blocked (15 eyes, 24%), 1.0 months; mottled (8 eyes, 13%), 2.8 months; hyper (24 eyes, 39%), 5.0 months; hyper/hypo (10 eyes, 16%), 7.0 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). IRAF patterns and the mean duration of symptoms were as follows: blocked (17 eyes, 27%), 1.0 months; hyper (22 eyes, 35%), 4.0 months; mixed/hyper dominant (9 eyes, 15%), 5.0 months; mixed/hypo dominant (9 eyes, 15%), 6.8 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). Abnormal autofluorescence corresponding to MNV lesion was seen in 34 eyes (55%) with SWAF and 59 eyes (95%) with IRAF (p < 0.01). Conclusions: SWAF and IRAF show multiple patterns and are related to disease chronicity in symptomatic PNV. IRAF could be helpful in detecting the lesion of MNV. 2025-04-21 Vision, Vol. 9, Pages 38: Short-Wavelength and Infrared Autofluorescence Imaging in Pachychoroid Neovasculopathy

Vision doi: 10.3390/vision9020038

Authors: Norihiko Nakagawa Takuya Shunto Issei Nishiyama Kohei Maruyama Miki Sawa

Purpose: The purpose of this paper is to investigate the relationship between short-wavelength autofluorescence (SWAF) and infrared autofluorescence (IRAF) patterns in pachychoroid neovasculopathy (PNV) with serous retinal detachment (SRD). Methods: This study used an observational case series of 62 eyes of 58 consecutive patients diagnosed with symptomatic PNV from January 2019 and October 2021 at a single institution. SWAF and IRAF patterns were analyzed with disease chronicity, and autofluorescence changes in macular neovascularization (MNV) were assessed in two images. Results: SWAF patterns and the mean duration of symptoms were as follows: blocked (15 eyes, 24%), 1.0 months; mottled (8 eyes, 13%), 2.8 months; hyper (24 eyes, 39%), 5.0 months; hyper/hypo (10 eyes, 16%), 7.0 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). IRAF patterns and the mean duration of symptoms were as follows: blocked (17 eyes, 27%), 1.0 months; hyper (22 eyes, 35%), 4.0 months; mixed/hyper dominant (9 eyes, 15%), 5.0 months; mixed/hypo dominant (9 eyes, 15%), 6.8 months; descending tract (5 eyes, 8%), 12.0 months (p < 0.01). Abnormal autofluorescence corresponding to MNV lesion was seen in 34 eyes (55%) with SWAF and 59 eyes (95%) with IRAF (p < 0.01). Conclusions: SWAF and IRAF show multiple patterns and are related to disease chronicity in symptomatic PNV. IRAF could be helpful in detecting the lesion of MNV.

]]> Short-Wavelength and Infrared Autofluorescence Imaging in Pachychoroid Neovasculopathy Norihiko Nakagawa Takuya Shunto Issei Nishiyama Kohei Maruyama Miki Sawa doi: 10.3390/vision9020038 Vision 2025-04-21 Vision 2025-04-21 9 2 Article 38 10.3390/vision9020038 https://www.mdpi.com/2411-5150/9/2/38 Vision, Vol. 9, Pages 37: The Phenomenology of Offline Perception: Multisensory Profiles of Voluntary Mental Imagery and Dream Imagery https://www.mdpi.com/2411-5150/9/2/37 Both voluntary mental imagery and dream imagery involve multisensory representations without externally present stimuli that can be categorized as offline perceptions. Due to common mechanisms, correlations between multisensory dream imagery profiles and multisensory voluntary mental imagery profiles were hypothesized. In a sample of 226 participants, correlations within the respective state of consciousness were significantly bigger than across, favouring two distinct networks. However, the association between the vividness of voluntary mental imagery and vividness of dream imagery was moderated by the frequency of dream recall and lucid dreaming, suggesting that both networks become increasingly similar when higher metacognition is involved. Additionally, the vividness of emotional and visual imagery was significantly higher for dream imagery than for voluntary mental imagery, reflecting the immersive nature of dreams and the continuity of visual dominance while being awake and asleep. In contrast, the vividness of auditory, olfactory, gustatory, and tactile imagery was higher for voluntary mental imagery, probably due to higher cognitive control while being awake. Most results were replicated four weeks later, weakening the notion of state influences. Overall, our results indicate similarities between dream imagery and voluntary mental imagery that justify a common classification as offline perception, but also highlight important differences. 2025-04-21 Vision, Vol. 9, Pages 37: The Phenomenology of Offline Perception: Multisensory Profiles of Voluntary Mental Imagery and Dream Imagery

Vision doi: 10.3390/vision9020037

Authors: Maren Bilzer Merlin Monzel

Both voluntary mental imagery and dream imagery involve multisensory representations without externally present stimuli that can be categorized as offline perceptions. Due to common mechanisms, correlations between multisensory dream imagery profiles and multisensory voluntary mental imagery profiles were hypothesized. In a sample of 226 participants, correlations within the respective state of consciousness were significantly bigger than across, favouring two distinct networks. However, the association between the vividness of voluntary mental imagery and vividness of dream imagery was moderated by the frequency of dream recall and lucid dreaming, suggesting that both networks become increasingly similar when higher metacognition is involved. Additionally, the vividness of emotional and visual imagery was significantly higher for dream imagery than for voluntary mental imagery, reflecting the immersive nature of dreams and the continuity of visual dominance while being awake and asleep. In contrast, the vividness of auditory, olfactory, gustatory, and tactile imagery was higher for voluntary mental imagery, probably due to higher cognitive control while being awake. Most results were replicated four weeks later, weakening the notion of state influences. Overall, our results indicate similarities between dream imagery and voluntary mental imagery that justify a common classification as offline perception, but also highlight important differences.

]]> The Phenomenology of Offline Perception: Multisensory Profiles of Voluntary Mental Imagery and Dream Imagery Maren Bilzer Merlin Monzel doi: 10.3390/vision9020037 Vision 2025-04-21 Vision 2025-04-21 9 2 Article 37 10.3390/vision9020037 https://www.mdpi.com/2411-5150/9/2/37 Vision, Vol. 9, Pages 36: The Relationship Between Anxiety Sensitivity, Emotional States, and Dry Eye Disease Symptom Severity: A Cross-Sectional Study https://www.mdpi.com/2411-5150/9/2/36 Dry eye disease (DED) is often comorbid with psychiatric conditions and psychological disturbances like anxiety and depression. The psychological symptoms are mostly considered to be a consequence of DED or a side-effect of medication. However, the possible psychological etiology of DED is seldom explored. This study explores the relationship between anxiety sensitivity (AS), unpleasant emotional states, and the severity of DED symptoms in a healthy general population sample in Croatia. A total of 766 adults (62.27% females) aged between 18 and 88 years completed an online survey consisting of the Ocular Surface Disease Index (OSDI), Anxiety Sensitivity Index (ASI), and Depression Anxiety Stress Scales (DASS21) together with socio-demographic data. The results revealed significant positive correlations between ASI, emotional states, and OSDI (r = 0.25–0.29, p < 0.01). Mediation analysis showed that DASS21 significantly mediates the relationship between ASI and OSDI (B = 0.1, CI = [0.004, 0.2]). Highly anxiety sensitive people are more sensitive to DED symptoms, which additionally increases in a state of emotional stress. Thus, DED symptoms are perceived more intensely and frequently than in less sensitive people. Understanding these associations is crucial for comprehensive DED management, indicating potential benefits from addressing psychological health in DED patients and eye health in psychiatric patients. 2025-04-18 Vision, Vol. 9, Pages 36: The Relationship Between Anxiety Sensitivity, Emotional States, and Dry Eye Disease Symptom Severity: A Cross-Sectional Study

Vision doi: 10.3390/vision9020036

Authors: Marko Toth Nataša Jokić-Begić Sandro Krašić

Dry eye disease (DED) is often comorbid with psychiatric conditions and psychological disturbances like anxiety and depression. The psychological symptoms are mostly considered to be a consequence of DED or a side-effect of medication. However, the possible psychological etiology of DED is seldom explored. This study explores the relationship between anxiety sensitivity (AS), unpleasant emotional states, and the severity of DED symptoms in a healthy general population sample in Croatia. A total of 766 adults (62.27% females) aged between 18 and 88 years completed an online survey consisting of the Ocular Surface Disease Index (OSDI), Anxiety Sensitivity Index (ASI), and Depression Anxiety Stress Scales (DASS21) together with socio-demographic data. The results revealed significant positive correlations between ASI, emotional states, and OSDI (r = 0.25–0.29, p < 0.01). Mediation analysis showed that DASS21 significantly mediates the relationship between ASI and OSDI (B = 0.1, CI = [0.004, 0.2]). Highly anxiety sensitive people are more sensitive to DED symptoms, which additionally increases in a state of emotional stress. Thus, DED symptoms are perceived more intensely and frequently than in less sensitive people. Understanding these associations is crucial for comprehensive DED management, indicating potential benefits from addressing psychological health in DED patients and eye health in psychiatric patients.

]]> The Relationship Between Anxiety Sensitivity, Emotional States, and Dry Eye Disease Symptom Severity: A Cross-Sectional Study Marko Toth Nataša Jokić-Begić Sandro Krašić doi: 10.3390/vision9020036 Vision 2025-04-18 Vision 2025-04-18 9 2 Article 36 10.3390/vision9020036 https://www.mdpi.com/2411-5150/9/2/36 Vision, Vol. 9, Pages 35: Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration https://www.mdpi.com/2411-5150/9/2/35 Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). To date, anti-vascular endothelial growth factor (VEGF) treatment has been widely used to manage neovascular diseases associated with retinal ischemia. Nonetheless, a substantial number of patients with DR or AMD still suffer from incomplete response and adverse effects related to its therapy with limitations. Therefore, research scientists have been developing and finding novel treatments to protect against or prevent vision loss in those diseases. In this review article, we summarize the recent novel therapeutic approaches for the treatment of ischemic retinopathy (e.g., cell therapy, advanced molecular targeting, or drug delivery). This summary enables further research to obtain more solid evidence of novel effective drug development in retinal ischemic diseases. 2025-04-17 Vision, Vol. 9, Pages 35: Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration

Vision doi: 10.3390/vision9020035

Authors: Deokho Lee Soo Jin Kim Junyeop Lee

Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). To date, anti-vascular endothelial growth factor (VEGF) treatment has been widely used to manage neovascular diseases associated with retinal ischemia. Nonetheless, a substantial number of patients with DR or AMD still suffer from incomplete response and adverse effects related to its therapy with limitations. Therefore, research scientists have been developing and finding novel treatments to protect against or prevent vision loss in those diseases. In this review article, we summarize the recent novel therapeutic approaches for the treatment of ischemic retinopathy (e.g., cell therapy, advanced molecular targeting, or drug delivery). This summary enables further research to obtain more solid evidence of novel effective drug development in retinal ischemic diseases.

]]> Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration Deokho Lee Soo Jin Kim Junyeop Lee doi: 10.3390/vision9020035 Vision 2025-04-17 Vision 2025-04-17 9 2 Review 35 10.3390/vision9020035 https://www.mdpi.com/2411-5150/9/2/35 Vision, Vol. 9, Pages 34: Reconciling the Neurophysiological and Cognitive Theories of Stimulus–Response Spatial Compatibility Effects: A Visual–Motor Dissociation Approach https://www.mdpi.com/2411-5150/9/2/34 This study investigated the differential impact of two visual dimensions (direction and spatial location) in two spatial Stroop tasks, where the relevant dimension for the response varied. Three studies compared the interactions between spatial compatibility and congruence effects on reaction time performances to infer how the dorsal pathway (DP) and ventral pathway (VP) of visual processing interfered with one another in processing relevant and irrelevant spatial information. This allowed us to bridge neurophysiological mechanisms with dual-process models of spatial compatibility. The participants responded from an avatar’s perspective, manipulated through rotations relative to the forward position, along with independent rotations of the avatar’s screen and keyboard. The results revealed two distinct response patterns: in the Direction Stroop, the performance was influenced equally by the relevant direction (VP) and the automatic processing of irrelevant location (DP); in the Location Stroop, the VP exerted minimal interference on the DP. Furthermore, the Only Keyboard rotation disrupted hand–eye coordination, modulating the DP interference on the VP in the Direction Stroop. These findings provide insights into the functional interaction of these visual pathways and their contributions to spatial compatibility effects, along with evidence for the dual-process model of spatial compatibility. Some issues about the separation of visual pathways are discussed based on our results. 2025-04-17 Vision, Vol. 9, Pages 34: Reconciling the Neurophysiological and Cognitive Theories of Stimulus–Response Spatial Compatibility Effects: A Visual–Motor Dissociation Approach

Vision doi: 10.3390/vision9020034

Authors: Elton H. Matsushima Jose Antonio Aznar-Casanova

This study investigated the differential impact of two visual dimensions (direction and spatial location) in two spatial Stroop tasks, where the relevant dimension for the response varied. Three studies compared the interactions between spatial compatibility and congruence effects on reaction time performances to infer how the dorsal pathway (DP) and ventral pathway (VP) of visual processing interfered with one another in processing relevant and irrelevant spatial information. This allowed us to bridge neurophysiological mechanisms with dual-process models of spatial compatibility. The participants responded from an avatar’s perspective, manipulated through rotations relative to the forward position, along with independent rotations of the avatar’s screen and keyboard. The results revealed two distinct response patterns: in the Direction Stroop, the performance was influenced equally by the relevant direction (VP) and the automatic processing of irrelevant location (DP); in the Location Stroop, the VP exerted minimal interference on the DP. Furthermore, the Only Keyboard rotation disrupted hand–eye coordination, modulating the DP interference on the VP in the Direction Stroop. These findings provide insights into the functional interaction of these visual pathways and their contributions to spatial compatibility effects, along with evidence for the dual-process model of spatial compatibility. Some issues about the separation of visual pathways are discussed based on our results.

]]> Reconciling the Neurophysiological and Cognitive Theories of Stimulus–Response Spatial Compatibility Effects: A Visual–Motor Dissociation Approach Elton H. Matsushima Jose Antonio Aznar-Casanova doi: 10.3390/vision9020034 Vision 2025-04-17 Vision 2025-04-17 9 2 Article 34 10.3390/vision9020034 https://www.mdpi.com/2411-5150/9/2/34 Vision, Vol. 9, Pages 33: Coherent Interpretation of Entire Visual Field Test Reports Using a Multimodal Large Language Model (ChatGPT) https://www.mdpi.com/2411-5150/9/2/33 This study assesses the accuracy and consistency of a commercially available large language model (LLM) in extracting and interpreting sensitivity and reliability data from entire visual field (VF) test reports for the evaluation of glaucomatous defects. Single-page anonymised VF test reports from 60 eyes of 60 subjects were analysed by an LLM (ChatGPT 4o) across four domains—test reliability, defect type, defect severity and overall diagnosis. The main outcome measures were accuracy of data extraction, interpretation of glaucomatous field defects and diagnostic classification. The LLM displayed 100% accuracy in the extraction of global sensitivity and reliability metrics and in classifying test reliability. It also demonstrated high accuracy (96.7%) in diagnosing whether the VF defect was consistent with a healthy, suspect or glaucomatous eye. The accuracy in correctly defining the type of defect was moderate (73.3%), which only partially improved when provided with a more defined region of interest. The causes of incorrect defect type were mostly attributed to the wrong location, particularly confusing the superior and inferior hemifields. Numerical/text-based data extraction and interpretation was overall notably superior to image-based interpretation of VF defects. This study demonstrates the potential and also limitations of multimodal LLMs in processing multimodal medical investigation data such as VF reports. 2025-04-11 Vision, Vol. 9, Pages 33: Coherent Interpretation of Entire Visual Field Test Reports Using a Multimodal Large Language Model (ChatGPT)

Vision doi: 10.3390/vision9020033

Authors: Jeremy C. K. Tan

This study assesses the accuracy and consistency of a commercially available large language model (LLM) in extracting and interpreting sensitivity and reliability data from entire visual field (VF) test reports for the evaluation of glaucomatous defects. Single-page anonymised VF test reports from 60 eyes of 60 subjects were analysed by an LLM (ChatGPT 4o) across four domains—test reliability, defect type, defect severity and overall diagnosis. The main outcome measures were accuracy of data extraction, interpretation of glaucomatous field defects and diagnostic classification. The LLM displayed 100% accuracy in the extraction of global sensitivity and reliability metrics and in classifying test reliability. It also demonstrated high accuracy (96.7%) in diagnosing whether the VF defect was consistent with a healthy, suspect or glaucomatous eye. The accuracy in correctly defining the type of defect was moderate (73.3%), which only partially improved when provided with a more defined region of interest. The causes of incorrect defect type were mostly attributed to the wrong location, particularly confusing the superior and inferior hemifields. Numerical/text-based data extraction and interpretation was overall notably superior to image-based interpretation of VF defects. This study demonstrates the potential and also limitations of multimodal LLMs in processing multimodal medical investigation data such as VF reports.

]]> Coherent Interpretation of Entire Visual Field Test Reports Using a Multimodal Large Language Model (ChatGPT) Jeremy C. K. Tan doi: 10.3390/vision9020033 Vision 2025-04-11 Vision 2025-04-11 9 2 Article 33 10.3390/vision9020033 https://www.mdpi.com/2411-5150/9/2/33