Vision

20 pages, 986 KB

Open AccessSystematic Review

Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review of Ophthalmic Management and Treatment

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

Vision 2025, 9(3), 78; https://doi.org/10.3390/vision9030078 - 11 Sep 2025

Abstract

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 [...] Read more.

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. Full article

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13 pages, 1000 KB

Open AccessArticle

Predicting Pattern Standard Deviation in Glaucoma: A Machine Learning Approach Leveraging Clinical Data

by Raheem Remtulla, Patrik Abdelnour, Daniel R. Chow, Andres C. Ramos, Guillermo Rocha and Paul Harasymowycz

Vision 2025, 9(3), 77; https://doi.org/10.3390/vision9030077 - 1 Sep 2025

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Retinal and Optic Nerve Diseases: New Advances and Current Challenges)

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10 pages, 505 KB

Open AccessArticle

Gaze Dispersion During a Sustained-Fixation Task as a Proxy of Visual Attention in Children with ADHD

by Lionel Moiroud, Ana Moscoso, Eric Acquaviva, Alexandre Michel, Richard Delorme and Maria Pia Bucci

Vision 2025, 9(3), 76; https://doi.org/10.3390/vision9030076 - 1 Sep 2025

Abstract

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 [...] Read more.

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. Full article

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12 pages, 1154 KB

Open AccessArticle

A Comparative Study Between Clinical Optical Coherence Tomography (OCT) Analysis and Artificial Intelligence-Based Quantitative Evaluation in the Diagnosis of Diabetic Macular Edema

by Camila Brandão Fantozzi, Letícia Margaria Peres, Jogi Suda Neto, Cinara Cássia Brandão, Rodrigo Capobianco Guido and Rubens Camargo Siqueira

Vision 2025, 9(3), 75; https://doi.org/10.3390/vision9030075 - 1 Sep 2025

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Section Retinal Function and Disease)

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19 pages, 2318 KB

Open AccessArticle

Modulating Multisensory Processing: Interactions Between Semantic Congruence and Temporal Synchrony

by Susan Geffen, Taylor Beck and Christopher W. Robinson

Vision 2025, 9(3), 74; https://doi.org/10.3390/vision9030074 - 1 Sep 2025

Abstract

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. [...] Read more.

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. Full article

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10 pages, 348 KB

Open AccessArticle

Effect of Acetazolamide on Intraocular Pressure After Uneventful Phacoemulsification Using an Anterior Chamber Maintainer

by Assaf Kratz, Tom Kornhauser, Eyal Walter, Ran Abuhasira, Ivan Goldberg and Aviel Hadad

Vision 2025, 9(3), 73; https://doi.org/10.3390/vision9030073 - 28 Aug 2025

Abstract

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, [...] Read more.

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. Full article

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17 pages, 1059 KB

Open AccessArticle

Three-View Relative Pose Estimation Under Planar Motion Constraints

by Ziqin Dai, Weimin Lv and Liang Liu

Vision 2025, 9(3), 72; https://doi.org/10.3390/vision9030072 - 25 Aug 2025

Abstract

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 [...] Read more.

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. Full article

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37 pages, 525 KB

Open AccessReview

Clinical Applications of Artificial Intelligence in Corneal Diseases

by Omar Nusair, Hassan Asadigandomani, Hossein Farrokhpour, Fatemeh Moosaie, Zahra Bibak-Bejandi, Alireza Razavi, Kimia Daneshvar and Mohammad Soleimani

Vision 2025, 9(3), 71; https://doi.org/10.3390/vision9030071 - 18 Aug 2025

Abstract

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 [...] Read more.

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. Full article

10 pages, 434 KB

Open AccessArticle

Color Vision in Schoolchildren with Low Birth Weight and Those Born Full-Term with Appropriate Weight for Gestational Age

by Paula Yuri Sacai, Maria Cecília Saccomani Lapa, Rosana Fiorini Puccini and Nívea Nunes Ferraz

Vision 2025, 9(3), 70; https://doi.org/10.3390/vision9030070 - 12 Aug 2025

Abstract

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) [...] Read more.

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. Full article

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14 pages, 895 KB

Open AccessArticle

Form and Temporal Integration in the Perception of Simple Glass Patterns

by Rita Donato, Michele Vicovaro, Massimo Nucci, Marco Roccato, Gianluca Campana and Andrea Pavan

Vision 2025, 9(3), 69; https://doi.org/10.3390/vision9030069 - 4 Aug 2025

Abstract

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 [...] Read more.

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. Full article

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9 pages, 557 KB

Open AccessArticle

Is Combined PhacoAhmed Less Effective than Ahmed Surgery Alone? A 5-Year Retrospective Study of Long-Term Effects

by Maria Vivas, José Charréu, Bruno Pombo, Tomás Costa, Ana Sofia Lopes, Fernando Trancoso Vaz, Maria João Santos and Isabel Prieto

Vision 2025, 9(3), 68; https://doi.org/10.3390/vision9030068 - 4 Aug 2025

Abstract

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 [...] Read more.

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. Full article

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13 pages, 692 KB

Open AccessArticle

Contrast Sensitivity Comparison of Daily Simultaneous-Vision Center-Near Multifocal Contact Lenses: A Pilot Study

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

Vision 2025, 9(3), 67; https://doi.org/10.3390/vision9030067 - 1 Aug 2025

Abstract

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) [...] Read more.

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. Full article

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12 pages, 1090 KB

Open AccessArticle

Behavioral Interference by Emotional Stimuli: Sequential Modulation by Perceptual Conditions but Not by Emotional Primes

by Andrea De Cesarei, Virginia Tronelli, Serena Mastria, Vera Ferrari and Maurizio Codispoti

Vision 2025, 9(3), 66; https://doi.org/10.3390/vision9030066 - 1 Aug 2025

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Section Visual Neuroscience)

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10 pages, 710 KB

Open AccessArticle

CPAP Use and Retinal Disease Risk in Obstructive Apnea: A Cohort Study

by 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 and Ricardo Noguera Louzada

Vision 2025, 9(3), 65; https://doi.org/10.3390/vision9030065 - 1 Aug 2025

Abstract

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) [...] Read more.

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. Full article

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14 pages, 727 KB

Open AccessReview

The Retinal Complications of C3 Dense Deposit Disease: A Scoping Review

by Jolene McCarney, Katie Curran, Tunde Peto, Giuliana Silvestri and Laura N. Cushley

Vision 2025, 9(3), 64; https://doi.org/10.3390/vision9030064 - 1 Aug 2025

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Retinal and Optic Nerve Diseases: New Advances and Current Challenges)

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6 pages, 1774 KB

Open AccessPerspective

Case Series: Reactivation of Herpetic Keratitis After COVID-19 mRNA Vaccination During Herpetic Prophylaxis

by Michael Tsatsos, Efthymia Prousali, Athanasios Karamitsos and Nikolaos Ziakas

Vision 2025, 9(3), 63; https://doi.org/10.3390/vision9030063 - 28 Jul 2025

Abstract

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 [...] Read more.

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. Full article

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16 pages, 554 KB

Open AccessSystematic Review

Ocular Manifestations in Congenital Insensitivity to Pain with Anhidrosis: A Window into a Rare Syndrome

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

Vision 2025, 9(3), 62; https://doi.org/10.3390/vision9030062 - 21 Jul 2025

Abstract

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, [...] Read more.

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. Full article

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11 pages, 1062 KB

Open AccessArticle

Third-Generation Trabecular Micro-Bypass Implantation and Phacoemulsification in Patients with Glaucoma: A Multicenter Study

by Mitchell Shultz, Zachary M. Vest, Valerie Trubnik, Steven R. Sarkisian, Jr. and Dana M. Hornbeak

Vision 2025, 9(3), 61; https://doi.org/10.3390/vision9030061 - 19 Jul 2025

Abstract

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 [...] Read more.

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. Full article

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14 pages, 633 KB

Open AccessArticle

Efficacy of Small Incision Cataract Surgery: A Multicenter Retrospective Study of Visual Outcomes in Coastal Ecuador

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

Vision 2025, 9(3), 60; https://doi.org/10.3390/vision9030060 - 15 Jul 2025

Abstract

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 [...] Read more.

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. Full article

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