bluuebunny/crossref_metadata_2025 huggingface dataset:
Where visual fields coming from? ‐ A short introduction from neurophysiology point of view
Authors: Lewin‐Kowalik Joanna
Published: January 2024

Visual fields refer to the area of vision that can be seen by each eye when it is fixed in a certain position. The visual fields are created by the combination of the images received by each eye, which are then processed by the brain to create a single, unified image. The visual fields are divided into four quadrants: superior, inferior, nasal, and temporal. Each eye sees a slightly different portion of the visual field, and the brain combines these two images to create a three‐dimensional perception of the world.

The visual fields are outcome of the interaction of the ocular structures, optic nerve, and brain centres. The eye captures images of the visual field through the cornea and lens, which focus the light onto the retina. The retina contains specialized photoreceptors, which convert the light into electrical signals that are transmitted through the optic nerve to the brain. The images are first integrated and processed within lateral geniculate nuclei of the thalamus. In this important structure visual stimuli are first filtered, to eliminate irrelevant or unnecessary information, allowing only important visual signals to pass on to the visual cortex, then integrated from both eyes, allowing for depth perception and 3D vision, processed, based on features such as colour, contrast, and movement, which are then relayed to the visual cortex and synchronized with other sensory information in the brain, allowing for a coherent perception of the environment. The visual cortex in the brain then processes these integrated signals to create the perception of the visual field. This complex process allows us to see and interpret the world around us, including objects, people, and scenery, and to respond to them in a meaningful way.
Benign masquerade syndromes ‐ An overview
Authors: Salas Ester Carreño
Published: January 2024

Uveitis are complex diseases with often a difficult diagnosis and management. Other conditions can mimic uveitis. Among those there are also benign (no malignant) conditions such as inherited retinal diseases or vascular retinopathies. The aim of this talks is to provide an overview of the different benign conditions that we need to know to properly diagnose and treat uveitis.
Low‐cost fundoscopy simulation for everyone? Evaluation of knowledge gain and student satisfaction with the Kyoto Kagaku model
Authors: Sneyers Albéric , Alles Felix , Dail Yaser Abu , Seitz Berthold , Flockerzi Elias
Published: January 2024

Purpose: To evaluate the influence of a relatively low‐cost fundoscopy simulator, the Kyoto Kagaku Model, on the subjective learning experience and an objective knowledge gain of medical students at Saarland University Medical Center, Homburg, Germany.

Methods: Medical students at the Saarland University Medical Center were enrolled in a clinical course about fundoscopic examination and pathologies. The course consisted of a theoretical part, an introduction to the practical basics of ophthalmoscopy with the Kyoto Kagaku fundoscopy simulator, and a clinical practice with dilated pupils on each other (the classical ophthalmoscopy course). They then completed two questionnaires. The first one was about the subjective learning experience and was filled out shortly after the course, the second one about the objective clinical knowledge gain in ophthalmoscopy and was filled out before the start of ophthalmoscopy training and 1 week thereafter.

Results: The medical students showed a significant (p < 0.001) gain in knowledge of the fundoscopic examination and pathologies after the course with the Kyoto Kaguka Fundoscopy Simulator. Specific anatomical structures in the fundus were identified significantly (p < 0.001) more often during the simulator training compared to the classical ophthalmoscopy course. 47% of the medical students preferred a simulator‐based course, 23% a classical ophthalmoscopy course and 30% a combination of both.

Conclusion: Simulator‐based training is a valuable tool for teaching medical students (and aspiring resident physicians) various skills, including those related to ophthalmology. Hands‐on courses using the Kyoto Kagaku fundoscopy simulator have been successful in increasing medical students' interest in medical simulation and ophthalmology. This model, known for its relatively low cost, is a good immersive tool for teaching the basics of direct and indirect fundoscopic examination and various retinal pathologies. Although there are still challenges to overcome, such as accessibility and cost, the future of simulator‐based training in ophthalmology looks promising.
New trends in effective monitoring of inflammation in uveitis
Authors: Tranos Paris
Published: January 2024

Ocular inflammatory diseases account for a significant number of blind registrations worldwide, involving predominantly young patients. Differential diagnosis of uveitis cases maybe challenging as they are infrequent and share common features. With the evolution of multimodal imaging several new signs of inflammation have been described facilitating prompt and effective diagnosis. Non‐invasive modalities including OCT, OCT‐A and Autofluorescence along with traditional diagnostic techniques such as fluoresceine and indocyanine green angiography provide plausible evidence of activity or remission of inflammation which can be used to determine further management and follow‐up. This lecture will highlight imaging features essential in efficacious monitoring of uveitis.
10 common mistakes in uveitis. A guide to escape disasters
Authors: Tranos Paris
Published: January 2024

Intraocular inflammatory diseases are relatively rare, involving predominantly younger patients and are usually characterized by rapid progression. Consequently, effective management of uveitis requires prompt diagnosis and initiation of the correct treatment regimen without delay, an occasionally challenging task for the non‐specialist ophthalmologist. Despite the frequent overlap of clinical features in uveitis patients, certain disease characteristics should be recognized to facilitate efficacy and avoidance of pitfalls. We provide a survival guide of 10 crucial key points, essential to ensure the optimum outcome and safe management in inflammatory conditions.
Dealing with the complications of uveitis
Authors: Koufakis Dimitris
Published: January 2024

The most frequent complications of uveitis are cataract, glaucoma and uveitic macular oedema.

The successful management of cataract requires uveitis remission for at least 3 months before surgery and perioperative intensification of anti‐inflammatory medication in order to prevent uveitis recurrences. Intraoperative strategy is also important for the final outcome.

Uveitic glaucoma management comprises medical and surgical treatment, considering that about 30% of cases will need invasive methods.

Uveitic macular oedema is mainly seen in intermediate, posterior or panuveitis. The mainstay of treatment is corticosteroids and the therapeutic role of immunosuppressives and biological agents will also be discussed.
Fundus autofluorescence in uveitis: Meeting an old friend
Authors: Follonosa Alejandro
Published: January 2024

Fundus autofluorescence (FAF) represents a relatively new imaging modality that has been investigated in a variety of uveitic disease processes. FAF relies on the presence of innate fluorophores within ocular tissues, which can be induced to emit light when stimulated with specific frequencies of light.

Autofluorescence in the RPE depends on the outer segment renewal and can be affected by the RPE's ability to clear lipofuscin. Hence, an increased autofluorescence is seen with RPE dysfunction and a decreased autofluorescence is seen with loss of photorecptors or the RPE.

Abnormal autofluorescence patterns have been described in a number of infectious and non‐infectious uveitides. Most reports of abnormal FAF in patients with uveitis belong to the spectrum of white‐dot‐syndromes. In the present course we will review the main autofluorescence abnormalities in disease like Serpiginous and Serpiginous‐like choroiditis, multifocal choroiditis, punctate inner choroiditis, multiple evanescent white dot syndrome and AZOOR. The recognition of theses abnormalities (in combination with other imaging techniques like optical coherence tomography and optical coherence tomography‐angiography) is extremely helpful for understanding their pathogenesis and monitoring the inflammatory activity.
Cost‐effective smMIPs‐based sequencing to provide a genetic diagnosis for patients with retinitis pigmentosa, Leber congenital amaurosis and macular diseases
Authors: Panneman Daan M. , Hitti‐Malin Rebekkah J. , Roosing Susanne , Cremers Frans P. M.
Published: January 2024

Obtaining a genetic diagnosis for IRDs is challenging as more than 280 genes are associated with these conditions. Next‐generation sequencing approaches such as whole exome and genome sequencing are often used but their costs and required infrastructure still prohibit global applicability. Previous studies have shown the cost‐effectiveness of sequence analysis using single molecule Molecular Inversion Probes (smMIPs) in a cohort of patients diagnosed with Stargardt disease and other maculopathies. Recently, we have developed two smMIPs based panels, one panel to target all genes known to cause retinitis pigmentosa (RP) and Leber congenital amaurosis (LCA), and one panel to target all genes associated with macular diseases (MD). The RP‐LCA and MD panels were used to sequence 4381 and 1352 genetically unsolved probands, respectively. During this lecture, we will discuss the results and effectiveness of our smMIPs based sequencing efforts and highlight some of the novel genotype–phenotype correlations that were identified using these large cohorts.
Altered cell fates of limbal stem cells in aniridia associated with PAX6 mutations
Authors: Zhou Huiqing (Jo)
Published: January 2024

Proper biological function of stem cells in tissues and organs relies on their correct cell fates, and transcription factors (TFs) play key roles in controlling cell fate. Altered cell fates of stem cells due to genetic mutations or other factors can lead to developmental and homeostatic abnormalities. Aniridia is caused by mutations that affect the transcription factor PAX6, and patients with aniridia suffer from congenital and progressive corneal opacification. This is at least partly due to deficient function of limbal stem cells (LSCs) located in the periphery of the cornea. To test the hypothesis that corneal opacity is associated with altered cell fates in LSCs of aniridia patients, we performed transcriptome analyses using two different types of stem cells derived from aniridia patients: induced pluripotent stem cells (iPSCs) and primary limbal stem cells (pLSCs). First, we differentiated iPSCs to obtain induced LSCs. Our transcriptome data showed that induced LSCs derived from aniridia patients do not have the same epithelial identity as normal cells, but instead have an enhanced neural or pluripotent identity. In parallel, we investigated whether patient‐derived pLSCs could adopt the cell fate of a similar epithelial cell type, specifically skin keratinocytes, which give rise to the non‐transparent epidermis. By comparing the transcriptomes of these two cell types, we observed a clear loss of the normal LSC fate in the aniridia pLSCs as compared to normal pLSCs. However, the gain of keratinocyte cell fate was not evident. These findings demonstrate the essential role of PAX6 function in determining the correct cell fate of LSCs.
Natural food or Nutraceutics. That is the question
Authors: Duran Maria Dolores Pinazo
Published: January 2024

Current knowledge on natural food and nutraceutics is an interesting research topic for the eyes and vision, especially regarding the mechanisms of action, as well as the development of strategies for their use in personalized medicine. Specific components of food are involved in the regulation of signalling pathways related to the main pathophysiological events, such as oxidative stress, inflammation, angiogenesis, or apoptosis, thus directly impacting the course of diseases. The potential interaction of the biologically active food/nutraceutic components with pharmaceutical drugs or its special impact in younger and older adults are taken into consideration to better address the appropriate use of natural food or nutraceutics, to reach the expected effect in each case. In this context, the ocular surface disorders, glaucoma, cataracts, diabetic retinopathy and age macular degeneration are revisited in this Special Interest Symposia.
Reactive microglia as triggers and effectors of inflammasome activation in the retina
Authors: Langmann Thomas
Published: January 2024

This talk highlights the role of retinal microglia in different aspects of inflammasome activation during retinal degenerative and inflammatory diseases. We will first highlight the mechanisms how loss of retinal homeostasis evokes an unbalanced immune reaction involving responses of local microglia and recruited macrophages. We then summarize the scientific evidence for a critical role of microglia for inflammasome activity in the retina derived from cell culture studies and experimental animal research.
Corneal tumours
Authors: Szalai Eszter
Published: January 2024

Cornea is considered a rare primary site for neoplasms, but it can be involved secondarily in a wide spectrum of pigmented and non‐pigmented ocular surface tumours. Although the gold standard diagnostic technique is excisional biopsy, non‐invasive imaging modalities offer a diagnostic alternative to biopsy by providing high‐resolution cross‐sectional images of the ocular surface. Traditionally corneal neoplasms have been treated with surgical excision. However, recurrence rates after surgery can be high and extended or repeated surgeries may lead to scarring and/or limbal stem cell deficiencies, thus non‐surgical treatment options have been used increasingly.
Is it possible to reduce glial activation in an old taupathia mouse model by deletion of microglial Hemoxygenase‐1?
Authors: Salobrar‐Garcia Elena
Published: January 2024

Tauopathies such as Alzheimer's disease are characterized by the accumulation of neurotoxic aggregates of tau protein. With aging and, especially, in Alzheimer's patients, the inducible enzyme heme oxygenase 1 (HO‐1) progressively increases in microglia, causing iron accumulation, neuroinflammation, and neurodegeneration. The retina is an organ that can be readily accessed and can reflect changes that occur in the brain. In this context, we evaluated how the lack of microglial HO‐1, using mice that do not express HO‐1 in microglia (HMO‐KO), impacts retinal macro and microgliosis of aged subjects (18 months old mice) subjected to tauopathy by intrahippocampal delivery of AAV‐hTauP301L (TAU). Our results show that although tauopathy, measured as anti‐TAUY9 and anti‐AT8 positive immunostaining, was not observed in the retina of WT‐TAU or HMO‐KO + TAU mice, a morphometric study of retinal microglia and macroglia showed significant retinal changes in the TAU group compared to the WT group, such as: (i) increased number of activated microglia, (ii) retraction of microglial processes, (iii) increased number of CD68+ microglia, and (iv) increased retinal area occupied by GFAP (AROA) and C3 (AROC3). This retinal inflammatory profile was reduced in HMO‐KO + TAU mice. Therefore, a reduction of microglial HO‐1 could be beneficial to prevent tauopathy‐induced neuroinflammation.
Impact of topical glaucoma medications on the ocular surface and adnexa
Authors: Messmer Elisabeth M.
Published: January 2024

Ocular surface disease (OSD) is a major and often unrecognized issue in patients with glaucoma. The prevalence of ODS symptoms in glaucoma patients is between 48% and 59%. The prevalence of ODS signs in glaucoma patients stretches from 22% for corneal fluorescein staining until 78% for tear film BUT. Possible risk factors for OSD in glaucoma include female gender, higher age, pre‐existing DED, glaucoma itself, glaucoma type, glaucoma duration, number of glaucoma medications and frequency of instillation, active ingredient of glaucoma drug, preservatives esp. Benzalkonium chloride in glaucoma drug, and glaucoma filtration surgery.
Optical methods in myopia control
Authors: Bremond‐Gignac Dominique
Published: January 2024

Myopia control devices are essentially based on hyperopic defocus phenomenon induced in mid‐periphery of the retina. Increased frequency of myopia in children and evolutive forms needs to propose at least an optical device. Ocular check‐up is performed to adapt the best system for control myopia evolution in children. Optical correction is based on defocus system to control myopia. Defocus glasses with different systems (DIMS, HALT, progressive system…), defocus soft contact lenses with systems (dual concentric ring, EDOF), and orthokeratology are proposed. Different systems to treat myopia must be customized to children and parents needs.
Repeated low‐level red‐light therapy as a new myopia control strategy
Authors: Zeng Junwen
Published: January 2024

Repeated low‐level red‐light therapy (RLRL) has been proposed as a new method to control myopia progression. RLRL is delivered by a desktop device at home under parental supervision. The device emits red light through semiconductor laser diode. This lecture will present the most up‐to‐date information on treatment, evidence on clinical efficacy and safety, as well as possible mechanism of the therapy.
Biomarkers in retinal detachment surgery. How can we improve visual outcomes
Authors: Tranos Paris
Published: January 2024

Rhegmatogenous retinal detachment (RRD) is associated with separation of the neurosensory retina from the RPE, leading to visual field defect and potential reduction of central vision. Despite significant improvement in primary and final reattachment rate exceeding 90% and 98% respectively, functional outcomes are still difficult to predict and vary widely. In cases with macular involvement several factors have been implicated in the final visual recovery. These biomarkers are either related to individual risk factors (e.g., duration of symptoms, age, high myopia, and concomitant retinal disease),or to peri and postoperative factors (time to surgery, type of surgery, day of the week, experience of surgeon, positioning before and after surgery, and follow‐up management). With the availability of high‐resolution imaging modalities additional biomarkers have emerged, facilitating further more accurate prediction of visual outcome. Incorporating retinal detachment biomarkers into the daily clinical practice is essential to provide more effective patient counselling and potentially modify the visual rehabilitation process.
Update in gene therapies or innovative therapies in aniridia associated keratopathy
Authors: Bremond‐Gignac Dominique
Published: January 2024

Ocular surface may be affected by various rare congenital diseases. Anterior segment dysgenesia and congenital panocular diseases affecting ocular surface is usually from genetic origin. The ocular surface in aniridia may present progressive opacities due to limbal insufficiency creating Aniridia Associative Keratopathy (AAK). Molecular genetics usually reveals PAX6 gene mutation or deletion. Gene therapies in eyedrop form and repurposing drugs are tested for their efficacy and safety in congenital aniridia. Mechanisms and physiopathology of new gene therapies and drugs will be developed.
RESTORE VISION: Novel advanced and repurposed therapeutics for vision restoration in a group of severe rare ocular diseases – Short introductory talk
Authors: Ritter Thomas
Published: January 2024

Rare Eye Diseases (REDs) collectively represent a major cause of visual impairment and blindness for children and young adults in Europe. But importantly, REDs also affect adults and the aging population. Defective wound healing at the cornea and ocular surface, excessive inflammation, nerve degeneration, stem cell dysfunction, and aberrant vessel ingrowth are the common denominators in many REDs, representing a critical medical problem and an area of unmet medical need. The onset and progression of many REDs are characterized by common pathophysiologic mechanisms. The goal of many research groups is to disrupt these aberrant mechanisms with the aim of making therapy more effective. Current management is often prohibitively expensive, has low efficacy and leads to debilitating side effects, pointing to a critical medical problem and area of unmet medical need.

Here, we will briefly introduce the RESTORE VISION project, which has been recently funded by the European Commission and brings together actors from across the full value chain: 6 leading research institutions, 3 SMEs and a European patient organization. The project will take a ground‐breaking approach to improve eye health by verifying disease pathomechanisms, using cutting‐edge models for each rare disease to test novel and repurposed compounds and determine drug mechanisms of action, formulating compounds as safe eye drop suspensions or subconjunctival drugs, and performing several first‐in‐human trials of novel therapies.
Tear film ocular surface lifestyle report: Lifestyle challenges
Authors: Ferrari Giulio ,   the Lifestyle Challenges Subcommittee of the TFOS lifestyle workshop
Published: January 2024

This presentation summarizes the findings of the Lifestyle Challenges Subcommittee of the recent Workshop of the Tear Film & Ocular Surface Society, entitled “A Lifestyle Epidemic: Ocular Surface Disease.”

Lifestyle includes different societal, physical and mental aspects, which have a deep impact on dry eye disease (DED).

Specifically, among societal factors, the use of tobacco is robustly associated with tear film instability, cocaine reduces corneal sensitivity, alcohol promotes DED symptoms and alterations of the tear film. Among physical factors, extensive mask wear or obesity are associated with Meibomian gland alterations. Moreover, depression, anxiety‐associated or sleep disorders, and medications used for their treatment, have been linked with DED symptoms. Finally, diseases associated with chronic pain, including migraine and fybromyalgia, appear to increase the risk of DED. Further studies are needed to better dissect the role of chronic pain in different DED subtypes.
Basis for the use of MSCs in optic nerve diseases
Authors: Jimeno Jose Carlos Pastor
Published: January 2024

Both the retina and optic nerve are expansions of the central nervous system (CNS). In this way they share pathophysiological and possibly therapeutic aspects. One of the acute pathologies that lack treatment is acute non‐arteritic anterior ischemic optic neuropathy (NAAION) that can be considered as a heart attack in the optic nerve head.

In CNS, the concept of penumbra is used to propose treatments for ischemic stroke. Around the focus of absolute ischemia there is an area (penumbra) of neural tissue that could be rescued with neuroprotective therapies.

Using this similarity, under the basis that NAAION lacks treatment and that mesenchymal stem cells are producers of several growth factors that are neuroprotective, its intravitreal use was proposed to treat the acute phases of this disease. After the precilinic safety tests, a pilot study was carried out with 5 patients that has provided encouraging results. Now the sample size has been expanded with a multicenter study involving Vall d'Hebron (Barcelona), Clinico and Ramon y Cajal (Madrid) and IOBA (Valladolid).
The optic nerve in glaucoma
Authors: Jonas Jost
Published: January 2024

Purpose: To describe particularities of the optic nerve head of axially highly myopic eyes.

Methods: Measurements were obtained from enucleated globes and from population‐based studies.

Results: Morphologic optic disc particularities in high axial myopia included enlarged disc size (secondary macrodisc), widening and temporal translocation of the papillary Bruch's membrane (BM) opening, parapapillary gamma and delta zone, elongation and thinning of lamina cribrosa and peripapillary scleral flange, steeper translamina cribrosa pressure gradient, decreased peripapillary choroid thickness, longer distance between peripapillary arterial circle and optic disc, optic cup flattening, presumably a stretching of the lamina cribrosa pores, and peripapillary intrachoroidal cavitations. These changes may be explained by growth of new BM in the retroequatorial region in the process of emmetropization or myopization as “overshooting” of the emmetropization process.

Conclusions: The intrapapillary and parapapillary changes in the highly myopic optic nerve head may be reason for the increased susceptibility for glaucomatous optic nerve damage in high axial myopia. The widening of the papillary BM opening and the potential shift of the optic nerve head's 3 layer into temporal direction, both potentially leading to the development of parapapillary gamma zone may be of interest for elucidating the process of emmetropization/myopization.
The effects of physical exercise on ocular blood flow
Authors: Redondo Beatriz
Published: January 2024

Vascular resistance is physiologically regulated by changing the local diameter of the arterioles to keep the local blood flow constant. It is well known that physical activity has profound impacts on the vasculature in humans. Short‐term exercise induces immediate changes in artery function, whereas long‐term exercise induces chronic functional adaptation and structural arterial remodelling which leads to a lower risk of risk for cardiovascular disease. These changes depended on the characteristics of the training load and are modulated by other factors such as exercise‐induced inflammation and oxidative stress.

The ocular circulation consists of the retinal and choroidal circulations. The retina is the tissue with the most active metabolism in the human body, resulting in a high rate of oxygen consumption. Therefore, ocular blood flow is particularly susceptible to physical exercise. With the arrival of imaging technologies numerous studies have explored the effects of exercise on the ocular blood flow. Most of these studies are focused on the transient impact of acute exercise on ocular blood flow. The objective of this talk is to discuss the scientific literature available about the effects of physical exercise on ocular blood flow, and to highlight its impact on ocular health.
The yin and the yang of molecular decompensation in LHON
Authors: Carelli Valerio
Published: January 2024

Leber hereditary optic neuropathy (LHON) remains an incompletely understood disease. Reduced penetrance and male prevalence are two active areas of investigation. In fact, the presence of a homoplasmic LHON‐related mtDNA missense mutation, affecting all individuals along a maternal line, is the necessary genetic factor predisposing to develop LHON, but in most individuals it is not sufficient as they remain unaffected lifelong. Other genetic or environmental factor are assumed to play a role. The other point of investigation is the catastrophic nature of disease onset and progression, which defines LHON as a subacute disease.

The application of iPSCs technology has advanced our understanding of LHON, refining the understanding of which mechanisms may be crucial to maintain cells compensated or prime them to degeneration. This presentation will focus on the balance between mitochondrial biogenesis and autophagic removal of mitochondria (mitophagy) as the emerging key mechanism priming individuals carrying the LHON mutation to become affected or to remain unaffected, possibly lifelong. This balance can be targeted by therapeutic strategies, opening new avenues to cure LHON.
Myopia, what causes it and can it be avoided?
Authors: Pärssinen Olavi
Published: January 2024

Myopia (short‐sightedness or near‐sightedness) is a condition of refraction where vision to distant is impaired. Axial elongation of the eye is the main anatomical cause of myopia.

The prevalence of myopia has increased alarmingly fast globally. The estimation of WHO report was that in 2020 27% of world's population would be myopic, and if there will be no changes in the trend then by 2050 there would be 2.56 billion myopic people worldwide. Highest prevalence of myopia has been reported in many South and East Asian countries, where about 80% of the school leavers are myopic. Parental myopia increases the risks of myopia in their children, two myopic parents more than one. Genetic studies have been able to explain only small part of myopia, nor have been able to explain the differences in the prevalence between populations. Myopia relates to higher education, near work and higher occupational status and is mare rare in urban environment and in occupations where people work outdoors. In children myopia usually develop after they had begun attending school and is associated with more time spent on reading and near work and less time on outdoor activities.

The major public health concerns connected with myopia are related to its complications. Myopia has become one of the main causes of vision loss due to complications, such as retinal detachment, macular degeneration and haemorrhage, choroidal neovascularization, and open angle glaucoma. The higher myopia is the higher is the risk of these complications. In countries where myopia is common, it is already a significant cause of low vision and blindness.

In a Finnish study prevalence of myopia in 7‐ and 11‐year‐olds, was 0.5% and 3.3%, respectively, if daily near work did not exceed 1 h. Multiple regression model adjusted by sex, parental myopia and time spent outdoors, showed that 1 h increase in near work increased the risk of myopia 47% (95% CI 1.099–1.984, P = 0.010) and 35% (CI 1.170–1.548, P < 0.001), in 7‐ and 11‐year‐olds, respectively. Each hour spent outdoors adjusted by sex, parental myopia and time spent outdoors decreased their same risk by 24% (95% CI 0.533–1050, P = 0.096 and 0.648–0.000, P = 0.001, respectively). Higher prevalence of myopia in girls could mainly be explained by their more time spent in near work and less time outdoors.

Plenty of long‐term near viewing, and short viewing distance, combined with low amount of time outdoors are risk factors for myopia. Avoiding these factors is more important the younger the child is. It is recommended that the daily time spent outdoors in children should be at least equal to near work time. Early school starting age, increases the risk of myopia and high myopia, and consequently risk for myopia related complications. Great educational stress in young children should be avoided.
Prevention and public awareness of myopia
Authors: Alvarez‐Peregrina Cristina
Published: January 2024

Myopia has become a Public Health issue, with prevalence rates that depend on age and geographical area, reaching the highest values in Asia. Thus, a recent review on the prevalence of myopia in children, measured with cycloplegia, established that the prevalence ranges from 10% in Africa to 60% in Asia, increasing in all areas every year. These results show the importance of taking action to prevent myopia.

The main factors with strong scientific evidence to prevent myopia are increasing outdoor time and decreasing near‐work activities.

Public awareness is an essential factor to stop the increase in the prevalence rates of myopia. However, the increase in scientific literature does not give us information about the sensitivity of the general population on a specific topic.

Through the internet search trends analysis, we can find out how much interest myopia has in the population, analysing the most concerned countries and how the related queries are being carried out and increased.

Thus, if we look for the search trends with the word “myopia” as “term search” in the last 10 years, we can see how the number of searches is increasing, reaching the maximum in 2022. China, Taiwan, and Hong Kong lead the searches on the Internet, reflecting how the higher prevalence in these areas has generated a greater concern. Concerning related queries, we find a high growth in interest caused by the inclusion of myopia among the diseases of the international classification of diseases of the World Health Organization, ICD 10, with an increase of 2000% in the searches. This search suggests that people interested in myopia are looking for reliable sources to collect information. Finally, it is remarkable that in the review of the related queries, we did not find the term prevention among the most performed searches, and treatment, cure, or control are queries that are in positions 20, 21, and 26 of those searches.

Compared with other of the most established eye pathologies in society, we can see as myopia is still behind them. For instance, if we compare the searches of the term myopia, with glaucoma or cataract, 61% of the web searches are related to glaucoma, 43% to cataracts, and only 16% corresponded to myopia.

In conclusion, even though scientific evidence alerts us about the increase in the rates of myopia and the importance of working on its prevention, there is still a long way to reach society to generate a clear awareness of myopia and the consequences of not taking action to prevent it.
Glaucoma surgical procedure choice in vulnerable corneal endothelium
Authors: Gkatzioufas Zisis
Published: January 2024

This talk will focus on the decision making in patients with vulnerable corneal endothelium requiring glaucoma surgical intervention. The effect of glaucoma surgical procedures on corneal endothelium will be briefly analysed and conditions with vulnerable corneal endothelium and co‐existent intraocular pressure (IOP) elevation, such as Fuchs corneal endothelial dystrophy with primary open angle glaucoma or post‐keratoplasty steroid response, will be adequately described. The aim of the talk is to indicate the most appropriate glaucoma surgical interventions depending on the status of corneal endothelium and the desired IOP lowering effect, covering a wide spectrum of surgical procedures including minimally invasive interventions, such as Preserflow implantation, as well as ab interno/ab externo viscocanaloplasty or conventional procedures such as trabeculectomy or big tube implantation. Finally, the talk will highlight useful surgical tips for the abovementioned surgical procedures, and it will provide suggestions for patient selection in order to optimize clinical outcomes.
Challenges of glaucoma management in Kosovo
Authors: Daka Qëndresë , Kaja Amina , Maloku Edlirë , Hoti Faik
Published: January 2024

Aims/Purpose: Most glaucoma studies are focused on high‐income countries, with very few focused on low‐to‐medium‐income countries such Kosovo. The aim of this study is to present challenges of glaucoma management in Kosovo, a country with a population of 1.8 million and overall life expectancy of 76.7 years that does not have a social insurance system (1–3).

Methods: Data are taken from official government documents, very few scientific publications, and individual experience.

Results: National health care system in Kosovo is subsidized by the government, through taxation system that struggles from underfunding. A growing private sector operates with out‐of‐pocket payments in up to 33%, that are mainly spend on pharmaceuticals (4–6). There have been efforts to develop treatment protocols, however still clinical practice can be based on the individual preferences or historical practice (7–9).

Glaucoma treatment is not an expectation. The reference centre is glaucoma department at the University Clinical Centre of Kosova (UCCK). Conservative glaucoma management is provided in seven regional hospitals and small private clinics through the country. However, many newer procedures are provided only in private hospitals, whereas conservative therapy is not imbursed by state. There is no special glaucoma fellowship programme and very few young ophthalmologists are interested to provide glaucoma care. In the absence of a generalized Health Information System (HIS), there are difficulties in obtaining glaucoma management data through the country, but many incentives and activities are taking places recently.

Conclusion: There is a need for HIS in glaucoma clinics, development of care standards as well as extensive training and knowledge transfer among the staff. Shifting to evidence‐based approach management is challenging, however there is potential for improvement.
IOL exchange for positive and negative dysphotopsia
Authors: Luyten Gregorius
Published: January 2024

Positive and negative dysphotopsia are complaints that sometimes occur after otherwise uneventful cataract surgery with intraocular lens (IOL) implantation. In positive dysphotopsia (PD), artefacts such as glare and halos are experienced around light sources, especially in scotopic conditions. In negative dysphotopsia (ND), a dark shadow or crescent is experienced in the temporal visual field, especially in photopic conditions. An IOL‐exchange, especially with an larger sized IOL, is one of the therapies of both conditions.

In this presentation, first the surgical technique to perform an IOL‐exchange will be presented. In short, the initially implanted IOL is removed through a small corneal incision (3.0 mm) after luxation of the IOL in the anterior chamber and cutting it in half before extraction. Subsequently, the new IOL is injected directly into the bag through the 3.0 mm corneal incision that was used for the removal of the initial IOL.

Subsequently the clinical results of such an IOL‐exchange, with the Aspira‐aXA, a monofocal, 1‐piece hydrophilic acrylic IOL with an optic diameter of 7.0 mm, will be presented. In total, 20 eyes of 16 patients with pseudophakic dysphotopsia were included in the analysis. Nine eyes suffered from PD, ten eyes from ND, and one eye from both complaints. 15 out of 20 eyes (75%) showed complete resolution of complaints after the IOL exchange and four eyes (20%) showed a partial resolution. Postoperatively, in one eye vitreous loss occurred and resulted in cystoid macular edema, and another eye developed posterior capsular opacification, all treated successfully.

As the bag‐to‐bag IOL exchange with a 7 mm IOL resulted in partial or complete resolution of positive and negative dysphotopsia in the majority of patients (95%), it is a potential treatment for patients with dysphotopsia.
Idiopathic epiretinal membrane and when to operate
Authors: Kontou Evgenia
Published: January 2024

Idiopathic epiretinal membrane is a product of pathological processes during the progression of posterior vitreous detachment. Its incidence increases over time and reaches up to 34% of the population over 60 years of age, a rate that significantly increased after the introduction of spectral‐domain optical coherence tomography (SD‐OCT) in daily clinical practice.

Traditionally, the decision to intervene was mostly based on the balance between subjective patient complaints and the risks related to vitrectomy surgery itself and less on OCT imaging, especially since advanced epiretinal membranes as seen on OCT are often accompanied by remarkably good visual acuity. Additionally, unilateral incidence, could mask symptoms, depending on eye dominance. However, more recently, technological advances in posterior segment surgery, have significantly reduced the rate of post vitrectomy complications, leading to earlier surgical intervention practices.

There is great literature debate concerning the determination of the right intervention timing for idiopathic epiretinal membrane. The most important predictive factors include preoperative visual acuity, the presence of metamorphopsia and impact on the quality of life.

According to existing literature, natural progression of the disease leads to anatomical deterioration in a rate ranging from 17 to 39%. Factors related to faster deterioration include metamorphopsia and the presence of cystic formations in the inner layers of the retina on SD‐OCT.
We would like to especially recognize the creativity, energy, and substantive contributions from all women in ophthalmology and vision science! You have brought a fresh and much needed perspective to EVER
Authors: Audo Isabelle , Votruba Marcela , Tassignon Marie‐José , Soubrane Gisèle , Ou Yvonne
Published: January 2024

We would like to especially recognize the creativity, energy, and substantive contributions from all women in ophthalmology and vision science! You have brought a fresh and much needed perspective to EVER.

What Are the Biggest Problems Women Face Today?

The lack of women in positions of power. …

Patriarchy. …

Not enough women at the table. …

Sexism, racism and economic inequality. …

Trauma‐centered feminism. …

Access to equal opportunity. …

The lack of respect for caregiving. …

Navigating career and motherhood.
Antioxidants. Pros and cons for ocular diseases
Authors: Garcia‐Medina Jose Javier
Published: January 2024

Oxidative stress has been demonstrated to play a role in the pathophysiology of several ocular diseases. Theoretically, its deleterious consequences can be reduced by antioxidants substances. This presentation intends to update the knowledge about antioxidants as adjuvant treatment of the most important ocular diseases.
Cataract surgery and keratoplasty
Authors: Barraquer Rafael I.
Published: January 2024

Cataract and keratoplasty constitute one of the most common association in anterior segment eye surgery. This includes both the technical aspects of the combined procedures (of cataract surgery with each of the different modalities of keratoplasty) and, possibly in a more relevant way, the indications and decision tree for the different scenarios and treatment options, including combined vs. sequential and, in the latter case, in which order. This presentation will review the development and current concepts regarding these topics, from the theory to the practical application, with examples in specific clinical cases.
Transcriptional control of retina development
Authors: Kozmik Zbynek
Published: January 2024

Genetic and expression studies have indicated that the development of vertebrate eyes is guided by a conserved gene regulatory network. The aim of the project was to study the role of selected transcription factors in neuroepithelium‐derived structures of the eye. We combined the power of mouse genetics via the use of conditional knockouts with molecular studies of transcriptional regulation through implementation of biochemical, transcriptomic and epigenomic approaches. In order to identify gene regulatory elements we generated genome‐wide occupancy data for a defined set of transcription factors using mouse embryonic retina as a sample. We will present our preliminary genetic data on functional validation of selected retina enhancers.
RNA‐binding proteins and their downstream regulatory networks in lens development and cataract
Authors: Lachke Salil
Published: January 2024

Development of the ocular lens involves dynamic control over gene expression, perturbations of which can cause congenital cataract. Thus far, several key proteins in the lens development program that are involved in signalling, transcription, and more recently, post‐transcriptional control – all distinct regulatory mechanisms that together determine the proteome – have been identified. To understand the pathology of congenital cataract, it is critical to continue to identify key regulatory genes that play an important role in the lens, and define their relationships with other regulators in the form of networks. We have characterized eye/lens defects in animal knockout models for several conserved RNA‐binding proteins (RBPs) such as Celf1, Caprin2, Rbm24 and Tdrd7 and demonstrated their important role in mediating post‐transcriptional networks in the lens. However, there are still many mechanistic events that remain to be defined in the lens. For example, while it is known that abundant levels of specific mRNAs (e.g. crystallins) need to be made in the lens, it is currently unknown whether regulators that control the ubiquitously important “transcription elongation” process, are specifically required for achieving optimal levels of such highly expressed transcripts in fibre cells. Furthermore, how these transcriptional and post‐transcriptional regulatory pathways coordinately function to achieve optimal transcriptome and proteome in lens epithelial and fibre cells is unknown. Here, we applied the bioinformatics tool iSyTE to identify the transcription elongation factor Ell2 and the RNA‐binding protein (RBP) Elavl1 in the lens. Lens‐specific conditional knockout mouse models for Elavl1 and Ell2 were generated using Pax6GFPCre. Lens tissue from Elavl1cKO and Ell2cKO mice was characterized by immunostaining, RNA‐sequencing (RNA‐seq) and RT‐qPCR. Elavl1cKO and Ell2cKO lenses exhibit morphological defects that are detected in embryonic and early postnatal stages, respectively. RNA‐seq identifies mis‐expression of many genes in both cKO lenses. Ell2cKO lenses show significantly reduced transcript levels of a cohort of fibre‐expressed genes such as crystallins, while Elavl1cKO lenses show abnormal mRNA levels of several novel factors in the lens, including Ell2. These data demonstrate that the new iSyTE‐predicted genes, the RBP, Elavl1, and transcription elongation factor, Ell2, mediate regulation of key genes in lens development, and provide new insights into the molecular pathology of cataract and lens defects in animals deficient in these genes. Importantly, in addition to Elavl1cKO lenses, Ell2 is found to be mis‐expressed in mouse cKO lenses for another RBP, Celf1, suggesting a crosstalk between transcriptional and post‐transcriptional regulatory networks that governs optimal transcriptome and proteome in lens development.
Applications of artificial intelligence in retinopathy of prematurity
Authors: Campbell Peter
Published: January 2024

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, despite the fact that treatment is available, and blindness can be prevented in most cases. There are two key gaps in care delivery. The first is access to care with many parts of the world underserved. The second is subjective diagnosis where the eye exam is challenging, and different clinicians may perceive different levels of severity. Multiple potential indications for use (IFUs) have been proposed for ROP AI algorithms that could impact both gaps in care. In this presentation I will review potential IFUs and the potential translational challenges in implementation.
Mechanisms of ocular surface pain
Authors: Gallar Juana
Published: January 2024

Ocular pain is evoked upon activation of a small number of nociceptive neurons located at the trigeminal ganglion whose peripheral projections profusely innervate the cornea and conjunctiva. In healthy conditions, nerve impulse activity originated at peripheral nerve endings of these primary sensory neurons in response to noxious or potentially noxious stimuli acting on the ocular surface travels centrally and reaches second‐order neurons located at the trigeminal brain stem complex. In turn, these brainstem neurons send their axons to the contralateral posterior thalamic nuclei, where the third neurons along the ocular nociceptive pathway are found. Thalamic neurons send their axons to the primary somatosensory area of the brain cortex and, after brain cortex processing if this sensory inflow, nociceptive pain sensation is experienced.

The activity of ocular nociceptor neurons is modified under inflammation. Inflammatory mediators released at the ocular surface increase the excitability of the nerve terminals. As a result, the impulse response of primary nociceptor neurons to noxious stimuli is increased, which constitutes the basis of hyperalgesia and leads to pain and other sensations such as gritty eyes, foreign body sensation, etc. experienced under ocular inflammation.

After a lesion (including surgery) or disease that affects any nerve or neuron of the ocular somatosensory pathway, the activity and connectivity of the neurons involved in ocular pain is altered, sometimes permanently. The excitability of damaged neurons is long‐lasting increased, leading to ocular dysesthesia and development of neuropathic pain referred to the eye.

(Supported by PID2020‐115934RB‐I00 from DOI: MCIN/AEI/10.13039/50110001103, and CIPROM/2021/48 from the Generalitat Valenciana, Spain)