bluuebunny/crossref_metadata_2025 huggingface dataset:
Keratoconus from corneal degeneration to systemic disease: implications for treatment
Authors: Ferrari Giulio
Published: January 2025

Keratoconus has been traditionally considered an ocular disaese, and, specifically, a non‐inflammatory corneal degeneration.

However, systemic comorbidities are associated with keratoconus in up to 50% of cases, and recent evidence is emerging that nutritional/metabolic inbalances are associated, and perhaps indispensable, co‐factors in disease pathogenesis.

Here, we will provide a review of current evidence, and our recent data, supporting a provocative hypothesis: keratoconus is the ocular manifestation of a systemic disease.
Insights into new therapies for aniridia associated keratopathy in a novel mouse model
Authors: Javidjam Dina , Lagali Neil
Published: January 2025

Aniridia is a rare genetic disorder that disrupts normal eye development. Heterozygous mutations of PAX6 are the main cause of the disease. Importantly, aniridia patients are susceptible to complete visual loss from a progressive aniridia‐associated keratopathy (AAK). The complete degeneration or disappearance of Vogt's limbal palisades is related to the more advanced stages of AAK, and therefore a limbal stem cell deficit or dysfunction (LSCD) is expected to have an important role in the development of AAK. In LSCD and aniridia, a neurotrophic deficit occurs leading to inflammation, neovascularization (CNV) consisting of blood and lymphatic vessels, and a chronic wound healing response. To establish new therapeutic options, essential knowledge is needed concerning the factors which maintain the limbal niche and how these relate to PAX6. Mouse models with aniridia often have a very aggressive phenotype, with advanced AAK observable shortly after birth, upon eye opening, despite the known delayed development of AAK in humans, occurring during the second to third decades of life. In this study, we intended to investigate more accurately the role of LSCD in progression of AAK in a new mouse model of aniridia with delayed onset of AAK using Single‐cell RNA sequencing (scRNA‐Seq) technology. This novel mouse model consists of the Pax6Sey mouse on a 129S1/SvImJ background was first developed and reported by the Simpson group in Vancouver and yields a transparent cornea at birth, and delayed development of AAK. The efficacy of new pharmacologic therapy to decrease the advancement of AAK or perhaps even stop its development can be assessed by comprehending the temporal dynamics of AAK development in this model. (scRNA‐Seq) technology is a potent tool for acquisition of essential knowledge about the characteristics and functions of LSCs, including the identification of new and highly specific expression markers and additional niche‐regulated elements that can either promote or inhibit the proliferation and differentiation of LSCs. Despite the other traditional techniques that were able to detect the average expression of genes in multiple cells, single‐cell sequencing may make it possible to detect differential signals between individual limbal stem cells. To this aim, we will compare the single cell RNA profile between Pax6 +/− haploinsufficient 129S1/SvImJ cornea vs healthy cornea from wild type mice of the same background at two different time points (at 1 month and 4 months of age). We will specifically focus on LSCs contribution to CNV pathophysiology in order to find novel therapeutic targets. The results of this study may lead to improved prevention and treatment methods for treating blindness and enhancing the clinical prognosis of people with LSCD and other LSC‐related disorders.
Towards bypassing anterior‐segment opacities
Authors: Irsch Kristina
Published: January 2025

The transparency of the cornea and crystalline lens (anterior segment) is essential to provide a clear view into and out of the eye, yet it deteriorates with age. Recent advances in physics of random media allow us to conceive the development of ophthalmic systems that, beyond characterization, enable compensation for loss of anterior‐segment transparency. Research has demonstrated the ability to focus and image through highly scattering media by actively shaping the incident wavefront by a spatial light modulator (SLM). This has opened a new route towards a matrix approach of light propagation through complex media, relating the modes (e.g., generated by a SLM) to output modes (e.g., detected by a camera). This lecture will discuss ongoing works on the application of the matrix approach to the eye, with the aim of performing retinal imaging through a cloudy cornea or through cataract opacities – a task that is currently not feasible with state‐of‐the‐art retinal imaging systems, including adaptive optics.
Management and investigation of high myopia in infants and young children
Authors: Flitcroft Ian
Published: January 2025

A growing array of behavioral, pharmacological, and optical interventions are now available. These interventions have typically been tested on children aged 6 to 16 who exhibit a typical pattern of myopia onset and progression. In such instances, myopia begins to develop after the age of 5 or 6 and progresses variably until stabilizing during the teenage years or early adulthood. However, there is a much rarer pattern of myopia where children exhibit very high levels of myopia in infancy or early childhood, often exceeding the ‐6D threshold of high myopia. In these cases, numerous diagnostic, health, and visual challenges must be addressed. Managing these issues may initially take higher clinical priority than treating observed progression.

High myopia in infants also poses challenges for optical correction to ensure normal visual development and prevent amblyopia. High myopia combined with significant behavioral or developmental issues can be particularly difficult, as uncorrected myopia or contact lens intolerance can exacerbate the behavioral issues of these children. The visual impairment from uncorrected refractive errors can negatively affect both their behavior and development. For instance, the inability to see faces and read emotions can be profoundly isolating, sometimes described as "visual autism" due to the impact of visual isolation.

The aim of this presentation is to provide an overview of this complex and multifaceted topic, offering recommendations for the identification, investigation, and management of high myopia in infants and young children. These patients may initially present to primary eye care services where specialist multidisciplinary investigation and management are not available. In such settings, a thorough clinical history, comprehensive examination, and recognition of the unusual features of these children are critical to facilitate prompt and appropriate referral.

This patient group is commonly referred to hospital‐based eye clinics. Here, the initial challenge is to correctly identify cases that require detailed investigation and to ensure that the appropriate clinical and diagnostic services are utilized. Management can be wide‐ranging, including advanced ocular imaging, electrophysiology, genetic investigations, involvement of pediatricians and clinical geneticists, genetic counseling, optical correction strategies, and appropriate follow‐up protocols for high‐risk children.
Beyond myopia and traction: Updates in staging and management for myopic traction maculopathy
Authors: Yang Chung‐May
Published: January 2025

Myopic traction maculopathy (MTM) can manifest as foveoschisis or macular retinoschisis (MRS), foveal detachment, lamellar macular hole (LMH), and full‐thickness macular hole (FTMH). The specific and core feature of MTM is the presence of MRS. The development of MTM is related to complex forces such as the rigid internal limiting membrane (ILM), extensively adherent posterior hyaloid, posterior staphyloma, and the presence of epiretinal membrane, all coinciding in highly myopic eyes.

Parolini et al. proposed a staging system of MTM, based on the predominant traction force. The perpendicular evolution started with inner and outer MRS, predominantly outer MRS, and progressed to foveal detachment and macular detachment. The presence of inner LMH was recognized as a sign of tangential traction, and an intermediate stage before the development of FTMH.

Another frequently used classification and staging system focusing on the MRS separates MTM to four types: MRS, MRS with foveal detachment, MRS with LMH, and MRS with LMH and foveal detachment. LMH or FTMH can develop before, at the same time or after the formation of MRS. Because of the complex traction forces, the evolutional processes of MTM may not be straight forward. Spontaneous improvement may occur; those with outer retinoschisis (stage 2a in the Parolini system) might downgrade to stage 1b with the LMH formation possibly because the traction was partially released.

There is no consensus regarding surgical indications and optimal treatment strategies. We perform surgery when progressive worsening of best‐corrected visual acuity (BCVA) down to 20/40 has been documented along with structural worsening, or when foveal detachment occurs without concerning the BCVA level.

Common applied surgical techniques include ILM peeling, fovea‐sparing ILM peeling, fovea‐sparing ILM peeling combined with inverted ILM flap technique, macular buckling, scleral imbrication, etc. The pros and cons of each procedure will be reviewed and discussed.
To peel, to keep or to flap? the role of internal limiting membrane in macular hole surgery
Authors: Nawrocka Zofia , Nawrocki Jerzy
Published: January 2025

The Temporal Inverted ILM Flap Technique was previously confirmed in prospective randomized trial performed by our group to be non‐ inferior to the original Inverted ILM Flap technique in large, long‐ standing full thickness macular holes.

During surgery, after core vitrectomy and membrane blue staining a flap is created from the temporal side of the fovea and then inverted upside down in order to close the macular hole. The vitreous cavity is filled with air and patients are advised to keep prone positioning for 3 days.

The success rate of this surgery was estimated to be about 95% in large, long‐ standing macular holes. It was also published, that macular holes associated with high myopia with and without a retinal detachment, macular holes coexisting with diabetic retinopathy (non‐ proliferative and proliferative), age related macular degeneration (dry and neovascular) and other diseases might not only be closed, but also experience improvement of visual acuity. During the talk also repeated surgeries will be presented, those in which the Temporal Inverted ILM Flap Technique could be used, and those, which required modifications of this technique (autologous ILM transplantation, pedicle flap, amniotic membrane).

The Temporal Inverted ILM Flap Technique not only improved anatomical and functional outcome, but also eliminated type 2 closure (Flat open macular hole) from postoperative closure types. Eyes, which previously would close in this form, now develop the “flap closure”. In contrary to type 2 closure, they experience regeneration of foveal anatomy and improvement of visual acuity.
Why no improvement? poor visual recovery after surgery for epiretinal membrane
Authors: Chen Shih‐Jen
Published: January 2025

Factors associated with poor post‐operative visual acuity (VA) may include older age, longer duration of symptoms, poorer baseline visual acuity, drusen, advanced glaucoma, increased fovea autofluorescence, and pre‐operative OCT characteristics such as ectopic inner fovea layer, inner nuclear layer (INL) microcysts, and disruption of ellipsoid zone. Concomitant internal limiting membrane peeling did not affect final visual acuity and metamorphopsia. However, retinal swelling and reduced retinal sensitivity with microscotoma may occur with additional ILM peeling.

Among these factors, we had found that INL microcysts, a common phenomenon evidenced by En Face OCT in patients with ERM, was associated with poorer post‐operative VA when in large extent. However, after long term follow‐up, the microcysts may become less with gradual modest visual recovery. The mechanism of the microcysts formation may be secondary to mechanical trauma and their evolution will be discussed. Instruments for ILM peeling to reduce surgical trauma, proper surgical timing for patients with glaucoma, as well as predicting the visual outcome with an AI model will be presented in this symposium.
Bilateral childhood cataracts – When it is genetic?
Authors: Kessel Line
Published: January 2025

Bilateral childhood cataracts may be caused by genetic changes, metabolic disease, infections or secondary to trauma, radiation or drug use. We reviewed 211 Danish children with bilateral cataracts and found that 29.4% had hereditary cataract with at least one affected first‐degree family member, one family alone accounted for 8.1% of all cases of bilateral childhood cataract. A genetic cause of cataract had been found by non‐routine genetic screening in 35.1% of all children. In a large number of children, the cataract was associated with systemic diseases or syndromes whereas isolated cataracts were only found in 27.0% of children. This led to change in work‐up and since 2017 all children with bilateral cataracts without a known cause have been offered genetic testing by an exome‐based panel. In a consecutive series of 28 children <5 years of age, a genetic cause of the cataract was found in 50.0%. Most causative genes were related to lens protein (CRYAA, CRYBB2, CRYGD, CRYGC CRYGS), lens structure (VIM), gap junctions (GJA3, GJA8(n = 2)) or syndromes (COL4A1, NHS (n = 2), PITX3) or other functions (MAF). However, in three families with autosomal dominant childhood cataract, standard panel testing failed to reveal the cause of cataract in the family. Thus, childhood cataract is frequently explained by genetic findings but even though there is strong evidence for a genetic origin, it can not always be found in known genes suggesting that there is still much to be explored.
Defining ai applications in clinical routine
Authors: Schmetterer Leopold
Published: January 2025

Despite the enormous interest in AI solutions for medical care the implementation has proven to be difficult. Issues include science of deep learning related to dataset shift, accidental fitting of confounders, unintended discriminatory bias, and generalization to new populations, logistical difficulties in implementation, sociocultural changes and patient perception, costs and burdens associated with false positives and false negatives, and number of non‐gradable images. The present talk will focus on the opportunities of AI. These may be related to improved diagnosis of disease but more likely to screening for common eye conditions such as diabetic retinopathy or glaucoma. In genomic medicine AI can recognize complex patterns of genetic variations linked with disease susceptibility and predict a spectrum of phenotypes. This topic is related to precision medicine and clinical decision support in order to tailor medical care to individual patients based on their unique characteristics. Population health management, establishment of working groups and guidelines, enhancing patient education, and clinical trial design and drug development are also discussed as potential areas of AI application in ophthalmology.
Vitrectomy for the management of macular edema in uveitis patients
Authors: Kontou Evgenia
Published: January 2025

Uveitis related macular edema constitutes a common complication for up to 8.3% of uveitis patients and is a leading cause of serious visual impairment in about 40% of cases. Despite rigorous treatment with steroids and other immunomodulators, at least a third of patients fail to achieve satisfactory improvement in visual acuity, due to drug intolerance or ineffectiveness, thus requiring addition of other therapeutic approaches.

Recent advances in the vitreoretinal surgery have expanded the indications of vitrectomy in a broad spectrum of diseases including uveitis macular edema. Research studies have investigated the efficacy and safety of pars plana vitrectomy (PPV) in addressing cystoid macular edema (CME) associated with chronic uveitis. Primary outcomes investigate changes in visual acuity and angiographic appearance of CME over a specified period post‐surgery.

According to a randomized, controlled pilot study, PPV resulted in significant improvement in terms of visual acuity, with a notable percentage of eyes achieving vision of 20/40 or better. An additional retrospective study highlighted the effectiveness of PPV without macular intervention in terms of reducing intraocular inflammation and resolving macular edema in uveitis eyes, leading to improved best‐corrected visual acuity and reduced reliance on systemic steroids and immunosuppressives. The findings suggest that PPV can be a safe and effective approach for managing persistent vitreous inflammation and opacities in uveitis patients, contributing to improved visual acuity, reduced inflammation, and resolution of macular edema. Despite limitations regarding small sample sizes and retrospective designs, these studies provide valuable insights into the potential role of vitrectomy in enhancing visual outcomes and controlling inflammation in uveitis eyes.

In conclusion, PPV should be considered as o noble option for the management of CME in uveitis patient, for its positive impact on Visual function and inflammatory control.
Pathophysiology and classification of diabetic retinopathy – risk factors for proliferative diabetic retinopathy progression
Authors: Pappelis Konstantinos
Published: January 2025

Diabetic retinopathy (DR) is the most frequent complication of diabetes mellitus (DM), occurring in at least 1 out of 3 diabetic patients and causing significant visual impairment in approximately 1 out of 100. DR is an important matter of public health, since the projected number of cases in 2045 exceeds 240 million. Currently, DR is estimated to account for over 15% of total blindness cases in the developed world.

DR is a microvascular disease of significant pathophysiological complexity. It is believed that, during the early stages of the disease, hyperglycaemia induces potassium channel and endothelial dysfunction, leading to vascular dysregulation, impaired neurovascular coupling, and, eventually, decreased blood flow. Hypoperfusion of the retinal blood vessels soon leads to a state of low‐grade chronic inflammation (leukostasis) and tissue hypoxia. A subsequent switch to hyperperfusion in response to the release of dilatory factors, such as the vascular endothelial growth factor (VEGF), increases capillary pressure and shear stress, leading to thickening of the basal membrane and pericyte and smooth muscle cell apoptosis. This cascade weakens the capillary wall, resulting in microaneurysms, endothelial cell death, and capillary occlusion and dropout. Consequently, DR is characterized by two main pillars: 1) ischemia (with or without concomitant neovascularization) and 2) vasopermeability (leakage), due to disruption of the blood‐retinal barrier.

The standard classification of DR is based on the Early Treatment of Diabetic Retinopathy Study (ETDRS) scale and focuses on vascular lesions as described by fundoscopy. Based on this staging, DR is subdivided in non‐proliferative and proliferative DR (NPDR and PDR, respectively). The latter signifies the presence of neovascularization. Poor blood sugar control, high triglyceride levels, kidney disease, and early‐onset type I DM are the most important among risk factors for the development and progression of PDR.

The ETDRS classification poses with numerous limitations. First, it does not comprise any aspects of visual function or systemic health. Second, it relies on vascular deficits and does not account for neurodegeneration through structural metrics. Last, it does not incorporate the presence of diabetic macular edema (DMO), which is the most frequent cause of DR‐related visual impairment, can occur at any stage of the disease, and is a major drive of clinical management and treatment. Recent efforts have been made in establishing a classification system for DMO, based on morphological characteristics as seen in optical coherence tomography (OCT) scans.
Intravitreal anti‐vegf agents and combination treatment in proliferative diabetic retinopathy
Authors: Gawęcki Maciej
Published: January 2025

Proliferative diabetic retinopathy (PDR) poses as a significant threat to patient's vision if untreated or treated insufficiently. Panretinal photocoagulation (PRP) has long been a mainstay treatment for this condition. The advent of anti‐VEGF therapy provided an additional option for the management of this condition. The aim of the presentation is to present the effects of anti VEGF treatment in PDR with special emphasis on the combination: PRP with anti‐VEGF therapy. Results of treatment with these modalities, especially regression of neovascularization, together with the incidence of potential complications will be discussed. Additional aspects of such therapy, such as BCVA improvement and central retinal thickness reduction will also be presented. Potential indications for such treatment will be outlined as well as possible treatment schedules for such management.
Management of neovascular glaucoma in proliferative diabetic retinopathy
Authors: Papakonstantinou Evangelia
Published: January 2025

This presentation navigates the intricate landscape of neovascular glaucoma (NVG) within proliferative diabetic retinopathy (PDR), addressing key topics crucial for effective management. Beginning with an exploration of NVG prevalence within diabetic retinopathy, it delves into the pathogenesis driving its progression, followed by a breakdown of the distinct stages of NVG and the corresponding treatment goals.

The presentation offers a comprehensive overview of treatment modalities tailored to each stage, covering medical, surgical, and laser interventions aimed at managing both intraocular pressure (IOP) and neovascularization. Additionally, it examines the complexities of NVG following vitrectomy and discusses emerging evidence and biomarkers that contribute to advancing therapeutic approaches.

Emphasizing the importance of interdisciplinary cooperation, the presentation underscores the collaborative effort necessary for optimizing patient outcomes.
Genetic diseases masquerading as uveitis
Authors: Salas Ester Carreno
Published: January 2025

A diverse array of examples wherein genetic diseases presents with clinical manifestations resembling uveitis will be presented. Through compelling case studies and in‐depth analysis, we will shed light on how retinal dystrophies can mimic uveitis in their clinical presentation and the key features that can help us in the differential diagnosis of these conditions.
Myopia calculators: present and future (carla lanca)
Authors: Lanca Carla Rita Dos Santos Costa
Published: January 2025

The development of tools to predict the risk of myopia onset and myopia progression has increased in the past few years. Currently, several myopia control therapies are available to slow the rate of progression. Additionally, environmental counselling, such as increasing outdoor time, can be used to delay the onset of myopia. However, the assessment of the need for treatment or counselling is dependent on an evaluation of the risk to develop myopia or the risk of myopia progression. Several tools to predict the risk of myopia development and myopia progression have been developed, such as percentile growth curves or artificial intelligence growth curve estimations for refractive error and axial length. Among these tools are web‐based and app resources on myopia risk calculators that display myopia risk and progression graphically. The diversity of calculators is wide and customisable fields allow the introduction of data necessary for predictions, such as age, spherical equivalent, ethnicity, axial length, and parental history of myopia or others. Some calculators allow the comparison of the risk of myopia development with myopia management and without. The use of myopia calculators, including axial length growth charts, has been encouraged as an educational tool that can be helpful to discuss myopia management with parents and children. How effective those tools are as part of a myopia workup in clinical practice is still unknown. In clinical practice, some biometers for axial length measurements have incorporated growth charts that allow to monitor axial length progression. However, scientific research or evidence of the accuracy of those calculators is scarce. Previous research has shown that some calculators may not provide accurate estimates for all children and should be used with cation, especially when taking ethnicity in consideration. Problems identified with the available calculators were related with underestimation and over estimation of the extent of myopia progression in about 64% of children. Overestimations may be more likely in younger children. Thus, calculators should be used with cation as relying on predictions of average progressors alone, may not be the best approach when considering individual myopia control management. Presently, available calculators may not be able to replace individual risk assessment and management. Further research is necessary with larger sample sizes, longer follows‐ups and wide range of ethnicities to validate the existing calculators before adoption into daily clinical practice to predict the individual risk of future myopia progression.
Transformative approaches for clinical trials in ophthalmology: Virtual reality as a metric for functional vision in inherited retinal diseases
Authors: Authié Colas
Published: January 2025

Determining the efficacy of therapeutic interventions in ophthalmology requires not only the assessment of retinal structure and visual function but also a comprehensive evaluation of functional vision. Functional vision pertains to the patient's capacity to execute essential, vision‐dependent tasks, thereby maintaining autonomy. Traditional measures like visual acuity, contrast sensitivity, and visual field evaluations can fall short in encapsulating the full spectrum of visual deficits experienced by patients. To address this gap, translational researchers are increasingly focusing on developing performance outcomes (PerfOs) that provide a holistic measure of the therapy's impact on daily life activities.

PerfOs are designed to strike a balance between measurement precision, relevance to the patient's daily life, and ecological validity, all while being adaptable for use in multicenter studies. A promising approach to achieving these objectives is the use of virtual reality (VR) for performance assessment. VR offers unparalleled control over experimental conditions, such as lighting, and enables rapid, objective behavioral measurements. Additionally, its reproducibility across various assessment centers and the safety it provides to participants make VR an ideal tool for this context.

In this presentation, we introduce two innovative PerfOs developed for inherited retinal diseases, employing VR to enhance clinical endpoint accuracy in ophthalmology. The first is a mobility test, validated extensively in both real‐world and virtual settings. It demonstrates high reproducibility and reliability, effectively differentiates between retinitis pigmentosa patients and healthy controls, and accurately categorizes disease stages. The second is a VR‐based visual search task, specifically designed for the same patient population. These studies collectively affirm the potential of VR in establishing novel, meaningful clinical endpoints, significantly advancing the field of ophthalmology and enhancing patient‐centric care.
Developments in instrumentation to improve the diagnosis of ocular pathology in the community
Authors: Heitmar Rebekka
Published: January 2025

Retinal imaging, whether it be photography or OCT is now commonplace in UK optometric practices. Identifying lesions, quantifying visual functional change and consideration of underlying history and symptoms has been aided by having access to images and allowed better quantification of longitudinal changes. The integration of functional, structural and long‐term data has further enhanced the diagnostic capacity in a community setting. Such developments have helped to ease the burden on hospital eye departments in that community practices can provide further services such as screening, monitoring and triaging assessments for a number of conditions including glaucoma and diabetic retinopathy. The integration of primary and secondary care data and access thereof is still in its infancy but has already had a positive impact in reducing and improving referrals to the hospital, benefitting not only the patient but also the reducing overall health care cost. Capturing retinal images and scans also enables the measure of more quantitative parameters such as vascular diameters which have been shown to be altered in both ocular and systemic pathology. The combination of image derived parameters and measurement of other health data (i.e. blood pressure) not only allows for better diagnostic capacity but also helps in providing better patient management of modifiable risk factors.

The present talk will provide an overview of how instrumentation, such as imaging devices have improved not only diagnosis of ocular pathology but also contributed to better manage risk of future pathology. With an ageing community, increased life expectancy and sadly more chronic illness such as hypertension and diabetes on the rise, it is vital to identify those at risk early and where possible reduce risk to ease the burden on society. Retinal imaging, in combination with other health data, allows for earlier diagnosis and better risk management.
Improving colour vision testing in the community
Authors: Evans Benjamin
Published: January 2025

A remarkable, and often underappreciated, property of the human visual system is its ability to perceive and distinguish colour. This occurs through a myriad of physiological and neurological processes with disruptions anywhere along the visual pathway having the potential to affect colour perception. This ability to perceive and process colour coded information, and human colour vision more generally, are valuable components of vision which, in addition to encoding information about our environment, provide clinicians with insights into the functioning of the retina and neural visual pathways. In clinics, monitoring occurs through tests that assess the ability to see, distinguish, and make use of colour.

The primary purpose of colour vision assessment often varies in hospital clinics compared to community practice. In a hospital setting, the colour vision deficiencies of primary interest will be acquired in nature. The detection, classification, quantification, and measurement of such deficiencies can enable early‐stage detection of retinal disease and an additional measure for monitoring progressive conditions.

Within community practice, the primary interest often will be congenital colour vision deficiency. Congenital defects are present in ~8% of males and ~0.5% of females and affect education and occupational suitability. The early detection of such deficiencies is important to identify any potential colour vision deficiency that may impact a child's education, or an adult's occupational suitability. Ensuring children are not educationally disadvantaged due to an inherited colour vision deficiency, whilst also ensuring that individuals employed in occupational roles that require a certain level of chromatic sensitivity are able to do so safely is hugely important and a key role of optometric practitioners working in the community.

Although most colour vision deficiencies encountered in community practices will be congenital, patients will also be encountered with acquired defects from ocular or neurological pathologies. In these cases, colour vision testing may play a key role in diagnosis of pathology.

There is a discrepancy between the quality of tools available in specialist centres and community and hospital clinics. Many of the insights gleamed from work carried out in specialised colour assessment clinics are currently not fully utilised within community practice. During this session we will review the main clinical colour vision tests, highlighting the differences between the tests that are most useful for diagnosing congenital and acquired defects.

This presentation will provide a timely refresher on colour vision testing, its importance, and, critically, the limitations present in several colour vision tests in current use. This presentation is likely to be of interest to those who regularly assess colour vision, and even more important for those who do not often use colour vision tests and who may therefore benefit from adopting this additional clinical tool.
The debate – when and how should i use idebenone for LHON?
Authors: Votruba Marcela
Published: January 2025

The International Consensus Statement on the Clinical and Therapeutic Management of Leber Hereditary Optic Neuropathy was published in 2017 based on data available in 2016. The intent was to provide expert consensus statements for the clinical and therapeutic management of LHON based on the currently available evidence. It provided the guidelines for clinical and therapeutic management of LHON. It established a number of benchmarks such as clinical staging of LHION into Asymptomatic (mutation carriers), Subacute (<6 months from onset), Dynamic (6–12 months) and Chronic (>12 months) stages. We can all agree on the criteria for the diagnosis of LHON, based on a careful history, evaluation of key structural and functional visual parameters, and on a molecular confirmation of a pathogenic mtDNA mutation. On management it is clearly highly important to include genetic counselling and informing the patient about potentially preventable lifestyle risk factors. The use of idebenone is more debated and much has changed. Further studies and case series have been published and issues around when to start, how long to treat for and whether to treat chronic patients have all emerged. In this debate we shall raise a number of these issues and provide a reflection of the available data, their validity and clinical relevance and debate next steps.
Normal findings
Authors: Schmidl Doreen
Published: January 2025

Gonioscopy is an important diagnostic examination in ophthalmology. It is essential to understand the mechanisms underlying the different subtypes of glaucoma, not only for didactic reasons, but especially to correctly diagnose and appropriately treat each individual patient.

Screening tests like the van Herrick method are helpful for screening purposes, but they cannot replace gonioscopy.

In this presentation it is shown how to perform gonioscopy including dynamic gonioscopy and the normal findings. The most important angle landmarks and the orientation in the angle will be shown by videos and pictures.
Concepts of recovering depth of field after cataract surgery
Authors: Kaymak Hakan
Published: January 2025

Patients presenting for cataract surgery who wish to reduce their dependence on spectacles for distance, intermediate and near viewing may choose from a wide range of options, from simple monofocal IOLs, to enhanced monofocal IOLs, to extended depth of focus (EDOF) IOLs, to bifocal and trifocal IOLs. These lenses are listed here in the generally accepted order of their ability to provide near vision. With any of the presbyopia correcting IOL options there is a higher likelihood of reduced contrast sensitivity and more visual disturbances relative to a monofocal IOL. The highest level of spectacle freedom is expected to be obtained with bilateral trifocal IOLs.

The ability to provide good near vision with a trifocal IOL is important to many patients. Results from early research designed to objectively quantify the percentage of time spent viewing near/intermediate and far objects indicated that participants spent more than 40% of their time on near tasks (43%, ± 15%), exceeding the time spent on intermediate (30%, ± 15%) and distance (27% ± 12%) tasks.As can be seen, the distribution was quite varied, which makes it important to consider the individual's vision requirements when recommending a presbyopia‐correcting IOL or IOLs. In this course we will present the best way to implement
Enhance the visibility, credibility, and clarity of scientific messages
Authors: Meseguer Victor , Gallar Ángeles , Díaz‐Tahoces Ariadna
Published: January 2025

Storytelling is a deeply human practice. Through narrative ‐understood as a representation of a possible world in a linguistic and/or visual medium, at whose center protagonists exist in a temporal and spatial sense (Fludernik, 2009)‐ the audience can immerse in a different world. Therefore, storytelling can be a powerful tool with which to engage any person with the societal relevance of a scientific project and enhance its visibility and credibility.

This engagement is essential for science, even before the actual research is done. A research proposal, for example, needs to stand out amongst other equally valid work to gain funding. Later, a scientific paper must present the results clearly to have an impact, even for a niche audience (Hillier, 2016).

The structure and language of storytelling can be helpful when conveying the planning and performing of experiments. A clear, orderly, and compelling narrative won’t compromise the integrity and authenticity of scientific research. On the contrary, when communicating outside the scientific community, a story arc provides a logical framework to present our research. Since people cannot like what they don’t understand and won't support what they don’t like, scientific research must bridge the gap between the scientific community and the general public to gain societal support. Yet, the constructs of scientific communication can be daunting for a nonscientific audience: the passive voice, overly formal language, undefined concepts, highlighting the results before explaining the problem we are trying to solve, etc.

Starting with a question, focusing on the journey of knowledge, and explaining what's at stake are more effective approaches to convey scientific messages (Ettinger, 2020). Communicating our motivations will make complex content sound less alienating. A narrative based on a first‐person voice and including the researcher's origin of interest increases perceived authenticity in the non‐expert audience (Saffran et al., 2020). Furthermore, storytelling can help counter misinformation (Sangalang, 2019). Combining the facts of science and the persuasion of storytelling, scientific messages can use the persuasion of narrative to empower society.

Ettinger, J. (2020). What Hollywood can teach researchers about scientific storytelling. Nature.

Hillier, A., Kelly, R. P., & Klinger, T. (2016). Narrative Style Influences Citation Frequency in Climate Change Science. PLOS ONE, 11(12), e0167983.

Saffran et al. (2020). Constructing and influencing perceived authenticity in science communication: Experimenting with narrative. PLOS ONE, 15(1), e0226711.

Sangalang, A., Ophir, Y., & Cappella, J. N. (2019). The Potential for Narrative Correctives to Combat Misinformation. Journal of Communication, 69(3), 298–319.
Classic focal laser photocoagulation in the rea of intravitreal injections
Authors: Święch Anna
Published: January 2025

Classic focal laser photocoagulation is still a procedure advised as a treatment option in macular edema present in conditions such as diabetic macular edema and macular edema secondary to retinal vein occlusion. The most important ophthalmological guidelines include that procedure as an option of treatment. However, in era of anti‐VEGF drugs, the indications for laser treatment should be carefully discussed. Besides the combination therapy of laser photocoagulation and anti‐VEGF drugs or intravitreally administered steroids may have potential in reducing the number of injections needed for treatment. On the other hand, advancements in laser treatment have led to the development of current laser settings that aim to minimize side effects, such as atrophic creep and the development of scotomata. Beside in taht course we will highlight the role of fluoresceine angiography in the process of qualification for laser therapy.
Multiwavelength retinal photobiomodulation
Authors: Kaymak Hakan
Published: January 2025

Dry age‐related macular degeneration (AMD) is the leading cause of visual impairment and irreversible blindness in the developed world. Treatments that impact the pathological underpinnings of the disease are of interest. Photobiomodulation (PBM) is a light‐based biotechnology that induces cellular changes and drives bioenergectic functioning in dysfunctional systems, such as those seen in degenerative disease. In this course we will present the clinical and anatomical benefits of PBM in a case series of dry AMD patients and explain how to implement this technology in routine clinical practice.
Who will implement simulation‐based education?
Authors: Thomsen Ann Sofia Skou
Published: January 2025

In this talk, we will discuss who can benefit from simulation‐based education, and how it is implemented in a "Best Practice" manner. We will also discuss the role of stake‐holders. Real‐life examples will be given.
What is needed for simulator‐based education?
Authors: Flockerzi Elias , Deuchler Svenja , Dail Yaser Abu , Sneyers Albéric , Berger Tim , Koch Frank , Seitz Berthold
Published: January 2025

While ophthalmologists relied primarily on learning on the real human eye and performed their first surgical steps on the pig's eye in the past, there exist nowadays multiple options for diagnostic and surgical simulation‐based education in ophthalmology.

These range from simple direct ophthalmoscopy simulators displaying pathologic fundus findings to direct and indirect ophthalmoscopy simulators that provide both instructions and information on learning progress by recording and analyzing the examination process.

Surgical simulators exist for both cataract and vitreoretinal surgery and are very popular. An expansion in the field of corneal and glaucoma surgery can be expected in the future.

Recently, the range of simulation‐based education in ophthalmology was further expanded to include a slit lamp simulator and a retinopathy of prematurity simulator.

In view of the various existing simulation‐based education options in ophthalmology, the aim is to work out what is necessary in addition to the pure offering of simulation in order to measure and guarantee the success of simulation‐based education.
Sensitive methods for assessing spatial vision suitable for early detection and monitoring of diabetes
Authors: Bohra Sajni , Rodriguez‐Carmona Marisa , Barbur John
Published: January 2025

Aims/Purpose: Emerging evidence suggests functional changes occur as early as during the prediabetic stage, yet the diagnostic criteria for diabetic ocular complications primarily focuses on retinal vasculature changes. This study explores functional contrast sensitivity (FCS) and visual acuity (VA) measured with briefly presented stimuli of positive and negative luminance contrast. The aim was to investigate if changes in spatial vision can be measured with greater sensitivity to serve as biomarkers for early diabetes.

Methods: Controls and subjects with prediabetes (HbA1c between 42‐47 mmol/mol) were included in the study. VA and FCS were measured monocularly using the Acuity‐Plus test. employing both positive and negative contrast optotypes in the same test using four interleaved stimulus conditions. Best‐corrected visual acuity was also measured in each subject using the ETDRS chart.

Results: VA and FCS thresholds were higher in the prediabetic groups compared to controls, with a more significant difference observed in negative contrast. Prediabetics exhibited ~18% (+ve contrast) and ~34% (‐ve contrast) poorer VA when compared to controls. When comparing FCS, the prediabetic group exhibited ~31% (+ve) and ~46% (‐ve) higher thresholds. Notably, none of the controls exceeded the upper limits for their corresponding age for negative contrast VA, contrasting with ~8.8% of prediabetics. Moreover, only ~2% of controls exceeded the upper limit, compared to ~14% of prediabetics. Furthermore, VA thresholds measured using the Acuity‐Plus test were significantly higher than the corresponding values measured using the ETDRS chart. This was especially so in prediabetics, suggesting that the Acuity‐Plus test is more sensitive in detecting early visual function impairments. Additionally, a positive correlation was found between HbA1c levels and increasing VA and FCS thresholds.

Conclusions: The findings indicate that VA and FCS, particularly with negative contrast stimuli, are impaired in individuals with prediabetes. This suggests that spatial vision tests, especially the Acuity‐Plus which employs briefly presented stimuli, could serve as valuable biomarkers for early detection of diabetes, potentially leading to more timely interventions.

References: DOI: 10.1111/opo.13037.
The incidence of serious anterior segment complications after selective laser trabeculoplasty
Authors: Ojanen Eeva , Turunen Joni , Harju Mika
Published: January 2025

Aims/Purpose: Selective laser trabeculoplasty (SLT) is a safe, effective, and common treatment for glaucoma and ocular hypertension. There are reports of rare complications of SLT, but the incidence of these events is not known. Here, we evaluated the incidence of serious anterior segment complications after SLT.

Methods: Eligible to the study were patients who underwent SLT at the Department of Ophthalmology, Helsinki University Hospital from the 1st of January 2004 to 30th of April 2018. From electronic medical records, demographics, procedure details, complications, predisposing factors, and clinical outcomes data were extracted retrospectively. The main outcome measure was complications including corneal edema, corneal scaring, hyperopic shift, and anterior chamber hyphema.

Results: A total of 4748 SLTs (3546 eyes) of 2189 patients were analyzed. Nine patients had hemorrhages in the anterior chamber angle (incidence 1.8/1000) during or after SLT. Three of them developed hyphema, and all three were on anticoagulation medication. One patient developed multiple peripheral anterior synechia after hyphema. The incidence of hyphema was 0.63/1000. Corneal edema was reported in four patients, resulting in an incidence of 0.84/1000. One myopic eye after a second SLT had a permanent corneal scaring and thinning with a hyperopic shift (5.3D) resulting in poor vision visual acuity from (0.9 to 0.6). The incidence was less than 1/4748 for all eyes and 1/368 for eyes with known myopia of ‐5D or more.

Conclusions: After SLT, the number of complications was low with only one permanent vision deterioration after 4748 treatments. These findings may help clinicians to reassure the patients when offering the SLT also as a first‐line treatment for ocular hypertension or primary open angle glaucoma.