bluuebunny/crossref_metadata_2025 huggingface dataset:
microRNAs as markers of congenital aniridia
Authors: Stachon Tanja , Nastaranpour Mahsa , Fries Fabian N. , Seitz Berthold , Amini Maryam , Suiwal Shweta , Ludwig Nicole , Szentmáry Nóra
Published: January 2024

Subjects with congenital aniridia often develop aniridia‐associated keratopathy (AAK), which is related to limbal stem cell insufficiency. Loss of limbal epithelial stem cell function results in corneal inflammation and neovascularization, and several subjective symptoms. MicroRNAs (miRNAs) are approximately 22 nt long non‐coding RNA molecules capable of regulating gene expression at the post‐transcriptional level.

It is of interest to investigate the expression of microRNAs and their possible effect on AAK development, as deeper understanding of their function in limbal epithelial cells could help in designing new therapeutic approaches of AAK.

Previous studies verified deregulated miRNAs in conjunctival cells of aniridia subjects, among others miR‐204‐5p and miR‐7150, which are more deregulated in mild cases of AAK. In addition, numerous studies suggest that miRNAs regulate genes involved either directly or indirectly in inhibition or promotion of pathological angiogenesis of the cornea. Several pathways, including JAK–STAT, focal adhesion, Hippo, WNT and PI3K‐AKT signalling pathways, could potentially play a role. In limbal epithelial cells of aniridia subjects, deregulation of miR‐138‐5p may play a role, which is involved in the regulation of cell differentiation and migration and in Hippo, Wnt, Focal adhesion cAMP and p53 signalling pathways.
Inflammasome activation in retinal pigment epithelium cells
Authors: Kauppinen Anu
Published: January 2024

Inflammasomes are intracellular protein complexes participating in the activation of inflammatory cytokines IL‐1b and IL‐18 as well as in the induction of pyroptosis. NLRP3 inflammasome is the most well‐known inflammasome type, and its functionality in retinal pigment epithelium (RPE) cells has been known since 2012. We have learned in 10 years that inflammasome activation in human RPE cells can result into the release of either IL‐1b or IL‐18 and even if released concurrently, they can be regulated by different pathways. Time and apparently also the route for the secretion of IL‐1b from RPE cells differs from that of macrophages. NLRP3 inflammasome can be activated by different mechanisms, and the activation mechanism depends on local conditions in a cell. Recent studies have shown that several inflammasome types can be activated in same cells, and full inflammasome activity may need co‐operation of different caspases although caspase‐1 is the predominant player upon inflammasome activation.
Retinal biomarkers in vascular occlusion
Authors: Makled Hebatalla
Published: January 2024

Objective: To clarify the diagnostic and prognostic values of the biomarkers detected by multimodal imaging procedures as coloured fundus imaging, fluorescein angiography, near infra‐red imaging, fundus Autofluorescence, SD‐OCT, and OCT angiography to predict the prognosis and the response to therapy in retinal vascular occlusions (artery or vein).

Recently, there has been an interest in determining the prognostic value of changes on optical coherence tomography (OCT) in retinal vein occlusion as it allows both quantitative and qualitative analysis of imaging biomarkers such as central retinal thickness, choroidal thickness, intraretinal hyper‐reflective foci (HRF), disorganization of the inner retinal layers (DRIL), external limiting membrane (ELM) disruption, ellipsoid zone (EZ) disruption. Also classifying the intraretinal edema if sponge‐like or cystoid or serous retinal detachment (and detecting its height). Also signs of ischemia can be detected such as prominent middle limiting membrane (p‐MLM), paracentral acute middle maculopathy (PAMM), as well as hyperreflectivity of the inner retinal layers (HIRL) which is commonly seen in cases of acute retinal artery occlusion. Internal limiting membrane detachment (ILMD) which is a novel biomarker that can be detected in some cases of acute CRAO.

OCT Angiography has added more information about the assessment of microvascular alterations, especially vessel density in the deep retinal vascular plexus, the foveal avascular zone and of areas with no capillary perfusion. Biomarkers of ultra‐widefield angiography, such as peripheral ischemia (ischemic index) and neovascularization are essential for retinal laser treatment decision.

Finally, FAF has been a very useful tool in monitoring the disease progression and response to treatment.

The speaker will present examples of multimodal imaging of different retinal biomarkers in retinal vascular occlusion that help in predicting the prognosis.
Improving transparency and corneal wound healing in rare diseases by promoting corneal nerve regeneration
Authors: Gallar Juana
Published: January 2024

Corneal nerves play a crucial role in maintaining the integrity of corneal tissue, as well as the proper regulation of tearing and blinking. When activated, corneal nerves release locally several factors, including neuropeptides, that contribute to the trophic maintenance of corneal tissues. So that, the reduction or absence of corneal nerves led to impaired corneal wound healing in addition to a loss of sensory input, resulting in lack of sensitivity and alterations in tearing and blinking rate. Such consequences are seen clinically in several rare diseases where severe nerve deficit is a prominent factor such as in neurotrophic keratopathy, where the cornea spontaneously ulcerates due to its inability to renew the epithelium and to heal epithelial wounds, leading to loss of corneal transparency. An advanced molecular therapy to increase corneal nerve regeneration and support the corneal neurotrophic environment in such ocular rare diseases is proposed.

(Supported by RESTORE VISION – 101 080 611, Horizon Europe Framework Programme, European Commission)
Myopia in mouse models
Authors: Wilmet Baptiste
Published: January 2024

Myopia is the most common ocular affection worldwide. It is a multifactorial disorder involving both environmental and genetic factors. To decipher the mechanisms implicated in emmetropisation process and the onset of refractive errors, a wide variety of animal models have been proposed to date. Among them, the chicken model is the most historical, provided the most basic findings and is still the most commonly used model nowadays. Non human primates were also extensively used due to their good optics and their proximity to humans. Due to their low optics and their nocturnal activity, the mouse model was largely excluded from the field of myopia for decades. However, it raised interest for a few years now, due to ethical and technical limitations observed in previous models. An increasing number of studies focus on the interaction of genetic and environmental factors. Thus, the easiness of breeding and manipulating lightning environment added to the wide range of genetic tools allowing the modification or inactivation of genes and biological functions highlighted the potential of mouse models. This talk will review the most recent contributions of mouse models to the research field in emmetropisation and myopia. As the retina is the first actor of the integration of light stimuli, we will focus on retinal signalling defects such as those observed in congenital stationary night blindness.
AI‐based studies using fundus images
Authors: Grzybowski Andrzej
Published: January 2024

The artificial intelligence (AI)/deep learning (DL) algorithms were shown to detect diseases based on image analysis, including retinal diseases from fundus photos and optical coherence tomography (OCT) scans, lung diseases from chest radiographs, and skin disorders from skin photos. It was also shown that retinal photos can be used to identify risk factors related with cardiovascular disorders, including blood pressure, smoking and body mass index.

The fundus picture was shown to source data for developing AI/DL algorithms detecting many ophthalmic diseases and pathologies, including diabetic retinopathy, diabetic macular edema, retinal artery and vein occlusion, macular hole, epiretinal membrane, AMD, glaucoma, retinopathy of prematurity, myopia, myopic macular degeneration, hyperopia, optic disc edema, optic nerve atrophy, central serous retinopathy, myelinated nerve fibres, and retinitis pigmentosa. Moreover, fundus pictures were also used to develop many AI/DL algorithms detecting non ophthalmic diseases and pathologies, including Alzheimer and Parkinson disease, risk of stroke, risk of cardiac infarction, systemic hypertension, chronic renal disease, peripheral arterial disease, and anaemia.
Artificial intelligence and neuro‐ophthalmology
Authors: Milea Dan
Published: January 2024

Deep‐learning (DL) methods have been successfully applied to Neuro‐ophthalmology and in particular to interpretation of images of retina and the optic nerve for detection of life‐ and/or vision‐treating cerebral conditions. DL systems are nowadays able to accurately detect papilledema related to raised intracranial pressure, (1) as well as other optic neuropathies, on standard retinal photographs alone. In addition to detection of specific retinal features and abnormalities, more recent DL methods suggest that neurodegenerative conditions (Alzheimer's disease, Parkinson's disease), affecting the ocular structures, can be also detected on trivial retinal photographs.(2).

Ophthalmologists and neuro‐ophthalmologists are in a privileged position to detect cerebral conditions affecting the eyes, using novel, cutting‐edge DL technologies, which may transform our clinical practice in the next years.(3) Such algorithms may be implemented in the future, if further validated in real‐life situations, for the triaging of patients who are seen in non‐ophthalmic set‐ups (emergency rooms, neurology offices, etc.). This presentation will share the current hopes, doubts, successes and failures of assistive AI applied to Neuro‐ophthalmic conditions.

References.

Milea D, Najjar RP, Zhubo J, Ting D, Vasseneix C, Xu X, Aghsaei Fard M, Fonseca P, Vanikieti K, Lagrèze WA, La Morgia C, Cheung CY, Hamann S, Chiquet C, Sanda N, Yang H, Mejico LJ, Rougier M‐B, Kho R, Thi Ha Chau T, Singhal S, Gohier P, Clermont‐Vignal C, Cheng C‐Y, Jonas JB, Yu‐Wai‐Man P, Fraser CL, Chen JJ, Ambika S, Miller NR, Liu Y, Newman NJ, Wong TY, Biousse V for the BONSAI Group. Artificial Intelligence to Detect Papilledema from Ocular Fundus Photographs. N Engl J Med. 2020 Apr 30;382(18):1687–1695.

Cheung CY, Ran A, Wang S, Chan VTT, Sham K, Hilal S, Venketasubramanian N, Cheng CY, Sabanayagam C, Tham YC, Schmetterer L, McKay GJ, Williams MA, 12, Wong A, Au L, Lu A, Yam JC, 1 Tham CC, Chen JJ, Dumitrascu OM, Pheng‐Ann H, Kwok T, Mok V **, Milea D**, Chen LH, ** Wong TY**. A deep‐learning screening model for Alzheimer's disease based on retinal photographs. Lancet Digital Medicine, 2022 Nov;4(11):e806‐e815.

Sathianvichitr K, Lamoureux O, Nakada S, Tang Z, Schmetterer L, Chen C, Cheung CY, Najjar RP, Milea D. Through the eyes into the brain, using artificial intelligence. Ann Acad Med Singap. 2023 Feb;52(2):88–95.
Development of a novel contact lens for drug delivery purposes
Authors: Fuchsluger Thomas
Published: January 2024

This talk will present a novel layer‐by‐layer technology to bind drugs to the surface of contact lenses. Technology, processing and release will be demonstrated as well as the potential of the technology and future possible use.
The benefits of physical exercise on glaucoma management: Evidence‐based recommendations for eye care providers
Authors: Vilchez Jesus Vera
Published: January 2024

The only proven method to treat glaucoma is the reduction and stabilization of intraocular pressure (IOP). A wide range of daily activities have shown to affect the IOP behaviour, and eye care specialists should be aware of their effects for the prevention and treatment of glaucoma. Indeed, the impact of physical activity on IOP has gained attention in the last years, and exercise prescription has emerged as a promising adjuvant strategy for IOP control in glaucoma patients. Previous studies have demonstrated that the IOP response to physical exercise may be dependent on numerous factors such as exercise type (e.g., endurance, resistance), exercise intensity, subjects´ fitness level, body position (e.g., supine vs. standing) and breathing pattern adopted during exercise, underlying medical conditions, concomitant mental effort or caffeine intake before exercise among others. This talk will summarize the available scientific evidence on the positive and negative effects of physical exercise on IOP, and provides practical recommendations for exercise prescription in glaucoma patients or those at risk. It will permit to better understand the potential benefits of exercise prescription as a coadjuvant strategy for the prevention and management of glaucoma, which would be of great relevance due to the important health, economic and social burdens associated with this condition.
Optic treatments to myopia management
Authors: Rodriguez Juan Gonzalo Carracedo
Published: January 2024

Myopia has become a challenge for public health in the last decades due to the increase in its prevalence and its effect on the axial growth of the eye. The main concern about the myopia progression in the child population is due to the appearance of secondary pathologies of myopia in the adulthood. They have been developed various optical and pharmacological treatments in the last years to try to minimize the axial growth of the eye and therefore to try to prevent, to delay or to minimize the impact of pathologies associated to myopia that could provoke loss of vision.

Within the optical treatments to control the axial growth progression, orthokeratology contact lenses, peripheral defocus soft contact lenses and ophthalmic lenses have been described. Other optical devices are also being developed that through the management of different wavelengths of light will serve as adjuvants for the myopia control.

That presentation will try to show the scientific evidence on the efficacy and safety of the use of these treatments as well as to discuss the possible mechanisms of action to minimize the axial growth progression.
Simulation of the effect of capsular opacification on retinal illumination
Authors: Langenbucher Achim
Published: January 2024

Posterior capsular opacification is the most common complication after cataract surgery with intraocular lens implantation. Different strategies have been proposed to avoid PCO including 360° continuous sharp edges of the posterior IOL optics rim, haptics angulations, or surface modification of the optics. However, depending on the IOL material and surgical technique 20 to 60% of eyes require Nd:YAG laser capsulotomy in the first 2 years after cataract surgery. In this talk we would like to define a scattering model for the posterior lens capsule and perform raytracing through the pseudophakic eye with a scattering capsule to investigate the impact of biometric parameters on the scatter characteristics and contrast transfer of the eye.
Photoreceptor rescue in retinal degenerative diseases
Authors: Perez Maria Paz Villegas
Published: January 2024

María Paz Villegas‐Pérez, Johnny Di Pierdomenico Spitilli, Ana Martínez Vacas y Diego García Ayuso.

Inherited retinal degenerations are genetic diseases that cause irreversible blindness at working age. Although the most common form is retinitis pigmentosa (RP) there are many forms of the disease. More than 100 genetic defects have been documented in RP and therefore genetic treatment for this disease is not possible at present. We have used pharmacological, dietary and cellular therapies to augment photoreceptor survival in two animal models of inherited retinal degeneration with genetic defects also observed in human RP, the P23H1 rat and the RCS rat. Different therapies have shown promising results and may be thus used alone or in combination to promote photoreceptor survival in inherited retinal degenerations.
Autophagy modulators as potential neuroprotective drugs in glaucoma
Authors: Russo Rossella
Published: January 2024

Glaucoma, a progressive age‐related optic neuropathy characterized by retinal ganglion cell degeneration and alteration of the optic nerve head, is a leading cause of irreversible blindness worldwide. Elevated intraocular pressure (IOP) is one of the main and the only known modifiable risk factor. However, despite lowering IOP, glaucomatous damage still progresses in a relevant percentage of patients.

Neuroprotection in glaucoma refers to any non‐IOP related treatments that can prevent or delay neurodegeneration. Metformin (1,1‐dimethylbiguanide hydrochloride) is one of the first‐line anti‐hyperglycemic drugs for type 2 diabetes mellitus. In recent years, several studies have investigated the neuroprotective effect of metformin in a variety of neurodegenerative diseases, revealing that this drug is able to regulate energy metabolism, prevent oxidative stress, reduce neuroinflammation and trigger autophagy.

The autophagy‐lysosome system, which is responsible for breaking down cellular components, preserving cellular homeostasis and preventing accumulation of protein aggregates and damaged organelles, is often dysregulated in neurodegenerative pathologies.

Here we show that the neurodegeneration observed in experimental models of glaucoma is associated with autophagy and mitophagy dysregulation, and describe the neuroprotective effects of treatment with metformin as autophagy modulator. To explore the possibility of the clinical translation of our findings, we performed a retrospective pilot study documenting for the first time a putative neuroprotective effect of metformin in glaucomatous diabetic patients.
Exfoliation syndrome and exfoliation glaucoma ‐ Current research and Management in Georgia
Authors: Kobakhidze Nino
Published: January 2024

Exfoliation Syndrome (XFS) is an age‐related disorder of extracellular matrix affecting millions of people worldwide. It is the most common identifiable cause of glaucoma which is characterized by much more severe clinical course, more fluctuation of intraocular pressure (IOP), less response to medical treatment, faster progression of optic nerve atrophy and visual field deterioration, more frequent need of surgical treatment.

XFS is a heritable condition. This fact is long known from familial aggregation studies. Very little is known about the mechanisms of disease development. This is especially true about Exfoliation Glaucoma (XFG), considering that not every XFS patient converts to XFG.

The only evidence‐based treatment of XFG nowadays is IOP lowering, although addressing mechanisms of IOP elevation could be the best preventive and treatment measure.

The aim of this talk is to summarize the current status of genetic studies of XFS/XFG and to provide some tips for treatment based on several clinical examples.
Anatomical and optical origins of negative dysphotopsia
Authors: Beenakker Jan‐Willem
Published: January 2024

Negative dysphotopsia (ND) is a complaint after, an otherwise uneventful, cataract surgery with intraocular lens (IOL) implantation. It is generally described as a shadow in the temporal peripheral visual field. Approximately 3% of the patients suffer from this condition and complaints range from mild visual field defects to a significant loss of peripheral vision that disturbs daily life. Originally, this condition was poorly understood as conventional ophthalmic techniques are not designed for a comprehensive evaluation of the peripheral vision. In the last years, however, a combination of dedicated anatomical measurements and optical ray tracing simulations have revealed the cause of ND and proposed different treatments.

In this presentation the basic principles of ray tracing of the eye will be presented, followed by the main results of the ESCRS vRESPOND study. In this study, a detailed anatomical assessment of the pseudophakic population with and without ND was made. The distinct differences between both groups, such as a smaller (p = <0.01) and more decentered (p < 0.01) pupil and an increased temporal‐tilted iris (p < 0.01), will be discussed. Interestingly, high‐resolution ocular MRI revealed that the in‐the‐bag IOL position and retinal shape did not differ significantly between both groups. The impact of these differences on the patient's peripheral vision will be shown through ray tracing simulations. First the optical origin of the shadow, caused by light rays missing the IOL, will be presented, followed by a quantitative analysis of the effect the different anatomical and IOL‐design parameters on the severity of this shadow. At the end of the presentation, the optical rationale behind some of the treatments of ND will be discussed.
Direct observation of negative dysphotopsia in a physical model of the pseudophakic eye
Authors: Ginis Harilaos
Published: January 2024

Introduction: Negative dysphotopsia (ND) is a phenomenon affecting pseudophakic eyes where a dark crescent or shadow is perceived in the peripheral temporal visual field. Although is it understood that the size and position of the intraocular lens (IOL) creating a space between the IOL's optic and the iris are involved, the exact aetiology and conditions remains unclear. The purpose of this study was to develop a physical model of the pseudophakic eye and to record ND at the retinal plane in a variety of conditions.

Methods: The eye model resembles anatomically the human eye with an aspheric cornea made of PMMA (R = 7.73 mm, Q = −0.24) an exchangeable iris and an IOL holder with variable distance (0.5 to 1.5 mm) from the pupil, representing a pseudophakic anterior chamber depth (pACD) ranging from 4.05 to 5.05 mm. The eye model is filled with distilled water. A camera, in a water‐tight housing is used to record images at the retinal plane. Negative dysphotopsia was investigated using both point sources and extended surfaces for two different pACD values (4.05 and 5.05 mm) and two pupil diameters (3 and 6 mm).

Results: A characteristic crescent appeared next to the point spread function (PSF) in the periphery, representing light that was propagated beyond the edge of the IOL. This crescent was more prominent in greater pupil diameters and greater pACD values. When testing with an extended field, a relatively dark band appeared at a specific location at approximately 75 degrees of field angle. Various optical strategies to eliminate negative dysphotopsia can be envisaged including inverted meniscus lenses that ‐naturally‐ have a narrower peripheral gap and allow optical propagation until greater field angles as well as formations that block peripheral light.

Conclusion: A peripheral crescent, corresponding to light that misses the IOL's optic results to a double‐peaked PSF for field angles as small as 45 degrees in some conditions (large pupil diameter, deep pACD). Yet, a dark band does not appear until much greater angles, where effectively the part of light passing through the IOL is eliminated while the peripheral crescent persists.
Retrospective analysis of negative Dysphotopsia after cataract surgery
Authors: Mihaltz Kata
Published: January 2024

Purpose: To describe the incidence and characteristics of negative dysphotopsia (ND) as well as the risk factors contributing to it.

Methods: In this retrospective study postoperative results of 8122 eyes after cataract surgery were analysed. Three different IOLs have been implanted (EyeCee® One by Bausch + Lomb, TECNIS® by Johnson & Johnson, HOYA Vivienx™ by HOYA). Following parameters were studied: pupil size, axial length, anterior chamber depth, angle kappa, IOL power and other biometrical factors. The scotomas were depicted on a Harms tangent screen.

Results: An incidence of 1.99% of ND was found, of which 1.58% was transient and 0.42% persistent. The average duration of the symptoms was 5.40 (±6.15) weeks in the transient ND group. In the total cohort of 8122 eyes, there was no difference in the distribution of implanted IOL types or IOL power; neither played the surgeon a significant role in the development of ND. There was no significant difference between ND and control eyes regarding pupil size, axial length, and angle kappa. The anterior chamber was significantly shallower in the ND group: 5.1 ± 0.58 mm vs. 5.41 ± 0.61 mm (p = 0.03).

Conclusion: According to our findings, a shallower anterior chamber poses a risk to the development of ND.
Management of idiopathic epiretinal membrane (iERM) combined phacovitrectomy versus a 2‐step sequential surgery
Authors: Xirou Tina
Published: January 2024

Reported prevalence of (iERM) is more than 34% in the over 60 years old, increasing with age. A respectful number of patients require surgical management to avoid further deterioration in their distance visual acuity, binocular function, metamorphopsia and anisekonia, it has been reported that vitrectomy for ERM removal accounts approximately 10% of the procedures in vitreo‐retinal units. In this age group where an iERM is present the prevalence of cataract is high. A dilemma appears in phakic presbyopic eyes with iERM whether to do combined phacovitrectomy or a 2‐step sequential surgery. Phacovitrectomy has been proven a safe procedure with non‐inferior anatomical and functional post‐operative results. Sequential surgery (cataract first)maybe preferable because visual acuity results after removal of cataract maybe sufficient for patients' satisfaction and no necessity for further surgical management maybe the case for up to 17% of patients originally listed for two procedures. Sequential surgery (vitrectomy first) may have advantages for better prediction in final refraction after the cataract removal, the percentage of post‐vitrectomy cataract complications may arise. Individualization for the procedure of choice (Sequential or Phaco‐vitrectomy) for combined Cataract and iERM will be discussed during the presentation of SIS.
ILM Peel?
Authors: Perez Rafael Martinez‐Costa
Published: January 2024

To peel or not to peel the internal limiting membrane (ILM) is a continuous matter of discussion among macula surgery practitioners.

Undoubtedly to remove ILM, which is responsible off the 50% of retina rigidity, turns neurosensorial retina more flexible, allows an easiest removal of the vitreous remnants on the posterior pole, inhibits further relapses of epiretinal membranes, and promotes closure of the retinal holes when they exist by activating a glial proliferation.

Nevertheless as any other surgical manoeuvre, peeling of the ILM can produce complications such as haemorrhages, harm to the retina, vascular capillaries of the internal plexus, and even macular holes. Transitory degree of fibre layer oedema, displacement of the macula towards the disk and sometimes thinning of the nerve fibre layer can occur.

Beneficial effects of ILM peeling in ERM regarding improving vision or reducing relapses, has not been proved, but peeling is routinely made by many surgeons, and many times when intentionally not peeled, the ILM is peeled following the ERM.
Presentation of cases who underwent vitrectomy for the management of idiopathic epiretinal membranes (iERM)
Authors: Gkizis Ilias
Published: January 2024

Epiretinal membrane (ERM) is a term used to describe cellular avascular membranes that form on the inner retinal surface, causing distortion and a decrease in the best corrected visual acuity (BCVA). The prevalence of ERM ranges from 7% to 29% in the general population. Pre‐macular fibroplasia, macular pucker, cellophane maculopathy and pre‐macular fibrosis have also been used to describe this condition. The majority of ERM's have no associated ocular abnormality and are termed idiopathic while the secondary ERM's are associated with preexisting or coexisting conditions such as diabetic retinopathy, cataract surgery, retinal detachment and retinal detachment surgery.

Patients with ERM are usually monitored by measuring BCVA and retinal morphology. Last decades a valuable tool in diagnosis, grading, follow up and post‐surgical evaluation of ERM is Optical Coherence Tomography (OCT). OCT can demonstrate the presence of ERM, degree of traction, the presence of cystoid macular edema and various biomarkers such us the disorganization of the inner retinal layers (DRIL).

ERM may remain stationary with minimal effect on visual performance. However, some cases may progress with worsening of symptoms, increasing retinal thickness and traction. In those symptomatic cases, surgical peeling of ERM through pars plana vitrectomy (PPV) is the treatment of choice. Some surgeons prefer to peel the Internal limiting membrane (ILM) during primary vitrectomy. Previous studies showed that 40–83% of patients gain on average of 2 or more lines of BCVA after ERM surgery.

We present three cases of successful surgical ERM repair. The first patient had a longstanding ERM with DRIL, his symptoms were metamorphopsia and low vision. One month following vitrectomy gained 5 lines. BCVA improved from CF pre‐op to 5/10 Snellen chart 1 month post‐op, with good macular anatomical restoration. The second patient, 1 month postoperatively, had also good anatomical result but presented an eccentric macular hole even though we did not perform an ILM peel. The third patient, 18 months after a successful vitrectomy for ERM peel in his only eye and BCVA 8/10 cc on Snellen chart the first 6 months, he experienced a decline in his vision and an OCT revealed a full thickness macular hole. Hence, a second operation was performed with ILM peel and good anatomical and functional restoration.
Fostering an international network of women scientists and clinicians, encouraging open dialogue, and inspiring future women scientists in ophthalmology and vision science
Authors: Soubrane Gisèle , Ou Yvonne , Audo Isabelle , Votruba Marcela , Tassignon Marie‐José
Published: January 2024

Fostering an international network of women scientists and clinicians, encouraging open dialogue, and inspiring future women scientists in Ophthalmology and Vision Science.

How to encourage women scientists and clinicians to go after their dreams

Be a listening ear. …

Stay open‐minded. …

Help her set attainable goals. …

Take action. …

Encourage her to visualize her goals. …

Reinforce the importance of positive life skills, such as hard work, persistence, a positive attitude, and responsibility.

Be realistic about challenges.
Walnuts for the eye and vision
Authors: Casaroli‐Marano Ricardo P.
Published: January 2024

The increase in lifespan with the consequent expansion of the aging of the world population has become an important challenge for public health. In recent decades, there has been a progressive increase in the incidence of debilitating diseases related to aging, including neurodegenerative disorders and eye diseases. Oxidative stress and inflammation are believed to play a critical role in several eye disorders, such as age‐related macular degeneration (AMD), diabetic retinopathy (DR), and cataracts, the leading causes of visual loss and blindness worldwide. Neurodegenerative events were also related to AMD and DR.

Nutrients such as n‐3 polyunsaturated fatty acids (n‐3 PUFA) and antioxidants, specifically polyphenols, carotenoids, and vitamins C and E, may play a role in preventing both cognitive decline and retinal degenerative processes. Nuts have been described as a “superfood”, containing a notable variety of natural components that may have additive and/or synergistic properties for health and may prevent some pathologies. Nuts in general and walnuts in particular have a rich matrix of these bioactive components and through additive effects, have the potential to beneficially impact neuronal function in the brain and retina. Among different nuts, walnuts contain n‐3 PUFAs, specifically α‐linolenic acid (ALA; C18:3n‐3). It is believed that ALA may improve brain health indirectly through conversion to docosahexaenoic acid (DHA; C22:6n‐3), which has the ability to modulate brain plasticity and counteracts neuroinflammation in experimental studies. Other bioactive compounds in walnuts, such as arginine, tocopherols, folate, melatonin and polyphenols, also support neurological health and cognitive well‐being by modulating blood pressure, HDL function, glucoregulation, endothelial vasodilator function, oxidative status and vascular dysfunction. Polyphenols (including ellagitannins) have high antioxidant and prebiotic properties, which can regulate the gut microbiome, which is related to the increased risk of several inflammatory diseases. There is growing evidence that walnuts may contribute positively to eye disorders such as AMD, DR, and cataract prevention.
Multi ‐ omics studies of eye and lens development
Authors: Cvekl Ales
Published: January 2024

Early eye development involves formation of a symmetric pair of optic vesicles from the anterior neuroectoderm and parallel formation of closely apposed lens placodes. Their reciprocal invaginations generate the 3D‐foundation of the optic cups. Embryonic lens development is initiated within the border between the anterior neuroectoderm and naïve ectoderm, called the anterior pre‐placodal region. The earliest stages of lens development require coordinated actions of DNA‐binding transcription factor Pax6, signalling growth factor BMP4 and a pair of chromatin remodelling enzymes p300 and CBP. Studies in model vertebrates postulated a common Pax6+ progenitor cell population to generate both the lens and olfactory placodes. Recent progress in technologies to probe chromatin structure, landscape of transcription factor binding, DNA methylation, coding (mRNA) and noncoding (e.g. eRNAs and ncRNAs) transcriptomes and chromatin conformation have been shown to generate unprecedented mechanistic insights into the earliest cell fate decisions and tissue organization. To examine lens development at E8.5, E9.5 and E10.5 mouse embryos, single cell RNA‐seq (scRNA‐seq) experiments using the 10XGenomics Chromium platform were conducted. E9.5 Pax6 null embryos and controls were also included. Whole genome bisulfite sequencing (WGBS) was performed in E14.5 and P0.5 microdissected mouse lenses to map DNA methylation and integrate the data with corresponding ATAC‐ and RNA‐seq data sets. Open chromatin and DNA methylation changes were defined through identification of differentially accessible regions (DARs), unmethylated/low methylated regions (UMRs/LMRs) coupled with differential gene expression during lens differentiation. To probe 3D‐organization of lens chromatin and to identify temporally and spatially regulated lens‐specific distal enhancers, Hi‐C was used in conjunction with ChIP‐seq analysis of transcription factor CTCF in microdissected newborn lenses. Previous ChIP‐seq data using whole newborn lenses include H3K27ac peaks to identify super‐enhancers. Pax6 proteins were found both in open and closed chromatin domains, including both closed and methylated regions. In vitro binding of Pax6 proteins was not inhibited by 5‐methylcytosines within one or two CpG dinucleotides present in the Pax6 binding sites. In summary, cell fate decisions are governed by complex changes in chromatin landscape controlled by sequence‐specific DNA‐binding transcription factors and their recruitment of chromatin remodelling complexes. A combination of different –omics is a powerful approach to examine molecular mechanisms governing eye development. These studies also reveal additional levels of genetic code complexity and stimulate follow up mechanistic studies of the individual cellular and molecular processes of lens morphogenesis and their underlying GRNs and identification of cataract‐causing mutation in non‐coding regulatory sequences.
The value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma
Authors: Rauscher Franziska G. , Edgar David F. , Chisholm Catharine M. , Barbur John L.
Published: January 2024

*Correspondence: franziska.rauscher@medizin.uni-leipzig.de

The value of assessing progressive loss of red/green and yellow/blue chromatic sensitivity in glaucoma.

The study employed visual stimuli designed to isolate and reveal how spatial, temporal and chromatic aspects of visual processing change from normal sensitivity to extreme loss in glaucoma. The experiments carried out examined the fovea and each of four paracentral retinal regions, arranged diagonally away from fixation at an eccentricity of 6°. Spatial vision was investigated by measuring both absolute detection thresholds and functional contrast sensitivity using Landolt ring stimuli (Ophthalmic Physiol Opt 2022;42:1363–1378). These psychophysical tests based on Landolt C optotypes measure both detection thresholds and gap orientation discrimination thresholds in the same experiments using randomly interleaved test locations. First‐order motion perception was examined by using moving stimuli embedded in static luminance contrast noise. Red/green (RG) and yellow/blue (YB) colour thresholds were measured with the Colour Assessment and Diagnosis (CAD) test, which makes use of random, dynamic luminance contrast noise (±45%) to isolate the use of RG and YB colour signals. Subjects were normal controls (n = 65) and glaucoma patients with binocular visual field defects (n = 15) classified based on their Humphrey Field Analyser mean deviation (MD) scores. The impairment of visual function varied depending on the stimulus attribute and location tested. The severity of loss increased monotonically with disease progression. For subjects with mild glaucoma (MD −0.01 to −6.00 dB), significantly more data points exceeded the upper normal threshold limits for the corresponding age for RG colour thresholds than for any other visual test (Br Med Bull 2017;122:51–77), followed by motion thresholds. This was particularly the case for the parafoveal locations when compared with the equivalent thresholds measured at the fovea. The results suggest that a multifaceted measure of binocular visual performance based on foveal and parafoveal tests of RG colour vision and first‐order motion, can best inform on the progression of glaucoma and the overall loss of visual performance for comparison with other measures of changes in the quality of life in patients with glaucoma.

Keywords: Glaucoma, Visual function, Colour vision, Motion detection, Contrast, Acuity, Colour Assessment and Diagnosis, CAD.
Short‐term intraocular pressure fluctuation in primary angle closure glaucoma
Authors: Tan Shaoying , Yu Marco , Chan Poemen P. , Tang Fang Yao , Cheung Carol Y. , Tham Clement C. Y.
Published: January 2024

Purpose: To identify the most sensitive period for detecting significant circadian and ultra‐short‐term intraocular pressure (IOP) fluctuation associated with disease progression in primary angle closure glaucoma (PACG).

Methods: PACG eyes, which had been followed up for over 2 years under the CUHK PACG Longitudinal (CUPAL) Study, were recruited. Eyes with or without functional or structural glaucomatous progression were classified into ‘progressive’ or ‘stable’ groups based on serial visual field (VF) and retinal nerve fibre layer (RNFL) thickness documentations, respectively. Circadian and ultra‐short‐term IOP fluctuations were recorded by Sensimed Triggerfish® sensors with 288 readings over 30 s, at 5‐min intervals, over a 24‐h period. The circadian IOP fluctuation was represented by smoothed sensor output signals using B‐spline smoothing transform and described by functional data analysis. In each of seven activity‐related 1‐h periods during the examining day, the mean value of the amplitude‐frequency profiles of the signal fluctuations in twelve 30‐s intervals, which represent the ultra‐short‐term IOP fluctuation, was calculated by semi‐variogram/semi‐variance. The signals were compared between ‘progressive’ and ‘stable’ groups by permutation tests on functional t‐statistics.

Results: Among the 25 recruited PACG eyes, 16 eyes were classified as RNFL ‘progressive’ group (the mean rate of change in global RNFL thickness: −0.199 ± 0.128 μm/month). Statistically significant differences were found during the time periods from 22:00 to 23:00 and from 07: 00 to 08:00 in gradients that reflected by the first derivative of the IOP fluctuation curve, as well as from 23:00 to 24:00 and 08:00 to 09:00 in curvatures that reflected by the second derivative of the IOP fluctuation curve, between the VF progressive and the VF stable groups (p < 0.05). Gradients differences were also found during the time periods from 24:00 to 01:00 and 02:00 to 03:00 between structural progressive and stable groups (p < 0.05). Higher signal fluctuations, in terms of amplitude‐frequency, were found during the first 1‐h period of sleeping in the RNFL ‘progressive’ group, compared to the RNFL ‘stable’ group (p = 0.028).

Conclusions: Between RNFL ‘progressive’ and ‘stable’ PACG eyes, significant differences in circadian IOP fluctuation and ultra‐short‐term IOP fluctuation at the 1‐h period after falling asleep were identified. Large circadian IOP fluctuations may be associated with disease progression in PACG eyes. The first hour of sleeping may be the most sensitive period for detecting significant short‐term IOP fluctuation in PACG eyes.
Autonomous AI testing for diabetic eye disease closes care gap and improves health equity on a systems level
Authors: Liu Alvin
Published: January 2024

We aimed to examine the change in adherence to annual diabetic eye disease (DED) testing in an integrated healthcare system (Johns Hopkins Community Physicians 30+ community based primary care clinics) before and after deployment of autonomous artificial intelligence (AI). Adherence to annual DED testing is defined as completed evaluation by either a human ophthalmology provider, or autonomous AI within a given calendar year. During the COVID pandemic, autonomous AI (IDx‐DR, Digital Diagnostics, Coralville, IA) was deployed at multiple clinics, so that by 2021, some clinics had autonomous AI (AI sites), while others did not (non‐AI sites). Overall adherence in 2019 (pre‐AI) and 2021 (with AI) were compared, and stratified by demographics, using chi‐square or Fisher's exact test. Changes from 2019 to 2021 in odds of adherence within each subgroup were assessed for significant differences by site type (AI vs. non‐AI), using logistic regression with a site type‐by‐time interaction term. From 2019 to 2021, the overall adherence rate increased from 42.6% to 55.5% at AI sites (1949 patients), and increased from 38.0% to 41.0% at non‐AI sites (5379 patients). The increase in overall adherence rate at AI sites was significantly greater than that at non‐AI sites.
Cornea on fire: PACK‐CXL in the treatment of infectious keratitis
Authors: Aiello Francesco
Published: January 2024

Infectious keratitis is a severe eye condition that can cause permanent vision loss if not treated promptly. The current standard of care for this condition involves the use of broad‐spectrum topical antibiotic drops. However, researchers have explored photoactivated chromophore for collagen cross‐linking (PACK‐CXL) as a potential treatment option for infectious keratitis. Studies have shown that PACK‐CXL can improve the healing process in bacterial keratitis and prevent corneal melting caused by bacterial enzymatic degradation.

When activated by UV light, riboflavin, the photosensitizer used in PACK‐CXL, induces changes in collagen properties, leading to a hardening and strengthening effect on the corneal stroma. However, individuals with corneal ulcers may experience greater penetration of UV light due to the compromised integrity of the cornea, which could cause endothelial cell loss and impair corneal function.

The purpose of this presentation is to provide a summary of the evidence on the comparative effectiveness and safety of PACK‐CXL with or without standard therapy versus standard therapy alone for the treatment of bacterial keratitis. The latest randomized controlled trials (RCTs) will be reviewed, and their findings regarding the efficacy and safety of PACK‐CXL in treating infectious keratitis will be discussed, as well as a comparison with standard antibiotic therapy alone. Ultimately, this talk aims to inform evidence‐based recommendations for the treatment of infectious keratitis and provide clinicians with the most up‐to‐date information to make informed treatment decisions.
Pearls and pitfalls in IOL power calculation
Authors: Langenbucher Achim
Published: January 2024

Before cataract surgery with intraocular lens implantation ocular biometry is performed as a standard procedure. From the biometric measures and the individual patient requirements an appropriate lens type is selected and the lens power is calculated based on a empirical/AI based, theoretical optical, or raytracing based calculation scheme. In this talk we give an overview on the most relevant calculation strategies and discuss the advantages and drawbacks of the most commonly used IOL power calculation concepts. Some systematic errors inherent to the calculation schemes and the clinical consequences are discussed.
Retinal delivery of nanotherapeutics in a model of inherited retinal dystrophy
Authors: Velasco Sheyla , Gallego Idoia , González Lorena Olivares , Valencia Dayra , Morales Silvia , Puras Gustavo , Pedraz José Luis , Rodrigo Regina
Published: January 2024

Inherited retinal dystrophies (IRDs) constitute a heterogeneous group of retinal diseases that cause the progressive loss of vision. They are mainly associated with photoreceptor (rods and cones) or retinal pigment epithelium (RPE) dysfunction and loss. Several therapeutic strategies are ongoing in animal models and in patients, including gene, cell, or pharmacological therapies. However, at present, there is only one effective treatment available, Luxturna.

The eye presents some characteristics that facilitate the development of different therapeutic strategies. It is an immune privilege and easily accessible organ. In the case of retinal diseases, one of the biggest challenges is the effective drug delivery to the diseased area because of the existence of several physiological and anatomical barriers of the eye. Among others, the routes for drug delivery to the retina include: 1) Topical that is a non‐invasive route, but does not provide the delivery of significant levels of therapeutic agents; 2) Systemic that can deliver a high level of therapeutic agents, but the blood‐retina barrier limits those that can be delivered; and 3) Intravitreal that provides a good delivery but can induce retinal endophthalmitis, retinal detachment, increased intraocular pressure or retinal haemorrhages. Nanotechnology has reformed the field of drug delivery and revolutionized medicine. Drug Delivery Systems (DDS) protect drugs from degradation, improve their permeability across cell membranes, their bioavailability, provide stable formulation and yield sustained and controlled release of drugs. Many types of nanoparticles (range in size from 10 to 1000 nm) used as drug carriers are made of polymers, lipids, inorganic metallic components, etc. DDS can overcome the limitations associated with current ocular therapy and ensure targeted and controlled drug delivery. We will present different nanocarriers loaded with therapeutic agents for the treatment of inherited retinal dystrophies.
Persistent epithelial defects in neurotrophic keratopathy
Authors: Georgoudis Panagiotis
Published: January 2024

One of the complications of neurotrophic keratopathy is the breakdown of the corneal epithelium. This can progress to non‐healing persistent epithelial defects (PED) which are challenging to manage and can lead to corneal ulceration, scarring and perforation.

The causes of epithelial breakdown, prevention and contemporary medical and surgical management will be discussed during this talk. The use of conservative methods available to all clinical settings all they way to more sophisticated surgical methods available in tertiary referral centres, will be presented and discussed.