bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vision science informing visual display symbology
Authors: Douglass Amanda , Coffey Kate , Baker Madeline , Karas Renee , Francis Lauren , Abel Larry , Gavrilescu Maria 
Published: January 2025

Aims/Purpose: Improvements in technology for head mounted displays allow both a large increase in the quantity of visual information presented and capacity to control how it is displayed. The requirements of defence operators are unique, including making quick and efficient decisions, operating in varying light conditions and using night vision devices and laser eye protection. Scientifically‐informed symbology is required to ensure maximal operational capacity is obtained from available technology.Methods: Applied tasks have been used to investigate the addition of colour to visual symbology. The first used a flight simulator to examine the effect of adding colour to symbology requiring attention; both day and night backgrounds were investigated with the plane on autopilot. Participants were required to identify randomly appearing symbols presented either as monochrome green or with additional colour, in addition to other tasks. The second task manipulated symbology colour to improve performance when using laser eye protection. Participants undertook two simulated drives wearing laser eye protection while responding to both standard and optimised coloured symbols.Results: For the flight simulator experiment, the use of colour to draw attention to symbology resulted in faster response times (1.81s vs 2.57s, p < 0.001) and fewer missed events (0.91 vs 3.32/15 missed, p < 0.001). For the driving experiment, manipulating the colours did not statistically significantly affect reaction time but resulted in a statistically significant improvement in the accuracy of symbol detection and identification (standard 88.7%, optimised 94.5%, p < 0.001).Conclusion: The judicious use of colour informed by vision science in displays has demonstrated improvements in reaction time and accuracy which may be operationally significant for defence operators. Further work is required to refine other salient aspects of symbology which may attract attention including size, luminance and flicker.
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.
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.
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.
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.
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.