Applications of dynamic visual acuity test in clinical ophthalmology

Curriculum in Neuro-Ophthalmic Principles for National Football League Game Officials: Comparison of Pretraining and Posttraining Ratings of Knowledge

BACKGROUND

We hypothesize that creation of a structured curriculum in neuro-ophthalmology principles might improve self-rated learner satisfaction and knowledge base of National Football League (NFL) game officials. Our initial objective is to create the said curriculum in coordination with game official experts and staff at the NFL to increase levels of understanding of neuro-ophthalmology principles. We reviewed the prior published literature on applicable neuro-ophthalmic principles in professional sports. Major neuro-ophthalmic principles reviewed include both the efferent (e.g., saccadic and pursuit eye movements and vestibulo-ocular reflex) and afferent (visual field, dynamic visual acuity during body movement, and selective attention deficits).

METHODS

A 6-question survey pertaining to levels of understanding, future applicability, relevance, satisfaction, and interest in additional training was then given to 26 individuals before and after a lecture given by Dr. Andrew Lee in Plano, TX. The primary outcome measure was the creation of the curriculum followed by real-world testing for face and content validity and ending with a self-rated assessment.

RESULTS

Twenty-one individuals completed the prelecture and postlecture survey out of 26 individuals who attended. Prelecture means for the level of understanding of oculomotor terms and the likelihood of using said terms were 3.4 and 3.2, respectively. Postlecture means were 8.9 and 8.8, respectively. The lecture was rated 9.2 of 10 for relevance to coaching and teaching officials, and individuals rated their interest in further content as 9.4 of 10.

CONCLUSIONS

This study found that NFL game officials are interested in learning more about the science behind play-calling in terms of neuro-ophthalmology principles and practices. In addition, from our pilot survey, it is evident that even one lecture can improve participants' level of understanding and likelihood of learning more about neuro-ophthalmic principles.

BCLA CLEAR Presbyopia: Evaluation and diagnosis

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

Glaucoma Detection through a Novel Hyperspectral Imaging Band Selection and Vision Transformer Integration

Conventional diagnostic methods for glaucoma primarily rely on non-dynamic fundus images and often analyze features such as the optic cup-to-disc ratio and abnormalities in specific retinal locations like the macula and fovea. However, hyperspectral imaging techniques focus on detecting alterations in oxygen saturation within retinal vessels, offering a potentially more comprehensive approach to diagnosis. This study explores the diagnostic potential of hyperspectral imaging for glaucoma by introducing a novel hyperspectral imaging conversion technique. Digital fundus images are transformed into hyperspectral representations, allowing for a detailed analysis of spectral variations. Spectral regions exhibiting differences are identified through spectral analysis, and images are reconstructed from these specific regions. The Vision Transformer (ViT) algorithm is then employed for classification and comparison across selected spectral bands. Fundus images are used to identify differences in lesions, utilizing a dataset of 1291 images. This study evaluates the classification performance of models using various spectral bands, revealing that the 610-780 nm band outperforms others with an accuracy, precision, recall, F1-score, and AUC-ROC all approximately at 0.9007, indicating its superior effectiveness for the task. The RGB model also shows strong performance, while other bands exhibit lower recall and overall metrics. This research highlights the disparities between machine learning algorithms and traditional clinical approaches in fundus image analysis. The findings suggest that hyperspectral imaging, coupled with advanced computational techniques such as the ViT algorithm, could significantly enhance glaucoma diagnosis. This understanding offers insights into the potential transformation of glaucoma diagnostics through the integration of hyperspectral imaging and innovative computational methodologies.

Dynamic Visual Acuity, Vestibulo-Ocular Reflex, and Visual Field in National Football League (NFL) Officiating: Physiology and Visualization Engineering for 3D Virtual On-Field Training

The ability to make on-field, split-second decisions is critical for National Football League (NFL) game officials. Multiple principles in visual function are critical for accuracy and precision of these play calls, including foveation time and unobstructed line of sight, static visual acuity, dynamic visual acuity, vestibulo-ocular reflex, and sufficient visual field. Prior research has shown that a standardized curriculum in these neuro-ophthalmic principles have demonstrated validity and self-rated improvements in understanding, confidence, and likelihood of future utilization by NFL game officials to maximize visual performance during officiating. Virtual reality technology may also be able to help optimize understandings of specific neuro-ophthalmic principles and simulate real-life gameplay. Personal communication between authors and NFL officials and leadership have indicated that there is high interest in 3D virtual on-field training for NFL officiating. In this manuscript, we review the current and past research in this space regarding a neuro-ophthalmic curriculum for NFL officials. We then provide an overview our current visualization engineering process in taking real-life NFL gameplay 2D data and creating 3D environments for virtual reality gameplay training for football officials to practice plays that highlight neuro-ophthalmic principles. We then review in-depth the physiology behind these principles and discuss strategies to implement these principles into virtual reality for football officiating.

Comparison of dynamic visual acuity after implantation of toric bifocal or trifocal intraocular lens in age-related cataract patients: a randomized controlled trial

Purpose

To investigate the dynamic visual acuity (DVA) after implantation of toric bifocal or trifocal intraocular lens in age-related cataract patients.

Methods

This was a prospective randomized controlled trial. Of one hundred and twenty-four patients enrolled and randomized to receive unilateral phacoemulsification and toric trifocal (939 M/MP, Carl Zeiss Meditec AG, Jena, Germany) or toric bifocal (909 M, Carl Zeiss Meditec AG, Jena, Germany) intraocular lenses (IOL) implantation, ninety-nine patients completed the follow-up and were included in final analysis. Postoperatively, uncorrected and corrected distance (UDVA and CDVA), intermediate (UIVA and DCIVA) and near (UNVA and DCNVA) static visual acuity, manifest refraction and uncorrected and corrected distance DVA (UDDVA and CDDVA) at 20, 40 and 80 degrees per second (dps) were evaluated at one week, one month and three months.

Results

Three months postoperatively, the UDVA were 0.13 ± 0.11 and 0.14 ± 0.13 in the toric trifocal and bifocal IOL group, respectively. Significant better UIVA (trifocal, 0.17 ± 0.13 vs. bifocal, 0.23 ± 0.13, p = 0.037) and DCIVA (trifocal, 0.16 ± 0.11 vs. bifocal, 0.20 ± 0.12, p = 0.048) were observed in patients implanting toric trifocal than bifocal IOL at three months postoperatively. Patients implanted with toric bifocal IOL obtained better CDDVA at 80 dps (0.5607 ± 0.2032) than the trifocal group (0.6573 ± 0.2450, p = 0.039) at three months. Postoperative UDDVA and CDDVA at 20, 40 and 80 dps were significantly associated with age (p < 0.05, respectively) and postoperative static visual acuity (p < 0.05, respectively).

Conclusion

Toric trifocal IOL provides better static intermediate visual acuity, and toric bifocal IOL implantation provides better distance dynamic visual acuity at high speed.

The impact of patient-reported visual disturbance on dynamic visual acuity in myopic patients after corneal refractive surgery

Purpose

To investigate the impact of patient-reported visual disturbance on dynamic visual acuity in myopic patients after corneal refractive surgery.

Methods

This is a prospective nonrandomized study. Adult myopic patients receiving bilateral laser-assisted sub-epithelial keratomileusis (LASEK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), or small incision lenticule extraction (SMILE) with Plano target were included. Eight types of patient-reported visual disturbance were evaluated regarding frequency, severity and bothersome and dynamic visual acuity (DVA) of 40 and 80 degrees per second (dps) was measured postoperatively at 3 months.

Results

The study enrolled 95 patients with an average age of 27.6 ± 6.4 years. The most frequently reported visual disturbance was the fluctuation in vision (70.5%), followed by glare (66.3%) and halo (57.4%). Postoperative DVA at 80 dps was significantly associated with the total score of haloes (p = 0.038) and difficulty in judging distance (p = 0.046). Significant worse postoperative DVA at 40 dps was observed in patients with haloes than those without (p = 0.024). The DVA at 80 dps for patients without haloes or difficulty in judging distance was significantly better than that with the symptoms (haloes, p = 0.047; difficulty in judging distance, p = 0.029). Subgroup analysis by surgical procedures demonstrated that the significant difference in DVA between patients with and without visual disturbance was only observed in patients receiving FS-LASIK.

Conclusion

Postoperatively, myopic patients undergoing corneal refractive surgery with haloes or difficulty in judging distance have significantly worse low and high-speed DVA than those without the symptoms. The present study provided the basis for postoperative guidance in daily tasks involving dynamic vision when patients have visual disturbances.

Advances in dynamic visual acuity test research

The dynamic visual acuity test (DVAT) is a functional evaluation tool for the impairment and compensation of the vestibular system, which could reflect the Vestibulo-ocular reflex (VOR) function. We present an overview of DVAT research, displaying recent advances in test methods, application, and influencing factors; and discussing the clinical value of DVAT to provide a reference for clinical application. There are two primary types of DVAT: dynamic-object DVAT and static-object DVAT. For the latter, in addition to the traditional bedside DVAT, there are numerous other approaches, including Computerized DVAT (cDVAT), DVAT on a treadmill, DVAT on a rotary, head thrust DVA (htDVA) and functional head impulse testing (fHIT), gaze shift dynamic visual acuity with walking (gsDVA), translational dynamic visual acuity test (tDVAT), pediatric DVAT. The results of DAVT are affected by subject [occupation, static visual acuity (SVA), age, eyeglass lenses], testing methods, caffeine, and alcohol. DVAT has numerous clinical applications, such as screening for vestibular impairment, assessing vestibular rehabilitation, predicting fall risk, and evaluating ophthalmology-related disorders, vestibular disorders, and central system disorders.

Binocular dynamic visual acuity in dry eye disease patients

Purpose

To investigate binocular dynamic visual acuity (DVA) for patients with dry eye disease (DED).

Methods

The prospective study included DED patients. The binocular DVA at 40 and 80 degrees per second (dps), Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time first (TBUTF), corneal fluorescein staining (CFS), eyelid margin abnormalities and meibomian gland (MG) abnormalities morphology and function were evaluated. A deep learning model was applied to quantify the MG area proportion. The correlation between DVA and DED parameters was analyzed.

Results

A total of 73 DED patients were enrolled. The age, OSDI, CFS, MG expressibility, secretion quality, and eyelid margin abnormalities were significantly positively correlated with the DVA for 40 and 80 dps (all P &lt; 0.05). The MG area proportion in the upper eyelid was negatively correlated with DVA at 40 dps (R = −0.293, P &lt; 0.001) and at 80 dps (R = −0.304, P &lt; 0.001). Subgroup analysis by MG grade demonstrated that the DVA of patients with severe MG dropout (&lt;25% of the total area) was significantly worse than other mild and moderate groups, both in 40 and 80 dps (all P &lt; 0.05). The patients with CFS showed worse 40 (P &lt; 0.001) and 80 dps (P &lt; 0.001) DVA than the patients without CFS.

Conclusion

Binocular DVA is significantly associated with DED symptoms and signs. The DED patients with CFS and severe MG dropout and dysfunction have worse DVA.

Dynamic Visual Acuity After Small Incision Lenticule Extraction for Myopia Patients

In the present study we compared dynamic visual acuity (DVA) of 84 eyes (for 42 adults with myopia; M age = 28.4, SD = 6.6 years; males = 38.1%, females = 61.9%) at 40 and 80 degree per second (dps) before surgery with eyeglass corrections and after a surgical procedure - a small incision lenticule extraction (SMILE). Participants underwent binocular SMILE surgery with plano refraction targets. Their eyeglass-corrected binocular DVA at 40 and 80 dps was evaluated preoperatively, and their uncorrected binocular DVA was assessed post-operatively at 1 week, 1 month and 3 months. The mean logMAR (logarithm of the minimum angle of resolution) uncorrected and corrected distance visual acuities (UDVA and CDVA) were -0.09 and -0.11 respectively, 3 months postoperatively. The mean preoperative eyeglass-corrected DVAs at 40 and 80 dps were 0.141 and 0.184, respectively, and significant improvements were observed for 40 dps and 80 dps DVAs 3 months postoperatively. Pearson's correlations were statistically significant between the postoperative DVAs at 3 months and for both the preoperative DVA and postoperative UDVA at both 40 dps and 80 dps. The change in the DVAs at 3 months were significantly associated with the preoperative DVAs at 40 dps and 80 dps. In conclusion, myopic patients' DVAs significantly improved following SMILE in comparison to corrected preoperative visual acuity when wearing eyeglasses. The post-SMILE DVA was associated with both the preoperative DVA and the postoperative UDVA.

Comparison of dynamic defocus curve on cataract patients implanting extended depth of focus and monofocal intraocular lens

BACKGROUND

The aim of the study was to compare the dynamic defocus curve on patients post-implantation of the extended depth-of-focus (EDOF) and monofocal intraocular lens (IOL).

METHODS

A total of 62 age-related cataract patients receiving phacoemulsification with implantation of TECNIS Symfony (ZXR00) or monofocal IOLs were enrolled. The binocular static and dynamic defocus curves with corrected distance visual acuity were evaluated at one month postoperatively.

RESULTS

The ZXR00 group achieved significantly better intermediate (P = 0.044) and near (P = 0.017) visual acuity (VA) than the monofocal group. Two groups had similar uncorrected and corrected distance VA (P > 0.05, respectively). The dynamic defocus curve revealed a smoother decline from 0.0 D to - 2.0 D in the ZXR00 group. Defocused dynamic VA in the ZXR00 group was significantly better (P < 0.05) except at 0.0 D (P = 0.724) and - 0.5 D (P = 0.176). The area under the curve (P = 0.002) and corrected dynamic vision accommodation (P = 0.001) derived from the dynamic defocus curves were better in the ZXR00 group. A positive correlation was observed between defocused dynamic and static VA in both groups (P < 0.001). Multiple linear regression analysis indicated that defocused static VA and corrected dynamic vision accommodation were significant influential factors for the defocused dynamic VA from - 1.0 D to - 3.0 D (P < 0.05).

CONCLUSIONS

The EDOF IOL provided similar distance vision, better intermediate and near vision, and a better overall dynamic defocus curve than the monofocal IOL. The dynamic defocus curve may be comprehensively applied to evaluate the all-distance dynamic visual performance post-cataract surgery.

The impact of different corneal refractive surgeries on binocular dynamic visual acuity

Purpose

To investigate the influence of different corneal refractive surgeries on dynamic visual acuity (DVA), and explore its potential influence factors.

Methods

This was a prospective non-randomized study. Adult myopic patients undergoing bilateral laser-assisted sub-epithelial keratomileusis (LASEK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), or small incision lenticule extraction (SMILE) with Plano refraction target were enrolled. Uncorrected and corrected distance visual acuity (UDVA/CDVA), manifest refraction and binocular optotype-moving DVA of 40 and 80 degrees per second (dps) were evaluated pre-operatively and post-operatively up to 3 months.

Results

The study included 264 eyes of 132 subjects, with an average age of 27.0 ± 6.7 years, and females accounted for 59% of the participants. Significant improvement was observed at the 3-month visit for 40 dps (SMILE, P = 0.001; LASEK, P = 0.006; FS-LASIK, P = 0.010) and 80 dps (SMILE, P = 0.011; LASEK, P = 0.025; FS-LASIK, P = 0.012) DVA. Adjusting for pre-operative DVA, there was no significant difference in DVA among groups at 3 months post-operatively (P > 0.05 for multiple comparisons). Overall, multiple linear models demonstrated that post-operative DVA at 3 months was correlated with pre-operative DVA (40 dps, β = 0.349, P = 0.001; 80 dps, β = 0.447, P < 0.001), pre-operative spherical equivalent (40 dps, β = 0.311, P = 0.003; 80 dps, β = 0.261, P = 0.009) and post-operative UDVA (40 dps, β = -0.224, P = 0.024; 80 dps, β = -0.188, P = 0.05).

Conclusion

Dynamic visual acuity at 3 months post-operatively of the three corneal refractive surgeries was better than that before the surgery in adult myopic patients, and there was no significant difference among different surgical techniques. Post-operative DVA at 3 months was found correlated with pre-operative DVA, pre-operative SE, and post-operative UDVA. With further improvement, DVA could be a promising functional visual indicator for myopic patients undergoing refractive surgeries.

Comparisons of visual outcomes between bilateral implantation and mix-and-match implantation of three types intraocular lenses

PURPOSE

To compare binocular static visual acuity (SVA), stereopsis, contrast sensitivity (CS) and dynamic visual acuity (DVA) of 5 combinations of bifocal intraocular lenses (IOLs), trifocal IOLs and extended-depth-of-focus (EDOF) IOLs in age-related cataract patients.

METHODS

Two hundred and ninety-two eyes of 146 patients who underwent cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University were involved. Subgroups included group MM (33patients, bilaterally bifocal IOL, ZMB00), group TT (31patients, bilaterally trifocal IOL, AT LISA tri839MP), group XX (34patients, bilaterally EDOF IOL, ZXR00), group MX (25patients, bifocal IOL, ZMB00 + EDOF IOL, ZXR00) and group TX (23patients, trifocal IOL, AT LISA tri839MP + EDOF IOL, ZXR00). The uncorrected SVAs (UDVA, UIVA and UNVA), uncorrected DVAs (UDDVA, UIDVA and UNDVA), near and distance stereopsis, and CS were assessed 3 months postoperatively.

RESULTS

Subgroups of TT, XX, MX and TX showed better UIVA than MM (bP = 0.039, 0.021, 0.035 and 0.037, respectively). MX showed better UNVA than MM and TX (bP = 0.031 and 0.013, respectively). MX group had the optimal outcomes of both near and distance stereopsis. In the UDDVA, XX group and MX group showed better outcomes than TX group at 24 fps (frames per second) (bP = 0.019 and 0.023, respectively). XX group and MX group showed optimal outcomes at all speeds of UIDVA (P = 0.001, 0.005, 0.003 and 0.005, respectively). As the speed increased, the XX group and the MX group showed better UNDVA than the MM group and the TT group (P = 0.019, 0.002 and 0.003, respectively).

CONCLUSIONS

Mix-and-match implantation of bifocal IOLs and EDOF IOLs provides excellent and stable binocular visual outcomes including SVA, stereopsis and DVA in distant and near distances.