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Visual evoked potentials (VEPs) can provide important diagnostic information regarding the functional integrity of the visual system. This document updates the ISCEV standard for clinical VEP testing and supersedes the 2009 standard. The main changes in this revision are the acknowledgment that pattern stimuli can be produced using a variety of technologies with an emphasis on the need for manufacturers to ensure that there is no luminance change during pattern reversal or pattern onset/offset. The document is also edited to bring the VEP standard into closer harmony with other ISCEV standards. The ISCEV standard VEP is based on a subset of stimulus and recording conditions that provide core clinical information and can be performed by most clinical electrophysiology laboratories throughout the world. These are: (1) Pattern-reversal VEPs elicited by checkerboard stimuli with large 1 degree (°) and small 0.25° checks. (2) Pattern onset/offset VEPs elicited by checkerboard stimuli with large 1° and small 0.25° checks. (3) Flash VEPs elicited by a flash (brief luminance increment) which subtends a visual field of at least 20°. The ISCEV standard VEP protocols are defined for a single recording channel with a midline occipital active electrode. These protocols are intended for assessment of the eye and/or optic nerves anterior to the optic chiasm. Extended, multi-channel protocols are required to evaluate postchiasmal lesions.

We investigated subjective symptoms during driving in 227 glaucoma patients at a driving assessment clinic. Patients underwent testing with the Humphrey Field Analyzer 24–2 (HFA 24–2) and a driving simulator (DS) with eye tracking. Patients reported whether they experienced symptoms during daily driving, such as fear or difficulty seeing under certain conditions. The integrated visual field (IVF) was calculated from HFA 24–2 data. The number of collisions in DS scenarios and eye movements during DS testing was recorded, and factors related to the presence of subjective symptom during driving were analyzed using multivariate logistic regression, with subjective symptoms as the dependent variable. Overall, 145 patients (63.9%) did not report subjective symptoms during driving. Rates of these symptoms were 22.9%, 36.6%, and 41.7% for mild, moderate, and severe glaucoma, respectively (P = 0.030). Patients with symptoms had worse better-eye mean deviation (MD) (P = 0.012) and lower IVF sensitivity in the superior hemifield (P < 0.002). Logistic regression revealed a significant association between symptoms and decreased superior IVF sensitivity from 0° to 12° (P = 0.0029; OR: 1.07). Our study highlights that many glaucoma patients, even with severe disease, may not be aware of visual symptoms during driving, though superior IVF mean sensitivity contributed to subjective symptoms during driving.

In the evaluation of smooth pursuit eye movements (SPEMs), recording the stimulus onset time is mandatory. In the laboratory, the stimulus onset time is recorded by electrical signal or programming, and video-oculography (VOG) and the visual stimulus are synchronized. Nevertheless, because the examiner must manually move the fixation target, recording the stimulus onset time is challenging in daily clinical practice. Thus, this study aimed to develop an algorithm for evaluating SPEMs while testing the nine-direction eye movements without recording the stimulus onset time using VOG and deep learning–based object detection (single-shot multibox detector), which can predict the location and types of objects in a single image. The algorithm of peak fitting–based detection correctly classified the directions of target orientation and calculated the latencies and gains within the normal range while testing the nine-direction eye movements in healthy individuals. These findings suggest that the algorithm of peak fitting–based detection has sufficient accuracy for the automatic evaluation of SPEM in clinical settings.

Background Classification of optical coherence tomography (OCT) images can be achieved with high accuracy using classical convolution neural networks (CNN), a commonly used deep learning network for computer-aided diagnosis. Classical CNN has often been criticized for suppressing positional relations in a pooling layer. Therefore, because capsule networks can learn positional information from images, we attempted application of a capsule network to OCT images to overcome that shortcoming. This study is our attempt to improve classification accuracy by replacing CNN with a capsule network. Methods From an OCT dataset, we produced a training dataset of 83,484 images and a test dataset of 1000 images. For training, the dataset comprises 37,205 images with choroidal neovascularization (CNV), 11,348 with diabetic macular edema (DME), 8616 with drusen, and 26,315 normal images. The test dataset has 250 images from each category. The proposed model was constructed based on a capsule network for improving classification accuracy. It was trained using the training dataset. Subsequently, the test dataset was used to evaluate the trained model. Results Classification of OCT images using our method achieved accuracy of 99.6%, which is 3.2 percentage points higher than that of other methods described in the literature. Conclusion The proposed method achieved classification accuracy results equivalent to those reported for other methods for CNV, DME, drusen, and normal images.

To evaluate the safety of a rotating gantry with scanning beams of carbon-ion radiotherapy (C-ion RT) for choroidal malignant melanoma. A prospective study of C-ion RT using a rotating gantry with scanning beams for choroidal malignant melanoma was initiated at the National Institute for Quantum Science and Technology, QST Hospital in March 2018. The inclusion criteria were as follows: (i) clinically diagnosed ocular/choroidal malignant melanoma; (ii) tumor measurable by imaging tests; (iii) score of 0–2 on the Eastern Cooperative Oncology Group Performance Status scale and (iv) ability to provide consent for treatment. All patients received 68 Gy in four fractions of C-ion RT by a rotating gantry with scanning beams. Between April 2018 and July 2019, 21 patients were enrolled and underwent C-ion RT as planned. All 21 patients completed the treatment schedule and the 3-year follow-up period. The median duration of follow-up was 43 months (range, 35.2–54.6 months). Regarding late normal tissue responses, three of the 21 patients developed grade 2 neovascular glaucoma; however, no other late grade ≥2 acute toxicities were observed. During the 3-year study period, all 21 patients survived with no local recurrence; none of the patients underwent enucleation. Three cases showed liver metastasis. The 3-year local control, overall survival and eye-retention rates were all 100%. The results of this prospective study confirmed that the effectiveness and safety of this method are equivalent to those of conventional passive irradiation methods, although the number of cases was small. The results of this prospective study confirmed that the effectiveness and safety of this method are equivalent to those of conventional passive irradiation methods, although the number of cases was small.

AimsTo evaluate the recovery of retinal function and the thicknesses of the photoreceptor inner (IS) and outer segment (OS) layers after a reattachment of a rhegmatogenous retinal detachment (RRD).Methods49 eyes of 49 patients (mean age, 57.4±10.3 years) with successfully reattached RRD were retrospectively studied. Spectral-domain optical coherence tomography was used to obtain images of the foveal area, and the thicknesses of the IS and OS were measured before and 1, 3, 6 and 12 months after surgery. The thicknesses of the corresponding structures of the healthy fellow eye served as control.ResultsThe thickness of the IS layer was 20.4±5.0 μm and that of the OS layer was 34.4±9.7 at 1 month after surgery, which was significantly thinner than the IS (28.9±2.9) and OS (55.4±5.2) layers of the fellow eyes. The thicknesses gradually increased and were not significantly different from that in the fellow eye at 12 months (IS, 28.4±4.4 µm and OS, 50.7±6.6 µm). The IS and OS thicknesses at 1 month after surgery in eyes that had a decimal visual acuity of 1.0 at 6 months were significantly thicker than those in eyes that had a visual acuity of <1.0.ConclusionsThe increase in the thicknesses of the IS and OS layers of the photoreceptors during the recovery phase of eyes with RRD indicates that the recovery process was slow and gradual. Quantitative analysis of the IS and OS thicknesses may be useful to follow the disease process.

Purpose Air pollutants, such as Asian sand and particulate matter (PM) 2.5, have become a global concern for causing ocular inflammation and allergic symptoms. This study, as part of an international investigation, examined the effects of eyewashes for ocular damage caused by air pollution in Indonesia. Methods This was a single-center, patient- and-evaluator-blinded, parallel two-arm, nonrandomized trial. In Jakarta, Indonesia, 30 eyes of 15 car commuters and 30 eyes of 15 motorcycle commuters were recruited from healthy volunteers. After commuting to work, both eyes were washed with a commercial eyewash. Before and after eyewashing, eight items of ocular surface symptoms and four items of rhinitis subjective symptoms were scored using a modified Japanese Allergic Conjunctival Disease Quality-of-Life Questionnaire. Results Five of the 12 subjective symptom scores before eyewashing were higher in motorcycle commuters than in car commuters ( p < 0.05). Motorcycle commuters showed improvement in the five symptom scores of “itchy eyes, foreign body sensation, eye mucus, dryness, and eye strain” after eyewashing compared to before eyewashing ( p < 0.05). In all patients, sootlike particles and ocular mucus were found in the solutions collected after eyewashing. Conclusion These findings indicate that eyewashing for ocular symptoms caused by airborne particles may be effective in removing foreign particles from the ocular surface and relieving subjective symptoms.

Choroideremia (CHM) is an incurable progressive chorioretinal dystrophy. Little is known about the natural disease course of visual acuity in the Japanese population. We aimed to investigate the genetic spectrum of the CHM gene and visual acuity outcomes in 24 CHM patients from 16 Japanese families. We measured decimal best-corrected visual acuity (BCVA) at presentation and follow-up, converted to logMAR units for statistical analysis. Sanger and/or whole-exome sequencing were performed to identify pathogenic CHM variants/deletions. The median age at presentation was 37.0 years (range, 5–76 years). The mean follow-up interval was 8.2 years. BCVA of the better-seeing eye at presentation was significantly worsened with increasing age (r = 0.515, p < 0.01), with a high rate of BCVA decline in patients > 40 years old. A Kaplan–Meier survival curve suggested that a BCVA of Snellen equivalent 20/40 at follow-up remains until the fifties. Fourteen pathogenic variants, 6 of which were novel [c.49 + 5G > A, c.116 + 5G > A, p.(Gly176Glu, Glu177Ter), p.Tyr531Ter, an exon 2 deletion, and a 5.0-Mb deletion], were identified in 15 families. No variant was found in one family only. Our BCVA outcome data are useful for predicting visual prognosis and determining the timing of intervention in Japanese patients with CHM variants.

Aim To evaluate the clinical characteristics, treatment course, and prognosis of patients with acute retinal necrosis (ARN), which can rapidly progress and cause severe vision loss. Design Single-center retrospective case series. Subjects and methods Six patients and seven eyes diagnosed with ARN at Teikyo University Hospital were included in this study. The clinical presentation and treatment prognosis were investigated based on data obtained from medical records. Results The mean age of the patients at the initial diagnosis was 63.6 years. Although the mean Logarithm of the Minimum Angle of Resolution (LogMAR) visual acuity tended to decrease from 0.77 at the first visit to 1.29 at the last visit, the difference was not statistically significant. Intraocular manifestations observed during the study period included ocular hypertension (14.3%), anterior uveitis (100.0%), retinal hemorrhage (71.4%), vitreous opacity (100.0%), retinal exudative vasculitis (85.7%), optic nerve atrophy (85.7%), retinal vascular occlusion (85.7%), choroidal atrophy (85.7%), macular edema (100.0%), subretinal fluid in the macula (71.4%), and retinal detachment (85.7%). Treatment modalities included oral and intravitreal antivirals (85.7%), antiplatelet medications (85.7%), steroid eye drops (85.7%), subcapsular (57.1%) and vitreous (42.9%) steroid injections, oral steroids (71.4%), and surgical intervention (85.7%). Vitrectomy led to retinal recovery in all five eyes that underwent the procedure. Conclusions The visual prognosis of patients with ARN is poor, particularly in those with preexisting visual impairment. Early detection coupled with antiviral therapy and prompt surgical intervention have been identified as potential factors that influence visual outcomes. Given the severity of ARN, collecting data from multiple centers could aid in devising future diagnostic and therapeutic strategies.

The temperature of the vitreous has been reported to vary during cataract and vitreous surgery. We measured intraocular temperature at four intraocular sites; the anterior chamber (AC), just behind the crystalline lens, mid-vitreous, and just anterior to the optic disc (OD) at the beginning of vitrectomy with a thermoprobe in 48 eyes. The temperatures were compared in three groups; eyes that underwent vitrectomy for the first time (Group V, n = 30), eyes that had previous vitrectomy and the vitreous cavity had been filled with balanced salt solution (BSS; Group A, n = 12), and eyes that had previous vitrectomy and the vitreous cavity was filled with silicone oil (Group S, n = 6). There was a gradient in the temperature in all groups, i.e., it was lowest in the AC, and it increased at points closer to the retina. The intraocular temperature was significantly correlated with the type of fluid in the vitreous cavity. The mean intraocular temperatures were not significantly different in Groups V and A, but they were significantly higher in Group S. Clinicians should be aware of the differences in the temperature at the different intraocular sites because the temperatures may affect the physiology of the retina and the recovery process.