PURPOSE:To develop and validate Deep24-2C, a machine learning (ML) model that reconstructs comprehensive Humphrey Field Analyzer (HFA) 10-2 visual field (VF) thresholds from HFA 24-2C. DESIGN:A retrospective study. PARTICIPANTS:A total of 3653 HFA 24-2C tests, including 181 actual tests from 136 eyes of 130 patients with glaucoma or suspected glaucoma, and 3472 synthesized tests at the Jikei University School of Medicine were included. Thirty-five actual HFA 24-2C tests from 24 eyes of 21 patients at Tajimi Iwase Eye Clinic were used for pilot external validation. METHODS:The HFA 24-2C testing grid incorporates 10 additional central test points into the conventional 24-2 pattern. Deep24-2C was trained to predict all 68 threshold values of the HFA 10-2 test using subsets of 24-2C points (22-26 within the 10° region) along with age. Three ML architectures-random forest (RF), XGBoost, and multilayer perceptron (MLP)-were developed, and their ensemble combination was evaluated. Model training and internal validation were conducted using the Jikei dataset, while external validation used the Tajimi dataset. Data augmentation was applied using synthesized 24-2C tests, which combined paired HFA 24-2 and 10-2 tests. Model performance was evaluated using mean absolute error (MAE). MAIN OUTCOME MEASURES:Mean absolute error for 10-2 point-wise thresholds and mean deviation. RESULTS:We first trained and validated Deep24-2C using the Jikei dataset. Incorporating synthesized data improved predictive accuracy from MAE 2.52 ± 0.07 dB to 2.42 ± 0.07 dB. Furthermore, models utilizing additional central test points outperformed those based on conventional 24-2 points across all ML architectures (RF, XGBoost, and MLP); the best-performing XGBoost model achieved MAE 2.30 ± 0.01 dB for predicting 10-2 thresholds. Subsequently, we performed external validation on the Tajimi dataset using an ensemble model that combined all models utilizing 10 additional central test points; the ensemble model yielded MAE 1.81 (95% confidence interval [1.69-1.93]) dB. CONCLUSIONS:Deep24-2C enables reconstruction of 10-2 VF thresholds from a 24-2C Swedish Interactive Thresholding Algorithm Faster test. Incorporating additional central points enhances predictive performance compared with conventional 24-2 grids. Deep24-2C may serve as a practical and efficient tool for evaluating central VF defects, reducing testing burden, and supporting individualized glaucoma management. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Purpose Fundus parameters can be used to quantify masculinity or femininity as a fundus sex index (FSI) ranging from 0 to 1. The purpose of this study was to investigate the association between smoking, hypertension, diabetes, and FSI in the Kumejima population study Study design Prospective cross-sectional observational population study Methods Using color fundus photographs obtained from the Kumejima population study, 1653 healthy right eyes with reliable fundus parameter measurements were included. The tessellation fundus index R/(R + G + B), red-green-blue intensity in eight locations around the optic disc and foveal region, optic disc ovality ratio, papillomacular angle, and retinal vessel angles were quantified using ImageJ. The FSI was calculated using machine learning from the 42 fundus parameters, and the Mann-Whitney U-test was used to assess whether there were differences in the FSI depending on the presence or absence of smoking, hypertension, and diabetes Results The mean age of the 838 men and 815 women included in this study was 52.8 and 54.0 years, respectively. The FSI of the smoking group was lower than of the non-smoking group overall (P < 0.001). The FSI of the hypertension and diabetes groups was significantly higher than of the non-hypertension (P = 0.005) and non-diabetes (P = 0.017) groups only in women Conclusion In the Kumejima population study of healthy eyes in individuals aged 40 years or older, the fundus tended to be more feminine in women with hypertension or diabetes than in those without these conditions

While observing fundus photographs from exploratory research investigating individual differences in the fundus, we discovered a black band around the optic nerve head that had not been reported in previous studies. Such eyes with parapapillary choroidal dense pigmentation (PCP) have a pigmented conus visible on color fundus photography. This study aimed to determine the prevalence of PCP in young healthy eyes and examine its relationships with axial length, optic disc tilt, and conus area. This prospective, observational, cross-sectional study included the right eyes of 133 participants, who were examined between November 1, 2010 and February 20, 2012. Among them, 117 right eyes of 117 patients were finally analyzed. Participants underwent comprehensive ophthalmologic examinations, including axial length measurement, fundus photography, and optic disc optical coherence tomography (OCT). Based on their color fundus photographs and optic disc cross-sectional OCT images, eyes were categorized into the non-PCP, temporal-PCP, and circum-PCP groups. Optic disc tilt was evaluated using a sine curve based on the retinal nerve fiber layer B-scan images. The conus area in the color fundus images was calculated using ImageJ and corrected using Bennett’s formula. The Steel–Dwass test was used to perform multiple comparisons of the axial length, optic disc tilt, and conus area among the three groups. The mean age and axial length of the participants were 25.8 years and 25.5 mm, respectively. Of the 117 eyes, 49, 17, and 51 had non-PCP, temporal-PCP, and circum-PCP, respectively. The axial length (p = 0.011) and conus area (p = 0.047) were significantly shorter and smaller, respectively, for the circum-PCP group than for the non-PCP group. No significant differences were observed in the other intergroup comparisons. OCT findings revealed that PCP appears black due to choroidal pigment. The eyes with circumferential PCP had shorter axial lengths and smaller conus areas than that of those without, suggesting that it may occur more likely in eyes with less axial elongation.

To evaluate the Multi-Stimulus Vision Tester for a single eye (MVT-s), a tablet-based perimetry tool for detecting glaucomatous visual field (VF) defects. Forty-two eyes of 42 patients with glaucoma were classified into three stages on the basis of the mean deviation (MD) measured by the imo perimeter: early (12 eyes), moderate (19 eyes), and advanced (11 eyes), with an overall median MD of MD of − 8.5 dB (IQR, − 13.2 to − 5.2). Additionally, 39 eyes of 39 visually normal individuals were included as controls. All participants underwent testing with the MVT-s and standard automated perimetry using the imo perimeter. The MVT-s used a multipoint stimulation paradigm with flickering stimuli, presenting up to three test points simultaneously. Participants recorded their responses by directly touching the stimulus locations on the screen. The MVT-s test was performed three times on the same day for each participant. We evaluated the relationship between the number of abnormal points detected by the MVT-s and MD obtained with the imo, diagnostic accuracy using sensitivity, specificity, and receiver operating characteristic curve analysis, short-term test–retest reproducibility using the intraclass correlation coefficient (ICC), and examination time. Abnormal points increased with disease severity (median 7.5, 17.0, and 22.0 in early, moderate, and advanced glaucoma; p < 0.001) and correlated with MD (ρ = − 0.84). Discrimination was high (AUC 0.93). Using cutoffs of ≥ 3/ ≥ 4/ ≥ 5 abnormal points, sensitivities were 92.9/92.9/90.5

Background Some eyes with parapapillary choroidal dense pigmentation (PCP) have a pigmented conus visible on color fundus photography. This study aimed to determine the prevalence of PCP in young healthy eyes and examine its relationships with axial length, optic disc tilt, and conus area. Methods This prospective, observational, cross-sectional study included the right eyes of 133 participants, who were examined between November 1, 2010 and February 20, 2012. Among them, 117 right eyes of 117 patients were finally analyzed. Participants underwent comprehensive ophthalmologic examinations, including axial length measurement, fundus photography, and optic disc optical coherence tomography (OCT). Based on their color fundus photographs and optic disc cross-sectional OCT images, eyes were categorized into the non-PCP, temporal-PCP, and circum-PCP groups. Optic disc tilt was evaluated using a sine curve based on the retinal nerve fiber layer B-scan images. The conus area in the color fundus images was calculated using ImageJ and corrected using Bennett's formula. The Steel–Dwass test was used to perform multiple comparisons of the axial length, optic disc tilt, and conus area among the three groups. Results The mean age and axial length of the participants were 25.8 years and 25.5 mm, respectively. Of the 117 eyes, 49, 17, and 51 had non-PCP, temporal-PCP, and circum-PCP, respectively. The axial length (p = 0.011) and conus area (p = 0.047) were shorter and smaller, respectively, for the circum-PCP group than for the non-PCP group. No significant differences were observed in the other intergroup comparisons. Conclusions The eyes with circumferential PCP had shorter axial lengths and smaller conus areas than those without.

Purpose:Predicting the Humphrey Field Analyzer (HFA) 10-2 visual field (VF) using machine learning (ML) based on IMOvifa 24plus(1-2) VF data. Design:Retrospective cross-sectional study. Participants:Seventy actual IMOvifa 24plus(1-2) tests from 25 patients (The Jikei University School of Medicine) and 3472 synthesized IMOvifa 24plus(1-2) tests from 884 patients who underwent HFA 24-2 and HFA 10-2 VF measurements at 4 affiliated hospitals. Methods:Synthesized 24plus(1-2) data were created by merging 54 points from HFA 24-2 and 24 points from HFA 10-2 tests. An XGBoost model, trained on the synthetic data set, predicted thresholds at the 68 HFA 10-2 test locations. Model performance was assessed on the actual data set using leave-one-out cross-validation. Stratified patient-level bootstrap analyses accounting for multiple tests per patient were used to compare results across 3 glaucoma severity groups (mild, moderate, and advanced) based on HFA 10-2 mean deviation. Four models utilizing different input subsets were evaluated: model 1 (all 78 IMOvifa 24plus[1-2] points), model 2 (54 points of 24-2), model 3 (central 40 points of 24plus[1-2]), and model 4 (central 16 points of 24-2). Test durations were also compared. Main Outcome Measures:Mean absolute error (MAE), root mean squared error (RMSE), and coefficient of determination (R2) between predicted and measured HFA 10-2 sensitivities. Results:Model 1 (all 24plus[1-2] points) achieved the highest overall accuracy (MAE 3.59 dB, RMSE 5.71 dB, R2 0.76), significantly outperforming model 2 (24-2 points; MAE 4.15 dB, RMSE 6.31 dB, R2 0.70) (P < 0.05 for all metrics). Similarly, model 3 significantly outperformed model 4 (P < 0.05). Stratified analysis indicated that adding central test points yielded significant accuracy improvements, consistently across all metrics in the moderate group, whereas results varied by metric in the mild and advanced groups. The IMOvifa 24plus(1-2) test duration (mean 155 seconds) was significantly shorter than the HFA 10-2 Swedish Interactive Thresholding Algorithm Standard test (mean 376 seconds) (P < 0.001). Conclusions:Incorporating the additional central test points from the IMOvifa 24plus(1-2) significantly enhances the accuracy of ML based HFA 10-2 VF prediction. This approach offers an efficient strategy for obtaining detailed central VF information from a single, rapid test, potentially improving glaucoma management. Financial Disclosures:Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To elucidate associations between optic nerve head (ONH) structures and the retinal nerve fiber layer optical texture analysis (ROTA)-detected retinal nerve fiber layer defects (RNFLDs) in primary open angle glaucoma (POAG) eyes. DESIGN:Prospective cross-sectional observational study. PARTICIPANTS:This study enrolled 136 eyes of 109 POAG patients. METHODS:All participants underwent comprehensive ophthalmologic examinations including standard automated perimetry and swept-source optical coherence tomography (SS-OCT). Two independent graders assessed ROTA images for the presence, location, and width of RNFLDs. Multivariable linear mixed effects model was used to investigate factors independently associated with ROTA-detected RNFLDs. Explanatory variables were systemic and ocular factors such as age, axial length (AXL), SS-OCT-derived ONH structural parameters such as Bruch membrane opening-centered circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and gamma zone area, and average visual field sensitivity (1/Lambert) (VFSaverage). MAIN OUTCOME MEASURES:Width and number of RNFLDs. RESULTS:RNFLD detection rates by ROTA were 86.8% overall, 69.0% and 94.7% in the early and moderate stages of POAG eyes, and 86.5% and 87.2% in the highly myopic (AXL >26.0 mm) and non-highly myopic eyes, respectively. Summed width of RNFLD per eye was positively correlated with gamma-zone area (P = .0007) and negatively correlated with age, cpRNFLT, and VFSaverage (P = .0111, .0001, .0124), whereas the number of RNFLDs per eye correlated negatively with age, cpRNFLT, and VFSaverage (P = .0153, .0029, .0007). CONCLUSIONS:The ROTA-detected extent of axonal damage was associated with ONH structural change represented by gamma zone area in POAG eyes after adjustment for other possible confounding factors.

PRÉCIS:Disagreement in the angle closure assessment was seen between gonioscopy and ultrasound biomicroscopy (UBM), to which not only anterior, but also posterior chamber configuration UBM parameters were significantly related. PURPOSE:To study diagnostic disagreement and its relating factors in assessing the angle classified as "occludable" by gonioscopy and by ultrasound biomicroscopy in eyes with van Herick grade 2 or less (eyes ≤VH2). METHODS:In 93 eyes ≤VH2 (93 subjects) with no peripheral anterior synechia, gonioscopy, UBM, and anterior segment-optical coherence tomography (AS-OCT) were performed in dark, the number of eyes with ≥2 ITC-positive quadrants (contact ≥180 degrees) based on UBM (eyes ≥2-ITC UBM Quad) and that with the angle classified as occludable by gonioscopy (eyes≥2-ITC GONIO Quad) were determined, and the number of eyes not meeting these criteria, that is, eyes <2-ITC UBM Quad (contact <180 degrees) and eyes <2-ITC GONIO Quad, was also determined. Multivariable logistic regression analysis was performed with systemic, ocular, UBM, and AS-OCT parameters as explanatory variables. RESULTS:Out of the 93 eyes, 49 were diagnosed as eyes ≥2-ITC GONIO Quad based on gonioscopy, 63 as eyes ≥2-ITC UBM Quad on UBM, 37 as both eyes ≥2-ITC GONIO Quad and eyes ≥2-ITC UBM Quad (agreement between gonioscopy and UBM), 12 as eyes ≥2-ITC GONIO Quad base on gonioscopy, but as eyes <2-ITC UBM Quad on UBM (UBM under-diagnosing), and 26 as eyes <2-ITC GONIO Quad based on gonioscopy, but as eyes ≥2-ITC UBM Quad on UBM (UBM over-diagnosing), respectively (McNemar test, P =0.0388). Longer axial length ( P =0.0002), deeper anterior chamber depth ( P =0.0121), greater angle-opening distance at 500 μm ( P =0.0159), and smaller iris convexity ( P =0.0031) were related to UBM over-diagnosing, while a greater angle-opening distance at 500 μm ( P =0.0046) and smaller trabecular ciliary angle ( P =0.0158) to UBM under-diagnosing. CONCLUSION:Both anterior and posterior chamber configuration parameters determined based on UBM were significantly related to disagreement between gonioscopy and UBM in assessing the appositional angle closure.

Purpose: The purpose of this study was to investigate the relationship among deep optic nerve head (ONH), lamina cribrosa (LC), and peripapillary sclera (pSc) configurations in healthy eyes. Methods: This prospective cross-sectional study included 205 healthy eyes of 141 subjects. Multivariable linear mixed models identified factors associated with LC curvature index, prelaminar thickness (PLT), pSc angle, and LC depth (LCD). Explanatory variables included age, gender, intraocular pressure, axial length (AXL), visual field sensitivity, disc area, disc ovality, disc torsion, Bruch's membrane opening (BMO)-minimum rim width (MRW), BMO and anterior scleral canal opening (ASCO) area, peripapillary zone area with and without Bruch's membrane (PPZ+BM/-BM), and peripapillary choroidal thickness (pChT). A sub-analysis was conducted by dividing the eyes at the median AXL. Results: LC curvature was flatter in eyes with large PPZ-BM, long AXL, and shallow LCD (P = 0.002, P = 0.015, and P = 0.042, respectively). Similar factors exhibited consistent effects in longer AXL eyes, whereas different factors, BMO-MRW, ASCO-area, and pSc-angle, were associated in shorter AXL eyes (P = 0.006, P = 0.012, and P = 0.018. respectively). PLT was thinner in eyes with thin BMO-MRW, large ASCO area, and young age (P < 0.001, P < 0.001, and P = 0.009, respectively). The pSc angle was steeper in eyes with long AXL and large PPZ+BM (P < 0.001). LCD was deeper in eyes with thick pChT, thin BMO-MRW, and small ASCO area (P < 0.001, P < 0.001, and P = 0.004, respectively). Conclusions: Novel associations between LC configurations with scleral canal size, PPZ+BM/-BM, and BMO-MRW were found after correction for confounding deep ONH morphologies. Given that these structures are associated with glaucomatous changes, these inter-structure correlations should be considered when distinguishing LC changes between healthy and glaucomatous eyes.

PurposeTo evaluate the diagnostic accuracy of a deep learning autoencoder-based model utilizing regions of interest (ROI) from optical coherence tomography (OCT) texture enface images for detecting glaucoma in myopic eyes.MethodsThis cross-sectional study included a total of 453 eyes from 315 participants from the multi-center "Swept-Source OCT (SS-OCT) Myopia and Glaucoma Study", composed of 268 eyes from 168 healthy individuals and 185 eyes from 147 glaucomatous individuals. All participants underwent swept-source optical coherence tomography (SS-OCT) imaging, from which texture enface images were constructed and analyzed. The study compared four methods: (1) global RNFL thickness, (2) texture enface image, (3) a single autoencoder model trained only on healthy eyes, and (4) a dual autoencoder model trained on both healthy and glaucomatous eyes. Diagnostic accuracy was assessed using the area under the receiver operating curves (AUROC) and precision recall curves (AUPRC).ResultsThe dual autoencoder model achieved the highest AUROC (95% CI) (0.92 [0.88, 0.95]), significantly outperforming the single autoencoder model trained only on healthy eyes (0.86 [0.83, 0.88], p = 0.01), the global RNFL thickness model (0.84 [0.80, 0.86], p = 0.003), and the texture enface model (0.83 [0.79, 0.85], p = 0.005). Using AUPRC (95% CI), the dual autoencoder model (0.86 [0.83, 0.89]) also outperformed the single autoencoder model trained only on healthy eyes (0.80 [0.78, 0.82], p = 0.02), the global RNFL thickness model (0.74 [0.70, 0.76], p = 0.001), and the texture enface model (0.71 [0.68, 0.73], p<0.001). No significant difference was observed between the global RNFL thickness measurement and the texture enface measurement (p = 0.47).DiscussionThe dual autoencoder model, which integrates reconstruction errors from both healthy and glaucomatous training data, demonstrated superior diagnostic accuracy compared to the single autoencoder model, global RNFL thickness and texture enface-based approaches. These findings suggest that deep learning models leveraging ROI-based reconstruction error from texture enface images may enhance glaucoma classification in myopic eyes, providing a robust alternative to conventional structural thickness metrics.

To evaluate the accuracy of predictive refractive error (RE) and axial length (AL) using regression analysis of fundus parameters in the Kumejima study and to identify RE- or AL-related fundus changes. Prospective cross-sectional observational population study. Non-mydriatic color fundus photographs (CFPs) from 1,646 right eyes of healthy Kumejima participants were analyzed. Mean red (R), green (G), and blue (B) intensities at eight locations around the optic disc and fovea were quantified, and the tessellation fundus index was calculated as R/(R + G + B). Optic disc ovality ratio, papillomacular angle, and retinal vessel angle were measured. Least absolute shrinkage and selection operator regression with leave-one-out cross-validation predicted RE and AL, validated using Pearson’s correlation coefficient. The mean ± standard deviation actual RE and AL of participants (834 men and 812 women) were -0.14±1.62 diopter and 23.50±0.88 mm. The mean ± standard deviation predicted RE and AL based on fundus parameters was -0.14±1.05 diopter and 23.50±0.48 mm, with a mean absolute error of 0.91 diopter and 0.59 mm, and the correlation coefficients between actual and predicted RE and AL were 0.63 and 0.51 (p<0.001). Eyes with a longer AL had narrower temporal vessel angles, weaker green intensities, stronger blue intensities, and increased tessellation of the fundus color (p<0.001). RE and AL could be predicted using CFP parameters; the RE- or AL-related changes in the fundus, such as vessel angles and peripapillary color intensity, may enhance our understanding of myopia mechanisms.

A multicenter cross-sectional study was conducted to investigate the magnification-corrected association between fovea-disc distance (FDD) and optical coherence tomography (OCT)-measured macular retinal layer thickness in eyes with and without primary open-angle glaucoma (POAG). A 12.0 × 9.0-mm-wide swept-source OCT scan, which includes both the macula and optic disc, was performed in 190 eyes from 124 healthy subjects (normal group) and 149 eyes from 117 POAG patients (POAG group). The FDD and thickness of the macular retinal nerve fiber layer (mRNFL), ganglion cell inner plexiform layer (GCIPL), and outer retina (OR, total retina minus (mRNFL plus GCIPL)) were measured and corrected for magnification effects. The mixed-effects models, accounting for potential confounding factors, revealed two significant associations between a longer FDD and retinal layer thickness: thinner mRNFL in the normal group (coefficients, -3.14, 95% confidence intervals (CI), -4.75 to -1.53; p = 0.0001) and thinner GCIPL in the POAG group (coefficients, -4.26; 95% CI, -6.85 to -1.67; p = 0.0013). The association between FDD and macular retinal layer thickness varies by retinal layer and the presence of POAG. FDD can significantly affect OCT-determined macular retinal layer thickness, especially GCIPL in POAG eyes and mRNFL in normal eyes.

PURPOSE:To compare the diagnostic accuracy of 24-2C Swedish Interactive Thresholding Algorithm (SITA) Faster and 10-2 SITA Standard in detecting macular damage in mild-stage glaucoma. DESIGN:Multicenter diagnostic accuracy study based on prospectively collected data. PARTICIPANTS:In total, 108 eyes from 108 patients with mild-stage glaucoma (normal-tension glaucoma, 58; high-tension glaucoma, 50) and 52 eyes from 52 healthy controls at the Jikei University School of Medicine and Tajimi Iwase Eye Clinic. METHODS:Participants underwent 24-2C SITA Faster and 10-2 SITA Standard visual field testing on the same day, in randomized order. OCT with ganglion cell analysis identified macular damage. McNemar test and noninferiority analysis (10% margin) compared detection accuracy. Test durations were compared using pairwise t-tests. MAIN OUTCOME MEASURES:Sensitivity and specificity of 24-2C SITA Faster and 10-2 SITA Standard for detecting macular damage and test duration. RESULTS:For overall macular damage, 24-2C SITA Faster demonstrated sensitivity or specificity of 0.64/0.93 (total deviation [TD]) and 0.67/0.93 (pattern deviation [PD]), while 10-2 SITA Standard demonstrated 0.69/0.94 (TD) and 0.77/0.93 (PD). McNemar test revealed no significant difference, and 24-2C SITA Faster was noninferior within the 10% margin. Subanalysis with a strict 5% margin, revealed that 10-2 SITA Standard was superior to 24-2C SITA Faster when using PD plot for all parameters. The mean test duration was significantly shorter for 24-2C SITA Faster (158.5 seconds) than for 10-2 SITA Standard (330.0 seconds; P < 0.001). CONCLUSIONS:24-2C SITA Faster is a noninferior and more time-efficient alternative to 10-2 SITA Standard for detecting macular damage in mild-stage glaucoma; however, 10-2 SITA Standard may be considered superior for detecting subtle macular defects using PD. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

To evaluate the effects of prophylactic sequential argon- Nd:YAG laser peripheral iridotomy (pLPIsequential) on the corneal endothelial cell density (CECD) over 5 years in Japanese eyes with narrow angles (NA-eyes). Prospective observational study The CECD of NA-eyes before and after pLPIsequential and of untreated NA-eyes were assessed annually over 5 years with non-contact specular microscopy. Routine ophthalmic examinations and measurements using anterior-segment imaging devices were performed at baseline. The time courses of the CECD were analyzed using a multivariable linear mixed-effect model and factors obtained at baseline. Sixty-nine pLPIsequential-treated NA-eyes (69 subjects; mean age, 68.9 years) and 67 pLPIsequential-untreated NA-eyes (67 subjects; mean age, 64.4 years) were enrolled. In the pLPIsequential-untreated NA-eyes, no baseline factors were correlated significantly with the time course of the CECD, and its decline rate − 4.7 (95

Purpose of review Rapid increase in the prevalence of myopia has been documented worldwide. Myopia, especially high myopia, is not only an important risk factor for having open angle glaucoma (OAG), but also has a strong linking with the progression of OAG. Since myopic axial length (AXL) elongation is associated with nonglaucomatous optic nerve head (ONH) and visual field abnormalities, myopia poses a challenge in differential diagnosis of OAG. This review provides an overview of literature studying relationships between myopic AXL-elongation and diagnosis and prognosis of OAG, and functional and structural changes in the eye. Recent findings Studies using optical coherence tomography (OCT), OCT-angiography, those using standard automated perimetry (SAP), other perimetric or electrophysiological methods showed dose-dependent effects of myopic AXL elongation on the structural changes in the ONH and parapapillary tissues, and functional abnormalities of an eye. Large cohort studies showed approximately one quarter of eyes with nonpathologic high myopia were complicated with various patterns of visual field defects including glaucoma-like ones. Summary Findings of cross-sectional and longitudinal studies obtained using various fundus imaging devices must be integrated to perimetric results to improve differential diagnosis of OAG in myopic eyes, in which artificial intelligence technology may be useful.

BACKGROUND:In 2024, WHO included effective refractive error coverage (eREC) into the results framework of the 14th General Programme of Work, which sets a road map for global health and guides WHO's work between 2025 and 2028. eREC is a measure of both the availability and quality of refractive correction in a population. This study aimed to model global and regional estimates of eREC as of 2023 and evaluate progress towards the WHO global target of a 40 percentage-point absolute increase in eREC by 2030. METHODS:For this systematic review and meta-analysis, the Vision Loss Expert Group analysed data from 237 population-based eye surveys conducted in 76 countries since 2000, comprising 815 273 participants, to calculate eREC (met need / met need + undermet need + unmet need]) and the relative quality gap between eREC and REC ([REC - eREC] / REC × 100, where REC = [met + undermet need] / [met need + undermet need + unmet need]). An expert elicitation process was used to choose covariates for a Bayesian logistic regression model used to estimate eREC by country-age-sex grouping among adults aged 50 years and older. Country-age-sex group estimates were aggregated to provide estimates according to Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) super-regions. FINDINGS:Global eREC was estimated to be 65·8% (95% uncertainty interval [UI] 64·7-66·8) in 2023, 6 percentage points higher than in 2010 (eREC 59·8% [59·4-60·2]). There were marked differences in eREC between GBD super-regions in 2023, ranging from 84·0% (95% UI 83·0-85·0) in high-income countries to 28·3% (26·4-30·4) in sub-Saharan Africa. In all super-regions, eREC was lower in females than males, and decreased with increasing age among adults aged ≥50 years. Since 2000, the relative increase in eREC was 60·2% in sub-Saharan Africa, 45·7% in North Africa and the Middle East, 41·5% in southeast Asia, east Asia and Oceania, 40·3% in south Asia, 16·2% in Latin America and the Caribbean, 8·3% in central Europe, eastern Europe and central Asia, and 6·8% in the high-income super-region. The relative quality gap ranged from 2·9% to 78·3% across studies, with larger gaps characteristically in regions of lower eREC. Globally, the percentage of those with a refractive need that was undermet reduced between 2000 and 2023, from 10·0% (95% UI 9·5-10·5) to 5·3% (5·1-5·5). INTERPRETATION:The current trajectory of improvement in eREC and the relative quality gap are insufficient to meet the 2030 target. Global efforts to equitably increase spectacle coverage, such as the WHO SPECS 2030 initiative, and to address equity failings associated with geography, age, and sex, are crucial to accelerating progress towards the 2030 targets. No region is close to achieving universal coverage. FUNDING:WHO, Sightsavers, The Fred Hollows Foundation, Fondation Thea, University of Heidelberg, German Federal Ministry for Education and Research. TRANSLATIONS:For the French, Chinese and Spanish translations of the abstract see Supplementary Materials section.

Purpose: To develop DeepISP, a deep learning model that predicts the comprehensive visual field (VF) information of the Humphrey visual field analyzer (HFA) based on rapid screening perimetry (Imo/TEMPO screening program [ISP]). Design: A retrospective, cross-sectional, and longitudinal cohort database study. Participants: One hundred eighty-seven actual ISPs from 112 patients who underwent both ISP and HFA 24-2 on the same day at the Jikei University School of Medicine Affiliated Hospital and 3470 synthesized ISPs from 883 patients who underwent VF measurements using HFA 24-2 and HFA 10-2 at 4 hospitals affiliated with Jikei University School of Medicine. Methods: We developed 2 variants of multitask neural networks designed to predict both current VF parameters and VF progression parameters. We also evaluated the efficacy of data augmentation to synthesize ISP tests created by combining 20 points from HFA 24-2 and 8 points from HFA 10-2, with thresholding applied to these 28 points. Main Outcome Measures: Mean absolute error for mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI). Mean F1 score for total deviation (TD) and pattern deviation (PD) probability plot classification. Area under the curve (AUC) for MD progression (MD slope <−1.0 decibel/year) and VFI progression (VFI slope <−1.8%/year). Results: DeepISP could predict current VF status. Mean absolute errors for predicting MD, PSD, and VFI were 1.869 ± 0.114, 1.918 ± 0.082, and 5.146 ± 0.487, respectively. The mean F1 scores for pointwise classification of TD and PD probability plots were 0.761 ± 0.002 and 0.775 ± 0.002, respectively. The AUC for classifying glaucoma hemifield test was 0.920 ± 0.008. DeepISP was also capable of predicting VF progression, with AUCs of 0.828 ± 0.060 and 0.832 ± 0.062 for predicting MD and VFI progression, respectively. Conclusions: We demonstrated ISP's versatility and capability in predicting comprehensive VF information, including current severity and progression risk. Our DeepISP serves as an efficient tool for screening and prioritizing patients with glaucoma for clinical intervention using only a single rapid ISP test. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To compare the performance of the 24-2C Swedish Interactive Thresholding Algorithm (SITA) Faster and Standard with the 10-2 SITA Standard in assessing visual function in patients with glaucoma. DESIGN:A multicenter prospective cross-sectional study. PARTICIPANTS:Overall, 71 eyes of 71 patients with primary open-angle or normal-tension glaucoma were included. METHODS:The participants underwent visual field testing using the 24-2C SITA Faster, 24-2C SITA Standard (research prototype), and 10-2 SITA Standard in a randomized order on the same day. The global indices, threshold values, total deviation (TD), pattern deviation (PD), and test durations of the algorithms were compared. Correlations among the 10-2 SITA Standard mean deviation (MD) and number of depressed test point locations in the TD and PD probability plots at P < 5%, P < 2%, and P < 1% significance levels within the central 10° were analyzed. MAIN OUTCOME MEASURES:Differences in global indices, threshold values, TD, PD, and test duration between algorithms. Correlations of the MD and number of TD and PD points of the 10-2 SITA Standard and those of the central 10° region for the 24-2C algorithms. RESULTS:No significant differences were found in the global indices between the 24-2C SITA Faster and Standard. The 24-2C SITA Faster had a significantly shorter test duration (55.2% shorter) than the 24-2C SITA Standard. The 24-2C SITA Standard was 45.2% shorter than the combined 24-2 SITA Standard plus 10-2 SITA Standard. The 24-2C SITA Standard showed significantly higher correlation with the 10-2 SITA Standard than the 24-2C SITA Faster. CONCLUSIONS:There were no significant differences in global indices between the 24-2C SITA Standard and 24-2C SITA Faster. However, the 24-2C SITA Standard showed a stronger correlation with the 10-2 SITA Standard. The 24-2C SITA Standard demonstrates potential for more effectively assessing central visual field function in patients with glaucoma. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To report aging-associated change rates in circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and macular ganglion cell-inner plexiform layer and complex thickness (MGCIPLT, MGCCT) in normal Japanese eyes and to compare the data in linear scaled visual field (VF) sensitivity of central 4 points of Humphrey Field Analyzer (HFA) 24-2 test (VF4TestPoints) to that in MGCIPLT in four 0.6-mm-diameter circles corresponding to the four central points of HFA 24-2 adjusted for retinal ganglion cell displacement (GCIPLT4TestPoints).STUDY DESIGN:Prospective observational study METHODS: HFA 24-2 tests and spectral-domain optical coherence tomography (SD-OCT) measurements of cpRNFLT, MGCIPLT, MGCCT and GCIPLT4TestPoints were performed every 3 months for 3 years in 73 eyes of 37 healthy Japanese with mean age of 50.4 years. The time changes of SD-OCT-measured parameters and VF4TestPoints were analyzed using a linear mixed model.RESULTS:The aging-associated change rates were -0.064 μm/year for MGCIPLT and and -0.095 for MGCCT (P=0.020 and 0.017), but could not be detected for cpRNFLT. They accelerated with aging at -0.009μm/year/year of age for MGCIPLT (P<0.001), at 0.011 for MGCCT (P<0.001) and at 0.013 for cpRNFLT(0.031). The aging-associated decline of -82.1 [1/Lambert]/year of VF4TestPoints corresponded to -0.095 μm/year of GCIPLT4TestPoints.CONCLUSION:We report that aging-associated change rates of cpRNFLT, MGCIPLT and MGCCT in normal Japanese eyes were found to be significantly accelerated along with aging. Relationship between VF sensitivity decline rates and SD-OCT measured GCIPLT decline rates during physiological aging in the corresponding parafoveal retinal areas are also documented.

Purpose This study sought to identify the most effective testing program for detecting visual-field defects in mild-stage glaucoma with central visual-field defects. Design A multicenter, retrospective diagnostic testing evaluation. Participants The study involved 93 eyes (83 patients) with mild-stage glaucoma (median mean deviation [interquartile range]: -1.79 [2.16] dB) with central visual-field defects and 69 eyes (63 patients; median mean deviation, -1.38 [2.31] dB) with mild-stage glaucoma without central visual-field defects, from Jikei University School of Medicine and Tajimi Iwase Eye Clinic. Methods Patients underwent 10-2 Swedish Interactive Thresholding Algorithm (SITA) Standard, 24-2 SITA Standard, and 24-2C SITA Faster tests. Central visual-field defects were defined using 10-2 SITA Standard and optical coherence tomography (OCT). A detection power of 4 points in the 24-2 that coincided with 10-2 (Center4), 12 points that lie within 10° (24-2-12), and 22 points that lie within 10° of 24-2C (24-2C-22) were analyzed using receiver operating characteristic (ROC) curves based on logistic regression analysis, using total deviation (TD) and pattern deviation (PD) probability plots. Main Outcome Measures Area under the receiver operating characteristic curve (AUC) of the Center4, 24-2-12, and 24-2C-22 tests. Results In the upper-central visual field, AUCs of the TD plot were 0.50 (0.40–0.58) for the Center4, 0.75 (0.67–0.83) for 24-2-12, and 0.85 (0.78–0.91) for 24-2C-22, with 24-2C-22 AUC significantly exceeding 24-2-12 AUC. For the PD plot, AUCs were 0.53 (0.44–0.63), 0.81 (0.74–0.89), and 0.84 (0.77–0.90), respectively. In the lower-central visual field, using a total plot, AUCs were 0.27 (0.18–0.36), 0.57 (0.47–0.69), and 0.57 (0.46–0.68) for the Center4, 24-2-12, and 24-2C-22, respectively. Using the PD plot in the upper field, AUCs were 0.27 (0.19–0.36), 0.64 (0.53–0.75), and 0.81 (0.72–0.90), respectively, with the AUC of the 24-2C-22 significantly exceeding that of 24-2-12. The 24-2C test was significantly faster than both the 24-2 and 10-2 tests, reducing testing duration by 46% and 52%, respectively. Conclusions The 24-2C SITA Faster test is highly effective and efficient for detecting mild-stage glaucoma with central visual-field defects. This, and its reduced duration, makes it a valuable tool in clinical settings.