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Background: Standard visual acuity (VA) is often preserved in early retinitis pigmentosa (RP), limiting its value as a marker of functional impairment. Alternative measures such as low-luminance deficit (LLD) and low-contrast deficit (LCD) may detect earlier changes in cone function. This study aimed to evaluate the diagnostic utility of these measures in RP patients under photopic and mesopic conditions. Methods: A prospective observational study was conducted on 57 RP patients and 54 age-matched controls. Binocular VA was assessed using ETDRS charts at 100% and 10% contrast under photopic (100 cd/m2) and mesopic (1 cd/m2) conditions. LLD and LCD scores were computed from VA differences across conditions. ROC curve analysis was used to determine diagnostic accuracy. Results: RP patients showed significant VA loss under reduced luminance and contrast (p < 0.001), independent of age. LLD under high contrast was reduced, while LLD under low contrast and LCD (both photopic and mesopic) were significantly higher than in controls. The mesopic LCD demonstrated the highest diagnostic capacity (AUC = 0.87), with a threshold of > 13 ETDRS letters yielding optimal sensitivity and specificity. Unlike standard VA, mesopic LCD correlated with functional symptoms and was unaffected by age. Conclusions: Low-contrast VA under mesopic conditions is a simple, reproducible, and sensitive marker for early visual dysfunction in RP. A difference > 13 ETDRS letters may serve as a clinically relevant threshold for disease monitoring and early detection in retinal dystrophies.

Background/Objectives: Asymmetric myopic peripheral defocus lenses (MPDLs) have proven to be effective in slowing the progression of myopia in Spanish children over a period of 12 months. The purpose of this study was to assess the MPDL spectacles’ efficacy in slowing myopia progression over a 24-month period in children. Methods: This study extends the follow-up period of the double-masked, prospective, and randomized clinical trial previously published to 24 months. Children from 6 to 12 years were assigned to two groups: a control group wearing spherotorical single vision lenses (SVLs) or a treatment group wearing MPDL lenses. Inclusion criteria included children with myopia less than −0.50 D, astigmatism below 1.50 D, and best-corrected visual acuity of at least 20/20. Participants underwent cycloplegic autorefractive examination and axial length (AL) measurements at the baseline and six and twelve months in the study already published, and twenty-four months later in the present study. Lifestyle factors, including outdoor activities and digital device use, were also assessed. Baseline characteristics, including age, refractive error, and AL, were comparable between groups. Dropout rates were 15.9%, with 14 participants lost to follow-up, distributed equally between the two groups. Results: After 24 months of follow-up, 69 children remained in this study, comprising 34 participants in the SVL cohort and 35 in the MPDL cohort. Over 24 months, the MPDL group showed significantly less AL elongation than the SVL group (0.27 ± 0.23 mm and 0.37 ± 0.24 mm; p = 0.0341). The mean relative AL increase was 1.10 ± 0.95% in the MPDL group, compared to 1.56 ± 1.02% in the SVL group (p = 0.0322). Younger children exhibited faster AL growth, while digital device use and outdoor activities did not affect AL changes. Conclusions: MPDL spectacle lenses substantially slowed myopia progression over a 24-month period, with 28.7% less progression in absolute AL growth and 29.8% in relative AL growth compared to SVL. These results indicate that MPDL lenses are an effective method for slowing myopia progression.

Background: Different designs of ophthalmic lenses have been studied to control the progression of myopia in children. This study aims to evaluate the short-term efficacy of a new design of ophthalmic lens with asymmetric myopic peripheral defocus (MPDL) on myopia progression in children compared to a control group wearing a single-vision lens (SVL). Methods: Children aged 5 to 12 with myopia up to −0.50 D, astigmatism and anisometropia under 1.50 D, and corrected visual acuity over 20/20 were randomized to either the study group (MPDL) or control group (SVL). The myopia progression was evaluated by measuring axial length (AL) growth (IOL Master; Zeiss) over a period of one year. Results: Ninety-two subjects were recruited. Forty-six children were randomly assigned to the control group, and 46 to the study group. In total, 83 children completed the clinical trial, with a mean age of 10.81 [9.53–11.92] years, among which 59.04% were female. After one year of treatment, there was less AL elongation in the study group compared to the control group (0.16 ± 0.16 mm vs. 0.24 ± 0.16 mm, p = 0.034). Conclusions: The MPDL significantly reduced the absolute growth of AL by 39% (p = 0.014) and relative growth of AL by 37.3% (p = 0.012) after 12 months in comparison to the control group in a Spanish population.

Power distribution of progressive power lenses provides usable regions based on power distribution analysis. However, recent studies demonstrated that these regions are not always used for certain tasks as predicted. This work determines the concordance between the actual region of lens use and compares it with the theoretically located regions. The pupil position of 26 subjects was recorded using an eye-tracking system (Tobii-Pro-Glasses 3) at distance and near-reading tasks while wearing a general use progressive power lens. Subjects were asked to read aloud a text showed on a screen placed at 5.25 m and 37 cm while looking though the central and lateral regions of the lens. The pupil position was projected onto the back surface of the lens to obtain the actual region of use for each fixation. Results showed that the actual region of use matched with the theoretically located. On average, the concordance between the actual and theoretical regions of use was 85% for a distance-reading task and 73% for a near-reading task. In conclusion, the proposed method effectively located the actual regions of the lens used, revealing how users’ posture affects lens usage. This insight enables the design of more customized progressive lenses based on the areas used during vision-based tasks.

ObjectiveThe purpose of this study is to evaluate reading time and characteristics of fixations at different distances when looking through different areas of progressive power lenses (PPL) with different power distributions by means of eye-tracking technology. MethodA wearable eye tracker system (Tobii-Pro Glasses 3) was used to record the pupil position of 28 PPL subjects when reading at near and distance vision while using 3 different PPL designs: a PPL optimized for distance vision (PPL-Distance), a PPL optimized for near vision (PPL-Near) and one of them balanced for a general use (PPL-Balance). Subjects were asked to read out loud a text displayed on a digital screen located at 5.25m and 0.37m when they were looking through the central and peripheral regions of each PPL. Reading time, total duration of fixations, and the number of fixations were analyzed for each reading condition and PPL. Statistical analysis was carried out using Statgraphics Centurion XVII.II Software. ResultsThe analysis of eye movements at distance-reading vision showed a statistically significant lower reading time (p = 0.004) and lower total duration of fixations (p = 0.01) for PPL-Distance. At near-reading vision, PPL-Near provided statistically significant lower reading time (p<0.001), lower total duration of fixations (p = 0.02), and less fixation count(p<0.001) in comparison with PPL-Balance and PPL-Distance. ConclusionsReading time and fixations characteristics are affected by the power distribution of a PPL. A PPL design with a wider distance region provides better distance-reading performance while a PPL with a wider near area performs better at a near-reading task. The power distribution of PPLs influences the user performance at vision-based tasks. Thus, to provide the user with the best visual experience, PPL selection must consider user needs.

Due to the lack of sensitivity of visual acuity (VA) measurement to quantify differences in visual performance between progressive power lenses (PPLs), in this study, we propose and evaluate an eye-tracking-based method to assess visual performance when wearing PPLs. A wearable eye-tracker system (Tobii-Pro Glasses 3) recorded the pupil position of 27 PPL users at near and distance vision during a VA test while wearing three PPL designs: a PPL for general use (PPL-Balance), a PPL optimized for near vision (PPL-Near), and a PPL optimized for distance vision (PPL-Distance). The participants were asked to recognize eye charts at both near and distance vision using centered and oblique gaze directions with each PPL design. The results showed no statistically significant differences between PPLs for VA. However, significant differences in eye-tracking parameters were observed between PPLs. Furthermore, PPL-Distance had a lower test duration, complete fixation time, and number of fixations at distance evaluation. PPL-Near has a lower test duration, complete fixation time, and number of fixations for near vision. In conclusion, the quality of vision with PPLs can be better characterized by incorporating eye movement parameters than the traditional evaluation method.

The purpose of this study is to determine if there is any correlation between the characteristics of the user’s eye movements (EMs) and the preference of the user when wearing different Progressive power lenses (PPLs) distributions. An eye-tracker system with a sample rate of 120Hz and temporal resolution of 8.3ms (Tobii-X3-120) was used to register EMs of 38 PPL users when reading in a computer screen with 2 types of PPLs (PPL-soft and PPL-hard). Number of fixations, complete fixation time, fixation duration mean, saccade duration mean, saccade distance mean, and number of regressions were analyzed for 6 different regions of the computer screen. A statistically significant difference was observed between the characteristics of the user’s EMs and the user’s PPL subjective preference (p<0.05*). Subjects that preferred the PPL-hard presented significantly lower complete fixation time, lower fixation duration mean and lower number of regressions than those subjects indicating a preference for the PPL-soft. Results of this study suggest that eye-tracking systems can be used as PPL design recommendation systems according to the user EMs performance.

(1) Background: In mesopic lighting conditions, or under adverse environmental circumstances, visual information is reduced, which increases the risk of traffic accidents. This effect could be reduced with a precise evaluation of the visual function under mesopic conditions, but it is difficult to replicate in clinics. This study aims to develop an easy-to-adopt method to evaluate mesopic visual acuity (VA) in drivers. (2) Methods: Prospective and observational study in drivers. logMAR mesopic VA was compared with photopic VA measured under different combinations of contrast charts and filters to find the combination that responds best to mesopic conditions. (3) Results: Fifty-six drivers were examined. The best correlation was found with an 80% density filter and a Weber contrast chart of 20%. The logMAR VA for this combination was 0.01 ± 0.11, which was close to the mesopic VA values (0.01 ± 0.12). The difference between both logMAR VA was 0.00 ± 0.06 (R = 0.86; p ≤ 0.001; ICC = 0.86). (4) Conclusions: The use of 20% contrast optotypes and the interposition of an 80% filter under photopic conditions provide VA values similar to those measured under mesopic lighting conditions, making this simple system a good predictor of mesopic VA values.