OBJECTIVE: To analyse in depth the associations between objectively measured corneal higher-order aberrations (HOAs) and subjectively perceived visual quality after small incision lenticule extraction (SMILE) as quantified with the standardized and clinically validated quality of vision (QOV) questionnaire.
METHODS: This cross-sectional study included patients after bilateral simultaneous SMILE for the treatment of myopia and/or myopic astigmatism with plano target refraction. Scheimpflug imaging (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to objectively quantify corneal HOAs. The standardized and validated QOV questionnaire was employed to gauge patients\' subjectively perceived visual quality regarding frequency, severity and bothering effect of visual disturbances.
RESULTS: A total of 394 eyes of 197 patients with a mean age of 32.4 ± 7.7 years and a mean postoperative follow-up of 24.3 ± 14.1 months were included. SMILE induced a statistically significant (p < 0.001) increase in spherical aberration (0.074 ± 0.131 µm), coma (0.142 ± 0.179 µm), trefoil (0.018 ± 0.067 µm) as well as in total HOAs (0.191 ± 0.176 µm). Surgically induced and postoperative levels of HOA showed no correlation with the three QOV scores representative of overall visual symptom frequency, severity and bothering effect (all R2 values ≤ 0.016). In addition, the associations between specific visual symptoms (e.g. starburst) and singular HOA terms (e.g. haloes) were very weak (all Rho values ≤ 0.164).
CONCLUSIONS: Small incision lenticule extraction induced significant amounts of corneal HOAs that, however, showed no clear relationships to patient-reported QOV or specific long-term visual symptoms.

Many neuronal types occur as pairs that are similar in most respects but differ in a key feature. In some pairs of retinal neurons, called paramorphic, one member responds to increases and the other to decreases in luminance (ON and OFF responses). Here, we focused on one such pair, starburst amacrine cells (SACs), to explore how closely related neuronal types diversify. We find that ON and OFF SACs are transcriptionally distinct prior to their segregation, dendritic outgrowth, and synapse formation. The transcriptional repressor Fezf1 is selectively expressed by postmitotic ON SACs and promotes the ON fate and gene expression program while repressing the OFF fate and program. The atypical Rho GTPase Rnd3 is selectively expressed by OFF SACs and regulates their migration but is repressed by Fezf1 in ON SACs, enabling differential positioning of the two types. These results define a transcriptional program that controls diversification of a paramorphic pair.

OBJECTIVE: The aim of this work was to examine the impact of Seidel spherical aberration (SA) on optimum refractive state for detecting and discriminating small bright lights on a dark background.
METHODS: An adaptive-optics system was used to correct ocular aberrations of cyclopleged eyes and then systematically introduce five levels of Seidel SA for a 7-mm diameter pupil: 0,±0.18, and±0.36diopters (D)mm-2. For each level of SA, subjects were required to detect one or resolve two points of light (0.54 arc min diameter) on a dark background. Refractive error was measured by adjusting stimulus vergence to minimize detection and resolution thresholds. Two other novel focusing tasks for single points of light required maximizing the perceived intensity of a bright point\'s core and minimizing its overall perceived size (i.e. minimize starburst artifacts). Except for the detection task, luminance of the point of light was 1000cdm-2 on a black background lower than 0.5cdm-2.
RESULTS: Positive SA introduced myopic shifts relative to the best subjective focus for dark letters on a bright background when there was no SA, whereas negative SA introduced hyperopic shifts in optimal focus. The changes in optimal focus were -1.7, -2.4, -2.0, and -9.2D of focus per Dmm-2 of SA for the detection task, resolution task, and maximization of core\'s intensity and minimization of size, respectively.
CONCLUSIONS: Ocular SA can be a significant contributor to changes in refractive state when viewing high-contrast point sources typically encountered in nighttime environments.

Retinal direction-selective ganglion cells (DSGCs) have the remarkable ability to encode motion over a wide range of contrasts, relying on well-coordinated excitation and inhibition (E/I). E/I is orchestrated by a diverse set of glutamatergic bipolar cells that drive DSGCs directly, as well as indirectly through feedforward GABAergic/cholinergic signals mediated by starburst amacrine cells. Determining how direction-selective responses are generated across varied stimulus conditions requires understanding how glutamate, acetylcholine, and GABA signals are precisely coordinated. Here, we use a combination of paired patch-clamp recordings, serial EM, and large-scale multi-electrode array recordings to show that a single high-sensitivity source of glutamate is processed differentially by starbursts via AMPA receptors and DSGCs via NMDA receptors. We further demonstrate how this novel synaptic arrangement enables DSGCs to encode direction robustly near threshold contrasts. Together, these results reveal a space-efficient synaptic circuit model for direction computations, in which \"silent\" NMDA receptors play critical roles.