BACKGROUND: Visual fields are important for postural stability and ability to manoeuvre around objects.
OBJECTIVE: Examine the association between visual field loss and falls requiring hospitalisation in adults aged 50 +.
METHODS: Older adults aged 50+ with and without visual field loss were identified using a fields database obtained from a cross-section of ophthalmologists\' practices in Western Australia (WA). Data were linked to the Hospital Morbidity Data Collection and WA Hospital Mortality System to identify participants who experienced falls-related hospitalisations between 1990 and 2019. A generalised linear negative binomial regression model examined the association between falls requiring hospitalisation for those with and without field loss, based on the better eye mean deviation (mild: -2 to -6 dB, moderate: -6.01 dB to -12 dB, severe < -12.01 dB) in the most contemporaneous visual field test (3 years prior or if not available, 2 years after the fall), after adjusting for potential confounders.
RESULTS: A total of 31 021 unique individuals of whom 6054 (19.5%) experienced 11 818 falls requiring hospitalisation during a median observation time of 14.1 years. Only mean deviation index of <-12.01 dB (severe) was significantly associated with an increased rate of falls requiring hospitalisations by 14% (adjusted IRR 1.14, 95% CI 1.0-1.25) compared with no field loss, after adjusting for potential confounders. Other factors included age, with those aged 80+ having an increased rate (IRR 29.16, 95% CI 21.39-39.84), other comorbid conditions (IRR 1.49, 95% CI 1.38-1.60) and diabetes (IRR 1.25, 95% CI 1.14-1.37). Previous cataract surgery was associated with a decreased rate of falls that required hospitalisations by 13% (IRR 0.87, 95% CI 0.81-0.95) compared with those who did not have cataract surgery.
CONCLUSIONS: The findings highlight the importance of continuous clinical monitoring of visual field loss and injury prevention strategies for older adults with visual field loss.

UNASSIGNED: Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence.
UNASSIGNED: To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis.
UNASSIGNED: This case series follows two patients with multiple sclerosis from August 1st, 2019 to April 24th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted.
UNASSIGNED: We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.
Does optic neuritis in multiple sclerosis cause optociliary shunt vessels? Our case study shows that optociliary shunt vessels have developed in eyes having previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations. We hypothesize that multiple sclerosis causes decreased retinal perfusion predisposing to the development of optociliary shunts. This will guide neurologists and ophthalmologists in diagnosing this debilitating condition upon the visualization of optociliary shunts; heralding previous or recurrent attacks of optic neuritis. @SanaNadeemS.

UNASSIGNED: Research on task performance under visual field loss is often limited due to small and heterogenous samples. Simulations of visual impairments hold the potential to account for many of those challenges. Digitally altered pictures, glasses, and contact lenses with partial occlusions have been used in the past. One of the most promising methods is the use of a gaze-contingent display that occludes parts of the visual field according to the current gaze position. In this study, the gaze-contingent paradigm was implemented in a static driving simulator to simulate visual field loss and to evaluate parallels in the resulting driving and gaze behavior in comparison to patients.
UNASSIGNED: The sample comprised 15 participants without visual impairment. All the subjects performed three drives: with full vision, simulated left-sided homonymous hemianopia, and simulated right-sided homonymous hemianopia, respectively. During each drive, the participants drove through an urban environment where they had to maneuver through intersections by crossing straight ahead, turning left, and turning right.
UNASSIGNED: The subjects reported reduced safety and increased workload levels during simulated visual field loss, which was reflected in reduced lane position stability and greater absence of large gaze movements. Initial compensatory strategies could be found concerning a dislocated gaze position and a distorted fixation ratio toward the blind side, which was more pronounced for right-sided visual field loss. During left-sided visual field loss, the participants showed a smaller horizontal range of gaze positions, longer fixation durations, and smaller saccadic amplitudes compared to right-sided homonymous hemianopia and, more distinctively, compared to normal vision.
UNASSIGNED: The results largely mirror reports from driving and visual search tasks under simulated and pathological homonymous hemianopia concerning driving and scanning challenges, initially adopted compensatory strategies, and driving safety. This supports the notion that gaze-contingent displays can be a useful addendum to driving simulator research with visual impairments if the results are interpreted considering methodological limitations and inherent differences to the pathological impairment.

OBJECTIVE: To determine whether primary trabeculectomy or medical treatment produces better outcomes in terms of quality of life (QoL), clinical effectiveness, and safety in patients with advanced glaucoma.
METHODS: Multicenter randomized controlled trial.
METHODS: Between June 3, 2014, and May 31, 2017, 453 adults with newly diagnosed advanced open-angle glaucoma in at least 1 eye (Hodapp classification) were recruited from 27 secondary care glaucoma departments in the United Kingdom. Two hundred twenty-seven were allocated to trabeculectomy, and 226 were allocated medical management.
METHODS: Participants were randomized on a 1:1 basis to have either mitomycin C-augmented trabeculectomy or escalating medical management with intraocular pressure (IOP)-reducing drops as the primary intervention and were followed up for 5 years.
METHODS: The primary outcome was vision-specific QoL measured with the 25-item Visual Function Questionnaire (VFQ-25) at 5 years. Secondary outcomes were general health status, glaucoma-related QoL, clinical effectiveness (IOP, visual field, and visual acuity), and safety.
RESULTS: At 5 years, the mean ± standard deviation VFQ-25 scores in the trabeculectomy and medication arms were 83.3 ± 15.5 and 81.3 ± 17.5, respectively, and the mean difference was 1.01 (95% confidence interval [CI], -1.99 to 4.00; P = 0.51). The mean IOPs were 12.07 ± 5.18 mmHg and 14.76 ± 4.14 mmHg, respectively, and the mean difference was -2.56 (95% CI, -3.80 to -1.32; P < 0.001). Glaucoma severity measured with visual field mean deviation were -14.30 ± 7.14 dB and -16.74 ± 6.78 dB, respectively, with a mean difference of 1.87 (95% CI, 0.87-2.87 dB; P < 0.001). Safety events occurred in 115 (52.2%) of patients in the trabeculectomy arm and 124 (57.9%) of patients in the medication arm (relative risk, 0.92; 95% CI, 0.72-1.19; P = 0.54). Serious adverse events were rare.
CONCLUSIONS: At 5 years, the Treatment of Advanced Glaucoma Study demonstrated that primary trabeculectomy surgery is more effective in lowering IOP and preventing disease progression than primary medical treatment in patients with advanced disease and has a similar safety profile.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Craniopharyngiomas are benign epithelial tumors derived from the suprasellar region of the brain. The classical presentation of midline craniopharyngiomas includes bitemporal hemianopsia. However, atypical presentations can lead to diagnosis delays and challenges in managing associated visual and endocrine deficits. The persistence of visual deficits and tumor regrowth despite surgical intervention emphasizes the intricacies of craniopharyngioma management. This underscores the significance of timely diagnosis in patients with visual disturbances and hormonal imbalances related to mass effect. Here, we present a case of a unique and rare recurrent craniopharyngioma in a 58-year-old male, featuring progressive and atypical visual disturbances, along with the development of endocrine dysfunction following multiple tumor resections.

Glaucoma is a group of diseases characterized by distinctive visual field defect and optic nerve atrophy usually associated with elevated intraocular pressure (IOP). It is one of the most serious visual disorders and the leading cause of irreversible blindness worldwide. As a multifactorial disease, the pathogenesis of glaucoma is complicated and has been far from fully understood, where vascular factors are recognized to play an important role in its development and progression of glaucoma. Empirical researches have shown that parapapillary choroidal microvasculature dropout (CMvD) is closely associated with the impairment of optic nerve head (ONH) perfusion, probably accelerating the progression of glaucoma. Accordingly, it is necessary to explore the details regarding the relationship between CMvD and glaucoma progress, hoping to enhance the understanding of pathogenesis of glaucoma. In this review, we aimed to establish comprehensive understanding of the relationship between CMvD and glaucoma with generally going through relevant up-to-date literatures. Among the events that are closely associated with CMvD, we summarized the ones specifically involved in the term of glaucomatous pathological process, including thickness of retinal nerve fiber layer (RNFL) thickness, lamina cribrosa (LC) morphology, cricumpapillary vessel density (cpVD) and visual function such as visual field (VF) defect as well as the prognosis of glaucoma. Although researchers have made great advances, there are still many issues need to be addressed particularly concerning the pathogenic role of CMvD in glaucoma development and its clinical implications with respect to glaucoma prognosis.

Optic disc drusen (ODD) are abnormal collections of protein and calcium that accumulate within the optic nerve. We report a case of a 17-year-old girl who presented to the Department of Ophthalmology at the Cheikh Khalifa International University Hospital, Casablanca, Morocco, with a decline in visual acuity, visual field deficiency, and color vision abnormalities. The patient was misdiagnosed and mistreated for optic neuritis given the presence of bilateral Stage III papilledema solely. After many months of diagnostic wandering, a fundus examination revealed a white atrophic papilla with calcified deposits grouped in a crown around the papillary excavation, suggesting papillary drusen. When the deposits are visible on ophthalmoscopy and manifest as an elevation and a blurring of the optic disc\'s margins, their diagnosis remains straightforward. However, their identification might be problematic when they are firmly lodged in the optic disc or with the presence of papilledema, leading to confusion with other differential diagnoses, particularly if the condition affects both eyes. The purpose of this case report is to increase neurologists\' and ophthalmologists\' knowledge of the incidence of drusen in order to prevent excessive biological and imaging investigation in addition to harmful effects from needless drugs.

Introduction Standard automated perimetry (SAP) is the gold standard of visual field assessment in patients with neuro-ophthalmic conditions. Glaucoma is a progressive optic neuropathy characterized by damage to the ganglion cell complex with corresponding visual field defects and intraocular pressure (IOP) being the only modifiable ocular risk factor. Recent advances in technology have paved the way for remote screening and monitoring of visual field defects with the aid of a computer or tablet-based software. One such personal computer (PC)-based software is \'Specvis\', which has shown promising reliability as compared to SAP. The primary objective of this study was to compare Specvis and Humphrey Field Analyzer (HFA) visual field reports in the graphical domain while secondary objectives were to estimate the ease of use of Specvis in comparison to HFA and comparison of test duration between Specvis and HFA.  Materials and methods This was a cross-sectional validation study performed at a tertiary care ophthalmology institute in Rawalpindi, Pakistan. Subjects presenting to the outpatient department were recruited based on consecutive sampling technique and were divided into healthy and diseased groups. Basic data collection instrument after informed consent was filled with demographic data, ophthalmic data, disease condition, and attached with analysis reports of both HFA and Specvis for assessment by three senior ophthalmology consultants independently. A total of 218 eyes of 109 subjects were included in this pilot study. SAP was done on the VF 30-2 program using HFA 3. The same patient then performed the visual field assessment on a PC with Specvis installed and settings adjusted to match the VF 30-2 program of HFA as closely as possible. Visual fields of a subject obtained from HFA and Specvis were then coupled and sent to three different senior ophthalmologists. The assessment was done by comparing the greyscale visual field printouts in the graphical domain and scored based on a 5-point Likert scale which were then analyzed for inter-observer reliability. After each test, all subjects were asked to rate the difficulty level of performing the test on HFA and Specvis based on a 5-point Likert scale. The duration of the test performed on HFA and Specvis was also noted for comparison. Results We observed male preponderance in our study participants (n=128, 58.72%). The majority of the participants were non-diseased (n=170, 77.98%) while advanced glaucoma was the commonest disease in the diseased group (n = 22, 10.09%). The mean age of the participants was 40.71 (SD=15.24). The observations for the HFA test duration had an average of 213.33 seconds (SD=33.49, Min=174.00, Max=314.00) while the Specvis test duration had an average of 267.36 seconds (SD=35.98, Min=228.00, Max=370.00). A significant positive correlation was observed between score 1, score 2, and score 3 given by the three ophthalmologists. A significant negative correlation was observed between ease of using HFA and age, with a correlation of -.28. A significant negative correlation was also observed between ease of using Specvis and age. Conclusion Specvis, a computer-based free open-source software used in our study, can give promising results in diagnosing as well as monitoring the progression of visual field defects. It can act as a significantly cost-effective and readily available bridge between visual field examination by confrontation method and SAP.

Visual field loss is a debilitating impairment that can impact normal daily activities. The advancement of augmented and virtual realities brings opportunities for potential substitutive technologies for visual field loss. Here we outline a conceptual approach to increasing the amount of useful information by overlaying the blind field into the sighted field. In this proof-of-concept experiment, 33 observers were allocated to either a left or right blind condition (with a simulated scotoma). All observers completed a line bisection task in all three conditions (baseline, scotoma, manipulation), with the baseline condition always completed first. The scotoma condition (baseline with the addition of a simulated scotoma) and the manipulated condition (baseline with the addition of a simulated scotoma, and a \"minified window overlay\") were randomised in order of presentation. Predictably, our results show that a simulated scotoma impaired performance on the task. However, observers were able to make use the overlay to improve their estimation of the line\'s midpoint. Our results show that a substitutive augmentation of this type improved accuracy in estimating the midpoint of a line with a (simulated) scotoma.

The purpose of this study was to compare the driving simulator performance of participants with visual field loss (VFL) from optic disc drusen (ODD) with a normally sighted control group and a group of individuals with glaucoma. Data on performance and safety from a traffic simulator test for five participants with VFL from ODD were retrospectively compared with data from 49 male individuals without visual deficits in a cross-sectional study. VFL of the ODD group was also compared with a group of 20 male glaucoma participants who had failed the same simulator test. Four individuals with ODD regained their driving licences after a successful simulator test and were then followed in a national accident database. All participants with ODD passed the test. No significant differences in safety or performance measures were detected between the normally sighted participants and the ODD group despite severe concentric visual field constrictions. Compared with failed glaucoma male participants, the ODD group had even lower mean sensitivity in the peripheral and peripheral inferior field of vision. None of the four participants with a regained licence were involved in a motor vehicle accident during a 3-year follow-up period after the simulator test. Despite having severe VFL, participants with ODD had no worse performance or safety than controls. As even individuals with severe VFL might drive safely, there is a need for individual practical assessments on licencing issues.