inSIGHT, Volume 4, Issue 1, 2024

Contents 8 - The Myopia Epidemic: Exploring the Pathology and Management of the World’s Most Common Eye Disorder By Gabriella Baldassare 15 - Evolution of Lamellar Keratoplasty By Ishan Kasat 19 - Bridging the Global Gap of Blindness Through Artificial Intelligence By Nathan Delacth 24 - CMV Retinitis: An Expert’s Perspective By Caitlyn Kwun 29 - Macular Holes: Diagnosis, Treatment, and Complications By Ayra Khan 36 - Chronic Progressive External OphthalmoplegiaBy Bahram Pashaee 39 - Medical Missions, Ethical Considerations, and the Future for Healthcare Delivery in Ophthalmology By Robert Medina 43 - Shaping the Future of Vision: The Rise of Light Adjustable Intraocular Lenses in Presbyopia Treatment By Shady Mina 48 - Cavernous Wonders: Delving into Cavernous Sinus Syndrome in Neuro-Ophthalmology By Anza Rizv

An Optoelectronic Stimulator for Retinal Prosthesis

Retinal prostheses require the presence of viable population of cells in the inner retina. Evaluations of retina with Age-Related Macular Degeneration (AMD) and Retinitis Pigmentosa (RP) have shown a large number of cells remain in the inner retina compared with the outer retina. Therefore, vision loss caused by AMD and RP is potentially treatable with retinal prostheses. Photostimulation based retinal prostheses have shown many advantages compared with retinal implants. In contrary to electrode based stimulation, light does not require mechanical contact. Therefore, the system can be completely external and not does have the power and degradation problems of implanted devices. In addition, the stimulating point is flexible and does not require a prior decision on the stimulation location. Furthermore, a beam of light can be projected on tissue with both temporal and spatial precision. This thesis aims at fi nding a feasible solution to such a system. Firstly, a prototype of an optoelectronic stimulator was proposed and implemented by using the Xilinx Virtex-4 FPGA evaluation board. The platform was used to demonstrate the possibility of photostimulation of the photosensitized neurons. Meanwhile, with the aim of developing a portable retinal prosthesis, a system on chip (SoC) architecture was proposed and a wide tuning range sinusoidal voltage-controlled oscillator (VCO) which is the pivotal component of the system was designed. The VCO is based on a new designed Complementary Metal Oxide Semiconductor (CMOS) Operational Transconductance Ampli er (OTA) which achieves a good linearity over a wide tuning range. Both the OTA and the VCO were fabricated in the AMS 0.35 µm CMOS process. Finally a 9X9 CMOS image sensor with spiking pixels was designed. Each pixel acts as an independent oscillator whose frequency is controlled by the incident light intensity. The sensor was fabricated in the AMS 0.35 µm CMOS Opto Process. Experimental validation and measured results are provided

Egocentric Computer Vision and Machine Learning for Simulated Prosthetic Vision

Las prótesis visuales actuales son capaces de proporcionar percepción visual a personas con cierta ceguera. Sin pasar por la parte dañada del camino visual, la estimulación eléctrica en la retina o en el sistema nervioso provoca percepciones puntuales conocidas como “fosfenos”. Debido a limitaciones fisiológicas y tecnológicas, la información que reciben los pacientes tiene una resolución muy baja y un campo de visión y rango dinámico reducido afectando seriamente la capacidad de la persona para reconocer y navegar en entornos desconocidos. En este contexto, la inclusión de nuevas técnicas de visión por computador es un tema clave activo y abierto. En esta tesis nos centramos especialmente en el problema de desarrollar técnicas para potenciar la información visual que recibe el paciente implantado y proponemos diferentes sistemas de visión protésica simulada para la experimentación.Primero, hemos combinado la salida de dos redes neuronales convolucionales para detectar bordes informativos estructurales y siluetas de objetos. Demostramos cómo se pueden reconocer rápidamente diferentes escenas y objetos incluso en las condiciones restringidas de la visión protésica. Nuestro método es muy adecuado para la comprensión de escenas de interiores comparado con los métodos tradicionales de procesamiento de imágenes utilizados en prótesis visuales.Segundo, presentamos un nuevo sistema de realidad virtual para entornos de visión protésica simulada más realistas usando escenas panorámicas, lo que nos permite estudiar sistemáticamente el rendimiento de la búsqueda y reconocimiento de objetos. Las escenas panorámicas permiten que los sujetos se sientan inmersos en la escena al percibir la escena completa (360 grados).En la tercera contribución demostramos cómo un sistema de navegación de realidad aumentada para visión protésica ayuda al rendimiento de la navegación al reducir el tiempo y la distancia para alcanzar los objetivos, incluso reduciendo significativamente el número de colisiones de obstáculos. Mediante el uso de un algoritmo de planificación de ruta, el sistema encamina al sujeto a través de una ruta más corta y sin obstáculos. Este trabajo está actualmente bajo revisión.En la cuarta contribución, evaluamos la agudeza visual midiendo la influencia del campo de visión con respecto a la resolución espacial en prótesis visuales a través de una pantalla montada en la cabeza. Para ello, usamos la visión protésica simulada en un entorno de realidad virtual para simular la experiencia de la vida real al usar una prótesis de retina. Este trabajo está actualmente bajo revisión.Finalmente, proponemos un modelo de Spiking Neural Network (SNN) que se basa en mecanismos biológicamente plausibles y utiliza un esquema de aprendizaje no supervisado para obtener mejores algoritmos computacionales y mejorar el rendimiento de las prótesis visuales actuales. El modelo SNN propuesto puede hacer uso de la señal de muestreo descendente de la unidad de procesamiento de información de las prótesis retinianas sin pasar por el análisis de imágenes retinianas, proporcionando información útil a los ciegos. Esté trabajo está actualmente en preparación.<br /

Intraocular Lens

The first clinical application of intraocular lens (IOL) goes back to 1949 when Dr. Harold Ridley successfully implanted a PMMA IOL into an eye on 29 November 1949. This innovation is a big step forward for cataract surgery. With development of the IOL material and biocompatibility, more and more IOL types have been used in clinical ophthalmology. This book is the fruit of worldwide cooperation between clinical teams. In this book we discuss the IOL materials and design, aberration and astigmatism correction with IOL, entopic phenomenon of IOL, myopia and phakic IOL, and secondary IOL techniques. We believe that this content provides the readers with a comprehensive knowledge of the latest developments of IOL

The nature of habits in the nonhuman primate : the formation of sequences of eye movements and neural activity in the frontal eye field

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Brain and Cognitive Sciences, 2011.This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Cataloged from student-submitted PDF version of thesis.Includes bibliographical references.The nature of habits, their formation, expression, and underlying causes have been pondered for centuries. Early definitions, still in use today, posited that habits are actions associated with outcomes that, when repeated, become stimulus-response associations that can be performed automatically, or without the reinforcement of a rewarding stimulus. A prominent theory of what drives the process is reinforcement learning (RL). This definition and underlying theory may be inadequate to describe the complicated series of actions that we form and express as habits in every day life. We designed a task that would test the limits of RL by providing a nearly infinite number of action choices and no clear association with reward. We recorded using ~100 chronically implanted independently moveable electrodes from the frontal eye fields (FEF), prefrontal cortex (PFC), and caudate nucleus (CN) simultaneously as naïve monkeys performed a free-viewing scan task. Neural recordings began on the first day of this task where a random dot on a grid of targets was chosen to be baited with reward on every trial and the monkeys were free to look around until they captured the baited target. We found that monkeys formed selfguided and uninstructed sequences of eye movements that gradually evolved over months of task performance and did not appear to be driven by overall reward or cost measures. Only on a much smaller, trial-by-trial, time scale were we able to detect the RL forces at work and that the monkeys were minimizing cost on an extremely local level. We also found that neural units in the FEF showed standard single direction and non-standard multiple direction tuning very early in task acquisition. We also found a disproportionately high number of units whose tuning directions were selective for those eye movement combinations that were members of the monkeys' habitual sequences. This suggested that the FEF very rapidly adapts to the task at hand and the neural representation becomes biased towards those sequences that are repeated. Together these findings lay the foundation to understand natural habit formation and the neural mechanisms that underlie it.by Theresa M. Desrochers.Ph.D

The Speed, Precision and Accuracy of Human Multisensory Perception following Changes to the Visual Sense

Human adults can combine information from multiple senses to improve their perceptual judgments. Visual and multisensory experience plays an important role in the development of multisensory integration, however it is unclear to what extent changes in vision impact multisensory processing later in life. In particular, it is not known whether adults account for changes to the relative reliability of their senses, following sensory loss, treatment or training. Using psychophysical methods, this thesis studied the multisensory processing of individuals experiencing changes to the visual sense. Chapters 2 and 3 assessed whether patients implanted with a retinal prosthesis (having been blinded by a retinal degenerative disease) could use this new visual signal with non-visual information to improve their speed or precision on multisensory tasks. Due to large differences between the reliabilities of the visual and non-visual cues, patients were not always able to benefit from the new visual signal. Chapter 4 assessed whether patients with degenerative visual loss adjust the weight given to visual and non-visual cues during audio-visual localization as their relative reliabilities change. Although some patients adjusted their reliance on vision across the visual field in line with predictions based on cue relative reliability, others - patients with visual loss limited to their central visual field only - did not. Chapter 5 assessed whether training with either more reliable or less reliable visual feedback could enable normally sighted adults to overcome an auditory localization bias. Findings suggest that visual information, irrespective of reliability, can be used to overcome at least some non-visual biases. In summary, this thesis documents multisensory changes following changes to the visual sense. The results improve our understanding of adult multisensory plasticity and have implications for successful treatments and rehabilitation following sensory loss

Hearing Loss

Authored by 17 international researchers and research teams, the book provides up-to-date insights on topics in five different research areas related to normal hearing and deafness. Techniques for assessment of hearing and the appropriateness of the Mongolian gerbil as a model for age-dependent hearing loss in humans are presented. Parental attitudes to childhood deafness and role of early intervention for better treatment of hearing loss are also discussed. Comprehensive details are provided on the role of different environmental insults including injuries in causing deafness. Additionally, many genes involved in hearing loss are reviewed and the genetics of recessively inherited moderate to severe and progressive deafness is covered for the first time. The book also details established and evolving therapies for treatment of deafness

A Neurocomputational Model of the Functional Role of Dopamine in Stimulus-Response Task Learning and Performance

Thesis (Ph.D.) - Indiana University, Psychology, 2009The neuromodulatory neurotransmitter dopamine (DA) plays a complex, but central role in the learning and performance of stimulus-response (S-R) behaviors. Studies have implicated DA's role in reward-driven learning and also its role in setting the overall level of vigor or frequency of response. Here, a neurocomputational model is developed which models DA's influence on a set of brain regions believed to be involved in the learning and execution of S-R tasks, including frontal cortex, basal ganglia, and cingulate cortex. An `actor' component of the model is trained, using `babble' (random behavior selection) and `critic' (rewarding and punishing) components of the model, to perform acceptance/rejection responses upon presentation of color stimuli in the context of recently presented auditory tones. The model behaves like an autonomous organism learning (and relearning) through `trial-and-error'. The focus of the study, the impact of hypo- and hyper-normal DA activity on this model, is investigated by three different dopaminergic pathways--two striatal and one prefrontal cortical--being manipulated independently during the learning and performance of the color response task. Hypo-DA conditions, analogous to Parkinsonism, cause slowing and reduction of frequency of learned responses, and, at extremes, degrade the learning (either initial or reversal) of the task. Hyper-DA conditions, analogous to psychostimulant effects, cause more rapid response times, but also can lead to perseveration of incorrect learning of response on the task. The presence of these effects often depends on which DA-ergic pathway is manipulated, however, which has implications for interpretation of the pharmacological experimental data. The proposed model embodies an integrative theory of dopamine function which suggests that the base rate of DA cell activity encodes the overall `activity-oriented motivation' of the organism, with hunger and/or expectation of reward driving both response vigor and tendency to generate an explorative `babble' response. This more `tonic' feature of DA functionality coexists naturally with the more extensively-studied `phasic' reward-learning features. The model may provide better insights on the role of DA system dysfunction in the cognitive and motivational symptoms of disorders such as Parkinsonism, psychostimulant abuse, ADHD, OCD, and schizophrenia, accounting for deficits in both learning and performance of tasks

Scleral structure and biomechanics

As the eye's main load-bearing connective tissue, the sclera is centrally important to vision. In addition to cooperatively maintaining refractive status with the cornea, the sclera must also provide stable mechanical support to vulnerable internal ocular structures such as the retina and optic nerve head. Moreover, it must achieve this under complex, dynamic loading conditions imposed by eye movements and fluid pressures. Recent years have seen significant advances in our knowledge of scleral biomechanics, its modulation with ageing and disease, and their relationship to the hierarchical structure of the collagen-rich scleral extracellular matrix (ECM) and its resident cells. This review focuses on notable recent structural and biomechanical studies, setting their findings in the context of the wider scleral literature. It reviews recent progress in the development of scattering and bioimaging methods to resolve scleral ECM structure at multiple scales. In vivo and ex vivo experimental methods to characterise scleral biomechanics are explored, along with computational techniques that combine structural and biomechanical data to simulate ocular behaviour and extract tissue material properties. Studies into alterations of scleral structure and biomechanics in myopia and glaucoma are presented, and their results reconciled with associated findings on changes in the ageing eye. Finally, new developments in scleral surgery and emerging minimally invasive therapies are highlighted that could offer new hope in the fight against escalating scleral-related vision disorder worldwide