<h2>ABSTRACT</h2><h3>Purpose</h3> To use volumetric analysis applied to total deviation perimetric data to characterise the presence of residual sensitivity measurable using the 10-2 in lieu of the 24-2 test grid in glaucoma (the functional vulnerability zone, FVZ) and develop a prototype end-user application for clinical guidance. <h3>Design</h3> Cross-sectional study <h3>Subjects</h3> 626 pairs of Humphrey Field Analyzer 10-2 SITA-Fast and 24-2 SITA-Faster test results of 160 subjects. <h3>Methods</h3> Total deviation (TD) values located within 10^o from fixation (10-2, 68 locations; 24-2, 12 locations) were extracted. Volumetric analysis was performed to calculate the difference in TD "volume" (10-2 – 24-2) for each pair of results. Then, 24-2 test locations were interpolated across the central 10^o to obtain "equivalent" 10-2 test locations used to calculate number of test locations gained (10-2 – 24-2). A positive TD volume difference and positive gain represented the presence of an FVZ. Linear regression and principal components analysis (PCA) were used to identify 24-2 test features that may predict the presence of an FVZ. <h3>Main outcome measure</h3> Volumetric differences in visual field total deviation as a surrogate for a functional vulnerability zone. <h3>Results</h3> VF global indices and the number of central 24-2 defects predicted TD volume difference (p<0.0001), with 24-2 mean deviation (MD) showing the highest R² (0.32). All parameters had low R² values when predicting gain. A simplified model comprising 24-2 MD and number of central 24-2 TD probability (TDP) defects (p<0.01) provided a method for clinically identifying the likelihood of an FVZ. PCA revealed two principal components (24-2 global indices and pointwise probability scores) that accounted for 79.7% of the variance, with PC1 accounting for 69.3% and comprising 24-2 mean deviation and number of central 24-2 total deviation probability scores at <i>p</i> < 2%. <h3>Conclusions</h3> The FVZ offers a data-driven approach to identifying residual dynamic range using the 10-2 test grid. A prototype model for predicting the likelihood of 10-2 utility in progression analysis is proposed.

To identify potential infectious agents in cases of seasonal hyperacute panuveitis syndrome (SHAPU) from vitreous biopsies of patients with this disorder. A retrospective cohort analysis. Vitreous biopsies were obtained during the course of care from 53 subjects with SHAPU. DNA extraction and whole genome shotgun sequencing was performed using Oxford Nanopore long read sequencing. Sequences were matched against microbial and human databases. Visual outcomes at presentation and at 6 months were recorded. Identification and characterization of metagenomic sequences in vitreous isolates from subjects with SHAPU. Adequate DNA for sequencing was obtained from 32 SHAPU subjects. Fifteen samples yielded bacteria on culture, with 14 S. pneumoniae and 1 S. aureus isolate recovered. Bacterial DNA was detected by whole genome sequencing in 29 of 32 cases. S. pneumoniae was the predominant organism recovered. Bacterial genomic loads ranged up to 10 000 bacteria/human cell, indicating active infection. No pathogens were detected in control samples. Reconstruction of bacterial genome was possible in 7 SHAPU cases and indicated diverse S. pneumoniae subtypes associated with individual cases. Sufficient DNA remained for analysis of torque teno virus by qualitative polymerase chain reaction in 17 cases, of which 13 were positive. Visual outcomes were mixed, with 7 patients having hypotonous eyes at 6 months, but 8 patients having better than 20/200 vision. No relationship could be discerned between presenting bacterial load and visual outcome. The majority of SHAPU cases show molecular evidence for concurrent S. pneumoniae infection. Good visual results are possible in treating SHAPU as endophthalmitis. The authors have no proprietary or commercial interest in any materials discussed in this article.

To determine whether baseline retinal and choriocapillaris (CC) vascular features measured by OCT angiography (OCTA) can predict diabetic retinopathy (DR) progression or visual acuity (VA) decline in a multiethnic longitudinal cohort. Prospective longitudinal cohort study. A total of 309 eyes from 192 patients with type 2 diabetes mellitus were recruited from a tertiary eye center in Singapore. All participants underwent 3 × 3 mm swept-source OCTA imaging at baseline. Quantitative vascular parameters-including vessel density (VD), perfusion density (PD), and CC flow deficit percentage-were obtained from the superficial and deep retinal layers and from the CC. Larger retinal arterioles and venules were analyzed separately from capillary networks. Diabetic retinopathy progression was defined as a ≥2-step increase on the ETDRS severity scale over 2 years, while VA decline was defined as >1-line reduction in best-corrected VA. Logistic regression and area under the receiver operating characteristic curve (AUC) analyses were used to evaluate predictive performance. Progression of DR and VA decline over 2 years, as predicted by baseline OCTA metrics. Over 2 years, 49 eyes (15.9%) demonstrated DR progression. Significant predictors in the superficial layer included larger foveal avascular zone (FAZ) area (odds ratio [OR] = 6.612; P = 0.034), longer perimeter (OR = 1.583; P = 0.002), poorer circularity (OR = 3.23; P = 0.019), higher large-vessel PD (OR = 1.561; P < 0.001) and VD (OR = 2.878; P < 0.001), and lower whole-vessel VD (OR = 0.798; P = 0.010). Adding FAZ perimeter and large-vessel VD improved prediction accuracy (AUC increased from 0.709-0.822). For VA loss, higher superficial large-vessel PD (OR = 1.609; P = 0.002) and lower capillary PD (OR 0.8; P = 0.010) were significant predictors, improving AUC from 0.602 to 0.702. Enlargement and irregularity of the FAZ, along with increased superficial large VD, independently predict DR progression. Incorporating FAZ and large-vessel OCTA parameters enhances prediction models for both DR worsening and vision decline in patients with diabetes. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.