Measuring the foveal avascular zone in diabetes: A study using optical coherence tomography angiography.

AIMS/INTRODUCTION: Diabetes is a global issue that currently affects 425 million people worldwide. One observable microvascular complication of this condition is a change in the foveal avascular zone (FAZ). In this study, we used optical coherence tomography angiography to investigate the effect of diabetes on the FAZ. MATERIALS AND METHODS: A total of 11 participants with diabetes and 11 participants without diabetes took part in this study. Participants in both groups were matched for age (P = 0.217) and sex (P = 0.338), and had no history of ocular disease. Macular optical coherence tomography angiography (OCT-A) scans of participants' right and left eyes were taken. Glycosylated hemoglobin (HbA1c ) and blood glucose levels were also measured. The FAZ area was manually segmented at the levels of the superficial capillary plexus (FAZSCP ) and deep capillary plexus (FAZDCP ). RESULTS: There was a strong relationship between the FAZ area of participants' right and left eyes (P ≤ 0.001) in both diabetes and non-diabetes groups. In the diabetes group, the FAZSCP (P = 0.047) and FAZDCP (P = 0.011) areas was significantly larger than in the non-diabetes group. Moreover, multiple linear regression analysis predicted a 0.07-mm2 increase in the FAZSCP and FAZDCP areas of individuals with diabetes for every 1% increase in their HbA1c level. CONCLUSIONS: Our findings show that there is enlargement of the FAZ in individuals with diabetes compared with individuals without diabetes. In the diabetes group, this enlargement appears to be correlated with HbA1c level. OCT-A imaging could, therefore, be a useful tool to monitor the FAZ and identify potential early microvasculopathy in diabetes.

Sub-clinical thickening of the fovea in diabetes and its relationship to glycaemic control: a study using swept-source optical coherence tomography.

BACKGROUND: Accumulation of multiple pockets of fluid at the fovea, as a complication of poor blood glucose control in diabetes, causes impairment of central vision. A new ability to demonstrate a pre-clinical phase of this maculopathy could be valuable, enabling diabetic individuals to be alerted to the need to improve their glycaemic control. This study aimed to use swept-source optical coherence tomography (SS-OCT) to measure foveal thickness and macular volume in diabetic individuals without cystoid macular oedema, and in non-diabetic individuals, and relate these measures to participants' glycaemic control. METHODS: Centre point thickness (CPT) and total macular volume (TMV) were measured using SS-OCT (DRI OCT Triton™, Topcon, Tokyo, Japan). Participants' glycosylated haemoglobin (HbA1c) level was also assessed (A1cNow®+ System, PTS Diagnostics, Indianapolis, IN, USA). The diabetic (n = 27) and non-diabetic (n = 27) groups were matched for age (p = 0.100) and sex (p = 0.414), and HbA1c level differed between diabetic and non-diabetic groups (p < 0.0005). The diabetic group comprised type 1 (n = 7) and type 2 (n = 20) diabetic individuals who were matched for duration of diabetes (p = 0.617) and whose glycaemic control was similar (p = 0.814). RESULTS: Diabetic individuals had significantly higher CPT (t(37) = 3.859, p < 0.0005) than non-diabetic individuals. In the diabetic group, multiple linear regression analysis revealed a conspicuous relationship between CPT and HbA1c level (ß = 0.501, t(21) = 3.139, p = 0.005): there was a 19-µm increase in CPT for each 1% increase in HbA1c level. This relationship was not present in the non-diabetic group (ß = - 0.068, t(23) = - 0.373, p = 0.712). CONCLUSIONS: SS-OCT is the only way to measure macular thickness in vivo. Diabetic individuals en bloc had higher CPT compared with non-diabetic individuals. Moreover, in the diabetic group, HbA1c level significantly predicted CPT. Our results suggest that, in diabetes, sub-clinical thickening may occur at the fovea before cystoid macular oedema becomes clinically evident. This could provide diabetic individuals with an early warning of disease progression and motivate them to improve control of their diabetes, with a view to avoiding the need of intra-vitreal injections with their attendant risks.

Measuring visual cortical oxygenation in diabetes using functional near-infrared spectroscopy.

AIMS: Diabetes mellitus affects about 6% of the world's population, and the chronic complications of the disease may result in macro- and micro-vascular changes. The purpose of the current study was to shed light on visual cortical oxygenation in diabetic individuals. We then aimed to compare the haemodynamic response (HDR) to visual stimulation with glycaemic control, given the likelihood of diabetic individuals suffering from such macro- and micro-vascular insult. METHODOLOGY: Thirty participants took part in this explorative study, fifteen of whom had diabetes and fifteen of whom were non-diabetic controls. The HDR, measured as concentrations of oxyhaemoglobin [HbO] and deoxyhaemoglobin [HbR], to visual stimulation was recorded over the primary visual cortex (V1) using a dual-channel oximeter. The stimulus comprised a pattern-reversal checkerboard presented in a block design. Participants' mean glycated haemoglobin (HbA1c) level (± SD) was 7.2 ± 0.6% in the diabetic group and 5.5 ± 0.4% in the non-diabetic group. Raw haemodynamic data were normalised to baseline, and the last 15 s of data from each 'stimulus on' and 'stimulus off' condition were averaged over seven duty cycles for each participant. RESULTS: There were statistically significant differences in ∆[HbO] and ∆[HbR] to visual stimulation between diabetic and non-diabetic groups (p < 0.05). In the diabetic group, individuals with type 1 diabetes displayed an increased [HbO] (p < 0.01) and decreased [HbR] (p < 0.05) compared to their type 2 counterparts. There was also a linear relationship between both ∆[HbO] and ∆[HbR] as a function of HbA1c level (p < 0.0005). CONCLUSIONS: Our findings suggest that fNIRS can be used as a quantitative measure of cortical oxygenation in diabetes. Diabetic individuals have a larger HDR to visual stimulation compared to non-diabetic individuals. This increase in ∆[HbO] and decrease in ∆[HbR] appears to be correlated with HbA1c level.

Distinct lower visual field preference for object shape.

Humans manipulate objects chiefly within their lower visual field, a consequence of upright posture and the anatomical position of hands and arms.This study tested the hypothesis of enhanced sensitivity to a range of stimuli within the lower visual field. Following current models of hierarchical processing within the ventral steam, discrimination sensitivity was measured for orientation, curvature, shape (radial frequency patterns), and faces at various para-central locations (horizontal, vertical, and main diagonal meridians) and eccentricities (5° and 10°). Peripheral sensitivity was isotropic for orientation and curvature. By contrast, observers were significantly better at discriminating shapes throughout the lower visual field compared to elsewhere. For faces, however, peak sensitivity was found in the left visual field, corresponding to the right hemispheric localization of human face processing. Presenting head outlines without any internal features (e.g., eyes, mouth) recovered the lower visual field advantage found for simple shapes. A lower visual field preference for the shape of an object, which is absent for more localized information (orientation and curvature) but also for more complex objects (faces), is inconsistent with a strictly feed-forward model and poses a challenge for multistage models of object perception. The distinct lower visual field preference for contour shapes is, however, consistent with an asymmetry at intermediate stages of visual processing, which may play a key role in representing object characteristics that are particularly relevant to visually guided actions.

Idiopathic, isolated fovea plana with bilateral off-centre multifocal ERGs.

BACKGROUND: The purpose of this paper is to report a case of idiopathic isolated fovea plana showing asymmetry in the multifocal electroretinogram (mfERG). METHODS: We carried out optical coherence tomography (OCT) imaging, macular pigment density measurement, genetic testing and electrophysiological testing with visual evoked potentials and mfERGs on a young, highly myopic female of Pakistani origin, who had good visual acuity and no nystagmus. RESULTS: OCT imaging revealed a complete absence of any foveal pit in either eye. Macular pigment density was normal and visual evoked potentials indicated normal chiasmal crossings, excluding albinism. Genetic testing revealed normal PAX6 coding data, excluding aniridia as a cause. mfERGs showed asymmetry consistent with off-centre fixation to the temporal side of the fovea in both eyes, but were otherwise normal. CONCLUSION: Lack of a foveal pit is a well-known finding in conditions such as oculocutaneous albinism and PAX6 gene-related aniridia. Isolated fovea plana is less common, and this case illustrates that the absence of a foveal pit does not necessarily result in a poor visual outcome. The finding of asymmetry in the mfERG in such a case is novel, and may indicate a functional adaptation to the structure of the fovea.

Non-linear global pooling in the discrimination of circular and non-circular shapes.

The ability to discriminate minute deviations from circularity is dependent upon global summation mechanisms integrating information along entire contours. The aim of this study was to determine how the strength of global summation depends on various stimulus features. To determine if the strength of global summation differs between shapes, contour discrimination for various contour shapes, generated by applying a sinusoidal modulation to the radius of a circle (radial frequency - RF - patterns), was measured. Shapes differed in frequency (number of lobes RF3, RF5 and RF20) and amplitude ('sharpness' of the lobes ranged between 0 and 20× thresholds for detecting deviation from a circle). Low amplitudes test discrimination against a circle while high amplitudes measure sensitivity for highly non-circular shapes (e.g. five-pointed star-shapes). The ability to integrate information along contours was assessed by comparing the effect of applying radial deformations to the entire contour or to only fractions (various number of cycles). Results show that discrimination thresholds remain in the hyperacuity range for low amplitudes, but increase for higher amplitudes. Concerning signal integration, discrimination, expressed as a function of the amount of contour deformed, exhibits a shallow and a steep regime. Discrimination improves only slowly as more contour cycles are deformed until the point when the entire pattern is modulated, when sensitivity increases substantially. The initial shallow regime is well captured by probability summation. The increase in sensitivity when the entire pattern is modulated compared to a single cycle provides evidence for global pooling. The pattern of integration and the existence of global pooling is dependent on shape frequency. The two-part behavior is independent of shape amplitude but is only seen for low RFs (3 and 5). Data for RF20 follow the prediction of probability summation. We next investigated various stimulus characteristics and their effect on integration strength. Global pooling exceeding probability summation is evident for different pattern sizes, presentation times and for high as well as low absolute contrasts. Only if the contrasts of different fractions of a contour shape are individually scaled to match their respective visibilities is integration strength below the level of probability summation. This explains the lack of apparent global pooling in previous studies employing mixed contrasts. The marked increase in performance for discriminating completely modulated RF patterns argues in favor of highly specialized, global shape mechanisms that are seen over a wide range of stimulus configurations. The results indicate global, non-linear mechanisms, which respond most strongly when stimulated by the entire pattern and comparatively weakly when only stimulated by parts of it.

The chromatic selectivity of visual crowding.

Precortical vision is mediated by three opponent mechanisms that combine receptoral outputs to form a luminance channel (L + M) and two chromatic channels, red-green (L/M) and blue-yellow (S/L + M). Here we ask the extent to which these basic color opponent mechanisms interact in the phenomenon of crowding, where nearby targets interfere with the processing of a central test target. The task was to identify the orientation of a Gabor patch while an annular plaid surrounded the patch. The radius of the annulus was varied in order to produce different separations of the test and flanker. The chromatic content of the Gabor and the annulus could be varied independently along the (L + M), (L/M), and (S/L + M) cardinal axes. For all targets, when the target and flanker shared the same chromaticity, performance decreased with decreasing separation of the target and annulus, i.e., a typical crowding effect was seen. When the test and flanker isolated different chromatic mechanisms, very little crowding was observed, even at the minimum separation of test target and annulus. In addition to this, intermediate chromaticities were found to produce intermediate levels of crowding. Finally, crowding effects using "half-wave rectified" stimuli suggest a locus for crowding effects beyond the level of color opponent mechanisms.

Early age-related decline in the effective number of trajectories tracked in adult human vision.

Human performance in many visual and cognitive tasks declines with age, the rate of decline being task dependent. Here, we used a multiple-object tracking (MOT) task to provide a clear demonstration of a steep cognitive decline that begins relatively early in adult life. Stimuli consisted of 8 dots that moved along linear trajectories from left to right. At the midpoint of their trajectories, a certain number of dots, D (1, 2 or 3), deviated either clockwise or counter-clockwise by a certain magnitude (57 degrees, 38 degrees or 19 degrees); the task for observers was to identify the direction of deviation. Percent correct responses were measured for 22 observers aged 18-62 years and were converted to effective numbers of tracked trajectories (E) (S. P. Tripathy, S. Narasimhan, & B. T. Barrett, 2007). In 5 of the 7 conditions tested, there was a significant negative correlation between age and E, indicating an age-related decline in tracking ability. This decline was found to be equivalent to a mean performance drop of 16% per decade over the four decades of adulthood tested. Further analysis suggests that performance in this task starts to decline at around 30 years of age and falls off at the rate of approximately 20% every subsequent decade.

Integration across Time Determines Path Deviation Discrimination for Moving Objects.

BACKGROUND: Human vision is vital in determining our interaction with the outside world. In this study we characterize our ability to judge changes in the direction of motion of objects-a common task which can allow us either to intercept moving objects, or else avoid them if they pose a threat. METHODOLOGY/PRINCIPAL FINDINGS: Observers were presented with objects which moved across a computer monitor on a linear path until the midline, at which point they changed their direction of motion, and observers were required to judge the direction of change. In keeping with the variety of objects we encounter in the real world, we varied characteristics of the moving stimuli such as velocity, extent of motion path and the object size. Furthermore, we compared performance for moving objects with the ability of observers to detect a deviation in a line which formed the static trace of the motion path, since it has been suggested that a form of static memory trace may form the basis for these types of judgment. The static line judgments were well described by a 'scale invariant' model in which any two stimuli which possess the same two-dimensional geometry (length/width) result in the same level of performance. Performance for the moving objects was entirely different. Irrespective of the path length, object size or velocity of motion, path deviation thresholds depended simply upon the duration of the motion path in seconds. CONCLUSIONS/SIGNIFICANCE: Human vision has long been known to integrate information across space in order to solve spatial tasks such as judgment of orientation or position. Here we demonstrate an intriguing mechanism which integrates direction information across time in order to optimize the judgment of path deviation for moving objects.

Global shape versus local feature: an angle illusion.

We have shown previously that the precision of angle judgments depends strongly on the global stimulus configuration: discrimination thresholds for angles that form part of isosceles triangles are up to 3 times lower than for those that form part of scalene triangles [Kennedy, G. J., Orbach, H. S., & Loffler, G. (2006). Effects of global shape on angle discrimination. VisionResearch, 46(8-9), 1530-1539]. Here, we investigated whether or not the perceived size of an angle (accuracy) is also affected by the overall shape of which it forms a part. Observers compared the relative sizes of angles contained in isosceles triangles with those of angles in scalene triangles and points of subjective equality were determined. For a reference angle of 60 degrees , angles embedded in isosceles triangles were judged to be on average 14 degrees larger than angles embedded in scalene triangles. This result is largely independent of the reference angle, triangle orientation and triangle size. Moreover, the effect is present whether or not triangles of different shapes enclose the same area, whether or not the side of the triangle opposite the angle is present and whether the triangle is outlined or defined by dots at its vertexes. In sum, our results provide evidence for a novel illusion where an angle embedded in an isosceles triangle is judged substantially larger than the same angle embedded in a scalene triangle. This finding demonstrates that mechanisms for computing angles are sensitive to the context within which angles are presented.

Judging the shape of moving objects: discriminating dynamic angles.

Studies of shape perception have typically focused on static shapes. Studies of motion perception have mainly investigated speed and direction. None have addressed performance for judging the shape of moving objects. We investigated this by determining the discrimination of geometric angles under various dynamic conditions (translation, rotation, and expansion). Angles were parts of imaginary triangles, defined by three vertex dots. Compared to static angles, results show no significant decline in the precision of angle judgments for any of the three motion types, up to speeds high enough to impair target visibility. Additional experiments provide evidence against a uniform mechanism underlying static and dynamic performance, which could rely on "snapshots" when processing moving angles. Rather, we find support for distinct mechanisms. Firstly, adding noise dots to the display affects rotating and expanding angles substantially more than those which are translating or static. Secondly, the ability to judge angles is unaffected when vertex dots are occluded for short periods. Given the dependence of dot trajectories on the overall triangle motion, the ability to precisely extrapolate the future position of a dot requires distinct computations for translating, expanding, and rotating shapes.

Effects of global shape on angle discrimination.

Previous studies have been inconclusive as to whether angle discrimination performance can be predicted by the sensitivity of orientation discrimination mechanisms or by that of mechanisms specialised for angle coding. However, these studies have assumed that angle discrimination is independent of the shape of the object of which the angle is a part. This assumption was tested by measuring angle discrimination using angles that were parts of different triangular shapes. Angle discrimination thresholds were lowest when angles were presented in isosceles triangles (sides forming the angle were of identical length). Performance was significantly poorer when angles were presented in scalene triangles (sides of different lengths) and as much as three times worse when the sides forming the angle varied randomly in length between presentations. Comparing orientation discrimination for single lines with angle discrimination for different stimulus conditions (isosceles, scalene and random triangles) leads to conflicting conclusions as to the mechanisms underlying angle perception: line orientation sensitivity correctly predicts angle discrimination for random triangles, but underestimates angle acuity for isosceles triangles. The fact that performance in angle discrimination tasks is strongly dependant on the overall stimulus geometry implies that geometric angles are computed by mechanisms that are sensitive to global aspects of the stimulus.