Objective. To establish an automated visual acuity test (AVAT) for infants, based on preferential looking technique and controlled with remote eye tracking. To validate the AVAT in a group of healthy children. To compare AVAT visual acuity (VA) values with corresponding VA values, acquired with standard tests (ST). Methods. ST, adapted for age (Keeler acuity cards in preverbal children, LEA symbols in verbal children), was performed to obtain monocular VA in a group of 36 healthy children. During AVAT, nine different stimuli with grating circles that matched spatial frequencies of nine Keeler acuity cards (raging between 0.29–14.5 cycles per degree) were projected on a screen. Three repetitions of each stimulus were showed during nine-second intervals, interchanging with an attention grabber. The remote eye tracker was used to evaluate the proportion of time a child spent looking at each grating circle compared to a homogenous grey background that matched the grating stimuli in average luminance. From this proportion of time child's binocular VA was evaluated. Results. 97 % (35/36) of healthy children successfully completed ST and AVAT. There was an agreement between the results of a ST and AVAT, Lin’s concordance coefficient being 0,53 (95% CI= 0,31–0,72). A tendency was observed towards VA overestimation on AVAT for children with VA> 0.4 logMAR on ST and towards VA underestimation on AVAT for children with VA ≤ 0.4 logMAR on ST. Conclusions. AVAT requires a minimally skilled investigator. The evaluation of better eye monocular VA on ST and binocular VA on AVAT were comparable for healthy children.
Achromatopsia has been proposed to be a morphologically predominately stable retinopathy with rare reports of progression of structural changes in the macula. A five-grade system of optical coherence tomography (OCT) features has been used for the classification of structural macular changes. However, their association with age remains questionable. We characterized the Slovenian cohort of 12 patients with pathogenic variants in CNGA3 or CNGB3 who had been followed up with OCT for up to 9 years. Based on observed structural changes in association with age, the following four-stage classification of retinal morphological changes was proposed: (I) preserved inner segment ellipsoid band (Ise), (II) disrupted ISe, (III) ISe loss and (IV) ISe and RPE loss. Data from six previously published studies reporting OCT morphology in CNGA3 and CNGB3 patients were additionally collected, forming the largest CNGA3/CNGB3 cohort to date, comprising 126 patients aged 1–71 years. Multiple regression analysis showed a significant correlation of OCT stage with age (p < 0.001) and no correlation with gene (p > 0.05). The median ages of patients with stages I–IV were 12 years, 23 years, 27 years and 48 years, respectively, and no patient older than 50 years had continuous ISe. Our findings suggest that achromatopsia presents with slowly but steadily progressive structural changes of the macular outer retinal layers. However, whether morphological changes in time follow the proposed four-stage linear pattern needs to be confirmed in a long-term study.
Background Immune checkpoint inhibitors (ICI) are becoming increasingly common in treating several cancer types. Durvalumab is a human IgG1 monoclonal antibody that blocks PD-L1 binding to PD-1 and CD80 and has recently been approved for the treatment of extensive-stage small-cell lung cancer (ES-SCLC) and locally advanced unresectable (NSCLC). The present review aimed to analyse immune-mediated uveitis, secondary to durvalumab treatment, through a review of the literature and a presentation of two clinical cases. Patients and methods A literature review using PubMed search was conducted to identify cases of uveitis secondary to durvalumab and cases of uveitis with optic disc oedema secondary to ICI use that were reported prior to November 14, 2021. Additionally, we report two cases of uveitis consequent on durvalumab treatment. Results Five cases of uveitis secondary to durvalumab use were identified in the literature. Anterior, posterior uveitis and vasculitis were reported. Additionally, we present a case of bilateral intermediate uveitis with bilateral optic disc oedema and a case of bilateral posterior uveitis. Our further search revealed 12 cases of uveitis with optic disc oedema secondary to ICI use, with the majority of cases reported secondary to PD-1 inhibitors. Conclusions Rarely reported, uveitis secondary to durvalumab can present various clinical pictures and requires a thorough diagnostic workup. Once the diagnosis is established, treatment, commonly with a local or systemic corticosteroid, should be adapted to the severity of the inflammation.
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