Low vision negatively affects quality of life and is associated with reduced functional ability, increased disability, falls, social isolation, institutionalization, and mortality. A recent systematic review identified hearing and visual loss as markers of frailty in community-based studies, with depression being a primary associated morbidity.¹ Depression is common in older adults and even more common in those with visual impairment. Clinically significant subthreshold depression has been found in one-third of older adults with visual impairment, approximately twice as high as the lifetime prevalence rates in older adults without visual impairment, where depressive symptoms are present roughly in 15%.^2-7 Depression is a serious medical condition, and even mild symptoms may affect quality of life.⁶ Patients with vision loss may experience a greater burden of their disability, as depression is often accompanied by low energy levels, sleep problems, cognitive problems, or disproportionate worrying. Depression can also affect a person’s learning capacity or the ability to retain information, make decisions, or achieve goals.⁸ Therefore, treatment of depression has increasingly gained attention within eye care settings as shown by numerous mental health care programs that have been tested and often found effective.⁹ A Cochrane systematic review investigated the effect of several interventions to improve the quality of life of patients with low vision and found that psychological therapies or group programs may reduce depression and increase self-esteem in people with low vision.¹⁰

Inherited retinal dystrophies (IRDs) are a group of clinically and genetically heterogeneous degenerative disorders. To date, mutations have been associated with IRDs in over 270 disease genes, but molecular diagnosis still remains elusive in about a third of cases. The methodologic developments in genome sequencing techniques that we have witnessed in this last decade have represented a turning point not only in diagnosis and prognosis but, above all, in the identification of new therapeutic perspectives. The discovery of new disease genes and pathogenetic mechanisms underlying IRDs has laid the groundwork for gene therapy approaches. Several clinical trials are ongoing, and the recent approval of Luxturna, the first gene therapy product for Leber congenital amaurosis, marks the beginning of a new era. Due to its anatomical and functional characteristics, the retina is the organ of choice for gene therapy, although there are quite a few difficulties in the translational approaches from preclinical models to humans. In the first part of this review, an overview of the current knowledge on methodological issues and future perspectives of gene therapy applied to IRDs is discussed; in the second part, the state of the art of clinical trials on the gene therapy approach in IRDs is illustrated.

We conducted a systematic review and meta-analysis to investigate whether depression is associated with vision impairment (VI) in population-based studies in adults. MEDLINE and EMBASE were searched, from inception to June 2020. Studies were included if they provided two-by-two data for calculating the OR of association between VI and depression, or crude and/or an adjusted odds ratio (OR) with a corresponding 95% confidence interval (CI) were reported. The proportion of VI and depression was also extracted. ORs were pooled using random-effect models, proportions were pooled using random intercepts logistic regression models. Overall, 29 articles (31 studies) were included: of those, 18 studies used survey data (622,312 participants), 10 used clinical examination data (69,178 participants), and 3 used administrative databases (48,162,290 participants). The proportion of depression (95%CI) was 0.17 (0.13–0.22) overall and 0.27 (0.21–0.33) in VI subjects. The proportion of VI was 0.10 (0.07–0.16) overall and 0.20 (0.13–0.29) in depressed subjects. The association between VI and depression was direct: crude ORs were 1.89 (1.51–2.37) for survey data, 2.17 (1.76–2.67) for clinical examination data, and 3.34 (1.01–11.11) for administrative databases; adjusted ORs were 1.75 (1.34–2.30), 1.59 (1.22–1.96), and 2.47 (0.97–6.33), respectively. In conclusion, VI and depression are prevalent morbidities and should be actively sought when either is identified, especially in older adults.

Conjunctival melanoma (CM) is a rare ocular malignant neoplasm, appearing as a variably pigmented, vascularized mass at any site of the conjunctiva. Conjunctival melanoma has been referred to as one of the most dreaded and unpredictable ocular tumors.¹ Local recurrence after therapy is high, up to 50% at 10 years.^2-5 Regional and distant metastases are reported in one-fourth of cases after 10 years since diagnosis, and the more common sites are lymph node (cervical, preauricular, parotid, and submandibular), lungs, liver, skin, brain, and adrenals.²

Cytidine 5’-diphosphocholine has been widely studied in systemic neurodegenerative diseases, like Alzheimer’s disease, Parkinson’s disease, and brain ischemia. The rationale for the use of citicoline in ophthalmological neurodegenerative diseases, including glaucoma, anterior ischemic optic neuropathy, and diabetic retinopathy, is founded on its multifactorial mechanism of action and the involvement in several metabolic pathways, including phospholipid homeostasis, mitochondrial dynamics, as well as cholinergic and dopaminergic transmission, all being involved in the complexity of the visual transmission. This narrative review is aimed at reporting both pre-clinical data regarding the involvement of citicoline in such metabolic pathways (including new insights about its role in the intracellular proteostasis through an interaction with the proteasome) and its effects on clinical psychophysical, electrophysiological, and morphological outcomes following its use in ophthalmological neurodegenerative diseases (including the results of the most recent prospective randomized clinical trials).