Visualization of the retinal structure is crucial for understanding the pathophysiology of ophthalmic diseases, as well as for monitoring their course and treatment effects. Until recently, evaluation of the retina at the cellular level was only possible using histological methods, because the available retinal imaging technology had insufficient resolution due to aberrations caused by the optics of the eye. Adaptive optics (AO) technology improved the resolution of optical systems to 2 µm by correcting optical wave-front aberrations, thereby revolutionizing methods for studying eye structures in vivo. Within 25 years of its first application in ophthalmology, AO has been integrated into almost all existing retinal imaging devices, such as the fundus camera (FC), scanning laser ophthalmoscopy (SLO), and optical coherence tomography (OCT). Numerous studies have evaluated individual retinal structures, such as photoreceptors, blood vessels, nerve fibers, ganglion cells, lamina cribrosa, and trabeculum. AO technology has been applied in imaging structures in healthy eyes and in various ocular diseases. This article aims to review the roles of AO imaging in the diagnosis, management, and monitoring of age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, hypertensive retinopathy (HR), central serous chorioretinopathy (CSCR), and inherited retinal diseases (IRDs).

Background: The COVID-19 pandemic led to the reorganization of the health care system. A decline in health- and life-saving procedures has been reported in various medical specialties. However, data on ophthalmic emergencies during lockdowns is limited. Methods: We conducted a retrospective, observational, case-control study of 2351 patients registered at the ophthalmic emergency department of a tertiary hospital in Poland during three national COVID-19 lockdowns (March/April 2020, November 2020, and March/April 2021) and corresponding months in 2019. Results: The total number of visits declined from a mean of 720/month in the non-COVID era to 304/month during COVID-19 lockdowns (p < 0.001). Ocular trauma incidence dropped significantly from 2019 (non-COVID months) to 2020/2021 (COVID group mean 201 vs. 97 patients monthly, respectively, p = 0.03). Of note, the percentage of foreign bodies removal was significantly higher during lockdowns than corresponding time in the non-COVID era. A downward trend for vitreous detachment and macular disorders cases was observed between COVID and non-COVID time. Uveitis and optic neuritis patients were seen more often during lockdowns (p < 0.001 and p = 0.0013, respectively). In contrast, the frequency of conjunctivitis and keratitis, potentially COVID-related problems, decreased significantly in COVID-19 time (mean 138 vs. 23 per month in non-COVID vs. COVID lockdowns, respectively, p < 0.001). Conclusions: The overall number of eye emergency visits declined during COVID-19 lockdowns. Conjunctivitis and keratitis rates dropped during the lockdowns. Interestingly, the frequency of immune-mediated ocular conditions (uveitis, optic neuritis) increased significantly which might be triggered by SARS-CoV2 infection.

Background: Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables the analysis of retinal vasculature at the cellular level in vivo. The purpose of this study was to evaluate retinal arteriolar parameters using the rtx1 adaptive optics fundus camera (AO-FC) in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in spectral-domain optical coherence tomography (SD-OCT) and perimetry. Methods: Parameters of the retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, which were divided into three groups according to the severity of the disease, and 70 healthy eyes. The associations between RTX1 values and the cup-to-disk ratio, SD-OCT parameters, and visual field parameters were assessed. Results: Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p < 0.05) and significantly higher WLR and WT values (p < 0.05) for the supratemporal and infratemporal arterioles. TD was significantly positively correlated with the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) (p < 0.05). LD was significantly positively correlated with the RNFL, GCC, and rim area (p < 0.05). The WLR was significantly negatively correlated with the RNFL, GCC, rim area, and MD (p < 0.05), while it was significantly positively correlated with the cup-to-disc ratio and PSD (p < 0.05). Conclusions: The results suggest that vascular dysfunction is present in POAG, even at a very early stage of glaucoma, and increases with the severity of the disease.

Purpose: To evaluate visual acuity improvement and identify contributing factors in patients with severe keratitis affecting both virgin and transplanted corneas, treated at a hospital. Methods: A retrospective analysis was conducted on 497 patients with unilateral corneal ulcers treated at a tertiary referral center between 2008 and 2023. Data included distance (BCVA) and near best-corrected visual acuity at initial presentation and at discharge, treatments before hospital admission, demographic details, risk factors, clinical signs and symptoms, ancillary test results, and management strategies. Patients were categorized into two groups: Group A (naïve corneal ulcers, 379 patients) and Group B (post-keratoplasty infectious keratitis, 118 patients). Additional analysis focused on patients with presenting visual acuity of at least 1.0 logMAR (≤5/50 Snellen charts = legal blindness) to predict final visual outcomes. Results: The median BCVA at presentation for the entire cohort was 1.9 logMAR, advancing to 1.5 logMAR at discharge (p < 0.001). At least one line improvement in BCVA was observed in 47% of patients (52% of naïve cornea and 33% of transplanted cornea patients). Significantly worse results were observed in Group B were observed for BCVA at presentation, BCVA improvement, and distance and near vision improvement. Among patients with legal blindness at presentation, vision status improved for 52/379 (14%) in Group A and 6/118 (5%) in Group B during hospital admission (p < 0.001), while 67% of the cohort was discharged with VA equal or worse than 5/50. The average hospital stay was 9 days. Near visual acuity got better in 23% of patients (27% in Group A vs. 9% in Group B). A multivariate regression model showed that older age and worse distance BCVA on admission were independent negative predictors of improvement (p < 0.001, p < 0.001, respectively) while midperiphery ulcers were associated with better visual outcomes. Conclusions: Hospital admission leads to BCVA improvement in 47% of the patients with severe corneal ulcer, though the prognosis is significantly worse for those with post-keratoplasty microbial keratitis. At discharge, 67% of patients remained at the legal blindness level. Older age and lower BCVA at first presentation are associated with worse prognosis, while ulcers located in the corneal midperiphery are linked to better visual outcomes.

Background: This study aimed to evaluate retinal arteriole parameters using adaptive optics (AO) rtx1™ (Imagine Eyes, Orsay, France) and peripapillary and macular vessel densities with optical coherence tomography angiography (OCTA) in eyes with different stages of primary open-angle glaucoma (POAG) compared to healthy eyes. It also investigated the associations between vascular parameters and glaucoma severity, as defined by structural (OCT) and functional (visual field) changes. Methods: Fifty-seven eyes from 31 POAG patients and fifty from 25 healthy volunteers were examined. Retinal arteriole morphology was assessed using the AO rtx1™-fundus camera, which measured lumen diameter, wall thickness, total diameter, wall-to-lumen ratio (WLR), and wall cross-sectional area. OCTA was used to measure vessel densities in superficial (SCP) and deep (DCP) capillary plexuses of the macula and radial peripapillary capillary plexus (RPCP) and FAZ area. Structural OCT parameters (RNFL, GCC, rim area) and visual field tests (MD, PSD) were also performed. Results: Glaucoma eyes showed significantly thicker arteriole walls (12.8 ± 1.4 vs. 12.2 ± 1.3 µm; p = 0.030), narrower lumens (85.5 ± 10.4 vs. 100.6 ± 11.1 µm; p < 0.001), smaller total diameters (111.0 ± 10.4 vs. 124.1 ± 12.4 µm; p < 0.001), and higher WLRs (0.301 ± 0.04 vs. 0.238 ± 0.002; p < 0.001) than healthy eyes. In glaucoma patients, OCTA revealed significantly reduced vessel densities in SCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), DCP (36.39 ± 3.60 vs. 38.46 ± 1.41; p < 0.001), and RPCP plexuses (35.42 ± 4.97 vs. 39.27 ± 1.48; p < 0.001). The FAZ area was enlarged in eyes with glaucoma (0.546 ± 0.299 vs. 0.295 ± 0.125 mm²); p < 0.001). Positive correlations were found between vessel densities and OCT parameters (RNFL, r = 0.621; GCC, r = 0.536; rim area, r = 0.489), while negative correlations were observed with visual field deficits (r = −0.517). Conclusions: Vascular deterioration, assessed by AO rtx1™ and OCTA, correlates closely with structural and functional damage in glaucoma. Retinal microcirculation changes may precede structural abnormalities in the optic nerve head. Both imaging methods enable the earlier detection, staging, and monitoring of glaucoma compared to conventional tests.

Background: Retinal vascular abnormalities may be associated with glaucomatous damage. Adaptive optics (AO) is a new technology that enables analysis of retinal vasculature at the cellular level in vivo. The purpose of this study is to evaluate retinal arteriolar parameters using the adaptive optics fundus camera (AO -FC) rtx1 in patients with primary open-angle glaucoma (POAG) at different stages and to investigate the relationship between these parameters and changes in optical coherence tomography (OCT) and perimetry. We wanted to assess whether vascular changes could be a cause or effect of glaucomatous damage. Methods: Parameters of retinal supratemporal and infratemporal arterioles (wall thickness (WT), lumen diameter (LD), total diameter (TD), wall-to-lumen ratio (WLR), and cross-sectional area of the vascular wall (WCSA)) were analysed with the rtx1 in 111 POAG eyes, divided into three groups according to the severity of disease and 70 healthy eyes in correlation of structural defects in retinal nerve fibre layer and visual fields defects. Results: Compared with the control group, the POAG groups showed significantly smaller TD and LD values (p<0,05) and significantly higher WLR and WT values (p<0,05) for supratemporal and infratemporal arterioles. Rtx1 parameters significantly correlated with OCT parameters (retinal nerve fibre layer, ganglion cell complex and rim area) and visual field parameters (mean deviation and pattern standard deviation) (p<0.05). Conclusion: The results suggest that vascular dysfunction may be involved in POAG pathogenesis and neurodegenerative damage, even at the very early stage of glaucoma, without visual field defects.