Background: Neurovascular coupling (NVC) is a fundamental mechanism that dynamically matches retinal blood flow to neuronal metabolic demand. While dynamic vessel analysis (DVA) has been established for assessing NVC through flicker-light stimulation, the potential of optical coherence tomography angiography (OCTA) to detect NVC during physiological stimuli, such as dark-to-light adaptation, remains unexplored. Methods: In this prospective cross-sectional study, OCTA imaging was performed in both eyes of 22 healthy participants under dark-adapted (scotopic) and light-adapted (photopic) conditions. Each condition was measured three times consecutively. Macular and peripapillary vessel density (VD) were quantified. Results: After adjustment for measurement order and scan quality, light adaptation significantly increased peripapillary small VD (Δ = +1.30%, p = 0.046; 95% CI: 0.03–2.56%). Peripapillary all VD demonstrated a similar trend but remained borderline significant (Δ = +1.19%, p = 0.069). In contrast, macular VD showed no significant association with light adaptation (Δ = −0.91%, p = 0.11; 95% CI: −2.02 to 0.21%), but was significantly affected by scan quality (Δ = 1.62%, p < 0.001, 95% CI: 1.23–2.02%). Conclusions: In healthy older adults, OCTA detected an increase in peripapillary VD associated with dark-to-light adaptation, reflecting retinal vascular reactivity consistent with neurovascular coupling. The pronounced influence of scan quality and measurement order underscores their importance as critical confounding factors that must be carefully controlled in functional and longitudinal OCTA studies. Together, these findings highlight OCTA’s promise as a non-invasive tool for assessing retinal neurovascular reactivity, while emphasizing the need for scan quality standardization and order correction to ensure reliable interpretation.

Objectives: Our objective was to evaluate the diagnostic accuracy of clinical diagnoses in patients with chronic conjunctival lesions (CCLs) in relation to prevalence data and to identify clinical features that improve diagnostic performance. Methods: Retrospective data were collected for all patients with CCLs at a tertiary eye clinic between 2006 and 2024. A total of 1304 patients were reviewed; 391 had available histopathological data. Results: Misclassification was the highest for clinically benign, non-melanocytic, non-degenerative CCLs (referral rates: 0.446; positive predictive value [PPV]: 0.289). The referral rates for histology assessment were comparable for malignant melanocytic and non-melanocytic CCLs (0.923 and 0.989, respectively) and for benign melanocytic and non-melanocytic CCLs (0.319 and 0.446, respectively). In contrast, the diagnostic agreement was double for melanocytic malignant CCLs (0.800 vs. 0.391) and triple for melanocytic benign CCLs (0.934 vs. 0.289) compared with non-melanocytic CCLs. However, the limbal involvement increased the odds ratio (OR) for proper diagnostic performance to 7.0 (95% confidence interval (CI): 2.7–19.1), whereas the limbal overlapping increased the OR to 11.2 (95% CI: 4.0–35.9) among malignant CCLs. Conclusions: The clinical diagnosis of non-melanocytic CCLs is less frequently and less accurately confirmed histologically. In this CCL subgroup, where the lesion involves or overlaps the limbus, the likelihood of malignancy is increased sevenfold to elevenfold.

Geographic atrophy (GA) is a progressive cause of central vision loss with limited rehabilitation options. This prospective case series aimed to evaluate the effects of biofeedback fixation training (BFT) on visual function and vision-related quality of life (QoL) in patients with GA. Eighteen patients with total central vision loss in one eye underwent BFT on the fellow eye (study eye) using the Macular Integrity Assessment (MAIA) system, which was used to select a new, previously chosen preferred retinal locus (PRL) to stabilize fixation or adopt a new fixation locus. Patients were followed for an average of 13.2 months (range 3–26 months). Functional outcomes included best corrected visual acuity (ETDRS chart), reading performance (Radner test), and contrast sensitivity (Spot Checks test). MAIA parameters comprised average retinal sensitivity, fixation distance and stability (P1, P2), and changes in the bivariate contour ellipse area (BCEA). Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Following BFT, visual acuity, reading ability and contrast sensitivity improved significantly (p value: p < 0.02), and fixation stability and NEI-VFQ-25 scores showed a positive trend. These findings indicate that BFT is a feasible and promising rehabilitation approach for patients with GA.

Geographic atrophy (GA) is a progressive cause of central vision loss with limited re-habilitation options. This prospective case series aimed to evaluate the effects of bio-feedback fixation training (BFT) on visual function and vision-related quality of life (QoL) in patients with GA. Eighteen patients with total central vision loss in one eye and partial involvement of the fellow eye (study eye) underwent BFT using the Macular Integrity Assessment (MAIA) system, which was used to select a new, previously chosen preferred retinal locus (PRL) on the study eye to stabilize fixation or adopt a new fixation locus. Patients were followed for an average of 13.2 months (range 3-26 months). Functional outcomes included best corrected visual acuity (BCVA, ETDRS), reading performance (Radner test), and contrast sensitivity (CS Spot Checks test). MAIA parameters comprised average retinal sensitivity, fixation distance and stability (P1, P2), and changes in the bivariate contour ellipse area (BCEA). Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Following BFT, BCVA, reading ability and contrast sensitivity improved significantly (p< 0.02), and fixation stability and NEI-VFQ-25 scores showed a positive trend. These findings indicate that BFT is a feasible and promising rehabilitation approach for patients with GA.