This article summarizes the results of the workshop on Visualization, Analytics & Spatial Decision Support, which took place at the GIScience conference in September 2006. The discussions at the workshop and analysis of the state of the art have revealed a need in concerted cross-disciplinary efforts to achieve substantial progress in supporting space-related decision making. The size and complexity of real-life problems together with their ill-defined nature call for a true synergy between the power of computational techniques and the human capabilities to analyze, envision, reason, and deliberate. Existing methods and tools are yet far from enabling this synergy. Appropriate methods can only appear as a result of a focused research based on the achievements in the fields of geovisualization and information visualization, human-computer interaction, geographic information science, operations research, data mining and machine learning, decision science, cognitive science, and other disciplines. The name 'Geovisual Analytics for Spatial Decision Support' suggested for this new research direction emphasizes the importance of visualization and interactive visual interfaces and the link with the emerging research discipline of Visual Analytics. This article, as well as the whole special issue, is meant to attract the attention of scientists with relevant expertise and interests to the major challenges requiring multidisciplinary efforts and to promote the establishment of a dedicated research community where an appropriate range of competences is combined with an appropriate breadth of thinking.

/pdf/geovisual-analytics-for-spatial-decision-support-setting-the-1ft2r4sirm.pdf

Geovisual analytics for spatial decision support: Setting the research agenda

Background Visual problems are an under-reported sequela following stroke. The aim of this study is to report annual incidence and point prevalence of visual problems in an acute adult stroke population and to explore feasibility of early timing of visual assessment. Methods and findings Multi-centre acute stroke unit, prospective, epidemiology study (1st July 2014 to 30th June 2015). Orthoptists reviewed all patients with assessment of visual acuity, visual fields, ocular alignment, ocular motility, visual inattention and visual perception. 1033 patients underwent visual screening at a median of 3 days (IQR 2) and full visual assessment at a median of 4 days (IQR 7) after the incident stroke: 52% men, 48% women, mean age 73 years and 87% ischaemic strokes. Excluding pre-existent eye problems, the incidence of new onset visual sequelae was 48% for all stroke admissions and 60% in stroke survivors. Three quarters 752/1033 (73%) had visual problems (point prevalence): 56% with impaired central vision, 40% eye movement abnormalities, 28% visual field loss, 27% visual inattention, 5% visual perceptual disorders. 281/1033 (27%) had normal eye exams. Conclusions Incidence and point prevalence of visual problems in acute stroke is alarmingly high, affecting over half the survivors. For most, visual screening and full visual assessment was achieved within about 5 days of stroke onset. Crucial information can thus be provided on visual status and its functional significance to the stroke team, patients and carers, enabling early intervention.

/pdf/high-incidence-and-prevalence-of-visual-problems-after-acute-2p8oyzdj7a.pdf

High incidence and prevalence of visual problems after acute stroke: An epidemiology study with implications for service delivery.

Correction of adult strabismus is not a cosmetic procedure but one that restores normality to an individual's appearance that has been altered by a disease process. Two fundamental principles underpinning facial attractiveness are symmetry and averageness—manifest strabismus affects both of these giving an unconscious signal of poor genetic history. The presence of manifest strabismus adversely affects many aspects of patients' lives including finding a partner, job prospects and interaction with peers, and may manifest more seriously as psychiatric disorders. Surgical correction has been shown to be safe and effective for the functional problems of strabismus in adults but the hugely positive effects on the psychosocial aspects are only now becoming apparent. The advent of a new adult strabismus specific quality-of-life questionnaire and its subsequent validation will make this quantification of improvement easier. The wider medical community and the public at large should be made aware of the benefits of corrective strabismus surgery in adults.

/pdf/the-psychosocial-effects-of-adult-strabismus-a-review-3shhigvyke.pdf

The psychosocial effects of adult strabismus: a review

Strabismus is one of the most common vision diseases that would cause amblyopia and even permanent vision loss. Timely diagnosis is crucial for well treating strabismus. In contrast to manual diagnosis, automatic recognition can significantly reduce labor cost and increase diagnosis efficiency. In this paper, we propose to recognize strabismus using eye-tracking data and convolutional neural networks. In particular, an eye tracker is first exploited to record a subject's eye movements. A gaze deviation (GaDe) image is then proposed to characterize the subject's eye-tracking data according to the accuracies of gaze points. The GaDe image is fed to a convolutional neural network (CNN) that has been trained on a large image database called ImageNet. The outputs of the full connection layers of the CNN are used as the GaDe image's features for strabismus recognition. A dataset containing eye-tracking data of both strabismic subjects and normal subjects is established for experiments. Experimental results demonstrate that the natural image features can be well transferred to represent eye-tracking data, and strabismus can be effectively recognized by our proposed method.

/pdf/strabismus-recognition-using-eye-tracking-data-and-belhvhqtj1.pdf

Strabismus Recognition Using Eye-Tracking Data and Convolutional Neural Networks

Objective To propose medial rectus (MR) recession to be equally as effective as lateral rectus (LR) resection, which has heretofore been the preferred treatment for divergence paralysis esotropia (DPE). Methods We examined a 17-year surgical experience comparing LR resection with MR recession in adults with DPE, defined as symptomatic distance esotropia (ET) at least double the asymptomatic ET of 10 or less prism diopters (Δ) at near. Results Twenty-four patients with DPE underwent surgery. Six patients underwent bilateral LR resection and 2 underwent unilateral LR resection (group L), while 13 underwent bilateral MR recession and 3 underwent unilateral MR recession, with the target angle double the distance ET (group M). One of 8 patients in group L and 15 of 16 patients in group M underwent intraoperative adjustable surgery under topical anesthesia. Mean (SD) preoperative central gaze ET measured 15.0 (7.7) Δ at distance and 4.1 (3.4) Δ at near in group L, but 10.4 (6.8) Δ at distance and 0.6 (1.7) Δ at near in group M (P = .15; distance, 0.003, near). Postoperatively, no patient in either group had symptomatic diplopia or convergence insufficiency in follow-up from 8.5 to 40 months. Twice the usual surgical dose of MR recession per prism diopter was required to achieve correction of the distance deviation in DPE as compared with that recommended for ET generally and also for LR resection in the same condition. Conclusions Recession of the MR provides binocular single vision in DPE without convergence insufficiency at near, and it is convenient for intraoperative adjustment under topical anesthesia.

/pdf/medial-rectus-recession-is-as-effective-as-lateral-rectus-3nc01qicqy.pdf

Medial Rectus Recession Is as Effective as Lateral Rectus Resection in Divergence Paralysis Esotropia

Purpose To compare two quality-of-life (QoL) scales and subscales: the Derriford Appearance Scale 59 (DAS59) and the Adult Strabismus-20 (AS-20) scale in a series of strabismic and nonstrabismic patients and to illustrate the differences in results between strabismic and nonstrabismic patients. Methods The DAS59 is a self-report QoL questionnaire generating an assessment of distress caused by problems of appearance. The AS-20 is a newly developed strabismus specific QoL scale. A prospective, noninterventional study of a series of consecutive adult patients undergoing strabismus surgery and a control group was performed. Patients were given both questionnaires to complete before surgery. The underlying condition, previous number of surgeries, and deviation measurements were recorded. Results Thirty-four patients and 30 controls correctly completed both questionnaires. In the strabismus group, the mean AS-20 score was 50.5. The mean DAS59 score was 122.5 (out of 269). There is strong correlation between the scales ( r = −0.813; 95% CI, −0.90 to −0.66; p t = 12.9 [ p t  = −4.642 [ p Conclusions The AS-20 shows strong correlation to the widely used DAS59. Strabismus patients show significantly more psychosocial distress than controls. The AS-20 is specific to strabismus patients and the result is not influenced by any other systemic factors that can impinge on the more general DAS59 scale.

The psychosocial aspects of strabismus: correlation between the AS-20 and DAS59 quality-of-life questionnaires

Purpose The introduction of the AS-20 strabismus-specific quality-of-life questionnaire allows clinicians to quantify the effects of strabismus on adults for the first time. We correlated strabismic patients' demographic and clinical findings to their AS-20 scores. Methods A consecutive cohort of patients from an ongoing prospective study of adults with manifest strabismus was recruited. The patients' age, sex, socioeconomic status (SES), magnitude, and direction of deviation were correlated to their AS-20 scores. Patients' zip codes were used to derive a score for their SES based on the English 2007 Index of Multiple Deprivation score (IMD2007). Results A total of 61 questionnaires with all demographic and clinical data were available. The median magnitude of deviation was 20.4 Δ in this group. The mean AS-20 score was 49.5 (SD 21.6). Women had significantly lower AS-20 scores than men ( p = 0.02). There was no difference in AS-20 scores between individuals with eso- and exodeviations ( p = 0.7). Multiple linear regression analysis shows female sex and lower SES to be significantly associated with lower AS-20 scores ( p = 0.03 and p = 0.006, respectively). Conclusions Strabismic patients who are female or live in a more deprived area have a significantly lower AS-20 score.

The psychosocial effects of strabismus: Effect of patient demographics on the AS-20 score

Purpose To describe our results using a technique modified from that described by Yokoyama in 1991 for treating heavy eye syndrome with high myopia by restoring the normal anatomical relationship of superior rectus and lateral rectus. We perform a simple loop myopexy between superior rectus and lateral rectus without concurrent muscle splitting, medial rectus recession, or scleral fixation. Methods Retrospective analysis of records of all patients with heavy eye syndrome who underwent our modified simple loop myopexy procedure between 2005 and 2008. Pre- and postoperative orthoptic measurements were recorded and analyzed. Surgical complications were noted. Success was deemed patient satisfaction. Results A total of 5 patients were identified who underwent the procedure for heavy eye syndrome. All patients requested surgery for aesthetically unacceptable strabismus. The mean preoperative horizontal deviation was 13 Δ esotropia and the mean vertical deviation was 21.8 Δ hypotropia. The mean postoperative horizontal deviation was 0 Δ and vertical deviation was 4.4 Δ hypotropia. Thus there were large improvements in both the vertical (17.4 Δ ) and the horizontal deviations (13 Δ ) following surgery. There were no surgical complications. Follow-up was 6 months. All patients have aesthetically acceptable deviations and have been discharged from care. Conclusions A simple loop myopexy can be an effective treatment in these difficult patients. We encourage a staged approach to these patients, with simple myopexy being the first line of approach.

Treatment of "heavy eye syndrome" using simple loop myopexy.

Purpose Scleral buckling for retinal detachment is a well-reported cause of secondary strabismus. We analyzed the effects on motility of removal of the exoplant alone to determine whether this is warranted as a separate step in the surgical management of these patients. Methods A retrospective case series of patients who underwent scleral exoplant removal due to symptomatic strabismus development following retinal detachment repair from 2007 to 2009 was conducted. Manifest horizontal and vertical deviations were treated as vectors of a single combined deviation (|dev|). Pre- and postoperative manifest |dev| in the primary position (|dev| pp) and in the gaze position of maximal deviation (|dev| max ) were analyzed. Results Five patients were identified, all with symptomatic, binocular diplopia in the primary position prior to exoplant removal. Median |dev| pp prior to exoplant removal was 21 Δ and following removal was 21 Δ ( P = 0.81). The median |dev| max prior to exoplant removal was 33 Δ and following removal, 22 Δ ( P = 0.82). Median follow-up was 8 months. There were no cases of retinal redetachment following the exoplant removal. No patient reported any subjective improvement of their diplopia. All 5 patients went on to have strabismus surgery as a separate procedure. Conclusions Median primary position deviation was unchanged by scleral buckle removal, and Exoplant removal has minimal long-term benefit on the strabismus following scleral buckling procedures.

The effect of scleral exoplant removal on strabismus following retinal detachment repair

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