Biomedical subjects

J P Szlyk

Publications and source records attributed to J P Szlyk.

At least 19 recordsLinked to original sources

PubMed2001

Perceived and actual performance of daily tasks: relationship to visual function tests in individuals with retinitis pigmentosa.

PURPOSE: To investigate the functioning in daily task performance of individuals with retinitis pigmentosa (RP). Goals were (1) to quantify the relationships among clinical tests of vision, self-reports, and evaluations of actual task performance to predict difficulty in these tasks; and (2) to validate self-report questionnaire data about daily task performance with observations and measurements of actual task performance conducted by a certified low-vision specialist. DESIGN: A cross-sectional study and survey. PARTICIPANTS: Sixty-two individuals with RP (mean age, 37 years) participated in the study. METHODS: We obtained data about task performance from subjects' reports about their daily performance as assessed by a 53-item questionnaire and from a specialist's rating about actual ability on a 64-item battery of tasks, including ones similar to those assessed with the questionnaire. MAIN OUTCOME MEASURES: Clinical measures of vision included visual acuity, visual fields using Goldmann perimetry, letter contrast sensitivity, and cone and rod electroretinogram (ERG) function. The questionnaire and functional tasks were clustered into three categories: "reading," "mobility," and "peripheral detection." RESULTS: Self-report was correlated significantly with actual task performance. Task performance was correlated significantly with clinical test performance. Moderate or worse difficulty in performance was observed only for visual acuity worse than 20/40; log contrast sensitivity less than 1.4; a visual field area smaller than 2000 deg(2) (area equivalent to a 50-degree diameter of visual field to the Goldmann II-4-e target); and ERG amplitudes less than 10 microvolts for 32-Hz light-adapted white flicker. CONCLUSIONS: Despite the significant correlations, there remains variability in task performance that is unaccounted for in some individuals with low levels of clinical test performance. The assessment of actual task performance validated the use of self-reports in individuals with RP.

Activities of Daily Living↗

PubMed2001

Duration thresholds for target detection and identification in the peripheral visual field.

PURPOSE: In the current study, we measured threshold duration required to perform the tasks of letter identification, letter detection, grating orientation discrimination, and symmetry detection of targets presented as a function of retinal eccentricity. METHODS: Targets were presented in the nasal visual field on the horizontal meridian at eccentricities ranging from 0 degree to 22 degrees. Threshold duration was calculated using a modified staircase procedure. RESULTS: We found that for the task of letter identification, the rate of duration sensitivity loss was independent of the letter size. In contrast, for the tasks of letter detection, grating discrimination, and symmetry detection, the rate of loss was greater for smaller targets than for larger targets. CONCLUSION: At equivalent target sizes, letter identification always demonstrated the steepest decline in duration sensitivity with increasing eccentricity. This might be the case if the final stages of the identification process are rate limiting. It was hoped that by quantifying duration sensitivity of the peripheral retina, more appropriate temporal stimuli could be used in rehabilitation programs that train reading using eccentric preferred retina loci in patients with advanced macular disease.

Adult↗

PubMed1998

Discrimination of spatial displacements by patients with retinitis pigmentosa.

We compared maximum displacement thresholds (Dmax) with minimum displacement thresholds (Dmin) in patients with retinitis pigmentosa (RP) in order to characterize the nature of their visual disability, as well as to assess possible models of foveal vision loss. Thresholds for discriminating the direction of the spatial displacement of random dot patterns were measured in a group of 20 patients with typical RP or Usher syndrome whose visual acuities were 20/40 or better and who had minimal or no clinical evidence of changes in the ocular media. Findings were compared with those from an age-similar group of 15 visually normal subjects. Displacement thresholds were measured using a two-frame random dot cinematogram and a four-alternative forced-choice procedure. Measurements were made at each of three dot contrasts and three dot sizes. For the patients with RP, reducing either the dot contrast or dot size increased Dmin and decreased Dmax such that the range of discriminable displacements became considerably restricted, even at modest reductions in dot contrast or size. This restriction in the displacement thresholds of the patients with RP was correlated significantly with their visual acuity. By comparison, the control subjects showed little change in either Dmin or Dmax under these conditions. These results indicate that patients with RP who have only relatively minor reductions in their visual acuity can have severely compromised motion perception. The pattern of findings suggests that an abnormal contrast response of the foveal cone system is a major determinant of the impaired displacement thresholds of these patients with RP.

Adult↗

PubMed1998

Use of bioptic amorphic lenses to expand the visual field in patients with peripheral loss.

PURPOSE: To test the effectiveness of a bioptic form of a peripheral vision-enhancement lens in patients with retinitis pigmentosa (RP), choroideremia, and Usher's syndrome Type II. METHODS: Fifteen patients with peripheral visual field loss were trained in the use of the amorphic lenses for driving and other everyday activities for a 3-month period. A cross-over study design was used, where one group of eight patients received training during the first 3 months of the 6-month study, and another group of seven patients received training during the second 3 months. All patients were administered a battery of clinical, psychophysical, functional, mobility, and driving assessment tests at the beginning of the study, at 3 months, and at 6 months. The assessment tests were coded according to the primary visual skill involved in the task. These visual skills included: recognition, peripheral detection, scanning, tracking, visual memory, and mobility. RESULTS: After training, the patients showed improvement in all visual skills categories on the assessment tests, with overall improvement of 37%. There was no significant difference in the levels of improvement between the two groups. Those with smaller visual field extents showed significantly greater improvement on peripheral detection and scanning tasks. Those patients trained during the first 3 months of the study maintained their skills when tested at the 6-month point. CONCLUSION: Patients with peripheral vision loss may benefit from a rehabilitation program which combines low vision training with amorphic lenses in a bioptic configuration.

Adult↗

PubMed1998

Legal blindness and employment in patients with juvenile-onset macular dystrophies or achromatopsia.

PURPOSE: The purpose of this study was to gain information about the employment status of legally blind patients. METHODS: Fifty-two patients with one of four juvenile-onset macular dystrophies or achromatopsia responded to questions about their employment histories and their psychological well-being. Results from the questionnaire were analyzed using z-tests for differences in proportions or t-tests for differences in means. RESULTS: Forty-eight percent of the patients reported that they were employed and 52% that they were not employed. The subgroup that was not employed had a significantly higher proportion of women than men, whereas the employed group had approximately equivalent proportions of men and women. The employed subgroup reported that their success at work was due to social support. This subgroup had significantly higher household incomes, was significantly less likely to collect disability-income benefits, had significantly higher educational levels, had significantly higher positive affect, and had significantly lower negative affect than the subgroup that was not employed. A logistic regression analysis indicated that education was the primary predictor of employment. CONCLUSION: Analysis supports the conclusion that it is beneficial for legally blind individuals to obtain an optimal level of education and receive suitable social support to facilitate their successful employment.

Adolescent↗

PubMed1998

Difficulty in performing everyday activities in patients with juvenile macular dystrophies: comparison with patients with retinitis pigmentosa.

AIMS: To ascertain the level of perceived difficulty experienced by patients with central vision loss due to juvenile macular dystrophies in the performance of everyday activities. A second objective was to compare their perceived difficulty with that of patients with retinitis pigmentosa (RP) with primarily peripheral vision loss. METHODS: 72 patients with Stargardt disease, cone dystrophy, or cone-rod dystrophy who had visual acuities worse than 20/40 and normal peripheral visual fields rated themselves on their difficulty in the performance of 33 activities encompassing a wide variety of everyday tasks. These findings were compared with the responses of 120 patients with typical RP or Usher syndrome type 2 who had visual acuities of 20/40 or better and peripheral visual field loss. RESULTS: The juvenile macular dystrophy group reported the greatest level of overall self perceived difficulty with activities involving central vision, and lesser and variable degrees of difficulty with items within the mobility, negotiating steps, driving, and miscellaneous categories. Consistent with these findings, there were highly significant correlations between subjects' rated performances of activities involving central vision and the clinical measures of vision, including visual acuity and size of central scotoma. There were fewer significant correlations between perceived performance of activities in the other categories and the clinical measures. In general, those activities that showed significant correlations with the clinical measures of vision for the patients with juvenile macular dystrophies also showed significant differences in the patterns of responses between the juvenile macular dystrophy group and the RP group. Those items which were not correlated with the clinical measures in the juvenile macular dystrophy group tended not to show significant differences in the response patterns between the two groups. CONCLUSION: These results provide insight into the types of perceived difficulties in performing tasks of everyday life in patients with these disorders which affect counselling of these patients.

Activities of Daily Living↗

PubMed1998

Effect of noise contrast polarity and temporal asynchrony on visual sensitivity.

We evaluated the effect of substitutive noise on contrast sensitivity within the context of linear (Fourier) and nonlinear (non-Fourier) visual processes. Orientation judgments for D6 (sixth spatial derivative of Gaussian) patterns were obtained from three visually normal subjects when random regions of the target and background were occluded by small (1.7 arc min) pixel arrays that were either all of the same contrast polarity or a mixture of equal percentages of negative and positive contrast. The target was presented either synchronously or asynchronously with the occluding elements. Our results indicate that the manipulation of noise characteristics in this way can bias performance either toward a nonlinear process that is insensitive to noise contrast polarity but sensitive to temporal asynchrony or toward a quasi-linear process that is sensitive to noise contrast polarity but insensitive to temporal asynchrony. These findings have relevance to models of the effect of spatial sampling on the visual performance of persons with retinal disease.

Adult↗

PubMed1997

Relationship between difficulty in performing daily activities and clinical measures of visual function in patients with retinitis pigmentosa.

OBJECTIVES: To assess the level of perceived difficulty experienced by patients with retinitis pigmentosa (RP) in the performance of everyday activities and to determine the correlation between patients' self-reported difficulty and clinical measures of visual function. METHODS: One hundred sixty-seven patients with typical RP and Usher syndrome type 2, with a wide range of disease severity, rated their difficulty in the performance of 33 activities. We obtained data on visual acuity and visual field area for all patients, and electroretinogram (ERG) recordings on a subgroup of 49 of these patients. Results from the questionnaire were analyzed with factor analysis, and patients' self-reports were compared with their clinical data using correlational analyses and multiple regression. RESULTS: The patients' questionnaire responses clustered into 6 factors: activities involving central vision, miscellaneous activities (no discernible common factor), activities related to mobility, driving, negotiating steps, and eating meals. Of the clinical tests, visual acuity was most strongly related to the patients' ratings of their difficulty in performance. Visual field area also was related to patients' self-assessments but not as strongly as visual acuity. Because visual field area and the ERG measures were correlated, adding ERG information did not improve predictability. CONCLUSIONS: In patients with RP, perceived difficulty in performing common tasks was most strongly related to level of visual acuity and visual fields. Although certain ERG amplitude measures did show positive correlations with some self-reported activities, overall, the ERG amplitude measures showed the least relationship with patients' self-reports. Our results provide insight into RP patients' perceived difficulties in performing everyday activities and the clinical measures of visual function that most highly correlate with these difficulties.

Activities of Daily Living↗

PubMed1996

Age-related functional field losses are not eccentricity dependent.

Previous studies have found an increase in peripheral target localization errors in normally sighted older adults. These results have been interpreted as indicative of a constriction of the "useful field of view". In the present study, we parametrically manipulated masking, distractors and stimulus luminance and examined the relationships between peripheral target localization and age. We found that backward masking and/or flashed distractors increased error rates. This decrement in performance was larger for more peripherally located targets and largest for the older subjects at all stimulus locations. Stimulus luminance (either 2 or 78 cd/m2) had no effect on peripheral localization performance at any age. We also demonstrated that all subjects, regardless of age, had higher localization error rates to more peripherally located targets. In older subjects, error rates increased equally at all eccentricities; that is, there was an eccentricity independent increase in the number of target localization errors as a function of age. This finding does not support the interpretation of a selective constriction of the functional visual field in older subjects.

Adult↗

PubMed1995

A comparison of driving in older subjects with and without age-related macular degeneration.

OBJECTIVE: To determine the effects of age and central vision loss on driving skills. METHODS: Ten subjects with age-related macular degeneration and average binocular visual acuity of 20/70, and 11 age-similar subjects with normal vision, were examined with a battery of cognitive and visual tests, an interactive driving simulator, and an on-road driving test. Data were collected on the frequency of real-world accidents and convictions for traffic violations. RESULTS: There were no significant differences between the two groups on any of the cognitive tests. The age-related macular degeneration group demonstrated poorer performance on the driving simulator, including delayed braking response times to stop signs, slower speeds, and more of both lane boundary crossings and simulator accidents. The age-related macular degeneration group also demonstrated poorer overall on-road test performance, including having significantly more points deducted for driving too slowly and for not maintaining proper lane position. However, these effects on the simulator and the on-road test did not translate into an increased risk of real-world accidents for the age-related macular degeneration group. Significantly more control subjects than patients with age-related macular degeneration were involved in self-reported accidents, and significantly more control subjects had state convictions for traffic violations. There was evidence of compensation in the age-related macular degeneration group in four major areas: (1) not driving in unfamiliar areas; (2) traveling at slow speeds; (3) self-restricting their nighttime driving, and (4) taking fewer risks while driving (eg, not changing lanes). There was also evidence of compensation in the older control group. CONCLUSIONS: Vision, simulator, and on-road test variables combined with subjective risk taking predicted self-reported real-world accidents in a logistic regression analysis. However, risk taking, rather than simulator or road-test performance, was the most significant predictor for both patients with age-related macular degeneration and the control group.

Accidents, Traffic↗

PubMed1995

Symmetry discrimination in patients with retinitis pigmentosa.

To investigate the relative sensory and perceptual contributions to central visual function of patients with retinitis pigmentosa (RP), we tested symmetry discrimination using block patterns with varying types of symmetric organization. Eleven control subjects with normal vision and 11 patients with RP with 20/30 visual acuity or better, viewed patterns presented for 255 msec. The patterns differed in the type of symmetric organization and the subjects were required to identify the type. The control subjects performed significantly better (89.2%) than the patients (74.5%). Four hypotheses to account for these findings were tested and the results were as follows, (1) A reduction in pattern luminance did not change symmetry discrimination performance in the control subjects. (2) Large reductions in pattern contrast did not alter symmetry discrimination in the control subjects. (3) Reductions in stimulus duration, likewise, did not produce similar error patterns in the control subjects as those observed in the patients with RP. (4) Alterations in spatial sampling density did not completely account for the patients' deficits. None of the retinally based explanations alone was sufficient to account for our findings. Additionally, we suggest that alterations of sensory input may affect the perceptual encoding of the relationship among pattern elements.

Adult↗

PubMed1995

The effects of random element loss on letter identification: implications for visual acuity loss in patients with retinitis pigmentosa.

The hypothesis that reductions in Snellen acuities in patients with retinitis pigmentosa are due solely to losses of photoreceptors was tested by measuring the effects of random losses of sampling elements on letter identification. Sampling element losses were mimicked by setting the luminance of randomly selected pixels equal to the luminance of the surround. The amount of pixel blanking ranged from 0 to 90%. Letters varying in retinal subtense from 5 to 17 min arc were presented for 500 msec. Although letter identification accuracy decreased with increasing pixel blanking for all letter sizes, performance remained relatively high even when a majority of the pixels was blanked. The data suggest that unless the loss of cone photoreceptors in greater than 80%, loss of sampling elements alone can not account for letter acuities poorer than 20/40. In addition to loss of cone photoreceptors in patients with RP, there are histological reports of photoreceptor abnormalities and psychophysical studies of visual sensory deficits. It is conceivable that these alone, or in combination with losses of photoreceptors, could account for decreased visual acuity. In a series of experiments, stimulus parameters were manipulated in order to mimic the effects of some of these abnormalities and deficits and the effects on letter identification were examined. The results of these experiments demonstrated that sampling element loss interacts with sensory factors (e.g. luminance and contrast sensitivity) and perceptual factors (e.g. set size and letter orientation) to reduce letter identification accuracy. The implication of these results is that decreases in letter acuity observed in patients with retinitis pigmentosa cannot be attributed solely to a random loss of sampling elements in the underlying retina, but may be due to the combination of photoreceptor degeneration and other sensory and perceptual factors.

Adult↗

PubMed1995

Level of processing in the perception of symmetrical forms viewed from different angles.

This study is concerned with the level of processing underlying the perception of symmetry about a vertical axis. Specifically, it asks whether the equality of the two sides of a symmetrical pattern must be present retinally or perceptually for the impression of symmetry to be realized. Sixty-four subjects were assigned to groups that viewed symmetrical and asymmetrical figures when the figures were in either a frontoparallel plane or one slanted by 65 deg from the line of sight. In the 65 deg condition, the objectively symmetrical stimuli projected an asymmetrical shape on the retina, and conversely the objectively asymmetrical stimuli produced a symmetrical retinal projection. From each viewing angle, patterns were observed under either full or reduced (monocular) depth cue conditions. Like their counterparts in the frontoparallel condition, observers in the 65 deg, full depth-cue condition identified the objective symmetry of the figures. By contrast, 65 deg, reduced depth-cue observers responded primarily to the retinal structure of the stimuli. The same pattern of responding was observed for both holistic and multielement patterns and for both 100 ms and 1 s exposures. These findings and the significant relationship obtained between phenomenal judgment of symmetry and a measure of shape constancy suggest that the perception of symmetrical figures depends upon the perception of the equality of their two halves, and is thus another example of perceptual causality.

Adolescent↗

PubMed1995

Effect of spatial sampling on grating resolution and letter identification.

The purpose of the study was to determine whether spatial sampling has equivalent effects on visual performance for grating and letter stimuli, two optotypes that are frequently used in the clinical assessment of visual function. Test targets consisted of five-bar square-wave gratings, spatial D6 (sixth derivative of a Gaussian) patterns, or individual Sloan letters, presented for 255 ms in the center of an adapting field. Spatial sampling was introduced by replacing random regions of the targets with occluding elements that had the same luminance as the adapting field, so that only random samples of the test target were visible on each trial. The occluding elements consisted of 4 x 4, 8 x 8, or 16 x 16 pixel arrays (subtending 0.67, 1.33, and 2.67 arcmin, respectively), and the percentage of the test target that remained unoccluded ranged from 3% to 100%. Visual acuity and contrast sensitivity for the spatially sampled targets were measured in two visually normal subjects. Results were compared with the predicted effect of the reduction in effective contrast that was introduced by the sampling paradigm. For grating stimuli the effect of spatial sampling was equivalent to the reduction in effective stimulus contrast produced by the sampling, regardless of occluding-element size. For letter stimuli the reduction in effective stimulus contrast predicted most, but not all, of the loss of visual acuity and contrast sensitivity for sampled targets, and the deficit in performance increased when larger occluding elements were used.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Relative effects of age and compromised vision on driving performance.

The aim of this study was to determine the relative effects of age and compromised vision on driving-related skills and on-road accidents. A total of 107 subjects were tested. They represented four groups that varied in age and visual status, as follows: (1) a younger, normally sighted group; (2) an older, normally sighted group; (3) a younger, visually compromised group; and (4) an older, visually compromised group. Driving performance was assessed by self-reported and state-recorded accident frequency and by an evaluation of performance on an interactive driving simulator. The older groups had poorer driving-related skills, as measured with our interactive driving simulator, than had the younger groups, but they did not have significantly higher on-road accident rates than the younger groups. The older subjects and those with compromised vision had reduced risk-taking scores, as measured with a self-report questionnaire. In addition, all older drivers had increased eye movements and had slower simulator driving speeds, which suggests that behavioral compensation is made for visuocognitive/motor deficits. Regression analyses showed that compromised vision and visual field loss predicted real-world accidents in our study population.

Accidents, Traffic↗

PubMed1993

Evaluation of driving performance in patients with juvenile macular dystrophies.

The driving performance of 20 subjects with central vision impairment due to either Stargardt disease or cone-rod dystrophy (visual acuity, 20/40 to 20/70) was compared with that of 29 control subjects with normal vision who had similar driving histories. Driving performance was defined by accident involvement based on self-report and state records and by an evaluation of performance on an interactive driving simulator. The proportion of individuals involved in accidents in the central vision loss group was comparable to that of the control group. For 13 of the 20 subjects with central vision loss who did not restrict their driving to daylight hours, there was a greater likelihood of involvement in nighttime accidents than in the control group. Visual function measures and simulator indexes did not predict accident involvement for the central visual loss group, although these subjects showed longer braking response times and a greater number of lane boundary crossings than the control group. These findings are in contrast to our previously published report of subjects with retinitis pigmentosa, who were more likely to have been involved in both daytime and nighttime accidents than a control group and for whom visual field extent was significantly related to accident involvement.

Accidents, Traffic↗

PubMed1993

Clinical subtypes of cone-rod dystrophy.

OBJECTIVE: To determine possible distinct phenotypic subtypes of cone-rod dystrophy. PATIENTS: Thirty-three patients with cone-rod dystrophy (from 25 families) were assessed prospectively on electroretinography, visual field testing, psychophysical threshold profiles, and fundus features. The clinical records of an additional 150 patients with cone-rod dystrophy were examined retrospectively in terms of the classification schema derived from the prospective study. RESULTS: Based on electroretinographic recordings, two major types of cone-rod dystrophy were differentiated. In type 1, cone amplitudes were reduced to a greater degree than were rod amplitudes on electroretinography, while in type 2, cone and rod electroretinographic amplitudes were reduced in equal proportion. These two types were further subdivided on the basis of patterns of visual field loss and threshold elevation. In type 1a, there was a central or paracentral scotoma, and cone thresholds were more elevated centrally than peripherally. In type 1b, there was no central scotoma, and cone thresholds were more elevated peripherally than centrally. In type 2a, there was a central scotoma, cone thresholds were more elevated centrally than peripherally, and rod thresholds were more elevated peripherally than centrally. In type 2b, a partial or complete ring scotoma was present, cone thresholds were more elevated peripherally than centrally, and rod thresholds were more elevated in the midperipheral than in either the central or far peripheral region of the retina. Of the 150 additional patients with cone-rod dystrophy, data sufficient for classification were available for 95 patients, and all but two had findings that were consistent with classification into one of these four subtypes. CONCLUSION: Our results identify four functionally distinct subtypes of cone-rod dystrophy that may be useful for patient counseling and future molecular genetic studies.

Adolescent↗

PubMed1993

Effects of age and hemianopic visual field loss on driving.

PURPOSE: With the use of an interactive driving simulator, we examined the driving performance of older patients with either homonymous or quadrantic hemianopsia with primarily occipital lobe damage resulting from cerebrovascular accidents (CVA's). METHODS: We compared the performance of these patients with that of a normally sighted, age-similar control group and that of a normally sighted younger group. RESULTS: The driving performance of the patients was either worse than, or similar to, that of the older control group; all of the older individuals (both patients and normally sighted subjects) had worse performance than the younger group. CONCLUSIONS: Age-related effects combined with the effects of visual field losses in older patients with cerebrovascular accidents had a negative impact on driving skills.

Aged↗