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Quality of life related to visual function in three young adults with mucopolysaccharidoses.

The systemic mucopolysaccharidoses are complex syndromes, which may include corneal clouding as a mechanism leading to decreased vision and hence decreased quality of life. This study presents three young adult patients with mucopolysaccharidoses in order to compare their visual status through retrospective chart review, including patient and guardian interview, history, and examination, including a modified form of the VF-14 questionnaire (visual function with 14 questions). When the visual acuity and VF-14 results of the three patients were compared, the results of the VF-14 correlated with the patients" visual acuity status. The two patients who retained clear corneas or underwent penetrating keratoplasty had a wider range of social and physical activities, and an overall better quality of life than did the patient with decreased vision due to opacified corneas. We conclude that close monitoring of the ocular health of patients with storage syndromes that may compromise visual acuity must be stressed, and intervention to insure good vision is of the utmost importance to maintaining a good quality of life for these patients, especially as new therapies assist these patients to achieve increased longevity with better health.

Adult↗

Evaluation of the myosin VIIA gene and visual function in patients with Usher syndrome type I.

Usher syndrome type I (USH1) is a recessively-inherited disorder consisting of retinitis pigmentosa, profound congenital deafness, and vestibular ataxia. It can be caused by mutations in at least six different loci (USH1A-1F). The gene encoding human myosin VIIA (MYO7A) is the USH1B locus. In this study, 66 unrelated patients with USH1 were evaluated for defects in MYO7A using single-strand conformation polymorphism analysis and direct genomic sequencing. Twenty-nine per cent of cases were found to have likely pathogenic MYO7A mutations. A total of 22 likely pathogenic changes were identified, 18 of which were novel. Cosegregation analysis of mutations in five available families showed that the MYO7A changes segregated with the disease in an autosomal recessive fashion. Average visual function as measured by visual acuity, visual field area, and ERG amplitude was not significantly different between the group of patients with likely pathogenic MYO7A changes and the group in which no likely pathogenic MYO7A changes were detected.

Adult↗

[Dynamics of visual functions in the conditions of glow and sodium lighting. I. Visual acuity, accommodation, flicker fusion, visual field and heterophoria].

Investigations of the functions cited in the title were performed in 23 persons with a normal visual system in conditions of equal illumination, first the glow and the next day or later--the sodium one. All the tests were carried out three times in the morning hours evaluating in this way their dynamics as the time goes. The authors are analyzing the degree of the variability of the discussed functions in the time, as well as their behaviour in conditions of applied illumination. The results obtained suggest that in conditions of illumination by a high-pressure sodium lamp no negative characteristics of this source of light emerged. Deterioration of a small degree was observed only in the range of accommodation for near.

Accommodation, Ocular↗

Alteration of visual function in impaired glucose tolerance.

People with impaired glucose tolerance are considered to be prone to diabetes. To evaluate their visual function we investigated colour vision with the Farnsworth-Munsell 100 Hue test and contrast sensitivity with Arden's grating cards in people with imparied glucose tolerance (IGT), people with normal glucose tolerance (NGT) and others with type II diabetes (NIDDM). Eyes with low vision or any anterior or posterior segment abnormalities were excluded. Contrast sensitivity and color vision differed significantly between the groups (p < 0.01). It thus appears that patients with IGT but without clinical diabetes could be followed up to see whether these alterations have any predictive value for the development of diabetes and diabetic retinopathy.

Color Perception↗

Evaluation of visual function and prognosis for patients with proliferative diabetic retinopathy with the low vision evaluator.

Proliferative diabetic retinopathy (PDR) is a leading cause of visual loss in adults in industrialized countries. PDR patients with light perception (LP) or hand movement (HM) acuity due to severe vitreous hemorrhage require vitreous surgery. The purpose of this study was to determine whether the visual acuity of PDR patients with LP or HM can be graded into finer steps with the Low Vision Evaluator (LoVE). In addition, we determined whether the LoVE results are correlated with the amplitude of the electroretinogram (ERG), the presence of retinal detachment (RD), or postoperative visual prognosis. The LoVE instrument is a subjective device that measures the thresholds for light stimulus and is equipped with a pair of goggles with white light-emitting diodes as the stimulus. We measured the LoVE thresholds of 19 PDR patients, whose fundi could not be observed due to vitreous hemorrhage and whose visual acuity was LP or HM. The 13 patients with HM vision had LoVE thresholds that ranged from 25.0 and 40.0 dB, and the 6 patients with LP vision had LoVE thresholds that ranged from 20.0 and 40.0 dB. The LoVE thresholds of 9 patients with RD were significantly lower than those of 10 patients without RD (p < 0.001). The LoVE thresholds were correlated with the amplitude of the a- and b-waves of the ERG and the postoperative best-corrected visual acuity (BCVA) (a-wave: r = 0.70, p < 0.001; b-wave: r = 0.71, p < 0.001; postoperative BCVA: r = 0.46, p < 0.05). These results indicate that the LoVE is capable of grading the visual function of PDR patients with conventional LP and HM vision into finer steps. Thus, the LoVE is an invaluable device in predicting the postoperative visual acuity of patients with vitreous hemorrhage.

Diabetic Retinopathy↗

Is adjustment of National Eye Institute Visual Function Questionnaire scores for general health necessary in randomized trials?

PURPOSE: To assess whether treatment comparison of National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores in a clinical trial is influenced by general health to warrant adjusting for it. DESIGN: Two randomized pilot trials. METHODS: Patients enrolled in two randomized pilot trials of submacular surgery versus observation for choroidal neovascularization had quality of life interviews (NEI-VFQ and the Short Form-36 Health Survey) 24 months after enrollment. Information on comorbidities was collected through chart reviews. Data from 120 patients were analyzed using linear regression methods. RESULTS: Adjustment for comorbidities did not change the magnitude of the treatment effect on NEI-VFQ scores. However, adjustment for Short Form-36 physical and mental component summaries produced changes in the estimated treatment effect when NEI-VFQ scores were compared. CONCLUSIONS: Adjustment of NEI-VFQ scores for general health may be advisable. The Short Form-36 summary scores may be appropriate for this purpose.

Aged↗

Visual function in term infants with hypoxic-ischaemic insults: correlation with neurodevelopment at 2 years of age.

AIMS: To determine if there is any association between the findings of visual assessment performed at the age of 5 months and neurodevelopmental outcome at the age of 2 years in children who have sustained hypoxic-ischaemic insults. METHODS: Twenty nine term infants with hypoxic-ischaemic encephalopathy and/or brain lesions on neonatal magnetic resonance imaging (MRI) were prospectively evaluated. At 5 months of age all the infants had their visual function assessed using the Atkinson Battery of Child Development for Examining Functional Vision, which includes the assessments of optokinetic nystagmus (OKN), acuity, visual fields, fixation shift and phase and orientation reversal visual evoked potentials. At 2 years of age the children had a structured neurological evaluation and a Griffiths developmental assessment. RESULTS: There was good correlation between the extent of the early detected visual impairment and both neuromotor and global development. Children with more than three out of five abnormal visual tests at 5 months of age tended to have abnormal neurological examination results and abnormal developmental quotients. Children with three or fewer abnormalities tended to have developmental quotients in the normal range; the level of their performance, however, was still related to the number of visual tests passed. CONCLUSIONS: Individual visual tests can provide important prognostic information. While abnormal OKN and acuity were always associated with abnormal outcome, normal results on visual evoked potentials and fixation shift tended to be associated with normal outcome.

Brain↗

Visual function in children with developmental disabilities.

Vision involves a process of maturation that occurs in early childhood. Early recognition of visual disorders such as amblyopia is necessary to assure prompt treatment and optimize visual potential. This is especially important in children with developmental disabilities, in whom there is a high prevalence of such problems. Certainly, the type of ocular disorder varies according to the type of disability. But individual ophthalmic assessment is important, regardless of diagnosis, to identify treatable conditions that may improve or maximize visual function. In addition, ophthalmic examination may reveal distinctive anomalies in cases in which the etiology of disability has been difficult to establish. The present level of expertise and technology allows a comprehensive ophthalmic assessment to be performed, regardless of a child's level of impairment or ability to cooperate.

Child↗

Binocular visual function in congenital esotropia after bilateral medial rectus recession with loop suture.

PURPOSE: Our aim was to evaluate the binocular visual function in congenital esotropia after bimedial rectus recession with loop suture and to address the factors that could take part in the attainment of binocular function. SUBJECTS AND METHODS: Forty children with congenital esotropia who were operated on between 12 and 48 months of age were included in the study group. Postoperative follow-up ranged from 2 to 10 years. In order to determine the factors affecting the sensory results in congenital esotropia, we classified our patients into two groups according to their fusion status. We compared the preoperative and postoperative characteristics of patients in these two groups. RESULTS: Twenty-one of 40 patients (52.5%) fused the Worth four-dot at near (Group 1), 19 patients (47.5%) did not (Group 2) at the final examination. No patient showed evidence of stereopsis. We found significant differences between these two groups in respect to the final angle of vertical deviation, the age at surgery, the presence of postoperative inferior oblique overaction, dissociated vertical deviation and abnormal head position. Correlation analysis revealed that early alignment of the eyes and the absence of postoperative vertical deviation were associated with increased incidence of achieving some degree of binocular vision. CONCLUSION: In congenital esotropia, not all infants may have the potential for normal binocular function owing to yet unknown constitutional factors. We determined that achieving some degree of binocular function may be related to early alignment of the eyes. Additionally, close follow-up and precise treatment of the accompanying vertical deviation, especially inferior oblique overaction and dissociated vertical deviation, in a timely manner may enhance the attainment of binocular sensory function.

Child, Preschool↗

[Visual function damage in primary open angle glaucoma (POAG) in relation to hemorheology, ocular rheograph and other factors].

Researches of glaucomatous visual damage, hemorheology, ocular rheograph and other multiplex factors, with computed multifactorial stepwise regression analysis, indicate that elevation of intraocular pressure (IOP) is not the only factor to induce visual impairment. POAG patients are shown to have markedly reduced diastolic perfusion pressure in the ophthalmic artery, besides prolonged filling time of the retinal artery and vein, diminished erythrocyte deformability and increased platelet adhesion rate. The characteristic ocular rheographic changes in POAG patients of controlled IOP suggest that hemorheological factors play a role in the visual function damage.

Adult↗

Visual function after laser hyperthermia and chemotherapy for macular retinoblastoma.

PURPOSE: To determine whether treatment of macular retinoblastoma with chemotherapy and laser hyperthermia can lead to satisfactory visual acuity. METHODS: A child with unilateral macular retinoblastoma was treated with chemotherapy and laser hyperthermia. Visual function was assessed one year after treatment. RESULTS: At age 25 months, the patient had normal visual behavior and a normal spatial-sweep visual-evoked potential. CONCLUSION: Treatment of macular retinoblastoma with chemotherapy and laser hyperthermia may enable recovery of satisfactory visual acuity.

Antineoplastic Combined Chemotherapy Protocols↗

[Mean-term variations of visual function of video display terminal operators: observations on 70 cases].

The aim of the study was to evaluate medium-term variations of visual functions in VDT operators and their possible relationship to VDT exposure. The clinical records of 70 VDT operators attending our outpatient service for periodical ergophthalmological evaluation were reviewed in order to evaluate the variation of some visual parameters after a two-years follow-up. These included refraction, phorias, fusional convergence and divergence, stereopsis. The group did not include subjects affected by hyperopia, large ametropias, or binocular vision disturbances and was divided into two subgroups: low exposure group (n = 20; < 4 hours/day) and high exposure group (n = 50; exposure > 4 hours/day). Asthenopia was frequent in both groups. Variation of refraction and binocular vision parameters were absent or rather limited in both exposure groups. This seems to indicate that in subjects without significant ophthalmological problems the risk of permanent functional damage is very low at medium-term.

Adult↗

[Visual functional changes in patients with pituitary adenoma: results of transnasal-transsphenoidal tumor removal].

The study was based on the analysis of case histories of 371 patients with pituitary adenoma who were examined and treated at the Acad. N. N. Burdenko Institute of Neurosurgery in 1999 to 2004. The patients' age was 13 to 75 years; the peak of the disease fell on the age of 40-50 years. Females were 61% and males 39%. The symmetrical and asymmetric chiasmal syndrome was detected in 42 and 58% of patients, respectively. Early chismal syndrome was identified in 32% of patients; insignificant and significant one being in 27 and 41%, respectively. According to the stage of visual disorders, the patients were divided as follows: those with an early stage (62.9%) and those with a late stage (37.1%). An analysis has indicated that the pattern of visual disorders correlates with the site, predominant growth, and sizes of a tumor. Early postoperative visual functions restore mainly in patients with early-stage visual disorders, which is accounted for by timely decompression of visual fibers and their better blood supply. Functional block cessation, axonal transport recovery, and, probably, visual fiber remyelination result in positive changes in the late postoperative period.

Adenoma↗

Complete recovery of visual functions after multimodality treatment for intrinsic chiasmatic-hypothalamic astrocytoma--case report.

A 21-year-old female was admitted with complaints of severe impairment of vision. The visual acuity was 0.02 in both eyes along with residual visual fields and central scotomas. Neuroimaging disclosed a chiasmatic-hypothalamic glioma. Surgery was performed with partial removal of the intrachiasmatic part of the intrinsic tumor. The histological diagnosis was fibrillary astrocytoma. Progressive recovery of vision began in the first week after surgery. Adjuvant treatment included one course of fractionated radiation therapy and six courses of chemotherapy. Complete recovery of visual acuity occurred after 10 months, and the visual fields were restored after an additional 6 months. Her vision has been stable during 2 years of follow up. The prognosis for recovery of vision after treatment of optic pathway gliomas mainly depends on the severity of visual loss at admission and is negatively influenced by intrinsic tumor growth, symmetrical extension, and involvement of the chiasm. Despite the presence of all these factors in the present case, multimodality management resulted in the complete recovery of visual functions. Surgery may be indicated in cases of intrinsic chiasmatic gliomas complicated by severe visual loss.

Adult↗

Change in visual function after macular translocation with 360 degrees retinectomy for neovascular age-related macular degeneration.

OBJECTIVE: To measure the change in vision and visual outcomes at 12 months after macular translocation with 360 degrees retinectomy (MT360) and silicone oil tamponade in patients with bilateral vision loss resulting from subfoveal choroidal neovascular membranes in age-related macular degeneration (AMD). DESIGN: A prospective, interventional, consecutive, noncomparative case series. PARTICIPANTS: Sixty-four patients with bilateral vision loss resulting from neovascular AMD. METHODS: Eligible patients had AMD with subfoveal choroidal neovascularization in the operative eye and a maximum of 6 months of central vision loss. Preoperative and 12-month postoperative evaluations included standardized testing of near and distance acuity and reading speed. Patients underwent MT360 with silicone oil tamponade, followed 2 months later by extraocular muscle surgery and silicone oil removal. MAIN OUTCOME MEASURES: Change in distance acuity, near acuity, and reading speed at 12 months after MT360 compared with those values before surgery. RESULTS: Sixty-one patients were followed up for 12 months. All eyes were translocated successfully. Median distance acuity letter score improved from 62 letters (Snellen equivalent of approximately 20/125) before surgery to 69 letters (approximately 20/80) by 12 months after surgery (P = 0.03). Median near acuity improved from 0.70 logarithm of the minimum angle of resolution (logMAR) units (approximately 20/100) before surgery to 0.44 logMAR units (approximately 20/55) at 12 months (P<0.001). Median reading speed improved from 71 words per minute (wpm) before surgery to 105 wpm at 12 months after surgery (P<0.001). At 12 months, distance acuity improved by 1 or more lines in 32 patients (52%). In patients with either preoperative distance or near acuity of 20/80 or better, 74% and 95% of patients, respectively, remained in this range of acuity. In patients with either preoperative distance or near acuity of worse than 20/80, 40% and 48% of patients, respectively, improved to 20/80 or better. Postoperative retinal detachment developed in 5 patients (8%), with the macula involved in 2 patients, and all retinas were reattached successfully. CONCLUSIONS: Macular translocation with 360 degrees retinectomy with silicone oil tamponade is effective in significantly improving visual function in patients with neovascular AMD, as demonstrated by the improvement in distance and near acuity and reading speed at 12 months after surgery in these patients. Although this is a complex surgical intervention, patients with preoperative visual acuity of 20/80 or better at near or distance are highly likely to retain the 20/80 or better acuity at 12 months after surgery. Macular translocation with 360 degrees retinectomy is an effective treatment option for patients with vision loss in their second eye resulting from neovascular AMD.

Aged↗

Does the lymph drainage from the head influence aqueous humour outflow and visual functions?

Effect of lymphoedema of the head on the central nervous system is known. Possible changes in intraocular pressure, tonogram, electroretinogram, visual functions and ophthalmologic state was studied in animal experiments and in patients following serious surgical impairment of the cervical lymph drainage. Lymph drainage from the orbit to the deep cervical lymphatics was established, while no ophthalmologic alteration was detected after surgery.

Animals↗

[Improvement of visual function after balloon angioplasty for innominate artery stenosis: a case report].

Occlusive disease of the innominate artery is relatively rare, but visual disturbance is a frequently encountered manifestation of this disease. A 48-year-old man presented with a 1-year history of right amaurosis fugaxs. During the nine years prior to admission, the patient had undergone aortic artery-coronal artery bypass surgery two times. Upon ophthalmological examination, the patient was found to have impaired right retinal sensitivity and prolonged right arm-to-retina circulation time. Aortic arch angiography demonstrated severe stenosis of the innominate artery near its origin. The stenosis was successfully treated by balloon angioplasty. Subsequently, right retinal sensitivity improved and right arm-to-retina circulation time normalized following the procedure. These findings indicate that this patient had sufferred impaired visual function due to hemodynamic retinal ischemia caused by innominate artery stenosis.

Angioplasty, Balloon↗

[Postoperative recovery of visual function in sella tumors: prognostic assessment by electro-ophthalmologic studies].

Preoperative examination of the visual system in patients with tumors of the sellar region is usually limited to checking the visual acuity, assessing the visual field, and ophthalmoscopy of the optic disc. In addition to these tests we investigated pre- and postoperatively 35 patients with meningiomas, pituitary adenomas and other sellar and parasellar tumors by recording the pattern electroretinogram (PERG) and the pattern-evoked cortical potential (PVECP) in order to evaluate functional and possible structural impairment of the visual pathway. Based on electro-ophthalmological tests, the retinal and cortical findings were classified as: regular ERG and VECP (0), regular ERG and irregular VECP (1), irregular ERG and VECP (2). Up to six months postoperatively, eyes with alteration of the VECP alone (category 1) showed recovery of visual function, while those with alteration of ERG as well (category 2) did not recover in visual function. Since loss of the PERG or long-lasting alteration of it is indicative of irreversible impairment of the inner retinal layers including the retinal ganglion cells, repeat examination of the pattern ERG is recommended in disturbances caused by alterations in the central nervous system.

Adenoma↗