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At least 577 records · Page 32Linked to original sources
PubMed2005

Transient monocular visual loss.

PURPOSE: To provide a practical update on the diagnosis and management of transient monocular visual loss (TMVL). DESIGN: Perspective. METHODS: Review of the literature. RESULTS: TMVL is an important clinical symptom. It has numerous causes but most often results from transient retinal ischemia. It may herald permanent visual loss or a devastating stroke, and patients with TMVL should be evaluated urgently. A practical approach to the evaluation of the patient with TMVL must be based on the patient's age and the suspected underlying etiology. In the older patient, tests should be performed to investigate giant cell arteritis, atherosclerotic large vessel disease, and cardiac abnormalities. In the younger patient, TMVL is usually benign and the evaluation should be tailored to the particular clinical setting. CONCLUSIONS: Specific prevention strategies are tailored to the most likely cause of TMVL and the patient's underlying risk factors. Prevention of a future event should begin in the ophthalmologist's office with education and aggressive treatment of artherosclerotic risk factors.

Humans↗
PubMed2006

Objective measurement of visual acuity by optokinetic response determination in patients with ocular diseases.

PURPOSE: To investigate the efficacy of optokinetic nystagmus (OKN) suppression and induction methods for the objective estimation of visual acuities in patients with various ocular diseases. DESIGN: Prospective, descriptive study. METHODS: One hundred seventy-three eyes of 89 patients aged between 27 and 75 years who registered at our institution from January to December 2004 were prospectively enrolled onto this study. Ocular diseases included generalized retinal diseases (47 eyes), media opacity (32 eyes), refractive errors (31 eyes), glaucoma (27 eyes), maculopathies (26 eyes), and optic neuropathies (10 eyes). Horizontal optokinetic stimuli were presented on a 17-inch monitor screen at a distance of 40 cm from the subject in a dark room. Horizontal eye movements were recorded in each eye separately by infrared oculography. Objective visual acuities measured by using OKN suppression or induction methods were compared with subjective visual acuity assessments. The logarithm of minimal angle of resolution visual acuity was 1.03, and ranged from -0.08 to hand movement. RESULTS: Linear regression identified minimum stripe stimuli required to induce OKN by using the OKN induction method, and the minimum dot size required to suppress OKN was found to be correlated with subjective visual acuity (P<.01). The induction method was useful in patients with visual acuities of 20/60 or worse, and the suppression method was useful in patients with visual acuities of 20/200 or better. CONCLUSIONS: Combined use of the OKN induction and suppression methods provides a satisfactory means of determining objective visual acuity.

Adult↗
PubMed2006

Contrast sensitivity and color vision in HIV-infected individuals without infectious retinopathy.

PURPOSE: To investigate the relationship between abnormal contrast sensitivity and abnormal color vision among human immunodeficiency virus (HIV)-infected individuals who have normal visual acuity and to seek host factors that predict these abnormalities. DESIGN: Noninterventional, cross-sectional study. METHODS: We evaluated 71 HIV-infected subjects with visual acuity of 20/25 or better, clear media, and no vision-threatening retinal lesions. Visual function was determined using the Pelli-Robson contrast sensitivity test and the Farnsworth-Munsell 100-Hue color test (FM-100). Results were compared with published values for normal populations and to measures of HIV disease severity. We evaluated two levels of impairment for each visual function. "Mild dysfunction" was defined as > or =1 standard deviation (SD), but <2 SD from normal means. "Abnormal" was defined as > or =2 SD from normal means. RESULTS: The prevalences of abnormal contrast sensitivity and abnormal color vision were 7.0% and 9.9%, respectively. We did not identify relationships between impaired contrast sensitivity and impaired color vision. Impaired color vision was associated with increasing age (r = 0.36, P = .002). We could not identify significant correlations between either contrast sensitivity or color vision values and the following factors: current or nadir (lowest previous) CD4+ T-lymphocyte count, HIV blood level, and Karnofsky score. CONCLUSIONS: Abnormal contrast sensitivity and abnormal color vision can occur independently in HIV-infected individuals and can be present in the absence of severe immunosuppression.

Adult↗
PubMed2004

Impact of an educational program on the safety of high-risk, visually impaired, older drivers.

BACKGROUND: Older drivers (licensed drivers aged 60 years and older) have among the highest rates of motor vehicle collision involvement per mile driven of all age groups. Educational programs that promote safe driving strategies among seniors are a popular approach for addressing this problem, but their safety benefit has yet to be demonstrated. The objective of this study was to determine whether an individualized educational program that promoted strategies to enhance driver safety reduces the crash rate of high-risk older drivers. DESIGN/ SETTING: Randomized, controlled, single-masked intervention evaluation at an ophthalmology clinic. PARTICIPANTS: A total of 403 older drivers with visual acuity deficit or slowed visual processing speed or both who were crash-involved in the previous year, drove at least 5 days or 100 miles per week or both, and were at least 60 years old. INTERVENTION: Patients were randomly assigned to usual care (comprehensive eye examination) or usual care plus an individually tailored and administered educational intervention promoting safe-driving strategies. MAIN OUTCOME MEASURE: Police-reported vehicle collision rate, expressed both in terms of person-years of follow-up and person-miles of travel for 2 years postintervention. RESULTS: The intervention group did not differ significantly from the usual care only group in crash rate per 100 person-years of driving (relative risk [RR], 1.08; 95% confidence interval [CI], 0.71-1.64) and per 1 million person-miles of travel (RR, 1.40; 95% CI, 0.92-2.12). The intervention group reported more avoidance of challenging driving maneuvers and self-regulatory behaviors during follow-up than did the usual care only group (p<0.0001). CONCLUSIONS: An educational intervention that promoted safe-driving strategies among visually impaired, high-risk older drivers did not enhance driver safety, although it was associated with increased self-regulation and avoidance of challenging driving situations and decreased driving exposure by self-report.

Accident Prevention↗
PubMed2006

Olfactory and gustatory disturbances caused by digitalism: a case report.

It is known that an overdose of digoxin causes visual disturbance, but the effect on the senses of smell and taste is not known. A case of olfactory and gustatory disturbance caused by digitalism is reported. In a 62-year-old male patient suffering from chronic digitalism, the serum digoxin level rose to 6.0 ng/ml. The patient was diagnosed not only with visual disturbance but also hyposmia and hypogeusia. The patient recovered from visual and chemosensory disturbances after the serum digoxin concentration returned to normal. Because the similarity of intracellular signal transduction between photoreceptor cells and olfactory and/or taste receptor cells is known, it is suspected that the influence of digoxin to chemosensory organs was caused by intermediation of sodium-potassium-adenosine triphosphatase (Na-K-ATPase) of the chemosensory receptor cells.

Anti-Arrhythmia Agents↗
PubMed2004

[Influence of temperature changes on clinical symptoms in multiple sclerosis: an epidemiologic study].

UNLABELLED: The effects of the modifications of temperature are well known in patients affected by multiple sclerosis (MS). They are variable and can influence daily living. This sensibility can be used in the management of the disabilities. METHOD: An epidemiological study was realized on a cohort of 191 patients suffering from MS referred to the MS clinic of Rennes (France). All the patients were questioned about the influence of heat and cold on their clinical symptoms (fatigue spasticity, walking disorders, vision, em leader ). Correlations with the main clinical characteristics were studied. POPULATION: One hundred ninety-one patients, 129 women and 62 men with an average age of 47.6 +/- 10 years were interviewed. Average score EDSS was of 5.2 +/- 1.5. The mean duration of MS was 13.5 +/- 10 years. RESULTS: One hundred forty-seven patients (77%) reported a sensibility to the temperature. Heat deteriorated function in 104 cases and 82 patients improved with cold. Paradoxically 20 patients reported to be deteriorated with cold and 19 improved with heat. Fatigue and walking were the most sensitive to temperature fluctuations. No particular clinical profile could be established. Fifty percent of the patients used this sensibility with therapeutic aim in everyday life. DISCUSSION: The clear influence of temperature fluctuations on the clinical symptom was confirmed in this study. However, there is a great variability from one patient to another. Different hypotheses have been evoked to explain this phenomenon. The most likely is an influence on the nervous specific conductivity. In routine practice cold physiotherapy will be proposed on case by case basis and still has an interesting place in the rehabilitation management.

Adult↗
PubMed2006

Thalamic atrophy in infants with PVL and cerebral visual impairment.

The aim of this retrospective study was to establish the presence and severity of cerebral visual impairment in preterm infants with PVL. We also wished to establish whether abnormalities of visual function are related to brain MRI findings and more specifically not only to the involvement of optic radiations and occipital cortex but also to changes in the thalami, that are often affected in infants with PVL. Twelve infants with cystic PVL were assessed at 1 year (+2) corrected age with a battery of tests specifically designed to assess various aspects of visual function in infancy, such as ocular movements, visual acuity, visual fields and fixation shift. All infants also had a brain MRI. Eleven of the 12 had involvement of the optic radiations: all had some abnormalities of visual function and visual impairment was more severe in infants with more extensive involvement of the optic radiations. The child with normal optic radiations had normal visual function. Six of the 12 infants also had obvious signs of atrophy of the thalami and all had severe and wide-ranging abnormalities of visual function in all testing domains. Two children had equivocal atrophy of the thalami, both had some abnormalities of visual function. Four children had normal thalami and had normal visual function or only minor abnormalities on one of the visual tests. Our results suggest that the atrophy of the thalami may play an additional role in the abnormal development of visual function in infants with PVL and abnormal optic radiations.

Atrophy↗
PubMed2003

Marshall Parks lecture. Binocular sensory outcomes in accommodative ET.

PURPOSE: To review what is known about the normal maturational sequence for fusion and stereopsis and the binocular sensory deficits associated with accommodative esotropia (ET) and to explore the clues that accommodative ET provides about critical periods for binocular sensory function. METHODS: Studies of binocular sensory function during infancy and early childhood are presented. RESULTS: Most of the maturation of binocular sensory function occurs during the first year of life, yet a later abnormal visual experience-such as the onset of accommodative ET--can profoundly and permanently disrupt fusion and stereopsis. CONCLUSIONS: Some binocular sensory deficits may exist before the onset of accommodative ET, but others may result directly from abnormal binocular experience. The functional organization of the maturing visual system appears to be maximally sensitive to disruption by abnormal visual experience during the first months of life, but susceptibility continues until at least 4 years of age.

Accommodation, Ocular↗
PubMed2004

Parent-administered visual acuity testing: is it reliable and can it improve office efficiency?

PURPOSE: To evaluate the accuracy of a parent-administered visual acuity test, using the electronic visual acuity tester (EVA) (JAEB Center, Tampa, FL) and evaluate its use as a means to improve efficiency of office acuity testing. METHODS: This was a prospective experimental study. Part I: Sixty-four children had their visual acuity determined using the EVA, first by their parents and then by an ophthalmic technician. Acuity scores were compared. Part II: Forty-four other children were randomly assigned to one of 2 groups. Group A (parent-prescreen) children had their visual acuity determined first by the parents using the EVA. The visual acuity result in that child was then rechecked by the technician using the Reinforcement Phase and Phase 2 of the Amblyopia Treatment Study (ATS) visual acuity testing protocol. Group B (full ATS protocol) children had their acuity determined by the technician using the full ATS protocol. The number of optotypes presented by the technician in order to determine the acuity in each group was compared. RESULTS: Part I: Reliability of parent-determined visual acuity scores was high (r = 0.91 and 0.81 for right eyes (OD) and left eyes (OS), respectively), with 93% of right eye parent scores and 85% of left eye parent scores within 0.11 logarithm of minimal angle of resolution (logMAR) units (ie, within one line of vision) of the technician score. Part II: The parent prescreen group (Group A) required presentation of 66% fewer optotypes to the OD and 68% fewer optotypes to the OS than the full ATS protocol group (Group B) (OD: P = 5.4 x 10(-18); OS: P = 6.5 x 10(-18)). CONCLUSIONS: Visual acuity testing results by parents using the EVA are reliable. Electronic visual acuity prescreening by parents reduces the number of optotype presentations required to be shown by the technician to accurately determine acuity. Use of a parent-assisted screening system in the waiting room may translate to increased office efficiency.

Caregivers↗
PubMed2004

How often are spectacles prescribed to "normal" preschool children?

INTRODUCTION: Legislation to require formal eye examination prior to school entry is being considered in several states and is supported by optical trade organizations. Pediatric ophthalmologists cite anecdotal cases that suggest children receive spectacles unnecessarily, but data to support this are lacking. METHODS: Eye examination results from children referred to local eye doctors following a statewide preschool photoscreening program were reviewed to determine how often glasses were prescribed for children who did not have amblyogenic factors (those with false-positive screenings). RESULTS: Of 102,508 preschool children screened, 890 children did not have amblyogenic factors (false-positive screenings). Nevertheless, spectacles were prescribed for 174 (19.5%) of these children. Only 5/272 children (1.8%) were prescribed glasses following examination by a pediatric ophthalmologist, while glasses were prescribed for 24/205 children (11.7%) examined by comprehensive ophthalmologists and 145/413 (35.1%) of children seen by optometrists (P < 0.001). Eighty children were prescribed glasses for refractive error ranging from -0.75 sph to +2.00 sph, 32 of whom had spherical equivalent of 1D or less. CONCLUSIONS: While some preschoolers without amblyogenic factors may require spectacle correction, a significant percentage of children are probably prescribed glasses unnecessarily. Extrapolation of these data to the United States population suggests that a single mandatory eye examination prior to school entry could cost over 200,000,000 US dollars yearly for unnecessary spectacles. Vision screening programs with high referral rates, and health policy proposals supporting comprehensive preschool eye exams, must consider these unnecessary costs.

Child, Preschool↗
PubMed2006

Correlation of grating acuity with letter recognition acuity in children with albinism.

PURPOSE: This study was undertaken to determine whether grating acuity in early childhood can be used as a predictor of letter recognition acuity in patients with albinism. METHODS: In this retrospective study, we compared the binocular grating acuities of children with albinism (30 at age 1, 29 at age 2, and 19 at age 3) to their letter recognition acuity at age 4-6 years. RESULTS: Mean binocular grating acuity was 2.0, 1.9, and 1.5 octaves below age matched norms at ages 1, 2, and 3 years, respectively (P<0.001 at all ages). Mean grating acuity at ages 1, 2, and 3 correlated moderately (r=0.458, 0.502, and 0.471, respectively; all with P<0.05) with mean binocular letter recognition acuity of the same children at ages 4-6. A subgroup analysis of 9 patients followed longitudinally showed strong correlation of binocular grating acuity at ages 1 and 2 with letter acuity (r=0.745, P=0.021; r=0.930, P<0.001, respectively) and moderate correlation at age 3 (r=0.685, P=0.042). In the larger group and the longitudinal subgroup, mean binocular grating acuity at ages 1 and 2 was worse than mean binocular letter recognition acuity at age 4-6 (paired-samples t-test, P<0.001). Mean binocular grating acuity at age 3 in both groups was not significantly different than mean binocular letter recognition acuity at age 4-6 (paired-samples t-test, P=0.790, 0.215, respectively). CONCLUSION: Parents should be informed that vision measured as grating acuity at age 3 provides an estimate of future letter recognition acuity in children with albinism.

Albinism, Ocular↗
PubMed2004

Reading performance depending on the type of cataract and its predictability on the visual outcome.

PURPOSE: To investigate the influence of various types of cataract on reading performance in a standardized reading test setting. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: The reading performance of 94 eyes with age-related cataract and normal macular function was evaluated with the Radner Reading Charts preoperatively and 4 weeks after cataract surgery. Distance visual acuity was tested with the ETDRS charts. Cataracts were graded using the Lens Opacities Classification System (LOCS) III, on which NO is nuclear opalescence and NC is nuclear color. RESULTS: Patients with pure nuclear cataracts (LOCS III: NO/NC 2.1-5) achieved a normally high MRS (99.84% +/- 7.65% of their postoperative MRS): preoperative MRS(1): 190.6 +/- 30.74 words per minute (wpm); postoperative MRS(2): 191.21 +/- 29.36 wpm. Patients with mixed nuclear-cortical cataracts (LOCS III: NO/NC 2.1-5; C>2) preoperatively achieved 96.96% +/- 5.6% of their postoperative MRS (MRS(1): 175.77 +/- 31.54 wpm; MRS(2): 181.34 +/- 30.56 wpm). In dense nuclear cataracts (LOCS III: NO/NC>5), the MRS was significantly reduced, achieving only 72.64 +/- 19.19% of the postoperative MRS (MRS(1): 133.06 +/- 39.43 wpm; MRS(2): 185.76 +/- 40.18 wpm). In posterior subcapsular cataracts, the preoperative MRS (134.1 +/- 33.72 wpm) was significantly lower than postoperatively (191.14 +/- 27.08 wpm). CONCLUSIONS: In contrast to dense nuclear cataracts and posterior subcapsular cataracts, the preoperative reading speed of patients with pure nuclear or nuclear-cortical cataracts was normal at large print sizes. The preoperative evaluation of reading acuity and speed with standardized reading tests can therefore be used to estimate the postoperative reading performance in the latter 2 types of cataract.

Aged↗