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At least 577 records · Page 32Linked to original sources

Effect of levodopa and carbidopa on recovery of visual function in patients with nonarteritic anterior ischemic optic neuropathy of longer than six months' duration.

PURPOSE: We conducted a pilot clinical trial to determine the efficacy of levodopa in promoting visual recovery in eyes with nonarteritic anterior ischemic optic neuropathy of greater than six months' duration. METHODS: This prospective, randomized, double-masked, placebo-controlled clinical trial involved 20 subjects with nonarteritic anterior ischemic optic neuropathy of 30 months' mean duration. Subjects were randomly assigned to receive either low-dose levodopa and carbidopa or a placebo for three weeks. At 12 weeks after the baseline visit, the levodopa group then was provided a higher, conventional dose of levodopa and carbidopa for three more weeks. Change in visual function was monitored at four, 12, 16, and 24 weeks after the baseline visit. RESULTS: At 12 weeks after the baseline visit, the levodopa group experienced a significant (P = .016) mean difference in improvement of visual acuity of 5.9 letters from the placebo group. At 24 weeks after the baseline visit, a significant treatment effect (P = .036) for visual acuity was still evident; the levodopa group had a mean gain in improvement of 7.5 letters difference from baseline from the placebo group. Three subjects in the levodopa group experienced a doubling of the visual angle as denoted by a gain of at least 15 letters. Significant improvement was not observed for color vision (P = .82) or mean deviation of visual field loss (P = .82). CONCLUSION: The study found significant improvement of visual acuity among subjects receiving levodopa and carbidopa despite long-standing visual loss from nonarteritic anterior ischemic neuropathy. Confirmation of our results is awaited from larger population studies and with a longer follow-up time interval regarding the efficacy of levodopa in reversing visual loss in this disease.

Aged↗

Responsiveness of the National Eye Institute Visual Function Questionnaire to progression to advanced age-related macular degeneration, vision loss, and lens opacity: AREDS Report no. 14.

OBJECTIVE: To describe the ability of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to detect meaningful change over time (responsiveness) to the primary Age-Related Eye Disease Study outcomes. METHODS: The 25-item NEI-VFQ plus appendix was administered at 2 visits at 1- to 4-year intervals to 4119 participants in the Age-Related Eye Disease Study. Events evaluated were progression to advanced age-related macular degeneration (AMD), visual acuity (VA) loss of at least 15 letters, and lens opacity progression. Responsiveness was measured by the t statistic, effect size (ES), responsiveness statistic, and area under the receiver operating characteristic curve. Variance components were used to estimate the contributions of events to variability of the NEI-VFQ score. RESULTS: Overall NEI-VFQ score was responsive to AMD progression (t = 14.0; P< .001; ES = 0.81) and VA (t = 16.2; P< .001; ES = 0.74). Mean changes ranged from 11 to 25 points for the subscales of general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, and driving. The NEI-VFQ was unresponsive to lens opacity progression, although when the event occurred in the eye with the best vision at the first administration, the lens opacity ES was moderate for the color vision (ES = 0.62) and driving subscales (ES = 0.66). Progression to advanced AMD and VA loss contributed significantly to the variation in the mean difference in overall VFQ score. CONCLUSIONS: Changes in the NEI-VFQ overall and subscale scores of 10 points or more are associated with clinically significant changes in vision and AMD. This finding may assist the design of interventional studies of AMD and VA loss that include the NEI-VFQ as an outcome measure.

Aged↗

Cross-validation of the Turkish version of the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25).

PURPOSE: To test the validity and reliability of the Turkish version of the self-administered form of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ 25). METHODS: Patients with no limitations to respond to a health status interview and affected by a chronic eye disease were enrolled. The Turkish versions of the abbreviated form of World Health Organization Quality of Life (WHOQOL-BREF) and the NEI-VFQ 25 instruments were administered to all participants. RESULTS: The mean (SD) age of the participants was 60.9 (14.5) years. There were 61 patients with one of the following conditions: Cataract (57.4%), diabetic retinopathy (13.2%), age related macular degeneration (ARMD) (11.4%), glaucoma (9.8%) and degenerative myopia (8.2%). The Cronbach alpha of the overall scale was 0.97; the Cronbach alpha ranged from 0.94 to 0.78 for the subscales. The physical, psychological, environmental and social domains of the WHOQOL-BREF had fair to good correlations with the NEI-VFQ 25 (r = 0.68 to r = 0.26), which indicated a sufficient convergent validity. Patients with lower visual acuity (VA) had lower index scores than those with higher VA (p = 0.001), which showed a sufficient responsiveness. CONCLUSION: Statistical analysis showed that Turkish version of the NEI-VFQ is a valid and reliable instrument to measure vision-related quality of life in patients with chronic eye diseases.

Cross-Cultural Comparison↗

Visual function following trabeculectomy: effect on corneal topography and contrast sensitivity.

PURPOSE: This study was to determine the role of changes in refractive error, contrast sensitivity, and corneal topography in transient changes in visual function following trabeculectomy. METHODS: We performed a prospective study evaluating these factors in 13 consecutive patients undergoing a standardized trabeculectomy. Preoperatively, and at 1, 4, and 12 weeks postoperatively, we measured best-corrected visual acuity, refractive error, and contrast sensitivity and analyzed computerized video-keratographic studies including estimated corneal visual acuity. RESULTS: One week postoperatively, best-corrected visual acuity decreased at least one line in 8 of 13 patients, whereas no eyes had decreased contrast sensitivity. Mean central corneal astigmatism increased 1.4 diopters along the surgical meridian. By 12 weeks, visual acuity returned to preoperative levels in all patients and the corneal topographic changes returned to within 1 diopter of preoperative values in 12 of 13 patients. Postoperative changes in estimated corneal visual acuity were similar to those in best-corrected visual acuity with no statistically significant difference. CONCLUSIONS: Corneal topographic changes appear to contribute to visual acuity reduction following trabeculectomy. In most cases this is transient with return to preoperative topography within 12 weeks.

Aged↗

Visual functions in a Swedish population of dyslexic and normally reading children.

Eighty-six 9-year old dyslexic children were carefully matched to controls with regard to age, sex, class in school, and intelligence and thorough visual functions tests and eye examinations were performed. As a group the dyslexic pupils exhibited a lower distance as well as near visual acuity both with monocular and binocular viewing. Furthermore, the dyslexic pupils had a lower contrast sensitivity at the lower and higher spatial frequencies. These differences were all statistically significant. However, no statistically significant differences between the two groups could be observed regarding refractive errors or contrast sensitivity in the middle spatial frequency range. Although some eyes were amblyopic, any severe eye anomalies or diseases were not found in any of the investigated children.

Child↗

Visual function in human ocular toxoplasmosis.

AIM: To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. METHODS: 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross-sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (> or =20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4 dB), moderate (mean defect 4-12 dB) or severe (mean defect >12 dB). RESULTS: 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. CONCLUSION: In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.

Adolescent↗

Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators.

OBJECTIVE: To test the reliability and validity of the 51-item Field Test Version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) across 5 common chronic eye conditions. DESIGN: Prospective observational cohort study of persons with 1 of 5 chronic eye diseases who were scheduled for nonurgent visits in ophthalmology practices or had low vision from any cause, and a reference sample of persons without eye disease. SETTING: Six university-based ophthalmology practices and the National Eye Institute Clinical Center, Bethesda, Md. PATIENTS: Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. Each of the 7 sites also enrolled persons in a reference sample. Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error. All eligible persons had to be aged 21 years or older, English speaking, and cognitively able to give informed consent and participate in a health status interview. MEASUREMENTS AND MAIN RESULTS: To provide the data needed to assess the reliability and validity of the 51-item NEI-VFQ, all subjects completed an interview that consisted of the 51-item NEI-VFQ, the Medical Outcomes Study 36-Item Short-Form Health Survey, and at least 1 measure of vision-targeted functional status. Estimates of internal consistency and test-retest reproducibility indicate that the 51-item NEI-VFQ is reliable. Tests of association with other scales and clinical variables support the construct validity of the survey. CONCLUSIONS: In this cross-sectional study, the 51-item NEI-VFQ seems to be reliable and valid and should be a useful tool for group-level comparisons of vision-targeted, health-related quality of life in clinical research. Additionally, the psychometric properties of the NEI-VFQ were not influenced by the type or severity of the underlying eye disease, suggesting that the measure will provide reproducible and valid data when used across multiple eye conditions.

Activities of Daily Living↗

RESIO revisited: visual function assessment and cataract surgery in British Columbia.

BACKGROUND: Cataract surgery in a population with mild levels of functional impairment was studied in the Regional Evaluation of Surgical Indications and Outcomes (RESIO) project. The RESIO investigators assessed the overall visual function assessment (VFA) score before and after surgery. In this study we reanalysed available RESIO data to better understand the findings for individual VFA items in this patient population. METHODS: We calculated effect sizes for longitudinal changes in each VFA item and for changes in overall VFA scores using the Mann-Whitney statistic. We considered effect sizes less than 0.3 as small, between 0.3 and 0.8 as moderate, and more than 0.8 as large. We compared differences in the individual VFA item scores before and after cataract surgery using a paired t test and Wilcoxon's signed-rank test. RESULTS: Of the 32 surgeons originally involved in the RESIO project, 18 (60%) agreed to have the data for their patients reanalysed. We found pre- and postoperative VFA data for 709 cataract operations (mean age of patients 73.4 years [standard deviation 9.4 years]; 60.7% women). Of the 47 people with a perfect preoperative VFA score, 28 (59.6%) had a perfect score postoperatively, 13 (27.6%) had a score of 90 or better, 5 (10.6%) had a score of 87 to 90, and 1 (2.1%) had a score of 67. Among the 200 people with a preoperative VFA score of 90 to 99, postoperatively the VFA score improved for 146 (73.0%), remained the same for 43 (21.5%) and worsened for 11 (5.5%). The mean scores for all individual VFA items improved postoperatively. The largest improvements were noted for "driving during the day" (effect size 1.1), "self-care activities" (0.8), "driving during the night" (0.5), "doing fine handiwork" (0.5), "reading newspaper or book" (0.4) and "participating in religious activities" (0.4). INTERPRETATION: The original conclusion from the RESIO project seems correct: based on VFA, the current threshold for cataract surgery in British Columbia is very low. Individual VFA items, particularly reading and night driving, are most strongly and consistently influenced by cataract surgery, regardless of overall VFA score. In the absence of visual acuity data, it is not possible to relate VFA to cataract surgical decision-making in British Columbia.

Activities of Daily Living↗

Evaluation of visual function following argon laser photocoagulation in central serous retinopathy.

The authors of previous studies on the role of photocoagulation for central serous chorioretinopathy (CSR) have based their deductions on the premise that a Snellen visual acuity of 6/6 is the end point of recovery. It is now known that patients with a visual acuity of 6/6 may have defective contrast sensitivity indicative of a visual function deficit. The present study was a prospective, controlled, and randomized evaluation of patients suffering from their first attack of CSR, in which contrast sensitivity was used to determine the effectiveness of argon laser photocoagulation as compared with more conservative treatment. Although long-term studies are necessary, the results of this study showed that while photocoagulation increases the rate of recovery for visual acuity, it is also linked with significant loss and slower recovery of contrast sensitivity.

Adult↗

Cortical connections and early visual function: intra- and inter-columnar processing.

While it is widely assumed that the long-range horizontal connections in V1 are present to support contour integration, there has been only limited consideration of other possible relationships between anatomy and physiology (the horizontal connections) and visual function beyond contour integration. We introduce the possibility of other relationships directly from the perspective of computation and differential geometry by identifying orientation columns in visual physiology with the (unit) tangent bundle in differential geometry. This suggests abstracting early vision in a space that incorporates both position and orientation, from which we show that the physiology is capable of supporting a number of functional computations beyond contour integration, including texture-flow and shading-flow integration, as well as certain relationships between them. The geometric abstraction emphasizes the role of curvature, which necessitates a coupled investigation into how it might be estimated. The result is an elaboration of layer-to-layer interactions within an orientation column, with non-linearities possibly implemented by shunting inhibition. Finally, we show how the same computational framework naturally lends itself to solving stereo correspondence, with binocular tangents abstracting curves in space.

Animals↗

Visual function in Vogt-Koyanagi-Harada patients.

BACKGROUND: Vogt-Koyanagi-Harada (VKH) disease presents with anterior segment inflammation, choroiditis and exudative retinal detachment. Following resolution of the inflammation, VKH patients have been noted to complain of visual disturbances despite good visual acuity. We therefore investigated the visual function deficits of convalescent VKH patients. METHODS: A cross-sectional observational nonrandomized controlled study of convalescent VKH patients from the Uveitis Service of the Singapore National Eye Centre, and normal subjects was performed. The best-corrected visual acuities (BCVA) and multifocal electroretinograms (mfERGs) of VKH patients with and without peripapillary atrophy (PPA) were compared with those of the normal eyes. The mfERG results were subdivided into those obtained from the peripapillary area and those from the rest of the macular. RESULTS: Eleven VKH eyes with large PPA to disc ratios (PPA/D ratio >2), 15 VKH eyes with PPA/D ratios<1 and 6 normal eyes were included in the study. Five eyes (54.5%) of VKH patients with PPA/D>2 had a BCVA of less than 20/40. All the other eyes had 20/20 vision. Nine of the 11 VKH eyes with PPA/D>2 also had large areas of chorioretinal atrophy. The mfERG responses of VKH eyes with PPA/D ratio >2 were markedly reduced in amplitude (p<0.001) and delayed in implicit time (p<0.001) throughout the entire macular area. VKH patients with PPA/D ratio<1 had significantly reduced mfERG amplitudes throughout the entire macular area, as well as delayed implicit times at the peripapillary region (p=0.026). Sub-division of VKH eyes with PPA/D<1 into eyes with no PPA and eyes with a small PPA, showed that both groups had a similar reduction in response amplitude over the entire macular region. However, the implicit time was significantly delayed in eyes with small PPA when compared to those without PPA (p<0.03). CONCLUSIONS: VKH patients with large PPA have clinically significant visual dysfunction. VKH patients without PPA also have subclinical retinal dysfunction. The mfERG may be a useful adjunct in the management of VKH by detecting early retinal damage.

Cross-Sectional Studies↗

Is thioridazine retinopathy progressive? Relationship of pigmentary changes to visual function.

Thioridazine toxicity has been described as a 'progressive chorioretinopathy', but this designation can be misleading. During the first year after thioridazine exposure retinal pigmentation evolves from a granular to a patchy or nummular appearance. However, visual function and the electroretinogram typically improve during this period. Some cases may show chorioretinal atrophy and functional loss many years later, but there is little evidence for ongoing drug-related progression. Late atrophy may represent degeneration of cells that were injured subclinically at the time of initial drug exposure. Although thioridazine toxicity produces an evolving pigmentary disturbance, functional changes must be monitored independently of fundus appearance.

Atrophy↗

The effects of hyperbaric oxygen on visual functions in ischaemic optic neuropathy.

The effects of hyperbaric oxygen therapy were studied in nine patients with non-arteritic anterior ischaemic optic neuropathy, who had been unsatisfactorily treated with corticosteroids. In four patients with signs of optic disc atrophy there was no improvement of visual functions after hyperbaric oxygen treatment, whereas in the other five patients, who had no signs of optic disc atrophy, visual acuity and visual field improved. The achieved improvements were maintained at a control examination six months later. Results suggest that hyperbaric oxygen might be a new remedy for the selected cases of non-arteritic ischaemic optic neuropathy and call for a controlled clinical study aiming to accurately assess its efficacy.

Aged↗

[Effects of nootropic agents on visual functions and lacrimal antioxidative activity in patients with primary open-angle glaucoma].

The paper presents the results of an investigation of the effect of the nootropic agents pantogam and nooclerine on visual functions in patients with primary open-angle glaucoma. These agents have been found to have a beneficial effect on the functional activity of the retina and optic nerve, light sensitivity, hemo- and hydrodynamics of the eye.

Aged↗

Lutein, but not alpha-tocopherol, supplementation improves visual function in patients with age-related cataracts: a 2-y double-blind, placebo-controlled pilot study.

OBJECTIVE: We investigated the effect of long-term antioxidant supplementation (lutein and alpha-tocopherol) on serum levels and visual performance in patients with cataracts. METHODS: Seventeen patients clinically diagnosed with age-related cataracts were randomized in a double-blind study involving dietary supplementation with lutein (15 mg; n = 5), alpha-tocopherol (100 mg; n = 6), or placebo (n = 6), three times a week for up to 2 y. Serum carotenoid and tocopherol concentrations were determined with quality-controlled high-performance liquid chromatography, and visual performance (visual acuity and glare sensitivity) and biochemical and hematologic indexes were monitored every 3 mo throughout the study. Changes in these parameters were assessed by General Linear Model (GLM) repeated measures analysis. RESULTS: Serum concentrations of lutein and alpha-tocopherol increased with supplementation, although statistical significance was reached only in the lutein group. Visual performance (visual acuity and glare sensitivity) improved in the lutein group, whereas there was a trend toward the maintenance of and decrease in visual acuity with alpha-tocopherol and placebo supplementation, respectively. No significant side effects or changes in biochemical or hematologic profiles were observed in any of the subjects during the study. CONCLUSIONS: Visual function in patients with age-related cataracts who received the lutein supplements improved, suggesting that a higher intake of lutein, through lutein-rich fruit and vegetables or supplements, may have beneficial effects on the visual performance of people with age-related cataracts.

Age Factors↗

Electrophysiologic testing of visual functions for vitrectomy candidates. I. Results in eyes with known fundus diseases.

A combination of various electrophysiologic tests--simultaneous recording of VER and ERG, EER, and single-flash ERG--is proposed to assess visual function in eyes being considered for vitrectomy. To establish the validity of the method, eyes of normal subjects and of some patients with clear media and types of ocular pathology often associated with opaque vitreous were tested. A higher stimulus threshold for VER than for ERG recorded simultaneously can be used to diagnose severe optic atrophy in eyes with opaque media. EER reflected the status of the retinal circulation and the function of the optic nerve, rather than the extent of the tractional retinal detachment in diabetic retinopathy. As electrical stimulation to the retina is little affected by opaque media, the EER can be a useful test in massive vitreous hemorrhage, diabetic retinopathy, and rhegmatogenous retinal detachment. Single-flash ERG was compared with ERG recorded with the response-summation technique. The b/a wave amplitude ratio in single-flash ERG was useful in assessing the middle layer of the retina in opaque media, whereas the latter technique, though useful when recorded simultaneously with VER, distorts the shape of the responses in such a way as to simulate the findings in retinal ischemia.

Diabetic Retinopathy↗

Visual function and the subsequent development of exudative age-related macular degeneration.

The eyes of 47 subjects with exudative age-related macular degeneration in the fellow eye were tested with a battery of visual function tests at baseline and followed for at least 18 mo. Fundus photographs also were obtained at baseline. These photographs were used to verify the absence of exudative lesions in the 47 eyes tested. Functional and funduscopic baseline data each were compared against outcome data obtained typically at 18 mo. The baseline data were analyzed for their ability to distinguish eyes that had developed detectable exudative age-related macular degeneration from eyes that had not. Eyes with relatively slow foveal dark adaptation rates despite low foveal quantum absorption capabilities (as inferred from the effects of test area on the Rayleigh color match) were especially likely to develop subretinal neovascularization. The resulting sensitivity/specificity and odds ratios were comparable to those of the most effective funduscopic risk indicators. Low S (blue) cone-mediated sensitivity also was associated with an exudative outcome.

Aged↗

The prism dissociation test in detecting unilateral functional visual loss.

The prism dissociation test is useful in quantifying visual acuity in an eye with functional unilateral visual loss, whether severe or mild in degree. A small vertical prism is used to induce diplopia of a 20/20 or larger size projected Snellen letter, and the patient is asked to comment on the quality of each image seen. The acknowledgement of diplopia and comments on the clarity of the dissociated images serve as testimony to the actual level of visual acuity in each eye. In one case, a patient feigned 20/50 visual acuity in one eye after trauma. The prism dissociation test confirmed visual acuity of 20/20 in that eye, as well as excluding an abnormality of contrast sensitivity. In another case, an amblyopic eye previously noted to have 20/30 visual acuity, which allegedly had acute severe visual loss, was documented to have 20/30 visual acuity by the prism dissociation test.

Diplopia↗