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PubMed1979

The effect of pupil size on visual acuity in uncorrected and corrected myopia.

The effect of pupil size on the relation between Snellen visual acuity and corrected and uncorrected myopia was examined for 22 young subjects with degrees of myopia ranging from 0.75 D to 7.5 D. Effective pupil size was varied by inducing mydriasis and then placing artificial pupils of between 1.0 and 8.0 mm diameter before the eye. Both a constant chart luminance of 120 cd/m2 and a constant retinal illuminance of 2150 trolands were used. There was little difference in results for the two lighting conditions. For the corrected myopes considered as a group, maximum visual acuity occurred for 2--3 mm diameter pupils, but larger pupils reduced acuity only marginally. For the uncorrected myopes, variation in pupil size produced a large variation in visual acuity, and for refractive errors greater than about 1.5 D, the optimum pupil diameter was less than 1 mm. For uncorrected myopes of 3.0 D or less, visual acuity was nearly as good with a 1-mm pupil as for corrected myopes. The presented data are a useful guide to the clinician.

Adult↗

PubMed1998

Relation between neurological status, refractive error, and visual acuity in children: a clinical study.

The aims of the present study were: (1) to determine the refractive status and visual acuity of a group of 75 neurologically impaired children (5 to 192 months of age); and (2) to investigate the relation between the visual and neurological status of these children. Refractive error was determined using non-cycloplegic near retinoscopy and visual acuity was estimated using acuity cards (Keeler or Cardiff) and pattern-onset visual evoked potentials (VEP). Subjects demonstrated a markedly different distribution of refractive error from that of a neurologically normal age-matched population. Refractive error anomalies were more prevalent in children older than 5 years, suggesting abnormal refractive development. A wide range of visual acuity was found with both tests (acuity cards, 0.07 to 2.08 logMAR; VEP, O.78 to 2.68 logMAR). Visual acuity and refractive status varied with level and type of physical impairment. Level of intellectual impairment exhibited a weak relation with visual status.

Adolescent↗

PubMed2002

Do junior house officers routinely test visual acuity and perform ophthalmoscopy?

UNLABELLED: Our objective was to assess junior house officer (JHO) practice of visual acuity testing and ophthalmoscopy in clerking patients. DESIGN: Cross-sectional questionnaire-based study using a standardised structured interview technique. SETTING: A Scottish university teaching hospital employing 65 JHOs. PARTICIPANTS: All medical and surgical JHOs from this hospital were interviewed over a three month period. MAIN OUTCOME MEASURES: Questionnaire-based data on the subjective responses studying current practice of visual acuity testing, and direct ophthalmoscopy with and without topical mydriatics. RESULTS: 18.5% and 4.6% of participants perform daily ophthalmoscopy and visual acuity testing respectively. Most do not routinely use the Snellen chart (80.0%) or topical mydriatics during ophthalmoscopy (75.4%). JHOs claimed these were not easily available in the wards. CONCLUSIONS: The majority of JHOs fail to test visual acuity or perform ophthalmoscopy in clerking patients. This study highlights the poor availability of Snellen charts, functioning ophthalmoscopes, and topical mydriatics in the wards. This warrants further investigation.

Hospitals, Teaching↗

PubMed2002

Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes.

OBJECTIVE: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. MAIN OUTCOME MEASURES: Visual acuity outcomes and intraocular pressure control after endophthalmitis. RESULTS: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31%) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31%) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: > or = 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and < 5/200 (64% versus 31%). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11%) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. CONCLUSIONS: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

Adult↗

PubMed2005

Visual acuity measurements using Fourier series harmonic analysis of videokeratography data in eyes after penetrating keratoplasty.

PURPOSE: Fourier harmonic analysis can decompose videokeratography data into spherical power, regular astigmatism, and irregular astigmatism (asymmetry and higher-order irregularity). The aim of this study was to evaluate whether determination of cylinder power by Fourier analysis facilitates measurements of visual acuity and refraction in eyes after penetrating keratoplasty. DESIGN: Cross-sectional study. PARTICIPANTS: Sixty-six eyes of 56 subjects who had undergone penetrating keratoplasty. METHODS: Spectacle-corrected visual acuity was measured in 2 ways: by the conventional and the Fourier methods. In the conventional method, the refraction was determined subjectively by reference to the measurement results of the autokeratometer and autorefractometer. In the Fourier method, the magnitude and axis of regular astigmatism were calculated by Fourier analysis of the videokeratography data, and spherical lenses were adjusted until best spectacle-corrected visual acuity was attained. MAIN OUTCOME MEASURES: Logarithm of the minimum angle of resolution (logMAR) visual acuity and refraction used for correction. RESULTS: The spectacle-corrected visual acuity obtained with the Fourier method (logMAR, 0.23+/-0.32; Snellen equivalent, 20/34) was significantly better than that attained with the conventional method (logMAR, 0.31+/-0.29; Snellen equivalent, 20/41; P<0.001, paired t test). The cylinder power used for spectacle-corrected visual acuity measurements was significantly lower with the Fourier method (-2.41+/-1.26 diopters [D]) than with the conventional method (-3.53+/-1.64 D; P<0.001). The spherical equivalent at the final refraction was not different between groups (P = 0.207). CONCLUSIONS: Fourier analysis of videokeratography data significantly facilitates determination of refraction and measurement of best spectacle-corrected visual acuity in eyes with corneal irregular astigmatism, such as eyes that have undergone penetrating keratoplasty.

Adolescent↗

PubMed2004

[Visual acuity testing in pre-school children: a comparison between the Sheridan-Gardiner test and the Räder (broken wheel) test].

PURPOSE: To evaluate the comparability between the well-established Sheridan-Gardiner test (SGT) and a new type of visual acuity test, called the Räder test (RT = broken wheel test) in pre-school children, and to compare test durations of these infant visual acuity tests. SUBJECTS AND METHODS: The RT consists of 16 cards with visus values of 0.16, 0.2, 0.25, 0.3, 0.5, 0.6, 0.8 and 1.0. One pair of cards depicting a car is used for testing. On one of the cards the car has intact wheels, on the other the wheels are incomplete, symbolized by a Landolt ring. The child must indicate, at a viewing distance of 3 meters, which of the wheels is incomplete. The SGT consists of seven visus plates: 5/60, 5/36, 5/24, 5/18, 5/12, 5/9 and 5/6. Each level is tested with one letter and can be repeated by the presentation of a further letter (A, H, O, T, U, V, X). The examination distance is 5 meters. The child must indicate, with reference to a card depicting all seven symbols, which letter the examiner is showing. The SGT and RT were performed in a randomized cross-over sequence in 30 children (20male, 10 female) of pre-school age (from 2 years up to and including the age of 5 years, mean 3.4 years +/- 0.77 SD, median 3.0 years). In all cases, the right eye was examined first. Examination duration was assessed for each acuity test, and for each eye separately with a stopwatch. The instruction time was not considered. The possible visual acuity values of both bests were replaced by a unified scale of visual acuity levels (ranging from 1 to 10). A difference of at least two levels was considered as relevant. The results were compared by means of the sign test at a significance level of 0.05. RESULTS: In particular, for higher visual acuity levels there were considerable differences, with SGT generally showing better results than RT: in 11 of 29 children, in both eyes RT values turned out to be at least 2 lines better than those obtained with SGT. The contrary situation, i. e., favoring SGT by more than 2 lines compared to RT, never occurred. According to the sign test, these differences were significant (p < 0.001). SGT revealed also clearly better visual acuity levels in those 22 children out of the 30, who exhibited differences by 2 lines or more in at least one eye (p < 0.001). The examination procedure with RT revealed problems in making the required directional decisions, especially between 2 and 4 years of age. This might interfere with the test interpretation and lead to distortion of the RT results. Total examination duration did not differ considerably between SGT (1.6 to 5.8 minutes, median 3.0 minutes) and RT (1.6 to 9.4 minutes, median 4.6 minutes), respectively. CONCLUSIONS: The Sheridan-Gardiner test generally shows better results than the new Räder (RT = broken wheel) test in pre-school children. Problems in making the required directional decisions may interfere with RT in this age group.

Bias↗

PubMed1997

Visual acuity scored by the letter-by-letter or probit methods has lower retest variability than the line assignment method.

PURPOSE: The optimal method for scoring visual acuity measures is unknown. Our goal was to determine, in a clinical setting, the method of scoring visual acuity with the lowest test-retest variability. METHODS: We investigated the effect of three different scoring methods using the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart comparing 32 patients with macular disease and 38 age-matched normal subjects. All subjects completed six repetitions of ETDRS charts. Three scoring methods were then used (line assignment, ETDRS or letter-by-letter and probit), the results were converted to log MAR values and the test-retest variabilities analysed. RESULTS: We found significant differences in variability among the three scoring methods (p < 0.0001). The variability was greatest with the line assignment method and less with the ETDRS and probit methods. The ETDRS and probit methods had similar variabilities. The difference in variability between normals and patients was not statistically significant. There were no differences in the calculated visual acuities among the three methods, only the variabilities. Using the ETDRS or probit methods, the within-test standard deviation was about 0.04 log MAR units (two letters). CONCLUSION: Test-retest variability of visual acuity measurements is lower using the ETDRS or probit methods than the traditional line assignment method.

Adult↗

PubMed2006

[Changes in diabetic retinopathy and visual acuity in patients with end-stage diabetic nephropathy after the introduction of hemodialysis].

PURPOSE: To study the diabetic retinopathy (DR) and visual acuity in patients with end-stage diabetic nephropathy in the predialysis period and the changes after the initiation of hemodialysis at Tokyo Postal Service Agency Hospital (TPSAH). METHODS: We retrospectively analyzed the systemic conditions and the stage of DR and visual acuity in the medical records, of 24 patients 48 eyes (male: female=20 : 4) with diabetic nephropathy, who were started on hemodialysis between June 1994 and August 2003 at TPSAH, and were followed ophthalmologically more than 6 months after the start of hemodialysis. RESULTS: At the start of hemodialysis, 46 of 48 eyes (95.8%) had already been treated by retinal photocoagulation. The DR activity was assessed as "low" in 62.5% of the patients at the start of hemodialysis, but 6 months later, over 95% of the patients were assessed as having "low-activity". At the start of hemodialysis visual acuity was less than 0.1 in 21% of the eyes, and over 0.7 in 42% of the eyes, and the ratio was stable in the follow-up period. In 2 eyes the stage of diabetic retinopathy became worse by more than one grade in Fukuda's grading of diabetic retinopathy, and in 4 eyes more than a 2 grade alteration in visual acuity was observed. CONCLUSIONS: After the start of hemodialysis, DR became less active relatively early, and only a few eyes became worse in visual acuity and DR.

Adult↗

PubMed2005

Effect of postoperative refractive error on visual acuity and patient satisfaction after implantation of the Array multifocal intraocular lens.

PURPOSE: To determine the ideal target refraction to optimize visual acuity (VA) and patient satisfaction after implantation of Array SA40N multifocal intraocular lens (IOL) (AMO). SETTING: Inha University College of Medicine, Incheon, Korea. METHODS: The study prospectively enrolled 188 eyes of 163 patients and assigned them to 1 of 3 groups according to their postoperative refractive status: Group 1 (43 myopic eyes, -0.50 diopter [D] to -1.50 D), Group 2 (114 emmetropic eyes, -0.50 D to +0.50 D) and Group 3 (31 hyperopic eyes, +0.50 D to +1.50 D). Uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), UCDVA under glare conditions, contrast sensitivity, and patient satisfaction were then compared between the 3 groups. RESULTS: Three months postoperatively, UCDVA, UCNVA, UCDVA under glare conditions, and contrast sensitivity were good in all eyes and more than 72% of patients never wore glasses for near vision. In Group 2, UCDVA was significantly better (0.74 +/- 0.20; P<.05) compared with Groups 1 and 3 (0.40 +/- 0.24 and 0.38 +/- 0.30, respectively); UCNVA was also significantly better in Group 2 (0.68 +/- 0.08; P<.05) than in Groups 1 and 3 (0.45 +/- 0.21 and 0.41 +/- 0.17, respectively). However, there were no significant differences in patient satisfaction, contrast sensitivity, and UCDVA under glare conditions between the 3 groups (P>.05). CONCLUSIONS: Aiming for emmetropia rather than myopia when calculating the power for the multifocal intraocular lens may improve visual acuity. However, patients must be considered on an individual basis to meet their expectations and requirements.

Adult↗

PubMed2000

Effect of ethanol on dynamic visual acuity during vertical body oscillation in healthy volunteers.

Visual orientation is the most important sensory input during locomotion (e.g. walking, driving a car, riding a bicycle). We investigated dynamic visual acuity (DVA) during vertical body-oscillations (amplitude 5 cm; frequency 1.5 Hz) in 12 healthy subjects before and twice after ethanol consumption. During oscillation, vertical eye movements were recorded under two test conditions: with eyes closed (EC) and during DVA testing. A significant increase in vertical eye-amplitude after ethanol ingestion occurred only during EC tests, as a possible sign of vestibular hyperreaction. During vestibular stimulation alone (EC), ethanol did not affect the phase shift between stimulus and eye movements. However, when the subjects were given an additional visual stimulus (DVA), the post-alcohol phase shift rose significantly. Surprisingly, the post-alcohol phase shift values for the two test conditions showed no significant differences. After ethanol ingestion we found no changes in static visual acuity but a significant loss of DVA. Volunteers with a change of DVA threshold (DVAT) showed significantly (P = 0.004) higher post-alcoholic changes in the phase shift. In summary, low doses of ethanol disturbed the visually guided oculomotor response during fixation of an earth-fixed target while the observer was subject to linear vertical acceleration. This effect led to an increasing delay between the beginning of body and eye movements. The consequence was an increasing phase shift and thus a decrease in DVA during whole-body oscillation which was comparable to movements during human locomotion.

Acceleration↗

PubMed2003

High- and low-contrast visual acuity measurements in spherical and aspheric soft contact lens wearers.

Visual reduction produced by spherical aberration is not always apparent with high-contrast optotypes, therefore, a measure of low-contrast visual acuity (LCVA) may be more revealing. In theory, by applying a series of curves to produce an aspheric surface, one should be able to reduce the defocus resulting from spherical aberration. This clinical investigation sought to evaluate high- and low-contrast visual acuity under natural conditions using the CooperVision Frequency 55 spherical and aspheric planned replacement soft contact lenses (CLs). The objective outcome showed no statistically significant difference between the spherical or aspheric design lenses for high- or low-contrast visual acuity. However, based on subjective outcomes, this study implies a 2:1 preference for the aspheric design lens, suggesting the consideration of individual corneal topography and the importance of diagnostic lens fitting for patient satisfaction.

Journal Article↗

PubMed1991

Visual acuity recovery rates following cataract surgery and implantation of soft intraocular lenses.

To determine whether eyes receiving soft optic lens implants had faster visual recovery times than eyes receiving firm optic lens implants, we calculated the visual acuity recovery rates following our standard cataract operation. Visual acuity of 20/50 or better without correction was obtained in 31% of eyes on the first day following surgery, 55% at one week, 74% at three weeks, and 89% at six weeks and three months. Fifty best-case soft optic lens implant cases were reviewed and their visual recovery rates were calculated. There were no statistically significant differences in the visual acuities without correction at any follow-up point. There was a slightly significant difference at one week with correction and a significant difference at three weeks with correction favoring the soft lens/small incision group. Because optical correction is generally not provided on these visits, we conclude that soft lens implants with small incisions did not provide clinically significant improvement in visual acuity recovery over our standard cataract procedure.

Cataract Extraction↗

PubMed2001

Effect of laser in situ keratomileusis correction on contrast visual acuity.

PURPOSE: To evaluate the changes in contrast visual acuity (CVA) based on the amount of myopic correction with laser in situ keratomileusis (LASIK). METHODS: In this prospective study, patients with myopia ranging from -2.0 to -14.0 diopters (D) were divided into 2 groups: those with myopia less than -6.0 D (n = 20) and those with myopia greater than -6.0 D (n = 13). The CVA was measured preoperatively and 1 week and 1 and 3 months postoperatively using Variable Contrast Visual Acuity Charts. RESULTS: The patients with less than -6.0 D of myopia had a CVA decrease of 15% 1 week postoperatively, which recovered by 1 month, and a decrease of 2.5% 1 week and 1 month postoperatively, which recovered by 3 months. The patients with more than -6.0 D of myopia had a decrease of 15% and 2.5% at all postoperative times. CONCLUSIONS: After LASIK to correct myopia of greater than -6.0 D, there may be a persistent decrease in intermediate and low CVA. Patients should be informed preoperatively of this possible decrease in CVA.

Adult↗

PubMed1993

[The relationship between the developmental change in visual acuity measurements and change of refractive error in young infants].

219 normal infants aged 3 to 36 months were tested to investigate the relationship between the development of visual acuity and the change of refractive error. 17 infants were tested over a period of time. Visual acuity was assessed by Teller Acuity Cards (TAC), and refractive error was measured by an infrared video refractor (PR1000) without cycloplegics. The results were as follows. 1) The success rate of both tests in 3 to 6 month-old infants was higher than in infants aged 11 to 14 months and 23 to 36 months. 2) Visual acuity showed a rather slow development in infants aged 3 to 12 months. 3) With-the-rule astigmatism of 1 diopter (D) or more occurred with a high incidence in the 3 to 8 month old infants, and decreased with age. 4) The visual acuity in the infants with astigmatism was no different than in those without it. 5) The slow developmental curve of visual acuity measured in 3 to 12-month old infants was probably the result of psychological aversion to the TAC.

Age Factors↗

PubMed1985

Eccentric visual acuity in patients with macular disease.

A series of cards each containing a two dimensional array of identical Snellen "E's" was used to determine best eccentric visual acuity in patients with macular disease having Snellen visual acuity of 20/70 or worse. Each "full field E" card simultaneously presents the same letter to foveal and parafoveal areas. This test can therefore determine quickly if potentially useful vision is present in any area of the central visual field. In our study of 37 eyes, 70% demonstrated potential visual acuity at least two times better than visual acuity measured by conventional methods, and 20% demonstrated at least a fourfold improvement. This suggests that most patients with macular disease do not spontaneously employ their best remaining area of retina for fixation.

Aging↗

PubMed1990

[Measuring contrast sensitivity using visual acuity tests in retinal and optic nerve diseases].

The luminance contrast needed to discern various test types was measured with monochromatic and achromatic light to detect discrete functional deficiencies of the retina and optic nerve in cases of normal visual acuity. Landolt rings corresponding to visual acuity levels from 0.04 to 1.0 were used as test types. A significant increase in the necessary minimum contrast was detectable with blue test light on large Landolt rings in patients with diabetic retinopathy, ocular hypertension and glaucoma and with green or yellow test light on medium-sized and small Landolt rings in patients with central serous chorioidopathy and optic atrophy. The additional contrast needed to reach the maximum visual acuity amounts to 14-100% compared with normal visual acuity, depending on the color of the test light and the diagnosis. The amount of contrast needed is greatest in retinal diseases, and it is therefore possible to a certain extent to distinguish these from diseases of the optic nerve.

Humans↗

PubMed2004

Quantitative ultrasound at the hand phalanges in subjects with poor visual acuity.

OBJECTIVE: The aim of the study was an assessment of skeletal status in a group of subjects with impaired vision. METHOD: 91 subjects with poor visual acuity (44 males, mean age: 61.4 +/- 10.9 years and 47 females, mean age: 61.3 +/- 16.8 years) were evaluated and compared with age-matched normal, healthy population (230 males and 964 females). Patients were recruited from members of Polish Blind Association and subjects living in a nursing home. In both patients and controls any reasons (medications or diseases) known to affect bone metabolism were not present. Skeletal status was assessed using the DBM Sonic 1200 (IGEA, Carpi, Italy) which measures amplitude-dependent speed of sound (Ad-SoS, m/s) at the hand phalanges. Binocular visual acuity was established using a Snellen chart. RESULTS: Mean binocular visual acuity was in males 0.09 +/- 0.14 and in females 0.179 +/- 0.2 and was significantly lower in males (P < 0.01). Place of stay (community or nursing home), previous fractures, and kind of work did not affect skeletal measurements. Ad-SoS, T-score, and Z-score in male patients were 1993 +/- 74 m/s, -1.89 +/- 1.05, and -0.97 +/- 1.03, respectively and were significantly higher than in male controls (1968 +/- 69 m/s, -2.25 +/- 0.99, and -1.29 +/- 0.92; P < 0.05. Ad-SoS, T-score, and Z-score in female patients were 1946 +/- 103 m/s, -2.54 +/- 1.5, and -0.7 +/- 1.05, respectively and did not differ significantly in comparison with data in control females (1946 +/- 75 m/s, -2.54 +/- 1.07, and -0.6 +/- 0.78). In both genders visual acuity did not correlate with Ad-SoS values. CONCLUSION: The association between poor visual acuity and skeletal status assessed by quantitative ultrasound (QUS) is dependent on gender and in females does not differ from controls; in males ultrasound parameter measured is even significantly higher than in male controls.

Accidental Falls↗

PubMed2003

Threshold visual acuity testing of preschool children using the crowded HOTV and Lea Symbols acuity tests.

PURPOSE: To compare the testability and threshold acuity levels for very young children on the crowded HOTV logMAR distance visual acuity test presented on the BVAT apparatus and the Lea Symbols logMAR distance visual acuity chart. METHODS: Subjects were 87 Head Start children from age 3 to 3.5 years. Testing consisted of binocular pretraining at near using a lap card as needed, binocular pretraining at 3 m, and threshold testing for each eye. The testing procedure, adapted from the Amblyopia Treatment Study, presented optotypes until the child was unable to correctly name or match three of three or three of four optotypes of a given size. Threshold acuity was the smallest size for which at least three optotypes were correctly identified. RESULTS: Both near and distance pretraining were completed by 71% of children for HOTV and by 75% for Lea Symbols (P =.39). The distribution of threshold acuities differed between the two tests. For the 69 eyes of 53 children who were successfully tested with both optotypes, results from the crowded HOTV acuity test were on average 0.25 logMar (2.5 lines) better than those from the Lea Symbols acuity test (P <.001). CONCLUSIONS: The proportion of children between 3 and 3.5 years of age whose monocular visual acuity could be assessed was high and was similar for the two charts tested. Crowded HOTV acuity results were better on average than results using Lea symbols. The different formats of the two tests may explain the observed differences in threshold acuity level.

Amblyopia↗