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[Physiologic principles of studying visual functions].

The retinal coding system for visual information comprises three important steps: 1) hyper- and depolarization of the sensory cells as the active basis for perception of light and dark; 2) reaction solely to changes in the bipolar cell on/off system, as a consequence of the action of the horizontal cells with the receptive fields, as a basis for adaptation to brightness and glare; and 3), under the influence of the amacrine cells, important time-space functions as a basis for visual perception of movement. The signal form, which changes over from analog to digital in the ganglion cell system, also results from this last step. therefore, both latencies and amplitudes (VEP) are important criteria for long signal response paths. Taking the examples of "statistical perimetry", visual acuity testing, and examination of contrast sensitivity, clinically relevant methodological problems from signal detection theory are illustrated: there are no "certain" measured values. This uncertainty and the age-dependence of normal values make it difficult to identify pathologic conditions, though trend analyses can help. As the sizes of the retinal areas examined by these methods differ so widely, correlations between the various examination methods are theoretically possible; but one method can never be substituted by another. In routine practice, to detect pathology early, one will sometimes deviate from the prescribed examination method (vision tests with low contrast for visual acuity).

Dark Adaptation↗

Visual function and brain organization in non-decussating retinal-fugal fibre syndrome.

Functional neuroimaging, psychophysical and electrophysiological investigations were performed in a patient with non-decussating retinal-fugal fibre syndrome, an inborn achiasmatic state in which the retinal projections of each eye map entirely to the ipsilateral primary visual cortex. Functional magnetic resonance imaging (fMRI) studies showed that for monocularly presented simple visual stimuli, only the ipsilateral striate cortex was activated. Within each hemisphere's striate cortex, the representation of the two hemifields overlapped extensively. Despite this gross miswiring, visual functions that require precise geometrical information (such as vernier acuity) were normal, and there was no evidence for the confounding of visual information between the overlapping ipsi-lateral and contralateral representations. Contrast sensitivity and velocity judgments were abnormal, but their dependence on the orientation and velocity of the targets suggests that this deficit was due to ocular instabilities, rather than the miswiring per se. There were no asymmetries in performance observed in visual search, visual naming or illusory contour perception. fMRI analysis of the latter two tasks under monocular viewing conditions indicated extensive bilateral activation of striate and prestriate areas. Thus, the remarkably normal visual behavior achieved by this patient is a result of both the plasticity of visual pathways, and efficient transfer of information between the hemispheres.

Adolescent↗

Ocular toxicity due to chloroquine and hydroxychloroquine: electrophysiological and visual function correlates.

Chloroquine (CQ) and hydroxycholorquine (HCQ) have been used widely for the treatment of rheumatoid arthritis and other similar inflammatory diseases since the early 50s. They remain the treatment of choice for many patients even today. Significant, either reversible or irreversible central visual loss associated with the drugs is very rare, but an important side effect that can warrant discontinuation of therapy. Early diagnosis of toxicity and evaluation of the visual function are, therefore, important parts of the treatment process. Various electrophysiological and psychophysical tests have been and are used for the detection, follow-up and prognosis of drug-associated central visual loss. A summary and comment on the tests, with emphasis on the use of more recently developed methods, such as the multifocal electroretinography (mfERG), are presented in this review.

Animals↗

[The importance of an in-depth study of visual functions in patients with a traumatic carotid-cavernous fistula].

As many as 78 patients with traumatic carotid-cavernous fistula were examined. Apart from routine clinical examination we determined th flickering fusion frequency, pupil cycle time; we employed visocontrastoperimetry and fluorescent angiography to identify early disturbances in visual functions and allow some judgement about time course of changes in the preoperative and postoperative course of the condition. This should help us in dealing efficiently with visual disorders.

Arteriovenous Fistula↗

Relationship of measures of frailty to visual function: the Beaver Dam Eye Study.

PURPOSE: To investigate the association of standard measures of frailty to visual acuity and contrast sensitivity. METHODS: Time to walk a measured course, handgrip strength, peak expiratory flow rate, ability to stand from a sitting position without using arms, best-corrected visual acuity, and contrast sensitivity were assessed at the third examination (1998-2000) of the Beaver Dam Eye Study. The study is population-based with the initial census in 1988-1990. RESULTS: All measures of frailty and vision were significantly associated with age (poorer function at older ages). In general, women had poorer function than men in each age category. An "index of frailty" consisting of highest quartile (slowest) gait time, lowest quartile of peak expiratory flow rate, lowest quartile of handgrip strength, and inability to stand from sitting in one try (for those not in a wheelchair) was constructed for women and men. A score of 0 was the minimum amount of frailty, while a score of 4 indicated the maximum amount. Controlling for age, those with no evidence of frailty (score = 0) were likely to have the best visual acuity and best contrast sensitivity, while those with maximum evidence of frailty (score = 4) were likely to have poorest visual acuity and contrast sensitivity. CONCLUSION: Greater frailty was associated with poorer visual functions. Including a measure of visual function when assessing frailty may improve upon the usefulness of an index of frailty in predicting incidence of chronic systemic diseases and survival.

Adult↗

Topical dorzolamide increases pericentral visual function in age-related maculopathy: pilot study findings with short-wavelength automated perimetry.

PURPOSE: Numerous studies have confirmed the enhancement of ocular circulation by carbonic anhydrase inhibitors (CAIs). Topical CAI treatment with dorzolamide averts the significant pericentral visual function loss accompanying retinal and choroidal vasoconstriction during acute hyperventilation-induced hypocapnia. This study was designed to discern whether dorzolamide might similarly enhance macular function in patients with age-related maculopathy (ARM). METHODS: In a masked, placebo-controlled study, 40 patients with ARM and acuity > 20/50 were randomized to receive either dorzolamide or placebo for 12 weeks, thrice daily. After pre-study perimetric training, pericentral function (mean sensitivity) was quantified using Humphrey 10-2 short-wavelength automated perimetry (SWAP), before and after 12 weeks of topical therapy. RESULTS: Dorzolamide-treated eyes demonstrated a significant increase in mean sensitivity of + 1.55 dB (p = 0.04); placebo-treated eyes showed no significant change (+ 0.58 dB; p = 0.10). Given the non-significant increase of mean sensitivity in the placebo-treated group, fewer than 100 subjects per group would be required to afford > 70% power to yield a significant direct comparative difference between treatment and placebo in a prospective, randomized study of equally short duration. CONCLUSIONS: This study demonstrated a significant increase in short-wavelength sensitivity in ARM with dorzolamide and the lack thereof with placebo. These encouraging pilot study data suggest a potential role for topical CAIs in ARM patients, and establish objective parameters for prospective studies to further evaluate the effects of dorzolamide in ARM.

Administration, Topical↗

Gyrate atrophy of the choroid and retina: improved visual function following reduction of plasma ornithine by diet.

In a patient with gyrate atrophy of the choroid and retina, an arginine-deficient diet has reduced plasma ornithine concentration fivefold during the past 20 months. Subjective improvement in her visual function was noted approximately 15 months after institution of her diet. This has been documented by improvements in the electroretinogram, dark-adaptation, and color vision. The improvement involves rod and, to a lesser extent, cone function. The results, although preliminary and limited to a single patient, suggest that reduction of plasma ornithine with a low arginine diet is beneficial in this disease.

Adult↗

Orthoptic effects on accommodation and related visual functions in an adult alternating esotrope.

Orthoptic therapy was instituted in an adult, alternating esotrope with asthenopia who exhibited inaccurate static accommodative responses with adequate, clinically determined, accommodative facility. During and following therapy the patient showed considerable improvement in accommodative accuracy and related visual functions, such as contrast sensitivity, in the absence of any change in strabismic deviation. This case provides the first laboratory documentation of orthoptic effects on accommodation in an adult strabismic.

Accommodation, Ocular↗

Rejuvenation of visual functions in older adult drivers and drivers with cataract during a short-term administration of N-acetylcarnosine lubricant eye drops.

The purpose of this study was to examine using the original halometer glare test of the type of visual impairment mediated by the increased glare sensitivity (halos) and associated with poorer visual function in both the better and worse eyes of older adult drivers and older drivers with cataract. The clinically validated (by Innovative Vision Products Inc.) formula of 1% N-acetylcarnosine (NAC) lubricant eye drops were applied topically to the eyes of older drivers to reduce glare disability and improve distance acuities for driving. This was a randomized, double-blind, placebo-controlled study. The examined subjects consisted of 65 older adults with cataract in one or both eyes, and 72 adult drivers who did not have cataract in either eye. In the control group, comparison with baseline values showed some variability of data in gradual worsening of glare sensitivity at red and green targets and minimal VA changes over 4 months. In the NAC-treated group, 4-month follow-up generally showed an improvement in VA and a significant improvement in glare sensitivity at red and green targets was documented in worse and better eyes using a critical cut point halometer score for driving. The NAC-treated eyes had statistically significant difference in VA, glare sensitivity compared with the control group ( p < 0.001) at 4-month timepoint of treatment, as supported by the overall t-test results of the ratio of the follow-up data to the baseline values. Tolerability of NAC eyedrops was good in almost all patients, with no reports of ocular or systemic adverse effects. It would be advisable for traffic safety if a Halometer glare sensitivity test was implemented for vehicles and/or was regularly added to the requirements for a driver's licence. The results of this study provide a substantial basis for further evaluation of NAC in the treatment and prevention of vision impairment in the older population of drivers for legal driving. The developed ophthalmic drug NAC formula showed potential for the non-surgical treatment of age-related cataracts.

Aged↗

Video display units and visual function.

The widespread use of visual display units (VDU) in the workplace has engendered visual complaints and concern for workers' health and safety. The detectable levels of radiation emitted from VDUs have been well below safety levels and exposure to VDUs does not appear to cause any organic damage to the eye. However, visual disturbance and eye discomfort affects many workers using VDUs, and these symptoms may be alleviated by a number of measures, including proper diagnosis of pre-existing ocular problems, use of special eyeglasses, and correct arrangement of lighting and furniture in the work area.

Cataract↗

Assessing visual function in children younger than 1 1/2 years with normal and subnormal vision: evaluation of methods.

PURPOSE: Methods for detecting subnormal vision early in life are needed to adequately diagnose the condition and begin treatment and rehabilitation. METHODS: Forty-six children ages 1 month to 1 1/2 years with either assumed normal vision, visual impairment due to eye disease, or strabismus were examined with the following tests: Stycar rolling balls; preferential looking (Teller acuity cards); and the ability to detect raisins, puffed rice, and sugar strands on two different backgrounds, one white and one black. RESULTS: Children with visual impairment and strabismus often showed normal values for their age, and children with assumed normal vision sometimes had values below those established for normal development of vision with the Stycar rolling balls and the Teller acuity cards. CONCLUSIONS: It is not possible to use these tests to reliably differentiate among normal vision, visual impairment, or strabismus in children younger than 1 1/2. Not until recognition acuity, symbols, or letters can be tested can reliable results be obtained. However, the tests are useful to estimate the general visual function of children in this age group.

Contrast Sensitivity↗

Psychometric properties of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), Japanese version.

BACKGROUND: The importance of evaluating the outcomes of health care from the standpoint of the patient is now widely recognized. The purpose of this study is to develop and test a Japanese version of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25). METHODS: A Japanese version was developed with a previously standardized method. The questionnaire and optional items were completed by 245 patients with cataracts, glaucoma, or age-related macular degeneration, by 110 others before and after cataract surgery, and by a reference group (n = 31). We computed rates of missing data, measured reproducibility and internal consistency reliability, and tested for convergent and discriminant validity, concurrent validity, known-groups validity, factor structure, and responsiveness to change. RESULTS: Based on information from the participants, some items were changed to 2-step items (asking if an activity was done, and if it was done, then asking how difficult it was). The near-vision and distance-vision subscales each had 1 item that was endorsed by very few participants, so these items were replaced with items that were optional in the English version. For example, more than 60% of participants did not drive, so the driving question was excluded. Reliability and validity were adequate for all subscales except driving, ocular pain, color vision, and peripheral vision. With cataract surgery, most scores improved by at least 20 points. CONCLUSION: With minor modifications from the English version, the Japanese NEI VFQ-25 can give reliable, valid, responsive data on vision-related quality of life, for group-level comparisons or for tracking therapeutic outcomes.

Adult↗

Relocation of specific visual functions following damage of mature posterior parietal cortex.

Many visual deficits have been reported following damage to specific cerebral sites within posterior parietal cortex. These deficits generally involve aspects of vision including spatial or motion perception and visuomotor control. One characteristic of many of these deficits is that they tend to attenuate over time. Presumably, other cortical regions possess adaptive neuroplastic mechanisms that allow them to accommodate functions that were previously dominated by the damaged region. This report summarizes a series of experiments that examined adaptive cortical plasticity following cerebral cortex damage sustained in maturity. Following bilateral lesions of posterior middle suprasylvian sulcal (pMSs) cortex in the cat, deficits were identified in both visual orienting and landmark discrimination tasks. However, the deficits on the visual orienting task were only profound for the first few days following the lesion and orienting abilities returned to normal levels within the first 2 weeks postlesion. In contrast, no such attenuation of the effect of the lesion was evident on the landmark discrimination task. Following recovery of function on the visual orienting task, individual cortical areas flanking the lesion were bilaterally deactivated with cooling. Reversible deactivation of anterior middle suprasylvian sulcal (aMSs) cortex, but none of the other adjacent cortices, yielded visual orienting deficits that are not found in intact animals during deactivation of aMSs cortex. Therefore, we concluded that the visual orienting functions normally mediated by pMSs cortex were able to relocate to aMSs cortex following lesion of pMSs cortex. Finally, bilateral lesion of both pMSs and aMSs cortices yielded visual orienting deficits that did not attenuate. Overall, this series of experiments demonstrates that certain visual functions may relocate to specific cortical loci following damage to discrete areas within posterior parietal cortex.

Animals↗

[Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation].

OBJECTIVE: To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. METHODS: 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. RESULTS: BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. CONCLUSIONS: Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

Adolescent↗

In situ measurements of lens fluorescence and its interference with visual function.

Irradiation of the primate lens by near-ultraviolet wavelengths results in a blue fluorescence, which can be an intraocular source of veiling glare. This study quantitated the fluorescence intensity as a function of exciting intensity and wavelength. As the exciting wavelength was increased from 360 to 430 nm, the decreasing fluorescence intensity (for equal radiant exposures) was partially offset by a shift in the fluorescence spectrum to wavelengths of greater luminous efficiency so the luminance of the lens fluorescence remained approximately constant. The measured luminance of the lens fluorescence was high enough to imply degradation of visual function as a result of reduced contrast of the retinal image. To obtain an objective measure of visual deficit associated with the fluorescent glare, the visual evoked potential (VEP) elicited by counterphased sine-wave gratings was recorded while the subject eye was continuously exposed to the 413 nm emission from a krypton laser. The VEP amplitude was reduced in the presence of the exciting laser even at levels defined as "safe" (ie, where exposure levels are insufficient to induce an acute ocular lesion). Because the direct glare effect of the exciting radiation was negligible in this experiment, the VEP response loss is attributed to the effect of the lens fluorescent glare.

Animals↗

Transcranial magnetic stimulation as an investigative tool in the study of visual function.

Transcranial magnetic stimulation (TMS) is a novel and powerful probe to study the relationship between human brain function and behavior. TMS is being widely used to investigate memory, language, attention, learning, and motor function and is even being utilized therapeutically in the treatment of depression. Some of the earliest applications of TMS have been directed toward the investigation of human visual perception. For example, a strong TMS pulse delivered to the occipital cortex in a sighted or even blind individual can evoke the sensation of perceiving light (visual phosphenes). TMS can also be used to suppress visual perception and investigate the timing of visual information processing. Furthermore, the functional connectivity between different brain areas can be mapped using TMS, thus establishing a causal link between visual cortical function and visual perception. The present article is meant as an overview of the technique of TMS and a review of the literature as it pertains to the study of visual function. The application of TMS in the diagnosis as well as possible therapeutic use in various visual disorders is also discussed.

Electromagnetic Fields↗

A randomised controlled trial investigating the effect of nutritional supplementation on visual function in normal, and age-related macular disease affected eyes: design and methodology [ISRCTN78467674].

BACKGROUND: Age-related macular disease is the leading cause of blind registration in the developed world. One aetiological hypothesis involves oxidation, and the intrinsic vulnerability of the retina to damage via this process. This has prompted interest in the role of antioxidants, particularly the carotenoids lutein and zeaxanthin, in the prevention and treatment of this eye disease. METHODS: The aim of this randomised controlled trial is to determine the effect of a nutritional supplement containing lutein, vitamins A, C and E, zinc, and copper on measures of visual function in people with and without age-related macular disease. Outcome measures are distance and near visual acuity, contrast sensitivity, colour vision, macular visual field, glare recovery, and fundus photography. Randomisation is achieved via a random number generator, and masking achieved by third party coding of the active and placebo containers. Data collection will take place at nine and 18 months, and statistical analysis will employ Student's t test. DISCUSSION: A paucity of treatment modalities for age-related macular disease has prompted research into the development of prevention strategies. A positive effect on normals may be indicative of a role of nutritional supplementation in preventing or delaying onset of the condition. An observed benefit in the age-related macular disease group may indicate a potential role of supplementation in prevention of progression, or even a degree reversal of the visual effects caused by this condition.

Clinical Trial↗

Monitoring of visual function during parasellar surgery.

Damage to the visual system is an unfortunate complication of surgery in the area of the optic chiasm. It is now possible tomonitor the functional status of the visual system intreoperatively at regulat intervals. This is accomplished by recording the Visual Evoked Response to flashes of light from light-emitting-eiodes. These diodes are embedded in a special plastic shell which inserts under the eye lids of each eye. Since the light comes from the diodes in the plastic shell, there is no need to disturb the surgical procedure when a test run is desired. A record is obtained by averaging 100 three-per-second flashes.

Adenoma, Acidophil↗