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Effect of natural deprivation and unilateral eye patching on visual acuity of infants and children. Evoked potential measurements.

Evoked potential measurements of visual acuity were made on four children aged from 5 months to 8 years. They were deprived of normal visual stimulation by various disorders: unilateral aphakia from a congenital cataract, vitreous hemorrhage, polar cataract, and esotropia. In the two younger children, aged 5 and 15 months, respectively, the visual acuity improved when the eye had good optical imagery and declined with poor or no imagery. Reversal of the imagery to the contralateral eyes again brought large changes in opposite directions. In the two older children, aged 4 and 8 years, respectively, there were marked decreases in acuity in the patched eye, but little or no change in the unpatched eye. It is not know whether these differences are due to age or to the original kind of visual disorder, such as deprivation, occlusion, or strabismus, or are merely individual differences. It is clear, however, that some children exhibit large changes in acuity in response to visual deprivation or patching, or to its removal, in a readily reversible manner. Also, we have demonstrated that visually evoked potential acuities may be obtained from pediatric, clinical patients without regard to age, which may be useful in management of the conditions.

Animals↗

Visual acuity following treatment of bilateral congenital cataracts.

Several studies have indicated that operation during the first months of life in children with dense congenital cataract improves the final visual acuity. In the current study seven otherwise healthy children operated on before the age of fifty-six days are compared with seven children operated on after the age of three months. The patients were followed by a team consisting of a paediatric ophthalmologist, a contact lens optician and an orthoptist. They were treated with contact lenses, spectacles with near addition and occlusion therapy when needed. Visual acuity was initially tested with preferential looking technique and later with Snellen optotypes. In the early treated group the visual development was almost normal with a final visual acuity of 20/20, while in the late treated group no patient obtained better visual acuity than 20/100. The findings indicate that dense congenital cataract should be treated before the age of three months.

Age Factors↗

Repeatability of the Waterloo Four-Contrast LogMAR Visual Acuity chart and Near Vision Test card on a group of normal young adults.

PURPOSES: To investigate the repeatability of logMAR visual acuity (VA) with the Waterloo Four-Contrast LogMAR Visual Acuity (FCLVA) chart and the Near Vision Test (NVT) card. The differences and agreements between near logMAR VA using horizontally- and vertically-presented letters were also determined. METHODS: Visual acuity of one eye (55 subjects) was first assessed by using the FCLVA chart, comprising four charts of varying contrast, and then with the NVT card (comprising four charts of two contrasts and two presentations). Measurements were repeated after 3 or 4 weeks. RESULTS: No significant between-visit differences were observed for any of the charts used. The repeatability coefficient for the distance 90, 60, 30 and 10% charts were 0.07, 0.11, 0.15 and 0.16 log units, respectively. The repeatability coefficients of the near vision charts were 0.06, 0.04 (high contrast), 0.11 and 0.10 (low contrast) log units. The agreements between horizontally- and vertically-presented letters were good. The differences were similar to the repeatability coefficient of each chart. CONCLUSIONS: The repeatability coefficient of the high contrast distance and near chart was about half a line. Repeatability coefficients increase with decreasing contrasts for both distance and near charts, with coefficients of one line or more for low contrast charts. Variabilities in both distance and near VA increase with decrease in contrast. The presentation of the letters does not affect near VA and the agreement between horizontally- and vertically-presented letters (both high and low contrast) was within the repeatability coefficient of each chart.

Adult↗

Visual acuity related to retinal distance from the fovea in macular disease.

The visual potential of patients with macular diseases involving the fovea has not been adequately documented. We evaluated 55 eyes of patients having discrete macular lesions and related best visual acuity to retinal distance from the fovea. Best visual acuity in the parafoveal area extending from the center of the fovea to a distance of 0.25 disk diameters (DD) away was 20/25 to 20/50; from 0.25 to 0.5 DD, 20/50 to 20/100; from 0.5 to 0.75 DD, 20/100 to 20/200; from 0.75 to 1.0 DD, 20/200 to 20/400; and greater than 1.0 DD, counting fingers. The clinical importance of the findings as they relate to the rationale of laser treatment of macular lesions and to the evaluation of the low-vision is discussed.

Adult↗

Vertical dynamic visual acuity in normal subjects and patients with vestibular hypofunction.

OBJECTIVE: This study was designed to measure visual acuity during active vertical head movement and to examine its relationship to subjective reports of oscillopsia. STUDY DESIGN: This was a prospective, clinical study. SETTING: The study was performed in a tertiary, ambulatory referral center. PATIENTS: Thirty normal subjects, 13 patients with unilateral vestibular hypofunction, 11 patients with bilateral vestibular loss, and 10 patients with nonvestibular dizziness were examined. Vestibular loss was confirmed with caloric or rotary chair testing. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Reliability, sensitivity, and specificity of a computerized test that measures visual acuity during active vertical head movement. Subjective complaint of oscillopsia was measured by use of a visual analog scale. RESULTS: The active vertical head movement test was reliable both for normal subjects (intraclass correlation coefficient, r = 0.89) and for patients with dizziness (intraclass correlation coefficient, r = 0.94). Age contributed significantly to active vertical head movement in normal subjects and in patients with dizziness over the age of 46 years but not in younger subjects. Older subjects had a decrement in active vertical head movement compared with younger subjects. Subjective reports of oscillopsia did not correlate positively with active vertical head movement. CONCLUSION: The active vertical head movement test is a reliable measure of visual acuity during active vertical head motion. The effect of age on active vertical head movement may reflect the physiologic impact of neuronal loss with aging. The poor correlation between active vertical head movement and reports of oscillopsia may be caused by the predictability of head movements during the active vertical head movement test compared with the unpredictability of head movements during walking.

Adult↗

Visual acuity at different retinal loci of eccentrically fixating functional amblyopes.

Visual acuity was measured in eccentrically fixating amblyopic subjects to determine the contribution of sensory (inhibitory) and motor (retinal-locus) components of the acuity loss. A unique aspect of this research involved the subjects' use of auditory feedback to control their unsteady and eccentric fixation while responding to flashed (800 msec) or continuously presented targets at various eccentricities in the visual field. All 4 amblyopic eyes had maximum visual acuity at the fovea; from there, the acuity declined approximately symmetrically into the nasal and temporal periphery. Foveal acuity for these amblyopic eyes was depressed from the acuity at the fovea of the normal eye. We conclude that Worth's explanation of eccentric fixation (eccentric fixation develops in an attempt by the amblyopic eye to fixate with a peripheral retinal locus having higher acuity than the fovea) cannot apply to our amblyopes. The acuity losses exhibited by the amblyopic eyes studied have a sensory (inhibition) component and a motor (retinal-locus) component, the sensory component being greater for small degrees of eccentric fixation and the motor component being greater for large amounts of eccentric fixation.

Acoustic Stimulation↗

[Prevalence of low visual acuity in public school's students from Brazil].

OBJECTIVE: Low visual acuity (VA) is an important public health problem due to its high prevalence and because it needs early diagnosis in order to prevent damage in childhood development and apprenticeship. To describe and analyze low visual acuity (VA) prevalence among school children. METHODS: Once performed the VA test to 1st and 4th grades primary school children data were analyzed by separating students according to sex, school grade, wearing of glasses, residence area and level of access to the supplementary medical assistance (SMA). RESULTS: The total of 9,640 students was evaluated during the year of 2000 and they presented a prevalence of low VA of 13.1% (CI 12.5-13.8%). There was a statistical significant lower prevalence in males (11.5%) compared to females (14.9%) - (PR=0.77). There was a statistical significant higher prevalence in 1st grade students (14.1%) compared to 4th grade (11.5%) - (PR=1.22). There was also a statistical significant lower prevalence for those who were not wearing glasses (12.1%) compared to those who were using glasses (42.0%) - (PR=0.29). Concerning to residence areas, Cajuru neighborhood had the lower prevalence of low VA (1.8%) and Vila Sabia neighborhood had the higher prevalence (32.4%), and a positive correlation, according to residence area, between the proportion of people with access to the Supplementary Medical Assistance and the proportion of children wearing glasses was found (r=0.64, p<0.001). CONCLUSIONS: The low VA high prevalence shows lack in early diagnosis and continuity of assistance pointing out to the urgent need of implementation in visual health public.

Brazil↗

Treatment strategies and visual acuity outcomes in chronic postoperative Propionibacterium acnes endophthalmitis.

PURPOSE: To report the treatment strategies and visual acuity outcomes of chronic postoperative endophthalmitis caused by Propionibacterium acnes. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: All patients presenting 8 or more weeks after cataract surgery with intraocular inflammation caused by culture-proven P. acnes infection and treated at two institutions from 1974 through 1996 were included. METHODS: Patients underwent three different initial treatment strategies. The study did not have a defined treatment protocol, but all patients received intraocular antibiotics. Patients were not randomly assigned to the various treatment strategies. MAIN OUTCOME MEASURES: Final visual acuity and effectiveness of various treatment procedures either as initial or follow-up therapy were assessed. RESULTS: Using the 3 initial strategies, 36 patients were treated: (1) intraocular antibiotic injection alone (IOAB; n = 12); (2) pars plana vitrectomy and IOAB injection (PPV; n = 10); and (3) PPV with subtotal capsulectomy and IOAB injection (PPV-PC; n = 14). The number of patients with recurrent or persistent inflammation after one of the three initial treatment strategies were as follows: (1) IOAB alone, 12 (100%); (2) PPV, 5 (50%); and (3) PPV-PC, 2 (14%). None of the patients that underwent subsequent PPV, total capsular bag removal, IOAB injection, and either intraocular lens (IOL) exchange or removal had persistent or recurrent intraocular inflammation. Overall, final visual acuity was 20/40 or better in 18 patients (50%), and a total of 28 patients (78%) retained 20/400 or better vision. The mean follow-up after the last treatment was 2.9 years. CONCLUSIONS: In this series of chronic P. acnes endophthalmitis, initial treatment with IOAB injection alone or vitrectomy without capsulectomy was associated with high rates of recurrent or persistent intraocular inflammation. Pars plana vitrectomy, partial capsulectomy, and IOAB injection without IOL exchange was usually successful on long-term follow-up. In patients with recurrent intraocular inflammation, pars plana vitrectomy, total capsular bag removal, IOAB injection, and IOL exchange or removal was a uniformly successful strategy. In contrast to other types of postoperative endophthalmitis, IOL exchange can be considered in these patients after total capsular bag removal.

Anti-Bacterial Agents↗

One-year outcomes after photodynamic therapy in patients with age-related macular degeneration with poor baseline visual acuity.

BACKGROUND: Photodynamic therapy with verteporfin (PDT) has been demonstrated in randomized controlled trials to be a safe and effective therapy for choroidal neovascular membranes (CNV) secondary to age-related macular degeneration (AMD). Limited information is available on the prognosis with PDT for patients who fell outside the inclusion criteria for the clinical trials, however. The purpose of this study is to describe the clinical course of patients with CNV lesions in AMD treated with PDT, with baseline visual acuities sufficiently poor to warrant exclusion from previous randomized trials. METHODS: Retrospective case series. Ten consecutive patients with CNV secondary to exudative AMD treated with PDT with baseline visual acuity less than 34 ETDRS letters were followed for 1 year. The main outcome was median change in visual acuity on the ETDRS chart. RESULTS: The median change in acuity over 12 months was + 13 letters. All patients lost <3 lines of ETDRS acuity, and eight of ten patients (80%) gained at least one line of vision, over 12 months. CONCLUSIONS: In our series, patients with low visual acuity at baseline appeared to respond to PDT on both visual acuity and fluorescein angiographic measurements. PDT treatment may be considered for selected patients with these baseline characteristics.

Aged↗

The Advanced Glaucoma Intervention Study (AGIS): 12. Baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma.

PURPOSE: To examine the relationships between baseline risk factors and sustained decrease of visual field (SDVF) and sustained decrease of visual acuity (SDVA). DESIGN: Cohort study of participants in the Advanced Glaucoma Intervention Study (AGIS). METHODS: This multicenter study enrolled patients between 1988 and 1992 and followed them until 2001; 789 eyes of 591 patients with advanced glaucoma were randomly assigned to one of two surgical sequences, argon laser trabeculoplasty (ALT)-trabeculectomy-trabeculectomy (ATT) or trabeculectomy-ALT-trabeculectomy (TAT). This report is based on data from 747 eyes. Eyes were offered the next intervention in the sequence upon failure of the previous intervention. Failure was based on recurrent intraocular pressure elevation, visual field defect, and disk rim criteria. Study visits occurred every 6 months; potential follow-up ranged from 8 to 13 years. For each intervention sequence, Cox multiple regression analyses were used to examine the baseline characteristics for association with two vision outcomes: SDVF and SDVA. The magnitude of the association is measured by the hazard ratio (HR), where HR for binary variables is the relative change in the hazard (or risk) of the outcome in eyes with the factor divided by the hazard in eyes without the factor, and HR for continuous variables is the relative change in the hazard (or risk) of the outcome in eyes with a unit increase in the factor. RESULTS: Characteristics associated with increased SDVF risk in the ATT sequence are: less baseline visual field defect (hazard ratio [HR] = 0.86, P <.001, 95% CI = 0.82-0.90), male gender (HR = 2.23, P <.001, 1.54-3.23), and worse baseline visual acuity (HR = 0.96, P =.001, 0.94-0.98); in the TAT sequence: less baseline visual field defect (HR = 0.93, P =.001, 0.89-0.97) and diabetes (HR = 1.87, P =.007, 1.18-2.97). Characteristics associated with increased SDVA risk in both treatment sequences are better baseline acuity (ATT: HR = 1.05, P <.001, 1.02-1.09; TAT: HR = 1.06, P <.001, 1.03-1.08), older age (ATT: HR = 1.05, P =.001, 1.02-1.08; TAT: HR = 1.04, P =.002, 1.01-1.06), and less formal education (ATT: HR = 1.92, P =.001, 1.29-2.88; TAT: HR = 1.77, P =.002, 1.22-2.54). CONCLUSIONS: For SDVF, risk factors were better baseline visual field in both treatment sequences, male gender, and worse baseline visual acuity in the ATT sequence, and diabetes in the TAT sequence. For SDVA, risk factors in both treatment sequences were better baseline visual acuity, older age, and less formal education.

Aged↗

[A study of the visual acuity and amblyopia in infants aged 3 to 5 from El Hierro island].

PURPOSE: To discover the prevalence of visual alterations in a static child population, like that of El Hierro island, and to evaluate the efficacy of having infant teachers carrying out visual screening in infants. METHODS: Infant teachers tested the visual acuity of children between 3 and 5 years of age, and referred those who did not reach a previously established visual level to the Ophthalmology Department of the island's Hospital. There, a complete ophthalmological study was undertaken. Subsequently, a group of children that the teachers considered normal was also checked. RESULTS: Of the 240 children between 3 and 5 years of age who live on the island, 205 had the visual acuity tested by teachers. It was found that 21 did not achieve the desired visual level for their age. Of these, 9 were truly pathological (6 of them were amblyopes). The other 12 were normal, ophthalmologically speaking. Of the 184 children which the teachers considered normal, 81 were studied in the ophthalmology department. Two children were found to be pathological (2.5% of false negatives), both being slightly myopic. The degree of correlation between the visual acuity taken by the teachers and by the ophthalmologists was r=0.6 and the mean difference was 0.07. CONCLUSIONS: We believe that infant teachers are a good choice for initial screening of visual abnormalities in infancy. Strategies are being discussed to diminish the high rate of false positives

Amblyopia↗

Relationship between visual acuity and nasal field thresholds in patients with temporal hemianopia.

The area of nasal field found with Goldmann static perimetry and the sum of decibels by Humphrey threshold 30/2 was calculated in normal subjects and in subjects with chiasmatic lesions, temporal field loss, and normal or abnormal visual acuity. There was a significant reduction of the mean of the area of the nasal field by static Goldmann perimetry and of the mean of decibels in the nasal field on Humphrey perimetry in patients with temporal field loss and chiasmatic lesions, as compared with normal controls. There were significant correlations of nasal field depression (Goldmann) and visual acuity and for sums of nasal field decibels (Humphrey) and visual acuity. Thus, a generally depressed nasal field was found in patients with chiasmatic lesions and temporal field loss when accompanied by lowering of visual acuity. This would appear to be the earliest stage of nasal field involvement.

Adult↗

The effect of Nd:YAG laser capsulotomy size on refraction and visual acuity.

PURPOSE: To determine the effect of Nd:YAG laser posterior capsulotomy size on refraction and visual acuity. METHODS: A total of 128 pseudophakic eyes (108 patients) were included in this study and divided into two groups by capsulotomy size: 80 eyes had small capsulotomies (<4 mm) without dilating the pupil and 48 eyes had large capsulotomies (> or = 4 mm and <7 mm) after dilating the pupil. Visual acuities and refractive errors were measured preoperatively and 1, 14, 30, and 90 days postoperatively. Results were analyzed statistically. RESULTS: The change in spherical equivalent refraction was 0.38 +/- 0.52 diopters (D) in the small capsulotomy group and 0.22 +/- 0.36 D in the large capsulotomy group. No statistically significant differences were noted in spherical equivalent refraction change (P=.47) or capsulotomy size (P=.0387) between the two groups. CONCLUSIONS: The size of posterior capsulotomy does not significantly affect refraction and visual acuity.

Cataract↗

Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Diabetic Retinopathy Vitrectomy Study (DRVS) report #1.

Seven hundred forty-four eyes with very severe proliferative diabetic retinopathy (PDR) were followed with conventional management over a two-year period. Decreases in visual acuity were more frequent during the first year of follow-up than during the second, and were related to baseline visual acuity level and retinopathy severity. After two years, visual acuity was less than 5/200 in 45% of eyes with more than four disc areas of new vessels and visual acuity of 10/30 to 10/50 at baseline, but in only 14% of eyes with traction retinal detachment not involving the center of the macula and without active new vessels or fresh vitreous hemorrhage at baseline. Vitrectomy, which was undertaken only if retinal detachment involving the center of the macula occurred or if severe vitreous hemorrhage failed to clear after a one-year waiting period, had been carried out in 25% of eyes after two years of follow-up.

Adolescent↗

[Effect of surgery of the vertical muscles on refraction and visual acuity].

BACKGROUND: The aim of this paper was to determine whether the surgery on vertical muscles of the eye influenced the change in refraction and visual acuity. METHODS: This prospective study included testing of 79 children with infantile esotropia who suffered from the vertical strabismus after the surgery on horizontal muscles. Patients were divided into two groups: the first group of 52 children (the test group) had only vertical component (overaction of m. obliqui inferior) and the second group (the control group) had two vertical components (dissociated vertical deviation-DVD and overaction of m. obliqui inferior). Refraction and visual acuity were tested before the surgery on the vertical muscles and one month and six months after the surgery. There was no significant difference between the results of the objective refraction in those three different periods of time. RESULTS: In both groups mild hypermetria (according to Costenbander) occurred in 40-48% of the examinees of both groups, while moderately-expressed hypermetropia occurred in 40-50% of the examinees. There was neither statistically significant difference between the results of the three observed measurings among every group, nor between the observed groups of patients (p > 0.05). By the analysis of the results of visual acuity it could be concluded that it was significantly improved 6 months after the surgery on cyclovertical muscles. This change was more significant in the sample group of patients (p < 0.01) than in the children from the control group (p < 0.05), who were much older. CONCLUSION: Objective refraction in patients was in the range of low values of hypermetropia (+2.00 Dsph--t 3.00 Dsph). Significant improvement of visual acuity occurred 6 months after the surgery performed on vertical muscles of the eye. These results were achieved by the repeated measuring of objective refraction and the precise correction of every new accommodative element.

Child↗

Decreased visual acuity and Diplopia in a patient with münchausen syndrome.

A 20-year-old woman complained of decreased visual acuity in her left eye and diplopia. She had visited several hospitals previously. On examination, her left visual acuity varied, and her squint angle also changed. No organic disorders that could have caused the symptoms were noted. She complained of edema of her left arm. On admission to another hospital, her arm was found bound tightly with tape. She wanted surgery to correct her esotropia but did not expect to improve her quality of life by having it done. We believe that our patient may have Münchausen syndrome and that the decreased visual acuity and diplopia may be a rare association with the syndrome.

Adult↗

Grating visual acuity using the preferential-looking method in elderly nursing home residents.

PURPOSE: To assess the performance of two approaches to visual acuity testing in a group of nursing home residents with cognitive impairment. The study was a cross-sectional comparison of the effectiveness of two tests of visual acuity. METHODS: Nursing home residents participating in a clinical trial were tested with both recognition acuity charts and grating acuity cards (Teller) by masked observers. RESULTS: Of the nursing home residents (n = 656) who participated in the study, 86% could respond to visual acuity testing in at least one eye. Eighty-four percent were testable using Teller cards versus 73% who were testable by Early-Treatment Diabetic Retinopathy Study (ETDRS) charts or Lea symbol charts. Forty-one percent of individuals with MiniMental Status Examination (MMSE) scores lower than 10 were testable by recognition acuity, whereas 61% were testable with grating acuity cards. Grating acuity correlated well with recognition acuity (R = 0.79; 95% CI, 0.75-0.98, intraclass correlation coefficient [ICC]). The correlation was slightly lower in individuals with decreased MMSE scores. Although grating acuity was one line better than recognition acuity on average and median acuities were the same, 24% of individuals had results that differed by three or more lines. CONCLUSIONS: Teller acuity cards can effectively test the vision in cognitively impaired individuals who are not testable by conventional means. Grating acuity results correlated well with those of recognition acuity, although differences of three or more lines were not uncommon. Wider use of grating acuity testing allows a more complete assessment of visual function in the cognitively impaired elderly.

Aged↗