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The use of accurate visual acuity measurements in clinical anti-cataract formulation trials.

A standardized visual acuity technique is presented for use in anti-cataract drug trials. Ferris Logmar charts were used in repeatability studies of vision, visual acuity and pinhole visual acuity measurements for twenty normal subjects (mean (+/- SD) age 64 +/- 6.3 years). Visual acuity measurements were shown to be the most repeatable and thought to be the most suitable for monitoring cataract progression. Repeated visual acuity measurements were made on 29 cataractous eyes of 15 subjects (mean (+/- SD) age 67.8 +/- 7.2 years). A Logmar score change of 0.1 (one line) was shown to be a statistically significant change. This value can be used in statistical analyses of drug efficacy. The normal data gives a mean Logmar visual acuity of 1.15 (Snellen equivalent 6/5). This indicates the inadequacy of using 6/6 as a norm value for visual acuity, even for older patients. As the possibility of reversal of cataract theoretically exists in the early stages of cortical and capsular cataracts, patients with small amounts of these types of cataract are ideal patients for anti-cataract formulation trials. The normal visual acuity results indicate that the inclusion criteria for clinical trials can include patients with cataracts with visual acuity as good as 6/6.

Aged

Contrast visual acuities in cataract patients. II. After IOL implantation.

Contrast visual acuities were measured in 100 eyes of 75 patients who attained a best-corrected visual acuity of greater than or equal to 0.8 (20/25) after intraocular lens (IOL) implantation. The variable contrast visual acuity chart (VCVAC), with three contrast levels of 90, 15, and 2.5% and reverse polarity of 90% contrast, was used to measure contrast visual acuities. The follow-up period ranged from 3 to 35 months (mean 7.41). The mean visual acuities measured with the 90, 15, and 2.5% charts were 0.92 (SD = 0.11), 0.59 (SD = 0.13), and 0.33 (SD = 0.14), respectively. The mean visual acuity measured with the 90% reverse polarity chart was 0.97 (SD = 0.11). The decreases in visual acuities compared with the 90% contrast were 0.64 and 1.48 octaves in the 15% and the 2.5% contrast charts, respectively. The pattern of the contrast acuity profile was comparable to normal subjects, but in 28 of 100 (28%) eyes, the visual acuities measured with the reverse polarity chart were slightly better than those measured with the standard 90% contrast chart, suggesting that the glare effect still exists after IOL implantation, though to a lesser degree than in cataractous eyes.

Adult

The significance of testing preoperative visual function in cataract using laser interferometric visual acuity and ERG.

Tests of preoperative visual function and prediction of postoperative E chart visual acuity (ECVA) using laser interferometric visual acuity (LIVA) and electroretinogram (ERG) were performed in 16 cases (19 eyes) of cataract. The results showed that the coincident rate between preoperative LIVA and postoperative ECVA was 63.2%, and there was a parallel correlation between preoperative amplitude of photopic ERG b-wave and postoperative ECVA in 79.0% of the eyes. Comparing these two methods, the test of LIVA is very simple, fast, and is easily accepted by the patients with cataract. ERG is an objective method, which is slightly influenced by dense lens, but the test is more complex. Therefore, the combined use of these two methods will provide a more comprehensive and correct evaluation of preoperative visual function and a more reliable prediction for postoperative visual acuity in patients with cataract.

Adolescent

Assessment of the visual acuity of human color mechanisms with the visually evoked cortical potential.

The amplitude of the human visually evoked cortical potential (VECP), which has been shown to vary as a function of the dimensions of checks in a checkerboard pattern, was used to objectively assess the visual acuity of the blue-sensitive compared with the red- and green-sensitive mechanisms in the eye. The results agree with psychophysical measures which have indicated poorer acuity of the blue system compared with the red and green systems.

Adult

Simulation of a phosphene-based visual field: visual acuity in a pixelized vision system.

A visual prosthesis for the blind using electrical stimulation of the visual cortex will require the development of an array of electrodes. Passage of current through these electrodes is expected to create a visual image made up of a matrix of discrete phosphenes. The quality of the visual sense thus provided will be a function of many parameters, particularly the number of electrodes and their spacing. We are conducting a series of psychophysical experiments with a portable "phosphene" simulator to obtain estimates of suitable values for electrode number and spacing. The simulator consists of a small video camera and monitor worn by a normally sighted human subject. To simulate a discrete phosphene field, the monitor is masked by an opaque perforated film. The visual angle subtended by images from the masked monitor is 1.7 degrees or less, depending on the mask, and falls within the fovea of the subject. In the study presented here, we measured visual acuity as a function of the number of pixels and their spacing in the mask. Visual acuity was inversely proportional to pixel density, and trained subjects could achieve about 20/26 visual acuity with a 1024 pixel image. We conclude that 625 electrodes implanted in a 1 cm by 1 cm area near the foveal representation of the visual cortex should produce a phosphene image with a visual acuity of approximately 20/30. Such an acuity could provide useful restoration of functional vision for the profoundly blind.

Blindness

[Objective and subjective determination of visual acuity].

The results of the present study show that the normal human visual acuity is not 1 (30 c/dg) but a remarkably higher value, about 1.73 (55 c/dg). Many authors, who studied the problem of objective determination of the visual acuity using visual evoked cortical potentials, corrected their results under the assumption that the objective method overestimates the real visual acuity. Now it is clear that the conventional determination of the visual acuity leads to serious underestimation of the real visual acuity. So, the way toward a more precise objective estimation of the human threshold visual acuity is now open.

Adolescent

Conditioned vocalizations as a technique for determining visual acuity thresholds in sea lions.

Aerial visual acuity and underwater visual acuity were measured in two sea lions (Zalophus californianus) by training them to emit click bursts if they saw a striped target or to remain silent if they saw a gray target. The closest grating spacings that could be resolved both in air and under water subtended a visual angle of 5.5 minutes of arc at a distance of 5.5 meters.

Animals

Visual acuity and contrast sensitivity in cataract: summation and inhibition of visual performance.

Patients exhibiting uniocular cataract often report an improvement in vision on closing their cataractous eye. Such qualitative evidence suggests the presence of binocular inhibition--the converse of binocular summation (that is the normal superiority of binocular over monocular vision). To quantify the extent of inhibition in cataract, binocular and monocular visual acuity and contrast sensitivity were measured in 28 patients. Twelve patients showed binocular inhibition for visual acuity whilst 11 showed inhibition for contrast sensitivity measured at four cycles per degree (c.deg-1). Contrast sensitivity for 8 c.deg-1 targets was further recorded in a subset of 14 patients in whom seven showed inhibition. In patients who demonstrated inhibition, the mean decrement in performance for visual acuity was 13%. For contrast sensitivity at 4 and 8 c.deg-1 the mean decrement was 25% and 32% respectively. The clinical significance of these findings is discussed with respect to the assessment of visual function and management of the cataract patient.

Adult

Binocular summation in visually evoked responses and visual acuity.

Monocular and binocular transient visually evoked responses (VER) were recorded on 50 adult subjects using a pattern reversal stimulus (check size 5.5 min arc). The peak-to-trough amplitude of the VER wave was measured and compared with the subjective visual acuity (Landolt C). The binocular amplitude enhancement over the monocular amplitude was around 26% across the acuity range studied, whereas the mean binocular subjective visual acuity improvement was around 11.3%, but this varied from 1% at the high acuity end to 17% at the low acuity end of the range.

Adolescent

Assessment of visual acuity in children with severe neurological impairments.

We used the Teller Acuity Cards to assess visual acuity in children with severe neurological handicaps (N = 12), all of whom had been previously untestable. With every child we were able to obtain at least one estimate of visual acuity, even with those described as likely having little or no visual function. However, in all cases, performance was poorer than that of unimpaired children of the same age. Our results confirm that the test is useful for assessing visual acuity in populations who, because of significant cognitive, linguistic, and motor deficits, cannot be assessed by more traditional techniques.

Adolescent

[Statistical evaluation of visual acuity].

The statistical evaluation of the visual acuity has to be based on the non-parametric test as the decimal scale of the visual acuity forms a serial scale and not the intervallic one. From the theoretic point of view, the most advantageous approach uses the paremetric statistical tests. Visual acuity is measured on optotypic tables with log gradiation of the optotype size. At present time optotypes of this kind are not available in Czechoslovakia.

Humans

Set shot shooting performance and visual acuity in basketball.

Common sense suggests that decreasing visual acuity will have a negative effect on basketball shooting performance. To test the hypothesis that basketball shooting performance monotonically decreases with decreasing acuity, 19 subjects attempted 25 set shots from a fixed location at each of 5 different acuity levels: 6/6 or better and vision blurred (by optical defocus) to visual acuities of 6/12, 6/24, 6/48, and 6/75. Our results revealed a small but statistically nonsignificant decrease in shooting performance between the 6/6+ and 6/12 conditions. For visual acuities between 6/12 and 6/75, the number of baskets made remained constant. We conclude that decreases in visual acuity over the range of 6/6+ to 6/75 resulting from defocus do not significantly reduce set shot shooting performance.

Adolescent

An analysis of the effect of intravitreal blood on visual acuity.

We investigated the effect of diffuse hemorrhage on Snellen visual acuity in a model of vitreous hemorrhage in phakic and aphakic eyes. Two cylindrical test chambers with optical paths of 17 mm and 23 mm were constructed to simulate the effect of vitreous hemorrhage in phakic and aphakic eyes. The visual acuity was measured in two subjects in a double-masked fashion for 17 dilutions of whole blood between 1/100 and 1/12,800. The visual acuity decreased approximately linearly between the 1/800 and 1/4,800 dilutions of blood. The visual acuity was 20/20 in all dilutions of blood higher than 1/4,800. The visual acuity was reduced to hand motions or worse with 12.5 microliter of blood in the 5-ml test chamber under all test conditions. The visual acuity was 20/20 in all tests with 1.04 microliter of blood in the test chamber. The visual acuity decreased from 20/20 to hand motions with only a twelve-fold change in concentration of blood in the test chamber.

Aphakia

Assessment of visual acuity via a telephone interview.

We compared the visual acuity of 89 patients obtained via a telephone interview with visual acuity elicited from the same patients in an ophthalmologist's office. Agreement within one line of vision between the telephone interview, in which patients used a modified Rosenbaum near card with attached patch, and the clinic near vision test was observed in 91% of eyes, while agreement within one line of vision between the telephone interview and clinic distance vision test was found in 86% of eyes. We conclude that testing visual acuity via a telephone interview is a potentially useful approach to assessment of visual acuity and prevalence of visual impairment in the larger population.

Adult

[Temporal integration in diseased eyes. I. Exposure duration in visual acuity testing].

Critical duration in visual acuity testing can be viewed as an expression of temporal integration in the human visual system. We examined this phenomenon in 13 eyes with central serous retinopathy (CSR) and 6 eyes with macular edema, by measuring visual acuity at several limited exposure times. The results were then compared with those for 17 normal eyes. The acuity target was a single Landolt ring projected upon a small square screen. The size, direction, and exposure time of the target were computer controlled. The mean critical durations of the CSR and macular edema groups were 1.78 sec. and 2.69 sec. respectively. These values were significantly (p less than 0.01) longer than the mean critical duration of the normal control group (0.62 sec.). Although the mechanism behind the longer critical duration in diseased eyes remains poorly understood, we believe this method provides a possible approach to the study of diseased visual conditions.

Humans

Effect of luminance on photopic visual acuity in the presence of laser speckle.

Visual acuity in coherent and incoherent light has been determined by using square-wave gratings of 100% contrast. Luminance was varied from 3 to 400 cd/m2. Coherent illumination resulted in a 40% loss of visual acuity. This is probably due to the masking effect of coherent spatial noise (speckle). However, the most interesting finding is the change in shape of the photopic visual-acuity-luminance function. With coherent illumination, the function is vertically displaced and of a different gradient. An increase in luminance produces a decrease in visual acuity. This indicates that the masking effect of the speckle is dependent on luminance. Two observers were used, and similar results were obtained by both.

Adult

[Clinical study for prediction of postoperative visual acuity in cataract patients].

In order to predict more quantitatively postoperative visual acuity in cataract patients, we employed the potential acuity meter (PAM). The PAM projects a Snellen visual acuity chart into the eye by a minute aerial aperture approximately 0.1 mm in diameter. The value of determining potential visual acuity is evident because of the frequent co-existence of macular abnormalities in cataract patients. The 20 cataract patients had an average of 64.8 years (range, 48 to 84 years), and 8 were men and 12 were women. In 23 of the 25 eyes examined, postoperative visual acuity was within two lines or better than the predicted visual acuity with the PAM. Provided the operator is skillful, and if one recognizes its limitations and indications, the PAM is a useful means of predicting postoperative visual acuity in patients with mild or moderate cataracts.

Aged

Validation of a self-report inventory for the measurement of visual acuity.

Previous attempts to assess visual acuity via self-report survey items have shown low sensitivity. This may be due to use of dichotomous response formats, too few items, and reliance upon face valid, rather than laboratory-validated items. On the basis of a preliminary sample of 164 individuals, we developed a self-report inventory, suitable for group testing or survey administration. The inventory was then validated against laboratory measures of acuity in a separate sample of 570 subjects. The resulting, brief, ten-item scale was shown to be a reliable and valid predictor of visual acuity. Conversion tables were developed which allow scale totals to be used to predict Snellen acuity. For 91% of the sample, the inventory predicts objectively measured acuity within plus or minus one Snellen line. A copy of the inventory and scoring procedure is appended to this report.

Humans