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PubMed1986

Fully automated screening procedure for early detection of visual field defects.

A major problem in mass screening for glaucoma is the substantial time required to detect areas of depressed visual sensitivity, scotoma. We have developed a novel instrument for testing rapidly and automatically the sensitivity of the visual field. The patient views a large CRT screen on which up to four luminous points are presented in a prearranged pattern. The patient's vocal response is a number from zero to four, the number of stimulus points that he has observed, which is recognized by the controller and recorded. A series of 90 such patterns is presented sequentially, giving a 288 points visual field test, at the conclusion of which a hard copy probabilistic map of the retinal location of scotoma is drawn. The examination procedure is much faster than that using conventional 'automatic' tests and its results are almost identical with those from two commercial instruments with which our experimental 'perimeter' has been compared. Initial clinical trials are very encouraging.

Glaucoma↗
PubMed2026

Obstructive sleep apnea and idiopathic intracranial hypertension: a systematic review and meta-analysis.

OBJECTIVE: To determine the pooled prevalence of obstructive sleep apnea (OSA) among adults with idiopathic intracranial hypertension (IIH) using polysomnography (PSG) and the Berlin Questionnaire screening. NATURE: IIH is a vision-threatening disorder characterized by elevated intracranial pressure. OSA shares overlapping risk factors and pathophysiological mechanisms with IIH, including nocturnal hypoxia and hypercapnia. Clarifying OSA prevalence in IIH is clinically important for diagnosis and management. METHODS: For this prospectively registered systematic review and meta-analysis (PROSPERO: CRD420251132794), we searched MEDLINE, Embase, and CENTRAL from inception to August 23, 2025, for studies reporting PSG-confirmed OSA or Berlin Questionnaire positivity in adults with IIH. Risk of bias was assessed using ROBINS-I and RoB-2, and certainty of evidence was checked using the Grading of Recommendations, Assessment, Development and Evaluation tool. Random-effects meta-analyses of proportions generated pooled prevalence estimates. Subgroup analyses excluded high-risk studies, leave-one-out analyses assessed robustness, and funnel plots evaluated publication bias. RESULTS: Eleven studies met the inclusion criteria. Across 9 PSG-based studies (n = 299), the pooled prevalence of OSA in IIH was 0.44 (95% CI: 0.26-0.63; I² = 90.5%). Leave-one-out analyses showed stable results (39%-50%). Excluding high-risk studies (4 studies; n = 132) yielded a pooled prevalence of 0.53 (95% CI: 0.32-0.74). Four Berlin Questionnaire studies (n = 154) showed a pooled prevalence of 0.65 (95% CI: 0.54-0.74; I² = 0%). Funnel plot asymmetry suggested publication bias, and certainty of evidence was very low. CONCLUSIONS: OSA is common among patients with IIH, supporting routine objective sleep evaluation. Prospective studies are needed to clarify this association.

Humans↗
PubMed2002

Classification and prediction of the progression of thyroid-associated ophthalmopathy by an artificial neural network.

OBJECTIVE: We have used an artificial neural network in an attempt to classify and predict the progression of thyroid-associated ophthalmopathy (TAO) at the first clinical examination. DESIGN: This retrospective comparative case series included a group of patients examined by the ophthalmologist only once because of the absence of signs of progressive disease (GR1), as subsequently monitored by an endocrinologist, and a group of patients on follow-up because of progressive disease (GR2). PARTICIPANTS AND METHODS: We examined 242 patients, of whom 207 were women and 35 were men. GR1 included 129 patients (257 eyes) who, on ophthalmologic assessment, were further classified as having no TAO (n = 53; GR1a) and only lid signs or inactive, stable TAO (n = 76; GR1b). GR2 included 113 patients (219 eyes). One hundred three normal subjects (205 eyes), 50 women and 53 men, were tested to provide normal ranges for proptosis values. We applied a model of back propagation neural network with 17 input variables, a training matrix of 414 observations, a randomly selected test group of 115 observations, and, as output, the progression of disease. The ophthalmologic assessment included (1) lid fissure measurement, (2) Hertel, (3) color vision, (4) cover test and Hess screen, (5) visual acuity, (6) tonometry, (7) fundus examination, (8) visual field, and (9) orbital computed tomography scan or ultrasonography. Other parameters included in the neural analysis were gender and age of the patients, their cigarette smoking, and the interval between follow-up visits. RESULTS: The prevalence of smokers among patients without TAO was significantly lower than that among those with TAO (P < 0.03). Mean proptosis values (Hertel) were significantly different in GR1, in GR2, and in a group of normal eyes (P < 0.0001), and the changes of values in consecutive measurements were associated with progression of the disease (P < 0.01). Differences of the proptosis values in the two groups of patients were not related to smoking. The neural network correctly classified 78.3% of 115 eyes (87 patients) and predicted TAO progression in 69.2% of 39 eyes (28 patients). CONCLUSIONS: In our opinion, neural network analysis can be successfully applied for classifying TAO and predicting progression at the first clinical examination.

Adolescent↗
PubMed2002

Adaptation to changes in vertical display gain during handwriting in Parkinson's disease patients, elderly and young controls.

Parkinson's disease (PD) patients, matched elderly controls, and normal young subjects were tested using a visuo-motor adaptation paradigm in which the gain of the vertical component of the visual feedback of handwriting was manipulated in real-time. Handwriting was performed on a digitizer tablet and displayed in real-time on a computer screen in front of the participant. Vision of the hand and pen was occluded. Feedback could be normal (pre- and post-exposure conditions), smaller, or larger than the actual handwriting (exposure conditions). All groups showed a gradual adaptation that compensated for the distorted visual feedback during the exposure conditions. Moreover, all the groups showed significant after-effects during the post-exposure conditions suggesting that all the participants learned to compensate for the novel display gains. Taken together, these data suggest that the mechanisms for visuo-motor adaptation to changes in vertical display gain during handwriting are robust to aging and early stage of PD. These results may have implications for the treatment of micrographia in Parkinsonism.

Adaptation, Psychological↗
PubMed2006

The incidence of visual perceptual impairment in patients with severe traumatic brain injury.

PRIMARY OBJECTIVES: To investigate the incidence of visual perceptual impairments in a sample of patients with traumatic brain injury (TBI) using the Occupational Therapy Adult Perceptual Screening Test (OT-APST), compare incidence rates to a normative sample and explore the relationship between the presence of visual perceptual impairment and the severity of cognitive and functional impairment following TBI. RESEARCH DESIGN: Cohort study using a convenience sample of patients with TBI and a normative sample. METHODS AND PROCEDURES: Thirty-one patients with severe TBI and 195 healthy people were compared on the OT-APST and measures of cognition and function. MAIN OUTCOMES AND RESULTS: The most common impairments in the TBI sample were unilateral neglect (45.2%) and impairments of body scheme (25.8%) and constructional skills (25.8%). Significantly higher incidences of agnosia, apraxia, unilateral neglect and impairments in body scheme and constructional skills were found in the TBI sample compared to the normative sample. No significant relationship was found between the presence of visual perceptual impairments and the level of cognitive and functional impairment after TBI. CONCLUSIONS: Visual perceptual changes are evident in patients with severe TBI when compared to a normative sample. Routine use of a screening tool such as the OT-APST may help identify visual perceptual impairments in these patients and the need for more detailed assessment.

Adolescent↗
PubMed2002

Prediction of the progression of thyroid-associated ophthalmopathy at first ophthalmologic examination: use of a neural network.

In the present work we analyzed patients with thyroid-associated ophthalmopathy (TAO) at various clinical stages of disease progression and implemented a model of neural analysis for disease classification and prediction of progression. We studied 246 patients (group 1), seen only once because they had absent, minimal, or inactive TAO and 152 patients (group 2), seen two or more times because of active and/or progressive TAO. The ophthalmologic assessment included: (1) lid fissure measurement; (2) Hertel; (3) color vision; (4) cover test and Hess screen; (5) visual acuity; (6) tonometry; (7) fundus examination; (8) visual field; (9) orbital computed tomography (CT) scan or ultrasound. A back propagation model of neural network was based on the relative variations of 13 clinical eye signs (input variables) for classification and prediction of disease progression (output variable). Approximately 300 eyes (20%) were randomly selected as a test group. Correlation between expected and calculated patients' classification was highly significant (p < 0.00001). Concordance between clinical assessment and the neural network prediction was obtained in 78 of 117 eyes (67%). We have developed a neural model that allows classification of TAO and preliminary prediction of disease progression at the first clinical examination. The results are validating the classification into the two groups on which our initial assumption was based.

Disease Progression↗
PubMed1983

Application of visual signal detection concepts to clinical decision analysis.

The performance of both clinical diagnostic and mass screening tests is commonly measured in terms of the two basic parameters, sensitivity and specificity. Selection of cut-off points, balancing the sensitivity-specificity trade-off, and comparison with alternative tests are often a matter of arbitrary decisions and are frequently made without consideration of outcome. Some of the concepts used in the analysis of visual signal detection systems can be helpful in this aspect of screening test selection and evaluation. A simplified version of these concepts is developed and its application to clinical and public health optometry is illustrated.

Cost-Benefit Analysis↗
PubMed1984

Large-sample norms for contrast sensitivity.

A portable microprocessor-controlled instrument automatically measured the static and dynamic contrast sensitivity functions (CSF's) of 265 observers for a normal population at the Dayton Air Fair and Air Force Museum. Repeat measures for six observers taken 6 months later show small, nonsystematic differences from original measurements. Median values of contrast sensitivity as well as regions encompassing 75 of 90% of our sample are shown.

Adult↗
PubMed1986

Evaluation of nursing practice in schools.

Evaluation of school nursing often focuses more on programmatic concerns than on performance. More emphasis is placed on program components than on quality of nursing performance. In addition, many such evaluations are conducted by non-nurses who do not possess the theoretical or clinical knowledge to evaluate practice accurately. Considerations in planning meaningful evaluations of school nursing practice are described. Types of objectives are identified, and suggestions for designing an evaluation are offered. The importance of standardizing an evaluation is discussed, including reference to some major evaluation resources.

Child↗
PubMed2006

Validating an asthma case detection instrument in a Head Start sample.

Although specific tests screen children in preschool programs for vision, hearing, and dental conditions, there are no published validated instruments to detect preschool-age children with asthma, one of the most common pediatric chronic conditions affecting children in economically disadvantaged communities of color. As part of an asthma education intervention, a 15-item Brief Respiratory Questionnaire (BRQ) was developed to detect children with probable asthma in Head Start and subsidized preschool settings in communities with high asthma prevalence and associated morbidity. Preschool personnel administered the BRQ to consenting parents of 419 enrolled children. Trained interviewers administered validation interviews (VALs) to parents of 149 case-positive children and 51 case-negative children. Three physicians independently assessed deidentified summaries of the VALs that captured responses about signs and symptoms of asthma, diagnosis and treatment, and use of medical services. The physicians' assessments of the summarized VALs were the validated standard to which the BRQ classifications were compared. A simple algorithm of 4 items was identified that can be administered and scored by nonmedical preschool personnel in less than 5 minutes. The chance-corrected agreement between these 4 items of the BRQ and the VAL was good: kappa, .73 (95% confidence interval, 0.62-0.84); specificity, 96%; sensitivity, 73%; and positive predictive value, 97%. The BRQ appears to be a valid instrument for detecting children with probable asthma in Head Start and other subsidized preschool settings in communities with high prevalence of asthma.

Allergens↗
PubMed2004

Bimanual directional interference: the effect of normal versus augmented visual information feedback on learning and transfer.

When performing movements with different spatial trajectories in both upper limbs simultaneously, patterns of interference emerge that can be overcome with practice. Even though studies on the role of augmented feedback in motor learning have been abundant, it still remains to be discovered how overcoming such specific patterns of spatial interference can be optimized by instructional intervention. In the present study, one group acquired a bimanual movement with normal vision, whereas a second group received augmented feedback of the obtained trajectories on a computer screen in real time. Findings revealed that, relative to normal vision, the augmented feedback hampered skill learning and transfer to different environmental conditions. These observations are discussed in view of the benefits and pitfalls of augmented feedback in relation to task context and instructional condition.

Adolescent↗
PubMed1980

Use of the Arden grating test for screening.

One hundred and forty patients were referred for a clinical evaluation of their eyes, having produced high scores on screening by the Arden grating test (AGT). In these patients 66% of the eyes were found to be normal, 31% abnormal, and 3% indeterminate on clinical examination. Suitable criteria for referral for clinical examination were determined and the recommended scores are: (a) A total AGT score of greater than or equal to 80; (b) One or more plates scoring greater than or equal to 17; (c) A difference between the two eyes of greater than or equal to 13. With these criteria at least 95% of the abnormal eyes will be detected. As a screening test the AGT is equal to the Snellen distance visual acuity test at separating the normal group from the abnormal group, and on the recommended criteria the AGT gives a better ratio of false positives to false negatives.

Adolescent↗
PubMed1998

Microvascular complications of diabetes. Strategies for managing retinopathy, nephropathy, and neuropathy.

The microvascular complications of diabetes mellitus are responsible for a substantial portion of associated morbidity and mortality. Fortunately, recent evidence indicates that improved glycemic and blood pressure control can slow and perhaps even stop the development of retinopathy, nephropathy, and neuropathy in diabetic patients. In addition, early recognition of these complications provides the opportunity for early treatment, which has been shown to preserve vision, renal function, and limb integrity. Screening for the early.

Diabetes Complications↗

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