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PubMed2000

A new, simple, inexpensive means of testing functional vitamin A status: the night vision threshold test (NVTT). A preliminary field-test report.

Vitamin A deficiency is the leading cause of preventable childhood blindness in developing countries. Each year, an estimated 13.5 million children world-wide are unable to adapt to the dark and half a million children progress to complete blindness annually from lack of vitamin A. Most of the currently available methods for assessing vitamin A status are expensive, require sophisticated instrumentation and are not efficacious in field conditions. A simple, inexpensive method was developed to identify children with defective dark-adaptability, thereby providing a reflection of marginal vitamin A stores. The purpose of this preliminary study was to test the field-efficacy of the Night Vision Threshold Tester (NVTT). Thirty-nine middle-school children with a mean age of 13.5 +/- 1.37 years were initially tested for their ability to adapt to the dark using the

Child↗
PubMed2002

Testing night vision goggles in a dark outside environment.

BACKGROUND: People with degenerative retinal diseases such as retinitis pigmentosa, may have adequate day vision but suffer from poor night vision. We have tested newly developed night vision goggles (NVG) to help these patients overcome their night blindness, thereby promoting more opportunities for normal activities at night or in the dark. METHODS: A total of 42 subjects with night blindness due to retinitis pigmentosa, choroideremia, cone rod dystrophy, or Bardet Biedl syndrome were recruited and clinically examined (visual acuity, visual field, and contrast sensitivity). Using an experienced mobility trainer, we tested binocular NVG on the subjects in two locations: a dark room and a 1 to 2 h outside course at night that provided different levels of difficulties (i.e., obstacles, brightness, and contrast). The assessment of which patients benefited from the NVG was predominantly based on the subjective evaluation of the mobility trainer, followed by their graded responses on two questionnaires. RESULTS: Based on the evaluation of the mobility trainer, 23 (61%) of the 42 subjects experienced improved mobility and orientation with the NVG outdoors, and 19 (39%) subjects did not. The ophthalmic data demonstrated that a visual acuity better than 20/100 and a visual field > 5 degrees (Goldmann perimetry III4) is necessary to benefit from NVG usage. In addition, subjective responses on increased mobility and independence were positively correlated with successful NVG testing. CONCLUSIONS: Night vision goggles have the ability to improve poor night vision in subjects with visual acuity > 20/100 and a visual field > or = 5 degrees (Goldmann: III4). In so doing, NVG can help overcome the obstacles experienced by many people suffering from night blindness. NVG, therefore, have the potential to greatly improve quality of life.

Adolescent↗
PubMed1995

Relationship between driver's license renewal policies and fatal crashes involving drivers 70 years or older.

OBJECTIVE: To assess the relationship between state driver's license renewal policies and fatal crashes involving drivers aged 70 years or older (seniors). DESIGN AND ANALYSIS: Poisson regression methods were used to isolate the relationship between different state policies mandating vision tests, knowledge tests, or road tests for driver's license renewal and fatal crashes involving senior drivers. The analysis controlled for differences among states, other than their renewal policies, likely to influence senior motor vehicle crashes. SETTING: United States, 1985 through 1989. PARTICIPANTS: All fatal crashes identified in the National Highway Traffic Safety Administration Fatal Accident Reporting System involving at least one driver aged 70 years or older. MAIN OUTCOME MEASURE: The number of fatal crashes per state in which at least one of the drivers was aged 70 years or older. When a single fatal crash involved more than one senior driver, each was included. RESULTS: State-mandated tests of visual acuity, adjusted for license renewal period, were associated with lower fatal crash risk for senior drivers (relative risk, 0.93; 95% confidence interval, 0.89 to 0.97). Knowledge tests, when added to vision tests and applied only to seniors, provided a nonsignificant reduction in the senior fatal crash risk (relative risk, 0.91; 95% confidence interval, 0.79 to 1.05). CONCLUSION: Tests of vision and knowledge for senior drivers at license renewal merit further attention as a means of improving senior traffic safety.

Accidents, Traffic↗
PubMed2004

Comparison of preschool vision screening tests as administered by licensed eye care professionals in the Vision In Preschoolers Study.

PURPOSE: To compare 11 preschool vision screening tests administered by licensed eye care professionals (LEPs; optometrists and pediatric ophthalmologists). DESIGN: Multicenter, cross-sectional study. PARTICIPANTS: A sample (N = 2588) of 3- to 5-year-old children enrolled in Head Start was selected to over-represent children with vision problems. METHODS: Certified LEPs administered 11 commonly used or commercially available screening tests. Results from a standardized comprehensive eye examination were used to classify children with respect to 4 targeted conditions: amblyopia, strabismus, significant refractive error, and unexplained reduced visual acuity (VA). MAIN OUTCOME MEASURES: Sensitivity for detecting children with > or =1 targeted conditions at selected levels of specificity was the primary outcome measure. Sensitivity also was calculated for detecting conditions grouped into 3 levels of importance. RESULTS: At 90% specificity, sensitivities of noncycloplegic retinoscopy (NCR) (64%), the Retinomax Autorefractor (63%), SureSight Vision Screener (63%), and Lea Symbols test (61%) were similar. Sensitivities of the Power Refractor II (54%) and HOTV VA test (54%) were similar to each other. Sensitivities of the Random Dot E stereoacuity (42%) and Stereo Smile II (44%) tests were similar to each other and lower (P<0.0001) than the sensitivities of NCR, the 2 autorefractors, and the Lea Symbols test. The cover-uncover test had very low sensitivity (16%) but very high specificity (98%). Sensitivity for conditions considered the most important to detect was 80% to 90% for the 2 autorefractors and NCR. Central interpretations for the MTI and iScreen photoscreeners each yielded 94% specificity and 37% sensitivity. At 94% specificity, the sensitivities were significantly better for NCR, the 2 autorefractors, and the Lea Symbols VA test than for the 2 photoscreeners for detecting > or =1 targeted conditions and for detecting the most important conditions. CONCLUSIONS: Screening tests administered by LEPs vary widely in performance. With 90% specificity, the best tests detected only two thirds of children having > or =1 targeted conditions, but nearly 90% of children with the most important conditions. The 2 tests that use static photorefractive technology were less accurate than 3 tests that assess refractive error in other ways. These results have important implications for screening preschool-aged children.

Amblyopia↗
PubMed2001

A new colour vision arrangement test to detect functional changes in diabetic macular oedema.

AIM: A study was undertaken to investigate the correlation between colour discrimination tests and the presence of macular oedema in patients with type I diabetes to find a sensitive diagnostic tool for the detection of early functional changes. METHODS: The study was performed in 39 type I diabetic patients, 10 with and 29 without macular oedema. The examination included biomicroscopy, fundus photography of the macula, videofluorescein angiography, the LogMAR visual acuity chart, Farnsworth-Lanthony desaturated D-15 test, and the new Mollon-Reffin "Minimalist" test for colour vision deficiencies version 6.0. RESULTS: A highly significant correlation was found between the tritan value of the Mollon test and the presence of clinically significant macular oedema (p<0.0015), with a high sensitivity (88.9%) and specificity (93.3%). The DD-15 test was not significant (p=0.345) and showed low sensitivity for the presence of macular oedema (36%). All variables concerning the grading of macular oedema showed a highly significant association with the tritan values of the Mollon test (p<0.0001). CONCLUSION: The results suggest that the Mollon-Reffin "Minimalist" test version 6.0 is the best colour discrimination test for detecting macular oedema, with higher specificity and sensitivity than the other methods used in the study.

Adolescent↗
PubMed2005

Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study.

PURPOSE: To compare the performance of nurse screeners with that of lay screeners in administering preschool vision screening tests. METHODS: Trained nurse and lay screeners administered the Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY), crowded Linear Lea Symbols visual acuity (VA) test at 10 ft (Precision Vision, Inc., La Salle, IL), and Stereo Smile II test (Stereo Optical, Inc., Chicago, IL) to 3- to 5-year-old Head Start participants. Lay screeners also administered a crowded Single Lea Symbols VA test at 5 ft (Good-Lite, Inc.). Screening results were compared with the classification of the children according to the presence of one or more of four conditions (amblyopia, strabismus, significant refractive error, and unexplained reduced VA) based on the results of a gold standard eye examination by study-certified optometrists and ophthalmologists. The primary outcome measure was sensitivity for detecting children with one or more targeted conditions at 0.90 specificity. RESULTS: Nurse screeners achieved slightly higher sensitivities with the Retinomax, SureSight, and Stereo Smile II tests than did lay screeners; however, most differences were small and not statistically significant. Nurse screeners achieved significantly higher sensitivity with the Linear Lea Symbols VA test than did lay screeners. Lay screeners achieved strikingly higher sensitivity with the Single Lea Symbols VA test than did nurse or lay screeners using the Linear Lea Symbols VA test. Combining the Stereo Smile II test with each of the other tests did not result in improved sensitivities for detecting one or more targeted conditions. CONCLUSIONS: Nurse and lay screeners can achieve similar sensitivity, when specificity is set at 0.90, for detecting preschool children in need of a comprehensive eye examination.

Allied Health Personnel↗
PubMed1999

Detection of color vision defects in chloroquine retinopathy.

OBJECTIVE: The effect of chloroquine toxicity on color vision is unclear. The authors identified the color defects seen in chloroquine retinopathy and determined the sensitivity and specificity of clinical color vision tests for detecting the presence of previously diagnosed chloroquine retinopathy. DESIGN: Case-control study. PARTICIPANTS: Chloroquine retinopathy was defined using previously published criteria. Data from 30 patients with retinopathy and 25 patients using chloroquine but with no evidence of retinal toxicity were collected. METHODS: All patients were tested with the following six clinical color vision tests: Ishihara, Farnsworth D-15, and Adams Desaturated-15 (Dsat-15), City University 2nd Edition (CU), Standard Pseudoisochromatic Plates Part 2 (SPP-2), and American Optical Hardy Rand Rittler (AO HRR). MAIN OUTCOME MEASURES: The number of failures was determined for each test. The types of color vision defects were classified as blue-yellow (BY), red-green (RG), or mixed RG and BY (mixed). RESULTS: Of the 30 patients with retinopathy, 28 (93.3%) of 30 patients failed at least 1 color vision test, demonstrating predominantly mixed defects. Five (25%) of 25 of the control subjects failed at least 1 test, and these defects were predominantly BY. The sensitivity and specificity of the tests are as follows: SPP-2 (93.3%, 88%), AO HRR (76.7%, 88%), Ishihara (43.3%, 96%), Dsat-15 (33.3%, 84%), D-15 (16.7%, 96%), and CU (20%, 92%). CONCLUSIONS: Color vision can be affected by chloroquine and should be tested routinely with a color vision test designed to detect both mild BY and protan RG defects to maximize sensitivity for toxicity. The SPP-2 and AO HRR are two tests that meet these criteria. The Ishihara has a low sensitivity, as do the D-15 tests and CU. All of the tests have similar specificity for chloroquine toxicity. If color vision defects are detected in patients at risk of developing chloroquine retinopathy, additional testing is indicated to rule out toxicity.

Adult↗
PubMed2000

The three point vernier alignment or acuity test (3Pt VA test): an analysis of variance.

A very useful clinical vernier acuity or vernier alignment test has been developed in this and associated laboratories over a span of two decades. We seek to refine further this test, to seek internal inconsistencies and to optimize parameters used in a variety of devices and environments. Vernier testing, and many aspects of this work have been considered by numerous able scientists over a long time period (not reviewed here), but none have encountered conditions faced by this group, particularly in the developing world. The three point vernier alignment (acuity) threshold test (3Pt VeA test) employed here has broad applications; it can be used as a clinical test of vision status, for triage, and as a reference standard for vision testing (in general). As one example, if sufficient luminance is employed, the test is applicable in the presence of truly dense media disorders, even advanced leucomas, mature cataracts, intraocular bleeds, as well as combinations of these disorders, with or without a window to the retina. Only retinal and centrally-based neural disorders, eccentricity from fixation, and about 50% of hypermature cataracts affect outcomes. With minor alterations, this test can be employed to assess the visual field. An analysis of variance (ANOVA) was performed on a defined set of parameters, to enable us to understand better the special properties and requirements associated with this test. Results are not significantly altered between ages 10-94 years (not assessed here). Employing settings well above threshold for test spot detection and well separated individual test spots, changes in test spot luminance, or background luminance (or adaptation level), contrast, veiling glare, test spot size, clear and variously degraded images, seem not to affect meaningfully measured outcomes. If an observer can define well a center of gravity for each test spot viewed, he can align the three points with remarkable precision.

Adult↗
PubMed1988

Fonda-Anderson reading chart for normal and low vision.

The purpose of our chart is to show all scientific and practical demands for near-vision testing. Comparable notations of measurement of visual acuity are explained, and the method of conversion from different notations is presented. One side of the chart has continuous, informative text in eight sizes progressing from 4 point to 24 point. The reverse side of the chart shows eight methods for testing visual acuity, namely: samples of the telephone directory, music, words, numbers, symbols, and a reduced distant chart. This side of the chart is designed especially for testing the vision of the partially sighted patient. The type size is designated using five methods of measurements.

Evaluation Studies as Topic↗
PubMed2007

Children unable to perform screening tests in vision in preschoolers study: proportion with ocular conditions and impact on measures of test accuracy.

PURPOSE: To examine the relative prevalence of ocular conditions among children who are unable to perform preschool vision screening tests and the impact on measures of screening test performance. METHODS: Trained nurse and lay screeners each administered a Lea Symbols visual acuity (VA) test (Good-Lite, Inc., Steamwood, IL), Stereo Smile II test (Stereo Optical, Inc., Chicago, IL), and Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), and SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY) examinations to 1475 children who later received a comprehensive eye examination to identify amblyopia, strabismus, significant refractive error, and unexplained reduced VA. The outcomes of the examination for children for whom screeners were unable to obtain results (Unables) were compared to the outcomes of children who passed and children who failed each screening test. When estimating sensitivity, specificity, and positive and negative predictive values (PPV and NPV), Unables were classified as either screening failures or screening passers. RESULTS: Less than 2% of children were classified as Unables for each test. The percentage with an ocular condition was at least two times higher for Unables than for screening passers for six of the eight modes of screening (P < 0.05). Considering Unables as screening failures, rather than screening passers, increased the estimate of sensitivity by 1% to 3% (depending on test) and decreased the estimate of specificity by 0% to 2%; PPV decreased by 0% to 4% for most tests, whereas NPV increased by <1%. CONCLUSIONS: Preschool children who are unable to perform VIP screening tests are more likely to have vision disorders than are children who pass the tests. Because < or =2% of children were unable to do each test, referring these children for an eye examination had little impact on the PPV and NPV of the tests, as administered in VIP.

Allied Health Personnel↗
PubMed1994

Assessment of functional vision performance: a new test for low vision patients.

Measures of functional vision are needed to assess elderly low vision patients, their success in using devices, and their ability to manage outside the treatment setting. A new test devised to measure functional ability through the performance of everyday tasks was administered to 94 patients who had acuities of 20/100 or worse in their better eye. Consisting of three versions and four subtests: spot reading, short-term text reading, identifying paper currency and clock reading, the test used standardized items and was timed. In a multiple regression model predicting test performance higher scores were associated with better near acuity (P = .002), higher education (P = .022) and higher levels of self-reported visual skills (P = .072). These predictors plus distance acuity, age and sex only accounted for 35 percent of the variance in test scores. Repeated administration of the test to a different group of 21 patients showed the test to be reliable (intraclass correlation = .85, P < .01) and to have no practice or version effects or differences between raters. This new test may be useful for natural history studies and clinical trials involving low vision patients but further evaluation of its sensitivity to change over time is required.

Adolescent↗
PubMed1988

Dynamic stereoacuity: a test for hitting a baseball?

Vision is a critical ingredient in professional sports such as baseball. It would, therefore, be logical to assume that vision testing should be able to discriminate between good and bad performance. Past attempts to establish this vision/performance relationship have not been successful. We believe the fault is anchored in the fact that all routine vision testing is static and unable to measure motion parameters. Using an instrument of our design to test dynamic stereoacuity, we have been able to detect subtle differences among individuals. The data show a segregation between major league hitters and pitchers. Such information could be used as one clue to predict hitting performance.

Baseball↗
PubMed2002

Relation between perceived driving disability and scores of vision screening tests.

AIM: To determine the relation between perceived driving disability and vision screening tests. METHODS: 93 subjects, aged 50 years and over, with binocular visual acuity of at least 20/80. Perceived driving disability (PDD) was assessed by a questionnaire. Subtracting daytime from night-time driving question scores revealed PDD at night (PDDN), subtracting scores of questions for driving in familiar places from those in unfamiliar places revealed PDD at unfamiliar places (PDDU). RESULTS: PDD was strongly related to visual acuity, contrast sensitivity and useful field of view (UFOV). Specific relations existed between PDDN and Nyktotests and Mesotests and between PDDU and UFOV. These associations were enhanced in a subset of subjects with better visual acuities. CONCLUSIONS: Vision screening tests correlate well with perceived driving disabilities, especially when a subtraction method is used in the questionnaire to reveal condition dependent disabilities. Additional tests for visual acuity are useful, especially in subjects with better visual acuity.

Automobile Driving↗
PubMed1987

Colour vision abnormalities in multiple sclerosis.

A battery of colour vision tests was employed to evaluate visual function in patients with multiple sclerosis (M.S.). Colour deficits were found in 45% of patients tested with the Ishihara plates and 42.5% of patients tested with the FM 100-Hue test. 65% of M.S. patients failed at least one of the tests. The colour vision deficits were not restricted to patients with optic neuritis or with visual evoked potential (VEP) abnormalities and there was no significant correlation between an abnormal VEP latency and a colour vision deficit. Colour vision testing may be a useful option to consider in the investigation of M.S. patients, even if there is no other evidence of visual system involvement.

Adult↗
PubMed2000

Improvements in clinical and functional vision and quality of life after second eye cataract surgery.

PURPOSE: To determine whether there is a need for second eye cataract surgery or whether cataract surgery in one eye provides sufficiently adequate vision. METHODS: The vision of 43 patients was assessed using a battery of clinical vision tests, performance-based functional vision tests, and quality of life questionnaires, both before and a few months after cataract surgery. Twenty-five patients underwent second eye surgery and 18 patients underwent first-eye surgery. To determine whether cataract surgery returned vision to normal levels, a control group of 25 subjects of a similar age with normal, healthy eyes was also assessed. RESULTS: Overall, greater improvements occurred in most aspects of vision after first eye surgery than after second eye surgery. However, second eye surgery provided similar improvements in mobility orientation and self-reported night driving to those after first eye surgery, and substantially greater improvements in stereoacuity and reductions in anisometropia. CONCLUSIONS: The study provides additional evidence to support the need for second eye cataract surgery. Second eye surgery may be particularly important to improve mobility orientation and the avoidance of falls.

Aged↗
PubMed1990

[Neuro-otological studies on the correlation between vision and oculomotor function tests].

The vision of 35 subjects with normal oculomotor function was artificially reduced with the use of convex and concave lenses and neutral density filters. The effects of blurred vision on the oculomotor function test were subsequently studied. In using neutral density filters, abnormal findings tended to be confirmed in the eye tracking test (ETT) and optokinetic nystagmus test (OKNT) for vision of 0.5 or less. However, the ratio of abnormal findings to the ETT markedly decreased as the intensity of the target luminance increased. Blurred vision due to refractive abnormality using lenses, had hardly any effect was detected on either test even in the cases of severe blurred vision. In conclusion, the effects on the oculomotor function test varied according to causes of blurred vision.

Electronystagmography↗