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PubMed2000

Detection of vision impairment in people admitted to aged care assessment centres.

Vision is not routinely tested when the health of older people is assessed, and the aim of this study was to detect older people with vision impairment for referral to appropriate eye care services. People admitted for assessment and or rehabilitation in three aged care assessment centres had distance and near visual acuity assessed with a simplified vision test. A pinhole test was used when necessary. Referral criteria were distance visual acuity of less than 6/12; near vision of less than N8, and people with diabetes who had not attended a dilated fundus examination in the last 2 years. Visual acuity results were obtained in 93% of patients (685/735). Those unable to perform the vision test were very ill or had severe cognitive impairment. Forty-three per cent of patients (266/646) had impaired vision and, of these, 70.6% (188/266) were referred to eye care specialists. Forty-five per cent were referred to ophthalmologists, 36% to optometrists and 20% to low vision services. This significant proportion of patients with poor vision suggests that vision screening is warranted.

Aged↗
PubMed1996

Accuracy and precision of the Tomey ViVA infrared photorefractor.

PURPOSE: The Fortune Optical (Tomey ViVA) VRB-100 video refractor was tested to determine its accuracy and precision in measuring manifest refractions of human eyes with and without cycloplegia. The specific issues addressed included its accuracy in measuring spherical and cylindrical refractive errors and its precision in refracting near emmetropia. METHODS: To determine its ability to measure moderate to high (> 4.00 D) myopia, we compared the VIVA's refractions to those taken by a Canon Autorefractor R1 and a retinoscopist. A spherical lens series from -7.00 to + 7.00 D at 1.00 D intervals, or -5.00 to + 5.00 at 0.50 D intervals, was placed over a subject's eye, which was then covered by an infrared (IR) filter, refracted, and analyzed to determine the VIVA's ability to measure spheres. Subjects with refractive errors of -2.00 to + 2.00 DS (diopters sphere) and 0 to 1.00 DC (diopters cylinder) were refracted 7 to 15 times during 1 sitting to determine the VIVA's precision. The instrument's accuracy in measuring cylinders was tested by placing + 3.00 to -3.00 D cylinders (at 0.50 D intervals) over the eyes of subjects at 0 degree, 45 degrees, 60 degrees, 75 degrees, 90 degrees, 105 degrees, 120 degrees, and 135 degrees. RESULTS: The VIVA measured spheres of +/- 3.00 D with a root mean squared (rms) error of 0.5 +/- 0.1 D. Beyond this power, its accuracy progressively worsened. In some subjects, irregular intensity profiles compromised the VIVA's accuracy even with low spherical refractive errors. The VIVA was very precise in measuring spheres from + 2.00 to -2.00 D and cylinders from 0 to 1.00 D. Although the ViVA adequately measured all cylinder powers at 0 degree and 90 degrees, the accuracy of cylindrical power measurement decreased with obliquity; only cylinders < or = 1.00 D magnitude were accurately measured at 45 degrees and 135 degrees. CONCLUSIONS: We conclude that, although the ViVA offers many attractive features for vision screening, it is seriously limited by its inability to property detect and measure oblique astigmatic errors.

Humans↗
PubMed1985

Inter-relationships between British drivers' visual abilities, age and road accident histories.

Statistical analysis is described of data on 1000 British drivers' accident histories and their performance on a vision screening instrument. Significant positive associations are evident between various accident variables and tests of hyperphoria, right eye visual acuity, left eye acuity and binocular acuity. The clustering of associations is strongest for older drivers. The significance of hyperphoria has received little attention previously. The age-related associations with accidents parallel the decline with age of other visual abilities. Statutory re-testing of drivers' vision at about the age of 50 is recommended.

Accidents, Traffic↗
PubMed2005

Amblyopia: prevalence, natural history, functional effects and treatment.

Amblyopia, defined as poor vision due to abnormal visual experience early in life, affects approximately three per cent of the population and carries a projected lifetime risk of visual loss of at least 1.2 per cent. The presence of amblyopia or its risk factors, mainly strabismus or refractive error, have been primary conditions targeted in childhood vision screenings. Continued support for such screenings requires evidence-based understanding of the prevalence and natural history of amblyopia and its predisposing conditions, and proof that treatment is effective in the long term with minimal negative impact on the patient and family. This review summarises recent research relevant to the clinical understanding of amblyopia, including prevalence data, risk factors, the functional impact of amblyopia and optimum treatment regimes and their justification from a vision and life skills perspective. Collectively, these studies indicate that treatment for amblyopia is effective in reducing the overall prevalence and severity of visual loss from amblyopia. Correction of refractive error alone has been shown to significantly reduce amblyopia and less frequent occlusion can be just as effective as more extensive occlusion. Occlusion or penalisation in amblyopia treatment can create negative changes in behaviour in children and impact on family life, and these factors should be considered in prescribing treatment, particularly because of their influence on compliance. Ongoing treatment trials are being undertaken to determine both the maximum age at which treatment of amblyopia can still be effective and the importance of near activities during occlusion. This review highlights the expansion of current knowledge regarding amblyopia and its treatment to help clinicians provide the best level of care for their amblyopic patients that current knowledge allows.

Adaptation, Psychological↗
PubMed1985

Visual acuity screening of children 6 months to 3 years of age.

The operant preferential looking (OPL) procedure allows a behavioral estimate of visual acuity to be obtained from children 6 mo to 3 yr of age. In clinical settings, there is often too little time available to obtain an acuity estimate with the standard OPL procedure. The goal of this study was to identify specific spatial frequencies, termed diagnostic grating frequencies, that could enable the OPL technique to be used as a screening procedure under conditions where completion of acuity estimation was not possible. One hundred eighty presumptively normal children, 6, 12, 18, 24, 30, and 36 mo of age, were each tested with up to 20 trials of a potential diagnostic grating frequency to determine the highest spatial frequency grating that could be resolved by 90% of children at each age. For all ages except 18 mo, there existed a spatial frequency that produced uniformly high OPL performance within the age group; this spatial frequency was separated by one-half to one octave from a higher spatial frequency that more than 30% of children at that age failed to detect. These results suggest that at all ages except 18 mo, it should be possible to use the OPL procedure as a vision screening tool by testing individual children with the diagnostic grating frequency appropriate for their age.

Child, Preschool↗
PubMed2003

Functional and structural recovery of the retina after gene therapy in the RPE65 null mutation dog.

PURPOSE: To assess the efficacy of AAV-mediated gene therapy to restore vision in a large number of RPE65(-/-) dogs and to determine whether systemic and local side effects are caused by the treatment. METHODS: Normal RPE65 dog cDNA was subcloned into an rAAV vector under control of a cytomegalovirus promoter, and an AAV.GFP control vector was also produced with the titers 2 x 10(12) particles/mL and 2 x 10(10) transducing U/mL, respectively. RPE65(-/-) dogs, aged 4 to 30 months were treated with subretinal injections of the AAV.RPE65 and control vectors, respectively, in each eye, and three 24- to 30-month-old normal control dogs with the latter. Baseline and postoperative systemic and ophthalmic examinations, blood screenings, vision testing, and electroretinography (ERG) were performed. Two RPE65(-/-) dogs were killed at 3 and 6 months after treatment for morphologic examination of the retinas. RESULTS: RPE65(-/-) dogs were practically blind from birth with nonrecordable or low-amplitude ERGs. Construct injections or sham surgeries were performed in 28 eyes; 11 were injected subretinally with the AAV.RPE65 construct. ERGs at 3 months after surgery showed that in the latter eyes, dark-adapted b-wave amplitudes recovered to an average of 28% of normal, and light adapted b-wave amplitudes to 32% of normal. ERG amplitudes were not reduced during a 6- to 9-month follow-up. No systemic side effects were observed, but uveitis developed in nine AAV.RPE65-treated eyes. No uveitis was observed in the eyes treated with the control vector. Immunocytochemistry showed expression of RPE65 in the retinal pigment epithelium (RPE) of AAV.RPE65-treated eyes. Fluorescence microscopy showed expression of green fluorescent protein (GFP) in the RPE and, to a lesser extent, in the neural retinas of AAV.GFP-treated eyes. Ultrastructurally, a reversal of RPE lipid droplet accumulation was observed at the AAV.RPE65 transgene injection site, but not at the site of injection of the control vector. CONCLUSIONS: In 10 of 11 treated RPE65(-/-) eyes, gene transfer resulted in development of vision, both subjectively apparent by loss of nystagmus, and objectively recorded by ERG. Structurally, there was reversal of lipid droplet accumulation in the RPE. Uveitis developed in 75% of the transgene-treated eyes, a complication possibly due to an immunopathogenic response to the RPE65 molecule.

Animals↗
PubMed1979

Dominant optic atrophy. The clinical profile.

We examined 24 individuals in four family pedigrees with dominantly inherited optic atrophy (DOA); 12 patients met the criteria for diagnosis of DOA and two were suspect. Our data indicate that (1) insidious onset usually occurred in childhood, but subjective visual symptoms may evolve in adulthood; (2) visual function was minimally (20/25) to moderately (20/400) abnormal, could be strikingly asymmetric in an individual (eg, 20/30 in the right eye and 20/200 in the left eye), and showed considerable intrafamilial and interfamilial variation; (3) visual field defects consisted of central and centrocecal scotomas, but no peripheral isopter abnormalities were found; (4) color-vision screening with Hardy-Rand-Rittler plates revealed dyschromotopsias, but only Farnsworth-Munsell 100-hue examination disclosed the typical tritan defects; (5) pattern-reversal visual-evoked responses were characterized by diminished amplitudes and prolonged latencies, consistent with neural conduction defects; (6) disc pallor was limited to the temporal segment in all cases, and 16 of 24 eyes showed focal temporal excavation, which is probably pathognomonic of DOA.

Adolescent↗
PubMed1998

Relationship between visual skills and performance on saccadic eye movement testing.

The effect of visual skills, such as binocularity, on saccadic eye movement test performance is currently unknown. Therefore, the relationship between performance on commonly used clinical saccadic eye movement tests and visual skill was studied in a masked investigation of 181 kindergartners and first graders (mean age 6.25 years) from a middle class, suburban, elementary school near Cleveland, Ohio. The New York State Optometric Association King-Devick saccade test (NYSOA K-D) and the Developmental Eye Movement test (DEM) were employed because they are two commonly used clinical saccadic eye movement tests. A Modified Clinical Technique (MCT) vision screening and Randot stereoacuity test were performed to evaluate other visual skills. Analysis revealed that for the whole study population, total errors on the NYSOA K-D were significantly related to referral on the MCT screening (p = 0.015) and stereoacuity worse than 100 sec arc (p = 0.011). A trend toward significance was also found between DEM ratio and stereoacuity worse than 50 sec arc for the whole study population. However, in the children who passed the MCT, stereoacuity was not found to be significantly related to performance on NYSOA K-D or DEM. Thus, our findings indicate that visual difficulties may affect performance on the NYSOA K-D in this population.

Child↗
PubMed1995

Effects of heterophoria on stereopsis.

The effects of horizontal heterophoria on Howard-Dolman stereopsis scores were investigated in a population of 1765 stereophotogrammetrists with no obvious impediment to binocular vision as determined in a vision screening. Exophoria over the 1 to 7 delta range showed no systematic and statistically valid effect on stereopsis but esophoria did show an effect. In a related population of 1339 stereophotogrammetrists, subjects with as little as 1 delta (+/- 0.5 delta) of vertical heterophoria exhibited a small but statistically significant decrease in stereopsis test scores compared to those with vertical orthophoria. Therefore, a heterophoria had different effects on stereoacuity depending on whether it was in the exo, eso, or vertical direction. An explanation for the difference is proposed using the known dependence of heterophoria and stereoacuity on fixation disparity.

Depth Perception↗
PubMed1989

Stereopsis testing in 18- to 35-month-old children using operant preferential looking.

Forced choice operant preferential looking (OPL) was used to evaluate stereopsis in children between 18 and 35 months of age. Eighty-three children who passed a vision screening were tested with a ring-shaped random dot target that stood out in depth. Food was used to reinforce looking at the target. Children were also administered the Random Dot E (RDE) as a comparison measure. Four children were unable to complete testing with OPL compared with 31 who were unable to complete testing with the RDE. This difference was most apparent in children under 24 months of age. This new procedure appears to be a useful technique to evaluate stereopsis in very young children.

Child, Preschool↗
PubMed1991

Vistech VCTS 6500 charts--within- and between-session reliability.

The aim of the study was to measure the reliability of the Vistech VCTS 6500 charts, in test score units, in order to allow clinicians to derive estimates of what constitutes a clinically meaningful change in performance over time. The reliability of a more familiar test, Bailey-Lovie high contrast visual acuity, was also measured to provide a comparison. Patients with normal vision and with early or subtle eye disease were recruited so that the results would be representative of the population likely to present for primary vision screening. Patients were tested on all three VCTS charts on two separate occasions at least 3 weeks apart to give estimates of within- and between-session reliability. Reliability was found to be low in all circumstances; between-session reliability could be improved by using the mean score for the three charts, but the 95% range of difference scores still encompassed at least one-half of the total performance range of the test. It was concluded that Vistech charts are unlikely to be of use for clinical measurements or for research studies.

Adult↗
PubMed2006

Evaluation of an eye health program: the vision initiative.

PURPOSE: The aim of this study was to develop an innovative, rapid and economical assessment methodology to determine the knowledge, attitudes and behaviours regarding eye health and to determine the rates of the most common causes of visual impairment and undiagnosed eye disease. METHODS: Letters were posted to Seniors Card holders aged 70-79 in 18 randomly selected areas, stratified by socio-economic status. A questionnaire was developed to measure knowledge, attitudes and behaviours regarding eye health. Uncorrected refractive error was determined by measuring presenting and best-corrected visual acuity (VA). Diabetic retinopathy and age-related macular degeneration were assessed using digital non-mydriatic retinal photography. Glaucoma was assessed using Frequency Doubling Technology (FDT) and digital images of the optic nerve head. Cataract was determined using digital retro-illumination images of the lens taken with a non-mydriatic camera. The cost for recruiting, examining and grading images for each participant was calculated by dividing the total study cost by the number of participants examined. RESULTS: Of the 13,483 participants invited to participate in the study, appointments were made for 1860 (13.8%) people with 1,701 (91%) actually attending. Overall, missing data from the 1,695 questionnaires represented less than 1.0% and all participants attended the vision screening over a three-month period. Presenting and best-corrected visual acuity and FDT results on both eyes were obtained on 99% of the sample. The proportion of gradable digital images of the fundus in both eyes in the sample was 89%, while 90% of participants with bilateral presenting VA<6/12 had assessable lens images. The cost for recruiting, examining and grading images for each participant was approximately 150 AUS dollars. CONCLUSION: The recruitment from a mailing obtained the required sample size for the study, allowing a large sample of participants to be examined efficiently over a short period of time. It is important that the most common causes of visual impairment and undiagnosed eye disease can be determined using this rapid assessment methodology.

Aged↗
PubMed1998

Anomalies of genetic development as predictors of oculo-visual abnormalities in velo-cardio-facial syndrome.

BACKGROUND: Subjects with velo-cardio-facial syndrome (VCFS) were assessed to determine whether the learning disabilities (LDs) characterizing the syndrome are compounded by visual function deficits, which would be predicted on the basis of the proposed embryonic derivation of the genetic anomaly. METHODS: Twelve subjects diagnosed with VCFS underwent a vision screening with emphasis on binocular function. RESULTS: Subjects exhibited deficits in accommodation (N = 5), convergence (N = 7), fusional reserves (N = 9), and stereopsis (N = 10). Three patients were strabismic at near. No patient was in the clinically normal range for all tests of binocular function. CONCLUSIONS: Individuals with VCFS have a chromosome 22 deficit thought to alter the migration of neural crest (NC) cells, which are the embryonic precursors of the autonomic innervation of the smooth muscle components of the eye and of cranial nerves III, IV, and VI. It was predicted that VCFS patients would demonstrate reduced accommodation and convergence flexibility, which would reduce visual comfort for near work. The pathological etiology of the visual anomalies suggests that if visual training is not successful, these patients should be provided with a suitable optical reading correction from an early age.

Accommodation, Ocular↗
PubMed2005

Frisby Davis distance stereoacuity values in visually normal children.

AIMS: To establish the range of normal distance stereoacuity in young children using the Frisby Davis distance stereo test (FD2). METHODS: Children passing preschool vision screening assessments underwent measurement of distance stereoacuity with the FD2 using a standard testing protocol. RESULTS: 59 visually normal children aged between 36 months and 68 months were recruited to this study. All 59 were able to understand the test requirements and were examined with the FD2 stereo test. Four (6.8%) had no measurable stereoacuity; 13 (24%) had stereoacuity measurable only at a 3 metre testing distance (mean 92.3 seconds of arc; SD 52.6). These children were significantly younger than the remaining 42 (76%) who demonstrated a stereoacuity response at a 6 metre testing distance (mean 29.6 seconds of arc; SD 13.1, p=0.008). CONCLUSION: The FD2 stereo test enables the measurement of distance stereoacuity in young children. There appears to be a maturational effect with distance stereoacuity improving between 36 months and 68 months. The data on age related normal values will provide a baseline from which to compare outcomes in clinical populations.

Aging↗
PubMed2004

A reevaluation of the Developmental Eye Movement (DEM) test's repeatability.

PURPOSE: To investigate the repeatability of the Developmental Eye Movement (DEM) Test in a group of third grade elementary school students. METHODS: Thirty, third grade children who passed a modified clinical technique vision screening were given the DEM and then retested 2 weeks later. RESULTS: A clinically and statistically significant improvement in mean scores from test to retest was found on the vertical time, horizontal time, and ratio score. The intraclass correlation coefficient (ICC) and the 95% limits of agreement (LoA) suggest that the vertical (ICC, 0.60; LoA, -4.2 +/- 16.5 s) and corrected horizontal (ICC, 0.55; LoA, -8.3 +/- 17.4 s) times have fair to good repeatability, whereas the ratio score was found to have poor repeatability (ICC, 0.27; LoA, -0.08 +/- 0.39). Based on these results, large changes can be expected on retest, which may result in a change in diagnostic classification from pass to fail. CONCLUSIONS: These results suggest that the ratio score of the DEM had poor repeatability in the third grade children who were evaluated. Poor repeatability of the ratio score may affect the clinician's diagnostic decisions and ability to monitor the effects of saccadic treatment.

Aging↗
PubMed1994

Eye disease among ambulatory Jewish senior citizens in California.

Knowledge of the epidemiology of eye disease among the elderly becomes increasingly important as our population ages. Leading causes of blindness in the elderly include age-related macular degeneration, open-angle glaucoma and cataract. Few studies have examined the prevalence of these blinding eye diseases among senior citizens. A retrospective review of vision screening examinations from 429 patients seen at the UCLA Mobile Eye Clinic in visits to a Jewish senior citizens' center was performed to examine the distribution of best recorded visual acuity and prevalence of eye disease in a group of ambulatory Jewish senior citizens. Best recorded visual acuity was > or = 20/40 in the better eye for 83.9% of the patients. The prevalence of age-related macular degeneration was 20.7%, and increased with increasing age (p < .00005). The prevalence of open-angle glaucoma was 6.3%. The prevalence of senile cataract was 59.0% and increased with increasing age (p < .00005). Despite the limitations imposed by a retrospective review of charts, our study provides an indication of the prevalence of blinding eye disease and distribution of visual acuity among ambulatory Jewish senior citizens in southern California. Except for the high prevalence of senile cataract, the prevalence data derived from this study are similar to other epidemiologic studies of eye disease in the elderly.

Aged↗
PubMed1977

Physical health of 7-year-old children. An epidemiological study of school entrants and a comparison with their preschool health.

At 7 years of age, all 649 7-year-old children in a school district underwent a physical examination, a vision screening and an auditory screening. 210 of the children were previously examined in an extensive health control at 4 years of age. The purpose of the present study was to describe the children's health situation and to evaluate the special health control performed at 4 years of age. In 15% of the children, functionally important health problems were found. Visual defects were most common, comprising 7.5%, then came physical health problems such as motor disturbances, obesity, bacteriuria in 6.5%, and hearing defects in 1%. About half of the important health problems were previously known. Children who had passed the special health control at 4 years of age had fewer newly detected important health problems and more previously known ones than other children, which means that many children with above all visual defects but also motor disturbances, bacteriuria and testis retention, were detected and treated earlier than would have happened without the special control at 4 years. It is concluded that the "ordinary" preschool Child Health Services did fulfill their purpose to detect handicapping disorders in an acceptable way; by the introduction of the special health control at 4 years of age, this function was further improved.

Child↗
PubMed1997

Association between visual reaction time and batting, fielding, and earned run averages among players of the Southern Baseball League.

BACKGROUND: This study was performed to investigate the relationship between vision reaction time (VRT) and batting, fielding, and pitching skill in baseball. METHODS: A vision screening of 213 professional baseball players in the Southern Baseball League was performed, and the visual reaction times of these players were determined. Official Southern Baseball League statistics were consulted to obtain the players' batting average, fielding average, and earned run average. RESULTS: The mean visual reaction time for all players was 239 msec. There was no significant association between mean VRT and age or race. The mean VRT for dominant eyes was not significantly different from the mean VRT for nondominant eyes. For the 92 players who batted at least 100 times, an association was found between mean VRT and batting average (p = 0.017). For the 168 fielders in the league playing at least 20 games, no statistically significant association was found between mean VRT and fielding average. Similarly, no association was found between mean VRT and earned run average for the B8 pitchers who had participated in more than 20 games. CONCLUSIONS: An association was found between visual reaction time and batting skill in baseball. No association was found between visual reaction time and fielding or pitching skill.

Baseball↗