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At least 613 records · Page 34Linked to original sources

[Screening of early color vision loss in diabetic patients].

Colour vision defects have been claimed to appear in diabetes before any retinopathy is visible. In the present study diabetic patients and non diabetic control subjects were screened with two different colour vision tests which include both red-green and blue-yellow parts, and are suitable for quantitative analysis of scores. The Lanthony 40 Hue test and the Tokyo Medical College--T.M.C. tables were used to assess colour vision in 106 diabetic (50 insulin dependent and 56 non insulin dependent) patients and in 99 non diabetic control subjects. Diabetic patients without visible retinopathy, familiar colour vision defects and/or lens changes, had significantly higher scores than control subjects in both eyes. The differences were more evident in non insulin dependent patients. Statistical analysis showed that early loss of colour vision was correlated with age and duration of diabetes for older patients, while correlation with glycosylated hemoglobin was moderately positive only for younger patients. Both tests (especially the Lanthony 40 Hue) resulted to be highly specific and could be used for the clinical study of colour vision losses in diabetic patients.

Adult↗

The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal.

PURPOSE: To define the risk of hydroxychloroquine (HCQ)-related retinal toxicity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who are receiving recommended dosages of the drug (< or =6.5 mg/kg/day). DESIGN: Prospective cohort study, from 1985 to 2000. PARTICIPANTS: Greek patients with RA (n = 335) and SLE (n = 191) treated with HCQ, 400 of whom had completed at least 6 years of treatment. METHODS: Ophthalmologic evaluation was performed every 6 months from 1985 to 1995, and yearly thereafter. This consisted of best-corrected visual acuity, color vision testing, static central visual field testing, fundoscopy, electroretinography, and fluorescein angiography, when indicated. MAIN OUTCOME MEASURES: Fundus lesions attributed to HCQ. RESULTS: No HCQ retinal toxicity was noted in any of the 526 patients during the first 6 years of treatment. Two (3.4%) of the first 58 long-term (>6 years) treated patients developed HCQ-related maculopathy at 8 and 6.5 years of treatment, despite regular ophthalmologic evaluation. On follow-up 7 and 9 years after cessation of HCQ treatment, both patients had stable eye disease. No HCQ retinal toxicity was observed in the subsequent 342 patients who were treated for >6 years. Overall, the incidence of HCQ-related retinopathy in 400 patients who were treated with recommended dosages of the drug for a mean of 8.7 years was reduced to 0.5%. CONCLUSIONS: After a baseline ophthalmic examination to confirm the absence of preexisting fundus pathology, patients with normal renal function may receive HCQ at a maximal daily dosage of 6.5 mg/kg and continue safely for 6 years. However, annual screening is recommended in patients who have taken the drug, even in recommended doses, for >6 years.

Adolescent↗

Stereopsis in refractive surgery.

PURPOSE: To examine stereopsis in myopic refractive surgery patients undergoing sequential bilateral and unilateral treatment. DESIGN: Prospective, observational, cohort study. METHODS SETTING: Clinical practice. PATIENTS: Eighty-three patients were studied; 55 had sequential bilateral and 28 had unilateral treatment. Mean age was 32 years. Stereopsis was measured using a multitarget red-green anaglyph stereo vision test. Only patients with fine preoperative stereopsis were included in the study. Repeat measurements were taken one week laser-assisted in situ keratomileusis (LASIK) or three weeks laser epithelial keratomileusis (LASEK) after treatment of one eye in all patients. Further measurements were taken at six and 12 weeks in unilaterally treated patients and after treatment of the fellow eye in bilaterally treated patients. RESULTS: A total of 38.6% of patients retained fine stereopsis (28 to 41 seconds of arc) over a range of anisometropia from 0.625 to 4.375. Moderate stereopsis (66 to 526 seconds of arc) was recorded 28.9% in the presence of 1.375 to 5.525 diopters of anisometropia. Poor/absent stereopsis (< or =2000 seconds of arc) was found in 32.5% in the presence of 2.1 to 8.0 diopters of anisometropia. A strong correlation was found between stereopsis and anisometropia, but interpatient variability was found. Uncorrected visual acuity (UCVA) in the untreated eye of > or =20/200 was associated with retention of fine stereopsis. Unilaterally treated patients showed improvement in stereopsis at six weeks after surgery. Sequential bilateral treatment had no deleterious effect on stereopsis. CONCLUSIONS: Loss of stereopsis was strongly correlated with anisometropia. UCVA in the untreated eye was a good indicator of postoperative stereopsis. Stereopsis improved during the postoperative adaptation period in unilateral treatments. Bilateral sequential treatment has no long-term effect on stereopsis.

Adult↗

Clinical use of the Pepper Visual Skills for Reading Test in low vision rehabilitation.

The Pepper Visual Skills for Reading Test (VSRT) is an assessment instrument designed by Whittaker et al. to evaluate the reading skills of patients with macular degeneration who were able to read to their satisfaction before their vision loss. The VSRT was administered to 10 patients with macular degeneration and central scotomas from the Low Vision Optometry Program at the Hines Veterans Administration Hospital Central Blind Rehabilitation Center and the Visual Impairment Center to Optimize Remaining Sight (VICTORS) at Westside Veterans Administration Medical Center, Chicago. Reading skills were measured before and after a low vision treatment program. Results indicate that this test may be useful in designing low vision training programs, evaluating the progress of individual patients receiving low vision services, and evaluating low vision programs designed to rehabilitate those with reading difficulty.

Aged↗

Phenotype in retinol deficiency due to a hereditary defect in retinol binding protein synthesis.

PURPOSE: To describe the phenotype caused by a retinol deficiency in a family with compound heterozygous missense mutations (Ile41Asn and Gly75Asp) in the gene for serum retinol binding protein (RBP). METHODS: The two affected sisters, 17 (BR) and 13 (MR) years old, were examined clinically and with perimetry, color vision tests, dark adaptometry, rod- and cone-isolated electroretinograms (ERGs), multifocal ERGs, electrooculograms (EOGs), and laboratory tests. RESULTS: There were no complaints besides night vision problems and no history of systemic disease. Visual acuity was reduced to 20/40 (BR) and 20/25 (MR). Anterior segments were normal except for a discrete iris coloboma. Both patients showed a typical "fundus xerophthalmicus," featuring a progressed atrophy of the retinal pigment epithelium. Dark adaptation thresholds were elevated. In the scotopic ERG, only reduced mixed responses were recordable. The photopic ERG was reduced in BR and normal in MR; implicit times were highly (BR) to slightly (MR) elevated. There was no (BR) to little (MR) light reaction in the EOG. All-trans retinol levels were 0.19 microM and 0.18 microM (normal range, 0.7-1.5 microM) for BR and MR, respectively, and did not increase in a dose-response test. RBP was below detection threshold, and retinyl esters were normal. CONCLUSIONS: Both affected siblings had no detectable serum RBP, one sixth of normal retinol levels, and normal retinyl esters. The retinal pigment epithelium was severely affected, but besides acne there were no changes to other organs. This gives evidence for an alternative tissue source of vitamin A, presumably retinyl esters from chylomicron remnants. The normal retinol levels in the tear fluid explain the lack of xerophthalmia. However, considering the role of RBP in the tear fluid and, during development, in the yolk sac there is also evidence that there are organ-specific RBP forms not affected by the genetic defect.

Adolescent↗

X-linked recessive cone dystrophy with tapetal-like sheen. A newly recognized entity with Mizuo-Nakamura phenomenon.

We encountered a new X-linked recessive cone dystrophy in which patients have a greenish-golden tapetal-like sheen of the retina; while the retinal sheen and electroretinographic abnormalities are present from childhood, patients are not symptomatic until adult years. All of the male patients tested showed evidence of cone dysfunction on color vision testing, dark adaptometry, and electroretinography. After three hours of dark adaptation, the tapetal-like sheen disappeared, with most areas changing from greenish-golden shades to orange-red hues (Mizuo-Nakamura phenomenon). One male patient had a retinal detachment from atrophic round holes in the equatorial retina.

Adolescent↗