Criteria for cataract surgery: the role of visual acuity and visual function.
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OBJECTIVE: To determine the usefulness of Teller Acuity Cards for detecting three levels of vision deficit, the cutoff for amblyopia (20/40 or poorer), vision impairment (20/70), or legal blindness (20/200). DESIGN: We compared grating visual acuity with the Teller cards with Snellen visual acuity (our gold standard) in 69 literate patients with amblyopia or other cause of vision loss in a prospective masked study. RESULTS: Teller card visual acuity and distance Snellen visual acuity correlated significantly (r = .508, P < .001); however, Teller card visual acuity explained only 26% of the variation in distance Snellen visual acuity. Teller card visual acuity had a low sensitivity for detecting vision deficit of 20/40 or poorer (58%), vision deficit of 20/70 or poorer (39%), or legal blindness (24%), but somewhat more accurately reflected near Snellen visual acuity than distance visual Snellen acuity. Teller cards had a higher positive predictive value--80% for 20/70 visual acuity and 43% for legal blindness, as determined by near Snellen visual acuity. Specificity of Teller cards was 88% for detecting visual acuity loss of 20/70 and 98% for legal blindness. Negative predictive value of Teller cards for detecting visual acuity loss of 20/70 was 50% and for legal blindness was 71%. CONCLUSIONS: Teller Acuity Cards may underestimate the presence of amblyopia of all types, legal blindness, and a specified level of vision impairment (20/70). Even in the presence of normal visual acuity measurements with Teller cards, significant visual loss as assessed by standard Snellen optotypes may be anticipated in many patients.
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OBJECTIVES: (1). To test the consistency and ease with which number-plates of different component figures can be read under DVLA driving test conditions; (2). to test the relative difficulty of reading corresponding figures on registration plates of white and yellow backgrounds.Design Prospective study of consecutive eligible clinic patients. SETTING: Ophthalmology outpatients. SUBJECTS: 210 individuals with a corrected visual acuity with both eyes open of between 6/9 and 6/12. MAIN OUTCOME MEASURES: The ability to read three different number-plates under standard DVLA driving-test conditions (ie at 20.5 m in good daylight with glasses if worn) and the ability to read identical number-plates against a white and a yellow background. RESULTS: There is a significant difference between the ease with which three different number-plates can be read depending on their letter and numeral composition, although this did not seem to be significantly affected by whether they were printed on a yellow or white background. Only 92.3% of subjects could read all the number-plates at the legal distance, 96.7% could read at least one number-plate at the legal distance and 3.3% of the test subjects could not read any of the number-plates at 20.5 m. CONCLUSIONS: The current test protocol used to obtain a driving licence and, moreover, the test the police will employ to assess visual competence to drive, is highly variable and is unlikely to give consistent repeatable results. The performance of those with equally good visual acuity is unpredictable and is highly dependent on the number-plate they are asked to read. This variability could exclude some who would otherwise pass the test or pass an individual with a visual acuity below accepted standards. The forthcoming changes in the regulations for design of number-plates is an ideal opportunity to standardise the whole testing procedure for driving visual acuity.
OBJECTIVE: To measure monocular distance visual acuity, near visual acuity, contrast sensitivity, and visual field extent in full-term, 10-year-old children tested according to the protocol used to test 10-year-old preterm children in the Cryotherapy for Retinopathy of Prematurity study. SUBJECTS AND METHODS: Subjects were 106 healthy, full-term children, 9.8 to 10.9 years of age, who had no ocular abnormalities other than ametropia. All were tested monocularly using Early Treatment and Diabetic Retinopathy Study distance and near visual acuity charts and Pelli-Robson contrast sensitivity charts, with refractive error corrected according to Cryotherapy for Retinopathy of Prematurity study criteria. Goldmann perimetry was tested without correction using the V-4-e and III-4-e stimuli along 8 meridia. A standard pediatric eye examination was performed on each subject. RESULTS: Mean (SD) distance visual acuity was 20/19.6 OD (0.082 log unit [lu]) and mean near visual acuity was 20/19.5 OD (0.100 lu). Mean (SD) contrast sensitivity was 1.69 OD (0.12 lu), with a mean (SD) of 36.4 (2.2) letters read. Visual field extent was larger for the V-4-e stimulus than for the III-4-e stimulus. CONCLUSIONS: The results provide the first monocular normative data from a large sample of 10-year-old children tested with Early Treatment and Diabetic Retinopathy Study distance and near visual acuity charts and the Pelli-Robson contrast sensitivity charts, and add to the literature on Goldmann perimetry in children.
PURPOSE: To report a computerized method for determining visual acuity in children using the Amblyopia Treatment Study visual acuity testing protocol. METHODS: A computerized visual acuity tester was developed that uses a programmed handheld device that uses the Palm operating system (Palm, Inc, Santa Clara, California). The handheld device communicates with a personal computer running a Linux operating system and 17-inch monitor. At a test distance of 3 m, single letters can be displayed from 20/800 to 20/12. A C program on the handheld device runs the Amblyopia Treatment Study visual acuity testing protocol. Using this method, visual acuity was tested in both the right and left eyes, and then the testing was repeated in 156 children age 3 to 7 years at four clinical sites. RESULTS: Test-retest reliability was high (r =.92 and 0.95 for and right and left eyes, respectively), with 88% of right eye retests and 94% of left eye retests within 0.1 logarithm of minimal angle of resolution (logMAR) units of the initial test. The 95% confidence interval for an acuity score was calculated to be the score +/- 0.13 logMAR units. For a change between two acuity scores, the 95% confidence interval was the difference +/- 0.19 logMAR units. CONCLUSIONS: We have developed a computerized method for measurement of visual acuity. Automation of the Amblyopia Treatment Study visual acuity testing protocol is an effective method of testing visual acuity in children 3 to 7 years of age.
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BACKGROUND AND OBJECTIVE: To evaluate the potential acuity meter in predicting visual acuity after photodynamic therapy of choroidal neovascular membranes caused by age-related macular degeneration. PATIENTS AND METHODS: Retrospective study of 55 eyes in 51 patients with subfoveal predominantly classic choroidal neovascularization due to age-related macular degeneration. Pre-photodynamic therapy Snellen visual acuity minus the visual acuity with the potential acuity meter was compared with the actual improvement in visual acuity. Significant improvement in visual acuity after photodynamic therapy was defined as a gain of more than 2 lines in Snellen visual acuity (0.2 logarithm of the minimal angle of resolution units). RESULTS: Eighteen (51.4%) of 35 eyes with a potential for improvement experienced an actual improvement in their Snellen visual acuity after photodynamic therapy (P < .001). All eyes lacking a potential for improvement failed to experience an actual improvement in visual acuity after photodynamic therapy. CONCLUSION: The eyes that demonstrated better visual acuity with the potential acuity meter in this study seemed more likely to experience an improvement in visual acuity after photodynamic therapy.
The relationship between Snellen visual acuity and central visual field loss as determined by the Humphrey 10-degree test was examined in 96 glaucomatous eyes of 79 patients. The severity of the field defect was determined by the number of affected quadrants, defined as a sensitivity loss of at least 10 decibels from normal at the most central point of 1.4-degree eccentricity. The decrease in median acuity was gradual, one-half line per quadrant for one and two affected quadrants, and an additional one and one-half line to two lines for three and four quadrants. Loss of acuity was disproportionate when both temporal quadrants were affected. The major source of error was difficulty with fixation. One type, a prolonged fixation shift, was not related to short-term fixation losses. There was a significant correlation between acuity and foveal threshold over a wide range of both variables. Sudden visual loss from additional optic nerve damage was studied retrospectively in 96 eyes with advanced glaucoma and a central field defect. A frequency of 3% for any loss of visual acuity and a frequency of 1% for a loss to 20/200 or worse were noted. There were no apparent predictive factors.
The visual function of 100 eyes with low visual acuity of 100 patients with age-related macular degeneration was examined using measurements of visual acuity, peak contrast sensitivity, and the ability to read, to tell time, and to distinguish colors, products, and facial expressions. Visual acuity and peak contrast sensitivity were correlated (r = .62); however, a range of peak contrast sensitivities was observed at each level of acuity. When considered individually, visual acuity and peak contrast sensitivity were related to the ability to perform each of the tasks. When multivariate methods were applied, both visual acuity and peak contrast sensitivity contributed independently to the ability to read and tell time. Among patients with the same contrast sensitivity, visual acuity had little or no relationship to the ability to identify colors, products, and faces.
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PURPOSE: To describe the 5-year change in visual acuity and the incidence of visual impairment in a population-based cohort. DESIGN: Population-based epidemiologic study. PARTICIPANTS: Of the 3654 participants of the Blue Mountains Eye Study (BMES I) baseline examination (aged 49 years+ during 1992-1994), 2335 were reexamined during the 5-year follow-up examinations from 1997 to 1999 (BMES II), and 543 persons had died since BMES I. METHODS: Visual acuity was measured using a logarithm of the minimum angle of resolution chart in both eyes separately before and after standardized refraction. Pupils were dilated and a detailed examination was performed. MAIN OUTCOME MEASURES: Visual impairment, after best refractive correction, was defined as any (visual acuity </=20/40; </=41 letters) and severe (visual acuity </=20/200; 0-5 letters) in keeping with the Beaver Dam Eye Study. Incident binocular visual impairment was defined as visual acuity </=20/40 in both eyes at follow-up, where visual acuity was >20/40 in both eyes at baseline. Incident binocular severe visual impairment was defined as visual acuity </=20/200 in both eyes at follow-up, where visual acuity was >20/200 in both eyes at baseline. The incidence for three other levels of visual impairment is also given: <20/40, <20/70, and <20/200. Monocular visual impairment was defined as impairment in one eye only at follow-up, where both eyes were unimpaired at baseline. Incident doubling and halving of the visual angle were calculated. RESULTS: Incidence rates for visual impairment increased significantly with age. Any incident impairment </=20/40 occurred binocularly in 41 persons (1.9%) and monocularly in 150 persons (7.1%). Severe incident impairment </=20/200 occurred binocularly in 3 persons (0.1%) and monocularly in 44 persons (2.1%). Incident impairment <20/40 occurred binocularly in 37 persons (1.7%) and monocularly in 134 persons (6.3%). Impairment <20/70 occurred binocularly in 15 persons (0.7%) and monocularly in 84 persons (3.8%). Impairment <20/200 occurred binocularly in 3 persons (0.1%) and monocularly in 44 persons (1.9%). Women consistently had a higher incidence of visual impairment than men, although this was often not statistically significant after adjusting for age. Increasing age was a strong predictor of visual impairment. CONCLUSIONS: This study has documented the 5-year incidence and causes of visual impairment in an older Australian population.
A computer program was designed for automated visual acuity testing, the aim of which was to evaluate the effectiveness of such systems in a busy out-patient department. The time required for explanation and performing the automated test was compared with that taken by nurses measuring visual acuities in the conventional manner using a Snellen's chart. The correlation of the results of the computer system and the manual measurements was tested.