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PubMedDate not supplied

Evaluation of night vision disturbances.

BACKGROUND: Evaluation of night vision disturbances has relied on subjective responses. We designed a test to more objectively measure night vision disturbances. METHODS: The test consisted of projecting a small circle onto a visual acuity screen. The patient is asked to draw exactly what he sees on an Amsler grid. We evaluated 118 eyes in photopic and scotopic conditions and under different conditions of refractive correction. RESULTS: Image degradation increased in scotopic conditions for myopes (p = .0001), hyperopes (p = .005), and emmetropes (p = .01). Myopic refractive error correlated with size of glare response (p = .001). Astigmatism correlated with decentration of glare response (p = .0001). Decentration increased in scotopic compared to photopic conditions (p = .002). CONCLUSION: Our test offers a simple, convenient way to evaluate night vision disturbances and may offer a means of assessing night vision disturbances in patients considering refractive surgery.

Adolescent↗
PubMed1995

Binocular vision anomalies: an emerging cause of malpractice claims.

BACKGROUND: Tumors that affect the visual system are a significant cause of liability claims involving eyecare practitioners. Individuals with brain tumors or intraocular tumors may seek examination for associated binocular vision disorders such as strabismus and reduced acuity. A disporportionate number of these individuals are children. METHODS: A review of malpractice claims was performed to identify representative clinical presentations in which binocular vision disorders were the cause for examination. RESULTS: Strabismus and amblyopia in children, if not promptly diagnosed and properly treated, can be the basis for a malpractice claim. Binocular vision disorders may also result from brain or intraocular tumors affecting children, and failure to timely detect the presence of these underlying diseases can also become the basis for a malpractice claim. CONCLUSIONS: Eyecare practitioners should examine carefully children with binocular vision disorders to rule out the possibility of an associated brain or intraocular tumor. Key findings include decreased visual acuity, acute strabismus, and indications of neurological disease such as optic atrophy, papilledema, visual field loss, and problems with gait and coordination.

Brain Neoplasms↗
PubMed1994

Analysis of an older adult vision screening project.

BACKGROUND: The purpose of this study was to determine how a variety of reasonable vision screening criteria affected the results of vision screening previously performed on a community-dwelling older adult population. METHODS: The records of 201 previously performed vision screening evaluations of adults over the age of 65 were reanalyzed to determine failure rates using new theoretical criteria. Those criteria included screening by history alone, visual acuity alone, history in combination with visual acuity and a multiple test format with both 20/40 and 20/60 acuity criteria. RESULTS: Theoretical screening that would have taken place using visual acuity of less than 20/60 failed the fewest individuals; however, even using this minimal criteria 46 percent of those screened would have failed. Using a multiple test format the failure rate rises to almost 90 percent. The combination of historical criteria and visual acuity failed almost an identical population as would be failed by using an elaborate multiple test format. CONCLUSIONS: The prevalence of ocular abnormalities in this older adult populations was so high that vision screening done with even minimal criteria can be expected to fail very high numbers. Similar failure rates and composition can be achieved by using historical criteria in combination with visual acuity as are achieved using a more elaborate multiple-test format. Given the high prevalence of eye abnormalities in the older adult population the public health value of screening for the need for eye examination is questionable.

Aged↗
PubMed1994

Results of community-based vision screenings of older adults in the Birmingham, Alabama metropolitan area.

BACKGROUND: Two-hundred one adults age 65 and older underwent vision screening at community senior centers and nutrition sites in the Birmingham, Alabama metropolitan area. METHODS: Using a multiple-test format recommended by the American Optometric Association, 89 percent of those screened failed. Reduction in visual acuity associated with anterior segment abnormalities was the most common reason for failure. Almost half (48 percent) of the overall population had less than 20/50 distance acuity in both eyes. Median visual acuity for the population was 20/50. Median visual acuity decreased with age from 20/40 at age 65 to 20/80 for those over the age of 85, while only 8 percent were legally blind. RESULTS: Results show that a large percentage of older adults have reduced vision without being legally blind and will fail vision screening. CONCLUSIONS: Given the high failure rate, the value of this type of vision screening is questionable.

Aged↗
PubMed1993

Vision with bifocal intraocular lenses.

The laboratory and clinical results of tests of different bifocal intraocular lenses (BIOLs) are compared. Included are two-zone refractive BIOLs with a central near zone and an annular distance zone (group 1); three-zone refractive BIOLs with a central distance zone, an annular near zone, and a peripheral distance zone (group 2); diffractive BIOLs (group 3); multizone refractive BIOLs (group 4); and other BIOLs (group 5). All BIOLs cause a significant loss of image contrast and acuity at low contrast. The incidence of visual side effects (e.g., halos, glare) varies but is significantly higher than that obtained with monofocal IOLs. On the other hand, BIOLs provide a depth of focus of 3-4 D as compared with only 1.5 D for monofocal IOLs. In group 1, distance vision is reduced in bright light, which limits the clinical use of these BIOLs. In group 2, distance vision is better than near vision. Thus, a temporary near add is required in some cases. In group 3, distance and near vision are similar, but the incidence of visual side effects is higher than that in group 2. Only BIOLs of groups 2 and 3 can be recommended for clinical use in selected patients. Not enough data are currently available on the other groups. Patient selection is the most critical factor for BIOLs. Ideal patients are relatively young and active, are highly motivated, show no ocular pathology, and have a normal pupil, an axial length of 22-24.5 mm, and a corneal astigmatism of less than 1 D. Reduced image contrast, mainly at near focus, and visual side effects must be acceptable. Bilateral implantation yields the best results. A monofocal fellow eye is a definite contraindication. In summary, BIOLs cannot replace monofocal IOLs. However, they provide a valuable alternative in selected patients.

Accommodation, Ocular↗
PubMed1993

Measuring vision with temporally modulated stripes in infants and children with ROP.

PURPOSE: To determine differences in preferential looking (PL) acuities using stationary and temporally modulated stripe patterns in patients with various stages of retinopathy of prematurity (ROP). METHODS: We measured the PL acuities of 134 patients (ages 4 mo to 13 yr) with various stages of ROP. Patients were divided into six subgroups according to PL vision measured with stationary stripes: (1) equal to or better than 20/200 (n = 24); (2) worse than 20/200 to 20/400 (n = 10); (3) worse than 20/400 to 20/800 (n = 15); (4) worse than 20/800 to 20/1600 (n = 13); (5) worse than 20/1600 to 20/6400 (n = 26); and (6) worse than 20/6400 (n = 46; no stationary vision). RESULTS: In the group with PL acuity equal to or better than 20/200, no difference in vision was apparent between the two methods. In patients with acuities worse than 20/200 to 20/400, the temporally modulated PL acuities were 0.23 octave better than the PL acuities measured with the stationary stripes. The difference increased to 0.86 and 1.12 octaves in the groups with visual acuities worse than 20/400 to 20/800 and worse than 20/800 to 20/1600, respectively. The difference in the group with PL acuities worse than 20/1600 to 20/6400 was 1.69 octaves. The 46 patients with no stationary vision detected only the temporally modulated stripes. CONCLUSIONS: The results suggest that the PL acuity difference between the temporally modulated and stationary stripes increases with visual impairment. Measuring PL acuity with temporally modulated stripes is an important addition to the evaluation of severely visually impaired subjects.

Adolescent↗
PubMed1996

Pediatric primary care vision examination.

Pediatric vision care is important to the welfare of every child. Recent research has shown that early vision care is advantageous for proper vision development. Primary vision care is recommended for infants and young children. Techniques used for the pediatric population are different from those used for the adult population. Measurement of visual function is greatly dependent on the examiner's skill in integrating knowledge of normal development, use of age-appropriate tests, and observational abilities. This paper is a summary of techniques that are applicable to the primary care examination of infants and young children. Comments are included on patient management and practice preparation to welcome young children.

Adult↗
PubMed1997

Seeing into the future. Vision and aging.

The leading causes of visual impairment in North Americans are age-related, but appropriate care can preserve useful vision for most older adults. Cataract surgery is highly successful. Early detection and treatment of glaucoma can prevent vision loss. Laser treatment is remarkably effective against diabetic retinopathy. Vision loss due to macular degeneration cannot be delayed in all patients, but low-vision rehabilitation can maximize the usefulness of remaining sight.

Adaptation, Physiological↗
PubMed1998

Fixation disparity at different viewing distances and the preferred viewing distance in a laboratory near-vision task.

Previous research has shown that subjects with normal binocular vision differ reliably in the extent to which their fixation disparity changes in the exo direction when the viewing distance is shortened from 100 to 20 cm. Since fixation disparity can lead to asthenopic complaints, the present study investigates whether an exo fixation disparity induced by proximity may cause subjects to move to a longer viewing distance during a near-vision task in order to reduce exo fixation disparity. In two optometric sessions, fixation disparity and accommodation were tested at 60, 40, and 30 cm viewing distance. In a further session, subjects were required to begin a one-hour near-vision task at about 40 cm viewing distance, at which the text characters subtended a comfortable visual angle of 21 min arc. Later, the subjects were free to adopt any viewing distance. In the initial phase of the task, subjects moved back from the screen to a greater or lesser extent that was correlated with the amount of proximal exo fixation disparity: the more a subject's fixation disparity changed to exo when the viewing distance had been shortened from 60 to 30 cm the more he or she moved to longer viewing distances in the course of the near-vision task. Further, the more distant the resting position of vergence (dark vergence), the more visual complaints the subjects indicated after the task relative to before.

Accommodation, Ocular↗
PubMed2004

The impact of visual impairment on functional vision of children in rural South India: the Kariapatti Pediatric Eye Evaluation Project.

PURPOSE: To determine the impact of visual impairment on functional vision of children in a rural population of south India. METHODS: A visual function questionnaire (LVP-VFQ) was administered to 1194 children aged 7 to 15 years identified through a systematic random sampling technique from 144 hamlets of Kariapatti in rural south India as part of a larger population-based project. Visual acuity estimations and clinical examinations for morbidity were performed in these 1194 children. A Rasch analysis was performed to validate the use of the instrument in this population. Bootstrap estimates (95% confidence intervals) of the regression coefficients were used to compare visual function scores between children with normal sight and children with uncorrected monocular and binocular visual impairment. RESULTS: The mean age of children was 10.3 +/- 2.1 years. The reliability estimates were 0.82 for person ability and 0.88 for item difficulty parameters, according to the Rasch analysis. A separation index of 2.15 was obtained for person measures and 2.74 for item measures, and the mean square infit and outfit statistics were 1.03 (Z(STD) 0.1) and 0.99 (Z(STD) -0.1), respectively. Children with monocular visual impairment (bootstrap estimate [95%CI] -0.05 [-0.08 to -0.01]) and binocular visual impairment (bootstrap estimate [95%CI] -0.09 [-0.11 to -0.07]) were more likely to have functional visual deficits than were normally sighted peers. CONCLUSIONS: Monocular or binocular visual impairment impacts on the functional vision of children in this rural population. Further studies are needed to determine the impact of treatment of visual impairment on functional vision in children of this population.

Adolescent↗
PubMedDate not supplied

Persistent blurred vision after blepharoplasty and ptosis repair.

BACKGROUND: Visual disturbance after upper (eyelid) blepharoplasty is a relatively common postoperative complaint. Recent ophthalmology literature has demonstrated alternations of corneal curvature after procedures that reposition the upper eyelid using corneal topography. Astigmatic changes induced by eyelid repositioning may be a cause of persistent blurred vision after upper eyelid procedures. This observation has not been reported in the facial plastic literature. OBJECTIVE: To determine the incidence of persistent visual disturbance after upper blepharoplasty. METHODS: A retrospective review of upper blepharoplasty by 1 facial plastic surgeon and 2 oculoplastic surgeons during the year 2000. Patient interviews were conducted via telephone. RESULTS: A total of 146 patients were identified, and 106 of them responded to the study request. Six patients (5.7%) had subjective visual acuity changes 1 year after upper blepharoplasty, and 4 of the 6 patients had combined blepharoplasty and ptosis repair. Three patients had worse vision, 2 had improved vision, and 1 was unable to wear rigid contact lenses because of fogging. CONCLUSIONS: Prior studies have shown that most patients have measurable astigmatic changes 3 months after blepharoplasty and ptosis repair. We found that only a small percentage of them have persistent subjective symptoms 1 year postoperatively. It is important for facial plastic surgeons to properly advise patients, especially those with combined procedures, that upper eyelid repositioning procedures may induce long-term vision changes. Patients may need to obtain new prescription spectacles and contact lenses postoperatively.

Astigmatism↗
PubMed2000

Prognostic indicators for vision and mortality in shaken baby syndrome.

OBJECTIVE: To study ocular and nonocular signs of patients diagnosed as having "shaken baby syndrome" and determine prognostic indicators for vision and mortality. METHODS: Medical records of child abuse cases involving bilateral retinal hemorrhages were reviewed. Particular attention was paid to visual function and pupillary light reaction at the time of admission as well as the location of retinal hemorrhages, neuroimaging findings, ventilatory requirement, and associated skeletal injuries. These findings were correlated with visual prognosis and mortality. RESULTS: Thirty consecutive cases met the criteria for review. At the initial visit, mean age of the children was 9.3 months (range, 1-39 months) and 12 children (40%) had at least fix-and-follow vision. Preretinal and intraretinal hemorrhages (93% [n = 28] and 100% [n = 30]) were more common than vitreous hemorrhage (10% [n = 3]). Subdural hematomas were detected in 21 patients (70%). Twenty children (67%) had seizures and 16 (53%) required ventilatory support; bruises and long bone fractures were seen in 14 (47%) and 4 (13%) children, respectively. Eight patients died. All patients with nonreactive pupils on presentation died, while all patients with a pupillary light reaction lived (P<.001). Six (86%) of 7 patients with midline shift died, whereas 21 (91%) of 23 with no midline shift lived (P<.001). At follow-up, retinal hemorrhages had resolved in nearly all children by 4 months, and 16 children (73%) had at least fix-and-follow vision. Ventilatory requirement was associated with poorer vision (P<.01). CONCLUSIONS: Nonreactive pupils and midline shift of the brain structures correlate highly with mortality. Ventilatory requirement, but not visual acuity on presentation, predicts visual outcome.

Battered Child Syndrome↗
PubMed2005

Health- and vision-related quality of life among patients with ocular histoplasmosis or idiopathic choroidal neovascularization at enrollment in a randomized trial of submacular surgery: Submacular Surgery Trials Report No. 5.

OBJECTIVES: To (1) summarize vision-targeted and general health-related quality-of-life scores at baseline and quantify the effect of the ophthalmic problem, (2) evaluate the strength of relations between visual acuity and interview scores, and (3) compare scores for patients who also had choroidal neovascular lesions in the fellow eye (bilateral cases) with those of patients who had choroidal neovascularization in only the study eye (unilateral cases) at time of enrollment in a randomized trial of surgical removal of subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or of idiopathic origin. DESIGN: Eligible patients had subfoveal choroidal neovascularization (including some classic choroidal neovascularization) and a visual acuity of 20/50 to 20/800 (Snellen equivalent), inclusive, in the eye to be assigned randomly to surgery or observation. Interviews that incorporated the 39-item version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) and 2 other instruments were conducted by telephone by trained interviewers before patients enrolled and were assigned randomly to surgery or observation. Information from baseline clinical examinations and fluorescein angiograms interpreted centrally by masked readers was used to classify patients as unilateral or bilateral cases and to provide potential explanations for variability of interview responses using linear regression models. RESULTS: The median overall NEI-VFQ score was 75 (interquartile range, 60-84). The median scores on individual subscales ranged from 55 (general vision) to 100 (color vision). The visual acuity of the better-seeing eye accounted for much of the variability in scores on most NEI-VFQ subscales; a 3-line difference in visual acuity was associated with a 10-point or greater difference in scores on 5 subscales after adjustment for other characteristics of patients and eyes. Scores on most scales of all 3 instruments differed between unilateral cases (n = 167) and bilateral cases (n = 58). Even after adjustment for visual acuity and reading speed of the better-seeing eye, age, gender, and scores on the other instruments, scores on the NEI-VFQ near and distance activities subscales differed by almost 13 and 10 points, respectively, between unilateral and bilateral cases. Neither age nor gender was an important independent explanatory variable for NEI-VFQ scores. CONCLUSIONS: Unilateral and bilateral cases had vision-targeted health-related quality-of-life scores worse than those published for a reference population without eye disease. Furthermore, despite younger age, better visual acuity, and better short-term visual prognosis, bilateral cases had NEI-VFQ scores at baseline similar to those published for 2 groups of patients with age-related macular degeneration. Unidentified factors, in addition to the visual acuity of the better-seeing eye, affected patients' perceptions of visual function.

Adolescent↗
PubMed2005

Responsiveness of the National Eye Institute Visual Function Questionnaire to progression to advanced age-related macular degeneration, vision loss, and lens opacity: AREDS Report no. 14.

OBJECTIVE: To describe the ability of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to detect meaningful change over time (responsiveness) to the primary Age-Related Eye Disease Study outcomes. METHODS: The 25-item NEI-VFQ plus appendix was administered at 2 visits at 1- to 4-year intervals to 4119 participants in the Age-Related Eye Disease Study. Events evaluated were progression to advanced age-related macular degeneration (AMD), visual acuity (VA) loss of at least 15 letters, and lens opacity progression. Responsiveness was measured by the t statistic, effect size (ES), responsiveness statistic, and area under the receiver operating characteristic curve. Variance components were used to estimate the contributions of events to variability of the NEI-VFQ score. RESULTS: Overall NEI-VFQ score was responsive to AMD progression (t = 14.0; P< .001; ES = 0.81) and VA (t = 16.2; P< .001; ES = 0.74). Mean changes ranged from 11 to 25 points for the subscales of general vision, near and distance activities, social functioning, mental health, role difficulties, dependency, and driving. The NEI-VFQ was unresponsive to lens opacity progression, although when the event occurred in the eye with the best vision at the first administration, the lens opacity ES was moderate for the color vision (ES = 0.62) and driving subscales (ES = 0.66). Progression to advanced AMD and VA loss contributed significantly to the variation in the mean difference in overall VFQ score. CONCLUSIONS: Changes in the NEI-VFQ overall and subscale scores of 10 points or more are associated with clinically significant changes in vision and AMD. This finding may assist the design of interventional studies of AMD and VA loss that include the NEI-VFQ as an outcome measure.

Aged↗
PubMed1986

A Random Dot E stereogram for the vision screening of children.

The purpose of school vision screenings is to detect those children with vision problems that may impede normal development (eg, amblyopia, refractive error, strabismus, suppression). In a double-blind investigation, 483 schoolchildren, ranging in age from 5 to 13 years, had their vision screened using both the Random Dot E (RDE) stereogram and the Modified Clinical Technique (MCT). The validity of each technique was determined using the phi coefficient and was compared with results of similar reports in the literature for the Modified Clinical Technique, Snellen letter acuity, and vision-screening kits. Our data show that the RDE is more effective than five of six other techniques in identifying those children who need further visual examination. In addition, screening with the RDE can be taught to nonprofessionals in ten minutes or less, can be completed on each child within two minutes, and is inexpensive.

Adolescent↗
PubMed1998

Quantitative assessment of color vision impairment in workers exposed to toluene.

Color vision was examined by the Lanthony-D-15 desaturated test in two groups of workers occupationally exposed to toluene and in a control group. Biological parameters of toluene exposure were analyzed: toluene in air and in venous blood, orthocresol, and hippuric acid in urine after workshift. The first exposed group, Group E1, comprised 41 workers (toluene exposure ranged from 11.30 to 49.30 ppm), and the second exposed group, Group E2, comprised 32 workers (toluene exposure ranged from 66.00 to 250.00 ppm). The nonexposed group, Group NE, comprised 83 subjects. Each group was divided into two subgroups; alcohol consumers and nonconsumers. Color vision loss was expressed as a color confusion index (CCI) and as age and alcohol intake-adjusted color confusion index (AACCI). Significantly higher values of CCI and AACCI (both P < 0.0001) in Group E2 in comparison to Group NE, and significantly higher CCI (P < 0.0001) and AACCI (P < 0.05) values in Group E2 in comparison to Group E1 were established. The significant difference in CCI value between alcohol consumers and nonconsumers was established only in Group NE (P < 0.05). In Group NE significant correlation was found between CCI value as a dependent and age and alcohol intake as independent cofactors (R2 = 0.45; P = 0.0000). In Group E2 significant correlation was established between CCI as a dependent factor and age, toluene in air, and alcohol intake (R2 = 0.72; P = 0.0001), or between CCI as dependent and age, toluene in blood and alcohol intake as independent cofactors (R2 = 0.68; P = 0.0002). In Group E1 significant correlation was established only between CCI and age (P <0.005). In Group E2, AACCI value significantly correlated with toluene in air (P < 0.0001), toluene in blood (r < 0.0005), orthocresol (P < 0.005) and hippuric acid (P < 0.005) in urine after workshift. There were no differences between smokers and nonsmokers in CCI values in the examined groups. Results of this study indicate that toluene in exposed workers can impair color vision. The role of alcohol intake and age influence on color vision loss cannot be ignored in such workers.

Adult↗
PubMed1993

Personal and family stress in individuals with diabetes and vision loss.

The intrapersonal distress and the impact of diabetes and vision impairment on marital functioning were assessed. Significant degrees of intrapersonal distress were demonstrated by the Beck Depression Inventory, Rosenberg Self-Esteem Scale, and Rand Mental Health Index. Family functioning as assessed by the Family Assessment Device was significantly compromised. Vision impairment was a major stressor in the spousal relationship. Of 18 subjects who had been involved in a committed relationship at the onset of vision impairment, 9 had separated. Separation occurred at a mean of 1.6 years after the vision impairment. Totally blind individuals were at greater risk for separation than those who were legally, but not totally, blind. Psychological intervention was a limited benefit. Studies are necessary to identify the appropriate timing for further interventions.

Adult↗
PubMed1993

Causes of low vision and blindness in south western Saudi Arabia. A hospital-based study.

The authors studied 1,681 consecutive patients who attended their ophthalmic outpatient clinics over a period of 12 months to determine the patients' visual acuity status and the causes of any visual loss. Using the World Health Organization criteria for definition of visual acuity status, 1004 (59.7%) patients had normal vision. Four hundred and thirty-one (25.6%) patients had low vision or visual impairment and 246 (14.6%) patients were blind. Twenty-eight (1.9%) patients had no light perception in both eyes. Cataract, both in isolation and co-existing with other ocular pathology, was the major cause of both low vision and blindness (58.5% and 81.7%, respectively). A concerted attack on cataract alone will markedly reduce blindness and low vision in this region.

Adolescent↗