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Psychophysics of reading. XVIII. The effect of print size on reading speed in normal peripheral vision.

Reading in peripheral vision is slow and requires large print, posing substantial difficulty for patients with central scotomata. The purpose of this study was to evaluate the effect of print size on reading speed at different eccentricities in normal peripheral vision. We hypothesized that reading speeds should remain invariant with eccentricity, as long as the print is appropriately scaled in size--the scaling hypothesis. The scaling hypothesis predicts that log-log plots of reading speed versus print size exhibit the same shape at all eccentricities, but shift along the print-size axis. Six normal observers read aloud single sentences (approximately 11 words in length) presented on a computer monitor, one word at a time, using rapid serial visual presentation (RSVP). We measured reading speeds (based on RSVP exposure durations yielding 80% correct) for eight print sizes at each of six retinal eccentricities, from 0 (foveal) to 20 deg in the inferior visual field. Consistent with the scaling hypothesis, plots of reading speed versus print size had the same shape at different eccentricities: reading speed increased with print size, up to a critical print size and was then constant at a maximum reading speed for larger print sizes. Also consistent with the scaling hypothesis, the plots shifted horizontally such that average values of the critical print size increased from 0.16 deg (fovea) to 2.22 deg (20 deg peripheral). Inconsistent with the scaling hypothesis, the plots also exhibited vertical shifts so that average values of the maximum reading speed decreased from 807 w.p.m. (fovea) to 135 w.p.m. (20 deg peripheral). Because the maximum reading speed is not invariant with eccentricity even when the print size was scaled, we reject the scaling hypothesis and conclude that print size is not the only factor limiting maximum reading speed in normal peripheral vision.

Adolescent↗

Asymmetrical vertical phorias indicating dissociated vertical deviation in subjects with normal binocular vision.

We measured the symmetry of phoria angles in six normal subjects. Subjects were selected on the basis of good visual acuity and stereopsis, normal binocular eye alignment and, apart from mild refraction errors, absence of ocular abnormalities. They were instructed to look at a word on a reading chart at 2 m distance. Each measurement consisted of five subsequent intervals of 5 s duration. During these five intervals viewing was binocular, with the right eye only, binocular, with the left eye only, and binocular, respectively. Each experiment consisted of twelve measurements. Eye movements were measured with scleral coils suited for measuring in horizontal, vertical and torsional directions. Five out of six subjects displayed an asymmetrical vertical phoria; one subject showed an alternating hyperphoria; four displayed a left over right vertical phoria that was largest for left eye occlusion. Only one subject showed a symmetrical vertical phoria. Both the size of the vertical phorias and the size of the asymmetries in these vertical phorias were very small: on average 0.16 +/- 0.01 and 0.17 +/- 0.01 degree, respectively. The direction of the vertical phoria asymmetries (the largest left over right was found with left eye occlusion) and the fact that asymmetries were found more often in vertical than horizontal and torsional phorias suggest that these asymmetries are related to dissociated vertical deviation. These results suggest that dissociated vertical deviation, often observed in subjects with a disruption of binocular vision early in life, reflects the enhancement of a phenomenon that is present in normal subjects as well.

Adult↗

[Ophthalmologic prevention of chloroquine and hydroxychloroquine induced retinopathy].

INTRODUCTION: Antimalarial drugs induce severe retinal toxicity. The aims of this study were to evaluate the strategy of screening clinical and preclinical intoxication due to antimalarial agents in two centres of reference and to describe the results of ophthalmologic examination. PATIENTS AND METHODS: Patients referred for ophthalmologic evaluation in connection with antimalarial agents therapy in the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts from October 1999 to December 2000 and in the Hôpital Lariboisière from January 1995 to December 1998 were investigated. A retrospective review of results of ophthalmologic examination, electroretinogram, electro-oculogram, colour vision test and central visual field was conducted to assess retinal intoxication. RESULTS: Among 705 patients recruited in the Centre des Quinze-Vingts, 10 out of 133 who were never treated had an electrophysiological contra-indication to the treatment. Among the 572 other patients, 31 presented with preclinical intoxication (5.4 p. 100) and 8 other patients presented with clinical intoxication. Among 925 patients recruited in the Hôpital Lariboisière, 37 presented with preclinical intoxication (4 p. 100) and four patients presented with clinical intoxication. DISCUSSION: The antimalarial drugs clinical intoxication is rare but nevertheless real. Screening for preclinical intoxication can prevent the evolution toward irreversible retinal intoxication. Diagnosis of preclinical intoxication is established through the confrontation of results of different tests and their evolution. The multifocal electroretinogram remains to be evaluated. CONCLUSION: Ophthalmologic monitoring including funduscopy, should be recommended at least once a year. Visual field seems to become interesting in the screening. Electroretinogram and electro-oculogram remain useful quantitative and obvious tests. A prospective study to assess the optimal way to prevent retinal intoxication is mandatory.

Antimalarials↗

Assessment of vision-related function in patients with age-related macular degeneration.

OBJECTIVE: To investigate the validity of the visual function index (VF-14) in assessing visual function in patients with age-related macular degeneration (AMD). DESIGN: Prospective noncomparative observational case series. PARTICIPANTS: One hundred fifty-nine consecutive patients attending a sole practitioner's academic retina-only clinic from May 1998 through August 1998 and from May 1999 through August 1999. MAIN OUTCOME MEASURES: Correlations were calculated between the VF-14 scores and the medical outcomes study 36-item short form (SF-36), weighted comorbidity scale, visual acuity and clinical AMD severity (stage), and vision self-assessment scales. Documentation of the severity of macular degeneration was performed by a sole examiner. RESULTS: There was a moderately strong correlation between visual acuity and trouble with vision (r = 0.51), satisfaction with vision (r = -0.50), and overall quality of vision (r = -0.56). A strong correlation was noted between VF-14 score and patients' self-rating of amount of trouble with vision (r = -0.67), satisfaction with vision (r = 0.62), and overall quality of vision (r = 0.67). In comparison, correlations between SF-36 score and patients' self-rating of amount of trouble with vision, satisfaction with vision, and overall quality of vision ranged from r = 0.37 to r = -0.40. Linear regression analysis for the overall study population indicated that AMD severity was not an independently significant predictor of VF-14 score after adjusting for visual acuity. However, among patients with 20/20 vision in the better eye, AMD severity was an independently significant predictor of VF-14 score after adjusting for visual acuity in the worse eye. CONCLUSIONS: The VF-14 exhibits a considerable degree of validity as a measure of functional impairment in patients with AMD. Age-related macular degeneration severity was an independently significant predictor of VF-14 score in the group of patients with 20/20 vision in the better eye, but this did not hold true for the overall study population. Age-related macular degeneration is associated with substantial impairment in reported visual function.

Aged↗

Evidence for alteration in photoreceptor orientation.

The effect of incident light, its point of origin, and its magnitude on receptor orientation was determined. A non-invasive test of vision, the Stiles-Crawford Effect (SCE), was used to investigate retinal directional sensitivity and alignment. The simple act of monocular black patching for a period of three to five days caused marked reduction in directional sensitivity and/or apparent dispersal of alignments. Recovery occurred in a comparable time period in normal adults 20 to 50 years of age. Special painted iris contact lenses with displaced pupillary apertures were worn to investigate the factors influencing alignment. Both light induced effects which caused alignment to shift toward a displaced aperture, and mechanical factors resulting in other alignment shifts were recorded. Thus, retinal receptors and/or associated anatomic components are apparently phototropic and subject to multiple forces influencing their directionality and/or alignment, and the milieu of the retinal receptor is active.

Adult↗

Visual function, driving safety, and the elderly.

The authors have conducted a survey of the Departments of Motor Vehicles in all 50 states, the District of Columbia, and Puerto Rico requesting information about the visual standards, accidents, and conviction rates for different age groups. In addition, we have reviewed the literature on visual function and traffic safety. Elderly drivers have a greater number of vision problems that affect visual acuity and/or peripheral visual fields. Although the elderly are responsible for a small percentage of the total number of traffic accidents, the types of accidents they are involved in (e.g., failure to yield the right-of-way, intersection collisions, left turns onto crossing streets) may be related to peripheral and central visual field problems. Because age-related changes in performance occur at different rates for various individuals, licensing of the elderly driver should be based on functional abilities rather than age. Based on information currently available, we can make the following recommendations: (1) periodic evaluations of visual acuity and visual fields should be performed every 1 to 2 years in the population over age 65; (2) drivers of any age with multiple accidents or moving violations should have visual acuity and visual fields evaluated; and (3) a system should be developed for physicians to report patients with potentially unsafe visual function. The authors believe that these recommendations may help to reduce the number of traffic accidents that result from peripheral visual field deficits.

Accident Prevention↗

Alzheimer's disease with prominent visual symptoms. Clinical and metabolic evaluation.

The authors examined eight patients with dementia of the Alzheimer's type (DAT), five with prominent visual symptoms early in the illness (VS) and three with no visual symptoms (NVS). Results of neuro-ophthalmologic examinations on VS patients showed relatively consistent abnormalities in figure copying, color vision tested by isochromatic plates, and stereopsis. Cerebral glucose metabolism determined by 18F-fluoro-2-deoxyglucose positron emission tomography (PET) was unchanged in primary visual cortex of VS and NVS patients compared with 12 normal volunteers of similar age and sex. Glucose metabolism in VS patients was decreased by 45 and 34% in left and right visual association cortex (P less than 0.01 and P less than 0.05, respectively) and 34 and 37% in left and right inferior parietal cortex (P less than 0.05) compared with controls; NVS patients had no significant metabolic alteration in these areas. Symptoms, physical examination, and metabolic imaging imply that these patients are a heterogenous but distinct clinical subgroup of DAT often with mild dementia who have visual symptoms due primarily to visual agnosia.

Aged↗

Serial foveal densitometry and visual function after retinal detachment surgery with macular involvement.

PURPOSE: Fundus reflection densitometry was used as an objective means for monitoring the recovery of foveal cone photopigments in nine patients who underwent anatomically successful surgery of a rhegmatogenous retinal detachment with macular involvement. METHODS: Postoperative assessment of foveal densitometry, visual acuity, color matching, and the Amsler grid were performed at repeated intervals for up to 14 months. RESULTS: Gradual recovery of foveal cone photopigments was found in all patients 1 to 14 months after surgery, with considerable interindividual variation. Maximal recovery to values equalling those in the fellow eye was found in only one patient with a macular detachment duration of 5 days. All other patients had final photopigment densities below those of the fellow eye. The length of the preoperative detachment period was inversely related to the recovery of photopigment. The recovery of photopigment seems to increase further in the second year after surgery. Visual acuity increased rapidly in all patients during the first 6 months after surgery, to levels ranging between 20/67 and 20/25; thereafter, visual acuity did not change. A return to normal color matching after an episode of pseudoprotanomaly was found in four of nine patients, whereas pseudoprotanomaly remained in five patients. Complete resolution of metamorphopsia after surgery was seen only in the patient who had the shortest detachment duration. Metamorphopsia was consistent with decreased foveal cone photopigment densities. CONCLUSION: Foveal densitometry shows a slow recovery of the cone photopigments after reattachment, probably because of regrowth and realignment of the cone photoreceptor outer segments and metabolic recovery of the retinal pigment epithelium-cone photoreceptor complex. Recovery of photopigment, color matching, and metamorphosia follow a slower time course than recovery of visual acuity.

Adult↗

Prevalence of uncorrected binocular distance visual acuity in Hispanic and non-Hispanic adults. Results from the HHANES and the NHANES I.

OBJECTIVE: This study aimed to provide a comparative analysis of American population-based prevalence of uncorrected binocular distance visual acuity in Hispanics and non-Hispanics. DESIGN: The study design was a population-based survey. PARTICIPANTS: Data from the Hispanic Health and Nutrition Examination Survey between 1982 and 1984 and the National Health and Nutrition Examination Survey I from 1974 through 1975 were analyzed to investigate the epidemiology of uncorrected binocular distance visual acuity in adults 25 to 74 years of age in Cuban Americans (N = 391), Mexican Americans (N = 1350), Puerto Ricans (N = 504), African Americans (N = 245), and non-Hispanic white Americans (N = 2571). MAIN OUTCOME MEASURE: Uncorrected binocular distance visual acuity in both eyes was assessed using Sloan letters or Landolt rings. RESULTS: Prevalence rates of 20/50 or worse uncorrected binocular distance visual acuity were 22%, 24%, 19%, 18%, and 32% for African Americans, Cuban Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites, respectively. After adjustment for gender and age, the rates were significantly higher (P < 0.05) for non-Hispanic whites compared to each of the other ethnic groups. Significant increases in the prevalence of 20/50 or worse distance visual acuity were observed for increasing age groups (25-39, 40-59, and 60-74 years) within each gender-ethnic subgroup. Analysis of differences in prevalence by gender (controlling for age) indicated a slightly higher prevalence of 20/50 or worse distance visual acuity in women than in men (range of odds ratios, 1.1-2.1). Based on 1993 census population estimates in the United States, more than 42 million adults 25 to 74 years of age have an uncorrected binocular distance visual acuity of 20/50 or worse. Approximately 1.7 million of these adults are of Hispanic origin. CONCLUSION: The prevalence of impaired uncorrected binocular distance visual acuity generally is lower in Hispanics than in non-Hispanic whites.

Adult↗

Learning to live with glaucoma: a qualitative study of diagnosis and the impact of sight loss.

Glaucoma is a major cause of preventable sight loss. As there are no obvious symptoms in the early stages, when it is most beneficial to start treatment, the key to reducing undiagnosed glaucoma in the community is better case finding among those at higher risk. This qualitative study aimed to identify triggers to self-referral for glaucoma symptoms in a sample from Britain, and to explore the meaning of symptoms for people living with moderate to severe glaucoma. Participants (N = 28) reported low levels of awareness of glaucoma prior to their diagnosis, and had assumed that symptoms were the 'normal' deterioration of eyesight expected with other morbidity or advancing age. As symptoms have a gradual onset, participants had learnt to cope with diminishing sight ability. However, many reported that such coping was 'at a cost', and that managing in a world designed for the well sighted caused problems for activities of everyday living, work and family life. The salience of these problems was shaped primarily by social factors, which framed both the practical consequences of sight loss and their meaning for respondents. Findings from this study suggest health promotion is a priority to increase public awareness of the existence and symptoms of glaucoma among those at high risk, and that more attention could be given to reducing the environmental and social causes of disability.

Activities of Daily Living↗

Visual acuity and contrast sensitivity in different types of posterior capsule opacification.

PURPOSE: To compare the visual acuity (VA) and contrast sensitivity in 2 types of posterior capsule opacification (PCO) in pseudophakic eyes before and after neodymium:YAG (Nd:YAG) capsulotomy and to evaluate vision test results after Nd:YAG capsulotomy. SETTING: Department of Ophthalmology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan. METHODS: Fourteen eyes with fibrosis-type PCO and 15 eyes with Elschnig-pearl-type PCO were enrolled prospectively. Before and 1 week after Nd:YAG capsulotomy, VA and contrast sensitivity were assessed using the illiterate E version of the Bailey-Lovie chart and the Vistech VCTS 6000 chart, respectively. RESULTS: Before capsulotomy, the mean logMAR acuity in the group with Elschnig-pearl-type PCO was 0.47 +/- 0.32 (SD) and in the group with fibrosis-type PCO, 0.17 +/- 0.07. The difference between the 2 groups was significant (P =.002). After capsulotomy, there was no significant between-group difference (P >.05). Before capsulotomy, the contrast sensitivity was significantly worse (P <.01) at all spatial frequencies in the group with pearl-type PCO, especially at 6 cycles per degree. After capsulotomy, there was no significant between-group difference (P >.05) at any spatial frequency. CONCLUSIONS: After cataract surgery, patients with pearl-type PCO had lower VA and contrast sensitivity than those with fibrosis-type PCO. An Nd:YAG capsulotomy improved the VA and contrast sensitivity in patients with both types of PCO.

Aged↗

Glare and contrast: indications for cataract surgery.

The present method of using Snellen visual acuity to evaluate the vision of cataract patients is inadequate because it may grossly overestimate the nature of their visual world. Many of these patients have poor visual functioning as a result of glare disability and loss of contrast. The loss of visual contrast on the retina may be quantified using devices currently available and applicable to a clinical setting in the office. These are described. A study of glare disability in pseudophakic eyes following phacoemulsification or planned extracapsular cataract extraction with intact capsules is made and compared with a previous report of eyes with a primary posterior capsulotomy. It is recommended that glare disability be measured in eyes of cataract patients and be used as an indication for cataract surgery.

Adolescent↗

Glare and contrast sensitivity testing in cataract patients.

I measured contrast sensitivity and glare in 51 cataract patients who had Snellen visual acuities of 20/60 or better. The VCTS contrast sensitivity plates, the Miller-Nadler glare tester, Baylor visual function tester, and the Stereo Optical glare tester were used. Patients indicated that the Baylor visual function tester most closely reproduced their daytime glare symptoms and that the Stereo Optical glare tester most closely reproduced their nighttime glare symptoms. Scores on the Stereo Optical glare tester and VCTS contrast sensitivity chart statistically were most strongly correlated with patients' complaints and the severity of their lens opacities. Contrast sensitivity and glare testing are important adjuncts in evaluating patients who have visual complaints and yet have good Snellen acuities.

Cataract↗

Visual thresholds in aphakia and pseudophakia.

Following extracapsular senile cataract extraction, visual thresholds were measured in 15 aphakic eyes corrected with glasses and compared with an appropriately matched group of 23 eyes with poly (methyl methacrylate) posterior chamber lenses. All subjects were six months to three years postoperative and had 20/30 or better visual acuity. The paramacular dark adapted threshold, the foveal luminance threshold, and the glare effect on both thresholds were not significantly different in the two groups despite the optical differences between aphakic and pseudophakic correction.

Aged↗