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PubMedDate not supplied

Testing vision on adults.

Visual acuity testing is the most important part of the diagnostic workup. Patients need to be "encouraged" to read the smallest possible symbols to achieve the level of best-corrected vision. The pinhole differentiates between decreased vision from refractive errors or pathology and will indicate which further tests are required for a diagnosis. Testing patients with low vision involves the use of special techniques. It is best to use the handheld 20/200 symbol instead of "counting fingers" to assess vision below the 5/200 level. Light perception should be further defined as with or without projection. Finally, no light perception, or NLP, should be determined only by the ophthalmologist. The ophthalmic medical assistant can indicate the possible presence of NLP, but should use the NLP notation only after it has been confirmed by the doctor to exist. Accuracy in determining visual potential is extremely important in screening patients. This assessment must be as careful and thorough as possible. Accuracy in documenting the best acuity level helps to create the correct visual baseline. This visual baseline is then used as the foundation for further diagnostic and therapeutic endeavors.

Adult↗
PubMedDate not supplied

[Transdermal electrostimulation of optic nerves in neurosurgical patients with vision disorders].

Transcutaneous electrostimulation of optic nerves after Ye. B. Kompaneyets et al. (1985) was used in the treatment of 203 neurosurgical patients aged 5 to 65 years with vision disorders. Improvement of visual functions (vision acuity and/or visual field) was attained in 112 (55.2%) patients. No changes were observed in 91 (44.8%) patients. The authors investigated the relationship between the efficacy of transcutaneous electrostimulation of optic nerves and neurosurgical disease, status of visual function, history of vision disorders, ophthalmoscopic picture, and electrophysiological parameters. The best results were achieved in patients with traumatic injuries of the optic route at the base of the brain, with cerebrovascular aneurysms, and the hypertensive hydrocephalic syndrome. The results depended on the history and stage of vision disorders.

Adolescent↗
PubMed1997

[Description of the prismation method in the rehabilitation of low visions of macular origin].

GOALS: This work aimed at presenting an original rehabilitation method based on the prismation available for patients with organic lesions of the macula. We report results obtained in our first series of patients. MATERIAL AND METHODS: The treatment was given to 14 patients, 7 women and 7 men, aged from 68 to 92 years, with an average age of 81.64, followed in "Low Vision" consultation, and suffering from bilateral macular diseases. All the patients with age-related macular degeneration developed retinal correspondences. They all received a bilateral prismation over their old correction. The orientation of the prisms taking into account the eccentric fixations. The criteria chosen for surveillance were binocular subjective and objective acuity, contrast sensitivity and vision of colours. RESULTS: For all the patients concerned, the method led to an immediate subjective improvement of the visual function. Tolerance to optical support was improved. The patients recovered better self-sufficiency in their daily life. The objective binocular for VA was improved by at least one line for 92.86% of the patients, by at least 2 lines for 42.85% and by 3 lines for 7.14%. The binocular contrast sensitivity was better for all the patients. Regarding the vision of binocular colours, the examination performance time was improved for all the patients. CONCLUSIONS: Prismation allows optimal use of the corresponding eccentric fixation areas. It appears as an interesting new therapeutic method for patients with macular-related low vision. It is complementary to rehabilitation treatment of such patients.

Aged↗
PubMed1977

Correcting low vision in aphakic children.

There are many children who have subnormal vision in spite of successful cataract surgery and aphakic spectacle lenses. There are children who have lens opacities for whom the state of aphakia would not be an improvement. Careful evaluation of functional vision, careful refraction, and the prescription of high adds or other optical devices are part of complete ophthalmological care for every one of these children. The dioptric strength of the reading add is determined by the functional reading vision and the calculation of the reciprocal of the visual acuity. It is also important to realize that many children who have lens opacities do not require special aids; functional vision is adequate until their accommodative reserve wanes with age. Continuous-wear contact lenses may eventually replace spectacle corrections for the aphakic child.

Adolescent↗
PubMed1997

[Recent progress in psychosensory rehabilitation of low vision. The third method for the prevention of blindness].

Functional strabism amblyopia is no more a problem: before 2 years old, they are cured in 95%. On the other and, low vision population beyond any medical or surgical treatment is increasing dramatically: over a million persons are concerned. Low vision is usually a consequence of age related macular degeneration related to the increase of life-span. Diabetic retinopathy, severe glaucoma, vitreoretinal disorders and chorioretinal diseases are also important blindness causes. Only a psychosensorial rehabilitation allow persons to see differently by developing functional vision thanks to the development of sensorial neurophysiology and cognitive psychology. This rehabilitation can only take place in well defined institution with a polyvalent team because such institution are so rare in France (4/33 Sweden) the authors ask National Academy of Medicine to beg public authority to create low vision rehabilitation center.

Blindness↗
PubMed1997

[(Neurological CPC-59). A 65-year-old man with a history of gastric cancer who presented progressive loss of vision, memory loss and consciousness disturbance].

We report a 65-year-old man with progressive loss of vision and consciousness disturbance. The patient was well until his age of 63 when he was found to have a gastric cancer. He was treated by the tumor resection and chemotherapy; he was apparently well, but hepatic metastases were found in the next year (1996). In June, 1996, he noted an onset of blurred vision more on the left. He was admitted to the ophthalmology service of our hospital on July 14, 1996. His vision was 0.8 on the right and 0.15 on the left. He was treated with oral prednisolone with slight improvement. He was also found to have IgM kappa-type monoclonal gammopathy; Bence-Jones protein was positive and a bone marrow aspiration revealed that approximately 10% of bone marrow cells were atypical plasma cells. His vision had progressively got worse and he became blind by the end of October 1996. A chest X-ray and cranial CT scan revealed multiple abnormal nodular densities. In the middle of November 1996, he became confused, disoriented and agitated. His mental symptoms had progressively became worse, and a neurologic consultation was asked on December 10, 1996. Neurologic examination revealed that he was somnolent with decreased attention to his surroundings. He showed marked disorientation and memory loss. Higher cerebral functions appeared intact. He was able to recognize only light and dark. Pupils were moderately dilated with very sluggish light reflex remained. Vertical gaze was moderately restricted and horizontal nystagmus was noted upon left and right lateral gaze. The remaining of the neurologic examination were unremarkable. General physical examination revealed hepatosplenomegaly; the liver was palpable by 3 cm below the right costal margin. Laboratory examination revealed anemia (Hb10.1 g/dl) and thrombocytopenia (43,000/microliter). A cranial CT scan and MRI revealed a mass lesion in involving the chiasmatic and bilateral hypothalamic areas. The tumor showed intense homogeneous enhancement after Gd-DTPA infusion. The patient was treated with dexamethasone and radiation. After 9 Gray radiation, he showed deterioration in the sensorium; a cranial CT scan revealed a hydrocephalus of the right ventricle with the midline shift towards left. The radiation was discontinued. The subsequent clinical course was complicated by aspiration pneumonia and thrombocytopenia. He expired on January 4, 1997. The patient was discussed in a neurological CPC and the chief discussant arrived at the conclusion that the patient had systemic malignant lymphoma with metastasis to the brain judging from the characteristics of MRI and CT findings. Opinions were divided between malignant lymphoma and metastatic brain tumor. Post-mortem examination revealed plasmacytoid lymphocytic infiltration in the bone marrow. Immunologically, these cells were positive for IgM and kappa-type light chain. These plasmacytic infiltrations were seen in the lungs and lymph nodes. These findings were consistent with the diagnosis of Waldenström's macroglobulinemia. In the liver metastatic cancer tissues were seen; microscopic pictures were essentially similar to those of resected gastric cancer. No local recidive was noted in the stomach. In the central nervous system, a necrotic tissue was involving the hypothalamic area bilaterally; no clear neoplastic cells were found, however, lymphocytic and plasmacytic infiltrations were seen in the perivascular space. In the optic nerves, loss of myelin and axons were seen. These findings most likely mass formation from macroglobulinemia which underwent necrotic change after radiation. Mass formation in the brain is rare for Waldenström's macroglobulinemia, although it has been reported. The relation between gastric cancer and macroglobulinemia in this patient is unclear.

Adenocarcinoma↗
PubMed1998

Postural vision loss in giant cell arteritis.

Two patients with biopsy-proven giant cell arteritis experienced bilateral transient vision loss after bending over and after getting up from a supine position. One patient had no demonstrable signs of carotid, ophthalmic, or anterior ciliary vascular disease, suggesting that his episodes of transient vision loss were due to vertebrobasilar insufficiency. The other patient experienced bilateral postural vision loss in the context of impending bilateral anterior ischemic optic neuropathy. Bilateral transient postural vision loss is an uncommon manifestation of giant cell arteritis that could reflect either severe bilateral vascular compromise of the anterior circulation or severe vertebrobasilar insufficiency. In either situation, prompt evaluation and treatment is indicated to prevent the irreversible sequelae of the disease.

Aged↗
PubMed1998

[Evaluation of binocular vision in persons employed at high work posts].

The study covered 250 workers, aged 20-63 years, employed at workposts over 3 meters high. We analysed visual acuity, refraction, anterior segment, eye ground, visual field, colour vision and binocular vision. The study revealed that 20% of persons examined lack the stereoscopic vision ability. In conclusion it is suggested to use combined methods in order to evaluate binocular vision and certify ability to work at high workposts.

Adult↗
PubMed1991

Effectiveness of vision-screening in pre-school populations with preferential-looking cards used for assessment of visual acuity.

Screening the vision of pre-school populations has been suggested as a way to assure early identification of vision problems as well as early intervention, thereby enabling normal development of the visual system and learning process. In a masked investigation, 119 pre-school children enrolled in Project Headstart with a mean age of 3.51 years (range 3 to 5 years) had their vision screened using the Modified Clinical Technique (MCT). Monocular visual acuities in this population were determined using preferential-looking (PL) cards. Visual acuity assessment of young children in screening settings is at best a challenge; yet, all 119 children were able to complete monocular acuity assessments on each eye. Acuities for nonreferrals (individuals who passed the screening) were significantly better than for referrals (individuals who failed the screening) at the 0.0167 level using a two-tailed Fisher's Exact Test with the Bonferroni Method for multiple comparisons. The effectivity of the screening technique as determined by phi-coefficient remained highest (phi = +0.94) with the visual acuity referral criterion set at 6/12 (20/40) or less either eye and/or greater than or equal to a 2-octave difference between the eyes. The resultant referral rate (17.6%) was higher than that predicted by extrapolation from the Orinda Study for this age group (12.3%) but expected because of the different socioeconomic group. PL cards enabled monocular visual acuity measurement on 100% of the children tested and measurably increased the effectiveness of the screening procedure.

Child, Preschool↗
PubMed1998

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↗
PubMed2003

Validity of the Titmus and Randot circles tasks in children with known binocular vision disorders.

PURPOSE: The Titmus and Randot (version 2) circles tests contain monocular form cues that may enable patients with binocular vision disorders to pass without any measurable stereopsis. The purpose of this study was to evaluate the validity of the Randot and Titmus circles tests for quantifying stereoacuity in children with known binocular vision disorders. METHODS: Participants included 170 consecutive children with diverse binocular sensory function ranging from fine to no measurable stereopsis. Stereoacuity was measured using the Randot circles, the Titmus circles, and the Randot Preschool Stereoacuity tests. RESULTS: Discrepancies between stereoacuity scores derived using either the Titmus or Randot circles tests and the Randot Preschool Stereoacuity test increased as a function of random-dot stereoacuity. Stereoacuity scores derived using the circles tests showed good agreement with random-dot stereoacuity when stereoacuity was 2.2 log seconds of arc (160 seconds of arc) or better, but they progressively overestimated stereoacuity for poorer random-dot stereoacuity scores. CONCLUSION: When measuring stereoacuity using either the Titmus or Randot circles tests in patients with known binocular vision disorders, stereoacuity scores > 2.2 log seconds of arc should be interpreted with caution because it is above this level of stereoacuity that the monocular form cues of each of the tests may invalidate the results.

Child↗
PubMed1997

[Reference values in vision development of infants with clinical use of the Teller Acuity Cards].

BACKGROUND: Using Teller Acuity Cards (TAC) for clinical visual testing, the question arose how our measurements fitted in the different standard tables of the producer's hand-book. In addition, we wanted to investigate how reliable the measurements of newborn and infants were and what the examination success rate under clinical conditions was. METHODS: At the paediatric clinic of the University of Erlangen, we tested the binocular grating acuity of 98 infants up to the age of one year, using the complete set of Teller acuity cards. In addition, 41 of the children underwent a monocular vision test. RESULTS: 1. Theoretical: At first we calculated conversion data for our card set. Using this conversion scale from cy/cm in cy/deg and the corresponding vision equivalent we produced our own standards for the development of grating acuity up to the age of one year. 2. Clinical: In 3-5 min per clinical examination we could determine for 90.8% of the patients a vision equivalent. The reliability of the results was age dependent and was at its best at the age of 5-11 months. The reliability was also very dependent on the duration of the test and the number of test runs. This resulted in a limited card choice for each age group.

Age Factors↗
PubMed1983

The assessment of 'vision for development' in severely visually handicapped babies.

Vision makes a substantial contribution to the pattern and rate of normal development. Considering infant development in 3 phases, global, integrative and specific the most important attributes to vision of development within each phase are discussed. A method for assessment of the aspects of vision most relevant to each child's current developmental needs is described and a philosophy outlined whereby the findings can be represented as a balanced practical prescription for development. The development of the visual system is often delayed in visually handicapped babies; some reasons are put forward and a concern that many may never achieve their potential maximum visual competence is expressed. A method for evaluating the current stage of visual development in a visually handicapped baby is described in which the findings form the starting point of a programme towards achieving maximum visual competence as young as possible.

Child↗
PubMed2004

Vision status among foster children in NYC: a research note.

A summary of the results of research on the vision status of foster children. Results indicate that the vision screenings being provided at mandated annual physical examinations are not sufficiently identifying children's vision dysfunctions.

Child↗
PubMedDate not supplied

Comparison of the HOTV and Lea Symbols charts for preschool vision screening.

PURPOSE: Two preliterate acuity charts, the Lea Symbol chart and the HOTV chart, were compared prospectively in an established preschool vision screening program. The charts were compared by measuring time required to test, reliability coefficients, and the percentage of children testable with each chart. METHODS AND MATERIALS: Seven hundred and seventy-seven 3- to 5-year-old children were randomized to four screening sequences that determined the order of chart use. Each child was screened on two occasions within 6 weeks. Testing was performed at 10 feet, and optotypes were not isolated for testing. RESULTS: Mean test time was significantly less for older children, but was not related to the chart used. Reliability coefficients were similar for the Lea Symbols and the HOTV charts. The percentage of children testable by each chart improved with increased age of the child. More 3 year olds were testable with the Lea Symbols chart compared to the HOTV chart (92% versus 85%, P = .05). CONCLUSIONS: Vision screening with either chart was more rapid and more frequently achieved with 4- and 5-year-old children compared with the 3 year olds. For the population as a whole, each chart gave similar results. Among the 3 year olds, however, testability rates were better for the Lea Symbols chart. The Lea Symbols chart is an acceptable option for preschool vision screening, and may be more efficacious than the HOTV chart for screening 3-year-old children.

Child, Preschool↗
PubMedDate not supplied

Development of a questionnaire to assess subjective vision score in myopes seeking refractive surgery.

PURPOSE: To assess vision in patients with myopia and myopic astigmatism before and after refractive surgery. METHODS: A prospective controlled study of visual quality amongst myopes and astigmatic myopes. Focus groups, ophthalmic surgeons, and questionnaire experts devised a Subjective Vision Questionnaire (SVQ), modified after a pilot trial. Participants were administered the SVQ before clinical evaluation. Items answered by over 95%, with factor loadings > 0.55 were included. Test-retest reliability was assessed by repeat testing. Factor analysis identified groups of questions measuring particular dimensions of data. RESULTS: Sixty-seven items were answered by 128 patients and reduced to 24 items in a final questionnaire. Factor analysis identified six types of questions within the questionnaire, the most important of which was related to driving. CONCLUSION: The simplicity, low cost, and psychometric properties of the Subjective Vision Questionnaire support its use clinically and in research.

Adult↗
PubMed2003

The symptomatic patient with normal phorias at distance and near: what tests detect a binocular vision problem?

PURPOSE: Patients often manifest symptoms that appear to be related to binocular distress. Many of these patients have normal heterophoria at distance and near, making the etiology of such symptoms perplexing. We performed a visual examination of patients having normal heterophoria at distance and near in order to investigate which visual analysis tests differentiate symptomatic from asymptomatic patients. METHODS: Eighty subjects (30 symptomatic, 50 asymptomatic) with ages between 18 to 35 years of either sex and any race were pooled based on vision-symptom level determined by a 9-question standardized visual-symptoms questionnaire scored using a 100-point scale (asymptomatic: score > or = 85; symptomatic: score < or = 75). Inclusion/exclusion criteria included vision correctable to 6/6 (20/20) Snellen acuity or better in each eye, normal phorias, no latent cyclovertical heterophoria, and normal ocular health. RESULTS: Of the 30 symptomatic patients, 18 had reduced vergence facility response using 3 pd base-in/12 pd base-out loose prism at distance (n = 10; t-score = 2.41, p < 0.02, d = 76) and near (n = 15; t-score = 3.32, p < 0.01, df = 78) with a significant difference beyond the 0.02 level. No other test including measurement of accommodation, showed a significant between-group difference. However, three patients with normal vergence facility (distance and near) showed a reduced binocular accommodative facility response (+/-2.00 D at 40 cm). CONCLUSION: Given a patent with asthenopia, normal phorias, and visual acuity, a differential diagnosis may be made based primarily on using vergence facility and accommodative facility testing. From a clinical standpoint, the results expedite diagnosis of binocular vision abnormalities and direct treatment.

Accommodation, Ocular↗
PubMed2002

Verteporfin therapy of subfoveal choroidal neovascularization in patients with age-related macular degeneration: additional information regarding baseline lesion composition's impact on vision outcomes-TAP report No. 3.

OBJECTIVE: To explore how baseline lesion composition influenced vision outcomes in patients with age-related macular degeneration (AMD) undergoing photodynamic therapy with verteporfin (Visudyne) for subfoveal choroidal neovascularization (CNV) in the Treatment of Age-Related Macular Degeneration With Photodynamic Therapy Investigation. METHODS: Patients with subfoveal lesions secondary to AMD with evidence of classic CNV were categorized into 2 subgroups based on baseline color photographs and fluorescein angiograms assessed by graders at the Wilmer Photograph Reading Center (The Johns Hopkins University School of Medicine) before any outcome analyses as follows: (1) predominantly classic CNV (area of classic CNV >/=50% of the area of the entire lesion) or (2) minimally classic CNV (area of classic CNV <50% but >0% of the area of the entire lesion). Additional exploratory analyses were performed in the predominantly classic subgroup to investigate the effects of visual acuity, lesion size, prior laser photocoagulation, phakic status, micronutrient use, and presence of occult CNV on vision outcomes. MAIN OUTCOME MEASURES: Subgroup analyses of vision and fluorescein angiographic outcomes at 1 and 2 years after study enrollment were examined in an intent-to-treat analysis from 2 multicenter, double-masked, placebo-controlled, randomized clinical trials. RESULTS: Compared with patients who had minimally classic CNV, patients with predominantly classic CNV had a worse initial mean visual acuity and smaller lesions and were more likely to have lesions that included blood or blocked fluorescence. When evaluated by treatment assignment and lesion composition, 84% to 88% completed the month 24 examination. In the subgroup with predominantly classic lesions, visual acuity outcomes were consistently better in verteporfin-treated patients. Outcomes for patients with predominantly classic lesions without occult CNV tended to be better than outcomes for patients with predominantly classic lesions with occult CNV, although the former tended to have smaller lesions and lower levels of visual acuity at baseline. Contrast sensitivity and fluorescein angiographic outcomes (total lesion size, progression of classic CNV, and absence of classic CNV) were better in verteporfin-treated patients than in placebo-treated patients in the predominantly classic and the minimally classic CNV subgroups. In patients with predominantly classic CNV, no interaction of the treatment benefit by phakic status, micronutrient use, or prior laser photocoagulation therapy was noted. CONCLUSIONS: Verteporfin therapy can safely reduce the risk of moderate and severe vision loss in patients with subfoveal lesions that are predominantly classic CNV secondary to AMD. While this benefit seemed to be even greater in the absence of occult CNV, the effect may be related to the smaller lesions and worse visual acuity associated with predominantly classic lesions without occult CNV and not solely to the lesion composition itself. These analyses support initial reports that verteporfin therapy should be used to treat patients with AMD who have predominantly classic CNV, with or without occult CNV, but suggest that further investigations should be performed to determine if lesions with a minimally classic composition might benefit when they are smaller and have lower levels of visual acuity.

Aged↗