Central and peripherial visual acuity.
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Estimates of monocular and binocular depth acuity were obtained on two samples of subjects with adequate visual acuity and capacity for stereopsis. Both a method of average error and a modified method of limits were employed to secure the estimates. Eight ratios of binocular to monocular depth acuity ranged from 2.4:1 to 4.2:1 at a distance of 15 ft. The results contradict the familiar generalization that binocular depth perception is about 20 times as acute as monocular depth perception.
Fluoangiography causes in diabetics a temporary increase of the number of errors when reading Birch and SPP II pseudoisochromatic plates, especially in case of macular edema and for tritan plates. Other experiments show that this change is more due to an increased filter effect by the fluorescein accumulation than to the increase of glare by the flashes for photography. Measurements of the foveal spectral increment threshold sensitivity curves does not show impairment of the blue mechanism by fluoangiography; on the contrary the green and red mechanisms become less sensitive.
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Ethambutol (EMB) is an important component of multidrug treatment regimens for Mycobacterium avium complex lung disease. Ocular toxicity is the most important potential EMB toxicity, especially in the elderly population with M. avium complex lung disease. Two hundred twenty-nine patients with M. avium complex lung disease, 55% women and 53% with nodular/bronchiectatic disease, received a mean of 16.1 +/- 10.8 months of multidrug therapy that included EMB. Fifty patients (22%) were known to have preexisting ocular disease. While on EMB, 97 (42%) patients consulted an opthalmologist and 24 (10%) stopped EMB at least temporarily. Eight of 139 patients (6%) on daily therapy were diagnosed with EMB ocular toxicity, whereas 0 of 90 patients on intermittent therapy had EMB ocular toxicity (p = 0.05). All patients with EMB ocular toxicity developed symptoms between outpatient clinic appointments; none were diagnosed with routine visual acuity and color vision testing. All patients with EMB ocular disease returned to baseline ocular status after discontinuation of EMB. Intermittent EBM administration was associated with less ocular toxicity than daily EMB administration in this patient population.
PURPOSE: To investigate the contribution of stimulus and response differences to the different developmental courses of grating and optotype visual acuity at the preschool age range. METHODS: Binocular visual acuity at 228 cm was assessed in 205 children in 7 age groups between 2.5 and 6 years and in 12 adults. Acuities were obtained in three tasks: detection of a grating in one of two positions, discrimination of the orientation of a single grating, and discrimination of the orientation of the gap in an uncrowded Landolt-C optotype. The three paradigms were as similar as possible in stimulus contrast, luminance, presentation mode, and psychophysical procedure. RESULTS: Mean grating and optotype acuities were lower than adult acuities at all ages. Optotype acuity was overall higher and increased faster with age than grating acuities. Grating orientation acuity was slightly but not significantly lower than grating detection acuity in all but one age group. The grating detection task was successful at earlier ages (100% at 3.5 years) than both the optotype acuity task (100% at 4.5 years) and the grating orientation task (100% at 5.75 years). CONCLUSIONS: Optotype and grating acuities follow a different developmental course in children between 3 and 6 years of age, with optotype acuity growing superior to grating acuity in that age range. The similarity of grating orientation to grating detection acuities and the difference between grating and optotype acuities suggest that superior optotype acuity is due to stimulus characteristics rather than to the complexity of the response required.
PURPOSE: To develop a reliable and valid questionnaire (the LV Prasad-Functional Vision Questionnaire, LVP-FVQ) to assess self-reported functional vision problems of visually impaired school children. METHODS: The LVP-FVQ consisting of 19 items was administered verbally to 78 visually impaired Indian school children aged 8 to 18 years. Responses for each item were rated on a 5-point scale. A Rasch analysis of the ordinal difficulty ratings was used to estimate interval measures of perceived visual ability for functional vision performance. RESULTS: Content validity of the LVP-FVQ was shown by the good separation index (3.75) and high reliability scores (0.93) for the item parameters. Construct validity was shown with good model fit statistics. Criterion validity of the LVP-FVQ was shown by good discrimination among subjects who answered "seeing much worse" versus "as well as"; "seeing much worse" versus "as well as/a little worse" and "seeing much worse" versus "a little worse," compared with their normal-sighted friends. The task that required the least visual ability was "walking alone in the corridor at school"; the task that required the most was "reading a textbook at arm's length." The estimated person measures of visual ability were linear with logarithm of the minimum angle of resolution (logMAR) acuity and the binocular high contrast distance visual acuity accounted for 32.6% of the variability in the person measure. CONCLUSIONS: The LVP-FVQ is a reliable, valid, and simple questionnaire that can be used to measure functional vision in visually impaired children in developing countries such as India.
PURPOSE: To evaluate the physiological characteristics of the macula in patients with Vogt-Koyanagi-Harada disease during the convalescent stage with specific reference to the kinetics of foveal cone photopigment regeneration. METHODS: Six eyes of three patients at the convalescent stage of Vogt-Koyanagi-Harada disease were studied. All the eyes had best corrected visual acuity of 1.0 or better and had had no recurrence of inflammation for at least 12 months after the last episode. Foveal cone densitometry (FCD), focal macular electroretinograms, color vision tests, two-color perimetry, and optical coherence tomography (OCT) were performed. RESULTS: No regeneration of cone photopigments was detected within the 7-minute testing time by FCD in all eyes at the first examination after the last episode. However, the other functional tests were normal, and the OCT-determined macular morphology was also normal. The regeneration kinetics of the foveal cone photopigment improved in three of six eyes at 36, 37, and 19 months after the last episode, whereas the other three remained delayed at 18, 18, and 49 months. CONCLUSIONS: These findings suggest that a disorder of the foveal cone photopigment regeneration, and its recovery, requires a significantly longer time than that of other macular functions in some patients with Vogt-Koyanagi-Harada disease.
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.
PURPOSE: Experiments in chickens have implicated the transcription factor ZENK (also known as Egr-1, NGFI-A, zif268, tis8, cef5, and Krox24) in the feedback mechanisms for visual control of axial eye growth and myopia development. ZENK is upregulated in retinal glucagon amacrine cells when axial eye growth is inhibited by positive spectacle lens wear and is downregulated when it is enhanced by negative spectacle lens wear, suggesting that ZENK may be linked to an inhibitory signal for axial eye growth. This study was undertaken to determine whether a Egr-1(-/-) knockout mouse mutant, lacking ZENK completely, has longer eyes and more myopic refraction, than do Egr-1(+/)(-) heterozygous and Egr-1(+/+) wild-type mice with near-identical genetic backgrounds. METHODS: Eye growth and refractive development were tracked from day P28 to P98. Corneal radius of curvature was measured with infrared photokeratometry, refractive state with infrared photoretinoscopy, and ocular dimensions with low-coherence interferometry. As a functional vision test, grating acuity was determined in an automated optomotor task. The abundance of ZENK protein in the retina was quantified by immunohistochemistry. RESULTS: Egr-1 knockout mice had longer eyes and a relative myopic shift in refraction, with additional minor effects on anterior chamber depth and corneal radius of curvature. Paraxial schematic eye modeling suggested changes in the optics of the crystalline lens as well. With increasing age, the differences between mutant and wild-type mice declined, although the differences in refraction persisted over the observation period. Grating acuity was not affected by the lack of the Egr-1 protein during development. CONCLUSIONS: Although it has been shown that different mouse strains may have differently large eyes, the present study shows that a specific gene knockout can produce relative myopia, compared with the wild-type with near-identical genetic background. Further experiments are needed to determine whether the observed effects of Egr-1 deletion are due to changes in function within the retina or other ocular tissues or to changes of function in other systems that may affect ocular growth from outside the eye.
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We report five children with previously unrecognized vestibular dysfunction detected by clinical examination and confirmed by quantitative vestibular testing. Patient 1 presented with fluctuating visual acuity and intermittent nystagmus. Patient 2 had congenital hearing loss associated with imbalance, delayed motor development, and cyclic vomiting. Patient 3 had neurotrophic keratitis with an intermittent head tilt, imbalance, and motor delays. Patient 4 showed ataxia and eye movement abnormalities following traumatic brain injury and had reading difficulties. Patient 5 had episodic vertigo and eye movement abnormalities from infancy. Clinical vestibular testing emphasized spontaneous nystagmus, rapid head thrust, and assessment of post-rotatory nystagmus. Quantitative vestibular testing included the sinusoidal chair rotation and velocity step tests, measurement of dynamic visual acuity, post-head-shake nystagmus, and computerized platform posturography. Pediatric neurologists encounter children with congenital and compensated vestibular dysfunction, which can be recognized on the basis of relevant history and clinical abnormalities of the ocular-ocular reflex.
CONTEXT: Despite a strong rationale for trials of somatostatin analogs in the treatment of Graves' ophthalmopathy (GO), recent studies have provided conflicting results. OBJECTIVE: The objective of the study was to determine whether octreotide long-acting release (LAR) is effective treatment for active GO. DESIGN: This was a prospective, randomized, double-blind, placebo-controlled study. SETTING: The setting was a single tertiary referral center. PATIENTS: Twenty-nine consecutive euthyroid patients with active GO [clinical activity score (CAS) >or= 3] were enrolled; 25 completed the study. INTERVENTION: Patients received four monthly doses of either octreotide LAR (20 mg) or saline by im injections. MAIN OUTCOME MEASURES: Primary measure was a change in CAS; the secondary measure was changes in retrobulbar tissue volume, proptosis, lid fissure width, range of motion, and diplopia fields. RESULTS: Median (range) CAS change was 2.5 (1, 5) in the treatment and 1.0 (0, 7) in the placebo group (P = 0.02). Median lid fissure width improved in the treatment group, (decreased 1 mm on the right and 0.5 mm on the left), compared with the placebo group (no change on the right, P < 0.01; increased 1 mm on the left, P < 0.01). No other significant differences between groups were identified. CONCLUSIONS: CAS improved to a greater extent in octreotide-LAR-treated patients than the control group. However, this finding may not represent clinical benefit because patients with higher baseline CAS were overrepresented in the treatment group, and the control group was small. In contrast, treatment-related improvement in eyelid fissure width was noted, suggesting that octreotide LAR may be useful in the treatment of a subgroup of active GO patients with significant lid retraction.