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The acuity card procedure: longitudinal assessments.

Traditional methods of visual assessment in preverbal pediatric patients rely on refined but subjective measurement techniques. A standard ophthalmologic examination includes evaluation of a child's fixation patterns, with performance ranked on the basis of ability to fix and follow an object (F & F) or maintain central, steady fixation (CSM). In the hands of a skilled clinician, these evaluations are important for diagnosis and treatment. Documentation of quantitative changes in visual abilities of preverbal patients, however, has only recently become feasible. We began using the acuity card procedure in our pediatric clinical practice more than 3 years ago. This assessment, a modified version of the standard Forced-Choice Preferential Looking paradigm (FPL), provides quantitative evaluation of visual functioning in preverbal patients. The total number of patients assessed on one or more occasions exceeds 900. Of this group, we followed 83 patients with at least four acuity card evaluations on separate visits. Thirty of these patients, all with different diseases, have been evaluated with acuity cards on six or more visits. We found the information provided by the acuity card assessments extremely helpful in quantifying the developmental and therapeutic changes in vision, previously monitored only qualitatively.

Child, Preschool↗

Prevalence of primary monofixation syndrome in parents of children with congenital esotropia.

The prevalence of primary monofixation syndrome (MFS) in the general population is approximately 1%. This study was performed to determine the prevalence of primary monofixation in biological parents of children with congenital esotropia. Ninety children with congenital esotropia were seen between November 1991 and June 1992 by one ophthalmologist (M.M.P.). One hundred and twenty-nine biological parents of these children were screened for sensorimotor abnormalities. Twelve parents were found to have secondary MFS and were removed from the analysis. This left 78 apparently non-strabismic families consisting of a total of 117 parents. Seven parents were identified as having primary MFS. The prevalence of primary MFS in this population is 9% of families and 6% of parents. Congenital esotropia is believed to be inherited in a multifactorial fashion. We believe that this increase in the prevalence of primary MFS compared to the general population lends support to the hypothesis that primary MFS may be a mild (subthreshold) effect of the "gene(s)" that cause congenital esotropia.

Adult↗

Measurement of low vision in advanced cicatricial retinopathy of prematurity.

This study evaluates functional vision in visually impaired children with stage IV to V cicatricial retinopathy of prematurity (CROP) by comparing results derived from the Teller acuity cards and a battery of behavioral tasks, the visual function battery (VFB). Vision was evaluated in 26 eyes of 15 children ages 6 months to 14 years, who underwent retinal reattachment procedures for active stage IV and stage V retinopathy of prematurity. Results showed that 10 of 26 eyes (38%) had a recordable grating acuity to Teller acuity card assessment. Twenty-five of 26 eyes (96%) showed a response to the VFB. Sixteen of 26 eyes (62%) showed recordable scores with the VFB but no corresponding scores with the Teller acuity cards. The VFB may be more reliable than the Teller acuity cards in measuring visual function in the very low acuity range.

Adolescent↗

Effect of higher-order wavefront aberrations on binocular summation.

PURPOSE: To determine the effect of individual Zernike wavefront aberrations on binocular summation and binocular visual acuity. METHODS: A 0.25-microm wavefront aberration of second, third and fourth order Zernike modes were introduced into a set of log minimum angle of resolution unit (logMAR) visual acuity charts convolved by CTView. Subjects were dilated and fitted with an artificial pupil of 3 mm. For each set of charts, right eye, left eye, and binocular acuity was measured. The gain in binocular visual acuity over monocular visual acuity was defined as binocular summation. The visual acuity lost binocularly reading aberrated charts was normalized for each subject and defined as the aberration induced loss in acuity. RESULTS: Binocular summation was 10.0% (95% limits of agreement 8.8 to 11.1%) in the unaberrated state and ranged from 17.3 to 3.4% in the Zernike modes studied. Binocular summation was greatest in defocus followed by coma and astigmatism. The aberration induced loss in monocular and binocular acuity was higher for Zernike modes with low angular frequency compared to those with high angular frequency. Linear regression showed a significant relationship between aberration-induced loss of visual acuity and binocular summation. CONCLUSIONS: A fixed amount of root mean square (RMS) aberration has a varied effect on binocular vision depending on the angular frequency and radial order of Zernike mode. Binocular vision has a positive effect in reducing the visual impact of aberrations as Zernike modes that suffer from the most loss of visual acuity also experience the greatest amounts of binocular summation.

Adult↗

Assessing the driving potential of cerebral vascular accident patients.

In this report, literature pertaining to training the post-cerebral vascular accident (CVA) driving candidate is reviewed; a driver training program is described, with special emphasis on evaluating the CVA candidate; the role of the occupational therapist as a disabled driver training instructor is outlined; information and suggestions for comprehensive evaluation and training of right- and left-CVA driving candidates are presented; and data comparing driver's training outcomes for right- and left-CVA candidates are provided. Retrospective data of left- and right-CVA driver performance are compared.

Automobile Driver Examination↗

Basic concepts and terms for low vision rehabilitation.

As the involvement of occupational therapists in the rehabilitation of people with visual impairments increases, it is important for all professionals involved to communicate clearly by using the most accurate terminology. This article suggests the most appropriate use of terms and concepts. It recommends that the distinctions between the various aspects of vision loss be recognized and that the old dichotomy of legally blind versus legally sighted be replaced by the more detailed classification of the International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM), which recognizes multiple levels of visual performance.

Aged↗

Culture and the development of vision.

Given Chinese ethnographic data, a model of a style of visual performance was predicted. The prediction was that the style would be "inwardizing". Inwardizing was related to individual styles of social behavior as observed in optometric offices. A complete 21-point optometric examination was performed on Chinese subjects and the results were compared to a control group of American subjects. Throughout the optometric examination the Chinese subjects displayed the predicted pattern of inwardizing visual performance. That physiologically measurable patterns of visual performance could be predicted on the basis of ethnographic data gives experimental support to the anthropological assumption of reciprocity between biology and culture. The discovery of a culturally determined pattern of visual performance beyond the work already done with various isolated refractive conditions and the observed relationship of this to patterns of social behavior pose interesting tasks for anthropology, optometry and other professions. First, there is need for further investigation of 1) the role of culture in determining visual performance and 2) the relationship of visual performance patterns to social behavior, beyond that which has already been done, for example, with myopia and hyperopia. Then there is need to incorporate these new areas of knowledge into all fields dealing with human behavior.

Adult↗