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PubMed2005

Scotomas of age-related macular degeneration detected and characterized by means of a novel three-dimensional computer-automated visual field test.

PURPOSE: We used the recently devised three-dimensional computer-based threshold Amsler grid test to acquire and identify typical patterns of visual field defects (scotomas) caused by age-related macular degeneration (AMD). METHODS: Patients with AMD traced on a computer touch screen the borders of those areas on an Amsler grid that were missing from their field of vision. Scotomas were repeatedly outlined and recorded at different grid contrast levels. The resulting three-dimensional "hole" in the central 25 degrees of the visual field was further characterized by its slope, location, shape, and depth. The results were compared with fundus photographs and fluorescein angiograms. RESULTS: Twenty-five patients and 41 eyes were examined. The three-dimensional depictions consistently demonstrated central scotomas with "scallop"-shaped borders and steplike patterns, with either steep slopes or a combination of steep and shallow slopes. The steep slopes corresponded to nonexudative AMD, while the shallow slopes indicated exudative AMD. CONCLUSION: The three-dimensional computer-automated threshold Amsler grid test may demonstrate characteristic scotoma patterns in patients with AMD that conform to the respective fluorescein angiograms. The test shows promise as an effective tool in accurately evaluating, characterizing, and monitoring scotomas in patients with AMD. It may have the potential as a screening tool for the early diagnosis of AMD.

Aged↗
PubMed2006

Diabetic retinopathy: the unmet needs for screening and a review of potential solutions.

Diabetic retinopathy remains the leading cause of severe vision loss and blindness in the developed world, in spite of recognized ocular treatments that are successful at reducing the rate of vision impairment. Retinal photography appears a promising method to perform screening in such a setting utilizing new 45 degrees + retinal cameras that do not require pupil dilation and can be operated by a trained, nonophthalmic technician. Certain developments may make the photography more successful including the conversion to electronic chip camera sensors that allow each picture as it is taken to be immediately projected onto a monitor for evaluation and assessment. Utilizing a nonmydriatic camera, studies of single-field photography through a dilated pupil have demonstrated superior or equal sensitivity to fundus examination by an ophthalmologist in a number of studies. However, photography without pupil dilation, especially in the older age group may result in poor-quality photographs owing to intense bilateral pupil constriction after the first images and also due to the presence of cataracts. Computer analysis of the retinal images allows extraction of quantitative data, not only of the diabetic lesions but also of vascular changes that, up until now, have been impossible by human grading and potentially allows a much more detailed and quantitative evaluation of the progression of retinopathy over time. When success of image processing algorithms is demonstrated for a large number of images taken under screening conditions, the benefits of retinal photography and image processing to provide timely, reliable, quantitative and cost-effective results, will make this the preferred method over physician examination or human grader evaluation of the images.

Clinical Trials as Topic↗
PubMed1997

[Usefulness of the 'Mini-Mental State Test'for the diagnosis of dementia; study of criterion validity in a Dutch rural population].

OBJECTIVE: To establish the criterion validity of the MMSE for dementia in a community-based population. DESIGN: Descriptive. SETTING: Eight rural general practices and eight adherent institutions for long-term care near Zwolle, the Netherlands. METHODS: In the first (screening) stage, the MMSE was applied, in the second (diagnostic) stage the 'Cambridge examination for mental disorders of the elderly' (CAMDEX) was used. After exclusion of subjects with clinically relevant impairment of hearing and (or) vision, analyses were based on 2151 screened subjects. Based on a non-proportional, stratified randomized sampling procedure using the MMSE score as the stratification variable, 390 of the screened subjects were examined with the CAMDEX. Seventy-seven cases of DSM-III-R dementia were identified. Based on 390 paired observations the relationship between MMSE score and DSM-III-R dementia was modelled by logistic regression. After extrapolation of this relationship to the total screened population, sensitivity and specificity figures were calculated at several cut-offs of the MMSE, and Receiver Operating Characteristic (ROC) curves were constructed for the total population as well as for four subpopulations. (men, women, < 80, > or = 80 years). RESULTS: At the cut-off of 23/24, sensitivity was 0.76 and specificity 0.91 in the total population. However, the criterion validity of the MMSE varied substantially between the four sex-age combinations. Criterion validity was especially poor for women in the younger age range. CONCLUSION: The MMSE has only limited value in clinical practice. Use of uniform cut-offs has to be rejected.

Aged↗
PubMed1991

Opportunistic screening of visual acuity of elderly patients attending outpatient clinics.

A standard Snellen letter chart was used to screen the visual acuities of 202 elderly patients while they attended outpatients clinics. Patients overestimated the adequacy of their vision: only 34 patients reported inadequate vision while 72 had significant measured visual impairment. Of these, 30 patients had refractive errors and 42 primarily non-refractive problems. Thirty patients were examined by an ophthalmologist, of whom 24 had previously undiagnosed conditions. Eighteen patients had treatable conditions, predominantly cataracts and glaucoma. Ten patients with untreatable conditions had the benefit of a definitive diagnosis, most commonly of age-related macular degeneration, and an assessment of eligibility for registration of blindness. The routine assessment of elderly patients should include objective screening of their visual acuity.

Aged↗
PubMed1976

A vision profile of American Indian children.

In an unselected study, Modified Clinical Technique screening plus keratometry was done on 398 American Indian grade school children. The results are compared to screening results for Caucasin grade school children.

Astigmatism↗
PubMed2005

Evaluation of a chromatometer: a new method for blue-yellow or green-red visual comparisons, and anomaly screening techniques.

BACKGROUND: Malbrel's chromatometer is a new apparatus which allows color vision to be monitored. The aim of this study was to assess the accuracy of this new examination method. MATERIAL/METHODS: The color vision of a patient was analyzed using a chromatometer for direct heterochromatic visual comparisons. The patient's task was to adjust, using one eye only, the brightness of a yellow (or red) window to the one of a fixed blue (or green) window. Overall, 158 patients, aged 20 to 28, took part in the experiment. First, parametric means were used to study the response distributions and the luminous effects on the responses. Second, using non-parametric means, we considered that a patient had an anomalous color vision according to the chromatometer if the response was higher than the 95th percentile or lower than 5th percentile. Third, anomalous responses were compared with the Ishihara plates and Farnsworth 28-hue responses. RESULTS: The effect of a luminous stimulus on the response was significant (adjusted to the patient effect). Thus, the chromatometer appears to be a good method to analyze color vision. This apparatus was easy to use and constituted a sensitive and specific test with high negative predictive value. CONCLUSIONS: The chromatometer can be used as a first-line screening test to detect color vision anomalies during ophthalmology consultations. The chromatometer can be useful in identifying early ocular disease, monitoring disease development, or checking possible iatrogenic effects of a specific treatment.

Adult↗
PubMed2001

The frequency of perioperative vision loss.

UNLABELLED: The frequency of perioperative vision loss, especially for spinal surgery, has been increasing recently. We undertook a retrospective study to determine the frequency of this outcome in a large surgical population receiving general or central neuraxis regional anesthesia for noncardiac procedures from 1986 to 1998. Specific criteria were used to separate cases in which the surgical procedure likely directly contributed to the vision loss. Vision loss was present if any part of the visual field was affected. Initial database screening found 405 cases of new-onset vision loss or visual changes in 410,189 patients who underwent 501,342 anesthetics and who survived at least 30 days after their final procedures. Two hundred sixteen of these patients regained full vision or acuity within 30 days. Of the 189 patients who developed vision deficits for longer than 30 days, 185 underwent ophthalmologic or neurologic procedures in which ocular or cerebral tissues were surgically damaged or resected. The remaining 4 patients (1 per 125,234 overall; 0.0008%) developed prolonged vision loss without direct surgical trauma to optic or cerebral tissues. In this large study population of noncardiac surgical patients, including those who underwent spinal surgical procedures, the frequency of perioperative vision loss persisting for longer than 30 days was very small. IMPLICATIONS: Vision loss and blindness after surgery and anesthesia is a very rare event. In this study, only one per 125,234 patients undergoing noncardiac surgery developed vision loss persisting for longer than 30 days.

Adolescent↗
PubMed2006

Advantage of dichromats over trichromats in discrimination of color-camouflaged stimuli in humans.

This study investigated whether 12 participants with color-vision deficiency had superior visual discrimination of color-camouflaged stimuli shown on a computer screen compared with 12 participants with normal trichromatic vision. Participants were asked to distinguish a circular pattern from other patterns in which textural elements differed from the background in orientation and thickness. In one condition, stimuli were single-colored, green or red; in the other condition, stimuli were color camouflaged with a green and red mosaic overlaid onto the pattern. Color-vision deficient participants selected the correct stimuli in the color-camouflaged condition as quickly as they did in the single-colored condition. However, normal color-vision participants took longer to select the correct choice in the color-camouflaged condition than in the single-colored condition. These results suggest that participants with color-vision deficiency may have a superior visual ability to discriminate the color-camouflaged stimuli.

Adult↗
PubMed1992

Screening of diabetics who read incorrectly colour-dependent glucose test-strips.

Forty-eight diabetic patients (82 eyes) were examined with four different colour vision tests and one blood glucose strip-test. The ages of the patients varied from 23 to 65 years (mean 44.3 years +/- 11.4, SD), the duration of diabetes from 13 to 41 years (mean 25.8 +/- 6.2), and the visual acuities from 0.2 to 1.0 (mean 0.8 +/- 0.2). Of the eyes, 77 had had photocoagulation, 25 had small peripheral lens opacities, and 55 had slight background retinopathy. The colour vision tests were: the Standard Pseudoisochromatic Plates part 2 (SPP2), the Lanthony Tritan Album, the Farnsworth Panel D 15 test and the box III of the Farnsworth-Munsell 100 hue (FM 100) test. The blood glucose test was Haemo-Glukotest 1-44. Of the 82 eyes, 38 incorrectly saw Haemo-Glukotest strips. The SPP2 test found 89% of the eyes, the Tritan Album 55%, the Panel D 15 71%, and the box III of the FM 100 test 76%. The strips were correctly interpreted in 44 of the eyes. However, 36% of them failed the SPP2, 16% the Tritan Album, 11% the Panel D 15 test and 18% the box III of the FM 100 test. The Panel D 15 test and the box III of the FM 100 test would be useful in screening those diabetics who cannot correctly interpret the colour-dependent glucose test-strips and would need a blood sugar meter for their blood glucose level testing.

Adult↗
PubMed1990

Detecting and treating retinopathy in patients with type I diabetes mellitus. A health policy model.

Diabetic retinopathy is the major cause of new cases of blindness among working-age Americans. The authors analyzed the medical and economic implications of alternative screening strategies for detecting retinopathy in a diabetic population. The approaches compared included dilated fundus examination at 6-, 12-, and 24-month intervals with and without fundus photography. Potential savings from screening and treatment are based on amounts paid by the federal government for blindness-related disability. Screening for and treating retinopathy in patients with type I diabetes mellitus was cost-effective using all screening strategies. Between 71,474 and 85,315 person years of sight and 76,886 and 94,705 person years of reading vision can be saved for each annual cohort of patients with type I diabetes mellitus when proper laser photocoagulation is administered. This results in a cost savings of $62.1 to $108.6 million. Annual examination of all diabetic patients and semi-annual examination of those with retinopathy was more effective than annual examination with fundus photography. This screening strategy is consistent with the Preferred Practice Pattern for Diabetic Retinopathy of the American Academy of Ophthalmology.

Adolescent↗
PubMed1982

The value of the preschool examination in screening for health problems.

The effectiveness of physicians in detecting abnormalities of height, weight, vision, hearing, blood pressure, and the presence of dental caries in 1,158 kindergarten pupils was compared with that of a separate screening program staffed by trained volunteers and public health nurses. The screening program was significantly more effective in identifying abnormalities in vision, hearing, blood pressure, and the presence of dental caries. Pediatricians were no more effective than other physicians in detecting abnormalities. We conclude that the preschool examination should be modified to emphasize screening tests. These screening tests can be effectively performed by paramedical personnel, resulting in increased detection of health problems and decreased demands on physicians' time.

Blood Pressure↗
PubMed1997

Active prevention in diabetic eye disease. A 4-year follow-up.

Ten years after the foundation of a national diabetic eye screening program in 1980, we have established a low prevalence of blindness and partial sight in type 1 and type 2 diabetics in Iceland. We ask whether the screening program is also associated with a low incidence of blindness in diabetics. We now report the results of a prospective study on the 4-year incidence of diabetic retinopathy and visual impairment in type 1 diabetics with age at onset less than 30 years. Out of 205 patients participating at baseline, 175 patients (85.4%) participated over the full 4-year period. Patients were examined annually and received laser treatment according to Diabetic- and Early Treatment Diabetic Retinopathy Study criteria. The 4-year incidence of any retinopathy was 38.1%, of proliferative retinopathy 6.6%, and of macular edema 3.4%. Out of 174 patients, 7.4% showed improvement in visual acuity of 2 Snellen lines while 2.5% experienced worsening of visual acuity of 2 Snellen lines during the 4-year period. No diabetic suffered more than 2 lines deterioration of vision and none became legally blind. The incidence of retinopathy in Icelandic type 1 diabetics participating in our annual eye screening program is low and the visual acuity stable. Our results suggest that visual impairment in diabetics can be prevented with active regular screening and standard laser therapy.

Adolescent↗
PubMed2002

Vision readiness in Operation Restore Hope.

Ensuring that our forces are vision ready for their mission is essential on today's battlefield. Vision readiness considers optical readiness (appropriate correcting eyewear) and visual readiness (adequate job-required visual acuity). A study of vision readiness among deploying personnel for Operation Restore Hope in Bosnia from December 1995 to September 1997 was conducted at Fort Benning, Georgia. Of the 10,063 personnel screened, 3,554 (35.3%) were not optically ready for deployment and 406 (4.0%) were not visually ready for deployment. Analyses indicated a statistically significant difference between the active duty and reserve components in optical and visual readiness. A more effective vision readiness process should be implemented before deployment to ensure that all personnel are deployment ready. Optometry personnel, commanders, and deploying soldiers, sailors, airmen, and marines must take a more active role in ensuring that our forces have the appropriate visual acuity and optical devices to deploy.

Contact Lenses↗
PubMed1976

Data concerning colour vision deficiencies amongst 29,985 young Greeks.

In this survey, 29,985 young Greek employees were screened by the Ishihara plates and if necessary by further more detailed methods (including anomaloscope). The examination of 21,231 young males revealed 212 (1.00%) protanopes, 241 (1.14%) deuteranopes, 254 (1.20%) protanomalous, 978 (4.61%) deuteranomalous and 2 with monochromatic vision. In total, 1,678 males (7.95%) had a colour vision disturbance. The examination of 8,754 young females revealed 1 (0.01%) protanope, 2 (0.02%) deuteranope, 3 (0.03%) protanomalous and 31 (0.35%) deuteranomalous; no case of monochromatic vision in females was detected. In total, only 37 (0.42%) females had a detectable colour vision disturbance with applied screening method. These results are discussed and compaired with the available bibliographic data.

Adolescent↗
PubMed1982

[A simple new device for screening eye tests in pre-school-age children (author's transl)].

A new method of testing the eyes of the children aged between four and six is described. This screening test has the following advantages: the children can be examined in familiar surroundings; there is no psychological pressure on the child; both visual acuity and binocular vision can be tested; the apparatus is simple to use and attractive to children; the results are reliable; the price is reasonable.

Age Factors↗
PubMed1990

The five year school medical--time for change.

School medical records of 1000 children born in 1981 were studied retrospectively. They showed that once known medical problems and those screened for by the school nurse (hearing, vision, growth) were excluded, only 17 problems requiring treatment were discovered: speech (n = 10), development (n = 3), undescended testes (n = 3), and phimosis (n = 1). This indicates that routine screening by a nurse, backed up by selective medical examination by the school doctor, is efficient and effective.

Child, Preschool↗