Visual Performance in Idiopathic Macular Holes
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Visual Acuity Assessment
VISUAL ACUITY ASSESSMENT J. R. WEATHERILL Bradford Tests of visual function in cataract patients are performed recognised that patients with macular dysfunction have in order to answer two questions: (I) To what extent is the difficulty in reading out of proportion to their Snellen cataract responsible for the patient's symptoms? (2) Will acuity. This difficultyis probably due to parafoveal scoto removal of the cataract improve the patient's sight? To mas which prevent the whole word being seen at the same answer the firstquestion the optical qualities of the eye are time. If a patient reports that the main problem is with assessed, and to answer the second tests are employed reading, it is helpful to observe whether the patient holds which assess retinal and neural function and which are the page steadily or keeps moving it to avoid scotomas. relatively unaffected by the optical degradation caused by With current reading tests patients with poor macular opacities in the media. At Bradford we employ the tests function can read small print for brief periods, particularly listed in Table I. if they are used to reading and recognise the overall shape of the words. A Logmar equivalent for near vision com Snellen Acuity prising random words of equal length and composed of Although the Snellen acuity test measures the function of letters without either ascenders or descenders, read under only the central 1_20 in monochrome at 100% contrast, it controlled conditions of illumination and at a standard dis is nonetheless the 'gold standard' by which ophthal tance, would provide a more accurate measure of macular mologists judge and are judged. -
GUIDE for the Evaluation of VISUAL Impairment
International Society for Low vision Research and Rehabilitation GUIDE for the Evaluation of VISUAL Impairment Published through the Pacific Vision Foundation, San Francisco for presentation at the International Low Vision Conference VISION-99. TABLE of CONTENTS INTRODUCTION 1 PART 1 – OVERVIEW 3 Aspects of Vision Loss 3 Visual Functions 4 Functional Vision 4 Use of Scales 5 Ability Profiles 5 PART 2 – ASSESSMENT OF VISUAL FUNCTIONS 6 Visual Acuity Assessment 6 In the Normal and Near-normal range 6 In the Low Vision range 8 Reading Acuity vs. Letter Chart Acuity 10 Visual Field Assessment 11 Monocular vs. Binocular Fields 12 PART 3 – ESTIMATING FUNCTIONAL VISION 13 A General Ability Scale 13 Visual Acuity Scores, Visual Field Scores 15 Calculation Rules 18 Functional Vision Score, Adjustments 20 Examples 22 PART 4 – DIRECT ASSESSMENT OF FUNCTIONAL VISION 24 Vision-related Activities 24 Creating an Activity Profile 25 Participation 27 PART 5 – DISCUSSION AND BACKGROUND 28 Comparison to AMA scales 28 Statistical Use of the Visual Acuity Score 30 Comparison to ICIDH-2 31 Bibliography 31 © Copyright 1999 by August Colenbrander, M.D. All rights reserved. GUIDE for the Evaluation of VISUAL Impairment Summer 1999 INTRODUCTION OBJECTIVE Measurement Guidelines for Collaborative Studies of the National Eye Institute (NEI), This GUIDE presents a coordinated system for the Bethesda, MD evaluation of the functional aspects of vision. It has been prepared on behalf of the International WORK GROUP Society for Low Vision Research and Rehabilitation (ISLRR) for presentation at The GUIDE was approved by a Work Group VISION-99, the fifth International Low Vision including the following members: conference. -
Vision Rehabi I Itation for Patients with Age Related Macular Degeneration
Vision rehabi I itation for GARY S. RUBIN patients with age related macular degeneration Epidemiology of low vision The over-representation of macular degeneration patients in the low-vision clinic is The epidemiology of vision impairment is dealt reflected in the chief complaints of those with in detail elsewhere.1 However, there is one referred for rehabilitation. A study of 1000 particularly salient factor that bears emphasis. consecutive patients seen at the Wilmer Low The prevalence of vision impairment increases Vision clinic indicated that 64% listed 'reading' dramatically with advancing age. Statistics as their chief complaint, while other activities compiled in the UK by the Royal National were identified by fewer than 8% of patients. Institute for the Blind2 indicate that there were Undoubtedly the bias towards reading approximately 1.1 million blind or partially problems results partly from the nature of the sighted persons in 1996, of whom 82% were 65 low-vision services offered. Those served by a years of age or older. Thus it is not surprising to community-based programme that includes learn that the major causes of vision impairment home visits might be more likely to report are age-related eye diseases. Fig. 1 illustrates the problems with activities of daily living, while a distribution of causes of vision impairment blind rehabilitation centre would be more likely 5 from three recent studies?- Approximately to address mobility issues. Nevertheless, most equal percentages are attributed to macular macular degeneration patients are referred to degeneration and cataract, with smaller hospital or optometry clinic services, and as percentages for glaucoma, diabetic retinopathy their overwhelming concern is with reading, and optic neuropathies. -
Visual Performance of Scleral Lenses and Their Impact on Quality of Life In
A RQUIVOS B RASILEIROS DE ORIGINAL ARTICLE Visual performance of scleral lenses and their impact on quality of life in patients with irregular corneas Desempenho visual das lentes esclerais e seu impacto na qualidade de vida de pacientes com córneas irregulares Dilay Ozek1, Ozlem Evren Kemer1, Pinar Altiaylik2 1. Department of Ophthalmology, Ankara Numune Education and Research Hospital, Ankara, Turkey. 2. Department of Ophthalmology, Ufuk University Faculty of Medicine, Ankara, Turkey. ABSTRACT | Purpose: We aimed to evaluate the visual quality CCS with scleral contact lenses were 0.97 ± 0.12 (0.30-1.65), 1.16 performance of scleral contact lenses in patients with kerato- ± 0.51 (0.30-1.80), and 1.51 ± 0.25 (0.90-1.80), respectively. conus, pellucid marginal degeneration, and post-keratoplasty Significantly higher contrast sensitivity levels were recorded astigmatism, and their impact on quality of life. Methods: with scleral contact lenses compared with those recorded with We included 40 patients (58 eyes) with keratoconus, pellucid uncorrected contrast sensitivity and spectacle-corrected contrast marginal degeneration, and post-keratoplasty astigmatism who sensitivity (p<0.05). We found the National Eye Institute Visual were examined between October 2014 and June 2017 and Functioning Questionnaire overall score for patients with scleral fitted with scleral contact lenses in this study. Before fitting contact lens treatment to be significantly higher compared with scleral contact lenses, we noted refraction, uncorrected dis- that for patients with uncorrected sight (p<0.05). Conclusion: tance visual acuity, spectacle-corrected distance visual acuity, Scleral contact lenses are an effective alternative visual correction uncorrected contrast sensitivity, and spectacle-corrected contrast method for keratoconus, pellucid marginal degeneration, and sensitivity. -
IMI Pathologic Myopia
Special Issue IMI Pathologic Myopia Kyoko Ohno-Matsui,1 Pei-Chang Wu,2 Kenji Yamashiro,3,4 Kritchai Vutipongsatorn,5 Yuxin Fang,1 Chui Ming Gemmy Cheung,6 Timothy Y. Y. Lai,7 Yasushi Ikuno,8–10 Salomon Yves Cohen,11,12 Alain Gaudric,11,13 and Jost B. Jonas14 1Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan 2Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 3Department of Ophthalmology and Visual Sciences, University Graduate School of Medicine, Kyoto, Japan 4Department of Ophthalmology, Otsu Red-Cross Hospital, Otsu, Japan 5School of Medicine, Imperial College London, London, United Kingdom 6Singapore Eye Research Institute, Singapore National Eye Center, Singapore 7Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong 8Ikuno Eye Center, 2-9-10-3F Juso-Higashi, Yodogawa-Ku, Osaka 532-0023, Japan 9Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan 10Department of Ophthalmology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan 11Centre Ophtalmologique d’Imagerie et de Laser, Paris, France 12Department of Ophthalmology and University Paris Est, Creteil, France 13Department of Ophthalmology, APHP, Hôpital Lariboisière and Université de Paris, Paris, France 14Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany Correspondence: Kyoko Pathologic myopia is a major cause of visual impairment worldwide. Pathologic myopia is Ohno-Matsui, Department of distinctly different from high myopia. High myopia is a high degree of myopic refractive Ophthalmology and Visual Science, error, whereas pathologic myopia is defined by a presence of typical complications in Tokyo Medical and Dental the fundus (posterior staphyloma or myopic maculopathy equal to or more serious than University, Tokyo, Japan; diffuse choroidal atrophy). -
Bass – Glaucomatous-Type Field Loss Not Due to Glaucoma
Glaucoma on the Brain! Glaucomatous-Type Yes, we see lots of glaucoma Field Loss Not Due to Not every field that looks like glaucoma is due to glaucoma! Glaucoma If you misdiagnose glaucoma, you could miss other sight-threatening and life-threatening Sherry J. Bass, OD, FAAO disorders SUNY College of Optometry New York, NY Types of Glaucomatous Visual Field Defects Paracentral Defects Nasal Step Defects Arcuate and Bjerrum Defects Altitudinal Defects Peripheral Field Constriction to Tunnel Fields 1 Visual Field Defects in Very Early Glaucoma Paracentral loss Early superior/inferior temporal RNFL and rim loss: short axons Arcuate defects above or below the papillomacular bundle Arcuate field loss in the nasal field close to fixation Superotemporal notch Visual Field Defects in Early Glaucoma Nasal step More widespread RNFL loss and rim loss in the inferior or superior temporal rim tissue : longer axons Loss stops abruptly at the horizontal raphae “Step” pattern 2 Visual Field Defects in Moderate Glaucoma Arcuate scotoma- Bjerrum scotoma Focal notches in the inferior and/or superior rim tissue that reach the edge of the disc Denser field defects Follow an arcuate pattern connected to the blind spot 3 Visual Field Defects in Advanced Glaucoma End-Stage Glaucoma Dense Altitudinal Loss Progressive loss of superior or inferior rim tissue Non-Glaucomatous Etiology of End-Stage Glaucoma Paracentral Field Loss Peripheral constriction Hereditary macular Loss of temporal rim tissue diseases Temporal “islands” Stargardt’s macular due -
Central Serous Choroidopathy
Br J Ophthalmol: first published as 10.1136/bjo.66.4.240 on 1 April 1982. Downloaded from British Journal ofOphthalmology, 1982, 66, 240-241 Visual disturbances during pregnancy caused by central serous choroidopathy J. R. M. CRUYSBERG AND A. F. DEUTMAN From the Institute of Ophthalmology, University of Nijmegen, Nijmegen, The Netherlands SUMMARY Three patients had during pregnancy visual disturbances caused by central serous choroidopathy. One of them had a central scotoma in her first and second pregnancy. The 2 other patients had a central scotoma in their first pregnancy. Symptoms disappeared spontaneously after delivery. Except for the ocular abnormalities the pregnancies were without complications. The complaints can be misinterpreted as pregnancy-related optic neuritis or compressive optic neuropathy, but careful biomicroscopy of the ocular fundus should avoid superfluous diagnostic and therapeutic measures. Central serous choroidopathy (previously called lamp biomicroscopy of the fundus with a Goldmann central serous retinopathy) is a spontaneous serous contact lens showed a serous detachment of the detachment of the sensory retina due to focal leakage neurosensory retina in the macular region of the from the choriocapillaris, causing serous fluid affected left eye. Fluorescein angiography was not accumulation between the retina and pigment performed because of pregnancy. In her first epithelium. This benign disorder occurs in healthy pregnancy the patient had consulted an ophthal- adults between 20 and 45 years of age, who present mologist on 13 June 1977 for exactly the same with symptoms of diminished visual acuity, relative symptoms, which had disappeared spontaneously http://bjo.bmj.com/ central scotoma, metamorphopsia, and micropsia. after delivery. -
Ophthalmology Abbreviations Alphabetical
COMMON OPHTHALMOLOGY ABBREVIATIONS Listed as one of America’s Illinois Eye and Ear Infi rmary Best Hospitals for Ophthalmology UIC Department of Ophthalmology & Visual Sciences by U.S.News & World Report Commonly Used Ophthalmology Abbreviations Alphabetical A POCKET GUIDE FOR RESIDENTS Compiled by: Bryan Kim, MD COMMON OPHTHALMOLOGY ABBREVIATIONS A/C or AC anterior chamber Anterior chamber Dilators (red top); A1% atropine 1% education The Department of Ophthalmology accepts six residents Drops/Meds to its program each year, making it one of nation’s largest programs. We are anterior cortical changes/ ACC Lens: Diagnoses/findings also one of the most competitive with well over 600 applicants annually, of cataract whom 84 are granted interviews. Our selection standards are among the Glaucoma: Diagnoses/ highest. Our incoming residents graduated from prestigious medical schools ACG angle closure glaucoma including Brown, Northwestern, MIT, Cornell, University of Michigan, and findings University of Southern California. GPA’s are typically 4.0 and board scores anterior chamber intraocular ACIOL Lens are rarely lower than the 95th percentile. Most applicants have research lens experience. In recent years our residents have gone on to prestigious fellowships at UC Davis, University of Chicago, Northwestern, University amount of plus reading of Iowa, Oregon Health Sciences University, Bascom Palmer, Duke, UCSF, Add power (for bifocal/progres- Refraction Emory, Wilmer Eye Institute, and UCLA. Our tradition of excellence in sives) ophthalmologic education is reflected in the leadership positions held by anterior ischemic optic Nerve/Neuro: Diagno- AION our alumni, who serve as chairs of ophthalmology departments, the dean neuropathy ses/findings of a leading medical school, and the director of the National Eye Institute. -
Visual Optics
Visual Optics Jim Schwiegerling, PhD Ophthalmology & Optical Sciences University of Arizona Visual Optics - Introduction • In this course, the optical principals behind the workings of the eye and visual system will be explained. • Furthermore, descriptions of different devices used to measure the properties and functioning of the eye will be described. • Goals are a general understanding of how the visual system works and exposure to an array of different optical instrumentation. 1 What is Vision? • Three pieces are needed for a visual system – Eye needs to form an “Image”. Image is loosely defined because it can be severely degraded and still provide information. – Image needs to be converted to a neural signal and sent to the brain. – Brain needs to interpret and process the image. Analogous Vision System Feedback Video Computer Camera Analysis Display Conversion & Image To Signal Interpretation Formation 2 Engineering Analysis • Optics – Aberrations and raytracing are used to determine the optical properties of the eye. Note that the eye is non- rotationally symmetric, so analysis is more complex than systems normally discussed in lens design. Fourier theory can also be used to determine retinal image with the point spread function and optical transfer function. •Neural– Sampling occurs by the photoreceptors (both spatial and quantification), noise reduction, edge filtering, color separation and image compression all occur in this stage. •Brain– Motion analysis, pattern recognition, object recognition and other processing occur in the brain. Anatomy of the Eye Anterior Chamber –front portion of the eye Cornea –Clear membrane on the front of the eye. Aqueous – water-like fluid behind cornea. Iris – colored diaphragm that acts as the aperture stop of the eye. -
Scleral Lenses in the Management of Keratoconus
ARTICLE Scleral Lenses in the Management of Keratoconus Muriel M. Schornack, O.D., and Sanjay V. Patel, M.D. Management of patients with keratoconus consists primarily of Purpose: To describe the use of Jupiter scleral lenses (Medlens Innova- providing optical correction to maximize visual function. In very tions, Front Royal, VA; and Essilor Contact Lenses, Inc., Dallas, TX) in the management of keratoconus. mild or early disease, spectacle correction or standard hydrogel or Methods: We performed a single-center retrospective chart review of our silicone hydrogel lenses may provide adequate vision. However, initial 32 patients with keratoconus evaluated for scleral lens wear. All disease progression results in increasing ectasia, which gives rise patients were referred for scleral lens evaluation after exhausting other to complex optical aberrations. Rigid gas-permeable contact lenses nonsurgical options for visual correction. Diagnostic lenses were used in mask these aberrations by allowing a tear lens to form between the the initial fitting process. If adequate fit could not be achieved with contact lens and the irregular corneal surface. Zadnik et al. found standard lenses, custom lenses were designed in consultation with the that 65% of patients who enrolled in the Collaborative Longitudi- manufacturers’ specialists. The following measures were evaluated for nal Evaluation of Keratoconus study were wearing rigid gas- each patient: ability to tolerate and handle lenses, visual acuity with scleral permeable lenses in one or both eyes at the time of enrollment.4 lenses, number of lenses, and visits needed to complete the fitting process. Despite their optical benefit, corneal rigid gas-permeable lenses Results: Fifty-two eyes of 32 patients were evaluated for scleral lens may not be appropriate for all patients with keratoconus. -
Dominant Optic Atrophy
Lenaers et al. Orphanet Journal of Rare Diseases 2012, 7:46 http://www.ojrd.com/content/7/1/46 REVIEW Open Access Dominant optic atrophy Guy Lenaers1*, Christian Hamel1,2, Cécile Delettre1, Patrizia Amati-Bonneau3,4,5, Vincent Procaccio3,4,5, Dominique Bonneau3,4,5, Pascal Reynier3,4,5 and Dan Milea3,4,5,6 Abstract Definition of the disease: Dominant Optic Atrophy (DOA) is a neuro-ophthalmic condition characterized by a bilateral degeneration of the optic nerves, causing insidious visual loss, typically starting during the first decade of life. The disease affects primary the retinal ganglion cells (RGC) and their axons forming the optic nerve, which transfer the visual information from the photoreceptors to the lateral geniculus in the brain. Epidemiology: The prevalence of the disease varies from 1/10000 in Denmark due to a founder effect, to 1/30000 in the rest of the world. Clinical description: DOA patients usually suffer of moderate visual loss, associated with central or paracentral visual field deficits and color vision defects. The severity of the disease is highly variable, the visual acuity ranging from normal to legal blindness. The ophthalmic examination discloses on fundoscopy isolated optic disc pallor or atrophy, related to the RGC death. About 20% of DOA patients harbour extraocular multi-systemic features, including neurosensory hearing loss, or less commonly chronic progressive external ophthalmoplegia, myopathy, peripheral neuropathy, multiple sclerosis-like illness, spastic paraplegia or cataracts. Aetiology: Two genes (OPA1, OPA3) encoding inner mitochondrial membrane proteins and three loci (OPA4, OPA5, OPA8) are currently known for DOA. Additional loci and genes (OPA2, OPA6 and OPA7) are responsible for X-linked or recessive optic atrophy. -
Contrast Sensitivity and Acuity Relationship in Strabismic and Anisometropic Amblyopia
Br J Ophthalmol: first published as 10.1136/bjo.72.1.44 on 1 January 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 44-49 Contrast sensitivity and acuity relationship in strabismic and anisometropic amblyopia M ABRAHAMSSON AND J SJOSTRAND From the Department of Ophthalmology, University of Goteborg, Sahlgren's Hospital S-413 45 Goteborg, Sweden SUMMARY The contrast sensitivity function (CSF) and visual acuity were determined in children and adults with unilateral amblyopia due to strabismus or anisometropia with central fixation. The preschool children were examined repeatedly during occlusion treatment. All amblyopes had CSF deficits. The CSF was characterised by its peak value (the maximal sensitivity, Smax, and the spatial frequency at which Smax occurs, Frmax) calculated by a single peak least-square regression method. The two amblyopic groups showed discrepancies in relationship of both Smax and Frmax versus visual acuity both initially and during treatment. The strabismic cases had a more marked visual acuity deficit in relation to the contrast sensitivity losses, whereas these parameters are affected similarly in anisometropic amblyopes. The relationship between recovery of visual acuity and CSF during the initial month of occlusion treatment was of prognostic significance for the outcome of visual acuity improvement. copyright. Amblyopia is defined as an optically uncorrectable receives an input with deprived form and contour. loss of vision, usually monocular, without demon- There is no evidence that a strabismic eye receives a strable pathology in the posterior pole of the eye. blurred image, whereas several studies indicate that This condition develops in early childhood and it abnormal binocular interaction is present in http://bjo.bmj.com/ affects up to 5% of the population.