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To clarify the changing characteristics of choroidal thickness over time within different age ranges and among different refractive statuses of children aged 6 to 18 years.Prospective cohort study.Data of axial length, cycloplegic refraction, and choroidal thickness (using swept-source optical coherence tomography) were collected at baseline and at a 1-year follow-up for 756 participants. One-year change in choroidal thickness and its association with age and refraction were analyzed.Significantly greater attenuation of choroidal thickness was observed in younger children aged 6-9 years for all participants (-9 ± 25 μm) and for those with a myopic shift (-12 ± 25 μm), whereas there was a larger increase in adolescents aged 10-13 years for those without a myopic shift (9 ± 23 μm). There was a marked decrease in the choroidal thickness for newly developed myopic patients compared with persistent-nonmyopic patients and persistent-myopic patients (P.01). The association between changes in axial length and choroidal thickness was less strong in persistent-myopic patients (β = -15.4, P = .022) than that in persistent-nonmyopic patients (β = -30.4, P.001) and newly developed myopic patients (β = -33.7, P = .001), whereas among the persistent-myopic patients, the association was less strong in the baseline mild-myopic patients (β = -10.4, P = .193) than that in the baseline moderate-to high-myopic patients (β = -31.4, P = .026).Changes in choroidal thickness varied by age. There was an increased rapid thinning of the choroid among newly developed myopic patients, and a nonsignificant association between changes in choroidal thickness and axial length in the early stages of myopia.

WE sought to evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOLs) with plate-haptic, c-loop haptic, and a rhexis-fixated lens were compared.Retrospective, multicenter, comparative case series.The study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic, or a novel rhexis-fixated IOL. Biometry and refraction measurements were conducted preoperatively and 3 months postoperatively. Lens constant optimization was performed.Seventy eyes of 56 subjects were included. ELP for rhexis-fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis-fixated IOL and both plate-haptic (P = .001) and c-loop haptic IOL (P = .000). Anterior chamber depth adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P.05). For the rhexis-fixated IOL the differences in refraction ranged from -0.039 diopters (D) for the Hill-Radial Basis Function to -0.096 D for Haigis. The other 2 lenses showed mean differences in refraction between +0.046 D for Hill-Radial Basis Function and +0.097 D for Haigis.The difference in IOL fixation and its resulting position in the capsular bag have a significant effect on the effective lens position and consequently a significant effect on the prediction of postoperative refraction.

Purpose To explore factors affecting the difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. Design Prospective observational case series. Methods setting: Institutional. study population: Twenty-nine healthy volunteers (58 eyes; mean age, 38.4 ± 10.0 years; range, 25–60 years). observation procedures: Objective monocular refractions (MR) measured with the Nidek Auto Ref/Keratometer ARK-730A; objective binocular refractions (BR) and objective accommodative amplitude (AA) measured with the Grand Seiko Auto Ref/Keratometer WAM-5500; ocular dominance measured using the hole-in-the-card test; presence and magnitude of far/near (30 cm) phoria evaluated by the cover test and alternating cover test using a prism bar. main outcome measure: The difference between objective refractive data measured under monocular closed-field viewing and binocular open-field viewing. Results The spherical equivalent (SE) of the BR was significantly ( P P = .08; r = 0.223, P = .092, respectively). The correlation between age and difference in SE was significant in dominant eyes (r = −0.372, P = .047) but not in nondominant eyes (r = −0.102, P = .60). In nondominant eyes, the amount of near phoria was correlated significantly (r = 0.403, P = .03) with the difference in SE. The correlation was strong (r = 0.598, P = .01) in 17 subjects with more than 3 D of AA. Conclusions Binocular assessment of refraction is important for precise refractive therapy.

To evaluate the diagnostic accuracy of rapid assessment of avoidable blindness (RAAB).Population-based diagnostic accuracy study.A total of 2145 (95.3%, 2145/2250) subjects aged 50 years and older who participated in the RAAB survey were included. All the recruited participants underwent ophthalmic examination according to the RAAB protocol and then were reexamined with instruments in a mobile eye clinic set up in a village center on the same day. Examination in the mobile clinic included standardized visual acuity (VA) tests using logMAR charts, refraction, slit-lamp biomicroscopy, and dilated fundal examination with a binocular indirect ophthalmoscope. Blindness and economic blindness were defined as VA in the better-seeing eye3/60 and6/60, respectively. Visual impairment (VI) was defined as VA6/18 in the better eye. The primary cause of blindness and VI was defined according to the cause of VI in the participant's better eye.The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and area under the curve (AUC) of receiver operating characteristics of RAAB for detection of blindness and the principal causes of VI.A total of 1816 subjects (84.7%), including 686 men (37.8%) and 1130 women (62.2%), underwent ophthalmic examination in the mobile eye clinic. The mean (±standard deviation) age was 64.4 ± 9.6 years. The sensitivities, specificities, AUC, PLR, and NLR of RAAB were 90.3%, 99.3%, 0.948, 124.0, and 0.10, respectively, for detection of blindness (presenting visual acuity, PVA3/60); 89.5%, 98.7%, 0.940, 69.2, and 0.11, respectively, for detection of economic blindness (PVA6/60); and 90.3%, 97.7%, 0.940, 38.7, and 0.10, respectively, for detection of VI (PVA6/18). The sensitivities, specificities, AUC, PLR, and NLR were 90.5%, 98.1%, 0.943, 48.1, and 0.10; and 60.4%, 98.7%, 0.796, 46.4, and 0.40 for detection of VI (PVA6/18) owing to cataract and refractive error, respectively.The diagnostic performances of RAAB were high for detecting the prevalence of blindness, VI, and VI owing to cataract.

To characterize age- and sex-related changes in corneal refractive parameters in myopic and hyperopic patients undergoing refractive surgery.A retrospective cross-sectional study.Analysis of demographic and refractive parameters of myopic and hyperopic patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2000 and December 2014 at the Care-Vision Laser Centers, Tel-Aviv, Israel.A total of 62,422 eyes of 31,211 patients were included. With advancing age, refractive surgery was performed for lower magnitudes of myopia and hyperopia. The magnitude of cylinder was higher in men than in women in both myopic and hyperopic patients. In comparison, women were significantly more myopic than men (spherical equivalent of -3.73 diopter [D] versus -4.07 D; P0.01). The myopic group sphere (r = 0.044; P0.001) had a positive correlation with age, whereas other parameters had a negative correlation with age: astigmatism (r = -0.09; P0.001), best-correct visual acuity (BCVA) (r = -0.04; P0.001), flat K (r = -0.09; P0.001), steep K (r = -0.06; P0.001), average K (r = -0.07; P0.001), and J0 (r = -0.05; P0.001). For hyperopic patients, astigmatism (r = 0.35; P0.001), BCVA (r = 0.11; P0.001), flat K (r = 0.30; P0.001), average K (0.14; P0.001), and central corneal thickness (r = 0.10; P0.001) correlated positively with age, whereas sphere (r = -0.23; P0.001), J0 (r = -0.31; P0.001), and overall blurring strength (r = -0.31; P0.001) had negative correlations with age.This large cohort study shows age- and sex-related refractive parameters among myopic and hyperopic patients seeking refractive surgery. These parameters can explain and predict trends in patients attending refractive surgery.

To assess the effects of sustained gazing on visual function of dry eye patients.Prospective, comparative before-and-after study.A total of 176 patients with dry eye and 33 control subjects ≥50 years old were included. Dry eye symptomatology along and clinical parameters were assessed. Out-loud reading speed was measured using the International Reading Speed Test (IReST) as words per minute (wpm). Reading speed was repeated using different IReST excerpts following 30-minute silent reading.At baseline, there were no differences between dry eye patients and control subjects with respect to reading speed (172 vs 180 wpm, respectively; P = 0.21) or the time to read the excerpt (33 vs 30 seconds, respectively; P = 0.17). After silent reading, the dry eye patients had decreased reading speed and increases in the length of time to read the passage compared to baseline (161 vs 172 wpm, respectively; P = 0.002; and 38 vs 33 seconds, respectively; P0.001). The control subjects did not show significant differences for either parameter. There were significant differences with respect to both parameters between the dry eye and control groups after sustained gazing (161 vs 188 wpm, respectively; P = 0.006; and 38 vs 31 seconds, respectively; P = 0.003). Each 1-point increase in baseline corneal staining score (0-6) led to a 5-wpm reduction in reading speed (95% confidence interval, -8 to -1; P = 0.01).Sustained gazing, such as in silent reading, has a measurable negative impact on visual performance of dry eye patients. Corneal staining represents a clinical parameter relevant to visual function.

To investigate the prevalence and associations of visual impairment and spectacle use in university students in central China.Cross-sectional study.This study included students aged 16-26 years in China. Study subjects from 2 universities underwent distance visual acuity (VA) assessment in both eyes with a logarithm of the minimum angle of resolution chart and their refractions were measured by cycloplegic autorefraction. Blindness was defined as presenting VA less than three-sixtieth in the better eye (World Health Organization definition), and visual impairment was defined as presenting VA less than six-twelfths.Overall, 9710 undergraduates were enumerated, 7704 (79.3%) subjects were included in this study. The prevalence of uncorrected VA less than six-twelfths and less than three-sixtieth in the better eye were 69.9% and 0.9%, respectively. Only 77.0% (4148/5388) of subjects with uncorrected VA in the better eye of less than six-twelfths wore glasses. For presenting VA, the prevalence of mild (VA6/12 to 6/18), moderate (VA6/18 to 6/60), and severe (VA6/60 to 3/60) visual impairment was 6.3%, 11.2%, and 0.7%, respectively. Overall, 71.7% (4300/6001) of students with myopia (spherical equivalent ≤-0.5 diopters) wore spectacles. In multiple logistic regression analysis, visual impairment was associated with female sex (P.001) and lower year level of education (P = .006) when presenting with VA.This study has documented a relatively high prevalence of visual impairment and relatively low spectacle coverage in Chinese university students. Given the potential impact of visual impairment, target education and accessible refraction services are highly important to solve the problem.

PURPOSE: To report on the utility of a computer tablet-based method for automated testing of visual acuity in children based on the principles of game design. We describe the testing procedure and present repeatability as well as agreement of the score with accepted visual acuity measures.DESIGN: Reliability and validity study.METHODS: Setting: Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department.PATIENT POPULATION: Total of 112 sequentially recruited patients.INTERVENTION: For each patient 1 eye was tested with the Mobile Assessment of Vision by intERactIve Computer for Children (MAVERIC-C) system, consisting of a software application running on a computer tablet, housed in a bespoke viewing chamber. The application elicited touch screen responses using a game design to encourage compliance and automatically acquire visual acuity scores of participating patients. Acuity was then assessed by an examiner with a standard chart-based near ETDRS acuity test before the MAVERIC-C assessment was repeated.MAIN OUTCOME MEASURE: Reliability of MAVERIC-C near visual acuity score and agreement of MAVERIC-C score with near ETDRS chart for visual acuity.RESULTS: Altogether, 106 children (95%) completed the MAVERIC-C system without assistance. The vision scores demonstrated satisfactory reliability, with test-retest VA scores having a mean difference of 0.001 (SD ±0.136) and limits of agreement of 2 SD (LOA) of ±0.267. Comparison with the near EDTRS chart showed agreement with a mean difference of -0.0879 (±0.106) with LOA of ±0.208.CONCLUSIONS: This study demonstrates promising utility for software using a game design to enable automated testing of acuity in children with ophthalmic disease in an objective and accurate manner.

Purpose The course of intermittent exotropia and response to surgery may depend on whether there is underlying monofixation. The purpose of this study was to report the prevalence of sensory monofixation in intermittent exotropia using different stereotests and to determine the risk of misclassifying monofixation based on a single administration of each test. Design Retrospective case review of children with intermittent exotropia. Methods Forty-four children were identified for whom Preschool Randot, Frisby, and Titmus stereoacuity were measured at a single examination. Ninety-two children were identified with near stereoacuity measured on 2 sequential visits (Preschool Randot, n=73; Frisby, n=66; and Titmus, n=40). Monofixation was defined as stereoacuity worse than previously published age-referenced normal thresholds, bifixation was defined as at least 40 arc seconds, and uncertain was defined as within normal range for age but worse than 40 arc seconds. Results In children measured by all 3 tests on the same visit, sensory monofixation occurred in 36% using Preschool Randot, in 48% using Titmus, and in 55% using Frisby ( P > .1 for each comparison). There was poor agreement between Frisby and Preschool Randot when classifying monofixation in individual patients ( P = .05). In children measured on sequential visits, misclassification occurred in 5% with Preschool Randot, in 13% with Titmus, and in 23% with Frisby (Preschool Randot vs Frisby, P = .005). Conclusions Classification of monofixation depends on the stereotest used. Regardless of the stereotest, there is a risk of misclassifying monofixation on a single assessment. Potential misclassification needs to be considered in clinical practice and in study design.

To determine the 4-year incidence of visual impairment (VI) and blindness and worsening of visual acuity in adult Latinos and Hispanics aged 40 years and older.Population-based, longitudinal study.Participants underwent a detailed ophthalmologic examination including assessing both presenting binocular visual acuity (PVA) and best-corrected distance visual acuity (BCVA) in both eyes using a standard Early Treatment Diabetic Retinopathy protocol. The main outcome measures are 4-year incidence of visual impairment and blindness based on PVA or BCVA in the better-seeing eye and defined as (1) baseline visual acuity (PVA or BCVA) of 20/40 or better and a follow-up PVA or BCVA of less than 20/40 but better than 20/200, and (2) baseline PVA better than 20/200 and a follow-up PVA of 20/200 or less, respectively. Monocular worsening was defined as a decrease of 5 or more, 10, and 15 letters in either eye.Four thousand six hundred fifty-eight participants were examined at baseline and the 4-year follow-up. The 4-year incidence of presenting binocular VI and blindness was 2.9% and 0.3%. The 4-year incidence of best-corrected VI and blindness was 1.2% and 0.3%. The 4-year incidence of monocular worsening by 5 or more, 10, and 15 letters was 24.8%, 8.5%, and 3.1%, respectively. The incidence of VI and blindness increased with age at baseline (P.01). The incidence of VI in the second eye (12.2%) was significantly higher than the incidence of VI in the first eye (2.9%; P.001).Overall, the annual incidence of VI in Latinos and Hispanics was higher than that reported in non-Hispanic white persons and the highest reported in a population-based study in the United States. Screening and intervention programs to reduce visual impairment and blindness should focus on the older Latino population.

PURPOSE: To report a computerized method for determining visual acuity in children using the Amblyopia Treatment Study visual acuity testing protocol. METHODS: A computerized visual acuity tester was developed that uses a programmed handheld device that uses the Palm operating system (Palm, Inc, Santa Clara, California). The handheld device communicates with a personal computer running a Linux operating system and 17-inch monitor. At a test distance of 3 m, single letters can be displayed from 20/800 to 20/12. A C program on the handheld device runs the Amblyopia Treatment Study visual acuity testing protocol. Using this method, visual acuity was tested in both the right and left eyes, and then the testing was repeated in 156 children age 3 to 7 years at four clinical sites. RESULTS: Test-retest reliability was high (r =.92 and 0.95 for and right and left eyes, respectively), with 88% of right eye retests and 94% of left eye retests within 0.1 logarithm of minimal angle of resolution (logMAR) units of the initial test. The 95% confidence interval for an acuity score was calculated to be the score +/- 0.13 logMAR units. For a change between two acuity scores, the 95% confidence interval was the difference +/- 0.19 logMAR units. CONCLUSIONS: We have developed a computerized method for measurement of visual acuity. Automation of the Amblyopia Treatment Study visual acuity testing protocol is an effective method of testing visual acuity in children 3 to 7 years of age.

PURPOSE: Cataract and hearing loss are each common at older ages and together may influence the ability to function independently and affect the sense of well-being. For these reasons, we sought to estimate the risk factors for comorbidity of age-related cataract and hearing loss. METHODS: A cross-sectional evaluation of a population-based cohort of older adults was conducted in Beaver Dam, Wisconsin, for presence of age-related cataract and hearing loss. The study evaluation included taking standardized medical histories, measuring blood pressures, and obtaining blood specimens. Standardized photographs, which were graded according to well-defined protocols to assess the presence of nuclear, cortical or posterior subcapsular cataract, were taken. Audiometric testing was performed according to well-defined study protocols. RESULTS: Any type of cataract in combination with hearing loss in either ear was frequent, occurring in 27.8% of the population overall and increasing consistently with age. Nuclear and posterior subcapsular cataract in combination with hearing loss occurred more often in men. Lifestyle factors that were associated with at least one cataract–hearing loss end point in at least one sex were history of heavy drinking and smoking. CONCLUSIONS: In this community, older adults appear to be at high risk of cataract and hearing loss. Although risk is strongly associated with age, some elective exposures appear to influence risk. It is possible that modification of certain lifestyle habits may alter these risks.

PURPOSE: To assess the prevalence of refractive errors and vision impairment in school-age children in a suburban area (La Florida) of Santiago, Chile. METHODS: Random selection of geographically defined clusters was used to identify a representative sample of children 5 to 15 years of age. Children in the 26 selected clusters were enumerated through a door-to-door survey and invited to report to a community health clinic for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus were done from April through August 1998. Independent replicate examinations of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in six clusters. RESULTS: A total of 6,998 children from 3,830 households were enumerated, and 5,303 children (75.8%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.50 (20/40) or worse in at least one eye was 15.8%, 14.7%, and 7.4%, respectively; 3.3% had best visual acuity 0.50 or worse in both eyes. Refractive error was the cause in 56.3% of the 1,285 eyes with reduced vision, amblyopia in 6.5%, other causes in 4.3%, with unexplained causes in the remaining 32.9%. Myopia −0.50 diopter or less in either eye was present in 3.4% of 5-year-old children, increasing to 19.4% in males and 14.7% in females by age 15. Over this same age range, hyperopia 2.00 diopters or greater decreased from 22.7% to 7.1% in males and from 26.3% to 8.9% in females. Females had a significantly higher risk of hyperopia than males. CONCLUSIONS: Refractive error, associated primarily with myopia, is a major cause of reduced vision in school-age children in La Florida. More than 7% of children could benefit from the provision of proper spectacles. Efforts are needed to make existing programs that provide free spectacles for school children more effective. Further studies are needed to determine whether the upward trend in myopia continues far beyond 15 years of age.

PURPOSE: To assess the prevalence of refractive error and vision impairment in school age children in the terai area of the Mechi zone in Eastern Nepal. METHODS: Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Children in the 25 selected clusters were enumerated through a door-to-door household survey and invited to village sites for examination. Visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and anterior segment, media, and fundus examinations were done from May 1998 through July 1998. Independent replicate examinations for quality assurance monitoring took place in all children with reduced vision and in a sample of those with normal vision in seven villages. RESULTS: A total of 5,526 children from 3,724 households were enumerated, and 5,067 children (91.7%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 2.9%, 2.8%, and 1.4%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 56% of the 200 eyes with reduced uncorrected vision, amblyopia in 9%, other causes in 19%, with unexplained causes in the remaining 16%. Myopia −0.5 diopter or less in either eye or hyperopia 2 diopters or greater was observed in less than 3% of children. Hyperopia risk was associated with female gender and myopia risk with older age. CONCLUSIONS: The prevalence of reduced vision is very low in school-age children in Nepal, most of it because of correctable refractive error. Further studies are needed to determine whether the prevalence of myopia will be higher for more recent birth cohorts.

PURPOSE: To assess the prevalence of refractive errors and vision impairment in school-age children in Shunyi District, northeast of Beijing, the Peoples Republic of China. METHODS: Random selection of village-based clusters was used to identify a sample of children 5 to 15 years of age. Resident registration books were used to enumerate eligible children in the selected villages and identify their current school. Ophthalmic examinations were conducted in 132 schools on children from 29 clusters during May 1988 to July 1998, including visual acuity measurements, cycloplegic retinoscopy, cycloplegic autorefraction, ocular motility evaluation, and examination of the external eye, anterior segment, media, and fundus. Independent replicate measurements of all children with reduced vision and a sample of those with normal vision were done for quality assurance monitoring in three schools. RESULTS: A total of 6,134 children from 4,338 households were enumerated, and 5,884 children (95.9%) were examined. The prevalence of uncorrected, presenting, and best visual acuity 0.5 (20/40) or worse in at least one eye was 12.8%, 10.9%, and 1.8%, respectively; 0.4% had best visual acuity 0.5 or worse in both eyes. Refractive error was the cause in 89.5% of the 1,236 eyes with reduced vision, amblyopia in 5%, other causes in 1.5%, with unexplained causes in the remaining 4%. Myopia −0.5 diopter or less in either eye was essentially absent in 5-year-old children, but increased to 36.7% in males and 55.0% in females by age 15. Over this same age range, hyperopia 2 diopters or greater decreased from 8.8% in males and 19.6% in females to less than 2% in both. Females had a significantly higher risk of both myopia and hyperopia. CONCLUSIONS: Reduced vision because of myopia is an important public health problem in school-age children in Shunyi District. More than 9% of children could benefit from prescription glasses. Further studies are needed to determine whether the upward trend in the prevalence of myopia continues far beyond age 15 and whether the development of myopia is changing for more recent birth cohorts.

Purpose To compare the performance of real depth and Randot stereotests in strabismic and nonstrabismic patients. Design Observational case series. Methods Stereoacuity was tested in 182 patients with a variety of strabismic conditions, using the Frisby-Davis 2 (FD2) distance stereotest, the near Frisby (nF) (both real depth tests), the Preschool Randot (nR), and Distance Randot (dR) tests (both based on Polaroid vectographs). Results Patients appreciated finer disparities with the nF test than the nR test at near and with the FD2 test than the dR test at distance. Conclusions The type of stereotest influences measurable thresholds, and the results from different tests are not interchangeable. The choice of test should depend on the question being asked; nF and FD2 would be appropriate for determining presence or absence of stereopsis and best measurable stereopsis. The more rigorous Randot tests would be appropriate for determining subtle changes.

Purpose To measure the visual acuity, stereoacuity, and contrast sensitivity of professional baseball players. Methods Three hundred eighty-seven professional baseball players underwent several tests of visual function including distance visual acuity. Stereoacuity was evaluated at near by the Randot test and at distance by both contour and random dot targets. Distance stereoacuity was also tested under timed and untimed conditions. Contrast sensitivity was evaluated by the Vision Contrast Test System, Contrast Sensitivity Viewer, and Binocular Visual Acuity Tester. Results Visual acuity (measured with players' regular distance correction) in 774 eyes ranged from 20/8.89 to 20/100. Near stereoacuity ranged from 23 to 37 seconds of arc, mean untimed distance contour stereoacuity from 55 to 35 seconds of arc, and mean untimed distance random dot stereoacuity from 98 to 76 seconds of arc. The results under timed conditions were 86 to 65 seconds of arc (timed distance contour stereoacuity) and 104 to 83 seconds of arc (timed distance random dot stereoacuity). Statistically significant differences were found between major and minor league players on tests of untimed distance contour and random dot stereopsis, and on contrast sensitivity testing with the 3.0- and 6.0-cpd gratings using the Contrast Sensitivity Viewer. Conclusions Professional baseball players have excellent visual skills. Mean visual acuity, distance stereoacuity, and contrast sensitivity are significantly better than those of the general population.

Purpose To compare 8 clinically relevant methods of staging visual field (VF) damage in glaucoma with a performance-based measure of the activities of daily living and self-reported quality of life. Design Prospective cross-sectional study. Methods One hundred ninety-two patients with various types of glaucoma were evaluated at the Wills Eye Institute using standard monocular and binocular VF testing, as well as an objective, performance-based measure of visual function (the Assessment of Disability Related to Vision), and a subjective, standardized measure of quality of life (the 25-item National Eye Institute Visual Function Questionnaire). Binocular VFs were scored according to the Esterman and Integrated VF Systems. Monocular VFs were scored according to the mean defect, pattern standard deviation, Hodapp-Parrish-Anderson method, glaucoma staging system, glaucoma staging system 2, and the field damage likelihood scale. Partial Spearman correlations between VF staging systems, Assessment of Disability Related to Vision scores, and 25-item National Eye Institute Visual Function Questionnaire scores were calculated. Results Assessment of Disability Related to Vision scores and 25-item National Eye Institute Visual Function Questionnaire scores were associated most closely with the VF score in the better eye and the binocular VF scoring systems. Conclusions The amount of binocular VF loss and the status of the better eye most accurately predict functional ability and quality of life in glaucoma.

A COLLEAGUE ONCE MADE THE WITTY OBSERVATION that he has never met a referring doctor he didn’t like. We can readily endorse this sentiment since for many of us referrals are our life blood. But among the referred patients is a group who present special difficulties. These are the patients whose visual symptoms the referring ophthalmologist suspects (or even knows) are on a psychological or sociopathic basis. Many clinicians are frustrated by, and even feel hostile to, these patients because they do not appear to share with the physician the goal of eliminating the symptoms. Their evaluation and management is difficult enough, but there is also the additional problem of selecting the best diagnostic term in each case. Many designations have been used and many clinicians consider them to be generic terms, unaware that they may have specific implications in law and psychiatry. Their casual use can have unintended consequences. For example, in the Commonwealth of Massachusetts “malingerers” would be denied workers’ compensation and would not be accepted on the rolls of the Commission for the Blind. “Hysterics,” however, may receive compensation for their illness and would be eligible to be registered with the Commission for the Blind. The requirement that we select billing codes listed in standard diagnostic manuals has brought the issue of nomenclaure into sharp focus. I hope to convince readers to arefully consider the terms that they use and to show that phthalmologists and neuro-ophthalmologists lack the raining necessary to employ the specific diagnoses curently available in the diagnostic manuals. “Organic” is a term used in psychology to designate a isorder “caused by neurochemical, neuroendocrinologic, tructural, or other impairment or change.” It would be fair to say that this is the definition that is generally used by clinicians to classify patients as having an organic or a nonorganic disorder. The existence of competing schools of dynamic psychiatry and biological psychiatry reflected this duality. For many years the former was in ascendancy, but the situation has changed. Advances in the neural

In August 1989, the Tokyo Metropolitan Government officially began a vision screening program for children aged 3 years 1 month. A 1988 pilot study of 1,303 children this age disclosed five cases (0.38%) of amblyopia. The home vision test, which uses picture cards of familiar figures, proved to be an efficient and inexpensive method of screening when incorporated into the existing health-check program for 3-year-old children. In the initial eight months of the program, 21,906 children were screened. Of these, 419 children (1.9%) were referred to an ophthalmologist for follow-up, and amblyopia was detected in 41 children (0.19%).

To evaluate the prevalence and causes of visual impairment among Chinese children aged 3 to 6 years in Beijing.Population-based prevalence survey.Presenting and pinhole visual acuity were tested using picture optotypes or, in children with pinhole vision6/18, a Snellen tumbling E chart. Comprehensive eye examinations and cycloplegic refraction were carried out for children with pinhole vision6/18 in the better-seeing eye.All examinations were completed on 17,699 children aged 3 to 6 years (95.3% of sample). Subjects with bilateral correctable low vision (presenting vision6/18 correctable toor= 6/18) numbered 57 (0.322%; 95% confidence interval [CI], 0.237% to 0.403%), while 14 (0.079%; 95% CI, 0.038% to 0.120%) had bilateral uncorrectable low vision (best-corrected vision of6/18 andor= 3/60), and 5 subjects (0.028%; 95% CI, 0.004% to 0.054%) were bilaterally blind (best-corrected acuity3/60). The etiology of 76 cases of visual impairment included: refractive error in 57 children (75%), hereditary factors (microphthalmos, congenital cataract, congenital motor nystagmus, albinism, and optic nerve disease) in 13 children (17.1 %), amblyopia in 3 children (3.95%), and cortical blindness in 1 child (1.3%). The cause of visual impairment could not be established in 2 (2.63%) children. The prevalence of visual impairment did not differ by gender, but correctable low vision was significantly (P.0001) more common among urban as compared with rural children.The leading causes of visual impairment among Chinese preschool-aged children are refractive error and hereditary eye diseases. A higher prevalence of refractive error is already present among urban as compared with rural children in this preschool population.

To compare the age- and gender-specific testability rates for the Amblyopia Treatment Study (ATS) HOTV visual acuity testing protocol using the electronic visual acuity (EVA) tester in African-American and Hispanic preschool children.Population-based, cross-sectional study.Measurement of presenting monocular distance visual acuity using the ATS HOTV protocol was attempted in all African-American and Hispanic children aged 30 to 72 months from the population-based Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Children able to be tested monocularly in both eyes were considered able. Age-, gender-, and ethnicity-specific testability rates were calculated. Comparisons of testability among different groups were performed using Chi-square analyses and the Cochran trend test.Testing was attempted on 3,126 children (1,471 African-American, 1,655 Hispanic; 50% female). Overall, 84% (83% African-American, 85% Hispanic; 86% female, 82% male) were testable. Older children were more likely to complete testing successfully than younger children (P.0001). Age-specific testability in children 30 to 36 months of age, 37 to 48 months of age, 49 to 60 months of age, and 61 to 72 months of age was 39%, 84%, 98%, and 100%, respectively. After stratifying by age, there were no ethnicity-related differences in children testable (P = .12). Girls (86%) were slightly more likely to be testable than boys (82%; P.003).Monocular threshold visual acuity testing using the ATS HOTV protocol on the EVA tester (Jaeb Center for Health Research, Tampa, Florida, USA) can be completed by most African-American and Hispanic preschool children, particularly those older than 36 months of age. This protocol therefore may be used in minority preschool children as an integral part of the diagnosis and management of amblyopia and other forms of visual impairment.

Purpose To compare contrast sensitivity using a commercially available technique between patients with infantile nystagmus syndrome (INS) and controls. Design Prospective, comparative case series. Methods The functional acuity contrast test (FACT) was used binocularly in patients with INS and aged-matched controls with best acuity under normal lighting using a progression of high-quality sine wave grating size changes with increasing spatial frequencies. Results Nine INS patients aged 5 to 11 years and 25 controls were tested. The INS patients' best binocular acuity ranged from 20/125 to 20/30, and that of the controls was 20/25 or better. When compared with age-matched controls, INS patients displayed deficiencies in contrast sensitivity syndrome using the FACT test. Conclusions The FACT or a similar testing system may have potential as a commercially available outcome measure in clinical trials in patients with INS.

Purpose To evaluate the correlation of functional visual acuity (FVA) measurement with ocular surface findings in patients with Stevens-Johnson syndrome (SJS). Design Prospective comparative study. Methods Sixty-nine eyes of 38 patients with chronic SJS assessed at the Tokyo Dental College, Tokyo Medical Center, and the Kyoto Prefectural University of Medicine, Department of Ophthalmology, Kyoto, Japan, were studied. Twenty eyes of 10 normal subjects and 40 eyes of 20 patients with Sjogren syndrome (SS) were also studied. Conventional Landolt visual acuity (VA) and FVA examinations and slit-lamp examinations were performed. FVA was measured continuously by the FVA measurement system during a 30-second blink-free period in one eye. The visual maintenance ratio (VMR) was calculated as follows: VMR = [(2.7 − FVA)/(2.7 − baseline VA)], where logarithm of minimal angle of resolution values of FVA were entered into the formula and 2.7 represented the lowest visual acuity in this series. Slit-lamp examinations, Schirmer test, and fluorescein vital stainings were also performed in all subjects. Results VMR was markedly lower in patients with SJS compared with patients with SS and controls. FVA values showed a relation with the presence of corneal opacity and vascularization. Conclusions The FVA measurement system is not only a useful tool in the evaluation of dynamic VA changes, but also reflects the ocular surface clinical findings in SJS.

PURPOSE: To compare the functional outcome of cataract surgery in terms of visual ability between patients ages younger than 84 years, 85 to 89 years, and 90+ years. Survival time will be estimated at 4 years. DESIGN: Population-based, observational case series. METHODS: We prospectively evaluated elderly cataract patients' self-assessed visual ability regarding reading, TV viewing, orientation ability, activities of daily life, satisfaction, and visual acuity (VA) before and approximately 3 months after cataract surgery. All patients operated on during a 1-year period from our geographically defined admitting area that participated with a questionnaire were included (n = 837). Survival was checked after 4 years. RESULTS: Before surgery, the most elderly were significantly more dissatisfied with their visual function (P =.007). Seventy-six percent of 85+ improved their subjective ability to read, and two-thirds of those unable to read newspaper print were able to read after surgery. A total of 79% of 90+ experienced improved postoperative ability to manage their daily lives. Best-corrected VA (BCVA) improved in 94% (90+ years of age), 90% (85 to 89 years of age), and 97% (younger than 84 years of age), respectively. After surgery, VA was significantly worse with increasing age, also after adjustment for ocular comorbidity (P

Purpose To determine if the monocular vertical prism dissociation test can differentiate between organic and nonorganic visual loss. Design A prospective, single-masked observational study. Methods Three institutional neuro-ophthalmology practices. Group 1 consisted of 30 normal controls. Group 2 included 30 patients with known organic visual loss. Group 3 contained 35 patients with suspected nonorganic monocular visual loss. Participants were asked to describe what they saw while viewing a single Snellen letter when a 4-prism diopter base-down prism was placed in front of their better eye. Outcome was measured by whether the participant sees one or two letters with the prism in place. Results Vision-appropriate results were given by all members of Group 1 (two images) and by all members of Group 2 (one image). Two images were seen by 31 of 35 members of Group 3, indicating nonorganic visual loss. The other 4 subjects in Group 3 saw one image; each was subsequently found to have occult pathology. Conclusion The vertical prism test quickly differentiates organic from nonorganic monocular visual acuity loss.

PURPOSE To assess visual function more than 10 years after an episode of optic neuritis in patients enrolled in the Optic Neuritis Treatment Trial. DESIGN Longitudinal follow-up of a randomized clinical trial. METHODS Vision testing included measures of visual acuity, contrast sensitivity, and visual field. Quality of life was assessed with the National Eye Institute Visual Function Questionnaire. RESULTS Examinations were completed on 319 patients. In most patients, visual function test results in the eyes that experienced optic neuritis at study entry ("affected eyes") were normal or only slightly abnormal after 9.9 to 13.7 years. Visual acuity in the affected eyes was >or=20/20 in 74%, 20/25 to 20/40 in 18%

Purpose To evaluate the sensitivity of the Eger Macular Stressometer (EMS) for early screening of age-related macular degeneration (AMD) in a clinical practice. We examined the null hypothesis that AMD eyes have EMS recovery times (RTs) that do not differ from eyes with cataract, diabetic retinopathy, or glaucoma. Design The design of this study was a nonrandomized clinical trial. Methods Ninety-two eyes from 92 patients with vision 20/80 or better, age 50 and older, of either gender, and any ethnic origin, were recruited into one of four groups: AMD (30 eyes), normal or mild cataract (30 eyes), diabetic retinopathy (16 eyes), and glaucoma (16 eyes). Recovery times were obtained with the EMS, according to manufacturer's instructions. Results The mean (SD) [median] RT for the AMD group was 11.8 (7.6) [9] seconds, the normal/cataract group 10.0 (4.3) [9] seconds, the diabetic retinopathy group 8.4 (3.0) [8] seconds, and glaucoma group 8.6 (2.4) [8] seconds. Recovery time did not appear to be related to group ( P = .58), age ( P = .50), visual acuity ( P = .52), or sex ( P = .23). Conclusion We found EMS RT distributions did not differ between AMD, cataract, diabetic retinopathy, and glaucoma groups. The EMS in its current form is not a sensitive screening tool for AMD. Further testing is needed to examine EMS sensitivity with other macular diseases such as central serous choroidopathy and diabetic macular edema.

PURPOSE: To investigate the impact of visual function parameters on computer task performance in patients with age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: Eighteen patients with visual impairment due to age-related macular degeneration underwent evaluation of visual acuity using the Early Treatment Diabetic Retinopathy Study protocol, contrast sensitivity using a Pelli-Robson chart, binocular simultaneous visual field using the Esterman program on an automated perimeter, and color vision using Farnsworth D-15. Each subject then completed 125 computer icon identification tasks. Relationships between computer task performance (accuracy and speed) and visual function parameters (visual acuity, contrast sensitivity, visual field, and color vision) were analyzed. RESULTS: Visual acuity and contrast sensitivity in the better eye, weighted average contrast sensitivity, and color vision defects are significantly associated with computer task accuracy. Visual acuity in the better eye, weighted average visual acuity, and color vision defects are significantly associated with performance speed. Visual function parameters and clinical features significantly associated with computer task accuracy in a multiple regression model include weighted average contrast sensitivity ( P = 0.001), protan color vision defect ( P = 0.002), cataract severity in the better-seeing eye ( P = 0.036), and geographic atrophy outside the central macula ( P = 0.046). Visual function parameters and clinical features significantly associated with computer task speed in a multiple regression model include color vision defects (deutan, P P P = 0.05). CONCLUSIONS: Among this cohort of patients with AMD, visual acuity, contrast sensitivity, and color vision defects are significant predictors of computer task performance. Visual function parameters of the better eye played a more significant role than parameters of the worse eye, and contrast sensitivity is the most significant predictor of computer task accuracy.

To evaluate transient, large visual acuity (VA) decreases, termed sporadic vision loss, during anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD).Cohort within a randomized clinical trial.setting: Comparison of Age-Related Macular Degeneration Treatments Trials (CATT). study population: Total of 1185 CATT patients. main outcome measures: Incidence of sporadic vision loss and odds ratio (OR) for association with patient and ocular factors. Sporadic vision loss was a decline of ≥15 letters from the previous visit, followed by a return at the next visit to no more than 5 letters worse than the visit before the VA loss.There were 143 sporadic vision loss events in 122 of 1185 patients (10.3%). Mean VA at 2 years for those with and without sporadic vision loss was 58.5 (∼20/63) and 68.4 (∼20/40) letters, respectively (P.001). Among patients treated pro re nata, no injection was given for 27.6% (27/98) of sporadic vision loss events. Multivariate analysis demonstrated that baseline predictors for sporadic vision loss included worse baseline VA (OR 2.92, 95% confidence interval [CI]:1.65-5.17 for ≤20/200 compared with ≥20/40), scar (OR 2.21, 95% CI:1.22-4.01), intraretinal foveal fluid on optical coherence tomography (OR 1.80, 95% CI:1.11-2.91), and medical history of anxiety (OR 1.90, 95% CI:1.12-3.24) and syncope (OR 2.75, 95% CI:1.45-5.22). Refraction decreased the likelihood of sporadic vision loss (OR 0.62, 95%CI: 0.42-0.91).Approximately 10% of CATT patients had sporadic vision loss. Baseline predictors included AMD-related factors and factors independent of AMD. These data are relevant for clinicians in practice and those involved in clinical trials.

PURPOSE. To examine how the response AC/A ratio (the amount of accommodative convergence per unit of accommodative response) varies as a function of refractive error and age, to determine whether it is a risk factor for the onset of myopia, and to examine the relation between ocular structural features and the AC/A ratio. METHODS. Accommodation was stimulated by a letter target presented in a Badal system at 0.00, 2.25, and 4.37 D to 828 children aged 6 through 14 years in 1996. Of these, 726 had no myopia in 1996 and were available for examination the following year. Accommodative response and cycloplegic refractive error were measured by autorefraction and convergence by monitoring the relative movement of Purkinje images I and IV. Lens radii of curvature were measured by video phakometry, corneal radius of curvature by topography, and ocular axial dimensions by A-scan ultrasonography. RESULTS. Adjusted for age, the response AC/A ratio was highest in myopes (6.39 D/D), intermediate in emmetropes (3.94 D/D), and lowest in hyperopes (3.40 D/D; P , 0.0001; two-way analysis of variance [ANOVA]). The stimulus AC/A ratio did not vary with refractive error. Adjusted for refractive error, the response AC/A ratio did not change as a function of age. In non-myopic children, having a response AC/A ratio of 5.84 D/D or more elevated the risk of development of myopia within 1 year by 22.5 times (95% CI 5 7.12‐71.1). In a subsample of children without myopia who had refractive errors less than 10.75 D, having a response AC/A ratio of 5.84 D/D or more elevated the risk of development of myopia within 1 year by 3.21 times (95% CI 5 1.14 ‐9.07). The AC/A ratio was associated with all measured ocular features except lens spherical volume. Only the negative correlations with refractive error and the shape of the crystalline lens (Gullstrand lens power) were significant in a multiple regression model (adjusted R 2 5 0.16). CONCLUSIONS. An elevated response AC/A ratio was associated with myopia and was an important risk factor for its rapid onset. The association between higher AC/A ratios and flatter crystalline lens shapes, as well as other reported features of accommodation in myopia, may be explained by “pseudocycloplegia,” which the authors define as tension on the crystalline lens that increases the level of effort needed to accommodate. Accommodative deficits in myopia may be the functional consequences of the underlying anatomy of the enlarged eye. (Invest Ophthalmol Vis Sci. 2000;41: 2469 ‐2478)

Purpose To estimate the prevalence of abnormalities in visual function and ocular structures associated with the long-term use of tamoxifen citrate. Methods A single-masked, cross-sectional study involving multiple community and institutional ophthalmologic departments was conducted with a volunteer sample of 303 women with breast cancer currently taking part in a randomized clinical trial to determine the efficacy of tamoxifen (20 mg/day) in preventing recurrences. Participants included women who had never been on drug (n = 85); women who had taken tamoxifen for an average of 4.8 years, then been off the drug for an average of 2.7 years (n = 140); and women who had been on tamoxifen continuously for an average of 7.8 years (n = 78). Women were evaluated by questionnaire, psychophysical testing, and clinical examination to determine any abnormalities in visual function and the comparative prevalences of corneal, lens, retinal, and optic nerve pathology. Results There were no cases of vision-threatening ocular toxicity among the tamoxifen-treated participants. Compared with nontreated participants, the tamoxifen-treated women had no differences in the activities of daily vision, visual acuity measurements, or other tests of visual function except for color screening. Intraretinal crystals (odds ratio [OR] = 3.58, P =.178) and posterior subcapsular opacities (OR = 4.03, P =.034) were more frequent in the tamoxifen-treated group. Conclusions Women should have a thorough baseline ophthalmic evaluation within the first year of initiating tamoxifen therapy and receive appropriate follow-up evaluations.

Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. Methods: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. Results: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.

Twenty-eight keratoconic patients with either contact-lens intolerance or marked corneal scarring over the visual axis underwent lamellar keratoplasty for visual rehabilitation. All 28 patients returned for follow-up at six months, 27 (98%) had follow-up at one year, and 23 (82%) at two years. The 23 patients with two-year follow-up showed progressive improvement of visual acuity over time. At six months, 11 of 23 patients (48%) had visual acuity of 20/30 or better. At one year, 17 of 23 (74%) had 20/30 or better, and at two years, 21 of 23 (91%) had 20/30 or better. The average postoperative keratometry measurement at two years was 43.5 diopters (S.D. = 2.5 diopters), which represented an average reduction of 13 diopters from preoperative keratometry. All patients who were less than 32 years old obtained visual acuity of 20/30 or better after two years and reached this level significantly (F = 6.75, P = .02) sooner than those more than 32 years old. These results compare favorably with previously reported visual results after penetrating keratoplasty.

Recurrent, unilateral, isolated, idiopathic lateral rectus muscle palsy is an uncommon but well-recognized disorder in children that has not been recognized as well in other age groups. We studied five cases of this uncommon entity that we encountered in adults and adolescents. Ages at onset ranged from 15 to 72 years and there were three to eight episodes per patient. Most of the patients shared the following features with the previously reported pediatric cases: ipsilateral recurrence, lack of pain, spontaneous recovery within six months, and no clear cause. Unlike the children, females or left-eye involvement was not preponderant in adults.

Purpose Distance stereoacuity is used to monitor deterioration of intermittent exotropia (IXT), but variability of stereoacuity has not been studied rigorously. The purpose of this study was to assess the variability of stereoacuity over one day in children with IXT. Design Prospective cohort study. Methods Twelve children with IXT were recruited. Stereoacuity was assessed using the Frisby Davis Distance test and the Distance Randot test at distance, and the Frisby and Preschool Randot tests at near. Tests were repeated three or four times over the day, with at least two hours between assessments. The main outcome measure was variable stereoacuity defined as a change by two or more log levels between any two time points over the day. Results Variable stereoacuity at distance was found in five (42%) of 12 patients. Four (33%) of 12 patients demonstrated variable results using the Distance Randot test, three of whom also showed variable results using the Frisby Davis Distance test. One patient had variable results using the Frisby Davis Distance test only. Nine (75%) of 12 patients completed near stereoacuity testing; two (22%) of nine showed variable near stereoacuity. Two (22%) of nine showed variable results using the Preschool Randot test, one (11%) of whom also had variable results using the Frisby test. In some cases, stereoacuity changed from measurable stereoacuity on one assessment to nil on another. Conclusions Nearly half of children with IXT show marked changes in stereoacuity over the course of a single day. When based on isolated measures, an apparent change in distance stereoacuity between visits should be interpreted with caution.

Purpose To examine stereopsis in myopic refractive surgery patients undergoing sequential bilateral and unilateral treatment. Design Prospective, observational, cohort study. Methods setting : Clinical practice. patients : Eighty-three patients were studied; 55 had sequential bilateral and 28 had unilateral treatment. Mean age was 32 years. Stereopsis was measured using a multitarget red-green anaglyph stereo vision test. Only patients with fine preoperative stereopsis were included in the study. Repeat measurements were taken one week laser-assisted in situ keratomileusis (LASIK) or three weeks laser epithelial keratomileusis (LASEK) after treatment of one eye in all patients. Further measurements were taken at six and 12 weeks in unilaterally treated patients and after treatment of the fellow eye in bilaterally treated patients. Results A total of 38.6% of patients retained fine stereopsis (28 to 41 seconds of arc) over a range of anisometropia from 0.625 to 4.375. Moderate stereopsis (66 to 526 seconds of arc) was recorded 28.9% in the presence of 1.375 to 5.525 diopters of anisometropia. Poor/absent stereopsis (≤2000 seconds of arc) was found in 32.5% in the presence of 2.1 to 8.0 diopters of anisometropia. A strong correlation was found between stereopsis and anisometropia, but interpatient variability was found. Uncorrected visual acuity (UCVA) in the untreated eye of ≥20/200 was associated with retention of fine stereopsis. Unilaterally treated patients showed improvement in stereopsis at six weeks after surgery. Sequential bilateral treatment had no deleterious effect on stereopsis. Conclusions Loss of stereopsis was strongly correlated with anisometropia. UCVA in the untreated eye was a good indicator of postoperative stereopsis. Stereopsis improved during the postoperative adaptation period in unilateral treatments. Bilateral sequential treatment has no long-term effect on stereopsis.

To investigate the relationship between abnormal contrast sensitivity and abnormal color vision among human immunodeficiency virus (HIV)-infected individuals who have normal visual acuity and to seek host factors that predict these abnormalities.Noninterventional, cross-sectional study.We evaluated 71 HIV-infected subjects with visual acuity of 20/25 or better, clear media, and no vision-threatening retinal lesions. Visual function was determined using the Pelli-Robson contrast sensitivity test and the Farnsworth-Munsell 100-Hue color test (FM-100). Results were compared with published values for normal populations and to measures of HIV disease severity. We evaluated two levels of impairment for each visual function. "Mild dysfunction" was defined asor =1 standard deviation (SD), but2 SD from normal means. "Abnormal" was defined asor =2 SD from normal means.The prevalences of abnormal contrast sensitivity and abnormal color vision were 7.0% and 9.9%, respectively. We did not identify relationships between impaired contrast sensitivity and impaired color vision. Impaired color vision was associated with increasing age (r = 0.36, P = .002). We could not identify significant correlations between either contrast sensitivity or color vision values and the following factors: current or nadir (lowest previous) CD4+ T-lymphocyte count, HIV blood level, and Karnofsky score.Abnormal contrast sensitivity and abnormal color vision can occur independently in HIV-infected individuals and can be present in the absence of severe immunosuppression.

Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing ( p = 0.0003). The probability of improvement was related to the time since injury ( p = 0.0003) with a 50 to 60% chance of improvement for cases tested within 1 month after injury that decreased to about 20% for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50% of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient’s ability to perform visual field testing reliably.

An 18-year-old man developed acute posterior multifocal placoid pigment epitheliopathy and homonymous hemianopia. Cerebral angiography showed cerebral vasculitis probably with occipital infarction. To the best of our knowledge, this is the first reported case with such concomitant visual defects. Other published reports suggest that such cerebral vasculitis may not be unusual in acute posterior multifocal placoid pigment epitheliopathy.