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Background: The National Eye Institute Visual Function Questionnaire (NEI-VFQ) measures vision-targeted quality of life, but it is unclear whether it is sensitive to changes within individuals over time., Objective: To determine the responsiveness of the NEI-VFQ to "within-individual" changes in visual acuity in patients who had subfoveal choroidal neovascularization in at least one eye secondary to age-related macular degeneration, ocular histoplasmosis syndrome, or idiopathic causes, and who participated in randomized trials of submacular surgery., Methods: Trained telephone interviewers administered the NEI-VFQ as part of annual follow-up data collection for pilot trials and larger clinical trials of submacular surgery. Best-corrected visual acuity was measured by local vision examiners at 12 months after enrollment and, typically, by central "traveling" vision examiners at 24 months after enrollment. Changes in visual acuity and NEI-VFQ scores from 12 to 24 months were analyzed using linear regression methods., Results: Two-hundred eighteen patients had both interviews and visual acuity measurements at 12 and 24 months after enrollment. Changes in the overall NEI-VFQ score and in 9 of the subscales (near activities, dependency, driving, role difficulties, distance activities, mental health, general vision, peripheral vision, and social functioning) were related to changes in visual acuity of the better-seeing eye based on linear regression analysis (P<.05). In our analysis, a 3-line decrease in the visual acuity of the better-seeing eye was associated with 3.6- to 16.2-point decreases in the overall NEI-VFQ score and 9 subscale scores., Conclusions: Most of the NEI-VFQ subscales were responsive to changes in the visual acuity of the better-seeing eye over a 12-month interval in this patient population. Thus, the NEI-VFQ can be used to measure change in vision-targeted quality of life over time to augment clinical measurements of visual acuity.

Background: Active inflammation has not been traditionally associated with the ocular histoplasmosis syndrome., Objective: To investigate the occurrence of presumed inflammatory chorioretinal lesions in patients with the ocular histoplasmosis syndrome., Methods: Patients seen with acute symptoms and a clinical picture of ocular histoplasmosis were observed prospectively between August 13, 1993, and December 2, 1997. Symptoms, visual acuity, and fluorescein sodium angiography were used to document changes in inflammatory loci., Results: Twelve patients were seen with active inflammatory lesions. Eleven had resolution of the loci with lessening of symptoms and improvement in acuity and angiographic findings. A typical subretinal neovascular membrane developed in 1 patient 8 months after the onset of symptoms., Conclusions: Inflammatory chorioretinal lesions can reactivate in the ocular histoplasmosis syndrome. In most of these patients, neovascularization did not develop and visual acuity was preserved.

Purpose: To compare 15-year incidence rates of visual impairment and vision-threatening conditions between cases with ocular histoplasmosis and controls residing in the same endemic community., Methods: Controls and cases with and without disciform lesions who were between 30 and 69 years of age when selected, interviewed, and examined in 1970 were reinterviewed and reexamined in 1985., Results: Of the 252 cases and controls examined in 1970, 216 were still alive in 1985. Of these, 202 (94%) were interviewed; 197 (91%) underwent visual acuity measurement; and 173 (80%) were examined by a study ophthalmologist. Both in 1970 and in 1985, cases with disciform macular lesions of ocular histoplasmosis had a higher prevalence of both unilateral and bilateral visual impairment and blindness. Although prevalence of visual impairment and blindness in 1985 was similar among controls and cases of ocular histoplasmosis without disciform lesions, this group of cases had about twice the incidence of visual impairment as that of controls. However, the 95% confidence intervals on estimates of relative risks were broad and included unity. No new disciform lesions attributable to ocular histoplasmosis were found in 28 eyes of 18 cases free of them in 1970 or among 148 controls., Conclusions: The 15-year risk of visual impairment and blindness appears to be somewhat higher among adults aged 30 years and older who have only peripheral atrophic scars characteristic of ocular histoplasmosis than among individuals without such scars who live in the same endemic community. Adults who already have a disciform lesion attributed to ocular histoplasmosis in one eye are at low risk of development of a disciform lesion in the fellow eye later in life.

The Macular Photocoagulation Study randomized controlled clinical trials designed to determine whether argon laser photocoagulation is effective for preventing or delaying severe visual loss in eyes with an extrafoveal choroidal neovascular membrane secondary to senile macular degeneration (Senile Macular Degeneration Study [SMDS]), ocular histoplasmosis (Ocular Histoplasmosis Study [OHS]), or idiopathic neovascularization (Idiopathic Neovascularization Study [INVS]). Eligible patients were assigned randomly to a "treatment" group or to a "no treatment" group until recruitment was terminated in 1982 (SMDS) and 1983 (OHS and INVS) because of demonstrated short-term treatment benefit. As of Aug 31, 1985, three or more years of scheduled follow-up examinations had been completed for 208 (88%) of 236 eyes in the SMDS, 203 (77%) of 262 eyes in the OHS, and 51 (76%) of 67 eyes in the INVS. The relative risk of experiencing severe loss of vision after three years in eyes initially assigned to the no treatment group in comparison with eyes assigned to the argon laser photocoagulation group was 1.4 in the SMDS (95% confidence interval [CI]: 1.1 to 1.9), 5.5 in the OHS (95% CI: 3.9 to 10.8), and 2.3 in the INVS (95% CI: 0.8 to 6.5). The beneficial effects of argon laser treatment have persisted in all three studies in spite of the fact that some eyes in the "no treatment" groups were treated later in their clinical course as a result of the evidence of early benefit. Follow-up of all patients continues so that treatment effectiveness over a five-year period can be assessed.

Central visual function is characteristically reported as Snellen acuity at distance and near. We performed functional tests in a group of patients with visual acuity of 20/100 or worse due to macular disease to determine whether there was a relationship between Snellen acuity and functional performance among these patients with poor visual acuity. Our tests of functional performance included currency discrimination, color recognition, reading a clock, and reading large print. Our results suggest that there is a correlation between Snellen acuity and functional vision, even among patients with poor visual acuity. Hence, therapeutic efforts to keep patients' visual acuity at 20/200 rather than 20/400, for example, appears to be justifiable in that better acuity levels seem to be associated with improved functional performance.

Ophthalmologists are becoming increasingly aware of the need for well-designed, controlled studies to investigate etiology and treatment of ocular conditions. While patients with the conditions of interest, or with characteristics that place them at high risk of eventual development of such conditions, may be readily identified in the ophthalmology clinic, identification of appropriate controls to be used for comparison may be quite difficult. In this article, epidemiologic principles for selection of controls for retrospective (case-control) and prospective (cohort) studies are reviewed. Two related studies, a case-control study in which multiple control groups were employed and a 15-year cohort study of all cases and controls, provided an opportunity to compare controls selected at random from an ophthalmology practice with controls selected at random from the general population. Participation rates were higher among office patients selected for study, both in the case-control study and in the cohort study. In the cohort study, office controls were more likely to lose visual acuity and to develop new degenerative eye conditions. These differences between control groups selected from two different sources emphasize the need for careful evaluation of potential groups of controls with respect to biases that each may bring to interpretation of clinical research findings.

Presumed ocular histoplasmosis syndrome is a multifocal choroiditis; it is not an uncommon cause of visual loss in patients who have positive cutaneous responses to histoplasmin tests. However, Histoplasma capsulatum infection is, most often, a pulmonary disease, or a systemically disseminated disorder, without visual symptoms. For this reason, a correspondence between the nonocular and ocular aspects of this disorder has been difficult to ascertain. In a series of eight patients with histoplasmosis, we found asymptomatic ocular lesions in six. We believe that the presence of asymptomatic lesions may have prevented earlier investigators from recognizing this correlation.