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Presbyopia treatments using various modalities have been developed recently, however, no standard criteria exist for the diagnosis and treatment endpoint. This study assessed the relationship between the near visual acuity (NVA) and the subjective symptoms of phakic presbyopia and determined the numerical NVA threshold to diagnose phakic presbyopia and evaluate the effectiveness of presbyopia treatment. The binocular distance, NVA with habitual correction, and monocular conventional VA were measured. Patients were asked about their awareness of presbyopia and difficulty performing near tasks. This prospective observational study included 70 patients (mean age, 56 years, range, 32–77). Most patients became aware of presbyopia in their late forties, although some had difficulty with vision-related near tasks before becoming aware of presbyopia. Eighty three percent of patients (20/24) experienced difficulty with near vision-related tasks even with excellent NVA at 40 cm with habitual correction of 0.0 logMAR (20/20 in Snellen VA). In conclusion, the current study showed that patients became aware of presbyopia in their late forties, although some had difficulty with near vision-related tasks before becoming aware of presbyopia. Further investigation should include the proposal of appropriate diagnostic criteria for presbyopia and better management for patients with presbyopia.

Background: Congenital colour vision defects are x-linked inherited, non-progressive and untreatable disorders that describe poor colour discrimination. Objective: To determine the prevalence of congenital colour vision deficiency among students in Lagos, Nigeria. Methods: A school-based cross-sectional, cluster sample study was conducted to test the colour vision of 2326 primary and high school students. Inclusion criteria were Snellen VA 20/20 or better and absence of known ocular pathologies. Colour vision deficiency (CVD) was evaluated with the Richmond-HRR colour vision test plates. Results: There were 1014 (43.6%) males and 1312 (56.4%) females with a mean age of 13.40 ± 2.40 years (range = 7−22 years). The prevalence of CVD was 58 (2.5%), which was higher in males 49 (4.8%) than females 9 (0.7%). The prevalence of congenital CVD was significantly associated with males (p = 0.00), but not with females (p = 0.22). Of the 58 cases of CVD, 17 (0.7%) had protan deficiency, 38 (1.6%) had deutan deficiency and three (0.1%) were unclassified. Conclusion: The prevalence of congenital CVD among students in Lagos is comparable to findings in other parts of Nigeria but differs from other parts of the country. These results strengthen the need to establish school vision screening. Keywords: Colour vision deficiency, Richmond-HRR, prevalence, red-green defects, Nigeria.

The aim of this paper is to summarise our own and to review published experience regarding the long-term outcome of intravitreal treatment for macular neovascularisation (MNV) secondary to Sorsby’s fundus dystrophy (SFD). A systematic literature search using the MeSH terms [Sorsby] and [anti-vascular endothelial growth factor (VEGF)] was conducted in NCBI/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Google Scholar and ClinicalTrials.gov to identify publications reporting anti-VEGF treatment outcomes in SFD. Treatment outcomes were extracted for this meta-analysis from 14 publications and an own patient reporting a total of 31 cases with a mean follow-up (FU) of 54 months. Both eyes were affected in ten (32.3%) instances. Heterogenous reporting limited the comparability of the outcomes. All papers in common, however, reported satisfied to excellent responses to anti-VEGF therapy if patients were diagnosed and treated immediately after onset of symptoms. Of 20 eyes, for which visual acuity was reported before and after treatment, five worsened and seven improved by more than 1 line, whereas eight eyes maintained their function by end of the follow up, and 11 eyes (55%) maintained a driving vision (Snellen VA ≥ 0.5). Of six eyes with a VA < 0.5, VA improved in one to VA ≥ 0.5, whereas of 14 eyes with an initial VA ≥ 0.5, this dropped to

Significance Scleral lenses (SLs) partially mask higher-order aberrations (HOAs) in highly aberrated eyes. Although visual acuity (VA) may show satisfactory quantitative clinical outcomes during SL wear, residual (uncorrected) HOAs can leave subjective visual quality goals unmet. Purpose The purpose of this study was to report a case where a "20/20 unhappy" patient with SLs was able to meet visual goals with wavefront-guided SLs. Case report A 40-year-old male with bilateral keratoconus, whose Snellen VA with SLs was 20/20 right eye (OD) 20/16 left eye (OS), reported halos and glare at night and perceptual smearing. When viewing a point of light, a "Ferris wheel" shadowing was observed OD and a U-shaped shadowing OS. Residual higher-order root mean square wavefront error was 0.49 μm OD and 0.39 μm OS; visual image quality measured by visual Strehl ratio was 0.067 OD and 0.092 OS (pupil size, 4.00 mm). Wavefront-guided SLs reduced residual higher-order root mean square to 0.19 μm OD and 0.25 μm OS, VA improved to 20/10 OD and 20/13 OS, and visual Strehl improved to 0.150 OD and 0.121 OS. The patient reported reduced smearing, shadowing, and night vision concerns, meeting his visual expectations and goals. Conclusions Wavefront sensing quantifies both lower and HOAs, which can cause visual dissatisfaction in individuals with highly aberrated eyes, despite sometimes reaching typical levels of VA. As wavefront-guided SLs targeting these residual aberrations to improve visual image quality become more available, they should be considered for 20/20 unhappy patients when conventional clinical options are unsatisfactory.

Introduction: We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naive diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. Methods: Thirty eyes of 30 treatment-naive DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using optical coherence tomography at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: The mean patients’ age at baseline was 63.0 ± 10.0 years. Patients underwent 3.9 ± 2.9 anti-VEGF injections for a mean of 9.1 ± 4.8 months. Following treatment, the mean Snellen visual acuity (VA) improved from 20/52 to 20/44 ( p = 0.05), CMT decreased from 432.5 ± 141.4 μm to 375.2 ± 121.4 µm ( p = 0.05) and IZ/EZ defect size decreased from 259.83 ± 375.94 µm to 65.34 ± 143.97 µm ( p = 0.001). In patients with no IZ/EZ defects at baseline, the mean Snellen VA was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p = 0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up ( p < 0.01). BCVA gain correlated with IZ/EZ defect size reduction ( r = 0.41, p = 0.02) but not with improvement in CMT ( r = 0.28, p = 0.121). Conclusions: IZ/EZ defect size correlated not only with baseline BCVA but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for the evaluation of treatment response.

To compare the variability between Snellen visual acuity (VA) and Early Treatment Diabetic Retinopathy (ETDRS) best-corrected VA (BCVA) measurements.Retrospective chart review.Eyes from subjects entering 12 prospective retinal trials in a large, urban retina practice.Eyes were included if a Snellen VA measurement was performed at the visit preceding trial screening and VA was better than counting fingers. Snellen VA and ETDRS BCVA were then converted to logarithm of the minimum angle of resolution (logMAR) units, and the variability between measurements was calculated.Outcome measures include VA variability among disease states, absolute VA, and central subfield thickness (CST).A total of 773 eyes of 413 subjects were identified with a mean of 27.2 days (median, 19; 95% confidence interval [CI], 25.1-29.3) between measurements. Mean Snellen and ETDRS measurements were 0.40 (20/50) and 0.27 logMAR (20/40), respectively. Overall, mean ETDRS BCVA was 6.1 letters better than Snellen VA (median, 5.8; 95% CI, 5.3-7.0; P0.05); 76.6% of eyes had improved ETDRS. Restricting the number of days between measurements did not result in any meaningful differences from this directionality. Among eyes with worse VA, variation was more pronounced than among eyes with better VA; eyes 20/25 or better were a mean +1.9 letters better on ETDRS testing (P0.05) and eyes 20/160 or worse were a mean +12.6 letters better on ETDRS testing (P0.05). Subgroup analyses by disease state found statistically significantly better vision measurements with the ETDRS protocol compared with Snellen in 4 of the 5 disease states studied. Although lens status did not affect the extent of discrepancy between ETDRS and Snellen measurements, amount of retinal edema (CST) did: increased CST correlated with increased variability.The ETDRS protocol BCVA measurement resulted in significantly better scores when compared with Snellen VA measurements. This difference was more pronounced among eyes with worse VA. Additionally, specific retinal disease states and anatomic variables such as extent of retinal edema (CST) may have a meaningful impact on the anticipated variability between ETDRS and Snellen VA measurement.

BACKGROUND AND OBJECTIVE: The authors evaluated long-term postoperative visual outcomes and recurrence rates following surgery for symptomatic epiretinal membrane (ERM) ± internal limiting membrane (ILM) peeling. PATIENTS AND METHODS: This was a retrospective, consecutive case series of 78 patients undergoing vitrectomy for symptomatic ERM between 1/2010 and 4/2012 with follow-up through at least postoperative year 5 (POY5). Outcomes included visual acuity (VA) (Snellen VA converted to logMAR), central retinal thickness (CRT; μm), and ERM recurrence. Subgroup analysis evaluated outcomes related to ILM peeling. RESULTS: Subgroup analysis based on ILM peeling did not find VA (20/50 [0.430 logMAR ± 0.061 logMAR; mean ± SD] vs. 20/60 [0.518 logMAR ± 0.128 logMAR] for ILM vs. non-ILM peeling respectively; P = .513) nor macular thickness (355 μm ± 13 μm vs. 360 μm ± 42 μm; P = .410) to be significantly different at POY5. Recurrence requiring surgery with and without ILM peeling was not statistically significantly different at POY5 (1.6% and 11.8%; P = .118). CONCLUSION: Vitrectomy for symptomatic ERM led to improved visual and anatomic outcomes with sustained benefit through 5 years. ILM peeling was was associated with reduced ERM recurrence, but this benefit was not statistically significant at POY5. [ Ophthalmic Surg Lasers Imaging Retina . 2018;49:296–302.]

ObjectiveTo evaluate the 6-year outcomes of anti-VEGF (vascular endothelial growth factor) monotherapy for polypoidal choroidal vasculopathy (PCV).MethodsThe charts of 66 eyes of 66 patients with newly diagnosed, symptomatic, treatment-naive PCV were reviewed retrospectively. All patients were treated with 0.5 mg intravitreal ranibizumab (IVR) injections for 3 months followed by as-needed reinjections based on monthly examinations until 3 years after the first IVR injection. Thereafter, anti-VEGF monotherapy was continued for another 3 years.ResultsThe mean best-corrected visual acuity (BCVA) improved significantly (p=0.001) 3 months after the first IVR injection (0.24±0.30 logarithm of the minimum angle of resolution (logMAR) VA; 20/35 Snellen VA) compared with the baseline BCVA (0.34±0.37 logMAR VA; 20/44 Snellen VA). However, the improved VA returned to 0.32±0.39 logMAR unit (20/42 Snellen VA), which was not significantly different at 3 years. This level was maintained to the end of 6 years (0.36±0.37 logMAR unit; 20/46 Snellen VA). The mean numbers of anti-VEGF injections administered annually during 6 years were 5.6±2.4 (including the initial three monthly injections), 3.3±2.2, 3.3±2.9, 3.6±3.2, 3.5±2.9 and 3.3±2.7, respectively. The mean total number of injections during 6 years was 21.5±10.1.ConclusionsThe results emphasised the efficacy of anti-VEGF therapy for preserving vision and the limitations of anti-VEGF therapy in that continuous treatment is required over an extended follow-up period.

This study aims to determine the course of vision loss after Baerveldt aqueous tube shunt placement and identify risk factors associated with unexplained severe long-term vision loss, or snuff-out. We retrospectively reviewed 247 eyes of 222 patients who underwent Baerveldt implantations at one of two academic institutions. Postoperative vision loss at 6 months following surgery was categorized as mild-to-moderate versus severe and long-term versus transient. Long-term vision loss, defined as 3 or more lines of Snellen visual acuity (VA) loss compared with preoperative VA, occurred in 63 of 247 eyes (25.5%), and 39 had mild-to-moderate and 24 had severe loss. Of these 63 eyes, 18 had no identifiable cause of vision loss. On multivariate analysis, poorer Snellen VA on postoperative day 1 (POD1) was found to be a significant risk factor for long-term vision loss (p=0.005). In addition, the negative change in preoperative versus POD1 Snellen VA (p=0.021) and the presence of split fixation involving the inferonasal quadrant on preoperative Humphrey visual field (p=0.044) were significant risk factors for snuff-out. Transient vision loss occurred in 76 of 242 eyes (30.8%). In conclusion, vision loss is not uncommon after Baerveldt surgery, with snuff-out occurring in 2.4% of cases in this study.

To evaluate the fulfillment of retreatment criteria in recurrent neovascular age-related macular degeneration (nAMD) for a pro-re-nata treatment regime with ranibizumab in routine clinical care.Data from patients with treatment-naive nAMD were analysed retrospectively. As an 'upload', all patients had received three-monthly intravitreal ranibizumab injections in a university eye hospital and were then seen by ophthalmologists in private practice who referred them back in case of recurrence. Recurrence was defined as a decrease of visual acuity (VA) of one line or more (functional retreatment criteria), a central retinal thickness (CRT) increase of at least 100 µm upon Optical Coherence Tomography (OCT) examination (morphological retreatment criteria) or a new macular haemorrhage (clinical retreatment criteria).We included 92 patients (36 men and 56 women). The mean VA before retreatment of a recurrence was -0.63 ± 0.33 logMAR and improved significantly (p0.001) by 0.10 ± 0.16 logMAR to -0.53 ± 0.28 logMAR thereafter. Mean CRT before retreatment was 278.07 ± 87.56 µm and decreased significantly (p0.001) by 71.22 ± 106.93 to 206.85 ± 60.30 µm. Evaluation of the fulfillment of retreatment criteria revealed functional retreatment criteria in 82.6% of patients. However, upon re-evaluation of VA using Early Treatment Diabetic Retinopathy Study (ETDRS) charts in the treatment centre, mean decrease of VA was 10 letters as compared with the end of upload therapy. All patients presented an increased CRT when treated for recurrence of nAMD (mean increase 69.47 µm), but the morphological retreatment criteria (CRT increase of 100 µm or more) were fulfilled in only 44.4% of patients upon Spectral Domain OCT (SD-OCT) evaluation in the treatment centre.In a routine clinical care, evaluation of VA using ETDRS charts seems to be more sensitive than Snellen VA testing. Quantitative OCT-based retreatment criteria (eg, increase of CRT of 100 µm or more) appear to be not sensitive enough in a clinical setting with referring ophthalmologists.

Purpose: To assess the Medmont C100 test as a colour vision screening tool. Methods: One hundred and seventeen young male adults were screened with the Medmont C100, Ishihara plates, and the screening mode of the Oculus Anomaloscope tests. All subjects were tested under constant room illumination, namely that of a day light fluorescent lamp at 200 lux. Inclusion criteria were visual acuities (VA) of 20/20 or better with or without correction and absence of known ocular pathologies. Aided and unaided visual acuities were measured with the Snellen VA chart. Results: Five out of the 117 subjects, were found to have red-green colour vision deficiency (CVD) with Ishihara and anomaloscope tests indicating a 4.7% CVD prevalence, while the Medmont C100 test yielded 33 cases ofred-green deficiency indicating CVD prevalence of 28%. With the Ishihara test, all five subjects were identified as deutans, while the anomaloscope revealed three as deutans and two as pro-tans, and the Medmont C100 test identified all 33 cases as protans. Conclusion: The Medmont C100 test yielded significantly higher prevalence of protan CVD compared with the Ishihara platesand Anomaloscope tests. These findings suggest that caution should be taken when using Medmont C100 test for colour vision screening as it tends to give more false positive results with bias for pro-tans. (S Afr Optom 2011 70(1) 14-20)

Purpose. To report visual acuity (VA) outcomes in eyes undergoing photodynamic therapy (PDT), with or without concurrent intravitreal Triamcinolone acetonide (IVTA), for symptomatic circumscribed choroidal hemangioma. Methods. We retrospectively reviewed clinical records of 16 patient treated from January 2001 to May 2006. Post-treatment Snellen VA was compared with pretreatment measurements. Results. Ten eyes underwent only PDT therapy, in which VA in three eyes improved by more than two lines and seven eyes remained stable. Four eyes were treated with combined PDT and IVTA. VA in two of those eyes improved more than 2 lines, one eye remained stable, and one eye worsened at most recent follow-up. Another two eyes failed initial treatment elsewhere and were not included in the final analysis. Conclusion. VA outcome is generally good in patients treated with PDT alone. This study was limited by a small sample size of PDT/IVTA treatment group, therefore, we could not compare outcomes to the PDT alone treatment.

Purpose: To estimate the random measurement error in visual acuity (VA) determination in the clinical environment in cataractous, pseudophakic and healthy eyes. Methods: The VAs of patients referred for cataract surgery or consultation by ophthalmic professionals were re-examined and the VA results for distance using projector acuity charts were compared. Refractive errors were also remeasured. A total of 99 eyes (41 cataractous, 36 pseudophakic and 22 healthy eyes) were examined. The healthy comparison group consisted of hospital staff. Only one eye of each person and eyes with Snellen VAs of 0.3–1.3 (logMAR 0.52 to − 0.11) were included. The mean time interval between the first and second examinations was 45 days. Results: The estimated standard deviation of measurement error (SDME) of repeated VA measurements of all eyes was logMAR 0.06. Eyes with the lowest VA (0.3–0.45) had the largest variability (SDME logMAR 0.09), and eyes with VA ≥ 0.7 had the smallest (SDME logMAR 0.04). The variability may be partly explained by the line size progression in lower VAs, partly by the difference in the remeasurement of the refractive error. The difference in the average VA between examinations 1 and 2 (logMAR 0.15 versus 0.12) was considered to be of some interest because it indicates that some learning effect is possible. Conclusion: Visual acuity results in clinical settings have a certain degree of inherent variability. In this series variability ranged from SDME logMAR 0.04 (eyes with good vision) to logMAR 0.09 (in the lower vision group) in the Snellen VA range of 0.3–1.3. Changes should be judged with caution, especially in cases of decreased VA.

Purpose: To determine the efficacy of medical treatment of cystoid macular edema (CME) in patients with uveitis. Methods: Retrospective study of 40 patients (57 eyes) with uveitis and CME. Inclusion criteria were presence of CME with minimal and no macular pathology, or vascular disease which could account for CME. Patients who had undergone intraocular surgery or had visual aucity (VA) of ≥20/40 were excluded. The diagnosis of CME was based on clinical and/or angiographic findings. Three treatment groups were defined: (1) transseptal injection of steroids (n=13 eyes); (2) systemic non steroidal anti-inflammatory drugs (NSAIDs) (n=11 eyes); both 1 and 2 (n=33 eyes). Results: Overall, 79% of eyes improved 3 or more lines of Snellen VA after treatment: 51% improved 4 or more lines. The average number of lines improved was 3.8 for eyes treated with transseptal injections of steroids, 2.9 for eyes treated with NSAIDs, and 4 for eyes treated with both. For all 3 treatment groups between 60–70% of eyes improving 2 or more lines reached best VA only after a minimum of 6 months of follow up. Conclusions: CME, a vision threatening complication of uveitis, respond fairly well to medical treatment; however, the best VA is achieved after several months. The improvement in VA did not differ markedly among the three treatment groups.

The purpose of this study was to evaluate visual performance with both spherical rigid gas permeable (RGP) and tonic hydrogel contact lenses. We hypothesized that both visual acuity and performance would be inferior with hydrogel lenses because of dynamic crossed-cylinder effects with eye movement-induced lens rotation. Eighteen subjects (23–45 years) having 0.75–2.50 D of astigmatism in each eye and matching corneal toricity were fitted with both types of lenses (providing at least 20 20 Snellen VA). Seventeen subjects successfully wore each lens type on a full-time basis for 3 weeks prior to testing. Our randomized, crossover study included logMAR threshold visual acuity, contrast sensitivity, and a VDT text-editing task interrupted by a short reading task in upper lateral gaze. Visual performance was assessed by counting errors identified, the error detection rate, and the total number of lines edited. Subjects rated the comfort, quality, and stability of vision just before and after the VDT text-editing task. Subjective ratings were also obtained at the end of the overall wearing period of each lens type in regard to lenswear comfort, visual clarity, and visual stability. Patients chose which pair of lenses to keep after the study. Our analysis of these data indicated no significant differences between threshold visual acuity or pre-post VDT task-related ratings of visual comfort, quality, or stability between the two types of lenses. Contrast sensitivity results were also not different between lens types. The overall ratings at the end of the wearing weeks of each type of lens indicated that tonic hydrogels were better than were RGP lenses for wearing comfort, dryness, and handling, whereas the RGP lenses were rated better for clarity of vision. Stability of vision was rated the same between the two lens types. Seventy-four percent of the subjects chose to continue wearing the tonic hydrogels after the study, whereas 24% chose the RGP lenses. These results suggest that tonic hydrogels can provide equivalent visual performance to spherical RGP contact lenses. Although overall clarity of vision was rated as better with RGP lenses by the subjects, there was a strong final preference for hydrogel lenses, largely due to better overall lens wearing comfort.

Purpose To compare the efficacy of neovascular AMD(NAMD) treatment options by monthly Lucentis(L)(monotherapy), combination therapy utilizing RF-PDT(P), and Lucentis combined with Kenalog(LK). Methods IRB-approved retrospective chart review of therapies administered only as-needed over 20 months. Inclusion criteria: active primary/recurrent subfoveal or juxtafoveal CNV (all types); Snellen BCVA ≥20/400. Exclusion criteria: f/u LK>PK, occurring 91%, 80%, 75%, 60%, respectively. 14% L gained ≥30 letters. 20% PK lost ≥30 letters. Leakage resolved greater for L>PA±K>LK>PK, occurring 86%, 80%, 69%, 40%, respectively. Conclusion At intermediate-term f/u, Lucentis monotherapy administered only as-needed had results similar to larger studies and was the most effective in maintaining or improving VA in NAMD. Lucentis monotherapy had the greatest leakage resolution and treatment-free interval. RF-PDT with Avastin was more effective than with Kenalog alone. Kenalog supplementation to Lucentis unlikely provided added benefit.

Purpose: To determine the prevalence of congenital red-green colour vision defects among Saudi Arabian male and female children.Methods: The study involved 1638 elementary and high school participants (838 males, and 800 females), who were randomly selected and screened for red-green colour vision defects using the Ishihara (pseudo-isochromatic plates) test. Inclusion criteria were Snellen VA 20/20 or better and absence of known ocular pathologies.Among the females, 0.75% of the 800 participants showed CVD, with 0.25% and 0.5% demonstratingprotan and deutan defects, respectively.Conclusion: The results show that the prevalence of red-green colour deficiency among the female children from central Saudi Arabia is not significantly different from that of female populations inwestern countries. The current prevalence among the males is higher than previously reported for central Saudi Arabia, but less than for Caucasian populations.

Using standard clinical procedures we have compared visual acuity (VA) estimates made with a hand-held white light interferometer to those obtained with a Snellen acuity chart. Fifty noncataractous patients with a mean age of 45 years (SD = 18) were tested. Snellen and interferometric acuity measures were obtained with and without refractive correction. On average, aided Snellen VA's were better (decimal acuity = 0.98) than the unaided interferometric VA's (decimal acuity = 0.67). Although we found a statistically significant p less than 0.01) correlation between unaided interferometric and aided Snellen VA's, the correlation was poor (r = 0.36). This poor correlation may account for the often observed failure to estimate postoperative aided Snellen VA with preoperative interferometric VA in cataract patients.

Purpose: To study the influence of central retinal artery (CRA) blood velocities, intraocular pressure (IOP) and Endothelin-1 (ET-1) on visual acuity (VA) of primary rhegmatogenous retinal detachment (RD) Methods: This is a prospective interventional clinical study of 66 patients undergoing scleral buckling (SB) procedure, with reattachment of the retina 8 months after surgery. CRA Doppler sonography parameters and IOP were measured before SB. Immunoreactive (IR) ET-1 was assayed (radioimmunoassay) in plasma and subretinal fluid (SRF). Snellen VA and fundus examination were checked before and 8 months after surgery. Stepwise multivariate linear regression analysis allowed us to find models for VA Results: IOP and CRA end diastolic velocity (EDV) explains preoperative VA (R2=0.509, p

The aim of the study was to validate the use of the short duration pattern onset visual evoked potential (PappVEP) in the objective assessment of visual acuity (VA) in patients referred with presumed non-organic visual loss.The combination of minimum check size and minimum contrast required to elicit a consistently discernible PappVEP (amplitudeor=5 microV) were measured in ten normal subjects under conditions of induced optical blur (0 to +3 dioptres) and the relationship to Snellen VA established. The data from 100 consecutive patients (167 eyes) referred for possible non-organic visual loss (NOVL) and 20 patients with confirmed visual pathway dysfunction were reviewed in relation to the results in normal subjects.Snellen VA, under conditions of blur, could be predicted in normal subjects from the check size and contrast required to elicit a criterion PappVEP. These data were tabulated and a quantitative guideline established for the estimation of VA in the patients referred with suspected NOVL. Most (88%) patients referred with suspected NOVL had normal electrophysiology and PappVEPs consistent with normal Snellen VA. In others, they suggested a degree of non-organic overlay. In 20 cases of organic visual loss, PappVEPs were in close agreement with subjective VA.The short duration pattern onset visual-evoked potential is confirmed as a clinically useful tool in the objective assessment of patients with suspected non-organic visual loss.

Importance Understanding the natural history of visual outcome in branch retinal vein occlusion (BRVO) is fundamental to its management. Objective To investigate the natural history of visual outcome in major and macular BRVO. Design, Setting, and Participants Observational cohort study at a university-based referral practice from 1973 until 1999. The study comprised 216 consecutive eyes with BRVO (144 eyes with major and 72 eyes with macular BRVO) seen within 3 months of onset. Intervention At first visit, all patients had a detailed ophthalmic and medical history and comprehensive ophthalmic evaluation. Ophthalmic evaluation at initial and follow-up visits included recording best-corrected visual acuity (VA) using the Snellen VA chart and visual fields with a Goldmann perimeter. Main Outcomes and Measures Best-corrected VA and visual field outcome on follow-up. Results The median time to macular edema resolution was 21 months in those with major BRVO and 18 months in those with macular BRVO. Overall, for eyes with initial VA of 20/60 or better, VA improved or remained stable in 75% (95% CI, 63%-86%) for major BRVO and 86% (95% CI, 73%-95%) for macular BRVO. In those with initial VA of 20/70 or worse, VA improved in 69% (95% CI, 56%-80%) for major BRVO and in 53% (95% CI, 27%-79%) for macular BRVO, with median final VA of 20/60 for both BRVO types. Conclusions and Relevance Major and macular BRVOs are 2 distinct clinical entities, and initial visual status and final visual outcome in the 2 types are quite different. Overall, on resolution of macular edema, our study suggests that in both major and macular BRVO, VA and visual fields improved to a variable degree in the majority of eyes without any treatment.