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Purpose: To evaluate responsiveness of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) to changes in visual acuity and to provide estimates of minimum clinically meaningful changes in NEI-VFQ scores., Methods: Data were combined from three clinical trials of submacular surgery for subfoveal choroidal neovascularization. Patients who completed NEI-VFQ interviews and visual acuity measurements at baseline and 2 years later contributed data for analysis. Data were analyzed using anchor-based (relating 2-year change in NEI-VFQ to 2-year change in visual acuity using correlation and linear regression) and distribution-based (standardized response mean) methods., Results: Of 1,015 patients enrolled, 828 patients completed NEI-VFQ interviews and had visual acuity measurements at baseline and 2 years later. Median age of patients was 75 years (range 18 to 94); all patients had subfoveal choroidal neovascularization in at least one eye. Median overall NEI-VFQ score at baseline was 69.9 (mean, 66.5). Based on anchor-based methods, a 2-line change in visual acuity of the better-seeing eye translated to a 3.4-point change in the overall NEI-VFQ score and from 2.4-point to 7.0-point changes in most subscale scores. The NEI-VFQ was sensitive to both gains and losses in visual acuity; the standardized response mean for the overall NEI-VFQ score in patients with a 2-line gain was 0.6 and for patients with 2-line loss was -0.3. In the subgroup of patients with a 2-line loss of visual acuity in the better-seeing eye, patients who had overall NEI-VFQ scores at baseline greater than the median (59.8) had an standardized response mean of -0.9 for the overall NEI-VFQ score and patients who had overall NEI-VFQ scores at baseline at or below the median had a standardized response mean of 0.2 for the overall NEI-VFQ score. A 4-point change in the overall NEI-VFQ and a 5-point change in individual subscale scores corresponded to a small clinically meaningful change., Conclusions: The NEI-VFQ was responsive to 2-year changes in visual acuity but was less responsive to changes among patients with poorer NEI-VFQ scores at baseline. Based on this analysis, a 4-point change in the overall NEI-VFQ and a 5-point change in individual subscale scores may be considered minimum clinically meaningful within-person changes in NEI-VFQ scores.

Purpose: To describe methods and results and to assess the value of a Traveling Vision Examiner (TVE) Program designed to provide masked vision measurements by expert vision examiners who were independent of, and traveled to, local clinical centers., Methods: The Submacular Surgery Trials (SST) Pilot Study was conducted to refine the design and methods for a set of multicenter, randomized clinical trials to evaluate submacular surgery in patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) or ocular histoplasmosis (OHS), or idiopathic CNV in which the primary study outcome would be change in 2-year best-corrected vision from baseline. As part of the SST Pilot Study, the feasibility and value of a TVE Program was assessed. The goal of the program was to obtain unbiased vision measurements, according to a standard protocol, of best-corrected visual acuity, reading speed, and contrast threshold, of each patient at 2 and 4 years after enrollment., Results: Eighty-three visits by TVEs were made to 16 centers participating in the SST Pilot Study; 239 patients had at least one masked vision examination. Comparison of pairs of vision measurements of the traveling vision examiners and local vision examiners for 71 patients made on the same day showed good agreement overall (intraclass correlation coefficient > or = 0.81)., Conclusions: The proposed TVE Program was judged to be a feasible and useful method of providing standardized, unbiased, masked vision measurements. This approach was incorporated into the larger clinical trials conducted by the SST Research Group.

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.

Purpose: The purpose of this analysis was to investigate the reliability of visual acuity screening and measurements made under field conditions when standardization of all test conditions is not possible., Setting and Methods: In the Washington County Follow-Up Eye Study conducted in 1985 among cases of ocular histoplasmosis and controls from the same community who had been selected in 1970, a primary goal was to obtain a current visual acuity measurement of each eye of each participant in order to assess 15-year changes in visual acuity. Both visual acuity screening and measurement were accomplished on two separate occasions and in two separate locations (home or workplace and clinic) for 308 eyes and 317 eyes, respectively, of 161 participants. Screening was used to classify the visual acuity as 20/40 or better, worse than 20/40 but at least 20/160, or worse than 20/160. Screening and measurement were accomplished on at least one occasion for the eyes of 192 of 216 eligible individuals., Results: Among 308 eyes screened twice, 289 (94%) were classified identically (kappa = 0.80). Among 317 eyes with visual acuity measured on two occasions, the measurements were within two lines for 305 eyes (96%; kappa = 0.50). Among eyes for which classifications of visual acuity from screening and measurement could be compared, 325 (96%) of 340 assessed at home and 326 (96%) of 338 assessed in clinic were classified in the same way (kappa = 0.86 and 0.88, respectively)., Conclusion: Despite the unavoidable lack of standardization of test conditions when visual acuity was screened and measured in the home or work-place, the results were highly reliable when compared with visual acuity testing in the clinic under standard conditions.

Macular choroidal neovascularization in young adults without any known underlying diseases is referred to under the general term of focal hemorrhagic chorioretinopathy. In endemic areas of the USA an infection with Histoplasma capsulatum is thought to be the causative agent, but in Europe the pathogenesis of this condition is unknown. With the aim of finding how European patients with this disease might be detected by clinical examination and to estimate the prognosis for sight in the affected eye and the fellow eye, a follow-up examination (follow up 1-24 years, mean 7 years) of 88 patients (age 15-48 years, mean 33.6 years) was undertaken. Most patients were between 20 and 40 years of age and mildly myopic. The number of chorioatrophic scars associated with the choroidal neovascularization in particular varied widely between patients. Therefore, this characteristic is most useful for clinical differentiation between patients. In contrast, the development of an atrophic conus at the optic disc was predominantly correlated with worsening myopia. One-third of all patients experienced decreased vision during follow-up. In two-thirds of the group, however, the final vision was still 0.1 or better. The initial visual prognosis in the eye affected was predominantly dependent upon the location of the neovascular membrane in relation to the fovea and therefore upon the possibility of photocoagulation treatment. Long-term follow up in these patients revealed visual acuity decreased further only in eyes with increasing atrophy of the retinal pigment epithelium surrounding the disciform or laser scar. One-fifth of the patients also developed choroidal neovascularization in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)

The visual prognosis of 148 eyes in patients with an active subfoveal or juxtafoveal subretinal neovascular membrane (SRNVM) in the presumed ocular histoplasmosis syndrome (POHS) was reviewed. Average follow-up was 39 months. One hundred twenty of 148 eyes (81.1%) had a final visual acuity worse than 20/40. One hundred three of 148 eyes (69.6%) had a final visual acuity equal to or worse than 20/200. Systemic and/or periocular steroids had no effect on final visual outcome. Factors affecting final visual outcome are described and prognosis in the fellow eye is discussed.

The authors present results of a study in which certified visual acuity examiners in the Macular Photocoagulation Study Group, performed independent replicate refractions and visual acuity measurements on both eyes of patients whose visual acuities ranged from 20/20 to less than 20/800. Patients with neovascular age-related macular degeneration (AMD), ocular histoplasmosis, or idiopathic neovascularization were represented. A total of 328 observations for 164 eyes from 82 patients were available for analysis. Overall reliabilities of the refraction data and the visual acuity data were 98.9% and 98.7%, respectively. Differences between replicate measurements were small; 87% were less than one line. However, differences were greater in patients with visual acuity less than 20/100 and in patients with AMD. These results indicate that the reliability of refraction and visual acuity measurements under a standard protocol is high and may depend on both visual acuity level and disease process. If a standard, systemic procedure is used for refraction and visual acuity testing, the clinician may be able to differentiate between true changes and measurement error, even among low vision patients with AMD.

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.

A series of cards each containing a two dimensional array of identical Snellen "E's" was used to determine best eccentric visual acuity in patients with macular disease having Snellen visual acuity of 20/70 or worse. Each "full field E" card simultaneously presents the same letter to foveal and parafoveal areas. This test can therefore determine quickly if potentially useful vision is present in any area of the central visual field. In our study of 37 eyes, 70% demonstrated potential visual acuity at least two times better than visual acuity measured by conventional methods, and 20% demonstrated at least a fourfold improvement. This suggests that most patients with macular disease do not spontaneously employ their best remaining area of retina for fixation.