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Purpose : To examine the effects of a biological treatment (adalimumab) on visual function in patients with ankylosing spondylitis and in uveitic patients without macular edema during one-year treatment with adalimumab. Methods : Sixteen eyes of eight consecutive Caucasian patients treated with adalimumab were followed up using microperimetry (MAIA; CenterVue, Padova, Italy). Five patients had ankylosing spondylitis without uveitis, three patients had panuveitis without macular edema. Macular sensitivity and macular integrity were recorded. Results : During six-month follow-up, the average threshold did not change significantly ( p = .649). Macular integrity was stable ( p = .225). The macular sensitivity point analysis showed no significant effects (examination F(3,56) = 0.494 and p = .688; point*examination F(108,2016) = 0.688 and p = .994) during the follow-up. Conclusions : During one-year follow-up, adalimumab did not affect macular function, unlike the well-established maculopathy induced by hydroxychloroquine. Microperimetry may be considered when following-up macular function in patients undertaking adalimumab.

Purpose: To study binocular balance by comparing dichoptic and standard monocular contrast sensitivity function (CSF) in stereonormal and stereoanomalous/stereoblind amblyopic subjects., Methods: Sixteen amblyopes and 17 controls participated. Using the capability of the passive three-dimensional display, we measured their CSF both monocularly and dichoptically at spatial frequencies 0.5, 1, 2, 4, and 8 cpds using achromatic Gabor patches on a luminance noise background. During monocular stimulation, the untested eye was covered, while for the dichoptic stimulation the untested eye viewed background noise. Dichoptic CSF of both eyes was acquired within one block., Results: In patients with central fixation, dichoptic viewing had a large negative impact on the CSF of the amblyopic eye, although it hardly affected that of the dominant eye. In contrast, dichoptic viewing had a small but significant effect on both eyes for controls. In addition, all participants lay along a continuum in terms of how much their two eyes were affected by dichoptic stimulation: by using two predefined contrast sensitivity ratios, namely, amblyopic sensitivity decrement and dichoptic sensitivity decrement, not only did we find a significant correlation between these variables among all participants, but also the two groups were identified with minimum error using a cluster analysis., Conclusions: Dichoptic CSF may be considered to measure visual performance in patients with altered binocular vision, because it better reflects the visual capacity of the amblyopic eye than the standard monocular examinations. It may also be a more reliable parameter to assess the efficacy of modern approaches to treat amblyopia.

Biofeedback training has been used to improve fixation stability in subjects with central vision loss, but the psychophysiological mechanisms underlying the functional improvements resulted was not reported. The aim of this study was to investigate the effects of microperimetric biofeedback training on different visual functions and self-reported quality of vision in subjects with age-related macular degeneration. This case-control study included six subjects (72.0 ± 6.1 years of age) diagnosed with age-related macular degeneration (wet or dry) with low vision (best corrected visual acuity ranging from 0.5 to 0.1 in the study eye) and five healthy volunteers (64.2 ± 3.7 years of age). Ophthalmological and functional examinations were obtained from all subjects twice with an approximately 3-month interval. Subjects with central vision loss performed 12 sessions (10 min each) of biofeedback training between the two examinations. Functional evaluation included: microperimetry, spatial luminance contrast sensitivities, color vision thresholds, visual acuity, and reading speed. Visual performance during daily activities was also assessed using a standardized questionnaire. The ratio (2nd/1st examination) of the spatial luminance contrast sensitivity at lower spatial frequencies were much higher for the training subjects compared with the controls. In addition, self-reported quality of vision improved after the training. The significant improvement of the visual function such as spatial luminance contrast sensitivity may explain the better self-reported quality of vision. Possible structural and physiological mechanisms underlying this neuromodulation are discussed.

Introduction:: The purpose of the study was to estimate the number of people with diabetes mellitus, the prevalence of diabetes mellitus and the prevalence of blindness and severe visual impairment among people with diabetes mellitus in Hungary based on our recent national representative survey., Methods:: Altogether 105 clusters of 35 people aged 50 years or older were randomly selected. Standardized rapid assessment of avoidable blindness with the diabetic retinopathy module was used. Each individual received a visual acuity assessment, and every person with diabetes mellitus underwent dilated fundus examination., Results:: The estimated number of people with diabetes mellitus was 807,885 in the adult (⩾18 years) population in Hungary with 9.9% prevalence. Diabetic retinopathy exhibited an increasing tendency with age. The prevalence rates of blindness and severe visual impairment in people with diabetes mellitus aged ⩾50 years were 1.0% and 0.9%, respectively. Diabetic retinopathy was responsible for 28% of blindness and 50% of severe visual impairment among participants aged ⩾50 years with diabetes mellitus., Conclusion:: The estimated number of people with diabetes mellitus and prevalence of diabetes mellitus were lower than those recently reported. However, if we extend our estimation, prevalence of undiagnosed diabetes mellitus may be higher and thus prevalence of diabetes mellitus may reach a higher value (between 9.9% and 13.4%). Because of the high number of ophthalmologically uncontrolled diabetic eyes and high rate of blindness due to diabetic retinopathy, primary eye care should be improved, and a nationwide telemedical eye-screening programme should be undertaken.

Purpose: To present experiences gained during the planning, implementation, and practical performance of the rapid assessment of avoidable blindness with diabetic retinopathy module (RAAB+DR) in an established market economy., Methods: A total of 3523 people aged 50 years or older were examined at their homes in 105 randomly selected clusters in Hungary. During the 4-month-long field work, five teams visited the clusters. Each team was composed of a senior ophthalmic resident or eye specialist, a nurse, an assistant, a driver, and a local guide. The local guides were found through local mayors of the towns or villages or other local leaders., Results: Of all 105 clusters, 41% were completed in 1 day and 59% required a longer stay. The shortest daily examination time was 3.5 hours and the longest was 10 hours. Altogether, 7.6% of the enumeration areas needed revisit, mainly due to insufficient preparatory work and absence of the subjects. The best local guides were the local government workers, health visitors, and general practitioner (GP) nurses. Refusal of pupillary dilatation was relatively high and varied greatly among the study groups (7.7-43.8%)., Conclusion: The performance of a RAAB+DR study in a well-industrialised country is difficult, but may be successful. The most critical factor for success is an excellent local guide who is able to achieve participation of the people. The results of the RAAB are a solid basis for the development of a national programme for universal eye health and to prepare active media campaigns.

Background: Acute severe postoperative endophthalmitis may lead to severe vision loss. The aim of this study was the analysis of macular microstructure imaged by spectral domain optical coherence tomography in patients after pars plana vitrectomy due to postcataract endophthalmitis., Methods: A cross sectional study was carried out in 17 patients who had cataract surgery in both eyes and underwent unilateral pars plana vitrectomy due to postcataract endophthalmitis. Postoperative best corrected visual acuity was determined in both eyes. Evaluation of macular thickness, macular volume, peripapillary retinal nerve fiber layer thickness and choroidal thickness using enhanced depth imaging technique was performed by spectral domain optical coherence tomography. The measurements obtained in the operated eye were compared to the fellow eye by Wilcoxon matched pair test. Correlation test was performed by Spearman rank order., Results: A mean postoperative best corrected visual acuity of 63 ± 30 ETDRS letters versus 75 ± 21 letters was achieved in the study and fellow eyes, respectively, after a mean of 5.3 ± 4.5 months (p = 0.1). The mean macular thickness was 320.6 ± 28.8 μm SD in the study eyes compared to 318.4 ± 18.8 μm in the fellow eyes (p = 0.767). No differences were noted in macular volume (p = 0.97) and in peripapillary retinal nerve fiber layer thickness (p = 0.31). Choroidal thickness was significantly lower in the study eyes compared to the fellow eyes (p = 0.018). Epiretinal membrane was found in 7 eyes after endophthalmitis, while in the fellow eyes only in 3 cases (p = 0.13, Fisher's exact test)., Conclusion: Choroidal thickness decreased significantly after endophthalmitis, but there was no functional correlation with the changes in choroidal microstructure. The development of epiretinal membranes may be associated with either vitrectomy or endophthalmitis in the history. Absence of other significant structural and morphological findings shows that successful treatment may guarantee good clinical results even in long term after this severe postoperative complication.

Introduction: The results of intravitreal ranibizumab treatment for exsudative age-related macular degeneration have been favourable until this time., Aim: To evaluate the two-year functional and anatomic results of intravitreal ranibizumab treatment., Method: 46 patients (age: 75 ± 9.1 years) were included in a prospective single center study. Treatment regimen was the following: monthly 0.5 mg ranibizumab was administered in the first 3 months, and later as required (pro re nata). The change of best corrected visual acuity and central retinal thickness was followed., Results: The visus change at the end of the follow-up time was not statistically significant compared to baseline (p = 0.760) and the at the end of the first year (p = 0.154). Central retinal thickness decreased significantly compared to baseline (p = 0.000001), but the change was not statistically significant compared to the end of the first year (p = 0.875)., Conclusions: Patients with neovascular macular degeneration treated with intravitreal ranibizumab using pro re nata regimen have stable visus for long term, and the exsudation could be reduced efficiently.

Purpose: To evaluate ocular wavefront aberrations owing to keratoconus compared with normal controls and to describe the changes in the axis of line of sight (LoS) among keratoconic patients., Design: Prospective case-control study., Participants: Fifty-five eyes of 30 patients with keratoconus and 100 eyes of 50 refractive surgery candidates with normal corneas., Methods: Ocular aberrations over a 4.5 mm (undilatated) pupil were measured with a Hartmann-Shack sensor. Corneal topographic measurement was performed with a Tomey corneal topographer. The axis of the displacement of LoS was calculated by vector analysis., Main Outcome Measures: Root mean square (RMS) and higher order RMS values, ocular aberrations up to the 6th Zernike order and the distance of the LoS from the pupillary center (x and y offset values) in keratoconic and normal eyes were measured with aberrometry. The steepest and average keratometric values and the axis of the steepest meridian were measured in keratoconic eyes with topography. Correlations were made between the size and the direction of the shift in the LoS and ocular aberrations., Results: The following parameters were significantly higher in the keratoconus group compared to the control group: higher order RMS (P<0.001), Z(3)(-1) (P<0.001), Z(3)(-3) (P<0.002), Z(3)(3) (P = 0.001), Z(4)(-2) (P<0.001), Z(4)(2) (P<0.001), Z(4)(4) (P = 0.016), Z(5)(-5) (P = 0.03), Z(5)(-1) (P = 0.04), Z(5)(3) (P = 0.01), and y offset value (P<0.001). In keratoconic patients there was a significant correlation between the axis of the shift in the LoS and the steepest keratometric axis on topography (r = 0.59; P<0.001), the distance of the LoS from pupil center and vertical coma (r = -0.39; P = 0.004), and spherical aberration (SA; r = 0.29; P<0.04). There was also a significant correlation between the average keratometry value measured by topography and SA (r = -0.49; P<0.001). A factorial regression model testing the interactive effects of vertical coma and SA on the shift of LoS had a good fit on our data (r(2) = 0.69; P<0.001)., Conclusions: A significant displacement of the LoS is observed in keratoconus and relates to the position of the cone on topography and the induced vertical coma measured by aberrometry., Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article., (Copyright 2010. Published by Elsevier Inc.)

Dichoptic therapy is a promising method for improving vision in pediatric and adult patients with amblyopia. However, a systematic understanding about changes in specific visual functions and substantial variation of effect among patients is lacking. Utilizing a novel stereoscopic augmented-reality based training program, 24 pediatric and 18 adult patients were trained for 20 h along a three-month time course with a one-month post-training follow-up for pediatric patients. Changes in stereopsis, distance and near visual acuity, and contrast sensitivity for amblyopic and fellow eyes were measured, and interocular differences were analyzed. To reveal what contributes to successful dichoptic therapy, ANCOVA models were used to analyze progress, considering clinical baseline parameters as covariates that are potential requirements for amblyopic recovery. Significant and lasting improvements have been achieved in stereoacuity, interocular near visual acuity, and interocular contrast sensitivity. Importantly, astigmatism, fixation instability, and lack of stereopsis were major limiting factors for visual acuity, stereoacuity, and contrast sensitivity recovery, respectively. The results demonstrate the feasibility of treatment-efficacy prediction in certain aspects of dichoptic amblyopia therapy. Furthermore, our findings may aid in developing personalized therapeutic protocols, capable of considering individual clinical status, to help clinicians in tailoring therapy to patient profiles for better outcome. [ABSTRACT FROM AUTHOR]

Red circles signify initially stereoblind patients, white dots in the center of datapoints mark acuity equal to or below 0.4 logMAR, while a light gray line indicates a linear fit for patients without limiting factors, which is copied to (e) as well. The negative exponential fit indicates improvement (solid line) during the therapy (thick black line) and the expected improvement rate (dotted line) had the therapy been continued. (e) The improvement of patients with only one of the limiting factors also lie along the same linear fit calculated for patients without either of the limiting factors, whereas patient affected by both factors showed no or very limited improvement. [Extracted from the article]

Background: Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus.Methods: Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus.Results: Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training.Conclusions: Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Fixation stability may be a biomarker of strabismus and amblyopia recurrence after strabismus surgery and therapeutic interventions to improve visual acuity in amblyopic eyes, respectively. We have recently shown that it is possible to improve fixation stability in adult amblyopic eyes after strabismus surgery using microperimetric biofeedback fixation training (BFT). In this study we evaluated the effects of BFT on fixation stability influencing monocular and binocular visual functions in adult patients with amblyopia. Methods: Participants were 18 patients with monocular amblyopia (mean age = 35.2 ± 9.8 years; 6 females, 3 anisometropic, 5 strabismic and 10 mixed amblyopia). BFT has been applied monocularly to 13 amblyopic eyes either on the spontaneous preferential retinal locus (PRL) or to a fixation area close to the PRL. The other five subjects did not undergo BFT (control group). Best‐corrected visual acuity (BCVA near and distance), monocular (PRL) and dichoptic contrast sensitivity function (CSF) and fixation stability (BCEA 68%) were measured three times: baseline, after 10 and after 20 BFT sessions or twice within 6 months interval for the controls. Results: Baseline fixation stability correlated positively with monocular amblyopic BCVA and CSF, especially in the high frequency range, whereas it was positively associated with dichoptic amblyopic CSF only in the low frequency range, most likely reflecting binocular imbalance. Preliminary results showed that BFT applied to amblyopic eyes improved fixation stability and visual functions. However, some clinical conditions may be required to achieve significant changes. Conclusions: BFT applied to adult amblyopic eyes is a new potential approach to aid in the treatment of suppresive amblyopia in adult patients. Critical pre‐treatment fixational and/or sensorial criteria associated with satisfactory therapeutic effects of BFT on amblyopia remains to be investigated. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to estimate the prevalence and causes of blindness, severe visual impairment (SVI), moderate visual impairment (MVI), and early visual impairment (EVI) and its causes in an established market economy of Europe. Design: A cross‐sectional population‐based survey. Methods: A sample size of 3675 was calculated using the standard Rapid Assessment of Avoidable Blindness (RAAB) software in Hungary. A total of 105 clusters of 35 people aged 50 years or older were randomly selected with probability proportionate to size by the Hungarian Central Statistical Office. Households within the clusters were selected using compact segment sampling. Visual acuity (VA) was assessed with a Snellen tumbling E‐chart with or without a pinhole in the households. Results: The adjusted prevalences of bilateral blindness, SVI, MVI and EVI were 0.9% (95% CI: 0.6–1.2), 0.5% (95% CI: 0.2–0.7), 5.1% (95% CI: 4.3–5.9) and 6.9% (95% CI: 5.9–7.9), respectively. The major causes of blindness in Hungary were age‐related macular degeneration (AMD; 27.3%) and other posterior segment diseases (27.3%), cataract (21.2%) and glaucoma (12.1%). Cataract was the main cause of SVI, MVI and EVI. Cataract surgical coverage (CSC) was 90.7%. Of all bilateral blindness in Hungary, 45.5% was considered avoidable. Conclusion: This study proved that RAAB methodology can be successfully conducted in industrialized countries, which often lack reliable epidemiologic data. The prevalence of blindness was relatively low, with AMD and other posterior segment diseases being the leading causes, and cataract is still a significant cause of visual impairment. [ABSTRACT FROM AUTHOR]