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Purpose:We report a case of paracentral acute middle maculopathy secondary to cholesterol embolization syndrome after an endovascular aortic aneurism repair (EVAR).Methods:Functional and anatomical damage was assessed by Snellen visual acuity, fundoscopy, and optical coherence tomography.Results:A 6

Tiffany A Chen,1 Jonathan Li,1 Julie M Schallhorn,1,2 Catherine Q Sun1,2 1Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA; 2F.I Proctor Foundation, University of California San Francisco, San Francisco, CA, USACorrespondence: Catherine Q SunF.I. Proctor Foundation, University of California San Francisco, Box 0944, 490 Illinois Street, San Francisco, CA, 94143, USAEmail catherine.sun@ucsf.eduPurpose: To evaluate the agreement of a home vision screening test compared to standard in-office technician-measured Snellen visual acuity to allow for remote screening and triaging of patients.Patients and Methods: In this prospective study, English-speaking patients with in-office ophthalmology appointments from May to August 2020 and visual acuity better than 20/125 were asked to complete a home vision test one week before their scheduled in-office appointment. The home vision test was a modified ETDRS chart displayed in a PDF document that could be printed or viewed on a monitor. The primary outcome was the mean difference between office-based and home visual acuity.Results: Eighty-two eyes of 45 patients were included in the study with 45 study eyes analyzed. The mean difference between office-based and home visual acuity was − 0.02 logMAR (SD 0.15, P=0.28) among study eyes. Of these eyes, 91% demonstrated agreement between the two methods within 0.2 logMAR of the mean difference, and 60% had agreement within 0.1 logMAR of the mean difference. There were no significant demographic or ocular risk factors leading to a greater difference between the tests.Conclusion: There was good agreement between the home and in-office Snellen tests for patients with vision better than 20/125. The home vision test can be used to remotely determine if there is a significant vision change of > 0.2 logMAR or approximately 2 lines of visual acuity.Keywords: telemedicine, tele-ophthalmology, home vision test, vision screening

Purpose: To determine whether ocular dominance strength influences success of monovision Design: Single-center, prospective, double blind crossover. Subjects received contact lenses with reading addition added to the left eye in the first trial period and to the right eye in the second period so that the type of monovision was randomized and blinded for the test subject and the investigator. Methods: 17 presbyopic subjects, aged 50-65, received conventional and crossed monovision, each for 2 weeks. Satisfaction, stereopsis (TNO, Titmus) and Snellen visual acuity were measured. Ocular dominance was examined according to Haidinger and +1D test. Results: Pearson correlation coefficient between strength of ocular dominance and subject satisfaction was ρ=0.088 for the conventional and ρ=0.000 for the crossed group. 93% of subjects were most satisfied with the type of monovision that yielded the highest Titmus score. For the TNO test this was only 64%. A statistical significant interaction effect was shown for this relationship (ρ=0.019). Conclusion: A significant correlation between dominance strength, refraction error and satisfaction could not be found. However, we observed that the highest stereopsis score according to the Titmus test was more likely to yield a higher satisfaction when comparing conventional and crossed monovision. When a physician opts for monovision correction, the Titmus test can be performed with test spectacles or contact lenses to decide which eye should be corrected for distance vision. The choice should be in favor of the correction that yields the best Titmus score.

John Sheppard,1 Mark Bergmann,2 Barry A Schechter,3 Jodi Luchs,4 Abayomi Ogundele,5 Paul Karpecki6 1Virginia Eye Consultants, Norfolk, VA, USA; 2Apex Eye, Cincinnati, OH, USA; 3Florida Eye Microsurgical Institute, Boynton Beach, FL, USA; 4Florida Vision Institute, West Palm Beach, FL, USA; 5Medical Affairs, Sun Pharmaceutical Industries, Inc, Princeton, NJ, USA; 6Kentucky Eye Institute, Lexington, KY, USACorrespondence: John SheppardVirginia Eye Consultants, Suite #210, 241 Corporate Blvd, Norfolk, VA 23502, USATel +1 757 226-8021Email jsheppard@cvphealth.comBackground: OTX-101 is approved for treatment of keratoconjunctivitis sicca (KCS). We present results of a phase 3 worse-eye efficacy analysis and 1-year safety extension.Methods: During the double-masked treatment phase, patients with bilateral KCS were randomized 1:1 to 12 weeks OTX-101 or vehicle 1 drop per eye twice daily. Efficacy assessments included Schirmer’s test and corneal and conjunctival staining. All patients who completed the treatment phase were eligible for enrollment in the open-label extension and received 1 drop OTX-101 twice daily for up to 52 weeks. Safety endpoints included adverse event (AE) monitoring, Snellen visual acuity (VA), intraocular pressure (IOP), slit-lamp examination (SLE), and dilated fundoscopy.Results: Overall, 745 and 258 patients enrolled in the treatment and safety extension phases, respectively. At 12 weeks, number (%) of patients with Schirmer’s score increase of ≥ 10 mm from baseline was 76 (20.5%) vs. 42 (11.3%) for OTX-101 vs. vehicle (P=0.0005). OTX-101 significantly improved total conjunctival staining vs. vehicle at week 12 (least squares mean change from baseline − 1.65 [0.12] vs. − 1.12 [0.12], P=0.0013), and number (%) of patients with clear central corneas vs. vehicle at week 12 (222 [64.0%] vs. 199 [55.3%], P=0.0179). In the 1-year safety extension, AEs were mostly mild; instillation site pain was most common in 59 (22.9%) patients (17 [13.2%] vs. 42 [32.6%] patients receiving prior OTX-101 and vehicle). No safety concerns were raised by VA, IOP, SLE, and fundoscopy.Conclusion: OTX-101 efficacy was confirmed in the eye with lower baseline Schirmer’s score. OTX-101 was well tolerated long term.Clinical Trial: Registered at ClinicalTrials.gov on July 27, 2016. NCT02845674 https://clinicaltrials.gov/ct2/show/NCT02845674?term=OTX-101&draw=2&rank=1.Keywords: cyclosporine A, dry-eye disease, keratoconjunctivitis sicca; KCS, OTX-101

A 66-year-old man presented with a 1-month history of hazy vision in his left eye, worsening over the past 2 days. His medical history included hypothyroidism and hypertension. Best-corrected Snellen visual acuity was 6/9 and hand movements in the right and left eyes, respectively, with no evidence

Purpose Behcet's disease is an immune-mediated condition which can commonly have ocular involvement. We present a case of Behcet's associated neuroretinitis, which is a rare ocular manifestation of Behcet's disease. Observations The patient experienced significant improvement in her neuroretinitis without initiation of treatment. After 28 days of observation there was spontaneous resolution of exam findings and return of Snellen visual acuity to 20/20. Conclusionand Importance There are only two other cases reported in the literature of Behcet's associated neuroretinitis. Both cases report bilateral involvement with concomitant frosted branch angiitis. This is also the only reported case with spontaneous resolution of abnormal exam findings with return to 20/20 visual acuity. This case highlights the complexity of ocular involvement in Behcet's disease.

To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case–control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM. Epithelialization and Best Corrected Snellen Visual Acuity (BCSVA) were compared between the two groups. At baseline, both groups had comparable age, gender, visual acuity (VA), size and location of corneal ulcer. Patients receiving additional placement of cryopreserved AM had significantly faster epithelialization within 3.56 ± 1.78 weeks vs 5.87 ± 2.20 weeks (p = 0.01) and achieved complete epithelialization in significantly more patients (72.7% vs 23.1% p = 0.04) despite overall larger baseline defect size (32.7 ± 19.5 mm2 vs 21.5 ± 10.7 mm2, p = 0.11). Consequently, the AM group had clinically significant BCSVA (> 3 lines) (81.8% vs 38.4%, p = 0.047) and total VA improvement (log MAR 0.7 ± 0.6 vs 1.6 ± 0.9, p = 0.016) compared to the control group at the time of complete epithelialization. In-office sutureless AM may be an effective adjuvant therapy in treating sight-threatening infectious corneal ulcers by promoting faster corneal epithelialization and overall better recovery of the VA.

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.

BACKGROUND AND OBJECTIVE: In 2018, cases of inflammation were reported after intravitreal aflibercept (IVA), which resulted in switches to intravitreal ranibizumab (IVR). The authors' purpose was to evaluate outcomes after switching from IVA to IVR in diabetic macular edema (DME). PATIENTS AND METHODS: Retrospective cohort study. Eyes switched from IVA to IVR for treating DME were included. Data were gathered from three visits before to three visits post-switch. Outcome measures included central subfoveal thickness (CFT) and Snellen visual acuity (VA). RESULTS: There was a statistically significant increase in CFT at the first visit (325 µm ± 234 µm; P = .006) compared to the switch visit, but no difference later visits (268 µm ± 103 µm; P = .32; 284 µm ± 118 µm; P = .11; n = 54). There was no statistically significant change in mean logarithm of the minimum angle of resolution VA between the switch and later visits (0.43 ± 0.38, P = .95; 0.38 ± 0.30, P = .12; 0.41 ± 0.37, P = .69). CONCLUSIONS: The authors observed transient worsening of macular edema in eyes treated for DME when switched from aflibercept to ranibizumab. [ Ophthalmic Surg Lasers Imaging Retina . 2020;51:691–697.]

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.

To describe a novel optokinetic visual acuity estimator (Oktotype) and to report the preliminary results obtained in poorly and non-collaborative subjects. Eleven series of symbols arranged horizontally and moving from left to right at a constant rate were displayed. In each sequence, the size of the stimuli was reduced logarithmically. By using this paradigm, the objective visual acuity was computed in 26 normal subjects as the minimum size of the symbols able to evoke the optokinetic response. In the preliminary phase, three contrast levels were tested, with white noise added to the first five sequences so as to normalize the overestimate found at the lower-half range of the acuity scale. Subsequently, the correspondence between subjective and objective visual acuity was compared in 10 poorly collaborative subjects, and the agreement between optokinetic and Teller visual acuity was measured in six non-collaborative subjects. The best agreement is provided by the minimum contrast level (20%) (R 2 = 0.74). The correspondence between the two techniques is satisfying both in the normal and in the poorly collaborative sample (concordance correlation coefficient: 0.85 and 0.83, respectively). In the non-collaborative group, the concordance correlation coefficient between Teller acuity and OKVA ranged between 0.79 (test) and 0.85 (retest). Test–retest reliability was very good for the Oktotype (K: 0.82), and better than the Teller test (K = 0.71), even if it was lower compared to Snellen acuity (K = 0.95). The Oktotype seems promising to predict Snellen visual acuity in normal and poorly collaborative subjects.

Purpose: To report the clinical findings in patients ≥100 years old who have age-related macular degeneration (AMD). Methods: We identified patients ≥100 years old who had non-neovascular AMD, neovascular AMD or both. Results: Sixty-two patients were included. The mean (SD) age was 102 (1.4) years (range, 100-106 years). Most patients were white (n = 51, 82%), women (n = 51, 82%), and had at least 1 eye affected by neovascular AMD (n = 55, 89%). The mean Snellen visual acuity (VA) among eyes with neovascular AMD was worse than that for eyes with non-neovascular AMD (20/600 [range, 20/40-hand motions] vs 20/250 [range, 20/20-hand motions], respectively, P = .03). Eyes with an intact subfoveal ellipsoid zone (EZ) had much better mean VA than eyes with an absent or disrupted EZ (20/50 vs 20/500, P = .002). Conclusion: Most centenarians with AMD in our cohort had the neovascular form, and these individuals tended to have poorer vision than those with non-neovascular AMD. The presence of an intact subfoveal EZ is associated with better VA in eyes with neovascular or non-neovascular AMD compared to eyes with an absent or disrupted EZ.

PurposeTo assess visual outcomes of Coats disease by classification stage.MethodsA retrospective review was conducted on consecutive patients with Coats disease, classified according to Shields classification and with available Snellen visual acuity before and after treatment.ResultsThere were 160 eyes with Coats disease (stage 1 (n=2) vs stage 2A (n=17) vs stage 2B (n=22) vs stage 3A1 (n=26) vs stage 3A2 (n=40) vs stage 3B (n=42) vs stage 4 (n=9) vs stage 5 (n=2)). By comparison, more advanced stage showed greater frequency of poor presenting visual acuity (ConclusionVisual acuity in eyes with Coats disease parallels staging with more advanced stage demonstrating poorer visual acuity at presentation and final visit.

Purpose To describe the learning curve for Descemet's membrane endothelial keratoplasty (DMEK) in the Rotterdam Eye Hospital and to evaluate safety and visual outcome. Methods This was a single-centre prospective study of 40 consecutive patients with Fuchs' endothelial dystrophy who underwent a DMEK procedure in the Rotterdam Eye Hospital. The performance of two corneal surgeons, each conducting their first series of 20 procedures, was examined with the cumulative summation test for the learning curve (LC-CUSUM). The surgical procedure was considered unsuccessful when >30% of the graft was not attached at any time during the first 12 postoperative weeks and a mixture of SF6 (20%) and air (80%) had to be injected in the anterior chamber (rebubbling) to reattach the graft. Also assessed were visual outcome, intraocular pressure and peri- and postoperative complications. Results In total, nine rebubbling procedures were performed in seven eyes. Following repeated rebubbling, two eyes did not achieve a satisfactory result and secondary surgery was required to restore visual function. Complications were usually manageable. The last 13 DMEK procedures (33%) of this series did not require rebubbling. After 3 months, 86% of the eyes had reached a Snellen visual acuity of 0.5 or more. Conclusion Together with the two surgeons' personal experience, the aggregate learning curve was considered to justify incorporation of Descemet membrane endothelial keratoplasty as a regular option of the standard of care for endothelial dysfunction in the Rotterdam Eye Hospital.

AimsTo determine the prevalence and subtypes of glaucoma in Vientiane Province.MethodsWe conducted a population-based study of 1264 participants aged ≥40 years of age from urban and rural areas of Vientiane Province. Data collection included Snellen visual acuity, slip lamp examination, tonometry, gonioscopy, dilated stereoscopic disc examination and perimetry. Glaucoma was categorised by clinical subtype.ResultsThe mean age of the 1264 participants was 57.6 years; 91.9% of eyes had a gradable disc. The prevalence of glaucoma of any category in at least one eye was 1.54% (95% CI 0.66% to 3.59%). The overall prevalence of primary open-angle glaucoma, primary angle-closure glaucoma and secondary glaucoma was 0.62% (95% CI 0.19% to 1.98%), 0.55% (95% CI 0.12% to 2.54%) and 0.37% (95% CI 0.07% to 1.86%); 12 (66.7%) of participants with glaucoma were at least unilaterally blinded by WHO definition.ConclusionsThe prevalence of glaucoma in the Vientiane Eye Study is relatively low compared with the prevalence reported in other studies from Asian regions; however, the median age in this study was low, reflecting the age group of the population and the rapid urbanisation occurring in the Lao People’s Democratic Republic. Nevertheless, glaucoma remains a blinding disease in this population.

Objective To review the problems found after a new follow-up protocol for patients on chloroquine and hydroxychloroquine treatment. Method Retrospective study was conducted between May 2012 and January 2013 on the clinical files, retinographies, fundus auto-fluorescence (FAF) images, and central-10 degree visual fields (VF) of patients who were referred to the Ophthalmology Department as they had started treatment with hydroxychloroquine. Results One hundred twenty-six patients were included; 94.4% were referred from the Rheumatology Department and 5.6% from Dermatology. Mean age was 59.7 years, and 73.8% were women. All of them were on hydroxychloroquine treatment, and 300 mg was the most frequent daily dose. Rheumatoid arthritis was the most common diagnosis (40.5%), followed by systemic lupus erythematosus (15.9%). The mean Snellen visual acuity was 0.76, and 26 patients had lens opacities. The VF were normal in 97 patients, 8 had mild to moderate defects with no definite pattern, and in 9 the results were unreliable. Of the 51 patients older than 65 years, 16 (31.4%) had altered or unreliable VF. The FAF was normal in 104 patients (82.5%), and abnormal, but consistent with ophthalmoscopic features, in 12 patients (pathological myopia, age related changes, early, middle or late age-related macular degeneration). Conclusions Visual fields as a reference test for the diagnosis of AP toxicity are not quite reliable for patients over 65. Therefore, the FAF is recommended as primary test, perhaps combined with another objective test, such as SD-OCT instead of VF.

This diagnostic study investigates whether there are clinically significant differences between Snellen visual acuity examinations performed by a human vs a smart speaker.

Bertram Meyer,1 Georg Sluyterman van Langeweyde,2 Matthias Wottke2 1Augencentrum Köln, Cologne, Germany; 2Carl Zeiss Meditec AG, Jena, Germany Purpose: A retrospective comparison of refractive outcomes of a new, aspherically optimized profile with an enhanced energy correction feature (Triple-A) and the conventionally used aspherically optimized profile (ASA, or aberration smart ablation) for correction of low-to-high myopia.Setting: Augen-OP-Centrum, Cologne, GermanyDesign: Retrospective nonrandomized comparative studyMethods: A central database at the Augen-OP-Centrum was used to gather retrospective data for low-to-high myopia (up to -10 D). One hundred and seven eyes (56 patients) were treated with the ASA profile, and 79 eyes (46 patients) were treated with the Triple-A profile. Postoperative outcomes were evaluated at 1 month, 3 months, 6 months, and 1 year follow-up time points.Results: The Triple-A profile showed better predictability indicated by a significantly lower standard deviation of residuals (0.32–0.34 vs 0.36–0.44, Triple-A vs ASA) in the 6-month to 1-year period. The Triple-A group had better stability across all time intervals and achieved better postoperative astigmatism improvements with significantly lower scatter. This group achieved better safety at 1 year, with 100% of eyes showing no change or gain in Snellen lines, compared with 97% in the ASA group. A better safety index was observed for the Triple-A group at later time points. The Triple-A group had a better efficacy index and a higher percentage of eyes with an uncorrected Snellen visual acuity of 20/20 or greater at all investigated follow-up time points.Conclusion: The new aspherically optimized Triple-A profile can safely and effectively correct low-to-high myopia. It has demonstrated superiority over the ASA profile in most refractive outcomes. Keywords: Triple-A, wavefront measurements, corneal aberrations, corneal asphericity, ablation profile

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.

Purpose To assess the intraoperative vaulting in patients undergoing implantable collamer lens (ICL) implantation with microscope-integrated intraoperative optical coherence tomography (iOCT) and correlate it with the postoperative vaulting. Methods Forty eyes of 22 consecutive patients undergoing ICL implantation were prospectively evaluated. Vaulting was measured intraoperatively using microscope-integrated iOCT. The ICL-lenticular relationship was dynamically assessed throughout the surgery. Postoperative vaulting was measured using anterior segment optical coherence tomography on the first postoperative day and after 1 month and compared with the intraoperative vaulting. Uncorrected and best-corrected Snellen visual acuity, intraocular pressure (IOP), and anterior and posterior segments were assessed in all cases. Results The mean central vaulting noted intraoperatively was 558.4 ± 122.8 µm. Postoperative mean vaulting was 576.0 ± 131.2 µm on day 1 and 551.1 ± 122.5 µm on day 30. There was a significant correlation between the intraoperative and the postoperative day 1 vaulting (paired samples correlation: 0.969, pConclusions Intraoperative vaulting correlates well with postoperative vaulting and can aid in on-table detection of extremes of vaulting and decision-making. It enhances the safety of the surgical procedure by providing a real-time display of the intraoperative manipulations.

In this observational study, a modified version of the Visual Function Index (VF-14) and the Snellen Visual Acuity Test were compared in how well they correlated with self-restricted driving habits in older adults. The VF-14 was originally designed to assess vision in cataract patients; however, in this study, a modified version (mVF-14) was evaluated as a tool for predicting self-restricted driving in older drivers.During a 3-month period, 151 drivers over the age of 65 were screened at the local senior center. In addition to the Snellen Visual Acuity Test and mVF-14, each participant was given a questionnaire about their driving habits, previously used in self-restriction studies.Out of 151 total participants, 134 were included and 7 nondrivers and 10 subjects who did not complete all questionnaires were excluded. One hundred one participants exhibited normal visual acuity of 20/40 or better (75%), and 110 scored over 90 on the mVF-14 (82%). Spearman's rank sum correlation coefficient was used to analyze the data and showed significant negative correlation of the mVF-14 and Snellen with self-restricted driving. Individuals with normal vision (20/40 or better on the Snellen eye test) had both high and low mVF-14 scores.The study shows that poor vision, as indicated by the Snellen scale and low mVF-14 scores, correlates to self-imposed driving limitations. The mVF-14 showed further distinctions of self-restriction between individuals in the same Snellen Visual Acuity category. Therefore, using the mVF-14 in addition to the Snellen Visual Acuity Test can be helpful to further differentiate visual ability within older drivers who appear to have normal vision.

Purpose Most retrospective reviews convert Snellen visual acuity measurements obtained during routine clinic visits to logarithm of the minimum angle of resolution (logMAR) units so that statistical manipulations can be performed. However, visual acuity measurements expressed as logMAR units are not intuitively interpretable by clinicians. A more intuitive approach is presented here which uses the conversion of Snellen visual acuity fractions to Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical manipulations. Methods Snellen visual acuity measurements were converted to approximate ETDRS (approxETDRS) letter scores for statistical manipulations and then converted back to Snellen equivalent fractions. The formula to convert Snellen visual acuity measurements to approxETDRS letter scores is 85 + 50 x log (Snellen fraction), which may be rounded to the nearest letter. Results A linear relationship exists between true ETDRS letter scores, approxETDRS letter scores, and logMAR units. The interconversion between Snellen visual acuity measurements, logMAR units, and approxETDRS letter scores was prepared in a tabular form for easy reference. The same outcomes (in Snellen fractions) were obtained with statistical manipulation of either approxETDRS letter scores or logMAR conversions. Conclusion Conversion of Snellen visual acuity fractions to approxETDRS letter scores for the purpose of performing statistical manipulations provides more readily interpretable outcomes compared with the current strategy of converting Snellen visual acuity fractions to logMAR units.

To evaluate which factor(s) might predict excellent Snellen visual acuity results in unilateral nontraumatic pediatric aphakes.Retrospective review of all unilateral pediatric aphakic patients seen in a specialty contact lens clinic between 1982 and 2009. Inclusion criteria as follows: (1) cataract extraction before age 6 weeks, (2) no other health complications, (3) contact lens fitting within 3 weeks postsurgery, and (4) measurable subjective visual performance on a clinical Snellen acuity chart. Fifteen patients were identified: 10 patients with persistent fetal vasculature syndrome (PFV) and 5 patients with the diagnosis of idiopathic congenital cataract (ICC).Final Snellen acuity results showed seven patients (46.67%) developed excellent Snellen visual acuities (defined as 20/50 or better), four patients (26.67%) developed moderate Snellen visual acuities (20/125 to 20/60), and four total patients (26.67%) developed poor Snellen visual acuities (worse than 20/200). Analysis used descriptive statistics.Approximately 50% of our unilateral nontraumatic pediatric aphakic patients aged older than 5 years achieved excellent Snellen visual acuity in the aphakic eye. The amount of surgical or ocular complications seems to have an inverse relationship with Snellen visual acuity in PFV. Patching compliance, without implying cause-effect direction, also had a direct relationship with final Snellen visual acuity for patients. Early cataract extraction, good to moderate patching compliance, and aggressive early contact lens management can lead to moderate to excellent Snellen visual results in several unilateral pediatric aphakic patients.

The aim of this study is to investigate the effect of yellow filter on visual acuity and contrast sensitivity under glare condition for various ages. A total of 60 subjects, aged 5–60 years, with no ocular pathology and no previous surgery were assessed in this cross-sectional study. We divided subjects into six subgroups according to their ages, and the number of subjects in each group was 10: group 1, aged 5–10 years; group 2, aged 11–20 years; group 3, aged 21–30 years; group 4, aged 31–40 years; group 5, aged 41–50 years; and group 6, aged 51–60 years. Snellen visual acuity and Pelli Robson contrast sensitivity with and without glare and with the use of yellow filter under glare condition were determined. Data analysis was carried out using SPSS, version 20. Our results showed a significant reduction in contrast sensitivity under glare condition in all age groups (p = 0.000), which improved significantly with the use of yellow filter (p = 0.000). Although when data in different age groups were analyzed separately, this improvement was only significant in older subjects, aged 51–60 years (p = 0.007). No significant difference was found between Snellen visual acuity with and without glare (p = 0.083), and also we found no yellow filter effect on visual acuity under glare condition. We conclude that yellow filter, which absorbs short wavelength, may provide significant contrast sensitivity benefits for individuals and influences older subjects more than younger ones.

Smartphone-based Snellen visual acuity charts has become popularized; however, their accuracy has not been established. This study aimed to evaluate the equivalence of a smartphone-based visual acuity chart with a standard 6-m Snellen visual acuity (6SVA) chart.First, a review of available Snellen chart applications on iPhone was performed to determine the most accurate application based on optotype size. Subsequently, a prospective comparative study was performed by measuring conventional 6SVA and then iPhone visual acuity using the 'Snellen' application on an Apple iPhone 4.Eleven applications were identified, with accuracy of optotype size ranging from 4.4-39.9%. Eighty-eight patients from general medical and surgical wards in a tertiary hospital took part in the second part of the study. The mean difference in logMAR visual acuity between the two charts was 0.02 logMAR (95% limit of agreement -0.332, 0.372 logMAR). The largest mean difference in logMAR acuity was noted in the subgroup of patients with 6SVA worse than 6/18 (n=5), who had a mean difference of two Snellen visual acuity lines between the charts (0.276 logMAR).We did not identify a Snellen visual acuity app at the time of study, which could predict a patients standard Snellen visual acuity within one line. There was considerable variability in the optotype accuracy of apps. Further validation is required for assessment of acuity in patients with severe vision impairment.

To prospectively evaluate the efficacy of oral corticosteroids and posterior subtenon injection in the treatment of macular edema in patients with intermediate uveitis using optical coherence tomography (OCT). Twenty-two patients with intermediate uveitis were treated with posterior subtenon injection when the disease was unilateral (group A, n=11) or with oral steroids when the disease was bilateral (group B, n=11). Changes in macular thickness from baseline was determined using OCT in both groups at day 0, day 3, day 14, 6 weeks and 12 weeks. Statistically significant improvement in Snellen visual acuity in group A was seen at 6 weeks and in group B at 2 weeks. In patients receiving oral corticosteroids, foveal thickness decreased by 63% by day 3. In those treated with posterior subtenon injection, even at day 14 only a 55% reduction of foveal thickness was evident. Spearman’s correlation coefficient for visual acuity and foveal thickness was found to be significant. OCT confirms a significantly more rapid decrease in macular edema in patients treated with oral corticosteroids. A short course of oral steroids may be useful in enabling earlier visual recovery in patients treated with posterior subtenon injection for unilateral uveitic macular edema.

* BACKGROUND AND OBJECTIVE: To evaluate the potential acuity meter in predicting visual acuity after photodynamic therapy of choroidal neovascular membranes caused by age-related macular degeneration. * PATIENTS AND METHODS: Retrospective study of 55 eyes in 51 patients with subfoveal predominantly classic choroidal neovascularization due to age-related macular degeneration. Pre-photodynamic therapy Snellen visual acuity minus the visual acuity with the potential acuity meter was compared with the actual improvement in visual acuity. Significant improvement in visual acuity after photodynamic therapy was defined as a gain of more than 2 lines in Snellen visual acuity (0.2 logarithm of the minimal angle of resolution units). * RESULTS: Eighteen (51.4%) of 35 eyes with a potential for improvement experienced an actual improvement in their Snellen visual acuity after photodynamic therapy (P < .001). All eyes lacking a potential for improvement failed to experience an actual improvement in visual acuity after photodynamic therapy. * CONCLUSION: The eyes that demonstrated better visual acuity with the potential acuity meter in this study seemed more likely to experience an improvement in visual acuity after photodynamic therapy. [Ophthalmic Surg Lasers Imaging 2006;37:6-11.]

To adapt a standardized technique for assessment of visual fields to the study of patients with birdshot chorioretinopathy and to describe visual field patterns and changes over time for affected individuals.A retrospective chart review was performed of patients with a diagnosis of birdshot chorioretinopathy who had undergone at least two automated visual field studies. A masked evaluation of each visual field was performed using standardized criteria. Subjective symptoms and visual acuity measurements were compared to visual field data from the same examination dates. Serial visual field studies were evaluated for changes in the findings over time.Six patients met inclusion criteria. A total of 104 visual field studies (ranging from 2-19 studies per eye) were evaluated. Visual field abnormalities occurred in all tested eyes and were observed even in eyes with a Snellen visual acuity of 20/15. Discordant patterns were observed in the two eyes of some individual patients. On serial testing, multiple patterns of visual field abnormality were observed in the same eye over time.A standardized protocol for systematic evaluation of visual field measurements can be used to characterize disturbances of vision in patients with birdshot chorioretinopathy. Abnormalities of visual fields may occur even when central visual acuity is preserved.

Corneal collagen cross-linking (CXL) is an emerging treatment in slowing the progression of keratectasia in patients with keratoconus (KCN). Today, there are over 40 clinical trials under way that involve CXL and KCN. With current estimates that 10–15 % of KCN patients will need penetrating keratoplasty (PKP) in their lifetime [2], many patients hope that treatments such as CXL will reduce the likelihood of requiring future PKP. It is postulated that CXL may allow surface photorefractive keratectomy (PRK) to correct the refractive error following CXL.

As ophthalmic science develops, the expectations of surgeons and patients undergoing cataract or refractive surgery also advance. Good Snellen visual acuity is not always an indicator for patient satisfaction, and the surgeon must understand the nature and pathogenesis of problems with other less recognised visual functions. This paper discusses the phenomenon of unwanted light images that may occur after surgery due to optical media imperfections, termed pseudophakic photic phenomena. It covers definitions, assessment, high-risk groups and possible explanations for the occurrence of such phenomena.

Snellen visual acuity was measured in 106 patients ranging in age from 20 to 88 years in routine examinations in the general refraction clinic with two kinds of charts: the standard chart using black letters on a white background and a reversed-contrast display featuring white letters on a black background. The overall ratio of the white-on-black to the black-on-white Snellen fractions was 1.043. A scattergram relating this ratio to patient age revealed that the older the patient, the more the visual acuity was improved by switching to the reversed-contrast chart, with a regression line slope of 0.5 +/- 0.10. Impairment of the eye's optics, in particular by intraocular scatter causing a widening and flattening of the eye's point-spread function, explains these findings and suggests prognostic and therapeutic value of reversing the contrast polarity of displays.

Purpose: The aim of this study was to explore the possibilities of acceptance of a ready-to-dispense spherical equivalent (SE) of spherocylindrical (SC) correction spectacles in rural India. Methods: Snellen visual acuity with SE power of refracted SC lenses was prospectively collected from all individuals visiting vision centers in Phase 1 (vision correction accuracy) of the study conducted in two South Indian districts. The satisfaction level was recorded by asking one standard question. The SE spectacles were dispensed in vision centers of one district in Phase 2 (SE acceptance) with a suggestion to return, if unsatisfied, for free exchange of spectacles within a month of dispensing. Results: In Phase 1, 929 of 3529 patients were refracted and it was found that 320 patients and one eye of one patient (641 eyes) had astigmatism. The average age was 41 (±16; range: 7–84) years. There was no reduction of visual acuity in SE of 0.25 Dcyl (100% satisfaction) and progressive decrease in satisfaction to 43%, 26%, and 19% with SE correction of 0.50, 0.75, and 1.00 Dcyl, respectively. In Phase 2, 988 of 6168 patients needed refraction and 240 had astigmatism. A total of 103 patients (206 eyes) accepted SE equivalent spectacles. No client returned for the free exchange of spectacles. Conclusion: Dispensing SE power up to 1 Dcyl in ready - made spectacles could be considered in remote rural populations in resource-poor economic conditions.

Aims To examine the effect of rounding of visual acuity data on estimates of surgical performance. Method In this observational study, the distribution of 1-year Snellen visual acuity data from 606 endothelial keratoplasties from the NHSBT UK transplant database was analysed. A curve was fitted to the data and used to estimate the frequencies of partly read Snellen lines. The estimates were used to create a virtual database of grafts with Snellen acuities that included individual letter scores. The virtual database was then sampled to produce datasets for 10 virtual surgeons. Various acuity analysis methods were then applied to simulate possible effects of surgeons rounding their data. Results Rounding of acuity data was found to have a notable effect on estimates of surgeons’ success rates. When a criterion of 6/12 or better was applied, the success rates ranged from 62% to 80% using a conservative method of estimation but ranged from 80% to 94% using a less conservative method. Conclusions Rounding of visual acuity scores is an important potential bias in outcome data and should be avoided. If rounding is required we recommend that it is carried out conservatively, giving credit only for lines read completely.

Purpose: To report a consecutive series of patients undergoing intraocular lens (IOL) implantation in the first year of life. A new procedure, referred to as temporary polypseudophakia , is reported. Methods: A retrospective chart analysis was conducted. Ocular growth and refractive change, complications and reoperation rates, and outcomes were analyzed. Results: Forty-seven eyes of 33 patients underwent IOL implantation in the first year of life. Average follow-up was 22 months (range, 7 weeks to 5 years). Thirty-two eyes of 22 patients had a single IOL implanted from 12 days to 11 months of age. Fifteen eyes of 11 infants received piggyback IOLs from 16 days to 6.8 months of age. Reoperation for complications within the anterior segment of the eye was needed in 23% of all patients (22% for single IOLs, 26% for piggyback IOLs). The average first postoperative refraction after single IOL was +7.98 D and after piggyback IOL was +1.67 D. The average last postoperative refraction was +1.76 D and −4.48 D, respectively. On average, eyes grew 2.68 mm over 17.5 months of follow-up. Eight patients were old enough for Snellen visual acuity, but each had deprivation amblyopia with visual acuities from 20/85 to 5/200. Of the remaining 25 patients, 17 had central, steady, and maintained fixation in the implanted eyes. Conclusion: IOL implantation in infancy is technically feasible and associated with a reoperation rate of approximately 25% in the first 2 years after implantation. Further follow-up is required before meaningful visual acuity data and long-term results can be reported. (J AAPOS 2001;5:238-45)

Background. We sought to consider the low success rate of bifocal soft contact lenses through low-contrast visual acuity measurements using one popular design. Methods. Visual performance was measured in 23 nonpresbyopic patients with a single-vision and a concentric bifocal soft contact lens. Results. There was a statistically significant difference (p = 0.01) between the performances of the two soft lenses when measuring low-contrast visual acuity using a Bailey-Lovie chart. However, no significant difference was found when measuring high-contrast Snellen visual acuity. Conclusion. While Snellen acuity is the most widely accepted form of acuity measurement, low-contrast visual acuity may be a sensitive measure of visual function when evaluating bifocal soft contact lenses.

PURPOSE To determine the functional predictive value of laser interferometry (LI) in retinal detachment (RD). METHODS Laser interferometry with test field diameters of 3 degrees and 8 degrees, both with and without light, was tested preoperatively in 42 eyes with rhegmatogenous RD that were candidates for scleral buckling. Snellen visual acuity (VA) and LI (four test fields) were tested preoperatively and postoperatively (1 week, and 1, 3, and 7 months). Sensitivity and specificity of LI to predict postoperative (7 months after surgery) VA improvement was calculated. Chi-square and Spearman correlation tests were used for statistical analysis. RESULTS Statistically significant Snellen VA improvement (P = 0.02) was first found 7 months after surgery. Laser interferometry at 3 degrees without light showed statistically significant improvement 3 months after surgery (P = 0.05). Laser interferometry at 3 degrees without light showed the highest sensitivity (93%) and specificity (87%) values. The best correlation between preoperative LI and postoperative Snellen VA (7 months after surgery) was also found with 3 degrees LI without light (r = 0.71, P = 0.002). CONCLUSION Laser interferometry (3 degrees without light) was useful in predicting VA improvement in cases with RD preoperatively and postoperatively. Laser interferometry at 3 degrees without light showed the best correlation with postoperative Snellen VA.

Background: To evaluate near vision contrast sensitivity as a measure of visual performance after photorefractive keratectomy (PRK). Setting: LSU Eye Center, New Orleans, Louisiana. Methods: Using Holladay Contrast Acuity Test cards, near (reading) vision for five levels of contrast sensitivity was evaluated in a cross section of 53 eyes of 31 patients 25 to 732 days after PRK. Twenty-four normal eyes of 22 myopic patients served as controls. Results: Near contrast sensitivity decreased at all tested contrast levels for approximately 7 months after PRK and then returned to baseline. This phenomenon paralleled the fluctuation in best corrected distance Snellen acuity. Conclusions: These preliminary results indicate that Snellen visual acuity and near contrast sensitivity returned to baseline within 1 year after PRK.

Purpose: To compare the efficacy of intravitreal ranibizumab for the treatment of neovascular age-related macular degeneration between phakic and pseudophakic eyes with visual acuity ≥0.5 Snellen equivalent. Methods: This was a retrospective, interventional, comparative study. The newly diagnosed neovascular age-related macular degeneration patients with visual acuity of ≥0.5 Snellen equivalent were included in the study. The patients were divided into two subgroups: phakic group and pseudophakic. All patients received three consecutive monthly intravitreal ranibizumab injections, and then, reinjection was performed as needed. Patients were examined monthly, and the data at the baseline, at Months 3, 6, 9, and 12 were evaluated. The changes in visual acuity, central retinal thickness, and the number of injections were compared between the groups. Results: The study included 96 eyes of 96 patients (56 phakic and 40 pseudophakic). Mean Snellen visual acuity at the baseline, at Months 3, 6, 9, and 12 was 0.56 ± 0.09, 0.64 ± 0.15, 0.62 ± 0.21, 0.60 ± 0.22, and 0.61 ± 0.20 for the phakic group; and 0.55 ± 0.08, 0.63 ± 0.14, 0.60 ± 0.13, 0.58 ± 0.14, and 0.59 ± 0.13 for the pseudophakic group, respectively. The change in mean visual acuity and central retinal thickness at the study visits was not statistically significant between the 2 groups (P > 0.05 for all). Mean injection number at Month 12 was 4.5 and 4.3 in the phakic and pseudophakic group, respectively (P = 0.5). Conclusion: Intravitreal ranibizumab treatment on an as-needed treatment regimen is effective in preserving vision and improving central retinal thickness in both the phakic and pseudophakic group of neovascular age-related macular degeneration patients with good baseline visual acuity.

Purpose To compare 3 surgical treatment options of pterygium: limbal sliding flap transplantation, primary closing, and amniotic membrane grafting methods. Methods Seventy-five patients with primary pterygium were included in the study Snellen visual acuity measurement, grading pterygium, slit-lamp examination, keratometry, and anterior segment photography were performed preoperatively. Twenty-eight eyes of 28 patients (group 1) underwent limbal-conjunctival sliding flap transplantation, 22 eyes of 22 patients (group 2) underwent amniotic membrane grafting, and 25 eyes of 25 patients (group 3) underwent primary closing surgery The patients were followed up on the first day and the first week after surgery and then at months 1, 3, 6, and 12. Results The mean size of the pterygium preoperatively was 3.58 ± 1.1 mm in group 1, 3.95 ± 0.90 mm in group 2, and 3.5 ± 0.87 mm in group 3. The mean follow-up time was 15.07 ± 13.8 months in group 1, 20.2 ± 6.7 months in group 2, and 28.04 ± 9.9 months in group 3. Grade 4 corneal recurrence rate in follow-up was 7.1% in group 1, 27.3% in group 2, and 56% in group 3 (p = 0.00). Mean recurrence times were 4.0 ± 1.7, 4.4 ± 3.3, and 4.4 ± 3.6 months according to groups 1, 2, and 3 (p = 0.963). After the surgery, corneal astigmatism decreased and keratometric values increased significantly in all the groups with no statistically significant difference between the groups (p>0.05). Conclusions Limbal-conjunctival sliding flap transplantation is an efficient method to manage primary pterygium. It may be a safe and effective initial treatment option to reduce risk of recurrence and postoperative complications of pterygium surgery.

The effect of artificially induced image defocusing on visual acuities (VAs) measured by spatial frequency sweep pattern reversal visual evoked response (SPVER) and Snellen measurement was studied in six normal subjects. The steady-state SPVER was recorded using vertical gratings of 10 different spatial frequencies ranging from 0.52 to 30.36 c/deg. The SPVER acuity was compared with Snellen acuity (SA) measured under the same conditions of optical defocus. With moderate defocusing [< + 1.0 diopter (D), VA> 20/40], the SPVER acuities were equal to or poorer than the SAs. With more defocus (> + 1.5 D, VA < 20/70), the SPVER acuities became better than the SAs. The discrepancies between the SA and SPVER acuities may be the result of the influence of the parafoveal area on the SPVER at lower visual acuity levels.

This study examines visual acuity estimation with character counting, which can be used in subjects with nonorganic visual loss. The right eyes of 35 healthy subjects were fogged with plus lenses and tested with the Snellen visual acuity chart (Reichert 11180). Visual acuity and counting level were assessed under various degrees of fogging, up to a maximal fogged acuity of 20/200. Counting level was defined as the smallest line that subjects could count the number of characters correctly. For each counting level, the visual acuity that 95% of subjects could see equal to or better than was determined. A counting level of 20/10 estimates (ie 95% chance) a visual acuity equal to or better than 20/30. Counting levels 20/15, 20/20, and 20/25 estimate visual acuities of at least 20/50, 20/80, and 20/80, respectively. Counting levels 20/30–20/60 estimate a visual acuity of at least 20/200. Character counting appears to be a useful technique of obtaining a rough estimate of visual acuity in subjects unable to be tested by standard methods, such as those with non-organic visual loss.

The early development of vision in an eye with a dislocated lens is often poor, leading to disappointing postoperative results due to amblyopia. A retrospective review of the best corrected visual acuity of 49 eyes of 27 children with ectopia lentis, who were rendered aphakic either spontaneously or by lensectomy, showed a gradual improvement. Nineteen eyes achieved an early postoperative acuity of 6/12 or better. Of the remaining 30 eyes, 21 were followed up for 1 or more years. During this period, an improvement of two or more Snellen visual acuity lines was noted in all but one of the eyes.