Assessment of age‐related maculopathy using subjective vision tests

This paper reviews non‐standard, clinical vision tests that may be used to detect the earliest visual loss in age‐related maculopathy (ARM), before fundus changes are detected. We recommend a clinical test battery for all patients aged 60 years and older, comprising low luminance/low contrast (SKILL) VA or low contrast VA, desaturated D‐15 colour vision assessment, flicker perimetry, glare recovery and dark adaptation if possible, together with conventional assessments of case history, ophthalmoscopy and high contrast visual acuity (VA) for the detection and diagnosis of ARM. Reading rate is also discussed as a potential indicator of early visual loss. For monitoring the progressive visual loss in age‐related macular degeneration (AMD) and determining the requirements for optometric vision rehabilitation, we recommend more conventional clinical vision tests of distance and near visual acuity, reading rate, the effects of varying illumination and a functional central visual field assessment.     

The College of Optometrists in Vision Development checklist related to vision function: Expert opinions

BackgroundThe College of Optometrists in Vision Development (COVD) Quality of Life (QOL) checklist has been reported to have good test-retest reliability. Symptom scores measured by this instrument have demonstrated validity by showing a significantly improved score with optometric vision therapy. The COVD-QOL scores inversely correlate with academic achievement on standardized tests, and the instrument has been shown to differentiate between attention deficit disorder/attention deficit hyperactivity disorder children. The individual items on the COVD-QOL have not, however, been studied as to their relationship to general areas of vision investigated by the optometric examination.MethodsTo ascertain if COVD-QOL symptoms can be related to areas of vision function, a group of 28 practicing optometrists from all parts of the United States were surveyed for their opinions. The venue was a conference whose theme was vision therapy and the functional use of lenses and prisms. All the participants offered vision therapy within their practices. They were asked to rank 5 general areas of vision skills (orientation, ocular motor, binocular, accommodation, and perception) as to whether these areas might relate to individual symptoms contained in the COVD-QOL. A frequency distribution was developed based on these results. A Likert scale was also used to compare the specific symptom (COVD-QOL item) to the opinion of the clinicians who participated. A Likert scale assumes equal separation among the 5 levels of symptom severity.ResultsThirteen items were found to have high agreement, and 11 were considered in moderate agreement when the opinions of these experts were compared. Each of the 5 areas of vision had at least 1 item with high or moderate agreement.ConclusionsExpert opinion is a reasonable first step in investigating symptoms as they relate to signs, but more study is needed to verify if these subjective relationships actually exist.     

Topographic impairment of night vision related to exercise.

We observed impaired night vision in the lower visual fields of long distance runners. We reduplicated our field observations by studying four vigorously exercising men, aged 26 to 52 years, under controlled laboratory conditions. Results of our observations showed impaired night vision did occur in the inferior visual fields of all four subjects.     

Assessment of vision using a computer

1. The authors elaborated and tested a computer method for assessment of vision. This method is compatible with the basic procedure for assessment of vision and its variability. 2. The authors recommend to supplement values of vision by the parameter of line steepness. This parameter is independent on the value of vision and gives the number of normalized lines on which the number of correctly assessed optotypes declines from 95 to 5%.     

Myelinated retinal nerve fibers (MRNF) – Dilemmas related to their influence on visual function

Myelinated nerve fibers (MNF) occur in less than 1% of the population, however, they might be responsible for diagnostic dilemmas in cases with visual loss. The case report of an aged pseudophakic patient with visual deterioration in the right eye and MNF in both eyes is presented. The documentation provided by the patient proved recent several examinations of both fundi, and all of them were described as normal. Physical examination revealed the posterior capsule opacification in the right eye, white lesions on the retina of the right eye around the optic disk, and in the left eye – the peripheral, which could correspond to the myelinated fibers. Although visual field changes and OCTs corresponded to the NMF, it turned out, however, that visual acuity loss was in fact caused by PCO and was reversed by the YAG capsulotomy procedure. This case shows some problems related to MNF diagnosis and evaluation of their influence on visual function.     

Assessment of the impact of vision impairment

PURPOSE: To describe the psychometric characteristics of the Impact of Vision Impairment (IVI) Profile and evaluate its validity and reliability over time and between different forms of administration. METHODS: The IVI is a 32-item questionnaire developed to measure the impact of vision impairment on restriction of participation in daily activities in five domains of functioning. Each item is rated on a six-level scale from "no difficulty" to "can't do because of vision." The IVI was administered by trained interviewers to 115 people with impaired vision (visual acuity less than 6/12 or visual field deficit) who attended the Royal Victorian Eye and Ear Hospital, a vision rehabilitation agency, or a self-help group for people with impaired vision. Data were also collected on demographic characteristics of participants, cause of vision impairment, and distance and near vision. General health status was assessed with the Short Form-12 (SF-12) of the Physical and Mental Health Summary Scales. A subset of participants completed the IVI twice, either 1 to 2 weeks apart or by different forms of administration (different interviewers or self). RESULTS: Internal consistency of total and domain average IVI scores was high (alpha = 0.80-0.96) and sequential elimination of items did not affect consistency. Total and domain average IVI scores correlated moderately with both near and distance vision (r = 0.21-0.31) but did not correlate with physical or general health or comorbidity. Total and domain average IVI scores correlated most closely with global measures of restriction of participation (r = 0.44-0.82). Principal-components analysis confirmed that all IVI items contribute to one underlying theme and tended to confirm two of the five domains: emotional reaction to vision loss and mobility. The first three components explained 43%, 8%, and 6% of the variation in the data. Guttman split-half reliability coefficients between different forms of administration and over time ranged from 0.73 to 0.94 for domain and total IVI scores. Mean absolute difference for domain and total scores between administrations was less than 1 step for all domains and the total score. CONCLUSIONS: This study provides support that the IVI has sufficient internal and construct validity to measure the effect of vision impairment on restriction of participation in daily activities. The IVI demonstrates acceptable reliability over a short period and yields consistent results between interviewers. The IVI can also be self-administered with assurance that the results will be comparable to those that would have been obtained by a trained interviewer. Therefore, the psychometric characteristics of the IVI support its use in assessment of the vision rehabilitation needs of people with impaired vision. Its stability over time indicates that it has potential to evaluate outcomes of intervention.     

Factors related to vision care in an older adult cohort.

PURPOSE: This study provides cross-sectional data on eye care utilization in a community-based adult population. METHODS: Data are from a questionnaire administered during the 7-year follow-up of the Epidemiology of Hearing Loss Study in 2000 to 2002. Participants in the population-based Beaver Dam Eye Study were eligible for the Epidemiology of Hearing Loss Study, which began in 1997. The primary outcome was self-reported vision testing within the past year. RESULTS: Subject ages ranged from 55 to 99 years (n = 2433), and 60.4% were female. Fifty-three percent of subjects reported they had their vision tested in the past year. Diabetes was self-reported by 11.5% of subjects, and 70.9% of diabetic participants had their vision tested in the past year. A current hospitalization or health insurance plan was reported by 98.6% of subjects. In multivariate analyses, self-reported factors significantly associated with having a vision test in the past year were female gender (odds ratio [OR] = 1.27; 95% confidence interval [CI] 1.06-1.52), current use of refractive correction for distance (OR = 1.98; 95% CI 1.56-2.52), glaucoma (OR = 3.52; 95% CI 2.37-5.24), cataract surgery (OR = 1.57; 95% CI 1.21-2.03), age-related macular degeneration (ARMD) (OR = 1.74; 95% CI 1.22-2.47), diabetes (OR = 2.46; 95% CI 1.83-3.31), visiting a primary care practitioner for any reason in the past year (OR = 1.72; 95% CI 1.32-2.25), having a hearing test in the past year (OR = 1.79; 95% CI 1.40-2.28), and the cessation of driving because of poor vision (OR = 1.64; 95% CI 1.16-2.52). In participants 65 years of age or older, having private insurance was associated with increased odds (OR = 3.39, 95% CI 1.82-6.31) of vision testing in the past year. CONCLUSION: This study suggests that chronic ocular conditions, diabetes, health insurance beyond government entitlements, and the use of other healthcare services are associated with increased eye care utilization.     

Assessment of functional vision and its rehabilitation

This article, based on a report prepared for the International Council of Ophthalmology (ICO) and the International Society for Low Vision Research and Rehabilitation (ISLRR), explores the assessment of various aspects of visual functioning as needed to document the outcomes of vision rehabilitation. Documenting patient abilities and functional vision (how the person functions) is distinct from the measurement of visual functions (how the eye functions) and also from the assessment of quality of life. All three areas are important, but their assessment should not be mixed. Observation of task performance offers the most objective measure of functional vision, but it is time‐consuming and not feasible for many tasks. Where possible, timing and error rates provide an easy score. Patient response questionnaires provide an alternative. They may save time and can cover a wider area, but the responses are subjective and proper scoring presents problems. Simple Likert scoring still predominates but Rasch analysis, needed to provide better result scales, is gaining ground. Selection of questions is another problem. If the range of difficulties does not match the range of patient abilities, and if the difficulties are not distributed evenly, the results are not optimal. This may be an argument to use different outcome questions for different conditions. Generic questionnaires are appropriate for the assessment of generic quality of life, but not for specific rehabilitation outcomes. Different questionnaires are also needed for screening, intake and outcomes. Intake questions must be relevant to actual needs to allow prioritization of rehabilitation goals; the activity inventory presents a prototype. Outcome questions should be targeted at predefined rehabilitation goals. The Appendix cites some promising examples. The Low Vision Intervention Trial (LOVIT) is an example of a properly designed randomized control study, and has demonstrated the remarkable effectiveness of vision rehabilitation. It is hoped that further similar studies will follow.     

视觉功能训练在弱视患儿Ⅲ级视功能重建中的作用

重建Ⅲ级视功能.