Visual function assessment in simulated real-life situations in patients with age-related macular degeneration compared to normal subjects

Purpose

To evaluate visual function variations in eyes with age-related macular degeneration (AMD) compared to normal eyes under different light/contrast conditions using a time-dependent visual acuity testing instrument, the Central Vision Analyzer (CVA).

Methods

Overall, 37 AMD eyes and 35 normal eyes were consecutively tested with the CVA after assessing best-corrected visual acuity (BCVA) using ETDRS charts. The CVA established visual thresholds for three mesopic environments (M1 (high contrast), M2 (medium contrast), and M3 (low contrast)) and three backlight-glare environments (G1 (high contrast, equivalent to ETDRS), G2 (medium contrast), and G3 (low contrast)) under timed conditions. Vision drop across environments was calculated, and repeatability of visual scores was determined.

Results

BCVA significantly reduced with decreasing contrast in all eyes. M1 scores for BCVA were greater than M2 and M3 (P<0.001); G1 scores were greater than G2 and G3 (P<0.01). BCVA dropped more in AMD eyes than in normal eyes between M1 and M2 (P=0.002) and between M1 and M3 (P=0.003). In AMD eyes, BCVA was better using ETDRS charts compared to G1 (P<0.001). The drop in visual function between ETDRS and G1 was greater in AMD eyes compared to normal eyes (P=0.004). Standard deviations of test–retest ranged from 0.100 to 0.139 logMAR.

Conclusion

The CVA allowed analysis of the visual complaints that AMD patients experience with different lighting/contrast time-dependent conditions. BCVA changed significantly under different lighting/contrast conditions in all eyes, however, AMD eyes were more affected by contrast reduction than normal eyes. In AMD eyes, timed conditions using the CVA led to worse BCVA compared to non-timed ETDRS charts.     

Visual function and subjective perception of visual ability after macular hole surgery

PURPOSE: To evaluate the functional and anatomical results of macular hole surgery and to explore its effect on patients' Health-Related Quality Of Life (HR-QOL) and to investigate the associations between self-reported HR-QOL and conventional measures of visual function. DESIGN: Case series. METHODS: The National Eye Institute 25-Item Visual Function Questionnaire (VFQ-25) and the 36-Item Short-Form Health Survey (SF-36) were self-administered by 30 patients before and 4 months after macular hole surgery. Preoperative, intraoperative, and postoperative clinical data were collected including visual acuity, contrast sensitivity, and metamorphopsia. Multi-item scales rating different aspects of HR-QOL were compared before and after surgery, and their correlation with traditional methods of outcome evaluation was analyzed. RESULTS: Macular hole closure was achieved in 26 patients (87%). Mean LogMAR visual acuity improved by 6 +/- 10 letters for distance and 7 +/- 12 letters for near. Metamorphopsia was reduced by a mean of 35 +/- 70 squares on Amsler chart, and Pelli-Robson contrast sensitivity decreased by a mean of -0.09 +/- 0.3 log units postoperatively. The VFQ-25 composite score as well as scale scores associated with general vision, near vision, vision-related mental health, and role difficulties were significantly improved (P < .05) after successful closure of macular hole. Conversely out of the eight SF-36 health concepts, limitation in usual role activities because of emotional problems was the only one that significantly improved postoperatively. Both baseline and postoperative best-corrected visual acuity significantly correlated with most of the VFQ subscale scores before and after surgery, respectively. CONCLUSIONS: In this case-series, macular hole surgery appears to have a beneficial effect on patients' subjective perception of visual function. The use of vision-targeted health status questionnaires in conjunction with detailed clinical examination provides a more comprehensive overview of individuals' daily well-being after surgical intervention. Further controlled studies are required to confirm our findings.     

Visual function and vision-related quality of life after macular hole surgery with short-duration, 3-day face-down positioning

Objective

To investigate the relationship of vision-related quality of life (VRQOL) and visual function in patients undergoing macular-hole (MH) repair with and without cataract surgery and short-duration, 3-day prone posturing. Previous communications have assessed VRQOL in European and Japanese populations, but this is the first study to investigate VRQOL after MH surgery in a Canadian population.

Design

Prospective interventional case series.

Participants

We studied 20 consecutive eyes in 19 patients with stage 2 and 3 idiopathic macular holes. Of those, 15 received combined cataract and MH surgery, and 5 received MH repair alone.

Methods

Patients completed the self-administered National Eye Institute 25-item Visual Function Questionnaire before and after surgery. All patients received full ocular examinations pre- and postsurgery. Along with the questionnaire scores, we examined macular-hole closure rates, complications, postoperative visual acuity, and intraocular pressure.

Results

Macular-hole closure was achieved in 20 of 20 eyes (100%). Mean postoperative logMAR decreased (i.e., improved) by −0.303 (95% CI, −0.501 − −0.105, p = 0.0047). The Visual Function Questionnaire composite score rose from 82.019 ± 12.612 SD to 88.499 ± 7.963 SD (p = 0.012). Subscale scores, including general vision, near activities, mental health, role difficulties, and dependency were all significantly improved (p < 0.05). No complications or intraocular pressure increases were observed.

Conclusions

Macular-hole surgery followed by short-duration, 3-day face-down positioning significantly improved VRQOL and visual acuity in a group of Canadian patients. The use of VRQOL tools alongside anatomic outcomes provide a more comprehensive overview of patients' experiences and satisfaction after surgical intervention.     

Visual function and quality of life in Korean patients with glaucoma

The relationship between visual acuity, the level of visual field impairment, visual functioning, and the quality of life was evaluated in Korean patients with glaucoma. Forty-three consecutive glaucoma patients from the glaucoma service at Severance Eye and Ear Hospital were included in this study. Each subject underwent a vision-specific functional status questionnaire (VF-14), a modified VF-14 (VF'-14) and general quality-of-life questionnaires of the Medical Outcomes Study 36-Items Short Form Health Survey (SF-36). The visual acuity and visual field measurements with a Humphrey automated perimeter were taken within one month of the initial visit. The mean age of the subjects was 57.9 +/- 17.8. Among these patients, there were 23 males and 20 females. The mean deviation (MD) and the corrected pattern standard deviation (CPSD) by the automated perimeter in the eye with the better visual acuity were -5.87 +/- 5.16 dB and 3.92 +/- 2.74 dB respectively. The VF-14 and SF-36 scores were 41.28 +/- 14.56 and 52.39 +/- 6.61 respectively. There were significant correlations between the VF-14, VF'-14, and the MD of the better eye (p < 0.05). In Korean patients with glaucoma, the VF-14 and VF'-14 have significant relationship with the MD of the better eye in the visual field.     

高度近视黄斑裂孔性视网膜脱离术后视功能及视觉相关生存质量分析

目的　评估高度近视黄斑裂孔性视网膜脱离患者术后视功能和视觉相关生存质量（visual-related quality of life,VRQoL）,并分析VRQoL与视功能之间的相关性。方法　回顾性分析2012年3月至2016年5月于上海交通大学附属第一人民医院行23G玻璃体切割联合内界膜剥除及硅油填充术的高度近视黄斑裂孔性视网膜脱离患者63例（63眼）术前及术后6个月的临床资料。记录主要观察指标,包括最佳矫正视力、对比敏感度。患者填写美国国家眼科研究院开发的视功能相关生存质量量表（visual function questionnaire-25,VFQ-25）中文版。比较患者手术前后VFQ-25总得分以及各维度得分,并分析其与视功能的相关性。结果　63例患者中60眼（95.24%）视网膜复位,术后6个月术眼平均logMAR视力（0.83±0.25）较基线logMAR视力（1.76±0.43）显著提高,差异有统计学意义（P<0.05）。术后术眼对比敏感度:1.5 c·d^-1为1.25±0.28,3 c·d^-1为1.27±0.31,6 c·d^-1为1.03±0.27,12 c·d^-1为0.71±0.23,18 c·d^-1为0.32±0.13。术后6个月患者VFQ-25总得分均值为（66.13±11.28）分,较术前［（50.07±14.42）分］显著提高,差异有统计学意义（P<0.05）。术后VFQ-25总得分和术眼最佳矫正视力无相关性,与双眼平均视力、术眼中空间频率（6 c·d^-1、12 c·d^-1）对比敏感度呈正相关。结论　高度近视黄斑裂孔性视网膜脱离患者术后视网膜复位率高,视力显著提高。术后患者VRQoL提高,并与双眼平均视力、术眼中空间频率对比敏感度相关,与术眼视力无显著相关性。     

Clinical outcome and subjective quality of life after photodynamic therapy in patients with age-related macular degeneration

PURPOSE: Whereas the efficacy of photodynamic therapy (PDT) in preventing the progression of age-related macular degeneration (ARMD) is established, its effect on quality of life is under discussion. METHODS: All patients who underwent PDT during 2000 and 2001 at the University Eye Hospital of Mainz were interviewed using a standardized 82-item questionnaire on quality of life and patient satisfaction in ophthalmologic patients. Information was assessed in terms of 82 questions; global scores ranging from 1.0 (optimum self-estimated quality of life) to 4.0 (worst) were derived. Cataract patients' scores were used to characterize the ARMD patients' subjective outcome; the latter were then related to clinical outcome parameters via logistic regressions. RESULTS: A total of 84 patients (50% female, median age 77 years) were interviewed, who underwent a median of three PDT interventions. During the period of PDT treatment, their median decrease in visual acuity was 3 lines from 0.125 to 0.063. Patients who reported a subjective increase in visual function during this period showed a median private flexibility score of 1.86; patients with the subjective impression of visual function decrease, a median score of 2.71; the median scores for mobility were 2.00 versus 3.00, for flexibility in reading 1.91 versus 3.64, for psychological stress 1.56 versus 2.25, and for communicational flexibility 1.72 versus 2.25. The difference in reading flexibility was statistically significant (p=0.001) after correction for clinical cofactors. CONCLUSIONS: The established clinical benefit of PDT treatment concerning its efficacy in ARMD progression prevention coincides with an at least slight subjective benefit in quality of life and patient satisfaction. However, the latter is associated with the patients' subjective impression of visual acuity progression rather than with clinically validated outcome after PDT treatment.     

康柏西普治疗糖尿病性黄斑水肿的视觉功能和视觉质量

目的:评价康柏西普注射液治疗糖尿病性黄斑水肿患者的视觉功能和视觉质量。方法:观察2018-02/2021-02连续3mo接受康柏西普治疗的糖尿病性黄斑水肿患者38例43眼。分析对比敏感度(CS)从基线到治疗12wk的平均变化,比较治疗前后最佳矫正视力(BCVA)、视网膜中央厚度(CRT)和视觉功能问卷(NEIVFQ-25)评分。结果:玻璃体腔注射康柏西普注射液后,CS从基线的1.060±0.14增加到治疗12wk的1.47±0.31(P<0.05)。基线时BCVA(LogMAR)为0.535±3.32,治疗12wk时为0.333±0.11(P<0.05)。基线时CRT为369.45±36.42μm,治疗12wk时降至226.53±39.48μm(P<0.05)。CRT与BCVA测量变化及CS的改善均无相关关系。患者30例(79%)从基线至第12wk,NEIVFQ-25综合评分总体改善,6例(16%)无变化,2例(5%)综合评分总体下降。结论:康柏西普注射液治疗糖尿病性黄斑水肿,可明显改善患者的视功能,提高视觉相关生活质量。     

Visual quality of life after macular hole surgery: outcome and predictive factors

BACKGROUND: In the present study we evaluated the functional success after macular hole surgery in correlation to visual quality of life and looked for predictive factors determining surgical success. METHODS: Fifty-nine patients that underwent pars plana vitrectomy for idiopathic macular hole were included. Follow-up visits were performed in regular intervals after surgery and included a clinical examination, optical coherence tomography (OCT) and measurement of visual acuity. To assess the visual quality of life patients filled out the National Eye Institute 25-item Visual Function Questionnaire (VFQ-25) before and three months and one year after surgery. RESULTS: Macular hole closure was achieved in 57 of 59 patients (97%). Mean visual acuity increased from 20/100 preoperatively to 20/34 one year after surgery (p = 0.02). Despite good visual acuity (20/27) in the fellow eye, visual quality of life (VFQ composite score) rose from 75.9 +/- 14.4 (SD) to 81.5 +/- 14.2 one year after surgery (p<0.001). Although there was no correlation between the increase in visual quality of life and visual acuity, the increase in VFQ-25 could be well predicted: low visual acuity and significant impairment on VFQ-25 testing preoperatively made patients most likely to benefit from macular hole surgery. A relatively high retinal thickness measurement at the hole border measured on OCT further increases the predictive value. CONCLUSION: Macular hole surgery is associated with an increase in visual quality of life despite good visual acuity of the fellow eye. Preoperative visual acuity, VFQ-25 value and partly OCT may help to predict the increase in patients' vision related quality of life after surgery.     

Visual function and vision-related quality of life after vitrectomy for idiopathic macular hole:a 12mo follow-up study

AIM: To investigate the visual function and the relationship with vision-related quality of life (VRQOL) after macular hole repair surgery．METHODS: Prospective case series. Thirty-six consecutive eyes in 36 patients who underwent pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling were included. The 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) was answered by the participants before and 3 and 12mo after operation. Follow-up visits examinations included best-corrected visual acuity (BCVA), clinical examination, and central macular thickness (CMT) measured by optical coherence tomography (OCT).RESULTS: Macular-hole closure was achieved in 35 of 36 eyes (97.2%). At baseline and months 3 and 12, the logMAR BCVAs (mean±SD) were 1.15±0.47, 0.68±0.53 (P<0.0001 versus baseline), and 0.55±0.49 (P<0.001 versus baseline, P =0.273 versus month 3), respectively; the CMTs (μm) were 330±81, 244±62 (P<0.001 versus baseline), and 225±58 (P<0.001 versus baseline, P=0.222 versus month 3), respectively; the median preoperative VFQ-25 composite score of 73.50 (63.92-81.13) increased postoperatively to 85.50 (80.04-89.63) at 3mo (P<0.001) and 86.73(82.50-89.63) at 12mo (P<0.001) respectively. The improved BCVA was correlated with improvements in five subscales (r=-0.605 to -0.336, P<0.001 to P=0.046) at 12mo.CONCLUSION: PPV with ILM peeling improved anatomic outcome, visual function, and VRQOL. The improved BCVA was an important factor related to the improved VRQOL.     

年龄相关性黄斑变性患者治疗后视功能及生活质量评价

目的：评估由雷珠单抗转为康柏西普治疗的年龄相关性黄斑变性(ARMD)患者治疗后视功能及生活质量情况。

方法：选取2016-01/2017-08我院收治的因雷珠单抗治疗疗效不佳转为康柏西普治疗的新生血管性ARMD患者20例29眼,比较行玻璃体腔注射康柏西普治疗前和治疗第4mo患者最佳矫正视力(BCVA)、对比敏感度(CS)、中央视网膜厚度(CRT)及生活质量评分情况。

结果：治疗第4mo,患者BCVA较治疗前改善,差异有统计学意义(P<0.05); OCT检测CRT较治疗前降低,差异有统计学意义(P<0.05); 各空间频率CS均较治疗前改善,差异均有统计学意义(P<0.05); NEI VFQ-25评分总分及各项目评分均较治疗前提高,差异均有统计学意义(P<0.05)

结论：玻璃体腔注射康柏西普治疗ARMD可明显改善患者的视功能和生活质量。     

Visual evoked potentials in macular disease

Although a delayed visual evoked potential is considered to be the hallmark of optic nerve disease, relatively little has been published about VEP delays in macular disease. In this study, 20 patients with either acquired unilateral maculopathy or bilateral maculopathy in which one eye was more affected than the other were evaluated. VEP amplitudes and peak latencies were compared between eyes when recordable. Nine patients (45%) exhibited significant interocular delays in the affected or more affected eye while only four patients (20%) exhibited significant interocular attenuations in amplitude. In the nine patients exhibiting delays, three patients had a visual acuity of 20/30 or better in the affected eye or more affected eye. In the patients exhibiting amplitude attenuations, no patient had a visual acuity better than 20/50 in the affected or more affected eye. Although the mechanism of VEP delays in maculopathy is not clear, a VEP delay, in isolation of other tests, should not be used in the differential diagnosis of macular vs optic nerve disease. The clinician should specifically rule out macular disease in any patient with a delayed VEP before presuming the presence of a visual pathway dysfunction.     

Associations between subjective and objective visual function in patients with unilateral macular holes

Forty-six patients with uniocular macular holes and unaffected, fellow eyes were studied to evaluate inter- and intraocular associations between various objective tests of visual function and perceived visual ability. The affected eye had significant associations between visual acuity (VA) and the fovea threshold test, but for the fellow eye only VA and low-contrast VA 10% were associated. The reduction in visual acuity under low-contrast conditions relative to high-contrast did not differ between the affected eye and the healthy eye. Subjective visual ability seems to depend more on the visual acuity of the affected eye than the healthy eye.     

Influence of photodynamic therapy for age related macular degeneration upon subjective vision related quality of life

Background Photodynamic therapy (PDT) has been used in the treatment of choroidal neovascularisation secondary to age-related macular degeneration (AMD). This study prospectively investigated patients’ subjective change in visual function following PDT as treatment for AMD.Methods Eighty-two consecutive patients receiving PDT in Tasmania, Australia, between May and November 2003 were recruited. In conjunction with a comprehensive clinical examination, the Visual Function-14 (VF-14) questionnaire was administered. Final follow-up occurred between February and March 2005. The VF-14 was scored by traditional summary scoring and by Rasch analysis.Results Five of the 82 (6.1%) subjects recruited were excluded from analysis. PDT was performed on average 5.7±2.6 times per patient. Raw VF-14 scores tended towards being significantly lower at follow-up than at baseline (67.6±27.2 against 64.5±27.7; P=0.052), and did significantly deteriorate using a collapsed Rasch analysis (P=0.0102). Following treatment, 38 (47.5%) eyes had lost three or more Snellen lines of best-corrected visual acuity.Conclusion Patients undergoing PDT typically report reasonable visual function. In parallel with visual acuity, self-reported visual function may deteriorate slightly after PDT for AMD, but not as much as reported in untreated AMD.The authors have no commercial interest or conflicts of interest in this publication     

Vision-related quality of life in patients with idiopathic macular hole

International Ophthalmology -     

特发性黄斑裂孔的视功能

随着玻璃体手术的飞速发展,特发性黄斑裂孔日益受到重视。另外,以往临床上一直作为评价术后疗效主要指标的裸眼及最佳矫正视力,已很难涵盖视觉质量的全部内容。本文介绍对比敏感度、视野、多焦点视网膜电图、立体视功能等现代视功能检查及其在特发性黄斑裂孔中的应用和临床意义,以及手术对其视功能的影响。这些检查不仅对特发性黄斑裂孔的早期诊断、手术适应证把握及术后视觉质量的评价有重要指导意义,而且有助于客观分析术后患者主观视觉质量差的原因并加以处理。熟悉视功能评价的内容和意义,有助于提高此类黄斑裂孔的手术水平,使患者获得更好的术后视觉质量。     

Visual function and performance with blue-light blocking filters in age-related macular degeneration

Purpose: Some dispute has occurred over the use of blue‐light‐attenuating intraocular lenses in age‐related macular degeneration (AMD), as they may reduce scotopic vision. This study aimed to determine if a blue blocking filter would affect performance during eye–hand coordination and mobility tasks in scotopic illumination, psychophysically measured scotopic sensitivity or colour discrimination in AMD patients. Methods: Scotopic measures performed with and without a blue‐attenuating filter included a mobility obstacle course, manipulation of cylindrical blocks and a psychophysical dark‐adapted full‐field flash test. A navy and blue sock colour sorting task evaluated photopic colour discrimination. Subjects were 22 bilateral pseudophakes with early AMD and visual acuity >6/24. Results: On average with the filter, there was a 13% increase in time during the block test. The differences in time and number of bumps with versus without the filter were not significant for the mobility course. Performance with and without the filter was well correlated for the blocks (r = 0.70), flash test (r = 0.83) and mobility (r = 0.66), and the regression slopes were not significantly different from unity. 77% of subjects misidentified at least one navy sock as black with the filter compared with 9% without, with a significant increase in such misidentifications with the filter. Conclusions: The difference in scotopic visual function or performance with versus without a blue‐blocking filter most likely does not produce a clinically significant effect or risk; however, detection of navy colour may be impaired.