Disadvantageous course of ophthalmological changes in young women with long-lasting diabetes mellitus followed by the symptoms of anorexia nervosa

PURPOSE: To present the course and progression of very severe proliferative retinopathy in young women with long lasting diabetes mellitus and symptoms of anorexia nervosa. MATERIAL AND METHODS: The data of 5 young women, in age 25-32 years, suffering from diabetes mellitus 15 to 29 years with intended weight lose. The progression of ophthalmological changes was observed, followed by considerable fluctuations of glucose blood. RESULTS: In the time of weight lose in all patients, the worsening of the visual acuity was observed and it was the first reason for ophthalmological check-up. The initial best corrected visual acuity was 0.1-0.9. The rubeosis of the iris, cataracts and proliferative retinopathy with intravitreal hemorrhage and tractional retinal detachment were observed. Despite the immediate ophthalmological treatment (lasertherapy, pars plana vitrectomy, criopexy and retinopexy) the useful visual acuity (>0.1) was maintained only in one eye. CONCLUSIONS: 1. In case of significant exacerbation of progression of ophthalmological changes in patients with long lasting diabetes mellitus and anorexia nervosa the monitoring of their psychological and physical conditions is essential. 2. In the case of weight lose in patients with long lasting diabetes mellitus the rigorous ophtalmological monthly consultations are obligate.     

唐山地区糖尿病低视力患者的现状调查及相关危险因素研究

目的：调查唐山地区糖尿病低视力患者的发病现状,并对致病的危险因素进行探讨。

方法：采用抽样调查的方式选择2016-01/12唐山地区2 000例糖尿病居民为研究对象,对其进行视力检查,观察统计唐山地区糖尿病低视力的发生率。将糖尿病低视力患者纳入观察组,另取2倍病例数的糖尿病正常视力患者为对照组,采用Logistic 回归分析对两组患者相关病史资料进行调查,分析导致低视力危险因素。

结果：参与视力检查的2 000例糖尿病患者中,共有189例276眼患者视力低下,发生率为6.90%,其中单眼视力低下患者102例102眼(2.55%),双眼视力低下87例174眼(4.35%)。经Logistic多因素回归分析显示,糖尿病患者的年龄、病程、视网膜病变程度是糖尿病患者视力低下的主要危险因素。

结论：唐山地区糖尿病患者并发视力低下的发生率较低,糖尿病患者的年龄、病程、视网膜病变是导致视力低下的主要原因。因此,加强对高龄、病程长、视网膜病变的糖尿病患者的视力检查,进行早期及时有效地防治,可减少对患者视力的损伤。     

Farnsworth-Munsell 100-hue test for patients with diabetes mellitus.

We evaluated 164 eyes of 87 patients with diabetes mellitus compared with 50 eyes from 25 healthy subjects as the control group. We compared 87 patients with diabetes mellitus (164 eyes) in relation to their duration of diabetes, fundus findings, visual acuity, and color vision defects. In all patients, color vision defects were determined using the Farnsworth-Munsell 100-hue test, and the total error score was established on the basis of age norms from subjects without diabetes. No color vision defect was detected in the control group. In the diabetic group, fundus degeneration and color vision defects were observed and correlated with the duration of diabetes. The dominant color defect was of the blue-yellow type.     

The role of color vision disturbances in diagnostics of early diabetic retinopathy

PURPOSE: The evaluations of color vision sensitivity in children with type I diabetes mellitus without retinopathy. MATERIAL AND METHOD: We examined 96 young patients. They was divided into three groups: I: 35 children from 7 to 16 years old with insulin-dependent diabetes mellitus duration of 1-8 years, II: 30 children with type I diabetes lasting more then 8 years, III--31 non-diabetic subjects as a control-matched for age and sex, without visual or systemic symptoms. The examinations of colour vision sensitivity were done with the IF-2AII-color Anomaloscope. In all cases were tested the dynamic blue-green equation of Moreland and two variables were determined: setting (matching) range (SR), calculated mid point (matching mid point) (CMP). RESULTS: In the blue-green equation setting range (SR) was significantly (p < 0.01) enlarged in the II group (diabetes mellitus duration > 8 years) and calculated mid point (CMP) was shifted but no significant. The results indicate a diminution of the colour discriminating sensitivity in the short wavelength half of the visible spectrum and diminution of the blue cone sensitivity in early diabetic retinopathy. CONCLUSIONS: Blue-green colour vision testing with the anomaloscope may serve as an additional test in the diagnosis of early diabetic retinopathy in children without vascular changes at the eye fundus.     

Ophthalmologic findings in fifteen patients with Wolfram syndrome

PURPOSE: To look for ophthalmologic abnormalities in 15 patients with Wolfram syndrome, also known as DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and deafness). METHODS: Fifteen patients from four inbred families diagnosed as having Wolfram syndrome at the National Center for Diabetes, Endocrinology and Genetics, in Amman, Jordan, were evaluated ophthalmologically. Their examination included best-corrected visual acuity, color vision testing, pupillary light reflexes, slit-lamp biomicroscopy and fundus examination. Fundus fluorescein angiography was done in all patients. RESULTS: The prevalence of optic atrophy was (93.3%), colordefect (92.9%), cataract (66.6%), pigmentary retinopathy (30%) and diabetic retinopathy (20%). Abnormal pupillary light reflexes and nystagmus were also reported. CONCLUSIONS: Although ourgroup of patients was genetically heterogeneous, the ophthalmic findings are consistent with those reported in other series, except for cataract which was highly prevalent but mild and did not contribute significantly to loss of vision.     

严重增殖性糖尿病视网膜病变患者术后疗效及影响因素

目的：分析严重增殖性糖尿病视网膜病变(PDR)玻璃体手术后的疗效及影响因素。

方法：将2015-01/2018-01我院收治的PDR Ⅵ期患者(94例112眼)按OCT情况分为黄斑病变组(61例70眼)与无黄斑病变组(33例42眼),比较两组随访6mo视力、黄斑区P1波振幅密度和视网膜复位情况,以视力改善作为疗效评估标准,分析PDR Ⅵ期术后疗效和影响因素。

结果：无黄斑病变组术后6mo视力分级优于黄斑病变组(P<0.05)。术后6mo黄斑病变组(1+2)环P1波振幅密度低于无黄斑病变组(P<0.05)。所有患者中,患眼1次手术视网膜解剖复位95眼(84.8%),2次复位10眼(8.9%),3次复位2眼(1.8%),4次复位1眼(0.9%),未复位4眼(3.6%),总复位率96.4%。合并黄斑病变、长糖尿病病程患者视力改善有效率低于未合并黄斑病变、短糖尿病病程者(P<0.05),合并黄斑病变、糖尿病病程均为影响严重PDR患者术后疗效的独立因素(P<0.05)。

结论：玻璃体切割术可改善PDR Ⅵ期患者术后视力,术前合并显著黄斑病变和糖尿病病程是影响严重PDR患者术后疗效的重要因素。     

Comprehensive functional vision assessment of patients with North Carolina macular dystrophy (MCDR1)

PURPOSE: Previous studies indicated abnormal development of fixation toward the optic nerve head in patients with the inherited retinal disease North Carolina macular dystrophy (NCMD). The implication of this development on functional vision and structural characteristics has not been described. METHODS: The anatomical characteristics of five NCMD-affected individuals were assessed by measuring the retinal thickness of the macula using optical coherence tomography. The underlying physiologic health of the retina was assessed using the multifocal ERG. Psychophysical assessment of remaining vision in the affected areas was done with a new microperimetry system that measures functional visual acuity at 27 discrete locations and the Humphrey visual field analyzer. RESULTS: All patients had better areas of visual sensitivity toward the nasal macula. Follow-up examination showed no changes in the clinical appearance of the retina. Visual acuities ranged from -0.10 logMAR (Snellen equivalent, approximately 20/16) to 0.50 logMAR (Snellen equivalent, approximately 20/63) in the better eye. No significant changes in visual acuity were found over time. Local multifocal electroretinogram deficits were found in all patients. Patients with grade 2 or 3 disease had large patches of decreased amplitudes and delayed implicit times. Results of the anatomical, electrophysiological, and psychophysical tests were consistent. CONCLUSION: The electrophysiological and psychophysical deficits found in patients with more severe disease were consistent with an abnormal development of fixation from the anatomical fovea toward the optic nerve head with the placement of the lesion temporal to fixation (into the nasal visual field).     

Detection of latent disorders of visual function during ambulatory care of children

For the purpose to select tests for diagnosis of latent disturbances of visual functions, dynamic observation was conducted over 88 healthy school children within 5 years (from the 3d to the 8th form). Once a year, the children underwent examination of visual acuity for far and near, the state of binocular vision on a synoptophore and a color test, the volume of relative and absolute accommodation, muscular balance of eyes for far and near, contrast sensibility, the time of perception of the negative successive contrast, refraction. For the period of 5 years, 7 children developed myopia of low degree, 32 showed transitory or lasting reduction of visual acuity due to spasm of accommodation. The authors believe that the most rapid and informative tests for diagnosis of latent disturbances in accommodation-convergence system are visual acuity for near, the volume of absolute accommodation, the threshold of remote vision, muscular balance of eyes for near. It is recommended to use these tests widely when conducting ophthalmologic thorough prophylactic examinations of children.     

The relation between visual acuity,fixation stability,and the size and location of foveal hard exudates after photocoagulation for diabetic maculopathy

PURPOSE: To study the relation between changes in visual acuity, fixation stability and the retinal area covered by hard exudates 3, 6 and 12 months after laser photocoagulation for diabetic maculopathy. METHODS: Twenty-four eyes of 24 patients with diabetes mellitus were examined 3, 6 and 12 months after retinal photocoagulation for clinically significant macular oedema. Each examination included visual acuity testing (ETDRS charts), quantification of fixation stability using a scanning laser ophthalmoscope (Rodenstock 101) and fundus photography. The fundus photographs were digitised and the retinal area covered by hard exudates determined by image processing. RESULTS: The retinal area covered by hard exudates decreased significantly during the first 6 months after treatment ( P=0.05, paired t-test), but increased again between 6 and 12 months after treatment. The visual acuity showed an increase, albeit non-significant, during the first 6 months after treatment followed by a decrease between 6 and 12 months after treatment. Quantification of fixation stability showed that four patients with central exudates fixated at the border of these lesions, and in two of these patients the disappearance of the exudates resulted in increased visual acuity and a change in fixation to the former exudate area. CONCLUSIONS: The retinal area covered by hard exudates decreases during the first 6 months after central photocoagulation, but increases again between 6 and 12 months after the treatment. Hard exudates covering the foveal region contribute to disturbance of central vision.     

Color vision impairment in type 2 diabetes assessed by the D‐15d test and the Cambridge Colour Test

Color vision impairment emerges at early stages of diabetes mellitus type 2 (DM2) and may precede diabetic retinopathy or the appearance of vascular alterations in the retina. The aim of the present study was to compare the evaluation of the color vision with two different tests – the Lanthony desaturated D‐15d test (a traditional color arrangement test), and the Cambridge Colour Test (CCT) (a computerized color discrimination test) – in patients diagnosed with DM2 without clinical signs of diabetic retinopathy (DR), and in sex‐ and age‐matched control groups. Both color tests revealed statistically significant differences between the controls and the worst eyes of the DM2 patients. In addition, the degree of color vision impairment diagnosed by both tests correlated with the disease duration. The D‐15d outcomes indicated solely tritan losses. In comparison, CCT outcomes revealed diffuse losses in color discrimination: 13.3% for best eyes and 29% for worst eyes. In addition, elevation of tritan thresholds in the DM2 patients, as detected by the Trivector subtest of the CCT, was found to correlate with the level of glycated hemoglobin. Outcomes of both tests confirm that subclinical losses of color vision are present in DM2 patients at an early stage of the disease, prior to signs of retinopathy. Considering the advantages of the CCT test compared to the D‐15d test, further studies should attempt to verify and/or improve the efficiency of the CCT test.     

Glycemic control and lens transparency in patients with type 1 diabetes mellitus

PURPOSE: To assess quantitatively the cumulative effect of hyperglycemia on lens transparency in patients with juvenile type 1 diabetes mellitus. METHODS: Subjects were 30 patients (30 eyes) with type 1 diabetes mellitus who had well-documented records on the duration of diabetes mellitus and condition of glycemic control from the onset. They were 35 years of age or younger (mean, 26.0 years), had a history of type 1 diabetes mellitus at least 5 years (mean, 8.4 years), had corrected visual acuity of 20/20 or better, and showed no clinically apparent cataract on slit-lamp examination. Twenty-one eyes of 21 subjects served as age-matched normal controls. They were 35 years of age or younger (mean, 25.7 years), had no diabetes mellitus, had corrected visual acuity of 20/20 or better, and showed no signs of cataract on slit-lamp examination. The degree of lens opacity was quantified using the anterior eye segment analysis system based on the Scheimpflug principle. An index was created to represent the cumulative effect of long-term glycemic control (hyperglycemic accumulation) by multiplying the average hemoglobin A(1c) value and the number of months from the onset. RESULTS: The patients with diabetes mellitus exhibited significantly greater degree of lens opacity than the normal controls (P =.017, Mann-Whitney U-test). Among the patients with diabetes mellitus, the lens opacity was greater in eyes with retinopathy than those without retinopathy (P =.011). Multiple regression analysis revealed that only the index of hyperglycemic accumulation significantly correlated with the degree of lens opacity (P =.042). CONCLUSION: Accumulated effect of hyperglycemia is related to the lens transparency in patients with diabetes.     

Untersuchungen zur Validität eines webbasierten Farbsehtests für Screeninguntersuchungen des Farbensehens

BACKGROUND: With standardized examination conditions, a web-based color vision test using pseudoisochromatic color plates can deliver test results comparable to those yielded by conventional color vision tests. The aim of the study is to analyze to what extent a web-based color vision test can be used as a screening test on the internet after visual monitor calibration. METHODS: A German-language web-based color vision test with 25 pseudoisochromatic color plates based on the color plates of Velhagen and Broschmann and of Ishihara was developed, which can be seen at http://www.farbsehtest.de. Volunteers were recruited by means of specific information distributed on the internet, in various print media, and on the radio. RESULTS: Over a period of 12 months, 2,126 of the initial volunteers [541 women and 1,588 men; mean age 34.27 (+/-14.1) years] with a valid test result for 25 color plates performed the web-based color vision test, 1,700 (506 women and 1,194 men) of whom passed it. Of the 426 volunteers who did not pass the test, 32 were women and 394, men. Counter-testing was performed on 101 volunteers (34 women and 67 men) with a mean age of 36.74 (+/-11.6) years. CONCLUSIONS: The results recorded in the patients who underwent counter-testing suggest that, if handled correctly, the web-based color vision test can be used as a color vision screening test on the internet.     

不同检测方法预测白内障术后视力的观察

目的 评价各种检测方法在预测白内障术后视功能恢复的作用。方法 白内障197例(214眼)术前行闪光视网膜电图(F-ERG)、闪光视诱发电位(BVEP)、视网膜计、光定位、色觉及注视性质等综合检测，术后3月复查最佳矫正视力。结果 术前F—ERG的b波、F—VEP的P1波、潜视力、色觉均与术后视力存在显著相关性，其中F-ERG、F—VEP、潜视力预测术后视力的可靠性分别为62．6％、79．0％、60．6％。但排除白内障完全成熟及高龄者(超过80岁)，潜视力预测的可靠性则达82．6％。结论 对于非完全成熟及非高龄者，视网膜计是术前预测白内障术后视力比较理想的方法，而对于完全浑浊及高龄者，视网膜计检查结果的准确性欠佳，应结合F-ERG、F-VEP、色觉及注视性质等多方面因素进行综合讲价。     

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.     

Color vision defects after central serous chorioretinopathy

PURPOSE: To reexamine patients diagnosed with central serous chorioretinopathy (CSC) during the 10-year period from 1987 to 1996 to identify remaining color vision defects in the eyes with normal visual acuity (VA). METHODS: Thirty-nine patients were found with normal VA of 20/20 (logMAR 0) or better 8 to 166 months (mean +/- SD, 58.8 +/- 41.2) after active CSC. Color vision was examined with the Standard Pseudoisochromatic Plates part 2, Farnsworth-Munsell 100 hue test, and Color Vision Meter 712 anomaloscope. RESULTS: Of the CSC eyes, 26 (67%) had a color vision defect, most of them in the blue area. There was no correlation between the time since the active disease and the results on the color vision tests. Of the contralateral eyes, 19 (49%) also had a color vision defect. CONCLUSION: In many patients some degree of color vision defect remains after CSC even if the VA has recovered to normal. The contralateral eye can also have a color vision defect. This has not been previously reported and might be due to earlier subclinical CSC.     

非动脉炎性前部缺血性视神经病变临床特征及相关因素分析

目的: 探讨非动脉炎性前部缺血性视神经病变(nonarteritic anterior ischem icoptic neuropathy,NAION)的临床特点、治疗效果、视力预后以及影响因素。方法: 采用回顾性病例分析方法,收集2006-01/2009-12在我院诊治的NAION患者116例116眼临床资料,分析其发病特点、眼底表现和荧光素眼底血管造影改变、治疗前后视力变化以及相关危险因素,治疗方法包括控制全身疾病、全身应用扩张血管药物、神经营养药物或糖皮质激素治疗。结果: 所有患者中,男65例,女51例;平均发病年龄为56.4±9.8岁。所有患者眼底均表现为视乳头水肿和边界不清,部分患者伴有视乳头旁出血。视野检查多表现为水平视野缺损,以下方或鼻下方视野缺损常见(53.7%)。荧光素眼底血管造影早期表现为视乳头部分血管荧光素充盈延缓,晚期表现为视乳头弥漫性强荧光和荧光素渗漏。经系统治疗后所有患者视乳头水肿消失,遗留有视乳头颜色变淡。116例116眼患者的初诊平均最佳矫正视力为0.52±0.21,治疗后末次随访最佳矫正视力为0.68±0.20,治疗后平均视力有显著提高(t=10.61,P=0.000)。治疗后多数患者的视野缺损有明显好转或稳定,视野缺损扩大者17眼(14.7%)。116例患者中伴发心脑血管疾病者72例(62.1%),其中高血压病52例(44.8%),糖尿病27例(23.3%)。经Logistic回归分析发现,患者最终视力低下(0.5及以下)与初诊时视力低下(0.5及以下)、糖尿病病史和老龄(60岁以上)密切相关,未发现与性别、高血压病史等因素有关。结论: 中老年人高血压病或糖尿病是NAION的常见发病危险因素,正确诊断和及时治疗可有效改善视乳头缺血状态,提高患者视力和改善视野缺损状态。     

No effects of long-term sildenafil treatment on ocular functions

Purpose Sildenafil is a new and effective oral medication for the treatment of erectile dysfunction. The purpose of this study was to assess the long-term effects of sildenafil on visual acuity, color vision, intraocular pressure (IOP), electroretinography (ERG), blue-on-yellow and white-on-white Humphrey visual field (HVF), and tear functions. Methods Ten impotent patients ingested 50 mg of sildenafil one or more times a week for a minimum of 3 months. Ten age-matched subjects without any ophthalmological disorders other than refractive problems served as controls. Visual acuity (Snellen), color discrimination (Ishihara), and a slit-lamp examination were performed on the patients. Cotton thread and Schirmer I tests and tear break-up time were applied to random eyes of all subjects. IOP was measured in both eyes of the patients by Goldmann applanation tonometry. Both eyes of each subject were tested with white-on-white (fastpac 30-2, size 3 stimulus) followed by blue-on-yellow (fastpac 30-2, size 5 stimulus) HVF analyzer. ERG in scotopic (dark-adapted) condition was performed with unipolar corneal electrodes and rod response was recorded. Results In comparison with control, no clinically or statistically significant differences were detected in the patients ingesting sildenafil with regard to the visual acuity, color discrimination, IOP, mean deviation, cotton thread and Schirmer I tests, tear break-up time, amplitude, and implicit time of b-wave. Conclusion Long-term treatment with sildenafil did not produce any significant abnormality on ocular functions. Repeated exposures of ocular tissues to therapeutic doses of sildenafil are unlikely to impair their functions. The authors do not have any significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes, unlabeled, unapproved, or investigative products or devices.     

Visual function tests on the Internet--sense or nonsense?

BACKGROUND: The quantitative capability of the visual system can be tested using graphic presentations with defined size, form and color. For presentations, a chart projector or monitor can be used. Today, the number of visual function tests on the Internet is increasing constantly. Options and limitations of visual function tests using the METHODS: Internet and the authors' own test results are described. RESULTS: Several visual function tests, such as visual acuity tests, the Amsler-Grid, stereo and color vision tests, can already be given via Internet. The variability of the tests ranges from the simple presentation of graphic elements to the laboriously programmed interactive input by the user to specify the test result. Under standardized examination conditions, there was a very high correspondence between the results of the authors' own web-based color vision test and those of luminescence color test plates and conventional pigment color plates. CONCLUSIONS: However, the interpretation of the test results is difficult due to the absence of controls during the test as well as the heterogeneity of the hardware. In order to obtain comparable test results, differences in size and resolution as well as in brightness, contrast and color of computer monitors must be taken into consideration. Due to the deficits described in the tests, the value of visual function tests on the Internet is rather limited. Currently, the data of test distributers with respect to the test conditions are all still insufficient. Standards need to be defined for Internet-based visual function tests. However, visual function tests on the Internet can achieve test results comparable to those of conventional visual function tests under standardized examination conditions in clinical practice. Further studies are needed to check the accuracy of web-based screening examinations in ophthalmology.     

Evaluation of state of the organ of sight in patients with diabetes type II

PURPOSE: To evaluate the state of eyes in patients with diabetes type 2, and to gain current data about the presence of diabetic retinopathy, cataract, prevalence of particular types of retinopathy and percentage of people treated with laser photocoagulations. MATERIAL AND METHODS: The study included 1300 patients, at the age from 18 to 91 years and treated for diabetes type 2 for the period between 1 and 46 years. The analysis was based on a full ophthalmologic examination. RESULTS: There was a significant decrease in visual acuity in relation to the duration of diabetes mellitus. In the whole group there were 474 patients (36.46%) without diabetic retinopathy and 826 patients (63.54%), who had diabetic retinopathy. Non-proliferative, simple diabetic retinopathy was present in 605 patients (46.54%), pre-proliferative diabetic retinopathy was found in 171 patients (13.15%), and proliferative retinopathy in 50 patients (3.85%). The study indicated a significant increase in the incidence of diabetic retinopathy in relation to the duration of diabetes, ranging from 27% in patients with diabetes lasting for about 1 year, to about 94% in patients with diabetes treated for about 30 years. An increase in the percentage of patients requiring laser therapy was also correlated with the duration of diabetes.     

The Glenn A. Fry Award Lecture 2003: Vision in elders--summary of findings of the SKI study.

PURPOSE: To assess a broad range of vision functions in a large older population, to investigate the impact of vision function loss on visual performance measures, and to determine whether low contrast vision measures can predict future loss of visual acuity. METHODS: A large battery of vision functions, including spatial vision measures, glare tests, visual fields, stereopsis, color vision, temporal sensitivity, reading performance, and face recognition, was administered to a population of 900 community-living older observers (mean age, 75.5 years; SD, 9.3 years; range, 58 to 102 years). A subsample (N = 596) was retested on average 4.4 years later (SD, 1.0 years). RESULTS: Each vision function is affected differentially by aging. Some functions show little change with age (e.g., standard clinically measured high contrast visual acuity), whereas others demonstrate drastic losses with increasing age. For the oldest age group (>90 years), vision function losses ranged from 1.2 times worse than young observers (critical flicker/fusion frequency) to 18 times worse than young observers (low contrast acuity in glare). Visual performance measures, such as reading or face recognition, are also significantly affected by aging even in those with intact visual acuity. The results demonstrate that low contrast vision functions can successfully predict subsequent loss of high contrast visual acuity. CONCLUSION: Nonstandard vision function measures show significant losses with age that cannot be predicted by standard clinical measures. Measures of low contrast vision function allow clinicians to identify and monitor those patients at high risk for future vision loss.