An objective VER assessment of visual acuity compared with subjective measures

Visual acuity was estimated by making amplitude measurements of the transient visually evoked response (VER) wave to pattern reversal using check sizes of 5.5, 7.5, 8.5, and 9.5 min arc. As in previous studies the 5.5 min arc check produced a response which reflected the visual acuity of the high acuity subjects, but often failed to produce a VER wave at the low acuity end. The proposal is made that where the 5.5 min arc check produces an acceptable wave (amplitude greater than 1.5 microV) then the regression line for the 5.5 check can be used to predict visual acuity. Where the VER amplitude is below 1.5 microV for this small check size then a second recording must be made using the 9.5 min arc check and the visual acuity predicted from the 9.5 check regression line.     

Corneal topography and fluctuating visual acuity after radial keratotomy

A high-resolution photokeratoscope using computer graphics to model corneal topography was used on patients who had undergone radial keratotomy. After radial keratotomy, central optical zones are created that can be characterized as round, oval or band-like, or dumbbell-shaped or split. The dumbbell form of optical zone was associated with larger amounts of refractive and keratometric astigmatism than the round or band-like zones. The authors correlated the shape of the optical zone with the presence or absence of diurnal variation (fluctuation) in visual acuity. Of the 26 eyes studied, 11 experienced fluctuation and 15 did not. Of those 11 eyes with fluctuating visual acuity, 10 (91%) had dumbbell-shaped or split optical zones and 1 (9%) had a round optical zone. Of the 15 eyes without fluctuation, 12 (80%) had round optical zones and 3 (20%) had band-like zones. The presence of a split or dumbbell-shaped optical zone after radial keratotomy indicates that the patient is likely to experience diurnal fluctuation of visual acuity.     

灯箱视力表与电脑视力表临床应用对比研究

目的:通过与灯箱视力表的对比研究了解电脑视力表的临床使用价值。方法:选取初三学生63例(126眼)同时用灯箱和电脑视力表进行远用视力检测,对视力检测值进行配对检验。结果:两种视力表检测值的t检验等于1.2671,P>0.20,两种视力表的检测在统计学上无显著性差异。结论:电脑视力表和灯箱视力表在临床上具有相同的应用价值,可以推广和普及。     

Corneal topography of patients with excellent Snellen visual acuity after epikeratophakia for aphakia

A computer-based corneal topographic analysis system was used to evaluate the patterns of power distribution in five patients with at least six months of postoperative follow-up who obtained excellent visual and refractive results after epikeratophakia for aphakia. All grafts were well centered relative to the visual axis. The range of surface power seen within the central 5 mm of the individual grafts ranged from 4.00 to 6.50 diopters. Each graft showed a unique, moderately irregular pattern of power distribution. Fair correlation was seen between the expected corneal power and that shown in the power map displays. These data suggest that moderate degrees of irregular astigmatism are compatible with good Snellen visual acuity after epikeratophakia for aphakia, though the effect of this irregularity on visual performance remains unclear.     

灯箱视力表与Freiburg电子视力表应用对比研究

目的 比较灯箱视力表与Freiburg电子视力表结果的一致性与可重复性,评价Freiburg电子视力表的临床应用价值。设计 诊断性技术评价。研究对象 空军杭州航空医学鉴定训练中心的工作人员86例,平均年龄（26.3±2.1）岁。方法 所有入选者均随机由2位固定检查者分别使用灯箱视力表和Freiburg电子视力表进行检查,两种视力表检查的顺序随机决定。所有检查均在同一房间内完成,房间内亮度小于3 lux。检查距离均为3 m。对不同视力表间与检查者间测量重复性采用配对t检验比较结果的差别并计算相关系数r值。主要指标 使用两种视力表获得的logMAR视力。结果 在检查者一,用灯箱视力表查,被检者logMAR视力为0.19±0.23,Freiburg电子视力表0.20±0.15,两者差值为-0.011±0.141,差异无统计学意义（t=-0.741, P=0.461）,但有显著相关性（r=0.808,P=0.000）。在检查者二,用灯箱视力表查,被检者logMAR视力为0.32±0.25,Freiburg电子视力表为0.20±0.15,两者差值为-0.118±0.151,差异有统计学意义（t=7.191, P=0.000）及显著相关性（r=0.810,P=0.000）。均用灯箱视力表,检查者一、二的差异有统计学意义（F=11.872,P=0.001）,两者显著相关（r=0.938,P=0.000）。而均用Freiburg电子视力表,检查者一、二的差异无统计学意义（F=0.019,P=0.890）,两者显著相关（r=0.986,P=0.000）。结论 Freiburg电子视力表受检查者因素的影响小于灯箱视力表,其在不同测量者间的可重复性优于灯箱视力表。（眼科, 2013, 22: 117-120）     

地形图观察角膜塑形术对角膜表面形态的影响及视力的变化

目的观察评价近视患者配戴角膜塑形镜后对角膜曲率的影响及视力的变化。方法对配戴角膜塑形镜的近视患者,127名（250只眼）进行配戴前后角膜地形图检查,观察角膜曲率、屈光度及视力的变化。结果角膜塑形镜配戴前后角膜曲率、屈光度及视力发生显著变化。结论地形图既可观察角膜塑形镜配戴前后角膜表面形态变化,也是作为验配角膜塑形镜不可或缺的方法。     

Comparison of topographic indices that correlate with visual acuity in videokeratography

OBJECTIVE: To evaluate the relationship between the best spectacle-corrected visual acuity (BSCVA) and two quantitative indices of the anterior corneal surface obtained by videokeratography. DESIGN: Prospective, single center, comparative, observational study. PARTICIPANTS: Eighty-nine normal eyes and 52 eyes with keratoconus with contact lens-corrected visual acuity of 20/20 or better. INTERVENTION: Videokeratography was performed with the TMS-2 and the CAS system 2000. MAIN OUTCOME MEASURES: The relationship between the BSCVA recorded in log minimal angle of resolution (logMAR) units, the surface regularity index (SRI), and the predicted corneal acuity (PCA) were assessed by linear regression analysis. RESULTS: The BSCVAs for all eyes ranged from 0.82 to -0.30 logMAR units. BSCVA was highly correlated with the SRI (r = 0.70, P < 0.0001) and the PCA (r = -0.61, P < 0.0001). There was no statistical difference in the regression slopes and the intercepts for the estimated BSCVA using the SRI and measured BSCVA, and the estimated BSCVA using PCA and measured BSCVA. CONCLUSIONS: Two quantitative topographic indices, SRI and PCA, are useful for estimating the effect of irregular astigmatism on visual acuity even though both indices quantify different aspects of the anterior surface of the cornea.     

三种视力表视力测量差异研究

目的:探讨mc-3投影式视力表(A)、普通箱式视力表(B)以及综合验光仪(C)对不同年龄段人的裸眼视力及校正视力的测量结果是否有差异.方法:志愿者206人(395眼),根据患者年龄分为3组:青年组:25～45岁,共116眼;中年组:46～70岁,共102眼;老年组:71～90岁,共177眼.用视力表投影仪、普通箱式视力表以及综合验光仪分别测量各志愿者的裸眼视力及矫正视力.结果:矫正视力:3组中均无差别.裸眼视力:青年组、中年组中无差别.老年组中综合验光仪的视力测量结果要好于视力表投影仪和视力了表箱,差别具有显著性意义(秩和检验P＜0.05).结论:在老年组的裸眼视力测量结果中,综合验光仪好于视力表投影仪和视力表箱,这种视力测量的差异可能足由于不同背景亮度及视标照度下视标的对比度不同所引起.     

Calculating the mean visual acuity and the change in visual acuity with a decimal acuity chart

The decimal visual acuity chart is not easy to use for statistical analysis and requires a transformation into LogMAR units (decimal logarithm of the Minimum Angle Resolution). In contrast to the decimal chart, the logarithmic chart has an arithmetic progression and a constant interval between lines. The LogMAR chart makes statistical analysis of visual acuity easy. Change in visual acuity is calculated directly by subtracting LogMAR data, while the average visual acuity is obtained with the arithmetic mean value of the LogMAR data. The mean acuity expressed in LogMAR units can be transformed into a decimal chart for a more comprehensive result. To calculate the average visual acuity directly from the decimal data, the geometric mean value must be used instead of the arithmetic mean value.     

Predicting visual acuity from wavefront aberrations

It is now possible to routinely measure the aberrations of the human eye, but there is as yet no established metric that relates aberrations to visual acuity. A number of metrics have been proposed and evaluated, and some perform well on particular sets of evaluation data. But these metrics are not based on a plausible model of the letter acuity task and may not generalize to other sets of aberrations, other data sets, or to other acuity tasks. Here we provide a model of the acuity task that incorporates optical and neural filtering, neural noise, and an ideal decision rule. The model provides an excellent account of one large set of evaluation data. Several suboptimal rules perform almost as well. A simple metric derived from this model also provides a good account of the data set.     

Predicting visual acuity from detection thresholds

Visual performance based exclusively on high luminance and high contrast letter acuity measures often fails to predict individual performance at low contrast and low luminance. Here we measured visual acuity over a wide range of contrasts and luminances (low mesopic to photopic) for 17 young normal observers. Acuity vs. contrast functions appear to fit a single template which can be displaced laterally along the log contrast axis. The magnitude of this lateral displacement for different luminances was well predicted by the contrast threshold difference for a 4 min arc spot. The acuity vs. contrast template, taken from the mean of all 17 subjects, was used in conjunction with individual spot contrast threshold measures to predict an individual's visual acuity over a wide range of luminance and contrast levels. The accuracy of the visual acuity predictions from this simple procedure closely approximates test-retest accuracy for both positive (projected Landolt rings) and negative contrast (Bailey-Lovie charts).     

Comparison of visual acuity measurements and Purkinje's vessel shadow perception for prediction of postoperative visual acuity in different ophthalmological diseases

PURPOSE: Prediction of postoperative visual acuity (VA) is extremely important to the patient and highly relevant to the surgeon. However, objective evaluation of the macula is frequently impossible in cases such as mature cataract, cataract in high myopia or vitreous haemorrhage. This study compares different preoperative examination techniques used to predict postoperative VA. METHODS: We retrospectively evaluated the charts of all patients who underwent any of the following procedures at our hospital in 2004: phacoemulsification for mature cataract or cataract in high myopia; vitrectomy for diabetic vitreous haemorrhage; macular pucker, and macular hole. The following methods were evaluated: preoperative distance and reading VA; laser interferential VA; Purkinje's vessel shadow perception, and postoperative distance VA. RESULTS: Complete documentation was available for 136 patients (29 mature cataracts, 25 immature cataracts in high myopia, 42 vitreous haemorrhages, 19 macular puckers, 21 macular holes). In cases of preoperative mature cataract, a positive Purkinje's vessel shadow perception predicted a postoperative VA >or= 20/50 (odds ratio 11.2). In cases of high myopia, interferential VA correlated best with visual outcome (p < 0.05). In macular surgery laser interferential VA predicted postoperative VA to be better and preoperative reading VA predicted it to be worse than it actually turned out after surgery. Laser interferential VA and last known VA prior to vitreous haemorrhage (mean of 20 months previously) correlated best with postoperative VA (p < 0.05) in cases of vitreous haemorrhage. Purkinje's vessel shadow perception--if positive--predicted a postoperative VA >or= 20/300 in these cases (odds ratio 15.0). CONCLUSIONS: Postoperative VA after vitrectomy for macular pucker or macular hole and in cases of cataract in high myopia is best predicted by laser interferential VA. Postoperative VA after vitrectomy for diabetic vitreous haemorrhage is best predicted by prehaemorrhage VA or laser interferential VA, especially when prehaemorrhage VA is unknown. Positive Purkinje's vessel shadow perception is an excellent method of predicting postoperative VA >or= 20/300 in cases of vitreous haemorrhage and VA = 20/50 in mature cataract.     

Comparison of 2 interferometers for predicting visual acuity in patients with cataract.

Two clinical interferometers generated gratings directly on to the retina in young experienced observers and also in patients about to undergo cataract surgery. Eyes in the patients with no media opacities were used as controls. We agreed with the manufacturers' claims that gratings are seen on the retina independent of refractive state and that gratings can still be seen through most cataracts. However, we did not find that preoperative retinal visual acuity was of any value in predicting postoperative Snellen visual acuity. Reasons for this are discussed.     

Comparison of contrast sensitivity,visual acuity,and Humphrey visual field testing in patients with glaucoma

BACKGROUND: Despite their normal or near-normal Snellen visual acuity, patients with glaucoma often complain of "poor" vision. OBJECTIVE: To investigate the relationship between large-letter contrast sensitivity, high-contrast visual acuity, and visual field defects in patients with glaucoma who have 20/40 or better visual acuity. DESIGN :Prospective, cross-sectional case series. PATIENTS AND METHODS: We evaluated 250 eyes of 144 subjects from the Glaucoma Service at the University of Illinois at Chicago College of Medicine. Subjects with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension who met the 20/40 or better vision requirement were recruited. Visual acuity was measured using the rear-illuminated Lighthouse Visual Acuity Chart at 4 m. Contrast sensitivity was measured using the Pelli-Robson Chart in a front-illuminated box with even luminance across the chart. Visual fields of the patients were measured using the 24-2 full-threshold program on the Humphrey Visual Field Analyzer. RESULTS: A significant correlation (r = 0.57, P < 0.001, n = 127) was found between the visual field mean deviations and the contrast sensitivity scores. The correlation (r = -0.322, P < 0.001, n = 127) was less between the visual field mean deviation and the log MAR visual acuity values, as was the correlation between the contrast sensitivity scores and log MAR visual acuity values (r = -0.370, P < 0.001, n = 127). In the subgroup of patients with chronic open-angle glaucoma, the correlation between the mean visual field deviation and the contrast sensitivity score was higher at 0.689 (P < or = 0.001, n = 62). CONCLUSIONS: Reduced contrast sensitivity is significantly correlated with visual field losses in patients with glaucoma and a visual acuity of 20/40 or better. The study data support the conclusion that, compared with visual acuity, the disease process preferentially affects contrast sensitivity. In our previous work, contrast sensitivity was shown to be more related than visual acuity to real-world function in patients with early glaucomatous changes.     

Comparison of preferential looking acuity and pattern reversal visual evoked response acuity in pediatric patients

? Background: We compared the visual acuities obtained with preferential looking (PL), the most widely used method of pediatric vision assessment, with those obtained with the spatial frequency sweep pattern-reversal visual evoked response (SPVER). ? Methods: Eighty patients (ages 1.5 months to 12 years) with various ocular pathologies pariticipated in this study. The PL acuity was determined using the up-and-down staircase procedure. The PVER was recorded with the spatial frequency sweep method using 10 spatial frequencies; the acuity was determined by placing the best-fit regression line on the descending slope of the PVER amplitude-spatial frequency function toward the higher spatial frequency to the baseline. ? Results: The PL acuities ranged from 20/25 to <20/1600 (mean 20/155). The correlation between the two methods was good (r=0.847). Fifty-six patients (70%) had an acuity agreement within 1.0 octave. When the PL acuity was >20/128, it was on average better than the PVER acuity. When the PL acuity was lower, the PVER acuity was usually better. This tendency was marked when the visual acuities were very poor (y=0.552x+0.362). ? Conclusion: The methods correlate well, although there is a dissociation of acuities in the presence of very low vision. PVER may be a useful addition to PL in assessment of vision in infants and young children.