Task Complexity and Visual Acuity in Senile Macular Degeneration

ABSTRACT The effects of choice of test object and inter-symbol spacing (contour interaction) on the measurement of low visual acuities was investigated. Visual acuities of sixteen subjects with senile macular degeneration and five age-matched normal subjects were measured using different test targets of varying complexities. Visual acuity of both groups of subjects decreased with increasing task complexity but the trend was more marked for the low vision subjects. However, within the low vision group, the complexity effect was not dependent on the level of visual acuity. This study showed that visual acuity of persons with senile macular degeneration can be measured equally well with single letters, constant contour interaction Landolt rings, or the Bailey-Lovie letter chart but the test used should be specified. Grating targets and word charts measure different visual functions from standard visual acuity tests.     

正常和低视力人黄斑光阈值的对比研究

目的:测定正常和低视力人的黄斑光阈值,探讨其黄斑光敏感度的变化。方法:应用Humphrey视野分析仪,选用黄斑阈值检查程序,测定93只正常视力眼和76只低视力眼黄斑区视野的光阈值。结果:1.黄斑的光阈值随着年龄的增长呈升高的趋势,光敏感度与年龄呈负相关变化;2.在同年龄组,低视力人的黄斑光阈值显著高于正常视力人的黄斑光阈值;3.在同年龄组,正常和低视力人视野的四个象限黄斑光阈值无显著性差异;4.男女性黄斑光阈值无显著性差异。结论:正常视力人黄斑光敏感度显著优于低视力人的黄斑光敏感度;黄斑光敏感度随着年龄的增长而降低。眼科学报 1996;12:1O3—106。     

老年黄斑变性的视力与眼底病变及荧光造影的关系

对１５８例（２１３眼）老年黄变性（ＡＭＤ）及早期ＡＭＤ病人的视力，眼诋改变及眼底血管荧光造影（ＦＡ）进行了观察，发现视力≥１．０的病人也有出血，渗出，视网膜下新生血管膜（ＳＲＮＶＭ）视网膜神经上皮或色素上皮脱离（ＲＮＥＤ或ＲＰＥＤ），视力的损害与ＳＲＮＶＭ的部位有关。讨论了视力与眼底改变及ＦＦＡ的关系，并分析了以视力标准划分ＡＭＤ的界限的弊端，提出对视力正常，眼底，ＦＡ及视力功能检测的正常，应诊断     

特发性黄斑裂孔患者手术前后视物变形的定量分析

目的:观察特发性黄斑裂孔(IMH)患者术前视物变形类型及玻璃体切割术后视物变形改善程度,并对玻璃体切割术后视物变形与视力进行相关性分析。方法:前瞻性非随机对照研究。选取2017年12月至2018年9月于吉林大学第二医院确诊为IMH并行玻璃体切割联合内界膜撕除术或翻转内界膜瓣填塞眼内消毒空气或硅油填充治疗的患者共29例(29眼)。手术前后均进行最佳矫正视力(BCVA)检查。使用M-Charts对视物变形的严重程度进行量化,测量患眼垂直视物变形评分(MV)、水平视物变形评分(MH)及其平均值(M-Score)。采用重复测量资料方差分析来比较患眼手术前后视功能改善情况,采用独立样本 t检验比较同一阶段MV和MH的变化,采用Pearson相关性分析来研究BCVA与视物变形之间的相关性。 结果:术前检测IMH视物变形为枕形失真的患眼22眼,病程小于6个月有21眼;不规则形失真的IMH患眼7眼,病程小于6个月有2眼。术后任一时间点MV较术前都有显著改善,差异有统计学意义( F=52.265, P<0.001);术后任一时间点MH较术前都有显著改善,差异有统计学意义( F=27.507, P=0.002)。手术前后各时间点MV与MH比,差异均无统计学意义。术后6个月M-Score与BCVA(logMAR)之间不存在相关性( r=0.360, P=0.055)。 结论:病程小于6个月的IMH患者视物变形类型以枕形失真为主,病程大于6个月的IMH患者视物变形以不规则形失真为主;IMH的玻璃体切割手术显著改善了视物变形,恢复视功能;视物变形可以作为评估IMH治疗效果的一项指标。     

Assessment of Visual Functions of Patients with Senile Macular Degeneration

ABSTRACT Senile Macular Degeneration (SMD) can be detected and the progression of the disease monitored by the assessment and measurement of a number of visual functions. Considerable research has been conducted during the past ten years, much of it in Australia, on the pathogenesis of senile macular degeneration and its effects on different visual functions. The purpose of this paper is to review the standard clinical tests used for the diagnosis of senile macular degeneration, to examine the use of these tests in low vision assessment with particular regard to SMD and, in the light of recent research, to recommend other tests which add to the evaluation of the visual characteristics of SMD. Those tests which can best indicate the rehabilitation needs of the person with SMD are stressed.     

特发性黄斑裂孔玻璃体切割手术后的视功能

目的：探讨特发性黄斑裂孔（IMH）玻璃体切割手术后的视功能状况，方法：复习并总结国内外相关文献资料，综合评述IMH玻璃体切割手术后视功能状况。结果：多数患者术后视力较术前提高2行或2行以上，并且主观感觉的视物变形和暗点，辨色力，双眼融合功能和立体视功能也有所改善，术后视野光敏度较术前有所提高；注视性质由术前的偏心注视多数恢复为主后的中心注视，然后部分患者视力的改善提高不显著甚至出现视力下降，部分患者黄斑裂孔虽然获得解剖愈合，但仍遗留某些视觉缺陷。影响术后视力和其他视功能恢复的因素是复杂的，通常与术前视力和视功能状况的好坏，病程长程，裂孔分期早期、手术方式，裂孔愈合状态以及手术合并症等诸多因素相关。结论：黄斑裂孔一旦发生，其裂孔愈合和视功能稳定的机会极少，因此多数学者主张若诊断明确应早手术封闭裂孔，评价玻璃体切割手术治疗IMH的疗效。应在解决形态愈合的基础上综合患者的视力，主观感觉及临床多项视功能进行全面评估。     

Prismatic Scanning Method for Improving Visual Acuity in Patients with Low Vision

Frequently, patients with macular lesions and others who are visually handicapped do not receive adequate low vision care by ophthalmologists if a routine trial of low vision aids has no gratifying results. This paper describes for the first time a technique in which functional vision was achieved with the aid of prismatic scanning in patients for whom the usual low vision aids had proved ineffectual. The procedure in which prisms are used to achieve functional vision in patients with macular lesions is uncomplicated, inexpensive, and rapid; indeed, it can be used by an ophthalmologist in routine office practice with existing equipment.     

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。     

Results of Visual Acuity and Foveal Thickness in Diabetic Macular Edema after Vitrectomy

Purpose

To report results of an investigation of visual acuity (VA) and foveal thickness in diabetic macular edema (DME) patients after vitrectomy.

Methods

A retrospective study was performed of the records of 47 patients (61 eyes) who received pars plana vitrectomy (PPV) for DME. All eyes were followed up for over 6 months (mean, 24.8 months; range, 6–60 months). VA and foveal thickness evaluated by optical coherence tomography were reviewed preoperatively and postoperatively.

Results

Twenty-four-month follow-up data were available for 46 of the 61 eyes (75%). VA at the final examination had improved by 0.2 log units or more in 34 of the 61 eyes (56%), remained unchanged in 21 eyes (34%), and worsened in six eyes (10%). Mean foveal thickness decreased by more than 20% of the preoperative value in 50 of the 61 eyes (82%), remained unchanged in ten eyes (16%), and increased by more than 20% in one eye (2%) at the final examination. Postoperative best-corrected visual acuity (BCVA) at both 12 and 24 months was significantly better than preoperative BCVA (P < 0.0001). Foveal thickness at 3 months or later significantly decreased from the preoperative value (P < 0.0001), but remained unchanged in comparison with postoperative 12 months and 24 months values (P = 0.19). Preoperative VA and presence of cystoid macular edema (CME) were independently associated with final visual acuity (P = 0.001).

Conclusions

PPV for DME effectively improved VA and reduced foveal thickness for a longer postoperative period. Better preoperative VA was associated with better final postoperative VA. The eyes without CME tended to have better final postoperative VA.?Jpn J Ophthalmol 2007;51:204–209 © Japanese Ophthalmological Society 2007

     

三种人工晶状体植入术后静态视力和动态视力的评估及比较

目的：对三焦点、双焦点及连续视程人工晶状体植入术后的单眼视力和动态视力（DVA）进行评估及比较。方法：前瞻性临床研究。选取2020年1月至2021年1月于重庆医科大学附属第一医院眼科行白内障超声乳化摘除联合人工晶状体植入且资料完整的白内障患者65例（81眼）。根据所选择的IOL 类型分为3组：双焦点组33眼,植入Tecnis ZMB00 IOL;三焦点组20眼,植入AT Lisatri.839MP IOL;EDOF组28眼,植入Tecnis ZXR00 IOL。术后3个月分别检测每眼的裸眼静态视力（SVA）：包括裸眼远视力（UDVA）、裸眼中视力（UIVA）、裸眼近视力（UNVA）（LogMAR视力）。采用运动视标法检测裸眼DVA（检测速度分别为4、8、12、24fps）：包括裸眼动态远视力（UDDVA)、裸眼动态中视力（UIDVA）、裸眼动态近视力（UNVA）（LogMAR视力）,并进行评估比较。通过“手抓尺子试验”检测患者反应速度。数据采用卡方检验、方差分析、Kruskal-WallisH检验进行统计分析。结果：3组的总体UDVA、UNVA差异均无统计学意义;3组的总体UIVA差异有统计学意义（H=23.13,P<0.001）,进一步两两比较发现EDOF组优于双焦点组（P<0.001）;三焦点组优于双焦点组（P=0.016）;EDOF 组与三焦点组差异无统计学意义。3组的总体UDDVA在4、8fps时差异均无统计学意义;而在12、24fps时总体差异均有统计学意义（H=10.96,P=0.004;H=11.52,P=0.003）,进一步比较发现双焦点组优于三焦点组（H=-16.21,P=0.003;H=-17.98,P=0.004）,EDOF组优于三焦点组（H=-12.67,P=0.030;H=-16.48,P=0.009）,双焦点组与EDOF组差异无统计学意义。3组的总体UIDVA在8fps 时差异无统计学意义,而在4、12、24fps时差异均有统计学意义（H=8.17~11.36,P<0.05）：4、12fps 时,EDOF组优于双焦点组（H=14.61,P=0.013;H=14.52,P=0.009）,与三焦点组差异无统计学意义;24fps时,EDOF组优于双焦点组、三焦点组（H=15.31,P=0.008;H=-16.60,P=0.027）。3组的总体UNDVA在4、8、12、24fps时差异均有统计学意义（H=11.25~17.61,P<0.05）,且EDOF组均分别优于双焦点组（H=12.71~17.87,P<0.05）和三焦点组（H=-23.04~-15.87,P<0.05）,双焦点组与三焦点组差异均无统计学意义（均P>0.05）。结论：在SVA方面,三焦点IOL及EDOFIOL均可获得较好的UDVA、UIVA、UNVA,而双焦点IOL的UIVA较弱。在DVA方面,远距离、低速度时,3种IOL结果相当;但是近距离、高速度时,EDOFIOL的DVA较其余二者更佳。     

Visual Acuity in a Community-dwelling Japanese Population and Factors Associated with Visual Impairment

Purpose The aim of this study was to describe the distribution of visual acuity and investigate the predictors of visual impairment in a Japanese population.Methods Best-corrected visual acuity was measured in 2263 subjects aged 40–79 years randomly selected from a local community. Relations between visual impairment and possible risk factors were investigated.Results Among these subjects, 41 individuals (1.8%) were identified as visually impaired (best-corrected visual acuity in the better eye 0.5). Both sexes in the older age groups had a higher frequency of visual impairment (Mantel-Haenszel chi-square test: P 0.001). A multiple logistic regression indicated that an increase in age of 10 years [odds ratio (OR) 3.9; 95% confidence interval (CI) 2.3–6.7] and myopia (OR 2.9; 95%CI 1.4–6.0) were independent risk factors for visual impairment. Individuals with the highest level of education (college or higher) had a lower risk of visual impairment (OR 0.1; 95%CI 0–0.7) compared to individuals with the lowest level of education.Conclusions As expected, visual impairment increased with advancing age, although the prevalence of visual impairment in our population was lower than in other surveys. Racial and regional differences and differences in study design may be responsible for discrepancies between surveys. It is noteworthy that myopia was a significant risk factor for visual impairment, although the reasons for this association are uncertain and need further investigation. Jpn J Ophthalmol 2004;48:37–43 © Japanese Ophthalmological Society 2004     

Visual Acuity Comparison of Vitrectomy with and without Internal Limiting Membrane Removal in the Treatment of Diabetic Macular Edema

Purpose To evaluate whether internal limiting membrane (ILM) peeling during vitrectomy affects vision outcome in patients with diabetic macular edema. Material and method Fifty-eight eyes of 49 patients were included in the study. Patients with persistent diffuse clinically significant macular edema were divided into two groups according to the surgical method used. Group I subjects (15 patients; mean age 56.60±8.50 years; 17 eyes total) underwent vitrectomy with ILM peeling. Group II subjects (34 patients; mean age 57.52±11.54 years; 41 eyes total) underwent vitrectomy without ILM peeling. The data recorded for each case were type and duration of diabetes, insulin treatment (yes/no), presence of arterial hypertension, stage of diabetic retinopathy, lens status, history of macular laser treatment, and detection of posterior vitreous detachment during surgery. Visual acuity was measured preoperatively and 1 year postoperatively in decimal notation, and values were converted to logarithm of minimal-angle-of-resolution (logMAR) scores. Mean pre- and postoperative visual acuity were compared within each group, and the mean change in visual acuity in Group I was compared to that in Group II. Results There were no significant differences between the groups with respect to age; sex distribution; diabetes type; duration of diabetes; numbers of patients on insulin treatment; frequencies of hypertension, proliferative diabetic retinopathy, previous macular laser treatment; or frequency of intraoperatively confirmed posterior vitreous detachment (chi-square, P>0.05 for all). Comparison of pre- and post-operative visual acuity revealed significant improvement in both Group I (1.15±0.307 vs. 0.764±0.355 logMAR, respectively; Wilcoxon rank test, P<0.01) and Group II (1.22±0.516 vs. 0.829±0.436 logMAR, respectively; Wilcoxon rank test, P<0.001). The change in visual acuity for Group I was not significantly different from that observed in Group II (0.391±0.335 vs. 0.393±0.273 logMAR, respectively; Mann–Whitney U test, P>0.05). Conclusion The visual acuity outcomes in the study indicate that vitrectomy without ILM peeling is just as effective as vitrectomy with ILM peeling in the treatment of diabetic macular edema. Both techniques led to significant and similar degrees of improvement in visual acuity.     

智能视力表投影仪的可重复性及其与传统视力表的比较

目的：分析智能视力表投影仪在视力检查中的可重复性及其与传统视力表测量结果的比较。方法：系列病例研究。收集2022年1月4—22日在首都医科大学附属北京同仁医院就诊的眼部不适患者60例（120眼）。先通过智能视力表投影仪（LSJ-IVAC-6000A）对患者进行3次视力检测,并采用组内相关系数（ICC）评价3次测量结果之间的可重复性;再用传统灯箱的国家标准视力表测量1次,并分别采用ICC和Bland-Altman图表法分析智能视力表投影仪与传统视力表检测结果的一致性。结果：同一受检者右眼、左眼使用智能视力表投影仪测量3次的ICC值分别为0.830和0.868,双眼的ICC值均>0.8（P<0.001）;同一受检者右眼、左眼使用智能视力表投影仪和传统灯箱的国家标准视力表测量的ICC值分别为0.846和0.873,双眼的ICC值均>0.8（P<0.001）。右眼、左眼使用智能视力表投影仪和传统灯箱的国家标准视力表测量差值的95%一致性界限分别为-0.25~0.20和-0.24~0.17。结论：智能视力表投影仪的可重复性较好,与传统灯箱的国家标准视力表的测量结果相比一致性较强,应用于临床工作中可提高视力筛查的效率并节省人力和物力。     

Aqueous Fibronectin Correlates With Severity of Macular Edema and Visual Acuity in Patients With Branch Retinal Vein Occlusion: A Proteome Study

PurposeLarge-scale protein analysis may bring important insights into molecular changes following branch retinal vein occlusion (BRVO). Using proteomic techniques this study compared aqueous humor samples from patients with BRVO to age-matched controls.MethodsAqueous humor samples from treatment naive patients with BRVO complicated by macular edema (n = 19) and age-matched controls (n = 18) were analyzed with label-free quantification nano liquid chromatography – tandem mass spectrometry (LFQ nLC-MS/MS). The severity of macular edema was measured as central retinal thickness (CRT) with optical coherence tomography. Control samples were obtained prior to cataract surgery. Proteins were filtered by requiring quantification in at least 50% of the samples in each group without imputation of missing values. Significantly changed proteins were identified with a permutation-based calculation with a false discovery rate at 0.05.ResultsIn BRVO, 52 proteins were differentially expressed. Regulated proteins were involved in cell adhesion, coagulation, and acute-phase response. Apolipoprotein C-III, complement C3, complement C5, complement factor H, fibronectin, and fibrinogen chains were increased in BRVO and correlated with CRT. Fibronectin also correlated with best corrected visual acuity (BCVA) and vascular endothelial growth factor (VEGF). Monocyte differentiation antigen CD14 (CD14) and lipopolysaccharide-binding protein (LBP) were upregulated in BRVO. Contactin-1 and alpha-enolase were downregulated in BRVO and correlated negatively with CRT.ConclusionsMultiple proteins, including complement factors, fibrinogen chains, and apolipoprotein C-III, correlated with CRT, indicating a multifactorial response. Fibronectin correlated with BCVA, CRT, and VEGF. Fibronectin may reflect the severity of BRVO. The proinflammatory proteins CD14 and LBP were upregulated in BRVO.     

Exploring Reticular Pseudodrusen Extent and Impact on Mesopic Visual Sensitivity in Intermediate Age-Related Macular Degeneration

PurposeTo explore the impact of the extent of reticular pseudodrusen (RPD) on mesopic visual sensitivity in individuals with intermediate age-related macular degeneration (AMD).MethodsIn total, 570 eyes from 285 participants with bilateral large drusen underwent microperimetry testing to assess the visual sensitivity of the central 3.6-mm region and multimodal imaging to determine the extent of RPD in the central 20° × 20° region (at the eye level). Mean visual sensitivity within five sectors in the central 3.6-mm region sampled on microperimetry and the extent of RPD in these sectors were derived. Linear mixed models were used to examine the association between the extent of RPD on overall mean visual sensitivity and sector-based mean sensitivity.ResultsAn increasing extent of RPD at the eye level and within sectors was associated with a significant reduction in overall and sector-based mean sensitivity, respectively (P < 0.001 for both). However, when both RPD parameters were considered together in a multivariable model, only an increasing extent of RPD at the eye level (P < 0.001) and not within each sector (P = 0.178) was independently associated with reduced sector-based mean sensitivity.ConclusionsMesopic visual sensitivity is generally reduced in eyes with large drusen and coexistent RPD compared to eyes without RPD, with greater reductions with an increasing extent of RPD. However, reduced sector-based visual sensitivities are explained by the overall extent of RPD present, rather than their extent within the sector itself. These findings suggest that there are generalized pathogenic changes in eyes with RPD accounting for the observed mesopic visual dysfunction.     

Central Photoreceptor Viability and Prediction of Visual Outcome in Patients with Idiopathic Macular Holes

Purpose

To identify the correlation between preoperative optical coherence tomography (OCT) features and postoperative visual outcomes in eyes with idiopathic macular holes (MHs).

Methods

Data from 55 eyes with idiopathic MHs which had been sealed by vitrectomy were retrospectively reviewed. Correlation analysis was conducted between postoperative visual acuity (V_postop, logarithm of the minimum angle of resolution [logMAR]) and preoperative factors, including four OCT parameters: the anticipated length (A) devoid of photoreceptors after hole closure, MH height (B), MH size (C), and the grading (D) of the viability of detached photoreceptors. Additionally, the formula for the prediction of visual outcome was deduced.

Results

V_postop was determined to be significantly correlated with the preoperative visual acuity (V_preop) and OCT parameters A, C, and D (p<0.001). Based on the correlation, the formula for the prediction of V_postop was derived from the most accurate regression analysis: V_postop=0.248×V_preop+1.1×10^-6×A²-0.121×D+0.19.

Conclusions

The length and viability of detached photoreceptors are significant preoperative OCT features for predicting visual prognosis. This suggests that, regardless of the MH size and symptom duration, active surgical intervention should be encouraged, particularly if the MH exhibits good viability in the detached photoreceptor layer.     

Long-Term Outcomes in Patients with Neovascular Age-Related Macular Degeneration Who Maintain Dry Macula after Three Monthly Ranibizumab Injections

Purpose: To evaluate long-term changes in visual acuity and retinal microstructure in patients with neovascular age-related macular degeneration (AMD) who had maintained dry macula after initial treatment. Methods: This retrospective observational study included 55 eyes that were diagnosed with neovascular AMD, were treated with three monthly ranibizumab injections, and maintained dry macula during a two-year follow-up. Best-corrected visual acuity (BCVA) at three months and at the final follow-up were compared, and the degree of visual improvement was compared between eyes with and without improvement of the ellipsoid zone. In addition, the incidence of improvement of the ellipsoid zone was compared between eyes with different extents of disruption. Results: The mean follow-up period was 30.3 ± 4.1 months. BCVA at three months and at the final follow-up was 0.51 ± 0.46 and 0.45 ± 0.49 (P<0.001). Among 35 eyes that exhibited >200 μm of disruption of the ellipsoid zone, 15 (42.9%) showed improvement of the ellipsoid zone, and the improvement in BCVA was greater in these eyes than that in the remaining 20 eyes (P=0.021). A higher incidence of improvement of the ellipsoid zone was noted in eyes with 200 to 800 μm of disruption than in eyes with >800 μm of disruption (P<0.001). Conclusions: Long-term improvement in visual acuity was noted in eyes that had maintained dry macula after three ranibizumab injections. The status of the ellipsoid zone at three months was closely associated with visual improvement.     

“Macular sink hole” with intrachoroidal cavitation in a case of pathological myopia

Intrachoroidal cavitation (ICC) is a morphological feature outlined by optical coherence tomography and is characterized by presence of a hyporeflective space beneath the unaltered retinal pigment epithelium. It can be peripapillary or macular in location. Macular ICCs are reported in both myopic and non-myopic eyes. We report a case of full thickness macular hole with retinal incarceration into the macular ICC in a patient with pathological myopia. The term “Peripapillary sink hole” has been described in the literature. We propose the use of term “Macular sink hole” for our case owing to similar findings in the macula.