Improvements in measures of vision and self-reported visual function after cataract extraction in patients with late-stage age-related maculopathy.

PURPOSE: A recent study indicated that patients with cataracts and early age-related maculopathy may benefit from cataract extraction. To ascertain whether cataract extraction in the presence of concurrent advanced age-related maculopathy was also associated with a clear benefit, we studied visual function and self-reported visual functioning in a cohort of 12 patients pre- and post-phakoemulsification. METHODS. All 12 patients had a diagnosis of advanced age-related maculopathy in the eye scheduled for cataract surgery. Preoperative assessment included refraction and recording of best corrected distance and near acuity and contrast sensitivity in both eyes. The Daily Living Tasks Dependent on Vision questionnaire was administered. After phakoemulsification and intraocular lens implantation, all patients were reviewed and assessed. RESULTS: After surgery, improvement in acuity was recorded in nine operated eyes, whereas acuity remained unchanged in three eyes. Improvement in contrast sensitivity in the operated eye occurred in 10 patients, but in two patients contrast was reduced postoperatively. In terms of self-reported visual functioning, improvement in the ability to undertake many daily living tasks dependent on vision was recorded after cataract surgery. CONCLUSIONS: Significant improvements in specific areas of self-reported visual functioning and measures of vision were recorded after cataract surgery. During the follow-up period, none of the operated eyes suffered a fall in visual acuity. There was also no evidence of worsening of the pre-existing macular lesion as judged by clinical examination and fundus photography.     

Pupil dilatation does affect some aspects of daytime driving performance

AIMS: To examine the effects of pupil dilatation on driving performance and determine whether this was related to changes in standard measures of visual function. METHODS: The driving and vision performance of 16 young, visually normal participants was measured with both normal and dilated pupils. Pupils were dilated with 1% tropicamide. Driving performance was measured under daytime conditions on a closed road circuit that was free of other vehicles and has been used in previous studies of driving performance. Measures included road sign detection and recognition, hazard detection and avoidance, gap perception and negotiation, driving reaction times and time to complete the circuit. Visual performance measures included high contrast visual acuity, Pelli-Robson letter contrast sensitivity, and glare sensitivity. RESULTS: Pupil dilatation significantly (p<0.05) decreased the ability of participants to recognise low contrast hazards and avoid them, decreased their visual acuity and contrast sensitivity and increased glare sensitivity. The decreases in vision performance were not, however, significantly related to the decrement in driving performance. CONCLUSION: Pupil dilatation can impair selected aspects of driving and vision performance and patients should be cautioned about these possible effects.     

Impact of cataract surgery on health-related quality of life in nursing home residents

AIM: To assess the impact of cataract surgery in nursing home residents on health-related quality of life, as compared to those who have cataracts but who do not undergo surgery. METHODS: A prospective cohort study enrolled 30 nursing home residents (>or=60 years old) who had cataracts and underwent cataract surgery, and evaluated vision-targeted and generic health-related quality of life and depressive symptoms before and approximately 4 months after surgery. This cataract surgery group was compared to 15 nursing home residents who had cataracts but who did not have surgery, over the same timeframe. RESULTS: Visual acuity for near and distance and contrast sensitivity improved following cataract surgery (p<0.001). Adjusting for age differences in the two groups, the cataract surgery group exhibited significant score improvement in the general vision (p = 0.005), reading (p = 0.001), psychological distress (p = 0.015), and social interaction (p = 0.033) subscales of the Nursing Home Vision-targeted Health-Related Quality of Life Questionnaire and the VF-14 (p = 0.004). There were no group differences in the SF-36, Geriatric Depression Scale or the Cataract Symptom Score. CONCLUSION: Nursing home residents who underwent cataract surgery because of functional problems experienced significant improvements in their vision-targeted health-related quality of life, in addition to dramatically improved vision.     

Functional vision with cataracts of different morphologies: comparative study

PURPOSE: To evaluate the influence of cataract morphology on the functional vision of patients with age-related cataract and normal macular function and compare subjectively perceived functional impairments to distance visual acuity, reading acuity, and maximum reading speed between cataract types. SETTING: Department of Ophthalmology, Medical University of Vienna, Vienna, Austria. METHODS: Seventy-five patients awaiting first-eye cataract surgery were asked to characterize their visual difficulties in everyday life using a German version of the VF-14 questionnaire. Cataracts were categorized and graded using the Lens Opacities Classification System III. Monocular and binocular visual acuity and reading performance were determined in randomized order. RESULTS: There were significant differences in functional vision between nuclear cataracts and posterior subcapsular cataracts (PSC); the VF-14 score and the self-reported visual satisfaction were significantly lower in PSC patients (P<.05). Posterior subcapsular cataracts significantly increased self-reported impairment in distance and near vision, although the visual acuity was comparable to that in the other groups (P =.9). Significant differences in functional vision were also seen between PSC and nuclear-cortical cataracts (P<.05). No significant differences in functional vision were found between nuclear cataracts and nuclear-cortical cataracts (P>.05). CONCLUSIONS: The VF-14 questionnaire reliably evaluated functional differences caused by different cataract morphologies; these differences were underestimated when only visual acuity was measured. Patients with PSC had increased functional impairment, indicating that cataract surgical intervention is indicated at an earlier stage in these patients. The significant differences between the morphological types of cataract should be taken into consideration when the benefit of cataract surgery is to be measured on the basis of functional improvement.     

Impact of cataract surgery on self-reported visual difficulties: comparison with a no-surgery reference group

PURPOSE: To examine the impact of cataract surgery on older adults' self-reported visual difficulties and compare them with those of patients with cataract who declined surgery over the same period. SETTING: Twelve area practices. METHODS: This was a consecutive chart review over a 6-month period. Primary inclusion criteria were 55 years or older, cataract in 1 or both eyes with 20/40 visual acuity or worse (best corrected, distance), and no previous cataract surgery in either eye. The Activities of Daily Vision Scale (ADVS) and visual acuity, contrast sensitivity, and disability glare tests were administered at baseline and at a 1-year follow-up visit. RESULTS: This study comprised 245 patients, 156 of whom elected to have cataract surgery and 89 of whom declined. Those electing surgery were more likely to be white, female, and have worse visual acuity and no ocular comorbidities. At baseline, ADVS subscale scores ranged from 53 to 76 in the surgery group and from 72 to 89 in the no-surgery group. In the surgery group, subscale scores improved by 15 to 21 points on average at the 1-year follow-up; scores were unchanged or worse in the no-surgery group over this period. This difference between the groups remained statistically significant after adjustment for group baseline differences in demographics, vision, and ADVS score. In the surgery group, visual acuity improvement in the first eye was an independent predictor of increases in the ADVS overall score and night driving and glare disability subscales; contrast sensitivity was an independent predictor of improvement in the night driving subscale. A reduction in disability glare in the second eye was independently linked to increases in the overall ADVS score and the night driving, near vision, and glare disability subscales. CONCLUSIONS: Baseline findings suggest that cataract patients who have surgery have more difficulty in visual tasks than those who decline surgery. After surgery, patients reported less difficulty with visual tasks. In the no-surgery group, no change was reported. Improvements in visual acuity and contrast sensitivity and reductions in disability glare after surgery were independently linked to improvements in ADVS scores.     

Improvements in clinical and functional vision and perceived visual disability after first and second eye cataract surgery

AIMS—To determine the improvements in clinical and functional vision and perceived visual disability after first and second eye cataract surgery.
METHODS—Clinical vision (monocular and binocular high and low contrast visual acuity, contrast sensitivity, and disability glare), functional vision (face identity and expression recognition, reading speed, word acuity, and mobility orientation), and perceived visual disability (Activities of Daily Vision Scale) were measured in 25 subjects before and after uncomplicated cataract surgery (10 first eye surgery and 15 second eye surgery) and in 10 age matched controls.
RESULTS—Significant improvements were found after surgery in clinical and functional vision and perceived visual disability. Greater improvements were found after first eye surgery than after second eye surgery. However, first eye surgery did not return all scores to age matched normal levels. There were significant improvements in several of the tests measured after second eye surgery, and all postoperative values were similar to those from age matched normals.
CONCLUSIONS—Significant improvements in clinical, functional, and perceived vision are obtained by cataract surgery. The improvements in objective measures of functional vision found in this study support previous findings of improvements in patients' perceived functional vision. In addition, these data provide support to the necessity of second eye surgery in some patients to improve certain aspects of visual function to age matched normal levels.

     

Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal hemangioma in Sturge-Weber syndrome

AIM: To investigate the prevalence and risk factors of age-related cataract (ARC), ARC surgery procedures, and postoperative vision results among adults over 50 years old in the Binhu District of Wuxi City, China. METHODS: Thirty basic sampling units were analyzed via a cluster random sampling method. Detailed medical histories were collected and eye examinations were performed. Cataract prevalence and surgical procedures were quantified. RESULTS: Among the 6150 participants, 1421 cataract cases were diagnosed and prevalence was 23.1%. The prevalence of cortical, nuclear, and posterior subcapsular cataracts increased with age (P<0.001). Cataract prevalence was significantly higher among elderly, female, or illiterate individuals and people with hypertension, diabetes, and a history of smoking and drinking (all P<0.05). As participant age increased and education level decreased, the frequency of cataract blindness surgeries gradually decreased, but without statistical significance within groups (P>0.05). The odds ratio of cataract patients who had or did not have cataract surgery was 3.15 (87/28) and the frequency of cataract blindness surgery was 75.7% (87/115). Poor visual outcomes was in 107 eyes (40.7%) after cataract surgery. Poor vision was mostly caused by uncorrected reflective errors (30.9%) and ocular comorbidities (41.1%). The prevalence of cataract surgery complications was 5.7% (15/263). Surgical complications and posterior capsular opacification were avoidable factors facilitating poor vision. CONCLUSION: ARC, especially in females and illiterate individuals, presents a public health problem in this district. Poor visual outcomes after cataract surgery are frequent. High-quality cataract surgeries and treatment of ocular comorbidities are vital.     

高度近视并发白内障的视功能

随着高度近视患者的增多,高度近视并发的白内障日益受到重视。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。本文介绍调节集合功能、立体视功能、对比敏感度等现代视功能检查及其在高度近视并发白内障中的应用和临床意义,以及手术对视功能的影响。这些检查不仅对白内障的早期诊断、手术适应证把握、个体化IOL选择及植入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,有助于提高此类白内障的手术水平,使患者获得更好的术后视觉质量。     

Improvements in clinical and functional vision and quality of life after second eye cataract surgery.

PURPOSE: To determine whether there is a need for second eye cataract surgery or whether cataract surgery in one eye provides sufficiently adequate vision. METHODS: The vision of 43 patients was assessed using a battery of clinical vision tests, performance-based functional vision tests, and quality of life questionnaires, both before and a few months after cataract surgery. Twenty-five patients underwent second eye surgery and 18 patients underwent first-eye surgery. To determine whether cataract surgery returned vision to normal levels, a control group of 25 subjects of a similar age with normal, healthy eyes was also assessed. RESULTS: Overall, greater improvements occurred in most aspects of vision after first eye surgery than after second eye surgery. However, second eye surgery provided similar improvements in mobility orientation and self-reported night driving to those after first eye surgery, and substantially greater improvements in stereoacuity and reductions in anisometropia. CONCLUSIONS: The study provides additional evidence to support the need for second eye cataract surgery. Second eye surgery may be particularly important to improve mobility orientation and the avoidance of falls.     

Driving performance of glaucoma patients correlates with peripheral visual field loss

PURPOSE: To identify clinical vision measures that are associated with the driving performance of glaucoma patients who have visual field loss and visual acuity better than 20/100 and to compare the driving performance of glaucoma patients with the driving performance of a group of age- and sex-equivalent individuals without eye disease. PATIENTS: Forty patients with glaucoma and 17 normally sighted control subjects participated in this study. METHODS: Clinical vision data, consisting of visual acuity, letter contrast sensitivity, and visual fields, were collected. Driving performance was assessed by (1) an interactive driving simulator that measured 7 indices of performance (including number of accidents) and (2) the self-reported accident involvement for the past 5 years. MAIN OUTCOME MEASURES: Driving simulator performance and real-world, self-reported accident involvement. RESULTS: The number of accidents as measured on the driving simulator in the glaucoma group was significantly correlated with three Goldmann visual field measures: combined horizontal extent (rho = -0.47, P = 0.01), total horizontal extent (rho = -0.49, P = 0.007), and total peripheral extent (rho = -0.55, P = 0.002). There were no statistically significant correlations between the driving performance of the glaucoma group and the visual acuity or contrast sensitivity measures. When compared with the control group, a significantly greater proportion of the glaucoma group reported having at least one real-world accident within the past 5 years (Fisher exact test, P = 0.005). CONCLUSIONS: Visual field reduced to less than 100 degrees of horizontal extent may place patients with peripheral field loss at greater accident risk. A higher incidence of real-world and simulator accidents was found for the group with glaucoma.     

儿童先天性白内障摘除和人工晶体植入

目的 评价儿童白内障摘除联合人工晶体植入术后的临床疗效。方法 对64例（104只眼）1．5-14岁儿童先天性白内障患儿行白内障囊外摘除联合局限性前段玻璃体切除和人工晶体垂袋内植入术。对术后平均随访22个月的并发症、视力变化等进行分析。结果 术后脱盲率为86．4％．脱残率为62．7％。41．8％的眼获得了双眼视，30．6％的患儿有立体视。3只眼发生后发性白内障．5只眼有一定程度的人工晶体夹持。结论 白内障摘除联合前段玻璃体切除和人工晶体植入治疗儿童白内障，术中和术后并发症少，绝大多数患儿术后视力能够显著提高并建立了良好的视功能。影响术后视功能的因素应进一步研究。     

Association between visual impairment and patient-reported visual disability at different stages of cataract surgery

PURPOSE: To evaluate the association between visual impairment (visual acuity, contrast sensitivity, stereopsis) and patient-reported visual disability at different stages of cataract surgery. METHODS: A cohort of 104 patients aged 60 years and over with bilateral cataract was assessed preoperatively, after first-eye surgery (monocular pseudophakia) and after second-eye surgery (binocular pseudophakia). Partial correlation coefficients (PCC) and linear regression models were calculated. RESULTS: In patients with bilateral cataracts, visual disability was associated with visual acuity (PCC = -0.30) and, to a lesser extent, with contrast sensitivity (PCC = 0.16) and stereopsis (PCC = -0.09). In monocular and binocular pseudophakia, visual disability was more strongly associated with stereopsis (PCC = -0.26 monocular and -0.51 binocular) and contrast sensitivity (PCC = 0.18 monocular and 0.34 binocular) than with visual acuity (PCC = -0.18 monocular and -0.18 binocular). Visual acuity, contrast sensitivity and stereopsis accounted for between 17% and 42% of variance in visual disability. CONCLUSIONS: The association of visual impairment with patient-reported visual disability differed at each stage of cataract surgery. Measuring other forms of visual impairment independently from visual acuity, such as contrast sensitivity or stereopsis, could be important in evaluating both needs and outcomes in cataract surgery. More comprehensive assessment of the impact of cataract on patients should include measurement of both visual impairment and visual disability.     

Quality of life after first- and second-eye cataract surgery: five-year data collected by the Swedish National Cataract Register.

PURPOSE: To study the benefits of surgery and satisfaction with vision after first- and second-eye cataract surgery in comparable groups of patients. SETTING: Clinics participating in the Swedish National Cataract Outcome Study from 1995 to 1999. METHODS: A prospective observational study evaluated patients' self-assessed visual function and satisfaction with vision before and 6 months after cataract extraction. Patients who had another cataract surgery in the fellow eye during the 6-month study were excluded. Data of 8595 patients having cataract extraction at participating clinics during the month of March for 1995 to 1999 were collected. Preoperative and intraoperative data were reported at the time of surgery. Final postoperative visual acuity was recorded. The Catquest questionnaire was completed before surgery and 6 months after surgery. RESULTS: First-eye surgery was performed in 5570 patients and second-eye surgery, in 3025. Patient-assessed benefits of surgery and satisfaction with vision as defined by the Catquest was higher after second-eye surgery (P <.001). The outcomes were studied in detail in patients with equal visual acuity in the fellow eye before and after surgery and without ocular comorbidity. The better outcome after second-eye surgery was most pronounced in patients with good or intermediate visual acuity in the fellow eye. CONCLUSION: The self-assessed visual outcomes and satisfaction with vision were better after second-eye surgery than after first-eye surgery in comparable groups of patients.     

Strabismus in developmental cataract

PURPOSE: To evaluate the presence of strabismus in patients with developmental cataract rendered pseudophakic and how this influences their visual acuity. METHODS: A retrospective study was carried out on 113 patients with developmental cataract who came under the authors' observation at the outpatient department of the Pediatric Ophthalmology Unit of the University of Federico II of Naples from 1990 to 2005. All patients were followed up for a long period (mean 62 months, range 36-144 months). Age at diagnosis, sex, laterality, age at cataract extraction, morphology, and cataract density were all considered as possible factors associated with strabismus. Visual acuity and ocular motility before and after cataract extraction surgery were especially noted. Statistical evaluation was performed using t-test, Chi-square test, and Fisher exact test. RESULTS: Out of the 113 patients a total of 181 eyes were affected: 68 patients (60%) presented bilateral cataract, 45 patients (40%) monolateral cataract. Strabismus was present in 39 patients (34%) before cataract surgery. Age at cataract diagnosis, age at surgery, sex, and cataract morphology were not found to be statistically associated with strabismus. However, laterality was found to be statistically associated with the onset of strabismus. Cataract density was found to be statistically associated with poor vision. Patients with strabismus presented a non statistically significant lower visual acuity. CONCLUSIONS: Strabismus has a greater incidence in developmental cataract compared to the general population, and can influence visual acuity, especially in monolateral and total cataracts. Intraocular lens implants produced satisfactory visual rehabilitation.     

Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified prolate anterior surface (Tecnis Z9000, AMO) results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: In an intraindividual randomized prospective study of 30 patients with bilateral cataract, the Tecnis Z9000 IOL was compared with 2 IOLs with spherical surfaces, the AR40e (AMO) and the Stabibag (Ioltech). Ocular aberrations for a 4.0 mm pupil and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. RESULTS: Eyes with the Tecnis Z9000 IOL had significantly less spherical aberration and a greater Strehl ratio after surgery. Significant reduction in coma aberration was also found in some cases. Refraction, visual acuity, and contrast sensitivity were not significantly different between the 3 IOL groups. CONCLUSION: A significant reduction in spherical aberration after Tecnis Z9000 IOL implantation was achieved, but visual acuity and contrast sensitivity were not affected by the aspheric silicone IOL compared to spherical acrylic IOLs.     

The impact of cataract surgery on visual functioning, vision-related disability and psychological distress: a randomized controlled trial

PURPOSE: Determine whether there are changes in visual functioning, vision-related disability, health status and mood after cataract surgery. METHODS: 45 adults (mean age = 73.7 years) with bilateral cataract needing surgery for the first eye were recruited from public ophthalmology clinics. The Visual Functioning-14 survey assessed visual disability. Minimal angle of resolution tested visual acuity, and the Melbourne Edge Test examined contrast sensitivity. Demographic, psychological, health and medication use variables were examined. Participants were randomized to either an intervention or control arm. Controls were assessed on two occasions at a 3-month interval before having surgery. The intervention group was assessed 1-2 weeks before surgery and then reassessed 3 months after surgery. RESULTS: Visual functioning improved for those who had cataract surgery with better visual acuity in the better (P = 0.010) and worse (P = 0.028) eye compared with controls. The intervention group reported fewer difficulties with overall vision-related disability (P = 0.0001), reading (P = 0.004) and instrumental activities of daily living (P = 0.010) post-surgery compared with controls. People with improved depression scores (P = 0.048) after surgery had less difficulty with reading compared with those with unchanged or worsened depression scores. Cataract surgery did not improve health status. CONCLUSIONS: First eye cataract surgery is effective in improving outcomes in visual functioning and disability. Improved mood after surgery was related to less vision-related disability compared with unchanged or worse depression.     

Influence of cataract and intraocular lens surgery on health-related quality of life

PURPOSE: To evaluate the vision-related quality of life(QOL) in patients undergoing cataract surgery with the Japanese version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). SUBJECTS AND METHODS: Subjects were 110 patients [70.4 +/- 9.2 (mean +/- standard deviation) years old] undergoing bilateral cataract surgery. Best-corrected visual acuity was 20/30 or worse in both eyes. The VFQ-25 was recorded before and 2 months after phacoemulsification and foldable intraocular lens implantation, and the influence of various clinical parameters was assessed. The VFQ-25 was also recorded in 69 glaucoma patients with visual field defects in both eyes, and in 31 normal subjects. RESULTS: The VFQ-25 scores before cataract surgery were as low as the scores obtained in glaucoma patients. Cataract surgery significantly improved VFQ-25 scores to the level of normal subjects Statistically significant improvements were observed in subscales such as general vision, near activities, distance activities, driving, peripheral vision, color vision, social functioning, dependency, role difficulties, mental health, and total score (p<0.001, paired t-test). The degree of improvement in VFQ-25 scores did not correlate with preoperative or postoperative visual acuity, uncorrected or corrected. The VFQ-25 scores improved more in younger patients, and improvement in the general vision subscale showed a significant negative correlation with age (r= -0.286, p=0.009, Pearson correlation coefficient). The degree of posterior subcapsular cataract in better eyes showed significant correlation with the improvement in subscales, such as distance activity (r =0.413, p<0.001), driving (r= 0.449, p=0.015), social functioning (r=0.308, p= 0.004), mental health (r=0.330, p=0.002), dependency (r=0.323, p=0.003), and total score (r=0.328, p=0.002). Other types of cataract had no correlation. Men tended to show more improvement in VFQ-25 scores by surgery than women, except for the dependency subscale. CONCLUSION: The current study quantitatively demonstrated that vision-related QOL is significantly impaired in patients with cataract, and that cataract surgery dramatically improves patients' QOL.     

Postoperative increase in grey matter volume in visual cortex after unilateral cataract surgery

Purpose: The developing visual cortex has a strong potential to undergo plastic changes. Little is known about the potential of the ageing visual cortex to express plasticity. A pertinent question is whether therapeutic interventions can trigger plastic changes in the ageing visual cortex by restoring vision. Methods: Twelve patients aged 50–85 years underwent structural high‐resolution T1‐weighted MRI of the whole brain 2 days and 6 weeks after unilateral cataract surgery. Voxel‐based morphometry (VBM) based on T1‐weighted magnetic resonance imaging (MRI) was employed to test whether cataract surgery induces a regional increase in grey matter in areas V1 and V2 of the visual cortex. Results: In all patients, cataract surgery immediately improved visual acuity, contrast sensitivity and mean sensitivity in the visual field of the operated eye. The improvement in vision was stable throughout the 6 weeks after operation. VBM revealed a regional expansion of grey matter volume in area V2 contralateral to the operated eye during the 6‐week period after surgery. Individual increases in grey matter were predicted by the symmetry in visual acuity between the operated eye and nonoperated eye. The more symmetrical visual acuity became after unilateral cataract surgery, the more pronounced was the grey matter increase in visual cortex. Conclusion: The data suggest that cataract surgery triggered a use‐dependent structural plasticity in V2 presumably through improved binocular integration of visual input from both eyes. We conclude that activity‐dependent cortical plasticity is preserved in the ageing visual cortex and may be triggered by restoring impaired vision.     

Association between vision impairment and driving exposure in older adults aged 70 years and over: a population‐based examination

Purpose: To examine the relationship between vision impairment and driving exposure (amount of driving one does) in a population‐based sample of older drivers and to examine to what extent cognitive status impacts this relationship. Methods: Enrollees consisted of a population‐based sample of older adults from Alabama who were ≥70 years old, held a current driver’s license, and had driven within the last 3 months. Three aspects of visual function were measured under binocular conditions – habitual distance visual acuity, contrast sensitivity and visual processing speed. General cognitive status was assessed with the mini‐mental status examination. Driving exposure was estimated by the Driving Habits Questionnaire that asked about the number of miles, places, trips and days driven per week. Results: Drivers with impaired contrast sensitivity exhibited reduced annual mileage, and a decreased number of places and trips driven per week compared to those with normal contrast sensitivity, even after adjustment for other factors. Slowed visual processing speed was associated with reduced number of days driven per week after adjustment. Visual acuity deficit was not associated with changes in driving exposure. Cognitive status did not impact any of the associations between vision impairment and driving exposure. Conclusion: Older drivers with contrast sensitivity impairment exhibit reduced driving exposure in terms of number of trips and places they drive per week, as well as decreased annual mileage. These apparent self‐regulatory practices should be viewed as adaptive because contrast sensitivity impairment elevates motor vehicle collision (MVC) risk and reduction in driving exposure can reduce MVC risk.     

后发性白内障评估方法和激光治疗时机的研究进展

白内障手术是目前根治白内障的唯一方法,后发性白内障(PCO)仍是白内障术后常见的长期并发症之一,可导致患者术后视力及视觉质量再次下降,影响患者生活质量并增加治疗成本。临床上对于PCO分级的评价及Nd:YAG激光后囊膜切开手术时机的选择多基于主观经验,尚无客观定量的评价方法。PCO的客观定量分析及其与视觉质量的关系对Nd:YAG激光治疗时机的选择与预后十分重要。本文就PCO图像采集方法、PCO分级、主观和客观定量分析、与视觉质量的关系及Nd:YAG激光后囊膜切开手术时机选择的新进展进行综述。