Photodynamic therapy for subretinal neovascularization in type 2A idiopathic juxtafoveolar telangiectasis

BACKGROUND: Photodynamic therapy (PDT) with verteporfin is now the standard of care worldwide for the treatment of choroidal neovascularization, but has been used only rarely in those with subretinal neovascular membranes (SRNVM) due to type 2A idiopathic juxtafoveolar retinal telangiectasis (IJT). We performed a retrospective study to examine the outcome of patients treated with PDT for SRNVM secondary to IJT. METHODS: Retrospective interventional case series of 7 eyes of 6 IJT patients with SRNVMs treated with PDT. Ophthalmic examination and fluorescein angiography were performed before treatment, with retreatment every 3 months as needed. The main outcome was the proportion of patients avoiding vision loss (change of +/- 4 letters, or better). RESULTS: Baseline Snellen acuity ranged from 20/40 to 20/400 (median 20/80). Mean follow-up was 21 months. Patients received 2.4 treatments on average. Five of 7 patients avoided vision loss; acuity improved in 3 eyes (> or = 1 line improvement), stayed the same in 2 eyes (+/- 4 letters) and decreased in 2 eyes (> or = 1 line decrease) over time. Median final acuity was 20/80. Five of 7 eyes had final acuities of > or = 20/200. No leakage was observed in any eyes following cessation of treatment.     

Arabic visual acuity chart for low vision examination

An Arabic visual acuity chart has been designed for low vision examination, using ten Arabic letters constructed on a 5 × 5 framework. The chart contains seven pages with acuity values ranging from 20/600 to 20/80, corresponding to letter sizes of 26.5–3.5 cm. Interletter spaces were made one-fifth the size of each letter in a row while inter-row spaces were made equal to the height of the letters in the row below. The chart will be useful to eye care practitioners who may wish to use Arabic charts in low vision evaluation.     

Repeatability of ETDRS visual acuity in children

PURPOSE: To evaluate repeatability of the best corrected log minimum angle of resolution (MAR) Early-Treatment Diabetic Retinopathy Study (ETDRS) acuity in a group of 6- to 11-year old children with myopia. METHODS: Best corrected monocular visual acuity (VA) of a subset of children (n = 86) enrolled in the Correction of Myopia Evaluation Trial (COMET; mean spherical equivalent refractive error -2.35 D with no more than 1.25 D astigmatism) was measured at baseline and 1 month later with ETDRS logMAR charts. Children started with logMAR 0.4 (6/15 or 20/50) and read each letter on all subsequent lines until they missed all letters in 1 line. RESULTS: At baseline, the mean best corrected logMAR VA was 0.003 +/- 0.076 (6/6 or 20/20 +/- 3.8 letters) in the right eye and 0.008 +/- 0.059 (6/6 or 20/20 +/- 2.95 letters) in the left eye. The signed difference between VA measured at baseline and that measured at 1 month was not significantly different from zero in either eye. Repeatability was not associated with age, but a small, statistically significant association with gender was detected in the left eye, with boys approximately 2 letters more variable than girls. The kappa statistic (agreement within 1 line) was good to excellent. CONCLUSIONS: Based on the 95% limits of agreement, the criterion for a statistically significant change in VA is no more than +/-0.15 logMAR (or +/-8 letters). This value is similar to those reported for adults and indicates that logMAR VA provides a repeatable measure of acuity in children.     

半量光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的疗效分析

目的 探讨半剂量维替泊芬光动力疗法治疗慢性中心性浆液性脉络膜视网膜病变的安全性和疗效.方法 结合患者病史和眼底检查、眼底荧光血管造影(FFA)及吲哚菁绿造影(ICGA)检查,诊断为慢性CSC的连续病例24例25只眼,以ICG为指导确定光斑大小和位置,采用1/2剂量维替泊芬PDT治疗.术后随访6～12个月.术前后进行最佳矫正视力(ETDRS视力表)、FFA、ICGA和OCT检查.结果 术后6个月时,最佳矫正视力平均提高(20.6±8.7)个字母(0～32个字母).视力稳定者(0～4个字母)2只眼,占8％;视力提高5～9个字母1只眼,占4％,视力提高10～19个字母8只眼,占32％,视力提高20个字母以上14只眼,占56％,无一只眼视力下降.所有患者诉眼前暗影减轻,视物变形改善.荧光血管造影显示,荧光素渗漏消失22只眼,占88％;渗漏减轻3只眼,占12％;无渗漏加重者.ICG示脉络膜血管通透性下降.OCT显示中央视网膜厚度由术前的(323.55±50.55)μm下降至(168.37±25.35) μm.术后未发现与PDT相关的并发症.结论 1/2剂量维替泊芬联合PDT治疗慢性CSC安全,具有良好疗效,但其长期安全性和有效性还有待于进一步对照研究来证实.     

First clinical experience with anecortave acetate (Retaane)

BACKGROUND: Anecortave acetate is an angiostatic cortisene which is injected as a posterior juxtascleral depot and has been shown to be effective in the treatment of exudative age-related macular degeneration (AMD). The compound is not yet approved in Switzerland but can be used as "compassionate use" in individual cases. PATIENTS AND METHODS: An uncontrolled case series with standardised documentation of ETDRS visual acuity, near acuity, need for magnification and fluorescein angiography was performed. RESULTS: 22 eyes of 19 patients (8 male, 11 female, average age 78.8 years) were treated with a posterior juxtascleral depot injection (PJD) of 15 mg anecortave acetate. The mean change in visual acuity after 3 months in eyes treated with anecortave acetate was -2.6 ETDRS letters corresponding to 0.52 Snellen lines. 3/20 eyes gained more than 1 line. 11/20 eyes showed stable visual acuity (+/- 1 Snellen line, +/- 5 ETDRS letters). 5/20 eyes developed moderate vision loss (one to two Snellen lines, 6-10 ETDRS letters). 1/20 lost 18 ETDRS letters (> 3 Snellen lines). There were no moderate or severe adverse events. CONCLUSIONS: A PJD of 15 mg anecortave acetate is safe and well tolerated. In eyes with occult CNV without recent progression or with residual neovascular activity after photodynamic therapy anecortave acetate may be an alternative therapeutic option before considering intravitreal anti-VEGF agents due to the much less invasive character and lower risk profile.     

Macular translocation with 360-degree peripheral retinectomy impact of technique and surgical experience on visual outcomes

PURPOSE: To evaluate the impact of technique and surgical experience on complications and outcomes of macular translocation surgery with 360-degree peripheral retinectomy (MTS360). METHODS: Twenty-six consecutive patients underwent MTS360 in a prospective study of macular translocation surgery for subfoveal choroidal neovascularization (CNV) in eyes with age-related macular degeneration (ARMD). Data gathered included intraoperative and postoperative events and pre- and postoperative standardized visual acuity recorded as number of letters read. Because the surgical technique changed particularly during the first 16 cases, patients were grouped into an evolving treatment group of the first 16 patients (Group 1) and a modified treatment group of the final 10 patients (Group 2). RESULTS: As techniques evolved in this series, ease of surgery increased. There were significant decreases in surgery duration and in number of retinotomies required to induce artificial retinal detachment. Number of postoperative retinal detachments decreased from five in Group 1 to none in Group 2. Change in visual acuity was significantly different between the two groups: Group 1 had an average loss of 14 letters (<3 lines) and Group 2 an average gain of 3 letters (<1 line) (P < 0.05). Average postoperative visual acuity was significantly better for Group 2 (68 letters, approximately 20/80) than for Group 1 (47 letters, approximately 20/250) (P < 0.01). CONCLUSION: Surgical experience and a progressively modified surgical technique decreased perioperative complications and improved visual outcomes after MTS360. With modified MTS360, central vision has been salvaged for almost 1 year of follow-up in patients presenting with vision loss from subfoveal CNV and ARMD.     

Preschool vision testing with a new device, the Scolatest

To determine the reliability of results obtained in preschool children by school nurses with a new device for testing vision, the Scolatest, 153 children aged 4 to 5 years were presented with the Snellen E on the standard American Optical projector and with five letters of the Sheridan test (H, O, V, T and X) on the Scolatest. Another 212 children aged 3 to 4 years were presented with the Allen symbols on the projector and with the Pigassou symbols on the Scolatest. The tests with the projector were given at 6 m by an experienced pediatric orthoptist, those with the Scolatest at 2.5 m by a school nurse. The proportion of good responses was higher with the Pigassou symbols than with the Allen symbols. The results with the Sheridan letters and the Snellen E were similar up to 20/30; beyond 20/30 the Snellen E appeared unreliable. The four vision-testing systems were also presented by a school nurse at 2.5 m on the Scolatest to 102 children aged 4 to 5 years (Snellen E and the five Sheridan letters) and 80 children aged 3 to 4 years (Allen and Pigassou symbols). The proportions of good responses were more comparable. The results suggest that a working distance of 2.5 m should be used in testing vision in preschool children. Visual screening at this distance should test acuity beyond the 20/30 equivalence if results comparable to those at 20 feet with the 20/30 standard requirement are to be obtained.     

An arabic letter distance visual acuity test chart for young children and illiterate adults

This paper describes the design of a kinetic response Arabic letter distance visual acuity test chart for young children and illiterate adults. An Arabic letter ein which has previously been used in the design of Arabic alphabet VA charts was employed. Four different orientations of the letter were constructed on a 5 x 5 unit format and graded according to log MAR principle of acuity scaling using an Apple computer. Inter-letter space in each row was made equal to the width of each letter in the row, and inter-row space was made equal to the height of letters in the next lower row. The chart has 14 acuity rows ranging from 4/40 to 4/2 (6/60 to 6/3) (20/200 to 20/10) (log MAR 1.0 to -0.3) at 4 metres. To establish the validity of the chart, acuity values obtained using the chart were compared with those from an existing Arabic log MAR distance VA chart and the Bailey and Lovie distance VA chart. Test retest reliability of the chart was also examined statistically. Results show that VA values from the new chart were significantly similar with those from which it was compared, and that values from the chart are reliable. The chart will be useful for evaluating vision, especially for young children and illiterate adults.     

Visual assessment of infants: vernier targets for the Catford drum.

Targets comprising a horizontal black line 5' thick offset by 1' were printed on strips to stick to the drums of the Catford Visual Acuity Apparatus. The 'vernier' targets so produced corresponded to the different sizes of Snellen letters from 6/6 to 2/60 when presented at 50 cm. Twenty-five children between the ages of 3 and 12 years with known amblyopia (mostly strabismic) were tested in a double blind trial to compare the visibility of the vernier targets with subjective Snellen acuity. All vernier results, both for better and amblyopic eye, were within one line of Snellen acuity. One hundred and twenty normal preverbal infants with normal eyes under the age of 2 1/2 years were tested with the vernier strips. Normal infants under the age of 6 months recorded a vision of 6/60-2/60; normal infants aged 6 to 12 months recorded 6/24-6/36, and infants between the ages of 1 and 2 1/2 years recorded 6/12-6/18.     

Rapid visual rehabilitation after endothelial transplants with deep lamellar endothelial keratoplasty (DLEK)

OBJECTIVE: To evaluate the speed of visual recovery in 30 consecutive patients with Fuchs endothelial dystrophy who received deep lamellar endothelial keratoplasty (DLEK) transplant surgery. METHODS: Best spectacle-corrected visual acuity (BSCVA) by manifest refraction and uncorrected visual acuity (UVA) were prospectively measured at preop, at 1 week, and at 1, 3, 6, 12, and 18 months after DLEK. The LogMAR of the postop vision was compared against each patient's preop vision. Visual results at 6 months were also compared against potential acuity meter (PAM) results in 27 patients. All eyes had reached at least the 6-month follow-up interval. RESULTS: Two of the first 32 eyes originally enrolled in the protocol were converted at surgery to standard penetrating keratoplasty (PK), and so DLEK data were obtained on 30 eyes for this report. Average BSCVA and UVA were better than preop vision at every time point, achieving statistical significance by 3 months (P < 0.05). Average preop BSCVA was 20/162 (range 20/40 to CF), improving to 20/63 at 3 months (range 20/25 to 20/200), 20/56 at 6 months, 20/51 at 1 year, and 20/46 at 18 months. Of the 27 patients who had PAM testing, 52% (14 of 27) had BSCVAs within 1 line of their PAM at 3 months, 63% (17 of 27) were within 1 line at 6 months, 71% (12 of 17) were within 1 line at 1 year, and 83% (10 of 12) were within 1 line at 18 months (P < 0.05 compared with preop from 3 months on). CONCLUSION: DLEK surgery preserves the normal corneal surface topography and allows rapid visual recovery of useful vision by 3 months. The visual acuity continues to improve over time.     

A novel high-frequency visual acuity chart

A high-frequency eye test chart using letters or figures of alternating black and white stripes (or dots) on a grey background was developed. Any cross-section of the letters has a Fourier transform with a zero frequency component equal to the luminance of the grey background. When the letters are out of focus, their image on the retina fades rapidly into the grey background, rendering them invisible rather than merely blurred as in a standard chart. The chart was calibrated by simulating refractive errors with defocusing lenses applied to a photographic camera and to subjects' eyes. No constant ratio was found between the size of the Snellen letters and the size of the high-frequency letters for equal visibility. The new chart requires letters for 20/200 acuity to be only 3.6 times larger than those for 20/20 vision. Results confirm the arbitrary nature of the Snellen fraction and warn about the accuracy of visual acuity determined by using charts of different letter types, calibrated by Snellen's system.     

Effects of cataract and scotoma on visual acuity: a simulation study.

Central field loss (CFL) and cataract both decrease visual acuity. For patients with CFL, visual acuity is further reduced when the acuity target is more visually complex. We tested visual acuity for targets of varying complexity (letters alone, letters flanked by one or two x's on each side, and words) in subjects with normal vision and in the presence of a simulated cataract, simulated scotoma, and their combination (scotoma + cataract). Visual acuity was best with normal vision and worst with scotoma + cataract for all of the acuity targets. There was little difference in visual acuity between the letters alone and flanked letters, and visual acuity was best for words under all vision conditions. The cataract had a greater impact on visual acuity when the subject's central visual field was clear (normal vision) than when it was occluded by the simulated scotoma.     

Factors influencing poor visual outcome in patients treated with photodynamic therapy for choroidal neovascularization secondary to age-related macular degeneration

BACKGROUND: This study evaluated patients with choroidal neovascular membranes secondary to age-related macular degeneration for factors that may predict the visual outcome after photodynamic therapy. METHODS: A retrospective review of 172 eyes of 172 consecutive patients who received photodynamic therapy for predominantly classic with and without occult, minimally classic and occult choroidal neovascular membranes secondary to macular degeneration in private practice from June 2000 to September 2004 was undertaken. All eyes had a baseline vision of 6/12 to 6/60. Classification of lesion composition, retreatment and follow up adhered to published photodynamic therapy guidelines. The primary outcomes measured were effects of patient age, baseline visual acuity, lesion composition and lesion size on final visual acuity and loss of less than 15 letters of logMAR at 12 months. RESULTS: All eyes were followed up for 12 months. Baseline mean logMAR visual acuity was logMAR 0.64. Using multivariate logistic regression, loss of logMAR vision at 12 months was independently associated with increasing age (P=0.004), better baseline vision (P=0.009) and increasing lesion size (P=0.035). However, there was no association with lesion composition (P=0.16). At 12 months the loss of 15 letters or less was found in 101 (59.7%; 95% confidence interval: 51.0-66.2%) of all patients. CONCLUSIONS: This study found no statistically significant association between lesion composition defined on fluorescein angiography and loss of visual acuity compared with previous studies. Factors associated with an increased rate of loss of 15 letters were increasing age of the patient, increasing lesion size and better baseline logMAR vision.     

Inefficacy of aspheric soft contact lenses for the correction of low levels of astigmatism.

PURPOSE: The purpose of this article is to compare the visual performance of a toric soft (TS) contact lens (SofLens 66 Toric; Bausch & Lomb, Rochester, NY), an aspheric soft (AS) contact lens (Frequency Aspheric; CooperVision, Fairport, NY) and a spectacle correction (SC) in subjects with low levels of astigmatism. METHODS: One eye of 30 subjects with refractive astigmatism of -0.75 DC or -1.00 DC was tested. After pupil dilation, each subject was fitted with all three forms of correction in random order. Subjects were masked from the contact lens type. High-contrast visual acuity (HCVA) and low-contrast visual acuity (LCVA) were recorded for each correction using 2-mm, 4-mm, and 6-mm artificial pupils. RESULTS: With a 2-mm pupil, HCVA was similar for the TS lens and the SC (p = 0.13); better HCVA was demonstrated with the TS lens than with the AS lens (p = 0.001). With 4-mm and 6-mm pupils, HCVA was poorer with the AS lens than with the SC (p < 0.002) and TS lenses (p < 0.0001). The difference in HCVA between the TS and AS lenses was two letters, three letters, and one line with pupil sizes of 2 mm, 4 mm, and 6 mm, respectively. LCVA was similar for the three refractive conditions with the 2-mm pupil size. With 4-mm and 6-mm pupils, LCVA was similar for the TS lens and SC, but better than the AS lens by approximately one line in each case (all p < 0.0001). CONCLUSIONS: For small pupil sizes, there is little difference in HCVA and LCVA between various refractive corrections. However, for larger pupils, HCVA and LCVA are superior with TS contact lenses and SC versus AS contact lenses by approximately a half-line or more, which is considered to be clinically significant. Superior vision can be achieved for low astigmatic contact lens wearers using TS rather than AS contact lenses.     

Higher risk of multiple falls among elderly women who lose visual acuity

OBJECTIVE: To determine the association between changes in visual acuity (VA) and frequent falls in older women. DESIGN: Prospective cohort study. PARTICIPANTS: Two thousand two elderly community-residing women participating in the Study of Osteoporotic Fractures with measurements of VA at baseline and a follow-up examination 4 to 6 years later (mean of 5.6 years). METHODS: Binocular VA with habitual correction was measured under standard illumination using Bailey-Lovie charts at baseline and fourth examinations. Change in VA was stratified into 5 categories: no change or VA gain, loss of 1 to 5 letters, loss of 6 to 10 letters, loss of 11 to 15 letters, and loss of >15 letters. A separate analysis considered decline in VA as the loss of >or=10 letters (>or=2 lines) on the Bailey-Lovie acuity measure between baseline and follow-up examinations. MAIN OUTCOME MEASURES: Data on falls were obtained from postcards sent every 4 months after the follow-up examination. Frequent falling was defined as >or=2 falls during a 1-year period after the follow-up examination. RESULTS: Compared with women with stable or improved VA, women with declining acuity had significantly greater odds of experiencing frequent falling during the subsequent year. Odds ratios after adjustment for baseline acuity and other confounders were 2.08 (95% confidence interval [CI]: 1.39-3.12) for loss of 1 to 5 letters, 1.85 (95% CI: 1.16-2.95) for loss of 6 to 10 letters, 2.51 (95% CI: 1.39-4.52) for loss of 11 to 15 letters, and 2.08 (95% CI: 1.01-4.30) for loss of >15 letters. In the analysis of visual decline defined as a loss of >or=10 letters, heightened risk of frequent falling was evident in each of 2 subgroups defined by splitting the sample on baseline VA, with borderline significant evidence of a more pronounced effect in those women with baseline VA of 20/40 or worse (P value for interaction, 0.083). CONCLUSIONS: Loss of vision among elderly women increases the risk of frequent falls. Prevention or correction of visual loss may help reduce the number of future falls.     

Macular translocation for subfoveal choroidal neovascularization in age-related macular degeneration: a prospective study.

PURPOSE: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold. RESULTS: All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 microm (range, 114 to 1,919 microm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye. CONCLUSIONS: Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.     

Intravitreal bevacizumab (Avastin) for neovascular age‐related macular degeneration using a variable frequency regimen in eyes with no previous treatment

Purpose: To evaluate a variable frequency regimen with intravitreal bevacizumab for treatment of neovascular age‐related macular degeneration (AMD) in eyes that have not received any previous treatment. Methods: Retrospective review of patients with neovascular AMD who were treated with three consecutive monthly intravitreal injections of bevacizumab (1.25 mg) and retreated based on the PrONTO study criteria. Outcome measures included visual acuity (VA) and central retinal thickness. Subgroup analysis was conducted to identify pretreatment characteristics that could determine visual outcome with treatment. Results: A total of 109 eyes of 109 patients were treated. The mean age was 82 years, and the mean follow‐up period was 9.4 months (range 6–12 months). At baseline, the mean VA was 45.6 letters (6/37.5) and mean central retinal thickness 343 µm. This improved to 51 letters (6/30) (P < 0.001)) and 231 µm (P < 0.001) at 6 months. At 6 months, VA was improved by at least five letters in 50%, remained stable in 30% and worsened by at least five letters in 20% of patients. Patients with large intraretinal cysts on optical coherence tomography before treatment had an increased risk of worse vision (odds ratio 10.5, 95% confidence interval 1.69–64.99; P = 0.018). Conclusions: The majority of patients had improvement or stability of VA regardless of the angiographic type of choroidal neovascularization. Intravitreal bevacizumab with this tailored regimen is beneficial in the treatment of neovascular AMD in the short term. The presence of large intraretinal cysts on optical coherence tomography is a poor prognostic factor for visual improvement with this treatment.     

Learning letter identification in peripheral vision

Performance for a variety of visual tasks improves with practice. The purpose of this study was to determine the nature of the processes underlying perceptual learning of identifying letters in peripheral vision. To do so, we tracked changes in contrast thresholds for identifying single letters presented at 10 degrees in the inferior visual field, over a period of six consecutive days. The letters (26 lowercase Times-Roman letters, subtending 1.7 degrees) were embedded within static two-dimensional Gaussian luminance noise, with rms contrast ranging from 0% (no noise) to 20%. We also measured the observers' response consistency using a double-pass method on days 1, 3 and 6, by testing two additional blocks on each of these days at luminance noise of 3% and 20%. These additional blocks were the exact replicates of the corresponding block at the same noise contrast that was tested on the same day. We analyzed our results using both the linear amplifier model (LAM) and the perceptual template model (PTM). Our results showed that following six days of training, the overall reduction (improvement across all noise levels) in contrast threshold for our seven observers averaged 21.6% (range: 17.2-31%). Despite fundamental differences between LAM and PTM, both models show that learning leads to an improvement of the perceptual template (filter) such that the template is more capable of extracting the crucial information from the signal. Results from both the PTM analysis and the double-pass experiment imply that the stimulus-dependent component of the internal noise does not change with learning.     

Comparison of multifocal and monovision soft contact lens corrections in patients with low-astigmatic presbyopia.

PURPOSE: The purpose of this study was to assess visual performance and patient satisfaction with two presbyopic soft contact lens modalities. METHODS: A crossover study of 38 patients with presbyopia was conducted. Patients were randomized first into either multifocal (Bausch & Lomb SofLens Multifocal) or monovision (SofLens 59) for 1 month. Visual performance was measured with high- and low-contrast visual acuity at distance and near and near stereoacuity. Patients' satisfaction was measured by the National Eye Institute Refractive Error Quality of Life Instrument questionnaire and by recording the patient's final lens preference. RESULTS: Patients maintained at least 20/20 binocular vision with both multifocal (MF) and monovision (MV) contact lenses under high-contrast conditions at distance and near. Under low-contrast conditions, patients lost less than a line of vision from the best spectacle correction to either multifocal or monovision contact lens correction at distance (pMF = 0.001, pMV = 0.006). Under low-contrast conditions at near, multifocal wearers lost five to six letters and monovision wearers lost two letters of vision (pMF < 0.001, pMV = 0.03, pMF/MV = 0.005). The average stereoacuity decreased by 79 s arc with monovision vs. multifocal contact lenses (p = 0.002). On the NEI-RQL, patients reported worse clarity of vision (pMF = 0.01, pMV < 0.001), more symptoms (pMF = 0.09, pMV = 0.01), and an improvement in their appearance with contact lens wear (pMF < 0.001, pMV < 0.001). Seventy-six percent of patients reported that they preferred multifocal contact lenses, and 24% preferred monovision contact lenses (p = 0.001). CONCLUSION: The majority of our patients preferred multifocals to monovision, most likely because the Bausch & Lomb SofLens Multifocal provides excellent visual acuity without compromising stereoacuity to the same degree as monovision.     

Suggested vision standards for drivers in the United States with vision ranging from 20/175 (6/52) to 20/50 (6/15)

This article creates two categories for individuals with vision ranging from 20/175 (6/52) to 20/50 (6/15). Statistically, there are approximately 532,000 drivers with vision ranging from 20/175 (6/52) to 20/100 (6/30) and 56,000 drivers with vision ranging from 20/80 (6/24) to 20/50 (6/15). The author contends that the plan to test the vision of a number of drivers over the next four years will turn up a large number of failures. This will result in the loss of licenses and conceivably cause many people to lose their jobs. One way to avoid this is to issue limited licenses. It is important for the Department of Motor Vehicles to consider this step.