Assessment Of Visual Function Research Articles

Exploratory Longitudinal Study of Ocular Structural and Visual Functional Changes in Subjects at High Genetic Risk of Developing Alzheimer's Disease.

This study aimed to analyze the evolution of visual changes in cognitively healthy individuals at risk for Alzheimer's disease (AD). Participants with a first-degree family history of AD (FH+) and carrying the Ε4+ allele for the ApoE gene (ApoE ε4+) underwent retinal thickness analysis using optical coherence tomography (OCT) and visual function assessments, including visual acuity (VA), contrast sensitivity (CS), color perception, perception digital tests, and visual field analysis. Structural analysis divided participants into FH+ ApoE ε4+ and FH- ApoE ε4- groups, while functional analysis further categorized them by age (40-60 years and over 60 years). Over the 27-month follow-up, the FH+ ApoE ε4+ group exhibited thickness changes in all inner retinal layers. Comparing this group to the FH- ApoE ε4- group at 27 months revealed progressing changes in the inner nuclear layer. In the FH+ ApoE ε4+ 40-60 years group, no progression of visual function changes was observed, but an increase in VA and CS was maintained at 3 and 12 cycles per degree, respectively, compared to the group without AD risk at 27 months. In conclusion, cognitively healthy individuals at risk for AD demonstrated progressive retinal structural changes over the 27-month follow-up, while functional changes remained stable.

Post-enucleation Functional Vision Assessment in Retinoblastoma Survivors. A neglected aspect in management plan!

Little is known about the impact of treatment in retinoblastoma (RB) survivors in terms of disabilities which may cause hindrance in taking part in daily life activities. van Dijk et al reported that 55% of the RB survivors perceive RB-related restrictions in their routine life activities related to their school, professional career, mobility, or self-care, etc.1 Weintraub and colleagues also found a negative correlations between motor functions and children's quality of life (QOL) who survived RB treatmentand have monocular vision.2

A cross-sectional study to assess the clinical utility of modern visual function assessments in patients with inherited retinal disease: a mixed methods observational study protocol

BackgroundTreatment options for patients with inherited retinal disease are limited, although research into novel therapies is underway. To ensure the success of future clinical trials, appropriate visual function outcome measures that can assess changes resulting from therapeutic interventions are urgently required. Rod-cone degenerations are the most common type of inherited retinal disease. Visual acuity is a standard measure but is typically preserved until late disease stages, frequently making it an unsuitable visual function marker. Alternative measures are required. This study investigates the clinical utility of a range of carefully selected visual function tests and patient reported outcome measures. The aim is to identify suitable outcome measures for future clinical trials that could be considered for regulatory approval.MethodsThis cross-sectional study involves two participant groups, patients with inherited retinal disease (n = 40) and healthy controls (n = 40). The study has been designed to be flexible and run alongside NHS clinics. The study is split into two parts. Part one includes examining standard visual acuity, low luminance visual acuity, the Moorfields acuity chart visual acuity, mesopic microperimetry and three separate patient reported outcome measures. Part two involves 20 min of dark adaptation followed by two-colour scotopic microperimetry. Repeat testing will be undertaken where possible to enable repeatability analyses. A subset of patients with inherited retinal disease will be invited to participate in a semi-structured interview to gain awareness of participants’ thoughts and feelings around the study and different study tests.DiscussionThe study highlights a need for reliable and sensitive validated visual function measures that can be used in future clinical trials. This work will build on work from other studies and be used to inform an outcome measure framework for rod-cone degenerations. The study is in keeping with the United Kingdom Department of Health and Social Care research initiatives and strategies for increasing research opportunities for NHS patients as part of their NHS care.Trial registrationISRCTN registry, ISRCTN24016133, Visual Function in Retinal Degeneration, registered on 18th August 2022.

Natural History of Visual Dysfunction in ABCA4 Retinopathy and Its Genetic Correlates

To systematically assess the ability to detect change and retest reliability for a panel of visual function assessments in ABCA4 retinopathy. Prospective natural history study (NCT01736293). Patients with at least 1 documented pathogenic ABCA4 variant and a clinical phenotype consistent with ABCA4 retinopathy were recruited from a tertiary referral center. Participants underwent longitudinal, multifaceted functional testing, including measures of function at fixation (best-corrected visual acuity, low-vision Cambridge Color Test), macular function (microperimetry), and retina-wide function (full-field electroretinography [ERG]). Two- and 5-year ability to detect change was determined based on the η2 statistic. A total of 134 eyes from 67 participants with a mean follow-up of 3.65 years were included. In the 2-year interval, the microperimetry-derived perilesional sensitivity (η2 of 0.73 [0.53, 0.83]; -1.79 dB/y [-2.2, -1.37]) and mean sensitivity (η2 of 0.62 [0.38, 0.76]; -1.28 dB/y [-1.67, -0.89]) showed most change over time, but could only be recorded in 71.6% of the participants. In the 5-year interval, the dark-adapted ERG a- and b-wave amplitude showed marked change over time as well (eg, DA 30 a-wave amplitude with an η2 of 0.54 [0.34, 0.68]; -0.02 log10(µV)/y [-0.02, -0.01]). The genotype explained a large fraction of variability in the ERG-based age of disease initiation (adjusted R2 of 0.73) CONCLUSIONS: Microperimetry-based clinical outcome assessments were most sensitive to change but could only be acquired in a subset of participants. Across a 5-year interval, the ERG DA 30 a-wave amplitude was sensitive to disease progression, potentially allowing for more inclusive clinical trial designs encompassing the whole ABCA4 retinopathy spectrum.

Visual function assessment of Chinese cataract patients after individual aspheric intraocular lens implantation according to preoperative cornea spherical aberration.

Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p< 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5∘, but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function.

Reliability and Agreement of an Integrated Platform for Intelligent Visual Function Measurement.

Phoropters are widely accepted for clinical use in refraction examination and visual function assessment. This study assessed the reliability of the new Inspection Platform of Visual Function (IPVF) in comparison with the conventional equipment phoropter (TOPCON VT-10) in visual function assessment. This prospective study enrolled 80 eyes of 80 healthy subjects. The horizontal phoria at distance and near (Phoria_D and Phoria_N, respectively) was measured with the von Graefe method, negative/positive relative accommodation (NRA/PRA) was measured with the positive/negative lens method, and accommodative amplitude (AMP) was measured with the minus lens method. Data of three consecutive measurements with each instrument were evaluated using the intraclass correlation coefficient (ICC) for repeatability, and the agreement of the two instruments was evaluated using a Bland-Altman plot. The ICCs of the three consecutive measurements for phoria, NRA/PRA, and AMP using the IPVF instrument were high (0.87-0.96), indicating high repeatability. The ICCs of the three consecutive measurements using the phoropter were high (0.914-0.983) for phoria, NRA, and AMP, indicating high repeatability, while that of PRA was 0.732 (between 0.4 and 0.75), indicating acceptable repeatability. The 95% limits of agreement of phoria, NRA/PRA, and AMP were narrow, indicating good agreement between the two instruments. The repeatability of both instruments was high, and the IPVF instrument was slightly better in terms of PRA repeatability than the phoropter. The agreement of phoria, NRA/PRA, and AMP measured by the new IPVF instrument and phoropter was also satisfactory.

Value of optical coherence tomography angiography for the assessment of visual functions in children with retinopathy of prematurity

AIM: To compare and assess morphometric, structural, and microvascular parameters of the macular zone in children with cicatricial ROP grades IIII with different visual acuity from those in healthy peers.&#x0D; MATERIAL AND METHODS: Eighteen children (36 eyes) aged 818 years with cicatricial ROP grades IIII were examined. Ten peers (20 eyes) made up the control group. All children, in addition to the standard ophthalmological examination, underwent optical coherence tomography and optical coherence tomography with angiography (OCTA). The diagnosis was carried out on a tomograph RS-3000 Advance 2 (Nidek (Japan)). In the resulting 33 mm scans with a center in the fovea, the vascular and perfusion density of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DSP), and the foveolar avascular zone, were measured, the thickness of the retina in the fovea was evaluated, and the structure of the neuroepithelium in the macula was assessed.&#x0D; RESULTS: In children born before 27 weeks, the central retinal thickness was higher than that in more mature children (231.818.2 and 208.215.2 m, respectively), and the relationship of this parameter with visual acuity was not explored. The vascular density of SCP in children with ROP and best-corrected visual acuity (BCVA) up to 0.4 and more than 0.4 were 1.46 mm-1 and 1.35 mm-1, respectively; and in the control group, it was 1.89 mm-1.&#x0D; The perfusion densities of the SCP in these groups were 9.2%, 10.03%, and 13.3%, respectively. The vascular densities of the Deep capillary plexus (DCP) in children with ROP with BCVA up to 0.4 and more than 0.4 were 2.8 mm-1 and 3.0 mm-1, respectively; in the control group, it was 3.2 mm-1, and the perfusion density of the deep capillary plexus (DCP) in indicated groups were 25.7%, 30.9%, and 31.7%, respectively.&#x0D; CONCLUSION: The analysis of the architectonics of the retinal vascular bed in children with ROP using OCTA makes it possible to assess the relationship between microcirculation disorders in the central zone of the retina and visual acuity, which is of great scientific and practical importance.

Development of an integrated telerehabilitation model in children with cerebral visual impairment in South India during the COVID-19 pandemic - A pilot study.

Coronavirus disease 2019 (COVID-19) pandemic affected the in-person rehabilitation/habilitation services in families with children with cerebral visual impairment (CVI) in India. This study aimed to develop a structured and family-centered telerehabilitation model alongside conventional in-person intervention in children with CVI to observe its feasibility in the Indian population. This pilot study included 22 participants with a median age of 2.5 years (range: 1-6) who underwent a detailed comprehensive eye examination followed by functional vision assessment. The visual function classification system (VFCS) was administered to the children and the structured clinical question inventory (SCQI) to the parents. Every participant underwent 3 months of telerehabilitation including planning, training, and monitoring by experts. At 1 month, the parental care and ability (PCA) rubric was administered to the parents. After 3 months, in an in-person follow-up, all the measures were reassessed for 15 children. After 3 months of Tele-rehabilitation there were significant improvements noted in PCA rubric scores (P<0.05). Also, statistically significant improvements were noted in functional vision measured using SCQI and VFCS scores (P<0.05) compared to baseline. The outcomes of the study provide the first steps towards understanding the use of a novel tele-rehabilitation model in childhood CVI along-side conventional face-to-face intervention. The added role of parental involvement in such a model is highly essential.

Assessment of Visual Function for Education: A Commentary on ‘VEP Visual Acuity in Children with Cortical Visual Impairment’

Assessment of Visual Function for Education: A Commentary on ‘VEP Visual Acuity in Children with Cortical Visual Impairment’

Binocular visual function improvement after pars plana vitrectomy for epiretinal membrane.

To report binocular visual function changes after pars plana vitrectomy for epiretinal membrane (ERM) and the related outcomes. Twenty-three eyes of 23 patients operated on for ERM were included in a retrospective study. Clinical data, best-corrected visual acuity (BCVA), contrast sensitivity and binocular visual function were assessed pre- and 1 and 3 months post-operatively. Binocular visual function assessment included the evaluation of fusional amplitudes (i.e., vergences) by the synoptophore, far distance stereopsis using polarized glasses and near stereopsis using Randot and TNO tests. Central macular thickness (CMT) was measured on Spectral Domain - Optical Coherence Tomography. Mean age of the patients was 67 years. Mean BCVA and contrast sensitivity significantly improved post-operatively at one (p = 0.0006 and p = 0.0022, respectively) and 3 months (p < 0.0001 and p < 0.0001, respectively), while CMT significantly decreased after 1-3 months (p < 0.0001 and p < 0.0001, respectively). Fusional amplitudes improved after 3 months (p < 0.0001). Far distance and near stereopsis significantly improved after 3 months (p < 0.0001 and p = 0.0007 for Randot test, and p < 0.0001 for TNO test, respectively). Pars plana vitrectomy for ERM surgery leads to an improvement of monocular and binocular visual functions (i.e., binocular fusion, near and far distance stereopsis), within 3 months post-operatively.

Sensory organization of postural control after long term space flight.

Alterations in motor control systems is an inevitable consequence of space flights of any duration. After the flight, the crew-members have significant difficulties with maintaining upright balance and locomotion, which last several days following landing. At the same time, the specific mechanisms of these effects remain unclear. The aim of the study was to assess effects of long-term space flight on postural control and to define the changes of sensory organization caused by microgravity. 33 cosmonauts of Russian Space Agency, the members of International Space Station (ISS) flights of duration between 166 and 196 days took part in this study. Computerized Dynamic Posturography (CDP) tests, which include assessment of visual, proprioceptive and vestibular function in postural stability, was performed twice before the flight and on the 3rd, 7th, and 10th days after landing. The video analysis of ankle and hip joints fluctuations was performed to investigate the basis of postural changes. Exposure to long-term space flight was followed by considerable changes of postural stability (-27% of Equilibrium Score value in the most complicated test, SOT5m). Changes in postural strategies to maintain balance were observed in the tests which provide the challenge for vestibular system. In particular, increased hip joint involvement (+100% in median value and +135% in 3rd quartile of hip angle fluctuation RMS in SOT5m) into postural control process was revealed. Decrease of postural stability after long-term space flight was associated with alterations in vestibular system and biomechanically was revealed by increased hip strategy which is less accurate, but simpler in terms of the central control.

Design and Validation of a Novel Smartphone-Based Visual Acuity Test: The K-VA Test.

Visual acuity (VA) testing is a critical screening examination for the assessment of visual function. This study describes the development and validation of a smartphone-based VA test: the K-VA test. A total of 171 patients with various ocular diseases were examined in our outpatient unit at Aristotle University of Thessaloniki, School of Medicine in Greece. Participants underwent VA examination using the standard Early Treatment Diabetic Retinopathy Study (ETDRS)charts and the K-VA smartphone-based test. The K-VA test was performed by participants themselves. The Bland-Altman method was employed to assess the agreement between the ETDRS charts and the new test for the examination of VA at 1m and 40cm. Test-retest reliability was also calculated. A questionnaire regarding the participants' feedback on the K-VA test was completed. No significant bias wasobserved between the gold standard ETDRS charts and the K-VA test measurements. The mean difference (95% limits of agreement, LoA) between the K-VA test at 1m and the ETDRS chart at 4m was -0.006 (95% LoA -0.129 to 0.117) logarithm of the minimal angle of resolution (logMAR). The agreement of the K-VA test at 40cm with thenear ETDRS chart was also high with a mean difference of -0.007 (95% LoA -0.105 to 0.090) logMAR. Test-retest reliability was found to be high with a mean difference of 0.003 (95% LoA -0.045 to 0.033) logMAR and 0.005 (95% LoA -0.065 to 0.076) logMAR for theK-VA testat 1m and 40cm, respectively. A total of 97 participants answered the questionnaire and 71 (73.2%) stated that the test was easy to very easy to use for self-performance. The study demonstrated that the K-VA application performed well compared with the ETDRS charts and provides reliable and repeatable measurements of VA across a wide range of VA.

Survey of Special Education Eligibility Criteria for the Category Visual Impairment Including Blindness

Introduction: Special education eligibility criteria vary across U.S. states; this study reports a systematic analysis of interstate eligibility criteria in the Individuals with Disabilities Education Act (IDEA) category of visual impairments including blindness. Method: Eligibility criteria for all 56 U.S. states, territories, and Washington, DC, were collected and coded on 20 different variables. Variables included use of federal language, qualifying conditions, assessment components, and eligibility team member requirements. Results: Fourteen of 56 states use similar or identical eligibility criteria written in IDEA. Forty-one states (73%) included language that specified criteria or operationally defined what it meant to be a student with a visual impairment in their state. Although about half of the states included an eye report as part of the eligibility process, few specifically mentioned functional vision, learning media, and orientation and mobility assessments in their criteria. Discussion: Significant interstate variations in the interpretation of who qualifies as a student with a visual impairment exist in the United States. Some eligibility criteria were written in an unclear language, making the criteria hard to interpret. Given that identification and prevalence rates of students with disabilities, including students with visual impairments, correlate to components of eligibility criteria, future work should seek to develop an operationalized universal definition of who qualifies as a student with visual impairment in schools. Implications for Practitioners: Since significant interstate variations exist, students, families, and educators must have easy access to all states’ criteria so that families may understand how a student's eligibility for services may change if they move between states.

Visual Function in Children with GNAO1-Related Encephalopathy

GNAO1-related encephalopathies include a broad spectrum of developmental disorders caused by de novo heterozygous mutations in the GNAO1 gene, encoding the G (o) subunit α of G-proteins. These conditions are characterized by epilepsy, movement disorders and developmental impairment, in combination or as isolated features. This study aimed at describing the profile of neurovisual competences in children with GNAO1 deficiency to better characterize the phenotype of the disease spectrum. Four male and three female patients with confirmed genetic diagnosis underwent neurological examination, visual function assessment, and neurovisual and ophthalmological evaluation. Present clinical history of epilepsy and movement disorders, and neuroimaging findings were also evaluated. The assessment revealed two trends in visual development. Some aspects of visual function, such as discrimination and perception of distance, depth and volume, appeared to be impaired at all ages, with no sign of improvement. Other aspects, reliant on temporal lobe competences (ventral stream) and more related to object-face exploration, recognition and environmental control, appeared to be preserved and improved with age. Visual function is often impaired, with patterns of visual impairment affecting the ventral stream less.

Pattern visual evoked potentials show an inferior-superior topographic shift through maturation in childhood.

The pattern-reversal visual evoked potential (prVEP) is an established routine clinical test. Its objectivity is particularly valuable for assessing visual pathway function in children. International standards specify at a minimum that an active electrode is placed on the occiput at Oz, but we find an additional inferior electrode at the inion (Iz) provides larger and more sensitive prVEPs in young persons. This study assesses the significance and age-dependence of these observations. PrVEPs were recorded from 1487 patients considered ophthalmologically normal aged <20years old, to a range of check widths including International Society for Clinical Electrophysiology of Vision (ISCEV)standard large (50') and small (12.5') check widths. P100 peak-time and amplitude from both electrode sites were analysed. A subset of 256 children were studied longitudinallybyfitting logistic regression models including a random effect on subjects. PrVEPs were largest over the Iz electrode for the majority of infants and children. This transitioned with age to become equal or smaller at Oz as a function of check width. For ISCEV standard large and small check widths, transition periods were ∼8 and ∼12years of age, respectively. We estimated abnormal result classifications of 3.7% with use of an Oz electrode alone, which decreases to 0.0-0.5% when adding or using an Iz electrode. The inferior dominance of prVEP topography in children may be explained by age-related anatomical changes altering the cortical dipole, combined with physiological maturation of the neural generators of the prVEP. We recommend the Iz electrode is used routinely in recording of prVEPs in children. KEY POINTS: Pattern visual evoked potentials (PVEPs) are an established clinical test which provide objective assessment of visual pathway function. These are particularly valuable in providing objective information of vision in children. International standards specify the active recording electrode should be placed at the mid-occiput (Oz), but we find that pattern-reversal visual evoked potential amplitudes are larger for a lower placed electrode (Iz) in young persons. This was assessed in 1487 patients who had simultaneous PVEP recording at both electrode positions, and it was found that the majority of PVEPs in children were larger over the Iz electrode. The developmental differences in PVEP distribution transitioned to be equal between Iz and Oz with increasing age as a function of check width, at ∼8 and ∼12years old for large and small check widths, respectively. These differences will improve diagnostic accuracy of paediatric PVEPs. We hypothesise these changes reflect developmental anatomical and neurophysiological changes altering the PVEP dipole.

Routine binocular examination of young Taiwanese adults as a predictor of visual behavior performance

BackgroundMorgan and Scheiman’s Optometric Extension Program (OEP) expected binocular vision findings have longstanding use in optometry. With technological advances, the demands and standards of binocular function have changed. This study aimed to investigate which binocular visual functions can effectively predict visual behavior performance.MethodsParticipants aged 15–24 years were recruited from two colleges and two universities. After completing the CSMU-Visual Behavioral Performance questionnaire (CSMU-VBP, with four components: near work, visual perception, visual comfort, and whole-body balance), participants were divided into symptomatic and asymptomatic groups based on questionnaire findings (cutoff: < 12 vs. ≥ 12 symptoms). Then a 24-step binocular visual examination was undertaken. Data were analyzed with one-sample, Student’s, and paired t-tests. Additionally, receiver operating characteristic analysis was used to determine the predictors of binocular visual function required for near work, visual perception, visual comfort, and body balance dimensions.ResultsAmong 308 participants, 43 (14%) and 265 (86%) were symptomatic and asymptomatic, respectively. Among the 46 participants with abnormal binocular vision, 36 (78%) reported that they had no obvious symptoms. The commonest dysfunctions were accommodative excess and convergence excess. Most of the binocular visual findings significantly diverged from traditional normal values: amplitude of accommodation, as well as base-in prism to break and recovery points at distance were higher than traditional normal values, whereas others were lower than traditional normal values. Total CSMU-VBP scores indicated that the asymptomatic and symptomatic groups had significant differences in DBO recovery (t = 2.334, p = 0.020) and BAF (t = 1.984, p = 0.048). Receiver operating characteristic curve analysis yielded the following binocular visual functional cutoff points: near work (DBO blur < 7, DBO recovery < 5.5), visual perception (MAF < 10.5, BAF < 10.25), visual comfort (DLP < − 2.25, DBI break > 11.5, NBI blur > 15, NBI break > 17.5, NBI recovery > 13, NPC < 5.75), and body balance (NFD_H > − 0.5, gradient AC/A [minus] > 2.25, NPC < 4.75).ConclusionsThe mean values of binocular visual function among young Taiwanese adults were statistically different from traditional normative values. Further research is required to confirm whether these findings reflect impaired binocular vision or stringent criteria. Assessments of binocular visual function, especially binocular accommodation sensitivity, are crucial in routine optometric examination.

Assessing the reliability of web-based measurements of visual function

Many behavioural phenomena have been replicated using web-based experiments, but evaluation of the agreement between objective measures of web- and lab-based performance is required if scientists and clinicians are to reap the benefits of web-based testing. In this study, we investigated the reliability of a task which assesses early visual cortical function by evaluating the well-known ‘oblique effect’ (we are better at seeing horizontal and vertical edges than tilted ones) and the levels of agreement between remote, web-based measures and lab-based measures. Sixty-nine young participants (mean age, 21.8 years) performed temporal and spatial versions of a web-based, two-alternative forced choice (2AFC) orientation-identification task. In each case, orientation-identification thresholds (the minimum orientation difference at which a standard orientation could be reliably distinguished from a rotated comparison) were measured for cardinal (horizontal and vertical) and oblique orientations. Reliability was assessed in a subsample of 18 participants who performed the same tasks under laboratory conditions. Robust oblique effects were found, such that thresholds were substantially lower for cardinal orientations compared to obliques, for both web- and lab-based measures of the temporal and spatial 2AFC tasks. Crucially, web- and lab-based orientation-identification thresholds showed high levels of agreement, demonstrating the suitability of web-based testing for assessments of early visual cortical function. Future studies should assess the reliability of similar web-based tasks in clinical populations to evaluate their adoption into clinical settings, either to screen for visual anomalies or to assess changes in performance associated with progression of disease severity.

Correlation of Retinal Sensitivity in Psoriasis and Psoriatic Arthritis with Tumour Necrosis Factor Alpha and Pigmented Epithelium Derived Factor

Early recognition is crucial because the natural course of psoriasis (Ps) may result in vision loss. Psoriatic arthritis (PsA) patients with ophthalmological manifestations of psoriasis (Ps) account for 30% of cases. Assessment of visual functions and correlation with blood levels of tumour necrosis factor-alpha (TNF-

Visual Impairment as a Learning Disability in Children with Cerebral Palsy: A Narrative Review

Cerebral Palsy (CP) is a group of non-progressive brain disorders causing movement, posture, and motor function impairments. Cerebral Visual Impairment (CVI) affects visual pathways, affecting clarity of vision, visual fields, and occulomotor incoordination. Symptoms vary in nature and severity due to the complexity of the visual cortex. Physiotherapy (PT) is essential for treating CP, promoting physical, mental, and social well-being. Physical therapists also teach parents, how to care for their children at home, including feeding, bathing, dressing, and other activities. CVI is often linked to CP and can lead to various visual problems, including reduced visual guidance of movement. To effectively manage this condition, a multidisciplinary approach is required, as children with CVI often have neurological deficits in addition to their visual problems. Visual function assessment involves measuring thresholds or limits for each eye, while functional vision assessment is conducted in the child’s environment with both eyes open. Levels of vision can be classified into light perception, intermittent fixation, reliable focus, constant attention to small objects, and reliable visual acuity. Children with Visual Difficulties (CVI) exhibit distinct visual behaviours and require proper training. Sensory room training improves gross and fine motor abilities, and early intervention reduces issues associated with these diseases. Physical therapy interventions are very important for this population’s health and wellness, which can be focused on acquiring and improving independence in motor abilities, visual function, coordination, balance and general health improvement. Children with CVI are at danger of developing neurological dysfunction. An early intervention and adequate training for young CP children with CVI can improve motor abilities and reduce issues associated with these diseases. The following review will help to understand briefly about visual impairments in patients with CP, mainly focusing on new therapeutic interventions following visual impairments that are effective and easily administered.

Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology Clinic.

Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions. A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively. A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77. Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.