Assessment Of Visual Function Research Articles

Measures and variability with age of low contrast acuity and near stereoacuity in children

ABSTRACT Clinical relevance Low contrast acuity (LCA) and near stereoacuity (NS) testing are integral to the comprehensive assessment of sensory visual function in children. However, routine ophthalmological evaluations seldom take these measures into consideration. Additionally, there is limited literature regarding the normative values of these parameters in children. Background This study investigated LCA and NS measures and their variability in children with normal visual acuity. The aim was to provide a benchmark for distinguishing normal measures from abnormal ones. Methods A prospective observational study was conducted in primary and secondary schools across North India. The participants numbered 240 children, aged between 3 and 15 years. They were split into 12 smaller groups of 20 participants in each age group. Only participants with normal monocular uncorrected visual acuity, no refractive error, normal birth history, and no systemic ailments, were recruited. All the participants underwent a complete ophthalmic examination and non-cycloplegic retinoscopy. LCA was measured, using the low contrast Lea number chart at three metres. NS was measured using the Randot® stereo test at 40 cm. Results The percentages of males and females, were found to be 55%, and 45%, respectively (p = 0.093). The mean NS was found to be 38.7 ± 11.5 arcsecs in the 3-9-year age group, and 26.7 ± 5.6 arcsecs in the 9-15-year age group (p-value <0.001). The mean NS showed an increasing trend up to 9 years of age. The mean LCA was 64.4 ± 20.1 in the age group of 3–8 years, and 76.38 ± 11.39 in the age group of 8–15 years (p-value <0.001). Considerable variability was noted in the LCA in the younger age group (p-value = 0.000). Conclusions LCA and NS mature gradually during childhood. LCA stabilises after the age of 8, while NS stabilises after the age of 9.

Discussing Questions of Laser Refractive Surgery in Hyperopia: Literature Review and Clinical Experience

Relevance. Modern keratorefractive surgery is a high-tech field of ophthalmology aimed at solving various problems of correcting a wide range of ametropias.Objective: to formulate recommendations for refractive surgeons when planning the correction of hypermetropic refraction using modern keratorefractive surgery.Materials and methods. An analysis of 20 literature sources and a retrospective analysis of outpatient records of 188 patients with hypermetropia who underwent surgery were carried out.Results. The analysis of the literature and our own clinical study allows us to recommend focusing on the final keratometry after keratorefractive surgery, which should not exceed 48 diopters. Among the analyzed charts of patients in compliance with these criteria, the accuracy of hitting the target refraction in the range of ± 1 D was 98.9 %, the regression did not exceed 0.5 D from that obtained 1 month after surgery in 96.8 %, and the loss of 1 line of BCVA was 3.7 % of cases. Among patients with achieved keratometry above 48 diopters, the loss of line 1 BCVA was 13.8 %, line 2 — 2.7 %.Conclusion. Thus, the tactics of correction of hypermetropia by CRC methods require an integrated approach to the assessment of visual functions, drug preparation for surgery, careful implementation of the surgical stages of the intervention, and rational postoperative pharmacological support.

Ontario Cataract Quality Outcome Initiative: appropriateness and prioritization of cataract surgery

ObjectifExaminer l'intérêt du questionnaire Catquest-9SF sur la fonction visuelle (FV) de même que la mesure de l'acuité visuelle (AV) pour ce qui est de déterminer la pertinence et le degré d'urgence d'une chirurgie de la cataracte, et évaluer la faisabilité d'administrer le questionnaire Catquest-9SF en milieu clinique en recourant à la saisie et à l'interprétation de données en ligne. NatureÉtude d'observation prospective multicentrique. ParticipantsSujets devant subir une chirurgie de la cataracte séquentielle dans les 2 yeux au sein de 4 établissements en Ontario. MéthodesNous avons noté, sur une tablette, la meilleure acuité visuelle corrigée (MAVC) et l'acuité visuelle de la correction actuelle (AVCA) dans chaque œil et dans les 2 yeux, de même que les réponses des patients au questionnaire Catquest-9SF avant et après la chirurgie de la cataracte. Des modèles de régression linéaire ont servi à vérifier les associations entre l'AV et la FV. RésultatsLa MAVC et l'AVCA du pire œil étaient d'importants facteurs de prédiction d'une modification de la FV (p = 0,006 et p = 0,008, respectivement); les sujets dont l'AV était moins bonne ont bénéficié d'une plus grande amélioration de la FV après l'intervention. On a noté une association significative entre l'amélioration de la FV et l'amélioration de l'AVCA dans les 2 yeux (p = 0,001). Sur les 151 sujets, 14 (9 %) n'ont obtenu ni amélioration ni aggravation de leurs scores de FV après l'intervention. Au sein de ce groupe, le score préopératoire de 10 des 14 sujets était ≤ –3, ce qui donne à penser que l'incapacité visuelle était minime. Parmi les patients de ce sous-groupe, la MAVC préopératoire de 4 des 14 sujets (2,6 %) était de 20/30 ou mieux dans le pire œil. ConclusionsDevant des groupes de patients dont l'AV est similaire, le score au questionnaire Catquest-9SF peut aider à déterminer l'ordre de priorité en ce qui a trait à la chirurgie. La saisie et l'interprétation des données en ligne permettent de réaliser des évaluations virtuelles efficaces de la FV. Une MAVC de 20/30 ou mieux dans le pire œil, conjointement à un score de < –3 au questionnaire Catquest-9SF, peuvent aider à identifier les cas moins prioritaires.

The Impact of Visual Impairment on Completion of Cognitive Screening Assessments: A Post-Hoc Analysis from the IVIS Study.

Aim:The aim of this study was to evaluate completed cognitive screens in stroke survivors with and without visual impairment to explore whether the presence of visual impairment impacts on completion of cognitive screening.Materials and methods:Cognitive screening assessment was undertaken using the Oxford Cognitive Screen (OCS). Data from visual function assessments (inclusive of visual acuity, visual fields, eye movements and visual perception evaluation) were analysed to determine whether presence and/or type of visual impairment impacted on cognitive screening scores achieved. Covariates, including glasses use, gender, age at stroke onset and stroke type, were used to assess confounding impacts on scores attained during cognitive screening.Results:1500 stroke admissions were recruited. One hundred ninety-seven who completed the OCS, were identified from the IVIS study database. Those who reported visual symptoms performed worse statistically on all cognitive tasks except the recall recognition (p = 0.232) and executive tasks (p = 0.967). Visual symptoms did not prevent participants from completing every section of the OCS (p = 0.095). In certain tasks, those not wearing their required glasses performed worse, including the executive function (p = 0.012), broken hearts and sentence reading tasks.Conclusions:Many tasks within cognitive screening assessment are impacted by presence of visual deficits, and adjustments, where possible (e.g. good lighting, large print) should be used to facilitate completion of cognitive screening. It is important to ensure required reading correction is worn during screening.

Repeatability and Discriminatory Power of Chart-Based Visual Function Tests in Individuals With Age-Related Macular Degeneration

There is a need for validated clinical end points that are reliably able to quantify potential therapeutic effects of future treatments targeting age-related macular degeneration (AMD) before the onset of serious visual impairment. To assess the reliability and discriminatory power of 5 simple chart-based visual function (VF) tests as potential measures for clinical trial end points with regulatory and patient-access intention in intermediate AMD (iAMD). This international noninterventional study took place at 18 tertiary ophthalmology departments across Europe. Participants were recruited between April 2018 and March 2020 and were identified during routine clinical review. Participants with no AMD and early AMD were recruited from hospital staff, friends, and family of participants with AMD and via referrals from community ophthalmologists and optometrists. The repeatability and discriminatory power of 5 simple chart-based assessments of VF (best-corrected visual acuity [BCVA], low-luminance visual acuity [LLVA], Moorfields Acuity Test [MAT], Pelli-Robson Contrast Sensitivity [CS], and International Reading Speed Test [IReST]) were assessed in a repeated-measures design. VF assessments were performed on day 0 and day 14. Participants with early AMD, iAMD, late AMD, and no AMD were recruited. Intraclass correlation coefficients (ICCs) and Bland-Altman 95% limits of agreement (LoA) were computed to assess repeatability. Area under the receiver operating characteristic curves (AUCs) determined the discriminatory ability of all measures to classify individuals as having no AMD or iAMD and to differentiate iAMD from its neighboring disease states. A total of 301 participants (mean [SD] age, 71 [7] years; 187 female participants [62.1%]) were included in the study. Thirty-four participants (11.3%) had early AMD, 168 (55.8%) had iAMD, 43 (14.3%) had late AMD, and 56 (18.6%) had no AMD. ICCs for all VF measures ranged between 0.88 and 0.96 when all participants were considered, indicating good to excellent repeatability. All measures displayed excellent discrimination between iAMD and late AMD (AUC, 0.92-0.99). Early AMD was indistinguishable from iAMD on all measures (AUC, 0.54-0.64). CS afforded the best discrimination between no AMD and iAMD (AUC, 0.77). Under the same conditions, BCVA, LLVA, and MAT were fair discriminators (AUC, 0.69-0.71), and IReST had poor discrimination (AUC, 0.57-0.61). BCVA, LLVA, MAT, CS, and IReST had adequate repeatability in this multicenter, multiexaminer setting but limited power to discriminate between no AMD and iAMD. The prognostic power of these variables to predict conversion from iAMD to late AMD is being examined in the ongoing longitudinal part of the MACUSTAR study.

Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment.

Cerebral Visual Impairment (CVI) has become the leading cause of children’s visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children’s neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity—BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients’ ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.

Visual Function of Myopic Students Wearing Contact Lens and Spectacles

Myopia people use contact lenses and spectacles as a visual aid. Measuring the suitability of the measure of visual impairment from contact lenses and spectacles is not enough to be assessed from visual acuity and visual field measurements alone, but also needed subjective patient-based visual function assessments, namely the VF-14 questionnaire. A total of 40 students were involved in this study. All of the participants were given the VF-14 questionnaire twice: for visual function using contact lenses; and visual function using spectacles. The mean VF-14 score among contact lenses and spectacles wearer were 90.63±2.96 and 93.04±2.45respectively. There were significant differences visual function between contact lens and spectacles wearer (p = 0.00) especially in reading small print activity; reading signs; watching TV; playing table games; cooking; driving during the day; and recognizing people at distance. Thus, it can be concluded that participants with low and moderate myopia, both contact lens and spectacle users, had visual function with mild and minimal disturbances. The visual function of spectacles is better for distant viewing activities and detailed work, while contact lenses are better for viewing activities at medium distances.

Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia

BackgroundInterest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia.MethodsWe aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex.DiscussionThe NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children.Trial registrationThis protocol was registered with ClinicalTrials.gov (NCT04819386) on 29 March 2021.

Development of Immersive Virtual Reality Environment for Assessment of Functional Vision in people with Low Vision: A Pilot Study.

Virtual Reality technology helps in creating virtual environments for evaluation of visual performance of low vision individuals with holistic experience. The purpose of this study was to develop a virtual reality (VR) platform for the objective assessment of functional vision in patients with low vision in two categories, central and peripheral vision loss . Focus group discussions (FGD) were organized to understand the difficulties faced on a day to day basis by patients with low vision. Based on the results of the focus group discussions, a virtual bank scenario incorporating specific visual tasks was developed. A pilot study was conducted which involved people with normal vision; low vision Patients secondary to central field loss (CFL) and peripheral field loss (PFL). Each subject completed all the tasks in the objective assessment; the data obtained from the assessment were further analyzed to understand the pattern. Comparing the three groups, there was a significant difference in distance (central field loss was lowest) and near visual angle, and three visual search tasks (peripheral field loss was lowest). In assessing the time taken, peripheral field loss group was again found to take the most time to complete tasks. Based on a newly developed virtual reality platform, assessment of functional vision of specially abled persons could be tested and was inferior to that of normal sighted persons. in a close to realistic environment. Multiple visual tasks were performed in the virtual environment and the visual performance was compared among all three groups of participants. Participants were matched for age and gender. Irrespective of the nature of tasks, visual performance of the normal group seemed significantly better than people with CFL and PFL.

Rapid Quantification of the Binocular Visual Field for Clinical Trials: Performance of a Modified Esterman Supra-Threshold Test Implemented with the Open Perimetry Interface.

PurposeWe aimed to assess the performance of the modified-Esterman test (mET) as a rapid suprathreshold binocular quantification tool for the assessment of peripheral visual fields. The mET consists of an even spread of test points across the visual field.Materials and MethodsThe mET was implemented on the Octopus 0900 perimeter using the Open Perimetry Interface (OPI) and consisted of 160 points. Patients with choroideremia, a rod-cone dystrophy, Stargardt disease, a cone-rod dystrophy, and healthy volunteers underwent both the mET and the standard Esterman tests twice. Disease severity (mild/moderate/severe) was graded on both tests independently. Voronoi tessellation was utilised to compare the tests.ResultsThe Voronoi visualisation was able to demonstrate that the mET was able to provide more information about the disease state at all stages of diseases. This was confirmed by the agreement statistic, which showed that the mET detected 27% more points of visual field loss compared to the Esterman test, being most useful in patients with rod-cone dystrophies.ConclusionThe mET provides a speedy quantitative measure of the peripheral visual field loss, which can be used in clinical trials to monitor longitudinal assessment of peripheral visual function. The mET provides a more even coverage across the visual field compared to the Esterman test points, making it more suitable for this purpose. This is a key part of safety monitoring in retinal clinical trials. The mET can easily be implemented on commercially available perimeters that allow Open Perimetry.

Intratendinous Injection of Autologous Conditioned Serum for Treatment of Lateral Epicondylitis of the Elbow: A Pilot Study.

Autologous conditioned serum (ACS) has been effectively used in treatment of osteoarthritis. However, less is known about its efficacy in tendon disorders. In this pilot study, we aimed to evaluate the short- and long-term effects of intratendinous injection of ACS in lateral epicondylitis (LE) of the elbow. This prospective cohort included 42 patients with LE of the elbow who received 4 intratendinous injections of Orthokine® (Orthogen Lab Services GmbH, Düsseldorf, Germany) under local anesthesia over 2 weeks in an outpatient setting. The clinical and functional outcomes of injections were evaluated at 3 months and 1 year after the procedure. Pain was assessed using a visual analog scale (VAS) and functional assessment was made using the Mayo Elbow Performance Score (MEPS) and Oxford Elbow Score (OES). The pre-injection VAS score (7.07±1.19) improved significantly after the procedure at both 3 months (3.55±0.56, P<0.001) and 1 year (1.73±0.82, P<0.001). Similarly, the mean MEPSs were significantly different between baseline and 3 months (56.42±7.51 vs. 79.76±3.81, P<0.001) and between baseline and 1 year (56.42±7.51 vs. 94.28±4.06, P<0.001). The baseline OESs (84.17±6.07) also improved with intratendinous injection of ACS at 3 months (41.96±9.23, P<0.001) and 1 year (7.43±4.31, P<0.001). Only six patients (14.2%) had mild ecchymosis and swelling around the injection site which resolved spontaneously. ACS is a promising option for treatment of LE of the elbow, given its early onset of pain-relieving action and longlasting functional effects. These findings await confirmation by large-scale and prospective trials.

Impact of visual impairment on balance and visual processing functions in students with special educational needs.

IntroductionVision is critical for children’s development. However, prevalence of visual impairment (VI) is high in students with special educational needs (SEN). Other than VI, SEN students are prone to having functional deficits. Whether visual problems relate to these functional deficits is unclear. This study aimed to assess the impact of vision on visual processing functions and balance in SEN students through a community service.MethodsVisual acuity (VA) and contrast sensitivity were measured in a total of 104 (aged 14.3±4.3) SEN students as the visual outcomes, followed by retinoscopy. Visual processing function assessment included facial expression recognition by card matching examiner’s facial expression matching, and visual orientation recognition. Dynamic balance, by Timed Up and Go test, and static standing balance (postural sway in double-legged standing with feet-together and tandem-stance for open-eye and closed-eye conditions) were assessed. Static balance was presented in terms of the maximal medial-lateral and antero-posterior sways.ResultsOf the 104 students, 62 (59.6%) were classified as visually impaired according to WHO classification of visual impairment based on presenting distance acuity. Ocular problems (e.g. optic nerve anomaly, uncorrected/ under-corrected refractive errors) and neurological anomalies were the major causes of vision loss. VA was positively associated with visual processing functions (all p ≤ 0.01), as SEN students with better vision tended to perform better in visual orientation and facial expression recognition tasks, as well as dynamic balance function (p = 0.04). For the static balance, postural sway and VA showed a positive relationship under open-eye and tandem stance conditions. However, the relationship between postural sway and VA became negative under closed-eye and tandem stance conditions.ConclusionThis study found a high prevalence of SEN students with visual impairment, in which many of them were undetected. Optometric examination is important to improve their visual function to minimize the effect of vision on functional performance. Vision is critical in visual processing as well as playing an important role in maintaining balance in SEN students.

Analysis of the Reliability and Repeatability of Distance Visual Acuity Measurement with EyeSpy 20/20.

BackgroundVisual acuity is a critical component of visual function assessment for all ages. Standardized vision testing protocols may help prevent testing inconsistencies resulting from variations in test administration and interpretation of different examiners. However, most vision assessments outside of research settings, including in doctor’s offices, rarely employ standardized protocols. Validated protocols such as the Early Treatment for Diabetic Retinopathy Study (ETDRS) are frequently employed by vision researchers to ensure accurate and repeatable visual acuity measurements.MethodsThis study evaluates a desktop-based standardized vision testing algorithm (EyeSpy 20/20) specifically designed for use on mobile electronic platforms. Subjects were tested on a desktop version of the EyeSpy software for both the accuracy and duration of measurement of visual acuity and compared to a e-ETDRS chart in a randomized sequence. Children were recruited for this study and tested between two different visual acuity measurement systems. Bland–Altman analysis and correlation tests were done.ResultsHundred and ten children were recruited for the study. The EyeSpy 20/20 visual acuity testing algorithm as tested with the desktop version was non-inferior to the gold standard e-ETDRS testing algorithm on a desktop platform, but statistically faster to implement when administered on the same electronic testing platform.ConclusionEyeSpy 20/20 is a promising tool for vision screening and visual acuity evaluation in children.

Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China

ObjectivesThis study aimed to explore the association of visual, hearing, or dual sensory impairment with healthcare use and costs. Study designThis is a cohort study. MethodsThese research data were from the China Health and Retirement Longitudinal Study spanning 2011–2018 and included 8982 community-dwelling middle-aged and older adults (aged ≥45 years at baseline). Sensory impairment was measured according to self-reported assessment of visual and hearing functions, and healthcare use and costs were ascertained via self-report. The associations of sensory impairment with healthcare use and costs were estimated using the mixed-effects regression models. ResultsOf the 8982 respondents, 4346 (48.39%) were females and their mean (standard deviation) age at baseline was 57.03 (8.26) years. Individuals with hearing impairment (HI) only, visual impairment (VI) only, and dual sensory impairment (DSI) were all at significantly higher risks of healthcare use and catastrophic health expenditure than those without sensory impairment (all P < 0.05), except that VI only non-significantly prolonged inpatient days. Compared with no impairment, DSI was associated with increases in outpatient (β = 50.67, 95% confidence interval [CI] = 17.47–83.86) and inpatient out-of-pocket costs (β = 40.35, 95% CI = 5.94–74.76), while VI only or HI only did not show significant effects. Further stratification analyses indicated that the associations between sensory impairment and outpatient use were more pronounced among males than among females but that age group did not moderate the associations with any healthcare outcomes. ConclusionsHI and VI were independently and together associated with higher risks of healthcare use and catastrophic health expenditure. Dual sensory impairment was the only category consistently associated with increased outpatient and inpatient costs.

Resting-State fMRI in Chronic Patients with Disorders of Consciousness: The Role of Lower-Order Networks for Clinical Assessment.

Resting-state fMRI (rs-fMRI) is a widely used technique to investigate the residual brain functions of patients with Disorders of Consciousness (DoC). Nonetheless, it is unclear how the networks that are more associated with primary functions, such as the sensory–motor, medial/lateral visual and auditory networks, contribute to clinical assessment. In this study, we examined the rs-fMRI lower-order networks alongside their structural MRI data to clarify the corresponding association with clinical assessment. We studied 109 chronic patients with DoC and emerged from DoC with structural MRI and rs-fMRI: 65 in vegetative state/unresponsive wakefulness state (VS/UWS), 34 in minimally conscious state (MCS) and 10 with severe disability. rs-fMRI data were analyzed with independent component analyses and seed-based analyses, in relation to structural MRI and clinical data. The results showed that VS/UWS had fewer networks than MCS patients and the rs-fMRI activity in each network was decreased. Visual networks were correlated to the clinical status, and in cases where no clinical response occurred, rs-fMRI indicated distinctive networks conveying information in a similar way to other techniques. The information provided by single networks was limited, whereas the four networks together yielded better classification results, particularly when the model included rs-fMRI and structural MRI data (AUC = 0.80). Both quantitative and qualitative rs-fMRI analyses yielded converging results; vascular etiology might confound the results, and disease duration generally reduced the number of networks observed. The lower-order rs-fMRI networks could be used clinically to support and corroborate visual function assessments in DoC.

Age-Related Effects on the Spectrum of Cerebral Visual Impairment in Children With Cerebral Palsy.

BackgroundCerebral Visual Impairment (CVI) is a very common finding in children affected by Cerebral Palsy (CP). In this paper we studied the characteristics of CVI of a large group of children with CP and CVI, describing their neurovisual profiles according to three different age subgroups (subgroup 1: infants 6 months–2 years; subgroup 2: pre-school age 3–5 years; subgroup 3: school age ≥ 6 years).MethodsWe enrolled 180 subjects (104 males, mean age 66 ± 42.6 months; range 6–192 months) with CP and CVI for the study. We carried out a demographic and clinical data collection, neurological examination, developmental or cognitive assessment, and a video-recorded visual function assessment including an evaluation of ophthalmological characteristics, oculomotor functions, and basic visual functions. In school-aged children, we also performed an evaluation of their cognitive-visual profiles.ResultsThere were signs of CVI in all the three subgroups. Subgroup 1 (62 children) and subgroup 2 (50 children) were different for fixation (p = 0.02), visual acuity (p = 0.03) and contrast sensitivity (p < 0.01), being more frequently impaired in younger children. Comparing subgroup 2 with subgroup 3 (68 children), the older children presented more frequently myopia (p = 0.02) while the younger ones esotropia (p = 0.02) and alteration in smooth pursuit (p = 0.03) and saccades (p < 0.01). Furthermore, fixation, smooth pursuit, visual acuity, contrast sensitivity and visual filed (p < 0.01) were more frequently impaired in younger children (subgroup 1) compared to the older ones. Multiple correspondence analysis (MCA) confirmed the different neurovisual profiles according to age: younger children with CP showed more signs of CVI compared to the older ones. 34 out of 68 children belonging to subgroup 3 underwent the cognitive visual evaluation; an impairment of cognitive visual skills was detected in 21 subjects.ConclusionYounger children with CP showed more signs of CVI compared to the older ones, likely for the physiological maturation of visual system and mechanisms of neuroplasticity. In this direction, we suggest an early neurovisual evaluation to detect any weak visual functions.

Assessing the impact of monocular deprivation on visual evoked potentials, behavior, and visual plasticity in juvenile mice.

BackgroundThe physiological mechanisms which underlie amblyopia are predicted using animal models which assess the impact of amblyogenic factors on visual function. This study used monocular-deprived mice as an amblyopic model to assess visual function by flash visual evoked potentials (fVEP), behavioral assessment, and visual plasticity.MethodsA total of 294 C57BL/6J mice (both genders) were used in this study. The mice were divided into the normal control (NC) group and monocular deprivation (MD) group. After mice were anesthetized with pentobarbital, fVEP was recorded. Long-term potentiation (LTP) was recorded from primary visual cortex slices. Behavioral assessment of visual function was performed using a visual water trapezoidal-shaped pool with a release chute, a hidden platform, and a middle divider.ResultsAll fVEP results showed that N1 waves and P2 waves were repeatable and N1–P2 amplitude was the most stable indicator. The amplitude of N1–P2 of MD eyes was significantly lower than that of non-deprived eyes or NC eyes. LTP failed to be induced in the visual cortex V1 area corresponding to deprived eyes in the MD group but could be induced successfully in the visual cortex V1 area corresponding to non-deprived eyes in the MD group. Behavioral vision testing also showed a longer time to reach the platform in MD mice compared to NC mice. The correlation coefficient suggested that LTP is the better indicator for visual impairment.ConclusionsThe fVEP can be utilized as an index of amblyopic changes in mice, which correlates well with behavioral results.

Multiprofessional Neurorehabilitation After COVID-19 Infection Should Include Assessment of Visual Function

ObjectiveTo report vision-related symptoms and neuro-visual clinical signs in patients approximately 4 months after discharge from hospitalization after COVID-19 infection. To report on coexisting functional and activity limitations. DesignThe study is part of an ambidirectional population-based cohort study. SettingAn outpatient setting in a hospital environment. ParticipantsPatients from a population-based cohort study including all patients with laboratory-confirmed COVID-19 admitted to hospital during a 3-month period in a health care region in Sweden. Among patients who, based on a standardized telephone interview, were identified as having persisting rehabilitation needs 4 months after discharge (n=185), several (n=57) reported vision-related symptoms. All 57 patients were invited to a neuro-visual examination. Six patients declined, 6 were unavailable, and 3 did not fulfil the inclusion criteria. Thus, 42 patients were included in the analysis (N=42). InterventionsNot applicable. Main Outcome MeasuresVision-related symptoms, neuro-visual function, and coexisting impairments affecting activities of daily life and participation. ResultsA total of 31% of patients with rehabilitation needs after COVID-19 reported vision-related symptoms. Reading-related issues (73.8%), blurry vision (69.0%), and light sensitivity (66.7%) were the most common symptoms. Patients with reading-related issues showed a higher level of eye strain (P<.001). Neuro-visual deficits were found in 83.3% of the patients, mainly concerning eye teaming (23.1%-66.7%) and eye movement (28.6%-30.8%) functions. Patients with vision-related symptoms reported fatigue and 18 other coexisting symptoms to a greater extent (P≤.0001 to .049). ConclusionsNeuro-visual symptoms and signs should be considered when assessing rehabilitation needs after COVID-19. The association between vision-related issues and coexisting symptoms with an effect on body function and activity and/or participation underlines the need for multiprofessional rehabilitation assessment and intervention.

Erratum: Behavioral Assessment of Visual Function via Optomotor Response and Cognitive Function via Y-Maze in Diabetic Rats.

An erratum was issued for:Behavioral Assessment of Visual Function via Optomotor Response and Cognitive Function via Y-Maze in Diabetic Rats. The author list was updated. The author list was updated from: Kaavya Gudapati*1,2, Anayesha Singh*1,3, Danielle Clarkson-Townsend1,4, Andrew J. Feola1,2, Rachael S. Allen1,2 1Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 2Department of Biomedical Engineering, Georgia Institute of Technology, 3Department of Neuroscience, Emory University, 4Gangarosa Department of Environmental Health, Emory University * These authors contributed equally to: Kaavya Gudapati*1,2, Anayesha Singh*1,3, Danielle Clarkson-Townsend1,4, Stephen Q. Phillips1, Amber Douglass1, Andrew J. Feola1,2, Rachael S. Allen1,2 1Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, 2Department of Biomedical Engineering, Georgia Institute of Technology, 3Department of Neuroscience, Emory University, 4Gangarosa Department of Environmental Health, Emory University * These authors contributed equally.

Functional outcomes of penetrating eye injuries in children

To assess visual acuity (VA) in the outcome of a penetrating wound of the eyeball in children. The study retrospectively analyzed VA in the outcome of type B open trauma of scleral (12.1%), corneal (59.1%), and scleral-corneal (28.8%) localization in 132 children (132 eyes) older than 4 years (mean age 8.3 years), who were admitted to the hospital on the first day after injury. The exclusion criteria from the main selection were: the presence of an intraocular foreign body, the age of patient higher than 4 years old, and the time of admission more than 24 hours post the moment of injury. Visual acuity was checked at the time of discharge from the hospital (average stay was 19.02 days) and amounted to 0-light projection in 50 (37.9%) children; 0.01-0.1 in 43 (32.6%); 0.2-0.3 in 29 (22.0%); above 0.4 in 10 (7.6%). High rate of vascular reactions to trauma was noted on admission on the first day - intraocular hemorrhage (28.8%), hyphema (10.6%), endophthalmitis (5.3%) as a result of a penetrating injury to the eyeball - as well as their negative effect on vision at discharge. Upon discharge from the hospital, in 92.4% of children the visual acuity in the outcome was 0.3 and below. Adverse visual outcomes significantly correlated with the depth of the injury (correlation coefficient 0.5931) and vascular reactions to trauma (correlation coefficient 0.503333).