Cause Of Visual Acuity Loss Research Articles

Epidemiological Profile of Pediatric Ocular Trauma in Hamadan, 2020

Background and aims: Ocular traumas are among the most important causes of visual acuity loss and acquired unilateral blindness in children, with permanent effects on their psychological and social development. The epidemiology of ocular traumas, especially those of children in different societies, is affected by the culture and level of education, lifestyle, and socioeconomic level. Considering that no accurate statistics on these injuries have been reported in Hamadan, Iran, this study aimed to investigate the epidemiology of various types of injuries in children following ocular traumas in Hamadan. Methods: This cross-sectional study included 293 patients under 18 years of age with ocular trauma who were visited in Farshchian Sina hospital in 2019. A detailed medical history was obtained including demographic information, type of injury, initial and final visual acuity, cause of injury, mother’s occupational status, and the delay between trauma and the examination, and the examiner-recorded definitive care. Finally, the data were analyzed using Excel software, and a significance level of 0.05 was used. Results: Out of 293 patients examined, 38.91% were female, and 61.09% were male. Children aged 1-5 years (30.72%) were the most commonly affected group, followed by those aged 6-10 years (29.35%). There were 19 cases of chemical injury, 33 cases of penetrating trauma, and 241 cases of blunt trauma. The mean initial vision in patients was 0.31±0.347 logMAR, and the mean final vision was 0.06±0.084 logMAR. In 94 patients, it was impossible to check visual acuity due to their lower age. Besides, 49.83% of injuries happened at home. Conclusion: In this research, the most common type of ocular trauma was blunt trauma in male patients, which occurred at home in the presence of the mother. Therefore, it is obvious that the most effective way to prevent these incidents is that parents should pay more attention to their children, implement well-established safety precautions while playing at home, and use standard play equipment.

Central serous chorioretinopathy of the third trimester of pregnancy A rare cause of visual acuity loss in pregnancy

We report a case of a 26-year-old patient, 32 weeks pregnant, who consults for a decrease in bilateral visual acuity. A macular OCT showed bilateral retinal serous detachment. Bilateral central serous chorioretinopathy in the context of pregnancy was diagnosed. The main differential diagnoses are with toxemia of pregnancy and other causes of RSD (infectious or non-infectious). Monitoring was recommended. The course was marked by the resorption of the RSD one month after giving birth. Pregnancy is a known risk factor for CRSC. The diagnosis is based on fundus examination and multimodal imaging data, especially macular OCT, given its safety and repeatability. The CRSC of the 3rd trimester of pregnancy is rare but often important. The condition usually resolves after childbirth with a risk of recurrence in subsequent pregnancies.

Irvine-Gass Syndrome: Clinical, Therapeutic and Progressive Aspects (A Series of 100 Eyes)

Postoperative macular oedema (MO), better known as Irvine-Gass syndrome, remains an important cause of visual acuity loss (VAL) after cataract surgery. Macular oedema (MO) is a thickening of the macular retina due to the accumulation of fluid and proteins in retinal tissue. Irvine Gass syndrome is a type of MO that can complicate cataract surgery. The frequency of occurrence of Irvine-Gass is significantly increased in case of capsular rupture or diabetic, uvetic context surgery or a history of venous occlusion. This is a descriptive study involving 100 eyes operated on for cataracts by phacoemilification in the adult ophthalmology department of the Avicenne Marrakech Military Hospital. The purpose of this work is to study the epidemiological profile, clinical, paraclinical, therapeutic and evolutionary aspects of MO after phacoemulsification.

Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life.

Subthreshold Laser and Subliminal (Micropulse) Laser in Diabetic Retinopathy and Diabetic Macular Edema

Diabetic macular edema (DME) is one of the main causes of a significant reduction in visual acuity in working-age adults and is the most common cause of visual acuity loss from diabetic retinopathy. Most of the studies have shown that the ability of the conventional laser to maintain or improve visual acuity is limited, possibly because of the development of retinal scars, which decrease the potential for improved visual acuity. Subthreshold laser and subliminal (micropulse) laser has the potential to reduce DME with better visual acuity results compared with conventional laser, as it does not cause collateral damage in the retina. These lasers cannot cause permanent damage to the retina. This article mentions subthreshold laser, and subliminal (micropulse) laser in diabetic retinopathy and diabetic macular edema.

Remote screening for age-related macular degeneration (AMD) using a nonmydriatic digital color fundus camera: Disrupted patient care pathways

Introduction/objectives/aim Age-related macular degeneration (AMD) is the leading cause of visual acuity loss in patients aged 65 and above, with the number of cases expected to increase over the next decade. We present the results of an AMD screening trial using a nonmydriatic digital color fundus camera and telemedicine, and report the impact this screening has on the medical course of positive patients. Material and method Over two years, color fundus photographs were taken for patients consulting health examination centers and transmitted electronically to an ophthalmology department. The rates of occurrence of different grades of AMD were then calculated. Positive patients were then contacted by telephone to complete a questionnaire. Results/observations A total of 1448 photos from 726 patients were interpreted, of which 82% were gradable. Age-related macular degeneration was diagnosed for 15.3% (111) of the patients, with 10.2% (74), 3.4% (25), 1.1% (8), and 0.5% (4) at grades 1, 2, 3, and 4, respectively. Among the positive patients, 74 agreed to participate in the survey. The mean time since their last ophthalmologic exam was seven years and 43 only consulted their ophthalmologist as recommended, on average 31 days after the initial screening. For 32 of these patients (74%), the face-to-face diagnostic was also positive. Prophylactic treatment was initiated for 5 patients, and 2 patients received intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections.

Visual acuity loss in open‐angle glaucoma patients: causes and risk factor

AbstractPurpose To identify causes of visual acuity loss in open angle‐glaucoma (OAG) patients and to determine associated risk factors.Methods From the visual field database of the University Medical Center Groningen, 400 patients with at least 3 reliable visual fields were randomly selected. Of these, 233 had OAG. OAG patients with a visual acuity of 0.5 or less in at least one eye were considered as cases; controls had to have a visual acuity above 0.5 in both eyes. Causes of visual acuity loss were determined from the medical records. Potential risk factors for visual acuity loss in OAG (age, gender, myopia, baseline IOP, corneal thickness, and visual field mean deviation [MD]) were assessed by comparing cases with acuity loss due to OAG with the controls, using logistic regression.Results Of the 233 patients with OAG, 134 (57%) were cases and 99 (43%) controls. Concerning the cases, visual acuity loss was caused by OAG in 40%, cataract 17%, AMD 14%, vitreo‐retinal surgery 10%, corneal pathology 4.5%, acquired retinal disorders 10%, and neuro‐ophthalmological disorders 4.5%. Among the assessed risk factors, cases had a lower MD (OR=0.90; P<0.001) and a higher age (OR=1.05; P=0.015).Conclusion Visual acuity loss in OAG is common but mostly due to other eye co‐morbidities. A lower MD and an older age were highly significant risk factors.

The Pattern of Visual Impairment in Patients with Pituitary Adenoma

This retrospective study aimed to identify the pattern of visual impairment in pituitary adenoma patients. Patients' eyes were categorized into four groups according to their visual acuity score. Trans-sphenoidal hypophysectomy was performed on all patients. Significant differences between groups were evaluated for visual field defects, visual symptoms duration, degree of suprasellar extension and tumour pathology. In the 201 patients (402 eyes) evaluated, 166 eyes had impaired visual acuity (45 eyes, < 4.0; 43 eyes, 4.0 - 4.4; and 78 eyes, 4.5 - 4.8), 236 eyes scored > 4.8 and were considered to be free of this disorder. A linear correlation was found between visual field defects and visual acuity score. Duration of visual symptoms between visual acuity groups was not significant. Suprasellar extension (measured by Hardy grades) was significant between visual acuity groups and may be the main cause of visual acuity loss in pituitary adenoma patients. Non-functional pituitary adenomas tended to affect visual acuity more than adenomas with other pathological diagnoses which are adrenocorticotropic hormone and prolactin. Further investigation is required to clarify visual loss cause in pituitary adenoma patients.

Causes of Visual Acuity Loss among Patients with AIDS and Cytomegalovirus Retinitis in the Era of Highly Active Antiretroviral Therapy

To quantitate the frequencies of the common causes of visual acuity loss for patients with AIDS and cytomegalovirus (CMV) retinitis in the era of highly active antiretroviral therapy (HAART). Multicenter prospective observational study. Three hundred seventy-nine patients (494 eyes) with CMV retinitis. Follow-up every 3 months with medical history, ophthalmologic examination, and laboratory testing. Loss of visual acuity across the 20/50 or worse and 20/200 or worse thresholds and doubling of the visual angle; frequencies of causes of such vision loss. Overall, involvement of the posterior pole with CMV retinitis (zone 1 retinitis) accounted for approximately one half of incident visual acuity loss of 20/50 or worse, 20/200 or worse, and of doubling of the visual angle. Cataract and retinitis-related retinal detachment were the second and third most common causes of vision loss, accounting for 22% to 33% and 13% to 20% of vision loss for the 3 outcomes, respectively. In subset analysis, cataract and cystoid macular edema (CME) accounted for approximately 50% of incident vision loss in eyes of patients with longstanding CMV retinitis and immune recovery at baseline, but these complications accounted for <10% of incident vision loss in eyes of patients with newly diagnosed CMV retinitis at baseline. Of eyes that had a vision-threatening complication of CMV retinitis, eyes that developed retinal detachment had the highest risk of vision loss, with 100% of eyes developing visual impairment (20/50 or worse vision) and 42% of eyes developing legal blindness (20/200 or worse vision) at 12 months after diagnosis of the retinal detachment. In the HAART era, zone 1 involvement and retinal detachment remain the most common causes of visual acuity loss among patients with CMV retinitis. Cataract and CME also are common causes of loss of visual acuity, primarily in those patients with HAART-induced immune recovery.

Probing the causes of visual acuity loss in patients diagnosed with functional amblyopia

Although amblyopia is normally defined as a deficit invisual acuity despite full optical correction and theabsence of observable pathology, the association be-tween ocular pathology in early life and amblyopicvisual loss is well established. For example, the presenceof monocular congenital cataract (von Noorden andMaumenee, 1968; von Noorden, 1981), unilateral ptosis(Anderson and Baumgartner, 1980; Harrad et al., 1988)or a wide variety of unilateral ocular pathologies presentduring early childhood (Kushner, 1981, 1984) canprecipitate often severe (deep) cases of amblyopia. Thesestudies provide strong support for the view that aunilateral decrease in the signal emerging from one eyebecause of patching or pathology during a sensitiveperiod early in life will precipitate a functional ambly-opia (Hardesty, 1959; Awaya et al., 1973; von Noorden,1981). In cases where the pathology cannot be resolvedthe total visual deficit reflects the combination of theprimary (organic) visual loss together with a super-imposed functional amblyopia. Recently, it has beensuggested that the visual deficit in many cases of themuch milder and more common forms of amblyopiamay also represent the sum of functional and organiccomponents (Lempert, 2000, 2003, 2004). That is, theamblyopia typically associated with strabismus and/oranisometropia, and considered to exist in the absence oforganic causes, may, in fact, be superimposed upon theloss which is due to a subtle organic defect. Thishypothesis clearly contradicts the generally held viewthat almost all amblyopias are caused by either strabis-mus or anisometropia in the absence of ocular patho-logy. This controversial hypothesis has prompted us tore-examine the traditional view of the causal agents formost amblyopias, and the implications for remediationof this condition.The vast majority of the 2–2.5% (von Noorden, 1996)ofhumansdiagnosedwithamblyopiaeitherhave,orhavepreviously had, strabismus and/or anisometropia. Theabsenceofclinically-detectedpathology,coupledwiththefact that experimentally induced anisometropia andstrabismusinanimalscausebroadlysimilarvisualdeficits(e.g. Harwerth et al., 1983; Smith et al., 1985), has led tothe ubiquitous terms anisometropic and strabismicamblyopia – with the resultant implication of a directcausalrelationship.Thatis,currentclinicaldogmaassertsthat chronic abnormal sensory input because of strabis-mus or anisometropia precipitates a neural deficit that ismanifest clinically as reduced monocular visual acuity.Improvement in visual acuity after treatment consistingonly of manipulation of sensory input (e.g. spectaclesand/or occlusion therapy) can be viewed as a formalconfirmation of the functional amblyopia diagnosis.Although the association between amblyopia andanisometropia and/or strabismus is clear, there has longbeen uncertainty regarding the causal relationshipsbetween anisometropia and strabismus and amblyopiain humans. The causal relationship is self-evident inlongitudinal animal studies in which either strabismus oranisometropia have been shown to precipitate ambly-opia (e.g. Kiorpes and Boothe, 1980; Harwerth et al.,1983; Smith et al., 1985). Furthermore, studies ofhuman infantile esotropia show that esotropia precedesthe development of amblyopia (Birch and Stager, 1985).Unfortunately, such longitudinal studies are rare in thehuman amblyopia literature. In addition to the absenceof definitive longitudinal data from human amblyopes,there are many experimental results that suggest a quitedifferent causal relationship between amblyopia andstrabismus or anisometropia. For example, althoughanimal investigations show that sustained, unilateralblurring is required to precipitate amblyopia (Smithet al., 1985), longitudinal refractive studies of human

Meningitis tuberculosa. Un caso: complicaciones oftalmológicas

An 18 year old female suffering from tuberculous meningitis with bilateral amaurosis, ophthalmoplegia, other cranial nerve palsies and loss of consciousness, is presented. Tuberculous meningitis is a rare cause of basal arachnoiditis with a bad prognosis. Possible causes of visual acuity loss and ophthalmoplegia are discussed and a favourable outcome without sequelae is noteworthy in our case.

Relationship between vision and motor impairment in children with spastic cerebral palsy: new evidence from electrophysiology

The aim of the present study was to measure visual acuity (VA) by the sweep visual evoked potential method (sVEP) and relate it to the degree of motor impairment in children with spastic cerebral palsy (SCP). Monocular VA was estimated in 37 SCP children aged from 6 to 48 months, classified as tetraplegic ( n=14), diplegic ( n=13), and hemiplegic ( n=10), without ophthalmological complaints with ages ranging from 6 to 48 months. Motor impairment was rated according to the Gross Motor Function Classification System (GMFCS), in five levels of severity. VA was below age norms in 13/14 (92%) tetraplegics, 10/13 (77%) diplegics and 4/10 (40%) hemiplegics. In addition, a two-way ANOVA within each subgroup showed significant differences in VA between the five GMFCS levels, with high positive correlation between VA loss and the GMFCS rating. Differences between the three types of SCP impairment in each level of GMFCS were not statistically significant, possibly due to the small number of patients. In conclusion, the use of an electrophysiological method (sweep-VEP) for the measurement of visual acuity in these patients allows a more precise and reliable estimate than behavioral measurements, since their motor impairment might interfere with the behaviorally assessed visual acuity. In addition, the finding of a high correlation between quantified motor impairment and VA loss in SCP patients is a new observation that might help to understand the causes of VA loss in these patients.

Limitation and Over-utilization of Angiographic Services

Fluorescein angiography has increased our understanding of the pathophysiology and appearance of most fundus disorders. Increased experience with the stereoscopic slit-lamp examination of the fundus has made it easier to predict what subsequent angiograms will demonstrate, and fluorescein studies are currently usually not required to make an appropriate diagnosis. Most cases of age-related macular degeneration and diabetic retinopathy can be managed without angiography, since most of the former are associated only with drusen and modest and progressive visual acuity loss and most cases of diabetic retinopathy are not associated with loss of visual acuity or with proliferative lesions. Angiography is an invaluable tool in evaluating newly symptomatic patients with the possibility of choroidal neovascularization, and it is also of great value in evaluating causes of visual acuity loss in diabetics as well as in the documentation of nonperfusion of their peripheral retinas.