Decline In Acuity Research Articles

The Angioid Streaks

Angioid streaks are a relatively rare complication and one of the etiologies of choroidal neovascularization. Asymptomatic at onset except at the complication stage where it is responsible for severe visual acuity decline with the macular syndrome. Diagnosis is clinically confirmed by angiography and OCT. Interest to propose a therapeutic adapted according to the localization and exudative phenomena of the neovessels. The prognosis is gloomy but seems improved by the arrival of anti-VEGF.

Contribution of parasol-magnocellular pathway ganglion cells to foveal retina in macaque monkey

Parasol-magnocellular pathway ganglion cells form an important output stream of the primate retina and make a major contribution to visual motion detection. They are known to comprise ON and OFF type response polarities but the relative numbers of ON and OFF parasol cells, and the overall contribution of parasol cells to high-acuity foveal vision are not well understood. Here we use antibodies against carbonic anhydrase 8 (CA8) and intracellular injections of the liphilic dye DiI to show that CA8 selectively labels OFF parasol cells in macaque retina. By combined labeling with CA8 antibodies and a previously-described marker for parasol cells (GABAA receptor antibodies), we show that ON and OFF parasol cells each comprise ∼ 6% of all ganglion cells in central retina (each peak density ∼ 3000 cells/mm2 at 5 deg.), and each population comprises ∼ 10% of all ganglion cells in peripheral temporal retina. Thus, the spatial density of parasol cells in central retina is greater than reported by previous anatomical studies, and the central-peripheral gradient in parasol cell density is shallower than previously reported. The data nevertheless predict decline in spatial acuity with visual field eccentricity for both midget-parvocellular pathway and parasol-magnocellular pathway mediated visual functions. The spatial resolving power of the OFF parasol array (peak ∼ 7 cpd) falls short of macaque behavioral grating acuity by at least a factor of three throughout the retina.

The impact of early aging on visual perception of space and time.

Visual perception of space and time has been shown to rely on context dependency, an inferential process by which the average magnitude of a series of stimuli previously experienced acts as a prior during perception. This article aims to investigate the presence and evolution of this phenomenon in early aging. Two groups of participants belonging to two different age ranges (Young Adults: average age 28.8 years old; Older Adults: average age 62.8 years old) participated in the study performing a discrimination and a reproduction task, both in a spatial and temporal conditions. In particular, they were asked to evaluate lengths in the spatial domain and interval durations in the temporal one. Early aging resulted to be associated to a general decline of the perceptual acuity, which is particularly evident in the temporal condition. The context dependency phenomenon was preserved also during aging, maintaining similar levels as those exhibited by the younger group in both space and time perception. However, the older group showed a greater variability in context dependency among participants, perhaps due to different strategies used to face a higher uncertainty in the perceptual process.

Age- and gender-specific normative data on computerized dynamic posturography in a cohort of Danish adults.

Balance performance can be measured with a computerized dynamic posturography (CDP). Frequently used CDP protocols include the sensory organization test (SOT), motor control test (MCT) and adaptation test (ADT). The primary aim of this study was to produce normative data using the Bertec® Balance Advantage CDP on a cohort of healthy adults aged 20-79years for the SOT, MCT and ADT. The secondary aim was to determine age- and gender-related differences. The study population of 120 participants were divided into age groups of 20-29, 30-39years, etc., with an equal number of men and women in each group. Using the Bertec® CDP, the SOT, MCT and ADT protocols were performed. SOT found that the 70-79 age group and men scored lower equilibrium scores (ES) on SOT4, and SOT6. Women had higher ES on SOT1. For the MCT, backward translation. latencies were higher for the 60s and 70s age groups. The 60s age group had higher forward translation latencies. Women had lower latencies on all MCTs. For the ADT toes up test, the 70-79 age group scored higher sway energy. On the toes down test, higher sway energy was registered for the 50-79 age groups. Women had lower sway energy for both ADT's. We have produced normative data for healthy adults aged 20-79years for the SOT, MCT and ADT protocols using the Bertec® Balance Advantage CDP. Balance performance differences might be due to decline in visual acuity, presbyvestibulopathy and differences in body composition.

Progressive decline in visual acuity due to optic nerve sheath meningioma

Progressive decline in visual acuity due to optic nerve sheath meningioma

Proton Therapy for 166 Patients with Iris Melanoma: Side Effects and Oncologic Outcomes

To investigate the oncological and functional outcomes of a large cohort of patients with a favorable stage of circumscribed and diffuse iris melanoma who underwent primary proton treatment and the risk factors related to initial tumor characteristics and the treatment field architecture. Retrospective, single-center, case study. We reviewed 225 patients with iris melanoma who were consecutively treated with proton beam therapy at our institution between 1998 and 2020. We performed Kaplan-Meier time-to-event analyses and multivariate Cox proportional hazard analyses to identify the impacts of tumor characteristics and target volumes on oncological and functional outcomes. We measured local tumor control, eye preservation rates, metastasis-free survival, cataract and glaucoma-directed surgery, intraocular pressure, and changes in visual acuity. Of the 192 patients with tumors confined to the iris (T1a-c) who underwent proton therapy as primary treatment, a total of 166 patients (mean age 58.4 years; 88 females) with a minimum follow-up of 6 months were included. Multifocal or diffuse tumor spread was present in 77 (46.4%) patients. The median follow-up time was 54.0 (IQR: 27.4-91.8) months. Local recurrence occurred in 2 patients (1.2%) with circumscribed iris melanoma. Enucleation was a rare event (n=5, 3%) and no patient developed metastatic disease. A large treatment field (full aperture, involving >10 clock hours) was identified as a risk factor for the development of secondary glaucoma (HR: 6.3; p<0.001) and subsequent surgical interventions (HR: 10.85; p<0.001). The large treatment field group showed a significant decline in visual acuity (logMAR >0.3; log-rank p<0.0001), which was associated with secondary glaucoma (HR: 3.40; p=0.002). Proton therapy provides an effective, non-invasive treatment option for patients with a favorable stage of iris melanoma. Irradiation of the anterior segment up to 10 clock hours is associated with a low risk of the development of secondary glaucoma and vision loss.

Association between structural and functional treatment outcomes in neovascular age-related macular degeneration.

The administration frequency of intravitreal anti-vascular endothelial growth factor (anti-VEGF) in neovascular age-related macular degeneration (AMD) have been widely discussed. The primary objective of the study was to explore the association between anatomical outcomes and changes in functional outcome. This was a retrospective cohort study of patients with newly diagnosed neovascular AMD with a minimum of 12 months of follow-up. Only one eye per patient was included. Patients were treated according to the observe-and-plan or the pro-re-nata regimen. All patients were regularly examined from the time of diagnosis up to 24 months. The effect of intraretinal fluid (IRF), subretinal fluid (SRF) and pigment epithelium detachment (PED) at any time point on visual acuity (VA) was tested, as well as the long-term effect and the risk of losing VA. Further, the variability of central retinal thickness (CRT) was calculated for each eyes' individual measures during the observation period, excluding the monthly loading phase. The prognostic effect of each factor on VA was estimated by regression analysis. The primary outcome measure was VA, which was correlated with the presence or absence of fluid, seen as IRF, SRF or PED. A total of 504 treatment naïve eyes from 504 patients was included. The presence of IRF was associated with lower VA at all visits (p < 0.001). However, the presence of SRF or PED was not significantly associated with worse VA at any time point during the observation period. Patients in the upper quartile of CRT variance had a greater loss in VA after 12 and 24 months (p < 0.001). In this retrospective cohort study, the presence of intraretinal fluid was associated with poorer visual outcome in neovascular AMD patients treated with anti-VEGF, but the presence of subretinal fluid and PEDs was not. This suggests that IRF is worse than subretinal fluid and PEDs for AMD outcomes and therefore requires the most intensive treatment. Further, we found that patients with the highest CRT variability during the study period had poorer visual outcomes after 12 and 24 months, indicating that stringent control of retinal fluid volume fluctuations is important to prevent visual acuity decline over time.

Case Report: Optical coherence tomography angiography findings in radiation retinopathy

We report the observation of a 31-year-old patient followed for a nasopharyngeal carcinoma since 2009, treated by locoregional radiotherapy, with a cumulative dose of 70 Gray. This case presented all ocular complications of radiotherapy; radiation retinopathy (RR), which is the most severe complication, could be diagnosed earlier and have a better prognosis if optic coherence tomography angiography (OCTA) was performed. She presented with a progressive decline in bilateral visual acuity. Ophthalmologic examination revealed bilateral posterior subcapsular cataract, radiation retinopathy, and optic neuropathy. The OCT B-scan showed more pronounced macular edema in the right eye. The OCTA revealed enlargement of the central avascular zone and loss of the deep and superficial retinal vascular network. The patient received three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor (VEGF), without improvement in visual acuity. The aim of this case report is to present the contribution of OCT-A in the diagnosis of radiation maculopathy, and attribute these changes to ischemia at the level of the retinal vascular network.

Visual Outcomes in Macula-Involving Retinal Detachments Based on Time to Surgical Repair.

To examine the relationship between duration of macular detachment and postoperative visual acuity in macula-involving rhegmatogenous retinal detachments. Retrospective review of patients who underwent surgical repair of macula-involving rhegmatogenous retinal detachments was conducted with Institutional Review Board approval. Primary outcome measure was postoperative best-corrected visual acuity (BCVA) as dependent on duration of macular detachment. In eyes with duration of macular detachment less than or equal to 7 days, postoperative BCVA increased by 0.017 logarithm of the minimum angle of resolution (logMAR) units (P = .001), and the odds of achieving logMAR 0 decreased by a factor of 0.43 (95% CI, 0.21 to 0.87; P = .02) with each additional day of detachment. Eyes repaired within 3 days of macular detachment were more likely to have postoperative BCVA of logMAR 0 than eyes repaired 4 to 7 days after macular detachment (odds ratio, 2.32; 95% CI, 1.15 to 4.70; P = .02). Increased duration of macular detachment is associated with progressive decline in postoperative visual acuity. [Ophthalmic Surg Lasers Imaging Retina 2022;53:439-444.].

Efficacy and safety of subliminal transscleral cyclophotocoagulation in uncontrolled glaucoma.

To determine the efficacy of subliminal cyclophotocoagulation in reducing intraocular pressure (IOP) and to assess the safety profile of the procedure. We reviewed the charts of all patients who underwent subliminal cyclophotocoagulation between August 2019 and August 2020. The IOP, number of antiglaucoma medications, and visual acuity were compared at baseline and at 6 months. The post-laser complications were noted. Paired t-test, Wilcoxon rank-sum test, and McNemar test were used for analysis. This study included 40 eyes of 40 patients. The most frequent diagnosis was neovascular glaucoma (55%), followed by primary open-angle glaucoma (17.5%). The mean IOP reduced from 32 to 21 mmHg (mean IOP reduction: 32%, 95% confidence interval [CI]: 27%-37%, P < 0.001). Mean number of antiglaucoma medications declined from 3.2 to 1.9 (P < 0.001). Use of oral acetazolamide decreased from 62% to 5% (P < 0.001). The success rate of the procedure at 6 months was 55%. One patient had unexplained visual acuity decline after the procedure. Subliminal sub-cyclophotocoagulation is effective in treating refractory glaucoma in the Indian population. It decreases the medication burden. However, subliminal lasers can also cause vision-threatening complications such as hypotony, uveitis, and optic nerve hypoperfusion. So, clinicians should be cautious when using sub-cyclophotocoagulation in patients with good vision.

Longitudinal Changes in Vision and Retinal Morphology in Wolfram Syndrome

To report long-term ophthalmic findings in Wolfram syndrome, including rates of visual decline, macular thinning, retinal nerve fiber layer (RNFL) thinning, and outer plexiform layer (OPL) lamination. Single-center, cohort study. A total of 38 participants were studied, who underwent a complete ophthalmic examination as well as optical coherence tomography imaging of the macula and nerve on an annual basis. Linear mixed-effects models for longitudinal data were used to examine both fixed and random effects related to visual acuity and optic nerve quadrants of RNFL and macula thickness. Participants completed a mean of 6.44 years of follow-up (range 2-10 years). Visual acuity declined over time in all participants, with a mean slope of 0.059 logMAR/y (95% CI=0.07-0.05 logMAR/y), although nearly 25% of participants experienced more rapid visual decline. RNFL thickness decreased in superior, inferior, and nasal quadrants (β=-0.5 µm/y, -0.98 µm/y, -0.28 µm/y, respectively). OPL lamination was noted in 3 study participants, 2 of whom had autosomal dominant mutations. Our study describes the longest and largest natural history study of visual acuity decline and retinal morphometry in Wolfram syndrome to date. Results suggest that there are slower and faster progressing subgroups and that OPL lamination is present in some individuals with this disease.

Progression Rate of Visual Function and Affecting Factors at Different Stages of Retinitis Pigmentosa.

We reviewed medical records of 121 patients/235 eyes of typical retinitis pigmentosa (RP) patients who could be followed up for at least 5 years with the aim of investigating the long-term course of visual function progression at each RP stage and appropriate assessment methods. Patients were classified into three groups: mild RP (baseline mean deviation (MD) ≥ −5), moderate RP (−25 < baseline MD < −5), and late RP (baseline MD ≤ −25). Linear mixed-effect models were used to follow MD, the average retinal sensitivity of the central four points of the Humphrey field analyzer 10-2 program (S4), and visual acuity (VA) with increasing time. The associations among factors (baseline MD group, sex, hereditary form) and the interaction between each factor and time were also investigated. The mean reduction of the MD, S4, and VA for all patients was -0.37 dB/year, -0.25 dB/year, and 0.018/year, respectively. The moderate RP group had a faster progression than other groups in MD (-0.43 dB/year, p < 0.05). The moderate (-0.31 dB/year, p = 0.01) and late RP groups (-0.25 dB/year, p < 0.01) had faster progression than the mild RP group in S4. The late RP group had faster progression in VA than the other groups (0.03/year, p < 0.05). Females had a slower progression of the S4 (-0.15 dB/year, p = 0.02) and VA (0.01/year, p < 0.001) than males. The autosomal dominant group had a slower progression than the sporadic group in MD (-0.22 dB/year, p = 0.02); the autosomal dominant and autosomal recessive groups had a slower VA decline than the sporadic group (0.01/year, p = 0.03; 0.01/year, p = 0.04). Because the progression rates of VA and visual field test differed as per the RP stage, S4 and VA can also be useful assessment methods depending on the stage. Inheritance form and sex may affect the progression rate.

Photoreceptor and vision protective effects of astragaloside IV in mice model with light-evoked retinal damage

Cone cell-enriched macular degeneration is a major cause of functional vision deterioration. Astragaloside IV (Asg IV), an active triterpenoid saponin component with properties of anti-oxidative and anti-apoptotic damage, which benefit retinal tissue and capillaries. But, the nutraceutical therapeutic effects on functional vision have not been fully evaluated. In this study, mice were administrated to high-intensity light exposure after either receiving a vehicle or Asg IV (0.05, 0.5, and 50 mg/kg, BID). During this time, their spatial-visual performance, visual acuity (VA), and visual contrast sensitivity function (VCSF) were measured using the behavioral optomotor reflex method. Morphological changes in the retina were determined by histological examination. High energy light-evoked visual damage was confirmed by the loss in structural tissue integrity in the retina accompanied by a decline in both VA and VCSF, whereas the retina tissue exhibited loss of cone cell density and severe cone-specific opsin misplacement. In contrast, prophylactic oral Asg IV (0.5, and 50 mg/kg, BID)-treated exerted protective and improvement effects against light-evoked deterioration of functional vision. Asg IV treatment significantly improved the thresholds of VA and VCSF. In particular, Asg IV (50 mg/kg, BID) modulated and increased the survival of the photoreceptors, especially the cone cells, which targeted and enhanced the high spatial frequency-characterized VCSF. In contrast, the cellular protective effect of Asg IV (50 mg/kg, BID) on photoreceptors was significantly reversed by synchronous injection of a glucocorticoid receptor (GR) antagonist (mifepristone). This study demonstrated the major neuroretina-protective effect and functional vision-improving effect of Asg IV in vivo.

Recurrent retinal detachment after pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

The recurrence of retinal detachment following rhegmatogenous retinal detachment (RRD) is a relatively common complication that can lead to reduced visual acuity and requires further surgery. The purpose of this study was to investigate the risk factors and visual outcomes of recurrent RRD following pars plana vitrectomy (PPV) with silicone oil tamponade for primary RRD. This was a retrospective follow-up study of 343 eyes that underwent initial PPV surgery with silicone oil tamponade for primary RRD. Patients were divided into a recurrence group and a reattachment group. The main outcome measures included causative factors, visual outcomes related to the recurrence of RRD, and the perioperative factors most affecting the recurrence of RRD. After retinal reattachment, we observed RRD recurrence after PPV for primary RRD in 42 out of 343 eyes (12.2%) during the follow-up period. Most causes of recurrence (69%) occurred within 6months of surgery. Multivariate logistic regression analysis showed that a PVR ≥ Grade C (odds ratio [OR]: 4.015; 95% confidence interval [CI] 1.721-9.367; P = 0.001) was a significant predictor for the development of recurrent RRD. Compared with the reattachment group, the recurrence group exhibited a significant decline in best-corrected visual acuity (BCVA) at the last follow-up visit (P = 0.000). Eyes with PVR prior to primary surgery, or at the diagnosis of re-detachment, showed a worse final BCVA. Our analysis shows that the predominant risk factor for the recurrence of RRD is a PVR ≥ Grade C. PVR prior to primary surgery, or at the diagnosis of re-detachment, was also shown to limit the recovery of final visual acuity.

The Use of Vascular Endothelial Growth Factor Inhibitors in Patients with Proliferative Diabetic Retinopathy

Diabetic retinopathy (DR) have been taking a leading position among retinal disorders, causing a persistent and significant decrease in visual functions. The base of the disease is a retinal vascular microangiopathy, which induces a tissue ischemia and excessive production of vascular endothelial growth factors. The main method of treatment for this pathology is a laser photocoagulation. However, it is not always possible to perform appropriate laser photocoagulation, by that limiting its efficacy (cases of hard cataract and hemophthalmos). In addition, this type of treatment might have a number of serious complications, such as macular oedema, recurrent vitreous hemorrhages, the occurrence of fibrosis, atrophic changes in the retina, which leads to a decline in visual acuity and contrast sensitivity, worsening the visual field. Over the past 10 years, vascular endothelial growth factor inhibitors have been introduced into clinical practice, and showed their benefits in the treatment of disorders leading to a pathological angiogenesis. But due to the limited number of systematic observations, assessing the impact of these drugs, is necessary to investigate their efficacy and safety in patients with proliferative DR, in order to develop indications for their use. The purpose of the review is evaluation of the effect of vascular endothelial growth factor inhibitors on active neovascularization in patients with proliferative diabetic retinopathy. There is a literature of international clinical guidelines, randomized clinical trials with a varying level of evidence, articles and publications by groups of authors in the article.

Retrospective Natural History Study of RPGR-Related Cone- and Cone-Rod Dystrophies While Expanding the Mutation Spectrum of the Disease.

Variants in the X-linked retinitis pigmentosa GTPase regulator gene (RPGR) and, specifically, in its retinal opening reading frame-15 isoform (RPGRORF15) may cause rod-cone (RCD), cone, and cone-rod dystrophies (CDs and CRDs). While RPGR-related RCDs have been frequently evaluated, the characteristics and progression of RPGR-related CD/CRDs are largely unknown. Therefore, the goal of our work was to perform genotype–phenotype correlations specifically in RPGRORF15-related CD/CRDs. This retrospective longitudinal study included 34 index patients and two affected relatives with a molecular diagnosis of RPGR-related CD/CRDs. Patients were recruited at the “Quinze-Vingts” Hospital, Paris, France and screened for mutations in RPGRORF15 at the Institut de la Vision, Paris, France. We identified 29 distinct variants, of which 27 were truncating. All were located in the 3′ half of the RPGRORF15 transcript. Twenty of them were novel. Fifteen subjects were affected by CD, the remaining had CRD. When analyzing the longitudinal data, a progressive decline in visual acuity (VA) was noted, with more than 60% of the patients reaching VA ≥ 1 LogMar in the best eye after the fifth decade of life. To our knowledge, this is the largest described study of a cohort of CD/CRD patients affected by RPGRORF15 variants. Longitudinal data showed a rapidly progressive disease, possibly locating an optimal window of intervention for future therapies in younger ages.

Analysing Subgroups and Treatment Discontinuation in a Finnish Cohort of Patients with Neovascular AMD

Purpose: We aimed to study the regional detailed visual outcome and treatment discontinuation of neovascular age-related macular degeneration (nAMD). Methods: Clinical records of 110 patients treated for nAMD at the sole referral centre in the Helsinki region were analysed retrospectively. The follow-up was up to the fourth year. Results: The mean visual acuity (VA) at baseline was 56.3 (SD 16.2) letters. The mean last VA at the first year was 59.7 (20.2), and the corresponding values for the second, third, and fourth years were 60.8 (20.6), 60.0 (19.0), and 59.7 (19.3). The mean difference from baseline was +3.39 (SD 14.6), +3.59 (17.6), +0.08 (18.9), and +3.08 (14.3). The number of patients declined each year, with only 51% of the patients being in treatment until the fourth year. The patients with shorter duration of follow-up tended to have a lower baseline VA, lesser gains, and an earlier decline in VA. The VA levels at the last visit were poorer in the shorter follow group. The initial VA response predicted later VA, whereas VA at baseline, age, or sex had no effect. However, the effect vanished with a longer time in treatment. Conclusions: Long-term VA stabilization was obtained in a regional material. Patients with neovascular AMD consist of cohorts with varying visual outcome and treatment time. Many of the patients benefit from the treatment for some time, however. When comparing real-world results, the outcome of the different follow-up time cohorts should be considered. This calls for new methods for analysing real-world nAMD treatment results.

Modifiable Determinants of Satisfaction with Intravitreal Treatment in Patients with Neovascular Age-Related Macular Degeneration.

The success of intravitreal treatment for neovascular age-related macular degeneration (nAMD) depends on maximal adherence to treatment, which in turn requires patient satisfaction. The aim of this study was to assess the factors associated with nAMD patient satisfaction to implement actions to improve treatment experiences and increase adherence. This was a prospective, observational, analytical, cross-sectional study. Our study included 100 consecutive nAMD patients under intravitreal treatment for at least 1year. Patients completed the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and the EuroQol Visual Analog Scale (EQ VAS). A logistic regression was estimated to model the low values of the satisfaction score (MacTSQ <50). The mean age of patients was 82.1±7.8 years and 62% were female. Males (p=0.002) and patients who improved their visual acuity (p=0.004) were more satisfied, while patients who received a higher number of injections (p=0.036) and treatment in both eyes (p=0.001) were less satisfied. Higher health-related quality of life was related to higher satisfaction. The sensitivity and specificity of the predictive model were 75.8% and 76.1%, respectively. Factors independently associated with low satisfaction were female sex (odds ratio [OR] 6.84), going to the clinic alone (OR 8.51), longer duration of treatment (OR 0.62), receiving treatment in both eyes (OR 3.54), and suffering a decline in visual acuity (OR 3.30). The questionnaire revealed patients' needs for more information and injection points closer to their homes. Well-defined areas for improvement were identified, i.e. to improve the information offered to each patient, to incorporate new long-acting drugs, and to establish locations for injection services in peripheral areas.

Quantification of the Dynamic Visual Acuity Space at Real-World Luminances and Contrasts: The VA-CAL Test.

PurposeBest-corrected visual acuity (BCVA) is assessed at a single standardized luminance with maximum optotype contrast, not reflecting the constantly changing daily-life viewing conditions. For a more realistic estimation of visual performance at varying object contrasts (Cs) and ambient luminances (ALs), we developed a new VA test, VA-CAL.MethodsLandolt-C-rings between 18% and 95% Weber contrast, were presented at 1 m distance (8 Alternative Forced Choice) on a 5.7 degree field in the middle of a frosted glass screen (66 degrees), back-lit by 3060 LEDs (generating ambient luminances between 0–10,000 cd/m²). Visual acuity (VA) was measured in 14 normally sighted participants twice for 8 conditions of ambient luminance and 6 conditions of contrast using a QUEST staircase procedure.ResultsVA improved continuously up to an ambient luminance of 3000 to 5000 cd/m² (best mean VA ± SEM: −0.47 ± 0.03 logMAR at C = 95%, AL = 3000 cd/m²), followed by a decline of VA at higher luminances with good test-retest variability. As expected, reduced contrast leads to a lower VA (worst mean VA ± SEM: −0.03 ± 0.03 logMAR at C = 18%, AL = 0 cd/m²). A 3D plot of these data shows the VA space (VAS) extending between the contrast and luminance axes, which describes the dynamics of VA continuously changing under varying everyday life conditions.ConclusionsVA-CAL, an automated device and procedure, allows for simultaneous evaluation of VA at various contrast-luminance combinations, thus providing a more comprehensive assessment of spatial vision problems not seen with standard BCVA tests.Translational RelevanceThe new BCVA test VA-CAL incorporates a range of everyday contrast and ambient luminance conditions for a more realistic description of visual performance.

The effects of simulated and actual visual impairment on the Montreal Cognitive Assessment

ABSTRACT Many cognitive assessments include a visual component; however, adults may experience a decline in visual acuity with age. Scores on cognitive assessments of adults with visual impairments are typically lower than adults with normal vision, however, it is unclear if these lower scores are a consequence of cognitive or visual impairment. We measured the impact of simulated visual impairment on a cognitive screening measure. Undergraduate students were administered the Montreal Cognitive Assessment (MoCA) under three vision conditions (20/20, simulated 20/80, simulated 20/200). We found a main effect of vision condition on test performance such that there is a statistically significant difference between scores on the 20/20 and 20/80 conditions and 20/200. However, no differences were observed between 20/80 and 20/200. Participants’ performance decreased with simulated impairments. A secondary between-subject analysis was conducted on a sample of older adults with and without vision impairment; no differences were found.