ETDRS Chart Research Articles

Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling.

IntroductionThe aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity.MethodsThe patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery.ResultsA total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant.ConclusionsNo difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.

A Comparison of different scoring terminations rules for visual acuity testing: from a computer simulation to a clinical study

ABSTRACTPurpose: To compare four visual acuity (VA) scoring termination rules.Methods: A computer simulation generated 30,000 virtual patients who underwent 10 repetitions for each of four termination rules, on both the Snellen and ETDRS charts (2.4 million tests performed in total). Three termination rules focused on the smallest character row: all characters were correctly identified (100%), one character was incorrectly identified (one miss) and 50% or more of the characters were correctly identified (50%). The forth termination rule used a calculation in which each character, when correctly recognized, contributed a proportional increment (per-letter). Accuracy, test-retest variability (TRV) and test duration were measured. Next, a clinical study was conducted in which 254 subjects underwent three repetitions of the ETDRS VA test from 4 m, and VA scores for each of the four scoring termination rules were calculated.Results: In the Snellen simulation, the mean accuracy of the 100%, one miss, 50% and per-letter termination rules in decimal was 0.23 (−0.16 logMAR), 0.11 (−0.09 logMAR), 0.10 (−0.08 logMAR), and −0.08 (0.08 logMAR) respectively; while with the ETDRS simulation, the mean accuracy in decimal was 0.34 (−0.22 logMAR), 0.14 (−0.11 logMAR), 0.07 (−0.06 logMAR), and 0.07 (−0.05 logMAR), respectively. For the ETDRS simulation, the per-letter had the lowest TRV values and the longest test duration. In the clinical study (n = 254), the reproducibility of the 100%, one miss, 50% and per-letter was 0.50, 0.53, 0.17, 0.14, respectively.Conclusions: Clinical study and simulation data both suggest that the 100% and one-miss termination rules have higher TRVs, while the 50% and per-letter demonstrated much tighter, and rather close, TRV values.

The effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema

Objective To observe the effect of conbercept combined with 577 nm subthreshold micropulse laser photocoagulation on diabetic macular edema (DME). Methods A prospective randomized controlled clinical study. From June 2016 to June 2017, 68 eyes of 68 patients with DME diagnosed in Central Theater Command General Hospital were enrolled in the study. The patients were randomly assigned to two different treatment groups: 36 eyes (36 patients) in the conbercept combined with 577 nm subthreshold micropulse lase group (combined treatment group) and 32 eyes (32 patients) in conbercept group (drug treatment group). All patients received three initial intravitreous injection of conbercept and re-treatment was performed according to the criteria which has been disigned before. BCVA was measured by ETDRS charts. The central macular thickness (CMT), total macular volume (TMV) were measured by Topcon 3D-OCT 2000. The BCVA, CMT and TMV in the combined treatment group and the drug treatment group were 57.9±12.4 letters, 427.8±129.4 μm, 10.14±1.50 mm3 and 59.0±16.0 letters, 441.0 ± 135.7 μm, 10.43±2.10 mm3, respectively. There was no significant difference (t=0.321, 0.410, 0.641; P=0.749, 0.683, 0.524). The follow-up period was more than 12 months. The changes of BCVA, CMT and TMV were compared between the two groups. Comparison of BCVA, CMT, TMV before and after treatment in and between groups using repeated measures analysis of variance. Results The average annual injection times was 5.8±1.9 in the combined treatment group and 8.5±2.4 in the drug treatment group. The difference was statistically significant (t=5.12, P=0.000). The BCVA in the 3rd, 6th, 9th and 12th month were 64.9±11.1, 65.6±10.5, 67.0±10.8, 66.6±10.7 letters and 65.7±15.8, 66.9±15.7, 66.4±13.0, 67.3±16.4 letters, respectively, and there were significant differences compared with BCVA before treatment (F=34.234, 10.137; P=0.000, 0.000). The CMT were 335.2±105.9, 352.6±106.6, 336.2±120.8, 305.9±97.0 μm and 323.9±92.8, 325.5±90.2, 327.6±108.2, 312.2±106.8 μm, respectively. The TMV were 9.20±1.08, 9.26±1.20, 9.20±1.63, 9.05±1.18 mm3 and 9.19±1.21, 9.35±1.69, 9.09±1.20, 8.92±1.10 mm3, respectively. Compared with the CMT (F=12.152, 12.917; P=0.000, 0.000) and TMV (F=11.198, 11.008; P=0.000, 0.000) before treatment, the differences were statistically significant. Conclusion Conbercept combined with 577 nm subthreshold micropulse laser and conbercept can effectively reduce CMT, TMV and improve BCVA in patients with DME, but combination therapy can reduce the injection times of conbercept. Key words: Diabetic retinopathy/complications; Macular edema/drug therapy; Angiogenesis inhibitors/therapeutic use; Antibodies, monoclonal/therapeutic use; Laser coagulation

A new counterintuitive training for adult amblyopia.

ObjectivesThe aim of this study was to investigate whether short‐term inverse occlusion, combined with moderate physical exercise, could promote the recovery of visual acuity and stereopsis in a group of adult anisometropic amblyopes.MethodsTen adult anisometropic patients underwent six brief (2 h) training sessions over a period of 4 weeks. Each training session consisted in the occlusion of the amblyopic eye combined with physical exercise (intermittent cycling on a stationary bike). Visual acuity (measured with ETDRS charts), stereoacuity (measured with the TNO test), and sensory eye dominance (measured with binocular rivalry) were tested before and after each training session, as well as in follow‐up visits performed 1 month, 3 months, and 1 year after the end of the training.ResultsAfter six brief (2 h) training sessions, visual acuity improved in all 10 patients (0.15 ± 0.02 LogMar), and six of them also recovered stereopsis. The improvement was preserved for up to 1 year after training. A pilot experiment suggested that physical activity might play an important role for the recovery of visual acuity and stereopsis.ConclusionsOur results suggest a noninvasive training strategy for adult human amblyopia based on an inverse‐occlusion procedure combined with physical exercise.

Anti-VEGF treatment for choroidal neovascularization complicating pattern dystrophy-like deposit associated with pseudoxanthoma elasticum.

To evaluate the efficacy of intravitreal anti-VEGF injections in choroidal neovascularization (CNV) related to pattern dystrophy-like deposit in pseudoxanthoma elasticum (PXE). One-year prospective, interventional study. Nine eyes were recruited in the ophthalmology departments of San Raffaele University and University of Barcelona. Each patient underwent best corrected visual acuity (BCVA) measurement on ETDRS chart, slit-lamp biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). The protocol included a first anti-VEGF injection, followed by monthly evaluations with re-treatments based on new funduscopic hemorrhages, fluid on OCT or leakage on FA and/or ICGA. Primary outcome measures were the mean BCVA changes. Secondary outcomes included central macular thickness (CMT) variations and the number of injections needed. At month 12, mean BCVA significantly improved from 20/45 to 20/35 Snellen equivalent, with 3 eyes gaining at least 3 ETDRS lines. Mean CMT decreased from 297 ± 22 to 262 ± 13μm, after 5.5 ± 4.0 injections. No leakage was observed at the end of follow-up. Intravitreal anti-VEGF injections represent an effective treatment for CNV related to pattern dystrophy-like deposit in PXE, with an improvement of BCVA and CMT. Mean injection number is in line with other studies performed in CNV secondary to angioid streaks.

Incidence and correction of vision impairment among elderly population in southern urban China

Data on the incidence of presenting vision impairment (PVI) and spectacle coverage rate (SCR) in urban China is limited. To estimate the 6-year incidence and risk factors for PVI and the SCR in urban Southern China. Population-based cohort study. A total of 1817 participants aged ≥35 years were identified from Guangzhou in 2008 at baseline and 1427 attended follow-up examination in 2014. Presenting visual acuity (PVA) was measured using the ETDRS chart with habitual spectacles. Participants with PVA ≤20/40 underwent subjective refraction at the follow-up visit. Incidence of PVI was calculated using the WHO and US criteria, respectively. The met-need SCR was defined as the percentage of participants with PVA <20/40 that had been improved to ≥20/40 after correction. Incidence of PVI and SCR. Incidence of PVI was 8.3% (95%CI, 6.9-9.8) and 12.2% (95%CI, 10.5-14.0) based on the WHO and US definition, respectively. Older age, female, lower education level, more myopic spherical equivalent and worse PVA at baseline were significantly related to a higher PVI incidence based on the WHO criteria, with similar associations identified using the US criteria except for gender. The overall met-need SCR was 42.5%, and was lower among the elderly, more hyperopic participants or participants with lower education level. The incidence of PVI is high in urban Southern China and spectacle wearing is available in less than half of those in need. This highlights the needs to promote spectacle coverage even in the urban population.

Two-Year Efficacy of Ranibizumab Plus Laser-Induced Chorioretinal Anastomosis vs Ranibizumab Monotherapy for Central Retinal Vein Occlusion

Adding a laser-induced chorioretinal anastomosis (L-CRA) to current treatments for central retinal vein occlusion (CRVO) may improve outcomes and lessen therapy burdens. To determine the 2-year efficacy of intravitreal ranibizumab with an L-CRA vs ranibizumab alone for patients with macular edema caused by CRVO. In this randomized clinical trial conducted at a single university clinic from March 2012 to June 2015, 58 participants with macular edema caused by CRVO were randomized 1:1 to either an L-CRA or sham procedure at baseline. All participants received monthly intravitreal injections of ranibizumab, 0.5 mg. Data were analyzed from April 2017 to September 2017. Random assignment to L-CRA plus monthly injections of intravitreal ranibizumab, 0.5 mg, (combination group; n = 29) or to a sham L-CRA procedure plus monthly injections of intravitreal ranibizumab, 0.5 mg, (ranibizumab alone group; n = 29) for 6 months. From month 7 to month 24, participants were evaluated monthly and received an injection of ranibizumab if a loss of 5 or more letters of best-corrected visual acuity (BCVA) on ETDRS chart from previous highest score occurred or if there was evidence of residual macular edema on optical coherence tomography. Mean number of injections from month 7 to month 24, change in BCVA, and change in central subfield thickness (CST). Of the 58 included participants, 38 (66%) were men, and the mean (SD) age was 68.6 (11.8) years; participants had a mean (SD) BCVA of 57.09 (11.87) ETDRS letters (Snellen equivalent, 20/73) and a mean (SD) CST of 738.36 (175.54) μm. A successful L-CRA was created in 24 of 29 participants (83%) in the combination group. The mean number of injections from month 7 to month 24 was 3.2 (95% CI, 2.5-3.8) in the combination group and 7.1 (95% CI, 6.0-8.0) in the ranibizumab alone group. The ratio of the number of injections in the combination group compared with the ranibizumab alone group was 0.46 (95% CI, 0.36-0.61; P < .001). Mixed-effects regression modeling showed a difference in mean BCVA at 2 years between the combination and ranibizumab alone groups (combination, 70.3 letters [Snellen equivalent, 20/40]; ranibizumab alone, 61.6 letters [Snellen equivalent, 20/60]; difference, 8.8 letters; 95% CI, 0.2-17.3; P = .05). There was also a difference in CST at 2 years between the combination and ranibizumab alone groups (mean CST: combination, 303.6 μm; ranibizumab alone, 394.5 μm; difference, 90.9 μm; 95% CI, 24.3-157.5; P = .01). Four participants (14%) in the combination group required a vitrectomy for early macular traction or vitreous hemorrhage. For macular edema caused by CRVO, an L-CRA significantly reduced the number of ranibizumab injections required. anzctr.org.au Identifier: ACTRN12612000004864.

Visual acuity and amblyopia prevalence in 11- to 12-year-old Danish children from the Copenhagen Child Cohort 2000.

To evaluate the prevalence of amblyopia and associated biometric factors in Danish children. Determination of best-corrected visual acuity (BCVA) using ETDRS charts, non-cycloplegic subjective refractioning guided by automated refractometry, axial length and corneal curvature, fundus photography and optical coherence tomography (OCT) in 1335 children from the population-based Copenhagen Child Cohort 2000 (CCC2000) Eye Study. Birth data were obtained from the Danish Medical Birth Registry. The mean (±SD) age of children was 11.7 (±0.4) years, and 47% were boys. Amblyopia prevalence was 1.5 (95% CL 0.8-2.2) %. Unilateral amblyopic eyes [BCVA<80 ETDRS letters (0.8 snellen) and ≥2 lines difference between the eyes] was 0.6 (95% CL 0.3-1.0) mm shorter, 1.34 (95% CL 0.30-2.37) D more hyperopic and had 0.79 (95% CL 0.14-1.44) D more astigmatism compared with fellow eyes. Compared with the right eyes of the non-amblyopic children, unilateral amblyopic eyes were 1.0 (95% CL 0.5-1.6) mm shorter, 2.48 (95% CL 1.11-3.86) D more hyperopic, 1.09 (95% CL 0.43-1.75) D more astigmatic and had a 47 (95% CL 13-81) μm thicker subfoveal choroid. Amblyopia was found in 1.5% of Danish children born 22years after the inception of the nationwide preschool visual screening programme. Amblyopia was associated with anisometropia, astigmatism, a thicker subfoveal choroid and a history of childhood strabismus.

Results of the first 12 months treatment of macular edema complicating BRVO in patients treated with ranibizumab.

Retrospective evaluation of the first 12 months treatment of macular edema in BRVO with ranibizumab based on anatomical and functional parameters. 54 eyes with macular edema complicating BRVO were included in the study, with an average initial best corrected visual acuity 4/16 ETDRS charts, an average central retinal thickness 512.3 μm, and in average 4 months till the beginning of treatment with ranibizumab. After 3 initial injections of 0.5 mg ranibizumab treatment was performed in pro re nata regimen, with adjuvant laser (grid laser photocoagulation) as an additional treatment option. The number of injections administered, the number of eyes where grid laser photocoagulation was provided, functional parameters as a letter gain and BCVA (eyes with final BCVA ≥ 4/8 ETDRS, final BCVA in according to initial BCVA) and anatomical parameters as a mean CRT and CRT ≤ 250 μm, respectively ≤ 300 μm were evaluated. In the whole group, an average of 4.8 injections of ranibizumab were administered in the first 12 months. Grid laser photocoagulation was performed in 42 eyes: in 8 eyes prior to the beginning of treatment with ranibizumab, 7 eyes before and during the treatment, 29 eyes only during the treatment. The main gain of letters after 12 months of treatment was +16.5 letters, with 63¨% (n = 34) eyes earning ≥ 15 letters. In the whole group 72 % (n = 39) eyes achieved the resulting BCVA ≥ 4/8 ETDRS after 12 months of treatment. The eyes with initial BCVA ≥ 4/10 ETDRS resulted in BCVA ≥ 4/8 ETDRS in 96 % (n = 23 eyes) and 11 eyes even achieved BCVA ≥ 4/4. The mean CRT after 12 months of treatment was 290.3 μm, 33.3 % of eyes had final CRT ≤ 250 μm, and 64.8 % had final CRT ≤ 300 μm. When applying a relatively low number of injections in the first year of treatment with ranibizumab, the final best corrected visual acuity was very good at the end of the observation period, and its dependence on the initial best corrected visual acuity was confirmed. Satisfactory results of central retinal thickness were found as well. Key words: branch retinal vein occlusion, macular edema, ranibizuma.

The optokinetic response is effective to assess objective visual acuity in patients with cataract and age-related macular degeneration.

To estimate objective visual acuity in subjects suffering from cataract and age-related macular degeneration via the optokinetic response evoked by a non-conventional induction method (oktotype); in addition, to compare such objective outcome with the subjective acuity based on the ETDRS charts. Patients were presented with 13 sequences of symbols arranged horizontally to form a serial pattern, moving from left to right at a constant rate. In each sequence, the size of the stimuli was reduced progressively, while the operator checked for the disappearance of the optokinetic response via a small video camera mounted on the test lens frame. The minimum angular size of the serial pattern able to evoke the optokinetic response (MAER) was referred to as the objective visual acuity of the subject. Correlation between logMAER and logMAR was significant in the cataract and macular degeneration group ([Formula: see text] = 0.70, p < .0001; [Formula: see text] = 0.63, p < .0007). In the two samples, the correspondence between subjective and objective visual acuity (as, respectively, decimal units and arbitrary decimal units) was satisfactory (concordance correlation coefficient: cataract group = 0.91 and AMD group = 0.93). Test-retest reliability of the oktotype was good for the cataract group and moderate for the AMD sample (Κ 0.81 and 0.59, respectively). The oktotype seems a promising tool to objectively assess visual acuity in noncooperating subjects with cataract or macular degeneration. Further research on other clinical conditions is needed to clarify the suitability of the procedure in the clinical setting.

Contrast sensitivity and visual acuity under low light conditions in macular telangiectasia type 2

Background/AimMacular pigment optical density (MPOD) is centrally depleted early on in macular telangiectasia type 2 (MacTel). Contrast sensitivity (CS) might be related to MPOD, and thus impaired in early MacTel....

Benefits of aflibercept treatment for age-related macular degeneration patients with good best-corrected visual acuity at baseline

Currently, age-related macular degeneration (AMD) is treated while patients exhibit good best-corrected visual acuity (BCVA). However, previous clinical trials only include patients with poor BCVA. We prospectively analyzed the benefits of intravitreal aflibercept (IVA) treatment for AMD patients exhibiting good BCVA at baseline. Twenty-nine treatment-naive AMD patients (29 eyes) with BCVA better than 0.6 (74 letters in ETDRS chart) were treated with IVA once a month for 3 months and every 2 months thereafter with no additional treatments. Improvement in mean BCVA, measured using the conventional Landolt C chart, contrast VA chart, and functional VA (FVA) system, and reductions in mean central retinal thickness (CRT), central choroidal thickness, macular volume (MV), and choroidal area on optical coherence tomography images were observed at 6 and 12 months. Improvements in contrast VA and FVA scores, in contrast to conventional BCVA, correlated with MV reduction; no VA scores correlated with a reduced CRT. The MV correlated with choroidal area after IVA. No severe adverse events occurred. IVA improved visual function, retinal condition, and quality of life evaluated by Visual Function Questionnaire, and was beneficial in these patients. The contrast VA and FVA scores and MVs, which detect subtle changes, helped demonstrate the benefits.

Kontrastna senzitivnost kod pacijenata sa dijabetes melitusom

Introduction: Diabetic retinopathy is one of the major complications of diabetes mellitus. It is a progressive disease that includes following stages: no apparent DR, non-proliferative DR and proliferative DR. Contrast sensitivity is defined as the ability to distinguish details at low contrast levels. Numerous studies have shown that in patients with DR, in stages when visual acuity is normal or only mildly reduced, CS function is significantly affected. Aim: The aim of our study was to examine whether CS is reduced in patients with diabetes, and whether is it significantly lower in diabetic patients compared to healthy subjects. Material and methods: 20 patients with diabetes treated at Hospital for Eye Diseases, Clinical Center of Serbia and 20 healthy subjects from general population participated in the study. We have conducted case-control study. We used low-contrast ETDRS chart to measure CS. Results: CS in diabetic patients was compared with CS in healthy subjects. We also examined CS in diabetics with and without retinopathy. A statistically significant difference was ob served between the patients and the control group, both at monocular and binocular vision and the diseased persons had significantly impaired CS function. Regarding the stage of retinopathy, statistical significance existed only in monocular vision, in terms of decreased CS in patients with non-proliferative DR. Our study shows that there was no statistically significant difference in CS in diabetics with hemoglobin A1c lower than 7 and in those with hemoglobin A1c equal or higher than 7. Conclusion: Our research found that CS in diabetic patients can be greatly impaired, even in early stages of disease, while there were still no retinal abnormalities. In view of the fact that in all of our respondents visual acuity was normal, we conclude that measuring CS, could be good indicator of early vision disorders in diabetic patients.

Evaluating refraction and visual acuity with the Nidek autorefractometer AR-360A in a randomized population-based screening study.

The evaluation of visual acuity (VA) and refraction in the Northern Finland Birth Cohort Eye study was performed using the Nidek AR-360A autorefractometer. The accuracy of the method for this population-based screening study was assessed. Measurements of the refractive error were obtained from the right eyes of 1238 subjects (mean age 47), first objectively with the AR-360A and then subjectively by an optometrist. Agreement with the subjective refraction was calculated for sphere, cylinder, mean spherical equivalent (MSE), cylindrical vectors J45 and J0 and presbyopic correction (add). Visual acuity (VA) was measured using an ETDRS chart and the autorefractometer. The refractive error measured with the AR-360A was higher than the subjective refraction performed by the optometrist for sphere (0.007 D±0.24 D p=0.30) and also for cylinder (-0.16 D±0.20 D p<0.0005). The bias between the measurements of MSE, J45 and J0 was low: -0.07 D±0.22 D (p=0.002), 0.01 D±0.43 D (p=0.25) and -0.01 D±0.42 D (p=0.43), respectively. The amount of add measured by the autorefractometer was higher than the subjective 0.35 D±0.29 D (p<0.0005). There was a statistically significant correlation between VA (p<0.0005) and the difference between the subjective and objective refraction. In 99.2% of the measurements, visual values were within one decimal line of each other. The Nidek AR-360A autorefractometer is an accurate tool for determining the refraction and VA in a clinical screening trial.

Standardized ETDRS charts for mobile devices

Charts displayed on mobile devices was verified in comparison to standardized ETDRS charts. Such method of visual acuity assessment is characterized by stabile brightness and contrast. Moreover the ability to dynamically display random optotypes eliminates the problem of memorizing the contents of charts, making measurements more reliable. Our tests showed that the VA measured with mobile device and the VA tested using standardized printed charts are not significantly different. Full Text: PDF ReferencesB. Shneiderman, Leonardo's Laptop: Human Needs and the New Computing Technologies (Boston, MIT Press 2002).A. Holzinger, M. Errath, "Mobile computer Web-application design in medicine: some research based guidelines", P. Univ. Access Inf. Soc. 6, 31 (2007). CrossRef R. K. Lord et al., "Novel Uses of Smartphones in Ophthalmology", Ophthalmology 117, 1274 (2010). CrossRef M. D. Crossland, R. S. Silva and A. F. Macedo, "Smartphone, tablet computer and e-reader use by people with vision impairment", Ophthalmic Physiol. Opt. 34, 552 (2014). CrossRef E. Zvornicanin, J. Zvornicanin and B. Hadziefendic, "The Use of Smart phones in Ophthalmology", Acta Inform. Med. 22, 206 (2014). CrossRef S. Tofigh et al., "Effectiveness of a smartphone application for testing near visual acuity", Eye 29, 1464 (2015). CrossRef C. Perera et al., "The Eye Phone Study: reliability and accuracy of assessing Snellen visual acuity using smartphone technology", Eye 29, 888 (2015). CrossRef Department of Epidemiology and Preventive Medicine, Early Treatment Diabetic Retinopathy Study: Manual of Operations. (Baltimore, U.S. Department of Commerce 1985).F. L. Ferris et al., "New Visual Acuity Charts for Clinical Research", Am. J. Ophthalmol. 94, 91 (1982). CrossRef W. F. Long, G. C. S. Woo, "Measuring Light Levels with Photographic Meters", Optometry Vision Sci. 57, 51 (1980). CrossRef F. L Ferris, R. D. Sperduto, "Standardized Illumination for Visual Acuity Testing in Clinical Research", Am. J. Ophthalmol. 94, 97 (1982). CrossRef Ch. Dancey, J. Reidy, Statistics Without Maths for Psychology (Harlow, Prentice Hall 2011).N. Balakrishnan, Methods and applications of statistics in the life and health sciences (New Jersey, John Wiley &amp; Sons 2010).ISO 8596:2009 Ophthalmic optics - Visual acuity testing - Standard optotype and its presentation (2009).S. Koenig et al., "Assessing visual acuity across five disease types: ETDRS charts are faster with clinical outcome comparable to Landolt Cs", Graefes Arch. Clin. Exp. Ophthalmol. 252, 1093 (2014). CrossRef A. Glasser, M. W. C. Campbell, "Presbyopia and the optical changes in the human crystalline lens with age", Vision Research 38, 209 (1998). CrossRef P. K. Kaiser, "Prospective Evaluation of Visual Acuity Assessment: A Comparison of Snellen Versus ETDRS Charts in Clinical Practice (An AOS Thesis)", Trans. Am. Ophthalmol. Soc. 107, 311 (2009). DirectLink L. Hyvärinen, R. Näsänen and P. Laurinen, "New Visual Acuity Test For Pre-School Children", Acta Ophthalmol. 58, 507 (1980). CrossRef M. Schuster, "Speech Recognition for Mobile Devices at Google", Lecture Notes in Computer Science 6230 (2010). CrossRef M. Werner, M. Kessel and C. Marouane, "Indoor positioning using smartphone camera", IPIN, International Conference on. IEEE (2011). CrossRef

Clinical experience with idebenone in the treatment of patients harboring rare mutations related to Leber's hereditary optic neuropathy (LHON)

PurposeLHON is a mitochondrial disease resulting in progressive, severe central vision loss, which in &gt;95% of patients is characterized by 1 of 3 primary mitochondrial DNA mutations. However, further rare mutations have also been identified. To date the only treatment approved for LHON is idebenone, which is safe and effective at a dose of 900 mg/day; however, there is little information about its use in patients with rare mutations.MethodsThe Expanded Access Program (EAP) assessed idebenone's therapeutic potential in patients with onset of symptoms within 1 year prior to enrollment, in a real‐world setting. Efficacy was assessed as clinically relevant recovery (CRR) or clinically relevant stabilization (CRS). CRR is defined as improvement from off‐chart to reading 5 letters on the ETDRS chart, or as an improvement of 10 letters. CRS is defined as maintenance of VA &lt;1.0 logMAR (20/200).ResultsOf 111 patients, 7 carried a rare mutation (A14495G, C3461T, G13051A, G3958A, T14487C, T4216C and T11253C+A14970G). The median age was 16.7 years, 57% were female and the time since onset was 2.8 months at the start of treatment. Patients presented with best visual acuity (VA) from 0.2 to 1.3 logMAR, and 3 patients presented with both eyes &lt;1.0 logMAR at baseline (BL). One patient had only BL data currently available while 6 provided follow‐up data, with a median treatment duration of 9.2 months at last observation. All 6 experienced a CRR (10/12 eyes total) and the range for magnitude of recovery was between 2 and 13 lines on the ETDRS chart. The 2 eyes which did not experience CRR maintained VA &lt;1.0 logMAR at last observation.ConclusionsLHON patients harboring rare mitochondrial mutations who received early treatment with idebenone presented with moderate VA loss at BL and experienced a very favorable outcome. All patients showed recovery of vision.

Visual and Topographical Outcomes Following Accelerated Trans-Epithelial Corneal Crosslinking in Progressive Keratoconus.

To assess the visual and topographical outcomes following accelerated trans-epithelial corneal crosslinking (TE-CXL) in progressive keratoconus. Case series. Laser Vision Centre, Karachi, from January 2015 to December 2016. Forty-five eyes of 25 patients affected with progressive keratoconus and treated with accelerated TE-CXL with riboflavin (vitamin B2) and ultra-violet A(UV-A) irradiation were enrolled in this study. The visual outcome was measured by ETDRS chart as improvement in best corrected visual acuity (BCVA) of at least one line or more as compared to pre-CXLBCVA. The topographical outcome was measured as decrease in maximum simulated keratometry values, astigmatism and spherical equivalent (SE) and an increase in central corneal thickness (CCT). K-max was defined as the steepest radius of curvature of the anterior corneal surface. SE was measured by subjective refraction, and K-max, astigmatism and CCTby scanning-slit corneal topography. Patients were followed-up 12 months post-treatment. At the end of follow-ups, mean BCVAshowed improvement of one line from LogMAR 0.58 ±0.067 to LogMAR 0.48 ±0.077. Seven (15.5%) eyes showed two lines of improvement while 3 (6.7%) eyes showed worsening of one line in BCVA. The mean K-max flattened by 0.7D. Mean astigmatism and SE decreased up to -0.5D and -0.4D, respectively. Mean preoperative CCTwas 454.31 ±36.34 µm, whereas mean postoperative CCTwas 456.47 ±35.60 µm with an average increase of 2.15 µm. No postoperative complications were reported. Based on topographical outcomes, accelerated TE-CXL is effective in preventing the progression of keratoconus without any safety concerns with improvement of vision in majority of cases.

Idebenone is effective and well tolerated in Leber's hereditary optic neuropathy (LHON): Long‐term results of real world clinical practice

PurposeLHON is a mitochondrial disease resulting in progressive, severe central vision loss, which is caused by 1 of 3 mitochondrial DNA mutations in &gt;95% of patients. Idebenone, at a dose of 900 mg/day, is effective and safe in patients with LHON. Here, we report long‐term treatment outcomes in real world clinical practice.MethodsThe Expanded Access Program (EAP) assessed idebenone's therapeutic potential in patients with onset of symptoms within 1 year prior to enrollment. Efficacy was assessed as clinically relevant recovery (CRR) or clinically relevant stabilization (CRS). CRR is defined as improvement from off‐chart to reading 5 letters on the ETDRS chart, or as an improvement of 10 letters. CRS is defined as maintenance of VA &lt;1.0 logMAR (20/200).Results85 patients carried one of the 3 most common mutations and had at least 1 post‐baseline (BL) visual acuity (VA) assessment. At BL, median age was 23.6 years and median treatment duration at last observation was 17.3 months. A subset of 25 patients presented with VA &lt;1.0 logMAR, from which 52% experienced CRS. CRR from nadir was observed in 51% of patients. The number of eyes which remained on chart increased from 51% at nadir to 67% at last observation, and those &lt;1.0 logMAR increased from 7% to 27%. At BL, 9% of patients were &lt;1.0 logMAR in both eyes, which increased to 23% following treatment. The proportion of patients with CRR increased with treatment duration, with approximately 50% observed up to 6 months, but extending up to 18 months. CRR and CRS were observed, to different degrees, regardless of mutation.ConclusionsIdebenone has a good safety profile for the long‐term treatment of LHON, and when initiated early, can stabilize good residual vision and prevent severe vision loss and blindness in a large proportion of patients. Maximal benefit may be achieved by prolonged treatment.

The Efficacy of Progesterone in Treatment of Traumatic Optic Neuropathy (Proton Study)

To evaluate the visual function improvement for treatment of indirect traumatic optic neuropathy Study design was comparative historical controlled trial. Seven patients newly diagnosed with indirect traumatic optic neuropathy Study design was comparative historical controlled trial. Seven newly diagnosed with indirect traumatic optic neuropathy (TON) were enrolled for progesterone group. Nineteen indirect Ton patients were reviewed medical records for steroid group (N= 12) and observation group (N= 7). Patients in progesterone group were given Depot medroxyprogesterone acetate (DMPA) 1 mg/kg. intramuscular injection every 12 hrs. for 5 days and observed for side effects. All patients were examined and reviewed for visual acuity by ETDRS chart, color vision test by Ishihara test, visual field testing by Humphrey automated perimetry, fundus and optic disc examination at baseline, follow-up 1 week, 1 month and 3 months. Demographic and clinical characteristic of patients in 3 groups were not different in terms of age, sex, underlying disease, side of eye, type of injury, baseline visual acuity, associated orbital fracture, history of amnesia, time to visit hospital and time to start treatment. Improvement in best-corrected visual acuity (BCVA) compared at 3 months from baseline showed no difference between 3 groups (p= 0.891). Analysis within steroid group showed statistically significant improvement of BCVA at 1 and 3 months (p= 0.015, 0.028 respectively). No improvement was shown in color vision and visual field in progesterone group. Only better baseline BCVA was the protective factor for better visual outcome (p= 0.027, Odds ratio = 0.004, 95%CI = 0.000 - 0.537). No side effects of progesterone were found in this study. Progesterone is a safe and promising neuroprotective agent that could be adjunctive or alternative to steroid in case of contraindication to corticosteroid treatment. This study showed no difference among choices of treatment therefor study in larger population is required. Steroid remains an effective option contrast with recent studies.

Visual rehabilitation via microperimetry in patients with geographic atrophy: a pilot study

BackgroundAge-related macular degeneration (AMD) is the leading cause of blindness in the western world. As a consequence of AMD, patients develop structural damage that comprises the fovea and subsequently present loss of central vision, low visual acuity and unstable fixation. Contrary to what happens with anti-angiogenic treatment in neovascular AMD, there is currently no definitive treatment to reverse geographic atrophy progression. The aim of this study was to determine the effectiveness of the visual rehabilitation treatment via microperimetry in patients with geographic atrophy.MethodsLongitudinal and prospective study, 18 patients with areas of geographic atrophy in their eye of better visual acuity were included. Macular integrity assessment (Maia) microperimeter (CentreVue, Padova, Italy) was used to diagnose retinal fixation and sensitivity in these patients. Based on these data and using the training module available in the equipment, the patients underwent visual rehabilitation sessions intended to allow the patient to establish the best possible fixation in the best area of retinal sensitivity. To determine the training effectiveness, the following variables were compared before and after: visual acuity in LogMAR scale with ETDRS charts, reading speed with Minnesota Low-Vision Reading Test (MN Read), average sensitivity threshold in microperimetry; P1 and 95% Bivariate Contour Ellipse Area (BCEA) values were used for fixation stability measurement.ResultsMean age was 77 years old (65–92). Visual acuity of the trained eye was on average 0.7 versus 0.6 LogMAR (p = 0.006) before and one week after training. Reading speed, using both eyes, was 47 words per minute (wpm) before training and 69 wpm after training (p = 0.04). Average retinal sensitivity was 14.1 versus 14.6 db (p = 0.4). Fixation stability improved with P1 values of 45% versus 51% (p = 0.05) and 95% BCEA values of 43 versus 25 (p = 0.02) before and after training, respectively.ConclusionsVisual training via microperimetry in patients with age-related macular degeneration is effective in improving fixation stability, reading speed, and visual acuity, measured one week after training is completed.