Good Visual Function Research Articles

Visual function after implantation of an aspheric bifocal intraocular lens

To evaluate distance, intermediate, and near vision after bifocal aspheric AcrySof ReSTOR SN6AD1 intraocular lens (IOL) implantation. Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Binocular distance best corrected visual acuity (BCVA) (4.0 m), best distance-corrected near (40.0 cm) and intermediate (70.0, 60.0, 50.0 cm) acuities, and contrast sensitivity under photopic (85.0 candelas [cd]/m(2)) and mesopic (3.0 cd/m(2)) conditions with and without glare were measured postoperatively. A patient-satisfaction and visual phenomena questionnaire was administered. Six months postoperatively, the mean acuities (logMAR) were binocular BCVA, -0.064 +/- 0.049 (SD); best corrected near, -0.041 +/- 0.061; best corrected intermediate, 0.147 +/- 0.130 (70.0 cm), 0.036 +/- 0.133 (60.0 cm), and -0.126 +/- 0.077 (50.0 cm). The BCVA and best corrected near acuity were 20/25 or better in all patients. Through-focus binocular logMAR acuities had 2 peaks at the expected far focus and near focus (0.00 diopter [D] and -2.40 D, respectively), with somewhat reduced acuity (20/32) at intermediate distances. Photopic contrast sensitivity was within the standard normal range. Mesopic contrast sensitivity was lower than under photopic conditions, particularly at higher spatial frequencies. Patients reported good performance for distance, near, and intermediate visual tasks with no or minimal difficulty with specific tasks. No patient reported severe visual phenomena; halos and glare were rated as none to moderate. The aspheric IOL provided good functional vision at far and near, with lower performance at intermediate distance; good photopic contrast sensitivity and lower mesopic performance; and a low incidence of visual disturbances.

Evaluation of potential visual acuity in eyes with macular oedema secondary to retinal vein occlusion

To evaluate the potential visual acuity (VA) of eyes with macular oedema (MO) associated with retinal vein occlusion (RVO). Thirty-one eyes of 31 patients with MO associated with RVO were examined and then treated with an intravitreal injection of bevacizumab. Of these 31 eyes, 22 showed complete resolution of the MO at 1 month after treatment, at which time potential VA was determined; 12 eyes had good function and 10 had poor function at this time. Optical coherence tomography was used to detect the junctions between inner and outer segments of the photoreceptors (IS/OS) as a hallmark of integrity of the outer photoreceptor layer. In the poor function group, pretreatment VA was significantly worse (P = 0.0106) and pretreatment central macular thickness was significantly greater (P = 0.0121). Preservation of the foveal photoreceptor layer before treatment was associated closely with good visual function after resolution of MO, and IS/OS line beneath the fovea was detected more frequently before treatment in eyes with good function (P = 0.0053). In eyes with MO associated with RVO, when the IS/OS line was detected beneath the fovea, they would be expected to have good vision after resolution of the MO.

Fronto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term visual outcome

We report our experience with the treatment of tuberculum sellae meningiomas using the fronto-basal interhemispheric approach. A retrospective analysis was performed on a series of 24 patients with tuberculum sellae meningiomas who were operated between March 2000 and January 2007. Patients' presenting symptoms, radiological images, operative reports, and clinical follow-up data were reviewed with special consideration for visual outcome. Visual deterioration was the presenting symptom in all patients, followed by headache in 9 patients (37.5%). The average duration of visual symptoms was 17.6 months. The average tumor diameter was 2.63 cm; encasement of the carotid artery was identified in 7 patients (29%). Complete tumor removal was achieved in 21 patients (87.5%). Mean follow-up period was 52 months. Vision improved in 19 patients (79%), remained stable in 4 (17%) and deteriorated in 1 patient (4%). The degree of tumor removal or visual outcome were both unrelated to the tumor size (p = 0.2 and p = 0.6 respectively). While the degree of preoperative visual deficit did not affect the visual improvement rate in the whole group (p = 0.9), those patients with improvement to good functional vision (>20/40) after the surgery, had a less severe preoperative deficit (p < 0.001). The most common complication was anosmia (29.1%) and there was no mortality. The frontobasal interhemispheric approach is safe and provides a direct anatomical approach to tuberculum sellae meningiomas with relatively low incidence of complications. Patients with improved vision to good functional level had a better preoperative visual status.

Visual outcome after surgery for cavernous sinus meningioma

Extension of cavernous sinus meningiomas can compromise vision by compressing the optic nerves and chiasm. Surgical tumour removal aims to protect vision in the long-term. However, the risks of surgery include transient or permanent damage to the anterior visual pathways. This study aims to 1) analyse the visual status in unilateral cavernous sinus meningioma with extra-cavernous extension, before and after removal of the extra-cavernous portion, without any adjuvant treatment with radiotherapy, 2) identify pre-surgical and early post-surgical prognostic factors for long-term visual outcome and 3) compare these results to previous studies. This is a retrospective study of 30 consecutive patients who underwent surgery between 1989 and 2004. Visual acuity, visual fields, and fundi were evaluated before surgery and during the mean follow-up period of 2 years. Total visual loss occurred in the ipsilateral eye following surgery in 10% of patients. There was improvement in vision in 23%, no significant change in 27% and worsening in 50% of patients. Pre-surgical visual acuity was not predictive of final visual outcome, but initial optic disc pallor was a poor prognostic factor. In pre-operatively normal contralateral eyes, 10% developed a mild visual deficit (visual acuity = 20/32 or better, and visual field defect <or=4 dB) post-operatively. Where vision in the contralateral eye was affected pre-operatively, 57% improved and 43% were unchanged. Overall, 93% of patients retained good visual function (mild or no visual deficit) in at least one eye, and 40% retained good visual function in both eyes after surgery. Visual handicap is rare after conservative surgery for cavernous sinus meningioma with supra/laterosellar extension. Since surgery protects contralateral visual pathways from local compression, it may preserve long-term vision in the contralateral eye. Visual outcome in the ipsilateral eye is unpredictable, and may significantly worsen after surgery.

Visual Function and Change in Quality of Life After Bilateral Refractive Lens Exchange With the ReSTOR Multifocal Intraocular Lens

To evaluate vision and quality of life and explore the correlation between vision and change of quality of life after bilateral refractive lens exchange of the Acrysof SA60D3 ReSTOR multifocal intraocular lens (IOL) for correction of ametropia in presbyopic populations. Pre- and postoperatively, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL) was self-administered by 30 consecutive refractive lens exchange patients, including 19 myopes and 11 hyperopes. The change of NEI-RQL scores was determined for each subscale covering a specific aspect of quality of life. Refraction, visual acuity, and contrast sensitivity function were evaluated 3 and 6 months postoperatively. Postoperatively, all patients achieved binocular uncorrected distance and near visual acuity of 20/30 or better. Photopic contrast sensitivity function decreased significantly at high spatial frequencies (P < .05). Overall scores of expectations, activity limitations, dependence on correction, appearance, and satisfaction were significantly higher postoperatively (P < .05). Greater improvement in near vision and dependence on correction was achieved in hyperopes. However, glare scores were significantly lower postoperatively (P < .001). Lower preoperative uncorrected near visual acuity was associated with higher scores for dependence on correction in myopes (r = 0.51, P = .027), and overall patient satisfaction correlated significantly with postoperative uncorrected distance visual acuity (r = -0.44, P = .015). Refractive lens exchange with the ReSTOR IOL in presbyopic patients provided good visual function and better patient satisfaction compared with preoperative corrections. Improvement in vision-related quality of life was most evident in hyperopes. A slight reduction in contrast sensitivity function appears to have no influence on quality of life.

Aberration-correcting effect of ThinOptX IOL

To evaluate spherical aberration and visual function after microincision cataract surgery using the ThinOptX rollable intraocular lens. Prospective, comparative, and interventional case series. SettingSingle-centre institutional practice. This prospective study evaluated 58 patients with cataracts who underwent bimanual microphaco cataract surgery in both eyes. A ThinOptX lens was introduced into one eye and an Alcon Acrysof lens, as a control, into the other. One month after cataract surgery, the corneal, whole-eye, and internal spherical aberration, and contrast sensitivity in both eyes were measured. We also measured the spherical aberration in artificial model eyes bearing Acrysof and ThinOptX lenses. Two-sided paired t-test was used for assessing all data. The root mean square (RMS) for both whole-eye and internal spherical aberrations was smaller in eyes bearing ThinOptX (P=0.03 and P=0.07, respectively). Although there was no statistically significant difference in the RMS for internal spherical aberration between ThinOptX- and Acrysof-bearing eyes, according to the Zernike polynomial expansion, all human and model eyes bearing ThinOptX registered negative internal spherical aberration in Z(4,0) and Z(6,0). On the other hand, all human and model eyes bearing Acrysof registered positive internal spherical aberration in Z(4,0) and Z(6,0). The ThinOptX lens yielded slightly higher contrast sensitivity in all cycles. As the ThinOptX lens is designed for negative spherical aberration, we encountered smaller whole spherical aberrations and higher contrast sensitivity than with the Acrysof lens. The implantation of ThinOptX IOL after microincision cataract surgery yielded good visual function.

Estallido ocular con luxación de cristalino al espacio subconjuntival

We present the case of a patient who suffered from rupture of her left eye due to moderate blunt trauma. The lens, which was dislocated to the nasal and superior subconjunctival space, was extracted and the wound explored and repaired; when the process had stabilized secondary vitrectomy and suture of an IOL to the sulcus were performed, achieving a final visual acuity of 0.3. Eye trauma is common and eye rupture may occur in those patients who have undergone ocular surgery or suffer from a debilitating condition of the eye. None of these predisposing factors existed in our case. Despite the seriousness of the problem, appropriate treatment achieved good visual function.

Cognitive visual impairment with good visual acuity in children with posterior periventricular white matter injury: A series of 7 cases

We describe a series of term and preterm children with occipito-parietal periventricular white matter abnormalities on magnetic resonance imaging (MRI) who manifest common clinical features of cognitive visual dysfunction. We also describe a strategy for taking clinical history that highlights the symptom complex and assists with management. A retrospective observational case series study of seven children with cognitive visual difficulties despite good (20/32 or better) visual acuities and MRI findings of periventricular white matter pathology in the territory subserving visual function. Structured history taking was used to identify and characterize the visual difficulties. Objective clinical findings (visual acuity, color vision, stereoacuity, visual fields, ocular motility, refraction, and fundoscopy) were recorded. Seven children with visual acuities of 20/32 (0.200 logMAR) or better had symptoms of cognitive visual difficulties consistent with dorsal stream dysfunction. Four had strabismus of different types and were identified on the basis of parental concern expressed at the ocular motility clinic. The other three children presented to the general ophthalmology clinic. All seven children had various degrees of focal periventricular white matter pathology in a similar distribution on neuroimaging. Children born prematurely are susceptible to periventricular white matter pathology. Such pathology can also occur in children born at term. This case series demonstrates that cognitive visual impairment due to periventricular white matter injury can occur despite good central visual function. A range of strategies to help affected children is described.

Visual fixation development in children

The ability to keep steady fixation on a target is one of several aspects of good visual function. However, there are few reports on visual fixation during childhood in healthy children. An infrared eye-tracking device (Orbit) was used to analyse binocular fixation behaviour in 135 non-clinical participants aged 4-15 years. The children wore goggles and their heads were restrained using a chin and forehead rest, while binocularly fixating a stationary target for 20 s. The density of fixations around the centre of gravity increased with increasing age (p < 0.01), and the time of fixation without intruding movements increased with increasing age (p = 0.02), while intruding saccades decreased with increasing age (p < 0.01). The number of blinks and drifts did not differ between 4 and 15 years, and there were no significant differences with regard to gender or laterality in any of the investigated variables. No nystagmus was observed. This study establishes values for visual fixation behaviour in a non-clinical population aged 4-15 years, which can be used for identifying children with fixation abnormalities.

Autologous Transplantation of the Retinal Pigment Epithelium and Choroid in the Treatment of Neovascular Age-Related Macular Degeneration

To assess excision of choroidal new vessels (CNV) combined with autologous transplantation of the equatorial retinal pigment epithelium (RPE) as a means of restoring vision for patients with acute neovascular age-related macular degeneration (AMD). Prospective interventional cohort study. Twelve patients were recruited into an ethics committee approved trial with informed consent between 2004 and 2005. All had <6 months of acute visual loss owing to subfoveal neovascular AMD and were ineligible for photodynamic therapy. Patients underwent submacular removal of CNV through a single retinotomy. A full-thickness patch graft of RPE, Bruch's membrane, and choroid was harvested from the superior equatorial retina and transplanted into the subfoveal space. The graft was flattened under heavy liquid, before silicone oil exchange. Removal of silicone oil and cataract surgery were performed 3 months later. All patients underwent cataract grading, full refraction, optical coherence tomography, fundus autofluorescence, and fluorescein and indocyanine angiography preoperatively and again 6 months postoperatively. Retinal pigment epithelium samples from 3 patients were tested for ex vivo gene transfer using a recombinant lentiviral vector. Six months after surgery, successful transplantation was determined by the presence of a pigmented subfoveal graft showing RPE autofluorescence and choroidal reperfusion. Visual outcome was assessed by subjective refraction and microperimetry of the retina overlying the graft. Successful viable grafts were seen in 11 patients. Three patients had good visual function on the grafts, with mean logarithm of the minimum angle of resolution (logMAR) improving from 0.88 to 0.79 and maintained beyond 1 year. Operative complications occurred in 8 patients, including retinal detachment in 5 patients and hemorrhage affecting the graft in 4 patients. The mean visual acuity over the whole cohort fell from logMAR 0.82 to 1.16. The excised RPE choroid could also be genetically modified outside the eye with a viral vector applied within the time frame of the operation. Autologous RPE transplantation can in principle restore vision in neovascular AMD, but surgical complications remain high. The possibility for ex vivo gene transfer to the free graft of RPE may widen the scope of this procedure to include gene therapy or adjunctive molecular treatments for AMD.

Visual Function after Primary Posterior Chamber Intraocular Lens Implantation in Pediatric Unilateral Cataract: Stereopsis and Visual Acuity

PurposeTo investigate the association between binocular function and vision after cataract removal and primary posterior chamber intraocular lens (PC-IOL) implantation in children with unilateral cataract and to identify visual function differences according cataract type.MethodsClinical records of 2- to 6-year-old patients with unilateral cataract removal and primary PC-IOL implantation were reviewed retrospectively. Visual acuity and ocular alignment were measured. Sensory fusion was assessed with the Worth 4-dot test, and stereoacuity with the Titmus stereo test. Cataracts were classified according to cause, lens opacity location, age at onset, and presence of strabismus. Clinical characteristics of patients who obtained good visual function were identified.ResultsForty-seven patients were included. Among 22 (46.8%) with good vision (20/40 or better), only 6 (27.3%) achieved good binocular function (the presence of fusion and 100 seconds of arc or better of stereoacuity). Visual acuity was better in eyes with good binocular function (p=0.002). No other variables were significant for achieving good binocular function.ConclusionsThe removal of unilateral cataract in a visually immature child can result in a combination of good visual acuity and binocular function. Good binocular function is closely related to good visual acuity.

Quality of Vision and Graft Thickness in Deep Anterior Lamellar and Penetrating Corneal Allografts

To compare visual function after deep anterior lamellar keratoplasty (DALK) with visual function after penetrating keratoplasty (PK) for keratoconus and correlate this with corneal thickness. Retrospective case series. Twenty-three patients (32 eyes) with unilateral or bilateral DALK or PK for keratoconus were analyzed for visual quality after suture removal. Evaluation included measurement of visual acuity, contrast sensitivity, and higher order aberrations (HOAs) (WaveScan; Visx, Santa Clara, California, USA). Readings were performed with both spectacle and rigid contact lens correction of refractive error. Total and residual stromal thickness after DALK was measured using optical coherence tomography (OCT) and correlated to visual quality. Eyes after PK had better visual acuity than eyes after DALK (P = .018). Subgroup analysis of DALK eyes revealed that the level of visual acuity was related to the thickness of residual recipient corneal stroma. Eyes with a recipient corneal bed thickness of <20 microm had visual acuities similar to eyes with a PK, whereas those with a recipient thickness of >80 microm had a significantly reduced visual acuity (P = .0009). Contrast sensitivity was similar in DALK and PK eyes. There was no significant difference in HOAs between eyes with DALK or PK. These data suggest that the main parameter for good visual function after DALK for keratoconus is the thickness of residual recipient stromal bed. An eye with a DALK with a residual bed of <20 microm can achieve a similar visual result as a PK.

Relationship between foveal birefringence and visual acuity in neovascular age-related macular degeneration

To investigate the relationship between visual acuity and foveal birefringence in patients with neovascular age-related macular degeneration. In total, 40 patients with choroidal neovascularization underwent macular imaging with scanning laser polarimetry. Bowtie patterns, typically seen in birefringence images of the macula, were evaluated and classified into three categories: (1) regular bowtie present; (2) bowtie present, but disrupted; and (3) no bowtie present. The relation of the bowtie appearance to the best-corrected logMAR visual acuities was tested (ANOVA). Mean visual acuity was best for the group that had regular bowties (mean logMAR=0.34) and differed statistically significantly from the disrupted bowtie group and no bowtie group (P=0.01 and 0.0007). Ages for the three groups did not differ (P=0.31). Appearance of a regular bowtie indicates a substantially intact Henle fibre layer with the potential for good visual function, despite the presence of underlying pathology. Conversely, disruption or absence of a bowtie may indicate severe damage to the photoreceptors, consistent with the finding of poorer visual acuity.

Effect of Visual Perception, Visual Function, Cognition, and Personality on Power Wheelchair Use in Adults

The purpose of this study was to determine to what extent visual perception, visual function, cognition, and personality traits affect power wheelchair use in adults. It also proposes to establish baseline information to help clinicians determine or predict power wheelchair driving performance and to develop service plans to address those driving skills that need improvement or compensation. Sixty-two adult power wheelchair users were recruited. Standardized instruments were used to evaluate visual perceptual skills, visual function, cognitive skills, and personality traits. The results of these evaluations were then correlated with participants' scores on a power wheelchair performance test. Strong correlations were found between power wheelchair driving performance and visual perception (p = .000), ocular motor function (p = .000 and p ≤ .001), stereodepth perception (p ≤ .001), and alertness to the environment (p ≤ .001). No significant correlations were found between personality traits and power wheelchair driving performance. These results indicate that good visual perceptual skills, visual function, and various aspects of cognition are necessary for proficient power wheelchair use. These data will assist clinicians in identifying significant factors to consider when evaluating and training clients for power wheelchair use.

Systemic T-cell activation in acute clinically isolated optic neuritis

We examined untreated 60 patients with acute monosymptomatic optic neuritis (ON). Patients examined early after onset showed increased expression of HLA-DR and CD45R0 on CD4 and CD8 T cells. Expression of HLA-DR on CD4 T cells was higher in patients without IgG oligoclonal bands. Expression of HLA-DR on CD4 and CD8 T cells correlated negatively with measures of disease activity and positively with measures of good visual function, and expression of CD45R0 on CD4 T cells correlated negatively with measures of disease activity. We hypothesize that HLA-DR expression may characterize a protective T-cell subset in ON.

Long-term follow-up of visual functions after pediatric cataract extraction and intraocular lens implantation

To assess the visual acuity and binocular function of children after pediatric cataract extraction and intraocular lens implantation. 47 children with 68 eyes (< 13 years old) were included in the study: 12 children with monolateral traumatic cataract, 14 children with monolateral congenital cataract and 21 children with bilateral congenital cataract. Cataract type, cataract extent, age at surgery and presence of strabismus and nystagmus and the best corrected distant visual acuity (BCDVA) before surgery were recorded and as well. In addition, the best corrected near visual acuity (BCNVA) and binocular function were followed up for an average of (41.3 +/- 12.3) months. Statistical analysis was used to define factors that correlated with achieving good visual acuity and binocular function. BCDVA and BCNVA were 0.5 or better in 34 eyes (50.0%) and a good binocular function was achieved in 18 children (38.3%). Age at surgery, extent of cataract, absence of strabismus and nystagmus were significant for good BCDVA. Age at surgery, absence of strabismus and nystagmus, good BCDVA were significant for good binocular function. Good visual acuity and binocular function can be achieved after pediatric cataract extraction and intraocular lens implantation. Multiple factors correlated with achieving good visual function such as timing of surgery, type and extent of cataract, absence of strabismus and nystagmus etal.

Wavefront Aberrations Associated With the Ferrara Intrastromal Corneal Ring in a Keratoconic Eye

To describe the optical implications of the aberration pattern of a keratoconic eye implanted with an intrastromal corneal ring (Ferrara ring). A 32-year-old man with bilateral keratoconus had a Ferrara intrastromal corneal ring implanted in his right eye. Surgery was uneventful and both uncorrected (UCVA) and best spectacle-corrected (BSCVA) visual acuity improved. Corneal topography was performed before and after surgery. Wavefront measurements were performed 1 month after the procedure in both eyes for comparison. The point spread function, modulation transfer function (MTF), and convolved acuity chart were analyzed. The right eye--implanted with the intrastromal Ferrara ring--had high root-mean-square (RMS) values for higher order aberrations. The left eye-keratoconus without an intrastromal ring-had moderate values. Point spread function, MTF, and convolution acuity charts are presented for each eye, with the latter two showing improved visual function in the implanted eye, despite a higher aberration value. The wavefront measurement device captured aberrations even in a highly aberrated eye. Despite better UCVA and BSCVA, the Ferrara ring notably increased higher order aberrations compared to the fellow eye, but with a more uniform central pattern. In this case, the larger RMS value was a poor predictor of good visual function; other metrics better predicted the patient's subjective response. Metrics other than RMS error may be necessary to better correlate aberration value with visual satisfaction in some eyes.

OUTCOME OF CHOROIDAL NEOVASCULARIZATION IN ANGIOID STREAKS AFTER PHOTODYNAMIC THERAPY

To evaluate the visual and anatomic outcomes of photodynamic therapy for choroidal neovascularization (CNV) in patients with angioid streaks. The authors retrospectively evaluated 40 consecutive patients (48 eyes) with visual acuity of 20/200 or greater who were treated at 6 referral centers for CNV associated with angioid streaks. Main outcome measures were visual acuity, greatest linear diameter of the lesion, and, in patients with nonsubfoveal CNV, distance from the foveola. Of 34 eyes with subfoveal CNV, 21 were followed up for at least 12 months (range, 5-33 months). Median visual acuity was 20/50 at baseline and 20/120 at the final examination. The 12-month estimate of the percentage of eyes with vision loss of fewer than 3 lines was 68% (95% confidence interval, 50%-85%) by using survival analysis, whereas eyes with no increase in the greatest linear diameter were 45% (95% confidence interval, 27%-62%). Fourteen eyes had extrafoveal (n = 11) or juxtafoveal (n = 3) CNV, 12 of which were followed up for at least 10 months (range, 4-36 months). Visual acuity was 20/40 or greater in all eyes with extrafoveal lesions at baseline and in 5 of 12 eyes at the last examination, when 3 cases of CNV had become subfoveal. At baseline, visual acuity was low in two eyes with juxtafoveal CNV and nearly normal in the third. It remained substantially stable at the end of follow-up (range, 10-36 months), when two lesions were subfoveal. Most of our patients had good baseline visual function and, thus, were at high risk for losing vision because of the poor prognosis of CNV in angioid streaks. Because most had no or limited vision loss after 1 year, the authors suggest that photodynamic therapy can be used to try to limit or delay visual damage caused by this aggressive disease.

Auckland proliferative diabetic vitrectomy fellow eye study.

To review medical and ophthalmic findings of primary diabetic vitrectomy patients to examine indices important in progression to fellow eye surgery. A retrospective analysis was undertaken of all diabetic patients undergoing vitreoretinal surgery at Auckland Public Hospital between January 1992 and July 1996. Kaplan-Meier survival analysis was performed along with univariate and multivariate (Cox Proportional Hazards) data analysis. One hundred and fourteen primary diabetic vitrectomy cases were reviewed with mean follow-up duration of 4 years. Thirty-eight per cent (n = 43) of the study group underwent fellow eye surgery at a mean time of 1.6 years after first eye surgery. Fourteen patients were already blind in the fellow eye at baseline, and five patients refused second eye surgery on intention to treat. Thus there were 62 (54%) patients with severe (surgical threshold) fellow eye disease diagnosed within the follow-up period. The presence of either tractional retinal detachment or combined rhegmatogenous/tractional retinal detachment but without vitreous haemorrhage in the presenting eye was, in this series, a risk factor for fellow eye surgery (OR 5.56; 95% CI 1.96-15.8). Maori and Pacific Islander ethnicity was significantly associated with traction retinal detachment (OR 2.23; 95% CI 1.05-4.7). At data analysis 57% (n = 60) of the study patients had died. The mean time to death was 4.3 years, with 84% of these patients having evidence of renal disease at the time of their first eye surgery. Good visual function in at least one eye was maintained in many patients. A substantial proportion of diabetic vitrectomy patients require fellow eye surgery. Absence of vitreous haemorrhage in the presenting eye (i.e. tractional or combined rhegmatogenous/tractional retinal detachments but without vitreous haemorrhage) was predictive of need for fellow eye surgery. The need for diabetic vitrectomy correlates with poor survival in this study population.

Baseline characteristics, the 25-Item National Eye Institute Visual Functioning Questionnaire, and their associations in the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT)

Objective To describe characteristics of participants in the Complications of Age-Related Macular Degeneration Prevention Trial (CAPT) at baseline and to investigate associations among visual function, fundus features, and vision-related quality of life. Design Cross-sectional study. Participants The 1052 participants in CAPT, a multicenter, randomized clinical trial. Eligibility criteria for CAPT included ≥10 large drusen and visual acuity ≥20/40 in each eye. Methods At baseline, the visual acuity, contrast sensitivity, and critical print size for each eye were measured, color stereo photographs of the disc and macula of each eye were taken, and the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) was self-administered. Graders from a central photograph reading center evaluated the photographs for drusen characteristics and focal hyperpigmentation. All procedures were performed using standardized protocols. Associations among characteristics were assessed by Spearman correlation coefficients and multiple linear regression. Results Among CAPT participants at baseline, the mean age was 71.0 years, 60.6% were women, and 99.3% were white. The median visual acuity of the better eye was 20/20 and of the worse eye 20/25. In approximately one third of eyes, drusen covered ≥10% of the retina within 3000 μm of the foveal center, and 67.7% of eyes had focal hyperpigmentation. Drusen area and focal hyperpigmentation were weakly correlated ( r = −0.08 to −0.18) with the measures of visual function. The measures of visual function were weakly associated with the NEI-VFQ-25 scores. An association of fundus features with NEI-VFQ-25 scores was not found. Conclusion At baseline, CAPT participants had good visual function and several risk factors for progression to neovascular age-related macular degeneration. Scores on the NEI-VFQ-25 indicated that participants perceived some problems with their vision. Within this relatively homogeneous group of participants, measures of visual function were only weakly associated with the measures of vision-related quality of life.