Good Visual Function Research Articles

Intermediate uveitis in childhood preceding the diagnosis of multiple sclerosis: a 13-year follow-up

Purpose An association between multiple sclerosis during childhood and uveitis is exceptionally rare. This is a report of a female patient who presented at the age of 8 years with bilateral intermediate uveitis and whose final diagnosis of multiple sclerosis was made at age 21 years. Design Case report. Methods Retrospective chart review of a 13-year follow-up history. Results Over 10 years our patient was treated systemically and underwent bilateral vitrectomy to reduce permanent side effects. Owing to good visual function and low inflammatory signs, systemic therapy was stopped. Multiple sclerosis was diagnosed at the age of 21, after a 13-year history of uveitis and after 3 years without medication. Conclusions In the constellation of uveitis in childhood and later diagnosis of multiple sclerosis, the outlined therapy provided good functional results. Moreover, it may have delayed the manifestation of the underlying disease for 13 years.

Rhegmatogenous PVR detachment: long-term results after extraocular minimal scleral buckling

To present the long-term anatomical and functional results and the dynamics of proliferative vitreoretinopathy (PVR) after precise segmental scleral buckling without drainage, known as extraocular minimal surgery. In a prospective study 172 consecutive rhegmatogenous PVR detachments were included which were operated on between January 1994 and February 1996 at the Department of Ophthalmology, Higher Medical Institute, Plovdiv, Bulgaria, with cryopexy and segmental scleral buckling without drainage. The follow-up ranged between 54 and 79 months (xmacr; 5S years). In 43 eyes was a PVR stage A, in 50 stage B, in 60 stage CP, and in 19 a PVR stage CA. All detachments were studied precisely for retinal breaks pre- and intraoperatively and the breaks tamponaded by a precise buckle. 1. Anatomical results: Complete retinal reattachment in 145 eyes (84 %) after 1 operation and in 148 eyes (86 %) after reoperation, residual tractional detachment with reattached macula in 12 eyes (7 %) and detachment due to progression of PVR in 12 eyes (7 %). 2. Functional results: Postoperative visual acuity ranged between 0.3 and 1.0 in 111 eyes after xmacr; 5S years. 3. Dynamics of PVR: In 113 detachments (65,7 %) PVR regressed completely and in 12 (7 %) it progressed; among these were 8 eyes with preoperative PVR-CA and 4 eyes with PVR-CP. Treatment of PVR detachments with nondrainage and minimal buckling provides good anatomical results with macular reattachment in 93 %, resulting in good long-term visual function. Results were best in detachments with PVR stage A, B and CP.

Cataract surgery in cataracta membranacea

A 27-year-old man with no history of intraocular surgery presented with progressive blurred vision in both eyes. Slitlamp evaluation revealed a white, thin membrane in the pupillary area that resembled posterior capsule opacification. A naturally formed lens was absent. Ultrasound biomicroscopy demonstrated a rarefaction of lens fibers in the equator region with a loss of the normal anatomic lens structure on the left side. Visual acuity was 20/32 with +10.00 −0.75 × 170 in the right eye and 20/100 with +11.50 −0.50 × 25 in the left eye. After capsulotomy and excision of the membranous capsule, an anterior vitrectomy, and implantation of a sulcus-fixed intraocular lens in both eyes, the patient was highly satisfied with the final visual outcome. The patient had stereopsis, which supported his history of good visual function in childhood.

Chorioretinitis Sclopetaria from BB Ex Memoria

Chorioretinitis sclopetaria presents a characteristic pattern of choroidal and retinal changes caused by a high velocity projectile passing into the orbit, in close proximity to the globe. While it is unlikely that a patient should completely forget the trauma causing such damage, preserved or compensated visual function may blur the patient's memory of these events over time. Characteristic physical findings help to clarify the antecedent history. Despite the lack of an acknowledged history of ocular trauma or surgery, in our case, the characteristic ocular findings discovered at presentation allowed for recognition of the underlying etiology. Because of good visual function, the patient had completely forgotten about the trauma that occurred 12 years earlier. Strabismus surgery was performed for treatment of the presenting symptomatic diplopia. The pathognomonic findings in chorioretinitis sclopetaria are invaluable in correctly diagnosing this condition, especially when a history of ocular trauma is unavailable.

Lymphocytic and granulocytic hypophysitis: a single centre experience

Lymphocytic and granulocytic hypophysitis are rare pituitary masses. A series of five dealt with at a single centre is presented and discussed. Retrospective analysis of pathology records revealed the cases. Of pituitary mass lesions dealt with in this centre, 0.8% have the diagnosis. Five females presented, one pregnant at the time of presentation, three presenting with signs and symptoms of panhypopituitarism, and two with visual problems. All were treated by surgical means. All had good postoperative visual function, but all were panhypopituitary. Follow-up was for a mean of 4 years and 1 month. This rare condition should be treated by surgical means to obtain a diagnosis. Further treatment of residual tumour can be with corticosteroids. Good visual function should be expected, but so should permanent loss of pituitary function.

Long-Term Outcome After Radiation Therapy for Subfoveal Choroidal Neovascularization Associated with Age-Related Macular Degeneration

Purpose: The purpose of this study was to investigate the long-term effect of low-dose radiation therapy on subfoveal choroidal neovascularization associated with age-related macular degeneration. Methods: The clinical course and visual outcome were compared retrospectively among two treated groups and a control group; 15 patients (15 eyes) received 10 Gy, another 15 patients (15 eyes) received 20 Gy. The control group consisted of 15 patients (15 eyes) without treatment. All patients were followed up for at least 18 months, and most were followed up for 3 years. The macula was irradiated with either 10 Gy in 5 fractions or with 20 Gy in 10 fractions after computed tomography (CT) simulation enabled real-time treatment planning from multiple CT slices. Results: During the 3 years of follow-up, the lesions became better in 5 eyes, unchanged in 1, and worse in 9 with 10 Gy radiation; better in 7 eyes, unchanged in 1, and worse in 7 eyes with 20 Gy; and better in 1 eye and worse in 14 with no treatment. The difference between the groups treated with radiation and the control was statistically significant ( P < .05). Visual acuity was also significantly better in the group receiving 20 Gy than in the control group up to 2 years after radiation ( P < .01). Conclusion: Radiation may extend the period of good visual function substantially by reducing subfoveal choroidal neovascularization activity.

Initial Experience With Posterior Chamber Intraocular Lens Implant

The results of extracapsular cataract extraction with posterior chamber intraocular lens implant at the Jos University Teaching Hospital are reviewed. The results suggest that despite lack of facilities to calculate the lens power for emmetropia, the use of a standard lens of about 19.0D will provide a good number of our patients with good functional vision and a quick return to independent life (Nig J Surg Res 2000; 2:135-138) KEY WORDS: Posterior chamber, lens implant

A prospective comparative study of the amo array zonal-progressive multifocal silicone intraocular lens and a monofocal intraocular lens

ObjectiveTo evaluate the safety and effectiveness of a zonal-progressive multifocal silicone intraocular lens (IOL). DesignProspective, nonrandomized, fellow eye comparative trial. ParticipantsFour hundred fifty-six subjects were enrolled at 14 investigational sites in the United States; 400 subjects achieved 1-year follow-up. A subset of 123 subjects (102 at 1 year) were enrolled in a monofocal fellow eye control substudy; subjects were implanted with the multifocal IOL in one eye and a comparable monofocal IOL in the fellow eye. MethodsCataract extraction and implantation of a zonal-progressive multifocal silicone IOL was performed using the surgeon’s standard technique. Subjects were followed at six postoperative examination intervals through 1 year. Main outcome measuresThe key efficacy measures were mean uncorrected and corrected distance and near visual acuity at 1 year after surgery. ResultsIn the monofocal fellow eye control substudy, the multifocal eyes showed a mean 2-line increase over monofocal eyes for uncorrected and distance-corrected near visual acuity (P < 0.0001). Mean uncorrected distance visual acuity was similar between multifocal and monofocal eyes (P = 0.116). A significantly higher proportion of bilateral multifocal subjects reported that they could function comfortably without glasses at near (81%, 96 of 118) compared with multifocal/monofocal subjects (56%; 93 of 165; P < 0.001) and unilateral multifocal subjects (58%; 56 of 97; P < 0.001). Low-contrast visual acuity was reduced in multifocal eyes by approximately 1 Snellen line. However, no perceived disadvantages attributable to the reduction in low-contrast acuity were found. Although the perception of halos and glare increased in the multifocal eyes, good visual function remained, and nearly all subjects were satisfied with the results of their surgery. ConclusionsIn a large study that included a subset of subjects with paired eye compared with those with monofocal lenses, this zonal-progressive multifocal lens provided a high level of uncorrected and corrected distance vision, improved uncorrected and distance-corrected near vision, reduced spectacle dependency, and a high level of patient satisfaction despite some loss of low-contrast visual acuity and increased reports of halos and glare.

Associations of performance-based and self-reported measures of visual function The Beaver Dam Eye Study

Objective : To describe and compare performance-based and self-reported measures of visual function and to evaluate how each varied with age and how the performance-based measures were associated with the responses to self-reported questions about visual function. Design : Population-based epidemiologic study. Participants : Adults participating in the first follow-up of the Beaver Dam Eye Study (n=3,722). Main outcome measures : Performance-based measures of vision including current binocular, best-corrected and near visual acuities, sensitivity to light as measured by an automated perimeter, contrast sensitivity, and self-reported measures from a standardized interview. Results : All performance-based and self-reported visual functions decreased with increasing age (p<0.0001 for each). On average, women did more poorly than men on all the performance-based measures (p<0.0001 for each), and on some of the self-reported measures. For both genders, correlations among the performance-based measures ranged from 0.38 to 0.67. In general, individuals reporting good visual function or little difficulty with visual tasks scored better on performance-based measures compared to individuals whose questionnaire responses reflected limited visual function. Overall, about 39% of drivers reported that their vision caused them to limit their night driving. Correlations of performance-based with self-reported measures of visual function were greater for best-corrected, binocular and near visual acuity compared to correlations of visual sensitivity to light and contrast sensitivity. There were 1,285 persons whose best-corrected acuity was better than their current binocular acuity and there were 97 people with visual impairment considering only current binocular acuity whose vision improved to better than 20/40 after refraction. Conclusions : Performance-based and self-reported measures of visual function were consistently and inversely related to age. Performance-based measures were, in general, more highly correlated between themselves than were self-reported measures. Self-reported visual functions were significantly positively correlated with all performance-based measures, but correlations were moderate. While high contrast measures are usually used in clinical settings and in many studies, the data suggest that in assessing function it is appropriate to measure several different aspects of vision, both performance-based and self-assessed. Our data give some indication of the impact these visual functions have on daily life as reflected by night driving and on near and distant visual acuity. New refractive corrections would likely improve the visual acuity in many older adults.

Conservative Treatment of Adnexal, Epibulbar and Intraocular Neoplasms by Means of Electron Microbeams: A Preliminary Study

At present, episcleral plaque brachytherapy and charged particle or photon irradiation are the most commonly employed methods in ocular and adnexal conservative treatments. In the near future, a different therapeutic approach to these malignancies could be represented by a new device based on electron beam emission. The equipment used consists of an electron accelerator originally developed for intraoperative radiotherapy, modified to fit ocular pathologies. Adequate collimators and an enhanced mechanical accuracy are required for this special practice. An operative planning for epibulbar, adnexal and intraocular tumors is described, discussing its rationale for possible applications. Experimental tests using phantoms and Gafchromic® films are in progress. As all conservative treatments, the main gaol of this activity is the maintenance of a good visual function.

Secondary implantation of open-loop, flexible, anterior chamber intraocular lenses

Purpose: To assess the results of implantation of secondary, open-loop, flexible, anterior chamber intraocular lenses (IOLs) and compare the findings with those of other published studies.Setting: A combined ophthalmology and ear, nose, and throat hospital in Middlesbrough, Cleveland, England.Methods: This retrospective study comprised 81 patients who had secondary implantation of a flexible, open-loop, anterior chamber IOL by one surgeon. The incidence of postoperative complications was ascertained, and best corrected preoperative and postoperative visual acuities were compared.Results: Two serious complications occurred: one severe loss of vision that is still under investigation and one retinal detachment that was repaired with good residual visual function. Of all 81 patients, 92.5% were within one Snellen line of their preoperative best corrected visual acuity. These results compare favorably with those of other published studies.Conclusion: Using an open-loop, flexible, anterior chamber lens for secondary implantation is still an acceptable way to treat aphakia. The poor reputation of these lenses is undeserved.

Mastocytosis-Induced Nyctalopia

Systemic mastocytosis is characterized by an increased number of mast cells in multiple organs particularly skin. A 55-year-old man with mastocytosis presented with nyctalopia caused by malabsorption of vitamin A. Diagnosis was made by documenting a low vitamin A level and an ERG that showed rod-cone deficiency with rods affected more than cones. Vitamin A therapy led to return of good visual function. To our knowledge, this is the first reported case of mastocytosis induced nyctalopia. Vitamin A deficiency should be considered as a potential cause of visual loss in patients with sudden onset of night blindness.

Oral tolerance therapy - an option on the therapeutic menu for uveitis?

Oral tolerance therapy with retinal antigens is a novel approach to treating patients with uveitis who require conventional immunosuppressive therapy to control their disease. In a pilot study involving 2 patients with uveitis, oral tolerance therapy with bovine retinal soluble antigen allowed the reduction or withdrawal of conventional immunosuppressive therapy, while maintaining good visual function. This approach is now under investigation in a doubleblind, placebo-controlled trial in patients with uveitis who are receiving immunosuppressant therapy. Details of these studies, and data from the preclinical investigations that led to the development of this approach in humans, were presented at the International Symposium on Clinical Immunology [San Francisco, US; July 1995].

Hyperacuity test to evaluate vision through dense cataracts: research preliminary to a clinical study in India

Using high luminance point-of-light stimuli, Vernier judgments can be made in the presence of markedly degraded retinal imagery. Without coaching, observers perform center-of-gravity assessments of relative locations of degraded point images. We seek to define, presurgery, individuals who will derive the most benefit from advanced cataract removal (a form of triage), and to determine which of two cataractous eyes has the better postsurgical visual prognosis. There are incredible and growing backlogs of patients with severe cataracts (and other dense media opacities) in the developing world, and generally, limited resources are available for provision of health care. Postcataract surgical failure rates for good visual function are often high, and only one eye is operated on in over 95% of indigent patients treated. Prior to initiating advanced studies in the developing world, at Berkeley we conducted preliminary research on Vernier acuity test techniques on normal adult subjects. We sought to determine the number of repeat trials necessary; to compare a two-point and a three-point Vernier display; to determine the shape of the measured response function at large gap separations between test points (required when testing advanced cataract patients); to assess the effect(s) of a broad range of uncorrected refractive errors on outcomes; and to consider means to minimize refraction-based errors. From these and prior data and analyses, we defined a protocol for use in the developing world. Using a newly designed and rugged precision instrument, these tests were repeated on an advanced cataract population at Aravind Eye Hospital in Madurai, India. Although we had much prior experience in India, the initial protocol required major revision on site. Necessary changes in test methods and analytical approaches were made, and next stages in this program were planned. And a new and simple gap «visual acuity» (gap «VA») test was added to the protocol, which greatly facilitated the outcome. The presented material is of interest for several reasons: The health care problems addressed are of considerable social and economic importance; it is valuable to compare the initial protocol and instrument defined in Berkeley and the resultant protocol and instrument designs that finally evolved in India; and the difficulties encountered when seeking to adapt what we thought were simple techniques to patient populations and technical personnel in a «small town setting» (ca. 1 million inhabitants in Madurai alone) in rural south India, are worthy of note. We point out that the Aravind Eye Hospital is an ophthalmological exemplar in the developing world

Vitreous surgery in children.

This study examines the results of research on the surgical treatment of children with various vitreous diseases. Vitrectomy was performed on 44 eyes in children, from four months to fifteen years of age, suffering from the following diseases: lensectomy complications as vitreocorneal adhesions or immersion of lens mass into the vitreous; persistent hyperplastic primary vitreous (PHPV), trauma consequences, uveitis and eyeball subatrophy. Preoperational examination included measurement of visual acuity, biomicroscopy, direct and indirect ophthalmoscopy, tonography, ultrasonography and electrophysiological examinations. Vitreotome 'ocutome' was used to perform the operations. A transcyliar approach was used in all but 14 cases, for which the operations were performed by limbal incision. Improvement of visual functions was noted in 28 eyes (63.3%), and relatively good visual function was achieved in 7 eyes (16.9%). Visual acuity remained unchanged in 6 eyes (13.6%) because of severe amblyopia, although the transparency of optic zone was restored and the fundus did become visible. IN 10 (22.7%) of the children visual acuity could not be measured because of too young an age. One day after surgery a cellular suspension in the vitreous was observed in many eyes. This however, resolved within 3 days. Intraocular pressure usually returned during the first week after surgery. Hypotonia remained for 1-2 months after subtotal vitrectomy. The transcyliar extraction of pathological vitreous in children is generally a less traumatic and more convenient means of intravitreal manipulation, but 2 cases of intraoperational hemophthalmia suggested that iridiocyclitis is a contraindication for transcyliar approach. Transcorneal extraction is a less traumatic surgical method in such cases.

Heredity and Age-Related Macular Degeneration

To determine the concordance of age-related macular degenerative changes in monozygotic twins. Between 1984 and 1993, we examined a total of nine pairs of monozygotic twins with substantial age-related macular degenerative changes in at least one member of the pair, ranging from extensive large drusen to advanced atrophic and/or disciform scarring. Eight pairs were female and one pair was male. Ages ranged from 62 to 88 years. Monozygosity was confirmed by genetic testing in each of the seven twin pairs on whom it was performed. In eight of the nine twin pairs, the fundus appearance and the incidence of visual impairment were similar. In the ninth pair, one twin had advanced exudative age-related macular degeneration with vision loss in one eye, while the other had large, confluent drusen and good visual function in both eyes. Environmental factor, including diet, geographic background, and medical history, were essentially similar in the twin pairs. Although selection factors and similar environmental influences might impact our findings, the markedly similar incidence of macular degenerative changes in these monozygotic twins suggests that a substantial genetic component may exist in a potentially large proportion of patients with age-related macular degeneration. Further studies are warranted to define this hereditary influence.

Surgery for paraclinoidal carotid artery aneurysms.

Aneurysms arising from the proximal carotid artery between the roof of the cavernous sinus and the origin of the posterior communicating artery pose conceptual and technical surgical problems with regard to acquisition of proximal control and safe intracranial exposure. Over the past 3 1/2 years, 89 patients with paraclinoidal aneurysms have been treated at the University of Texas Southwestern Medical Center. Thirty-nine (44%) of these patients presented with subarachnoid hemorrhage. A total of 149 aneurysms and six arteriovenous malformations have been identified in this patient group such that 38 (43%) of the patients suffered multiple vascular anomalies. Temporary artery occlusion has been employed during operation in 48 cases (54%), permanent carotid artery occlusion in four (4%), and hypothermic circulatory arrest in two (2%). Twenty-two patients harbored giant aneurysms, seven of which had ruptured. Outcome was considered good in 77 patients (86.5%), fair in eight (9%), and poor in three (3%); one patient died. This concentrated experience permitted a practical anatomical grouping of aneurysms into three types: carotid-ophthalmic artery aneurysms with a superior or superomedial projection (44 cases); superior hypophyseal aneurysms with a medial or inferomedial projection (26 cases); and proximal posterior carotid artery wall aneurysms projecting posteriorly or posterolaterally (19 cases). Despite the fact that paraclinoidal aneurysms often disobey the traditional teachings of aneurysm development, having no vessel of origin or clear hemodynamic cause, this practical grouping has allowed individualized and focused operative approaches unique to each aneurysm projection with good visual function and outcome in most patients.

Long-term Prognosis of Intraocular Lens Implantation in Children

In cases of congenital cataract, improvement in visual function can be expected with the progress in surgical techniques and postoperative pleoptics. In many cases, however, there are various factors which will indicate an unfavourable prognosis. The results of our study on intraocular lens implantation in children over the course of 10 years showed poor visual acuity in most cases, although two of the nine cases attained corrected acuities of 1.0 or better. The results of endothelial cell studies in all cases were extremely poor. To obtain good visual function in congenital cataract at the present time, early pars plana lensectomy, prompt optical correction with contact lenses and aggressive therapy against amblyopia are recommended. However, in children intraocular lens implantation or epikeratophakia may prove to be a safe and promising procedure in the future.

Limbal Autograft Reconstruction After Conjunctival Squamous Cell Carcinoma

Two patients who had squamous cell carcinoma with extensive limbal and corneal involvement were treated with surgery and cryotherapy. Rarely large areas of the cornea are involved by this tumor. Visual prognosis in such patients is poor. In these two patients, autologous limbal transplants were effective in restoring an excellent corneal surface and good visual function. This technique may be useful in the reconstruction of eyes with extensive neoplastic involvement of the corneoscleral limbus and cornea.

The Effects of Brain Damage on Visual Functioning in Children

This article reviews the research literature on the direct effects of brain damage on the visual functioning of children and the electrodiagnostic tests used to diagnose them. Although the studies documented that brain damage affects visual functioning, they suggested that the prognosis for good functional vision after remedial intervention is more optimistic than was previously thought. They also found that electrodiagnostic testing is a valuable tool, but that the use of a combination of tests yields a more complete picture of the effects than does any single test.