Improvement In Near Visual Acuity Research Articles

Baltimore Reading and Eye Disease Study: vision outcomes of school-based eye care

ObjectiveThere are unmet needs for refractive correction in the pediatric population, especially in high-poverty communities. We reported the impact of refractive correction on vision outcomes over a 2-year follow-up in the Baltimore Reading and Eye Disease Study. DesignProspective, school-based cohort study. ParticipantsStudents of second and third grades who were prescribed glasses during baseline assessment. MethodsWe conducted baseline eye exams in 12 Baltimore public schools during the fall of school year 2014–15 with follow-up visits in the spring of school year 2014–15 (first follow-up) and school year 2015–16 (second follow-up). Visual acuity (VA) was measured at distance and near with correction. Refractive status was determined based on the eye with the larger refractive error and categorized as myopia, hyperopia, and astigmatism. Main outcome measuresVA in better-seeing and worse-seeing eye at first and second follow-up, and acuity improvement from baseline. ResultsIn the 206 students (84% African American) who completed the first follow-up, both distance (from 0.14 ± 0.20 to 0.05 ± 0.10 logMAR) and near presenting VA (from 0.08 ± 0.16 to 0.03 ± 0.06 logMAR) improved from the baseline assessment; children with more severe hyperopia showed improvement in near VA by 0.05 ± 0.16 logMAR. Children who were prescribed glasses through a school-based research study had improved vision, which was sustained into the following school year. ConclusionsMany second and third graders in Baltimore Schools needed refractive correction and benefited from provision of glasses with sustained vision improvement over the 2-year observation.

Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial

ObjectivesThis study evaluated the safety of topical lipoic acid choline ester (UNR844, 1.5%) ophthalmic solution and its efficacy in improving distance-corrected near visual acuity (DCNVA) in subjects with presbyopia.Subjects and methodsThis was a prospective, randomized, double-masked, and multicentre clinical trial. Subjects with a diagnosis of presbyopia (n = 75) were randomized 2:1 to UNR844 or placebo. On days 1–7, all subjects were dosed unilaterally (twice a day, b.i.d.) in their non-dominant eye to ensure safety and tolerability prior to days 8–91 when dosing was changed to bilateral (b.i.d.). Clinical assessments, including DCNVA and adverse events (AEs), were recorded at each study visit. Patients who completed the study were recruited into a non-interventional follow-up study that monitored them until 7 months after their final UNR844 exposure. The primary endpoints were safety and the mean change in DCNVA from baseline in the study eye.ResultsUNR844 administration (n = 50) produced no safety concerns and was well-tolerated, with no clinically-relevant changes in best-corrected distance visual acuity, pupil size, intraocular pressure, or discontinuations due to adverse events. DCNVA improved in the study eye in the UNR844 group compared to placebo during the 91 days of treatment [UNR844 vs. placebo, mean change in LogMAR (SD); −0.159 (0.120) vs. −0.079 (0.116)]. Bilateral DCNVA improved, with 53.1% UNR844 vs. 21.7% placebo subjects gaining ≥10 letters. Improvements in DCNVA were sustained at 5 and 7 months after UNR844 dosing ceased.ConclusionsThese results support further development of UNR844 ophthalmic solution for the treatment of presbyopia.

Time‐course of the visual Impact on presbyopes of a low dose miotic

To examine the pupil and visual impact of a single early morning drop of a low concentration miotic. Pupil size, refraction, visual acuity (VA), near reading performance and intraocular pressure were monitored for 8h at a wide range of light levels following bilateral instillation of single drops of 0.1% brimonidine tartate in 19 early presbyopes (40-50years) and 11 mature presbyopes (>50years). Pupil miosis did not alter distance VA or refraction. Significant pupil miosis peaked at 1-2h after dosing, which expanded the depth of focus of mature presbyopes with the mean improvement in near logMAR VA of -0.15, -0.07 and -0.03, at 20, 200 and 2000 lux, respectively. One hour after instillation, near reading speed improved by 21, 24 and 5 words per min for text size commonly seen in US newspaper and cellphone text messages, 18, 21 and 19 words per min for text size of grocery labels and 12, 13 and 30 words per min for text size of over-the-counter medications at light levels of 20, 200 and 2000 lux, respectively. No such improvements in near VA and near reading speed were observed in the young presbyopes having some residual accommodation. Most of the pupil miosis remained 8h after instillation, whereas near VA improvements disappeared after 4h. Low dose miotics can enhance near vision in presbyopic subjects while retaining high quality distance vision over a wide range of light levels. Significant improvements in near vision were observed only during the 1-2h period after dosing when miosis peaked.

Experiences with the Scharioth Macula Lens – new hope for patients with dry macular degeneration

Objective (aim): Age-related macular degeneration (AMD) is the main cause of visual impairment in developed countries among the elderly. Our aim was to share our experiences with an implant designed to help improve near vision of patients with the non-exudative form of the disease. Methods: 15 pseudophakic patients suffering from dry type AMD, who had been implanted with the Scharioth Macula Lens (A45SML; Medicontur, Hungary), were included in the retrospective study. Prospective visual improvement was tested preoperatively, using the method recommended by the manufacturer: improvement in near visual acuity with +2.5D compared to +6.0D addition. Follow-up period was three months. Using pre- and postoperative data, changes in near and distance visual acuity, and the correlation between the predicted and achieved improvement were evaluated. Results: Preoperative corrected near vision with +2.5D and +6.0D addition was 0.17±0.07, and 0.36±0.11, respectively. Uncorrected near visual acuity 3 months postoperatively was 0.46±0.16. Predicted and actual visual improvement was 3.5 and 4.4 lines, respectively. No significant change in either the uncorrected or the best-corrected distance vision could be observed three months postoperatively. Neovascularization occurred three months postoperatively in one patient who had had stabilized wet macular degeneration before. Following treatment, the visual acuity returned to the sixth week level. Conclusions: The preoperative test is a reliable tool to predict the effectiveness of the implant. Our results suggested that the SML significantly improves near visual acuity without affecting distance vision; therefore, the SML can be an effective method to ameliorate the quality of life for these patients. Abbreviations: AMD = Age-Related Macular Degeneration, anti-VEGF = Anti-Vascular Endothelial Growth Factor, AREDS = Age-Related Eye Disease Study, BCDVA = Best Corrected Distance Visual Acuity, CNVA = Corrected Near Visual Acuity, ETDRS = Early Treatment Diabetic Retinopathy Study, IOL = Intraocular Lens, SML = Scharioth Macula Lens, T2.5 = Corrected Near Visual Acuity at 40 cm with an addition of +2.5 D, T6.0 = Corrected Near Visual Acuity at 15 cm with an addition of +6.0 D, UCDVA = Uncorrected Distance Visual Acuity, UCNVA = Uncorrected Near Visual Acuity.

Results of Scharioth macular lens implant in patients with age-related macular degeneration

Abstract Objective: To describe the outcomes in terms of near visual acuity and quality of life in 10 patients submitted to Scharioth Macular Lens implantation. Setting: Joao Eugenio Eye Institute, Brasilia, Brazil. Design: Uncontroled clinical trial. Methods: Ten pseudophakic patients with DMRI were submitted to the implantation of intraocular SML in the dominant eye in the period of December of 2017 to the March of 2018. All the patients had answered the Low-Vision Quality of Life Questionaire (LVQOLQ) before and after the surgery, with interval of 30 days. Results: The results points showed a statistical significant improvement (p<0.001) in the near visual acuity (NVA), without interference in the distance vision. All patients had significant improvements (p<0,05) in LVQOLQ on the item that evaluates the near visual acuity. Conclusion: There was an improvement of NVA in all 10 patients, as well as an enhancement to the quality of life in the postoperative period when compared to the preoperative period.

The Experience of a Randomized Clinical Trial of Closed-Circuit Television versus Eccentric Viewing Training for People with Age-Related Macular Degeneration

IntroductionIn addition to optical devices, closed-circuit televisions (CCTVs) and eccentric viewing training are both recognized interventions to improve reading performance in individuals with vision loss secondary to age-related macular degeneration. Both are relatively expensive, however, either in the cost of the device or in the amount of time personnel need to provide training. In this randomized trial, we compared the effectiveness of these two interventions.MethodsParticipants with age-related macular degeneration and visual acuity between 6/48 (20/160) and 6/120 (20/400) first received basic low vision care, including optical devices. At the subsequent baseline visit, they undertook a battery of measures including logMAR visual acuity; reading speed and accuracy for text in 1.3M and 1M fonts; reading information on medicine bottles, utility bills, and food packages; the NEI-VFQ; the Geriatric Depression Scale; and a reading inventory questionnaire. They were then randomized to either obtaining a CCTV for home use or eccentric viewing training over the following six weeks.ResultsRecruitment was more difficult than expected for this population. Of 145 patients referred, 29 met the inclusion-exclusion criteria, 14 were willing to enroll, and 10 completed the trial. For the primary outcome (reading speed for 1.3M print), there was a significant improvement between baseline and outcome for the CCTV group (p = 0.005), but not for the eccentric viewing training group (p = 0.28), and the CCTV group showed significantly greater change (p = 0.04). There was a nonsignificant improvement in reading speed for 1M text and a decrease in the amount of time taken to read utility bill information in the CCTV group. There was a significant improvement in near visual acuity with current glasses with eccentric viewing training. The other measures did not reach statistical significance.DiscussionRandomized clinical trials for low vision rehabilitation, particularly in the elderly population with vision loss, are challenging, but such trials are important for the allocation of resources. This trial showed early indications of more impact on reading performance from CCTV than eccentric viewing training.

Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia.

BackgroundTo test and compare in a masked fashion the efficacy of using a parasympathomimetic drug (3% carbachol) and an alpha-2 agonist (0.2% brimonidine) in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia.MethodsA prospective, double-masked, randomized, controlled clinical trial was conducted. Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. All subjects received 3% carbachol and 0.2% brimonidine in both combined and separate forms, 3% carbachol alone and 0.2% brimonidine (control) alone in their non-dominant eye in a crossover manner with one week washout between tests. The subjects’ pupil sizes and both near and distance visual acuities will be evaluated pre- and post-treatment at 1, 2, 4, and 8 h, by a masked examiner at the same room illumination.ResultsStatistically significant improvement in mean near visual acuity (NVA) was achieved in all subjects who received combined 3% carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone (P < 0.0001).ConclusionBased on the data, the combined solution demonstrated greater efficacy than the other solutions that were tested. Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity, with no change in binocular distance vision.Trial registration ACTRN12616001565437. Registered 11 November 2016.

Clinical utility of the KAMRA corneal inlay.

The treatment of presbyopia has been the focus of much scientific and clinical research over recent years, not least due to an increasingly aging population but also the desire for spectacle independence. Many lens and nonlens-based approaches have been investigated, and with advances in biomaterials and improved surgical methods, removable corneal inlays have been developed. One such development is the KAMRA™ inlay where a small entrance pupil is exploited to create a pinhole-type effect that increases the depth of focus and enables improvement in near visual acuity. Short- and long-term clinical studies have all reported significant improvement in near and intermediate vision compared to preoperative measures following monocular implantation (nondominant eye), with a large proportion of patients achieving Jaeger (J) 2 to J1 (~0.00 logMAR to ~0.10 logMAR) at the final follow-up. Although distance acuity is reduced slightly in the treated eye, binocular visual acuity and function remain very good (mean 0.10 logMAR or better). The safety of the inlay is well established and easily removable, and although some patients have developed corneal changes, these are clinically insignificant and the incidence appears to reduce markedly with advancements in KAMRA design, implantation technique, and femtosecond laser technology. This review aims to summarize the currently published peer-reviewed studies on the safety and efficacy of the KAMRA inlay and discusses the surgical and clinical outcomes with respect to the patient’s visual function.

Gains following perceptual learning are closely linked to the initial visual acuity.

The goal of the present study was to evaluate the dependence of perceptual learning gains on initial visual acuity (VA), in a large sample of subjects with a wide range of VAs. A large sample of normally sighted and presbyopic subjects (N = 119; aged 40 to 63) with a wide range of uncorrected near visual acuities (VA, −0.12 to 0.8 LogMAR), underwent perceptual learning. Training consisted of detecting briefly presented Gabor stimuli under spatial and temporal masking conditions. Consistent with previous findings, perceptual learning induced a significant improvement in near VA and reading speed under conditions of limited exposure duration. Our results show that the improvements in VA and reading speed observed following perceptual learning are closely linked to the initial VA, with only a minor fraction of the observed improvement that may be attributed to the additional sessions performed by those with the worse VA.

Improved Presbyopic Vision With Miotics.

To evaluate the efficacy of using a parasympathomimetic drug (carbachol) with an alpha agonist (brimonidine) to create optically beneficial miosis to reduce the effect of presbyopia. In this prospective, double-masked, randomized, placebo-controlled clinical trial, 48 naturally emmetropic and presbyopic subjects aged between 43 and 56 years with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Subjects were divided into 2 groups. The treatment group (n=30 eyes) received single dose of 2.25% carbachol plus 0.2% brimonidine eye drops. The control group (n=18 eyes) received placebo drops. Drops were given to all subjects in a masked fashion, in their nondominant eye. The minimum posttreatment follow-up was 3 months. The subjects' pupil size and both near and distance visual acuities were evaluated before and after treatment at 1, 2, 4, 8, and 10 hr, by a masked examiner at the same room illumination. Statistically significant improvement in near visual acuity was achieved in all subjects who received carbachol plus brimonidine drops (P<0.0001). In this masked study, all subjects liked and would use this therapy if it was available. None would use the placebo. There was no evidence of tolerance or tachyphylaxis during the study period. Improving the depth of focus by making the pupil smaller caused statistically significant improvement in near visual acuity in emmetropic presbyopic subjects. Carbachol plus brimonidine seem to be an acceptable and safe alternative to corrective lenses and surgical procedures.

Editorial: Improving visual deficits with perceptual learning.

Editorial: Improving visual deficits with perceptual learning.

Effect of Intracor surgery on visual acuity and Refractive error in presbyopic people

Background and Aim: Presbyopia is an age-related loss of lens accommodation that results in an inability to focus at near distances. Intracor is a new surgical treatment for presbyopic patients which claim to be a replacement for near spectacle. Due to great desire among patients for not using spectacles, evaluation of efficiency and results of this surgical treatment has a great significance. The purpose of this study was determining visual acuity and refraction after Intracor surgery in presbyopic patients. Materials and Method : In an observational cohort study, 22 eyes (left eye: 11, right eye: 11) of 15 presbyopic patients underwent intracore surgery were enrolled. Refractive error and visual acuity were evaluated before and 12 months after surgery. Patients with history of previous ocular surgery, corneal irregularity or incident of cataract were excluded. Statistical analyzes was performed by SPSS-19 software. Paired T-test and Wilcoxon signed ranked test was used. Results : Mean age of patients was 50.1 ± 4 years (range 44.5 to 66 years). Average monocular uncorrected distance visual acuity increased from 0.74 ± 0.20 decimal at base line to 0.85 ± 0.16 decimal at the last visit (P< 0.01). Average binocular uncorrected distance visual acuity increased from 0.85 ± 0.16 decimal at base line to 0.92 ± 0.09 decimal at the last visit (P < 0.05). Average monocular and binocular near visual acuity with distance correction increased from 0.27 ± 0.07 and 0.30 ± 0.07 decimal at base line to 0.39 ± 0.15 and 0.50 ± 0.21decimal at the last visit respectively (P < 0.01). Average near visual acuity without distance correction increased from 0.23 ± 0.05 decimal at base line to 0.68 ± 0.24 decimal at the last visit (P< 0.001). Average of monocular spherical refraction and monocular and binocular corrected near visual acuity had a statistically significant decrease (P<0.001). Conclusion : There was a statistically significant improvement in both distance and near visual acuity after Intracor surgery. Improvement in near visual acuity was more significant. Key words : Presbyopia, visual acuity, refractive error, Intracor

Outcomes of small aperture corneal inlay implantation in patients with pseudophakia.

To evaluate the improvement in near visual acuity after KAMRA corneal inlay (AcuFocus, Inc., Irvine, CA) implantation in patients with pseudophakia. A retrospective study analysis of patients with pseudophakia undergoing monocular corneal inlay implantation in the non-dominant eye was performed. The inlay was implanted monocularly in the non-dominant eye of patients. Manifest refractive spherical equivalent, uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, and corrected near visual acuity were evaluated. The follow-up period was 3 months. Thirteen eyes from 13 patients were evaluated. Four patients underwent LASIK for improved distance acuity at the time of inlay implantation. Mean uncorrected near visual acuity improved five lines (from J10 to J4) postoperatively. Mean uncorrected distance visual acuity, corrected distance visual acuity, and corrected near visual acuity remained stable and were 20/20, 20/16, and J1, respectively, before and after KAMRA implantation. Three eyes lost two lines and 1 eye lost one line of uncorrected distance visual acuity. Two eyes lost two lines and 1 eye lost 1 line of corrected distance visual acuity. Mean manifest refractive spherical equivalent changed before and after KAMRA implantation from -0.01 ± 1.07 diopters (D) (range: 2.25 to -1.88 D) to -1.12 ± 0.87 D (range: 0.25 to -2.75 D), respectively. Implantation of a small aperture corneal inlay improved uncorrected near visual acuity while maintaining uncorrected and corrected distance visual acuity in monofocal patients with pseudophakia.

Bifocals in Down Syndrome Study (BiDS): Design and Baseline Visual Function

Among children and young people with Down syndrome (DS) there is a high prevalence of reduced accommodation. Prescribing bifocals for these patients has not become fully clinically accepted, although it would be anticipated to improve visual acuity (VA). The aim of this study is to investigate the impact of bifocal correction on VA, visual perceptual skills and early literacy development in children with DS who have reduced accommodation and who are provided with a bifocal correction. This paper describes the study design and the baseline optometric findings. We have chosen a longitudinal design with frequent measures of subtests of performance to control for progression with time. The main outcome measures are early literacy and visual perception skills. Secondary outcomes are VA and accommodative function. These are measured at baseline, the participant followed for 6 months when bifocals are prescribed if necessary, and the participants were followed for another 6 months with bifocals. Fourteen participants with DS aged 8 to 19 years were enrolled. At baseline 79% required a change in their distance spectacle prescription. One hundred percent had reduced accommodation both before and after new single vision glasses were prescribed. None had an adverse reaction to 0.5 or 1% Cyclopentolate. All the subjects were able to perform either a distance or near crowded Patti-pics symbols test and 93% were able to perform both. There was a significant improvement of near VA with the new single vision spectacles (p = 0.015). The mean binocular distance VA was 0.362 +/- 0.17 logMAR whereas binocular near VA was 0.489 +/- 0.235. This study confirms previous findings of a high prevalence of reduced accommodation and shows that near VA is reduced compared to distance VA. The present results indicate that all subjects might benefit from bifocals.

Meta-analysis of accommodating intraocular lenses

Accommodating intraocular lenses (IOLs) based on the concept of optic shift were introduced to restore accommodation after cataract surgery. Currently, 3 types of accommodating IOLs are commercially available: 1CU (HumanOptics), BioComFold (Morcher), and AT-45 Crystalens (eyeonics, Inc.). We present a meta-analysis of the peer-reviewed data from studies of these IOLs that use optic-shift measurements and visual acuity as the main outcome measures. In the 6 randomized controlled studies, 5 of which studied the 1CU IOL, the visual acuity results showed moderate to no improvement in near visual acuity compared with control IOLs and a statistically significant but small and inter-patient variable anterior shift of the IOL optic after pilocarpine stimulation. More clinical trials with randomized, controlled, and patient- and examiner-masked study designs that follow the guidelines of evidence-based medicine are needed to prove a benefit of accommodating focus-shift IOLs.

IMPACT OF FLUORESCEIN ANGIOGRAPHIC CHARACTERISTICS OF MACULAR LESIONS ON OUTCOMES AFTER MACULAR TRANSLOCATION 360° SURGERY IN EYES WITH AGE-RELATED MACULAR DEGENERATION

To evaluate the relationship between preoperative lesion size and composition and visual outcomes at 1 year after macular translocation surgery with 360 degree peripheral retinectomy (MT360) for neovascular age-related macular degeneration (AMD). A prospective, interventional, consecutive, noncomparative case series of 64 patients with bilateral neovascular AMD treated with MT360 in the eye with more recent vision loss. Masked reviewers graded preoperative fluorescein angiograms for lesion size in Macular Photocoagulation Study disk areas (MPS DAs) and predominant lesion composition (classic or occult choroidal neovascularization or subretinal hemorrhage). Median changes in distance and near visual acuities and reading speed at 12 months after surgery were analyzed with respect to lesion size and composition. There was no significant difference between the outcomes for small-, medium- or large-sized preoperative lesions. Patients in each predominant lesion composition group had median improvement in visual outcomes with significant improvement in near visual acuity and reading speed for predominantly classic and occult lesions. MT360 stabilizes or improves visual function in patients with neovascular AMD irrespective of lesion size categories and with a variety of lesion compositions. Removal of the subretinal lesion and repositioning of the fovea over a healthier retinal pigment epithelial bed may account for these improvements.

The Effect of Periocular Warming on Accommodation

To investigate the effect of periocular warming on accommodation amplitude and near vision after prolonged near work in visual display terminal (VDT) workers in an office setting. Prospective interventional observational case series. Ten healthy Japanese male volunteers (mean age, 39.3+/-2 years [range, 36-43]) with a best distance corrected visual acuity (VA) of >20/20 who performed near work for 7 hours were included in the study. The differences of subjective and objective accommodations, near acuity, and pupil diameters were compared and studied in 2 experimental settings with and without periocular warming. Two experiments were performed on each subject on 2 different days. In one experiment, the subjects wore an eye mask and closed their eyelids for 10 minutes after 7 hours of VDT work (lid closure [LC] group). In the other experiment, the subjects applied warming sheets (WSs) to their eyelids and the periocular region and wore masks for 10 minutes again after 7 hours of VDT work (WS group). Visual display terminal work was performed under the same settings on both days. Subjective and objective accommodations, near vision, and pupil diameters were measured immediately before and immediately after the resting or warming procedure and again 90 minutes after the resting or warming procedures. Fifty percent of eyes had an increase in the accommodation amplitude of at least 0.5 diopters immediately after application of the WSs. Forty percent of eyes still maintained the accommodation amplitude level at 90 minutes. The mean near logarithm of the minimum angle of resolution VA immediately after application of WSs and at 90 minutes significantly improved relative to the near acuity values after simple eyelid closure. Periocular warming was found to be associated with increases in subjective and objective accommodations, with a concomitant improvement in near VA. Periocular warming with disposable WSs is a simple and effective method of increasing near work-related ergonomy.