Logarithmic Visual Acuity Chart Research Articles

Primary intraorbital inflammatory lumpy lesion: A rare case report.

Eosinophilic angiocentric fibrosis (EAF) is considered to be a kind of benign IgG4-related disease, and it is more often found in the nasal cavity. We present a pretty rare case of orbital EAF that is unlike any other reported case for this case is an IgG4 negative orbital EAF and successfully treated by the fronto orbitozygomatic approach surgery. This is a 68-year-old man from a rural area of Inner Mongolia Autonomous Region, went to our hospital for a 2-month history of vision loss with a local hospital orbital computer tomography which showed that there was a lesion in his left orbit. The inspection of the patient revealed that the patient left eye was protruding outward and the left eyelid unable to complete open or close. And his left eyeball movement had difficulty in all directions. Postoperative pathology diagnosed that this was a case of IgG4-negative EAF case. Orbital EAF. Surgical radical resection and postoperative glucocorticoid therapy. After surgery, the left eye vision of this patient increased to 0.6 tested in the standard logarithmic visual acuity chart. And his left eyeball movement dysfunction and eyeball outward protruding get a partially relief. EAF occurring in the orbit is a very rare disease and immunohistochemical results of EAF can be IgG4 negative.

Association between body stature and prevalence of reduced visual acuity in high school graduates in Hangzhou, China

ABSTRACT Clinical relevance The association between myopia and body stature is of great significance for understanding prevention and control of myopia. It has been extensively studied in previous studies but without consistent conclusions. Background The aim of this study is to investigate the association between body stature and prevalence of reduced visual acuity in high school graduates in Hangzhou, China. Methods 50,620 high school graduates who finished the physical examination of the national college entrance examination in 2020 were included. Data were derived from the database of physical examination of the national college entrance examination. Height and weight were measured, and body mass index (BMI) was calculated according to the general formula. Visual acuity was measured by the standard logarithmic visual acuity chart. Results The prevalence of reduced visual acuity was 90.38% in high school graduates. Girls had a higher prevalence of reduced visual acuity than boys (93.07% vs 87.60%, P < 0.001). Boys with normal visual acuity were significantly taller (P < 0.001) and heavier (P < 0.001) than those with reduced visual acuity. Girls with normal visual acuity were significantly taller than those with reduced visual acuity (P < 0.001). The prevalence of reduced visual acuity was significantly inversely associated with height in both boys (P < 0.001) and girls (P < 0.001). The risk of reduced visual acuity was the lowest in the fourth quartile of height. The prevalence of reduced visual acuity was significantly associated with BMI only in boys (P < 0.001). The risk of reduced visual acuity was the lowest in the third quartile of BMI. Conclusions The prevalence of reduced visual acuity was inversely associated with height in both boys and girls, and there was a U-shaped association with BMI only in boys.

Prevalence and associated factors of myopia among school students in Shenyang, China: a cross-sectional study.

In recent years, the prevalence of myopia has increased significantly and caused great concern. Nevertheless, an estimate of myopia in the student population in Shenyang, Liaoning Province, China is still lacking. This study aims to determine the prevalence of myopia among students in Shenyang and investigate the associated factors affecting myopia development. Standard logarithmic visual acuity chart and automatic computerized optometry under non-ciliary muscle paralysis were used to test the students' naked visual acuity of their right and left eyes. The included students were organized to fill in questionnaires on WeChat to collect the factors affecting myopia. A total of 34,644 students with a median age of 11.9 years were examined, including 17,563 males and 17,081 females. The overall prevalence of myopia was 60%, with a prevalence of 45% for mild myopia, 13% for moderate myopia, and 1.9% for high myopia. The sex, high educational stage, family history of myopia, doing homework after school or reading and writing for more than 2 h were associated with a higher risk of myopia, while doing eye exercises twice a day or more, going outdoors during recess, reading and writing with eyes more than one foot from books, and sleeping more than 8 h a day were associated factors for preventing myopia. The associated factors influencing myopia vary among different subgroups. The prevalence of myopia in Shenyang is at a high level. In addition to sex, high educational stage and genetic factors, environmental factors including length of eye usage, eye exercises, outdoor activities, eye working distance, and sleep duration are associated with myopia prevalence. Therefore, it is recommended that the occurrence and development of myopia can be prevented by controlling the above environmental factors.

Prevalence and influence factors for myopia and high myopia in schoolchildren in Shandong, China.

The aim of the study was to identify the prevalence and risk factors of myopia and high myopia in students from primary school and junior high school in Shandong. A total of 35,614 subjects completed the visual acuity test, refraction error measurement, and questionnaire in 2019. The visual acuity test was performed using the standard logarithmic visual acuity chart and the refractive error was measured by an automatic refractometer without cycloplegia. The average age was 12.38 ± 1.78 years, with 18,501 boys and 17,113 girls. The overall prevalence of myopia and high myopia was 68.02% and 5.90%, respectively, and reached up to 85.54% and 13.13% for the grade 9 students. The risk factors included girls, parental myopic history, time spent doing homework, and less sleep time. Performing eye exercise was significantly associated with a lower risk of myopia. Use of mobile devices and reading while lying down were only related to myopia, not high myopia. The prevalence of myopia and high myopia is at a high level. In addition to genetic factors, continuous close work and a lack of sleep was an important factor associated with children myopia and high myopia.

Visual acuity of urban and rural adults in a coastal province of southern China: the Fujian Eye Study.

To evaluate the vision status and sociodemographic associations of visual acuity (VA) in an urban and rural population in a coastal province of southern China. The Fujian Eye Study, a population-based cross-sectional study, was performed from May 2018 to October 2019. Totally 10 044 participants over 50 years old from all nine cities in Fujian Province were enrolled, and underwent a questionnaire and a series of standard physical and ocular examinations. VA was measured by E Standard Logarithmic Visual Acuity Chart (GB 11533-1989). Data was double entered with EpiData v3.1 for data collation and Stata/SE statistical software v15.1 was used to analyze the data. Totally 8211 (81.8%) participants were finally included and were divided into urban populations (4678 subjects), rural populations (n=3533), coastal residents (n=6434), and inland residents (1777 subjects); 4836 participants were female. The mean age was 64.39±8.87y (median 64y; range 50-98y). The mean presenting VA was 0.61±0.30 (0.23±0.27 logMAR), and the mean best corrected visual acuity (BCVA) was 0.82±0.28 (0.08±0.19 logMAR). In the multiple regression analysis, BCVA was significantly correlated with several socioeconomic and biologic factors, including age (P<0.001), education level (P<0.001), income (P=0.005), rural residency (P<0.001), inland residency (P=0.001) and refractive error (P<0.001), while sex (P=0.194) was independent with BCVA. Accessible services and eye health policies targeting the elderly, people with high myopia and people living in rural or inland areas are needed.

The incidence of myopia and myopic progression from 2019 to 2020 in school-age children in Zhuozhou

Objective: To analyze the changes in refractive status and prevalence of myopia in 6-to 14-year-old children at 2 time points in Zhuozhou, Hebei Province. Methods: In the current cohort study, the visual acuity and refractive status of primary and secondary school students aged 6 to 14 years were examined from June to August 2019 and reexamined from June to August 2020. A total of 30 412 subjects with examination data were enrolled, including 15 861 males (52.2%) and 14 551 females (47.8%), with an average age of (10.0±2.7) years. The participants underwent autorefraction without cycloplegia and a naked eye visual acuity test with a standard logarithmic visual acuity chart. Myopia was screened by the standard of equivalent spherical refraction less than -0.75 diopter (D). The categorical data were analyzed by the Chi-square or Fisher's exact test. Clopper-Pearson was used to estimate the 95% confidence intervals for the incidence of myopia. Results: After the 1-year interval, the change of equivalent spherical refraction was(-0.67±1.11) D and(-0.76±1.11) D, respectively, in male and female participants, and their visual acuity decreased by 0.11±0.19 and 0.12±0.21, respectively. There were significant inter-group differences in the annual change of spherical power in different age groups (χ²=276.23, P<0.001). The naked eye visual acuity reduction was greatest in the 10-year-old students. The incidence of myopia was 42.2% (95% confidence intervals of 41.47% to 42.93%) during the 1-year follow-up period. The incidence of myopia was highest at the age of 14 (52.0% in males and 54.2% in females) and lowest at the age of 6 (31.0% in males and 33.1% in females). Conclusions: The 1-year follow-up revealed an obvious myopic shift in the refractive status of school students in Zhuozhou, with their naked eye visual acuity decreased. The incidence of myopia was higher in females than that in males.

Association of sedentary behaviors with visual acuity among primary school students: a cohort study

Objective To examine the association of sedentary behaviors with visual acuity among primary school children, and to provide a reference basis for the prevention and control of poor vision. Methods Using stratified random cluster sampling method, a total of 4 969 students in grade 1–4 were selected from 5 primary schools in Guangzhou in 2017, and then were followed up in 2019. A validated questionnaire was used to collect data on children’s sedentary behaviors, including doing homework, watching TV, playing computer/video games, and taking the bus/car between home and school. Visual acuity was measured in the baseline and the follow-up using a 5 m standard logarithmic visual acuity chart. Multiple linear regression and Logistic regression were conducted to analyze the relationship between sedentary behaviors and visual changes. Results The two-year cumulative incidence of poor vision was 48.74%. Homework time was inversely associated with visual acuity of left eye ( β = −0. 012, 95% CI = −0.023–−0.002). Homework time was positively correlated with poor vision ( OR = 1.16, 95% CI = 1.05–1.27). However, total sedentary time, screen time and bus/car time were not statistically associated with changes in visual acuity ( P>0.05). Conclusion Increased homework time was associated with poorer vision in primary school students. Interventions to reduce the academic burden should be taken. 【摘要】 目的 探究小学生静态行为与视力变化的关联性, 为学生视力不良防控工作提供参考依据。 方法 采用分层整群随机抽样的方法, 于 2017 年抽取广州市 5 所小学, 纳入一至四年级学生 4 969 名, 并于 2 年后进行随访。采用经信、效度检验的《广州市小学生体质健康监测系统问卷》收集小学生基线放学后做作业、看电视、用电脑/玩游戏、往返交通等静态行为时间。使用 5 m 标准对数视力表分别测量基线和随访的视力。分别采用多重线性回归和 Logistic 回归分析小学生静态行为与视力变化值以及视力不良的关联性。 结果 2 年期间, 一至四年级学生视力不良的累积发病率为 48.74%。放学后做作业时间与左眼视力变化值呈负相关 ( β = −0.012, 95% CI = −0.023~−0.002)。放学后做作业时长与视力不良的发生正性相关 ( OR = 1.16, 95% CI =1.05~1.27)。静态行为总时长、视屏时间、往返交通时间与视力变化相关均无统计学意义 ( P 值均>0.05)。 结论 静态行为中的放学后做作业时间增加与小学生视力降低相关, 合理减轻课业负担有利于视力保护。

A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients

To compare the results of visual acuity (VA) measured by Early Treatment Diabetic Retinopathy Study (ETDRS) chart, 5 m Standard Logarithm Visual Acuity (5SL) chart, and 2.5 m Standard Logarithm Visual Acuity (2.5SL) chart in outpatients of age 12-80y. Each patient (totally 2000 outpatients) had both eyes tested with ETDRS chart at 4 m, 5SL chart at 5 m, and 2.5SL chart at 2.5 m in random order. The VA values of outpatients were categorized by ages. VA values were expressed by logMAR recording method. The mean VA results of ETDRS charts, 5SL, and 2.5SL chart were 0.52±0.28, 0.50±0.30, and 0.46±0.28 logMAR, respectively. There was a statistically significant difference in the three eye charts in the whole group (P<0.001). For all subjects, the correlation of VA tested with three charts was statistically significant (Spearman correlation coefficient=0.944, 0.937, 0.946, all P<0.001). Bland-Altman analysis shows the 95% limits of agreement between the 5SL and 2.5SL chart were -0.182 to 0.210, -0.139 to 0.251, and -0.151 to 0.235 logMAR, respectively). The agreement between the three eye charts is not high. The VA measured by 5SL chart is slightly better than that by ETDRS chart and 5SL chart would be a suitable alternative when ETDRS chart are not available in the clinical situation. The VA measured by 2.5SL chart is about 0.5 line better than VA tested with ETDRS chart, which may overestimate VA.

Associations between Poor Vision, Vision-Related Behaviors and Mathematics Achievement in Chinese Students from the CNAEQ-PEH 2015.

Purpose: Poor vision is prevalent in school-aged students, especially in East Asia. This can not only cause irreversibly physical health impairments like glaucoma and cataracts, but also the loss of individual education and employment opportunities and deterioration of the quality of life. The present study aims to investigate the associations between poor vision, vision-related risk behaviors, and mathematics achievement in youth from China. Methods: The present study included a total of 106,192 Grade 4 students and 70,236 Grade 8 students from the China National Assessment of Educational Quality-Physical Education & Health 2015 (CNAEQ-PEH 2015). We conducted a standard logarithmic visual acuity scale for vision screening, a self-reported questionnaire for vision-related risk behavior and a standardized mathematics assessment for mathematics performance. Poor vision is defined as the visual acuity below 5.0 by using the standard logarithmic visual acuity chart. Linear regression was conducted. Results: The prevalence rate of poor vision in China was 37.1% in Grade 4 and 66.2% in Grade 8 in 2015. Students who had poor vision were more likely to have better mathematics achievement than those with normal vision. Reading in bed, insufficient sleep, and screen time during weekdays and weekends were associated with higher odds of poor vision. Conclusions: Poor vision was positively associated with mathematics academic achievements, while vision-related risk behaviors such as screen time, homework time and reading in bed were associated with a high prevalence of poor vision in compulsory education cycle students.

Seven-Year Outcomes of Uveitic Macular Edema: The Multicenter Uveitis Steroid Treatment Trial and Follow-up Study Results

To evaluate the long-term outcomes of uveitic macular edema (ME). Longitudinal follow-up of a cohort of participants in a randomized clinical trial. A total of 248 eyes of 177 participants with uveitic ME enrolled in the Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study. OCT measurements, taken at baseline and annually, were graded by reading center graders masked to clinical data. Macular edema was defined as a center macular thickness (CMT) ≥240 μm on time-domain OCT or time-domain OCT equivalent. Resolution of ME was defined as normalization of macular thickness on OCT. Relapse of ME was defined as increase in macular thickness to ≥240 μm in an eye that previously had resolution. Visual acuity was measured at each visit with logarithmic visual acuity charts. Resolution and relapse of ME. Visual acuity. Among 227 eyes with ME followed ≥1 year, the cumulative percent of eyes with ME resolving at any point during 7 years was 94% (95% confidence interval [CI], 89-97). Epiretinal membranes on OCT were associated with a lower likelihood of ME resolution (hazard ratio [HR], 0.74; 95% CI, 0.55-1.01; P= 0.05). Among 177 eyes with resolved ME, the cumulative percent with relapse within 7 years was 43% (95% CI, 32-51). Eyes in which ME resolved gained a mean of 6.24 letters (95% CI, 4.40-8.09; P < 0.001) compared with eyes that remained free from ME during the 1-year follow-up intervals, whereas eyes in which ME did not resolve experienced no gain in vision (mean change-1.30 letters; 95% CI,-2.70 to 0.09; P= 0.065), and eyes that developed ME during the year (incident or relapsed) experienced a mean loss of-8.65 letters (95% CI,-11.5 to-5.84, P<0.001). Given sufficient time and treatment, nearly all uveitic ME resolves, but episodes of relapse were common. Visual acuity results were better among eyes with resolved ME, suggesting that control of inflammation and resolution of ME might be visually relevant treatment targets.

Prenatal and neonatal factors for the development of childhood visual impairment in primary and middle school students: a cross-sectional survey in Guangzhou, China

ObjectivesIn this cross-sectional survey, we sought to determine the prevalence of and the influence of prenatal and neonatal factors on childhood visual impairment without correction (VIUC) in a paediatric population...

Clinical study of modified Xuefu-Zhuyu decoction combined with conventional western medicine in the treatment of nonarteritic anterior ischemic optic neuropathy

Objective To evaluate the efficacy of modified Xuefu-Zhuyu decoction in the treatment of nonarteritic anterior ischemic optic neuropathy (NAION). Methods A total of 87 patients with NAION who met the inclusion criteria were divided into control group (43 cases) and study group (44 cases) by the random number table method. The control group was given the routine treatment combined with compound anisodine injection, while the study group was treated with routine treatment combined with modified Xuefu-Zhuyu decoction. Both groups were treated for 28 days. The standard logarithmic visual acuity chart was used to detect and record the best corrected visual acuity. The Visual field photosensitivity and visual field defect was recorded by visual field program(Oc-topus-101). The systolic peak blood flow velocity (PSV), end diastolic velocity (EDV), resistance index (RI) of the posterior ciliary short artery were measured by color Doppler ultrasound. The clinical effect was evaluated. Results The total effective rate was 97.7% (43/44) in the study group and 76.7% (33/43) in the control group. There were significant differences between the two groups (χ2=8.669, P=0.003). After treatment, the best corrected visual acuity (0.85 ± 0.21 vs. 0.72 ± 0.32 , t=2.245), visual field photosensitivity (18.71 ± 4.79 φ/db vs. 16.32 ± 5.22 φ/db, t=2.226) in the study group was significantly higher than those in the control group (P<0.05); the visual field defect (6.06 ± 1.52 φ/db vs. 8.13 ± 2.43 φ/db, t=4.775) in the study group was significantly lower than that of the control group (P<0.05); the PSV (10.03 ± 1.79 cm/s vs. 8.85 ± 1.88 cm/s, t=2.999), EDV (3.06 ± 0.37 cm/s vs. 2.67 ± 0.31 cm/s, t=5.323) in the study group was significantly higher than those of the control group (P<0.05), RI (0.61 ± 0.08 vs. 0.69 ± 0.09, t=4.385) in the study group was significantly lower than that of control group (P<0.05). Conclusions The modified Xuefu-Zhuyu decoction combined with conventional medicine can effectively improve the hemodynamics and visual function of posterior ciliary short artery in NAION patients and improve the clinical efficacy. Key words: Optic neuropathy, ischemic; Vision disorders; Xue Fu Zhu Yu Tang; Visual fields; Hemorheology; Integrated Chinese traditional and western medicine therapy

Development of Corneal Astigmatism (CA) according to Axial Length/Corneal Radius (AL/CR) Ratio in a One-Year Follow-Up of Children in Beijing, China.

Purpose The correlations between the axial length-to-corneal radius (AL/CR) ratio and corneal astigmatism (CA) were studied by prospectively analyzing and comparing survey data from school children in the Beijing urban area from 2014 to 2015. Methods In this longitudinal study, a total of 2,970 students were enrolled in 2014, and 2,179 students were enrolled in 2015. The students were in grades 1 and 4 of primary schools located in the Yangfangdian district of Beijing. The students were examined using the standard logarithmic visual acuity chart for uncorrected visual acuity (UCVA) and IOLMaster for ocular components. Results From 2014 to 2015, the students from grades 1 and 4 had significantly worse UCVA results, longer axial lengths (AL), and greater AL/CRs (p < 0.001). The boys had a longer AL and corneal radius (CR) than the girls (p < 0.001). A significantly higher rate of increased CA was observed for the students with increased AL/CR than for those with decreased or unchanged ratios (AL/CR for grade 1, X2 = 12.304, p=0.001; for grade 4, X2 = 29.044, p < 0.001). In addition, with increased AL/CR over one year, the CA value of the students in grades 1 and 4 became significantly larger (grade 1, p=0.001; grade 4, p < 0.001); moreover, the UCVA became worse (p < 0.001). Conclusions We found that UCVA and AL growth were affected by aging. An increase in the AL/CR ratio is a risk factor for the progression of corneal astigmatism for school children.

Ranibizumab combined with photodynamic therapy for the treatment of advanced-stage exudative age-related macular degeneration: Study protocol for a self-controlled trial and preliminary results

Background and objectives: The lack of visual field in the visual center of older adults with age-related macular degeneration (AMD) has a serious impact on daily activities. AMD is subdivided into atrophic and exudative AMD according to pathology. Patients with advanced stage exudative AMD develop aged-related degeneration in the macular area. Ranibizumab combined with photodynamic therapy is mainly used for the treatment of early exudative AMD; however, treatment outcomes in advanced stage exudative AMD are not well documented. Therefore, we attempt to analyze vision recovery, retinal thickness, and leakage of choroidal neovascular lesions in patients with advanced stage exudative AMD after treatment with ranibizumab plus photodynamic therapy. We also further explore the therapeutic efficacy of the combined therapy. Design: A prospective self-controlled trial. Methods: The trial will be undertaken in the Department of Ophthalmology, Affiliated Hospital of Qinghai University, China. The study population will comprise 113 patients with advanced exudative AMD who are eligible for inclusion. Photodynamic therapy combined with intravitreal injection of ranibizumab will be given as the interventional therapy. Outcome measures and preliminary results: The primary outcome measure of the trial is visual improvement in patients 12 months after treatment. Secondary outcome measures include logarithmic visual acuity chart scores, retinal thickness, and leakage of choroidal neovascular lesions assessed monthly at 1-12 months after treatment. Adverse events are also recorded during follow-up. Pre-test results showed that at 12 months after treatment, visual acuity in 43 affected eyes was increased by ≥ 2 lines, and the average retinal thickness decreased by 111.21 μm compared with before treatment. Leakage of choroidal neovascular lesions in most affected eyes stopped or the lesions were contracted. Discussion: Findings from the trial are expected to provide reliable data on the efficacy of ranibizumab combined with photodynamic therapy in the treatment of advanced exudative AMD. This will provide a basis for the rational use of this combined therapy in the treatment of advanced exudative AMD. Ethics and dissemination: The study was designed in December 2017, and approved by the Ethics Committee of the Affiliated Hospital of Qinghai University (approval No. QHY001Y) in January 2018. The trial was registered with the Chinese Clinical Trial Registry in March 28, 2018. Participant recruitment was initialized in March 2018, and data analysis will be completed in December 2020. The results of this study will be disseminated by publications in peer-reviewed journals. Trial registration: This trial was registered in the Chinese Clinical Trial Registry with registration No. ChiCTR1800015410 (protocol version 1.0).

Cataract Surgery Outcomes in Uveitis: The Multicenter Uveitis Steroid Treatment Trial

To assess the visual outcomes of cataract surgery in eyes that received fluocinolone acetonide implant or systemic therapy with oral corticosteroids and immunosuppression during the Multicenter Uveitis Steroid Treatment (MUST) Trial. Nested prospective cohort study of patients enrolled in a randomized clinical trial. Patients that underwent cataract surgery during the first 2 years of follow-up in the MUST Trial. Visual outcomes of cataract surgery were evaluated 3, 6, and 9 months after surgery using logarithmic visual acuity charts. Change in visual acuity over time was assessed using a mixed-effects model. Best-corrected visual acuity. After excluding eyes that underwent cataract surgery simultaneously with implant surgery, among the 479 eyes in the MUST Trial, 117 eyes (28 eyes in the systemic, 89 in the implant group) in 82 patients underwent cataract surgery during the first 2 years of follow-up. Overall, visual acuity increased by 23 letters from the preoperative visit to the 3-month visit (95% confidence interval [CI], 17-29 letters; P < 0.001) and was stable through 9 months of follow-up. Eyes presumed to have a more severe cataract, as measured by inability to grade vitreous haze, gained an additional 42 letters (95% CI, 34-56 letters; P < 0.001) beyond the 13-letter gain in eyes that had gradable vitreous haze before surgery (95% CI, 9-18 letters; P < 0.001) 3 months after surgery, making up for an initial difference of -45 letters at the preoperative visit (95% CI, -56 to -34 letters; P < 0.001). Black race, longer time from uveitis onset, and hypotony were associated with worse preoperative visual acuity (P < 0.05), but did not affect postsurgical recovery (P > 0.05, test of interaction). After adjusting for other risk factors, there was no significant difference in the improvement in visual acuity between the 2 treatment groups (implant vs. systemic therapy, 2 letters; 95% CI, -10 to 15 letters; P = 0.70). Cataract surgery resulted in substantial, sustained, and similar visual acuity improvement in the eyes of patients with uveitis treated with the fluocinolone acetonide implant or standard systemic therapy.

Evaluation of transcranial surgical decompression of the optic canal as a treatment option for traumatic optic neuropathy

PurposeTraumatic optic neuropathy (TON) is a serious complication of head trauma, with the incidence rate ranging from 0.5% to 5%. The two treatment options widely practiced for TON are: (i) high-dose corticosteroid therapy and (ii) surgical decompression. However, till date, there is no consensus on the treatment protocol. This study aimed to evaluate the therapeutic efficacy of transcranial decompression of optic canal in TON patients. MethodsA total of 39 patients with visual loss resulting from TON between January 2005 and June 2013 were retrospectively reviewed for preoperative vision, preoperative image, visual evoked potential (VEP), surgical approach, postoperative visual acuity, complications, and follow-up results. ResultsAll these patients underwent transcranial decompression of optic canal. During the three-month follow-up period, among the 39 patients, 21 showed an improvement in their eyesight, 6 recovered to standard logarithmic visual acuity chart “visible,” 10 could count fingers, 2 could see hand movement, and 3 regained light sensation. ConclusionVisual evoked potential could be used as an important preoperative and prognostic evaluation parameter for TON patients. Once TON was diagnosed, surgery is a promising therapeutic option, especially when a VEP wave is detected, irrespective of the HRCT scan findings. Operative time between trauma and operation is not necessary reference to assess the therapeutic effect of surgical decompression. The poor results of this procedure may be related to the severity of optic nerve injury. The patient's age is an important factor affecting the surgical outcomes.

Long-term Outcomes of Cytomegalovirus Retinitis in the Era of Modern Antiretroviral Therapy: Results from a United States Cohort

To describe the long-term outcomes of patients with cytomegalovirus (CMV) retinitis and AIDS in the modern era of combination antiretroviral therapy. Prospective, observational cohort study. Patients with AIDS and CMV retinitis. Immune recovery, defined as a CD4+ T-cell count >100 cells/μl for ≥3 months. Mortality, visual impairment (visual acuity <20/40), and blindness (visual acuity ≤20/200) on logarithmic visual acuity charts and loss of visual field on quantitative Goldmann perimetry. Patients without immune recovery had a mortality of 44.4/100 person-years (PYs) and a median survival of 13.5 months after the diagnosis of CMV retinitis, whereas those with immune recovery had a mortality of 2.7/100 PYs (P < 0.001) and an estimated median survival of 27.0 years after the diagnosis of CMV retinitis. The rates of bilateral visual impairment and blindness were 0.9 and 0.4/100 PYs, respectively, and were similar between those with and without immune recovery. Among those with immune recovery, the rate of visual field loss was approximately 1% of the normal field per year, whereas among those without immune recovery it was approximately 7% of the normal field per year. Among persons with CMV retinitis and AIDS, if there is immune recovery, long-term survival is likely, whereas if there is no immune recovery, the mortality rate is substantial. Although higher than the rates in the population not infected by human immunodeficiency virus, the rates of bilateral visual impairment and blindness are low, especially when compared with rates in the era before modern antiretroviral therapy.

Association between elevated light levels in classrooms and change in vision acuity among elementary and secondary students

To explore the association between elevated light levels in classrooms and change in vision acuity among elementary and secondary students. A total of 4 elementary (grade 1-5) and secondary (grade 7-8) schools in urban and rural areas in Sujiatun, Shenyang, China were selected by cluster sampling as experimental schools, and lighting systems have been rebuilt to improve the ambient light levels in 56 classrooms in November 2012. The control schools were chosen for the comparable academic burden and adjacent location to experimental schools, 4 schools in all. Cluster sampling of all students in the selected schools as the subjects was carried out. A total of 2 092 students were chosen as experimental group and 1 595 students were in the control group. The luxmeter was used to measure illuminance of classrooms in two groups at baseline, and intervention for 1 month, respectively.Students in both groups were underwent 3 times for vision acuity examination by standard logarithmic visual acuity chart at baseline, intervention for 6 month and intervention for 1 year, respectively. The light levels of desk and blackboard in two groups were compared by Wilcoxon test. Multivariate analysis of covariance with repeated measures was performed to assess three vision acuity results between groups. After intervention, the average illuminance of desk (117.5 vs 532.5 lx, Z = -5.38, P < 0.001) and blackboard (75.6 vs 423.5 lx, Z = -5.38, P < 0.001) and uniformity of desk (Z = -4.28, P < 0.001) with new lighting were improved significantly than that with old lighting, however the uniformity of blackboard was lower than baseline significantly (0.64 vs 0.70, Z = -2.34, P = 0.019). The average scores of vision acuity in students at baseline, intervention for 6 month and intervention for 1 year were 4.87 ± 0.23, 4.84 ± 0.25 and 4.85 ± 0.23 in experimental group, and 4.88 ± 0.22, 4.84 ± 0.25 and 4.81 ± 0.27 in control group, respectively. The significant differences between groups were found and F values were 1.41, 0.13, 19.99, P values were 0.235,0.724, <0.001. At last the average vision acuity in experimental group were significantly better than that in control group either among elementary (4.90 ± 0.20) vs (4.87 ± 0.21) score, F = 13.61, P < 0.001 or secondary students (4.73 ± 0.28) vs (4.68 ± 0.32) score, F = 14.25, P < 0.001. Visual acuity loss could be decreased in students with elevated light levels which may slow the response to myopiagenic stimuli for eyes, therefore the ambient light levels of blackboard and desk in classroom should be improved.

Incidence and Long-term Outcomes of the Human Immunodefıciency Virus Neuroretinal Disorder in Patients with AIDS

Patients with AIDS have an abnormality of retina/optic nerve function, manifested as decreased contrast sensitivity (in the absence of ocular opportunistic infections or media opacity), abnormalities on automated perimetry, and loss of retinal nerve fiber layer, even among those with good visual acuity, termed the "human immunodeficiency virus (HIV) neuroretinal disorder." The objectives of this study were to determine the prevalence, incidence, risk factors, and outcomes of HIV neuroretinal disorder. Prospective cohort study. A total of 1822 patients with AIDS without ocular infections or media opacities. Patients with HIV neuroretinal disorder were identified by a contrast sensitivity <1.50 log units in either eye in the absence of ocular opportunistic infections or media opacity. Incidence of HIV neuroretinal disorder, mortality, visual impairment (visual acuity ≤20/50), and blindness (≤20/200) on logarithmic visual acuity charts. Sixteen percent of participants had HIV neuroretinal disorder at enrollment. The estimated cumulative incidence by 20 years after AIDS diagnosis was 51% (95% confidence interval [CI], 46-55). Human immunodeficiency virus neuroretinal disorder was more common in women and African Americans. Risk factors for HIV neuroretinal disorder included hepatitis C infection, low CD4+ T cells, and detectable HIV RNA in the blood. Patients with HIV neuroretinal disorder had a 70% excess mortality versus those without it, even after adjusting for CD4+ T cells and HIV load (hazard ratio [HR], 1.7; 95% CI, 1.3-2.1; P < 0.0001). Patients with HIV neuroretinal disorder had increased risks of bilateral visual impairment (HR, 6.5; 95% CI, 2.6-10.6; P < 0.0001) and blindness (HR, 5.9; 95% CI, 2.8-13.7; P = 0.01) versus those without HIV neuroretinal disorder. Human immunodeficiency virus neuroretinal disorder is a common finding among patients with AIDS, and it is associated with an increased mortality and an increased risk of visual impairment. Successful antiretroviral therapy decreases but does not eliminate the risk of HIV neuroretinal disorder.

A new specialized visual acuity chart for amblyopic children aged 3-5 years old: development and its clinical applications.

To introduce a new specialized visual acuity chart for amblyopic children aged 3-5 years old and its clinical applications. The new visual acuity chart and notations were designed based on Weber-Fechner law. The optotypes were red against a white background and were specially shaped four basic geometric symbols: circle, square, triangle, and cross. A regular geometric progression of the optotype sizes and distribution was employed to arrange in 14 lines. The progression rate of the optotype size between two lines was 1.2589 and the testing distance was 3m. Visual acuity score could be recorded as logMAR notation or decimal notation. Age-stratified diagnostic criteria for amblyopia established by consensus statement on diagnosis of amblyopia (2011) among members of the Strabismus and Pediatric Ophthalmology Group, Ophthalmology Society, Chinese Medical Association (SPOGOSCMA) were illustrated in the new visual acuity chart. When assessing visual acuity in children aged 3-5 years old, this new visual acuity chart that consists of four symmetrical shapes (triangle, square, cross, and circle) overcame an inability to recognize the letters of the alphabet and difficulties in designating the direction of black abstract symbols such as the tumbling 'E' or Landolt 'C', which the subjects were prone to lose interest in. The visual acuity score may be recorded in different notations: decimal acuity and logMAR. These two notations can be easily converted each other in the new eye chart. The measurements of this new chart not only showed a significant correlation and a good consistency with the international standard logarithmic visual acuity chart (r=0.932, P<0.01), but also indicated a high test-retest reliability (89% of retest scores were within 0.1logMAR units of the initial test score). The results of this study support the validity and reliability of distance visual acuity measurements using the new eye chart in children aged 3 to 5 years over a wide range of visual acuities, and the new eye chart is great for early detection of amblyopia. It can be applied in various clinical settings.