logMAR Chart Research Articles

Prevalence and Associated Factors of Uncorrected Refractive Error in Older Adults in a Population-Based Study in France

Uncorrected refractive error (URE) is a common cause of visual impairment, but its prevalence in groups of older adults who could be pragmatic targets for improving optical correction remains unknown. To estimate the prevalence of URE in older adults, particularly in those with age-related eye disease and those who are unable to attend an outpatient clinic, and to identify the factors associated with URE. This population-based cross-sectional analysis included 707 adults 78 years or older from the Alienor Study in Bordeaux, France. Data were collected from February 12, 2011, through December 21, 2012, and analyzed from November 1, 2017, through July 7, 2018. Uncorrected refractive error was defined as the presenting distance visual acuity in the better-seeing eye improved by at least 5 letters on the Early Treatment Diabetic Retinopathy Study chart (≥1 line on the logMAR chart) using the best-achieved optical correction. Multivariate logistic regressions were used to determine the factors associated with URE. The study population of 707 adults 78 years or older (64.8% women; mean [SD] age, 84.3 [4.4] years) had a prevalence of URE of 38.8% (95% CI, 35.2%-42.5%). Prevalence was high for participants with eye disease (range, 35.0% [95% CI, 28.4%-42.0%] to 44.1% [95% CI, 27.2%-62.1%], depending on the disease) and those without eye disease (30.1%; 95% CI, 24.0%-36.7%). Prevalence was higher in participants who were examined at home (because they could not come to the clinic) than in those examined at the clinic (49.4% [95% CI, 42.8%-55.9%] vs 33.5% [95% CI, 29.2%-37.9%]; P < .001). Having an eye examination performed at home (odds ratio [OR], 1.64; 95% CI, 1.13-2.37), living alone (OR, 0.65; 95% CI, 0.47-0.90), and having the perceptions that the ophthalmologist consultation fees are too expensive (OR, 1.94; 95% CI, 1.12-3.36) and that declining visual acuity is normal with aging (OR, 1.47; 95% CI, 1.04-2.08) were all associated with URE. These study results show that the prevalence of URE was high in this population and suggest that preventive strategies aimed at enhancing optical correction could be directed to all older adults and to specific groups by implementing at-home eye examinations for those who have difficulties attending an outpatient clinic and by focusing on those with eye disease who probably already have a regular ophthalmologic follow-up. More studies are needed to evaluate prevalence of URE in different populations and countries with various eye care systems.

Visual Acuity Comparison of Alternate Esotropia for Different Amount of Deviation

Purpose: Aim of the present study is to compare visual acuity in different amounts of deviation of Alternate Esotropia. Methods: Pilot, cross sectional, observational study was performed at tertiary eye care centers. Subjects with Ocular deviation between 10 to 40 prism diopters, Corrected distance Visual Acuity should be greater than 6/18 and Age should be between 10 to 40 years of age were included in the study. Visual Acuity was assessed with Log Mar chart. Results: 30 subjects were included in the study. Out of that, 16 subjects were in the age group of 11-20 years, 12 subjects were in the age group of 21-30 years and 2 subjects were in the age group of 31-40 years. 60% subjects were Female and 40% subjects were Male. The mean visual acuity was considered in each amount of deviation. It shows that maximum acuity is deteriorated in the ocular deviation of 31-40 prism diopters of Alternate Esotropia. Conclusion: As the amount of ocular deviation increases, visual acuity will be more deteriorated in cases of Alternate Esotropia.

Macular phototoxicity after corneal cross-linking.

PurposeTo assess potential vascular, structural, and functional changes to the macula in patients with keratoconus that underwent ultraviolet A (UVA)–riboflavin-mediated corneal collagen cross-linking (CXL) therapy.Patients and methodsSeventeen eyes from 17 patients of age 16 years or older with keratoconus undergoing CXL treatment were studied. The same eye served as its own control (before CXL vs after CXL). Eyes were evaluated in terms of best-corrected visual acuity (BCVA), refractive error, intraocular pressure, Amsler grid, retinography, fluorescein angiography, autofluorescence, and spectral domain optical coherence tomography (SD-OCT) prior to CXL and 7 and 30 days after treatment. Multifocal electroretinography (mfERG) was recorded prior to and 7 days after CXL.ResultsMean (SD) BCVA by logMAR chart was 0.47 (±0.12) pre-CXL, 0.55 (±0.15) 7 days post-CXL (P=0.57), and 0.46 (±0.10) 30 days post-CXL (P=0.87). Mean (SD) SD-OCT central macular thickness (µm) was 253.62 (±20.9) pre-CXL, 260.5 (±18.7) 7 days post-CXL (P=0.48), and 256.44 (±21.6) 30 days post-CXL (P=0.69). In 12 eyes, mfERG revealed a statistically significant increase (P=0.0353) in P1 latency (ms) of ring four from the pre-CXL period (39.45±2.05) to 7 days post-CXL (41.04±1.28) period. Regression analysis showed that the increase in P1 latency was correlated with the increase in central macular thickness (P=0.027). Furthermore, nine patients experienced a significant decrease in P1 amplitudes of rings 1 (P=0.0014), 2 (P=0.0029), 3 (P=0.0037), 4 (P=0.0014), and 5 (P=0.0012) from pre-CXL to 7 days post-CXL. Conclusion: In this pilot study, most of the patients exhibited slight changes in their mfERG parameters and OCT thickness, despite a lack of vascular abnormalities observed on fluorescein angiography/autofluorescence imaging, no alteration in BCVA, and no reports of symptoms. These changes could, therefore, be categorized as a mild subclinical effect of the corneal cross-linking procedure.

3-year-data of combined navigated laser photocoagulation (Navilas) and intravitreal ranibizumab compared to ranibizumab monotherapy in DME patients.

PurposeThe prospective, comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema has shown advantage of a combination therapy compared to ranibizumab monotherapy at year 1 with significantly reduced injections. The purpose of this retrospective study was to determine the long-term visual gains and need of injections in a 3 year-follow-up period.MethodsRetrospective analysis of patients of the original study in the long-term follow-up from month 12 to 36. BCVA measurements following the original 1 year study were taken using logMAR charts. Injections were provided with standard of care using PRN, based on change in BCVA and CRT using SD-OCT scans. Main outcome measures were change in BCVA and mean number of injections from 12 to 36 months.ResultsBCVA was stable in both groups from 12 through 36 months, showing a change of 0.16 ± 0.1 log MAR. Following the initial reduction in required injections at month 12, combination therapy patients continued to require 1.3 times fewer injections over the next 24 months (2.91 ± 2.3 vs 3.85±3.7 injections for monotherapy).ConclusionsCombination of navigated laser and ranibizumab achieved BCVA gains equivalent to anti-VEGF monotherapy. These results could be maintained through month 36. Required injections were 2.0 injections lower in year 1 and further 1.3 times fewer in year 2 and 3 in the combination group compared to monotherapy. Adding navigated laser photocoagulation to intravitreal anti-VEGF therapy may still represent a superior therapeutic approach to DME patients.

The effect of astigmatic axis on visual acuity measured with different alphabets in Roman alphabet readers.

ObjectiveAstigmatism produces meridional variations in the retinal blur pattern, thus interacting with object spatial detail and altering visual performance as the axis changes. This study investigates the influence of astigmatic axis orientation on visual acuity (VA) for four alphabets used worldwide.MethodsVisual acuity was measured monocularly in 25 Roman alphabet users (mean age: 25.6±7.5 years) using computer-presented logarithm of the minimum angle of resolution (log-MAR) charts with letters from four different alphabets (Arabic, Chinese, Roman, and Tamil). VA was assessed under the effect of four optical conditions: best distance correction and three astigmatic conditions (using a +2.00 cylindrical diopter trial case lens with its axis oriented at 180, 45, or 90 degrees). For each alphabet, single optotypes were presented on a monitor viewed from a distance of 4.0 m, and a matching technique was used to identify the letters.ResultsThe degradation in VA with astigmatic defocus was influenced by the alphabet used (p<0.001) and by the astigmatic axis (p<0.001). Interactions in VA degradation between astigmatic axes and alphabet (p<0.001) showed differences within 0.10 logMAR. These interactions were more pronounced in alphabets with higher dominance of curves and vertical (Tamil) and horizontal (Arabic) detail.ConclusionInteractions between alphabet and type of astigmatism indicate that the effects of meridional blur on letter discrimination differ between alphabets. These findings have relevance in the way VA is assessed in populations using different typographies, and ultimately in the impact of astigmatic axis on their visual performance.

Intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life.

To describe the outcome of phacoaspiration with intraocular lens implantation in children with unilateral congenital cataract in the first 4 years of life. A retrospective chart review of children with visually significant unilateral congenital cataract presenting in the first 4 years of life was done. Children with a minimum postsurgical follow-up of 1 year were included. Outcome measures were mean spherical equivalent, visual axis clarity, visual acuity and complications till the last follow-up. Ninety-three children met the inclusion criteria. The mean age of surgery was 13.23 ± 11.89 months and the mean follow-up period was 24.37 ± 17.35 months. Nearly 40% of children presented during their first year of life. No difference was noted between the subgroups in terms of age ( p = 0.310), sex ( p = 0.475) or laterality ( p = 0.349). Surgical membranectomy was performed in 22 eyes (23.6%) after an average period of 4.85 ± 2.58 months after surgery. One eye underwent piggy back intraocular lens and four eyes underwent intraocular lens exchange after a mean duration of 50 months (range 40-60 months). The mean visual acuity was 0.79 ± 0.11 (log MAR chart). A total of 60.7% of these children ( n = 31) achieved best corrected visual acuity or 20/80 or better. The results of our study suggest that primary intraocular lens implantation in children with unilateral congenital cataract gives good structural and functional results. Besides a meticulous surgery, visual outcome is affected by the time of presentation and postoperative compliance to amblyopia therapy.

Mesopic visual acuity is less crowded.

The decrease in visual acuity under low luminance conditions is well known. Recent laboratory evidence showed that crowding under low luminance (mesopic) light levels is less robust than under photopic conditions. The present study examines whether such differences in crowding influence clinical measurements of mesopic visual acuity, including test-retest repeatability. Twenty adult subjects with normal or corrected to normal visual acuity were recruited for the study. Monocular visual acuity was measured under photopic (228cd/m2) and mesopic (0.164cd/m2) luminance conditions using a letter chart, similar in principle to the ETDRS logMAR chart, presented on a computer monitor. Three rows of five letters, each row differing in size by 0.05 logMAR from largest to smallest were displayed at the center of the monitor. The level of crowding was varied by varying the separation between horizontally adjacent letters from 100% optotype size to 50, 20, and 10% optotype size. Inter-row spacing was proportional to optotype size. Observers read the letters on the middle row only. Measurements continued by reducing the size of the letters, until three or more errors on the middle row were made. Each correctly identified letter contributed 0.01 to the recorded logMAR score. All measurements were repeated for each subject on two separate days. Visual acuity (logMAR) was significantly better under photopic than mesopic luminance conditions with a mean difference of 0.48 logMAR. Visual acuity also decreased with decreasing letter separation (i.e. increase in crowding). However, the decrease in visual acuity for the smallest letter separation was less under the mesopic luminance condition, even after accounting for the increased size of threshold acuity letters. Test-retest repeatability for mesopic and photopic conditions was not significantly different. Crowding under mesopic luminance conditions has less impact on visual acuity than under photopic luminance.

Influence of Static Visual Acuity, Tachistoscopic Vision and Eye Movements on Dynamic Visual Acuity

Purpose: The purpose of this study was to investigate the relationship between dynamic visual acuity and static visual acuity, tachistoscopic vision, or eye movements to determine the characteristics of dynamic visual acuity. Methods: The experiment was performed on 40 subjects. Dynamic visual acuity was measured for subjects to recognize the direction of target which was oriented in four directions(top, bottom, right, left) and moved horizontally. Dynamic visual acuity was specified as the maximum angular velocity that subjects can resolve an orientation of a snellen E target projected onto the screen. Static visual acuity was assessed using the logMAR chart at 4 m; high-contrast(100%) and low-contrast(10%) static visual acuity were evaluated according to the contrast between optotypes and a background of the chart respectively. Tachistoscopic vision was evaluated by a five-number-digit target which was presented for 14 and 7 msec. A remote eye-tracking device recorded fixation and saccadic eye movements while subjects were reading the NYSOA King-Devick test. Results: High-contrast and low-contrast static visual acuity were significantly correlated with dynamic visual acuity(high-contrast visual acuity: r=-0.43, p=0.01, low-contrast visual acuity: r= -0.40, p=0.01). Dynamic visual acuity showed no correlation both with tachistoscopic vision (r= -0.29, p=0.07) and tachistoscopic vision when reduced influence of the visual memory during the tachistoscopic vision test (r=-0.10, p=0.57). Fixation and saccadic eye movements were not correlated with dynamic visual acuity (fixation counts: r=0.07, p=0.65, fixation duration: r=0.27, p=0.10, saccade counts: r=0.02, p=0.93, saccade duration: r=0.01, p=0.98, saccade amplitude: r= 0.22. p=0.18, saccadic velocity: r=0.23, p=0.15). The most influential factor for dynamic visual acuity was high-contrast visual acuity in a multiple regression analysis(β=-0.43, p=0.01). Conclusion: These results suggest that the dynamic visual acuity is related with vision and visual quality based on static visual acuity. High-contrast visual acuity is the most effective factor on dynamic visual acuity among static visual acuity, tachistoscopic vision and eye movements. However, It is considered that further investigations need to analyze the correlation between dynamic visual acuity and tachistoscopic vision or eye movements.

Detection of Amblyopia Using Sweep VEP Vernier and Grating Acuity.

PurposeVernier and grating acuity can be measured with swept-parameter visual evoked potentials (sVEP). However, whether sVEP Vernier and grating acuities are comparable in predicting letter acuity has not been systematically evaluated. This study evaluated the validity and reliability of sVEP Vernier and grating acuity for the detection of amblyopia in adults.MethodsThree types of acuity were measured in 36 adults with amblyopia and 36 age-matched normal-vision controls. Letter acuity was measured with a logMAR chart. Both Vernier and grating acuity were estimated by sVEP and psychophysics for the same stimuli. Regression analyses were performed between the perceptual and electrophysiologic acuity measurements.ResultsSVEP Vernier and grating acuities were significantly correlated with their corresponding psychophysical acuities (P < 0.001). Both the sVEP Vernier (P < 0.0001) and grating (P < 0.01) acuities were also significantly correlated with letter acuity. However, Vernier acuity more precisely reflected the magnitude of the letter acuity loss than did grating acuity for both sVEP and psychophysical measures. Repeating sVEP grating acuity tests with different temporal frequencies and modulation types indicated good reliability of sVEP acuity measures.ConclusionsSVEP Vernier acuity has a 1:1 relationship with letter acuity, but sVEP grating acuity does not. SVEP Vernier acuity thus provides a better characterization of the magnitude of the amblyopic acuity loss than does sVEP grating acuity. Nonetheless, each of the sVEP measurements can be used to predict letter acuity and because they can be made without a behavioral response, they may be useful measures of visual function in pre- and nonverbal patients.

COMPARISON OF VISUAL ACUITY IN DIFFERENT TYPES OF OCULAR DEVIATION FOR DIFFERENT AMOUNT OF DEVIATION

Purpose: Aim of the present study is to compare visual acuity in different types of ocular deviation for different amount of deviation.&#x0D; Methods: A pilot, cross sectional, observational study was performed at tertiary eye care centers. Subjects with Ocular deviation between 10 to 40 prism diopters, Corrected distance Visual Acuity should be greater than 6/18 and Age should be between 10 to 40 years of age were included in the study. Visual Acuity was assessed with Log Mar chart.&#x0D; Results: 30 subjects were included in the study. Out of that, 16 subjects were in the age group of 11-20 years, 12 subjects were in the age group of 21-30 years and 2 subjects were in the age group of 31-40 years. 60% subjects were Female and 40% subjects were Male. The mean visual acuity was considered in each type and amount of deviation. It shows that maximum acuity is deteriorated in Esotropia and in the ocular deviation of 31-40 prism diopters.&#x0D; Conclusions: This concludes that with increase in ocular deviation, there is a deterioration of Visual Acuity. Maximum Visual Acuity is deteriorated in Esotropia which is followed by Exotropia, Alternate Esotropia and Alternate Exotropia.

A standardized logarithm of the minimum angle of resolution visual acuity chart in Hindi.

Purpose:The purpose of this study to develop and calibrate a new Hindi logarithm of the minimum angle of resolution (logMAR) visual acuity chart.Methods:A new Hindi visual acuity chart was designed to logMAR specifications using Hindi optotypes experimentally selected to have similar relative legibility under equivalent spherical and cylindrical defocus. The chart calibration study was carried out in a large clinical setup in India. Participants who were literate in English and Hindi participated in the study. Visual acuity was measured with the new Hindi logMAR chart and a modified ETDRS (m-ETDRS) logMAR chart. The method of presentation was randomized between the charts. Repeat visual acuity was measured on a subsequent day with a second version of the Hindi logMAR chart.Results:The Hindi logMAR chart correlated highly with the m-ETDRS logMAR chart (r2 = 0.92); however, the mean visual acuity difference (Hindi logMAR-m-ETDRS logMAR) was nearly one and half lines (0.13 logMAR, 95% confidence interval [CI] = ±0.15 logMAR). The Hindi logMAR chart also proved to be highly repeatable (r2 = 0.99; mean difference 0.005, 95% CI = ±0.04 logMAR).Conclusion:This study reports the first standardized visual acuity chart developed in Hindi incorporating equal letter legibility and logMAR chart design features. The Hindi logMAR visual acuity chart provides a valid and repeatable tool for the measurement of visual acuity in native Hindi language speakers. Future use of the new Hindi chart should incorporate an increase in optotype size of 0.13 logMAR.

Construction and validation of logMAR visual acuity charts in seven Indian languages.

Purpose:The evaluation of visual impairment requires the measurement of visual acuity with a validated and standard logMAR visual acuity chart. We aimed to construct and validate new logMAR visual acuity chart in Indian languages (Hindi, Bengali, Telugu, Urdu, Kannada, Malayalam, and Assamese).Methods:The commonly used font in each language was chosen as the reference and designed to fit the 5 × 5 grid (Adobe Photoshop). Ten letters (easiest to difficult) around median legibility score calculated for each language based on the results of legibility experiment and differing by 10% were selected. The chart was constructed based on the standard recommendations. The repeatability of charts was tested and also compared with a standard English Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart for validation.Results:A total of 14 rows (1.0 to -0.3 logMAR) with five letters in each line were designed with the range of row legibility between 4.7 and 5.3 for all the language charts. Each chart showed good repeatability, and a maximum difference of four letters was noted. The median difference in visual acuity was 0.16 logMAR for Urdu and Assamese chart compared to ETDRS English chart. Hindi and Malayalam chart had a median difference of 0.12 logMAR. When compared to the English chart a median difference of 0.14 logMAR was noted in Telugu, Kannada, and Bengali chart.Conclusion:The newly developed Indian language visual acuity charts are designed based on the standard recommendations and will help to assess visual impairment in people of these languages across the country.

Characteristics of astigmatism in Black South African high school children.

Astigmatism impairs vision at various distances and causes symptoms of asthenopia which negatively impacts reading efficiency. The aim of conducting this study was to determine the prevalence and distribution of astigmatism and its relationship to gender, age, school grade levels and spherical ametropia. Using a multi-stage random cluster sampling, 1589 children who included 635 (40%), males, and 954 (60%), females were selected from 13 out of a sample frame of 60 schools. Their ages ranged between 13 and 18 years with a mean of 15.81±1.56 years. The parameters evaluated included visual acuity using the LogMAR chart and refractive errors measured using an autorefractor and then refined subjectively. Axis of astigmatism was presented in the vector method where positive values of J0 indicated with-the-rule, negative values described against-the-rule and J45 represented oblique astigmatism. The mean cylinder power was -0.09 ± 0.27 and mainly with-the-rule, J0 = 0.01 ± 0.11. The overall prevalence of clinically significant astigmatism (≤ - 0.75 cylinder) in the sample was 3.1% [(95% Confidence interval = 2.1-4.1%)]. Cylinder of at least - 0.25 power was considered to classify astigmatism types. Thus, the estimated distributions of types of astigmatism were: axis- 11.5%, sphero-astigmatism 10.1% and magnitude-astigmatism 11.2% while 67.2% had no cylinder of any magnitude. The prevalence of astigmatism is relatively low in this population studied. Older children and those in high school grade levels were more likely to have with-the-rule or against-the-rule astigmatism. The prevalence of astigmatism were comparable within but not across regions.

Relationship between macular thickness and mesopic visual acuity in older subjects without retinal disease

PurposeImpaired mesopic visual acuity (VA) is a risk factor for incident early age‐related macular degeneration 3 years later. However, there is a lack of data on the retina structure‐function relationship in healthy eyes. In this study, the correlations of macular thicknesses with photopic and mesopic VA were analyzed in young and older subjects without retinal disease.MethodsRetinal thickness was measured by spectral‐domain optical coherence tomography in one eye of 40 young and 41 older healthy subjects with best corrected VA of 20/20. Macular thicknesses measurements from complete and inner and outer retinal‐segmentation (IRS and ORS) of the central fovea, inner ring, outer ring, and ganglion cell complex were used in analyses. Best‐corrected distance VA was measured using HC and LC logMAR charts under photopic and mesopic (1 cd/m2) luminance conditions. The decrease in mesopic VA when compared to photopic VA (low luminance VA deficit) was registered. Pearson correlation followed by multiple forward stepwise regression analyses were performed in each age group.ResultsIn the older group, the macula was thicker in the ORS of the central fovea and inner ring, and thinner in the IRS of inner ring and outer ring (all, P &lt; 0.01). Mean photopic and mesopic HC‐VA and LC‐VA, and mean HC‐low luminance VA defict were significantly worse in the older group (all, P &lt; 0.01). Significant correlations were detected only in the older group. Multiple regression analysis showed that ORS thickness of inner ring was independent contributor to mesopic LC‐VA (r = 0.40, P = 0.01) and the complete thickness of central fovea was independent contributor to HC‐ and LC‐low luminance VA deficit (r = 0.45, P = 0.003; r = 0.32, P = 0.04

Intervalos de referencia de agudeza visual y sensibilidad al contraste en una población escolar de Pereira, Colombia

Introducción: las pruebas que evalúan la agudeza visual (AV) y la función de sensibilidad al contraste (FSC) permiten cuantificar e identificar la calidad de la visión. En Colombia, los intervalos de referencia para estas dos pruebas visuales se han establecido a partir de parámetros hallados principalmente en poblaciones foráneas. Objetivos: determinar los intervalos de referencia de la AV y la FSC en una población escolar sana de 5 a 19 años de Pereira, Colombia. Materiales y métodos: estudio descriptivo-transversal en el que se evaluaron 626 sujetos entre los 5 y los 19 años de edad, identificados en un muestreo aleatorio por conglomerados bietápico. La AV se evaluó con cartas tipo logMAR y la FSC, con el CSV 1000E. Resultados: se encontró que la AV en un sujeto normal entre los 5 y los 19 años oscila entre −0,20 y 0,10 logMAR, con una mediana de 0,0. La AV es superior entre los 15 y los 19 años; así mismo, los hombres presentan mayor AV. El intervalo de normalidad de la FSC con CSV 1000E en las frecuencias espaciales de 3, 6, 12 y 18 cpd son 1,49 y 2,08 logSC; 1,70 y 2,29 logSC; 1,40 y 1,99 logSC y 0,96 y 1,55 logSC, respectivamente. Conclusiones: en relación con la literatura, la AV en escolares entre los 5 y los 19 años es similar y la FSC es menor en las frecuencias espaciales bajas.

Efficacy of the SENSIMED Triggerfish ® in the postoperative follow-up of PHACO-ExPRESS combined surgery

Abstract Objective To determine the usefulness of the SENSIMED Triggerfish® system in the postoperative control of combined phacoemulsification and ExPRESS implant (PHACO-ExPRESS) surgery in patients with cataract and chronic open angle glaucoma (COAG) during a 2 months follow-up. Methods A prospective study conducted on 15 eyes that were subjected to PHACO-ExPRESS combined surgery. Using the SENSIMED Triggerfish® system, two records of the circadian patterns of intraocular pressure (IOP) were performed, one before and one after surgery. A record was made of the best corrected visual acuity (BCVA), comorbidities, previous IOP, and 7–30–60 days after surgery, as well as any hypotensive drugs and complications. Results The final sample was 12 eyes. The mean pre-operative BCVA (log MAR chart) before surgery was 0.5 ± 0.2, and after surgery 0.14 ± 0.1 (p = 0.02). The previous IOP was 18.7 ± 3.8 mmHg with 2.9 ± 0.7 drugs. The mean IOP at 7, 30, and 60 days after surgery decreased to 13 ± 4.1 mmHg (p = 0.002), 13.5 ± 2 mmHg (p = 0.001), and 13.9 ± 2.5 mmHg (p = 0.001), respectively. The amplitudes of the circadian curves changed significantly after surgery (p = 0.007). The mean values between daytime and night-time periods decreased significantly from 146.8 ± 80.9 mVeq and 61.2 ± 92 mVeq before surgery to 36.4 ± 36 mVeq (p = 0.000), and −23,2 ± 47.6 mVeq (p = 0.014) after surgery, respectively. There were complications in one patient. Conclusions The SENSIMED Triggerfish® monitoring system showed changes in the curves of the circadian patterns, as well as decreased mean amplitudes after the combined PHACO-ExPRESS technique, suggesting that it may become a useful tool for postoperative follow-up of COAG.

HIGH PREVALENCE AND SEVERITY OF POSTPARTUM RETINOVASCULAR CHANGES FOLLOWING PRE- ECLAMPSIA WITH SEVERE FEATURES COMPARED TO NORMAL PREGNANCY.

Background: Hypertensive retinopathy complicates about 40-100% of pregnancies with hypertensive disorders and its severity worsens with progression of hypertension. Reactive retinal vessel changes demonstrably also mirror cardiovascular changes in the course of normal pregnancy. There is low utility of fundoscopy in assessing target organ damage and prognosis in pre-eclampsia in low resource setting. Objective: To compare postpartum maternal retinovascular (RV) findings between pregnancies complicated with preeclampsia with severe features (PES) and normal pregnancies at Kenyatta National Hospital (KNH). Methodology: Design: Comparative cross-sectional study conducted between May 2017 and March 2018. Setting: KNH, a regional Teaching and Referral hospital. Study population: Sixty-five women within 72 hours postpartum without preexisting ocular or medical co morbidities following normal pregnancy (n=35) or pregnancies complicated with PES (n=30). Data collection: Participants were interviewed on sociodemographic and reproductive health characteristics and clinical parameters obtained from medical records. Visual acuity assessment was done using a portable LogMAR chart and non-mydriatic fundus photography used for retinovascular evaluation. RV changes were graded using Keith Wagner grading. Data analysis: Postpartum retinovascular findings and severity grades were analyzed and presented as percentages and compared between the two groups using Chi square or Fisher’s exact test. Odds ratios (OR) of retinovascular changes following pre-eclampsia compared to normal pregnancy was estimated. A p value of &lt;0.05 and 95% confidence interval (CI) that doesn’t include the null value were considered significant. Results: Overall prevalence of hypertensive retinovascular change was 90.8% (83.3% in PES versus 97.1% in normal pregnancies). We found statistically significantly greater odds, OR 5.05 CI (0.93, 27.6) of severe retinovascular changes after pregnancies complicated with PES (p=0.045). Conclusion: There is high but comparable prevalence of maternal retinovascular changes within 72 hours postpartum after pregnancies complicated with PES or normal pregnancy. PES is associated with greater odds of postpartum retinovascular changes Compared to normal pregnancies.

Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients

Background: Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. Objectives: To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. Methods: A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women’s hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland–Altman analysis and paired t-test. Results: For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were −7.9 to +8.5 letters for the right eye and −10.9 to +11.2 letters for the left eye. Conclusion: An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.

Eficacia del SENSIMED Triggerfish® para el seguimiento postoperatorio de la cirugía combinada FACO-ExPRESS

ObjectiveTo determine the usefulness of the SENSIMED Triggerfish® system in the postoperative control of combined phacoemulsification and ExPRESS implant (PHACO-ExPRESS) surgery in patients with cataract and chronic open angle glaucoma (COAG) during a 2 months follow-up. MethodsA prospective study conducted on 15 eyes that were subjected to PHACO-ExPRESS combined surgery. Using the SENSIMED Triggerfish® system, two records of the circadian patterns of intraocular pressure (IOP) were performed, one before and one after surgery. A record was made of the best corrected visual acuity (BCVA), comorbidities, previous IOP, and 7-30-60 days after surgery, as well as any hypotensive drugs and complications. ResultsThe final sample was 12 eyes. The mean pre-operative BCVA (log MAR chart) before surgery was 0.5±0.2, and after surgery 0.14±0.1 (P=.02). The previous IOP was 18.7±3.8mmHg with 2.9±0.7 drugs. The mean IOP at 7, 30, and 60 days after surgery decreased to 13±4.1mmHg (P=.002), 13.5±2mmHg (P=.001), and 13.9±2.5mmHg (P=.001), respectively. The amplitudes of the circadian curves changed significantly after surgery (P=.007). The mean values between daytime and night-time periods decreased significantly from 146.8±80.9 mVeq and 61.2±92.mVeq before surgery to 36.4±36 mVeq (P=.000), and -23,2±47.6mVeq (P=.014) after surgery, respectively. There were complications in one patient. ConclusionsThe SENSIMED Triggerfish® monitoring system showed changes in the curves of the circadian patterns, as well as decreased mean amplitudes after the combined PHACO-ExPRESS technique, suggesting that it may become a useful tool for postoperative follow-up of COAG.

Near visual impairment and spectacle coverage in Telangana, India.

The study highlights the burden of near visual impairment (NVI) in India. NVI is a common condition that can be addressed through provision of spectacles. The study aims to assess the prevalence of NVI and spectacle coverage among those aged ≥40years in south Indian state of Telangana. Population-based cross-sectional study using a rapid assessment methodology. Five thousand one hundred forty participants enumerated from 123 clusters in two districts and have presenting distance visual acuity of ≥6/18 in the better eye. Presenting near vision was assessed binocularly at a fixed distance of 40cm using a log MAR chart with tumbling E optotypes in ambient lighting conditions. If the presenting near vision was worse than 6/12 (log MAR 0.3), then it was re-assessed with addition lens appropriate to the age. NVI was defined as binocular presenting near vision worse than 6/12. Prevalence of NVI and spectacle coverage. The mean age of the participants was 51.1years (standard deviation: 9.3years), and 46.5% (n=2392) were women. About 80% (n=4142) of them had no education, and 21.9% (n=1126) were using spectacles for near vision. Nearly half of the participants were from Adilabad district (n=2665). The prevalence of NVI was 58.3% (95% confidence interval: 56.9-59.6). NVI was associated with older age groups, male gender and no education. The spectacle coverage was 26.5%. NVI is common in rural Telangana with low spectacle coverage. Service delivery programs should use a multi-pronged approach to address the burden of NVI.