Low-contrast Acuity Research Articles

An Evaluation of the Repeatability of Visual Function Following Surgical Repair of Macula-Off Rhegmatogenous Retinal Detachment.

To evaluate the reliability and reproducibility of visual function assessments for patients with macula-off rhegmatogenous retinal detachment (RRD). This prospective study included patients with unilateral macula-off RRD of <10-day duration successfully treated with a single, uncomplicated surgery at least 1 year following repair. Visual function assessments were performed at time of enrollment and 1 month later. Testing included Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA), low-luminance visual acuity (LLVA), low-contrast visual acuity (VA) 2.5% and 5%, contrast sensitivity assessment with Mars and Gabor patches, reading speed (acuity, speed, and critical print size), color vision testing (protan, deutan, and tritan), and microperimetry. Spectral-domain ocular coherence tomography (SD-OCT) was performed. Paired t-statistics were used to compare values between visits and between the study and fellow eyes. Fourteen patients (9 male, 5 female) with a mean age of 69 years at time of surgery were evaluated. Correlation coefficients across the two visits were highest for ETDRS BCVA (0.97), tritan color vision testing (0.96), and low-contrast VA 5% (0.96), while the average t-statistic was largest for low-luminance deficit (4.2), ETDRS BCVA (4.1), and reading speed critical print size (3.7). ETDRS BCVA did not correlate with SD-OCT findings. ETDRS BCVA can be considered a highly reliable and reproducible outcome measure. LLVA, protan color discrimination, contrast sensitivity, and reading speed may be useful secondary outcome measures. This study provides guidance on the selection of visual function outcome measures for clinical trials of patients with macula-off RRD.

Quality of life and vision assessment with scleral lenses in keratoconus.

The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.

Клинико-функциональные результаты лечения идиопатических макулярных разрывов с сохранением фовеальной внутренней пограничной мембраны

Purpose. To evaluate clinical and functional results of originally developed technique of preserving foveal internal limiting membrane (ILM) in the surgical treatment of idiopathic macular holes (IMH) with a minimum diameter of less than 500μm in comparison with standard technique that does not require preservation of the foveal ILM. Material and methods. This study included 75 patients (75 eyes) with IMH with a minimum diameter of less than 500μm and complaints manifestation of no more than 12 months. 35 patients (35 eyes, control group) were operated using standard technique. In 40 patients (40 eyes, main group) surgical intervention was performed using originally developed technique of foveal ILM sparing. Results. The anatomical closure of the IMH after surgery was obtained in all 75 patients. In two patients (one in the main and one in the control groups) within 1 month after surgery, a recurrence of IMH developed. All functional results in the main group had significant positive dynamics if compared with control group: increase in central and general light sensitivity, spatial contrast sensitivity, low-contrast visual acuity without and with glare. The increase in the best corrected visual acuity was also greater in the main group, but the difference from the control group was not significant. Conclusion. Originally developed technique of preserving the foveal ILM is highly effective in the surgical treatment of IMH with a minimum diameter of less than 500μm. In comparison with the standard technique of surgery with the removal of the ILM, this technique allows to achieve higher functional results with an equal frequency of positive anatomical outcomes. Key words: idiopathic macular hole, ILM peeling, surgical treatment, foveal sparing, ILM peeling, light sensitivity, contrast sensitivity, low contrast visual acuity

Dynamics of retinal perfusion parameters in patients with post-COVID syndrome

BACKGROUND: A major current health issue is the rehabilitation of patients who previously had a coronavirus infection (COVID-19), as well as the treatment of patients with post-COVID syndrome. For a long time after COVID-19, patients may have complaints, including vision-related ones. One of the theories is that this may be due to long-term persistent microcirculatory retinal changes.&#x0D; AIM: To assess the long-term dynamics of retinal microcirculation changes in patients with post-COVID syndrome and to evaluate the relationship of these parameters with visual functions.&#x0D; MATERIALS AND METHODS: The main group consisting of 41 patients (82 eyes) was divided into groups depending on the severity of COVID-19: mild, moderate and severe. The control group included 13 people (26 eyes) who did not have COVID-19 to the time of the examination. All patients underwent an ophthalmological examination, including low-contrast visual acuity testing and optical coherence tomography-angiography. Vessel density (VD) was examined within the superficial capillary plexus (SCP), deep capillary plexus (DCP), and radial peripapillary capillaries (RPC). The following structural indicators were also measured: the retinal thickness, the retinal nerve fiber layer thickness and the ganglion cell complex. All patients were examined twice: 6 weeks after COVID-19 and in 27 weeks (6 months after the first visit).&#x0D; RESULTS: Patients who went through moderately severe and severe COVID-19 showed a significant decrease in low-contrast visual acuity in comparison to the control group at Visit 1 (p .001 in both cases), which totally recovered to the Visit 2. In the same group of patients, there was a significant decrease in VD SCP (p .001) and VD DCP (p .001) in comparison to the control group, and these parameters significantly decreased at visit 2 (p .001 in both cases). In the group of patients with moderate COVID-19, there was also a decrease in VD SCP and VD DCP in comparison to the control group (p .001 in both cases), while the indicators remained stable during 6 months of follow-up (p = .082). There were no significant changes in VD RPC and main morphometric parameters during 6 months of follow-up.&#x0D; CONCLUSIONS: In patients with COVID-19 from moderate severity to severe, there is a significant decrease in contrast sensitivity, which is temporary and fully recovers after 6 months. In patients with severe COVID-19, there was a negative dynamic of retinal perfusion during 6 months, both in deep and superficial capillary plexuses. Patients with post-COVID syndrome, or those who have had COVID-19 and present with visual complaints, need a deep ophthalmological examination including optical coherence tomography-angiography, with a possible involvement of related specialists.

Delayed oculomotor response associates with optic neuritis in youth with demyelinating disorders

IntroductionImpairment in visual and cognitive functions occur in youth with demyelinating disorders such as multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease. Quantitative behavioral assessment using eye-tracking and pupillometry can provide functional metrics for important prognostic and clinically relevant information at the bedside. MethodsChildren and adolescents diagnosed with demyelinating disorders and healthy, age-matched controls completed an interleaved pro- and anti-saccade task using video-based eye-tracking and underwent spectral-domain optical coherence tomography examination for evaluation of retinal nerve fiber layer and ganglion cell inner plexiform layer thickness. Low-contrast visual acuity and Symbol Digit Modalities Test were performed for visual and cognitive functional assessments. We assessed saccade and pupil parameters including saccade reaction time, direction error rate, pupil response latency, peak constriction time, and peak constriction and dilation velocities. Generalized Estimating Equations were used to examine the association of eye-tracking parameters with optic neuritis history, structural metrics, and visual and cognitive scores. ResultsThe study included 36 demyelinating disorders patients, aged 8–18 yrs. (75% F; median = 15.22 yrs., SD = 2.8) and 34 age-matched controls (65% F; median = 15.26 yrs., SD = 2.3). Surprisingly, pro- and anti-saccade performance was comparable between patients and controls, whereas pupil control was altered in patients. Oculomotor latency measures were strongly associated with the number of optic neuritis episodes, including saccade reaction time, pupil response latency, and peak constriction time. Peak constriction time was associated with both retinal nerve fiber layer and ganglion cell inner plexiform layer thickness. Pupil response latency and peak constriction time were associated with visual acuity. Pupil velocity for both constriction and dilation was associated with Symbol Digit Modalities Test scores. ConclusionThe strong associations between oculomotor measures with history of optic neuritis, structural, visual, and cognitive assessments in these cohorts demonstrates that quantitative eye-tracking can be useful for probing demyelinating injury of the brain and optic nerve. Future studies should evaluate their utility in discriminating between demyelinating disorders and tracking disease progression.

Comparison of visual performance and image quality between a myopia-control contact lens and a single-vision contact lens

ObjectiveThis study aimed to evaluate the visual performance and image quality of concentric dual-focus-designed contact lenses (CLs) compared with single-vision CLs in myopic Chinese people. MethodsTwenty myopic volunteers aged between 18 and 26 years were recruited at a university eye hospital to wear both defocus-incorporated soft contact (DISC) lenses and single-vision CLs for 1 week in random order. High- and low-contrast visual acuity (VA), contrast sensitivity (CS), ocular higher-order aberrations (HOA), Strehl ratio and the Quality of Vision (QoV) questionnaire were assessed with each type of CL at weekly follow-up. ResultsDistance VA was not affected by DISC lenses compared to single-vision CLs in either high (p = 0.414) or low contrast (p = 0.431). However, there was a significant reduction in low-contrast near VA with DISC lenses compared with single-vision CLs (p = 0.011). The differences of CS between DISC lenses and single-vision CLs were significantly associated with lighting conditions and spatial frequencies (F = 128.81, P < 0.001). Compared with single-vision CLs, wavefront aberrations of DISC lenses were significantly increased in total HOA, trefoil, and spherical aberrations for either 3.0 mm or 6.0 mm pupil size. The Strehl ratio wearing DISC lenses reduced significantly compared to the single-vision CLs (p < 0.001) at a pupil diameter of 6.0 mm. QoV scores were higher overall (p = 0.026) and frequency (p = 0.019) with DISC lenses than with single-vision CLs, indicating poorer visual performance. ConclusionDISC lenses provide satisfactory distance VA. However, the higher scores of the QoV questionnaire with DISC lenses may be related to decreased CS at medium or high spatial frequencies and increased higher-order aberrations.

Acute optic neuritis: What are the clues to the aetiological diagnosis in real life?

Previous cross-sectional studies have reported distinct clinical and radiological features among the different acute optic neuritis (ON) aetiologies. Nevertheless, these reports often included the same number of patients in each group, not taking into account the disparity in frequencies of ON aetiologies in a real-life setting and thus, it remains unclear what are the truly useful features for distinguishing the different ON causes. To determine whether clinical evaluation, ophthalmological assessment including the optical coherence tomography (OCT), CSF analysis, and MRI imaging may help to discriminate the different causes of acute ON in a real-life cohort. In this prospective monocentric study, adult patients with recent acute ON (<1 month) underwent evaluation at baseline and 1 and 12 months, including, high- and low-contrast visual acuity, visual field assessment and OCT measurements, baseline CSF analysis and MRI. Among 108 patients, 71 (65.7%) had multiple sclerosis (MS), 19 (17.6%) had idiopathic ON, 13 (12.0%) and 5 (4.6%) had myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies, at last follow up respectively.At baseline, the distribution of bilateral ON, CSF-restricted oligoclonal bands, optic perineuritis, optic nerve length lesions and positive dissemination in space and dissemination in time criteria on MRI were significantly different between the four groups (p <0.001). No significant difference in visual acuity nor inner retinal layer thickness was found between the different ON aetiologies. In this large prospective study, bilateral visual involvement, CSF and MRI results are the most useful clues in distinguishing the different aetiologies of acute ON, whereas ophthalmological assessments including OCT measurements revealed no significant difference between the aetiologies.

Twenty-Year Follow-Up of Cataract Surgery in Car-Drivers: Associations Between Subjective Visual Difficulties and Objective Visual Function.

Driving especially at night is a visually demanding task. Long-time outcome of cataract surgery in drivers is important to study, as many patients live for decades after surgery. The purpose of this study is to longitudinally investigate visual function in active car drivers, 20 years after cataract surgery. From a population-based, prospective, cohort of cataract surgery patients, initiated in 1997-98, 114 of the 133 surviving patients were included. Preoperatively, postoperatively 5, 10, 15 and 20 years after surgery, the patients answered a visual function questionnaire including driving status and difficulty. Habitual visual acuity, best corrected visual acuity (BCVA), and low contrast acuity (LCVA) 10% and 2.5% were measured. The driving difficulties in daylight were almost absent after surgery and did not change over 20 years. Nighttime driving was more difficult and declined longitudinally after surgery, p=0.013, but were at 20 years still less than before cataract surgery. Patients with better BCVA experienced less difficulties driving in darkness, p=0.005. Self-reported problems with glare were significantly associated with BCVA of the better-seeing eye, LCVA 10% and LCVA 2.5% (p=0.046, p=0.033, and 0.024 respectively). Self-reported difficulties with seeing in low-contrast conditions were also significantly associated with BCVA, p=0.004. Twenty years after cataract surgery, most active drivers have no or minor visual functional problems during driving in daytime. Difficulties in nighttime driving are more common and increase significantly over time. Twenty years after surgery, all current drivers had still better subjective ability to drive, compared with before surgery.

Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy™ Intraocular Lens.

To evaluate vision, visual quality, patient satisfaction and spectacle independence after bilateral implantation of the TECNIS Synergy™ intraocular lens. Two clinical practices in the USA. Ambispective unmasked non-randomized clinical trial. Patients with a history of uneventful bilateral femtosecond laser assisted cataract surgery with the study IOL implanted, targeted for emmetropia, at least 3 months prior to the study visit were enrolled. Monocular and binocular visual acuity (VA) were measured at distance, intermediate and near, along with binocular mesopic VA. Low contrast binocular VA and reading speed in mesopic and photopic conditions were also measured. Patient satisfaction, spectacle independence, visual symptoms, and functional vision questionnaires were completed. Results from 52 subjects were available for analysis. Mean binocular unaided visual acuity was ~0.1 logMAR (20/20) from distance to 33 cm, with 81% of subjects having 0.2 logMAR (20/25) vision or better at all test distances and 92% reporting never needing glasses at any distance. Average reading speed at 40 cm was only 10 words/minute slower in dim light (p = 0.03). Mesopic and low contrast acuity appeared good. Halos were the most frequent and bothersome visual disturbances, with the greatest effect on driving at night. Eighty-eight percent of subjects reported being "completely" or "mostly" satisfied with their overall unaided vision. This hybrid technology IOL provided a range of binocular visual acuity from distance to 33 cm and good functional vision, even in dim light. Patients should be advised of the likelihood of visual disturbances, particularly halos.

Effect of Contact Lens Design on Objective Visual Acuity-Based Parameters in Pre-Presbyopic Patients in Photopic and Mesopic Lighting Conditions.

Presbyopia is often corrected by progressive soft contact lenses (CL), and the resulting visual acuity-based parameters can be affected by the lens design and pupil size under different lighting conditions. In this study, we examined the effect of CL design (spheric vs. aspheric) on objective parameters of visual acuity-based parameters under mesopic vs. photopic lighting conditions. In a prospective, double-blind study, pre-presbyopic and presbyopic patients were fitted with spheric (Dispo Silk; 8.6 base curve, 14.2 diameter) and aspheric (Dispo Aspheric; 8.4 base curve, 14.4 diameter) CLs. The low contrast (10%) and high contrast (100%) visual acuity (VA), amplitude of accommodation (AA) (push-away method, Diopters) and distance contrast sensitivity (CS) (FACT chart, cycles per degree (CPD)) were measured with both types of CLs under mesopic and photopic lighting conditions. The eye with the better visual acuity was tested and analyzed. Thirteen patients (age range: 38-45 years) were included. The mean CS was significantly better with spheric compared to aspheric lenses for low spatial frequencies (3 CPD: 81.69 ± 7.86, 67.62 ± 5.67, respectively; p < 0.05), though there was no significant difference for lower or higher spatial frequencies (1.5, 6, 12, 18 CPD). The low-contrast (10%) and high-contrast (100%) VAs were not different between the two lens designs. However, there were significant differences between near VA, distance low-contrast VA and AA obtained under mesopic (dim) vs. photopic (bright) conditions with the aspheric design correction modality. In conclusion, photopic lighting conditions improved both the visual acuity and measured amplitude of accommodation with both lens designs, though the amplitude of accommodation was significantly higher with aspheric lenses. However, contrast sensitivity demonstrated the superiority of the spheric lens at a 3 CPD spatial frequency. This suggests that the ideal lens differs from patient to patient, depending on the visual demands.

A Randomized Prospective Trial Comparing Repository Corticotropin Injection and Intravenous Methylprednisolone for Neuroprotection in Acute Optic Neuritis.

Repository corticotrophin injection (RCI, Acthar Gel) and intravenous methylprednisolone (IVMP) improve the rate but not the extent of visual recovery following acute optic neuritis. RCI has adrenal-stimulating and melanocortin receptor-stimulating properties that may endow it with unique anti-inflammatory properties relative to IVMP. Individuals with acute optic neuritis of less than 2 weeks duration were prospectively enrolled and randomized 1:1 to receive either RCI or IVMP. Peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell plus inner plexiform layer thickness (GC + IPL) were serially evaluated by OCT. In addition, patient-reported outcomes (PROs) for changes in fatigue, mood, visual function, depression, and quality of life (QOL) were measured, and high and low contrast visual acuity were recorded. Thirty-seven subjects were enrolled (19 RCI; 18 IVMP); the average time from symptom to treatment was 8.8 days. At 6 months, there was no difference in the primary outcome: loss of average pRNFL thickness in the affected eye (RCI vs IVMP: -13.1 vs -11.7 µm, P = 0.88) 6 months after randomization. Additional outcomes also showed no difference between treatment groups: 6-month attenuation of GC + IPL thickness (RCI vs IVMP: -13.8 vs -12.0 µm, P = 0.58) and frequency of pRNFL swelling at 1 month (RCI vs IVMP: 63% vs 72%, P = 0.73) and 3 months (RCI vs IVMP: 26% vs 31%, P = 0.99). Both treatments resulted in improvement in visual function and PROs. Treatment of acute optic neuritis with RCI or IVMP produced no clinically meaningful differences in optic nerve structure or visual function.

Multifocal versus modified monovision corrections: A non-dispensing comparison of visual assessment in presbyopic neophytes.

To compare the visual performance of two simultaneous-vision soft multifocal contact lenses and to compare multifocal contact lens and its modified monovision counterpart in presbyopic neophytes. A double-masked, prospective, comparative study was conducted on 19 participants fitted with soft PureVision2 multifocal (PVMF) and clariti multifocal (CMF) lenses in random order. High- and low-contrast distance visual acuity, near visual acuity, stereopsis, contrast sensitivity, and glare acuity were measured. The measurements were conducted using multifocal and modified monovision design with one brand and then repeated with another brand of lens. High-contrast distance visual acuity showed a significant difference between CMF (0.00 [-0.10-0.04]) and PureVision2 modified monovision (PVMMV; -0.10 [-0.14-0.00]) correction (P = 0.003) and also between CMF and clariti modified monovision (CMMV; -0.10 [-0.20-0.00]) correction (P = 0.002). Both modified monovision lenses outperformed CMF. The current study did not show any statistically significant difference between contact lens corrections for low-contrast visual acuity, near visual acuity, and contrast sensitivity (P > 0.01). Stereopsis at near distance was significantly lower with both modified monovision (PVMMV: 70 [50-85]; P = 0.007, CMMV: 70 [70-100]; P = 0.006) and with CMF (50 [40-70]; P = 0.005) when compared to spectacles (50 [30-70]). Glare acuity was significantly lower with multifocal (PVMF: 0.46 [0.40-0.50]; P = 0.001, CMF: 0.40 [0.40-0.46]; P = 0.007) compared with spectacles (0.40 [0.30-0.40]), but no significant difference was noted between the multifocal contact lenses (P = 0.033). Modified monovision provided superior high-contrast vision compared to multifocal correction. Multifocal corrections performed better for stereopsis when compared to modified monovision. In parameters like low-contrast visual acuity, near acuity, and contrast sensitivity, both the corrections performed similarly. Both multifocal designs showed comparable visual performances.

Commentary: Leap forward in presbyopia management - Correcting beyond spectacles.

Commentary: Leap forward in presbyopia management - Correcting beyond spectacles.

Longitudinal Assessment of High- and Low-Contrast Visual Acuity in Normally-Sighted Children (P10-9.009)

<h3>Objective:</h3> To characterize longitudinal visual changes in healthy children. <h3>Background:</h3> Visual acuity (VA) is often used as an outcome measure in clinical and research investigations, although age-related normative contrast data is lacking. We have previously demonstrated in a cross-sectional cohort (ages 5–20 years, grouped by age) that mean monocular and binocular high-contrast visual acuity (HCVA) and monocular low-contrast letter acuity (LCLA) scores increase with age linearly between 5–14 years in normally-sighted youth; however, improvements in acuity scores have not been validated longitudinally in individual children. <h3>Design/Methods:</h3> Children and young adults without neurologic, systemic, or ocular diseases (except refractive error) enrolled in our research program were eligible for longitudinal vision testing. Binocular HCVA and LCLA were assessed at 2 meters using EDTRS and Sloan charts (2.5% and 1.25% contrast). Linear regression with generalized estimating equations to account for repeated observations were used to calculate mean annual visual acuity change. <h3>Results:</h3> Among 101 subjects enrolled in the cross-sectional study, 27 subjects returned for longitudinal testing at a mean of 2.78 years after initial testing. For subjects ≥13 years of age, the mean annual change in binocular scores in letters was −0.67 (p=0.01), −0.82 (p=0.04), and −1.58 (p=0.01) for HCVA, LCLA 2.5%, and LCLA 1.25%, respectively. For subjects &lt;13 years, the mean annual change in binocular scores was 2.31 (p=0.008), 1.71 (p=0.003), and 2.03 (p=0.04) for HCVA, LCLA 2.5%, and LCLA 1.25%, respectively. For all levels of contrast, subjects &lt;7 years of age demonstrated the greatest mean annual changes. <h3>Conclusions:</h3> While HCVA, LCLA 2.5%, and LCLA 1.25% increase annually in children &lt;13 years, scores are expected to remain constant or slightly decrease thereafter. Given variabilities in normal visual acuity changes across the age span, clinicians should use caution when interpreting treatment response or disease progression based on such measures. <b>Disclosure:</b> Mr. Sollee has nothing to disclose. Amy Lavery has nothing to disclose. An immediate family member of Geraldine Liu has received publishing royalties from a publication relating to health care. Dr. Pistilli has nothing to disclose. Gui-Shuang Ying has nothing to disclose. Dr. Waldman has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for SwanBio. An immediate family member of Dr. Waldman has stock in Pfizer. The institution of Dr. Waldman has received research support from Ionis Pharmaceuticals. Dr. Waldman has received publishing royalties from a publication relating to health care.

Treatment With Erythropoietin for Patients With Optic Neuritis: Long-term Follow-up.

Erythropoietin (EPO) is a candidate neuroprotective drug. We assessed its long-term safety and efficacy as an adjunct to methylprednisolone in patients with optic neuritis and focused on conversions to multiple sclerosis (MS). The TONE trial randomized 108 patients with acute optic neuritis but without previously known MS to either 33,000 IU EPO or placebo in conjunction with 1,000 mg methylprednisolone daily for 3 days. After reaching the primary end point at 6 months, we conducted an open-label follow-up 2 years after randomization. The follow-up was attended by 83 of 103 initially analyzed patients (81%). There were no previously unreported adverse events. The adjusted treatment difference of peripapillary retinal nerve fiber layer atrophy in relation to the fellow eye at baseline was 1.27 µm (95% CI -6.45 to 8.98, p = 0.74). The adjusted treatment difference in low-contrast letter acuity was 2.87 on the 2.5% Sloan chart score (95% CI -7.92 to 13.65). Vision-related quality of life was similar in both treatment arms (National Eye Institute Visual Functioning Questionnaire median score [IQR]: 94.0 [88.0 to 96.9] in the EPO and 93.4 [89.5 to 97.4] in the placebo group). The rate of multiple sclerosis-free survival was 38% in the placebo and 53% in the EPO group (hazard ratio: 1.67, 95% CI 0.96 to 2.88, p = 0.068). In line with the results at 6 months, we found neither structural nor functional benefits in the visual system of patients with optic neuritis as a clinically isolated syndrome, 2 years after EPO administration. Although there were fewer early conversions to MS in the EPO group, the difference across the 2-year window was not statistically significant. This study provides Class II evidence that for patients with acute optic neuritis, EPO as an adjunct to methylprednisolone is well tolerated and does not improve long-term visual outcomes. The trial was preregistered before commencement at clinicaltrials.gov (NCT01962571).

Comparison of visual performance between peripheral gradient high-addition multifocal soft contact lenses and orthokeratology.

The aim of this study was to evaluate the short-term effects of peripheral gradient high-addition multifocal soft contact lenses (MFSCLs) and orthokeratology (Ortho-K lenses) on visual performance in myopic children. Thirty myopic children participated in this prospective study. Each participant wore different sets of lenses in the following sequence: single-vision spectacles (SVSPs) as a control, MFSCLs and Ortho-K lenses. Ocular aberrations, topography, high-contrast visual acuity (HCVA), low-contrast visual acuity (LCVA) and accommodation of the right eye were measured with each type of correction on a different day. Compared with SVSPs, high-addition MFSCLs and Ortho-K lenses significantly increased all items of aberrations (all p < 0.05) except trefoil (p = 0.17). MFSCLs induced less coma, root mean square of the third-order aberration (RMS3) and higher order aberrations than Ortho-K lenses (all p < 0.05). No significant difference in HCVA was found across the three correction types (F = 1.19, p = 0.39). In terms of LCVA, MFSCLs performed significantly poorer than SVSPs (difference, 0.16 logMAR; p = 0.001) and slightly worse than Ortho-K lenses (difference, 0.08 logMAR; p = 0.35). No significant difference in decentration was found between the two types of contact lenses, and no associations were observed between decentration and visual acuity at both high- and low-contrast levels (all p > 0.05). For MFSCLs, decentration was positively related to coma (r = 0.43, p = 0.02) and RMS3 (r = 0.44, p = 0.02), which was not the case for Ortho-K lenses. Accommodative facility was worse with MFSCLs than Ortho-K lenses (p = 0.001). Multifocal soft contact lenses differed from Ortho-K lenses in aberration profile and LCVA, although decentration was similar. Decentration <1 mm had minimal influence on both HCVA and LCVA for either type of correction, but significantly increased third-order aberrations for MFSCLs, but not Ortho-K lenses.

Optical Coherence Tomography: Retinal Imaging Contributes to the Understanding of Brain Pathology in Classical Galactosemia.

It remains unresolved whether central nervous system involvement in treated classical galactosemia (CG) is a progressive neurodegenerative process. This study aimed to investigate retinal neuroaxonal degeneration in CG as a surrogate of brain pathology. Global peripapillary retinal nerve fibre layer (GpRNFL) and combined ganglion cell and inner plexiform layer (GCIPL) were analysed in 11 CG patients and 60 controls (HC) using spectral-domain optical coherence tomography. Visual acuity (VA) and low-contrast VA (LCVA) were acquired to test visual function. GpRNFL and GCIPL did not differ between CG and HC (p > 0.05). However, in CG, there was an effect of intellectual outcome on GCIPL (p = 0.036), and GpRNFL and GCIPL correlated with neurological rating scale scores (p < 0.05). A single-case follow-up analysis showed GpRNFL (0.53-0.83%) and GCIPL (0.52-0.85%) annual decrease beyond the normal aging effect. VA and LCVA were reduced in CG with intellectual disability (p = 0.009/0.006), likely due to impaired visual perception. These findings support that CG is not a neurodegenerative disease, but that brain damage is more likely to occur early in brain development. To clarify a minor neurodegenerative component in the brain pathology of CG, we propose multicenter cross-sectional and longitudinal studies using retinal imaging.

The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis.

ClinicalTrials.gov, identifier: NCT05605951.

Investigation of contrast visual acuity with rigid gas permeable contact lenses after penetrating Keratoplasty

BackgroundTo investigate the effects of rigid gas permeable contact lens (RGP-CL) wear on contrast visual acuity in patients after penetrating keratoplasty.MethodsNineteen patients (19 eyes), aged 30.45 ± 5.83 years, who had received penetrating keratoplasty and were successfully fitted with RGP-CLs at our hospital from July 2017 to June 2018 were included. Contrast visual acuities at 100%, 25%, and 10% with spectacles and RGP-CLs were analyzed using the Chi-square test. The wavefront aberrations at the anterior surface of the cornea before and 1 month after RGP-CL wear were compared using the matched sample t-test.ResultsThe mean best spectacle-corrected visual acuities were 0.390 ± 0.135 logMAR, 0.706 ± 0.182 logMAR, and 0.952 ± 0.223 logMAR at the 100%, 25%, and 10% contrast levels, respectively, which were significantly lower than the RGP-CL-corrected visions at the three levels (0.255 ± 0.133 logMAR, 0.488 ± 0.168 logMAR, and 0.737 ± 0.159 logMAR; all P < 0.001). The vision losses with RGP-CLs were 0.231 ± 0.099 logMAR and 0.466 ± 0.094 logMAR at the 25% and 10% contrast levels, respectively. The Zernike spherical aberration Z04 was reduced from 3.734 ± 1.061 μm to 2.622 ± 0.725 μm after wearing the RGP-CLs (P ≤ 0.001). The astigmatism parameters of Z− 22 and Z22 were also reduced from 3.761 ± 2.309 μm and 3.316 ± 2.147 μm to 2.637 ± 1.722 μm and 2.016 ± 1.184 μm, respectively (P < 0.05).ConclusionFor post-keratoplasty patients, RGP-CLs can help to improve visual performance, especially low contrast visual acuity. The improvement may be related to the reduction of corneal aberrations, mainly the spherical and astigmatism aberrations.

Dual visual impairment and contrast sensitivity among community-dwelling older adults: a cross-sectional study from the PrevQuedas Brazil trial

Objective: To investigate the importance of improving visual assessment for community-dwelling older adult fallers. Methods: This cross-sectional study included eligible community-dwelling older adults (&gt; 60 years of age) from the PrevQuedas Brazil clinical trial who had suffered at least 1 fall in the last 12 months (n = 703). We evaluated visual acuity and contrast sensitivity using the Snellen E chart and low contrast visual acuity tests; those with both impairment types were considered to have dual visual impairment. Results: Visual acuity, low contrast sensitivity, and dual visual impairment were associated with recurrent falls (OR 1.85); visual impairment was more prevalent among the oldest old. Approximately 90.00% of the participants reported using glasses, and 63.80% used multifocal lenses. Dual impairment was identified in 143 (20.30%) participants. In multivariate logistic regression, the predictive variables for recurrent falls were low contrast sensitivity (95%CI 1.15–2.47), dual visual impairment (95%CI 1.16–2.83), and self-perceived fall risk (95%CI 1.16–2.46) which was measured using the Falls Efficacy Scale-International. Conclusion: Older adults with dual visual impairment are more likely to suffer recurrent falls. Low contrast sensitivity is crucial for fall risk assessment. Trial registration: ClinicalTrials.gov (NCT01698580).