Mean Difference In Visual Acuity Research Articles

The Impact of the COVID-19 Pandemic on Ophthalmic Outpatient Care in a Tertiary Care Center in Riyadh.

In this paper, we measured the impact of a full COVID-19 lockdown on ophthalmic patients after a period of lockdown in Saudi Arabia, from March to September 2020. A cross-sectional analytical study was carried out on 180 patients who had their appointments delayed or canceled due to the lockdown. Data was collected from electronic medical records and patients via voice calls using a validated questionnaire that were analyzed using a multivariable binary regression analysis. The results show no statistically significant mean difference in visual acuity when comparing pre- and post-lockdown measurements. The median number of appointment cancellations/delays per patient was two, and the estimated delay for the first canceled appointments was equal to 178.8 days. Of the cohort studied, 15.4% of patients faced delays in necessary surgical and therapeutic interventions; 22.1% of patients sought eye care at other institutions due to the delay, and 15% of those were seen by doctors unspecialized in ophthalmology. The odds of dissatisfaction with care were higher in patients who experienced cancellations in a surgical procedure and patients who experienced difficulty in obtaining medications. In conclusion, the pandemic hampered ophthalmic patients’ access to medications. Subjective visual outcomes of patients were also negatively affected; however, the change in objective visual parameters was not statistically significant.

Thinning of the Skull Base and Calvarial Thickness in Patients With Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure without secondary causes on neuroimaging. IIH typically occurs in young, obese female patients and, when severe, can cause permanent and irreversible vision loss. The association between skull base thinning in patients with intracranial hypertension and obesity has been previously reported; however, no study has reported these findings in IIH. The goal of our study is to determine whether IIH is independently associated with skull base and calvarial thinning. A retrospective, matched case-control study was performed. Each patient diagnosed with IIH (case) was matched with a patient diagnosed with headache (control) by age, gender, and race. Patients were included if they underwent computed tomographic imaging of the head, maxillofacial, or orbits within 3 months of their diagnosis. Exclusion criteria were history of skull base or frontal bone pathology because of surgery or skull trauma, central nervous system infections, or incomplete radiologic data. Patient demographics, medical history, clinical examination, and skull base, calvarial, and zygoma thickness were recorded. Skull base thickness was measured by the height of the auditory canal in the coronal plane. Calvarial thickness was measured just anterior to the foramen rotundum in the coronal plane. Extracranial zygoma thickness was measured and used as an internal imaging control because the zygoma is not subject to intracranial forces. One hundred twenty-six patients were included in the study, 63 cases and 63 controls. Each group comprised 61 female patients (97%), 24 (38%) Caucasian, 23 (37%) black, 1 (2%) Asian, and 15 (24%) others. The average age was 31.5 ± 8.7 years. Patients with IIH were more likely to be obese (n = 60, 95%) compared with the control patients (n = 23, 37%, P < 0.001). All patients with IIH underwent lumbar puncture (LP) with an average opening pressure (OP) of 40.5 ± 15.6 cm H2O, whereas only 13 (20%) controls underwent an LP with a mean OP of 19.5 ± 8.5 cm H2O. There was no statistical difference in mean visual acuity between the IIH and control groups (logMar 0.22 [20/30] ± 0.45 vs logMar 0.09 [20/25] ± 0.30, P = 0.093, respectively). Compared with the controls, patients with IIH were more likely to have headache (97% vs 74%, P = 0.001), pulsatile tinnitus (48% vs 7%, P < 0.001), horizontal binocular diplopia (24% vs 4%, P = 0.006), confrontational visual field deficit (23% vs 2%, P = 0.003), and papilledema (74% vs 0%, P < 0.001). Patients with IIH had thinner skull base and calvarium width compared with the controls (mean skull base thickness 4.17 ± 0.94 mm vs 5.05 ± 1.12 mm, P < 0.001 and mean calvarial width 1.50 ± 0.50 mm vs 1.71 ± 0.61 mm, P = 0.024). Zygoma thickness was similar in both groups (mean zygoma thickness 1.18 ± 0.30 mm in the IIH group vs 1.26 ± 0.35 mm in the control group, P = 0.105). In a subgroup analysis controlling for obesity (body mass index >30 kg/m2), there was no statistically significant difference in skull base, calvarial, or zygoma thickness between obese and nonobese patients. Patients with IIH have thinner mean skull base and calvarial thickness compared with the controls. There was no difference in the mean extracranial zygoma thickness, which was the internal imaging control. Contrary to previous reports, we did not find an association between obesity and skull base or calvarial thinning. These findings suggest that IIH is associated with skull base and calvarial thinning.

Screening of refractive errors and ocular disorders of professional soccer players

To improve their performance, many athletes already invest a significant amount of time and effort in training camps, personal trainers, and equipment, while neglecting to invest in their vision. However, improving visual performance can help improve overall performance in a way that other training regiments cannot. Even for athletes without vision problems, improving visual performance - such as increasing dynamic visual acuity, decreasing reaction times, and improving eye-hand coordination - is an integral component of improving overall performance. To verify if the changes found in soccer players exceeded the 40% found in the literature. The athletes were all submitted to visual acuity (VA) tests without correction using the Snellen eye chart and the noncontact intraocular pressure (IOP) by means of a computerized tonometer. They also underwent a self-refraction examination through a self-refractor. Among the 54 athletes that presented to the screening (108 eyes) 93/108 (86%) had refractive errors in one or both eyes. In 108 eyes there was 50 (46%) hyperopic eye with astigmatism; 19/108 (18%) of myopic astigmatism, 15/108 (14%) with myopia, 6/108 (6%) with hypermetropy and 15/108 (14%) were emmetropes. The prevalence of refractive errors was hyperopic astigmatism followed by myopic astigmatism (50 vs 19 cases). The left eye was the one that presented more hyperopic and myopic astigmatism in relation to the right eye, 52% and 58%, respectively. There were no differences in mean VA and IOP between in the right and left eyes, respectively. The changes verified in the screening of the present study exceeded 40% of ophthalmological alterations found in soccer players and contemplates the hypothesis of the study.

The dynamic optotype (Dyop): a novel visual acuity test for use in children

To evaluate the "dynamic optotype" (Dyop), a simple visual acuity test based on a dynamic target that requires minimal knowledge of symbols and letters. A total of 160 consecutive, systemically healthy children, 4-17years of age were prospectively recruited from the Pediatric Ophthalmology Unit of Meir Medical Center. Children were tested with the Dyop visual acuity test and the Early Treatment Diabetic Retinopathy Study (ETDRS) Lea numbers chart. The results of both tests were compared. The eye with the poorest acuity was tested with the new Dyop eye chart and the Lea numbers chart. The order of the testing was reversed between children. The logMAR visual acuity scores for each eye chart were compared. We found a strong linear correlation (r=0.88) between visual acuity measures. The mean difference in visual acuity was -0.01 (95% CI, -0.02 to 0.01). The 95% limits of agreement were ±1.2 lines. The logMAR equivalent mean difference was about less than 1 letter. The Dyop test underestimated visual acuity relative to the Lea numbers chart. The results of this study support the Dyop eye chart as a valid measure of visual acuity in children 4-17years of age, with visual acuity ranging from 20/16 to 20/200.

Visual Acuity, Vitreous Hemorrhage, and Other Ocular Outcomes After Vitrectomy vs Aflibercept for Vitreous Hemorrhage Due to Diabetic Retinopathy

Although there were no differences in mean visual acuity (VA) over 24 weeks after vitrectomy with panretinal photocoagulation (PRP) vs aflibercept in a randomized clinical trial among eyes with vitreous hemorrhage due to proliferative diabetic retinopathy (PDR), post hoc analyses may influence treatment choices. To compare exploratory outcomes between treatment groups that may affect treatment choices for patients with vitreous hemorrhage due to PDR. This post hoc analysis of a randomized clinical trial conducted at 39 DRCR Retina Network sites included adults with vision loss due to PDR-related vitreous hemorrhage for whom vitrectomy was considered. Data were collected from November 2016 to January 2020. Random assignment to 4 monthly injections of aflibercept vs vitrectomy with PRP. Both groups could receive aflibercept or vitrectomy during follow-up based on protocol-specific criteria. Visual acuity area under the curve (adjusted for baseline VA) and clearance of vitreous hemorrhage. A total of 205 eyes were included in the analysis (115 male [56%] and 90 [44%] female participants; mean [SD] age, 57 [11] years). Among 89 eyes with a baseline VA of 20/32 to 20/160 (47 receiving aflibercept, including 4 [9%] that had undergone vitrectomy; 42 undergoing vitrectomy, including 3 [7%] that had received aflibercept), the adjusted mean difference in VA letter score over 24 weeks between the aflibercept and vitrectomy groups was -4.3 (95% CI, -10.6 to 1.9) compared with -16.7 (95% CI, -24.4 to -9.1) among 59 eyes with baseline VA worse than 20/800 (P = .02 for interaction; 26 in the aflibercept group, including 6 [23%] that had undergone vitrectomy; 33 in the vitrectomy group, including 8 [24%] that had received aflibercept). In the full cohort, the median time to clearance of the initial vitreous hemorrhage was 36 (interquartile range [IQR], 24-52) weeks in the aflibercept group vs 4 (IQR, 4-4) weeks in the vitrectomy group (difference, 32 [95% CI, 20-32] weeks; P < .001). Both initial aflibercept and vitrectomy with PRP are viable treatment approaches for PDR-related vitreous hemorrhage. Although this study did not find a significant difference between groups in the primary outcome of mean VA over 24 weeks of follow-up, eyes receiving initial vitrectomy with PRP had faster recovery of vision over 24 weeks when baseline VA was worse than 20/800 and faster vitreous hemorrhage clearance. Approximately one-third of the eyes in each group received the alternative treatment (aflibercept or vitrectomy with PRP). These factors may influence treatment decisions for patients initiating therapy for PDR-related vitreous hemorrhage. ClinicalTrials.gov Identifier: NCT02858076.

Keratoconus progression after intrastromal corneal ring segment implantation according to age: 5-year follow-up cohort study.

Intrastromal corneal ring segments (ICRS) have been found to be useful in correcting keratoconus by decreasing irregular astigmatism, thereby potentially improving visual acuity. However, its long-term effects in keratoconus progression are not completely understood, mainly concerning the effects of age on ICRS implantation results. This study aimed to evaluate long-term effects of ICRS implantation according to age at implantation. We conducted a longitudinal retrospective study, where we evaluated patients with keratoconus who underwent ICRS implantation between 2004 and 2012. We evaluated 34 eyes for 5years post-operatively. The mean age of the 21 men and 7 women was 20.59 ± 4.65years. Best spectacle-corrected visual acuity (BSCVA) improved from 0.32 ± 0.19 in the preoperative period to 0.46 ± 0.27 6months post-operatively. After up to 5years of follow-up, there was no significant difference in mean visual acuity of the group. As expected, there was a significant decrease in keratometric values after corneal ring implantation, which remained stable over the 5-year follow-up. Among the 34 cases analysed, nine (26%) showed signs of disease progression. In eight of the nine documented progression cases, patients were 21years old or younger, revealing that these patients were sevenfold more likely to progress than those aged over 21years. In our series of cases, ICRS implantation was shown to be an excellent treatment to reduce corneal curvature and improve visual acuity at all ages, but it did not stabilize the disease, especially in young patients with more aggressive forms of the keratoconus.

Diabetic retinopathy outcomes in patients undergoing pancreatic transplants in West London

AbstractPurposeTo quantify the proportion of diabetic patients undergoing pancreas transplant in West London and their service use. To characterise their long‐ and short‐term retinopathy grading and visual function outcomes following surgery, the incidence of ophthalmic interventions and factors associated with DR progression.MethodsRetrospective study of diabetic patients undergoing pancreatic transplant in West London between 2001–2018. Key outcomes examined included visual acuity (VA) and retinopathy grading, as well as service use and subsequent ophthalmic treatments. Patients with failed pancreatic transplants acted as a comparison group.ResultsData from 56 patients were analysed including 51 patients with Type 1 and 5 with Type 2 diabetes mellitus. Mean age (±SD) at the time of transplant was 42 ±9 years with mean duration of disease 24 ±7 years. Data from 56 patients were analysed including 51 patients with Type 1 and 5 with Type 2 diabetes mellitus. Among them, 63% of patients were found under diabetic eye screening programme and 11% under ophthalmic secondary care at the time of transplant. At the time of transplant, 7% of eyes had no DR, 13% had background retinopathy, 13% had non‐proliferative and 67% had stable or treated proliferative retinopathy. During short‐term follow‐up (3 years), 17% of eyes developed DR progression. Amongst patients who underwent a successful transplant, there was no significant change in mean VA before and after the intervention. Long‐term follow‐up (6.6 years) revealed no significant difference in mean VA between patients with successful and failed transplants.ConclusionThis study shows that pancreatic transplantation does not guarantee prevention of DR progression. Close monitoring of these patients both in primary and secondary care is advised, however, favourable long‐term visual outcomes are possible with appropriate and timely treatment.

Comparison of visual acuity measurement with Landolt rings versus numbers

Landolt rings are commonly used for the measurement of visual acuity, especially for legal purposes. For multiple reasons, in clinical practice these optotypes are not in use and not practical. Therefore, the difference between visual acuity tested with Landolt rings as opposed tonumbers was evaluated. Visual acuity measurements of 2335 eyes from 1394 patients (aged 5-98years, median 51years) were retrospectively analyzed at the Low Vision Department of the University of Heidelberg. The patients had abroad range of ophthalmological disorders. In all patients the measurement of visual acuity was performed with numbers as well as Landolt rings according to DIN58220. Visual acuity was determined in LogMAR and compared between the two optotypes. Correlation between both optotypes was high with r2 = 0.927 but there was apronounced mean difference in visual acuity of 0.13 ± 0.14 LogMAR. Using numbers, visual acuity was 0.13 LogMAR higher, somewhat more than one line. These differences were mostly independent of visual acuity and increased slightly with age; however, the variations were greater for lower visual acuity. Whereas in clinical practice visual acuity is typically determined using numbers and early treatment diabetic retinopathy study (ETDRS) charts are the gold standard for a scientific assessment of visual acuity, only the use of Landolt rings enables an examination without the influence of form recognition. The use of Landolt rings is therefore valid for legal reasons in Europe according to EN ISO 8596 and in Germany according to DIN 58220. Comparing Landolt rings with the SnellenE chart or LEA symbols, these results confirm previous reports that visual acuity measured with Landolt rings results in lower visual acuity. On average visual acuity is approximately one line worse than when tested with numbers, afact that has to be taken into account when comparing different examination results. This may be explained by incorrect correlation of the used numbers exceeding the allowed difference in eligibility of 0.05 LogMAR. Hence, it is important for legal assessment to measure visual acuity correctly with Landolt rings.

Intravitreal diclofenac versus intravitreal bevacizumab in persistent diabetic macular edema: Anatomical and functional outcome

PurposeTo compare the efficacy of diclofenac versus bevacizumab following single intravitreal injection in eyes with persistent diabetic macular edema. MethodsFifty eyes with persistent DME were randomly allocated to intravitreal injection of 500 µg/0.1 ml of diclofenac (N = 20) or 1.25 mg/0.05 mL of bevacizumab (N = 20) or to non-treatment (10 eyes). Preoperative and postoperative visual acuity, central, paracentral macular thickness and intraocular pressure (IOP) were recorded and compared between the three groups up to 4 weeks. ResultsDiclofenac and bevacizumab groups showed statistically significant reduction in central and paracentral macular thickness (diclofenac: p = 0.006, 0.02 and bevacizumab: p = 0.02, 0.01), without statistically significant difference between the two groups. The two groups showed no statistically significant difference in mean visual acuity or mean line improvement. Mean visual acuity improvement didn't reach statistical significance in either group. Diclofenac group showed statistically significant reduced IOP (P = 0.02). Control eyes did not show any change in mean visual acuity, macular thickness or IOP. ConclusionIn persistent DME, diclofenac has a structural effect comparable to bevacizumab on central macular thickness. However, significant functional gain may not be accomplished by single injection. Unlike naïve DME, persistent cases may be confounded by systemic and local factors necessitating repeated injection of diclofenac.

Community screening for visual impairment in older people.

Community screening for visual impairment in older people.

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.

Internal limiting membrane peeling Vs no peeling in primary vitrectomy for macula off retinal detachment: A comparative study

Purpose:To compare the visual outcome and the rate of epiretinal membrane formation after primary vitrectomy with internal limiting membrane peeling Vs no peeling for patient with macula off retinal detachment. Patients and methods: This was a Prospective comparative uncontrolled case series. The study enrolled 30eyeswith rhegmatogenousretinaldetachmentwith macula off subjected to primaryvitrectomy , and classifiedinto 2 groups, Group A cases subjectedtoprimaryvitrectomywithoutinternallimiting membrane peeling and group B casessubjectedto primaryvitrectomy, with internal limiting membrane peeling, Assessment of best corrected visual acuityand rate of epiretinal membrane formation after removal of silicone oil had been done. Results:This study included 30 eyes of 30 patients, 16 (53.33 %) were males and 14 (46.67 %) were females, the mean age of studied patients was (43.37 ± 10.40) years old. There was no statistically significant difference in mean logMAR BCVA after silicone oil removal (1.18 ± 0.29 for group A versus 0.99 ± 0.38 for group B; P = 0.12).OCT done for all cases after silicone oil removal after 6 months and show that; epiretinal membrane with cystoid macular edema is formed in 5 cases in group A while ERM is not formed in any cases in group B (P = 0.04) , IS / OS line is interrupted in 6 cases in group A and in 3 cases (P = 0.43) as regarding foveal contour; it is lost in 5 cases and preserved in 10 cases in group A while in group B the foveal contour is preserved in 13 cases ,lost in 1 case and flat in 1 case (P = 0.06) , while comparing the mean of the central foveal thickness shows no statistically significant difference 295.73±129.46 for group A versus 237.6±47.60 for group B; P = 0.66. Conclusion:There was no statistically significant difference in mean visual acuity after silicone oil removal in both procedures.however, the epiretinal membrane formation was absent in group B with ILM peeling in comparison to group A.

Comparing distance visual acuity measurement with a novel eye chart and the Landolt C chart in a population of children aged 6-18years.

The Handy Eye Chart™ is designed to assist in evaluating the visual acuity of patients with non-standard communication styles. The Handy Eye Chart™ has been previously validated against the early treatment diabetic retinopathy study (ETDRS) chart. The aim of this research is to compare visual acuity outcomes with The Handy Eye Chart™ against the international gold standard, the Landolt C chart, in a population of children. Sixty participants between the ages of 6 and 18 were recruited at the Pediatric Section of the Department of Ophthalmology at the Emory Eye Center. Visual acuity was evaluated using The Handy Eye Chart™ and the Landolt C Chart, altering the order of administration between charts. The visual acuity data were compared using t test, linear regression, and Bland-Altman analysis. The mean difference in visual acuity was 0.02 logMAR (CI 0.009-0.04, p=0.002). The correlation coefficient was 0.98. The Bland-Altman analysis shows the 95% limits of agreement between the charts to be -0.14 to 0.09 logMAR. The Handy Eye Chart™ is a valid measure of visual acuity when compared with the international gold standard, the Landolt C Chart.

Comparison of Visual Recovery Following Ex-PRESS Versus Trabeculectomy

To compare the rate of visual recovery after Ex-PRESS implantation versus standard trabeculectomy. Subjects enrolled in a prospective randomized controlled trial comparing Ex-PRESS to trabeculectomy were analyzed for postoperative changes in visual acuity (VA). Risk factors for visual loss (split fixation, cup-disc ratio, intraocular pressure, visual field mean deviation, and hypotony) were evaluated. Sixty-four subjects were enrolled (33 Ex-PRESS, 31 trabeculectomy). There was no significant difference in mean logMAR VA between groups at baseline or any study visit. VA was significantly reduced up to week 2 following surgery in both the groups. However, by month 1, VA in the Ex-PRESS group was no longer significantly different from baseline (P=0.23) and remained nonsignificant at subsequent visits up to 6 months. In the trabeculectomy group, VA remained significantly lower than baseline at each study visit. At 6 months, 47% of the trabeculectomy eyes compared with 16% of the Ex-PRESS eyes had lost ≥2 Snellen lines (P=0.01). Reasons for VA loss included cataract, central retinal vein occlusion, and diabetic retinopathy, however, in a significant number of cases no cause could be determined. None of the risk factors evaluated were associated with vision loss. Although there was no difference in mean VA between the Ex-PRESS and trabeculectomy groups at any time point, trabeculectomy eyes were more likely to lose ≥2 Snellen lines. In addition, VA recovered faster in the Ex-PRESS group.

Virtually controlled computerised visual acuity screening in a multilingual Indian population

The efficacy of tele-based (virtually monitored) visual acuity (VA) examination in a hospital-based multilingual population was assessed based on subjects from the Outpatient Department of Optometry, School of Allied Health Sciences, Manipal University and Department of Ophthalmology, Kasturba Medical College, Manipal, India. Visual acuity measurement using a computerized VA chart (COMPlog) was done using a telemethod and face-to-face method in a randomized fashion for all subjects. Virtual (remotely operated) control of examination procedure and video-conferencing helped the optometrist positioned elsewhere (different physical location) to remotely operate the COMPlog VA chart and also interact with the subjects. The connection was facilitated using Lync software connected through local area network connections. During tele-examination, instructions were given on subject's language preference (Kannada, Malayalam or English). Mean age of 96 subjects (three language groups) was 40.3±14.1 years and a Bland-Altman plot showed good agreement with clinically acceptable limits of agreement. The mean difference in VA between the telemethod and face-to-face method was 0.00 logMAR (±0.16), p=0.844. Two methods had good intra-class correlation (0.912, 95% confidence interval 0.868-0.941) and had good agreement across the language groups (kappa>0.7). Visual acuity measurements using the telemethod along with native dialect was comparable to conventional face-to-face method in a hospital-based multilingual population. Digital VA testing systems along with communication in native dialect can be effectively integrated into a tele-eyecare model.

Interventions for strabismic amblyopia.

Amblyopia is reduced visual acuity in one or both eyes in the absence of any demonstrable abnormality of the visual pathway. It is not immediately resolved by the correction of refractive error. Strabismus develops in approximately 5% to 8% of the general population. The aim of treatment for amblyopia is to obtain the best possible level of vision in the amblyopic eye. Different treatment options were examined within the review. By reviewing the available evidence we wanted to establish the most effective treatment for strabismic amblyopia. In particular this review aimed to examine the impact of conventional occlusion therapy for strabismic amblyopia and to analyse the role of partial occlusion and optical penalisation for strabismic amblyopia. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2013, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to January 2014), EMBASE (January 1980 to January 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to January 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 30 January 2014. We included randomised controlled trials (RCTs) for the treatment of strabismic amblyopia including participants of any age. Two authors working independently extracted and entered data into Review Manager 5 and then independently checked the data for errors. We included three RCTs in this review. The studies reported mean logMAR visual acuity achieved. Mean difference in visual acuity was calculated. When comparing conventional part-time occlusion (with any necessary glasses), PEDIG 2006 reported that this treatment was more beneficial than glasses alone for strabismic amblyopia; the mean difference between groups was -0.18 LogMAR (statistically significant 95% confidence interval (CI) -0.32 to -0.04). Supplementing occlusion therapy with near activities may produce a better visual outcome compared to non-near activities after four weeks of treatment (PEDIG 2005). The results of the pilot study showed mean difference between groups was -0.17 LogMAR (95% CI -0.53 to 0.19). Results from a larger RCT (PEDIG 2008) are now available, showing that supplementing occlusion therapy with near activities may produce a better visual outcome after eight weeks of treatment; the mean difference between groups was -0.02 LogMAR (95% CI -0.10 to 0.06). One further article ia awaiting assessment as in its current format there is insufficient information to include (Alotaibi 2012). Occlusion, whilst wearing necessary refractive correction, appears to be more effective than refractive correction alone in the treatment of strabismic amblyopia. The benefit of combining near activities with occlusion is unproven. No RCTs were found that assessed the role of either partial occlusion or optical penalisation to refractive correction for strabismic amblyopia.

Comparison of intracameral dexamethasone and intracameral triamcinolone acetonide injection at the end of phacoemulsification surgery.

Purpose:To compare the results of intracameral dexamethasone and intracameral triamcinolone acetonide injection in patients that underwent cataract surgery with phacoemulsification.Materials and Methods:Sixty eyes of 60 patients that underwent cataract surgery with phacoemulsification were randomized into two groups. Preoperative visual acuity of all patients was 0.5 or lower and intraocular pressures were under 21mmHg. After surgery, eyes in group 1 (30 eyes) were injected with 0.4 mg/0.1 ml dexamethasone into the anterior chamber, and eyes in group 2 (30 eyes) were injected with 2 mg/0.05 ml triamcinolone acetonide into the anterior chamber. All eyes received standard postoperative prednisolone acetate and moxifloxacin eye drops. The biomicroscopic evaluation, visual acuity, and intraocular pressure measurements were done at baseline (preoperatively) and on postoperative days 1, 7 and 30.Results:There were no statistically significant differences in mean visual acuity, the amount of anterior cells and flare between the two groups (P ≥ 0.05). Mean intraocular pressure values at postoperative first day were significantly higher in group 2 than in group 1 (P = 0.009). The mean intraocular pressures on days 7 and 30 after surgery were not statistically different between the two groups (P ≥ 0.05).Conclusions:Intracameral dexamethasone and intracameral triamcinolone acetonide were similarly effective in controlling postoperative inflammation following phacoemulsification. However, the intraocular pressures on postoperative first day were higher in patients receiving intracameral triamcinolone acetonide. The highest intraocular pressure in triamcinolone acetonide group was 24 mmHg, and stabilized in a few days, therefore using triamcinolone acetonide may impose a minimal risk to patients. Nevertheless, intracameral dexamethasone seems to be a better alternative to apply at the end of surgery to suppress the inflammation during the first 24 hours.

A Randomized Trial of Increasing Patching for Amblyopia

After treatment with refractive correction and patching, some patients have residual amblyopia resulting from strabismus or anisometropia. We conducted a clinical trial to evaluate the effectiveness of increasing prescribed daily patching from 2 to 6 hours in children with stable residual amblyopia. Prospective, randomized, multicenter clinical trial. A total of 169 children aged 3 to <8 years (mean, 5.9 years) with stable residual amblyopia (20/32-20/160) after 2 hours of daily patching for at least 12 weeks. Random assignment to continue 2 hours of daily patching or increase patching time to an average of 6 hours/day. Best-corrected visual acuity (VA) in the amblyopic eye after 10 weeks. Baseline VA was 0.44 logarithm of the minimum angle of resolution (logMAR) (20/50(-2)). Ten weeks after randomization, amblyopic eye VA had improved an average of 1.2 lines in the 6-hour group and 0.5 line in the 2-hour group (difference in mean VA adjusted for acuity at randomization = 0.6 line; 95% confidence interval, 0.3-1.0; P = 0.002). Improvement of 2 or more lines occurred in 40% of participants patched for 6 hours versus 18% of those who continued to patch for 2 hours (P = 0.003). When amblyopic eye VA stops improving with 2 hours of daily patching, increasing the daily patching dosage to 6 hours results in more improvement in VA after 10 weeks compared with continuing 2 hours daily.

A new Gujarati language logMAR visual acuity chart: Development and validation

Aims:Gujarati is the main spoken language of a large proportion of the population of India. The aim of this study was to develop and validate a new Minimum Angle of Resolution (logMAR) visual acuity chart in the Gujarati language.Materials and Methods:A new Gujarati visual acuity chart was designed to logMAR specifications using Gujarati optotypes experimentally selected to have similar relative letter legibility under spherical and cylindrical defocus. The chart validation study was carried out using 153 adult subjects in a large clinical setting in India. Subjects who were literate in English and Gujarati participated in the study. Visual acuity was measured with the new Gujarati logMAR chart and a modified Early Treatment of Diabetic Retinopathy Study-(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 Gujarati logMAR chart.Results:The Gujarati chart correlated highly with the m-ETDRS logMAR chart (r2 = 0.974). The mean visual acuity difference (Gujarati – m-ETDRS logMAR) was equal to three letters (–0.06 logMAR). The Gujarati logMAR chart also proved to be highly repeatable (r2 = 0.994, test-retest) with 95% CI of ± 0.04 logMAR.Conclusions:The new Gujarati logMAR visual acuity chart provides a valid and repeatable tool for the measurement of visual acuity in native Gujarati language speakers.

INTRAVITREAL DICLOFENAC VERSUS INTRAVITREAL TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF DIABETIC MACULAR EDEMA

To compare the efficacy and safety of intravitreal diclofenac versus intravitreal triamcinolone acetonide in the treatment of diabetic macular edema. Thirty-two eyes with diffuse diabetic macular edema were randomly allocated to intravitreal injection of 4 mg/0.1 mL of triamcinolone (Group 1: N = 16) or 500 μg/0.1 mL of diclofenac (Group 2: N = 16). Preoperative and postoperative visual acuity, intraocular pressure, and central macular thickness were recorded and compared between the 2 groups up to 12 weeks. Both groups showed statistically significant reduction in central macular thickness (triamcinolone: P = 0.02 and diclofenac: P = 0.01), without statistically significant difference between the 2 groups. Visual improvement was significant only in triamcinolone group (P = 0.05). However, the 2 groups showed no statistically significant difference in mean visual acuity or mean line improvement. Transient elevation of intraocular pressure occurred in 12.5% of the triamcinolone group. Diclofenac group showed statistically significant reduced intraocular pressure (P = 0.02). Intravitreal diclofenac is effective in the treatment of diffuse diabetic macular edema up to 12 weeks. Intravitreal triamcinolone and diclofenac appear to have comparable therapeutic effects on retinal thickness. The degree of visual improvement is higher with triamcinolone.