Radner Reading Charts Research Articles

The accuracy of reading speed measurement by stopwatch versus measurement with an automated computer program (rad-rd©).

To compare the reading time and reading speed measurements obtained with a stopwatch with those of an automated computer program for measuring reading speed and acuity (rad-rd© ; patent: AT 504635B1/10-2006). The rad-rd© was used (in conjunction with a PC and microphone) for the computer-based measurements. In rotation, each of four examiners took a turn reading the 12 sentences from one of the four RADNER Reading Charts to three other examiners, who served as stoppers. The stoppers simultaneously measured the reading time with a stopwatch while a fifth investigator used the rad-rd© to obtain computerized measurements. The stopwatch measurements were then statistically compared with the rad-rd© measurements. The mean reading time obtained with the stopwatch measurements was 4.34±0.57seconds (196.21±21.79wpm), versus 4.44±0.59seconds (192.24±22.20wpm) by computer measurement (r=0.84). Of the 144 stopwatch measurements, 97 (67.36%) were shorter, and 47 (32.64%) were equal to (n=5) or longer than the computer measurements. The mean difference for the shorter measurements was -0.17±0.1seconds (3.91% of the mean reading time), and the mean difference for the longer measurements was 0.11±0.1seconds (2.53% of the mean reading time). Most differences ranged from -0.1 to 0.1seconds (42.36%). The results did not differ significantly among the four stoppers. The rad-rd© is an accurate, automated computer program for measuring reading time. Stopwatch measurements, although subject to inaccuracy from several sources, remain a reliable and simple method for analysis of reading performance.

Distinguishing between Better and Worse Visual Acuity by Studying the Correlation with Quality of Life in Neovascular Age-Related Macular Degeneration

To determine whether there is a level of visual acuity (VA) in neovascular age-related macular degeneration (nAMD) above which the correlation of VA with disease-related quality of life (QoL) is significantly greater than below this level. An observational, cross-sectional study. A total of 184 patients with nAMD aged at least 50 years were included in the study. In face-to-face interviews, we assessed QoL with the Macular Disease-Dependent Quality of Life (MacDQoL) questionnaire. We measured VA with standardized Radner reading charts. We used regression splines analysis with a single hinge point, with the MacDQoL score as the dependent variable and VA as the independent variable. The x-coordinate (VA) of the hinge point was varied and tested with each iteration. A second method of regression splines analysis was also performed, without a preset hinge point. The primary outcome measure is the cutoff point at or below which VA is associated with significantly less change in QoL than above this cutoff. The linear coefficients below and above the cutoff are defined as change in MacDQoL score per logarithm of the minimum angle of resolution (logMAR) unit of change in VA. With Snellen equivalent VA 0.05 (1.3 logMAR) or worse, the linear coefficient was 0.15. With VA better than 0.05, the linear coefficient was 2.40 (P value of the difference: 0.009). When VA is above 0.05, there is a stronger and significant relation between VA and QoL. At or below this level, the relation between VA and QoL approaches zero. With better VA, a difference in VA implies a significant difference in QoL. With poorer VA, a difference in VA is unlikely to imply a difference in QoL. Therefore, in treating nAMD, the aim should be to keep Snellen VA above 0.05 to have an impact on QoL. If it is certain that the best-corrected VA below 0.05 is permanent, these findings imply there may be less, if any, benefit to continue further treatment. This is to be evaluated on a case-by-case basis.

This issue of ACTA, printed and electronic

The cover illustration shows a variety of orbital implants that have been used following enucleation. This is discussed by Mourits et al in this issue of ACTA. Prins et al. in the Netherlands review the use of MRI imaging of the brain in eye disease. Structural changes in the visual pathways of the brain are seen in glaucoma, AMD and other eye diseases and might suggest a general neurological disorder. Yassin in Saudi Arabia reviews bleb-related infections following glaucoma filtering surgery. The prognosis is usually good if the infection is limited to the bleb but poor when endophthalmitis develops. de Vries et al. in the Netherlands report that the relatively few patients require glaucoma drainage surgery following vitreoretinal surgery. These patients were more likely to have history of glaucoma, many vitreoretinal operations and silicon oil. Tryggvason et al. in Norway, Iceland and USA examined the hearing of patients with glaucoma and/or exfoliation syndrome. Many individuals have hearing loss, and this was associated with age and male gender but not with glaucoma or exfoliation syndrome. Jonas et al. in Germany report thinning of Bruch's membrane in patients in secondary high axial myopia caused by congenital glaucoma. Timlin et al. in London recommend anterior segment OCT for diagnostic examination of lacrimal puncta. Ringvold and Reubsaet in Norway found that acetylcholine affects corneal epithelial cells in vitro and influences iron channels. Mourits et al. in the Netherlands evaluate complications from different types of orbital implants following enucleation for retinoblastoma. They recommend acrylic implants. Klingenstein et al. in Germany and USA examine microcirculation patterns and suggest that these may guide in differentiating uveal nevi from malignant melanomas. Munch et al. in Denmark and Austria validate the Radner reading chart for reading acuity and speed in a Danish cohort. Breukink et al. in the Netherlands recommend half-dose photodynamic therapy and subthreshold diode micropulse laser for chronic central serous chorioretinopathy. Haas et al. in Austria found no difference in pain during intravitreal injections with 27 and 30 gauge needles. However, 30 gauge needles were preferred by the surgeons. Segal et al. in Israel found an association between anxiety levels and perceived pain during intravitreal injections. Norn documents the history of ophthalmology in Denmark up to 1865. The following articles are published electronically only. They are accessible on www.actaophthalmologica.com, where you can find all published articles of ACTA from the beginning. Kim and Choi in Korea found that early postoperative overcorrection was associated with success in surgical treatment of intermittent exotropia. Creuzot-Garcher et al. in France examined elderly people over 75 years old and found visual impairment (visual acuity <0.3) in 2.3% and increasing to 5.6% in patients over 85 years old. Lee et al. in Korea associated the location of retinal nerve fibre layer defects with peripapillary atrophy in glaucoma patients. Kiliç et al. in Turkey found exfoliation syndrome in 5.7% of a Turkish population and this was associated with advancing age and male gender. Hayes et al. in UK recommend a modification of iontophoresis technique for riboflavin penetration into corneal stroma for cross-linking. Prakash et al. in the United Arab Emirates discuss the differences between central and non-central keratoconus in terms of corneal topography. GamalElDin et al. in Egypt recommend big-bubble technique for Descemet's endothelial grafts. Agrawal et al. in UK and Singapore propose a classification for semi-automated laser flare readings in uveitis. Gupta et al. in Singapore suggest that the visibility of choroidal–scleral interface on OCT images influences choroidal thickness measurements. Fernández-Vigo et al. in Spain found the variation in anterior chamber depth to be associated with age, sex, spherical error, corneal diameter and anterior chamber angle. Njikam et al. in Kenya, Cameroon and Germany report on the epidemiology of diabetic retinopathy in Cameroon. Sansom et al. in UK found an association between systolic blood pressure and ocular perfusion pressure with subfoveal choroidal thickness. Vannozzi et al. in Italy report cytomegalovirus retinitis in a patient who received a dexamethasone implant. Barteselli et al. in Italy and USA report transient structural abnormalities of the retina following intravitreal ocriplasmin injection. Suh and Kee in Korea examined long-term outcome of patients with congenital glaucoma and found that many need reoperation. Mulder et al. in the Netherlands and Belgium suggest shallowing of the anterior chamber to protect the crystalline lens during vitrectomy. Kessel et al. in Denmark discuss early results from preoperative scoring of cataract patients. Mazeikaite et al. in Lithuania and USA report elevated levels of antiphospholipid antibodies in patients with pseudoexfoliation syndrome. Alberti and la Cour in Denmark compare treatment of macular holes with vitrectomy and ocriplasmin. More macular holes are closed after vitrectomy but visual acuity outcomes are similar. Cennamo et al. in Italy recommend transpupillary thermotherapy for choroidal haemangioma. I hope you find This Issue of ACTA informative and interesting.

Development of the Portuguese version of a standardized reading test: the Radner-Coimbra Charts.

To develop 27 short sentence optotypes for the Portuguese version of the Radner Reading Charts. Thirty-four Portuguese sentences were constructed following the concept of the Radner Reading Charts to obtain highly comparable sentences in terms of lexical difficulty, syntactical complexity, word length, number of syllables, and position of words. A long text (106 words) at the 5th grade reading level was also tested to assess the validity of the reading speeds obtained with the short sentences. The short sentences and long text were tested in 50 volunteers with similar educational backgrounds (mean age 30.98 years ± 6.99 years, range 19-47 years). Reading speeds were measured with a stop-watch and reported as words per minute (wpm). The reading time for each of the short sentences to be selected for the chart was defined as falling within the range of the mean ± 0.40 × standard deviation (SD). The overall mean reading speed for each of the short sentences was 235.43 ± 36.39 wpm. The 27 sentences with a mean between 220.8 and 250.0 wpm (overall mean ± 0.40 × SD) were selected for construction of the reading charts. The mean reading speed for the long text was 212.42 ± 26.20 wpm. Correlation between the selected short sentences and long text was high (r =0.86). Reliability analysis yielded an overall Cronbach's alpha coefficient of 0.97. The 27 short Portuguese sentences were highly comparable in terms of syntactical structure, number, position and length of words, lexical difficulty, and reading length. This reading test can overcome the limitations of the current tests for homogeneity and comparability, reducing subjectivity in the evaluation of the functional outcomes of medical and surgical ophthalmologic treatments.

The Danish version of the Radner Reading Chart: design and empirical testing of sentence optotypes in subjects of varying educational background.

To develop 28 short texts to be used as sentence optotypes in a Danish version of the Radner Reading Chart for the measurement of reading acuity and speed. Forty-six short texts of comparable lexical and grammatical difficulty were constructed. The short texts were tested together with two longer reference texts in 100 persons with visual acuity 6/6, of which 50 were university students (age: 24.7 ± 3.1 years, 36% males) and 50 were blue-collar workers (37.2 ± 13.4 years, 54% males). Study parameters were mean reading speed and error rate per participant, and mean reading time, variance and number of errors per short text. The students read the short texts faster than the blue-collar workers (184 ± 21.4 words per minute (wpm) versus 163 ± 26.3 wpm, p < 0.0001). There was a high correlation between the reference texts and the short texts [Pearson's correlation coefficient = 0.89 (95% CI 0.83-0.92)]. The mean reading time for each of the short texts ranged from 4.4 s to 5.8 s with a mean of 4.96 ± 0.35 s, and the median number of errors was eight. Twenty-eight short texts were selected for sentence optotypes with mean reading times between 4.6 s and 5.2 s, a mean standard deviation of 1.2 s or less and a number of errors of 17 per 100 persons or less. Reading time uniformity in the Danish version of the Radner Reading Chart was comparable to that of the original German version. Education had an influence on reading performance that may warrant stratification for this parameter when reading tests are used in clinical trials.

Effect of pseudophacic mini-monovision as an option for independence of spectacles in everyday life

Modern day patients who undergo bilateral cataract surgery expect to be spectacles-independent after surgery. The options that are available to attain this goal are pseudophakic monovision, implanting multifocal IOLs or alternatively accommodative IOLs. The aim of this study is to establish the suitability in daily life when attaining minor monovision, named hereafter mini-monovision. In this clinical retrospective study 30 patients were examined. These subjects where bilaterally pseudophake and received either AcrySof®-IOL or Acreos® Adapt-IOL with a slight anisometropia of between 0.5 and 1.75 D and with a maximal astigmatism up to 1.5 D. Visual acuity (VA) for distance (ETDRS), intermediate (Jaeger 80 cm) and near (Jaeger 40 cm) as well as defocus curves were assessed. Furthermore were examined: the reading speed using the font size of the Radner reading chart, anisoconia (FA Oculus according to Esser), stereopsis (Titmus), subjective patient satisfaction (adapted VF-14-questionnaire) and the subjective dependence on having to wear spectacles. The median anisometropia was at 0.75 D; the age was between 61 and 80 (median being at 73 years). 12 patients were male and 18 female. When examined with binocular vision 100 % could attain distance VA of at least decimal 1.0 (LogMAR 0) and an intermediate VA of at least decimal 0.8 (LogMAR 0.1), up to 86.57 % a near VA of at least Jaeger 5, (LogMAR 0.4); up to 63.33 % even managed at least Jaeger 3 (LogMAR 0.3). The median average reading speed for binocular uncorrected reading under photopic conditions was 145 words/minute and under mesopic conditions 117 words/minute. The critical font size was LogRAD 0.60 (Jaeger 5-6), the anisoconia at 2 % and stereopsis at 80 arc seconds. The general dependence on glasses was reduced from 100 % preoperatively to 13 %, postoperatively. Simultaneously a high patient satisfaction score of 93.18 in the VF-14 questionnaire was attained. The result is comparable to those quoted in the literature on full monovision and mulitifocal IOLs. To attain spectacles independency, pseudophake mini-monovision is a cost efficient alternative to multifocal lenses for well selected patients. A relative reduction in near VA must be taken into account. To establish the refractive target further examinations are required. Establishing the accurate depth of vision will be helpful in attaining this.

Measurement properties of continuous text reading performance tests.

Measurement properties of tests to assess reading acuity or reading performance have not been extensively evaluated. This study aims to provide an overview of the literature on available continuous text reading tests and their measurement properties. A literature search was performed in PubMed, Embase and PsycInfo. Subsequently, information on design and content of reading tests, study design and measurement properties were extracted using consensus-based standards for selection of health measurement instruments. Quality of studies, reading tests and measurement properties were systematically assessed using pre-specified criteria. From 2334 identified articles, 20 relevant articles were found on measurement properties of three reading tests in various languages: IReST, MNread Reading Test and Radner Reading Charts. All three reading tests scored high on content validity. Reproducibility studies (repeated measurements between different testing sessions) of the IReST and MNread of commercially available reading tests in different languages were missing. The IReST scored best on inter-language comparison, the MNread scored well in repeatability studies (repeated measurements under the same conditions) and the Radner showed good reproducibility in studies. Although in daily practice there are other continuous text reading tests available meeting the criteria of this review, measurement properties were described in scientific studies for only three of them. Of the few available studies, the quality and content of study design and methodology used varied. For testing existing reading tests and the development of new ones, for example in other languages, we make several recommendations, including careful description of patient characteristics, use of objective and subjective lighting levels, good control of working distance, documentation of the number of raters and their training, careful documentation of scoring rules and the use of Bland-Altman analyses or similar for reproducibility and repeatability studies.

Design of short Italian sentences to assess near vision performance

PurposeTo develop and validate 28 short Italian sentences for the construction of the Italian version of the Radner Reading Chart to simultaneously measure near visual acuity and reading speed. Methods41 sentences were constructed in Italian language, following the procedure defined by Radner, to obtain “sentence optotypes” with comparable structure and with the same lexical and grammatical difficulty. Sentences were statistically selected and used in 211 normal, non-presbyopic, native Italian-speaking persons. The most equally matched sentences in terms of reading speed and number of reading errors were selected. To assess the validity of the reading speed results obtained with the 28 selected short sentences, we compared the reading speed and reading errors with the average obtained by reading two long 4th-grade paragraphs (97 and 90 words) under the same conditions. ResultsThe overall mean reading speed of the tested persons was 189±26wpm. The 28 sentences more similar in terms of reading times were selected, achieving a coefficient of variation (the relative SD) of 2.2%. The reliability analyses yielded an overall Cronbach's alpha coefficient of 0.98. The correlation between the short sentences and the long paragraph was high (r=0.85, P<0.0001). ConclusionsThe 28 short single Italian sentences optotypes were highly comparable in syntactical structure, number, position, and length of words, lexical difficulty, and reading length. The resulting Italian Radner Reading Chart is precise (high consistency) and practical (short sentences) and therefore useful for research and clinical practice to simultaneously measure near reading acuity and reading speed.

English sentence optotypes for measuring reading acuity and speed--the English version of the Radner Reading Charts.

To develop 28 short sentence optotypes for the English version of the Radner Reading Charts that are as comparable as possible in number and length of words, as well as in difficulty and syntactical construction. Thirty-four English sentences were constructed following the method used for other Radner Reading Charts to obtain "sentence optotypes" with comparable structure and the same lexical and grammatical difficulty. Best comparable sentences were statistically selected and standardized in 50 volunteers. Reading speed and the number of errors were determined. Validity was analyzed with a 124-word long 4th-grade paragraph of the Florida Comprehensive Assessment Test®. Computerized measurements of reading parameters were performed with the RADNER Reading Device (RAD-RD©; in conjunction with a PC and microphone). The mean reading speed obtained with the 28 selected short sentences was 201.53 ± 35.88 words per minute (wpm), as compared to 215.01 ± 30.37 wpm for the long paragraph. The mean reading times were 4.30 ± 0.79s and 35.26 ± 4.85s, respectively. The mean number of reading errors was 0.11 ± 0.34. The correlation between the short sentences and the long paragraph was high (r = 0.76; p < 0.05; n = 50). Reliability analyses yielded an overall Cronbach's alpha coefficient of 0.9743. The present study indicates that the 28 selected English sentence optotypes are comparable in terms of both lexical difficulty as well as in reading length, and it demonstrates the validity and reliability of such sentences as test items for determining reading parameters such as reading acuity and speed.

A Randomized Controlled Trial Comparing Soft Contact Lens and Rigid Gas-Permeable Lens Wearing in Infantile Nystagmus

To perform the first randomized controlled trial comparing soft contact lens (SCL) with rigid gas-permeable lens (RGPL) wearing in infantile nystagmus (IN), using spectacle wear as a baseline. Randomized, controlled cross-over trial with an intention-to-treat design. A total of 24 participants with IN (12 idiopathic, 12 with albinism). Participants were randomized into 1 of 2 treatment arms receiving the following sequence of treatments (2-3 weeks for each treatment): (A) spectacles, SCL, RGPL, and spectacle wear; or (B) spectacles, RGPL, SCL, and spectacle wear. The main outcome measure was mean intensity of nystagmus at the null region viewing at 1.2 m. Secondary outcome measures included the same measure at 0.4 m viewing and across the horizontal meridian (measured over a ±30° range at 3° intervals) for distance and near. The nystagmus foveation characteristics were similarly assessed over ±30° and at the null region at 1.2 m and 0.4 m viewing. Visual outcome measures included best-corrected visual acuity (BCVA) at 4 m and 0.4 m, gaze-dependent visual acuity (GDVA) (i.e., visual acuity when maintaining gaze angles over a ±30° range at 10° intervals) at 4 m, and reading performance at 0.4 m derived from the Radner reading chart. There were no significant differences between SCL and RGPL wearing for any nystagmus characteristics or compared with spectacle wearing. The BCVA, reading acuity, and critical print size were significantly worse for SCL wearing compared with RGPL and baseline spectacle wear (P<0.05), although mean differences were less than 1 logarithm of the minimum angle of resolution (logMAR) line. Nystagmus was not significantly different during SCL and RGPL wearing in IN, and contact lens wearing does not significantly reduce nystagmus compared with baseline spectacle wearing. The wearing of SCL leads to a small but statistically significant deterioration in visual function compared with both RGPL and spectacle wearing at baseline, although mean effect sizes were not clinically relevant.

Clinical Outcomes with a New Trifocal Intraocular Lens

To evaluate visual and refractive outcomes, contrast sensitivity, and quality of vision after cataract surgery with the implantation of a new modality of trifocal intraocular lens (IOL). This case series comprised 30 patients who had bilateral implantation of the AT.LISA tri 839 MP trifocal IOL after phacoemulsification for either cataract or refractive lens exchange surgery. Uncorrected (UDVA) and corrected monocular distance visual acuity (CDVA) using a logMAR chart, binocular uncorrected (UNVA) and corrected near visual acuity (CNVA) (40 cm and patients' preferred distance) using the Radner Reading Charts, distance-corrected intermediate visual acuity (DCIVA) (70 cm), a binocular defocus curve, contrast sensitivity (CS) with the Pelli-Robson test, and subjective quality of vision by a short questionnaire were evaluated at 1, 3, and 6 months postoperatively. At 6 months, mean values of 0.05 ± 0.07 and -0.02 ± 0.05 logMAR were obtained for monocular UDVA and CDVA, respectively. Mean values of 0.16 ± 0.07, 0.12 ± 0.07, and 0.16 ± 0.07 logRAD were obtained for binocular UNVA, CNVA, and DCIVA, respectively. Significant changes were only detected in monocular CDVA (p<0.01) and UDVA that improved between 3 and 6 months postoperatively (p = 0.01). A visual acuity level of 0.2 logRAD could be seen in binocular defocus curves between +1.00 and -3.00 D. At 6 months, mean photopic and mesopic CS were 1.52 ± 0.11 and 1.54 ± 0.11. Regarding the questionnaire, almost all patients were satisfied with their distance, intermediate, and near vision. Difficulties associated with photic phenomena decreased significantly over time. The AT.LISA trifocal IOL provides excellent uncorrected distance, intermediate, and near visual outcomes.

Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions

To compare changes in reading performance parameters after implantation of 4 multifocal intraocular lens (IOL) models and a monofocal IOL. Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria. Prospective randomized controlled clinical trial. Patients with bilateral cataract without additional ocular pathology were scheduled for bilateral implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, AT LISA 366D diffractive multifocal, Tecnis ZMA00 diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral corrected and uncorrected reading acuity, reading distance, mean and maximum reading speeds, and smallest log-scaled print size of a Radner reading chart were evaluated under bright lighting conditions (500 lux) using the Salzburg Reading Desk. Pupil size was not measured throughout the trial. The minimum follow-up was 12 months. The diffractive multifocal groups had significantly better uncorrected reading acuity and uncorrected smallest print size than the monofocal and refractive multifocal groups 1, 6, and 12months postoperatively. The diffractive IOL groups had comparable uncorrected reading distance of approximately 32 cm, which was larger in the monofocal group (38.9 ± 8.4 cm) and refractive multifocal group (37.1 ± 7.3 cm) at the last visit. Patients with diffractive IOLs could read print sizes of approximately 0.74 to 0.87 mm, which was much better than in the monofocal and refractive multifocal groups. The diffractive AT LISA IOL provided the best reading speed values (mean and maximum, corrected and uncorrected). Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL. Drs. Grabner and Dexl were patent owners of the Salzburg Reading Desk technology (now owned by SRD-Vision, LLC). No other author has a financial or proprietary interest in any material or method mentioned.

Reading performance and patient satisfaction after corneal inlay implantation for presbyopia correction: Two-year follow-up

To evaluate change in reading performance parameters after monocular Kamra corneal inlay implantation for the surgical correction of presbyopia. University surgical outpatient center. Prospective interventional case series. A corneal inlay was implanted in the nondominant eye. Naturally emmetropic and presbyopic patients between 45 years and 60 years old with an uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion. Bilateral uncorrected reading acuity, reading distance, mean and maximum reading speed, and the smallest log-scaled print size (lower case letter of a Radner reading chart) were evaluated using the Salzburg Reading Desk. The minimum postoperative follow-up was 24 months. Twenty-four patients were enrolled. The mean reading distance was 46.7 cm ± 6.3 (SD) preoperatively and 39.5 ± 6.4 cm 24 months postoperatively (P<.001). The mean reading acuity at best distance improved (0.33 ± 0.13 logRAD versus 0.23 ± 0.11 logRAD) (P=.004). The mean reading speed increased from 141 ± 20 words per minute (wpm) to 146 ± 20 wpm, respectively (P=.261), and the mean maximum reading speed from 171 ± 28 wpm to 180 ± 22 wpm, respectively (P=.110). The smallest print size improved from 1.50 ± 0.42 mm to 1.01 ± 0.22 mm, respectively (P<.001). Improving the depth of focus by monocular implantation of a small-aperture optic caused statistically significant changes in all tested reading performance parameters except reading speed metrics in emmetropic presbyopic patients.

Reading Performance After Implantation of a Modified Corneal Inlay Design for the Surgical Correction of Presbyopia: 1-Year Follow-up

To evaluate change in different reading performance parameters after monocular ACI7000PDT corneal inlay implantation for the improvement of near and intermediate vision. Prospective, interventional case series. Twenty-four patients were scheduled for corneal inlay implantation in the nondominant eye in a university outpatient surgery center. Naturally emmetropic and presbyopic patients between 45 and 60 years of age, with uncorrected distance visual acuity of at least 20/20 in both eyes, without any additional ocular pathology were eligible for inclusion. Bilateral uncorrected reading acuity, mean and maximum reading speed, and smallest log-scaled print size were evaluated with the standardized Radner Reading Charts. Measurements of reading parameters and reading distance were performed with the Salzburg Reading Desk (SRD). Minimum postoperative follow-up was 12 months. The reading desk results showed significant changes in each parameter tested. After 12 months the mean reading distance changed from the preoperative value of 46.7 cm (95% CI: 44.1-49.3) to 42.8 cm (95% CI: 40.3-45.3, P < .004), and the mean reading acuity "at best distance" improved from 0.33 logRAD (95% CI: 0.27-0.39) to 0.24 logRAD (95% CI: 0.20-0.28, P < .005). Mean reading speed increased from 141 words per minute (wpm, 95% CI: 133-150) to 156 wpm (95% CI: 145-167, P < .003), maximum reading speed increased from 171 wpm (95% CI: 159-183) to 196 wpm (95% CI: 180-212, P = .001), and the smallest print size improved from 1.50 mm (95% CI: 1.32-1.67) to 1.12 mm (95% CI: 1.03-1.22, P < .001). After ACI7000PDT implantation, there were significant changes in all tested reading performance parameters in emmetropic presbyopic patients. These 1-year results indicate that the inlay seems to be an effective treatment for presbyopia.

Subjective perception versus objective outcome after intravitreal ranibizumab for exudative AMD

The efficacy of ranibizumab in preserving visual acuity in exudative age-related macular degeneration (AMD) has been widely demonstrated. However, statistically significant improvements in outcome measures such as best-corrected visual acuity (BCVA) may not necessarily be clinically relevant. Clinical relevance can be assumed when the treatment success is perceivable for the patient. We therefore investigated the relation between subjective perception of the treatment success and the objective outcome after intravitreal ranibizumab treatment. In this prospective interventional case series, patients received three monthly ranibizumab injections for exudative AMD. To assess the subjective study outcome (SSO) 4weeks after the third injection, patients had to grade the overall trend of visual quality in the treated eye since baseline. Objective changes of functional (BCVA measured with ETDRS reading charts; reading visual acuity (RVA) and reading speed measured with Radner reading charts) and morphological parameters (central retinal thickness measured with OCT) were evaluated. Agreement between SSO and objective parameters was assessed with nonparametric statistical tests. Seventy-four eyes of 74 patients were analyzed. Mean BCVA increased from 55 (SD ±13) ETDRS letters by +3.16 letters (SD ±11.99, p = 0.03). Mean RVA (measured as logRAD score) increased by -0.067 (SD ±0.294, p = 0.052). Fifty patients (68%) perceived a subjective improvement, 16 (21%) no change, and eight (11%) a worsening in the study eye (SSO). SSO was independent of whether treating the better- or worse-seeing eye (p = 0.83). SSO was significantly correlated with BCVA, RVA, and reading speed (as assessed using the critical print size (CPS)) changes (p = 0.002, p < 0.001, and p = 0.002), but showed no correlation to central retinal thickness changes (p = 0.783). Patients gaining ≥ +5 ETDRS letters had a significantly better SSO (p = 0.001). The rate of subjective improvement increased distinctly to >80% among patients gaining ≥ +7 letters. In this study, 2/3 of patients reported a subjective improvement from ranibizumab injections. Patients' perception was significantly correlated with objective changes in BCVA and reading visual acuity. Our data indicate that the mean threshold for perceived improvement is a +5 to +7 letter gain, which might accordingly be considered clinically meaningful and relevant. Patients' perception was independent of whether the better- or worse-seeing eye was treated.

Multifocal intraocular lens with a surface-embedded near section: Short-term clinical outcomes

To evaluate the visual and refractive outcomes and quality of life after implantation of a multifocal intraocular lens (IOL) with a surface-embedded near section. Private practice, United Kingdom. Case series. This study comprised patients who had implantation of a Lentis Mplus multifocal IOL after phacoemulsification. The main outcome measures were refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities (logMAR), uncorrected (UNVA) and corrected (CNVA) near visual acuities (M notation), reading speed (Radner reading chart), contrast sensitivity (Pelli-Robson), and Quality of Life Impact of Refractive Correction (QIRC) questionnaire scores. A +3.00 diopter (D) reading addition (add) IOL was placed in the nondominant eye and a +1.50 D add IOL in the dominant eye. The study enrolled 44 eyes of 22 patients (mean age 59.9 years). The mean values 3 months postoperatively were UDVA, 0.04 logMAR ± 0.25 (SD); contrast sensitivity, 1.57 ± 0.13 logCS; near vision, M0.75 ± 0.33 at 32 cm and M0.90 ± 0.27 at 66 cm; reading speed, 161.74 words/minute; sphere, 0.08 ± 0.58 D; astigmatism, -0.60 ± 0.50 D; CDVA, -0.08 ± 0.07 logMAR. With best correction, intermediate (66 cm) and near (32 cm) vision were M0.89 ± 0.26 and M0.74 ± 0.32, respectively. The mean binocular UNVA at the preferred viewing distance was M0.57 ± 0.18, improving to M0.54 ± 0.19 with distance correction. The mean QIRC score improved from 42.15 ± 4.66 to 51.14 ± 8.22. Postoperative visual acuity was good with high-level contrast sensitivity, producing significant improvement in quality of life.

Feasibility of the Radner Reading Charts in low-vision patients

Being unable to read is a major problem for visually impaired patients. Since distance visual acuity (VA) does not adequately reflect reading ability, it is important to also evaluate near VA. The Radner Reading Charts (RRCs) are available to measure patients' reading performance. The present study tested the inter-chart and test-retest reliability of the RRCs in Dutch low-vision patients (i.e., visual acuity ≥0.3 logMAR) with various eye disorders. Thirty-eight patients read the three RRCs in random order. Then, about 1 month after the initial measurements, a test-retest procedure was performed in 15 of the 38 patients. Tested variables were reading acuity (logRAD), logRAD score, logRAD/logMAR ratio, maximum reading speed (MRS), and critical print size (CPS). Both MRS and CPS were calculated in two different ways. To determine the variability, a mixed-model analysis was used. For all variables, the largest part of the variance was explained by the individual subject (86-89%) whereas the chart accounted for only 0-0.78% of the variability. Therefore, the inter-chart and test-retest reliability was high, except for the CPS which had a poor to moderate reliability (31-62%) when calculated in the two different ways. The inter-chart and test-retest results showed high reliability in patients with low vision due to various diseases; therefore, the charts are feasible to determine effects in large groups.

Device for Improving Quantification of Reading Acuity and Reading Speed

To present a new device, the Salzburg Reading Desk (SRD), for the standardized testing of reading acuity and reading speed at a subjectively convenient reading distance (best distance). First, in a systematic experimental setup, testing for validity and reliability was performed at 450 simulated reading distances (90 different test situations, each repeated 5 times) between 16 and 70 cm. The distance read-outs by the SRD software were correlated to the distances measured with a meter ruler. Second, reading distance and reading speed of 27 naturally emmetropic and presbyopic patients were evaluated using the log-scaled Radner Reading Charts implemented in the SRD. In the experimental setup, an overall mean difference of the SRD distance read-out-compared to a standard distance measurement with a meter ruler-of 0.08±0.13 cm was observed. In the presbyopic patients, overall mean reading distance was 49.74±4.43 cm. Patients were able to read with their own subjectively convenient reading distance. A constant mean reading speed of sentences with bigger typeface (between 152.4±22.6 words/minute [wpm] and 157.3±15.8 wpm) was found, but reading speed gradually diminished over time when reading sentences with smaller typeface. The SRD seems to be a valid and reliable device for testing reading acuity at the best reading distance in an experimental setup as well as in clinical use in presbyopic patients. The SRD may be used whenever a detailed comparison of different methods for correcting presbyopia is required.

To the Editor: Reliability Testing of the Dutch Version of the Radner Reading Charts

To the Editor: Reliability Testing of the Dutch Version of the Radner Reading Charts

Reliability Testing of the Dutch Version of the Radner Reading Charts

To statistically analyze the test-retest and inter-chart reliability of the newly developed actual logarithmically scaled Dutch Radner Reading Charts in an older population affected by macular disease. These Dutch Radner Reading Charts are developed according to the strict principles of sentence construction of the originally German language Radner Reading Charts. Thirty-six subjects aged 50 years or older and affected with a macular disease monocularly read the three charts of the Radner Reading Charts in a randomized order twice with 1 month in between. The subjects were divided into three groups according to their distance logMAR visual acuity (group 1, > or =0.1; group 2, 0.12 to 0.4; and group 3, 0.42 to 0.8). Reading acuity (logRAD, the reading equivalent of logMAR), logRAD score, maximum reading speed, critical print size, and logRAD/logMAR ratio were measured. Variance component analysis was used to determine the sources of variability. The test-retest and inter-chart reliability was high for all visual acuity groups and variables. For all groups together the chart accounted for maximal 5% of the total variability for all measurements. The individual subject did have the largest influence on the measurements (88 to 98% of the variability). The Dutch version of the Radner Reading Charts provided high reliable test-retest and inter-chart measurements of reading performance in a heterogeneous group of subjects with subnormal to low vision. This study also showed that the strict principles of sentence construction of the originally German Radner Reading Charts may also be successfully used for other languages.