Reading Small Print Research Articles

Forensic Hypoglycaemia & Neuroglycopenia — A Clinical Legal Social Endocrinology Challenge for 2024, Forensic Law in Hypoglycaemia 4

Forensic Hypoglycaemia & Neuroglycopenia — A Clinical Legal Social Endocrinology Challenge for 2024, Forensic Law in Hypoglycaemia 4

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry.

To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US. This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL). Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty. Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

Accuracy and stability of accommodation and vergence responses during sustained near tasks in uncorrected hyperopes

This study investigated the accuracy and stability of accommodative and vergence functions in children with and without hyperopia while engaged in two sustained near tasks. The sustained accommodative and vergence characteristics of participants without refractive correction (n = 92, aged 5–10 years) with and without hyperopia (defined as cycloplegic retinoscopy ≥ + 1.00D and less than + 5.00D) were measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular measures of accommodation and eye position were recorded while participants engaged in 2 tasks at 25 cm for 15 min each: (1) reading small print on an Amazon Kindle and (2) watching an animated movie on liquid crystal display screen. Comprehensive visual assessment, including measurement of presenting visual acuity, amplitude of accommodation, and stereoacuity was conducted. The magnitude of accommodative and vergence responses was not related to refractive error (P > 0.05). However, there were inter-task differences in the accuracy and stability of the accommodative responses across refractive groups (P < 0.05). The relationship between accommodation and vergence was not significant in both tasks (P > 0.05). However, increased accommodative and vergence instabilities were associated with total accommodative response (P < 0.05). Despite having greater accommodative demand, uncorrected hyperopes accommodate comparably to emmetropic controls. However, uncorrected hyperopes have increased instabilities in their accommodative and vergence responses, which may adversely impact their visual experience.

"Power" ful eye causing postoperative blurring of vision after non-ocular surgery under general anesthesia.

Dear Editor, Ocular complications can occur in patients following non-ocular surgeries under general anesthesia which range from transient blurring of vision to irreversible blindness.[1] We report a case where preexisting hypermetropia was the cause of postoperative blurring of vision. A 38-year-old man with no comorbidities was posted for laparoscopic orchidectomy for right undescended testis. Preoperative evaluation revealed no abnormalities. General anesthesia was induced with fentanyl 100 mg, propofol 120 mg, atracurium 30 mg, and intubated with 8 mm endotracheal tube. Anesthesia was maintained with oxygen, air, sevoflurane and atracurium 5 mg, and fentanyl 50 mg. Opticlude eye patch (3M India) was used to gently close the eyes during surgery. Surgery in supine position lasted for 1 h and was uneventful. After reversal with neostigmine 2.5 mg and glycopyrrolate 0.5 mg, the patient was extubated. Postoperative recovery was uneventful. 24 h later in the ward, the patient complained of blurring of vision in both eyes while viewing a mobile phone. Ophthalmologist’s opinion was taken. Anterior segment examination including cornea was normal in both eyes. Fundus examination and extraocular movements were normal in both eyes. Uncorrected Snellen’s visual acuity for distance was 6/12 right eye and 6/6 left eye and uncorrected near visual acuity was N6 in both eyes. On refraction testing, the patient had simple hypermetropia of + 1.5 diopters in the right eye and no refractive error in the left eye. On questioning, the patient accepted that he had some difficulty while reading small print even before the surgery but never visited an ophthalmologist. The patient was reassured and glasses were prescribed for hypermetropia following which the blurring of vision resolved. The causes of postoperative blurring of vision after non-ocular surgeries can range from simple corneal abrasion to serious retinal vascular occlusions and ischemic optic neuropathy.[2,3] Our patient complained of blurring of vision postoperatively. We ruled out corneal abrasion and other serious ocular causes. To our surprise, he had hypermetropia which was corrected with spectacles. In a study by Warner et al.[4] on 671 patients undergoing non-ocular surgery under anesthesia, 4.2% of patients experienced new-onset blurred vision of at least 3 days duration postoperatively. In most of them, it resolved spontaneously over weeks. 25% of patients with blurred vision required new corrective lens or changes to existing lens over the next 18 months. The authors found no significant risk factors. Our patient had hypermetropia preoperatively itself which got unmasked after surgery. Preexisting refractive errors can get exaggerated following surgical stress due to transient accommodative weakness and can cause blurring of vision postoperatively. Due to limited mobility in the postoperative period, patients commonly watch mobile and read books for a prolonged time. This constant focus on simple visual tasks may cause patients to notice any small change in their vision. Further studies are required to know the incidence and risk factors for the transient postoperative blurring of vision from refractive errors. It is also important to enquire about the difficulty in vision for both near and far during preanesthetic checkup in all patients coming for surgery as medicolegal documentation. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Impact of Dry Eye Diseases in Daily Life: A Review Study in a Tertiary Care Hospital in Dhaka

Background: Now a day, dry eye disease (DED) is one of most common ocular disease and reason for primary eye care visit worldwide. Dry eye disease should be considered as an important public health problem deserving increased attention. As a rising public health concern, dry eye disease causing ocular distress, fatigue and visual disturbance that obstructs with quality of life, including aspects of physical, social, psychological functioning, daily activities as well as workplace productivity. Objective: The objective of this study was to assess the effect of dry eye disease on daily life and activities of the patients with dry eye diseases. Materials and Methods: This was a prospective observational study, conducted at the National Institute of Ophthalmology and Hospital (NIO &amp; H), Dhaka, Bangladesh during the period from January 2003 to December 2004. In total 43 patients of dry eye diseases of several ages with proper documents were finalized as the study population. The study was approved by the ethical committee of the mentioned hospital. The proper written consents were taken from all the participants before starting the main part of intervention. Data were collected by predesigned questioner and analyzed by SPSS program. Results: We found the highest 30.23% (n=13) participants felt difficulties in driving at night. Besides this 27.91%(n=12), 25.58% (n=11), 20.93% (n=9), 18.60% (n=8), 11.63%(n=5), 9.30%(n=4), 6.98%(n=3), 4.65%(n=2), 4.65% (n=2), participants felt difficulties in reading small print out, reading newspaper, fill-up printed forms, viewing road signs, watching television, navigating stairs, cooking, playing chess/cards and driving at daytime respectively. In this study we found, among all the participants 3(6.98%) felt major difficulties, 8(18.60%) felt minor difficulties and 32(74.42%) felt no difficulty in reading newspaper. Conclusion: In this study, we found that symptomatic dry eye was significantly associated with a reduced ability .........

Visual Function of Myopic Students Wearing Contact Lens and Spectacles

Myopia people use contact lenses and spectacles as a visual aid. Measuring the suitability of the measure of visual impairment from contact lenses and spectacles is not enough to be assessed from visual acuity and visual field measurements alone, but also needed subjective patient-based visual function assessments, namely the VF-14 questionnaire. A total of 40 students were involved in this study. All of the participants were given the VF-14 questionnaire twice: for visual function using contact lenses; and visual function using spectacles. The mean VF-14 score among contact lenses and spectacles wearer were 90.63±2.96 and 93.04±2.45respectively. There were significant differences visual function between contact lens and spectacles wearer (p = 0.00) especially in reading small print activity; reading signs; watching TV; playing table games; cooking; driving during the day; and recognizing people at distance. Thus, it can be concluded that participants with low and moderate myopia, both contact lens and spectacle users, had visual function with mild and minimal disturbances. The visual function of spectacles is better for distant viewing activities and detailed work, while contact lenses are better for viewing activities at medium distances.

Evaluation of Vision-Related Quality of Life After Unilateral Implantation of a New Trifocal Intraocular Lens.

Objectives:The objective of the study was to evaluate visual performance and subjective quality of life after unilateral implantation of a new trifocal intraocular lens (IOL) in young and middle-aged patients.Methods:Patients that underwent unilateral cataract surgery with implantation of trifocal TFNT00 IOL with an emmetropic fellow eye were included in the study. Vision related daily activity performance was evaluated in postoperative 6th month. Patients were divided in two groups according to the uncorrected near visual acuity of their fellow eyes: İn Group I if worse than the operated eye and in Group II if equal or better than the operated eye. The visual function-14 (VF-14) questionnaire was used with scores of 4 with no difficulty, 3 points with mild difficulty, 2 points with moderate difficulty, 1 point with severe difficulty, and 0 point if unable to perform.Results:Twenty-one patients were enrolled in this study. Patients had good visual performance, showing VF-14 scores above 3 in all categories. Reading small print (3.67±0.48) and driving at night (3.67±0.48) were found to be the most difficult tasks to perform. No significant difference was found between two groups in any category that was investigated by the VF-14 questionnaire.Conclusion:Unilateral implantation of TFNT00 trifocal IOL is well tolerated with good patient satisfaction assessed by VF-14 questionnaire in subjects that have cataract in one eye, encouraging single-eye surgical procedure in this particular group of patients.

Development of the Near Vision Presbyopia Task-based Questionnaire for use in evaluating the impact of presbyopia

BackgroundPresbyopia is a progressive condition that reduces the eye’s ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed.ResultsTo explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach’s coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes.ConclusionsThis research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability.Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1.

Effect of age and font on reading ability

To inform our knowledge of the typographical variables of stroke weight, letter width, and letter spacing, and their effects on different age groups and reading scenarios, we used Radner Reading Chart, where we measured reading speed at different sizes, to compare the fonts KBH Text, KBH Display, and Gill Sans Light. The experiment showed that for older participants, reading Gill Sans resulted in faster reading speed compared to KBH Text. However, Gill Sans could not be recognized at small sizes by either the younger or older participants. For critical print size (CPS), older participants were better at reading small print sizes at a regular reading speed when the text was set in KBH Text than when it was set in Gill Sans. The findings indicate that older readers are more sensitive to font legibility differences than younger readers. We discuss the implications of different reading scenarios putting different demands on the fonts as well as the perspective of older readers benefitting from certain visual qualities of fonts.

PENTOSAN POLYSULFATE AND VISION: Findings from an International Survey of Exposed Individuals.

To investigate patient-reported visual function among individuals taking pentosan polysulfate (PPS) for interstitial cystitis. A 27-item online survey was distributed to an international mailing list of individuals with interstitial cystitis in November 2018. Demographic characteristics, PPS exposure history, subjective visual function, and previous macular diagnoses were queried. The impact of PPS use, grouped by tertile of cumulative exposure, on visual function and macular diagnoses was assessed with multivariate logistic regression. The survey was completed by 912 respondents. Eight hundred and sixty-one (96.4%) were women, and the median age was 55 [interquartile range (IQR), 45-64 years]. Among PPS users, the median exposure was 547.5 g (IQR, 219-1,314 g). Respondents in the highest PPS exposure tertile were more likely to report difficulty with reading small print [adjusted odds ratio 2.29, 95% confidence interval (CI) 1.15-4.57] and to have a diagnosis of macular degeneration and/or pigmentary maculopathy (adjusted odds ratio 2.41, 95% CI 1.44-4.03) than unexposed respondents. In this large sample of individuals with interstitial cystitis, those in the highest PPS exposure category were more likely to have difficulties reading small print and to report a previous diagnosis of macular disease. Further study of objective measures of visual function in PPS users is warranted.

Correction of Low-Moderate Hyperopia Improves Accommodative Function for Some Hyperopic Children During Sustained Near Work.

PurposeThis study investigated whether refractive correction improved accommodative function of hyperopic children while engaged in two sustained near activities.MethodsSustained accommodative function of 63 participants (aged 5–10 years) with varying levels of uncorrected hyperopia (>/= +1.00 D and < + 5.00 D spherical equivalent in the least hyperopic eye) was measured using eccentric infrared photorefraction (PowerRef 3; PlusOptix, Germany). Binocular accommodation measures were recorded while participants engaged in 2 tasks at 25 cm for 15 minutes each: an “active” task (reading small print on an Amazon Kindle), and a “passive” task (watching an animated movie on liquid crystal display [LCD] screen). Participants also underwent a comprehensive visual assessment, including measurement of presenting visual acuity, prism cover test, and stereoacuity. Reading speed was assessed with and without hyperopic correction. Refractive error was determined by cycloplegic retinoscopy.ResultsHyperopic refractive correction significantly improved accuracy of accommodative responses in both task (pairwise comparisons: t = −3.70, P = 0.001, and t = −4.93, P < 0.001 for reading and movie tasks, respectively). Accommodative microfluctuations increased with refractive correction in the reading task (F(1,61) = 25.77, P < 0.001) but decreased in the movie task (F(1,59) = 4.44, P = 0.04). Reading speed also significantly increased with refractive correction (F(1,48) = 66.32, P < 0.001).ConclusionsCorrecting low-moderate levels of hyperopia has a positive impact on accommodative performance during sustained near activity in some schoolchildren. For these children, prescribing hyperopic correction may benefit performance in near vision tasks.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange

ABSTRACT Purpose To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients. Materials and methods This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV‑IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire). Results A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit. Conclusions The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study.

BackgroundPresbyopia is defined as the age-related deterioration of near vision over time which is experienced in over 80% of people aged 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery, or the use of a magnifying glass.ObjectiveThis study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life.MethodsSocial media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization, and clustering. Key themes relating to symptoms, impacts, treatment, and lived experiences were identified.ResultsA total of 4456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2229 (50.0%) posts for manual review, with 1470 (65.9%) of these 2229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1470, 38.0%) and the United States (426/1470, 29.0%). Of the relevant posts, 270/1470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%), and blurred vision (8/37, 21.6%). 81 of the 270 posts (30.0%) discussed impacts of presbyopia—emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%).ConclusionsFindings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals’ quality of life. The social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.

THE EFFECT OF CORNEAL TRANSPLANTATION ON VISUAL FUNCTION AND VISION-RELATED QUALITY OF LIFE

Introduction: The success of corneal transplantation surgery is usually determined by graft clarity, absence of complications such as rejection, low astigmatism, and good visual acuity. However, patients are often more concerned about their visual function and its impact on their activities of daily living which are determinants of vision-related quality of life (QOL). Currently it is agreed upon that the real success of a medical intervention can be measured by its effect on the quality of life.[1] The patients’ expectations may not be met, and they may still experience poor functional outcome despite successful corneal transplantion.[2] National Eye Institute Visual Function Index 14 (NEI VF-14) was designed and validated to assess vision-related functioning in patients undergoing cataract surgery, but it has also been validated for use with other eye conditions such as glaucoma, retinal, and corneal diseases.[3][4][5][6] The aim of this study was to assess the QOL and satisfaction of patients who underwent corneal transplantation by using the NEI VF-14. Patients and Methods: Survey data using a modified version of the VFI were collected at the 3rd postoperative month from 38 patients who underwent corneal transplantation in 2018 at Baskent University Faculty of Medicine. The questionnaire was administered by a trained researcher (LA) in a face-to-face manner. The grading was performed as follows: 0, no difficulty; 1, a little difficulty; 2, moderate difficulty; 3, quite difficult; 4, impossible to perform. Sociodemographic and clinical data, including age, sex, initial and follow-up visual acuities, were collected. QOL survey measures were compared with patients’ clinical findings to assess the differences between objective and subjective visual functioning. Results: Mean age of the patients was 54.5±11.4 years. All patients underwent an uneventful surgery and had no complications during follow-up (Figure 1).Fig. 1. Mean best corrected Snellen visual acuity was 0.32±0.21 preoperatively and increased to 0.56±0.24 at the end of the 3rd month. The results of the NEI VF-14 questionnaire are shown in Figure 2.Fig. 2. The most difficult tasks to perform were reading small print, reading traffic signs, doing fine handwork and driving at night. Although there was almost a twofold increase in mean visual acuity, most patients reported difficulty in daily activities with mean scores between 1.07 and 3.82 for different tasks. Discussion: Corneal transplantation patients face difficulties in many daily activities at the 3rd postoperative month and report a low QOL despite increase in vision. Studies have shown that depression is common among adults with visual impairment.[7] This is of relevance to corneal graft recipients and might be the reason for the reported low QOL after corneal transplantation. Conclusion: Corneal graft recipients should receive preoperative counselling helping them to gain a realistic expectation of the outcome following corneal transplantation.

Randomized Clinical Trial of Near Visual Performance with Digital Devices Using Spherical and Toric Contact Lenses.

Visual demands today incorporate a significant amount of time using digital devices. Results of this randomized crossover study of spherical and toric contact lenses demonstrated that participants were able to read smaller print size more comfortably and preferred toric contact lenses when using digital devices. The purpose of this study was to assess how toric contact lens correction affects subjective and objective outcomes of astigmatic patients using real-world digital devices. Adult participants, aged between 20 and 38 years with -0.75 to -1.50 D of astigmatism were enrolled in this double-masked randomized crossover 10-day study of Alcon Dailies Aqua Comfort Plus Sphere and Toric (Alcon, Geneva, Switzerland) contact lenses. Electronic high- and low-contrast near logMAR visual acuity and contrast sensitivity were tested. Reading performance was assessed using custom iPad applications; one used a reading sentences test, whereas the other analyzed zoom, contrast, and distance with website-based articles. Participants completed the Near Activity Visual Questionnaire and stated their preferred contact lens correction. Thirty seven participants were screened, 35 participants were enrolled, and 34 participants completed the study. Toric lens correction improved near high- and low-contrast visual acuity by 0.5 to 1 full line (P < .0001) and allowed participants to read one line smaller text on the iPad (P = .01). Participants increased the zoom 11% (P = .004) and the contrast 4% (P = .006) more with spherical lenses while reading articles. Participants held the iPad at approximately the same distance, about 33 cm (P = .63). Eighty five percent of participants preferred the toric correction (P < .0001). Participants reported improved satisfaction with toric lens correction (P = .0002) and noticed the most benefit with tasks such as reading small print and labels/instructions. This study used digital devices to demonstrate realistic benefits of toric contact lens designs for astigmatic patients.

Visual outcomes after surgery for childhood cataracts.

To describe long-term objective and subjective visual outcomes in a group of Danish children after cataract surgery. Follow-up examination of 56 children aged 7-18years who had undergone uni- or bilateral cataract surgery. Subjective visual function was assessed using the Cardiff Visual Ability Questionnaire for Children (CVAQC) and compared to objective visual acuity for distance and near, contrast vision and stereopsis. Better visual acuity on the better seeing and contrast vision on worst seeing eye were significant predictors of increased subjective visual function in a multivariate analysis, p=0.024. Children in the unilateral group had a significantly better CVAQC ratio compared to children in the bilateral group, median of 0.88 (range 0.50-1.00) versus 0.80 (range 0.55-0.98), p=0.027. Reading small print, playing ball games and seeing friends in the playground were the most difficult CVAQC items in the unilateral group and reading small print, seeing the board in the classroom and seeing friends in the playground were the most difficult in the bilateral group. Children with unilateral disease often have a healthy eye to support the operated eye, why they overall have better subjective visual function. Many of the most difficult visual tasks were related to academic activities which might hamper future academical capabilities.

PDB103 HUMANISTIC BURDEN ASSOCIATED WITH DIABETIC RETINOPATHY: EVIDENCE FROM A LITERATURE REVIEW

Diabetic Retinopathy (DR) is the most common microvascular complication of diabetes. Globally DR is the leading cause of visual impairment and blindness among working-age adults. The aim of this study was to review literature on the humanistic burden associated with DR. A targeted literature search was performed for studies published in English from database inception to January 2019 in Embase, MEDLINE, MEDLINE-In Process, and Cochrane library. Studies reporting on the humanistic burden in adult DR patients were included. The review identified 57 studies from 60 publications. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ 25) was the most frequently used instrument to assess vision related QoL (VRQoL). Literature findings indicated that DR has a significant negative impact on patients’ VRQoL, mental health, and activities of daily living (ADLs). VRQoL assessed using the NEI VFQ-25 showed significantly poorer QoL in DR patients compared to controls in the US (Proliferative DR [PDR] vs. controls: Mean score, 82.7 vs. 95.0), Japan (PDR vs. control: 52.8 vs. 85.0; p<0.0001), Sweden (PDR vs. control: 88.6 vs. 96.3), Australia (DR vs. control: 88.0 vs. 93.4) and India (DR vs. control: 73.9 vs. 99.2; p<0.0001). Generic QoL assessed using the SF-36 showed patients with DR had a worse physical component score to controls (77.1 vs. 84.1) whereas the mental component score was similar. In terms of ADLs, DR patients had greatest difficulty in reading small prints, labels and street signs compared to controls. An increased rate of depression (35% vs. 21.1%) was seen compared to controls and an inverse relationship between cognitive impairment and DR severity was observed. The presence of DR and visual impairment lead to significant impairment of VRQoL, physical components of HRQoL, ADLs and emotional well-being of patients. As impairment increases with disease severity, treatments that delay disease progression are warranted.

One-year clinical evaluation of rotationally asymmetric multifocal intraocular lens with +1.5 diopters near addition

We conducted a one-year prospective, multicenter study to assess clinical outcomes after implantation of segmented, rotationally asymmetric multifocal intraocular lenses (IOLs) with +1.5 diopters (D) near addition. In this phase III clinical trial, 120 eyes of 65 patients undergoing phacoemulsification and implantation of Lentis Comfort LS-313 MF15 (Oculentis GmbH) were included. The ophthalmological examinations were performed before and 1 day, 1 week, 1, 3, 6, 9, and 12 months after surgery. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 70 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 30 cm were measured. A defocus curve was obtained and patients were asked about the severity of photic phenomena. Postoperative distance and intermediate visual acuity was excellent, with UDVA, CDVA, UIVA, and DCIVA of approximately 20/20, 20/16, 20/25, 20/25 were attained, respectively. The level of near visual acuity was lower; UNVA and DCNVA remained at around 20/60 and 20/70, respectively. The defocus curve indicated that postoperative uncorrected visual acuity of 20/25 and 20/40 was obtained at as close as 67 cm and 50 cm, respectively. Contrast sensitivity was within the normal range, with a minimal level of subjective symptoms and high patient satisfaction. The rotationally asymmetric multifocal IOLs with +1.5 D near addition provided excellent distance and intermediate vision, but near vision was not enough for reading small prints. Contrast sensitivity was high, with very low incidences of photic phenomena and a high level of patient satisfaction.

Evaluation and comparison of quality of life in different categories of low vision

Objectives: To study the quality of life (QoL) in patients with low vision and comparison of QoL in patients with moderate and severe visual impairment. Material and Methods: Category 1 comprised of a total of 100 cases of low vision who belonged to category of moderate visual impairment and Category 2 comprised of a total of age matched 100 patients with low vision who belonged to the category of severe visual impairment.Results: Mean age of Category 1 patients was 59.26±12.61 years and 60.49±9.75 years in Category 2 (p> 0.05). Mean comparison of various questions asked related to IOL during the study period was found to be statistically significant, when compared between the two categories. It shows that Category 2 people have more difficulty in reading ordinary print in newspaper, seeing how people react to things, going to street festivals / fairs and accomplish less than they would because of their vision. They relied too much on others because of their eye sight. Based on NEI-VFQ-25, Category 2 people have more difficulty in reading small print in telephone book, on a medicine bottle, or on legal forms, reading and outdoor activities. Conclusion: Low vision affects quality of life of patients in both categories: Category 2 people have more difficulty in reading and outdoor activities to rely too much on other people because of their eye sight.

Idiopathic orbital inflammation: An unusual presentation of benign essential blepharospasm

A case of a 48-year-old man with recurrent twitching of the right eye associated with the drooping of the upper eyelid, ipsilateral periorbital headache and blurring of vision aggravated by direct exposure to strong sunlight. Eye examination revealed intermittent twitching of the right upper eyelid, mild restriction of range of motion (downward gaze) and difficulty reading small prints (presbyopia). Computed tomographic scan showed thickened right superior rectus muscle and tendons. Based on the clinical and neuroimaging abnormalities a diagnosis of right orbital myositic inflammation was made. Patient was given high dose oral corticosteroids and remarkable improvement in his symptoms was recorded after 6 weeks of treatment.