Reading Acuity Research Articles

Evaluating Reading Performance in Different Preferred Retinal Loci in Persian-Speaking Patients with Age-Related Macular Degeneration.

Purpose:To evaluate reading performance in different preferred retinal loci (PRLs) using a Persian version of a Minnesota Low Vision Reading (MNREAD) chart in Persian-speaking patients with age-related macular degeneration (AMD).Methods:In this cross-sectional study, 35 patients with AMD were assessed. The reading performance was investigated by the MNREAD chart without using low vision aids. The location of PRL was determined monocularly using an MP1 microperimeter (Nidek Technologies, Padua, Italy). The anatomical location of the fovea was determined using optical coherence tomography (OCT). Images were taken with the MP1 microperimeter, and Spectralis HRA-OCT device was processed using graphic software to determine the location of the PRL on the retina.Results:Thirty-five patients (51 eyes) with a mean age of 73.8 ± 7.7 years (range, 54–88 years) were assessed. Mean best corrected distance visual acuity (logMAR) was 0.65 ± 0.35 (range, 0.2–1.3). Mean levels of reading acuity (RA) (P = 0.009) and critical print size (CPS) (P = 0.015) were significantly different in different locations of PRL. Average scores of maximum reading speed (MRS) (P = 0.058) and reading accessibility index (ACC) (P = 0.058) were not statistically significant in different locations of PRL. There was a positive correlation between PRL-fovea distance and RA (P < 0.001, r = 0.591) and CPS (P < 0.001, r = 0.614). Significant negative correlations were observed between PRL-fovea distance and MRS (P < 0.001, r = −0.519) and ACC (P < 0.001, r = −0.545).Conclusions:This study provides evidence for differences in the reading performance of Persian-speaking patients with AMD in different PRL locations. The average scores of all reading indices obtained in the right-field PRL are lower than those in other areas and are highly correlated with the PRL-fovea distance.

Compromised Vision Impairs Successful Aging Among Assisted Living Residents

Community dwelling independent older adults’ successful aging is known to be hampered by sensory and cognitive impairments. However, little is known about to what degree these impairments affect successful aging among assisted living (AL) residents. The purpose of this quantitative study, conducted in three (AL) facilities, was to describe factors affecting successful aging. A total of 88 older adults (M=89.0, SD=7.54), mostly women (n=68), completed hearing (CALFRAST-Strong procedure at 75cm, 35cm, and 2cm), vision (Jaeger reading [proximate], Snellen Acuity [visual acuity]), and cognitive screening (MiniCog, Borson et al), as well as the Lawton Instrumental Activities of Daily Living (IADL) and Successful Aging Inventory (SAI, Troutman et al, 2011). Most (68%) demonstrated hearing loss >25DB, with a significant difference demonstrated between age groups (age 65-89; n=38) (90-100; n=49) with the older group demonstrating worse hearing (F(1,80)=5.9, p=.017). Some vision compromise was noted for both reading (14.3%) and visual acuity (10.8%). Over one third of participants (34.1%) demonstrated compromised cognition. The SAI results indicated most participants were managing IADLs well (M=6.11, SD=1.42) and aging successfully (M=63.39, SD=9.04). Hearing, cognition and IADLs were not significantly related to successful aging. However, when compared to those without vision issues, participants with compromised vision, both reading and visual acuity, scored significantly lower on the SAI (reading F(1,75)= 24.9,p=.000; visual acuity F(1,28)=4.31, p=000). The infrastructure provided by AL settings may compensate for hearing, cognition, and IADL problems, but not as well for vision problems. Interventions supporting AL residents’ vision should be a priority to improve successful aging.

Repeatability and Validity of MNREAD Test in Children With Vision Impairment.

PurposeTo evaluate the test–retest reliability and validity of the MNREAD test for use in children with vision impairment (VI) and to compare their performance on the test to that of normally sighted children.MethodsChildren with VI (n = 62) and without VI (n = 40) were administered the MNREAD test and the Basic Reading Inventory (BRI) on two study visits, 1 to 3 weeks apart. The maximum reading rate, critical print size, and reading acuity were determined for the MNREAD test, and test–retest reliability was evaluated. The reading rate for the MNREAD test was compared to the BRI results.ResultsStrong correlations between visits were found for all MNREAD parameters (0.68–0.99). Older, but not younger, children with VI read significantly more slowly on both the MNREAD and the BRI than children with normal vision (P < 0.05). Reading rates between the two tests were strongly correlated (r = 0.88). For the MNREAD test, the reading rate increased 4.4 words per minute (wpm) per year for VI and 10.6 wpm/y for those with normal vision. For the BRI, the reading rate increased by 5.9 wpm/y for VI and 9.7 wpm/y for those with normal vision. Poorer visual acuity was associated with slower reading rates on the MNREAD test but not on the BRI, as the MNREAD relies largely on visual factors but the BRI also relies on linguistic and grammar skills.ConclusionsThe MNREAD test are reliable and valid for use in children with vision impairment.Translational RelevanceThe MNREAD test can be utilized by clinicians, as they are a quick, easy-to-administer method for evaluating reading vision in children with VI.

Standardized ophthalmic tests for evaluating reading parameters: a brief historical review

In the review, the analysis of the most common ophthalmic standardized tests for evaluating reading was carried out: BaileyLovie Word Reading Charts, MNREAD Acuity Chart, Radner reading chart, SmithKettlewell Reading Test (SKread), IReST, Salzburg Reading Desk, Ramulu test, Radner paragraph optotypes, Balsam AlabdulkaderLeat (BAL) chart, Chinese Reading Acuity Charts (C-READ), chart for reading threshold and reading speed evaluation by T.S. Egorova. The following parameters were considered: maximum reading speed, reading threshold, reading acuity, reading accessibility index, threshold reading speed. Recovering the ability to read fluently is one of the criteria for assessing the success of treatment, as well as quality of life for patients of various age groups

Sensory function, cognition, and brain structure in SCD, MCI, and AD: Initial findings from the COMPASS‐ND Study

AbstractBackgroundThere is a strong relationship between sensory and cognitive function in older adults and impairment in hearing, vision, and olfaction are each independently associated with dementia. However, these have rarely been examined together in persons with dementia, nor their concurrent relationship with cognitive function and brain structure. The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS‐ND) study is a large‐scale study of older Canadians who are living with, or are at risk for, dementia, including those with subjective cognitive decline (SCD), mild cognitive impairment (MCI), Alzheimer’s disease (AD), other causes of dementia, and normal controls. We collect clinical and cognitive data, structural brain imaging, and measures of sensory function.MethodComplete sensory, cognitive, and brain imaging data have been released on participants with study diagnoses of SCD (n=35; 74% women, mean age = 69.4 years; mean education = 16.6 years), MCI (n=79; 49% women, mean age = 73.5 years; mean education = 15.5 years), and AD (n=21; 10% women, mean age = 75.9 years; mean education = 15.5 years).Hearing function was assessed by pure tone screening at 25 and 40 dB and with a computerized speech in noise perception task. Vision function was assessed by measuring reading acuity and contrast sensitivity. Olfaction was assessed with a 16‐item olfactory recognition test.ResultControlling for age, sex, and education, cognitive performance measures decreased over the groups (SCI&gt;MCI&gt;AD), as expected. The groups differed in contrast sensitivity and olfaction, but not hearing (audiometric category, perceiving digits in noise) or visual reading acuity. Poorer olfaction was associated with poorer auditory episodic memory and lower hippocampal volume. Poorer hearing thresholds were associated with lower right hippocampal volume in SCD participants. Within MCI participants, poorer hearing was associated with a disruption in the relationship between auditory episodic memory and a number of variables, including visual episodic memory and lateralized hippocampal volume.ConclusionThese results illustrate a complex interplay between sensory‐cognitive‐brain measures in older adults with or at risk for dementia and suggest that sensory status has important implications for brain structure and clinical status.

Introduction of a digital near-vision reading test for normal and low vision adults: development and validation

BackgroundMNREAD is an advanced near-vision acuity chart that has already been translated and validated in Greek language. Considering that no validated Greek digital near-vision test exists, our primary objective was to develop and validate a digital near-vision reading test based on the fundamental properties of the Greek printed MNREAD (MNREAD-GR).MethodsThis is a prospective, comparative study. A digital near-vision chart was developed (Democritus Digital Acuity Reading Test – DDART) with text size calibration, audio recording for automatic reading timing, as well as automatic calculation of reading acuity (RA), maximum reading speed (MRS), critical print size (CPS) and reading accessibility index (ACC). Normal and low vision subjects participated in the validation process, responding to MNREAD-GR and DDART at the same day, at a 40 cm viewing distance. Differences in all parameters between the charts were compared with t-test and intraclass correlation coefficients (ICCs). Within 15 days, all participants responded again to DDART in a different set of sentences to assess its test-retest reliability.ResultsOne hundred patients (normal vision group - NVG: 70 patients; low vision group - LVG: 30 patients) responded to both reading tests. Non-significant differences were detected for all parameters between DDART and MNREAD-GR except for MRS and ACC that were significantly higher in MNREAD-GR in NVG (p < 0.01). NVG participants demonstrated sufficient ICCs that ranged from 0.854 to 0.963, while LVG demonstrated ICCs for RA, ACC, MRS and CPS equal to 0.986, 0.894, 0.794 and 0.723, respectively. All parameters calculated with DDART demonstrated excellent test-retest reliability (ICCs: 0.903 – 0.956).ConclusionsThe proposed reading test presented comparable validity and repeatability to MNREAD-GR suggesting that it can be used both in normal and low vision Greek patients.Trial registrationClinicalTrials.gov, NCT04242836. Registered 24 January 2020 – Retrospectively registered.

Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma

ABSTRACT Purpose To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. Materials and Methods 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. Results The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). Conclusion Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.

Lifetime Outcomes of Anti–Vascular Endothelial Growth Factor Treatment for Neovascular Age-Related Macular Degeneration

Neovascular age-related macular degeneration (nAMD), the largest single cause of irreversible severe vision loss in high-income countries, can now be treated with vascular endothelial growth factor (VEGF) inhibitors, but to our knowledge, no data on lifetime outcomes are available. To determine visual acuity (VA) outcomes of anti-VEGF treatment for nAMD in both eyes for patients' remaining lifetime. Multistate modeling using real-world cohort data of 3192 patients with nAMD (>67 000 visits) treated in routine eye clinics in Australia, New Zealand, and Switzerland. Data were analyzed between 2007 and 2015. Intravitreal anti-VEGF treatment at the treating physician's discretion and prospective data collection in standardized registry. Visual acuity in both eyes over the remaining lifetime. For the mean remaining lifetime of 11 years, an estimated 12% (n = 371; 95% CI, 345-400) of the sample retained driving VA and an estimated 15% (n = 463; 95% CI, 434-495) reading VA in at least 1 eye. At that time, an estimated 82% of the sample (n = 2629; 95% CI, 2590-2660) had dropped out. Younger age at baseline and more injections during the first year of treatment were associated with better long-term outcomes. Anti-VEGF treatment was associated with preserved useful visual acuity in almost 20% of patients over their average remaining lifetime. More than 80% of patients will cease treatment over that time, having likely experienced a deterioration of vision beforehand. This is a remarkable outcome compared with outcomes without intervention, which lead to legal blindness within 3 years of disease onset in 80% of those affected. These findings underline the public health necessity of providing anti-VEGF treatment to persons in need.

Usability of smartphone apps as reading aids for low vision patients

Purpose Reading is one of the main complaints of low vision patients referred for visual rehabilitation, since it is fundamental for full participation in modern society. The purpose of this study was to analyse the usability of free smartphone apps with magnification tools as digital aids for reading visual rehabilitation in low vision patients. Methods Low vision adult patients were included regarding the following criteria: best-corrected visual acuity in the better-seeing eye from 0.6 to 1.3logMAR, previous habit of smartphone use, without former aid adaptation. Android system was used for the selection of three applications (apps) to be tested as digital reading aids. Visual acuity (VA) for near, reading acuity (RA) and reading speed (RS) using each app were measured. The participants were also asked about apps usability concerning accessibility, focus adjustment and text tracking. Results Seventeen participants (10 females – 58.8%) with ages ranging from 26 to 73 years (mean = 45.2 ± 13.1 years) were included. Mean binocular VA, RA and RS without the apps were respectively 1.00 ± 0.22 logMAR, 1.01 ± 0.28 logMAR and 41.7 ± 28.6 words/minute. Statistically better visual and RA results through the apps were found with a mean ≥9-line gain for both, and no significant difference for RS was found. All apps achieved good usability scores (means > 7). Conclusions All tested apps provided improvement in VA and reading performance, with proven usability. Free smartphone apps for magnification should be considered in reading rehabilitation programmes for low vision patients. Implications for rehabilitation Reading is essential for performing productive daily activities and for full participation in modern society, being a clinical indicator of visual function and quality of life. Difficulty in reading is one of the main complaints of low vision patients referred for visual rehabilitation. Smartphone apps for magnification and readability optimization of printed texts may provide improvement in visual acuity and reading performance of low vision patients. Digital technologies should be considered in the low vision reading rehabilitation programme since they provide additional advantages such as accessibility, cost, portability and social acceptance. Usability is the user’s experience when interacting with a software application and associated with pleasantness, usefulness, ease of use, safety and efficiency. Low vision patient’s feedback on the usability of assistive technologies is important for a successful visual rehabilitation which meets his/her needs and expectations.

Comparison of reading performance with low add bifocal and extended depth of focus intraocular lenses implanted with mini-monovision.

To evaluate reading performance, preferred reading distance, and spectacle independence in patients implanted with a low add multifocal or an extended depth of focus (EDOF) intraocular lens (IOL) after phacoemulsification. In this prospective study, patients were randomized into two groups: the diffractive multifocal Tecnis + 2.75D (ZKB00) IOL (Tecnis + 2.75 group; 15 patients) or the EDOF Tecnis Symfony (ZXR00) IOL (Symfony group; 14 patients) for bilateral implantation with mini-monovision. Reading performance parameters (reading acuity [RA], critical print size [CPS], and maximum reading speed [MRS]) were evaluated with MNREAD acuity charts at 40cm, and preferred reading distances and spectacle independence for near activities were assessed preoperatively and at the postoperative 1st, 3rd, and 6th months. At the postoperative 6th month, binocular logMAR UNVA and DCNVA were significantly better in the Symfony group than in the Tecnis + 2.75 group (UNVA: 0.15 ± 0.07 vs. 0.22 ± 0.08, p = 0.046; DCNVA: 0.21 ± 0.05 vs. 0.28 ± 0.07, p = 0.043; respectively). There was no significant difference in reading performance parameters between the groups; however, the Symfony group preferred significantly closer reading distance than the Tecnis + 2.75 group (42.00 ± 4.67cm; 45.87 ± 5.32cm, respectively, p = 0.030). At the postoperative 6th month, 14.3% and 26.7% of patients reported that they needed spectacles, rarely or occasionally, for near activities in the Symfony and Tecnis + 2.75 groups, respectively (p > 0.05). When implanted with mini-monovision, although functional near visual acuity and a high degree of spectacle independence at near distances were achieved with both IOLs, patients implanted with the EDOF IOL preferred closer reading distance than those implanted with the low add diffractive multifocal IOL.

Effect of illumination on reading performance in Japanese patients with age-related macular degeneration.

Several studies of Western patients with age-related macular degeneration (AMD) have investigated reading performance that improved at high levels of illumination; however, the relation between reading performance and macular function has not been evaluated in detail in Japan. The goals of this study were to evaluate the effect of different levels of illumination on reading performance in Japanese patients with AMD and determine the factors, such as macular function, that affect these results. Cross-sectional study. We prospectively included 39 patients with bilateral AMD or maculopathy. We evaluated reading performance; reading acuity (RA), critical print size (CPS), and maximal reading speed (MRS) using charts with Japanese sentences based on the MNREAD-J in 500-7500lx. Patients were classified into two groups based on the presence of a central scotoma (CS) or no CS (NCS) diagnosed by microperimetry. The RA improved significantly in 500-7500lx in both groups (NCS, p = 0.001; CS, p = 0.046). The RA improvement differed significantly (2000lx, p = 0.021; 5,000lx; p = 0.021; 7500lx, p = 0.047) between 500lx and other illumination levels only in the NCS group and then plateaued over 2000lx. The CPS and MRS did not improve significantly at any illumination level. These results suggest that the difference in macular function was related to improvement in the RA with increased illumination in Japanese patients with AMD.

Multivariate Regression Analysis Identifying Predictors of Patient Satisfaction with Multifocal IOLs: +4.00/+4.00 vs +3.25/+3.25 vs +3.25/EDOF.

PurposeTo detect and compare the predictors of “overall patient satisfaction” with an EDOF/+3.25 versus +3.25/+3.25 versus +4.00/+4.00 diffractive multifocal IOLs.SettingBucci Laser Vision Institute, Wilkes-Barre, PA, USA.DesignNon-interventional, observational, retrospective-prospective.Patients and MethodsA total of 55 (EDOF/+3.25) “best case patients” with 1) 4 months neuroadaptation 2) corrected residual refractive error 3) necessary YAGs performed and 4) aggressive ocular surface management underwent regression analysis to identify predictors of “overall patient satisfaction”. Satisfaction was regressed against 40 independent variables – 31 clinical metrics such as reading speed and acuity, angle kappa, aberrations, mesopic pupil size, residual spherical equivalent and astigmatism, near, intermediate vision at fixed and preferred focal distances, etc., and 9 responses from a questionnaire evaluating the performance of everyday tasks. Results were compared to two prior cohorts (67 bilateral +3.25 and 55 bilateral +4.00) with identical methods.ResultsEighty percent (44/55) of the EDOF/+3.25 patients were “very satisfied” and 20% (11/55) were “satisfied” compared to 82% “very satisfied”/18% “satisfied” (+3.25/+3.25) and 64% “very satisfied”/36% “satisfied” (+4.00/+4.00). Subjective scores for near VA (p=0.02) were in favor of the +3.25/+3.25 (1.92/2.00) vs EDOF/3.25 (1.76/2.00). However, EDOF/+3.25 scores for intermediate VA (4.65/5.00 vs 4.32/5.00; p=0.02) and distance VA (4.76/5.00 vs 4.53/5.00; p=0.047) were significantly better than bilateral +3.25 and bilateral +4.00. In the bilateral +3.25 cohort, regression revealed that variables related to intermediate vision were responsible for outperforming the bilateral +4.00 cohort, and it also showed that smaller mesopic pupils (p=0.005) again predicted better intermediate vision as was observed in the bilateral +4.00 patients.ConclusionThe EDOF/+3.25 patients had equal patient satisfaction vs the bilateral +3.25, and greater satisfaction vs the bilateral +4.00 patients because of significantly better intermediate and distance vision, despite scoring less for near vision with fine print and no difference with moderate print. Regression predicted better intermediate vision with smaller mesopic pupils with the +3.25 and +4.00 IOLs.

Exploring preferred and actual lighting levels for reading for adults with visual impairment at a center for the blind

Introduction Light plays a crucial role in facilitating or hindering participation in reading. The purpose of this study is to examine the preferred lighting and actual lighting levels for reading for adults with visual impairment at a center for the blind. Method This mixed-methods study gathered reading acuity level and lighting preferences for reading for 18 adults with visual impairment. The researcher used the Warren Text Card to measure reading acuity, and participants identified the preferred lighting level for reading on the LuxIQ 2. A Lighting Inventory was used to record lighting at the site. Findings Preferred lighting levels varied for adults with visual impairment. Preferred lux ranged from 250–5000 and kelvin ranged from 3000–6500 degrees. Reading acuity significantly improved (&lt;.01) with increased lighting ( t = 3.441). The actual lighting levels at the center did not meet preferred lighting levels for reading. Conclusion Adults with visual impairment preferred increased levels of lighting for reading. As desired levels varied across participants, recommending customized lighting for each individual is optimal. Occupational therapists ideally should evaluate lighting and educate clients on how to increase lighting levels to the preferred level of lighting for reading to optimize reading performance.

Effects of Task on Reading Performance Estimates.

Reading is a primary problem for low vision patients and a common functional endpoint for eye disease. However, there is limited agreement on reading assessment methods for clinical outcomes. Many clinical reading tests lack standardized materials for repeated testing and cannot be self-administered, which limit their use for vision rehabilitation monitoring and remote assessment. We compared three different reading assessment methods to address these limitations. Normally sighted participants (N = 12) completed MNREAD, and two forced-choice reading tests at multiple font sizes in counterbalanced order. In a word identification task, participants indicated whether 5-letter pentagrams, syntactically matched to English, were words or non-words. In a true/false reading task, participants indicated whether four-word sentences presented in RSVP were logically true or false. The reading speed vs. print size data from each experiment were fit by an exponential function with parameters for reading acuity, critical print size and maximum reading speed. In all cases, reading speed increased quickly as an exponential function of text size. Reading speed and critical print size significantly differed across tasks, but not reading acuity. Reading speeds were faster for word/non-word and true/false reading tasks, consistent with the elimination of eye movement load in RSVP but required larger text sizes to achieve those faster reading speeds. These different reading tasks quantify distinct aspects of reading behavior and the preferred assessment method may depend on the goal of intervention. Reading performance is an important clinical endpoint and a key quality of life indicator, however, differences across methods complicate direct comparisons across studies.

Long-term follow-up of an amblyopia treatment study: change in visual acuity 15 years after occlusion therapy.

PurposeTo determine change in visual acuity (VA) in the population of a previous amblyopia treatment study (Loudon 2006) and assess risk factors for VA decrease.MethodsSubjects treated between 2001 and 2003 were contacted between December 2015 and July 2017. Orthoptic examination was conducted under controlled circumstances and included subjective refraction, best corrected VA, reading acuity, binocular vision, retinal fixation, cover‐uncover and alternating cover test. As a measure for degree of amblyopia, InterOcular VA Difference (IOD) at the end of occlusion therapy was compared with IOD at the follow‐up examination using Wilcoxon’s signed‐rank test. Regression analysis was conducted to determine the influence of clinical and socio‐economic factors on changes in IOD.ResultsOut of 303 subjects from the original study, 208 were contacted successfully, 59 refused and 15 were excluded because of non‐amblyopic cause of visual impairment. Mean IOD at end of therapy (mean age 6.4 years) was 0.11 ± 0.16 logMAR, and IOD at follow‐up examination (mean age 18.3 years) was 0.09 ± 0.21 logMAR; this difference was not significant (p = 0.054). Degree of anisometropia (p = 0.008; univariable analysis), increasing anisometropia (p = 0.009; multivariable), eccentric fixation (p < 0.001; univariable and multivariable); large IOD (p < 0.001; univariable and multivariable) and non‐compliance during therapy (p = 0.028; univariable) were associated with IOD increase.ConclusionLong‐term results of occlusion therapy were good. High or increasing anisometropia, eccentric fixation and non‐compliance during occlusion therapy were associated with long‐term VA decrease. Subjects with poor initial VA had a larger increase despite little patching, but often showed long‐term VA decrease.

Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

Background/ObjectivesTo investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO).MethodsIntravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (reading acuity [RA], maximum reading speed [MRS], critical print size [CPS]), CGS (CS/GS), and central macular thickness (CMT) in optical coherence tomography (OCT) before and after treatment were evaluated. The area (superior/inferior) affected by BRVO was determined by fluorescein angiography.ResultsAll parameters improved significantly following treatment (p < 0.05), and all MNREAD and CGS parameters were significantly correlated with BCVA in the treated eye before and after treatment (p < 0.01). The changes in BCFVA, BCNVA, MRS, and CS were significantly correlated with the amount of change in CMT (p < 0.007; r = 0.415, 0.528, -0.465, and -0.508, respectively). MRS exhibited a percentage change that was significantly correlated with that in CMT (p < 0.007; r = -0.511). Additionally, MRS exhibited the lowest threshold CMT (397 μm) at which the most significant change in improvement was observed. CMT was less likely to improve if BRVO occurred at a superior site than if it occurred at an inferior site (0.05 < p = 0.07 < 0.1).ConclusionsMNREAD and CGS testing were useful for evaluating BRVO treatment efficacy. MRS might be a valuable index for evaluating treatment success and making treatment decisions.

Development and Validation of the Persian Version of the MNREAD Acuity Chart.

Purpose:To develop the Persian version of MNREAD acuity charts and test their repeatability in a normal adult population.Methods:Two hundred sentences were constructed using the most frequent words of 8-year-olds schoolbooks. The number of characters and sentence length were adjusted based on the design principles of the Minnesota Low Vision Reading Test. Two Persian language teachers checked the sentences for syntax and meaning. The accepted sentences were read by 20 adults and then by 20 children. Using RADNER charts method, the sentences with inappropriate reading time and repeated errors were excluded. Thirty-eight sentences were approved to create charts. To check the charts' validity and repeatability, 20 adults read both charts and a paragraph of a daily newspaper. Reading acuity, critical print size, and maximum reading speed were calculated. The measured reading speeds were compared to the readers' reading speeds for a paragraph of a daily newspaper. Bland-Altman plots were used to evaluate the agreement between the two charts.Results:Thirty-eight selected sentences were used in the final printed charts. There were significant correlations between maximum reading speed for Charts 1 and 2 (r = 0.87, P < 0.0001), Chart 1 and newspaper paragraph (r = 0.73, P = 0.001), and Chart 2 and newspaper paragraph (r = 0.83, P = 0.0001). Correlations were observed between reading acuities and critical print sizes of two charts (r = 0.72, P < 0.002 and r = 0.77, P = 0.00). The 95% limits of agreement in reading acuity, critical print size, and reading speed between Charts 1 and 2 were ± 0.034 logMAR, ±0.11 logMAR, and ±8.00 words per minute, respectively.Conclusion:The designed Persian MNREAD charts are repeatable and could be used reliably to calculate near acuity, reading speed, and critical print size in Persian-speaking people.

Individualizing Therapy for Neovascular Age-Related Macular Degeneration with Aflibercept (VITAL): A Two-Year Prospective, Interventional Single-Centre Trial.

AimsTo report the mean change in Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (BCVA) and reading performance (reading acuity and maximum reading speed (MRS) using the MNREAD test) between baseline and 24 months in treatment-naïve patients with neovascular age-related macular degeneration (nAMD) treated with intravitreal aflibercept injections.MethodsA prospective, open-label, interventional non-randomised case series with 24 months’ duration. Patients were recruited to the study from medical retina clinics at Moorfields Eye Hospital. Intravitreal injections of 2.0 mg aflibercept in the study eye were administered using a fixed dosing regimen during the first year and a treat-and-extend treatment regimen during the second year of treatment.ResultsFifty patients were enrolled with a mean age (SD) of 78.7 (7.6) years; a mean BCVA of 62.8 ETDRS letters; mean reading acuity of 0.52 logMAR; mean maximum reading speed (MRS) of 141.3 words per minute and a central macular thickness of 322.6 µm at baseline. The mean improvement in BCVA was 6.4 letters for the 44 patients (88%) for whom data was available at 2 years. The mean improvement in reading acuity was 0.13 logMAR with an improvement in MRS of 2.9 words per minute. The mean reduction in CRT from baseline was 104.8 µm.ConclusionsAflibercept treatment of nAMD using fixed dosing in year 1 and treat and extend in year 2 leads to improvements in reading ability, visual acuity and retinal morphology which were maintained to 2 years of treatment.Trial RegistrationClinicalTrials.gov Identifier NCT02441816, the VITAL study.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00267-5) contains supplementary material, which is available to authorized users.

Biofeedback Low Vision Rehabilitation with Retimax Vision Trainer in Patients with Advanced Age-related Macular Degeneration: A Pilot Study

ABSTRACT Purpose To evaluate the effectiveness of Visual Evoked Potential (VEP) biofeedback rehabilitation in selected low vision patients with advanced age-related macular degeneration (AMD). Design Retrospective observational cohort study. Methods Patients affected by advanced AMD, central macular atrophy with unstable fixation and best corrected visual acuity (BCVA) between 20/100 and 20/320 were considered. Selected patients underwent fundus photography and microperimetry with fixation analysis for the selected eye (highest BCVA). Ten consecutive training sessions of 10 min each were performed twice a week in the selected eye with Retimax Vision Trainer (CSO, Florence). BCVA, reading acuity and reading speed, contrast sensitivity, fixation, retinal sensitivity and quality of life questionnaire (VFQ-25) were evaluated at baseline and 7 days following the final session. Results Significant improvements in terms of BCVA [p = .011], reading speed [p = .007], VFQ-25 score [p = .007], retinal sensitivity [p = .021] and fixation stability in the central 2° and 4° [p = .048; p = .037] post-treatment were observed for the 9 patients enrolled, with insignificant improvements observed in reading acuity and contrast sensitivity [p = .335; p = .291]. Conclusions Preliminary results support VEP biofeedback rehabilitation improvements for visual function and quality of life in advanced AMD patients with low vision.

Evaluation of pre- and post-surgery reading ability in patients with epiretinal membrane: a prospective observational study

BackgroundThis study aimed to investigate the pre- and post-surgery reading ability in patients with idiopathic epiretinal membrane (ERM) to evaluate whether measurement of reading performance is a helpful test in addition to visual acuity (VA) as an assessment measure.MethodsThis prospective observational study involved 42 eyes of 40 patients with idiopathic ERM. Best-corrected visual acuity (BCVA), reading ability, and metamorphopsia score were evaluated at baseline and at 3, 6, and 12 months post-surgery. As the outcome measure, the reading ability of each patient (i.e., overall performance) was examined with MNREAD-J, the Japanese version of the MNREAD reading acuity (RA) charts, to determine RA, critical print size (CPS), and maximum reading speed (MRS). Generally, a difference of 0.2 logMAR or more is considered a significant change in BCVA. Thus, as a subgroup analysis, we additionally evaluated the BCVA and reading ability of the patients with a BCVA difference of 0.1 logMAR or less between at baseline and at 12 months post-surgery.ResultsRelative to their values at baseline, the subjects exhibited significantly improved BCVA, RA, and CPS throughout the post-surgery examination period (P < 0.001) and significantly improved MRS at 12 months post-surgery (P = 0.04). No significant change in the vertical metamorphopsia score was observed throughout the post-surgery follow-up period. However, and compared to the value at baseline, significant improvements in the horizontal metamorphopsia score were observed at 3, 6 (P < 0.05), and 12 months (P < 0.001) post-surgery. In the subgroup analysis of the 23 eyes that exhibited a BCVA improvement of 0.1 logMAR or less, the median BCVA did not change, but the median RA and CPS improved by 0.2 logMAR.ConclusionsOur findings showed that the surgical removal of ERM improves reading ability, even when the BCVA score does not improve. The measurement of reading performance appears to be a helpful test in addition to VA as a measure for assessing the surgical removal of ERM.