Reduction In Best-corrected Visual Acuity Research Articles

Visual loss and perimetric sensitivity in eyes with retinitis pigmentosa

To investigate the various perimetric parameters that best predict reduction of best-corrected visual acuity (BCVA) to worse than 0.5 in the near future in eyes with retinitis pigmentosa (RP). The most recent records obtained by Humphrey Field Analyzer (HFA) central 10-2 perimetry were studied for the right eyes of 123 patients (60 men and 63 women) with typical RP. The correlation between various parameters of perimetric sensitivity and BCVA was retrospectively studied. The receiver operating characteristic (ROC) curves were used to find the best parameter to discriminate eyes with BCVA ≥0.5 from those with BCVA <0.5. Spearman rank correlation coefficients with logMAR BCVA were the highest for the foveal threshold (FT) and mean sensitivity of the test points within 1.4° of the fixation point (MS1.4). The ROC curve analysis revealed that the area under the curve was the largest for the MS1.4 among all the perimetric parameters for discriminating eyes with BCVA ≥0.5 from those with BCVA <0.5. The cutoff value of 30dB showed 100% specificity and 57% sensitivity. The risk of vision decreasing below 0.5 in the near future may be predicted when the mean sensitivity within 1.4° of the fixation point in the HFA 10-2 reaches 30dB in eyes with RP.

Intravitreal injections at the Massachusetts Eye and Ear Infirmary: analysis of treatment indications and postinjection endophthalmitis rates

AimTo report the incidence rate of acute postoperative endophthalmitis secondary to therapeutic intravitreal injections.MethodsA retrospective review of all consecutive eyes after intravitreal injections was performed at the Massachusetts Eye and...

Quantification of Retinal Tangential Movement in Epiretinal Membranes

To describe a technique of quantifying retinal vessel movement in eyes with epiretinal membrane (ERM) and correlate the retinal vessel movement with changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and patients' subjective reports about experienced symptoms (symptoms). Retrospective, observational, comparative case series. A total of 206 eyes of 113 patients: 142 eyes with ERM and 64 healthy fellow eyes. All patients were examined as part of a screening protocol for a randomized clinical trial on ERM. Heidelberg Spectralis (Heidelberg Engineering Inc, Carlsbad, CA) optical coherence tomography (OCT) scanning had been performed twice or more in all patients. Eyes with ERM and healthy fellow eyes were examined. For each eye, the 2 fundus images were aligned using Heidelberg's AutoRescan feature. The macular area was divided into 9 subfields, and retinal vessel movements were calculated. For each eye, the total length of the 9 vectors was summed to describe the total retinal vessel movement (retinal tangential movement [RTM]). To quantify retinal vessel movements associated with ERM. The secondary outcome was to correlate measured retinal vessel movement with changes in BCVA, CMT, and patients' subjective symptoms. The study found significantly greater RTM in ERM eyes compared with healthy eyes (P<0.001). Among ERM eyes, the RTM was significantly greater in patients with worsening of symptoms compared with ERM eyes with unchanged assessment of symptoms. There were statistically significant correlations between increased RTM and reduction in BCVA (P = 0.024), increased CMT (P<0.001), and time between visits (P<0.001). This study showed that ERM is not a static retinal disease but a dynamic condition in which retinal vessel movement associated with ERM was measureable, even in patients who had stable BCVA and CMT. The retinal vessel movements correlated to worsening of BCVA and increased CMT, and were more pronounced in patients with worsening of symptoms.

Vitamins E and C and Medical Record-Confirmed Age-related Macular Degeneration in a Randomized Trial of Male Physicians

To test whether supplementation with alternate-day vitamin E or daily vitamin C affects the incidence of the diagnosis of age-related macular degeneration (AMD) in a large-scale randomized trial of male physicians. Randomized, double-masked, placebo-controlled trial. We included 14 236 apparently healthy United States male physicians aged ≥50 years who did not report a diagnosis of AMD at baseline. Participants were randomly assigned to receive 400 international units (IU) of vitamin E or placebo on alternate days, and 500 mg of vitamin C or placebo daily. Participants reported new diagnoses of AMD on annual questionnaires and medical record data were collected to confirm the reports. Incident diagnosis of AMD responsible for a reduction in best-corrected visual acuity to ≤20/30. After 8 years of treatment and follow-up, a total of 193 incident cases of visually significant AMD were documented. There were 96 cases in the vitamin E group and 97 in the placebo group (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.78-1.37). For vitamin C, there were 97 cases in the active group and 96 in the placebo group (HR, 0.99; 95% CI, 0.75-1.31). In a large-scale, randomized trial of United States male physicians, alternate-day use of 400 IU of vitamin E and/or daily use of 500 mg of vitamin C for 8 years had no appreciable beneficial or harmful effect on risk of incident diagnosis of AMD.

Amblyopia and Strabismus in Iranian Schoolchildren, Mashhad

Purpose: To determine the prevalence of amblyopia and strabismus among the population of schoolchildren Mashhad, Iran.Materials and Methods: In a cross-sectional study with cluster sampling, 2510 schoolchildren were selected from schools of district 1 in Mashhad. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes.Results: Of the 2510 selected schoolchildren, 2150 participated (response rate, 85.6%). The mean (± standard deviation) age of the participants was 13.2 ± 3.2 (range, 6-21) years. The prevalence of amblyopia was 1.9% (95% CI: 0.94-2.90); 2.1% (95% CI: 0.10-3.16) in girls and 1.7% (95% CI: 0.30-3.12) in boys (P = 0.6). Among myopic, hyperopic, and astigmatic students, 3.7%, 27.8%, and 6.5% had amblyopia, respectively (P<0.001). The causes of amblyopia were anisometropia in 65.9%, strabismus in 24.4%, and isoametropia in 9.8%. The prevalence of strabismus was 3.1% (95% CI, 1.3% to 4.3%); 4.2% (95% CI, 3.05 to 5.7%) in girls, and 2.0% (1.3% to 2.9%) in boys (P = 0.0011). Strabismus was significantly more prevalent among hyperopic students (7.9%) compared with myopic ones (3.7%).Conclusion: Results of the present study indicate that the prevalence rate of amblyopia was in the mid-range of other studies, and the prevalence of strabismus was relatively high. Since refractive errors, especially hyperopia, are responsible for some cases of strabismus.

Classification of Early Dry-Type Myopic Maculopathy with Macular Choroidal Thickness

To compare the macular choroidal thickness in 2 types of early dry-type myopic maculopathy. Prospective, observational, comparative study. Patients with a refractive error of less than -8 diopters were included and were classified into 2 groups. Group 1 consisted of 24 eyes with a tessellated fundus, and group 2 consisted of 33 eyes with diffuse chorioretinal atrophy, but not to the extent of patchy chorioretinal atrophy. These 2 groups were compared with regard to their clinical characteristics, refractive error, axial length, macular choroidal thickness, and best-corrected visual acuity (BCVA). Linear regression was used to evaluate the explanatory variables in terms of macular choroidal thickness and BCVA. Patients in group 1 were significantly younger and had better BCVA, less myopia, shorter axial length, and less staphyloma than those in group 2. Refractive error, axial length, and BCVA correlated significantly with macular choroidal thickness in group 2. However, no such significant correlations were observed in group 1. Multiple linear regression analysis showed that age and macular choroidal thickness were the variables that associated most strongly with BCVA, whereas neither refractive error nor axial length was a significant predictor of BCVA. In group 2, eyes with lacquer cracks showed worse BCVA and thinner macular choroidal thickness than eyes without lacquer cracks. Macular choroidal thickness is an important factor in myopic maculopathy and can be a better indicator of its severity. These findings suggest that BCVA reduction in eyes with dry-type myopic maculopathy can be related to a thinner macular choroidal thickness and to the development of lacquer cracks.

Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers

To investigate the incidence and cause of severe visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (RRD). Consecutive case series of 216 patients operated with vitrectomy for primary RRD in 2004-2005. In 162 eyes, SiO (5500 centiStoke) had been used as intravitreal tamponade and in 54 eyes gas (perflouropropane, C(3) F(8) ) had been used. Following chart review, we identified 16 eyes in 16 patients (nine SiO eyes, seven gas eyes) with macula-on and documented visual acuity ≥6/12 before surgery, where SiO had been removed, cataract surgery performed and no re-detachment had occurred. Examinations included best-corrected visual acuity (BCVA) and high-definition optical coherence tomography (OCT) of the macular area. Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes (>6/24) compared to gas eyes (>6/7.5), p = 0.005. Three of 9 (33%) SiO eyes had final BCVA ≤6/60 and 67% had final BCVA ≤6/12. No gas eyes had final BCVA <6/9. Macular OCT revealed thinning of inner retinal layers in SiO-operated eyes (5148 pixels) compared to gas-operated eyes (6897 pixels), p < 0.002. No other visually significant structural differences were found. Severe visual loss after SiO use was observed in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation.

Strabismus and amblyopia in Iranian schoolchildren

AbstractPurpose To determine the prevalence of amblyopia and strabismus among the population of school children mashahd, IranMethods In a cross‐sectional study with cluster sampling, 2510 school children were selected from schools of district one in Mashhad. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2‐line interocular optotype acuity differences in the absence of pathological causes.Results Of the 2510 selected population, 2150 school children participated (response rate of 85.6%). The prevalence of amblyopia was 1.9% (95% CI: 0.94 ‐ 2.90); 2.1% (95% CI: 0.10 ‐ 3.16) in girls and 1.7% (95% CI: 0.30 ‐ 3.12) in boys (P=0.620). Among myopic, hyperopic and astigmatic students, 3.7%, 27.8% and 6.5% had amblyopia respectively (p&lt;0.001). the causes of amblyopia were 65.9%, 24.4% and 9.8% anisometropia, strabismus and Isoametropic respectively. The prevalence of strabismus was 3.1% (95% CI, 1.3% to 4.3%); 4.2% (95% CI, 3.05 to 5.7%) in girls, and 2.0% (1.3% to 2.9%) in boys(P=0.0011). Strabismus was significantly more prevalent among hyperopic students compared to myopic ones.Conclusion Results of the present study indicate that, the prevalence rate of amblyopia was in the mid range and the prevalence of strabismus was relatively high. Since refractive errors, especially hyperopia, are responsible for some cases of strabismus, a timely diagnosis and treatment can prevent a high percentage of cases with amblyopia and strabismus in children.

Dietary ω-3 Fatty Acid and Fish Intake and Incident Age-Related Macular Degeneration in Women

To examine whether intake of ω-3 fatty acids and fish affects incidence of age-related macular degeneration (AMD) in women. A detailed food-frequency questionnaire was administered at baseline among 39876 female health professionals (mean [SD] age: 54.6 [7.0] years). A total of 38022 women completed the questionnaire and were free of a diagnosis of AMD. The main outcome measure was incident AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. A total of 235 cases of AMD, most characterized by some combination of drusen and retinal pigment epithelial changes, were confirmed during an average of 10 years of follow-up. Women in the highest tertile of intake for docosahexaenoic acid, compared with those in the lowest, had a multivariate-adjusted relative risk of AMD of 0.62 (95% confidence interval, 0.44-0.87). For eicosapentaenoic acid, women in the highest tertile of intake had a relative risk of 0.66 (95% confidence interval, 0.48-0.92). Consistent with the findings for docosahexaenoic acid and eicosapentaenoic acid, women who consumed 1 or more servings of fish per week, compared with those who consumed less than 1 serving per month, had a relative risk of AMD of 0.58 (95% confidence interval, 0.38-0.87). These prospective data from a large cohort of female health professionals without a diagnosis of AMD at baseline indicate that regular consumption of docosahexaenoic acid and eicosapentaenoic acid and fish was associated with a significantly decreased risk of incident AMD and may be of benefit in primary prevention of AMD.

Age-Related Cataract in a Randomized Trial of Vitamins E and C in Men

To test whether supplementation with alternate-day vitamin E or daily vitamin C affects the incidence of age-related cataract in a large cohort of men. In a randomized, double-masked, placebo-controlled trial, 11,545 apparently healthy US male physicians 50 years or older without a diagnosis of cataract at baseline were randomly assigned to receive 400 IU of vitamin E or placebo on alternate days and 500 mg of vitamin C or placebo daily. Incident cataract responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. Long-term use of vitamin E and C supplements has no appreciable effect on cataract. After 8 years of treatment and follow-up, 1174 incident cataracts were confirmed. There were 579 cataracts in the vitamin E-treated group and 595 in the vitamin E placebo group (hazard ratio, 0.99; 95% confidence interval, 0.88-1.11). For vitamin C, there were 593 cataracts in the treated group and 581 in the placebo group (hazard ratio, 1.02; 95% confidence interval, 0.91-1.14). Long-term alternate-day use of 400 IU of vitamin E and daily use of 500 mg of vitamin C had no notable beneficial or harmful effect on the risk of cataract. clinicaltrials.gov Identifier: NCT00270647.

The Prevalence of Anisometropia, Amblyopia and Strabismus in Schoolchildren of Shiraz, Iran

Purpose: To determine the prevalence of amblyopia, anisometropia, and strabismus in schoolchildren of Shiraz, Iran.Materials and Methods: A random cluster sampling was used in a cross-sectional study on schoolchildren in Shiraz. Cycloplegic refraction was performed in elementary and middle school children and high school students had non-cylcoplegic refraction. Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were recorded for each participant. Anisometropia was defined as spherical equivalent (SE) refraction difference 1.00D or more between two eyes. Amblyopia was distinguished as a reduction of BCVA to 20/30 or less in one eye or 2-line interocular optotype acuity differences in the absence of pathological causes. Cover test was performed for investigating of strabismus.Results: Mean age of 2638 schoolchildren was 12.5 years (response rate = 86.06%). Prevalence of anisometropia was 2.31% (95% confidence interval [CI], 1.45 to 3.16). 2.29% of schoolchildren (95% CI, 1.46 to 3.14) were amblyopic. The prevalence of amblyopia in boys and girls was 2.32% and 2.26%, respectively (p = 0.945). Anisometropic amblyopia was found in 58.1% of the amblyopic subjects. The strabismus prevalence was 2.02% (95% CI, 1.18 to 2.85). The prevalence of exotropia and esotropia was 1.30% and 0.59%, respectively.Conclusions: Results of this study showed that the prevalence of anisometropia, amblyopia, and strabismus are in the mid range. The etiology of amblyopia was often refractive, mostly astigmatic, and non-strabismic. Exotropia prevalence increased with age and was the most common strabismus type.

Axonal loss occurs early in dominant optic atrophy

This study set out to investigate retinal nerve fibre layer (RNFL) thickness and best corrected visual acuity (BCVA) in relation to age in healthy subjects and patients with OPA1 autosomal dominant optic atrophy (DOA). We carried out a cross-sectional investigation of RNFL thickness and ganglion cell layer density in 30 healthy subjects and 10 patients with OPA1 DOA using optical coherence tomography (OCT). We then performed a regression analysis of RNFL thickness and BCVA versus age. Both healthy subjects and DOA patients demonstrated a gradual reduction in RNFL thickness with age; the relationship was best described statistically by a model that assumed a constant offset between the two groups. Best corrected VA decreased significantly with age in DOA patients, in whom BCVA was correlated with peripapillary RNFL thickness in the inferior and superior peripapillary quadrants and with total macular thickness at eccentricities of 500-3000 microm. The observations were best described by a constant offset of 41.9 microm separating the two groups and an annual decrease in RNFL thickness of 0.48 microm (p < 0.0001). In patients with DOA, increasing age was associated with decreasing BCVA (p = 0.046). This cross-sectional study found evidence of comparable age-related decreases in RNFL thickness in healthy subjects and in DOA patients, where the deficit in DOA patients is best described using a model that assumes the deficit between the groups does not vary with age. The gradual reduction of BCVA with age may be a consequence of a relative deficit in RNFL thickness that is established before the second decade of life.

Vitamin E and Age-Related Macular Degeneration in a Randomized Trial of Women

To test whether alternate day vitamin E affects the incidence of age-related macular degeneration (AMD) in a large-scale randomized trial of women. Randomized, double-masked, placebo-controlled trial. Thirty-nine thousand eight hundred seventy-six apparently healthy female health professionals aged 45 years or older. Participants were assigned randomly to receive either 600 IU of natural-source vitamin E on alternate days or placebo. Incident AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. After 10 years of treatment and follow-up, there were 117 cases of AMD in the vitamin E group and 128 cases in the placebo group (relative risk, 0.93; 95% confidence interval, 0.72-1.19). In a large-scale randomized trial of female health professionals, long-term alternate-day use of 600 IU of natural-source vitamin E had no large beneficial or harmful effect on risk of AMD.

Low-Dose Aspirin and Medical Record–Confirmed Age-related Macular Degeneration in a Randomized Trial of Women

To test whether alternate-day low-dose aspirin affects incidence of age-related macular degeneration (AMD) in a large-scale randomized trial of women. Randomized, double-masked, placebo-controlled trial. Thirty-nine thousand eight hundred seventy-six healthy female health professionals aged 45 years or older. Participants were assigned randomly to receive either 100 mg aspirin on alternate days or placebo and were followed up for the presence of AMD for an average of 10 years. Incident AMD responsible for a reduction in best-corrected visual acuity to 20/30 or worse based on self-report confirmed by medical record review. After 10 years of treatment and follow-up, there were 111 cases of AMD in the aspirin group and 134 cases in the placebo group (hazard ratio, 0.82; 95% confidence interval, 0.64-1.06). In a large-scale randomized trial of female health professionals with 10 years of treatment and follow-up, low-dose aspirin had no large beneficial or harmful effect on risk of AMD.

Reading Performance Is Reduced by Parafoveal Scotomas in Patients with Macular Telangiectasia Type 2

Macular telangiectasia (MacTel) type 2 typically exhibits sharply demarcated parafoveal scotomas. In an investigation of their significance for reading performance, reading acuity and speed were measured and correlated with parafoveal sensitivity and fixation stability. In this prospective controlled cross-sectional observational study, 49 eyes of 26 patients with MacTel type 2 were investigated. Twenty-four eyes of 14 age-matched normal subjects served as the control. Reading acuity and reading speed (in words per minute [wpm]) were assessed by Radner charts. Retinal sensitivity was measured using fundus controlled microperimetry (MP1; Nidek Technologies). Fixation stability was quantified by the bivariate contour ellipse area (BCEA). Multiple logistic regression analysis was used to delineate outcome predictors of reading acuity and speed. Mean reading speed was considerably reduced in patients (to 141 wpm; control speed, 190 wpm; P < 0.001) as was reading acuity (patients, 20/63; control subjects, 20/32; P < 0.001). Mean best corrected visual acuity (BCVA) was reduced in most eyes (patients, 20/50; control subjects, 20/20; P < 0.001). Mean BCEA was not reduced compared with that in the control subjects. BCVA reduction predicted reading acuity loss (P = 0.02) and a decrease in maximum reading speed (P < 0.001). Parafoveal sensitivity loss resulted in decreased reading acuity (P = 0.03) and reading speed reduction (P < 0.001). These findings indicate that parafoveal sensitivity loss in MacTel type 2 is associated with loss of reading performance despite stable central fixation. Reading performance appears to be a sensitive variable of functional impairment in MacTel type 2 and should therefore be considered an outcome measure in future interventional trials.

Post-Trabeculectomy Choroidal Detachment: Not an Adverse Prognostic Sign for Either Visual Acuity or Surgical Success

To report the incidence of choroidal detachment (CD) following trabeculectomy and to evaluate its effect on long-term surgical success and best-corrected visual acuity (BCVA). A total of 253 eyes of 198 subjects who underwent trabeculectomy between 1993 and 2003 with at least 1 year follow-up were reviewed retrospectively. Twenty-eight eyes of 28 subjects which developed CD postoperatively were classified as Group 1 and the remaining 225 eyes of 170 subjects as Group 2. The risk factors for the development of CD and the influence of CD on BCVA and on the success of trabeculectomy were analyzed and compared between the two groups. In Group 1, preoperative BCVA was significantly lower and cup to disc ratio and the frequency of pseudoexfoliative glaucoma were higher with respect to the control group (p=0.009, p=0.01, p=0.02). The correlations between the development of CD and postoperative findings such as shallowing of the anterior chamber, hypotony, hypotonic maculopathy, hyphema, and fibrin reaction in the anterior chamber were statistically significant.CD was not associated with a significant reduction of BCVA. Intraocular pressures at postoperative first day, sixth month, and first year were lower in Group 1. The success of trabeculectomy and the average number of medications used were not significantly different between the two groups. CD following trabeculectomy occurred in 11% of our patients. CD was not associated with either a significant drop in BCVA or an adverse influence on long-term IOP control.

Dietary Carotenoids, Vitamins C and E, and Risk of Cataract in Women

To examine in prospective data the relation between dietary intake of carotenoids and vitamins C and E and the risk of cataract in women. Dietary intake was assessed at baseline in 39,876 female health professionals by using a detailed food frequency questionnaire. A total of 35,551 women provided detailed information on antioxidant nutrient intake from food and supplements and were free of a diagnosis of cataract. The main outcome measure was cataract, defined as an incident, age-related lens opacity responsible for a reduction in best-corrected visual acuity in the worse eye to 20/30 or worse based on self-report confirmed by medical record review. A total of 2031 cases of incident cataract were confirmed during a mean of 10 years of follow-up. Comparing women in the extreme quintiles, the multivariate relative risk of cataract was 0.82 (95% confidence interval, 0.71-0.95; test for trend, P = .04) for lutein/zeaxanthin and 0.86 (95% confidence interval, 0.74-1.00; test for trend, P = .03) for vitamin E from food and supplements. In these prospective observational data from a large cohort of female health professionals, higher dietary intakes of lutein/zeaxanthin and vitamin E from food and supplements were associated with significantly decreased risks of cataract.

Laser-assisted subepithelial keratectomy for anisometropic amblyopia in children: Outcomes at 1 year

To assess the refractive, visual acuity, and binocular results of laser-assisted subepithelial keratectomy (LASEK) for anisomyopia, anisohyperopia, and anisoastigmatia in children with various levels of amblyopia secondary to the anisometropic causes. Nonhospital surgical facility with follow-up in a hospital clinic setting. This retrospective review was of 53 children with anisometropia who had LASEK to correct the refractive difference between eyes. All LASEK procedures were performed using general anesthesia. Patients were divided into 3 groups according to their anisometropia as follows: myopic difference greater than 3.00 diopters (D), astigmatic difference greater than 1.50 D, and hyperopic difference greater than 3.50 D. The children were followed for at least 1 year, and their refractive status, visual acuity, and binocular vision were assessed and recorded at 2 and 6 months as well as 1 year. The mean age at treatment was 8.4 years (range 10 months to 16 years). The mean preoperative anisometropic difference was 6.98 D in the entire group, 9.48 D in the anisomyopic group, 3.13 D in the anisoastigmatic group, and 5.50 D in the anisohyperopic group. One year after LASEK, the mean anisometropic difference decreased to 1.81 D, 2.43 D, 0.74 D, and 2.33 D, respectively, and 54% of all eyes were within +/-1.00 D of the fellow eye, 68% were within +/-2.00 D, and 80% were within +/-3.00 D. Preoperative visual acuity and binocular vision could be measured in 33 children. Postoperatively, 63.6% of children had an improvement in best corrected visual acuity (BCVA) and the remainder had no noted change. No patient had a reduction in BCVA or a loss in fusional ability after LASEK. Of the 33 children, 39.4% had positive stereopsis preoperatively and 87.9% had positive stereopsis 1 year after LASEK. Laser-assisted subepithelial keratectomy is an effective surgical alternative to improve visual acuity in anisometropic children unable to tolerate conventional methods of treatment or in whom these methods fail.

Beta Carotene Supplementation and Age-Related Maculopathy in a Randomized Trial of US Physicians

To test whether beta carotene supplementation affects the incidence of age-related maculopathy (ARM) in a large-scale randomized trial. Randomized, double-masked, placebo-controlled trial among 22 071 apparently healthy US male physicians aged 40 to 84 years. Participants were randomly assigned to receive beta carotene (50 mg every other day) or placebo. Main Outcome Measure Incident ARM responsible for a reduction in best-corrected visual acuity to 20/30 or worse. After 12 years of treatment and follow-up, there were 162 cases of ARM in the beta carotene group vs 170 cases in the placebo group (relative risk [RR], 0.96; 95% confidence interval [CI], 0.78-1.20). The results were similar for the secondary end points of ARM with or without vision loss (275 vs 274 cases; RR, 1.01; 95% CI, 0.86-1.20) and advanced ARM (63 vs 66 cases; RR, 0.97; 95% CI, 0.69-1.37). These randomized data relative to 12 years of treatment among a large population of apparently healthy men indicate that beta carotene supplementation has no beneficial or harmful effect on the incidence of ARM. Long-term supplemental use of beta carotene neither decreases nor increases the risk of ARM.

Association Between Vision and Hearing Impairments and Their Combined Effects on Quality of Life

To assess associations between age-related vision and hearing impairments and whether combined sensory losses magnify effects on health-related quality of life. Seventy-five percent of survivors (n = 2334) were reexamined at Blue Mountains Eye Study 5-year examinations and 86.3% (2015) attended hearing assessments. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB (500-4000 Hz, better ear). Persons with visual impairment, compared with those without visual impairment, had lower mean audiometric thresholds across all frequencies (P< or =.05). For each 1-line (5-letter) reduction in best-corrected visual acuity and presenting visual acuity, hearing loss prevalence increased by 18% and 13%, respectively. Cataract and age-related maculopathy were also associated with hearing loss (respectively, multivariate-adjusted odds ratio, 1.3 and 1.6; 95% confidence interval, 1.0-1.7 and 1.1-3.1). The association between age-related maculopathy and hearing loss was stronger at younger ages (<70 years). Combined impairments were associated with poorer health-related quality of life than were single impairments (multivariate-adjusted 36-Item Short-Form Health Survey mean physical and mental component scores; Ptrend = .001 and <.001, respectively). Older persons with visual impairment were also more likely to have hearing loss in this study, which suggests that these sensory impairments could share common risk factors or biologic aging markers. Combined sensory impairments also cumulatively affect health-related quality of life.