Subjective Visual Improvement Research Articles

Visual performance and comfort with the Rose K lens for keratoconus.

The "Rose K Lens for Keratoconus" is a proprietary rigid contact lens design that has been reported and marketed as a lens that provides better visual acuity and comfort than other rigid contact lens designs for keratoconus. Twenty patients with keratoconus who were wearing rigid contact lenses were refitted into the Rose K lenses. Visual acuity measurements were taken with habitual lenses at the baseline visit and with the Rose K lenses at the completion of the study. Questionnaires were used to assess vision-specific quality of life, contact lens comfort, and self-reported assessment of vision. There were no statistically significant changes in high- or low-contrast visual acuity with the Rose K lenses. There was statistically significant improvement in self-reported assessment of vision and self-reported assessment of comfort in the eyes with more advanced keratoconus. At the conclusion of the study, 72% of patients preferred the Rose K lenses over their habitual lenses, and 87% reported that they would continue wearing the Rose K lenses. There was no difference in the visual acuity with the Rose K lenses compared with the patients' habitual lenses. Subjective assessment of vision and comfort indicate a statistical improvement for more advanced keratoconus with the Rose K lens. We could not rule out a placebo effect as a source of subjective improvement in vision and comfort. Nevertheless, the successful fit rate and patient preference demonstrate the usefulness of the Rose K lens in clinical practice.

Extracranial Cerebrovascular Revascularization for Chronic Ocular Ischemia

We investigated the demographics, presentation, and outcome of patients undergoing cerebrovascular reconstruction for chronic ocular ischemia (COI) at a single institution through a review of 17 patients over a 9-year period. A total of 558 extracranial cerebrovascular reconstructions were performed during the period of study. Seventeen patients (3%) suffered symptoms of COI. There were 19 symptomatic eyes and 15 asymptomatic eyes. Two patients suffered bilateral symptoms. Eighteen (95%) symptomatic eyes experienced rapidly degenerating global visual acuity, and one suffered bright-light amaurosis. Concomitant ocular pathology was present in 10 (59%) patients, consisting of glaucoma (n = 4), cataracts (n = 4), diabetic retinopathy (n = 3), and macular degeneration (n = 1). Symptomatic eyes were found to have significantly worse ipsilateral internal carotid artery (p = 0.004), external carotid artery (p = 0.002), aortic arch branch disease (p = 0.04), and vertebral artery disease (p = 0.04). All 17 reconstructions treated ipsilateral disease. Twelve patients (70.6%) had significant bilateral disease at the time of operation. Three patients underwent staged contralateral reconstruction. Following revascularization, subjective visual improvement or stabilization occurred in 16 patients (94%). A single patient worsened after developing acute narrow angle glaucoma in the perioperative period. Worse cerebrovascular disease is present ipsilateral to symptomatic eyes. When revascularization is performed, arrest of progression or improvement of symptoms occurs in most patients.

Surgical outcomes in adult patients after repair of anterior segment trauma sustained during childhood

Purpose To evaluate the outcomes and possible benefit of surgery performed on adults for anterior segment trauma sustained during childhood. Setting Private practice. Methods A retrospective review of patient records was performed. Adult patients who had anterior segment surgery for injuries that occurred during childhood were identified. The surgical outcomes were evaluated to determine whether intervention was beneficial in this subgroup of patients. Results Six patients were identified. Preoperative best corrected visual acuity (BCVA) was 20/200 or worse in all patients. After surgery, the BCVA in 3 patients had improved to 20/30 or better and in 1 patient, to 20/60. The other 2 patients had less improvement; however, each noted subjective improvement in vision. No major intraoperative or postoperative complications occurred. Conclusion In the absence of evidence of accompanying posterior segment trauma, surgery in adults to correct anterior segment damage from childhood trauma was safe and often beneficial.

Upper blepharoplasty: A novel approach to improving progressive myopathic blepharoptosis

Objective To describe the results of upper blepharoplasty for the treatment of progressive myopathic upper eyelid blepharoptosis. Design Retrospective, noncomparative case series. Participants Six consecutive patients treated bilaterally. Intervention Upper blepharoplasty in 6 patients (12 eyelids) with progressive myopathic ptosis. Main outcome measures Subjective visual improvement, ocular comfort, preoperative and postoperative margin reflex distances, lagophthalmos, and degree of corneal keratopathy at last follow-up date. Results All patients had subjective visual improvement and denied ocular discomfort. Upper eyelid ptosis, measured by margin reflex distances, was improved. No worsening of lagophthalmos or corneal keratopathy was noted. Conclusions Upper blepharoplasty may be an excellent alternative for ptosis treatment in patients with progressive myopathies. Improvement in ptosis, margin reflex distance, without concomitant lagophthalmos, and corneal keratopathy can be achieved.

Functional improvement after phacoemulsification cataract surgery

Purpose To evaluate subjective functional visual improvement after phacoemulsification and intraocular lens (IOL) implantation and identify patient characteristics and treatment features associated with no functional improvement. Setting Academic referral practice, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. Methods A retrospective review was performed of the surgical results in 106 consecutive eyes of 102 patients who completed the American Society of Cataract and Refractive Surgery (ASCRS) Cataract Data Collection Form © preoperatively and 1 month postoperatively. One surgeon performed all the surgery. The relationship of patient characteristics and treatment features and reported visual function was analyzed using an analysis of variance and the Wilcoxon rank sum and Fisher exact tests. Results One month postoperatively, all patients demonstrated improved visual acuity. However, 15 patients (14%) reported unimproved or decreased visual function. No statistically significant intergroup difference ( P > .05) was detected in mean preoperative, postoperative, and fellow eye best spectacle-corrected visual acuities or refractive errors; reported severity of preoperative symptoms or satisfaction with vision; reported preoperative daily activity functioning or prevalence of hypertension and diabetes; type of anesthesia, lens material, or wound closure used; intraoperative or postoperative complication rates. However, patients reporting unimproved vision tended to be older and less satisfied with their quality of life and medical care than those reporting improved vision ( P = .02, .03, .01, respectively). Conclusions Self-reported visual function generally improved after phacoemulsification and IOL implantation; however, some older patients less satisfied with their quality of life and medical care reported no functional improvement despite improved visual acuity. These patients might benefit from an extended preoperative discussion of postoperative expectations.

Posterior chamber lens implantation combined with pars plana vitrectomy

Purpose: To assess the outcome of cataract extraction and posterior chamber intraocular lens (IOL) implantation combined with pars plana vitrectomy.Setting: Ophthalmic ward in a district general hospital.Methods: This study evaluated seven consecutive patients who had cataract extraction, IOL implantation, and pars plana vitrectomy in one procedure. Four patients were diabetic, and three had perforating eye injuries with cataract formation and intraocular foreign bodies.Results: No significant postoperative complications occurred, and the posterior chamber lenses were well tolerated. In all cases, good subjective visual improvement was achieved and visualization of the posterior pole was excellent.Conclusion: Combining cataract extraction with posterior chamber IOL implantation and vitrectomy in one procedure may be indicated, especially if there is traumatic rupture of the lens capsule.

The association of postoperative subjective visual function with acuity, glare, and contrast sensitivity in patients with early cataract.

It has been shown in our previous studies that early cataracts affect vision in ways that can be measured by objective means and that this objective impairment in visual acuity, glare, and contrast sensitivity can be successfully reversed by cataract surgery. To evaluate the association of subjective visual function with objective measures of acuity, glare, and contrast sensitivity in patients who were symptomatic from early cataract. We administered a task-oriented questionnaire prior to and 4 months after cataract surgery to patients who were symptomatic from early cataract (median preoperative ETDRS [Early Treatment Diabetic Retinopathy Study] visual acuity of 20/40 [range, 20/20 to 20/80]); ETDRS visual acuity, disability glare, and contrast sensitivity were also measured at those times. Uncomplicated cataract surgery resulted in resolution or improvement of subjective symptoms for the great majority of subjects, and in a few subjects new symptoms developed or current symptoms worsened. We found a positive association between postoperative improvement in subjective visual function (as measured by the questionnaire) and postoperative improvement in objective visual function (as measured by visual acuity and contrast sensitivity). We also found that the greater the degree of preoperative impairment in objective visual function (as measured by visual acuity and contrast sensitivity), the greater the postoperative improvement in subjective visual function (as measured by the questionnaire). No such association was found for our disability glare test. Cataract surgery for symptomatic individuals with mild impairment in visual acuity does relieve visual symptoms, and preoperative measurement of contrast sensitivity can help determine who with early cataract is most likely to report subjective improvement in vision.

Band Keratopathy and Excimer Laser Phototherapeutic Keratectomy

OBJECTIVE: To assess the efficacy of the VISX 20:20 excimer laser for phototherapeutic keratectomy (PTK) for band keratopathy. DESIGN: A prospective assessment of subjective and objective parameters associated with both the treatment and the disease. SETTING: This study was undertaken in a specialist clinic receiving many tertiary referrals at a specialist teaching hospital in a capital city. PATIENTS: Twenty-one eyes of 21 patients attending the corneal clinic with band keratopathy elected to undergo PTK. RESULTS: Although restricted to a single diagnosis, the patients proved to be heterogeneous with regards to visual potential and pain. All patients with visual potential had a subjective improvement in vision after treatment, and objective improvement was documented in over half. A shift to hypermetropia, by a mean of 2.4 D was seen. Where pain was the indication for treatment, all patients had markedly reduced or no symptoms after therapy. CONCLUSIONS: Excimer laser PTK with the VISX 20:20 laser is a highly effective, minimally invasive, out-patient treatment for band shaped keratopathy, which is likely to be the most common of the superficial corneal opacities and corneal surface disorders with pain which can be considered for PTK.

Hyperplastic Pupillary Membrane and Laser Therapy

The eyes in two cases of extensive hyperplastic pupillary membranes with significant reduction of visual acuity and clarity were subjected to sectioning of the membranes in the superior 270 degrees of the pupil using a Q-switched Nd:YAG laser. The complications of microhemorrhages, pigment dispersal, and elevation of intraocular pressure were insignificant, while the objective and subjective improvement in vision was remarkable.

Improvement of visual acuity and corneal physiology in keratoconus by fitting aspherical, high oxygen-permeable contact lenses

Keratoconus is a condition in which the cornea assumes a complex irregular curvature caused by central corneal thinning. The abnormal topography of the cornea in combination with central corneal scarring results in an impaired visual acuity. Even in mild cases spectacles do not correct vision adequately. The use of hard contact lenses with a spherical geometry in the past has already given a marked therapeutic improvement. The use of these lenses however, is complicated by hypoxia and mechanical trauma of the cornea. These complications could theoretically be avoided by fitting elliptical lenses with a high oxygen transmission. To investigate this hypothesis we compared low oxygen-permeable spherical lenses with high oxygen-permeable elliptical contact lenses in a group of twenty patients with mild keratoconus. Our results showed both a marked subjective and objective visual improvement after fitting elliptical lenses with a low incidence of complications.

Binocular summation in visually evoked responses and visual acuity

Monocular and binocular transient visually evoked responses (VER) were recorded on 50 adult subjects using a pattern reversal stimulus (check size 5.5 min arc). The peak-to-trough amplitude of the VER wave was measured and compared with the subjective visual acuity (Landolt C). The binocular amplitude enhancement over the monocular amplitude was around 26% across the acuity range studied, whereas the mean binocular subjective visual acuity improvement was around 11.3%, but this varied from 1% at the high acuity end to 17% at the low acuity end of the range.

Binocular summation in visually evoked responses and visual acuity

Monocular and binocular transient visually evoked responses (VER) were recorded on 50 adult subjects using a pattern reversal stimulus (check size 5.5 min arc). The peak-to-trough amplitude of the VER wave was measured and compared with the subjective visual acuity (Landolt C). The binocular amplitude enhancement over the monocular amplitude was around 26% across the acuity range studied, whereas the mean binocular subjective visual acuity improvement was around 11.3%, but this varied from 1% at the high acuity end to 17% at the low acuity end of the range.

Drug prevention and therapy of diabetic angiopathy

In 53 patients with diabetes mellitus of varying severity, the functional state of the kidneys after a course of treatment with retabolil was studied using radioisotope methods. There was a significant improvement in the general condition, a decrease in weakness, subjective improvement in vision, etc. Patients with concomitant diseases or multiple angiopathies were resistant to retabolil. Long-term results were followed in 14 patients.