Acuity Measurements Research Articles

Рroblems of diagnostics of dysfunctions of the olfactory analyzer of laboratory animals on the basis of behavioral and electrophysiological methods of research

Olfactory impairment (decreased acuity, impaired adequate identification of odorants) reduces the quality of life of patients and can be a symptom of a wide range of pathologies of the organism, in particular neurodegenerative processes in the brain. Quantitative measurement of olfactory acuity is necessary for diagnostics of olfactory dysfunctions, monitoring the dynamics of olfaction after pharmacological or surgical treatment. The searching for optimal methods of analyzing olfactory thresholds on animal models of human diseases accompanied by anosmia and comparing them with those in humans seems to be especially urgent problem at the moment. This is necessary for the selection of a valid animal model for the evaluation of new drugs and development the therapy for a wide range of pathologies. The review analyzes publications devoted to the study of diseases accompanied by anosmia or hyposmia, their zootropic models, and methods of olfactory function assessment. Models for COVID19, Alzheimer’s disease, Parkinson’s disease, diabetes types (1 and 2 type), Kalman syndrome, and Bardet-Biedl syndrome, for which olfactory dysfunction and/or defects of olfactory system are present, were analyzed. The review notes the paucity of data on the measurement of olfactory thresholds in model animals.

Evaluating the precision of an online visual acuity test tool.

The aim of this study was to assess the precision of a web-based tool in measuring visual acuity (VA) in ophthalmic patients, comparing it to the traditional in-clinic evaluation using a Snellen chart, considered the gold standard. We conducted a prospective and in-clinic validation comparing the Eyecare Visual Acuity Test® to the standard Snellen chart, with patients undergoing both tests sequentially. Patients wore their standard spectacles as needed for both tests. Inclusion criteria involved individuals above 18 years with VA equal to or better than +1 logMar (20/200) in each eye. VA measurements were converted from Snellen to logMAR, and statistical analyses included Bland-Altman and descriptive statistics. The study, encompassing 322 patients and 644 eyes, compared Eyecare Visual Acuity Test® to conventional methods, revealing a statistically insignificant mean difference (0.01 logMAR, P = 0.1517). Bland-Altman analysis showed a narrow 95% limit of agreement (0.22 to -0.23 logMAR), indicating concordance, supported by a significant Pearson correlation (r = 0.61, P < 0.001) between the two assessments. The Eyecare Visual Acuity Test® demonstrates accuracy and reliability, with the potential to facilitate home monitoring, triage, and remote consultation. In future research, it is important to validate the Eyecare Visual Acuity Test® accuracy across varied age cohorts, including pediatric and geriatric populations, as well as among individuals presenting with specific comorbidities like cataract, uveitis, keratoconus, age-related macular disease, and amblyopia.

Effect of artificial natural light on the development of myopia among primary school-age children in China: a three-year longitudinal study.

To assess the efficacy of artificial natural light in preventing incident myopia in primary school-age children. This is a prospective, randomized control, intervention study. A total of 1840 students from 39 classes in 4 primary schools in Foshan participated in this study. The whole randomization method was adopted to include classes as a group according to 1:1 randomized control. Classrooms in the control group were illuminated by usual light, and classrooms in the intervention group were illuminated by artificial natural light. All students received uncorrected visual acuity and best-corrected visual acuity measurement, non-cycloplegic autorefraction, ocular biometric examination, slit lamp and strabismus examination. Three-year follow-up, the students underwent same procedures. Myopia was defined as spherical equivalent refraction ≤ -0.50 D and uncorrected visual acuity <20/20. There were 894 students in the control group and 946 students in the intervention group with a mean±SD age of 7.50±0.53y. The three-year cumulative incidence rate of myopia was 26.4% (207 incident cases among 784 eligible participants at baseline) in the control group and 21.2% (164 incident cases among 774 eligible participants at baseline) in the intervention group [difference of 5.2% (95%CI, 3.7% to 10.1%); P=0.035]. There was also a significant difference in the three-year change in spherical equivalent refraction for the control group (-0.81 D) compared with the intervention group [-0.63 D; difference of 0.18 D (95%CI, 0.08 to 0.28 D); P<0.001]. Elongation of axial length was significantly different between in the control group (0.77 mm) and the intervention group [0.72 mm; difference of 0.05 mm (95%CI, 0.01 to 0.09 mm); P=0.003]. Artificial natural light in the classroom of primary schools can result in reducing incidence rate of myopia during a period of three years.

Improvement in Central Serous Chorioretinopathy Following Multiwavelength Photobiomodulation Treatment - Case Report.

Central serous chorioretinopathy (CSCR) is a condition where fluid build-up accumulates underneath the retina, resulting in retinal pigment epithelium (RPE) detachment and vision loss. Irreversible retinal functional and anatomical changes are possible consequences. Research into novel strategies to aid in recovery are of interest. Photobiomodulation (PBM) uses light wavelengths to improve cellular function and shows positive effects in several conditions including those with edema. This prospective case report details a 39-year-old woman with CSCR. Multiwavelength PBM treatment was initiated with the Valeda® Light Delivery System. A series of treatment included nine sessions delivered over 3-5weeks. Follow-up treatments were conducted. Optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA) measures were taken. The patient has been followed for approximately 1year. The patient presented with blurred vision and a BCVA score of 65 letters in the left eye. After 3weeks of observation, the patient's vision had further declined two lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart to 55 letters. Fluorescein angiography was performed, confirming CSCR diagnosis, and PBM was initiated. PBM treatment improved BCVA and fluid build-up in the RPE within 1week of treatment (three treatment sessions). Following the full series of treatment (nine PBM treatment sessions), fluid was completely resolved and BCVA scored at 80 letters. The patient had a repeat PBM treatmentseries ~ 6months later and has shown stable vision and no fluid present on OCT scan. The patient was seen again ~ 1year later with continued stable vision and no fluid detection. PBM is a non-invasive treatment option that may provide benefit in CSCR to resolve fluid build-up, macular change, and vision loss. Research into PBM as an immediate treatment option for CSCR, especially those with chronic presentations or those posed to have irreversible damage, is warranted to confirm effectiveness.

Choroidal thickness and retinal vascular changes in patients with lichen planus: an inflammatory disease beyond the skin.

Lichen planus (LP) is a common inflammatory condition of unknown etiology that commonly affects the skin and mucous membranes. Optical coherence tomography angiography (OCTA) is a noninvasive technique for identifying early retinal vascular impairment in systemic disease without clinical damage by imaging deep and superficial capillary networks. To assess the impacts of LP on the choroid and assess vascular changes in retinal capillary density using OCTA. This single-center prospective case-control study included 30 therapeutic-naïve LP patients and 30 age and sex-matched healthy individuals. All study subjects underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) measurement using a Snellen chart, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and fundus examination. They were then examined using spectral domain OCT and choroidal thickness was measured. The vessel density of the superficial and deep capillary networks was measured and assessed using OCTA. Patients had significantly thicker choroidal and retinal thickness than controls, with subfoveal, nasal, and temporal areas showing a significant difference. A significantly higher vascular density in the superficial capillary plexus, particularly in the nasal perifoveal area, was found compared to the control group. Significantly, higher vascular density in the deep capillary plexus in the parafoveal area compared to controls was reported. Significant correlations were found between visual acuity and IOP, and age, duration of disease, and severity of disease. This study is the first to reveal that LP patients exhibit choroidal changes and retinal vascular alterations compared to healthy controls.

Quantitative comparison of binocular suppression of patients with anisometropic amblyopia and ametropic amblyopia

Objective: To explore the differences in clinical characteristics and interocular interactions between patients with anisometropic amblyopia and ametropic amblyopia. Methods: Cross-sectional study. The newly diagnosed anisometropic (the binocular difference in spherical equivalent≥1.00 D) amblyopia patients and ametropic amblyopia patients (aged 4 to 6 years) in Beijing Tongren Hospital from January 2020 to December 2022 were involved. Patients were further categorized by the refractive status after cycloplegia, including hyperopia, myopia, astigmatism, hyperopia with astigmatism, myopia with astigmatism, mild anisometropia and severe anisometropia. Quantitative measurements of best-corrected visual acuity (logMAR), stereoacuity (transformed to log units), perceptual eye position and interocular suppression were performed, and the differences between groups were analyzed. The rank sum test was used for statistical evaluation. Results: The average age of 45 ametropic amblyopia patients (21 males and 24 females) and 84 anisometropic amblyopia patients (48 males and 36 females) was 5.0 (4.0, 5.0) years and 5.0 (4.0, 6.0) years, respectively. The interocular differences in spherical equivalent [2.56 (1.50, 4.19) D vs. 0.25 (0.13, 0.56) D] and best-corrected visual acuity [0.40 (0.18, 0.70) logMAR vs. 0.07 (0.00, 0.12) logMAR] were larger in patients with anisometropic amblyopia than those with ametropic amblyopia. The anisometropic amblyopia patients had worse stereoacuity [2.60 (2.00, 2.90) log arcsec vs. 2.00 (2.00, 2.30) log arcsec] and deeper suppression [20.0% (13.3%, 40.0%) vs. 10.0% (0, 23.3%)], compared with the ametropic amblyopia patients. The differences were all statistically significant (P<0.05). The suppression and stereoacuity between patients with hyperopic anisometropic amblyopia [suppression, 30.0% (17.5%, 50.0%); stereoacuity, 2.90 (2.30, 2.90) log arcsec] and astigmatic anisometropic amblyopia [suppression, 10.0% (0, 20.0%); stereoacuity, 2.00 (2.00, 2.30) log arcsec] were significantly different (P<0.05). The differences of suppression and stereoacuity between patients with severe (binocular difference in spherical equivalent>2.50 D) [suppression, 30.0% (20.0%, 53.3%); stereoacuity, 2.90 (2.57, 2.90) log arcsec] and mild anisometropia [suppression, 20.0% (0, 30.0%); stereoacuity, 2.00 (2.00, 2.90) log arcsec] were also statistically significant (P<0.05). Conclusions: Patients with anisometropic amblyopia have deeper binocular suppression, worse stereoacuity and more severe binocular interaction abnormality than those with ametropic amblyopia. The severity of anisometropia affects the degree of the interaction abnormality.

Impact of gender on clinical features and outcomes of ocular toxoplasmosis

AimTo investigate the effect of gender on the clinical features and outcomes of ocular toxoplasmosis.Methods262 patients (139 women and 123 men) presenting to a tertiary referral uveitis service in Ribeirão...

Two-Point Discrimination for Upper Extremity and Face in Healthy Young Adults: A Cross-Sectional Study

Background and Aim: The threshold values of two-point discrimination (TPD) provide a numerical measure of tactile acuity. Normal reference values are needed to decide whether sensory variability is within normal sensorial limits. The study aimed to determine the upper extremity and face threshold values in healthy young adults. Materials and Methods: Static TPD thresholds of 67 healthy young adults aged 18–35 years were assessed. Eight skin areas in the face and upper extremity on the dominant side were assessed using a “method of limits” approach with an aesthesiometer. Differences between genders were examined with the Mann–Whitney U test. The Spearman correlation analysis investigated the relationship between age and TPD measurements. Results: TPD values ranged between 4.66 and 19.16 mm and 1.33-68.66 mm in the face and upper extremity, respectively, in the participants with a mean age of 23.83 ± 4.66 years. Fingertips and the area over the lateral mandibula showed the greatest sensitivity. The threshold values of TPD showed both interindividual and intraindividual variability. There was no statistical difference in the TPD values according to gender in any of the measured areas, and there was no relationship between age and TPD test values. Conclusions: The threshold values of TPD have clinical applicability in various diseases affecting the sensation of the upper extremity and/or face. These data may help the detection of early sensory loss.

Visual impairment and cognitive performance: A nationwide study of 1.4 million adolescents.

Previous research highlights the adverse effects of visual impairment (VI) on academic achievement in children, yet its impact on cognitive performance among adolescents and young adults remains under-studied. Therefore, this investigation aimed to analyse this association in a nationwide sample of Israeli adolescents. A retrospective population-based cross-sectional study was conducted among 1,410,616 Israeli-born adolescents aged 16-19 years, who were assessed before mandatory military service between 1993 and 2017. The definition of VI was based on best-corrected visual acuity (BCVA) measurements using a standard Snellen chart. Adolescents with BCVA worse than 6/9 in either or both eyes were classified as having unilateral or bilateral VI, respectively. Cognitive performance was measured using the General Intelligence Score (GIS), based on a validated four-domain test. Relationships were analysed using regression models yielding adjusted odds ratios (ORs) for low (<-1 standard deviation [SD]) and high (≥1 SD) cognitive Z-scores. Of 1,410,616 adolescents (56.1% men), 13,773 (1.0%) had unilateral and 3980 (0.3%) had bilateral VI. Unilateral VI was associated with adjusted ORs for low and high cognitive Z-scores of 1.24 (1.19-1.30) and 0.84 (0.80-0.89), respectively. ORs were accentuated for bilateral VI, reaching 1.62 (1.50-1.75) and 0.81 (0.74-0.90) for low and high cognitive Z-scores, respectively. Cognitive performance subscores mirrored these results, with the visual-spatial functioning subtest demonstrating the greatest effect size. These associations persisted in sub-analyses restricted to adolescents with amblyopia-related VI, mild VI and unimpaired health status. Visual impairment, including mild and unilateral cases, is associated with reduced cognitive performance scores assessed in late adolescence. Further research is required to gain a comprehensive understanding of the dynamics underlying this relationship.

Telemedicine Screening for Eye Disorders in Federally Qualified Health Centers: Relationship to Vision-Targeted Health-Related Quality of Life.

Introduction: Federally Qualified Health Centers (FQHCs) play a crucial role as safety-net primary health care clinics in the United States, serving medically underserved areas and populations. However, eye services are rarely offered at FQHCs. We examined how telemedicine-generated ocular diagnoses impacted vision-targeted health-related quality of life at FQHCs in rural Alabama. Methods: We focused on patients who are at risk for glaucoma. Both visual function and retinal imaging were assessed. The telemedicine vision screening protocol performed by a remote ophthalmologist evaluated eyes for glaucoma, diabetic retinopathy, cataract, age-related macular degeneration, and a measurement of habitual visual acuity. The National Eye Institute Visual Function Questionnaire-9 (VFQ-9) was administered. Results: Using stepwise regression, the best-fitting model for predicting VFQ-9 scores incorporated visual acuity 20/40 or worse, a diabetic retinopathy diagnosis, and sociodemographic variables (gender, transportation, insurance type/status, and employment status). Conclusion: Vision-targeted, health-related quality of life in our FQHC settings was related to the visual acuity impairment and the diagnosis of diabetic retinopathy but was also influenced by a variety of sociodemographic factors.

Early diagnosis and treatment by newborn screening (NBS) or family history is associated with improved visual outcomes for long-chain 3-hydroxyacylCoA dehydrogenase deficiency (LCHADD) chorioretinopathy.

Long chain 3-hydroxyacyl-CoA dehydrogenase (LCHADD) is the only fatty acid oxidation disorder to develop a progressive chorioretinopathy resulting in vision loss; newborn screening (NBS) for this disorder began in the United States around 2004. We compared visual outcomes among 40 participants with LCHADD or trifunctional protein deficiency diagnosed symptomatically to those who were diagnosed via NBS or a family history. Participants completed ophthalmologic testing including measures of visual acuity, electroretinograms (ERG), fundal imaging, contrast sensitivity, and visual fields. Records were reviewed to document medical and treatment history. Twelve participants presented symptomatically with hypoglycemia, failure to thrive, liver dysfunction, cardiac arrest, or rhabdomyolysis. Twenty eight were diagnosed by NBS or due to a family history of LCHADD. Participants diagnosed symptomatically were older but had similar percent males and genotypes as those diagnosed by NBS. Treatment consisted of fasting avoidance, dietary long-chain fat restriction, MCT, C7, and/or carnitine supplementation. Visual acuity, rod- and cone-driven amplitudes on ERG, contrast sensitivity scores, and visual fields were all significantly worse among participants diagnosed symptomatically compared to NBS. In mixed-effects models, both age and presentation (symptomatic vs. NBS) were significant independent factors associated with visual outcomes. This suggests that visual outcomes were improved by NBS, but there was still lower visual function with advancing age in both groups. Early diagnosis and treatment by NBS is associated with improved visual outcomes and retinal function compared to participants who presented symptomatically. Despite the impact of early intervention, chorioretinopathy was greater with advancing age, highlighting the need for novel treatments.

Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study

ObjectiveAlthough aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DesignObservational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Setting and ParticipantsMulticenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. MethodsThe numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. ResultsAmong the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). Conclusions and ImplicationsOur findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

Первый опыт применения субпорогового наносекундного лазерного воздействия при промежуточной форме возрастной макулярной дегенерации

Purpose. To present a clinical case of the first experience of subthreshold nanosecond laser treatment for an intermediate age-related macular degeneration (AMD). Methods. A 70-year-old patient T. diagnosed with intermediate AMD, underwent subthreshold nanosecond laser exposure using a 2RT device (Ellex, Australia). The patient underwent multimodal diagnostics, including best-corrected visual acuity (BCVA) measurement, fundus ophthalmoscopy, short-wave and infrared autofluorescence, infrared light imaging, multispectral laser scanning and optical coherence tomography at the baseline, 1- and 3-month follow-up. Results. No significant changes were observed at 1-month follow-up. 3 months after 2RT, the patient noted a subjective improvement in the contrast and quality of vision, while BCVA increased from 0.7 to 0.8. When performing OCT scans in followup mode, the disappearance of a number of large confluent drusen in the area nasal to the fovea was noted. A decrease in retinal thickness was also observed in this area due to the resorption of large confluent drusen. The infrared imaging and autofluorescence showed no changes in retinal pigment epithelium and no appearance hypoautofluorescence of atrophic zones. Conclusion. The first experience of subthreshold nanosecond laser treatment of intermediate AMD revealed a potential positive functional and structural outcome in case of the presence of large confluent drusen. Further studies with a larger number of patients are needed. Key words: subthreshold nanosecond laser exposure, age-related macular degeneration, confluent drusen

Changes in peripapillary retinal nerve fibre layer and ocular parameters in acute anterior uveitis

ABSTRACT Clinical relevance Acute anterior uveitis (AAU) can lead to the thickening of the peripapillary retinal nerve fibre layer (pRNFL) and induce refractive changes during its active phase. Background AAU is a common form of uveitis characterised by inflammation in the anterior chamber. A notable prevalence of optical coherence tomography – defined pRNFL thickening was observed among patients with AAU. The alterations in pRNFL thickness and their associations with other relevant ocular parameters in patients with AAU were investigated. Methods A retrospective, consecutive case series was conducted at a specialised uveitis referral clinic in Taiwan. This study gathered data on various demographic characteristics and various ocular parameters, namely anterior chamber cell grading, refractive error, best-corrected visual acuity, intraocular pressure, and optical coherence tomography measurements. A comparative analysis of baseline and subsequent follow-up data was conducted. Additionally, this study examined the correlations between alterations in pRNFL thickness and various ocular parameters. Twenty-one patients with AAU (21 affected eyes/21 unaffected eyes) were examined. Results Initial measurements revealed pRNFL thickening in 20 patients. Treatment led to significant improvements in best-corrected visual acuity, intraocular pressure recovery, and pRNFL thickening (p < 0.01). The correlation between changes in pRNFL thickness and best-corrected visual acuity was weak (r = 0.20, p = 0.41). By contrast, a significant negative correlation was identified between changes in pRNFL thickness and refractive error alterations (r = −0.71, p = 0.01). Conclusion This study demonstrated that AAU is associated with pRNFL thickening, which in turn is inversely correlated with changes in refractive error alterations throughout the disease course. Monitoring changes in pRNFL thickness can be effective in assessing ocular inflammation status.

Optical coherence tomography (OCT) and OCT-angiography in syndromic versus non-syndromic USH2A-associated retinopathy.

To compare non-syndromic and syndromic forms of USH2A-related retinitis pigmentosa (RP) by means of structural optical coherence tomography (OCT) and OCT-angiography (OCTA). Observational, cross-sectional, multicenter study. All patients underwent best corrected visual acuity (BCVA) measurement, OCT (Spectralis HRA + OCT, Heidelberg Engineering) and OCTA (OCT DRI Topcon Triton, Topcon Corporation). We compared subfoveal choroidal thickness (SCT), choroidal vascularity index (CVI), presence of cystroid macular edema (CME), macular vessel density (VD) at the superficial and deep capillary plexa, as well as VD of the radial peripapillary capillary (RPC) network, between syndromic and non-syndromic patients with USH2A-associated retinopathy. Thirty-four eyes from 18 patients (7 females) were included. Thirteen patients (72.2%) were affected by Usher syndrome type 2, whereas the remaining 5 subjects (27.8%) had non-syndromic retinitis pigmentosa (nsRP). Syndromic patients were younger than nsRP (p = 0.01) and had a worse visual acuity than those with the exclusively retinal phenotype. Patients with Usher syndrome type 2 had a higher prevalence of CME and a thicker choroid compared to nsRP, although these results were not statistically significant (p = 0.775 and p = 0.122, respectively). Similarly, none of the other quantitative OCT and OCTA parameters was statistically different between the two groups. Despite their younger age, patients with Usher syndrome type 2 displayed similar choroidal and microvascular changes compared to those with nsRP.

Efficacy and safety of the implantation of a single-piece angulated foldable IOL in the sulcus.

To study the visual results and tolerance of a Zeiss CT Lucia 601P intraocular lens (IOL) implanted in the sulcus after complicated cataract surgery or during IOL exchange for clouded IOL. In total, 64 patients who underwent sulcus implantation were recalled to the hospital to undergo subjective and objective refraction, best corrected visual acuity measurement, tonometry, optical coherence tomography, laser flare photometry, biometry, and wavefront aberrometry. In spite of a large variation in preoperative refraction, the target refraction was obtained within 1.5 diopters in approximately 97% of patients and within 0.5 diopter in 53% of patients. Average BCVA was high (Snellen 0.86) and related to concomitant (mostly retinal) pathologies in eyes with poorer visual performance. Wavefront aberrometry showed no evidence of IOL tilting or decentration after long-term implantation in the sulcus. Tonometry was not different from the fellow eye of the patient (p > 0.5). In 53 patients with bilateral pseudophakia, the laser flare photometry was not significantly different from the fellow eye (p < 0.05). This study demonstrates that this single-piece angulated foldable acrylic IOL can be considered for implantation in the sulcus. The visual results are favorable, and the IOL can be well-positioned and tolerated in the sulcus. Moreover, there were no safety issues found since there was no evidence of elevated IOP or chronic uveitis.

Development and Implementation of a Pediatric Nursing Emergency Behavioral Health Assessment Tool

IntroductionThe national pediatric mental and behavioral health crisis dramatically increased emergency department mental and behavioral health visits and changed emergency nursing practice. Acuity assessment determines patient severity level and supports appropriate resources and interventions. There are no established nursing tools that assess pediatric mental or behavioral health acuity in the emergency department setting. Our goal was to develop and implement the novel pediatric emergency nurse Emergency Behavioral Health Acuity Assessment Tool. MethodsThis quality-improvement project used the plan, do, study, act model to design/refine the Emergency Behavioral Health Acuity Assessment Tool and a non-experimental descriptive design to assess outcomes. The setting was a 47-bed urban level 1 pediatric trauma center with more than 60,000 annual visits. The team designed the tool using published evidence, emergency nurse feedback, and expert opinion. The tool objectively captured patient acuity and suggested acuity-specific nursing interventions. Project outcomes included acuity, length-of-stay, restraint use, and patient/staff injuries. Analyses included descriptive statistics and correlations. ResultsWith over 3000 annual mental/behavioral-related visits, the emergency department had an average daily census of 23 mental and behavioral health patients. Implementation occurred in August 2021. The Emergency Behavioral Health Acuity Assessment Tool dashboard provided the number of patients, patient location, and acuity. Length-of-stay did not change; however, patient restraint use and patient/staff injuries declined. Number of restraints positively correlated with moderate acuity levels (r = 0.472, P = 0.036). DiscussionFor emergency nurses, the Emergency Behavioral Health Acuity Assessment Tool provided an objective measure of patient acuity. Targeted interventions can improve the care of this population.

Clinical Relevance of Plasma Prolylcarboxypeptidase Level in Patients with Idiopathic Acute Optic Neuritis.

Objectives: This study evaluated the plasma concentration of prolylcarboxypeptidase (PRCP) and its clinical relevance in patients with idiopathic acute optic neuritis (ON). Methods: We investigated the expression of PRCP in the optic nerves of experimental autoimmune optic neuritis (EAON)-induced mice. Peripheral blood samples were collected from ON patients (n = 20) and healthy controls (n = 20). ELISA was used to measure the plasma PRCP levels. We performed measurements of visual acuity and the mean thicknesses of the macular ganglion cell layer plus inner plexiform layer (GCL+IPL) at diagnosis and 6 months after diagnosis. Results: The PRCP mRNA expression in EAON-induced mice was markedly higher than that in naïve mice. The mean plasma PRCP level was significantly higher in patients with ON than in controls. Plasma PRCP levels were negatively correlated with logMAR visual acuity at 6 months after diagnosis and differences in macular GCL+IPL thickness during an ON attack. A plasma PRCP level of 49.98 (pg/mL) predicted the recurrence of ON with a 75% sensitivity and 87.5% specificity. Conclusions: Patients with idiopathic acute ON had higher plasma PRCP levels, and this was positively correlated with final visual outcome and well-preserved macular GCL+IPL thickness during an ON attack. The increase in plasma PRCP level may reflect its compensatory secretion to counteract neuroinflammation in ON patients.

Erratum: Motion-Acuity Test for Visual Field Acuity Measurement with Motion-Defined Shapes.

This corrects the article 10.3791/66272.

Impact of dry eye on visual acuity and contrast sensitivity

Background Although normal visual acuity (VA) has been documented in dry eye disease (DED), it has a deleterious effect on multiple aspects of visual functions. Objective The aim of this study was to evaluate the VA and contrast sensitivity in patients with DED. Patients and methods The study included 60 eyes of 30 patients with bilateral DED. The patients were evaluated on presentation and one month and 3 months after treatment. The evaluation included measurement of VA, contrast sensitivity, tear break-up time (TBUT), and Schirmer’s test. The treatment was prescribed for 3 months and included hot fomentations, topical steroids 4 times daily, tear substitutes with sodium hyaluronate 0.1% and tear substitutes with polyethylene glycol 0.3%, propylene glycol, and hydroxypropyl guar 4 times daily, and cyclosporine 0.05% eye drops twice daily. Results There was a statistically significant improvement in the functional outcome from baseline to 3 months after treatment. The uncorrected VA improved from LogMAR 0.585±0.27 at baseline to 0.52±0.26, 3 months after treatment (P=0.017). Similarly, the best corrected VA improved from 0.332±0.235 at baseline to 0.217±0.138 (P=0.012), and the contrast sensitivity improved from 1.188±0.255 to 1.59±0.118 (P=0.009) after 3 months. The TBUT significantly improved from 4.08±2.895 s to 8.35±1.665 s (P=0.001) and the Schirmer’s test from 5.45±3.72 mm to 9.53±2.38 mm (P=0.001) 3 months after treatment. There was a significant negative correlation between the TBUT and VA 3 months after treatment (r=−0.4094, P &lt;0.021). Conclusion There was a significant improvement in VA, contrast sensitivity, TBUT, and Schirmer’s test within a few months of treatment of DED.