Visual Impairment Score Research Articles

Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach.

Tuberculum sellae meningioma (TSM) represents a complex skull base tumor. The primary goals of surgical treatment are represented by maximal safe resection and visual recovery; therefore, appropriate patient selection is critical to optimize results. In the last 2 decades, the endoscopic endonasal approach (EEA) has appeared as a successful and viable strategy for the management of these tumors. The authors identified preoperative factors associated with extent of resection and visual outcome after EEA for TSM. In this retrospective cohort study, the authors analyzed patients who underwent extended endoscopic endonasal surgery for TSM between January 2005 and April 2022 at the Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. Tumor size, vessel encasement, and optic canal involvement were classified according to University of California, San Francisco, score. Visual acuity and visual fields were analyzed according to the visual impairment score (VIS), defined as a four-level classification: grade 1 (VIS 0-25), grade 2 (VIS 26-50), grade 3 (VIS 51-75), and grade 4 (VIS 76-100). Ophthalmological functions were tested preoperatively and during the early postoperative period (within 6 months after surgery) and late postoperative period. A total of 48 patients were enrolled. Forty-one (85.4%) patients experienced blurred vision or visual field defect as a presenting sign. Gross-total resection was achieved in 40 (83.3%), near-total resection in 2 (4.2%), and subtotal resection in 6 (12.5%). Visual defect improved in 82.9% (34/41) of cases, 12.2% (5/41) had no significant changes, and 2.4% (1/41) had worsened visual defect. The mean change in VIS was 42% (95% CI 58.77-31.23). Visual outcome was poorer when preoperative VIS (VIS-pre) was greater than 25 (p = 0.02). Six postoperative CSF leaks occurred (12.5%), and 1 patient (2.1%) required revision surgery. The EEA is a safe and effective approach for TSM removal, with the advantage of preserving optic apparatus vascularization, and can promote gross-total resection and visual improvement. The authors have defined four categories based on VIS that relate to postoperative outcome: the lower the VIS-pre, the higher the rate of postoperative VIS improvement. This finding may be useful for predicting a patient's visual outcome at the preoperative stage.

Quantifying refractive error in companion dogs with and without nuclear sclerosis: 229 eyes from 118 dogs.

To evaluate the relationship between nuclear sclerosis (NS) and refractive error in companion dogs. One hundred and eighteen companion dogs. Dogs were examined and found to be free of significant ocular abnormalities aside from NS. NS was graded from 0 (absent) to 3 (severe) using a scale developed by the investigators. Manual refraction was performed. The effect of NS grade on refractive error was measured using a linear mixed effects analysis adjusted for age. The proportion of eyes with >1.5 D myopia in each NS grade was evaluated using a chi-square test. Visual impairment score (VIS) was obtained for a subset of dogs and compared against age, refractive error, and NS grade. Age was strongly correlated with NS grade (p < .0001). Age-adjusted analysis of NS grade relative to refraction showed a mild but not statistically significant increase in myopia with increasing NS grade, with eyes with grade 3 NS averaging 0.58-0.88 D greater myopia than eyes without NS. However, the myopia of >1.5 D was documented in 4/58 (6.9%) eyes with grade 0 NS, 12/91 (13.2%) eyes with grade 1 NS, 13/57 (22.8%) eyes with grade 2 NS, and 7/23 (30.4%) eyes with grade 3 NS. Risk of myopia >1.5 D was significantly associated with increasing NS grade (p = .02). VIS was associated weakly with refractive error, moderately with age, and significantly with NS grade. NS is associated with visual deficits in some dogs but is only weakly associated with myopia. More work is needed to characterize vision in aging dogs.

APOE4 Status and Cognitive Function in Middle-aged and Elderly People.

APOE is one of the prominent genes involved in the increased risk of developing Alzheimer's disease, but its effect on cognition in patients who are not yet diagnosed with dementia or mild cognitive impairment is relatively understudied. We aimed to examine the effect of ApoE4 on cognitive performance in unimpaired middle-aged and elderly persons. Our study included 51 cognitively unimpaired participants divided into ApoE4 positive patients and controls by APOE genotyping. The following clinical and demographic characteristics were collected: age, gender, education, social status, BMI, history of medical or psychiatric disorders. Patients with current anxiety or depressive disorders were excluded. Cognitive function was evaluated using MMSE, Rey Auditory-Verbal Learning Test, Rey Complex Figure test, TMT A and B and verbal fluency test. The two groups were matched for age, sex, and education. Categorial data was analyzed using Chi-Square and continuous data using Student-T test (parametric variables) or Mann-Whitney test (non-parametric variables). Statistical significance was considered at p≤.05. There were 11 (21.6%) ApoE4 positive patients and 40 (78.4%) controls. There were no significant differences between the groups regarding socio-demographic and clinical characteristics. The ApoE4 positive group performed slightly worse on cognitive evaluations compared to controls but only the mean scores of the Rey Complex Figure Test - Memory reached statistical significance (p=.019). Cognitive evaluation generally rendered lower scores in the ApoE4 group compared to the control group. However, only visual memory impairment scores were significantly lower in the ApoE4 positive individuals than in controls.

A retrospective cohort study assessing geometrical parameters related to visual deterioration in pituitary macroadenoma

PurposeWe aim to identify specific parameters that will allow identification of those patients at greater risk of vision loss, specifically variables such as geometry, volume and size of the pituitary tumour. MethodologyVolume measurements were made with both manual (using the formula width × height × length × 0.5) and video size, sub-voxel interpolation using Brainlab software. The shape of the tumour was divided into four categories, ovoid, dumbbell, pyramidal and other. Chiasmal compression was divided into central and lateral compression and the chiasm location was classified based on pre/post and normal fixed chiasm in relation to the tuberculum sella. We used a visual impairment score ranging from (0–100), which was then further subdivided in to four grades: Grade I – 0–25 (mild); Grade II – 26–50 (moderate); Grade III – 51–75 (severe); Grade IV – 76–100 (subtotal or complete). ResultsUnivariate analysis of variables related to vision loss found tumour volume, suprasellar growth and lateral chiasmal compression related to pre-operative vision loss. On multivariate regression analysis tumour volume and lateral chiasmal compression remained significant (p < 0.008). In relation to post-operative vision, univariate analysis indicated that variables such as giant macroadenoma, pre-operative visual impairment score and suprasellar growth were significant. Multivariate analysis showed pre-operative visual impairment and suprasellar growth as the only statistically significant variables. ConclusionOur ROC analysis suggests tumours with suprasellar extension 16 mm (sensitivity 85 %, specificity 67 %) in sagittal plane are more likely to result in moderate to severe grade vision loss (VIS grade ≥ 2).

Ophthalmologic problems correlates with cognitive impairment in patients with Parkinson's disease.

ObjectiveVisual impairment is a common non-motor symptom (NMS) in patients with Parkinson's disease (PD) and its implications for cognitive impairment remain controversial. We wished to survey the prevalence of visual impairment in Chinese Parkinson's patients based on the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q), identify the pathogens that lead to visual impairment, and develop a predictive model for cognitive impairment risk in Parkinson's based on ophthalmic parameters.MethodsA total of 205 patients with Parkinson's disease and 200 age-matched controls completed the VIPD-Q and underwent neuro-ophthalmologic examinations, including ocular fundus photography and optical coherence tomography. We conducted nomogram analysis and the predictive model was summarized using the multivariate logistic and LASSO regression and verified via bootstrap validation.ResultsOne or more ophthalmologic symptoms were present in 57% of patients with Parkinson's disease, compared with 14% of the controls (χ2-test; p < 0.001). The visual impairment questionnaire showed good sensitivity and specificity (area under the curve [AUC] = 0.918, p < 0.001) and a strong correlation with MoCA scores (Pearson r = −0.4652, p < 0.001). Comparing visual impairment scores between pre- and post-deep brain stimulation groups showed that DBS improved visual function (U-test, p < 0.001). The thickness of the retinal nerve fiber layer and vessel percentage area predicted cognitive impairment in PD.InterpretationThe study findings provide novel mechanistic insights into visual impairment and cognitive decline in Parkinson's disease. The results inform an effective tool for predicting cognitive deterioration in Parkinson's based on ophthalmic parameters.

Analysis of visual field disturbance in patients with sellar and suprasellar lesions: relationship with magnetic resonance imaging findings and sagittal bending of the optic nerve.

Visual dysfunction due to sellar and suprasellar lesions is thought to be caused by chiasmatic compression and bending of the optic nerve at the entrance of the optic canal. We examined the relationship between visual field impairment and magnetic resonance (MR) imaging. This study reviewed 122 consecutive patients with sellar and suprasellar tumors. We have newly devised a simple visual field impairment score (SVFIS) that was divided into 12 areas. SVFIS is classified into four grades as mild (0-3 points), moderate (4-6 points), severe (7-9 points), and most severe (10-12 points) for each eye. We investigated the relationship between SVFIS grades and MR imaging, including the recently reported optic nerve-canal bending angle (ONCBA) and visual acuity. Ipsilateral visual acuity tended to deteriorate with increased SVFIS grade. Larger ONCBA was associated with increased SVFIS grades. Bitemporal hemianopia occurred in the early stage (mild case), but the central visual field within 30° was particularly likely to be impaired. The visual field disturbance progressed clockwise (counterclockwise on the left side) from the upper temporal side. Disorders of the central visual field within 5° were associated with ipsilateral large ONCBA. The newly developed SVFIS grades are closely associated with indicators of visual pathway impairment on MR imaging, and are useful as indicators of the severity and progression of visual field impairment due to sellar and suprasellar lesions. Disorders of the central visual field within 5° were found to be associated with ipsilateral large ONCBA.

A Factorial Analysis on Visual Outcomes of Transsphenoidal Surgery for Pituitary Macroadenoma.

Objective Sellar lesions are possible reversible causes of vision loss. This study is to provide quantitative objective measurement of efficacy of surgery for non-functioning pituitary adenoma and discuss different factors that could affect visual outcome of non-functioning pituitary adenoma. Method This is a single centre, retrospective study conducted at a tertiary neurosurgery referral centre. 108 cases of sellar tumors which underwent surgery during the 3-year period from early June 2015 to late May 2018 were reviewed. Pituitary adenoma that were non-functioning and without apoplexy at initial presentation were selected for the study. We have analyzed the correlation of different factors with the visual outcome, including the extent of vertical decompression in terms of change in tumor height post operation and the extent of lateral decompression in terms of change in Knosp grading. Visual outcome was represented by the visual impairment score (VIS), an integrated measurement of visual acuity and visual field deficit. Results Preoperative absolute tumor height and supracarotid height correlated with preoperative VIS scale ( p ≤ 0.01). Absolute Knosp grading correlates significantly with VA ( p = 0.001) and VF ( p ≤ 0.001) of that particular eye. Although most patients had an objective improvement in visual acuity (VA) (88%) and visual field (VF) (99%) after operation, a larger reduction in tumor height and successful Knosp downgrading after surgery is associated with better VIS improvement. ( p = 0.025) Change in supracarotid height shows trend in correlating with change in VIS ( p = 0.084). Conclusion Height of tumor measured from genu of cavernous ICA correlates better with visual outcome than absolute tumor height. The extent of both vertical and lateral decompression of non-functioning pituitary adenoma are important determinants that lead to better visual outcome. As endoscopic approach is able to achieve a greater degree of lateral decompression, it is a preferred approach in pituitary surgery to achieve a better visual outcome.

Predictors of early visual outcome after endoscopic trans sphenoidal excision of pituitary adenomas

BACKGROUND: Endoscopic transsphenoidal excision has revolutionized the surgical management of pituitary macroadenoma. There had been several retrospective studies on the factors determining the visual outcome after surgical excision of pituitary adenoma, but very few prospective studies were published in this context. This is a prospective study of the factors predicting visual outcome following endoscopic transsphenoidal excision of pituitary adenoma. Various factors like age, duration of visual symptoms, the volume of the tumour, suprasellar extension, parasellar extension, type of adenoma, pituitary apoplexy, completion of excision, fundoscopic changes, and preoperative visual deficits were studied. METHODS: Single centre prospective observational study done between November 2016 to December 2018. Thirty patients with pituitary macroadenoma who underwent trans nasal endoscopic excision were studied with preoperative and postoperative visual impairment score (VIS) and the visual outcome was categorized as a good outcome if there was more than 5% improvement in VIS and as worse otherwise. Various predictors that may influence the outcome were statistically compared. RESULTS: 83.3% of patients (n=25) showed improvement in their vision at 6months follow-up. Overall visual outcome (considering both parameters visual acuity and visual field together) was dependent on suprasellar extension (P=0.01), completion of excision (P=0.004), and primary optic atrophy (P=0.018). On subgroup analysis recovery in visual acuity was significantly determined by the preoperative tumour volume(P=0.041), suprasellar extension (P=0.006), completion of excision(P=0.003), and primary optic atrophy (P=0.013). The improvement in the field of vision depended on the severity of preoperative field defects (P=0.04) and completion of excision (P=0.01). CONCLUSIONS: The factors predicting the early visual outcome were the suprasellar extension, completion of excision, preoperative field deficits, and primary optic atrophy. This study highlights the importance of early and proper intervention in pituitary adenomas managed surgically to procure the desired result.

Depression and anxiety increase the odds of developing delirium in ICU patients; a prospective observational study

ABSTRACT Background Delirium is prevalent among hospitalised patients, especially in critically ill patients. Preventing delirium by recognising its modifiable risk factors could improve life quality, decrease mortality and restrain its devastating consequences. Method We investigated 50 patients who had been hospitalised in the general ICU and monitored them for developing delirium. We employed CAM and CAM-ICU Scales to assess delirium, RASS score to determine the consciousness level, HADS questionnaire for anxiety and depression, and the demographic data questionnaire. Results We found that 20% of ICU patients developed delirium and found a meaningful correlation between the incident delirium, older ages, visual impairment, and higher anxiety and depression scores (HADS) of first and second days of hospitalisation. By utilising logistic regression, we found that older ages, visual impairment, higher anxiety and depression scores (HADS) of the first day of hospitalisation were statistically significant to predict the risk model of developing delirium. Conclusion Depressive and anxiety symptoms were associated with higher odds of transitioning to delirium; so, at the admission time, it may be useful to screen patients for the symptoms of affective disorders, particularly, who are at higher risks for developing delirium.

Cerebral Visual Impairment in CDKL5 Deficiency Disorder Correlates With Developmental Achievement.

Cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder is a rare neurodevelopmental disorder characterized by infantile-onset refractory epilepsy, profound developmental delays, and cerebral visual impairment. Although there is evidence that the presence of cerebral visual impairment in CDKL5 deficiency disorder is common, the potential impact of cerebral visual impairment severity on developmental attainment has not been explored directly. Focusing on a cohort of 46 children with CDKL5 deficiency disorder, examination features indicative of cerebral visual impairment were quantified and compared to developmental achievement. The derived cerebral visual impairment severity score was inversely correlated with developmental attainment, bolstering the supposition that cerebral visual impairment severity may provide a useful early biomarker of disease severity and prognosis. This study demonstrates the utility of a cerebral visual impairment score to better capture the range of cerebral visual impairment severity in the CDKL5 deficiency disorder population and further elucidates the interaction between cerebral visual impairment and developmental outcomes.

Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging Assessment of Optic Pathway Function in Patients With Anterior Visual Pathway Compression.

In patients with sellar or parasellar tumors, it is crucial to evaluate visual field impairment in the preoperative stage and to predict visual field improvement after the surgery. The purpose of this study was to investigate the associations of diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) parameters in the optic radiations with preoperative and postoperative visual field impairment. This prospective study included 81 participants with sellar or parasellar tumors. Multishell diffusion imaging and a visual field impairment score (VFIS) were acquired before and after the surgery. The multishell diffusion-weighted imaging was acquired to measure the neurite density and neurite orientation dispersion, as well as the diffusivity. DTI parameters were fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity (RD). NODDI provided intracellular volume fraction (Vic), the orientation dispersion index, and isotropic volume fraction (Viso). The associations of DTI and NODDI parameters in the optic radiations with VFIS were investigated, adjusting for age, tumor height, and symptom duration. Among 162 optic radiations, 117 were functionally impaired in the preoperative stage. FA and Vic had significant negative correlations, whereas MD and RD had significant positive correlations with the VFIS (all P < 0.001). In the preoperative stage, lower FA (P = 0.001; odds ratio = 0.750) and Vic (P = 0.003; OR = 0.827) and higher MD (P = 0.007; OR = 1.244) and RD (P < 0.001; OR = 1.361) were significantly associated with the presence of visual field impairment. For the degree of postoperative improvement, preoperative lower Vic (P = 0.034; OR = 0.910) and higher MD (P = 0.037; OR = 1.103) and RD (P = 0.047; OR = 1.090) were significantly associated with more postoperative improvement. DTI and NODDI parameters in the optic radiations were correlated with VFIS and associated with preoperative visual field impairments and postoperative improvement. It may help in predicting visual field improvement after the surgery in patients with sellar or parasellar tumors.

Comparative analysis of pituitary adenoma with and without apoplexy in pediatric and adolescent patients: a clinical series of 80 patients.

Pituitary adenomas (PAs) have a low incidence in pediatric and adolescent patients, and their clinical characteristics remain unclear. As a severe complication of PA, apoplexy was investigated in young patients in the present study. Eighty patients younger than 20years with PAs who underwent surgery were included and divided into an apoplexy group and non-apoplexy group. The clinical data of these two groups were statistically analyzed and compared. The study included 33 boys and 47 girls, with a mean age of 16.9years. There were six (7.5%) adrenocorticotropic hormone-secreting, 13 (16.3%) growth hormone-secreting, 47 (58.7%) prolactin-secreting, and 14 (17.5%) non-functioning PAs. There were 34 (42.5%) patients in the apoplexy group and 46 (57.5%) patients in the non-apoplexy group. Pre-operatively, patients in the apoplexy group were more likely to have visual impairment (hazard ratio: 2.841, 95% confidence interval: 1.073-7.519; P = 0.033) and had poorer visual impairment scores than those in the non-apoplexy group (P = 0.027). Furthermore, a longer duration of symptoms before surgery was significantly correlated with a poorer visual outcome in the apoplexy group (R = - 1.204; P = 0.035). However, apoplexy was not associated with tumor type, tumor size, resection rate, or tumor recurrence. Tumor apoplexy is common in pediatric and adolescent patients with PAs and is associated with more severe preoperative visual deficits. Hence, the appropriate timing of surgical treatment may be important for rescuing visual function in young PA patients.

Predictors of Postoperative Visual Outcome After Surgical Intervention for Craniopharyngiomas

Because of involvement of the optic apparatus, craniopharyngiomas frequently present with visual deterioration. Although visual improvement is a primary goal of surgical intervention, prediction models are lacking. We retrospectively reviewed all patients undergoing craniopharyngioma surgery at a single institution (2014-2019). Preoperative, intraoperative, and postoperative variables of interest were collected. Visual acuity and visual fields (VFs) were standardized into Visual Impairment Scores (VISs), defined by the German Ophthalmological Society. VIS ranged from 0 (normal vision) to 100 (complete bilateral blindness). Visual improvement/deterioration was defined as a postsurgical decrease/increase of ≥5 VIS points, respectively. Complete ophthalmologic assessments were available for 61 operations, corresponding to 41 patients (age, 4-73 years). Vision improved after 28 operations (46%), remained stable after 27 (44%), and deteriorated after 6 (10%). In bivariate analysis, significant predictors of visual improvement included worse preoperative VIS (odds ratio [OR], 1.058; P < 0.001), worse preoperative VF mean deviation (OR, 1.107; P= 0.032), preoperative vision deficits presenting for longer than 1 month (OR, 6.050; P= 0.010), radiographic involvement of the anterior cerebral arteries (OR, 3.555; P= 0.019), and gross total resection (OR, 4.529; P= 0.022). The translaminar surgical approach was associated with visual deterioration (OR, 6.857; P= 0.035). In multivariate analysis, worse preoperative VIS remained significantly associated with postoperative visual improvement (OR, 1.060; P= 0.011). Simple linear correlation (R2=0.398; P < 0.001) suggests prediction of postoperative VIS improvement via preoperative VIS. Patients with reduced preoperative vision, specific radiographic vascular involvement, and gross total resection showed increased odds of visual improvement, whereas the translaminar approach was associated with visual deterioration. Such characteristics may facilitate patient-surgeon counseling and surgical decision making.

What is the effect of constraint-induced movement therapy on children with unilateral cerebral palsy? A Cochrane Review summary with commentary.

What is the effect of constraint-induced movement therapy on children with unilateral cerebral palsy? A Cochrane Review summary with commentary.

The Impact of a Summer Sports Camp for Children with Visual Impairments on the Self-Efficacy of Physical Education Pre-Service Teachers: A Pilot Study

Training and self-confidence of the instructor are important components in the success of any inclusive physical education (PE) or recreation program. The purpose of this study was to determine if the self-efficacy toward teaching students with intellectual disabilities, physical disabilities or visual impairment in PE would increase in PE pre-service teachers working at a one-week intensive sports camp for youth with visual impairments. PE pre-service teachers (n=18) filled out the Self-Efficacy Scale for Physical Education Teacher Education Majors towards Children with Disabilities (SE-PETE-D) pre- and post-camp. SE-PETE-D measured participants’ self-efficacy toward including students with disabilities. Participant’s self-efficacy for teaching youth with a visual impairment scores significantly increased during camp, t(17) = 3.75, p = .002, d = 0.88. A similar pattern was observed in self-efficacy for teaching youth with an intellectual disability and physical disability, with scores also significantly increasing, t(17) = 5.32, p < .001, d = 1.25 and, t(17) = 3.83, p = .001, d = .90, respectively. Results from this study suggest teaching and learning experiences that are both practical and disability-orientated can be quite effective in increasing PE pre-service teacher’s confidence working with youth with disabilities

Surgical Outcomes and Predictors of Visual Function Alterations After Transcranial Surgery for Large-to-Giant Pituitary Adenomas

Factors associated with visual outcomes after transcranial surgery for large-to-giant pituitary adenomas have not been fully elucidated. We recruited 37 patients with large-to-giant pituitary adenomas between January 2014 and December 2016 and assessed their tumor characteristics and surgical outcomes. Visual acuity and visual field were evaluated by visual impairment score before and 3-6 months after transcranial surgery. Multivariable logistic regression analysis was applied to show the factors associated with visual outcomes after surgery. The severity levels of visual impairment before surgery were mild, moderate, severe, and complete in 24.3% (9/37), 24.3% (9/37), 35.1% (13/37), and 16.2% (6/37), respectively. After surgery, the visual function was improved, stabilized, and worsened in 43.2% (16/37), 43.2% (16/37), and 13.5% (5/37) of patients, respectively. Multivariable logistic regression analysis showed that subarachnoid space invasion was the only independent prognostic factor adversely influencing the postoperative visual outcomes. Patients with subarachnoid space invasion had a higher possibility of visual deterioration (36.4% vs. 3.8%; P= 0.021) after transcranial surgery, compared with those without subarachnoid space invasion. Visual compromise is still an unignorable complication during transcranial surgery for large-to-giant pituitary adenomas. Subarachnoid space invasion indicated by preoperative magnetic resonance imaging was an independent negative predictor for visual outcomes after surgery.

Health related quality of life in Friedreich Ataxia in a large heterogeneous cohort

IntroductionThis study assessed the Health Related Quality of Life (HRQOL) of individuals with Friedreich Ataxia (FRDA) through responses to HRQOL questionnaires. MethodsThe SF-36, a generic HRQOL instrument, and symptom specific scales examining vision, fatigue, pain and bladder function were administered to individuals with FRDA and analyzed by comparison with disease features. Multiple linear regression models were used to study independent effects of genetic severity and age. Assessments were performed at baseline then intermittently after that. ResultsSubjects were on average young adults. For the SF36, the subscale with the lowest HRQOL score was the physical function scale, while the emotional well-being score was the highest. The physical function scale correlated with age of onset, duration, and subject age. In assessment of symptom specific scales, bladder control scores (BLCS) correlated with duration and age, while impact of visual impairment scores (IVIS) correlated with duration. In linear regression models, the BLCS, Pain Effect Score, and IVIS scores were predicted by age and GAA length; modified fatigue impact scale scores were predicted only by GAA length. Physical function and role limitation scores declined over time. No change was seen over time in other SF-36 subscores. Symptom specific scales also worsened over time, most notably the IVIS and BLCS. ConclusionThe SF-36 and symptom specific scales capture dysfunction in FRDA in a manner that reflects disease status. HRQOL dysfunction was greatest on physically related scales; such scales correlated with disease duration, indicating that they worsen with progressing disease.

Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions.

Visual acuity impairment due to sellar and suprasellar tumors is not fully understood. The relationship between these tumors and disturbance of visual function was examined using preoperative MRI. This study reviewed 93 consecutive patients with sellar and suprasellar tumors. Best-corrected visual acuity (BCVA) and visual impairment score (VIS) were used for estimation of visual impairments. Preoperative MR images were examined to obtain several values for estimation of chiasmatic compression. Additionally, the optic nerve-canal bending angle (ONCBA) was newly defined as the external angle formed by the optic nerve in the optic canal and the optic nerve in the intracranial subarachnoid space at the junction, using preoperative sagittal T2-weighted MR images. The mean ONCBA was about the same on the right (44° ± 25°) and the left (44° ± 24°). Sagittal ONCBA was defined as large (> 45°) and moderate (≤ 45°) on each side. Preoperative VIS was found to be significantly worse if the right or left ONCBA (or both) was large (right side: ONCBA large [median 20, IQR 8-30] > ONCBA moderate [median 10, IQR 3-17], p = 0.003, Mann-Whitney U-test; left side: ONCBA large [median 22, IQR 9-30] > ONCBA moderate [median 10, IQR 2-16], p = 0.001). A large ONCBA showed a significant relationship with unfavorable ipsilateral BCVA (> logMAR, 0; right side, p = 0.001, left side, p = 0.001, chi-square test). The ONCBA had a positive correlation with ipsilateral BCVA (right: r = 0.297, p = 0.031; left: r = 0.451, p = 0.000, Pearson's correlation coefficient). Preoperative BCVA was significantly lower on the same side in the large ONCBA group compared with the moderate ONCBA group (right side: large ONCBA 0.169 ± 0.333 [logMAR, mean ± standard deviation] vs moderate ONCBA 0.045 ± 0.359, p = 0.026, Student t-test; left side: large ONCBA 0.245 ± 0.346 vs moderate ONCBA 0.025 ± 0.333, p = 0.000). This visual acuity impairment improved after resection of the tumors. Sagittal bending of the optic nerve at the entrance from the intracranial subarachnoid space to the optic canal may be related to ipsilateral deterioration of visual acuity in sellar and suprasellar lesions. Sagittal T2-weighted MRI is recommended for preoperative estimation of the optic nerve bending.

Extended endoscopic endonasal resection of craniopharyngioma using intraoperative visual evoked potential monitoring: technical note.

To avoid deterioration of visual function, extended endoscopic endonasal transsphenoidal surgery (TSS) for craniopharyngioma was performed with visual evoked potential (VEP) monitoring using light-emitting diodes (LEDs). The position of the optic chiasm was carefully evaluated on the preoperative midsagittal magnetic resonance (MR) images. Intraoperatively, direct and sharp dissection of the tumor from the optic chiasm was performed under VEP monitoring with LEDs through extended endoscopic endonasal TSS. If the VEP finding changed and became unstable, the operator were informed and stopped the surgical manipulation for the optic chiasm to recover. After 5-10min, recovery of VEP findings was checked and the procedure resumed. Extended endoscopic endonasal TSS with VEP monitoring was performed in consecutive 7 adult patients with newly diagnosed suprasellar craniopharyngiomas with maximum diameters of 25-41mm (mean 33.7mm). VEPs were stable throughout the surgery in 5 cases, but showed temporary instability and amplitude decrease in 2 cases, although the VEPs had recovered at the end of the surgery. Visual function, evaluated using visual impairment score, was improved after surgery in all patients. Gross total removal was achieved in 5 cases, and subtotal removal (90%) in 2 cases. Intraoperative VEP monitoring is the only way to test visual function during surgery, and may be important and helpful in extended endoscopic endonasal TSS, which requires direct dissection between the optic nerve and craniopharyngioma under the endoscope.

The relationship between severity of visual impairment and learning scores of the blind at the bangkok school of the blind

The development of the education system of the blind student can be considered as an increase in quality of life. At present, there is no definite conclusion about the relationship between visual impairment and cognitive function. The aim is to study the relationship between the severity of visual impairment and learning scores of the blind.