A reassessment and comparison of the Landolt C and tumbling E charts in managing amblyopia

AbstractCurrent criteria for amblyopia do not account for difference in visual acuity charts. This prospective observational study analyzed 100 children younger than 10 years treated at a tertiary referral center. Visual acuity was separately tested in each eye using Landolt C and tumbling E charts in a random order. For each chart, receiver operating characteristic curve analysis was performed to determine the best cutoff for visual acuity score. Main outcome measures included the difference in visual acuity scores between the two charts, the feasibility of repeated testing of visual acuity in each eye, and amblyopia cutoff values for each chart. Mean logMAR visual acuity scores obtained by tumbling E chart were significantly better than those obtained by Landolt C chart. For amblyopia, the best cutoff values were < + 0.14 (20/27 Snellen equivalent) for tumbling E chart and < + 0.24 (20/35 Snellen equivalent) for Landolt C chart. For children under 10 years old, visual acuity scores for tumbling E chart were significantly better than those for Landolt C chart. We suggest that amblyopia management in children should account for age and the type of visual acuity chart used.

Download Full-text

Streptococcus pneumoniae endophthalmitis: clinical settings, antibiotic susceptibility, and visual outcomes

Scientific Reports ◽

10.1038/s41598-021-85456-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kuan-Jen Chen ◽

Ying-Jiun Chong ◽

Ming-Hui Sun ◽

Hung-Chi Chen ◽

Laura Liu ◽

...

Keyword(s):

Visual Acuity ◽

Streptococcus Pneumoniae ◽

Antibiotic Susceptibility ◽

Vision Loss ◽

Clinical Settings ◽

Light Perception ◽

Tertiary Referral Center ◽

Visual Outcomes ◽

Pars Plana ◽

Better Than

AbstractStreptococcus pneumoniae endophthalmitis is clinically more severe, more difficult to treat, and carry a higher risk of vision loss, evisceration, or enucleation. This study is to investigate the clinical settings, antibiotic susceptibility, and visual outcomes of S. pneumoniae endophthalmitis at a tertiary referral center in Taiwan. S. pneumoniae endophthalmitis was diagnosed in 38 eyes of 38 patients. The main clinical features were postcataract endophthalmitis (n = 13, 34%) and endophthalmitis associated with corneal ulcer (n = 12, 32%), trauma (n = 6, 16%), endogenous etiology (n = 4, 11%), trabeculectomy (n = 2, 5%), and pterygium excision-related scleral ulcer (n = 1, 3%). Presenting visual acuity ranged from counting fingers to no light perception. Pars plana vitrectomy with intravitreal antibiotics was performed in 17 eyes (39%) in primary or secondary treatments. S. pneumoniae isolates were susceptible to vancomycin (38/38, 100%), penicillin (37/38, 97%), ceftriaxone (37/38, 97%), cefuroxime (12/15, 80%), levofloxacin (13/15 ,87%), and moxifloxacin (15/17, 88%). Final visual acuity was better than 20/400 in 3 of 38 eyes (8%), 5/200 to hand motions in 3 eyes (8%), and light perception to no light perception in 32 eyes (84%). Ten eyes (26%) underwent evisceration or enucleation. Although S. pneumoniae isolates were susceptible to vancomycin, S. pneumoniae endophthalmitis had a very poor visual prognosis.

Download Full-text

Visual acuity through Night Vision Goggles (NVGs): A comparative assessment between Gen 2++ and Gen 3 NVGs under different illumination conditions

Indian Journal of Aerospace Medicine ◽

10.25259/ijasm_15_2021 ◽

2021 ◽

Vol 65 ◽

pp. 17-22

Author(s):

D Sharma ◽

NK Tripathy ◽

V Raghunandan ◽

BM Sekhar

Keyword(s):

Visual Acuity ◽

Full Moon ◽

Night Vision ◽

Dynamic Changes ◽

Operational Conditions ◽

Measure Design ◽

Image Intensification ◽

Night Sky ◽

The Difference ◽

Better Than

Introduction: During night flying operations, Night Vision Goggles (NVGs) help the aircrew to visualize by intensifying lights reflected from an object. Night sky illumination and image intensification mechanism are the two important factors that affect visual acuity (VA) through NVG. Hence, assessment of visual acuity through Gen 2++ and Gen 3 NVG under different illumination conditions and comparative analysis between the two NVGs was the desired objective of the study. Material and Methods: In a prospective repetitive measure design, a total of 60 volunteered subjects were examined for their VA through Gen 2++ and Gen 3 NVGs using USAF Tri-Bar Chart in the eye lane room of the NVG Lab. The VA was measured under four different illumination conditions; full moon (FM), half moon (HF)quarter moon (QM), and starlight (SL) conditions. The measured VA was converted to logMAR values and analyzed. Results: VA deteriorated significantly with decreasing illuminations through both Gen 2++ (χ2 = 149.9, P < 0.001) and Gen 3 NVGs (χ2 = 156.5, P < 0.001). For Gen 2++ NVG, the difference in VA was statistically significant in all conditions other than between FM and HM. Whereas, it was almost significant for all illumination conditions for Gen 3 NVG. The VA through Gen 2++ was better than Gen 3 in all conditions and the difference in VA widened with decreasing illuminations. Conclusion: VA declined with decreasing illuminations for Gen 2++ as well as Gen 3 NVG, even though, the difference was not significant between FM and HM for Gen 2++ NVG. VA was observed to be consistently better through Gen 2++ NVG compared to Gen 3 across all four illumination conditions. However, keeping in view the dynamic changes in night sky illuminations during flying operations, the findings of the study need to be validated in operational conditions.

Download Full-text

A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients

International Journal of Ophthalmology ◽

10.18240/ijo.2021.04.09 ◽

2021 ◽

Vol 14 (4) ◽

pp. 536-540

Author(s):

Tao Wang ◽

◽

Chen Chen ◽

Ding-Wei Liu ◽

Jing-Lin Yi ◽

...

Keyword(s):

Visual Acuity ◽

Random Order ◽

Clinical Situation ◽

Spearman Correlation ◽

Altman Analysis ◽

Limits Of Agreement ◽

Suitable Alternative ◽

Significant Difference ◽

The Mean ◽

Better Than

AIM: To compare the results of visual acuity (VA) measured by Early Treatment Diabetic Retinopathy Study (ETDRS) chart, 5 m Standard Logarithm Visual Acuity (5SL) chart, and 2.5 m Standard Logarithm Visual Acuity (2.5SL) chart in outpatients of age 12-80y. METHODS: Each patient (totally 2000 outpatients) had both eyes tested with ETDRS chart at 4 m, 5SL chart at 5 m, and 2.5SL chart at 2.5 m in random order. The VA values of outpatients were categorized by ages. VA values were expressed by logMAR recording method. RESULTS: The mean VA results of ETDRS charts, 5SL, and 2.5SL chart were 0.52±0.28, 0.50±0.30, and 0.46±0.28 logMAR, respectively. There was a statistically significant difference in the three eye charts in the whole group (P&#x003C;0.001). For all subjects, the correlation of VA tested with three charts was statistically significant (Spearman correlation coefficient=0.944, 0.937, 0.946, all P&#x003C;0.001). Bland–Altman analysis shows the 95% limits of agreement between the 5SL and 2.5SL chart were -0.182 to 0.210, -0.139 to 0.251, and -0.151 to 0.235 logMAR, respectively). CONCLUSION: The agreement between the three eye charts is not high. The VA measured by 5SL chart is slightly better than that by ETDRS chart and 5SL chart would be a suitable alternative when ETDRS chart are not available in the clinical situation. The VA measured by 2.5SL chart is about 0.5 line better than VA tested with ETDRS chart, which may overestimate VA.

Download Full-text

Distance Visual Acuity Versus Near Visual Acuity in Amblyopia.

10.21203/rs.3.rs-371532/v1 ◽

2021 ◽

Author(s):

masoumeh ahadi ◽

Afsaneh Ebrahimi ◽

Shahrokh Ramin

Keyword(s):

Visual Acuity ◽

Spherical Equivalent ◽

Significant Relation ◽

Distance Visual Acuity ◽

Snellen Chart ◽

History Of ◽

Near Visual Acuity ◽

The Mean ◽

The Difference ◽

Better Than

Abstract Purpose: To measure and compare distance and near visual acuity in amblyopic patients.Methods: This study was evaluated 167 patients with amblyopia between ages of 6 and 55 years. In all subjects, a comprehensive ophthalmic examination including visual acuity, refraction, slit lamp biomicroscopy, and funduscopy was performed. Distance visual acuity (DVA) was measured by Snellen chart at 4 m and near visual acuity (NVA) was measured by Snellen chart at 40 cm, and then DVA and NVA were compered and analyzed.Results:In our subjects, the mean distance and near visual acuity was 0.39± 0.30 log MAR and 0.30± 0.32 log MAR respectively. The mean NVA was 0.12±0.12 log MAR better than DVA and difference between them was statistically significant (P<0.001). In 40% of patients, there were no difference between DVA and NVA, and in 60% of them, NVA was 0.1 or more log MAR better than DVA. The difference between DVA and NVA was not significantly related with age (p=0.225), spherical equivalent (P=.820) and strabismus (P=.336) and type of amblyopia (P=.405). Although all of these subjects had subnormal DVA, but 43 subjects (26%) had normal NVA. In mild and moderate amblyopic groups, difference between DVA and NVA was 0.14±0.10 log MAR and 0.15±0.14 log MAR respectively, but in severe amblyopic group it was 0.03±0.08 log MAR. The difference between DVA and NVA showed a significant relation with severity of amblyopia (P<0.001). The difference between DVA and NVA was 0.16±0.11 log MAR in patients with history of amblyopia therapy and 0.07.± 0.11 log MAR in patients without treatment. This difference was statistically significant (P<0.001).Conclusion: Our results showed that near visual acuity in amblyopia especially in mild to moderate types was significantly better than distance visual acuity. More than 50% of subjects with mild amblyopia had normal near visual acuity. The difference between DVA and NVA showed no relation with age, spherical equivalent, strabismus, and type of amblyopia. Also, difference between the DVA and NVA in patients with history of amblyopia therapy was better than of it in non-treated subjects.

Download Full-text

Removal of inelastically scattered electrons substantially increases phase contrast on frozen-hydrated molecules

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100127694 ◽

1987 ◽

Vol 45 ◽

pp. 652-653

Author(s):

John P. Langmore ◽

Brian D. Athey

Keyword(s):

Electron Diffraction ◽

Phase Contrast ◽

Low Dose ◽

Dark Field ◽

Biological Structure ◽

Bright Field ◽

Low Contrast ◽

Negative Stain ◽

The Difference ◽

Better Than

Although electron diffraction indicates better than 0.3nm preservation of biological structure in vitreous ice, the imaging of molecules in ice is limited by low contrast. Thus, low-dose images of frozen-hydrated molecules have significantly more noise than images of air-dried or negatively-stained molecules. We have addressed the question of the origins of this loss of contrast. One unavoidable effect is the reduction in scattering contrast between a molecule and the background. In effect, the difference in scattering power between a molecule and its background is 2-5 times less in a layer of ice than in vacuum or negative stain. A second, previously unrecognized, effect is the large, incoherent background of inelastic scattering from the ice. This background reduces both scattering and phase contrast by an additional factor of about 3, as shown in this paper. We have used energy filtration on the Zeiss EM902 in order to eliminate this second effect, and also increase scattering contrast in bright-field and dark-field.

Download Full-text

PENERAPAN MODEL PEMBELAJARAN KOOPERATIF TIPE STAD DENGAN PENDEKATAN RME UNTUK MENINGKATKAN HASIL BELAJAR MATEMATIKA SISWA KELAS IX SMP MUHAMMADIYAH PADANG LUAS KECAMATAN TAMBANG KABUPATEN KAMPAR

JURNAL PAJAR (Pendidikan dan Pengajaran) ◽

10.33578/pjr.v2i5.6123 ◽

2018 ◽

Vol 2 (5) ◽

pp. 744

Author(s):

Zainur Zainur

Keyword(s):

Action Research ◽

Cooperative Learning ◽

Student Learning ◽

Learning Outcomes ◽

Mathematics Learning ◽

Student Learning Outcomes ◽

Learning Model ◽

Research Instrument ◽

The Difference ◽

Better Than

This research was motivated by the low learning outcomes of grade IX SMP Muhammadiyah Padang LuasKecamatan Tambang Kabupaten Kampar. This study aims to improve learning outcomes in mathematicslearning through STAD type cooperative learning with the RME approach in class IX SMP MuhammadiyahPadang Luas Kecamatan Tambang Kabupaten Kampar. The subjects of this study were all classes IX in SMPMuhammadiyah Padang Luas Kecamatan Tambang Kabupaten Kampar totaling 26 people. The form ofresearch is classroom action research. This research instrument consists of performance instruments and datacollection instruments in the form of teacher activity observation sheets and activities. The results of the studystated that there were significant differences between students' mathematics learning outcomes before applyingthe STAD type cooperative learning model with the RME approach with after applying the STAD typecooperative learning model with the RME approach. The difference shows student learning outcomes after theaction is better than before the action with completeness reaching 80.77% or 21 completed. Based on the resultsof the study and discussion it can be concluded that the application of STAD type learning model with RealisticMathematic Education (RME) approach can improve the learning outcomes of grade IX students of SMPMuhammadiyah Padang Luas Kecamatan Tambang Kabupaten Kampar on statistical material.

Download Full-text

Comparison of the Effectiveness of Intravitreal Ranibizumab for Diabetic Macular Edema in Vitrectomized and Nonvitrectomized Eyes

Ophthalmologica ◽

10.1159/000446992 ◽

2016 ◽

Vol 236 (2) ◽

pp. 67-73 ◽

Cited By ~ 5

Author(s):

Yoshito Koyanagi ◽

Shigeo Yoshida ◽

Yoshiyuki Kobayashi ◽

Yuki Kubo ◽

Muneo Yamaguchi ◽

...

Keyword(s):

Visual Acuity ◽

Macular Edema ◽

Diabetic Macular Edema ◽

Treatment Option ◽

Central Macular Thickness ◽

Intravitreal Ranibizumab ◽

Corrected Visual Acuity ◽

The Mean ◽

The Difference ◽

Best Corrected Visual Acuity

Purpose: To compare the effectiveness of intravitreal ranibizumab (IVR) for diabetic macular edema (DME) between eyes with and without previous vitrectomy. Procedures: We prospectively assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) after IVR for 6 months. Results: There were no significant differences in the baseline BCVA and CMT between both groups. In the nonvitrectomized group (n = 15), the mean changes of BCVA and CMT from baseline to month 6 were significant (p < 0.01). In the vitrectomized group (n = 10), the improvement appeared to be slower, and the mean BCVA improvement was not significant (p = 0.5), although the mean CMT decrease was significant (p < 0.05). There were no significant differences in the mean changes of BCVA and CMT between both groups at 6 months. Conclusions: The difference in the effectiveness of IVR between both groups was not significant. IVR can be a treatment option even for vitrectomized DME eyes.

Download Full-text

Clinical Phenotype of PDE6B-Associated Retinitis Pigmentosa

International Journal of Molecular Sciences ◽

10.3390/ijms22052374 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2374

Author(s):

Laura Kuehlewein ◽

Ditta Zobor ◽

Katarina Stingl ◽

Melanie Kempf ◽

Fadi Nasser ◽

...

Keyword(s):

Visual Acuity ◽

Genetic Testing ◽

Retinitis Pigmentosa ◽

Fundus Autofluorescence ◽

Retinal Disease ◽

New Drugs ◽

Autofluorescence Imaging ◽

Full Field ◽

Tertiary Referral Center ◽

The Right

In this retrospective, longitudinal, observational cohort study, we investigated the phenotypic and genotypic features of retinitis pigmentosa associated with variants in the PDE6B gene. Patients underwent clinical examination and genetic testing at a single tertiary referral center, including best-corrected visual acuity (BCVA), kinetic visual field (VF), full-field electroretinography, full-field stimulus threshold, spectral domain optical coherence tomography, and fundus autofluorescence imaging. The genetic testing comprised candidate gene sequencing, inherited retinal disease gene panel sequencing, whole-genome sequencing, and testing for familial variants by Sanger sequencing. Twenty-four patients with mutations in PDE6B from 21 families were included in the study (mean age at the first visit: 32.1 ± 13.5 years). The majority of variants were putative splicing defects (8/23) and missense (7/23) mutations. Seventy-nine percent (38/48) of eyes had no visual acuity impairment at the first visit. Visual acuity impairment was mild in 4% (2/48), moderate in 13% (6/48), and severe in 4% (2/48). BCVA was symmetrical in the right and left eyes. The kinetic VF measurements were highly symmetrical in the right and left eyes, as was the horizontal ellipsoid zone (EZ) width. Regarding the genetic findings, 43% of the PDE6B variants found in our patients were novel. Thus, this study contributed substantially to the PDE6B mutation spectrum. The visual acuity impairment was mild in 83% of eyes, providing a window of opportunity for investigational new drugs. The EZ width was reduced in all patients and was highly symmetric between the eyes, making it a promising outcome measure. We expect these findings to have implications on the design of future PDE6B-related retinitis pigmentosa (RP) clinical trials.

Download Full-text

Six ultraviolet minutes for cleaner operating theatres

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.580 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

R Bosco ◽

S Gambelli ◽

V Urbano ◽

G Cevenini ◽

G Messina

Keyword(s):

Cross Sectional Study ◽

Cross Sectional ◽

Before And After ◽

Operating Theatres ◽

Cleaning Procedures ◽

The Difference ◽

Contamination Levels ◽

Different Levels ◽

Better Than ◽

Final Cleaning

Abstract Background Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D). Methods Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively. Results In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p < 0.001). Without UVC-D we had a significant CFU drop (p < 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p < 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p < 0.05). Conclusions UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered. Key messages UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.

Download Full-text

Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

Journal of Academic Ophthalmology ◽

10.1055/s-0041-1725582 ◽

2021 ◽

Vol 13 (01) ◽

pp. e26-e31

Author(s):

Spencer C. Cleland ◽

Daniel W. Knoch ◽

Jennifer C. Larson

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Retrospective Chart Review ◽

Dissipated Energy ◽

Independent Practice ◽

Postoperative Visual Acuity ◽

Included Patient ◽

Duration Of Surgery ◽

The Difference

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

Download Full-text