Visual impairment and perceptual visual disorders in children with cerebral palsy in Nigeria

2020 ◽  
pp. bjophthalmol-2020-317768
Author(s):  
Roseline Ekanem Duke ◽  
Justin Nwachukuw ◽  
Chima Torty ◽  
Uche Okorie ◽  
Min J Kim ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cerebral Palsy ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Wide Spectrum ◽  
Visual Fields ◽  
Cross River State ◽  
Age Appropriate ◽  
Ocular Morbidity ◽  
Visual Disorders

Cerebral palsy (CP) is the most common cause of childhood physical disability globally. This study describes the spectrum of ocular morbidity and visual impairment in a community-based (recruited by key informants) sample of children with CP in Cross River State, Nigeria.MethodsA paediatric neurologist clinically confirmed CP and assessed systemic comorbidity. Ophthalmological assessment included developmental age appropriate acuity tests, objective refraction and objective and subjective tests of perceptual visual dysfunction (PVD).Results388 children aged 4–15 years with CP were identified. Visual problems were reported by carers in only 55 (14%) cases. Binocular visual acuity impairment was seen in 20/201 by Lea symbols test (10%) and 213/388 (55%) by the mirror test. Abnormal visual fields were seen in 58/388 (14.9%); strabismus in 183 (47%) abnormal contrast sensitivity in 178 (46%) and abnormal saccades in 84 (22%), spherical refractive errors in 223 (58%), significant astigmatism in 36 (12%), accommodative dysfunction in 41 (10.6%), optic atrophy in 198 (51%). Perceptual visual disorders were present in 22 (6%) subjectively and 177 (46%) objectively. The estimated frequency of cerebral visual impairment (CVI) in children ranged from 61 (16%) to 191 (49%) if children with optic atrophy were included.ConclusionChildren with CP have a wide spectrum of ocular morbidity and visual impairment, underestimated by carers. Children with CP require visual acuity assessments with a range of tests which account for associated comorbidities and oculomotor dysfunction. Functional vision assessments for PVD is important. CVI is common.

Neuro-ophthalmological assessment of vision before and after radiation therapy alone for pituitary macroadenomas

1990 ◽  
Vol 72 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Stephen C. Rush ◽  
Mark J. Kupersmith ◽  
Irving Lerch ◽  
Paul Cooper ◽  
Joseph Ransohoff ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Radiation Therapy ◽  
Visual Field ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Radiation Treatment ◽  
Visual Field Defects ◽  
Content Type ◽  
Pituitary Macroadenomas

✓ Between 1972 and 1988, 25 patients were treated by radiation therapy (RT) alone for pituitary macroadenomas causing visual impairment. Twenty-three patients were evaluated by a neuro-ophthalmologist before treatment and at the time of follow-up review. Radiation treatment consisted of 4000 to 5000 cGy over 4 to 5 weeks. The median follow-up period was 36 months (range 2 to 192 months). Eighteen patients (78%) experienced visual field improvement. Deterioration occurred in four patients due to tumor recurrence, tumor hemorrhage, possible optic nerve necrosis, and optic chiasm herniation. Visual field improvement occurred predominantly in patients whose pretreatment visual field defects were less than a dense hemianopsia, who did not have diffuse optic atrophy, and who were younger than the median age of 69 years (p < 0.001). Visual acuity improvement occurred in patients without diffuse optic atrophy, with only mild impairment of the visual acuity, and with only mild visual field loss prior to RT (p < 0.002). It is concluded that there is a subset of patients with pituitary macroadenomas and visual impairment for whom primary RT is a treatment option.

scholarly journals Characterization of SSBP1-related optic atrophy and foveopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Isabelle Meunier ◽  
Béatrice Bocquet ◽  
Sabine Defoort-Dhellemmes ◽  
Vasily Smirnov ◽  
Carl Arndt ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Impairment ◽  
Optic Atrophy ◽  
Age Of Onset ◽  
Fundus Autofluorescence ◽  
Cone Dystrophy ◽  
Incomplete Penetrance ◽  
Fiber Layer ◽  
Major Criterion

AbstractDominant optic atrophy (DOA) is genetically heterogeneous and most commonly caused by mutations in OPA1. To distinguish between the classical OPA1-related and the recently identified SSBP1-related DOAs, the retina and fovea of 27 patients carrying the SSBP1 p.Arg38Gln variant were scrutinized using 20° × 20° macular cube and 30° and 55° field fundus autofluorescence photographs. Age of onset, visual acuity, retinal nerve fiber layer and macular thicknesses were recorded. Three SSBP1-patients were asymptomatic, 10 had isolated DOA, and 12 had a combined DOA plus foveopathy. The foveopathy, with a tiny defect of the ellipsoid and interdigitation lines, was similar in all patients, independent of age. There were no significant statistical differences in terms of visual acuity and SD-OCT measurements between patients with isolated DOA (mean visual acuity in decimals: 0.54 ± 0.41) and those with combined foveopathy (0.50 ± 0.23). Two patients over 50 years of age developed a progressive rod-cone dystrophy, leading to severe visual impairment. SSBP1-related DOA shares similarities with OPA1-related DOA with an incomplete penetrance and an early childhood visual impairment. Nevertheless, the presence of a congenital foveopathy with no impact on visual acuity is a major criterion to distinguish SSBP1 cases and orient the appropriate genetic analysis.

Reading Speed under Real and Simulated Visual Impairment

1983 ◽  
Vol 77 (8) ◽  
pp. 386-388 ◽  
Author(s):  
Christof C. Krischer ◽  
Ralf Meissen
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Impairment ◽  
Reading Speed ◽  
Visual Fields ◽  
Central Field ◽  
Normal Visual Field ◽  
Partially Sighted

The reading speed of subjects was studied under conditions of simulated and real visual impairment. For subjects with normal visual field and average reading speeds, two types of visual impairment were simulated: cataracts and deteriorated retinas. Three groups of partially sighted persons also were studied: those with normal visual fields, those with defects in peripheral fields, and those with defects in the central field. The results for these three groups were similar to those obtained under conditions of simulated visual impairment. The authors conclude that reading speed depends on visual acuity.

scholarly journals Pattern of comorbidities in school-aged children with cerebral palsy in Cross River State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roseline E. Duke ◽  
Chimaeze Torty ◽  
Uche Okorie ◽  
Min J. Kim ◽  
Nnena Eneli ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cerebral Palsy ◽  
School Attendance ◽  
Learning Difficulties ◽  
Speech Impairment ◽  
Cross River ◽  
Cross River State ◽  
School Aged Children ◽  
Children With Cerebral Palsy ◽  
Poor School

Abstract Background To describe the pattern of comorbidities in school-aged children with cerebral palsy (CP) and to identify which, if any, were associated with poor school attendance. A cross-sectional study, using the key informant methodology, between December 2017 and July 2018 was conducted in Cross River State, Nigeria. Assessments, confirmation of CP and identification of systemic comorbidities using standard tools and questionnaires were performed. Children confirmed to have CP between the ages 4 to 15 years were included. Results Three hundred and eighty-eight children were confirmed to have CP, 59% males. The mean age was 9.2 years ± SD 4.0; 28% were non-ambulatory (gross motor function classification system (GMFCS) level IV-V) and spastic CP was seen in 70%. Comorbidities included Speech impairment 85%, feeding difficulties 86%, and swallowing difficulties 77%, learning difficulties 88%, abnormal behaviour 62%, visual acuity impairment 54%, objective perceptual visual disorders 46%, communication difficulties 45%, epilepsy 35%, hearing impairment 12% and malnutrition 51%. Learning difficulties (OR 10.1, p < 0.001; CI: 3.6–28.1), visual acuity impairment (OR 2.8, p = 0.002; CI: 1.5–5.3), epilepsy (OR 2.3, p = 0.009; CI:1.2–4.3) manual ability classification scale 4–5 (OR 4.7,p = 0.049; CI:1.0–22.2) and CP severity (GMFCS V-VI) OR 6.9 p = 0.002, CI: 2.0–24.0.) were seen as increasing the likelihood of poor school attendance. Conclusion Comorbidities were common, and some were associated with limited school attendance. A multidisciplinary tailored approach to care, with application of available therapeutic interventions for comorbidities is suggested. This may be useful in reducing barriers to school attendance.

Visual Impairment and Objectively Measured Physical Activity in Middle-Aged and Older Adults

2021 ◽  
Author(s):  
Yurun Cai ◽  
Jennifer A Schrack ◽  
Hang Wang ◽  
Jian-Yu E ◽  
Amal A Wanigatunga ◽  
...  
Keyword(s):  
Physical Activity ◽  
Visual Acuity ◽  
Visual Impairment ◽  
Daily Activity ◽  
Activity Patterns ◽  
Visual Fields ◽  
Corrected Visual Acuity ◽  
Objectively Measured ◽  
Objectively Measured Physical Activity ◽  
Best Corrected Visual Acuity

Abstract Background Vision loss is associated with increased falls risk and restricted physical activity, yet the relationship between multiple vision measures and objectively measured physical activity, especially activity patterns, in mid-to-late life is not well understood. Methods This study included 603 participants aged ≥ 50 years (mean age=73.5) in the Baltimore Longitudinal Study of Aging who had the following assessments: presenting and best-corrected visual acuity, contrast sensitivity, visual fields, stereo acuity, and free-living physical activity using a wrist-worn ActiGraph accelerometer for 7 days. Linear regression models were used to examine the association between vision measures and daily activity counts, active minutes, and activity fragmentation (defined as an active-to-sedentary transition probability), adjusting for potential confounders. Mixed-effects models estimated differences in activity by time of day comparing those with and without each visual impairment. Results In the fully adjusted model, worse presenting visual acuity, contrast sensitivity, and visual fields were associated with fewer activity counts, less active time, and more fragmented activity patterns (p&lt;0.05 for all). Participants with presenting or best-corrected visual acuity impairment had 19.2 and 29.3 fewer active minutes (p=0.05, p=0.03, respectively) per day. Visual field impairment was associated with 268,636 fewer activity counts (p=0.02), 46.2 fewer active minutes (p=0.02) per day, and 3% greater activity fragmentation (p=0.009). Differences in activity levels tended to be greatest from 6am-6pm (p&lt;0.05). Conclusions Older adults with visual impairment have restricted and more fragmented patterns of daily activity. Longitudinal studies to quantify the long-term impacts of visual impairments on activity decline are warranted.

Early retinal atrophy predicts long-term visual impairment after acute optic neuritis

2017 ◽  
Vol 24 (9) ◽  
pp. 1196-1204 ◽  
Author(s):  
Bernardo Sanchez-Dalmau ◽  
Elena H Martinez-Lapiscina ◽  
Ruben Torres-Torres ◽  
Santiago Ortiz-Perez ◽  
Irati Zubizarreta ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Visual Impairment ◽  
Color Vision ◽  
Visual Fields ◽  
Inner Plexiform Layer ◽  
Linear Regression Models ◽  
Acute Optic Neuritis ◽  
Retinal Atrophy

Background: Visual recovery after optic neuritis (ON) used to be defined as good, although patients frequently complain of poor vision. Methods: We carried out a prospective study on 38 consecutive patients with acute ON followed monthly for 6 months and evaluated high- and low-contrast visual acuity (HCVA and LCVA, respectively), quality of vision (National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25)), visual fields, and retinal thickness by spectral domain optical coherence tomography (OCT). Results: We found significant impaired LCVA and color vision in ON eyes 6 months after acute ON, which impact on quality of life. LCVA and color vision were correlated with the thicknesses of the ganglion cell and inner plexiform layer (GCIPL; 2.5% LCVA r = 0.65 and p = 0.0001; color vision r = 0.75 and p < 0.0001) and that of the peripapillary retinal nerve fiber layer (pRNFL; LCVA r = 0.43 and p = 0.0098; color vision r = 0.62 and p < 0.0001). Linear regression models that included the change in the GCIPL and pRNFL thicknesses from baseline to month 1 after onset explained 47% of the change in 2.5% LCVA and 67% of the change of color vision acuity. When adjusting for the value of visual acuity at baseline, predictors of the change in vision from baseline to month 6 achieved similar performance for all three types of vision (HCVA, LCVA, and color vision). Conclusion: Monitoring retinal atrophy by OCT within the first month after ON onset allows individuals at a high risk of residual visual impairment to be identified.

scholarly journals Visual outcomes endorse surgery of patients with spheno-orbital meningioma with minimal visual impairment or hyperostosis

2020 ◽  
Vol 163 (1) ◽  
pp. 73-82
Author(s):  
Amir H. Zamanipoor Najafabadi ◽  
Stijn W. Genders ◽  
Wouter R. van Furth
Keyword(s):  
Visual Acuity ◽  
Visual Impairment ◽  
Linear Regression Analysis ◽  
Visual Fields ◽  
Case Series ◽  
Who Grade ◽  
Visual Outcomes ◽  
Simpson Grade ◽  
Orbital Meningioma

Abtract Background Most spheno-orbital meningioma series span multiple decades, and predictors of visual outcomes have not yet been systemically assessed. We describe visual outcomes in a recent cohort and assess predictors of postoperative visual outcomes. Methods Consecutive case series operated by a team of a neurosurgeon and orbital surgeon between May 2015 and January 2019. Best corrected visual acuity (BCVA), visual fields (static perimetry), and relative proptosis were measured preoperatively and postoperatively at 3/6/12 months after which it was assessed yearly. Predictors were assessed with linear regression analysis. Results Nineteen patients (all WHO grade I) were operated by the pterional approach (median follow-up 2.4 years). Preoperative visual acuity deficits (n = 10) normalized in 70% and improved in 10% (median preoperative: 0.8, postoperative: 1.2, p = 0.021). Preoperative visual field deficits (n = 8) normalized in all patients (preoperative: − 6.5 dB, postoperative: − 1.5 dB, p = 0.008). Preoperative proptosis (n = 16) normalized in 44% and improved in 56% (preoperative: 5 mm, postoperative: 2 mm, p < 0.001). BCVA and visual fields remained stable at longer follow-up in 95% of patients, while 21% showed progression of proptosis. Predictors for worse longer-term (> 12 months) BCVA were worse preoperative BCVA (p = 0.002) and diagnosis of multiple meningioma (p = 0.021). Predictors for worse longer-term visual fields were higher diameter of hyperostosis (p = 0.009) and higher Simpson grade (p = 0.032). Predictor for short-term (3 months) proptosis was preoperative proptosis (p = 0.006). Conclusion We recommend surgery, even of patients with minimal visual impairment or hyperostosis, as patients who present with deteriorated visual function or extensive hyperostosis are less likely to have postoperative visual outcomes restored to normal.

scholarly journals FRI0198 OCULAR MORBIDITY IN PATIENTS WITH PMR AND GCA IN THE UK - A CPRD STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 682.2-683
Author(s):  
M. Yates ◽  
A. Clark ◽  
R. Watts ◽  
A. Macgregor ◽  
S. Mackie
Keyword(s):  
Relative Risk ◽  
Visual Impairment ◽  
Optic Neuropathy ◽  
Optic Atrophy ◽  
Visual Loss ◽  
Age At Diagnosis ◽  
P Value ◽  
Temporal Artery Biopsy ◽  
Ocular Morbidity ◽  
Read Codes

Background:Visual loss is the most serious consequences of a diagnosis of polymyalgia rheumatic (PMR) and giant cell arteritis (GCA). To date, information on the occurrence of eye disease in GCA has been based almost exclusively on small hospital-based patient series. Furthermore the lack of control group for these studies results in a lack of relative risk estimates for visual loss.There are no accurate data on the prevalence and nature of eye complications among patients in the community. Patients with GCA may be exclusively managed in the primary care setting without referral for either temporal artery biopsy or ophthalmic department examination. Currently the incidence and prevalence of eye complications within this group are unknown.Objectives:Examine the absolute rate and relative risk of ocular morbidity, in a longitudinal community setting, in patients with PMR and or GCA including visual loss, AOIN including optic atrophy, cataract and glaucoma identified from Read codes in the (Clinical Practice Research Datalink) CPRD dataset.Methods:Construction of a disease cohort of incident diagnoses of PMR and GCA from patients in the CPRD matched to controls on age, sex (+/- 2 years) and practice location. Diagnosis were identified by CPRD researchers of those individuals between January 1997 to December 2015, with a minimum age at diagnosis of 50 years. Those with both a diagnosis of PMR and GCA were analysed in the GCA group. The outcomes of ocular morbidity included Read codes for severe visual impairment (multiple codes covered: blindness, severe visual impairment, registered partially sighted, issue of certificate of visual impairment, examination findings of 4/60 or worse), anterior ischaemic optic neuropathy (including codes of optic neuropathy and atrophy but not codes of glaucomatous atrophy), cataract, cataract extraction and glaucoma. Statistically modelling with Cox proportional hazards was used to generate hazard ratios for ocular morbidity taking account of censorship through death and moving out of area.Results:We identified 30,714 individuals with PMR (20,270 women; 66%) with a mean age at diagnosis of 72.9 year (sd 9.1) and 6,104 with GCA (4,309 women; 70.6%) with a mean age of 72.1 years (sd 9.4). Of those diagnosed with GCA 1,669 were also diagnosed with PMR. Using Read codes for severe visual impairment and blindness 5.9% of patients with GCA and 2.7% with PMR had this complication compared with 1.6% of the matched controls. The hazard ratio for the various ocular morbidities and by cases of PMR or GCA are shown in the table below:Ocular morbidityPMR HR (95% CI) p valueGCA HR (95% CI) p valueSevere visual impairment1.76 (1.60, 1.94) p=<0.0013.55 (3.10, 4.08) p=<0.001Anterior ischaemic optic atrophy3.37 (2.15, 5.31) p=<0.00136.33 (25.19, 52.39) p=<0.001Cataract2.18 (2.04, 2.32) p=<0.0012.48 (2.22, 2.78) p=<0.001Cataract operation2.11 (1.97, 2.25) p=<0.0012.41 (2.13, 2.72) p=<0.001Glaucoma2.10 (1.91, 2.32) p=<0.0012.50 (2.10, 2.97) p=<0.001Conclusion:These community-based national data on risk of ocular morbidity in PMR and GCA show for the first time the risk of various ocular morbidities are increased for both groups. In addition this are the first estimates of relative risk compared to an age and sex matched population. These data are crucial for providing information to patients about their relative risk of ocular morbidity following a diagnosis of PMR or GCA.Acknowledgments:We would like to thank Dr Helen Strongman at the CPRD for carrying out patient searchers. We thank Dr Ferran Espuny Pujol for completion of the linkage request for dates of death.Disclosure of Interests:Max Yates: None declared, Allan Clark: None declared, Richard Watts: None declared, Alex MacGregor: None declared, Sarah Mackie Grant/research support from: Roche (attendance of EULAR 2019; co-applicant on research grant), Consultant of: Sanofi, Roche/Chugai (monies paid to my institution not to me)

scholarly journals Blindness and Visual Impairment among Egyptian Glaucoma Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
M. A. Eldaly ◽  
M. M. Salama ◽  
K. G. Abu Eleinen ◽  
D. Ghalwash ◽  
M. Youssef ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Impairment ◽  
Demographic Data ◽  
Visual Fields ◽  
Developed Countries ◽  
Cross Sectional Study ◽  
University Hospitals ◽  
Visual Disability ◽  
Cross Sectional ◽  
Total Blindness

Purpose. Glaucoma is the second commonest cause of blindness worldwide. Visual fields and intraocular pressures are optimum outcomes to be assessed in developed countries. Visual acuity as an outcome is the key player when assessing blindness in developing countries. The aim of this study is to assess visual impairment and blindness in glaucoma patients and to identify the bulk they represent in comparison to nonglaucoma patients in the same practice setting.Methods. Patients attending outpatient clinics of Cairo University Hospitals were enrolled in this cross-sectional study. Clinical data collected for these patients included their demographic data, best obtained visual acuity, and whether or not they have had an established diagnosis of glaucoma. Results were compared at 95% confidence intervals.Results. 988 eyes of 494 patients were included for this study. Their mean visual acuity was 6/24 (±3 Snellen lines). Legal blindness was found in 5% and 4% of glaucoma and nonglaucoma groups, respectively. There were high odds for finding eyes with total blindness due to glaucoma. That was statistically significant (P<0.05).Conclusions. A large proportion of glaucoma patients suffered from blindness in at least one eye. Interventional strategies are recommended regarding visual disability among Egyptian glaucoma patients.

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