Detection of VOR dysfunction during the gaze stabilization test: Does target size matter?

2021 ◽  
pp. 1-10
Author(s):  
Adam Thompson-Harvey ◽  
Charlotte E. Dutcher ◽  
Heather A. Monroe ◽  
Belinda C. Sinks ◽  
Joel A. Goebel
Keyword(s):  
Visual Acuity ◽  
Vestibular Dysfunction ◽  
Target Size ◽  
Control Group ◽  
Likelihood Ratios ◽  
Gaze Stabilization ◽  
Head Velocity ◽  
The Gaze ◽  
Significant Difference ◽  
Size Matter

BACKGROUND: The Gaze Stabilization Test (GST) identifies vestibulo-ocular reflex (VOR) dysfunction using a decline in target recognition with increasing head velocity, but there is no consensus on target (optotype) size above static visual acuity. OBJECTIVE: To determine the optimal initial optotype size above static visual acuity to be used during the GST in subjects with unilateral vestibular dysfunction and healthy individuals. METHODS: Eight subjects with unilateral vestibular dysfunction (UVD) and 19 age-matched, healthy control subjects were studied with the standard GST protocol using two optotype sizes, 0.2 and 0.3 logMAR above static visual acuity (ΔlogMAR). Maximal head velocity achieved while maintaining fixation on both optotypes was measured. Sensitivity, specificity and receiver-operator characteristic area under the curve (ROC AUC) analyses were performed to determine the optimal head velocity cut off point for each optotype, based on ability to identify the lesioned side of the UVD group from the control group. RESULTS: There was a significant difference in maximal head velocity between the UVD group and control group using 0.2 ΔlogMAR (p = 0.032) but not 0.3 ΔlogMAR (p = 0.061). While both targets produced similar specificities (90%) for distinguishing normal from subjects with UVD, 0.2 ΔlogMAR targets yielded higher sensitivity (75%) than 0.3 logMAR (63%) and accuracy (86% vs 80%, respectively) in detecting the lesioned side in subjects with UVD versus controls with maximal head velocities≤105 deg/s (p = 0.017). Furthermore, positive likelihood ratios were nearly twice as high when using 0.2 ΔlogMAR targets (+ LR 10) compared to 0.3 ΔlogMAR (+ LR 6.3). CONCLUSION: The 0.2 ΔlogMAR optotype demonstrated significantly superior identification of subjects with UVD, better sensitivity and positive likelihood ratios than 0.3 ΔlogMAR for detection of VOR dysfunction. Using a target size 0.2logMAR above static visual acuity (ΔlogMAR) during GST may yield better detection of VOR dysfunction to serve as a baseline for gaze stabilization rehabilitation therapy.

scholarly journals A Randomized Controlled Trial of Conbercept Pretreatment before Vitrectomy in Proliferative Diabetic Retinopathy

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Xiaochun Yang ◽  
Jianbiao Xu ◽  
Ruili Wang ◽  
Yan Mei ◽  
Huo Lei ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Controlled Trial ◽  
Control Group ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Pars Plana ◽  
Effective Adjunct

Purpose.To determine the efficacy and safety of preoperative intravitreal conbercept (IVC) injection before vitrectomy for proliferative diabetic retinopathy (PDR).Methods.107 eyes of 88 patients that underwent pars plana vitrectomy (PPV) for active PDR were enrolled. All patients were assigned randomly to either preoperative IVC group or control group. Follow-up examinations were performed for three months after surgery. The primary bioactivity measures were severity of intraoperative bleeding, incidence of early and late recurrent VH, vitreous clear-up time, and best-corrected visual acuity (BCVA) levels. The secondary safety measures included intraocular pressure, endophthalmitis, rubeosis, tractional retinal detachment, and systemic adverse events.Results.The incidence and severity of intraoperative bleeding were significantly lower in IVC group than in the control group. The average vitreous clear-up time of early recurrent VH was significantly shorter in IVC group compared with that in control group. There was no significant difference in vitreous clear-up time of late recurrent VH between the two groups. Patients that received pretreatment of conbercept had much better BCVA at 3 days, 1 week, and 1 month after surgery than control group. Moreover, both patients with improved BCVA were greater in IVC group than in control group at each follow-up.Conclusions.Conbercept pretreatment could be an effective adjunct to vitrectomy in accelerating postoperative vitreous clear-up and acquiring stable visual acuity restoration for PDR.

Comparison of the Gaze Stabilization Test and the Dynamic Visual Acuity Test in Unilateral Vestibular Loss Patients and Controls

2015 ◽  
Vol 36 (4) ◽  
pp. 746-753 ◽  
Author(s):  
Courtney C. J. Voelker ◽  
Amelia Lucisano ◽  
Dorina Kallogjeri ◽  
Belinda C. Sinks ◽  
Joel A. Goebel
Keyword(s):  
Visual Acuity ◽  
Dynamic Visual Acuity ◽  
Vestibular Loss ◽  
Gaze Stabilization ◽  
The Gaze ◽  
Visual Acuity Test ◽  
Acuity Test

scholarly journals Efficacy of microsurgical tumor removal for treatment of patients with intracanalicular vestibular schwannoma presenting with disabling vestibular symptoms

2017 ◽  
Vol 126 (5) ◽  
pp. 1514-1519 ◽  
Author(s):  
Madjid Samii ◽  
Hussam Metwali ◽  
Venelin Gerganov
Keyword(s):  
Quality Of Life ◽  
Vestibular Schwannoma ◽  
Symptom Relief ◽  
Vestibular Dysfunction ◽  
Control Group ◽  
Surgical Removal ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Vestibular Symptoms

OBJECTIVEThe aim of this study was to analyze the efficacy and risks of microsurgery via the hearing-preserving retrosigmoid approach in patients with intracanalicular vestibular schwannoma (VS) suffering from disabling vestibular symptoms, with special attention to vertigo.METHODSThis is a retrospective analysis of 19 patients with intracanalicular VS and disabling vestibular dysfunction as the main or only symptom (Group A). All of the patients reported having had disabling vertigo attacks. Subjective evaluation of the impairment of patients was performed before surgery, 3 weeks after surgery, 3 months after surgery, and 1 year after surgery, using the Dizziness Handicap Inventory (DHI). The main outcome measures were improvement in quality of life as measured using the DHI, and general and functional outcomes, in particular facial function and hearing. Patient age, preoperative tumor size, preoperative DHI score, and preservation of the nontumorous vestibular nerve were tested using a multivariate regression analysis to determine factors affecting the postoperative DHI score. The Mann-Whitney U-test was used to compare the postoperative DHI score at 3 weeks, 3 months, and 1 year after surgery with a control group of 19 randomly selected patients with intracanalicular VSs, who presented without vestibular symptoms (Group B). The occurrence of early postoperative discrete vertigo attacks was also compared between groups.RESULTSThe preoperative DHI score was ≥ 54 in all patients. All patients reported having had disabling rotational vertigo before surgery. The only significant factor to affect the DHI outcome 3 weeks and 3 months after surgery was the preoperative DHI score. The DHI outcome after 1 year was not affected by the preoperative DHI score. Compared with the control group, the DHI score at 3 weeks and 3 months after surgery was significantly worse. There was no significant difference between the groups after 1 year. Vertigo was improved in all patients and completely resolved after 1 year in 17 patients.CONCLUSIONSDisabling vestibular dysfunction that affects quality of life should be considered an indication for surgery, even in otherwise asymptomatic patients with intracanalicular VS. Surgical removal of the tumor is safe and very effective in regard to symptom relief. All patients had excellent facial nerve function within 1 year after surgery, with a very good chance of hearing preservation.

scholarly journals The efficacy of moxifloxacin in patients with bacterial keratitis

2018 ◽  
Vol 75 (2) ◽  
pp. 206-212
Author(s):  
Katarina Janicijevic ◽  
Sanja Kocic ◽  
Snezana Radovanovic ◽  
Svetlana Radevic ◽  
Olgica Mihailjevic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Local Therapy ◽  
Developed Countries ◽  
Healing Time ◽  
Control Group ◽  
Double Blind Study ◽  
Bacterial Keratitis ◽  
Double Blind ◽  
Corneal Scarring ◽  
Significant Difference

Background/Aim. Keratitis is a sociomedical problem of moderately developed countries. including Serbia, too. The incidence of bacterial keratitis in the world is about 20% in relation to all keratitis, but its frequency in Serbia is still not known. Bearing in mind the complications in the front segment of the eye after bacterial keratitis (ulcer, neovascularization, fibrosis) and decline in visual acuity, it was necessary to assess the efficacy of local therapy by moxifloxacin which will shorten the healing time and reduce complications. The aim of the study was to analyze the efficiency of shortening the treatment of bacterial keratitis with moxifloxacin. Methods. The study was designed as prospective, randomized, double-blind study. The study included 30 patients with diagnosed keratitis and locally applied antibiotic moxifloxacin, and 60 patients in a control group, with locally applied artificial tears. All participants were subjected to complete clinical ophthalmologic analysis (2015/16), for a period of 1?15 days after the application of therapies (healing time of corneal pathology). The following was determined in all patients: degree of hyperemia, degree of epithelial defect, level of corneal sensitivity, level of tear secretion and tear quality, degree of conjunctival secretion, degree of neovascularisation and corneal scarring, degree of visual acuity, score of subjective symptomatology and correlation of ophthalmological findings and subjective symptoms. Results. There was a statistically significant difference in times of therapeutic efficacy/clinical response between the study group patients who received moxifloxacin and the control group patients who received arteficial tears. Conclusion. Local application of moxifloxacin had therapeutic effect (total benefit) both in terms of the effective shortening of the healing time and also the reduction of the complications of bacterial keratitis, without unwanted effects.

scholarly journals Objective Optical Quality in Eyes with Customized Selection of Aspheric Intraocular Lens Implantation

2019 ◽  
Author(s):  
Qing-Qing Tan ◽  
Jia Lin ◽  
Jing Tian ◽  
Xuan Liao ◽  
Chang-Jun Lan
Keyword(s):  
Visual Acuity ◽  
Spherical Aberration ◽  
Optical Quality ◽  
Control Group ◽  
Modulation Transfer ◽  
Iol Implantation ◽  
Postoperative Visual Acuity ◽  
Aspheric Iol ◽  
Significant Difference ◽  
Selection Of

Abstract Backgroud To compare the postoperative optical quality in eyes with customized selection and random selection of aspheric intraocular lens (IOL) implantation. Methods A prospective, nonrandomized study was implemented in adult cataract patients who underwent unilateral phacoemulsification with aspheric IOL implantation. Patients were allocated into two treatment groups: a customized group and a control group. In the customized group, the aspheric IOL selection was based on the corneal spherical aberration to enable the postoperative target ocular spherical aberration closest to zero; in the control group, the aspheric IOLs were chosen using a random strategy. Primary outcome measurements included the following objective optical quality assessments: higher-order aberrations obtained by a Hartmann-shack aberrometer at 4mm and 6mm pupil diameters; objective scatter index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR) and a simulated contrast visual acuity—optical quality analysis system value (OV) obtained by a double-pass system with a 4-mm aperture. Subjective visual acuity was measured as secondary outcome. All the patients were followed up for 3 months. Results Eighty-four patients in the customized group and 78 patients in the control group were evaluated. There was no significant difference in postoperative visual acuity between the two groups (P>0.05). Significantly less ocular higher-order aberrations were shown in the customized group (P<0.05). No significant difference was shown in OSI, MTF cut-off, SR and OV between the two groups (P>0.05). Conclusions Although customized selection of aspheric IOL implantation showed less postoperative ocular aberrations, it performed similarly to random selection of aspheric IOL implantation in terms of postoperative visual acuity, simulated contrast visual acuity, intraocular scatter, modulation transfer function and Strehl ratio.

scholarly journals Corneal Collagen Cross-Linking for Keratoconus: Systematic Review

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Hidenaga Kobashi ◽  
Shi Song Rong
Keyword(s):  
Systematic Review ◽  
Visual Acuity ◽  
Corneal Thickness ◽  
Cross Linking ◽  
Control Group ◽  
Significant Heterogeneity ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
One Year ◽  
Collagen Cross Linking

Purpose. To evaluate the efficacy of collagen cross-linking (CXL) one year after treatment for keratoconus compared to no treatment by summarizing randomized controlled trials (RCTs) using a systematic review. Methods. Trials meeting the selection criteria were quality appraised, and the data were extracted by two independent authors. The outcome parameters included maximum keratometry (Kmax), corneal thickness at the thinnest point, best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), spherical equivalent (SE) refraction, and cylindrical refraction one year after CXL. We compared the changes in the above parameters with the control group. Results. We identified five RCTs involving 289 eyes that met the eligibility criteria for this systematic review. The changes in BSCVA from baseline to one year exhibited a significant difference between the two groups. There was no statistically significant difference between the two groups for changes in corneal thickness and cylindrical refraction. We did not conduct a meta-analysis in Kmax, UCVA, and SE refraction because their I2 values were greater than 50%. Conclusions. According to the systematic review, CXL may be effective in halting the progression of keratoconus for one year under certain conditions, although evidence is limited due to the significant heterogeneity and paucity of RCTs.

scholarly journals Efficacy of Voriconazole Corneal Intrastromal Injection for the Treatment of Fungal Keratitis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Chenshuang Li ◽  
Kunpeng Pang ◽  
Liqun Du ◽  
Xinyi Wu
Keyword(s):  
Visual Acuity ◽  
Corneal Stroma ◽  
Fungal Keratitis ◽  
Antifungal Treatment ◽  
Treatment Modalities ◽  
Control Group ◽  
Significant Difference ◽  
The Difference ◽  
Contralateral Eye ◽  
Intrastromal Injection

Purpose. To evaluate efficacy and safety of novel tricyclic corneal stroma injection (TCSI) voriconazole for the treatment of fungal keratitis. Methods. This retrospective cohort study included data of 57 patients (57 eyes) with fungal keratitis. The TCSI group consisted of 27 patients (27 eyes) who were injected voriconazole once via TCSI procedure within one week after enrollment, in addition to conventional antifungal treatment. The control group consisted of 30 patients (30 eyes) who were treated using conventional antifungal treatment modalities. The outcome measures consist of the 3-week and 3-month best-corrected visual acuity (BCVA) values and size of infiltrate or scar, time to re-epithelialization, corneal perforation rate and/or therapeutic penetrating keratoplasty (TPK) requirement, the preoperative and post-TCSI corneal endothelial cell density (ECD), and the intraocular pressure (IOP) of the treated eye and the respective contralateral eye. Results. There were no significant differences in the baseline demographic and clinical characteristics between the two groups. 3 weeks and 3 months after enrollment, the TCSI group exhibited an increase in visual acuity ( P < 0.05 ), and there was no significant difference in the size of infiltrate or scar between two groups ( P > 0.05 ). Time to re-epithelialization was shorter in the TCSI group than in the control group ( P < 0.05 ). There was no statistically significant difference between corneal ECD on the day before and 7 days after TCSI and the IOP of treated and contralateral healthy eyes on the day before and 1 day, 3 days, 7 days, and 1 month after TCSI ( P > 0.05 ). The difference in the risk of perforation and/or TPK requirement was not statistically significant between two groups ( P > 0.05 ). Conclusion. Localized injection of voriconazole using TCSI may be a minimally invasive, safe, and effective adjuvant treatment modality for fungal keratitis.

scholarly journals Efficacy and safety of extended depth of focus intraocular lenses in cataract surgery: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Jing Liu ◽  
Yi Dong ◽  
Yan Wang
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Contrast Sensitivity ◽  
Intraocular Lenses ◽  
Control Group ◽  
Efficacy And Safety ◽  
Depth Of Focus ◽  
Extended Depth Of Focus ◽  
Significant Difference ◽  
Near Visual Acuity

Abstract Background : This study aims to evaluate the efficacy and safety of extended depth of focus (EDOF) intraocular lenes (IOLs) in cataract surgery. Methods: All comparative clinical trials that involved bilaterally implanting EDOF IOLs in patients with cataract were retrieved from the literature database. We used random effects models to pool weighted mean differences (WMD) and risk ratio (RR) for continuous and dichotomous variables, respectively. Results: Nine studies with a total of 1336 eyes were identified. The subgroup analysis was conducted according to the type of IOLs used in the control group. Compared with monofocal IOLs, EDOF IOLs produced better uncorrected intermediate visual acuity (WMD: -0.17, 95% CI: -0.26 to -0.08, P = 0.0001) and uncorrected near visual acuity (WMD: -0.17, 95% CI: -0.21 to -0.12, P < 0.00001). EDOF IOLs resulted in reduced contrast sensitivity, more frequent halos, however, higher spectacle independence (RR: 2.81, 95% CI: 1.06 to 7.46, P = 0.04) than monofocal IOLs. Compared with trifocal IOLs, EDOF IOLs produced worse near visual acuity (MD: 0.10, 95% CI: 0.07 to 0.13, P<0.0001). EDOF IOLs performed better than trifocal IOls in contrast sensitivity, and there were no significant difference in halos and spectacle independence. Serious postoperative complications were rare, with no adverse events were reported in most studies. Conclusions: Increasing the risk of contrast reduction and more frequent halos, EDOF IOLs provided better intermediate and near VAs than monofocal IOLs. At the expense of near vision, patients receiving EDOF IOLs have better contrast sensitivity than those receiving trifocal IOLs. Halo incidence and spectacle independence of EDOF IOLs were similar to those of trifocal IOLs.

Static and dynamic pupillary characteristics in multiple sclerosis

2021 ◽  
pp. 112067212110443
Author(s):  
Ersin Muhafiz ◽  
Erdinç Bozkurt ◽  
Can Emre Erdoğan ◽  
Şerif Nizamoğulları ◽  
Mehmet Siraç Demir
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Control Group ◽  
Fiber Layer ◽  
Time Intervals ◽  
Rnfl Thickness ◽  
Significant Difference ◽  
Ophthalmologic Examination ◽  
And Control

Purpose: To examine the static and dynamic pupillary functions with automated pupillography in multiple sclerosis (MS) patients with preserved visual acuity. Methods: Forty-seven MS patients with preserved visual acuity were included in the study group and 43 healthy volunteers in the control group. The visual evoked potential of the patients was obtained. After routine ophthalmologic examination contrast sensitivity and the retinal nerve fiber layer (RNFL) thickness were measured. Finally scotopic, mesopic, and photopic pupillographies followed by dynamic pupillography were undertaken, and the pupillary dilatation speed was calculated. Results: The contrast sensitivity and RNFL thickness of the MS group were significantly lower than those of the control group ( p < 0.05; for both). In the MS and control groups, the scotopic pupil diameters were 5.48 ± 1.03 and 5.28 ± 0.78 mm, mesopic pupil diameters were 4.82 ± 0.83 and 4.48 ± 0.70 mm, and photopic pupil diameters were 3.84 ± 0.79 and 3.42 ± 0.49 mm, respectively ( p = 0.315, p = 0.044, and p = 0.004, respectively). In dynamic pupillography, the pupil in the MS group was more dilated than control group at all time sections examined except the sixth second ( p < 0.05; for all). Although the mean pupillary dilation speed in the first second was higher in the MS group ( p = 0.044), there was no significant difference between the groups for the other time intervals examined ( p > 0.05; for all). There was no correlation between pupillary parameters and P100-wave latency, RNFL thickness, or contrast sensitivity ( p > 0.05; for all). Conclusions: Static and dynamic pupillary functions may be affected in MS patients with preserved visual acuity. Although scotopic pupillary functions are preserved, mesopic, and photopic pupil functions are weakened.

scholarly journals The Effect of Multiple Sclerosis on Nerve Fiber Layer of the Retina

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A A Mohamed ◽  
A M Saad ◽  
T H Mohamed ◽  
Y A Elzanklony
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Optic Neuritis ◽  
Control Group ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
University Hospitals ◽  
Rnfl Thickness ◽  
Study Results ◽  
Significant Difference

Abstract Background Multiple Sclerosis is a chronic idiopathic inflammatory demyelinating disease involving Central Nervous System white matter with relapsing-remitting nature. Optic neuritis is a common initial manifestation. Multiple Sclerosis is characterized by dual pathological process of inflammation and neurodegeneration. It causes prominent retinal neural ganglion cell layer loss in addition to related axonal loss which can be identified by thinning of RNFL seen in OCT. Patients and Methods This case control study was carried out at Ain Shams University Hospitals in MS clinic of neurology department and Ophthalmology outpatient clinics. with a total of 100 eyes, from 50 subjects, Group A (10 patients, 20 eyes): normal persons with normal eyes as a Control group and 40 patients (80 eyes) having multiple sclerosis who satisfied the inclusion and exclusion criteria subdivided into 2 groups,(group B) 20 patients having previous attack of Optic Neuritis & (group C) 20 patients not having previous Optic Neuritis. Informed consents were obtained from all subjects and ethics approval were obtained from Ain Shams University Hospitals Ethical Commitee: A complete ophthalmic history and ophthalmological examination were done for each subject. Visual acuity assessment using Auto Refractometer, refraction, uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) assessment using Snellen chart and also calculated in Logarithm of Minimum Angle of Resolution (LogMAR).Pupil reaction. Color vision assessment. Anterior segment detailed Slit Lamp examination. Posterior segment examination (ONH examination) using Slit lamp biomicroscopy, Volk +90 Diopter lens. Intraocular tension measured by Goldmann applanation tonometry. OCT to evaluate RNF layer thickness and c/d ratio. Results Our study results demonstrated that: VA & BCVA were statistically significant lower in MS group than the control group (P = 0.011, 0.006 respectively). Total, superior, inferior and temporal RNFL thickness were statistically significant lower in MS group than the control group(P = 0.003, 0.004, 0.028, 0.018 respectively), while there was no statistically significant difference between the two studied groups regarding nasal RNFL thickness. Total, all the four quadrants superior, inferior, temporal and nasal RNFL thickness were statistically significant lower in MS group with previous attack of ON compared with the MS group not having previous ON (P = 0.000, 0.000, 0.004, 0.004, 0.024 respectively). Conclusion This study also suggests a great role of ocular imaging techniques such as OCT as an effective noninvasive, high-resolution, non contact tool in mapping of subclinical retinal changes (GCIP layer) in MS patients. It may also serve as a diagnostic adjunct for monitoring disease activity and responses to neuroprotective drugs.

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