Visual Performance and Cortical Atrophy in Vision-Related Brain Regions Differ Between Older Adults with (or at Risk for) Alzheimer’s Disease

Background: Visual impairment is associated with deficits in cognitive function and risk for cognitive decline and Alzheimer’s disease (AD). Objective: The purpose of this study was to characterize the degree of visual impairment and explore the association thereof with cortical atrophy in brain regions associated with visual processing in individuals with (or at risk for) AD. Methods: Using the Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) dataset, we analyzed vision and brain imaging data from three diagnostic groups: individuals with subjective cognitive decline (SCD; N = 35), mild cognitive impairment (MCI; N = 74), and mild AD (N = 30). We used ANCOVAs to determine whether performance on reading acuity and contrast sensitivity tests differed across diagnostic groups. Hierarchical regression analyses were applied to determine whether visual performance predicted gray matter volume for vision-related regions of interest above and beyond group membership. Results: The AD group performed significantly worse on reading acuity (F(2,138) = 4.12, p < 0.01, ω 2 = 0.04) compared to the SCD group and on contrast sensitivity (F(2,138) = 7.6, p < 0.01, ω 2 = 0.09) compared to the SCD and MCI groups, which did not differ from each other. Visual performance was associated with volume in some vision-related structures beyond clinical diagnosis. Conclusion: Our findings demonstrate poor visual performance in AD and that both group membership and visual performance are predictors of cortical pathology, consistent with the idea that atrophy in visual areas and pathways contributes to the functional vision deficits observed in AD.

Simulating Visibility and Reading Performance in Low Vision

PurposeLow vision reduces text visibility and causes difficulties in reading. A valid low-vision simulation could be used to evaluate the accessibility of digital text for readers with low vision. We examined the validity of a digital simulation for replicating the text visibility and reading performance of low-vision individuals.MethodsLow-vision visibility was modeled with contrast sensitivity functions (CSFs) with parameters to represent reduced acuity and contrast sensitivity. Digital filtering incorporating these CSFs were applied to digital versions of the Lighthouse Letter Acuity Chart and the Pelli-Robson Contrast Sensitivity Chart. Reading performance (reading acuity, critical print size, and maximum reading speed) was assessed with filtered versions of the MNREAD reading acuity Chart. Thirty-six normally sighted young adults completed chart testing under normal and simulated low-vision conditions. Fifty-eight low-vision subjects (thirty with macular pathology and twenty-eight with non-macular pathology) and fifteen normally sighted older subjects completed chart testing with their habitual viewing. We hypothesized that the performance of the normally sighted young adults under simulated low-vision conditions would match the corresponding performance of actual low-vision subjects.ResultsWhen simulating low-vision conditions with visual acuity better than 1.50 logMAR (Snellen 20/630) and contrast sensitivity better than 0.15 log unit, the simulation adequately reduced the acuity and contrast sensitivity in normally sighted young subjects to the desired low-vision levels. When performing the MNREAD test with simulated low vision, the normally sighted young adults had faster maximum reading speed than both the Non-macular and Macular groups, by an average of 0.07 and 0.12 log word per minute, respectively. However, they adequately replicated the reading acuity as well as the critical print size, up to 2.00 logMAR of both low-vision groups.ConclusionA low-vision simulation based on clinical measures of visual acuity and contrast sensitivity can provide good estimates of reading performance and the accessibility of digital text for a broad range of low-vision conditions.

Switching to Brolucizumab in Neovascular Age-Related Macular Degeneration Incompletely Responsive to Ranibizumab or Aflibercept: Real-Life 6 Month Outcomes

Purpose: The aim of this study was to evaluate the effect of switching treatment in eyes with neovascular age-related macular degeneration (nAMD) and treatment intervals of ≤6 weeks to brolucizumab. Methods: In this prospective series, eyes with persisting retinal fluid under aflibercept or ranibizumab every 4–6 weeks were switched to brolucizumab. Visual acuity (BCVA), reading acuity (RA), treatment intervals, central subfield thickness (CST), and the presence of intra- and subretinal fluid were recorded over 6 months. Results: Seven of 12 eyes completed the 6 month follow-up and received 4.4 ± 0.5 brolucizumab injections within 28.0 ± 2.8 weeks. Treatment intervals increased from 5.3 ± 0.9 weeks to 9.0 ± 2.8 weeks (95% confidence interval of extension (CI): 1.6 to 5.9). BCVA improved from 67.8 ± 7.2 to 72.2 ± 7.5 (95% CI: −0.3 to 9.1) ETDRS letters, RA improved from 0.48 ± 0.15 to 0.31 ± 0.17 LogRAD (95% CI: 0.03 to 0.25), and CST improved from 422.1 ± 97.3 to 353.6 ± 100.9 µm (95% CI: −19.9 to 157.1). Treatment was terminated early in five eyes (two intraocular inflammations with vascular occlusion without vision loss, one stroke, and two changes in the treatment plan). Conclusions: Improvement in visual performance and longer treatment intervals in our series over 6 months indicate the potential of brolucizumab to reduce the treatment burden in nAMD, while two instances of intraocular inflammation were encountered.

Increased letter spacing and greater letter width improve reading acuity in low vision readers

Low vision readers depend on magnification, but magnification reduces the amount of text that can be overviewed and hampers text navigation. In this study, we evaluate the effects that font variations letter spacing, letter width, and letter boldness have on low vision reading. We tested 20 low-vision patients with age-related macular degeneration (AMD) and used the Radner Reading Chart, which measures reading acuity (logRAD), maximum reading speed, and critical print size. The results demonstrated a small, but measurable effect of letter spacing and letter width on reading acuity near critical font sizes.

The effects of amblyopia on children’s reading performance after patching treatment

Purpose: The purpose of this study was to evaluate the effects of amblyopia on children’s reading performance after the successful patching treatment with 20/20 visual acuity (VA) in the treated eye. Methods: The treated amblyopes group included 10 children with strabismic amblyopia diagnosed on the first visit presenting VA equal or better than 0.0 logMAR (20/20 Snellen) in the better vision eye and VA worse than 0.2 logMAR (20/32 Snellen) in the worse eye that underwent patching treatment of amblyopia reaching a final VA equal to 0.0 logMAR in the treated eye. The control group comprised 10 children matched by age, gender and school-grade with no visual disorders. Reading performance was evaluated according to reading acuity (RA), critical print size (CPS), reading speed (RS) at 0.7 logMAR, and maximum reading speed (MRS) using the MNREAD chart. Results: Binocular reading performance was compared between groups and no statistically significant differences were found on RA, CPS, RS, or MRS ( p > 0.05). When analyzing monocular reading performances of treated amblyopes, a worse RA ( p = 0.04) and CPS ( p = 0.04) were observed on the previously amblyopic eye when compared to the fellow eye. When comparing the fellow eye from treated amblyopes and a randomly selected eye from controls, no statistically significant differences on RA, CPS, RS, or MRS were found ( p > 0.05). Conclusions: The results suggest that even patients who reached 20/20 VA in the treated eye after patching treatment for amblyopia may present persistent impaired reading performance. These findings reinforce the importance of reading performance testing as a tool when evaluating the visual function development in amblyopic patients.

Standardized ophthalmic tests for evaluating reading parameters: a brief historical review

In the review, the analysis of the most common ophthalmic standardized tests for evaluating reading was carried out: BaileyLovie Word Reading Charts, MNREAD Acuity Chart, Radner reading chart, SmithKettlewell Reading Test (SKread), IReST, Salzburg Reading Desk, Ramulu test, Radner paragraph optotypes, Balsam AlabdulkaderLeat (BAL) chart, Chinese Reading Acuity Charts (C-READ), chart for reading threshold and reading speed evaluation by T.S. Egorova. The following parameters were considered: maximum reading speed, reading threshold, reading acuity, reading accessibility index, threshold reading speed. Recovering the ability to read fluently is one of the criteria for assessing the success of treatment, as well as quality of life for patients of various age groups

Introduction of a digital near-vision reading test for normal and low vision adults: development and validation

Background MNREAD is an advanced near-vision acuity chart that has already been translated and validated in Greek language. Considering that no validated Greek digital near-vision test exists, our primary objective was to develop and validate a digital near-vision reading test based on the fundamental properties of the Greek printed MNREAD (MNREAD-GR). Methods This is a prospective, comparative study. A digital near-vision chart was developed (Democritus Digital Acuity Reading Test – DDART) with text size calibration, audio recording for automatic reading timing, as well as automatic calculation of reading acuity (RA), maximum reading speed (MRS), critical print size (CPS) and reading accessibility index (ACC). Normal and low vision subjects participated in the validation process, responding to MNREAD-GR and DDART at the same day, at a 40 cm viewing distance. Differences in all parameters between the charts were compared with t-test and intraclass correlation coefficients (ICCs). Within 15 days, all participants responded again to DDART in a different set of sentences to assess its test-retest reliability. Results One hundred patients (normal vision group - NVG: 70 patients; low vision group - LVG: 30 patients) responded to both reading tests. Non-significant differences were detected for all parameters between DDART and MNREAD-GR except for MRS and ACC that were significantly higher in MNREAD-GR in NVG (p < 0.01). NVG participants demonstrated sufficient ICCs that ranged from 0.854 to 0.963, while LVG demonstrated ICCs for RA, ACC, MRS and CPS equal to 0.986, 0.894, 0.794 and 0.723, respectively. All parameters calculated with DDART demonstrated excellent test-retest reliability (ICCs: 0.903 – 0.956). Conclusions The proposed reading test presented comparable validity and repeatability to MNREAD-GR suggesting that it can be used both in normal and low vision Greek patients. Trial registration ClinicalTrials.gov, NCT04242836. Registered 24 January 2020 – Retrospectively registered.

Exploring preferred and actual lighting levels for reading for adults with visual impairment at a center for the blind

Introduction Light plays a crucial role in facilitating or hindering participation in reading. The purpose of this study is to examine the preferred lighting and actual lighting levels for reading for adults with visual impairment at a center for the blind. Method This mixed-methods study gathered reading acuity level and lighting preferences for reading for 18 adults with visual impairment. The researcher used the Warren Text Card to measure reading acuity, and participants identified the preferred lighting level for reading on the LuxIQ 2. A Lighting Inventory was used to record lighting at the site. Findings Preferred lighting levels varied for adults with visual impairment. Preferred lux ranged from 250–5000 and kelvin ranged from 3000–6500 degrees. Reading acuity significantly improved (<.01) with increased lighting ( t = 3.441). The actual lighting levels at the center did not meet preferred lighting levels for reading. Conclusion Adults with visual impairment preferred increased levels of lighting for reading. As desired levels varied across participants, recommending customized lighting for each individual is optimal. Occupational therapists ideally should evaluate lighting and educate clients on how to increase lighting levels to the preferred level of lighting for reading to optimize reading performance.

Functional Results and Photic Phenomena with new Extended-Depth-of-Focus Intraocular Lens

Background: Evaluation of clinical and functional results of a new extended depth of focus intraocular lens (EDOF-IOL). Methods: Fourteen cataract patients (twenty-eight bilateral implantations) were assessed for uncorrected (UDVA) and corrected (CDVA) distance visual acuities; uncorrected (UNVA), distance-corrected (DCNVA) and best corrected (CNVA) near visual acuities; and uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuities - as well as binocular defocus curves. Photopic and mesopic contrast sensitivity was recorded. Reading acuity was evaluated using an electronic reading desk at fixed distances and at the patient’s preferred near and intermediate distances. Visual symptoms were assessed with a halo and glare simulator plus a patient questionnaire which also recorded quality of life. Results: Median postoperative monocular UDVA was 0.13logMAR (range -0.08 to 0.42logMAR), median CDVA was -0.01logMAR (range -0.20 to 0.22logMAR), median UIVA at 80 cm was -0.05logMAR (range -0.18 to 0.58logMAR) and median UNVA at 40 cm was 0.14logMAR (range -0.10 to 0.64logMAR). Binocular uncorrected reading acuity was 0.10logMAR at 40 cm and 0.11logMAR at 80 cm. Patients preferred a median intermediate reading distance of 62.8 cm over the predetermined 80 cm, which allowed them to read smaller letter size but did not improve reading acuity. Patients reported a high rate of spectacle independence and satisfaction in everyday life and little to no dysphotopsia. Conclusion: The Mini WELL Ready IOL provided good postoperative functional results at far and intermediate distances and improved the visual and reading acuity at reading distance. The lens caused little to no dysphotopsia.