Pediatric Visual Acuity Testing

Visual acuity measurement is an essential component of any eye exam. In adults and older children, letter-based acuity (i.e., recognition acuity) is commonly used to measure vision. However, in infants and toddlers, performing traditional visual acuity testing is nearly impossible. Instead, modified optotypes such as gratings and pictures are shown to observe the young child's visual behavior. Additionally, there are objective visual acuity methods that negate the need for observing visual behavior. For the practicing clinician, the choices are many and can be confusing. With new commercial products coming into the market every day, it is nearly impossible to comprehensively cover each one of them. Instead, in this chapter, commonly used and/or studied visual acuity tests are covered. For each test, the set-up, procedure, documentation, and scientific evidence supporting or negating its use are discussed.

Telehealth and Screening Strategies in the Diagnosis and Management of Glaucoma

Telehealth has become a viable option for glaucoma screening and glaucoma monitoring due to advances in technology. The ability to measure intraocular pressure without an anesthetic and to take optic nerve photographs without pharmacologic pupillary dilation using portable equipment have allowed glaucoma screening programs to generate enough data for assessment. At home, patients can perform visual acuity testing, web-based visual field testing, rebound tonometry, and video visits with the physician to monitor for glaucomatous progression. Artificial intelligence will enhance the accuracy of data interpretation and inspire confidence in popularizing telehealth for glaucoma.

Portable Ophthalmic Device for Remote Slit-Lamp Examinations and Visual Acuity Screening

A multi-functional self-examination ophthalmic device for remote eye examinations has been studied in this paper. The device integrates two standard ophthalmic examinations: slit-lamp and visual acuity. Testing of the device has been performed in a preliminary clinical study. The results show good and comparable images to those of conventional instruments routinely used in ophthalmic clinics. The device can be used in a myriad of remote settings including home monitoring.

Observations on Refractive Status and Risk Factors for Visual Impairment in Children with Disabilities

Vision integrates all the senses and plays a fundamental role in the acquisition of different skills and the general development of a child. Recently, refractive errors and visual impairment have become serious health problems among children. Background and Objectives: The aim of this study was to identify the prevalence of refractive errors and visual impairment in children with disabilities. Moreover, this study aimed to explore the risk factors for visual impairment in children with respect to vitamin D levels, parental smoking, and the use of spectacles. Materials and Methods: We retrospectively analyzed 161 children aged 5–16 years old, divided into two groups: a group of 80 children with disabilities and a control group consisting of 81 clinically healthy children. All the children underwent refraction measurements, visual acuity testing, and plasmatic vitamin D level dosing, measured in ng/mL. Results: Refractive errors and visual impairment were found to have a higher prevalence in the group of children with disabilities than in the control group. Moreover, the plasma level of vitamin D was lower in the group of children with special health needs. Conclusions: Given the present results, children with disabilities should undergo special eye examinations as soon as possible to ensure the quality of their socio-academic lives.

Spatial and temporal resolution of the photoreceptors rescue dynamics after treatment with voretigene neparvovec

BackgroundVoretigene neparvovec is a gene therapeutic agent for treatment of retinal dystrophies caused by bi-allelic RPE65 mutations. In this study, we report on a novel and objective evaluation of a retinotopic photoreceptor rescue.MethodsSeven eyes of five patients (14, 21, 23, 24, 36 years, 1 male, 4 females) with bi-allelic RPE65 mutations have been treated with voretigene neparvovec. The clinical examinations included visual acuity testing, dark-adapted full-field stimulus threshold (FST), dark-adapted chromatic perimeter (DAC) with a 30-degree grid, and a 30 degrees grid scotopic and photopic chromatic pupil campimetry (CPC). All evaluations and spectral domain optical coherence tomography were performed at baseline, 1 month and 3 months.ResultsAll except the oldest patient had a measurable improvement of the rod function assessed via FST, DAC or scotopic CPC at 1 month. The visual acuity improved slightly or remained stable in all eyes. A cone function improvement as measured by photopic CPC was observed in three eyes. The gain of the dark-adapted threshold with blue FST and the DAC stimuli (cyan) average correlated strongly with age (R2>0.7). The pupil response improvement in the scotopic CPC correlated with the baseline local retinal volume (R2=0.5).ConclusionsThe presented protocols allow evaluating the individual spatial and temporal effects of gene therapy effects. Additionally, we explored parameters that correlated with the success of the therapy. CPC and DAC present new and fast ways to assess functional changes in retinotopic maps of rod and cone function, measuring complementary aspects of retinal function.