Visual Outcomes of Macula-Involving Rhegmatogenous Retinal Detachment in Patients with and Without Age-Related Macular Degeneration

Background Patients presenting with macula-off rhegmatogenous retinal detachment (RRD) with concomitant age-related macular degeneration (AMD) and their treating physicians would benefit from knowledge regarding the visual prognosis after repair. The prognosis for such patients is not well known. The purpose of this study is to compare visual outcomes in macula-off RRD in eyes with AMD versus a group of comparison eyes without AMD. Methods This was a retrospective chart review of 1,149 patients. A total of 191 eyes met study criteria, 162 non-AMD eyes (controls) and 29 AMD eyes. The main outcome measure was postoperative visual acuity in control eyes versus AMD eyes, and this was compared using Fisher’s exact test. Results There was a statistically significant difference in postoperative visual acuity by AMD status, with those without AMD having a higher frequency of Count Fingers (CF), Hand Motion (HM), Light Perception (LP), or No Light Perception (NLP) vision (p = 0.023). More specifically 5.56% of non-AMD eyes and 3.45% of AMD eyes were 20/40 or better, 77.16% of non-AMD and 55.17% of AMD eyes were worse than 20/40 and better than 20/200, 10.49% of non-AMD eyes and 37.93% of AMD eyes were 20/200 or worse, and there were 11 eyes in the non-AMD group with CF, HM, LP, or NLP vision while there was only 1 eye in the AMD group with CF vision. Conclusions Though postoperative visual acuity was worse in the non-AMD group with a higher frequency of patients having final vision of CF, HM, LP, or NLP, this is not likely a clinically significant finding. Rather, it is a function of the difference in sample size and composition between the two groups. Importantly, this study suggests AMD patients can expect similar outcomes to non-AMD patients after RRD repair. Our study suggests that approximately 58% of patients with AMD can expect to maintain functional vision better than 20/200. We conclude that AMD patients can achieve functional vision after RRD surgery, similar to those without AMD. These findings may be helpful in guiding realistic expectations of AMD patients with RRD.

Affordable and effective optokinetic response methods to assess visual acuity and contrast sensitivity in larval to juvenile zebrafish

The optokinetic response (OKR) is an effective behavioural assay to investigate functional vision in zebrafish. The rapid and widespread use of gene editing, drug screening and environmental modulation technologies has resulted in a broader need for visual neuroscience researchers to access affordable and more sensitive OKR, contrast sensitivity (CS) and visual acuity (VA) assays. Here, we demonstrate how 2D- and 3D-printed, striped patterns or drums coupled with a motorised base and microscope provide a simple, cost-effective but efficient means to assay OKR, CS and VA in larval-juvenile zebrafish. In wild-type, five days post-fertilisation (dpf) zebrafish, the 2D or 3D set-ups of 0.02 cycles per degree (cpd) (standard OKR stimulus) and 100% black-white contrast evoked equivalent responses of 24.2±3.9 or 21.8±3.9 saccades per minute, respectively. Furthermore, although the OKR number was significantly reduced compared to the 0.02 cpd drum (p<0.0001), 0.06 and 0.2 cpd drums elicited equivalent responses with both set-ups. Notably, standard OKRs varied with time of day; peak responses of 29.8±7 saccades per minute occurred in the early afternoon with significantly reduced responses occurring in the early morning or late afternoon (18.5±3 and 18.4±4.5 saccades per minute, respectively). A customised series of 2D printed drums enabled analysis of VA and CS in 5-21 dpf zebrafish. The saccadic frequency in VA assays was inversely proportional to age and spatial frequency and in CS assays was inversely proportional to age and directly proportional to contrast of the stimulus. OKR, VA and CS of zebrafish larvae can be efficiently measured using 2D- or 3D-printed striped drums. For data consistency the luminance of the OKR light source, the time of day when the analysis is performed, and the order of presentation of VA and CS drums must be considered. These simple methods allow effective and more sensitive analysis of functional vision in zebrafish.

Diagnostic Agents in the Pediatric Eye Examination

In this chapter, the author reviews the most common topical ophthalmic drops for diagnostic use in a pediatric eye exam. Topical diagnostic agents have become an integral part of an ocular health examination even in infants and young children. Topical local anesthetics are commonly used for eye procedures such as tonometry, gonioscopy, and minor office procedures. The proper use of mydriatic drugs allows clinicians to identify and diagnose various ocular abnormalities that might otherwise go undetected. Cycloplegic refraction is a reliable procedure to determine the true refractive status of patients with accommodative esotropia, pseudomyopia, and latent hyperopia. Cycloplegic refraction is also useful in non-communicative or uncooperative patients and when a functional vision problem is suspected such as when visual acuities do not correlate with symptoms or clinical expecteds. Many times, diagnostic drops can help a clinician be more confident of the patient's clinical findings.

Prevalence of Concurrent Functional Vision and Hearing Impairment and Its Association with Dementia

Vision and hearing impairment are common and independently linked to dementia risk. Adults with concurrent vision and hearing impairment (dual sensory impairment, DSI) may be particularly at-risk. Data were from the National Health and Aging Trends Study (NHATS) (2011–2018, N=7,562). Functional sensory impairments were self-reported (no impairment, vision only, hearing only, and DSI). We calculated age-specific prevalence of sensory impairments. Discrete time proportional hazards model with a complementary log-log link were used to assess 7-year dementia risk. Of 7,562 participants, overall prevalence of functional vision, hearing and DSI was 5.4%, 18.9% and 3.1%, respectively. DSI prevalence increased with age, impacting 1 in 7 adults ≥90 years. DSI was associated with a 50% increased 7-year dementia risk (adjusted hazard ratio 1.50; 95% confidence interval, 1.12–2.02) compared to no impairment. Sensory rehabilitative interventions for multiple impairments may be an avenue for consideration in efforts to reduce dementia risk.

Development of Gazi Functional Vision Assessment Instrument

<p style="text-align: justify;">This study aimed to develop a valid and reliable instrument that measures the functional vision of students with low vision. Thus, an assessment tool and performance activities were developed for three vision skill groups (near vision skills, distance vision skills, and visual field) that include functional vision skills. The universe was 1485 students studying in various primary and middle schools (from 2nd to 7th grades) affiliated to the Ministry of National Education, and simple random sampling was used to select 310 students. The data were collected using the Gazi Functional Vision Assessment Instrument developed by the researchers. Many-facet Rasch model and generalizability theory were used for the rater reliability of the measurements obtained from the instrument, while discriminant analysis was used for the validity of the measurements. The analysis showed that the measurements were reliable, and the inferences based on these measurements were valid. Thus, this instrument can be used to identify and assess the functional vision status of students with low vision.</p>

Visual Function and Functional Vision of Retinitis Pigmentosa

Patients with retinitis pigmentosa have defects in visual function, including the visual field, color vision, contrast sensitivity, and impaired functional vision, such as reading and driving. An assessment of visual function is required when interpreting the outcome of clinical trials of retinitis pigmentosa. Various defects of functional vision should be considered when assessing visual impairment for patients with retinitis pigmentosa.

Visual outcomes and patient satisfaction 1 and 12 months after combined implantation of extended depth of focus and trifocal intraocular lenses

Purpose To assess the 1-month and 12-month postoperative visual performance and subjective outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL. Methods The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and trifocal IOL. Uncorrected (UDVA) and best-corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, and subjective questionnaires were evaluated 1 month and 12 months postoperatively. Results The study enrolled 58 consecutive patients. Binocular UDVA, UIVA and UNVA were − 0.08 ± 0.07 logMAR, 0.15 ± 0.14 logMAR and 0.17 ± 0.11 logMAR at 1 month, compared to − 0.09 ± 0.06 logMAR (P = .323), 0.11 ± 0.10 logMAR (P = .030) and 0.13 ± 0.10 logMAR (P = 0.008) at 12 months. Satisfaction was high with 93.1% of patients fulfilled or more than fulfilled postoperatively, and 84.5% and 86.3% reported spectacle independence for near at the respective postoperative assessments. The mean daytime and nighttime quality of vision (QoV) scores were 9.12 ± 0.94 and 7.88 ± 1.74 at 1 month, compared to 9.24 ± 0.78 (P = .183) and 8.26 ± 1.38 (P = .043) at 12 months. Conclusions This IOL combination provides good unaided visual acuity at 1 and 12 months postoperatively, with high functional vision and postoperative satisfaction reported at 1 and 12 months. However, a significant improvement in overall nighttime QoV at the 12 months assessment was found.

Affordable and effective optokinetic response methods to assess visual acuity and contrast sensitivity in larval to juvenile zebrafish

The optokinetic response (OKR) is an effective behavioural assay to investigate functional vision in zebrafish. The rapid and widespread use of gene editing, drug screening and environmental modulation technologies has resulted in a broader need for visual neuroscience researchers to access affordable and more sensitive OKR, contrast sensitivity (CS) and visual acuity (VA) assays. Here, we demonstrate how 2D- and 3D-printed, striped patterns or drums coupled with a motorised base and microscope provide a simple, cost-effective but efficient means to assay OKR, CS and VA in larval-juvenile zebrafish. In wild-type, five days post-fertilisation (dpf) zebrafish, the 2D or 3D drums printed with the standard OKR stimulus of 0.02 cycles per degree (cpd), 100% black-white contrast evoked equivalent responses of 24.2 or 21.8 saccades per minute, respectively. Furthermore, although the OKR number was significantly reduced compared to the 0.02 cpd drum (p<0.0001), the 2D and 3D drums evoked equivalent responses with the 0.06 and 0.2 cpd drums. Notably, standard OKRs varied with time of day; peak responses of 29.8 saccades per minute occurred in the early afternoon with significantly reduced responses occurring in the early morning or late afternoon (18.5 and 18.4 saccades per minute, respectively). A customised series of 2D printed drums enabled analysis of VA and CS in 5-21 dpf zebrafish. The saccadic frequency in VA and CS assays was inversely proportional to age, spatial frequency and contrast of the stimulus. OKR, VA and CS of zebrafish larvae can be efficiently measured using 2D- or 3D-printed striped drums. For data consistency the luminance of the OKR light source, the time of day when the analysis is performed, and the order of presentation of VA and CS drums must be considered. These simple methods allow effective and more sensitive analysis of functional vision in zebrafish.