Reading ability with pseudophakic monovision and with refractive multifocal intraocular lenses: Comparative study

Presbyopia Treatments by Mechanism of Action: A New Classification System Based on a Review of the Literature

Presbyopia, a loss of accommodative ability associated with aging, is a significant cause of vision impairment globally. At the clinical level, it is a frustrating and difficult issue that negatively impacts patients’ quality of life. Less appreciated is the fact that loss of accommodative ability and its current treatments methods may present safety concerns, for example, increasing the risk of falls. Therefore, a more complete understanding of treatment options with respect to how they relate to the natural ability of the eye is needed to improve decision making and to aid clinicians in individualizing treatment options. This article reviews the options for expanding functional through focus—a term coined to describe the ability of the eye to see at all distances with minimal latency—by how they vary the refractive power over time, across the visual field, between eyes, or across a range of distances.

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Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series

PURPOSE

We report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision.

DESIGN

Prospective, observational case series.

METHODS

Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 intraocular lens, with the dominant eye and nondominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire.

RESULTS

Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03 ± 0.06, 0.12 ± 0.18, and 0.11 ± 0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P = .004) whereas binocular distance VA was better in the distance-corrected condition (P = .014). Near VA was similar in both conditions (P > .05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in the National Eye Institute Visual Function Questionnaire-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of subjects, respectively. All subjects reported a satisfaction score of ≥3.5 of 5 and required no spectacles postoperatively. No intraocular lens exchange was required.

CONCLUSIONS

Monovision with bilateral bifocal multifocal intraocular lens was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal multifocal intraocular lens, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.

Evaluation of pre- and post-surgery reading ability in patients with epiretinal membrane: a prospective observational study

Background

This study aimed to investigate the pre- and post-surgery reading ability in patients with idiopathic epiretinal membrane (ERM) to evaluate whether measurement of reading performance is a helpful test in addition to visual acuity (VA) as an assessment measure.

Methods

This prospective observational study involved 42 eyes of 40 patients with idiopathic ERM. Best-corrected visual acuity (BCVA), reading ability, and metamorphopsia score were evaluated at baseline and at 3, 6, and 12 months post-surgery. As the outcome measure, the reading ability of each patient (i.e., overall performance) was examined with MNREAD-J, the Japanese version of the MNREAD reading acuity (RA) charts, to determine RA, critical print size (CPS), and maximum reading speed (MRS). Generally, a difference of 0.2 logMAR or more is considered a significant change in BCVA. Thus, as a subgroup analysis, we additionally evaluated the BCVA and reading ability of the patients with a BCVA difference of 0.1 logMAR or less between at baseline and at 12 months post-surgery.

Results

Relative to their values at baseline, the subjects exhibited significantly improved BCVA, RA, and CPS throughout the post-surgery examination period (P < 0.001) and significantly improved MRS at 12 months post-surgery (P = 0.04). No significant change in the vertical metamorphopsia score was observed throughout the post-surgery follow-up period. However, and compared to the value at baseline, significant improvements in the horizontal metamorphopsia score were observed at 3, 6 (P < 0.05), and 12 months (P < 0.001) post-surgery. In the subgroup analysis of the 23 eyes that exhibited a BCVA improvement of 0.1 logMAR or less, the median BCVA did not change, but the median RA and CPS improved by 0.2 logMAR.

Conclusions

Our findings showed that the surgical removal of ERM improves reading ability, even when the BCVA score does not improve. The measurement of reading performance appears to be a helpful test in addition to VA as a measure for assessing the surgical removal of ERM.

Quantification of accommodative response and visual performance in non-presbyopes wearing low-add contact lenses

PURPOSE

Digital eye strain encompasses a range of ocular and visual symptoms across all age groups. Recently, symptoms associated with accommodative or binocular vision stress have become a major problem, especially in young individuals. The purpose of this prospective, single-blinded study was to objectively quantify the accommodative response and visual performance of low-add soft contact lenses (CLs) in young non-presbyopic individuals.

METHODS

A daily disposable low-add bifocal design lens (low-add CL) was tested. It employs a centre-distance optical zone and peripheral zone with the added power of +0.50 D to support near vision. Sixteen subjects aged 20-39 years were enrolled in the study. Refractive state and accommodation were measured using an open-field autorefractor with three target vergences, namely, -0.20 D, -2.5 D, and -4.0 D. Binocular visual acuity at high (100%) and low (40%, 20%) contrast and reading ability were assessed. Monofocal soft CLs were used as controls.

RESULTS

Accommodative response with low-add CLs was significantly smaller than those with two monofocal CL wearing conditions, i.e., at 40 cm (2.5 D of stimulus) and 25 cm (4.0 D of stimulus) (all p < 0.05). The 20% contrast visual acuity at distance was significantly better with low-add CLs and second-time monofocal CLs compared to first-time monofocal CLs (all p < 0.05). The reading ability was not significantly different.

CONCLUSIONS

Quantification of accommodative response and visual performance demonstrated that using low-add CLs alleviated the accommodation under the near-vision condition, without sacrificing distance vision, in non-presbyopes.

Subjective evaluation of uncorrected vision in patients undergoing cataract surgery with (diffractive) multifocal lenses and monovision

Purpose

To analyze patient satisfaction and difficulties with bilateral multifocal intraocular lenses (IOLs) implantation and aspheric monofocal IOLs implantation using monovision, after cataract surgery.

Materials and methods

A total of 61 participants were included in the study, 29 with monovision and 32 with multifocal lenses. The inclusion criteria were patients undergoing phacoemulsification for bilateral visual impairment due to cataracts and presenting with postoperative visual acuity of 20/30 or better for distance and line J3 or better for near vision.

Results

The 2 groups had similar results regarding difficulties with daily activities such as distance vision, near vision, watching television, reading, cooking, using a computer or cellphone, shaving/putting on makeup and shopping. There were differences in responses between the groups regarding difficulty with night vision (P=0.0565) and night driving (P=0.0291). Degree of satisfaction in terms of distance vision without glasses was statistically significantly better in monovision group (P=0.0332), but not for near (P=0.9101).

Conclusion

Both techniques yielded satisfactory results regarding visual acuity for different activities without the need to use glasses. Multifocal lenses are a good option for patients with the exception of night driving, and who desire independence from glasses.

A systematic review of pseudophakic monovision for presbyopia correction

A systematic review of the recent literature regarding pseudophakic monovision as a reliable methods for presbyopia correction was performed based on the PubMed, MEDLINE, Nature and the American Academy of Ophthalmology databases in July 2015 and data from 18 descriptive and 12 comparative studies were included in this narrative review. Pseudophakic monosvision seems to be an effective method for presbyopia with high rates of spectacles independence and minimal dysphotopsia side-effects, that should be considered by the modern cataract surgeons.

[The search for electrophysiological predictors of visual comfort after presbyopia correction with contact lenses]

Starting at 40 years of age, prespyopia affects a quarter of the world population. Many techniques of presbyopia surgery have emerged in recent years. The purpose of this study was to compare monovision and multifocality and to identify clinical and electrophysiological predictive markers of visual comfort for each correction available in clinical practice. Ten presbyopic patients participated in this study. Patients received monovision and multifocal correction using contact lenses for three weeks each in a random order. A clinical evaluation (visual acuity, TNO test, binocular contrast sensitivity and quality of vision questionnaires) and an electrophysiological evaluation (monocular and binocular pattern VEP with multiple spatial frequencies: 60, 30 and 15') were performed before and after each correction modality. The P100 was significantly wider and slightly earlier after binocular compared to monocular stimulation at T0. The TNO stereopsis score decreased significantly after correction. No other significant differences, either on clinical or electrophysiological criteria, were found between the two modes of correction. Several significant correlations were found between the stereoacuity difference depending upon correction and evoked potentials by binocular pattern at T0. The larger the stereoacuity difference (better stereoacuity with multifocal compensation), the longer the latency of the P100 using 60' checks (R=0.82; P=0.004) and the greater the amplitude of the N75 using 30' (R=0.652; P=0.04). Our study found no differences between the 2 types of correction, but it highlights a benefit of VEP used in current practice and measurement of the P100 wave, the best indicator of stereopsis and the most consistent, to predict visual comfort after compensation presbyopia.

Development of a Reading Accessibility Index Using the MNREAD Acuity Chart

IMPORTANCE

We define a Reading Accessibility Index for evaluating reading in individuals with normal and low vision.

OBJECTIVE

To compare the Reading Accessibility Index with data from the Impact of Cataracts on Mobility (ICOM) study.

DESIGN, SETTING, AND PARTICIPANTS

This investigation was a secondary data analysis from the ICOM study performed between July 1, 2014, and September 20, 2015, at 12 eye clinics in Alabama from October 1, 1994, through March 31, 1996. Participants were 321 adults with cataract (n = 92), pseudophakia (n = 131), or natural crystalline lenses without cataract (n = 98).

MAIN OUTCOMES AND MEASURES

The Reading Accessibility Index (hereafter referred to using the abbreviation ACC for the first 3 letters of Accessibility) is defined as an individual's mean reading speed measured across the 10 largest print sizes on the MNREAD Acuity Chart (Precision Vision) (0.4-1.3 logarithm of the minimum angle of resolution at 40 cm), normalized by 200 words per minute, which was the mean value for a group of 365 normally sighted young adults. The ACC is a single-value measure that captures an individual's range of accessible print sizes and reading fluency within this range.

RESULTS

The study cohort comprised 321 participants. Their age range was 55 to 85 years, and 157 (48.9%) were female. The ACCs for the ICOM study participants ranged from 0.19 to 1.33, where 1.00 is the mean value for normally sighted young adults. The ACC for the cataract group (mean [SD], 0.65 [0.18]) was significantly lower than that for the pseudophakia group (mean [SD], 0.77 [0.16]) and the control group (mean [SD], 0.76 [0.19]) (P < .001 for both). The correlation between the ACC and Early Treatment Diabetic Retinopathy Study visual acuity (r = -0.22) and Pelli-Robson contrast sensitivity (r = 0.20) was weaker than that with a reading-related measure of instrumental activities of daily living (r = -0.60) (P < .001 for both).

CONCLUSIONS AND RELEVANCE

The ACC represents an individual's access to text across the range of print sizes found in everyday life. Its calculation does not rely on curve fitting and provides a direct comparison with the performance of normally sighted individuals. Changes in an individual's ACC might be used to evaluate the effect of ophthalmic treatment, rehabilitation programs, or assistive technology on reading accessibility. Data from the ICOM study show that the ACC reflects characteristics of reading performance in everyday life and is sensitive to improved reading accessibility for pseudophakic eyes.

IURead: a new computer-based reading test

PURPOSE

To develop a computer-based single sentence reading test especially designed for clinical research enabling multiple repeat trials without reusing the same sentences.

METHODS

We initially developed 422 sentences, with an average of 60 characters and 12 words. Presentation controls were improved by employing computer-based testing and the oral reading was recorded by visual inspection of digital audio recordings. Variability in reading speed of normally sighted adults between sentences, between charts, between subjects, between formats, and between display devices was quantified. The impact of display size and pixel resolution on test geometry was assessed, and the impact of reduced retinal image quality and retinal illuminance were compared for reading and standard letter acuities. Eleven visually normal subjects (age: 18-60 years) participated in this study.

RESULTS

Stopwatch timing of sentences reliably underestimated reading times by about 0.3 s, and exhibited coefficients of repeatability 17 times larger than those estimated from visual inspection of digital recordings. A slight relaxing of the lexical content constraints had no effect on reading speed; neither did sentence format (single vs three lines) or display size or distance. Within subject standard deviations of reading speed for different sentences were small (between 6% and 9% of the mean speed) requiring only small samples sizes to achieve typical statistical reliability and power when comparing conditions within individual subjects. The greater variability associated with stopwatch timing necessitates larger sample sizes. As defocus and light level were varied, reading acuity and standard letter acuity were highly correlated (r(2)  = 0.99), and reading acuity was slightly better.

DISCUSSION

A computer-based IURead reading test provides a useful reading speed and reading acuity tool for clinical research involving multiple conditions and repeat testing of individual subjects. Ready to use IURead files for use with a computer, tablet or cell phone can be downloaded from our lab website (https://www.opt.indiana.edu/Bradley/Downloads.aspx).

Binocular visual function of modified pseudophakic monovision

PURPOSE

To compare binocular visual function of pseudophakic patients having modified monovision (0.75 diopter [D] anisometropia) with that of patients having conventional monovision (1.75 D anisometropia).

DESIGN

Prospective observational study.

METHODS

Eighty-two patients that underwent bilateral implantation of a monofocal intraocular lens were recruited at 3 months postoperatively. Modified monovision was simulated by adding a +0.75 D spherical lens to the nondominant eye, while conventional monovision was simulated by adding a +1.75 D spherical lens. Binocular corrected visual acuity (VA) at various distances, binocular contrast VA (contrast VA) and that with glare (glare VA), and stereoacuity were evaluated.

RESULTS

With modified monovision, mean binocular corrected intermediate VA at 1.0 m was 20/19 and near VA at 0.3 m was 20/51, and stereoacuity was 125 ± 100 seconds of arc. Mean binocular intermediate VA at 1.0 m was significantly better with modified monovision than with conventional monovision (P = .0001), while near VA and intermediate VA at 0.5 m were significantly worse (P < .0001). Mean binocular photopic and mesopic contrast VA and glare VA tended to be better with modified monovision than with conventional monovision, but the difference was not significant. Mean stereoacuity was significantly better with modified monovision than with conventional monovision (P = .0020).

CONCLUSIONS

Modified pseudophakic monovision provided excellent binocular VA from far to intermediate distances, although near VA was worse than that with conventional monovision. Contrast VA with and without glare tended to be better and stereoacuity was significantly better with modified monovision, suggesting that this method is useful for correcting presbyopia without marked impairment of binocular function.

[Uncorrected visual function after cataract surgery]

PURPOSE

To study the relationship between refraction after cataract surgery and the use of spectacles in patients older than 65 years.

METHODS

Retrospective case control study. The study included 40 retired subjects older than 65 years-old who fulfilled our inclusion criteria. Clinical ophthalmic and optical information was collected, and patients were requested to complete a validated questionnaire of visual function (VF14) and a test of independence of spectacles. The difference between VF14 test results with and without glasses (difVF14) was calculated.

RESULTS

The study included 16 men and 24 women, with a mean age of 74 years. There was a significant correlation between difVF14 and postoperative refraction, with lower difVF14 values associated with postsurgical refraction in the range -0.50 to -1.00 D (OD 0.479 [95% CI; 0.286-0.804]). The questionnaire of independency of lenses did not show significant correlation with postoperative refraction.

CONCLUSIONS

Patients with postsurgical refraction between -0.50 and -1.00 diopters displayed better visual function without glasses than those with refraction out of that range. Neutral distant refraction and positive lenses for near vision might not be the ideal solution for every patient. Postsurgical refraction should be individualized for each patient according to their personal preferences, in order to achieve the best visual function and the best vision-related quality of life.

Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions

PURPOSE

To compare changes in reading performance parameters after implantation of 4 multifocal intraocular lens (IOL) models and a monofocal IOL.

SETTING

Department of Ophthalmology, Paracelsus Medical University, Salzburg, Austria.

DESIGN

Prospective randomized controlled clinical trial.

METHODS

Patients with bilateral cataract without additional ocular pathology were scheduled for bilateral implantation of Acri.Smart 48S monofocal, Acrysof Restor SN6AD3 apodized multifocal, AT LISA 366D diffractive multifocal, Tecnis ZMA00 diffractive multifocal, or Rezoom refractive multifocal IOLs. Bilateral corrected and uncorrected reading acuity, reading distance, mean and maximum reading speeds, and smallest log-scaled print size of a Radner reading chart were evaluated under bright lighting conditions (500 lux) using the Salzburg Reading Desk. Pupil size was not measured throughout the trial. The minimum follow-up was 12 months.

RESULTS

The diffractive multifocal groups had significantly better uncorrected reading acuity and uncorrected smallest print size than the monofocal and refractive multifocal groups 1, 6, and 12 months postoperatively. The diffractive IOL groups had comparable uncorrected reading distance of approximately 32 cm, which was larger in the monofocal group (38.9 ± 8.4 cm) and refractive multifocal group (37.1 ± 7.3 cm) at the last visit. Patients with diffractive IOLs could read print sizes of approximately 0.74 to 0.87 mm, which was much better than in the monofocal and refractive multifocal groups. The diffractive AT LISA IOL provided the best reading speed values (mean and maximum, corrected and uncorrected).

CONCLUSION

Multifocal IOLs with a diffractive component provided good reading performance that was significantly better than that obtained with a refractive multifocal or monofocal IOL.

FINANCIAL DISCLOSURE

Drs. Grabner and Dexl were patent owners of the Salzburg Reading Desk technology (now owned by SRD-Vision, LLC). No other author has a financial or proprietary interest in any material or method mentioned.

Surgical management of presbyopia

Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.

Five-year clinical study of patients with pseudophakic monovision

PURPOSE

To assess the long-term clinical outcomes and acceptability of pseudophakic monovision.

SETTING

Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan.

DESIGN

Case series.

METHODS

Patients who had surgery using the monovision method with monofocal intraocular lenses had routine postoperative examinations. Assessed were visual acuity, near stereopsis, ocular deviation, patient satisfaction, and the rate of spectacle dependence preoperatively and 1, 3, and 6 months and 1, 2, 3, 4, and 5 years postoperatively.

RESULTS

The study enrolled 54 patients with a mean age of 74.7 years ± 7.9 (SD). The mean difference in the spherical equivalent refractive error between eyes of each patient was 2.13 diopters. The binocular uncorrected distance visual acuity was at least 0.10 logMAR in 98% of patients, with 76% achieving Jaeger 2 or better binocular uncorrected near visual acuity. Near stereopsis in patients who shifted from exophoria to intermittent exotropia decreased, although no serious problems were observed. The rate of spectacle dependence was 88% preoperatively, 41% at 1 year, and 22% at 5 years. Patient satisfaction improved gradually during the follow-up.

CONCLUSION

Pseudophakic monovision was an effective approach for correcting presbyopia throughout the 5-year observation period; however, a longer follow-up, including further studies is necessary to allow selection of appropriate patients.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Intentional extreme anisometropic pseudophakic monovision: new approach to the cataract patient with longstanding diplopia

PURPOSE

To determine whether extreme pseudophakic monovision can reduce or eliminate diplopia in patients with cataract and longstanding acquired strabismus.

SETTING

Department of Ophthalmology, University of Cincinnati, and the Cincinnati Eye Institute, Cincinnati, Ohio, USA.

DESIGN

Case series.

METHODS

Intentional extreme monovision was created in patients with stable diplopia having cataract surgery. Intraocular lens selection was targeted for emmetropia in 1 eye and at least 3.0 diopters of myopia in the fellow eye.

RESULTS

Twelve patients with stable diplopia attained excellent uncorrected distance and near vision with a marked reduction in or elimination of double vision.

CONCLUSION

Patients with stable acquired strabismus with diplopia may be candidates for extreme pseudophakic monovision, which may be a new strategy to eliminate double vision.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Pseudophakic monovision using monofocal and multifocal intraocular lenses: hybrid monovision

PURPOSE

To evaluate the visual function after bilateral cataract surgery performed with a new technique (hybrid monovision) that uses a monofocal intraocular lens (IOL) and a diffractive multifocal IOL.

SETTING

Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan.

DESIGN

Case series.

METHODS

Hybrid monovision was achieved by implanting a monofocal IOL (AQ310Ai) in the dominant eye and a diffractive multifocal IOL (Tecnis ZM900) in the nondominant contralateral eye. The target refraction was emmetropia in both eyes. Visual acuity at various distances, contrast sensitivity, near stereopsis, reading ability, and the degree of patient satisfaction were measured.

RESULTS

The study enrolled 32 patients with a mean age of 61.2 years ± 14.7 (SD). At all distances, the mean binocular visual acuity was better than 0.1 logMAR. Binocular contrast sensitivity was better than monocular vision in the eye with the diffractive multifocal IOL. Near stereopsis within normal range was maintained in 62.5% of patients. Of the patients, 18.8% reported spectacle dependence. With binocular vision, no patients reported waxy vision (ie, as though they were looking through water).

CONCLUSION

Hybrid monovision may be an effective approach for managing loss of accommodation after cataract surgery and may be the method of choice in cases of waxy vision caused by bilateral multifocal IOL implantation.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Pseudophakic monovision is an important surgical approach to being spectacle-free

There are few studies on pseudophakic monovision even though it is widely applied. We reviewed the published literature on pseudophakic monovision. Surgeons select patients who not only have a strong desire to be free of glasses after surgery, but also fully understand monovision design and its drawbacks. However, other criteria adopted for pseudophakic monovision are very different. Both traditional monovision and cross monovision are used in pseudophakic monovision, and the target binocular anisometropia ranges from -1.0 D to -2.75 D. Postoperative results were acceptable in every study and most patients were satisfied, with vision being improved and presbyopia corrected. Complications were decreased stereopsis, contrast sensitivity, and visual fields, similar to other types of monovision. The term "pseudophakic monovision" should include more than just monocular intraocular lens implantation in two eyes, and further studies are required.

Visual function and spectacle independence after cataract surgery: bilateral diffractive multifocal intraocular lenses versus monovision pseudophakia

PURPOSE

To evaluate and compare patient-reported visual function, spectacle independence, and quality of life before and after cataract surgery with bilateral diffractive multifocal or monofocal intraocular lens (IOL) implantation.

SETTING

Department of Ophthalmology, Henry Ford Health System, Taylor Branch, Detroit, Michigan, USA.

DESIGN

Prospective cohort study.

METHODS

This study evaluated consecutive cataract patients having bilateral implantation of Acrysof Restor SN60D3 multifocal IOLs or monofocal Acrysof SN60WF IOLs, the latter as monovision, between July 2007 and June 2009. Parameters analyzed 3 months postoperatively included binocular uncorrected distance, intermediate, and near visual acuities; stereo vision; spectacle independence; subjective visual symptoms; and patient satisfaction. Preoperative and postoperative quality of life was assessed with the National Eye Institute Visual Function Questionnaire-25(NEI VFQ-25).

RESULTS

The multifocal group comprised 21 patients and the monovision group, 22 patients. Binocular uncorrected visual acuity at distance and near at 3 months was significantly better than preoperatively in both groups. In both groups, there was an improvement in all ocular and visual-related NEI VFQ-25 responses postoperatively.

CONCLUSION

Bilateral multifocal IOLs and conventional monofocal IOL pseudophakic monovision significantly improved spectacle independence and visual quality-of-life measures.

Reading acuity in albinism: evaluation with MNREAD charts

INTRODUCTION

The MNREAD reading acuity (RA) charts use continuous-text reading to measure (1) RA, ie, the smallest size of print that the patient can resolve; (2) maximum reading speed (MRS); and (3) critical print size (CPS), ie, the smallest print that the patient can read with maximum speed. This project used the MNREAD charts to evaluate reading performance in children and adults with albinism to determine the smallest print size recommended to facilitate effortless reading.

METHODS

A total of 63 subjects with albinism were administered the MNREAD test to determine the critical print size for effortless reading. The subjects read continuous, high-contrast text print until they could no longer discern the words. The MRS and CPS were determined with the MNREAD protocol. Presence or absence of nystagmus and strabismus was recorded. Distance visual acuity was measured with ETDRS charts.

RESULTS

The sample included 25 male and 38 female subjects with a median age of 16 years. Median MRS was 150 words per minute. The mean CPS was 0.84 logMAR, notably larger than the mean RA of 0.53 logMAR.

CONCLUSIONS

The MNREAD acuity charts can be used to determine functional reading ability and critical print size for effortless reading in individuals with albinism. The amount of enlargement in print size can be used in educational and vocational recommendations to facilitate reading.