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Mateos-Olivares M, Pastor-Idoate S, Martín-Vallejo J, García-Vazquez C, Pastor JC, Usategui-Martín R, Sobas EM. Stress and sleep deprivation-related biomarkers in saliva in patients with retinitis pigmentosa. PLoS One 2024; 19:e0304261. [PMID: 38870197 PMCID: PMC11175419 DOI: 10.1371/journal.pone.0304261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE Patients with Retinitis Pigmentosa (RP) commonly experience sleep-related issues and are susceptible to stress. Moreover, variatiaons in their vision are often linked to anxiety, stress and drowsiness, indicating that stress and sleep deprivation lead to a decline in vision, and vision improves when both are mitigated. The objective of this study was to investigate the utility of salivary biomarkers as biochemical indicators of anxiety and sleep deprivation in RP patients. METHODS Seventy-eight RP patients and 34 healthy controls were included in this observational study. Anxiety and sleep-quality questionnaires, a complete ophthalmological exam for severity grading and, the collection of salivary samples from participants were assessed for participants. The activity of biomarkers was estimated by ELISA, and statistical analysis was performed to determine associations between the parameters. Associations between underlying psychological factors, grade of disease severity, and biomarkers activity were also examined. RESULTS Fifty-two (67%) of patients had a severe RP, and 26 (33%) had a mild-moderate grade. Fifty-eight (58,9%) patients reported severe levels of anxiety and 18 (23.,1%) a high level. Forty-six (59%) patients obtained pathological values in sleep-quality questionaries and 43 (55.1%) in sleepiness. Patients with RP exhibited significant differences in testosterone, cortisol, sTNFαRII, sIgA and melatonin as compared to controls and patients with a mild-moderate and advanced stage of disease showed greater differences. In covariate analysis, patients with a severe anxiety level also showed greater differences in mean salivary cortisol, sTNFαRII and melatonin and male patients showed lower IgA levels than female. CONCLUSIONS The present findings suggest that salivary biomarkers could be suitable non-invasive biochemical markers for the objective assessment of sleep deprivation and anxiety in RP patients. Further research is needed to characterize the effects of untreated negative psychological states and sleep deprivation on increased variability of vision and disease progression, if any.
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Affiliation(s)
- Milagros Mateos-Olivares
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
| | - Salvador Pastor-Idoate
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results (RICORS), Carlos III Health Institute, Madrid, Spain
| | - Javier Martín-Vallejo
- Department of Statistics, Institute of Biomedical Research of Salamanca (IBSAL), University of Salamanca, Salamanca, Spain
| | | | - José Carlos Pastor
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results (RICORS), Carlos III Health Institute, Madrid, Spain
| | - Ricardo Usategui-Martín
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results (RICORS), Carlos III Health Institute, Madrid, Spain
- Faculty of Medicine, Department of Cell Biology, Genetics, Histology and Pharmacology, University of Valladolid, Valladolid, Spain
| | - Eva María Sobas
- Institute of Applied Ophthalmobiology (IOBA), University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results (RICORS), Carlos III Health Institute, Madrid, Spain
- Faculty of Nursing, University of Valladolid, Valladolid, Spain
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Lei Q, Gage R, Kersten D, Legge GE. The effect of illumination on the visibility of steps and ramps for people with low vision. Optom Vis Sci 2024; 101:399-407. [PMID: 38990238 DOI: 10.1097/opx.0000000000002146] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
SIGNIFICANCE Poor visibility of indoor features such as steps and ramps can pose mobility hazards for people with low vision. For purposes of architectural design, it is important to understand how design parameters such as the illumination level of an indoor space affect the visibility of steps and ramps. PURPOSE This study was aimed to examine the effect of typical variation in photopic illumination level in an indoor space on the visibility of steps and ramps for individuals with low vision. METHODS Steps and ramps were constructed in a large windowless room illuminated by overhead lights. Subjects with low vision completed a 5-alternative forced choice task to recognize the targets at three levels of photopic illumination, i.e., 800, 80, and 8 lux, and gave confidence ratings about their judgments on a 5-point scale. Acuities and contrast sensitivities of the subjects were also measured at each illumination level. For comparison, a group of normally sighted subjects with simulated acuity reduction also completed the step-and-ramp recognition task. RESULTS For both groups of subjects, recognition accuracy was not affected by illumination level. For subjects with low vision, however, there was a significant effect of illumination level on confidence rating: subjects became more confident about their judgments with increasing illumination. There was also a weak effect of illumination level on acuity and contrast sensitivity, both worsening with decreasing illumination. Recognition performance was best predicted by contrast sensitivity, whereas confidence was best predicted by visual acuity. CONCLUSIONS Illumination variation over a typical photopic range in an indoor space had minimal effect on the objective visibility of steps and ramps for people with low vision. However, illumination level affected subjects' confidence in hazard recognition. Design decisions on parameters such as illumination should consider the consequences on both the objective and the subjective accessibility of a space.
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Affiliation(s)
| | - Rachel Gage
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Daniel Kersten
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
| | - Gordon E Legge
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Cheung R, Ly A, Wang H, Kalloniatis M, Nivison-Smith L. Evaluating the clinical relevance and reliability of outer retinal band length on optical coherence tomography in retinal disease: a cross-sectional study. BMJ Open 2023; 13:e077874. [PMID: 38086596 PMCID: PMC10729289 DOI: 10.1136/bmjopen-2023-077874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES Hyper-reflective outer retinal band (HORB) disruptions are reported across a range of retinal disease, yet a reliable, easily implemented assessment method and thorough evaluation of their association to retinal disease is lacking. The purpose of the study was to assess the reliability of using magnitude estimation to evaluate HORB length and determine its association to visual acuity and retinal disease. DESIGN Cross-sectional, retrospective study. SETTING Patients attending a secondary eye care clinic in Sydney, Australia. PARTICIPANTS 2039 unique consecutive patients were screened for inclusion between 2 November and 18 January 2021, and 600 were included in the study population. Patients were included if they were referred from primary care, presented for an initial, comprehensive eye examination during the study period, imaged with optical coherence tomography during their visit and over 18 years of age. PRIMARY OUTCOME Reliability of HORB length estimations and associations to clinical outcomes. RESULTS Intragrader (intraclass correlation coefficient, ICCfovea=0.81; ICCworst=0.91) and intergrader (ICCfovea=0.78-0.79; ICCworst=0.75-0.88) agreement of HORB length was good to excellent. HORB length was significantly associated with age (p<0.001, β=-0.22 to -0.24) and refractive error (p<0.001, β=0.12-0.16) at all B-scan locations. Visual acuity (p=0.001, β=-0.13) was associated with the primary outcome for foveal B-scans and eccentricity (p=0.002, β=-0.13) and device type (p=0.002, β=0.13) for non-foveal B-scans. Glaucoma was associated with HORB length on univariate analysis (p=0.05-0.06, β=-0.08); however, multivariate analysis revealed no significant association between HORB length and retinal disease. CONCLUSION HORB length is reliably assessed using magnitude estimation and may be useful as a surrogate biomarker of visual acuity. Several factors affect HORB length estimations, which may contribute to the lack of association to retinal disease and highlights the need for covariable adjustment when examining HORB disruptions.
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Affiliation(s)
- Rene Cheung
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Angelica Ly
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Deakin University, Waurn Ponds, Victoria, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
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Zhao Y, Lesmes LA, Dorr M, Lu ZL. Collective endpoint of visual acuity and contrast sensitivity function from hierarchical Bayesian joint modeling. J Vis 2023; 23:13. [PMID: 37378989 DOI: 10.1167/jov.23.6.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Clinical trials typically analyze multiple endpoints for signals of efficacy. To improve signal detection for treatment effects using the high-dimensional data collected in trials, we developed a hierarchical Bayesian joint model (HBJM) to compute a five-dimensional collective endpoint (CE5D) of contrast sensitivity function (CSF) and visual acuity (VA). The HBJM analyzes row-by-row CSF and VA data across multiple conditions, and describes visual functions across a hierarchy of population, individuals, and tests. It generates joint posterior distributions of CE5D that combines CSF (peak gain, peak frequency, and bandwidth) and VA (threshold and range) parameters. The HBJM was applied to an existing dataset of 14 eyes, each tested with the quantitative VA and quantitative CSF procedures in four Bangerter foil conditions. The HBJM recovered strong correlations among CE5D components at all levels. With 15 qVA and 25 qCSF rows, it reduced the variance of the estimated components by 72% on average. Combining signals from VA and CSF and reducing noises, CE5D exhibited significantly higher sensitivity and accuracy in discriminating performance differences between foil conditions at both the group and test levels than the original tests. The HBJM extracts valuable information about covariance of CSF and VA parameters, improves precision of the estimated parameters, and increases the statistical power in detecting vision changes. By combining signals and reducing noise from multiple tests for detecting vision changes, the HBJM framework exhibits potential to increase statistical power for combining multi-modality data in ophthalmic trials.
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Affiliation(s)
- Yukai Zhao
- Center for Neural Science, New York University, New York, NY, USA
| | | | - Michael Dorr
- Adaptive Sensory Technology Inc., San Diego, CA, USA
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, USA
- NYU-ECNU Institute of Brain and Cognitive Neuroscience, Shanghai, China
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Toutounchian S, Ahmadbeigi N, Mansouri V. Retinal and Choroidal Neovascularization Antivascular Endothelial Growth Factor Treatments: The Role of Gene Therapy. J Ocul Pharmacol Ther 2022; 38:529-548. [PMID: 36125411 DOI: 10.1089/jop.2022.0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Neovascularization in ocular vessels causes a major disease burden. The most common causes of choroidal neovascularization (CNV) are age-related macular degeneration and diabetic retinopathy, which are the leading causes of irreversible vision loss in the adult population. Vascular endothelial growth factor (VEGF) is critical for the formation of new vessels and is the main regulator in ocular angiogenesis and vascular permeability through its receptors. Laser therapy and antiangiogenic factors have been used for CNV treatment. Bevacizumab, ranibizumab, and aflibercept are commonly used anti-VEGF agents; however, high costs and the need for frequent intraocular injections are major drawbacks of anti-VEGF drugs. Gene therapy, given the potency of one-time treatment and no need for frequent injections offers the real possibility of such a lasting treatment, with fewer adverse effects and higher patient quality of life. Herein, we reviewed the role of gene therapy in the CNV treatment. In addition, we discuss the advantages and challenges of current treatments compared with gene therapy.
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Affiliation(s)
- Samaneh Toutounchian
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Naser Ahmadbeigi
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Mansouri
- Gene Therapy Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Dunbar HMP, Behning C, Abdirahman A, Higgins BE, Binns AM, Terheyden JH, Zakaria N, Poor S, Finger RP, Leal S, Holz FG, Schmid M, Crabb DP, Rubin GS, Luhmann UFO. Repeatability and Discriminatory Power of Chart-Based Visual Function Tests in Individuals With Age-Related Macular Degeneration: A MACUSTAR Study Report. JAMA Ophthalmol 2022; 140:780-789. [PMID: 35737401 PMCID: PMC9227684 DOI: 10.1001/jamaophthalmol.2022.2113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Question Under multicenter, multiexaminer conditions, do simple chart-based assessments of visual function (VF) have sufficient repeatability and discrimination in people with age-related macular degeneration (AMD) to be considered as measures for future clinical trial end points? Findings In this cross-sectional study including 245 people with AMD and 56 healthy, age-similar control individuals, best-corrected visual acuity, low-luminance visual acuity, Moorfields Acuity Test, contrast sensitivity, and International Reading Speed Test had adequate repeatability but limited power to discriminate between no AMD and intermediate AMD (iAMD). Meaning The findings suggest that the chart-based tests included in this study perform sufficiently well to be considered as potential measures for clinical trial end points; their prognostic power to predict conversion from iAMD to late AMD needs to be examined with longitudinal data. Importance There is a need for validated clinical end points that are reliably able to quantify potential therapeutic effects of future treatments targeting age-related macular degeneration (AMD) before the onset of serious visual impairment. Objective To assess the reliability and discriminatory power of 5 simple chart-based visual function (VF) tests as potential measures for clinical trial end points with regulatory and patient-access intention in intermediate AMD (iAMD). Design, Setting, and Participants This international noninterventional study took place at 18 tertiary ophthalmology departments across Europe. Participants were recruited between April 2018 and March 2020 and were identified during routine clinical review. Participants with no AMD and early AMD were recruited from hospital staff, friends, and family of participants with AMD and via referrals from community ophthalmologists and optometrists. The repeatability and discriminatory power of 5 simple chart-based assessments of VF (best-corrected visual acuity [BCVA], low-luminance visual acuity [LLVA], Moorfields Acuity Test [MAT], Pelli-Robson Contrast Sensitivity [CS], and International Reading Speed Test [IReST]) were assessed in a repeated-measures design. VF assessments were performed on day 0 and day 14. Participants with early AMD, iAMD, late AMD, and no AMD were recruited. Main Outcomes and Measures Intraclass correlation coefficients (ICCs) and Bland-Altman 95% limits of agreement (LoA) were computed to assess repeatability. Area under the receiver operating characteristic curves (AUCs) determined the discriminatory ability of all measures to classify individuals as having no AMD or iAMD and to differentiate iAMD from its neighboring disease states. Results A total of 301 participants (mean [SD] age, 71 [7] years; 187 female participants [62.1%]) were included in the study. Thirty-four participants (11.3%) had early AMD, 168 (55.8%) had iAMD, 43 (14.3%) had late AMD, and 56 (18.6%) had no AMD. ICCs for all VF measures ranged between 0.88 and 0.96 when all participants were considered, indicating good to excellent repeatability. All measures displayed excellent discrimination between iAMD and late AMD (AUC, 0.92-0.99). Early AMD was indistinguishable from iAMD on all measures (AUC, 0.54-0.64). CS afforded the best discrimination between no AMD and iAMD (AUC, 0.77). Under the same conditions, BCVA, LLVA, and MAT were fair discriminators (AUC, 0.69-0.71), and IReST had poor discrimination (AUC, 0.57-0.61). Conclusions and Relevance BCVA, LLVA, MAT, CS, and IReST had adequate repeatability in this multicenter, multiexaminer setting but limited power to discriminate between no AMD and iAMD. The prognostic power of these variables to predict conversion from iAMD to late AMD is being examined in the ongoing longitudinal part of the MACUSTAR study.
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Affiliation(s)
- Hannah M P Dunbar
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom.,Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Charlotte Behning
- Medical Faculty, Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Amina Abdirahman
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom
| | - Bethany E Higgins
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Alison M Binns
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Jan H Terheyden
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Nadia Zakaria
- Translational Medicine, Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Stephen Poor
- Ophthalmology Research, Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Medical Faculty, Institute of Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - David P Crabb
- Department of Optometry and Visual Sciences, School of Health Sciences, City, University London, London, United Kingdom
| | - Gary S Rubin
- Department of Visual Neuroscience and Function, University College London Institute of Ophthalmology, London, United Kingdom.,Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Ulrich F O Luhmann
- Roche Pharmaceutical Research and Early Development, Translational Medicine Ophthalmology, Roche Innovation Center Basel, Switzerland
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Nguyen XTA, Talib M, van Schooneveld MJ, Wijnholds J, van Genderen MM, Schalij-Delfos NE, Klaver CCW, Talsma HE, Fiocco M, Florijn RJ, Ten Brink JB, Cremers FPM, Meester-Smoor MA, van den Born LI, Hoyng CB, Thiadens AAHJ, Bergen AA, Boon CJF. CRB1-Associated Retinal Dystrophies: A Prospective Natural History Study in Anticipation of Future Clinical Trials. Am J Ophthalmol 2022; 234:37-48. [PMID: 34320374 DOI: 10.1016/j.ajo.2021.07.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the natural disease course of retinal dystrophies associated with crumbs cell polarity complex component 1 (CRB1) and identify clinical end points for future clinical trials. DESIGN Single-center, prospective case series. METHODS An investigator-initiated nationwide collaborative study that included 22 patients with CRB1-associated retinal dystrophies. Patients underwent ophthalmic assessment at baseline and 2 years after baseline. Clinical examination included best-corrected visual acuity (BCVA) using Early Treatment Diabetic Retinopathy Study charts, Goldmann kinetic perimetry (V4e isopter seeing retinal areas), microperimetry, full-field electroretinography, full-field stimulus threshold (FST), fundus photography, spectral-domain optical coherence tomography, and fundus autofluorescence imaging. RESULTS Based on genetic, clinical, and electrophysiological data, patients were diagnosed with retinitis pigmentosa (19 [86%]), cone-rod dystrophy (2 [9%]), or isolated macular dystrophy (1 [5%]). Analysis of the entire cohort at 2 years showed no significant changes in BCVA (P = .069) or V4e isopter seeing retinal areas (P = .616), although signs of clinical progression were present in individual patients. Macular sensitivity measured on microperimetry revealed a significant reduction at the 2-year follow-up (P < .001). FST responses were measurable in patients with nonrecordable electroretinograms. On average, FST responses remained stable during follow-up. CONCLUSION In CRB1-associated retinal dystrophies, visual acuity and visual field measures remain relatively stable over the course of 2 years. Microperimetry showed a significant decrease in retinal sensitivity during follow-up and may be a more sensitive progression marker. Retinal sensitivity on microperimetry may serve as a functional clinical end point in future human treatment trials for CRB1-associated retinal dystrophies.
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Affiliation(s)
- Xuan-Thanh-An Nguyen
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Mays Talib
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Mary J van Schooneveld
- Department of Ophthalmology (M.J.v.S., C.J.F.B.), Amsterdam University Medical Center (UMC), Academic Medical Center, Amsterdam, the Netherlands
| | - Jan Wijnholds
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands; The Netherlands Institute for Neuroscience (NIN-KNAW) (J.W., A.A.B.), Amsterdam, the Netherlands
| | - Maria M van Genderen
- Bartiméus Diagnostic Centre for Complex Visual Disorders (M.M.v.G., H.E.T.), Zeist, the Netherlands; Department of Ophthalmology (M.M.v.G.), University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Nicoline E Schalij-Delfos
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology (C.C.W.K., M.A.M.-S., A.A.H.J.T.); Department of Epidemiology (C.C.W.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, the Netherlands; Institute for Molecular and Clinical Ophthalmology (C.C.W.K.), Basel, Switzerland
| | - Herman E Talsma
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands; Bartiméus Diagnostic Centre for Complex Visual Disorders (M.M.v.G., H.E.T.), Zeist, the Netherlands
| | - Marta Fiocco
- Mathematical Institute (M.F.), and Department of Biomedical Data Sciences (M.F.), Leiden University Medical Center, Leiden, the Netherlands
| | - Ralph J Florijn
- Department of Clinical Genetics (R.J.F., J.B.t.B., A.A.B.), Amsterdam University Medical Center (UMC), Academic Medical Center, Amsterdam, the Netherlands
| | - Jacoline B Ten Brink
- Department of Clinical Genetics (R.J.F., J.B.t.B., A.A.B.), Amsterdam University Medical Center (UMC), Academic Medical Center, Amsterdam, the Netherlands
| | - Frans P M Cremers
- Department of Human Genetics and Donders Institute for Brain, Cognition and Behaviour (F.P.M.C.), Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Carel B Hoyng
- Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Arthur A Bergen
- The Netherlands Institute for Neuroscience (NIN-KNAW) (J.W., A.A.B.), Amsterdam, the Netherlands; Department of Clinical Genetics (R.J.F., J.B.t.B., A.A.B.), Amsterdam University Medical Center (UMC), Academic Medical Center, Amsterdam, the Netherlands
| | - Camiel J F Boon
- From the Department of Ophthalmology (X.-T.-A.N., M.T., J.W., N.E.S.-D., H.E.T., C.J.F.B.), Leiden University Medical Center, Leiden, the Netherlands; Department of Ophthalmology (M.J.v.S., C.J.F.B.), Amsterdam University Medical Center (UMC), Academic Medical Center, Amsterdam, the Netherlands.
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Britten-Jones AC, Jin R, Gocuk SA, Cichello E, O'Hare F, Hickey DG, Edwards TL, Ayton LN. The safety and efficacy of gene therapy treatment for monogenic retinal and optic nerve diseases: A systematic review. Genet Med 2021; 24:521-534. [PMID: 34906485 DOI: 10.1016/j.gim.2021.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE This study aimed to systematically review and summarize gene therapy treatment for monogenic retinal and optic nerve diseases. METHODS This review was prospectively registered (CRD42021229812). A comprehensive literature search was performed in Ovid MEDLINE, Ovid Embase, Cochrane Central, and clinical trial registries (February 2021). Clinical studies describing DNA-based gene therapy treatments for monogenic posterior ocular diseases were eligible for inclusion. Risk of bias evaluation was performed. Data synthesis was undertaken applying Synthesis Without Meta-analysis guidelines. RESULTS This study identified 47 full-text publications, 50 conference abstracts, and 54 clinical trial registry entries describing DNA-based ocular gene therapy treatments for 16 different genetic variants. Study summaries and visual representations of safety and efficacy outcomes are presented for 20 unique full-text publications in RPE65-mediated retinal dystrophies, choroideremia, Leber hereditary optic neuropathy, rod-cone dystrophy, achromatopsia, and X-linked retinoschisis. The most common adverse events were related to lid/ocular surface/cornea abnormalities in subretinal gene therapy trials and anterior uveitis in intravitreal gene therapy trials. CONCLUSION There is a high degree of variability in ocular monogenic gene therapy trials with respect to study design, statistical methodology, and reporting of safety and efficacy outcomes. This review improves the accessibility and transparency in interpreting gene therapy trials to date.
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Affiliation(s)
- Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Department of Surgery (Ophthalmology), Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
| | - Rui Jin
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Sena A Gocuk
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Department of Surgery (Ophthalmology), Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Elise Cichello
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Fleur O'Hare
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Department of Surgery (Ophthalmology), Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Doron G Hickey
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Thomas L Edwards
- Department of Surgery (Ophthalmology), Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Lauren N Ayton
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Department of Surgery (Ophthalmology), Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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Adhikari P, Carter DD, Feigl B, Zele AJ. Design and validation of a chart-based measure of the limits of spatial contrast sensitivity. Ophthalmic Physiol Opt 2021; 42:110-122. [PMID: 34755353 DOI: 10.1111/opo.12914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Current chart-based tests of spatial contrast sensitivity (SCS) with fixed or narrow frequency ranges (≤18 cycles/°) cannot characterise the limits of spatial contrast vision. Here we present the design and validation of a chart-based measure of the spatial contrast envelope. METHODS Following the principles of the standard visual acuity (Bailey-Lovie) and contrast sensitivity (Pelli-Robson) charts, a combined spatial-contrast and visual acuity chart was designed using a language-independent triangular symbol for a four-alternative forced-choice procedure plus chart rotation. Symbol frequencies ranged between 0.38 and 60 cycles/° spaced along 10 radial axes (0.55%-100% contrast). The chart was validated with reference to the Bailey-Lovie and Pelli-Robson charts; its reliability and sensitivity to changes in illumination, simulated cataract and blur was evaluated in healthy adults. RESULTS The photopic SCS function could be measured in 5.5 ± 0.5 min; thresholding around the spatial contrast resolution limit reduced completion times to ~2 min. There was good agreement with high-contrast visual acuity (difference = 0.08 ± 0.02 logMAR) and contrast-sensitivity at 1.5 cycles/° (0.13 ± 0.06 logCS). Test-retest reliability was excellent at all spatial frequencies (ICC = 0.99). Mesopic illumination or simulated cataract caused a generalised SCS loss; myopic blur reduced high-frequency sensitivity. Spatial contrast sensitivity was independent of radial axis orientation (cardinal or oblique). CONCLUSIONS The chart provides a time-efficient, reliable and inexpensive measure of SCS with applications in research and clinic for detecting subtle deficits in early stages of ocular and neurological conditions that often manifest at higher frequencies. It is sensitive to vision changes occurring in dim lighting and with simulated cataract and blur. The chart is available open-access for self-printing; contrast variation in print can be controlled through user calibration and/or establishing normative SCS functions using the theoretical values.
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Affiliation(s)
- Prakash Adhikari
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Drew D Carter
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,Queensland Eye Institute, Brisbane, Queensland, Australia
| | - Andrew J Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.,School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
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10
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Ridder WH, Comer G, Oquindo C, Yoshinaga P, Engles M, Burke J. Contrast Sensitivity in Early to Intermediate Age-Related Macular Degeneration (AMD). Curr Eye Res 2021; 47:287-296. [PMID: 34412522 DOI: 10.1080/02713683.2021.1966478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Previous studies indicated that advanced age-related macular degeneration (AMD) affects contrast sensitivity (CS) in humans. The CS results for early/intermediate AMD patients are contradictory. The purpose of this study was to determine if CS testing discriminates early/intermediate AMD patients with normal acuity from normal patients. METHODS Forty-nine subjects (25 control and 24 early/intermediate AMD patients) were chosen for this project. The age (p = .16) and acuity (p = .34) was not significantly different between the groups. The average simplified AREDS AMD grade for the AMD patients was 2.75 ± 1.03. Three CS functions employing a descending method of limits were measured at the fovea (1. stationary stimulus and, 2. 16 Hz counter-phase stimulus under photopic conditions and 3. the stationary stimulus viewed through a 2 log unit neutral density filter (mesopic condition, background luminance of 1 cd/m2)) and at 4 deg right or left of the fovea with a horizontally oriented sine wave grating (5 deg diameter) viewed on a VPixx monitor (luminance of 100 cd/m2). RESULTS The early AMD patients were no different from the control patients for any test condition. The intermediate AMD patients were significantly different from the control patients for the mesopic CS function (p = .05). Post-hoc 2-sample t-tests for the intermediate AMD patients were significantly different from the control patients under the stationary photopic and mesopic conditions for the 1.5 cycle per degree stimulus. CONCLUSIONS Group differences in CS were only found in intermediate AMD patients. The loss in CS increased for the intermediate AMD patients under low light levels. Thus, CS may not be the optimal test to discriminate early AMD from control patients so other tests measured under dark adapted conditions should be investigated.
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Affiliation(s)
- William H Ridder
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - George Comer
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Caren Oquindo
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Pat Yoshinaga
- Southern California College of Optometry, Marshall B. Ketchum University, Fullerton, California, USA
| | - Michael Engles
- Biological Research, AbbVie, Inc, Irvine, California, USA
| | - James Burke
- Biological Research, AbbVie, Inc, Irvine, California, USA
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11
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Xiong YZ, Lei Q, Calabrèse A, Legge GE. Simulating Visibility and Reading Performance in Low Vision. Front Neurosci 2021; 15:671121. [PMID: 34290578 PMCID: PMC8287255 DOI: 10.3389/fnins.2021.671121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Low 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. METHODS Low-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. RESULTS When 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. CONCLUSION A 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.
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Affiliation(s)
- Ying-Zi Xiong
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
| | - Quan Lei
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
- Department of Psychology, Wichita State University, Wichita, KS, United States
| | | | - Gordon E. Legge
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States
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12
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Brussee T, Alagahgi B, Nispen RMA, Rens GHMB. Measurement properties of reading tests in subjects with maculopathy. Acta Ophthalmol 2021; 99:275-287. [PMID: 32833321 DOI: 10.1111/aos.14574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/02/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants. METHODS In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined. RESULTS Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12). CONCLUSION This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended.
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Affiliation(s)
- Tamara Brussee
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Ophthalmology Elkerliek Hospital Helmond The Netherlands
| | - Basel Alagahgi
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ruth M. A. Nispen
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Ger H. M. B. Rens
- Ophthalmology Amsterdam Public Health Research Institute Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
- Ophthalmology Elkerliek Hospital Helmond The Netherlands
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13
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Bailie M, Wolffsohn JS, Stevenson M, Jackson AJ. Functional and perceived benefits of wearing coloured filters by patients with age‐related macular degeneration. Clin Exp Optom 2021; 96:450-4. [DOI: 10.1111/cxo.12031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maura Bailie
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland,
| | - James Stuart Wolffsohn
- School of Life and Health Sciences, Ophthalmic Research Group, Aston University, Birmingham, United Kingdom,
| | - Michael Stevenson
- Centre for Public Health, Queens University, Belfast, Northern Ireland,
| | - A Jonathan Jackson
- National Vision Research Institute, Australian College of Optometry, Carlton, Australia,
- Department of Ophthalmology, Royal Victoria Hospital/Queens University, Belfast, Northern Ireland,
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14
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O'Hare F, Edwards TL, Hu ML, Hickey DG, Zhang AC, Wang JH, Liu Z, Ayton LN. An optometrist's guide to the top candidate inherited retinal diseases for gene therapy. Clin Exp Optom 2021; 104:431-443. [PMID: 33689629 DOI: 10.1080/08164622.2021.1878851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This review presents the phenotypic and genotypic profiles of a select group of inherited retinal diseases (IRDs) that are currently the focus of retinal gene therapy trials globally. Research progress in IRD treatment trials may soon lead to their availability in Australia and New Zealand, as either approved treatment or a clinical trial. The salient clinical characteristics of retinitis pigmentosa-the largest IRD category-are highlighted, with specific reference to RPE65-associated Leber congenital amaurosis, followed by other specific IRDs, namely choroideremia and ABCA4-associated Stargardt disease. These IRDs are selected based on their candidacy for gene therapy. Guidance on the clinical diagnostic tests that support each of these diagnoses will be presented. More broadly, the most useful structure and function measures to monitor IRD progression is discussed, along with the key assessments that offer differential diagnostic insight. This review is intended to be a clinical guide for optometrists, to assist in assessment and management of individuals who may be eligible for current and future gene therapies. A companion article in this issue will provide an overview of the basic principles of gene therapy and its development as a new treatment for inherited retinal diseases.
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Affiliation(s)
- Fleur O'Hare
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Thomas L Edwards
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Monica L Hu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Doron G Hickey
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia
| | - Alexis C Zhang
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
| | - Jiang-Hui Wang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Zhengyang Liu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Lauren N Ayton
- Department of Surgery (Ophthalmology), The University of Melbourne, Melbourne, Australia.,Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Australia
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15
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Randomized Controlled Trial of a Spectacle Lens for Macular Degeneration. Optom Vis Sci 2020; 97:889-897. [PMID: 33055515 DOI: 10.1097/opx.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
SIGNIFICANCE E-Scoop, a spectacle lens, provides no clinically relevant improvements on quality of life, visual acuity, and contrast sensitivity for patients with AMD. Because patients' burden is high and therapeutic options are scarce, the incentive to develop effective vision rehabilitation interventions remains. PURPOSE Patients with AMD experience low quality of life due to vision loss, despite angiogenesis inhibitor interventions that slow down progression for some patients. E-Scoop, which includes low-power prisms, 6% magnification, yellow tint, and antireflection coating, might aid in daily activities by improving distance viewing. Separately, these features have little proven effectiveness. E-Scoop has not been formally tested. This study aimed to determine the impact of E-Scoop on quality of life and the effect on visual acuity and contrast sensitivity. METHODS In this randomized controlled, open-label trial, 190 of 226 eligible patients were included. The primary outcome was quality of life measured with the 25-item National Eye Institute Visual Function Questionnaire. Secondary outcomes were visual acuity and contrast sensitivity. The follow-up for quality of life was after 6 weeks for controls and after 3 weeks of use for E-Scoop wearers. The visual measures were repeated after 6 weeks, with optimal refractive correction, with and without E-Scoop. RESULTS Randomization resulted in 99 E-Scoop and 86 control group patients for intention-to-treat analysis. No differential change was found between the E-Scoop and control groups on the 25-item National Eye Institute Visual Function Questionnaire using Rasch analysis (Cohen d = -0.07, P = .53). Statistically significant but small effects were found in favor of E-Scoop on binocular visual acuity (mean difference, 0.05 logMAR [2.5 letters, P < .001]) and contrast sensitivity (mean difference, 0.10 logCS [2 letters, P < .001]). CONCLUSIONS No effect of E-Scoop on quality of life was found. E-Scoop showed effects that were statistically significant, although not clinically meaningful and within typical variability, on visual measures.
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16
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Mayer DL, Taylor CP, Kran BS. A New Contrast Sensitivity Test for Pediatric Patients: Feasibility and Inter-Examiner Reliability in Ocular Disorders and Cerebral Visual Impairment. Transl Vis Sci Technol 2020; 9:30. [PMID: 32879786 PMCID: PMC7442875 DOI: 10.1167/tvst.9.9.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 05/12/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Assess feasibility and interexaminer reliability of a new test of contrast sensitivity (CS) for pediatric populations. Methods The Double Happy (DH) measures CS using a method similar to the Teller Acuity Cards. The schematic DH face is 16 degrees in diameter with features of 0.3 c/d and a channel frequency of 0.8 c/d. DH log10 CS is in 0.15 log unit steps, 0.05 to 2.1. Participants were 43 unselected patients, ages 2 to 18 years: 23 were diagnosed with ocular disorders only; 20 were diagnosed with cerebral visual impairment (CVI). Two examiners measured DH log10 CS. Visual acuity (VA) was also measured. Results All 43 participants were tested for binocular DH log10CS. Cohen's kappa values for interexaminer reliability were fair. The between examiner ICC was +0.92 (P < 0.001). The mean difference between examiners was near zero, and the 95% CI was −0.44 to 0.45 log10CS. DH log10CS was near normal in the ocular disorder group and reduced in the CVI group. VA was reduced in both groups. DH log10 CS and VA were correlated (r = −0.65). DH log10 CS was a marginally better predictor of diagnosis than VA. Conclusions DH log10CS test was successful in a diverse pediatric population diagnosed with ocular disorders or CVI. Interexaminer reliability was comparable to that of adults tested previously using the same stimuli and methods. Both CS and VA are reduced in CVI. Translational Relevance CS and VA both should be tested in pediatric clinical populations, especially in those at risk of CVI.
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Affiliation(s)
- D Luisa Mayer
- New England College of Optometry, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Boston, MA, USA
| | | | - Barry S Kran
- New England College of Optometry, Boston, MA, USA
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17
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Guo X, Swenor BK, Goldstein JE. Association of Visual Acuity Improvement With Uncorrected Refractive Error in Patients New to Low Vision Clinics. JAMA Ophthalmol 2020; 138:765-771. [PMID: 32437505 DOI: 10.1001/jamaophthalmol.2020.1677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is substantial socioeconomic and individual burden from uncorrected refractive error (URE) and chronic ocular disease. Understanding the association of visual acuity (VA) reduction with URE and the adults most likely to benefit from refraction may help support clinical decision-making in ophthalmologic care and maximize patient outcomes. Objectives To assess the magnitude of VA improvement associated with URE among adults under ophthalmic care who obtain low vision rehabilitation (LVR) services and identify the characteristics of the patients who are most likely to experience improvement. Design, Setting, and Participants This retrospective case series assessed patients 20 years or older who were new to the LVR clinics from August 1, 2013, to December 31, 2015, and who had habitual VA between 20/40 and counting fingers (not including) and underwent refraction. Data analysis was performed from April 4, 2018, to December 20, 2019. Exposures Patient demographics and clinical data, including habitual and refraction VA, refraction, and disease diagnosis. Habitual VA was categorized as mild (VA worse than 20/40 and at least 20/60), moderate (VA worse than 20/60 and better than 20/200), severe (VA 20/200 or worse and better than 20/500), and profound (VA 20/500 or worse) vision impairment (VI). Main Outcomes and Measures At least 2-line VA improvement and any VA improvement (≥1-line) by refraction. Results Among the 2923 patients new to LVR clinics, 1773 (mean [SD] age, 70 [18.2] years; 1069 [60.3%] female) were included in these analyses. The mean habitual VA was 20/100 (mean [SD], 0.67 [0.36] logMAR). At least 2-line improvement was observed in 493 patients (27.8%), and any VA improvement was seen in 1023 patients (57.7%). At least 2-line improvement was observed in 54 patients (34.8%) with corneal disorders and was more likely seen among patients aged 40 to <65 years compared with those aged 20 to <40 years (odds ratio [OR], 1.57; 95% CI, 1.02-2.41), African American patients compared with white patients (OR, 1.41; 95% CI, 1.08-1.85), or patients with moderate VI compared with mild VI (OR, 1.36; 95% CI, 1.07-1.72). Conclusions and Relevance The findings suggest that URE is prevalent among patients with ocular disease and accessing LVR and that refractive evaluation should be considered for patients with ocular disease and reduced VA, especially working-age adults aged 40 to <65 years, African American patients, and those with moderate VI.
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Affiliation(s)
- Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Judith E Goldstein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Lacy GD, Abalem MF, Popova LT, Santos EP, Yu G, Rakine HY, Rosenthal JM, Ehrlich JR, Musch DC, Jayasundera KT. Content generation for patient-reported outcome measures for retinal degeneration therapeutic trials. Ophthalmic Genet 2020; 41:315-324. [PMID: 32571121 DOI: 10.1080/13816810.2020.1776337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Generate content for a patient-reported outcome (PRO) measure for use in future clinical trials for inherited retinal degenerations. METHODS Patients at the University of Michigan Kellogg Eye Center with a clinical diagnosis of inherited retinal degeneration with varying phenotypes were recruited for interviews. First, in-depth interviews were performed to solicit a wide range of patient experiences pertaining to visual function. Coders qualitatively analyzed the transcripts from these interviews using Atlas.ti software (Version 8.1.3 (522)) to draft questionnaire items. Next, the questionnaire was tested and refined based on participant feedback in cognitive interviews and administrator feedback in the pilot survey administration (pilot interviews). RESULTS A total of 55 participants with a clinical diagnosis of inherited retinal degeneration were interviewed throughout the three study phases: in-depth interviews (n = 26), cognitive interviews (n = 16), and pilot interviews (n = 13). Coded items were analyzed for frequency of occurrence and related themes, then organized into common domains. Within each domain, PRO items were drafted to address the functional limitations or adaptations experienced by patients. CONCLUSIONS Items for a PRO measure have been drafted and evaluated for interpretability in the target inherited retinal degeneration patient population. Content validity for the items was established through a process of in-depth interviews, cognitive interviews, and pilot interviews.
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Affiliation(s)
- Gabrielle D Lacy
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA.,Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School , Sao Paulo, Brazil
| | - Lilia T Popova
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Erin P Santos
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Gina Yu
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Hanan Y Rakine
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Julie M Rosenthal
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, Michigan, USA
| | - K Thiran Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School , Ann Arbor, Michigan, USA
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19
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Xiong YZ, Kwon M, Bittner AK, Virgili G, Giacomelli G, Legge GE. Relationship Between Acuity and Contrast Sensitivity: Differences Due to Eye Disease. Invest Ophthalmol Vis Sci 2020; 61:40. [PMID: 38755787 PMCID: PMC7415312 DOI: 10.1167/iovs.61.6.40] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/10/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Visual acuity (VA) and contrast sensitivity (CS) characterize different aspects of visual function. Whereas VA is a standard test in routine eye exams and clinical trials, CS is often not included. We investigated the pathology-specific dissociation between VA and CS by quantifying and comparing the relationship between these two measures in common ocular pathologies. Methods VA and CS data were assembled from 1113 subjects, including groups with cataract (n = 450), age-related macular degeneration (AMD; n = 232), glaucoma (n = 100), retinitis pigmentosa (RP; n = 87), and normal ocular health (n = 244). VA and CS were measured by the Early Treatment Diabetic Retinopathy Study chart and Pelli-Robson chart, respectively. Results Even when VA was relatively normal (<0.3 logMAR), the four ocular pathology groups showed quantitatively different mean CS deficits relative to normal controls, ranging from -0.01 log units for cataract to 0.23 log units for RP. When the entire range of VA was considered, the corresponding deficits in CS were noticeably different across these four groups, being least for cataract and progressively more severe for glaucoma, AMD, and RP. For every 1.0 logMAR loss of VA, the corresponding deficit in CS ranged from 0.22 logCS for cataract to 0.97 logCS for RP. Conclusions The quantitative relationship between VA and CS depends on the ocular pathology. CS appears to provide valuable complementary information to VA in the early detection of eye disease and when evaluating visual impairment.
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Affiliation(s)
- Ying-Zi Xiong
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States
| | - MiYoung Kwon
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Ava K. Bittner
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, United States
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Florence, Italy
| | - Giovanni Giacomelli
- Department of Neuroscience, Psychology, Drug Research and Child's Health, University of Florence, Florence, Italy
| | - Gordon E. Legge
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States
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20
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Abstract
PURPOSE OF REVIEW Diabetic retinopathy (DR), a leading cause of visual impairment in the developed country, is characterized by vascular lesions and neuronal damage of the retina. Treatment options for this condition are currently limited. The advent of therapy targeting vascular endothelial growth factor (VEGF) demonstrated significant benefits to patients with DR. However, this treatment is limited by its short half-life and requirement for frequent invasive intravitreal injections. In addition, many patients failed to achieve clinically significant improvement in visual function. Gene therapy has the potential to provide an alternative treatment for DR with distinct advantages, such as longer therapeutic effect, less injection frequency, ability to intervene at disease onset, and potentially fewer side effects. RECENT FINDINGS Strategies for gene therapy in DR, stemming from the current understanding of the disease pathogenesis, focus on the inhibition of neovascularization and protection of neurovascular degeneration in the retina. Studies with promising results have mainly focussed on animal models due to efficacy and safety concerns, despite a number of successful preclinical studies using adeno-associated virus-mediated transduction to treat both vascular dysfunction and neuronal degeneration. With the optimization of delivery vectors, transgene regulation, and outcome measure, gene therapy will potentially become available for patients with DR. This review provides an update on the current strategies utilized in DR gene therapy research. Several barriers to the clinical application of gene therapy for DR are highlighted, and future directions for this research are proposed.
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Affiliation(s)
- Jiang-Hui Wang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Georgina Eloise Roberts
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Guei-Sheung Liu
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
- Ophthalmology, Department of Surgery, University of Melbourne, East Melbourne, Australia.
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21
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Abstract
SIGNIFICANCE Access to digital text is increasingly widespread, but its impact on low-vision reading is not well understood. PURPOSE We conducted an online survey of people with low vision to determine what assistive technologies they use for visual reading, their preferred text characteristics, and the time they devote to reading digital and hard-copy text. METHODS One hundred thirty-three low-vision participants completed an online survey. Participants reported the nature and history of their low vision, their usage of different assistive technologies, and time devoted to five visual reading activities. RESULTS The three largest diagnostic categories were albinism (n = 36), retinitis pigmentosa (n = 20), and glaucoma (n = 15). Mean self-reported acuity was 0.93 logMAR (range, 0.1 to 1.6 logMAR). Mean age was 46 years (range, 18 to 98 years). Participants reported on percentage time spent reading using vision, audio, or touch (braille). Seventy-five percent of our participants did more than 50% of their reading visually. Across five categories of reading activities-work or education, news, pleasure, spot reading, and social networking-participants reported more time spent on digital reading than hard-copy reading. Eighty-nine percent of our participants used at least one technology from each of our two major categories of assistive technologies (digital content magnifiers and hard-copy content magnifiers) for visual reading. CONCLUSIONS Despite the growing availability of digital text in audio or braille formats, our findings from an online sample of people with low vision indicate the continuing importance of visual reading. Our participants continue to use technology to access both hard-copy and digital text, but more time is devoted to digital reading. Our findings highlight the need for continued research and development of technology to enhance visual reading accessibility.
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Menghini M, Cehajic-Kapetanovic J, MacLaren RE. Monitoring progression of retinitis pigmentosa: current recommendations and recent advances. Expert Opin Orphan Drugs 2020; 8:67-78. [PMID: 32231889 PMCID: PMC7104334 DOI: 10.1080/21678707.2020.1735352] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Retinitis pigmentosa (RP) is the most common form of inherited retinal degenerations with an estimated prevalence of 1 in 4,000 and more than 1 million individuals affected worldwide. With the introduction of the first retinal gene therapy in 2017 the importance of understanding the mechanisms of retinal degeneration and its natural progression has shifted from being of academic interest to being of pivotal for the development of new therapies. AREAS COVERED This review covers standard and innovative diagnostic techniques and complementary examinations needed for the evaluation and treatment of RP. It includes chapters on the assessment of visual function, retinal morphology, and genotyping. EXPERT OPINION Monitoring the progression of RP can best be achieved by combining assessments of both visual function and morphology. Visual acuity testing using ETDRS charts should be complemented by low-luminance visual acuity and colour vision tests. Assessment of the visual field can also be useful in less advanced cases. In those with central RP involvement measuring retinal sensitivity using microperimetry is recommended. Retinal morphology is best assessed by OCT and autofluorescence. Genetic testing is pivotal as it contributes to the pathophysiological understanding and can guide clinical management as well as identify individuals that could benefit from retinal gene therapy.
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Affiliation(s)
- Moreno Menghini
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +41 79 704 52 58
| | - Jasmina Cehajic-Kapetanovic
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +44 7725 197054
| | - Robert E MacLaren
- Oxford Eye Hospital and Nuffield Department of Clinical Neurosciences, Oxford University, The John Radcliffe Hospital, West Wing, Oxford OX3 9DU, United Kingdom, +44 1865 228974
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23
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Lacy GD, Abalem MF, Musch DC, Jayasundera KT. Patient-reported outcome measures in inherited retinal degeneration gene therapy trials. Ophthalmic Genet 2020; 41:1-6. [PMID: 32100594 DOI: 10.1080/13816810.2020.1731836] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient-reported outcome (PRO) measures have the potential to uniquely capture patient experience and serve as an outcome measure in inherited retinal degeneration (IRD) gene therapy trials. An IRD-specific patient-reported outcome measure may yield valuable information that has not been obtained from inherited retinal dystrophy gene therapy trials published to-date. Existing PRO measures have inherent limitations for use in IRD gene therapy trials. Developing an applicable patient-reported outcome measure for such trials needs to incorporate patient input from the target population, demonstrate sound psychometric properties, and be made in accordance with U.S. Food and Drug Administration (FDA) guidelines. This review will discuss the currently available PRO instruments, their limitations for IRD therapeutic trials, and suggestions for future PRO development in IRD populations. The PRO instruments highlighted were identified in PubMed search of English-language journals and previously published review articles.
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Affiliation(s)
- Gabrielle D Lacy
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maria Fernanda Abalem
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Ophthalmology and Otolaryngology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kanishka T Jayasundera
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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24
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Abstract
PURPOSE To estimate the number of patients accessing eye care with low vision (LV) at a large multi-site ophthalmology institute who utilize low vision rehabilitation (LVR) services and compare their characteristics to individuals who do not utilize LVR services. METHODS This is an electronic health record-based retrospective chart analysis. Patients with LV were identified as having at least one encounter in 2014 where the best visual acuity (VA) in the better-seeing eye was worse than 20/40. Utilization of LVR services across 9 clinic locations was evaluated. Logistic regression analyses were used to examine patient characteristics associated with service utilization. RESULTS Of the 7,752 LV patients, 1,585 (20%) utilized LVR services over the 17-month period. Those utilizing LVR were more likely to have VA between 20/60 and 20/200 or between 20/200 and 20/500 than non-users (P < .001). The highest LVR utilization rates were in patients evaluated in retina (23%), glaucoma (22%), and neuro-ophthalmology (18%) subspecialties. Patients seen at clinic locations with onsite LVR services available were more likely to utilize services (odds ratio [OR] ranged from 2.69 [95% confidence interval, 95% CI: 1.63-4.44] to 4.94 [95% CI: 2.12-11.48] across location categories), as were patients who had evidence of fluctuations in VA measurements (OR = 3.33, 95% CI: 2.89-3.84). CONCLUSIONS Patients are more likely to utilize services when VA is moderately to severely impaired, VA fluctuations are present, or when LVR services are provided at the same location where other ophthalmic services are obtained. These estimates are important for developing interventions aimed at improving LVR utilization.
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Affiliation(s)
- Judith E Goldstein
- Wilmer Eye Institute, Johns Hopkins University , Baltimore, Maryland, USA
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University , Baltimore, Maryland, USA
| | - Michael V Boland
- Wilmer Eye Institute, Johns Hopkins University , Baltimore, Maryland, USA.,Division of Health Sciences Informatics, Johns Hopkins University School of Medicine , Baltimore, Maryland, USA
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University , Baltimore, Maryland, USA.,Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland, USA
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25
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Bittner AK, Ferraz MC. Reliability of Mesopic Measures of Visual Acuity and Contrast Sensitivity and Their Correlation with Rod and Cone Function in Retinitis Pigmentosa. Ophthalmic Res 2019; 63:133-140. [PMID: 31805550 PMCID: PMC10053993 DOI: 10.1159/000503931] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mesopic conditions elicit both rod and cone responses, and they are more commonly encountered in daily life than are scotopic conditions; yet visual function outcome measures of mesopic visual acuity (VA) or contrast sensitivity (CS) are rarely evaluated. OBJECTIVE In retinitis pigmentosa (RP), we explored whether visual reductions in mesopic versus photopic conditions were correlated with cone or rod function, as well as the between-visit test-retest variability in mesopic measures. METHODS At each of two visits, 22 RP subjects completed mesopic and photopic ETDRS VA and Pelli-Robson chart CS tests obtained with and without a U23 NoIR 4% transmission filter; testing of perifoveal scotopic cone or rod sensitivity with the AdaptDx; and the Rabin Cone Contrast Test (CCT). RESULTS A greater CS reduction in mesopic versus photopic conditions was significantly related to absence of scotopic rod function (p = 0.038) or longer self-reported duration of night vision loss (p = 0.044). VA reductions >0.2 logMAR in mesopic versus photopic conditions were significantly related to reduced cone-mediated scotopic sensitivity (p = 0.038). Significant predictors of the CCT ratio of S-cone to M- and L-cone sensitivity were mesopic VA (p = 0.038) and absence of AdaptDx rod function (p = 0.008). Test-retest 95% coefficients of repeatability were not significantly different when comparing between photopic and mesopic tests of VA (0.16 and 0.12 logMAR, respectively) or CS (0.21 and 0.24 logCS, respectively). CONCLUSIONS Perifoveal scotopic rod and cone function measured with the AdaptDx was significantly correlated with mesopic CS and VA, respectively, which had good, acceptable test-retest repeatability; thus, they appear to be suitable outcome measures to monitor mesopic visual function in clinical practice or trials. RP subjects with reduced mesopic VA and no perifoveal rod function had a greater loss of sensitivity for S-cones than for L-/M-cones.
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Affiliation(s)
- Ava K Bittner
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California, USA, .,College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, USA,
| | - Mariana C Ferraz
- College of Optometry, Nova Southeastern University, Fort Lauderdale, Florida, USA
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26
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Jolly JK, Juenemann K, Boagey H, Nadsady M, Bridge H, Maclaren RE. Validation of electronic visual acuity (EVA) measurement against standardised ETDRS charts in patients with visual field loss from inherited retinal degenerations. Br J Ophthalmol 2019; 104:924-931. [PMID: 31585961 DOI: 10.1136/bjophthalmol-2019-315124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/09/2019] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND With the increase in clinical trials testing therapy for retinal disease, there is a need to ensure that outcome measures are both accurate and standardised. The US Food and Drug Administration favours the use of visual acuity measured using ETDRS logMAR charts. The loss of visual field can interfere with visual tracking across the charts, leading to increased variability of measurements. Electronic visual acuity (EVA) presents the optotype on the centre of a screen, thereby removing the tracking element of the task, and may provide a more precise measurement. METHODS Visual acuity was measured twice using ETDRS charts, EVA automated single letter (E-ETDRS) and EVA single line (EVA-SL) presentation (EMMES). Patients underwent microperimetry (MAIA; Centervue) to determine visual field. We tested 65 patients with rod-cone dystrophies and 41 healthy volunteers. RESULTS Both participant groups read 2-3 letters more on average on the electronic charts compared with ETDRS. Limits of agreement using a modified Bland-Altman analysis account for replicates were wider in eyes with foveal defects (-9 to 18) compared with eyes without foveal defects (-11 to 15). Electronic charts in the presence of foveal defects reduced the range (-11 to 13). CONCLUSION EVA may provide more accurate measures of visual acuity than traditional ETDRS charts in patients when the visual field loss encroached on the central vision. Electronic presentation with a single line of letters was the favoured style reported by patients and should be considered in future interventional clinical trials.
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Affiliation(s)
- Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK .,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Kristin Juenemann
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Heather Boagey
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marie Nadsady
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Holly Bridge
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Robert E Maclaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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27
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Jolly JK, Bridge H, MacLaren RE. Outcome Measures Used in Ocular Gene Therapy Trials: A Scoping Review of Current Practice. Front Pharmacol 2019; 10:1076. [PMID: 31620003 PMCID: PMC6759794 DOI: 10.3389/fphar.2019.01076] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 08/23/2019] [Indexed: 12/14/2022] Open
Abstract
Multiple gene therapy trials are occurring for a variety of ophthalmic diseases around the world. The safety of gene therapy in the eye has been established, and the next step is to reliably assess efficacy. This is primarily done through the use of imaging techniques and visual function measures. Standardized visual function assessments, however, were originally developed for a clinical setting and may not be suitable for detecting and quantifying therapeutic changes. This scoping review takes a comprehensive look at current practice in terms of the outcome measures defined at trial registration. These were compared to the outcome measures reported in the literature. All published trials reported the pre-registered primary outcome measure. A range of additional secondary outcomes were reported that were not originally planned. Gaps in gene therapy assessment exist and further discussion are required to find a way forward, particularly as more conditions progress to phase 2 and 3 trials. Several factors impacting on trial design and outcome measure choice are discussed.
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Affiliation(s)
- Jasleen K Jolly
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Wellcome Integrative Neuroimaging Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Holly Bridge
- Wellcome Integrative Neuroimaging Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Robert E MacLaren
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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28
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A Randomized Crossover Study to Assess the Usability of Two New Vision Tests in Patients with Low Vision. Optom Vis Sci 2019; 96:443-452. [DOI: 10.1097/opx.0000000000001380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Costela FM, Saunders DR, Rose DJ, Katjezovic S, Reeves SM, Woods RL. People With Central Vision Loss Have Difficulty Watching Videos. Invest Ophthalmol Vis Sci 2019; 60:358-364. [PMID: 30682208 PMCID: PMC6354940 DOI: 10.1167/iovs.18-25540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose People with central vision loss (CVL) often report difficulties watching video. We objectively evaluated the ability to follow the story (using the information acquisition method). Methods Subjects with CVL (n = 23) or normal vision (NV, n = 60) described the content of 30-second video clips from movies and documentaries. We derived an objective information acquisition (IA) score for each response using natural-language processing. To test whether the impact of CVL was simply due to reduced resolution, another group of NV subjects (n = 15) described video clips with defocus blur that reduced visual acuity to 20/50 to 20/800. Mixed models included random effects correcting for differences between subjects and between the clips, with age, gender, cognitive status, and education as covariates. Results Compared to both NV groups, IA scores were worse for the CVL group (P < 0.001). IA reduced with worsening visual acuity (P < 0.001), and the reduction with worsening visual acuity was greater for the CVL group than the NV-defocus group (P = 0.01), which was seen as a greater discrepancy at worse levels of visual acuity. Conclusions The IA method was able to detect difficulties in following the story experienced by people with CVL. Defocus blur failed to recreate the CVL experience. IA is likely to be useful for evaluations of the effects of vision rehabilitation.
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Affiliation(s)
- Francisco M. Costela
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Daniel R. Saunders
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
| | - Dylan J. Rose
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Sidika Katjezovic
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Stephanie M. Reeves
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Russell L. Woods
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts, United States
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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30
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Bittner AK, Seger K, Salveson R, Kayser S, Morrison N, Vargas P, Mendelsohn D, Han J, Bi H, Dagnelie G, Benavente A, Ramella-Roman J. Randomized controlled trial of electro-stimulation therapies to modulate retinal blood flow and visual function in retinitis pigmentosa. Acta Ophthalmol 2018; 96:e366-e376. [PMID: 29130647 DOI: 10.1111/aos.13581] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/05/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE We examined changes in visual function and ocular and retinal blood flow (RBF) among retinitis pigmentosa (RP) participants in a randomized controlled trial of electro-stimulation therapies. METHODS Twenty-one RP participants were randomized (1:1:1) to transcorneal electrical stimulation (TES) at 6 weekly half-hour sessions, electro-acupuncture or inactive laser acupuncture (sham control) at 10 half-hour sessions over 2 weeks. Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity (VA), quick contrast sensitivity function, Goldmann visual fields, AdaptDx scotopic sensitivity, spectral flow and colour Doppler imaging of the central retinal artery (CRA), and RBF in macular capillaries were measured twice pre-treatment, after 2 TES sessions, within a week and a month after intervention completion. RESULTS We measured a significant improvement in retrobulbar CRA mean flow velocity for both the TES (p = 0.038) and electro-acupuncture groups (p = 0.001) on average after 2 weeks of treatment when compared to sham controls. Transcorneal electrical simulation (TES) and electro-acupuncture subjects had significant 55% and 34% greater increases, respectively, in RBF in the macular vessels when compared to sham controls (p < 0.001; p = 0.008) within a week of completing six TES sessions or a month after electro-acupuncture. There was a significant difference in the proportion of eyes that had improved visual function when comparing the three intervention groups (p = 0.038): four of seven TES subjects (57%), two of seven electro-acupuncture subjects (29%) and none of the seven control subjects (0%) had a significant visual improvement outside of typical test-retest variability at two consecutive post-treatment visits. CONCLUSION Increased blood flow following electro-stimulation therapies is an objective, physiological change that occurred in addition to visual function improvements in some RP patients.
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Affiliation(s)
- Ava K. Bittner
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Kenneth Seger
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Rachel Salveson
- College of Osteopathic Medicine; Nova Southeastern University; Fort Lauderdale FL USA
| | - Samantha Kayser
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | - Natalia Morrison
- Healing Blossom - Acupuncture and Holistic Medicine; Miami FL USA
| | - Patricia Vargas
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Deborah Mendelsohn
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Jorge Han
- Medical Sonography Program; College of Health Care Sciences; Nova Southeastern University; Fort Lauderdale FL USA
| | - Hua Bi
- College of Optometry; Nova Southeastern University; Fort Lauderdale FL USA
| | | | | | - Jessica Ramella-Roman
- Department of Biomedical Engineering; Florida International University; Miami FL USA
- Department of Cellular Biology and Pharmacology and Ophthalmology; Herbert Wertheim College of Medicine; Miami FL USA
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31
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Boven LC, Jiang QL, Moss HE. Validation of Simplified Visual Acuity Testing Protocols in Amyotrophic Lateral Sclerosis. Neuroophthalmology 2018; 41:247-252. [PMID: 29339958 DOI: 10.1080/01658107.2017.1305422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 12/12/2022] Open
Abstract
High- and low-contrast visual acuity (HCVA, LCVA) are potential quantitative markers of neurological dysfunction in amyotrophic lateral sclerosis (ALS). The complex nature and duration of gold standard (GS) protocols precludes widespread use in neurology settings. This study compares simplified to GS visual acuity (VA) protocols. Monocular HCVA and LCVA were measured in ALS (n = 10) and control (n = 4) subjects using six protocols, varying by two chart and three refraction methods. Intraclass correlation coefficients between simplified and GS protocols ranged from 0.83 to 0.98 (HCVA, excellent agreement) and 0.56 to 0.75 (LCVA, moderate agreement). Differences between LCVA and GS protocols exceeded test-retest reliability. Simplified HCVA protocols using LCD (liquid crystal display) tablet charts and/or pinhole correction produced valid measurements. None of the modified LCVA testing protocols produced valid measurements.
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Affiliation(s)
- Lindsay C Boven
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Qin Li Jiang
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Heather E Moss
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
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32
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Restricted Spatial Windows of Visibility in Myalgic Encephalomyelitis (ME). Vision (Basel) 2018; 2:vision2010002. [PMID: 31735866 PMCID: PMC6835387 DOI: 10.3390/vision2010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/02/2018] [Accepted: 01/11/2018] [Indexed: 01/20/2023] Open
Abstract
Myalgic encephalomyelitis (ME) is a devastating disorder marked by debilitating fatigue. It not well understood and its diagnosis is controversial. It is very important therefore that significant clinical features are investigated. Visual symptoms in ME represent a group of distinct, quantifiable, clinical features that could significantly improve diagnosis and provide insights into underlying pathology. The purpose of the present study was therefore to explore the effect of ME on spatial windows of visibility using the spatial contrast sensitivity function. Contrast sensitivity was determined for stationary luminance-defined sinusoidal gratings spanning a five-octave range of spatial frequencies (0.5 to 16 c/deg) in a group of 19 individuals with ME and a group of 19 matched (age, gender) controls. Compared to controls, the ME group exhibited a restricted spatial window of visibility for encoding stimulus contrast. This was characterised principally by a contrast sensitivity deficit at lower spatial frequencies and a narrower bandwidth. Our findings suggest that contrast sensitivity deficits may represent a visual marker of ME, and be indicative of abnormal visual processing at the level of the retina and in the cortical and subcortical visual pathways.
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33
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Anderson RS. Improving ophthalmic diagnosis in the clinic using the Moorfields Acuity Chart. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1395696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Roger S. Anderson
- Optometry and Vision Science Research Group, School of Biomedical Sciences, Ulster University at Coleraine, N. Ireland, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, UK
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Hopkins GR, Dougherty BE, Brown AM. The Ohio Contrast Cards: Visual Performance in a Pediatric Low-vision Site. Optom Vis Sci 2017; 94:946-956. [PMID: 28972542 PMCID: PMC5626115 DOI: 10.1097/opx.0000000000001119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/03/2017] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE This report describes the first clinical use of the Ohio Contrast Cards, a new test that measures the maximum spatial contrast sensitivity of low-vision patients who cannot recognize and identify optotypes and for whom the spatial frequency of maximum contrast sensitivity is unknown. PURPOSE To compare measurements of the Ohio Contrast Cards to measurements of three other vision tests and a vision-related quality-of-life questionnaire obtained on partially sighted students at Ohio State School for the Blind. METHODS The Ohio Contrast Cards show printed square-wave gratings at very low spatial frequency (0.15 cycle/degree). The patient looks to the left/right side of the card containing the grating. Twenty-five students (13 to 20 years old) provided four measures of visual performance: two grating card tests (the Ohio Contrast Cards and the Teller Acuity Cards) and two letter charts (the Pelli-Robson contrast chart and the Bailey-Lovie acuity chart). Spatial contrast sensitivity functions were modeled using constraints from the grating data. The Impact of Vision Impairment on Children questionnaire measured vision-related quality of life. RESULTS Ohio Contrast Card contrast sensitivity was always less than 0.19 log10 units below the maximum possible contrast sensitivity predicted by the model; average Pelli-Robson letter contrast sensitivity was near the model prediction, but 0.516 log10 units below the maximum. Letter acuity was 0.336 logMAR below the grating acuity results. The model estimated the best testing distance in meters for optimum Pelli-Robson contrast sensitivity from the Bailey-Lovie acuity as distance = 1.5 - logMAR for low-vision patients. Of the four vision tests, only Ohio Contrast Card contrast sensitivity was independently and statistically significantly correlated with students' quality of life. CONCLUSIONS The Ohio Contrast Cards combine a grating stimulus, a looking indicator behavior, and contrast sensitivity measurement. They show promise for the clinical objective of advising the patient and his/her caregivers about the success the patient is likely to enjoy in tasks of everyday life.
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35
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Retrospective Analysis of Structural Disease Progression in Retinitis Pigmentosa Utilizing Multimodal Imaging. Sci Rep 2017; 7:10347. [PMID: 28871101 PMCID: PMC5583352 DOI: 10.1038/s41598-017-10473-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/10/2017] [Indexed: 12/02/2022] Open
Abstract
In this report, we assess the natural progression rate of retinitis pigmentosa (RP) over an average of three years using spectral-domain optical coherence tomography (SD-OCT) and short wavelength fundus autofluorescence (SW-AF). Measurement of the ellipsoid zone (EZ) line width and hyperautofluorescent ring diameters was performed in 81 patients with RP in a retrospective, longitudinal fashion. Rate of structural disease progression, symmetry between eyes, and test-retest variability were quantified. We observed on average, EZ-line widths decreased by 140 µm (5.2%, p < 0.001) per year, and average horizontal and vertical hyperautofluorescent ring diameters decreased by 149 µm (3.6%, p < 0.001) and 120 µm (3.9%, p < 0.001) per year, respectively. The 95th percentile of this cohort had differences in progression slopes between eyes that were less than 154 µm, 118 µm, and 132 µm for EZ-line width and horizontal and vertical ring diameters, respectively. For all measures except horizontal ring diameter, progression rates were significantly slower at end-stage disease. From our data, we observed a statistically significant progression rate in EZ line width and SW-AF ring diameters over time, verifying the utility of these measurements for disease monitoring purposes. Additionally, calculated differences in progression slopes between eyes may prove useful for investigators evaluating the efficacy of unilateral treatments for RP in clinical trials.
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Efficacy of rituximab in non-paraneoplastic autoimmune retinopathy. Orphanet J Rare Dis 2017; 12:129. [PMID: 28709429 PMCID: PMC5512938 DOI: 10.1186/s13023-017-0680-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/05/2017] [Indexed: 12/27/2022] Open
Abstract
Background Autoimmune retinopathy (AIR) is a rare but potentially blinding condition that is often underdiagnosed. Common features in AIR presentation include rapidly progressive vision loss with abnormal electrophysiological responses of the retina associated with positive anti-retinal antibodies. AIR is also challenging to treat, and thus, the introduction of new potential therapeutic agents is welcomed. The goal of this communication is to assess the effects of rituximab infusions on electroretinogram (ERG) responses and visual function outcomes in patients with non-paraneoplastic autoimmune retinopathy (npAIR). Results Following infusion(s), three out of five patients showed no evidence of disease progression or improved, while two patients continued to progress on ERG. One patient demonstrated improvement in visual acuity (2 lines) in both eyes. ERG responses provided objective monitoring of patients’ visual function and response to immunosuppression over time. Conclusions These findings suggest that patients with npAIR unresponsive to other immunosuppression therapies may benefit from rituximab infusion, although stabilization rather than improvement was more frequently the outcome in our case series. Furthermore, regularly scheduled ERG follow-up examinations are recommended for monitoring patients’ progression during treatment.
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Sattarnezhad N, Farrow S, Kimbrough D, Glanz B, Healy B, Chitnis T. Agreement analysis comparing iPad LCVA and Sloan testing in multiple sclerosis patients. Mult Scler 2017; 24:1126-1130. [PMID: 28585909 DOI: 10.1177/1352458517713667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visual symptoms are common in multiple sclerosis (MS). Low-contrast visual acuity (LCVA) testing using Sloan charts has demonstrated increased sensitivity for visual deficits compared to high-contrast acuity testing. Computerized testing of visual acuity may facilitate use in the clinic setting. OBJECTIVES To evaluate the agreement between an iPad-based and Sloan testing of LCVA in a cohort of MS patients. METHODS A total of 38 patients with relapsing-remitting MS were enrolled after providing informed written consent at Partners MS Center, Brigham and Women's hospital. Monocular LCVA was measured using retroilluminated Sloan chart and iPad-based LogMAR chart. Number of correct letters and agreement between two measurements were assessed for each eye using Bland-Altman analysis and paired t-test. RESULTS For both eyes, there was no significant difference in number correct between the two measurements using a paired t-test, and there was high correlation between two measurements (oculus dextrus (OD) r = 0.89, p < 0.001; oculus sinister (OS) r = 0.78, p < 0.001). The limits of agreement were -7.9 to +8.5 letters for the right eye and -10.9 to +11.2 letters for the left eye. CONCLUSION An iPad-based LCVA test shows good agreement with Sloan testing in MS patients.
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Affiliation(s)
- Neda Sattarnezhad
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Samantha Farrow
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Dorlan Kimbrough
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Bonnie Glanz
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Brian Healy
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA/Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tanuja Chitnis
- Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, MA, USA
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Dorr M, Lesmes LA, Elze T, Wang H, Lu ZL, Bex PJ. Evaluation of the precision of contrast sensitivity function assessment on a tablet device. Sci Rep 2017; 7:46706. [PMID: 28429773 PMCID: PMC5399462 DOI: 10.1038/srep46706] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/28/2017] [Indexed: 11/26/2022] Open
Abstract
The contrast sensitivity function (CSF) relates the visibility of a spatial pattern to both its size and contrast, and is therefore a more comprehensive assessment of visual function than acuity, which only determines the smallest resolvable pattern size. Because of the additional dimension of contrast, estimating the CSF can be more time-consuming. Here, we compare two methods for rapid assessment of the CSF that were implemented on a tablet device. For a single-trial assessment, we asked 63 myopes and 38 emmetropes to tap the peak of a “sweep grating” on the tablet’s touch screen. For a more precise assessment, subjects performed 50 trials of the quick CSF method in a 10-AFC letter recognition task. Tests were performed with and without optical correction, and in monocular and binocular conditions; one condition was measured twice to assess repeatability. Results show that both methods are highly correlated; using both common and novel measures for test-retest repeatability, however, the quick CSF delivers more precision with testing times of under three minutes. Further analyses show how a population prior can improve convergence rate of the quick CSF, and how the multi-dimensional output of the quick CSF can provide greater precision than scalar outcome measures.
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Affiliation(s)
- Michael Dorr
- Technical University Munich, Department of Electrical and Computer Engineering, Munich, 80333, Germany
| | - Luis A Lesmes
- Adaptive Sensory Technology, Inc., San Diego, CA 92121, USA
| | - Tobias Elze
- Harvard Medical School, Schepens Eye Research Institute, Boston, MA 02114, USA
| | - Hui Wang
- Harvard Medical School, Schepens Eye Research Institute, Boston, MA 02114, USA.,Jilin University of Finance and Economics, Changchun, China
| | - Zhong-Lin Lu
- The Ohio State University, Department of Psychology, Columbus, OH 43210, USA
| | - Peter J Bex
- Northeastern University, Department of Psychology, Boston, MA 02115, USA
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Chung STL, Legge GE. Comparing the Shape of Contrast Sensitivity Functions for Normal and Low Vision. Invest Ophthalmol Vis Sci 2016; 57:198-207. [PMID: 26795826 PMCID: PMC4727522 DOI: 10.1167/iovs.15-18084] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose The contrast sensitivity function (CSF) provides a detailed description of an individual's spatial-pattern detection capability. We tested the hypothesis that the CSFs of people with low vision differ from a “normal” CSF only in their horizontal and vertical positions along the spatial frequency (SF) and contrast sensitivity (CS) axes. Methods Contrast sensitivity for detecting horizontal sinewave gratings was measured with a two temporal-interval forced-choice staircase procedure, for a range of SFs spanning 5 to 6 octaves, for 20 low-vision observers and five adults with normal vision. An asymmetric parabolic function was used to fit the aggregate data of the normal-vision observers, yielding the “normal template.” Each of the 20 low-vision CSFs was fit in two ways, by using a shape-invariant version of the normal template (with the width parameters fixed) that was shifted along the log-SF and log-CS axes, and by an unconstrained asymmetric parabolic function (“free-fit”). Results The two fitting methods yielded values of the peak CS, the SF corresponding to peak CS, and the high cut-off SF that were highly correlated and in good agreement with each other. In addition, the width parameters of the low-vision CSFs were comparable with those of the normal template, implying that low-vision CSFs are similar in shape to the normal CSF. Conclusions The excellent agreement of parameters estimated by the two fitting methods suggests that low-vision CSFs can be approximated by a normal CSF shifted along the log-SF and log-CS axes to account for the impaired acuity and contrast sensitivity.
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Affiliation(s)
- Susana T L Chung
- School of Optometry University of California, Berkeley, Berkeley, California, United States
| | - Gordon E Legge
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota, United States
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Sun Y, Erdem E, Lyu A, Zangalli C, Wizov SS, Lo D, Spaeth EE, Richman J, Spaeth GL. The SPARCS: a novel assessment of contrast sensitivity and its reliability in patients with corrected refractive error. Br J Ophthalmol 2016; 100:1421-6. [PMID: 26758536 DOI: 10.1136/bjophthalmol-2015-307378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/12/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To explore the reliability of the Spaeth/Richman Contrast Sensitivity (SPARCS) test and to assess the contrast sensitivity (CS) distribution among subjects with various refractive errors. METHODS Cross-sectional study. Ninety-three individuals (182 eyes) with varying amounts of refractive error were included in this study and divided into six groups according to their spherical equivalent. CS was evaluated using Pelli-Robson (PR) and SPARCS assessments. Each eye was tested twice with both measurements. Outcomes included the correlations of PR and SPARCS scores, the test-retest agreement of the two measurements and the limits of agreement between tests of CS measurements. The distribution of CS among the six groups was compared. RESULTS Pearson correlation analysis showed statistically significant correlations between SPARCS and PR scores (p<0.001). Reliability analysis showed that SPARCS had better test-retest agreement than PR, with SPARCS exhibiting a higher intraclass coefficient (ICC=0.635). Bland-Altman plots showed that the mean difference of measurements was close to 0 for both CS measurements. Among the six refractive groups, there were no significant differences in CS scores with either measurement. CONCLUSIONS SPARCS appears to be a reliable assessment for CS. The difference in CS among myopes, emmetropes and hyperopes wearing their habitual correction was statistically insignificant in this study. CLINICAL TRIAL NUMBER NCT01300949, post results.
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Affiliation(s)
- Yi Sun
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Elif Erdem
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew Lyu
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Camila Zangalli
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Sheryl S Wizov
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - David Lo
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - Eric E Spaeth
- Department of Glaucoma, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jesse Richman
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
| | - George L Spaeth
- Department of Ophthalmology, Glaucoma Research Center, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Scholl HPN, Moore AT, Koenekoop RK, Wen Y, Fishman GA, van den Born LI, Bittner A, Bowles K, Fletcher EC, Collison FT, Dagnelie G, Degli Eposti S, Michaelides M, Saperstein DA, Schuchard RA, Barnes C, Zein W, Zobor D, Birch DG, Mendola JD, Zrenner E. Safety and Proof-of-Concept Study of Oral QLT091001 in Retinitis Pigmentosa Due to Inherited Deficiencies of Retinal Pigment Epithelial 65 Protein (RPE65) or Lecithin:Retinol Acyltransferase (LRAT). PLoS One 2015; 10:e0143846. [PMID: 26656277 PMCID: PMC4687523 DOI: 10.1371/journal.pone.0143846] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Restoring vision in inherited retinal degenerations remains an unmet medical need. In mice exhibiting a genetically engineered block of the visual cycle, vision was recently successfully restored by oral administration of 9-cis-retinyl acetate (QLT091001). Safety and visual outcomes of a once-daily oral dose of 40 mg/m2/day QLT091001 for 7 consecutive days was investigated in an international, multi-center, open-label, proof-of-concept study in 18 patients with RPE65- or LRAT-related retinitis pigmentosa. Eight of 18 patients (44%) showed a ≥20% increase and 4 of 18 (22%) showed a ≥40% increase in functional retinal area determined from Goldmann visual fields; 12 (67%) and 5 (28%) of 18 patients showed a ≥5 and ≥10 ETDRS letter score increase of visual acuity, respectively, in one or both eyes at two or more visits within 2 months of treatment. In two patients who underwent fMRI, a significant positive response was measured to stimuli of medium contrast, moving, pattern targets in both left and right hemispheres of the occipital cortex. There were no serious adverse events. Treatment-related adverse events were transient and the most common included headache, photophobia, nausea, vomiting, and minor biochemical abnormalities. Measuring the outer segment length of the photoreceptor layer with high-definition optical coherence tomography was highly predictive of treatment responses with responders having a significantly larger baseline outer segment thickness (11.7 ± 4.8 μm, mean ± 95% CI) than non-responders (3.5 ± 1.2 μm). This structure-function relationship suggests that treatment with QLT091001 is more likely to be efficacious if there is sufficient photoreceptor integrity.
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Affiliation(s)
- Hendrik P. N. Scholl
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
- * E-mail:
| | - Anthony T. Moore
- Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom
- Dept. of Ophthalmology, University of California San Francisco, San Francisco, CA, United States of America
| | | | - Yuquan Wen
- Retina Foundation of the Southwest, Dallas, TX, United States of America
- Baylor Visual Function Center, Baylor University Medical Center, Dallas, TX, United States of America
| | - Gerald A. Fishman
- Chicago Lighthouse, Pangere Center for Inherited Retinal Diseases, Chicago, IL, United States of America
| | | | - Ava Bittner
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
- Nova Southeastern University, College of Optometry, Fort Lauderdale, FL, United States of America
| | - Kristen Bowles
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
- College of Optometry, University of Houston, Houston, TX, United States of America
| | - Emily C. Fletcher
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
- Gloucester Royal NHS Foundation Trust, Gloucester Royal Hospitals, Gloucester, United Kingdom
| | - Frederick T. Collison
- Chicago Lighthouse, Pangere Center for Inherited Retinal Diseases, Chicago, IL, United States of America
| | - Gislin Dagnelie
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
| | - Simona Degli Eposti
- Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom
| | - Michel Michaelides
- Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom
| | - David A. Saperstein
- Vitreoretinal Associates of Washington, Seattle, WA, United States of America
- QLT Inc., Vancouver, Canada
| | - Ronald A. Schuchard
- QLT Inc., Vancouver, Canada
- Stanford Univ School of Medicine, Palo Alto, CA, United States of America
| | - Claire Barnes
- QLT Inc., Vancouver, Canada
- VA Palo Alto Health Care System, Palo Alto, CA, United States of America
| | - Wadih Zein
- Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Ditta Zobor
- Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - David G. Birch
- Retina Foundation of the Southwest, Dallas, TX, United States of America
- Ophthalmology, UT Southwestern, Dallas, TX, United States of America
| | | | - Eberhart Zrenner
- Institute for Ophthalmic Research, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
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PROSPECTIVE EVALUATION OF VISUAL ACUITY AGREEMENT BETWEEN STANDARD EARLY TREATMENT DIABETIC RETINOPATHY STUDY CHART AND A HANDHELD EQUIVALENT IN EYES WITH RETINAL PATHOLOGY. Retina 2015; 35:1680-7. [DOI: 10.1097/iae.0000000000000518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Self-Testing of Vision in Age-Related Macula Degeneration: A Longitudinal Pilot Study Using a Smartphone-Based Rarebit Test. J Ophthalmol 2015; 2015:285463. [PMID: 26124958 PMCID: PMC4466471 DOI: 10.1155/2015/285463] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. There is a need for efficient self-tests of vision in patients with neovascular age-related macula degeneration. A new tablet/smartphone application aiming to meet this need is described and its performance is assessed in a longitudinal pilot study. Materials and Methods. The new MultiBit Test (MBT) employs segmented digits defined by rarebits, that is, receptive field-size bright dots briefly presented against a dark background. The number of rarebits per digit segment was varied in a cyclic fashion, in preset steps. There were no fixation demands. Twenty-eight patients with neovascular AMD of varying severity were monitored for an average of 30 weeks. Test scores were evaluated on an individual basis, by contrasting observed trends with the clinical status recorded at independently scheduled clinical examinations. Results. Serial plots of MBT results revealed gradual improvement after successful antineovascular treatment. Recurrences were signalled by gradual deteriorations of results. Test results remained stable during clinically stable time intervals. MBT results agreed well with clinical assessments whereas an acuity test performed at chance level. The MBT was well accepted by all subjects. Conclusions. The MBT appears to have a good potential for effective self-testing of vision in AMD and merits large-scale studies. Exploration of MBT performance with other forms of macula conditions may be worthwhile.
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Chen FK, Agelis LE, Peh KK, Teong J, Wong ENXM. Factors Contributing to Discrepancy Between Visual Acuity Fractions Derived From a Snellen Chart and Letter Scores on the Early Treatment Diabetic Retinopathy Study Chart. Asia Pac J Ophthalmol (Phila) 2014; 3:277-85. [PMID: 26107914 DOI: 10.1097/apo.0000000000000007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report factors influencing the relationship between visual acuity (VA) fractions measured on Snellen chart and letter scores on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. DESIGN This was a retrospective review from a single ophthalmology outpatient clinic. METHODS All patients had routine consecutive VA testing in the right eye using a Snellen chart (1-6 m) and the ETDRS chart (4 m and/or 1 m), by the same optometrist, using a standardized testing protocol for each chart. Both acuity fractions and letter scores were converted to their equivalent logarithm of minimum angle of resolution (logMAR) for comparison. Multiple regression analysis was performed. RESULTS A total of 237 patients with a wide range of ocular disease and VAs were enrolled. Mean age was 63 years (range, 18-95 years). Recorded VA (logMAR) was better on Snellen chart by a mean (95% limits of agreement) of -0.07 (-0.33 to +0.18, P < 0.001). There was a trend for subjects with VA worse than 6/36 to read 3 to 6 letters more and those better than 6/36 to read 4 to 5 letters less on the ETDRS chart. Visual acuity level and amblyopia contributed to a small portion (17%-26%) of the total variance in the difference between logMAR equivalents derived from the 2 charts. CONCLUSIONS The discrepancy in VA derived from Snellen and ETDRS charts was nonuniform across VA range. This has implications on interpretation of published studies converting Snellen fractions to logMAR for analysis and reporting of VA outcomes.
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Affiliation(s)
- Fred K Chen
- From the *Centre for Ophthalmology and Visual Science (Lions Eye Institute), The University of Western Australia, Nedlands; †Department of Ophthalmology, Royal Perth Hospital, Perth; and ‡Department of Ophthalmology, Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
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Khambhiphant B, Chansangpetch S, Tulvatana W, Busayarat M. Original article. Repeatability assessment of the New Numbers Contrast Sensitivity Chart. ASIAN BIOMED 2014. [DOI: 10.5372/1905-7415.0803.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: The validity and agreement of the New Numbers Contrast Sensitivity Chart with the original Mars chart have been found to be good. The two charts can be used interchangeably; however, evidence of the repeatability of the new chart remains to be sought. This study was to assess the repeatability of the New Numbers Contrast Sensitivity Chart.
Objectives: We assessed the repeatability of the Numbers Contrast Sensitivity Chart.
Methods: Two hundred subjects from the ophthalmic clinic of the King Chulalongkorn Memorial Hospital, who were able to communicate and read Arabic numerals were recruited. The contrast sensitivity (CS) scores were collected by reading the same Numbers Contrast Sensitivity Chart in the same environment with each eye and both eyes ten minutes apart. The repeatability of the CS score was assessed by Bland-Altman plot analysis.
Results: The visual acuity of subjects with variety in diagnoses ranged from 20/480 to 20/20. The mean differences were -0.006, -0.008, -0.002 log CS and the coefficients of repeatability were 0.155, 0.141, and 0.093 for the right eye, left eye, and both eyes, respectively. The plots showed a narrow range of 95% limit of agreement, which were (+0.146, -0.159) in the right eye, (+0.130, -0.147) in the left eye, and (+0.089, -0.093) in both eyes.
Conclusions: The New Numbers Contrast Sensitivity Chart has good repeatability. With proven good validity and repeatability, this easy and convenient numbers chart is beneficial for practical use in a clinical setting where English is not used as the primary language.
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Affiliation(s)
- Bharkbhum Khambhiphant
- Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330 Thailand
| | - Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Wasee Tulvatana
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Mathu Busayarat
- Department of Ophthalmology, Khon Kaen General Hospital, Khon Kaen 40002, Thailand
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Finger RP, Guymer RH, Gillies MC, Keeffe JE. The impact of anti-vascular endothelial growth factor treatment on quality of life in neovascular age-related macular degeneration. Ophthalmology 2014; 121:1246-51. [PMID: 24518613 DOI: 10.1016/j.ophtha.2013.12.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the impact of anti-vascular endothelial growth factor (VEGF) treatment in routine medical practice on vision-related quality of life (VRQoL) in neovascular age-related macular degeneration (AMD). DESIGN Prospective case series. PARTICIPANTS A total of 169 patients with neovascular AMD undergoing anti-VEGF treatment. METHODS The VRQoL interviews at baseline (n = 169), 6 months (n = 138), and 12 months (n = 120), routine anti-VEGF treatment with up to monthly follow-ups, and re-treatment as indicated. The Impact of Vision Impairment (IVI) questionnaire was subjected to Rasch analysis to assess its measurement performance and generate interval-level estimates of VRQoL at all time points, anchoring the instrument to its baseline measurement characteristics. Factors associated with a change in reported VRQoL were assessed using generalized linear regression models. MAIN OUTCOME MEASURES The VRQoL as measured by the IVI using its 3 subscales: Accessing Information, Mobility, and Emotional Well-being. FINDINGS The mean age was 70 years (±6 years standard deviation [SD]); 56% were female. Visual acuity (VA) improved by a mean of 8 letters (±17 SD), and mean retinal thickness decreased by 87 (±89.7) μm with an average of 6.5 (±2.6) injections over 12 months. Those who lost >2 lines (n = 13, 11%) reported worse VRQoL at 12 months on the Accessing Information and Mobility subscales (P = 0.007 and P = 0.050, respectively). Conversely, those who gained >2 lines (n = 29, 24%) reported better VRQoL on the Accessing Information and Emotional Well-being subscales (P = 0.009 and P = 0.008, respectively). Patients who did not experience a change in VA reported no change in their VRQoL. In multivariate analyses, only a change in VA but not whether the better or worse eye was treated predicted a change in VRQoL on the Accessing Information (P = 0.004) and the Emotional Well-being (P = 0.008) subscales. CONCLUSIONS We confirmed that anti-VEGF treatment for neovascular AMD improves patients' VRQoL in those who gain vision and maintains VRQoL in those who maintain VA in their treated eye, irrespective of whether the worse or better eye is treated. Against this background, the best possible outcomes should be aimed for even if the worse eye is treated because a loss of VA in the worse eye will adversely affect patients' VRQoL.
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Affiliation(s)
- Robert P Finger
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia.
| | - Robyn H Guymer
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
| | - Mark C Gillies
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Jill E Keeffe
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Australia
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Bittner AK, Gould JM, Rosenfarb A, Rozanski C, Dagnelie G. A pilot study of an acupuncture protocol to improve visual function in retinitis pigmentosa patients. Clin Exp Optom 2013; 97:240-7. [PMID: 24773463 DOI: 10.1111/cxo.12117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/27/2013] [Accepted: 07/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with retinitis pigmentosa are motivated to try complementary or integrative therapies to slow disease progression. Basic science, clinical research and retinitis pigmentosa patients' self-reports support the hypothesis that acupuncture may improve visual function. METHODS A prospective, case series, pilot study enrolled 12 adult patients with RP treated at an academic medical centre with a standardised protocol that combined electroacupuncture to the forehead and below the eyes and acupuncture to the body, at 10 half-hour sessions over two weeks. Pre- and post-treatment tests included Early Treatment Diabetic Retinopathy Study visual acuity (VA), Pelli-Robson contrast sensitivity (CS), Goldmann visual fields, and dark-adapted full-field stimulus threshold (FST)(n = 9). Scotopic Sensitivity Tester-1 (SST-1) dark-adaptometry was performed on the last two subjects. RESULTS Six of 12 subjects had measurable, significant visual function improvements after treatment. Three of nine subjects tested with the FST had a significant 10.3 to 17.5 dB (that is, 13- to 53-fold) improvement in both eyes at one week after acupuncture, maintained for at least 10 to 12 months, which was well outside typical test-retest variability (95% CI: 3-3.5 dB) previously found in retinitis pigmentosa. SST-1 dark-adaptation was shortened in both subjects tested on average by 48.5 per cent at one week (range 36 to 62 per cent across 10 to 30 dB), which was outside typical coefficients of variation of less than 30 per cent previously determined in patients with retinitis pigmentosa and normals. Four of the five subjects with psychophysically measured scotopic sensitivity improvements reported subjective improvements in vision at night or in dark environments. One subject had 0.2 logMAR improvement in VA; another had 0.55 logCS improvement. Another subject developed more than 20 per cent improvement in the area of the Goldmann visual fields. The acupuncture protocol was completed and well tolerated by all, without adverse events or visual loss. CONCLUSIONS Acupuncture entails minimal risk, if administered by a well-trained acupuncturist and may have significant, measurable benefits on residual visual function in patients with retinitis pigmentosa, in particular scotopic sensitivity, which had not previously been studied. These preliminary findings support the need for future controlled studies of potential mechanisms.
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Affiliation(s)
- Ava K Bittner
- Johns Hopkins University, Wilmer Eye Institute, Baltimore, Maryland, USA.
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Ratnam K, Carroll J, Porco TC, Duncan JL, Roorda A. Relationship between foveal cone structure and clinical measures of visual function in patients with inherited retinal degenerations. Invest Ophthalmol Vis Sci 2013; 54:5836-47. [PMID: 23908179 DOI: 10.1167/iovs.13-12557] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To study the relationship between cone spacing and density and clinical measures of visual function near the fovea. METHODS High-resolution images of the photoreceptor mosaic were obtained with adaptive optics scanning laser ophthalmoscopy from 26 patients with inherited retinal degenerations. Cone spacing measures were made close to or at the foveal center (mean [SD] eccentricity, 0.02 [0.03] degree; maximum eccentricity, 0.13 degree) and were converted to Z-scores, fraction of cones, and percentage-of-cones-below-average compared with normal values for each location (based on 37 age-similar visually normal eyes). Z-scores and percentage of cones below average were compared with best-corrected visual acuity (VA) and foveal sensitivity. RESULTS Visual acuity was significantly correlated with cone spacing (Spearman rank correlation ρ = -0.60, P = 0.003) and was preserved (≥ 80 letters), despite cone density measures that were 52% below normal. Foveal sensitivity showed significant correlation with cone spacing (ρ = -0.47, P = 0.017) and remained normal (≥ 35 decibels), despite density measures that were approximately 52% to 62% below normal. CONCLUSIONS Cone density was reduced by up to 62% below normal at or near the fovea in eyes with VA and sensitivity that remained within normal limits. Despite a significant correlation with foveal cone spacing, VA and sensitivity are insensitive indicators of the integrity of the foveal cone mosaic. Direct, objective measures of cone structure may be more sensitive indicators of disease severity than VA or foveal sensitivity in eyes with inherited retinal degenerations.
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Affiliation(s)
- Kavitha Ratnam
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
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Aslam T, Mahmood S, Balaskas K, Patton N, Tanawade RG, Tan SZ, Roberts SA, Parkes J, Bishop PN. Repeatability of visual function measures in age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2013; 252:201-6. [PMID: 23884391 DOI: 10.1007/s00417-013-2421-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess repeatability of visual function measures in patients with early, intermediate or late age-related macular degeneration (AMD) without active neovascular disease in the study eye, but active neovascular AMD in the fellow eye. METHODS One hundred subjects from an ongoing trial were screened for this study in which their LogMAR acuity, contrast sensitivity and reading performance were assessed using standardised protocols by trained optometrists. The same measures were repeated one month later and repeatability of the visual functions assessed. RESULTS Data from 83 subjects satisfied inclusion criteria for analysis. Coefficient of repeatability was 14.9 letters for LogMAR visual acuity , 7.2 letters for Pelli Robson contrast sensitivity, 0.72 for LogMAR reading acuity, 110.4 words/ min for reading speed and 0.67 for LogMAR critical print size. Intraclass correlation coefficients allowed comparison between measures and were found to be 0.96 for LogMAR visual acuity, 0.93 for contrast sensitivity, 0.75 for LogMAR reading acuity, 0.79 for reading speed and 0.74 for LogMAR critical print size. Coefficients of variation were 9.4 %, 10.7 %, 48.4 %, 28.4 % and 31.8 % respectively. CONCLUSIONS We found coefficients of repeatability that concurred with previous studies demonstrating variability of visual functions in patients with AMD. In addition, we found intraclass correlation coefficients to be better with visual acuity and contrast sensitivity than with measures of reading performance.
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Affiliation(s)
- Tariq Aslam
- Manchester Royal Eye Hospital, Manchester Academic Health Science Centre, Manchester, UK
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Branham K, Yashar BM. Providing comprehensive genetic-based ophthalmic care. Clin Genet 2013; 84:183-9. [PMID: 23662791 DOI: 10.1111/cge.12192] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/08/2013] [Accepted: 05/08/2013] [Indexed: 12/21/2022]
Abstract
The diagnosis of an inherited retinal dystrophy can have a significant impact on both the physical and emotional lives of patients and their families. In order to optimize the health and quality of life for these individuals, a comprehensive approach to clinical care starting at the time of diagnosis and continuing throughout their lifespan is critical. A multidisciplinary team approach integrating ophthalmic and genetic counseling services can optimize the diagnostic process and long-term management of these patients. When vision loss is first appreciated, the diagnostic specificity of an ophthalmic evaluation can be enhanced by a detailed genetic work-up. This evaluation can help confirm the diagnosis and allow for accurate risk counseling of the patient and their family. Genetic counseling is critical at the time of diagnosis and is an opportunity to provide education about the diagnosis, discuss low-vision rehabilitation, and explore impacts on academics and employment. In addition, counseling can help patients deal with the current psychological aspects of their vision loss, prepare for the lifelong impact of their diagnosis and over time adjust to the impact of progressive vision loss.
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Affiliation(s)
- K Branham
- Department of Ophthalmology and Visual Sciences
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