Evaluation of Functional Visual Acuity in Glaucoma Patients

Association of macular structure, function, and vessel density with foveal threshold in advanced glaucoma

Identifying new biomarkers associated with central visual function impairment is important in advanced glaucoma patients. This retrospective cross-sectional study enrolled 154 eyes from 154 subjects, consisting of 86 patients with advanced open-angle glaucoma (mean deviation of 24-2 visual field [VF] tests < - 15 dB) and 68 healthy controls. Structure, function, and vessel density (VD) parameters were obtained using optical coherence tomography (OCT), 24-2 standard automated perimetry, and OCT angiography, respectively. The relationships of macular thickness, central 5° and 10° VF mean sensitivity (MS), and macular VD parameters with foveal threshold (FT), representing central visual function, were investigated using partial correlation analyses and linear regression analyses, with age adjustment. Superficial and deep layer macular VD, central 5° and 10° VF MS, and best corrected visual acuity (BCVA) correlated significantly with FT after age adjustment (P < 0.05). In multivariate linear regression analyses, FT associated significantly with BCVA (β = - 8.80, P < 0.001), central 5° MS (β = 0.30, P = 0.037), and deep-layer global parafoveal VD (β = 0.37, P = 0.037). Thus, deep-layer parafoveal VD is an independent predictor of FT and may be a potential biomarker for central visual function in advanced glaucoma.

Effect of Photochromic Contact Lens Wear on Indoor Visual Performance and Patient Satisfaction

INTRODUCTION

To quantitatively assess visual performance and patient satisfaction during photochromic contact lens (CL) wear in an indoor environment.

METHODS

This observational study comprised 82 eyes of 41 healthy subjects (mean age ± standard deviation, 21.7 ± 0.7 years) who had no ophthalmic diseases except for refractive errors at Kitasato University in 2021. We prospectively compared visual acuity, kinetic visual acuity, functional (time-dependent) visual acuity, the maintaining rate of visual acuity, the response time, contrast sensitivity function, higher-order aberrations, and patient satisfaction score for overall vision in such subjects during photochromic and non-photochromic CL wear in such an environment.

RESULTS

The kinetic visual acuity at 30 km/h was 0.32 ± 0.21 and 0.41 ± 0.24 in the photochromic and non-photochromic CL groups, respectively (p = 0.008). The kinetic visual acuity at 60 km/h was 0.32 ± 0.21 and 0.41 ± 0.24, respectively (p = 0.034). The functional visual acuity was 0.00 ± 0.21 and 0.05 ± 0.25, respectively (p = 0.030). The average response time was 1.19 ± 0.15 s and 1.23 ± 0.15 s, respectively (p = 0.029). The patient satisfaction score for overall visual performance was 4.22 ± 0.11 and 3.59 ± 0.68, respectively (p < 0.001). Otherwise, we found no significant differences in visual acuity, the maintaining rate, higher-order aberrations, or contrast sensitivity function (p = 0.116, p = 0.053, p = 0.371, or p = 0.943). We found no apparent complications such as ocular discomfort, superficial punctate keratitis, conjunctival injection, or infectious keratitis during the observation period.

CONCLUSIONS

According to our experience, the photochromic CL showed good visual quality, especially in terms of kinetic and functional visual acuities and subsequent high patient satisfaction, even in an indoor environment, suggesting its viability of visual correction not only in daily activities but also in indoor sports activities.

The effects of acute angle closure crisis on corneal endothelial cells in patients with type 2 diabetes mellitus

OBJECTIVE

This study investigated the effects of acute angle closure crisis (AACC) on the corneal endothelial cells in patients with type 2 diabetes mellitus (DM) to identify the factors that cause corneal endothelial cell injury.

METHODS

We examined 154 patients who visited Qingdao Eye Hospital for AACC in one eye (154 eyes; 28 men and 126 women; mean age of 68 ± 8 years). We divided the participants into non-DM, DM well-control, and DM poor-control groups, with the unaffected eyes used as controls. Each participant was evaluated at the hospital while under AACC. We measured the relevant index and corneal parameters of the participants for statistical analysis.

RESULTS

There were significant statistical differences in corneal parameters among the three groups. The decreased levels of central endothelial cell density (CD) and the percentage of hexagonal cells (6A) were statistically relevant among the groups (P<0.05). The AACC duration was correlated with CD loss rate among the groups (P<0.05). The DM duration was correlated with CD loss rate in the DM well-control group. Compared with the non-DM group, the level of 6A decreased more significantly in the DM group after AACC (P<0.05). The AACC duration in the DM well-control group was significantly shorter than in the non-DM and DM poor-control groups (P<0.001). The DM poor-control group showed significantly worse visual acuity when compared with the other groups (P<0.05).

CONCLUSIONS

DM may impact the functional status of corneal endothelial cells. AACC can worsen the corneal endothelium damage in patients with DM. Blood glucose levels and the duration of intraocular hypertension are closely related to the severity of corneal endothelial injury.

Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

Background

To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21 mmHg, and to detect the associated factors.

Methods

A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications.

Results

Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR, within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = − 0.511, r = − 0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively.

Conclusions

Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.

Shortened Measurement Time of Functional Visual Acuity for Screening Visual Function

The functional visual acuity test which is the average of the visual acuities measured during a specific time frame (standard, 60 seconds) has been used recently to assess the visual function in various conditions. The availability of a shorter version of the functional visual acuity test promises to be patient friendly in that it is a simple screening test performed in a shorter period of time than the standard test. The results of measurements of the FVA test between the 30-second measurement time (short-version FVA test) and the standard 60-second measurement are compared, and the feasibility of the short-version FVA test instead of the standard FVA test is investigated. Twenty-eight healthy volunteers (25 men and 3 women) were enrolled in this prospective observational study. All subjects underwent measurement of the binocular distance-corrected visual acuity and the binocular distance-corrected FVA with the 60-second and 30-second measurement times. The interchangeability of the corrected-distance FVA, maximal VA, visual maintenance ratio, and average response time in the short-version and the standard FVA tests was evaluated using the Bland–Altman method, and the results showed agreements of the two tests except for the minimal VA. The short-version FVA test is equivalent to the standard method except for evaluating the visual acuity fluctuations and promises to be a simple visual screening test that can be performed in a shorter time.

Three-rods test as drivers' license vision test from the viewpoint of reproducibility, eye deviation, and functional visual acuity

Background

Three-rods test is required as depth perception vision test to obtain motor vehicle license to drive taxies, buses, and trucks in Japan. Functional visual acuity is measured automatically by successive visual target presentation in a fixed period of time. This study examined three-rods test from the viewpoint of reproducibility, eye deviation, and functional visual acuity to assess the feasibility for drivers' license vision test.

Methods

At three-rods test, a central rod was moved at the speed of 50 mm/sec forward and backward automatically against two fixed rods on both sides inside an illuminated box. An examinee at the distance of 2.5 m observed the rods inside the box from a small window and pushed a button to stop the central rod in alignment with the fixed rods. Erred distance of the central rod from the fixed rods as a mean of 4 measurements was used. At functional visual acuity test, an examinee moved a joystick to the same direction as Landolt-C opening as a visual target which was sequentially presented every 2 seconds for 30 times in 1 minute.

Results

The mean erred distance of three-rods test was reproducible between two tests done on separate occasions (n = 44, ρ = 0.679, P < 0.0001, Spearman rank correlation). Exophoria induced by wearing 4-prism-diopter base-out prism did not significantly influence the mean erred distance while vertical diplopia induced by wearing 4-prism-diopter base-up prism disrupted the measurement (n = 9). The mean erred distance of three-rods test was better correlated with functional visual acuity tested with both eyes open than with conventional visual acuity with both eyes open (n = 17, ρ = 0.2 versus ρ = 0.179).

Conclusion

In the context of the small sample size in the present study, the three-rods test was reproducible, and testable in the presence of phoria, but not testable in diplopia, indicating the feasibility as a depth perception vision test.

Assessment of Visual Function in Patients with Myopic Foveoschisis

Purpose: To assess the visual function in patient with myopic foveoschisis (MF). Methods: Fifty-one eyes of 51 subjects were enrolled and divided into myopic foveoschisis group (MFG, N = 16), myopic control group (MCG, N = 18), and normal control group (NCG, N = 17) according to their diagnoses. Measurements of the logarithm of the minimum angle of resolution (LogMAR), the objective scatter index (OSI), the cut-off value of modulation transfer function (COMTF), the Strehl ratio (SR), the foveal threshold (FT), and the amplitude density (AD) in the first central ring of multifocal electroretinography were recorded and compared amongst groups. Results: LogMAR of MFG was the highest (MFG vs. MCG p＜0.001, MFG vs. NCG p＜0.001), and LogMAR of MCG and NCG were similar (p = 0.258). OSI of MFG was higher than that of MCG (p＜0.001), and the latter was higher than OSI of NCG (p＜0.001). COMTF was lowest in MFG, intermediate in MCG and highest in NCG (MFG vs. MCG p = 0.001, MFG vs. NCG p＜0.001, MCG vs. NCG p＜0.001). SR, FT, and AD were all similar between MFG and MCG (p = 0.187, p = 0.401, and p = 0.446, respectively) while highest in NCG (SR MFG vs. NCG p＜0.001, MCG vs. NCG p＜0.001; FT MFG vs. NCG p = 0.003, MCG vs. NCG p = 0.025; AD MFG vs. NCG p＜0.001, MCG vs. NCG p＜0.001). Conclusions: Similarities were found between various functional parameters from different devices, revealing that the visual function in MF patients was impaired.