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Balaskas K, Drawnel F, Khanani AM, Knox PC, Mavromaras G, Wang YZ. Home vision monitoring in patients with maculopathy: current and future options for digital technologies. Eye (Lond) 2023; 37:3108-3120. [PMID: 36973405 PMCID: PMC10042418 DOI: 10.1038/s41433-023-02479-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/25/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Patients with macular pathology, including that caused by age-related macular degeneration and diabetic macular oedema, must attend frequent in-clinic monitoring appointments to detect onset of disease activity requiring treatment and to monitor progression of existing disease. In-person clinical monitoring places a significant burden on patients, caregivers and healthcare systems and is limited in that it only provides clinicians with a snapshot of the patient's disease status. The advent of remote monitoring technologies offers the potential for patients to test their own retinal health at home in collaboration with clinicians, reducing the need for in-clinic appointments. In this review we discuss visual function tests, both existing and novel, that have the potential for remote use and consider their suitability for discriminating the presence of disease and progression of disease. We then review the clinical evidence supporting the use of mobile applications for monitoring of visual function from clinical development through to validation studies and real-world implementation. This review identified seven app-based visual function tests: four that have already received some form of regulatory clearance and three under development. The evidence included in this review shows that remote monitoring offers great potential for patients with macular pathology to monitor their condition from home, reducing the need for burdensome clinic visits and expanding clinicians' understanding of patients' retinal health beyond traditional clinical monitoring. In order to instil confidence in the use of remote monitoring in both patients and clinicians further longitudinal real-world studies are now warranted.
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Affiliation(s)
- Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Institute of Ophthalmology, University College London, London, UK.
| | | | - Arshad M Khanani
- The University of Nevada, Reno School of Medicine, Reno, NV, USA
- Sierra Eye Associates, Reno, NV, USA
| | - Paul C Knox
- Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | | | - Yi-Zhong Wang
- Retina Foundation of the Southwest, Dallas, TX, USA
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, USA
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Żołubak A, Garcia-Suarez L. Shape discrimination in peripheral vision: Addressing pragmatic limitations of M-scaling radial frequency patterns. Vision Res 2021; 188:115-125. [PMID: 34315091 DOI: 10.1016/j.visres.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
Peripheral worsening in shape discrimination (SD) can be compensated by size-scaling of peripheral stimuli. However, such scaling results in production of large stimuli that occupy a vast range of eccentricities. We used six proportionally decreasing spatial scales to address this pragmatic limitation and to explore how shape discrimination varies with radius in the nasal visual field. Five participants with normal vision discriminated circles and radial frequency (RF) patterns presented nasally to the fixation point at 5°, 10°, 15° and 20°. Stimuli were scaled with the nasal cortical magnification factor (nCMF) from a central stimulus in six spatial scales, which varied from 0.125 to 1, where 1 corresponded to 1.2° radius. Thresholds expressed in Weber fractions remained constant at eccentricities up to 20° regardless of the spatial scale. Weber fractions for the smaller spatial scales (0.125-0.5) were higher and more variable than for the larger spatial scales (0.75-1), yet still constant across periphery. The results provide evidence that peripheral shape discrimination is constrained by low-level properties, such as eccentricity, and can be predicted by the cortical magnification theory. However, above the peripheral modulation resolution limits, RF shape discrimination is based on the proportion between the modulation amplitude and the radius for larger scales (0.75-1), and demonstrates peripheral scale invariance for these stimuli. For eccentric shape discrimination tests, stimuli with low spatial frequency, high contrast, and radii corresponding to SS 0.75-0.875 should be used to ensure constant Weber fractions, small variability, and peripheral stimuli that are not excessively magnified.
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Affiliation(s)
- Anna Żołubak
- School of Health Professions, University of Plymouth, Derriford Road, Plymouth PL6 8BH, United Kingdom.
| | - Luis Garcia-Suarez
- School of Health Professions, University of Plymouth, Derriford Road, Plymouth PL6 8BH, United Kingdom
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Jiang H, Yin Y, Wu CR, Liu Y, Guo F, Li M, Ma L. Dietary vitamin and carotenoid intake and risk of age-related cataract. Am J Clin Nutr 2019; 109:43-54. [PMID: 30624584 DOI: 10.1093/ajcn/nqy270] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 09/11/2018] [Indexed: 12/29/2022] Open
Abstract
Background Existing studies suggest that dietary vitamins and carotenoids might be associated with a reduced risk of age-related cataract (ARC), although a quantitative summary of these associations is lacking. Objectives The aim of this study was to conduct a meta-analysis of randomized controlled trials (RCTs) and cohort studies of dietary vitamin and carotenoid intake and ARC risk. Methods The MEDLINE, EMBASE, ISI Web of Science, and Cochrane Library databases were searched from inception to June 2018. The adjusted RRs and corresponding 95% CIs for the associations of interest in each study were extracted to calculate pooled estimates. Dose-response relations were assessed with the use of generalized least-squares trend estimation. Results We included 8 RCTs and 12 cohort studies in the meta-analysis. Most vitamins and carotenoids were significantly associated with reduced risk of ARC in the cohort studies, including vitamin A (RR: 0.81; 95% CI: 0.71, 0.92; P = 0.001), vitamin C (RR: 0.80; 95% CI: 0.72, 0.88; P < 0.001), vitamin E (RR: 0.90; 95% CI: 0.80, 1.00; P = 0.049), β-carotene (RR: 0.90; 95% CI: 0.83, 0.99; P = 0.023), and lutein or zeaxanthin (RR: 0.81; 95% CI: 0.75, 0.89; P < 0.001). In RCTs, vitamin E (RR: 0.97; 95% CI: 0.91, 1.03; P = 0.262) or β-carotene (RR: 0.99; 95% CI: 0.92, 1.07; P = 0.820) intervention did not reduce the risk of ARC significantly compared with the placebo group. Further dose-response analysis indicated that in cohort studies the risk of ARC significantly decreased by 26% for every 10-mg/d increase in lutein or zeaxanthin intake (RR: 0.74; 95% CI: 0.67, 0.80; P < 0.001), by 18% for each 500-mg/d increase in vitamin C intake (RR: 0.82; 95% CI: 0.74, 0.91; P < 0.001), by 8% for each 5-mg/d increase in β-carotene intake (RR: 0.92; 95% CI: 0.88, 0.96; P < 0.001), and by 6% for every 5 mg/d increase in vitamin A intake (RR: 0.94; 95% CI: 0.90, 0.98; P < 0.001). Conclusions Higher consumption of certain vitamins and carotenoids was associated with a significant decreased risk of ARC in cohort studies, but evidence from RCTs is less clear.
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Affiliation(s)
- Hong Jiang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Yue Yin
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Chang-Rui Wu
- The First Affiliated Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Yan Liu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fang Guo
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Ming Li
- Center for Population Health Research, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Le Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.,Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education of China, Xi'an, China
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Ho CYD, Wu Z, Turpin A, Lawson DJ, Luu CD, McKendrick AM, Guymer RH. A Tablet-Based Retinal Function Test in Neovascular Age-Related Macular Degeneration Eyes and At-Risk Fellow Eye. Transl Vis Sci Technol 2018. [PMID: 29520334 PMCID: PMC5837668 DOI: 10.1167/tvst.7.2.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To determine the feasibility of a tablet-based application to detect changes in retinal sensitivity and correlations with underlying pathology in neovascular age-related macular degeneration (nAMD) eyes undergoing treatment and in at-risk fellow eyes. Method Participants with nAMD in at least one eye were recruited, examined, and imaged using spectral-domain optical coherence tomography (SD-OCT). Retinal sensitivity was measured within the central 5° at 12 locations using a customized test delivered on an iPad. Test points were superimposed on SD-OCT locations to investigate structure/function relationships. Results Included in the study were 53 nAMD eyes and 21 at-risk fellow eyes. In nAMD eyes, the mean retinal sensitivity was 24.1 ± 1.8 dB with reduced retinal sensitivity associated with the presence of atrophy (P < 0.01), retinal pigment epithelium (RPE) disruption (P < 0.01), and absent ellipsoid zone (EZ) (P < 0.01), but not with the presence of subretinal fluid (P = 0.94) nor intraretinal fluid (P = 0.52). In at-risk eyes, the average retinal sensitivity was 28.8 ± 0.6 dB, with reduced sensitivity significantly associated with the presence of drusen, atrophy, RPE disruption, and absent EZ (P < 0.01). Conclusion The tablet-based test of retinal sensitivity was able to be performed by an elderly cohort with nAMD. The ability to correlate differences in sensitivity with pathology is encouraging when considering using the tablet devices as a home monitoring tool with remote surveillance. Dual pathology often present with retinal fluid confounded our ability to correlate fluid with sensitivity. Translational Relevance These findings highlight the potential of tablet-based devices in performing visual function measures as a home monitoring tool with remote surveillance for the earlier detection of nAMD.
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Affiliation(s)
- Chi Yun Doreen Ho
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Zhichao Wu
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Andrew Turpin
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - David J Lawson
- Department of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Chi D Luu
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Australia
| | - Robyn H Guymer
- Center for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Melbourne, Australia
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Ly A, Yapp M, Nivison-Smith L, Assaad N, Hennessy M, Kalloniatis M. Developing prognostic biomarkers in intermediate age-related macular degeneration: their clinical use in predicting progression. Clin Exp Optom 2017; 101:172-181. [PMID: 29136680 DOI: 10.1111/cxo.12624] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022] Open
Abstract
Age-related macular degeneration is a common, complex and blinding eye disease. When early and intermediate levels of severity are detected in one or both eyes, there is a wide-ranging 0.4 to 53 per cent risk of progression to advanced disease in five years. In order to maximise visual outcomes for their patients, practising eye-care professionals must be able to stratify patients according to their risk of progression, intervene (for example by recommending smoking cessation or nutritional supplements and Amsler grid self-monitoring in intermediate disease) and monitor accordingly. With the aid of ocular imaging, a range of under-recognised yet meaningful risk factors have been identified. The purpose of this review is to assist the eye-care practitioner in stratifying the risk of progression in intermediate age-related macular degeneration using the range of established and emerging precursory signs that herald loss of vision.
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Affiliation(s)
- Angelica Ly
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Hennessy
- Centre for Eye Health, Sydney, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia
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Aslam TM, Parry NRA, Murray IJ, Salleh M, Col CD, Mirza N, Czanner G, Tahir HJ. Development and testing of an automated computer tablet-based method for self-testing of high and low contrast near visual acuity in ophthalmic patients. Graefes Arch Clin Exp Ophthalmol 2016; 254:891-9. [PMID: 26899899 DOI: 10.1007/s00417-016-3293-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Many eye diseases require on-going assessment for optimal management, creating an ever-increasing burden on patients and hospitals that could potentially be reduced through home vision monitoring. However, there is limited evidence for the utility of current applications and devices for this. To address this, we present a new automated, computer tablet-based method for self-testing near visual acuity (VA) for both high and low contrast targets. We report on its reliability and agreement with gold standard measures. METHODS The Mobile Assessment of Vision by intERactIve Computer (MAVERIC) system consists of a calibrated computer tablet housed in a bespoke viewing chamber. Purpose-built software automatically elicits touch-screen responses from subjects to measure their near VA for either low or high contrast acuity. Near high contrast acuity was measured using both the MAVERIC system and a near Landolt C chart in one eye for 81 patients and low contrast acuity using the MAVERIC system and a 25 % contrast near EDTRS chart in one eye of a separate 95 patients. The MAVERIC near acuity was also retested after 20 min to evaluate repeatability. RESULTS Repeatability of both high and low contrast MAVERIC acuity measures, and their agreement with the chart tests, was assessed using the Bland-Altman comparison method. One hundred and seventy-three patients (96 %) completed the self- testing MAVERIC system without formal assistance. The resulting MAVERIC vision demonstrated good repeatability and good agreement with the gold-standard near chart measures. CONCLUSIONS This study demonstrates the potential utility of the MAVERIC system for patients with ophthalmic disease to self-test their high and low contrast VA. The technique has a high degree of reliability and agreement with gold standard chart based measurements.
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Affiliation(s)
- Tariq M Aslam
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Heriot-Watt University, Edinburgh, UK
| | - Neil R A Parry
- Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Centre for Hearing and Vision Research, Institute of Human Development, University of Manchester, Manchester, UK
| | - Ian J Murray
- Vision Science Centre, Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Eye Hospital, Central Manchester University, Manchester, UK.,Faculty of Life Sciences, University of Manchester, Room 3.005, Carys Bannister Building, Dover Street, Manchester, M13 9PL, UK
| | - Mahani Salleh
- Centre for Hearing and Vision Research, Institute of Human Development, University of Manchester, Manchester, UK
| | - Caterina Dal Col
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Naznin Mirza
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Gabriela Czanner
- Department of Biostatistics, Faculty of Health and Life Sciences, Department of Eye and Vision Science, University of Liverpool, Liverpool, UK
| | - Humza J Tahir
- Faculty of Life Sciences, University of Manchester, Room 3.005, Carys Bannister Building, Dover Street, Manchester, M13 9PL, UK.
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Hou F, Lesmes LA, Kim W, Gu H, Pitt MA, Myung JI, Lu ZL. Evaluating the performance of the quick CSF method in detecting contrast sensitivity function changes. J Vis 2016; 16:18. [PMID: 27120074 PMCID: PMC4898274 DOI: 10.1167/16.6.18] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 03/24/2016] [Indexed: 11/24/2022] Open
Abstract
The contrast sensitivity function (CSF) has shown promise as a functional vision endpoint for monitoring the changes in functional vision that accompany eye disease or its treatment. However, detecting CSF changes with precision and efficiency at both the individual and group levels is very challenging. By exploiting the Bayesian foundation of the quick CSF method (Lesmes, Lu, Baek, & Albright, 2010), we developed and evaluated metrics for detecting CSF changes at both the individual and group levels. A 10-letter identification task was used to assess the systematic changes in the CSF measured in three luminance conditions in 112 naïve normal observers. The data from the large sample allowed us to estimate the test-retest reliability of the quick CSF procedure and evaluate its performance in detecting CSF changes at both the individual and group levels. The test-retest reliability reached 0.974 with 50 trials. In 50 trials, the quick CSF method can detect a medium 0.30 log unit area under log CSF change with 94.0% accuracy at the individual observer level. At the group level, a power analysis based on the empirical distribution of CSF changes from the large sample showed that a very small area under log CSF change (0.025 log unit) could be detected by the quick CSF method with 112 observers and 50 trials. These results make it plausible to apply the method to monitor the progression of visual diseases or treatment effects on individual patients and greatly reduce the time, sample size, and costs in clinical trials at the group level.
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