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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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Hess K, Park YJ, Kim HA, Holz FG, Charbel Issa P, Yoon YH, Tzaridis S. Tamoxifen Retinopathy and Macular Telangiectasia Type 2: Similarities and Differences on Multimodal Retinal Imaging. Ophthalmol Retina 2023; 7:101-110. [PMID: 35948211 DOI: 10.1016/j.oret.2022.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Tamoxifen-induced retinopathy (TR) and macular telangiectasia type 2 (MacTel) share a highly similar retinal phenotype. In this study, we aimed to evaluate differences and similarities that may point toward underlying mechanisms linking both disease entities. DESIGN Retrospective, cross sectional study. SUBJECTS Patients diagnosed with MacTel or TR. METHODS Patients underwent multimodal retinal imaging, including color fundus photography, spectral-domain OCT, fundus autofluorescence, fluorescein angiography, and OCT angiography (if available). Age, age of onset, best-corrected visual acuity, and bilaterality of changes were evaluated. Patients' eyes were graded for different morphologic characteristics by 4 experienced graders. MAIN OUTCOME MEASURES Phenotypical characterization and comparison of frequencies of retinal characteristics of TR and MacTel on multimodal imaging. RESULTS Twenty-eight eyes of 14 patients with TR and 118 eyes of 59 patients with MacTel were included. Age, age of onset, and best-corrected visual acuity were similar in both cohorts. All but 1 patient showed bilateral changes. In patients with MacTel, neurodegenerative changes and vascular alterations were equally present, whereas in patients with TR, neurodegenerative changes usually prevailed. Predilection sites within the central retina differed between the 2 diseases: most findings in patients with TR were limited to the foveal center, whereas changes in patients with MacTel were present throughout a slightly larger region ("MacTel area"), with an epicenter temporal to the foveal center. Distinct morphologic features included the distribution of retinal crystals, the size and position of ellipsoid zone breaks, and the presence of hyperreflective changes on OCT images. Focal hyperpigmentation and neovascular membranes were only present in eyes with MacTel. CONCLUSIONS Macular telangiectasia and TR share a highly similar retinal phenotype, especially in early disease stages. Subtle differences on multimodal retinal images may help distinguish between these 2 disease entities. Our findings indicate the involvement of Müller cells in both diseases, which may explain the observed phenotypic characteristics and similarities.
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Affiliation(s)
- Kristina Hess
- Department of Ophthalmology, University of Bonn, Bonn, Germany; National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Yu Jeong Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Ah Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Simone Tzaridis
- Department of Ophthalmology, University of Bonn, Bonn, Germany; The Lowy Medical Research Institute, La Jolla, California; The Scripps Research Institute, Department of Molecular Medicine, La Jolla, California.
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Keuken A, Subramanian A, Mueller-Schotte S, Barbur JL. Age-related normal limits for spatial vision. Ophthalmic Physiol Opt 2022; 42:1363-1378. [PMID: 35979702 DOI: 10.1111/opo.13037] [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: 09/22/2021] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To establish age-related, normal limits of monocular and binocular spatial vision under photopic and mesopic conditions. METHODS Photopic and mesopic visual acuity (VA) and contrast thresholds (CTs) were measured with both positive and negative contrast optotypes under binocular and monocular viewing conditions using the Acuity-Plus (AP) test. The experiments were carried out on participants (age range from 10 to 86 years), who met pre-established, normal sight criteria. Mean and ± 2.5σ limits were calculated within each 5-year subgroup. A biologically meaningful model was then fitted to predict mean values and upper and lower threshold limits for VA and CT as a function of age. The best-fit model parameters describe normal aging of spatial vision for each of the 16 experimental conditions investigated. RESULTS Out of the 382 participants recruited for this study, 285 participants passed the selection criteria for normal aging. Log transforms were applied to ensure approximate normal distributions. Outliers were also removed for each of the 16 stimulus conditions investigated based on the ±2.5σ limit criterion. VA, CTs and the overall variability were found to be age-invariant up to ~50 years in the photopic condition. A lower, age-invariant limit of ~30 years was more appropriate for the mesopic range with a gradual, but accelerating increase in both mean thresholds and intersubject variability above this age. Binocular thresholds were smaller and much less variable when compared to the thresholds measured in either eye. Results with negative contrast optotypes were significantly better than the corresponding results measured with positive contrast (p < 0.004). CONCLUSIONS This project has established the expected age limits of spatial vision for monocular and binocular viewing under photopic and high mesopic lighting with both positive and negative contrast optotypes using a single test, which can be implemented either in the clinic or in an occupational setting.
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Affiliation(s)
- Arjan Keuken
- Applied Vision Research Centre, The Henry Wellcome Laboratories for Vision Science, City, University of London, London, UK.,Department of Optometry, University of Applied Sciences, Utrecht, The Netherlands
| | - Ahalya Subramanian
- Applied Vision Research Centre, The Henry Wellcome Laboratories for Vision Science, City, University of London, London, UK
| | - Sigrid Mueller-Schotte
- Department of Optometry, University of Applied Sciences, Utrecht, The Netherlands.,Department Technology for Healthcare Innovations, University of Applied Sciences, Utrecht, The Netherlands
| | - John L Barbur
- Applied Vision Research Centre, The Henry Wellcome Laboratories for Vision Science, City, University of London, London, UK
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Hirji SH, Hood DC, Liebmann JM, Blumberg DM. Association of Patterns of Glaucomatous Macular Damage With Contrast Sensitivity and Facial Recognition in Patients With Glaucoma. JAMA Ophthalmol 2021; 139:27-32. [PMID: 33151275 DOI: 10.1001/jamaophthalmol.2020.4749] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Facial recognition is a critical activity of daily living that relies on macular function. Glaucomatous macular damage may result in impaired facial recognition that may negatively affect patient quality of life. Objective To evaluate the association of patterns of glaucomatous macular damage with contrast sensitivity and facial recognition among patients with glaucoma. Design, Setting, and Participants In this prospective cohort study at a single tertiary care center, 144 eyes of 72 consecutive patients with glaucoma with good visual acuity (20/40 or better in each eye) were studied. Data were collected from March to April 2019. Exposures Eyes with macular damage were categorized as having focal, diffuse, or mixed (focal and diffuse) damage based on optic disc and macular spectral-domain optical coherence tomography and 10-2 visual field (VF) damage. Only eyes with focal or diffuse damage were included. Higher-acuity and lower-acuity eyes were determined by 10-2 VF mean deviation (MD). Facial disability was defined as facial recognition scores at the 2% level of normal participants. Main Outcomes and Measures (1) Monocular contrast threshold as measured by the Freiburg Visual Acuity and Contrast Test and (2) binocular facial recognition as measured by the Cambridge Face Memory Test. Results Of the 72 included patients, 49 (68%) were White and 41 (57%) were female, and the mean (SD) age was 67.0 (11.6) years. Eyes with diffuse damage had greater contrast impairment compared with eyes with focal damage (β = -0.5; 95% CI, -0.6 to -0.4; P < .001) after adjusting for 10-2 VF MD, 24-2 VF MD, age, presence of an early cataract, and number of drops. Similarly, Cambridge Face Memory Test scores were significantly lower in patients with diffuse rather than focal macular damage, regardless of eye (better-seeing eye: β = 10.0; 95% CI, 2.0 to 18.2; P = .001; worse-seeing eye: β = 5.5; 95% CI, 0.8 to 10.0; P = .23). Relative risk of facial disability was greater for patients with diffuse but not focal macular damage in the better-seeing eye (relative risk, 86.2; 95% CI, 2.7 to 2783.3; P = .01). Conclusions and Relevance In this cohort study, diffuse rather than focal glaucomatous macular damage was associated with diminished facial recognition and contrast sensitivity. Evaluation of macular optical coherence tomography and 10-2 VF and resultant detection of diffuse macular damage may help minimize glaucoma-related visual disability.
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Affiliation(s)
- Sitara H Hirji
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Donald C Hood
- Department of Psychology, Columbia University, New York, New York.,Department of Ophthalmology, Columbia University, New York, New York
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
| | - Dana M Blumberg
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Low Luminance Visual Acuity and Low Luminance Deficit in Proliferative Diabetic Retinopathy. J Clin Med 2021; 10:jcm10020358. [PMID: 33477954 PMCID: PMC7835861 DOI: 10.3390/jcm10020358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/07/2021] [Accepted: 01/15/2021] [Indexed: 11/21/2022] Open
Abstract
This study aimed to determine the relation of best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) in proliferative diabetic retinopathy (PDR) following treatment with either aflibercept or pan-retinal photocoagulation (PRP). The study was conducted as a post-hoc analysis of the CLARITY trial in which naïve and PRP treated PDR patients were randomised to receive either aflibercept or PRP. BCVA and LLVA were assessed at baseline and at week 52. Our analyses showed that the BCVA and LLVA correlate well in treatment naïve PDR with an average low luminance deficit of 11.79 Early Treatment Diabetic Retinopathy Score (ETDRS) letters. However, LLVA at lower levels of BCVA showed more variance. Post aflibercept therapy, the mean change in BCVA and LLVA at 52 weeks after aflibercept was +2.1 (SD 6.05) letters and +0.39 (SD 5.6) letters, respectively. Similarly, after PRP, it was −2.5 (SD 4.9) letters and −1.9 (SD 8.7) letters, respectively. When comparing treatment arms, BCVA change was found to be statistically significant (p < 0.001) whereas LLVA was not (p = 0.11). These findings show that LLVA does not respond as well as BCVA following any treatment for PDR, even though BCVA and LLVA both test foveal function.
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Wood LJ, Jolly JK, Buckley TM, Josan AS, MacLaren RE. Low luminance visual acuity as a clinical measure and clinical trial outcome measure: a scoping review. Ophthalmic Physiol Opt 2021; 41:213-223. [PMID: 33403668 DOI: 10.1111/opo.12775] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/03/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE The measurement of standard visual acuity (VA) is the most well-known part of any ophthalmic examination to indicate visual function. Despite this, it is insensitive in detecting early disease changes. Therefore, other visual function tests have been developed including low luminance VA (LLVA) and low luminance deficit (LLD). This scoping literature review aims to summarise the current published applications of LLVA and LLD assessments to evaluate their utility as clinical markers and research outcome measures in a variety of ophthalmic conditions. RECENT FINDINGS Sixty-five peer-reviewed publications were included. LLVA was pioneered for use in geographic atrophy, a subtype of age-related macular degeneration, which remains the mainstay of its clinical application. However, other studies have reported additional useful applications in inherited retinal diseases including rare maculopathies and rod-cone dystrophies. Although there are some variations in testing methodology, use of the standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart with a 2.0 log unit neutral density filter is the most popular approach. The optimal testing luminance is still to be defined. SUMMARY Overall, LLVA is an earlier clinical marker of change in central retinal function than standard VA. It has been shown to be a risk factor for disease progression and a better indicator of a patient's level of everyday visual function. It is inexpensive and simple to implement using readily available standard ophthalmic equipment.
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Affiliation(s)
- Laura J Wood
- 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
| | - 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
| | - Thomas Mw Buckley
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Amandeep S Josan
- 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
| | - 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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Wu D, Liu N, Xu P, Sun K, Xiao W, Li C. Reduced Contrast Sensitivity Function in Central and Peripheral Vision by Disability Glare. Perception 2020; 49:1348-1361. [PMID: 33131398 DOI: 10.1177/0301006620967641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Various glares can decrease visual performance and cause discomfort, thus increasing drivers' risk for traffic accidents in real life. The current study aimed to systematically investigate glare sensitivity in the central and peripheral visual fields by measuring contrast sensitivity function (CSF) under nonglare, steady glare, and transient glare conditions. Nine observers with normal visual acuity in the dominant eye were enrolled. The CSF in central and peripheral vision (the 5° upper left visual field) was measured in a mesopic environment while the stimulus was displayed under three conditions: nonglare, steady glare, and transient glare. An orientation identification task was used to obtain the CSF. After the experiment, the observers were asked to report their level of discomfort in the presence of the glare. The area under the log CSF (AULCSF) and cut-off spatial frequency served as indicators of visual performance. In agreement with previous studies, both steady and transient glare reduced the AULCSF and cut-off frequency. However, the AULCSF and cut-off frequency were reduced more for central vision than for nearly peripheral vision. In addition, the extent of the decreases in the AULCSF and cut-off frequency was greater for steady glare than for transient glare; in contrast, more discomfort was associated with transient glare than steady glare.
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Affiliation(s)
- Di Wu
- Yueyang Vocational Technical College, China
| | - Na Liu
- Yueyang Vocational Technical College, China
| | - Pengbo Xu
- Yueyang Vocational Technical College, China
| | - Kewei Sun
- Yueyang Vocational Technical College, China
| | - Wei Xiao
- Air Force Medical University, China.,Yueyang Vocational Technical College, China
| | - Chenxi Li
- Yueyang Vocational Technical College, China
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Hirji SH, Liebmann JM, Hood DC, Cioffi GA, Blumberg DM. Macular Damage in Glaucoma is Associated With Deficits in Facial Recognition. Am J Ophthalmol 2020; 217:1-9. [PMID: 32360859 DOI: 10.1016/j.ajo.2020.04.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This report examines the relationship between glaucomatous macular damage and facial recognition. In addition, it assesses the role of contrast sensitivity (CS) as an intermediary step in the causal pathway between macular damage and impairment of facial recognition. DESIGN Prospective cross-sectional study. METHODS This study was conducted in a single tertiary care center. The study population included 144 eyes of 72 participants with a diagnosis of open angle glaucoma in one or both eyes and a visual acuity of 20/40 or better in each eye. The presence or absence of macular damage was determined by comparing corresponding regions of the retinal nerve fiber layer and the retinal ganglion cell layer with spectral-domain optical coherence tomography with the 10-2 visual field (VF). Better and worse eye was determined by 10-2 VF mean deviations (MDs). Interventions were 1) macular function as measured by 10-2 VF and 2) CS as measured by the Freiburg Visual Acuity and Contrast Test (FrACT). The primary outcome measure was the Cambridge Face Memory Test (CFMT) score. RESULTS Regardless of eye, there was a significant correlation between facial recognition and 10-2 VF MD (P < .0001 better, worse eye). The 10-2 VF MD remained a significant predictor of facial recognition after adjusting for potential confounders including glaucoma severity, CS, age, and visual acuity (P = .004 better eye, P = .019 worse eye). CONCLUSIONS Even with good central visual acuity, patients with glaucomatous macular damage exhibit diminished facial recognition, which is partly mediated through diminished CS.
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Abstract
PURPOSE To evaluate dark adaptation (DA) in patients with macular telangiectasia Type 2 (MacTel). METHODS After a local photobleach (4 × 4° size, 83% bleach), DA was measured using a test stimulus (2° diameter) projected at 5° eccentricity horizontal from the foveal center within the temporal parafovea. Cone plateau, rod intercept time, and rod recovery rate (S2) were calculated from the resulting DA curves. Findings were correlated with disease stages (according to Gass and Blodi), the area of ellipsoid zone loss in optical coherence tomography, and macular pigment loss ("MP-Classes 1-3"). RESULTS Fifty-nine eyes of 59 patients were compared with 18 eyes of 18 healthy controls. Dark adaptation was significantly impaired in patients with MacTel. Although differences were most pronounced for parameters indicating rod-mediated recovery, cone-mediated recovery was also decreased, yet to a lesser extent. Dark adaptation parameters were only weakly associated with disease stages and ellipsoid zone loss. A better association was found between rod-mediated recovery (S2 and rod intercept time) and macular pigment loss (Kendall's tau for rod intercept time: 0.69 and S2: -0.51; both P < 0.0001). CONCLUSION Dark adaptation is significantly impaired in patients with MacTel. Our results indicate an association of reduced macular pigment and rod dysfunction in MacTel.
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Heeren TFC, Tzaridis S, Bonelli R, Pfau M, Fruttiger M, Okada M, Egan C, Charbel Issa P, Holz FG. Dark-Adapted Two-Color Fundus-Controlled Perimetry in Macular Telangiectasia Type 2. ACTA ACUST UNITED AC 2019; 60:1760-1767. [DOI: 10.1167/iovs.18-25360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Tjebo F. C. Heeren
- Department of Ophthalmology, University of Bonn, Bonn, Germany
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Simone Tzaridis
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Roberto Bonelli
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Mali Okada
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Catherine Egan
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- UCL Institute of Ophthalmology, University College London, London, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospital NHS Foundation Trust and the Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
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