Impact of Cataract Surgery on Low Luminance Visual Acuity Deficit Measurements.

Purpose: The impact of cataract surgery on low luminance visual acuity deficit (LLVAD) measurements was investigated by measuring the LLVAD before and after cataract surgery. Design: Prospective, longitudinal study. Participants: Patients undergoing cataract surgery. Methods: Photopic luminance (PL)-best-corrected visual acuity (BCVA) and low luminance (LL)-BCVA were obtained using the ETDRS chart. Low luminance visual acuity deficit scores were calculated by subtracting the LL-BCVA letter score from the PL-BCVA letter score. To demonstrate the reproducibility of these visual acuity measurements, we used data from drusen-only eyes previously published in the Complement Inhibition with Eculizumab for the Treatment of Nonexudative Age-Related Macular Degeneration (COMPLETE) study. The PL-BCVA, LL-BCVA, and LLVAD measurements obtained at an interval of 3 months in this cohort were used for comparison. In the current study, the impact of cataract surgery on LLVAD measurements was analyzed by comparing the PL-BCVA, LL-BCVA, and LLVAD measurements before and after cataract surgery. Main Outcome Measures: The reproducibility of the visual acuity measurements and the changes in LLVAD measurement after cataract surgery. Results: In the COMPLETE study, no clinically significant differences were found in the PL-BCVA, LL-BCVA, or LLVAD measurements between baseline and the 3-month follow-up visits with a change of -1.1 letters, -1.3 letters, and 0.1 letters, respectively (P = 0.02, P = 0.11, and P = 0.88, respectively). In the current study, significant increases were found in the PL-BCVA and LL-BCVA measurements, with a change of 7.3 letters and 10.2 letters after cataract surgery (P < 0.001 for both), and a statistically significant decrease in LLVAD measurements was found, with a change of -3.0 letters after cataract surgery (P = 0.002). Conclusions: Because of the variable effect of cataracts on LL-BCVA measurements and the significant change in LLVAD measurements after cataract surgery, investigators should be aware that cataract surgery during a trial will have an unpredictable impact on LLVAD measurements, and pseudophakic and phakic patients should be analyzed separately.

Vision Loss Secondary to Meningioma in the Pregnant Patient.

A 31-year-old primagravid female at 27 weeks gestation presented to the emergency room with three weeks of progressive blurring of vision associated with intermittent headaches. Ocular examination revealed diminished visual acuity, decreased color discrimination, and constricted confrontation visual fields; optic nerve appearance was however normal. Magnetic resonance imaging of the brain and orbits revealed a large tuberculum meningioma compressing the optic chiasm and prechiasmatic optic nerves, as well as a small sphenoid wing meningioma. Given the risk of permanent vision loss, the patient underwent emergent tumor resection. Near total resection of the masses was achieved and the patient had complete resolution of her vision post-operatively. She gave birth via Caesarean section at 39 weeks. This case report describes the clinical presentations of intracranial meningiomas and discusses the challenges this condition poses in management during pregnancy.