Visual performance 3 years after successful macular hole surgery.

BACKGROUND/AIMS: To evaluate the visual performance of patients with successful macular hole surgery with a minimum follow-up of 3 years. Results were compared with the performance of the healthy fellow eyes. METHODS: 15 patients were studied. The healthy fellow eyes of the patients (13 eyes) served as a control group. Age, gender and best-corrected logMAR visual acuity were recorded. Reading acuity (in log reading acuity determination (RAD), reading equivalent of logMAR) and speed were tested monocularly. Scotoma size was measured with SLO perimetry, and hole closure was confirmed with an OCT scan. RESULTS: The mean distance visual acuity of the operated eyes (logMAR 0.32 (SD 0.21)) was significantly lower than that of the healthy fellow eyes (logMAR 0.05 (0.17)), but significantly higher than preoperatively (logMAR 0.71 (0.32)). The mean reading acuity was logRAD 0.47 (0.25) for the operated eyes ( = 77.9% of logMAR), and statistically significantly higher (logRAD 0.16 (0.16)) for the fellow eyes ( = 89.4% of logMAR). The mean maximum reading speeds were comparable for the operated eyes (168.3 (23.1) words per minute (wpm)) and the fellow eyes (178.7 (26.1) wpm) (p = 0.3). Within logRAD 1.3 and 0.5, the mean reading speeds of the two groups were comparable, but critical print size (CPS) for the operated group (logRAD 0.7 (0.2)) was significantly worse than those for the fellow eyes (logRAD 0.4 (0.2)). The SLO analysis showed absence of absolute scotoma in 12 eyes. CONCLUSION: Distance and reading acuity showed remaining deficits compared with the healthy fellow eyes; however, mean maximum reading speeds of the operated eyes achieved results comparable with healthy eyes. The results show a long-term benefit in the visual function of eyes with closed macular holes.

Repeated mobility testing for later artificial visual function evaluation.

The study investigates the utility of a newly designed mobility test for repeated testing of visual function in patients with severe visual impairment and future application in evaluating functional progress in patients with artificial vision. Ten subjects divided into three groups based on visual acuity (VA) ranging from light perception to 20/200 and reduced visual field (VF) were included in the study. The mobility test consisted of using a set of four different but structurally similar and relatively short mazes having a constant number of obstacles of various sizes. The subjects, divided into three groups by acuity, passed through each course several times. In general, the patients with better VA had a larger extent of VF. Average speed and number of contacts were recorded as measures of performance. The average passing times of the groups through the courses were significantly different (p = 0.03), which was influenced by VA and VF. There was no significant difference in average number of contacts between the groups (p = 0.15). The mobility test proved to be appropriate for gaining statistically relevant results in repeated individual testing of patients with severe vision impairment. Results show promise for use this mobility test as a tool for assessing visual function of patients undergoing implantation of a visual prosthesis for artificial vision.

[Development of an epiretinal prosthesis for stimulation of the human retina]. / Entwicklung einer epiretinalen Prothese zur Stimulation der humanen Netzhaut.

Degenerations of the outer retina in retinal diseases such as retinitis pigmentosa lead to blindness due to photoreceptor loss. A therapeutic option for visual rehabilitation is presently not available. Over the last few years, a retinal prosthesis has been developed and its use has been tested in animal experiments as well as in humans. With the epiretinal implant images of the environment are taken by a camera, these data are transmitted to an intraocular encoder, and the retina is electrically stimulated by a retinal stimulator placed epiretinally. The stimulation electrodes are placed as flexible microcontact electrodes by pars plana vitrectomy in an epimacular position. The threshold is determined by stimulations of increasing amplitudes. Initial results of acute epiretinal stimulation using an epiretinal implant in legally blind patients demonstrate that acute epiretinal stimulation of the human retina is feasible and safe.

Influence of sex, visual acuity, and systemic disease on delayed presentation for cataract surgery in Austria.

PURPOSE: To determine the influence of sex, age, preoperative visual acuity, and systemic disease on the delay in presentation for first-eye cataract surgery. SETTING: University Eye Clinic, Vienna, Austria. METHODS: This retrospective study comprised 200 consecutive patients with age-related cataract who were referred to the Ophthalmology Department of the University of Vienna and who had cataract surgery in the first eye. Patients with additional intraocular procedures or with other ocular comorbidity were excluded. Age, sex, preoperative best corrected Snellen visual acuity in both eyes, ocular and systemic comorbidity, and the duration of preoperative visual deterioration were recorded. The patients were divided into groups depending on systemic comorbidity. The severity of disease was categorized as no therapy necessary or nonexistent, nonsevere, or severe. RESULTS: The mean age of women and men was 74.9 years and 70.7 years, respectively, and the mean preoperative visual acuity, 0.31 and 0.24. The duration of preoperative visual deterioration was 8.6 months and 12.2 months, respectively. All differences were statistically significant (P <.05). The visual acuity in the better eye was not significantly different between men and women. Neither the presence nor the type of systemic disease influenced preoperative visual acuity or the duration of preoperative visual deterioration. CONCLUSIONS: Although the visual acuity in the better eye was not different between men and women, men had cataract surgery after a longer duration of visual deterioration and with a worse visual acuity. More public information about cataract surgery is required to keep visual deterioration secondary to cataract to a minimum.

[A new reading chart for simultaneous determination of reading vision and reading speed]. / Eine neue Lesetafel zur gleichzeitigen Bestimmung von Lesevisus und Lesegeschwindigkeit.

BACKGROUND: Reading acuity as well as reading speed are good predictors of everyday visual function. As visual acuity tests are poor predictors of the real-world function, performance-based tests, e.g., reading speed measurements, can be used for the determination of visual function. Thus, a German reading chart was developed in order to evaluate reading acuity as well as reading speed. METHODS: Print size is defined as the height of a lower case x and progresses logarithmically from one phrase to another (factor: 1.25). Reading acuity is determined in LogRAD (Reading Acuity Determination). 32 short German phrases were created, comparable concerning grammatical difficulty as well as in number (n = 14), length and position of words. The reading speed parameters measured with a stop-watch in 160 persons (aged: Phi = 21a +/- 3.8a) were calculated in words per minute (w/min). Out of the 32 phrases the 24 most similar ones were selected statistically and used for the reading charts (Radner Reading Charts). With these reading charts a reading acuity score (LogRAD-score) can be calculated considering reading errors in words of different length. Reading speed can be determined at the same time. Reading acuity (LogRAD-Score) was measured in 32 normal eyes of 16 students and compared to the angular visual acuity (LogMAR). RESULTS: The mean reading speed of the test persons was 211.8 +/- 34.1 w/min. 24 phrases fulfilled the test item criteria for the reading chart: mean +/- 0.25 x SD. The reliability analyses yielded an overall Cronbach's alpha coefficient of 0.98! The mean visual acuity measured in 32 eyes was -0.115 +/- 0.097 LogMAR and the mean reading acuity score was +0.026 +/- 0.091 LogRAD. The mean difference was +0.104 +/- 0.066 and the correlation between LogMAR and LogRAD was good (r = 0.59). CONCLUSIONS: With these reading charts it is for the first time possible to simultaneously determine reading acuity as well as reading speed in German. The high reliability of the 24 phrases and the high correlation between LogMAR and LogRAD leads us to expect a good reproducibility of the reading acuity evaluations. For the "Radner Reading Charts" we have shown that print size is the main reason for changes of reading speed.