Test time affects Farnsworth D15 outcomes in practiced, but not unpracticed, subjects with color vision deficiency.

SIGNIFICANCE: Imposing a time limit on the Farnsworth D15 test may prevent patients from compromising the test. PURPOSE: This study aimed to investigate the effect of test time on the Farnsworth D15 color vision test in unpracticed and practiced subjects and determine an optimal test time. METHODS: Twenty-one subjects (mean/standard deviation age, 33.1/9.3 years) with a range of congenital color vision deficiency participated in the study. Pseudoisochromatic plate screening, Farnsworth D15, and anomaloscope testing were performed for classification purposes. At each of 2 visits, 10 trials of the Farnsworth D15 were performed with a range in test times from 30 seconds to 10 minutes. Between visits, subjects practiced the test. Major crossovers were used as the outcome measure. A repeated-measures analysis of variance compared the scores across trials. Post hoc Dunnett's testing analyzed the pairwise data. RESULTS: Although no significant difference in the mean number of major crossovers was found across the 10 trials for the first visit ( F (9, 180) = 1.30, p=0.24), a significant difference was found for the second visit ( F (9, 180) = 4.77, p<0.001). The range of mean number of major crossovers for the second visit was 1.71 to 5.1, with the 30-second trial resulting in the largest number of major crossovers and the longest trial resulting in the smallest number of major crossovers. Analysis showed that a 2-minute time limit resulted in a Farnsworth D15 outcome that would be expected based on the anomaloscope for a majority of subjects. CONCLUSIONS: In this study, test time was found to affect performance in practiced subjects but not in unpracticed subjects. Based on this study, we recommend enforcing a time limit of 2 minutes to discourage those who try to pass the Farnsworth D15 through practice. Additional measures, such as recording patient behavior, can also be taken.

Lanthony D15 for Occupational Testing: Short-term Repeatability.

SIGNIFICANCE: The Lanthony D15 has been reported to have poorer repeatability than the Farnsworth D15. This study found that two trials of the test provide high short-term repeatability and can be administered this way for occupational testing. PURPOSE: This study aimed to determine the short-term repeatability of the Lanthony D15 in patients with color vision deficiency. Repeated trials were used to examine if learning effects occur and to determine how many trials would be necessary to ensure the highest short-term repeatability for occupational testing. METHODS: Twenty male subjects (mean [standard deviation] age, 27.2 [4.3] years) with congenital color vision deficiency, ranging from mild to severe, participated in this single-visit study. Visual acuity, color vision book screening, Farnsworth D15, and anomaloscope testing were performed for classification purposes. Ten trials of the Lanthony D15 were performed. Color confusion index scores from each trial were determined, and a repeated-measures analysis of variance was used to compare the scores across trials. Orthogonal polynomial analysis was performed to detect any trends across trials through the third order. The intraclass correlation coefficient was calculated. RESULTS: No differences in color confusion index (mean [standard error of the mean], 3.57 [0.04]) were found across the 10 trials ( P = .18). Legendre polynomials showed no statistical significance (all P > .39). The intraclass correlation coefficient was 0.81 (95% confidence interval, 0.70 to 0.90). Based on the method of Shrout and Fleiss, intraclass correlation coefficients of 0.7, 0.8, and 0.9 could be achieved with an average of one, two, and four trials of the test, respectively. However, empirically, 0.9 was not achievable. CONCLUSIONS: The Lanthony D15 test has fairly high short-term repeatability. Thus, although more trials would likely improve clinical certainty, the mean result of two trials appears sufficient for occupational testing.

Prevalence of Color Vision Deficiency in an Adult Population in South Korea.

SIGNIFICANCE: Large differences in failure rates for color vision screening have been reported among different regional groups. However, color vision deficiency prevalence in Korea has only been investigated within a small area of the country. PURPOSE: This study examines the prevalence of failing a color vision screening and its sex-related differences using a sample that is representative of the whole Korean population. METHODS: This population-based cross-sectional study evaluated 2686 subjects (age, 19 to 49 years) who participated in the sixth Korea National Health and Nutrition Examination Survey (2013). Color vision deficiency was assessed using the Hardy-Rand-Rittler (HRR) test by an ophthalmologist. According to standard criteria for the HRR, it classified each subject as color normal, protan, deutan, tritan, or unclassified color vision loss. All participants had comprehensive medical evaluations and ocular history taken. RESULTS: The weighted overall prevalence of color vision deficiency in the Korean population was 3.9% (95% confidence interval, 3.0 to 5.4%). The prevalence of color vision deficiency was higher in male participants (6.5%) than in female participants (1.1%). Among all participants, deutan deficiency (2.5%) had a higher prevalence than did protan deficiency (0.4%). For male participants who failed the HRR screening, deutan-type deficiency was detected most often (64.2%), whereas an unclassified color vision deficiency type was the most common (52.9%) among female participants who failed the HRR screening. As expected, male participants were more likely to fail the HRR screening compared with female participants (prevalence ratio, 6.08; 95% confidence interval, 3.61 to 10.26). CONCLUSIONS: This large population-based study of color vision deficiency among Koreans gives the most accurate estimate of failing a color vision screening test to date and provides useful information for planning adaptive strategies.

Can the Farnsworth D15 Color Vision Test Be Defeated through Practice?

SIGNIFICANCE: This study suggests that it is possible for some patients with severe red-green color vision deficiency to do perfectly on the Farnsworth D15 test after practicing it. PURPOSE: The Farnsworth D15 is a commonly used test to qualify people for certain occupations. For patients with color vision deficiency, there may be high motivation to try to pass the test through practice to gain entry into a particular occupation. There is no evidence in the literature on whether it is possible for patients to learn to pass the D15 test through practice. METHODS: Ten subjects with inherited red-green color vision deficiency and 15 color-normal subjects enrolled in the study. All subjects had anomaloscope testing, color vision book tests, and a Farnsworth D15 at an initial visit. For the D15, the number of major crossovers was determined for each subject. Failing the D15 was determined as greater than 1 major crossover. Subjects with color vision deficiency practiced the D15 as long as desired to achieve a perfect score and then returned for a second visit for D15 testing. A paired t test was used to analyze the number of major crossovers at visit 1 versus visit 2. RESULTS: Color-normal subjects did not have any major crossovers. Subjects with color vision deficiency had significantly (P < .001) fewer major crossovers on the D15 test at visit 2 (mean/SD = 2.5/3.0), including five subjects with dichromacy that achieved perfect D15 performance, compared to visit 1 (mean/SD = 8.7/1.3). CONCLUSIONS: Practice of the Farnsworth D15 test can lead to perfect performance for some patients with color vision deficiency, and this should be considered in certain cases where occupational entry is dependent on D15 testing.

Case Report: Invalidation of the Farnsworth D15 Test in Dichromacy Secondary to Practice.

SIGNIFICANCE: The Farnsworth D15 test can be subverted by patients even with severe red-green color deficiency. PURPOSE: To describe a case showing that perfect performance on the Farnsworth D15 is possible after practicing the test. CASE REPORT: A 23-year-old man presented for a comprehensive color vision evaluation. He had only minor complaints with regard to color vision and otherwise normal vision and ocular health. Based on anomaloscope findings, he was diagnosed with protanopia, a form of dichromacy in which the patient does not have any functional L cones, only S and M cones. The patient practiced the Farnsworth D15 test and returned for a follow-up visit in which he performed the test perfectly four times (i.e., twice in the regular order and twice using cap 15 as the pilot cap). In addition, the patient returned a year later and again performed the test perfectly, indicating long-term learning. CONCLUSIONS: All studies to date have shown that patients with dichromacy fail the Farnsworth D15 test. This case report shows that it is indeed possible for highly motivated patients to subvert the test through practice, and knowledge of this possibility is very important, especially in occupational testing.

Determinants and standardization of mesopic visual acuity.

PURPOSE: It is well established that visual acuity (VA) decreases with luminance but the specific factors that are responsible remain unclear. The purpose of this study was to quantify the contributions of accommodative error, pupil size, and higher-order aberrations to the decrease in VA when transitioning from photopic to mesopic light levels. Additionally, repeatability of VA at photopic and mesopic levels was measured to derive a luminance recommendation for mesopic VA testing, which can provide the standardization needed for future translational clinical studies and the widespread adoption of mesopic VA testing. METHODS: Monocular VAs were assessed at one photopic and three mesopic light levels: 94, 3, 0.75, and 0.38 cd/m, with an E-ETDRS testing system in 43 normal subjects. Accommodative error, pupil size, and higher-order aberrations were obtained. Twenty subjects were retested at another visit to assess VA repeatability. RESULTS: The mean (±SD) logMAR (logarithm of the minimum angle of resolution) VA was -0.08 (±0.06) at 94 cd/m, 0.05 (±0.07) at 3 cd/m, 0.16 (±0.06) at 0.75 cd/m, and 0.27 (±0.09) at 0.38 cd/m. Light level and accommodative error were significantly associated with VA, and light level explained 75% of the variance. The mean differences in VAs between two visits were not significantly different from zero (p > 0.05). The coefficients of repeatability for 94, 3, 0.75, and 0.38 cd/m were 0.08, 0.11, 0.14, and 0.14 logMAR, respectively. CONCLUSIONS: Light level, among all other factors studied, contributes the most to the reduction in VA tested under mesopic conditions. Testing mesopic VA at 0.75 cd/m, or about 2.0 log units less than photopic testing, provides a significant and repeatable decrease in VA similar to standardized low-contrast VA testing, and therefore this level is recommended.

Evaluation of the Waggoner Computerized Color Vision Test.

PURPOSE: Clinical color vision evaluation has been based primarily on the same set of tests for the past several decades. Recently, computer-based color vision tests have been devised, and these have several advantages but are still not widely used. In this study, we evaluated the Waggoner Computerized Color Vision Test (CCVT), which was developed for widespread use with common computer systems. METHODS: A sample of subjects with (n = 59) and without (n = 361) color vision deficiency (CVD) were tested on the CCVT, the anomaloscope, the Richmond HRR (Hardy-Rand-Rittler) (4th edition), and the Ishihara test. The CCVT was administered in two ways: (1) on a computer monitor using its default settings and (2) on one standardized to a correlated color temperature (CCT) of 6500 K. Twenty-four subjects with CVD performed the CCVT both ways. Sensitivity, specificity, and correct classification rates were determined. RESULTS: The screening performance of the CCVT was good (95% sensitivity, 100% specificity). The CCVT classified subjects as deutan or protan in agreement with anomaloscopy 89% of the time. It generally classified subjects as having a more severe defect compared with other tests. Results from 18 of the 24 subjects with CVD tested under both default and calibrated CCT conditions were the same, whereas the results from 6 subjects had better agreement with other test results when the CCT was set. CONCLUSIONS: The Waggoner CCVT is an adequate color vision screening test with several advantages and appears to provide a fairly accurate diagnosis of deficiency type. Used in conjunction with other color vision tests, it may be a useful addition to a color vision test battery.

Color vision deficiency in Zahedan, Iran: lower than expected.

PURPOSE: To estimate the prevalence of congenital red-green color vision defects in the elementary school students of Zahedan in 2012. METHODS: In this cross-sectional study, 1000 students with a mean (±SD) age of 9.0 (±1.4) years were selected randomly from a large primary school population. Color vision was evaluated using the Ishihara pseudoisochromatic color plates (38-plate edition). A daylight fluorescent tube was used as an illuminant C equivalent (i.e., 860 lux, color rendering index greater than 92, and color temperature = 6500 K). Having more than three misreadings on the test was considered a failing criterion. Data were analyzed in SPSS version 17 software using χ2 tests. RESULTS: Nine students (0.9%) made more than three errors on the Ishihara test. Based on this criterion, the prevalence of red-green color vision deficiency in girls and boys was 0.2 and 1.6% (p = 0.02), respectively. CONCLUSIONS: The prevalence of red-green color vision deficiency was found to be significantly lower in Zahedan than comparable reports in the literature.

Diabetic Retinopathy during pregnancy in Hispanic women with latent Toxoplasma gondii infection.

BACKGROUND: Retinal photography was performed in pregnancy and postpartum in pregnant Hispanic women with latent Toxoplasma gondii (TG) infection in order to screen for characteristic retinal lesions or the particular scars found in people with active T. gondii infection. A comparison group of TG negative women was included in the study but they did not have retinal photography. OBJECTIVE: The goal of the parent study was to assess for adverse pregnancy events and evidence for parasite reactivation in TG positive (TG + ) women, through examination of the eyes for characteristic lesions. Retinal photography, usually at prenatal visits 2 (17 +/- 3.35 weeks) and 3 (26.3+/-1.75) weeks, was done on TG + women. Fifty-six of these women also (43 %) had retinal photography at the postpartum visit. Health and demographic data were obtained at the first prenatal visit for all women. STUDY DESIGN: From the 690 recruited at the first prenatal visit, 128 TG- women and 158 TG + women were enrolled in a prospective study through pregnancy and the postpartum. All TG- women (n = 532) provided data at the first prenatal visit and throughout their pregnancy and birth through the EHR. This allowed comparison of health and outcome data for the TG + compared to a larger number of TG- Hispanic pregnant women. RESULTS: While there was no evidence of ocular toxoplasmosis during pregnancy, there was a surprisingly large number (42 %) of TG + women with diabetic retinopathy (DR). We also observed that TG + women had a 20 % incidence of gestational diabetes mellitus (GDM) compared to 11.3 % in the TG- women (p = 0.01). At postpartum (mean 5.6 weeks), 23 of 30 women with pregnancy DR showed no DR in the postpartum. CONCLUSIONS: No characteristic T. gondii lesions were discovered. Retinal photography serendipitously revealed DR in these T. gondii positive women. It was also found that latent TG infection was associated with increased incidence of GDM. Hispanic pregnant women's increased risk for latent TG infection, GDM and DR are underappreciated. Retinal photography may need to be considered an innovative approach to screening.

Line-by-line visual acuity scoring equivalence with letter-by-letter visual acuity scoring.

CLINICAL RELEVANCE: A scoring criterion of three-or-more letters correct on a line results in the most equivalent visual acuity score to letter-by-letter scoring. BACKGROUND: Using the criterion of three-or-more letters correct on a line of five letters to measure a line visual acuity is common. In this study, different line acuity criteria are compared to letter-by-letter visual acuity scoring to determine which criterion is the most accurate as well as least variable. METHODS: One eye each of 32 subjects was tested with high-contrast visual acuity charts at 4.88 m. Subjects had 16 acuities measured: 8 under normal conditions and 8 under a + 1.50D blur condition. For each set of 8, logMAR visual acuity results were obtained by retrospectively applying each of four scoring criteria twice: letter-by-letter acuity and three line acuities (three-or-more, four-or-more, or five correct on a line). Differences in means were analysed using repeated measures ANOVA with post-hoc Tukey testing. Test-retest variability was analysed via Bland-Altman analysis. RESULTS: The mean visual acuities (in logMAR) were -0.10, -0.11, -0.07, and -0.01 for letter-by-letter, three-or-more correct, four-or-more correct, and all five correct, respectively. With blur, the mean visual acuities were 0.41, 0.39, 0.45, and 0.53 for the respective criteria. Under both normal and blur conditions, the different acuity scoring criteria resulted in significant differences (p < 0.001), except for the letter-by-letter and three-or-more criteria (p ≥ 0.18). Whereas the criteria resulted in similar test-retest variability under blur, the line acuity using a criterion of three-or-more letters correct resulted in the lowest test-retest variability under best-corrected conditions. CONCLUSION: A line visual acuity scoring criterion of three-or-more letters correct on a line, whether with good visual acuity or poorer visual acuity due to defocus, provides the most similar acuity and test-retest variability compared to letter-by-letter visual acuity.

Reproducibility of the mfERG between instruments.

PURPOSE: First, to examine both the reproducibility of the multifocal electroretinogram (mfERG) recorded on different versions of the same instrument, and the repeatability of the mfERG recorded on a single instrument using two different amplifiers. Second, to demonstrate a means by which multicenter and longitudinal studies that use more than one recording instrument can compare and combine data effectively. METHODS: Three different amplifiers and two mfERG setups, one using VERIS 4.3 software (mfERG1) and another using VERIS Pro 5.2 software (mfERG2), were evaluated. A total of 73 subjects with normal vision were tested in three groups. Group 1 (n = 42) was recorded using two amplifiers in parallel on mfERG1. Group 2 (n = 52) was recorded on mfERG2 using a single amplifier. Group 3 was a subgroup of 21 subjects from groups 1 and 2 that were tested sequentially on both instruments. A fourth group of 26 subjects with diabetes were also recorded using the two parallel amplifiers on mfERG1. P1 implicit times and N1-P1 amplitudes of the 103 local first order mfERGs were measured, and the differences between the instruments and amplifiers were evaluated as raw scores and Z-scores based on normative data. Measurements of individual responses and measurements averaged over the 103 responses were analyzed. RESULTS: Simultaneous recordings made on mfERG1 with the two different amplifiers showed differences in implicit times but similar amplitudes. There was a mean implicit time difference of 2.5 ms between the amplifiers but conversion to Z-scores improved their agreement. Recordings made on different days with the two instruments produced similar but more variable results, with amplitudes differing between them more than implicit times. For local response implicit times, the 95% confidence interval of the difference between instruments was approximately +/-1 Z-score (+/-0.9 ms) in either direction. For local response amplitude, it was approximately +/-1.6 Z-scores (+/-0.3 microV). CONCLUSIONS: Different amplifiers can yield quite different mfERG P1 implicit times, even with identical band-pass settings. However, the reproducibility of mfERG Z-scores across recording instrumentation is relatively high. Comparison of data across systems and laboratories, necessary for multicenter or longitudinal investigations, is facilitated if raw data are converted into Z-scores based on normative data.

OCT reveals regional differences in macular thickness with age.

PURPOSE: To assist identification of macular thickness abnormalities by optical coherence tomography (OCT), we use techniques that improve spatial localization across the retina to establish any age-related retinal thickness changes in healthy eyes. METHODS: Retinal thickness was measured in 30 eyes of 30 healthy subjects aged 13 to 69 years. Using Stratus OCT 3, 12 radial scans centered at the foveola were acquired and points between scans were interpolated to create a topographic map of the central 20 degrees . The thickness map was divided into 37 hexagonal regions. A mean retinal thickness for each hexagon was computed. Retinal thickness vs. age was evaluated for the entire scanned area, five anatomical regions, and within individual hexagons. The retinal nerve fiber layer (RNFL) contribution to total retinal thinning was analyzed in the papillomacular region. RESULTS: There was a small but significant thinning of the overall macular area with increasing age (2.7 mum/decade; p = 0.027). Comparing the 10 youngest subjects (age 13 to 27 years) with the 10 oldest (age 51 to 68 years), retinal thicknesses in the temporal, superior, inferior, and foveal regions were not significantly different. However, the two age groups differed significantly in retinal thickness in the nasal region (p < 0.008). Across all subjects, retinal thickness in this region was linearly correlated with age, decreasing by 4.1 mum/decade (p < 0.002). Approximately 43% of the retinal thinning in the nasal region was attributed to RNFL loss. CONCLUSIONS: The method of OCT acquisition and analysis used in this study allows for greater spatial localization of change in retinal thickness associated with aging or pathological processes. Based on the results of this study, the macula thins with increasing age but does so nonuniformly. The greatest amount of thinning occurs nasal to the fovea. RNFL loss accounts for much, but not all the thinning in this area.

Associations between macular pigment, iris color and reflectance, ethnicity, and color vision: An observational study.

PURPOSE: Conflicting findings exist in the literature with regard to the relationship between iris color, ethnicity, macular pigment optical density (MPOD), and hue discrimination. This study re-examined these relationships, accounting for factors that may have confounded prior studies. Clinically, the relationship between MPOD and hue discrimination may impact the utility of macular pigment supplementation as a treatment for conditions such as macular degeneration. METHODS: Subjects (n = 30, mean/SD age = 25.1/2.5 yrs.) with normal color vision completed MPOD testing and Farnsworth-Munsell 100 hue (FM100) testing. MPOD data was derived from the average of three measurements using the QuantifEYE II device and FM100 testing included training runs. The total error score of the FM100 test was used for analysis. Iris color was determined subjectively, while iris reflectance was derived using calibrated iris images. Spearman correlations were used to determine the relationship between MPOD and FM100 test scores. Kruskal-Wallis testing was used to investigate MPOD differences among different ethnicities and iris colors. RESULTS: MPODs were normally distributed with a mean/SD = 0.38/0.13. Total error scores had a mean/SD of 10.7/9.7, but were not normally distributed. Iris reflectances had a mean/SD = 11.0/8.7. MPODs were not correlated to total error scores (p = 0.93). MPODs were also not correlated with iris reflectances (p = 0.28) even though MPODs differed significantly by iris color (brown = 0.44, hazel = 0.31, blue = 0.33, p = 0.04). Iris reflectances were not correlated with total error scores (p = 0.68). MPODs differed significantly (p = 0.003) between Asian and Caucasian subjects, 0.44 and 0.33, respectively. CONCLUSIONS: This study did not find a correlation between MPOD and hue discrimination as in some previous studies. While MPOD was associated with iris color and ethnicity as found in prior studies, it was not associated with iris reflectance, which may be a better indicator of ocular pigmentation compared to either iris color or ethnicity.

Local diabetic retinopathy prediction by multifocal ERG delays over 3 years.

PURPOSE: To derive and validate a model for use in predicting local retinal areas in which nonproliferative diabetic retinopathy (NPDR) lesions will develop over a 3-year period, by using primarily the implicit time (IT) of the multifocal electroretinogram (mfERG). METHODS: Eighteen diabetic patients were examined at baseline and at three annual follow-ups. Ophthalmic examinations, including fundus photographs and mfERG testing, were performed at each visit. Thirty-five retinal zones were constructed from the 103-element stimulus array, and each zone was assigned the maximum IT z-score within it based on 30 age-similar control subjects. Logistic regression was used to investigate the development of retinopathy in relation to baseline mfERG IT delays and additional diabetic health variables. Receiver operating characteristic (ROC) curves were used to evaluate the models. RESULTS: Retinopathy developed in 77 of the 1208 retinal zones, of which 25 had recurring retinopathy. Multivariate analyses yielded baseline mfERG IT, duration of diabetes, and blood glucose concentration as the most important predictors of recurring retinopathy. mfERG ITs were not predictive of transient retinopathy. ROC curves based on the multivariate model for the prediction of recurring retinopathy resulted in an area under the curve of 0.95, sensitivity of 88%, and specificity of 98%. Ten-fold cross-validation confirmed the high sensitivity and specificity of the model. CONCLUSIONS: The development of recurring retinopathy over a 3-year period can be well predicted by using a multivariate model based on mfERG implicit time. Multifocal ERG delays are promising candidate measures for trials of novel therapeutics directed at preventing or slowing the progression of NPDR.

Level of visual acuity necessary to avoid false-positives on the HRR and Ishihara color vision tests.

PURPOSE: Minimizing false-positives (FPs) when evaluating color vision is important in eye care. Identification of plate 1 (demonstration plate) is often considered a way to avoid FPs. However, few studies have quantified the minimum level of visual acuity (VA) that would minimize FPs for the Ishihara and HRR color tests. METHODS: Threshold levels of optical defocus were obtained from 25 color normal subjects. Blur levels were obtained for Ishihara (38 plate) plates 1, 10, and 15 and 4th edition HRR plates 1, 7, 10, and 20 using the method of limits. Corresponding VAs were measured through these blur levels at 40 centimeters after adjusting for the dioptric distance difference. Analysis of variance testing was used to analyze the data. RESULTS: Mean optical defocus values in diopters (mean ± SD) for HRR plates 1, 7, 10, and 20 were 6.23 ± 1.61, 1.23 ± 1.16, 2.41 ± 1.31, and 7.96 ± 2.03, respectively, and for Ishihara plates 1, 10, and 15 were 5.70 ± 1.52, 3.68 ± 1.71, and 4.62 ± 1.56, respectively. There was a significant difference between the screening and demonstration plates for both tests (p<0.001). CONCLUSIONS: Based on the plate in each test that was found to be the least tolerant to blur, the average minimum VAs needed to identify the screening plates were approximately 20/180 for the Ishihara test and 20/50 for the HRR test. Identifying the demonstration plate in the Ishihara and HRR tests does not ensure FPs will be avoided.

Accommodative amplitude using the minus lens at different near distances.

PURPOSE: The purpose of this study was to compare the mean findings and the repeatability of the minus lens (ML) amplitude of accommodation (AA) at 33 cm and 40 cm. MATERIALS AND METHODS: AA was measured from the dominant eye of 120 fully corrected subjects using the ML procedure when viewing the target at both 33 and 40 cm. Each measurement was repeated between 24 and 48 hours after the first trial. RESULTS: Mean AA when tested at 33 cm and 40 cm was 10.20 diopter (D) (standard deviation [SD] =1.24) and 8.85 D (SD = 1.23), respectively (P < 0.001). The limits of agreement of the measured amplitude calculated with taking into account of the replicates at 33 and 40 cm were - 0.19 (95% confidence interval [CI]: -0.34 to -0.04) and 2.53 (95% CI: 2.38 to 2.68), respectively. The repeatability of testing at the two distances 33 and 40 cm was ± 1.24 and ± 0.99, respectively. In addition, the retest reliability of measured amplitude using the intraclass correlation coefficient was 0.87 (95% CI: 0.789-0.920) at 33 cm and 0.91 (95% CI: 0.872-0.945) at 40 cm. CONCLUSION: There is no agreement in the obtained amplitude at the two measurement distances. Testing the ML AA at 40 cm may be superior given that a lower repeatability coefficient was observed. However, it is unclear whether the larger amplitude measured at 33 cm reflects a larger increase in accommodation (greater proximity effect) or a decrease in the ability to perceive the first slight sustained blur.

Multifocal electroretinograms predict onset of diabetic retinopathy in adult patients with diabetes.

PURPOSE: The authors' previous models predicted local formation of diabetic retinopathy (DR) in adults with diabetes and existing retinopathy. Here they derived a multivariate model for local prediction of DR onset in patients with no previous retinopathy. METHODS: Seventy-eight eyes from 41 diabetes patients were tested annually for several years. The presence or absence of DR at the last study visit was the outcome measure, and measurements of risk factors from the previous visit were used for prediction. Logistic regression was used to assess the relationship between DR development and 7 factors: multifocal ERG (mfERG) implicit time (IT) Z-score, sex, diabetes duration, blood glucose, HbA1c, age, and diabetes type. Thirty-five retinal zones, spanning 45°, were constructed from the mfERG stimulus elements. The maximum IT Z-score for each zone was calculated based on data from 50 control subjects. ROC curve analysis, using fivefold cross-validation, was used to determine the model's predictive properties. RESULTS: Mild DR developed in 80 of 2730 retinal zones (3%) in 29 of 78 eyes (37%). Multivariate analysis showed mfERG IT to be predictive for DR development in a zone after adjusting for diabetes type. The multivariate model has a sensitivity of 80% and a specificity of 74%. CONCLUSIONS: mfERG IT is a good predictor of DR onset, 1 year later, in patients with diabetes without DR. It can be used to assess the risk for DR development in these patients and may be a valuable outcome measure in evaluation of novel prophylactic therapeutics directed at impeding DR.

Specific medical intervention for diabetic retinopathy.

Diabetes is a global epidemic and the major complication of diabetes in the eye, diabetic retinopathy, is a leading cause of blindness in several countries. Medical and surgical interventions have been formally investigated for over half a century, but currently only surgical interventions are the standard of care and these treatments are not without significant side effects. Several clinical trials have investigated a protein kinase C (PKC) beta inhibitor as a possible medical intervention for diabetic retinopathy. Though successful in animal studies and smaller clinical studies, the drug showed only marginal success in clinical trials. It is likely that the clinical trials failed for two reasons: (1) enrolling patients with too severe a disease state at baseline and (2) utilizing conventional outcome measures that essentially require severe disease states at baseline for evaluation after a standard follow-up time. Additional clinical trials that enroll patients with earlier stages of diabetic retinopathy and/or utilizing more sensitive surrogate outcomes over a longer follow-up would likely show clinical success of PKC-beta inhibition for the treatment of the diabetic retinopathy.