Objective: To evaluate concurrent and predictive validity for low-contrast le tter acuity (L-CLA) testing as a candidate visual component for the Multiple Sc lerosis Functional Composite (MSFC). Methods: L-CLA testing...Objective: To evaluate concurrent and predictive validity for low-contrast le tter acuity (L-CLA) testing as a candidate visual component for the Multiple Sc lerosis Functional Composite (MSFC). Methods: L-CLA testing was conducted in tw o MS patient cohorts. In the MSFC Validation Study, 137 participants from a Phas e III trial of inteferon beta-1a (Avonex) for relapsing-remitting MS were foll owed. A second cohort included 65 patients with secondary progressive MS who par ticipated in a substudy of the International MS Secondary Progressive Avonex Con trolled Trial (IMPACT). The total number of letters read correctly at four contr ast levels (100, 5, 1.25, and 0.6%) was correlated with Expanded Disability Sta tus Scale (EDSS), MSFC, Sickness Impact Profile, Multiple Sclerosis Quality of L ife Inventory, and brain parenchymal fraction (BPF), as determined by MRI. Resul ts: Low-and high-contrast letter acuity scores correlated with BPF at follow- up in the MSFC Validation Study (5%: r=0.40, p < 0.0001; 100%: r=0.31, p=0.000 2). L-CLA also correlated with EDSS (5%: r=-0.35, p < 0.0001; 1.25%: r=-0.2 6, p=0.0003) and MSFC (5%: r=0.47, p < 0.0001; 1.25%: r=0.45, p < 0.0001). In the IMPACT Substudy, change in L-CLA scores from baseline to year 1 predicted s ubsequent change in the EDSS from year 1 to 2 at the 5%(p=0.0142) and the 1.25 %(p=0.0038) contrast levels, after adjusting for change in MSFC scores from bas eline to year 1. Conclusions: Low-contrast letter acuity (L-CLA) scores demons trate concurrent and predictive validity in patients with relapsing-remitting a nd secondary progressive multiple sclerosis (MS). L-CLA testing provides additi onal information relevant to the MS disease process that is not entirely capture d by the Multiple Sclerosis Functional Composite.展开更多
Purpose: To examine whether standardized, preoperative evaluation of pupil siz es can predict the risk of night vision visual disturbances after bilateral lase r in situ keratomileusis (LASIK) for myopia. Methods: A p...Purpose: To examine whether standardized, preoperative evaluation of pupil siz es can predict the risk of night vision visual disturbances after bilateral lase r in situ keratomileusis (LASIK) for myopia. Methods: A prospective study was ca rried out involving 46 patients who underwent bilateral LASIK for myopia. Pupil sizes were measured before surgery using an infrared pupillometer under standard ized settings. Pre-and postoperative refraction and best spectacle-corrected v isual acuity (BSCVA) were registered. At the 3-month follow-up visit, the pati ents completed a questionnaire regarding night vision pre-and postoperatively. Results: The mean bilateral, spherical equivalent refraction (SE) was-8.76 D (r ange 6.32 to-12.0 D) preoperatively, and-1.69 D (range 0 to-4.38 D) postopera tively. The mean bilateral BSCVA was not changed by the operations. We found a s ignificant correlation between large scotopic pupil sizes and the impression of worsened night vision (P < 0.01). A significant correlation between gender (male s) and subjectively reduced night vision postoperatively was also found (P < 0.0 5). Conclusion: Large pupil size measured preoperatively is correlated with an i ncreased frequency of subjectively experienced post-LASIK visual disturbances d uring scotopic conditions. We recommend preoperative evaluation of pupils size in all patient s prior to LASIK surgery.展开更多
PURPOSE: To compare macular thickness and best-corre-cted visual acuity (BcVA) before and after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy and good visual acuity (VA) to identify fa...PURPOSE: To compare macular thickness and best-corre-cted visual acuity (BcVA) before and after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy and good visual acuity (VA) to identify factors that predict post-operative visual function. DESIGN: Prospective, non-comparative, interventional case series. METHODS: Sixty-four consecutive patients with severe non-proliferative diabetic retinopathy or with non-high-risk proliferative diabetic retinopathy whose VA was 20/20 or better before PRP were studied. Sixty-four eyes of 64 patients underwent scatter PRP in four sessions every other week. Macular thickness was measured by optical coherence tomography (OCT), and VA was measured before and periodically after PRP. RESULTS: During the 24- week observation period, patients were classified into three groups according to changes in VAduring the post-operative period. In groupA, VA was maintained at pre-operative levels in 54 (84% ) eyes during the 24 weeks after PRP. In group B, VA initially decreased in three eyes but subsequently recovered to baseline during the observation period; in group C, VA did not recover during follow-up in seven eyes. There was no significant difference in pre-operative foveal thicknesses among the three groups, but parafoveal thickness was < 260 μ m in group A, ranged from 270 to 280 μ m in group B, and was > 300 μ m in group C. CONCLUSION: For eyes with severe diabetic retinopathy and good VA, PRP did not affect post-operative VA in more than 80% of patients. Patients whose pre-operative parafoveal thickness was > 300 μ m had a worse visual prognosis.展开更多
Axonal loss is thought to be a likely cause of persistent disability after amultiple sclerosis relapse; therefore, noninvasive in vivo markers specific for axonal loss are needed. We used optic neuritis as a model of ...Axonal loss is thought to be a likely cause of persistent disability after amultiple sclerosis relapse; therefore, noninvasive in vivo markers specific for axonal loss are needed. We used optic neuritis as a model of multiple sclerosis relapse to quantify axonal loss of the retinal nerve fiber layer (RNFL) and secondary retinal ganglion cell loss in die macula with optical coherence tomography. We studied 25 patients who had a previous single episode of optic neuritis with a recruitment bias to those with incomplete recovery and 15 control subjects. Optical coherence tomography measurement of RNFL thickness and macular volume, quantitative visual testing, and electrophysiological examination were performed. There were highly significant reductions (P < 0.001) of RNFL thic kness and macular volume in affected patient eyes compared with control eyes and clinically unaffected fellow eyes. There were significant relationships among RNFL thicknessand visual acuity, visual field, color vision, and visual evoked potential amplitude. This study has demonstrated functionally relevant changes indicative of axonal loss and retinal ganglion cell loss in the RNFL and macula, respectively, after optic neuritis. This noninvasive RNFL imaging technique could be used in trials of experimental treatments that aim to protect optic nerves from axonal loss.展开更多
文摘Objective: To evaluate concurrent and predictive validity for low-contrast le tter acuity (L-CLA) testing as a candidate visual component for the Multiple Sc lerosis Functional Composite (MSFC). Methods: L-CLA testing was conducted in tw o MS patient cohorts. In the MSFC Validation Study, 137 participants from a Phas e III trial of inteferon beta-1a (Avonex) for relapsing-remitting MS were foll owed. A second cohort included 65 patients with secondary progressive MS who par ticipated in a substudy of the International MS Secondary Progressive Avonex Con trolled Trial (IMPACT). The total number of letters read correctly at four contr ast levels (100, 5, 1.25, and 0.6%) was correlated with Expanded Disability Sta tus Scale (EDSS), MSFC, Sickness Impact Profile, Multiple Sclerosis Quality of L ife Inventory, and brain parenchymal fraction (BPF), as determined by MRI. Resul ts: Low-and high-contrast letter acuity scores correlated with BPF at follow- up in the MSFC Validation Study (5%: r=0.40, p < 0.0001; 100%: r=0.31, p=0.000 2). L-CLA also correlated with EDSS (5%: r=-0.35, p < 0.0001; 1.25%: r=-0.2 6, p=0.0003) and MSFC (5%: r=0.47, p < 0.0001; 1.25%: r=0.45, p < 0.0001). In the IMPACT Substudy, change in L-CLA scores from baseline to year 1 predicted s ubsequent change in the EDSS from year 1 to 2 at the 5%(p=0.0142) and the 1.25 %(p=0.0038) contrast levels, after adjusting for change in MSFC scores from bas eline to year 1. Conclusions: Low-contrast letter acuity (L-CLA) scores demons trate concurrent and predictive validity in patients with relapsing-remitting a nd secondary progressive multiple sclerosis (MS). L-CLA testing provides additi onal information relevant to the MS disease process that is not entirely capture d by the Multiple Sclerosis Functional Composite.
文摘Purpose: To examine whether standardized, preoperative evaluation of pupil siz es can predict the risk of night vision visual disturbances after bilateral lase r in situ keratomileusis (LASIK) for myopia. Methods: A prospective study was ca rried out involving 46 patients who underwent bilateral LASIK for myopia. Pupil sizes were measured before surgery using an infrared pupillometer under standard ized settings. Pre-and postoperative refraction and best spectacle-corrected v isual acuity (BSCVA) were registered. At the 3-month follow-up visit, the pati ents completed a questionnaire regarding night vision pre-and postoperatively. Results: The mean bilateral, spherical equivalent refraction (SE) was-8.76 D (r ange 6.32 to-12.0 D) preoperatively, and-1.69 D (range 0 to-4.38 D) postopera tively. The mean bilateral BSCVA was not changed by the operations. We found a s ignificant correlation between large scotopic pupil sizes and the impression of worsened night vision (P < 0.01). A significant correlation between gender (male s) and subjectively reduced night vision postoperatively was also found (P < 0.0 5). Conclusion: Large pupil size measured preoperatively is correlated with an i ncreased frequency of subjectively experienced post-LASIK visual disturbances d uring scotopic conditions. We recommend preoperative evaluation of pupils size in all patient s prior to LASIK surgery.
文摘PURPOSE: To compare macular thickness and best-corre-cted visual acuity (BcVA) before and after panretinal photocoagulation (PRP) in patients with severe diabetic retinopathy and good visual acuity (VA) to identify factors that predict post-operative visual function. DESIGN: Prospective, non-comparative, interventional case series. METHODS: Sixty-four consecutive patients with severe non-proliferative diabetic retinopathy or with non-high-risk proliferative diabetic retinopathy whose VA was 20/20 or better before PRP were studied. Sixty-four eyes of 64 patients underwent scatter PRP in four sessions every other week. Macular thickness was measured by optical coherence tomography (OCT), and VA was measured before and periodically after PRP. RESULTS: During the 24- week observation period, patients were classified into three groups according to changes in VAduring the post-operative period. In groupA, VA was maintained at pre-operative levels in 54 (84% ) eyes during the 24 weeks after PRP. In group B, VA initially decreased in three eyes but subsequently recovered to baseline during the observation period; in group C, VA did not recover during follow-up in seven eyes. There was no significant difference in pre-operative foveal thicknesses among the three groups, but parafoveal thickness was < 260 μ m in group A, ranged from 270 to 280 μ m in group B, and was > 300 μ m in group C. CONCLUSION: For eyes with severe diabetic retinopathy and good VA, PRP did not affect post-operative VA in more than 80% of patients. Patients whose pre-operative parafoveal thickness was > 300 μ m had a worse visual prognosis.
文摘Axonal loss is thought to be a likely cause of persistent disability after amultiple sclerosis relapse; therefore, noninvasive in vivo markers specific for axonal loss are needed. We used optic neuritis as a model of multiple sclerosis relapse to quantify axonal loss of the retinal nerve fiber layer (RNFL) and secondary retinal ganglion cell loss in die macula with optical coherence tomography. We studied 25 patients who had a previous single episode of optic neuritis with a recruitment bias to those with incomplete recovery and 15 control subjects. Optical coherence tomography measurement of RNFL thickness and macular volume, quantitative visual testing, and electrophysiological examination were performed. There were highly significant reductions (P < 0.001) of RNFL thic kness and macular volume in affected patient eyes compared with control eyes and clinically unaffected fellow eyes. There were significant relationships among RNFL thicknessand visual acuity, visual field, color vision, and visual evoked potential amplitude. This study has demonstrated functionally relevant changes indicative of axonal loss and retinal ganglion cell loss in the RNFL and macula, respectively, after optic neuritis. This noninvasive RNFL imaging technique could be used in trials of experimental treatments that aim to protect optic nerves from axonal loss.
