Conspicuity of staircase configuration: Effects of markings and contrast.

PURPOSE: To be able to walk safely up or down a staircase, we must be able to judge the configuration and slope of the staircase and our viewing position. Adding markings to the stairs might help form correct perceptions of the staircase geometry. In this study, we examined how visual judgements about staircase configuration are affected by different marking patterns. METHODS: Fifteen normally sighted young participants viewed computer-generated images of staircases as seen from the top landing of the stairs. Marking patterns included contrasting baseboard, transverse edge-stripes, longitudinal side-stripes, longitudinal stripes, diamond patterns, longitudinal stripes extended to landing and diamond patterns extended to landing. For comparison, we included the no-marking condition as a control. We tested several contrast levels of marking patterns (3.2%-50%), pitch lines of the staircases (shallow/medium/steep) and viewing positions (left/centre/right). The effect of the overall shape cue of the staircase on participants' performance was also evaluated. We measured participants' accuracies in judging whether the staircase was shallow, medium or steep, and whether the viewing position was located to the left, centre or right. RESULTS: Transverse edge-stripes markings yielded fewer underestimations of slope (9% [transverse] vs. 18% [others]) when compared with other markers. The presence of an overall shape cue helped both slope (67% [presence] vs. 51% [absence]) and viewing position judgements (79% [presence] vs. 62% [absence]). When the overall shape cue was present, only the transverse edge-stripes markings yielded a significant improvement in performance (compared with no-marking condition). When the cue was absent, performance was significantly better with markings with high and moderate contrasts. CONCLUSIONS: Adding marking patterns such as high-contrast transverse stripes to stairs may help enhance the visibility of the stairs and judgements of staircase geometry. This might be particularly useful for people with visual impairment or normally sighted individuals under compromised environmental conditions.

Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials: Recommendations from the International HOVER Taskforce.

Translational research in vision prosthetics, gene therapy, optogenetics, stem cell and other forms of transplantation, and sensory substitution is creating new therapeutic options for patients with neural forms of blindness. The technical challenges faced by each of these disciplines differ considerably, but they all face the same challenge of how to assess vision in patients with ultra-low vision (ULV), who will be the earliest subjects to receive new therapies. Historically, there were few tests to assess vision in ULV patients. In the 1990s, the field of visual prosthetics expanded rapidly, and this activity led to a heightened need to develop better tests to quantify end points for clinical studies. Each group tended to develop novel tests, which made it difficult to compare outcomes across groups. The common lack of validation of the tests and the variable use of controls added to the challenge of interpreting the outcomes of these clinical studies. In 2014, at the bi-annual International "Eye and the Chip" meeting of experts in the field of visual prosthetics, a group of interested leaders agreed to work cooperatively to develop the International Harmonization of Outcomes and Vision Endpoints in Vision Restoration Trials (HOVER) Taskforce. Under this banner, more than 80 specialists across seven topic areas joined an effort to formulate guidelines for performing and reporting psychophysical tests in humans who participate in clinical trials for visual restoration. This document provides the complete version of the consensus opinions from the HOVER taskforce, which, together with its rules of governance, will be posted on the website of the Henry Ford Department of Ophthalmology (www.artificialvision.org). Research groups or companies that choose to follow these guidelines are encouraged to include a specific statement to that effect in their communications to the public. The Executive Committee of the HOVER Taskforce will maintain a list of all human psychophysical research in the relevant fields of research on the same website to provide an overview of methods and outcomes of all clinical work being performed in an attempt to restore vision to the blind. This website will also specify which scientific publications contain the statement of certification. The website will be updated every 2 years and continue to exist as a living document of worldwide efforts to restore vision to the blind. The HOVER consensus document has been written by over 80 of the world's experts in vision restoration and low vision and provides recommendations on the measurement and reporting of patient outcomes in vision restoration trials.

Lens Opacity and Hydrogen Sulfide in a New Zealand Geothermal Area.

PURPOSE: Hydrogen sulfide (H2S) is a highly toxic gas with well-established, acute irritation effects on the eye. The population of Rotorua, New Zealand, sited on an active geothermal field, has some of the highest ambient H2S exposures in the world. Evidence from ecological studies in Rotorua has suggested that H2S is associated with cataract. The purpose of the present study was, using more detailed exposure characterization, clinical examinations, and anterior eye photography, to more directly investigate this previously reported association. METHODS: Enrolled were 1637 adults, ages 18 to 65, from a comprehensive Rotorua primary care medical register. Patients underwent a comprehensive ophthalmic examination, including pupillary dilation and lens photography to capture evidence of any nuclear opacity, nuclear color, and cortical and posterior subcapsular opacity. Photographs were scored for all four outcomes on the LOCS III scale with decimalized interpolation between the exemplars. H2S exposure for up to the last 30 years was estimated based on networks of passive samplers set out across Rotorua and knowledge of residential, workplace, and school locations over the 30 years. Data analysis using linear and logistic regression examined associations between the degree of opacification and nuclear color or cataract (defined as a LOCS III score ≥2.0) in relation to H2S exposure. RESULTS: No associations were found between estimated H2S exposures and any of the four ophthalmic outcome measures. CONCLUSIONS: Overall, results were generally reassuring. They provided no evidence that H2S exposure at the levels found in Rotorua is associated with cataract. The previously found association between cataract and H2S exposure in the Rotorua population seems likely to be attributable to the limitations of the ecological study design. These results cannot rule out the possibility of an association with cataract at higher levels of H2S exposure.

Slope of psychometric functions and termination rule analysis for low contrast acuity charts.

PURPOSE: To assess whether the slopes of psychometric functions for measuring low contrast letter acuity were different from those for measuring high contrast letter acuity. METHODS: Ten participants, wearing their best spectacle correction, were assessed monocularly. Stimuli were logarithmic progression charts, generated on a computer monitor, with nine rows of five randomised Sloan letters generated in either high contrast format (Weber contrast 99.2%) or low contrast format (Weber contrast 18.7%). For each participant, psychometric functions were generated by probit analysis of the data on each of 16 attempts at a low contrast chart and 16 attempts at a high contrast chart. Each of these probit fits yielded an estimate of Probit Size which provided information about how steep or flat the psychometric function was, along with an estimate of Probit Acuity Threshold. RESULTS: Probit Size was significantly larger (p < 0.001) for low contrast charts than for high contrast charts, indicating that psychometric functions were flatter for low contrast charts. Mean Probit Sizes in logMAR were 0.099 (SEM 0.022) for low contrast charts and 0.071 (SEM 0.009) for high contrast charts if a guess rate of 1/26 was assumed, or were 0.086 (SEM 0.019) for low contrast charts and 0.064 for high contrast charts if a guess rate of 1/10 was assumed. Monte Carlo analysis showed that these means were likely to be biased estimates, with true Probit Size probably being larger (i.e. slightly flatter fits) by 0.016-0.019 logMAR. As expected, Probit Acuity Thresholds were poorer for low contrast charts than for high contrast charts (p < 0.001). CONCLUSION: Our Monte Carlo modelling showed that such differences in acuity psychometric functions would be expected to give greater intra-subject variability in low contrast letter-by-letter acuity thresholds than for high contrast letter-by-letter acuity thresholds, and that this difference would depend on the termination rule used when measuring acuity. Likewise the variation in letter-by- letter acuity thresholds with termination rule will be different for high and low contrast charts. For low contrast and high contrast Sloan letter charts in a standard logarithmic format, a termination rule of four mistakes on a row, will give close to optimum sensitivity-to-change.

Effect of font size and glare on computer tasks in young and older adults.

PURPOSE: At a fixed viewing distance (VD), reading speed increases with print size. It is not known if this holds for computer tasks when postures are not constrained. Reflective glare on a monitor may reduce productivity. The effects of both may be modified by age. We evaluated effects of age, font size, and glare on performance for visually demanding text-based tasks on a computer. METHODS: Nineteen young (18 to 35 years old) and eight older (55 to 65 years old wearing progressive lenses that correct for presbyopia) subjects participated in a study with two trial factors: font size (1.78, 2.23, and 3.56 mm) and glare (produced by bright light-emitting diode task light reflective off a matte liquid crystal display monitor). The monitor location was fixed but subjects were allowed to change their posture and move the chair. Subjects performed visual tasks that required similar visual skills to common tasks such as Internet use, data entry, or word processing. RESULTS: Productivity, accuracy, and VD increased as font size increased. For each 1-mm increase in font size, there was a mean productivity gain of 3 correct clicks/min and an improvement in accuracy of 2%. Font size increase also led to lowered perceived task difficulty. Adding reflective glare on the monitor surface led to a reduced VD but had no effect on productivity or accuracy. With visual corrections for presbyopia, age had no effect on these relationships. CONCLUSIONS: Productivity is improved when the font is increased from 1.78 or 2.23 to 3.56 mm for text-based computer tasks. The largest font size corresponds to a visual angle of font of 23.4 arcmin. This visual angle of font is above the high end of ISO recommendations (International Organization for Standardization, 1992, 2011). The findings may be useful for setting the font sizes for computers and for training office workers.

Visual acuity testing. From the laboratory to the clinic.

The need for precision in visual acuity assessment for low vision research led to the design of the Bailey-Lovie letter chart. This paper describes the decisions behind the design principles used and how the logarithmic progression of sizes led to the development of the logMAR designation of visual acuity and the improved sensitivity gained from letter-by-letter scoring. While the principles have since been adopted by most major clinical research studies and for use in most low vision clinics, use of charts of this design and application of letter-by-letter scoring are also important for the accurate assessment of visual acuity in any clinical setting. We discuss the test protocols that should be applied to visual acuity testing and the use of other tests for assessing profound low vision when the limits of visual acuity measurement by letter charts are reached.

Biomass stoves and lens opacity and cataract in Nepalese women.

PURPOSE: Cataract is the most prevalent cause of blindness in Nepal. Several epidemiologic studies have associated cataracts with use of biomass cookstoves. These studies, however, have had limitations, including potential control selection bias and limited adjustment for possible confounding. This study, in Pokhara City, in an area of Nepal where biomass cookstoves are widely used without direct venting of the smoke to the outdoors, focuses on preclinical measures of opacity while avoiding selection bias and taking into account comprehensive data on potential confounding factors. METHODS: Using a cross-sectional study design, severity of lenticular damage, judged on the LOCS (Lens Opacities Classification System) III scales, was investigated in women (n = 143), aged 20 to 65 years, without previously diagnosed cataract. Linear and logistic regression analyses were used to examine the relationships with stove type and length of use. Clinically significant cataract, used in the logistic regression models, was defined as a LOCS III score ≥2. RESULTS: Using gas cookstoves as the reference group, logistic regression analysis for nuclear cataract showed evidence of relationships with stove type: for biomass stoves, the odds ratio was 2.58 (95% confidence interval, 1.22 to 5.46); and for kerosene stoves, the odds ratio was 5.18 (95% confidence interval, 0.88 to 30.38). Similar results were found for nuclear color (LOCS III score ≥2), but no association was found with cortical cataracts. Supporting a relationship between biomass stoves and nuclear cataract was a trend with years of exposure to biomass cookstoves (p = 0.01). Linear regression analyses did not show clear evidence of an association between lenticular damage and stove types. Biomass fuel used for heating was not associated with any form of opacity. CONCLUSIONS: This study provides support for associations of biomass and kerosene cookstoves with nuclear opacity and change in nuclear color. The novel associations with kerosene cookstove use deserve further investigation.

Perspective: visual acuity-keeping it clear.

Research and clinical papers in the ophthalmic literature commonly report visual acuity data. There is considerable variation in the way visual acuity measurements are expressed, and frequently, the charts and the procedures used for the visual acuity testing are inadequately described. Materials and methods can significantly affect visual acuity scores. Contributions to the scientific and professional literature should provide enough detail about their methodologies to allow others to replicate their studies. Here we call for authors and clinicians to be more careful about defining their term, to specifically identify their testing materials, and to give detailed descriptions of their methods of testing.

The Berkeley Rudimentary Vision Test.

PURPOSE: Very poor visual acuity often cannot be measured with letter charts even at close viewing distances. The Berkeley Rudimentary Vision Test (BRVT) was developed as a simple test to extend the range of visual acuity measurement beyond the limits of letter charts by systematically simplifying the visual task and using close viewing distances to achieve large angular sizes. The test has three pairs of hinged cards, 25 cm square. One card-pair has four single tumbling E (STE) optotypes at sizes 100 M, 63 M, 40 M, and 25 M. Another card-pair has four grating acuity (GA) targets at sizes 200 M, 125 M, 80 M, and 50 M. The third card-pair has a test of white field projection (WFP) and a test of black white discrimination (BWD). As a demonstration of feasibility, a population of subjects with severe visual impairment was tested with the BRVT. METHODS: Adults with severe visual impairments from a wide variety of causes were recruited from three different rehabilitation programs. Vision measurements were made on 54 eyes from 37 subjects; test administration times were measured. RESULTS: For this population, letter chart visual acuity could be measured on 24 eyes. Measurements of visual acuity for STE targets were made for 18 eyes and with GA targets, for two eyes. Five eyes had WFP, and one had BWD. Four had light perception only. The median testing time with the BRVT was 2.5 min. DISCUSSION: The BRVT extends the range of visual acuity up to logMAR = 2.60 (20/8000) for STEs, to logMAR = 2.90 (20/16,000) for gratings and includes the WFP and BWD tests. CONCLUSIONS: The BRVT is a simple and efficient test of spatial vision that, with 13 increments, extends the range of measurement from the limits of the letter chart up to light perception.

Peripheral light-focusing: measurement reliability and correlations with ocular dimensions.

PURPOSE: When a beam of light is directed toward the temporal limbus from an angle of about 120 degrees temporal to the primary line of sight, an illuminated patch appears on the sclera at the nasal limbus. An optical apparatus was developed for measuring the angular range of this optical phenomenon, often called the temporal catchment angle. It is possible that the temporal catchment angle or its correlates could serve as a key risk factor for the development of pterygia or cortical cataract. METHODS: We built an apparatus that allows variation in the angle of a beam directed toward the temporal limbus. Two examiners measured the angular catchment range over which peripheral light focusing occurred for the right eyes of 30 subjects. Other anterior segment dimensions, including palpebral aperture height, refractive error, central and peripheral corneal power, anterior chamber depth, and corneal diameter, were measured. RESULTS: There was no statistically or clinically significant difference between the repeated measures of the examiners. The mean temporal catchment angle was 17.1 degrees (SD, 6.5). The intraobserver and interobserver 95% limits of agreement were 6.2 and 9.7 degrees, respectively. The mean posterior limit was 121.0 degrees (SD, 5.5), and the mean anterior limit was 104.1 degrees (SD, 6.5) from the primary line of sight. The temporal catchment angle was positively correlated with central corneal power (R(2) = 0.18; p = 0.02), peripheral corneal power (R(2) = 0.18; p = 0.01), anterior chamber depth (R(2) = 0.29; p = 0.002), and corneal diameter (R(2) = 0.37; p = 0.002). Using multivariate linear regression analysis, we determined that central corneal power in the horizontal meridian and corneal diameter, in combination, best predicted the magnitude of the temporal catchment angle (R(2) = 0.37; p = 0.0001). CONCLUSIONS: We have developed a reliable method of measuring the temporal catchment angle using a new head-mounted instrument. The temporal catchment angle was highly correlated with central corneal power and corneal diameter, in combination. The temporal catchment angle or its correlated ocular dimensions could be used to investigate risk factors for pterygia and cortical cataract.