Computer-based visual evaluation as a screening tool after intravitreal injections of vascular endothelial growth factor inhibitors.

PURPOSE: To evaluate the visual acuity (VA) of patients following intravitreal (IVT) injections. METHODS: 15 patients received 3 anti-vascular-endothelial-growth-factor (VEGF) injections on a monthly basis. Prior to each injection as well as 2 months after, the patients received a standardized examination including Snellen VA and optical coherence tomography (OCT). During this time the patients were trained to evaluate their central VA by 3 computer-based tests: (a) VA was examined by the patient on a computer-based vision chart and (b) subjectively categorized as 'same', 'worse' or 'better'; (c) the edge of metamorphopsia was outlined on a digital Amsler grid. RESULTS: VA improved during the 3 injections by >or=2 lines (13/15). The assessment demonstrated subjective improvement (13/15), i.e. a gain of 2 or more lines or decreased central metamorphopsia (12/15). Reevaluation 2 months later demonstrated a decline of >or=1 Snellen line or increased retinal thickness on OCT (8/15), and a decline of >or=1 line or an enlarged metamorphopsia in the computer-based tests (6/15). CONCLUSION: Our pilot study demonstrated a good correlation between the professional examination and the computer-based assessment. Selected patients can define their visual impairment. A web-based VA evaluation may help to screen patients after IVT injections on a regular basis at home.

Functional changes after photodynamic therapy with verteporfin.

OBJECTIVE: To investigate image preferences after photodynamic therapy (PDT). DESIGN: Prospective, cross-sectional study. METHODS: Seventeen patients with neovascular age-related macular degeneration were tested by color vision, contrast sensitivity, and near visual acuity (VA) with positive images and negative images before, 1 week after, and 3 months after PDT. RESULTS: Before PDT, 13 patients (76%) preferred positive images; the difference was not significant (P < .04). One week after PDT, 16 patients (94%) preferred negative images. The average near VA improved to 27 letters on positive images and to 32 letters on negative images (P < .00001). Three months after PDT, near VA declined to 19 letters on positive images and to 26 letters on negative images (P < .000001). Color vision and contrast sensitivity remained constant during all examinations. CONCLUSION: Although PDT may not alter the neurosensory retina, it may affect intraretinal function by changing image preference.

Improvement in near visual function after macular translocation surgery with 360-degree peripheral retinectomy.

BACKGROUND: Information is limited on how specific near-vision skills are impacted by therapies such as macular translocation surgery with 360-degree retinectomy (MT360) for age-related macular degeneration (AMD). METHODS: Standardized tests of near vision were given to 25 consecutive patients with AMD who met entry criteria for this study, preoperatively and 6 and 12 months after MT360. Tests included: near acuity with the Lighthouse chart, timed reading speed using Sloan cards, contrast sensitivity, and color vision. Distance acuity was measured using Bailey-Lovey charts. Measures of preoperative visual function were analyzed to identify those predictive of visual outcomes. RESULTS: Distance acuity was 20/80 or better in 52% of patients at 12 months after surgery, and mean acuity improved from approximately 20/125 preoperatively to approximately 20/100 at 12 months. Mean near acuity improved from 3.2+/-2.5 M before surgery to 1.5+/-1.0 M at 12 months (significant change of -1.5+/-2 M, P<0.001). Gain of greater than five numbers in contrast sensitivity at 12 months was also significant ( P<0.001). Mean reading speed improved from 41+/-31 words per minute (wpm) before surgery to 67+/-44 wpm at 12 months (significant gain of 25+/-33 wpm, P=0.001). Preoperative distance acuity, near acuity, and reading speed were each predictors of postoperative near visual function. CONCLUSION: Standardized testing of near visual function provides important predictive and functional outcome data for MT360. MT360 significantly improved near visual function (including near acuity, reading speed and contrast sensitivity) in patients with subfoveal lesions from AMD in the second eye.

Visual outcomes following macular translocation with 360-degree peripheral retinectomy.

OBJECTIVE: To evaluate visual outcomes following macular translocation with 360 degrees peripheral retinectomy in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration. METHODS: In a prospective study, 15 consecutive patients with large subfoveal choroidal neovascularization underwent macular translocation with 360 degrees peripheral retinectomy and silicone oil tamponade. Preoperative and postoperative photographs and fluorescein angiograms were obtained to evaluate lesion size and characteristics and translocation results. Standardized near and distance visual acuity and reading speed were measured preoperatively and 6 and 12 months postoperatively. MAIN OUTCOME MEASURES: Changes in and final levels of near and distance visual acuity and reading speed. RESULTS: Median lesion size was 9 Macular Photocoagulation Study disc areas (range, 4-16 disc areas). In all patients, the fovea was successfully translocated off the subfoveal lesion. The median near visual acuity logMAR score (logarithm of the minimum angle of resolution) improved significantly from 0.54 units to 0.40 units (Snellen equivalent, 20/70 to 20/50; P =.02) at the 6-month follow-up and stabilized at 0.54 (12 months postoperatively; Snellen equivalent, 20/70). Seven (54%) of 13 patients and 7 (58%) of 12 patients achieved reading speeds of 70 words/min or greater at the 6-month and 12-month postoperative visits, respectively. Median preoperative distance visual acuity (20/100) was maintained at both the 6-month and 12-month examinations. No postoperative retinal detachments occurred in this series. CONCLUSION: Macular translocation with 360 degrees peripheral retinectomy and silicone oil tamponade stabilizes and can sometimes improve near and distance visual acuity and reading speed in patients with vision loss from subfoveal neovascular age-related macular degeneration.

Foveal hypoplasia in oculocutaneous albinism demonstrated by optical coherence tomography.

PURPOSE: To document, in vivo, the foveal morphology and thickness in a patient with oculocutaneous albinism. METHODS: Observational case report. In a 10-year-old female with oculocutaneous albinism, multiple cross-sectional scans of the fovea were performed using optical coherence tomography. RESULTS: Optical coherence tomography scans were unable to detect the foveal pit. A widespread thickening of the retina occurred throughout the entire fovea with no difference from the surrounding macula. The foveal thickness was greater than 300 microm in the eyes of this patient with oculocutaneous albinism, compared with 150 microm in the normal eye. The inner retina had a highly reflective signal on optical coherence tomography. CONCLUSION: Optical coherence tomography demonstrated in the anatomical location of the fovea a highly reflective inner retinal signal, possibly consistent with multiple layers of ganglion cells, and it confirmed foveal hypoplasia in a patient with oculocutaneous albinism.