Investigating the impact of asymmetric macular sensitivity on visual acuity chart reading in choroideraemia.

INTRODUCTION: Degeneration in choroideraemia, unlike typical centripetal photoreceptor degenerations, is centred temporal to the fovea. Once the fovea is affected, the nasal visual field (temporal retina) is relatively spared, and the preferred retinal locus shifts temporally. Therefore, when reading left to right, only the right eye reads into a scotoma. We investigate how this unique property affects the ability to read an eye chart. METHODS: Standard- and low-luminance visual acuity (VA) for right and left eyes were measured with the Early Treatment of Diabetic Retinopathy Study (ETDRS) chart. Letters in each line were labelled by column position. The numbers of letter errors for each position across the whole chart were summed to produce total column error scores for each participant. Macular sensitivity was assessed using microperimetry. Central sensitivity asymmetry was determined by the temporal-versus-nasal central macular difference and subsequently correlated to a weighted ETDRS column error score. Healthy volunteers and participants with X-linked retinitis pigmentosa GTPase regulator associated retinitis pigmentosa (RPGR-RP) were used as controls. RESULTS: Thirty-nine choroideraemia participants (median age 44.9 years [IQR 35.7-53.5]), 23 RPGR-RP participants (median age 30.8 years [IQR 26.5-40.5]) and 35 healthy controls (median age 23.8 years [IQR 20.3-29.0]) were examined. In choroideraemia, standard VA in the right eye showed significantly greater ETDRS column errors on the temporal side compared with the nasal side (p = 0.002). This significantly correlated with greater asymmetry in temporal-versus-nasal central macular sensitivity (p = 0.04). No significant patterns in ETDRS column errors or central macular sensitivity were seen in the choroideraemia left eyes, nor in RPGR-RP and control eyes. CONCLUSION: Difficulty in tracking across lines during ETDRS VA testing may cause excess errors independent of true VA. VA assessment with single-letter optotype systems may be more suitable, particularly for patients with choroideraemia, and potentially other retinal diseases with asymmetric central macular sensitivity or large central scotomas including geographic atrophy.

Measuring Vision at Home in 2023.

Introduction: The ability to measure a patient's visual acuity at home (HVA) is by far the most desired remote telemedicine capability sought by ophthalmologists. Methods: A systematic literature review was done using Pubmed to search for publications from 2010 to 2022 in English reporting on 10 studies that compared a patient's HVA to the clinic visual acuity (CVA). Results: Approaches to measuring HVA included using a phone-based application, a physical chart, a computer, and a website. The most accurate of these was the use of personal computers (COMPlog, Macustat, Web based test) at home with a bias of 1 letter. The most accessible and reliable was the use of a printable visual acuity chart, available in the public domain, which had adifference between HVA and CVA of 1 to 3.5 letters. Phone apps (Verana Vision) and stand-alone websites (Farsight.com) both had a greater mean difference of about 6 letters, respectively,with a moderate correlation coefficient. Discussion: Overall, all three methodologies demonstrated a good negative predictive value demonstrating their potential use as an effective screening tool to flag drastic vision decline between clinic visits.

Reliability of self-measurement of visual acuity in AMD patients with two electronic devices based on the ETDRS chart: A randomized study.

INTRODUCTION: Age-related macular degeneration (AMD) requires continuous visual acuity (VA) monitoring, increasing the burden on the health care system. Self-measurement VA tests are available on various devices. However, none of them have been based on an internationally validated benchmark chart, such as that of the Early Treatment Diabetic Retinopathy Study (ETDRS). The goal of this study was to assess the reliability of two digitized ETDRS charts adapted to two electronic devices for self-measurement of VA. MATERIAL AND METHODS: A prospective, single-center, 1:1 randomized, two-arm, parallel group trial was conducted. The main objective was to compare VA variation as conventionally measured on a 4-m ETDRS chart versus self-measured with digitized ETDRS charts in patients treated for AMD. At each visit, conventional measurement and patient self-measurement, either on a computer at 80-cm (arm 1) or on a tablet at 40-cm (arm 2), were performed. RESULTS: Eighty patients were included (25 men, 55 women, mean age 81.3±7.4 years). No significant differences were observed between VA variation, conventionally measured and self-measured on a computer (arm 1; P=0.914) or tablet (arm 2; P=0.913). CONCLUSION: These results confirm the reliability of these two methods for self-measurement of VA, and will lead to the development of a wider "telemedicine" project extended to self-measurement of VA in various pathologies.

Research progress on commonly used visual acuity charts for preschool children / 国际眼科杂志(Guoji Yanke Zazhi)

Preschool age(3-6 years old)is a critical period for visual development, and it is crucial to detect and treat visual problems in preschool children as early as possible. Visual acuity charts are important tools for screening visual issues in children. In China, the commonly used charts are the standard logarithmic visual acuity chart and the pediatric optotype chart, while overseas, the Lea, HOTV, and ETDRS visual acuity charts are frequently employed. Numerous studies have reported the measurability, repeatability, and sensitivity of these three charts in diagnosing visual-related problems in children. However, the application of these three charts is relatively limited in China. This article provides a comprehensive review of the design principles, clinical applications, and characteristics of these three visual acuity charts, so as to better understand their applicability and limitations in preschool children, and provide reference for the selection and improvement of vision examination methods in the future.

Visual Acuity Examination Methodology in Keratoconus.

Visual acuity is one of the most important parameters for evaluating the vision of patients with keratoconus. This study reviewed 295 articles related to keratoconus published between 2017 and 2022 in which visual acuity was one of the parameters measured. The methodology of visual acuity testing in studies on keratoconus was thoroughly analyzed. The analysis showed that the most commonly indicated chart for testing visual acuity papers on keratoconus is the Snellen chart. It was shown that in 150 out of 295 articles, the authors do not describe the methodology for testing visual acuity. What is more, it was also shown that in 68 of the 295 articles which were analyzed, a procedure for converting visual acuity tested with a Snellen chart into a logMAR scale was used. In this review, we discuss the validity and reliability of such conversions. In particular, we show that insufficient description of visual acuity testing methodology and lack of information on the conversion of visual acuity results into the logMAR scale may contribute to the misinterpretation of visual acuity test results.

HAS SNELLEN CHART LOST THE BATTLE TO ETDRS IN CATARACT SURGERY VISUAL ACUITY EVALUATION?

This study was designed to explore practical differences between visual acuity (VA) scores measured on Snellen chart versus ETDRS chart, to grade cataracts using LOCS III system, and to compare VA on both charts depending on cataract grade and type. Prospective evaluation of uncorrected and best-corrected visual acuity was carried out on the eye scheduled for cataract surgery preoperatively and postoperatively on the Snellen and ETDRS charts. The study was carried out at Department of Eye Diseases, Clinical Center of Serbia, during a two-year period. Inclusion criteria were met by 540 patients who underwent testing, surgery, data collection and analysis. The mean VA score was better on ETDRS than on Snellen chart. The mean difference was 6.05 letters or 1.21 lines. VA results correlated with all types of cataract regardless of the chart used, with the highest statistical significance (p<0.0001) for subcapsular cataract. The ETDRS chart was found to be more discriminative and precise than Snellen chart, especially for poor VA.

Comparison of Visual Acuity Measurement Using Three Methods: Standard ETDRS Chart, Near Chart and a Smartphone-Based Eye Chart Application.

PURPOSE: To validate the Rosenbaum near vision card (Near Chart) and a smartphone-based visual acuity (VA) test (Eye Chart) against a standard retro-illuminated Early Treatment Diabetic Retinopathy Study (ETDRS) chart within participants. MATERIALS AND METHODS: A cross-sectional study of participants aged ≥18 years was conducted. VA was measured in all participants using the ETDRS chart, Near Chart and smartphone-based Eye Chart application, respectively. VA was converted to logarithm of the minimum angle of resolution (logMAR) for statistical analysis. Eyes with ETDRS VA worse than 1.0 logMAR (20/200) were excluded. The main outcome measures were levels of agreement between VA measured using the Near Chart or Eye Chart application vs the ETDRS chart. RESULTS: A total of 295 eyes of 151 participants were included. One hundred participants (66.2%) were female and the mean age was 64.3 ± 12.5 years. Educational level was high school or below for 49% of participants and at Bachelor's degree or above for 51%. The median logMAR VAs of all eyes tested using the ETDRS chart, Near Chart and Eye Chart application were 0.1, 0.0 and 0.1, respectively. The median VA difference between the Near Chart vs ETDRS chart and Eye Chart application vs ETDRS chart was 0.0 logMAR in both cases for both the right eye (OD) and left eye (OS). Intraclass correlation coefficient (ICC) demonstrated a strong positive correlation between VA tested with the Near Chart vs ETDRS chart (OD: ICC=0.85; p<0.001, OS: ICC=0.77; p<0.001) and Eye Chart application vs ETDRS chart (OD: ICC=0.88; p<0.001, OS: ICC=0.74; p<0.001). CONCLUSION: VA measurements with the Near Chart and smartphone-based Eye Chart application corresponded well to the standard ETDRS chart, suggesting potential utility of alternative portable VA tests for in-office or remote vision monitoring, particularly during periods of physical distancing such as the Coronavirus disease 2019 (COVID-19) era.

Validation of a Standardized Home Visual Acuity Test for Teleophthalmology.

Purpose: The recent exponential growth in teleophthalmology has been limited in part by the lack of a validated method to measure visual acuity (VA) remotely. We investigated the validity of a self-administered Early Treatment Diabetic Retinopathy Study (ETDRS) home VA test. We hypothesized that a home VA test with a printout ETDRS chart is equivalent to a standard technician-administered VA test in clinic. Design: Prospective cohort study. Participants: Two hundred nine eyes from 108 patients who had a scheduled in-person outpatient ophthalmology clinic visit at an academic medical center. Methods: Enrolled patients were sent a .pdf document consisting of instructions and a printout ETDRS vision chart calibrated for 5 feet. Patients completed the VA test at home before the in-person appointment, where their VA was measured by an ophthalmic technician using a standard ETDRS chart. Survey questions about the ease of testing and barriers to completion were administered. For the bioequivalence test with a 5% nominal level, the 2 1-sided tests procedure was used, and an equivalent 90% confidence interval (CI) was constructed and compared with the prespecified 7-letter equivalence margin. Main Outcome Measures: The primary outcome was the mean adjusted letter score difference between the home and clinic tests. Secondary outcomes included the unadjusted letter difference, absolute letter difference, and survey question responses. Results: The mean adjusted VA letter score difference was 4.1 letters (90% CI, 3.2-4.9 letters), well within the 7-letter equivalence margin. Average unadjusted VA scores in clinic were 3.9 letters (90% CI, 3.1-4.7 letters) more than scores at home. The absolute difference was 5.2 letters (90% CI, 4.6-5.9 letters). Ninety-eight percent of patients agreed that the home test was easy to perform. Conclusions: An ETDRS VA test self-administered at home following a standardized protocol was equivalent to a standard technician-administered VA test in clinic in the examined population.

[Visual acuity assessment: historical overview and current trends]. / Otsenka ostroty zreniia: vzgliad v proshloe i sovremennye tendentsii.

The article reviews the evolution of visual acuity assessment and gives comparison of the visual acuity charts (Snellen vs. ETDRS) widely used in research and clinical practice.

Comparative analysis of Lea Symbols chart and ETDRS chart in Chinese preschool children's vision examination / 中华实验眼科杂志

Objective@#To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children.@*Methods@#A prospective self-control study design was performed.Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61.9±10.3) months.Among them, 132 pre-school children had normal refractive index.All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart.All monocular visual acuity scores were recorded in LogMAR form.This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University (No.2017[62]). Written informed consent was obtained from all guardians before entering the study.@*Results@#The cooperation degrees of Lea Symbols chart and ETDRS chart were 96.7% and 95.0% in 42-78 months of children, respectively, with no significant difference between the two visual acuity tables (χ2=1.669, P>0.05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (rs=0.726, P<0.001). The measurement consistency of the two chart was good (Kappa=0.531). Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7.461, P<0.001); the measurement consistency of the two visual acuity chart was good (Kappa=0.467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0.889, P=0.374); the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls, and the difference was statistically significant (U=-3.352, -4.679; both at P<0.001); the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age (rs=-0.423, -0.437; both at P<0.001); the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups, and the differences were statistically significant (all at P<0.001).@*Conclusions@#The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children.The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart.In the preschool children's vision screening, we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.

Comparative analysis of Lea Symbols chart and ETDRS chart in Chinese preschool children ' s vision examination / 中华实验眼科杂志

Objective To compare cooperation degree and visual acuity difference between Lea Symbols chart and ETDRS chart in Chinese preschool children. Methods A prospective self-control study design was performed. Two hundred and forty-one children aged from 42 months to 78 months in Quanzhou Quangang Experimental Kindergarten were enrolled and the mean age was (61. 9±10. 3) months. Among them,132 pre-school children had normal refractive index. All children completed comprehensive ophthalmological examinations and measurement of monocular visual acuity using Lea Symbols chart and ETDRS chart. All monocular visual acuity scores were recorded in LogMAR form. This study followed the Declaration of Helsinki and this study protocol was approved by Medical Ethics Committee of The Second Affiliated Hospital of Fujian Medical University ( No. 2017 [ 62 ] ) . Written informed consent was obtained from all guardians before entering the study. Results The cooperation degrees of Lea Symbols chart and ETDRS chart were 96. 7％ and 95. 0％ in 42-78 months of children,respectively, with no significant difference between the two visual acuity tables (χ2=1. 669,P>0. 05). The visual acuity measured by Lea Symbols chart was positively correlated with that measured by ETDRS chart (rs=0. 726,P<0. 001). The measurement consistency of the two chart was good ( Kappa=0. 531 ) . Among 132 normal refractive children, the visual acuity level measured by Lea Symbols chart was higher than that measured by ETDRS chart (W=-7. 461,P<0. 001);the measurement consistency of the two visual acuity chart was good (Kappa=0. 467). There was no significant difference between the two charts in measuring the binocular vision difference (W=-0. 889,P=0. 374);the visual acuity levels of boys measured by Lea Symbols chart and ETDRS chart were higher than those of girls,and the difference was statistically significant (U=-3. 352,-4. 679;both at P<0. 001);the visual acuity values measured by Lea Symbols chart and ETDRS chart were negatively correlated with age ( rs =-0. 423,-0. 437;both at P<0. 001 );the visual acuity measured by Lea Symbols chart was higher than that measured by ETDRS chart in different age groups,and the differences were statistically significant (all at P<0. 001). Conclusions The measurement of visual acuity by Lea Symbols chart and ETDRS chart can be achieved with a high cooperation degree in 42 months and older children. The visual acuity measured by Lea Symbols chart is higher than that measured by ETDRS chart. In the preschool children's vision screening,we should pay attention to the difference between the two kinds of visual charts, and be careful to judge the abnormal vision.

Application of ETDRS chart and mfERG in assessing pathologic myopia combined with macular CNV after treatment / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the efficacy of anti - vascular endothelial growth factor ( VEGF ) and photodynamic therapy ( PDT) on pathological myopia ( PM) combined with choroidal neovascularization ( CNV ) using ETDRS chart and multifocal electroretinogram (mfERG). ·METHODS: Forty-three patients ( 45 eyes) diagnosed by fundus fluorescein angiography ( FFA ), indocyanine green angiograph ( ICGA ) and optical coherence tomography (OCT) with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab ( 20 patients, 22 eyes) and PDT (23 patients, 23 eyes). After treatment, all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity ( BCVA) was recorded with the ETDRS chart and mfERG. At the last follow-up, the therapy efficacy was determined by ETDRS numbers and mfERG and analyzed. ·RESULTS: Before treatment, there was no significant difference on the baseline in ETDRS and mfERG latency of N1 wave, latency and the density values of P1 wave between ranibizumab group and PDT group. After 12mo treatment, the ETDRS number in ranibizumab group (39. 23± 20. 06) significantly increased to the baseline by 5. 88±9. 03(P<0. 05), and in PDT group (37. 38±16. 95) was not significantly improved by 0. 33±6. 94(P>0. 05). There was no significant difference in latency of N1 wave, latency and the density values of P1 wave from treatment response of mfERG in the two groups (P>0. 05). · CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT, while similar on macular.

Evaluation of Ranibizumab and PDT for patients with pathologic myopia and macular CNV / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the efficacy of anti - vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) on pathological myopia (PM) combined with choroidal neovascularization (CNV). ·METHODS: Forty-three patients (45 eyes) diagnosed by fundus fluorescein angiography (FFA), indocyanine green angiography ( ICGA ) and optical coherence tomography (OCT) with PM combined with macular CNV were recruited in this study. The patients were randomly divided into two groups for different treatments, intravitreal injection with Ranibizumab (20 patients, 22 eyes) and PDT(23 patients,23 eyes). After treatment,all patients had been followed up monthly for 12mo. The further treatments were operated according to referral situations. The best corrected visual acuity (BCVA) was recorded with the ETDRS chart and the mean defect(MD) of the center 10° visual field was measured. At the last follow-up,the therapy efficacy was determined by ETDRS numbers and MD and analyzed. ·RESULTS: Before treatment, there was no significant difference on the baseline in ETDRS and MD between ranibizumab group and PDT group (P>0.05). After 12mo treatment, the ETDRS number in ranibizumab group (39.23±20.06) significantly increased (by 5.88 ± 9.03, P<0.05), but the PDT group (37. 38 ± 16. 95) was not significantly improved(by 0.33±6.94,P>0.05). The MD in ranibizumab group decreased significantly (P<0.05), and no significant change was found in PDT group(P>0.05). · CONCLUSION: In the treatment of macular CNV complicated by the PM, ranibizumab injection can improve visual function better than PDT.

Contribution of sVEP visual acuity testing in comparison with subjective visual acuity.

AIMS: Visual acuity determination is an important task in ophthalmology and optometry practices. Visual acuity can be examined objectively or subjectively. The objective examination method, sVEP, allows for quick objective measurements of patient's visual acuity. Previous studies have not demonstrated the repeatability of this objective sVEP method. This study aims to evaluate the sVEP method and compare it to a subjective method. METHODS AND RESULTS: The sample was divided into two groups. For the first group, visual acuity was measured with sVEP and Snellen methods on only one patient twelve times. In the second group, visual acuity was measured twice with sVEP followed twice with the Snellen method with Landolt's rings and logMAR modification on 32 non-pathological patients. Results showed significant differences between average values of visual acuity obtained with both methods (sVEP and Snellen) in both samples (T-test, P < 0.01; Wilcoxon test, P = 0.02 in second group). In the second group, significant correlations between repeated sVEP measurements (Spearman test, P < 0.05, r = 0.69) were found but no significant correlation between average sVEP measurement and average Snellen measurement (Spearman test, P > 0.05, r = 0.15) was found. CONCLUSION: Objective measurement of visual acuity with sVEP is a valid and reliable method, but is recommended only when it is not possible to use a subjective method for measuring visual acuity, e.g. children, patients with mental retardation or simulating/dissimulating patients.