Visual Functions in Patients with Optic Neuritis Pre and Post Treatment: An Observational Study.

Introduction: Optic neuritis (ON) is an inflammation of the optic nerve that can occur alone or in association with neurological inflammatory or infectious disorders, or local or systemic inflammatory diseases. Vision function will return to near normal in weeks or months regardless of treatment, but it will be hastened with corticosteroid treatment. Objective: To determine the clinical features of ON patients and difference of visual acuity, contrast sensitivity and color vision before and after steroid therapy.Methods: Analytical descriptive research with retrospective data collection based on medical records of patients visiting Prof. dr. I. G. N. G. Ngoerah General Hospital in 2021-2022. Statistical analysis regarding comparation of variables before and after treatment used Wilcoxon test. Results: There were 14 patients with equal percentage of males and females, 15-40 years old (64.3%), bilateral cases (57.1%), and atypical neuritis (92.9%). The chief complaint was blurred vision (57.1%) and onset was less than one week (57.1%). Baseline visual acuity log MAR 2,00±0,51, contrast sensitivity and color vision were mostly not evaluable, respectively 57.1% and 85.7%. After steroid therapy, visual acuity reached log MAR 0,93±1,05, contrast sensitivity and color vision reached normal, both 35.7%. Conclusion: The NO patients had an equal percentage of males and females, aged 15-40 years, with bilateral atypical neuritis type. There were differences in visual acuity, contrast sensitivity, and color vision before and after steroid therapy. Whereas clinical features were better after steroid therapy. Keyword: optic neuritis, visual acuity, steroid

Estudio longitudinal de la función visual en pacientes con esclerosis múltiple remitente-recurrente con y sin antecedentes de neuritis óptica

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Background: Rigid gas permeable (RGP) and silicone hydrogel (SH) contact lenses with specific designs are currently being used to improve visual function in patients with keratoconus. However, there are minimal data available comparing the effects of these lenses on visual function in patients with keratoconus. The objectives of this study were to compare visual acuity and contrast sensitivity using spectacles, RGP lenses, and SH lenses, and to evaluate the effects of RGP and SH lenses on higher-order aberrations and visual quality in eyes with keratoconus. The relationship between visual outcomes, aberration, and visual quality were also examined. Methods: This was a pilot study involving 13 eyes from nine subjects with keratoconus. Subjects were fitted with RGP and SH contact lenses. Visual acuity and contrast sensitivity were measured using Snellen and Pelli-Robson charts, respectively. Ocular aberrations and visual quality were measured using an OPD-Scan II device. All measurements were conducted before and after contact lens wear. Results: Significantly better visual acuity was obtained with RGP lenses than with spectacles or SH lenses ( P <0.001). No significant difference in contrast sensitivity values was detected between RGP and SH lenses ( P =0.06). Both SH and RGP lenses significantly reduced total ocular and higher-order aberrations ( P <0.001) when compared with spectacles, but RGP lenses reduced trefoil, coma, and spherical aberrations more than SH lenses. No significant difference in astigmatic aberrations was found between RGP and SH lenses ( P =0.12). Negative correlations were found between visual acuity and coma aberration and contrast sensitivity with higher-order aberrations and coma, trefoil, and astigmatic aberrations. Regarding visual quality, no significant difference was found between RGP and SH lenses, but RGP significantly improved visual quality when compared with spectacles ( P =0.04). Conclusion: RGP lenses provided better visual acuity and greater reduction of aberrations than spectacles or SH lenses in patients with keratoconus. However, more data are needed to confirm these findings. Keywords: visual acuity, contrast sensitivity, aberration, visual quality, keratoconus

Optical coherence tomography (OCT) analyzes the neurodegeneration in neuromyelitis optica (NMO) and multiple sclerosis (MS) and quantifies optical atrophy. The retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness are decreased, and this structural change is correlated with visual function of patients, including contrast vision and visual field deviation. The main objective of this study was to evaluate the Bruch membrane opening minimum rim width (BMO) of the patients with NMO. We studied the thickness of the BMO by OCT, in patients with NMO (n = 25; 34 eyes), MS (n = 50; 70 eyes), and a control group (n = 51; 100 eyes). The study evaluated the structure-function relationship with the correlation between OCT and visual function: Visual acuity, Pelli-Robson score, Sloan 2.5 and 1.25, color vision, standard automated perimetry (SAP), and frequency-doubling technology perimetry (FDT). The average thickness of BMO was significantly reduced in NMO and MS with or without a history of optic neuritis (ON). Significant thinning of the average, nasal, and inferonasal BMO in the absence of ON in NMO was found compared with controls (P = 0.022, 0.006, and 0.026, respectively). BMO was strongly correlated with Pelli-Robson score (P < 0.001), Sloan 2.5 (P < 0.001), and mean deviation of SAP and FDT (P = 0.004). The sectorial study found a high correlation between the BMO and the corresponding sector of the visual field. The BMO thickness is decreased after ON in NMO and MS. This study showed an improved ability of BMO over RNFL and GCL to detect infraclinical impairment in patients with NMO without a history of optic neuropathy. Like the RNFL and GCL, BMO is well correlated with visual function, including contrast vision and visual field deviation.

To ascertain the effect of tinted optical filters (TFs) on visual function in patients with inflammatory cystoid macular edema (CME). A prospective study included 14 patients with inflammatory CME and best-corrected visual acuity between 0.1 and 0.8 (CME group) and 16 sex-, age-, and best-corrected visual acuity-matched patients with macular disorders but no CME (non-CME group). All patients from both groups underwent the following tests: determination of visual acuity at distance, contrast sensitivity (CS) testing; and subjective grading of each TF for best-corrected visual acuity and CS compared with no TFs. All tests were performed with the following TFs: Corning photochromic filter with a cutoff at 450 nm; Zeiss filter with a cutoff at 560 nm; and cheap widely available yellow filter with a cutoff at 489 nm. Without TFs, the CME and non-CME groups did not differ in best-corrected visual acuity (P = 0.79). Using the TFs, a clinically significant improvement was not achieved by any patient. However, using the definition of any improvement, best-corrected visual acuity with all TFs showed a significant improvement in the CME group compared with no TFs (P < 0.01). The CME group rated the Corning photochromic filter with a cutoff of 450 nm significantly higher than the other TFs when determining visual acuity (P = 0.05) and CS (P = 0.01) in contrast to no improvement in the non-CME group. Although the use of TFs for the CME patients was not associated with criteria of clinically significant improvement, our results indicate that visual acuity and CS in patients with inflammatory CME might benefit from the use of TFs.

Daily experience shows that colour of a very distant object cannot be accurately determined. It is assumed that visual acuity (VA) loss is one of the factors at play in this case. The effects of reduced VA as a result of refractive error or optical defocus on colour vision have not been examined. Such study willdictate the need or otherwise for optical correction before assessment of colour vision. The purpose of this study therefore, was to investigate the effects of optical defocus on colour vision in individuals with normal colour vision. Twenty nine young adult subjects (11 male and 18 females) were included in this study. Their ages ranged from 11 to 29 years with a mean of 22.1 ± 3.4 years. All subjects had VA of 6/6 or better and normal colour vision. The colour vision was evaluated with the Farnsworth panel D-15 (desaturated). Each subject was optically defocused to VA of 6/24, 6/60 and 1/60(6/360) at 6 meters respectively and colour vision was assessed at each reduced VA. At VA of 6/24, colour vision was not affected in all subjects. When the VA was reduced to 6/60, however, 15 (51%) of the subjects failed the colour vision test. When the VA was further reduced to 1/60 by optical defocus, 24 (83%) of the subjects failed the colour vision test. It was concluded that optical defocus and reduced VA can adversely affect colour vision test findings. While VA reduction to 6/24 may not affect the colour vision results, VA of 6/60 can. It is therefore, recommended that in clinical colour vision testing and colour vision screening, VA should first be assessed andcompensated, especially if uncorrected VA is 6/24 or worse.

Impact of visual function on computer task accuracy and reaction time in a cohort of patients with age-related macular degeneration

Purpose : To report visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after iodine-125 brachytherapy for choroidal and ciliary body melanoma (CCM).Design : Prospective interventional case series.Participants : Thirty-seven patients (37 eyes) with CCM.Methods : Patients had best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, Pelli-Robson contrast sensitivity and Hardy-Rand-Rittler color vision measurement; comprehensive ophthalmology examination; optical coherence tomography; and ultrasonography at baseline prior to, 1 year after, 2 years after and 3 years after I-125 brachytherapy.Main Outcome Measures : Visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after brachytherapy.Results :Nineteen (19) men and 18 women with mean age of 58 years (SD 13, range 30-78) prior to, 1 year after, 2 yearsafter and 3 years after brachytherapy had mean best-corrected visual acuity of 77 letters (20/32), 65 letters (20/50), 56letters (20/80) and 47 letters (20/125); contrast sensitivity of 30, 26, 22 and 19 letters; color vision of 26, 20, 17 and 14test figures, respectively. Decrease in visual acuity, contrast sensitivity and color vision was statistically significant frombaseline at 1 year, 2 years, and 3 years after brachytherapy. Decreased acuity at 3 years was associated with mid-choroidand macula melanoma location, ≥ 4.1 mm melanoma height, radiation maculopathy and radiation optic neuropathy.Conclusion : 1, 2 and 3 years after brachytherapy, eyes with CCM had significantly decreased visual acuity, contrast sensitivity and color vision.

Background: Comprehensive data on fellow eyes in unilateral optic neuritis is lacking. Aims: Evaluation of visual function of fellow eyes of patients with unilateral optic neuritis and response to treatment. Material and Methods: This was a retrospective study which included 20 patients with unilateral optic neuritis from a database of 34 patients of acute optic neuritis (bilateral or unilateral). All patients had assessment of visual acuity, contrast sensitivity, color vision, visual fields, visual evoked potentials (VEP) at presentation in affected and asymptomatic eyes. Patients were followed up at 1month, 3 months and 6 months after treatment with corticosteroids (IV Methylprednisolone followed by oral prednisone in rapid tapering doses), and then visual tests were repeated. Data was expressed as mean (95% confidence limit) and; analyzed by Mann–Whitney U test and paired t-test as appropriate. The probability level of <0.05 was set for statistical significance. Result: Most of the apparently normal asymptomatic fellow eyes at baseline had abnormal visual parameters [visual fields (90%), visual acuity (70%), contrast sensitivity (10%), color vision tests (10%) and VEP (40%)]. Mean values (±standard deviation) of visual parameters were reduced [visual acuity, 0.31 (0.280) logmar values; contrast sensitivity, 1.36 (±0.26) log units and visual fields, mean deviation -10.03 (±-7.39) dB respectively]. Most common field defect in fellow eye was peripheral scotoma, in contrast to affected eyes in which diffuse scotoma were predominant. None of the patient had dyschromatopsia. After IV Methylprednisolone, all visual parameters showed recovery which was maximum at 1 month, however only visual acuity showed a near significant trend (p=0.07). Conclusion: Patients with ‘unilateral’ optic neuritis have subtle bilateral affliction, detailed evaluation of fellow eye is warranted in all cases.

Aim: To find the effect of Methotrexate therapy on visual functions (visual acuity, contrast sensitivity, color vision, glare sensitivity, visual field) and ocular adnexa&#x0D; Study Design: Descriptive cross-sectional study&#x0D; Place and Duration: College of Ophthalmology and Allied Vision Sciences (COAVS), Mayo Hospital Lahore from September 2016 to November 2016.&#x0D; Material and Methods: A total of 30 patients having psoriasis and rheumatoid arthritis taking methotrexate therapy with different doses and different durations were questioned through a specified performa and then examined for changes in ocular adnexa and visual functions. Results were saved on Excel Sheets and analyzed with SPSS v.25.0.&#x0D; Results: Patients taking methotrexate therapy were found to have affected visual functions with color vision and visual field being more affected as compared to other visual functions. Dosage significantly affects color vision (p=.002) and visual field (p=.001). While in terms of duration, it was analyzed that there is significant relation (p=.006) between duration and the color vision and same was with the visual field (p=.001).&#x0D; Conclusion: Methotrexate therapy has less effect on visual acuity, contrast sensitivity, glare sensitivity and ocular adnexa. However, color vision and visual field were affected due to methotrexate therapy, and neurological visual field defects occur due to long term (1-2 years) therapy.

Background: Colour vision assessment correlates with damage of the visual pathway and might be informative of overall brain damage in multiple sclerosis (MS). Objective: The objective of this paper is to investigate the association between impaired colour vision and disease severity. Methods: We performed neurological and ophthalmic examinations, as well as magnetic resonance imaging (MRI) and optical coherence tomography (OCT) analyses, on 108 MS patients, both at baseline and after a follow-up of one year. Colour vision was evaluated by Hardy, Rand and Rittler plates. Dyschromatopsia was defined if colour vision was impaired in either eye, except for participants with optic neuritis (ON), for whom only the unaffected eye was considered. We used general linear models adjusted for sex, age, disease duration and MS treatment for comparing presence of dyschromatopsia and disease severity. Results: Impaired colour vision in non-ON eyes was detected in 21 out of 108 patients at baseline. At baseline, patients with dyschromatopsia had lower Multiple Sclerosis Functional Composite (MSFC) scores and Brief Repeatable Battery-Neuropsychology executive function scores than those participants with normal colour vision. In addition, these patients had thinner retinal nerve fiber layer (RNFL), and smaller macular volume, normalized brain volume and normalized gray matter volume (NGMV) at baseline. Moreover, participants with incident dyschromatopsia after one-year follow-up had a greater disability measured by the Expanded Disability Status Scale and MSFC-20 and a greater decrease in NGMV than participants with normal colour vision. Conclusions: Colour vision impairment is associated with greater MS severity.

Analysis of Visual Acuity, Contrast Sensitivity and Color Perception in Multiple Sclerosis Patients

To determine the efficacy of corticosteroids as treatment for acute demyelinative optic neuritis after completion of 1 year of patient follow-up in the Optic Neuritis Treatment Trial. Randomized placebo controlled multicenter clinical trial. Fifteen university or hospital-based centers throughout the United States. Four hundred fifty-seven patients with acute demyelinative optic neuritis between 18 and 46 years of age. Either intravenous methylprednisolone sodium succinate (250 mg every 6 hours) for 3 days followed by oral prednisone (1 mg/kg per day) for 11 days, oral prednisone (1 mg/kg per day) for 14 days, or oral placebo for 14 days. The first two regimens were followed by a short taper of corticosteroid therapy. Visual acuity, visual field, contrast sensitivity, and color vision. Visual acuity at 1 year was 20/40 or better in 95% of the placebo group, 94% of the intravenous group, and 91% of the oral prednisone group. Comparing each corticosteroid group with the placebo group, there were no statistically significant differences in the distributions of any of the four measures of visual function. Patients in the oral prednisone group suffered a higher rate of new attacks of optic neuritis than patients in either of the other two groups. The visual benefit from treating acute optic neuritis with intravenous followed by oral corticosteroids is short term, limited to an accelerated rate of recovery. The decision whether to prescribe this regimen for optic neuritis, or to prescribe no treatment, must be made for each patient on an individual basis. Oral prednisone alone, in the dose range used in the Optic Neuritis Treatment Trial, should not be prescribed.

Introduction The purpose of the study was to determine whether personality traits influence self-reported functional vision in patients with age-related macular degeneration (AMD). Methods This is a prospective cross-sectional analysis of baseline data from the Low Vision Depression Prevention Trial. Participants ( N = 182) over age 65 with bilateral AMD, visual acuity worse than 20/70 in the better-seeing eye, and subthreshold depression were recruited from the Wills Eye Hospital retina practice. Assessments included visual acuity, contrast sensitivity, National Eye Institute Visual Function Questionnaire–25 plus Supplement (NEI VFQ–25) near and distance subscales, depression, and personality testing. Structural equation models were used to investigate the relationship of the NEI VFQ near activities and distance activities with the various demographic, clinical, and psychological predictors. Results In the single-predictor model for near functional vision, visual acuity at logMAR ≤ 1 (estimate = −0.33 [95% confidence interval {CI} −0.46, −0.20]; p ≤ 0.001), neuroticism (estimate = −0.05 [95% CI −0.08, −0.01]; p = 0.01), and education (estimate = −0.08 [95% CI 0.01, 0.15]; p = 0.03) were statistically significant predictors. In the single-predictor model for distance functional vision, only visual acuity at logMAR ≤ 1 (estimate = −0.49 [95% CI −0.69, −0.29]; p ≤ 0.001) and neuroticism (estimate = −0.09 [95% CI −0.15, 0.02]; p = 0.008) were statistically significant predictors. Discussion: Self-reported functional vision depends on the severity of vision loss as well as the personality trait of neuroticism. Implications for practitioners Assessment of personality traits, particularly neuroticism, may increase the precision of rating scales of functional vision and suggest new rehabilitative interventions to improve the functional vision and quality of life of patients with AMD.