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Cerebral visual impairment (CVI), the leading cause of bilateral visual impairment in children, is often characterized by visual acuity (VA) loss and higher visual function deficits (HVFDs). However, the relationship between VA loss and HVFDs remains unknown. A previous study using the Higher Visual Function Question Inventory (HVFQI) demonstrated that normal VA did not preclude HVFDs. In this prospective controlled study of children with CVI, we examine the relationship between HVFDs and degrees of VA loss to refine our understanding of this relationship. We introduce two new indices—HVFD spectrum and severity—to provide a comprehensive view of how CVI affects the individual child and the entire cohort. We also performed an analysis to determine the effectiveness of the HVFQI in eliciting HVFDs and present a preliminary analysis of the relationship between HVFDs and age. The study participants included 59 children with CVI (age: 9.87 ± 3.93 years [mean ± SD]; binocular VA: 0.35 ± 0.34 log MAR.) and 120 neurotypical (NT) children with normal visual acuity (age: 8.7 ± 2.8 years; binocular VA: 0.14 ± 0.16 logMAR). Clinical history and notes independently confirmed the diagnosis of CVI. Parents were interviewed with the HVFQI, and their responses were recorded using a five-level Likert scale. Mann–Whitney U-test (MWU) determined the ability of HVFQI to distinguish between CVI and NT participants; Fisher’s exact test (FET) and d-variable Hilbert–Schmidt independence criteria (dHSIC) assessed the independence between HVFDs and VA. The average spectrum (range 0–1) and severity (range 1–5) indices for CVI (spectrum: 0.65 ± 0.24, severity: 3.1 ± 0.77) and NT (spectrum: 0.12 ± 0.17, severity: 1.42 ± 0.49) were markedly different. MWU ( p -value <0.00001) confirmed the ability of HVFQI to distinguish CVI from NT children for both indices. The FET reported a p -value of 0.202, which indicates that the data does not exhibit any relation between the HVFDs severity and VA. Analysis using dHSIC supports these findings ( p -value 0.784). Based on these results, we urge that all children with suspected CVI need to be assessed for HVFDs in addition to VA measures. The HVFQI can potentially increase our understanding of the neural basis of visual perception, cognition, and visually guided action and lead us toward a conceptual model of CVI, translating to clinical practice improvements.

Utility index is a significant outcome in terms of health economics assessment while patient-reported outcome measure (PROMs) evaluates quality of life (QOL) from patient's perspective. Our objective was to evaluate both utility indices and PROMs using generic and eye specific QOL in glaucomatous patients compared with normal population. This is a case-control study. We interviewed normal and glaucomatous participants with the European Quality of Life questionnaire (EQ-5D-5L), the European visual analogue scale (EQ-VAS) and the visual function questionnaire 28 (Thai version) (VFQ-28). The visual function questionnaire utility index (VFQ-UI) and generic utility index from EQ-5D-5L were calculated. There were 47 normal and 127 glaucomatous participants in this study. Amongst glaucoma group, 35 participants were in the early stage of the disease, 43 were in the moderate stage, 30 normal vision participants were in the severe stage, 14 participants had blindness one eye, and 5 had blindness both eyes. The mean age of the participants in both groups was statistically similar (63.78±6.84 vs 66.30±8.93 years old, respectively, p=0.062). Underlying diseases between groups were also comparable. The EQ-5D-5L utility index score and the EQ-VAS score were not statistically different between normal and glaucomatous groups, respectively (EQ-5D-5L: 0.874±0.122 vs 0.837±0.191, p=0.215; EQ VAS: 76.06±15.07 vs 74.02 ±15.10, p=0.43). By contrast, VFQ-UI of the glaucomatous group was significantly lower than that of the normal group, (VFQ-UI: 0.833±0.147 vs 0.895±0.070, accordingly, p<0.05). Utility index from the VFQ-UI was a relevant PROMs for evaluating the QOL of glaucomatous patients in terms of visual function specificity and acceptable validity.

To evaluate the subjective visual functions of early cataracts patients and assess their surgical indications. Eyes were separated into a control group (Group A without cataract) and two early cataracts groups (Group B with 2.0 ≤ OSI < 3.0 and Group C with 3.0 ≤ OSI < 4.0). The objective scatter index (OSI), modulation transfer function cut-off frequency (MTF cut-off), and Strehl ratio (SR) values were applied to measure objective visual functions. The contrast sensitivity (CS) and scores of the questionnaires (QOL and VF-14) characterized subjective visual functions. Above visual functions were compared among three groups. Postoperative visual functions in Group B and C were analyzed to assess the outcome of surgery. Ninety two subjects (126 eyes) were included in the study. All objective visual function in Group B were significantly better than Group C (all < 0.01), but worse than Group A (all < 0.01). Except for 1.5 c/d CS, subjective visual function in Group A were significantly better than Group B and C (all < 0.05), but there was no significant differences between Group B and C. As for eyes that underwent surgery in Group B and C, all visual functions significantly improved after surgery ( < 0.05), except for 1.5 c/d CS in Group C. There were no significant differences among the three groups after surgery. The subjective visual function can be impaired in early cataracts patients with OSI < 3.0, whose objective visual functions were statistically better than patients with OSI ≥ 3.0. These patients can benefit equally from surgery as patients with OSI ≥ 3.0. Subjective visual functions can be used as surgical indications for these patients.

Introduction Visual function and cognitive impairment are interrelated; however, little is known about the impact of modifying treatable vision impairment on the development of cognitive dysfunction. This study examines the relationship between cognition and self‐reported visual function using the National Eye Institute's Visual Function Questionnaire (NEI VFQ). Methods Participants completed the NEI VFQ 25‐Item questionnaire as well as the Mini‐Mental State Examination (MMSE). Additionally, all participants were assigned a consensus clinical diagnosis based on established criteria. We used a general linear model and analysis of variance approach to compare means between multiple groups. Results A significant association between overall composite score on the NEI VFQ and total MMSE score was revealed (P = 0.04). On average, for every 1‐point increase in MMSE score, the overall composite score increased by 0.40 units (95% confidence interval: 0.03–0.77). Discussion Reduced visual function should raise concerns about cognitive decline and prompt additional assessment.

Retinitis pigmentosa is an incurable, degenerative retinal condition causing progressive sight loss, significantly affecting patients' quality of life. The Argus II Retinal Prosthesis is a surgically implanted medical device that delivers electrical stimulation to the retina. It is intended to produce a form of artificial vision for blind people with severe-to-profound retinitis pigmentosa by stimulating the remaining viable retinal cells to induce visual perception. This study has been initiated by National Health Service England's Commissioning through Evaluation program and funded through the National Institute of Health Research of the United Kingdom. The aim of this study was to assess the effect of the Argus II device on patient's daily activities and quality of life. This protocol is a prospective, single-arm, open-label, mixed methods study on 10 consecutive participants receiving the Argus II device. The patient representatives played an integral role in the design of this study. Eligibility criteria include ultra-low vision in both eyes as a result of end-stage retinitis pigmentosa and a willingness and capacity to complete the postimplantation rehabilitation program. Participants will be interviewed by independent researchers at baseline and 12 months later by using a semistructured, in-depth approach, alongside validated questionnaires (Impact of Vision Impairment-Very Low Vision, 5-level EuroQoL-5 dimensions scale, EuroQoL-visual analog scale, and Hospital Anxiety and Depression Scale) and a bespoke device-related questionnaire, which includes questions about users' experiences with the procedure, the device, and rehabilitation. The effect of the device on patients' functional vision and activities of daily living will be assessed by vision rehabilitation specialists using a set of tests measured on an ordinal scale (eg, ability to locate objects and avoid obstacles). Clinical outcomes include full-field stimulus light threshold, square localization, direction of motion, grating visual acuity, Landolt-C, procedural success, and adverse events. Qualitative and quantitative outcomes will be linked in a single database to enable individual participant measures to be considered in toto, comparing baseline to the final review. This study was approved by the local ethics committee on April 24, 2019 (London-Camberwell St. Giles Research Ethics Committee, reference 19/LO/0429). It has also been approved by the Health Research Authority and Health and Care Research Wales. At the time of protocol writing, Argus II was available for use in the United Kingdom; however, the manufacturer recently withdrew the Argus II device from sale in the United Kingdom. Therefore, the study is not going ahead at this time. The mixed methods approach provides a rich and in-depth assessment of the effect of the device on participants' quality of life. Despite the work not going ahead, the publication of this publicly funded protocol is important for researchers planning similar work. PRR1-10.2196/17436.

Introduction Cerebral Visual Impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of cerebral visual impairment but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/ or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method. Patients and methods We developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤18 years) were performed in the databases Medline, Embase and Psychinfo, each with a distinct topic. Results Based on evidence articles were selected on five topics: 1 Medical history and CVI-questionnaires 23 (out of 1007) 2 Ophthalmological and orthoptic assessment 37 (out of 816) 3 Neuropsychological assessment 5 (out of 716) 4 Neuroradiological evaluation and MRI 9 (out of 723) 5 Genetic assessment 5 (out of 458) Conclusions In medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of transsynaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups (brain maldevelopment, white and grey matter lesions, postnatal lesions and a normal MRI). In children with CVI and PVL (periventricular leukomalacia), brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.

In clinical practice Cerebral Visual Impairment (CVI) is typically diagnosed by observation of abnormal visually guided behaviors which indicate higher visual function deficits (HVFDs) suggesting abnormal brain development or brain damage in a child with a suitable clinical history. HVFDs can occur even in the presence of good visual acuity and may remain undiagnosed because the good visual acuity does not prompt further investigation. This leads to a lack of understanding of the child’s visual perceptual difficulties. In a prospective study, we determined the spectrum of HVFDs in a group of children with history suggestive of brain damage or disruption of brain development and an independent diagnosis of CVI in comparison with typically developing children with a structured 51 question inventory, the Higher Visual Function Question Inventory (HVFQI-51) adapted from the Cerebral Vision Impairment Inventory, CVI-I. Here, we show that the HVFQI-51 can detect a range of HVFDs in children with CVI with good visual acuity and clearly distinguishes these children from typically developing children. HVFDs in our study group could mostly be attributed to dorsal stream visual processing dysfunction though the spectrum varied between children. We report on the inclusion of the “not applicable” response option in analysis providing a picture of HVFDs more in tune with the overall disability of each child. We also propose a subset of 11 questions (Top-11) which discriminate between children with CVI vs. behaviors seen in typical children: this provides both a potential screening tool for initial assessment of HVFDs and a measure of CVI-related impairment, and needs further validation in a secondary independent sample.

Relevance. Vitrectomy with the covering of the macular defect with an inverted flap of the inner boundary membrane (IBM) is one of the promising areas of macular hole surgery (MH). However, anatomical closure of a macular defect is not always accompanied by visual functions increase. Purpose. To evaluate the possibility and degree of restoration of the retinal structure and visual functions after surgical treatment of medium and large diameter MH using the method of inversion and fixation of the free flap of the IBM. Material and methods. The prospective study included 40 patients (40 eyes) with medium and large diameter MH, average age 67.5±5.31 (56–78) years. In the long-term postoperative period, all patients, depending on the received visual acuity, were divided into 3 groups: group 1 — an increase in visual acuity by 0.1 or more, group 2 — no changes in visual acuity, group 3 — visual impairment by 0.1 or more. Results. In the first group, in the long-term postoperative period, there was a significant increase in visual acuity from 0.16±0.14 to 0.46± 0.2 (p=0.002), accompanied by the formation of a U-shaped macular profile. In the second group, despite the subjective improvement in the quality of vision, visual acuity remained at the preoperative level of 0.2±0.07 (p≥0.05). In the third group, there was a moderate and unreliable decrease in visual acuity to 0.2±0.08 compared with preoperative indicators of 0.27±0.09 (p≥0.05). Conclusion. Endovitreal intervention in MH of medium and large diameter using the technology of inversion and fixation of the free flap of the IBM is highly effective, allowing to achieve 100% anatomical closure of the macular defect, provided the correct intraoperative location and normal postoperative adaptation of the flap of the IBM. The possibility of restoring visual functions is determined by the initial state of the hole, in which the most significant criteria are the correspondence of the minimum and maximum diameter of the hole, the absence of epiretinal proliferation and the duration of the hole up to 3 months determine the closure of the U-type hole, the restoration of the ellipsoid zone and the functional activity of the retina. The predictors of V- and W-type macular hole closure are: a trapezoidal hole shape with an initial maximum diameter significantly larger than the minimum diameter; a mean hole height of 357.2±44.9 μm; the presence of intraretinal cyst resorption; and evidence of preretinal fibrosis. As a result, recovery of the ellipsoid zone and the patient’s visual function is not anticipated. Keywords: macular hole, internal boundary membrane, multifocal ERG, visual functions restoration

[This corrects the article DOI: 10.3389/fnint.2023.1234471.].

To explore functional visual recovery after retinal reattachment surgery employing full-field electroretinography (ffERG). In this case series, scotopic and photopic ffERGs were compared 2 days before, and 1, 3 and 6 months after successful scleral buckling for total rhegmatogenous retinal detachment (RRD). Main outcome measures were changes in ERG a-and b-wave amplitudes postoperatively. Twenty eyes of 20 patients including 14 male and 6 female subjects with mean age of 34.7±8.2 (range, 23 to 50) years were enrolled. Preoperatively, mean a-wave amplitude in the maximal combined response was 27.5±11.7 mV which was increased to 110.7±41.9 (P<0.001), 175.7±53.1 (p<0.001) and 174.6±51.4 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative a-wave amplitude of the cone ERG response was 2.1±0.8 mV, which was increased to 2.2±0.9 (P=0.03), 5.1±1.7 (P<0.001) and 5.3±1.6 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude in the maximal combined response was 97.6±28.9 mV which was increased to 179.2±44.9 (P<0.001), 264.2±56.3 (P<0.001) and 267.8±54.2 (P<0.001) mV at 1, 3 and 6 months, respectively. Mean preoperative b-wave amplitude of the cone ERG response was 2.9±0.9 mV which was increased to 3±0.9 (P=0.32), 9.9±1.9 (P<0.001) and 9.8±1.9 (P<0.001) mV at 1, 3 and 6 months, respectively. After retinal reattachment surgery, photoreceptor and visual function show parallel improvement. The scotopic ERG response recovered faster than the photopic response. Incomplete recovery of ERG parameters indicates that photoreceptor cell damage in retinal detachment is not completely reversible.