Download ARVO 2014 Annual Meeting Abstracts 414 Low vision I Wednesday

ARVO 2014 Annual Meeting Abstracts
414 Low vision I
Wednesday, May 07, 2014 8:30 AM–10:15 AM
Exhibit/Poster Hall SA Poster Session
Program #/Board # Range: 4126–4163/A0114–A0151
Organizing Section: Visual Psychophysics / Physiological Optics
Contributing Section(s): Retina
Program Number: 4126 Poster Board Number: A0114
Presentation Time: 8:30 AM–10:15 AM
MOTION PERCEPTION IN DRY AGE-RELATED MACULAR
DEGENERATION
Claudine Bellerive1, 3, Gilles Lalonde1, Laurence Letartre1, Martin
Simoneau2, 4, Normand Teasdale2, 4, Denis Laurendeau4, Chantal
Mérette3, 4, Marcelle Giasson1, Marc Hébert3, 4. 1Centre Universitaire
d’Ophtalmologie, Saint-Sacrement Hospital, Quebec, QC, Canada;
2
Centre d’excellence en vieillissement de Quebec, Quebec, QC,
Canada; 3Universite Laval, Quebec, QC, Canada; 4Centre de
recherche Robert-Giffard, Quebec, QC, Canada.
Purpose: To investigate the speed discrimination performance
in peripheral fields of patients with dry age-related macular
degeneration (AMD).
Methods: Fifty-two participants were recruited for this prospective
cross-sectional study; 18 AMD patients, 18 age-matched controls and
16 young controls. Initial clinical assessment included the measure of
best-corrected visual acuity (BCVA) with ETDRS chart. The contrast
sensitivity (CS) was also evaluated with sine-wave gratings chart
for five spatial frequencies (1.5, 3, 6, 12 and 18 cycle per degree).
Optic coherence tomographic (OCT) scans and visual field (VF)
examinations were performed for all participants to exclude presence
of other ocular diseases. At the time of the study, all participants
held a valid driver’s license. Speed discrimination performance was
assessed by a two-alternative forced choice paradigm. Random dot
cinematograms used as speed stimuli moved from the center to the
periphery.
Results: Patients with AMD had significant worse BCVA and CS
outcomes than age-matched and young controls. On average, the
AMD group showed lower speed discrimination thresholds compared
with age-matched control (p=0.04). The spread and the bias of the
resulting psychometric function were not significantly different
between the study groups (p>0.05). A tendency to overestimate
speeds in both control groups and to underestimate speeds in AMD
group was also observed.
Conclusions: This study presents psychophysical evidence for
better speed discrimination in peripheral fields of patients with AMD
compared to their age-matched controls. In addition, these data
highlight the importance of peripheral vision in AMD even for mild
to moderate central visual loss.
Commercial Relationships: Claudine Bellerive, None; Gilles
Lalonde, None; Laurence Letartre, None; Martin Simoneau,
None; Normand Teasdale, None; Denis Laurendeau, None;
Chantal Mérette, None; Marcelle Giasson, None; Marc Hébert,
None
Program Number: 4127 Poster Board Number: A0115
Presentation Time: 8:30 AM–10:15 AM
Mobility performance in low vision: Capturing the dynamics of
target finding and obstacle avoidance across different tasks
Joram J. van Rheede1, Iain Wilson1, Rose I. Qian1, Stuart Golodetz1,
Susan M. Downes2, 3, Robert E. MacLaren2, 3, Christopher Kennard1,
Stephen L. Hicks1. 1Nuffield Dept. of Clinical Neurosciences,
University of Oxford, Oxford, United Kingdom; 2Nuffield
Department of Ophthalmology, University of Oxford, Oxford, United
Kingdom; 3Oxford Eye Hospital, University of Oxford, Oxford,
United Kingdom.
Purpose: Recent developments in visual prosthesis and assistive
technology research have increased the need for accurate visual
mobility performance (VMP) measures in low vision (LV). Current
approaches are based on the time participants take to follow a set
course, overall walking speed, and the number of collisions. These
measures do not generalise well across experimental setups, and
do not capture the dynamics of VMP, which may provide useful
information about the nature of visual constraints on mobility. We
aim to address these issues by developing measures to dynamically
assess VMP that generalise across different tasks, that do not require
participants to follow a set course, and that are sensitive enough
to differentiate between performance with and without assistive
technology.
Methods: 12 LV and 4 control participants performed target finding
and obstacle avoidance tasks in a custom VMP assessment facility.
We used cameras to track the position of participants in relation to
obstacles and targets over time, and compared VMP with and without
residual vision glasses (RVGs), a new assistive technology for LV.
Results: We report that dynamic measures of walking behaviour
provide more information about VMP than aggregate measures.
Taking into account walking speed as a function of proximity to
objects and targets and the heading direction of participants, it was
possible to extract simple measures that reflect different aspects of
VMP (see Figures). These measures could differentiate between LV
and control participants, were able to quantify differences in VMP
with and without RVGs, and did not require participants to follow a
set course.
Conclusions: Current strategies for quantifying VMP can be
improved upon by tracking the position of participants in relation to
targets and obstacles over time to capture the dynamics of walking
behaviour. This information can be used to generate simple output
measures that can be generalised across tasks, and that are sensitive
enough to differentiate between LV patients, monitor VMP over time,
and investigate the potential benefit of assistive technology.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Path of a subject for an obstacle avoidance task (top) and observed
walking speed (bottom). Arrows indicate obstacle-related velocity
adjustments.
The point at which a subject begins to deviate from an obstacle
provides a readout of obstacle awareness.
Commercial Relationships: Joram J. van Rheede, None; Iain
Wilson, None; Rose I. Qian, None; Stuart Golodetz, None; Susan
M. Downes, None; Robert E. MacLaren, None; Christopher
Kennard, None; Stephen L. Hicks, None
Support: NIHR i4i II-LB-1111-20005
Program Number: 4128 Poster Board Number: A0116
Presentation Time: 8:30 AM–10:15 AM
Multiplexing Prism: A novel optical element for visual field
expansion
Eli Peli. 1Ophthalmology, Schepens Eye Research Institute, Boston,
MA; 2Ophthalmology, MEE, Harvard Medical School, Boston, MA.
Purpose: Prisms for visual field loss shift images into the seeing
field; however, they also block part of that field (apical scotoma),
resulting in field substitution rather than expansion. When fitted
unilaterally in binocular patient, the other eye sees the images that
fall into the apical scotoma, giving true expansion which is dependent
on binocular visual confusion, tolerable in peripheral vision.
However, binocular confusion is impossible in monocular patients or
in conditions with no overlap of the seeing fields of the two eyes. A
new optical element, called a multiplexing prism (MxP), addresses
these limitations of conventional prisms in a number of applications.
Methods: MxPs provide simultaneous shifted and unshifted views
(i.e., multiplexed) by inserting flat areas between the prismatic
segments of a Fresnel prism. This results in monocular visual
confusion and thus monocular field expansion. The ratio of flat
and prismatic area controls the relative contrast of the two views.
Prototype MxPs of varying ratios (1:1, 1:2, etc.) and in powers of 30,
40 and 57 prism diopters (Δ) were developed and evaluated. Novel
designs were evaluated for field expansion of patients with: tunnel
vision with one or two functional eyes, for hemianopic patients
with only one eye, and for patients that lost vision in one eye. The
temporal field of normally sighted people can be expanded by placing
MxP at the far temporal edge of the spectacle lenses for athletic, road
safety, or military purposes. Conventional prisms and MxPs were
perimetrically compared for these designs.
Results: In all tested conditions the conventional prism resulted
in field substitution (field expansion with equivalent field loss
elsewhere) while the MxPs provided field expansion without an
apical scotoma. The unshifted view through the prism was natural
and continuous. When viewing directly through the MxP, visual
confusion was apparent, but in peripheral locations it was not
noticeable. With 57Δ MxP, the nasal periphery of a monocular patient
was expanded up to 100° and the temporal periphery of normally
sighted up to 145°. This higher field expansion was achieved due to
minification effects of the prisms.
Conclusions: MxP is a new device that may be applied to provide
field expansion in a wide range of conditions. While early perimetric
results are promising, testing in more natural conditions (with
monocular rivalry) is needed to establish the utility of the MxPs.
Commercial Relationships: Eli Peli, Schepens (P)
Support: NIH Grant EY023385
Program Number: 4129 Poster Board Number: A0117
Presentation Time: 8:30 AM–10:15 AM
Multiplexing prism glasses for field expansion in bitemporal
hemianopia
Jae-Hyun Jung, Eli Peli. Schepens Eye Research Institute,
Massachusetts Eye and Ear, Department of Opthalmology, Harvard
Medical School, Boston, MA.
Purpose: Bitemporal hemianopia (BTH) is a heteronymous visual
field (VF) loss in both eyes due to lesions at the optic chiasm.
Previous field expansion devices for BTH required scanning into
the prism and the prism apical scotoma created a blind area. Thus,
a novel multiplexing prism (MxP) was developed that expands VFs
without apical scotoma. We optimized the MxP design to maximize
the size of BTH patient’s expanded VF and developed prototype
glasses for bilateral nasal field expansion.
Methods: The residual nasal field on each side is limited to ≈55°. We
placed two MxPs (base-in) over the nose bridge to expand the nasal
VF bilaterally. The MxPs prevent apical scotomas by superimposing
both see-through and shifted views. The MxP configuration for wide
field expansion was determined by considering the rated and effective
prism powers, and interference between both prisms. Increasing the
rated prism power expands VF farther, while rotating the prism nasal
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
edge towards the eye can increase the effective prism power due to
the increased angle of incidence. The deflected ray at the nasal edge
of one prism has to pass forward to the temporal edge of the fellow
eye’s prism, constraining the amount of rotation.
Results: Field expansion for BTH using MxPs is limited to 90°
nasally by the nose and interference with the fellow eye’s prism.
Ray tracing shows that even with moderate (30Δ) rated prism power
(with MxP serration directed towards the eye) effective prism power
of 70Δ can be achieved by rotating the prism 10°. On the other hand,
high power prism (57Δ) requires a much high rotation angle (30°)
to achieve same effective prism power without the interference by
fellow eye’s prism. The rotation results in minification of the shifted
image by the induced variation of prism power. The expanded VF
is compressed and projected into a smaller part of the patient’s VF,
effectively expanding both nasal VFs. Prototype MxP glasses for
BTH were implemented with 40Δ MxPs rotated by 15°. Wrap-around
single lens glasses were used to provide space for the rotated prisms.
The binocular VF of about 110° in the BTH patient was expanded up
to 80° in each eye giving a binocular VF of about 160°.
Conclusions: A novel design of MxPs mounted nasally in both eyes
can expand VF to compensate for the temporal crescents loss. The
rotation angle, the rated power of prism, and the size of prism are best
fitted individually due to variations in facial biometry.
Commercial Relationships: Jae-Hyun Jung, None; Eli Peli,
Schepens Eye Research Institute, Massachusetts Eye and Ear,
Harvard Medical School (P)
Support: NIH grant R01EY023385
Program Number: 4130 Poster Board Number: A0118
Presentation Time: 8:30 AM–10:15 AM
Biased Collision Judgments by People with Left but not Right
Hemianopia
Kevin E. Houston1, 2, Rui Liu2, 3, Sarah Sheldon2, 1, Eli Peli1, 2,
Robert B. Goldstein2, Gang Luo1, 2, Russell L. Woods1, 2, Alexandra
R. Bowers1, 2. 1Department of Ophthalmology, Harvard Medical
School, Massachusetts Eye and Ear Infirmary, Boston, MA; 2Vision
Rehabilitation Laboratory, Schepens Eye Research Institute, Boston,
MA; 3Department of Ophthalmology, Shanghai Eye and ENT
Hosptial of Fudan University, Shanghai, China.
Purpose: To characterize collision judgment behaviors in patients
with homonymous hemianopia (HH). Specifically, to evaluate
whether there were asymmetries in perceived safe passing distance
thresholds for obstacles on the blind and seeing sides; in prior studies
normal-sighted had no difference between their right and left side
judgments on this task.
Methods: 27 HHs (11 RHH, 13 LHH, & 3 LHH with Left
Hemispatial Neglect (LHSN)) seated facing a projector screen (94
× 79°) performed collision judgments for a life-sized human figure
appearing at various distances from a simulated walking path.
Scanning was allowed, limiting blindside detection failures to 9%
(of which 83% were for figures appearing > 60cm from the walking
path). Data were fitted with a cumulative Gaussian to calculate a
collision threshold (50%) for right and left sides.
Results: LHH showed significant (p=0.005) asymmetry in judgments
such that the left threshold was much smaller than the right (median
left 37cm, right 50cm). Thus LHHs reported the figure as NOT
posing a collision hazard when it was much closer to the path of
simulated movement on the left. The 3 with LHSN had even greater
asymmetry (left 27cm, right 49cm). Patients with RHH showed no
difference (p=0.8) (median right 41cm, left 46cm). Line bisection
error for RHHs & LHHs was near 0cm whereas LHSNs bisected
0.7cm to the right.
Conclusions: Asymmetry was measured in our sample of LHSNs,
but also unexpectedly in LHHs without clinically measurable LHSN.
Possible explanations are 1) blindside detection failures (but these
were low and similar for RHH and LHH), 2) cognitive de-emphasis
of left-side hazards, or 3) a shift in egocentric perception of
straight-ahead. As the width of the collision envelope (right and left
thresholds combined) was identical for LHH & RHH, a uniform shift
of LHHs egocentric perception to the right seems the most plausible
explanation. Results need to be verified in a larger population along
with lesion analysis, and compared against specific measurements
of egocentric localization (ie. visual open loop pointing) and against
behaviors during actual mobility.
Commercial Relationships: Kevin E. Houston, None; Rui Liu,
None; Sarah Sheldon, None; Eli Peli, None; Robert B. Goldstein,
None; Gang Luo, None; Russell L. Woods, None; Alexandra R.
Bowers, None
Support: NIH grant 5-K12-EY016335-08 and DoD grant
W81WXH-07-2-0038
Program Number: 4131 Poster Board Number: A0119
Presentation Time: 8:30 AM–10:15 AM
Compensatory gaze scanning by patients with hemianopia during
outdoor walking
Matteo Tomasi, Alexandra R. Bowers, Eli Peli, Gang Luo. Schepens
Eye Research Institute, Boston, MA.
Purpose: To investigate whether patients with hemianopia
demonstrate compensatory gaze scanning to their blind side when
walking outdoors, with and without visual field expansion prisms.
Methods: 9 patients with homonymous hemianopia walked 0.8mile routes on busy downtown streets on two occasions, 1.5 months
apart. At each visit they walked one route with and one without
57Δ peripheral prism glasses. Eye movements were tracked using a
head-mounted camera system. Head position relative to body was
measured using a pair of motion sensors (one on the head and one on
the trunk). Head and eye positions were synchronized and combined
to generate gaze position relative to body (approximately the walking
direction). Gaze fixations and eye fixations were detected using a
speed criterion of <15°/s. The percentage of gaze and eye fixations
exceeding specific visual directions (e.g., >20°, >30°, >40°) relative
to primary body and eye position, respectively, were analyzed using
repeated-measures ANOVAs to evaluate the effects of side (seeing/
blind) and prism (with/without).
Results: For gaze fixations, patients looked far peripherally (30°)
from their body heading direction toward the blind side significantly
more often than toward the seeing side (7.2% of total valid samples
vs. 5.7%, p = 0.049; data pooled for with and without prisms).
However, the number of gaze fixations to the far periphery was lower
with vs. without the prisms on both the blind and seeing sides, but to
a greater extent on the seeing side (blind side 6.7% vs 7.7%; seeing
side 4.7% vs 6.7%, p = 0.018). No significant effects of side or prism
were found for the eye fixation data.
Conclusions: These preliminary results suggest that hemianopes
make larger compensatory gaze scanning movements towards the
far periphery on their blind than their seeing side. They make fewer
scans to the far peripheral region with the prism glasses than without;
but that effect is found also on the seeing side and in fact the effect
on seeing side is larger. These data suggest both a beneficial effect
of the prism expansion on the blind side, as well as, a possible
shift of attention from the seeing to the blind side when using the
prism glasses. The lack of significant effects in the eye movement
data indirectly suggests the important role of head movements in
compensatory scanning in natural walking conditions.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Commercial Relationships: Matteo Tomasi, None; Alexandra R.
Bowers, None; Eli Peli, Schepens Eye Research Institute (P); Gang
Luo, None
Support: DOD DM090420, Harvard Milton Award
Program Number: 4132 Poster Board Number: A0120
Presentation Time: 8:30 AM–10:15 AM
Modified Visiocoach training in Hemianopia
Giovanni Sato, Gianfrancesco Villani, Elisabetta Piccolo, Federica
Tiso. Low Vision Rehabilitation Center, Padova, Italy.
Purpose: Explorative saccade training proved to selectively improve
saccadic behavior, natural search, and scene exploration on the
blind side of hemianopic patients (Roth T, 2009). We evaluated the
acceptance of this type of training (VisioCoach) by patients referred
to our low-vision practice, and the outcome of a modified training
protocol
Methods: Nine patients with hemianopia and no hemineglect were
enrolled. The types of VF defects were: 6 left hemianopias, 1 left
hemianopia with a macular right-sided scotoma, 2 right hemianopias.
Evaluation included Humphrey VF Test 30-2, ETDRS VA, Greene
Test, Pelli-Robson CS, binocular reading performance (MN Read,
SK Read, IReST), MP-1 microperimetry, and video-recording of eye
movements. Standard daily self-training with VisioCoach at home
was proposed to all patients (www.visiocoach.de).However,if this
was not accepted by the patient, a modified training protocol was put
into effect: one supervised VISIOcoach session per week at the low
vision clinic, for 8 weeks.Compliance to the schedule was a measure
for the acceptance of the intervention
Results: Age median was 43 years (20-84), VA 20/25 (20/20-20/60),
log CS 1.5 (1.95-1.35). All patients declined self daily training but
accepted the modified protocol. Attended training sessions average
was 6.4, median 8, range 3-8. MN READ minimum print size (MPS)
median was 0.8 M (0.8-3.2), errors median 0 (0-1). SK READ MPS
was 0.8 M (0.8-3.2), errors 6 (0-14). SK READ error (side) pattern
matched with the hemianopia side in 5 patients, did not in 2, and was
not determinable in 2 (who made no reading error). IReST reading
time median (range) was 97 sec (49-476). All reading tests scores
did not differ significantly after training (p>0.05). Noticeably, the
patient who scored the least at referral improved by about 50% on all
tests. Head and eye movements (qualitative assessment) improved
in all patients in terms of head position, saccade amplitude and gaze
direction towards the blind hemifield.Greene Test improved.
Conclusions: Supervised office-based reduced-frequency Visiocoach
training can be more acceptable for some patients than standard daily
training. Reading errors could be related to the blind hemifield only
on SK READ, as there was almost no error on MN READ. Reading
errors on the same side of the VF defect would indicate a fixed gaze,
or a delay in performing the compensatory saccade to the blind side
Commercial Relationships: Giovanni Sato, None; Gianfrancesco
Villani, None; Elisabetta Piccolo, None; Federica Tiso, None
Program Number: 4133 Poster Board Number: A0121
Presentation Time: 8:30 AM–10:15 AM
Intraocular mini-telescope for AMD patients
Pablo Artal1, Juan Tabernero1, Scott J. Robbie2, Bobby A. Qureshi2.
1
Laboratorio de Optica, Universidad de Murcia, Murcia, Spain;
2
London Eye Hospital, London, United Kingdom.
Purpose: Age-related macular degeneration (AMD) severely reduces
central vision and is often associated with cataracts. Improved quality
of vision in affected patients may be achieved by the implantation
of a pair of intraocular lenses in a Galilean-telescopic configuration.
A common drawback with this approach is the large refractive error
that results from inconsistencies in the positioning of the two lenses
and the large incision required to implant them. In this context, the
purpose of this study was to develop a new intraocular telescope with
an optimized optical design more tolerant to a variety of surgical
outcomes.
Methods: Ray-tracing techniques were used to design a Galilean
telescope within a realistic eye model such that a positive lens is
placed in the ciliary sulcus and a second, negative lens in the capsular
bag. To facilitate surgical implantation, a high refractive index,
soft hydrophobic material was used for the lenses. The aim was to
produce a tilt of 3 degrees and a magnification of around 1.2. The
prismatic effect was achieved by the relative decentration of the
two lenses and additional optical refinements were incorporated to
minimize associated astigmatism and coma. The distance between
the two lenses after implantation is a critical factor in determining the
quality of the retinal image.
Results: We were able to generate an optimized optical design that
reduces off-axis aberrations and produces quality retinal images for
a range of relative positions of the two lenses in the telescope. We
were able to increase the tolerance in lens positioning by at least
six-fold. Whilst the design sacrifices some image quality at best focus
to achieve this, it produces images with sufficient quality for the
purposes of enhanced extrafoveal viewing. Since the lenses may also
be implanted through a small incision, induced corneal astigmatism is
also minimized.
Conclusions: A new optical design has been devised for an
intraocular mini-telescope to be implanted in patients with macular
disorders. The system confers both optical and surgical advantages
that make it suitable for extension to a wider patient base.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Commercial Relationships: Pablo Artal, London Eye Hospital
(C), London Eye Hospital (F), London Eye Hospital (P); Juan
Tabernero, London Eye Hospital (F), London Eye Hospital (P);
Scott J. Robbie, London Eye Hospital (E), London Eye Hospital (P);
Bobby A. Qureshi, London Eye Hospital (I), London Eye Hospital
(P)
Support: London Eye Hospital Pharma, London, UK
Program Number: 4134 Poster Board Number: A0122
Presentation Time: 8:30 AM–10:15 AM
Epidemiology of low visual acuity and driving habits amongst
533 drivers
Hussein Morfeq1, 2, Pierre Betermiez1, Ilié Cretu1, Solange
Milazzo1. 1Ophthalmology, Jules verne University, Amiens, France;
2
Ophthalmology, King Abdulaiz University, Jeddah, Saudi Arabia.
Purpose: To evaluate the prevalence of low visual acuity that does
not meet the requirement of European Driving License Committee
(EDLC) amongst automobile drivers and its influence on their driving
habits.
Methods: Cross sectional study of 533 participants. Our study
was held from October 2011 until August 2012. Inclusion criteria:
having a binocular vision, practicing drivers aged 18 years or older,
and having european class A (motorcycles), B (Motor vehicles), or
BE (Motor vehicles with trailer exceeding 750 kilograms) driving
license. The best corrected binocular visual acuity (VA) were
assessed with a Snellen E chart using standardized protocols and
compared to the standards of EDLC. The driving habits questionnaire
was focused on the frequency, duration and distance of driving of our
study group.
Results: 184 females (34.5%) and 349 males (65.5%) were included
in our study. The mean age was 60.6 years (19 to 93). The mean
of binocular VA was 20/25. 470 patients (88.2%) had binocular
VA greater than or equal to 20/40 which meets the current minimal
visual acuity requirement of EDLC. 63 patients (11.8%) of the study
population had binocular VA less than 20/40. 61.9% of persons with
binocular vision less than 20/40 drive in daily pattern, 27% drive
once a week and 11.1% occasionally. Amongst the group who didn’t
meet the required VA, 27% drive in rural, urban roads and highways.
15.9% drive in urban and rural pathways. The percentage of patients
driving within the city was 14.3%. 6.3% take the rural and highways.
3.2% only drive in urban zone and highways. 57.1% of persons
with binocular VA less than 20/40 travel for a distance more than
10 kilometers (6.2 miles). The mean of kilometers traveled by low
binocular vision group was 6404 kilometers (3979.26 miles).
Conclusions: Driving with a low VA is a real security and public
health problem. Further visual screening such as visual field and
cognitive capacity evaluation should be studied to be considered as
screening parameters for high risk group drivers.
Commercial Relationships: Hussein Morfeq, None; Pierre
Betermiez, None; Ilié Cretu, None; Solange Milazzo, None
Program Number: 4135 Poster Board Number: A0123
Presentation Time: 8:30 AM–10:15 AM
Motor Vehicle Collision Rates in Bioptic Drivers and NormallySighted Drivers
Bradley E. Dougherty1, Roanne E. Flom1, Mark A. Bullimore2,
Thomas W. Raasch1. 1Optometry, Ohio State University, Columbus,
OH; 2The University of Houston, Houston, TX.
Purpose: In more than 40 US states, drivers who cannot meet vision
standards with conventional optical correction are permitted to
use bioptic telescopic spectacles to obtain licensure. There are few
studies comparing risk of motor vehicle collisions (MVC) for bioptic
drivers with that of normally-sighted drivers. This study compared
the MVC rate of bioptic drivers to normally-sighted control drivers
and examined the effect of previous, non-bioptic driving experience
on rates.
Methods: A retrospective study of patients identified as having
received an initial daylight bioptic examination at the College of
Optometry at the Ohio State University was conducted. Data were
collected on vision and demographics, and driving records from the
Ohio BMV were obtained. BMV driving records were also obtained
for a control group of age, sex, and population density matched Ohio
drivers in order to compare MVC rates. Rate ratios for MVC were
calculated using the total number of MVC over the total time since
last license renewal for both bioptic and control drivers.
Results: 186 bioptic drivers who had an exam for the daylight bioptic
program and 3001 matching control drivers were identified. Age
ranged from 21 to 84 years (mean = 49±14 years) in both groups.
Mean logMAR visual acuity OU at initial exam for bioptic drivers
was 0.77±0.12 (20/115) and mean log letter contrast sensitivity
was 1.55±0.23. 16% of the bioptic drivers were involved in at least
one MVC since the last license renewal (mean licensure time = 22
months). The mean±SD number of MVC per year for bioptic drivers
without previous experience (n = 76) was 0.16±0.41, and 0.084±0.25
for those with previous experience. The MVC rate ratio [95% CI] for
all bioptic drivers compared to controls was 3.0 [2.2, 4.3]. The ratio
for inexperienced bioptic drivers was 3.4 [2.1, 5.4], and the ratio for
experienced bioptic drivers was 2.8 [1.7, 4.7].
Conclusions: The MVC rate of bioptic drivers was elevated
compared to matched controls, though less so in bioptic drivers with
previous driving experience. The increased risk of MVC for bioptic
drivers in this study is comparable to that shown previously for
drivers with other medical restrictions (Janke, 1983).
Commercial Relationships: Bradley E. Dougherty, None; Roanne
E. Flom, None; Mark A. Bullimore, None; Thomas W. Raasch,
None
Support: NIH K23 EY022940-01, Ohio Lions Eye Research
Foundation
Program Number: 4136 Poster Board Number: A0124
Presentation Time: 8:30 AM–10:15 AM
Identification of Preferred Retinal Loci during Binocular Viewing
in Patients with Central Vision Loss
Luminita Tarita-Nistor1, 2, Esther G. Gonzalez1, 3, Moshe Eizenman1,
4
, Natalie Landon-Brace5, Samuel N. Markowitz3, Martin J.
Steinbach1, 2. 1Vision Science Research Program, Toronto Western
Hospital, Toronto, ON, Canada; 2Centre for Vision Research, York
University, Toronto, ON, Canada; 3Ophthalmology and Vision
Sciences, University of Toronto, Toronto, ON, Canada; 4Biomedical
Engineering, University of Toronto, Toronto, ON, Canada;
5
Engineering Science, University of Toronto, Toronto, ON, Canada.
Purpose: Until now, the absolute location of the PRL of patients with
central vision loss could only be identified monocularly. We tested a
new method to measure/predict the location of the PRL in each eye
in patients with central vision loss when viewing binocularly. The
method uses a unique remote eye-tracking system that estimates the
optical axes of both eyes without user calibration. We hypothesized
that this method predicts the locations of monocular and binocular
PRLs accurately.
Methods: Five experienced controls and 6 patients with stable central
vision loss were tested. Their fixation was recorded monocularly
with both the MP-1 microperimeter and the eye-tracking system and
binocularly with the eye-tracking system. The eye-tracker measured
the direction of the optical axis and the angle between the PRL (fovea
for control subjects) and the optical axis in each eye. The MP-1
measured the location of the PRL relative to the optic disk; that is,
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
its absolute location. Using the monocular measurements of the eyetracker and the MP-1, in control subjects, a transformation from eyetracking measurements to MP-1 measurements was created and used
to predict the absolute location of the PRLs in patients. The predicted
values for monocular viewing for each eye were compared with the
measured MP-1 values.
Results: The prediction errors of the horizontal and vertical
coordinates were -0.1 ± 0.7 deg and -0.1 ± 1.1 deg for the right
eye, and -0.1 ± 0.9 deg and 0.0 ± 1.0 deg for the left eye. The same
transformation was then used with measurements of the eye-tracker’s
PRLs under binocular viewing, to obtain the absolute locations of the
PRLs in the MP-1 coordinate system.
Conclusions: By transforming the measurements of the PRL location
from an eye tracking coordinate system to the MP-1 coordinate
system, the absolute location of the PRLs (i.e., relative to the optic
disk) during binocular viewing can be predicted with an acceptable
accuracy.
Commercial Relationships: Luminita Tarita-Nistor, None; Esther
G. Gonzalez, None; Moshe Eizenman, El-MAR Inc. Toronto (P);
Natalie Landon-Brace, None; Samuel N. Markowitz, None;
Martin J. Steinbach, None
Support: Natural Sciences and Engineering Research Council of
Canada (NSERC) grant A7664 (MJS) and 130149 (ME); Vision
Science Research Program, Toronto Western Hospital; Sandra and
David Smith postdoctoral fellowship; and an anonymous donor.
Program Number: 4137 Poster Board Number: A0125
Presentation Time: 8:30 AM–10:15 AM
The Longitudinal Relationship Between Visual Acuity and
Fixation Instability in Patients with Age –Related Macular
Degeneration
Gina Mitzel1, Joost Felius1, 2, Mitch Cruz1, Yi-Zhong Wang1, 2. 1Retina
Foundation of the Southwest, Dallas, TX; 2UT Southwestern Medical
Center, Dallas, TX.
Purpose: Previous findings have shown that patients with
advanced age-related macular degeneration (AMD) present fixation
abnormalities. Deterioration of visual acuity and changes in fixation
location presumably both result in fixation instability. This study
compared the relationship between visual acuity (VA) and fixation
instability in patients with various stages of AMD. We investigated
whether the relationship between fixation instability and VA is driven
by the preferred eye.
Methods: A longitudinal study was conducted among 51 eyes of
28 AMD patients, categorized as early (10), intermediate (13), and
advanced (5), who had at least two visits at ~6-month intervals (range
2-7, median 3). VA was measured by using the EVA E-ETDRS.
Fixation was recorded with the Nidek MP-1 for 30 sec while
the subject fixated on a 2 degree circle monocularly and fixation
instability was quantified by calculating the 68%-bivariate contour
ellipse area (BCEA, 1 SD).
Results: At baseline, patients showed mean±SD BCEA=1.6±2.4
deg2 and VA=0.23±0.30 logMAR. Mixed-effects modeling of the
longitudinal data showed fixation instability was associated with
visual acuity (P=0.006) and with disease stage (P=0.05). Overall,
the BCEA increased at a mean rate of 0.36 deg2/y; this change was
associated with the rate of VA change for the preferred eye (P=0.03)
of each patient, but not for the poorer eye (P=0.48).
Conclusions: The findings support the hypothesis that VA loss in
AMD is associated with the loss of fixation stability in the preferred
eye. Assessment of fixation on the MP-1 is useful for demonstrating
the shift of stability of fixation related to the disease progression.
While fixation stability may not be affected significantly in early
stages of macular degeneration, the deterioration of macular function
over time leads to fixation instability in patients with AMD.
Commercial Relationships: Gina Mitzel, None; Joost Felius,
None; Mitch Cruz, None; Yi-Zhong Wang, None
Program Number: 4138 Poster Board Number: A0126
Presentation Time: 8:30 AM–10:15 AM
Stability of Fixation in Diabetes Patients With and Without
Clinically Significant Macular Edema
Karthikeyan Baskaran1, Ann E. Elsner1, 2, Matthew S. Muller2, Bryan
P. Haggerty1, Joel A. Papay1, Thomas Gast1, 2, Taras V. Litvin3, Glen
Y. Ozawa3, Jorge Cuadros3, Benno L. Petrig2. 1School of Optometry,
Indiana University, Bloomington, IN; 2Aeon Imaging, LLC,
Bloomington, IN; 3School of Optometry, University of California
Berkeley, Berkeley, CA.
Purpose: Eye diseases affecting central vision impair fixation and
interfere with day-to-day tasks such as reading. Diabetic retinopathy
and clinically significant macular edema (CSME) are leading causes
of visual impairment in diabetes patients. The aim of this study is
to find whether diabetic patients with CSME have poorer fixation
stability compared to patients without CSME, by analyzing the
fundus images obtained from the Laser Scanning Digital Camera
(LSDC).
Methods: Two hundred underserved, diabetic patients were screened
for diabetic retinopathy at the Eastmont Wellness Center within
the EyePACS telemedicine network, using LSDC. One eye of each
patient who had diabetic retinopathy was included in this study. Nonmydriatic color fundus photos were classified for presence of CSME
by two independent, certified EyePACS graders. The first 50 patients
(25 males & 25 females) with CSME were selected and 50 (27 males
& 23 females) diabetic patients without CSME were selected as
controls. Mean age was 59 (±9) years for patients with CSME and
was 55 (±10) years for patients without CSME. The subjects included
53% Hispanics, 26% African Americans and 21% other. A series
of 20 images (36 deg field, 1024 X 1024 pixels, and 850 nm) were
acquired at 11 fps. Eye positions were obtained by selecting a region
of interest in the first image of each series and aligning the remaining
images to that region by cross-correlation. The bi-contour ellipse area
(BCEA) and the standard deviation of the Euclidean distance (SDED)
were used to quantify fixation stability.
Results: The fixation stability for patients with CSME was
significantly worse than for those without CSME (t test: p < 0.001,
0.007 for BCEA and SDED, respectively). The mean fixation stability
obtained by the BCEA metric was 2.74 (±0.40) log(minArc2) and
2.34 (±0.42) log(minArc2) for patients with and without CSME,
respectively. For SDED the mean was 48.4 (±28.8) microns and 34.6
(±20.4) microns for patients with and without CSME, respectively.
The correlation with age was not significant for either group (R2 =
0.052, 0.011).
Conclusions: Diabetic patients with CSME had poorer fixation
stability than patients without CSME for both metrics. Fixation
stability is a potential tool for assessing macular function and could
be used for tracking the treatment and progression of macular edema.
The LSDC images provide one method to quantify fixation stability
rapidly.
Commercial Relationships: Karthikeyan Baskaran, None;
Ann E. Elsner, Aeon Imaging, LLC (F), Aeon Imaging, LLC (I),
Aeon Imaging, LLC (P); Matthew S. Muller, Aeon Imaging,
LLC (F), Aeon Imaging, LLC (I), Aeon Imaging, LLC (P); Bryan
P. Haggerty, None; Joel A. Papay, None; Thomas Gast, Aeon
Imaging, LLC (E), Aeon Imaging, LLC (F), Aeon Imaging, LLC
(S); Taras V. Litvin, None; Glen Y. Ozawa, None; Jorge Cuadros,
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
EyePACS, LLC (C), EyePACS, LLC (I); Benno L. Petrig, Aeon
Imaging, LLC (E), Aeon Imaging, LLC (F), Aeon Imaging, LLC (P)
Support: NIH Grant EY020017, EY018772, EY007624
Program Number: 4139 Poster Board Number: A0127
Presentation Time: 8:30 AM–10:15 AM
Dynamic Multifixation Target for Microperimetry to Use in
Patients With Large Central Scotoma
Marco U. Morales1, Gianfrancesco M. Villani2, Fabio Turra3,
Chiara Borgogno3. 1Ophthal & Visual Sciences, Nottingham
University, Nottingham, United Kingdom; 2Ophthalmology, Centro
Riabilitazione Ipovedenti e Microperimetria - CRIM, Castel d, Italy;
3
Information Engineering, Padova University, Padova, Italy.
Purpose: The microperimetry MAIA (Centervue; Padova, Italy) has
a standard LED fixation target (FT) consisting of a small red circle
of 0.76° diameter size. However, subjects with low-vision due to
large central scotoma and unstable fixation may find it difficult to
see. The current study explored the use of an alternative eccentric FT
assembly in such patients.
Methods: An array of 20 LED cross-shaped eccentric FTs located
around the standard central FT was designed. Such eccentric FTs
are distributed on a 5 by 5 grid without all four corners. The grid
horizontal and vertical spacing is 2.4°. The center of the grid is
the standard central FT. Each cross FTs are sized 1.2° by 1.2°. Ten
patients with central geographic atrophy secondary to dry AMD
performed the MAIA examination at the CRIM Low Vision Center in
Verona, Italy. First, they were asked to fixate the standard central FT.
If they failed, the operator selected an eccentric FT located outside of
the macular lesion according to the SLO image. Once the target was
detected, the operator switched the FT to an adjacent one to guide
the vision in the direction of the central FT. The examination started
when the patient was either able to perceive the central FT or with
the last perceived eccentric FT. Visual acuity (VA), scotoma size
(SS), fixation stability (FS) and the ability to see the target for the
examination was recorded.
Results: 10 patients with CGA and unstable fixation (mean age =
71.3, mean VA=0.8 LogMAR, mean SS=9.5° and mean FS=33%)
performed the MAIA examination. Four patients (40%) were able
to find easily the standard central FT. Their mean VA was 0,76
LogMAR, mean SS and mean FS were 7.2° and 31% respectively.
Five patients (50%) (mean VA=0.88 LogMAR, mean SS=10.2° and
mean FS=40%) were initially unable to detect the central FT, but
successfully did it after being directed by the sequential lighting
of eccentric FTs. One patient (10%) with VA=1.2 LogMAR,
SS=15°, and FS=5% never saw the small central FT, although
the microperimetry examination was performed while fixating an
eccentric FT adjacent to the central one.
Conclusions: Patients with central vision loss may have difficulties
in detecting the standard MAIA small FT. With the proposed dynamic
multi-fixation target, patients with large central scotomas and
unstable fixation were able to perform the MAIA microperimetry
examination.
Commercial Relationships: Marco U. Morales, Centervue (C),
Centervue (I); Gianfrancesco M. Villani, None; Fabio Turra,
Centervue (C), Centervue (I), Centervue (P); Chiara Borgogno,
None
Purpose: The quality of smooth pursuit eye movements is known
to be affected by a textured background, the pursuit direction and
the target velocity. Losing foveal input may interrupt smooth pursuit
but the effects have not been well documented. This study compared
smooth pursuit with the fovea (FOV), a simulated central scotoma
(SCS) and a real central scotoma (RCS) under a wide range of
conditions.
Methods: Ten young normal subjects and 6 patients with longstanding bilateral central scotomas visually pursued a target that
moved along a 10 deg horizontal (H) or vertical (V) line over a
uniform gray background (NB) or a binary random check background
(TB). The speed profile of the target was a 0.15 Hz (S) or 0.40 Hz
(F) sinusoid. Normal subjects performed 4-8 pursuits under each
combination of background, direction and velocity with the fovea and
with a 10 deg simulated central scotoma. Central scotoma patients
did the same tasks with their impaired vision. Composite and smooth
gains were computed using standard procedures.
Results: SCS composite gain was the highest (1.17) while FOV and
RCS composite gains (1.04 and 0.97) were similar. Although some
of the differences were statistically significant, the composite gains
under most conditions were above 0.9. FOV smooth gain (0.84)
was better than those of RCS and SCS (0.54 and 0.42), indicating a
significant reduction of pursuit quality when foveal input was cut off.
Adding a textured background, pursuing in a vertical direction and
increasing target velocity all significantly reduced composite gains,
but the reductions were no greater than 0.1 under most conditions.
The same stimulus changes reduced smooth gain more substantially.
The highest smooth gains (0.95, 0.52 and 0.74 for FOV, SCS and
RCS, respectively) were obtained with pursuing a slow target moving
horizontally over a uniform background. They dropped to 0.68, 0.34
and 0.4 when pursuing a fast target moving vertically over a textured
background (see figure). The type of background contributed the
most to the observed smooth gain changes. SCS appeared to have
suffered the smallest loss of smooth gains from the best to the worse
pursuit conditions.
Conclusions: Composite gains are poor indicators of smooth pursuit
deficits due to a central scotoma. Smooth gains obtained when
pursuing a target moving fast in vertical direction over a textured
background are more powerful measures of deficits.
Program Number: 4140 Poster Board Number: A0128
Presentation Time: 8:30 AM–10:15 AM
Smooth Pursuit Eye Movements with the Fovea, a Simulated
Central Scotoma and a Real Central Scotoma
Lei Liu, Alex Keith, Mark Bolding. University of Alabama at
Birmingham, Birmingham, AL.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Movement was more closely associated with word length than
syllables. Probability of more movement at word recognition trial
versus non-recognition trial: P = 0.00752. Subjects viewing words
under suprathreshold conditions had average eye movements of
530X98 microns.
Conclusions: The size of horizontal eye movements during word
recognition increases as word length increases at threshold noise.
There is also a significant increase in eye movement size during the
noise level trial with recognition as compared to noise levels that
preclude word recognition. These findings provide a signature of
eye movements made during word recognition, which may improve
understanding of reading with diffuse central vision loss.
Commercial Relationships: Elli J. Kollbaum, None; Christopher
A. Clark, None; Max Rumbach, None; Bryan P. Haggerty, None;
Ann E. Elsner, Aeon Imaging, LLC (I)
Support: NEI Grants EY018772 and EY022064
Commercial Relationships: Lei Liu, None; Alex Keith, None;
Mark Bolding, None
Program Number: 4141 Poster Board Number: A0129
Presentation Time: 8:30 AM–10:15 AM
Eye Movement Changes during Word Recognition Task in Varied
Visual Noise
Elli J. Kollbaum, Christopher A. Clark, Max Rumbach, Bryan P.
Haggerty, Ann E. Elsner. School of Optometry, Indiana University,
Bloomington, IN.
Purpose: Visual search patterns of naive subjects were analyzed for
a word recognition task with visual noise. Varied levels of contrast
were presented by adding visual noise to word and background,
simulating widespread internal visual noise found in ocular and
neurological disease.
Methods: Eleven subjects included 4 males & 7 females, ages 22-50
yr with visual acuity of 20/20. The stimulus was a 20/200 size word,
5-9 letters in length, in Arial font presented centrally in the Laser
Scanning Digital Camera Stimulator (LSDC-S). A 16 word list was
generated from the Low Vision Training Manual (Quillman). The
visual stimuli were projected in the LSDC-S with the stimulus and
retinal image focal planes linked. The background illuminance and
the contrast for stimuli and background were matched to Goldmann
perimetry. Pattern noise at a fixed spatial frequency was presented
with the words, starting with 9% and lowered by 3% over 4 levels
until the word was recognized. The trial ended if recognition did not
occur in 6 sec. Time to recognition was recorded for the final trial.
Fixation and scan patterns were evaluated from x,y coordinates of a
retinal image feature over time. A control experiment was performed
without pattern noise.
Results: No words were recognized at noise levels > 6%. At subthreshold levels, there was no association between word length
and extent of eye movements for either the horizontal or vertical
direction. At threshold, the word length was significantly associated
with extent of the eye movements (R2 = 0.492, P= 0.033) for the
horizontal direction. Average eye movements were 765X90 microns
at threshold, while they were 668X89 microns subthreshold.
Program Number: 4142 Poster Board Number: A0130
Presentation Time: 8:30 AM–10:15 AM
Correlation between bivariate contour ellipse area (BCEA)
and reading speed before and after rehabilitation with
microperimetric biofeedback in patients with branch retinal vein
occlusion (BRVO)
Francesca Verboschi, Erika Rigoni, Emanuele Gerace, Giorgia
Maraone, Cristina Diana, Leopoldo Spadea, Enzo M. Vingolo.
University of Rome “La Sapienza”, Latina, Italy.
Purpose: To evaluate if there is a correlation between BCEA and
reading speed in patients with BRVO submitted to rehabilitation with
microperimetric biofeedback.
Methods: 11 patients were enrolled for a total of 11 eyes, mean
age 72 + 2.3, with diagnosis of BRVO. All the patients underwent
the same rehabilitative protocol: microperimetry MP-1 (Nidek
technologies, Padova, Italia) threshold strategy 4-2, Goldmann III
stimolus, with fixation study that was quantified by calculating
BCEA; 10 training sessions, once a week, 10 minutes for each eye,
with microperimetric biofeedback. The reading speed was calculated
by trial lenses with the addition to read appropriate for the age, on a
text in Times New Roman 18 printing body, calculating the number
of words per minute. At the end of 10 training session patients
repeated microperimetry with evaluation of BCEA and measurement
of the reading speed. Data obtained before and after rehabilitative
protocol were related using Kendall correlation.
Results: At the end of the study mean BCEA before rehabilitation
was 4.88+8.89 deg^2 and mean BCEA after rehabilitation was
2.34+3.71deg^2; mean reading speed was 27.1+13.7 number of
words per minute before rehabilitation and 32.54+15.23 number of
words per minute after rehabilitation. Correlation between BCEA
and reading speed before rehabilitation was 0.62 (p value=0.028);
correlation between BCEA and reading speed after rehabilitation was
0.66 (pvalue=0.003).
Conclusions: This study demonstrated that there is a correlation
between BCEA and reading speed before and after rehabilitation, in
which reading speed increased with the BCEA decrease. Increasing
stability of fixation the patient acquires a greater ability to vision in
the near work and therefore a better quality of life.
Commercial Relationships: Francesca Verboschi, None; Erika
Rigoni, None; Emanuele Gerace, None; Giorgia Maraone, None;
Cristina Diana, None; Leopoldo Spadea, None; Enzo M. Vingolo,
None
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Program Number: 4143 Poster Board Number: A0131
Presentation Time: 8:30 AM–10:15 AM
Object Localization and Tracking System – Evaluation of Speech
Synthesized Feedback Mechanisms
Nii Tete Mante1, 2, Gerard Medioni2, James D. Weiland1, 3, Armand
R. Tanguay1, 4. 1Biomedical Engineering, University of Southern
California, Doheny Eye Inst, Los Angeles, CA; 2Computer
Science, University of Southern California, Los Angeles, CA;
3
Ophthalmology, University of Southern California, Los Angeles,
CA; 4Electrical Engineering - Electrophysics, University of Southern
California, Los Angeles, CA.
Purpose: The purpose of this study was to test our ‘Object
Localization and Tracking System’ (OLTS), which assists blind/low
vision subjects with reaching and grasping for objects. The main goal
was to explore how varying the visual angle of a computer generated
feedback mechanism alters the accuracy of reaching and grasping in
object localization tasks.
Methods: The OLTS utilized a wide-angle (~100 degrees) monocular
camera (Tanguay, Sahin), a central processing unit (CPU) and bone
conduction headphones. Computer Vision algorithms (Context
Tracker, Dinh & Medioni) on the CPU parsed, and processed the
camera input to determine object(s) position. Bone conduction
headphones produced verbal auditory feedback for the blind test
subject based on object position. Thus, objects positioned left of the
center of vision of the camera would elicit a “Left” to the test subject.
Objects within the “central-region” of the field of view cause the
computer to say “Center”. Once the object was centralized within the
cameras center of vision, test subjects were asked to reach out and
touch the object. Two blind test subjects evaluated the device. Four
different “central-region” visual angles of the feedback algorithm
were used (7.8, 15.6, 23.4 and 31 degrees); three experiments per
angle were conducted. Each experiment consisted of localizing and
grasping for an object.
Results: Subject O-N was able to grasp the object on the first “reach”
1/3, 1/3, 1/3, and 2/3 times for visual angles 7.8, 15.6, 23.4 and 31
degrees, respectively. The average amount of “reaches” it took to
successfully grasp the object were 3, 2.33, 1.67, and 1.33 for angles
7.8, 15.6, 23.4 and 31 degrees, respectively. Subject R-T was able to
grasp the object on the first “reach” 0, 0, 2/3 and 0 times for angles
7.8, 15.6, 23.4 and 31 degrees. The average amount of reaches it
took to grasp the object were 3.33, 3, 1.33 and 1.33 for angles 7.8,
15.6, 23.4 and 31 degrees, respectively. Object tracking paths, time to
grasp, video and audio data were also recorded for each experiment.
Conclusions: The experiments conducted have given initial
indicators to finding an optimal visual angle for our sound guided
feedback mechanism. Specifically, the initial results show that
increasing the visual angle decreases the amount of attempts to grasp
the object.
Commercial Relationships: Nii Tete Mante, None; Gerard
Medioni, None; James D. Weiland, Second Sight Medical Products,
Inc. (F), Second Sight Medical Products, Inc. (P), Second Sight
Medical Products, Inc. (S); Armand R. Tanguay, University of
Southern California (P)
Support: Research to Prevent Blindness, W.M. Keck Foundation;
USAMRMC-W81XWH-10-2-0076
Program Number: 4144 Poster Board Number: A0132
Presentation Time: 8:30 AM–10:15 AM
Tactile output as a method for communicating with the visually
impaired in mobility
Aminat Adebiyi1, Shadi Bohlool1, Mort Arditti2, James D. Weiland1,
3 1
. Biomedical Engineering, University of Southern California,
Los Angeles, CA; 2Doheny Eye Institute, Los Angeles, CA;
3
Ophthalmology, University of Southern California, Los Angeles,
CA.
Purpose: This study evaluated the ability of blind subjects to
navigate complex routes when guided with vibrotactile commands.
Methods: The tactile feedback system consists of six vibration
motors that are attached to individual points on a subject’s upper
torso through a vest. The motors are connected to a push-button
microcontroller system that delivers commands to the subject when
the researcher presses a button that activates the corresponding
motor(s). Eight navigational commands are encoded into the sixmotor array, including, ‘forward’, ‘veer left’, ‘approaching left turn’,
‘turn left’, ‘veer right’, ‘approaching right turn’, turn right’ and ‘stop’.
For example, ‘approaching left turn’ is coded as a single pulse of a
motor, whereas ‘turn left’ is coded as two pulses of the same motor.
Ten low-vision subjects were recruited from the Braille Institute,
Los Angeles. Wearing the tactile feedback system, subjects were
guided through indoor and outdoor courses. As a control, the subject
navigated the same course using a cane for guidance. Appropriate
response to commands, time to complete a trial, and reaction
time were measured. Subjects were also given an exit survey that
measured the usability of the feedback system. A parallel LED-array
allowed alignment of a given command to video footage recorded for
each trial.
Results: Using tactile commands, subjects displayed responses
consistent with 82.46% of commands and an average reaction time
of 1.46 seconds. Subjects also completed routes faster than with their
cane alone (p = 0.04). When using the device, subjects complained
that encoding multiple commands on a single motor affected their
ability to successfully comply with commands, probably stemming
from a cognitive dissonance effect. They also preferred that the
motors were placed closer to their skin. The device was rated 76%
usable with subjects enthusiastic for its use as a street crossing guide.
Conclusions: The tactile feedback system shows promise as an
alternative to verbal-assist devices as means of communicating
important information to users for mobility. However, optimal motor
positioning and command encoding need to be investigated further to
maximize its benefit.
Commercial Relationships: Aminat Adebiyi, None; Shadi
Bohlool, None; Mort Arditti, None; James D. Weiland, Second
Sight Medical Products, Inc (P), Second Sight Medical Products, Inc
(S), Second Sight Medical Products, Inc. (F)
Support: Research to Prevent Blindness, W.M. Keck Foundation,
USAMRMC-W81XWH-10-2-0076
Program Number: 4145 Poster Board Number: A0133
Presentation Time: 8:30 AM–10:15 AM
Trade-offs between tactile and visual function
Deyue Yu, Landon Perry. College of Optometry, Ohio State
University, Columbus, OH.
Purpose: To compensate for vision loss, low-vision patients often
utilize information gathered by other senses such as touch to facilitate
object recognition. Understanding the relationship between visual
and tactile functions is therefore important to the visual rehabilitation
of these patients. The present study investigates the relationships
between tactile performance and basic visual functions.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Methods: There are two experiments. Twenty-two normallysighted young adults participated in Experiment 1. Fifteen returned
for Experiment 2. Measurements include near visual acuity,
distance visual acuity (high and low contrast), contrast sensitivities
(Experiment 2 only), tactile acuity (measured using three-dot
patterns), and tactile object recognition performance. To evaluate
tactile object recognition, we adopted two types of raised linedrawing objects—everyday objects for the object-identification task
in Experiment 1, and structurally possible/impossible objects for
the object-discrimination task (discriminating between possible and
impossible objects) in Experiment 2. Both tasks require integrating
local features of the object to form a global representation, with
the main difference being the stimulus familiarity. Tactile stimuli
were created on Swell Paper. Subjects were blindfolded for tactile
tasks, and were later asked to recognize the same line drawings
visually. Since visual performance for possible/impossible objects
did not reach 100% accuracy for some subjects, we compared
tactile response with the corresponding visual response and used the
matching rate instead of discrimination accuracy as a measure of
performance.
Results: Despite little variation in visual acuity across subjects,
we found a negative correlation between tactile acuity and distance
visual acuity (r2=0.22; p=0.03). Consistently, we also found
negative relationships between tactile performance in both object
tasks and visual acuities (r2=0.18 to 0.41; p=0.001 to 0.096). In
general, subjects with worse visual acuity exhibited superior
tactile performance—better tactile acuity, and higher accuracy for
identifying everyday objects and discriminating possible/impossible
objects.
Conclusions: This study demonstrates an interesting trade-off
relationship between visual function, specifically visual acuity, and
tactile functions such as tactile acuity and tactile object recognition.
Commercial Relationships: Deyue Yu, None; Landon Perry, None
Support: Ohio Lions Eye Research Foundation Grant
Program Number: 4146 Poster Board Number: A0134
Presentation Time: 8:30 AM–10:15 AM
Returning Sensory Substitution to practical visual rehabilitation
Amir Amedi1, 2, Daniel-Robert Chebat1, Shelly Levy-Tzedek1,
Galit Buchs1, Shachar Maidenbaum2. 1ELSC, Hebrew university
of Jerusalem, Jerusalem, Israel; 2IMRIC, Hebrew University of
Jerusalem, Jerusalem, Israel.
Purpose: Sensory substitution devices (SSDs) have come a long
way since first developed for visual rehabilitation, producing exciting
experimental results, and furthering our understanding of the human
brain. Unfortunately, they are still not in wide use for practical
visual rehabilitation, and are considered as reserved mainlyy for
experiments in controlled settings.
Why haven’t they been adopted? This is usually blaimed on a
combination of practical problems such as the length and complexity
of training, unpleasantness of stimuli, cost, weight etc. on the one
hand, while on the other biological glass-ceiling reasons such as
missed critical periods and plastic reassignment of visual regions
were a cause for pessimism.
Over the past years, both of these categories underwent significant
changes. Our understanding of the neural mechanisms behind
visual restoration has changed as a result of converging evidence,
much of which was gathered with SSDs. This evidence suggests
that the brain is more than a pure sensory-machine but rather is a
highly flexible task-machine, i.e., brain regions can maintain or
regain their function in vision even with input from other senses,
offering a neurobiological basis for the use of SSDs. In parrallel, new
technological opportunities have arisen for creating new SSDs and
improving existing ones.
Here we utilized these new technologies and this new understanding
of brain organization back into practical visual rehabilitation, and test
SSDs under various practical behavioral tasks.
Methods: In this work we used several SSDs – the veteran vOICe
SSD, the new EyeCane SSD, which conveys single-point depth, and
the EyeMusic SSD, which conveys whole-scene shape and color
information - in a series of practical behavioral tests.
Results: We show that while still far from vision, results were
far above the expected by previous pessimistic views of SSDs.
Users succeeded in a series of tasks in real-world settings such as
correctly reaching for objects, recognizing real facial expressions and
navigating through obstacle courses and unknown environments.
Conclusions: These new results, combined with the understanding of
the brain as a task machine and other recent behavioral achievements
strongly suggest that the time has come to revive the focus on
practical visual rehabilitation with SSDs and we will chart several
key steps we believe are necessary in this direction such as training
protocols and self-train tools.
Commercial Relationships: Amir Amedi, None; Daniel-Robert
Chebat, None; Shelly Levy-Tzedek, None; Galit Buchs, None;
Shachar Maidenbaum, None
Support: European Research Council grant to A.A. (grant
number 310809), The Charitable Gatsby Foundation, The James
S. McDonnell Foundation scholar award (to AA; grant number
220020284), The Israel Science Foundation (grant number ISF
1684/08), The Edmond and Lily Safra Center for Brain Sciences
(ELSC) Vision center grant (to AA, SL, DRC)
Program Number: 4147 Poster Board Number: A0135
Presentation Time: 8:30 AM–10:15 AM
The blind man who saw his hands. Cross-modal plasticity
revisited
Avinoam B. Safran1, 2, Norman Sabbah1, 2, Nicolae Sanda1, 2, JoséAlain Sahel1, 2. 1Paris-6 University, Paris, France; 2UMR S968, Institut
de la Vision, Paris, France.
Purpose: To describe a most remarkable, consistent cross-modal
perceptual phenomenon experienced by a subject blinded by retinitis
pigmentosa and fitted with a retinal prosthesis. This previously
unreported phenomenon is informative on effects of cross-modal
processes taking place in the visual cortex.
Methods: History taking in a 53 year old man with retinitis
pigmentosa, who had for the last ten years his visual function limited
to bare light projection. Four years ago, his right eye was fitted in
our ophthalmology department with a retinal prosthesis (Argus® II,
Second Sight Medical Products, Sylmar, California), which restored
some visual function in the central 20 degree visual field, and
improved visual acuity to 20/800.
Results: The subject volunteered that, when standing in complete
darkness, his prosthetic device being turned off, he consistently
“saw” his hands and/or arms when he was moving them. The
perceptual phenomenon was exclusively elicited by his limbs
movements, and instantly disappeared when his limbs were still. The
subject also noted that the perceived shape of his limbs was occluded
in a small, well delineated area, approximately 20 degrees in diameter
and precisely located in the direction he felt that he was “looking at”.
Conclusions: This observation deserves consideration, as it illustrates
peculiar aspects of cross-modal processing in the visual cortex,
including the impact own limbs movement on the generation of
such synesthetic percepts. The central perceptually occluded area of
these qualia presumably reflects either the peripheral predominance
of non-visual sensory input in the retinotopic areas of the visual
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
cortex, or the possibly prosthesis-induced reversal of the functional
reorganization that had occurred in the deafferented visual cortex, an
apparently unreported phenomenon.
Commercial Relationships: Avinoam B. Safran, None; Norman
Sabbah, None; Nicolae Sanda, None; José-Alain Sahel, Pixium (C)
Clinical Trial: NCT00407602
Program Number: 4148 Poster Board Number: A0136
Presentation Time: 8:30 AM–10:15 AM
Variations of intraocular scattering in retinitis pigmentosa by
interposing short wavelengths filters
Celia Sanchez-Ramos, Juan Cedrún, Eva Chamorro, Cristina
Bonnin-Arias, Maria Jesus Perez-Carrasco. Universidad
Complutense de Madrid, Madrid, Spain.
Purpose: The intraocular scattering is a distorting effect of the
retinal image. In people with retinitis pigmentosa, the resolution of
the retinal image is particularly important. The halometer (Software
Halo v1.0 © 2008 Universidad de Granada) can assess quantitatively
the intraocular scattering. In recent years it has been shown that the
implementation of blue light filters improve visual perception in
persons with low vision. The aim of this study is to assess the effect
of blue light filters in mesopic perception of patients with retinitis
pigmentosa studing the intraocular scattering.
Methods: Prospective observational study in mesopic conditions.
The sample consisted of 26 patients with retinitis pigmentosa and
visual acuity of more than 0.1. The mean age was 45 ± 11 years.
After assessing symptoms and optometric visual was determined
visual disturbance index (VDI) with the halometer without and with
filters selective absorption of short wavelengths. The filters A and B
absorbed 9% and 50% of the wavelengths between 380 and 500 nm,
respectively.
Results: Reducing the incidence of short wavelengths of light using
filters selective absorbance significantly improve the VDI. The values
of VDI were without filter: 0.45 ± 0.30, with filter A: 0.30 ± 0.28 and
with filter B: 0.29 ± 0.27. The improvement of VDI was statistically
significant being for filter A 33.33 % (p = 0.0067) and for filter B
35.56 % ( p = 0.0067).
Conclusions: The absorbing short wavelengths filters reduce the
intraocular scatter improving the mesopic visual perception of
patients with retinitis pigmentosa. Those filters are a good option to
improve the quality of vision in mesopic conditions.
Commercial Relationships: Celia Sanchez-Ramos, None; Juan
Cedrún, None; Eva Chamorro, None; Cristina Bonnin-Arias,
None; Maria Jesus Perez-Carrasco, None
Program Number: 4149 Poster Board Number: A0137
Presentation Time: 8:30 AM–10:15 AM
Image stabilization in smart phone magnification apps helps read
distant text
Gang Luo, Shrinivas Pundlik. Schepens Eye Research Inst, Boston,
MA.
Purpose: Smart phone based magnification can be a convenient and
helpful tool for the elderly and visually impaired people for reading
distant text, such as street signs, but usually a telescope would need
to be added on to increase the magnification power. Otherwise, the
images on phone screens are usually smaller than the objects directly
viewed when a reasonable image resolution has to be maintained.
With combination of optical and digital magnification, image shaking
due to small hand movement can make it difficult to read distant
text. An image stabilization function has been implemented in an
iPhone magnifier app to reduce the effect of shaking in magnified
images. This study investigates the effect of stabilization on reading
performance of distant letters.
Methods: Randomized triplet was shown in each trial for 0.2, 0.47
or 0.93 second on a computer screen. An iPhone 5 attached with an
8x telescope was hand-held by subjects to read the triplet from 20
feet away. In combination with digital zoom, the actual magnification
of the triplet was about 7.3x for a viewing eye 15.7 inch (40cm)
from the iPhone screen, and the letter size on the phone screen was
about 20/100 at that distance. One young subject with central vision
loss (visual acuity: 20/200, age: 29, read the letters at her habitual
short distance) and 4 normally sighted old subjects (visual acuity:
20/15 to 20/25; age: 53-73) were tested, with and without the image
stabilization function activated.
Results: Overall, the reading accuracy for all the subjects was
improved from 36% to 63% when image stabilization was activated
(the visually impaired subject improved from 51% to 82%). On
average, the accuracy without and with stabilization for 0.2, 0.47 and
0.93 second presentations was 19% vs 40%; 47% vs 69%, and 51%
vs 75%, respectively. Significant effects were found for both duration
(p=0.001) and stabilization (p=0.036). The interaction between the
two factors was not significant (p=0.97).
Conclusions: When viewing text in the distance through a handheld device, such as a smart phone, image shaking problem at high
magnification levels due to small hand movement reduces reading
speed or reading accuracy. The image stabilization may potentially
help visually impaired people and old people to improve reading
performance.
Commercial Relationships: Gang Luo, None; Shrinivas Pundlik,
None
Program Number: 4150 Poster Board Number: A0138
Presentation Time: 8:30 AM–10:15 AM
Smartphones in visual impairment
Antonio F. Macedo1, Laura H. Moreno1, Rui S. Silva2, Michael D.
Crossland3, 4. 1Department/Centre of Physics and Optometry, Minho
University, Braga, Portugal; 2Office for Inclusion, Minho University,
Braga, Portugal; 3Vision and Eye Research Unit, Anglia Ruskin
University, Cambridge, United Kingdom; 4Moorfields Eye Hospital
NHS Foundation Trust, London, United Kingdom.
Purpose: We have previously shown that electronic devices can
be used by people with relatively low visual acuity and contrast
sensitivity. The aim of this study was to determine if people with
visual impairment use smartphones to compensate their visual
deficits.
Methods: An online survey was advertised to people with visual
impairment using personal contacts, social media and online
discussion groups. This survey was administered in two languages:
English and Portuguese. The first author is fluent in both languages
and ensured accurate translation. The questionnaire was designed
to collect basic demographic information and self-reported cause of
visual impairment. Participants were asked to specify whether they
used smartphones, and if so which operating system they used, what
they used the device for, and which accessibility functions they used.
Results: In total 131 responses were obtained: 75 to the English and
56 to the Portuguese survey. 93% of the respondents were younger
than 64 years and 25% had no perception of light. From the total
number of 131 respondents, 101 used smartphone. Of these, 57%
used an Apple OS, 22% used Android and 15% used Symbian. 98%
of smartphone users made phone calls with their device and sending
text messages was reported by 93%. Internet navigation was used by
84%, photo capabilities were used by 53% to help them to see and by
73% for other purposes. 80% also used apps on their device. Speech
navigation was used by 67% of respondents, ability to enlarge print
was used by 58% and a large screen was important to 40%. Font type
and contrast changes were less commonly used. Only 14% received
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
information about these devices from a vision care professional.
Other sources included online search, recommendations from friends
or blind associations.
Conclusions: Smartphones are widely used by people with visual
impairment. The current accessibility features such as speech
navigation and large print allow people with visual impairment to
use of these devices not only as phones but also as an electronic low
vision aid.
Commercial Relationships: Antonio F. Macedo, None; Laura H.
Moreno, None; Rui S. Silva, None; Michael D. Crossland, None
Support: FCT grant PTDC/DPT-EPI/0412/2012
Program Number: 4151 Poster Board Number: A0139
Presentation Time: 8:30 AM–10:15 AM
Usage of accessibility options for the iPhone/iPad in a visually
impaired population
Vanessa Braimah1, 4, Joshua Robinson1, 3, Rob Chun3, 1, Walter M.
Jay2. 1Illinois College of Optometry, Chicago, IL; 2Ophthalmology,
Loyola University Chicago, Chicago, IL; 3Spectrios Institute for Low
Vision, Wheaton, IL; 4Chicago Lighthouse for People who are Blind
or Visually Impaired, Chicago, IL.
Purpose: The iPad and iPhone have a number of low vision
accessibility features including Siri Voice Assistant, Large Text,
Zoom magnification, Invert Colors, Voice Over, and Speech
Selection. We studied their usage and preferences in a low vision
population.
Methods: Thirty-three low vision patients responded to an IRBapproved survey regarding their usage of the iPad and/or iPhone
(15 males, 18 females). Patients were eligible to participate if they
were 18 years of age or older and met one of the following criteria:
best corrected visual acuity worse than 20/60, central or significant
peripheral visual field defects, or a combination of both. Patients with
significant peripheral visual field defects were all tested on Goldmann
perimetry and had monocular fields of less than 60 degrees.
Participants were asked to rate the following: how frequently they use
each feature, the reported benefit of using each feature, and their own
self-assessed proficiency in using each feature.
Results: The mean age of the respondents was 54.3 years, ranging
from 26 to 87. There were 18 different diagnoses represented,
with Stargardt disease (5), oculocutaneous albinism (4), retinitis
pigmentosa (3), and retinal detachments (3) being the most common.
Six of thirty-three (18%) patients owned an iPhone, twelve (36%)
owned an iPad, and fifteen (45%) owned both devices. The average
visual acuity of respondents was 20/119 in the right eye and 20/133
in the left eye. Twenty-one patients (64%) had reduced central visual
acuity, six (18%) had peripheral visual field defects, and six (18%)
had some combination of both. The most commonly used vision
accessibility features were Large Text, with nineteen patients (58%),
and Zoom Magnification, with eighteen patients (55%). The feature
shown to be most beneficial was Large Text with 37% of users
ranking it number one, while Speak Selection exhibited the lowest
values for both proficiency and benefit of use with 42.8% of users
ranking it in last place. Twenty-one patients (63%) were self-taught
in the use of their device(s), four (12%) received clinical training,
four (12%) received consumer training, and four (12%) utilized
some combination of these methods. Five (15%) patients reported
having the iPad or iPhone recommended to them by a healthcare
professional.
Conclusions: Many low vision patients are using the accessibility
features of iPad and/or iPhone when operating these devices.
Commercial Relationships: Vanessa Braimah, None; Joshua
Robinson, None; Rob Chun, None; Walter M. Jay, None
Support: Illinois Society for the Prevention of Blindness Research
Grant
Program Number: 4152 Poster Board Number: A0140
Presentation Time: 8:30 AM–10:15 AM
Determinants of Rankings of Small Display Quality in Normally
Sighted Persons and Persons with Low Vision Due to Diabetic
Retinopathy
J. Vernon Odom1, 2, William Reuschel3. 1Ophthalmology, West
Virginia Univ Eye Inst, Morgantown, WV; 2Smith-Kettlewell Eye
Research Institute, San Francisco, CA; 3American Foundation for the
Blind, Huntington, WV.
Purpose: To assist development of a simplified metric for small
visual displays of use to low vision patients, we evaluated consumers’
rankings of display quality of glucometers under two lighting
conditions.
Methods: Two groups, 10 normally sighted and 10 low vision
patients with diabetic retinopathy ranked the displays of 8
glucometers from best=1 to worst=8 under two light levels, in room
light (480 lux) and in sunlight (15,000 lux). The normalized font size
(NFS) and contrast (NC) of the 8 devices were assessed under the
two lighting conditions. A preliminary metric, DeviceRating (D-R),
was calculated using NFS and NC. Subjects’ age, visual acuity (VA;
ETDRS) and contrast sensitivity (CS; MARS) were determined. The
normally sighted group was aged 68.6 ± 5.97 years with corrected
VA of 0.15 ± 0.14 logMAR and log CS of 1.7 ± 0.1. The visually
impaired group was aged 59.8 ± 11.74 years with corrected VA of
1.04 ± 0.41 logMAR and log CS of 0.95 ± 0.28. Subjects ranked the
visual displays of 8 glucometers. Subjects rankings were evaluated
using Spearman Rank Order Correlations (rho), logistic regressions,
and a three factor ANOVA (Group, Lighting, and Device) were used
to interpret the rankings.
Results: The ANOVA failed to indicate a significant main effect
of Group or Lighting as did rho and logistic regression (p>0.50).
However, there was a significant main effect of Device (p<0.00005)
and significant interaction terms for DevicexLighting (p<0.00005)
and DevicexGroup (p=0.001658). Similarly logistic regressions
indicated significant effects of Device (p<0.001), D-R (p<0.04) and
NC (p<0.05). The only significant correlations with Ranking were
D-R and NC (p<0.05).
Conclusions: Subjects rank the displays of glucometers, small panel
devices frequently used by low vision patients, differently. Relative
rankings are not affected by patient characteristics such as age, VA,
or CS. Differences in Device rankings varied by Lighting and by
Group, presumably because NC was reduced in higher Lighting and
reduced contrast affected the low vision diabetic patients more than
the normally sighted.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
DevicexLighting Interaction. The display quality of glucometers is
not ranked the same in 480 lux or 15,000 lux illumination.
Device x Group Interaction. The display quality of glucometers is not
ranked the same by persons who are normally sighted and those with
Low Vision.
Commercial Relationships: J. Vernon Odom, None; William
Reuschel, None
Program Number: 4153 Poster Board Number: A0141
Presentation Time: 8:30 AM–10:15 AM
Characteristics of low vision patients that prefer reverse contrast
settings on Closed Circuit Televisions
(CCTVs) and iPads
Joshua Robinson1, 2, Rob Chun2, 1, Alex Zemke2, Danielle Irvine2,
Vanessa Braimah1, 2, Walter M. Jay3. 1Illinois College of Optometry,
Chicago, IL; 2Spectrios Institute for Low Vision, Wheaton, IL;
3
Ophthalmology, Loyola University, Maywood, IL.
Purpose: Reverse contrast is an accessibility feature generally
offered on video magnifiers and tablets like the iPad. To our
knowledge, no correlations have been identified between type of
diagnosis (retinal versus optic nerve) and preference for reading
with reverse contrast mode. The recommendation for use of reverse
contrast on electronic magnifiers is driven by the patient’s subjective
comfort level when reading text on an electronic device, and is
not necessarily driven by the clinical findings or diagnosis of the
low vision patient. The impact and its relationship to the patient’s
condition have never been clinically investigated.
Methods: Analysis was completed on a previously approved
IRB study where contrast sensitivity results from a prior ARVO
study were not analyzed or published (Zemke A, et al. IOVS
2013;313:ARVO E-Abstract 2749). Fourteen patients, 18 years
or older, with best corrected visual acuities between 20/50 and
20/200 and minimal prior experience with an iPad or CCTV were
enrolled in the study. Patients were asked to read a paragraph from
a newspaper article and book at their preferred magnification setting
on each device. Patients were then surveyed with a questionnaire
investigating subjective comfort and preference for positive (black
print with white background) or negative contrast (white print with
black background).
Results: Four of the 14 patients (28.6%) preferred the reverse
contrast setting. Three of these 4 patients preferred using the iPad
over the CCTV. The four patients that preferred reading with reverse
contrast had 4 different diagnoses including primary open angle
glaucoma, retinal detachment, proliferative diabetic retinopathy,
and non-arteritic ischemic optic neuropathy. A two-tailed p-value
by Fisher’s exact test revealed no statistical significance when
comparing patient diagnosis (retinal versus optic nerve) to patient
preference for reading with reverse contrast (p = 0.5205).
Conclusions: The results of the study suggest that low vision
practitioners may not be guided by the type of patient diagnosis when
considering which patients would benefit from reading with reverse
contrast. The reduced sample size was a limitation to the study and
more data is needed to confirm the findings. Investigations are also
needed to analyze potential relationships with baseline contrast
sensitivity or symptoms of photoaversion.
Commercial Relationships: Joshua Robinson, None; Rob
Chun, None; Alex Zemke, None; Danielle Irvine, None; Vanessa
Braimah, None; Walter M. Jay, None
Program Number: 4154 Poster Board Number: A0142
Presentation Time: 8:30 AM–10:15 AM
Can vision impaired children perform visual search tasks?
PremNandhini Satgunam, Cyril Sara Babukutty. Hyderabad Eye
Research Foundation, L.V.Prasad Eye Institute, Hyderabad, India.
Purpose: Visual search experiments (feature and conjunction search)
have indicated younger children to have poorer performance in
comparison to adults because of attention deployment. However,
visual search can be used as a marker for visual performance. Such
a marker can help objectively evaluate the effectiveness of image
enhancement technology as a potential rehabilitation tool, as shown
in adults. We asked the questions could vision impaired (VI) children
perform visual search task (in real world scenes)? How does their
performance compare to normally sighted (NS) children?
Methods: VI (binocular acuity worse than 20/60) children (n=12,
mean age±SD:11±3.4) and NS (monocular acuities better than 20/30)
children (n=8, mean age:10±4) were enrolled with parents informed
consent. 150 images with real-world scenes (half randomly enhanced)
were presented on a computer monitor. A search target was displayed
at the top left corner of the monitor along with the image. Children
were asked to point to this target within the image as quickly and
accurately as possible. The examiner clicked the mouse in the pointed
direction. The images were divided into 3 categories: Face, Indoor
and Collections. Accuracy and search time were measured and was
used in computing the overall visual performance.
Results: All the children were able to complete all the 150 trials.
Face images were harder to search in both groups. Assumptions
for parametric test was satisfied, hence 2 sample t-test was used.
Search time (VI: 7s±1.7 (mean±SD) and NS: 4.5s±1.2) and accuracy
(VI:77.5% and NS:92.5%) were significantly different between
the groups whether the images were enhanced or not (p≤0.01).
The overall visual performance accounting for speed and accuracy
together was significantly different between NS and VI for both
enhanced (p=0.04) and unenhanced (p=0.01) images. About 75% of
VI children had better performance with image enhancement.
Conclusions: We have shown that search task (real-world scenes)
is possible in children as young as 5 years and even with VI.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Interestingly, VI children tended to show an improvement in
performance with enhanced images. This finding opens up some
exciting possibilities for rehabilitation in VI children.
Commercial Relationships: PremNandhini Satgunam, None;
Cyril Sara Babukutty, None
Program Number: 4155 Poster Board Number: A0143
Presentation Time: 8:30 AM–10:15 AM
Effectiveness of low-vision rehabilitation in humans under 18 yo
Swati Chavda, William Hodge, Francie F. Si, Karim Diab.
Ophthalmology, Western University, London, ON, Canada.
Purpose: There are various rehabilitation methods that aim to
increase quality of life for children with low vision. These methods
include low vision aids, exercise therapy and the use of optical
aids such as CCTV. This systematic review aims at determining
how effective varying low vision rehabilitation techniques are for
improving quality of life for those that have low vision and are
eighteen years old and under.
Methods: An exhaustive systematic review was conducted on
Medline, Embase, Cochrane, CINAHL, Biosis, Web of Knowledge,
Scopus, PsycINFO, and ERIC to screen for relevant articles. A three
stage screening and data abstraction process was performed by two
independent reviewers. Based on the inclusion criteria, there were a
total of 2854 articles that were screened but only 28 articles that were
used for data extraction after the entire PRISMA flow process was
conducted.
Results: The most common study focus area was reading skills and
methods included large print texts, magnifiers, CCTV’s and Braille.
Magnifiers performed better than large print devices by two levels
on basic reading inventory and both did better when visual training
was first given to the child. CCTV’s can be cost-effective but have
only been tried on small sample sizes. Other outcomes that showed
positive results with small sample sizes included visual attention and
visual perception.
Conclusions: In this systematic review, reading ability was the most
frequent outcome tested and did best with magnifiers after reading
training had been instituted. However, most studies have been
descriptive and with small sample sizes. Larger analytical studies
including randomized studies will need to be done in order to assess
both the needs and most appropriate interventions for this group of
patients needing visual rehabilitation.
Commercial Relationships: Swati Chavda, None; William Hodge,
None; Francie F. Si, None; Karim Diab, None
Support: AMOSO Innovation 2011-2012 funding (INN12-010),
Ontario, Canada.
Program Number: 4156 Poster Board Number: A0144
Presentation Time: 8:30 AM–10:15 AM
Performance Measures in Low Vision Patients Before and After
Occupational Therapy (OT) Training
Donald C. Fletcher1, 2, Laura Renninger1, Ken Downes1.
1
Ophthalmology, California Pacific Medical Center/SmithKettlewell Eye Research Institute, San Francisco, CA; 2Low Vision
Rehabilitation, Envision, Wichita, KS.
Purpose: To examine activities of daily living (ADL) performance
metrics before and after occupational therapy in low vision patients in
order to determine if OT improves ADL performance.
Methods: 28 patients at their first low vision referral were evaluated
in the study. 26 patients received OT training; 2 patients declined
OT and acted as controls. A battery of performance measures was
performed pre and post training or 1 year after the initial evaluation.
These measures included SK Read, utility bill and bank statement
reading, currency identification, hand writing performance, and
subjective frustration level estimation.
Results: Patient age median/range was 83/70 - 94 years with 79%
female. Vision loss was due to AMD in 93% of patients. Visual acuity
median/range was 20/160 and 20/20 to 20/730. 26 out of 28 patients
received occupational therapy training, median total therapy time was
3.5 hours (Range: 1 – 6.5). SK Read mean error rate improved from
4.1 to 2.4 errors per block after OT training, while the control group
had no improvement in error rate after 1 year. Only 31% of patients
at the initial consultation could accurately read a utility bill. After
OT training, 96% of patients gained this ability. The control patients
were not able to do this task at initial consultation or at 1 year follow
up. All subjects could identify currency and both the OT trained and
control groups improved in the mean time to identify (OT trained 23
to 16 seconds vs control group 24 to 11 seconds at 1 year follow up).
Hand writing performance was unchanged in both trained and control
groups. Subjective frustration estimates (scale from 1-10) improved
substantially in the OT trained group (6.7 to 3.8), while the control
group had minimal improvement (9.0 to 8.5).
Conclusions: After OT training most of the ADL performance
metrics showed an improvement and a profound decrease in
subjective frustration score was also noted. The small control group
without training did not demonstrate these improvements. The value
of low vision rehabilitation programs including a training component
is supported by this evidence.
Commercial Relationships: Donald C. Fletcher, None; Laura
Renninger, None; Ken Downes, None
Support: Pacific Vision Foundation and Envision
Program Number: 4157 Poster Board Number: A0145
Presentation Time: 8:30 AM–10:15 AM
Health State Effects on Accuracy and Precision of Visual Ability
Measures in Low Vision Patients
Robert W. Massof, Judith E. Goldstein. Ophthalmology, Johns
Hopkins Wilmer Eye Inst, Baltimore, MD.
Purpose: The Activity Inventory (AI) is an adaptive rating scale
questionnaire for measuring visual ability and its functional domains.
Visual acuity is the strongest predictor of visual ability, but other
health states also contribute to the measures. This study determines
how physical functioning, depression, and cognitive impairment
affect the accuracy and precision of low vision patient outcome
measures made with the AI.
Methods: The AI, the Geriatric Depression Scale (GDS), the physical
functioning component of the SF-36, and the Telephone Interview for
Cognitive Status (TICS) were administered by telephone to 760 new
low vision patients at 28 collaborating low vision centers throughout
the U.S. prior to the patients’ first visit appointment. The study was
approved by the Johns Hopkins IRB and oral consent was obtained
prior to the interview.
Results: Rasch analysis of the AI item responses was used to
estimate AI person measures, standard errors of the measure, and
information weighted mean square fit statistics for each of the
patients from their difficulty ratings of all valued items and of subsets
of items that define four visual ability domains: reading, mobility,
visual information processing, and visual motor function. Rasch
analyses of GDS, SF-36, and TICS responses were employed to
obtain measures of depression, physical functioning, and cognitive
functioning from the same patients. Multivariate regression with
health states as independent variables and AI person measures,
standard errors of the measure, and information weighted mean
squares as dependent variables showed that: 1) depressed mood
biased visual ability measures and increased the standard error of
the measure for all domains, but had no effect on mean squares;
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
2) physical functioning biased only mobility function measures
and increased mean squares only for mobility, but had no effect
on standard errors; 3) cognitive function biased reading function
measures only and increased mean squares for reading and other
visual ability domains, but had no effect on standard errors.
Conclusions: We conclude that 1) depression introduces response
bias and decreases measurement precision for all visual ability
domains ; 2) physical limitations affect the accuracy of mobility
function measures, but have no effect on measurement precision; 3)
cognitive disorders affect reading function accuracy, but, have no
effect on measurement precision.
Commercial Relationships: Robert W. Massof, None; Judith E.
Goldstein, None
Support: NIH EY012045 and EY018696
Program Number: 4158 Poster Board Number: A0146
Presentation Time: 8:30 AM–10:15 AM
Partnership Between Private And Public Institutions To Deliver
Comprehensive Low Vision Care: First-Year Experience In
Verona, Italy
Gianfrancesco M. Villani, Silvia Pellegrini, Fabio Di Cerbo,
Yuri Nalini. Ophthalmology, C. Riabilitazione Ipovedenti e
Microperimetria, Castel d’ Azzano, Italy.
Purpose: To evaluate the efficacy of the rehabilitative intervention
at the Low Vision Center of Verona (CRIM) from Dec 2012 to Nov
2013
Methods: Efficacy of treatment was evaluated in terms of
achievement of independent performance for the desired (visual) task
(e.g., main outcome measure for reading was independent reading of
IReST text). Cost-effectiveness of the intervention was measured by
the number of low vision rehabilitation sessions (LVR-S) per patient.
Patients’s satisfaction was investigated by a structured phone survey
Results: 59 patients were referred. Age median (range) was 76
(12-97) years. ETDRS BCVA median (range) was 20/200 (32-NLP).
44 patients (74.6%) had “low vision” according to the VA ranges in
ICD-9-CM. Among patients’s goals, reading was stated by all but
two patients (96.6%), followed by glare control (40.7%), and face
recognition (20%). LVR-S were 155 overall, with a median (range)
of 2 (1-8) per patient. 29 patients (49.2%) successfully completed a
LVR pathway, consisting of evaluation, training, and prescription of
a device (group “y”). 11 patients (18.6%) were not prescribed any
device, and were not expected to benefit from further intervention
in a reasonable period of time (group “n”). 19 patients (32.2%)
were considered to be still in the process (group “ny”). LVR-S total,
median (range), and average for each group are as follows: 93, 2 (18), 3.2 [group y]; 20, 2 (1-4), 1.8 [group n]; 42, 2 (1-8), 2.21 [group
ny]. In terms of LVR-S, a significant difference was found between
group y and n (p<0.01), and a weaker difference between group y and
ny (p=0.08). The phone survey was answered by 34 patients, as the
others were out of reach. Among them, 30 (88%) patients declared to
be satisfied with the intervention received
Conclusions: Applied low vision care struggles between the ambition
to meet patients’s needs thoroughly and the shortage of resources.
The median of two LVR-S per patient advocates the elaboration of an
algorithm that allows a comprehensive, effective, and standardized
intervention to be carried out in this limited number of sessions.
A more extensive workup will be provided to selected patients (as
testified by LVR-S ranging up to 8 in groups y and ny) according to
their assessed areas of likely improvement and overall potential.
Commercial Relationships: Gianfrancesco M. Villani, None;
Silvia Pellegrini, None; Fabio Di Cerbo, None; Yuri Nalini, None
Support: LCIF GA11747/108-TA1
Program Number: 4159 Poster Board Number: A0147
Presentation Time: 8:30 AM–10:15 AM
Prevalence and Causes of Vision Loss in North Africa and the
Middle East: 1990-2010.
Moncef Khairallah1, Rim Kahloun1, Jost B. Jonas2, Jill Keeffe3,
Kovin S. Naidoo4, Serge Resnikoff5, Hugh R. Taylor6, Rupert
Bourne7. 1Fattouma Bourguiba University Hospital, Faculty of
Medicine, University of Monastir, Monastir, Tunisia; 2Department of
Ophthalmology, Universitätsmedizin, Mannheim, Medical Faculty
Mannheim, Heidelberg University, Mannheim, Germany; 3Centre
for Eye Research Australia, University of Melbourne, Melbourne,
VIC, Australia; 4African Vision Research Institute, University of
Kwazulu-Natal, South Africa & Brien Holden Vision Institute,
Sydney, Australia, Kwazulu-Natal, South Africa; 5International
Health and Development, Geneva, Switzerland; 6Melbourne School
of Population Health, University of Melbourne, Melbourne, VIC,
Australia; 7Vision & Eye Research Unit, Anglia Ruskin University,
Cambridge, United Kingdom.
Purpose: To examine vision impairment and its changes from 1990
to 2010 in North Africa and the Middle East (NAME).
Methods: Based on a systematic review of medical literature, we
examined prevalence and causes of moderate and severe vision
impairment (MSVI; presenting visual acuity <6/18, ≥3/60) and
blindness (presenting visual acuity <3/60).
Results: In NAME, the age-standardized prevalence of blindness
decreased from 2.1% to 1.1% and MSVI from 7.1% to 4.5%. In 2010,
3.119 million people were blind, and 13.700 million had MSVI.
Women were generally more often affected than men. Main causes
of blindness were cataract, uncorrected refractive error, macular
degeneration, and glaucoma. Main causes of MSVI were cataract and
uncorrected refractive errors. Proportions of blindness and MSVI
from trachoma significantly decreased.
Conclusions: Although the absolute numbers of people with
blindness and MSVI increased from 1990 to 2010, the overall agespecific prevalences of blindness and MSVI and the prevalences
in people aged 50 years decreased significantly. Cataract and
uncorrected refractive error were the major causes of blindness and
MSVI.
Commercial Relationships: Moncef Khairallah, None; Rim
Kahloun, None; Jost B. Jonas, None; Jill Keeffe, None; Kovin
S. Naidoo, None; Serge Resnikoff, None; Hugh R. Taylor, None;
Rupert Bourne, None
Program Number: 4160 Poster Board Number: A0148
Presentation Time: 8:30 AM–10:15 AM
Hospitalization rate among chronically ill low vision patients
using a home prescription label reader vs. a pill box.
Bruce I. Gaynes1, 2, Tatyana Spektor3, Nicole Nikolic1.
1
Ophthalmology, Loyola University Chicago, Maywood,
IL; 2Pharmacy Practice, University of Illinois, Chicago, IL;
3
Ophthalmology, Rush University Medical Center, Chicago, IL.
Purpose: ScripTalk® is a text-to-speech prescription medication
label reader designed to help the visually impaired prevent
medication administration errors in the home environment. Our study
focuses on characterizing the users of ScripTalk®, highlighting risk
factors for adverse events, and addressing efficacy of the label reader
technology vs use of common pill-box organizers.
Methods: A retrospective cohort study was done with 84 highrisk chronically ill patients enrolled into the ScripTalk® program
from 2006-2011 at the Hines Veterans Affairs Hospital focusing on
the degree of visual impairment, co-morbidities, use of a pillbox,
reported missed medications, and hospitalizations.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Results: In our study sample, patients who did not use a pillbox
had approximately double the rate of hospitalizations per year
compared to pillbox users. With regard to non-modifiable risk factors,
patients with visual impairment from both diabetic retinopathy and
glaucoma had the highest average yearly hospitalization rate. Of note,
the overall adherence rate with ScripTalk reader was found to be
approximately 13%. Interestingly, patients with no light perception
were approximately five times more likely to miss taking their
medications compared to those with higher levels of visual acuity,
despite use of the ScripTalk device.
Conclusions: With respect to modifiable risk factors, the use of a
pillbox appears to be a relatively simple and effective addition to
assist visual impaired patients in appropriate home medication use.
The implementation of a prescription label reader appears to offer
benefit in reducing hospitalization rate among individuals with visual
impairment and concomitant non-modifiable risk factors for home
medication misadventure, however durability of the device in terms
of persistence of use appears to be low.
Commercial Relationships: Bruce I. Gaynes, None; Tatyana
Spektor, None; Nicole Nikolic, None
Support: Richard A Perritt Charitable Foundation
Program Number: 4161 Poster Board Number: A0149
Presentation Time: 8:30 AM–10:15 AM
Acquired color vision deficiency among visually impaired adults
attending a vision rehabilitation clinic
Janis Winters, Tracy Matchinski, Karen Squier. Illinois College of
Optometry, Chicago, IL.
Purpose: Visually impaired (VI) patients have significant ocular
disease and therefore may have acquired color vision defects (CVD).
Color vision (CV) testing however may be limited among VI patients
since anecdotal evidence suggests VI patients have difficulty with
pseudoisochromatic plate tests assessing acquired CVD. These testing
limitations may have led to the scarcity of reports on CV testing and
CVD prevalence among VI patients in vision rehabilitation clinics
(VRC). The purpose of this study is to assess moderate/ severe CVD
among VI patients attending a VRC clinic and trends related to
symptomology, level of VI and ocular diagnosis.
Methods: Patients attending a VRC were surveyed regarding CV.
CV was tested using the 1.3 inch stimulus size ‘Panel 16 Quantitative
Color Vision Test’ (D-15) and the Richmond Daylight Illuminator.
Patients were classified as CVD if there were 2 or more major
crossover errors in either eye on the D-15. Patients assessed as ‘likely
congenital CVD’ were excluded (N=2). VI was classified using World
Health Organization criteria. For VI classification, VA in the eye with
CVD or ‘better seeing’ eye (if both CVD), was used. Primary cause
of VI was sub-classified into optic nerve or retina.
Results: Range of VAs for those who completed D-15 testing (N=84)
was 20/20- 20/3000. Mean age was 53 yrs. Nearly half of patients
tested (48.8% (N=41)) were classified as CVD. Type of CVD could
not be assessed in the majority. Change in CV was reported by 35%
with CVD and 13% non-CVD. CVD was assessed in 52% of those
with optic nerve disease and 61% of those with retinal disease.
Level of VI among those CVD was 17% normal/near normal, 44%
moderate impairment and 39% severe impairment/worse.
Conclusions: D-15 testing was completed on patients with a wide
range of VI levels; demonstrating the feasibility of this method of
color vision assessment in a VRC clinic. There was a high percentage
of moderate/severe CVD identified among adults studied. Of those
with CVD, there was variability in report of change in CV, level of
VI and ocular disease causing VI. Therefore in this population CVD
cannot be assumed based upon these factors. Although there is no
treatment for CVD, education about acquired CVD and specific
activities CVD may impact is essential especially due to possible
CVD progression as the ocular conditions worsen.
Commercial Relationships: Janis Winters, None; Tracy
Matchinski, None; Karen Squier, None
Support: Research Allocation Committee of the Illinois College of
Optometry
Program Number: 4162 Poster Board Number: A0150
Presentation Time: 8:30 AM–10:15 AM
Calibration of eye movements using reaching movements under
simulated blindness conditions
Takao Endo1, Takashi Fujikado2, Hiroyuki Kanda2, Takeshi
Morimoto2, Kohji Nishida1. 1Department of Ophthalmology, Osaka
Univ Grad School of Med, Suita, Japan; 2Department of Applied
Visual Science, Osaka Univ Grad School of Med, Suita, Japan.
Purpose: Eye movements can affect where a phosphene is perceived
by patients with advanced retinitis pigmentosa (RP) who are
implanted with a retinal prosthesis and equipped with an external
camera (Fujikado, IOVS 2011). Because blind patients cannot fixate
a target for calibration, we examined whether we can calibrate the
eye position using the eye movements accompanied by reaching
movement in subjects with simulated blindness.
Methods: The eye movements of ten normal subjects with right
eye-dominance (4 men, 6 women; age, 22 to 50 years) were recorded
with an eye tracker (Glass-type, Tobii®). Initially, the eye movements
were calibrated using targets of known distances. Then, the eye
movements were recorded with the subjects told to follow the index
finger which pointed to the markers attached to an acrylic board
located 40 cm in front of subjects (sighted condition). Nine markers
were arranged in a lattice configuration with a 9.2 cm separation on
the board. Then, the eyes were occluded by placing a piece of foil
on the eye tracker glasses which decreased the visual acuity to NLP
(blinded condition). Subjects were trained to explore and touch the
marker in the blinded condition. Then, eye movements of the blinded
subjects were recorded while the subjects were forced to fixate the
index finger, which pointed the marker on the board. The distance
between the gaze position to the central mark and that to each
residual mark was measured and was divided by the distance between
the central and each residual mark. The average of the 8 values was
defined as the R value, and it was compared between the sighted and
the blinded conditions.
Results: In the sighted condition, R = 0.99±0.12 with a variance of
0.015, and in the blinded condition R = 0.76±0.76 with a variance of
0.053. R was significantly smaller under the blinded condition than
the sighted condition (paired t test; P<0.001).
Conclusions: The distance of the gaze positions in the reaching
movements was about 20% shorter in the blinded condition than
in the sighted condition in normal subjects. These findings indicate
that when we map the perceived position of phoshenes in advanced
RP patients implanted with retinal prosthesis and with an external
camera, the effect of eye movements on the location of perceived
phosphene can be evaluated by an eye tracker which is calibrated
by the eye movement following the reaching movement with a
correction factor.
Commercial Relationships: Takao Endo, None; Takashi Fujikado,
None; Hiroyuki Kanda, None; Takeshi Morimoto, None; Kohji
Nishida, None
Support: None in the Support field below.
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2014 Annual Meeting Abstracts
Program Number: 4163 Poster Board Number: A0151
Presentation Time: 8:30 AM–10:15 AM
Assessment of pain after IVT of Ranibizumab in patients
undergoing AMD or CME post to diabetic retinopathy or vein
occlusion
Nathalie Massamba1, 2, Juliette Knoeri1, 2, Maud Elluard1, 2, Bernard
Pasquier1, 2. 1OPHTHALMOLOGY, CH CERGY PONTOISE, Cergy
pontoise, France; 2OPHTHALMOLOGY, CH CERGY PONTOISE,
CERGY PONTOISE, France.
Purpose: To evaluate the degree of pain of patients undergoing
antiangiogenic (ranibuzumab) treatment for exudative age-related
macular degeneration, CME for diabetic retinopathy, vein occlusion
Methods: Prospective, interventional, consecutive case series. We
evaluate the degree of pain after ranibizumab intravitreal injection
in patients undergoing exudative age-related macular degeneration
(AMD), CME for diabetic retinopathy, vein occlusion during five
months between May and September 2013 at Cergy hospital. The
degree of pain has been evaluated only once by Visual Analog Scale
Score(VAS).
Results: 80 eyes of 80 patients were analyzed between the may
and july 2013 at department of ophthalmology of Cergy Hospital.
The mean age of patients was 73.5, for 45 (56 %)men and 35(44%)
women, with an average follow-up of 45 days. 34 eyes had AMD
and 37 suffering from diabetic retinopathy and seven eyes followed
for CRVO. Of the 80 eyes examined, 42 left eyes (52%) and 38
right eyes (48%). The average injection was 4.17 with an average
pain rating of 1.831. 43 (54%) eyes had chirurgical history of phaco
emulsification of the eye under study. Three group were identified
according to arrival time, 22 (28%)eyes were injected 30 minutes
after arrival (group 1) vs 29 (36%) in group 2 and 29 (36%) for group
3. The greater part of the factors analyzed were not only correlated
to pain including Age, gender, site of injection, the waiting time
for the injection, pathologies and the history of cataract surgery
and p = were respectively (0.7;0.2;0.8;0.8;0.6;0.7). Nonetheless the
number of injection was correlated to pain. p (0.07). The pain was
also correlated to the injected eye, patients injected in the LE have
experienced more pain than those injected in RE (0.02).
Conclusions: Pain is a complex phenomenon that poses a problem
of definition. The I A.S.P (International Associationfor Study of Pain
(pain)) proposes to define the pain as a subjective sensory experience
and unpleasant emotional harm associated tissue present or potential,
such damage. This definition is also used by O. m.s (World Health
Organization). Many patients experience pain after intravitreal
injection of ranibizumab, therefore the interest of this study was
to improve our understanding of the concept of pain due to the
intravitreal injection of ranibizumab in the treatment management of
our patients.
Commercial Relationships: Nathalie Massamba, None; Juliette
Knoeri, None; Maud Elluard, None; Bernard Pasquier, None
©2014, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].