Rating Visual System Impairment using the Sixth Edition: Technical Aspects

2011 ◽  
Vol 16 (6) ◽  
pp. 7-11
Author(s):  
Bernard R. Blais
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual System ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Test Procedures ◽  
Reasonable Estimate ◽  
Sixth Edition ◽  
Functional Vision ◽  
Vision Defects

Abstract Use of The Visual System section of the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, requires knowledge and skills in ophthalmology and assessing impairment. Visual acuity usually is measured using symbols (letters, numbers, pictures, or other symbols) presented in a letter chart format. The Visual Acuity Scale (VAS) is a linear scale with fixed increments and provides a reasonable estimate of acuity-related visual abilities; the associated impairment rating is a reasonable estimate of acuity-related performance loss. This article shows how to perform visual acuity calculations and how to assess impairment of visual fields, including visual field test procedures and calculations. Additional factors can lead to a loss of functional vision and can limit the individual's ability to perform activities of daily living and include contrast sensitivity, glare sensitivity, color vision defects, and binocularity, stereopsis, suppression, and diplopia. If functional vision is affected and is not accounted for by visual acuity or visual field loss, the impairment rating of the visual system can be adjusted but should be limited to an increase of the impairment rating of the visual system by, at most, 15 points (ie, less severe than the total loss of one eye). The ability to rate visual impairment requires significant knowledge and education, and therefore a physician trained in ophthalmology should perform the visual examination and visual system impairment rating.

scholarly journals Novel Pathogenic Sequence Variants in NR2E3 and Clinical Findings in Three Patients

Genes ◽  
2020 ◽  
Vol 11 (11) ◽  
pp. 1288
Author(s):  
Saoud Al-khuzaei ◽  
Suzanne Broadgate ◽  
Stephanie Halford ◽  
Jasleen K. Jolly ◽  
Morag Shanks ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Clinical Findings ◽  
Sequence Variants ◽  
Childhood Onset ◽  
Distinctive Features ◽  
Targeted Ngs ◽  
Clinical Records

A retrospective review of the clinical records of patients seen at the Oxford Eye Hospital identified as having NR2E3 mutations was performed. The data included symptoms, best-corrected visual acuity, multimodal retinal imaging, visual fields and electrophysiology testing. Three participants were identified with biallelic NR2E3 pathogenic sequence variants detected using a targeted NGS gene panel, two of which were novel. Participant I was a Nepalese male aged 68 years, and participants II and III were white Caucasian females aged 69 and 10 years old, respectively. All three had childhood onset nyctalopia, a progressive decrease in central vision, and visual field loss. Patients I and III had photopsia, patient II had photosensitivity and patient III also had photophobia. Visual acuities in patients I and II were preserved even into the seventh decade, with the worst visual acuity measured at 6/36. Visual field constriction was severe in participant I, less so in II, and fields were full to bright targets targets in participant III. Electrophysiology testing in all three demonstrated loss of rod function. The three patients share some of the typical distinctive features of NR2E3 retinopathies, as well as a novel clinical observation of foveal ellipsoid thickening.

Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

2012 ◽  
Vol 117 (2) ◽  
pp. 295-301 ◽  
Author(s):  
Juri Kivelev ◽  
Elina Koskela ◽  
Kirsi Setälä ◽  
Mika Niemelä ◽  
Juha Hernesniemi
Keyword(s):  
Visual Field ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Occipital Lobe ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Long Term Outcome ◽  
Visual Field Deficit

Object Cavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome. Methods Of the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3–59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5–14 years). Results All patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up. Conclusions Surgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

Arteriovenous malformations in the optic apparatus: systematic literature review and report of four cases

2021 ◽  
pp. 1-11
Author(s):  
Visish M. Srinivasan ◽  
Phiroz E. Tarapore ◽  
Stefan W. Koester ◽  
Joshua S. Catapano ◽  
Caleb Rutledge ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Visual Fields ◽  
Optic Tract ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Subtotal Resection

OBJECTIVE Rare arteriovenous malformations (AVMs) of the optic apparatus account for < 1% of all AVMs. The authors conducted a systematic review of the literature for cases of optic apparatus AVMs and present 4 cases from their institution. The literature is summarized to describe preoperative characteristics, surgical technique, and treatment outcomes for these lesions. METHODS A comprehensive search of the English-language literature was performed in accordance with established Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all published cases of AVM in the optic apparatus in the PubMed, Web of Science, and Cochrane databases. The authors also searched their prospective institutional database of vascular malformations for such cases. Data regarding the clinical and radiological presentation, visual acuity, visual fields, extent of resection, and postoperative outcomes were gathered. RESULTS Nine patients in the literature and 4 patients in the authors’ single-surgeon series who fit the inclusion criteria were identified. The median age at presentation was 29 years (range 8–39 years). Among these patients, 11 presented with visual disturbance, 9 with headache, and 1 with multiple prior subarachnoid hemorrhages; the AVM in 1 case was found incidentally. Four patients described prior symptoms of headache or visual disturbance consistent with sentinel events. Visual acuity was decreased from baseline in 10 patients, and 11 patients had visual field defects on formal visual field testing. The most common visual field defect was temporal hemianopia, found in one or both eyes in 7 patients. The optic chiasm was affected in 10 patients, the hypothalamus in 2 patients, the optic nerve (unilaterally) in 8 patients, and the optic tract in 2 patients. Six patients underwent gross-total resection; 6 patients underwent subtotal resection; and 1 patient underwent craniotomy, but no resection was attempted. Postoperatively, 9 of the patients had improved visual function, 1 had no change, and 3 had worse visual acuity. Eight patients demonstrated improved visual fields, 1 had no change, and 4 had narrowed fields. CONCLUSIONS AVMs of the optic apparatus are rare lesions. Although they reside in a highly eloquent region, surgical outcomes are generally good; the majority of patients will see improvement in their visual function postoperatively. Microsurgical technique is critical to the successful removal of these lesions, and preservation of function sometimes requires subtotal resection of the lesion.

Distracted Driving and Driving Patterns in Older Drivers With Glaucoma

2021 ◽  
pp. 155982762110428
Author(s):  
Purva Jain ◽  
Jonathan T. Unkart ◽  
Fabio B. Daga ◽  
Linda Hill
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Fields ◽  
Distracted Driving ◽  
Night Vision ◽  
Driving Ability ◽  
Safe Driving ◽  
Ability To Drive ◽  
Acuity Score

Limited research exists examining self-perceived vision and driving ability among individuals with glaucoma, and this study assessed the relationship between glaucoma, visual field, and visual acuity with driving capability. 137 individuals with glaucoma and 75 healthy controls were asked to evaluate self-rated vision, self-perceived driving ability, and self-perceived distracted driving. Visual acuity and visual field measurements were also obtained. Multivariable linear regressions were run to test each visual measure with driving outcomes. The average age was 72.2 years, 57.3% were male, and 72.5% were White. There were significant associations for a one-point increase in visual field and quality of corrected vision (RR = 1.06; 95% CI = 1.03–1.10), day vision (RR = 1.05; 95% CI = 1.03–1.08), night vision (RR = 1.08; 95% CI = 1.05–1.13), visual acuity score and higher quality of corrected of vision (RR = .41; 95% CI = .22-.77), day vision (RR = .39; 95% CI=.22–.71), and night vision (RR = .41; 95% CI = .18–.94); visual acuity score and ability to drive safely compared to other drivers your age (RR = .53; 95% CI = .29–.96). Individuals with poorer visual acuity and visual fields rate their vision and ability to drive lower than those with better vision, and this information will allow clinicians to understand where to target interventions to enhance safe driving practices.

scholarly journals Sign language experience redistributes attentional resources to the inferior visual field

2019 ◽  
Author(s):  
Chloé Stoll ◽  
Matthew William Geoffrey Dye
Keyword(s):  
Visual Field ◽  
Visual Attention ◽  
Visual System ◽  
Visual Fields ◽  
The Body ◽  
Language Experience ◽  
Bayesian Hierarchical ◽  
Signed Languages ◽  
Covert Visual Attention ◽  
Deaf Signers

While a substantial body of work has suggested that deafness brings about an increased allocation of visual attention to the periphery there has been much less work on how using a signed language may also influence this attentional allocation. Signed languages are visual-gestural and produced using the body and perceived via the human visual system. Signers fixate upon the face of interlocutors and do not directly look at the hands moving in the inferior visual field. It is therefore reasonable to predict that signed languages require a redistribution of covert visual attention to the inferior visual field. Here we report a prospective and statistically powered assessment of the spatial distribution of attention to inferior and superior visual fields in signers – both deaf and hearing – in a visual search task. Using a Bayesian Hierarchical Drift Diffusion Model, we estimated decision making parameters for the superior and inferior visual field in deaf signers, hearing signers and hearing non-signers. Results indicated a greater attentional redistribution toward the inferior visual field in adult signers (both deaf and hearing) than in hearing sign-naïve adults. The effect was smaller for hearing signers than for deaf signers, suggestive of either a role for extent of exposure or greater plasticity of the visual system in the deaf. The data provide support for a process by which the demands of linguistic processing can influence the human attentional system.

Charles Bonnet syndrome as first manifestation of occipital infarction

2022 ◽  
pp. 112067212110697
Author(s):  
Marta Isabel Martínez-Sánchez ◽  
Gema Bolívar
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Hallucinations ◽  
Correct Treatment ◽  
Cerebral Magnetic Resonance Imaging ◽  
Full Field ◽  
Charles Bonnet Syndrome ◽  
The Right

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

scholarly journals Estimating Rates of Progression and Predicting Future Visual Fields in Glaucoma Using a Deep Variational Autoencoder

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Samuel I. Berchuck ◽  
Sayan Mukherjee ◽  
Felipe A. Medeiros
Keyword(s):  
Visual Field ◽  
Learning Algorithm ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Absolute Error ◽  
Rate Of Change ◽  
Mean Deviation ◽  
Automated Perimetry ◽  
Standard Automated Perimetry ◽  
Deep Learning Algorithm

AbstractIn this manuscript we develop a deep learning algorithm to improve estimation of rates of progression and prediction of future patterns of visual field loss in glaucoma. A generalized variational auto-encoder (VAE) was trained to learn a low-dimensional representation of standard automated perimetry (SAP) visual fields using 29,161 fields from 3,832 patients. The VAE was trained on a 90% sample of the data, with randomization at the patient level. Using the remaining 10%, rates of progression and predictions were generated, with comparisons to SAP mean deviation (MD) rates and point-wise (PW) regression predictions, respectively. The longitudinal rate of change through the VAE latent space (e.g., with eight dimensions) detected a significantly higher proportion of progression than MD at two (25% vs. 9%) and four (35% vs 15%) years from baseline. Early on, VAE improved prediction over PW, with significantly smaller mean absolute error in predicting the 4th, 6th and 8th visits from the first three (e.g., visit eight: VAE8: 5.14 dB vs. PW: 8.07 dB; P < 0.001). A deep VAE can be used for assessing both rates and trajectories of progression in glaucoma, with the additional benefit of being a generative technique capable of predicting future patterns of visual field damage.

scholarly journals Visual Field Defect after Cardiac Surgery: The Striking Role of Interdisciplinary Collaboration

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Raffaele Nuzzi ◽  
Carlo Lavia
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Interdisciplinary Collaboration ◽  
Visual Fields ◽  
Cortical Blindness ◽  
Visual Field Defects ◽  
Ischemic Optic Neuropathy ◽  
Intraoperative Hypotension ◽  
Perioperative Visual Loss ◽  
Vascular Occlusions

Perioperative visual loss (POVL) is a potentially devastating complication that can occur following ocular or nonocular surgery. The leading causes of this disease are retinal vascular occlusions, ischemic optic neuropathies, and cortical blindness. POVL pathogenesis is strictly influenced by surgery, anesthesia, and patients’ comorbidities. We report of a 55-year-old caucasian man who presented with complaints of sudden painless loss of vision and unilateral campimetric deficit. We recorded a preserved visual acuity but at fundus examination a bilateral ischemic optic neuropathy (ION) was suspected. Our hypothesis was supported by uncommon and peculiar visual field defects and a history of cardiovascular surgery shortly before was a striking data. When we examined his medical records we found strong accordance with what is reported in literature to be risk factors for postoperative ION development. He presented intraoperative hypotension, anemia, and hypothermia, he was older than 50 years, and surgery lasted for more than five hours. We are currently monitoring his visual acuity and visual fields which remain unchanged. As there is no proved therapy for such severe adverse events, we recommend intraoperative check of blood pressure, blood loss, and body temperature, associated with repeated eye checks and patients’ interview.

scholarly journals Comparison of Diagnostic Accuracy between Octopus 900 and Goldmann Kinetic Visual Fields

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Fiona J. Rowe ◽  
Alison Rowlands
Keyword(s):  
Visual Field ◽  
Diagnostic Accuracy ◽  
Visual Fields ◽  
Visual Field Loss ◽  
Area Measurement ◽  
Test Duration ◽  
Bonferroni Adjustment ◽  
Goldmann Perimetry ◽  
Field Defect ◽  
Octopus Perimetry

Purpose. To determine diagnostic accuracy of kinetic visual field assessment by Octopus 900 perimetry compared with Goldmann perimetry.Methods. Prospective cross section evaluation of 40 control subjects with full visual fields and 50 patients with known visual field loss. Comparison of test duration and area measurement of isopters for Octopus 3, 5, and 10°/sec stimulus speeds. Comparison of test duration and type of visual field classification for Octopus versus Goldmann perimetry. Results were independently graded for presence/absence of field defect and for type and location of defect. Statistical evaluation comprised of ANOVA and paired t test for evaluation of parametric data with Bonferroni adjustment. Bland Altman and Kappa tests were used for measurement of agreement between data.Results. Octopus 5°/sec perimetry had comparable test duration to Goldmann perimetry. Octopus perimetry reliably detected type and location of visual field loss with visual fields matched to Goldmann results in 88.8% of results(K=0.775).Conclusions. Kinetic perimetry requires individual tailoring to ensure accuracy. Octopus perimetry was reproducible for presence/absence of visual field defect. Our screening protocol when using Octopus perimetry is 5°/sec for determining boundaries of peripheral isopters and 3°/sec for blind spot mapping with further evaluation of area of field loss for defect depth and size.

Letter Structure Factors in the Recognition of Alphabetical Arrays Presented in the Right and Left Visual Fields

1970 ◽  
Vol 31 (2) ◽  
pp. 555-559
Author(s):  
Robert Fudin
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Fields ◽  
Structure Factors ◽  
The Right

Six-letter nonsense arrays made up of the letters H N Z D W J were tachistoscopically exposed either to the right or left of fixation at four displacements to 20 Ss. Structurally similar letters (i.e., the H and N) tended to be recognized with greater difficulty than dissimilar items. Following certain ideas about scanning (Fudin, 1969), the possible effect of letter structure was investigated separately in the first half of targets (letters 1, 2, and 3) and in the last half. This effect was almost exclusively limited to the array-half at each displacement which, because of its position in the visual field, fell in an area of greater visual acuity. Further research concerning the influence of letter structure upon recognition whenever stimuli are briefly presented seems warranted.

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