Abstract: Diabetic retinopathy (DR) is the most common microvascular complication in patients with diabetes mellitus (DM), and remains the single greatest cause of blindness in working age adults around the world. In this article, we review the evolution of pharmacotherapies for both diabetic macular edema (DME) and DR such as anti-vascular endothelial growth factor inhibitors and various steroid formulations, as well as other emerging pharmacotherapies currently in late stage clinical testing for this disease.
Background: To compare objective electrophysiological contrast sensitivity function (CSF) in patients implanted with either multifocal intraocular lenses (MIOLs) or monofocal intraocular lenses (IOLs) by pattern reversal visual evoked potentials (prVEP) measurements.
Methods: Fourty-five cataract patients were randomly allocated to receive bilaterally: apodized diffractive-refractive Alcon Acrysof MIOL (A), full diffractive AMO Tecnis MIOL (B) or monofocal Alcon Acrysof IOL (C). Primary outcomes: 1-year differences in objective binocular CSF measured by prVEP with sinusoid grating stimuli of 6 decreasing contrast levels at 6 spatial frequencies. Secondary outcomes: psychophysical CSF measured with VCTS-6500, photopic uncorrected distance (UDVA), and mesopic and photopic uncorrected near and intermediate visual acuities (UNVA and UIVA respectively).
Results: Electrophysiological CSF curve had an inverted U-shaped morphology in all groups, with a biphasic pattern in Group B. Group A showed a lower CSF than group B at 4 and 8 cpd, and a lower value than group C at 8 cpd. Psychophysical CSF in group A exhibited a lower value at 12 cpd than group B. Mean photopic and mesopic UNVA and UIVA were worse in monofocal group compared to the multifocal groups. Mesopic UNVA and UIVA were better in group B.
Conclusions: Electrophysiological CSF behaves differently depending on the types of multifocal or monofocal IOLs. This may be related to the visual acuity under certain conditions or to IOL characteristics. This objective method might be a potential new tool to investigate on MIOL differences and on subjective device-related quality of vision.
Background: With a large portion of older adults living longer, the number of individuals diagnosed with low vision is increasing. The use of optical coherence tomography/scanning laser ophthalmoscope (OCT/SLO) to diagnose retinal disease has become common place in the last 10 years, yet currently there are no OCT/SLO databases for pathological vision. Our aim is to develop a clinical database of individuals who have drusen (i.e., lipid deposits found under the retina), or have been diagnosed with age-related macular degeneration (AMD), with information as to how the structure of the diseased retina changes over time, as well as measures of visual and cognitive functional performance.
Methods: Fundus photographs and retinal scans will be taken using the same model of optos OCT/SLO located in three test sites (MAB-Mackay Rehabilitation Centre, School of Optometry Clinic at the University of Montreal, and the Lighthouse Institute, New York, USA). For each individual entry in the database, demographic and diagnosis information will be available. All OCT/SLO images will be graded according to the Age-related Eye Disease Study standard, in addition to number and size of drusen, severity of geographic atrophy, severity of pigment mottling and presence of choroidal neovascularization. Retinal topography and Raster scans from the OCT/SLO will provide a cross-sectional look at affected retinas. Fixation stability will be recorded using the SLO function, and present four different tasks that are designed to reproduce typical tasks of daily vision, with each task lasting for 10 seconds. The tasks are cross fixation, face recognition, visual search, and reading. These tasks in addition to the retinal scans will be used to determine the eccentricity of a preferred retinal locus from the anatomical fovea, and can be used as an outcome measure for clinical interventions in visually impaired patients.
Results: The database will be available to professors training eye-care practitioners and rehabilitation specialists as a teaching tool. Students will be able to familiarize themselves with the retina and a variety of AMD-related pathologies before they start working with patients. The database will also be accessible by researchers interested in studying AMD from basic science to epidemiology, to investigate how drusen and AMD impact visual and cognitive functional performance.
Conclusions: The common infrastructure is easily accessible to all VHRN members on request. The database will also be accessible online in 2018 (see http://cvl.concordia.ca for more information).
Background: With the arrival of a new standardized tool and considering the multiple disadvantages of the actual method used for assesses lighting needs, the goal of the study was to compare the actual lighting assessment method used by the clinicians working in a rehabilitation center with the use of the LuxIQTM. As reading is found to be the main difficulty mentioned by the majority of the clients at the rehabilitation centre and that past studies have shown the impact of lighting on improving reading speed and deceasing print size, the hypothesis stated that the use of the standardized tool would be statistically significantly superior than the use of the standard method on the variables on reading speed, print size, ocular fatigue, application of the recommendations and satisfaction of the length of time read.
Methods: Three clinicians proceeded to home lighting assessments for 28 participants aged from 19 to 100 years (mean =75, SD =27) old diagnosed with age-related macular degeneration or glaucoma. The study evaluated and compared pre and post results between the two methods.
Results: The intervention did not have a statistically significant impact on any of the variables mentioned. The lighting assessment itself, with either the standard method or using the LuxIQ, statistically significantly decreased print size for reading (P<0.001, ω2 =0.47).
Conclusions: Lighting has a significant impact on reading print size. Participants value the assessment but encounter various obstacles that prevent them from applying the lighting recommendations. Considering the positive impact of lighting, finding a solution so participants may profit from the benefits of this intervention is crucial.
