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JAMA Network Open Jul 2021Associations between visual and global cognitive impairments have been previously documented, but there is limited research examining these associations between multiple...
IMPORTANCE
Associations between visual and global cognitive impairments have been previously documented, but there is limited research examining these associations between multiple measures of vision across cognitive domains.
OBJECTIVE
To examine the association between vision and cognitive across multiple cognitive domains using multiple measures of vision.
DESIGN, SETTING, AND PARTICIPANTS
This longitudinal cohort study used data from the Baltimore Longitudinal Study of Aging for 2003 to 2019. Participants in the current study were aged 60 to 94 years with vision and cognitive measures. Data analysis was performed from May 2020 to May 2021.
MAIN OUTCOMES AND MEASURES
Cognitive function was measured across multiple domains, including language, memory, attention, executive function, and visuospatial ability. Cognitive domain scores were calculated as the mean of standardized cognitive test scores within each domain. Visual function was assessed using measures of visual acuity, contrast sensitivity, and stereo acuity at baseline.
RESULTS
Analyses included 1202 participants (610 women [50.8%]; 853 White participants [71.0%]) with a mean (SD) age of 71.1 (8.6) years who were followed up for a mean (SD) of 6.9 (4.7) years. Worse visual acuity (per 0.1 logarithm of the minimal angle of resolution) at baseline was associated with greater declines in language (β, -0.0035; 95% CI, -0.007 to -0.001) and memory (β, -0.0052; 95% CI, -0.010 to -0.001) domain scores. Worse contrast sensitivity (per 0.1 log units) at baseline was associated with greater declines in language (β, -0.010; 95% CI, -0.014 to -0.006), memory (β, -0.009; 95% CI, -0.015 to -0.003), attention (β, -0.010; 95% CI, -0.017 to -0.003), and visuospatial ability (β, -0.010; 95% CI, -0.017 to -0.002) domain scores. Over the follow-up period, declines on tests of language (β, -0.019; 95% CI, -0.034 to -0.005) and memory (β, -0.032; 95% CI, -0.051 to -0.012) were significantly greater for participants with impaired stereo acuity compared with those without such impairment.
CONCLUSIONS AND RELEVANCE
These findings suggest that the association between vision and cognition differs between visual acuity, contrast sensitivity, and stereo acuity and that patterns of cognitive decline may differ by type of vision impairment, with impaired contrast sensitivity being associated with declines across more cognitive domains than other measures of visual functioning.
Topics: Aged; Aged, 80 and over; Attention; Cognitive Aging; Cognitive Dysfunction; Contrast Sensitivity; Executive Function; Female; Geriatric Assessment; Humans; Language; Longitudinal Studies; Male; Memory; Middle Aged; Spatial Processing; Vision Disorders; Visual Acuity
PubMed: 34269806
DOI: 10.1001/jamanetworkopen.2021.17416 -
Ophthalmologica. Journal International... 2021Endpoint development trials are underway across the spectrum of retinal disease. New validated endpoints are urgently required for the assessment of emerging gene... (Review)
Review
Endpoint development trials are underway across the spectrum of retinal disease. New validated endpoints are urgently required for the assessment of emerging gene therapies and in preparation for the arrival of novel therapeutics targeting the early stages of common sight-threatening conditions such as age-related macular degeneration and diabetic macular oedema. Visual function measures are likely to be key candidates in this search. Over the last 2 decades, microperimetry has been used extensively to characterise functional vision in a wide range of retinal conditions, often detecting subtle defects in retinal sensitivity that precede visual acuity loss and tracking disease progression over relatively short periods of time. Given these appealing features, microperimetry has already been adopted as an endpoint in interventional studies, including multicentre trials, on a modest scale. A review of its use to date shows a concurrent lack of consensus in test strategy and a wealth of innovative disease and treatment-specific metrics which may show promise as clinical trial endpoints. There are practical considerations to consider for its use, but these have not held back its popularity and it remains a widely used psychophysical test in research. Endpoint development trials will undoubtedly be key in understanding the validity of microperimetry as a clinical trial endpoint, but existing signs are promising.
Topics: Humans; Macular Degeneration; Retinal Diseases; Visual Acuity; Visual Field Tests; Visual Fields
PubMed: 33567434
DOI: 10.1159/000515148 -
Journal of Neuro-ophthalmology : the... Mar 2022Visual tests in Alzheimer disease (AD) have been examined over the last several decades to identify a sensitive and noninvasive marker of the disease. Rapid automatized...
BACKGROUND
Visual tests in Alzheimer disease (AD) have been examined over the last several decades to identify a sensitive and noninvasive marker of the disease. Rapid automatized naming (RAN) tasks have shown promise for detecting prodromal AD or mild cognitive impairment (MCI). The purpose of this investigation was to determine the capacity for new rapid image and number naming tests and other measures of visual pathway structure and function to distinguish individuals with MCI due to AD from those with normal aging and cognition. The relation of these tests to vision-specific quality of life scores was also examined in this pilot study.
METHODS
Participants with MCI due to AD and controls from well-characterized NYU research and clinical cohorts performed high and low-contrast letter acuity (LCLA) testing, as well as RAN using the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number test, and vision-specific quality of life scales, including the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement. Individuals also underwent optical coherence tomography scans to assess peripapillary retinal nerve fiber layer and ganglion cell/inner plexiform layer thicknesses. Hippocampal atrophy on brain MRI was also determined from the participants' Alzheimer disease research center or clinical data.
RESULTS
Participants with MCI (n = 14) had worse binocular LCLA at 1.25% contrast compared with controls (P = 0.009) and longer (worse) MULES test times (P = 0.006) with more errors in naming images (P = 0.009) compared with controls (n = 16). These were the only significantly different visual tests between groups. MULES test times (area under the receiver operating characteristic curve [AUC] = 0.79), MULES errors (AUC = 0.78), and binocular 1.25% LCLA (AUC = 0.78) showed good diagnostic accuracy for distinguishing MCI from controls. A combination of the MULES score and 1.25% LCLA demonstrated the greatest capacity to distinguish (AUC = 0.87). These visual measures were better predictors of MCI vs control status than the presence of hippocampal atrophy on brain MRI in this cohort. A greater number of MULES test errors (rs = -0.50, P = 0.005) and worse 1.25% LCLA scores (rs = 0.39, P = 0.03) were associated with lower (worse) NEI-VFQ-25 scores.
CONCLUSIONS
Rapid image naming (MULES) and LCLA are able to distinguish MCI due to AD from normal aging and reflect vision-specific quality of life. Larger studies will determine how these easily administered tests may identify patients at risk for AD and serve as measures in disease-modifying therapy clinical trials.
Topics: Alzheimer Disease; Atrophy; Humans; Pilot Projects; Quality of Life; Vision Tests
PubMed: 34029274
DOI: 10.1097/WNO.0000000000001228 -
Journal of the International... Jan 2023Emerging evidence suggests low vision may be a modifiable risk factor for cognitive decline. We examined effects of baseline visual acuity (VA) on level of, and change...
OBJECTIVE
Emerging evidence suggests low vision may be a modifiable risk factor for cognitive decline. We examined effects of baseline visual acuity (VA) on level of, and change in, cognitive test performance over 9 years.
METHOD
A population-based sample of 1,621 participants (average age 77 years) completed a comprehensive neuropsychological evaluation and VA testing at baseline and reassessed at nine subsequent annual visits. Linear regression modeled the association between baseline VA and concurrent cognitive test performance. Joint modeling of a longitudinal sub-model and a survival sub-model to adjust for attrition were used to examine associations between baseline VA and repeated cognitive test performance over time.
RESULTS
Better baseline VA was associated cross-sectionally with younger age, male sex, greater than high school education, and higher baseline neuropsychological test scores on both vision-dependent (B coefficient range -0.163 to -0.375, = .006 to <.001) and vision-independent tests (-0.187 to -0.215, = .003 to .002). In longitudinal modeling, better baseline VA was associated with slower decline in vision-dependent tests (B coefficient range -0.092 to 0.111, = .005 to <.001) and vision-independent tests (-0.107 to 0.067, = .007 to <.001).
CONCLUSIONS
Higher VA is associated with higher concurrent cognitive abilities and slower rates of decline over 9 years in both vision-dependent and vision-independent tests of memory, language, and executive functioning. Findings are consistent with emerging literature supporting vision impairment in aging as a potentially modifiable risk factor for cognitive decline. Clinicians should encourage patient utilization of vision assessment and correction with the added aim of protecting cognition.
Topics: Humans; Male; Aged; Longitudinal Studies; Cognitive Dysfunction; Cognition; Aging; Neuropsychological Tests; Visual Acuity
PubMed: 36630994
DOI: 10.1017/S1355617721001363 -
Nutrients Sep 2021Twilight and low luminance levels are visually challenging environments for the elderly, especially when driving at night. Carotenoid rich diets are known to increase... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
Twilight and low luminance levels are visually challenging environments for the elderly, especially when driving at night. Carotenoid rich diets are known to increase macular pigment optical density (MPOD), which in turn leads to an improvement in visual function. It is not known whether augmenting MPOD can lead to a decrease in vision related night driving difficulties. Additionally, it is unknown if carotenoid supplementation provides additional measurable benefits to one's useful field of view (UFOV) along with a decreased composite crash risk score. The aim of the study was to evaluate changes in night vision function and UFOV in individuals that took carotenoid vitamin supplements for a six-month period compared to a placebo group.
METHODS
A prospective, randomized, double-blind, six-month trial of a 14 mg zeaxanthin/7 mg lutein-based supplement was carried out. Participants were randomized into active or placebo group (approx 2:1).
RESULTS
= 33 participants (26 males/7 females) participated with 93% capsule intake compliance in the supplemented group ( = 24) and placebo group ( = 9). MPOD (mean/standard error SE) in the active group increased in the Right eye from 0.35 density units (du)/0.04 SE to 0.41 du/0.05 SE; < 0.001 and in the Left eye from 0.35 du/0.05 SE to 0.37 du, > 0.05). The supplemented group showed significant improvements in contrast sensitivity with glare in both eyes with improvements in LogMAR scores of 0.147 and 0.149, respectively ( = 0.02 and 0.01, respectively), monocularly tested glare recovery time improved 2.76 and 2.54 s, respectively, ( = 0.008 and = 0.02), and we also noted a decreased preferred luminance required to complete visual tasks ( = 0.02 and 0.03). Improvements in UFOV scores of divided attention ( < 0.001) and improved composite crash risk score ( = 0.004) were seen in the supplemented group. The placebo group remained unchanged.
CONCLUSIONS
The NVC demonstrates that augmenting MPOD in individuals with difficulty in night vision showed measurable benefits in numerous visual functions that are important for night vision driving in this small sample RCT. Additionally, we observed an improvement in UFOV divided attention test scores and decreased composite risk scores.
Topics: Accidents, Traffic; Aged; Automobile Driving; Dietary Supplements; Double-Blind Method; Female; Humans; Lutein; Macula Lutea; Macular Degeneration; Macular Pigment; Male; Middle Aged; Night Vision; Prospective Studies; Vision, Ocular; Visual Acuity; Visual Field Tests; Zeaxanthins
PubMed: 34579067
DOI: 10.3390/nu13093191 -
Acta Ophthalmologica Nov 2020To evaluate the colour vision severity classification standard 'CIE 143:2001 International recommendations for colour vision requirements in transport' (CIE 143:2001),... (Comparative Study)
Comparative Study
PURPOSE
To evaluate the colour vision severity classification standard 'CIE 143:2001 International recommendations for colour vision requirements in transport' (CIE 143:2001), which has become out of date because of the lack of commercial availability of required colour vision tests.
METHODS
One-hundred-five subjects had colour vision tested and colour vision severity classified according to a modified CIE 143:2001 algorithm that included pseudoisochromatic plates (Ishihara's test and Hardy Rand Rittler (HRR) 4th edition), Optec 900 lantern and Farnsworth D-15. Subject's results and colour vision severity classification were compared to performance and colour vision severity classification on the computerized 'Colour Assessment and Diagnosis' (CAD) test.
RESULTS
According to CIE 143:2001, using Ishihara's test, Optec lantern and Farnsworth D 15, 11 subjects (10%) were category I (normal), 16 (15%) were category II (mild), 48 (46%) were category III (poor), and 30 (29%) were category IV (severe). Classified by CAD score, 10 (10%) were category I, 11 (10%) were category II, 41 (39%) were category III, and 43 (41%) were category IV. The correlation between the two estimates of the severity of colour vision loss (i.e. CIE 143:2001 and CAD) was high, with a Kendall's Tau test of 0.81 (τ = 0.81 p < 0.001). A suggested CIE 143:2001 classification including new CAD score limits improves the classification correlation to 0.90 (τ = 0.90 p < 0.001) for all diagnoses.
CONCLUSION
The colour vision severity classification standard 'CIE 143:2001 International recommendations for colour vision requirements in transport', has not implemented new diagnostic tools with better accuracy. We propose three possible revisions to the CIE 143:2001 algorithm, based on the availability of CAD: (1) Replacing the current CIE 143:2001 algorithm using new CAD threshold limits, (2) Use of CAD as a secondary test to Ishihara's test and HRR or (3) Revising the current CIE 143:2001 algorithm using Ishihara's test, HRR, Optec 900 and FD15.
Topics: Adolescent; Adult; Aged; Algorithms; Color Perception Tests; Color Vision; Color Vision Defects; Female; Humans; Male; Middle Aged; Transportation; Young Adult
PubMed: 32385912
DOI: 10.1111/aos.14450 -
Ophthalmic & Physiological Optics : the... Jul 2022To simulate both lens-induced and screen-induced aniseikonia, and to assess its influence on stereopsis. Additionally, to determine if screen-based size differences...
PURPOSE
To simulate both lens-induced and screen-induced aniseikonia, and to assess its influence on stereopsis. Additionally, to determine if screen-based size differences could neutralise the effects of lens-induced aniseikonia.
METHOD
A four-circle (4-C) paradigm was developed, where one circle appears in front or behind the others because of crossed or uncrossed disparity. This stereotest was used for three investigations: (1) Comparison with the McGill modified random dot stereogram (RDS), with anisometropia introduced with +2 D spheres and cylinders, and with aniseikonia introduced with 6% overall and 6% meridional (×180, ×90) magnifiers before the right eye; (2) Comparison of lens-induced and screen-induced 6% overall and meridional magnifications and (3) Determining if lens and screen effects neutralised, by opposing 6% lens-induced magnification to the right eye with screen-inducements of either 6% left eye magnification or 6% right eye minification. A pilot study of the effect of masking versus not masking the surround was also conducted.
RESULTS
The 4-C test gave higher stereo-thresholds than the RDS test by 0.5 ± 0.2 log units across both anisometropic and aniseikonic conditions. However, variations in power, meridian and magnification affected the two tests similarly. The pilot study indicated that surround masking improved neutralisation of screen and lens effects. With masking, lens-induced and screen-induced magnifications increased stereo-thresholds similarly. With lens and screen effects opposed, for most participants stereo-thresholds returned to baseline for overall and ×180 magnifications, but not for ×90 magnification. Only three of seven participants showed good compensation for ×90 magnification.
CONCLUSIONS
Effects of lens-induced aniseikonia on stereopsis cannot always be successfully simulated with a screen-based method. The ability to neutralise refractive aniseikonia using a computer-based method, which is the basis of digital clinical measurement, was reasonably successful for overall and ×180 meridional aniseikonia, but not very successful for ×90 aniseikonia.
Topics: Aniseikonia; Depth Perception; Eyeglasses; Humans; Pilot Projects; Refraction, Ocular
PubMed: 35253250
DOI: 10.1111/opo.12973 -
Scientific Reports Mar 2021Corneal inlays (CIs) are the most recent surgical procedure for the treatment of presbyopia in patients who want complete independence from the use of glasses or contact...
Corneal inlays (CIs) are the most recent surgical procedure for the treatment of presbyopia in patients who want complete independence from the use of glasses or contact lenses. Although refractive surgery in presbyopic patients is mostly performed in combination with cataract surgery, when the implantation of an intraocular lens is not necessary, the option of CIs has the advantage of being minimally invasive. Current designs of CIs are, either: small aperture devices, or refractive devices, however, both methods do not have good performance simultaneously at intermediate and near distances in eyes that are unable to accommodate. In the present study, we propose the first design of a trifocal CI, allowing good vision, at the same time, at far, intermediate and near vision in presbyopic eyes. We first demonstrate the good performance of the new inlay in comparison with a commercially available CI by using optical design software. We next confirm experimentally the image forming capabilities of our proposal employing an adaptive optics based optical simulator. This new design also has a number of parameters that can be varied to make personalized trifocal CI, opening up a new avenue for the treatment of presbyopia.
Topics: Cornea; Humans; Presbyopia; Refractive Surgical Procedures; Treatment Outcome; Vision Tests; Visual Acuity
PubMed: 33758219
DOI: 10.1038/s41598-021-86005-8 -
Acta Ophthalmologica Sep 2020To describe long-term objective and subjective visual outcomes in a group of Danish children after cataract surgery.
PURPOSE
To describe long-term objective and subjective visual outcomes in a group of Danish children after cataract surgery.
METHODS
Follow-up examination of 56 children aged 7-18 years who had undergone uni- or bilateral cataract surgery. Subjective visual function was assessed using the Cardiff Visual Ability Questionnaire for Children (CVAQC) and compared to objective visual acuity for distance and near, contrast vision and stereopsis.
RESULTS
Better visual acuity on the better seeing and contrast vision on worst seeing eye were significant predictors of increased subjective visual function in a multivariate analysis, p = 0.024. Children in the unilateral group had a significantly better CVAQC ratio compared to children in the bilateral group, median of 0.88 (range 0.50-1.00) versus 0.80 (range 0.55-0.98), p = 0.027. Reading small print, playing ball games and seeing friends in the playground were the most difficult CVAQC items in the unilateral group and reading small print, seeing the board in the classroom and seeing friends in the playground were the most difficult in the bilateral group.
CONCLUSION
Children with unilateral disease often have a healthy eye to support the operated eye, why they overall have better subjective visual function. Many of the most difficult visual tasks were related to academic activities which might hamper future academical capabilities.
Topics: Adolescent; Case-Control Studies; Cataract Extraction; Child; Denmark; Female; Follow-Up Studies; Humans; Male; Surveys and Questionnaires; Vision Tests; Visual Acuity
PubMed: 32180359
DOI: 10.1111/aos.14403 -
European Review For Medical and... Jun 2023This study aimed to evaluate the diagnostic accuracy of the intelligent flipper (IFLIP) system in identifying binocular vision anomalies.
OBJECTIVE
This study aimed to evaluate the diagnostic accuracy of the intelligent flipper (IFLIP) system in identifying binocular vision anomalies.
PATIENTS AND METHODS
This study comprised 70 participants aged 18 to 22. Participants underwent comprehensive eye assessments, including measurement of visual acuity, refraction, far and near cover test, stereopsis, and worth four dot test. The manual accommodation amplitude and facility, as well as the IFLIP system test, were also evaluated. The correlation between the indices of the IFLIP and manual accommodation tests was analyzed using multiple regression models, and the diagnostic ability of the IFLIP was characterized using Receiver Operating Curve (ROC) analysis. The significance level was 0.05.
RESULTS
The mean age of the 70 participants was 20.03±0.78 years. The mean manual and IFLIP accommodation facilities were 12.00±3.70 cycle per minute (CPM) and 10.01±2.77 CPM, respectively. No correlation was found between the indices of the IFLIP system and manual accommodative amplitude. However, the regression model showed that the contraction/relaxation ratio of the IFLIP system was positively correlated to the manual accommodation facility, and the average contraction time was negatively correlated with the manual accommodation facility. The ROC analysis proposed a cut-off of 10.15 CPM monocularly for the IFLIP accommodation facility assessment.
CONCLUSIONS
This study indicated that the parameters obtained by the IFLIP system and the manual accommodation facility were comparable, and the IFLIP system had good sensitivity and specificity in the assessment of the accommodation facility, thus may serve as a promising tool for screening and diagnosis of binocular visual function anomalies in clinical and community settings.
Topics: Humans; Young Adult; Adult; Vision, Binocular; Vision Tests; Visual Acuity; Accommodation, Ocular; Sensitivity and Specificity
PubMed: 37401300
DOI: 10.26355/eurrev_202306_32802