Correlation between visual function and visual ability in patients with uveitis

Aim: To investigate the correlation between tests of visual function and perceived visual ability recorded with a quality of life questionnaire for patients with uveitis. Methods: 132 patients with various types of uveitis were studied. High (monocular and binocular) and low (binocular) contrast logMAR letter acuities were recorded using a Bailey-Lovie chart. Contrast sensitivity (binocular) was determined using a Pelli-Robson chart. Vision related quality of life was assessed using the Vision Specific Quality of Life (VQOL) questionnaire. Results: VQOL declined with reduced performance on the following tests: binocular high contrast visual acuity (p = 0.0011), high contrast visual acuity of the better eye (p = 0.0012), contrast sensitivity (p = 0.005), binocular low contrast visual acuity (p = 0.0065), and high contrast visual acuity of the worse eye (p = 0.015). Stepwise multiple regression analysis revealed binocular high contrast visual acuity (p <0.01) to be the only visual function adequate to predict VQOL. The age of the patient was also significantly associated with perceived visual ability (p <0.001). Conclusions: Binocular high contrast visual acuity is a good measure of how uveitis patients perform in real life situations. Vision quality of life is worst in younger patients with poor binocular visual acuity.

An overview of eye-related photophobias

This chapter provides an overview of the various eye-related causes of photophobia and the likely mechanisms responsible. Photophobia is the experience of discomfort affecting the eyes as a result of exposure to light. It has a variety of causes, including the result of eye or brain disease, or it can be a side effect of various drugs or laser surgery. Photophobia can also be a symptom of a more serious disorder such as meningitis and therefore, requires appropriate investigation, diagnosis, and treatment. Trauma or disease affecting several structures of the eye are a common cause of photophobia and can be associated with: (1) the ocular adnexia, such as blepharitis and blepharospasm, (2) the cornea, including abrasion, ulcerative keratitis, and corneal dystrophy, (3) problems in eye development, such as aniridia, buphthalmos, coloboma, and aphakia, (4) various eye inflammations, including uveitis, and (5) retinal disorders, such as achromatopsia, retinal detachment, and retinal dystrophy. There may be two main explanations for photophobia associated with these conditions: (1) direct stimulation of the trigeminal nerve due to damage, disease, or excessive light entering the eye and (2) overstimulation of the retina including a specific population of light-sensitive ganglion cells.

Reply: 'Myopic foveoschisis: An ectatic retinopathy, not a schisis'

Full text: We thank Tsilimbaris et al1 for their comments on the appropriateness of the term ‘myopic foveoschisis’ to describe the condition that is characterized by the separation of neural retina layers associated with high myopia and posterior staphyloma. They have proposed the term ‘myopic ectatic retinopathy’ as a more literal and functionally more accurate descriptor of the condition to avoid the use of the word ‘schisis’, which may be misleading because it is also used to describe other conditions where there is separation of neural retina layers without the presence of staphyloma.2 Using the word ‘ectatic’ for this condition would imply that we are fairly certain about the pathogenesis and mechanistic factors that underlie its development and progression. However, this is not the case, unfortunately, as our review of the literature has shown. There are several theories ranging from vitreous traction to sclerosing changes of retinal vessels to progression of staphylomas as possible etiological factors. Therefore, it is likely to be multifactorial in nature—hence the success reported with different procedures that address either the vitreous traction factor using vitrectomy, peel plus tamponade or the scleral ectasia factor using posterior buckling techniques. In the absence of a good understanding of underlying pathogenesis, it is probably best to use purely descriptive names rather than mechanistic terms. The use of descriptive terms, even though similar, do not necessarily cause confusion as long as they are widely accepted as differentiating terminology, for example, postoperative pseudophakic cystoid macular edema (Irvine–Gass syndrome) vs cystoid macular edema associated with posterior uveitis in a phakic patient. The introduction of too many mechanistic or pathogenetic terms in the absence of clear understating of etiology can in fact cause more confusion, for example, serous chorioretinopathy vs central serous retinopathy vs serous choroidopathy. The confinement to broad descriptive terms can enhance communication and reduce confusion without committing to any presumption about etiology until it is better understood. This approach is probably best illustrated by the recent advances in the understanding of mactel21, a condition initially described and classified, using descriptive nomenclature, by Don Gass as bilateral, idiopathic acquired juxtafoveolar telangiectasis (Group2A) and as distinctly different from unilateral, congenital parafoveolar telangiectasis (Group 1A; Gass,3 pp 504–506 vs 127–128). Finally, it is worthy to note that for myopic foveoschisis associated with a staphyloma that is associated with outer layer macular detachment, Don Gass also descriptively included the additional observation (before the advent of OCT) that the retinal profile was concave rather than convex in shape, thereby differentiating it from rhegmatogenous detachments with recruitment of subretinal fluid that is associated with posteriorly located breaks and macular holes in myopic eyes. References 1.Tsilimbaris MK, Vavvas DG, Bechrakis NE. Myopic foveoschisis: an ectatic retinopathy, not aschisis. Eye 2016; 30: 328–329. 2.Powner MB, Gillies MC, Tretiach M, Scott A, Guymer RH, Hageman GS et al. Perifoveal müller cell depletion in a case of macular telangiectasia type 2. Ophthalmology 2010; 117(12): 2407–2416. 3.Gass DM. Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, 4th edn. Mosby-Yearbook: St. Louis, 1997.

Eye-related photophobia

This article provides an overview of the various eye-related causes of photophobia and the likely mechanisms responsible. Photophobia is an experience of discomfort affecting the eyes due to exposure to light. It has a variety of causes including the result of eye or brain disease, or it can be a side effect of various drugs or laser surgery. Photophobia can also be a symptom of a more serious disorder such as meningitis and therefore, requires appropriate investigation, diagnosis, and treatment. Trauma or disease affecting several structures of the eye are a common cause of photophobia and can be associated with: (1) the ocular adnexia, such as blepharitis and blepharospasm, (2) the cornea, including abrasion, ulcerative keratitis, and corneal dystrophy, (3) problems in eye development, such as aniridia, buphthalmos, coloboma, and aphakia, (4) various eye inflammations, including uveitis, and (5) retinal disorders, such as achromatopsia, retinal detachment, and retinal dystrophy. There may be two main explanations for eye-related photophobia: (1) direct stimulation of the trigeminal nerve due to damage, disease, or excessive light entering the eye and (2) overstimulation of the retina including a specific population of light-sensitive ganglion cells.