Comparative study of stereopsis with three different tests: TNO®, Stereo Acuity Test Fly® and StereoTAB® in students in higher school

Purpose: Stereopsis is the perception of depth based on retinal disparity. Global stereopsis depends on the process of random dot stimuli and local stereopsis depends on contour perception. The aim of this study was to correlate 3 stereopsis tests: TNO®, StereoTA B®, and Fly Stereo Acuity Test® and to study the sensitivity and correlation between them, using TNO® as the gold standard. Other variables as near convergence point, vergences, symptoms and optical correction were correlated with the 3 tests. Materials and Methods: Forty-nine students from Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), aged 18-26 years old were included. Results: The stereopsis mean (standard-deviation-SD) values in each test were: TNO® = 87.04” ±84.09”; FlyTest® = 38.18” ±34.59”; StereoTA B® = 124.89’’ ±137.38’’. About the coefficient of determination: TNO® and StereoTA B® with R2 = 0.6 e TNO® and FlyTest® with R2 =0.2. Pearson correlation coefficient shows a positive correlation between TNO® and StereoTA B® (r = 0.784 with α = 0.01). Phi coefficient shows a strong and positive association between TNO® and StereoTA B® (Φ = 0.848 with α = 0.01). In the ROC Curve, the StereoTA B® has an area under the curve bigger than the FlyTest® with a sensivity of 92.3% for 94.4% of specificity, so it means that the test is sensitive with a good discriminative power. Conclusion: We conclude that the use of Stereopsis tests to study global Stereopsis are an asset for clinical use. This type of test is more sensitive, revealing changes in Stereopsis when it is actually changed, unlike the test Stereopsis, which often indicates normal Stereopsis, camouflaging a Stereopsis change. We noted also that the StereoTA B ® is very sensitive and despite being a digital application, possessed good correlation with the TNO®.

Estudo comparativo da estereopsia com três testes diferentes: TNO®, Fly Stereo Acuity Test® e StereoTAB® em estudantes do ensino superior

Estereopsia define-se como a perceção de profundidade baseada na disparidade retiniana. A estereopsia global depende do processamento de estímulos de pontos aleatórios e a estereopsia local depende da perceção de contornos. O objetivo deste estudo é correlacionar três testes de estereopsia: TNO®, StereoTAB® e Fly Stereo Acuity Test® e verificar a sensibilidade e correlação entre eles, tendo o TNO® como gold standard. Incluíram-se 49 estudantes da Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL) entre os 18 e 26 anos. As variáveis ponto próximo de convergência (ppc), vergências, sintomatologia e correção ótica foram correlacionadas com os três testes. Os valores médios (desvios-padrão) de estereopsia foram: TNO® = 87,04’’ ±84,09’’; FlyTest® = 38,18’’ ±34,59’’; StereoTAB® = 124,89’’ ±137,38’’. Coeficiente de determinação: TNO® e StereoTAB® com R2=0,6 e TNO® e FlyTest® com R2=0,2. O coeficiente de correlação de Pearson mostra uma correlação positiva de entre o TNO® e o StereoTAB® (r=0,784 com α=0,01). O coeficiente de associação de Phi mostrou uma relação positiva forte entre o TNO® e StereoTAB® (Φ=0,848 com α=0,01). Na curva ROC, o StereoTAB® possui uma área sob a curva maior que o FlyTest®, apresentando valor de sensibilidade de 92,3% para uma especificidade de 94,4%, tornando-o num teste sensível e com bom poder discriminativo.

Comparative study of the Gaze Stabilization Test (GST) and the Dynamic Visual Acuity Test (DVAT) for detecting patients with unilateral vestibular dysfunction

This paper compares the use of two diagnostic tests, Gaze Stabilization Test (GST) and the Dynamic Visual Acuity Test (DVAT) to detect unilateral vestibular dysfunction.

Distance doubling visual acuity test: a reliable test for nonorganic visual loss

BACKGROUND: To determine the value of the distance doubling visual acuity test in the diagnosis of nonorganic visual loss in a comparative observational case series. METHODS: Twenty-one consecutive patients with nonorganic visual acuity loss and 21 subjects with organic visual loss as controls were included. Best corrected visual acuity was tested at the normal distance of 5 meters using Landolt Cs. The patient was then repositioned and best corrected visual acuity was tested with the previous optotypes at double the distance via a mirror. RESULTS: Nonorganic visual acuity loss was identified in 21 of 21 patients. Sensitivity and specificity of distance-doubling visual acuity test in functional visual loss were found to be 100% (CI; 83%-100%) and 100% (CI; 82%-100%), respectively. CONCLUSION: Distance doubling visual acuity test is widely used to detect nonorganic visual loss. Our results show that this test has a high specificity and sensitivity to detect nonorganic visual impairment.

Multi-system neurological disease is common in patients with OPA1 mutations

Additional neurological features have recently been described in seven families transmitting pathogenic mutations in OPA1, the most common cause of autosomal dominant optic atrophy. However, the frequency of these syndromal `dominant optic atrophy plus` variants and the extent of neurological involvement have not been established. In this large multi-centre study of 104 patients from 45 independent families, including 60 new cases, we show that extra-ocular neurological complications are common in OPA1 disease, and affect up to 20% of all mutational carriers. Bilateral sensorineural deafness beginning in late childhood and early adulthood was a prominent manifestation, followed by a combination of ataxia, myopathy, peripheral neuropathy and progressive external ophthalmoplegia from the third decade of life onwards. We also identified novel clinical presentations with spastic paraparesis mimicking hereditary spastic paraplegia, and a multiple sclerosis-like illness. In contrast to initial reports, multi-system neurological disease was associated with all mutational subtypes, although there was an increased risk with missense mutations [odds ratio = 3.06, 95% confidence interval = 1.44-6.49; P = 0.0027], and mutations located within the guanosine triphosphate-ase region (odds ratio = 2.29, 95% confidence interval = 1.08-4.82; P = 0.0271). Histochemical and molecular characterization of skeletal muscle biopsies revealed the presence of cytochrome c oxidase-deficient fibres and multiple mitochondrial DNA deletions in the majority of patients harbouring OPA1 mutations, even in those with isolated optic nerve involvement. However, the cytochrome c oxidase-deficient load was over four times higher in the dominant optic atrophy + group compared to the pure optic neuropathy group, implicating a causal role for these secondary mitochondrial DNA defects in disease pathophysiology. Individuals with dominant optic atrophy plus phenotypes also had significantly worse visual outcomes, and careful surveillance is therefore mandatory to optimize the detection and management of neurological disability in a group of patients who already have significant visual impairment.

Expert opinion on best practice guidelines and competency framework for visual screening in children

PURPOSE: Screening programs to detect visual abnormalities in children vary among countries. The aim of this study is to describe experts' perception of best practice guidelines and competency framework for visual screening in children. METHODS: A qualitative focus group technique was applied during the Portuguese national orthoptic congress to obtain the perception of an expert panel of 5 orthoptists and 2 ophthalmologists with experience in visual screening for children (mean age 53.43 years, SD ± 9.40). The panel received in advance a script with the description of three tuning competencies dimensions (instrumental, systemic, and interpersonal) for visual screening. The session was recorded in video and audio. Qualitative data were analyzed using a categorical technique. RESULTS: According to experts' views, six tests (35.29%) have to be included in a visual screening: distance visual acuity test, cover test, bi-prism or 4/6(Δ) prism, fusion, ocular movements, and refraction. Screening should be performed according to the child age before and after 3 years of age (17.65%). The expert panel highlighted the influence of the professional experience in the application of a screening protocol (23.53%). They also showed concern about the false negatives control (23.53%). Instrumental competencies were the most cited (54.09%), followed by interpersonal (29.51%) and systemic (16.4%). CONCLUSIONS: Orthoptists should have professional experience before starting to apply a screening protocol. False negative results are a concern that has to be more thoroughly investigated. The proposed framework focuses on core competencies highlighted by the expert panel. Competencies programs could be important do develop better screening programs.

Comparação entre acuidade visual e photoscreening como métodos de triagem visual para crianças em idade escolar

OBJETIVO: Avaliar a sensibilidade do aparelho photoscreener na detecção de alterações oculares em crianças informantes, comparando os dados à acuidade visual obtida pela tabela E de Snellen. MÉTODOS: Foram avaliadas 500 crianças de idades entre 5 e 12 anos, de escola do município de Botucatu, estado de São Paulo. As crianças foram submetidas ao teste de acuidade visual pela tabela E de Snellen e foram fotografadas utilizando-se o aparelho photoscreenerTM system model MTI-PS100, seguindo-se a análise das fotos obtidas. RESULTADOS: Houve concordância negativa (criança com boa acuidade visual e teste negativo com o photoscreener) em 81,0%; concordância positiva (acuidade visual alterada e teste positivo) em 7,6% e não houve concordância de resultados em 11,0% dos casos. CONCLUSÃO: A avaliação comparativa entre o método da acuidade visual pela tabela E de Snellen e o photocreener para detecção de problemas visuais mostrou alta concordância. Os autores sugerem entretanto, a triagem usando tabelas de acuidade visual quando se trata de crianças informantes, devido aos custos com o aparelho.

Escala diagramática para quantificação da severidade de manchas em folhas de Eucalyptus globulus Labill. causadas por Teratosphaeria nubilosa (Cooke) Crous & U. Braun

The leaf spot (Mycosphaerella leaf disease = MLD) caused by Teratosphaeria nubilosa has caused damage in eucalypt plantations in southern and southeastern Brazil. The need to assess the disease in the field to evaluate of this damage, efficiency control, evaluation of germplasm induces to the necessity of having a visual scale for evaluation of disease. The objective was to develop a diagrammatic scale for young leaves and one for adult leaves of Eucalyptus globules for MLD. To do so, the leaves collected in the field were scanned for image analysis. The damaged area, the healthy leaf area and the external area of the same scale RGB (Red, Green, Blue) were determined. Subsequently, it was determinate the levels of severity depending on the sample distribution with seven levels for young leaves and six for adult leaves. For the visual acuity test and validate the scale, the leaves were evaluated for severity, with and without scale. With this proposed scales, the assessors showed good accuracy both for young and adult leaves with R2=0,98 and R2=0,80, respectively. The importance of the development of diagrammatic scales for assessing MLD in eucalyptus must to the fact that allows quantification of the symptoms accurately and precisely.

Effects of (un)predictable whole body vibrations on visual performance

Over recent years, it has repeatedly been shown that optimal gaze strategies enhance motor control (e.g., Foulsham, 2015). However, little is known, whether, vice versa, visual performance can be improved by optimized motor control. Consequently, in two studies, we investigated visual performance as a function of motor control strategies and task parameters, respectively. In Experiment 1, 72 participants were tested on visual acuity (Landolt) and contrast sensitivity (Grating), while standing in two different postures (upright vs. squat) on a ZEPTOR-platform that vibrated at four different frequencies (0, 4, 8, 12 Hz). After each test, perceived exertion (Borg) was assessed. Significant interactions were revealed for both tests, Landolt: F(3,213)=13.25, p<.01, ηp2=.16, Grating: F(3,213)=4.27, p<.01, ηp2=.06, elucidating a larger loss of acuity/contrast sensitivity with increasing frequencies for the upright compared with the squat posture. For perceived exertion, however, a diametrical interaction for frequency was found for acuity, F(3,213)=7.45, p<.01, ηp2=.09, and contrast sensitivity, F(3,213)=7.08, p < .01, ηp2=.09, substantiating that the impaired visual performance cannot be attributed to exertion. Consequently, the squat posture could permit better head and, hence, gaze stabilization. In Experiment 2, 64 participants performed the same tests while standing in a squat position on a ski-simulator, which vibrated with two different frequencies (2.4, 3.6 Hz) and amplitudes (50, 100 mm) in a predictable or unpredictable manner. Control strategies were identified by tracking segmental motion, which allows to derive damping characteristics. Considerable main effects were found for frequency, all F’s(1,52)>10.31, all p’s<.01, all ηp2’s>.16, as well as, in the acuity test, for predictability, F(1,52)=10.31, p<.01, ηp2=.17, and by tendency for amplitude, F(1,52)=3.53, p=.06, ηp2=.06. A significant correlation between the damping amplitude in the knee joint and the performance drop in visual acuity, r=-.97, p<.001, again points towards the importance of motor control strategies to maintain optimal visual performance.

Objective and psychophysical studies of infant visual development

Distortion or deprivation of vision during an early `critical' period of visual development can result in permanent visual impairment which indicates the need to identify and treat visually at-risk individuals early. A significant difficulty in this respect is that conventional, subjective methods of visual acuity determination are ineffective before approximately three years of age. In laboratory studies, infant visual function has been quantified precisely, using objective methods based on visual evoked potentials (VEP), preferential looking (PL) and optokinetic nystagmus (OKN) but clinical assessment of infant vision has presented a particular difficulty. An initial aim of this study was to evaluate the relative clinical merits of the three techniques. Clinical derivatives were devised, the OKN method proved unsuitable but the PL and VEP methods were evaluated in a pilot study. Most infants participating in the study had known ocular and/or neurological abnormalities but a few normals were included for comparison. The study suggested that the PL method was more clinically appropriate for the objective assessment of infant acuity. A study of normal visual development from birth to one year was subsequently conducted. Observations included cycloplegic refraction, ophthalmoscopy and preferential looking visual acuity assessment using horizontally and vertically oriented square wave gratings. The aims of the work were to investigate the efficiency and sensitivity of the technique and to study possible correlates of visual development. The success rate of the PL method varied with age; 87% of newborns and 98% of infants attending follow-up successfully completed at least one acuity test. Below two months monocular acuities were difficult to secure; infants were most testable around six months. The results produced were similar to published data using the acuity card procedure and slightly lower than, but comparable with acuity data derived using extended PL methods. Acuity development was not impaired in infants found to have retinal haemorrhages as newborns. A significant relationship was found between newborn binocular acuity and anisometropia but not with other refractive findings. No strong or consistent correlations between grating acuity and refraction were found for three, six or twelve months olds. Improvements in acuity and decreases in levels of hyperopia over the first week of life were suggestive of recovery from minor birth trauma. The refractive data was analysed separately to investigate the natural history of refraction in normal infants. Most newborns (80%) were hyperopic, significant astigmatism was found in 86% and significant anisometropia in 22%. No significant alteration in spherical equivalent refraction was noted between birth and three months, a significant reduction in hyperopia was evident by six months and this trend continued until one year. Observations on the astigmatic component of the refractive error revealed a rather erratic series of changes which would be worthy of further investigation since a repeat refraction study suggested difficulties in obtaining stable measurements in newborns. Astigmatism tended to decrease between birth and three months, increased significantly from three to six months and decreased significantly from six to twelve months. A constant decrease in the degree of anisometropia was evident throughout the first year. These findings have implications for the correction of infantile refractive error.

Efeito agudo do exercício físico associado a praxias ideomotoras sobre as concentrações séricas de cortisol e memória declarativa em indivíduos com idade entre 51 e 74 anos

Introduction: Several modifications are identified as aging, causing more or less limitation imposed by over the years. Among these, one can highlight the different degrees of cognitive decline, particularly memory that can involve the daily activities and the subject functionality. Studies have shown an association between levels of serum cortisol and stress imposed by the exercise on this. However, there are few studies that references the performance on cognitive aspects of declarative memory and cortisol on the exercise in the water with automatic and práxicos movements and moderate. Objective: Check the effect based on the acute physical exercise and práxicos automatic movements on the performance of visual declarative memory and in serum cortisol in subjects aged between 51 and 74 years. Materials and Methods: It builds a survey characterized as cross with a first sample of 32 physically active subjects aged between 51 and 74 years, divided into two exercise groups (March of Automatic Group - MAG and the March of Praxis Group - MPG). We used a probabilistic and random sampling for sample selection. Used the MMSE (Mini Mental State Examination) to check the general cognitive status, visual acuity test - optotypes chart "E" Rasquin and was even used the declarative visual memory test proposed by Nitrini and collaborators (1994), applying before motor stimulation and immediately after, and the day of blood collection with 2 ml for analysis of cortisol hormone. The normality and homogeneity were verified from the Shapiro-Wilk and Levene tests. Thus we adopted a descriptive statistics to characterize the sample. The Split-Plot ANOVA was used along with the paired t-test to verify the identified differences. We adopted a significance level of p <0.05. Results: It was observed that the groups (MAG and MPG) and the anthropometric variables, perceived exertion, education, cognitive assessment and visual acuity showed no significant differences (p > 0.05), showing that the groups are homogeneous, with variables and similar means. After the stimulation session, lasting 30 min, it was observed that the amount of hits for Δ of declarative memory questionnaire visual images increased, presenting significant for both groups (MAG, p < 0.001; MPG, p = 0.042). The same was observed for cortisol concentration with a reduction in the levels immediately after the stimulus (MAG and MPG, p < 0.001). Conclusion: The results showed that the exercises proposed in its acute effect provide significantly memories of gains and also showed a reduction in cortisol levels.

The Lea Grating Test In Assessing Detection Grating Acuity In Normal Infants Less Than 4 Months Of Age.

To assess binocular detection grating acuity using the LEA GRATINGS test to establish age-related norms in healthy infants during their first 3 months of life. In this prospective, longitudinal study of healthy infants with clear red reflex at birth, responses to gratings were measured at 1, 2, and 3 months of age using LEA gratings at a distance of 28 cm. The results were recorded as detection grating acuity values, which were arranged in frequency tables and converted to a one-octave scale for statistical analysis. For the repeated measurements, analysis of variance (ANOVA) was used to compare the detection grating acuity results between ages. A total of 133 infants were included. The binocular responses to gratings showed development toward higher mean values and spatial frequencies, ranging from 0.55 ± 0.70 cycles per degree (cpd), or 1.74 ± 0.21 logMAR, in month 1 to 3.11 ± 0.54 cpd, or 0.98 ± 0.16 logMAR, in month 3. Repeated ANOVA indicated differences among grating acuity values in the three age groups. The LEA GRATINGS test allowed assessment of detection grating acuity and its development in a cohort of healthy infants during their first 3 months of life.

Discrepancy between Visual Acuity and Microperimetry in AMD Patients: Visual Acuity Appears as an Inadequate Parameter to Test Macular Function.

BACKGROUND: Best corrected visual acuity (BCVA) of 0.8 or above in AMD patients can sometimes correspond to poor macular function inducing a serious visual handicap. Microperimetry can be used to objectivize this difference. PATIENTS AND METHODS: A retrospective study was undertaken on 233 files of AMD patients of whom 82 had had a microperimetry. BCVA was compared with microperimetry performance. All examinations were performed in an identical setting by the same team of 3 persons. RESULTS: Among the 82 patients included, 32 (39.0%) had a BCVA equal to or above 0.8 even though their microperimetry performance was lower than 200/560 db. 10 of them (12.2% of total) had an even poorer microperimetry below 120/560 db indicating poor macular function. CONCLUSIONS: More than a third of the AMD patients had a bad or very bad microperimetry performance in parallel with a good visual acuity. Microperimetry is a valuable tool to assess and follow real macular function in AMD patients when visual acuity alone can be misleading.

Effects of age and optical blur on real depth stereoacuity

Stereoscopic depth perception utilizes the disparity cues between the images that fall on the retinae of the two eyes. The purpose of this study was to determine what role aging and optical blur play in stereoscopic disparity sensitivity for real depth stimuli. Forty-six volunteers were tested ranging in age from 15 to 60 years. Crossed and uncrossed disparity thresholds were measured using white light under conditions of best optical correction. The uncrossed disparity thresholds were also measured with optical blur (from +1.0D to +5.0D added to the best correction). Stereothresholds were measured using the Frisby Stereo Test, which utilizes a four-alternative forced-choice staircase procedure. The threshold disparities measured for young adults were frequently lower than 10 arcsec, a value considerably lower than the clinical estimates commonly obtained using Random Dot Stereograms (20 arcsec) or Titmus Fly Test (40 arcsec) tests. Contrary to previous reports, disparity thresholds increased between the ages of 31 and 45 years. This finding should be taken into account in clinical evaluation of visual function of older patients. Optical blur degrades visual acuity and stereoacuity similarly under white-light conditions, indicating that both functions are affected proportionally by optical defocus.