Visual acuity best-corrected

The rationale for the court s opinion was that the diagnosis of cataract (a disease ) required dilation of the pupil and that had dilation been performed at the time of the optometrist s examination, the possibility of a retinal detachment could have been ruled out. In finding the optometrist liable, the court imposed a medical standard of care.Therefore a dilated fundus examination should be used whenever best-corrected visual acuity is reduced, and coexisting disease should be considered a possibihty until an examination determines otherwise. Optometrists may be held responsible for the diagnosis of intraocular tumors—even those as rare as malignant melanoma—in symptomatic patients. 

Cycloplegic refraction is also indicated for patients with active accommodative systems whose best corrected visual acuity in each eye is less than 20/20 and for whom there is no apparent reason for the decreased vision. It allows the clinician to determine whether uncorrected refractive error is responsible for the reduced acuity. This data may be particularly helpful in young patients with uncorrected antimetropia, latent hyperopia, or hyperopic anisometropia. 

Patients presenting with acute corneal hydrops typically are aware of the preexisting diagnosis of keratoconus. Symptoms of hydrops include a sudden decrease in best-corrected visual acuity, redness, and a foreign body sensation or pain in the involved eye. 

Superficial epithelial keratectomy with a variable-speed diamond burr or Amoils epithelial scrubber has also been shown to be safe and effective in treating larger erosion areas and areas that affect the visual axis. No significant difference was found in corneal haze, recurrence of erosions, or best-corrected visual acuity in patients treated with superficial epithelial keratectomy with diamond burr polishing and patients undergoing PTK. Both treatment options are safe and effective. However, treatment with a diamond burr is simpler and less expensive. 

Best corrected visual acuities Pupillary testing (rule out afferent papillary defect) Exophthalmometry (baseline readings)... 

Because tamoxifen retinopathy can occur at relatively low total doses of drug, it is important to obtain a baseline examination within the first year after therapy is begun. This should include best-corrected visual acuity, visual fields and Amsler grid evaluations, and fundus examination. It is important to monitor symptomatic... 

Figure 30.1. Causes of blindness (best-corrected visual acuity <6/60 [<20/200] in tlie better-seeing eye) by race/etlmicity. AMD indicates age-related maculai degeneration DR, diabetic retinopatliy. Reproduced witli permission from Congdon N, O Colmain B, Klaver CC, Klein R, Mmioz B, Friedman DS, Kempen J, Taylor HR, Mitchell P, Eye Diseases Prevalence Reseai ch Group (2004) Causes and prevalence of visual impairment among adults in tlie United States. Ai ch Ophtlialmol 122 477-485.

For CNV lesions recurring after standard laser therapy, foveal center must not have been included in area treated by laser Best-corrected visual acuity of 20/40 or worse >50yrs of age Exclusion criteria Tears of the RPE at screening... 

A multicenter, open-label, repeat-dose Phase IIA study of pegaptanib sodium (3.0 mg/eye) was performed in patients with subfoveal CNV secondary to AMD (72). The ophthalmic criteria included best-corrected visual acuity in the study eye worse than 20/100 on the ETDRS chart, best-corrected visual acuity in the fellow eye equal to or better than 20/400, subfoveal CNV with active CNV (either classic and/or occult) of less than 12 total disc areas in size secondary to AMD, clear ocular media and adequate pupillary dilation to permit good quality stereoscopic fundus photography, and IOP of 21 mmHg or less. A cohort scheduled to receive PDT with verteporfin prior to their first dose of pegaptanib sodium had to have equal to, or more than a 50% classic component (predominantly classic lesion). 

In view of successful animal experiments (20 see also Chapter 14), a sustained-release dexamethasone device was implanted in one eye of a patient with bilateral severe uveitis associated with multiple sclerosis (20,21). The patient had previously undergone pars plana lensectomy and vitrectomy in the right eye for decreased vision associated with cataract. Despite chronic topical corticosteroids, the patient had persistent bilateral low-grade inflammation and recurrent severe bilateral iridocyclitis. Best corrected visual acuity was 20/400 in both eyes. Systemic corticosteroids and methotrexate controlled the intraocular inflammation but the patient was intolerant of these medications because of systemic side effects. The nondegradable dexamethasone device was inserted into the patient s left eye. 

A 75-year-old woman developed bilateral ocular irritation, swollen eyelids, and reduced visual acuity after using dorzolamide 2% eye-drops tds for 2 days, in addition to long-term latanoprost - - timolol Her best-corrected visual acuity deteriorated from 6/9 right and left, to 6/12 and 6/18 respectively. The eyelids were erythematous and there was bilateral conjunctival injection. The anterior chambers were deep and the intraocular pressure was 22 mmHg in both eyes, with no intraocular inflammation. Fundoscopy showed extensive bilateral choroidal detachment. Dorzolamide was withdrawn and the problem resolved within 2 weeks. 

A 75-year-old woman developed progressively worse peripheral vision in both eyes after taking ethambutol 1200 mg/day for almost 1 year, plus clarithromycin and rifampicin for infection with Mycobacterium avium complex and Mycobacterium kansasii. Best corrected visual acuity was 20/80— in the right eye and 20/60-1-in the left eye. Eye movements were full. Slit lamp exam showed -1-1 nuclear sclerosis in both eyes. On fundoscopy the optic discs were not swollen or pale. A 30-2 Humphrey visual field showed bitemporal hemianopia. An MRI scan of the brain was normal, as was optical coherence tomography. 

Comparative studies Adverse reactions have been studied in 32 patients with exudative age-related macular degeneration who received standard fluence photodynamic therapy with verteporfin at baseline and months 3, 6, and 9 and ranibizumab 0.5 mg at baseline and months 1, 2, and 3 [5 ]. The main adverse reactions outcome measure was severe loss of vision (a loss of best-corrected visual acuity of at least 30 letters). There was no severe loss of vision due to ocular inflammation or uveitis. One patient had moderate loss of vision (of at least 15 letters). Three patients had mild/moderate uveitis. There were two serious ocular adverse events (a retinal pigment epithelial tear and a moderate reduction in best-corrected visual acuity). There were no systemic adverse events. 

Injected autologous fat was associated with worse final best-corrected visual acuity than the other materials. All patients with ophthalmic artery occlusion had ocular pain and no improvement in best-corrected visual acuity. Optical coherence tomography revealed thinner and less vascular choroids in eyes with ophthalmic artery occlusion than in adjacent normal eyes. Concomitant brain infarction developed in 2 cases each of central retinal artery occlusion and ophthalmic artery occlusion. Phthisis developed in 1 case of ophthalmic artery occlusion. 

Another study evaluates a 5-year PDT in patients with polypoidal choroidal vasculopathy (PCV). For this, 42 eyes of 36 patients with PCV were followed up for at least 60 months after PDT and reviewed afterwards. All eyes were primarily treated with PDT. The main outcome measure was best-corrected visual acuity at baseline and at each follow-up visit. The eyes were classified into three groups improved, decreased and stable [59 ]. 

Examinations included best-corrected visual acuity (BCVA) and high-definition optical coherence tomography of the macular area. Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes compared to gas eyes. Three of nine SiO eyes had final BCVA<6/60. No gas eyes had final BCVA <0.002. No other visually significant structmal differences were foxmd. The authors concluded that there was severe visual loss after SiO use in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation. 

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