Psychophysical Evaluation of Congenital Colour Vision Deficiency: Discrimination between Protans and Deutans Using Mollon-Reffin’s Ellipses and the Farnsworth-Munsell 100-Hue Test

We have used the Farnsworth-Munsell 100-hue (FM 100) test and Mollon-Reffin (MR) test to evaluate the colour vision of 93 subjects, 30.4 ± 9.7 years old, who had red-green congenital colour vision deficiencies. All subjects lived in Belém (State of Pará, Brazil) and were selected by the State of Pará Traffic Department. Selection criteria comprised the absence of visual dysfunctions other than Daltonism and no history of systemic diseases that could impair the visual system performance. Results from colour vision deficient were compared with those from 127 normal trichromats, 29.3 ± 10.3 years old. For the MR test, measurements were taken around five points of the CIE 1976 colour space, along 20 directions irradiating from each point, in order to determine with high-resolution the corresponding colour discrimination ellipses (MacAdam ellipses). Three parameters were used to compare results obtained from different subjects: diameter of circle with same ellipse area, ratio between ellipse’s long and short axes, and ellipse long axis angle. For the FM 100 test, the parameters were: logarithm of the total number of mistakes and positions of mistakes in the FM diagram. Data were also simultaneously analysed in two or three dimensions as well as by using multidimensional cluster analysis. For the MR test, Mollon-Reffin Ellipse #3 (u’ = 0.225, v’ = 0.415) discriminated more efficiently than the other four ellipses between protans and deutans once it provided larger angular difference in the colour space between protan and deutan confusion lines. The MR test was more sensitive than the FM 100 test. It separated individuals by dysfunctional groups with greater precision, provided a more sophisticated quantitative analysis, and its use is appropriate for a more refined evaluation of different phenotypes of red-green colour vision deficiencies.     

Frequencies of different types of colour vision defects in the Netherlands.

Two different population samples in Holland--one consisting of 1,093 boys from a technical school and the other of 493 male and 416 female students--were analysed for the presence of red-green colour vision defects. A total percentage of 7.3 for the male population was found. Based on the combined results of the Ishihara and HRR pseudoisochromatic plates, the Farnsworth 15-hue test and the anomaloscope, a subdivision of the deuteranomalous individuals into 3 subgroups is made. It is suggested that the differences between these groups may be genetic in nature and that the actual number of different genetic entities may still be greater.     

Use of visually evoked responses in evaluation of visual blurring in brain-damaged patients

Pattern visual evoked potentials were recorded in brain-damaged patients who complained of fluctuation of vision causing visual blurring. Continuous prolonged pattern stimulation revealed marked variability of P100 amplitudes. In contrast, normal subjects and brain-damaged patients who did not complain of visual blurring showed stable P100 amplitudes. Fluctuation of vision thus seems to have an electrophysiological correlate in terms of P100 amplitude lability, which can be objectively assessed by prolonged continuous recording of pattern visual evoked potentials.     

Comparison of different presbyopia treatments: refractive lens exchange with multifocal intraocular lens implantation versus LASIK monovision

There are several methods for presbyopia treatment. Refractive lens exchange (RLE) followed by multifocal intraocular lens (MFIOL) implantation enables high rate of spectacle independence but have some visual disturbances. Laser in Situ Keratomileusis (LASIK) monovision gives patient ability to have good distant vision with dominant eye and good near vision with nondominant eye. In this prospective randomized study we wanted to compare clinical outcomes in patients who underwent either of the mentioned procedures. The first group included 50 patients (N = 100 eyes) who underwent RLE with MFIOL implantation and the second group included 50 patients (N = 100 eyes) who underwent LASIK monovision as presbyopia treatment. Uncorrected distant, near and intermediate visual acuity, patient's subjective satisfaction and visual disturbances were measured. Follow up was 6 months. Patients in RLE group had better near uncorrected visual acuity (UCVA) and patients in LASIK monovision group had better distant and intermediate vision. Patients in RLE group reported visual disturbances (halo, glare). Patients satisfaction and spectacle independence was high in both groups. Refractive lens exchange with multifocal intraocular lens implantation and LASIK monovision are effective methods for presbyopia treatment. LASIK monovision with -0.50D - 1.25D of residual dioptry at nondominant eye in patients under 50 years enables good vision at all distances without affecting stereovision. Patient selection and preoperative counseling are key to success.     

Rapid stereology based quantitative immunohistochemistry of dendritic cells in lymph nodes: a methodological study.

This study was done to arrive at a fast and reliable protocol for assessment of fractional volumes of immunohistochemically stained dendritic cells in lymph nodes. Twenty axillary lymph nodes of patients with locally advanced breast cancer were immuno-histochemically stained with an S100 antibody. Fractional volumes of dendritic cells were assessed by stereology based quantitative immunohistochemistry using an interactive video overlay system including an automated microscope. The gold standard percentage of dendritic cells was the fractional volume of S100 stained cells in 500 fields systematically spread over the whole lymph node. Then, in a computer simulation, different sample sizes (1-200 fields of vision) were tested and the coefficient of variation (CV) for each sample size was calculated. The CV dropped with increasing sample size. A sample size of 100 fields of vision appeared to be optimal. Intra- and interobserver reproducibility appeared to be good (correlation coefficients of 0.95 and 0.86, respectively) when re-analyzing the cases with the established protocol.In conclusion, a fast and reliable assessment of the fractional volume of dendritic cells in lymph nodes is possible with semi-automated quantitative immuno-histochemistry. This method will form the base for further clinical studies into the immunological response in lymph nodes of patients with locally advanced breast cancer.     

Color vision defects in adrenomyeloneuropathy.

The relationship between abnormal color vision and adrenomyeloneuropathy (AMN) was investigated in 27 AMN patients and 31 age-matched controls by using the Farnsworth-Munsell 100 Hue test. Twelve (44%) of 27 patients showed test scores significantly above normal. The axes of bipolarity determined by the testing differed widely between the patients with abnormal scores, compatible with the notion that different alterations in visual pigment genes occur in different AMN kindreds. These observations confirm our earlier impression that the frequency of abnormal color vision is increased in these kindreds, and it supports our contentions that (1) AMN (and its companion, adrenoleukodystrophy) are very closely linked to the visual pigment loci at Xq28 and (2) this proximity might provide the opportunity to observe contiguous gene defects.     

A vitreoretinal service.

Many serious disorders that threaten eyesight can now be treated with vitreoretinal surgery. As there was no regional facility for this treatment a service was developed to provide it. Among the first 100 patients treated over half had diabetic vitreoretinal disease. The remainder had ocular trauma (15), non-diabetic vasculopathy (10), rhegmatogenous retinal detachment (10), and miscellaneous disorders including diagnostic procedures (14). Sight was improved in most cases, 27 diabetic and 21 non-diabetic patients regaining navigating vision. Few patients were made worse: one only of the 49 non-diabetic patients and 12 of the 51 diabetic patients, and none whose vision was better than the ability to count fingers before operation. The many indications for this procedure, the size of the population that could benefit (an estimated minimum of 3800 operations per year in the United Kingdom in patients with diabetes alone), and the great potential benefit of the procedure all suggest the need for regional services. These would be cost effective in preventing blindness.     

Mitochondrial oxidative phosphorylation compensation may preserve vision in patients with OPA1-linked autosomal dominant optic atrophy

Autosomal Dominant Optic Atrophy (ADOA) is the most common inherited optic atrophy where vision impairment results from specific loss of retinal ganglion cells of the optic nerve. Around 60% of ADOA cases are linked to mutations in the OPA1 gene. OPA1 is a fission-fusion protein involved in mitochondrial inner membrane remodelling. ADOA presents with marked variation in clinical phenotype and varying degrees of vision loss, even among siblings carrying identical mutations in OPA1. To determine whether the degree of vision loss is associated with the level of mitochondrial impairment, we examined mitochondrial function in lymphoblast cell lines obtained from six large Australian OPA1-linked ADOA pedigrees. Comparing patients with severe vision loss (visual acuity [VA]<6/36) and patients with relatively preserved vision (VA>6/9) a clear defect in mitochondrial ATP synthesis and reduced respiration rates were observed in patients with poor vision. In addition, oxidative phosphorylation (OXPHOS) enzymology in ADOA patients with normal vision revealed increased complex II+III activity and levels of complex IV protein. These data suggest that OPA1 deficiency impairs OXPHOS efficiency, but compensation through increases in the distal complexes of the respiratory chain may preserve mitochondrial ATP production in patients who maintain normal vision. Identification of genetic variants that enable this response may provide novel therapeutic insights into OXPHOS compensation for preventing vision loss in optic neuropathies.     

Vision Loss and Psychological Distress among Ethiopians Adults: A Comparative Cross-Sectional Study

Background

Vision loss causes major changes in lifestyle and habits that may result in psychological distress and further reduction in the quality of life. Little is known about the magnitude of psychological distress in patients with vision loss and its variation with the normal. The aim of this study is, therefore, to investigate the psychological effects of vision loss and its determinants among Ethiopians.

Methods

A comparative cross-sectional study was conducted on adults attending the Eye clinic of Jimma University Hospital. One hundred fifteen consecutive adults with visual loss at least in one eye and 115 age-and sex-matched controls with normal vision were studied. The psychological distress was measured using standardized Self-Reporting Questionnaire (SRQ-20). Chi-square test and logistic regression were carried out and associations were considered significant at P<0.05.

Results

The overall prevalence of psychological distress was 33.4%. While psychological distress was found in 49.8% of patients who had loss of vision at least in one eye, only 18.3% of the controls had it. In the adjusted analysis, patients with vision loss had 4.6 times higher risk of suffering from psychological distress compared to patients with normal vision (AOR 4.56; 95% CI 2.16-9.62). Moreover, patients with vision loss in both eyes (AOR 4.00; 95% CI 1.453-11.015) and with worse visual acuity in the better eye (AOR 3.66; 95% CI 1.27-10.54) were significantly more likely to have psychological distress than those patients with vision loss in one eye only and good visual acuity in the better eye respectively. The cause of visual loss, pattern of visual loss, duration of visual loss and sociodemographic variables did not influence the likelihood of having psychological distress.

Conclusion

Prevalence of psychological distress was significantly higher in patients with visual loss compared to patients with normal vision. There is a need for integration of psychosocial care into the current medical and surgical treatment of patients with vision loss.     

Visual Function Assessment in Simulated Real-Life Situations in HIV-Infected Subjects

Visual function abnormalities are common in people living with HIV disease (PLWH) without retinitis, even after improvement in immune status. Abnormalities such as reduced contrast sensitivity, altered color vision, peripheral visual field loss, and electrophysiological changes are related to a combination of retinal dysfunctions, involving inner and outer retinal structures. The standard protocol for testing vision performance in clinical practice is the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. However, this method poorly correlates with activities of daily living that require patients to assess visual stimuli in multiple light/contrast conditions, and with limited time. We utilized a novel interactive computer program (Central Vision Analyzer) to analyze vision performance in PLWH under a variety of light/contrast conditions that simulate stressful and real-world environments. The program tests vision in a time-dependent way that we believe better correlates with daily living activities than the non-timed ETDRS chart. We also aimed to correlate visual scores with retinal neuro-fiber layer thickness on optical coherence tomography. Here we show that visual acuity is more affected in PLWH in comparison to HIV-seronegative controls in varying contrast and luminance, especially if the nadir CD4+ T-cell count was lower than 100 cells/mm³. Visual impairment reflects the loss of retinal nerve fiber layer thickness especially of the temporal-inferior sector. In PLWH the ETDRS chart test led to better visual acuity compared to the Central Vision Analyzer equivalent test, likely because patients had indefinite time to guess the letters. This study confirms and strengthens the finding that visual function is affected in PLWH even in absence of retinitis, since we found that the HIV serostatus is the best predictor of visual loss. The Central Vision Analyzer may be useful in the diagnosis of subclinical HIV-associated visual loss in multiple light/contrast conditions, and may offer better understanding of this entity called “neuroretinal disorder”.     

Deficient colour vision and interpretation of histopathology slides: cross sectional study.

OBJECTIVE: To determine whether histopathologists with deficient colour vision make more errors in slide interpretation than those with normal colour vision. DESIGN: Examination of projected transparencies of histopathological slides under standardised conditions by subjects whose colour discriminating ability was accurately assessed. SETTING: Departments of histopathology in 45 hospitals in the United Kingdom. SUBJECTS: 270 male histopathologists and medical laboratory scientific officers. MAIN OUTCOME MEASURES: Number of slides correctly identified by subjects whose colour vision was measured on the Ishihara, City University, and Farnsworth-Munsell 100 hue tests. RESULTS: Mean (SD) scores (out of 10) for doctors with colour deficient vision were 9.4 (0.7) v 9.9 (0.4) for controls (P < 0.01) and 7.5 (1.6) v 9.4 (0.7) for scientific officers (P < 0.001). When subjects with colour deficient vision were categorised into severe, moderate, or mild, there was a significant trend towards those with severe deficiency making more mistakes (P < 0.001). CONCLUSIONS: Histopathologists and medical laboratory scientific officers should have their colour vision tested; if they are found to have a severe protan or deutan deficiency, they should be advised to adopt a safe system of working.     

左旋多巴联合综合疗法治疗屈光不正性弱视患儿的临床效果

目的:探究左旋多巴联合综合疗法治疗屈光不正性弱视患儿的临床效果。方法:选取2013年4月至2016年3月在我院接受治疗的屈光不正性弱视青少年103例(180眼),随机分为对照组52例(90眼)和观察组51例(90眼)。对照组患儿给予常规的综合治疗,观察组在对照组之上给予左旋多巴治疗。治疗6个月后,观察比较两组患儿的治疗有效率、图形视觉诱发电位(P-VEP)、视觉对比敏感度和视功能等以及不良反应的发生情况。结果:观察组的视力治疗有效率为90.00%,显著高于对照组(68.89%),差异具有统计学意义(P0.05)。治疗6个月后,两组的振幅出现明显的升高,且观察组显著高于对照组(P0.05);两组的潜伏期发生明显降低,且观察组的显著低于对照组(P0.05)。观察组患儿的100%、25%、10%及5%空间频率视觉对比敏感度均显著低于对照组(P0.05)。观察组患儿的矫正辐辏范围、矫正分开范围显著高于对照组,矫正近立体锐度显著低于对照组(P0.05)。治疗期间,两组不良反应发生情况比较差异无统计学意义(P0.05)。结论:左旋多巴联合综合疗法可有效改善屈光不正患儿的视觉中枢神经元功能,明显提高视力水平及视觉敏感度。     

The role of the spectral domain ocular coherence tomography in detection of age-related macular degeneration

Age-related macular degeneration (ARMD) is one of the most common causes of the vision loss and blindness in developed countries. Among other harmful effects, exposure to the UV radiation is the most prominent factor for the development of the disorder. Using the method of SD OCT (Spectral Domain Ocular Coherence Tomography) we performed measurement of the neurosensory retinal thickness of 19 eyes of low vision patients from the population of Primorsko-Goranska County of Republic of Croatia, with dry form of the terminal macular degeneration. These results we compared with control measurements performed on 28 eyes of healthy, normal vision subjects from same County. We determined following parameters: central foveal thickness (CFT), macular volume (MV) and mean foveal thickness (MFT) in the both groups. Results showed statistically significant reduction of CFT in the group of normal vision female patients when compared to males, while any significant difference of CFT between total groups of normal vision individuals and low vision patients was not detected. Furthermore, we noticed statistically significant (p < 0.000001) decrease of the MV in the group of the low vision patients in comparison to healthy subjects and statistically significant (p < 0.000001) reduction of the MFT of the low vision patients when compared to normal vision individuals. In our study we detected the absence of any significant difference of the CFT between healthy and low vision population, what looks like controversial finding, because neurosensory retina in the ARMD is thin and atrophic, but on the other side it is known that fixation point in low vision patients is translocated from the damaged fovea to extrafoveal region, usually above the fovea, where neurosensory retina is of the normal thickness, but with the less sensitivity. Furthermore, our results suggest possible connection of higher incidence of ARMD with lower CFT in females. Owing to the thicker neurosensory retina in males and better protection, damaging effect of the UV irradiation, which is the proven factor of ARMD development, is smaller. From the evolutionary point of view it is possible that males in all vertebrates have more resistant macula because during the evolutionary process they have spent much more time outside in the sunlight than females.     

人工视觉辅助系统：现状与展望

通过视觉获取图像信息是人类学习和生活的重要功能,失明则会显著降低其生活质量.因视网膜色素变性、青光眼和黄斑变性等疾病而造成后天失明者,以及由意外事故、战争等造成眼部创伤者,有可能通过人工视觉辅助系统的帮助恢复部分视觉,或者完成复杂的生活任务.一些盲症患者视觉通路的神经传导剩余部分依然有功能,因此可以借助电极阵列刺激视神经向大脑传递视觉信息,也可在大脑视觉皮层贴敷电极阵列的方法输入视觉信息.此外,还能借助体外装置,如通过人工智能将视觉转换成语音指令、触觉阵列编码等,帮助盲症患者获得环境信息.本文综述各类人工视觉辅助系统的现状,展望其发展趋势,并提出了新的植入器件与随身体外装置的新设想.     

Seeing without Seeing? Degraded Conscious Vision in a Blindsight Patient

Blindsight patients, whose primary visual cortex is lesioned, exhibit preserved ability to discriminate visual stimuli presented in their "blind" field, yet report no visual awareness hereof. Blindsight is generally studied in experimental investigations of single patients, as very few patients have been given this "diagnosis". In our single case study of patient GR, we ask whether blindsight is best described as unconscious vision, or rather as conscious, yet severely degraded vision. In experiment 1 and 2, we successfully replicate the typical findings of previous studies on blindsight. The third experiment, however, suggests that GR's ability to discriminate amongst visual stimuli does not reflect unconscious vision, but rather degraded, yet conscious vision. As our finding results from using a method for obtaining subjective reports that has not previously used in blindsight studies (but validated in studies of healthy subjects and other patients with brain injury), our results call for a reconsideration of blindsight, and, arguably also of many previous studies of unconscious perception in healthy subjects.     

Transcaruncular orbital decompression for management of compressive optic neuropathy in thyroid-related orbitopathy

This study was conducted to assess the outcome of transcaruncular orbital decompression to treat compressive optic neuropathy in thyroid-related orbitopathy. It involved a retrospective, noncomparative case series of 18 eyes of 10 consecutive patients with documented vision loss secondary to thyroid-related orbitopathy. Bony decompression of the orbital apex was performed via a transcaruncular approach. Main outcome measures were visual acuity, color vision, presence of diplopia, and reduction of exophthalmos. Of 18 eyes, 16 (89 percent) had improved visual acuity after the operation. One eye had no improvement and one had worsening of vision in the setting of diabetic retinopathy. Color vision was improved in 12 eyes (67 percent). Five of the patients did not have diplopia before the operation; none of these patients developed double vision after intervention. Exophthalmos was decreased by an average of 2.6 mm. The authors conclude that transcaruncular orbital decompression for compressive optic neuropathy in thyroid-related orbitopathy is successful in restoring visual function. Compared with other approaches used for decompression surgery, the transcaruncular approach offers direct access to the medial wall and orbital apex without a cutaneous incision or disruption of the medial canthus. In addition, this approach allows a controlled, graded removal of the ethmoidal air cells and reduced recovery time.     

Colour Vision Impairment in Young Alcohol Consumers

Alcohol consumption among young adults is widely accepted in modern society and may be the starting point for abusive use of alcohol at later stages of life. Chronic alcohol exposure can lead to visual function impairment. In the present study, we investigated the spatial luminance contrast sensitivity, colour arrangement ability, and colour discrimination thresholds on young adults that weekly consume alcoholic beverages without clinical concerns. Twenty-four young adults were evaluated by an ophthalmologist and performed three psychophysical tests to evaluate their vision functions. We estimated the spatial luminance contrast sensitivity function at 11 spatial frequencies ranging from 0.1 to 30 cycles/degree. No difference in contrast sensitivity was observed comparing alcohol consumers and control subjects. For the evaluation of colour vision, we used the Farnsworth-Munsell 100 hue test (FM 100 test) to test subject’s ability to perform a colour arrangement task and the Mollon-Reffin test (MR test) to measure subject’s colour discrimination thresholds. Alcohol consumers made more mistakes than controls in the FM100 test, and their mistakes were diffusely distributed in the FM colour space without any colour axis preference. Alcohol consumers also performed worse than controls in the MR test and had higher colour discrimination thresholds compared to controls around three different reference points of a perceptually homogeneous colour space, the CIE 1976 chromaticity diagram. There was no colour axis preference in the threshold elevation observed among alcoholic subjects. Young adult weekly alcohol consumers showed subclinical colour vision losses with preservation of spatial luminance contrast sensitivity. Adolescence and young adult age are periods of important neurological development and alcohol exposure during this period of life might be responsible for deficits in visual functions, especially colour vision that is very sensitive to neurotoxicants.     

Treatmenf of optic neuritis by retrobulbar injection of triamcinolone.

In a single-blind controlled clinical trial patients with optic neuritis caused by demyelination were given a single retrobulbar injection of triamcinolone. Though the treated group showed a trend towards more rapid recovery of vision than the controls, there was no significant difference in visual acuity, colour vision, or visual fields during the first six months after treatment. We conclude that routine use of corticosteroids is not justified in unilateral optic neuritis when vision in the other eye is good. Shortening the period of visual disability in bilateral disease or unilateral disease when vision in the other eye is poor, however, may be justifiable.     

老年白内障患者术前焦虑障碍的影响因素分析及对术后干眼症状和视觉相关生活质量的影响

摘要 目的：探讨老年白内障患者术前焦虑障碍的影响因素,并观察术前焦虑障碍对术后干眼症状和视觉相关生活质量的影响。方法：选择2020年12月~2022年5月期间江苏省人民医院眼科收治的老年白内障患者100例作为研究对象。所有患者入院第1天采用状态-特质焦虑问卷（STAI）评估焦虑状况,采用单因素和多因素Logistic回归分析老年白内障患者发生术前焦虑障碍的影响因素,并观察其对术后干眼症状和视觉相关生活质量的影响。结果：本研究100例老年白内障患者中,有46例患者出现术前焦虑障碍,占比46.00%,平均STAI评分为（59.27±3.16）分;有54例未出现术前焦虑障碍,占比54.00%,平均STAI评分为（35.39±5.28）分。根据是否出现术前焦虑障碍将患者分为焦虑障碍组（n=46）和无焦虑障碍组（n=54）。单因素分析显示,老年白内障患者术前焦虑障碍与年龄、性别、文化程度、家庭人均月收入、外科手术史、合并基础疾病种类、是否双眼白内障、付费方式、家庭关系有关（P<0.05）,而与婚姻状况、居住地无关（P>0.05）。年龄为60~69岁、家庭关系差、性别为女、文化程度为小学及以下、无外科手术史、双眼白内障、合并基础疾病种类为2种及以上是老年白内障患者发生术前焦虑障碍的危险因素（P<0.05）。焦虑障碍组术后干眼症状评分高于无焦虑障碍组（P<0.05）。焦虑障碍组社会角色限制、精神健康状态、社交功能、近距离工作、总体视觉情况、远距离工作、周边视野、独立性、一般健康状态、驾驶、色彩视觉、眼痛分值及总分均低于无焦虑障碍组（P<0.05）。结论：年龄、家庭关系、性别、文化程度、外科手术史、双眼白内障、合并基础疾病种类是老年白内障患者术前焦虑障碍的影响因素。老年白内障患者存在术前焦虑障碍可增加术后发生干眼症状的风险,并降低其视觉相关生活质量。     

Chloroquine retinopathy and secondary trauma

This report describes a patient who initially presented with established chloroquine retinopathy resulting in reduced distance visual acuity, color vision anomalies and maculopathy in each eye. Subsequent trauma to the left side of the head produced a further decline in vision, accompanied by iritis and macula edema. A differential diagnosis, classification and treatment plan for patients with chloroquine retinopathy is presented.