Reliability of Semiautomated Kinetic Perimetry (SKP) and Goldmann Kinetic Perimetry in Children and Adults With Retinal Dystrophies.

PurposeTo investigate the precision of visual fields (VFs) from semiautomated kinetic perimetry (SKP) on Octopus 900 perimeters, for children and adults with inherited retinal degenerations (IRDs). Goldmann manual kinetic perimetry has long been used in the diagnosis and follow-up of these patients, but SKP is becoming increasingly common. Octopus VFs (OVFs) and Goldmann VFs (GVFs) were both mapped on two occasions.MethodsNineteen females and 10 males with IRDs were tested on OVFs and GVFs, with two targets per test (V4e and one smaller target). Tests were performed in the same (randomized) order at two visits about 1 week apart. The VFs were digitized to derive isopter solid angles. Comparisons, within and between visits, were performed with paired t-tests and Bland-Altman plots.ResultsMedian age was 20 years (range, 7-70; 10 participants aged ≤17 years old). There were no significant differences in solid angles between OVFs and GVFs (P ≥ 0.06) or between the two visits' solid angles on either perimeter (P ≥ 0.30). Between-visit test-retest variability for GVFs and OVFs was similar (P ≥ 0.73), with median values of approximately 9% to 13%. Overall variability was lower for children than adults (medians of 7.5% and 12.8%, respectively).ConclusionsOctopus SKP and Goldmann perimetry produced VFs of similar size and variability.Translational relevanceOur study indicates that SKP provides a viable alternative to traditional Goldmann perimetry in clinical trials or care involving both children and adults with IRDs

Feasibility of Using Bluetooth Beacon Sensors to Detect Magnifier Usage by Low Vision Patients in Clinic and at Home

Objective. Bluetooth beacons were evaluated as an indicator of held-held optical magnifier use during reading by low vision patients. Background. Bluetooth low energy beacons are an emerging, novel technology involving tiny sensors that collect real-time continuous, objective data, which might help ascertain the abandonment of low vision devices (magnifiers) in a timely manner to prompt a follow-up evaluation to resolve any issues. Methods. Temperature and/or humidity data were recorded by Estimote and BlueMaestroTM beacons that we attached to the handle of optical magnifiers used to help with reading by low vision patients in clinic(n=13) and at home(n=3). Results. In the clinic, patients whose hand/fingers made direct vs. indirect contact with Estimote beacons had greater temperature increases on average from baseline after 30 seconds (0.68°C vs. 0.26°C), 60 seconds (1.02°C vs. 0.35°C), 90 seconds (1.39°C vs. 0.54°C), 105-120 seconds (1.54°C vs. 0.62°C), and 135-150 seconds (2.07°C vs. 0.8°C). During magnifier usage at home, the BlueMaestroTM beacon measured rapid increases in temperature (5.6°C per minute on average; range 2.7-7.3°C) and humidity (19.4% per minute on average; range 8.7-34%). Humidity tended to reach its maximum increase and return back to baseline more quickly than temperature. All increases during magnifier usage were much greater than the maximum room fluctuations without use (clinic: 0.2°C over 120 seconds; home: 0.6°C and 2.4% over 1 minute). The beacons were non-intrusive and acceptable by patients. Conclusions. Estimote and BlueMaestroTM beacons can reliably detect temperature and humidity increases when held by low vision patients while reading with a magnifier

Reliability of Mesopic Measures of Visual Acuity and Contrast Sensitivity and Their Correlation with Rod and Cone Function in Retinitis Pigmentosa.

BackgroundMesopic conditions elicit both rod and cone responses, and they are more commonly encountered in daily life than are scotopic conditions; yet visual function outcome measures of mesopic visual acuity (VA) or contrast sensitivity (CS) are rarely evaluated.ObjectiveIn retinitis pigmentosa (RP), we explored whether visual reductions in mesopic versus photopic conditions were correlated with cone or rod function, as well as the between-visit test-retest variability in mesopic measures.MethodsAt each of two visits, 22 RP subjects completed mesopic and photopic ETDRS VA and Pelli-Robson chart CS tests obtained with and without a U23 NoIR 4% transmission filter; testing of perifoveal scotopic cone or rod sensitivity with the AdaptDx; and the Rabin Cone Contrast Test (CCT).ResultsA greater CS reduction in mesopic versus photopic conditions was significantly related to absence of scotopic rod function (p = 0.038) or longer self-reported duration of night vision loss (p = 0.044). VA reductions >0.2 logMAR in mesopic versus photopic conditions were significantly related to reduced cone-mediated scotopic sensitivity (p = 0.038). Significant predictors of the CCT ratio of S-cone to M- and L-cone sensitivity were mesopic VA (p = 0.038) and absence of AdaptDx rod function (p = 0.008). Test-retest 95% coefficients of repeatability were not significantly different when comparing between photopic and mesopic tests of VA (0.16 and 0.12 logMAR, respectively) or CS (0.21 and 0.24 logCS, respectively).ConclusionsPerifoveal scotopic rod and cone function measured with the AdaptDx was significantly correlated with mesopic CS and VA, respectively, which had good, acceptable test-retest repeatability; thus, they appear to be suitable outcome measures to monitor mesopic visual function in clinical practice or trials. RP subjects with reduced mesopic VA and no perifoveal rod function had a greater loss of sensitivity for S-cones than for L-/M-cones

Longitudinal Study of Efficacy of Retreatment and Duration of Visual Improvements following Transcorneal Electrical Stimulation in Three Individuals with Retinitis Pigmentosa

Objective: A small-scale randomized controlled trial conducted by our group found that four of seven retinitis pigmentosa (RP) subjects who received six weekly Transcorneal Electrical Stimulation (TES) sessions developed significant improvements in visual acuity (VA), quick contrast sensitivity function (qCSF), and/or Goldmann visual fields (GVF). We longitudinally monitored three of these participants for declining visual function due to natural RP progression to determine the duration of their responses and administered retreatments. Background: Retinitis Pigmentosa is a hereditary ocular disease that leads to restricted visual fields and night blindness. It has been resistant to any treatments which might mitigate the effects of the disease. The initial experience with TES has shown encouraging results. Methods: Over a period of 29-35 months, repeated ETDRS VA, qCSF and/or GVF tests and three to six TES treatment courses consisting of six weekly sessions were administered in each eye of three RP participants every four to 16 months in an unmasked, prospective case series study Results: For two participants, there were significant VA improvements of 44-52 letters (0.88-1.04 logMAR) and 15-23 letters (0.3-0.46 logMAR) in the worse eye at baseline after each of three or four treatment courses of TES compared to initial baseline. They had no significant decreases from baseline for VA or qCSF over 29 to 35 months, The third participant had a significant mean improvement in VA in the eye with better baseline vision (p=0.004) and binocularly (p Conclusion: Following encouraging visual improvements after TES that lasted for several months, it appears it may be possible to restore and prevent slowly diminishing vision over time with retreatments, which requires confirmation in a large-scale randomized controlled trial

Reliability of Mesopic Measures of Visual Acuity and Contrast Sensitivity and Their Correlation with Rod and Cone Function in Retinitis Pigmentosa.

BackgroundMesopic conditions elicit both rod and cone responses, and they are more commonly encountered in daily life than are scotopic conditions; yet visual function outcome measures of mesopic visual acuity (VA) or contrast sensitivity (CS) are rarely evaluated.ObjectiveIn retinitis pigmentosa (RP), we explored whether visual reductions in mesopic versus photopic conditions were correlated with cone or rod function, as well as the between-visit test-retest variability in mesopic measures.MethodsAt each of two visits, 22 RP subjects completed mesopic and photopic ETDRS VA and Pelli-Robson chart CS tests obtained with and without a U23 NoIR 4% transmission filter; testing of perifoveal scotopic cone or rod sensitivity with the AdaptDx; and the Rabin Cone Contrast Test (CCT).ResultsA greater CS reduction in mesopic versus photopic conditions was significantly related to absence of scotopic rod function (p = 0.038) or longer self-reported duration of night vision loss (p = 0.044). VA reductions >0.2 logMAR in mesopic versus photopic conditions were significantly related to reduced cone-mediated scotopic sensitivity (p = 0.038). Significant predictors of the CCT ratio of S-cone to M- and L-cone sensitivity were mesopic VA (p = 0.038) and absence of AdaptDx rod function (p = 0.008). Test-retest 95% coefficients of repeatability were not significantly different when comparing between photopic and mesopic tests of VA (0.16 and 0.12 logMAR, respectively) or CS (0.21 and 0.24 logCS, respectively).ConclusionsPerifoveal scotopic rod and cone function measured with the AdaptDx was significantly correlated with mesopic CS and VA, respectively, which had good, acceptable test-retest repeatability; thus, they appear to be suitable outcome measures to monitor mesopic visual function in clinical practice or trials. RP subjects with reduced mesopic VA and no perifoveal rod function had a greater loss of sensitivity for S-cones than for L-/M-cones

Bluetooth Low Energy Beacon Sensors to Document Handheld Magnifier Use at Home by People with Low Vision

We explored the feasibility of using Bluetooth low energy (BLE) beacon sensors to determine when individuals with low vision (LV) use handheld magnifiers at home. Knowing the frequency and duration of magnifier use would be helpful to document increased magnifier use after successful rehabilitation training, or conversely, to know when someone has abandoned a magnifier and requires assistance. Estimote Sticker BLE beacon sensors were attached to the handles of optical handheld magnifiers and dispensed to eight LV subjects to use at home. Temperature and motion data from the BLE beacon sensors were collected every second by a custom mobile application on a nearby smartphone and transmitted to a secure database server. Subjects noted the date and start/end times of their magnifier use in a diary log. Each of the 99 diary-logged self-reports of magnifier use across subjects was associated with BLE beacon sensor recordings of motion (mean 407 instances; SD 365) and increased temperature (mean 0.20 °C per minute; SD 0.16 °C) (mean total magnitude 5.4 °C; SD 2.6 °C). Diary-logged duration of magnifier use (mean 42 min; SD 24) was significantly correlated with instances of motion (p < 0.001) and rate of temperature increase (p < 0.001) recorded by the BLE beacon sensors. The BLE beacon sensors reliably detected meaningfully increased temperature, coupled with numerous instances of motion, when magnifiers were used for typical reading tasks at home by people with LV

Characteristics and Possible Visual Consequences of Photopsias as Vision Measures Are Reduced in Retinitis Pigmentosa

In advanced retinitis pigmentosa, photopsias tend to be located centrally, over larger regions, and in areas with vision and/or observed more frequently and therefore potentially interfere with patients' functioning or with obtaining vision measures

Test-Retest, Within-Visit Variability of Goldmann Visual Fields in Retinitis Pigmentosa

The authors have established test-retest reliability values for Goldmann visual fields (GVF) in retinitis pigmentosa. Under optimal conditions (single well-trained operator; same day retest) changes greater than 25% appear to rarely occur in patients with GVF radius greater than 7°