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To compare the intraocular pressure and hypotony outcomes of primary phakic trabeculectomies with no mitomycin C (MMC), shorter MMC, and longer MMC exposure.We evaluated primary phakic trabeculectomies with no MMC (36 eyes of 36 patients), 0.5- to 1-minute MMC (50 eyes of 50 patients), and 3- to 5-minute MMC (38 eyes of 38 patients) at the concentration of 0.5 mg/ml. Successful trabeculectomy was defined as an intraocular pressure of 21 mm Hg or less without development of a marked visual acuity loss associated with prolonged hypotony (intraocular pressure6 mm Hg over 3 months) and without the need for additional surgery to control intraocular pressure or treat postoperative complications.The three groups were similar in demographics, preoperative intraocular pressure, and medical dependency. However, the incidence of hypotony during the postoperative periods of 3 to 12 months was significantly higher in the 3- to 5-minute MMC group (P.05, chi-square test). Severe visual acuity loss associated with hypotony was also more frequently found in the 3- to 5-minute MMC group than in the 0.5- to 1-minute (P = .009, chi-square test) group or the control group (P = .014, chi-square test). In addition, the success probabilities were significantly different among the three groups (P = .001, Kaplan-Meier survival analysis with log-rank test) and were the highest in the 0.5- to 1-minute MMC group and the lowest in the 3- to 5-minute MMC group.Shorter application (0.5 to 1 minute) of MMC appears to be optimal for the successful outcome of primary phakic trabeculectomy compared with no MMC or longer application of MMC at a concentration of 0.5 mg/ml.

Penetrating head and face injuries can cause hemorrhages, neurological lesions, visual acuity loss, fractures and facial deformities. This report discusses an injury caused by a knife that penetrated the left orbit and reached the skull base without damaging any important structures. The knife was removed through the entrance wound and no complications were observed either during or after surgery.

Coping with sensory loss is the bane of the elderly. Each day the population over age 65 increases by 1500 people (Kutza, 1961). Many of these individuals will suffer visual acuity loss to between 20/25 and 20/70. This may be due to age-related macular degeneration or because they are waiting for cataract surgery. All too often older persons give up favorite acitivties and necessary tasks because these activities have become difficult to perform.

We compared visual acuity with visual field radius in 235 patients with typical retinitis pigmentosa and no evidence of other visual acuity-limiting problems (such as cataract or foveal cystoid edema). Results show a strong relationship between visual acuity loss and proximity to the fovea of the visual field border (shortest distance from the foveal center to the border of the V-4-e isopter) for these patients. Ninety-six percent of patients with central visual field radii greater than 30 degrees have visual acuities of 20/40 or better; 32% of patients with central visual field radii smaller than 10 degrees have visual acuity of 20/40 or better.

PURPOSE To determine the factors associated with visual acuity loss following transscleral Nd:YAG cyclophotocoagulation (TYC). METHODS The authors retrospectively studied 479 patients followed for a mean of 22 months after the initial TYC in one eye and analyzed the data with univariate and multivariate analysis for the factors associated with visual acuity loss. Data analyzed included age, race, sex, preoperative intraocular pressure (IOP) and visual acuity, type of glaucoma, total energy per treatment, number of retreatments, final IOP, and duration of follow-up. RESULTS The preoperative factors associated with visual acuity loss after TYC as determined by both univariate and multivariate analysis were neovascular glaucoma (p = 0.001, odds ratio = 2.80) and black race (p = 0.044, odds ratio = 1.67). Postoperative hypotony and follow-up of > 6 months were also associated with visual acuity loss (p < 0.001, odds ratio = 6.68 and p = 0.046, odds ratio = 2.61, respectively). CONCLUSIONS Transscleral Nd:YAG cyclophotocoagulation is associated with a greater risk of visual acuity loss in patients with neovascular glaucoma and in the black population. Postoperative hypotony is associated with a poor visual outcome, whereas the association with longer follow-up duration suggests that other factors, related to the patient's underlying disease, are also significant factors.

Strabismus, the misalignment of the visual axis of one eye relative to that of the other eye, reduces visual acuity in the affected eye. Several processes contributing to that loss are: amblyopia, which results in a chronic acuity loss whether or not the fellow eye is viewing; strabismic deviation, which shifts the image of an acuity target onto more peripheral, and therefore less acute, retina when the fellow eye fixates; interocular suppression and binocular masking, which reduce visibility in the strabismic eye due to neural influences from the other eye. We measured the losses due to these processes in nine small-angle strabismic subjects. Amblyopia reduced acuity by a median of 34% relative to its value in subjects with normal binocular vision, and strabismic deviation produced a loss of 44%. Suppression and masking together reduced acuity by 20%, and therefore had substantially less effect than the other factors.

To the Editor. —The recent article by Madreperla et al1shows that the visual acuity in retinitis pigmentosa (RP) falls in rough association with the degree of visual field loss. However, I question the implication that the degree of visual field loss is directly related to, or determines, the risk of visual acuity loss. This article really only tells us that advanced disease is advanced. The termRPrefers to a group of hereditary diseases that differ in severity, but all progress slowly over time. Every visual parameter that changes with age or with duration of disease will be "related" to every other such visual parameter, but this doesnotsignify any direct pathophysiologic correlation. Both visual field loss and visual acuity in RP are known, on a statistical basis, to worsen with age (duration of disease), but also to be better preserved in the milder (eg, type II

SUMMARY Evaluation of macular function in cataract patients using blue field entoptoscopy (BFE) has been reported as useful in all cases by some authors; another found it useful only in patients with moderate visual acuity loss due to cataract. This paper reports findings in 101 cataractous eyes evaluated consecutively with BFE. A strong correlation was found between cataract type and percentage of false negatives, but the correlation between the preoperative acuity level and percentage of false negatives was poor. BFE was also poor in detecting moderate macular dysfunction (20/60 - 20/80). Four cases with profound visual acuity loss due to macular holes had normal perception of BFE.

Regan Contrast Sensitivity Letter Charts were used to assess the effects of reduced contrast and luminance on visual acuity in retinitis pigmentosa (RP) patients. Letter acuity was measured monocularly in 17 RP patients and in 14 age-similar normals using charts of three different contrast levels presented at each of four levels of illumination. Despite visual acuities of 20/40 or better under standard clinical test conditions, an appreciable number of RP patients were unable to identify any letters on the intermediate- and/or low-contrast Regan charts. For example, even at the recommended test luminance, 5 patients could not read any letters on the intermediate (11%) contrast chart, and 9 could not be scored on the low (4%) contrast chart. Consequently, the Regan charts were found to have limited usefulness in quantifying the exact extent of visual impairment in this group of RP patients. Nevertheless, our results document the degree of visual acuity loss that can be experienced by RP patients under conditions of low contrast and luminance.

• Using a life-table analysis, visual acuity loss with age was determined for a population of 106 patients with type 1 (N = 35) and type 2 (N = 71) Usher's syndrome. The cumulative percentage of patients maintaining visual acuity of 6/12 (20/40) or better in at least one eye by age 29 years was 69% for type 1 patients and 94% for type 2 patients. The cumulative percentage maintaining visual acuity of 6/24 (20/80) or better at this age was 89% for type 1 and 98% for type 2 patients. Within each subtype, the cumulative percentage maintaining 6/60 (20/ 200) or better was similar to the percentage maintaining 6/24 (20/80) or better. Knowledge of these data provides an objective basis for counseling patients with Usher's syndrome about their probability of developing loss of central visual acuity with age.

IN THIS investigation a single defect in childhood is examined with respect to a variety of factors which may be subtly associated with it. The abnormality, loss of distant visual acuity, is common and easily measured. Because the eye is so highly specialized. minimal changes in its structure produce disordered function that would go undetected in less specialized tissue. The study of an ocular disability, then, may reveal environmental and genetic influences that are not recognizable by current measurements of other organ systems. Unfortunately, loss of distant visual acuity is not a diagnosis but a physical sign produced by an array of eye diseases. An attempt will be made to sort these out and to focus attention on myopia, a defect with a pathogenesis that has intrigued physicians for centuries. BACKGROUND The study. In the years following the war pregnant women in Japan were allowed an extra ration of rice for which they could register beginning in the fifth month of pregnancy. This gave the Atomic Bomb Casualty Commission (ABCC) a case-finding mechanism that brought into its Genetics Program 93 per cent of all children born in Hiroshima and Nagasaki from mid-1948 through 1953. A full description of the plan and the outcome of 71,270 pregnancies is given in a monograph by NEEL and &HULL [I]. From the histories obtained it was found that about 5 per cent of the marriages were between first cousins and another 2 per cent were between first-cousins-once-removed *This work is a portion of a Child Health Survey sponsored by the U.S. Atomic Energy Commission, the Rockefeller Foundation, the Association for Aid to Crippled Children, and the U.S. Public Health Service’s National Institute of Dental Research. The Atomic Bomb Casualty Commission, a research agency of the National Academy of Sciences-National Research Council and the Japanese National Institute of Health, contributed facilities and personnel in Hiroshima and Nagasaki.

Diabetic retinopathy has an enormous impact on visual function, even before permanent visual acuity loss. Moreover, adequate functional tests are mandatory to diagnose and follow diabetic patients treated for diabetic macular edema (DME). More precisely, the visual function safety profile of any therapy for DME should be accurately investigated. Microperimetry offers the possibility to obtain an exact fundus-related quantification of retinal sensitivity, and it is changing the current approach to the functional investigation of diabetic retinopathy. Keywords: Diabetic retinopathy, Visual function, Microperimetry

Endpoint development trials are underway across the spectrum of retinal disease. New validated endpoints are urgently required for the assessment of emerging gene therapies and in preparation for the arrival of novel therapeutics targeting the early stages of common sight-threatening conditions such as age-related macular degeneration and diabetic macular oedema. Visual function measures are likely to be key candidates in this search. Over the last 2 decades, microperimetry has been used extensively to characterise functional vision in a wide range of retinal conditions, often detecting subtle defects in retinal sensitivity that precede visual acuity loss and tracking disease progression over relatively short periods of time. Given these appealing features, microperimetry has already been adopted as an endpoint in interventional studies, including multicentre trials, on a modest scale. A review of its use to date shows a concurrent lack of consensus in test strategy and a wealth of innovative disease and treatment-specific metrics which may show promise as clinical trial endpoints. There are practical considerations to consider for its use, but these have not held back its popularity and it remains a widely used psychophysical test in research. Endpoint development trials will undoubtedly be key in understanding the validity of microperimetry as a clinical trial endpoint, but existing signs are promising.

The colour discrimination of 15 subjects manifesting senile macular degeneration was investigated, over a wide range of illuminances, using the Farnsworth-Munsell 100-Hue test and Panel D-15. Ten subjects of similar ages with normal colour vision were investigated concurrently to provide a control group. Colour discrimination was shown to deteriorate with decreasing illuminance this being more marked for the subjects with senile macular degeneration than for the normal subjects. It is demonstrated that the FM 100 is the preferred test for assessment of colour discrimination loss in senile macular degeneration with early visual acuity loss. The Panel D-15 is more useful as acuity loss becomes more marked.

Twenty-five cases of blowout fracture were treated at Yamaguchi University hospital between 1981 and 1984. Eighteen cases were male and seven cases were female. Chief complaints and major symptoms were diplopia, disturbance in eyeball movement and disturbance of vison. Sinus-x-ray examination by occipito-frontal view, Waters' view and occipito-frontal polytomography were recommended for precise diagnosis. Ophthalmological evaluation, including Hess chart and forced duction. test should be done both preoperatively and postoperatively. Fifteen cases were treated surgically and ten cases, who did not have visual acuity loss, were conservatively treated. Among the surgically treated (15 cases), diplopia, disturbance in eyeball movement and disturbance of vision improved in 73.3%, 80.0%, 73.3%, respectively. Site of the fracture was mostly seen at the orbital floor. Postoperative results were satisfactory. The blowout fracture with such major symptoms as the loss of visual acuity should be carefully and conservatively treated for two weeks. If the symptoms remained without improvement, the surgical intervention should be considered within a month.

A 43-year-old woman had a history of gradual unilateral visual acuity loss and proptosis. A 2.5-cm cystic dilatation of the intraorbital dura mater was removed. Microscopic examination revealed a vascular proliferation within the leptomeninges. We inadvertently injected the lesion during orbitography, providing us with an unusual radiographic appearance.

• Visual acuity and contrast threshold functions of five patients with bilateral keratoconus were measured following optimal spectacle correction. Contrast attenuation occurred before visual acuity loss, and its nature could not always be predicted by the visual acuity findings. Routine visual acuity tests do not describe well the extent of the visual disability in keratoconus.

PURPOSE: To report the clinical course of early transient reduction of uncorrected visual acuity (UCVA) after LASIK surgery resulting from steroid-induced elevation of intraocular pressure (IOP). METHODS: Twenty-nine eyes of 15 patients who received topical corticosteroids after uneventful myopic LASIK surgery and had a decrease in UCVA within the first 3 weeks were evaluated retrospectively. RESULTS: Intraocular pressure increased by 4 to 30 mmHg from preoperative to postoperative days 4 to 20. Twenty-seven of 29 eyes had a decrease in UCVA and/or best spectacle-corrected visual acuity (BSCVA). All eyes, except one, had edema without evidence of inflammation in the interface or the remainder of the cornea. Discontinuation of topical corticosteroids and application of anti-glaucoma medications resulted in a decrease of IOP to normal levels, reduction or disappearance of the edema, and recovery of BSCVA. CONCLUSIONS: Early onset steroid-induced elevation of IOP after LASIK may cause corneal edema and a sudden decrease in UCVA. Rapid diagnosis and treatment can control IOP and recover the visual loss. [J Refract Surg. 2007;23:244-251.]

Background and purpose To evaluate the retina dose as a risk factor associated with loss of visual acuity (VA) in 106 Ru plaque brachytherapy. Material/methods 45 patients receiving 106 Ru plaques brachytherapy (median follow-up 29.5 months) were included in this study. An in-house developed treatment planning system with Monte Carlo based dose calculation was used to perform treatment planning and dose calculation. Risk factors associated with loss of VA were evaluated using the Cox proportional hazards models, Kaplan–Meier estimates and Pearson correlation coefficients. Results A significant correlation was found between VA loss and mean ( r = 0.49, p = 0.001) and near maximum ( r = 0.47, p = 0.001) retina dose D 2% and tumor basal diameter ( r = 0.50, p 0.3 Snellen) for patients receiving a maximum dose of >500 Gy ( p = 0.002). A Cox multivariate analysis including the macula dose ( p = 0.237) and basal diameter ( p = 0.791) showed that a high maximum retinal dose is the best risk factor ( p = 0.013) for VA loss. Conclusion The study showed that retina dose (D 2% and D mean ) is a suitable predictor for VA loss.

To the Editor. —Photic retinal damage has been shown to be associated with exposure to the light from the operating microscope in aphakic, phakic, or pseudophakic eyes, even in the presence of an ultraviolet filter. 1,2 I wish to describe a patient who suffered photic retinal damage during an extracapuslar cataract extraction with posterior lens insertion that resulted in profound visual acuity loss (20/400), noted the first day postoperatively and persisting for four weeks. The patient's visual acuity eventually returned to 20/20, but she was left with a paracentral scotoma and macular dysfunction such that exposure to a bright light would cause a marked loss of acuity that would persist for many minutes. Method. —The operation was performed using a Week model 1206 ceiling-mounted microscope with coaxial fiberoptic illumination, fitted with an ultraviolet filter (Edward Weck and Co Inc, Research Triangle Park, NC). Illumination at the operative setting was 13000

• Sixty-eight patients with autosomal dominant retinitis pigmentosa were divided into two distinct subtypes and studied for visual function using a life-table analysis. Type 1 patients (n = 23) had diffuse pigmentation, concentric visual field loss, and no recordable electroretinogram. Type 2 patients (n = 45) as a group had regionalized pigmentation, sectorial field loss, and some recordable electroretinogram. The cumulative probability of maintaining a visual acuity of 6/12 (20/40) or better over each decade of life decreased rapidly in eyes of type 1 patients; for type 2 eyes, this probability remained above 90% through the fifth decade of life. The presence of an atrophic-appearing foveal lesion was associated with a reduction in visual acuity to 6/15 (20/50) or worse in a majority of patients. Data from this study indicate that investigators should look for subtypes within the major genetic groupings of retinitis pigmentosa for more accurate assessment of a patient's potential for maintaining good central visual acuity.

Unexplained visual acuity loss or a complaint of intermittent blurred vision experienced by the contact lens corrected aphakic may all too frequently be caused by surfacing imperfections in the front surface optical zone of these high-plus corneal lenses. The lensometer is a highly inadequate instrument for "checking the optics" of a corneal contact lens; yet it is usually the only instrument used for this purpose. The "radiuscope" can be used to check the "back-surface optics" of a corneal lens; yet it is rarely used to check anything but the radius of the central 3 or 4 mm of the rear surface of the lens. The radiuscope is almost never used to check the peripheral optical portions of the front surface. It can be particularly revealing and useful in front surface checking of the periphery of the lenticular zone of the high-plus corneal lens. After suspecting flaws in peripheral optical quality