OSLI Retina

August 2020

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456 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ E X P E R I M E N T A L S C I E N C E ■ Reading Speed as an Objective Measure of Improvement Following Vitrectomy for Symptomatic Vitreous Opacities Edwin H. Ryan, MD; Linda A. Lam, MD; Christine M. Pulido, MD; Steven R. Bennett, MD; Aurélie Calabrèse, PhD BACKGROUND AND OBJECTIVE: There is currently no objective measure of the visual deficits experienced by patients with symptomatic vitreous opacities (SVOs) that would also correlate with the func- tional improvement they report following vitrecto- my. This study aims to determine whether reading speed can be used as a reliable outcome measure to assess objectively the impact of both SVOs and vitrectomy on patients' visual performance. PATIENTS AND METHODS: Twenty adult patients seeking surgery for SVO were included. Measures of visual function were obtained before and after vitrectomy using the Early Treatment Diabetic Retinopathy Study acuity chart, the National Eye Institute Visual Function Questionnaire, and the MNREAD acuity chart. RESULTS: In patients with nonopacified lenses (n = 10), maximum reading speed increased sig- nificantly from 138 to 159 words per minute after complete removal of SVOs by vitrectomy (95% confidence interval, 14-29; P < .001). CONCLUSIONS: Reading speed is impaired with SVOs and improves following vitrectomy in phakic and pseudophakic eyes with clear lenses. Reading speed is a valid objective measure to assess the pos- itive effect of vitrectomy for SVOs on near-distance daily life activities. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:456-466.] INTRODUCTION Patients with symptomatic vitreous opacities (SVOs) experience visual impairment from multiple dense particles floating in the vitreous gel, which often cast a mobile dark shadow on the retina. However, standard objective measures of visual function, such as Snellen visual acuity (VA), remain often excellent in the pres- ence of SVOs. 1,2 Nonetheless, patients with SVOs re- port significant visual improvement after their removal by vitrectomy. 3,4 For instance, previous studies have shown postoperative improvement in subjective visual quality of life. 5,6 These results were obtained with the National Eye Institute Visual Function Questionnaire (NEI-VFQ), which assesses the level of difficulty experi- enced by individuals with chronic eye diseases during daily living activities, such as driving or reading. 7 To complement such subjective evaluations, there is a need for establishing a quantifiable measure to as- sess objectively (1) the impairment in visual function caused by SVOs and (2) the improvement in visual function following vitrectomy. 3 First, such a clinical measure would help detect patients with functional im- pairment from vitreous floaters. Second, it would bring valuable insight to help resolve the existing controversy over vitrectomy's clinical relevance. So far, intraocular straylight 8 and contrast sensitivity 6 have been proposed as independent objective measures of visual perception with symptomatic floaters. Despite their impact on vi- sion-related quality of life, these measures do not evalu- ate daily life function directly. A frequent complaint from patients with prominent opacities is interference with ease of reading. Even if unilateral, these patients often complain of interfer- ence with binocular visual function. 9,10 Patients usually From VitreoRetinal Surgery PA, Edina, Minnesota (EHR, CMP, SRB); USC Keck School of Medicine, Los Angeles, California (LAL); Feinberg School of Medi- cine, Chicago, Illinois (CMP); and Université Côte d'Azur, Inria, Sophia-Antipolis, France (AC). Originally submitted February 5, 2020. Revision received May 5, 2020. Accepted for publication July 1, 2020. Supported by grants from the National Eye Institute/NIH (grant EY002934) and Foundation de France (AC). Dr. Calabrèse received royalties for sales of the MNREAD iPad app through a licensing agreement between the University of Minnesota and Precision Vision outside of the present work. Dr. Ryan reports royalties for patents related to vitrectomy surgery from Alcon Surgical. The remaining authors report no relevant financial disclosures. The authors would like to thank Gordon E. Legge for his help in the earlier stages of this study. Address correspondence to Aurélie Calabrèse, PhD, Université Côte d'Azur, 2004 Route des Lucioles - BP 93, 06902 Sophia Antipolis, Cedex, France; email: aurelie.calabrese@inria.fr. doi: 10.3928/23258160-20200804-06

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