OSLI Retina

August 2020

Issue link: http://osliretina.healio.com/i/1279094

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August 2020 ยท Vol. 51, No. 8 457 report moderate or extreme difficulty in reading small print. 5 In the low-vision literature, reading speed is al- ready considered a strong objective predictor of visual ability and vision-related quality of life for patients with ocular disorders, such as macular degeneration. 11-14 Here, we conducted a prospective study to test whether reading performance can also be used as a reliable out- come measure to investigate the impact of SVOs and therapeutic vitrectomy on patients' visual performance. Our main objective was to investigate whether read- ing performance, evaluated with the standardized MN- READ VA test (Precision Vision, La Salle, IL), could pro- vide an objective measure of functional improvement in patients with SVOs treated with pars plana vitrectomy (PPV). To this aim, we compared pre- and postopera- tive measures of (1) vision-related quality of life (sub- jectively obtained with the NEI-VFQ) and (2) reading performance (objectively obtained with the MNREAD test). Given that reading performance is rapidly degrad- ed with reduced contrast from cloudy ocular media, 15 these comparisons were performed while controlling for patients' lens status (clear vs. mildly opacified). Additionally, we investigated whether a potential im- provement in these subjective and objective measures following vitrectomy would be correlated with preop- erative opacity severity. PATIENTS AND METHODS Patients older than 21 years of age were included in the present work if they (1) elected to undergo vitrec- tomy, (2) presented symptoms consistent with examina- tion findings of dense opacities for at least 6 months, (3) had VA of 20/80 (0.6 logMAR) or better in both eyes be- fore surgery, and (4) did not experience a significant drop in acuity in the nonoperated eye between the pre- and post-surgery measurements. Phakic and pseudophakic patients were included, as well as patients with or with- out a vitreous detachment. History of scleral buckle for retinal detachment (RD) was acceptable if the macula was not involved. If an epiretinal membrane (ERM) was noted on optical coherence tomography (OCT) but not clinically visible or deemed significant, patients were included in the study. Patients were excluded if they had history of cognitive impairment, macula-off RD, severe glaucoma, macular degeneration, diabetic mac- ular edema, or other confounding ocular disorders. A total of 20 patients were recruited, tested, and treated at two different sites: 11 at a private retina practice in Minnesota and nine at an academic retina practice in California. Figure 1 illustrates the protocol sequence. Institutional review board (IRB)/ethics committee ap- proval was obtained and written informed consent was obtained before the study from each patient according to IRB guidelines. The study also complied with tenets of the Declaration of Helsinki and HIPAA. Surgery Twenty eyes of 20 patients underwent outpa- tient three-port, 25-gauge PPV using the Constella- tion system (Alcon, Fort Worth, TX). Inspection of Figure 1. Protocol schematic showing the different test procedures along with the resulting outcome measures. Subjective measures are represented in blue; objective measures are represented in pink. OCT-SLO = optical coherence tomography scanning laser ophthalmo- scope; NEI-VFQ = National Eye Institute Visual Function Questionnaire

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