Improvement of visual acuity by refraction in a low-vision population

Janet S. Sunness, Jaafar El-Annan

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: Refraction often may be overlooked in low-vision patients, because the main cause of vision decrease is not refractive, but rather is the result of underlying ocular disease. This retrospective study was carried out to determine how frequently and to what extent visual acuity is improved by refraction in a low-vision population. Design: Cross-sectional study. Participants: Seven hundred thirty-nine low-vision patients seen for the first time. Methods: A database with all new low-vision patients seen from November 2005 through June 2008 recorded presenting visual acuity using an Early Treatment Diabetic Retinopathy Study chart; it also recorded the best-corrected visual acuity (BCVA) if it was 2 lines or more better than the presenting visual acuity. Retinoscopy was carried out on all patients, followed by manifest refraction. Main Outcome Measures: Improvement in visual acuity. Results: Median presenting acuity was 20/802 (interquartile range, 20/5020/200). There was an improvement of 2 lines or more of visual acuity in 81 patients (11% of all patients), with 22 patients (3% of all patients) improving by 4 lines or more. There was no significant difference in age or in presenting visual acuity between the group that did not improve by refraction and the group that did improve. When stratified by diagnosis, the only 2 diagnoses with a significantly higher rate of improvement than the age-related macular degeneration group were myopic degeneration and progressive myopia (odds ratio, 4.8; 95% confidence interval [CI], 3.06.7) and status postretinal detachment (odds ratio, 7.1; 95% CI, 5.29.0). For 5 patients (6% of those with improvement), the eye that was 1 line or more worse than the fellow eye at presentation became the eye that was 1 line or more better than the fellow eye after refraction. Conclusions: A significant improvement in visual acuity was attained by refraction in 11% of the new low-vision patients. Improvement was seen across diagnoses and the range of presenting visual acuity. The worse-seeing eye at presentation may become the better-seeing eye after refraction, so that the eye behind a balance lens should be refracted as well.

Original languageEnglish (US)
Pages (from-to)1442-1446
Number of pages5
JournalOphthalmology
Volume117
Issue number7
DOIs
StatePublished - Jul 2010
Externally publishedYes

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Low Vision
Visual Acuity
Population
Degenerative Myopia
Odds Ratio
Retinoscopy
Confidence Intervals
Eye Diseases
Macular Degeneration
Diabetic Retinopathy
Lenses
Retrospective Studies
Cross-Sectional Studies
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Improvement of visual acuity by refraction in a low-vision population. / Sunness, Janet S.; El-Annan, Jaafar.

In: Ophthalmology, Vol. 117, No. 7, 07.2010, p. 1442-1446.

Research output: Contribution to journalArticle

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abstract = "Purpose: Refraction often may be overlooked in low-vision patients, because the main cause of vision decrease is not refractive, but rather is the result of underlying ocular disease. This retrospective study was carried out to determine how frequently and to what extent visual acuity is improved by refraction in a low-vision population. Design: Cross-sectional study. Participants: Seven hundred thirty-nine low-vision patients seen for the first time. Methods: A database with all new low-vision patients seen from November 2005 through June 2008 recorded presenting visual acuity using an Early Treatment Diabetic Retinopathy Study chart; it also recorded the best-corrected visual acuity (BCVA) if it was 2 lines or more better than the presenting visual acuity. Retinoscopy was carried out on all patients, followed by manifest refraction. Main Outcome Measures: Improvement in visual acuity. Results: Median presenting acuity was 20/802 (interquartile range, 20/5020/200). There was an improvement of 2 lines or more of visual acuity in 81 patients (11{\%} of all patients), with 22 patients (3{\%} of all patients) improving by 4 lines or more. There was no significant difference in age or in presenting visual acuity between the group that did not improve by refraction and the group that did improve. When stratified by diagnosis, the only 2 diagnoses with a significantly higher rate of improvement than the age-related macular degeneration group were myopic degeneration and progressive myopia (odds ratio, 4.8; 95{\%} confidence interval [CI], 3.06.7) and status postretinal detachment (odds ratio, 7.1; 95{\%} CI, 5.29.0). For 5 patients (6{\%} of those with improvement), the eye that was 1 line or more worse than the fellow eye at presentation became the eye that was 1 line or more better than the fellow eye after refraction. Conclusions: A significant improvement in visual acuity was attained by refraction in 11{\%} of the new low-vision patients. Improvement was seen across diagnoses and the range of presenting visual acuity. The worse-seeing eye at presentation may become the better-seeing eye after refraction, so that the eye behind a balance lens should be refracted as well.",
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