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Screening for visual acuity loss (VAL) is not applied systematically because of uncertain recommendations based on observations from affordable countries. Our study aimed to evaluate the effectiveness of primary health care-based screening. A cross-sectional investigation was carried out among adults who did not wear glasses and did not visit an ophthalmologist in a year (N = 2070). The risk factor role of sociodemographic factors and the cardiometabolic status for hidden VAL was determined by multivariable linear regression models. The prevalence of unknown VAL of at least 0.5 was 3.7% and 9.1% in adults and in the above-65 population. Female sex (b = 1.27, 95% CI: 0.35; 2.18), age (b = 0.15, 0.12; 0.19), and Roma ethnicity (b = 2.60, 95% CI: 1.22; 3.97) were significant risk factors. Higher than primary school (bsecondaryschoolwithoutgraduation = -2.06, 95% CI: -3.64; -0.47; and bsecondaryschoolwithgraduation = -2.08, 95% CI: -3.65; -0.51), employment (b = -1.33, 95% CI: -2.25; 0.40), and properly treated diabetes mellitus (b = -2.84, 95% CI: -5.08; -0.60) were protective factors. Above 65 years, female sex (b = 3.85, 95% CI: 0.50; 7.20), age (b = 0.39, 95% CI: 0.10; 0.67), Roma ethnicity (b = 24.79, 95% CI: 13.83; 35.76), and untreated diabetes (b = 7.30, 95% CI: 1.29; 13.31) were associated with VAL. Considering the huge differences between the health care and the population's social status of the recommendation-establishing countries and Hungary which represent non-high-income countries, the uncertain recommendation of VAL screening should not discourage general practitioners from organizing population-based screening for VAL in non-affordable populations.

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Objectives: To define the clinical features of ocular syphilis and analyze the cerebrospinal fluid (CSF) of ocular syphilis patients to determine the co-occurrence of neurosyphilis. Methods: This was a retrospective study of 17 patients (23 eyes) with ocular syphilis admitted to the Fifth People's Hospital, Suzhou, China from September 2017 to December 2021. Clinical manifestations, laboratory tests, treatment, and clinical outcomes were analyzed, and a review was conducted. Results: Eight males (12 eyes) and nine females (11 eyes) were enrolled. Mean patient age was 49.06 ± 3.47 years. The total manifestation time for ocular symptoms ranged from 10 days to 6 years. The cohort was comprised of three cases of early syphilis, four cases of late syphilis, and ten cases of unknown stage. The primary complaints were decreased visual acuity in 15 cases (21 eyes), ptosis in 1 case (1 eye), and loss of light perception in 1 case (1 eye). Cases were diagnosed as chorioretinitis in 7 cases (8 eyes), optic nerve retinitis in 4 cases (6 eyes), optic neuritis in 4 cases (7 eyes), and oculomotor nerve palsy in 1 case (1 eye), syphilitic stromal keratitis in 1 case (1 eye). Serum HIV antibody was positive in one case(Nos.2). All patients had reactive serum Treponema Pallidum Particle Agglutination (TPPA) and Toluidine Red Unheated Serum Test (TRUST). All patients underwent CSF examination. CSF white blood cell count was ≥5 × 106/L in 13 cases, CSF protein was >500 mg/L in 6 cases, TPPA was reactive in 15 cases, and TRUST was reactive in 5 cases. Eleven cases were also diagnosed with neurosyphilis. Patients were treated with either penicillin G sodium or ceftriaxone sodium. At time of discharge, 12 patients reported improved visual acuity. Abnormal serum or CSF examination improved in ten patients during the 6-12 month follow-up. Conclusion: Visual acuity loss is a warning indicator of ocular syphilis. Ocular syphilis primarily manifests as posterior uveitis, involving the choroid, retina, and optic nerve, and often co-occurs with neurosyphilis. Effective treatment should be administered immediately to avoid irreversible visual impairment and other serious adverse outcomes.

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PURPOSE: To compare visual acuity (VA) change at 24 months in eyes with clinically significant DME (CSDME) and good VA initially treated versus initially observed in routine clinical practice. METHODS: Retrospective analysis of treatment-naïve eyes with CSDME and good VA (baseline VA ≥ 79 letters), with at least 24 months of follow-up and initially managed with treatment (intravitreal treatment and/or macular laser) or observation with possible treatment after 4 months that were tracked in a prospectively designed observational registry. RESULTS: We identified 150 eligible eyes (98 initially observed, 52 initially treated) of 130 patients. The proportion of eyes with at least a 5-letter VA loss at 24 months was not significantly different between the groups: 65% with initial observation and 42% with initial treatment (p = 0.39). However, initially observed eyes were more likely to have a 10-letter VA loss at 24 months (OR = 4.6, p = 0.022). Most of eyes in the initial observation group received at least one treatment (an intravitreal injection in 66% and macular laser in 20%) during the 24-month period. CONCLUSIONS: The risk of 5 letters loss was similar between both management groups. However, initially observed eyes were more at risk of developing moderate visual loss and more than 80% of them required treatment over 24 months.

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PURPOSE: To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes. DESIGN: Prospective, observational 5-year study. PARTICIPANTS: Advanced glaucoma patients with well-controlled intraocular pressure (IOP), mean deviation (MD) of the Humphrey Field Analyzer (HFA) 24-2 program ≤-20 dB and best-corrected visual acuity (BCVA) of 20/40. METHODS: The HFA 10-2 test and BCVA examination were performed every 6 months, and the HFA 24-2 test was performed every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA 10-2 and 24-2 results and BCVA. MAIN OUTCOME MEASURES: Deterioration of HFA 10-2 results was defined by the presence of the same ≥3 points with negative total deviation slope ≤-1 dB/year at P < 0.01 on ≥3 consecutive tests, deterioration of HFA 24-2 results by an increase ≥2 in the Advanced Glaucoma Intervention Study score on ≥2 consecutive tests, and deterioration of BCVA by an increase of ≥0.2 logarithm of the minimum angle of resolution (logMAR) on ≥2 consecutive tests. RESULTS: A total of 175 eyes of 175 patients (mean age, 64.1 years; mean baseline IOP, 13.2 mmHg; mean BCVA, 0.02 logMAR; mean HFA 24-2 and 10-2 MD, -25.9 and -22.9 dB, respectively) were included. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 ± 0.043 (standard error), 0.173 ± 0.031, and 0.194 ± 0.033, respectively, at 5 years. Lower BCVA at baseline (P = 0.012) was associated significantly with further deterioration of HFA 10-2 results. Better HFA 24-2 MD (P < 0.001) and use of systemic antihypertensive agents (P = 0.009) were associated significantly with further deterioration of HFA 24-2 results, and a greater ß-peripapillary atrophy area-to-disc area ratio (P < 0.001), use of systemic antihypertensive agents (P = 0.025), and lower BCVA (P = 0.042) were associated significantly with further deterioration of BCVA, respectively. CONCLUSIONS: In advanced glaucoma eyes with well-controlled IOP, BCVA, ß-peripapillary atrophy area-to-disc area ratio, and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function.

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PURPOSE: To describe the incidence of and risk factors for visual acuity (VA) loss in patients with AIDS and cytomegalovirus (CMV) retinitis. METHODS: A total of 132 patients were included. The main outcome measurements were the incidences of VA loss to ≤20/50 and ≤20/200. RESULTS: The incidences of VA loss to ≤20/50 and ≤20/200 were 0.22/eye-year (EY) and 0.12/EY, respectively. Risk factors for the incidence of VA loss to ≤20/50 were low nadir CD4+ T-cell count (adjusted hazard ratio [aHR], 3.1), large area of retinitis (aHR, 3.7), and no immune recovery (IR) (aHR, 13.9). Risk factors for the incidence of VA loss to ≤20/200 were not receiving highly active antiretroviral therapy (HAART) (aHR, 4.4) and large retinitis area (aHR, 2.1). CONCLUSIONS: The incidence of VA loss in eyes affected by CMV retinitis was high. The use of HAART, particularly with subsequent immune recovery, substantially reduced the incidence of VA loss.

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Objective A 10 year old presented with painless loss of vision as the first manifestation of neurofibromatosis 1 (NF1). Clinical assessment detected diagnostic features of NF1 and Magnetic Resonance Imaging (MRI) scan confirmed presence of plexiform neurofibroma and bilateral optic pathway glioma (OPG). The child was managed with chemotherapy which helped in improvement of vision. Review of current literature recommends vision testing in diagnosed cases of NP1 till 7 years of age; this is aimed at detecting visual impairments resulting from a symptomatic OPG.

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Excimer laser photorefractive keratectomy(PRK) has been used as a good treatment modality for myopia. However many surgeon reported its complications, especially loss of best corrected visual acuity(BCVA) after PRK with an incidence of 0~12%. Thus we studied the causes and incidence of BCVA loss in myopic eyes that were followed up at least 12 months after PRK. We defined `BCVA loss` as 2 or more lines decrease by Snellen chart comparing to preoperative visual acuity. We found that 16 of 313 eyes(5.1%) lost BCVA during follow up period after PRK. High myopes, 8.25diopters or more, developed BCVA loss(8.8%) more commonly than myopes below 8.00 diopters(3.3%) (P<0.05). But BCVA loss recovered after post-operative 2 years except one eye. The causes of BCVA loss were corneal haze, irregular astigmatism, incidental cataract and steroid-induced glaucoma. According to the corneal haze scoring, average corneal haze was greater in eyes(1.47 score) with BCVA loss than eyes(0.36) without BCVA loss (P<0.01). However average cornea haze score in eyes with BCVA loss gradually decreased with time.As a result, main causes of BCVA loss after PRK was corneal haze, irregular astigmatism. High myopia more than 8.25 diopters showed greater BCVA loss than myopia less than 8.00diopters after PRK, but BCVA loss recovered with time.

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