Combined fovea-sparing internal limiting membrane peeling with internal limiting membrane flap technique for progressive myopic traction maculopathy

The visual acuity (VA) of patients with very low vision is classified using the semiquantitative scale "counting fingers" (CF), "hand motion" (HM), "light perception" (LP), and "no light perception." More quantitative measures would be desirable, especially for clinical studies. The results of clinical VA measurements, Early Treatment Diabetic Retinopathy Study (ETDRS) charts, and the Freiburg Visual Acuity Test (FrACT) were compared. The FrACT is a computerized visual acuity test that can present very large Landolt C optotypes when necessary. Examined were 100 eyes of 100 patients with various eye diseases (e.g., diabetic retinopathy, ARMD), covering a range of VAs from LP to decimal 0.32. The FrACT optotypes were presented on a 17-inch LCD monitor with random orientation. After extensive training, two ETDRS and FrACT measurements were obtained. The testing distance was 50 or 100 cm. ETDRS and FrACT coincided closely for VA > or = 0.02 (n = 80). ETDRS measures were successfully obtainable down to CF (at 30 cm; test-retest averaged over all patients, coefficient of variation [CV](ETDRS) = 9% +/- 8%), and FrACT provided reproducible measurements down to HM (test-retest CV(FrACT) =12% +/- 11%). For CF (n = 6), both ETDRS and FrACT resulted in a mean VA of 0.014 +/- 0.003 (range, 0.01-0.02). The VA results of FrACT for HM (n = 12) were 0.005 +/- 0.002 (range, 0.003-0.009); the individual values were highly reproducible. No results were obtainable for LP (n = 2). The three acuity procedures concur above a VA of 0.02. The results suggest that the category CF at 30 cm can be replaced by 0.014, using ETDRS or FrACT. Using FrACT, one can even reproducibly quantify VA in the HM-range, yielding a mean VA of 0.005.

To summarize the epidemiology of pathologic myopia and myopic choroidal neovascularization (CNV) and their impact on vision.

To evaluate the tomographic features of the retina in patients with severe myopia and posterior staphyloma. In a prospective study of 32 eyes of 19 consecutive patients with severe myopia and posterior staphyloma, we performed complete ophthalmic examinations and studied cross-sectional images of the macula with optical coherence tomography. Patients' age ranged from 41 to 83 years (average, 62.7 years). Best-corrected visual acuity ranged from 20/500 to 20/40 (average, 20/120). The study included 26 phakic and six pseudophakic eyes. The refractive errors of 26 phakic eyes ranged from -8 to -31 diopters (average, -16.7 diopters). Although refractive errors were within -8 diopters in six pseudophakic eyes, the eyes had apparent posterior staphyloma. The axial lengths measured by A-mode ultrasonography ranged from 25.7 to 32.7 mm (average, 29.2 mm). Slit-lamp examination with contact lens showed that none of the eyes had a macular hole. In nine eyes with shallow retinal elevation on slit-lamp examination, optical coherence tomography disclosed a foveal retinal detachment with retinoschisis in eight eyes and a foveal retinal detachment in one eye. Two of the remaining 23 eyes had retinoschisis. Foveal retinal detachment and retinoschisis are common features in severely myopic eyes with posterior staphyloma. Retinal detachment may precede the formation of a macular hole in severely myopic eyes.