António Filipe Macedo

Investigating Unstable Fixation in Patients with Macular Disease

PURPOSE To assess the effect on visual acuity of compensating fixation instability by controlling retinal image motion in people with macular disease. METHODS Ten patients with macular disease participated in this study. Crowded and noncrowded visual acuity were measured using an eye tracking system to compensate for fixation instability. Four conditions, corresponding to four levels of retinal image motion, were tested: no compensation (normal motion), partial compensation (reduced motion), total compensation (no motion), and overcompensation (increased motion). Fixation stability and the number of preferred retinal loci were also measured. RESULTS Modulating retinal image motion had the same effect on crowded and noncrowded visual acuity (P = 0.601). When fixation instability was overcompensated, acuity worsened by 0.1 logMAR units (P < 0.001) compared with baseline (no compensation) and remained equal to baseline for all other conditions. CONCLUSIONS In people with macular disease, retinal image motion caused by fixation instability does not reduce either crowded or noncrowded visual acuity. Acuity declines when fixation instability is overcompensated, showing limited tolerance to increased retinal image motion. The results provide evidence that fixation instability does not improve visual acuity and may be a consequence of poor oculomotor control.

Smartphone, tablet computer and e-reader use by people with vision impairment.

Consumer electronic devices such as smartphones, tablet computers, and e‐book readers have become far more widely used in recent years. Many of these devices contain accessibility features such as large print and speech. Anecdotal experience suggests people with vision impairment frequently make use of these systems. Here we survey people with self‐identified vision impairment to determine their use of this equipment.

The effect of retinal image slip on peripheral visual acuity

Retinal image slip promoted by fixational eye movements prevents image fading in central vision. However, in the periphery a higher amount of movement is necessary to prevent this fading. We assessed the effect of different levels of retinal image slip in peripheral vision by measuring peripheral visual acuity (VA), with and without crowding, while modulating retinal image slip by using gaze-linked stimuli. Measurements were carried out at four isoeccentric positions at 5 and at 10 degrees eccentricity. Gaze position was monitored throughout using an infrared eyetracker. The target was presented for up to 500 msec, either with no retinal image slip, with reduced retinal slip, or with increased retinal image slip. Without crowding, peripheral visual acuity improved with increased retinal image slip compared with the other two conditions. In contrast to the previous result, under crowded conditions, peripheral visual acuity decreased markedly with increased retinal image slip. Therefore, the effects of increased retinal image slip are different for simple (noncrowded) and more complex (crowded) visual tasks. These results provide further evidence for the importance of fixation stability on complex visual tasks when using the peripheral retina.

Fixation in Patients with Juvenile Macular Disease

Purpose. The instability of fixation with central scotoma has been mainly studied in patients with age-related macular diseases (MDs). However, early macular lesions can lead to different characteristics of fixation. The aim of this work was to study fixation in patients with juvenile MD. Methods. Eye movements of 10 patients and 10 controls were monitored during fixation. Visual fields were assessed by static perimetry to determine the extent of the field defects. Eye movements were separated into saccades and drifts, with fixation stability assessed by bivariate contour ellipse area (BCEA). To quantify the number and location of preferred retinal loci (PRL), the kernel density estimator and expectation maximization for mixtures of gaussians were used. Results. Patients have worse fixation stability than controls and large BCEAs resulted in more than one PRL. It was found that central field defects (10°) have negative correlation with the size of BCEA. In addition, the meridian of saccades during fixation was correlated with the meridian inter-PRL. Conclusions. Patients with juvenile MDs have large BCEAs, frequently associated with two PRL. Similar results had been found for patients with age-related MDs. Also, the meridian of involuntary saccades during fixation was found to be correlated with the location of PRLs, suggesting a useful role of these movements in alternating between them.

Electronic books as low vision aids

Every year, around 34 000 people in England and Wales are newly registered as sight impaired or severely sight impaired, the majority of whom have some residual vision.1 In order to read books, people with low vision will generally rely on large print books and supplementary optical2 or electronic3 magnifiers. Only about 1.5% of the approximately two million books currently in print are available in large print format.4 Recently, several electronic book readers have become commercially available.5 These consist of a low glare electronic paper screen and internal memory, which can typically hold the full text of between 150 and 2000 full-length novels. Electronic paper has a wide viewing angle of …

Visual and health outcomes, measured with the activity inventory and the EQ-5D, in visual impairment

Generic instruments to assess health utilities can be used to express the burden of health problems in widely used indexes. That is in contrast with what can be obtained with condition‐specific instruments, outcomes are very specific and difficult to compare across conditions. The purpose of this study was to assess health and visual outcomes and its determinants in patients with visual impairment (VI) using the EQ‐5D‐3L and the Activity Inventory (AI).

Diffusion of anti-VEGF injections in the Portuguese National Health System

Objectives To analyse the temporal and geographical diffusion of antivascular endothelial growth factor (anti-VEGF) interventions, and its determinants in a National Health System (NHS). Setting NHS Portuguese hospitals. Participants All inpatient and day cases related to eye diseases at all Portuguese public hospitals for the period 2002–2012 were selected on the basis of four International Classification of Diseases 9th revision, Clinical Modification (ICD-9-CM) codes for procedures: 1474, 1475, 1479 and 149. Primary and secondary outcome measures We measured anti-VEGF treatment rates by year and county. The determinants of the geographical diffusion were investigated using generalised linear modelling. Results We analysed all hospital discharges from all NHS hospitals in Portugal (98 408 hospital discharges corresponding to 57 984 patients). National rates of hospitals episodes for the codes for procedures used were low before anti-VEGF approval in 2007 (less than 12% of hospital discharges). Between 2007 and 2012, the rates of hospital episodes related to the introduction of anti-VEGF injections increased by 27% per year. Patients from areas without ophthalmology departments received fewer treatments than those from areas with ophthalmology departments. The availability of an ophthalmology department in the county increased the rates of hospital episodes by 243%, and a 100-persons greater density per km2 raised the rates by 11%. Conclusions Our study shows a large but unequal diffusion of anti-VEGF treatments despite the universal coverage and very low copayments. The technological innovation in ophthalmology may thus produce unexpected inequalities related to financial constraints unless the implementation of innovative techniques is planned and regulated.

Using endogenous saccades to characterize fatigue in multiple sclerosis

PURPOSE Multiple Sclerosis (MS) is likely to cause dysfunction of neural circuits between brain regions increasing brain working load or a subjective overestimation of such working load leading to fatigue symptoms. The aim of this study was to investigate if saccades can reveal the effect of fatigue in patients with MS. METHODS Patients diagnosed with MS (EDSS<=3) and age matched controls were recruited. Eye movements were monitored using an infrared eyetracker. Each participant performed 40 trials in an endogenous generated saccade paradigm (valid and invalid trials). The fatigue severity scale (FSS) was used to assess the severity of fatigue. FSS scores were used to define two subgroups, the MS fatigue group (score above normal range) and the MS non-fatigue. Differences between groups were tested using linear mixed models. RESULTS Thirty-one MS patients and equal number of controls participated in this study. FSS scores were above the normal range in 11 patients. Differences in saccade latency were found according to group (p<0.001) and trial validity (p=0.023). Differences were 16.9ms, between MS fatigue and MS non-fatigue, 15.5ms between MS fatigue and control. The mean difference between valid and invalid trials was 7.5ms. Differences in saccade peak velocity were found according to group (p<0.001), the difference between MS fatigue and control was 22.3°/s and between MS fatigue and non-fatigue was 12.3°/s. Group was a statistically significant predictor for amplitude (p<0.001). FSS scores were correlated with peak velocity (p=0.028) and amplitude (p=0.019). CONCLUSION Consistent with the initial hypothesis, our study revealed altered saccade latency, peak velocity and amplitude in patients with fatigue symptoms. Eye movement testing can complement the standard inventories when investigating fatigue because they do not share similar limitations. Our findings contribute to the understanding of functional changes induced by MS and might be useful for clinical trials and treatment decisions.

The Effect of Religious Clothing on Gaze Behavior : An Eye-Tracking Experiment

ABSTRACT There are very few experimental studies regarding religious clothing. In the current study, we hypothesized that the function of conservative clothing hiding female curvaceous body features is to restrict visual access and consequently decreases female physical attractiveness. Using eye-tracking, we quantified dwell times and number of fixations on religious clothing, ranging from conservative to liberal. Results showed that conservative religious clothing decreased visual access to female curvaceous body features and instead focused visual attention to the head/face region. Results were discussed in terms of the roles of conservative clothing in women’s clothing choice, men’s mate retention tactics, and parent-offspring conflict over mate choice.

The use of informal care by people with vision impairment

Purpose To estimate and characterize the use of informal care by people with vision impairment in Portugal. Methods A total of 546 visually impaired individuals were recruited from Portuguese hospitals. Clinical information was obtained from medical records, socio-demographic details and informal care use were collected during face-to-face interviews. In addition, participants responded to a functional vision questionnaire (activity inventory) to assess their visual ability. Logistic regression was used to determine independent factors associated with informal care use and linear regression was used to determine independent predictors of intensity of informal care use. Results Informal care was reported by 39.6% of the participants. The probability of reporting informal care was higher in non-married, those with comorbidities, with lower visual ability and worse visual acuity. The median number of caregivers’ hours per year was 390 (mean = 470; 95%CI = 488–407), which represent a median opportunity cost of €2,586. Visual ability was the only independent predictor of number of hours of informal care received. Conclusions Informal care was frequently used by individuals with impaired vision. Improving visual ability of people with impaired vision when performing valued activities may reduce the burden of visual loss at personal and societal level. This could be achieved with person-centred visual rehabilitation.