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Jennifer K. Sun, Lloyd Paul Aiello, Margaret Stockman, Jerry D. Cavallerano, Ann Kopple, Sharon Eagan, Haijing Qin, Craig Kollman, Roy W. Beck, Adam R. Glassman; Effects of Dilation on Electronic-ETDRS Visual Acuity in Diabetic Patients. Invest. Ophthalmol. Vis. Sci. 2009;50(4):1580-1584. doi: 10.1167/iovs.08-2426.
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purpose. To evaluate the effect of pupillary dilation on electronic-ETDRS visual acuity (EVA) in diabetic subjects and to assess postdilation EVA as a surrogate for predilation VA.
methods. DRCR.net-protocol refraction and EVA were measured before and after dilation in diabetic subjects by independent, masked examiners.
results. In 129 eyes of 66 subjects, the median (25th, 75th percentiles) predilation EVA score was 69 (54, 86) (Snellen-equivalent 20/40−1 [20/80−1, 20/20+1]). Predilation VA was ≥20/20, <20/20 to 20/40, <20/40 to 20/80, and <20/80 in 29%, 19%, 26%, and 26% of eyes, respectively. Median EVA change postdilation was −3 letters (−7, 0). The absolute change in EVA score was ≥15 letters (≥3 ETDRS lines) in 9% of eyes and ≥10 letters (≥2 ETDRS lines) in 19% of eyes. Extent of change (range +12 to −25 letters) was associated with baseline VA. No relationship was identified between EVA change and gender, race, lens status, refractive error, DR severity, or primary cause of vision loss.
conclusions. In an optimized clinical trial setting, there is a decline in best corrected EVA after dilation in diabetic subjects. The large range and magnitude of VA change preclude using postdilation EVA as a surrogate for undilated VA.
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