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L. Tarita-Nistor, E. G. Gonzalez, L. Lillakas, M. Mandelcorn, M. J. Steinbach; Visual Acuity Is Test Dependent Before and After Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4726.
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To examine changes in visual acuity before and after successful macular hole surgery, measured with three different acuity tests: a recognition test (ETDRS), and two resolution tests (Single E and Multiple E Optotype Acuity Tests).
Ten patients (mean age = 64 years, SD = 8.9) with stage IV macular hole were tested before surgery and at one and three months after surgery. Best corrected visual acuity at 1 m was measured with three acuity tests: 1) ETDRS chart, 2) Single E, and 3) in reverse polarity (computerized version). Best corrected potential visual acuity at 1 m Multiple E. The last two tests were computerized and in reverse polarity (white optotypes on black background). The Singe E test minimizes the effects of crowding while the Multiple E minimizes the effects of fixation instability while maximizing the likelihood of one of the optotypes falling on the most sensitive part of the retina. Macular hole closure was confirmed by OCT examination.
A two-way repeated measures analysis revealed that, overall, acuity improved significantly one month after surgery and continued to do so three months after surgery. Acuity measurements were test dependent: Singe E yielded significantly poorer acuity (mean = .88 logMAR) than Multiple E (mean = .49 logMAR) and ETDRS (mean = .54 logMAR) tests. Multiple E test detected the best acuity, but it was not significantly different than that measured with the ETDRS.
Visual acuity improves significantly in the early stages after successful macular hole surgery, but is test dependent. When measuring changes in visual acuity, same test should be used before and after surgery for an accurate evaluation.
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