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R.E. Morris, P.H. Scharper, Jr, C. Witherspoon, D. Fletcher, K. Wilson, M. Harrill; Comparing the MNREAD Continuous Text Reading Score With Snellen Acuity in Assessing Visual Impairment in Patients Undergoing Macular Pucker Surgery . Invest. Ophthalmol. Vis. Sci. 2005;46(13):1918.
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INTRODUCTION: Single letter Snellen visual acuity testing has traditionally been used to functionally assess the indications for surgical treatment of macular pucker (MP). However, when queried, many patients with MP note profound loss of reading ability in the affected eye, even with relatively preserved Snellen acuity. The MNREAD acuity charts are continuous text reading acuity charts for normal and low vision which measure maximum and average reading speeds, and critical print size, the smallest print that supports the maximum reading speed. Purpose: To assess the value of the MNREAD reading test as a measure of macular dysfunction in MP, and to compare preoperative and postoperative macular function, using both Snellen acuity and the MNREAD score. MATERIALS AND METHODS: 17 consecutive patients who underwent surgery for MP were evaluated. The preop and postop Snellen acuities and reading performance using the MNREAD test were compared. FELLOW eyes were used as controls. Results: Average patient age was 69 years. Mean duration of symptoms prior to surgery was 11 months. Mean preop and postop Snellen acuities were 20/50 and 20/40, with a mean follow–up after surgery of six months. The FELLOW eye mean Snellen acuity was 20/25. Mean preop and postop MNREAD critical print sizes were 20/100 and 20/60 (p=0.02). Mean average reading speed increased by 48% from 68 wpm preop to 132 wpm postop. Mean maximum reading speed increased by 27% from 142 wpm preop to 194 wpm postop. 47% of patients were pseudophakic prior to the EMP removal; 18% of the phakic patients experienced cataract progression following surgery and underwent phacoemulsification. Conclusions: Based on the substantial reduction of MNREAD scores, despite only modest Snellen acuity loss, MP eyes received early treatment. MP eyes achieved almost a 50% increase in average reading speed postoperatively despite only a slight increase in single letter Snellen acuity. The MNREAD continuous text reading score is a more valid estimation of the macula’s ability to perform real world visual tasks than is single letter Snellen acuity. MNREAD testing should be considered to assess macular dysfunction in MP eyes, and to better plan timing of surgery. Timely surgery may prevent further permanent loss of macular function, after the macula has already become dysfunctional for normal reading tasks. The MNREAD score is also valuable in assessing postoperative visual recovery.
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