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Randomized Controlled Trial
. 2020 May 6;20(1):184.
doi: 10.1186/s12886-020-01436-7.

Visual rehabilitation of patients with corneal diseases

Michael Oeverhaus  1 , Dirk Dekowski  2 , Herbert Hirche  3 , Joachim Esser  2 , Barbara Schaperdoth-Gerlings  2 , Anja Eckstein  2
Affiliations
Randomized Controlled Trial

Visual rehabilitation of patients with corneal diseases

Michael Oeverhaus et al. BMC Ophthalmol. .

Abstract

Background: Although most patients with visual impairment due to corneal diseases can be treated successfully with surgery, some require visual rehabilitation to restore reading ability. To evaluate the best LVAs especially in terms of reading speed and characterize this specific patient group we performed a prospective, randomized cross-over trial.

Methods: All 34 patients underwent a detailed examination (slit-lamp, funduscopy, SD-OCT, ETDRS) as screening. Only patients with corneal diseases without other ocular diseases were included. Reading-speed was assessed with International-Reading-Speed-Texts (IReST) consecutively with five different LVAs (low vision aids) during one day in a randomized cross-over design. Corneal haze was quantified with corneal densitometry (Pentacam).

Results: Patients were either visually impaired (n = 28), severely impaired (n = 4) or legally blind (n = 2). Patients read significantly faster with LVAs (p < 0.0001). Fastest reading speed could be achieved with video magnifier (CCTV). Optical magnifier and portable-electronic magnifier enabled significantly lower reading speeds (p < 0.01). In a subgroup of patients (VA < 3/60,n = 6) black background enabled patients to read significantly faster compared to white background (p = 0.03).

Conclusion: Patients with low magnification requirement can be treated successfully with optical LVAs and portable-electronic magnifiers. More severely afflicted patients need a CCTV. Black background enables fastest reading-speeds, probably due to less blinding. Visual impairment can be estimated with corneal densitometry. Our trial confirms the capability of LVAs to successfully restore the reading ability in patients with corneal diseases, which is a crucial part of visual rehabilitation.

Trial registration: This trial was registered at the German Clinical Trials Register as DRKS00010887 at 09.08.2016.

Keywords: Corneal densitometry; Corneal diseases; Corneal haze; LVAs; Low vision; Low vision aids; Magnifier.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Linear Regression showed a significant correlation between the degree of corneal haze (0–100 Units, no haze – total opacification) in the central annular zone (0-6 mm) and best corrected visual acuity (BCVA)
Fig. 2
Fig. 2
Reading performance with different LVAs of (a) all 34 patients and (b) only of 6 patients with severe visual impairment (BCVA≤20/400). Subjective rating of the different LVAs of (c) all 34 patients and (d) only of 6 patients with severe visual impairment. * = p < 0.05 ** = p < 0.01 *** = p < 0.001
Fig. 3
Fig. 3
Reading performance was best predicted by (a) magnification need, but also significantly influenced by (b) the grade of corneal haze (0–100 Units, no haze – total opacification)
See this image and copyright information in PMC

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