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Measurement of visual function in infantile nystagmus: A systematic review

Almagren, Bader, Arblaster, Gemma, Carter, Perry, Erichsen, Jonathan ORCID: https://orcid.org/0000-0003-1545-9853, Griffiths, Helen, Harris, Christopher, Kubavat, Harshal, Kuht, Helen, Lee, Helena, McLean, Rebecca, McIlreavy, Lee ORCID: https://orcid.org/0000-0002-8986-0562, Proudlock, Frank, Ricketts, Sue, Self, Jay, Shawkat, Fatima, Theorodou, Maria, Thomas, Mervyn, Thomas, Nikita, Ward, Katherine, Woodhouse, Margaret ORCID: https://orcid.org/0000-0002-7149-5077 and Dunn, Matt J. ORCID: https://orcid.org/0000-0002-0295-2182 2023. Measurement of visual function in infantile nystagmus: A systematic review. British Journal of Ophthalmology 10.1136/bjo-2023-324254

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Abstract

Background/aims: Recent work has called into question the ability of visual acuity (VA) to accurately represent changes in visual function in infantile nystagmus (IN). This systematic review investigated factors affecting visual performance in IN, to guide development of suitable alternatives to VA. Methods: Included studies used an experimental manipulation to assess changes in visual function in people with IN. Interventional studies, case series and case studies were excluded. Six databases were searched in August 2023. Selection, detection, attrition and measurement bias were assessed. Due to heterogeneous methodologies, narrative synthesis was undertaken. Results: Eighteen relevant papers were identified, 11 of which complied with the review criteria. Articles were grouped according to the factor manipulated to evoke within-participant changes in performance (motion blur, psychological state, gaze angle or visual crowding). Optotype, image, grating and moving stimuli have been employed under varying lighting conditions and exposure duration. Conclusion: Several factors affecting visual performance should be considered when assessing visual function in IN. While maximum VA is a useful metric, its measurement deliberately minimises nystagmus-specific factors such as changes in visual performance with gaze angle and the ‘slow to see’ phenomenon. Maximum VA can be measured using the null zone, providing unlimited viewing time, reducing stress/mental load and minimising visual crowding. Gaze-dependent functional vision space is a promising measure which quantifies the impact of the null zone but does not consider temporal vision. Although no complete measurement technique has yet been proven, this review provides insights to guide future work towards development of appropriate methods.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Optometry and Vision Sciences
Publisher: BMJ Publishing Group
ISSN: 1468-2079
Date of First Compliant Deposit: 23 November 2023
Date of Acceptance: 30 October 2023
Last Modified: 16 Dec 2023 17:21
URI: https://orca.cardiff.ac.uk/id/eprint/164267

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