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The development and evaluation of a reading test for low vision individuals with macular loss
70
Surv Ophthalmol
32( 1) July-August
CURRENT
1987
OPHTHALMOLOGY
patients with small and medium sized choroidal melanomas. New radiotherapeutic procedures may improve the possibilities oflocal radiotherapy by I-25 seeds and proton beam irradiation or heavy helon ions. (Author’s address: P.K. Lommatzsch. Augenklinik der Karl-Mars-Universitat, Liehigstrasse 14, DDR 7010, Leipzig, German Democratic
Republic)
Comment This article summarizes the follow-up data on 309 patients treated by one of the world’s experts on uveal melanomas using ruthenium-106 plaques over a 20-year period. From my personal experience with Dr. Lommatzsch, I have no doubt that his obser\.ations are correct and that the data are presented accurately. The strong points of the paper include the large number of cases collected by a single observer over a long period of time. The photographs illustrate the excellent response of some choroidal melanomas to this therapy. The author rightfully makes no attempt to sell his method as being superior to heavy ion radiotherapy or other methods of plaque radiotherap),. On the \Vills Eye Hospital Oncology Service we treated 907 eyes with choroidal and ciliar), hod>, melanomas with plaque therapy between February 1, 1974, and ,\larch 13, 1987. In addition to our using ruthenium106 applicators as ad\,ocated by Dr. Lommatzsch we have also employed cobalt-CO, iridium- 192, and iodine125 plaques. Our preliminary observations suggest that there are no significant differences in the type of plaque employed with regard to eflectiveness in locally controlling the melanoma. Like Dr. Lommatzsch, \ve have been quite pleased with the ruthenium plaque up to this time. The obvious (but perhaps unavoidable) weak points of the paper include the lack of‘randomization in selecting the patients for radiotherapy or enucleation. It is ine\Gtable that there was considerable selection bias in choosing patients for plaque therapy and that patients with smaller tumors in e)‘es with better vision were managed with radiotherapy while those with larger tumors were treated by enucleation. Consequently, his conclusion that the survi\.al rate in patients treated by enucleation is substantially higher is probably not correct. If appropriate statistical adjustments had been made in an attempt to elimmate selection bias and factors such as tumor size, tumor location, patient’s age, etc., it is quite possible that there would 1lai.e been no appreciable difference in tumor-related mortality between patients treated kvith ruthenium plaques and those treated by enucleation. The two studies which have specifically addressed this issue in this manner halve found no significant differences between radiotherapy and enucleation with regard to tumor-related mortalit) (Seddon Jhl et al: Am JOphthalmol.B:282-290, 1985; Augsburger J.J et al: A4rch OphthalmolIO4:655-661, 1986). Dr. Lommatzsch’s paper provides further information suggesting that radiotherapy is an ef’t‘ecti\.e method \l’e should look forward to further contributions by Dr. for treating selected posterior uveal melanomas. Lommatzsch and his colleagues in the future. JI:KKY SHIlXl)h, h1.D. P~ill..\l~l~~I.I~HI.\,
PESSS\.I>\‘ANl.\
The Development and Evaluation of a Reading Test for Low Vision Individuals with Macular Loss, by J. Baldasare, G.R. Watson, S.G. Whittaker, and H. Miller-Shaffer. J Visual Impairment Blindness, June 1986, pp 785-789 One of the crucial elements for research and rehabilitation with low \.isual individuals is an assessment instrument designed to accurately and reliably measure some particular beha\.ior or skill. The authors present an assessment instrument of \Gsual skills required for reading among patients with macular loss, along with studies designed to elraluate its reliability. Data are included to verify claims regarding the aspects of reading that are particularly problematic for such patients. In addition the authors outline techniques for efrective rehabilitation of these individuals. (Author’s address: Dr. Baldasare, Penns)-l\.ania College ofOptometry. 1200 IVest Godfrey Avenue, Philadelphia, PA 19 141)
Comment Age-related maculopathy (ARM) is the leading cause of severe xrisual impairment among the elderly. Loss of central vision due to ARhI can seriously interfere with performance ofeveryday visual tasks such as reading
CURRENT
71
OPHTHALMOLOGY
and face rvcqqni~ioti, (‘\.cti IL-hen visual acuity is onl) modcratelv afkted. In order to e\~dluiltv [ht. r+lk~ri\wtt3a ofmedical twatment and rehabilitation strategies, eve need reliable means lbr asstwing \kual perti)rmance. III this article, Mdasare et al describe a new. simple test for assrssittg reading ability in tltv \-isuall>. impaired. ‘1‘- lY8.i: and Elttw ElAl 1.1al: .1,-A Unlike previous wading tests (e.g., Ixgge GE; et al: li’.tiu~~RP.~3:25:I--b.>. ~~~~~~l~ll~~lu/ 107: 1009-101 It. 1986), the current test uws unrelated \\.ords and lt*ttcbrs to vlimitta[ts ctjntt.stual ittti~rmatiott \vhicli the patient ma)’ use to guess tlir words and thewhy mask it \.i>ual tlisal>ilit). The t*sperintent~ reportc.d in this paper clear11 demonstrate chat the ttc\v tr’st is reliahlv - tltv corwlation lxtweett test and retest scores is 0.90. But the authors haw Ilot !-ct sltowtt ho\\. the tt‘hl w>ultb arc related IO perfinmancc in cb\.er?,da>, reading tasks. Further research is uttclctx~a~ to comp,trt* tll(’ tt~u wadin? ttssl witIt standardised tests of reading ability. Accurate c’ye nio\~.3nwit conlrol can be an especially diflicult prol)leni ti)r patient> with macxlar diwasc~. The reading test is arranyd in a series of lines which progress liwlt indi\,idual ~vcll-spaced Icrrt,rs to \\ords 01‘ greater and mow x~ariahle length kvhich are spaced c~loscl~ togetht~. ii:, iii normal printvtl 1~x1. .I%(* authors argue Ihat succchsi\,c lines hecome iticrcasiqq~v diflicult li)r the patitwl v irh (x(‘-mo\ cxntc%nt~~t~~~IJl~~ttts. IHo\\.c\ et-, otiv might argucl that Ilic closer spacing and loti
Irradiation persmith,
of Meningiomas F.A.
Warren,
of the Intracranial
J. Newall,
and J. Ransohoff:
Anterior
Visual Pathway,
1,). 11 .,J. Ku-
:inr1 LVeuwl 21: 13 l-l 37. 19837
Intracranial mrnin$omas that in\rol\.e the anterior \ku;tl p;~11iwa!~ gcwt*rall! ptxwnI with insidiousI!, progressi\~c visual loss in either one or both eyes. ‘Fiz.c.ttt!. paticxts with pro~rvssi\.t. \ ihual Ios4 c~auscd 1)) intracranial metiingiomas in\wl\.ing the anterior \-isual path14 a\ were rrcatccl ln the authors 11itlt irratlialicbn alone. Improvement in \+sual performance occurred in 13 patients. T\vo patient5 cxpc~ritxlcetl (entporar! improvement and five others maintained stable \Gual function for ~111 to 9.5 \~c;ttx (tllcatt ti)llo\+,-up. ti)ul years). Radiotherapy seemed to have no effect in t\\o patients. ()tte patitwt csperienwd trIllp(JIXI’~ impro\~ement Imt eventually died from the spread of tumor. Onl>. one delinite complication of radio~herap\ occurrc*d and was related to excessive radiation dose (greater than 7000 CC;\,). Irradiation in the range of3()i)O to 5.500 cGy baas cft‘ective either alone or in combitiatioti \vith sur,gical csciGon. Serial assessment c~t‘\~isital ,ic3iit\. at~d fields allot\ us to demonstrate and quantify improvement in our pativnts ti)llowin,g radio~lt~rap~ I II contr;~s~. followup computed tomographic studies rarely cletnons~ratc~d rvduwtl tumor sizt*. l.\11111~,1~‘~ .LtltlIT\s: -\I,,J. K~ipcwtnith. 11.11.. 530 II .~LYWU~,#SH. Ntw YoA. NY IClOl(ii
Comment In most instanws radiation therapy is considered a second-liite trwtmcnt l&r mtwiqionna. ‘l‘hcs authors itr Ihirlwii. Iransictit revieb.ed their resulls in twenty patients and report improved Gsual pcrfornian~x improsement in two and stable funcCon maintained fbr neat-l\- VII I, rat3 in ii1.e othtw. R;idiarion ~li~xip) \\ 3s a complete failure in two patients. The). recommend the use 01‘ 3000 to 5300 cGy \\.hen radiariott is ittclicatetl. Carc*ful r-c.\.itz\\ 01‘ (ltt’ \.isual acuity, and \*isual Geld lindings in each of their three paticitt gt-oups is instructi\ v. \~isukil ,tcuit) In group LA>those patients who recei\.ed radiation tht,rap! as a priniar~- mode 01‘trc’alnittit. was improved iti half of the vves and was utichatigcd in tht. rvniaitider. Filiy, pc’rc~~iit (11‘tIt(s lxkric~iits shob cd impro\wi visual Lield. In qroup B, those patic.nts v-h~ had the radiation thcrap) li)r tu~ltot~ rtxurrenct ’ alivr sltrgic.,il ni,~itaqc~tilvnt~
Surv Ophthalmol
32( 1) July-August
CURRENT
1987
OPHTHALMOLOGY
patients with small and medium sized choroidal melanomas. New radiotherapeutic procedures may improve the possibilities oflocal radiotherapy by I-25 seeds and proton beam irradiation or heavy helon ions. (Author’s address: P.K. Lommatzsch. Augenklinik der Karl-Mars-Universitat, Liehigstrasse 14, DDR 7010, Leipzig, German Democratic
Republic)
Comment This article summarizes the follow-up data on 309 patients treated by one of the world’s experts on uveal melanomas using ruthenium-106 plaques over a 20-year period. From my personal experience with Dr. Lommatzsch, I have no doubt that his obser\.ations are correct and that the data are presented accurately. The strong points of the paper include the large number of cases collected by a single observer over a long period of time. The photographs illustrate the excellent response of some choroidal melanomas to this therapy. The author rightfully makes no attempt to sell his method as being superior to heavy ion radiotherapy or other methods of plaque radiotherap),. On the \Vills Eye Hospital Oncology Service we treated 907 eyes with choroidal and ciliar), hod>, melanomas with plaque therapy between February 1, 1974, and ,\larch 13, 1987. In addition to our using ruthenium106 applicators as ad\,ocated by Dr. Lommatzsch we have also employed cobalt-CO, iridium- 192, and iodine125 plaques. Our preliminary observations suggest that there are no significant differences in the type of plaque employed with regard to eflectiveness in locally controlling the melanoma. Like Dr. Lommatzsch, \ve have been quite pleased with the ruthenium plaque up to this time. The obvious (but perhaps unavoidable) weak points of the paper include the lack of‘randomization in selecting the patients for radiotherapy or enucleation. It is ine\Gtable that there was considerable selection bias in choosing patients for plaque therapy and that patients with smaller tumors in e)‘es with better vision were managed with radiotherapy while those with larger tumors were treated by enucleation. Consequently, his conclusion that the survi\.al rate in patients treated by enucleation is substantially higher is probably not correct. If appropriate statistical adjustments had been made in an attempt to elimmate selection bias and factors such as tumor size, tumor location, patient’s age, etc., it is quite possible that there would 1lai.e been no appreciable difference in tumor-related mortality between patients treated kvith ruthenium plaques and those treated by enucleation. The two studies which have specifically addressed this issue in this manner halve found no significant differences between radiotherapy and enucleation with regard to tumor-related mortalit) (Seddon Jhl et al: Am JOphthalmol.B:282-290, 1985; Augsburger J.J et al: A4rch OphthalmolIO4:655-661, 1986). Dr. Lommatzsch’s paper provides further information suggesting that radiotherapy is an ef’t‘ecti\.e method \l’e should look forward to further contributions by Dr. for treating selected posterior uveal melanomas. Lommatzsch and his colleagues in the future. JI:KKY SHIlXl)h, h1.D. P~ill..\l~l~~I.I~HI.\,
PESSS\.I>\‘ANl.\
The Development and Evaluation of a Reading Test for Low Vision Individuals with Macular Loss, by J. Baldasare, G.R. Watson, S.G. Whittaker, and H. Miller-Shaffer. J Visual Impairment Blindness, June 1986, pp 785-789 One of the crucial elements for research and rehabilitation with low \.isual individuals is an assessment instrument designed to accurately and reliably measure some particular beha\.ior or skill. The authors present an assessment instrument of \Gsual skills required for reading among patients with macular loss, along with studies designed to elraluate its reliability. Data are included to verify claims regarding the aspects of reading that are particularly problematic for such patients. In addition the authors outline techniques for efrective rehabilitation of these individuals. (Author’s address: Dr. Baldasare, Penns)-l\.ania College ofOptometry. 1200 IVest Godfrey Avenue, Philadelphia, PA 19 141)
Comment Age-related maculopathy (ARM) is the leading cause of severe xrisual impairment among the elderly. Loss of central vision due to ARhI can seriously interfere with performance ofeveryday visual tasks such as reading
CURRENT
71
OPHTHALMOLOGY
and face rvcqqni~ioti, (‘\.cti IL-hen visual acuity is onl) modcratelv afkted. In order to e\~dluiltv [ht. r+lk~ri\wtt3a ofmedical twatment and rehabilitation strategies, eve need reliable means lbr asstwing \kual perti)rmance. III this article, Mdasare et al describe a new. simple test for assrssittg reading ability in tltv \-isuall>. impaired. ‘1‘- lY8.i: and Elttw ElAl 1.1al: .1,-A Unlike previous wading tests (e.g., Ixgge GE; et al: li’.tiu~~RP.~3:25:I--b.>. ~~~~~~l~ll~~lu/ 107: 1009-101 It. 1986), the current test uws unrelated \\.ords and lt*ttcbrs to vlimitta[ts ctjntt.stual ittti~rmatiott \vhicli the patient ma)’ use to guess tlir words and thewhy mask it \.i>ual tlisal>ilit). The t*sperintent~ reportc.d in this paper clear11 demonstrate chat the ttc\v tr’st is reliahlv - tltv corwlation lxtweett test and retest scores is 0.90. But the authors haw Ilot !-ct sltowtt ho\\. the tt‘hl w>ultb arc related IO perfinmancc in cb\.er?,da>, reading tasks. Further research is uttclctx~a~ to comp,trt* tll(’ tt~u wadin? ttssl witIt standardised tests of reading ability. Accurate c’ye nio\~.3nwit conlrol can be an especially diflicult prol)leni ti)r patient> with macxlar diwasc~. The reading test is arranyd in a series of lines which progress liwlt indi\,idual ~vcll-spaced Icrrt,rs to \\ords 01‘ greater and mow x~ariahle length kvhich are spaced c~loscl~ togetht~. ii:, iii normal printvtl 1~x1. .I%(* authors argue Ihat succchsi\,c lines hecome iticrcasiqq~v diflicult li)r the patitwl v irh (x(‘-mo\ cxntc%nt~~t~~~IJl~~ttts. IHo\\.c\ et-, otiv might argucl that Ilic closer spacing and loti
Irradiation persmith,
of Meningiomas F.A.
Warren,
of the Intracranial
J. Newall,
and J. Ransohoff:
Anterior
Visual Pathway,
1,). 11 .,J. Ku-
:inr1 LVeuwl 21: 13 l-l 37. 19837
Intracranial mrnin$omas that in\rol\.e the anterior \ku;tl p;~11iwa!~ gcwt*rall! ptxwnI with insidiousI!, progressi\~c visual loss in either one or both eyes. ‘Fiz.c.ttt!. paticxts with pro~rvssi\.t. \ ihual Ios4 c~auscd 1)) intracranial metiingiomas in\wl\.ing the anterior \-isual path14 a\ were rrcatccl ln the authors 11itlt irratlialicbn alone. Improvement in \+sual performance occurred in 13 patients. T\vo patient5 cxpc~ritxlcetl (entporar! improvement and five others maintained stable \Gual function for ~111 to 9.5 \~c;ttx (tllcatt ti)llo\+,-up. ti)ul years). Radiotherapy seemed to have no effect in t\\o patients. ()tte patitwt csperienwd trIllp(JIXI’~ impro\~ement Imt eventually died from the spread of tumor. Onl>. one delinite complication of radio~herap\ occurrc*d and was related to excessive radiation dose (greater than 7000 CC;\,). Irradiation in the range of3()i)O to 5.500 cGy baas cft‘ective either alone or in combitiatioti \vith sur,gical csciGon. Serial assessment c~t‘\~isital ,ic3iit\. at~d fields allot\ us to demonstrate and quantify improvement in our pativnts ti)llowin,g radio~lt~rap~ I II contr;~s~. followup computed tomographic studies rarely cletnons~ratc~d rvduwtl tumor sizt*. l.\11111~,1~‘~ .LtltlIT\s: -\I,,J. K~ipcwtnith. 11.11.. 530 II .~LYWU~,#SH. Ntw YoA. NY IClOl(ii
Comment In most instanws radiation therapy is considered a second-liite trwtmcnt l&r mtwiqionna. ‘l‘hcs authors itr Ihirlwii. Iransictit revieb.ed their resulls in twenty patients and report improved Gsual pcrfornian~x improsement in two and stable funcCon maintained fbr neat-l\- VII I, rat3 in ii1.e othtw. R;idiarion ~li~xip) \\ 3s a complete failure in two patients. The). recommend the use 01‘ 3000 to 5300 cGy \\.hen radiariott is ittclicatetl. Carc*ful r-c.\.itz\\ 01‘ (ltt’ \.isual acuity, and \*isual Geld lindings in each of their three paticitt gt-oups is instructi\ v. \~isukil ,tcuit) In group LA>those patients who recei\.ed radiation tht,rap! as a priniar~- mode 01‘trc’alnittit. was improved iti half of the vves and was utichatigcd in tht. rvniaitider. Filiy, pc’rc~~iit (11‘tIt(s lxkric~iits shob cd impro\wi visual Lield. In qroup B, those patic.nts v-h~ had the radiation thcrap) li)r tu~ltot~ rtxurrenct ’ alivr sltrgic.,il ni,~itaqc~tilvnt~