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PubMed2004

Perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh.

PURPOSE: To determine the distribution of perceived visual ability for functional vision performance among persons with low vision in the Indian state of Andhra Pradesh. METHODS: As part of a population-based epidemiologic study, the Andhra Pradesh Eye Disease Study (APEDS), a 16-item visual function questionnaire was designed and applied to 7363 persons older than 15 years, to record the levels of difficulty perceived by the subjects. Of these, 123 persons were found to have low vision. Rasch analysis was used to convert the ordinal difficulty ratings of these 123 persons into interval measures of perceived visual ability for functional vision. RESULTS: Content validity of the questionnaire was demonstrated by good separation indices (3.17 and 5.44) and high reliability scores (0.91 and 0.97) for person and item parameters. Construct validity was shown with model fit statistics. Criterion validity of the questionnaire was shown by good discrimination among the general vision ratings. The functional situation that required the least visual ability was "reaching an object farther or closer than you thought"; the situation requiring the most visual ability was "recognizing small objects." Bivariate regression analysis determined that for every unit of logMAR visual acuity, perceived visual ability for functional vision decreased by 2.9 logit, which could explain 32% of the variability in the person measure. CONCLUSIONS: The described assessment, across a range of visual problems, is a valid way to measure perceived ability for functional vision in persons with low vision. Perceived visual ability varies with every unit of logarithm of the minimum angle of resolution (logMAR) visual acuity.

Adolescent↗
PubMedDate not supplied

Acquisition and integration of low vision assistive devices: understanding the decision-making process of older adults with low vision.

The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants' narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.

Aged↗
PubMed1999

Providing timely and ongoing vision rehabilitation services for the diabetic patient with irreversible vision loss from diabetic retinopathy.

BACKGROUND: Diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the United States among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses. CASE REPORTS: After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems. CONCLUSIONS: The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.

Adult↗
PubMed2006

[Comparing the effects of cataract surgery on vision function in the first eye with that in the second eye measured by the questionnaire of vision function].

PURPOSE: To compare the outcomes of phacoemulsification with intraocular lens implantation on vision function in the first eye with that in the second eye in one week after surgery measured by the questionnaire of vision function. METHODS: Forty-seven patients who underwent phacoemulsification with intraocular lens implantation in both eyes, were interviewed by the questionnaire of vision function. Meanwhile, the clinical outcomes were obtained before surgery and one week after surgery. RESULTS: The scores of vision function and its subscales in one week after the first eye surgery were higher than that before surgery, and in one week after the second eye surgery the scores of the vision function, peripheral vision and depth perception were higher than that before the second eye surgery. The scores of limitation in everyday activities and sensory adaptation didn't change significantly. CONCLUSION: The vision function improved after phacoemulsification with intraocular lens implantation in the first or the second eye surgery, and only the peripheral vision and depth perception improved after the second eye surgery.

Aged↗
PubMed2001

Vision multiplexing: an engineering approach to vision rehabilitation device development.

Multiplexing is the transmission of two or more messages simultaneously over the same communication channel in a way that enables them to be separated and used at the receiving end. The normal visual system provides us with a very wide field of view at an apparent high resolution. The wide field of view is continuously monitored at a low resolution, providing information for navigation and detection of objects of interest. These objects of interest are sampled over time using the high-resolution fovea. Most disabling visual conditions impact only one of the components, the peripheral low-resolution wide field or the central high-resolution fovea. The loss of one of these components prevents the interplay of central and peripheral vision needed for normal function and causes disability. Traditionally low-vision aids replace or supplement the missing function, but usually at a cost of a significant loss in the surviving function. For example, magnifying devices increase resolution but reduce the field of view, whereas minifying devices increase the field of view but reduce resolution. A proposal to resolve many of the problems of current visual aids by exploring a general engineering approach--vision multiplexing--that takes advantage of the dynamic nature of human vision is presented. Vision multiplexing seeks to provide both the wide field of view and the high-resolution information in ways that could be accessed and interpreted by the visual system. This paper describes the use of optical methods and computer technologies in the development of a number of new visual aids, all of which apply vision multiplexing to restore the interplay of central and peripheral vision using eye movements in a natural way.

Biomedical Engineering↗
PubMed2001

Preliminary investigation of the responsiveness of the Melbourne Low Vision ADL index to low-vision rehabilitation.

PURPOSE: To conduct a preliminary investigation on the ability of the Melbourne Low Vision ADL Index to detect changes in functional ability as a result of low-vision rehabilitation. METHODS: Twenty two subjects with age-related macular degeneration (ARMD) who were newly referred to the Kooyong Low Vision Clinic were recruited. The Melbourne Low Vision ADL Index was administered prerehabilitation and postrehabilitation. Changes in scores and effect size statistics were analyzed. RESULTS: The median total score for the subjects prerehabilitation was 67, and the median total score postrehabilitation was 76. The difference in prerehabilitation and postrehabilitation scores was statistically significant (Wilcoxon signed rank test = 248.5, p < 0.001). The mean change score for the total Melbourne Low Vision ADL Index was 9.3 (SD, 5.6). Thus the overall effect size statistic (mean change score divided by SD of prerehabilitation score) was 0.78. CONCLUSIONS: This preliminary investigation indicates that the Melbourne Low Vision ADL Index is responsive to a rehabilitation program for patients with ARMD. It has potential to be used as a measure of low-vision rehabilitation outcomes.

Activities of Daily Living↗
PubMed2006

Measuring outcomes of vision rehabilitation with the Veterans Affairs Low Vision Visual Functioning Questionnaire.

PURPOSE: To evaluate the sensitivity to change, in patients who undergo vision rehabilitation, of the Veteran Affairs (VA) Low Vision Visual Functioning Questionnaire (LV VFQ-48), which was designed to measure the difficulty visually impaired persons have in performing daily activities and to evaluate vision rehabilitation outcomes. METHODS: Before and after rehabilitation, the VA LV VFQ-48 was administered by telephone interview to subjects from five sites in the VA and private sector. Visual acuity of these subjects ranged from near normal to total blindness. RESULTS: The VA LV VFQ exhibited significant differential item functioning (DIF) for 7 of 48 items (two mobility tasks, four reading tasks, and one distance-vision task). However, the DIF was small relative to baseline changes in item difficulty for all items. Therefore, the data were reanalyzed with the constraint that item difficulties do not change with rehabilitation, which assigns all changes to the person measure. Subjects in the inpatient Blind Rehabilitation Center (BRC) program showed the largest changes in person measures after vision rehabilitation (effect size = 1.9; t-test P < 0.0001). The subjects in the outpatient programs exhibited smaller changes in person measures after rehabilitation (effect size = 0.29; t-test P < 0.01). There was no significant change in person measures for the control group (test-retest before rehabilitation). CONCLUSIONS: In addition to being a valid and reliable measure of visual ability, the VA LV VFQ-48 is a sensitive measure of changes that occur in visual ability as a result of vision rehabilitation. Patients' self-reports of the difficulty they experience performing daily activities measured with this instrument can be used to compute a single number, the person measure that can serve as an outcome measure in clinical studies. The VA LV VFQ-48 can be used to compare programs that offer different levels of intervention and serve patients across the continuum of vision loss.

Activities of Daily Living↗
PubMed2001

The development of the Melbourne low-vision ADL index: a measure of vision disability.

PURPOSE: To develop a new test of activities of daily living (ADLs) appropriate for the low-vision population: the Melbourne Low-Vision ADL Index (MLVAI). METHODS: The MLVAI was designed as a desk-based clinical assessment, comprising 18 observed items on complex ADLs in part (a) and 9 questions on broad self-care ADLs in part (b). Each item was rated on a five-level descriptive scale from 0 to 4, based on independence, speed, and accuracy of performance. It was designed to be administered under standardized conditions with regard to the instructions, illumination, and working distances. The validity and reliability of the new MLVAI was determined for 122 subjects who were representative of the general low-vision population, in a cross-sectional study. RESULTS: Two items were found to be redundant and were eliminated from the test. Thus, the final test comprised 25 items, with 100 being the highest possible score. Cronbach's alpha indicated an internal reliability of 0.96, and an intraclass correlation coefficient indicated an overall reliability of 0.95. The SE of measurement was 4.5. According to Spearman's correlation coefficient, the test-retest reliability was 0.94 (P < 0.001), and the interpractitioner reliability for five different pairs of practitioners was 0.90 or higher (P < 0.001). With regard to validity, there was a moderately high correlation with vision impairment (r = -0.68, P < 0.001). Using Rasch analysis, content validity was also demonstrated by good separation indexes (4.70 and 9.88) and high reliability scores (0.96 and 0.99) for the person and items parameters, respectively. Separate calculation of indexes and reliability scores for parts (a) and (b) indicated high content validity and reliability of each part. However, the separation indexes and reliability scores were higher for part (a) than for part (b). The correlation coefficient for part (a) and part (b) was 0.68. CONCLUSIONS: The MLVAI is a highly valid and reliable standardized test of ADL performance for the general low-vision population. It may be used to assess patients with low vision and has the potential to be used as a measure of low-vision rehabilitation outcomes.

Activities of Daily Living↗
PubMed2006

[Colour vision and acquired colour vision disturbances. Part I: basic aspects].

Colour vision is the most sensitive sensory ability of the human eye, making it possible to distinguish several million nuances of colour. The physiology of colour vision has meanwhile been researched in depth, including the genetic and biochemical principles. This knowledge has facilitated a better understanding of the results of clinical tests on colour vision. These clinical tests provide useful information on the aetiology of very different clinical pictures in ophthalmology and as such are important for the diagnosis of these diseases. Acquired colour vision deficiencies in patients with systemic vascular disease are early signs of dysfunctional microcirculation and play a role in the early diagnostic work-up. Part I of this review summarizes the basic principles of colour vision and its disturbances. Congenital and acquired colour vision disturbances are distinguished. The second part then describes the most commonly employed examination procedures to assess colour vision.

Color Perception↗
PubMed2007

[Validity of a web-based color vision test for screening examinations of color vision].

BACKGROUND: With standardized examination conditions, a web-based color vision test using pseudoisochromatic color plates can deliver test results comparable to those yielded by conventional color vision tests. The aim of the study is to analyze to what extent a web-based color vision test can be used as a screening test on the internet after visual monitor calibration. METHODS: A German-language web-based color vision test with 25 pseudoisochromatic color plates based on the color plates of Velhagen and Broschmann and of Ishihara was developed, which can be seen at http://www.farbsehtest.de. Volunteers were recruited by means of specific information distributed on the internet, in various print media, and on the radio. RESULTS: Over a period of 12 months, 2,126 of the initial volunteers [541 women and 1,588 men; mean age 34.27 (+/-14.1) years] with a valid test result for 25 color plates performed the web-based color vision test, 1,700 (506 women and 1,194 men) of whom passed it. Of the 426 volunteers who did not pass the test, 32 were women and 394, men. Counter-testing was performed on 101 volunteers (34 women and 67 men) with a mean age of 36.74 (+/-11.6) years. CONCLUSIONS: The results recorded in the patients who underwent counter-testing suggest that, if handled correctly, the web-based color vision test can be used as a color vision screening test on the internet.

Adolescent↗
PubMed1998

A systems model for low vision rehabilitation. II. Measurement of vision disabilities.

BACKGROUND: This study presents and tests a method of measuring vision disabilities. Based on the model presented in the first paper of this series, cognitive and motor activities ("tasks") are organized in a hierarchy that identifies the tasks' behavioral goals (purposes) and the social objectives the goals serve. Two latent variables important to the definition of vision disability are identified: "value of living independently" and "visual ability for independent living." The basic principles of the Rasch measurement model are reviewed, and Rasch models are used to measure the two variables that define vision disability. The need for rehabilitation to meet each goal is represented by "rehabilitative demand," a mathematical function of the measurements made of the value and difficulty of achieving each goal independently. METHODS: Over 400 patients with low vision rated both the importance and difficulty of independently achieving each of 24 goals. Rasch analysis was used to derive interval measures of the social value of each goal, the value that individual patients placed on each goal relative to the derived social definition of independence, the visual ability required to achieve each goal without help, and the visual ability of individual patients to live independently. A rehabilitative demand function was ascertained from the judgments of 17 AAO Diplomates in Low Vision through triadic comparisons and multidimensional scaling. RESULTS: Self-care had the greatest "social value" for independence; performing music had the least. Recreational reading required the greatest "visual ability" to accomplish independently; self-care required the least. Rehabilitative demand was linear with value and nonmonotonic with difficulty. CONCLUSIONS: Rehabilitative demand, an algorithm for defining vision disability, incorporates interval measures of visual ability and the value of independent living estimated from patient-based assessments, a social scale of the value of activities relative to independent living, and a consensus opinion of low vision experts on the prioritization of the need for rehabilitation.

Activities of Daily Living↗
PubMed1990

"Object vision" and "spatial vision": the neuropsychological evidence for the distinction.

The distinction between "object vision" and "spatial vision" was made by Ungerleider and Mishkin (1982) on the evidence of behavioural and neuroanatomical studies, largely with monkeys. It holds that separate cortical systems are involved, the occipito-temporal in object vision, the occipito-parietal in spatial vision. This distinction has been unquestioned; it appears as though fact in influential textbooks; but has never been subjected to critical scrutiny. Theoretically, there are substantial difficulties, for instance because during perception objects do not form a special category, apart from their features; and because shape, pattern and size are spatial features of objects. Empirically, for the monkey the behavioural distinction does not hold (because parietal cortex is not the sole cortical area involved in "spatial vision"); and in man because parietal lesions have long been known to lead to impaired perception of incomplete pictures. Moreover, although Ungerleider and Mishkin do not generalise their distinction to touch, this sense deserves consideration, given that Mishkin had earlier argued that vision and touch have a similar organisation. In touch there are direct anatomical connections between the areas serving "object touch" and "spatial touch", and both in man and in the monkey it seems established that the same region processes spatial performance in vision and in touch. Further work is needed particularly on the spatial disorder after parietal lesions: in the monkey, research has frequently been confined to one non-specific test; in man, important differences related to the laterality of the lesion, have only recently emerged. Then "spatial performance" may be found to be more closely linked to motor output than to sensory input.

Animals↗
PubMed1999

Evaluation of a new color vision test: "color vision testing made easy".

PURPOSE: A new pseudoisochromatic color plate test, "Color Vision Testing Made Easy" (CVTMET) has recently been introduced. Said to be designed for all age groups, including pre-school children, it uses the identification of simple shapes and objects to detect red-green color deficiencies. We evaluated the CVTMET to determine if the test is suitable for color vision screening of young children. METHODS: Forty-one adults predetermined to be color normal (n = 20) or to have hereditary red-green color deficiency (n = 21), served as subjects. A battery of color vision tests including the Ishihara, Panel D-15, and the anomaloscope were used for diagnosis and color deficiency classification. Subjects were then tested with Part I and Part II of the CVTMET test and results were compared to the Ishihara, Panel D-15, and anomaloscope. In addition, the CVTMET was used to screen for color vision deficiency in 152 kindergarten children 5 to 7 years of age. RESULTS: The pass/fail results for the adult subjects were the same for Parts I and II and compared favorably with the anomaloscope. There were no false positives (100% specificity) and only a few (2 of 21) false negatives (90.5% sensitivity). The two color-deficient subjects who passed the CVTMET had the mildest color deficiencies (simple deuteranomaly) and also passed the Ishihara test. Testability of kindergarten children was found to be 100%. Color vision deficiency occurred in 5.06% of the boys, which is about the same frequency found in older boys of similar ethnic background. CONCLUSION: This preliminary study indicates that the CVTMET appears to be an excellent screening instrument for red-green color deficiency in adults and has been shown to be useful for examining color vision in children 5 to 7 years of age.

Adult↗
PubMed2001

Quality of life of low-vision patients and outcomes of low-vision rehabilitation.

PURPOSE: The impact of low vision on self-reported quality of life and changes after low-vision intervention are investigated. METHODS: Literature reports from 1990 to 2000 are reviewed. RESULTS: Low vision is associated with increased risk for depression and decreased functional status and quality of life. Decreased visual acuity, visual field loss, and occasional blurred vision are also associated with decreased quality of life. Improvements in both functional status and quality of life occur after low-vision service delivery. CONCLUSIONS: Self-reported quality of life is a significant outcome measure for low-vision rehabilitation. Questionnaires that are more sensitive to rehabilitation services provided as well as patient needs and goals are required to facilitate development of rehabilitation plans and to compare techniques, devices, and programs. Attention should be given to measurement properties, validity, and reliability of instruments used currently and in development of new instruments.

Humans↗
PubMed2003

Impact of an interdisciplinary low vision service on the quality of life of low vision patients.

AIM: To investigate the impact of an interdisciplinary low vision service on the vision related quality of life of service users. METHODS: 71 patients were interviewed 2 weeks before their appointment with the service and again 6 months later to assess any changes in their vision related quality of life. The majority of these patients had age related macular degeneration. RESULTS: After contact with the service the majority of patients indicated a reduction in concern about most quality of life issues. They were significantly less anxious about deterioration of their vision, safety within the home, and coping with everyday life. CONCLUSION: Improvements in many areas of their vision related quality of life indicate that this interdisciplinary low vision service has a positive impact on the lives of service users. However many patients were still unable to carry out their preferred everyday activities, and feelings of loneliness and isolation were unchanged. The identification of issues unrelieved by input from the service will be important in planning future service delivery.

Activities of Daily Living↗
PubMed1988

Molecular basis of abnormal red-green color vision: a family with three types of color vision defects.

The molecular nature of three different types of X-linked color-vision defects, protanomaly, deuteranomaly, and protanopia, in a large 3-generation family was determined. In the protanomalous and protanopic males the normal red pigment gene was replaced by a 5' red-3' green fusion gene. The protanomalous male had more red pigment DNA in his fusion gene than did the more severely affected protanopic individual. The deuteranomalous individual had four green pigment genes and one 5' green-3' red fusion gene. These results extend those of Nathans et al., who proposed that most red-green color-vision defects arise as a result of unequal crossing-over between the red and green pigment genes. The various data suggest that differences in severity of color-vision defects associated with fusion genes are caused by differences in crossover sites between the red and green pigment genes. Currently used molecular methodology is not sufficiently sensitive to define these fusion points accurately, and the specific color-vision defect within the deutan or protan class cannot be predicted. The DNA patterns for color-vision genes of female heterozygotes have not previously been described. Patterns of heterozygotes may not be distinguishable from those of normals. However, a definite assignment of the various color pigment gene arrays could be carried out by family study. Two compound heterozygotes for color-vision defects who tested as normal by anomaloscopy were found to carry abnormal fusion genes. In addition, a normal red pigment gene was present on one chromosome and at least one normal green pigment gene was present on the other.(ABSTRACT TRUNCATED AT 250 WORDS)

Blotting, Southern↗
PubMed1999

Evaluation of the Night Vision Spectacles on patients with impaired night vision.

BACKGROUND: The Night Vision Spectacles (NiViS) were developed by a consortium of European companies to assist individuals who suffer from impaired night vision. They consist of a head-mounted video camera (input) and binocular displays (output) connected to a portable computer processor, which uses an algorithm to enhance the luminance and contrast of the video image. METHODS: Eighteen patients with impaired night vision were tested, including those with retinitis pigmentosa (7), Usher syndrome (2), fundus albipunctatus (1) and complete (4) and incomplete (4) congenital stationary night blindness. Normal trichromats (3) and typical, complete achromats (2) acted as controls. A battery of tests assessed: visual acuity at 5 m (projection unit) and 1 m (chart) and at high and low contrasts; contrast sensitivity; absolute and increment threshold; the influence of glare; contrast motion detection; and hand-eye performance. The tests were performed, with and without the NiViS, at three adaptation levels: low scotopic (10(-3) cd/m2), high scotopic (10(-2) cd/m2) and mesopic (10(-1) cd/m2). RESULTS: At the low and high scotopic levels, the majority of patients showed improved performance on the visual acuity, contrast sensitivity and motion contrast tests with the NiViS. At the mesopic level, the advantage with the NiViS was greatly reduced, but still present for contrast sensitivity. CONCLUSION: Patients with impaired night vision can benefit from the NiViS when performing tasks involving contrast and motion perception. Those with normal visual fields and retaining good photopic vision will benefit more than those with constricted visual fields and impaired cone vision. Recommendations regarding desirable improvements of the NiViS and suitability for the individual patient are given.

Adolescent↗
PubMed2000

A measure of handicap for low vision rehabilitation: the impact of vision impairment profile.

This study aims to further develop the Impact of Vision Impairment (IVI) profile into a practical, valid instrument for use in low vision rehabilitation. The IVI item pool was derived from focus groups of people with impaired vision, relevant content of existing quality of life questionnaires, and the administration of two trial versions. The second trial version of IVI was administered to 256 people who were vision impaired. Items were deleted if they were of little or no concern or were unable to be performed by most people, had moderate to high inter-item correlation, or did not contribute to a factor in the factor analysis. Two items were deleted due to floor and ceiling effects, 11 due to moderate to high inter-item correlation r> or =0.6. None were removed as a result of factor analysis. The first three factors explained 59% of the variance.This reduced version of the IVI, a tool able to determine rehabilitation needs for people who are vision impaired, will now undergo its final validation procedures.

Adult↗