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PubMed1993

Discrepancy in the evaluation of visual impairment of elderly low-vision patients by general eye care practitioners and by low-vision practitioners.

Levels of impairment and disability determine eligibility for different welfare programs for visually handicapped persons. General eye care practitioners have to determine the level of impairment for administrative purposes, whereas the low-vision practitioner measures the level of impairment in order to plan the rehabilitation program. We compared the severity of visual impairment reported by the referring practitioners and the one reported by the low-vision specialists for the population of elderly low-vision patients receiving care from one of the largest rehabilitation centers for the visually handicapped in Quebec. Visual acuity ratings reported by general practitioners are lower than those reported by low-vision practitioners. The presence of visual handicap is generally well identified but the severity of visual impairment according to the World Health Organization (WHO)'s categories is not properly gauged by the general eye care practitioners as expressed by the sensitivity and the positive predictive value of the classification of the general practitioners in respect to the classification of the low-vision optometrists. The need to use existing standardized methods to measure visual acuity (VA) is emphasized. It may be hypothesized that this overestimation of the severity of the visual condition may have a negative impact on the process of rehabilitation of the elderly.

Aged↗
PubMedDate not supplied

Low vision rehabilitation: visual acuity measurement in the low vision range.

1. To predict function and prescribe low vision aids, accurate measurements are needed. The routine measurement range can be extended by moving test charts normally used at 20 ft to a closer distance; 1 m is recommended, which gains a factor of 6. 2. Some practitioners recommend testing all reading at a standard distance, but they differ in the distances they recommend. Using a variable distance and recording the distance with every measurement allows for patients' preferred distances. 3. If the distance and letter size are properly recorded, the same visual acuity score should be calculated for all distances. Inches and J numbers, the most prevalent measurements, make visual acuity calculations impossible, but by adopting metric measurements, calculations are far easier.

Distance Perception↗
PubMed1993

Reading with low vision.

Most low vision patients express a desire to read standard print as easily and as quickly as possible. There are a multitude of visual factors that can interfere with reading, yet we have only an incomplete understanding of these factors. These include the relationship between acuity, magnification, and reading performance, the role of eye movements in low vision reading, and the effect of central scotomas on reading performance. We describe current research in each of these areas, and discuss their potential clinical implications.

Eye Movements↗
PubMed1982

Residual vision in the low vision patient--some concepts.

The ability to function with residual sight--visual ability--varies widely among individuals with low vision. The theoretical nature of visual ability, however, is poorly understood. Various components of visual ability are defined in an attempt to advance the understanding of this subject.

Blindness↗
PubMed1992

Vision assessment and rehabilitation in low vision.

This subjective review of the year's literature on low vision, with particular emphasis on rehabilitation, attempts to search out and discuss what is new and innovative rather than to cover the year's publications with equal weight. The review covers areas of testing and assessment of children and the multiply impaired with low vision, vision stimulation, low vision aids and devices, approaches in congenital and acquired nystagmus, potential advances in high-technology applied to low vision, and psychological and educational aspects including lighting requirements for the elderly.

Disability Evaluation↗
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↗
PubMed1986

Ten years' experience in low vision practice.

The Low Vision Clinic at the Palmerston North Hospital has now been operating for 10 years. Over the course of these ten years a number of factors have emerged which can be as readily applied to general ophthalmological practice as to low vision practice. The philosophy of low vision care is one of which all ophthalmologists should be aware and includes factors to be taken into account when dealing with children, people in the workplace, and everyday factors involved in daily living activities, all of which are equally relevant in routine ophthalmological practice. This paper endeavours to share some thoughts on these factors and also discusses means by which the visually handicapped can be helped in areas where specialist low vision services are not readily available.

Humans↗
PubMed2006

Reading aids for adults with low vision.

BACKGROUND: The purpose of low vision rehabilitation is to allow people to resume or to continue to perform daily living tasks, reading being one of the most important. This is achieved by providing appropriate optical devices and special training in the use of residual vision and low vision aids, which range from simple optical magnifiers to high power video magnifiers. OBJECTIVES: The objective of this review was to assess the effects of reading aids for adults with low vision. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library, MEDLINE, EMBASE, SIGLE, LILACS, IndMed to July 2006 and the reference lists of relevant articles. We used the Science Citation Index to find articles that cited the included studies and contacted investigators and manufacturers of low vision aids. We handsearched the British Journal of Visual Impairment from 1983 to 1999 and the Journal of Visual Impairment and Blindness from 1976 to 1991. SELECTION CRITERIA: This review included randomised and quasi-randomised trials in which any device or aid used for reading had been compared to another device or aid in people aged 16 or over with low vision as defined by the study investigators. DATA COLLECTION AND ANALYSIS: Each author independently assessed trial quality and extracted data. MAIN RESULTS: Eight small studies with a cross-over design (221 people overall) and one three parallel-arm study (243 participants) were included in the review. The cross-over studies evaluated various types of aids. The quality of the studies was unclear in most cases, especially concerning carry-over or period effects. In one study on 20 participants head-mounted electronic devices (four types) were worse than optical devices. We could not find any differences in comparisons among electronic devices when pooling 23 participants of two small studies. One study on 10 people found that overlay coloured filters were no better than a clear filter. A parallel-arm study including 243 patients with age-related macular degeneration found that custom or standard prism spectacles are not different from conventional near spectacles, but the estimated difference was not precise. AUTHORS' CONCLUSIONS: Further research is needed on the comparison of different types of low vision aids. It will be also necessary to delineate patient's characteristics that predict performance with costly electronic devices as well as their sustained use in the long term compared to simpler and cheaper optical devices.

Adult↗
PubMed1997

Evaluating the value of low-vision services.

BACKGROUND: Low-vision care is a widely accepted and valued service provided by many optometrists. As in other areas of health care, evaluation of the outcome of low-vision care is increasingly necessary so it can be properly positioned in the health care delivery system. METHODS: This article reviews the literature relating to the prevalence of low vision, its impact on affected individuals, and how low-vision intervention affects those with visual impairments. This review considers the ways in which the impact of low-vision care has been evaluated. RESULTS: The existing literature demonstrates that low-vision intervention can be highly valued by low-vision patients and can have a significant impact on an individual's daily life and activities. Evaluating this impact is a significant challenge-particularly if the goal is to gauge the outcome of low vision care as broadly as possible. CONCLUSIONS: Evaluation of health-related quality of life is a desirable option for evaluation of outcomes, and the application of quality of life instruments to the visually impaired population is necessary. There remain unresolved issues of optometric research that need to be addressed.

Delivery of Health Care↗
PubMed1976

The role of eye pathology in low vision evaluation.

The low vision patient's ultimate function and ability to profit from his rehabiliation are influenced by his eye disease. A discussion of low vision patient management uses as a basis the observation that greater success is evidenced when the low vision patient is treated in the context of his eye disease, visual acuity and his subsequent adjustment problems. The diagnosis, visual acuity and the visual field are explored as elements of a functional classification. The author classifies eye diseases according to the pattern of visual field loss: no loss of visual field; central or macular field loss; peripheral or perimacular field loss. Visual characteristics are then elaborated and case management is suggested in the context of each category.

Eye Diseases↗
PubMed1979

Managing the low vision patient.

The low vision child has long been neglected by the professional community. A self-analysis of the usefulness of optometric service must be made as to professional attitudes and the understanding of the low vision aids as well as the patient that is expected to wear them. Once these hurdles are overcome, the optometrist is more able to help the low vision child become a productive, contributing member of society.

Child↗
PubMed1996

Low vision and surfing.

Low vision rehabilitation often concentrates on vocational and living skills training. Nonetheless, the motivation for improving reading or travel skills may be to pursue some enjoyable recreational activity. A case report of a telescopic aid for surfing is presented, emphasizing the importance of recreation in low vision rehabilitation.

Adult↗
PubMed1995

Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision.

The prevalence of visual impairment among elderly patients admitted to hospital is unknown. This group of patients may be particularly at risk from poor vision which could jeopardise their independence. A prospective study of visual imapairment and its aetiology in acute geriatric admissions assessed after the acute illness had settled was performed. Subjects were all patients aged 65 years or over, excluding those chronically confused, admitted to the Department of Geriatric Medicine at the Royal Liverpool University Hospital with an acute medical illness. After the acute illness had settled visual impairment, as defined by the American criteria (best acuity 6/18), was assessed on the ward with a Snellen chart read at 6 m using binocular vision and current glasses. Those patients identified with impaired vision on initial screening were formally assessed in the ophthalmology department to identify the cause. 200 patients were examined. 101 patients (50.5%) had impaired vision. In these patients, correctable refractive errors were present in 40%, cataract in 37% and senile macular degeneration in 14%. Of the 101 patients with impaired vision 79% had a reversible cause. Comparing these results with a recent study in the community showed a much higher incidence for patients admitted to hospital. There was a particularly high prevalence in those elderly patients who were admitted with falls (76%, p = 0.0003). In conclusion, elderly patients, especially those presenting with falls, admitted to hospital have a high prevalence of visual impairment. Visual impairment may be compounding or causing falls.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMedDate not supplied

Low vision: the forgotten treatment.

Low vision is subnormal visual acuity or abnormal visual field resulting from a disorder in the visual system that cannot be corrected with ordinary eye glasses or by medical or surgical intervention. The major causes for low vision are macular degeneration, diabetic retinopathy, glaucoma, and cataracts. Low vision devices are often helpful for all of these causes. A low vision comprehensive visual rehabilitation examination usually includes initial interviews with patients and their families, with an emphasis on the patients' goals and realistic expectations of what they want to achieve.

Aged↗
PubMedDate not supplied

Profile of a low vision clinic population.

BACKGROUND: Causes of low vision and types of low vision devices (LVDs) prescribed in other low vision clinics have been studied extensively. Similar studies have not been conducted in Malaysia. This paper reports the results of a retrospective study of 573 patients seen at the Universiti Kebangsaan Malaysia-Malaysian Association for the Blind (UKM-MAB) low vision clinic in Kuala Lumpur. METHODS: The record cards of 573 patients seen at the UKM-MAB clinic over 10 years were examined and the following information extracted: date of first consultation, age, sex, cause of visual impairment as diagnosed by an ophthalmologist and types of low vision devices (LVDs) prescribed. RESULTS: The majority of patients were from the younger age groups with 423 (73.8 per cent) less than 50 years of age. Three hundred and ninety-five (68.9 per cent) of the subjects were males and 178 (31.1 per cent) female. The main causes of low vision were congenital structural defects including nystagmus among patients in the zero to 29 years age group, retinitis pigmentosa among the 30 to 59 years age group and age-related macular degeneration (ARM) among those over 60 years of age. CONCLUSIONS: Since the majority of the patients were from the younger age group the main causes of low vision were congenital and hereditary diseases. Three hundred and forty-one (59.5 per cent) patients seen at the low vision clinic accepted the use of LVDs.

Journal Article↗