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PubMed2004

Long-term evaluation of a health education programme for elderly persons with visual impairment. A randomized study.

UNLABELLED: In order to implement evidence-based practice, a randomized study was set up to evaluate the ADL- based Health Education Programme 'Discovering new ways' for elderly persons with age-related macular degeneration. PURPOSE: To investigate the impact of this program on perceived security in the performance of daily activities 28 months after the intervention. METHOD: Two-hundred and twenty-nine persons randomized to either the Health Education programme or an Individual Intervention Programme participated in the study. At the 28-month follow-up there was a dropout of 98 persons and the results are based on 62 persons participating in the Health Education Programme and 69 persons in the Individual Intervention Programme. RESULTS: There were statistically significant differences in perceived security between the groups in 15 out of 28 daily activities. Furthermore, the Health Education Group showed a significant tendency towards an improved level of security while the Individual Intervention Group tended to deteriorate. CONCLUSIONS: The findings provide strong support for the long-term effect of the programme and for the implementation of evidence-based practice. The study corroborates the effectiveness of the Health Education Programme in enhancing security and hindering a progressive decline in perceived security in daily activities.

Activities of Daily Living↗
PubMed2005

Using virtual environments to prototype auditory navigation displays.

There is a critical need for navigation and orientation aids for the visually impaired. Developing such displays is difficult and time consuming due to the lack of design tools and guidelines, the inefficiency of trial-and-error design, and experimental participant safety concerns. We discuss using a virtual environment (VE) to help in the design, evaluation, and iterative refinement of an auditory navigation system. We address questions about the (real) interface that the VE version allows us to study. Examples include sound design, system behavior, and user interface design. Improved designs should result from a more systematic and scientific method of assistive technology development. We also point out some of the ongoing caveats that researchers in this field need to consider, especially relating to external validity and over-reliance on VE for design solutions.

Auditory Perception↗
PubMed2007

Semantic numerical representation in blind subjects: the role of vision in the spatial format of the mental number line.

Does vision play a role in the elaboration of the semantic representation of small and large numerosities, notably in its spatial format? To investigate this issue, we decided to compare in the auditory modality the performance of congenitally and early blind people with that of a sighted control group, in two number comparison tasks (to 5 and to 55) and in one parity judgement task. Blind and sighted participants presented exactly the same distance and SNARC (Spatial Numerical Association of Response Codes) effects, indicating that they share the same semantic numerical representation. In consequence, our results suggest that the spatial dimension of the numerical representation is not necessarily attributable to the visual modality and that the absence of vision does not preclude the elaboration of this representation for 1-digit (Experiment 1) and 2-digit numerosities (Experiment 2). Moreover, as classical semantic numerical effects were observed in the auditory modality, the postulate of the amodal nature of the mental number line for both small and large magnitudes was reinforced.

Acoustic Stimulation↗
PubMed2026

VIJB: a companion of the JBROWSE genome browser for the visually impaired people.

MOTIVATION: The availability of touch-sensitive and haptic devices has been a keystone development for the inclusion of visually impaired people (VIPs) in modern, highly digitized work environments. Braille displays have proven efficient and versatile enough to parse large and complex text files, making bioinformatics and text-heavy programming accessible to VIPs. However, the complex graphical objects -combining numerous datasets- typically generated during data integration remain challenging, even with the aid of descriptive AI. This is particularly true in functional genomics. Here, we present VIJB, a simple application that displays the multilayered output of the JBROWSE genome browser on a Braille reader, enabling VIPs to fully participate in data integration in functional genomics. AVAILABILITY AND IMPLEMENTATION: VIJB is programmed in Python and relies on the scientific library NumPy, the braillegraph and pyBigWig libraries, and the TABIX software. The architecture is summarized in Supplementary Material 1, available as supplementary data at Bioinformatics online. VIJB is available for download at the GitHub repository https://GitHub.com/NiBuMNHN/VIJB and is licenced under the GPL 3.0.

Persons with Visual Disabilities↗
PubMed2004

The impact of diabetic retinopathy: perspectives from patient focus groups.

BACKGROUND: Diabetic retinopathy (DR) affects 50-85% of people with diabetes and may result in visual impairment or blindness. OBJECTIVE: This exploratory qualitative research was conducted to evaluate the symptom experience of DR, its impact on daily activities and health-related quality of life (HRQL), and the applicability of two vision-specific questionnaires. METHODS: Four focus groups (n = 15) were conducted with people with DR to explore their symptom experience and the impact on functioning and HRQL. Adults with type I or II diabetes and mild, moderate or severe non-proliferative DR (NPDR) or proliferative DR (PDR) were recruited. Content analysis and descriptive statistics were used to analyse the data. RESULTS: Participants described a range of symptoms and impact. Difficulty driving, especially at night, and trouble reading were noted with all levels of severity. Participants with PDR and decreased visual acuity have foregone many other important life aspects such as work, reading and sports. For the severely affected, diabetic care activities (e.g. exercising, reading nutritional labels, preparing insulin injections and glucose testing) were difficult to accomplish. Loss of independence, especially mobility and increased fear of accidents, had a profound impact on social activities. For those patients who had not experienced other complications of diabetes, the threat of vision loss was the most devastating. CONCLUSION: The loss of independence and mobility associated with decreased visual functioning and visual loss were major concerns. Moderate, severe NPDR and PDR associated with visual impairment have a significant impact on HRQL, particularly in the areas of independence, mobility, leisure and self-care activities.

Activities of Daily Living↗
PubMed2005

Self-reported visual function in healthy older people in Britain: an exploratory study of associations with age, sex, depression, education and income.

BACKGROUND: Tractable but undetected visual impairment in older people may be relatively common, particularly amongst the very old and in more deprived populations. Measurement of visual acuity is unlikely to be helpful in identifying this impairment, but targeted assessment of visual function may be beneficial. There is uncertainty about the defining characteristics of the target group. OBJECTIVE: To explore factors associated with self-reported visual impairment in community dwelling older people. METHODS DESIGN: secondary cross sectional analysis of baseline data from a randomised controlled trial. SETTING: three large group practices in outer London. PARTICIPANTS: older people aged 65 and over enrolled in a study of health risk appraisal. METHOD: postal questionnaire using questions from the National Eye Institute Visual Function questionnaire. RESULTS: Moderate or extreme visual function loss occurred in 4 to 12% of community-dwelling older people in this population reporting less than excellent vision, depending on which aspect of visual function is considered. Visual function loss in this subgroup increases in prevalence with advancing age, but is not associated with female sex, low educational attainment or low income. It is associated with depressed mood. CONCLUSION: Questions about visual function identify a group of older people whose vision and mental state needs further investigation.

Aged↗
PubMed2001

Interactive effect of support from family and friends in visually impaired elders.

The interactive relationship of high and low friend and family support for adaptation to chronic vision impairment was examined in 241 men and women. Two 2 (High/Low Family Support) x 2 (High/Low Friend Support) x 2 (Gender) multivariate analyses of covariance tested for psychological well-being, one with qualitative support measures, the other with quantitative support measures. Two analyses of covariance models tested for adaptation to vision loss. A significant multivariate 3-way interaction effect for qualitative support was found. Women with high support from both friends and family had better psychological well-being, whereas men with high support from both friends and family or just from family had better psychological well-being. Two univariate main effects showed that participants with high qualitative friend support and high quantitative family support had better adaptation to vision loss. Findings demonstrate the complexity of measuring and understanding relationships among social support, well-being, and domain-specific adaptation to chronic impairment.

Adaptation, Psychological↗
PubMed2005

Assistive device use in visually impaired older adults: role of control beliefs.

PURPOSE: We investigate whether psychological control, conceptually framed within the life-span theory of control by Heckhausen and Schulz, drives assistive device use in visually impaired elders. In particular, we expect the two primary control modes differentiated in the life-span theory of control (i.e., selective primary and compensatory primary control) to be positively related to assistive device use. We present cross-sectional as well as repeated measures analyses. DESIGN AND METHODS: We assessed a sample of 71 participants (age, M = 79.5 years) suffering from age-related macular degeneration at two measurement occasions covering a 1-year interval. In addition to the application of a standardized control questionnaire based on the life-span theory of control distinctions of different control modes, we measured assistive device use as the reported number of devices used, based on a given list. RESULTS: On the bivariate level, we could find the theoretically expected relation between selective primary control and selective compensatory control only for the analyses at Time 1. We used multiple regression models to acknowledge overlapping variance beneath the different control modes; we did this separately for both measurement occasions. Consistent with our expectation, we found selective primary control to be a significant predictor of assistive device use at Time 1, whereas after a 1-year period of disease progression, compensatory primary control took over at Time 2. IMPLICATIONS: Findings provide empirical support for the assumption that educational programs related to assistive device use in visually impaired elders also should take psychological control issues more strongly into consideration.

Aged↗
PubMed2003

Music interventions and group participation skills of preschoolers with visual impairments: raising questions about music, arousal, and attention.

The purposes of this pilot study were two-fold: First, to document and compare attentive behavior during music and play-based group instructional sessions and second, to document and compare 4 group participation behaviors during music and play-based sessions. The 4 group participation behaviors included facing a central speaker, following onestep directions, manipulating objects according to their function, and remaining seated. Six of the 12 children enrolled completed the study, with all participants enrolled in an early intervention program due to visual impairments. Study participants were between the ages of 4 and 6 years inclusively. Children participated in 4, 30-minute instructional sessions. Two instructional sessions were music-based and two were play-based with the 4 sessions equally distributed across a 2-week period. An ABBA design was used to control for possible order effects. Each session was videotaped to facilitate collection of behavioral data. Statistical analysis of these data revealed that attentive behavior was significantly higher during music based-sessions (t(5) = 5.81; p =.002). Mean scores for the remaining group participation behaviors were higher in the music condition, but these differences were not statistically significant. Discussion regarding differential outcomes among participants, as well as an exploration of theories related to music, arousal, and attention are discussed in an effort to guide future research.

Arousal↗
PubMed2006

Sensory impairment in older adults: part 2: Vision loss.

A decline in vision occurs naturally with age; more severe impairment can result from medical conditions such as age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. Nurses can pick up signs of visual impairment and suggest certain environmental modifications to prevent injury, such as keeping floors free of clutter and rooms well lit. Although assistive technologies such as optical devices, magnifiers, telescopes, and electronic magnification can help, some forms of impairment, such as that caused by cataracts and uncorrected refractive error, can be corrected.

Aged↗
PubMed2005

Sound lateralization test in adolescent blind individuals.

Blind individuals require to compensate for the lack of visual information by other sensory inputs. In particular, auditory inputs are crucial to such individuals. To investigate whether blind individuals localize sound in space better than sighted individuals, we tested the auditory ability of adolescent blind individuals using a sound lateralization method. The interaural time difference discrimination thresholds of blind individuals were statistically significantly shorter than those of blind individuals with residual vision and controls. These findings suggest that blind individuals have better auditory spatial ability than individuals with visual cues; therefore, some perceptual compensation occurred in the former.

Acoustic Stimulation↗
PubMed1998

Visual correlates of obstacle avoidance in adults with low vision.

This study examined how mobility performance in a heterogeneous sample of visually impaired adults relates to measures of visual sensory and perceptual function. We found that the best predictors of mobility performance under photopic and scotopic lighting conditions were models that incorporated visual field extent (VFE) and scanning ability. Together with measures of contrast sensitivity and spatial resolution, these models accounted for approximately 50% of the variance in mobility performance. We also found that VFE and scanning ability were the dominant predictor variables when the sample was broken down by subjects' type of vision loss into an acuity loss, a visual field restriction, and a combination loss group.

Adaptation, Ocular↗
PubMed1999

Study of luminance effects on pinhole test results for visually impaired patients.

PURPOSE: The visual acuity of visually impaired patients has been reported to improve after a refraction, despite pinhole test results that show a decline or no change in acuity. Our aim was to investigate whether the pinhole-induced reduction in retinal illuminance accounted for these unreliable predictions of best-corrected acuity. METHODS: Participants were 64 adult patients referred for low-vision rehabilitation. Neutral density filters reproduced the pinhole-induced luminance loss, allowing pinhole test and postrefraction acuities to be measured at essentially equivalent levels of retinal illuminance. The following data were collected in random order from each subject's better eye: (1) habitual visual acuity, (2) habitual visual acuity with filter, (3) habitual visual acuity with pinhole, (4) best-corrected/postrefraction visual acuity, (5) postrefraction visual acuity with filter. RESULTS: On average, the pinhole test under-estimated postrefraction visual acuity by six letters (95% confidence limits = +/- 20). The pinhole test underestimated postrefraction visual acuity with the filter by two letters (95% confidence limits = +/- 16). Among subjects whose acuity improved with the pinhole test (N = 24), 83% experienced better postrefraction visual acuity. Among subjects whose acuity declined or remained unchanged with the pinhole test (N = 40), 50% achieved better postrefraction visual acuity. CONCLUSIONS: The pinhole-induced luminance loss contributed to inadequate predictions of postrefraction visual acuity. Pinhole test results were enormously variable, underestimating and overestimating postrefraction visual acuity. The pinhole test was less reliable when improvements in postrefraction visual acuity were small. Visually impaired patients deserve periodic refractions, and the pinhole test result should not be used as a dichotomizer for clinical decisions regarding the need for a refraction.

Adult↗
PubMed2000

Distance telescopes: a survey of user success.

The distance telescope has a historical reputation for causing difficulties in prescribing and adaptation. Hence, we considered that a retrospective survey of patients at Nottingham Low Vision Clinic might elucidate specific attributes that influence an individual patient's success in using a distance telescope. From 142 patients prescribed distance telescopes since the Clinic's inception, 133 apparently remained users and were mailed a preliminary three-question enquiry about usage of their distance telescopes. The 87 respondents were followed up with questionnaire 2, requesting explicit information about usage, namely frequency, degree of ease or difficulty, and purpose. Older patients required higher magnification (p < 0.025). Seventeen of 74 respondents to questionnaire 2 had various adaptational problems, which are discussed; 57 of 74 patients found their distance telescopes easy to use, and 49 of 57 were frequent users. Thus, ease and frequency are linked (p < 0.05). People tended to use their distance telescopes outdoors and indoors with similar frequency (p > or = 0.29). Adaptation was found to be unrelated to visual acuity, binocularity/monocularity, ocular pathology, or restricted mobility; magnification seemed to be influential, although not significantly. Aging did not significantly impede adaptation. We infer that the universal criterion for selecting treatable patients seems to be personality type. We conclude that adaptation to a device is dependent upon active recognition of its benefits, paralleled with a tolerance of its constraints, which combine to make usage easy and regular on at least one common task.

Adaptation, Physiological↗
PubMed2001

Does mobility performance of visually impaired adults improve immediately after orientation and mobility training?

BACKGROUND: Previous studies that have attempted to determine the effect of orientation and mobility training on mobility performance of visually impaired adults have had a number of limitations. With the inclusion of a control group of subjects, this study investigated the effect of orientation and mobility training on mobility performance of a group of visually impaired adults. METHODS: Vision was measured binocularly as high- and low-contrast visual acuity, letter and edge contrast sensitivity, and Humphrey kinetic visual fields. The subjects' mobility performance was assessed as percentage preferred walking speed (PPWS) and error score before and after mobility training. RESULTS: Orientation and mobility training did not enhance mobility performance compared with the control group, who did not receive training, when performance was measured immediately after training. PPWS improved for both groups with short-term practice only, but there was no improvement in error score due to either practice or training. CONCLUSIONS: There was no immediate improvement in mobility performance of visually impaired adults after orientation and mobility training. Familiarity with the route may play an important role in measured improvement of mobility performance after orientation and mobility training.

Adaptation, Ocular↗
PubMed2002

A model of the prevalence and incidence of low vision and blindness among adults in the U.S.

Population-based vision screening studies of the prevalence rate of low vision and blindness in the U.S. are reviewed to evaluate the sources of disagreement among studies. The major reasons that studies disagree on prevalence rate estimates are differences in best-corrected visual acuity criteria for low vision and differences in the age range of the oldest age category. When corrections are made for these differences, the results of all prevalence rate studies, except the Mud Creek Valley Study, fit the same prevalence rate vs. age function. The greater prevalence rate of low vision and blindness for each age category that was observed in the Mud Creek Valley Study can be attributed to the higher prevalence rate of cataract associated with a paucity of health care services in the Mud Creek Valley population. The time-derivative of the prevalence rate vs. age function fit to the data provided an estimate of the annual incidence rate of low vision and blindness vs. age. The estimated annual incidence agreed with estimates from unpublished 8-year incidence data of the Baltimore Eye Survey. The incidence rate of low vision and blindness for Americans aged 40 to 60 years is higher among blacks than among whites. For Americans greater than age 60 years, the incidence rate for whites exceeds that for blacks. This observation probably reflects the different natural histories of glaucoma, a leading cause of low vision and blindness among black Americans, and age-related macular degeneration, a leading cause of low vision and blindness among white Americans. Using the age-dependent models of prevalence rate of low vision and blindness for white and black populations, an estimated 1.5 million Americans over age 45 years have a best-corrected visual acuity in the better eye that is < or = 20/70. Based on the incidence rate estimates, approximately 240,000 new cases of low vision and blindness occur each year. With the aging of the U.S. population, that number is expected to double over the next 25 years.

Adult↗