Does mobility performance of visually impaired adults improve immediately after orientation and mobility training?
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Humans↗
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Results for “Persons with Visual Disabilities”
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Driving habits and health-related quality of life in patients with age-related maculopathy.
PURPOSE: To characterize the driving habits of persons with age-related maculopathy who present to a low-vision rehabilitation clinic and to examine how driving status relates to vision-specific health-related quality of life. METHODS: The Driving Habits Questionnaire, the National Eye Institute Vision Function Questionnaire-25, and the Life Space Questionnaire were administered via telephone interview to 126 patients with age-related maculopathy who presented to a low-vision clinic during the previous year and were either past or current drivers. RESULTS: Twenty-four percent of the sample reported being a current driver. Compared with those who stopped driving, current drivers were more likely to be male, younger, have better visual acuity and higher National Eye Institute Vision Function Questionnaire-25 scores. Drivers reported driving an average of 4 days and 10 miles per week. Over 50% of drivers reported that because of their vision, they had difficulty with or did not drive at all in rain, at night, on freeways or interstate highways, in heavy traffic areas, or during rush hour. Drivers and nondrivers did not differ in their life space, the spatial extent of their excursions into their environment. CONCLUSION: Some individuals who present to a low-vision clinic with age-related maculopathy do drive, although their driving exposure is low and they report avoiding challenging on-road situations. Driving status in age-related maculopathy appears to be related to better eye visual acuity and vision-specific health-related quality of life.
Activities of Daily Living↗
Prevalence and distribution of corrective lenses among school-age children.
BACKGROUND: No population-based data are available regarding the proportion of school-age children who have corrective lenses in the U.S. The objective of this study was to quantify the proportion of children who have corrective lenses (glasses or contact lenses) and to evaluate the association of corrective lenses with age, gender, race/ethnicity, health insurance status, and family income. METHODS: Children 6 to 18 years of age were identified in the 1998 Medical Expenditure Panel Survey. National estimates were made of the proportion with corrective lenses. Logistic regression modeling was used to assess factors that were associated with corrective lenses. RESULTS: Based on the 5,141 children in the 1988 Medical Expenditure Panel Survey, an estimated 25.4% of the 52.6 million children between 6 and 18 years had corrective lenses. Girls had greater odds than boys of having corrective lenses (odds ratio, 1.41; p < 0.001). Insured children, regardless of race/ethnicity, and uninsured nonblack/non-Hispanic children had similar odds of having corrective lenses. Compared with uninsured black or Hispanic children (odds ratio, 1), greater odds of corrective lens use was found among uninsured nonblack/non-Hispanic children (odds ratio, 2.29; p = 0.002) and black or Hispanic children with public (odds ratio, 1.67; p = 0.005) or private health insurance (odds ratio,1.77; p = 0.004). Among families with an income > or =200% of the federal poverty level, the odds of having corrective lenses increased with age (p < or = 0.04). In contrast, among those families <200% of the federal poverty level, the odds of having corrective lenses at 12 to 14 years was similar to 15- to 18-year olds (p = 0.93). CONCLUSIONS: The use of corrective lenses suggests that correctable visual impairment is the most common treatable chronic condition of childhood. Income, gender, and race/ethnicity, depending on insurance status, are associated with having corrective lenses. The underlying causes and the impacts of these differences must be understood to ensure optimal delivery of eye care.
Adolescent↗
Visual impairment and dyslexia in childhood.
Although visual screening programs seem to be more and more effective, we face new problems with visual dysfunction that are not always detected in the visual screening programs. Many children born prematurely develop cerebral visual impairment. These children suffer from a cognitive visual impairment, causing them to have problems with orientation and visual perception. Brain impairment also seems to be relevant for the dyslexia syndrome, which continues to fascinate and puzzle many researchers. New findings in visual brain function cast light on these questions and might ultimately answer a few of the mysterious findings in dyslexia.
Child↗
Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration.
BACKGROUND: To assess the patient-reported use of caregiving among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHODS: A survey including the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision Questionnaire (DLTV) was mailed to members of the Macular Degeneration Partnership. The study was approved by an institutional review board, and respondents provided consent before participating. Responses were analyzed by estimated visual acuity determined by scores from the DLTV. Deidentified data were analyzed using SAS Version 8.2 (SAS Institute, Cary, NC). RESULTS: Of 803 respondents, 56% were male, and the mean age was 73 years. Use of paid and unpaid help significantly increased as visual acuity decreased. Using a national average for caregiver time, annual costs for caregiving ranged from 225 to 47,086 US dollar depending on visual acuity. CONCLUSION: There are substantial differences in caregiver support with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.
Aged↗
Thirty years in an urban low vision clinic: changes in prescribing habits of low vision practitioners.
PURPOSES: The purposes of this study were to determine the types of low vision devices (LVDs) prescribed by clinicians in a large optometrist led hospital low vision clinic and to investigate changes in these prescribing habits between 1973 and 2003. METHODS: Data were collected from departmental records for all patients attending the low vision clinic at Moorfields Eye Hospital in London, U.K., during the month of June in 1973, 1978, 1983, 1988, 1993, 1998, and 2003. The primary outcome measure was the type or types of LVDs prescribed to patients attending the clinic for the first time. Data were collected on the age, sex, and diagnosis of all patients attending the clinic. RESULTS: One thousand four hundred thirty-eight patient visits were identified, of which 563 (39%) were first attendances. The median age of the patients examined did not change significantly over this time. Eighty-four percent of the patients attending the clinic for the first time were prescribed at least one LVD. The devices most frequently prescribed to new patients were nonilluminated hand magnifiers, illuminated hand magnifiers, and illuminated stand magnifiers. There was a linear increase in the proportion of hand magnifiers prescribed between 1973 and 2003 (r = 0.62, p < 0.05) and a corresponding decrease in the number of near spectacle-mounted telescopes prescribed (r = 0.70, p < 0.05). CONCLUSIONS: Between 1973 and 2003, the low vision clinic at Moorfields Eye Hospital provided nearly 100,000 low vision consultations. The demographics of patients attending the clinic remained remarkably constant over this time. The number of spectacle-mounted devices prescribed to new patients fell between 1973 and 2003. It is thought this is in part the result of the increased availability of electronic magnification devices and the development of illuminated hand magnifiers. The development of the acrylic bright field magnifier and LED-illuminated LVDs have had particular clinical impact.
Eyeglasses↗
Retrospective analysis of refractive errors in children with vision impairment.
PURPOSE: Emmetropization is the reduction in neonatal refractive errors that occurs after birth. Ocular disease may affect this process. We aimed to determine the relative frequency of ocular conditions causing vision impairment in the pediatric population and characterize the refractive anomalies present. We also compared the causes of vision impairment in children today to those between 1974 and 1981. METHODS: Causes of vision impairment and refractive data of 872 children attending a pediatric low-vision clinic from 1985 to 2002 were retrospectively collated. As a result of associated impairments, refractive data were not available for 59 children. An analysis was made of the causes of vision impairment, the distribution of refractive errors in children with vision impairment, and the average type of refractive error for the most commonly seen conditions. RESULTS: We found that cortical or cerebral vision impairment (CVI) was the most common condition causing vision impairment, accounting for 27.6% of cases. This was followed by albinism (10.6%), retinopathy of prematurity (ROP; 7.0%), optic atrophy (6.2%), and optic nerve hypoplasia (5.3%). Vision impairment was associated with ametropia; fewer than 25% of the children had refractive errors < or = +/-1 D. The refractive error frequency plots (for 0 to 2-, 6 to 8-, and 12 to 14-year age bands) had a Gaussian distribution indicating that the emmetropization process was abnormal. The mean spherical equivalent refractive error of the children (n = 813) was +0.78 +/- 6.00 D with 0.94 +/- 1.24 D of astigmatism and 0.92 +/- 2.15 D of anisometropia. Most conditions causing vision impairment such as albinism were associated with low amounts of hyperopia. Moderate myopia was observed in children with ROP. CONCLUSIONS: The relative frequency of ocular conditions causing vision impairment in children has changed since the 1970s. Children with vision impairment often have an associated ametropia suggesting that the emmetropization system is also impaired.
Adolescent↗
Tactile perception recruits functionally related visual areas in the late-blind.
When blind people touch Braille characters, blood flow increases in visual areas, leading to speculation that visual circuitry assists tactile discrimination in the blind. We tested this hypothesis in a functional magnetic resonance imaging study designed to reveal activation appropriate to the nature of tactile stimulation. In late-blind individuals, hMT/V5 and fusiform face area activated during visual imagery of moving patterns or faces. When they touched a doll's face, right fusiform face area was again activated. Equally, hMT/V5 was activated when objects moved over the skin. We saw no difference in hMT/V5 or fusiform face area activity during motion or face perception in the congenitally blind. We conclude that specialized visual areas, once established through visual experience, assist equivalent tactile identification tasks years after the onset of blindness.
Adult↗
Spatial and nonspatial peripheral auditory processing in congenitally blind people.
Congenitally blind adults' performance in spatial and nonspatial peripheral auditory attention tasks was compared with that of sighted adults in a paradigm manipulating location-based and frequency-based inhibition of return concurrently. Blind study participants responded faster in spatial attention tasks (detection/localization) and slower in the nonspatial frequency discrimination task than sighted participants. Both groups, however, showed the same patterns of interaction between location-based and frequency-based inhibition of return. These results suggest that early vision deprivation enhances the function of the posterior-dorsal auditory 'where' pathway but impairs the function of the anterior-ventral 'what' pathway during peripheral auditory attention. The altered processing speed in the blind, however, is not accompanied by alteration in attentional orienting mechanisms that may be localized to higher cortices.
Acoustic Stimulation↗
A microfabricated electrostatic haptic display for persons with visual impairments.
An electrostatic haptic display with three 7 x 7 electrode arrays of three different sizes was fabricated on a 4-in wafer using lithographic microfabrication techniques. The display utilizes electrostatic stimulation to generate a tactile sensation of texture on a scanning finger. The tactile sensation appeared to be a result of increased friction and vibration due to the electrostatic forces between the finger skin and the electrodes. Various spatial tactile patterns (lines, circles, squares, and triangles, etc.) can be presented on the display. Experiments of threshold, line separation, and pattern recognition were performed on subjects with visual impairments to study the spatial resolution and information transmission on arrays of variant electrode size and spacing. Two columns with two-column spacing can be resolved with 80% accuracy on the small array, for a spatial resolution of 5.8 mm in terms of edge-to-edge electrode distance. The overall percentages of correct recognition for the patterns were 68.3, 72.1, and 71.3% on the small, medium, and large arrays, respectively. While subject is an important factor for both threshold and pattern recognition, electrode size was statistically significant for threshold only. Frequency and duty cycle of the stimulation waveform did not show statistical significance.
Adult↗
Three-dimensional tactile display for the blind.
A tactile display device that can present tangible relief graphics for visually impaired persons has been developed. The tactile surface consists of a 64 x 64 arrangement of tactorpins with 3 mm interspacing. The tactor-pins are aligned in a hexagonal, rather than a square formation, to assure smooth depiction. The matrix has a total area of 200 mm x 170 mm. Each pin can be raised in 0.1 mm steps to a maximum height of 10 mm. Users can get certain information by touching the pins raised at varying heights with fingers and/or palms. Laboratory assessment of the device with six blind subjects showed its ability to transmit various kinds of information.
Blindness↗
LAXATIVE EFFECT OF SENNOSIDE A AND PLACEBO IN A DOUBLE-BLIND CROSS-OVER TEST.
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Biomedical Research↗
Medical licensure examination for the visually impaired in Japan.
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Education, Medical↗
Visual acuity and refractive errors in a suburban Danish population: Inter99 Eye Study.
PURPOSE: The present study was performed as part of an epidemiological study, the Inter99 Eye Study. The aim of the study was to describe refractive errors and visual acuity (VA) in a suburban Danish population. METHODS: The Inter99 Eye Study comprised 970 subjects aged 30-60 years and included a random control group as well as groups at high risk for ischaemic heart disease and diabetes mellitus. The present study presents VAs and refractive data from the control group (n = 502). All subjects completed a detailed questionnaire and underwent a standardized general physical and ophthalmic examination including determination of best corrected VA and subjective refractioning. RESULTS: Visual acuity </= 0.05 was found in one eye of one subject and VA </= 0.3 in 11 eyes of 11 subjects. The main cause of reduced visual function was strabismic amblyopia. Myopia (</= - 0.5 D, spherical equivalent refraction) was present in 33.1% of right eyes of the total population but in 56.8% of subjects with a university degree. CONCLUSIONS: Strabismic amblyopia was a significant cause of unilateral visual impairment. Myopia was approximately twice as frequent in subjects with a university degree as in the remaining study population.
Adult↗
Impact of vision impairment on functioning.
PURPOSE: The aim of the present study was to determine the impact of vision loss on the activities of adults. METHODS: Focus groups were conducted that were either disease specific, such as for people with age-related macular degeneration, diabetic retinopathy, glaucoma or those with congenital vision impairment, or according to previous involvement in rehabilitation services. Discussions were recorded and transcribed. Because many people were retired, leisure activities and personal independence were paramount. RESULTS/CONCLUSIONS: Younger people were concerned with gaining or continuing in employment or with educational opportunities. The age at onset of vision loss and the cause and duration of vision loss influence its impact. There appears to be a greater level of handicap in people with comorbid eye disease and related disease, such as diabetes.
Activities of Daily Living↗
Utilization of eye care services by Victorians likely to benefit from eye care.
AIM: To assess the utilization of eye care services by Australians most likely to benefit from eye assessment. METHODS: The Melbourne Visual Impairment Project was a population-based study that collected demographic, health and vision-related information including use of eye care services. A standardized detailed ophthalmic examination was performed. Utilization of eye care services by those who might most benefit from eye care was assessed and compared to the general population. These participants include those with undiagnosed glaucoma, unoperated visually significant cataract, undercorrected refractive error, diabetes mellitus, age-related macular degeneration and visual acuity < 6/12. Sociodemographic characteristics were assessed for their influence on eye care utilization among these participants. RESULTS: A total of 4744 urban and rural residents participated (86% of those eligible) and 4612 (83% of total eligible) of these had a complete data set for the use of eye care services and were included. There were 933 participants (20.2%) who did not report eye assessment in the previous 5 years, and 891 participants (19.3%) had one or more aforementioned conditions potentially benefiting from eye care. Of these, between 34.4% and 59.4% reported no examination in the previous year and between 9% and 25% reported no examination within the previous 5 years. These participants were more likely to seek eye care within the short term (1 year) if they had a family history of eye disease, otherwise a noticed change in vision was the main influence in the longer term (2-5 years). Male participants, younger participants and those whose main spoken language was not English were less likely to seek eye care in the longer term. CONCLUSIONS: In Victoria 19% of those >40 years of age have potentially unmanaged eye disease including glaucoma, unoperated visually significant cataract, undercorrected refractive error, age-related macular degeneration, diabetes mellitus or visual acuity < 6/12. A substantial proportion of these report no eye assessment in the previous 1, 2 or 5 years or ever before. Younger age, male sex and main language other than English make assessment less likely. Many may have these conditions despite having had a recent eye assessment.
Adult↗
Eye care service utilization in older people seeking aged care.
BACKGROUND: To assess the need for, and the use of eye care services in older people seeking aged care. METHODS: In total, 188 people (69.1% of those eligible) aged 65+ years who were assessed for aged care provision at Westmead Hospital, Sydney, were recruited in 2003 and re-examined a year later. At baseline, presenting visual acuity (VA) was randomly assessed in half the participants. People with under-corrected refractive error (pinhole VA improved at least 10 letters in those with presenting VA <6/6), bilateral visual impairment (better eye VA <6/12), or self-reported visual problems, were recommended to have further assessment by eye care professionals. At follow up, information on utilization of eye care services in the past 12 months was collected and VA was assessed in all returned participants. RESULTS: Of the 188 baseline participants, 121 (70% of survivors) were revisited a year later. Overall, 90/121 participants (74%) had seen an eye care professional in the previous year. Of the 66 participants who were recommended to see an eye care professional, 42 (64%) were revisited and 37/42 (88%) complied with the recommendation. At revisit, bilateral visual impairment was found in 49/120 (41%). The proportion with bilateral visual impairment was lower in participants whose vision was assessed at baseline (35%) than in those whose vision was not assessed (47%, P = 0.17), and also lower among people who had visited an eye care professional during the previous 12 months (39%) than those who had not (45%, P = 0.57). CONCLUSIONS: This pilot study indicates a relatively high need for, and high utilization of eye care services in the subgroup of older people seeking aged care services.
Aged↗
Blindness and vision impairment in the elderly of Papua New Guinea.
BACKGROUND: To estimate the magnitude and causes of blindness and vision impairment in Papua New Guinea for service delivery planning and ophthalmic education development. METHODS: Using the World Health Organization standardized Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By systematic, two-stage cluster random sampling, 39 clusters each of 30 people aged 50 years and over were selected from urban and rural locations. A cause of vision loss was determined for each eye with a presenting visual acuity worse than 6/18. RESULTS: Of the 1191 people enumerated, 1174 were examined (98.6%). The 50 years and older age-gender adjusted prevalence of vision impairment (presenting visual acuity less than 6/18 in the better eye) was 29.2% (95% Confidence Interval [CI]: 27.6, 35.1, Design Effect [deff] = 2.3). That of functional blindness (presenting visual acuity less than 6/60 in the better eye) was 8.9% (95% CI: 8.4, 12.0, deff = 1.2), and of World Health Organization blindness (but presenting, rather than best corrected, visual acuity of less than 3/60 in the better eye) was 3.9% (95% CI: 3.4, 6.1, deff = 1.0). Uncorrected refractive error (13.1%, 95% CI: 11.3, 15.1, deff = 1.2) and cataract (7.4%, 95% CI: 6.4, 10.2, deff = 1.3) were leading causes of vision impairment, age-gender adjusted. Cataract was the most common (age-gender adjusted 6.4%, 95% CI: 5.1, 7.3, deff = 1.1) cause of functional blindness. On bivariate analysis, increasing age (P < 0.001), illiteracy (P < 0.001) and unemployment (P < 0.001) were associated with functional blindness. Gender was not. CONCLUSIONS: The identification and treatment of refractive error and cataract need to be priorities for eye health services in Papua New Guinea if the burden of vision impairment and blindness is to be diminished. The education of community and hospital eye care providers, whether medical, nursing or other cadres, must emphasize these. Eye care services must be structured and provided to allow and encourage accessibility and uptake, with satisfactory treatment outcomes for these conditions.
Aged↗