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PubMed1995

Low vision in east African blind school students: need for optical low vision services.

AIMS: There is increasing awareness of the needs of children with low vision, particularly in developing countries where programmes of integrated education are being developed. However, appropriate low vision services are usually not available or affordable. The aims of this study were, firstly, to assess the need for spectacles and optical low vision devices in students with low vision in schools for the blind in Kenya and Uganda; secondly, to evaluate inexpensive locally produced low vision devices; and, finally, to evaluate simple methods of identifying those low vision students who could read N5 to N8 print after low vision assessment. METHODS: A total of 230 students were examined (51 school and 16 university students in Uganda and 163 students in Kenya, aged 5-22 years), 147 of whom had a visual acuity of less than 6/18 to perception of light in the better eye at presentation. After refraction seven of the 147 achieved 6/18 or better. Eighty two (58.6%) of the 140 students with low vision (corrected visual acuity in the better eye of less than 6/18 to light perception) had refractive errors of more than 2 dioptres in the better eye, and 38 (27.1%) had more than 2 dioptres of astigmatism. RESULTS: Forty six per cent of students with low vision (n = 64) could read N5-N8 print unaided or with spectacles, as could a further 33% (n = 46) with low vision devices. Low vision devices were indicated in a total of 50 students (35.7%). The locally manufactured devices could meet two thirds of the need. CONCLUSION: A corrected distance acuity of 1/60 or better had a sensitivity of 99.1% and a specificity of 56.7% in predicting the ability to discern N8 print or better. The ability to perform at least two of the three simple tests of functional vision had a sensitivity of 95.5% and a specificity of 63.3% in identifying the students able to discern N8 or better.

Adolescent↗
PubMed1994

The sight test fee: effect on ophthalmology referrals and rate of glaucoma detection.

OBJECTIVE: To assess changes, if any, in the numbers of referrals and outcome of glaucoma referrals to the hospital eye service since the introduction of the sight test fee on 1 April 1989. DESIGN: Review of referral records and clinical notes. SETTING: Referrals to the Bristol Eye Hospital. SUBJECTS: 51,919 patients referred to the Bristol Eye Hospital between 1984 and 1992. 9438 case notes of patients referred between 1987 and 1991 were examined in detail. MAIN OUTCOME MEASURES: Numbers of referrals; rate of adult true positive glaucoma referrals. RESULTS: Referrals to the Bristol Eye Hospital were between 13.7% and 19.0% fewer than expected after the introduction of the sight test fee. True positive glaucoma referrals were reduced by the same proportion. CONCLUSIONS: The numbers of patients being identified as requiring treatment or follow up for potentially blinding glaucoma have declined by nearly one fifth since the introduction of the sight test fee. An increased prevalence of preventable blindness may result.

Adult↗
PubMed2005

Posterior cortical atrophy: clinical presentation and cognitive deficits compared to Alzheimer's disease.

BACKGROUND: Posterior cortical atrophy (PCA) is an uncommon dementia syndrome with initial manifestations of visual dysfunction and preservation of memory and language until late in the disease. Since prognosis and management differ from typical Alzheimer's disease (tAD), clinical tests to distinguish PCA from tAD are needed. METHODS: Fifteen PCA cases and 15 tAD cases, defined by clinical and MRI criteria, were compared by present symptoms and scores on four cognitive tests. RESULTS: Symptoms of visual disturbance and dyslexia were more commonly reported in PCA cases (p = 0.0001 and p = 0.006, respectively), and memory loss was more commonly reported in tAD (p = 0.006). Patients with PCA were less accurate on the Cortical Vision Screening Test (t = 6.0; p < 0.001) and in copying the Rey-Osterreith Complex Figure (t = 6.0; p < 0.001), in comparison to the tAD group. Memory, evaluated by the Rey Auditory Verbal Learning Test, was impaired in both groups; however, delayed recall was more impaired in the tAD group (t = 2.5; p = 0.03). CONCLUSION: Compared to patients with tAD, patients with PCA are more likely to present to their providers with symptoms of visual dysfunction. Performance on simple tests of visual perception and copying can be used to distinguish the two disorders even a few years after initial symptoms.

Age of Onset↗
PubMed2004

Psychometric properties of the Veterans Affairs Low-Vision Visual Functioning Questionnaire.

PURPOSE: To describe psychometric properties of a self-report questionnaire, the Veterans Affairs (VA) Low-Vision Visual Functioning Questionnaire (LV VFQ-48), which was designed to measure the difficulty visually impaired persons have performing daily activities and to evaluate low-vision outcomes. METHODS: The VA LV VFQ-48 was administered by telephone interview to subjects with visual acuity ranging from near normal to total blindness at five sites in the VA and private sector. Rasch analysis with the Andrich rating scale model was applied to difficulty ratings from 367 subjects, to evaluate measurement properties of the instrument. RESULTS: High intercenter correlations for item measure estimates (intraclass correlation coefficient [ICC]=0.97) justified pooling the data from these sites. The person measure fit statistics (mean square residuals) confirm that the data fit the assumptions of the model. The item measure fit statistics indicate that responses to 19% of the items were confounded by factors other than visual ability. The separation reliabilities for pooled data (0.94 for persons and 0.98 for items) demonstrate that the estimated measures discriminate persons and items well along the visual ability dimension. ICCs for test-retest data (0.98 for items and 0.84 for persons) confirm temporal stability. Subjects used the rating categories in the same way at all five centers. Ratings of slight and moderate difficulty were used interchangeably, suggesting that the instrument could be modified to a 4-point scale including not difficult, slightly/moderately difficult, extremely difficult, and impossible. Fifty additional subjects were administered the questionnaire with a 4-point scale to confirm that the scale was used in the same way when there were four rather than five difficulty ratings. CONCLUSIONS: The VA LV VFQ-48 is valid and reliable and has the range and precision necessary to measure visual ability of low-vision patients with moderate to severe vision loss across diverse clinical settings.

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↗
PubMed2005

Telemedicine for eye care.

Tele-ophthalmology has been employed mainly for patients in under-served rural areas in need of specialty care, but other applications such as telementoring have also been used. In certain populations, cost containment is a significant issue and telemedicine is a solution. Tele-ophthalmology can be performed in realtime, by store-and-forward mode, or by hybrid techniques. After appropriate modification, a range of peripherals may be used for tele-ophthalmology, including the direct ophthalmoscope, indirect ophthalmoscope, slit lamp or retinal camera. Tele-ophthalmology applications include: detecting, screening and diagnosing diabetic retinopathy; anterior segment imaging; glaucoma screening; low vision consultation; telementoring. Tele-ophthalmology shows great promise for improving patient care and increasing access to specialty care not available in under-served areas. In developing countries tele-ophthalmology may be a cost-effective method by which richer countries can assist them.

Diabetic Retinopathy↗
PubMed2005

Importance of generational status in examining access to and utilization of health care services by Mexican American children.

OBJECTIVES: To describe the sociodemographic differences among Mexican American children (first, second, and third generation), non-Hispanic black children, and non-Hispanic white children; to compare the health status and health care needs of Mexican American children (first, second, and third generation) with those of non-Hispanic black children and non-Hispanic white children; and to determine whether first-generation Mexican American children have poorer health care access and utilization than do non-Hispanic white children, after controlling for health insurance status and socioeconomic status. METHODS: The Third National Health and Nutrition Examination Survey was used to create a sample of 4372 Mexican American children (divided into 3 generational groups), 4138 non-Hispanic black children, and 4594 non-Hispanic white children, 2 months to 16 years of age. We compared parent/caregiver reports of health status and needs (perceived health of the child and reported illnesses), health care access (usual source of health care and specific provider), and health care utilization (contact with a physician within the past year, use of prescription medications, physician visit because of earache/infection, and hearing and vision screenings) for different subgroups within the sample. RESULTS: More than two thirds of first-generation Mexican American children were poor and uninsured and had parents with low educational attainment. More than one fourth of first-generation children were perceived as having poor or fair health, despite experiencing similar or better rates of illnesses, compared with other children. Almost one half of first-generation Mexican American children had not seen a doctor in the past year, compared with one fourth or less for other groups. Health care needs among first-generation Mexican American children were lower, on the basis of reported illnesses, but perceived health status was worse than for all other groups. After controlling for health insurance coverage and socioeconomic status, first-generation Mexican American children and non-Hispanic black children were less likely than non-Hispanic white children to have a usual source of care, to have a specific provider, or to have seen or talked with a physician in the past year. CONCLUSIONS: Of the 3 groups of children, Mexican American children had the least health care access and utilization, even after controlling for socioeconomic status and health insurance status. Our findings showed that Mexican American children had much lower levels of access and utilization than previously reported for Hispanic children on the whole. As a subgroup, first-generation Mexican American children fared substantially worse than second- or third-generation children. The discrepancy between poor perceived health status and lower rates of reported illnesses in the first-generation group leads to questions regarding generalized application of the "epidemiologic paradox." Given the overall growth of the Hispanic population in the United States and the relative growth of individual immigrant subgroups, the identification of subgroups in need is essential for the development of effective research and policy. Furthermore, taking generational status into account is likely to be revealing with respect to disparities in access to and utilization of pediatric services.

Adolescent↗
PubMed1992

Binocularity and photophobia in intermittent exotropia.

The relationship between photophobia and binocular function in intermittent exotropia was examined in 42 subjects (21 patients and 21 controls). In all subjects fusional amplitude and strength of binocular sensory status were tested before and during exposure to bright light. An explanation of photophobia in intermittent exotropia was suggested as impairment in binocular cooperation, since the indicators of binocular function were significantly altered in the patients, particularly during light exposure.

Adolescent↗
PubMedDate not supplied

The moving Dynamic Random Dot Stereosize test: development, age norms, and comparison with the Frisby, Randot, and Stereo Smile tests.

PURPOSE: To determine the response of infants and children to the Moving Dynamic Random Dot Stereosize (MDRS) test and to collect cross-sectional age-related data. METHODS: Sixty visually normal individuals were divided into four age groups: 0.5-<2, 2-<5, 5-<8, and 8-<20 years. Stereopsis was measured with the MDRS test on two occasions, plus the Frisby, Randot, or Stereo Smile tests, as was age appropriate. RESULTS: All children aged >2 years and 80% of the children between ages 6 months and 2 years were able to perform the MDRS test on at least one occasion. Sixty percent of the 6-month to 2-year-old children were able to perform the Stereo Smile test on both occasions. Performance on the MDRS test improved with age up to 9 years. Improvement on the Frisby and Randot tests was seen in children aged up to 7 years. Mean and 95% confidence interval ranges for each test are given. CONCLUSION: This study gives evidence that aspects of the visual system are not fully mature until age 7-9 years. The MDRS test is a visually demanding but cognitively simple test that shows potential for detecting visual anomalies in young children.

Adolescent↗
PubMedDate not supplied

Introduction of the Low Vision Evaluator (LoVE) for children.

PURPOSE: To determine whether the Low Vision Evaluator (LoVE) can grade the visual acuity of young children with light perception and hand movement acuity into finer acuity steps and at what age reliable measurements can be obtained. METHODS: Two hundred twenty children were tested with the LoVE. Each eye was tested separately, and each stimulus magnitude (intensity x duration) was presented three times. Three catch trials per eye also were presented. RESULTS: Scores ranged from -8 to -1 on variable-duration tests and from 22.5 to 37.5 dB on fixed-duration tests for four children with hand movement vision. Scores ranged from -12 to 0 on variable-duration tests and from 12.5 to 40 dB on fixed-duration tests for five children with light perception vision. Reliable measurements were obtained at different times on different days. Mean scores for children with counting finger vision or better were significantly better than scores for eyes with light perception and hand movement (P < .001 and P < .01, respectively). Reliability was less for children younger than age 4 years. CONCLUSIONS: The LoVE is capable of grading the visual function of children with light perception and hand movement vision into finer steps. Reliable measurements can be obtained for children age 4 years and older.

Child↗
PubMed1999

A 25-year prospective study of visual acuity in the Japan Air Self Defense Force personnel.

BACKGROUND: In the Japan Air Self Defense Force (JASDF), new vision standards for student pilots allow lower uncorrected monocular acuity (from 1.0 to 0.8). In flight environments, where the use of corrective lenses may present problems, the risk of decreasing visual acuity in pilots who should wear corrective lenses must be defined. METHODS: We conducted a 25-yr prospective study of visual acuity with regard to distance vision in 752 JASDF nonaviation personnel followed from ages 20 to 45. The test subjects were divided into four groups according to their right monocular visual acuity at entry: > or =1.0, between 0.9 and 0.7, between 0.6 and 0.2, and <0.2. RESULTS: At entry, 94.1% of all subjects had visual acuity > or =0.7. The proportion of subjects who required corrective lenses for distance increased with age from 15.8% to 37.1%. After 25-yr, 30.2% of subjects with visual acuity > or =1.0 at entry and 62.7% of subjects with visual acuity between 0.9 and 0.7 at entry required corrective lenses. CONCLUSIONS: Over 25 yr, the population with the best eyesight at age 20 had a lower increase in the need for corrective lenses than the population with visual acuity between 0.9 and 0.7 at age 20. These results suggest an increased risk of visual acuity loss in pilots over time as a result of the lower vision standards for student pilots in the JASDF.

Adult↗
PubMed1975

Symposium on sensorineural hearing loss in children: early detection and intervention. Delivery systems in the management of hearing impaired children.

The management of a hearing impaired child involves the family as well as the child himself, especially when the child is very young. Delivery systems therefore must include the parents as an integral part of the delivery chain and be sensitive to the parents' need to understand the treatment or therapy and, when appropriate, to sustain it in the home. Health care services that have educational implications have been termed eduhealth, which in the case of the hearing impaired child, refers to such services as the early detection of hearing loss, the proper fitting of hearing aids, the prompt treatment of upper respiratory infections that might lead to further hearing loss, and vision screening. The otolaryngologist, audiologist, and parent all have eduhealth responsibilities. Professionals in medicine and allied fields, although well trained and experienced in their specialities, are rarely prepared to meet all the needs of the young hearing impaired child and his parents with appropriate services and in the manner most appropriate for them. Some agencies, however, have demonstrated comprehensive capabilities in this area. In referring a family to a delivery system, the otolaryngologist should establish to his own satisfaction that the requisite skills are present. Common complaints of parents of hearing impaired children are the lack of communication with the physician and clinician, which is frequently the result of the vocabulary used by the specialist and the limited time spent with the parents during visits. The result can be parental failure to follow instructions and possibly irreversible damage to the child's development of listening, language, and speech skills. The eduhealth delivery service index is a new attempt to measure the effectiveness of systems for the delivery of education and health care services to young hearing impaired children and their parents. It has been demonstrated in a limited population and may prove useful in the comparison of delivery systems. The otolaryngologist is urged to become better acquainted with the various elements of delivery systems and to be cautious in accepting claims of comprehensive quality services until verified by his own experience or the reports of actual consumers of the services offered.

Audiometry↗
PubMed2000

Eye-hand and eye-foot visual reaction times of young soccer players.

PURPOSE: The aim of this study was to investigate the eye-hand and eye-foot visual reaction time among young soccer players and to compare those with non-soccer players in order to evaluate possible differences. METHODS: A vision screening of 53 young male soccer players belonging to the Valencia Soccer Club was done. Soccer players were divided in three categories, with mean ages of 8.2 +/- 0.5 years (range, 8- to 9-year olds), 10.6 +/- 0.2 years (range, 10- to 11-year-olds), and 12.7 +/- 0.3 years (range, 12- to 13-year-olds). An age-matched sample of 60 young male non-soccer players served as a control population. Mean ages in this population were 8.3 +/- 0.6 years, 10.5 +/- 0.4 years, and 12.6 +/- 0.2 years for each category, respectively. Eye-hand and eye-foot visual reaction times were determined in players and non-players by means of a computer-controlled stimuli device. RESULTS: We obtained a mean and standard deviation value (in seconds) of eye-hand reaction time in soccer players of 0.301 +/- 0.037, 0.256 +/- 0.040, and 0.207 +/- 0.031, respectively, for each category, and for non-soccer players of 0.382 +/- 0.061, 0.320 +/- 0.063, and 0.282 +/- 0.043, respectively. The values for eye-foot reaction time in players were: 0.412 +/- 0.062, 0.406 +/- 0.046, and 0.387 +/- 0.034, respectively, for each category, and for nonplayers of 0.496 +/- 0.081, 0.460 +/- 0.026, and 0.446 +/- 0.054, respectively. There are statistically significant differences between eye-hand and eye-foot reaction times between players and nonplayers (p < 0.05). There was no correlation between visual reaction times and age (p > 0.05). CONCLUSIONS: Eye-hand and eye-foot visual reaction times were found to be different between the two populations evaluated. The results show differences between soccer and non-soccer players, with the soccer players demonstrating faster reaction times.

Adolescent↗
PubMed2003

Refractive error blindness.

Recent data suggest that a large number of people are blind in different parts of the world due to high refractive error because they are not using appropriate refractive correction. Refractive error as a cause of blindness has been recognized only recently with the increasing use of presenting visual acuity for defining blindness. In addition to blindness due to naturally occurring high refractive error, inadequate refractive correction of aphakia after cataract surgery is also a significant cause of blindness in developing countries. Blindness due to refractive error in any population suggests that eye care services in general in that population are inadequate since treatment of refractive error is perhaps the simplest and most effective form of eye care. Strategies such as vision screening programmes need to be implemented on a large scale to detect individuals suffering from refractive error blindness. Sufficient numbers of personnel to perform reasonable quality refraction need to be trained in developing countries. Also adequate infrastructure has to be developed in underserved areas of the world to facilitate the logistics of providing affordable reasonable-quality spectacles to individuals suffering from refractive error blindness. Long-term success in reducing refractive error blindness worldwide will require attention to these issues within the context of comprehensive approaches to reduce all causes of avoidable blindness.

Amblyopia↗