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PubMed2006

Blindness and low vision in Cape Verde Islands: results of a national eye survey.

AIMS: Prior to establishing a national prevention of blindness program a population based survey was conducted in Cape Verde Islands in1998. The objectives of the survey were to estimate the overall and age-specific prevalence of blindness and low vision, to identify the main disorders causing blindness and low vision, and to estimate the population need for basic eye care services. METHODS: A two-level cluster random sampling procedure was used, selecting 30 clusters from the nine inhabited islands and 3,803 persons of all ages were included in the sample. RESULTS: 3,374 persons were examined (coverage 88.7%). The prevalence of bilateral blindness (visual acuity in the better eye less than 3/60) was 0.8% (95% confidence interval [CI] 0.5-1.1), of bilateral low vision (6/18 to 3/60 in the better eye) 1.7% (95% CI: 1.3-2.2) and of monocular blindness 1.5% (95% CI: 1.2-2.0). The major causes of blindness were age related cataract and glaucoma (57.7% and 15.4%, respectively, of blind people recruited). The major causes of bilateral low vision were cataract, refractive errors, and macular disorders (46.2%, 26.8%, and 8.9%, respectively, of persons with low vision). Nontrachomatous corneal opacities accounted for 7.7% of bilateral and for 11.5% of monocular blindness. Vascular retinopathy was responsible for 7.7% of bilateral and for 9.6% of monocular blindness. Trachoma is not a public health problem as only 2.3% of children less than 10 years of age were suffering from active trachoma. Palpebral or limbal vernal conjunctivitis were encountered in 4.5% of persons under 25. CONCLUSION: More than half of the visual impairments are treatable by provision of cataract surgery and cataract has been indicated as a priority target in the recently designed National Blindness Program of the Cape Verde Republic. Pathologic conditions such as diabetes are emerging as serious burden for ageing populations and account for most of the retinal vascular disease.

Adolescent↗
PubMed2004

Problems with vision associated with limitations or avoidance of driving in older populations.

OBJECTIVES: This report examines the role of (a) disease processes affecting vision, (b) reported troubles with vision, (c) physical symptoms affecting the eyes, and (d) objective measures in reported driving limitation due to problems with eyesight among older drivers. METHODS: Data for this study (N = 1,840) were obtained from participants in a community-based study of aging and physical performance in people age 55 or older in the city of Sonoma, California. Each of 16 visual conditions was assessed for impact on reported driving limitation due to eyesight by calculating a "risk" ratio. Then, prevalence of the condition was combined with the ratio to generate an attributable risk for that condition for vision-related limitations in driving. RESULTS: Each condition was significantly associated with reported limitations in driving due to eyesight. "Avoiding physical activity due to vision" (ratio = 3.4) and "trouble seeing steps up/down stairs" (ratio = 2.9) had the strongest association. However, "glasses/contacts required for driving" and "trouble with glare from sun/lights" had the highest attributable risks (35.8 and 29.4). DISCUSSION: The risk ratio is relevant for evaluating individuals; the attributable risk is relevant to planning countermeasures in populations. Addressing specific problems related to vision should substantially reduce driving limitations due to eyesight.

Aged↗
PubMed1998

Assessment of colour vision impairment in male workers exposed to toluene generally above occupational exposure limits.

We investigated colour vision impairment in 45 male workers occupationally exposed to toluene (mean value of toluene concentration in ambient air = 119.96 ppm) and in 53 controls. Colour vision was evaluated by Lanthony-D-15 desaturated test and expressed as Age and Alcohol Intake Adjusted Colour Confusion Score (AACDS) or types of dyschromatopsia. Exposure was evaluated by measurement of toluene concentration in ambient air and blood, and hippuric acid and orthocresol determined in urine after the workshift. A statistically significant higher AACDS value was established in the exposed subjects compared to the controls (p < 0.0001). There was no significant difference between AACDS values on Wednesday morning compared to Monday morning. In the exposed group AACDS significantly correlated with the concentration of toluene in ambient air, concentration of toluene in blood and the concentration of hippuric acid in urine after the workshift (all p < 0.0001). Dyschromatopsias were detected in both groups, although no significant difference between groups was established. In the exposed group concentration of toluene in ambient air, alcohol intake and age explained 35.1%, concentration of toluene in blood, age and alcohol intake explained 19.9%, and concentration of hippuric acid in urine and age explained 19.2% of the variation in type III dyschromatopsia. Concentration of toluene in ambient air and age explained 28.3% of the variation in total dyschromatopsia, and concentration of hippuric acid and age explained 13.8%. In the control group, age and alcohol intake explained 19.6% of the variation in type III dyschromatopsia. In exposed workers a significant difference was found in the AACDS value compared to controls. However, no significant difference was found in the prevalence of colour vision loss in the yellow-blue and/or red-green axis. Based on the results of this study the authors conclude that the effect of toluene on colour vision can be chronic and that the possible reparation period in colour vision impairment is longer than 64 hours.

Adult↗
PubMed1985

Clinical management of nearpoint stress-induced vision problems.

Functional vision problems caused by or associated with nearpoint vision stress include: accommodative disorders (insufficiency, ill-sustained, infacility); abnormal heterophorias (esophoria, high exophoria); and vergence disorders. These vision disorders cause problems with acuity, comfort, and performance (efficiency). A combination of lens prescribing, vision therapy, and work/study visual hygiene recommendations can eliminate or greatly reduce nearpoint stress-induced vision problems.

Eyeglasses↗
PubMed2000

Vision-specific quality of life and modes of refractive error correction.

PURPOSE: Many studies currently use surveys to assess patients' reports of vision-specific quality of life to determine the impact of the disease or the most appropriate mode of treatment. One such instrument, the National Eye Institute Visual Function Questionnaire (NEI-VFQ), was developed to assess vision-related quality of life with respect to emotional well-being and social function as well as difficulty with tasks and symptoms. We administered the NEI-VFQ to 218 subjects free of eye disease to see if the survey was sensitive enough to detect differences in three modes of refractive error correction: spectacles, soft contact lenses, and rigid contact lenses. METHODS: Surveys were administered to 117 rigid contact lens wearers, 51 spectacle wearers, and 50 soft contact lens wearers. Kruskal-Wallis one-way analysis of variance was conducted to determine significant differences in each of the subscales. RESULTS: The Peripheral Vision subscale score (mean +/- SD) was 92.6 +/- 15.2 for the spectacle wearers, 100.0 +/- 0.0 for the soft contact lens wearers, and 98.3 +/- 7.1 for the rigid gas-permeable contact lens wearers; the spectacle wearers' Peripheral Vision score was significantly lower than the other two groups (Wilcoxon rank sum, p < 0.003 for both). The spectacle wearers (96.6 +/- 9.2) also had a significantly lower Dependency subscale score than the rigid contact lens group (99.7 +/- 1.5) (Wilcoxon rank sum, p = 0.001). There were no significant differences between the three groups detected in the mean of any of the other subscale scores. At least 50% of the subjects reported the maximum score for 6 of the 11 subscales. Given our sample size, we have 100% power to detect a difference of 10 points with a SD of 10 at the alpha = 0.05 level. CONCLUSION: The NEI-VFQ is not appropriate for detecting significant differences in vision-related quality of life among spectacle, soft contact lens, and rigid gas-permeable contact lens wearers, primarily due to maximum ratings by many of the subjects.

Adolescent↗
PubMed2000

The relation between visual acuity and other spatial vision measures.

PURPOSE: To examine to what extent measurement of standard visual acuity allows prediction of other spatial vision measures on an individual basis when high correlations exist between visual acuity and the other measures. METHODS: A series of spatial vision functions were measured in a sample of 900 community-dwelling older observers. Regression analysis was performed, and correlation coefficients were calculated between standard high-contrast visual acuity and other spatial vision measures including contrast sensitivity, low-contrast acuity, low-contrast low-luminance acuity (SKILL card), and disability glare acuity. RESULTS: All measures were highly and significantly correlated with standard visual acuity (r = 0.68 to 0.91). Despite the high correlations, many predictions of the other spatial vision measures from the correlation with standard acuity fell considerably outside of acceptable ranges determined by repeatability. The influence of the range of values in correlations is emphasized. CONCLUSIONS: Other spatial vision measures cannot be predicted on an individual basis from visual acuity despite high and significant correlations between the measures.

Aged↗
PubMed2000

Restoration of vision by training of residual functions.

A new paradigm emerges: visual field defects after optic nerve or brain injury are partially reversible. Using high-resolution visual field tests, areas of residual vision can be identified which are characterized by impaired vision (relative defect) with some residual capacities. By repetitively stimulating these partially damaged areas with daily computer-based visual restitution training it is now possible to enlarge the visual field. Average border shifts of 5 degrees (range, 0 to 20 degrees) have been found in clinical trials, and training is effective even when started years after the injury. Visual restitution training is useful for the treatment of patients with stroke, head injury, or partial optic nerve damage, as long as the patient presents some residual vision. The improved vision is maintained in most patients after training is discontinued. Brain plasticity is likely to provide the substrate for restoration of vision, opening new opportunities to treat partial blindness, which has been considered irreversible.

Animals↗
PubMed2006

New evidence that vision rehabilitation is a key component in the management of patients with macular degeneration.

PURPOSE OF REVIEW: Vision rehabilitation has been considered as an adjunct support option or just the dispensing of magnifiers in the management of macular degeneration. RECENT FINDINGS: New research suggests that vision rehabilitation can cause physical changes in the brain that help patients adjust to permanent vision loss. SUMMARY: Vision rehabilitation is related to physical changes that occur in the brain. Its use in conjunction with clinical low-vision programs may pave the way for developing better rehabilitation techniques for patients with macular blindness.

Delivery of Health Care↗
PubMedDate not supplied

Contribution to the theory of prosthetic vision.

By way of extracellular, electrical stimulation of the visual pathway, the various approaches to vision prosthesis aim to provide crude, patterned vision to individuals with profound blindness. Common to all approaches is the implantable electrode array and the rendering of phosphenes-the actuated percepts occupying the visual field of the implantee. Thus prosthetic vision may be simulated, and underlying theories as to how to render it efficacious developed. We review the field of simulated prosthetic vision. Furthermore, with retinal prosthesis in mind, we suggest a revised approach-an approach with regard to sampling theory, the vertebrate central visual pathway, and eye movements. The parallel development of prosthetic vision theory, explored via simulation and bioengineering issues surrounding neurostimulator design and implantation has bearing on the success of clinical trials by numerous groups in coming years.

Biomedical Engineering↗
PubMedDate not supplied

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↗
PubMed1989

Low vision aids for preschool children.

A study was made of the use of low vision aids to augment the vision of children with very severe visual disability. This paper reports the results for 28 children, using a 'lobster pot' stand magnifier, 26 of whom were aged between 18 and 60 months. Success was evaluated by measuring functional vision for nursery-age learning material in aided and unaided conditions. Half the children showed improved functional vision and one-third retained the magnifier for continued use. The influence of visual power and developmental maturity in five key areas was explored. A two-year developmental level was shown to be adequate, with some interaction between developmental maturity and visual level. There was also a tendency for unaided functional vision to improve during the trial period with the magnifier at home.

Child↗
PubMed1992

Image enhancement filters significantly improve reading performance for low vision observers.

As people age, so do their photoreceptors; many photoreceptors in central vision stop functioning when a person reaches their late sixties or early seventies. Low vision observers with losses in central vision, those with age-related maculopathies, were studied. Low vision observers no longer see high spatial frequencies, being unable to resolve fine edge detail. We developed image enhancement filters to compensate for the low vision observer's losses in contrast sensitivity to intermediate and high spatial frequencies. The filters work by boosting the amplitude of the less visible intermediate spatial frequencies. The lower spatial frequencies. These image enhancement filters not only reduce the magnification needed for reading by up to 70%, but they also increase the observer's reading speed by 2-4 times. A summary of this research is presented.

Adult↗
PubMed1994

Colour vision screening in glaucoma: the Tritan Album and other simple tests.

Results from simple colour vision tests used for the detection of the Type III colour vision deficiency in glaucoma and ocular hypertension are presented. We assessed 49 patients with primary open angle glaucoma, 16 ocular hypertensives, 54 age matched normals and 50 young normal observers using six established tests and the recently introduced Tritan Album. This test was introduced specifically for acquired colour vision deficiencies. Results show in general that individual tests have low sensitivity and poor screening efficiency. The best screening efficiency was achieved by the City University Colour Vision Test and the AO HRR plate test, no acquired tritan defects were identified by the Farnsworth F2 plate, and the Tritan Album had very low sensitivity (the lowest excluding the F2 plate). Best results were obtained from a combination of City University and HRR test scores and this combination could provide useful additional data on colour vision in a glaucoma screening programme.

Aged↗
PubMed2004

Reading errors made by children with low vision.

Previous research has shown that, on average, children with low vision lag their sighted peers in general reading development (in terms of speed, accuracy and comprehension). This study sought to examine this apparent lag by comparing the reading profiles of 25 normally sighted readers (mean age 8 years 8 months) with 25 low vision readers. The children were tested using a reading test (the Neale Analysis of Reading Ability, NARA) and were matched on the reading accuracy score produced by the test. Therefore in terms of the reading accuracy scores (and reading ages) derived from the NARA both groups were the same. The low vision readers were on average older than the normally sighted children (mean = 10 years, 5 months). When the reading profile (i.e. accuracy, comprehension and speed) was examined in the same analysis no significant effect was revealed [d.f. = 1, 48; F = 0.05; p > 0.1], but a general lag for these children is suggested (in keeping with previous research). However, a closer analysis of the reading error profile revealed the most common reading errors made by all readers in the analysis were either mispronunciations or substitutions. The low vision readers were more prone to making substitution errors than mispronunciations and the reverse was true for normally sighted readers [d.f. = 1, 48; F = 7.1; p < 0.05]. This indicates that the reading strategies adopted by low vision readers may differ from those of normally sighted readers of the same apparent reading ability.

Case-Control Studies↗
PubMed1984

Testing of colour vision for vocational purposes.

All red-green defects of colour vision can be effectively screened with a combination of two pseudo- isochromatic tests. Severe (major) colour vision defects regarded as a serious handicap in all occupations needing colour naming ability can be quickly detected with the Panel D-15 dichotomous test. Only a trained ophthalmologist can make the detailed estimation of the type and degree of the colour vision defect with the aid of the anomaloscope and the Farnsworth-Munsell 100-hue test. In the diagnosis of a congenital colour vision defect the exclusion of an eye disease with a consecutive acquired colour vision defect is important.

Color Perception Tests↗
PubMed1989

Human photopic vision with only short wavelength cones: post-receptoral properties.

1. Spatial and temporal contrast sensitivities were investigated in two subjects whose photopic vision has been previously shown to be subserved by only short wavelength cones. 2. Spatial contrast sensitivity was uniformly reduced compared with that of the normal trichromatic observer. Peak contrast sensitivity reached 40 which is a factor of 2-3 better than previous estimates and extrapolated acuity was around 15 cycles deg-1. Central, non-aliased grating acuity was between 6-9 cycles deg-1. This declined with eccentricity such that at 20 deg it was around 1 cycle deg-1. 3. The variation in contrast sensitivity across the visual field was measured for a range of different spatial frequencies. It was found to be of the same form as that for the normal trichromat but reduced in overall sensitivity. 4. Temporal contrast sensitivity was measured for two different spatial frequencies and found to exhibit the spatio-temporal covariation which is typical of normal trichromatic vision. Temporal acuity exhibited a strong dependence on illuminance and reached asymptotic values of around 40-45 Hz. While this is more than a factor of two above most previous estimates for the short wavelength receptors of normal vision it agrees with some more recent estimates obtained using a different technique. Temporal resolution was found to be evenly distributed across the visual field. 5. Similarities were found between the post-receptoral properties of these achromats and the properties of the isolated blue mechanism of normal vision and also the properties of normal luminance contrast processing in general. The present results provide an upper bound on the contribution of the short wavelength mechanism to normal vision and also provide a suitable model of its possible contribution to the processing of luminance contrast in the normal visual system.

Adaptation, Ocular↗
PubMed1996

Visual pigment gene structure and the severity of color vision defects.

Rearrangements of the visual pigment genes are associated with defective color vision and with differences between types of red-green color blindness. Among individuals within the most common category of defective color vision, deuteranomaly, there is a large variation in the severity of color vision loss. An examination of specific photopigment gene sites responsible for tuning photopigment absorption spectra revealed differences that predict these variations in the color defect. The results indicate that the severity of the defect in deuteranomalous color vision depends on the degree of similarity among the residual photopigments that serve vision in the color-anomalous eye.

Blotting, Southern↗
PubMed1996

Preschool vision screening: outcome of children referred to the hospital eye service.

AIMS: To assess the outcome of children referred to the hospital eye service (HES) from an orthoptist based preschool vision screening programme. METHODS: A retrospective study was conducted of children referred from screening during a 2 year period. Children were screened by community orthoptists at 3 1/2 years of age. The main outcome measures were (1) HES findings for children referred from screening, and (2) visual outcome for amblyopic children after completion of treatment. RESULTS: The attendance rate at screening was 79.3% (6794 children): 348 children (5.1% of those screened) were referred to the HES. The HES findings were refractive error (32.9%), amblyopia (29.9%), false positive referral (20.1%), strabismus (13.2%), and other ocular disorders (3.9%). The positive predictive value of screening was 79.9%. Screening detected 48 children with straight eyed amblyopia and 43 children with strabismic amblyopia. A visual acuity of 6/9 or better in the amblyopic eye was achieved by 87.2% of straight eyed amblyopes and 64.3% of strabismic amblyopes (chi 2 = 5.27, p = 0.02). Residual amblyopia of 6/24 or worse occurred in only 5.6% of amblyopic children. CONCLUSION: Most amblyopic children detected by preschool vision screening achieve a good visual outcome with treatment. While treatment earlier in the sensitive period might be expected to give improved results, it remains to be demonstrated that preschool screening results in a better outcome than screening at school entry. Preschool vision screening also detects a significant number of children without amblyopia who have reduced vision due to refractive errors. This group of children must be included in any analysis of the cost effectiveness of preschool vision screening.

Amblyopia↗