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PubMedDate not supplied

Psychosocial issues in older adults' adjustment to vision loss: findings from qualitative interviews and focus groups.

Although more therapists are responding to the increasing need for visual rehabilitation services for older adults, little is reported in the literature about the emotional experience of vision loss, especially in the words of persons with low vision themselves. This paper reports findings from a qualitative inquiry involving focus groups and in-depth interviews with 15 older adults using or considering using low vision assistive devices (Copolillo & Teitelman, 2005). Although the study's original intent was to focus primarily on decisions about LVAD use, psychological and social implications of vision loss emerged spontaneously as a dominant area of concern for participants. From an analysis of 154 codes derived from transcripted data, three themes related to psychosocial experience were generated: (a) Emotional Challenges, (b) Negative Emotional Outcomes, and (c) Indicators of Emotional Adaptation. In this article, individual components of the themes are described using illustrative quotes, and potential practice implications for therapists are presented.

Adaptation, Psychological↗

PubMed1998

The virtual retinal display: a new technology for virtual reality and augmented vision in medicine.

INTRODUCTION: The Virtual Retinal Display (VRD) is a new technology for creating visual images. It was developed at the Human Interface Technology Laboratory (HIT Lab) by Dr. Thomas A. Furness III. The VRD creates images by scanning low power laser light directly onto the retina. This special method results in images that are bright, high contrast and high resolution. In this paper, we describe how the VRD functions, the special consequences of its mechanism of action and potential medical applications of the VRD, including surgical displays and displays for people with low vision. A description of its safety analysis will also be included. In one set of tests we had a number of patients with partial loss of vision view images with the VRD. There were two groups of subjects: patients with macular degeneration, a degenerative disease of the retina and patients with keratoconus. Typical VRD images are on the order of 300 nanowatts. VRD images are also readily viewed superimposed on ambient room light. In our low vision test subjects, 5 out of 8 subjects with macular degeneration felt the VRD images were better and brighter than the CRT or paper images and they were able to reach the same or better level of resolution. All patients with Keratoconus were able to resolve lines of test several lines smaller with the VRD than with their own correction. Further, they all felt that the VRD images were sharper and easier to view. The VRD is a safe new display technology. The power levels recorded from the system are several orders below the power levels prescribed by the American National Standard. The VRD readily creates images that can be easily seen in ambient roomlight and it can create images that can be seen in ambient daylight. The combination of high brightness and contrast and high resolution make the VRD an ideal candidate for use in a surgical display. Further, tests show strong potential for the VRD to be a display technology for patients with low vision.

Equipment Design↗

PubMed1999

Seeking a comprehensive vision plan.

The demand for vision care services continues to rise rapidly. A comprehensive vision benefit can be of tremendous value to the employer and employee alike. Although nationwide standards do not exist for the provision of vision care services, the authors outline the features of a vision benefit that are crucial to offering a quality plan.

Costs and Cost Analysis↗

PubMed2000

Vision and low self-rated health: the Blue Mountains Eye Study.

PURPOSE: To assess the relationship between reduced vision and low self-rating of global health, after taking into account many other related factors. METHODS: The Blue Mountains Eye Study examined 3654 residents aged > or =49 years (82.4% response) in an area west of Sydney, Australia. Presenting and best-corrected visual acuity (VA) were measured before and after refraction using a LogMAR chart. During a face-to-face interview, self-rated health was assessed by asking: "For someone of your age, how would you rate your overall health?: excellent, good, fair, or poor." Information about demography, socioeconomic status, need for assistance in daily living activities, medical history, and health risk behaviors was also collected. Logistic regression analyses were performed after dichotomizing self-rated health as poor or fair (low) versus good or excellent. RESULTS: Among persons without visual impairment (defined from best-corrected VA in the better eye), 24.5% rated their health as either poor or fair, compared with 35.5% and 48.8% of persons with mild or moderate-to-severe visual impairment, respectively. In multivariate logistic regression models that included 17 other related factors, reduced vision was statistically significantly associated with lower self-rated health in persons aged <80 years. For each one-line (5 letter) reduction in best-corrected VA, there was 20% increased likelihood of low self-rated health, after adjustment for other factors found associated with self-rated health (multivariate-adjusted odds ratio 1.2, 95% confidence interval 1.1-1.3). In persons aged 80 years or older, reduced vision had no impact on global health rating. CONCLUSIONS: Decreased vision was found to have an independent impact on global health ranking by persons younger than age 80 years, but not by older persons in this population. Taking into account many other factors affecting perceived health, people younger than age 80 years who see well are also more likely to say that they feel well!

Activities of Daily Living↗

PubMed1975

Color vision: blue deficiencies in children?

Recent publicized reports based on the use of the Farnsworth Panel D-15 test suggest that a large percentage of young children have a deficiency of blue vision (tritan type). In our study, 413 school children (ages 3 to 10) were tested with both the Farnsworth Panel D-15 test, as well as the A.O. H-R-R plates. None of the children failed either test for blue-yellow vision when traditional scoring instructions were observed. As in previous reports, we find that the children make a number of minor errors which adults rarely make. These errors show marked age-related patterns, being more frequent in younger children. However, further analysis of these errors revealed that the relative frequency with which particular error types were made on the D-15 test was significantly correlated with the existing perceived color difference data for the visually normal adult population. In addition, retesting significantly reduced all error types and reversing the test sequence demonstrated that most of the minor errors were made in the last half of the test regardless of the color vision task. The overall increase in the number of minor test errors seen with young children seems unrelated to color defects. The modified scoring methods in conjunction with the characteristics of the Panel D-15 test design account for the high percentage of errors classified as errors of blue vision.

Age Factors↗

PubMed1976

Data concerning colour vision deficiencies amongst 29,985 young Greeks.

In this survey, 29,985 young Greek employees were screened by the Ishihara plates and if necessary by further more detailed methods (including anomaloscope). The examination of 21,231 young males revealed 212 (1.00%) protanopes, 241 (1.14%) deuteranopes, 254 (1.20%) protanomalous, 978 (4.61%) deuteranomalous and 2 with monochromatic vision. In total, 1,678 males (7.95%) had a colour vision disturbance. The examination of 8,754 young females revealed 1 (0.01%) protanope, 2 (0.02%) deuteranope, 3 (0.03%) protanomalous and 31 (0.35%) deuteranomalous; no case of monochromatic vision in females was detected. In total, only 37 (0.42%) females had a detectable colour vision disturbance with applied screening method. These results are discussed and compaired with the available bibliographic data.

Adolescent↗

PubMed2000

Characteristics of a paediatric low vision population in a private eye hospital in India.

While private hospitals provide an important access point for low vision services for children in urban India, little is known about this service delivery route. A cross sectional survey was done of consecutive records of 220 children presenting at a newly opened paediatric low vision centre in a private eye hospital in Hyderabad. On presentation, 49% of the children were classified as moderately visually impaired, 31% were severely visually impaired and 20% were blind. The four major causes of visual impairment were the hereditary/genetic conditions of congenital glaucoma, hereditary macular degeneration, retinitis pigmentosa and albinism. Approach magnification was sufficient for required near tasks in all pre-school children and about 50% of school children. Provision of a distance refraction decreased the prevalence of severe visual impairment and blindness by 31%. The most commonly prescribed low vision devices were spectacles indicating a key role for optometry in the management of visual impairment in Indian children. Establishment of low vision clinics in existing Indian eye hospitals using associated optometric staff would be a cost effective method to minimise visual impairment in Indian children.

Adolescent↗

PubMedDate not supplied

Low vision in persons aged 50 and above in the onchocercal endemic communities of Anambra State, Nigeria.

OBJECTIVE: To determine the prevalence and causes of low vision among persons aged 50 and above in the onchocercal endemic rural areas of Anambra State, Nigeria. MATERIALS AND METHODS: Normal residents of three onchocercal rural villages in 3 local government areas of Anambra State, Nigeria, selected through simple random sampling, were examined using interviewer-administered structured questionnaire. Eye examination included visual acuity test, refraction, tonometry, color vision test and direct ophthalmoscopy. Skin-snips were examined for onchocercal microfilaria. RESULTS: Four hundred and seventy-two persons aged 50 years and above were examined, out of which 8.6% were bilaterally blind; 11.9% were monocularly blind and 23.7% had visual impairment. Cataract caused blindness in nearly two-third of the cases. Other causes of low vision include age-related macular degeneration, glaucoma, onchocerciasis and refractive errors. Of the 56 subjects blinded by cataract in at least one eye, only 16 (28.6%) had undergone cataract surgery. But none had intra-ocular lens implant. Only 2 of these 16 subjects had aphakic eyeglasses. CONCLUSIONS: Blindness rate among the population studied is 6 times the rate in similar aged-matched population in developed countries. Most of the bilaterally blind will have vision restored through cataract surgery. Cataract extraction with intra-ocular lens implant is recommended for better visual rehabilitation.

Age Distribution↗

PubMed2000

The measurement of patient-reported outcomes of refractive surgery: the refractive status and vision profile.

PURPOSE: To develop a questionnaire, the Refractive Status and Vision Profile (RSVP), to assess health-related quality of life associated with refractive error and its correction. METHODS: The published literature on patient report of visual and overall function was reviewed, and the RSVP was self-administered by 550 participants with refractive error. Cross-sectional validation was performed using standard psychometric techniques. The responsiveness of the RSVP to surgical intervention was assessed prospectively in a subset of 176 patients. The principal outcomes measures were scores on the overall RSVP scale (S) and on 8 RSVP subscales (functioning, driving, concern, expectations, symptoms, glare, optical problems, problems with corrective lenses). RESULTS: The RSVP (S) and its subscales demonstrated very good internal consistency (Cronbach's alpha, 0.70-0.93). S and several subscale scores were independently associated with satisfaction with vision and were more correlated with satisfaction with vision than with either visual acuity or refractive error. Higher refractive error was associated with lower scores on S and on 5 subscales. In the prospective surgical cohort, 15% of patients had some worsening in their total RSVP score; however, substantial variation was seen in the individual subscales where worsening ranged from 7% (problems with corrective lenses) to 41% (driving). The effect size (measure of responsiveness) of the RSVP and most of its subscales was very high. Approximately 14% of patients had significant worsening in 3 or more subscales, and this outcome was found to be independently associated with being dissatisfied with vision following surgery (OR, 5.84; 95% CI, 1.88, 8.13). CONCLUSIONS: The RSVP has been validated as a questionnaire that measures patient-reported quality of life related to refractive error and its correction. It is responsive to surgical intervention and provides important information regarding patient outcomes not available from standard clinical measurements.

Adult↗

PubMed1999

[Comparison between motion sickness induced by reversed vision and that by parallel swing].

OBJECTIVE: To make clear the characteristics of motion sickness induced by reversed vision and to see whether it can be used in motion sickness experiments. METHODS: 10 healthy young men experienced walking tests wearing up-down or left-right reversing prisms, and parallel swing test on different days with intervals of 5-7d. Ataxia and motion sickness symptoms induced by walking wearing reversing prisms and those by parallel swing were observed. The reversed vision tolerance index (RVTI) and linear acceleration tolerance index (LATI) were calculated by an empirical formula. RESULTS: Both types of reversing prisms can induce obvious ataxia and motion sickness symptoms. The ataxia is correlative (P<0.05) with the susceptibility to motion sickness. In comparison with symptoms of swing motion sickness, the symptoms of reversed vision motion sickness are not too serious and appear slowly. There are correlativities (P< 0.01) between the susceptibility to motion sickness induced by up-down and left-right reversing prisms. The susceptibilities to motion sickness induced by reversing prisms are not correlative completely with that by swing. CONCLUSION: Reversed vision test is simple and easy and can be used for simulating space motion sickness or training of adaptation to sensory conflict on the ground.

Acceleration↗

PubMed2002

Low vision and methods of rehabilitation: a comparison between the past and present.

BACKGROUND: The aims of this study were to determine the clinical effectiveness of optical and video low vision aids (LVA) and analyze the characteristics of the visually impaired at the low vision clinic of Chang Gung Memorial Hospital. METHODS: The use of LVA to improve distance and near visual functions was evaluated in 203 new patients from 1998 through 2001 at our clinic. The age, gender, visual status, and primary condition causing low vision of the patients were also compared with data obtained from two different study periods, from 1984 through 1987 and 1991 through 1994. RESULTS: After careful refraction, spectacles only were able to meet both distance and near visual requirements in 21 patients (10.3%), and among them, 3 patients with hemianopsia were further prescribed Fresnel prisms. Of the 121 patients with distance visual requirements, 84 (69.4%) benefited from using telescopes; however, only one additional patient benefited from the addition of a head-mounted device. Of the 136 patients who could not read the newsprint, 118 (86.8%) succeeded in reading newsprint using optical magnifiers, and up to 125 (91.9%) with using the addition of a closed circuit television. Compared with the previous data, the average age of our patients has steadily increased, and the main cause of ocular pathology has changed accordingly. CONCLUSION: Video magnifiers provided suitable rehabilitation for some patients who failed to see clearly using optical magnifiers. However, most of our low vision patients, who have changed during the last decades, can accomplish their desired visual tasks using traditional LVA.

Adolescent↗

PubMed2002

Learning disabilities, dyslexia, and vision: a subject review--a rebuttal, literature review, and commentary.

BACKGROUND: In 1998, the American Academy of Pediatrics, the American Academy of Ophthalmology, and the American Association of Pediatric Ophthalmology and Strabismus (AAP/AAO/AAPOS) published a position paper entitled "Learning Disabilities, Dyslexia And Vision: A Subject Review," intended to support their assertion that there is no relationship between learning disabilities, dyslexia, and vision. The paper presents an unsupported opinion that optometrists (by implication) have said that vision problems cause learning disabilities and/or dyslexia and that visual therapy cures the conditions. The 1998 position paper follows two very similar and discredited papers published in 1972 and 1981. METHOD: This article critically reviews and comments on the many problems of scholarship, the inconsistencies, and the false allegations the position paper presents. Perhaps the foremost problem is that the authoring committee has ignored a veritable mountain of relevant literature that strongly argues against their assertion that vision does not relate to academic performance. It is for this reason that an overview, drawn from more than 1,400 identified references from Medline and other database sources and pertinent texts that were reviewed, is incorporated into this current article. The AAP/AAO/AAPOS paper is also examined for the Levels of Evidence that their references offer in support of their position. CONCLUSION: The AAP/AAO/AAPOS paper contains errors and internal inconsistencies. Through highly selective reference choices, it misrepresents the great body of evidence from the literature that supports a relationship between visual and perceptual problems as they contribute to classroom difficulties. The 1998 paper should be retracted because of the errors, bias, and disinformation it presents. The public assigns great trust to authorities for accurate, intellectually honest guidance, which is lacking in this AAP/AAO/AAPOS position paper.

Dyslexia↗

PubMed2002

[An epidemiological survey of low vision and blindness of senile persons in Beixinjing blocks, Shanghai].

OBJECTIVE: To investigate the morbidities of low vision and blindness and the leading cause of blindness in residents aged >or= 60 years in Beixinjing blocks, Shanghai. METHODS: The vision archives were first established for total old residents. The pinhole visual acuity was recorded and classified under WHO grading system. Assigned ophthalmologic doctors assured the leading blind causes of every blind person. RESULTS: The response rates in 1994, 1997 and 2000 were 83.87%, 88.32% and 91.98% respectively. The morbidities of low vision and blindness in these 3 years were 3.61% and 1.51%, 2.31% and 1.09%, 1.31% and 0.71% respectively. The leading causes of blindness were degenerative retinopathy (including age-related maculopathy), cataract, corneal diseases and retinal angiopathy (including hypertensive and diabetic retinopathy, retinal artery or venous occlusion, etc). CONCLUSIONS: The morbidities of low vision and blindness in this area decreased from 1994. The leading cause of blindness was degenerative retinopathy.

Aged↗

PubMed2003

[The recovery of binocular vision in the early post-operative stage of senile cataract patient].

OBJECTIVE: To study the recovery of binocular vision and the risk factors that affect the recovery in the early post-operative stage of senile cataract patients. METHODS: Patients undergone extracapsular cataract extraction with intraocular lens implantation (ECCE group) or cataract phacoemulsification with intraocular lens implantation (PHACO group) were examined for their corrected visual acuity, refractive power, simultaneous perception, fusion, near and far-distance stereoacuity. RESULTS: Before operation, the visual acuity was worse in the ECCE group than that in the PHACO group (chi(2) = 9.769, P < 0.05); After operation, the visual acuity between ECCE group and PHACO group was not statistically significant (chi(2) = 0.52 for operated eyes, P > 0.05, chi(2) = 3.52 for non-operated eyes, P > 0.05). The cylinder anisometropia in ECCE group was worse than the PHACO group (chi(2) = 12.496, P < 0.01). All patients obtained simultaneous perception and fusion sense. There was more or less far-distance stereoacuity 83.3% in ECCE group and 94.7% in PHACO group, which was no statistical significant (chi(2) = 1.456, P > 0.05). Foveal near stereoacuity was established in ECCE group (2.8%) and in PHACO group (21.1%), which were statistically significant (chi(2) = 5.029, P < 0.05). CONCLUSIONS: There is incomplete recovery of binocular vision in the early post-operative stage of senile cataract patients. The vision depression, especially monocular depression before surgery and the anisometropia after operation may affect the recovery of binocular vision.

Adult↗

PubMed1992

[The 1987 National Epidemiological Survey of Blindness and Low Vision in China].

According to the 1987 National Epidemiological Survey of Blindness and Low Vision, the prevalence of blindness in China was 0.43%, resulting chiefly from cataract (41.06%), corneal diseases (15.38%), trachoma (10.87%), and glaucoma (8.80%); the prevalence of low vision was 0.58%, of which the main causes were cataract (49.83%), ametropia/amblyopia (14.98%), trachoma (9.55%), corneal diseases (8.48%), chorioretinal diseases (6.27%), etc. Among children under 14 years of age, the leading cause of blindness and low vision was hereditary diseases (48.46%), and among the elderly of 60 years and over, the leading cause of blindness and low vision was cataract (73.13%).

Adolescent↗

PubMed1992

National epidemiological survey of blindness and low vision in China.

According to the National Sample Survey of Blindness and Low Vision, the prevalence of blindness in China was 0.43%, resulting chiefly from cataract (41.06%), corneal diseases (15.38%), trachoma (10.87%), and glaucoma (8.80%); and the prevalence of low vision in China was 0.58%, of which the main causes were cataract (49.83%), ametropia/amblyopia (14.98%), trachoma (9.55%), corneal diseases (8.48%), chorioretinal diseases (6.27%), etc. Among children under 14 years of age, the leading cause of blindness and low vision was heredity (48.46%). Among elderly of 60 years and over, the leading cause of blindness and low vision was cataract (73.13%).

Aged↗

PubMed2003

Accommodative response to PRIO Computer Vision Tester versus printed text.

BACKGROUND: Video display terminals (VDTs) have Gaussian display characteristics. Research suggests that patients accommodate differently to Gaussian images. In the present study, we asked if the accommodative response to the PRIO Computer Vision Tester (a Gaussian image) is different than the accommodative response to a Monocular Estimation Method (MEM) printed text target. METHOD: A normally sighted prepresbyopic group of subjects (N = 60) was recruited from the student body of Nova Southeastern University. Low neutral retinoscopy was performed on each subject at a distance of 50 cm. using both the PRIO vision tester and an MEM target. RESULTS: The PRIO vision tester and the printed text provided essentially the same measures of accommodative response. In addition, the luminance of the PRIO dropped by nearly 40% over the course of 1 hour of intermittent use. CONCLUSION: The PRIO vision tester and traditional nearpoint retinoscopy provided essentially the same measures of accommodative response in prepresbyopic subjects. Further studies should be considered to evaluate whether the change in luminance of the PRIO system has any effect on the measurement of accommodative response.

Accommodation, Ocular↗

PubMed1992

Color vision testing for the U.S. Naval Academy.

Normal color vision is a prerequisite for admission to the United States Naval Academy. The Farnsworth Lantern (FALANT) is the Navy's definitive test for color vision. A FALANT is not available at many locations where candidates are examined, so satisfactory performance on pseudoisochromatic plates has been considered an acceptable alternative. Until recently, the Farnsworth Dichotomous Test Panel D-15 had also been used as an alternative test, but is now considered unacceptable. In the summer of 1991, a large number of candidates reported for induction who were unable to pass the FALANT. Since their screening physical examinations had been reported to show normal color vision, a shadow of doubt was cast upon the ability of the alternative tests to predict performance on the FALANT. Four hundred subjects were then tested on several color vision tests to determine if these tests could predict FALANT success. The results of this study and recommendations are presented.

Adolescent↗