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Sensitivity to perspective structure while walking without vision.

Experiments are reported of the nonvisual sensitivity of observers to their paths of locomotion and to the resulting changes in the structure of their perspectives, ie changes in the network of directions and distances spatially relating them to objects fixed in the surrounding environment. In the first experiment it was found that adults can keep up to date on the changing structure of their perspectives even in the absence of sights and sounds that specify changes in self-to-object relations. They do this rapidly, accurately, and, according to the subjects' reports, automatically, as if perceiving the new perspective structures. The second experiment was designed to investigate the role of visual experience in the development of sensitivity to occluded changes in perspective structure by comparing the judgments of sighted adults with those of late-blinded adults (who had extensive life histories of vision) and those of early-blinded adults (who had little or no history of vision). The three groups performed similarly when asked to judge perspective while imagining a new point of observation. However, locomoting to the new point greatly facilitated the judgments of the sighted and late-blinded subjects, but not those of the early-blinded subjects. The findings indicate that visual experience plays an important role in the development of sensitivity to changes in perspective structure when walking without vision.

Adolescent↗

Visual perception in 'low vision'.

'Low vision' has an international classification as an impairment of vision that is defined by loss of visual acuity and the size of the visual field. Functional classification that would depict capability to use vision in different activities has not yet been agreed upon. Abnormal visual information leads to changes in visual perception, and brain-damage-related visual impairment may alter or prevent one or several cognitive visual functions. Abnormal visual perception opens a window into brain mechanisms that the psychophysicists otherwise do not have. Together with clinicians, psychophysicists can help visually impaired persons to understand the nature of their disability by thoroughly studying the nature of the altered image and the profile of cognitive visual functions.

Humans↗

From dichoptic to dichotic: historical contrasts between binocular vision and binaural hearing.

Phenomena involving vision with two eyes have been commented upon for several thousand years whereas those concerned with hearing with two ears have a much more recent history. Studies of binocular vision and binaural hearing are contrasted with respect to the singleness of the percept, experimental manipulations of dichoptic and dichotic stimuli, eye and ear dominance, spatial localisation, and the instruments used to stimulate the paired organs. One of the principal phenomena that led to studies of dichotic hearing was dichoptic colour mixing. There was similar disagreement regarding whether colours or sounds could be combined when presented to different paired organs. Direction and distance in visual localisation were analysed before those for auditory localisation, partly due to difficulties in controlling the stimuli. Instruments for investigating binocular vision, like the stereoscope and pseudoscope, were invented before those for binaural hearing, like the stethophone and pseudophone.

Auditory Perception↗

Hypoglycemia leads to age-related loss of vision.

The retina is among the most metabolically active tissues in the body, requiring a constant supply of blood glucose to sustain function. We assessed the impact of low blood glucose on the vision of C57BL/6J mice rendered hypoglycemic by a null mutation of the glucagon receptor gene, Gcgr. Metabolic stress from moderate hypoglycemia led to late-onset loss of retinal function in Gcgr(-/-) mice, loss of visual acuity, and eventual death of retinal cells. Retinal function measured by the electroretinogram b-wave threshold declined >100-fold from age 9 to 13 months, whereas decreases in photoreceptor function measured by the ERG a-wave were delayed by 3 months. At 10 months of age Gcgr(-/-) mice began to lose visual acuity and exhibit changes in retinal anatomy, including an increase in cell death that was initially more pronounced in the inner retina. Decreases in retinal function and visual acuity correlated directly with the degree of hypoglycemia. This work demonstrates a metabolic-stress-induced loss of vision in mammals, which has not been described previously. Linkage between low blood glucose and loss of vision in mice may highlight the importance for glycemic control in diabetics and retinal diseases related to metabolic stress as macular degeneration.

Age Factors↗

An A-71C substitution in a green gene at the second position in the red/green visual-pigment gene array is associated with deutan color-vision deficiency.

We studied 247 Japanese males with congenital deutan color-vision deficiency and found that 37 subjects (15.0%) had a normal genotype of a single red gene followed by a green gene(s). Two of them had missense mutations in the green gene(s), but the other 35 subjects had no mutations in either the exons or their flanking introns. However, 32 of the 35 subjects, including all 8 subjects with pigment-color defect, a special category of deuteranomaly, had a nucleotide substitution, A-71C, in the promoter of a green gene at the second position in the red/green visual-pigment gene array. Although the -71C substitution was also present in color-normal Japanese males at a frequency of 24.3%, it was never at the second position but always found further downstream. The substitution was found in 19.4% of Chinese males and 7.7% of Thai males but rarely in Caucasians or African Americans. These results suggest that the A-71C substitution in the green gene at the second position is closely associated with deutan color-vision deficiency. In Japanese and presumably other Asian populations further downstream genes with -71C comprise a reservoir of the visual-pigment genes that cause deutan color-vision deficiency by unequal crossing over between the intergenic regions.

Asian People↗

Homing in pigeons with impaired vision.

In order to test the importance of vision in homing pigeons, their vision was impaired by frosted contact lenses. Pigeons wearing such lenses seemed unable to recognize artificial landmarks at 6-m distance. Nevertheless, most birds homed from distances of 15 km, and some even from 130-km distance. This result indicates that, contrary to common expectation, vision need not play an essential role in homing.

Animals↗

Residual vision in transition zones in patients with cerebral blindness.

Using high resolution perimetry in repeated sessions, we investigated 27 patients with homonymous visual field defects in order to detect islands of vision within the damaged area, and to determine color- and form-recognition abilities within these zones of residual vision. In most patients we found circumscribed areas within the "blind" field in which the stimulus was detected in about 50% of presentations. Only one patient had an island of vision greater than 5 degrees within the defective area. We also found an area of variable performance between the blind and the intact field. Borders of field defects were classified as being: (a) sharp (small transition zone), (b) medium, or (c) fuzzy (scattered deficits). We propose that transition zones are functional representations of partially spared neuronal structures in areas of the brain which are only partially injured.

Adult↗

Evaluating the effectiveness of a vision rehabilitation intervention using an objective and subjective measure of functional performance.

PURPOSE: To test the hypothesis that vision rehabilitation using optometry, occupational therapy and social work services increases patients' functional ability and to assess whether involving families in the intervention results in more successful outcomes. METHODS: We conducted an outcome study of 97 patients new to the Vision Rehabilitation Service. Subjects were between the ages of 19 and 91 years, with a median age of 76. Their visual acuities were 20/100 or worse in the better eye, with 50% of the subjects having acuities worse than 20/200. Macular degeneration was the most prevalent diagnosis. Subjects were assigned to either an individually focused (n=48) or a family focused (n=49) intervention. The outcome measure was change in function, as assessed by speed and accuracy of performance (objective measure) and by the patients' self-reports of difficulty and dependency in performing daily activities (subjective measures). Data were collected before and after the intervention. RESULTS: Most patients had documented improvement after rehabilitation on both objective (p=.0001) and subjective (decreased dependency, p=.01) measures of function. The sample size did not provide adequate statistical power to show differences between family focused and individually focused interventions. CONCLUSIONS: This study documents significant improvement after vision rehabilitation for a predominantly elderly population. Patients in both family and individually focused interventions improved comparably.

Activities of Daily Living↗

Infant vision screening predicts failures on motor and cognitive tests up to school age.

In a population-based infant vision screening programme, 5295 infants were screened and those with significant refractive errors were followed up. To assess the relationship between the development of vision and other domains, we report a longitudinal study comparing infants with significant hyperopia, identified at age 9 months ('hyperopes') with infants with normal refractions ('controls'). Children are included who completed at each age a broad set of visual, cognitive, motor and language measures taken over a series of follow-up visits up to age 5.5 years. Hyperopes performed significantly worse than controls on the Atkinson Battery of Child Development for Examining Functional Vision at 14 months and 3.5 years and the Henderson Movement Assessment Battery for Children at 3.5 and 5.5 years. The Griffiths Child Development Scales, MacArthur Communicative Development Inventory and British Picture Vocabulary Scales showed no significant differences. Exclusion of those infants who became amblyopic and strabismic did not substantially alter these results, suggesting that the differences between groups were not a consequence of these disorders. These results indicate that early hyperopia is associated with a range of developmental deficits that persist at least to age 5.5 years. These effects are concentrated in visuocognitive and visuomotor domains rather than the linguistic domain.

Cognition Disorders↗

A critical appraisal of current knowledge and future directions of ergophthalmology: consensus document of the ICOH Committee on 'Work and Vision'.

In the past, occupational health gave scant attention to the visual apparatus. Studies on issues relating to 'work and vision' have predominantly addressed industrial accidents and the toxic effects of exposure to chemical and physical agents, with secondary prevention being more common than primary prevention. In recent years, the huge transformations implemented in workplaces, mainly due to computer-based technologies, demand a progressively higher efficiency of the eye and the related nervous system components that co-ordinate eye movements and accommodation. At the moment these aspects are managed by medical, psychosocial and a variety of technical disciplines, without any shared criteria, terminology and method. Objectives of the Committee are: to investigate holistically the many possible hazards associated to the occupational visual performance; to come to a consensus on terminology, risk assessment and health surveillance procedures. The present status of research and practice in ergophthalmology does not allow for clear-cut decision about health risk and nor is there a clear direction on the prevention of work-related ocular and visual disturbances and disorders. Specifically, at least three determinants must be objectively considered, namely: (a) visual effort; (b) environmental agents; (c) individual characteristics. Although criteria exist for the evaluation of some of these determinants, a greater refinement is necessary 'for a good working life' of the visual apparatus. The ICOH Scientific Committee on 'Work and Vision' is seeking to systematically develop this matter, yielding a more rational and complete approach to the relationship between work and vision.

Advisory Committees↗

The binocular fusion of human vision on stereoscopic displays--field of view and environment effects.

This paper points out that the fusional limits of binocular stereoscopic viewing are an important factor, not only determining the reproduction range of stereoscopic images, but also the conformity between the stereoscopic display and stereoscopic vision. Experimental results showed that fusional limits increase in proportion to the field of view angle, and that they are affected not only by the size of the viewing target, but also by the effects that the environment has on the target. These findings explain the differences between binocular vision in real space and binocular vision in a stereoscopic display. Finally, the conditions under which observers are able to view images of stereoscopic displays without excessive visual strain are discussed.

Attention↗

Control of locomotion in expert gymnasts in the absence of vision.

The main aim of this study was to determine how gymnasts are affected by the removal of vision when executing simple moves. A secondary aim was to establish whether crucial sensory cues exist for blindfolded gymnasts. Eight expert gymnasts were asked to maintain a straight displacement during three types of blindfolded locomotion: walking, steering a wheelchair and verbally ordering a second person pushing their wheelchair. In the first two conditions, active displacement made proprioceptive cues available to update the body trajectory. In the last condition, however, proprioceptive cues were greatly reduced, since the gymnasts displaced passively. The performance of the gymnasts was compared to that of eight experts in other non-gymnastic sports (control group). The results showed that the participants veered in all conditions. However, except in the verbal condition, the gymnasts departed less from linearity than the controls. We conclude that: (1) even for a simple motor task, gymnasts' performance is altered by eliminating vision; (2) compared with other sportsmen and women, gymnasts are better able to deal with the absence of vision when proprioceptive cues are available. These findings suggest two possible explanations: (1) gymnasts are more able to 'pick up' crucial information and (2) a gymnast's proprioceptive system is more sensitive.

Adolescent↗

Prevalence and causes of blindness and low vision in a rural setting in Pakistan.

PURPOSE: To determine the prevalence and causes of blindness and visual impairment in people 40 years of age and older in Budni, Peshawar, Pakistan. METHODS: A population-based cross-sectional study was carried out involving 1,106 men and women 40 years of age and older in a rural area in Pakistan's North West Frontier Province (NWFP). All subjects with a presenting visual acuity < 6/18 in either eye were referred to a centralized clinic for a standardized eye examination that included refraction and dilated fundal examination. The main outcome was blindness (presenting visual acuity < 3/60 in the better eye) and low vision (presenting VA < 6/18-3/60 in the better eye). RESULTS: Of 1,106 people examined, 21 (1.9%; 95% CI: 1.1-2.7%) were blind, while another 27 (2.4%) and 62 (5.5%) subjects had severe visual impairment (< 6/60-3/60) and visual impairment (< 6/18-6/60), respectively. Women, as compared to men, had a higher prevalence of visual impairment and severe visual impairment; but they had a lower prevalence of blindness (1.6 vs. 2.2%); however, the difference was not statistically significant (0.6%; 95% CI: -0.9-2.1%). Similarly farmers had the highest prevalence of blindness. The leading cause of blindness and low vision was cataract, which accounted for 14 of 21 (66.6%) cases of blindness and 49 of 89 (55.5%) cases of low vision. The second leading cause of blindness was uncorrected aphakia. CONCLUSION: Much of the blindness was due to unoperated cataract and uncorrected aphakia. Thus, there is an urgent need to develop ways in which cataract surgical output could be increased, and glasses provided to those who need them.

Adult↗

Registered blindness and low vision in Kuwait.

AIM: To estimate the incidence rates and major causes of registered blindness and low vision in Kuwait. METHODS: Data on age, gender and cause of blindness and low vision were collected from the Visual Disability Committee while evaluating Kuwaiti citizens applying for a blindness allowance from January 2000 to December 2004. Criteria for legal blindness in Kuwait are visual acuity 6/60 or less in the better eye with best possible correction or a visual field less than 20 degrees around the central fixation point. Incidence rates per 100,000 person years of observation were calculated for both genders in four age subgroups and four severity categories. The causes of registered blindness were classified according to the International Classification of Diseases, 10th edition. RESULTS: 412 persons were registered as blind, 272 males (66.01%) and 140 females (33.98%), mean age 28.7 +/-25.2 years, 39.32% below 20 years of age, 31.79% 21-40 years, 18.68% 41-60 years, and 9.95% 61 years and over . Male gender was prevalent for all age subgroups. The overall incidence rate was 9.97 per 100,000 person years of observation, 13.33 for the male and 6.69 for the female patients. The incidence rates rose from 7.35 for those 20 years and younger to 14.80 for the age subgroup 41-60 and 23.16 for those 61 years and above. The rates of severe visual impairment classified in categories 4 and 5 were higher than the rates for categories 2 and 3. Retinitis pigmentosa was the leading cause of blindness, followed by congenital anomalies and optic atrophy. In the subgroup below 20 the rate of optic atrophy was highest, followed by congenital malformations, retinitis pigmentosa and retinopathy of prematurity. In the next age subgroup (21-40 years), the rate of retinitis pigmentosa was three times as high as in the younger subgroup, followed by optic atrophy, congenital malformations and albinism. In the subgroup 41-60 the incidence rate for phthisis bulbi was twice as high as the rates for retinitis pigmentosa and optic atrophy. For those 61 years and older, the incidence rate of phthisis bulbi was almost five times as high as that for optic atrophy. The incidence rates for the male patients were higher for the major causes of disability in all age subgroups. CONCLUSIONS: The overall incidence rate of registered blindness for Kuwait is less than in many other national registries. The marked prevalence of the male gender in all age subgroups is specific for Kuwait. The rates of the leading causes of registered blindness reflect the prevalence of the younger subgroups in our registry. Additional data on co-morbidity and dedicated efforts to reveal unrecognized and unregistered blindness, particularly among females, will overcome the limitations of the registry, and will serve to outline the tendencies in avoidable vision loss and monitor the efficacy of the prevention programs in the future.

Adolescent↗

Assessment of vision-related quality of life in an older population subsample: The Blue Mountains Eye Study.

PURPOSE: To assess visual functioning and vision-specific health-related quality of life (HRQOL) in an older, community-dwelling-based population subsample, using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). METHODS: Three-quarters (76%, n = 892) of Extension Blue Mountains Eye Study participants (aged > or = 50 years, mean 60.8 years) completed the self-administered NEI-VFQ-25, an instrument consisting of 12 dimensions and one summary composite score, and comprehensive eye examinations, including monocular distance visual acuity. Visual impairment was defined as visual acuity < 6/12. Unilateral and bilateral visual impairment was defined by the worse eye and better eye, respectively. Correctable visual impairment was defined as that which improved, and non-correctable visual impairment as that which persisted after subjective refraction. Mild visual impairment was defined as visual acuity < 6/12 but > or = 6/24, moderate as < 6/24 but > or = 6/60, and severe as < 6/60. RESULTS: There were no significant differences in age, sex, or vision status between NEI-VFQ-25 responders and non-responders. Men had significantly better scores in three subscales than women but there were no significant differences in their overall composite scores (men 88.5+/- 0.5; women 88.1+/- 0.4). Persons aged 60-69 years had the best NEI-VFQ-25 profiles (mean composite score +/- standard error, 90.2 +/- 0.5; 50-59 years, 88.5 +/- 0.4; > or =70 years, 86.2 +/- 0.8). Presenting bilateral visual impairment (77.1 +/- 1.4) was associated with significantly poorer functioning than unilateral (87.5 +/- 0.8) or no visual impairment (89.4 +/- 0.3). Increasing levels of impairment were associated with poorer levels of visual functioning. The impact of impairment was principally from non-correctable (49.2 +/- 2.6) rather than refractive impairments (85.3 +/- 1.4), although the latter accounted for over three-quarters (77.5%) of presenting bilateral impairment. Non-correctable unilateral impairment (85.3 +/- 1.1) was associated with poorer functioning than no impairment. CONCLUSIONS: The findings from this community-dwelling older population show that the NEI-VFQ-25 differentiates well between various levels of visual impairment with regard to the magnitude of their impact on vision-specific quality of life. Greater impacts were noted among persons with bilateral compared to unilateral impairment, with increasing impacts at greater severities of visual impairment. Visual impairment from refractive errors is more frequent than from underlying pathologic disorders, but the impact of correctable visual impairment was considerably milder than the impact of non-correctable visual impairment.

Aged↗

Color-vision mechanisms in the peripheral retinas of normal and dichromatic observers.

It is possible that so-called normal trichromatic vision occurs only between the central blue-blind fixation area and about 30 degrees peripherally. Beyond about 30 degrees vision has been alleged to become dichromatic (red-green blind), and beyond about 60 degrees , monochromatic. Hence every form of color blindness may characterize various zones of the normal retina. We have studied mechanisms of peripheral color vision, mainly by measuring the spectral sensitivities of the blue-, green-, and red-sensitive systems, isolated by differential color adaptation. In normal observers the sensitivity of the blue-mechanism falls off about 2 log units by 80 degrees out. The green- and red-sensitive systems decline only about 0.7 log unit over the same range. Protanopes, deuteranopes, and tritanopes exhibit comparable changes. We have not found any color mechanism present centrally to be wholly lost peripherally. Nor, for dichromats, have we found any mechanism missing centrally to be present peripherally. Whatever evidences of peripheral color blindness have been observed appear to involve other mechanisms than failure of receptors, probably including some fusion of neural pathways from receptors to centers.

Color Perception↗

Colour vision deficiencies in Alzheimer's disease.

OBJECTIVE: visual disorders are among the earliest symptoms of Alzheimer's disease. It is, however, still controversial as to whether Alzheimer's disease impairs colour vision. In this study, colour vision of Alzheimer's disease patients was tested using the Ishihara test and the PV-16 choice test. The latter test, primarily designed for children, was chosen in order to avoid problems due to cognitive decline. METHODS: 26 patients with mild to severe Alzheimer's disease (M:F=5:21; mean age: 80+/-9 years, range: 53-95 years) and 25 controls (M:F=5:20; mean age 80+/-10 years, range: 56-100 years) were rated after undergoing complete neuro-ophthalmologic examination. RESULTS: the Alzheimer's disease patients made significantly more unspecific errors in the Ishihara test (P=0.02) and in the PV-16 choice test (P=0.0008) than the controls. No relation between test performance and severity of Alzheimer's disease was found. CONCLUSIONS: Alzheimer's disease patients have an unspecific colour vision deficiency independent of the severity of the disease.

Aged↗

Evaluation of vision in slow-stream wards.

Two hundred and twenty-one patients in slow-stream geriatric wards in the Portsmouth district were questioned about their vision; 159 of these were examined. It was possible to give help with vision to 21 per cent of patients and to give a further 6 percent help with other eye problems. Eighteen months later, when half the patients examined had died, 14 per cent of those still alive were continuing to enjoy their improved vision, and 6 per cent were benefitting from the help they had received with other eye problems. As a result, we recommend that all admissions should be assessed with regard to their visual ability and that all those with adequate mental faculties should be examined by an ophthalmologist or an optician on admission and when necessary therafter.

Aged↗