Young adults with vision impairment in India: Loneliness and social networks.

PURPOSE: To examine the prevalence of loneliness and associated factors in young adults with vision impairment (VI), including quality of life (QoL) in India. METHODS: Two hundred and three VI young adults (18-35 years) and 219 age-matched non-VI (controls) adults completed the loneliness scale, WHOQOL-BREF, Social Network Index (SNI) (network diversity, people in network size and number of embedded network subscales) and questions regarding sociodemographic characteristics and independent mobility. Rasch analysis was used to validate the questionnaires and interval-level scores were generated. Generalised linear models were used to estimate independent associations of sociodemographic factors, VI characteristics, social networks and QoL with loneliness. RESULTS: The prevalence of moderate and severe loneliness in the VI group was 10% (95% CI: 6.5, 15.4) and 4.4% (95% CI: 2.0, 8.2), respectively, and higher than that of controls. The VI group had a worse loneliness score than controls (-1.66 ± 2.25 vs. -2.13 ± 1.85 logits; p = 0.03). Those with ≤12 years and >12 years of education had loneliness scores of -1.58 ± 2.45 and -1.82 ± 1.99 logits, respectively (p = 0.01). Compared with controls, the VI group reported fewer extended family members, neighbours and friends leading to significantly smaller networks and network diversity (all p < 0.001). Loneliness scores demonstrated a significant correlation with only two SNI subscales for both groups: people in network size (r = -0.28 for VI; r = -0.30 for non-VI; p < 0.001 for both) and number of embedded networks (r = -0.22 for VI; r = -0.21 for non-VI; p = 0.002 for both). Both education (ß = 0.45; p = 0.04) and QoL (ß = -0.27, p = 0.02) were predictors of loneliness. CONCLUSIONS: Loneliness was commonly experienced by young VI adults and was higher among those with lower levels of education. Loneliness decreased with the presence of a larger number of people in network, suggesting that interventions to increase social activity and participation may be valuable in young VI adults.

Social media use and vision impairment in adults between the ages of 18 and 35 years in India.

SIGNIFICANCE: Social media is used by >4.48 billion people worldwide. Despite its popularity, vision-impaired individuals struggle to use social media given visual inaccessibility of content and lack of access to Internet/Wireless-Fidelity-enabled devices. Our study explores visually impaired adult's use of social media in comparison to a control group. PURPOSE: This study aimed to report the demographic profile and patterns of social media use among adults with vision impairment (VI) aged 18 to 35 years and compare it with an age-matched normally sighted group in India. In addition, we explored barriers to use of social media among adults with VI. METHODS: Vision-impaired and normally sighted adults (controls) aged 18 to 35 years at L V Prasad Eye Institute, Hyderabad, India, answered a questionnaire about social media use (e.g., platform used). RESULTS: Four hundred twenty-two individuals (201 VI, 221 controls) participated. Normally sighted adults (98%) used social media more than the VI group (81%; p<0.001). Vision-impaired users were predominantly male (85%) and unemployed (57%; p<0.00001 for both). There was no significant difference in educational level between groups (p=0.17). Smartphones were the most popular device used (VI, 161 [99%]; control, 206 [95%]), with tablet PC/iPad being the least popular (VI, 5 [3%]; control, 12 [6%]). Adults with VI and controls commonly used WhatsApp as communication platforms, and Facebook and Twitter as networking platforms. Approximately one-third of individuals across both social media user groups reported barriers to use (VI, 48 [30%]; control, 74 [34%]; p<0.001). Vision-impaired individuals cited accessibility issues of having to rely on audio over vision to navigate social media, whereas controls reported having to share a phone. CONCLUSIONS: The proportion of social media usage among VI adults is high (81%) and is substantially higher than the 33% reported in the general Indian population. Vision-impaired adults who used social media were male with moderate VI and were less likely to be employed compared with controls.

Barriers and enablers to medication adherence in glaucoma: A systematic review of modifiable factors using the Theoretical Domains Framework.

PURPOSE: Nonadherence to medication reduces treatment effectiveness, and in chronic conditions it can significantly reduce health outcomes. In glaucoma, suboptimal adherence can lead to sight loss, which places a greater financial burden on society and reduces patients' quality of life. Interventions to improve adherence have so far had limited success and lack robust theoretical underpinnings. A better understanding of the determinants of medication adherence behaviour is needed in order to develop interventions that can target these factors more effectively. This systematic review aims to identify modifiable barriers and enablers to glaucoma medication adherence and identify factors most likely to influence adherence behaviour. RECENT FINDINGS: We searched CINAHL, MEDLINE, PsycINFO, EMBASE, the Cochrane Library and sources of grey literature up to August 2022 for studies reporting determinants of glaucoma medication adherence. Data describing modifiable barriers/enablers to adherence were extracted and analysed using the Theoretical Domains Framework (TDF), a behavioural framework consisting of 14 domains representing theoretical factors that most likely influence behaviour. Data were deductively coded into one of the TDF domains and inductively analysed to generate themes. Key behavioural domains influencing medication adherence were identified by frequency of study coding, level of elaboration and expressed importance. Eighty-three studies were included in the final synthesis. Four key domains influencing glaucoma medication adherence were identified: 'Environmental Context and Resources', 'Knowledge', 'Skills' and 'Memory, Attention and decision processes'. Frequently reported barriers included complex eyedrop regimens, lack of patient understanding of their condition, forgetfulness and difficulties administering eyedrops. Whereas simplified treatments, knowledgeable educated patients and good patient-practitioner relationships were enablers to adherence. SUMMARY: We identified multiple barriers and enablers affecting glaucoma medication adherence. Four theoretical domains were found to be key in influencing adherence behaviour. These findings can be used to underpin the development of behaviour change interventions that aim to improve medication adherence.

Parent-Reported Visual Concerns in Children with Cerebral Visual Impairment Presenting to a Pediatric Neurology Clinic.

Purpose: Children with cerebral visual impairment (CVI) present with delayed developmental milestones. Pediatricians and pediatric neurologists are usually the first point of contact, and eye exam largely remains referral based. This study documented the visual concerns reported by parents of children with CVI visiting a pediatric neurology clinic. Additionally, we investigated the association between visual concerns, functional vision measures and visual functions. Patients and Methods: A cross-sectional study was undertaken in children with CVI (chronological age range: 7 months-7 years). Visual concerns reported by the parents/caregivers were documented as open-ended statements. Additionally, a functional vision assessment was conducted using the CVI Range instrument with phase 1, 2 and 3 indicating low, moderate and high visual functioning, respectively. Grating acuity and contrast sensitivity were measured using Teller acuity cards-II and Ohio contrast cards respectively. Results: A total of 73 children (mean age of 2.84 ± 1.87 years) were recruited. Sixty-eight parents reported visual concerns that were broadly grouped into 14 unique concerns. Nineteen parents (27.9%) reported more than one visual concern. Difficulty maintaining eye contact and recognizing faces were the top two visual concerns in phases 1 and 2. Missing objects in the lower visual field was the top concern in phase 3. A larger number of visual concerns were reported in phase 1 (43%) than phase 2 (40.6%) and phase 3 (16.2%). Multiple regression analysis revealed that grating acuity, contrast sensitivity and chronological age were able to predict the functional vision, F (3, 55) = 63.0, p < 0.001, r2 = 0.77. Conclusion: Targeted questions enquiring about eye contact and face recognition can be included in history elicitation in children with CVI in pediatric neurology clinics. In the presence of visual concerns, it will be important to assess grating acuity and contrast sensitivity. A poor functional vision score requires referral for eye examination and vision rehabilitation services.

What do individuals with visual impairment need and want from a dialogue-based digital assistant?

CLINICAL SIGNIFICANCE: Optometrists are well-placed to provide helpful advice and guidance to patients with visual impairment but may not know how best to do this. The availability of a reliable and comprehensive conversational agent to which patients could be directed would be a valuable supplement to clinical intervention. BACKGROUND: The Artificial Intelligence in Visual Impairment (AIVI) Study is a proof-of-concept study to investigate whether ongoing information support for people with visual impairment (VI) can be provided by a dialogue-based digital assistant. The phase of the AIVI Study reported here explored the different dimensions of the information-seeking behaviour of individuals with VI: in particular, their need for information, the methods for obtaining it at present, and their views on the use of a digital assistant. METHODS: Qualitative data were collected from 120 UK-resident adults who responded to an online survey who were either visually impaired (86.7%), a carer or family member of someone with VI (5.8%), or a professional involved in the support of those with VI (7.5%). In addition, 10 in-depth 1:1 semi-structured interviews explored opinions in more detail. Thematic analysis was used to analyse the findings. RESULTS: Analysis of information needs identified 7 major themes: ocular condition; equipment, technology and adaptations; daily activities; registration; finance/employment; emotional support; and support for the carer. Participants used a wide variety of methods to access information from many sources and explained the barriers to access. Participants accepted the merit of a dialogue system aiding in a goal-directed search for specific information, but expressed reservations about its abilities in other areas, such as providing emotional support. CONCLUSIONS: Participants highlighted potential benefits, limitations, and requirements in using a digital assistant to access information about VI. These findings will inform the design of dialogue systems for populations with VI.

Age-related normal limits for spatial vision.

PURPOSE: To establish age-related, normal limits of monocular and binocular spatial vision under photopic and mesopic conditions. METHODS: Photopic and mesopic visual acuity (VA) and contrast thresholds (CTs) were measured with both positive and negative contrast optotypes under binocular and monocular viewing conditions using the Acuity-Plus (AP) test. The experiments were carried out on participants (age range from 10 to 86 years), who met pre-established, normal sight criteria. Mean and ± 2.5σ limits were calculated within each 5-year subgroup. A biologically meaningful model was then fitted to predict mean values and upper and lower threshold limits for VA and CT as a function of age. The best-fit model parameters describe normal aging of spatial vision for each of the 16 experimental conditions investigated. RESULTS: Out of the 382 participants recruited for this study, 285 participants passed the selection criteria for normal aging. Log transforms were applied to ensure approximate normal distributions. Outliers were also removed for each of the 16 stimulus conditions investigated based on the ±2.5σ limit criterion. VA, CTs and the overall variability were found to be age-invariant up to ~50 years in the photopic condition. A lower, age-invariant limit of ~30 years was more appropriate for the mesopic range with a gradual, but accelerating increase in both mean thresholds and intersubject variability above this age. Binocular thresholds were smaller and much less variable when compared to the thresholds measured in either eye. Results with negative contrast optotypes were significantly better than the corresponding results measured with positive contrast (p < 0.004). CONCLUSIONS: This project has established the expected age limits of spatial vision for monocular and binocular viewing under photopic and high mesopic lighting with both positive and negative contrast optotypes using a single test, which can be implemented either in the clinic or in an occupational setting.

Clinical Utility of 'Peekaboo Vision' Application for Measuring Grating Acuity in Children with Down Syndrome.

Peekaboo Vision is an iPad grating acuity app built with typically developing children in mind. Given the ease of using this app in the pediatric age group, this study determined its clinical utility in children with Down syndrome. Two groups of participants (children with Down syndrome and age-matched controls) were included. Presenting binocular grating acuity was measured using Peekaboo Vision and Teller acuity cards II in random order. Parents' feedback about their child's engagement and time taken to complete each test was documented. Thirty-seven children with Down syndrome (males = 23; mean age = 8.1 ± 4.2 years) and 28 controls (males = 15; mean age = 8.71 ± 3.84 years) participated. Time taken to complete the tests was comparable (p = 0.83) in children with Down syndrome. Controls were significantly faster with Peekaboo Vision (p = 0.01). Mean logMAR acuities obtained with Peekaboo Vision (0.16 ± 0.34) and Teller acuity cards II (0.63 ± 0.34) were significantly different (p < 0.001) in children with Down syndrome (mean difference in acuities: -0.44 ± 0.38 logMAR (95% LoA: -1.18 to 0.3). For controls, the mean logMAR acuity with Peekaboo Vision (-0.13 ± 0.12) and Teller acuity cards II (0.12 ± 0.09) was also found to be significantly different (p < 0.001) (mean difference in acuities: -0.24 ± 0.14 logMAR (95% LoA: -0.51 to 0.03) Peekaboo Vision test can be used on children with Down syndrome. Peekaboo Vision and Teller acuity cards II can be used independently but not interchangeably. The differences in the acuity values between the two tests could be a result of the differences in the thresholding paradigms, different testing mediums and the range of acuities covered.

An exploratory study on support for caregivers of people with vision impairment in the UK.

PURPOSE: Many of the UK's 2.5 million individuals living with vision loss receive support from relatives or friends (so-called 'informal caregivers'). However, there is limited understanding of how caregivers of people with visual impairment (PVI) are, or feel, supported by UK healthcare/statutory services and charities. This exploratory study was conducted to explore caregivers' experiences and their suggestions for enhancing support. METHODS: Participants self-identifying as UK-based caregivers of PVI (N = 100) volunteered to undertake an online survey, distributed through charity partners. The survey was comprised of the Client Satisfaction Questionnaire-8 (CSQ-8, a validated, self-report measure of satisfaction with support services), Likert-type questions and two open-ended, free-text questions. Interview participants (N = 22) were then selected from survey respondents, and semi-structured interviews were conducted to focus on caregivers' ideas for improving support. The Framework Method was used for inductive analysis of the free-text question responses and interview data. RESULTS: The mean (SD) CSQ-8 score was 21.60 (7.2), with no significant differences by demographic, relationship or vision-related factors, likely limited by the small subgroup sizes. Qualitative data demonstrated the heterogeneity of participating caregivers' experiences, highlighting the importance of personalised support for caregivers. Many participants advocated enhancing informational, practical, emotional and social support for caregivers, and stressed the importance of accessible services and consistent points of contact to turn to for support and advice. CONCLUSIONS: Although our sample was arguably better connected to support services than the general caregiver population, this study identified concrete suggestions to improve practical, emotional and peer support for caregivers of PVI.

What support do caregivers of people with visual impairment receive and require? An exploratory study of UK healthcare and charity professionals' perspectives.

BACKGROUND: Previous research has established that some informal caregivers (relatives/friends) of people with visual impairment (PVI) may require support themselves. However, there is limited understanding of how healthcare services and sight charities in the UK currently support caregivers. This study was therefore conducted to explore what support, information, and advice healthcare and charity professionals (HCCPs) currently provide for caregivers, and which additional support HCCPs would recommend in order to benefit caregivers. METHODS: HCCPs filled out an online survey, distributed among UK-based professional bodies and charity partners. Of 104 individuals who consented to participate, 68 (65%) HCCPs completed the survey in September-November 2019. Participants responded to Likert-type questions about how they interact with and support caregivers of PVI. Thirty-eight (56%) participants provided responses to open-ended questions about improving support for caregivers; qualitative analysis was conducted using the Framework Method. RESULTS: The survey showed that caregiver support activities most commonly undertaken related to onward signposting (90% (95% CI: 82-97%) of participants), or providing information about low vision aids and adaptations (85% (95% CI: 77-94%)), compared to activities focused on broader caregiver wellbeing. In open-ended responses, HCCPs highlighted the difficulties caregivers face in navigating an under-resourced and complex system. They recommended improving coordination and accessibility of information, as well as provision of emotional support and tangible assistance such as respite care and financial support. CONCLUSIONS: The study suggests that HCCPs perceive significant unmet needs among caregivers of PVI, and would welcome further resources, information, and training to support caregivers.

Life in lockdown: impact of COVID-19 lockdown measures on the lives of visually impaired school-age children and their families in India.

PURPOSE: The COVID-19 outbreak has adversely impacted all societal domains including education. Home confinement, school closures and distance learning impacted children's, teachers' and parents' lives worldwide. In this study, we aimed to examine the impact of the COVID-19 lockdown on the lives, including education, of school-age children with vision impairment (VI) and their parents in India. METHODS: Primary and secondary school children with VI were recruited from the Institute for Vision Rehabilitation, L V Prasad Eye Institute, Hyderabad, India. A qualitative research methodology, utilising a self-constructed questionnaire with open and closed questions and stem and leaf design, was employed to explore the experiences of school closure and its impact on education and attending online classes during the COVID-19 lockdown. Textual data from responses to the questions were analysed using content analysis to identify themes pertinent to the cohort studied. RESULTS: Forty eight child-parent dyads were included. The median age of children was 10 years (range, 7-19 years) and 60% were male. Inherited retinal disorders were the major cause of VI (40%). Best spectacle corrected visual acuity (better eye) ranged from 0.30 to 2.09 logMAR (6/12 to 6/750). Six major themes were identified: (1) accessibility of technology (online learning and technology); (2) parental beliefs/concerns (harmful effects of technology, prioritisation of normally sighted children, online classes considered a distraction); (3) support (peers, parents, teachers, private tuition); (4) socialisation and physical activity; (5) socioeconomic status and (6) near vision. CONCLUSIONS: This study provides an understanding of the adverse impact of lockdown on the lives of children with VI and their parents, especially related to education in India. The study identified critical factors that affect online learning and the participation of children with VI in these sessions. Policymakers and educators should implement effective measures for supporting online classes.

A comparison of reading, in people with simulated and actual central vision loss, with static text, horizontally scrolling text, and rapid serial visual presentation.

Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or rapid serial visual presentation (RSVP). The rationale for these dynamic text formats is that they can be read while holding gaze away from the text, potentially supporting reading while using the eccentric viewing strategy. This study was designed to evaluate the practice of reading with CVL, with passages of text presented as static sentences, with horizontal scrolling sentences, or as single-word RSVP. In separate studies, normally sighted participants with a simulated (artificial) central scotoma, controlled by an eye-tracker, or participants with CVL resulting from macular degeneration read passages of text using the eccentric viewing technique. Comprehension was better overall with scrolling text when reading with a simulated CVL, whereas RSVP produced lower overall comprehension and high error rates. Analysis of eye movement behavior showed that participants consistently adopted a strategy of making multiple horizontal saccades on the text itself. Adherence to using eccentric viewing was better with RSVP, but this did not translate into better reading performance. Participants with macular degeneration and an actual CVL also showed the highest comprehension and lowest error rates with scrolling text and the lowest comprehension and highest errors with RSVP. We conclude that scrolling text can support effective reading in people with CVL and has potential as a reading aid.

Evaluation of photoreceptor function in inherited retinal diseases using rod- and cone-enhanced flicker stimuli.

PURPOSE: Clinical assessment of rod and cone photoreceptor sensitivity often involves the use of extended dark adaptation times to minimise cone involvement or the use of bright adapting backgrounds to saturate rods. In this study we examine a new rod/cone sensitivity test, which requires minimal dark adaptation. The aim was to establish whether rod/cone sensitivity losses could be measured reliably in patients with retinal diseases that selectively affect rods or cones when compared to age-matched subjects with normal vision. METHODS: Flicker modulation thresholds (FMTs) were measured psychophysically, using cone- and rod-enhanced stimuli located centrally, and in four quadrants, at 5° retinal eccentricity in 20 patients (age range: 10-41 years) with cone-dominated (Stargardt's disease or macular dystrophy; n = 13) and rod-dominated (retinitis pigmentosa; n = 7) disease. These data were compared against age-matched normals tested with identical stimuli. RESULTS: Across all retinal locations, cone FMTs in cone-dominated diseases (Median ± IQR: 32.32 ± 28.15% for central location) were greater than a majority (83%; 49/59) of corresponding rod FMTs (18.7 ± 3.29%; p = 0.05) and cone FMTs of controls (4.24 ± 2.00%). Similarly, rod FMTs in rod-dominant disease (14.99 ± 22.58%) were greater than a majority (88%; 29/39) of the corresponding cone FMTs (9.09 ± 10.33%) (p = 0.13) and rod FMT of controls (6.80 ± 2.60 %). CONCLUSIONS: Cone-specific deficits were larger than rod-specific deficits in cone-dominated diseases, and vice versa in rod-dominated disease. These results suggest that the new method of assessing photoreceptor sensitivity has potential application in detecting specific rod/cone losses without the need for dark adaptation.

What support is beneficial for caregivers of individuals with vision impairment?

Previous studies and reviews have documented the stress and challenges that may be associated with providing informal care for individuals with vision impairment (IVI). This scoping review was therefore conducted in order to synthesise published literature about forms of support which may benefit the informal caregivers of both adults and children with vision impairment (VI), and to identify research gaps in the support available for this population. A systematic literature search was carried out using CINAHL, Medline, PsycINFO and PsycARTICLES, followed by citation tracking. A total of 23 published studies met the eligibility criteria and were included in the review. The included studies focused on: exploring caregiver support needs (8/23); novel interventions supporting caregivers of IVI (10/23); evaluating usual care (2/23); and exploring how treatment for IVI directly impacts the caregiver (3/23). Overall, support for caregivers of IVI is a relatively new research topic, with no eligible studies identified before 1999. Twelve of the 23 studies (52%) focused on support for caregivers of adults with VI, while 11 (48%) focused on support for caregivers of children with VI. The studies illustrate that support groups may generally help to improve caregivers' knowledge and awareness of VI, although benefits for emotional wellbeing are more modest. Support interventions for parents of children with VI appear to reduce stress effectively; however, evidence regarding the value of interventions for caregivers of adults with vision impairment is less clear, partly due to small samples and a lack of standardised, comparable outcome measures. Caregivers often express a need for better information about the condition of the IVI, even when information is apparently available. Further research is required comparing the benefits of different support modalities for caregivers of people with VI over longer follow-up periods.

Associations between adult attachment and vision-related quality of life in visually impaired individuals.

PURPOSE: An attachment theory framework approach may allow insight into how social and psychosocial factors interact to impact vision-related quality of life (QoL). In this pilot study, we investigated potential associations between adult attachment style and visual function QoL of visually impaired individuals. METHODS: We recruited 38 visually impaired individuals (15 females, 23 males; 51.8 ± 16.0 years). Visual function measures included distance and near visual acuity (VA) and contrast sensitivity. All participants completed: the 25-item National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ 25) and the Experiences in Close Relationships-Relationships Structures questionnaire. RESULTS: Presenting conditions included inherited retinal dystrophy (n = 10), nystagmus (n = 9), glaucoma (n = 7) and other eye conditions (n = 12). There was a statistically significant negative correlation between the NEI-VFQ-25 composite score (45.5 ± 14.7) and attachment-related anxiety (r = -0.352, p = 0.033). The latter correlation still held when controlling for participants' level of vision (r = -0.352, p = 0.035). Despite the range of conditions and wide age range, these were not significantly correlated with any variable of interest in the current study. CONCLUSION: Attachment-related anxiety ought to be taken into account when managing a visually impaired individual. Attachment-based approaches could be used to improve access to support services for visually impaired individuals, as well as self-management of their condition.

Age-related change in flicker thresholds with rod- and cone-enhanced stimuli.

PURPOSE: Rod and cone photoreceptor-specific tests can be time-consuming. A new non-invasive test is described. The test is based on the measurement of flicker modulation thresholds with rod- and cone-enhanced visual stimuli, which requires only minimum adaptation time. Here, we investigated how the rod-and cone-mediated flicker thresholds vary with age. METHODS: Monocular thresholds with rod and cone-enhanced stimuli were measured in 140 healthy adults, (age range: 18-75 years), foveally (0°) and at four parafoveal locations, at an eccentricity of 5° in each of the four quadrants using five, adaptive, interleaved staircases. Temporal frequencies, stimulus sizes, background luminance and spectral composition, were adjusted appropriately to achieve approximately 1 log unit separation in sensitivity between the rod- and cone-enhanced stimuli. Spectrally calibrated, 'neutral density' filters were used to enable adequate control of display luminance for rod enhanced stimuli. RESULTS: The magnitude of central and parafoveal rod thresholds was significantly higher than the central and parafoveal cone thresholds, respectively (p < 0.001) in both the age groups. However, the rate of increase in central rod thresholds (y = 0.45x-12.79; linear regression equation) was not significantly steeper than the rate of increase in central (y = 0.29x-8.53) cone thresholds (p = 0.15). Centrally, cone thresholds showed a better correlation with rod central thresholds for the age > 45 years (Spearman correlation, ρ = 0.74, p < 0.001) compared to age ≤ 45 years (ρ = 0.41, p < 0.001). CONCLUSIONS: Thresholds with rod- and cone-enhanced stimuli are largely invariant below 45 years of age and increase rapidly above this age. This age-wise normative database can be used as an effective functional-marker to assess photoreceptor sensitivities in retinal diseases.

Acuity and colour vision changes post intravitreal dexamethasone implant injection in patients with diabetic macular oedema.

PURPOSE: To evaluate changes in colour vision following intravitreal injection of Dexamethasone implant (Ozurdex) in patients with diabetic macular oedema (DMO). Both red-green (RG) and yellow-blue (YB) chromatic sensitivity were assessed using the Colour Assessment & Diagnosis (CAD) test which isolates the use of colour signals and provides age-corrected, statistical limits for normal trichromats. To determine whether colour changes and visual acuity (VA) post-treatment relate to central sub-field retinal thickness (CST). METHODS: Fourteen patients with DMO who were undergoing treatment with Ozurdex were recruited for this study. RG and YB colour thresholds were measured using the CAD test, best corrected visual acuity was assessed using the ETDRS chart and CST was measured using spectral domain optical coherence tomography (SD-OCT). All tests were performed monocularly at baseline and 24 weeks post injection. RESULTS: All patients (n = 14 eyes), had significant loss of RG and YB chromatic sensitivity at baseline (p<0.05). The mean age was 56 ± 9.5 years. The age specific, monocular, upper normal limits for a 56 year old subject are 2.66 for RG and 2.85 for YB. In this study, the measured, pre injection thresholds (mean±SD) were 22.6 ± 11.3 for RG and 16.2 ± 3.76 for YB. There was significant improvement in RG threshold post injection (i.e., 19.2 ± 10.8 (p<0.05)). No significant changes were found in the YB thresholds with corresponding mean and range values of: 15.8 ± 4.6 (p = 0.23). CST pre-treatment was 542 ±135 µm. After treatment and by week 24 the CST values decreased to 435 ±127 µm. CONCLUSIONS: RG colour thresholds provide a sensitive measure of functional change in diabetic subjects with macular oedema. The YB system is damaged severely in the DMO patients studied and shows little or no recovery post treatment. The improvement in VA and particularly in RG colour vision correlate well with the measured decrease in CST. The results suggest that the improvement in the RG chromatic sensitivity can provide a useful biomarker for monitoring the efficacy of treatment in DMO.

Eye care in young children: a parent survey exploring access and barriers.

BACKGROUND: A questionnaire was designed to investigate the attitudes of parents toward eye care for their young children (4-6-year-olds) and possible barriers to accessing eye care for this age group. An exploration was undertaken to determine whether these beliefs and barriers are influenced by certain demographic factors such as ethnicity, level of parental income, level of parental education, confidence with speaking English and a reported family history of eye problems. METHODS: A total of 1,317 questionnaires (hard copies) were distributed to parents of children in primary school reception and year one classes (ages four to six) from 14 schools across five London boroughs. Ninety online surveys were sent to parents at two further London schools. All questionnaires were anonymous. RESULTS: A total of 384 completed questionnaires were analysed (27 per cent response rate). Three hundred and thirty-eight parents (24 per cent) completed the 'parental knowledge' section of the questionnaire. Of all responses, 65 per cent (n = 249) were from parents whose children attended a school where a program of school entry vision screening took place. Of these, 15 per cent (n = 36) of parents reported that they were aware of the screening program. Barriers to accessing eye care for their children were reported by 38 per cent (n = 153) of parents/carers who responded. Twelve per cent (n = 47) reported not knowing how to access an eye test for their child and 12 per cent (n = 47) reported that they were concerned their child would be given glasses that were not needed. When compared to parents from White ethnic groups, parents from African/Afro-Caribbean ethnic groups were more likely to report not knowing how to access an age-appropriate eye test for their child (p = 0.001). Parents of African/Afro-Caribbean ethnic origins were statistically more likely to report barriers to eye care (p = 0.001). CONCLUSION: The study provides evidence of some parental misconceptions around eye care for young children and some barriers to access. Possible solutions to this are discussed.

Evaluating the Effectiveness of an Established Community-Based Eccentric Viewing Rehabilitation Training Model-the EValuation Study.

PURPOSE: This study evaluated the community-based eccentric viewing (EV) training offered across the United Kingdom by the Macular Society. Volunteer trainers deliver free one-to-one training, usually in learners' homes. They also share information about lighting, magnification, social support, and low-vision technology. METHODS: The audio-recorded reading performance of learners was compared before and after training. Telephone questionnaires were used to assess life satisfaction, amount of reading performed, and health- and vision-related quality of life. Learners were also interviewed to obtain their subjective opinions. RESULTS: A total of 121 learners completed all stages of the study. There was no significant change in maximum reading speed. A statistically significant (P < 0.001) but small improvement in both critical print size and threshold print size was found, but frequency and duration of reading did not increase. There was a borderline significant (P = 0.022) increase in "life satisfaction" for the learners, but a highly significant (P < 0.001) decrease in their "positive affect." There was no change in health- or vision-related quality of life, or in the difficulty experienced in performing everyday tasks. However, according to learner interviews, 72% felt they had achieved a positive outcome from the training, and 75% felt they had received helpful advice in addition to the EV training. CONCLUSIONS: The lack of improvement of reading speed and modest improvement in threshold print size should be interpreted in the context of the unique features of this EV program, since many learners who would seem to have limited scope for improvement still undertake the training.