Toward an internationally accepted standard for reading charts.

Patients who suffer from sight-threatening eye diseases share a desire to regain a comfortable reading ability. In light of the modern advances achieved in ophthalmic diagnosis and therapy, and because a significant lack of comparability between reading charts still exists, there is an increasing need for a worldwide standard in the form of a norm for diagnostic reading charts. Already, applied advancements such as digital print, which allow a calibration of the print sizes of reading charts in correctly progressing geometric proportions by using the actual height of a lower case "x" in millimeters (x-height), and psychophysically standardizing reading charts and their test items by applying modern statistical methods have significantly contributed to establishing a norm for reading charts. In 2020, a proposal of the British delegation was accepted by the International Organization for Standardization (ISO) group "Visual Optics and Optical Instruments," and a working group was established. Bearing in mind the efforts of the ISO with regard to an international norm, this review article is intended to (a) give an overview of the historical background and related normative approaches for diagnostic reading tests used in ophthalmology and optometry, (b) explain psychophysical and technical concerns, and (c) discuss the possibilities and limits of concepts that seem relevant to developing a modern standard for reading charts.

A reassessment and comparison of the Landolt C and tumbling E charts in managing amblyopia.

Current criteria for amblyopia do not account for difference in visual acuity charts. This prospective observational study analyzed 100 children younger than 10 years treated at a tertiary referral center. Visual acuity was separately tested in each eye using Landolt C and tumbling E charts in a random order. For each chart, receiver operating characteristic curve analysis was performed to determine the best cutoff for visual acuity score. Main outcome measures included the difference in visual acuity scores between the two charts, the feasibility of repeated testing of visual acuity in each eye, and amblyopia cutoff values for each chart. Mean logMAR visual acuity scores obtained by tumbling E chart were significantly better than those obtained by Landolt C chart. For amblyopia, the best cutoff values were < + 0.14 (20/27 Snellen equivalent) for tumbling E chart and < + 0.24 (20/35 Snellen equivalent) for Landolt C chart. For children under 10 years old, visual acuity scores for tumbling E chart were significantly better than those for Landolt C chart. We suggest that amblyopia management in children should account for age and the type of visual acuity chart used.

Indicators for Assessing the Quality of Refractive Error Care.

SIGNIFICANCE: Quality refractive error care is essential for reducing vision impairment. Quality indicators and standardized approaches for assessing the quality of refractive error care need to be established. PURPOSE: This study aimed to develop a set of indicators for assessing the quality of refractive error care and test their applicability in a real-world setting using unannounced standardized patients (USPs). METHODS: Patient outcomes and three quality of refractive error care (Q.REC) indicators (1, optimally prescribed spectacles; 2, adequately prescribed spectacles; 3, vector dioptric distance) were developed using existing literature, refraction training standards, and consulting educators. Twenty-one USPs with various refractive errors were trained to visit optical stores across Vietnam to have a refraction, observe techniques, and order spectacles. Spectacles were assessed against each Q.REC indicator and tested for associations with vision and comfort. RESULTS: Overall, 44.1% (184/417) of spectacles provided good vision and comfort. Of the spectacles that met Q.REC indicators 1 and 2, 62.5 and 54.9%, respectively, provided both good vision and comfort. Optimally prescribed spectacles (indicator 1) were significantly more likely to provide good vision and comfort independently compared with spectacles that did not meet any indicator (good vision: 94.6 vs. 85.0%, P = .01; comfortable: 66.1 vs. 36.3%, P < .01). Adequately prescribed spectacles (indicator 2) were more likely to provide good comfort compared with spectacles not meeting any indicator (57.7 vs. 36.3%, P < .01); however, vision outcomes were not significantly different (85.9 vs. 85.0%, P = .90). Good vision was associated with a lower mean vector dioptric distance (P < .01) but not with comfort (P = .52). CONCLUSIONS: The optimally prescribed spectacles indicator is a promising approach for assessing the quality of refractive error care without additional assessments of vision and comfort. Using USPs is a practical approach and could be used as a standardized method for evaluating the quality of refractive error care.

Measurement properties of reading tests in subjects with maculopathy.

PURPOSE: A reliable reading test provides a standardized measure of the visual component of reading performance. This study evaluated reproducibility, agreement and feasibility of five Dutch language continuous text reading tests used in clinical practice and research in visually impaired participants. METHODS: In 42 participants with macular pathologies (mean age 77 years), the Colenbrander Reading Card (Colenbrander), International Reading Speed Texts (IReST), Laboratory of Experimental Ophthalmology (LEO) charts, 'de Nederlanders' (NED) and the Radner Reading Charts (Radner) were evaluated. The coefficient of repeatability was calculated for different reading parameters, and agreement between the reading tests was determined. RESULTS: Between the reading tests, the differences found in repeatability for reading performance were mainly within the limit of one line (0.1 logMAR). Exceptions were the inter-session repeatability for critical print size: Colenbrander (0.35 logMAR), LEO (0.34), Radner (0.23). The highest agreement was found between the LEO and Radner; Reading acuity bias 0.03 logMAR (SD 0.10), CPS 0.03 (0.12). CONCLUSION: This study shows that reading performance results obtained with reading tests are not always reliable and reading parameters could not always be properly assessed in participants with maculopathies. Therefore, choices regarding which reading test to use especially for research purposes should be based on both the feasibility and reliability of the reading test. The NED (a historical test) was the least feasible, and it is recommend that this test is no longer used. To allow standardized and comparable analysis of reading performance a highly standardized reading test, like the Radner is recommended.

Visual attention outperforms visual-perceptual parameters required by law as an indicator of on-road driving performance.

PURPOSE: A variety of visual and psychometric tests have been developed for assessing on-road driving performance and fitness to drive. The diagnostic power of a state of the art psychometric test battery (Vienna Test System) combined with a set of standard visual parameters recommended for assessing fitness to drive is investigated using an on-road driving test. The study aimed to determine whether a psychometric test battery could predict older adults' on-road driving performance. The relevance of visual standards required by law is discussed. METHODS: Vision impairment is more prevalent in later adulthood and many studies on visual and cognitive impact on driving safety and performance therefore focus on adults above 60 years of age. We therefore acquired an extensive set of driving-related visual and psychometric performance parameters in a group of elderly drivers (N = 84, median age 69, SD 6.6 years). Visual assessment included foveal acuity, perimetric field size, and dynamic aspects of peripheral vision (termed "PP") in the computer-based Vienna Test System (VTS; Schuhfried), as well as letter contrast thresholds in foveal and parafoveal vision in a separate setup. A selection of psychometric driving-aptitude tests that demonstrated the battery's capacity to predict aspects of driving performance and safety were further conducted on the VTS. Driving performance was assessed in a standardized on-road driving test. Two independent observers rated driving performance using a fixed scoring system assessing the number of driving errors in pre-defined traffic situations. In addition, globalized driving competence scores were assigned on a 6-point scale. RESULTS: The test battery performed excellent in identification of good drivers but failed in the prediction of bad driving performance. Visual performance indicators required by German law were less indicative of driving ability than psychometric assessment. Selective and divided attention turned out to be much more important for predicting fitness to drive than either visual acuity, size of the visual field, or contrast sensitivity. CONCLUSION: Predicting fitness to drive by means of visual and psychometric tests is an ambitious challenge. On the one hand sensitivity of a multi-disciplinary test-battery is too low to predict reliable driving ability in diagnostic settings which require an unambiguous interpretation of test results for individual drivers. Low sensitivity and low predictive values are incompatible with that objective. On the other hand, the results are valuable for a routine screening of fitness to drive. For that case, the assessment of attentional abilities in particular appears to be promising. Performance measures of divided and selective attention showed themselves to be the most predictive for fitness to drive in a sample pre-screened for clear visual deficits. Visual performance parameters required by law, in contrast, had no meaningful impact on driving performance, indicating a gap between mandatory regulations of state authorities and research results. Our results suggest that visual acuity tests designed for clinical diagnosis and monitoring of eye diseases should not at all be the choice for a screening of fitness to drive.

Technical Report: Repeatability of Contrast Sensitivity Test in Children.

Contrast sensitivity (CS) in children is not routinely measured in the clinical setting, although CS losses have been found in amblyopic and premature children. Thus simple visual acuity measurements do not completely assess their quality of vision. To evaluate contrast sensitivity in children, a reliable and easy test, sampling the entire spatial frequency range, is necessary. PURPOSE: This study aimed to evaluate the repeatability and normal range of the contrast sensitivity function measured using the Topcon CC-100 instrument, in children aged between 4 and 9 years, for use as a diagnostic tool. METHODS: Contrast sensitivity was measured in 25 children, 11 boys and 14 girls, with normal or corrected-to-normal visual acuity, normal binocular function, and stereopsis. Two measurements were performed, 3 months apart, with a Topcon CC-100 device using achromatic sinusoidal gratings of 1.5, 3, 6, 12, and 18 cycles per degree (cpd) with random orientation in a circular window with sharp edges. RESULTS: The normal range in the first visit is wider than in the second. Coefficients of variation are better for the middle-range spatial frequencies (6.6 and 7.8% at 3 and 6 cpd, respectively) and worst at 18 cpd (18.2%), with intermediate values at 1.5 cpd (11.3%) and 12 cpd (13.7%), and better for older than for younger children. No significant sex differences were found (P > .05, Mann-Whitney U test). CONCLUSIONS: Repeatability measured by the coefficient of variation is better for the middle frequency range (3 and 6 cpd) than for low (1.5 cpd) and high frequencies (12 and 18 cpd). The variability of the differences between the first and second measurements suggests that the participants were not able to maintain a stable response criterion. The test seems to be subject to a learning effect, and the standard normality range may not be adequate for children.

Validity of the Wide-range Assessment of Vision-related Essential Skills in Japanese Children with Learning Problems.

SIGNIFICANCE: Our study revealed that the validity of a new Japanese visual-perceptual test was acceptable. Visual-perceptual abilities are important to activities of daily living; thus, accurate assessment of visual perception is especially important for children with neurodevelopmental disorders and particularly so for those with learning problems. PURPOSE: Visual perception refers to the process by which one receives visual information through sensory impulses and then translates those impulses into meaning based on a previously developed view of the environment. A problem in Japan is the paucity of visual perception tests that use normative data from children who are native Japanese. The Wide-range Assessment of Vision-related Essential Skills (WAVES), which measures visual perception and eye-hand coordination skills and is based on Japanese normative data, was recently published in Japan. The validity of this test has not been comprehensively established. METHODS: To investigate the validity of the WAVES, we used the Pearson correlation coefficient to calculate the degrees of association among WAVES scaled and index scores compared with Developmental Test of Visual Perception, Third Edition, scores from 108 elementary school children with symptoms of learning problems. Participants were recruited at Osaka Medical College Learning Disability Center and Sakai Seikeikai Learning Disability Center. RESULTS: The concurrent validity of the WAVES was supported by moderate correlation (r = 0.67, P < .01) between the total scores for visual perception and eye-hand coordination index from the WAVES and general visual perception index from the Developmental Test of Visual Perception, Third Edition, even though a correlation analysis of subtests found differences between the two tests. CONCLUSIONS: Our results showed that the indices from the two tests measured nearly the same underlying visual-perceptual constructs and indicated that the WAVES had acceptable levels of concurrent validity.

Implementation of a Novel Near Visual Acuity Chart in an Emergency Department Setting.

PURPOSE: The quality of visual acuity (VA) measurement in emergency department (ED) settings can be affected by patient immobility and lack of standardized testing conditions. We implemented a previously validated, novel VA chart, the Runge Sloan letter near card, in a hospital ED and evaluated its impact on frequency and consistency of VA testing. METHODS: Two hundred seventeen hospital ED ophthalmology consult records from December 1, 2016, to November 15, 2017, were evaluated in an IRB-approved protocol. Frequency of VA measurement and agreement between nonophthalmic ED technicians and ophthalmology physicians-in-training were assessed. RESULTS: Implementation of the Runge card saw missed technician VA evaluations decrease from 36% (43/120) to 21% (20/97) of ophthalmic consults (p = .01), without significant change in agreement of VA measurements. After implementation, the proportion of VA measurements differing between technicians and residents by ≤2 lines was 51%; with pinhole testing, it improved to 64% (p < .05). In patients with good VA of >20/80, pinhole increased agreement from 58% to 73% (p < .05). CONCLUSIONS: Implementation of the Runge card was associated with improved frequency of VA measurement and, when combined with pinhole testing, increased agreement rates. Our findings suggest utility of training in the use of the Runge card in ED settings.

Sources of error in clinical measurement of the amplitude of accommodation.

Measurement of the amplitude of accommodation is established as a procedure in a routine optometric eye examination. However, clinical methods of measurement of this basic optical function have several sources of error. They are numerous and diverse, and include depth of focus, reaction time, instrument design, specification of the measurement end-point, specification of the reference point of measurement, measurement conditions, consideration of refractive error, and psychological factors. Several of these sources of inaccuracy are composed of multiple sub-sources, and many of the sub-sources influence the common methods of measurement of amplitude of accommodation. Consideration of these sources of measurement error casts doubt on the reliability of the results of measurement, on the validity of established normative values that have been produced using these methods, and on the value of reports of the results of surgery designed to restore accommodation. Clinicians can reduce the effects of some of the sources of error by modifying techniques of measurement with existing methods, but a new method may further improve accuracy.

Assessing Variability in Reading Performance with the New Greek Standardized Reading Speed Texts (IReST).

SIGNIFICANCE: This article evaluates the standardized Greek version of the International Reading Speed Texts (IReST) set, which enriches interlanguage comparisons and international clinical studies of reading performance. Moreover, it investigates how specific textual and subject-related characteristics modulate the variability of reading speed across texts and readers. PURPOSE: The purpose of this study was to develop a standardized Greek version of the IReST set and investigate how specific textual and subject-related factors modulate the variability of reading speed across texts and readers. METHODS: The English IReST texts were translated to Greek and matched for length, content, and linguistic difficulty. The Greek IReSTs were presented at a distance of 40 cm and size of 1 M to assess reading speeds of 25 normally sighted native speakers (age range, 18 to 35 years). The participants read the texts aloud while reading time was measured by stopwatch. Reading performance included measurement of reading speed in three units of analysis. Reading efficiency was assessed using a word-level oral reading task. Statistical analysis included evaluation of subject- and text-related variability, as well as correlations between reading speed and specific textual and subject-related factors. RESULTS: The average reading speed between texts was 208 ± 24 words/min, 450 ± 24 syllables/min, and 1049 ± 105 characters/min. Differences between readers accounted for the 76.6%, whereas differences across texts accounted for the 23.4% of the total variability of reading speed. Word length (in syllables per word) and median word frequency showed a statistically significant contribution to the variability of reading speed (r = 0.95 and 0.70, respectively). Reading speed was also statistically correlated with word reading efficiency (r = 0.68). CONCLUSIONS: The addition of the Greek version in the IReST language pack is expected to be a valuable tool for clinical practice and research, enriching interlanguage comparisons and international studies of reading performance.

Standardization of Reading Charts: A Review of Recent Developments.

This review gives an overview of the current status of standardization by statistical evaluation of reading charts. First begun only 20 years ago, the statistical evaluation of reading charts now reflects an increasing clinical and scientific interest in standardized, comparable, and reproducible reading charts.For clinical or research purposes in human subjects, standardization of psychophysical tests and their test items by statistical evaluation is mandatory because it provides experimental control. Initial attempts at reading chart standardization were made by characterizing the test items, either in terms of a selection of unrelated words or in terms of sentences representing a constant number of characters, including spaces. As initiated by the RADNER Reading Charts, standardization of reading charts (and test items) by statistical evaluation has gained increasing clinical and scientific interest in the last two decades and has later also been applied to some of the other modern reading charts. A literature search was performed with respect to reading charts that (a) have been produced in accordance with the recommendations of the International Council of Ophthalmology (geometrical print size progression), (b) have been statistically analyzed, and/or (c) use clearly characterized test items (conceptually and statistically). These reading charts are as follows: the Bailey-Lovie Word Reading Charts, the Colenbrander Cards, the RADNER Reading Charts, the MNREAD Acuity Charts, the Smith-Kettlewell Reading Test (SKread Test), the C-Read Charts, and the Balsam Alabdulkader-Leat (BAL) Chart. The test items of these charts have been characterized either empirically or by statistical analysis and selection. The extent of the statistical evaluation of the reading charts varies. Despite their different methodological approaches, these reading charts represent an advancement that has made possible the useful comparison and reproducible evaluation of near visual performance.

Transnational review of visual standards for driving: How Australia compares with the rest of the world.

IMPORTANCE: Driving is a highly visual task and a primary mode of transportation for many people around the world. BACKGROUND: There appears to be little uniformity of vision standards across the world for driving. We reviewed the basic screening visual requirements for obtaining standard private and commercial driving licences for a total of 70 jurisdictions, and reviewed the evidence behind these standards. DESIGN: Systematic review of basic screening vision standards worldwide for driving and literature review. SAMPLES: Published online documentation on visual acuity and field requirements for driving. METHODS: Journal articles, government reports and websites obtained via a Google search were used to review the regulations for driving. This was limited by the comprehensiveness of resources, and countries were excluded if the requirements were unclear or unattainable. A literature review was performed using Medline with keywords vision, driving and visual field. MAIN OUTCOME MEASURES: Visual parameters used for driving assessment. RESULTS: The results suggest significant variations across the world. The visual acuity requirements for a private licence range from a minimum of 6/9 to 6/60. The minimum binocular horizontal field requirement ranges from 110° to 150°. In general, standards for a commercial licence are stricter compared to a private licence. A literature review could not support the current driving standards as evidence-based. CONCLUSIONS AND RELEVANCE: The disunity of driving vision requirements worldwide likely reflects the inconclusive evidence base. Accounting for individual differences and the ability to predict individual risk is important in the context of determining driving licensure.

Clinical Accuracy of the Nidek ARK-1 Autorefractor.

SIGNIFICANCE: Autorefractors are commonly used by eye care practitioners worldwide as a starting point for clinical prescribing and by researchers as an instrument to study development of refractive errors and accommodation. This study demonstrates that the Nidek ARK-1 provides a reasonable and repeatable estimate of refractive error. PURPOSE: The purposes of this study were (a) to compare refraction measurements of the Nidek ARK-1 (2016 release) autorefractor with that of subjective refraction and retinoscopy performed by an experienced clinician and (b) to determine the intratest and intertest variability of autorefraction measures taken using the ARK-1 autorefractor. METHODS: Sixty-seven adult patients aged 18 to 69 years underwent retinoscopy, subjective refraction, and ARK-1 autorefraction on a same day by a single clinician. A separate subset of 14 participants was invited for the repeatability and reproducibility study. Both eyes of each participant were included in the analysis. RESULTS: A statistically significant (but not clinically significant) positive spherical difference was observed between the ARK-1 and subjective refraction (P = .003). Spherical equivalent refractive errors were statistically similar between the ARK-1 and subjective refraction (P = .20). A statistically and clinically significant difference was observed in the cylindrical component between the ARK and subjective refraction (P < .01). No statistically significant difference was observed between the ARK and subjective refraction in both the horizontal (J0; P = .08) and oblique cylindrical vector (J45; P = .96). Bland-Altman analysis revealed that the 95% limits of agreement were widest between the ARK and subjective refraction in all of the refractive components (-0.60 to 0.89 diopter for spherical component, -0.80 to 0.69 diopter for spherical equivalent, and -0.98 to 0.30 diopter for cylindrical component). The intertest and intratest variability of the ARK-1 was small. CONCLUSIONS: The Nidek ARK-1 autorefractor is a useful clinical tool that provides a reasonable and repeatable estimation of refractive error in adults.

Binocular non-stereoscopic cues can deceive clinical tests of stereopsis.

Stereoscopic vision plays a critical role in visual perception; however, it is difficult to assess. In clinical settings, stereoacuity is assessed with clinical stereotests. Observers can use monocular cues to deceive some of the most common stereotests, such as the Titmus test. The Randot test has been found free of monocular cues, and here we confirm that result by testing observers under monocular viewing. However, there is a common misconception that only monocular cues can be used to deceive stereotests. Here we demonstrate that binocular non-stereoscopic cues can also be used to pass the Randot, by testing participants with the test rotated, a condition that abolishes stereopsis, and comparing the performance to a monocular viewing condition. We also assessed the Random Dot Butterfly test and discovered considerable amounts of non-stereoscopic cues, including binocular cues in the Circles that can be used to deceive the test. Participants with amblyopia had more difficulty using non-stereoscopic cues than neurotypical observers. We gathered normal-viewing Randot stereoacuities for 110 participants (90 neurotypical and 20 with amblyopia) and compared them to psychophysical stereoacuities (our gold standard). The Randot test showed low positive normalized predictive values for detecting stereoblindness. It could perfectly detect stereo-impairment but with a low sensitivity.

The King-Devick test in an outpatient concussion clinic: Assessing the diagnostic and prognostic value of a vision test in conjunction with exercise testing among acutely concussed adolescents.

OBJECTIVE: This study investigated the diagnostic and prognostic value of the King-Devick (K-D) test in conjunction with treadmill testing in adolescents after sport-related concussion (SRC) in an outpatient concussion management clinic without baseline measures. DESIGN: Prospective cohort. METHODS: The K-D test was administered pre- and post-exercise on a graded treadmill test to acutely concussed (AC, <10 days from injury, n = 46, 15.4 ±â€¯2.1 years) participants for 2 clinic visits (1 week apart) and to matched controls (MC, n = 30, 15.8 ±â€¯1.4 years) for 2 visits (1 week apart). Initial K-D test times were compared between MC and AC. Changes in times from pre- to post- exercise during a treadmill test were compared for MC and AC and from Visit 1 to Visit 2. Smooth pursuits and repetitive saccades were compared with initial visit K-D test performance. RESULTS: Comparison of pre-exercise K-D test times at Visit 1 distinguished MC from AC (46.1 ±â€¯9.2 s vs. 53.7 ±â€¯13.0 s, p = .007). Comparison of pre- and post-exercise K-D test times revealed significant improvements for MC (46.1 ±â€¯9.2 s vs. 43.1 ±â€¯8.5 s, p < .001) and AC who recovered by Visit 2 (Fast Recovery Group [FRG], n = 23, 50.4 ±â€¯10.0 s vs. 47.3 ±â€¯9.8 s, p = .002). No significant difference was seen in pre- and post-exercise K-D test times on Visit 1 for AC who took longer than 2 weeks to recover (Slow Recovery Group [SRG], n = 23, 57.0 ±â€¯15.0 s vs. 56.0 ±â€¯16.3 s, p = .478). At Visit 1, AC had more abnormal smooth pursuits than MC (17% vs. 3%, non-significant, p = .064). AC, however, had significantly more abnormal repetitive saccades than MC (37% vs. 3%, p = .001) and AC with abnormal repetitive saccades took significantly longer to complete the Visit 1 pre-exercise K-D test than AC with normal repetitive saccades (58.6 ±â€¯16.0 s vs 50.8 ±â€¯10.2 s, p = .049). CONCLUSION: The study supports utility of the K-D test as part of outpatient concussion assessment. Lack of improvement in K-D test performance after an exercise test may be an indicator of delayed recovery from SRC.

One-year test-retest reliability of ten vision tests in Canadian athletes.

Background: Vision tests are increasingly being suggested for use in concussion management and baseline testing. Concussions, however, often occur months after baseline testing and reliability studies generally examine intervals limited to days or one week. Therefore, our objective was to determine the one-year test-retest reliability of these tests. Methods: We assessed one-year test-retest reliability of ten vision tests in elite Canadian athletes followed by the Institut National du Sport du Quebec. We included athletes who completed two baseline (preseason) annual evaluations by one clinician within 365±30 days. We excluded athletes with any concussion or vision training in between the annual evaluations or presented with any factor that is believed to affect the tests (e.g. migraines, etc.). Data were collected from clinical charts. We evaluated test-retest reliability using Intraclass Correlation Coefficient (ICC) and 95% limits of agreement (LoA). Results: We examined nine female and seven male athletes with a mean age of 22.7 (SD 4.5) years. Among the vision tests, we observed excellent test-retest reliability in Positive Fusional Vergence at 30cm (ICC=0.93) but this dropped to 0.55 when an outlier was excluded in a sensitivity analysis. There was good to moderate reliability in Negative Fusional Vergence at 30cm (ICC=0.78), Phoria at 30cm (ICC=0.68), Near Point of Convergence break (ICC=0.65) and Saccade (ICC=0.56). The ICC for Positive Fusional Vergence at 3m (ICC=0.56) also decreased to 0.21 after removing one outlier. We found poor reliability in Near Point of Convergence (ICC=0.47), Gross Stereoscopic Acuity (ICC=0.03) and Negative Fusional Vergence at 3m (ICC=0.0). ICC for Phoria at 3m was not appropriate because scores were identical in 14/16 athletes. 95% LoA of the majority of tests were ±40% to ±90%. Conclusions: Four tests had moderate one-year test-retest reliability. The remaining tests had poor reliability. The tests would therefore be useful only if concussion has a moderate-large effect on scores.

Development and Validation of the Minnesota Low Vision Reading Test (MNRead) Acuity Chart for the Asante Twi Language.

AIM: To design and validate a MNREAD Asante Twi version reading chart, to aid in the assessment of near visual acuity of natives Ghanaians. METHODS: Cross-sectional and experimental designs were employed in phases I and II respectively of this study. The chart was developed using 20 transited pupils in class four in the Kumasi metropolis in phase I and validated in a clinical setting at the Manhyia District Hospital, Kumasi, using students in phase II. RESULTS: A total of 100 participants (mean age; 22.19 ± 1.61 years) were involved in the second phase of this study. A Pearson product-moment correlation coefficient was computed to assess the relationship between MNREAD Asante Twi charts logMAR scores in both eyes. The MNREAD-Asante Twi acuity charts had very strong correlations (r = 0.94, p < 0.001) for MNREAD set 1A (black on white background) scores and MNREAD set 2A (black on white background) for acuity scores. Correlation between MNREAD set 1B (white on black background) scores and MNREAD set 2B (white on black background) scores was r = 0.95, p < 0.001. CONCLUSION: MNREAD Asante Twi reading chart will enhance the measurement of near visual function in native Ghanaians.

Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study.

BACKGROUND: The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment. METHODS: As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis. RESULTS: Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed. CONCLUSIONS: Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

Da visão à cidadania: tipos de tabelas de avaliação funcional da leitura na educação especial / From vision to citizenship: types of tables to assess reading in special education

Resumo A importância da leitura já foi amplamente demonstrada ao longo do tempo e vem sendo mais profundamente compreendida e elucidada através de estudos científicos. No caso de pessoas com baixa visão, a leitura pode ser a garantia de acesso à educação e consequentemente à cidadania. Por isso, permitir boa capacidade de leitura tornou-se objeto de estudo de diversos pesquisadores. O desafio de garantir uma boa leitura é ainda maior no caso de pessoas portadoras de baixa visão, e frequentemente auxílios ópticos e tecnológicos são necessários para que a leitura se torne possível e seja fluida. Diversas tabelas, como a MNRead, Radner, Bailey-Lovie, entre outras, têm sido utilizadas para avaliar a capacidade de leitura, o tamanho mínimo de letra suficiente para a leitura fluente, e a velocidade máxima de leitura em palavras ou caracteres por minuto. Essas tabelas foram desenvolvidas e calibradas de acordo com normas internacionais, tornando-se padronizadas e adequadas para a aquisição de dados que poderão ser utilizados em pesquisas científicas reprodutíveis em qualquer parte do mundo. As tabelas possuem versões em diversas línguas, e a única tabela padronizada e traduzida para o português brasileiro disponível atualmente é a MNRead-P. Discutimos aqui as diferentes tabelas, a importância de sua calibração, e sua utilização na prática. As medidas obtidas com as tabelas de leitura são de grande importância para o planejamento do tratamento e acompanhamento de indivíduos com baixa visão, pois as comparações são feitas a partir de um parâmetro individual, entre as medidas do próprio indivíduo, em diferentes momentos, indicando melhora ou piora da qualidade de leitura. A alfabetização de indivíduos com deficiência visual é parte do exercício pleno de sua cidadania. A educação é a lente por meio da qual a pessoa é vista e enxerga a sociedade. Educar os portadores de deficiência é por si só uma forma de inclusão. Por isso, auxiliar os portadores de baixa visão pode ser um diferencial no seu desenvolvimento, permitindo a adequada composição do núcleo de identidade do indivíduo.

Abstract The importance of reading hability has already been greatly shown throughout time and has been studied and understood through scientific research. In the case of people with low vision, reading can be the guarantee of access to education and, consequently, to citizenship. Therefore, allowing good reading ability has become the object of study of several researchers. The challenge of ensuring good reading is even greater for people with low vision, and often optical and technological aids are needed to make reading possible and fluid. Several tables, such as MNRead, Radner, Bailey-Lovie, among others, have been used to evaluate reading ability, minimum letter size for fluent reading, and maximum reading speed in words or characters per minute. These tables have been developed and calibrated according to international standards, becoming standardized and suitable for the acquisition of data that can be used in reproducible scientific research anywhere in the world. The tables have versions in several languages, and the only table standardized and translated into Brazilian Portuguese currently available is MNRead-P. We discuss here the different tables, the importance of their calibration, and their practical use. The measurements obtained with the reading tables are of great importance for planning the treatment and follow-up of individuals with low vision, since the comparisons are made from an individual parameter, between the individual's measurements, at different moments, indicating improvement or worse reading quality. The literacy of visually impaired individuals is part of the full exercise of their citizenship. Education is the lens through which the person is seen and sees society. Educating people with disabilities is in itself a form of inclusion. Therefore, assisting low vision sufferers may be a differential in their development, allowing adequate composition of the individual's identity core.