Mental healthcare access among US adults with vision impairment and depression and/or anxiety symptoms.

BACKGROUND: Although individuals with vision impairment are at greater risk for depression and anxiety, there has been limited study of mental healthcare utilization among this population. OBJECTIVES: To address this gap, this pooled cross-sectional study estimates the prevalence of mental healthcare utilization among individuals with vision impairment during the COVID-19 pandemic. METHODS: We calculated adjusted relative risk ratios and 95% confidence intervals of depression and/or anxiety symptoms and mental healthcare utilization using multinomial logistic regression, accounting for demographics, social determinants of health, and survey week. The population-based, U.S. Census Bureau Household Pulse Survey was administered April 2021-March 2022. Participants included 800,935 US adults (weighted population: 174,598,530) RESULTS: Adjusting for other factors, adults with vision impairment were more likely to report depression symptoms (RRR: 2.33; 95% CI: 2.03-2.68), anxiety symptoms (RRR: 2.12; 95% CI: 1.94-2.33, and comorbid depression and anxiety symptoms (RRR: 3.77; 95% CI: 3.51-4.04) compared with individuals with no vision impairment. Among individuals reporting anxiety or depression symptoms, individuals with vision impairment (RRR: 1.46; 95% CI: 1.35-1.59) were more likely to lack of mental healthcare utilization compared with individuals with no vision impairment. CONCLUSION: Findings suggest that individuals with vision impairment are at increased risk for depression and/or anxiety symptoms and report reduced mental healthcare utilization compared with individuals without vision impairment. Additional programs and policies are needed to improve mental healthcare utilization among individuals with vision impairment and depression and/or anxiety symptoms, such as increased telehealth accessibility and coordination of behavioral health and ophthalmology services.

The effects of simulated and actual visual impairment on the Montreal Cognitive Assessment.

Many cognitive assessments include a visual component; however, adults may experience a decline in visual acuity with age. Scores on cognitive assessments of adults with visual impairments are typically lower than adults with normal vision, however, it is unclear if these lower scores are a consequence of cognitive or visual impairment. We measured the impact of simulated visual impairment on a cognitive screening measure. Undergraduate students were administered the Montreal Cognitive Assessment (MoCA) under three vision conditions (20/20, simulated 20/80, simulated 20/200). We found a main effect of vision condition on test performance such that there is a statistically significant difference between scores on the 20/20 and 20/80 conditions and 20/200. However, no differences were observed between 20/80 and 20/200. Participants' performance decreased with simulated impairments. A secondary between-subject analysis was conducted on a sample of older adults with and without vision impairment; no differences were found.

Assessment of hearing and vision impairment in cohort studies collecting cognitive data in older adults.

INTRODUCTION: There are no standard practices for considering sensory impairment in studies measuring cognitive function among older adults. Exclusion of participants with impairments may inaccurately estimate the prevalence of cognitive impairment and dementia. METHODS: We surveyed prospective cohort studies measuring cognitive function in older adults, determined the proportion that excluded participants based on sensory impairment and the proportion that assessed each type of sensory impairment, and described the methods of sensory assessment. RESULTS: Investigators/staff from 85 (of 192 cohorts) responded; 6 (7%) excluded participants with severe impairment; 80 (94%) measured hearing and/or vision impairment, while 5 (6%) measured neither. Thirty-two (38%) cohorts assessed hearing objectively and 45 (53%) assessed vision objectively. DISCUSSION: Findings indicate variation in methods used to assess sensory impairment, with potential implications for resource allocation. To ensure equitable inclusion of study participants, consensus is needed on best practices standardized protocols for assessment and accommodations of sensory impairment.

The Longitudinal Association of Late-Life Visual and Hearing Difficulty and Cognitive Function: The Role of Social Isolation.

OBJECTIVES: Sensory impairments are prevalent among older adults and have been associated with cognitive challenges in later life, yet mechanisms are less well understood. We examined the mediating role of social isolation in the longitudinal relationship between self-reported sensory difficulty and impaired cognitive functioning among older adults. METHODS: Data were taken from the NHATS Study, an annual survey of Medicare beneficiaries' age ≥ 65. Participants (N = 6,338) provided data at Rounds 5, 6, and 7 (2015, 2016, 2017). Structural equation models were estimated to test longitudinal direct and indirect associations. RESULTS: All sensory difficulties were negatively associated with all cognitive functioning measures cross-sectionally through social isolation. Longitudinally, vision difficulty and dual sensory difficulty were indirectly associated with cognitive functioning across time. Hearing difficulty had no longitudinal indirect associations with cognitive functioning through social isolation. DISCUSSION: Social isolation is an important pathway through which late-life vision difficulty is associated with decreased cognitive function.

Quality of Life and Participation of Children With Visual Impairment: Comparison With Population Reference Scores.

Purpose: The purpose of this study was to investigate quality of life and participation in children aged 3 to 17 years with visual impairment (VI) compared to reference groups and between subgroups with increasing severity levels of VI. Methods: Parents of children aged 3 to 17 years (n = 500) and children aged 13 to 17 years (n = 75) completed the Child and Adolescent Scale of Participation (CASP). Children aged 7 to 17 years (n = 263) and their parents (n = 255) completed the KIDSCREEN-27 questionnaire to assess quality of life. Scores were compared to age and/or gender-appropriate population-based samples. For the CASP, a comparison was also made with children with chronic conditions or disabilities. The association between severity of VI and quality of life or participation was analyzed with linear regression models. Results: Children reported significantly worse on Physical Wellbeing and Social Support & Peers, but better on the School Environment KIDSCREEN-27 subscales compared to reference groups. Parents additionally reported worse on Autonomy & Parent Relation. Children's participation was significantly worse compared to a population-based sample, but significantly better compared to children with chronic conditions and disabilities. Having moderate or severe VI/blindness was significantly associated with worse participation, as reported by parents relative to those with no VI. Conclusions: Quality of life of children with VI is affected especially regarding Physical Wellbeing and Social Support & Peers compared to a reference population, and their participation is considerably worse. Participation was more affected in children with more severe VI. These results contribute to the understanding of the impact of VI. Interventions targeting physical health, social skills, and participation are warranted.

Psychometric validation of an Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA).

PURPOSE: Handicap evaluation in adults with acquired or progressive congenital visual loss allows for identification of the individual's specific needs and targeted therapy (medical, technical, rehabilitative and psychological). Currently, the subjective dimension of the handicap remains poorly explored in the field of visual loss. Our questionnaire aims to understand the whole of these subjective impacts. It differs from existing quality of life scales in ophthalmology in its approach centered on the process of adaptation, individual resources (technical, cognitive, psychic and environmental), and investigation of the perception of the handicap. The goal of the present study is to validate this questionnaire, which could be used in any adult with a visual handicap, regardless of the extent of the visual loss, its etiology, or the type of treatment or compensatory mechanisms. MATERIALS AND METHODS: The Assessment Questionnaire on the Perception of and Adaptation to Visual Handicap in Adults (QUEPAHVA) is composed of 28 items relating to perception of the visual impairment, its impact, and adaptive resources. They are divided into 3 sub-categories: Perception of daily life and relationships (10 items), Perception of visual status and compensatory mechanisms (8 items), and Psychological impact of the visual handicap (10 items). The responses are graded on a Likert scale. Factor analysis and verification of psychometric qualities were performed based on the responses of 446 subjects. The discriminatory validity of the NEI-VFQ 25 was proven with 99 subjects. Reliability over time (mean interval between T1 and T2=49.43 days) was measured in 31 subjects. Sensitivity to change between pre- and post-management (mean interval between T1 and T2=410 days) was tested in 123 subjects. RESULTS: Internal consistency was very good for the global scale (α=.90) as well as for the 3 sub-dimensions (α=.86; α=.79; α=.80). The discriminatory validity was satisfactory (r=.70). This result had to be interpreted as a function of the qualitative specificity of the questionnaire. The questionnaire enjoyed good reproducibility over time with regard to its total score and relatively satisfactory reproducibility with regard to its sub-dimensions. Sensitivity to change was very high and accounted for adaptations to the disability over time. CONCLUSION: The QUEPAHVA displays good psychometric qualities. It constitutes a new means of evaluation. Its potential applications are many. It permits evaluation of the needs of the individual and adaptation of the protocol of care. Its use in institutions may support a step forward in the science of evaluation and continued improvement in quality of care.

The impact of sensory impairment on cognitive performance, quality of life, depression, and loneliness in older adults.

OBJECTIVES: The objective of this study was to evaluate the relationship between sensory impairment (hearing loss only, vision loss only, and dual sensory impairment [DSI]) and depression, loneliness, quality of life, and cognitive performance in older adults. METHODS: A total of 229 community-dwelling older adults aged 60 years or older participated in this study. Variables were measured using the Geriatric Depression Scale (GDS-15), Revised University of California at Los Angeles Loneliness Scale (R-UCLA), Satisfaction with Life Scale (SWLS), and Mini-Mental State Examination (MMSE). RESULTS: There was an independent association between DSI and quality of life (P < .05) and between DSI and hearing loss alone and cognitive function (P < .05) in older adults. In addition, higher education was associated with better quality of life and cognitive function. CONCLUSIONS: DSI is a significant factor affecting the quality of life and cognitive function in older adults. Sociodemographic factors such as education play an important role in improving quality of life and cognitive function. Thus, increasing the awareness of this disability is important to ensure that older adults receive the necessary support services and rehabilitation to improve their level of independence.

Psychological, social and everyday visual impact of diabetic macular oedema and diabetic retinopathy: a systematic review.

AIMS: To synthesize the evidence on the impact of diabetic retinopathy and diabetic macular oedema from the patient perspective. METHODS: A systematic literature review was conducted using MEDLINE Complete, PsycINFO, EMBASE and AMED. We included articles investigating the impact of the condition on quality of life, symptoms, visual functioning, activities of daily living, well-being, social functioning, and financial status. The studies evaluated were observational, including cross-sectional, prospective cohort and retrospective cohort designs. Outcome data were extracted and synthesized. RESULTS: Searches yielded 5114 publications. After screening, 85 studies were included, measuring the following outcomes: visual functioning (n=46); quality of life (n=22); well-being (n=16); functional status (n=5); work (n=4); and visual task performance (n=2). Diabetic retinopathy has a considerable impact on visual functioning and this is greater in people with greater disease severity. Diabetic retinopathy significantly limits activities including working, driving, walking and reading, and has the potential to have a negative impact on psychological well-being. CONCLUSIONS: Diabetic retinopathy is associated with poor self-reported visual functioning, well-being, and health-related quality of life. Ability to perform basic everyday tasks appears to diminish with disease severity. Some studies suggest impaired mobility and problems with work, but there are gaps in this evidence.

Validation of a novel diabetic retinopathy utility index using discrete choice experiments.

BACKGROUND/AIMS: To validate a preference-based Diabetic Retinopathy Utility Index (DRU-I) using discrete choice experiment (DCE) methods and assess disutilities associated with vision-threatening DR (VTDR: severe non-proliferative DR, proliferative DR and clinically significant macular oedema) and associated vision impairment. METHODS: The DRU-I comprises five quality-of-life dimensions, including Visual symptoms, Activity limitation/mobility, Lighting and glare, Socio-emotional well-being and Inconvenience, each rated as no, some, or a lot of difficulty. The DRU-I was developed using a DCE comprising six blocks of nine choice sets which, alongside the EuroQoL-5D (EQ-5D-3L) and Vision and Quality of Life (VisQoL) utility instruments, were interviewer-administered to participants. To ensure the DRU-I was sensitive to severe disease, we oversampled patients with VTDR. Data were analysed using conditional logit regression. RESULTS: Of the 220 participants (mean±SD age 60.1±11.3 years; 70.9% men), 57 (29.1%) and 139 (70.9%) had non-VTDR and VTDR, respectively, while 157 (71.4%), 20 (9.4%) and 37 (17.3%) had no, mild or moderate/severe vision impairment, respectively. Regression coefficients for all dimensions were ordered as expected, with worsening levels in each dimension being less preferred (theoretical validity). DRU-I utilities decreased as DR severity (non-VTDR=0.87; VTDR=0.80; p=0.021) and better eye vision impairment (none=0.84; mild=0.78; moderate/severe=0.72; p=0.012) increased. DRU-I utilities had low (r=0.39) and moderate (r=0.58) correlation with EQ-5D and VisQoL utilities, respectively (convergent validity). DISCUSSION: The DRU-I can estimate utilities associated with vision-threatening DR and associated vision impairment. It has the potential to assess the cost-effectiveness of DR interventions from a patient perspective and inform policies on resource allocation relating to DR.

Burden of visual impairment associated with eye diseases: exploratory survey of 298 Chinese patients.

OBJECTIVES: To explore the economic burden, prevalence of catastrophic healthcare expenditure (CHE) and the quality of life (QoL) of Chinese patients with visual impairment (VI) associated with eye diseases. DESIGN: A questionnaire survey from March to May 2016 by structured face-to-face interviews of patients with VI. PARTICIPANTS: 302 patients who were diagnosed with moderate VI or worse in both eyes (visual acuity <6/18) were included, and 298 patients (98.7%) who completed the survey questionnaires were eligible for the study. OUTCOME MEASURES: The economic burden was estimated by calculating participants' direct costs covered in 2015 and the definition of CHE was out-of-pocket (OOP) costs exceeding 30% of annual household income. QoL was weighed by health utility value using time-trade-off valuation techniques. RESULTS: Annual average direct costs per patient caused by VI were US$6988.6±US$10 834.3, and 70.3% were direct medical costs of which only 26.9% were reimbursable by medical insurance. 32.2% of households that suffered from CHE, in particular, were less wealthy patients with VI living in rural areas and without medical insurance. The health utility value was rated at 0.65 on average, and patients with VI aged 51-57, living alone and insured by commercial medical insurance had relatively less QoL. CONCLUSION: Our study explored the economic burden and QoL of VI associated with patients with eye diseases in China, indicating a substantial economic burden and poor QoL. Preferential medical insurance policies should be designed in relation to people with VI to further reduce the health inequalities, avoid CHE and promote QoL.

Development of core outcome sets for vision screening and assessment in stroke: a Delphi and consensus study.

OBJECTIVES: Visual impairment following stroke is common with a reported incidence of visual impairment in 60% of stroke survivors. Screening for visual impairment is neither routine nor standardised. This results in a health inequality where some stroke survivors receive comprehensive vision assessment to identify any existent visual problems while others receive no vision assessment leaving them with unmet needs from undiagnosed visual problems. The aim of this study was to define two core outcome sets (COS), one for vision screening and one for full visual assessment of stroke survivors. DESIGN: A list of potentially relevant visual assessments was created from a review of the literature. The consensus process consisted of an online 3-round Delphi survey followed by a consensus meeting of the key stakeholders. PARTICIPANTS: Stakeholders included orthoptists, occupational therapists, ophthalmologists, stroke survivors and COS users such as researchers, journal editors and guideline developers. SETTING: University. OUTCOME MEASURES: COS. RESULTS: Following the consensus process we recommend the following nine assessments for vision screening: case history, clinical observations of visual signs, visual acuity, eye alignment position, eye movement assessment, visual field assessment, visual neglect assessment, functional vision assessment and reading assessment. We recommend the following 11 assessments for full vision assessment: case history, observations, visual acuity, eye alignment position, eye movement assessment, binocular vision assessment, eye position measurement, visual field assessment, visual neglect assessment, functional vision assessment, reading assessment and quality of life questionnaires. CONCLUSIONS: COS are defined for vision screening and full vision assessment for stroke survivors. There is potential for their use in reducing heterogeneity in routine clinical practice and for improving standardisation and accuracy of vision assessment. Future research is required to evaluate the use of these COS and for further exploration of core outcome measures.

Qualitative, exploratory pilot study to investigate how people living with posterior cortical atrophy, their carers and clinicians experience tests used to assess vision.

OBJECTIVES: To investigate the experiences and views of people living with posterior cortical atrophy (PCA), their family carers and healthcare professionals of vision assessment tests. DESIGN: A qualitative investigation using video recordings of vision assessments, semistructured interviews and audio recordings of a focus group. Interviews and focus group used broad, open questions around the topic to prompt and guide discussion. Video and audio recordings were transcribed, manually coded and analysed using framework analysis. SETTING: University College, London's Queen Square neurology centre provided the venues for all stages of the research. PARTICIPANTS: Participants living with PCA were one male and two females (age range 67-78 years). Health professional participants were a neurologist (male), two ophthalmologists (male) and an optometrist (female). PRIMARY AND SECONDARY OUTCOMES: (1) Experiences and attitudes of people living with PCA and health professionals to vision assessment tests, (2) views of health professionals and people living with PCA of whether some tests are more effective at discriminating between cortical vision problems and vision problems related to optical or ocular causes. RESULTS: Patients were able to engage with and complete a number of tests. Their partners played a vital role in the process. Participants reported that simple, short tests were more effective than more subjective tests. Examples of tests that appeared to be more problematic for the patient participants were the Amsler Grid and visual field analysis. CONCLUSIONS: Although limited in scope and execution, the project suggests that some vision assessment tests are likely to support health professionals to discriminate between cortical and optical/ocular causes of visual impairment. It supports existing evidence that there are vision assessments that people with dementia can engage with and complete. We identify areas of importance for future research and make tentative suggestions for clinical practice.

Social capital, social relationships and adults with acquired visual impairment: a Nigerian perspective.

PURPOSE: This study investigates the social capital implications of vision loss among working-age adults in Nigeria. The study explores the challenges of acquiring and maintaining social relationships post-vision loss, and investigates the extent to which visual rehabilitation services support social goals. METHOD: A qualitative study using a phenomenological approach was undertaken. Eight adults (18-59 years) were recruited from disability service organizations in Nigeria. Telephone interviews were recorded and transcribed, and thematic content analysis was used to analyze the data gathered in this study. RESULTS: Three broad themes were developed from participants' accounts of their experiences: (1) changes to relationships with friends and others; (2) finding strength in family relationships; and (3) rehabilitation and the confidence to interact. The findings indicate that the relationship between participants and their family members improved post vision impairment, enhancing bonding social capital. However, participants experienced reduced bridging and linking social capital due to diminished or broken relationships with managers, coworkers, friends, and others in the community. CONCLUSIONS: As social connectedness and relationships are highly valued in Nigeria's diverse society, we suggest that adults with visual impairment would significantly benefit from visual rehabilitation services placing greater emphasis on addressing the social goals of participants. Implications for Rehabilitation Visual impairment in working-age adults can strengthen family relationships (homogenous groups), creating bonding capital that is associated with access to important resources including emotional and moral support, and some financial and material resources. Visual impairment can negatively impact relationships with managers, coworkers, and others in the community (heterogeneous groups), resulting in diminished bridging and linking capital. Visual impairment can reduce access to resources such as an income, social status, and reduces participation in the wider community. Visual Rehabilitation Services could significantly benefit participants by placing greater emphasis on social goals, such as building and maintaining social networks, particularly with diverse (heterogeneous groups), which are valued in Nigeria's diverse cultural climate.

The Economic Burden of Visual Impairment and Comorbid Fatigue: A Cost-of-Illness Study (From a Societal Perspective).

Purpose: To investigate the burden of visual impairment and comorbid fatigue in terms of impact on daily life, by estimating societal costs (direct medical costs and indirect non-health care costs) accrued by these conditions. Methods: This cost-of-illness study was performed from a societal perspective. Cross-sectional data of visually impaired adults and normally sighted adults were collected through structured telephone interviews and online surveys, respectively. Primary outcomes were fatigue severity (FAS), impact of fatigue on daily life (MFIS), and total societal costs. Cost differences between participants with and without vision loss, and between participants with and without fatigue, were examined by (adjusted) multivariate regression analyses, including bootstrapped confidence intervals. Results: Severe fatigue (FAS ≥ 22) and high fatigue impact (MFIS ≥ 38) was present in 57% and 40% of participants with vision loss (n = 247), respectively, compared to 22% (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] [2.7, 7.6]) and 11% (adjusted OR 4.8; 95% CI [2.7, 8.7]) in those with normal sight (n = 233). A significant interaction was found between visual impairment and high fatigue impact for total societal costs (€449; 95% CI [33, 1017]). High fatigue impact was associated with significantly increased societal costs for participants with visual impairment (mean difference €461; 95% CI [126, 797]), but this effect was not observed for participants with normal sight (€12; 95% CI [-527, 550]). Conclusions: Visual impairment is associated with an increased prevalence of high fatigue impact that largely determines the economic burden of visual impairment. The substantial costs of visual impairment and comorbid fatigue emphasize the need for patient-centered interventions aimed at decreasing its impact.

Validity of Brief Cognitive Assessment Tool modifications for older adults with visual and motor limitations.

INTRODUCTION: The prevalence of cognitive, sensory, and physical impairments is expected to grow alongside increasing life expectancy. These chronic conditions pose challenges for geriatric assessment. We examined whether Brief Cognitive Assessment Tool (BCAT) modifications to accommodate visual and motor limitations would retain strong validity for identifying mild cognitive impairment (MCI) and dementia. METHOD: Psychometric analyses were performed on archival data (N = 458) from community-dwelling older adults and residents of assisted living facilities and nursing homes in Maryland, USA (age ≥ 50 years). Participants completed a brief testing battery, including the BCAT, and were assigned a cognitive diagnosis (normal cognition, MCI, mild dementia, moderate dementia, severe dementia) by licensed clinical psychologists. RESULTS: Receiver operator characteristic curve analyses evidenced excellent diagnostic validity of BCAT modification cutoffs for identifying the cognitive categories. Contextual memory and executive control factors, which explained over 80% of variance in cognitive diagnoses, may account for the preservation of validity despite BCAT modifications. CONCLUSIONS: The results indicate strong psychometric evidence for the BCAT modifications and provide cutoffs for identifying MCI and staging dementia. For clinicians, the score guidelines are preferable to the guesswork involved with adjusting cutoffs to accommodate visual and motor limitations.

Driving in unheard silence: Disability and the politics of shutting up.

The politics of silence is central to disability experience and the field of disability studies. In this analytical autoethnography, I write about my silences as a visually impaired woman. I explore and make sense of personal life stories through a theoretical perspective. The analysis of these personal experiences lead me to argue that disability-related silences are mostly created through the confluence of inaccessible physical and social environments and the psychological internalisation of these worlds. I also discuss the ways in which I am currently regaining my voice. Further research on resistance by disabled persons is recommended.

Factors associated with participation on the competitive labour market of people with visual impairments in The Netherlands.

BACKGROUND: Worldwide, the employment rate of people with visual impairments (PVIs) is lower than that of the general working-age population. To improve the employment rate of this group, there is a need for knowledge about differences in modifiable factors between working and non-working PVIs. OBJECTIVE: To identify modifiable factors associated with participation on the competitive labour market of PVIs. Based on the findings, we aim to develop an individual assessment instrument for determining the odds of labour market success of PVIs. METHODS: Data were collected among 299 PVIs by means of a cross-sectional telephone survey based on existing (validated) and self-developed scales and items. Logistic regression analysis was used to find the strongest predictors of the dichotomous outcome of 'having paid work on the competitive labour market' (yes/no). RESULTS: We found three personal non-modifiable factors (level of education, comorbidity, level of visual impairment) and three modifiable factors (mobility, acceptance and optimism) to be significantly (p <  0.05) associated with having paid work. CONCLUSIONS: The factors of optimism, acceptance and mobility should be included in an individual assessment instrument which can provide PVIs and their job coaches with good starting points for improving the labour market situation of the PVIs.

Assessment of sleep in subjects with visual impairment: Comparison using subjective and objective methods.

The objective of the present study was to verify the agreement between objective and subjective measures of sleep in people with and without visual impairment. Thirty-seven subjects with visual impairment participated in the study (19 blind without light perception and 18 low-vision), as well as 34 subjects with normal vision, with paired age and gender characteristics. For the subjective sleep evaluation, we used the Sleep Quality Index-PSQI and for the objective evaluation we used the ActiGraph GT3X+. Among the three analyzed groups, the blind was the only ones who presented differences between subjective and objective sleep duration (p = 0.021). Furthermore, the concordance between subjective and objective sleep duration (ICC = 0.388; p = 0.108) was not observed in blind subjects, and a greater variability of differences in sleep duration between the two methods was observed by the Bland Altman scatter plot. We concluded that the sleep duration obtained by PSQI did not show agreement for the objective sleep duration in blind subjects without light perception.

Impact of the Alexander technique on well-being: a randomised controlled trial involving older adults with visual impairment.

BACKGROUND: Older adults with visual loss have high rates of depression, restricted participation and reduced quality of life. We sought to measure the impact of lessons in the Alexander technique on vision-related emotional and social well-being, as secondary outcomes to a study on improving physical functioning in this population. METHODS: This is a single-blind randomised controlled trial. One hundred and twenty community-dwelling adults aged 50 to 90 years with visual impairments were randomised to either 12 Alexander lessons over 12 weeks and usual care or usual care. The Perceived Visual Ability Scale, the Keele Assessment of Participation, the emotional subscale of the Impact of Vision Impairment Profile, the Positive and Negative Affect Scale and the five-item Geriatric Depression Scale were administered at baseline and three and 12 months. Participants were receiving services from Guide Dogs NSW/ACT. RESULTS: None of the validated questionnaires found statistically significant improvements after adjustment for baseline at three or 12 months, although the emotional subscale of the Impact of Vision Impairment approached significance in favour of the intervention group (4.54 points, 95 per cent CI: -0.14 to 9.21, p = 0.06). Depressive symptoms were prevalent and associated with greater impact of visual impairment on emotional well-being (odds ratio: 1.12, 95 per cent CI: 1.07 to 1.17, p < 0.0001). Faster gait, an indicator of general mobility, was associated with less depressive symptoms (odds ratio: 1.27, 95 per cent CI: 1.06 to 1.54, p = 0.01). CONCLUSION: On average, there was no significant impact of weekly lessons in the Alexander technique on social and emotional well-being, although the emotional impact of visual impairment showed a trend toward less distress in the intervention group. Our data found that emotional distress associated with visual impairment influences depressive symptoms but contrary to expectations, the level of social support received was not significant. Additionally, gait speed is a significant predictor of depressive symptoms, suggesting that general mobility is of importance to the well-being of older adults with visual impairments.

Low reliability of sighted-normed verbal assessment scores when administered to children with visual impairments.

The most common and advocated assessment approach when a child cannot access visual materials is to use the verbal subscales of a test the psychologist already has and is familiar with. However, previous research indicates that children with visual impairments experience atypical verbal development. This raises the question of whether verbal subscale scores retain their reliability and interpretation validity when given to children with visual impairments. To answer this question, we administered a vocabulary subscale from a common intelligence test along with several nonverbal subscales to 15 early-blind adolescents (onset of ≤2 years). Reliability of only the vocabulary test scores was insufficient for high-stakes testing. This finding points to the broader issue of difficulties in assessing populations of exceptional children who experience atypical development trajectories, possibly making their assessment with common tests inappropriate. (PsycINFO Database Record