Resultados a largo plazo del tratamiento de la degeneración macular asociada a la edad neovascular mediante fármacos antiangiogénicos: revisión de la bibliografía / Long-term results of treatment of neovascular age-related macular degeneration using antiangiogenic drugs: A review of the literature

La degeneración macular asociada a la edad (DMAE) constituye una de las principales causas de la pérdida de agudeza visual (AV) en los mayores de 50 años en el mundo, siendo la DMAE neovascular (DMAEn) la causante del 80% de los casos de pérdida de visión severa debido a esta enfermedad. Hace ya más de una década que se emplean los fármacos antifactor de crecimiento del endotelio vascular (anti-VEGF) para el tratamiento de esta enfermedad, cambiando drásticamente el pronóstico visual de estos pacientes. Sin embargo, los primeros estudios de los que se disponían datos de los resultados eran a corto plazo. En la actualidad existen ya diferentes series publicadas de los resultados de la DMAE a largo plazo tras el tratamiento con anti-VEGF, siendo el objetivo de la presente revisión sintetizar dichos resultados. El seguimiento medio de los estudios incluidos fue de 8,2 años (rango: 5-12 años). La AV inicial media fue 55,3 letras del Early Treatment Diabetic Retinopathy Study (ETDRS) (rango: 45,6-65) siendo la AV final media 50,1 letras (rango: 33,0-64,3), existiendo una pérdida media de 5,2 letras. Al final del seguimiento un 29,4% de los pacientes mantuvieron una AV>70 letras. El 67,9% de los pacientes se mantuvo estable al final del seguimiento (<15 letras de pérdida), existiendo una pérdida severa (≥15 letras) del 30,1%. La fibrosis y la atrofia fueron las principales causas de pérdida de AV a largo plazo, presentándose al final del seguimiento en un 52,5% y un 60,5%, respectivamente.(AU)

Age-related macular degeneration (AMD) is one of the main causes of visual acuity (VA) loss in people over 50 years of age worldwide, with neovascular AMD (nAMD) accounting for 80% of cases of severe vision loss due to this disease. Anti-vascular endothelial growth factor (anti-VEGF) drugs have been used for the treatment of this disease for more than a decade, changing drastically the visual prognosis of these patients. However, initial studies reporting data on outcomes were short term. Currently, there are different series published on the long-term results of AMD after treatment with anti-VEGF, and the aim of this review is to synthesize these results. The mean follow-up of the included studies was 8.2 years (range 5-12 years). The mean initial VA was 55.3 letters in the Early Treatment Diabetic Retinopathy Study (ETDRS) (range 45.6-65) and the mean final VA was 50.1 letters (range 33.0-64.3), with a mean loss of 5.2 letters. At the end of follow-up, 29.4% of the patients maintained a VA>70 letters. The 67.9% of patients remained stable at the end of follow-up (<15 letter loss), with a severe loss (≥15 letters) of 30.1%. Fibrosis and atrophy were the main causes of long-term VA loss, occurring at the end of follow-up in 52.5% and 60.5%, respectively.(AU)

24-H movement behaviors and visual impairment among Chinese adolescents with and without obesity.

BACKGROUND: Previous studies have identified obesity, sleep patterns, screen time, and physical activity as independent risk factors for the visual health of adolescents. However, our understanding of how these factors interact and contribute to visual impairment remains limited. This study aimed to investigate the relationship between adherence to the 24-h movement guidelines (24-HMG) and visual impairment in adolescents with and without obesity. METHODS: We analyzed data from the 2014-2015 China Education Panel Survey. Participants provided self-reported information on their screen time, sleep duration, and physical activity levels. The data on weight, height, and visual acuity were obtained from school health examination reports. Logistic regression analysis was conducted to assess the association between 24-h movement behaviors and visual impairment, reported as odds ratios (ORs) with a 95 % confidence interval (CI). RESULTS: After controlling for covariates such as sex and age, it was found that adolescents with obesity who adhered to the sleep guidelines had a lower risk of visual impairment compared with adolescents without obesity who did not adhere to the 24-HMG (OR = 0.84, 95 % CI: 0.75-0.94, P = 0.003). Additionally, adolescents who adhered to both the physical activity and sleep guidelines had an even lower risk of visual impairment (OR = 0.58, 95 % CI: 0.42-0.79, P = 0.001). CONCLUSIONS: Adhering to the Sleep and physical activity + Sleep recommendations in the 24-HMG could significantly reduce the risk of visual impairment in adolescents without obesity. No significant relationship was observed between adherence to 24-HMG and the risk of visual impairment in adolescents with obesity.

A Multi-Center Cross-Sectional Study on Visual Impairment and Depression Among Students - Jiangsu Province, China, 2017-2022.

What is already known about this topic?: China exhibits a significantly high prevalence of myopia compared to other countries globally. Children with vision impairment have been found to engage less in physical activities, achieve lower academic performance, and have increased vulnerability to depression. What is added by this report?: During a six-year observational study, a population-level correlation was identified between varying degrees of visual impairment and the presence of depressive symptoms among students. Specifically, individuals with a visual acuity below 4.0 had a significantly higher odds ratio of 1.90 (95% confidence interval: 1.53-2.37) compared to individuals with normal vision (visual acuity ≥5.0). What are the implications for public health practice?: This study highlights the importance of holistic health interventions that address both visual and psychological aspects. Understanding common mechanisms and influential factors can guide the development of more impactful public health strategies.

Tocilizumab for the fifth progression of cystic childhood craniopharyngioma-a case report.

We present the case of a 15-year-old girl, with a fifth cystic progression of an adamantinomatous craniopharyngioma after multiple surgeries and previous local radiotherapy. She had severe visual impairment, panhypopituitarism including diabetes insipidus, and several components of hypothalamic damage, including morbid obesity and severe fatigue. To prevent further late effects hampering her quality of survival, she was treated biweekly with intravenous tocilizumab, an anti-interleukin-6 agent, which stabilized the cyst for a prolonged time. Based on the biology of adamantinomatous craniopharyngioma, this immune-modulating treatment seems promising for the treatment of this cystic tumor in order to reduce surgery and delay or omit radiotherapy.

Acute-Onset Visual Impairment in Wilson's Disease: A Case Report and Literature Review.

Objective: We reported the case of a patient with Wilson's disease (WD) with acute-onset visual impairment and summarized previously reported cases to make physicians aware of the complicated clinical expressions of WD and improve diagnosis efficiency. Methods: The patient was recruited from the Second Affiliated Hospital of Zhejiang University School of Medicine. Clinical data, including cranial images, laboratory tests, and ophthalmic findings were obtained. The PubMed database was searched for published cases of WD with visual impairment. Results: We reported a 22-year-old male who presented with hand tremor, personality change, and acute-onset binocular vision blurring. WD was considered to be closely correlated with neuropsychiatric and ocular involvements. After low-copper diet and regular copper-chelation therapy, the related symptoms improved compared to before. Six WD cases of optic neuropathy have been reported, including ours. The patients usually had neurological and/or hepatic symptoms for a period without any treatment. All the reported cases manifested as acute episodes of visual changes, and the ocular manifestations improved after copper-chelation treatment. Conclusions: Excess copper accumulation may be a rare cause of visual impairment in patients with WD. While the etiology behind patients' acute-onset visual impairment remained uncertain, the possibility of WD should be considered through neuropsychiatric and hepatic symptoms, corneal K-F rings, decreased serum ceruloplasmin, and low likelihood or exclusion of other causes. Clinicians need to recognize this rare manifestation and give appropriate treatment to avoid misdiagnosis and unnecessary overtreatment.

Using tactile imagery to teach geometry to students with visual impairments in the United Arab Emirates.

Learning geometry is difficult for students with visual impairments (VIs). However, tactile imagery, the process of constructing mental images of physical objects with certain shapes, may help them make sense of geometrical shapes. Thus, discussions have centred on interventions to promote the participation of students with VIs in the learning of shapes. This study explored tactile imagery connecting physical touch to memory as an approach to teaching shapes to students with VIs. Eleven students, five with VIs and six sighted students took part in this experimental design study. A tactile imagery test and intervention lessons were developed for this study. Four tactile imagery domains (tactile discrimination, tactile memory 2D, tactile memory 3D and pattern recall), each made up of 10 tests, guided the design of the tests and training lessons. The students' scores from the pre-test and post-test were subjected to mean computations, Mann-Whitney U tests and the Wilcoxon signed-rank test. The post-test results revealed that students with VIs performed better than their sighted peers. The study concludes with a discussion of the need for teacher educators to consider using tactile imagery as a way of teaching geometry to students with VIs.

Judô paralímpico: atuação profissional de professores das américas e europa / Paralympic judo: professional performance of coaches from the americas and europe / Judo paralímpico: desempeño profesional de profesores de las américas y europa

O judô é uma das modalidade esportivas dos Jogos Paralímpicos e é exclusivo para pessoas com deficiência visual. O objetivo desta pesquisa foi analisar as estratégias de ensino adotadas por professores dessa modalidade de diferentes países. Esta pesquisa quantitativa utilizou o método survey com escala Likert de 5 pontos. A amostra foi formada por 20 professores de 11 países das Américas e Europa. Como resultado, constatou-se que todos os professores participantes mesclam em sua atuação profissional aspectos tradicionais e inovadores, porém com maior ênfase nos inovadores (p<0.05). Os materiais mais utilizados nas aulas foram: cordas (25%), bolas (23,3%) e panos (11,6%). Esperamos que esta pesquisa2 possa contribuir com futuros professores de judô paralímpico possibilitando novas perspectivas e reflexões (AU).

Judo is a sport of the Paralympic Games and is exclusively for people with visual impairments. The objective of this research was to analyze the teaching strategies adopted by coaches of paralympic judo from different countries. This quantitative research used the survey me-thod with a 5-point Likert scale. The sample consisted of 20 coaches from 11 countries. As a result, it was found that all teachers mix traditional and innovative aspects in their professional performance, but with a greater emphasis on innovators (p <0.05). The most used materials mentioned were: strings (25%) balls (23.3%) and cloths (11.6%). We hope that this re-search can contribute to future Paralympic judo coaches, enabling new perspectives and reflections (AU)

El judo es una de las modalidades deportivas de los Juegos Paralímpicos y es exclusivamente para personas con discapacidad visual. El objetivo de esta investigación fue analizar las estrategias de enseñan-za adoptadas por docentes de esta modalidad de diferentes países. Esta investigación cuantitativa utilizó el método de encuesta con una escala Likert de 5 puntos. La muestra estuvo formada por 20 profesores de 11 países. Como resultado, se encontró que todos los docentes mezclan as-pectos tradicionales e innovadores en su desempeño profesional, pero con un mayor énfasis en los innovadores (p <0.05). Los materiales más uti-lizados mencionados fueron: cuerdas (25%) bolas (23,3%) y telas (11,6%). Esperamos que esta investigación pueda contribuir a los futuros profeso-res de judo paralímpico, posibilitando nuevas perspectivas y reflexiones (AU).

Clinimetric properties of visuo-perceptual and visuo-cognitive assessment tools used for children with cerebral visual impairment and cerebral palsy or developmental delay: a systematic review.

PURPOSE: The aim of this systematic review is to evaluate the psychometrics and clinical utility of visuo-perceptual and visuo-cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP) or neurodevelopmental delay (DD). MATERIALS AND METHODS: Five databases (PubMed, EMBASE, SCOPUS, CINAHL, and Cochrane Database) were comprehensively searched from 1970 till June 2021. The PRISMA checklist was utilised to report on the process of selecting eligible papers. The methodological quality of included studies was evaluated using COnsenus-based Standards for the selection of health Measurement INstrument (COSMIN) checklist. RESULTS: Of the 26 assessment tools identified, only seven tools had psychometric evidence supporting their use. Based on COSMIN guidelines, 60% of included studies were rated as inadequate or doubtful for their methodological quality of measurement properties, with equal number being rated as indeterminate on the overall rating. CONCLUSIONS: Cerebral visual impairment due to its varied clinical presentation is often missed in children with CP and DD. There is a paucity of studies reporting on the validity and reliability of functional vision tools. Further studies are needed to conduct high-quality psychometric reporting using the updated COSMIN guidelines to identify appropriate functional vision tools for children with CP or DD.Implications for rehabilitationThere are paucity of studies evaluating the validity and reliability of existing perceptual and cognitive assessment tools in children with cerebral visual impairment (CVI) and cerebral palsy (CP).Development of age-appropriate assessment tools evaluating all aspects of functional vision will assist in providing more holistic child-centric rehabilitation programs.A combination of detailed perinatal history, direct observation, and clinical assessments of functional vision are important to recognise CVI in children with CP.

Impact of Prajña yoga on cognition in adolescents with congenital and adventitious visual impairment.

CONTEXT: Numerous scientific studies have investigated the impact of yoga on cognition in children and adults. However, fewer studies have assessed the impact of yogic practices on cognition in children and adolescents with visual impairment. Despite their keen intellectual abilities and advanced linguistic skills, teens with visual impairment often experience difficulties with cognitive control and behavioral regulation. Memory plays an important role in cognition. Besides storing information, memory is also used for recall, defined as the retrieval of information the brain has recently been exposed to, and recognition, defined as the ability to recognize or retrieve the information previously encountered and stored in the brain. OBJECTIVE: The objective of the study was to observe the effectiveness of Prajña Yoga on enhancing the cognition and verbal memory in adolescents with visual impairment. Degree of visual impairment and age of onset of visual impairment were considered while analyzing the study data. DESIGN: An open-trial, single arm, pre-post study design was adopted. 273 adolescents with visual impairment were assessed across India using the Rey Auditory Verbal Learning Test (RAVLT), at baseline (before the intervention), immediately after the intervention, and at 40 days after the intervention. RAVLT measures recall and recognition through verbal memory. INTERVENTION: Prajña Yoga (PY) or the Art of Living Intuition Program is a unique intervention, based on ancient techniques of Pranayama, Super Brain Yoga, and Meditation, taught to children & adolescents between the ages 5 and 17. RESULTS: The mean scores for Recognition (p=0.011) and Immediate recall (p=0.011) improved significantly after PY for the entire study population, regardless of the degree of visual impairment, gender and age of onset. A significant improvement in mean scores for Delayed Recall was seen after 40 days of daily practice (p = 0.007).

Unilateral visual impairment after a dental procedure: Case report.

The use of intra-oral local anaesthetics for dental procedures is a widely extended practice that may cause side effects. As such, in rare cases it may cause ocular complications such as diplopia, ptosis, blurry vision, miosis, vision loss, or amaurosis. (Most of them are transient, recovering after several hours or days). A case is presented of a 26 year-old male patient who had visual impairment in the right eye 2 days after a dental procedure was performed. Six months later he had a complete restoration of the previous visual acuity, despite the fact that he had not received any treatment. Several ways have been proposed in the literature that may explain the appearance of ocular complications following these kinds of procedures. In this case, inadvertent intravenous injection is believed to have been the cause.

Arts activity and well-being for visually impaired military veterans: a narrative discussion of current knowledge.

OBJECTIVES: The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans. STUDY DESIGN: A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge. RESULTS: While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans. CONCLUSIONS: Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities.

Assessing the Stiffness Perception of Acupressure Massage Beginning Learners: A Pilot Study.

Visually impaired licensed therapists must have the ability to perceive stiffness through their fingertips in the school for the blind. The teachers strive to provide careful introductory education based on a quantitative assessment of new students' basic stiffness perception. However, assessment materials to help teachers understand new students' stiffness perception are lacking. This study aimed to develop suitable fundamental assessment materials that visually impaired licensed teachers could use to quantitatively assess the difference in the stiffness perception ability of beginning learners in the early stages of learning. They were asked to discriminate the presented materials one at a time, which consisted of thermoplastic elastomers with different degrees of stiffness. We used these materials to compare the beginning learners' ability to perceive stiffness with that of teachers and found that teachers answered correctly at an overall significantly higher rate. Specifically, the teachers' correct response rate (78.8%) for the stiffness perception of all presented stimuli was approximately 15% higher than the beginning learners' correct response rate (64.2%). These results revealed areas of stiffness that are difficult for beginning learners to identify.

[Effect of acupuncture on pattern visual evoked potential of cerebral visual impairment in children aged 3-10 years].

OBJECTIVE: To observe clinical effect of acupuncture combined with conventional visual stimulation on cerebral visual impairment (CVI) in children aged 3-10 years and influence on the pattern visual evoked potential (P-VEP). METHODS: A total of 60 cases of children aged 3-10 years with CVI were randomly divided into an observation group and a control group, 30 cases in each group. The children in the control group received conventional visual stimulation therapy, 1 month as a course of treatment. On the basis of the control group, the children in the observation group was treated with acupuncture at Baihui (GV 20), Jingming (BL 1), Taiyang (EX-HN 5), Sibai (ST 2), etc. 3 times a week, and the treatment was given 4 weeks continuously as a course. Both groups received 3 courses of treatment. The visual acuity and P-VEP improvement were compared between the two groups before and after treatment. RESULTS: After treatment, the incubation period (P100-L) of the two groups was shorter than before treatment, and the amplitude (P100-A) was higher than before treatment (P<0.05); and the degree of above changes in the observation group was lager than the control group (P<0.05). The percentage of best corrected visual acuity of 0.6-0.8 in the observation group after treatment and follow-up 1 year after treatment was higher than before treatment (P<0.05), and was higher than the control group (P<0.05). CONCLUSION: Acupuncture combined with conventional visual stimulation can improve the incubation period (P100-L) and amplitude (P100-A) of P-VEP in children with CVI, and improve the best corrected visual acuity in children, the clinical effect is better than the conventional visual stimulation alone.

Simultaneous bilateral cochlear implantation under local anaesthesia in a visually impaired adult with profound sensorineural deafness: A case report.

Objective: The National Institute of Clinical Excellence recommends that adult patients with severe to profound deafness are eligible for simultaneous bilateral cochlear implantation if they are blind or have other disabilities increasing their reliance on auditory stimuli. Cochlear implant (CI) surgery is routinely performed under general anaesthesia (GA), precluding patients who have higher risk associated with GA. Recent literature describes the safety and efficacy of performing unilateral CI surgery under local anaesthesia (LA). We report the first simultaneous bilateral CI under LA in the UK in an adult patient with profound sensorineural deafness and visual impairment.Case study: A 46-year-old gentleman, registered blind, presented with a 20-year history of bilateral progressive hearing loss. He was assessed as unfit for surgery under GA due to significant cardiac comorbidities. We performed simultaneous bilateral CI surgery under LA on the patient; he was discharged home the following day. Postoperative free field audiometry showed a significant improvement; speech discrimination using Bamford, Kowal and Bench sentences presented in quiet, increased from 0% pre-operatively to 100% four months post-operatively.Conclusion: Simultaneous bilateral CI surgery under LA is a safe and feasible procedure for eligible patients who may otherwise have been denied surgery due to their GA risk.

Effect of acupuncture on pattern visual evoked potential of cerebral visual impairment in children aged 3-10 years / 中国针灸

OBJECTIVE@#To observe clinical effect of acupuncture combined with conventional visual stimulation on cerebral visual impairment (CVI) in children aged 3-10 years and influence on the pattern visual evoked potential (P-VEP).@*METHODS@#A total of 60 cases of children aged 3-10 years with CVI were randomly divided into an observation group and a control group, 30 cases in each group. The children in the control group received conventional visual stimulation therapy, 1 month as a course of treatment. On the basis of the control group, the children in the observation group was treated with acupuncture at Baihui (GV 20), Jingming (BL 1), Taiyang (EX-HN 5), Sibai (ST 2), etc. 3 times a week, and the treatment was given 4 weeks continuously as a course. Both groups received 3 courses of treatment. The visual acuity and P-VEP improvement were compared between the two groups before and after treatment.@*RESULTS@#After treatment, the incubation period (P100-L) of the two groups was shorter than before treatment, and the amplitude (P100-A) was higher than before treatment (@*CONCLUSION@#Acupuncture combined with conventional visual stimulation can improve the incubation period (P100-L) and amplitude (P100-A) of P-VEP in children with CVI, and improve the best corrected visual acuity in children, the clinical effect is better than the conventional visual stimulation alone.

Differential changes in visual and auditory event-related oscillations in dementia with Lewy bodies.

OBJECTIVE: Aside from the cognitive impairment, patients with dementia with Lewy bodies (DLB) have a high frequency of visual hallucinations and a number of other vision-related symptoms, whereas auditory hallucinations are less frequent. To better understand the differential dysfunction of the visual network in DLB, we compared auditory and visual event-related potentials and oscillations in patients with DLB. METHODS: Event-related potentials elicited by visual and auditory oddball tasks were recorded in 23 patients with DLB and 22 healthy controls and analyzed in time and time-frequency domain. RESULTS: DLB patients had decreased theta band activity related to both early sensory and later cognitive processing in the visual, but not in the auditory task. Patients had lower delta and higher alpha and beta bands power related to later cognitive processing in both auditory and visual tasks. CONCLUSIONS: In DLB visual event-related oscillations are characterized by a decrease in theta and lack of inhibition in alpha bands. SIGNIFICANCE: Decreased theta and a lack of inhibition in alpha band power might be an oscillatory underpinning of some classical DLB symptoms such as fluctuations in attention and high-level visual disturbances and a potential marker of dysfunction of the visual system in DLB.

Corneal Thinning Induced by Self-administered Alum Substance: A Case Report and Analysis of the Active Components.

We report a case of severe ocular injury and impaired vision after self-administration of alum. A 56-year-old female administered an alum substance in the left eye and experienced severe corneal thinning, a scar, and decreased vision. The active compounds in the alum substance were analyzed using scanning electron microscopy. When topically administered, alum may cause severe ocular injury. Public awareness, early recognition of the injuries, and timely intervention may prevent permanent ocular damage.

Retinopathy of prematurity: Overview and highlights of an initiative to integrate prevention, screening, and management into the public health system in India.

Purpose: In India, more than 800 special newborn care units (SNCUs) have been established since 2008 in government facilities. More preterm infants are now surviving and blindness from retinopathy of prematurity (ROP) is increasing. The aim of the Queen Elizabeth Diamond Jubilee Trust's initiative (2012-1019) was to improve the quality of neonatal care and integrate ROP services into the government health system using expertise in the government and nongovernment sector in four states in a sustainable and scalable manner. Methods: State Ministries of Health were engaged and collaboration was established between three government programs (Ministry of Health and Family Welfare, Rashtriya Bal Swasthya Karyakram, and blindness prevention) and relevant professionals. Extensive training took place and equipment was provided. Implementation was guided by a multidisciplinary National Task Force and was monitored by state coordination committees. The Task Force appointed technical expert groups to support implementation through advocacy, information, education and communication materials, operational guidelines, a competency-based training curriculum, and an online database and website. Results: Twenty-two ophthalmologists in government facilities were trained to screen for ROP and nine to treat ROP. Almost 13,500 preterm infants were screened in 17 SNCUs and 86% of the 456 infants with sight-threatening ROP were treated. An educational resource using latest pedagogy based on key domain areas for best practices for small and preterm neonates including ROP has been developed and pilot tested and is being evaluated and scaled up. Conclusion: All four states are scaling up services or have plans to scale up, and several other states have started the initiatives.

Changed Eye Functions and Quality of Life of Seniors with Diabetic Retinopathy.

AIM: To monitor and evaluate the differences in the evaluation of monitored indicators of quality of life of patients with proliferative and non-proliferative diabetic retinopathy (DR). METHODS: The research sample comprised a total of 80 patients with DR.The first group consisted of 27 patients with proliferative diabetic retinopathy and the second group of 53 patients with non-proliferative diabetic retinopathy. The comparison was carried out according to the degree of DR. The data were collected using the standardized National Eye Institute Visual Function Questionnaire (NEI VFQ-25). RESULTS: In both compared patient groups, T-tests showed significant differences in all studied quality of life parameters: general health and vision, difficulty seeing far away and up close, the impact of the disease on achieving life goals, being limited in control over and in length of their activities, being limited to their homes, relying on the information provided by other people and needing help from others. CONCLUSION: In a holistic concept, i.e. biological, psychological and social dimensions, partial or complete loss of the ability to see due to diabetes has a negative impact  on the quality of life of patients with proliferative DR. Therefore, this chronic complication must be prevented by any available means.

Orientation and mobility outcome measures.

Despite orientation and mobility (O&M) being a significant factor determining quality of life of people with low vision or blindness, there are no gold standard measures or agreement on how to measure O&M performance. In the first part of this systematic review, an inventory of O&M outcome measures used by recent studies to assess the performance of orientation and/or mobility of adults with vision impairment (low vision and blindness) is presented. A wide variety of O&M outcome measures have been implemented in different fields of study, such as epidemiologic research and interventional studies evaluating training, assistive technology, vision rehabilitation and vision restoration. The most frequent aspect of outcome measures is efficiency such as time, distance, speed and percentage of preferred walking speed, followed by obstacle contacts and avoidance, and dis/orientation and veering. Other less commonly used aspects are target identification, safety and social interaction and self-reported outcome measures. Some studies employ sophisticated equipment to capture and analyse O&M performance in a laboratory setting, while others carry out their assessment in real-world indoor or outdoor environments. In the second part of this review, the appropriateness of implementing the identified outcome measures to assess O&M performance in clinical and functional O&M practice is evaluated. Nearly a half of these outcome measures meet all four criteria of face validity (either clinical or functional), responsiveness, reliability and feasibility and have the potential to be implemented in clinical or functional O&M practice. The findings of this review confirm the complicated and dynamic nature of O&M. Multiple measures are required in any evaluation of O&M performance to facilitate holistic assessment of O&M abilities and limitations of each individual.