Visual habilitation in young children with visual impairment.

PURPOSE: To evaluate the effectiveness of the visual habilitation programme in improving the visual functions of visually impaired children under 3 years old. METHODS: Case records of children with visual impairment (VI) who had at least 1 follow-up visit were reviewed. Children's visual functions were scored between 0 and 15 based on mainly fixation and following skills. Differences in patients' visual function score (VFS) between the time of the presentation and the last follow-up visit were recorded. RESULTS: One hundred thirty children with VI (63 male and 67 female) were identified. The mean age at the presentation was 13.94 ± 9.23 months, and the mean follow-up was 12.79 ± 9.4 months. Forty of the patients had ocular, 70 of them had cerebral, and 20 of them had combined VI. Correlations were found between the age of the patients at the presentation and the initial VFS; and gestational age and the initial VFS (p Ë‚ 0.001, r = 0.332; p Ë‚ 0.05, r = 0.262, respectively). Vision improvement was noted in ocular, cerebral and combined VI groups. No significant difference among the groups was found (p = 0.430). There was a significant difference between the change in the VFSs of those who attended the special education and rehabilitation centre regularly for 2 h a week and had regular visual stimulation for 8-10 sessions every day at home and those who did not go to the centre and did not receive any visual stimulation by their parents at home (p Ë‚ 0.001). CONCLUSIONS: The visual functions of visually impaired children can be improved by habilitation, which includes visual stimulation programmes.

Ocular and cerebral causes of visual impairment in young children and a new scoring system to evaluate visual function.

PURPOSE: Childhood blindness is important cause contributing to the burden of blindness. It is necessary to identify the most frequently observed diseases in different populations. We aimed to demonstrate clinical features of low vision children and to evaluate the factors affecting visual function by a new visual function scoring system. METHODS: Two hundred forty nine children between the age of 6 months and 3 years were included. Visual function was scored from 0 to 15 according to; response to threat, light, object, presence of fixation, duration of fixation, following of light and object in horizontal, vertical, oblique, and circular gazes, optokinetic nystagmus. Patients were classified according to neurological diagnosis and cranial magnetic resonance imaging findings. Correlation between visual function score and ocular and neurologic findings were evaluated. RESULTS: While 136 patients (54.6%) had cerebral visual impairment (CVI), 89 (35.7%) had ocular pathology, 24 patients (9.6%) had combined pathology. The most common ocular and cerebral pathologies were oculocutaneous albinism (23.9%) and hypoxic ischemic encephalopathy (HIE) (27.5%), respectively. Patients with CVI had lower visual function than ocular pathologies. Neurological structural disorders and HIE had worse visual function. Widespread involvement of brain had lower visual function score. Seizure negatively affected visual function. CONCLUSIONS: Cerebral causes were found in approximately half of infants and children with low vision who were referred to our center for visual habilitation. The visual function scoring system we developed in this study will provide an opportunity to be objective in the follow-up of babies and in evaluating the effectiveness of visual habilitation programs.

Structure-function relationship of reading performance in patients with early to moderate glaucoma.

PURPOSE: To assess reading performance in patients with mild to moderate primary open-angle glaucoma (POAG), and to determine the relationship between reading ability and visual field (VF), microperimetry, and optical coherence tomography (OCT) parameters. METHODS: Reading performance of 30 POAG patients examined by the Minnesota Reading Acuity Chart (MNREAD) was compared to that of 21 age-matched controls collected from Ankara University in Turkey. Humphrey Field Analyzer (HFA) 24-2 SITA Standard and 10-2 patterns, and microperimetry were used for VF measurements. All subjects underwent OCT analysis for retinal nerve fiber layer thickness (RNFLT), optic nerve head (ONH) measurements, and ganglion cell inner plexiform layer thickness (GCIPLT). The linear relationship between reading parameters and VF, microperimetry, and OCT parameters was investigated. Univariate and multiple logistic regression models were used to identify the risk factors for glaucoma. RESULTS: In POAG patients, maximum reading speed (MRS) had a significant association with average rim area, mean cup-to-disc ratio (CDR), and cup volume (p < 0.05, for all). Decreased MRS was associated with thinner average GCIPLT and inferotemporal, superior, and inferior GCIPLT quadrants (p < 0.05, for all). Global index values for the HFA 24-2/10-2 tests, microperimetry, and ONH/RNFLT parameters had no correlation with reading performance. After accounting for the better and worse eyes, gender, education, age, and visual acuity of the glaucoma patients, MRS score was 23 units lower in the worse eye (p = 0.009), critical print size (CPS) was 0.21 units larger in the better eye (p = 0.03) and 0.25 units larger in the worse eye (p < 0.001), reading accesibility index (ACC) was 0.11 units lower in the better eye (p = 0.02) and 0.13 units lower in the worse eye (p = 0.002), and RA was 0.13 units higher in the worse eye (p = 0.003) of POAG patients. CONCLUSION: POAG had significantly lower reading performance when compared to healthy subjects. Reading speed was associated with decreased macular GCIPLT indicating that reading performance may be affected in the earlier stages of the disease.

A Report on Children with CEP290 Mutation, Vision Loss, and Developmental Delay.

Mutations in CEP290, which encodes a centrosomal protein, cause Joubert syndrome, retinal dystrophy, and several other manifestations. Retinal dystrophy related to CEP290 mutation (Leber's congenital amaurosis type 10) presents with a severe visual impairment from birth, wandering eye movements, and oculodigital reflex. Fundus examination may initially be normal, but varying degrees of retinal pigmentation can be detected over time. This report presents 4 children who were referred to the ophthalmology clinic with a lack of eye contact and the suspicion of low vision. The ophthalmological examination revealed very poor visual function, the vision slightly improved over time, and enophthalmos became evident. There was neuromotor retardation in their history and mutations in the CEP290 gene were revealed in the whole-exome analysis. Both pediatricians and ophthalmologists should be aware of the coincidence between severe vision loss and neuromotor retardation and should refer patients for genetic testing if they suspect it. Genetic diagnosis will enable patients to be followed both neurologically and ophthalmologically and to benefit from rehabilitation opportunities that will contribute to visual and neurological development. It will also allow the family to receive genetic counseling on disease progression and heredity, and to follow ongoing gene therapy studies for mutations in the relevant gene.

Rehabilitation Methods for Patients with Geographic Atrophy due to Age-Related Macular Degeneration and Effects of Rehabilitation on Quality of Life.

Purpose: The purpose of the study is to evaluate the low vision rehabilitation methods and to investigate the effect of visual rehabilitation on quality of life in patients with low vision due to geographic atrophy from age-related macular degeneration (ARMD). Methods: The better-seeing eye of 78 patients with geographic atrophy due to ARMD were included in the study. Sociodemographic characteristics, ophthalmological examination findings, and preferred low vision aids for near and distant were recorded. Fifty-seven patients who preferred to use a low vision aid device in daily life were considered as a rehabilitation group, whereas 21 patients who did not use any device were considered as a control group. The National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was applied to all patients at the initial examination and at least 6 months after the initial examination. Results: In the rehabilitation group, statistically significant increases were found in the overall composite score, and general vision, near and distance activities, social functioning, mental health, role difficulties, and dependency subscale scores of the NEI-VFQ-25 quality of life scale after low vision rehabilitation (p=0.009 for general vision, p < 0.001; for others). In the control group, there was no statistically significant change in any of the subscale scores or the overall score of the scale (p > 0.05). All patients (n = 78) were recommended to use at least one low vision aid for near vision. Hyperocular glasses were recommended for 77 patients (98.72%), magnifiers for 15 patients (19.23%), electro-optical devices for 2 patients (2.56%), and telemicroscope for one patient (1.28%). Furthermore, 17 patients (21.8%) were prescribed more than one low vision aids. However, for distance vision, only 29 patients (37.18%) received a recommendation for a low vision aid. Conclusions: Low vision patients with ARMD-related geographic atrophy should meet with low vision aids as soon as possible and should be included in low vision rehabilitation programs.

Macular sensitivity assessment and fixation analysis using microperimetry in children with retinopathy of prematurity.

BACKGROUND/AIMS: To investigate retinal sensitivity and fixation stability using microperimetry in children with retinopathy of prematurity (ROP). METHODS: Observational case series. Totally 51 preterm children who had been followed for ROP were examined in three groups (n=17 in each group). The groups were defined as children without ROP (group 1), children with spontaneously resolved ROP (group 2) and children who had laser treatment for ROP (group 3). All subjects underwent a detailed ophthalmic examination. Macular Analyzer Integrity Assessment Microperimetry was used to analyse macular light sensitivity and fixation stability. The results were compared between groups. The measurements were also analysed according to age, gender, birth weight and gestational age. RESULTS: The mean age was 10.84±0.97 years, and 27 children were female. Mean average threshold (AT) for macular sensitivity was 25.5±2.1 decibel in group 1, 26.8±3.8 decibel in group 2 and 26.3±3.0 decibel in group 3. These differences were not statistically significant between the groups (p=0.067), but AT was abnormal in 29% of the whole study population. Outputs about fixation stability were similar between the three groups but fixation was unstable in 27% of the subjects. Mean AT was better in children ≥11 years old compared with the younger ones (p=0.022). CONCLUSION: Preterm children may have some abnormalities in macular light sensitivity and fixation stability. These abnormalities may be more prominent in children less than 11 years old. ROP itself or the laser treatment seems not to affect macular light sensitivity and fixation stability.

Comparison of Two Different Contrast Sensitivity Testing Methods in Patients with Low Vision.

Purpose: To assess the agreement between two different contrast testing modalities using the index of contrast sensitivity (ICS) in patients with low vision. Methods: Thirty-eight patients with low vision were included in the study. Contrast sensitivity (CS) was measured binocularly with both the Vector vision-standardized CS test (CSV-1000E, Vector Vision Co, Greenville, Ohio, USA) and the MonPack 3 (Metrovision, France) after refractive correction for each participant. Based on the data from the two tests, the ICS was calculated. The Bland-Altman technique was used to evaluate the agreement between ICSs obtained from different test methods. Results: Range of best corrected visual acuity was 0.50-1.00 logMAR. According to the median logCS values, CS values were highest at 3 cycles per degree (cpd) for the CSV-1000E test and at 1.5 cpd for the Metrovision MonPack 3 test. The median ICS for CSV-1000E was -0.22 (95th percentile 4.75), and the median ICS for Metrovision MonPack 3 was 0.08 (95th percentile 1.65). The mean difference was 0.655 (between -3.82 and 5.13) within limits of agreement (LoA). The difference and mean values between the two CS test measurements were found to be within LoA range. Conclusions: An agreement was found between the Metrovision MonPack 3 test and the standard CSV-1000E test results in patients with visual impairment. However, the agreement range was within very wide limits. Therefore, it was thought that they may not be used interchangeability in clinical practice.

Sports participation and quality of life in individuals with visual impairment.

BACKGROUND: The positive effects of sports participation on health can be an important issue for rehabilitation of visually impaired individuals. AIMS: Our aim was to determine the relationship between sports participation and quality of life in individuals with visual impairment. METHODS: The study included 100 athletes who participated in national games for people with visual impairment and 100 subjects who did not participate in sports as the control group. The two groups were matched according to age, gender, visual acuity and visual field. The Short-Form Health Survey (SF-36) was applied for assessment of quality of life. RESULTS: All subjects had best corrected visual acuity less than 6/60 and/or visual field less than central 10 degrees in radius in the better eye. The sociodemographic characteristics of the study and control groups were similar except the level of education being higher in the athlete group and level of income higher in the control group. All of the SF-36 scores were higher among athletes compared to controls. Duration of sports activities (years) was positively correlated with Physical Functioning score. There were no significant relations between SF-36 scores and weekly sports participation time (hours). Athletes who had visual loss at an earlier age had better scores in Physical Functioning and Role Limitations due to Physical Problems. CONCLUSIONS: Sports activities had positive relationships with all domains of the quality of life in individuals with visual impairment. Thus, appropriate sports activities would increase the success of rehabilitation programs and their quality of life.

Evaluation of the effect of subtenon autologous platelet-rich plasma injections on visual functions in patients with retinitis pigmentosa.

Aim: The photoreceptors in retinitis pigmentosa (RP) remain in dormant status for a while with a decrease in the growth factors in their microenvironment before apoptosis. Growth factors reduce retinal degeneration and apoptosis in animal models. Materials & methods: The data of 188 eyes of 94 patients who were injected with autologous platelet-rich plasma (PRP) into the subtenon space three-times every 2 weeks were evaluated retrospectively. Results: Statistically significant improvements in visual acuity, visual field and fixation stability were detected after treatment. When the treatment response of the patients' better-seeing eye compared with the response of the other eye, there was no statistically significant difference. Conclusion: The PRP treatment has a favorable effect on visual functions in patients with RP. This approach is promising as it is safe and easy.

How Much Do Clinical and Microperimetric Findings Affect Reading Speed in Low Vision Patients with Age-related Macular Degeneration?

Purpose: To investigate the factors affecting the reading speed of patients with central scotoma due to age-related macular degeneration (AMD).Materials and Methods: We included 63 eyes of 63 patients with AMD who applied to our low vision clinic between August 2018 and September 2019 in this prospective study. We evaluated socio-demographic characteristics, eye examination findings and Minnesota Low Vision Reading Test (MNREAD) results. We used the MAIA microperimeter device to evaluate the properties of the preferred retinal locus for fixation (PRL) of the patients. Evaluations included the assessment of the effects of all parameters on reading speed.Results: The PRL was most commonly in the nasal (31%) and superior (26%) quadrants. Twenty-nine percent of the cases preferred the left visual field. PRL localization had no effect on reading speed, whereas, fixation stability, educational status, presence of foveal absolute scotoma, reading acuity and duration of reading interruption were found to have the most significant effects. Multiple regression analysis showed that reading speed decreased by 67 units in the presence of unstable fixation, by 17 units in the presence of foveal absolute scotoma, by 3 units with every 0.1 increase in logMAR value, and by 1.7 units with every 1-year increase in reading interruption. Additionally, being a university graduate was associated with an increased reading speed (by 18 units)Conclusion: Increased reading performance is one of the factors that can improve quality of life. The factors found to affect the reading speed in the current study may guide the rehabilitation process in low vision patients.

Causes of severe visual impairment in infants and methods of management.

OBJECTIVES: To examine the causes of severe visual impairment (SVI) in infants below the age of 2 years and to review management methods. METHODS: The data of 2657 patients followed between January 2014 and July 2019 were reviewed, and 148 (5.6%) infants who had SVI were enrolled. Data including age, gender, affected anatomical site, diagnosis, presence of any non-ophthalmological deficiencies, and methods of management were reviewed. The diagnoses were investigated in the categories of avoidable and unavoidable basis. The methods of management were analysed from the perspective of low vision habilitation. RESULTS: The mean age at first eye examination was 6.61 ± 5.25 months, and 84 (56.7%) infants were male. Of the 148 infants, 69 (46.6%) were premature. Cerebral visual impairment (CVI) was the most common diagnosis in both preterm (39.1%) and term (11.4%) infants. Delayed visual maturation, optic nerve pathologies, oculocutaneous albinism, and congenital cataract were the other frequent causes. The rate of multiple disabilities was 30% in the whole group and 94% in infants with CVI. Most of the babies had a normal-appearing globe (43.3%). Retina was affected in 23.7% of the infants. Avoidable causes were identified in 79.7% of the infants. The used methods of management were optic interventions, visual stimulation therapy, medical and/or surgical treatment. CONCLUSIONS: CVI was found the most common cause of SVI in both preterm and term-born infants, and the higher rate of multiple disabilities in these infants was remarkable. Optic interventions and visual stimulation therapy were the most common methods of management.

Demographic, ocular and associated neurological findings in corpus callosum malformations.

BACKGROUND: The corpus callosum is a primary commissural part of the brain which connects the two hemispheres. Processing sensory, motor, visuo-motor and cognitive functions are related to a healthy connection. In this study, we aimed to evaluate the ocular, neurologic and other systemic findings of corpus callosum malformations and to focus on the association between the ocular and neurological findings and the type of callosal malformation according to cranial magnetic resonance imaging (MRI). METHODS: A retrospective chart review of 57 patients with corpus callosum malformation was performed. Demographic features, neurologic, ocular and other systemic findings were noted. Patients were divided into 3 groups according to the severity of corpus callosum malformation on MRI (total agenesis, partial agenesis and hypoplasia) and also evaluated as a part of a genetic disorder/syndrome or not. The differences between demographic features, ocular and neurological findings between these 3 groups and also between syndromic and non-syndromic groups were evaluated statistically. RESULTS: Only 35.1% of patients had fixation and following pattern of visual acuity. Anterior segment pathologies were observed in 6.9% of patients. However, 57.9% of patients had posterior segment malformations. Only 19.3% of patients had a normal ocular alignment. There was no statistically significant difference of demographic features, ocular and neurologic findings between the 3 groups or between the syndromic/non-syndromic groups. CONCLUSIONS: Ocular findings can be reliable depending on the severity of the corpus callosum malformations. However, delay in fixation reflex development or loss of fixation should remind us of central nervous system pathologies especially corpus callosum malformations.

Effectiveness of Low Vision Rehabilitation Using Microperimetric Acoustic Biofeedback Training in Patients with Central Scotoma.

PURPOSE: To evaluate the efficacy of visual rehabilitation with microperimeter biofeedback in patients with central scotoma. MATERIALS AND METHODS: 35 consecutive patients with central scotoma (17 age-related macular degeneration (AMD), 14 Stargardt disease, and 4 cone dystrophy) were included in the study. Visual acuity, reading performance by Minnesota Low Vision Reading Test (MNREAD), quality of life by 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and fixation analysis by MAIA microperimeter were evaluated before and 1 month after training. The rehabilitation program consisted of 10 training sessions of 10 minutes. RESULTS: The median best-corrected visual acuity (BCVA) was 0.80 logMAR (range 0.3 to 1.3 logMAR). Fifty-nine percent of patients with AMD developed a preferred retinal locus (PRL) nasal to the fovea, and 64% of the patients with Stargardt disease preferred a PRL superior to the fovea. The PRL location in 3 of 4 cone dystrophy patients was nasal to the fovea. The mean PRL distance from the fovea was 7.57 ± 3.61 degrees. Fixation stability improved with P1 values of 22.34 ± 11.81 versus 32.05 ± 18.79 (p = .003) and 95% bivariate contour ellipse area (BCEA) values of 41.6 versus 23.6 (p = .018) before and after training, respectively. There was a significant difference in reading acuity between before and after training (p = 0.008). The overall score and near activities score of NEI VFQ-25 were found to be increased at the end of the rehabilitation (p < 0.001). CONCLUSION: Rehabilitation with acoustic biofeedback in patients with central scotoma looks like a useful technique for improving fixation stability, reading performance and quality of life.

A Common Approach to Low Vision: Examination and Rehabilitation of the Patient with Low Vision

Due to the increasing age of the global population, rates of visual disability are increasing. Visual rehabilitation is an effective method for increasing quality of life among individuals with low vision or blindness due to unpreventable or untreatable causes. The goal of low vision rehabilitation is to produce people who are independent, have an economically viable profession or skill, and are able to enjoy their lives. The stages of modern low vision rehabilitation include the intake interview, assessment of residual visual functions, assessment of residual functional vision, interventions and recommendations, and vision rehabilitation therapies.

Results of Screening in Schools for Visually Impaired Children.

OBJECTIVES: The aim of this study was to identify the causes of visual impairment in children attending schools for students with visual impairment and to identify children suitable for treatment and rehabilitation. MATERIALS AND METHODS: All students were examined in our department by a pediatric ophthalmologist and an ophthalmologist experienced in low vision and visual rehabilitation. The children's medical histories were recorded. All children underwent ophthalmological examination including visual acuity measurement, anterior segment and dilated fundus evaluation, retinoscopy with cycloplegia, and intraocular pressure measurement. The causes of visual impairment were grouped as avoidable and unavoidable. Children with residual visual acuity better than 20/1250 were included in the low vision rehabilitation programme. RESULTS: A total of 120 patients were evaluated and 79.2% were legally blind (visual acuity less than 0.05), 18.4% had low vision (visual acuity between 0.05 and 0.3), and 0.8% had normal vision (>0.3). The main causes of visual impairment were retinal dystrophies (24.2%) and retinopathy of prematurity (17.5%). Of all diseases related to visual impairment, 27.6% were avoidable. Improvement in visual acuity was achieved with low vision aids in 57.5% of all patients. CONCLUSION: The incidence of visual impairment due to avoidable causes can be decreased by ophthalmic screening. Treatment of these children in the early stages of visual development can improve visual acuity. Even in cases with delayed diagnosis, low vision aids are important for visual and neurobehavioral development, and these programmes may improve quality of life and education in these children.

Evaluation of awareness of diabetes mellitus and associated factors in four health center areas.

OBJECTIVE: As in all chronic diseases, providing patients with necessary information about Diabetes Mellitus (DM) and educating them are the best method of control of DM and preventing further complication. The aim of this study was to investigate the awareness of DM and related factors in diabetics. METHODS: This cross-sectional study was conducted in four health centre areas of Ankara (n = 96,348) between 1997 and 2000. In these areas, the researches were visited every home and detected the total of 2136 diagnosed patients with DM. 62.5% of diabetics (1334) participated in the study in which a face-to-face interview was conducted to fill in a questionnaire followed by eye examination and fasting blood glucose level testing. Chi-square test and logistic regression analyses were performed to investigate the relationships between factors. RESULTS: Statistical analysis has shown that mean age of respondents was 57.4 +/- 10.9 years and majority were female (67.9%) and older onset DM (96.6%). Mean duration of DM was 7.8 +/- 6.5 years. Only 28.6% of patients (n = 382) have had informed about DM. The main information resource was found to be hospitals (76.4%), then media 19.1% and primary health care centers (PHCC) 3.9%. Patients who graduated from university were 13.5 times; who were under 50 years of age were 1.92 times; who have had prior eye examination were 1.84 times and who had co-morbidities were 1.52 times more likely to have informed about DM than the other groups. CONCLUSION: Awareness of DM amongst diabetics is very low and mainly determined by their education levels. The PHCC play a very small role in dissemination of information towards diabetics. PRACTICE IMPLICATIONS: Results from this study have implications for patient education efforts. Accurately, clinicians need to strive to improve overall levels of patients' awareness and knowledge of their specific conditions, regardless of their literacy. Many opportunities exist for raising diabetic's awareness of their disease and linking diabetic's growing health awareness with those health promoting behaviors known to reduce morbidity and mortality.

Validation and reliability of the Cardiff Visual Ability Questionnaire for Children using Rasch analysis in a Turkish population.

AIM: To develop a Turkish version of the 25-item Cardiff Visual Ability Questionnaire for Children (CVAQC) and to evaluate the validity and reliability of the questionnaire. METHODS: The study involved two main phases. The first phase involved a cross-cultural adaptation of the CVAQC from English into Turkish. The second phase involved the completion of the Turkish version of the CVAQC by 150 partially sighted children (6-18 years old) and validity and reliability checks. Extent and construct validity were investigated using Rasch analysis and reliability by internal consistency and person separation index (PSI). RESULTS: An adequate conceptual equivalence was achieved following the linguistic adaptation process. The dataset for validation comprised 150 participants, 88 (58.7%) of whom were male. Evidence of disordered thresholds was found for one item (item 17). This item was recorded by collapsing two categories and ordered thresholds were evident. All items of the CVAQC were found to fit the Rasch model (χ² (df)=59.90 (2), p=0.159). The internal construct validity was good (mean item fit (SD) -0.054 (1.132), person fit (SD) -0.629 (2.079)) indicating a single underlying construct. The reliability was good with Cronbach's α of 0.91 and PSI of 0.94. Differential item functioning (DIF) was tested for age, sex, diagnosis, degree of visual impairment, and comorbidity. Evidence of DIF was found on age for one item (item 10, reading the board at school). CONCLUSIONS: The Turkish version of the CVAQC is a valid, reliable, and unidimensional questionnaire for partially sighted children aged 6-18 years. TRIAL REGISTRATION NUMBER: Ankara University Ethics Committees registry number 06-177-12.

Clinical Characteristics and Low Vision Rehabilitation Methods for Partially Sighted School-Age Children.

OBJECTIVES: To determine the clinical features and the distribution of diagnosis in partially sighted school-age children, to report the chosen low vision rehabilitation methods and to emphasize the importance of low vision rehabilitation. MATERIALS AND METHODS: The study included 150 partially sighted children between the ages of 6 and 18 years. The distribution of diagnosis, accompanying ocular findings, visual acuity of the children both for near and distance with and without low vision devices, and the methods of low vision rehabilitation (for distance and for near) were determined. The demographic characteristics of the children and the parental consanguinity were recorded. RESULTS: The mean age of children was 10.6 years and the median age was 10 years; 88 (58.7%) of them were male and 62 (41.3%) of them were female. According to distribution of diagnoses among the children, the most frequent diagnosis was hereditary fundus dystrophies (36%) followed by cortical visual impairment (18%). The most frequently used rehabilitation methods were: telescopic lenses (91.3%) for distance vision; magnifiers (38.7%) and telemicroscopic systems (26.0%) for near vision. A significant improvement in visual acuity both for distance and near vision were determined with low vision aids. CONCLUSION: A significant improvement in visual acuity can be achieved both for distance and near vision with low vision rehabilitation in partially sighted school-age children. It is important for ophthalmologists and pediatricians to guide parents and children to low vision rehabilitation.

Screening 5 and 6 year-old children starting primary school for development and language.

Beginning school is an important milestone for children. Children's readiness for school involves cognitive, physical, and emotional development. Certain school programs allow children to start first grade after 66 months of age, together with 72 month-old children. In order to estimate school readiness, we screened children before starting first grade and compared their school performance according to their age and socio-demographic characteristics. Marmara School Readiness, Denver II developmental screening, and language assessment tests were applied. Language delays were more frequent and school readiness test scores were lower in the younger group compared to older children. However, school achievement did not differ between the two age groups. Preschool education, parental income and education affected performance in most tests. Preschool screening seems effective in detecting children with lower than average developmental skills, and the school system may provide a practical opportunity for providing support to those children.

Low Vision Rehabilitation in Older Adults.

OBJECTIVES: To evaluate the diagnosis distribution, low vision rehabilitation methods and utilization of low vision rehabilitation in partially sighted persons over 65 years old. MATERIALS AND METHODS: One hundred thirty-nine partially sighted geriatric patients aged 65 years or older were enrolled to the study between May 2012 and September 2013. Patients' age, gender and the distribution of diagnosis were recorded. The visual acuity of the patients both for near and distance were examined with and without low vision devices and the methods of low vision rehabilitation were evaluated. RESULTS: The mean age of the patients was 79.7 years and the median age was 80 years. Ninety-six (69.1%) of the patients were male and 43 (30.9%) were female. According to the distribution of diagnosis, the most frequent diagnosis was senile macular degeneration for both presenile and senile age groups. The mean best corrected visual acuity for distance was 0.92±0.37 logMAR and 4.75±3.47 M for near. The most frequently used low vision rehabilitation methods were telescopic glasses (59.0%) for distance and hyperocular glasses (66.9%) for near vision. A significant improvement in visual acuity both for distance and near vision were determined with low vision aids. CONCLUSION: The causes of low vision in presenile and senile patients in our study were similar to those of patients from developed countries. A significant improvement in visual acuity can be achieved both for distance and near vision with low vision rehabilitation in partially sighted geriatric patients. It is important to guide them to low vision rehabilitation.