Effect of vision impairment on match-related performance and technical variation in attacking moves in Paralympic judo.

In Paralympic judo for athletes with vision impairment (VI judo) all eligible athletes (i.e. B1, B2 and B3 classes) compete against each other in the same competition. Evidence suggests that athletes with more impairment may be disadvantaged, but that more sensitive measures of performance are necessary to understand the impact of impairment on performance. The aim of this study was to investigate the relationship between Para sport class and technical variation, time-motion variables, and performance in Paralympic judo. All 175 judo matches from the Rio 2016 Paralympic Games were analysed across 129 competitors (82 male and 47 female). The main results indicated that athletes who demonstrated less technical variation also experienced less competitive success, with the functionally blind athletes (class B1) demonstrating less technical variation than partially sighted (class B2 and B3) athletes (p < 0.05). There was no difference in the time-motion variables between sport classes (p > 0.05). We conclude that measures of technical variation are sensitive to differences in impairment and are suitable for studies that investigate the impairment-performance relationship in VI judo. Results further confirm that some athletes with impairment are disadvantaged under the current rules of VI judo.

Exploration of the minimum visual disability criteria for Para nordic and Para alpine skiing using simulated vision impairments.

The International Paralympic Committee Classification Code requires sports to develop evidence-based, sports-specific classification systems. This project aimed to determine the minimum eligibility criteria for Para nordic and Para alpine skiing by simulating vision impairments and measuring the impact of the impairments on performance in twenty-two nordic (28.09 ± 9.68 years; 16 male) and eleven alpine (37.91 ± 18.9 years, 11 male) able-sighted skiers. Eight visual acuity (VA)/contrast sensitivity (CS) (Cambridge Simulation Glasses, University of Cambridge) and six visual field (VF) impairments (bespoke goggles; University of Waterloo) were simulated. VA, CS and VF were measured in each participant before they completed an on-snow session, skiing short competition-style courses with each of the 14 simulated impairments in a randomized order. Clear goggle (no impairment) trials were used as controls. Receiver Operating Characteristic (ROC) and decision tree analyses were conducted to determine the optimum VA, CS and VF cut-offs for classifying performance based on differences from baseline in real time. Moderate impairments in VA, CS and VF negatively affect skiing performance. The recommended cut-off criteria based on both analyses were VA ≥0.90 logMAR and ≤48% VF extent for nordic and VA of ≥0.60 logMAR and VF extent of ≤59.0% for alpine.

Expert opinion on classification for footballers with vision impairment: Towards evidence-based minimum impairment criteria.

In Para sport, the aim of classification is to minimize the impact of impairment on the outcome of competition. Despite requirements of the International Paralympic Committee Athlete Classification Code for classification to be evidence-based and sport-specific, sports for athletes with VI, including football, use the same generic classes across almost all sports. The aim of this study was to consult with experts to establish the needs and challenges for developing a code-compliant system of classification for VI football. A panel of 18 experts with international experience in VI football (16.8 ± 10.2 years) took part in a three-round Delphi study using online surveys. Results showed that the panel did not think that the current system completely fulfils the aim of classification. The panel identified measures of visual function they considered to be relevant but are not currently measured during classification including dynamic acuity, depth and motion perception, and contrast and light sensitivity. Moreover, they identified technical skills such as ball control, dribbling and passing, as well as perceptual-cognitive skills, as most likely to be affected by vision impairment. Findings outline the need for change and offer a framework for future research to develop an evidence-based classification for VI football.

Perspectives of a new sport-specific Para Shooting classification system for athletes with vision impairment.

The International Paralympic Committee (IPC) and individual sports federations have established the need to develop evidence-based systems of classification for athletes with vision impairment (VI) that may differ depending on the visual demands of each sport. As a consequence, research has been conducted that led to a new classification system for athletes competing in VI shooting. The purpose of this study was to canvas the experiences of key stakeholders (athletes, coaches and classifiers) when the new system of classification was implemented. Twenty-eight participants (17 athletes, 7 coaches and 4 classifiers) completed a questionnaire to rate their experiences of the previous and new classification systems and were interviewed to gain richer insights into their opinions. It was apparent that the changes to the classification system were not adequately communicated to the athletes in particular, and that the classifiers may require a better understanding of the principles of evidence-based classification. The new system was perceived to be significantly more specific for VI shooting and intentional misrepresentation was observed to be significantly less likely than when using the old system. This research provides valuable insights into both the positive and negative experiences of key stakeholders experiencing change in a classification system.

Teràpies visuals I noves teràpies. Paper del pediatre d'atenció primària / No disponible

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VISUAL IMPAIRMENT IN RETINITIS PIGMENTOSA.

PURPOSE: Retinitis pigmentosa (RP) is an inherited pigmentary retinal dystrophy where patients experience poor peripheral, night, and eventually central vision. There are statements in the literature which suggest visual acuity loss can progress to total blindness in these patients. This study sought to examine these statements by performing a retrospective analysis of the visual acuity measured in a large cohort of RP patients. METHODS: The charts of 1,095 RP patients were reviewed in this retrospective cross-sectional analysis. They included all of the RP patients examined by one of the authors (G.A.F.). Patients with sector RP or a delimited form of this disease were not included. The review was focused on the analysis of patients with 20/200 or worse vision in the better-seeing eye (N = 215). RESULTS: We determined that 0.46% of the enrolled patients progressed to no light perception in each eye. Ninety-two percent of the 1,095 patients examined were able to read a visual acuity chart. There were 6.8% who saw only hand motion, count fingers, or light perception. CONCLUSION: No light perception was measured in only 0.46% of patients. Thus, only a very small number of the RP patients in our cohort progressed to total blindness.

Opportunities and Pitfalls in Applying Emotion Recognition Software for Persons With a Visual Impairment: Simulated Real Life Conversations.

BACKGROUND: A large part of the communication cues exchanged between persons is nonverbal. Persons with a visual impairment are often unable to perceive these cues, such as gestures or facial expression of emotions. In a previous study, we have determined that visually impaired persons can increase their ability to recognize facial expressions of emotions from validated pictures and videos by using an emotion recognition system that signals vibrotactile cues associated with one of the six basic emotions. OBJECTIVE: The aim of this study was to determine whether the previously tested emotion recognition system worked equally well in realistic situations and under controlled laboratory conditions. METHODS: The emotion recognition system consists of a camera mounted on spectacles, a tablet running facial emotion recognition software, and a waist belt with vibrotactile stimulators to provide haptic feedback representing Ekman's six universal emotions. A total of 8 visually impaired persons (4 females and 4 males; mean age 46.75 years, age range 28-66 years) participated in two training sessions followed by one experimental session. During the experiment, participants engaged in two 15 minute conversations, in one of which they wore the emotion recognition system. To conclude the study, exit interviews were conducted to assess the experiences of the participants. Due to technical issues with the registration of the emotion recognition software, only 6 participants were included in the video analysis. RESULTS: We found that participants were quickly able to learn, distinguish, and remember vibrotactile signals associated with the six emotions. A total of 4 participants felt that they were able to use the vibrotactile signals in the conversation. Moreover, 5 out of the 6 participants had no difficulties in keeping the camera focused on the conversation partner. The emotion recognition was very accurate in detecting happiness but performed unsatisfactorily in recognizing the other five universal emotions. CONCLUSIONS: The system requires some essential improvements in performance and wearability before it is ready to support visually impaired persons in their daily life interactions. Nevertheless, the participants saw potential in the system as an assistive technology, assuming their user requirements can be met.

[Ophthalmological assessment in procedures for disability benefits for the blind : Why medical certificates alone are insufficient]. / Augenärztliche Begutachtung im Blindengeldverfahren : Warum Atteste alleine nicht ausreichen.

BACKGROUND AND OBJECTIVES: Financial aid for the blind which is awarded based only on medical certificates and results of examinations has in the past resulted in too many false diagnoses; therefore, Bavaria seeks to pay financial aid to the blind only on the basis of a specific ophthalmological assessment according to the standards of the German pension medical ordinance (VersMedV, Versorgungsmedizinische Verordnung). Because these ophthalmological assessments initially contribute to a higher financial burden on the state, longer processing times and inconvenience to the patient, investigations should be undertaken to determine if ophthalmological findings, reports and medical certificates can be a suitable basis for an expert assessment and in how many cases blindness which had been certified by the original examination could be confirmed by a specific ophthalmological assessment. METHODS: A total of 925 applications for financial assistance to the blind within the catchment area of the Bavarian Center for Family and Social Services (ZBFS, Zentrum Bayern Familie und Soziales) regional center in Upper Bavaria between 2003 and 2008, all of which had been subjected to an assessment by the same practitioner acting as external expert, were statistically analyzed. RESULTS: Of the 357 applicants who had been classified as blind according to the medical certificate and findings, 283 (79 %) were confirmed as being blind after the assessment and in 73 (21 %) blindness could not be confirmed. Of the 262 applicants who were classified as not being blind during the first examination, the diagnosis was confirmed in 192 (73 %) while 70 cases (27 %) were classified as blind. Of the 304 applicants for whom an assessment was not possible by the medical certification, 165 were ultimately classified as blind and 139 as not blind. Out of 32 applicants who were explicitly classified as being blind in the medical certificate, 13 were confirmed as being blind while the remaining 18 were classified in the subsequent assessment as not blind. CONCLUSION: Apart from unambiguous cases, the awarding of financial aid to the blind should only be based on an ophthalmological assessment which follows the VersMedV guidelines. Only this approach can result in an equal treatment of all applicants before the law and the awarding of financial aid to the blind to assist those truly in need. In addition, fiscal budget results revealed that the falsely awarded financial aid to the blind reached well beyond millions of Euros.

Visual impairment registration: evaluation of agreement among ophthalmologists.

PURPOSE: To evaluate consistency among consultant ophthalmologists in registration of visual impairment of patients with glaucoma who had a significant visual field component to their visual loss. METHOD: Thirty UK NHS consultant ophthalmologists were asked to grade data sets comprising both visual acuity and visual fields as severely sight impaired, partially sight impaired, or neither. To assess intra-consultant agreement, a group of graders agreed to repeat the process. RESULTS: Kappa for inter-consultant agreement (n=30) for meeting the eligibility criteria for visual impairment registration was 0.232 (95% CI 0.142-0.345), the corresponding inter-class correlation score was 0.2 (95% CI 0.172 to 0.344). Kappa for intra-consultant agreement (n=16) ranged from 0.007 to 0.9118. CONCLUSIONS: When presented with the clinical data necessary to decide whether patients with severe visual field loss are eligible for vision impairment registration, there is very poor intra- and inter-observer agreement among consultant ophthalmologists with regard to eligibility. The poor agreement indicates that these criteria are open to significant subjective interpretation that may be a source of either under- or over-registration of visual impairment in this group of patients in the UK. This inconsistency will affect the access of visually impaired glaucoma patients to support services and may result in inaccurate recording of the prevalence of registerable visual disability among glaucoma patients with severe visual field loss. More objective criteria with less potential for misclassification should be introduced.

Certification for vision impairment: researching perceptions, processes and practicalities in health and social care professionals and patients.

OBJECTIVES: To explore the patient experience, and the role of ophthalmologists and other health and social care professionals in the certification and registration processes and examine the main barriers to the timely certification of patients. DESIGN: Qualitative study. SETTING: Telephone interviews with health and social care professionals and patients in three areas in England. PARTICIPANTS: 43 health and social care professionals who are part of the certification or registration process. 46 patients certified as severely sight impaired (blind) or sight impaired (partially sighted) within the previous 12 months. RESULTS: Certification and registration are life changing for patients and the help they receive can substantially improve their lives. Despite this, ophthalmologists often found it difficult to ascertain when it is appropriate to certify patients, particularly for people with long-term conditions. Ophthalmologists varied in their comprehension of the certification process and many regarded certification as the 'final stage' in treatment. Administrative procedures meant the process of certification and registration could vary from a few weeks to many months. The avoidable delays in completing certification can be helped by Eye Clinic Liaison Officers (ECLO). CONCLUSIONS: A better understanding of the certification and registration processes can help improve standards of support and service provision for people who are severely sighted impaired or sight impaired. Better education and support are required for ophthalmologists in recognising the importance of timely referral for rehabilitative support through certification and registration. ECLOs can improve the process of certification and registration. Finally, better education is needed for patients on the benefits of certification and registration.

The variability of vision loss assessment in federally sponsored surveys: seeking conceptual clarity and comparability.

PURPOSE: To review U.S. national population-based surveys to evaluate comparability and conceptual clarity of vision measures. DESIGN: Perspective. METHODS: The vision questions in 12 surveys were mapped to the World Health Organization's International Classification of Functioning, Disability and Health framework under the domains of condition, impairment, activity limitation, participation, and environment. Surveys examined include the National Health Interview Survey, the Behavioral Risk Factor Surveillance Survey, National Health and Nutrition Examination Survey, the Census, and the Visual Function Questionnaire. RESULTS: Nearly 100 vision measures were identified in 12 surveys. These surveys provided no consistent measure of vision or vision impairment. Survey questions asked about differing characteristics of vision-related disease, function, and social roles. A question related to ability to read newspaper print was the most commonly asked question in surveys. CONCLUSIONS: Limited comparability of data and lack of conceptual clarity in the population-based surveys resulted in an inability to consistently characterize the population of people experiencing vision impairment. Consequently, vision surveillance was limited.

Blindness and visual impairment in Remo, Ogun State, Nigeria: a hospital-based study.

AIMS AND OBJECTIVES: This study was conducted to determine the magnitude and causes of blindness and visual impairment in Remo, Ogun State, Nigeria. MATERIALS AND METHODS: A retrospective clinic based study to analyse the cases of patients with blindness in general hospitals of Iperu and Isara areas of Ogun state between May 2005 and December 2005. The data of demographic characteristics and diagnosis were retrieved from the outpatient cards. RESULTS: Three hundred and sixty-nine cases registered in the eye clinic during the period of the study and were examined. 177 were males and 190 were females. The age range of patients seen was between 17 days and 89years with a mean age of 43.3 years, ± 23.62(SD). 116 patients were aged 70years and above while 13 patients were less than 10years. 29.5% of the clinic attendance were uniocularly blind, 21.1% were bilaterally blind while 25 2% were visually impaired. 55.1% of the bilateral blindness was in males. 30.8% cases of the bilaterally blind were from age related cataract, 23.1% from glaucoma, 6 cases were due to Retinitis Pigmentosa and 3 from pterygium, Cataract followed by glaucoma was the leading cause of uniocular blindness. Cataract was responsible for 66.7% of visually impairment. CONCLUSIONS: Blindness and visual impairment is a public health problem in Remo Ogun State, Nigeria; cataract, glaucoma and pterygium were the important causes of blindness and visual impairment. The major causes of blindness in this part of Ogun state are preventable.

Reconsideration of the most appropriate criterion in the lowest classification of vision disability in Japan.

PURPOSE: To verify the current Japanese classification of vision disability in regard to visual acuity. METHODS: A questionnaire was sent to 100 ophthalmology services in Japan. Each service was asked to extract 300 of their outpatient records. From these records, patients who had a sum of corrected visual acuity in both eyes of less than or equal to 0.62 were selected for the questionnaire. The questionnaire consisted of items related to prevalence, age, sex, with or without vision-disabled certification at any grade, the corrected visual acuity of each eye and the name of any disease the subject may have had. RESULTS: Sixty-five services responded, and, of 20,235 total records reviewed, 971 patients were eligible for the questionnaire. The average age was 66.9 ± 20.0 years, and 74.6% were over 60 years old. The distribution of corrected visual acuity showed three categories. CONCLUSIONS: Our analysis indicates that a new candidate criterion for vision-disabled certification is needed for the sixth grade, which, at present is defined as, "The sum of the corrected visual acuity of both eyes is more than 0.2, but less than or equal to 0.4."

Health risk profile for older adults with blindness: an application of the International Classification of Functioning, Disability, and Health framework.

PURPOSE: To develop a health risk profile for adults age 65 years or older with blindness, using the International Classification of Functioning, Disability and Health (ICF) as our conceptual framework. METHODS: We combined and analyzed data from the 2000-2006 National Health Interview Survey after backcoding questions to the ICF. We compared older adults with blindness (n = 477) and older adults with vision loss but not blindness (n = 6,721) with older adults who reported no vision loss (n = 33,497) for the following outcome measures: demographics, functional limitations (self-care, social participation, and mobility limitations), level of psychological distress, physical health status, selected chronic conditions and health risk behaviors (smoking, alcohol use, obesity, and physical inactivity). RESULTS: Older adults with blindness were more likely to be poorer, older, and less educated than older adults without vision loss. They were also more likely to have fair to poor health; to have difficulty walking; to experience diabetes, heart problems, and breathing problems; and to be physically inactive, compared with older adults reporting vision loss but not blindness and older adults without vision loss. CONCLUSION: Older adults with blindness face significant health disparities that can diminish their quality of life without timely, disability-sensitive interventions to address serious psychological distress and physical inactivity.

Physical fitness of visually impaired adolescent goalball players.

This study compared the physical fitness of 28 visually impaired goalball players (M=13 yr.) and a group of 27 less active age-matched adolescents. Physical characteristics (age, height, weight, sex) and visual acuity of the children were recorded. Body composition (Body Mass Index, skinfold thickness of triceps plus calf), musculoskeletal function (trunk-lift, curl-up, isometric push-up, shoulder-stretch tests) and aerobic function (1-mile run/walk test) were evaluated according to the Brockport Physical Fitness Test Battery. Also, anaerobic power was assessed by a vertical jump test. Physical fitness of visually impaired goalball players was higher than that of the more sedentary group (p<.05), except shoulder-stretch test values (p>.05). It was considered that directing visually impaired children to participation sports or recreational activities such as goalball has importance in improving their physical fitness.

Valoración de las lesiones oculares producidas en los accidentes de tráfico / Assessment of ocular injuries due to traffic accidents

Objetivo: Analizar cómo se realiza, desde el punto de vistapericial, la valoración de las lesiones y secuelas oculares delos accidentes de tráfico en nuestro medio.Método: Hemos realizado un estudio retrospectivo de 127informes sobre lesiones oculares realizados en la Secciónde Oftalmología de la Clínica Médico Forense de Madriddurante cinco años (del 2002 al 2006), analizando lassiguientes variables: la proporción que representan losaccidentes de tráfico (ATF), el tipo de lesión producida enel ATF, la duración media de la baja, las secuelas más frecuentesy la puntuación total media asignada a estassecuelas oculares.Resultados: Los ATF son la causa de la cuarta parte de lassecuelas oculares que vemos. Las lesiones más frecuentementeproducidas son traumatismos cráneo-encefálicos,contusiones oculares directas y esguinces cervicales.Hemos hallado un alto porcentaje de casos (22%), en losque no encontramos lesiones objetivas que justifiquen lasmolestias alegadas por el lesionado, o bien estas no guardanrelación evidente con el accidente de tráfico sufrido.Conclusiones: Que los ATF son una de las causas más frecuentesde secuelas oculares (diplopias, disminuciones deagudeza visual…), con una puntuación media de 15 puntosy una duración media de la baja de 71 días, hay un importanteporcentaje de reclamaciones injustificadas.Considera necesario revisar el actual Baremo de la Ley34/2003, subsanando los errores y deficiencias que presenta,e incluyendo secuelas oculares típicamente postraumáticasque actualmente no recoge, para facilitar la valoraciónde las secuelas oculares

Aim: To analyse how it is performed, from expert evidenceview point, the assessment of ocular injuries and aftereffectsdue to traffic accidents in our area.Method: We have accomplished a retrospective study of127 reports on ocular injuries, carried out in theOphthalmologic Section of the Medical Forensic Clinic ofMadrid for five years –from 2002 to 2006-, analyzing thefollowing variables: the proportion represented by trafficaccidents (TAs); the kind of injury sustained in the TAs; theaverage length of sick leave; the most frequent after-effects;and the overall average punctuation given to these ocularafter-effects.Results: TAs represent the cause of a quarter of the ocularafter-effects we see. The most frequent injuries produced inan accident are cranioencephalic traumatisms, direct ocularcontusions, and cervical sprains. We have met a highpercentage of cases (22%) in which we have not foundobjective injuries that can justify the pains claimed by theinjured, or rather the pains are not evidently connectedwith the TAs suffered.Conclusions: TAs are one of the most frequent causes ofocular after-effects (diplopias, decreases of visualacuity...), with an average punctuation of 15 points and anaverage length of sick leave of 71 days, existing an importantpercentage of unjustified claims. It is considered asnecessary the revision of the present scale of the Law34/2003 rectifying errors and defects that it presents andincluding typically post-traumatic ocular after-effects, whichare not registered presently, to facilitate the assessment of ocular after-effects

Queratoplastia lamelar posterior / Posterior lamellar keratoplasty

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Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration.

BACKGROUND: To assess the patient-reported use of caregiving among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHODS: A survey including the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision Questionnaire (DLTV) was mailed to members of the Macular Degeneration Partnership. The study was approved by an institutional review board, and respondents provided consent before participating. Responses were analyzed by estimated visual acuity determined by scores from the DLTV. Deidentified data were analyzed using SAS Version 8.2 (SAS Institute, Cary, NC). RESULTS: Of 803 respondents, 56% were male, and the mean age was 73 years. Use of paid and unpaid help significantly increased as visual acuity decreased. Using a national average for caregiver time, annual costs for caregiving ranged from 225 to 47,086 US dollar depending on visual acuity. CONCLUSION: There are substantial differences in caregiver support with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.