Life space limitations in visually impaired older adults.

SIGNIFICANCE: Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town. PURPOSE: Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors. METHODS: Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state. RESULTS: During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009). CONCLUSIONS: Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town.

Functional performance of a vibrotactile sensory substitution device in people with profound vision loss.

SIGNIFICANCE: This study has shown a vibrotactile sensory substitution device (SSD) prototype, VibroSight, has the potential to improve functional outcomes (i.e., obstacle avoidance, face detection) for people with profound vision loss, even with brief familiarization (<20 minutes). PURPOSE: Mobility aids such as long canes are still the mainstay of support for most people with vision loss, but they do have limitations. Emerging technologies such as SSDs are gaining widespread interest in the low vision community. The aim of this project was to assess the efficacy of a prototype vibrotactile SSD for people with profound vision loss in the face detection and obstacle avoidance tasks. METHODS: The VibroSight device was tested in a movement laboratory setting. The first task involved obstacle avoidance, in which participants were asked to walk through an obstacle course. The second was a face detection task, in which participants were asked to step toward the first face they detected. Exit interviews were also conducted to gather user experience data. Both people with low vision (n = 7) and orientation and mobility instructors (n = 4) completed the tasks. RESULTS: In obstacle avoidance task, participants were able to use the device to detect (p<0.001) and avoid (p<0.001) the obstacles within a significantly larger range, but were slower (p<0.001), when compared with without the device. In face detection task, participants demonstrated a great level of accuracy, precision, and sensitivity when using the device. Interviews revealed a positive user experience, although participants identified that they would require a lighter and compact design for real-world use. CONCLUSIONS: Overall, the results verified the functionality of vibrotactile SSD prototype. Further research is warranted to evaluate the user performance after an extended training program and to add new features, such as object recognition software algorithms, into the device.

Assistive Systems for Visually Impaired Persons: Challenges and Opportunities for Navigation Assistance.

The inability to see makes moving around very difficult for visually impaired persons. Due to their limited movement, they also struggle to protect themselves against moving and non-moving objects. Given the substantial rise in the population of those with vision impairments in recent years, there has been an increasing amount of research devoted to the development of assistive technologies. This review paper highlights the state-of-the-art assistive technology, tools, and systems for improving the daily lives of visually impaired people. Multi-modal mobility assistance solutions are also evaluated for both indoor and outdoor environments. Lastly, an analysis of several approaches is also provided, along with recommendations for the future.

A Wearable Visually Impaired Assistive System Based on Semantic Vision SLAM for Grasping Operation.

Because of the absence of visual perception, visually impaired individuals encounter various difficulties in their daily lives. This paper proposes a visual aid system designed specifically for visually impaired individuals, aiming to assist and guide them in grasping target objects within a tabletop environment. The system employs a visual perception module that incorporates a semantic visual SLAM algorithm, achieved through the fusion of ORB-SLAM2 and YOLO V5s, enabling the construction of a semantic map of the environment. In the human-machine cooperation module, a depth camera is integrated into a wearable device worn on the hand, while a vibration array feedback device conveys directional information of the target to visually impaired individuals for tactile interaction. To enhance the system's versatility, a Dobot Magician manipulator is also employed to aid visually impaired individuals in grasping tasks. The performance of the semantic visual SLAM algorithm in terms of localization and semantic mapping was thoroughly tested. Additionally, several experiments were conducted to simulate visually impaired individuals' interactions in grasping target objects, effectively verifying the feasibility and effectiveness of the proposed system. Overall, this system demonstrates its capability to assist and guide visually impaired individuals in perceiving and acquiring target objects.

Scoping review: Mobility aids for people with sight loss across the ICF domains of functions, activities, and participation.

SIGNIFICANCE: There is little literature linking mobility aids for people with sight loss to the functions, activities, and participation domains of the International Classification of Functioning, Disability and Health (ICF). Future studies on this relationship should be funded and pursued to better understand ways to maximize the benefit of mobility aids. PURPOSE: The ICF domains of functions, activities, and participation are potentially health-supporting aspects of daily living that may be impeded for people with sight loss. Although mobility aids facilitate safely navigating obstacles to optimize independence, it is not clear if they have any effect on functions, activities, or participation. This review explores the current literature to establish the associations between mobility aids and ICF domains. METHODS: An established scoping review methodological framework was used to systematically search, select, and synthesize the existing literature. RESULTS: Of 116 unique retrieved articles, three observational studies were eligible for inclusion with a total of 124 participants. A small experimental study found that blind adults had slower Timed Up and Go times than sighted and better performance with a long cane than without. One observational study found that physical activity was strongly related to level of visual acuity but with no independent impact of mobility aids. A single mixed-methods study explored travel frequency for blind people with assistance dogs and considered constraints to participation. CONCLUSIONS: Despite the included studies involving some aspect of mobility aid use by people with sight loss, to date, no study has focused exclusively on mobility aid intervention for people with sight loss within the physical function, physical activity, and participation domains of the ICF. There is no reliable evidence on the associations between mobility aids and physical function, physical activity, and participation. This is an important knowledge gap for determining the most suitable aids, as well as their use, to best facilitate health-supporting activities.

Performance on clinical outcomes, activities of daily living and user experience on head-mounted displays for people with vision impairment.

PURPOSE: To compare the objective performance, acceptance and usability of head-mounted displays (HMDs) to provide evidence-based data that could be used to increase the efficiency of device referrals based upon a person's vision loss and functional needs. METHODS: A cross-sectional, counterbalanced, individually controlled crossover study was performed on 15 adults with various eye conditions. Performance was measured when using four HMDs: eSight4, Eyedaptic EYE3, Eyedaptic EYE4 and IrisVision Inspire. Performance on clinical visual acuity tests and contrast were assessed, as well as vision-related activities of daily living (ADL) which were divided into three categories: Reading, Searching & Identifying and Eye-hand Coordination. User-experience was also assessed. Logistic regression analyses, Friedman one-way repeated measure analyses of variance by ranks and multivariate permutation testing were used for analysis. RESULTS: There was a significant improvement in visual acuity when using all devices. For contrast tasks, only the eSight4 and Eyedaptic EYE3 improved performance relative to baseline. For most Reading and Searching & Identifying tasks, the odds of being able to perform the tasks were significantly higher while using the devices. However, the actual performance with most devices (e.g., number of words read or reading speed) did not improve significantly over baseline for most tasks. For the Eye-hand Coordination tasks, participants performed equivalent to or significantly poorer than baseline when using the devices. No demographic or clinical predictors of outcomes were identified. Participants expressed dissatisfaction with the devices' effectiveness, acceptability and usability. CONCLUSIONS: While performance on clinical tests was better when using the devices, performance on most real-world ADLs was equal to or worse than baseline. No single device improved performance on all tasks, and performance on any one task was not improved with all the devices. The overall dissatisfaction with the devices paralleled the lack of objective improvement in the performance of real-world tasks.

Factors related to training time and achieving proficiency with visual-assistive mobile applications in visually impaired older adults.

SIGNIFICANCE: A majority of visually impaired older adults were able to learn to proficiently use visual-assistive iPhone applications (apps) following a median 1 hour and/or multiple training sessions, which should be considered when planning vision rehabilitation service delivery, including the option for remote telerehabilitation for those who prefer that modality. PURPOSE: Older adults with low vision are increasingly using technology to improve their visual functioning. We examined whether age-related comorbidities were potential barriers to success in learning to use visual-assistive apps on a smartphone. METHODS: A clinical trial assessed visual-assistive apps in 116 older adults aged 55+ years (mean [standard deviation], 72 [10] years). Subjects were randomized to use an app (SuperVision+, Seeing AI, or Aira) preloaded to a loaner iPhone and completed one-on-one training. App proficiency was measured by the participant's ability to use the iPhone/app without cueing at the end of training sessions. Training time was recorded for the initial session and totaled after subsequent sessions. Multiple regression models explored significant factors associated with training time and proficiency. RESULTS: Median initial and total training times were 45 and 60 minutes, respectively. Increased initial and total training times were both significantly related to increased age (p<0.001), legal blindness (p<0.007), Seeing AI versus SuperVision+ app (p<0.03), and participants from New England versus California (p<0.001). Most (71%) achieved proficiency after the initial training session; those odds were significantly greater among younger participants (p=0.04), those who opted for telerehabilitation (p=0.03), those who had higher cognitive scores (p=0.04), or those who were from New England (p=0.04). The majority (90%) was ultimately proficient with the app; those odds were significantly greater among participants who already had an optical magnifier (p=0.008), but were unrelated to other factors including study site. CONCLUSIONS: Following multiple, extensive training sessions, age, mild cognitive loss, or level of visual impairment did not preclude gaining proficiency with visual-assistive apps by visually impaired seniors, but those factors were associated with longer training times. Telerehabilitation can be a viable option to provide app training remotely for visually impaired seniors who choose that modality.

Enhancing mathematics learning through finger-counting: A study investigating tactile strategies in 2 visually impaired cases.

Finger-counting plays a crucial role in grounding and establishing mathematics, one of the most abstract domains of human cognition. While the combination of visual and proprioceptive information enables the coordination of finger movements, it was recently suggested that the emergence of finger-counting primarily relies on visual cues. In this study, we aimed to directly test this assumption by examining whether explicit finger-counting training (through tactile stimulation) may assist visually impaired children in overcoming their difficulties in learning mathematics. Two visually impaired participants (2 boys of 8.5 and 7.5 years) were therefore trained to use their fingers to calculate. Their pre- and post-training performance were compared to two control groups of sighted children who underwent either the same finger counting training (8 boys, 10 girls, Mage = 5.9 years; 10 kindergarteners and eight 1st graders) or another control vocabulary training (10 boys, 8 girls, Mage = 5.9 years; 11 kindergarteners and seven 1st graders). Results demonstrated that sighted children's arithmetic performance improved much more after the finger training than after the vocabulary training. Importantly, the positive impact of the finger training was also observed in both visually impaired participants (for addition and subtraction in one child; only for addition in the other child). These results are discussed in relation to the sensory compensation hypothesis and emphasize the importance of early and appropriate instruction of finger-based representations in both sighted and visually impaired children.

Are rehabilitation professionals familiar with visual impairments? A survey of professional orders in Quebec, Canada.

SIGNIFICANCE: The number of patients with mild to moderate visual impairments (MVIs) is increasing as the average age of the population increases. Thus, it is important to understand the training and resources available for rehabilitation practitioners to provide adequate care to these patients within their scope of practice. PURPOSE: This study explores rehabilitation professionals' perceptions of their competence in screening and treating patients with MVI, and identifying the tools and resources needed to increase these professionals' comfort level in managing these patients. METHODS: Data collection was carried via an online questionnaire to Quebec rehabilitation professionals and student-trainees who are members of their respective professional orders. The questionnaire consisted of 29 to 30 questions (open- and close-ended) related to demographics, service provision to MVI patients, education in MVI and future training, and future service delivery to MVI patients. RESULTS: Data were collected from 96 professionals, with 52 fully completing the questionnaire, with all the responses included in the analysis. Most respondents had little or no confidence in adequately screening or treating patients with MVI and mentioned that they knew little or nothing about the range of services offered by vision rehabilitation centers in Quebec (81%), whereas 55% at least occasionally offer services to these patients. The majority felt that their profession would benefit from continuing education on MVI (73%), with a marked interest in online training. CONCLUSIONS: Rehabilitation professionals in Quebec are not confident in identifying or treating patients presenting MVI but express an interest in attending continuing education courses given by optometrists, low vision professionals, or a member of their own profession. Numerous barriers account for this problem, including a lack of experience and competence in the assessment and treatment options for MVI, as well as a lack of informational and human resources available in their workplaces.

Blind people can actively manipulate virtual objects with a novel tactile device.

Frequently in rehabilitation, visually impaired persons are passive agents of exercises with fixed environmental constraints. In fact, a printed tactile map, i.e. a particular picture with a specific spatial arrangement, can usually not be edited. Interaction with map content, instead, facilitates the learning of spatial skills because it exploits mental imagery, manipulation and strategic planning simultaneously. However, it has rarely been applied to maps, mainly because of technological limitations. This study aims to understand if visually impaired people can autonomously build objects that are completely virtual. Specifically, we investigated if a group of twelve blind persons, with a wide age range, could exploit mental imagery to interact with virtual content and actively manipulate it by means of a haptic device. The device is mouse-shaped and designed to jointly perceive, with one finger only, local tactile height and inclination cues of arbitrary scalar fields. Spatial information can be mentally constructed by integrating local tactile cues, given by the device, with global proprioceptive cues, given by hand and arm motion. The experiment consisted of a bi-manual task, in which one hand explored some basic virtual objects and the other hand acted on a keyboard to change the position of one object in real-time. The goal was to merge basic objects into more complex objects, like a puzzle. The experiment spanned different resolutions of the tactile information. We measured task accuracy, efficiency, usability and execution time. The average accuracy in solving the puzzle was 90.5%. Importantly, accuracy was linearly predicted by efficiency, measured as the number of moves needed to solve the task. Subjective parameters linked to usability and spatial resolutions did not predict accuracy; gender modulated the execution time, with men being faster than women. Overall, we show that building purely virtual tactile objects is possible in absence of vision and that the process is measurable and achievable in partial autonomy. Introducing virtual tactile graphics in rehabilitation protocols could facilitate the stimulation of mental imagery, a basic element for the ability to orient in space. The behavioural variable introduced in the current study can be calculated after each trial and therefore could be used to automatically measure and tailor protocols to specific user needs. In perspective, our experimental setup can inspire remote rehabilitation scenarios for visually impaired people.

Rehabilitation of the Severely Visually Impaired and the Blind in a Developing Country.

Blind individuals whether from birth or after being sighted for different periods of their lives constitute about 1% of the Nigerian population. These are individuals who can meaningfully contribute to the growth and development of society if properly guided. However, the traditional way of thinking within the society they find themselves in contributes to their lack of productivity. From birth to adulthood, they need to be guided and consciously prepared for independence. This is not yet widely obtainable in Nigerian society and other developing societies and generally may result in rejection, neglect, and high mortality rates in those affected with the majority unemployed sometimes for up to 10-15 years. It is imperative to offer comprehensive rehabilitation services that can assist this group of individuals to assert/reassert control and independence by designing a program tailored to meet their individual needs (not forgetting those who become blind as adults). A regional center, The Lens Rehabilitation center for the blind and severely visually impaired (TLEC ReHab Nig) located in Port Harcourt, Nigeria has put together a comprehensive program to ensure all round preparedness for independent, productive and fruitful living for persons living with blindness in line with best practices. This is an initial report on the outcome.

Les aveugles, qu'ils soient nés ou qu'ils aient été voyants pendant différentes périodes de leur vie, constituent environ 1% de la population nigériane. Ce sont des personnes qui peuvent contribuer de manière significative à la croissance et au développement de la société si elles sont correctement guidées. Cependant, le mode de pensée traditionnel au sein de la société dans laquelle ils se trouvent assure en grande partie leur manque de productivité. De la naissance à l'âge adulte, ils doivent être traités et préparés consciemment à l'indépendance. Cela n'est pas encore possible dans la société nigériane et dans d'autres sociétés en développement et en général, cela peut entraîner le rejet, la négligence et des taux de mortalité élevés chez les personnes touchées, la majorité d'entre elles restant à la maison jusqu'à 10 ou 15 ans sans rien faire. Il est impératif d'offrir des services de réadaptation complets qui peuvent aider ce groupe d'individus à s'affirmer/réaffirmer leur contrôle et leur indépendance en concevant un programme adapté à leurs besoins individuels. leurs besoins individuels. Un centre régional, The Lens Rehabilitation center for the blind and severely visually impaired (TLEC ReHab Nig), situé à Port Harcourt, au Nigeria, a mis en place un programme complet visant à préparer les personnes atteintes de cécité à une vie indépendante, productive et fructueuse, conformément aux meilleures pratiques. Il s'agit d'un premier rapport sur les résultats obtenus. Mots clés: Aveugle, Éducation inclusive, Réhabilitation visuelle, Réhabilitation TLEC, Nigeria.

Avaliação da qualidade de vida relacionada à saúde em um programa de reabilitação para pessoas com deficiência visual / Health-related quality of life assessment in a rehabilitation program for people with visual impairment

RESUMO Objetivo: Aplicar um protocolo para avaliar a qualidade de vida relacionada à saúde de participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência. Métodos: Foi realizado um estudo transversal com 60 adultos com deficiência visual participantes de um programa de reabilitação para pessoas com deficiência visual de um instituto de referência no Rio de Janeiro. O protocolo de pesquisa consistiu em um questionário com dados pessoais, sociais, demográficos e informações clínicas; no European Quality of Life 5 Dimensions 3 Level Version para medição genérica de qualidade de vida relacionada à saúde; no Patient Health Questionnaire-2 para rastrear a depressão e no Visual Function Questionnaire 25 para avaliar a qualidade de vida relacionada à saúde específica da função visual. A principal variável independente analisada foi o tempo de exposição ao programa. Modelos de regressão linear foram utilizados para investigar a relação entre o tempo no programa e a qualidade de vida relacionada à saúde do Visual Function Questionnaire 25 e do European Quality of Life 5 Dimensions 3 Level Version. Resultados: A maioria dos participantes (73%) possuía deficiência visual adquirida; 68% tinham menos de 60 anos e 53% perderam a visão há mais de 10 anos. A condição visual autorreferida mais comum foi cegueira em ambos os olhos (48%) e 42% frequentavam o programa há mais de 3 anos. A mediana do índice de utilidade do European Quality of Life 5 Dimensions 3 Level Version foi de 0,75. O instrumento específico para rastreamento de depressão, o Patient Health Questionnaire, identificou proporção de 27% de participantes positivos. O Visual Function Questionnaire 25 apresentou escores abaixo de 50 (escala de zero a cem) nos subdomínios visão geral, atividades de perto e atividades à distância. As medianas de dor ocular e aspectos sociais do Visual Function Questionnaire 25 foram significativamente menores entre aqueles que realizavam tratamento psiquiátrico. O tempo de reabilitação foi independentemente associado a melhores escores dos subdomínios saúde mental e atividades da vida diária. Conclusão: O protocolo demonstrou aplicabilidade para a avaliação de qualidade de vida relacionada à saúde em pessoas com deficiência visual, permitindo concluir que o maior tempo no programa de reabilitação foi associado a maiores escores de qualidade de vida.

ABSTRACT Purpose: This study aimed to implement a health-related quality of life (HRQoL) assessment protocol to measure the consequences of a rehabilitation program for visual impaired people at a leading reference institute in Brazil. Methods: A cross-sectional study was conducted with 60 visual impaired adults enrolled in a Rehabilitation Program of the Instituto Benjamin Constant. The research protocol consisted of a questionnaire with personal data, social, demographic, and clinical information; the EQ-5D-3L instrument for generic HRQoL measurement; the Patient Health Questionnaire-2 (PHQ- 2) to screen for depression, and the 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) to assess specific HRQoL of visual function. The main independent variable analyzed was the exposure time to the rehabilitation. Linear regression models were used to investigate the relationship between rehabilitation time and HRQoL of the NEI VFQ-25 and EQ 5D-3L instruments. Results: Most participants (73%) have acquired visual impairment, 68% are under 60 years old, 53% lost their vision more than 10 years ago, the most common self-reported visual condition (48%) was blindness in both eyes and 42% are in the Rehabilitation Program for more than 3 years. The median HRQoL utility index for EQ 5D-3L was 0.75. The specific instrument for screening for depression, PHQ-2, identified 27% of participants above the cut-off point. The NEI VFQ-25 instrument showed scores below 50 (scale from 0 to 100) in subdomains: "general vision", "near activities" and "distance activities". The medians of "ocular pain" and "social aspects" of the VFQ-25 were significantly lower among those who have undergone psychiatric treatment. "Rehabilitation time" was independently associated with better scores of "mental health" and "role difficulties" subdomains. Conclusion: The protocol showed applicability for the assessment of HRQoL, allowing the conclusion that longer time in the rehabilitation program was associated with higher quality of life scores.

The application of computer vision to visual prosthesis.

A visual prosthesis is an auxiliary device for patients with blinding diseases that cannot be treated with conventional surgery or drugs. It converts captured images into corresponding electrical stimulation patterns, according to which phosphenes are generated through the action of internal electrodes on the visual pathway to form visual perception. However, due to some restrictions such as the few implantable electrodes that the biological tissue can accommodate, the induced perception is far from ideal. Therefore, an important issue in visual prosthesis research is how to detect and present useful information in low-resolution prosthetic vision to improve the visual function of the wearer. In recent years, with the development and broad application of computer vision methods, researchers have investigated the possibility of their utilization in visual prostheses by simulating prosthetic visual percepts. Through the optimization of visual perception by image processing, the efficiency of visual prosthesis devices can be further improved to better meet the needs of prosthesis wearers. In this article, recent works on prosthetic vision centering on implementing computer vision methods are reviewed. Differences, strengths, and weaknesses of the mentioned methods are discussed. The development directions of optimizing prosthetic vision and improving methods of visual perception are analyzed.

A self-training program for sensory substitution devices.

Sensory Substitution Devices (SSDs) convey visual information through audition or touch, targeting blind and visually impaired individuals. One bottleneck towards adopting SSDs in everyday life by blind users, is the constant dependency on sighted instructors throughout the learning process. Here, we present a proof-of-concept for the efficacy of an online self-training program developed for learning the basics of the EyeMusic visual-to-auditory SSD tested on sighted blindfolded participants. Additionally, aiming to identify the best training strategy to be later re-adapted for the blind, we compared multisensory vs. unisensory as well as perceptual vs. descriptive feedback approaches. To these aims, sighted participants performed identical SSD-stimuli identification tests before and after ~75 minutes of self-training on the EyeMusic algorithm. Participants were divided into five groups, differing by the feedback delivered during training: auditory-descriptive, audio-visual textual description, audio-visual perceptual simultaneous and interleaved, and a control group which had no training. At baseline, before any EyeMusic training, participants SSD objects' identification was significantly above chance, highlighting the algorithm's intuitiveness. Furthermore, self-training led to a significant improvement in accuracy between pre- and post-training tests in each of the four feedback groups versus control, though no significant difference emerged among those groups. Nonetheless, significant correlations between individual post-training success rates and various learning measures acquired during training, suggest a trend for an advantage of multisensory vs. unisensory feedback strategies, while no trend emerged for perceptual vs. descriptive strategies. The success at baseline strengthens the conclusion that cross-modal correspondences facilitate learning, given SSD algorithms are based on such correspondences. Additionally, and crucially, the results highlight the feasibility of self-training for the first stages of SSD learning, and suggest that for these initial stages, unisensory training, easily implemented also for blind and visually impaired individuals, may suffice. Together, these findings will potentially boost the use of SSDs for rehabilitation.

Assessing optimal colour and illumination to facilitate reading.

PURPOSE: This study examined the effectiveness of the LuxIQ, the Apple iPad and a smart bulb in assessing optimal colour and illumination to facilitate reading in younger, older and visually impaired adults. METHODS: Participants read standardised texts at baseline (normal lighting/no device), then using the Apple iPad, LuxIQ and smart bulb, with their normal vision (20/20 condition) and using a simulated reduction in visual acuity/contrast sensitivity (20/80 condition). Visually impaired participants followed the same procedure used in the 20/80 condition. RESULTS: There was a significant interaction between condition and device in younger, F(1.5, 43.51) = 30.41, p < 0.001, ω2  = 0.34 and older, F(1.5, 4.51) = 4.51, p = 0.03, ω2  = 0.05 adults with normal vision, and there was a significant effect of device, F(2, 58) = 5.95, p = 0.004, ω2  = 0.12 in visually impaired adults. In the 20/20 condition, age and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R2  = 0.37, whereas age, lighting and colour predicted reading speed, F(3, 176) = 36.25, p < 0.001, Adj. R2  = 0.37 in the 20/80 condition. In the visual impairment condition, lighting, colour and impairment severity predicted reading speed, F(3, 85) = 10.10, p < 0.001, Adj. R2  = 0.24. CONCLUSIONS: The clinical implications of this study are that reading speeds improve in individuals with low vision under improved lighting conditions, specifically, with higher levels of luminance and colour temperature. The effectiveness of the devices varied across groups; however, the LuxIQ was the only device to improve reading speeds from baseline in older adults with visual impairments.

Design considerations for the ideal low vision aid: insights from de-brief interviews following a real-world recording study.

PURPOSE: Low Vision Aids (LVAs) can have a transformative impact on people living with sight loss, yet the everyday requirements for developing such devices remain poorly understood and defined. This study systematically explored LVA requirements through a structured de-brief interview following a real-world self-recording study. The purpose of this work was to define the actual needs of those living with sight loss so that low vision services can better address them in future. METHODS: Thirty-two visually impaired volunteers with varying levels of previous LVA experience participated in a de-brief interview centred around a structured questionnaire. The de-brief followed a one-week real-world study during which participants used recoding spectacles to capture and narrate all situations in which they would use a 'perfect sight aid'. Content and thematic analyses were used to analyse interviews which had the purpose of contextualising these recordings and exploring requirements around psychological, functional and design factors. RESULTS: Participants reported that 46% of tasks which they had recorded were most important to them. Of these tasks, 82% were encountered frequently. Few tasks emerged as very important across many participants, the remaining tasks reflecting individual lifestyles or circumstances. Every participant used at least one LVA in their everyday life and 72% identified further coping strategies. Current LVAs identified as consistently poor were distance LVAs, with all other devices receiving mixed or only positive feedback. Around two-thirds of participants would prefer LVA use on an ad-hoc / quick access basis rather than over long periods of time, and just over half would prefer to carry it rather than wearing it all day. Lack of consistency in these responses illustrated potentially different user clusters with divergent design needs. Two-thirds of participants emphasised the desire for a discreet LVA that does not attract attention. However, since half of all participants felt self-conscious in public or in front of other people when wearing the small recording spectacles, this may not be technically achievable. CONCLUSIONS: There is a substantial opportunity for new LVAs to address visual needs that traditional devices and coping strategies cannot support. Functional, psychological and design factors require careful consideration for future LVAs to be relevant and widely adopted.

Clinical guidelines for the management of keratoconus patients with gas permeable contact lenses based on expert consensus and available evidence.

PURPOSE OF REVIEW: Fitting rigid gas permeable contact lenses (RGP CLs) in keratoconic patients is the most common visual rehabilitation option to improve patients' quality of life, but require long patient and practitioner chair time. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs. RECENT FINDINGS: An extensive literature review from 1990 to 2017 identified 354 potentially relevant publications. Fifty-two articles were reviewed and included in the CPG. An international expert panel of eight contact lens practitioners, with vast experience in keratoconus management reviewed and appraised the CPG following the Appraisal of Guidelines for Research and Evaluation II consortium requirements. The developed CPG clearly outlines a strategy for the successful fitting of RGP CLs in patients with keratoconus. This includes how to calculate parameters of the first diagnostic lens, criteria for assessing good fit and a standardized schedule of wear time and follow-up appointments. SUMMARY: The current evidence and consensus-based CPG helps guide clinicians in a successful strategy for fitting RGP CLs in patients with keratoconus.

Efficacy of Visual Retraining in the Hemianopic Field after Stroke: Results of a Randomized Clinical Trial.

PURPOSE: To evaluate the efficacy of motion discrimination training as a potential therapy for stroke-induced hemianopic visual field defects. DESIGN: Clinical trial. PARTICIPANTS: Forty-eight patients with stroke-induced homonymous hemianopia (HH) were randomized into 2 training arms: intervention and control. Patients were between 21 and 75 years of age and showed no ocular issues at presentation. METHODS: Patients were trained on a motion discrimination task previously evidenced to reduce visual field deficits, but not in a randomized clinical trial. Patients were randomized with equal allocation to receive training in either their sighted or deficit visual fields. Training was performed at home for 6 months, consisting of repeated visual discriminations at a single location for 20 to 30 minutes daily. Study staff and patients were masked to training type. Testing before and after training was identical, consisting of Humphrey visual fields (Carl Zeiss Meditech), macular integrity assessment perimetry, OCT, motion discrimination performance, and visual quality-of-life questionnaires. MAIN OUTCOME MEASURES: Primary outcome measures were changes in perimetric mean deviation (PMD) on Humphrey Visual Field Analyzer in both eyes. RESULTS: Mean PMDs improved over 6 months in deficit-trained patients (mean change in the right eye, 0.58 dB; 95% confidence interval, 0.07-1.08 dB; mean change in the left eye 0.84 dB; 95% confidence interval, 0.22-1.47 dB). No improvement was observed in sighted-trained patients (mean change in the right eye, 0.12 dB; 95% confidence interval, -0.38 to 0.62 dB; mean change in the left eye, 0.10 dB; 95% confidence interval, -0.52 to 0.72 dB). However, no significant differences were found between the alternative training methods (right eye, P = 0.19; left eye, P = 0.10). CONCLUSIONS: To date, no widely accepted therapy is available to treat HH. This study evaluated the efficacy of a promising potential treatment, visual perceptual training. We failed to find a difference between treatment training within the deficit field and control training within the sighted field when performed in a home environment.

Indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal disease in India.

PURPOSE: To describe the indications and prognosis for keratoplasty in eyes with severe visual impairment and blindness due to corneal diseases in India. METHODS: This hospital-based cross-sectional study included 1 057 215 new patients presenting to a multitier ophthalmology network from 2016 to 2018. All patients with a central corneal pathology and best corrected visual acuity of less than 20/200 in the affected eye(s) were identified as cases and grouped according to laterality. The main outcome measure was the prognosis for keratoplasty, based on the surgical indication. RESULTS: A total of 28 824 (2.73%) patients were identified with severe visual impairment or blindness due to corneal diseases; of which, 22 582 (78.3%) had unilateral and 6242 (21.7%) had bilateral affliction. Overall, 85% of the corneal pathologies were due to avoidable causes, which accounted for 97% and 63% of the unilateral and bilateral cases, respectively (p<0.0001). The most common aetiologies were microbial keratitis (27.2%) and corneal opacification (25.5%) in unilateral cases; and corneal opacification (38.2%) and ectasias (14.5%) in bilateral cases. Overall, 60.1% of affected eyes carried a fair to poor prognosis for keratoplasty. However, while in unilateral cases only 29.9% of eyes carried good to excellent prognosis for keratoplasty, in bilateral cases, 58% of eyes carried good to excellent prognosis for keratoplasty (p<0.0001). CONCLUSIONS: The indications and prognosis for keratoplasty varied greatly based on whether the affliction was unilateral or bilateral. Most of the eyes affected by corneal visual impairment or blindness, however, carried an unfavourable prognosis for keratoplasty.