Equating Visual Function Scales to Facilitate Reporting of Medicare Functional G-Code Severity/Complexity Modifiers for Low-Vision Patients.

OBJECTIVE: To present a method of estimating and equating scales across functional assessment instruments that appropriately represents changes in a patient's functional ability and can be meaningfully mapped to changes in Medicare G-code severity modifiers. DESIGN: Previously published measures of patients' overall visual ability, estimated from low-vision patient responses to 7 different visual function rating scale questionnaires, are equated and mapped onto Medicare G-code severity modifiers. SETTING: Outpatient low-vision rehabilitation clinics. PARTICIPANTS: The analyses presented in this article were performed on raw or summarized low-vision patient ratings of visual function questionnaire (VFQ) items obtained from previously published research studies. INTERVENTIONS: Previously published visual ability measures from Rasch analysis of low-vision patient ratings of items in different VFQs (National Eye Institute Visual Functioning Questionnaire, Index of Visual Functioning, Activities of Daily Vision Scale, Visual Activities Questionnaire) were equated with the Activity Inventory (AI) scale. The 39 items in the Self-Report Assessment of Functional Visual Performance (SRAFVP) and the 48 items in the Veterans Affairs Low Vision Visual Functioning Questionnaire (VA LV VFQ) were paired with similar items in the AI in order to equate the scales. MAIN OUTCOME MEASURES: Tests using different observation methods and indicators cannot be directly compared on the same scale. All test results would have to be transformed to measures of the same functional ability variable on a common scale as described here, before a single measure could be estimated from the multiple measures. RESULTS: Bivariate regression analysis was performed to linearly transform the SRAFVP and VA LV VFQ item measures to the AI item measure scale. The nonlinear relationship between person measures of visual ability on a logit scale and item response raw scores was approximated with a logistic function, and the 2 regression coefficients were estimated for each of the 7 VFQs. These coefficients can be used with the logistic function to estimate functional ability on the same interval scale for each VFQ and for transforming raw VFQ responses to Medicare's G-code severity modifier categories. CONCLUSIONS: The principle of using equated interval scales allows for comparison across measurement instruments of low-vision functional status and outcomes, but can be applied to any area of rehabilitation.

Visual impairment, rehabilitation and International Classification of Functioning, Disability and Health / Deficiência visual, reabilitação e Classificação Internacional de Funcionalidade, Incapacidade e Saúde

Objetive: To describe the characteristics of people with visual impairment who participated in the Visual Rehabilitation Groups, according to the ICD-10 and the International Classification of Functioning, Disability and Health (ICF). Methods: Quantitative, cross-sectional survey, developed in a university rehabilitation research center between october and december 2012. The users from the Visual Rehabilitation Groups were invited; 13 of them agreed to participate. We performed an occupational therapy evaluation – with anamnesis, performance evaluation and functional vision assessment – an analysis of medical charts and patient description with the use of the ICF Results: The major causes of visual impairment were diabetic retinopathy, glaucoma, optical neuritis and keratoconus. Some functions and structures of the body, performance and capabilities in activities and participation, environmental factors facilitators or limiters were highlighted in this study, allowing the description of the characteristics of each participant through the functionality and the improvement of the therapeutic planning. Assistive technologies, optical and non-optical aids used and their everyday benefits were presented. Conclusion: Visual loss, at any level, led to functional impairments, limiting and restricting the participation and performance in everyday activities, interfering with the individuals’ independence, autonomy and quality of life. However, the use of optical aids, non-optical aids and environmental adaptations proved to be beneficial for increasing the functionality, showing the influence of external factors on the performance. Knowing and recognizing the existence of diversities within the visual impairment universe allows us to understand who the treated individual is, avoiding the generalization by the visual condition. The ICF showed to have a fundamental role in this context. .

Objetivo: Descrever as características das pessoas com deficiência visual participantes de Grupos de Reabilitação Visual, segundo a CID-10 e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). Métodos: Pesquisa quantitativa de corte transversal, desenvolvida em um centro universitário de pesquisas em reabilitação entre outubro e dezembro de 2012. Usuários de Grupos de Reabilitação Visual foram convidados, sendo 13 os que aceitaram participar. Foi realizada avaliação de terapia ocupacional – com anamnese, avaliação de desempenho e avaliação funcional da visão – consulta aos prontuários e a classificação dos participantes utilizando a CIF. Resultados: As principais causas de deficiência visual foram retinopatia diabética, glaucoma, neurite óptica e ceratocone. Algumas funções e estruturas do corpo, desempenho e capacidades em atividades e participação, fatores ambientais facilitadores ou limitadores foram destacados neste estudo, possibilitando descrever as características de cada participante por meio de sua funcionalidade e auxiliando no planejamento terapêutico. Tecnologias assistivas, auxílios ópticos e não ópticos utilizados e seus benefícios cotidianos foram apresentados. Conclusão: A perda visual, em qualquer nível, levou a prejuízos funcionais, limitando e restringindo a participação e o desempenho em atividades cotidianas, interferindo na independência, autonomia e qualidade de vida dos sujeitos. Entretanto, o uso de recursos ópticos, não ópticos, auxílios e adaptações ambientais mostraram-se benéficos para a ampliação da funcionalidade, evidenciando a influência de fatores externos no desempenho do indivíduo. Conhecer e reconhecer a existência da diversidade dentro do universo da deficiência visual possibilita entender quem é o sujeito atendido, evitando a generalização pela condição visual, tendo a CIF papel fundamental nesse contexto. .

Sight-threatening diabetic retinopathy at presentation to screening services in Fiji.

PURPOSE: To report the spectrum of retinopathy at first presentation to photoscreening services, to determine the proportion of patients that present with sight-threatening diabetic retinopathy (STDR), and to raise awareness of the burden of diabetic eye disease in Fiji. METHODS: This retrospective observational cohort study used data from the initial visit of all new patients presenting to the diabetes retinal screening service at the Pacific Eye Institute in Fiji over the 3-month period between July and September 2012. Patients were assessed using a detailed questionnaire regarding diabetes type, duration of disease, medications, complications and co-morbidities, and blood sugar control. Patients subsequently underwent non-mydriatic fundus photography according to Pacific diabetes retinal screening guidelines. Images were graded at the time of acquisition, and data were entered onto a computerized database. For the purposes of this study, information regarding retinopathy grading, visual acuity and patient demographics was used. RESULTS: A total of 522 new patients were screened over the 3-month period. STDR was observed in 27% of patients, with 15% observed to have bilateral STDR. Diabetes control was generally poor. Blindness and visual impairment were observed in 2.7% and 6.7% of the cohort, respectively. CONCLUSION: Severe and advanced diabetic retinopathy was present in this population presenting to screening. This was observed 4 years after the formal expansion of the screening services and reflects the high prevalence of diabetes in the population. The need for increased public awareness and greater resource allocation into diabetes and its complications is emphasized.

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.

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.

Different types of optic disc shape in patients with advanced open-angle glaucoma.

PURPOSE: To study the characteristics of patients with advanced open-angle glaucoma. METHODS: A hospital-based retrospective study was performed. Advanced glaucoma was defined as visual acuity of 0.3 or less, or mean deviation of -24 dB or less. First, we screened patients with advanced glaucoma and classified their glaucoma types. For patients with open-angle glaucoma (OAG), including both primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG), disc types were classified into four groups: focal ischemic (FI), myopic glaucomatous (MY), senile sclerotic (SS), and generalized cup enlargement (GE). RESULTS: After checking the medical history of 750 glaucoma patients, we classified 141 (18.8%) as having the advanced stage of the disease. The proportion of patients with advanced OAG was 47% (28% POAG, 19% NTG). The classification of optic disc appearances in OAG patients showed that in patients with POAG the predominant disc type was GE (P = 0.0012) and in those with NTG it was MY (P < 0.0001). CONCLUSION: In OAG patients in this study with severe glaucomatous damage, the predominant disc phenotype was GE in patients with POAG and MY in those with NTG.

[The IOL-Vip system : Principles and clinical application]. / Das IOL-Vip System : Grundlagen und klinische Anwendung.

There are various retinal disorders that cause macular degeneration. However, age-related macular degeneration (ARMD) is the main cause of legal blindness in developed countries. Even today the end stage of this disease can often not be avoided. Patients suffer from central scotoma and severe vision loss. Low vision aids may help in certain situations, but these devices are often functionally and cosmetically inadequate. The implantation of the IOL-Vip system is a new surgical alternative. The lens system consists of a high negative power lens (-64 D) which is implanted in the capsular bag and a high positive power lens (+53 D) which is implanted in the anterior chamber. An intraocular Galilean telescope is reproduced by this arrangement. The IOL-Vip system provides a magnification of 1.3 without notably compromising the peripheral visual field. Investigations have shown that visual improvement can be achieved after implantation of the IOL-Vip system combined with a rehabilitation program. In particular orientation and the ability of patients to perform everyday tasks showed improvement.

Are current guidelines for categorization of visual impairment in India appropriate?

CONTEXT: Visual disability in India is categorized based on severity. Sometimes the disabled person does not fit unambiguously into any of the categories. AIMS: To identify and quantify disability that does not fit in the current classification, and propose a new classification that includes all levels of vision. SETTINGS AND DESIGN: Retrospective chart review of visual disability awarded in a teaching hospital. MATERIALS AND METHODS: The last hundred records of patients who had been classified as visually disabled were screened for vision in both eyes and percentage disability awarded. Data were handled in accordance with the Helsinki Declaration. RESULTS: Twenty-one patients had been classified as having 30% disability, seven each had 40% and 75%, and 65 had 100% disability. Eleven of them did not fall into any of the current categories, forcing the disability board to use its own judgment. There was a tendency to over-grade the disability (seven of 11; 63.6%). The classification proposed by us is based on the national program for control of blindness' definition of normal vision (20/20 to 20/60), low vision ( < 20/60 to 20/200), economic blindness ( < 20/200 to 20/400) and social blindness ( < 20/400). It ranges from the mildest disability (normal vision in one eye, low vision in the other) up to the most severe grade (social blindness in both eyes). CONCLUSIONS: The current classification of visual disabilities does not include all combinations of vision; some disabled patients cannot be categorized. The classification proposed by us is comprehensive, progresses logically, and follows the definitions of the national program.

Trends in blind and low vision registrations in Taipei City.

PURPOSE: To determine the overall reported incidence and causes of registrable blindness and low vision in Taipei, Taiwan, that have occurred in the previous 10 years. METHODS: Study data were obtained from disability identification registration forms completed between January 1995 and December 2004. Definitions of low vision and blindness were defined by WHO criteria: low vision included visual acuity worse than 6/18 (20/60) to a lower limit of 3/60 (20/400). Blindness was defined as visual acuity worse than 3/60 (20/400) in the better eye with best possible correction. RESULTS: There were 3151 registrations for visual impairment during the study period. A total of 239 registrations were excluded due to insufficient data. Of the remaining 2912 (1518 males and 1394 females), 640 males and 647 females were legally blind (44.20%). A total of 878 males and 747 females were partially sighted. The six leading causes of low vision and blindness, in decreasing frequency, were glaucoma, optic neuropathy, diabetic retinopathy, retinitis pigmentosa, age-related macular degeneration, and myopic macular degeneration. CONCLUSIONS: The proportions of new registrations owing to glaucoma, diabetic retinopathy, age-related macular degeneration, and myopic macular degeneration have changed significantly since 2000; the proportion due to diabetic retinopathy has increased.

Pediatric and adolescent population with visual impairment: study of 385 cases.

OBJECTIVE: To analyze data on the pediatric population attending the Ophthalmologic Clinic's Low Vision Service at the São Paulo University Medical School. METHODS: Low vision ophthalmologic assessment, from April 1998 to December 2003, of 385 children and adolescents with mean age of 7 years; 51.7% males and 48.3% females. The main data analyzed were age, diagnosis, anatomic site of the ocular injury, visual acuity, and prescription of optical aids. RESULTS: 45.4% were below 6 years, and 54.6% were between 6 and 16 years. 35.5% experienced moderate visual impairment, 26% had severe visual impairment, 8.6% had profound visual impairment, 10.6% were near blind, and 1.6% were blind. The main causes of visual impairment included congenital glaucoma (30.6%), macular retinochoroiditis due to congenital toxoplasmosis (16.7%), congenital cataract (12.8%), retinal and macular inherited disorders (11.7%), and optic atrophy (9.8%). Among school-age children, 52.9% received a prescription of optical aids. The most widely used optical aids for distance were 2.8 X 26 (34.4%); 4.2 X 12 (30.3%); and 6 X 17 (26.8%) telescopic systems. The most frequently prescribed optical aid for near vision was the 2x magnifying bar (33.3%). CONCLUSIONS: There is a need for prevention of primary (congenital infections), secondary (congenital glaucoma and retinopathy of prematurity), and tertiary (congenital cataract) visual impairment. The prescription of optical aids for school-age children will help them perform better at school and contribute to their social inclusion.

Pediatric and adolescent population with visual impairment: study of 385 cases

OBJETIVO: Analisar as características da população infantil atendida no Serviço de Visão Subnormal da Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.MÉTODOS: Avaliação oftalmológica de 385 crianças e adolescentes, de abril de 1998 a dezembro de 2003, com idade média de 7 anos; 51,7% do sexo masculino e 48,3% do sexo feminino. Idade, diagnóstico oftalmológico, localização anatômica da lesão ocular, acuidade visual e auxílios ópticos adaptados foram observados. RESULTADOS: 45,4% tinham idade inferior a 6 anos e 54,6% tinham entre 6 e 16 anos de idade. 35,5% apresentavam baixa visão moderada, 26% baixa visão grave, 8,6% baixa visão profunda, 10,6% quase cegueira e 1,6% cegueira. As principais causas da deficiência visual foram: glaucoma congênito (30,6%), retinocoroidite macular por toxoplasmose congênita (16,7%), catarata congênita (12,8%), doenças hereditárias da retina e mácula (11,7%) e atrofia óptica (9,8%). Na população de crianças em idade escolar, 52,9% tiveram auxílios ópticos adaptados. Os auxílios ópticos para longe mais utilizados foram os sistemas telescópicos de 2,8X 26 (34,4%), de 4,2 X 12 (30,3%) e de 6 X 17 (26,8%). O auxílio óptico para perto mais adaptado foi a barra de ampliação de 2 X de aumento (33,3%). CONCLUSÕES: Necessidade de prevenção primária (infecções congênitas), prevenção secundária (glaucoma congênito e retinopatia da prematuridade) e prevenção terciária (catarata congênita). A adaptação de auxílios ópticos nas crianças em idade escolar irá colaborar para o seu maior desempenho escolar e sua inclusão social.

What is low vision? A re-evaluation of definitions.

PURPOSE: To re-evaluate definitions of low vision, visual impairment, and disability. METHODS: We review current definitions of legal blindness and low vision and how these definitions are variably based on disability or impairment. We argue for a definite distinction being made between criteria for visual impairment and visual disability, low vision being defined as the presence of a visual impairment that results in a disability. Visual impairment is defined according to population norms and a statistical cut-off is used. Visual disability is defined by consideration of the level of visual measures which result in measurable or reportable disability. We consider the evidence that contrast sensitivity should be a criterion for visual disability in addition to visual acuity and visual field. CONCLUSIONS: According to the current information, we define visual impairment as best monocular or binocular visual acuity <(worse than) 6/7.5, total horizontal visual field <146 degrees (Goldmann III-4e) or <109 degrees (III-3e), and contrast sensitivity <1.5 (PelliRobson); we define visual disability as best monocular or binocular visual acuity <6/12 or contrast sensitivity <1.05.

[Borderline blindness, practical blindness and severe visual debility]. / Hranice slepoty, praktické slepoty a tezké slabozrakosti.

In the presented paper the author explains assessment aspect of social welfare departments as regard evaluation of complete of practical blindness with reference to generally blinding legal regulations. The author draws attention to another interpretation not consistent with these regulations, in chapter 26 of the Compendium of Ophthalmology (Grada 1997) and recommends ophthalmologists to use a procedure which will prevent imminent difficulties which could arise as a result of the interpretation in chapter 26 of the Compendium.

[The low vision cyclist: handicapped orientation and assessment with the nystagmogram]. / Der sehschwache Fahrradfahrer: Orientierungsbehinderung und -aufwertung im Nystagmogramm.

BACKGROUND: Visually impaired individuals who are unable to obtain a driving licence may use a bicycle and feel fit for traffic as part of this "bio-physical model". MATERIALS AND METHODS: Five nystagmic amblyopes who claimed to ride a bicycle were tested in respect to visual acuity, peripheral vision and oculomotor functions. In three of these cases visual acuity amounted to 0.3, in one to 0.6, in another one only to 1/35. Eye movements were recorded by electro-oculography. The following qualities of gaze were determined: Fixation-saccadic eye movements-pursuit eye movements-behaviour in light and dark-vestibulo-optokinetic movements-eye positioning in resting states and influence of mood. RESULTS: In four of the cases oculomotor regularities were found. These were explained to the patients. One of the cases was affected with a form of chaotic nystagmus. CONCLUSION: Bicycling demands on both the vestibular and the visual system. Deficiencies relevant to behaviour in traffic and the possibilities to compensate for these may be estimated based on a oculographic evaluation. This should therefore be used to advise bicyclists with a visual impairment.