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.

Utilization and Abandonment of Low Vision Devices Prescribed on a Mobile Clinic.

SIGNIFICANCE: Device utilization and abandonment for patients seen on a mobile clinic are explored. Findings are informative for resource allocation in a novel low vision rehabilitation (LVR) delivery model. This study also explores the relationships between device abandonment and LVR patient-reported functional outcomes. PURPOSE: This prospective cohort study investigated low vision device utilization and abandonment in a novel mobile clinic delivery model. METHODS: A device abandonment questionnaire was administered by telephone 3 months and 1 year after mobile clinic LVR. Participants (n = 65) had previously met the U.S. definition of legal blindness and were prescribed a total of 154 devices at their low vision consultative visits. Trends in device utilization and correlations with clinical and demographic participant characteristics, as well as functional outcomes as assessed by Massof Activity Inventory, are explored. RESULTS: An average of 2.6 device recommendations were made per participant. Digital magnification, optical magnifiers, and filters were most frequently recommended. At 3 months, 29% of participants abandoned at least one device, although only 17% of received devices were abandoned. There was no significant difference in the number of devices used, abandoned, or not received at 3 months versus 1 year after LVR. Devices prescribed for reading goals were most frequently used and least often abandoned, whereas glare control and distance magnification devices were more frequently abandoned. Neither patient characteristics nor Massof Activity Inventory change score was predictive of device abandonment. There was no significant difference in the odds of device abandonment in comparison with a previous study that assessed academic outpatient LVR clinics using the same questionnaire. CONCLUSIONS: Although more device recommendations are given per patient on the mobile clinic, there is no significant difference in device abandonment for patients seen on the mobile clinic versus other outpatient LVR delivery models.

Amplified music with headphones and its implications on hearing health in teens.

OBJECTIVE: To analyze the habits and behavior of adolescents exposed to amplified music with headphones and its implications on their hearing health. METHODS: One hundred thirty-one high school students, aged 15 to 18 years were given a questionnaire containing closed questions regarding their habits and behavior related to personal stereos use. It is a descriptive cross-sectional study and used the Chi-square test. RESULTS: It was shown that 79% of young people make use of portable music devices, 61.83% have a habit of using them often, 34.35% have long periods of exposure, and 37.40% use them at high volume. In terms of symptoms, present were: difficulty concentrating 63.36%; the need to ask people to repeat what was said 64.12%; the need to increase the TV volume 43.51%; tinnitus 38.93%, excitability 38.93%; and 36.64% of teens say they are somewhat worried about losing their hearing through the use of personal stereos. For the preventive aspects, 90.84% believe that noise is part of society, 80.92% find it important to reduce noise pollution, 51.91% would like to know the influence of the noise/pollution, but 74.81% would not like to participate in projects with questions about hearing health. CONCLUSION: The youths in this study are making indiscriminate use of personal stereos with headphones, within a population at risk for hearing loss considering its habits. Hearing Health Promotion Programs are recommended for this population.

Baseline traits of patients presenting at a low vision clinic in Shanghai, China.

BACKGROUND: Low vision, along with cataract, trachoma, onchocerciasis, childhood blindness and refractive error, is one of the priorities in the global initiative, VISION 2020-The Right to Sight. The purpose of this study was to characterize the traits of patients presenting at a low vision clinic in China. METHODS: A retrospective study was conducted of the records of 299 patients who visited the Low Vision Clinic of Eye and ENT Hospital Affiliated to Fudan University from January 2009 to May 2014. Reviewed parameters included age, gender, education, occupation, cause of visual impairment and types of low vision aids (LVAs) dispensed. RESULTS: Of all the patients (193 male; aged from 3 to 96 years, with a mean of 29.74 ± 25.23 years), 43.48% experienced moderate visual impairment, 25.42% had severe visual impairment and 21.07% were blind. The four major causes of visual impairment were congenital cataract (14.38%), degenerative myopia (13.71%), juvenile macular degeneration (9.36%) and retinitis pigmentosa (9.36%). The most common causes of visual impairment were congenital cataract (22.67%) in 0-19-year-olds, retinitis pigmentosa (20.62%) in 20-59-year-olds, and age-related macular degeneration (36.54%) in the 60+ group. With the help of LVAs, a significant improvement of distance and/or near vision or visual field was observed in 243 patients, of whom 185 accepted LVAs and 58 patients refused due to high price, inconvenience, young age (≤ 6 y), clumsy appearance and ignorance. The most commonly dispensed LVAs were stand magnifiers (21.57%) followed by spectacle-type LVAs (19.21%). CONCLUSIONS: The majority of the patients in our low vision clinic were young, the main causes of visual impairment were congenital and hereditary diseases. Stand magnifiers were the most commonly dispensed LVAs. High price was the major reason for refusing LVAs.

Refractive errors, visual impairment, and the use of low-vision devices in albinism in Malawi.

BACKGROUND: This study focuses on the refractive implications of albinism in Malawi, which is mostly associated with the burden of visual impairment. The main goal was to describe the refractive errors and to analyze whether patients with albinism in Malawi, Sub-Saharan Africa, benefit from refraction. METHODS: Age, sex, refractive data, uncorrected and best-corrected visual acuity (UCVA, BCVA), colour vision, contrast sensitivity, and the prescription of sunglasses and low vision devices were collected for a group of 120 albino individuals with oculocutaneous albinism (OCA). Refractive errors were evaluated objectively and subjectively by retinoscopy, and followed by cycloplegic refraction to reconfirm the results. Best-corrected visual acuity (BCVA) was also assessed binocularly. RESULTS: One hundred and twenty albino subjects were examined, ranging in age from 4 to 25 years (median 12 years), 71 (59 %) boys and 49 (41 %) girls. All exhibited horizontal pendular nystagmus. Mean visual acuity improved from 0.98 (0.33) logMAR to 0.77 (0.15) logMAR after refraction (p < 0.001). The best improvement of VA was achieved in patients with mild to moderate myopia. Patients with albinism who were hyperopic more than +1.5 D hardly improved from refraction. With the rule (WTR) astigmatism was more present (37.5 %) than against the rule (ATR) astigmatism (3.8 %). Patients with astigmatism less than 1.5 D improved in 15/32 of cases (47 %) by 2 lines or more. Patients with astigmatism equal to or more than 1.5 D in any axis improved in 26/54 of cases (48 %) by 2 lines or more. CONCLUSIONS: Refraction improves visual acuity of children with oculocutaneous albinism in a Sub-Saharan African population in Malawi. The mean improvement was 2 logMAR units.

Enhancing activity by means of tactile symbols: a study of a heterogeneous group of pupils with congenital blindness, intellectual disability and autism spectrum disorder.

This study investigates responses to verbal versus tactile requests in children with congenital blindness, intellectual disability and autism spectrum disorder (ASD). Observation was conducted on two occasions. At T1, requests were given verbally, and at T2, tactile requests were given. All pupils perceived tactile symbols to be explicit requests to perform the act referred to by the symbols. The children seldom or never followed verbal requests. All children followed more tactile than verbal requests. Individual differences in verbal skills, motivations and the complexity of the activity are discussed. The availability of tactile symbols for individuals with congenital blindness, intellectual disability and ASD seems to increase their level of activity and their participation in school.

Indoor navigation by people with visual impairment using a digital sign system.

There is a need for adaptive technology to enhance indoor wayfinding by visually-impaired people. To address this need, we have developed and tested a Digital Sign System. The hardware and software consist of digitally-encoded signs widely distributed throughout a building, a handheld sign-reader based on an infrared camera, image-processing software, and a talking digital map running on a mobile device. Four groups of subjects-blind, low vision, blindfolded sighted, and normally sighted controls-were evaluated on three navigation tasks. The results demonstrate that the technology can be used reliably in retrieving information from the signs during active mobility, in finding nearby points of interest, and following routes in a building from a starting location to a destination. The visually impaired subjects accurately and independently completed the navigation tasks, but took substantially longer than normally sighted controls. This fully functional prototype system demonstrates the feasibility of technology enabling independent indoor navigation by people with visual impairment.

Guías visuales como herramienta terapéutica en la enfermedad de Parkinson. Una revisión sistemática / Visual cues as a therapeutic tool in Parkinson's disease. A systematic review

Los estímulos o guías sensoriales se están utilizando como una herramienta terapéutica para la mejora de los trastornos de la marcha en los pacientes con enfermedad de Parkinson, pero la mayoría de los estudios parecen centrarse en el uso de estímulos auditivos. El objetivo del presente estudio fue realizar una revisión sistemática referente al uso de estímulos visuales sobre los trastornos de la marcha y la ejecución de tareas duales durante la misma, su influencia sobre los bloqueos motores y la incidencia de caídas en los pacientes con enfermedad de Parkinson, al objeto de poder extraer implicaciones terapéuticas. Se realizó una búsqueda bibliográfica sistemática en las principales bases de datos, como Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE, y Physiotherapy Evidence Database, durante el periodo 2005 al 2012, de acuerdo con las recomendaciones de la Consolidated Standards of Reporting Trials, valorando la calidad de los trabajos con el Quality Index de Downs y Black. Fueron incluidos 21 artículos en la presente revisión sistemática (con un total de 892 participantes), con calidad metodológica variable, obteniendo una puntuación media en el Quality Index de 17,27 puntos (rango: 11-21). Los estímulos visuales producen mejoras en parámetros temporoespaciales de la marcha, la ejecución de giros, disminuyendo la aparición de freezing y caídas en la enfermedad de Parkinson. Las tareas duales durante la marcha parecen beneficiarse mediante su uso, disminuyendo la interferencia de esta segunda tarea. Existe una necesidad de mayores estudios que determinen el tipo de estímulo preferente para cada estadio de la enfermedad(AU)

Sensory stimuli or sensory cues are being used as a therapeutic tool for improving gait disorders in Parkinson's disease patients, but most studies seem to focus on auditory stimuli. The aim of this study was to conduct a systematic review regarding the use of visual cues over gait disorders, dual tasks during gait, freezing and the incidence of falls in patients with Parkinson to obtain therapeutic implications. We conducted a systematic review in main databases such as Cochrane Database of Systematic Reviews, TripDataBase, PubMed, Ovid MEDLINE, Ovid EMBASE and Physiotherapy Evidence Database, during 2005 to 2012, according to the recommendations of the Consolidated Standards of Reporting Trials, evaluating the quality of the papers included with the Downs & Black Quality Index. 21 articles were finally included in this systematic review (with a total of 892 participants) with variable methodological quality, achieving an average of 17.27 points in the Downs and Black Quality Index (range: 11-21). Visual cues produce improvements over temporal-spatial parameters in gait, turning execution, reducing the appearance of freezing and falls in Parkinson's disease patients. Visual cues appear to benefit dual tasks during gait, reducing the interference of the second task. Further studies are needed to determine the preferred type of stimuli for each stage of the disease(AU)

Effectiveness of the community-based Low Vision Service Wales: a long-term outcome study.

AIMS: To evaluate the long-term effectiveness of the community-based Low Vision Service Wales (LVSW). METHODS: A long-term observational study of the Government-funded, community-based, low-vision rehabilitation service which operates in over 180 optometry practices in Wales. Participants were recruited from the LVSW (n=342; 246 women; median age 82 years) at baseline (before the Low Vision intervention). The primary outcome measure was change in visual disability as evaluated by the seven-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). Change was measured on the same cohort at three separate time points, and comparisons were made between these: baseline-3 months; 3-18 months; baseline-18 months. Secondary outcome measures included: use of low-vision aids (LVAs) and satisfaction with the service provided. RESULTS: Questionnaires were sent to 281 participants (whose visual disability had been measured at baseline and 3 months) at 18 months postintervention. Responses were received from 190 (67.6%) people; 24 were deceased. Self-reported visual disability was significantly reduced (Wilcoxon Signed Rank (WSR) test: p<0.001) between baseline and 18 months by -0.28 logits (-1.24 to 0.52). This was less than that found between baseline and 3 months; -0.61 logits (-1.81 to 0.02). At 18 months, 79% patients used their LVAs at least once a week which was not significantly different to that found at 3 months (WSR: p=0.127). CONCLUSIONS: This study provides evidence that the effect of the LVSW persists over a period of 18 months; disability is reduced from baseline, and use of LVAs remains high.

Use of prescribed optical devices in age-related macular degeneration.

PURPOSE: To evaluate prescribed optical device use in terms of frequency and perceived usefulness among people with age-related macular degeneration (AMD). We also sought to determine the tasks for which they were using their prescribed low vision device(s). METHODS: One hundred ninety-nine patients with AMD presenting for the first time to the low vision service were recruited from a university-based clinic. Prior to the low vision evaluation and device prescription, they completed the National Eye Institute Visual Function Questionnaire 25, Center for Epidemiological Studies Depression Scale, Short Portable Mental Status Questionnaire, and a general health questionnaire. The low vision evaluation included best-corrected Early Treatment of Diabetic Retinopathy Study visual acuity, MNREAD testing, microperimetry, prescription, and dispensing of optical low vision devices. Telephone follow-up interviews were conducted about device usage 1-week, 1-month, and 3-months postintervention. RESULTS: One hundred eighty-one participants were prescribed low vision devices. Of them, 93% completed all 3 follow-up interviews. Intensive users (≥1 hours/day) of devices were similar in demographic and visual characteristics to non-intensive users (<1 hours/day), except for habitual reading acuity and speed as well as contrast sensitivity. Overall, device use increased slightly over 3 months of follow-up. Magnifiers were reported to be moderately-to-extremely useful by >80% of participants at all time points except the 1-month follow-up for hand magnifiers (75%). High plus spectacles were the least frequently prescribed device and rated as moderately-to-extremely useful by 70%, 74%, and 59% at 1 week, 1 month, and 3 months, respectively. Most participants used their devices for leisure reading, followed by managing bills. Very few devices (n = 3, <1%) were not used at any time point. CONCLUSIONS: Patients with AMD who are provided with prescribed optical low vision devices do use them and perceive them as useful, especially for leisure reading activities. High rates of usage were maintained over 3 month.

Braille use among Norwegian children from 1967 to 2007: trends in the underlying causes.

PURPOSE: The aim of the study was to estimate the occurrence, diagnoses and time trends among Norwegian children that have received education in braille from 1967 to 2007. METHODS: We used a retrospective population-based study design. The health care system is free for all inhabitants in Norway. We included all children that had received braille education the last four decades. From each student's record, we abstracted year born, country of birth, gender, year diagnosed, diagnosis, classification of visual impairment and type of reading media. RESULTS: We identified 287 children (137 girls and 150 boys) that had received braille education over the last 40 years. Of these, 262 (91.3%) children were born in Norway, 145 (53.7%) were diagnosed within the first year of life and 59 (20.6%) from age of one to five. The most frequent diagnoses were Retinopathy of Prematurity (ROP), Juvenile Ceroid Lipofuscinoses (JNCL), Lebers Congenital Amaurosis (LCA) and Retinitis Pigmentosa (RP). Among the children, 63% (N = 170) used braille only, 9% (N = 25) braille and print, but priority braille, and 27% (N = 73) braille and print, priority print. The number of children with ROP using braille had a peak in 1977, then the number declined. The number diagnosed with LCA increased from 1987 to 1992. The number of braille users among children diagnosed with JNCL tended to increase substantially after 1992. CONCLUSION: Braille education seemed to be dependent of trends in diagnoses as well as trends in recommendations from professional educators.

Synthetic synaesthesia and sensory substitution.

Visual information can be provided to blind users through sensory substitution devices that convert images into sound. Through extensive use to develop expertise, some blind users have reported visual experiences when using such a device. These blind expert users have also reported visual phenomenology to other sounds even when not using the device. The blind users acquired synthetic synaesthesia, with visual experience evoked by sounds only after gaining such expertise. Sensorimotor learning may facilitate and perhaps even be required to develop expertise in the use of multimodal information. Furthermore, other areas where expertise is acquired in dividing attention amongst cross-modal information or integrating such information might also give rise to synthetic synaesthesia.

Visual experiences in the blind induced by an auditory sensory substitution device.

In this report, the phenomenology of two blind users of a sensory substitution device - "The vOICe" - that converts visual images to auditory signals is described. The users both report detailed visual phenomenology that developed within months of immersive use and has continued to evolve over a period of years. This visual phenomenology, although triggered through use of The vOICe, is likely to depend not only on online visualization of the auditory signal but also on the users' previous (albeit distant) experience of veridical vision (e.g. knowledge of shapes and visual perspective). Once established, the sensory substitution mapping between the auditory and visual domains is not confined to when the device is worn and, thus, may constitute an example of acquired synaesthesia.

Usefulness of post-assessment reports in a paediatric low vision clinic: a questionnaire survey of parents and education professionals.

This survey aimed to evaluate how helpful parents and those working in the educational setting found written low vision assessment reports. A questionnaire survey was sent to 25 parents and to the corresponding and relevant member of the educational team for each of the 25 children. All were satisfied with the level of information contained in the report and agreed that the report was easy to understand and that the level of explanations given regarding visual function were clear. The main disparities between parents and teaching professionals were concerning the amount of medical terminology used in the report, with only 7% (n = 1) of those from the educational setting, but 30% (n = 6) of parents feeling there was too much. Adaptations were also more likely to have been implemented in the educational setting [82% (n = 11)] as compared with 62% (n = 16) in the home. Eighty-three per cent (n = 43) of respondents reported that low vision aids were used at either home or school on at least a weekly basis.

Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: a US multisite retrospective study.

PURPOSE: Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). MATERIALS AND METHODS: A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. RESULTS: Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. CONCLUSIONS: End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.

[Utilization of optical devices and equipments by students with visual impairment]. / Utilização de recursos ópticos e equipamentos por escolares com deficiência visual.

PURPOSE: To verify perceptions and conduct of students with visual impairment regarding devices and equipment utilized in schooling process. METHODS: A transversal descriptive study on a population of 12-year-old or older students in schooling process, affected by congenital or acquired visual impairment, inserted in the government teaching system of Campinas during the year 2000. An interview quiz, created based on an exploratory study was applied. RESULTS: A group of 26 students, 46% of them with low vision and 53.8% affected by blindness was obtained. Most of the students were from fundamental teaching courses (65.4%), studying in schools with classrooms provided with devices (73.1%). Among the resources used in reading and writing activities, 94.1% of the students reported they used the Braille system and 81.8% reported that the reading subject was dictated by a colleague. Most of the students with low vision wore glasses (91.7%), and 33.3% utilized a magnifying glass as optical devices. Among the non-optical devices, the most common were the environmental ones, getting closer to the blackboard (75.0%) and to the window (66.7%) for better lighting. CONCLUSIONS: It became evident that students with low vision eye-sight made use of devices meant for bearers of blindness, such as applying the Braille system. A reduced number of low vision students making use of optical and non-optical devices applicable to their problems were observed, indicating a probable unawareness of their visual potential and the appropriate devices to improve efficiency.

Availability of accessible publications: designing a methodology to provide reliable estimates for the Right to Read Alliance.

OBJECTIVES: To establish reliable estimates of the proportion of books available in formats accessible to visually impaired people; to recommend a practical method of updating the estimates. METHODS: The project had two stages. Stage one estimated the overall availability of all categories of books. The British National Bibliography (BNB) for 1999-2003 was chosen as the sampling frame. A sample of 2069 titles over the 5 years was selected using a systematic sample design. These titles were then checked for availability against the catalogues of four major producer/suppliers of materials in accessible formats. The second stage involved checking the availability of books in six genres; about 400 titles for each genre were examined. RESULTS: Of the titles selected for the overall estimate, 92 (4.4%) were found to be available in one or more accessible formats. Availability of titles in accessible formats varied greatly between categories. Adult fiction had the highest number of available publications (26.3%), least represented were cookery (1.9%) and gardening (1.8%). CONCLUSIONS: This study provided baseline figures and a methodology for the Right to Read Alliance to monitor their progress in campaigning for more books to be accessible to visually impaired people.