Making science accessible for blind and low-vision people, and those with diverse needs.

The May-June 2024 issue of Immunology & Cell Biology contains an Immunology Futures Special Feature on Disability Inclusion in Science. Diverse groups do better in science, yet individuals with disabilities face barriers to accessing education and opportunities within scientific disciplines. The Monash Sensory Science program, led by Professor Jamie Rossjohn and legally blind artist in residence Dr Erica Tandori, has transformed the accessibility for those with blindness, low vision and diverse needs (BLVDN) to experience biomedical data visualization through the form of multisensory scientific communication. The Monash Sensory Science Exhibition, first hosted in 2018 with the support of Monash University and the Australian Research Council, utilizes tactile multisensory and multimodal artworks, interactive displays and multisensory science books for BLVDN participants. In this Special Feature, scientists and researchers involved in the 2023 Autoimmunity Monash Sensory Science Exhibition discuss the novel models and displays designed to improve the scientific understanding of complex autoimmune diseases including rheumatoid arthritis, lupus, celiac disease, psoriasis and type 1 diabetes. This Special Feature aims to inform the inclusive teaching of immunology and raise discussions of how to improve access to all within our scientific institutions.

Art, science and inclusion: multisensory Sciart of immunology for blind, low-vision and diverse-needs audiences.

Art is a powerful tool for conveying scientific discovery. Despite the perceived gap between art and science, as highlighted by CP Snow and others, examples of art communicating science can be found in the ancient world, the Renaissance and contemporary data visualization, demonstrating an enduring and historic connection. However, much of science relies on visual elements, excluding those with blindness, low vision and diverse needs, resulting in their low representation in STEM discourse. This paper introduces a novel science and art collaboration in the form of an exhibition program exploring the concepts of Immunology and Biomedicine to blind and vision-impaired audiences, capitalizing on the lived experience of a legally blind artist. Employing multisensory design, art and co-creation methodologies, it transcends traditional vision-based science communication, showcasing the potential for multisensory art to bridge the gap at the intersection of science and inclusion.

Visual function loss in fungal sphenoid sinusitis: clinical characteristics and outcomes.

Potentially fatal fungal sphenoid sinusitis (FSS) causes visual damage. However, few studies have reported on its visual impairment and prognosis. Five hundred and eleven FSS patients with ocular complications treated at Beijing Tongren Hospital were recruited and clinical features and visual outcomes were determined. Thirty-two of the 511 patients (6%) had visual impairment, with 13 and 19 patients having invasive and noninvasive FSS, respectively. Eighteen patients (56.25%) had diabetes and 2 patient (6.25%) had long-term systemic use of antibiotics (n = 1) and corticosteroids (n = 1). All patients had visual impairment, which was more severe in invasive FSS than in noninvasive FSS. Bony wall defects and sclerosis were observed in 19 patients (59.38%), and 11 patients (34.38%) had microcalcification in their sphenoid sinusitis on computed tomography (CT). After a 5-year follow-up, three patients (9.38%) died. Patients with noninvasive FSS had a higher improvement rate in visual acuity than their counterparts. In the multivariate analysis, sphenoid sinus wall sclerosis on CT was associated with better visual prognosis. FSS can cause vision loss with persistent headaches, particularly in those with diabetes. CT showed the sphenoid sinus wall sclerosis, indicating a better visual prognosis in FSS with visual impairment.

Transformer with difference convolutional network for lightweight universal boundary detection.

Although deep-learning methods can achieve human-level performance in boundary detection, their improvements mostly rely on larger models and specific datasets, leading to significant computational power consumption. As a fundamental low-level vision task, a single model with fewer parameters to achieve cross-dataset boundary detection merits further investigation. In this study, a lightweight universal boundary detection method was developed based on convolution and a transformer. The network is called a "transformer with difference convolutional network" (TDCN), which implies the introduction of a difference convolutional network rather than a pure transformer. The TDCN structure consists of three parts: convolution, transformer, and head function. First, a convolution network fused with edge operators is used to extract multiscale difference features. These pixel difference features are then fed to the hierarchical transformer as tokens. Considering the intrinsic characteristics of the boundary detection task, a new boundary-aware self-attention structure was designed in the transformer to provide inductive bias. By incorporating the proposed attention loss function, it introduces the direction of the boundary as strongly supervised information to improve the detection ability of the model. Finally, several head functions with multiscale feature inputs were trained using a bidirectional additive strategy. In the experiments, the proposed method achieved competitive performance on multiple public datasets with fewer model parameters. A single model was obtained to realize universal prediction even for different datasets without retraining, demonstrating the effectiveness of the method. The code is available at https://github.com/neulmc/TDCN.

It feels like lupus: accessible science for the low-vision community on immune system dysfunction in lupus.

Science communication is often confined to spoken, written or graphical form, neglecting the integration of other tools that would open inclusive scientific dialog to the low-vision community. To address this barrier, members from the Monash Rheumatology clinical and laboratory research groups formed a Lupus Sensory Science team to create a breakout room at the 2023 Monash Sensory Science Exhibit on Autoimmunity. Our goal was to develop multimodal displays and artworks to engage participants with blindness and low vision with the immunological underpinnings of systemic lupus erythematosus (SLE). Here I describe how we created several stations using a combination of tactile posters and models to communicate disease manifestations and immune system dysregulation in SLE. I reflect on how participants keenly engaged with our artworks, asking thoughtful questions that stimulated interesting discussions about treatment options in SLE. In addition, I analyze how our exhibit could be improved to further increase accessibility for the low-vision community. Overall, we learned a lot about how to be inclusive in scientific communication methods and we will strive to continue to engage all members of our community in scientific discussion.

Estimation of the lost productivity to the GDP and the national cost of correcting visual impairment from refractive error in Kenya.

BACKGROUND: In developing countries such as Kenya, minimal attention has been directed towards population based studies on uncorrected refractive error (URE). However, the absence of population based studies, warrants utilization of other avenues to showcase to the stakeholders in eye health the worth of addressing URE. Hence this study estimated the lost productivity to the Gross Domestic Product (GDP) as a result of URE and the national cost required to address visual impairment from URE in Kenya. METHODS: The lost productivity to the GDP for the population aged 16-60 years was calculated. Thereafter the productivity loss of the caregivers of severe visual impaired individuals was computed as a product of the average annual productivity for each caregiver and a 5% productivity loss due to visual impairment. The productivity benefit of correcting refractive error was estimated based on the minimum wage for individuals aged between 16-60 years with URE. Estimation of the national cost of addressing URE was based on spectacle provision cost, cost of training functional clinical refractionists and the cost of establishing vision centres. A cost benefit analysis was undertaken based on the national cost estimates and a factor of 3.5 times. RESULTS: The estimated lost productivity to the GDP due to URE in in Kenya is approximately US$ 671,455,575 -US$ 1,044,486,450 annually for population aged between 16-60 years. The productivity loss of caregivers for the severe visually impaired is approximately US$ 13,882,899 annually. Approximately US$ 246,750,000 is required to provide corrective devices, US$ 413,280- US$ 108,262,300 to train clinical refractionists and US$ 39,800,000 to establish vision centres. The productivity benefit of correcting visual impairment is approximately US$ 41,126,400 annually. Finally, a cost benefit analysis showed a return of US$ 378,918,050 for human resources, US$ 863,625,000 for corrective devices and US$ 139,300,000 for establishment of vision centres. CONCLUSION: The magnitude of productivity loss due to URE in Kenya is significant warranting prioritization of refractive error services by the government and all stakeholders since any investment directed towards addressing URE has the potential to contribute a positive return.

Working Together to Support Self-Determination for Tangata Kapo (Blind and Low Vision) Maori: An Exemplar.

This paper addresses the marginalisation of tangata kapo Maori (blind and low-vision Indigenous New Zealanders) in health- and vision-related research, despite New Zealand's commitments to international conventions. Utilising a purakau-based approach, it challenges existing colonial narratives and emphasises the importance of Maori perspectives. We advocate for Maori self-determination over research processes. This paper shares insights from a systematic review and the development of a declaration for engaging with tangata kapo Maori, reflecting the 3-year collaborative process. The Materials and Methods section details a Kaupapa Maori-grounded data collection, prioritising relationships and cultural practices. Feedback loops with participants and forums ensure accurate representation. In conclusion, the study underscores NZ government obligations and presents the "3Rs" framework-relationships, respect, and reciprocity-as essential for meaningful research engagements with tangata kapo Maori. The findings contribute valuable insights to guide future research practices, advocating for the inclusion and recognition of tangata kapo Maori rights in practice and research.

Foraging predicts the evolution of warning coloration and mimicry in snakes.

Warning coloration and Batesian mimicry are classic examples of Darwinian evolution, but empirical evolutionary patterns are often paradoxical. We test whether foraging costs predict the evolution of striking coloration by integrating genetic and ecological data for aposematic and mimetic snakes (Elapidae and Dipsadidae). Our phylogenetic comparison on a total of 432 species demonstrated that dramatic changes in coloration were well predicted by foraging strategy. Multiple tests consistently indicated that warning coloration and conspicuous mimicry were more likely to evolve in species where foraging costs of conspicuous appearance were relaxed by poor vision of their prey, concealed habitat, or nocturnal activity. Reversion to crypsis was also well predicted by ecology for elapids but not for dipsadids. In contrast to a theoretical prediction and general trends, snakes' conspicuous coloration was correlated with secretive ecology, suggesting that a selection regime underlies evolutionary patterns. We also found evidence that mimicry of inconspicuous models (pitvipers) may have evolved in association with foraging demand for crypsis. These findings demonstrate that foraging is an important factor necessary to understand the evolution, persistence, and diversity of warning coloration and mimicry of snakes, highlighting the significance of additional selective factors in solving the warning coloration paradox.

Korean version of the MNREAD acuity chart.

To investigate the efficacy of the Korean version of the Minnesota low vision reading chart. A Korean version consisting of 38 items was prepared based on the MNREAD acuity chart developed by the University of Minnesota. A linguist composed the representative sentences, each containing nine words from second and third grade levels of elementary school. Reading ability was measured for 20-35-year-old subjects with normal visual acuity (corrected visual acuity of logMAR 0.0 or better). The maximum reading speed (words per minute [wpm]) for healthy participants, reading acuity (smallest detectable font size), and critical print size (smallest font size without reduction of reading speed) were analyzed. The average age of the subjects was 28.3 ± 2.6 years (male:female ratio, 4:16). The average reading time for 38 sentences was 3.66 ± 0.69 s, with no differences in the average maximum reading speed between sentences (p = 0.836). The maximum reading speed was 174.2 ± 29.3 and 175.4 ± 27.8 in the right and left eye, respectively. Reading acuity was measured as logMAR 0.0 or better in 80% of the cases. All subjects showed a critical print size of 0.2 logMAR or better. The overall reading ability can be measured using the Korean version of the MNREAD acuity chart, thereby making it useful in measuring the reading ability of those with Korean as their native language.

The 6-Item Vision-Related Quality of Life and Limitations Questionnaire: Evaluation of Psychometric Properties.

Purpose: We developed the Vision-related Quality of life and Limitations Questionnaire (VQL-6), a screening instrument to signal a need for additional care resulting from reduced vision-related quality of life in patients with chronic ophthalmic diseases. The aim of the present study was to evaluate psychometric properties. Methods: A Dutch population-based sample of 2032 participants (mean age, 55 ± 19 years) completed the VQL-6 and other questionnaires on vision-related quality of life, executive functioning, attention, mental health, and symptom validity. In addition, we recruited a sample of 208 ophthalmic patients (mean age, 72 ± 12 years) and 98 age and gender similar controls (mean age, 69 ± 11 years) who completed the VQL-6 and the National Eye Institute Visual Function Questionnaire-25. We studied the factor structure, internal consistency, convergent and divergent validity, and known-groups validity. Results: For the factor analyses, the population-based sample was split randomly in two subsamples. Exploratory factor analysis on the first subsample suggested a two-factor model (visual limitations and general health and quality of life), which was supported by confirmatory factor analyses on the second subsample, and on the patients. The VQL-6 demonstrated good internal consistency within each factor (0.78-0.89), sufficient convergent (r2= 55%) and divergent validity (r2 = 11%-24%), and good known-groups validity (Cohen's r = 0.57; P < 0.001). Conclusions: The VQL-6 has a robust two-factor structure and seems to be a valid tool to assess vision-related quality of life. Additional validation is needed in patients with chronic ophthalmic diseases. Translational Relevance: Future research is needed to determine if the VQL-6 can be used to identify patients with chronic ophthalmic diseases who are in need of additional care.

Daily Functionality of People with Low Vision: The Impact of Visual Acuity, Depression, and Life Orientation-A Cross-Sectional Study.

Background: Low vision (LV) has a significant negative impact on the activities of daily life as well as on the psychological health of patients. Objectives: The objective of this study is to investigate psychological, clinical, and demographic factors that may impact the daily functionality of patients with LV. Methods: A convenience sample of 53 patients, meeting the WHO criteria for LV, was recruited. Questionnaires on daily functionality, depression, and life orientation (in terms of optimism/pessimism) were administered along with a semistructured personal interview. Key Findings. The main results revealed a significant negative correlation between daily functionality and depression (r = -0.423, p < 0.001). Conversely, there is a positive correlation between daily functionality and visual acuity (r = 0.415, p < 0.001), while years since diagnosis were negatively correlated with depression (r = -0.345, p < 0.001). Depression seems to be a moderate predictor of a person's daily functionality (ß = -0.389, p < 0.002), followed by visual acuity (ß = -0.344, p = 0.006), explaining the 31.1% of the total variance. Conclusions: The study supports a correlation between daily functionality and both depression and visual acuity. Optimism as a personality characteristic did not factor into the prediction model for daily functionality, but it showed a strong correlation with lower levels of depressive symptoms. This highlights the potential for developing coping strategies for chronic disease management. Recommendations. The study could serve as a useful guide and may urge clinicians to pay attention to the psychological evaluation of these patients, supporting their unique emotional needs. Mental health professionals can use patients' positive resources to provide appropriate counseling and embrace the coping skills that encourage their engagement in activities of daily life.

Performance of students with different accessibility needs and preferences in "Design for All" MOOCs.

Recent research has shown that Massive Open Online Courses (MOOCs) create barriers for students with disabilities. Not taking into account their needs in the design, production or delivery of MOOCs may be one of the main causes behind this. It leads to poor compliance with suitable learning designs and web accessibility standards, as well as a lack of knowledge about the students' needs. The objective of our research is to analyze the learning performance of the students in MOOCs on topics related to Design for All, offered in an Open edX-based platform. Accessibility support was conceived from the outset, including compliance of both the platform and the learning resources with the WCAG 2.1 accessibility standard, and with a subset of the principles of Universal Design for Learning. Additionally, students were consulted on their accessibility needs and preferences, following publicly available modeling schemes and previous research. From a sample of 765 students, who completed at least one of the graded assessment activities of the course, a multilevel multiple logistic regression model was fitted. Based on that model, the results indicate that: a) users of screen readers and users of captions show a statistically significant positive association with a good performance when compared to students with no preferences, with an odds ratio of, respectively, OR = 13.482 and OR = 13.701; b) students who have low vision or very low vision show a significant negative association with a good performance when compared to users of screen readers and to users of captions, with OR = 26.817 and OR = 27.254, respectively.

Efectos secundarios oculares de las terapias oncológicas. Revisión / Ocular side effects of oncological therapies: Review

Con el avance de la terapia contra el cáncer en los últimos años, ha aumentado el conocimiento de los mecanismos involucrados en esta enfermedad, lo que ha supuesto un aumento de la calidad de vida y de la supervivencia de los pacientes con afecciones tumorales anteriormente consideradas incurables o refractarias al tratamiento. El número de fármacos utilizados ha sufrido un aumento exponencial, y a pesar de que la toxicidad implícita es menor que la de la terapia antineoplásica convencional, conllevan la aparición de nuevos efectos adversos asociados, que el oftalmólogo debe reconocer y manejar.(AU)

With the advance of cancer therapy in recent years, the knowledge of the mechanisms involved in this disease has increased, which has meant an increase in the quality of life and survival of patients with tumor pathologies previously considered incurable or refractory to treatment. The number of drugs used has increased exponentially in number, and although the implicit toxicity is lower than that of conventional antineoplastic therapy, they lead to the appearance of new associated adverse effects that the ophthalmologist must recognize and manage.(AU)

Visual Impairment and Real-World Home Physical Activity With Home Environment in an Older Population.

Importance: Physical activity levels are lower in visual impairment. However, additional factors, such as home environmental features, which can modify physical activity in this group, are unknown. Objective: To investigate the association between home environment features and home physical activity in patients with visual impairment. Design, Setting, and Participants: This cross-sectional study of clinical patients included participants with glaucoma suspect and primary glaucoma who were 60 years or older with varying degrees of visual field damage. Study participants were recruited from the Johns Hopkins Wilmer Eye Institute Glaucoma Clinic, Baltimore, Maryland, from September 2013 through March 2015. Data were analyzed from December 19, 2022, through December 25, 2022. Main Outcomes and Measures: Total in-home steps taken per day was the primary outcome measure; time in daily home physical activity and nonsedentary activity were secondary outcomes. Results: A total of 153 participants were included in analyses with mean age of 71 (SD, 7.8) years and 71 were female (46%). Sixty percent had more than 1 comorbid illness, about one-third took 5 or more prescription drugs, and median daily home steps were 1137. Median integrated visual field sensitivity was 28 dB. Better-eye median visual acuity in logMAR was 0.05 (20/22 Snellen equivalent). For every 0.1-log unit increment in average measured home lighting, participants took 5% more daily steps (rate ratio [RR], 1.05; 95% CI, 1.00-1.10; P = .04) and had a 3% faster average daily peak cadence (RR, 1.03; 95% CI, 1.01-1.05; P = .01). The average number of nonsedentary activity minutes (RR, 1.04; 95% CI, 1.00-1.07; P = .06), average bout duration (ß = 0.03; 95% CI, 0.00-.07; P = .06), and activity fragmentation (ß = -0.06; 95% CI, -0.13 to 0.00; P = .06) showed associations with home lighting. The number of hazards was not associated with any activity metric (steps: RR, 1.14; 95% CI, 0.96-1.34; P = .13; peak cadence: RR, 1.00; 95% CI, 0.93-1.08; P = .98; and nonsedentary time: RR, 1.11; 95% CI, 0.98-1.26; P = .11), nor was the frequency of hazards. Conclusions and Relevance: In this study, results demonstrated that home environment features, particularly lighting, may influence home activity metrics in older adults with visual impairment. Further prospective studies would be needed to confirm if home modifications can improve at-home activity.

Identifying causes of vision loss and assistive technology needs among patients attending rehabilitation clinic of a tertiary care center in North India.

PURPOSE: Investigating the causes of visual loss and the best corrected visual acuity (BCVA) is crucial for identifying avoidable eye problems and planning appropriate rehabilitation and assistive technology (AT) services. The study aimed to identify various causes of vision loss and determine AT required for vision rehabilitation (VR). METHODS: The electronic records of patients who attended the VR clinic at a tertiary eyecare for the past 2 years were reviewed. Information such as demographics, BCVA, and causes of visual impairment were retrieved from the records. BCVA was categorized into better than or equal to 1/60 and less than <1/60 for AT services. RESULTS: In total, 1723 patients, mostly male (71.2%), visited the rehabilitation clinic from 2018 to 2019. Around 58.6% of patients belonged to the age group 16-49 years, whereas 25.6% were less than 15 years old. The most frequent eye problems were retinal disorders (63.5%), followed by retinitis pigmentosa (15.2%) and rod-cone dystrophy (4.7%). In contrast, congenital disorders were the most common cause of vision loss among younger groups. Approximately 36.0% of patients had <1/60 blindness and 16.6% had ≥1/60. Around 17.1% of patients would benefit from large prints (near vision acuity N18-N12). CONCLUSION: Early detection and timely management will prevent a significant proportion of patients from developing irreversible vision loss. Around one-third of patients would benefit from visual substitution AT.

Prevalence of comorbidities with the potential to increase the risk of nonadherence to topical ocular hypotensive medication in patients with open-angle glaucoma.

OBJECTIVE: To evaluate the prevalence of comorbidities that may limit or prevent adherence to topical ocular hypotensive therapy in patients with open-angle glaucoma (OAG). METHODS: The UK Clinical Practice Research Datalink (CPRD) database of primary and secondary care and prescription records was analyzed to identify patients with a first (index) diagnosis of OAG during 2016-2020. The primary care records of these patients were screened for diagnostic terms linked to prespecified (qualifying) comorbidities considered to have the potential to impact patients' ability to instill eye drops. The prevalence of each of 10 categories of qualifying comorbidity recorded within the period from 5 years before to 2 years after the index OAG diagnosis was analyzed. RESULTS: A total of 100,968 patients with OAG were included in the analysis. Among the patients in the OAG cohort, 13,962 (13.8%) were aged 40-54 years, 32,145 (31.8%) were aged 55-69 years, 42,042 (41.6%) were aged 70-84 years, and 12,819 (12.7%) were aged 85+ years. Within the OAG population, 82.7%, 14.6%, and 2.7% of patients had no category, one category, and two or more categories of qualifying comorbidity, respectively. Qualifying comorbidities were most common in older patients. The most prevalent qualifying comorbidities were categorized as degenerative, traumatic, or pathological central nervous system disorder disrupting cognitive function (5.2%), movement disorder (4.4%), and low vision (4.1%). The prevalence of arthropathies and injuries affecting upper limbs (including arthritis in the hands) was 2.4%. CONCLUSIONS: The presence of comorbidities should be considered when determining whether eye drops are suitable treatment for glaucoma. Neurodegenerative disease affecting cognition and memory, motor disease, and low vision are common comorbidities that may impact adherence to eye drops, and affected patients may benefit from non-drop treatment modalities.

Uncorrected Refractive Error in the African American Eye Disease Study.

Importance: Refractive error remains the largest cause of correctable visual impairment in the US. Correction of refractive error will reduce visual impairment and its associated morbidity but also improve quality of life and productivity. Objective: To determine the burden of and risk factors (RFs) associated with any uncorrected refractive error (UCRE) and unmet refractive need (URN) in a population-based sample of African American adults. Design, Setting, and Participants: This cross-sectional study, conducted from April 2014 to April 2018, included a population-based sample of self-identified African American participants 40 years and older from 30 contiguous census tracts in Inglewood, California. Participants underwent a complete ophthalmic examination and an in-home-administered questionnaire to assess sociodemographic, lifestyle, biological, medical, and health care and eye care usage RFs associated with UCRE and URN. Measurements of visual acuity (VA) were performed using a standard Early Treatment Diabetic Retinopathy Study protocol. Noncycloplegic automated refraction with supplemental subjective refraction was performed. UCRE was defined as an improvement of 2 or more lines with refraction in the better-seeing eye. URN was defined as an improvement of 2 or more lines with refraction in the better-seeing eye in those persons who were visually impaired. Sex- and age-specific burden of UCRE and URN were calculated, and multiple regression analyses were used to identify independent RFs. Study data were analyzed from May 2018 to December 2023. Exposures: Presence or absence of correctable refractive error. Main Outcomes and Measures: Self-reported sex- and age-specific prevalence of and risk indicators of UCRE and URN. Results: Of the 7957 eligible participants in the African American Eye Disease Study (AFEDS), 6347 (80%) completed both the in-home interview and the clinical examination. Of these, 6337 participants (mean [SD] age, 61 [11] years; 3997 female [63%]) with complete refractive error data were included in the analysis. Refractive error-related correctable visual impairment was present in over two-thirds of participants with visual impairment (68.7%). The overall prevalence of any UCRE was 14.6% (925 of 6337), and the overall prevalence of any URN was 5.4% (URN1 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve 20/40 or better with correction], 157 of 2893; URN2 [those with presenting VA of worse than 20/40 in the better-seeing eye but who could achieve an improvement of 2 or more lines with refractive correction], 155 of 2891). Conclusions and Relevance: Results of this cross-sectional study suggest a high burden of refractive error-associated correctable refractive error in African American adults, making it the leading cause of visual impairment in this population. Providing universal coverage for vision care and prescription glasses is an affordable and achievable health care intervention that could reduce the burden of visual impairment in African American adults by over two-thirds and likely raise the quality of life and work productivity, especially in this vulnerable minority population.