Expert Views on Evidence-Based Classification for Goalball: A Delphi Study.

Para sport classification aims to minimize the impact of impairments on the outcome of competition. The International Paralympic Committee requires classification systems to be evidence based and sport specific, yet the sport of goalball uses a structure that is not supported by evidence demonstrating its legitimacy for competition. This study aimed to establish expert opinions on how a sport-specific system of classification should be structured in the sport of goalball. Using a three-round Delphi survey, 30 international experts expressed their views across topics linked to goalball classification. Participants were divided as to whether the current system fulfills the aim to minimize the impact of impairment on competition. Most felt that less impairment should be required to compete but that the one-class structure should remain. Experts identified measures of visual function that should be considered and 15 core components of individual goalball performance. Findings constitute a crucial first step toward evidence-based classification in goalball.

Avaliação dos alunos deficientes visuais e videntes do Instituto de Cegos Padre Chico / Evaluation of the visually impaired and sighted students at the Instituto de Cegos Padre Chico

RESUMO Objetivo Avaliar o perfil dos alunos concluintes, deficientes visuais e videntes do Instituto de Cegos Padre Chico entre os anos 2011 e 2020. Métodos Entre janeiro e março de 2021, foi realizada uma análise documental dos alunos concluintes entre os anos de 2011 e 2020. Foram coletados dados relacionados à situação social, educacional, socioeconômica e oftalmológica. Os dados foram tratados no programa Microsoft Excel 2013 da Microsoft e analisados no software livre Bioestat, versão 5.0. Resultados Foram coletados os dados de 110 concluintes cegos, com baixa visão e videntes. Mais de 90% dos alunos declararam rendimento familiar equivalente a um salário-mínimo e meio. Do total da amostra, 52 alunos eram cegos; 38 tinham baixa visão, e 20 eram videntes. Dentre as 36 patologias identificadas entre os alunos, 57,78% levaram à cegueira e 42,22%, à baixa visão. Em alunos cegos, as patologias mais frequentes foram glaucoma congênito (32,69%) e amaurose congênita de Leber (11,53%); em alunos com baixa visão, foram glaucoma congênito e distrofias de retina (ambas em 10,53% da amostra). Conclusão É de suma importância a avaliação da saúde ocular para que o professor realize de forma mais rápida as práticas de ensino e alcance resultados satisfatórios na alfabetização de crianças com deficiência visual.

ABSTRACT Objective To evaluate the profile of visually impaired and sighted students at the Instituto de Cegos Padre Chico (ICPC) between 2011 and 2020. Methods Between January and March 2021, a document analysis of the students who completed the undergraduate course between 2011 and 2020. Data related to social, educational, socioeconomic, and ophthalmological situation were collected. The data were treated in Microsoft Excel 2013 and analyzed in the free software Bioestat, version 5.0. Results Retrospective data were collected from 110 blind, low-vision and sighted students who were graduating. More than 90% of the students declared family income equivalent to one and a half minimum wages. Of the total sample, 52 students were blind; 38 had low vision, and 20 were sighted students. Among the 36 pathologies identified among the students, 57.78% led to blindness, and 42.22%, to low vision. In blind students, the most frequent diagnosis was congenital glaucoma (32.69%) and Leber congenital amaurosis (11.53%); in low vision students, congenital glaucoma and retinal dystrophies (both in 11.53% of the population of this study). Conclusion The evaluation of the eye health is of vital importance for the teacher to perform teaching practices faster and achieve satisfactory results in the literacy of visually impaired children.

Time-Trial Performance of Para-Cycling Athletes With Visual Impairment in Tandem Competitions: A Retrospective Analysis of 20 Yrs.

ABSTRACT: Identifying performance variables associated with visual impairment classification in para-cycling is one of the steps to improve the evidence-based classification system, and consequently, bring equality in Paralympic sports. Thus, this retrospective study aimed to analyze a 1-km tandem-track race performance among para-cyclists (male and female) with different visual impairment degrees (B1, B2, and B3) and to verify the retrospective performance over 20 yrs in all sport classes. The data were extracted from 427 para-cyclists (251 male and 176 female) who competed in the Para-Cycling World Championships and Paralympic Games. The following performance variables were analyzed: time trial, velocity, pace strategies, and number of medals. A one-way analysis of variance was used to compare performance variables among athletes of different sport classes (B1, B2, and B3) and χ2 tests were implemented to test the association between sport classes and medal distribution with a level of significance set at a P value of less than 0.05. The main results revealed that partially sighted athletes exhibited better tandem-track race performance compared with blind athletes (P < 0.05). Significant associations between sport classes and medal distribution in male (P = 0.026) and female (P = 0.017) athletes were found (higher in B3 athletes). Only 23.2% of male and 41.5% of female B3 athletes were medalists, and B3 athletes performed better specifically compared with B1 in most race distances. Finally, B2 and B3 athletes showed higher performance improvements than B1 throughout 20 yrs in the male group. It was concluded that male and female visual impairment athletes who classified as B1 displayed lower tandem-track race performance and medal frequency compared with partially sighted athletes, mainly considering those in the B3 class. The competitive system for athletes with visual impairment should be improved to provide more equity in the track para-cycling events.

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

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

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

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

May the best-sighted win? The relationship between visual function and performance in Para judo.

This study aimed to establish the optimal cut-off point(s) between classes in a new, evidence-based classification system for VI judo. We collected results from international VI judo competitions held between 2012 and 2018. Data on visual acuity (VA) and visual field (VF) measured during classification were obtained. Performance was determined by calculating a win ratio for each athlete. VA was significantly associated with judo performance (r = -.33, p <.001), VF was not (r =.30, p =.15). Decision tree analysis suggested to split the data into two groups with a VA cut-off of 2.5 logMAR units. Stability assessment using bootstrap sampling suggested a split into two groups, but showed considerable variability in the cut-off point between 2.0 and 3.5 logMAR. We conclude that to minimise the impact of impairment on the outcome of competition, VI judo should be split into two sport classes to separate partially sighted from functionally blind athletes. To establish an exact cut-off point and to decide if other measures of visual function need to be included, we argue for continued research efforts together with careful evaluation of research results from a multidisciplinary perspective.

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

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

Delphi methodology for symptomatology associated with visual dysfunctions.

To analyse what eyecare clinicians think about which symptoms are associated with refractive, accommodative and binocular dysfunctions, and which of them should be used in a questionnaire of visual symptomatology. A Delphi method was developed, using a coordinating group and a group of experts, and the process was conducted in three rounds. In the first round we compiled a list of 34 symptoms from the scientific literature and additional 10 suggested by the experts. These symptoms were categorized by each expert to the associated visual anomalies and working distance. In the second round, the relationship between each symptom and visual dysfunctions was analysed using a numeric scale. In the third round, the appearance or absence of the 44 symptoms in a questionnaire was assessed. Symptoms most frequently assigned by the experts to visual anomalies were related to near vision. Symptoms of blurred vision, difficulty focusing from one distance to another and close one eye obtained the highest mean score for refractive, accommodative and binocular disorders respectively. The experts were in agreement for 15 symptoms and in disagreement for 5 symptoms that should appear in a questionnaire. Delphi method has been used to identify the symptoms related to visual dysfunctions according to eyecare professionals and has allowed to arrive at appropriate symptoms to be asked for in a visual symptomatology questionnaire.

Evidence-based Classification in Track Athletics for Athletes with a Vision Impairment: A Delphi Study.

SIGNIFICANCE: The Delphi analysis presented here highlights the need for a sport-specific evidence-based classification system for track athletics for athletes with a vision impairment (VI). This system may differ for different race distances. Further research is required to develop a useful test battery of vision tests for classification. The issue of intentional misrepresentation during classification needs particular attention. PURPOSE: At present, athletes with VI are placed into competition classes developed on the basis of legal definitions of VI. The International Paralympic Committee Athlete Classification Code states that all sports should have their own classification system designed to reflect the (visual) demands of that individual sport. This project gathered expert opinion on the specific requirements for an evidence-based sport-specific classification system for VI track athletics and to identify any particular issues within track athletics that require further research into their impact on sport performance. METHODS: A three-round Delphi review was conducted with a panel of 17 people with expertise in VI track athletics. RESULTS: The panel agreed that the current classification system in VI track athletics does not completely minimize the impact of impairment on competition outcome, highlighting the need for improvements. There was clear agreement that the existing measures of vision may fail to adequately reflect the type of vision loss that would impact running performance, with additional measures required. Intentional misrepresentation, where athletes "cheat" on classification tests, remains a serious concern. CONCLUSIONS: The panel has identified measures of vision and performance that will inform the development of an evidence-based classification system by better understanding the relationship between VI and performance in track athletics. Issues such as the use of guides and whether the current class system was equitable gave rise to differing opinions within the panel, with these varying across the different running distances.

Artificial Intelligence Classification of Central Visual Field Patterns in Glaucoma.

PURPOSE: To quantify the central visual field (VF) loss patterns in glaucoma using artificial intelligence. DESIGN: Retrospective study. PARTICIPANTS: VFs of 8712 patients with 13 951 Humphrey 10-2 test results from 13 951 eyes for cross-sectional analyses, and 824 patients with at least 5 reliable 10-2 test results at 6-month intervals or more from 1191 eyes for longitudinal analyses. METHODS: Total deviation values were used to determine the central VF patterns using the most recent 10-2 test results. A 24-2 VF within a 3-month window of the 10-2 tests was used to stage eyes into mild, moderate, or severe functional loss using the Hodapp-Anderson-Parrish scale at baseline. Archetypal analysis was applied to determine the central VF patterns. Cross-validation was performed to determine the optimal number of patterns. Stepwise regression was applied to select the optimal feature combination of global indices, average baseline decomposition coefficients from central VFs archetypes, and other factors to predict central VF mean deviation (MD) slope based on the Bayesian information criterion (BIC). MAIN OUTCOME MEASURES: The central VF patterns stratified by severity stage based on 24-2 test results and a model to predict the central VF MD change over time using baseline test results. RESULTS: From cross-sectional analysis, 17 distinct central VF patterns were determined for the 13 951 eyes across the spectrum of disease severity. These central VF patterns could be divided into isolated superior loss, isolated inferior loss, diffuse loss, and other loss patterns. Notably, 4 of the 5 patterns of diffuse VF loss preserved the less vulnerable inferotemporal zone, whereas they lost most of the remaining more vulnerable zone described by the Hood model. Inclusion of coefficients from central VF archetypical patterns strongly improved the prediction of central VF MD slope (BIC decrease, 35; BIC decrease of >6 indicating strong prediction improvement) than using only the global indices of 2 baseline VF results. Eyes with baseline VF results with more superonasal and inferonasal loss were more likely to show worsening MD over time. CONCLUSIONS: We quantified central VF patterns in glaucoma, which were used to improve the prediction of central VF worsening compared with using only global indices.

Visual Function Classification System for children with cerebral palsy: development and validation.

AIM: To develop and validate the Visual Function Classification System (VFCS), which was created to classify how children with cerebral palsy (CP) use visual abilities in daily life. METHOD: The process of development and validation of the VFCS involved four phases: (1) drafting of the five levels from the analysis of literature and clinical experience; (2) validation of constructs and revision of the levels for concept meaningfulness, using nominal group process; (3) refinement by international Delphi survey; and(4) assessment of interrater reliability among professionals and with caregivers, and of test-retest reliability. RESULTS: Five nominal groups involved 29 participants; 65 people completed the first round and 51 the second round of the Delphi survey. Construct validity was demonstrated within an expert group and external validation through several stakeholders, with the involvement of patients and families to ensure meaningfulness of the concept. Discussions continued until consensus was reached about the construct and content of the five levels. Participants in the reliability study included 29 professionals, 39 parents, and a total sample of 160 children with CP (mean age [SD] 6y 6mo [3y 4mo]; median 5y 7mo, range 1-19y). Absolute interrater agreement among professionals was 86% (weighted κ=0.88; 95% confidence interval [CI] 0.83-0.93). Test-retest reliability was high (weighted κ=0.97; 95% CI 0.95-0.99). Parent-professional interrater reliability on 39 children was moderate (weighted κ=0.51; 95% CI 0.39-0.63). INTERPRETATION: The VFCS has been appropriately constructed and provides a reliable system to classify visual abilities of children with CP both in clinical and in research settings. WHAT THIS PAPER ADDS: The Visual Function Classification System is a valid and reliable system. It classifies visual abilities of children with cerebral palsy in clinical and research settings. At a clinical level, it can be used to harmonize communication among professionals and identify patients' strengths and weaknesses. In research settings, it can be used to stratify patients, define natural history evolution, and interpret intervention studies.

SISTEMA DE CLASIFICACIÓN DE LA FUNCIÓN VISUAL PARA NIÑOS CON PARÁLISIS CEREBRAL: DESARROLLO Y VALIDACIÓN: OBJETIVO: Desarrollar y validar el Sistema de Clasificación de la Función Visual (VFCS, siglas en inglés), que fue creado para clasificar cómo los niños con parálisis cerebral (PC) usan las habilidades visuales en la vida diaria. MÉTODO: El proceso de desarrollo y validación del VFCS involucró cuatro fases: (1) elaboración de los cinco niveles a partir del análisis de la literatura y la experiencia clínica; (2) la validación de constructos y la revisión de los niveles para el significado de los conceptos, utilizando un proceso de grupo nominal; (3) refinamiento por encuesta internacional de Delphi; (4) evaluación de la confiabilidad entre evaluadores entre profesionales y con los cuidadores, y de confiabilidad de prueba y reevaluación RESULTADOS: Cinco grupos nominales incluyeron 29 participantes; 65 personas completaron la primera ronda y 51 la segunda ronda de la encuesta de Delphi. La validez de constructo se demostró dentro de un grupo de expertos y una validación externa a través de varias partes interesadas, con la participación de los pacientes y las familias para garantizar el significado del concepto. Las discusiones continuaron hasta que se llegó a un consenso sobre el constructo y el contenido de los cinco niveles. Los participantes en el estudio de confiabilidad incluyeron 29 profesionales, 39 padres y una muestra total de 160 niños con PC (edad media [DS] 6 años 6 meses [3 años 4 meses]; mediana 5 años 7 meses, rango 1-19 años). El acuerdo de evaluador absoluto entre profesionales fue del 86% (κ ponderada = 0,88; intervalo de confianza del 95% [IC] 0,83-0,93). La fiabilidad de Test-Retest fue alta (κ ponderada = 0,97; IC del 95%: 0,95 a 0,99). La confiabilidad entre los padres y profesionales entre 39 niños fue moderada (ponderada κ = 0,51; IC del 95%: 0,39 a 0,63). INTERPRETACIÓN: El VFCS se ha construido de manera adecuada y proporciona un sistema confiable para clasificar las habilidades visuales de los niños con PC, tanto en el ámbito clínico como en el de investigación.

SISTEMA DE CLASSIFICAÇÃO DA FUNÇÃO VISUAL PARA CRIANÇAS COM PARALISIA CEREBRAL: DESENVOLVIMENTO E VALIDAÇÃO: OBJETIVO: Desenvolver e validar o Sistema de Classificação da Função Visual (SCFV), que foi criado para classificar como crianças com paralisia cerebral (PC) usam capacidades visuais na vida diária. MÉTODO: O processo de desenvolvimento e validação do SCFV envolve quatro fases: (1) rascunho dos cinco níveis a partir da análise da literatura e experiência clínica; (2) validação de construtos e revisão dos níveis de significância dos conceitos, usando processo nominal de grupos; (3) refinamento por meio de levantamento Delphi internacional; (4) avaliação da confiabilidade inter-examinadores entre profissionais e cuidadores, e confiabilidade teste-reteste. RESULTADOS: Cinco grupos nominais envolveram 29 participantes; 65 pessoas completaram a primeira rodada e 51 a segunda rodada do levantamento Delphi. A validade de constructo foi demonstrada em um grupo de especialistas, e a validade externa por meio de vários interessados, com envolvimento de pacientes e famílias para assegurar a significância do conceito. As discussões continuaram até que fosse atingido consenso sobre o constructo e o conteúdo dos cinco níveis. Os participantes no estudo de confiabilidade incluíram 29 profissionais, 39 pais e uma amostra total de 160 crianças com PC (média de idade [DP] 6a 6m [3a 4m]; mediana 5a 7m, variação 1-19a). A confiabilidade inter-examinadores absoluta entre profissionais foi 86% (κ ponderado=0,88; intervalo de confiança [IC] a 95% 0,83-0,93). A confiabilidade teste-reteste foi alta (κ ponderado =0,97; IC 95% 0,95-0,99). A confiabilidade inter-examinadores pais-profissionais em 39 crianças foi moderada (κ ponderado =0,51; IC 95% 0,39-0,63). INTERPRETAÇÃO: O SCFV foi elaborado apropriadamente e é um sistema confiável para classificar as capacidades visuais de crianças com PC em ambientes clínicos e acadêmicos.

Delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale (RASS): Inattention and visuo-spatial impairment as potential screening domains.

OBJECTIVE: In the intensive care setting, delirium is a common occurrence; however, the impact of the level of alertness has never been evaluated. Therefore, this study aimed to assess the delirium characteristics in the drowsy, as well as the alert and calm patient. METHOD: In this prospective cohort study, 225 intensive care patients with Richmond Agitation and Sedation Scale (RASS) scores of -1 - drowsy and 0 - alert and calm were evaluated with the Delirium Rating Scale-Revised-1998 (DRS-R-98) and the Diagnostic and Statistical Manual 4th edition text revision (DSM-IV-TR)-determined diagnosis of delirium. RESULTS: In total, 85 drowsy and 140 alert and calm patients were included. Crucial items for the correct identification of delirium were sleep-wake cycle disturbances, language abnormalities, thought process alterations, psychomotor retardation, disorientation, inattention, short- and long-term memory, as well as visuo-spatial impairment, and the temporal onset. Conversely, perceptual disturbances, delusions, affective lability, psychomotor agitation, or fluctuations were items, which identified delirium less correctly. Further, the severities of inattentiveness and visuo-spatial impairment were indicative of delirium in both alert- or calmness and drowsiness. SIGNIFICANCE OF RESULTS: The impairment in the cognitive domain, psychomotor retardation, and sleep-wake cycle disturbances correctly identified delirium irrespective of the level alertness. Further, inattentiveness and - to a lesser degree - visuo-spatial impairment could represent a specific marker for delirium in the intensive care setting meriting further evaluation.

[Vision screening in children: Review of the literature]. / Dépistage visuel de l'enfant : revue de la littérature.

In children, refractive errors and amblyopia are the two most common causes of avoidable visual impairment. Screening for these is essential, especially since there is a so-called "sensitive" period during which the maturation of the visual pathways is not complete. The child's visual prognosis will therefore depend on his or her age, the duration of the visual deprivation and the timing of management. Visual screening is part of a public health approach, but there are significant regional disparities regarding its organization and the means used. We conducted a review of the literature in order to establish an inventory of available resources and improve practices.

Degree of vision impairment influence the fight outcomes in the Paralympic judo: a 10-year retrospective analysis.

BACKGROUND: In the International Blind Sports Federation (IBSA) judo Sports Classes B1, B2, and B3 compete against each other within weight- and gender-specific categories. B1 athletes are totally blind, whereas B2 and B3 are partially sighted. The aim of this study was to examine the impact of the degree of vision impairment on fight outcomes. METHODS: We analyzed 1936 fights from official competitions and compare win ratio in fights between discordant Sports Classes. RESULTS: B1 won B2 ratio was 34.8%, B1 won B3 ratio was 36.5%, B2 won B3 ratio = 50.6%. The B1 percent of IBSA judo athletes decreased from 25.9% in 2007 to 19.4% in 2016, while the total number of participants increased over this period. CONCLUSIONS: These findings confirm that blind athletes have fewer chances to win a fight in IBSA Judo and become a member of National Team. Loss of vision functions affects movement coordination, balance, and emotional state, which are important for martial arts and may explain why B1 athletes are more likely to lose competitions against either B2 or B3. Creation of the evidence-based and sport-specific classification system and/or improvement of the technical rules are necessary for fair IBSA Judo competitions.

Deep-learning Classifier With an Ultrawide-field Scanning Laser Ophthalmoscope Detects Glaucoma Visual Field Severity.

PURPOSE: To evaluate the accuracy of detecting glaucoma visual field defect severity using deep-learning (DL) classifier with an ultrawide-field scanning laser ophthalmoscope. METHODS: One eye of 982 open-angle glaucoma (OAG) patients and 417 healthy eyes were enrolled. We categorized glaucoma patients into 3 groups according to the glaucoma visual field damage (Humphrey Field Analyzer 24-2 program) [early; -6 dB (mean deviation) or better, moderate; between -6 and -12 dB, and severe as mean deviation of -12 dB or worse]. In total, 558 images (446 for training and 112 for grading) from early OAG patients, 203 images (162 for training and 41 for grading) from moderate OAG patients, 221 images (176 for training and 45 for grading) from severe OAG patients and 417 images (333 for training and 84 for grading) from normal subjects were analyzed using DL. The area under the receiver operating characteristic curve (AUC) was used to evaluate the accuracy after 100 trials. RESULTS: The mean AUC between normal versus all glaucoma patients was 0.872, the sensitivity was 81.3% and the specificity was 80.2%. In normal versus early OAG, mean AUC was 0.830, the sensitivity was 83.8% and the specificity was 75.3%. In normal versus moderate OAG, mean AUC was 0.864, sensitivity was 77.5%, and specificity was 90.2%. In normal versus severe OAG glaucoma mean AUC was 0.934, sensitivity was 90.9%, and specificity was 95.8%. CONCLUSIONS: Despite using an ultrawide-field scanning laser ophthalmoscope, DL can detect glaucoma characteristics and glaucoma visual field defect severity with high reliability.

Vision In Stroke cohort: Profile overview of visual impairment.

AIM: To profile the full range of visual disorders from a large prospective observation study of stroke survivors referred by stroke multidisciplinary teams to orthoptic services with suspected visual problems. METHODS: Multicenter prospective study undertaken in 20 acute Trust hospitals. Standardized screening/referral forms and investigation forms documented data on referral signs and symptoms plus type and extent of visual impairment. RESULTS: Of 1,345 patients referred with suspected visual impairment, 915 were recruited (59% men; mean age at stroke onset 69 years [SD 14]). Initial visual assessment was at median 22 days post stroke onset. Eight percent had normal visual assessment. Of 92% with confirmed visual impairment, 24% had reduced central visual acuity <0.3 logMAR and 13.5% <0.5 logMAR. Acquired strabismus was noted in 16% and acquired ocular motility disorders in 68%. Peripheral visual field loss was present in 52%, most commonly homonymous hemianopia. Fifteen percent had visual inattention and 4.6% had other visual perceptual disorders. Overall 84% were visually symptomatic with visual field loss the most common complaint followed by blurred vision, reading difficulty, and diplopia. Treatment options were provided to all with confirmed visual impairment. Targeted advice was most commonly provided along with refraction, prisms, and occlusion. CONCLUSIONS: There are a wide range of visual disorders that occur following stroke and, frequently, with visual symptoms. There are equally a wide variety of treatment options available for these individuals. All stroke survivors require screening for visual impairment and warrant referral for specialist assessment and targeted treatment specific to the type of visual impairment.

Sport classification for athletes with visual impairment and its relation with swimming performance / Classificação esportiva para atletas com deficiência visual e sua relação com o desempenho na natação

Abstract The medical classification (MC) adopted for swimmers with vision visual impairment (VI) does not clearly elucidate the influence of vision loss on performance. In a documentary research, the final time in the 50-, 100- and 400-m freestyle events and MC (S11, S12 and S13) of national (n = 40) and international (n = 72) elite swimmers was analyzed. The analysis was performed using the Kruskal-Wallis test and Spearman’s correlation with 95% confidence (P < 0.05) and Cohen’s d was calculated. There was a large effect of MC on the final time in the 50-m (P = 0.034, d = 1.55) for national athletes and in the 50-m (P = 0.001, d = 2.64), 100-m (P = 0.001, d = 3.01) and 400-m (P = 0.001, d = 2.88) for international athletes. S12 and S13 classes were faster compared to S11 class for all international events, but only in the 50-m for the national event (P < 0.05). It was found a strong negative relationship between the final time and MC for international athletes (Spearman’s Rho ≥ 0.78). There was a significant influence of MC on the performance of swimmers in freestyle races, especially in international swimmers. Thus, having a visual residue seems to be sufficient for S12 and S13 swimmers to achieve similar performance.

Resumo A classificação médica (CM) adotada aos nadadores com deficiência visual (DV) não consegue elucidar claramente a influência da perda da visão no desempenho. Em uma pesquisa documental, analisou-se o tempo final de prova dos 50, 100 e 400m livre e a CM (S11, S12 e S13) de nadadores nacionais (n = 40) e internacionais (n = 72) de elite. Utilizou-se o teste de Kruskal-Wallis e a correlação de Spearman, com 95% de confiança (P < 0,05) e o tamanho do efeito d de Cohen foi calculado. Verificou-se um grande efeito da CM no tempo final de prova dos 50m (P = 0,034; d = 1,55) para atletas nacionais e dos 50m (P = 0,001; d = 2,64), 100m (P = 0,001; d = 3,01) e 400m (P = 0,001; d = 2,88) para atletas internacionais. As classes S12 e S13 foram mais rápidas comparadas à classe S11 em todas as provas internacionais, mas apenas nos 50m nas provas nacionais (P < 0,05). Foram encontrados fortes relacionamentos negativos entre o tempo final de prova e a CM para os atletas internacionais (Rho de Spearman ≥ 0,78). Houve uma significativa influência da CM no desempenho de nadadores nas provas do nado livre, especialmente em nadadores internacionais. Assim, ter um resíduo visual parece ser o suficiente para que os nadadores com baixa visão, nas classes S12 e S13, adquiram performance semelhante.