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1.
Ophthalmic Physiol Opt ; 39(6): 422-431, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31696539

RESUMO

PURPOSE: To evaluate the efficacy of electronic head-mounted low vision aid (e-LVA) SightPlus (GiveVision, UK, givevision.net) and to determine which people with low vision would see themselves likely using an e-LVA like this. METHODS: Sixty participants with low vision aged 18 to 93 used SightPlus during an in-clinic study session based on a mixed methods design. Visual acuity (ETDRS), contrast sensitivity (Pelli-Robson) and reading performance (MNREAD) were measured binocularly at baseline (no device), with the device in 'normal' mode (zoom only), and with preferred enhanced mode (zoom and one of four digital image enhancements). At the end of the session, a short questionnaire recorded willingness to use an e-LVA like SightPlus, potential use cases, positive/negative comments and adverse effects. RESULTS: Binocular distance visual acuity improved significantly by 0.63 logMAR on average (p < 0.0001) to 0.20 logMAR. Contrast sensitivity improved significantly by 0.22 log units (p < 0.0001) to 1.21 log units with zoom only and by 0.40 log units to 1.37 log units with zoom and preferred image enhancement. Reading performance improved significantly for near visual acuity and critical print size (p < 0.015), although reading speed significantly decreased (p < 0.0001). Nearly half (47%) of the participants indicated they would use an e-LVA like SightPlus, especially for television, reading and entertainment (e.g. theatre). Multivariate logistic regression showed that proportion of lifetime affected by sight loss, baseline contrast sensitivity and use of electronic LVAs explained 41% of the variation in willingness to use. CONCLUSIONS: SightPlus improves visual function in people with low vision and would be used in its current form by one half of the people who tried it. Adverse effects were infrequent and resolved when the device was removed. Future work should focus on comparing e-LVAs through repeatable real-world tasks and impact on quality of life.


Assuntos
Sensibilidades de Contraste/fisiologia , Qualidade de Vida , Auxiliares Sensoriais , Baixa Visão/reabilitação , Acuidade Visual , Dispositivos Eletrônicos Vestíveis , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Visuais , Baixa Visão/fisiopatologia , Pessoas com Deficiência Visual/reabilitação , Adulto Jovem
2.
Optom Vis Sci ; 96(10): 718-725, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31592954

RESUMO

SIGNIFICANCE: One-year follow-up is recommended for patients with macular diseases to assess functional changes associated with disease progression and to modify low-vision (LV) treatment plans, if indicated. PURPOSE: The purpose of this study was to observe 255 patients with macular diseases who received LV rehabilitation (rehabilitation with a therapist) or basic LV services (LV devices dispensed without therapy) during Veterans Affairs Low-vision Intervention Trial II after the trial ended at 4 months until 1-year follow-up. METHODS: The primary outcome measure was visual ability measured with the 48-item Veterans Affairs Low-vision Visual Functioning Questionnaire. Mean visual ability scores for the treatment groups were compared from baseline to 4 months, 4 months to 1 year, and baseline to 1 year. Changes from baseline to 1 year were compared between the two groups. Predictors of changes in visual ability from 4 months to 1 year were assessed using linear regression. RESULTS: Both groups experienced significant improvement in all measures of visual ability from baseline to 1 year but lost visual reading ability during the observation period (LV rehabilitation group, -0.64 [1.2] logit; 95% confidence interval [CI], -0.84 to -0.44 logit; basic LV group, -0.63 [1.4] logit; 95% CI, -0.88 to -0.38 logit), and overall visual ability was lost in the LV rehabilitation group (-0.20 [0.8] logit; 95% CI, -0.34 to -0.06 logit). Loss of visual reading ability in both groups from 4 months to 1 year was predicted by reading ability scores at 4 months, loss of near visual acuity from 4 months to 1 year, and lower EuroQol-5D utility index scores; loss of overall visual ability in the LV rehabilitation group during the same time period was predicted by lower overall ability scores at 4 months. CONCLUSIONS: Visual ability significantly improved in all groups from baseline to 1 year. However, the loss of visual reading ability experienced by both groups from 4 months to 1 year reduced the benefit of the services provided.


Assuntos
Doenças Retinianas/reabilitação , Veteranos/estatística & dados numéricos , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Reabilitação , Doenças Retinianas/fisiopatologia , Perfil de Impacto da Doença , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos , United States Department of Veterans Affairs , Baixa Visão/fisiopatologia , Acuidade Visual/fisiologia
3.
Rev Chil Pediatr ; 90(3): 293-301, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31344189

RESUMO

INTRODUCTION: A low-vision (LV) rehabilitated child can receive comprehensive education. Objec tive: To study the profile of school children referred for evaluation to a rehabilitation project in a social assistance agency. PATIENTS AND METHOD: Descriptive cross-sectional study of beneficiaries evaluated between September 2015 and September 2016 in the National Board of School Assistan ce and Scholarships (JUNAEB). The referral diagnosis, monocular visual acuity (VA) with optical correction at far (Feinbloom chart) and close (Zeiss chart) distances were considered. They were classified according to VA and perimetry. Treatment success was considered if VA reaches > 0.4 at far and/or close distances with optical devices. RESULTS: 278 students were assessed. 153 (55%) were men, 121 (43.5%) between the ages of 10 to 14. Bilateral congenital cataract, retinal dystrophies, high myopia, optic atrophy, and congenital nystagmus were the most frequent pathologies. 224 students (80.6%) received optical devices. 85 (37.9%) presented moderate LV and 63 (28.6%) severe LV; 122 (54.5%) presented normal perimetry, 68 (30.4%) tubular Visual Field (VF), 19 (8.5%) sectoral VF defects, and 15 (6.7%) central scotoma. 198 (88.4%) students achieved visual success at a far distance and all achieved visual success at a near distance. 48 (17.2%) students could not be rehabilitated due to a neuro-ophthalmological condition (41.7%), high refractive error (16.6%) or congenital glauco ma (10.4%).Six (2.2%) cases improved VA with a new optical correction. CONCLUSION: This success demonstrates the need to provide low vision aids to schoolchildren with LV. Our challenge is to maintain this program and to educate ophthalmologist for timely referral.


Assuntos
Transtornos da Visão/reabilitação , Baixa Visão/reabilitação , Acuidade Visual , Adolescente , Criança , Pré-Escolar , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos da Visão/epidemiologia , Transtornos da Visão/fisiopatologia , Baixa Visão/epidemiologia , Baixa Visão/fisiopatologia , Adulto Jovem
4.
Turk J Ophthalmol ; 49(3): 154-163, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31245978

RESUMO

With increased life expectancy at birth and especially the rising incidence of age-related macular degeneration, low vision (re)habilitation is becoming more important today. Important factors to consider when presenting rehabilitation and treatment options to patients presenting to low vision centers include the diagnosis of the underlying disease, the patient's age, their existing visual functions (especially distance and near visual acuity), whether visual loss is central or peripheral, whether their disease is progressive or not, the patient's education level, and their expectations from us. Low vision patients must be guided to the right centers at the appropriate age, with appropriate indications, and with realistic expectations, and the rehabilitation process must be carried out as a multidisciplinary collaboration.


Assuntos
Oftalmologia/métodos , Baixa Visão/reabilitação , Acuidade Visual/fisiologia , Humanos , Baixa Visão/fisiopatologia
5.
Graefes Arch Clin Exp Ophthalmol ; 257(7): 1499-1512, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111250

RESUMO

BACKGROUND: Age-related macular degeneration (AMD) causes reading impairment, reduced quality of life (QoL), and secondary depression. We have shown that support with magnifying aids improved reading speed (RS), emotional and cognitive status, and QoL. The present study investigates whether additional reading training (RT) (after adapting to appropriate visual aids) can further improve vision rehabilitation. METHODS: Patients with dry AMD were randomly assigned to 2 groups. The primary RT group (P-RTG, n = 25) trained with sequentially presented text (RSVP), and the control group (CG, n = 12) performed placebo training (crossword puzzles) and later crossed over to RT, so that altogether 37 participants performed reading training. Patients trained at home on a PC for 6 weeks. RS was assessed during reading printed paragraphs of text aloud. Using a scanning laser ophthalmoscope, we examined fixation stability and preferred retinal locus (PRL) for fixating a cross, as well as PRL and eye movements during reading single words. We assessed emotional status by Montgomery-Åsberg Depression Rating Scale (MADRS), cognitive status by dementia detection test ( DemTect ) and QoL by Impact of Vision Impairment (IVI) profile. Visual acuity and magnification requirement were examined by standard procedures. All variables were measured before and after placebo training, before and after RT, and after 6 weeks without training (follow-up). RESULTS: RS improved significantly in the P-RTG during RT, but not in the CG during placebo training. The effect remained stable at follow-up. Fixation performance and eye movement variables did not change. Emotional status (MADRS) improved in P-RTG during RT and showed a significant difference of the change of scores between the 2 groups. Complete IVI scores improved significantly during RT and remained stable. CONCLUSION: The results indicate that patients with AMD, who already use magnifying aids, benefit from additional RT and that it can contribute in preventing depression and improve QoL. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register (DRKS00015609).


Assuntos
Movimentos Oculares/fisiologia , Degeneração Macular/reabilitação , Qualidade de Vida , Leitura , Ensino , Baixa Visão/reabilitação , Acuidade Visual/fisiologia , Idoso , Feminino , Fixação Ocular/fisiologia , Humanos , Degeneração Macular/complicações , Degeneração Macular/fisiopatologia , Masculino , Oftalmoscopia , Baixa Visão/etiologia , Baixa Visão/fisiopatologia
6.
Optom Vis Sci ; 96(5): 345-353, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31046017

RESUMO

SIGNIFICANCE: The successful uptake, integration, and use of vision rehabilitation devices with speech output depend to a large part on their audibility. However, individuals with combined vision and hearing impairments are at a disadvantage when using devices that do not consider multiple impairments. PURPOSE: Sensory rehabilitation for individuals with combined vision and hearing impairment often relies on the use of assistive technology devices that use speech outputs (e.g., talking clock), but in individuals with dual impairment, their use is likely compromised by a concurrent hearing loss. The goal of this study was to evaluate the audibility of these devices in a population of individuals with acquired dual sensory impairment. METHODS: We measured the ability to correctly repeat speech output presented by three assistive technology devices (talking watch, calculator, scanner) and confidence levels in response accuracy in 24 participants with visual impairment only and in 22 individuals with dual sensory loss. Stimuli were presented at three volumes that were repeated one or four times. Participants were placed at a fixed distance of 74 cm from the sound source. RESULTS: The pattern of results was similar across the different devices, whereby an interaction of volume and repetition indicated that participants' accuracy to repeat a phrase and their confidence in their response improved with increasing volume, but more so at higher numbers of repetition (P < .05; ω, from 0.005 to 0.298). Participants with dual sensory loss generally had lower accuracy and confidence. CONCLUSIONS: Scores and confidence levels being very low across devices and users suggest that even participants with normal hearing for their age experienced a certain level of difficulty understanding speech output, confirming the need for better assistive technology device design.


Assuntos
Recursos Audiovisuais , Percepção Auditiva/fisiologia , Auxiliares de Audição , Perda Auditiva Neurossensorial/reabilitação , Pessoas com Deficiência Auditiva/reabilitação , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Idoso , Idoso de 80 Anos ou mais , Correção de Deficiência Auditiva/instrumentação , Feminino , Audição/fisiologia , Perda Auditiva Neurossensorial/fisiopatologia , Testes Auditivos , Humanos , Masculino , Equipamentos de Autoajuda , Baixa Visão/fisiopatologia
7.
Indian J Ophthalmol ; 67(5): 669-676, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31007237

RESUMO

Purpose: Coping strategies employed by people with visual disability can influence their quality of life (QoL). We aimed to assess coping in patients with low vision or blindness. Methods: In this descriptive cross sectional study, 60 patients (25-65 years) with <6/18 best-corrected vision (BCVA) in the better eye and vision loss since ≥6 months were recruited after the institutional ethics clearance and written informed consent. Age, gender, presence of other chronic illness, BCVA, coping strategies (Proactive Coping Inventory, Hindi version), and vision-related quality of life (VRQoL; Hindi version of IND-VFQ33) were recorded. Range, mean (standard deviation) for continuous and proportion for categorical variables. Pearson correlation looked at how coping varied with age and with VRQoL. The analysis of variance (ANOVA) and t-test compared coping scores across categorical variables. Statistical significance was taken at P < 0.05. Results: Sixty patients fulfilled inclusion criteria. There were 33 (55%) women; 25 (41.7%) had low vision, 5 (8.3%) had economic blindness, and 30 (50.0%) had social blindness; 27 (45.0%) had a co-morbid chronic illness. Total coping score was 142 ± 26.43 (maximum 217). VRQoL score (maximum 100) was 41.9 ± 15.98 for general functioning; 32.1 ± 12.15 for psychosocial impact, and 41.1 ± 17.30 for visual symptoms. Proactive coping, reflective coping, strategic planning, and preventive coping scores correlated positively with VRQoL in general functioning and psychosocial impact. Conclusion: Positive coping strategies are associated with a better QoL. Ophthalmologists who evaluate visual disability should consider coping mechanisms that their patients employ and should refer them for counseling and training in more positive ways of coping.


Assuntos
Adaptação Psicológica , Qualidade de Vida/psicologia , Baixa Visão/reabilitação , Acuidade Visual/fisiologia , Pessoas com Deficiência Visual/reabilitação , Adulto , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Perfil de Impacto da Doença , Inquéritos e Questionários , Baixa Visão/psicologia
8.
Ophthalmic Physiol Opt ; 39(2): 113-126, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30776848

RESUMO

PURPOSE: To evaluate outcome measures of the Participation and Activity Inventory (PAI) in a sample of adults with acquired visual impairment entering vision rehabilitation. Both Priority Scores, indicating level of rehabilitative need, and Person Measures, indicating goal difficulty, were considered. METHODS: Participants were newly registered adults with visual impairment within Leicestershire, United Kingdom. The importance and difficulty of 48 goals of the PAI were assessed, as were demographic factors, clinical visual function (visual acuity, contrast sensitivity, reading function) and psychosocial function (adjustment to visual loss, depression, anxiety and fear of falling). Priority scores were calculated as the product of importance and difficulty of each goal. All questionnaires were Rasch analysed, and person and item measures of perceived difficulty with goals were derived. RESULTS: Sixty people (mean age ± S.D. = 75.8 ± 13.8 years) took part. PAI goals with greatest rehabilitative need were reading (6.82 ± 2.91), mobility outdoors (6.55 ± 3.92), mobility indoors within an unfamiliar environment (5.52 ± 3.93) and writing (5.27 ± 3.02). Greater rehabilitative need was associated with younger age (ß = -0.46, p < 0.001), and with higher depressive symptomatology (ß = 0.35, p < 0.01; model R2 34%). Goals with greatest difficulty were mending clothing (-1.95 ± 0.35 logits) and hobbies and crafts (-1.32 ± 0.23 logits). Greater difficulty was associated with higher depressive symptomatology (ß = 0.39, p < 0.001), lower visual acuity (ß = 0.42, p < 0.001) and lower adjustment of visual loss (ß = 0.31, p < 0.01; model R2 53%). CONCLUSIONS: Key rehabilitation needs for adults at entry to services require both optical and non-optical interventions. As rehabilitative need was not associated with the level of visual impairment, eyecare professionals should not wait until the end of medical treatment before referral for support. Similarly, rehabilitative need was associated with younger age, indicating the importance to refer younger people with sight loss at an early stage. The use of structured assessment, such as the PAI, ensures goals that have an impact upon quality of life are specifically identified. Depression screening on entry to rehabilitation is relevant as it predicts both perceived difficulty and rehabilitative need.


Assuntos
Atividades Cotidianas , Sensibilidades de Contraste/fisiologia , Qualidade de Vida , Baixa Visão/reabilitação , Acuidade Visual/fisiologia , Pessoas com Deficiência Visual/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Leitura , Inquéritos e Questionários , Baixa Visão/epidemiologia , Baixa Visão/fisiopatologia , Pessoas com Deficiência Visual/reabilitação
9.
Optom Vis Sci ; 96(3): 213-220, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30801506

RESUMO

SIGNIFICANCE: Delivering personalized three-dimensional (3D)-printed solutions for our patients is easier now than it has ever been. This technological revolution makes things possible that it would be extremely challenging to achieve using traditional approaches. PURPOSE: The purpose of this study was to increase awareness among the optometric and vision science community of opportunities to apply 3D printing to enhance clinical practice and research. METHODS: A widely available fused deposition modeling 3D printing approach was used to fabricate several plastic items for use in optometric practice and low vision rehabilitation. RESULTS: The authors will share nine optometric extensions of 3D printing: (1) an attachment for glare-acuity testing, (2) a disposable cover paddle to limit infection spread for red-eye visits, (3) ophthalmic equipment repair/modification, (4) ophthalmic lens thickness calipers, (5) NoIR lens filter flipper, (6) Optivisor faceplate, (7) EasyPocket lanyard card holder, (8) dome magnifier handle, and (9) a phoropter near card holder. CONCLUSIONS: Designing customized solutions and problem-solving for our patients and offices are becoming easier to do using 3D printing every year. The possible applications for this technology are constantly being expanded. This technology allows for cost-effective production of solutions, some of which would not be feasible otherwise.


Assuntos
Optometria/métodos , Impressão Tridimensional , Baixa Visão/reabilitação , Ofuscação , Humanos , Oftalmologia , Acuidade Visual/fisiologia
10.
Surv Ophthalmol ; 64(4): 512-557, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703405

RESUMO

Visual impairment in childhood often has life-long implications. To aim for the highest levels of functioning, participation, and quality of life and to ensure children's well-being, children should be entitled to the most effective rehabilitation programs. We review evidence for the effectiveness of rehabilitation interventions for children with visual impairment to improve skills and behavior, thereby improving participation and quality of life as an ultimate goal. Of the 441 potentially relevant articles identified, 66 studies met our inclusion criteria (i.e., 28 randomized controlled trials, 18 nonrandomized controlled trials, and 20 before-after comparisons). The results suggest that sports camps, prescription and training in the use of low vision devices, and oral hygiene programs might be effective in improving functioning and elements of participation and quality of life in children with visual impairment. Other interventions showed mixed or negative results. The results should be interpreted with caution because of moderate to high risk of bias and suboptimal reporting. Heterogeneity of results and the use of over 50 different outcome measures prevented a meta-analysis. Future studies should focus on promising interventions for which effectiveness is still unclear (e.g., mobility, social skills), with adequately designed methodology.


Assuntos
Atividades Cotidianas , Qualidade de Vida , Baixa Visão/reabilitação , Humanos , Destreza Motora/fisiologia , Leitura , Habilidades Sociais
11.
Optom Vis Sci ; 96(2): 130-132, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601361

RESUMO

This work challenges the standard of the past 40 years, which required the use of a bioptic telescope by individuals with vision loss wanting to be licensed to drive in most states in the United States.Driving continues to be the key to independence for many individuals, particularly older drivers who live in an area where public transportation is limited or nonexistent. For the past 40 years, the most frequently option to allow drivers who are visually impaired to maintain driving privileges was to require them to use a bioptic telescope. Bioptic telescopes were felt to be necessary for wayfinding when driving. In addition, it was thought that a person could look through a bioptic telescope and still be aware of the driving environment around him/her. Human factor research has shown that the assertion that an individual can attend to two tasks simultaneously is not possible. Taking one's eyes off the road for as little as 2 seconds can lead to lane position breakdown. In 2018, wayfinding can now be more easily accomplished with the use of ubiquitous technologies like Global Positioning System systems on our telephones and in our cars. Driver distraction principles support safer alternatives to bioptic telescopes because these audio options allow the drivers to maintain their eyes and their attention on the road and the traffic around them. The switching of view within the bioptic spectacles is attentionally demanding, and the visual field restriction of such devices reduces overall situation awareness by narrowing the driver's attention.


Assuntos
Condução de Veículo , Conscientização , Sistemas de Informação Geográfica/instrumentação , Processamento Espacial , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Acidentes de Trânsito , Adulto , Exame para Habilitação de Motoristas , Feminino , Humanos , Masculino , Acuidade Visual
12.
Acta Ophthalmol ; 97(2): 165-172, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30207073

RESUMO

PURPOSE: To compare health-related quality of life and participation of visually impaired young adults with normative groups, and to explore severity of vision loss and its association with participation and quality of life. METHODS: Young adults aged 18-25 years (n = 172) registered at two Dutch low vision rehabilitation organizations completed the Short Form Health Survey (SF-36), EuroQol-5 Dimensions (EQ-5D), Impact on Participation and Autonomy (IPA) and Low Vision Quality of Life questionnaire (LVQOL). EQ-5D and SF-36 scores were compared to age-specific norms. IPA scores were compared to norms of a population having three chronic diseases simultaneously. Linear regression was used to assess the association between severity of vision loss (mild VI, moderate VI and severe VI/blindness), and quality of life and participation. RESULTS: Participants scored significantly worse on almost all (sub)scales compared with relevant norms. Effect sizes for the EQ-5D and SF-36 (sub)scales were mostly small; moderate and large effect sizes were found for the IPA. Compared to young adults with mild VI, corrected models showed a significant association between having moderate VI and the physical component score of the SF-36, and between severe VI/blindness and the LVQOL. CONCLUSION: VI has a moderate impact on some aspects of quality of life and a large impact on participation of young adults when compared with relevant normative populations. Severity of vision loss is associated with worse physical functioning and vision-related quality of life. The results contribute to a better understanding of the impact of VI and might lead to improved low vision services.


Assuntos
Inquéritos Epidemiológicos/métodos , Participação do Paciente/estatística & dados numéricos , Qualidade de Vida , Inquéritos e Questionários , Baixa Visão/psicologia , Acuidade Visual , Pessoas com Deficiência Visual/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Baixa Visão/epidemiologia , Baixa Visão/reabilitação , Adulto Jovem
13.
Eur J Ophthalmol ; 29(6): 615-620, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30280594

RESUMO

PURPOSE: To evaluate the efficacy of the IOL-Vip Revolution telescopic intraocular lens in age-related macular degeneration patients. METHODS: A total of 13 eyes of 12 age-related macular degeneration patients with senile cataract were enrolled. Selection of the patients was done by means of a low vision diagnostic and rehabilitative program (IOL-Vip software) that evaluates residual visual function. After standard phacoemulsification surgery, the incision site was enlarged and the IOL-Vip Revolution system was implanted in the capsular bag. The outcome measures were best corrected visual acuity, contrast sensitivity, anterior chamber depth, endothelial cell density, central corneal thickness, and quality-of-life questionnaire. RESULTS: The mean age of the subjects was 72.3 ± 8.5 years. The mean positive power of the intraocular lens was 59 ± 2 D and the negative intraocular lens power was standard (-46 D). Pre- and postoperative best corrected visual acuity were 1.08 ± 0.14 and 0.81 ± 0.16 logMAR in the operated eye and 1.13 ± 0.36 and 1.01 ± 0.40 logMAR in the unoperated eye, respectively. The best corrected visual acuity was increased significantly in both operated and unoperated eyes (p = 0.005 and 0.021, respectively). Quality of life and anterior chamber depth increased significantly (p = 0.018 and 0.008, respectively), while endothelial cell density decreased (p = 0.002). No significant differences were detected in central corneal thickness or contrast sensitivity (p = 0.133 and 0.684, respectively). CONCLUSION: The results showed that IOL-Vip Revolution telescopic intraocular lens is a promising treatment option in age-related macular degeneration patients. The rehabilitation program may have an important role in the restored clinical results, which also provided visual improvement in the unoperated eyes.


Assuntos
Catarata/complicações , Implante de Lente Intraocular/métodos , Degeneração Macular/complicações , Facoemulsificação/métodos , Idoso , Idoso de 80 Anos ou mais , Catarata/fisiopatologia , Sensibilidades de Contraste/fisiologia , Feminino , Humanos , Lentes Intraoculares , Degeneração Macular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pseudofacia/fisiopatologia , Qualidade de Vida , Inquéritos e Questionários , Baixa Visão/reabilitação , Acuidade Visual/fisiologia
14.
Optom Vis Sci ; 96(2): 79-86, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30589759

RESUMO

SIGNIFICANCE: This study explores whether eccentric viewing training (EVT) changes the properties of the retinal area used for fixation in subjects with bilateral macular disease. The data presented demonstrate the feasibility of conducting a randomized controlled trial on EVT. PURPOSE: Patients with bilateral central scotomas adopt other retinal area(s) called preferred retinal locus to substitute the blind fovea. EVT is offered with the goal to improve functional vision by learning how to identify and use a more useful retinal area for fixation-a trained retinal locus-and/or to improve fixation stability with their existing preferred retinal locus. An observational study was conducted to determine whether patients change and adopt a new trained retinal locus location and/or if fixation stability improves after EVT. METHODS: Seventy-six patients with bilateral central scotomas received EVT from an experienced rehabilitation therapist. Retinal locations for repeated fixations and sizes of central scotomas of the better eye were recorded before and after EVT with a scanning laser ophthalmoscope. The position and area of the 95% confidence bivariate ellipse that defines the retinal area in which 95% of fixations occur were analyzed. RESULTS: We observed no significant difference between the size of the area of the fitted ellipses before (mean [SD], 26.4° [19.7°]) and after (mean [SD], 24.8° [20.9°]) EVT (P = .54). However, we observed a shift in the preferred retinal locus location after EVT (P < .0001). The mean (SD) shift in the position of the center of fixation after EVT was 7.5° (5.2°; range, 0.45 to 23°). This mean difference was larger than would be expected from average within-subject fixation stability. CONCLUSIONS: The location of the retinal area used for fixation changes after EVT. Fixation stability does not change after EVT. These preliminary data are yet to be confirmed with the use of a control group.


Assuntos
Fixação Ocular/fisiologia , Educação de Pacientes como Assunto/métodos , Retina/fisiopatologia , Escotoma/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Doenças Retinianas/fisiopatologia , Baixa Visão/reabilitação
15.
Optom Vis Sci ; 96(2): 87-94, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30589760

RESUMO

SIGNIFICANCE: This research is significant because, although vision-related quality of life (VRQoL) is improved after vision rehabilitation (VR), patients with certain characteristics respond less positively on VRQoL measures, and this should inform future care. PURPOSE: The purposes of this study were to evaluate how two VRQoL questionnaires compare in measuring change in patient-reported outcomes after VR and to determine if patient characteristics or occupational therapy (OT) predict higher scores after rehabilitation. METHODS: In a prospective clinical cohort study, 109 patients with low vision completed the Impact of Vision Impairment (IVI) and the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and after VR. Comprehensive VR included consultation with an ophthalmologist and OT if required. The relationships of six baseline characteristics (age, sex, visual acuity, contrast sensitivity, field loss, diagnosis) and OT were assessed with VRQoL scores using multivariable logistic regression. RESULTS: The mean (SD) age was 68.5 (19.2) years, and 61 (56%) were female. After rehabilitation, increases in scores were observed in all IVI subscales (reading [P < .001], mobility [P = .002], well-being [P = .0003]) and all NEI VFQ-25 subscales (functional [P = .01], socioemotional [P = .003]). Those who were referred to OT but did not attend and those who had hemianopia/field loss were less likely to have higher VRQoL in IVI mobility and well-being. Those attending OT for more than 3 hours were less likely to have better scores in emotional NEI VFQ. Men were less likely to have increased scores in functional and emotional NEI VFQ, whereas those with diagnoses of nonmacular diseases had higher odds of having increased scores on the emotional NEI VFQ (all, P < .05). CONCLUSION: Both the IVI and the NEI VFQ-25 detected change in patients' VRQoL after rehabilitation. Most of the patient characteristics we considered predicted a lower likelihood of increased scores in VRQoL.


Assuntos
Qualidade de Vida/psicologia , Perfil de Impacto da Doença , Baixa Visão/reabilitação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Sensibilidades de Contraste/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , National Eye Institute (U.S.) , Estudos Prospectivos , Leitura , Inquéritos e Questionários , Estados Unidos , Baixa Visão/fisiopatologia , Baixa Visão/psicologia , Acuidade Visual/fisiologia
16.
Indian J Ophthalmol ; 67(1): 101-104, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30574902

RESUMO

Purpose: To elucidate the clinical profile of visual impairment (VI) and rehabilitation of the uveitic patients with irreversible low vision. Methods: Retrospective analysis of visual rehabilitation of patients with uveitis suffering from poor vision with low vision devices (LVD). Results: Most common cause of uveitis was choroiditis (46.29%), followed by retinitis (25.92%), retinochoroiditis (18.51%), and chronic panuveitis sequelae (9.25%). Of these 54 cases, 35.18% had moderate VI, 25.92% had severe VI, 20.37% had mild VI, and 18.51% had profound VI or blindness. Statistically significant improvement (P < 0.05) in near vision was seen in choroiditis (52%) and retinitis (72%), whereas clinically significant improvement in distance vision was found in patients with choroiditis. Most commonly prescribed LVD was half-eye prismatic spectacle magnifier (22.2%). Conclusion: Rehabilitation of the uveitic patients with low vision is challenging. LVD may be a beneficial tool in these patients to help them perform their day-to-day activities independently.


Assuntos
Óculos , Uveíte/complicações , Baixa Visão/reabilitação , Acuidade Visual/fisiologia , Adolescente , Adulto , Progressão da Doença , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Uveíte/diagnóstico , Uveíte/reabilitação , Baixa Visão/etiologia , Baixa Visão/fisiopatologia , Adulto Jovem
17.
Middle East Afr J Ophthalmol ; 26(4): 216-222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32153333

RESUMO

PURPOSE: Childhood blindness and visual impairment accounts for enormous burden of blindness. This study aimed to analyze the causes of severe visual impairment and blindness in students attending schools for the blind and to identify those whose vision could be improved by optical aids. On dispensing such aids, the study also aimed to analyze the improvement in their vision function. METHODS: This was a prospective interventional study of 428 certified students from four special schools for blind. All the students underwent a comprehensive ophthalmic examination by a team of four ophthalmologists and four optometrists. The World Health Organization-Prevention of Blindness forms were used to record history and examination details. Spectacles and low-vision aids (LVAs) were dispensed to those whose vision could be improved. The main outcome measure was L V Prasad- Functional Vision Questionnaire (LVP-VFQ), which was used to compare the vision function before and 6 months after the intervention. RESULTS: Two hundred and thirteen (49.5%) students were girls. The causes of blindness in 370 children (<18 years) with vision <6/60 were whole globe involvement in 117 (31.6%) students (this included anophthalmos 47 [12.7%], microphthalmos 61 [16.4%], both 9 [2.4%]), nystagmus 29 (7.8%), optic atrophy 22 (5.9%), retinal causes 42 (11.3%), cataract 18 (4.9%), phthisis bulbi 24 (6.4%), corneal scarring in 40 (10.8%), and retinopathy of prematurity in 4 (1.1%). Fifty-four (12.6%) students were given spectacles and 41 (9.57%) LVA. There was a statistically significant difference in all questions (P < 0.01) of LVP-VFQ for the students dispensed with optical aids 6 months after the intervention. Twenty-four students had their vision improved to 6/60 or better, whereas 26 could now identify letters and print. CONCLUSION: A significant proportion of students in schools for the blind can be helped to improving vision function using optical aids. Students in schools for the blind, nay all visually impaired individuals, need periodic ocular examination and ophthalmic care.


Assuntos
Recursos Audiovisuais , Óculos , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Instituições Acadêmicas/estatística & dados numéricos , Inquéritos e Questionários
18.
PLoS One ; 13(12): e0208165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30507973

RESUMO

Audio description (AD) is one of the main methods that people who are blind or low vision (B/LV) use to access film, television, and theatre content. AD is a second audio track inserted into the space(s) where speech is absent, which tends to be only a few seconds. Contained in that second track is an audio description of the important visual information contained within a specific scene. However, as there is insufficient time to describe all visual information, decisions about what is important to describe and how to present that information (style) to optimize a B/LV viewer's entertainment experience are required. Most research to date has considered only short-term, single-episode experiences to gauge viewers' reactions to the AD content. In addition, this research typically has used a monotone, single style of audio description, which is defined as "the conventional style" in this paper. We use an integrative style instead, that is defined as 'AD designed to fit a specific show", and differed between shows. We carried out a within-subjects longitudinal study with eight episodes of a dark comedy, using different description styles and describers in order to assess viewer engagement and preferences for AD describer style, language use, timing, and fit to the show. Twenty-four blind participants viewed and rated all eight episodes. Major findings included that most participants found the integrative style entertaining, a fit with the specific episodes, and enjoyable. Some participants, however, preferred the conventional style and struggled with the language and topic of a dark comedy and its associated descriptions.


Assuntos
Atividades de Lazer/psicologia , Televisão , Baixa Visão/psicologia , Pessoas com Deficiência Visual/psicologia , Emoções , Humanos , Estudos Longitudinais , Ontário , Prazer , Pesquisa Qualitativa , Inquéritos e Questionários , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação
19.
J Med Syst ; 42(12): 256, 2018 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-30406503

RESUMO

Ocular disorders such as vitreoretinal pathologies are widespread, especially in older adults. In particular, degenerative diseases of the retina such as macular senile degenerations are on the rise and affect millions of people with hundreds of thousands of new cases each year. These diseases can cause profoundly disabling visual impairments, in some cases severely compromising the central and/or the peripheral vision in one or both eyes. In this paper, we present a novel vision aids technology that allows for correcting or attenuating the perception of visual field defects due to ocular pathologies of diverse origins or traumas by using techniques of 3D visualisation, eye tracking, and image processing. The presented technology is mainly conceived for providing vision aids that can significantly improve the quality of life of people with this kind of visual disorders. As well, it could be employed for supporting the diagnosis of ocular dysfunctions and for monitoring the progression of diseases. The technology shown in this work is protected by an International Application in Patent Cooperation Treaty (PCT).


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Auxiliares Sensoriais , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Desenho de Equipamento , Movimentos Oculares , Humanos , Imagem Tridimensional , Qualidade de Vida , Visão Binocular
20.
Optom Vis Sci ; 95(9): 720-726, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30169351

RESUMO

Touchscreen-based, multimodal graphics represent an area of increasing research in digital access for individuals with blindness or visual impairments; yet, little empirical research on the effects of screen size on graphical exploration exists. This work probes if and when more screen area is necessary in supporting a pattern-matching task. PURPOSE: Larger touchscreens are thought to have distinct benefit over smaller touchscreens for the amount of space available to convey graphical information nonvisually. The current study investigates two questions: (1) Do screen size and grid density impact a user's accuracy on pattern-matching tasks? (2) Do screen size and grid density impact a user's time on task? METHODS: Fourteen blind and visually impaired individuals were given a pattern-matching task to complete on either a 10.5-in tablet or a 5.1-in phone. The patterns consisted of five vibrating targets imposed on sonified grids that varied in density (higher density = more grid squares). At test, participants compared the touchscreen pattern with a group of physical, embossed patterns and selected the matching pattern. Participants were evaluated on time exploring the pattern on the device and their pattern-matching accuracy. Multiple and logistic regressions were performed on the data. RESULTS: Device size, grid density, and age had no statistically significant effects on the model of pattern-matching accuracy. However, device size, grid density, and age had significant effects on the model for grid exploration. Using the phone, exploring low-density grids, and being older were indicative of faster exploration time. CONCLUSIONS: A trade-off of time and accuracy exists between devices that seems to be task dependent. Users may find a tablet most useful in situations where the accuracy of graphic interpretation is important and is not limited by time. Smaller screen sizes afforded comparable accuracy performance to tablets and were faster to explore overall.


Assuntos
Cegueira/fisiopatologia , Computadores de Mão , Apresentação de Dados , Reconhecimento Visual de Modelos/fisiologia , Equipamentos de Autoajuda , Smartphone , Baixa Visão/fisiopatologia , Adulto , Idoso , Cegueira/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Baixa Visão/reabilitação , Pessoas com Deficiência Visual/reabilitação , Adulto Jovem
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