A multidiscipline approach in low vision rehabilitation

The first low vision clinic was instituted at the Industrial Home for the Blind in 1953 in response to a growing demand that more effective use be made of the residual vision in blind persons. The technology was there. Eye practitioners certainly knew enough about vision problems to offer many of these people an opportunity to enter a new life. The problem was: how to put that knowledge to work through a sound service delivery system. By its twentieth anniversary in 1973 the clinic had seen almost 5,000 patients for low vision evaluation and had built a service which consistently provided substantial and useful improvement in vision through the use of optical aids to a majority of its patients. The low vision optometric staff works as an integral part of a rehabilitation team. That team consists of a number of professionals, including ophthalmologists, social workers, teachers, and a variety of rehabilitation instructors. All members work simultaneously to create a total program of rehabilitation for thepartially sighted. We feel this teamwork approach is of basic importance to effective rehabilitation.     

Social Problem-Solving Abilities and Psychological Adjustment of Persons in Low Vision Rehabilitation.

Objective: Tested the relations of social problem-solving abilities to distress, depression, and well-being and impairment reported by persons participating in a low vision rehabilitation program. Study Design: Correlational and multiple regression analyses. Setting: Outpatient low vision rehabilitation clinic. Participants: 25 men (M = 73.88 years old, SD = 11.94 years) and 29 women (M = 68.79 years old, SD = 17.25 years) participating in a comprehensive admitting examination. Main Outcome Measures: Emotional distress specific to the condition, depressive behavior, satisfaction with life, and functional ability. Results: A negative problem orientation significantly predicted depression and emotional distress; rational problem-solving skills predicted life satisfaction. Conclusions: A negative problem orientation toward problem solving predicts poor emotional adjustment reported by persons with low vision, and proactive problem-solving skills appear to promote optimal adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The etiology of vision impairment in target population

PURPOSE: research the etiology of vision impairment in target persons over 45 years old in Doumen county, Guangdong province. METHODS: Depending on the prevalences of the blindness among the person aged over 50 years, the theoretic sample rate is 1,000/4,8733 x 100% = 2.05%. The 8 districts were divided into 3 parts according to the local economic situation and the proportion of the population in the areas. In fact, the sampling rate is 932/10055 = 88.34%. RESULTS: We found that impairment < 0.3 accounted for 10.94%. The prevalence of bilateral blindness and low vision was 1.61% and 3.22%, respectively. Both prevalences of blindness and low vision were increased with age. The leading cuase of blindness was cataract (45.2%). The second was corneal opacity (16.7%). Prevalences of the low vision and the blindness were higher in females than in males (P < 0.005). CONCLUSIONS: Curable and preventable diseases were the leading cause for the blindness (70%). Prevalences of blindness and the low vision increase with age. We will continually follow up the population over 50 years of age in Doumen county.     

Varicella vaccine in immunocompromised patients

OBJECTIVE: To determine the prevalence of depressive symptoms and their relationship to disability in older low vision patients. DESIGN: Panel study with 2-year follow-up. PARTICIPANTS: Community-residing older people (N = 31). MEASUREMENTS: Geriatric Depression Scale, Community Disability Scale, and Snellen visual acuity. RESULTS: Twelve of 31 patients (38.7%) had GDS scores > or = 11 at baseline. Two years later, 10 of these 12 patients remained depressed, and three of the 19 (15.8%) previously nondepressed patients had become depressed. Depressed patients tended to be more disabled functionally than nondepressed patients at follow-up. The correlation of disability with depression and with vision were examined for the entire sample and revealed a strong correlation between disability and depression (r = .40; P = .013) compared with that of disability and vision (r = .34; P = .032) at baseline and at follow-up: depression (r = .68; P = .001), vision (r = .45; P = .006). There was no significant correlation between depression and vision at baseline (r = .06; P = .383), but there was a trend toward correlation at follow-up (r = .28; P = .067). CONCLUSION: Depressive symptoms are prevalent and persistent among low vision patients and appear more highly related to disability than is vision. The frequent occurrence of depression and the availability of effective treatment argue for its recognition and treatment as possible ways to reduce disability in older persons with low vision.     

Mental effort required for walking: effects of retinitis pigmentosa

PURPOSE: To determine whether retinitis pigmentosa (RP) increases the mental effort required for walking. METHODS: A dual-task methodology was used; walking speed and reaction time (RT) to randomly emitted tones were measured in 13 persons with RP and 29 persons with normal vision. Measures of RT were used to estimate the mental effort required for walking. In a second experiment, 15 persons with RP and 17 persons with normal vision navigated a "simple" and a "complex" route. RESULTS: The RP subjects had longer RT compared with the normal-vision subjects when walking the complex but not the simple route. Normalized to each person's baseline, RT while walking the complex route was significantly correlated with log contrast sensitivity (r = -0.63) and log retinal area (r = -0.64) in the RP group. The amount of mental effort required for walking was shown to also depend on familiarity with the route. CONCLUSIONS: Route complexity is critical in determining whether walking requires more mental effort for persons with RP than for persons with normal vision. The magnitude of mental effort required for mobility covaries with the visual impairment measures which correlate with mobility performance in RP.     

Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators

OBJECTIVE: To test the reliability and validity of the 51-item Field Test Version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) across 5 common chronic eye conditions. DESIGN: Prospective observational cohort study of persons with 1 of 5 chronic eye diseases who were scheduled for nonurgent visits in ophthalmology practices or had low vision from any cause, and a reference sample of persons without eye disease. SETTING: Six university-based ophthalmology practices and the National Eye Institute Clinical Center, Bethesda, Md. PATIENTS: Eligible participants had to have 1 of the following eye conditions: age-related cataracts, age-related macular degeneration, diabetic retinopathy, primary open-angle glaucoma, cytomegalovirus retinitis, or low vision from any cause. Each of the 7 sites also enrolled persons in a reference sample. Reference sample participants had no evidence of underlying eye disease but were scheduled for either screening eye examinations or correction of refractive error. All eligible persons had to be aged 21 years or older, English speaking, and cognitively able to give informed consent and participate in a health status interview. MEASUREMENTS AND MAIN RESULTS: To provide the data needed to assess the reliability and validity of the 51-item NEI-VFQ, all subjects completed an interview that consisted of the 51-item NEI-VFQ, the Medical Outcomes Study 36-Item Short-Form Health Survey, and at least 1 measure of vision-targeted functional status. Estimates of internal consistency and test-retest reproducibility indicate that the 51-item NEI-VFQ is reliable. Tests of association with other scales and clinical variables support the construct validity of the survey. CONCLUSIONS: In this cross-sectional study, the 51-item NEI-VFQ seems to be reliable and valid and should be a useful tool for group-level comparisons of vision-targeted, health-related quality of life in clinical research. Additionally, the psychometric properties of the NEI-VFQ were not influenced by the type or severity of the underlying eye disease, suggesting that the measure will provide reproducible and valid data when used across multiple eye conditions.     

Personnel with poor vision at fighter pilot school

The piloting of fighting aircraft, the navigation of space-shuttle, the piloting of an helicopter in tactical flight at an altitude of 50 metres require the use of all sensorial, ocular, vestibular, proprioceptive ... sensors. So, the selection and the follow-up of these aerial engines' pilots need a very complete study of medical parameters, in particular sensorial and notably visual system. The doctors and the expert researchers in Aeronautical and spatial Medicine of the Army Health Department, which have in charge the medical supervision of flight crew, should study, create, and improve tests of visual sensorial exploration developed from fundamental and applied research. These authenticated tests with military pilots were applied in ophthalmology for the estimation of normal and deficient vision. A proposition to change norms of World Health Organisation applied to the vision has been following these to low visual persons was equally introduced.     

The role of vitrectomy for diabetic retinopathy

BACKGROUND: Diabetic retinopathy is an important cause of severe vision loss. The risk of vision loss from diabetic retinopathy is substantially reduced by intensive control of diabetes and appropriate laser surgery for proliferative diabetic retinopathy and diabetic macular edema. METHODS: The Diabetic Retinopathy Vitrectomy Study (DRVS) helped identify the indications and most propitious time for performing diabetic vitrectomy for nonresolving vitreous hemorrhage. The DRVS also highlighted the risks and potential complications of vitrectomy surgery. RESULTS: Diabetic persons with severe vision loss from severe proliferative diabetic retinopathy are candidates for vitrectomy after vitreous hemorrhage and severe fibrous changes in the retina. CONCLUSION: In cases in which vision loss occurs, pars plana vitrectomy frequently can restore useful vision, and reduce the risk of vision loss from traction retinal detachment.     

Focus groups with persons who have age-related macular degeneration: Emotional issues.

Objective: To identify content areas characterizing emotional issues faced by persons with age-related macular degeneration (AMD). Design and Participants: Six focus groups (N = 53) were conducted with persons having AMD, with discussion addressing feelings about vision. Discussion was audiotaped, transcribed, and subjected to content analysis. Results: Twice as many comments conveyed negative as compared with positive affect. Negative comments communicated feelings of frustration, fear, sadness, and inadequacy. Positive comments addressed gratitude and hope. Positive and negative comments were just as likely regardless of disease severity. The tendency to make positive versus negative comments was related to participants' mental health score on the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) but unrelated to other psychosocially oriented subscales of the NEI VFQ-25 and the presence of probable depression as defined by the 10-item Center for Epidemiological Studies-Depression Scale. Conclusions: When persons with AMD are given the opportunity to frame the emotional accompaniments of vision impairment from their own perspectives, predominantly negative issues were expressed, yet positive emotions were also mentioned. This information can be used for psychoeducational interventions for this population and the selection of emotional outcome measures when evaluating interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A simplified screening test for identifying people with low vision in developing countries

Simple but effective tests have been produced for screening subjects with low vision in developing countries. These tests of distance and near vision, based on the E test, were evaluated and validated in trials with people aged 4-90 years, and have been field tested in the health, education and rehabilitation services in 32 developing countries. Their sensitivity and specificity as screening tools for low vision have been calculated; sensitivity of 85% and specificity of 96% for the distance vision test, and sensitivity of 100% and specificity of 84% for the near vision test. The content and format of the tests have been demonstrated to be appropriate for developing countries, and their effectiveness for screening for low vision has been confirmed.     

The comparative costs of operating a team and primary nursing unit

An examination was conducted in 310 persons surviving injuries of the scull and brain of varying severity. In 146 patients the acuity of vision, pupil reactions, the oculomotor function of the nerves, visual fields and ocular fundus were examined, employing florescent angiography in some cases: and in 164 patients the state of the acoustic and vestibular analyzers was studied. The neuro-ophthalmological sequelae of scull and brain injuries manifested themselves mainly in disorders of the acuity of vision and in alterations of the fields of vision, those of the ocular fundus being less distinct. Injuries of different levels of the acoustic and vestibular analyzers depended on the nature of the injury of the scull bones.     

Assistive technology and learning disabilities: today's realities and tomorrow's promises

Many forms of technology, both "high" and "low," can help individuals with learning disabilities capitalize on their strengths and bypass, or compensate for, their disabilities. This article surveys the current status of assistive technology for this population and reflects on future promises and potential problems. In addition, a model is presented for conceptualizing assistive technology in terms of the types of barriers it helps persons with disabilities to surmount. Several current technologies are described and the research supporting their effectiveness reviewed: word processing, computer-based instruction in reading and other academic areas, interactive videodisc interventions for math, and technologies for daily life. In conclusion, three themes related to the future success of assistive technology applications are discussed: equity of access to technology; ease of technology, use; and emergent technologies, such as virtual reality.     

A ''tachometer'' feedback model of smooth pursuit eye movements

This paper reviews the literature on the effects of luminance and chromatic contrast on reading and object recognition in low vision. The general consensus is that whereas luminance contrast can enhance reading and object recognition for some low vision subjects, chromatic contrast does not aid low vision reading but may be useful in low vision object recognition. Although providing useful theoretical results, the experimental designs have so far been remote from the conditions that low vision patients may experience in the home and work environment. Suggestions are made for an 'ideal' experimental design and details of current research, using conditions more likely to be experienced by low vision subjects in everyday life, are given. This research makes use of a recently developed instrument, the Intuitive Colorimeter.     

Technology and true presence in nursing

If there is to be a future for nursing in the next millenium, it must be dictated not by technologic advances directly but by the manner in which technology relates with persons in health and illness. Technology enables nurses to care for persons in a more efficient and cost-effective manner. True presence, as articulated in the human becoming theory, affords members of the profession opportunities to be with persons in ways that make a difference to their quality of life. The article illustrates the recognition of the link between technology and true presence through the use of a nurse-person encounter.     

Visual experience, visual field size, and the development of nonvisual sensitivity to the spatial structure of outdoor neighborhoods explored by walking.

When places are explored without vision, observers go from temporally sequenced, circuitous inputs available along walks to knowledge of spatial structure (i.e., straight-line distances and directions characterizing the simultaneous arrangement of the objects passed along the way). Studies show that a life history of vision helps develop nonvisual sensitivity, but they are unspecific on the formative experiences or the underlying processes. This study compared judgments of straight-line distances and directions among landmarks in a familiar area of town by partially sighted persons who varied in types and ages of visual impairment. Those with early childhood loss of broad-field vision and those blind from birth performed significantly worse than those with early or late acuity loss and those with late field loss. Broad-field visual experience facilitates perceptual development by providing a basis for proprioceptive and efferent information from locomotion against distances and directions relative to the surrounding environment. Differences in the perception of walking, in turn, cause the observed differences in sensitivity to spatial structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Home monitoring of pulmonary function

The use of healthcare technology in homes is increasing. This article details an electronic home spirometry unit used by lung transplant patients. The unit can also be used with other populations including persons with asthma or cystic fibrosis, or persons awaiting transplants. Home health nurses are in a prime position to assist patients in using technology that provides direction for the treatment regimen.     

Keeping an eye on vision: primary care of age-related ocular disease. Part 1

Normal changes in the lens, retina, and vitreous accompany aging, but loss of vision in late life is not an inevitable consequence of aging. Cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration (ARMD) account for most vision loss in the older population. Visual impairment reduces older patients' ability to function independently and increases their risk of depression and of injury due to falls. When older persons have a visual complaint, they tend to blame it on being old and do not tell their physicians. In the primary care office, simple screening questions and examination of the dilated eye can often reveal a need for further examination and/or referral.     

The mouse Cat4 locus maps to chromosome 8 and mutants express lens-corneal adhesion

HYPOTHESIS: Does occupational exposure to solvents in combination with alcohol intake give rise to acquired color vision defects? METHOD: A total of 138 individuals exposed to solvents (toluene, xylene, trichloroethylene, tetrachloroethylene) were examined using Lanthony's D-15 test and compared with 100 nonexposed controls. The extent of color vision loss was quantitatively assessed based on Bowman's color confusion index (CCI). A cumulative exposure index was calculated from the hours of exposure per day and the years of exposure. In 30 persons who were exposed to trichloroethylene and tetrachloroethylene, urinary trichloroacetic acid was assessed as a parameter of exposure. Alcohol intake was calculated as based on interviews of patients in grams of ethyl alcohol per week. RESULTS: Individuals who consumed more than 250 g alcohol/week and were simultaneously exposed to solvents showed a significantly elevated CCI (P = 0.0044). No significant correlation emerged between trichloroacetic acid excretion in the urine or the cumulative exposure index and the CCI. CONCLUSION: The combination of alcohol intake and occupational exposure to solvents discloses the risk of acquired subclinical color vision defects.     

Psychometric testing and reasonable accommodation for persons with disabilities.

Addresses the legal and psychometric issues related to nondiscrimination in employment testing for persons who have disabilities. The Rehabilitation Act of 1973, as amended; the Americans with Disabilities Act of 1990; and psychometric literature on nondiscriminatory testing have introduced and extended the concept from the federal government to the private sector. The comparability of results on the Scholastic Aptitude Test and Graduate Record Examinations, when accommodations are made in the testing process for persons with hearing, vision, and physical impairments and learning disabilities, were examined by the Educational Testing Service and reported by W. W. Willingham et al (1988). Test timing appears to be the critical accommodation for these tests. Testing accommodations are discussed in terms of testing medium, time limits, and test content. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Causes of low vision and blindness in south western Saudi Arabia. A hospital-based study

The authors studied 1,681 consecutive patients who attended their ophthalmic outpatient clinics over a period of 12 months to determine the patients' visual acuity status and the causes of any visual loss. Using the World Health Organization criteria for definition of visual acuity status, 1004 (59.7%) patients had normal vision. Four hundred and thirty-one (25.6%) patients had low vision or visual impairment and 246 (14.6%) patients were blind. Twenty-eight (1.9%) patients had no light perception in both eyes. Cataract, both in isolation and co-existing with other ocular pathology, was the major cause of both low vision and blindness (58.5% and 81.7%, respectively). A concerted attack on cataract alone will markedly reduce blindness and low vision in this region.