宁夏银川市322例视力损伤患者特点及康复现状调查分析

目的 了解在宁夏残疾人康复中心进行视力残疾康复的银川市视力损伤人群的人口学和临床特点及助视器使用情况。设计 横断面研究。研究对象 收集在宁夏残疾人康复中心进行视力残疾康复的银川市患者资料共322例。方法 记录患者的性别、年龄、民族、受教育程度、视力、视力损伤的病因,视力损伤程度（分为轻度、中度、重度）和适配的助视器类型。主要指标 年龄、性别、视力损伤程度、视力损伤病因、助视器适配类型的构成比。结果 资料完整者322例,男性占56.2%,平均年龄（50.9±16.2）岁,40~69岁年龄段人数最多（65.2%）。其中中度视力损伤126例（39.1%）,重度视力损伤50例（15.5%）,盲146例（45.3%）。引起视力损伤最主要原因为病理性近视（16.5%）。助视器中非视觉性辅具应用最多（54.2%）。近用助视器使用（45.1%）多于远用助视器（0.7%）。最常用的近用助视器为手持式放大镜（35.9%）和眼镜式放大镜（32.3%）。结论 视力损伤患者多数为中老年人,主要病因为病理性近视。非视觉性辅具对患者日常生活有较大帮助。近用助视器的使用多于远用助视器。（眼科, 2017, 26： 135-138）     

Visual problems: a review of prevalence studies on visual impairment in school-age children

Childhood visual impairment (VI) have a significant impact on the educational achievement, career choices and social life of affected individual, and in children, is mainly due to either preventable or treatable causes. Reliable data on the prevalence and causes of VI in children will guide the development of a systematic vision screening program for its early detection and successful treatment of possible causes. The purpose of this literature review is to summarize the available data on prevalence and causes of VI in school-age children from various regions globally. A discussion on the major findings highlighting the definition criteria, classifications and limitations for further studies is also presented.     

Causes of visual impairment in children

The populations formed by the pupils of the eleven Dutch institutions for visually handicapped children on the first of January 1980 were investigated, repeating the investigation of the International Association for Prevention of Blindness in 1970. The total number of pupils was nearly the same in both instances (1300 in 1970 and 1334 in 1980). No significant differences were found in the distribution of diagnoses and etiologies between the two groups. The congenital cataracts, the tapeto-retinal dystrophies and the optic nerve affections are still the three diagnostic groups with the highest prevalence (together 48.6%). To gain more reliable insight into morbidity patterns one needs longitudinal investigations with central registration of patient data, especially in studying the influence of pre-and perinatal problems.     

Recent experiences in the management of visual impairment in albinism

One hundred patients with albinism seen within two years in the Low Vision Clinic at Moorfields Eye Hospital are reviewed. They are predominantly young people within the definition of 'Partially-sighted' rather than blind. Clinical methods are described and the distribution of alternative types of appliance loaned surveyed. Emmetropia and low ametropia are rare in the group. Most patients are using telescopic lenses for distance vision, tending to select binocular devices. Over half are able to read print of newsprint size in a clinical situation without extra magnification, but often elect to use extra magnification for some tasks. The need for near vision aids increases with age.     

不同程度视力残疾患者应用助视器的康复效果

目的探讨不同程度视力残疾患者在应用光学和电子助视器后远、近视力的康复效果。方法对天津医科大学眼科中心低视力康复中心283例(9～79岁)视力残疾患者按视力残疾程度分为盲(110例)和低视力(173例)两组。分别比较两组应用Keplerian及Galilean望远镜前后远视力及脱残率的差异,以及应用带光源手持放大镜、近用眼镜式助视器及电子助视器后阅读成功率的差异。应用助视器前后的远视力差异采用配对t检验,脱残率及阅读成功率的差异采用χ2检验。结果两组应用两种远用助视器后远视力均有所提高,差异均有统计学意义(均为P<0.01);盲目组应用Keplerian及Galilean望远镜后脱残率分别为10.9%和9.1%,低视力组分别为76.3%和77.5%,差异均无统计学意义(P=0.823、P=0.899)。两组应用电子助视器阅读成功率(26.4%、86.1%)均高于带光源手持放大镜(13.6%、71.1%)及近用眼镜式助视器(15.5%、68.2%),差异均有统计学意义(P=0.031、P<0.01)。结论助视器能帮助视力残疾患者有效利用其残余视力,改善视功能及提高生活质量,是视力残疾患者康复的有效手段,应加强宣传及推广普及。     

Prevalence and causes of visual impairment and blindness in Sichuan province of China

AIM: To describe the prevalence and causes of low vision and blindness in a population within Sichuan province in southwestern China. · METHODS: A stratified, multi-phased and cluster probability sampling design was employed to enumerate 125641 participants from 40351 households within 38 counties/cities. Participants underwent a comprehensive eye examination, including standardized visual acuity (VA) tests using logarithm of the minimum angle resolution charts. Prevalence was age- and gender-standardized to the 2000 China Census. · RESULTS: Population-weighted prevalence of blindness was 0.77% (95%CI: 0.72-0.82, n=966) and low vision was 1.22% (95%CI: 1.14-1.27, n=1513). Overall, the prevalence of visual disability was 1.40% in the urban population, and 2.22% in the rural population (P<0.01). Cataract was the leading cause of visual disability (55.7%, n =1381), and was of similar frequency in both urban and rural populations. Retinal disease was the second leading cause(9.7%, n =236), but was more common in urban than in rural participants (34.3% vs 2.7%, P <0.01). Corneal disease accounted for 6.5% (n=161) of cases of visual disability, and was more common in the rural population (7.2% vs 3.9%, P =0.006). · CONCLUSION: We estimate that 1.72 million people suffer from visual disability within Sichuan province, of which 525000 are blind, the focus of blindness prevention should be in rural area.     

低视力患者助视器验配的应用效果评估

目的 评估低视力患者助视器验配后的实际应用效果,探讨低视力康复有效性的维持与改进方法.方法 对173例低视力患者进行视功能评估及助视器验配,l a后对助视器使用情况进行回访调查,就低视力患者视觉改善状况、助视器日均使用时间、助视器弃用原因以及存在的问题等进行分析.结果 173例低视力患者的前三位主要病因为高度近视、先天性眼病及糖尿病视网膜病变.助视器日均使用时间:偶尔使用者占66.47％,使用≤lh者占4.62％,使用＞l～2h者占19.08％,使用＞2～3 h者占4.62％,使用＞3h者占5.20％.助视器验配的总有效率为79.77％,远用光学助视器之间的使用效果差异无统计学意义(x2 =0.794,P=0.939);近用助视器的使用效果间差异有统计学意义(X2=12.535,P＜0.05).弃用的23个助视器中,因视力差弃用者占73.91％,因使用不方便弃用者占17.39％,因不会使用弃用者占8.70％.结论 个性化验配助视器能够使助视器得到有效的利用,光学和电子助视器的适当使用能够明显提高低视力患者的残余视功能,但需要加强后续的随访及服务,解决助视器验配及使用中出现的问题.     

A comparison of the Viewpoint CCTV magnifier with three conventional CCTV magnifiers

Closed-circuit television (CCTV) magnifiers can now be prescribed more frequendy for persons with low vision because of the reducing costs of electronic components and the availability of rental or lease plans for those who cannot afford the initial cost. The performance of CCTV models which are more commonly used in New Zealand are compared in this paper. Magnification ranges, screen luminance, screen contrast and depth of field were measured. The ergonomic aspects of using hand-scanned or fixed video cameras are discussed.     

Cerebral visual impairment in children: Multicentric study determining the causes,associated neurological and ocular findings,and risk factors for severe vision impairment

Purpose:To evaluate the causes, associated neurological and ocular findings in children with cerebral visual impairment (CVI), and to identify risk factors for severe vision impairment.Methods:A multicenter, retrospective, cross-sectional analysis was carried out from January 2017 to December 2019 on patients less than 16 years of age with a diagnosis of CVI.Results:A total of 405 patients were included of which 61.2% were male and 38.8% were female. The median age at presentation was 4 years (range 3 months to 16 years). Antenatal risk factors were present in 14% of the cases. The most common cause of CVI was hypoxic-ischemic encephalopathy (35.1%), followed by seizure associated with brain damage (31.3%). The most common neurological finding was seizure (50.4%), followed by cerebral palsy (13.6%). Associated ophthalmological findings were significant refractive error (63.2%), esotropia (22.2%), exotropia, (38%), nystagmus (33.3%), and optic nerve atrophy (25.9%). Severe visual impairment (<20/200) was associated with optic atrophy (odds ratio: 2.9, 95% confidence interval: 1.4–6.0; P = 0.003) and seizure disorder (odds ratio: 1.9, 95% confidence interval: 1.2–3.3; P = 0.012).Conclusion:The various ophthalmic, neurological manifestations and etiologies could guide the multidisciplinary team treating the child with CVI in understanding the visual impairment that affects the neuro development of the child and in planning rehabilitation strategies.     

中国四川省视力损伤及盲的原因和发病率

目的:了解四川省低视力及盲的原因和发病率。方法:分层多阶段及随机抽样调查38个县市40351户125641人,进行全面眼部检查,包括标准对数视力表检测视力,发病率以年龄和性别为标准根据2000年中国人口普查结果进行分析。结果:盲率0.77%(95%可信区间:0.72～0.82,n=966),低视力率1.22%(95%可信区间1.14～1.27,n=1513)。视力残疾率城市1.40%,农村2.22%(P<0.01),白内障无论城市还是农村均是首位致残原因(55.7%,n=1381),视网膜疾病居第二(9.7%,n=236),但是城市明显高于农村(34.3%vs2.7%,P<0.01)。角膜病居第三(6.5%,n=161),农村明显多于城市(7.2%vs3.9%,P=0.006)。结论:四川省估计有约172万视力残疾患者,其中52.5万盲人,防盲重心在农村。     

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

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

天津市视障学校学生视觉损害的病因及康复现状

目的：调查天津市视障学校学生视觉损害的分级及病因,分析不同类型助视器的康复效果,为儿童视觉损害的康复工作提供指导依据。

方法：于2019-08/09纳入天津市视力障碍学校学生86例。通过视力、屈光及眼部检查等方法,评估学生视觉损害的分级及主要病因。对盲和低视力学生分别验配3种远用及近用助视器,分析其康复效果。

结果：学生86例中盲49例,低视力37例,主要病因为先天性眼球发育不良26例(30%)。盲和低视力学生应用助视器后康复远视力均有所提升(F=110.59,P<0.01),低视力组远视力优于盲目组(F=184.06,P<0.01)。盲目组应用3种远用助视器脱残率及低视力组脱残率均无差异,3种近用助视器阅读成功率在盲目组无差异,低视力组电子助视器优于手持放大镜及眼镜式助视器(χ²=7.974、10.571,均P<0.01)。

结论：儿童视觉损害以先天性眼病为主,验配合适的助视器可提高其康复效果,低视力患者电子助视器康复效果优于手持放大镜及眼镜式助视器。     

Impact of low vision care on reading performance in children with multiple disabilities and visual impairment

Background:

Lack of evidence in literature to show low vision care enhances the reading performance in children with Multiple Disabilities and Visual Impairment (MDVI).

Aim:

To evaluate the effectiveness of Low Vision Care intervention on the reading performance of children with MDVI.

Materials and Methods:

Three subjects who were diagnosed to have cerebral palsy and visual impairment, studying in a special school were recruited for the study. All of them underwent detailed eye examination and low vision care evaluation at a tertiary eye care hospital. A single subject multiple baseline (study) design was adopted and the study period was 16 weeks. The reading performance (reading speed, reading accuracy, reading fluency) was evaluated during the baseline phase and the intervention phase. The median of all the reading parameters for each week was noted. The trend of the reading performance was graphically represented in both the phases.

Results:

Reading speed increased by 37 Word per minute, 37 Letters per minute and 5 letters per minute for the subject 1, 2 and 3 respectively after the intervention. Reading accuracy was 84%, 91% and 86.4% at the end of the baseline period and 98.7%, 98.4% and 99% at the end of 16 weeks for subject 1, 2 and 3 respectively. Average reading fluency score was 8.3, 7.1 and 5.5 in the baseline period and 10.2, 10.2 and 8.7 in the intervention period.

Conclusion:

This study shows evidence of noticeable improvement in reading performance of children with MDVI using a novel study design.     

Mobility performance of low‐vision adults using an electronic mobility aid

Visually impaired people rank obstacle location and identification as two of the most important mobility problems faced. Traditional mobility aids (the long cane) provide information about where an object is located but only within their limited (one metre) range. Although objects are located when traditional aids are used, it is unlikely that they are identified. The Bristol Mobility Aid (BMA) is an electronic travel aid that presents scene images to remaining residual vision in a number of view formats. Previous work has suggested visually impaired observers have better static object recognition using this aid. We investigated the mobility performance of subjects with retinitis pigmentosa using the BMA by determining the percentage preferred walking speed (PPWS), and the number of errors made with three different BMA headset views on an indoor mobility course. We found low‐vision subjects had significantly reduced PPWS in two of the three headset views and interestingly, sighted subjects had significantly reduced PPWS when using the BMA in all three views. The numbers of errors made were significantly higher across all vision groups when the BMA was worn. We found that the BMA does not currently increase mobility in the visually impaired. Results are discussed in terms of modifications that could be made to the aid and methodological limitations.     

The Magnilink: A New Approach to CCTV Magnifiers for the Visually Impaired

:A hand held videocamera connected to portable control circuitry and a normal black and white television provides a new degree of versatility in electro-optical aids for the visually impaired.     

Correctable visual impairment in older people: a major unmet need

This review seeks to determine the prevalence of correctable visual impairment (VI) in older people in the UK, to discover what proportion of these cases are undetected, to suggest reasons for the poor detection and to make recommendations for improving the detection. To establish the context of these issues, the review will also touch on the general prevalence and causes of VI in older people in developed countries and on the impact of VI in older people. Typically, studies suggest that VI affects about 10% of people aged 65-75, and 20% of those aged 75 or older. There is a strong relationship between impaired vision in older people and both reduced quality of life and increased risk of accidents, particularly falls. The literature suggests that those with low vision are about two times more likely to have falls than fully sighted people, and the annual UK cost of treating falls directly attributable to VI is pound 128 million. The literature on the prevalence of undetected reduced vision in older people reveals that between 20 and 50% of older people have undetected reduced vision. The majority of these people have correctable visual problems (refractive errors or cataract). It is particularly startling that, in 'developed countries', between 7 and 34% of older people have VI that could simply be cured by appropriate spectacles. The reasons why so many cases of treatable VI remain untreated are discussed, and suggestions are made for improving the detection of these cases. We conclude that there should be better publicity encouraging older people to attend for regular optometric eye examinations. A complementary approach is annual visual screening of the elderly, possibly as part of GPs annual health check on people aged 75 years and older. Recommendations are made for evaluating new approaches to screening and for improving the management of cases detected by screening.