Near Vision Aids In Geriatric Patients With Reduced Visual Acuity

ABSTRACT The usefulness of near vision aids was studied in one hundred and forty-one patients in a geriatric hospital. The patients were over 65 years of age and had reduced vision. Where lens power exceeded +10DS spectacle lenses seldom worked well. Aspheric stand magnifiers were the most useful device in cases where greater magnification was needed. Elderly patients had difficulty in adapting to optical aids over 5X. Impaired cerebral function was the main reason for failure of the low vision aids of lower magnification.     

Causes of visual impairment among patients referred to a visual rehabilitation clinic in Iran

Purpose

Epidemiologic evaluation and investigating the causes of visual impairment in any society is a matter of concern and has a direct effect on the country''s health care planning. In this study we describe causes of low vision and blindness in Iranian patients referred to rehabilitation clinics for taking vision aids.

Methods

In this cross-sectional study, visual acuity was classified based on best-corrected visual acuity in the better eye according to the World Health Organization definition (blindness, visual acuity [VA] < 20 / 400; severe visual impairment, VA < 20 / 200-20 / 400; mild to moderate visual impairment, VA < 20 / 60-20 / 200). The causes of blindness and low vision were determined using the 10th version of International Classification of Diseases based on the main cause in both eyes. To describe data, we used mean ± SD and frequency.

Results

The study included 432 patients, 65% male, with a mean age of 43.6 ± 25.5 years (range, 3 to 92 years). Mild to moderate visual impairment, severe visual impairment and blindness were present in 122 (28.8%), 196 (46.4%) and 105 (24.8%) of the patients, respectively. The main causes of visual impairment were retinal and choroidal diseases (74.5%), optic nerve and optic tract diseases (9.8%), vitreous and globe disorders (5.3%), congenital cataract (3.1%), and glaucoma (2.6%). The distribution pattern of the causes was similar in all age subgroups.

Conclusions

Diseases of the retina and choroid are the main cause of visual impairment among patients referred to an academic visual rehabilitation clinic in Iran.     

Results obtained with low vision aids

In this retrospective study of 261 patients (181 female and 80 male) the results obtained in a special low vision clinic are described. The mean age of the patients was 73.5 years (range 16–95 years). Visual acuity of the best eye was 0.08 in 26 patients (10.0%); better than 0.08 but 0.25 in 130 (50%); 0.30 in 62 (23.8%) and better than 0.30 in 42 patients (16.1%). Persons with a visual acuity better than 0.30 either could not read normal print or had restricted visual fields. Main causes of visual impairment were macular degeneration (38.9%), diabetic retinopathy (16.1%), glaucoma (8.4%) and cataract (7.4%). Low vision aids could be prescribed for 208 persons (79.7%). Follow-up of an average of 12 months (range, 3–22 months) was carried out in 250 cases (96%). In this period 24 patients (9%) died. At least 161 persons (62%) used their aids regularly, i.e. 77% of the patients who were given a low vision aid.     

Visual acuity testing. From the laboratory to the clinic

The need for precision in visual acuity assessment for low vision research led to the design of the Bailey–Lovie letter chart. This paper describes the decisions behind the design principles used and how the logarithmic progression of sizes led to the development of the logMAR designation of visual acuity and the improved sensitivity gained from letter-by-letter scoring. While the principles have since been adopted by most major clinical research studies and for use in most low vision clinics, use of charts of this design and application of letter-by-letter scoring are also important for the accurate assessment of visual acuity in any clinical setting. We discuss the test protocols that should be applied to visual acuity testing and the use of other tests for assessing profound low vision when the limits of visual acuity measurement by letter charts are reached.     

不同程度视力残疾儿童应用助视器康复的研究

目的对有残余视力的视力残疾儿童在给予光学和电子助视器康复后进行远、近视力的分析和效果评估,探讨不同程度视力残疾患儿有效的康复手段及其对低视力康复对象范围界定的影响。方法对盲校及低视力门诊共206名4～14周岁（含14岁）视力残疾儿童按视力残疾的程度进行分组,比较应用国产4倍、6倍望远镜前后远视力和应用国产眼镜式助视器、国产简易电子助视器后两种助视器间阅读成功率的差异。远视力康复结果采用秩和检验,近视力康复结果采用卡方检验进行统计学分析。结果视力0．05以下至眼前指数的盲童组和0．3以下至0．05的低视力组应用远用助视器前后远视力差异均有统计学意义（P〈0．05）;视力0．05以下至光感的肓童和低视力儿童分别使用眼镜式近用助视器与简易电子助视器后,两种助视器间阅读成功率的差异均有统计学意义,使用简易电子助视器的阅读成功率均明显高于使用眼镜式近用助视器。结论助视器康复的对象可以从低视力范围扩展到0．01甚至以下的盲童。低视力助视器是视力残疾儿童视觉康复有效和必要的手段,早期视觉康复特别是使用简易电子助视器进行近视力阅读的康复,对视力残疾儿童提高学习认知能力、促进身心健康成长和回归社会具有重要意义。     

视力残疾儿童的视觉康复与教育康复

作者７年来为低视力门诊２９７例６￣１４岁盲及低视力儿童配戴了光学助视器，配远用助视器的２３４例（占７８．８％），配近用助视器的２０６例（占６９．４％），其中１４３例同时选择了远近两种助视器，使广大视残儿童视觉得到了较好的康复，脱盲率达８０．２％，脱残率达６７．８％，视觉康复促进了教育康复，视残儿童的入学率由原来的５７．９％，提高到９０％，而且８０％的视残儿童可以进入普通学校“随班就读”，这样有利于     

Prevalence and associated factors of diabetic retinopathy. The Beijing Eye Study 2006

Background  To evaluate the prevalence and associated factors of diabetic retinopathy in adult Chinese with diabetes mellitus. Methods  The Beijing Eye Study 2006 is a population-based cross-sectional study that included 3,251 (73.2%) subjects (aged 45+ years) out of 4,439 subjects originally participating in the Beijing Eye Study 2001. Diabetes defined as fasting glucose concentrations ≥7.0 mmol/L or self-reported diagnosis of diabetes was detected in 381/3,251 (12.9%) subjects. Diabetic retinopathy was defined by the presence of at least one microaneurysm in the diabetic subjects according to the Early Treatment of Diabetic Retinopathy Study (ETDRS). Results  Gradable fundus photographs were available for 362 (95.0%) subjects. Diabetic retinopathy was detected in 101 subjects (27.9%). Most of the diabetic retinopathy was of the mild type (74/101; 73%). Severe non-proliferative or proliferative diabetic retinopathy was present in 16 (16%) subjects, and clinically significant macular edema in four (4%) subjects. Presence of diabetic retinopathy was significantly associated with rural region (Odds ratio (OR): 3.52), duration of diabetes mellitus (OR: 1.08), fasting plasma glucose concentration (OR: 1.14), type of diabetes treatment (OR: 2.09), and marginally significantly, with hyperopic refractive error (OR: 1.13; P = 0.08). The stage of diabetic retinopathy was associated with rural region (P < 0.001), known duration of diabetes (P = 0.001), type of diabetes treatment (P = 0.001), concentrations of high-density lipoproteins (P = 0.004), and fasting glucose concentrations (P = 0.002). Conclusions  Prevalence of diabetic retinopathy among adult diabetic Chinese was about 27.9%. The stage of retinopathy was mild in 75% of the subjects with diabetic retinopathy. Associated factors were diabetes duration, diabetic treatment type, low metabolic control, rural region, and marginally hyperopia. Supported by the Beijing Natural Science Foundation No. 7071003, Beijing, China.     

低视力门诊患者的特征及视觉康复需求

目的探讨低视力患者的视觉康复需求以及拒绝视觉康复的原因,为推广低视力视觉康复模式提供参考。方法回顾性病例研究。收集2013年7月至2014年7月来温州医科大学附属眼视光医院就诊的低视力患者361例,年龄（44.2±23.0）岁,男193例,女168例,主要来自院内转诊（68.5%）。对视力损伤的病因、患者对视觉康复的需求、视觉康复的有效性进行统计和分析。结果20岁以下低视力患者的病因主要是先天性白内障（30.7%）和眼球震颤（28.0%）;20岁及以上主要是病理性近视（25.5%）和其他视网膜疾病（25.2%）。88.2%的患者有视觉康复需求,远视力康复的首要、次要需求是娱乐休闲活动;近视力康复的首要需求是娱乐休闲活动,次要需求是阅读。患者助视器接受率为59.4%,93.6%患者拒绝的原因是仍希望能通过手术、药物等治疗方式改善视功能。结论娱乐休闲活动是温州医科大学附属眼视光医院低视力门诊患者视觉康复的首要需求,制定融合娱乐休闲活动的低视力康复策略可能是一种有效的康复方法。     

不同助视器在低视力学生阅读康复中的应用

目的明确新型非球面光学助视器与电子助视器在低视力学生阅读康复方面的作用,为临床及低视力康复工作提供参考。方法前瞻性临床对照研究。选取广州市培英职业学校的低视力学生30例,年龄（21.1±3.0）岁。每名受检者分别在不使用助视器、使用新型非球面光学助视器和便携式电子助视器3种条件下阅读。记录不同条件下受检者的持续时间、阅读距离、阅读速度、换行时间和错误率。数据比较采用单因素方差分析,两两比较采用Bonferroni法检验。结果不使用助视器、使用新型非球面光学助视器和便携式电子助视器在阅读持续时间[（4.35±2.82）min vs. (7.27±4.50）min vs. (10.71±3.09）min,F=4.60,P<0.01],阅读距离[（7.44±4.40）cm vs. (13.38±7.07）cm vs. (20.97±6.84）cm,F=11.21,P<0.01],阅读速度[（35.64±24.01）字/min vs. （49.41±24.96）字/min vs. （65.59±20.03）字/min,F=13.77,P<0.01]、换行时间[（1.52±1.13）s vs. （2.24±1.25）s vs. （3.42±0.94）s,F=7.40,P<0.01]和错误率[（10.34±11.01）% vs. （5.84±3.61）% vs. （5.26±2.72）%,F=1.79,P<0.05）]上的差异有统计学意义。其中便携式电子助视器在阅读持续时间、阅读距离、阅读速度上均优于新型非球面光学助视器（P<0.0167）;新型非球面光学助视器在阅读持续时间、阅读距离、阅读速度上优于不使用助视器（P<0.0167）;在错误率上便携式电子助视器、不使用助视器与新型非球面光学助视器相比差异无统计学意义（P＞0.0167）,便携式电子助视器错误率低于不使用助视器（P<0.0167）。换行时间上便携式电子助视器、新型非球面光学助视器长于不使用助视器（P<0.0167）,便携式电子助视器长于新型非球面光学助视器（P<0.0167）。结论助视器对于低视力学生在阅读上有很大的帮助;便携式电子助视器总体上明显优于新型非球面光学助视器。     

中老年人视觉损害的流行病学调查

视觉损害严重影响患者的生活质量,加重家庭和社会负担,因此全面认识视觉损害具有重要意义。近年来全世界开展了许多以中老年人群为基础的眼病流行病学调查,报道了视觉损害在中老年人群中的患病率及主要病因。我们应密切关注中老年人群的视力健康,制定相应的干预措施,预防不可矫治的视觉损害。     

Prevalence of Blindness and Low Vision in a Rural Population in Northern China: Preliminary Results from a Population-Based Survey

Purpose: To investigate the prevalence of visual impairment in a rural northern Chinese population.

Methods: A cross-sectional, population-based survey was conducted in 2010 in Ci County, Hebei Province in northern China. Residents aged 7 years and older in Lucunying Town, located within Ci County, underwent presenting visual acuity (VA) testing at home; those with presenting VA <20/60 were invited to participate in further examination at the local hospital. Population-weighted prevalences of blindness and low vision were determined according to World Health Organization definitions.

Results: Among the 24,539 residents aged older than 7 years, 20,298 (82.7%) participated in the study, and 20,072 (98.9%) of these had valid VA data. The population-weighted prevalence rates of presenting bilateral blindness and bilateral low vision were 0.3% and 2.4% for the entire population, 0% and 0.5% for residents 7–39 years of age, and 0.8% and 6.4% for residents 40 years and older, respectively. Based on best-corrected VA, the corresponding prevalence rates of bilateral blindness and bilateral low vision were 0.2% and 1.4% for the entire population, 0% and 0.1% for residents 7–39 years, and 0.6% and 4.0% for residents 40 years and older, respectively. Prevalence rates of blindness and low vision were generally higher among women than men. Blindness and low vision increased with age among residents 40 years and older.

Conclusion: Our findings highlight the need for eye healthcare services for visual impairment in rural China.     

The Developmental History and an Evaluation of the Queensland Low Vision Care Centre

ABSTRACT: The decisive shift in attitute from partial blindness and conservation of residual vision towards partial sightedness and maximal use of residual vision in the last fifteen years has resulted in low vision care being a relatively new field of particular concern to health care professionals. In Australia, the first multi-disciplinary clinic providing a comprehensive low vision service was established at the Association for the Blind, Kooyong, Victoria in 1972. Since then, a number of low vision clinics in a variety of locations have developed throughout Australia, with the establishment of the Low Vision Care Centre in Brisbane, Queensland occurring in 1979. This paper describes the developmental history of this service and evaluates the comprehensive low vision care which this clinic provides to the Queensland population. The effectiveness and future considerations of this service are also discussed.     

Causes of childhood visual impairment and unmet low-vision care in blind school students in Ghana

The purpose of this study was to determine the causes of childhood visual impairment and blindness in students of a school for blind children, to determine how many students had some residual vision, and to evaluate any unmet low-vision care. A survey of students in the blind school was conducted in two parts in May–June and then October 2003. The sample consisted of 201 students who became blind before the age of 16. Information was obtained from student interviews, doctors’ referral notes and ophthalmic examination of all students who consented. Students with residual vision had low-vision assessments. These investigations were supplemented with active participation of the investigators in Parent–Teacher Association meetings and focus group discussions with parents. One hundred and ninety-nine students consented and were recruited, whereas two declined. Ninety-six became visually impaired within their first year of life and 33 by the age of 5 years. Pathology of the cornea and then the lens were the commonest causes of blindness. One hundred and eight students were totally blind, whereas 87 (43.7%) had some residual vision and formed the target for the second part of the study. Fifty-one out of 77 of this target group who turned up for low-vision examination had useful residual vision by the World Health Organisation (WHO) low-vision examination chart. Spectacle magnifiers aided two students to read normal print at N5 and N8, respectively. Different visual aids would help enhance the residual vision in some of the others. Emotional trauma was apparent in parents and teachers. Children who became blind later in life remained in shock for a longer time and adapted less well to their visual impairment. Visual impairment in the population is not uncommon. Some causes are preventable. There is a significant unmet need for low-vision care, particularly amongst children in Ghana, and perhaps many countries in the West Africa subregion. It is hoped that the findings from this study will help spur sustained interventions.

Visual rehabilitation of patients with advanced diabetic retinopathy

Seventy-nine patients with advanced diabetic retinopathy were subjected to a full range of low vision rehabilitation measures and followed for an average of 3.6 years at the Low Vision Clinic. They were provided with high power optical aids, followed by educational training in the use of such aids and of residual vision, including the utilization of peripheral retina by means of eccentric viewing technique in many cases (23%). Mean age was 52.7 years. Type I diabetes was diagnosed in 69 subjects and type II in 10 subjects. Proliferative retinopathy was present in 73 cases and background retinopathy in 6 cases. All subjects showed macular changes in varying degrees. (Another 36 patients participated in the first series of visits but could not be followed up, the main reason being that 31 of them died before follow-up. There were no major differences between the two groups regarding rehabilitation results.)The average power of the telescopes used for distance vision was 4.8 X, and the mean power of the aids used for reading and near vision, mainly increased near addition and hyperocular lenses, was 22.2 dioptres (5.6 X). The patients were also provided with aids for intermediate distance and for spot use. The average number of series of visits was 2.7 and the number of 1 h training sessions 2.5 per series of visits.With aids and training, mean visual acuity improved from 0.17 to 0.73 on the first series of visits. After the last series of visits acuity was still as good as 0.64. Ability to read TV titles increased from 15.2% to 79.7% in the group and reached 64.6% after the last series of visits. The number of individuals able to read newspaper text increased from 1.3% to 97.5%. After the last series of visits the number was still as large as 86.1%. Of the individuals who had to stop working because of poor vision, 89% would have been able to return to work after rehabilitation. However, because of unemployment problems in the area, only 72% managed to return.It is quite obvious from the results that the presented methods, including high power aids and training sessions, are extremely successful in rehabilitation of patients with advanced diabetic retinopathy, provided that they have at least some residual vision. Dramatic improvements in visual performance were seen, allowing a life of much better quality than before. This is of great importance in a group of patients often suffering from other severe complications of diabetes. Furthermore, social aid may often be reduced or eliminated.     

Effectiveness of low vision services in improving patient quality of life at Aravind Eye Hospital

Context:In India, where the heavy burden of visual impairment exists, low vision services are scarce and under-utilized.Aims:Our study was designed to survey the effectiveness of low vision exams and visual aids in improving patient quality of life in southern rural India.Results:About 44 of 55 low vision patients completed baseline and follow-up LVQOL surveys, and 30 normal vision controls matched for age, gender, and education were also surveyed (average 117.34 points). After the low vision clinic visit, the low vision group demonstrated a 4.55-point improvement in quality of life (from 77.77 to 82.33 points, P = 0.001). Adjusting for age, gender, and education, the low vision patients who also received LVAs (n = 24) experienced an even larger increase than those who did not (n = 20) (8.89 points, P < 0.001).Conclusion:Low vision services and visual aids can improve the quality of life in South Indian rural population regardless of age, gender, and education level. Thus, all low vision patients who meet the criteria should be referred for evaluation.     

Alcohol Consumption,Drinking Pattern,and Self-Reported Visual Impairment

Purpose: To examine whether alcohol drinking status and drinking pattern are associated with self-reported visual impairment.

Methods: We used data from the Behavioral Risk Factor Surveillance System, a state-based telephone health survey conducted by random-digit dialing among non-institutionalized US adults. The Visual Impairment and Access to Eye Care module was implemented among 42, 713 adults aged 50 years and older in 2005 and 2006. Visual impairment was defined as any degree of difficulty experienced in recognizing a friend across the street or reading print in newspaper, magazine, recipe, menu, or numbers on the telephone with usual correction. Drinking patterns included drinking quantity (drinks per drinking day), frequency (drinking days in the past month), and binge drinking.

Results: After adjustment for age, sex, race/ethnicity, educational attainment, smoking status, Body Mass Index, history of cardiovascular diseases, diabetes, and eye diseases, current drinking status was not associated with distance and/or near vision impairment. However, drinking more than 1 drink per drinking day (odds ratio [OR], 1.21; 95% confidence intervals [CI], 1.09–1.35) and binge drinking (OR, 1.32; 95% CI, 1.14–1.53) were associated with visual impairment among current drinkers.

Conclusion: Among current drinkers, drinking patterns were significantly associated with near and distance vision impairment. Longitudinal studies are needed to confirm whether drinkers who drink beyond drinking guidelines, especially binge drinkers, are at higher risk of visual impairment than those who drink at lower levels.     

Visual rehabilitation of patients with advanced stages of glaucoma,optic atrophy,myopia or retinitis pigmentosa

Ninety-six patients with advanced stages of glaucoma, optic atrophy, myopia or retinitis pigmentosa (RP) who could not manage with ordinary spectacles or simple magnifying aids were taken care of at the Low Vision Clinic for rehabilitation and followed for an average of 3.6 years (the glaucoma group) up to an average of 6.0 years (the optic atrophy group). They were given high power optical aids and subjected to educational training in the proper use of these aids for best utilization of residual vision. Many of them (for optic atrophy as high a percentage as 40.7) were taught to use extra macular retina by means of eccentric viewing technique. The mean age of the oldest group, the glaucoma patients, was 69.3 years. The three other groups were about 20 to 25 years younger, on an average. (Another 35 patients) were seen for the first series of visits but could not be followed up, the main reasons being death (13 patients) and moving out of the area (9 patients).The mean power of the aids (mainly telescopes) used for distance vision was 2.1 × (RP)-5.3 x (optic atrophy). Increased near addition and hyperocular lenses were the main aids for reading and near vision, the mean power being 17.0 dioptres (glaucorna)–23.5 dioptres (RP)(4.3 × –5.9 x). Aids were also provided for intermediate distance and for spot use. The mean number of series of visits was 3.1 (myopia)–3.5 (glaucoma) and the average number of l h training sessions 2.2 (glaucoma)–2.5 (optic atrophy, RP) per series of visits.With aids and educational training, the mean visual acuity improved on the first series of visits from 0.31 to 0.60 for the glaucoma group, from 0.19 to 0.70 for the optic atrophy group, from 0.12 to 0.68 for the myopes and from 0.35 to 0.52 for the RP group. After the last series of visits acuity was still as good as 0.51, 0.61, 0.73 and 0.45, respectively.The number of individuals able to read newspaper text increased from 16.1% to 100.0% for the glaucoma patients, from 14.8% to 100.0% for the optic atrophy patients, from 75.0% to 100.0% for the myopes, and from 50.0% to 95.5% for the RP patients.The results show clearly that the methods used for rehabilitation of patients with glaucoma, optic atrophy, myopia or RP through optical aids and sessions of educational training are very successful, with substantial improvement of life quality.     

Visual impairment in children with multiple disabilities in schools for children with special needs in South India

Purpose:To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting.Methods:Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps.Results:Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVIConclusion:Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision-related problems in children with multiple disabilities.     

低视力患者视功能与表情识别的相关关系

目的：了解低视力患者视功能与表情识别的相关关系,指导患者进行视力康复。方法：分别检查低视力患者视力、对比敏感度及表情识别水平。结果：低空间频率对比敏感度水平与表情识别的相关关系非常显著,视力与表情识别之间存在相关关系,无法得出中、高空间频率对比敏感度与表情识别之间存在相关关系。结论：低空间频率对比敏感度水平能够比视力水平更好地推断低视力患者识别表情的能力。     

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）