The changing face of the visually impaired: the Kooyong low vision clinic's past, present, and future.

PURPOSE: To demonstrate the changes that have occurred in a developed world low vision population over the past three decades and to examine the present rehabilitation of the visually impaired attending a multi-disciplinary low vision clinic. METHODS: A retrospective examination of the 22,860 patients attending the low vision clinic at Kooyong since its inauguration in 1972 to 1996 allowed the extraction of information on their age, gender, living status, and primary condition causing low vision. A prospective unified study of 590 patients attending the clinic over a 6-month period in 1998 examined the demographics of the present low vision population and what rehabilitation they received. RESULTS: The average age of patients attending the low vision clinic has steadily increased, with 87% over the age of 60 years in the mid-1990s compared to 71% in the mid-1970s. The percentage of female patients attending the clinic has also steadily risen over the past three decades (from 59 to 66%), as has the percentage of patients living alone (from 23 to 41%). The main change in the conditions causing visual impairment in the clinic's low vision population has been the increase in age-related macular degeneration (ARMD). The average presenting distance acuity was 6/38, improving to 6/30(-1) with refraction. One-third of the patients could manage N5 print with the aid of +4.00 near addition lenses or less. Over one-half were prescribed magnification aids, with 19% having need for 2 or more to accomplish their desired visual tasks. Two-thirds of the patients made use of staff from multiple disciplines during their visual rehabilitation. CONCLUSIONS: The low vision population has changed over the past three decades. Major changes that have implications on low vision rehabilitation services are the increasing age of the patients and the preponderance of ARMD.     

Prismatic Scanning Method for Improving Visual Acuity in Patients with Low Vision

Frequently, patients with macular lesions and others who are visually handicapped do not receive adequate low vision care by ophthalmologists if a routine trial of low vision aids has no gratifying results. This paper describes for the first time a technique in which functional vision was achieved with the aid of prismatic scanning in patients for whom the usual low vision aids had proved ineffectual. The procedure in which prisms are used to achieve functional vision in patients with macular lesions is uncomplicated, inexpensive, and rapid; indeed, it can be used by an ophthalmologist in routine office practice with existing equipment.     

湖北阳新县2型糖尿病患者盲与低视力状况及原因分析

目的：探讨湖北阳新县2型糖尿病( T2 DM )患者盲与低视力的患病率及原因。
　　方法：纳入8316名常住人口,开展盲与低视力流行病学调查。先将T2 DM患者纳为观察组、将其它受检对象纳为对照组,对比两组盲与低视力患病率及发病原因;随后仅分析观察组数据。
　　结果：观察组盲与低视力出现率明显更高;白内障及视网膜病变出现率明显更高。随年龄增加,观察组盲与低视力出现率明显提升;女性致低视力率明显更高;初中及以上学历者盲与低视力出现率明显更高。上述分析均有统计学意义(P<0.05)。
　　结论：我区T2 DM患者盲与低视力患病率明显高于未合并T2 DM者;T2 DM患者盲与低视力出现与年龄、性别、学历有一定关系。     

Prescribing near magnification for low vision patients

Most patients with low vision request help with reading. Despite improvements in the assessment of visual functions, determining the appropriate magnification for reading still often involves a trial and error approach. Recent research has shown that with accurate and systematic assessments of vision, the required magnification can be predicted but this magnification needs to be much higher than has been previously recommended. This paper presents a systematic approach to enable practitioners to determine the power of a near addition or simple magnifier needed to assist patients with mild or moderate low vision who may present seeking help for reading. Guidelines for appropriate referral to low vision services are also provided.     

Clinical effect of low vision aids

The number of patients with low vision is increasing as life expectancy increases. In addition, the interest and demand for low vision aids are also increasing with improved socioeconomic status and the development of mass media. Therefore, it is imperative to recognize the importance of low vision aids. We reviewed the clinical records of 118 patients who visited our low vision clinic more than twice. According to the data analyzed, optic nerve atrophy, retinal degeneration, diabetic retinopathy and age-related macular degeneration were the most common causes of low vision in these patients. The best corrected visual acuities without low vision aids were less than 0.3, but with the help of low vision aids, vision improved to more than 0.4 in 87% of the patients for near vision, and 56% for distant vision. The patients had complained that they could not read books, see a blackboard, recognize a person at a distance, and had other problems because of low vision. However, with the use of low vision aids their satisfaction with their vision rose to 70%. Hand magnifiers, high-powered spectacle lenses, and stand magnifiers were the low vision aids commonly used by people for near vision, while the Galilean telescope and Keplerian telescope were the most popular devices used for distant vision. In conclusion, low vision aids are very helpful devices to patients with low vision.     

The experience of a university-based low vision clinic

An open low vision clinic has been in operation at University of Wales College of Cardiff, Department of Optometry for 5 years. This paper describes the demography and visual characteristics of 218 consecutively presenting patients. A detailed survey of the aids prescribed is conducted. A significant proportion of low vision patients required only simple aids (56.8%) and low magnification (71.6%). It is suggested that these patients could be assisted in an optometric practice. In addition, visual acuity, distance or near is not a good indicator of eventual visual performance with an LVA. Therefore, it was concluded that all patients having measurable form vision should receive a low vision assessment.     

唐山地区糖尿病低视力患者的现状调查及相关危险因素研究

目的：调查唐山地区糖尿病低视力患者的发病现状,并对致病的危险因素进行探讨。

方法：采用抽样调查的方式选择2016-01/12唐山地区2 000例糖尿病居民为研究对象,对其进行视力检查,观察统计唐山地区糖尿病低视力的发生率。将糖尿病低视力患者纳入观察组,另取2倍病例数的糖尿病正常视力患者为对照组,采用Logistic 回归分析对两组患者相关病史资料进行调查,分析导致低视力危险因素。

结果：参与视力检查的2 000例糖尿病患者中,共有189例276眼患者视力低下,发生率为6.90%,其中单眼视力低下患者102例102眼(2.55%),双眼视力低下87例174眼(4.35%)。经Logistic多因素回归分析显示,糖尿病患者的年龄、病程、视网膜病变程度是糖尿病患者视力低下的主要危险因素。

结论：唐山地区糖尿病患者并发视力低下的发生率较低,糖尿病患者的年龄、病程、视网膜病变是导致视力低下的主要原因。因此,加强对高龄、病程长、视网膜病变的糖尿病患者的视力检查,进行早期及时有效地防治,可减少对患者视力的损伤。     

Referral to low vision services by ophthalmologists

Purpose: People in need of low vision rehabilitation services often experience delays in referral to services. This study investigated referral criteria of Australian ophthalmologists, the frequency of referral of their patients with low vision and their perceptions of low vision services.
Methods: A survey was sent to a representative, random sample of 200 ophthalmologists. They were asked about criteria used for the referral of their patients with low vision. The survey included questions on the frequency with which they prescribed low vision devices (LVD) and referral of their patients to low vision and rehabilitation services and peer support groups. Perceptions of the quality and availability of low vision services were also investigated.
Results: The response rate was 82%. Approximately 11% of ophthalmologists' patients have low vision. It is uncommon for ophthalmologists to prescribe LVD but 67% refer most of their patients with low vision. It is less common for them to refer to rehabilitation services (29%) or peer support services (18%). The perceived local availability of services influences the rate of referral. Ophthalmologists who used the criteria of moderate low vision (<6/21 to <6/60) are more likely to refer more of their patients than those who use the criteria of severe low vision.
Conclusions: Australian ophthalmologists refer most of their visually impaired patients to low vision services, but infrequently to rehabilitation services or peer support groups. Differences in perceived need for low vision services indicated by the criteria used for referral, and the perceived availability, influence the rate at which ophthalmologists refer their patients for services. Ophthalmologists are encouraged to refer patients with permanent visual loss to low vision services earlier.     

新型近用连续变焦电子助视器在低视力和盲康复中的应用

目的比较新型近用连续变焦电子助视器和近用光学助视器在低视力和盲康复中的有效性。方法前瞻性病例对照研究。19例低视力患者和14例盲患者分别使用近用光学助视器和近用连续变焦电子助视器阅读报纸里的新闻文章,记录使用2种仪器后的近视力、阅读速度和阅读持续时间,采用配对t检验对检查结果进行统计学分析。结果所有患者使用近用光学助视器和近用连续变焦电子助视器后近视力相比,差异有统计学意义（t=-2.392,P＜0.05）;盲患者和低视力患者分别使用2种助视器后近视力比较,差异有显著统计学意义（t=-7.433、-8.721,P＜0.01）。所有患者和盲患者使用近用光学助视器和近用连续变焦电子助视器后阅读速度相比,差异有显著的统计学意义（t=-4.290、-6.728,P＜0.01）;低视力患者分别使用2种助视器后阅读速度比较,差异无统计学意义（t=-1.534,P＞0.05）。所有患者、盲患者以及低视力患者分别使用近用光学助视器和近用连续变焦电子助视器后阅读持续时间相比,差异有显著统计学意义（t=-8.211、-6.137、-6.007,P＜0.01）。结论新型近用连续变焦电子助视器与传统的近用光学助视器相比,更能提高患者的近视力和改善阅读能力。     

Study on preferred retinal locus

Preferred retinal locus (PRL) is always found in the age-related macular degeneration and other macular damages in patients with low vision, and it is a very important anatomic position in patients with central vision impairment to achieve the rehabilitation. In recent years, the training of preferred retinal locus (PRL) has become a research hotspot of low vision rehabilitation, it can clearly improve functional vision and quality of life. The authors reviewed relevant literatures, and summarized the definition, position, characteristics, training and clinical implications of the PRL.     

老年人白内障超声乳化手术摘除联合人工晶状体植入术后低视力分析

目的探讨老年人白内障术后永久性低视力原因。方法对2505只眼老年人白内障患者行白内障超声乳化摘除联合人工晶状体植入术。白内障术后3个月,除外手术并发症等原因,将矫正视力＜0.3者按原因分类。结果引起术后永久性低视力主要原因为高度近视眼视网膜病变,占28.2%;老年性黄斑变性,占23.6%,糖尿病视网膜病变累及黄斑,占13.9%。结论老年性白内障术后永久性低视力主要原因是黄斑病变,白内障超声乳化摘除及人工晶状体植入术对低视力者仍有重要意义。     

助视器提升低视力患者生活质量

目的：调查低视力助视器（LVAs）在提高低视力患者生活质量方面的有效性。方法：前瞻性临床研究。选取2017年1月至2018年2月在温州医科大学附属眼视光医院就诊的符合低视力诊断标准的患者55例，给患者验配远用、近用助视器。在低视力患者配戴LVAs前和配戴30 d后采用中文版低视力患者生活质量量表（CLVQOL）评估低视力患者的生活质量，问卷内容涉及远视力、移动和光感，心 理调节能力，阅读和精细工作能力及日常生活能力。对各组LVQOL评分结果进行配对t检验，对影 响因素进行回归分析。结果：55例低视力患者中，44例完成了基线和随访时的生活质量问卷调查。经过低视力助视器等辅助后，生活质量评分从77.8±19.0上升到82.3±22.5，差异具有统计学意义（t=4.56，P=0.001）。性别、识字率、学习状况和视力等因素不影响低视力患者生活质量。结论：低视力助视器可以提高不同年龄段、不同性别的低视力人群的生活质量。     

Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation

PURPOSE: To design and validate a vision-specific quality-of-life assessment tool to be used in a clinical setting to evaluate low-vision rehabilitation strategy and management. METHODS: Previous vision-related questionnaires were assessed by low-vision rehabilitation professionals and patients for relevance and coverage. The 74 items selected were pretested to ensure correct interpretation. One hundred and fifty patients with low vision completed the chosen questions on four occasions to allow the selection of the most appropriate items. The vision-specific quality of life of patients with low vision was compared with that of 70 age-matched and gender-matched patients with normal vision and before and after low-vision rehabilitation in 278 patients. RESULTS: Items that were unreliable, internally inconsistent, redundant, or not relevant were excluded, resulting in the 25-item Low Vision Quality-of-Life Questionnaire (LVQOL). Completion of the LVQOL results in a summed score between 0 (a low quality of life) and 125 (a high quality of life). The LVQOL has a high internal consistency (alpha = 0.88) and good reliability (0.72). The average LVQOL score for a population with low vision (60.9 +/- 25.1) was significantly lower than the average score of those with normal vision (100.3 +/- 20.8). Rehabilitation improved the LVQOL score of those with low vision by an average of 6.8 +/- 15.6 (17%). CONCLUSIONS: The LVQOL was shown to be an internally consistent, reliable, and fast method for measuring the vision-specific quality of life of the visually impaired in a clinical setting. It is able to quantify the quality of life of those with low vision and is useful in determining the effects of low-vision rehabilitation.     

Profile of patients presenting at a low vision clinic in a developing country

ABSTRACT: BACKGROUND: Low vision is an important public health problem;however, very few low vision clinics are available to address the needs of low vision patientsin most developing countries. The purpose of this study was to describe the characteristics of patients attending the low vision clinic of a Nigerian tertiary hospital. METHODS: This was a prospective cross sectional study of all new patients seen at the low vision clinic over a 36 month period. Patients were administered with a structured questionnaire, and were examined and tested with low vision devices by the attending low vision specialist. Information on the demographic and clinical characteristics of the patients was recorded. RESULTS: A total of 193 new patients seen during the period were studied. The mean age was 41.4 years, and their ages ranged between 6 and 90 years with a male to female ratio of 1.9:1. Majority (58%) were aged below 50 years, 23.3% were children ([less than or equal to]15 years), while 21.8% were elderly patients ([greater than or equal to]65 years). The commonest cause of low vision was retinitis pigmentosa (16.6%); 14.5% had age related macular degeneration (ARMD); 9.8% had albinism; while only 1% had diabetic retinopathy. ARMD(45.2%) was the commonest cause in the elderly patients, while albinism (24.4%) and optic atrophy (24.4%) were the commonest in children. CONCLUSION: The demographic and clinical characteristics of low vision patients seen in this clinicare similar to that of patients in other developing countries, but different from those in developed countries. Elderly patients and females may be under-utilising low vision services. There is a need for further research into the determinants of low vision service utilisation in developing countries. This would further aid the planning and delivery of services to low vision patients in these countries.     

深圳市低视力和盲患者的生活质量分析

目的通过对深圳市低视力和盲人群进行问卷调查,了解低视力和盲患者的生活质量及影响生活质量的因素。为科学的制定低视力和盲康复方案提供一定的依据。方法对低视力和盲的患者进行低视力康复调查问卷一般检查评估表和生存质量的问卷调查,根据得分评估低力和盲对患者生存质量的影响。主要指标：低视力患者生活质量得分;盲患者生活质量得分。结果共联系了100名低视力和盲患者,完成问卷调查100份。其中低视力患者50例,盲50例。低视力患者生活质量得分为36．78±5．02。影响生活质量的因素主要有：经济状况、社交能力、活动能力。均P ＜0．01。盲患者生活质量得分为25．25±3．65;影响生活质量的因素主要有：经济状况、心理状况、自理能力。均P ＜0．01。结论低视力和盲患者都处于低质量生活水平,影响低视力和盲患者生活质量的相关因素大致相同,又不尽相同,要提高低视力和盲患者的生活质量水平,需要针对不同的主要影响因素。     

Vision-specific health-related quality of life in age-related maculopathy patients presenting for low vision services

Few studies have examined the effectiveness of low vision rehabilitation for age-related maculopathy (ARM) patients and its impact on vision-specific health-related quality of life (HRQoL). However, before a multi-site clinical trial can be conducted, appropriate outcome measures need to be identified for ARM patients who seek out low vision rehabilitation, including a vision-specific HRQoL instrument. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was developed to assess vision-specific HRQoL for low vision patients, including those with ARM. This study examines the performance of the NEI VFQ-25 among ARM patients who seek out low vision services and examines its relationship with visual acuity and self-reported use of low vision aids. One hundred and twenty-seven patients were recruited from a University-affiliated low vision clinic. During two telephone interviews, subjects completed the NEI VFQ-25 and a short cognitive test and provided information on general health and use of low vision aids. Additional information on visual acuity and eye health were collected from the medical record. Our results indicate that ARM patients who seek out low vision services report significant impairment in their vision-specific HRQoL. Their NEI VFQ-25 scores were lower compared to other ARM and low vision rehabilitation samples previously studied. The VFQ subscales with the largest deficits were near and distance visual acuities and psychosocial issues (near vision, distance vision, role difficulties, dependency, social functioning, mental health). These subscale scores were lower for those with greater visual acuity impairment. The VFQ subscale scores most impacted by the disease had wide variability and were higher for those who used low vision aids, suggesting that the NEI VFQ-25 is suitable for measuring further decline and treatment-related improvements. Thus, it should be strongly considered for a multi-site clinical trial on the effectiveness of low vision rehabilitation.     

Vision-specific health-related quality of life in age-related maculopathy patients presenting for low vision services

Few studies have examined the effectiveness of low vision rehabilitation for age-related maculopathy (ARM) patients and its impact on vision-specific health-related quality of life (HRQoL). However, before a multi-site clinical trial can be conducted, appropriate outcome measures need to be identified for ARM patients who seek out low vision rehabilitation, including a vision-specific HR QoL instrument. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was developed to assess vision-specific HRQoL for low vision patients, including those with ARM. This study examines the performance of the NEI VFQ-25 among ARM patients who seek out low vision services and examines its relationship with visual acuity and self-reported use of low vision aids. One hundred and twenty-seven patients were recruited from a University-affiliated low vision clinic. During two telephone interviews, subjects completed the NEI VFQ-25 and a short cognitive test and provided information on general health and use of low vision aids. Additional information on visual acuity and eye health were collected from the medical record. Our results indicate that ARM patients who seek out low vision services report significant impairment in their vision-specific HRQoL. Their NEI VFQ-25 scores were lower compared to other ARM and low vision rehabilitation samples previously studied. The VFQ subscales with the largest deficits were near and distance visual acuities and psychosocial issues (near vision, distance vision, role difficulties, dependency, social functioning, mental health). These subscale scores were lower for those with greater visual acuity impairment. The VFQ subscale scores most impacted by the disease had wide variability and were higher for those who used low vision aids, suggesting that the NEI VFQ-25 is suitable for measuring further decline and treatment-related improvements. Thus, it should be strongly considered for a multi-site clinical trial on the effectiveness of low vision rehabilitation.     

Long-term results of low vision rehabilitation in age-related macular degeneration

One to five years after successful low vision rehabilitation, 199 patients with agerelated macular degeneration were asked by means of a questionnaire whether they still used their low vision aids and whether they were satisfied with the low vision counceling. We received feedback from 66% of the patients. 20 patients had already passed away. 74% of the 112 answering patients still use a low vision aid today. Three-quarters of them still use the originally prescribed low vision aid. Interestingly enough, the daily reading time was rather short, only 16% of the patients read more than 1 hour per day, 42% read somewhat more and 13% somewhat less than 10 minutes per day. Retrospectively, 81% of all responding patients found their low vision counceling at least a little, more of them quite or very helpful. These numbers suggest, that the initial labor of patiently examining and training older, visually handicapped patients is worthwhile.     

Helping blind and partially sighted people to read: the effectiveness of low vision aids

AIMS: To substantiate the claim that low vision aids reduce the degree of disability associated with visual impairment. METHODS: An observational study of vision, ocular pathology, age, sex, and reading ability in new referrals to a low vision clinic. Reading ability was assessed both with the patients' own spectacles and with an appropriate low vision aid. RESULTS: The reading performance and biographical characteristics of new referrals to a low vision clinic were recorded. Data were collected for 168 people over a 6 month period. Upon arrival at the clinic the mean functional visual acuity equated to 6/36 and 77% of patients were unable to read newsprint (N8). After a low vision assessment and provision of a suitable low vision aid 88% of new patients were able to read N8 or smaller text. CONCLUSIONS: The degree of visual impairment observed in new referrals to a low vision clinic is sufficient to prevent the majority from performing many daily tasks. Low vision aids are an effective means of providing visual rehabilitation, helping almost nine out of 10 patients with impaired vision to read.