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Introduction: Various retinal implants are being developed and appear to be a promising option for improving the visual capacities of individuals with retinal dystrophy. A multidisciplinary approach to both assessment of a candidate's factors and rehabilitation could contribute to improved activity and participation. The purpose of this study was (i) to document the approach taken by a multidisciplinary team in the candidate selection process and in training in the use of the Argus II retinal prosthesis system (RPS), and (ii) to examine the effects of the RPS on sensory and mental functions and on activity and participation. Methods: An A1-B1-A2-B2 experimental case report was used, with repeated measures pre- and post-rehabilitation program design. The A phases represent the periods with the system off, whereas the B phases represent the periods with the system on. A 65-year-old man with retinitis pigmentosa and total blindness was followed by a multidisciplinary team for over 18 months. After receiving the retinal implant, he benefited from a 10-week rehabilitation program (twice per week; B1 phase). Results: Globally, the RPS improved vision in the B phases when the system was on and visual acuity was stable at 2.3 logMAR (functional blindness). The participant's mental and neuromusculoskeletal function scores were generally stable throughout the data collection periods. Lower performance on some measures at the end of phase B2 coincided with a negative mood. Discussion: Use of the RPS improved activity, but this did not transfer into greater participation in the living environment. Despite efforts made by the rehabilitation team to manage the user's expectations concerning the RPS, the interventions reactivated his grieving over his vision loss. Implications for Practitioners: New technologies can make users dream of unrealistic possibilities, and managing their expectations requires problem solving supported by a multidisciplinary team.

Our article addresses how our not-for-profit organization responded to the COVID-19 pandemic by shifting our paradigm, in how we deliver programs. We created virtual programs and have been delivering them via the Zoom platform, to provide education and training to individuals adjusting to vision loss, and their family members.

Introduction: This study seeks to examine the association between the age of the Vision Rehabilitation Therapist (VRT) and the frequency at which they carry out technology job tasks. Methods: A secondary data analysis was performed, using chi square to test for an association between the age of the VRT and the frequency at which they carry out 11 specific job tasks related to technology. Results: Age of the VRT was shown to be negatively associated with the frequency at which 6 of the 11 technology job tasks are performed. Discussion: Overall, younger VRTs are teaching access technology at higher frequencies than older VRTs. Newer specific technologies are being taught more often by younger VRTs, such as mobile technologies, voice-controlled devices, and social media. Older technologies such as keyboarding and OCR are being taught at similar frequencies regardless of age. Given the aging population of VRTs and the small number of university VRT programs, it may not be sustainable to rely on recent graduates or younger VRTs to fulfill access training needs for persons with visual impairment. With the availability, affordability, and quick emergence of new technologies, it is critical that all VRTs have access to continuing education to become comfortable and proficient in teaching newer technologies. Implication for Practitioners: Technology training is critical for employment and independence for many persons with vision impairment. Continuing education for VRTs to be comfortable and competent in teaching emerging technologies may be important in ensuring that access technology training is available to all persons with visual impairment.

Introduction: Pediatric cataract is still a major cause for childhood visual impairment. The goal of our study was to analyze the prevalence of children with impaired vision (6/15 or worse) after surgery for bilateral cataract, to evaluate factors associated with it and to emphasize the importance for visual rehabilitation including the use of visual aids, educational measures, and social worker services. Methods: Retrospective analysis of medical records from children who underwent surgery for cataract up to age 6 years, with a follow-up of at least 4 years. Clinical characteristics retrieved from medical records included visual acuity, presence of nystagmus and/or strabismus, age at surgery, intraocular lens (IOL) implantation, and others. Results: Fifty-five children were included in the study. Follow-up ranged from 4 to 13 years (Mdn = 6.8). Visual impairment was found in 15/24 (62.5%) of children operated on before the age of 6 months (group 1), and in 7/31 (22.5%) n those operated after the age of 6 months (group 2; p = 0.019). Thirty-eight of the 55 children had a primary IOL implantation; nystagmus and microphthalmos were also associated with higher rates of visual impairment. Discussion: Despite early and modern surgery, long-term visual outcome remains poor in children undergoing bilateral cataract surgery at young age. When discussing visual prognosis with parents, it is important to recognize factors associated with visual impairment, such as need for surgery before age 6 months, nystagmus and microphthalmos, as well as the importance for early visual rehabilitation services when needed.

Introduction: This study assessed whether basic spatialcognitive abilities can be enhanced in people who are blind through transfer of learning from drawing training. Methods: Near-body spatial-cognitive performance was assessed through the Cognitive Test for the Blind (CTB), which assesses a wide range of basic spatial-cognitive skills. The CTB was administered to 21 participants who are blind in two behavioral testing sessions separated by five days. For participants in the "trained" group, these intervening days were occupied by the Cognitive-Kinesthetic Drawing Training method, during which participants learned how to draw freehand from memory. The "control" participants were not trained. Results: The results showed significantly increased overall CTB performance in the trained but not in the control group, indicating that the drawing training effectively enhanced spatial-cognitive abilities. A three- to six-month follow-up session with a subset of trained participantssuggested that these training-induced spatial-cognitive improvements might persist over time, at least for some tasks. Discussion: These findings demonstrate that learning to draw from memory without vision over just five sessions can lead to enhancement of basic spatial-cognitive abilities beyond the drawing task. This study is the first to examine the transfer of learning of cognitive ability in blind individuals. Implications for practitioners: This study sheds light on the Cognitive-Kinesthetic Drawing Training as an effective wide-range rehabilitation technique that could be used to enhance basic spatial-cognitive abilities in those who are blind.

Introduction: Rehabilitation can improve visual outcomes for adults with acquired homonymous visual field loss. It is unclear, however, whether rehabilitation improves visual outcomes for children because previous training schedules have been tiresome, uninteresting, and have failed to keep them engaged. In this study, we assessed whether children and young people with homonymous visual field loss would adhere to six weeks of unsupervised compensatory training using a specialized video game. Methods: Participants aged between 7 and 25 years with homonymous visual field loss completed tabletop assessments of visual search across four site visits. Two baseline assessments separated by four weeks evaluated spontaneous improvements before training began. Participants were then given a copy of the video game to use unsupervised at home for six weeks. Two follow-up assessments separated by four weeks were then conducted to evaluate immediate and acutely maintained effects of training. Results: Fifteen candidates met the inclusion-exclusion criteria, nine participated, and eight completed the study. Participants completed an average of 5.6 hours of unsupervised training over the six weeks. Improvements on in-game metrics plateaued during week three of training. The time taken to find objects during tabletop activities improved by an average of 24%--95% CI (2%, 46%)--after training. Discussion: The findings demonstrate that children and young people with homonymous visual field loss will engage with gamified compensatory training, and it can improve visual outcomes with less of a time commitment than has been required of adults participating in non-gamified training in previous studies. Appropriately powered, randomized controlled trials are required to evaluate the validity and generalizability of observed training effects. Implications for practitioners: Rehabilitation specialists can use specialist video games and gamification technique to engage children and young people with homonymous visual field loss in long-term unsupervised training schedules.

A model Center of Excellence in Low Vision and Vision Rehabilitation was created in a health care setting in China utilizing an inter-institutional relationship with a United States optometric institution. Accomplishments of, limitations to, and stimuli to the provision of low vision and vision rehabilitation services are shared.

Over the last decade, many innovations have significantly changed the classroom. As a result, the authors believe the roles of vision professionals, primarily teachers of students with visual impairments, orientation and mobility (O&M) specialists, and braille transcribers, have likewise changed drastically in that time period. Although the core mission of these professionals remains advancing the independence and capabilities of individuals who are visually impaired (that is, those who are blind or have low vision), the scope of practice in the field of visual impairment has undergone shifts that require the attention of fellow practitioners and professional training programs. This thought piece is a result of observations from the field and discussions with fellow colleagues and stakeholders who are visually impaired, including a focused discussion held with attendees of the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER) conference in the summer of 2016. This paper is not intended to reflect a stance but rather to open a discussion on updating professionals' roles within the field of educational and rehabilitative vision services. More specifically, addresses changes to the tools used to accomplish the mission of the field of visual impairment, the way its professionals instruct students and train future personnel, and the professional linkages that must be forged for members of the field of visual impairment to be successful in their work. Some of the principal changes discussed in this paper include: (1) the effect of ubiquitous computing on daily living and learning experiences; (2) the increased prevalence of multimedia in the classroom and community; (3) advancements in delivery options for accessible educational materials; (4) changes in the built environment (both physical and digital); and (5) the need for more transdisciplinary collaborations, including partnerships in the design, technology, engineering, and architecture fields.

Since much of what constitutes successful vision rehabilitation is measurable, specific quantifiable goals are key to ensuring a commitment that is shared by the patient. There are many nonmeasurable goals, however, that are also important, and these areas had not been addressed in a system based on metrics. The consideration of how the patient's social support and environment may affect vision rehabilitation is one example. The patient's adjustment to vision loss and its potential affect on vision rehabilitation is another example. Since the author is an optometrist, he will limit his discussion in this report of important nonmeasurable goals to the low vision exam. By presenting two stroke-related vision rehabilitation cases managed by the Virginia Department for the Blind and Vision Impaired (DBVI), he hopes to provide some insight into the value the department places on such non measurable goals.

In partnership with state vocational rehabilitation and special education agencies, a local university contributed interprofessional expertise in low vision rehabilitation to an established pre-employment transition services (Pre-ETS) program (Coduti, Herbert, Chiu, & Doke, 2017). This program was established to provide high school students with visual impairments experience in college life, while reinforcing all nine expanded core curriculum (ECC) areas. The addition of a low vision rehabilitation component contributed to meeting the functional vision needs of these students as they transitioned to college and postsecondary employment.

Introduction: This study characterizes self-reported functional vision goals and the use of low vision resources (for example, services and devices) in ophthalmology clinic patients with age-related macular degeneration (AMD) and comorbid depressive symptoms. Methods: From July 2009 to February 2013, we assessed 188 consecutive patients (age 65+; mean 84.0 years; 70.2% female) with AMD (best corrected distance acuity 20/70 or worse) enrolled in a 12-month randomized clinical trial to test the efficacy of a multicomponent intervention that combined low vision optometry and home-based occupational therapy to prevent depression (Low Vision Depression Prevention Trial [VITAL]). A geriatric nurse conducted in-home assessments to measure visual acuity and contrast sensitivity, self-reported functional vision, functional vision goals that were personally important yet difficult to achieve (targeted vision function goals), and the use of low vision resources (defined as services, devices and strategies utilized by low vision patients to compensate for visual deficits). This study reports on baseline data collected prior to randomization. Results: Only 9.6% of the sample had received formal low vision services. The five most common goals were newspaper reading, leisure and entertainment, computer use, personal communication, and correspondence. Participants engaged in targeted vision function goals less frequently since being diagnosed with AMD, despite using low vision resources and reporting low to moderate difficulty in using them. Discussion: Few patients with AMD seen in ophthalmology clinics received low vision rehabilitation. Patients who utilized resources engaged in goals less frequently since being diagnosed with AMD. Implications for practitioners: Patients with AMD are underutilizing low vision rehabilitation resources. Strategies for increasing low vision referrals are suggested.

Introduction: One way to understand a profession is to examine the job tasks undertaken by professionals within the field. The profession of vision rehabilitation therapy is examined by finding the frequency at which 100 specific job tasks are performed on average by current vision rehabilitation therapists (VRTs). Fifty-one of the job task frequencies are compared to 1989 frequencies for changes across the last 28 years. Methods: An anonymous online survey was carried out with current and recently retired VRTs. Participants were asked to rate the frequency at which they perform 100 specific job tasks and 13 demographic questions. Results: One hundred eighty-nine practitioners completed the survey. Mean frequencies for the 100 job tasks fell between a low of 1.08 (slightly above "do not perform the task") for "writes grants for funding of agency services" and a high of 5.51 (above "perform 4 or 5 times a week") for "writes case notes and reports for documentation." Half of the 51 comparable job tasks indicated statistically significant changes in frequency across the 28-year period. Discussion: Statistically significant changes in job task frequencies occurred across job roles of teaching, case management, and professional or administrative activities, indicating that many aspects of the therapist's job have changed. Individualized teaching remains a common aspect of the job, personalizing the skills taught and the teaching methods, for the individual client. VRTs are less frequently providing consultation to medical and community organizations. Implications for practitioners: The results presented provide an understanding of current job tasks of a practicing VRT. Understanding the changing trends of job tasks may inform university personnel preparation programs to better prepare students for employment demands. Decreasing community outreach may negatively affect the visibility of blind rehabilitation services and inadvertently affect referrals for vision rehabilitation therapy services.

Introduction: Vision rehabilitation therapists (VRTs) carry out many specific job tasks. This study seeks to better understand the VRT profession by organizing many tasks into a few specific roles in which VRT practitioners are involved. Methods: Using the results of the 2017 online survey, a principle component analysis was carried out to extract clusters of specific job tasks. The reliability of the resulting job role constructs was assessed using Cronbach's alpha. Results from this analysis are compared to a similar analysis of VRT job roles conducted 28 years ago. Results: Four job roles are extracted from the survey's frequency data: (1) teaching activities, (2) case management, (3) technology, and (4) low vision and assessment. Seventy specific job tasks are retained under the four roles. Discussion: Extracted job roles of teaching and case management are similar to Leja's (1990) findings, indicating that these roles remain important aspects of the VRT job. Two new roles have emerged since Leja's examination, and they are related to technology and low vision and assessment. The advancement, availability, and affordability of technologies and low vision interventions has increased the need for teaching the use of access technologies across the daily living spectrum. The availability of low vision devices has expanded the role of the VRT in the provision of functional low vision assessments, strategies for reading and daily tasks, appropriate use of optical and nonoptical aids, and environmental assessment for safety and optimal visual performance. Implications for practitioners: VRT survey participants are performing additional job roles in technology and low vision and assessment. This presents challenges related to resources and training for practitioners who already provide instruction across a broad set of skill domains. Issues include access to new technologies, adequate time to learn new devices and software, and standardized assessment tools.

Introduction: The purpose of this article was to conduct a systematic review of peer-reviewed studies on factors related to employment in consumers who are visually impaired using Rehabilitation Services Administration (RSA-911) Case Service Report data. Methods: We used database, hand, and ancestral search strategies to systematically identify peer-reviewed studies published between 1990 and August 2018 where researchers used RSA-911 data to address the target question. All included articles were coded by two reviewers for study and participant characteristics, quality indicators, and outcomes. Results: Nine articles consisting of 14 analyses were included. Twelve analyses concerned employment outcomes; two concerned earnings. Researchers in most studies used large samples of 3,000 or more consumers and used multivariable analyses, most commonly multilevel logistic regression. Factors that consistently predicted lower employment across studies included presence of a secondary disability and legal blindness; higher education level consistently predicted higher employment, as did earnings and self-support at vocational rehabilitation application. Few analyses included state- or agency-level variables or specific vocational rehabilitation services. Discussion: These results indicate that certain groups of vocational rehabilitation consumers with visual impairments may be at greater risk of unsuccessful closures; researchers should examine specific strategies that may improve outcomes in these groups. These results also highlight the importance of education in securing employment among people with visual impairments. Researchers should examine state- and agency-level variables that may affect outcomes as well as the effects of specific services on outcomes. Additionally, researchers should analyze factors that may affect employment quality as well as employment outcomes. Implications for practitioners: Practitioners who are working with visually impaired people who do not have a postsecondary degree should encourage and assist their clients in obtaining one; practitioners may also wish to provide more targeted support for consumers from potentially high-risk subpopulations.

Teaching braille is one of the most time-consuming tasks for a vision rehabilitation therapist. Complicating this process, adults who might be considered to be good candidates for learning braille are often resistant to the idea (Ponchillia & Ponchillia, 1996). In an attempt to address these challenges, a combination of correspondence braille classes supplemented with face-to-face group activities was implemented. Perseverance in learning braille was assessed for the six participants of this intervention.

Health promotion interventions for adults who are visually impaired have received little attention. This article reports what is currently known about the health, overweight and obesity, and levels of physical activity reported by these adults. Conclusions about the need for health promotion activities based on this information are provided, and suggestions for implementing these activities or interventions are offered.

Visual impairment (blindness or low vision) is a leading cause of disability among older adults and is most often due to age-related macular degeneration (AMD). It is predicted that 2.95 million people will have AMD by 2020 (Eye Diseases Prevalence Research Group, 2004). Unfortunately, there is no cure for AMD, nor can lost vision be restored. Although there are interventions to slow the progression of the condition, treatment is primarily rehabilitative. Services for people with low vision include low vision rehabilitation, occupational therapy, social support programs, and orientation and mobility training. Assistive devices include magnifiers, large-print materials (such as books, clocks, and calculators), audio materials (such as books and magazines), electronic reading devices, and speech-output systems. Despite the availability of these rehabilitative services and devices, they are underutilized. A series of focus groups that were conducted by the National Eye Institute (NEI) indicated that many older persons with low vision have little or no awareness of these services, and, as a consequence, few take advantage of them (National Eye Institute, 2001). The goal of the current study was to obtain more detailed information on the use of low vision services and devices by older adults with AMD and to determine whether knowledge and use of such services are related to the severity of vision loss. (Contains 1 table.)

In-depth interviews with 20 people with monocular vision identified a number of themes associated with the impairment, including psychological, psychosocial, physical, vocational, and daily living problems. They also revealed that in many cases, these problems had profound implications for people's adjustment to daily living. The implications of these findings for the delivery of rehabilitation services are discussed.

Introduction: In the Province of Quebec, Canada, it is estimated that only about one-third of working-age adults with visual impairments are part of the workforce, despite ongoing efforts of rehabilitation and government agencies to integrate these individuals. The present article describes the development and adaptation of a pre-employment program specifically designed for English-speaking visually impaired persons in Quebec. Methods: Based on a model program introduced at the University of Texas in the United States, and further developed with the Royal National Institute of Blind People in the United Kingdom, the MAB-Mackay Rehabilitation Centre (MMRC) adapted the training materials for its pre-employment program to the local requirements. Its effectiveness was appraised using post training employment status as well as responses by participants, using the Canadian National Institute for the Blind (CNIB) Tool to Assess Preparedness for Employment (TAPE) measure of employment readiness. Results: Of the eight participants who completed the four-week program, five had found employment and, of those, four had maintained employment within the eight-month follow-up period (one full-time, three part-time). Further, two of those employed part-time also returned to school part-time. An additional two participants chose to continue their education in order to improve their employability. Scores on the CNIB TAPE subscale of communication showed statistically significant post-training improvement ("p" = 0.01) that was maintained after eight months. A statistical trend indicated improvement on the technology subscale following participation in training ("p" = 0.10). Discussion: MMRC's pre-employment training program was developed to address the need for a structured employment preparation program that was integrated with the available rehabilitation services for English speaking visually impaired individuals in a predominantly French-speaking environment. Implications for practitioners: The multidisciplinary nature of this approach facilitated a common language and shared perspective for practitioners across disciplines that are involved in preparing clients for the job market.

Age-related maculopathy is the leading cause of vision loss among adults in developed countries, and its prevalence is expected to double over the next decade. The two forms of age-related maculopathy--exudative and nonexudative--are capable of affecting the macula, with potential symptoms including decreased contrast sensitivity, decreased visual acuity, abnormal adaptation to the dark, and central or pericentral scotomas. When a central scotoma impairs the ability of the fovea to distinguish detail, one or more preferred retinal loci (PRL), also known as pseudo-foveas, naturally develop at eccentric retinal locations and become the new points of fixation. The location of the PRL varies from person to person, as does the ability to maintain steady fixation with the PRL and to use it for reading and activities of daily living. Fletcher and Schuchard (1997) reported the results of a study examining patterns of PRL ability and location relative to macular scotomas. They mapped dense scotomas and determined the location of the PRL in 1,339 eyes in 825 persons with a scanning laser ophthalmoscope during a standard low vision rehabilitation evaluation. Fletcher and Schuchard created a scoring system to measure the pursuit ability, fixation stability, and saccadic ability of the PRL. They determined the characteristics of dense scotomas within 2.5 degrees of the PRL or fovea. Of the 1,339 eyes, 84% (1,130) demonstrated an established PRL, ranging in size from 1.0 degrees to 9.0 degrees in diameter, and 82.5% had a central dense scotoma. The PRL had no dense scotomas on any border in 14.8% of the eyes. It had one, two, or three borders with a dense scotoma in 39.7%, 19.0%, and 9.0% of the eyes, respectively. Ring scotomas, bordering the PRL on four borders, were present in 17.4% of the eyes. Of the eyes with one scotomatous border, most had a field defect located either superior (39.0%) or to the right (33.7%). It was less common for the eyes to have field defects to the left or inferior, with 19.9% and 7.5% of the eyes, respectively. This report presents a 10-year comparison of these previous findings. It examines whether the PRL characteristics of persons with low vision remained steady over the ensuing decade. Changes in PRL and visual field characteristics among persons with low vision over time could have implications for the approaches of low vision rehabilitation professionals to training in eccentric viewing and other rehabilitation techniques. (Contains 4 figures and 1 table.)

Introduction: The study presented here examined rehabilitation providers' beliefs about services and service delivery strategies that are successful in facilitating the transition from school to competitive employment for youths who are blind or have low vision. Methods: Five focus groups were conducted, two with rehabilitation state agency personnel and three with members of professional organizations at their annual conferences. A protocol with four queries about transition services generated data for a content analysis by a team of three researchers. Results: The participants identified transition services before age 16, communication among service providers and families, assessment, and the development of specific skills as important factors in facilitating the transition to competitive employment. Parental involvement was also identified as a positive factor in the transition and career planning. Discussion: Transition services are not routinely provided before age 16, thus hindering the development of skills and careers. Improved communication among service providers and parents can promote advocacy and the successful transition to work. The qualitative research strategies used in the study did not generate results that can be generalized to other populations or settings or that can be used to evaluate outcomes. The results can be assessed for transferability and to understand the transition process. Implications for practitioners: Requiring specific documentation of collaboration between parents and service providers may increase communication among the stakeholders. Increased communication may lead to students' participation in transition-to-work activities at an earlier age, thus promoting successful transitions.

Rehabilitation efforts for children with congenital dual sensory impairments, or deafblindness, have a long-standing history. Rehabilitation for older people with acquired dual impairments has recently moved to center stage because of the increasing number of clients who require such services (Saunders & Echt, 2007). For both these groups of clients, service delivery follows already established pathways. However, it has been the authors' experience that a third group of rehabilitation clients, namely, those who are affected by slowly progressive and early-onset impairments, often require individually tailored unique interventions that need to remain flexible over long periods. This article describes one such process in which a client's (and the rehabilitation agency's) rehabilitation goal was to make telephone services accessible in the presence of a progressive sensory-and-motor impairment that was due to Charcot-Marie-Tooth (CMT) syndrome. (Contains 1 figure.)

A statewide assessment of stakeholders' needs was conducted for a state agency providing habilitation, rehabilitation, and independent living services to persons of all ages who are visually impaired (that is, those who are are blind or have low vision). This needs assessment was designed to acquire an accurate and thorough picture of the agency's strengths and weaknesses. Five focus groups were conducted as part of this assessment to identify stakeholders' views of the service delivery needs of persons who are visually impaired. The analyses of the data from the focus groups were clustered into four distinct themes or concerns regarding the variability in services, outreach, transportation, and service delivery.

A model of vision rehabilitation that assumes that functional ability will affect the emotional and psychosocial adjustment of older persons with visual impairments, and ultimately their quality of life, was assessed using structured equation modeling. The proposed model was upheld. In addition, the ability to get around was found to contribute to both functional ability and quality of life. (Contains 1 table and 2 figures.)

A limited amount of research has been conducted on the knowledge of and familiarity with individuals with disabilities of medical students. There have been studies on these individuals' satisfaction with medical services and the accessibility of medical services to them, the role of health care providers in working with these individuals, and the perceptions of medical students by individuals with physical disabilities. Only two studies, however, have investigated medical students' perception of individuals with visual impairments and hearing impairments. To ensure high-quality care for individuals with visual impairments, there is a need to investigate future physicians' knowledge of visual impairments. This study investigates medical students' overall comfort with and knowledge of examining the eye and understanding of ocular conditions, comfort level in working with children and adults with visual impairments, and knowledge of local and state educational and rehabilitation services for individuals with visual impairments. The responses of the participants regarding confidence in performing eye examinations followed a distinct pattern of being most comfortable in examining the posterior section of the eye and the least confident in examining the anterior section of the eye. In general, the participants were comfortable performing a general eye examination screening. The participants reported a general discomfort in working with patients who are blind or have low vision. Almost 93.0% of the participants were unaware of educational agencies, and an alarming 97.4% were unaware of rehabilitation agencies.

Central scotomas--areas of the nonseeing retina within the central 20 degrees of the visual field--are present in approximately 90% of vision rehabilitation patients. They vary in size and shape and can be small or large, symmetrical or asymmetrical, round or irregularly shaped. Most central scotomas border fixation on one side and can be overcome with magnification and sometimes eccentric viewing. However, these strategies seldom suffice in the case of ring scotomas, which border three or four sides of fixation and have been present in 20%-47.5% of patients with eye conditions that affect central vision. Patients with ring scotomas generally have near-normal acuity, which does not reflect their functional impairment in reading and activities of daily living. They display a characteristic slow-fast-slow reading pattern when performing tests such as the MNREAD acuity chart. They read the largest print slowly, speed up with the middle print sizes as more letters fit within the central island of vision, and then slow again when the print drops below the size they can discern. Most patients with ring scotomas fixate centrally even for targets that are larger than the central island, possibly because reorganization of cortical visual processing only occurs in the absence of foveal vision. This article discusses the three principles that characterize the approach to intervention for patients with foveal-sparing scotomas: (1) education about the scotoma; (2) supporting the use of the limited central vision; and (3) maximizing the potential to use the peripheral retina. (Contains 1 figure.)

The wars in Afghanistan and Iraq have been notable for the high rates of traumatic brain injury (TBI) that have been incurred by the troops. Visual impairments often occur following TBI and present new challenges for rehabilitation. We describe a neurological vision rehabilitation therapy that addresses the unique needs of patients with vision loss that is due to TBI. (Contains 1 figure.)

Macular degeneration is the leading cause of vision loss in the United States for persons aged 60 and older. Compared to individuals without disabilities, individuals with low vision demonstrate a 15% to 30% higher dependence on others to perform activities of daily living. In addition, low vision can adversely affect a person's quality of life. Vision rehabilitation has been shown to improve the performance of everyday activities and to increase the quality of life of people with low vision. However, a standard of care has not been established for low vision rehabilitation, and most outcome studies have focused on individual, rather than on group, rehabilitation. This article reports a pilot study whose purpose was threefold. First, the authors sought to pilot-test a new instrument that measures independence in activities of daily living, the Smith's Activity of Daily Living Independence Survey (hereafter Smith's), which is in the early stages of development and is being designed specifically for use with people with low vision. Second, they sought to pilot-test an educational program that has been developed specifically for a low vision population to determine if it needs to be altered to be more effective when used with people with low vision. Third, they wanted to determine if the methodology that they used in the study needed to be revised so that the effects of an educational program on the independence of persons with macular degeneration in everyday activities can be more effectively determined by identifying factors that may affect the strength of any treatment effect. The research hypothesis was this: Individuals with low vision who receive the educational program will demonstrate higher change scores in independence in their activities of daily living than will individuals with low vision who do not receive the educational program. To obtain additional information about the educational program if the research hypothesis was confirmed, the following research question was posed: Which of the six sections of the Smith's was responsible for the overall score of the Smith's being statistically significant?

Closed-circuit televisions (CCTVs) are used by many elderly people who have age-related macular degeneration (AMD). The functional vision of 68 participants, which was measured immediately after they adopted CCTVs, suggested successful outcomes, but the psychosocial impact of the use of CCTVs did not peak until a month later. The findings help identify circumstances in which CCTV-assisted rehabilitation may be enhanced for better long-term outcomes. (Contains 2 figures and 3 tables.)

Older adults with age-related macular degeneration (AMD) are not immune to the other diseases of aging. Although AMD is the leading cause of low vision in older Americans, stroke is the leading cause of disability, and dementias affect another 2.5 million older Americans. Each condition alone can significantly impair a person's ability to participate fully in daily life, and these conditions often occur together. This article describes impairment from memory loss, dementia, and stroke to provide insights into how these conditions may affect the visual rehabilitation of clients with AMD.

This survey of 560 older adults who were visually impaired or sighted analyzed whether the two groups differed in their levels of activity, independence, and life satisfaction and the degree to which activity and independence contribute to the prediction of life satisfaction. Implications for rehabilitation services are discussed. (Contains 5 tables and 1 figure.)

This systematic review of the effectiveness of driver rehabilitation interventions found that driver training programs enhance driving skills and awareness, but further research is needed to determine their effectiveness in improving driving performance of drivers with low vision. More research is also needed to determine the effectiveness of low vision devices for driving. (Contains 1 table.)

Retinitis pigmentosa (RP) causes restriction of the visual field, progressive vision loss, and night blindness. This article presents an overview of the most common problems in orientation and mobility (O&M) for individuals with RP, appropriate interventions, vision science discoveries related to RP, and the impact of RP on functional visual performance as it relates to O&M. (Contains references.) (DB)

This article explores issues of allied health professionals who provide vision rehabilitation services to individuals with visual impairments. It questions whether allied health professionals receive sufficient training to work with this population, identifies challenges facing the rehabilitation field, and suggests ways allied health professionals and vision rehabilitation professionals can work together. (Contains references.) (Author/DB)

The Texas Commission for the Blind's (TCB's) braille literacy initiative is an agency-based program designed to enhance the braille skills of teaching staff. In addition, TCB has established braille-production stations in 30 of its district offices and offers technical assistance to regional rehabilitation personnel. (Author)

This article describes the assessment and rehabilitation processes of three children with deaf-blindness due to Usher syndrome who received cochlear implants at ages six and nine. Follow-up data two and three years after implant for two of the children are analyzed, indicating substantial positive benefits. (DB)

This study evaluated the quality and costs of services for 16 young adults with dual sensory impairments and mental retardation before and during their placement at a specialized, community-based, residential, further-education facility in England. Results indicated that overall quality and costs were higher than in previous placements, though there were wide variations among clients. (Author/DB)

A nationwide survey of braille instructors in adult rehabilitation centers found that: most teachers taught braille to fewer than 20 percent of clients; few taught complex reading skills; instructors' attitudes were influenced by their training site, type of college degree, and degree of vision; and teaching behaviors were affected by teaching site, degree of vision, and degree type. (Author/DB)

Ideas for expanding vision-related rehabilitation services, possibly through the health care system, are addressed. Need areas include gaining support nationally and within states, professionalizing the vision-related rehabilitation field, using innovative health care practices, acquiring funding, and improving accountability. (SW)

This study investigated the relationship between perceived family environment and psychological distress among 76 adults with visual impairments of fewer than 4 years duration, who had undergone at least 4 months of rehabilitation classes. Family environmental traits strongly influenced adjustment to vision loss. Distress was positively correlated with conflict and control and was negatively correlated with cohesion and independence. (Author/PB)

This article presents results of a noncontrolled clinical study of 20 persons with Leber's hereditary optic neuropathy who were treated from 1976 to 1990 at the Low Vision Centre of the Finnish Federation of the Visually Handicapped. The importance of early functional visual rehabilitation is emphasized, as is the use of low vision aids to help patients perform their daily activities. (Author/PB)

This study evaluated the gains in capacity and mode of performance made by 57 elderly blind persons who were clients of an independent living services program in Mississippi. It was found that the gains in capacity were significant in all areas and the gains in mode of performance were significant for 41 of the 47 skill areas that were assessed. (Author)

A survey of the attitudes toward people with visual impairments in rehabilitation agencies or health care centers in the Netherlands received 263 responses from the general public and rehabilitation workers. Analysis supported the usefulness of distinguishing between the emotional and cognitive components of attitudes. Implications for public and professional education are presented. (Author/DB)

This study analyzed scores of 469 British adult clients with recent loss of sight on the Nottingham Adjustment Scale using LISREL structural modeling techniques. Results supported a theoretical model of the self in terms of two latent factors--internal self-worth and self as agent. Implications for rehabilitation and intervention with cognitive therapy are considered. (Author/DB)

This article addresses the lack of access to low-vision rehabilitation services by individuals needing them, due to lack of coverage by public or private health insurance. Improved insurance coverage would result in improved access as well as more direct referrals by ophthalmologists, more consumer choice, more timely rehabilitation, reduced costs, and increased independence. (DB)

This paper describes a summer program teaching independent living skills to 20 adults with visual impairments. Results suggest the program had a lasting and profound impact on clients' previously low knowledge of job hunting, decision making, stress management, and self-care skills. Interaction with other adults with visual impairments and client-driven curriculum were strengths of the program. (PB)

Introduction: This study, conducted in the United States, investigated the challenges faced by drivers with homonymous visual field loss and their coping strategies, including the use of in-vehicle Advanced Driver Assistance Systems (ADAS). Methods: Four current drivers with either homonymous quadrantanopia or homonymous scotoma caused by a stroke completed an in-depth semi-structured telephone interview. Using mostly open-ended questions, the interview addressed the difficulties encountered while driving, strategies used to cope with the difficulties, and the use of ADAS. Results: The main difficulties related to seeing objects on the side of the field loss, especially at intersections and when merging or changing lanes. Individuals with left-sided field loss reported problems with left turns and seeing oncoming cars at intersections. Those who had homonymous scotomas described how cars disappeared in and out of the scotoma. Two participants reported many driving difficulties at first, but fewer difficulties as they became used to driving with the field loss. The most common coping strategies included scanning to the side of the field loss (including large scans with head movements), use of rearview and side mirrors, adding mirrors to the car, leaving more space on the side of the field loss, avoiding difficult driving situations and the use of ADAS (blind spot warning, GPS navigation, and rearview camera). Discussion: All participants reported some difficulties consistent with those found in on-road and driving simulator studies of individuals with homonymous visual field loss. Over time they each reported developing a set of strategies, including the use of ADAS, for coping with the field loss that enabled them to be active drivers with relatively few self-imposed restrictions. Implications for Practitioners: Advising drivers with stroke-related field loss about potential difficulties and compensatory strategies is an important part of preparation for return to driving. This article provides examples of problem situations, coping strategies, and ADAS use which can be used to guide discussion. [ABSTRACT FROM AUTHOR]

Introduction: Research supports the benefits of job search interventions in improving employment outcomes for various populations, but previous studies involved face-to-face implementation and did not include adults with visual impairments. The purpose of this study was to investigate the feasibility and acceptability of a job search intervention designed for synchronous distance implementation with adults with visual impairments. Methods: Two trainers implemented a 5-day job search skills training program with 12 job seekers with visual impairments, ages 22–63 years, via Zoom videoconferencing software. Researchers documented participant attendance and intervention fidelity during the program. Participants completed electronic surveys that included quantitative measures of cognitive load and acceptability, plus open-ended questions about their overall perceptions of the program. Results: Attendance, intervention fidelity, and germane cognitive load were high, whereas intrinsic and extraneous cognitive load were low. Most implementation issues resulted from technical difficulties experienced by participants, which were most prevalent on the first day. Acceptability ratings indicated high levels of engagement; relevance; interactivity; and satisfaction with the trainers, group processes, and virtual format. Participants commented on many positive aspects of the program, and some acknowledged the technical issues that occurred. Discussion: The results support the acceptability and feasibility of the job search intervention. The trainers successfully implemented the program via videoconferencing with adults with visual impairments and developed a positive group atmosphere with high social support. Implications for Practitioners: Our findings have implications for facilitating group interventions through videoconferencing, including strategies for building group cohesion and social support. [ABSTRACT FROM AUTHOR]