Search

Introduction: This study analyzed 39 data collection tools used by teachers of students with visual impairments when completing functional vision assessments (FVAs). Methods: In 2017, teachers of students with visual impairments submitted data collection tools used in the FVA process. These tools were then compared with the 23 FVA components suggested by two established resources, Erin and Paul and D’Andrea and Farrenkopf. Results: The most commonly assessed skills and abilities were near visual acuity, distance visual acuity, and color perception. Only five of the submitted data collection tools contained at least 80% of the FVA components identified by the established resources. Fewer than 25% of the tools incorporated an orientation and mobility (O&M) screening. Discussion: There was considerable variation in the background information, medical data, and visual skills information that was collected. Variability in the data collected during the FVA process may impact a teacher’s recommendations, including referrals for specialized evaluations such as O&M and clinical low vision evaluations. Implications for practitioners: Since FVA reports are used by Individualized Education Program teams, it is essential that data collection tools used during the assessment process are complete and address key areas such as near visual acuity and color perception. Teachers should carefully review their tools to determine whether the data collected are sufficient to make informed recommendations regarding accommodations, goals, and referrals. If the data collected are not sufficient, then the tools should be revised or additional data should be collected.

Introduction: Within the field of visual impairment, there is no set of standards that guide teachers of students with visual impairments as they conduct, report, and share functional vision assessment (FVA) results with other educational team members, and university instructors vary in how they teach the assessment process to preservice teachers. Methods: In parallel, a group of teachers of students with visual impairments and a group of university instructors completed three rounds of a Delphi study. After providing background information in Round 1, they rated 84 statements about the FVA process. The level for consensus was set at 80%. Results: Of the 84 statements, consensus was reached for 45 statements regarding the level of importance by both groups. Participants rated 11 of 22 visual skills (e.g., near acuity, distance acuity) as extremely important to include in the FVA process. Discussion: There continues to be a need to build consensus on when FVAs should be conducted, what visual skills should be included when conducting them, what should be included in reports, and with whom assessment information should be shared. The importance of conducting such assessments for all students, including students under the age of 5 years and those with additional disabilities, needs to be recognized by the field of visual impairment. Implications for practitioners: University personnel need to work together to develop consistent curricula that focuses on the FVA process. Future studies that examine the FVA practices of individual teachers are necessary.

Vision plays a key role in a child’s development. Early detection and treatment of vision abnormalities decreases future complications. Follow-up vision care is a common problem. Barriers to vision care include financial cost, lack of insurance knowledge to cover costs, and disbelief of vision results. The purpose of this evidence-based pilot project was to improve the rate of follow-up vision care obtained by school-aged children. The target population was school-aged children from kindergarten to fifth grade at an elementary school within Lake County, Ohio. The vision referral program included phone calls to families to identify and overcome barriers to obtaining vision care. Barriers identified with the target population include disbelief of vision results, lack of knowledge about vision health, and financial cost. Results indicated an increase of vision care rates during the 2017–2018 academic year by 60% above baseline rates from the previous academic year.

Background Several visual tasks have been proposed as indirect assays of the balance between cortical inhibition and excitation in migraine. This study aimed to determine whether daily measurement of performance on such tasks can reveal perceptual changes in the build up to migraine events. Methods Visual performance was measured daily at home in 16 non-headache controls and 18 individuals with migraine using a testing protocol on a portable tablet device. Observers performed two tasks: luminance increment detection in spatial luminance noise and centre surround contrast suppression. Results Luminance thresholds were reduced in migraine compared to control groups ( p Conclusions Daily portable testing of vision enabled insight into perceptual performance in the lead up to migraine events, a time point that is typically difficult to capture experimentally. Perceptual surround suppression of contrast fluctuates during the migraine cycle, supporting the utility of this measure as an indirect, non-invasive assay of the balance between cortical inhibition and excitation.

Introduction This study analyzed survey responses from 314 teachers of students with visual impairments regarding the tools and procedures used in completing functional vision assessments (FVAs). Methods Teachers of students with visual impairments in the United States and Canada completed an online survey during spring 2016. Results The majority of participants reported that they primarily assess pre-academic and academic students in kindergarten through 12th grade (K-12). More than 95% of all participants indicated that they assess near and distance visual acuity. Other commonly assessed skills and abilities were tracking ( n = 298; 95%), peripheral visual fields (n = 296; 94%), and color perception (n = 293; 93%). Approximately 50% of survey participants indicated that they use a screening tool in determining the need for an orientation and mobility (O&M) evaluation. Discussion The procedures and tools used by participants in completing FVAs varied based on the specific student being assessed. There was also considerable variation in visual skills assessed, as well as in what was included in the assessment report by the participants. Based on comments from participants, it appears that there are complex factors that influence the decision-making process regarding possible referrals for an O&M evaluation or a clinical low vision evaluation. Implications for practitioners Teachers should reflect on their own practices and procedures to determine whether they are including all pertinent information in their FVA reports, as well as explore whether they should assess additional visual skills in order to provide a rich description of how the student uses his or her vision throughout the day in a variety of environments.

Objective:To examine factors associated with visual impairment (VI) and eye care in the International Mobility in Aging Study (IMIAS). Method: IMIAS data were analyzed ( N = 1,995 with ages 65-74). Outcomes were VI defined as presenting visual acuity worse than 6/18 in the better eye and eye care utilization assessed by annual visits to eye care professionals. The Hurt–Insult–Threaten–Scream (HITS) questionnaire requested information on domestic violence. Results: Among men, VI varied from 24% in Manizales (Colombia) to 0.5% in Kingston (Canada); among women, VI ranged from 20% in Manizales to 1% in Kingston; lifetime exposure to domestic violence was associated with VI (odds ratio [OR] = 1.87; 95% confidence interval [CI] = [1.17, 3.00]). Eye care utilization varied from 72% in Kingston’s men to 25% in Tirana’s men; it was associated with domestic violence (prevalence ratio [PR] = 1.3; 95% CI = [1.1, 1.6]). Discussion: VI is more frequent where eye care utilization is low. Domestic violence may be a risk factor for VI.

Purpose To analyze the accuracy of the Lambda 100 (Heine) potential visual acuity (VA) measurements in subjects undergoing cataract surgery. Methods The medical records of all consecutive patients who underwent clear corneal incision phacoemulsification cataract surgery by a single surgeon between 2010 and 2012 at the Department of Ophthalmology, Hadassah Medical Center, a tertiary care hospital in Jerusalem, Israel, were reviewed. Subjects age 18 or older with a follow-up time of at least 30 days were included. Subjects with previous ocular comorbidities other than glaucoma were excluded. In addition, patients with intraoperative or perioperative complications that could affect final VA were excluded. Analyses were performed to analyze the accuracy of preoperative retinometer potential VA as a predictor of postoperative best-corrected VA. Results A total of 374 operated eyes were included. There was a moderate positive correlation between Lambda estimated VA potential and postoperative achieved best-corrected VA (BCVA) (β coefficient 0.35, pConclusions Lambda may be used to relatively accurately predict postoperative BCVA in cataract patients, specifically in those with moderate cataracts.

Although good visual capacity is essential for children’s learning, we have limited understanding of the various visual functions among school starters. In order to extend this knowledge, a small-scale study was undertaken involving 24 preschool children age 5–6 years who completed a test battery originally designed for visual impairment specialists to measure visual acuity for distance and close work, and for visual attention and reaction capacity in the field of vision. The results revealed that school starters have a less mature visual acuity at a close reading distance than at a far distance. In this group, there were significant gender differences in visual acuity and reaction time in the visual field. This article discusses whether the level of visual development and gender differences may influence how pupils react, behave and learn in school, and questions whether this insight ought to have an impact on our expectations with regard to children’s school performance. In the context of pressures to begin formal teaching of literacy and numeracy earlier in some countries, the question of visual readiness becomes critical. The question should also make educators alert to the dangers of expecting all children to succeed in learning to read at the same early age, and of labelling those who do not succeed in making an early start as intellectually deficient.

Purpose To evaluate the optical coherence tomography angiography (OCT-A) features of a peripapillary intrachoroidal cavitation (ICC) in a patient with high myopia. Methods A 67-year-old woman with ICC underwent visual acuity testing, refraction, slit-lamp biomicroscopy, dilated fundus examination, and OCT-A. The main findings are described in this case report. Results Best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed in the right eye a macular scar, a tilted disc along with a peripapillary staphyloma, and an orange-yellowish lesion on the inferior border of the disc. Structural OCT B-scan showed ICC as an intrachoroidal hyporeflective space located below the normal plane of the retinal pigment epithelium adjacent to the optic nerve head. Optical coherence tomography angiography showed the cavitation as a hyporeflective area, devoid of detectable flow from the choriocapillaris and large choroidal vessels layers, suggesting the choroid, including the residual hyperreflective tissue in the outer aspect of the retinal pigment epithelium/Bruch membrane, to be avascular in ICC. Conclusions Optical coherence tomography angiography demonstrated the absence of choroidal and choriocapillary network.

Vision screenings are intended to efficiently identify students with possible visual impairment and initiate a referral for diagnosis and treatment. In many cases, at-risk students do not access the recommended care or experience delays in receiving care. The purpose of this article is to report the effect on adherence to vision screening recommendations by providing the eye examination at the students’ school and at no cost. Of the 1,306 students screened, 382 (29.2%) were identified with possible visual impairment. Parental consent for examination was obtained for 198 (51.8%) students. Our vision screening and examination program yielded similar adherence to follow-up as stand-alone vision screening programs. Future program considerations should address perceptual barriers that may be contributing to parental nonadherence to vision screening recommendations.

To assess the preventable visual impairment in children with nonprofound intellectual disability (ID). A total of 215 children with IDs (90 Down syndrome [DS], 125 nonprofound ID) and 116 age- and sex-matched healthy subjects were enrolled in this study. All participants underwent ophthalmologic examinations including cycloplegic refraction measurements, ocular movement evaluation, screening for strabismus (Hirschberg, Krimsky, or prism cover test), slit-lamp biomicroscopy, funduscopy, and intraocular pressure measurements. All data were recorded for statistical analysis. Ocular findings in decreasing prevalence were as follows: refractive errors 55 (61.1%), strabismus 30 (33.2%), cataract 7 (7.8%), and nystagmus 7 (7.8%) in children with DS; refractive errors 57 (45.6%), strabismus 19 (15.2%), cataract 7 (6.4%), nystagmus 5 (4%), and glaucoma 1 (0.8%) in children with other ID; and refractive errors 13 (11.2%) and strabismus 4 (3.5%) in controls. Cataracts, glaucoma, and nystagmus were not observed in the control group. The most common ophthalmic findings in children with DS compared with other ID and controls were with hyperopia (p0.03 and p0.001, respectively) and esotropia (p0.01 and p0.01, respectively). The pediatric population with ID has a high prevalence of preventable visual impairments, refractive errors, strabismus, and cataracts. The prevalence of strabismus and refractive errors was more frequent in children with DS. The importance of further health screenings including ophthalmic examinations should be utilized to implement appropriate care management and improve quality of life.

To indicate the relationship between constant, correct use of hyperopic spectacles and relaxation of accommodation in children.After thorough ophthalmic examination (cycloplegia included), 52 children 2.5 to 9 years old were detected with hyperopia3 D, out of all examined within a year. These children were fully or partially corrected, with hyperopic glasses, depending on whether accommodative esotropia was or was not present. Constant and correct use of spectacles was strongly suggested to all children. During follow-up 3 and 6 months later, the amount of manifest hyperopia was measured in each case by an autorefractometer (without the use of cycloplegic factor).Out of the 52 children, 37 who participated in our study fully complied with hyperopic spectacle treatment, wearing their glasses constantly and correctly. The 15 others wore their glasses partially or not at all or made incorrect use of them. During follow-up 3 and 6 months later, refractive measurements of manifest hyperopia in the first group of children were identical or similar to the refractive power of their glasses. On the contrary, in the second group of children, strong accommodation did not allow the expression of hyperopia, and in a few cases myopic refractive measurements appeared (similar to those on the first examination, before spectacle treatment was prescribed).Constant and correct use of hyperopic spectacles leads to relaxation of accommodation in children and is thus an accurate indicator of compliance.

Background: Retinal nerve fiber layer (RNFL) loss occurs with multiple sclerosis and after optic neuritis. Vision or RNFL changes at presentation of optic neuritis are not predictive of outcome, but vision loss at 1 month correlates with vision deficits at 6 months. We hypothesized that RFNL thinning at 1 month would predict RNFL loss at 6 months. Methods: We prospectively studied the RNFL by optical coherence tomography (OCT) and scanning laser polarimetry (SLP), and determined the threshold field mean deviation, in 25 subjects with acute optic neuritis over a 6-month period. RNFL values, including the amount of thinning at 1-month, were correlated with 6-month outcome. Results: Baseline visual performance and RNFL values were similar for eyes grouped by 1 month RNFL thinning. Eyes with 1 month RNFL thinning had greater and significant RNFL thinning at 6 months, for all quadrants by OCT and for the nasal and inferior quadrants by SLP. RNFL thinning by OCT and SLP at 1 month correlated with 6-month OCT ( r = 0.58; p = 0.006) and SLP ( r = 0.59; p = 0.002) RNFL thinning, respectively. Conclusion: Early RNFL loss at 1 month was predictive of the RNFL thinning at 6 months, which corroborated the importance of the 1-month time point for predicting the outcome of an optic neuritis attack.

The study assessed the effectiveness of a pilot intervention to promote the use of eyeglasses in one school in California. The intervention used a one-group pretest, posttest design. Between January and June 2011, during the intervention, all first- and second-grade children received eye evaluations and the children with refractive error received two pairs of attractive eyeglasses. Parents received eye care education. Teachers monitored the use of eyeglasses in the classroom. Prior to the intervention in January 2011, 1 of the 15 children with refractive error (6.7%) wore eyeglasses in the classroom and the remaining 14 (93.3%) lacked eyeglasses altogether; 6 months following the end of the intervention in December 2011, 11 of the 15 children (73.3%) wore eyeglasses in the classroom and the remaining 4 (26.7%) did not ( p = .002). The multifactorial intervention increased the use of eyeglasses in the classroom even months after the end of the summer vacation.

Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries. Design: Systematic literature review. Setting: Only research studies done in developing countries were included. Method: The review is restricted to English-language articles published between 1997 and 2007. It includes studies that reported randomized trials (controlled and uncontrolled) and surveys with some form of outcome measure, with or without process evaluation. The literature search was conducted on six electronic databases. Data were extracted and synthesized using a standard data extraction form. A narrative synthesis was carried out for the purpose of this review. The quality of the included trials was assessed by CRD guidelines and Crombie’s checklist. The applicability of research findings was evaluated by the RE-AIM model. Results: One randomized cluster trial and nine surveys were critically appraised. Three multi-faceted interventions were judged effective while another three were found ineffective. Two out of the three effective interventions used service provision and educational input. Two out of the three ineffective interventions also used service provision alongside other methods including screening and counselling. Findings of effective interventions were generalizable. Conclusion: The review suggests that eye health education and service provision lessen the barriers to service uptake and increase the uptake of eye care services. The role of counselling and screening services needs further review by large and good-quality studies.

In the typical human visual system, the macula allows for high visual resolution. Damage to this area from diseases, such as age-related macular degeneration (AMD), causes the loss of central vision in the form of a central scotoma (Kanski, 2008). Since no treatment is available to reverse AMD, providing low vision rehabilitation to compensate for the loss of central vision is invaluable for individuals with this condition. Teaching persons with a central scotoma the technique of eccentric viewing to use their remaining peripheral retina to read and perform tasks of daily living has been shown to be effective (Nilsson, Frennesson, & Nilsson, 2003; Petre, Hazel, Fine, & Rubin, 2000; Vukicevic & Fitzmaurice, 2002). It has been reported that persons with AMD can unconsciously adopt an eccentric area of the uncompromised retina, allowing them to achieve better vision. This eccentric area acts as a pseudo-fovea and is termed the preferred retinal locus (PRL) (Schuchard, 1995; Timberlake et al., 1986). Although useful, this spontaneous choice of location may not provide optimal vision for individuals to perform various visual tasks, such as reading, recognizing faces, or performing activities of daily living. Optimizing the location of the retinal area used can be addressed with formal training in eccentric viewing to teach individuals to use a more suitable part of their retina to see by introducing a trained retinal locus (TRL) (Culham, Silver, & Bird, 1990; Fletcher, Schuchard, & Watson, 1999; Nilsson et al., 2003; Vukicevic & Fitzmaurice, 2005, 2009). Although there are many methods for training eccentric viewing, the fundamental principles are equivocal and involve two stages: 1. Identification of the residual areas of the healthy retina by mapping the individual's visual field and 2. Location of the most suitable area to be used as the TRL on the basis of the proximity to the fovea. A number of methods and apparatuses are available to chart the visual field, but the preferred method is by microperimetry with such devices as the Macular Integrity Assessment Microperimeter (CenterVue SpA, Padova, Italy) or the Nidek MP-1 Micro Perimeter (Nidek Technologies Srl, Padova, Italy). Alternately, the visual field can be mapped by tangent screen perimetry, such as the Bjerrum tangent screen. Microperimetry allows clinicians to precisely delineate the borders of the scotoma and the corresponding visible pathology on the retina. The technique is also capable of displaying direct, real-time observation of the retina, and stimuli can be placed on the retina for the purposes of training in eccentric viewing. For this reason, microperimetry is useful (Sunness, Bressler, & Maguire, 1995; Timberlake et al., 1986). Nevertheless, microperimetry is not widely used clinically because it is considered to be the least popular method of identifying the retinal locus for eccentric viewing training (Weisser-Pike, 2008). Low vision practitioners have reported that microperimeters are difficult to use and difficult for clients to understand how to perform the required task. The preference is for simpler methods, such as the Amsler grid or the Bjerrum tangent screen. Clinicians' preference is not the only issue that restricts the clinical use of microperimetry in a low vision setting: it is expensive equipment and hence is generally reserved for research purposes (Manivannan et al., 2001). Low vision practitioners commonly use the Bjerrum tangent screen as a method of mapping the central visual field or the central scotoma or both. The Bjerrum tangent screen is a black felt screen that evaluates the central 30 degrees of the retina at a one- or two-meter (about 3 feet or 6.5 feet) testing distance. The Bjerrum has statico-kinetic properties that allow the borders of the scotoma to be accurately charted (kinetically) and individual test points to be grossly quantified (statically). …

Background: We previously reported that performance on the Stroke Driver Screening Assessment (SDSA), a battery of four cognitive tests that takes less than 30 min to administer, predicted the driving performance of participants with multiple sclerosis (MS) on a road test with 86% accuracy, 80% sensitivity, and 88% specificity. Objectives: In this study, we further investigated if the addition of driving-related physical and visual tests and other previously identified cognitive predictors, including performance on the Useful Field of View test, will result in a better accuracy of predicting participants’ on-road driving performance. Methods: Forty-four individuals with relapsing–remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the SDSA. The model that explained the highest variance of participants’ performance on a standardized road test was identified using multiple regression analysis. A discriminant equation containing the tests included in the best model was used to predict pass or fail performance on the test. Results: Performance on 12 cognitive and three visual tests were significantly associated with performance on the road test. Five of the tests together explained 59% of the variance and predicted the pass or fail outcome of the road test with 91% accuracy, 70% sensitivity, and 97% specificity. Conclusion: Participants’ on-road performance was more accurately predicted by the model identified in this study than using only performance on the SDSA test battery. The five psychometric/off-road tests should be used as a screening battery, after which a follow-up road test should be conducted to finally decide the fitness to drive of individuals with relapsing–remitting MS. Future studies are needed to confirm and validate the findings in this study.

Objective:To evaluate the effect of education sessions on Indian schoolteacher awareness of childhood eye health issues, responsibility for children’s eye health, and successful participation in a teacher-led eye screening health intervention programme in primary schools aimed at addressing avoidable childhood blindness in India.Design:Quantitative study, pre-intervention and post-intervention surveys and questionnaires.Setting:One hundred and four government-employed schoolteachers in primary schools of Hyderabad, India.Method:Prior to the screening intervention programme, questionnaires were administered to evaluate baseline teacher knowledge and observed responsibility for management of children’s eye health. The intervention consisted of three one-hour educational training sessions at central community locations about children’s eye health and proper screening practices, followed by on-site monitoring of teacher screenings after a period of 10 school days. Post-programme questionnaires and surveys were administered to evaluate changes in knowledge and attitudes.Results:Despite low levels of pre-programme knowledge and felt responsibility, teachers demonstrated significant improvements in overall knowledge of eye parts and functions, common childhood diseases, and local myths (39.3% to 63.7%, p < 0.01) and significant increases in felt responsibility for children’s eye health (45.5% to 77.8%, p < 0.01) through the course of the programme.Conclusion:Apart from technical training, educational sessions may play an important role in promoting sustained teacher interest in school-based health intervention programmes and overall impact on community health. Urban schoolteachers have therefore been identified as promising candidates in the continued effort to eliminate avoidable childhood blindness in India and other parts of the developing world.

To report the frequency of nonorganic visual loss (NOVL) and associated psychopathology in children.A total of 973 children were examined in our ophthalmology practice between 2006 and 2009. Basic ophthalmologic exploration (visual acuity, stereopsis, cycloplegic refraction, ocular motility, pupil dynamics, biomicroscopy, indirect ophthalmoscopy) and specific tests for NOVL diagnosis were performed (confusion with lenses test, mirrors test, Roth test, Bravais test). We also investigated the psychosocial situation and associated psychiatric problems.Thirty children were diagnosed with NOVL. The mean age of the children was 8.93 years (± 2.61); 70% were girls. September was the commonest month of presentation (26.7%) and unilateral (3.3%) or bilateral (80%) visual loss was the most frequent symptom (83.3% in total). In 20% of cases we detected psychosocial anomaly and 40% were seeking to wear glasses.Malingering in children is very frequent. We can make the diagnosis with simple tests. It is not necessary to perform imaging and electrophysiologic testing, thus avoiding unnecessary examinations as well as absenteeism from work for parents and health care costs.

Aims: An open-label, extension clinical study was conducted to assess the safety of a novel, oral formulation of tranexamic acid (TA) in women with cyclic heavy menstrual bleeding. Patients & methods: Eligible patients who completed either a three- or six-cycle double-blinded clinical trial of TA were offered enrollment into a study of nine cycles with TA (1.3 g orally three times/day for a maximum of 5 days per cycle). Safety was assessed by the incidence of treatment-emergent adverse events, ophthalmologic examinations and ECGs, among other evaluations. Results: The most commonly reported treatment-emergent adverse events were menstrual discomfort (46.2%), headache (43.9%) and back pain (23.1%). A small proportion of participants (3.8%) reported ocular adverse events, but there was no evidence of ocular toxicity. No prothrombotic effects were observed. Conclusion: During nine menstrual cycles of treatment, this novel formulation of TA was well tolerated and exhibited a favorable safety profile supporting its use as a therapy for cyclic heavy menstrual bleeding.

Background: Post-mortem analyses of multiple sclerosis (MS) eyes demonstrate prominent retinal neuronal ganglion cell layer (GCL) loss, in addition to related axonal retinal nerve fiber layer (RNFL) loss. Despite this, clinical correlations of retinal neuronal layers remain largely unexplored in MS. Objectives: To determine if MS patients exhibit in vivo retinal neuronal GCL loss, deeper retinal neuronal loss, and investigate correlations between retinal layer thicknesses, MS clinical subtype and validated clinical measures. Methods: Cirrus HD-optical coherence tomography (OCT), utilizing automated intra-retinal layer segmentation, was performed in 132 MS patients and 78 healthy controls. MS classification, Expanded Disability Status Scale (EDSS) and visual function were recorded in study subjects. Results: GCL+inner plexiform layer (GCIP) was thinner in relapsing–remitting MS (RRMS; n = 96, 71.6 µm), secondary progressive MS (SPMS; n = 20, 66.4 µm) and primary progressive MS (PPMS; n = 16, 74.1 µm) than in healthy controls (81.8 µm; p Conclusions: OCT segmentation demonstrates in vivo GCIP thinning in all MS subtypes. GCIP thickness demonstrates better structure-function correlations (with vision and disability) in MS than RNFL thickness. In addition to commonly observed RNFL/GCIP thinning, retinal inner and outer nuclear layer thinning occur in MS.

As teacher educators we have been struck by the consistency, urgency, and frequency in which students employ color-blind perspectives. This orientation has negative consequences in K-12 settings. In this manuscript, we lay out the multiple meanings of color blindness, drawing from legal, educational, and social science traditions, and offer arguments for color consciousness in education. In addition, we use this theoretical perspective to investigate interventions for countering color blindness in teacher education. Using a framework steeped in the tenets of color consciousness, we draw from scholars as well as our own work to provide interventions designed to challenge color-blind orientations in teachers.

Individuals with cognitive and developmental disabilities have a high probability of visual impairment. This study revealed the effects of deficits in the appropriate diagnosis of vision and medical treatment, as well as the lack of necessary refraction correction and support, specifically for adults with intellectual and developmental disabilities. ********** There have no been studies of the prevalence or type and severity of visual impairments (both blindness and low vision) in adults with cognitive disabilities in the Federal Republic of Germany to date. A literature review of research in Denmark, the Netherlands, and Great Britain points to a prevalence of 5% to 50% for this population (Evenhuis, Theunissen, Denkers, Verschuure, & Kemme, 2001; Van Splunder, Stilma, Bernsen, Arentz, & Evenhuis, 2003; Warburg, 2001) and leads to the assumption that a similar proportion of adults with cognitive and developmental disabilities in Germany would also have visual impairments that are often not diagnosed. A literature review also showed that people with Trisomy 21 have a high risk of ocular disorders (Down's Syndrome Medical Interest Group, 2005) and that the prevalence of individuals with a visual acuity of less than 20/40 (0.5) is increasing with age (Deremeik et al., 2007). Undiagnosed visual impairments, untreated eye diseases, and insufficient correction of refractive errors may have direct medical consequences. Furthermore, there can be additional difficulties in the lives of individuals in this population because behavioral patterns are not appropriately interpreted and interventions specifically for visual impairments are not implemented. There is a danger that the goal of participation in social life and particularly in the employment sector will be limited in individuals with cognitive disabilities and undiagnosed visual impairment. The study PARTICIPANTS Adults with cognitive and developmental disabilities in Germany work mainly in sheltered workshops for individuals with disabilities and live in small group homes or dormitories, with their families, or independently in the community. The study presented here evaluated the functional vision of 241 employees with cognitive disabilities in a sheltered workshop for individuals with cognitive and developmental disabilities in Glueckstadt, northern Germany. This workshop has two departments: the manufacturing and vocational training department for employees who need intermittent, limited, or extensive support (those with mild, moderate, or severe cognitive disabilities) and the day-support center, with services for individuals with extensive or pervasive needs (severe and pervasive cognitive disabilities). The 241 persons shared the characteristics of an almost complete sample in the two departments of the sheltered workshop; only those who worked outside the workshop in the community or who were ill for a long period of time were not included. To estimate the degree of intellectual and developmental disability of the participants, we used the classification of the American Association on Intellectual Disabilities. This classification is based on the needs for support of the individual (Luckasson et al., 2002). For 53.5% of the employees, the cause of cognitive and developmental disabilities was unknown to the staff of the workshop. Early childhood brain damage was diagnosed for 14.5%; Trisomy 21 was the cause of intellectual disability for 12.9%; and other causes, such as "accident," "meningitis," or "brain tumor," were mentioned for 19.1%. COURSE OF THE INVESTIGATION The evaluation of functional vision was conducted in a room of the sheltered workshop by the first author (a low vision specialist and special education teacher of children who are visually impaired at the State Resource Center for the Visually Impaired in Schleswig) from September 2006 until April 2008. …

Introduction Optic neuritis causes retinal nerve fiber layer damage, which can be quantified with optical coherence tomography. Optical coherence tomography may be used to track nerve fiber layer changes and to establish a time-dependent relationship between retinal nerve fiber layer thickness and visual function after optic neuritis. Methods This prospective case series included 78 patients with optic neuritis, who underwent optical coherence tomography and visual testing over a mean period of 28 months. The main outcome measures included comparing inter-eye differences in retinal nerve fiber layer thickness between clinically affected and non-affected eyes over time; establishing when RNFL thinning stabilized after optic neuritis; and correlating retinal nerve fiber layer thickness and visual function. Results The earliest significant inter-eye differences manifested 2-months after optic neuritis, in the temporal retinal nerve fiber layer. Inter-eye comparisons revealed significant retinal nerve fiber layer thinning in clinically affected eyes, which persisted for greater than 24 months. Retinal nerve fiber thinning manifested within 6 months and then stabilized from 7 to 12 months after optic neuritis. Regression analyses demonstrated a threshold of nerve fiber layer thickness (75μm), which predicted visual recovery after optic neuritis. Conclusions Retinal nerve fiber layer changes may be tracked and correlated with visual function within 12 months of an optic neuritis event.

Early detection and treatment of vision disorders in children are important to avoid lifelong visual impairment; however, preschool vision-screening rates are low. Traditional methods of screening lack the precision of objective tests and are difficult to administer in preschoolers. This study adopted a method using school nurses to conduct vision screening in preschoolers with a portable autorefractor. In addition, the effectiveness of the school nurse in conducting follow-up was evaluated. In a sample of 600 children, more than 98% completed the screening, and 7% were referred for follow-up evaluation. Seventeen percent of parents had plans to follow-up after receiving a brochure indicating that their child would benefit from a comprehensive eye exam. However, after a conversation with the school nurse, 86% had plans to schedule an evaluation with an eye care professional. Of the 15 students with known follow-up, 10 received glasses. The described method is effective in identifying young children with potential vision problems and facilitating their correction after contact made by the school nurse.

Visual assessment of deaf persons presents a challenge to the ophthalmologist and the optometrist. At the time they want to measure visual function, the interpreter uses visual communication, competing for the patient's attention. Important rules of good assessment of visual functioning include taking turns and giving the interpreter sufficient time to convey the questions related to each test. This has implications for audiologists working with this population as well. Communication should be tailored to the varying needs of people who may have long-standing deafness and good sign language, may have lost their hearing at an advanced age and have limited or no sign language, or may be young persons or children who have congenital or progressive loss of hearing combined with congenital or progressive vision loss. Individuals with sudden hearing and vision loss, as well as those with intellectual disabilities and limited language, are particularly challenging groups for the assessment of vision and require special communication skills for ophthalmologists and audiologists. The ophthalmologist usually knows the nature of vision changes typical of disorders that the patient has. For the clinical follow-up of a condition, a few measurements are usually taken. For a comprehensive assessment of visual functioning for rehabilitation and education, many more measurements, observations, and questions are needed so that vision for communication, orientation in the environment, and performance of near-vision tasks can be reported and the effects of the environment can be evaluated. Testing should cover ocular disorders and vision loss caused by brain damage.

A new model of achromatic transparency has been recently proposed by Singh and Anderson as an alternative to the model proposed long ago by Metelli. The study reported here compared these models using achromatic stimuli consisting of a transparent disk on a background formed by two adjoining rectangles, with the common border of the rectangles dividing the disk in half. Let a and b denote the luminances of the left and right parts of the background, respectively, and let p and q denote the luminances of the left and right parts of the disk, respectively. The value of b was varied for fixed values of a, p, and q. For these values the Singh-Anderson model predicts that the perceived extent of transparency T of the disk is constant with b, while Metelli's model predicts that T decreases as b increases. Participants rated T. The results confirm the prediction of Metelli's model. It is also shown that the Singh-Anderson model is invalid in principle in that, unlike Metelli's model, it fails to capture the principle of independence of the effects of a, b, p, and q on T.

The aim of this study was to study the effectiveness of a motor training program for visually impaired children. 40 children with low vision took part in the study. 20 children (10 boys, 10 girls), mean age 8:9 yr.:mo. ( SD = 1:6), were in a Training group and 20 children (10 boys, 10 girls), mean age 8:10 yr.:mo. ( SD = 1:65), were in a Home Training group. The Snellen Chart and Bruininks Oseretsky Motor Proficiency Test were used for assessment. Training program included training balance, coordination, strength, visuomotor control, and finger dexterity. Significant differences were found on all skills after training in the Training group, but no significant differences were observed, other than visual motor control, in the Home Training group. Children with low vision have some useable vision and learning to use the available vision depends on proper rehabilitation.

A simple method was designed to evaluate visual abilities such as distance visual acuity, binocular horizontal visual field, simple and choice visual reaction times, and stereoscopic vision in skilled 11- to 13-yr.-old basketball players participating in a 15-day summer training camp. On a test battery, visual abilities were monitored in 473 players of the Spanish Basketball Federation over a 5-yr. period. The players showed outstanding scores on distance visual acuity and stereoscopic vision, and good visual reaction times and horizontal visual fields. When scores were compared by sex and age, significant differences on certain visual measures were observed. Many players showed crossed eye-hand dominance. Visual screening programs may help promote visual health among junior basketball players and could be used for performance training.

Contrast sensitivity is one of several factors necessary to obtain good visual quality. The aim of this study was to develop normal data on the Cambridge Low Contrast Gratings test in children and to compare these data with data from a group of children with developmental delay. Ninety-nine normal children (aged 2-14 years) and 146 children with developmental delay were tested with the contrast sensitivity test. All children had normal visual acuity and stereopsis. The normal children had an age-dependent development in contrast sensitivity, and adult level was reached after the age of 10 years. A significantly lower score was found in children with developmental delay compared to normal children. The Cambridge Low Contrast Gratings test is suitable for preschool children and children with developmental delay because of its simplicity, and it might be a valuable tool in diagnosing ophthalmologic diseases in children with developmental delay.

Educators work very hard to help students solve the cognitive problems that impede their learning. Sometimes, the authors argue, it's the problems we can't "see" that need to be fixed first. TWO OF THE most pressing issues in education today are the demands for improved academic performance and higher test scores and the mandate to close the achievement gaps between poor and middle-class students and minority and nonminority students. In response to these challenges, increased attention is being given to staff development that focuses on instructional methods, reading strategies, differentiated teaching and learning, test-taking strategies for students, and so on. However, before these approaches can begin to bring about improved student performance and close the achievement gaps, schools need to address a much more basic issue affecting learning for many students, especially those who live in poverty. This is the issue of undetected and uncorrected vision problems. It is estimated that one out of four school-age children have undiagnosed vision problems significant enough to affect their performance in school and in life. Research shows that in at-risk populations, such as children born in poverty, this percentage is likely to be much higher.1 Since 70% of classroom learning depends on the visual system, students with uncorrected vision problems are at a tremendous disadvantage before they even enter the classroom.2 It seems obvious that if a student cannot see clearly, he or she is going to have a very difficult time reading, writing, and even participating in sports. Yet parents and educators almost always overlook vision problems as a possible roadblock to learning. Vision Problems of Children in Poverty In April 2001 the Harvard Graduate School of Education hosted a conference at which educators and optometrists shared their findings on the topic of "Visual Problems of Children in Poverty and Their Interference with Learning." Dr. Antonia Orfield, an optometrist at the Harvard University Health Services Eye Clinic and chief investigator of the Inner-City Vision and Learning Project at the Boston Mather School, discussed the high incidence of visual problems in urban poor children and reported that 53% of the children tested at the Mather School had vision problems that could hinder their ability to read. School vision screenings typically check only for nearsightedness, which affects reading at a distance -- looking at chalkboards or whiteboards. Dr. Orfield recommended expanding the screenings to test for conditions that affect close-up (book) reading, such as farsightedness and problems with tracking. Dr. Rochelle Mozlin, associate clinical professor of optometry at the College of Optometry, State University of New York, New York City, presented her research on vision problems of urban at-risk high school students. She tested students at two inner-city high schools, where 52% of the students failed the vision screening. She emphasized that treating the students proved to be difficult because parents and students generally did not follow up, even though there were several offers of free services. Only 17 of the 62 students (or 27%) identified as priority cases actually received the vision care they needed. Dr. Robert Duckman, pediatric optometrist and professor of optometry at the SUNY College of Optometry, researched vision problems of children in foster care in New York City. He found that a staggering 83.5% of the 351 children he tested had vision problems.3 Vision Problems and Juvenile Delinquency Several studies have linked uncorrected vision problems with juvenile delinquency. One rather alarming statistic is that in the population of all school-age students, 25% suffer from undiagnosed vision problems; however, among juvenile offenders, it is estimated that 70% have undiagnosed vision problems. If we understand that vision problems result in skill deficiencies, difficulty in reading and learning, and poor academic performance -- which, in turn, create feelings of failure, low self-esteem, and lack of interest in academics -- then the connection to delinquency becomes clear. …

Providing Access to the Visual Environment (Project PAVE) is a statewide multidisciplinary project that provides low vision services to children aged 3–21 in Tennessee. This article describes the project's administrative, direct service, and research components and the philosophy on which it is based.

In response to data from the initial survey published in October 2001, interventions were developed to increase vision screening knowledge and promote use of the Iowa Vision Screening Program Guidelines ( Iowa Department of Education [IDE], 1997 ). The purpose of this evaluation was to measure differences in practice after interventions, including attendance at a half-day workshop and practice session. Results of the study indicate that participants of the workshop and practice session were more likely to conduct yearly distance and near vision, and depth perception screening. In addition, they were more likely to use the recommended screening instruments for distance and near vision, and depth perception. They were also much more likely to use recommended referral criteria for all types of screening and to have changed some aspect of their vision screening practice in the past year. Results are presented with implications for school nursing practice.

In this study the effects of visual impairment and age on driving were investigated and related to visual function. Participants were 139 licensed drivers (young, middle-aged, and older participants with normal vision, and older participants with ocular disease). Driving performance was assessed during the daytime on a closed-road driving circuit. Visual performance was assessed using a vision testing battery. Age and visual impairment had a significant detrimental effect on recognition tasks (detection and recognition of signs and hazards), time to complete driving tasks (overall course time, reversing, and maneuvering), maneuvering ability, divided attention, and an overall driving performance index. All vision measures were significantly affected by group membership. A combination of motion sensitivity, useful field of view (UFOV), Pelli-Robson letter contrast sensitivity, and dynamic acuity could predict 50% of the variance in overall driving scores. These results indicate that older drivers with either normal vision or visual impairment had poorer driving performance compared with younger or middle-aged drivers with normal vision. The inclusion of tests such as motion sensitivity and the UFOV significantly improve the predictive power of vision tests for driving performance. Although such measures may not be practical for widespread screening, their application in selected cases should be considered.

Background: In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Methods: Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Results: Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. Conclusions: This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors.

Visual recognition functions, such as acuity and contrast sensitivity, deteriorate rapidly over the declining luminances found during civil twilight. Thus civil twilight, a critical part of the transition between daylight and darkness, represents lighting conditions that may be useful to describe artificial illumination. Automotive headlamps project a three-dimensional beam that ranges from illumination levels comparable to daylight at the vehicle to the dark limit of civil twilight (3.3 lx) at some distance ahead. This twilight envelope is characterized as a distance beyond which foveal visual functions are severely impaired, and thus it provides a general, functional description of the useful extent of the headlamp beam. This user-centered approach to describing illumination is useful for characterizing visibility when driving at night or in other artificially lit environments. This paper discusses the twilight envelope approach and its application to intervehicle variations in headlamp systems. Actual or potential applications of this research include user-centered description of artificial illumination and driver/pedestrian safety education

Two experiments were performed to determine the effectiveness of a newly developed vision test for measuring human contrast sensitivity under dynamic conditions. In Experiment 1, measurements of dynamic contrast sensitivity were determined for 24 male and 24 female observers as a function of target velocity (0-120 deg/s) for letter stimuli of two sizes and two durations. Significant main effects were found for target velocity, target size, and target duration, while significant interactions among the variables indicated especially pronounced adverse effects of increasing target velocity for small targets and brief durations. In Experiment 2, the effects of simulated cataracts on dynamic contrast sensitivity were determined for 10 male and 10 female observers using the new test. Although the simulated impairment had no effect on traditional acuity scores, dynamic contrast sensitivity was markedly reduced under all conditions and this effect was particularly apparent with smaller targets and at higher velocities. Results are discussed in terms of dynamic contrast sensitivity as a useful composite measure of visual functioning that may provide a better overall picture of an individual's visual functioning than do traditional tests of static visual acuity, dynamic visual acuity, or contrast sensitivity alone.

Introduction This study aims to measure the visual acuity of practising dentists and to establish the average time elapsed since their last routine eye examination. Materials and methods Distance visual acuity, near visual acuity, convergence, accommodation, contrast sensitivity, heterophorias and stereoscopic vision were measured in a diverse group of 46 dentists practising in Scotland. Results The results indicated that distance visual acuity was at least 6/6 for all but one of the subjects. All had acceptable near visual acuity. Accommodation followed the expected age-related trend of decreasing with age. No subjects had a definitely abnormal contrast sensitivity score although four were in the borderline zone. No subjects had a horizontal squint but two had a significant vertical phoria. Three subjects had no stereoscopic vision and one subject had a very high threshold level. All other subjects were able to see stereoscopically. Of the subjects 57% had been for an eye examination within the previous two years, with the range being from less than one month to 17 years. Conclusion The eyesight of this group of clinicians exceeds generally accepted normal population values. Although the majority of the clinicians had attended for an eye examination within two years, the large range of time since last attendance is of concern and regular eye examinations are to be encouraged.

The purpose of this study was to examine the value of a clinical driving assessment battery in predicting performance on an on-road driving test. 43 participants referred to the Bryn Mawr Rehab Adapted Driving Program for evaluation of driving ability underwent an evaluation consisting of a predriver screening and an on-road driving test. The predriver screening included a vision screening, a reaction time task, a split-attention task, the Hooper Visual Organization Test, verbal and symbolic sign recognition, and assessment of Useful Field of View. Logistic regression analyses were applied to identify which predriver screening variables could be used to predict outcome on the on-road driving test (pass/fail); UFO® was that best single predictor. The addition of screening tests beyond UFOV® alone did not increase predictive validity. These findings suggest that UFOV® may serve as an indicator of the need for further driving assessment.

Amblyopia is used as a comprehensive term for unexplained reduction of visual acuity, usually unilateral. As long as the visual deficit is monocular the visual loss is more of a potential problem than an actual handicap. Amblyopia is one of the most common causes of visual deficit in childhood, and since it is treatable, at least in children, considerable efforts have been made to detect it as early in life as possible. Screening programmes for amblyopia among preschool and school children have been widely organized throughout the world, although questions remain about their utility. This study evaluated amblyopia screening, focussing on some essential points that need thorough consideration before a screening programme is started. We also try to demonstrate some of the pros and cons of a screening system.

Apparent minification of virtual images has been attributed to accommodation micropsia, that is, a reduction in the apparent size of viewed objects accompanying an inward accommodation of the eyes. Thirteen bilateral pseudophakes incapable of accommodation but with good residual vision were tested monocularly for apparent minification in the viewfinder of a single-lens reflex camera. Apparent minification of about the same order as that typically found with normals occurred with the pseudophakic observers, demonstrating that pseudophakes are subject to distortions in apparent size with virtual-imaging displays in the same way as normals, thus establishing that visual accommodation is not a necessary condition for the effect.

Current systems for characterizing infants and young children with disabilities have been associated with a number of problems. The ABILITIES Index was developed as a way to describe the functional abilities and limitations of children across nine domains. This article reports the results of a survey of parents and professionals in early intervention programs to determine their perceptions of the ABILITIES Index as a means of assessing its consumer validity. A total of 209 parents, 91 teachers, 93 therapists, and 55 Developmental Evaluation Center specialists in early intervention and preschool programs in North Carolina evaluated the ABILITIES Index. Mean satisfaction ratings across five dimensions were generally positive, with parents consistently rating the instrument more positively than other consumers. Subsequent analyses indicated that, overall, level of education did not predict positive appraisal of the ABILITIES Index. Consumers offered a number of suggestions for how the Index could be used in early intervention.

This article describes the development of a test for assessing the visual functioning (capacity, processing, and attention) of visually impaired infants and preschool children and its underlying factor structure.

Functional visual assessments of children with severe neurological and physical handicaps are difficult to conduct and frequently do not provide clear guidelines for training. The addition of a learn a routine procedure, which capitalizes on the child's interest of the moment, provides information on the child's patterns of responses, ability to accommodate to variations of a stimulus, and strategies for interaction.

In the authors’ previous study, the success rate for forced-choice preferential looking (FPL) with preverbal visually impaired children was higher than that with pattern visual evoked potential (VEP). The current study sought to increase the VEP success rate and to improve agreement between the FPL and the VEP acuity estimates using horizontal-bar stimuli for children with nystagmus and steady-state presentation for those without nystagmus.

Children with multiple impairments often have visual impairments. This article reports on a study of the methods that 21 ophthalmologists used to assess the visual acuity of such children and the difficulties they encountered. In many cases, the information that was obtained by these methods would not be clearly understood by parents and educational and rehabilitation personnel and would not facilitate the educational management of the children. The authors describe additional means of assessing visual function and suggest alternative avenues of communicating the results.

Techniques to assess vision capabilities of multihandicapped persons are discussed as used in a specialty Optometric clinic. The major emphasis of the assessment is to obtain information about visual abilities and to make recommendations that promote optimum vision functioning. Techniques for working with children from special populations are discussed. The assessment includes a modified ophthalmic examination to identify and correct refractive error and to assess oculomotor functioning and ocular health. Visual acuity is measured using preferential looking and visual evoked potential techniques. Confrontation visual fields are measured. Several aspects of visual function are assessed with a parent interview.

This article reviews the research literature on the direct effects of brain damage on the visual functioning of children and the electrodiagnostic tests used to diagnose them. Although the studies documented that brain damage affects visual functioning, they suggested that the prognosis for good functional vision after remedial intervention is more optimistic than was previously thought. They also found that electrodiagnostic testing is a valuable tool, but that the use of a combination of tests yields a more complete picture of the effects than does any single test.

This laboratory study evaluated the effect of the size of the glare source (a headlamp) on discomfort glare. The subject performed two simultaneous tasks: continuous compensatory tracking, and evaluation of discomfort from glare stimuli presented periodically in the near visual periphery. The glare stimuli were circles of two sizes (approximately 0.3 and 0.6 degrees in diameter), and produced five illuminance levels (from 0.03 to 3.1 lux) at the observer's eye. Subjects used a nine-point response scale to evaluate discomfort glare. The results indicate that there was a small but statistically significant effect of the size of glare source, with the smaller glare stimuli resulting in more discomfort glare. The mean difference over the range of glare illuminances tested was 0.2 points on the nine-point response scale. (A)