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Purpose Although there have been many population-based studies of age-related macular degeneration (AMD), only limited information is available in Asia on the epidemiology of geographic atrophy (GA). We aimed to determine the prevalence and patterns of GA through an analysis of multiple studies conducted within the Asian Eye Epidemiology Consortium (AEEC). Design Cross-sectional meta-analyses. Participants A total of 97 213 individuals aged 40 years and older. Methods Data from 22 population-based studies from countries belonging to the AEEC were included. In all studies, AMD was defined on the basis of standardized grading systems. Geographic atrophy was defined as an area of pallor in the fundus with visibility of the underlying choroidal blood vessels and sharply defined borders. Random-effects meta-analysis was performed to estimate overall and age-, gender-, and region-specific pooled prevalence of GA. Main Outcome Measures Prevalence of GA per 1000 persons. Results The mean age was 60.8 ± 10.0 years, and 42 673 (43.9%) were male. Overall, a total of 223 individuals (0.2%) had GA. The pooled overall prevalence of GA was 1.57 per 1000 persons (95% confidence interval [CI], 1.04–2.10), which was 3 times less than that of neovascular AMD of 5.20 per 1000 persons (95% CI, 3.97–6.43). Compared with those aged 50 to 59 years, the prevalence of GA increased from 0.34 per 1000 persons (95% CI, 0.07–0.62) to 2.90 per 1000 persons (95% CI, 1.55–4.25) in those aged ≥70 years. The GA prevalence per 1000 persons was similar between urban (2.22; 95% CI, 1.22–3.23) and rural residents (1.33; 95% CI, 0.70–1.96). Geographic atrophy was more prevalent in South Asia (based on studies from India and Nepal, 3.82 per 1000 persons; 95% CI, 1.72–5.93) compared with East Asia (based on studies from China, Korea, Hong Kong, Taiwan, and Japan, and the Singapore Chinese Eye Study, 0.76 per 1000 persons; 95% CI, 0.31–1.22, P = 0.005). Conclusions Geographic atrophy is uncommon in Asian populations compared with those of European ancestry. Even within Asia, geographic differences in GA prevalence were seen. The findings of this meta-analysis suggest that better dissection of risk factors in the Asian population for GA may provide insights into the biological pathways that drive these late-stage manifestations, thus suggesting better targets for prevention.

Background This study aims to explore the prevalence and causes of low vision and blindness focused on retinal disease in a population above 60 years in Nepal. Methods Two thousand one hundred subjects were enrolled in a population-based cross-sectional study. History, presenting and best corrected visual acuity after subjective refraction, anterior and posterior segment examinations was obtained in detail. Results Among the total subjects, 1860 (88.57%) had complete information. Age varies from 60 to 95 (mean age: 69.64 ± 7.31) years. Low vision and blindness in both eyes at presentation was found in 984 (52.90%, 95% confidence interval (CI): 50.60–55.19) and 36 (1.94%, 95% CI: 1.35–2.66) subjects respectively. After best correction, bilateral low vision and blindness was found in 426 (22.92%, 95% CI: 21.01–24.88), and 30 (1.61%, 95% CI: 0.10–2.30) subjects respectively. As compared to 60–69 years old, risk of visual impairment was four times higher (95% CI:3.26–5.58) in the 70–79 year olds and 14 times higher (95% CI: 9.72–19.73) in the age group 80 years and above. Major causes of bilateral low vision were cataract (68.07%), followed by retinal disorders (28.64%), and for blindness; retinal disorders (46.66%), followed by cataract (43.33%). Illiteracy was significantly associated with visual impairment. Conclusion Among the elderly population, prevalence of visual impairment was high. Refractive error, cataract and retinal disorders were the major cause of low vision. Screening the population at the age 60 years and above, focused on cataract and posterior segment diseases, providing glasses and timely referral can help reduce visual impairment.

PURPOSE. We assessed the prevalence of subthreshold depression and anxiety, and major depressive, dysthymic, and anxiety disorders (panic disorder, agoraphobia, social phobia, and general anxiety disorder) in visually impaired older adults and compared these estimates with those of normally sighted peers. METHODS. Cross-sectional data were analyzed based on telephone interviews with visually impaired older adults aged ± 60 years (n = 615) with a visual acuity of ≥ 0.30 logMAR (20/40 Snellen) in the best eye from outpatient low vision rehabilitation centers, and face-to-face interviews with community-dwelling normally sighted peers (n = 1232). To determine prevalence rates, the normally sighted population was weighted on sex and age to fit the visually impaired population. Logistic regression analyses were used to compare the populations and to correct for confounders. RESULTS. The prevalence of major depressive disorder (5.4%) and anxiety disorders (7.5%), as well as the prevalence of subthreshold depression (32.2%) and subthreshold anxiety (15.6%), were significantly higher in visually impaired older adults compared to their normally sighted peers (P < 0.05). Agoraphobia and social phobia were the most prevalent anxiety disorders in visually impaired older adults. CONCLUSIONS. This study shows that depression and anxiety are major public health problems in visually impaired older adults. Research on psychotherapeutic and psychopharmacologic interventions to improve depression and anxiety in this population is warranted. (http:/?www.trialregister.nl number, NTR3296.)

Objectives Dual sensory loss (DSL; concurrent vision and hearing loss) negatively affects quality of life. As speechreading is hampered, use of hearing aids (HAs) is important for older adults with DSL. However, due to vision loss, use of small and complex HAs is assumed to be difficult. An integrative DSL protocol that addresses rehabilitative care for older adults with DSL, including proper HA use, was implemented in low vision rehabilitation centers. The present study aims to evaluate the effectiveness of the DSL protocol among HA owners on HA outcomes (i.e., HA use, benefit, satisfaction with HAs, and hearing with HAs). Design In a randomized controlled trial, the DSL protocol was compared to a waiting list control group among clients (aged ≥50 years) of low vision rehabilitation centers with DSL. The International Outcome Inventory for Hearing Aids (IOI-HA) and the HA Fitting Questionnaire (HAFQ) were administered at baseline and 3 months follow-up. Participants (n = 128) were randomly allocated to either the intervention (n = 63) or control group (n = 65). Results Intention-to-treat analyses showed a near significant effect on IOI-HA Residual problems (effect size, 0.35; p = 0.063). Per-protocol analyses showed similar (nonsignificant) results on the main outcomes, and a ceiling effect was found on the HAFQ. Significant effects were found in subgroups of patients: among patients with low HAFQ scores (HAFQ-Use: effect size = 0.56, p = 0.046; HAFQ-Hearing with HAs: effect size = 0.64, p = 0.019), male participants (effect size = 0.80; p = 0.003), and those with moderate hearing loss (effect size = 0.72; p = 0.028), significantly better IOI-HA scores were found in the intervention group at 3 months follow-up. Conclusions Although the per-protocol and subgroup analyses need to be interpreted with caution, DSL patients who experience HA difficulties could benefit from the DSL protocol by making better use of their HAs. The increasing prevalence and impact of DSL on a person's independence and social participation call for more awareness of concurrent sensory impairments in both low vision and audiology rehabilitation. Interdisciplinary training for rehabilitation professionals could be an important step, followed by integration of vision and hearing services using the DSL protocol.

Purpose To gain qualitative insight into the rehabilitation needs of visually impaired young adults (18-25 years) and how these needs relate to the International Classification of Functioning, Disability and Health (ICF) and patient characteristics. Methods Rehabilitation needs and patient characteristics of young adults (N = 392) who applied for multidisciplinary services in 2012 and 2013 were obtained from structured and semi-structured intake records. Linking rules were used to assess how the needs related to Environmental Factors, Body Functions, Body Structures, and Activity and Participation (A&P) ICF components. The relationship between the type of rehabilitation goal and patient characteristics was assessed using multivariate logistic regression analyses. Results Most rehabilitation needs (67.6%; N = 510) were found on the A&P component of the ICF. Most prevalent needs were related to 'major life areas' (e.g. finding internship or job), followed by the chapters: 'mobility' (e.g. self-reliance in travelling), 'communication' (e.g. using communication devices and techniques), 'general tasks and demands' (e.g. psychological aspects of vision loss) and 'domestic life' (e.g. household tasks). Patients in one of the multidisciplinary rehabilitation centres (odds ratio (OR) = 7.07; 95% confidence interval (CI) [2.97-16.83]) and patients with comorbidity (OR = 3.82; 95% CI [1.62-9.02]) were more likely to report rehabilitation needs related to chapter E3 'support and relationships'. Conclusion 'Major life areas' prevail in the content of rehabilitation needs, but tend to overshadow topics regarding peer interaction and social, community and civic life. A suitable survey method for young adults with visual impairments is required that contains rehabilitation domains and goals relevant to their lives and development.

PURPOSE: In the past, rehabilitation centers for the visually impaired used unstructured or semistructured methods to assess rehabilitation needs of their patients. Recently, an extensive instrument, the Dutch ICF Activity Inventory (D-AI), was developed to systematically investigate rehabilitation needs of visually impaired adults and to evaluate rehabilitation outcomes. The purpose of this study was to investigate the underlying factor structure and other psychometric properties to shorten and improve the D-AI. METHODS: The D-AI was administered to 241 visually impaired persons who recently enrolled in a multidisciplinary rehabilitation center. The D-AI uses graded scores to assess the importance and difficulty of 65 rehabilitation goals. For high-priority goals (e.g., daily meal preparation), the difficulty of underlying tasks (e.g., read recipes, cut vegetables) was assessed. To reduce underlying task items (>950), descriptive statistics were investigated and factor analyses were performed for several goals. The internal consistency reliability and test-retest reliability of the D-AI were investigated by calculating Cronbach α and Cohen (weighted) κ. Finally, consensus-based discussions were used to shorten and improve the D-AI. RESULTS: Except for one goal, factor analysis model parameters were at least reasonable. Internal consistency reliability was satisfactory (range, 0.74 to 0.93). In total, 60% of the 65 goal importance items and 84.4% of the goal difficulty items showed moderate to almost perfect κ values (≥0.40). After consensus-based discussions, a new D-AI was produced, containing 48 goals and less than 500 tasks. CONCLUSIONS: The analyses were an important step in the validation process of the D-AI and to develop a more feasible assessment tool to investigate rehabilitation needs of visually impaired persons in a systematic way. The D-AI is currently implemented in all Dutch rehabilitation centers serving all visually impaired adults with various rehabilitation needs. © 2013 American Academy of Optometry.

Item does not contain fulltext BACKGROUND/AIMS: To investigate crowding ratios in children with a visual impairment due to ocular disease (n = 58) and normally sighted children (n = 75) aged 4 to 8 years using several variants of two clinically available tests with different optotype spacing (fixed or proportional to the optotype size). METHODS: Crowding ratios, calculated by dividing the single acuity by the linear acuity, were measured binocularly with the C-test and the LH line chart. Ratios >1.00 indicate crowding. RESULTS: The charts with fixed spacing revealed significantly higher crowding ratios for visually impaired children than normally sighted children (both for measurements at 40 cm and 5 m). The age-related reduction of the crowding ratios seen in normally sighted children when tested with near-vision charts with fixed spacing was not present in the visually impaired group. Visually impaired children with nystagmus showed higher crowding ratios than visually impaired children without nystagmus. The chart with proportional intersymbol spacing (ISS) did not reveal differences between the normally sighted and visually impaired children; nor did it show group, age, or nystagmus effects. CONCLUSION: Visually impaired children showed higher crowding ratios than normally sighted children when measured with charts with fixed ISS. This study illustrates that test design and target/flanker interference as a manifestation of crowding are critical issues to bear in mind when assessing crowding ratios in children. 01 juni 2012

It is a widely accepted belief in clinical practice that children with a visual impairment can profit from the use of a low vision aid (LVA). However, we found a considerable gap in our scientific understanding of LVA use, particularly in young children. This is the reason for the analysis presented in this paper. A selected overview of LVA use in adults is given, from which valuable insights are taken. Additionally, an action perspective for analysing LVA use is discussed as well as the results of tool-use studies in children. Mainly based on these three ingredients, we developed a conceptual framework for LVA use. The framework consists of three interacting relations between LVA, child and task. Performance of a particular child on a specific task with a certain LVA is constrained by the following three reciprocal and dynamic relations: the Child-to-Task relation (related to goal-information), the Child-to-LVA relation (related to control-information), and the LVA-to-Task relation (related to topology information).

Doel Het in kaart brengen van het aantal ouderen met een visuele beperking in Nederland, nu en in de toekomst. Mogelijkheden tot interventie worden aangegeven. Methode en materiaal De schattingen zijn gebaseerd op een recent onderzoek in opdracht van Stichting InZicht, ZonMw, waarin literatuur gegevens over prevalentie van blindheid en slechtziendheid en de oorzaken daarvan uit bevolkingsonderzoeken in Nederland, West Europa, de Verenigde Staten en Australie zijn gerelateerd aan de laatste demografische gegevens voor Nederland. Resultaten Van de 16,4 miljoen Nederlanders in 2008 zijn er 2,4 miljoen (14,7%) 65 jaar of ouder. Van deze laatste groep wonen 155.000 mensen in een verpleeg of verzorgingshuis, de rest woont zelfstandig. In 2008 zijn naar schatting 77.000 Nederlanders blind en 234.000 slechtziend. Van hen is 79% 65 jaar of ouder. Van de ouderen in instellingen is 20% blind (32.000) en 22% slechtziend (34.000). Bij 62% van hen is de visuele beperking te behandelen of was te voorkomen geweest (‘vermijdbaar’). Van de zelfstandig wonende ouderen is 1,2% blind (27.000) en 6,8% slechtziend (154.000). Bij 57% van hen is de aandoening vermijdbaar. Conclusie In 2008 hebben 247.000 ouderen een visuele beperking die bij 143.000 (58%) van hen te behandelen is of te voorkomen was geweest. Screening en behandeling van ouderen in instellingen lijkt aangewezen, evenals voorlichting aan en gerichte screening van zelfstandig wonende ouderen.

Purpose: In visually impaired older patients, it is unclear which co-existing conditions patients suffer from and whether all co-existing conditions are reported by the patient. Our purpose was to present the level of agreement between patients' and their general practitioners' co-morbidity reports. Methods: Analyses were performed on data from an observational study among 296 visually impaired older patients. Agreement between patients and 165 general practitioners was obtained from twelve (chronic) condition categories. Cohen's Kappa was used to assess the level of agreement. Results: Patients reported a median number of co-existing conditions of 1 (range: 0-4) and general practitioners 3 (range: 0-7). Agreement was 'very good' for diabetes (Kappa 0.82; 95% CI [0.73;0.92]) and 'moderate' for heart conditions (Kappa 0.48; 95% CI [0.33;0.62]) and COPD or asthma (Kappa 0.60; 95% CI [0.45;0.75]). Kappa values were 'fair' (0.29 to 0.34) for cancer, musculo-skeletal conditions, hearing impairments and stroke, and 'poor' (-0.01 to 0.18) for psychological problems, chronic skin problems, gastrointestinal conditions, chronic allergies, thyroid gland conditions and hypertension. Conclusions: Agreement between patients and their general practitioners differed per condition, but was for most conditions poor to fair. Rehabilitation services, ophthalmologists and rehabilitation researchers should be aware that patients often under report co-morbidity. We recommend using medical charts or asking visually impaired older patients for co-existing conditions using pre-structured questionnaires in order to obtain a more complete view of the patient's health status. Copyright © Informa Healthcare USA, Inc.

PU R P O S E. One to two percent of the population in the We s t e rn world is visually impaired or blind. For most of these people there is no curative therapy. There f o re, the Dutch Ophthalmic Society has taken the initiative to develop an evidence-based guideline for the referral of visually impaired persons to low vision serv i c e s . ME T H O D S. A systematic literature search was performed in the Embase (1991‐2001) and Medline (1966‐2003) databases. Literature was searched for definitions of visual impairm e n t , for physician-patient communication, and for outcome of interventions for visually impaire d persons. Results of the articles that were selected were summarized and rated according to the level of evidence. Other considerations such as the current organization of re h a b i l itation for visually impaired persons in the Netherlands were also taken into account. R E S U LT S. The World Health Organization criteria were slightly adapted in order to include all people who experience problems with reading and other daily life activities due to visual i m p a i rment. A large number of recommendations were devised. Among these is that the complete diagnosis should be communicated to the patient and that a second appointment should be offered in which the diagnosis and potential treatment options are discussed again. Another recommendation is that in general visually impaired adults eligible for referral should be re f e r red for the provision of low vision aids and that patients with complex problems or extensive rehabilitative demand should be re f e r red to a rehabilitation center. CO N C L U S I O N S. This article presents a summary of the first European evidence-based guideline for the referral of visually impaired persons. (Eur J Ophthalmol 2005; 15: 400-6)

Contains fulltext : 142280.pdf (Publisher’s version ) (Open Access) Purpose.: The effect of infantile nystagmus syndrome (INS) on the efficiency of goal-directed hand movements was examined. Methods.: We recruited 37 children with INS and 65 control subjects with normal vision, aged 4 to 8 years. Participants performed horizontally-oriented, goal-directed cylinder displacements as if they displaced a low-vision aid. The first 10 movements of 20 back-and-forth displacements in a trial were performed between two visually presented target areas, and the second 10 between remembered target locations (not visible). Motor performance was examined in terms of movement time, endpoint accuracy, and a harmonicity index reflecting energetic efficiency. Results.: Compared to the control group, the children with INS performed the cylinder displacements more slowly (using more time), less accurately (specifically in small-amplitude movements), and with less harmonic acceleration profiles. Their poor visual acuity proved to correlate with slower and less accurate movements, but did not correlate with harmonicity. When moving between remembered target locations, the performance of children with INS was less accurate than that of the children with normal vision. In both groups, movement speed and harmonicity increased with age to a similar extent. Conclusions.: Collectively, the findings suggest that, in addition to the visuospatial homing-in problems associated with the syndrome, INS is associated with inefficiency of goal-directed hand movements. 11 p.

PURPOSE To investigate the longitudinal outcomes of rehabilitation (from baseline to 4 and 12 months) at a multidisciplinary rehabilitation center. The three goals ("Reading," "Writing," and "Watching TV") were measured with the Dutch ICF Activity Inventory (D-AI). In addition, outcomes were compared with the Low Vision Quality-of-Life questionnaire (LVQOL) for better insight into the (longitudinal) interpretation. METHODS In a cohort of 241 visually impaired persons, corrected and uncorrected linear mixed models were used to determine longitudinal rehabilitation outcomes for the D-AI goals "Reading," "Writing," and "Watching TV," and difficulty and underlying tasks, as well as for the LVQOL scales "Basic aspects" and "Reading and fine work." At baseline, Spearman correlations were determined for similar scales of the D-AI and LVQOL. RESULTS Importance scores of goals were stable over time. Difficulty scores decreased over time, but the differences were not significant at each measurement moment. For reading, difficulty of underlying tasks seemed to reflect the (change in) difficulty at the goal level; however, change in writing tasks did not reflect the change in the umbrella goal. Each of the three subscales of underlying tasks of the goal "Watching TV" changed in a different way. Changes in similar LVQOL scales were comparable, although less pronounced and more influenced by depression. Prescription or advice of low-vision aids and training in visual devices was not related (p > 0.01) with any of the outcome measures. CONCLUSIONS It seems reasonable to conclude that the decrease in perceived difficulty was an effect of rehabilitation. The D-AI goal scores for difficulty were less influenced by depression and may be more sensitive to measure change over time compared with the LVQOL. Importance scores may not be useful for evaluation purposes.

Introduction: The Bhaktapur Glaucoma Study is a population-based, cross-sectional and longitudinal study undertaken in one of the districts of Nepal. Objectives: To determine the prevalence of glaucoma in Bhaktapur district, Nepal. Materials and methods: Thirty clusters were randomly selected and a door-to-door census was conducted to identify citizens 40 years of age and older. Four thousand eight hundred individuals fulfilling the eligibility criteria were referred to the base hospital in Kathmandu for a detailed clinical examination. The diagnosis of glaucoma was based upon criteria described by the International Society for Geographic and Epidemiological Ophthalmology (ISGEO). Results: Complete data was available on 3991 subjects (response rate 83.15 %). The mean IOP was 13.3 mm Hg (97.5 th and 99.5 th percentiles, 18 and 20 mm Hg, respectively) and mean VCDR 0.26 (97.5 th and 99.5 th percentiles, 0.6 and 0.8 mm Hg, respectively). Seventy-five subjects had glaucoma, an age-sex-standardized prevalence of 1.80 (95 % confidence interval (CI), 1.68 - 1.92). The age-and sex-standardized prevalence of POAG was 1.24 % (CI, 1.14 - 1.34), PACG 0.39 % (CI, 0.34 - 0.45) and secondary glaucoma 0.15 % (CI, 0.07-0.36). The prevalence of glaucoma increased with increase in age and there was no significant difference in gender. Nine eyes were blind and two subjects bilaterally blind from glaucoma. Conclusion: The overall prevalence of glaucoma was 1.9 %. POAG was the most common form of glaucoma. Visual morbidity from PACG, however, was higher. A large majority of the subjects with POAG had not been previously diagnosed and had intraocular pressure within the normal range. Nepal J Ophthalmol 2013; 5(9):81-93 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7832

PURPOSE: The purpose of the study was to evaluate the characteristics of central corneal thickness and its association with age, sex, and intraocular pressure in a Nepalese population. PATIENTS AND METHODS: The study design was a cross-sectional, population-based survey. Two thousand three hundred thirty patients aged 40 years and older were examined at Tilganga Institute of Ophthalmology, a tertiary referral eye centre in Kathmandu, Nepal. All patients underwent a complete ophthalmic examination that included measurements of central corneal thickness with an ultrasonic pachymeter and intraocular pressure with a Goldman type applanation tonometer. RESULTS: The main outcome measures were central corneal thickness and intraocular pressure. Mean age of the 2330 patients examined was 51.3 years (SD±9.56). The mean central corneal thickness and mean intraocular pressure was 539.10 μm (SD±33.73) and 13.33 mm Hg (SD±2.26), respectively. Central corneal thickness showed an average decrease of 2.67 μm (95% confidence interval, 2.21-4.1) per decade increase in age. A 100 μm increase in central corneal thickness was associated with a 1.03 mm Hg (95% confidence interval, 0.79-1.26) increase in intraocular pressure after adjusting for age and sex. CONCLUSIONS: The changes in central corneal thickness values cause a significant variation in intraocular pressure in this population, suggesting that measurement of central corneal thickness will have implications in the diagnosis and management of glaucoma. Copyright © 2012 by Lippincott Williams & Wilkins.

PURPOSE To investigate the effectiveness of training in the use of closed-circuit television (CCTV) on reading performance in visually impaired patients. METHODS In a multicenter masked randomized controlled trial, 122 patients were randomized either to a treatment group that received usual delivery instructions from the CCTV supplier combined with concise outpatient standardized training, or to a control group that received delivery instructions only. The main outcome measure was reading performance, which was obtained by measuring reading acuity, reading speed, reading errors, column-tracking time, and technical reading, approximately two weeks after patients had received their CCTV and 3 months later. Videotapes of all measurements were rated by two investigators. Training effects were analyzed with linear mixed modeling. RESULTS There were no statistically significant differences in results between the treatment and control group. However, introducing a CCTV increased reading acuity (mean difference [MD] 0.93 logRAD; P < 0.01) and maximum reading speed (MD 15 wpm; P < 0.01), and decreased the number of errors (MD 0.33; P = 0.04), compared to reading without CCTV. Average reading speed (P = 0.05), number of errors (P = 0.04), and column-tracking time (P = 0.01) improved over time. CONCLUSIONS Prescribing a CCTV and the delivery instructions by the supplier seemed sufficient to improve reading performance. Additional training in the use of this device did not result in further improvement. Based on these results, outpatient low-vision rehabilitation centers may consider reallocating part of the training resources into other evidence-based rehabilitation programs. (trialregister.nl number, NTR1031.).

The Low Vision Quality of Life (LVQOL) questionnaire and the Vision-related Quality of Life Core Measure (VCM1) are two of the many vision-related quality of life (QOL) questionnaires that have been developed in recent years. Although psychometric properties of the LVQOL and VCM1 compare well with other vision-related QOL questionnaires, construct and longitudinal validity have not been assessed (adequately). The purpose of this study was to examine the cross-sectional and longitudinal construct validity of these questionnaires by testing specific pre-specified hypotheses about the relations of these questionnaires with other measures. The percentage of hypotheses regarding the cross-sectional construct validity that were refuted for the LVQOL was 22% for the basic aspects of vision subscale, 50% for the mobility subscale, 39% for the adjustment subscale and 17% for the reading and fine work subscale. For the VCM1 this percentage was 57%. For the longitudinal construct validity the percentage of hypotheses that were refuted ranged from 33 to 75% for the LVQOL subscales and was 50% for the VCM1. In conclusion, cross-sectional construct validity was satisfactory for the LVQOL subscales, but seemed poor for the VCM1. In addition, the longitudinal validity of these scales was poor to moderate.

Purpose The prognosis of visual acuity (VA) after branch retinal vein occlusion (BRVO) in patients with diabetes mellitus is unknown compared to the VA in non-diabetic patients with BRVO. The aim of this study was to evaluate the visual outcome of BRVO in diabetic and non-diabetic patients. Methods A retrospective case-control study of diabetic and non-diabetic patients with BRVO was performed. VA and commonly known risk factors and complications of BRVO were compared in a follow-up period of at least 1 year. Results A total of 28 eyes of patients with diabetes and 49 eyes of non-diabetic patients with BRVO were included. One year after BRVO, the VA in the patients with diabetes decreased significantly more than that of the non-diabetic patients. During the second year after BRVO, the VA did not change significantly in either group. BRVO in patients with diabetes occurs at an earlier age. Diabetic patients needed more outpatient visits. Conclusions The VA 1 year after BRVO in patients with diabetes is worse compared to the VA in patients without diabetes. The VA stabilizes 1 year after onset in both groups. Diabetic patients tend to need more frequent follow-up in order to treat the sequelae of BRVO.

Background: Orientation and mobility training (O&M-training) in using an identification cane, also called symbol cane, is provided to people with low vision to facilitate independent participation in the community. In The Netherlands this training is mainly practice-based because a standardised and validly evaluated O&M-training in using the identification cane is lacking. Recently a standardised O&M-training in using the identification cane was developed. This training consists of two face-to-face sessions and one telephone session during which, in addition to usual care, the client's needs regarding mobility are prioritised, and cognitive restructuring techniques, action planning and contracting are applied to facilitate the use of the cane. This paper presents the design of a randomised controlled trial aimed to evaluate this standardised O&M-training in using the identification cane in older adults with low vision. Methods/design: A parallel group randomised controlled trial was designed to compare the standardised O&M-training with usual care, i.e. the O&M-training commonly provided by the mobility trainer. Community-dwelling older people who ask for support at a rehabilitation centre for people with visual impairment and who are likely to receive an O&M-training in using the identification cane are included in the trial (N = 190). The primary outcomes of the effect evaluation are ADL self care and visual functioning with respect to distance activities and mobility. Secondary outcomes include quality of life, feelings of anxiety, symptoms of depression, fear of falling, and falls history. Data for the effect evaluation are collected by means of telephone interviews at baseline, and at 5 and 17 weeks after the start of the O&M-training. In addition to an effect evaluation, a process evaluation to study the feasibility of the O&M-training is carried out. Discussion: The screening procedure for eligible participants started in November 2007 and will continue until October 2009. Preliminary findings regarding the evaluation are expected in the course of 2010. If the standardised O&M-training is more effective than the current O&M-training or, in case of equal effectiveness, is considered more feasible, the training will be embedded in the Dutch national instruction for mobility trainers. Trial registration: ClinicalTrials.gov NCT00946062. © 2009 Zijlstra et al.