Search

BACKGROUND: Visual impairments are associated with low quality of life, impairment of daily activities, and accidental falls. As dialysis patients are increasingly older and more disabled, we sought to assess visual impairments within an elderly dialysis population. Based on data from the general population, we hypothesized that more than 30% of dialysis patients 65 years or older would have visual impairment manifested by loss of visual acuity, depth perception, or contrast sensitivity. STUDY DESIGN: Single-center cross-sectional study. SETTING & PARTICIPANTS: Patients established on hemodialysis therapy, age older than 65 years. OUTCOMES: The proportion of elderly hemodialysis patients with impairments in visual acuity, contrast sensitivity, and depth perception. MEASUREMENTS: Lighthouse Near Visual Acuity Test, Lea Screener contrast sensitivity test (Goodlite, MA, USA), Titmus Stereotest, Folstein Mini-Mental Status Examination. RESULTS: 152 of 159 patients (95.6%) had visual acuity levels less than age-expected values. Under North American (American Medical Association, edition 4) guidelines for disability compensation, 62 patients (39.0%) fulfilled criteria for legal blindness. Sixty patients (37.0%) had poor contrast sensitivity and 48 (30.6%) failed the Housefly component of the Titmus Stereotest. Failing the Housefly component was associated with a lower Folstein Mini-Mental Status Examination score (23.4 +/- 4.2 v 25.1 +/- 3.5; P = 0.01). LIMITATIONS: This study is limited by the cross-sectional study design and abbreviated test protocol used for vision assessment. CONCLUSIONS: Results of this study suggest that elderly hemodialysis patients have a high frequency of visual impairment. Formal low vision assessment and low vision rehabilitation may be useful in elderly dialysis patients. Additional study is required to determine whether the absence of depth perception in this patient group is associated with deteriorating cognitive function. [ABSTRACT FROM AUTHOR]

Background: Brain tumor in children can induce hemianopia, a loss of conscious vision, profoundly impacting their development and quality of life, yet no effective intervention exists for this pediatric population. This study aimed to explore the feasibility, safety, and potential effectiveness of a home-based audiovisual stimulation in immersive virtual-reality (3D-MOT-IVR) to improve visual function and functional vision., Methods: In a phase 2a, open-labeled, nonrandomized, single-arm study, conducted from July 2022 to October 2023 (NCT05065268), 10 children and adolescents with stable hemianopia were enrolled to perform 20-min sessions of 3D-MOT-IVR every other day for six weeks from home. We assessed feasibility by monitoring adoption, adherence and completion rates, remote data transfer and qualitative feedback. Safety was evaluated using validated cybersickness questionnaires. Comprehensive vision assessments following standardized low-vision evaluation procedures were conducted pre- and post-intervention, with follow-ups at 1- and 6 months., Findings: The home-based 3D-MOT-IVR intervention proved both feasible and safe, with no reported adverse events. All participants completed the prescribed stimulations and the pre- and post-intervention assessment points, 90% completed the follow-ups. Nine out of ten participants showed clinically meaningful enhancement in visual function and/or functional vision, namely binocular visual field restoration and increased reading speed, but two showed concomitant deterioration in monocular visual field. These positive effects were sustained at the 6-month follow-up. Exploratory outcomes revealed a significant positive correlation between the performance at the 3D-MOT-IVR intervention and the visual perception at the binocular visual field test., Interpretation: Our findings underscore the feasibility and safety of home-based audiovisual stimulation in immersive virtual-reality as a potential intervention for improving visual perception in children/adolescents with hemianopia consecutive to a pediatric brain tumor. These promising results lay a strong foundation for a larger randomized controlled trial, offering hope for a meaningful breakthrough in visual rehabilitation for this vulnerable population., Funding: Meagan Bebenek Foundation and University Health Network Foundation., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s).)

Purpose: To report a case with epiretinal membrane (ERM) treated with audio-luminous Biofeedback training (BT) which resulted in improvement of monocular and binocular visual functions., Observations: We report a case of ERM with distance Best Corrected Visual Acuity (BCVA) of 20/40 in the right dominant eye, and 20/20 in the left eye. The main symptom was binocular blurry vision, and the patient did not desire to pursue posterior vitrectomy due to its risks. Using a 10-2 microperimetry test with the MAIA Microperimeter, it was possible to identify an inferior paracentral relative scotoma in the right eye with splitting fixation. The right eye was trained with five 20-minute sessions with Biofeedback training towards a trained retinal locus (TRL) with better retinal sensitivity and 1.46° superior and temporal to the current preferred retinal locus (PRL). After training, the patient reported total improvement of symptoms, and BCVA was 20/25 in the right eye and 20/20 in the left eye., Conclusions and Importance: Biofeedback training is a valuable treatment with no known adverse effects that can be performed as an alternative to patients with ERM with no surgical indication and debilitating symptoms, or as a post-surgery adjuvant treatment., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Homonymous hemianopsia (HH) corresponds to vision loss in one hemi-field secondary to retro-chiasmal injury. Patients with HH experience difficulties in scanning and orientation in their environment. Near vision daily activities such as reading can also be impaired. There is an unmet need for standardized vision rehabilitation protocols for HH. We investigated the effectiveness of biofeedback training (BT), used for vision rehabilitation in patients with central vision loss, in individuals with HH., Methods: In this prospective pilot pre/post study, 12 participants, with HH consecutive to brain injury, performed 5 weekly BT sessions for 20 min each under supervision using the Macular Integrity Assessment microperimeter. BT consisted of relocation of the retinal locus 1-4° toward the blind hemi-field. Outcomes measured post-BT were paracentral retinal sensitivity, visual acuity (near vision), fixation stability, contrast sensitivity, reading speed, and visual functioning questionnaire. Statistical analysis was performed using Bayesian paired t-tests., Results: Paracentral retinal sensitivity significantly increased by 2.7 ± 0.9 dB in the treated eye in 9/11 of the participants. Significant improvements with medium-to-large effect size were observed for fixation stability (8/12 participants), contrast sensitivity (6/12 participants) and near vision visual acuity (10/12 participants). Reading speed increased by 32.5 ± 32.4 words per minute in 10/11 participants. Quality of vision scores improved significantly with large effect size for visual ability, visual information and mobility., Conclusion: BT led to encouraging improvements in visual functions and functional vision in individuals with HH. Further confirmation with larger trials is required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Misawa, Pyatova, Sen, Markowitz, Markowitz, Reber and Daibert-Nido.)

To evaluate usability of and satisfaction with OrCam MyEye, a finger-size wearable assistive technology device for visually impaired during real-world tasks. This prospective multicenter study was conducted on visually impaired people recruited from 5 vision rehabilitation centers. Patients performed real-world tasks such as near and distance reading, money handling, colour identification and face recognition in 2 different scenarios: without using any low vision aid and with OrCam. System Usability Scale (SUS), Patient's Global Impression of Change (PGIC), the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) and the Psychosocial Impact of Assistive Devices Scale (PIADS) were administered after the use of the OrCam device. Among the 100 participants, use of OrCam MyEye device improved many daily-living tasks (F = 1.67, P < .05), and in particular reading and face recognition. Multivariate logistic regression showed that age and visual field defect explained 89% of the variation in efficacy of the device. Nearly half (45%) of the participants indicated a positive rating with the SUS. The PGIC rates showed a minimal improvement with a mean score of 4.2 (SD:1.8). The most highlighted parameter with the QUEST 2.0 test was "ease of use" in 58% (48 subjects). The PIADS indicator showed that the device positively impacted on the daily-living tasks of users (r 2  = 0.72, P < .05). Regression modelling demonstrated a good relation between the questionnaires scores and demographic, disease and visual factors (P < .05). OrCam MyEye allowed visually impaired people to read, handle money and face recognition independently. This device may offer to these subjects to be independent., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: This study reports the repeatability of 20 s-duration fixation stability measurements recorded with the Macular Integrity Assessment (MAIA) microperimeter in patients with central vision loss, in contrast to the Nidek MP1 microperimeter., Methods: Fixation stability was recorded in 39 eyes of 25 patients with macular disease using MAIA and the MP1 for 20 s intervals, twice for each eye, with each instrument. Twenty eyes were identified as the better eye (BE) and 19 eyes as the worse eye (WE). Fixation stability was quantified with the 95% bivariate contour ellipse area (BCEA), logarithmically transformed. Bland-Altman plots were used to determine the 95% limits of agreement., Results: For MAIA, the 95% limits of agreement were ±0.84 log deg 2 for the BE and ±0.66 log deg 2 for the WE. Similarly, for the MP1 these limits were ±0.48 log deg 2 for the BE and ±0.72 log deg 2 for the WE. Inter-device repeatability was modest, ±1.09 log deg 2 for the BE and ±1.01 log deg 2 for the WE, and a proportional bias was detected. Occasionally, MAIA did not register all the expected number of data points, and included far outliers in the BCEA calculation; the inter-device repeatability did not improve when these outliers were removed., Conclusions: Repeatability of 20 s-duration fixation stability examination in patients with central vision loss is specific to the instrument used. We recommend that only data from same type of microperimeter with the same fixation duration should be compared when using fixation stability as an outcome measure to monitor disease progression, effect of treatment or in clinical trials., (© 2022 The Authors Ophthalmic and Physiological Optics © 2022 The College of Optometrists.)

For normally sighted observers, the centre of the macula-the fovea-provides the sharpest vision and serves as the reference point for the oculomotor system. Typically, healthy observers have precise oculomotor control and binocular visual performance that is superior to monocular performance. These functions are disturbed in patients with macular disease who lose foveal vision. An adaptation to central vision loss is the development of a preferred retinal locus (PRL) in the functional eccentric retina, which is determined with a fixation task during monocular viewing. Macular disease often affects the two eyes unequally, but its impact on binocular function and fixational control is poorly understood. Given that patients' natural viewing condition is binocular, the aim of this article was to review current research on binocular visual function and fixational oculomotor control in macular disease. Our findings reveal that there is no overall binocular gain across a range of visual functions, although clear evidence exists for subgroups of patients who exhibit binocular summation or binocular inhibition, depending on the clinical characteristics of their two eyes. The monocular PRL of the better eye has different characteristics from that of the worse eye, but during binocular viewing the PRL of the better eye drives fixational control and may serve as the new reference position for the oculomotor system. We conclude that evaluating binocular function in patients with macular disease reveals important clinical aspects that otherwise cannot be determined solely from examining monocular functions, and can lead to better disease management and interventions., (© 2021 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Background: Age-related macular degeneration (AMD) is the leading cause of loss of vision in the older age groups. In the absence of a known therapy, low vision rehabilitation aims at preserving residual functional vision at optimal levels. Long term functional outcomes from Low Vision Rehabilitation (LVR) in AMD cases were never scrutinized in the past. This study brings some clarification in this matter., Methods: This is a retrospective case series study including data up to 2 years following the baseline visit. Low Vision Assessments included microperimetry testing and recommendations for low vision devices for distance vision. Outcomes measures selected for this study were best corrected distance visual acuity, fixation stability and preferred retinal locus (PRL) topography and LVR interventions., Results: Data on 17 patients with an average age of 89.2 ± 4.4 years was collected. In those with better vision than 20/400 loss of vision was about 1.4 letter per year as tested with ETDRS charts compared with losses of four letters per year in a population without LVR interventions. Fixation stability continued to deteriorate while PRL eccentricity seemed to remain the same. In about half of cases there was a change in the topographic location of the PRL to a different retinal quadrant., Conclusion: Long term, as expected, changes were noticed in visual acuity, fixation stability and PRL topography. However, it seems that LVR interventions for distance vision help patients retain significantly better functional vision at the 2 years follow up interval when compared to others.

Purpose: Biofeedback training (BT) was adapted to idiopathic infantile nystagmus syndrome (IINS) cases to enhance visual functions and quality of life (QoL)., Methods: 10 patients (age 9 ± 3.2 years) treated with the audio-visual BT module of the MAIA microperimeter (Centervue, Padova, Italy) were assessed in two baseline visits and 1week post-BT (BT 80 min in total). The outcomes were distance and near binocular best corrected visual acuity (BBCVA), fixation stability, reading speed, contrast sensitivity, stereopsis and Children's Visual Function Questionnaire. One-way repeated measured ANOVA and paired t -tests were used., Results: Distance BBCVA improved from 0.46 ± 0.21 and 0.43 ± 0.18 pre-BT to 0.33 ± 0.2 logMAR post-BT ( F (2,27) = 13.75, p  = 0.0002). Post-BT was better than baseline ( p  = 0.0001) and pre-BT ( p  = 0.001). Near BBCVA improved from 0.23 ± 0.09 and 0.21 ± 0.14 pre-BT to 0.04 ± 0.08 post-BT (F (2,27) = 22.12, p  = 0.000014), post-BT was better than baseline ( p  = 0.0001) and pre-BT ( p  = 0.0006). Stereopsis improved from 283 ± 338″ to 39 ± 32.2″ ( p  = 0.04), contrast sensitivity from 0.26 ± 0.17 to 0.08 ± 0.12 log units ( p  = 0.01), and reading speed improved from 74.7 ± 51.2 wpm to 104.7 ± 53.6 wpm ( p  = 0.0006). Fixation stability improved from 33.6 ± 28.1 to 14.3 ± 10.1 sq. QoL increased from 23.8 ± 2.2 to 26.3 ± 2.3 units ( p  = 0.001)., Conclusion: BT benefited all visual functions and QoL in this pilot study, heralding a new possibility for Low Vision Rehabilitation in IINS.

Purpose: To determine the efficacy of prisms when used for redirection of incoming images towards the preferred reinal loci (PRLs) for restitution of potential visual acuity (PVA) in low vision cases with age-related macular degeneration (AMD)., Methods: Retrospective comparative interventional case series review. Low vision rehabilitation (LVR) protocol used included best corrected visual acuity (BCVA), PVA, topographic PRL identification and use of prisms to produce image redirection to the presumed PRL. The primary outcome measure selected for analysis was BCVA for viewing distance targets after use of yoke prisms., Results: Image relocation with prisms in patients with AMD resulted in significantly better BCVA levels (t 32  = 8.57, p < 0.0001) in the better eye. Distance BCVA levels achieved were almost identical to PVA levels (t 32  = 0.415, p < 0.681) (y= -0.136 + 1.195x, r = 0.8333, p < 0.001)., Conclusions: Use of yoke prisms for image redirection towards a peripheral identifiable PRL may result in PVA restitution in most cases., (Copyright © 2020 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.)

Background/Objectives: Visual field loss is frequent in patients with brain tumors, worsening their daily life and exacerbating the burden of disease, and no supportive care strategies exist. In this case series, we sought to characterize the feasibility and potential effectiveness of a home-based visual rehabilitation program in hemianopia patients using immersive virtual-reality stimulation. Subjects/Methods: Two patients, one with homonymous hemianopia and the other with bitemporal hemianopia, consecutive to pediatric brain tumors, with no prior visual rehabilitation performed 15 min of home-based audiovisual stimulation every 2 days for 6 weeks (case 2) and 7 weeks (case 1) between February and August 2020. Patients used a virtual-reality, stand-alone, and remotely controlled device loaded with a non-commercial audiovisual stimulation program managed in real time from the laboratory. Standard visual outcomes assessed in usual care in visual rehabilitation were measured at the clinic. Following a mixed method approach in this pragmatic study of two cases, we collected quantitative and qualitative data on feasibility and potential effectiveness and compared the results pre- and post-treatment. Results: Implementation and wireless delivery of the audiovisual stimulation, remote data collection, and analysis for cases 1 and 2 who completed 19/20 and 20/20 audiovisual stimulation sessions at home, respectively, altogether indicated feasibility. Contrast sensitivity increased in both eyes for cases 1 and 2. Visual fields, measured by binocular Esterman and monocular Humphrey full-field analyses, improved in case 1. A minor increase was observed in case 2. Cases 1 and 2 enhanced reading speed. Case 2 strongly improved quality of life scores. Conclusion: This is the first report of a home-based virtual-reality visual rehabilitation program for adult patients with hemianopia consecutive to a pediatric brain tumor. We show the feasibility in real-world conditions and potential effectiveness of such technology on visual perception and quality of life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Daibert-Nido, Pyatova, Cheung, Nayomi, Markowitz, Bouffet and Reber.)

BACKGROUND Homonymous hemianopia is a loss of conscious vision in one hemifield, strongly affecting everyday life. Audiovisual stimulation programs improve visual perception in the blind hemifield; however, they use large equipment operated in clinical settings. Such treatments require frequent visits at the clinic, hampering the patient's adherence and compliance. In one hemianopia patient, we tested a 4-week dynamic audiovisual rehabilitation program in the stand-alone, remotely controlled, virtual-reality, head-mounted display Oculus Go and measured the effect on visual perception. CASE REPORT A 15-year-old Caucasian male was diagnosed with a right homonymous hemianopia with splitting of central fixation after a traumatic occipital contusion at age 7 months. Visual assessment showed impaired binocular contrast sensitivity and retinal sensitivity. Fixation stability and visual fields were strongly affected. After a 4-week audiovisual rehabilitation program, including 3 hours 20 minutes of stimulation, the contrast sensitivity, fixation stability, and paracentral visual perception were significantly enhanced, improving quality of life. CONCLUSIONS This pioneering work reports the use of virtual-reality in a head-mounted display to provide an audiovisual stimulation protocol for low-vision rehabilitation in a hemianopia patient. Real-time data recording and remote control of the stimulation program demonstrate that such rehabilitation treatment can be performed by the patient at home without interruption of care, decreasing the burden of disease. Beneficial effects on visual function were measured according to clinical guidelines of low-vision assessment. Improvement in visual function and quality of life challenge the prevailing belief that post-acute vision loss is both permanent and unchangeable.

Background: Insurance coverage may reduce cost barriers to obtain vision correction. Our aim was to determine the frequency and source of prescription eyewear insurance to understand how Canadians finance optical correction., Methods: We conducted a repeated population-based cross-sectional study using 2003, 2005 and 2013-2014 Canadian Community Health Survey data from respondents aged 12 years or older from Ontario, Canada. In this group, the cost of prescription eyewear is not covered by the government unless one is registered with a social assistance program or belongs to a specific population. We determined the frequency and source of insurance coverage for prescription eyewear in proportions. We used survey weights provided by Statistics Canada in all analyses to account for sample selection, a complex survey, and adjustments for seasonal effect, poststratification, nonresponse and calibration. We compared unadjusted proportions and adjusted prevalence ratios (PRs) of having insurance., Results: Insurance covered all or part of the costs of prescription eyewear for 62% of Ontarians in all 3 survey years. Of those insured, 84.1%-86.0% had employer-sponsored coverage, 9.0%-10.3% had government-sponsored coverage, and 5.7%-6.8% had private plans. Employer-sponsored coverage remained constant for those in households with postsecondary graduation but decreased significantly for those in households with less than secondary school graduation, from 67.0% (95% confidence interval [CI] 63.2%-70.8%) ( n = 175 000) in 2005 to 54.6% (95% CI 50.1%-59.2%) ( n = 123 500) in 2013-2014. Government-sponsored coverage increased significantly for those in households with less than secondary school graduation, from 29.2% (95% CI 25.5%-32.9%) ( n = 76 400) in 2005 to 41.7% (95% CI 37.2%-46.1%) ( n = 93 900) in 2013-2014. In 2013-2014, Ontarians in households with less than secondary school graduation were less likely than those with secondary school graduation to report employer-sponsored coverage (adjusted PR 0.79, 95% CI 0.75-0.84) but were more likely to have government-sponsored coverage (adjusted PR 1.27, 95% CI 1.06-1.53)., Interpretation: Sixty-two percent of Ontarians had prescription eyewear insurance in 2003, 2005 and 2013-2014; the largest source of insurance was employers, primarily covering those with higher education levels, whereas government-sponsored insurance increased significantly among those with lower education levels. Further research is needed to elucidate barriers to obtaining prescription eyewear and the degree to which affordability impairs access to vision correction., Competing Interests: Competing interests: Sherif El-Defrawy reports research grant support from Alcon, outside the submitted work. Ya-Ping Jin reports research grant support from the Lindenfield Family Research Grant for this study, and from the Glaucoma Research Society of Canada and the Kensington Eye Institute, outside the submitted work. Yvonne Buys reports consulting fees from Allergan and Bausch & Lomb, outside the submitted work. No other competing interests were declared., (© 2021 Joule Inc. or its licensors.)

Purpose: The LIGHTSITE I study investigated the efficacy and safety of photobiomodulation (PBM) treatment in subjects with dry age-related macular degeneration., Methods: Thirty subjects (46 eyes) were treated with the Valeda Light Delivery System, wherein subjects underwent two series of treatments (3× per week for 3-4 weeks) over 1 year. Outcome measures included best-corrected visual acuity, contrast sensitivity, microperimetry, central drusen volume and drusen thickness, and quality of life assessments., Results: Photobiomodulation-treated subjects showed a best-corrected visual acuity mean letter score gain of 4 letters immediately after each treatment series at Month 1 (M1) and Month 7 (M7). Approximately 50% of PBM-treated subjects showed improvement of ≥5 letters versus 13.6% in sham-treated subjects at M1. High responding subjects (≥5-letter improvement) in the PBM-treated group showed a gain of 8 letters after initial treatment (P < 0.01) and exhibited earlier stages of age-related macular degeneration disease. Statistically significant improvements in contrast sensitivity, central drusen volume, central drusen thickness, and quality of life were observed (P < 0.05). No device-related adverse events were reported., Conclusion: Photobiomodulation treatment statistically improved clinical and anatomical outcomes with more robust benefits observed in subjects with earlier stages of dry age-related macular degeneration. Repeated PBM treatments are necessary to maintain benefits. These pilot findings support previous reports and suggest the utility of PBM as a safe and effective therapy in subjects with dry age-related macular degeneration.

Purpose: To investigate the effect of disease progression on the monocular preferred retinal locus (PRL) of the better eye (BE) and worse eye (WE) of patients with central vision loss., Methods: Fifty-one patients with bilateral macular diseases were included. The monocular PRL was recorded for each eye ( N = 102 eyes) with the MP-1 microperimeter in two visits that were 458 ± 249 days apart. For each eye and visit, the PRL distance from the former fovea, polar angle, and scotoma size were measured. The change in PRL location from visit 1 to visit 2 was evaluated with the differential map analysis., Results: Scotoma size increased significantly in both eyes. The PRL distance from the former fovea increased significantly from visit 1 to visit 2 in the BE, but not in the WE. The polar angle was relatively stable in both visits for the BE. The change in PRL location in the BE was predicted only by the PRL distance from the former fovea in visits 1 and 2, but not by polar angle or scotoma size. For the WE, the change in PRL location depended on the change in PRL location in the BE, rather than on measurements made on that eye., Conclusions: Disease progression affects monocular PRL location differently in the 2 eyes. The results suggest a recalibration of the oculomotor system with its reference at the PRL from the BE., Translational Relevance: These findings are important for deciding the course of treatment and/or for developing rehabilitation techniques focusing on PRL relocation., Competing Interests: Disclosure: L. Tarita-Nistor, None; M.S. Mandelcorn, None; E.D. Mandelcorn, None; S.N. Markowitz, None, (Copyright 2020 The Authors.)

Objectives: Biofeedback training (BT) is a modern method for enhancing the use of preferred retinal loci (PRL) retraining for new retinal loci (TRL), hence improving far and near vision. This article attempts to clarify the optimal methodology for BT and the types of patients who can benefit most from BT., Methods: This is a retrospective review of cases who received BT with the macular integrity assessment (MAIA) microperimetre. Outcome measures selected for analysis were visual acuity, PRL location, fixation stability, fixation pattern orientation, reading acuity, critical print size, and reading speed., Results: Out of 30 cases who received BT, only those with age-related macular degeneration and visual acuity of logMAR 0.8 (20/126) or poorer showed a visual acuity gain (statistically significant of 12 letters) after BT. Those with other diagnoses and those with residual Early Treatment Diabetic Retinopathy Study best-corrected visual acuity of logMAR of 0.7 (20/100) or better showed only positive trends for visual acuity and a negative trend for fixation stability. All subjects showed a shift in PRL location toward the superior quadrant of the retina (p < 0.02) in those who received BT., Conclusion: BT seems to offer patients a unique and efficient modality to improve distance vision outside of using optical devices., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Significance: Head-mounted low vision devices have received considerable attention in recent years owing to rapidly developing technology, facilitating ease of use and functionality. Systematic clinical evaluations of such devices remain rare but are needed to steer future device development., Purpose: The purpose of this study was to investigate, in a multicenter prospective trial, the short- and medium-term effects of a head-worn vision enhancement device (eSight Eyewear)., Methods: Participants aged 13 to 75 years with stable vision (distance acuity, 20/60 to 20/400; visual field diameter >20°) were recruited across six sites. Data were collected at baseline (no device), at fitting (with device), and after 3 months of everyday use. Outcome measures were visual ability measured by the Veterans Affairs Low Vision Visual Functioning Questionnaire 48, distance acuity (Early Treatment Diabetic Retinopathy Study), reading performance (MNREAD chart), contrast sensitivity (MARS chart), face recognition, and a modified version of the Melbourne Low Vision Activities of Daily Living (ADL) Index., Results: Among the 51 participants, eSight introduction immediately improved distance acuity (0.74 ± 0.28 logMAR), contrast sensitivity (0.57 ± 0.53 log units), and critical print size (0.52 ± 0.43 logMAR), all P < .001, without any further change after 3 months; reading acuity improved at fitting (0.56 ± 0.35 logMAR) and by one additional line after 3 months, whereas reading speed only slightly increased across all three time points. The Melbourne ADL score and face recognition improved at fitting (P < .01) with trends toward further improvement at 3 months. After 3 months of use, Veterans Affairs Low Vision Visual Functioning Questionnaire 48 person measures (in logits) improved: overall, 0.84, P < .001; reading, 2.75, P < .001; mobility, 0.04, not statistically significant; visual information, 1.08, P < .001; and visual motor, 0.48, P = .02., Conclusions: eSight introduction yields immediate improvements in visual ability, with face recognition and ADLs showing a tentative benefit of further use. Overall, visual ability, reading, and visual information showed greatest benefit with device use. Further studies need to examine benefits of practice and training and possible differential effects of underlying pathology or baseline vision.

Reading is the most frequent clinical complaint and the primary goal for patients with macular degeneration seeking vision rehabilitation. The current prevalent methods for reading skills training across the globe are still magnification and basic scotoma awareness training. More recent studies showed that specific eccentric training, comprehension ability training, and specific oculomotor training are all beneficial to reading skills rehabilitation. In clinical practice, ophthalmologists should strive to implement reading skills methods that include assessment of cognitive skills, optimal eyewear, optimal reading material, PRL assessment, training of better oculomotor control, and efficient perceptual training., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Surgical restoration of vision with retinal prostheses is a new and developing technology currently available in a select group of countries, Canada among them. The Argus II retinal prosthesis is the first commercially available device for restoration of vision in patients with Retinitis Pigmentosa or with similar retinal pathology who still have minimal residual native vision. The surgery is complex and requires training however it is within the abilities of any experienced retina surgeon. Surgical experience builds up with each case and in our patients length of surgery constantly went down. Complications occurred however we experienced no catastrophic events. Most notable is that in our implanted cases the Argus II technology proved to be beneficial to most patients. In order to obtain optimal results with this surgical intervention it is absolutely required that the surgical work is complemented simultaneously with the work of a specialized rehabilitation team. A review of the technology, of our experience, comments and concerns is presented in this paper., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

The Argus II retinal prosthesis is the first commercially available device for restoration of vision in patients with Retinitis Pigmentosa or with similar retinal pathology who still have minimal residual native vision. The technology is able to restore vision with production of artificial visual percepts which usually are given adequate useful interpretation by the visual system in most implanted patients. The technology usually produces visual perception at the level of shape identification or better in some cases enabling in many less dependence on vision substitution devices and skills. There is no consensus among vision rehabilitation practitioners on single methods for assessments, outcome measures and training, yet there is constant progress in these areas of concern. Hence the current vision rehabilitation practice related to the implantation of the Argus II retinal prosthesis is a work in progress with many learning opportunities for all involved. All agree that implementation of this technology in clinical practice requires the combined work of a multi-disciplinary team which includes a specialized surgical team as well as a specialized rehabilitation team in order to obtain optimal results. Our own experience is presented in this paper and indicates so far that the Argus II technology is beneficial to patients and that it could be successfully managed within the Canadian heath care system., (Copyright © 2018 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: In this study we evaluated the reading accessibility index (ACC) and a quality of reading grid as assessment tools for reading and as outcome measures for reading rehabilitation of patients with central vision loss., Methods: Reading performances on the MNRead chart (www.precision-vision.com) were reviewed from our research database. Participants were 24 controls with normal vision [mean age: 34 (SD, 14) years] and 61 patients with bilateral central vision loss [mean age: 81 (SD, 9) years] among which a subgroup of 18 patients [mean age, 76 (SD, 13) years] had undergone perceptual learning training for reading rehabilitation. The outcome measures were maximum reading speed, reading acuity, critical print size, ACC, and the reading quality. A reading quality grid that classified reading speed as spot, slow, functional, or fluent and print size as small, regular, medium, or large was used. All reading speed values were normalised (i.e., divided by 200, the average reading speed in young adults with normal vision measured with the MNRead)., Results: The ACC was associated perfectly with the maximum reading speed in the control group (r 22  = 0.99, P < 0.001) and strongly with all parameters of reading in the patient group (smallest r value: r 59  = -0.66, P < 0.001). For patients with central vision loss, reading was functional for large print, but slow for medium print and spot for regular print. For some patients with the same ACC values, the quality of reading grid revealed important performance differences. For the subgroup (n = 18) of patients who were trained, the ACC revealed a greater effect of training than the other three parameters of reading, and although there were statistically significant improvements across all print size categories, a qualitative improvement in reading was noticed only for the medium print sizes., Conclusions: The ACC is a good measure of reading performance in patients with central vision loss. Examining reading quality for different print size categories can provide a more detailed picture of reading impairment and should be considered as an outcome for rehabilitation in addition to the ACC., (© 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists.)

Objective: Patients with central vision loss develop preferred retinal loci (PRLs) in the eccentric retina. The characteristics of the PRLs for the better eye (BE) are well studied, but not those of the worse eye (WE). We examined the distribution of monocular PRLs in the visual field (VF), as well as visual acuity, fixation stability, and PRL eccentricity for the BE and WE of patients with central vision loss., Design: Retrospective consecutive case series., Participants: A total of 87 BE and 50 WE of patients with central vision loss., Methods: Visual acuity, fixation stability, PRL location, and PRL eccentricity measures were retrieved from our database. PRL location was categorized into 5 VF segments: central, superior, inferior, left, and right., Results: For BE, PRL frequency distribution was significantly different for the 5 VF segments, χ 2 (4) = 19.9, p = 0.001. Most PRLs occurred in inferior (31%) and left (31%) VF segments. Visual acuity, fixation stability, and PRL eccentricity depended on the VF segment. Visual acuity correlated with fixation stability and PRL eccentricity. For WE, PRL frequency distribution was not different for the 5 VF segments and visual acuity was not dependent on the VF segment. No relationships between visual acuity and PRL eccentricity or fixation stability were found., Conclusions: Different patterns of PRL characteristics were found for BEs and for WEs. These findings are important to consider when factors such as PRL eccentricity, visual acuity, fixation stability, and PRL location are used as outcome measures after treatment or rehabilitation and when monitoring disease progression., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

The State of the Art is strong - to paraphrase another famous saying. Low vision rehabilitation (LVR) is today a recognized discipline in Ophthalmology, expanding and improving the quality of life of numerous visually impaired patients. It was not so about a century ago when it all started. Then, charity work aimed at helping blind children was all that LVR was. With advances in science, medicine and public health policy, help for the blind expanded its reach to all who were visually impaired. Devices and re-training of skills have been added to complement diagnosis and charity work. Modern LVR, which took hold in the last few decades, was propelled to new heights by relentless advances in basic and clinical sciences. Today we can provide significant and meaningful help to visually impaired patients in most situations. It could be as simple as a hand magnifier or as intricate as a retinal prosthesis. In many instances it seems to be just a beginning for things still to come., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: We present a new method for identifying the absolute location (i.e., relative to the optic disc) of the preferred retinal location (PRL) simultaneously for the two eyes of patients with central vision loss. For this, we used a binocular eye-tracking system that determines the pupillary axes of both eyes without a user calibration routine., Methods: During monocular viewing, we measured the pupillary axis and the angle between it and the visual axis (angle Kappa) for 10 eyes with normal vision. We also determined their fovea location relative to the middle of the optic disc with the MP-1 microperimeter. Then, we created a transformation between the eye-tracking and microperimeter measurements. We used this transformation to predict the absolute location of the monocular and binocular PRLs of nine patients with central vision loss. The accuracy of the monocular prediction was evaluated with the microperimeter. The binocular PRLs were checked for retinal correspondence and functionality by placing them on fundus photographs., Results: The transformation yielded an average error for the monocular measures of 0.2 (95% confidence interval, 1.0 to -0.6 degrees) horizontally and 0.5 (95% confidence interval, 1.1 to -0.1 degrees) vertically. The predicted binocular measures showed that the PRLs were generally in corresponding locations in the two eyes. One patient whose PRLs were not in corresponding positions complained about diplopia. For all patients, at least one PRL fell onto functional retina during binocular viewing., Conclusions: This study shows that measurements of the location of the binocular PRLs relative to the pupillary axes can be transformed into absolute locations.

Purpose: Large moving scenes can induce a sensation of self-motion in stationary observers. This illusion is called "vection." Glaucoma progressively affects the functioning of peripheral vision, which plays an important role in inducing vection. It is still not known whether vection can be induced in these patients and, if it can, whether the interaction between visual and vestibular inputs is solved appropriately. The aim of this study was to investigate vection responses in patients with mild to moderate open-angle glaucoma., Methods: Fifteen patients with mild to moderate glaucoma and 15 age-matched controls were exposed to a random-dot pattern at a short viewing distance and in a dark room. The pattern was projected on a large screen and rotated clockwise with an angular speed of 45 degrees per second to induce a sensation of self-rotation. Vection latency, vection duration, and objective and subjective measures of tilt were obtained in three viewing conditions (binocular, and monocular with each eye). Each condition lasted 2 minutes., Results: Patients with glaucoma had longer vection latencies (p = 0.005) than, but the same vection duration as, age-matched controls. Viewing condition did not affect vection responses for either group. The control group estimated the tilt angle as being significantly larger than the actual maximum tilt angle measured with the tilt sensor (p = 0.038). There was no relationship between vection measures and visual field sensitivity for the glaucoma group., Conclusions: These findings suggest that, despite an altered visual input that delays vection, the neural responses involved in canceling the illusion of self-motion remain intact in patients with mild peripheral visual field loss.

Objective: To determine the effect of residual stereopsis on vision-related abilities of low vision (LV) patients with age-related macular degeneration (AMD)., Methods: Prospective non-randomized observational case series. Inclusion criteria included documented AMD, LV with best corrected visual acuity (BCVA) of 20/50-20/400 in the better eye, and ages between 50 and 90 years. Stereoacuity was measured using the near Frisby Stereotest. Vision related abilities were documented with the VA LV VFQ-48 questionnaire., Results: Twenty-seven subjects with mean age of 84±6 years old were recruited, of which 59.3% (16/27) were female. 59.3% (16/27) of the subjects were not able to see any stereoacuity plate, 25.9% (7/27) had stereoacuity of 340s of arc (SOA), 11.1% (3/27) had stereoacuity of 170 SOA and 3.7% (1/27) had stereoacuity of 85 SOA. The mean Overall Functional Visual Abilities (OFVA) score was significantly higher in those with stereopsis (2.25±0.99) than those without stereopsis (1.50±0.92) (P=0.028)., Conclusions: LV patients with stereopsis have better OFVA than those without. Stereopsis should be considered as a component of LV rehabilitation and considered as an outcome measure in research and clinical practice., (Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Purpose: To evaluate the effectiveness of a perceptual learning technique for improving reading performance of patients with central vision loss and to explore whether this learning generalizes to other visual functions., Methods: Ten patients with central vision loss were trained binocularly, in four consecutive sessions, with serially presented words printed at each patient's reading acuity limit. Patients read 10 blocks of 100 words in each session. They were encouraged to read the whole word and were discouraged to read letter by letter. Assessment sessions before and after training measured fixation stability, monocular and binocular visual acuity, as well as reading acuity, critical print size, and maximum reading speed with continuous text. Another six patients with central vision loss were included in a test-retest control group and were tested twice, 1 week apart, with no intervention., Results: The average time required to read a block of trials decreased significantly with each training session. After training, continuous text reading improved in terms of reading acuity (p = 0.017) and maximum reading speed (p = 0.01), but critical print size did not change. Binocular acuity improved significantly from an average of 0.54 logMAR before training to 0.44 logMAR after training. Binocular ratio (better eye acuity/binocular acuity) increased from an average of 1.0 before training to 1.17 after training. There was a 62% improvement in fixation stability in the better eye and 58% in the worse eye. There were no changes in the outcome measures for the test-retest control group., Conclusions: The technique described in this article can be used for vision rehabilitation of patients with central vision loss. When training is done with size threshold stimuli, learning generalizes to visual acuity, continuous text reading, and fixation stability.

Objective: It is the aim of this study to review residual vision in the less used eye of patients with age-related macular degeneration (AMD) using modern concepts for residual visual functions in addition to traditional methods for assessing visual acuity., Design: The study was designed as a retrospective, nonrandomized, observational case series., Participants: Consecutive cases tested with microperimetry instruments were identified from archives. Included were cases with diagnosed AMD of all age groups and all visual acuity levels., Methods: In all cases, microperimetric technology was used to assess residual visual function. Outcome measures selected for analysis were visual acuity, preferred retinal loci (PRL) topography, fixation stability, and PRL span., Results: Data were collected and analyzed for both eyes from 51 patients with AMD low vision. There were 23 males and 28 females whose mean age was 84 (± 7) years. Within the group the difference in visual acuity estimates between the better seeing and the less used eye was statistically significant (p = 0.001). Similar positive statistical significant differences were noticed at all spatial frequencies (except at 6 cycles/degree) when testing contrast sensitivity. All other measurements were not statistically different between the better seeing and the poorer eye. This applies to the fixation stability and PRL span estimates. Almost half (49%) of the cases showed retinal noncorrespondence of PRLs between the 2 eyes., Conclusions: Visual acuity estimates are not a reliable measure for residual vision. The less used eye in AMD cases has much better residual vision than thought before according to modern outcome measures. This new concept should be taken into account by all practitioners and be applied during all low vision rehabilitation interventions., (© 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Microperimeters embody technological abilities required to assess components of residual visual functions and functional vision. Residual visual functions and functional vision after macular vision loss are mostly defined by 3 major components: scotoma characteristics, preferred retinal loci (PRLs) and oculomotor control. Microperimetry may be proven superior as a method to standard automated perimetry (SAP) for residual visual function assessment. During microperimetry stimuli are projected directly on the retina with accurate test-retest of the same retinal point monitored by eye tracking technology. Microperimeters offer also abilities to determine accurately the location of a PRL. Recent research reveals also that fixation stability estimates in low vision cases are reliable predictors of visual acuity estimates. Fixation stability estimates provided automatically by the microperimeters are based on proprietary algorithms and provide reasonable estimates very close to BCEA values calculated from raw data. More and more microperimeters are used in clinical retina practice to assess more accurately the impact of diseases or of interventions on the retina. Microperimeters are also in use more often in glaucoma practices and it seems evident that the main usage for microperimeters is destined to monitor glaucoma damaged residual visual functions and functional vision. In addition identification of eccentric location of PRLs and fixation stability estimates at the PRL in low vision patients offers the LVR practitioner the option to use the best residual visual function available for rehabilitation. For mainstream ophthalmology many indicators point to the fact that microperimeters may take the lead role played by SAP in the last decades. For vision rehabilitation practitioners the advent of multiple choices for microperimetry portends the introduction of modern rehabilitation concepts in most clinical practices. Both developments seem to happen sooner, rather than later as expected by most., (Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the effect from using prisms for image relocation on fixation stability estimates in low-vision (LV) patients with age-related macular degeneration (AMD)., Methods: The study was designed as a prospective, nonrandomized, observational case series. Inclusion criteria included documented AMD, LV with best corrected visual acuity of 20/50 to 20/400 in the better eye, and cases wearing distance glasses with prisms for image relocation incorporated in the glasses. Preferred retinal locus (PRL) and fixation stability were assessed using the Nidek MP1 and MAIA microperimeters. A control group was used to compare results., Results: We recruited 14 study subjects with AMD and 10 with no retinal pathology serving as a control group. On average, 6 (SD 2) prisms diopters were prescribed to all in distant viewing glasses. Fixation stability was better at 3-month interval from baseline (p = 0.021) in the AMD group and stayed the same for the following 9 months. No change in fixation stability was noticed in the control group. There was no statistically significant difference in PRL eccentricity between the 3- and 12-month intervals in the AMD group (p = 0.39). However, there was a positive correlation between PRL eccentricity and baseline bivariate contour ellipse area in the AMD group (p = 0.052)., Conclusions: Patients with LV with AMD who are using prisms for image relocation toward the peripheral retinal exhibit better fixation stability than those who are not using prisms. Better fixation stability may impact on other visual outcomes. Use of prisms should be considered in any LV rehabilitation attempt and used in conjunction with other modern interventions in LV rehabilitation., (Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: Visual acuity is a poor predictor of the maximum reading speed of patients with central vision loss. This study examines the effects of binocular summation of acuity on the maximum reading speed of these patients., Design: Prospective, observational case series., Participants: Twenty patients with central vision loss participated., Methods: Maximum reading speed was measured binocularly using the MNREAD acuity charts. Monocular and binocular acuities were measured with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Binocular summation was evaluated with a binocular ratio (BR) calculated as the ratio between the acuity of the better eye to binocular acuity. Fixation stability and preferred retinal locus (PRL) distance from the former fovea were evaluated with the MP-1 microperimetre., Results: Six patients experienced acuity summation (BR > 1.05), 5 experienced acuity inhibition (BR < 0.95), and 9 showed equality (BR = 1 ± 0.05). There were no differences in the mean acuity of the better eye, fixation stability, or PRL distance from the fovea of the 3 groups. Maximum reading speed was significantly slower (p < 0.05) for patients who experienced binocular inhibition (mean 42 ± 27 words/min [wpm], median 40 wpm) than for those who experienced binocular summation (mean 107 ± 39 wpm, median 108 wpm) or equality (mean 111 ± 62 wpm, median 90 wpm). BR correlated with the maximum reading speed for the overall sample (r[18] = 0.49, p = 0.03). BR together with PRL distance from the former fovea in the better eye explained 45% of the variance in maximum reading speed., Conclusions: Binocular summation of acuity rather than visual acuity alone affects maximum reading speed of patients with central vision loss. Patients with binocular inhibition read significantly slower than those with binocular summation or equality. Assessment of binocular summation is important when devising reading rehabilitation techniques., (© 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To quantify residual abilities to identify a target's colour in cases with age-related macular degeneration (AMD)., Methods: Subjects with AMD with best corrected visual acuity (BCVA) of 20/50 to 20/400 in the better eye (test eye) and age older than 55 years were recruited. A separate matching control group was recruited with subjects with BCVA of 20/40 or better. Each subject was presented sequentially with square-shaped colour targets corresponding in size to optotype sizes used in standard Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity testing protocols, all against a white background. Four major colour hues were selected for testing: blue, yellow, green, and red. The same subjects were tested with standard ETDRS targets (black on white), and results served as control group references. The primary outcome measure selected for analysis was the minimum angle of resolution (MAR) required to correctly identify the hue presented., Results: Forty study subjects (14 males and 26 females) aged 55 to 95 years (mean 79.45 years, SD 8.82) were recruited. Thirty similar subjects were recruited for a control group. Red on white estimates were better than for other colours and related best to standard black on white ETDRS estimates (20/121 vs 20/132, respectively). Also, red on white estimates seem not to be affected by age. Estimates for colour detection for the control group were not different among colours tested and were not affected by age., Conclusions: Ranking abilities according to the MAR required to identify a hue can serve as a quantifying measure for residual colour vision. Our findings reflect functional abilities rather than psychophysical measurements., (Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Objective: To compare chromatic and achromatic potential visual acuity (PVA) in patients with bilateral low vision caused by age-related macular degeneration (AMD)., Design: Prospective, nonrandomized, observational case series., Participants: Fifty-five patients, representing a consecutive series of patients all presenting with bilateral AMD., Methods: Best-corrected visual acuity of each eye was measured using an Early Treatment in Diabetic Retinopathy Study (ETDRS) chart with appropriate near correction. Included were cases with visual acuity of 0.4 logMAR (20/50) or worse in both eyes. Achromatic and chromatic PVA were measured in each eye using white on black and red on yellow flooding E charts at 50 cm in controlled lighting conditions., Results: One hundred and seven eyes from 55 patients were included in the analysis. Mean achromatic and chromatic PVA were 0.69 ± 0.26 and 0.65 ± 0.22 logMAR, respectively. Overall, patients had a significantly higher chromatic than achromatic PVA, with a median difference of 0.1 logMAR (p<0.05). Patients with ETDRS visual acuity worse than 0.9 logMAR also had a significantly higher chromatic than achromatic PVA, with a median difference of 0.1 logMAR (p<0.05). Patients with ETDRS visual acuity between 0.4 and 0.9 logMAR had a trend toward a higher chromatic than achromatic visual acuity that was not significant, with a median difference of 0.1 logMAR (p = 0.8539)., Conclusions: Patients with low vision caused by AMD can discern smaller targets when a red on yellow colour scheme is used than when using achromatic white on black charts., (Copyright © 2013 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

To determine the efficacy of prisms used for redirection of incoming images towards the peripheral retina in cases with macular function loss. Meta-analysis of published work reporting outcomes from interventions using prisms was performed. The primary outcome measure selected for analysis was visual acuity (VA) used for viewing distance targets. Pooled data from 449 cases where prisms were prescribed for wearing in distance glasses were analysed. Visual acuity was better after using prisms (1.05 versus 0.89 logMAR units, p < 0.044). Mean effect size for improving VA was 79 bigger than the effect size calculated for the control group (0.158 versus 0.002). Most patients (76%) reported compliance with the therapy and also reported other benefits directly derived from the realized VA improvement. Published studies collectively offer positive evidence in support of using prisms for low vision rehabilitation after macular function loss. Further research is required to reach definitive binding conclusions., (© 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.)

Objective: To clarify the efficacy of the macular mapping test (MMT) to identify eccentric fixation with preferred retinal loci (PRL)., Design: Retrospective observational case series from archived data., Participants: Cases with age-related macular degeneration with low vision in both eyes and best corrected visual activity (BCVA) of 20/50 to 20/400 in the better eye., Methods: Identification of preferred retinal loci with the Nidek MP-1 microperimeter and correlation with scotoma displacement on perimetry records as recorded with the MMT., Results: We recruited data on 43 patients (12 males and 31 females), aged 57-96 years (mean 84.05 years ± SD 8.00). Mean BCVA was 0.9 ± 0.32 SD logMar units (20/160). PRL location matched the direction of scotoma displacement in 32 study subjects (74.41%, p < 0.002)., Conclusions: Scotoma displacement recorded with the MMT offers reasonable indirect estimates on PRL location., (Copyright © 2012 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

This paper presents the case of a 47-year-old female with low vision secondary to high myopic macular degeneration who remains active in the work force as a spiritual and religious care coordinator for a large institution. An ophthalmologist with a specialty in low vision rehabilitation initially assessed the client. The ophthalmologist prescribed optical devices which used residual retinal vision available at preferred retinal loci. This availed better vision for viewing targets located at far, near and intermediate distances from the client. An optician provided and dispensed the devices prescribed to the client. Additionally, the ophthalmologist made a referral to an occupational therapist. The occupational therapist conducted a series of sessions to further enhance reading and writing skills and a work place assessment aimed at optimizing workplace conditions in order to achieve optimal functional vision. This case illustrates and emphasizes the multi-disciplinary nature of low vision rehabilitation, which involved in this case co-operation between ophthalmology, occupational therapy and opticianry., (© 2011 - IOS Press and the authors. All rights reserved)