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Previous research has shown that visual impairment results in reduced audio, tactile and proprioceptive ability. One hypothesis is that these issues arise from inaccurate body representations. Few studies have investigated metric body representations in a visually impaired population. We designed an ecologically valid behavioural task in which visually impaired adults haptically explored various sized gloves or shoes. They were asked to indicate if they perceived each clothing item as bigger than the size of their hand or foot. In the post-hoc analyses we fit psychometric curves to the data to extract the point of subjective equality. We then compared the results to age/sex matched controls. We hypothesized the blind participants body representations should be more distorted. Because previous research has shown that females are more likely to overestimate body size, we predicted sex differences in the sighted participants. However, because blind adults have no exposure to visual ideals of body size, we predicted that there would be no sex differences. Our results showed thatblind participants overestimated their hands and feetto a similar degree. Sighted controls overestimated their hands significantly more than their feet. Taken together, our results partially support our hypothesis and suggest that visual deprivation, even for short periods result in hand size overestimation., Competing Interests: Declaration of competing interest 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., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: The present study aimed to identify factors associated with self-perceived oral health (SPOH) in Iranian visually impaired (VI) adolescents aged 10-19., Methods and Materials: This cross-sectional study was conducted on 90 VI adolescents of Mashhad, Iran, in 2023. We collected socio-demographic information and details about oral health behavior, SPOH, and self-perceived general health (SPGH) through a questionnaire. Furthermore, we used the DMFT index to determine the oral health status. The data were analyzed using a chi-square test and binary logistic regression., Results: The prevalence of poor SPOH and SPGH were 67.8% and 85.6%, respectively. We found positive correlations between poor SPOH and various factors, including poor SPGH (p = 0.002), exposure to second-hand smoke (p= 0.01), irregular toothbrushing (p = 0.048), last dental appointment within the past year (p=0.033), poor SPGH, and high DMFT index (p = 0.002)., Conclusion and Discussion: SPOH could serve as an indicator to assess an individual's oral health behavior and treatment needs. We also revealed an association between poor SPOH and poor SPGH, highlighting the importance of giving more attention to oral health to increase general health.

Mobile ICT, such as smartphones and tablets, has become integral for everyday tasks like finance, communication, and entertainment. While these technologies offer significant opportunities for integration and combating loneliness, visually impaired individuals still face challenges. These include practical barriers due to poor universal design, motivational hurdles, and inadequate lifelong education. In this paper, we aim to identify both the motivational and educational facilitators, as well as the technical and societal inhibitors, to digital skill development in mobile ICT among visually impaired individuals. Our approach involved participating as silent observers in an IT course for visually impaired users. Our study underscores that visually impaired individuals value mobile ICT for enhancing their daily lives. We identify opportunities, including key motivations to learn about ICT, and compile a list of useful apps and devices for visually impaired people. Simultaneously, we identify challenges related to technical and universal design, competence and societal issues, motivation, and attitudes, as well as security, privacy, and fraud concerns.

Connected and autonomous vehicles (CAVs) will greatly impact the lives of individuals with visual impairments, but how they differ in expectations compared to sighted individuals is not clear. The present research reports results based on survey responses from 114 visually impaired participants and 117 panel recruited participants without visual impairments, from Germany. Their attitudes towards autonomous vehicles and their expectations for consequences of wide-spread adoption of CAVs are assessed. Results indicate significantly more positive CAV attitudes in participants with visual impairments compared to those without visual impairments. Mediation analyses indicate that visually impaired individuals' more positive CAV attitudes (compared to sighted individuals') are largely explained by higher hopes for independence, and more optimistic expectations regarding safety and sustainability. Policy makers should ensure accessibility without sacrificing goals for higher safety and lower ecological impact to make CAVs an acceptable inclusive mobility solution.

Being visually impaired or legally blind (having vision that is uncorrectable or cannot be corrected to a legally acceptable level) is inherently uncertain. Although uncertainty can result in positive, negative, or neutral consequences, little is known about how uncertainty is experienced and negotiated in this understudied population. Thus, through in-depth, semi-structured interviews of 24 individuals with a visual impairment, we apply uncertainty management theory (UMT) to examine the communication strategies visually impaired individuals used to manage the personal, vision-related, and social uncertainty they experienced. Many participants appraised the uncertainty negatively and consequently aimed to reduce it by seeking social support and information, using instrumental strategies, and proactively disclosing their visual impairment. Interviewees who preferred to remain uncertain maintained it by avoiding thinking about their visual impairment or worsening vision and/or by concealing their low vision and passing as sighted. Last, some participants, particularly those who were born with low vision or had been visually impaired longer, learned to adapt to the uncertainty through reframing and accepting, self-care, and by turning to God. The study also uncovered that some participants' uncertainty management was limited by ableist constraints, such as inadequate support systems, systemic barriers, and stigma. The study also underscores the universal and fluid nature of uncertainty and uncovers tangible ways individuals with visual impairment can navigate uncertainty within a pervasive cultural biomedical model of disability.

Echolocation is a vital method of spatial orientation for many visually impaired individuals who are willing to and able to learn it. Blind echolocators use a variety of sounds, such as mouth clicks, cane taps, or specialized sound-emitting devices, to perceive their surroundings. In our study, we examined the effectiveness of several different sounds used in echolocation by conducting trials with 12 blind and 14 sighted volunteers. None of the participants had received formal training in echolocation, though a number identified as self-taught experts. The sounds tested included those played from a loudspeaker, generated by a mechanical clicker, or made by the participants themselves. The task given to the participants was to identify the direction and distance to an obstacle measuring 1x2 meters in an outdoor environment, with the obstacle placed in one of nine possible positions. Our findings indicated that the blind participants displayed significantly better echolocation skills when compared to the sighted participants. The results of the blind participants were also strongly divided into two distinct subgroups-totally blind participants performed much better than those which were legally blind, but had some residual vision. In terms of sound comparisons, we found that sounds with a center frequency near 3-4kHz and a wide spectrum provided higher accuracy rates than those with lower frequency peaks. Sighted participants performed best with 3kHz and 4kHz percussion sounds, while the blind group performed best with blue and pink noise. The loudspeaker generated tones generally yielded better results than those generated by the participant (using a mechanical clicker, mouth clicks or hand claps). These results may be useful in developing training programs that teach echolocation as well as artificial sounds to improve echolocation effectiveness., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bujacz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Significance: Low vision is a public health priority disability condition. People with this condition face multiple types of discrimination in a society that is not accustomed to diversity., Purpose: This study aimed to describe the life experience of people with low vision from an intersectional perspective in Medellín, Colombia., Methods: A qualitative ethnographic case study was conducted, considering the intersectional perspective as an analytical element to comprehend the everyday experience of people with low vision. Twenty-nine interviews were conducted with 10 participants, along with 16 participant observation exercises in their daily lives, with prior informed consent., Results: Participants experienced discrimination due to their visual condition, which had negative implications for the development of their life projects. Three categories emerged: Discrimination in everyday contexts: ocularcentrism, gender challenges in the lives of people with low vision, and challenges in seeking vision rehabilitation services., Conclusions: The results of the study show that people experience discrimination, exclusion, and stigmatization in their daily activities, which vary according to the traditionally assigned roles of gender, social class, age, and educational level, among others. Given the complexity of the experience, it is important for health and visual rehabilitation professionals to broaden their perspective and transition toward vision rehabilitation models that address the various dimensions affected by this condition., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2024 American Academy of Optometry.)

Purpose: This study aimed to evaluate the perception and degree of satisfaction of blind individuals regarding an electronic cane prototype with a wearable haptic interface., Methods: Two scenarios with different obstacles were created to conduct tests with the canes (the user's cane and the prototype one). The perception and satisfaction of participants regarding the electronic cane were assessed using a questionnaire, the number of collisions during the tests, and the time each individual took to complete the course in each scenario., Results: Ten blind individuals who used the white cane participated in this study. Eight were males, and two were females. Their age ranged from 23 to 43 (average 32.3 ± 7.13 years and median 32 years). There was a tendency for fewer collisions with ground obstacles when the electronic cane was used than when the white cane was used. However, there was no statistically significant difference between the number of collisions and the course completion time in each scenario with either canes tested., Conclusion: Overall, the perception and satisfaction of individuals regarding the prototype used were positive.

Few studies have focused on people with hearing loss and intellectual disabilities engaging in gambling activities. However, people with visual impairments' energetic participation in sports betting activities is unexplored. This article highlights sports betting strategies of visually impaired students to understand how their motives affect their gambling behaviours as an alternative to their survival. Six male adults aged between 27 and 40 years participated using semi-structured interviews, which were conducted face-to-face, recorded, transcribed, and thematically analysed with the Braun and Clarke model. Findings show that sports betting prevails in communities fostering peer persuasion including family relations serving as an inducer for visually impaired students. Their strategies are varied including the fewer the better concept based on teams' selection dynamics. While they are inspired by potential economic gains, some recognise it as acquiring entrepreneurial skills because of risk-taking, thus asymmetry and disconnected. The article recommends stakeholders' education to provide better policies that can remind them to bet for leisure or desist from gambling., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To evaluate associations between visual impairment, anxiety, and depression during the COVID-19 pandemic in the US., Design: Retrospective cross-sectional METHODS: This study included a cohort of US adults enrolled in the National Institute of Health All of Us Research Program. Individuals who were blind/visually impaired (BVI) were identified via SNONMED codes and compared to a control cohort. Prevalence of baseline, new, and worsened depression and anxiety, as defined by SNONMED codes and medication use were compared between the two groups. Anxiety and depression during the COVID-19 pandemic were evaluated using the Generalized Anxiety Disorder 7 and the Patient Health Questionnaire 9 survey, respectively., Results: 324,915 participants, (7,526 BVI individuals and 317,389 controls) were included. BVI individuals had higher prevalence of baseline anxiety and depression (50.4% vs. 28.7%, p<0.001), new anxiety and depression (0.98% vs. 0.66%, p<0.001), and worsened anxiety and depression throughout the COVID-19 pandemic (0.19% vs. 0.07%, p<0.001) compared to controls. Being BVI was significantly associated with baseline and worsened anxiety and depression, after controlling for age, gender, race, ethnicity, and comorbidity (adjusted odds ratio (aOR)=1.61; 95% CI 1.46-1.78, aOR=2.07; 95% CI 1.03-4.13). Similarly, being BVI was associated with a 2.07-point increase on the GAD-7 survey (adjusted beta=2.07; 95% CI 1.32-3.27) and a 2.96-point increase on the PHQ-9 survey (adjusted beta=2.96; 95% CI 1.64-5.36)., Conclusions: These findings indicate that BVI individuals are disproportionately affected by anxiety and depression at baseline and throughout the pandemic, highlighting an important need to promote access to mental health services among this population., (Copyright © 2022 Canadian Ophthalmological Society. All rights reserved.)

Background: It is well established that meeting physical activity (PA) guidelines has a range of physical and mental health benefits. For people who are blind and vision impaired (BVI) there may be additional benefits in terms of social inclusion and the prevention of sight deterioration., Objective: This study aimed to quantify PA levels, barriers to and motivators for PA in adults who are BVI., Methods: PA levels, perceived barriers to, and motivators for PA were measured via questionnaire of 310 self-identifying BVI adults (n = 310 mean age = 29.77 ± 11.37, 55.8% male)., Results: PA levels were low, with 21.7% meeting PA guidelines. Median PA levels were not statistically significantly different between different age groups. There was no significant difference between genders, though mean days of PA for males was 0.382 days lower than for females. There was a significant difference between PA levels between the "no vision" (B1) and "useful vision" (B3) groups (p = 0.027), and the "no vision" (B1) and the "low vision" (B2) groups (p = 0.003). Transport (54.8%) and lack of access to enjoyable activities (47.0%) were the most commonly cited barriers, while "to relax" (36.4%) and "to have fun" (35.6%) were most commonly cited as very important motivators., Conclusions: This study provides a valuable insight into the low levels of PA that persist amongst adults with BVI. Future research should seek to gain a deeper understanding of the PA barriers, motivators and facilitators in this cohort., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Visual impairment has been strongly associated with the incidence of dementia. Appropriate cognitive screening for the elderly with visual impairment is crucial for early identification of dementia and its management. Due to challenges in processing visually presented stimuli among participants, the cut-off score of the Hong Kong version of the Montreal Cognitive Assessment for the Visually Impaired (HKMoCA-VI), also known as MoCA-BLIND or MoCA-22, was unknown. Besides, the cognitive status of elderly with visual impairment residing in care homes is rarely investigated. The current study aimed to 1) establish the cut-off score for HKMoCA-VI and 2) examine the general cognitive functioning of elderly with visual impairment living in residential homes in Hong Kong in terms of MoCA-VI percentile scores., Method: HKMoCA-VI and the Cantonese version of the Mini-Mental State Examination (CMMSE) were administered to 123 visually impaired elderly residents in care homes in Hong Kong. Percentile scores of HKMoCA-VI by age and education level were determined, and the concurrent validity, sensitivity, and specificity of HKMoCA-VI were assessed., Results: A cut-off score 12 was suggested for HKMoCA-VI, which yielded a sensitivity and specificity of 89.29% and 83.58%, respectively. Moreover, it strongly correlated with CMMSE, indicating satisfactory concurrent validity., Conclusions: HKMoCA-VI is suggested to be a viable cognitive screening tool for elderly individuals with visual impairment in residential homes. Further modifications to enhance the sensitivity and specificity of the measure are proposed., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Yip et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: Bioptic telescopic spectacles can allow individuals with central vision impairment to obtain or maintain driving privileges. The purpose of this study was to (1) compare hazard perception ability among bioptic drivers and traditionally licensed controls, (2) assess the impact of bioptic telescopic spectacles on hazard perception in drivers with vision impairment, and (3) analyze the relationships among vision and hazard detection in bioptic drivers., Methods: Visual acuity, contrast sensitivity, and visual field were measured for each participant. All drivers completed the Driving Habits Questionnaire. Hazard perception testing was conducted using commercially available first-person video driving clips. Subjects signaled when they could first identify a traffic hazard requiring a change of speed or direction. Bioptic drivers were tested with and without their bioptic telescopes in alternating blocks. Hazard detection times for each clip were converted to z-scores, converted back to seconds using the average response time across all videos, and then compared among conditions., Results: Twenty-one bioptic drivers and 21 normally sighted controls participated in the study. The hazard response time of bioptic drivers was improved when able to use the telescope (5.4 ± 1.4 seconds vs 6.3 ± 1.8 seconds without telescope); however, it remained significantly longer than for controls (4.0 ± 1.4 seconds). Poorer visual acuity, contrast sensitivity, and superior visual field sensitivity loss were related to longer hazard response times., Conclusions: Drivers with central vision loss had improved hazard response times with the use of bioptic telescopic spectacles, although their responses were still slower than normally sighted control drivers., Translational Relevance: The use of a bioptic telescope by licensed, visually impaired drivers improves their hazard detection speed on a video-based task, lending support to their use on the road.

Significance: Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town., Purpose: Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors., Methods: Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state., Results: During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009)., Conclusions: Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town., Competing Interests: Conflict of Interest Disclosure: There are no relevant financial conflicts of interest for any author. The sponsor provided funding but was not involved in the study design, conduct, analysis, or manuscript preparation. The authors had access to and control of the data in this study. The authors were responsible for preparation of this manuscript and the decision to submit this article for publication. Each of the authors had full access to the study data and take full responsibility for their presentation in this article., (Copyright © 2024 American Academy of Optometry.)

Purpose: The main objective of this study is to assess the test-retest and inter-administration mode reliability of the Impact of Vision Impairment profile (IVI), a common patient-reported outcome measure (PROM) for people with chronic eye diseases., Methods: The IVI was administered to adult patients with stable, chronic eye diseases two to four times per participant (average intervals between administrations 12 to 20 days; maximum two phone interviews, paper administration, electronic administration) by two trained interviewers. Rasch models were fit to the data. Intra-class correlation coefficients (ICCs), mean differences and Cronbach's alpha between test-retest administrations (two phone interviews) and inter-mode comparisons were calculated., Results: Two hundred-sixteen patients (mean age 67 ± 12 years, 40% male) were included in the study. The IVI met all psychometric requirements of the Rasch model, and the division into the domains of functional items (IVI&#95;F) and emotional items (IVI&#95;E) corresponded to the German validation study. ICCs (all for IVI&#95;F and IVI&#95;E, respectively) for the retest administrations were 0.938 and 0.912, and 0.853 and 0.893 for inter-mode comparisons phone/paper, 0.939 and 0.930 for phone/electronic, and 0.937 and 0.920 for paper/electronic (all p < 0.01). Mean differences (all for IVI&#95;F and IVI&#95;E, respectively) for the retest administrations were 2.8% and 0.7% and ranged from 2.0% to 6.2% and from 0.4 % to 4.9% between administration modes. Cronbach's alpha ranged from 0.886 to 0.944 for retest and inter-mode comparisons., Conclusion: Due to the high test-retest reliability and the almost equally high comparability of different modes of administration of the IVI, the study endorses its use as a robust PROM to capture vision-related quality of life. Our results further support the use of the IVI as an endpoint in clinical trials and may simplify implementing it in both clinical trials or real-world evidence generation by offering multiple administration modes with high reliability., (© 2024. The Author(s).)

Significance: Autonomous vehicles (AVs) have the promise to be an alternative transportation solution for those with vision loss. However, the impact of vision loss on the perceptions and concerns of AVs is unknown. This study therefore examined whether AVs are perceived differently by blind, visually impaired (VI), and normally sighted people., Purpose: This study compared the perceptions of AVs among the blind, VI, and normally sighted., Methods: Participants' opinions on four perception measures (general opinion, trust, impact on quality of life, and intention to use AVs) and nine concerns regarding AVs were measured. The survey was administered to 51 normally sighted, 68 VI, and 65 blind participants. Analyses of covariance assessed whether the four perception measures and nine concerns varied by vision status (normal vision, VI, blind) and driving status (driver, nondriver). Univariate correlations and multiple regression analyses identified associations and predictors of AV perceptions and concerns from demographic, mood, cognition, travel behavior, and vision measures, which included visual acuity, contrast sensitivity, and visual field., Results: The blind (p<0.001), VI (p<0.001), and nondrivers (p<0.001) showed a greater intention to use AVs compared with those with normal vision and drivers. Similar findings were found for the other perception measures. As visual acuity, contrast sensitivity, and visual field extent declined, positivity toward AVs increased (p<0.001). Visual field extent best predicted general opinion and trust in AVs, whereas driving measures were the best predictors of impact on quality of life and intention to use AVs. Concerns about AVs showed no differences based on vision (p=0.94) or driving (p=0.63) status., Conclusions: Individuals with vision loss expressed more acceptance of AVs despite their concerns. How positive someone is toward AVs appears to be dependent on their visual field extent and driving status., Competing Interests: Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest., (Copyright © 2024 American Academy of Optometry.)

Visual stimuli play key roles in influencing men sexual behavior. However, few studies have explored the sexual behavior of blind men. To provide more information about blind men for the study of andrology by surveying the characteristics of their current sexual behavior. A questionnaire-based cross-sectional study design was performed. The questionnaire contained questions regarding demographic characteristics of participants, access to sexual knowledge, perception of the sexual partners' beauty, and sexual arousal. Blind men were interviewed face-to-face by the trained investigator. Complete questionnaires were collected from 54 participants, with an average age of 40.57 ± 9.80 years old. Eye diseases were the most frequent cause of blindness. In terms of sexual orientation, all participants were heterosexual. Notably, 90.7% of the participants reported to have had a sexual experience. Among those who had engaged in sexual behavior, 93.6% experienced sexual pleasure and 69.4% had a normal erectile function. Overall, 16.7% of the participants received sex education. The participants obtained sexual knowledge mainly through sounds from mobile phones, peer-to-peer communication, sounds of television and radio. Voice was the most frequent perception of the sexual partners' beauty, followed by figure, skin, and body fragrance. In terms of stimuli of sexual arousal, tactile sensation and auditory sensation in that order were the most frequent stimuli of sexual arousal. Stimuli of sexual arousal in blind men are mainly mediated by sound and touch. Blind men understand their sexual partners' beauty through auditory, tactile, and olfactory sensations. Blind men in Ganzhou lack formal and systematic sex education., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: This study examined how ableism influences blind and visually impaired women's experiences accessing and engaging in exercise, physical activity, and sport., Methods: Ten women between the ages of 27 and 45 years completed a one-on-one audio-recorded virtual interview where they reflected on the meaningfulness of their exercise, physical activity, and/or sport experiences, as well as described any experiences related to direct, indirect, systemic, or internalized ableism within or when attempting to access those physical activity experiences. The interview transcripts were analyzed using reflexive thematic analysis., Findings: The analysis resulted in the construction of 2 themes that depicted the participants' experiences: (1) "It's exhausting": navigating inaccessibility and (2) "You feel like a fish out of water": internalized ableism., Discussion: The themes highlight the participants' experiences which were largely focused on being forced to navigate inaccessible environments which resulted in exhaustion and expressions of internalized ableism. These findings provide insight into what makes and does not make a physical activity space accessible and welcoming for blind and visually impaired adults.

In this paper, we analyze the subjective inclusion experiences of visually impaired (VI) adult tennis players from an ableism-critical perspective. The primary focus of this research is the inclusive potential of blind tennis from the perspective of VI individuals. Episodic interviews were conducted to capture subjective perspectives. A qualitative text analysis revealed that the interviewees were confronted with multiple ability assumptions by sighted people in their everyday lives. Deficit notions on the performance of VI people included sports, work, and general activities. Participation in blind tennis helped the interviewees build a "competent identity" and acquire various skills useful for their everyday lives as participation in blind tennis was a pathway for competence in sports. Further research is needed to identify exclusion experiences from the perspective of disabled people to recognize the potential of different sports in reducing barriers to participation.

The article, based on an online survey of 433 blind and visually impaired people aged 65-94 years conducted in 10 regions of the Russian Federation, states that, in general, older visually impaired people are more satisfied with life than dissatisfied. However, the level of satisfaction is mediated by the level that they have and their socio-typological well-being - general, socio-demographic plans, and typical, typhlological ones, in the light of which the corresponding predictors of satisfaction are discovered. In terms of disability, all major categories of life activity are reflected as such outstanding abilities. In the context of the socio-demographic characteristics of elderly visually impaired people, predictors of their satisfaction with life are the stage of old age at which blind or visually impaired people find themselves, involvement in family and household relationships, high educational status, continuation of employment, including in the system of the Association of the Blind, the presence of hobbies and financial situation, and in terms of typhological characteristics - the age period when the disabling impairment of visual functions arose, the preservation of residual vision in case of blindness, as well as the experience of undergoing a rehabilitation course.

Objective: Pain evaluation scales often rely on the sense of sight. There is so far no pain assessment scale designed specifically for persons with visual impairment., Design: This study aims to validate a tactile pain evaluation scale, Visiodol (Copyright Prof Pickering), in blind or visually impaired persons, by correlation with a numeric pain scale., Setting: The study took place at University Hospital Clermont-Ferrand, France., Methods: Pain intensity for a range of thermal stimuli (Pathway Medoc) was evaluated with Visiodol and a numeric pain scale. Secondary outcomes, including pain thresholds, catastrophizing, emotion, and quality of life, were compared in persons who were blind or visually impaired and in sighted persons. Lin's concordance correlation coefficient was estimated. Weighted Cohen's κ accounted for degrees of disagreement between scales with 95% confidence intervals (95% CI)., Subjects: Sixteen healthy sighted and 21 healthy nonsighted volunteers (n = 13 congenital, n = 8 acquired) were included., Results: Lin's correlation coefficient for repeated data was 0.967 (95% CI, 0.956-0.978; P < 0.001) for visually impaired participants, with a good agreement at each temperature plateau. A weighted Cohen's κ of 0.90 (95% CI, 0.84-0.92) and 92.9% percentage of agreement for visually impaired participants were satisfactory. Pain perception, psychological components, and quality of life were more impaired in persons who were blind or visually impaired than in sighted persons., Conclusions: This study validates Visiodol, a tactile scale for persons who are blind or visually impaired, and addresses health care inequalities in the context of pain evaluation. Visiodol will now be tested in a larger population of patients to give the millions of persons worldwide who are blind or visually impaired an option for pain intensity evaluation in clinical situations., Trial Registration: French National Agency for the Safety of Medicines and Healthcare Products (2018-A03370-55) and www.ClinicalTrials.gov (NCT03968991)., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: To study the mental health status of patients with visual impairment in a tertiary institution in Southwestern Nigeria., Objectives: To determine the mental health status of individuals with loss of vision in Ogbomoso and associated factors., Methodology: A descriptive cross-sectional study. Questionnaires were administered to obtain information on the socio-demographic characteristics and mental health status. Test for association was done. A total score greater than or equal to 4 out of the 28 items of the General Health Questionnaire was considered a case of mental ill-health., Results: 250 subjects were studied, out of which 126 (50%) were found to have mental ill-health. Statistically significant association was found between age, level of education, occupation, duration of loss of vision, and pattern of loss of vision (p-values < 0.001, 0.020, 0.001, and 0.001 respectively) in bivariate analysis, however, age and pattern of vision loss were not significantly associated with loss of vision in multivariate analysis. Those who lost their vision less than two years from the time of the study had a higher risk of mental health morbidity. Those with sudden vision loss were 3.48 times more likely to have mental health morbidity in bivariate analysis, compared with those with progressive visual loss., Conclusion: The prevalence of mental ill-health among people with vision loss is high. Associated factors included level of education, occupation and duration of loss of vision. Predictors of good mental health included younger age group, higher level of education, being employed, longer duration of loss of vision and progressive pattern of vision loss., Competing Interests: The Authors declare thatno competing interest exists, (Copyright © 2023 by est African Journal of Medicine.)

Older adults are likely to develop adverse drug events owing to age-related changes in pharmacokinetics and polypharmacy. In terms of pharmacokinetics, the drug should be prescribed at a reduced dose, which should be reconsidered and reduced during long-term use. For polypharmacy, "List of drugs to be prescribed with special caution" should be referred and deprescription should be practiced in consideration of the priority of treatment. Because older adults often show reduced ability to manage their medication due to cognitive dysfunction, low visual acuity, and hearing loss, measures should be taken to maintain their adherence.

Emotion regulation develops from the earliest years of a child's life and mostly through visual information. Considering the importance of emotion regulation in daily life situations, it is important to study the effect of visual experience on the development of this ability. This study is the first to examine the effect of visual experience and age in emotion regulation by comparing groups of children with different visual status and age. For this purpose, after testing the reliability and consistency of the French version of Emotion Regulation Checklist (ERC-vf) with 245 parents of blind, visually impaired and sighted children aged 3-5, 6-8 or 9-12 years, we conducted analyses on the effect of visual status and age on emotion regulation composite scores. The first result confirmed that the ERC-vf can be reliably used on populations of blind and visually impaired children. The second result revealed an effect of visual status on ER composite scores of emotion regulation: Blind children and visually impaired children each had significantly lower composite scores than sighted children. Moreover, the effect of age and the interaction between age and visual status were not significant on ER composite scores. The ER subscale results suggest, however, that age may have a variable effect for blind and visually impaired children as blind children's scores become lower and those of visually impaired children become equal to sighted children with age. The results of our study may help the children's entourage to better adapt their interactions in a context of visual impairment., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

In this paper, we wanted to verify the hypothesis that extruding cartographic symbols on tactile maps to different heights might allow reducing the minimum (suggested in the literature) horizontal distances between them, without impacting the overall map's legibility. This approach might allow preparing tactile maps in smaller scales and thus, reducing production cost, or putting additional spatial information on the same map sheet that would not fit otherwise. To verify the hypothesis we have prepared 6 different stimuli variants with or without height differentiation applied and different horizontal distances between tactile symbols adopted (1 mm, 2 mm and 3 mm). In the controlled study sessions with 30 participants with visual impairments we have measured the times required for solving 3 different spatial tasks on 3D printed tactile stimuli. We have also performed qualitative analysis to learn participants' opinions about the proposed design and materials used. It turns out that applying height differentiation not only results in shorter times required for solving spatial tasks but is also considered by blind individuals as a convenient improvement in terms of use comfort and allows reduction of recommended minimum horizontal distances between symbols on tactile maps., Competing Interests: The authors have declared that no competing interests exist.

Purpose: An attachment theory framework approach may allow insight into how social and psychosocial factors interact to impact vision-related quality of life (QoL). In this pilot study, we investigated potential associations between adult attachment style and visual function QoL of visually impaired individuals., Methods: We recruited 38 visually impaired individuals (15 females, 23 males; 51.8 ± 16.0 years). Visual function measures included distance and near visual acuity (VA) and contrast sensitivity. All participants completed: the 25-item National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ 25) and the Experiences in Close Relationships-Relationships Structures questionnaire., Results: Presenting conditions included inherited retinal dystrophy (n = 10), nystagmus (n = 9), glaucoma (n = 7) and other eye conditions (n = 12). There was a statistically significant negative correlation between the NEI-VFQ-25 composite score (45.5 ± 14.7) and attachment-related anxiety (r = -0.352, p = 0.033). The latter correlation still held when controlling for participants' level of vision (r = -0.352, p = 0.035). Despite the range of conditions and wide age range, these were not significantly correlated with any variable of interest in the current study., Conclusion: Attachment-related anxiety ought to be taken into account when managing a visually impaired individual. Attachment-based approaches could be used to improve access to support services for visually impaired individuals, as well as self-management of their condition.

Background: Knowledge about self-efficacy and its significance for the quality of life of people with visual impairment is lacking. The aims of the study were to compare general self-efficacy in individuals with visual impairment with the general population, and to investigate the association between self-efficacy and life satisfaction., Methods: A telephone-based cross-sectional survey was conducted between January and May 2017 in a probability sample of adults who were members of the Norwegian Association of the Blind and Partially Sighted. Participants were asked questions about their sociodemographic characteristics, characteristics of vision loss, general self-efficacy (General Self-efficacy Scale), and life satisfaction (Cantril's Ladder of Life Satisfaction). We obtained norm data from a representative survey of the general Norwegian population (N = 1792; mean age 53.2 years; 52.5% females)., Results: People with visual impairment had higher levels of general self-efficacy than people in the general population (Mean: 31.5 versus 29.0, p < .001). Results from linear regression analyses of the visual impairment population showed that higher education and residential in an urban municipality were associated with higher self-efficacy. Having additional impairments and a previous history of physical or sexual assaults were associated with lower self-efficacy. A linear dose-response relationship was found between self-efficacy and life satisfaction, in the visual impairment population as well as in the general population., Conclusions: People with visual impairment have higher self-efficacy than people in the general population, possibly due to extensive mastery experience in how to handle life as visually impaired. Self-efficacy seems to be important in achieving the best possible life., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Research grants from the European Commission and research grants from the Norwegian Association of the Blind and Partially Sighted. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Objective: To explore feasibility of using child/young person patient-reported outcome measures (PROMs) routinely in practice, using vision-specific instruments and paediatric ophthalmology as the exemplar., Methods: Participants comprised patients aged 8-17 years, with visual impairment or low vision (visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.3 in the better eye), attending the Department of Ophthalmology at Great Ormond Street Hospital, London, UK. All participants completed age-appropriate PROMs before attending their outpatient appointment. Half were randomly assigned to completion at home, with the choice of paper-and-pencil or electronic format. The other half were invited to complete PROMs during their hospital appointment, and randomly assigned to completion format. All participants completed a face-to-face survey exploring their attitudes and preferences. Analysis comprised survival analysis, and direct comparisons of proportions, with complementary qualitative data analysis., Results: 93 patients participated. 48 (98%) completing PROMs at home chose the paper-and-pencil format. Completion at home took longer than at hospital (median=20, vs 14 min, p<0.001). Visual acuity was associated with completion time (p=0.007) and missing data (p=0.03). Overall, 52 (60%) reported a preference for completion at home but there was no clear preference for format (37 (43%) preferred either format)., Conclusion: PROM completion at home ahead of hospital appointments may be preferable for collecting complete, high-quality datasets. Despite equipoise on preference for format, the majority of those completing at home chose the traditional paper-and-pencil format, despite impaired sight. These findings should inform implementation of child/young person PROMs into routine practice., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of this study was to examine caregiving relationships for older adults with vision impairment (VI)., Design: Cross-sectional study with a nationally representative sample., Methods: Setting: the National Health and Aging Trends Study linked to the National Study of Caregiving, Year 2011., Study Population: 1,776 family or unpaid caregivers to community-dwelling Medicare beneficiaries age ≥65 years old., Outcome Measurement: in the preceding month, 1) the number of hours of care provided; 2) the valued activities affected by caregiving; and 3) the odds of experiencing substantial emotional, financial, and physical difficulty related to providing care., Exposure: VI was defined as a report of blindness or difficulty with distance or near vision., Results: Among 1,776 caregivers, 428 caregivers spent an average ± standard error (SE) of 111 ± 9.1 hours per month assisting older adults with VI, whereas 1,348 spent an average of 72 ± 3.3 hours assisting older adults without VI. In fully adjusted negative binomial regression analyses, caregivers of older adults with VI spent 36% more hours (incident rate ratio [IRR]: 1.36; 95% confidence interval [CI]: 1.15-1.60) providing care and reported having 61% more valued activities affected (IRR: 1.61; 95% CI: 1.23-2.10) than caregivers of older adults without VI. In fully adjusted logistic regression analyses, caregivers of older adults with VI had greater odds of emotional (odds ratio [OR]: 1.46; 95% CI: 1.04-2.03) but not financial (OR: 1.33; 95% CI: 0.87-2.03) or physical (OR: 1.13; 95% CI: 0.74-1.74) difficulty related to providing care than caregivers of older adults without VI., Conclusions: These results suggest that caring for older adults with VI places different demands on time and emotional wellbeing than caring for older adults without VI, but no differences in financial or physical difficulties., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Understanding the factors that determine if a person can successfully learn a novel sensory skill is essential for understanding how the brain adapts to change, and for providing rehabilitative support for people with sensory loss. We report a training study investigating the effects of blindness and age on the learning of a complex auditory skill: click-based echolocation. Blind and sighted participants of various ages (21-79 yrs; median blind: 45 yrs; median sighted: 26 yrs) trained in 20 sessions over the course of 10 weeks in various practical and virtual navigation tasks. Blind participants also took part in a 3-month follow up survey assessing the effects of the training on their daily life. We found that both sighted and blind people improved considerably on all measures, and in some cases performed comparatively to expert echolocators at the end of training. Somewhat surprisingly, sighted people performed better than those who were blind in some cases, although our analyses suggest that this might be better explained by the younger age (or superior binaural hearing) of the sighted group. Importantly, however, neither age nor blindness was a limiting factor in participants' rate of learning (i.e. their difference in performance from the first to the final session) or in their ability to apply their echolocation skills to novel, untrained tasks. Furthermore, in the follow up survey, all participants who were blind reported improved mobility, and 83% reported better independence and wellbeing. Overall, our results suggest that the ability to learn click-based echolocation is not strongly limited by age or level of vision. This has positive implications for the rehabilitation of people with vision loss or in the early stages of progressive vision loss., Competing Interests: The authors have declared that no competing interests exist.

Objectives: The objective of this study was to offer an overview of literature relating to the topic of arts as activity within the context of military and veteran health and to consider the implications of current knowledge on future research with visually impaired veterans., Study Design: A search for literature addressing the topic of visual art activities with visually impaired veterans was undertaken. No research addressing this topic was identified. A review of literature on the related topics of mental health and well-being in military veterans, visual impairment and mental health and well-being, and art therapy for veteran populations was carried out to offer an overview of current knowledge., Results: While there is growing evidence of the benefits of arts engagement among both general and military populations, the role of the visual arts in the everyday lives of broader veteran samples, and the impact of these activities on holistic well-being, remains underexplored. The current article highlights the need for art as activity to be differentiated from art as therapy and argues that the former might offer a tool to positively impact the holistic well-being of visually impaired veterans., Conclusions: Future research relating to the use of visual art activities in the context of veteran health and well-being should endeavour to explore the potential impacts of engagement on holistic well-being. Research is needed to build on anecdotal evidence of the positive impact of arts engagement on visually impaired veterans by systematically exploring if, and how, holistic well-being in this population may be impacted by engagement with visual art activities., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Retinal implants have now been approved and commercially available for certain clinical populations for over 5 years, with hundreds of individuals implanted, scores of them closely followed in research trials. Despite these numbers, however, few data are available that would help us answer basic questions regarding the nature and outcomes of artificial vision: what do recipients see when the device is turned on for the first time, and how does that change over time?, Methods: Semi-structured interviews and observations were undertaken at two sites in France and the UK with 16 recipients who had received either the Argus II or IRIS II devices. Data were collected at various time points in the process that implant recipients went through in receiving and learning to use the device, including initial evaluation, implantation, initial activation and systems fitting, re-education and finally post-education. These data were supplemented with data from interviews conducted with vision rehabilitation specialists at the clinical sites and clinical researchers at the device manufacturers (Second Sight and Pixium Vision). Observational and interview data were transcribed, coded and analyzed using an approach guided by Interpretative Phenomenological Analysis (IPA)., Results: Implant recipients described the perceptual experience produced by their epiretinal implants as fundamentally, qualitatively different than natural vision. All used terms that invoked electrical stimuli to describe the appearance of their percepts, yet the characteristics used to describe the percepts varied significantly between recipients. Artificial vision for these recipients was a highly specific, learned skill-set that combined particular bodily techniques, associative learning and deductive reasoning in order to build a "lexicon of flashes"-a distinct perceptual vocabulary that they then used to decompose, recompose and interpret their surroundings. The percept did not transform over time; rather, the recipient became better at interpreting the signals they received, using cognitive techniques. The process of using the device never ceased to be cognitively fatiguing, and did not come without risk or cost to the recipient. In exchange, recipients received hope and purpose through participation, as well as a new kind of sensory signal that may not have afforded practical or functional use in daily life but, for some, provided a kind of "contemplative perception" that recipients tailored to individualized activities., Conclusion: Attending to the qualitative reports of implant recipients regarding the experience of artificial vision provides valuable information not captured by extant clinical outcome measures., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes., Methods: Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis., Results: Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly., Conclusion: It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful., Competing Interests: The authors declared no conflict of interest., (© 2021 Korean Society of Nursing Science.)

The COVID-19 pandemic imposed dramatic changes to everyone's daily routines, but especially to children with developmental disabilities. The Robert Hollman Foundation decided not to interrupt its service to all the visually impaired children and initiated a Distance Support Project. It was an online process covering all aspects of support for the children and involving audio-video calls, videos and tailored-made multisensory material created specifically for each child. A questionnaire, carried out after the 5-month project duration, was created to collect feedback from parents and professionals to understand the impact this project had on everyone involved. Overall both parents and professionals indicated high levels of satisfaction, but in a significant number of questions parents reported consistently higher levels of satisfaction (p-value <0.001). It was shown that parents felt reassured at this otherwise very difficult time because their children were able to continue their treatment, even if in a very different way. This fact encourages us to consider enriching our existing programmes of support and care, integrating this online approach when necessary. At the same time, it seems clear that the responses of the professionals indicate their belief that the benefits of the traditional ways of working remain of unquestionable importance for children with sight deprivation., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Although often considered a nondominant sense for spatial perception, chemosensory perception can be used to localize the source of an event and potentially help us navigate through our environment. Would blind people who lack the dominant spatial sense-vision-develop enhanced spatial chemosensation or suffer from the lack of visual calibration on spatial chemosensory perception? To investigate this question, we tested odorant localization abilities across nostrils in blind people compared to sighted controls and if the time of vision loss onset modulates those abilities. We observed that congenitally blind individuals (10 subjects) outperformed sighted (20 subjects) and late-blind subjects (10 subjects) in a birhinal localization task using mixed olfactory-trigeminal stimuli. This advantage in congenitally blind people was selective to olfactory localization but not observed for odorant detection or identification. We, therefore, showed that congenital blindness but not blindness acquired late in life is linked to enhanced localization of chemosensory stimuli across nostrils, most probably of the trigeminal component. In addition to previous studies highlighting enhanced localization abilities in auditory and tactile modalities, our current results extend such enhanced abilities to chemosensory localization., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: Perceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality., Objective: To assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination., Design, Setting, and Participants: Cross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019., Exposures: Participants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI., Main Outcomes and Measures: Perceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis)., Results: The sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (β [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (β = 0.07; 95% CI, 0.02-0.11), and DSI (β = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone., Conclusions and Relevance: Older adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.

With age-related functional deterioration, sensory impairment including vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) usually occurred among the elderly population, causing a decrease in functional capacity and quality of life. The study aimed to explore how sensory impairment is associated with the risk of all-cause mortality among the elderly adults in China. We prospectively investigated the association among 37,076 participants enrolled from 1998 to 2019 in the Chinese Longitudinal Healthy Longevity Survey. We also, as a sensitivity analysis, explored the association among 11,365 newly incident sensory impairment participants. Cox regression model with sensory impairment as a time-varying exposure was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs). Compared with participants without sensory impairment, those with VI (HR=1.20, 95% CI: 1.15-1.24), HI (HR=1.26, 95% CI: 1.21-1.31), and DSI (HR: 1.46, 95% CI=1.41-1.52) had significant higher risk of all-cause mortality after adjusting for potential confounders. These associations were robust among subgroup analyses stratified by sex and entry age, and sensitivity analyses performed among newly incident sensory impairment participants. In conclusion, sensory impairment was associated with higher mortality risk among the elderly adults in China.

Background: Visually impaired students have been reported to struggle with value system and rash decision making process. This study examined the impact of rational emotive behavioral therapy (REBT) in reducing negative personal value system of visually impaired people., Method: A group-randomized trial design was adopted using 56 students with visual impairment. The participants received a value-based rational emotive behavior progamme and were assessed at 3 points using PVS and ABS-2-AV., Results: The result of analysis of covariance showed that there was no significant difference between the treatment and control groups in initial personal value in Nigerian as measured by PVS. At the post-treatment the effect of V-REBP was significant in personal value and follow-up assessment respectively in favour of treatment group., Conclusion: We concluded that there is significant impact of rational emotive behavioral therapy on reduction of negative personal value system of students with visual impairment.

Background: Blind individuals have demonstrated the ability to detect danger and facial expressions without conscious awareness of visual stimuli. These embodied sensations are believed to be the result of primitive neural networks refined by evolutionary adaptations. We postulate that similar embodied sensations may have evolved to allow blind individuals to perceive beauty., Objective: To determine whether the visually blind can detect physical beauty., Patients and Methods: This observational study consisted of 8 blind and 10 nonblind test subjects and 6 models that were categorized into predetermined beauty categories. Test subjects were individually asked to rate 6 models on a 1 to 10 numerical beauty scale. This process was repeated in both groups while blindfolded (masked). All groups' mean model beauty scores underwent multivariate and univariate analysis., Results: All groups rated preselected (greater than 8) more beautiful models, higher except for the masked, nonblind group. Intraclass correlation was good in the blind raters with a score of 0.751, whereas poor in the nonblind masked raters with a score of 0.458., Conclusion: This is the first pilot study demonstrating with supporting evidence that blind individuals can detect beauty and supports that beauty may rely on primal forms of messaging that are subconsciously appreciated.

Purpose: To evaluate the ARAMAV 13-30 questionnaire, a new autonomy and quality of life questionnaire developed for visually impaired patients., Methods: We carried out a single-center prospective study at the ARAMAV institute in collaboration with the University Hospital of Nîmes. The patients included were admitted for low vision rehabilitation. Each patient received an occupational therapy assessment, the Short Forms 36 (SF36) quality of life questionnaire and the ARAMAV 13-30 questionnaire at the start and at the end of rehabilitation. We verified the reproducibility, the sensitivity to change, and internal and external consistency of the questionnaire., Results: We included 231 patients over a period of 4 years. All the patients were blind or visually impaired. We observed excellent intra- and interuser reproducibility of the questionnaire, with a Lin coefficient>0.9 (0.99 and 0.91, respectively). By comparing the variations of the different scores between before and after low vision rehabilitation, we observed excellent sensitivity to change for both the autonomy and quality of life portions of the questionnaire. Finally, we observed excellent internal and external consistency., Conclusion: We therefore propose the ARAMAV 13-30 questionnaire as a new tool in evaluating autonomy and quality of life specifically in visually impaired patients, which may also be used to assess the effect of low vision rehabilitation., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: A variety of visual and psychometric tests have been developed for assessing on-road driving performance and fitness to drive. The diagnostic power of a state of the art psychometric test battery (Vienna Test System) combined with a set of standard visual parameters recommended for assessing fitness to drive is investigated using an on-road driving test. The study aimed to determine whether a psychometric test battery could predict older adults' on-road driving performance. The relevance of visual standards required by law is discussed., Methods: Vision impairment is more prevalent in later adulthood and many studies on visual and cognitive impact on driving safety and performance therefore focus on adults above 60 years of age. We therefore acquired an extensive set of driving-related visual and psychometric performance parameters in a group of elderly drivers (N = 84, median age 69, SD 6.6 years). Visual assessment included foveal acuity, perimetric field size, and dynamic aspects of peripheral vision (termed "PP") in the computer-based Vienna Test System (VTS; Schuhfried), as well as letter contrast thresholds in foveal and parafoveal vision in a separate setup. A selection of psychometric driving-aptitude tests that demonstrated the battery's capacity to predict aspects of driving performance and safety were further conducted on the VTS. Driving performance was assessed in a standardized on-road driving test. Two independent observers rated driving performance using a fixed scoring system assessing the number of driving errors in pre-defined traffic situations. In addition, globalized driving competence scores were assigned on a 6-point scale., Results: The test battery performed excellent in identification of good drivers but failed in the prediction of bad driving performance. Visual performance indicators required by German law were less indicative of driving ability than psychometric assessment. Selective and divided attention turned out to be much more important for predicting fitness to drive than either visual acuity, size of the visual field, or contrast sensitivity., Conclusion: Predicting fitness to drive by means of visual and psychometric tests is an ambitious challenge. On the one hand sensitivity of a multi-disciplinary test-battery is too low to predict reliable driving ability in diagnostic settings which require an unambiguous interpretation of test results for individual drivers. Low sensitivity and low predictive values are incompatible with that objective. On the other hand, the results are valuable for a routine screening of fitness to drive. For that case, the assessment of attentional abilities in particular appears to be promising. Performance measures of divided and selective attention showed themselves to be the most predictive for fitness to drive in a sample pre-screened for clear visual deficits. Visual performance parameters required by law, in contrast, had no meaningful impact on driving performance, indicating a gap between mandatory regulations of state authorities and research results. Our results suggest that visual acuity tests designed for clinical diagnosis and monitoring of eye diseases should not at all be the choice for a screening of fitness to drive., Competing Interests: The author WG is related to Volkswagen as paid employee. Period and place of origin of this work are not related to that membership. They refer to the author’s previous employment as scientific associate at the LMU Munich. The author’s employment at Volkswagen does not alter our adherence to PLOS ONE policies on sharing data and materials.

The purpose of this study was to describe the reflections of adults with visual impairments about learning to run during K-12 physical education. An interpretative phenomenological analysis research approach was used, and eight adults (age 22-35 years) with visual impairments served as participants. Primary data sources were semistructured, audiotaped telephone interviews and reflective interview notes. Based on a thematic data analysis process, two themes were developed: (a) "I wouldn't expect anything better from you": running instruction in physical education and (b) "You look like the guy in the crosswalk signal": making up for the shortcomings of physical education. The narratives portraying these themes highlight the lack of instruction that took place in physical education, and the fact that no running instruction occurred at all. These findings indicate that professionals working with individuals with visual impairments should use instructional strategies that will allow for maximum access to learning fundamental movement skills such as running.

Background: People who are blind (PWB) are often perceived as being incompetent with common tasks and functions. When patients detect that their healthcare providers (HCPs) have negative perceptions of them, they often report less satisfaction with their healthcare and disengage in their own healthcare., Objective: A scale assessing the experiences of PWB interacting with HCPs was developed and validated across two studies., Methods: In Study 1, 144 participants completed the scale and provided feedback. In Study 2, 214 participants completed the scale and 4 additional scales to assess construct validity., Results: An exploratory factor analysis in Study 1 revealed a two-factor model consisting of General Quality of Health Care (30.5% variance explained) and Stereotype Content-related items (9.4% variance explained). Study 2 confirmed and validated this two-factor structure (RMSEA (90% CI) = 0.068 (0.057, 0.079), CFI = 0.898, SRMR = 0.066, AIC = 14568.902)., Conclusions: This scale is one of the first tools developed from the perspectives of PWB. Results from these studies highlight and elaborate on how PWB perceive that they are viewed by their HCPs in terms of competence and how they perceive to be treated by these HCPs. This scale can be used in training HCPs to better serve their patients with disabilities., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Visually impaired children encounter some challenges for their oral health. We aimed to compare the effectiveness of oral health education using Audio Tactile Performance (ATP) technique alone, ATP combined with oral health education for mothers, and ATP along with art package on the oral health status of visually impaired children., Materials and Methods: This cluster, randomized trial, included visually impaired children from preschool to 10th grade (32 classes, n = 200), in Tehran, Iran, in 2018-2019. A questionnaire was filled out through face to face interviews at baseline regarding age, gender, status of visual impairment, and place of residence. The Simplified Oral Hygiene Index (OHI-S) and Bleeding on Probing (BOP) were examined afterward. Classes were randomly assigned to three groups through simple randomization: 1. Art group (ATP, game-based, and music-based education (11 classes, n = 66); 2. Mothers group (children received ATP and their mothers received education by telephone (10 classes, n = 73); and 3. Control group (children received ATP (11 classes, n = 61). Children received reinforcement after 1 and 2 weeks. Follow-up oral examinations were performed after 1 and 2 months by a blind calibrated examiner. Descriptive statistics were performed using Chi-Square, and ANOVA tests by SPSS (version 22). In analytic statistics, two-level mixed-effects models for BOP and OHI-S were fitted using the Statistical Analysis Software (SAS) version 9.4. Both models fitted with the grouping variable and time (baseline, 1, and 2 months after interventions) as the fixed effects., Results: The mean age (SD) of the children was 12.29 (3.45) years (range: 6-17). Male children (67%) more than female children (33%) participated in the study. Also, 35.5% were blind, and 12% resided at the dormitory. The art and mothers groups had no statistically significant difference compared with the control group, in terms of OHI-S (P = 0.92, and 0.39, respectively) and BOP (OR = 0.64, and 0.66, respectively). The time effect was statistically significant in both BOP and OHI-S models (P < 0.0001)., Conclusions: ATP technique is an effective method to improve the oral health status of visually impaired school children. Oral health promotion programs can be done using this method to tackle oral hygiene problems in visually impaired children., Trial Registration: (https://www.irct.ir/trial/34676: Nov 29th, 2018).

From an ergonomics perspective, the environmental characteristics should facilitate user activities. Matching user capabilities to demands of the environment is essential. However, about some users such as those with visual impairments, there is little information available for use in designing products and spaces. There is also a gap in information regarding the commutes and needs of the visually impaired, making it even more difficult to establish how environments should be designed to include this population.This study aimed to identify the information needs of people with visual impairment in terms of: 1) Daily life activities, 2) Wayfinding in the complex built environments, 3) Use of the signals provided by the environment 4) Characteristics of the environment which reduce the usability of a space and may put the user in danger, and 5) Safety perception. Data were obtained through a semi-structured interview to which eighteen adults responded. All had either complete blindness or severe visual impairment. For orientation, the most common references were texture or changes in ground level/surface, along with such ambient elements as noise or smells. Information presented in Braille was reported as little used, due to difficulty in finding such information. Regarding safety, participants reported feeling unsafe; most mentioned crossing the street as a major risk. Using auditory, tactile or even olfactory signals may provide important information while commuting: thus, designing signals which consider and highlight these senses is paramount. Assessing features and location of existing tactile signals is also required, to identify opportunities for improving the safety and independence of people with visual impairment., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

There is a lack of research based on in-depth theoretical and scientific knowledge to understand the visually impaired, and there has been little effort in the application of strategies for early intervention to minimize the risk these people might encounter during development. This study used semi-structured interviews from eight persons with visual impairments who had various experiences of coping process. Three coping processes based on life experiences were identified: (1) self-awareness and adaptation process: "self-awareness of disability" and "adaptation to disability and the environment"; (2) facing the circumstance process: "the exposure to concealment and abuse," "the suppression of potential," "denial and abandonment by family," "poverty and disability," "expansion of thinking," and "opportunities of special participation"; and (3) the positive reinforcement process: "self-disclosure and jump-starting life," "maintain satisfaction and achievement," and "socioeconomic independence." These findings expand the understanding of the factors common to the coping process experienced by individuals with visual impairment and highlight the importance of psychological support, family, education, and social support.

Objectives: Compared with sighted individuals, people with visual impairment have a higher prevalence of chronic conditions and lower levels of physical activity. This review aims to systematically review physical activity interventions for those with a visual impairment and to assess their effectiveness., Design: A systematic review of articles reporting physical activity interventions in visually impaired individuals was conducted. Medline, EMBASE, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus and the Physiotherapy Evidence Database were searched in August 2018. Meta-analyses were conducted on randomised controlled trials with the same outcome measure., Setting: Most interventions were conducted in a group setting, with some including an at-home, self-directed component., Participants: Following identification of a recent systematic review of physical activity interventions in children, our review focused on adults aged 18 years and older with a visual impairment., Primary and Secondary Outcome Measures: Outcomes included measures of balance, mobility, mental well-being (eg, quality of life), number of falls, muscle strength, flexibility and gait., Results: Eighteen papers from 17 studies met inclusion criteria. Physical activity components include falls prevention and/or balance-based activities, walking, tai chi, Alexander Technique, Yoga, dance, aerobics and core stability training. Significant results in favour of the intervention were reported most commonly in measures of functional capacity (9/17 studies) and in falls/balance-related outcomes (7/13 studies). The studies identified were generally small and diverse in study design, and risk of bias was high across several categories for most studies. Meta-analyses indicated non-significant effects of the included interventions on the Timed Up and Go, Chair Sit Test and Berg Balance Scale., Conclusions: Physical activity interventions in individuals with visual impairment incorporating activities such as tai chi, Yoga and dance can have positive results, particularly in physical measures such as mobility and balance. However, when performing a meta-analysis of randomised controlled trials, the evidence for effectiveness is less clear. More studies with larger sample sizes, stronger designs and longer follow-up periods are needed., Prospero Registration Number: CRD42018103638., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Developmentally sensitive measures of vision-related quality of life (VQoL) are needed to capture age-specific concerns about the impact of living with visual impairment (VI) in children and young people. Our objective was to use our validated VQoL instrument for children and young people 10 to 15 years of age (the VQoL&#95;CYP) as the foundation for development of age-specific extensions., Design: Questionnaire development., Participants: A representative sample of children and young people 6 to 19 years of age with VI, defined as visual acuity worse than 0.50 logarithm of the minimum angle of resolution in the better eye. They were recruited from pediatric ophthalmology clinics at Great Ormond Street Hospital and Moorfields Eye Hospital and, in the final phase of the study, from 20 additional United Kingdom hospitals., Methods: Standard instrument development processes were followed across 4 phases. Twenty-nine semistructured interviews with children and young people permitted draft age-appropriate extensions. Twenty-eight cognitive interviews informed items and response options. Age-appropriate extensions were prepiloted with 49 participants to ensure feasibility and administered via a postal survey to a national sample of 160 participants for psychometric evaluation using Rasch analysis. Construct validity was evaluated through correlations with the Pediatric Quality of Life Inventory., Main Outcome Measures: Psychometric indices of validity and reliability of the instrument versions., Results: Interviews confirmed that the existing VQoL&#95;CYP content and format were relevant across a wider age range. Age-appropriate extensions were drafted for children (8-12 years) and young people (13-17 years). Psychometric item reduction produced 20-item child and 22-item young person versions, each with acceptable fit values, no notable differential item functioning, good measurement precision, ordered response categories and acceptable targeting, and no notable differential item functioning on items common to both. Construct validity was demonstrated through correlations with health-related quality of life (r = 0.698)., Conclusions: Using an efficient child- and young person-centered approach, we developed 2 robust, age-appropriate versions of an instrument capturing VQoL that can be used cross-sectionally or sequentially across the age range of 8 to 17 years in research and clinical practice. This approach may be applicable in other rare childhood ophthalmic disorders., (Copyright © 2019 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)