Low vision in east African blind school students: need for optical low vision services.

Introduction: This study aims to investigate the knowledge, awareness, and perceived barriers among optometrists regarding low vision services in the Klang Valley. It also seeks to identify areas for improvement and evaluate differences in service provision based on type of practice, years of experience, and the number of low vision patients seen annually. Methods: A cross-sectional study used a Google Form questionnaire adapted from previous research. It covered participants’ demographics, the range of low vision services provided, their knowledge and awareness of these services, and perceived barriers and improvement areas. Results: The study involved 193 optometrists and highlighted inadequate low vision services in the Klang Valley. Many respondents lacked an understanding of “visual acuity criteria for low vision” (44.5%) and were unfamiliar with “available low vision devices” (39.8%). The primary challenge cited was “lack of public awareness” (84.4%), with respondents suggesting that services could improve by offering “low-cost low vision devices” (88.1%). Discussion: Optometrists in the Klang Valley identified the lack of public awareness as being the main hurdle for low vision services and suggested that services could be enhanced by providing affordable low vision devices. Addressing knowledge gaps, improving public awareness, and ensuring accessibility of low vision devices are crucial for enhancing service quality, warranting further research and collaboration. Implications for Practitioners: The study underscores the need for optometrists to improve their understanding of low vision criteria and devices, highlighting the necessity for targeted training and education. Additionally, optometrists should prioritize raising public awareness and advocate for affordable low vision devices to effectively meet the needs of individuals with low vision.

Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. Cross-sectional study conducted in 13 blind schools in Delhi, North India. Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.

Visual impairment (blindness or low vision) is a leading cause of disability among older adults and is most often due to age-related macular degeneration (AMD). The prevalence of AMD is rapidly increasing with the aging of the population; from 1991 to 1997, it increased from 5.0% to 27.1% in a cohort of Medicare beneficiaries (Crews, 1991; Lee, Feldman, Ostermann, Brown, & Sloan, 2003). It is predicted that 2.95 million people will have AMD by 2020 (Eye Diseases Prevalence Research Group, 2004). Compared to older people with typical vision, those with AMD report greater difficulty with a variety of daily activities (Williams, Brody, Thomas, Kaplan, & Brown, 1998). For example, in a community sample of 872 older people, those with AMD were 9.7 times more likely to have impairments in instrumental activities of daily living (such as taking medication and shopping) than were people with typical vision (Rovner & Ganguli, 1998). Unfortunately, there is no cure for AMD, nor can lost vision be restored. Although there are interventions to slow the progression of the condition, treatment is primarily rehabilitative. Services for people with low vision include low vision rehabilitation, occupational therapy, social support programs, and orientation and mobility training. Assistive devices include magnifiers, large-print materials (such as books, clocks, and calculators), audio materials (such as books and magazines), electronic reading devices, and speech-output systems. Despite the availability of these rehabilitative services and devices, they are underutilized. A series of focus groups that were conducted by the National Eye Institute (NEI) indicated that many older persons with low vision have little or no awareness of these services, and, as a consequence, few take advantage of them (National Eye Institute, 2001). Similar findings were reported in the Lighthouse National Survey on Vision Loss (Lighthouse International, 1995). Among adults with low vision, only 30% were using optical devices, 21% were using large-print reading materials, and 6% received rehabilitation. The most common reason for the lack of utilization of low vision devices and services was the participants’ unawareness of them. Ophthalmologists may not be informing and educating their patients about these resources. Some studies have reported that ophthalmologists refer only 28%–35% of appropriate patients to low vision rehabilitation services (Greenblat, 1988). Leinhaas and Massof (2001) found that only 15% of ophthalmologists and 21% of optometrists “always or often” prescribed low vision devices, and only 44% of ophthalmologists and 27% of optometrists “always or often” referred patients for low vision services. The goal of the current study was to obtain more detailed information on the use of low vision services and devices by older adults with AMD and to determine whether knowledge and use of such services are related to the severity of vision loss.

A retrospective study of causes of visual impairment and use of low vision devices in the low vision clinic in Trinidad and Tobago

Background: Only a small percentage of people with low vision in Australia receive comprehensive low vision rehabilitation services. In an attempt to examine reasons for this under-utilisation of low vision services, the referral criteria used by Australian ophthalmologists and optometrists were investigated. This paper reports the results for optometric referrals; the results for the ophthalmological referrals have been reported elsewhere. Method: A survey was sent to a random sample of 800 optometrists in Australia. Information requested included the vision loss criteria used for referral of patients to services for visually impaired people, the frequency of prescription of low vision devices (LVDs), frequency of referrals and perceptions of the availability and quality of low vision services. Results: The response rate was 36 per cent. Optometrists reported that only 4.7 per cent of their patients have low vision. Optometrists frequently prescribe LVDs but the majority infrequently refer patients to low vision or rehabilitation services. The rate of referral is influenced by their referral criterion and the perceived availability and quality of low vision services. Conclusions: Optometrists do not manage many patients with low vision because the patients are usually referred to ophthalmologists for management of the underlying eye disease. However, many optometrists could adopt a lesser degree of vision loss as their referral criteria for low vision services and encourage ophthalmologists to do the same. With improved communication between the eye care practitioners and low vision services, patients will be referred to low vision services earlier, before vision loss severely affects their daily lives.

Background: In accordance with the objectives envisaged by the Vision 2020 WHO global initiative, this study was designed to reveal the causes of low vision (LV), patient preference for and acceptance of specific types of low vision devices. The study was performed between January, 2006 and December, 2006 at the Low Vision Clinic in Lumbini Eye Institute (LEI). Materials and Methods: A descriptive clinical study of patients with low vision was performed. All patients were examined by an Ophthalmologist and an Optometrist. Un-corrected visual acuity (VA), best-corrected visual acuity (BCVA), visual loss based on anatomical sites, low vision assessment was performed and patient preference for a specific low vision device was observed and documented. Standard National Low Vision Assessment Form was used. Results: A total of 166 new Nepali patients were included in the study out of whom 70% were male. Of these patients, lens related causes like aphakia, pseudophakia was the main cause of low vision in 35.55% patients, followed by refractive errors / amblyopia accounted for 19.23%, retinitis pigmentosa for 10.84%, whole globe abnormalities 10.25%, corneal pathology accounted for 7.24%, retinal disease (different types of maculopathies, retinal scars, retinal hemorrhages, vein occlusion, etc.) in 6.64%, and other causes (albinism, nystagmus, different syndromes, etc.) in 10.25%. In low vision assessment, 6.02 % not needed any device (sufficient near vision enough to conduct his or her near task without any type of devices / glasses) as per the guidelines set up by National Low Vision Programme), distance glasses gave enough improvement for 19.27%, spectacle magnifier was preferred by 51.80%, other magnifiers (hand/stand/dome) was preferred by 12.65%, and monocular handheld telescope was preferred by 20.48% for distance. The above includes certain patients requiring assistance with both near and distance vision who opted for multiple LV devices (i.e., for near and distance vision separately) instead of LV devices with multiple functionality. In non-optical Low-vision devices, 25 % preferred reading lamp, 10 % preferred reading stand, 12% preferred black felt tip pen, 6 % preferred sunglasses, 7 % preferred peaked cap, 4 % preferred typoscope, and 3 % preferred LV note book. Conclusion: Lens related causes and refractive errors/amblyopia seem to be two of the most important causes of low vision and should not be overlooked. In addition, low vision devices with a usage similar to that of spectacles were preferred by patients for near and telescope for distance.

People in need of low vision rehabilitation services often experience delays in referral to services. This study investigates referral criteria of Australian ophthalmologists, the frequency of referral of their patients with low vision and their perceptions of low vision services. A survey was sent to a representative, random sample of 200 ophthalmologists. They were asked about criteria used for the referral of their patients with low vision. The survey included questions on the frequency with which they prescribed low vision devices (LVD) and referral of their patients to low vision and rehabilitation services and peer support groups. Perceptions of the quality and availability of low vision services were also investigated. The response rate was 82%. Approximately 11% of ophthalmologists' patients have low vision. It is uncommon for ophthalmologists to prescribe LVD but 67% refer most of their patients with low vision. It is less common for them to refer to rehabilitation services (29%) or peer support services (18%). The perceived local availability of services influences the rate of referral. Ophthalmologists who used the criteria of moderate low vision (< 6/21 to < 6/60) are more likely to refer more of their patients than those who use the criteria of severe low vision. Australian ophthalmologists refer most of their visually impaired patients to low vision services, but infrequently to rehabilitation services or peer support groups. Differences in perceived need for low vision services indicated by the criteria used for referral, and the perceived availability, influence the rate at which ophthalmologists refer their patients for services. Ophthalmologists are encouraged to refer patients with permanent visual loss to low vision services earlier.

Background/aimsHospital-based low vision services in the UK typically involve one consultation with an optometrist. In this study we investigated the effect of adding further low vision device training.MethodsParticipants were recruited...

The prevalence of functional low vision in southeast Nigeria is reportedly the highest in the country. This study evaluated the state of low vision services and perceptions of providers and users of the service in tertiary hospitals in the region, to facilitate advocacy and planning. This was a cross-sectional survey of available low vision services in the nine tertiary hospitals in Southeast Nigeria utilizing mixed methods. Data were collected on human resources, service delivery, and low vision equipment and devices. In-depth interviews were conducted to determine the perceptions of providers and users of the service. Varying levels of low vision services were actively provided in three of the nine hospitals surveyed. Services, equipment, and devices were suboptimally available. The three functional centers had a combined output of 61 patients seen within 6 months preceding the study and had at most two-thirds of required equipment. Low vision devices (LVDs) were available in varying degrees in only four (44%) of the hospitals. Twenty-one (7.6%) of the 278 eye care personnel had some low vision training across seven hospitals. The challenges highlighted by providers were mainly inadequate funding (infrastructure, training, and equipment), communication gaps, and bureaucracy. Poor awareness, affordability, acceptability, and accessibility of LVDs were major constraints for users. Low vision services are available in some tertiary facilities in southeast Nigeria. Improved funding and better awareness of the availability of low vision services by eye care providers and the general public are needed to strengthen services.

Introduction: Surveys conducted in schools for blind students have become useful alternatives to population-based surveys in generating data on childhood blindness and low vision. This survey determined the prevalence of low vision, causes of visual impairment, and the proportion of students requiring low vision devices and provided the low vision devices required. Methods: The study was conducted in three schools for blind students in two states of north-central Nigeria. The standard examination protocol of the World Health Organization’s Prevention of Blindness and Low Vision for Children (WHO, 2005) was used to interview and assess participants. The causes of visual impairment were categorized using the definitions in the coding instruments (WHO, 1988). Results: The study examined 170 eyes of 85 students between 7 and 49 years of age with a male-to-female ratio of 1.4:1. Of the 83 (97.6%) students with visual impairments, 59 (69.4%) of them had low vision. The major anatomical sites of vision loss by eyes were the whole globe ( n = 84, 55.3%), followed by the lens ( n = 23, 15.1%) and the retina ( n = 21, 13.8%). Overall, the leading causes of visual impairment in eyes were glaucoma ( n = 52, 34.2%), retinitis pigmentosa ( n = 21, 13.8%), phthisis bulbi ( n = 16, 10.5%), cataract ( n = 14, 9.2%), and keratoconus ( n = 10, 6.6%). A total of 37 (43.5%) students were prescribed optical low vision devices, and 28 (32.9%) received nonoptical low vision devices. Discussion: A large number of the students in this study had low vision. They were prescribed and provided the low vision devices required. The causes of visual impairment were a mix of the patterns seen in both developing and developed countries. The finding of glaucoma as a more important cause of vision loss calls for improved efforts in screening, early detection, and treatment of glaucoma among children. Implications for Practitioners: Routine comprehensive visual assessment, refraction, and low vision assessment before enrollment will guard against improper school placements and enhance optimization of vision for those with low vision.

Purpose: To address the human resources challenge for the provision of low vision services in Saudi Arabia, this study sought to investigate the knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision services. The knowledge and attitudes to low vision services can influence the provision of low vision services by optometrists. Methods: A prospective cross-sectional survey of optometrists practicing in Saudi Arabia was undertaken using an online questionnaire designed to elicit the opinions of respondents. The online questionnaire was sent out to optometrists on the official mailing list of registered optometrists and those on the mailing list of the Saudi Society of Optometry. Results: Only 26.5% of the respondents correctly indicated the correct designation of low vision in terms of visual acuity. Although 95.8% indicated that optical low vision devices could help people with low vision, 81.6% reported that low vision devices were expensive, and 42.9% felt low vision practice was not profitable. Only 10.4% of respondents provide low vision services in their practice. Insufficient training in low vision care was the main barrier militating against the provision of low vision services. Conclusion: The pertinent finding in this study is that about a quarter of the respondents could correctly designate low vision in terms of visual acuity using the World Health Organization (WHO) definition. The study concluded that there was poor knowledge, attitudes, and practices of optometrists in Saudi Arabia regarding low vision, which has implications for the provision of low vision services by optometrists.

To determine the main causes of visual impairment in children with low vision. To assess the need of spectacles and low vision devices (LVDs) in children and to evaluate visual outcome after using their LVDs for far and near distance. Observational study. Khyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan, from June 2006 to December 2007. The clinical record of 270 children with low vision age 4-16 years attending the Low Vision Clinic were included. All those children, aged 4-16 years, who had corrected visual acuity (VA) less than 6/18 in the better eye after medical or surgical treatment, were included in the study. WHO low vision criteria were used to classify into visually impaired, severe visually impaired and blind. Results were described as percentage frequencies. One hundred and eighty nine (70%) were males and 81 (30%) were females. The male to female ratio was 2.3:1. The main causes of visual impairment included nystagmus (15%), Stargardt's disease (14%), maculopathies (13%), myopic macular degeneration (11%) and oculocutaneous albinism (7%). The percentages of visually impaired, severe visually impaired and blind were 33.8%, 27.2% and 39.0% respectively. Spectacles were prescribed to 146 patients and telescopes were prescribed to 75 patients. Spectacles and telescope both were prescribed to 179 patients while Ocutech telescope was prescribed to 4 patients. Retinal diseases nystagmus and macular conditions were mainly responsible for low vision in children. Visually impaired children especially with hereditary/congenital ocular anomalies benefit from refraction and low vision services which facilitate vision enhancement and inclusive education.

To evaluate prescribed optical device use in terms of frequency and perceived usefulness among people with age-related macular degeneration (AMD). We also sought to determine the tasks for which they were using their prescribed low vision device(s). One hundred ninety-nine patients with AMD presenting for the first time to the low vision service were recruited from a university-based clinic. Prior to the low vision evaluation and device prescription, they completed the National Eye Institute Visual Function Questionnaire 25, Center for Epidemiological Studies Depression Scale, Short Portable Mental Status Questionnaire, and a general health questionnaire. The low vision evaluation included best-corrected Early Treatment of Diabetic Retinopathy Study visual acuity, MNREAD testing, microperimetry, prescription, and dispensing of optical low vision devices. Telephone follow-up interviews were conducted about device usage 1-week, 1-month, and 3-months postintervention. One hundred eighty-one participants were prescribed low vision devices. Of them, 93% completed all 3 follow-up interviews. Intensive users (≥1 hours/day) of devices were similar in demographic and visual characteristics to non-intensive users (<1 hours/day), except for habitual reading acuity and speed as well as contrast sensitivity. Overall, device use increased slightly over 3 months of follow-up. Magnifiers were reported to be moderately-to-extremely useful by >80% of participants at all time points except the 1-month follow-up for hand magnifiers (75%). High plus spectacles were the least frequently prescribed device and rated as moderately-to-extremely useful by 70%, 74%, and 59% at 1 week, 1 month, and 3 months, respectively. Most participants used their devices for leisure reading, followed by managing bills. Very few devices (n = 3, <1%) were not used at any time point. Patients with AMD who are provided with prescribed optical low vision devices do use them and perceive them as useful, especially for leisure reading activities. High rates of usage were maintained over 3 month.

There is an increasing awareness about the needs of students with low vision, particularly in developing countries where programs of integrated education are being developed. However, the appropriate low vision services are usually neither available, nor affordable. To study the profile of students with low vision in Lumbini Zone of Nepal. A cross-sectional study included students with low vision from 8 integrated schools. The reading performance was measured using their own text-books with optical low vision devices prescribed for near reading. The reading rates were measured on a range of print sizes. The Standard Clinical Low Vision Assessment Form and the National Low Vision Program protocol were used. SPSS software was used in data analysis. Of 46 students enrolled, 23 had a mild visual impairment, 18 had severe visual impairment and 5 were blind. Spectacles were needed for 29 (63 %) students. Of the 11 students who had been wearing glasses, the visual acuity improved in 4 with a change in prescription. 91 % of the students had near vision better or equal to 1.5 M with optical low vision services for near reading. The reading rate was 24 WPM at the age of 5 years, whereas at the age of 21 years, it was 55 WPM. The majority of the students with low vision need optical low vision services. Accurate refraction is important in these students. The reading rate increases significantly with improved near visual acuity.

PurposeTo identify the need for optical intervention including spectacles and low vision devices (LVDs) in children attending the only school for the blind in Eritrea.MethodsA total of 92 children were examined using the World Health Organization Prevention of Blindness program form for the recording of children with blindness and vision impairment. Examination included distance and near visual acuity (VA), refraction, trial of LVDs and evaluation of anterior and posterior segments. All the children who showed at least one line improvement in distance or near VA with refractive correction and/or LVDs were provided with these devices.ResultsSix children had distance VA of ≥6/18 (no vision impairment, NVI) at presentation and were excluded from analysis. For the remaining 86 children, male to female ratio was 1.2:1.0 with a mean age of 11.8 ± 2.8-years (range: 6–17-years). At presentation, 47 (54.7 per cent) children were blind (VA <3/60) and 24 (27.9 per cent) were severely visually impaired (VA <6/60–3/60), which reduced to 42 (48.9 per cent) and seven (8.1 per cent) children after refraction, respectively. A further 5.8 per cent (five children) achieved NVI with refractive correction. Using distance LVDs, 26 (30.2 per cent) and 16 (18.6 per cent) children had NVI and moderate vision impairment (VA <6/18–6/60), respectively. In terms of near vision, eight (9.3 per cent) children had near VA better than 1.00-M at presentation, which improved to 11 (12.8 per cent) with refractive correction and 19 (22.1 per cent) with near LVDs. A total of 29 spectacles and 42 LVDs were provided.ConclusionA significant number of children at the school for the blind benefited from refractive correction and LVDs. With such optical intervention, many of these children could study at mainstream schools with print media. A system including comprehensive vision examinations before admission to the school, refractive services and low vision rehabilitation is required to ensure that children with adequate residual vision do not have to be limited to learning in Braille media.