A scoping review of adverse visual outcomes among preterm infants without, versus those with, retinopathy of prematurity.

Ocular diseases have emerged as the leading causes of blindness and low vision, necessitating timely detection and treatment. However, computer-aided approaches face significant challenges in accurately diagnosing these diseases. Specifically, ocular diseases often exhibit a long-tailed distribution, leading to a complex class-imbalanced scenario. Moreover, the coexistence of multiple diseases in a single patient gives rise to a problematic issue of label co-occurrence. In this study, we propose a novel alternate group training strategy as an effective approach to tackle the multi-label long-tailed data distribution problem. Firstly, we partition the long-tailed data into several groups based on semantic feature relations. This division helps reduce the challenges of class imbalance and label co-occurrence. With these groups established, we employ a gradient-based self-weighted loss to train a teacher network in an alternate way. Furthermore, a student model is trained on the original dataset under the guidance of the teacher network, utilizing a weighted class-balanced distillation loss. The class-balanced distillation loss also alleviates the class-wise imbalanced distribution and instance-wise label co-occurrence. Extensive experimental results have demonstrated the superiority of our proposed method which achieves promising performance on the publicly available dataset. In addition, our approach achieves promising performance when expanding the single-teacher model to multiple-teacher models.

In recent years, the role of libraries in modern society has evolved from traditional book repositories to modern socio-cultural and information centers. In the context of digitalization and changing user demands, libraries are expanding their range of functions, integrating educational, outreach, communication, and inclusive practices, strengthening their position as key cultural institutions in the information society. With the growing number of visually impaired and blind people, inclusive initiatives aimed at supporting people with disabilities, including visually impaired and blind readers, are becoming especially important. The development of tactile and audio formats, digital technologies for text adaptation, specialized reading rooms, and services makes libraries accessible to all categories of the population. Extensive experience in working with this target audience has been accumulated in Russia and worldwide, and is being utilized and developed by the Sverdlovsk Regional Special Library for the Blind and Visually Impaired. The D. N. Mamina-Sibiryak Library is a key regional center for ensuring accessibility of information and cultural services for people with visual impairments. The library uses both traditional and alternative marketing communications to promote its services, improving accessibility to literature, creating equal opportunities for people with visual impairments, and fostering a sustainable community for education and leisure, increasingly utilizing digital tools. A key focus of the library's activities is the social project "Hearing the World of Literature," initiated by its authors. It exemplifies how a specialized library, with the help of students and faculty from the Yekaterinburg Academy of Contemporary Art, can use digital media products—crowdfunding, podcasts, and audiobooks—to promote its services, cultivate a positive image, and attract new audiences. High viewership rates, subscriber growth, and user activity confirm that digital formats are becoming a key tool for inclusive communication. This article aims to identify promising and effective digital library promotion tools, such as podcasts, crowdfunding, and audiobooks, for engaging people with disabilities in cultural and educational spaces. The primary research methods include a literature review, Russian and international practices, comparisons, analysis of local cases, and a comparative matrix for transferring experience. The key findings of the study are that, even with limited resources, innovative digital promotion methods can increase the reach of inclusive audiences and engage them in the activities of specialized libraries, ensuring that every user has the opportunity to fully participate in social and cultural life.

For persons with visual impairment, taking part in day-to-day activities can be especially challenging, because their physical limitations also put them at a greater risk of falling. In some cases, it can be life-threatening. We present an innovative assistive device that intends to help blind people in wayfinding and determining the presence of objects, especially at face-level, as well as for alerting them about dangerous situations. This obstacle avoidance and navigation system, based on an ATmega328 Arduino microcontroller, is intended for blind pedestrians. This device uses ultrasonic sensors, which detect obstacles nearby, allowing safe and easy manoeuvrability in risky places. Attached is a buzzer that produces auditory alerts for impending danger. The main component is the Arduino Uno board, which holds the ATmega328 microcontroller essential for control and coordination of the system. The whole system in the form of smart eyeglasses weighs merely 73 grams, runs on a 3.7-volt battery and, has an obstacle detection range of 59.97 cm. The ultrasonic sensor sends a signal to the microcontroller when it detects an obstacle within the 59.97 cm range. The microcontroller processes this input and activates the buzzer output components. The buzzer will give audio alerts, providing an auditory alert to the user regarding the obstacle through these alerts. The main objective of the system that is being proposed is to improve the user awareness regarding their path, along with detecting and informing any obstacles that may come their way.

This phenomenological qualitative study explores the lived experiences of mainstream school teachers with partial sight, severe visual impairment, and blindness regarding their limited access to personal assistants, the difficulties they face in finding suitable ones, and assistants` insufficient competencies. The research gathers valuable insights from a range of stakeholders, including teachers with partial sight, severe visual impairment, and blindness, as well as their school administrations, colleagues, and field experts. A purposive sampling technique was employed to select the teachers and their school personnel. In contrast, a snowball sampling technique was used to identify and include field experts, thereby enhancing the research quality and ensuring a diverse range of perspectives. In total, 20 teachers with partial sight, severe visual impairment, and blindness, along with three school principals, one deputy principal, two colleagues, and two experts, all volunteers, participated. The findings reveal that mainstream school teachers encounter significant challenges with personal assistants, including not being provided with them, considerable difficulty finding appropriate personnel, and dealing with assistants who lack basic knowledge and essential skills. These challenges arise from a variety of sources, including policy limitations, personality differences, cultural barriers, and financial constraints. As a result, the Ministry of Preschool and School Education of the Republic of Uzbekistan is recommended to review and revise its existing regulations on personal assistants for mainstream school teachers with partial sight, severe visual impairment, and blindness. Ultimately, this study can assist policymakers and government officials in gaining a comprehensive understanding of issues related to blindness, spanning from interpersonal interactions to broader disability legislation.

Voice-based interfaces integrated into content management systems (CMSs) represent a feasible way to achieve more accessible digital publishing; however, while voice-enabled technologies are gaining widespread adoption, there is a lack of evidence on the effectiveness of voice interfaces for users who encounter difficulties using the traditional keyboard-and-mouse interaction paradigm. This study proposes and evaluates a voice-controlled WordPress interface for users with different accessibility needs, focusing on users with motor impairments, visual impairments (low vision), and limited computer literacy, and a pilot study with five participants (N= 5) compared the proposed voice interface to a standard input method in a within-subjects experimental design. The system was developed using the Google Voice Assistant, Dialogflow, and the WordPress REST API to enable end-to-end voice-driven content creation and management, and the results show that, although the voice interface led to a 22% increase in the average task completion time (M= 185.8 s vs. 152.4 s), it significantly reduced text entry errors by 77% (M= 2.6 vs. 11.2 errors). Participants also reported higher satisfaction with the voice-based system (M= 6.2/7 vs. 3.4/7 on the SEQ scale), and the results suggest that voice-controlled CMS interfaces may enhance accessibility and overall user experience while providing a validated and replicable framework for inclusive digital publishing.

People with visual impairments often develop a high level of independence in their living environment due to repeated daily interactions. However, this independence is often achieved through personal adaptation rather than intentional architectural design support. This study aims to identify residential design criteria that improve orientation and navigation for the visually impaired through non-visual strategies. A descriptive qualitative method was used, combining a review of national and international literature (2020-2024) and in-depth interviews with three visually impaired respondents. The results of the study formulated specific design criteria that include tactile elements, consistent spatial organization, the use of materials with different textures, and optimal lighting for users with low vision. These findings provide guidance for architects to create more inclusive and accessible housing.

Background: Visual impairment, ranging from low vision to blindness, is a growing global problem affecting about 2.2 billion people in 2026, with many cases preventable. Retinal diseases are a major cause, especially in developing regions, emphasizing the need for early detection and intervention. Aims: To determine the burden and pattern of visual impairment and blindness, with focus on retinal diseases among new patients attending a tertiary eye-care centre in North-Central Nigeria. Study Design: A hospital-based, cross-sectional study Place and Duration of Study: Department of Ophthalmology, Jos University Teaching Hospital, Jos, Plateau State, conducted from June-December 2014. Methodology: Consecutive adult patients (≥18 years) were recruited. Presenting and best corrected visual acuity (VA) were assessed using standard protocols and classified according to WHO criteria. Ocular examination including mydriatic posterior segment examination was carried out to diagnose patients with retinal diseases. Data were analyzed using SPSS version 19, with statistical significance set at P< .05. Results: Of the 278 participants (556 eyes), 6.1% were blind, 1.4% had severe visual impairment (SVI) and 15.4% were visually impaired (VI) at presentation. After best correction, 5.4% remained blind, 0.7% had SVI, 7.9% had VI. Posterior-segment diseases were identified in 43.5% of patients and 49% of eyes. Of these, 25% of eyes were blind at presentation while 3.4% had SVI and 16.9% were visually impaired. Patients with retinal disease were nearly twice as likely to be blind both at presentation (9.5%) and after best correction (9.5%) compared to those with non-retinal conditions (4.9% and 3.9%, respectively), although the differences were not statistically significant (P > .05). Retinal diseases accounted for over 22% of blindness after best correction among affected eyes. Conclusion: The burden of visual impairment and blindness remains high in North-Central Nigeria, with retinal diseases emerging as a major contributor to irreversible blindness. These findings underscore the urgent need for early detection strategies, improved retinal diagnostic and treatment capabilities and integration of posterior-segment disease management into routine eye-care services. Strengthening referral systems and public awareness initiatives are critical to reducing the burden of avoidable blindness in this population.

Due to the absence of visual perception, blind people are faced with great difficulties in safe navigation. The traditional white cane is not very helpful. It can only tell you something is in your way after you hit it. This makes it more likely that you will get hurt. We made a Smart Stick to help blind people navigate safely. This Smart Stick uses sensors to help them get around. We used a Raspberry Pi and an ultrasonic sensor to detect things that're in the way and to measure how far away they are. We also use a Pi-Camera to take pictures of what's around them. Then we use methods to look at these pictures and find different kinds of things that might be in their way. The Smart Stick can tell the user what it finds out. It uses Text-to-Speech technology to turn what it detects into sound. For example, it can tell them how away something is or what kind of thing is in their way. Our tests show that the Smart Stick can detect things that're farther away and can tell the user faster than a regular white cane. We want the Smart Stick to be light, inexpensive and work inside and outside. The Smart Stick helps blind people get around easily feel more confident and be safer. This makes it a helpful tool for them to find their way around. The Smart Stick is very useful, for people.

Estimating the prevalence of visual impairment in the Netherlands, with forecasts up to 2050: a meta-analysis of national databases.

Poor quality of life (QOL) has emerged as a key morbidity in patients with idiopathic intracranial hypertension (IIH). This work aimed to develop and validate an IIH-specific quality of life assessment tool. This cross-sectional study was conducted on 146 Egyptian and 156 Turkish patients with IIH. A 14-item questionnaire was created to assess QOL in those patients; Quality of Life in IIH patients questionnaire (QOLIH). The questionnaire items were hypothesized into two domains: one domain represents activities of daily living (ADL) (Q1-7 and Q12), and the other domain represents psycho-cognitive function (Q8-11, Q13, Q14). To assess the convergent validity of this questionnaire, the following tests were also employed: the Visual Analog Scale (VAS), Headache Impact Test-6 (HIT-6), Short Form-12 Health Survey (SF-12), and Low Vision Quality-of-Life Questionnaire (LVQOL). Confirmatory factor analysis (CFA) revealed that standardized factor loadings were generally acceptable (>0.60) for Q1-12. However, Q13 and Q14 consistently displayed weak loadings (<0.40), suggesting their removal. Cronbach's Alpha for the total score of the QOLIH questionnaire (Q1-12) in the Egyptian patients was 0.940, and in the Turkish patients, it was 0.938, indicating excellent internal consistency. There were statistically significant correlations of a strong degree between QOLIH total score and HIT-6, SF-12, and LVQOL total scores in Egyptian and Turkish patients (r coef. > 0.7). The final Arabic and Turkish versions of QOLIH questionnaire consist of 12 items. Both versions are valid and reliable tools that can be used in the assessment of QOL in IIH patients.

BackgroundLittle is known about confirming that an employment environment is truly inclusive and accessible for people with visual impairments (low vision and blindness). Advocacy, policy development, and decades-long calls for inclusive practice have aimed to address the high unemployment rates among those with visual impairments. A one-size-fits-all, inclusive approach that focuses on preparing people with visual impairment (PVI) for employment has been the practice. Yet, job acquisition (54% employment rate) and retention remain challenging.ObjectiveThis study explored the aspect([s) of the employment environment readiness to support the inclusion of people with visual impairment.MethodsWe employed a co-creation approach to gather insights from employees with visual impairment and employment domain experts through twelve virtual interviews and four focus groups (Zoom). The transcripts from the recorded sessions were analyzed using thematic analysis.ResultsThe findings highlight three main themes critical to workplace preparedness: willingness, education and experience, and collaboration. Sub-themes include support, leadership, and resource allocation, among others. Effective preparedness depends on addressing knowledge and practice gaps, fostering collaboration, being vulnerable in seeking necessary help, and clear communication. Generally, intangible factors (non-physical) were deemed more important than tangible ones (e.g., assistive devices).ConclusionAssessing and prioritizing workplace readiness is crucial for creating sustainable employment opportunities for individuals with vision impairment. The factors described in this study can inform the development of assessment tools that support both organizations and policymakers. Enhancing data collection for evidence-based policymaking and enforcing compliance checks to promote workplace inclusivity for people with vision impairment.***This manuscript is based in part, on one of the author's dissertations.

Background: Visual impairment constitutes a significant public health concern, affecting a large number of individuals on a global scale. The impact of visual impairment on the daily lives of individuals is considerable, in particular with regard to the administration of medications and interactions with community pharmacists. Community pharmacists occupy a pivotal role as a point of contact for visually impaired patients. The pharmacy is a place of reception and support, and therefore must provide the best possible services to all its patients. Consequently, it is imperative to gain an understanding of the specific needs of visually impaired individuals, who are particularly vulnerable, to facilitate their inclusion in healthcare. Approach: The objective of this study was twofold: firstly, to examine the perceptions, challenges, and needs of visually impaired individuals in managing their medications; secondly, to enhance pharmacist-patient communication and ensure more accessible and inclusive healthcare for these individuals. A qualitative study was conducted with French-speaking visually impaired individuals living in Belgium. The participants were recruited voluntarily, and an interview guide comprising six main topics was developed based on a comprehensive literature review. Semi-structured interviews were carried out until theoretical data saturation was reached, recorded, transcribed verbatim, and analysed in a double-blind fashion using abductive thematic and interpretative phenomenological analyses. The data were organised by NVivo® 14 software, and a Cronbach's α coefficient was calculated using IBM® SPSS 29 Advanced software to verify the reliability of the analyses. Results: Two dimensions, psychological and pharmaceutical, were explored in the semi-structured interviews. In total, 19 interviews were conducted, and seven themes were identified. The Cronbach's alpha coefficient was 0.938, indicating that the analyses were highly reliable. From a psychological perspective, the experience of individuals with visual impairment appears to be linked to their family and social context. The emotional states of visually impaired individuals and the actions of their family members and friends, who occasionally assume the role of informal caregivers, can be either beneficial or detrimental. The relationship they have with their pharmacist is also important, especially in regard to the relational aspect and the knowledge of visual impairment. During the interviews, visually impaired individuals indicated that pharmacists do not frequently offer additional guidance beyond dosage and storage instructions. They also reported that they devised themselves strategies to facilitate the administration of their medications (color-coding system, touch to identify medications, memory, or assistive products). Implications: Visual impairment is a complex phenomenon that is influenced by a variety of factors. Consequently, adaptation systems are necessary at all levels of the society (micro, meso, and macro) to provide visually impaired individuals with the best living conditions and people-centred care. The results of this qualitative study offer valuable insights that can inform the development of recommendations for community pharmacists.

PurposeThe visual accessibility of fonts refers to the range of print sizes and efficiency with which readers can access text. One goal of font design may be to maximize accessibility for a wide range of users including those with low vision. Here, we compare behavioral and automated methods for evaluating the accessibility of a font for both normal and simulated low vision.MethodWe evaluated the accessibility of a newly designed font, ACT Easy. In Experiment 1, we used a behavioral (psychophysical) approach to compare regular and bold versions of ACT Easy to Courier, Frutiger, and Gotham. 22 normally sighted young adults were tested with a computerized version of MNREAD in two conditions: normal viewing, and text digitally filtered to simulate moderate low vision (20/90 acuity). The outcome measures were reading acuity, critical print size, maximum reading speed, and participants’ preference rankings. In Experiment 2, we used an automated method to estimate the equivalent of reading acuity for eleven state-of-the-art Optical Character Recognition models. The models read MNREAD sentences in ACT Easy and five mainstream fonts. We explored how accurately the models mimicked human performance.ResultsIn Experiment 1, ACT Easy Regular compared well in reading acuity and critical print size with Courier, the best of the other fonts for both normal and simulated low-vision conditions. ACT Easy Regular and Gotham were favored in the preference rankings. In Experiment 2, nine of the eleven OCR models showed changes in reading acuity similar to humans in the normal and simulated low-vision conditions. Two of the models also exhibited human-like variations across fonts.ConclusionsBehavioral and automated methods are both capable of revealing subtle differences in the visual accessibility of fonts. The behavioral method requires labor-intensive human testing. The automated method does not require human testing, and may sometimes provide a practical alternative.

To characterize the features of open globe injuries (OGIs) and the visual outcomes of pediatric patients using a modified Pediatric Ocular Trauma Score (POTS). A retrospective chart review was conducted of pediatric patients presenting to a Level I Trauma Center with unilateral OGIs from 2015 to 2023. Demographic data, injury characteristics, clinical findings at presentation, surgical timing, and visual outcomes were analyzed. The POTS was calculated to assess its prognostic value. A total of 53 individuals were analyzed (mean age: 9.3 ± 5.3 years). Blunt trauma accounted for 69.8% of injuries, most of which occurred at home (54.7%). More than half (52.8%) were transferred from outside facilities, and surgical repair was performed within 48 hours in 60.4% of cases. Most injuries were zone I (83.0%). Uveal prolapse (71.7%) and traumatic cataract (39.6%) were frequently observed. At presentation, 5.7% had no light perception (NLP) and 35.8% had light perception/hand motion (LP/HM). Three-month follow-up best corrected visual acuity (BCVA) was available for 25 patients (47.2%); among these, 76% achieved a final BCVA of 0.1 or better. The POTS for all patients was 53.9 ± 19.9. For individuals with follow-up, mean POTS were correlated with final BCVA: LP/HM (47.5), CF (37.5), 0.1 to 0.5 (56.5), and 0.6 to 1.0 (70.0). This evaluation of pediatric OGIs found mainly zone I injuries causing LP/HM visual acuity. The incorporation of POTS highlights the potential for visual recovery in some patients, with 24% achieving 20/32 BCVA at 3 months of follow-up. These data support POTS as a prognostic tool for physicians managing OGIs in children.

ABSTRACT Clinical relevance Services for patients with low vision and blindness aim to improve their well-being. This can be achieved by understanding the effects of vision loss on all aspects of life, thereby enabling clinicians to design appropriate rehabilitation models. Background This study explored the socioeconomic impact of low vision and blindness, mainly due to untreatable bilateral eye diseases, on individuals and their households. Methods A cross-sectional study conducted at a low-vision clinic, in which participants were interviewed regarding socioeconomic changes following visual impairment. Multivariable logistic regression was used to identify predictors of income reduction. Results A total of 110 patients (mean age 51.4 ± 14.6 years) were enrolled. Retinitis pigmentosa was the leading cause of visual impairment (35.4%), followed by optic atrophy, glaucoma, and age-related macular degeneration. Following vision loss, 41.8% of patients became unemployed. A significant occupational shift occurred, with many transitioning from professionals to having no occupation (p < 0.001). The primary monthly income of patients decreased significantly (p < 0.001), and the proportion of patients with no income increased (7.3–50.9%). Multivariable analysis showed significant associations between primary income reduction and age groups of 31–40 years (adjusted odds ratio [AOR] 10.7, 95% CI: 1.2–96.0, p = 0.035), 51–60 years (AOR 8.4, 95% CI: 1.2–59.9, p = 0.034), and over 60 years (AOR 46.5, 95% CI: 4.8–445.6, p < 0.001). Although not significant, the income decline was greater in patients with poor visual acuity or large peripheral field loss than in those with central scotoma. Most patients had family caregivers who remained employed. Conclusion Low vision and blindness due to incurable bilateral eye disease were associated with substantial income loss and transition out of paid employment, underscoring the need for integrated rehabilitation and social protection policies to address functional and socioeconomic needs.

This study presents a 35-week training and assessment program designed to enhance the physical fitness, strength, and endurance of adult female goalball athletes with visual impairments. Recognizing the unique demands of physical training for athletes with disabilities, particularly those with visual impairments, the program was developed to support their preparation for the Goalball World Championship (GWCC). The training program included 2–3 weekly physical fitness sessions. Assessments were conducted at weeks 1, 22, and 31 to objectively evaluate strength, using three 10RM exercises (i.e., the maximum resistance that the athlete can perform with correct technique for 10 repetitions), and aerobic fitness, measured through running on a treadmill or cycling on a stationary bicycle. Significant and consistent improvements were observed in body weight and BMI, 10RM strength, and aerobic fitness over the 35-week period. These enhancements in physical fitness underscore the effectiveness of the training program. The training and assessment program presented in this study is designed for female adult athletes with visual impairments of all degrees, with general adjustments made to each exercise and personalized modifications tailored to each athlete. While the program is specifically focused on athletes with visual impairments, the principles and methods may also be applicable to other populations with specific needs, though further research is required to determine its broader applicability. This program provides a structured approach to improving physical fitness among visually impaired athletes, with measurable outcomes in strength and aerobic fitness. Practitioners can adapt the methods and assessments described to suit individual needs and ensure a safe and effective training environment that supports athletic performance.

Although Japan has an established welfare system for individuals with visual impairments, medical-welfare coordination remains limited. To address this gap, the Low Vision Care Hub (LVCH) was established within a university hospital. We evaluated the impact of LVCH on visitor satisfaction before and after consultation STUDY DESIGN: A single-center, one-group pre-post study METHODS: Individuals with self-reported functional vision difficulties who visited LVCH between July 1 and December 20, 2024 were included. Consultation was provided based on seven domains of low vision care outlined by the Japan Society for Low-Vision Research and Rehabilitation. Satisfaction was measured on a custom 6-point ordinal scale (0-5) pre/post consultation. Changes in satisfaction scores were analyzed using the Wilcoxon signed-rank test. Multivariable logistic regression adjusted for potential confounders RESULTS: Ninety-three participants were included. Satisfaction scores significantly increased after consultation (p < .001) and improvements were consistent across sex, age groups, and visual impairment classification using the International Council of Ophthalmology (ICO) criteria (all p < .001). Notably, participants not meeting the ICO-defined low vision criteria also improved (p < .001). On multivariable logistic regression, only older age (≥ 60 years) remained significantly associated with a markedly improved satisfaction score (OR = 2.98, 95% CI 1.10-8.05, p = .03) CONCLUSION: Consultations provided at LVCH significantly improved visitor satisfaction, including those who did not meet the ICO low vision criteria. Consultation may be particularly effective in individuals aged over 60 years. Overall, early-stage intervention through structured consultation may benefit individuals with functional vision difficulties.

Aims: To examine (1) the etiological patterns of low vision across pediatric, working-age, and geriatric populations; (2) the severity distribution of visual impairment; and (3) the prescription trends of low-vision devices (LVDs) at a single tertiary eye care centre in western India.Methods: This single-center retrospective study reviewed the records of 1,039 patients who visited a low-vision clinic between January 2019 and April 2024.Demographic details, ocular diagnoses, visual acuity [classified per International Statistical Classification of Diseases and Related Health Problems, 10 th Revision (ICD-10)], and LVD prescriptions were analysed. Results:The cohort consisted predominantly of male patients (70.0%), with the following age distribution: working-age adults (45.0%; mean age 38.916.1 years), children (40.2%; mean age 10.23.3 years), and geriatric patients (14.7%; mean age 76.06.6 years).Retinal disorders (57.8%) were the leading cause of low vision, with age-specific variations: nystagmus (17.9%) and congenital cataracts (20.3%) in children; retinitis pigmentosa (25.0%) and diabetic retinopathy (25.6%) in working-age adults; and agerelated macular degeneration (37.9%) and cataracts (55.6%) in the geriatric population.Moderate visual impairment was most common (48.8%), followed by blindness (25.9%).Telescopes were the most frequently prescribed LVDs (72.9%), and spectacle magnifiers were the most common near-vision aid (83.4%). Conclusions:The findings highlight distinct age-related patterns in the etiology of low vision and assistive device needs within this patient population.Although limited by its single-centre scope, this study offers valuable baseline data to guide age-specific rehabilitation strategies.

Low vision (LV) services are likely to become more in demand as the prevalence of vision impairment increases. Primary eye care clinicians represent a substantially underutilised resource for LV service provision and increasing their participation could considerably improve service capacity and accessibility. This study aimed to gain a comprehensive in-depth theory-based understanding of factors influencing participation of primary eye care clinicians in LV services to inform the evidence base for future behaviour change intervention design. Semi-structured one-to-one interviews using topic guides based on the capability, opportunity, motivation - behaviour (COM-B) system were conducted with a maximum variation sample of primary eye care clinicians and other relevant stakeholders. Thematic data analysis was undertaken; codes were inductively generated then mapped to domains of the theoretical domains framework (TDF) to generate themes and subthemes, which were mapped back to the COM-B system. A total of 31 individual interviews were conducted. Multiple TDF domain themes and subthemes were found to influence primary eye care clinicians' participation in LV services, including knowledge (knowledge gaps); memory, attention and decision processes (case identification); social influences (professional support and influences, clinician-patient relationships, interprofessional relationships); environmental context and resources (funding and commissioning, practice resources); intentions (passion); beliefs about consequences (LV outcome expectations); beliefs about capabilities (confidence); goals (profitability); professional role and identity (scope of practice); reinforcement (rewards) and emotion (enjoyment, clinician wellbeing). This is the first study to qualitativelyexplore factors influencing participation of primary eye care clinicians in LV services and to explicitlyapply behaviour change theory to do so. It provides a novel, comprehensive, in-depth and theory-based understanding of influences on primary eye care clinicians' participation in LV services. This evidence base is fundamental to designing successful theory-informed behaviour change interventions which aim to increase primary eye care clinicians' participation and facilitate LV service expansion.