Diagnosis Of Visual Impairment Research Articles

Assessment and treatment of multiply maintained self injury for a visually impaired elementary student with autism

AbstractAssessment of challenging behavior via functional analysis (FA) and subsequent treatment including functional communication training (FCT) is a common approach to treating severe problem behavior for individuals with autism and intellectual disability. Assessment and treatment for these behaviors exhibited by individuals who have a co‐occurring diagnosis of visual impairment and autism spectrum disorder present unique challenges to this approach. The current study included an 8‐year‐old White, visually impaired male on the autism spectrum who engaged in self injurious behavior (SIB). Based on the results of the FA, conducted in his classroom, the researchers began FCT to address the multiple maintaining functions of SIB. Results suggest that adaptations to FCT may be necessary for visually impaired individuals on the autism spectrum to make the communication response more salient to the individual and establish independent communication responses.

Visual impairment service review

Aims: To assess the quality of documentation of patients with a visual impairment within a neurosurgery department to see if they have a corresponding vision alert within their medical notes. Methods: Retrospective case note analysis over 3 years of neurosurgical patients diagnosed with a space occupying lesion involving the anterior fossa near the optic apparatus was conducted. Post-surgical clinical assessment validated by formal visual assessment revealed 56 patients had a visual impairment diagnosis. Visual acuity and visual field mean deviations in the best eye were studied, along with the documentation of a vision alert. A total of nine patients did not meet the inclusion criteria and were removed from the study. Results: Out of 47 patients, four were found to have a severe sight impairment. Only 11 (23.40%) patients had a vision alert on their medical records. Out of the 47 patients with a visual impairment, three patients certified as sight impaired and severely sight impaired (75%) did not have a vision alert on their medical record. Conclusions: Although visual impairment was common in this study population, most patients had useful vision. Documentation to alert clinicians and carers about visual impairment was poor and needs improvement.

Burden and depression among informal caregivers of visually impaired patients in Mexico

BackgroundThe needs of informal caregivers who provide care to family relatives with visual impairment are often neglected, resulting in burden and depression. ObjectiveTo determine the degree of burden and the prevalence of major depression experienced by caregivers, defined as non-paid family relatives, of legally blind individuals in a Mexican population. MethodsObservational, single-center, cross-sectional study in adults providing care to their family relatives with visual impairment (visual acuity ≤ 20/200 in the best eye for at least 3 months). According to visual impairment degree, care provided included activities of daily living (ADL) and instrumental ADL. Burden of care was evaluated with the Zarit burden interview (ZBI)-22 and the prevalence of major depression was determined by the patient health questionnaire (PHQ)-9. Results115 patients and 115 caregivers were included. Male caregivers had significantly higher ZBI-22 (28.7 ± 15.5 vs. 19.2 ± 12.6, p = 0.001) and PHQ-9 (10.0 ± 5.5 vs. 5.3 ± 5.1, p < 0.001) scores than females. Likewise, parent caregivers of adult children and the hours of daily care were significantly associated with higher burden and depression scores. A significant linear correlation between ZBI-22 and PHQ-9 scores in caregivers was also found (r = 0.649, p < 0.001). ConclusionsMale caregivers, parent caregivers of adult children, and caregivers providing greater hours of care were at higher risk of burden and depression. Upon diagnosis of visual impairment, adults providing care to visually impaired family relatives should be screened for burden and depression and referred to a mental health specialist when necessary. Tailored interventions targeting the caregivers’ needs are required to reduce burden and depression.

Relationship between the Children’s Visual Function Questionnaire and psychophysical measures of visual acuity and chromaticity discrimination in older visually impaired children

The Children’s Visual Function Questionnaire (CVFQ) is an instrument to measure the impact of visual impairment in children and their families. It can be used as a research tool to verify the effectiveness of treatment, therapy, and different methods for visual stimulation and rehabilitation. The aim of this study is to describe the relationship between General Health, General Vision Health, Personality, Family Impact, and Treatment – subscales of the CVFQ and psychophysical measures of visual acuity (VA) and chromaticity discrimination (CV). This prospective, cross-sectional study was conducted at the Sensory Psychophysiology Laboratory – University of São Paulo in partnership with the Ambulatory of Visual Stimulation in the Sector of Low Vision and Visual Rehabilitation – Federal University of São Paulo. The children who participated in this study were divided into two groups: study group (SG), composed of 11 children with a diagnosis of visual impairment and mean age of 55.36 months ( SD = 16.88), and control group (CG), composed of 8 children with normal vision and mean age of 64.87 months ( SD = 13.22). Both groups underwent the application of CVFQ, were tested for VA using the Teller Acuity Cards (TAC) test, and CV using the Cambridge Colour Test program for children (CCT Kids). The result of applying the CVFQ to groups of children over 3 years, comparing SG and CG, differences were observed in the following subscales: General Vision Health ( F = 10.00, p &lt; .001); Competence ( F = 7.03, p = .030); Personality ( F = 6.48, p = .010); Total Quality of Life ( F = 11.39, p = .010). These differences show a worse score for the SG. In the VA test using TAC, the data collected in groups of children over 3 years, comparing SG and CG, differences were observed in VA RE ( F = 19.25, p &lt; .001); VA LE ( F = 25.99, p &lt; .001); VA BE ( F = 15.45, p &lt; .001). These differences show worse scores for the SG. In the CV using the CCT Kids, the data collected in groups of children over 3 years, comparing SG and CG, no statistically significant differences for protan, tritan, and deutan groups were observed. For the SG, while for children over 3 years, correlations were found for General Vision Health, Competence, Family Impact, and General Quality of Life. We conclude that there are statistically significant differences when comparing the SG with the CG for the visual function of visual acuity and chromaticity discrimination, and we also demonstrated the sensitivity in the use of CVFQ in reflect VA and CV impairments.

Generation of a Transplantable Population of Human iPSC-Derived Retinal Ganglion Cells.

Optic neuropathies are a major cause of visual impairment due to retinal ganglion cell (RGC) degeneration. Human induced-pluripotent stem cells (iPSCs) represent a powerful tool for studying both human RGC development and RGC-related pathological mechanisms. Because RGC loss can be massive before the diagnosis of visual impairment, cell replacement is one of the most encouraging strategies. The present work describes the generation of functional RGCs from iPSCs based on innovative 3D/2D stepwise differentiation protocol. We demonstrate that targeting the cell surface marker THY1 is an effective strategy to select transplantable RGCs. By generating a fluorescent GFP reporter iPSC line to follow transplanted cells, we provide evidence that THY1-positive RGCs injected into the vitreous of mice with optic neuropathy can survive up to 1 month, intermingled with the host RGC layer. These data support the usefulness of iPSC-derived RGC exploration as a potential future therapeutic strategy for optic nerve regeneration.

Ophthalmologic Abnormalities in Children with Congenital Sensorineural Hearing Loss

ABSTRACTObjective: To review a single center experience with the diagnosis of visual impairment in patients with sensorineural hearing loss (SNHL) and propose a diagnostic algorithm.Study Design: Retrospective study of patients with SNHL who were diagnosed with ophthalmologic abnormalities in the course of evaluation.Setting: University children’s hospital and university-associated eye institute.Subjects and Methods: Children with the diagnosis of sensorineural hearing loss aged 0–18 who received a formal ophthalmology examination between the dates of December 2000-December 2016 were included for analysis. Children were identified using ICD-9 and ICD-10 billing codes. Primary measures included diagnosis of SNHL, ophthalmologic diagnoses, and referral source.Results: Two hundred and sixty-nine patients with SNHL met inclusion criteria. One hundred and thirty-one (48.5%) of these patients had an ophthalmic abnormality. When evaluating referral source, patients referred by a pediatrician following failed vision screen or visual complaint were more likely to have an ophthalmologic finding (61%, n = 147) when compared to referral by an otolaryngologist following diagnosis of SNHL (9.6%, n = 73). Seventeen of the 131 (13%) patients with at least one ophthalmic abnormality had an abnormality that was deemed unlikely to be detected by routine screening.Conclusion: Our study agreed with previously published works that there is a high rate of ophthalmic abnormalities in patients with SNHL. Evaluation of referral source for ophthalmology evaluation suggests that routine referral by otolaryngologists in patients with SNHL may not be an efficient means of identifying patients with treatable ophthalmic disease. Reliance on school and office screenings to detect ophthalmic abnormalities, prior to referral, is likely a more efficient model, even among patients with SNHL.

Diabetic foot ulcer: risk factors among patients of a secondary healthcare facility in south west Nigeria

Background : Diabetic foot ulcer is a common long term complication of diabetes and the most common cause of non-traumatic amputation and prolonged hospitalization. These increases disease burden and further worsen quality of life. Aim : This study evaluated exposure risk factors for foot ulcers among diabetics attending a secondary healthcare facility in Southwest Nigeria. Methods : A case control study of exposure risk factors for diabetes foot ulcer (DFU) at General Hospital Marina Lagos. Using a structured interviewer administered questionnaire, information on foot care education, 24-hour dietary recall, medical history, anthropometric indices and social habits of participants were obtained and analyzed. Results : There were 636 participants in this study (106 cases and 530 controls) with median age of 61.1±11.0 years in both study groups and mostly females, (75.5% in cases and 78.7% controls) with female to male ratio of 3:1. Majority, (83% in cases and 85% in controls) were in the low socioeconomic class and had lived with DM for more than 5years. Of the studied risk factors, lacking foot care education, diagnosis of visual impairment and hypertension, dietary intake of large proportion of carbohydrate meal at breakfast and dinner and obesity occured in significantly higher proportion of cases and controls and were associated with presence of DFU. (p<0.05)  Conclusions : Lack of foot care education, diagnosis of visual impairment, hypertension and poor dietary habit are associated with presence of DFU. Addressing these factors from point of diagnosis will go a long way in stemming the burden of diabetes foot ulcer.  Funding: Self-funding. Keywords: Diabetes, foot ulcer, exposure risk factors, Southwest Nigeria.

Flash Visual Evoked Potentials in the Diagnosis of Visual Impairment in Infancy

Flash Visual Evoked Potentials in the Diagnosis of Visual Impairment in Infancy

Permanent neonatal diabetes mellitus and neurological abnormalities due to a novel homozygous missense mutation inNEUROD1

The basic helix-loop-helix (bHLH) transcription factor, neuronal differentiation 1 (NEUROD1) (also known as BETA2) is involved in the development of neural elements and endocrine pancreas. Less than 10 reports of adult-onset non-insulin-dependent diabetes mellitus (NIDDM) due to heterozygous NEUROD1 mutations and 2 cases with permanent neonatal diabetes mellitus (PNDM) and neurological abnormalities due to homozygous NEUROD1 mutations have been published. A 13 year-old female was referred to endocrine department due to hyperglycemia. She was on insulin therapy following a diagnosis of neonatal diabetes mellitus (NDM) at the age of 9-weeks but missed regular follow-up. Parents are second cousin. There was a significant family history of adult onset NIDDM including patient's father. Auxological measurements were within normal ranges. On laboratory examination blood glucose was 33.2 mmol/L with undetectable c-peptide and glycosylated hemoglobin level of 8.9% (73.8 mmol/mol). She had developed difficulty in walking at the age of 4 years which had worsened over time. On further evaluation, a diagnosis of visual impairment, mental retardation, ataxic gait, retinitis pigmentosa and sensory-neural deafness were considered. Cranial magnetic resonance imaging revealed cerebellar hypoplasia. Molecular genetic analysis using targeted next generation sequencing detected a novel homozygous missense mutation, p.Ile150Asn(c.449T>A), in NEUROD1. Both parents and 2 unaffected siblings were heterozygous for the mutation. We report the third case of PNDM with neurological abnormalities caused by homozygous NEUROD1 mutation, the first caused by a missense mutation. Heterozygous carriers of the p.Ile150Asn mutation were either unaffected or diagnosed with diabetes in adulthood. It is currently unclear whether the NEUROD1 heterozygous mutation has contributed to diabetes development in these individuals.

Optimizing safety for the visually impaired patient

Information and support are crucial for successful adaptation after a visual impairment diagnosis.

Familiarity, Use and Perceived Effectiveness of Evidence Based Practices Among Teachers of Students with Visual Impairment and other Comorbid Conditions

Students who have comorbid conditions, diagnosis of Visual Impairment (VI) coupled with other disabilities have specific areas of need of which teachers who only have experience with the visually impaired (TVIs) are expected to identify and address. As such TVIs in a Midwestern state (N=56) completed a survey which asked them to report their level of familiarity, use, and perceived effectiveness of Evidence-Based Practices (EBPs) in their classrooms. Results show much incongruity in the familiarity, use, and perceived effectiveness of EBPs by TVIs. The data indicates that TVIs may need more resources and consistent training in practices that go beyond what they know in order to meet the needs of all students in their classrooms.

Book Review: “Religious Beliefs of Parents of Children with Visual Impairments

Religious Beliefs of Parents of Children with Visual Impairments, by Jane N. Erin, Dale Rudin, and Michael Njoroge, published in the April 1991 issue of the Journal of Visual Impairment & Blindness, Volume 85, Number 4, pp. 157-162. About 15 years ago, I read a thought-provoking article in the Journal of Visual Impairment & Blindness (JVIB), entitled Religious Beliefs of Parents of Children with Visual Impairments, by Jane N. Erin, Dale Rudin, and Michael Njoroge. At the time, I had just begun my master's studies at the University of Arizona and formal training to become a teacher of students with visual impairment, a milestone that also marked my introduction to JVIB. Prior to graduate school, I had worked in the field of visual impairment for over five years at two completely dissimilar and unequal residential schools. I was a paraeducator for the Texas School for the Blind and Visually Impaired (TSBVI), in Austin, and a Peace Corps volunteer for the Organization Alaouite pour la Protection des Aveugles (OAPAM) [Alawite Organization for the Protection of the Blind], in Fez, Morocco. While TSBVI offered students a swimming pool, bowling alley, and specialized running track, the children at OAPAM were surprisingly skilled at playing soccer using a balled-up piece of braille paper. In addition to a lack of recreational facilities, unfortunately, the goodhearted teachers at OAPAM also received very little training to teach students with visual impairments. Even though religious affiliation varies between the United States and Morocco, the influence of religion on beliefs about disability is universal. When parents first learn that their child is visually impaired, their expectations for the child's future often feel crushed. The authors of the article I chose to highlight in this essay aptly note that the diagnosis of visual impairment can destabilize parents' religious beliefs. In a survey of 161 parents of children with visual impairments, immediately after their children's births, 20% felt that the presence of visual impairment was punishment from God. This percentage decreased to 5% as time passed. The authors suggested that parents might undergo a temporary shift in religious beliefs, which is a natural early stage of the grieving process that individuals often experience when confronted with visual impairments. The authors made clear that the voices of parents are crucial ones to listen to, and they encouraged practitioners to engage in dialogue with parents about their needs: The professional who questions or criticizes a family's belief system, even when those beliefs seem to contradict an educational goal, risks losing the trust and cooperation of family members (p. 161). Early in my career as a paraeducator at TSBVI, I had an experience that illustrates the importance of listening to families and compromise as described in the article. I worked with a young, energetic African American boy with deafblindness. His grandmother was his legal guardian, and she communicated to the Individualized Education Program (IEP) team that she wanted her grandson to learn to be able to sit quietly for church service. Rather than dismiss her concern, the educational team developed strategizes to gradually increase his time in quiet, seated engagement with a few favorite toys. This skill, of course, helped him with other tasks that involved sitting calmly, in particular during long bus rides to and from school. This article also resonated with me, because I was introduced to it soon after my Peace Corps assignment. A major responsibility of a Peace Corps volunteer is to build cross-cultural understanding and share the knowledge and experience gained from the host country service. …

The influence of visual impairment on pregnancy outcomes.

To investigate whether visually impaired women are at higher risk for adverse maternal and perinatal complications, with an emphasis on visual impairment due to autoimmune etiology. A retrospective cohort study compared obstetric, delivery complications and perinatal outcomes of patients with and without a diagnosis of visual impairment in one or both eyes. Multivariable models were conducted to control for confounders. During the study period (1988-2012), 265,741 deliveries were included; of these 80 (0.03%) occurred in visually impaired patients. These patients were significantly older than the comparison group, and had higher rates of gestational diabetes mellitus (GDM) and severe preeclampsia. Visually impaired women had higher rates of delivery prior to 37 weeks gestation and significantly higher rate of delivery by cesarean section (CS). A multivariable analysis model demonstrated that the risk factor for CS and packed cell transfusion in visually impaired women remained significantly high even after controlling for confounders such as maternal age, ethnicity, etc. (weighted OR = 2.04; 95% CI 1.23-3.37; p = 0.006). However, visual impairment was not an independent risk factor for congenital malformations, using another multivariable model (weighted OR = 1.96; 95% CI 0.99-3.85; p = 0.051). Perinatal outcome was comparable between the groups. The sub-group of visually impaired women due to possible autoimmune etiology was 19.4% and they had higher rates of recurrent miscarriages and CS compared to the other sub-groups. Visually impaired pregnant women are at high risk for CS and packed cell transfusion. Nevertheless, perinatal outcome is comparable to the general population.

Accuracy of referrals for visual assessment in a stroke population

To evaluate accuracy of referrals from multidisciplinary stroke teams requesting visual assessments. Multicentre prospective study undertaken in 20 acute Trust hospitals. Stroke survivors referred with suspected visual difficulty were recruited. Standardised screening/referral and investigation forms were used to document data on referral signs and symptoms, plus type and extent of visual impairment. Referrals for 799 patients were reviewed: 60% men, 40% women. Mean age at onset of stroke was 69 years (SD 14: range 1-94 years). Signs recorded by referring staff were nil in 58% and positive in the remainder. Symptoms were recorded in 87%. Diagnosis of visual impairment was nil in 8% and positive in the remainder. Sensitivity of referrals (on the basis of signs detected) was calculated as 0.42 with specificity of 0.52. Kappa statistical evaluation of agreement between referral and diagnosis of visual impairment was 0.428 (SE 0.017: 95% confidence interval of -0.048, 0.019). More than half of patient referrals were made despite no signs of visual difficulty being recorded by the referring staff. Visual impairment of varying severity was diagnosed in 92% of stroke survivors referred for visual assessment. Referrals were made based predominantly on visual symptoms and because of formal orthoptic liaison in Trusts involved.

An inquiry into the emotional impact of sight loss and the counselling experiences and needs of blind and partially sighted people

AbstractBackground: The link between sight loss and depression is well documented. The UK Vision Strategy seeks to bring the emotional impact of sight loss into public awareness and improve access to emotional support for visually impaired people. However, dedicated counselling services for visually impaired people remain scarce, and research into the effectiveness of psychological interventions is predominantly anecdotal rather than evidence based. Aim: To explore the emotional impact of sight loss in four core areas (mood, self concept, social connectedness and loss), and to explore the counselling experiences and needs of blind and partially sighted adults. Method: Data were collected using the mental health and social functioning sub‐scales of the National Eye Institute Visual Functioning Questionnaire‐25 and semi‐structured interviews transcribed and analysed using grounded theory. Results: Participants with a serious eye condition shared a common transition from sight to blindness, starting with diagnosis, coping with deterioration of sight, experiencing loss in different areas of life, experiencing changed perceptions of self in relation to society, experiencing others in a changed way and experiencing rehabilitation. A theoretical model describing the transition from sight to blindness is proposed. Participants reported negative perceptions of counselling and a lack of counselling opportunities in relation to their sight loss. Implications: The implications for policy and practice are discussed, particularly the need for counselling after diagnosis of visual impairment and the specific challenges facing those who deliver counselling to blind and partially sighted clients.

Visual impairment in an aged care ward

Introduction:  Visual impairment is common in older people, and is a risk factor for falls and hip fractures, reduced independence and quality of life. Objectives:  To assess the prevalence and causes of visual impairment in an aged care ward, and to evaluate whether routine eye assessment, and referral to an eye specialist was worthwhile to detect patients with low vision that could be correctable. Method:  Clinical eye examination of 100 consecutive inpatients and review of medical records. Patients with a new diagnosis of visual impairment were referred for ophthalmology or optometry assessment. Results:  The prevalence of low vision was 36% and the prevalence of blindness was 9%. There were 18 patients referred for specialist review, three patients were recommended a new treatment but only two received treatment. Conclusion:  Visual impairment was prevalent. Although refractive error and cataracts were common, in only a few cases did detection and specialist referral lead to improved visual outcomes.

O faz-de-conta em crianças com deficiência visual: identificando habilidades

O presente trabalho tem por objetivo descrever modos de brincar de crianças com deficiência visual na situação de brincadeira faz-de-conta em pequenos grupos, enfocando a construção de conhecimentos. Participaram do projeto quatro crianças de quatro a sete anos, com diagnóstico de deficiência visual (baixa visão ou cegueira), algumas com outros problemas orgânicos associados. A maioria freqüentava pré-escola; e várias crianças eram caracterizadas por alterações no desenvolvimento e/ou apresentavam dificuldades escolares. Foram realizadas seis sessões com dois grupos de crianças, que duravam em média 25 minutos, nas quais eram oferecidos diferentes brinquedos propícios ao faz-de-conta (miniaturas de cozinha e quarto, bonecos e carrinhos). As sessões foram filmadas, transcritas e analisadas, buscando-se selecionar trechos representativos de capacidades das crianças, em suas várias manifestações. A análise das transcrições permitiu a identificação de capacidades das crianças, relativas a: a) reconhecimento de objetos e criação de cenas; b) criação de narrativas e faz-de-conta; c) exploração de objetos por criança que usualmente recusava qualquer tipo de contato; d) construção conjunta de significados. Considerou-se que as situações de brincadeira faz-de-conta proporcionaram o reconhecimento de habilidades que normalmente não seriam notadas em atividades cotidianas e/ou dirigidas. A interação entre parceiros e a situação de brincadeira relativamente livre, mediada por adultos, que buscavam principalmente facilitar e propiciar o brincar, proporcionou um ambiente favorável às múltiplas elaborações das crianças. Essa proposta, com foco no processo de construção de conhecimentos e habilidades permitiu descrever e promover o desenvolvimento das crianças com deficiência, mais do que caracterizá-las por suas incapacidades.

Prevalence of ocular diagnoses found on screening 1539 adults with intellectual disabilities

Objective To study the prevalence of ocular disorders in adults with intellectual disabilities (IDs) in the Netherlands. Design Cross-sectional survey. Subjects A stratified random sample (for age more than 50 years and Down syndrome [DS]) of 1598 participants drawn from a base population of 9012 adult users of ID services with mild to profound intellectual disabilities in the Netherlands. Methods Participants underwent on-site visual screening on the basis of a protocol. Results were related to degree of ID, occurrence of DS, age, and a diagnosis of visual impairment or blindness. Referral to ophthalmologists followed when visual impairment was diagnosed. Main outcome measures Diagnosis of ocular disorders and their prevalence. Results Refractive errors were most prevalent (60.6%), followed by strabismus (44.1%) and lens opacities (18.1%). Besides these, in participants diagnosed as visually impaired, cerebral visual impairment was the most common untreatable disorder (12.6%), followed by macular degeneration (5.4%). Compared with known figures from general populations, the prevalence of ocular diagnoses in adults with ID was significantly higher. The occurrence of refractive errors and strabismus was significantly related to DS (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.56 to 3.00; and OR, 2.47; 95% CI, 1.93 to 3.17, respectively). Lens opacities had an independent relation with age more than 50 years (OR, 4.23; 95% CI, 3.04 to 5.88) and DS (OR, 8.27; 95% CI, 5.95 to 11.49). Keratoconus was independently related to DS (OR, 7.65; 95% CI, 3.91 to 14.96) and degree of ID (OR, 5.56; 95% CI, 2.79 to 11.06). Corneal opacities also were related to DS (OR, 2.70; 95% CI, 1.41 to 5.18) and degree of ID (OR, 5.53; 95% CI, 2.66 to 11.48). The risk of ocular hypertension was increased by age more than 50 years (OR, 2.54; 95% CI, 1.16 to 5.57) and severe or profound ID (OR, 4.86; 95% CI, 2.06 to 10.63); DS decreased the risk (OR, 0.21; 95% CI, 0.05 to 0.94). Conclusions In 1539 adults with ID in the Netherlands, high prevalences of ocular disorders were found. Adults with ID in general have an increased risk of severe myopia, strabismus, and lens opacities; DS, older age, or severe ID further increase the risk of specific ocular disorders.

Parent Reactions/Professional Reactions to the Diagnosis of Visual Impairment in Children

Parent Reactions/Professional Reactions to the Diagnosis of Visual Impairment in Children

Early diagnosis of visual impairment in children.

Early diagnosis of visual impairment in children.