Blindness Research Articles

Bridging the Gap: Exploring Practices and Challenges for Including Children with Disabilities in Mainstream Classroom

This study aimed to explore the perception of students with disability towards the existing practice of inclusive education in mainstream schools. The qualitative research design along with interpretative phenomenological approach was employed in this study. Four students with disabilities including physical, deaf and children with visual impairment were purposively selected from integrated school located in Kathmandu Valley. In-depth interview was taken through semi-structured interview guidelines. The thematic analysis technique was applied to generate findings. The themes were discussed by linking with prospective and literature. The findings reported as setting disable friendly infrastructure, professional development opportunity for teachers, technology-based instruction and teacher’s collaboration are essential strategies for inclusion. Meaningful inclusive education practices maintain a supportive and equitable learning environment for all types of children including those with disabilities. To implement inclusive practices in the classroom, administrative hurdles, infrastructure barriers, technological barriers, environmental barriers and legislative barriers are the major challenges in practising equity strategies in the classroom. The findings can contribute to set up effective practices for combating such challenges. By using the scope of the study, the policy maker, education planners and teachers can level up appropriate strategies for increasing the access of children with disability in education.

Corticosteroid-sparing topical treatment with cyclosporin for juvenile keratoconjunctivitis

Ocular surface inflammation due to allergy and blepharitis can lead to corneal complications and visual impairment. The aim of this study is to evaluate the efficacy of a cyclosporin 0.1% topical treatment achieving steroid-sparing. Eighty pediatric patients with moderate and severe vernal and blepharitis-related keratoconjunctivitis were included. Symptoms (photosensitivity, itching, discharge, tearing), signs (corneal fluorescein staining, papillary hypertrophy) and patients’ subjective assessment were evaluated during a 6-month follow-up. At the follow-up, all patients treated with topical cyclosporin showed a significant improvement in all subjective symptoms and objective signs (p < 0.001). The total number of courses of rescue steroids courses decreased from 3.71 ± 1.72 to 0.25 ± 0.49 at month 3 and to 0.13 ± 0.38 dropping bottle at month 6 (p < 0.001 at both time points). The 96.1% of the allergic cohort and 96.4% of the blepharitis cohort experienced a satisfactory good or rapid and good effect during the 6-month follow-up. The probability of needing rescue corticosteroids increased with an odds ratio of 1.98, (95% CI: 1.19–3.28, p = 0.008) for each unit increase in Oxford score when analysing the whole cohort. Topical cyclosporin seems to be very effective reducing the number of recurrences of corneal involvement and the need for steroid treatment.

Association of ocular adverse events with varenicline solution use: a population-based study.

Approved by the FDA in 2021, varenicline solution is the first nasal spray specifically designed to enhance basal tear film production for treating dry eye disease (DED). However, there is a lack of data comprehensively comparing its safety profile to conventional DED therapies. Herein, we assess whether ocular adverse events (AEs) are disproportionately reported with the real-world use of varenicline solution. This observational, population-based pharmacovigilance study analyzed the Food and Drug Administration Adverse Event Reporting System (FAERS) data (inception-April 2024) using reporting odds ratio (ROR), with significance defined as a 95% CI lower bound > 1.0. Nasal saline and systane were the controls. A total of 1,125 AE reports were associated with varenicline solution. No disproportionate reporting of specific ocular AEs was observed when comparing varenicline solution with nasal saline. However, when compared with systane, varenicline solution showed higher odds of lacrimation (ROR = 2.18, 95%CI = 1.46-3.26, p < 0.0001), visual impairment (ROR = 2.27, 95%CI = 1.24-4.16, p = 0.0085), and photophobia (ROR = 7.50, 95%CI = 3.68-15.27, p < 0.0001). Although a direct causal relationship for higher RORs cannot be established for varenicline solution compared to systane, our findings provide evidence for potential risk signals and highlight the crucial role of post-marketing pharmacovigilance in monitoring long-term safety.

Characterization of visual cognition in pre-manifest, manifest and reduced penetrance Huntington’s disease

Cognitive and visual impairment are common in Huntington’s Disease (HD) and may precede motor diagnosis. We investigate the early presence of visual cognitive deficits in 181 participants, including HD carriers (40 pre-manifest, 30 early manifest, 27 manifest, and 6 reduced penetrance) and 78 healthy controls (HC). Significant differences in visual memory were observed between reduced penetrance and pre-manifest groups (p = .003), with pre-manifest showing worse performance. Age, education, CAG repeats, motor status, executive function, and verbal fluency, accounted for up to 72.8% of the variance in general and visual cognitive functions, with motor status having the strongest impact on visual domains in HD carriers. In pre-manifest HD, visual cognitive domains were primarily influenced by executive function, verbal fluency, age, and CAG repeats, while in early and manifest stages motor status and verbal fluency becomes more influential. ROC analyses showed that especially visuospatial abilities, visual memory, and visual attention (AUC = 0.927, 0.878, 0.874, respectively) effectively differentiated HC and pre-manifest from early and manifest HD. Early assessment of visual cognitive domains, particularly visual memory, could be an early marker of cognitive decline in HD. Our findings highlight the different profiles of impairment in visual cognition across HD carriers.

Carotid revascularization and circle of Willis in ocular ischemic syndrome: association with neovascular glaucoma and visual prognosis

BackgroundOcular ischemic syndrome (OIS) and subsequent neovascular glaucoma (NVG) lead to irreversible visual impairment. This study aimed to investigate the association of carotid artery revascularization and the collateral circulation types...

Visuospatial outcomes of a prospective national cohort of young adults with very low birthweight.

Visuospatial processing is reportedly impaired in children born very preterm (VP) compared with full term (FT) controls but there are few data for VP adults. At 26-30 years, 225 very low birthweight (VLBW) adults (70% national cohort survivors) and 100 FT controls were assessed on motor-dependent visuospatial skills using the Block Design subtest of the Wechsler Adult Intelligence Scale, and nonmotor-dependent skills by the Benton Judgment of Line Orientation and Brixton Spatial Anticipation tests. A composite score was created by summing standardized scores for the three tests. MRI measures of cortical volume, thickness and surface area were obtained for 150 VLBW participants. VLBW born adults performed less well than controls across all visuospatial measures and their composite score (P < 0.001), with moderate to large effect sizes (Cohen's ds = 0.41-0.82). Between group differences were not explained by current vision impairment, cerebral palsy, sex, ethnicity or socio-demographic factors. The unadjusted visuospatial composite score was significantly correlated with reduced cortical surface area and cortical volume, but few correlations remained significant after adjustment for age, sex and intracranial volume. The visuospatial functioning of adults born VLBW is significantly poorer than their FT peers with only modest associations with cortical brain structure. Previous reports have shown very preterm children have impaired visuospatial processing compared with term-born peers but only limited data address whether these impairments persist into adulthood. Visuospatial functioning, assessed by both motor and non-motor dependent tests, of adults born very low birthweight is significantly poorer than that of term-born peers. Poorer visuospatial functioning in this very low birthweight cohort is not explained by vision impairment and had only modest associations with cranial MRI brain structure. Persisting visuospatial impairment in very preterm adults may significantly impact quality of life. Early recognition of these difficulties could facilitate support strategies to improve outcomes.

Cerebral venous sinus thrombosis in a postpartum woman: a case report on early diagnosis and management

Introduction and importance Cerebral venous sinus thrombosis (CVST) is a rare but serious condition that can cause permanent neurological impairments if not promptly diagnosed and treated. Its nonspecific presentation, such as headache and altered awareness, often delays diagnosis. Postpartum women are at heightened risk for CVST, necessitating vigilance. Case presentation We describe a 25-year-old woman diagnosed with CVST two weeks postpartum. She presented with fever, severe headache, impaired vision, expressive dysphasia, and disturbed mental status. Magnetic resonance imaging and magnetic resonance venography confirmed multiple thrombosed cerebral sinuses. The patient was treated with low-molecular-weight heparin (LMWH), followed by rivaroxaban, and demonstrated significant clinical improvement. She was subsequently discharged on oral anticoagulation therapy. Clinical discussion This case emphasizes the significance of maintaining a high level of suspicion for CVST in postpartum women who exhibit neurological symptoms. Early detection and intervention are essential to stop the disease’s course and reduce its long-term effects. The use of anticoagulation medication, commencing with LMWH followed by oral anticoagulants like Rivaroxaban, was beneficial in this patient, illustrating the typical approach to CVST management. Conclusion CVST in postpartum women requires prompt diagnosis and anticoagulation therapy to prevent severe complications. High clinical suspicion and early intervention can mitigate long-term neurological sequelae. Further research is needed to explore intensive treatment strategies for high-risk populations.

The relation between clutter and visual fatigue in children with cerebral visual impairment.

Cerebral visual impairment (CVI) is a brain-based condition which can be exacerbated by clutter. This study aimed to explore the relation between clutter and visual fatigue in children with CVI and evaluate the effectiveness of clutter algorithm metrics in assessing visual clutter in photographs of children's play areas and the relation to visual fatigue. Visual clutter was measured using algorithmic metrics, subjective observations by a clinical researcher (who also observed visual fatigue) and a Qualtrics survey. Seventy-two children (mean performance age = 7 years 4 months) were included. Visual fatigue was present in over 90% of children. Results revealed a relation between clutter and visual fatigue observations (rs = 0.29; p = 0.01) and between visual clutter observations from researchers and Qualtrics participants (rs = 0.32; p = 0.02). Certain metrics were correlated with visual clutter observations (rs ranging from -0.30 to 0.51, p-values ranging from <0.001 to 0.03), but not with visual fatigue. Children with CVI presented with visual fatigue, particularly in cluttered environments. Therefore, parents, caregivers, teachers and clinicians should be attentive to visual fatigue signs, as early recognition and intervention can help address the child's needs more effectively. Algorithms that effectively quantify visual clutter are valuable tools that can be integrated to enhance the assessment of clutter and its relation with visual fatigue to advance CVI research methodology. However, a clinician is required to assess visual fatigue and to obtain detailed information on environmental clutter, which algorithms alone may not fully capture. Finally, we recognise that visual fatigue and the impact of clutter should be integrated into psychoeducation and the comprehensive assessment of individuals with CVI.

A case of posterior and reversible encephalopathy syndrome in a patient previously undiagnosed with lupus nephritis.

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-neuroradiologic disease associated with various conditions, such as hypertension, eclampsia, chronic kidney disease, and autoimmune diseases. Here, we present the case of the unusual occurrence of PRES with hypertensive emergency and renal insufficiency in a 37-year-old woman previously undiagnosed with systemic lupus erythematosus (SLE) and lupus nephritis. The patient was emergently admitted to our hospital with sudden onset of visual impairment, headache, and high blood pressure, and she was eventually diagnosed with PRES by brain magnetic resonance imaging (MRI). Her PRES-associated clinical symptoms and MRI abnormalities were improved following anti-hypertensive treatment with calcium channel blocker. A kidney biopsy revealed diffuse proliferative glomerulonephritis with a full-house immunofluorescence pattern and fibrinoid necrosis in small blood vessels, suggesting a class IV-G (A) lupus nephritis with vasculitis. The immunosuppressive therapy with intravenous methylprednisolone pulse followed by oral prednisolone, mycophenolate mofetil, and intravenous belimumab, attenuated SLE-associated clinical manifestations including butterfly rush, edema, renal dysfunction, and proteinuria. Our case highlights the need to consider PRES as an initial clinical presentation of lupus nephritis and provide the early diagnosis and timely treatment to achieve a favorable outcome.

Assessment of surgical smoke knowledge and exposure symptoms of the operating room team: a Turkish sample.

The aim of this study was to assess the level of knowledge of operating room (OR) staff about surgical smoke and to examine its negative effects on health. A descriptive and cross-sectional design was used. The study population consisted of the health care team working in the OR of a university and a state hospital. The sample consisted of 113 participants who met the inclusion criteria and agreed to participate in the study. Data were collected using a data collection form based on the literature. A P-value of >0.05 was considered statistically significant. The mean age of the participants was 36.10 ± 8.13 years. 61.9% of the participants had not received training on surgical smoke. It was determined that 85% of the participants were bothered by surgical smoke, always experiencing discomfort from the odour (39.9%), occasionally pain or burning in the throat (33.6%), and rarely vision impairment (31.9%) due to exposure to surgical smoke. The level of knowledge of the healthcare team working in the OR about the risks of surgical smoke and prevention measures is inadequate. Exposure to surgical smoke has been linked to adverse effects such as eye irritation, headaches, and respiratory symptoms.

In situ Forming Nanoemulgel for Diabetic Retinopathy: Development, characterization, and in vitro efficacy assessment.

Diabetic retinopathy, the most common microvascular complication of diabetes mellitus, is the leading cause of vision impairment worldwide. Flavonoids with antioxidant properties have been shown to slow its progression. Myricetin, a flavonoid polyphenolic compound, possesses antioxidant properties, but its clinical use in ocular delivery is limited by poor aqueous solubility, stability, and bioavailability. Recently, in situ gels have gained interest as ocular drug delivery vehicles due to their ease of installation and sustained drug release. This study aimed to develop a myricetin-loaded thermoresponsive in situ nanoemulgel to enhance its efficacy in treating diabetic retinopathy. Nanoemulsions were developed via aqueous phase titration using Sefsol 218 as the oil phase, Kolliphore RH40 as the surfactant, and PEG 400 as the co-surfactant. Physicochemical evaluations identified formulation batch ISG17, consisting of 10% oil phase, 30% Smix (1:2), and 60% distilled water, as the optimal formulation. The developed in situ nanoemulgel showed significant enhancement in corneal permeation and retention, which was further confirmed by fluorescence microscopy. Ocular tolerability was demonstrated through corneal hydration tests and histopathology investigations. The antioxidant potential of the myricetin-loaded nanoemulgel was assessed using the DPPH assay. Myricetin was found to be an efficient antioxidant, as indicated by its IC50 values compared to ascorbic acid. The MTT cell viability assay results showed that the developed formulation effectively inhibits the proliferation of Y79 retinoblastoma cells, demonstrating comparable efficacy to the standard marketed preparation Avastin (Bevacizumab injection). In conclusion, the nanoemulsion formulation containing a thermoresponsive polymer for in situ gelling presents a promising drug delivery system, offering superior therapeutic efficacy and better patient compliance for the treatment of diabetic retinopathy.

Application of deep learning algorithm for judicious use of anti-VEGF in diabetic macular edema

Diabetic Macular Edema (DME) is a major complication of diabetic retinopathy characterized by fluid accumulation in the macula, leading to vision impairment. The standard treatment involves anti-VEGF (Vascular Endothelial Growth Factor) therapy, but approximately 36% of patients do not respond adequately, highlighting the need for more precise predictive models to guide treatment. This study aims to develop a Hybrid Deep Learning model to predict treatment responses in DME patients undergoing anti-VEGF therapy, thereby improving the accuracy of treatment planning and minimizing the unnecessary use of costly anti-VEGF agents. The model integrates both Optical Coherence Tomography (OCT) images and clinical data from 181 patients, including key parameters such as serum VEGFR-2 concentration and the duration of DME. The architecture combines convolutional neural networks (CNNs) for image data with multi-layer perceptron (MLP) for tabular clinical data, allowing for a comprehensive analysis of both data types. These pathways converge into a unified predictive framework designed to enhance the model’s accuracy. This study utilized a Hybrid Deep Learning model that achieved an 85% accuracy, with additional metrics including precision, recall, and the area under the receiver operating characteristic curve (AUC-ROC) confirming its robustness and reliability. The findings suggest that the model accurately predicts patient responses to anti-VEGF therapy, paving the way for more personalized and targeted treatment strategies. This approach has the potential to enhance patient outcomes and minimize unnecessary administration of anti-VEGF agents, thereby optimizing therapeutic interventions in ophthalmology.

Ophthalmic Manifestations of the Mpox Virus: A Systematic Review and Meta-Analysis.

Recent outbreaks of monkeypox (Mpox) have raised concerns about its complications, including ophthalmic manifestations such as conjunctivitis, keratitis, and potential vision impairment. The lack of comprehensive data on these ocular complications hinders the development of effective clinical guidelines. This review aim to synthesize existing evidence on the prevalence and characteristics of Mpox-related ocular complications. A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus, covering studies up to September 8, 2024. Studies focusing on conjunctivitis, keratitis, eye lesions, visual impairment, and other ophthalmic outcomes in Mpox cases were included. Meta-analyses were performed using a random-effects model to estimate pooled prevalence rates, with heterogeneity assessed using the I² statistic. Sensitivity analyses and publication bias assessments were also conducted. A total of 25 studies were included, with 22 contributing to the meta-analysis. The pooled prevalence of conjunctivitis in Mpox cases was 8.9% (95% CI: 4.4%-17.1%), keratitis 3.4% (95% CI: 1.4%-7.7%), eye lesions 3.4% (95% CI: 1.4%-7.7%), and visual impairment 4.3% (95% CI: 0.8%-20.6%). Other ocular manifestations had a pooled prevalence of 12.4% (95% CI: 0.6%-76.9%). Significant heterogeneity was observed, particularly for conjunctivitis and other ocular manifestations, suggesting variability in presentation. Conjunctivitis is the most common ophthalmic complication of Mpox, followed by notable rates for keratitis, eye lesions, and visual impairment. These findings emphasize the need for early recognition, routine ocular exams, and effective management of Mpox-related eye complications. Further high-quality research is necessary to better understand and address these ocular complications.

Single and Multiple Visual Function Impairments and Associated- Vision-Related Quality of Life Impact in Older Adults Aged 60 to 100 Years.

Determine the prevalence and vision-related quality of life (VRQoL) effects of single and multiple visual function impairments (VFIs) in multi-ethnic older Asians. A total of 2380 participants from a population-based cohort study were included. Visual function comprised presenting visual acuity (VA), contrast sensitivity (CS), depth perception (DP), and color vision (CV). Rasch-transformed VRQoL was obtained using the Brief Impact of Visual Impairment questionnaire. Multiple linear regression explored the independent (mutually adjusting for each VFI) impact of bilateral single (VAI, CSI, CVI and DPI) and multiple (i.e., the co-occurrence of any two, three, or four bilateral VFI) VFIs on VRQoL. Dominance analysis estimated the relative contribution for each of the single VFI on VRQoL. The prevalence of bilateral VAI, CSI, CVI, or DPI alone was 15.3%, 20.7%, 8.1%, and 23.5%, respectively, whereas for concurrent two, three and four bilateral VFIs was 11%, 4.1% and 1.6%, respectively. Participants with single bilateral VFI (except CVI) experienced poorer overall VRQoL (β -0.25 to -0.34; all p < 0.05) compared to those without. CSI had the largest contribution (25%), to the decline in overall VRQoL. As the number of concurrent bilateral VFIs increased, VRQoL progressively worsened (% decrements -12.26% to -25.61%; all P < 0.001) compared to no VFI. Bilateral single and multiple VFIs are prevalent in older Asians. CSI had the largest contribution to VRQoL decrements. There was a systematic worsening in VRQoL scores with an increase in concurrent bilateral VFI. Comprehensive visual function testing may be warranted to prevent the debilitating consequences of VFIs on healthy aging.

Inclusive Museum Engagement: Multisensory Storytelling of Cagli Warriors’ Journey and the Via Flamina Landscape Through Interactive Tactile Experiences and Digital Replicas

This paper presents a case study from the Archaeological and Via Flaminia Museum in Cagli (Italy), developed within the ERASMUS+ Next-Museum project, which explores inclusive approaches through the digital transformation of small museums and their connection to the surrounding territory. A key goal was to “return” bronze statuettes to the museum, symbolically compensating the community for their absence. The initiative integrates accessibility and multisensory storytelling following “Design for All” principles. Three installations were implemented: tactile replicas of the statuettes produced through 3D printing, a sensorized table for interactive storytelling, and a story map displayed on a touchscreen for exploring local archaeological heritage. The design prioritized inclusivity, particularly for visitors with visual impairments, while addressing practical constraints such as the need for a mobile and flexible setup within a limited budget. Verification and validation tests were conducted with visually impaired participants during the pre-opening phase, and the installations were later evaluated using the User Experience Questionnaire, complemented by qualitative feedback. These evaluations highlight the potential of phygital experiences to foster engagement with cultural heritage while addressing technological and design challenges.

Real world data on digital remote refraction in a healthy population of 14,680 eyes

Refractive errors are the leading cause of preventable visual impairment, to which web-based remote refraction could contribute. We report real-world 2021–2022 data of the underlying algorithm and validated these to conventional prescriptions among healthy individuals (high visual acuity and satisfactied current refraction). Participants were 18–45 years with a spherical (S) error between −3.50 + 2.00S to −2.00 Diopter Cylinder (DC), reported as Spherical Equivalent (SEQ) in mean differences and 95% Limits of agreement. Consecutive measurements (n = 14,680) were assessed of which n = 6386 selected for validation. The mean difference was 0.01D(SD 0.69) and −0.73D(SD 0.92) for myopes and hyperopes respectively. This algorithm shows variation, nonetheless, 67% and 82% of myopes were within ±0.5 and ±0.75D. The test underestimates hyperopes (34% and 50% within ±0.5D and ±0.75D) and had inconsistencies distinguishing hyperopia. This proof-of-concept shows home testing has the potency to increase accessibility to care by delivering a valuable alternative for uncomplicated refractive assessments.

Advanced glaucoma detection through retinal fundus image segmentation and stacking classifier

Abstract Identification of diseases affecting the optic nerve is paramount in ophthalmology. Traditional diag nostic methods often rely heavily on manual intervention, leading to potential errors and delays.&amp;#xD;Consequently, there’s a pressing need for automated systems capable of early disease detection to&amp;#xD;initiate timely treatment, thereby averting permanent vision impairment. Glaucoma, a chronic eye&amp;#xD;condition with the potential for irreversible blindness, stands as a prime example. Recent strides in&amp;#xD;deep learning have revolutionized the diagnosis of glaucoma through the analysis of retinal fundus&amp;#xD;images. These technologies enable the development of algorithms capable of identifying subtle signs&amp;#xD;indicative of glaucoma, often imperceptible to the human eye. By harnessing vast datasets, these&amp;#xD;algorithms can learn to distinguish between healthy and diseased retinas with remarkable accuracy,&amp;#xD;facilitating early intervention and treatment. The novelty of the work comes from the combination of&amp;#xD;existing machine learning techniques on tabular datasets as well as deep learning image segmentation&amp;#xD;to increase the performance compared to using any one technique alone. The proposed methodology&amp;#xD;for glaucoma diagnosis makes use of a combination of a deep learning model and several machine learn ing and achieves Receiver Operating Characteristics Area Under Curve (ROC-AUC) of 88% (0.88)&amp;#xD;on healthy, glaucomatous and suspicious images in the testing data of the publicly available PAPILA&amp;#xD;dataset. The mean absolute error for the horizontal cup to disc ratio of 0.093 was obtained and the&amp;#xD;mean absolute error for the vertical cup to disc ratio of 0.082 was obtained on the testing dataset.&amp;#xD;

‘Yes, everyone is blindfolded but that doesn’t make it equal': the intersectional experiences of visually impaired women footballers in England

ABSTRACT In recent years, there have been concerted global efforts to develop women’s visually impaired (VI) football. However, these developments have not occurred without challenges and the players’ experiences during this significant period of progress have received no academic attention. We adopt an intra-categorical complexity approach to intersectionality to explore VI women’s experiences of becoming and being footballers. The study utilises a focus group and in-depth semi-structured interviews with a purposive sample of seven women, with differing sight conditions, who have participated in VI football in England. Using abductive analysis, we examine how the players’ lived experiences have been shaped by the complex intersections of being female, disabled and, more specifically, VI. Our analysis reveals that these intersections create inequitable outcomes for footballers with various subordinate identities. The main inequities derive from the historic marginalisation of women in disability football and include the challenges of learning a new sport, players with different sight conditions adjusting to wearing blindfolds in blind football, and tensions between players brought about by the combination of B1–B3 classes. The findings reveal the complex lived realities of VI women footballers, which have implications for key stakeholders tasked with growing the game in a manner that leads to more equitable outcomes for VI women.

Role of visual function and performance of activities of daily living in cognitive function in patients with mild cognitive impairment: a cross-sectional study

BackgroundMild cognitive impairment (MCI) is a precursor to dementia, with many patients showing early decline in activities of daily living (ADLs). However, the role of visual impairment in this process is underexplored despite evidence suggesting it may accelerate cognitive decline. Current research does not understand how visual dysfunction affects cognitive abilities and how ADLs might moderate this relationship. This gap is crucial because early interventions targeting visual impairments could potentially delay progression to dementia, offering new avenues for supporting MCI patients.ObjectiveThis study investigates the relationship between visual function and cognitive abilities in patients with MCI. Specifically, it seeks to determine how different aspects of visual function, such as visual field indices and visual acuity, correlate with various cognitive domains measured by standardized assessments. Additionally, the study aims to examine the role of ADLs as a potential moderating factor in this relationship. By analyzing how ADL performance influences the strength and direction of the association between visual impairments and cognitive function, this research intends to identify key areas where visual deficits may contribute to cognitive decline in MCI.MethodsThis is a cross-sectional study. Two hundred and seventy four elderly patients were diagnosed with MCI from various communities in Taicang City, Jiangsu Province, China. Most participants were women (68.6%), and the average age was 69 years. Notable comorbidities included hypertension (41.6%) and diabetes (33.2%), indicating a higher burden of health conditions than typical older adult populations. Visual function, Montreal Cognitive Assessment (MoCA), and the ADLs were measured. Pearson's correlation coefficients were used to examine the unadjusted associations between visual function measures and cognitive performance. Multivariable linear regression models were employed to further explore these relationships and to assess the moderating role of ADLs.ResultsSignificant positive correlations were found between visual function and cognitive performance, particularly with Visual Function Index (VFI) showing a strong initial correlation with the total MoCA score (r = 0.61, p &amp;lt; 0.001), which was attenuated after adjusting for ADL (β = 0.06, p = 0.23). Maximum Visual Field (Max VF) was positively correlated with language skills (r = 0.13, p &amp;lt; 0.05). The negative correlation of Minimum Visual Field (Min VF) with cognitive performance became positive after ADL adjustment (β = 0.12, p = 0.04).ConclusionsThese findings suggest that visual function plays a crucial role in the cognitive and functional abilities of patients with MCI. Early interventions targeting visual impairments may help mitigate cognitive decline and improve the quality of life for these patients.

Anatomy-guided Injection Techniques for Nasal Augmentation in Asians: Practical Guidelines and Safety Considerations.

Nasal augmentation using dermal fillers has become a popular nonsurgical esthetic procedure, particularly among Asian populations. This review explores the anatomical considerations, injection techniques, and safety measures essential for successful outcomes. The complex nasal anatomy, comprising 5 distinct soft tissue layers and intricate vascular networks, necessitates a thorough understanding to minimize risks of complications such as skin necrosis and visual impairment. The authors discuss the ideal nasal proportions and angles, emphasizing the importance of tailoring treatments to individual ethnic characteristics. The article outlines both needle-based and cannula-based injection techniques for the nasal dorsum, tip, and columella, highlighting the advantages and precautions for each approach. The dual-plane remodeling technique, utilizing firm and soft fillers, is presented as an advanced method for comprehensive nasal reshaping. Special attention is given to the columella injection technique, which addresses both esthetic and functional aspects of nasal tip projection. The discussion emphasizes the importance of choosing appropriate fillers, understanding vascular anatomy, and employing safe injection practices. As the field of non-surgical rhinoplasty evolves, continued refinement of techniques and ongoing research are crucial for enhancing safety and expanding the range of achievable outcomes in nasal augmentation with dermal fillers.