Low Vision Services Research Articles

Glaucoma blind registration in Fife (2000–2009) – a retrospective cohort study

To collate information on patients registered blind secondary to glaucoma between 2000 and 2009 and compare findings to an identical study completed a decade earlier between 1990 and 1999. The records of all people registered as blind via the Fife Society for the Blind between 2000 and 2009 were retrospectively examined and those with glaucoma as the primary cause were studied in detail. We compared these results with the results of our previous study, in which we examined the same documents for the preceding decade, 1990-1999. The glaucoma blind registration rate was reduced by 31% in the current study compared to the previous one (60 vs 87 patients, p = 0.013). At the same time, there was a 6% increase in blindness registrations due to all causes (881 vs 938, p = 0.62). Patients were referred with significantly fewer visual symptoms (33% vs 60%, p = 0.002) and glaucoma surgery rates increased from 44% to 62% in the current study (p = 0.013). In the later decade, more patients were offered partial sight registration before blind registration (37% vs 10%, p < 0.0001) and sustained independent living at the time of blind registration in this study (66% vs 33%, p < 0.0001). Nearly one-third of patients in the study group had cognitive impairment and/or hearing loss and this was similar to the first study. The study demonstrates a downward trend in the rates of blind registration due to glaucoma, compared to stable rates of registration for all diseases. Over the time period of the two studies there were refinements in the way glaucoma is managed medically by the hospital eye service and in the community, with a high level of input maintained from the local low vision service.

A Global Survey of Low Vision Service Provision

Purpose: To conduct a global survey of low vision services to describe the needs, priorities, and barriers in provision and coverage.Methods: Data were mainly derived from a survey and from some secondary sources. The survey was distributed to Vision 2020 contacts, government, and non-government organizations (NGOs) in 195 countries during 2006–2008. Themes in the survey were: epidemiology of low vision, policies on low vision, provision of services, human resources, barriers to service delivery, equipment availability, and monitoring and evaluation of service outcomes. Contradictory and/or incomplete data were returned for further clarification and verification. The Human Poverty Index was used to compare the findings from developed and developing countries.Results: Service availability was established for 178/195 countries, with 115 having some low vision service. Approximately half the countries in the African and Western Pacific regions have no services. Few countries have >10 low vision health professionals per 10 million of population. In many of the countries NGOs were the main providers and funders. Funding and awareness were frequently cited as barriers to service access. Women, people with disabilities, and rural dwellers were less likely to access services. There were few reports of monitoring and evaluation into the quality and impact of services.Conclusion: This global survey provides the first consolidated baseline of low vision service provision. Where data are available, coverage of services is generally poor. Low vision health professional numbers are low. Services in over half of the world’s countries are funded by NGOs, raising issues of sustainability.

Identifying the Critical Success Factors in the Coverage of Low Vision Services Using the Classification Analysis and Regression Tree Methodology

To identify the critical success factors (CSF) associated with coverage of low vision services. Data were collected from a survey distributed to Vision 2020 contacts, government, and non-government organizations (NGOs) in 195 countries. The Classification and Regression Tree Analysis (CART) was used to identify the critical success factors of low vision service coverage. Independent variables were sourced from the survey: policies, epidemiology, provision of services, equipment and infrastructure, barriers to services, human resources, and monitoring and evaluation. Socioeconomic and demographic independent variables: health expenditure, population statistics, development status, and human resources in general, were sourced from the World Health Organization (WHO), World Bank, and the United Nations (UN). The findings identified that having >50% of children obtaining devices when prescribed (χ(2) = 44; P < 0.000), multidisciplinary care (χ(2) = 14.54; P = 0.002), >3 rehabilitation workers per 10 million of population (χ(2) = 4.50; P = 0.034), higher percentage of population urbanized (χ(2) = 14.54; P = 0.002), a level of private investment (χ(2) = 14.55; P = 0.015), and being fully funded by government (χ(2) = 6.02; P = 0.014), are critical success factors associated with coverage of low vision services. This study identified the most important predictors for countries with better low vision coverage. The CART is a useful and suitable methodology in survey research and is a novel way to simplify a complex global public health issue in eye care.

Low Vision Services in Nepal: An Overview

A person with low vision is someone who has an impairment of visual functioning despite treatment or standard refractive correction. By definition (World Health Organization, 1993), this impairment includes a visual acuity of less than 6/18 (20/60) to light perception or a visual field of less than 10 degrees from the point of fixation in people who are using or are potentially able to use vision for planning or implementing tasks. Globally, of about 314 million people who are visually impaired, 45 million are blind; however, refractive error as a cause of visual impairment is not included in that number, which implies that the actual global magnitude of visual impairment is greater (Siddiqui, Backman, & Awan, 1997). Worldwide, for each person who is blind, an average of 3.4 people have low vision, with country and regional variations ranging from 2.4 to 5.5 (Brilliant et al., 1985). Although low vision does not fall into the category of blindness per se, it has enormous social and economic consequences in terms of productivity losses and dependence. Nearly 87% of the world's people who are blind live in the developing world. More than half live in Asia, and the vast majority of them live in rural communities (Siddiqui et al., 1997). The statistics for Nepal are similar to those of the rest of the developing world: The prevalence of blindness is 0.84 per 100 inhabitants, 92% of the people who are blind live in rural areas, and 80% of the blindness is avoidable (curable or preventable) (Brilliant et al., 1985). In Nepal, the prevalence of low vision is 1% (Nepal Netra Jyoti Sangha, NNJS, 2009). Many reasons have been identified for the rising tide of blindness and low vision. Prominent among them is the increase in the world's elderly population, particularly in developing countries. It is estimated that by 2025, there will be about 1.2 billion older people, almost three-quarters of whom will be living in developing countries (Shamanna, Dandona, & Rao, 1998). Although no nationwide study has been conducted on low vision in Nepal, a report from Lumbini, in the western part of the country, showed that lens-related causes like aphakia, pseudophakia, and cataract are the main causes of low vision (35.55%), followed by refractive errors or amblyopia (19.23%). In addition, retinitis pigmentosa accounted for 7.24%, retinal causes for 6.64%, and other causes (albinism, nystagmus, different syndromes, and so forth) for 10.25% (KC et al., 2007). In a report from Kathmandu, in the central region of the country, Paudel, Khadka, and Sharma (2005) noted that the major cause of low vision was diabetic retinopathy (15.8%), followed by macular diseases (13.2%), age-related macular degeneration (10.5%), retinitis pigmentosa (9.6%), and amblyopia (8.8%). Hence, the distribution of the causes of low vision in Nepal varies significantly from place to place. ACCESS TO LOW VISION SERVICES Nepal is one of the poorest countries in the world, with a per capita income of US$219. It has a low literacy rate of 69.7% for men and 55.9% for women, and this rate is worse in rural communities, where more than 80% of the people live (United Nations Development Programme, 2000). Despite the presence of significant low vision, only 1% of people with low vision in Nepal had access to low vision services before 2005, and such services were available only in Kathmandu, the capital city. The lack of education, high cost of the optical devices, and poor access to the tertiary hospital from rural communities were identified as the major barriers to the receipt of such services. The program Vision 2020: The Right to Sight has recognized that low vision and refraction are important strategic themes for the control of avoidable blindness and recommended good-quality low vision services as an integral part of comprehensive eye care. The leading nongovernmental organization in eye care, NNJS (2009), which was given the mandate by Vision 2020 to develop low vision services as an integral part of comprehensive eye care services, has been implementing a national low vision program since 2005 with financial support from Dark & Light Blind Care of the Netherlands. …

Causes of visual impairment in children with low vision.

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

Nonarteritic Anterior Ischemic Optic Neuropathy

Currently there is no generally accepted, well-proven treatment for nonarteritic anterior ischemic optic neuropathy (NAION). Most proposed treatments are empirical and include antithrombotics, vasodynamic agents, treatments aimed at reducing optic disc edema, and various neuroprotective strategies. Most potential treatments have been inadequately studied, prematurely embraced, or prematurely discarded. Evidence for antithrombotic agents is lacking, and small vessel arterial occlusion has never been demonstrated in NAION. Antiplatelet agents have not been studied in acute NAION, but they are often prescribed for acute treatment because of their proven role in stroke prevention. Because NAION is an ischemic disorder occurring more often after the age of 50 in patients with vascular risk factors, I recommend aggressive risk-factor management and antiplatelet therapy. The evidence that aspirin can help to prevent NAION in the fellow eye is divided. I recommend aspirin for secondary prevention, mostly for its proven role in stroke prevention. NAION occurs in patients with physiologically crowded optic nerves and small cup-to-disc ratios. Disc edema may contribute to a "compartment syndrome," which compresses the fine capillary blood supply of the optic nerve head, resulting in ischemia and axonal damage. There is some limited and debatable evidence that oral steroids may shorten the duration of disc edema and improve visual outcome in NAION. I discuss this evidence with patients who present acutely with NAION, and although I consider prescribing oral steroids on a case-by-case basis, I will not routinely recommend oral steroids until a properly randomized clinical trial is performed. Some neuroprotective strategies have been studied, but none have proven to be helpful. Although some (eg, brimonidine) are probably not harmful, I do not recommend these treatments. Early referral to low vision services may help to improve functional visual outcome.

The efficacy of low vision device training in a hospital-based low vision clinic

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

Provision Of Low Vision Service In The Department Of Ophthalmology University Of Calabar Teaching Hospital

No Abstract Keywords: Low vision services, Residual vision, Low vision assessment, Retinal dystrophies

How effective is the new community-based Welsh low vision service?

AimsTo determine if there was a significant difference between user-centred and clinical outcomes in people with low vision who attended a new community-based low vision service (CLVS) or the hospital-based...

Serviço de visão subnormal do Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC): análise dos pacientes atendidos no 1º ano do departamento (2004)

To outline low vision (LV) patients profile of the low vision department of the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira (IBOPC). Transversal study of 82 medical charts from the low vision service at the Instituto Brasileiro de Oftalmologia e Prevenção da Cegueira of the first year of the department--2004, considering age, gender, etiology, distance and near visual acuity with and without optical aids and prescription assistance. Of the 82 available patients, 11 (13.4%) were excluded of the study because they did not present low vision. Of the 71 patients, 32 (45%) were younger than 20 years old. Regarding the gender, there was not a significant difference (51% female and 49% male). The most frequent etiology in infants and adolescents was congenital glaucoma and in patients aged between 20-39 years was ocular toxoplasmosis (21.1%). In patients with 40-59 years old, pigmentary retinosis was the most frequently pathology (19%). In elderly people it was glaucoma (49%). Thirty-three patients (40.2%) had visual acuity between 20/60 and 20/160. The telescopic system was the only optical aid indicated for distance (44%) and glasses were the most indicated for near (54.5%). There is a high prevalence of low vision in infants and adolescents that live in developing countries like Brazil. Therefore, ophthalmologists need to be aware to promote early diagnosis and treatment to these patients, creating preventive programs and better assistance conditions.

Psychological outcomes following interventions for people with low vision: a systematic review

Psychological distress and depression is common in people with vision loss and is associated with heightened disability. It is therefore important to determine if current low-vision rehabilitation services meet the psychological needs of people with vision impairment. The aim of this article is to describe and summarize current evidence on psychological outcomes following low-vision rehabilitation programs, as well as the impact of novel interventions designed specifically to address psychological outcomes. Several electronic databases were searched to identify studies assessing the impact of vision rehabilitation services on psychological outcomes and 35 reports from 30 studies were reviewed. Findings suggested that multidisciplinary low-vision rehabilitation services may improve aspects of psychological well-being such as vision-specific quality of life, but have limited impact on depressive symptoms. Specifically designed psychological group and individual programs based on cognitive-behavioral techniques have been shown to improve a range of psychological outcomes and may be able to prevent depressive symptoms in people with vision impairment. Further studies with sophisticated designs and well-validated outcome measures are required to understand the effectiveness, mechanisms, moderators and cost–effectiveness of existing and new low-vision rehabilitation programs on psychological well-being in people with low vision.

Balancing independence and safety: the challenge of supporting older people with dementia and sight loss

dementia and visual impairment are common in older adults, and both conditions create a high risk of disability. Care professionals lack evidence on how best to support older adults with both conditions. the study investigated attitudes towards working with older adults with concurrent sight loss and dementia, the challenges involved and suggestions for service development. a qualitative study was conducted comprising 18 in-depth interviews and two focus groups with care professionals within mental health and low vision services. care professionals were alert to the high levels of risk among patients with joint sight loss and dementia. In-depth interviews revealed that insufficient time and expertise can lead to an overcautious approach that prioritises the reduction of risk rather than the promotion of independence. Focus groups highlighted the role that joint working can play in supporting older adults' valued roles and activities. Barriers to joint working were identified alongside strategies to assist the process. it is essential that care professionals and service providers acknowledge and respond to the complex needs of this population. Joint working was considered key to assessing risks and targeting interventions. The research workshop presented here provides a useful format for improving practice across inter-professional boundaries.

The newly established primary care based Welsh Low Vision Service is effective and has improved access to low vision services in Wales

The aim of this study was to determine whether the new, primary care based, Welsh Low Vision Service (WLVS) improved access to low vision services in Wales and was effective. The impact of the WLVS was determined by measuring the number of low vision appointments; travel time to the nearest service provider; and waiting times for low vision services for 1 year before, and for 1 year after, its establishment. Change in self-report visual function (using the 7 item NEI-VFQ), near visual acuity, patient satisfaction and use of low vision aids were used to determine the effectiveness of the service. Following instigation of the WLVS, the number of low vision assessments increased by 51.7%, the waiting time decreased from more than 6 months to less than 2 months for the majority of people, and journey time to the nearest service provider reduced for 80% of people. Visual disability scores improved significantly (p < 0.001) by 0.79 logits and 97.42% patients found the service helpful. The extension of low vision rehabilitation services into primary care identified a considerable unmet burden of need as evidenced by the substantial increase in the number of low vision assessments provided in Wales. The new service is effective and exhibits improved access.

Struggling to Maintain Occupation While Dealing with Risk: The Experiences of Older Adults with Low Vision

The primary aim of this descriptive phenomenological study was to describe the core aspects of living with low vision in later life among older adults (aged 70 years and older) who had not accessed rehabilitation services for low vision. Thirty-four older adults from urban and rural areas participated in a semi-structured qualitative interview and a telephone follow-up. Drawing on an occupational science perspective and using Giorgi and Giorgi's (2003) method of analysis, the essence of the experience of living with low vision was identified as struggling to maintain valued and necessary occupations while dealing with risk. Additional themes included enhanced sense of risk, striving for independence, and shrinking physical and social life spaces. Findings are interpreted in relation to occupational adaptation and environmental influences on occupation, and implications for the role of occupational therapists are discussed.

Visual loss in a school for the blind in Nigeria

There are an estimated 1.4 million blind children worldwide, it has been observed that almost 90% of the so-called blind population (children inclusive) do not have total loss of visual function, but retain a degree of usable residual vision. The study aims to determined the sites and causes of visual loss in the students of a school for the blind in Nigeria, and also the proportion of those students who could benefit from low vision devices. Forty-five students of the school were examined using the standard World Health Organization/Prevention of blindness examination record for childhood blindness. Refraction and assessment for low vision devices were conducted, where necessary. Glaucoma/buphthalmos (22.2%) and corneal lesions (20%) were the major causes of vision loss. Six students (13.3%) benefited from spectacles and/or low vision devices. Glaucoma/buphthalmos is assuming great significance in this study population, though most of the causes of vision loss are avoidable (77.7%). There is need for low vision service in the schools for the blind in South East Nigeria.

Community rehabilitation of disabled with a focus on blind persons: Indian perspective

India, the largest democratic country in the world, is marching ahead strongly on the growth and developmental front and is poised to be the leader in the market economy. This role creates and increases far greater responsibilities on us in ensuring that the benefit of the developmental cycle reaches each and every citizen of this country, including the able and the disabled ones. It has been enshrined in the Constitution of India to ensure equality, freedom, justice, and dignity of all individuals and implicitly mandates an inclusive society. With increase in consideration of quality parameters in all spheres of life including availability, access, and provision of comprehensive services to the disabled, it is pertinent to have a look on the contribution of government in keeping the aspiration and commitment towards common people. The article attempts to review the concept of rehabilitation for the disabled keeping a focus on the blind person, and list out the activities, programs/schemes, institutional structure and initiatives taken by the Government of India (GOI) for the same and the incentives/benefits extended to blind persons. The article concludes by reiterating the importance of individual need assessment and mentioning new initiatives proposed on Low Vision services in the approved 11th plan under National Programme for Control of Blindness (NPCB). The source of information has been annual reports, notification and the approved 11th five-year plan of GOI, articles published with key words like rehabilitation, disability, assistive devices, low vision aids, and/or blind person through the mode of Internet. Annexure provides a list of selected institutions in the country offering Low Vision services compiled from various sources through personal communication and an approved list of training institutes under NPCB, GOI offering Low Vision training.

Characteristics of 681 Low Vision Patients in Korea

The purpose of our study was to evaluate the characteristics and the changes of low vision patients over ten years in Korea, and to establish useful data for planning low vision services, active care and rehabilitation. We conducted a retrospective study of 681 low vision patients who visited two low vision clinics in Seoul from 1995 to 2008. Age and sex distribution, cause of low vision, type of prescribed low vision aids, and changes of the characteristics were reviewed. In result, male were more than female. The age group between 11 and 20-yr-old (18.1%) was the largest age group. Optic atrophy (28.3%) was main causes of low vision. However, elderly low vision patients is increasing and macular degeneration is becoming a leading cause of low vision (P<0.05). One thousand five low vision aids (LVAs) were prescribed for 681 patients (1.46±0.62 aids for each patient). Near LVAs were prescribed more than distance LVAs. In most patients, the use of LVAs improved both near and distance visual function. This study is the first survey of a large number of low vision patients over a ten year period in Korea. On the base of this study, the planning of low vision services and more active rehabilitation for low vision patients, especially elderly patients, need in Korea.

See for yourself

Access to information about services and support is an important part of the rehabilitation process for patients diagnosed with sight loss. Manchester Royal Eye Hospital (MREH) has worked in partnership with the Royal National Institute of Blind People (RNIB) and Henshaws Society for Blind People to create an information pack aimed at patients attending the Low Vision clinic, named ‘See for Yourself: An Information Pack for People with Sight Loss’. To assess its impact, satisfaction questionnaires were sent to 182 patients receiving the pack, and the results analysed. Overall, 94.4 per cent of respondents rated the pack ‘very’ or ‘quite’ useful, with 90.5 per cent of respondents feeling the pack contained the right amount of information. Very positive comments were received. The ‘See for Yourself’ pack will continue to play a role in the provision of low vision services at MREH, and its use may be expanded to other service providers in the future.

When Self-Presentation Trumps Access: Why Older Adults With Low Vision Go Without Low-Vision Services

Reasons were sought for low-vision service nonuse in a group of Canadian seniors with self-reported low vision. Audio-recorded semistructured interviews were completed with 34 seniors with low vision: age range (70 to 94 years; mean: 82 years); 16 urban dwellers (12 women); 18 rural dwellers (14 women). Qualitative content analysis and template analytic techniques were applied to transcriptions. Informant nonuse of low-vision services involved: insufficient knowledge, managing for now, and practitioner behavior (inadequate rehabilitation education and management). Underlying seniors’ attitudes that shaped their self-presentation and service nonuse included a strong need for independence, a contextualization of vision loss relative to other losses, and an acceptance of vision loss in life. Service delivery strategies should consider not only knowledge access and healthcare practitioner behavior but also senior self-presentation strategies (e.g., viewing aids as counterproductive to independence). Subtle rural-urban attitudinal differences may further delay access for rural seniors; further research is advised.

The History and Current Status of Low Vision Services in Scandinavian Countries

The History and Current Status of Low Vision Services in Scandinavian Countries